Journal Issue: Volume: 55, No. 202 (2016)
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Volume
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Issue Date
2016
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Articles
Smoking cessation and attitudes, belief, observation, and education of medical students, in Turkey
(Nepal Medical Association, 2016) Ebru Turhan; Tacettin Inandi; Meltem Col; Resul Bugdayci; Olga Eker; Mustafa Ilhan
Abstract
Introduction: Tobacco use is an important public health problem around the world. Aim of this study is to assess attitudes,belief and observation of the students on smoking cessation and medical education.
Methods: This study is part of a multi-country study called “Global Health Profession Student Surveyâ€. The study population consisted of third year medical students in Turkey. The sample consisted of a total of 1834 medical students from randomly selected 12 medical schools.
Results: Of the students, 1209 (92.1%)thought that health professionals should get specific training on cessation techniques, and that health professionals should serve as "role models" for their patients and the public. The percentage of the students who answered “Health professionals should routinely advise their patients who smoke to quit smoking†was 1211 (93.3%). Of the students, 1204 (60.8%) responded that health professionals who use other tobacco products were less likely to advise patients to stop smoking. The percentage of the students who had received a formal training on smoking cessation approaches was 48.2% (1196). Of the students, 91.5% (1203) had heard of nicotine replacement therapies in tobacco cessation programs. More than half of smokers tried to quit smoking last year, and majority of them did not take professional help or advice.
Conclusions: Majority of students are aware of health professionals’ role on smoking cessation. Most of the students are willingness to take specific formal training on tobacco. Student’s behaviours and attitudes were different by gender and smoking status. Improvement of tobacco cessation issues in medical curricula will be beneficial.
Keywords: Attitudes; Beliefs; Medical education; Medical students; Smoking cessation.
Clinical evaluation of fused/ankylosed hip with severe flexion deformity after conversion to total hip arthroplasty
(Nepal Medical Association, 2016) Suwal, Saroj Kumar; Peng Songming; Luo Gang; Huang Kui
Abstract
Introduction: Fused or Ankylosed hip is late complication of chronic inflammatory disorder with progressive changes in and around articular as well as periarticular structures with alteration in bio-force line of body which later lead to severe flexion deformity of joint. This not only results decreased movements of hip, it’s also increase pain around the hip, back and contralateral hip.
Methods: Retrospectively, all patients aged 18 years or older undergoing THA between June 2006 to June 2012 were reviewed with selection criteria. The five ankylosed hips (three left and two right) with severe flexion deformities which ankylosed spontaneously were successfully converted to THA at time period of 2006 to June 2012. Range of Motion (ROM), Harris Hip Score and Flexion Deformity Angle at preoperative, postoperative and follow-up periods were used as evaluation.
Results: Mean follow up is 42 months. Mean HHS increased from 21.6±4.97 to 81.8±4.02 points with one excellent, two good and two fair cases. The FDA is corrected to mean 8°±10.95 postoperatively and 4°±5.47 at final follow up from 81.6°±4.39 with two hips of 10° residual deformity. Hip ROM is improved as flexion 70° to 100°, adduction 10° to 20°, abduction 10° to 30°, internal rotation 5° to 10° and external rotation 2° to 50° from 0° activity. As complications, one hip had loose prosthesis, two had early postoperative dislocations, one had Deep Vein Thrombosis and one had femoral nerve palsy with quadriceps weakness.
Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties.
Keywords: Ankylosed hip; Fused hip; Severe flexion deformity; Total hip arthroplasty.
Hyponatremia in patients with community acquired pneumonia
(Nepal Medical Association, 2016) Karki, Lochan; Thapa, Bhawesh; Sah, Manoj Kumar
Abstract
Introduction: Community acquired pneumonia is one the frequent cause of hospital admissions. Whereas, hyponatremia is a common electrolyte abnormality in hospitalized patients and has been shown to be associated with considerable morbidity and mortality. We aim to studyt the association of hyponatremia with community acquired pneumonia in terms of morbidity and mortality.
Methods: A prospective observational hospital based study was conducted in a hospital for a year. All patients with a diagnosis of community acquired pneumonia and admitted in medicine ward, were included. Patients with diarrhea, known Chronic Kidney Disease, Heart Failure, Cirrhosis of Liver, Malignancy, taking diuretics, chemical pneumonitis, interstitial pneumonias and other debilitating disease were excluded.
Results: Among the 72 cases of CAP, 61% were females and 39% were males. The mean age of patients was 51.3 years, 22 (30.55%) patients had severe CAP. A total of 7 cases expired with an overall mortality of 13.7%. The mortality risk increased with increasing CURB-65 score; CURB-65 score 0, 0%; CURB-65 score 1, 0%; CURB-65 score 2, 0%; CURB-65 score 3, 10%; CURB-65 score 4, 33%; CURB-65 score 5, 100%. i.e higher the CURB-65 score, higher the death rate of CAP patients (p<0.05). Hyponatremia was a common occurrence at hospital admission with an incidence of 36.11%. Hyponatremia at hospital admission was also associated with a longer length of hospital stay in cured CAP patients. The mean length of hospital stay was 4.3 days.
Conclusions: High CURB-65 scores and lower values of serum sodium at admission in patients of CAP are associated with adverse outcomes both in terms of mortality and longer length of hospital stay. CURB-65 score should be incorporated into assessment of CAP and sodium of the patients during admission.
Keywords: CURB-65 score; Hyponatremia; Mortality.
Molecular identification of extended-spectrum β-lactamase and integron genes in klebsiella pneumonia
(Nepal Medical Association, 2016) Ehsan Estabraghi; Taghi Zahraei Salehi; Kumarss Amini; Mahmoud Jamshidian
Abstract
Introduction: Infections caused by Gram negative bacteria, producing extended-spectrum β-lactamase, including Klebsiella pneumoniae are increasing all over the world with high morbidity and mortality. The aim of the present study was determined antimicrobial profile susceptibility and the prevalence of antibiotic resistance genes by multiplex PCR.
Methods: In the present study, we obtained one-hundred isolates of K. pneumoniae from different clinical samples. The antibiotic susceptibility testing was done in thirteen antibiotic and, therefore, M-PCRs were conducted using the DNA amplification for detection of ESBLs (blaTEM, blaCTX-M, blaSHV) and int (I, II, III) genes.
Results: The results of resistance to amoxicillin/clavulanate, ciprofloxacin, amikacin, trimethoprim-sulfamethoxazole, cefotaxime, ampicillin, aztreonam, imipenem, gentamicin, ceftazidime, Cefepime, ceftriaxone and levofloxacin were obtained 37%, 37%, 93%, 84%, 52%, 87%, 59%, 8%, 24%, 67%, 52%, 43% and 26%, respectively. The frequency of the extended-spectrum β-lactamase K. pneumoniae was obtained 37%. The prevalence of resistance genes of ESBLs in the M-PCR method showed that the blaTEM, blaCTX and blaSHV were 38%, 24% and 19%, respectively, however, only 8 (8%) out of 100 isolates were found to have positive outcomes for the existence of class 1 integrons and there were no detected class 2 or class 3 integrons.
Conclusions: Our results recommend the likely co-carriage of some ESBLs genes and antibiotic resistance integrons on the same plasmids harboring the MDR genes.
Keywords: FKlebsiella pneumonia, Integrons, Drug resistance.
Myomectomy revisited: experiences in a teaching hospital
(Nepal Medical Association, 2016) Subedi, Shanti; Chhetry, Manisha; Lamichhane, Sabina
Abstract
Introduction: Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital.
Methods: A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016.
Results: Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours.
Conclusions: Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status.
Keywords: Abnormal uterine bleeding; Degeneration; Myomectomy.