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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 4 | Issue 1
Page Nos. 1-42

Online since Thursday, March 12, 2020

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EDITORIAL  

A novel coronavirus (2019-nCoV): What do we know so far? Highly accessed article p. 1
Ibrahim A Taher, Amany A Ghazy
DOI:10.4103/2588-9044.280562  
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VIEW POINT Top

Feedback in medical education: Changing concepts p. 3
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/LJMS.LJMS_58_19  
Feedback has been regarded as one of the most essential and integral components of medical education and other training programs. It aids the students to optimize their potential during different stages of training by giving them an insight about their strengths and also the areas which requires improvement. It is important to understand that giving feedback has to be a two-way communication, wherein the involved stakeholders discuss together and eventually develop an action plan for expediting the professional growth. In the current era of medical education, the feedback is actually considered as not only the process of identifying faults, but also the identification of the positive attributes of the students. In conclusion, feedback in medical education plays a defining role in shaping the career of a medical student and also enriches the curriculum by periodic reforms. The need of the hour is to encourage feedback from all stakeholders regarding different aspects of teaching-learning and take remedial measures for the improvement.
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COMMENTARY Top

Defeating cancer pain while fighting without pain: A brief guide p. 5
Edoardo Arcuri, Patrizia Ginobbi, Walter Tirelli
DOI:10.4103/2588-9044.280563  
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REVIEW ARTICLE Top

Vaccination of healthcare workers in Nigeria: A review of barriers, policies and level of implementation p. 9
Olorunfemi Akinbode Ogundele, Ayodeji Andrew Omotosho
DOI:10.4103/LJMS.LJMS_4_20  
Health-care workers (HCWs) constitute a high-risk group frequently exposed to workplace hazards from contacts with infected body fluids. The World Health Organization recommends that high-risk groups, which include HCWs, be vaccinated against vaccine-preventable diseases considering their exposure risks. This review provides insight into vaccination coverage rates and barriers of vaccination of HCWs against vaccine-preventable diseases, especially hepatitis B virus (HBV) vaccination currently in place in Nigeria and provides recommendations for policy creation. A narrative review of peer-reviewed published original research, reports, and reviews was done after identifying relevant literature using Goggle Scholar as the major search engine. Peer-reviewed articles in databases such as PubMed, Medline, African Journals Online, and Google Scholar were reviewed. Nigeria, like many other countries in sub-Sahara Africa, has no clear policy on vaccination of HCWs against vaccine-preventable diseases; this constitutes a significant challenge that contributes to poor uptake of vaccination by HCWs. HBV is a major occupational health hazard that HCWs face in the course of their work. HCWs, in Nigeria, are at increased risk of hepatitis B infection because Nigeria is a holoendemic area. Lack of vaccination policy for HCWs, poor risk perception, cost of the vaccine, and unavailability of vaccine are some of the major barriers to vaccine uptake and coverage among HCWs. There is a need to create and appropriately implement policies explicitly meant for HCWs vaccination. Model program options that can be adopted across health institutions at an affordable cost are recommended.
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ORIGINAL ARTICLES Top

Acute myocardial infarction in libyan patients below 45 years of age: Prevalence and risk factors Highly accessed article p. 16
Naser El Sanousi Younis, Ragab B Roaeid, Mohamed Ali Ibrahim Hamedh, Abdulhamid A Kablan
DOI:10.4103/LJMS.LJMS_14_19  
Background and Aims: Acute myocardial infarction (AMI) below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. The aim of the study was to assess the frequency and risk factors of AMI in patient's ≤45 years of age.Patients and Methods: A cross-sectional retrospective study was conducted involving 187 patients with clinical diagnosis of AMI. They were studied for risk factors, clinical characteristics, coronary angiographic finding and in-hospital outcome during January 2015 and December 2015 at Benghazi medical center, Benghazi - Libya. Results: Out of total 187 AMI patients studied, there were 41 (22%) young patient ≤45 years of age. Risk factors was studied, smoking was found in 63.4% of young patients, 44% were had history of dyslipidemia, 14% had history of alcohol drinking and 12% had family history of coronary artery disease. In young AMI patients, anterior wall STEMI was the most common site and single vessel disease was the most common finding in coronary angiography. However, 13% of patients have normal or non-obstructive coronary lesions. Arrhythmia (24%) and heart failure (17%).Conclusion: In our young AMI patients, smoking was the single most important modifiable risk factor, other conventional risk factors are less strongly associated than older patients. Our young patients tend to have less extensive coronary artery lesions. The presence of normal or non-obstructive coronary lesions would suggest possibility of different mechanism of myocardial necrosis.
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Corrected estimated glomerular filtration rate is a predictor for survival in multiple myeloma patients p. 21
Elmukhtar Habas, Abdulatif Khamaj, Amnna Rayani, Afaf Aboshala, Ismail Siala, Mohamed Tabib, Ala Habas, Kalifa Farfar, Islam A Elzouki
DOI:10.4103/LJMS.LJMS_8_20  
Background/Aim: Kidneys' involvement in multiple myeloma (MM) adversely affects the prognosis. The aim of this study is to assess the relationship between corrected estimated glomerular filtration rate (corrected eGFR) and patients' survival during the first 1 year of follow-up. Methods: Thirty-eight patients with MM and renal impairment followed up from 2013 to 2014 were enrolled in this study. Data were collected and analyzed. Paired t-test and one-way ANOVA were used to compare means at presentation, after 6 months, and at 1 year. Results: There were 20 female (52.6%) and 18 male patients (47.4%) at presentation, aged between 43 and 92 years; their mean weight was 61.3 ± 1.9 kg, and mean body surface area was 1.53 ± 0.04 m2. The mean of blood urea, serum creatinine, and corrected eGFR at presentation was 65.5 ± 7.4 mg/dl, 2 ± 0.41 mg/dl, and 40.6 ± 4.5 ml/min/1.73 m2, respectively. After 6 months, only twenty patients were still alive (i.e., 13 females and 7 males, aged 68.2 ± 2 years), and their mean corrected eGFR was 67.8 ± 29.1 ml/min/1.73 m2. After 1 year, only nine patients (i.e., six females and three males) were alive and continued in follow-up; their mean corrected eGFR was 96.7 ± 10.3 ml/min/1.73 m2. Corrected eGFR mean was statistically significantly lower at presentation than that after 6 months (P = 0.002), whereas during 6 months, the mean corrected eGFR was statistically significantly lower than that after 1 year (P = 0.014), and patients lived a year of follow up, corrected eGFR was higher than at presentation (P = 0.003). The correlation between corrected eGFR and patients' survival at 6 months and 12 months showed that the lower the corrected eGFR, the higher the rate of patient death (P = 0.0001). Conclusion: Corrected eGFR is a good indicator for survival in renal impairment in MM patients during the 1st year of diagnosis.
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Exploring the ready knowledge of drug prescribing among junior doctors in Libya p. 25
Ahmed Atia, Sabrin Zanned, Nafisah Bakait
DOI:10.4103/LJMS.LJMS_52_19  
Background: Essential drug knowledge is a ready knowledge of frequently prescribed drugs acquired by the clinician for the rational prescription. The present study was undertaken with the aims of assessing the knowledge of Libyan junior doctors about commonly prescribed drugs that necessary for rational prescribing and to determine the level of their ready knowledge. Methods: A questionnaire was distributed to 162 junior doctors employed at primary health centers in the city of Tripoli, Libya, and were requested to answer questions about rational prescribing of three commonly prescribed drugs (bisoprolol, pseudoephedrine, and co-amoxiclav). All items were categorized into six sets of core knowledge: drug class, indications, method of administration, contraindication, interaction, and adverse effects. The knowledge level to which junior doctors answer these statements was examined with a face-to-face assessment. Results: A number of 19 statements per drug were considered to be ready knowledge important for rational prescribing. Overall, knowledge about “drug class” (74.5%) and “Methods of administration (86.4%)” comprise most of the essential ready knowledge. Items concerning “interactions” (23.8%) and “contra-indication” (36.1%) were little acknowledged. Conclusion: Junior doctors' ready knowledge, in our population sample, seems to be insufficient to good prescribing. Our findings could be used in measuring the prescribing skills of future junior doctors in Libya.
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CASE REPORTS Top

Minimally invasive percutaneous C1–C2 transarticular screw fixation as a palliative management option in C2 metastases p. 29
Michael Craig, Shawn Kroetsch, Dana El-Mughayyar, Najmedden Attabib
DOI:10.4103/LJMS.LJMS_49_19  
Bone metastasis in patients with esophageal carcinoma is rare but serious, often resulting in structural complications of the spine such as atlantoaxial instability and C2 metastases. Atlantoaxial instability is usually managed surgically using screw-rod constructs; however, in patients undergoing radiotherapy, surgical wound healing is a concern. We present a technical note involving a terminally ill patient diagnosed with esophageal carcinoma who suffered from a metastatic lytic lesion of C2 and mechanical neck pain. Due to the patient starting palliative radiotherapy, a percutaneous approach and transarticular screws were used to achieve atlantoaxial fixation and minimize the surgical wound while maintaining the midline tension band. Significant clinical improvement was found. Our patient was able to begin palliative radiotherapy within 1 week of surgery, without surgical and wound complications. This report provides unique insight into the utilization of a minimally invasive approach for pain management and stabilization of the cervical spine for oncology patients.
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Postendoscopic variceal sclerotherapy campylobacter jejuni bacteremia p. 32
Deema Hussam Al Soub, Mashuk Uddin, Nadia Karim Bakhsh
DOI:10.4103/LJMS.LJMS_70_19  
Campylobacter jejuni bacteremia is rare. We herein report a case of C. jejuni bacteremia in a patient with multiple risk factors, including diabetes mellitus, liver cirrhosis, and hepatocellular carcinoma. The presentation was nonspecific. Diagnosis was made only after positive blood culture which took 5 days. The organism was resistant to several antibiotics; however, treatment with azithromycin was associated with successful outcome.
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Diagnosis of neuroschistosomiasis: How to overcome this challenge p. 35
Ijaz Kamal, Ahmed Abdallah, Madeha Khalid, Ahmedelmustafa Musa, Abdel Naser Elzouki
DOI:10.4103/LJMS.LJMS_66_19  
We report the case of a 25-year-old female from the Philippines who presents with seizure and left-sided body weakness. Initial magnetic resonance imaging showed cortical mass lesion suggestive of tumor or neuroschistosomiasis based on her ethnicity. This study aimed to confirm the diagnosis which can be done with direct brain biopsy which is associated with complications and rule out other causes such as tumor. The identification of schistosome eggs in a stool or urine sample is the gold standard for the diagnosis of schistosomiasis. However, the alternative model for the diagnosis of neuroschistosomiasis requires the detection of infection at an extraneural site which is suitable for biopsy together with laboratory and imaging evidence. This approach will help to avoid direct brain biopsy and its associated complications.
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Reno-caval fistula – a rare cause of secondary hypertension and heart failure: A case report and review of the literature p. 38
Abdulhak A Sadalla, Mohamed A Elrishi
DOI:10.4103/LJMS.LJMS_3_20  
A 15-year boy presented with features of high-output heart failure. He was managed successfully with heart failure treatment for 1 year, and then, he sustained refractory hypertension. A reno-caval fistula was discovered which is caused by previous bullet injury. His hypertension was cured by nephrectomy.
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LETTER TO EDITOR Top

Dural arteriovenous fistula classifications: An overview p. 41
Jamir Pitton Rissardo, Ana Leticia Fornari Caprara
DOI:10.4103/LJMS.LJMS_74_19  
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