Issues and Developments in Medicine and Medical Research Vol. 2

Introduction: In Africa, inguinal hernia is a common surgical condition with an incidence of 175 inguinal hernias per 100,000 people each year. Pain that persists for at least a duration of 3 months postoperatively following repair of an inguinal hernia defines chronic groin pain. Chronic groin pain is a potentially incapacitating complication, presenting a therapeutic and diagnostic challenge to the surgeon.

Objective: The objective of this study was to determine the prevalence of chronic groin pain in a group of patients in a hospital setting in rural Africa.

Methodology: A descriptive retrospective study was carried out between 1^st April 2008 to the 31^st July 2012 on all patients \(\geq\)15 years of age that underwent an inguinal hernia repair were eligible in this study. Data was retrieved from patients’ clinical notes and theatre log books on age, sex, recurrence of hernia and post-operative pain lasting at least 3 months. Data obtained in the interview questionnaire included duration of pain, pain at the operation site, type of postoperative analgesia and a physical examination to determine recurrence was performed in the surgical-out-patients clinic.

Results: One hundred and fifty eight patients following repair of inguinal hernia using the modified Bassini technique were analysed. Mean age was 44.84 years. The male:female ratio was 3.65:1 with a male predominance. Chronic groin pain/discomfort was reported in 22(13.92%) and this pain/discomfort lasted for at least 3 months post-operatively.

Conclusions: The low incidence of chronic groin pain in our study may be due to the majority of them being operated as elective procedures under local anaesthesia with routine identification of the ilioinguinal nerve. However, a study with a larger sample size and a longer follow up may be required to ascertain the true prevalence of chronic groin pain following inguinal hernia surgery in rural Africa.

Introduction: Although pap test is effective to screen abnormal cervical cytology before therapy, it is not very useful after therapy because of radiation-induced changes. Diagnostic accuracy of post therapy Papanicolaou (pap) tests is low, as it is difficult to differentiate benign from malignant lesions due to post radiation cellular changes, also known as post radiation dysplasia.

Aims and Objectives: In this study we have evaluated the role of biomarker p16INK4a and Ki67on conventional cell blocks (CCBs) in post therapeutic surveillance of cervical cancer to detect residual disease and site recurrence. We have also evaluated CCBs as a primary screening test.

Materials and Methods: In this cross-sectional study, patients who were diagnosed as cervical cancer before one year were followed between periods of April 2018-April 2019. We collected conventional pap smears and samples in 10% neutral buffered formalin for CCBs. The immunohistochemistry was performed on all cell blocks using Ki67 and p16INK4a as primary antibodies.

Results: Out of total 35 cases, recurrences and residual disease were diagnosed in 8 cases. Sensitivity, specificity, diagnostic accuracy for pap, cell blocks and p16INK4a for detecting cervical cancer were 75%, 74.07%, 88.57%; 100%, 88.89%, 91.43% and 37.50%, 96.30% and 82.86% respectively. We observed that Ki67 labeling index \(\geq\) 20% had a diagnostic accuracy of 100%.

Conclusion: Our findings suggest that Ki67 labeling index \(\geq\)20% on CCBs can differentiate residual and recurrent cancer from post radiation dysplasia in post therapy surveillance cytology (p value <0.001). We also observed that CCBs has better diagnostic accuracy than pap test (Mac Nemar p value, 0.027). We did not found p16INK4A much useful as a biomarker in evaluation recurrence/residual disease.

Alpha-2-macroglobulin’s ability to generally inhibit proteases both in chronic and neuropathic pains and inflammatory joint problems showed promise from a biological perspective. Cytokines are released as a result of nerve injury and inflammation. Axonal damage and neuropathic pains may ensue as a result of this inflammation. In a degenerative disc disease where the cartilage degradation product, the Fibronectin-Aggrecan complex (FAC) is identified, intradiscal autologous A2M injection showed clinical improvements, although further studies is needed to see consistent results. Pro-inflammatory cytokines such as IL-1, IL-6 and TNF increased during inflammation not only in the peripheral nerves but also in inflammatory joint problems, cardiovascular events and athrosclerosis event, it is interesting to note how this could be utilized to address inflammation and neuropathic pains and other inflammatory conditions.

Background: The more divisions of cells, the more senescent cells. Senescent cells are one of the most toxic cells in human and animal organisms. When their amount reaches great quantities, it leads to strong manifestation of ageing signs. According to the explanation of the citogenetic centriolar theory of ageing during the division process, the cell's generation reaches ultimate morphogenetic status. As a result, programmed cell death (apoptosis) must be activated, otherwise if the cell does not kill itself it switches to a senescent state.

Purpose: Senescent cells cause age-related pathologies. Theoretically, partial elimination of senescent cells must lead to improved life capacity. This hypothesis was confirmed on Ercc1 -/\(\bigtriangleup\) mice. Periodic simultaneous administration of dasatinib and quercetin in Ercc1 -/\(\bigtriangleup\) mice led to extension of their healthspan, delaying age-related symptoms and pathologies. We decided to test the senolytic effect of dasatinib and quercetin combination on humans.

Study Design: With this purpose the clinical trial was undertaken on 64 male volunteers over the age of 36. To put things into perspective our volunteers were classified into 4 groups with 16 people in each. D+Q group orally administered 50mg of dasatinib with 500 mg of quercetin once a day within 5 days.

Methods: To register and to assess changes stemming from the drug compounds the whole trial was complemented with full medical screening and stair ascending test.

Results: As a result 50mg of dasatinib along with 500 mg of quercetin demonstrated obvious senolytic effect, it was justified by improved results of stair ascending test and tranquilized state of systolic blood pressure. Such dosage combination of these two compounds is highly probable to be harmless.

Aim: The purpose of this study is to compare the level of warmth, autonomy and hovering in mother with level of stress loneliness and depression with respect to student.

Background: Emerging adulthood is defined by efforts to develop one's individuality in areas such as love, work, and worldview. Work is regarded as preparation for a later adult career during emerging adulthoods. This is the time when the groundwork is laid for the jobs and careers that will be pursued later in life. With higher level of freedom and greater time spent in exploration of possible career paths, jobs with short term commitments.

Methods: A cross-sectional study of 150 medical college students at MGM Medical College in Indore was conducted to determine the existing relationship between medical students and their mothers.

The information was gathered using a pre-designed semi-structured questionnaire with 16 questions.

Result: The Pearson co-relation test reveals a significant relationship between mother warmth and stress, loneliness, and depression. With increase in warmth there is decrease in, loneliness and depression.

Conclusion: When mothers are warmer/affectionate to their children, they feel more secure and able to communicate better with their mother, which develops a habit in them that helps them communicate better with others as well. Mother's autonomy has a positive relationship with stress, loneliness, and depression. When a mother gains more autonomy over her three children, the level of stress, loneliness and depression rises.

COVID-19 disease has affected the world with a great impact. The spectrum of disease presentation varies from asymptomatic individuals who recover without any aid to those with multi-system involvement requiring intensive care. Severity of the disease depends upon multiple factors like age, gender, associated co-morbidities, etc. The cardiovascular system being one of the target organs of SARS-CoV 2 also contributes toward significant morbidity and mortality in these patients. Autonomic imbalance associated with cardiac involvement can be easily assessed by non-invasive cardiac autonomic function tests.

Objective: To assess cardiac autonomic function tests in COVID 19 patients as a possible predictor of severity of disease.

Summary: Brachial Plexus formed by ventral rami of spinal nervers C5-T1, Occasionally C4 and T2 may contribute in the formation of brachial plexus. It gives rise to various motor and sensory nerves; median, ulnar, musculocutaneous, cutaneous nerves of arm and forearm etc innervating upper limb. These nerves may be injured by trauma and birth injuries causing different types of disability like erb’s palsy creating difficulties in carrying out day to day activities. Thus, aim of the study is to consolidate the information related to brachial plexus, how it is injured and what are their repercussions. To full this aim, literature survey was carried out using different data bases like scielo, pubmed, medline, researchgate etc. Various terms used for surfing were, brachial plexus, injuries of brachial plexus, significance of brachial plexus. Injury to erb’s point is mostly observed in childrens delivered by forceps delivery. The deformity is called erb’s palsy. Similary lower trunk, lateral and medial cord may be injured causing various type of deformities. Thus detailed knowledge of brachial plexus is of utmost use to neurosurgeongs to to detect the disability and correct the deformity.

Purpose: The goal of this study is to compare the outcomes of primary pterygium surgery using a conjunctival flap versus an autograft in terms of recurrence rate and complications.

Methods: With an 18-month follow-up, a total of 70 patients (thirty male and forty female) were operated on for primary pterygium using conjunctival auto grafts (in 36 eyes) or conjunctival flaps (in 34 eyes) at AL-Hussain teaching hospital-Kerbala. Patients were asked to perform voluntary examinations of their ocular surface status.

Results: The average age was 43.5 years (range 21-70) 42.65% of the patients were male, and 70% of them worked primarily outdoors. The average period of follow-up was 12 months (3-18).

The graft recurrence rate was 8.3 percent, while the flap recurrence rate was 8.8 percent; however, oedema was more prevalent in the graft, while granuloma was absent in both.

Conclusions: There were no statistically significant differences in recurrence rates after this long follow-up period for conjunctival flap and autograft surgeries, despite the fact that autograft is a longer technique with more postoperative oedema.

Vermiform appendix as the name defines is a narrow, worm-shaped tube which arises from the posteromedial wall of the caecum. Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Acute appendicitis is the most common surgical emergency in most Surgical Emergency Rooms. Arriving at the correct diagnosis is essential; however, a delay may allow progression to perforation and significantly increased morbidity and mortality. Methods advocated to assist in the diagnosis of appendicitis include scoring systems, ultrasonography, computer programs, computed tomography, magnetic resonance imaging and laparoscopy. Several scoring systems have been used globally for early diagnosis of acute appendicitis. One of the most practical scoring systems is the Alvarado scoring system which is based on history, physical examination, and some laboratory investigations that are convenient to apply Modified Alvarado Score has a decent Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value. Modified Alvarado and ultrasonography can  be used together in surgical emergency for diagnosing cases of acute appendicitis.

Objective: Soccer has a reduced overall recovery time. If these situations are not properly controlled they can cause the athlete chronic fatigue, an increase in delayed-onset muscle soreness (DOMS) and thus result in a decrease in athletic performance. There are several therapies that have attempted to improve athletic performance, decrease the percentage of injuries and results in soccer. Training and recovery instances are opportunities to find ways to address this issue. Understanding the physiology of recovery is essential to accelerate some processes, with the aim of shortening the times.

Subjects: Cryotherapy could improve functional performance tests and decrease pain in soccer players. Our work design is an experimental prospective study.

Methods: Twenty subjects (10 experimental subjects and 10 control group subjects), between the ages of 17 and 23, who are members of a university men's soccer team, participated in the study. The following variables were controlled: power; the number of jumps, the average height of a jump in a 30-second continuous jump test, and DOMS perception through visual analog scale (VAS). Both groups shall be subjected to a more active recovery as well as elongation carried out by the coaching staff. In addition to this, the experimental group shall also be subjected to ice baths (42-47 °F) for three minutes.

Results: We found significant statistical differences in the number of jumps and the power of the same in the control group, thus obtaining improvements. No significant differences were observed in either group for the average jump height and percentage yield variables. In the assessment of DOMS significant differences were observed, with a lower perception of DOMS seen in the experimental group.

Conclusion: Regarding the proposed protocol, it can be concluded that it is effective in reducing DOMS, but it is difficult to determine the effectiveness of this, in the short term performance evaluation. Ice baths provide favorable results in some aspects of the 30-second continuous jump test, decreasing the perception of leg pain and fatigue, and therefore they can be considered a valid alternative in the management of these athletes.

Back Ground: Internet began with the development of electronic computers in the 1950s.Internet usage has been rapidly increased in our daily life, and is directly affecting people’s ideas and behavior. With the development of the Internet, both male and female users to certain extent are unquestionably dependent on it as a medium of sharing ideas, building communication network as well as for searching information. Because of difference in opinion by the researchers regarding the internet usage among gender the present study is an attempt to quantify the gender difference in internet usage.

Materials and Methods: A cross sectional study was carried on 120 first year MBBS students at tertiary care center. Data was collected with the help of a questionnaire.

Results: The present study observed gender differences in awareness and pattern of internet use among first MBBS students which is relatively less compared to the previous studies.

Conclusion: The Internet has become an inseparable part of today's educational system. The academics of an individual increasingly depends on the Internet for educational purposes. Absence of gender gap in internet usage is probably due to both genders having better exposure to the technology through their educational experience.

Tuberculosis (TB) and tobacco smoking are two major public health problems worldwide causing a high mortality. Tobacco smoke increases the risks of Mycobacterium tuberculosis infection, development for pulmonary and extrapulmonary TB, of severe forms of the disease and death from TB, smokers with TB are less compliant with TB medications. The risk of TB increases in people who smoke more and who smoked for a long time. Smoking cessation interventions help TB smokers to quit and reduces the impact of tobacco use on the course of the disease. Stopping smoking increases adherence to TB treatment and contributes to control epidemic in emerging countries. Smoking cessation interventions are effective in TB smokers and require the involvement of healthcare professionals.

Study Design: Prospective study, simple crossover design.

Background: Proprioception is a cornerstone for maintaining joint and postural stability. Dynamic stability is particularly emphasized within these components. This feature is important in the rehabilitation field. Therefore, the quest for elements to improve these values can bring advantages in sports. Star Excursion Balance Test seeks to evaluate the stability of the lower extremity, the progress of rehabilitation and the deficit caused by the injury thus identifying athletes who have a greater risk of subsequent injuries.

Objectives: Evaluate if there are advantages in the performance of a Star Excursion Balance Test (SEBT) using Kinesio taping.

Methods: We evaluated 10 professional soccer players from the Chilean women’s national team. They were randomly divided into 2 groups. One group had Kinesio taping and their SEBT performance was evaluated. The other group performed the measurements without the use of Kinesio Taping. Afterward, each group performed the evaluation they did not do during the first stage. We then compared the performance achieved with and without the use of Kinesio Taping

Results: There were significant differences in the performance achieved by the players who had the SEBT bandage applied in comparison to the players that did no. This was confirmed by using the non-parametric Wilcox test for each of the SEBT positions.

Conclusions: Kinesio taping has positive implications in the SEBT. We can extrapolate that its use can improve the dynamic balance and thus become an important pillar in sports rehabilitation.

This chapter aims to highlights Pelvic Floor Dyssynergia (PFD) and It’s Relevance to the Anorectal Bowel Dysfunctions and Management Guidelines. Clinical presentation of PFD is straining at stools and feelings of incomplete evacuation. The need for perineal or vaginal pressure with relaxed pelvic floor to allow evacuation of stools is a strong clue for its diagnosis. Anorectal Manometry is now widely used to define bowel evacuation problems related to chronic constipation. In majority of the patients, an approach to the bowel program for adequate evacuation is individualized with a set time, diet control, and digital stimulation with and without a glycerin suppository; Often more than one procedure is necessary for individuals that have difficulty in developing an effective bowel routine.

Objective: To determine the efficacy (sensitivity, specificity, and accuracy) of the VeinesQol/Sym with metric statements fewer than the EQ5D in detecting the quality of life of patients with Chronic Venous Disease (CVD) before and after treatment.

Introduction

Chronic Venous Disease (CVD) commonly presents as varicose veins posing a significant health problem with socio-economic impact in developed countries. Patients with CVD tend to have abnormal ankle-brachial indices and other manageable risk factors for cardiovascular disease.

Methods: This is a descriptive-comparative design in collecting the necessary data to arrive at conclusions that respond to the specific questions of the study in 2 private hospitals. The responses gathered from patients through EQ5D and VeinesQol/Sym, before and after they received treatment were utilized in describing and comparing the efficacy of the health questionnaires. Data were further subjected to a comparative analysis to elaborate the efficacy of the VeinesQol/Sym.

Results: A total of 114 CVD patients completed the study after excluding 13 patients due to failure to follow up after eight weeks of treatment. The study showed that VeinesQol/Sym and EQ5D has similar efficacy in determining quality of life of CVD patients. However, VeinesQol/Sym has higher accuracy (84.96% vs 76.99%), higher sensitivity (87.85% vs 83.87%), detects greater level of impairment in mobility, anxiety/depression, pain and discomfort, disruptions in usual activity and lower quality of current state of health condition than EQ5D

Conclusion: The disease-specific VeinesQol/Sym questionnaire has a higher accuracy and sensitivity rate than the generic EQ-5D-5L. With the responses to the metric statements of the indicators of quality life in both VeinesQol/Sym and EQ5D, VeinesQol/Sym was found to have a greater efficacy in establishing the precise status of quality of life of patients with CVD than the EQ5D.

Megameatus Intact Prepuce (MIP) is a rare variant of glandular hypospadias that affects about 3-6 percent of hypospadias cases. Juskiewenski et al first described MIP in 1983, and Duckett and Keating described the pyramid procedure in 1989. In 2011, Elbatarny et al reported modified Glanular Approximation Procedure (GAP) for seventeen patients. Our patient was a 2-year-old boy who had an anomalous external urethral meatal orifice of 6cm in diameter, for which he received a successful modified glanular approximation procedure (GAP). Our patient underwent a modified Glanular Approximation Procedure (GAP) with excision of the redundant skin, as described by Elbatarny et al. (6), and we used a size 6 French Foleys catheter as a stent, as described by Gittes et al. We monitored our patient for six months with excellent results, as reported by Zaontz et al. and Gittes et al. Megameatus intact prepuce is a social emergency that must be addressed as soon as possible to avoid the catastrophic psychological effects that it can cause.

Background: When performed for the indicated reasons, Caesarean section (CS) is a potentially life-saving surgery. In recent years, the rate of CS deliveries has skyrocketed. A CS is not without complications and risk, so its trends in all institutes should be audited to ensure that obstetric care standards are optimised. 

Methods: The study was carried out as a retrospective analysis of all CS deliveries over a 12-month period and their categorization using the WHO-recommended Robson ten group classification system, with the goal of evaluating and understanding the indication for each CS performed at the institute. The Robson was further subclassified in order to gain a better understanding of the circumstances under which the CS was performed in each group. 

Results:  This study looked at a total of 2831 deliveries, with 1557 (55 percent) of them being CS births. 48.5 percent of these CS births were indicated for emergency indications. Class 5, 1, and 10 were the main contributors to the CS rate, accounting for 50.6 percent, 19.3 percent, and 10%, respectively. Only 12.1 percent of 799 patients with previous CS were able to have a successful scar trial. In decreasing order, the most common indications documented for Group 1 were foetal distress, cephalo pelvic disproportion, and prolonged labour. The majority (92.3 percent) of singleton pre-terms who had a CS were operated on before the onset of labour.

 Conclusions: The audit assisted in understanding the trends of CS in the institute and in realising that all of the CS in the institute has questionable indications. This resulted in the implementation of clinical and administrative reforms to reduce unnecessary CS.

Background: As COVID-19 pandemic continues to affect every nation, Healthcare Workers (HCW) who care for the patients are psychologically impacted. The  fear of contracting the disease and bringing it home to their family members, especially aged parents, and those with underlying health conditions, also makes them susceptible to stress and anxiety. This study aims to assess the psychological impact experienced by HCW and the psychosocial support they received.

Methods: Using PubMed, google scholar and Embase from December 2019 through June 2021, we found 376 studies on the impact of the COVID-19 pandemic on the mental health of HCW. Using our inclusion criteria, 325 studies were excluded. 51 full-text articles were assessed for eligibility. 9 articles which met our criteria and eligibility criteria reported on 19,232 HCW, and 75.2% of the study participants were women.

Results: The study participants reported high levels of stress, hypervigilance, fatigue, sleep problems, PTSD symptoms, poor concentration, depression, anxiety, burnout, emotional exhaustion, depersonalization, suicide and self-harm ideations and somatic symptoms due to the COVID-19 pandemic. The psychosocial support provided to HCW includes counseling and psychotherapy-based sessions on stress adaptation, onsite mindfulness-based crisis intervention, online form of emotional freedom technique, and Effort-reward system.

Conclusion: Multiple interventions found in our review were effective in mitigating psychological stress among HCWs. These interventions should be considered as part of support provided to HCW with psychosocial challenges.  

Introduction: In Sub-Saharan Africa, surgical conditions remain neglected in its health care systems. This results in a low surgical output from district hospitals with many patients referred to Referral Hospitals in the region. Therefore surgical camps in district hospitals are often necessary where volunteer surgical teams perform a wide range of mostly elective surgical procedures. These surgical camps are pre-planned activities carried out at no cost to the patients who belong to poor and hard to reach vulnerable communities. The objective of this surgical camp was to offer free specialised surgical service in a rural hospital and hence improve surgical access to a poor vulnerable community in Northern Uganda. Training basic surgical skills and the provision of continuous medical education to medical officers in the region was also part of the purpose of this surgical camp.

Methods: A descriptive study using data collected from a one week surgical camp in the year 2011 was performed at St. Joseph’s Maracha Hospital. Data from operating log forms regarding date of procedure, patient gender, clinical diagnosis, operation performed and type of anaesthesia was obtained. Data was analysed for age, sex, type and rate of surgical procedure and type of anaesthesia. The participants’ involved specialist general surgeons, medical officers, clinical officers, theatre nurses and anaesthetists.

Results: In total, 105 surgical procedures were performed during the 7-day-long camp. Mean age of the patients was 39.54 years. The male: female ratio was 1:0.38. Adult inguinal herniorrhaphy formed 68.6% of all surgical procedures.

Conclusions: The bulk of surgical disease encountered during the camp were inguinal hernias. Surgical camps improve access to surgical care to vulnerable hard to reach populations and should become an integral part of health service delivery in rural Africa. Better knowledge and basic surgical skills resulting in better management of surgical cases by local medical officers is achieved with surgical camps.

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