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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 10 | Issue 1
Page Nos. 1-59

Online since Thursday, January 23, 2020

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ORIGINAL ARTICLES  

Childhood horse and donkey bites; a single tertiary health center experience in a rural area p. 1
Ibrahim Hakan Bucak, Kasım Turgut, Habip Almis, Mehmet Turgut
DOI:10.4103/ajm.ajm_158_19  
Background: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. Materials and Methods: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. Results: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48–190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin–clavulanic acid was prescribed in 28 (77.8%) cases. Conclusion: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.
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Status of 25-hydroxy vitamin D level in simple febrile seizures and its correlation with recurrence of seizures p. 6
Jehangir A Bhat, Tasleem Arif Bhat, Sajad A Sheikh, Zubair A Wani, Roshan Ara
DOI:10.4103/ajm.ajm_57_19  
Background: Febrile seizures are associated with a lot of modifiable and nonmodifiable risk factors. Extensive research is currently going on to discover more and more risk factors of febrile seizures, so that they can be modified to decrease their incidence and recurrence. Aims and Objectives: The aim of this study was to determine the status of 25-hydroxy vitamin D in children presented with simple febrile seizures and to find its correlation with recurrence of seizures. Materials and Methods: This prospective observational study was conducted on 223 children of age group 7–59 months who presented with simple febrile seizures. 25-hydroxy vitamin D were sent to laboratory for quantitative estimation. All data were recorded, status of vitamin D in these children was analyzed, and statistical significance of correlation of vitamin D with the number of recurrent seizure episodes was derived. Statistical Analysis: The comparison among groups was carried out by analysis of variance and correlation was conducted by Pearson’s correlation analysis. A value of P < 0.05 was considered statistically significant. Results: 25-hydroxy vitamin D insufficiency was present in 43.5% of the children, deficiency in 30.85 %, and normal level in 25.56% of children who had simple febrile seizures. Majority of the children presented with recurrent episodes of seizures had vitamin D deficiency followed by insufficiency and normal level. Comparison of Vitamin D showed significant negative correlation (As vitamin D level increases frequency of seizure febrile seizure recurrence decreases and vice versa) with recurrence of simple febrile seizures. Conclusion: Deficiency of vitamin D is associated significantly with simple febrile seizures and their recurrence is negatively correlated with it.
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The status of drug wastage in the pediatric emergency department of a tertiary hospital p. 10
Ibrahim Hakan Bucak, Habip Almis, Cagla Nur Dogan, Mehmet Turgut
DOI:10.4103/ajm.ajm_58_19  
Background: The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage. Materials and Methods: The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment. Results: The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495. Conclusion: If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure.
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Knowledge about imaging modalities, risks, and protection in radiology among medical students at the University of Hail p. 15
Meshael N Alreshidi, Dalal Alshubrmi, Fayez Alreshidi, Khaled Soliman, Ibrahim Alrashidi
DOI:10.4103/ajm.ajm_49_19  
Aim: The aim of this study was to evaluate awareness and knowledge about radiation risks and safety principles among medical students at the College of Medicine, University of Hail, Hail, Saudi Arabia, in their clinical years. Materials and Methods: In this cross-sectional study, an anonymous electronic questionnaire was sent to 174 randomly selected students in clinical years 4–6. The questionnaire contained 38 questions. The respondents’ answers to these questions were used to classify them according to their demographic characteristics and to evaluate their knowledge about common imaging modalities, radiation risks, and safety measures. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 22. Results: Seventy-five (51.7%) of 145 respondents were female and 70 (48.3%) were male. Fifty-five respondents (37.9%) were in year 4, 38 (26.2%) were in year 5, and 52 (35.9%) were in year 6. The mean score for knowledge about common imaging modalities was 4.10 ± 2.030 of 10, that for knowledge about the risks of radiation was 3.17 ± 1.954 (range, 0–8) of 13, and that for knowledge about radiation protection measures was low at 0.79 ± 0.922 (range, 0–4) of 8. Overall, there was an improvement in knowledge about the imaging modalities and the risks of radiation as the number of clinical years increased (P = 0.000), but it was still unsatisfactory. Conclusion: The results of this study indicate that the medical students at the University of Hail have very limited knowledge about radiation risks and safety measures. These findings highlight the need for urgent action to improve students’ knowledge of these topics.
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Transcatheter aortic valve replacement in patients with bicuspid aortic valve stenosis: National trends and in-hospital outcomes p. 22
Mohamad Soud, Yasser Al-khadra, Fahed Darmoch, Homam Moussa Pacha, Zaher Fanari, M Chadi Alraies
DOI:10.4103/ajm.ajm_134_19  
Background: Bicuspid aortic valve (BAV) disease is considered the most common congenital heart disease and the main etiology of aortic valve stenosis (AS) in young adults. Although transcatheter aortic valve replacement (TAVR) is routinely used in high- and intermediate-risk patients with AS, BAV patients with AS were excluded from all pivotal trials that led to TAVR approval. We sought, therefore, to examine in-hospital outcomes of patients with BAV who underwent TAVR in comparison with surgical aortic valve replacement (SAVR). Methods: Using the National Inpatient Sample from 2011 to 2014, we identified patients with BAV with International Classification of Diseases-Ninth Revision-CM code 746.4. Patients who underwent TAVR were identified using ICD-9 codes 35.05 and 35.06 and those who underwent SAVR were identified using codes 35.21 and 35.22 during the same period. Results: A total of 37,052 patients were found to have BAV stenosis. Among them, 36,629 patients (98.8%) underwent SAVR, whereas 423 patients (1.14%) underwent TAVR. One-third of enrolled patients were female, and the majority of the patients were White with a mean age of 65.9 ± 15.1 years. TAVR use for BAV stenosis significantly increased from 0.39% in 2011 to 4.16% in 2014 (P < 0.001), which represents a 3.77% overall growth in procedure rate. The median length of stay decreased significantly throughout the study period (mean 12.2 ± 8.2 days to 7.1 ± 5.9 days, P < 0.001). There was no statistically significant difference between SAVR and TAVR groups in the in-hospital mortality (0% vs. 5.9%; adjusted P = 0.119). Conclusion: There is a steady increase in TAVR use for BAV stenosis patients along with a significant decrease in length of stay.
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Work-related musculoskeletal disorders among clinical laboratory workers p. 29
Atheer F AlNekhilan, Anfal M AlTamimi, Bothainah Y AlAqeel, Alanoud A AlHawery, Shoog F AlFadhel, Emad M Masuadi
DOI:10.4103/ajm.ajm_67_19  
Aims and Objectives: The aim of this study was to estimate the prevalence and risk factors of work-related musculoskeletal disorders (WMSDs) among clinical laboratory workers. Materials and Methods: This questionnaire-based cross-sectional study included the clinical laboratory departments of six governmental tertiary and secondary hospitals in Riyadh, Saudi Arabia. The selected instrument was a self-administered adapted standardized questionnaire. The sample comprised 306 laboratory workers, and the selected sampling technique was a non-random convenient method. Results: The overall prevalence of WMSDs in any body region was 82% in the last 12 months; it was mainly linked to lower back pain (61%). In the logistic regression, age <30 years, working in specific laboratories and working in hematology/flow-cytometry laboratory divisions were all found to be significant risk factors (P < 0.05). Conclusion: Clinical laboratory workers are at a high risk for WMSDs; it is essential that we take preventative action to address this.
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Evaluation of knowledge of the united arab emirates population on measles and its control, following a nationwide campaign p. 35
Ghiath Ismayl, Hiba J Barqawi, Abdelkader Harous, Mohamad Balchi, Dania AbuZahra, Ghanayem AlMazrouei, Tasnim Elzini
DOI:10.4103/ajm.ajm_56_19  
Introduction: In 2015, a nationwide campaign to eradicate measles was launched by the health authorities in the United Arab Emirates (UAE). This study aimed to assess the UAE society’s knowledge of measles and its control following this campaign. Methods: A cross-sectional study was conducted among UAE residents above the age of 18 years from March to May 2017. A self-administered anonymous questionnaire was distributed, and a convenience sampling method was used. The data collected were entered and analyzed using the Statistical Package for the Social Sciences, version 22 software. Results: A total of 391 questionnaires were completed from the overall 410 distributed. Most of the population have heard of measles (94.6%). However, only 23.5% claimed they have high knowledge of the disease. Information on measles was mainly acquired from family and friends (50.3%). Individuals with higher educational status were more knowledgeable about several aspects of the disease. Married individuals and those with children were more likely to identify the symptoms and associated conditions of the disease correctly. However, married participants had more misconception about the relationship between autism and the measles vaccine. No significant differences were found between the different age groups, genders, or nationalities. Conclusion: Despite the nationwide campaign to eradicate measles, based on the results of our study, the majority of the UAE population did not have knowledge about the measles disease and its preventive measures. It is important that public health authorities and public health organizations seek to address these issues.
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BRIEF REPORTS Top

Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors) p. 41
Ziad Arabi, Basmeh Ghalib, Ibrahim Asmari, Mohammed Gafar, Syed Alam, Mohamad Abdulgadir, Ala AlShareef, Awatif Rashidi, Mohammed Alruwaymi, Abdulrahman Altheaby
DOI:10.4103/ajm.ajm_120_19  
Medical providers are often asked by their kidney recipients and donors about what to do or to avoid. Common questions include medications, diet, isolation, return to work or school, pregnancy, fasting Ramadan, or hajj and Omrah. However, there is only scant information about these in English language and none in Arabic. Here, we present evidence-based education materials for medical providers (in English language) and for patients and donors (in Arabic language). These educational materials are prepared to be easy to print or adopt by patients, providers, and centers.
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Building mental health and resilience: regional and global perspectives from the inaugural Syrian American Medical Society Mental Health Mission Trip (July 2 to July 7, 2019) p. 54
Mohammad K Hamza, Kevin Clancy
DOI:10.4103/ajm.ajm_157_19  
The Syrian conflict has resulted in the most significant refugee crisis since World War II. Current estimates suggest there are over 13.5 million Syrians in need of comprehensive humanitarian assistance as a direct result of the conflict. These humanitarian needs include mental health services to address the elevated rates of psychiatric disorders in this population. Towards this end, the Syrian American Medical Society conducted its inaugural mental health mission trip to Lebanon and Jordan from June to July 2019 to advance the state of mental health care for displaced Syrians. Following two weeks of trainings by international experts in trauma psychology, the mission concluded with a two-day scientific symposium, identifying two key elements for the advancement of humanitarian mental health care: 1) the need for community-based mental health services, and 2) the importance of transitioning from a crisis-response model in humanitarian mental health towards a model of resilience and post-traumatic growth.
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