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   2015| October-December  | Volume 5 | Issue 4  
    Online since October 8, 2015

 
 
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ORIGINAL ARTICLES
Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty
Randa Alfargieny, Zuhir Bodalal, Riyad Bendardaf, Mustafa El-Fadli, Salem Langhi
October-December 2015, 5(4):117-122
DOI:10.4103/2231-0770.165122  PMID:26629466
Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.
  11 2,783 710
BRIEF REPORT
English language proficiency and academic performance: A study of a medical preparatory year program in Saudi Arabia
Feroze Kaliyadan, Nazer Thalamkandathil, Srinivas Rao Parupalli, Tarek Tawfik Amin, Magdy Hassan Balaha, Waleed Hamad Al Bu Ali
October-December 2015, 5(4):140-144
DOI:10.4103/2231-0770.165126  PMID:26629471
Introduction: All medical schools in Saudi Arabia have English as the primary official medium of instruction. Most of the high school education, however, is delivered in Arabic and hence the transition to an English based learning environment tends to be difficult for some students. Our study aims to correlate English language proficiency with academic performance among medical students in their preparatory year. Methods: A cross-sectional study design was used. Test scores of 103 preparatory year students (54 female and 49 male) were analyzed after the students completed an English language course and medical introductory course in their preparatory year. The total score obtained in the English course assessment was compared to each component of the medical content assessment. Results: A significantly positive correlation (Spearman's Rho, at 0.01 levels) was seen between the scores of the English exam and the written exam (P<0.001) and the oral exam (P = −0.003) parts respectively of the medical examination. Significant correlation with the English exam score was not obtained for the other components of the medical assessment, namely; student assignments, presentations and portfolios. Conclusion: English language proficiency is an important factor in determining academic proficiency of medical students in our college at the preparatory year level.
  5 2,621 281
Specialty preferences of 1st year medical students in a Saudi Medical School – Factors affecting these choices and the influence of gender
Feroze Kaliyadan, Tarek Tawfik Amin, Habib Qureshi, Fahad Al Wadani
October-December 2015, 5(4):134-139
DOI:10.4103/2231-0770.165120  PMID:26629470
Background and Aims: In recent years there has been a growing appreciation of the issues of career preference in medicine as it affects student learning and academic performance. Various factors influence the specialty choices of medical students. Some specialties tend to attract students more than others. One possible consequence of this would be a mismatch between health needs and specialist numbers in the region. This study investigated the career preferences of 1st year medical students in a Saudi medical school and to assess factors affecting these choices. Materials and Methods: The study was a cross-sectional survey carried out on the 1st year undergraduate students in the college of medicine, King Faisal University, Saudi Arabia. A total of 109 students (57 female and 52 males) responded to the questionnaire which was initially administered to all the students of the 1st year – A total of 120 students (response rate was 90.8%). A mixed method approach was used and qualitative data from open-ended questions were analyzed based on thematic analysis. Results: The top choices were general surgery, internal medicine, and pediatrics. Among female students; the top specialty choices were: General surgery (23%), pediatrics (18%), and dermatology (15%). Among the male students; the top choices were: General surgery (54%) and internal medicine (23%). Of the total, 57% of the students agreed or strongly agreed that primary aptitude was the main factor affecting the choice. Only 31% felt that there was a significant influence of role model, 48% felt that the advice of others – peers and family, would be a factor influencing their choices, and 53% agreed that specialty choice would influence their future learning patterns. Males were more likely to choose a specialty based on actual aptitude for the specialty, financial rewards, and scope for research; and this gender difference was statistically significant. Conclusion: Surgery was the top-choice in both genders. Other popular choices included internal medicine, pediatrics, and dermatology. Important factors affecting these choices included – primary aptitude, advice of peers, reputation, financial rewards, and the challenge involved.
  3 2,246 276
CASE REPORTS
Nasal angioma with osseous metaplasia
Adriana Handra-Luca, Damien Bisseret, Philippe Gorphe, Nebojsa Arsenovic
October-December 2015, 5(4):128-130
DOI:10.4103/2231-0770.165124  PMID:26629468
Nasal angiomas are rare. We report a case showing osseous metaplasia and discuss pathogenesis hypotheses. A 41-year-old woman presented with a right lateronasal firm, immobile mass, and interfering with glass wearing. The computed tomography scan imaging was suggestive of chondroma while the magnetic resonance imaging showed on T1-weighted images nodule isosignal, on T2-weighted images hypersignal, and intense enhancement after contrast substance injection. The lesion was surgically resected. Histological examination revealed a 0.8 cm angioma with multifocal osseous metaplasia. The diagnosis of nasal angiomas with extensive osseous metaplasia is difficult requiring microscopic examination. Conservative surgery is the treatment of choice even at an early stage due to the limited effectiveness of embolization or drugs on the osseous component.
  2 1,905 162
ORIGINAL ARTICLES
Risk factors associated with chronic low back pain in Syria
Mohammad Salem Alhalabi, Hassan Alhaleeb, Sarah Madani
October-December 2015, 5(4):110-116
DOI:10.4103/2231-0770.165123  PMID:26629465
Background: We aimed to identify risk factors associated with chronic low back pain (C-LBP) in Syria. Materials and Methods: We conducted the study in a busy outpatient neurology clinic in Damascus city from October 2011 to August 2012. We enrolled all eligible adults presenting with C-LBP along with those who denied any back pain as a controls. We considered C-LBP any LBP lasting over 3 months. We developed our own questionnaire. A clinical nurse interviewed each person and filled in the results. Results: We had a total of 911 subjects; 513 patients and 398 controls. We found that C-LBP increased with age. Having a sibling with C-LBP was a strong predictor of C-LBP. In women obesity, but not overweight, was a risk factor. Number of children was a risk factor for mothers. Higher level of education decreased the chance of C-LBP in women. Sedentary job increased the risk of C-LBP. Conclusion: This study sheds some light on risk factors for C-LBP in our population and might help find possible preventive measures.
  2 4,334 1,265
Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoingin vitro fertilization/intracytoplasmic sperm injection treatment cycles: A randomized controlled study
Niyazi Kilic, Özhan Özdemir, Hakan Cevdet Başar, Fadime Demircan, Fırat Ekmez, Oğuz Yücel
October-December 2015, 5(4):123-127
DOI:10.4103/2231-0770.165121  PMID:26629467
Background: Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during assisted reproductive technology protocols. The aim of this study was to evaluate the role of dopamine agonist as a preventive strategy of OHSS in women at high risk in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles. Methods: Seventy women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included. The study group received 0.5 mg of cabergoline for 8 days from the day of human chorionic gonadotropin administration in comparison to those who undergo no treatment for the prevention of OHSS. The reduction of the incidence of OHSS was the primary outcome. Results: The actual incidence of OHSS was 8.33% in the cabergoline group and 20.58% in the control group. Thus, the incidence of OHSS was significantly reduced, by almost 60%, in the cabergoline group in comparison with the control group (relative ratios: 0.4, 95% confidence interval: 0.18–0.79). Conclusion: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment. However, the effects of cabergoline on important outcomes, namely, live birth, miscarriage, and congenital abnormalities are still uncertain.
  1 2,363 424
CASE REPORTS
Acute promyelocytic leukemia presenting as pulmonary thromboembolism: Not all APLs bleed
Ashok K Vaid, Sandeep Batra, Suman S Karanth, Sachin Gupta
October-December 2015, 5(4):131-133
DOI:10.4103/2231-0770.165125  PMID:26629469
We present a rare case of acute promyelocytic leukemia (APL) presenting as pulmonary thromboembolism being misdiagnosed as community.acquired pneumonia. Thrombotic phenomenon in APL are poorly understood and grossly underreported. In our case, following no response to standard antibiotic treatment, the patient was further investigated and detected to have an acute pulmonary thromboembolism following right lower limb deep vein thrombosis (DVT). Though, complete blood picture revealed only mild hyperleukocytosis, bone marrow biopsy and aspiration revealed 60% blasts and a positive t (15,17)(q22,12) and PML retinoic acid receptor alpha (RARA) fusion protein on molecular cytogenetics. He was diagnosed as APL and received treatment with all.transretinoic acid (ATRA) and arsenic trioxide (ATO) and therapeutic anticoagulation
  - 2,134 184
ORIGINAL ARTICLES
Three stitch hernioplasty: A novel technique for beginners
Manikandan Patchayappan, Sangara Narayanan Narayanasamy, Nagarajan Duraisamy
October-December 2015, 5(4):106-109
DOI:10.4103/2231-0770.166891  PMID:26629464
Objective: To analyze mesh fixation with minimum sutures and postoperative complications. Study Design: Prospective study. Place and Duration of Study: Department of General Surgery, Thanjavur Medical College and Hospital, Tamil Nadu, from July 2010 to June 2012. Materials and Methods: All inguinal hernia patients, who fulfilled the sample selection criteria, were admitted and planned for surgery. The prolene mesh is fashioned as in Lichtenstein's repair, placed and fixed only by three prolene stitches. The first stitch is made in the periosteum of pubic tubercle. The second stitch is taken in the inguinal ligament (1.5 cm lateral to the pubic tubercle) and the third stitch is from the medial most part of the conjoint tendon, that is, the mesh is fixed in the medial aspect alone. Results: Majority of the patients fall between the age group of 40 and 60 (72%) years and all are male patients. Of the total cases, 50% were right sided, 25% were left sided, and 25% were bilateral. Of the postoperative complications, 12% had seroma, 4% had hematoma, 2% developed surgical site infection, 2% developed chronic groin pain, 1% presented with recurrence, and none developed foreign body sinus. Conclusion: The incidence of long-term complications of three stitch hernioplasty are comparable to that of the other standard, tension-free open hernia repair as well as other laparoscopic procedures. Moreover, the three stitch hernioplasty method is a simple method, easy for the beginners to adopt, has less foreign body reaction, less time consuming, causes less tissue trauma, and lesser chance for vascular injury.
  - 2,414 2,047
REVIEW ARTICLE
Case reports and research productivity among Syrian medical students: Review, reality, and suggested solutions
Naji Alhamid, Nawar Almounayer, Bana Alsabbagh, Baseel Atassi
October-December 2015, 5(4):101-105
DOI:10.4103/2231-0770.165119  PMID:26629463
Medical students are precious seeds for better future medical research. Case reports writing may represent a relatively simple first step for beginners. Only 47 case reports are published in the literature by Syrian Medical Institutions compared to more than 500 case reports in a comparable country in the last 5 years. Many obstacles stand against developing fruitful research environment in Syria. Increasing awareness to research productivity in Syria along with comparative analysis is discussed in this article.
  - 2,461 9,772
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