Leiomyoma of the Vulva: A Diagnostic Challenge Case Report | Chapter 17 | Innovations in Medicine and Medical Research Vol. 1

Uterine leiomyomas are common and can affect up to 30% of women older than 35 years. Despite this, leiomyomas of the vulva are rare, masquerading and usually misdiagnosed as Bartholin cyst preoperatively. These smooth muscle tumors are typically painless, solitary and well circumscribed and can affect female of any age group. We present a case of a 46-year-old female that presented to the clinic with 2-year history of right labial mass and was diagnosed as Bartholin cyst initially. The patient underwent elective excision under spinal anaesthesia and the mass was removed. The final diagnosis after microscopy result showed benign vulvar leiomyoma.

Author(s) Details

Saad Kurdi
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.

Abdullah S. Arafat
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

Maysan Almegbel
King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

Mayson Aladham
King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

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Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature | Chapter 16 | Innovations in Medicine and Medical Research Vol. 1

Background: Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.

Introduction: Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations.

Case Report: A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition.

Discussion: The etiopathogenesis, presentation, investigations and management are discussed briefly.

Conclusion: Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

Author(s) Details

Ketan Vagholkar
Department of Surgery, D.Y. Patil University, School of Medicine, Navi Mumbai 400706, India.

Suvarna Vagholkar
Consultant Gynaecologist, Thane, India.

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Economic Burden of Diabetic Tuberculosis Patients from 3 Malaysian Hospitals | Chapter 15 | Innovations in Medicine and Medical Research Vol. 1

Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment.

Study Design: Prevalence based cohort.

Place and Duration of Study: Penang General Hospital, Hospital USM, and – Univesiti Malaya Medical Center; 2005 – 2008. 

Methods: Study patients were placed in the TB only, DM only, or DM-TB groups, with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests.

Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DM only group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for the TB only and DM only groups, respectively.

Conclusions: DM antedated HTN in our patients. Durations of both DM and HTN were longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.

Author(s) Details

Daud M. I. Aweis  
Pharmacy and Medical Supply Division, Ahmadi Hospital, Kuwait Oil Company, Kuwait and School of Pharmaceutical Sciences, USM, 11800 Penang, Malaysia.

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“Tibial Blowout”- A Complication of Arthroscopic Anterior Cruciate Ligament Reconstruction | Chapter 14 | Innovations in Medicine and Medical Research Vol. 1

The reconstruction of Anterior Cruciate Ligament (ACL) has become the standard of care for a torn ACL in active, young athletes. Various technical complications during the surgery are documented. Of the complications pertaining to the bony tunnel preparation, the posterior femoral blow out is common. In this report we describe a complication that can occur while preparing the Tibial tunnel – “Tibial blow out”. This is a complication of anterior placement of the tibial tunnel and this has not been reported in the literature. We describe the identification, the possible mechanism, prevention and management of such an intra operative complication.

Author(s) Details

A. RavirajDepartment of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Ashish Anand
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Dr. Vidyasagar
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Dr. Shivareddy
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

Azhar Amin
Department of Orthopaedic Surgery, Centre of Arthroscopy and Sports Medicine, Apollo Hospital, Bannerghatta Road, Bangalore -76, India.

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Attitude and Perception to Tattoos and Scarified Skin Marks in Makurdi, North Central Nigeria | Chapter 13 | Innovations in Medicine and Medical Research Vol. 1

Aim: Tattoo art which has been practiced all over the world for centuries is undergoing a revolution. Some people like it, others don’t. The aim of the study was to estimate the prevalence of tattooing among students and residents of Makurdi, like or dislike, who gave consent before tattooing, symbolism/motive of tattooing and whom to go to for removal of tattoos.

Study Design: A survey research using structured questionnaire as instrument for data collection among students of Benue State University and residents of Makurdi over a period of one month in January, 2017.

Methodology: Views of one hundred and seventy two residents and  students  in Makurdi, North Central Nigeria, were collated via a pre-tested structured questionnaire and analyzed on the basis of sex, age, like/dislike of tattoos, symbolism, consent given, whether one would tattoo himself if given a chance and what to do when one got tired of tattoos.

Results: Two hundred and ten questionnaires were administered and one hundred and seventy two were returned giving attrition rate of 18.1%. All returned questionnaires were completely filled. One hundred and seventy two respondents participated in the study comprising 123 males and 49 females giving a male to female ratio of 2.5:1. Twenty one respondents had tattoos giving a tattoo prevalence of 12.2%. One hundred and thirty eight (80.2%) did not like tattoos and forty two (24.4%) indicated that there was no significance to symbolism of tattoos and indeed thirty (17.4%) felt tattoos are a body mutilation. One hundred and fifty one (87.8%) indicated they will not have tattoos when given a chance to do so. Ninety seven (56.4%) believed the best person to go to for tattoo removal is a Plastic Surgeon.

Conclusion: The study showed that majority of students and residents of Makurdi metropolis in Nigeria do not like tattoos and would not like to have one when given a chance to do so. A large scale study involving other parts of Nigeria needs to be done to assess a true like/dislike of tattoos in this environment.

Author(s) Details

Dr. P. Denen Akaa
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. C. N. Ahachi
Benue State University Teaching Hospital, Makurdi, Nigeria.

Dr. Ojo Babarinde
Benue State University Teaching Hospital, Makurdi, Nigeria.

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Antibacterial Activity of Polyphenolic Extracts from Different Algerian Honeys against Methicillin Resistant Staphylococcus aureus | Chapter 11 | Innovations in Medicine and Medical Research Vol. 1

The prevalence of patients infected with Methicillin resistant Staphylococcus aureus present different problems of nosocomial infections diseases in addition to multidrug resistance. This work aim to evaluate the antibacterial effect of four polyphenolic extracts from honey against Methicillin resistant Staphylococcus aureus. An extraction of polyphenol was carried out from different honey samples collected from different regions of the Algerian territory. First, the physicochemical, microbiological quality and pollen analysis was studied. Then, the evaluation of the antibacterial effect was performed by the determination of inhibition diameter and the minimal inhibitory concentration. The results clearly show the sensitivity of Methicillin Resistant Staphylococcus aureus against the polyphenolic extracts. The four samples presented an inhibitory effect and the polyphenolic extract of Jijel has the highest inhibitory effect among all extracts. This activity depend not only with the type of polyphenolic compounds but also with the botanical origin and the type of honey as honeydew honeys which is more effective than nectar honey.

Author(s) Details

Belkhodja Hamza
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

Belmimoun Asmaa
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

Pr. Meddah Boumediene
Laboratory of Bioconversion, Microbiology Engineering and Health Safety, University of Mustapha Stambouli, Mascara, Algeria.

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A Comparison of Rheumatoid Arthritis Patients in Kuwait with Other Populations: Results from the KRRD Registry | Chapter 07 | Innovations in Medicine and Medical Research Vol. 1

Objective: Data on rheumatoid arthritis (RA) in Kuwait and The Middle East is scarce. Available data from Western countries may not be representative of the region. We describe RA patients in Kuwait and compare them with other RA populations and with Kuwaiti general population.

Methods: Adult RA patients from Kuwait Registry for Rheumatic Diseases (KRRD), the first RA registry in The Middle East, were studied from February 2013 through February 2015. Demographic, clinical and serologic data were compared with other RA populations and with Kuwaiti general population.

Results: 835 patients were enrolled, 62.3% female. Mean age 50.6±12 years and disease duration 6.1±6 years. RA was diagnosed at a mean age of 44.9±12 years. 17.1% had family history of autoimmune rheumatic diseases. 3.1% had rheumatoid nodules. Rheumatoid factor (RF) and anti-citrullinated peptide (ACPA) were detected in 75.6% and 57.8%, respectively. Both were positive in 49% (r=0.287, p=0.001). ANA was positive in 19.1%. Both ACPA and a combination of positive RF and ACPA were more in males (p=0.017, 0.004 respectively), whereas ANA was more in females (p=0.01). One third of male patients were smokers versus 1.9% of females. Smoking was correlated to RF (p=0.009) and ACPA (p=0,002). Difference in ACPA between genders was statistically explained by the predominance of smoking in males. Comorbidities included diabetes mellitus (DM) (20.8%), hypertension (20.2%), hyperlipidemia (10.5%) and coronary artery disease (CAD) (3.1%). 4 cases of cancer were reported.

Conclusion: RA population in Kuwait includes less women than other RA populations but more than Kuwaiti general population. Family history is more common. A higher positive ACPA in males was explained by smoking difference. Hypertension and hyperlipidemia were less reported than in both Kuwaiti general population and other RA populations. CAD was similar to other RA populations. DM was more reported, reflecting its high background prevalence in Kuwait.

Author(s) Details

Dr. Adeeba Al-Herz
Amiri Hospital, Kuwait City, Kuwait.

Adel Al-Awadhi
Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.

Khulood Saleh
Farwania Hospital, Farwaniya Governorate, Kuwait

Waleed Al-Kandari
Farwania Hospital, Farwaniya Governorate, Kuwait.

Eman Hasan
Amiri Hospital, Kuwait City, Kuwait.

Aqeel Ghanem
Mubarak Al-Kabeer Hospital, Hawally Governorate, Kuwait.

Fatemah Abutiban
Jahra Hospital, Jahra Governorate, Kuwait.

Ahmad Alenizi
Jahra Hospital, Jahra Governorate, Kuwait.

Mohammed Hussain
Amiri Hospital, Kuwait City, Kuwait.

Yaser Ali
Mubarak Al-Kabeer Hospital, Hawally Governorate, Kuwait.

Ahmad Khadrawy
Farwania Hospital, Farwaniya Governorate, Kuwait.

Ammad Fazal
Farwania Hospital, Farwaniya Governorate, Kuwait.

Khaled Mokaddem
Amiri Hospital, Kuwait City, Kuwait.

Beena Aftab
Jahra Hospital, Jahra Governorate, Kuwait.

Najaf Haider
Jahra Hospital, Jahra Governorate, Kuwait.

Ajaz Zaman
Mubarak Al-Kabeer Hospital, Hawally Governorate, Kuwait.

Ghada Mazloum
Mubarak Al-Kabeer Hospital, Hawally Governorate, Kuwait.

Youssef Bartella
Amiri Hospital, Kuwait City, Kuwait.

Sally Hamed
Amiri Hospital, Kuwait City, Kuwait.

Ahmed Al-Saber
Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland.

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Self Esteem among Adolescents in Nigerian Secondary Schools: A Neglected Issue | Chapter 06 | Innovations in Medicine and Medical Research Vol. 1

Background: Self esteem among adolescents is a neglected issue in pediatrics, especially in this part of the world. Females ages fourteen to seventeen seemed to have positive self-esteem and so do the males but self esteem is low at middle ages. Females tend to have a low self esteem than males.

Objectives: The objective of this study is to determine the pattern of self esteem among adolescents and associated factors.

Methods: The study was carried out among adolescents attending secondary schools from two cities; (Enugu and Abakiliki located in south eastern part of Nigeria) within age range of 10-19 yr. A structured self administered questionnaire developed from self esteem scores was used for data collection.

Pearson’s chi-square was used to test for relationship between categorical variables while student t- test was used to test significant relationship between continuous variables. Test of significance was set at p<0.5.

Results: The self esteem questionnaire used was classified into two major questions with several sub questions. The first group is about self confidence, self fulfillment and self worth and confidence, the second group include depression, hopelessness, loneliness, and suicidal thoughts. We enrolled 507 adolescents in this study. The mean age of all participants was 16.3 (1.2) yr. Total mean self esteem score for all respondents is 15.77±2.769. Low self esteem was observed in 3.6% of the respondents with 4.3% of females and 2.5% of Males. Low self esteem is mostly seen in older adolescents aged 18-19 (44%) and rare among (adolescents less than 11 yr (0%). Low self esteem was more common among the female respondents in all the age ranges.

Conclusion: Self esteem is high among adolescents, though this is may be overemphasized as more research is needed in this area.

Author(s) Details

Josephat M. Chinawa
Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, Enugu State, Nigeria.

Herbert A. Obu
Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, Enugu State, Nigeria.

Pius C. Manyike
Department of Pediatrics, College of Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.

Ikechukwu E. Obi
Department of Community Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria.

Odetunde O. Isreal
Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku- Ozalla, Enugu State, Nigeria.

Awoere Tamunosiki Chinawa
Department of Community Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria.

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Perception of Early Pregnancy Symptoms among Antenatal Women in Port Harcourt, Southern Nigeria | Chapter 05 | Innovations in Medicine and Medical Research Vol. 1

Background: Early pregnancy symptoms are commonly experienced by most women during pregnancy. While some such as missed periods may serve as an early warning symptom, others may be troublesome, necessitating treatment, and even hospital admission.

Objective: The main objective of this study is to determine the pattern of early pregnancy symptoms among pregnant women in Port Harcourt, Southern Nigeria. Specifically, it would determine the type of symptoms, the period of onset, climax, and when they subside. It would also determine the recurrence rate and the maternal effects in the index pregnancy.  

Materials and Methods: A cross-sectional observational study of 616 booked pregnant women who attended antenatal care at the department of obstetrics and gynaecology, University of Port Harcourt Teaching Hospital, from February 2015 to January 2016. The patients were educated about early pregnancy symptoms, and relevant questions and concerns were addressed.  Verbal consent was obtained from those who agreed to participate; a structured questionnaire was then distributed among the participants, which was filled and data were analyzed. 

Results: The prevalence rate for early pregnancy symptoms was very high 89.6%, the symptoms were commoner among primigravid women 208(33.8%) and they tend to reduce significantly with increasing parity. The recurrent rate among parous women was high 82.6%.

The mean gestational age at onset of symptoms was 4.06 ± 1.64 weeks and by eight weeks, about 87% of the women have developed pregnancy symptoms. The symptoms were perceived to be worse between 5 and eight weeks, with a mean of 7.20 ± 2.15 weeks and they started to subside by 9 – 12 weeks, with a mean of 14.06 ± 3.85 weeks.

Amenorrhoea was the commonest symptom 98.6%, followed by nausea and vomiting 52.3%, then breast pain and heaviness 52.3%, low back pain 45.3% and urinary symptoms 36.4%. Pregnancy symptoms interfered very little with professional and domestic activities, and the hospital admission rate was quite low 8.4%.

Conclusion: Women hardly go through pregnancy without experiencing multiple pregnancy symptoms. The prevalence rate was high, especially among Primigravidas and symptoms tend to be recurrent among multiparous women. Pregnancy symptoms tend to peak around 5 – 8 weeks and begin to subside by 9 -12 weeks.

Author(s) Details

Ikobho Ebenezer Howells
Department of Obstetrics and Gynaecology, Niger Delta University Teaching Hospital, Nigeria.

Isaac Joel Abasi
Department of Obstetrics and Gynaecology, Niger Delta University Teaching Hospital, Nigeria.

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Clinical Epidemiology of Chickenpox in Iraq, 2007-2011 | Chapter 04 | Innovations in Medicine and Medical Research Vol. 1

Chickenpox (Varicella zoster) infection is an acute disease caused by varicella zoster virus (VZV). In endemic areas, primary infection tends to occur at a younger age. The World Health Organization (WHO) recommended that routine childhood varicella vaccination should be considered in countries where the disease is a relatively important public health and socioeconomic problem, and where high (85 to 90%) and sustained vaccine coverage can be achieved.

Aim: 1- To describe the epidemiology (occurrence, age, gender and season) of registered clinical cases of chickenpox in Iraq from 2007-2011, 2- To determine the need for the use of chickenpox vaccine in Iraq.

Methods: A retrospective descriptive analysis of surveillance data. Frequency and percentage were used to describe the data. The occurrence per 100,000 of Iraqi population was calculated. Chi square test was used.

Results: There was an obvious rise in the registration of clinical chickenpox cases from 21,798 case in 2007 to 74, 195 case in 2011. This corresponds to an increase in the occurrence rate of clinical chickenpox cases from 73.41/100,000 in 2007 to 222.61/100, 000 in 2011. There were possible outbreaks in 2008 and 2011. The occurrence of chickenpox showed the same seasonal distribution throughout the years 2007-2011, being highest in spring (April, May) season. The highest registered number of chickenpox cases was in provinces of Ninawa, Baghdad/Russafa, Dihok, Baghdad/Karkh, Al-Basrah and As-Sulaymaniyah. There was a sustained preponderance for the males over females with nearly the same percentage over the years. Most of the cases occurred in those of age 5-14 years (65%), only 1% occur in those >45 years with statistical significance p=0.001.

Conclusions: There is a rising trend in the registration of clinical chickenpox cases. Most cases occur in the age group of less than 15 years. Males are slightly higher than females. The highest frequencies were reported in March, April and May. Most of the cases were registered in Baghdad, Ninawa, Dihok and Al-Basrah.

Author(s) Details

Hanan Abdulghafoor Khaleel
Viral Hepatitis Section, CDCC, Public Health Directorate, MOH, Iraq.

Dr. Hassan Muslem Abdulhussein
Public Health Directorate, MOH, Iraq.

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