Immunoglobulin G4 related disease: an overview

Immunoglobulin G4 related disease (IgG4-RD) is a recently perceived fibroinflammatory condition, identified as a systemic illness for the first time in the early 2000. It can involve virtually every organ of the body, commonly presenting as lymphadenopathy, retroperitoneal fibrosis, autoimmune pancreatitis, tubulointerstitial nephritis, parotid or lacrimal gland enlargement. The diagnosis is confirmed by histopathological analysis and is often, but not always accompanied by an increased level of serum IgG4 concentration. In fact, the name addressing this autoimmune fibroinflammatory condition may be considered a misnomer, as the role of the non-inflammatory immunoglobulin IgG4 in the immune mechanism of IgG4-RD remains to be elucidated. Ibrahim Med. Coll. J. 2021; 15(2): 44-51

Analysis of genitourinary trauma patients admitted to the emergency department

Background and objective: Genitourinary injuries are commonly encountered in the emergency department but may be over looked in case of multi-trauma. Determining the clinical features of genitourinary injuries will help physicians in the management of genitourinary trauma. Methods: The study was conducted in a tertiary hospital. Patients of all ages, admitted in the emergency department, with trauma between 2015 and 2020 were included and analyzed. The cause of genitourinary trauma, affected organs, any accompanying injury, treatments, mortality status, and laboratory tests related to mortality were obtained from the hospital records and analyzed. Results: During the study period, 87 patients admitted to the emergency department with genitourinary trauma were included in the study. The majority of these patients (n=79) were male. Of the patients, 9.2% died. All the patients in the mortality group had additional injuries. The most frequently injured organ was determined as the kidney (51.7%), followed by the scrotum (25.3%) and penis (8.1%). Additional injuries were observed in 81.6% of the patients. Intra-abdominal organ injuries (19.5%) were the most common accompanying injuries. White blood cell count (WBC), aspartate aminotransferase (AST), alanine aminotransferase ( ALT), blood glucose and creatinine values measured at the time of admission to the emergency department were found to be higher in the non-survivor group. The majority of the patients (81%) were discharged with conservative treatment and follow-up. Conclusion: It was determined that genitourinary injuries were frequently seen with additional injuries. Genitourinary injury should be evaluated carefully, especially in the presence of intra-abdominal organ injuries. Ibrahim Med. Coll. J. 2021; 15(2): 32-37

Finally they are convinced and will release the cheque this upcoming sunday and verbally told to collect it.

Background and objectives: Science congresses have begun to be recognized as a tourism model that named as congress tourism. The hotels where the National Emergency Medicine Congresses are hosted, which are held once a year, contribute to congress tourism.The aim of this study is to find out views of attendees of emergency medicine congresses about the congress and presentations. Methods: A survey form consisting of 16 questions (without demographic question) was shared with participants attending the 14th National Emergency Medicine Congress of the Association of Emergency Medicine Specialists (EPAT) by SMS, e-mail, and social media messenger programs (WhatsApp, etc.). Results: A total of 238 participants took part in the study of whcih73.9% (n = 176) were male. The age of the majority (68, 28.6%) participants was between 35 to 39 years. Maximum participants (n = 95, 39.9%) were specialist titleholders and the majority's (n = 81, 34.0%) length of service was 6-10 years. Of the total particinats, 73.1% and 65% expressed that curiosity about the scientific content and refreshing the knowledge respectively were the reasons for attending the conferences. Conclusion: Even if congresses are held in holiday hotels, participants are more interested in scientific content. Paramedical activities and visuals used in presentations are viewed positively. Although there are very intense programs in the congress, the majority of the participants stated that they would listen to eight presentations most efficiently. Ibrahim Med. Coll. J. 2021; 15(2): 38-43

Effects of metformin on polycystic ovary syndrome: a randomized, double-blind, placebo-controlled study

Background and objectives: Metformin improves manifestations of polycystic ovary syndrome (PCOS) by reducing insulin resistance. The objective of this study was to determine how metformin, in combination with lifestyle changes, affects the clinical manifestations of PCOS. Materials and Methods: Patients with PCOS attending the outpatient of a tertiary care hospital were enrolled in the study. Revised Rotterdam Consensus 2003 criteria were used to diagnose cases of PCOS. Clinical information, anthropometric measurement, serum progesterone and polycystic ovarian morphology (PCOM) of each subject were recorded in a prescribed data sheet at baseline and after a period of nine months. Randomized placebo controlled double blind design was used to assign participants in respective groups. Participants were randomly assigned to receive 9-month course of either metformin (1500 mg/day) or placebo. Both groups were advised regarding schedule of lifestyle modification. Outcome variables were clinical manifestations related to metabolic, reproductive and androgenic status of PCOS. Results: Out of 80 enrolled PCOS cases, 49 completed the study (metformin=26, placebo=23). The mean age of the study participants of metformin and placebo groups was 23.52±5.18 and 22.09±3.58 years respectively (p=0.262). Menstrual cycle significantly improved in both the study groups (before vs. after - metformin: 19.2% vs. 76.9%, p=0.003; placebo: 19.2% vs. 47.8%, p=0.02) after 9 months, but compared to placebo group no such significant (p=0.12) improvement occurred in metformin group. Severity of hirsutism, presence of acne, serum progesterone level and ovulatory status improved significantly in both groups after completion of the study. Except acanthosis nigricans, other metabolic manifestations did not significantly improve in metformin compared to placebo group after the intervention. While comparing the percentage changes, body mass index (BMI) and waist circumference (WC) reduced significantly in metformin than placebo group (BMI in kg/m2- metformin vs. placebo: -3.63±8.22 vs. +1.42±6.67, p= 0.024; WC in cm - 2.81±7.74 vs. +1.68±7.89, p= 0.05). No significant adverse event was observed in metformin group. Conclusion: Metformin, in conjunction with lifestyle modifications, has favorable impacts on clinical manifestations of PCOS. Ibrahim Med. Coll. J. 2021; 15(2): 1-12

Evaluation of the effectiveness of handwashing training given to paramedic students remotely

Background and objectives: The COVID-19 pandemic has affected face to face medical education and training activities around the world. The aim of this study was to provide remote practical handwashing training to health sciences students and to measure the effectiveness of the training provided and to create a feedback model. Methods: Students of the Paramedic department were included in the study. Two virtual classrooms were created via Zoom Video Communication system. An 11-step handwashing algorithm was developed. Two hours of remote handwashing training was given. Participants were asked to apply the handwashing application they learned at their own location and to record videos. Application videos were evaluated and scored. Results: A total of 135 Term-1 and Term 2 students of the Paramedic department participated in the study. The duration of the evaluated videos was on average 57.67 ± 12.69 (34-95) seconds. Fifty-five (40.7%) of the participants successfully completed all the steps and their average success score was 10.3 ± 0.67 (8-11). The most failure (33.3%) in the process steps was the 9th step in which the wrists are rubbed with soap. Conclusion: Suitable teaching and feedback methods are required for medical and health science students who receive education and practical training remotely from home. Ibrahim Med. Coll. J. 2021; 15(2): 18-25

Comparison of the outcome of transverse and circumferential capitonnage in surgical treatment of pulmonary hydatid cyst - a single centre study

Background and objectives: The enucleation of the pulmonary hydatid cyst is followed by individual closure of bronchial air leaks and obliteration of the residual pericystic cavity by capitonnage, either by circumferential or interrupted transverse suture. The objective of the study was to compare the surgical outcome of transverse and circumferential capitonnage in terms of postoperative recovery course, residual cavitations, air leaks, cavitatory or pleural collections and the recurrence of primary disease after enucleation of the pulmonary hydatid cyst. Methods: Patients with pulmonary hydatid cyst were included in the study and divided into two groups. Each group consisted of 30 patients. Patients of Group-1 underwent enucleation of the hydatid cyst followed by closure of bronchial air leaks with classical circumferential closure of the cavity and patients of Group-2 had enucleation of the hydatid cyst and closure of the cavity by transverse capitonnage. Results: Ten cases (33.33%) of Group-1 had hospital stay for more than 5 days compared to 4(13.33%) in Group-2 (p=0.03). Out of 30 patients who had undergone circumferential closure of the hydatid cavity, 5 (16.67%) patients had residual cavitatory fluid collection while there was none in the other group. In Group-1, 7 (23.3%) cases had reactionary intrapleural fluid collection compared to 2 (6.6%) in Group-2 (p=0.035). After 3 months of follow-up, 4 patients in circumferential capitonnage had mild haemoptysis and 1 had aspergilloma while no such complication occurred in any patient in the transverse capitonnage group. No recurrence of cyst occurred in any case in both groups. Conclusion: There was a considerable advantage of transverse capitonnage of the hydatid lung cavity after enucleation in terms of short hospital stay, minimal or no reactionary intrapleural or intra cavitatory collections and less air leaks. Ibrahim Med. Coll. J. 2021; 15(2): 13-17

Perspective and a brief overview of genome-wide association studies in moderate to severe asthma

Asthma is a common chronic respiratory disease that shares phenotypic heritability and shows clusters of symptoms among the relatives. A large number of studies have been conducted to examine the genetic susceptibility of asthma over the past three decades. In the last decade, genome-wide association studies (GWAS) have readdressed the perspective of viewing asthma and have identified some novel genes associated with the susceptibility of asthma. However, few genetic studies have been conducted focusing the moderate to severe asthma, and the molecular targets explain a small proportion of asthma heritability. This review focuses on the principal findings of the genomic studies investigating the genome-wide association of moderate to severe asthma and how it is transitioning the phenotype-based approach towards the fundamental genomic studies. It further illustrates the integrative perspectives aimed towards the translation of the findings in precision medicine. Therefore, a better understanding of asthma pathogenesis would focus the individual at the center of asthma care. Ibrahim Med. Coll. J. 2021; 15(2): 52-61

Red blood cell profile in patients with mild, moderate and severe COVID-19

Background and objectives: Coronavirus disease 2019 (COVID-19) pandemic has affected millions of people world-wide. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Increasing evidence has shown abnormalities of different hematological parameters with the severity of the diseases. The present study was undertaken to determine the red blood cell (RBC) profile in different categories of COVID-19 patients. Materials and methods: The study was conducted from January 2020 to December 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 patients were enrolled. Patients were categorized into mild, moderate and severe COVID-19 cases. Blood samples were analyzed by Automated Hematology Analyzer for hemoglobin concentration, total erythrocyte count and RBC indices. ANOVA followed by Bonferroni test, Chi square test, Spearman’s rho correlation coefficient test were performed as applicable using SPSS version 25.0. Results: A total of 100 RT-PCR positive COVID-19 patients were included in the study. There were 25, 38 and 37 mild, moderate and severe cases respectively. The mean age of the study participants was 44.68 + 13.16 years (range: 18 to 65 years). There were 67 (67%) males and 33 (33%) females. No significant difference in hemoglobin (Hb), hematocrit (HCT), total RBC count, red blood cell distribution width (CDW) was observed among the three groups. Significant negative correlation of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH); rs-0.362 & -0.255 respectively) was observed with disease severity. Conclusion: The study showed low MCV and MCH were significantly related with the severity of the COVID-19 illness. Therefore, comprehensive analysis of the RBC profile would be helpful to understand the disease course. Ibrahim Med. Coll. J. 2021; 15(2): 26-31

Prevalence of morbidity and mortality of diabetes mellitus in a rural community cohort

Background and objectives: The developing countries are facing the double burden of the communicable (CD) and non-communicable (NCD) diseases. The initiation of primary health care (PHC) adopted in the past century, which included sanitation and immunization, remarkably reduced the load of CDs in the least developing nations. The burden of NCDs remained the same or showed an increasing trend. Of the NCDs, diabetes has become a serious threat to human health and the related morbidity and mortalities are affecting the younger people. As a consequence, the disease complications render huge number of people to disabilities and unusual enormous health expenditures. Very few studies addressed the prevalence of complications among the diabetes patients in a rural community. This study aimed to determine the prevalence of sequels (morbidity and mortality) among the diabetic cases eight years after the initial diagnosis of diabetes in a rural community cohort Subjects and Methods: A rural community survey in 10 villages was conducted in 1993. The survey screened 1319 (797 men, 522 women) for diabetes mellitus (DM) and impaired glucose tolerance (IGT). Those who were diagnosed DM and IGT referred to a referral center (BIRDEM) for registration. A retrospective cohort was designed in 2001. The addresses of the patients were retrieved from the BIRDEM registry. These registered patients, both survivors and non-survivors, were traced in ten villages. The survivors were investigated (anthropometry, glycemia, fundoscopy, urine protein etc.). A verbal autopsy was performed to determine the cause(s) of death in the non-survivors. Results: Of the188 registered cases, 79 were found and located (survivors 43 (54.4%, non-survivors 36 (45.6%). Of the survivors, 44.2% developed complications. The observed complications were sensory neuropathy 16.3%, CAD 9.3%, retinopathy 7% and nephropathy 4.7%. Among the non-survivors, 19.4% were found to have nephropathy leading to end-stage renal disease. Conclusions: The study cohort revealed that more than one-third of the people with diabetes died in less than ten years after being diagnosed. The cohort also revealed that diabetic nephropathy (end-stage renal disease) and dearth of dialysis facilities contributed to early death in the rural community. Among the complications, most frequent incidence was neuropathy and neuro-psychiatric disorders. Ibrahim Med. Coll. J. 2021; 15(1): 31-36

Radiofrequency ablation of varicose veins: experience at a tertiary hospital

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated by radiofrequency ablation technique was analyzed. Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated. Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately. Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation. Ibrahim Med. Coll. J. 2021; 15(1): 37-40