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   Table of Contents - Current issue
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April-June 2022
Volume 6 | Issue 2
Page Nos. 29-64

Online since Tuesday, April 12, 2022

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REVIEW ARTICLE  

Vascular loop of anterior inferior cerebellar artery causing disabling tinnitus, vertigo, and hearing loss - A review p. 29
Santosh Kumar Swain
DOI:10.4103/mtsm.mtsm_21_21  
The vascular anatomy of the anterior inferior cerebellar artery (AICA) is highly variable. In respect to the neurovascular relationship in the internal auditory canal (IAC), the AICA is intimately related with vestibulocochlear and facial nerve. Vascular loop of AICA, especially located in the IAC, is rare. This vascular loop of the IAC may result in the compression over the vestibulocochlear nerve. Microvascular compression of the eighth cranial nerve is an important cause for disabling tinnitus, vertigo, and hearing loss. Disabling tinnitus and vertigo due to intrameatal vascular loop of AICA compression, the vestibulocochlear nerve can be treated with help of drilling the internal acoustic meatus and separate the vascular loop from the vestibulocochlear nerve. The intrameatal AICA and vestibulocochlear nerve conflict produce specific pathological features and their surgical treatment is also invariably challenging. Decompression of the vestibulocochlear nerve by the opening of the IAC and transposition of the AICA is thought to be an effective treatment modality for radiologically confirmed cases with clinical presentations of unilateral sensorineural hearing loss and pulsatile tinnitus. The aim of this review article is to describe the details of vascular anatomy, etiopathology, clinical presentations, diagnosis, neurophysiology, and current treatment of the vascular loop of AICA in IAC which often pose challenge to the clinicians.
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ORIGINAL ARTICLES Top

Community pharmacists' knowledge and practice toward upper respiratory tract infections in Khartoum State: A cross-sectional survey p. 34
Mohammed A Aldomah, Yousif A Ahmed, Ahmed Y Ezaldeen, Musaab A Aldomah, Rana A Nasir, Muhammad A Abdulraheem, Bashir Alsiddig Yousef, Safaa Badi
DOI:10.4103/mtsm.mtsm_55_20  
Background: Upper respiratory tract infections (URTIs) are mainly viral in their etiologies but sometimes are complicated by secondary bacterial infections detected by the persistence of symptoms. This study aimed to evaluate community pharmacist's knowledge and practice regarding URTIs. Methods: A descriptive cross-sectional study was performed using self-administered questionnaire. The study targeted 338 community pharmacists selected randomly from community pharmacies in Khartoum state. The overall knowledge and practice scores were calculated, then the associations between these scores and demographic characteristics were evaluated using Chi-square test and analyzed by statistical package for social sciences. Results: Out of 327 pharmacists, 65.4% of them were females. Whereas pharmacists with B. Pharm. represented 79.1%. Regarding the knowledge, it was found that 59.7% of community pharmacists have sufficient knowledge toward URTIs, while 40.3% of them have insufficient knowledge. Community pharmacists exhibited varying degrees of practice, but most of them have a good practice. Furthermore, 52.6% of them reported patient's interest as barrier to counseling, while 38.9% reported pharmacy crowdedness as a barrier. Statistically, higher knowledge scores are associated mainly with female gender and educational levels. On the another hand, 64.4% of the participants relied on medical websites as a source of information. Conclusion: Community pharmacists have good knowledge about URTIs. The practice is diverse, but good practice is mainly linked to those with sufficient knowledge. Most of the community pharmacists relied on medical websites as a source of information.
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Social support and quality of life in cancer patients: A study of palliative shelters in West Java p. 40
Laili Rahayuwati, Tuti Pahria, Kusman Ibrahim, Ikeu Nurhidayah, Habsyah Saparidah Agustina
DOI:10.4103/mtsm.mtsm_58_20  
Background: The risk of lifestyle and environment will lead to an increase in cancer prevalence. Therefore, it needs managing support for palliative cancer patients. The purpose of the study was to obtain the correlation between social support characteristics and cancer patients' quality of life. Method: This research using a cross-sectional approach was conducted in several palliative shelters. Samples were 93 respondents, obtained using a quota sampling technique. The variables used were social support (family, friends, and others) and the cancer patient's quality of life. Result: The results showed that social support received at a high level was most obtained from the family as many as 65 respondents (69.9%). Furthermore, the social support factor of cancer patients related to the quality of life was friends' support (p-value <0.05), while other factors were considered irrelevant. The collecting data technique was used due to the dynamics of patients seeking treatment at the West Java provincial referral hospital. Conclusion: the friend's support is significant for improving the quality of life of cancer patients. Peer groups are an essential component in managing health care in the community.
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Assessment of risk factors and management of ischemic stroke at Ibrahim Malik Teaching Hospital in Khartoum, 2018 p. 48
Ayat A Mohammed, Ahmed H Arbab, T Mohammed T. Abdalla
DOI:10.4103/mtsm.mtsm_2_21  
Context: Ischemic stroke is an acute medical condition with life-threatening complications; therefore, understanding its common risk factors, early management, prevention from recurrent attack, and in our population is necessary. Aim: The aim of this study is to assess common risk factors and management of ischemic stroke at Ibrahim Malik Teaching Hospital (Khartoum, Sudan). Methodology: A retrospective, hospital-based study was conducted at Ibrahim Malik Teaching Hospital Khartoum State. The study included all medical records of patients hospitalized with Ischemic stroke from January 2017 to January 2018. The data were collected using a well-designed data collection form and analyzed with SPSS. Results: Out of 116 participants, ischemic stroke was more frequent in males (59.5%), adults over 65 years (57.8%). Forty-four percent of participants had a history of hypertension. Smoking and family history with ischemic stroke were observed only in 10.3% and 5.2% of participants, respectively. Aspirin (100–300) mg plus atorvastatin 40 mg were the most prescribed regimen of 44.8%. The highest type of drug-drug interaction reported was monitor closely (41.4%) and serious (33.6) type drug-drug interactions. While 74.1% of participants were discharged, the rate of death was significantly higher in females and participants over 65 years' age. Conclusions: Past medical history of hypertension and elderly age were the major risk factors with ischemic stroke. Aspirin plus statin therapy is the most frequently used regimen with nonadherence to the guidelines regarding the use of thrombolytic therapy and anticoagulants. Serious type drug-drug interactions were detected among prescribed medications.
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Spectrum of neurological complications of pregnancy on magnetic resonance imaging p. 53
Sheema Ahmad Posh, Suhail Rafiq, Beenish Jeelani, Saima Wani
DOI:10.4103/mtsm.mtsm_9_21  
Introduction: Catastrophic neurological decline, although exceedingly rare, takes a huge toll on pregnant population. In view of varied symptomatology and risks to the fetus, diagnosis and management of the neurological disorders in pregnancy is always a challenging task. The evaluation and management should be performed in a stepwise fashion and requires a multidisciplinary approach. Radiological imaging, especially magnetic resonance imaging (MRI), has revolutionized the diagnosis of these disorders, thereby exacerbating maternal and fetal outcome. Aim: The present study was conducted with the aim to characterize some of the significant neurological disorders complicating pregnancy and puerperium and to study the role of imaging, especially MRI, in differentiation and exclusion of various neurologic conditions, which helps an obstetrician to point to a specific diagnosis and management. Materials and Methods: Our study was an observational study conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Radiodiagnosis of GMC, Srinagar, from June 2018 to January 2020. The images were obtained with MRI and subjected for radiological interpretation. Results: A total of 750 patients were included in the study out of which 25 patients had neurological complications. Out of 25 patients, 13 were in the antenatal period and 12 were in the puerperium. There were 10 (40.0%) cases of posterior reversible encephalopathy syndrome (PRES), 6 (24%) cases of cerebral venous thrombosis (CVT), 3 (12.0%) cases of embolic infarcts, 2 (8.0%) cases of status epilepticus, 2 (8.0%) cases of pituitary apoplexy, 1 (4.0%) case of Wernicke encephalopathy, and 1 (4.0%) case of metastasis to brain (choriocarcinoma). Conclusion: Diagnosis of neurological complications of pregnancy and postpartum plays a crucial role in reducing fetomaternal morbidity and mortality. MRI stands above all imaging modalities in early diagnosis of these neurological complications, simultaneously taking care of fetal safety as well. The most common neurological complications that cause increased maternal mortality are PRES and CVT. Hence, early imaging can help in early and appropriate management of serious pregnancy-related neurological catastrophes.
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Otological manifestations in oral submucous fibrosis: Our experiences p. 60
Santosh Kumar Swain, Rohit Agrawala
DOI:10.4103/mtsm.mtsm_18_21  
Background: Oral submucous fibrosis (OSMF) is a chronic premalignant condition seen in the oral cavity, but sometimes extends to the pharynx, esophagus, or even the larynx. OSMF causes stiffness in the oral cavity leads to trismus and affects speech and swallowing. Sometimes this lesion affects the Eustachian tube opening at the nasopharynx which results in Eustachian tube dysfunction followed by middle ear diseases. The purpose of the present work is to evaluate otological manifestations in OSMF patients. Materials and Methods: Patients with OSMF were evaluated for otological manifestations such as hearing impairment and fullness in the ear. All of them were evaluated with pure tone audiometry and tympanometry. Results: In this study group of 58 patients of OSMF comprising 116 ears, the hearing was within the normal limit in 60 ears (51.72%), a mild degree of conductive deafness in 52 ears (44.82%), a mild degree of sensorineural deafness in 2 ears (1.72%) and a moderate degree of sensorineural deafness were present in 2 ears (1.72%). There is a significant difference in mean quantitative hearing impairment was seen in OSMF groups C and group D with respect to the control group. Conclusion: Involvements of palatal muscles in OSMF patients reduce the patency of the Eustachian tube, resulting in a conductive type of deafness. OSMF patients should be assessed for hearing impairment and suggested for proper management.
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