Open Access Case Study

Boerhaave Syndrome: An Unusual Complication in a Case of Retropharyngeal Abscess

Devajit Chowlek Shyam

Asian Journal of Medical Principles and Clinical Practice, Page 1-6

Introduction: Boerhaave's syndrome is a rare entity and it results from increased intraluminal esophageal pressure following sudden forceful vomiting. The most common presentation of BS is a sudden onset retrosternal and/or epigastric pain following vomiting, and CT scan is the investigation of choice. The most common site of perforation is in the posterolateral aspect of the distal esophagus, and surgical intervention is the gold standard approach for treating BS.

Case Detail: A 27-years old male presented with dysphagia and throat pain. 6 hours after the admission, the patient had multiple episodes of vomiting. Videolaryngoscopy revealed posterior pharyngeal wall ulcer. CT scan of neck shows features suggestive of rupture retropharyngeal abscess. After 24 hours patient developed respiratory distress and chest X-ray revealed right side pleural effusion. CT scan confirmed Boerhaave's syndrome and the patient was managed conservatively.

Discussion: If diagnosed within 24 hours surgery carries a 90% success rate but the main concern is the diagnosis and management of late presented cases. Conservative management and adequate drainage of the pleural cavity is the mainstay of treatment in such cases.

Conclusion: Due to its non-specific presentation BS is difficult to diagnose. In our case, there was a little delay and due to the patient's poor general condition, we managed with conservative treatment.

Open Access Original Research Article

Tuberculosis Situation in El-Minia Governorate (1997-2010) before and after Direct Observed Therapy Short Course Strategy (DOTS)

Abdelsadek Hamed Al-Aarag, Magdy Mohammad Omar, Ahmad Abdelsadek Mohammad, Maged Moreis George

Asian Journal of Medical Principles and Clinical Practice, Page 1-10

Aim of the Work: Was to study the tuberculosis situation in El-Minia governorate before and after applications of the direct observed therapy short course strategy (DOTS).

Subjects and Methods: A retrospective study that was carried out at El-Minia chest hospitals and dispensaries to include all the cases of tuberculosis from January 1997 till December 2010. The materials in this study were collected from TB registration units in El-Minia governorate. DOTS Strategy in chest hospitals and dispensaries started since 2002. Collection and analysis of data included (demographic data, diagnosis of disease, sputum smear results, previous treatment history, and treatment outcome, Measurement of indicators for every year and Comparison of indicators. A descriptive analysis of data was performed using SAS software. Data were described in absolute numbers and percentages. Statistical significance was set at P values less than 0.05.

Results: The total number of recorded TB cases was 7860 (3838 before DOTS and 4022 after DOTS).The highest incidence occurred in the age group of 15 to less than 30 years (30.69% before and 31.15% after DOTS), males constituted 53.35 % while females constitute 46.65%, Rural cases (68.28%) were significantly higher than urban cases (31.72%) during all years of the study. total number of extrapulmonary tuberculous cases was 2440, the highest incidence was in tuberculous lymphadenitis.(36.8%).Conversion rate was improved after DOTS from 33.05% to 60.94%. There was an improvement in cure rate, treatment completion rate, and treatment success rate after DOTS.

Conclusion: Tuberculosis is still a health care problem in El-Minia governorate the burden of the productive age group of 15–45 years. The implementation of DOTS in El-Minia governorate had led to significant increase in treatment success rate (93.87%) and decrease in default and failure rates.

Open Access Original Research Article

Evaluation of DKK1 and NANOG Genes Expression as Prognostic Biomarkers in Iranian Women with Breast Cancer

Fatemeh Heidari, Parisa Rafati, Fahimeh Nemati

Asian Journal of Medical Principles and Clinical Practice, Page 1-8

Background: Breast cancer is the second leading cause of death in Iranian women following lung cancer with high morbidity rate among those aged 40-55 years. The aim of this study was to evaluate the expression of DKK1 and NANOG genes as prognostic biomarkers in Iranian patients with breast cancer using quantitative Real-Time PCR (RT-qPCR).

Materials and Methods: In this study, 30 clinical specimens from patients with breast cancer and 30 normal adjacent tissues from these patients were collected from Tehran Imam Khomeini Hospital in 2017 and their age ranged from 23 to 83 years (mean, 51.27 years). For evaluation of DKK1 and NANOG genes expression, following the extraction of RNA and cDNA synthesis, the expression of the genes was evaluated using Real-Time PCR.

Results: Two patients (6.6%) were in the first stage, 15 (50%) in the second stage, 11 (36.6%) in the third stage and 2 (6.6%) in the fourth stage of breast cancer. In terms of tissue grade, 4 (13.3%) patients were in Grade 1, 15 (50%) in Grade 2 and 10 (3.33%) were in Grade 3. The results demonstrated that the expression of DKK1gene was10.774 Fold and the expression of NANOG gene was 11.19 Fold higher in patients with breast cancer compared to those genes from normal tissues.

Conclusion: In our study, we used two biomarkers including DKK1 and NANOG genes, both of which appeared as proper biomarkers as their expression was significantly higher for the prognosis of breast cancer among patients. With the development of molecular medical techniques, the use of gene expression biomarkers in the diagnosis and prognosis of various diseases, such as cancers has become increased. By evaluation of the expression of various genes, we can prognosticate the specific types of cancers.

Open Access Original Research Article

Health Services Utilization Patterns among Enrollees of the National Health Insurance Scheme at a Tertiary Health Facility in Federal Capital Territory (FCT) – Abuja, Nigeria

O. E. Daramola, C. T. Adesina, J. M. Abu, T. M. Akande

Asian Journal of Medical Principles and Clinical Practice, Page 1-8

Background: The National Health Insurance Scheme (NHIS) was established to provide accessible, affordable and quality healthcare to the Nigerian population and the enrollees utilize healthcare services at the various NHIS accredited healthcare facilities.

Objective: This study assessed the types and patterns of health services utilization and perception of patients towards the NHIS in a tertiary hospital in FCT-Abuja, Nigeria.

Methodology: A cross-sectional study of 305 NHIS enrollees selected by systematic random sampling was done at the General Outpatient Clinic, University of Abuja Teaching Hospital, Gwagwalada, FCT-Abuja, Nigeria. Participants’ sociodemographic variables, reasons for hospital choice, utilization and perceptions about NHIS services were assessed. Data were analyzed with IBM SPSS Statistics 20.0.

Results: Majority 204 (66.9%) of the respondents were principal enrollees, 93 (30.5) were spouses and 8(2.6%) were extra-dependants, 157 (51.5%) had been enrolled for more than 5 years, and availability of specialist doctors was the main reason most patients 198 (64.9%) chose to access care at the hospital.

An average of 4 services were utilized by the respondents, with outpatient care and laboratory services being the most utilized services. Majority 208 (68.2%) stated that health insurance positively influences prompt health seeking behaviour, while 182 (59.7%) felt that NHIS gives access to quality health services.

Conclusion: The study revealed the types of healthcare services utilized and the perception of NHIS beneficiaries towards the scheme. While continuous advocacy and sustained efforts towards improved services and coverage expansion should be intensified, further studies considering patients and healthcare providers’ perspectives and other associated factors are recommended.

Open Access Original Research Article

The Role of Psychological Correction in Inflammatory Bowel Diseases

Jamilya Kaibullayeva, Natalia Imtossimi, Zhanna Romanova, Anar Dushpanova

Asian Journal of Medical Principles and Clinical Practice, Page 1-7

Inflammatory bowel diseases (IBD),are the life-lasting progressive diseases with destruction of gastrointestinal tissue and patients disability. The influence of stress or psychosocial factors as pathology triggers well known in ulcerative colitis and Crohn's disease diseases [5-9]. During a comprehensive psycho-correctional program that included individual and then group work with IBD patients various cognitive-behavioral therapy techniques were used. The results obtained testify not only about the need for individual psychological support, but also about the great benefits of group analysis. The usage of various methods of cognitive-behavioral therapy allows you to optimize psychological assistance to patients with IBD.