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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 4 | Issue 4
Page Nos. 91-135

Online since Friday, October 9, 2020

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REVIEW ARTICLES  

Nonsurgical treatment of oral cavity leukoplakia p. 91
Santosh Kumar Swain, Priyanka Debta
DOI:10.4103/MTSM.MTSM_22_20  
Treatment of the oral cavity leukoplakia, a potentially malignant lesion, is presently not evidenced based. Leukoplakia is a premalignant lesion of the oral cavity which has increased risk for oral cancer. If the leukoplakia is treated in its incipient stage, the chance of occurrence of the oral cancer can be reduced. Although there are several treatment options for leukoplakia, there is no specific and appropriate one for minimizing the malignant transformation of the leukoplakia. Tobacco and prolonged use of alcohol can cause significant risk factors toward origin of the oral cavity leukoplakia. Surgical excision, cryotherapy, and laser excision are the useful modes of the treatment for oral leukoplakia, but the minimizing the risk of the malignant transformation is still doubtful. However, the medical treatment for oral cavity leukoplakia is often attractive particularly to prevent the transformation of the leukoplakia into malignancy. The medical treatment is based on chemoprevention such as Vitamin A and retinoid, carotenoids, tea extract, bleomycin, and Vitamin C have been used although with inconclusive output. The nonsurgical treatment overweighs because of its non-invasiveness, good cosmetic result, well tolerated by the patient without cumulative toxicity and used when the surgery is avoided or contraindicated. In this review article, we will discuss different nonsurgical treatment options for oral cavity leukoplakia.
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The possible role of immunoglobulin A monoclonal antibodies against COVID-19 infection Highly accessed article p. 96
Raghdah Maytham Hameed, Mohanad Kadhim Mirdan Al-Ibraheemi, Falah Hasan Obayes Al-Khikani, Noor Flayyih Hasan, Huda Ali Salman Almosawey, Atyaf Ali Al-Asadi
DOI:10.4103/MTSM.MTSM_27_20  
The coronavirus adheres to the nasal ciliated epithelium and replicates before transporting it to the nasopharynx. Immunopathogenesis and severity of coronavirus disease 2019 (COVID-19) are influenced by viral and immune system factors. COVID-19 infection is capable of producing an excessive immune reaction in the host that called a cytokine storm. The effect is extensive tissue destruction. Detection and monitoring of the immunopathological changes in patients with COVID-19 may provide potential targets for drug development and discovery, besides it is necessary for clinical management. Immunoglobulin A (IgA) is the most abundant antibody class present at mucosal surfaces, including the upper respiratory tract, providing the first line of defense in mucosal immunity at the primary site of virus infection. Secretory IgA neutralizes the virus without causing inflammation because of its inability to fix and activate the complement cascade. Hence, it is suggested that induction of the mucosal immune response is more desirable to prevent respiratory infection to avoid unregulated inflammatory innate responses and impaired adaptive immune responses that may lead to locally and systemically harmful tissue damage. The advantage of IgA for protecting mucosal surfaces, such as the respiratory tract, relates to the presence of a specialized mechanism for transporting oligomeric IgA across epithelial surfaces.
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ORIGINAL ARTICLES Top

Left versus right-sided percutaneous transhepatic biliary drainage in relief of malignant obstruction p. 103
Musaib Ahmad Dar, Naseer Choh, Suhail Rafiq, Feroze Shaheen, Sadaf Ali, Irfan Robbani
DOI:10.4103/MTSM.MTSM_9_20  
Background: Biliary tree obstruction and consequent jaundice occur in 70%–90% of these patients and have important consequences mainly for the patient's quality of life, morbidity, and overall mortality. Percutaneous transhepatic biliary drainage (PTBD) is an excellent palliative procedure to drain the bile ducts in malignant obstruction. We compared left- and right-sided approach in relief of malignant obstruction. The most common causes of malignant biliary obstruction (MBO) include pancreatic adenocarcinoma, hilar cholangiocarcinoma, ampullary/duodenal adenocarcinoma, gallbladder adenocarcinoma, lymphoma, and compressive metastatic peri-portal lymph node Materials and Methods: This study was a prospective, hospital-based study performed for 2 years from 2016 to 2018. PTBD was performed either through right in 16 patients or left approach in 15 patients. Two approaches were compared in terms of clinical and technological success, changes in laboratory data, internalization and survival. Results: (1) Rate of technological success was 100%. (2) There was a significant reduction in bilirubin, alanine transaminase (ALT), and alkaline phosphatase (ALP) levels after the procedure in both the approaches, but the decrease was more in the right-sided approach. Only the decrease in bilirubin levels was statistically significant. The decrease in albumin was attributed to the progression of the disease. (3) Clinical success was seen in 93.33% and 93.75% in left- and right-sided approach. (4) Internalization was done in 86.67% patients in the left-lobe approach, while as in right-lobe approach, it was done in 93.75% patients. Conclusion: PTBD causes a significant reduction in the bilirubin level, irrespective of the amount of liver drained or the type of drainage (external/internal). In our study, the reduction in bilirubin, ALT and ALP was more in the right-lobe approach. However, only reductions in levels of bilirubin were statistically significant.
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Trends in antibiotic resistance of major uropathogens p. 108
Falah Hasan Obayes AL-Khikani
DOI:10.4103/MTSM.MTSM_24_20  
Background: Around the world, there is no population clear from urinary tract infection (UTI), particularly among women. UTI is considered the most predominant bacterial infection. This study aimed to detect the incidence of the most common major uropathogens in patients severe from UTI with antibiotic-sensitivity tests that assist urologist doctors for appropriate antimicrobial empirical therapy. Materials and Methods: This study was carried in a private laboratory in Babil city, Iraq, from May 2019 to May 2020. A total of 70 individuals suffering from the clear symptoms of UTI, as well as, 20 healthy persons participated in this study as a control group. Then, the standard microbiological methods carried out to isolate and identify the the bacterial species. Antimicrobial-susceptibility tests were performed using different antimicrobial discs by applying the Kirby–Bauer disc-diffusion method. Results: Totally, 90 specimens were obtained from them 20 control group, 19 with no growth, and 51 patients with bacterial growth distributed as 43 (83%) females and 8 (17%) males. Escherichia coli were the most common predominant organisms. All isolates were showed a high rate of resistance to evaluated cephalosporins 100% and 82% to cefotaxime and ceftriaxone, respectively, while very low resistance recorded in aminoglycosides 20% and 13% to Gentamicin and amikacin, respectively. Most age group infected with UTI was 21–40 year-old. Conclusion: The current study showed an increasing burden of UTI caused by various bacteria implicated in UTI that causes changeable sensitivity to various antimicrobial agents. Therefore, in clinical use appropriate medications should be selected based on the data obtained from antimicrobial-susceptibility tests.
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Effects of montelukast versus inhaled beclomethasone on asthma control and immunoglobulin-E levels in asthmatic children p. 112
Afrah A A. Hasan, Zuhair M Al-Musawi, Haidar A N. Abood, Raghdah Maytham Hameed
DOI:10.4103/MTSM.MTSM_26_20  
Background: Beclomethasone dipropionate inhaler is a corticosteroid medication used as the controller of persistent asthma. Montelukast is a leukotriene receptor antagonist used as the second-line in controlling the symptoms of the asthmatic child. Objective: The objective of this study is to determine the comparison between the effects of beclomethasone dipropionate inhaler and montelukast on the total serum level of immunoglobulin E (IgE) and childhood asthma control test (C-ACT) in asthmatic children. Patients and Methods: A randomized clinical trial was done in Kerbala Teaching Hospital of pediatric from August 2014 to the end of October 2015, 97 patients were collected from asthma outpatient clinic aged 4 to 11 years with mild persistent asthma and randomly divided into beclomethasone group (51 patients) and montelukast group (46 patients), the total serum IgE was done before the initiation of treatment, and another reading was done after 3 months. The score of symptoms control was evaluated by C-ACT after 1 month of treatment, and another evaluation was done 2 months later. Results: There was a significant reduction in total serum IgE level (21% for montelukast group and 27% for beclomethasone group) after 3 months of treatment compared to baseline IgE, and there was significant improvement in childhood C-ACT scores (16% for montelukast group and 24% for beclomethasone group) after 3 months of treatment compared to the 1st month of treatment. There was a significant improvement in the beclomethasone group compared to the montelukast group after 3 months of treatment. Conclusions: Both beclomethasone and montelukast are effective controllers for asthma symptoms and reducing the total serum IgE level. Beclomethasone is better than montelukast in improving C-ACT scores.
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Adherence of health-care providers to hypertension management guidelines in Khartoum, Sudan, 2020 p. 116
Ali Awadallah Saeed, Lamees Abdelrhman, Lamiaa Saad, Marah Omran, Inas Osman
DOI:10.4103/MTSM.MTSM_33_20  
Introduction: Hypertension has the highest prevalence among the major non-communicable diseases in Sudan (prevalence 27.6%) due to high amount of salt intake in foods, lack of exercise, obesity, stress, smoking, and increase in age. Different guidelines have been proposed from time to time to increase the number of patients with controlled blood pressure. It is a well-established fact that poor disease control is largely related to the poor patient compliance to medical advice and medications. However, the other important aspect of the same problem is the physician's adherence to evidence-based management of hypertension, but, unfortunately, this has not been studied adequately. Objective: The objective is to investigate adherence practices of health care providers to the use of clinical practice guidelines in Khartoum, Sudan. Materials and Methods: An observational cross-sectional study was carried out from February to April 2020 among health-care providers which include prescribing doctors and community pharmacists in Khartoum locality. Data were collected using electronic delivery validated questionnaire. Results: A total of 200 health-care professionals (HCPs) voluntary participated, 51% were pharmacists, while 49% were prescribing doctors. As overall 86.125% of participated health-care provider aware about hypertension as a health problem as a mean of their correct responses. In the area of measurement and management of a new case of hypertension, the mean of the responses (mean of correct answers) which follow guidelines was 55.75%. In the area of selection of anti-hypertensive treatment in comorbid conditions the mean responses of correct responses was 58.88%. Conclusions: Our study observed that the majority of HCP adhere to guidelines for hypertension in Khartoum locality. The study showed a lack of knowledge among HCPs in managing hypertension in patients with the comorbid condition.
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CASE REPORTS Top

Monitoring and epidemiological trends of coronavirus disease (COVID-19) around the world p. 121
Arnab Saha, Komal Gupta, Manti Patil, Urvashi
DOI:10.4103/MTSM.MTSM_16_20  
Coronavirus disease 2019 (COVID-19) has struck fear into populaces all through the world and shocked the worldwide restorative community, with the World Health Organization pronouncing it a widespread as it were approximately 3 months after the flare-up of the infection. A new different virus (primarily called “novel coronavirus 2019 [nCoV]”) causing severe acute respiratory syndrome (COVID-19) emerged in Wuhan, Hubei Province, China, in December 2019 and rapidly spread to other parts of China and other countries around the world. The outbreak of the nCoV disease (COVID-19) has caused more than 850,000 people infected and approx. 40,000 of deaths in more than 190 countries up to March 2020, extremely affecting economic and social development. Presently, the number of infections and deaths is still increasing rapidly. COVID-19 seriously threatens human health, production, life, social functioning, and international relations. In the fight against COVID-19, geographic information systems (GIS) and big data technologies have played an important role in many aspects. This article describes the usage of practical GIS and mapping dashboards and applications for monitoring the coronavirus epidemic and related activities as they spread around the world. At the fact level, in the generation of massive data, information no longer come on the whole from the authorities but are gathered from greater diverse enterprises. As of now and for a long time in future, the improvement of GIS should be fortified to create a data-driven framework for fast information securing, which implies that GIS ought to be utilized to fortify the social operation parameterization of models and methods, particularly when giving back for social administration.
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Myomectomy of incision site uterine fibroid during cesarean section p. 127
Rabia Khurshid, Saima Wani, Sheema Posh, Abida Ahmad
DOI:10.4103/MTSM.MTSM_25_20  
Myomectomy is the most common surgery with cesarean section. There is a controversy between obstetricians about doing myomectomy with cesarean section. A 29-year-old primigravida patient presented with a massive lower segment myoma, who underwent myomectomy during cesarean section at term pregnancy. She did not have intraoperative hemorrhage or any postpartum complications. There seems to be no absolute contraindication for myomectomy during cesarean section especially if the surgeon has enough experience even if the myoma is large, located at the lower segment.
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SHORT COMMUNICATIONS Top

Coronavirus disease-2019 infection among health-care professionals: predisposing factors and preventive strategies p. 130
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MTSM.MTSM_13_20  
The Corona Virus Disease-2019 (COVID-19) infection has been reported among all, regardless of their region, nation, ethnicity, religion, age-group, gender, socioeconomic class and work profile. Against this novel viral infection, the health care workers are the only group of professionals who are working right from the day one, when the first case was reported and nothing was known about the infection. It is extremely important to protect health care professionals from infection both in the hospital and community settings. A wide range of factors has been attributed to the acquisition of infection among health workers in hospital settings. In conclusion, the role of health care professionals in the containment of the COVID-19 pandemic is of utmost importance and thus it is crucial to get more epidemiological insights about the infection and thus ensure their safety and well-being in the workplace.
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Coronavirus disease-2019 pandemic: Tracing the source of viral infection and minimizing the possibility of reintroduction of virus in human population p. 132
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MTSM.MTSM_15_20  
The Corona Virus Disease-2019 (COVID-19) outbreak has overwhelmed the public health authorities and the health care delivery system of multiple nations. The ongoing pandemic is caused by one of the viruses - SARS-CoV-2, belonging to the coronaviruses family. The genetic sequence of the isolated virus was similar among all the initial patients from Wuhan, which clearly indicate that the outbreak began from a single point introduction among the humans. At present, it is critical to understand about the origin of the virus, as it is a novel viral infection. These findings will aid us in getting significant insights about the start of the outbreak or the origin of the virus and thus we will be able to mount a better public health emergency response. In conclusion, in order to contain the COVID-19 pandemic, it is vital to identify the source of the virus and then take appropriate prevention and control measures, otherwise there is always a potential risk of reintroduction of the virus in the future once again and then once again we might be facing the challenge of containing the outbreak.
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Significance of surveillance in COVID-19 pandemic and adoption of innovative strategies for its strengthening p. 134
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MTSM.MTSM_19_20  
The Corona Virus Disease 2019 (COVID-19) pandemic has spread rapidly across the globe and has impacted each and every community directly or indirectly. Amidst the various components which require strengthening for the successful containment, surveillance is a critical aspect and it significantly aids in reducing the spread of the infection by empowering the public health authorities with the right information. Acknowledging the importance of surveillance, the need of the hour is to strengthen surveillance through adoption of digital technologies which aid in the rapid reporting & data analysis, and even expand in regions with lesser number of cases. In conclusion, surveillance is an integral component of the preparedness and emergency response against the COVID-19 pandemic. It is the need of the hour to adopt innovative strategies to ensure that surveillance is strengthened and we succeed in obtaining comprehensive information about the disease and its spread in the community.
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