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  1. Atif M, Sulaiman SA, Shafie AA, Saleem F, Ahmad N
    Pan Afr Med J, 2012;12:40.
    PMID: 22891098
    Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure.
  2. Burud IAS, Alsagoff SMI, Ganesin R, Selvam ST, Zakaria NAB, Tata MD
    Pan Afr Med J, 2020;36:45.
    PMID: 32774621 DOI: 10.11604/pamj.2020.36.45.21824
    Introduction: Testicular torsion is a surgical emergency that is caused by twisting of the spermatic cord and its content. This condition causes irreversible changes after 6 hours. Early recognition and management of testicular torsion is important for testicular salvage and preservation of fertility.

    Methods: This is a retrospective study done on all patients who presented with acute scrotal pain from January 2013 to December 2017. The data collected included the patient's age, symptoms, the time duration between the onset, ultrasound, and surgery, ultrasound findings with Doppler and the surgical intervention. Statistical analysis was performed using SPSS 25.0. Data are presented as mean (SD) values. Differences between groups and predictive values were calculated using Chi-square, t-test and Mann-Whitney U-test and are expressed by value with 95% CI.

    Results: The total number of patients who presented with acute scrotal pain were 88. Testicular torsion was diagnosed in 55 (62.50%) of the patients, 17 (19.32%) had epididymis-orchitis, 5 (5.68%) had torsion of appendage/cyst, and 11 (12.50%) had normal testis. Ultrasound has a sensitivity and specificity of 88.24% and 68.40% respectively. It is a good tool to detect testicular torsion but it is operator dependent. Positive predictive value was 83.33% and negative predictive value was 76.47%. When ultrasound is combined with clinical findings the rate of negative exploration is reduced by 10%.

    Conclusion: Good medical history, appropriate clinical evaluation and performing an ultrasound of the scrotum are important in testicular torsion. US evaluation in cases presented after 24 hours does not change the outcome.

  3. Burud I, Ikram MA, Tata MD, Jaafar J
    Pan Afr Med J, 2020;36:16.
    PMID: 32774593 DOI: 10.11604/pamj.2020.36.16.20697
    Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed Mycobacterium tuberculosis. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.
  4. Hashim M, Tizen NMS, Alfian N, Hashim H, Nawi AM, Pauzi SHM
    Pan Afr Med J, 2021;38:200.
    PMID: 33995806 DOI: 10.11604/pamj.2021.38.200.19978
    Introduction: endometrial carcinoma (EC) is the seventh most common cancer in females in Malaysia, of which the majority is composed of lower grade type I EC. Although less prevalent, type II EC which is of higher grade has poorer outcome and prognosis. Human epidermal growth factor receptor 2 (HER2) is one of the possible prognostic molecular markers which can be a target for immunotherapy. This study aimed to assess the expression of HER2 in common type of EC in the local population and to determine its correlation with the clinicopathological features.

    Methods: a total of 53 cases of endometrioid type of EC were selected within a six-year period comprising of 22 cases of grade 1, 25 cases of grade 2 and six cases of grade 3 carcinoma. The selected whole tumour tissue sections were immune-stained with HER2 antibody. The scoring was semi-quantitatively analyzed based on 2013 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAPs) guidelines for the scoring of HER2 in breast cancer.

    Results: all cases regardless of grades of endometrioid carcinoma showed negative expression of HER2 (score 0).

    Conclusion: there was no significant HER2 expression in endometrioid carcinoma. However, a follow-up study with a larger number of samples from different type of endometrial carcinoma is needed. Testing of several tumour tissue blocks to assess possible tumour heterogeneity, as well as correlation with HER2 gene amplification status by in-situ-hybridisation, are also recommended.

  5. Gan DEY, Alagoo D, Chan KH, Choi RXY, Sellappan H, Sharif MS, et al.
    Pan Afr Med J, 2021;38:398.
    PMID: 34381542 DOI: 10.11604/pamj.2021.38.398.29228
    Situs inversus totalis is the complete transpositioning of thoracoabdominal viscera into a mirror image of the normal configuration. Choledochal cyst is the congenital cystic dilation of the biliary tract. Both these conditions coexisting in a patient is extremely rare. We hereby present a case of type IC choledochal cyst in a patient with situs inversus totalis presenting with biliary sepsis secondary to choledocholithiasis. Also detailed are the management and operative strategies employed to deal with this rare entity.
  6. Alagoo D, Sellappan H, Jayasilan J, Azizan N, Hayati F
    Pan Afr Med J, 2021;39:141.
    PMID: 34527157 DOI: 10.11604/pamj.2021.39.141.29895
    Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.
  7. Essiet IA, Baharom A, Shahar HK, Uzochukwu B
    Pan Afr Med J, 2017;26:110.
    PMID: 28533833 DOI: 10.11604/pamj.2017.26.110.10409
    INTRODUCTION: Physical activity among university students is a catalyst for habitual physical activity in adulthood. Physical activity has many health benefits besides the improvement in academic performance. The present study assessed the predictors of physical activity among Nigerian university students using the Social Ecological Model (SEM).

    METHODS: This cross-sectional study recruited first-year undergraduate students in the University of Uyo, Nigeria by multistage sampling. The International Physical Activity Questionnaire (IPAQ) short-version was used to assess physical activity in the study. Factors were categorised according to the Socio-Ecological Model which consisted of individual, social environment, physical environment and policy level. Data was analysed using the IBM SPSS statistical software, version 22. Simple and multiple logistic regression were used to determine the predictors of sufficient physical activity.

    RESULTS: A total of 342 respondents completed the study questionnaire. Majority of the respondents (93.6%) reported sufficient physical activity at 7-day recall. Multivariate analysis revealed that respondents belonging to the Ibibio ethnic group were about four times more likely to be sufficiently active compared to those who belonged to the other ethnic groups (AOR = 3.725, 95% CI = 1.383 to 10.032). Also, participants who had a normal weight were about four times more likely to be physically active compared to those who were underweight (AOR = 4.268, 95% CI = 1.323 to 13.772).

    CONCLUSION: This study concluded that there was sufficient physical activity levels among respondents. It is suggested that emphasis be given to implementing interventions aimed at sustaining sufficient levels of physical activity among students.

  8. Ibrahim U, Wan-Puteh SE
    Pan Afr Med J, 2018;30:150.
    PMID: 30374396 DOI: 10.11604/pamj.2018.30.150.15851
    Introduction: This study sets out to assess the roles of Civil Society Organizations (CSOs) in post donor health project sustainability in Low and Middle Income Countries (LMICs), the case of the Bauchi State, Nigeria. This study equally investigated the CSOs strategies and roles in health project sustainability.

    Methods: For quantitative data collection, the random, purposive, and convenient sampling techniques were used and 156 respondents selected from relevant organizations operating in Bauchi state, Nigeria, and 15 respondents for Key Informant Interviews (KIIs). A Semi-structured questionnaire was the study instrument, and consent from the participants as well as ethical clearances were duly obtained.

    Results: The study revealed that 87.8% of the respondents indicate un-friendly operational policies, while 88.9% of them identified lack of resources (human, money and machineries) as impediments to project sustainability. Also, 74.3% of the respondents said partnership among key stakeholders and 86.6% of them affirmed that community participation and use of available (local) resources ensure health project sustainability. The study further revealed that CSOs fund health projects, support government efforts and encourage development of project sustainability road map in the state.

    Conclusion: Hence, health project sustainability plan should form part of a project right from inception through the donor period and thereafter. In addition to the above, internal income framework, community involvement, enabling policies and partnership among stakeholders, especially with the host government, should always guide project implementation, because without these in place, project sustainability will remain a mirage.

  9. Hassan MR, Jamhari MN, Hayati F, Ahmad N, Zamzuri MIA, Nawi AM, et al.
    Pan Afr Med J, 2021;39:206.
    PMID: 34603587 DOI: 10.11604/pamj.2021.39.206.30410
    Introduction: type 2 diabetes mellitus has become a global public health crisis. The increment in the cases has contributed significantly to the parallel increase in the prevalence of overweight and obesity. This paper aimed to analyse the relationship between lipid profile, waist circumference and body mass index (BMI) with the glycaemic control of the diabetes patients in Kedah.

    Methods: a cross-sectional study was conducted, using the Kedah audit samples data extracted from the National Diabetes Registry (NDR) from the year 2014 to 2018. A total of 25,062 registered type 2 diabetes mellitus patients were selected using the inclusion and exclusion criteria from the registry. Only patients with complete data on their HbA1C, lipid profile, waist circumference and BMI were analysed using SPSS version 21.

    Results: the means for the age, BMI and waist circumference of the samples were 61.5 (±10.85) years, 27.3 (±5.05) kg/m2 and 89.46 (±13.58) cm, respectively. Poor glycaemic control (HbA1c>6.5%) was observed in 72.7% of the patients, with females having poorer glycaemic control. The BMI and waist circumference were found to be significantly associated with glycaemic control (P<0.001). The total cholesterol, triglycerides and low-density lipoproteins values showed positive correlation with glycaemic control (r = 0.178, 0.157, 0.145, p<0.001), while high-density lipoproteins values are negatively correlated (r = -0.019, p<0.001).

    Conclusion: implementing lifestyle changes such as physical activity and dietary modifications are important in the management of BMI, waist circumference and body lipids, which in turn results in improved glycaemic control.

  10. Nagandla K, Jamli MFBM, Hanim F, Xu Mei JL, Din SFS
    Pan Afr Med J, 2021;40:52.
    PMID: 34795832 DOI: 10.11604/pamj.2021.40.52.30961
    The common gynaecological causes of acute pelvic pain include ruptured ectopic pregnancy, haemorrhagic corpus luteal cyst or torsion of an ovarian cyst. Ovarian vascular accidents are reported in women on oral anticoagulation presenting as an acute pelvic pain. Although such vascular accidents with anticoagulation therapy are an unusual entity, a meticulous history, clinical examination, and laboratory workup to confirm the diagnosis and timely intervention is needed to reduce attending morbidity and mortality. However, a standard algorithm for management is not described in the literature. We hereby report successful management of recurrent hemorrhagic ovarian cyst due to coagulopathy in a woman with mechanical heart valves with timely surgical intervention. This case report discusses operative versus non operative management approach and may provide value addition to readers encountering such cases in their clinical practice.
  11. Khajotia R
    Pan Afr Med J, 2021;40:169.
    PMID: 34970411 DOI: 10.11604/pamj.2021.40.169.31223
    Twenty months into the COVID-19 pandemic, we are still learning about the various long-term consequences of COVID-19 infection. While many patients do recover with minimal long-term consequences, some patients develop irreversible parenchymal and interstitial lung damage leading to diffuse pulmonary fibrosis. Unfortunately, these are some of the consequences of post-SARS-CoV-2 infection which thousands more people around the world will experience and which will outlast the pandemic for a long time to come. It is now being observed at various leading medical centres around the world that lung transplantation may be the only meaningful treatment available to a select group of patients experiencing serious lung damage and non-resolving COVID-19-associated respiratory failure, resulting from the triad of coronavirus infection, a hyper-inflammatory immune response to it and the inability of the human body to repair that injury.
  12. Md Noh MSF, Muhammad SJSS
    Pan Afr Med J, 2017 Jun 23;27:138.
    PMID: 28904667 DOI: 10.11604/pamj.2017.27.138.12227
  13. Ong CY, Lim JL, Galang LD
    Pan Afr Med J, 2017;28:30.
    PMID: 29138666 DOI: 10.11604/pamj.2017.28.30.13544
    We report a case study on a patient who presented with low back and thigh pain of one month duration. He was eventually diagnosed with left thigh pyomyositis. Tissue from thigh grew Staphylococcus aureus. With commencement of antibiotics and surgical drainage, patient made recovery despite prolonged hospital stay. The underlying mechanism of the extensive abscess accompanied by lack of systemic symptoms; is related to relative immunocompromised state of having underlying diabetes mellitus.
  14. Aizuddin AN, Zamzuri M'IA, Mansor J, Nurumal SR, Yunus SZSA, Razak MAA, et al.
    Pan Afr Med J, 2022;43:19.
    PMID: 36451723 DOI: 10.11604/pamj.2022.43.19.31133
    There is a growing trend in complementary and alternative medicine (CAM) usage among the population with medical conditions. However, there is hesitancy for medical practitioners to integrate its application with the current treatment modality, despite governance by the authority. Hence, our objective is to systematically evaluate the healthcare perception towards integrating CAM in their practices. We systematically searched three large and renowned databases i.e., Scopus, Web of Science and PubMed, regarding "Perception on Integrating CAM Usage in Patient's Treatment among Healthcare Practitioners" from 2016 until 2020. At least two independent reviewers comprehensively screened and extracted the data from the accepted articles. A total of 15 studies were included in the final qualitative synthesis following a strict and rigorous assessment checked using MMAT 2018 checklist. The studies included providing the richness of information due to the qualitative nature of the study design. There were three main domains extracted i.e. knowledge, attitude, and perspective of the healthcare practitioner towards CAM integration. Limited knowledge of CAM among healthcare providers may be the possible main reason for non-supportive attitude and negative perspective on CAM. However, those who showed an inclination towards CAM were found to be more open and ready to learn about CAM if it provides benefits to the patients. There is a heterogeneity of perception towards CAM integration from healthcare providers' point of view. A proactive and systematic CAM literacy awareness program may help to improve their understanding and possibly gain more trust in its application.
  15. Sureshkumar S, Mwangi KJ, Gathecha G, Marcus K, Kohlbrenner B, Issom D, et al.
    Pan Afr Med J, 2023;44:153.
    PMID: 37455892 DOI: 10.11604/pamj.2023.44.153.38616
    INTRODUCTION: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies.

    METHODS: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling.

    RESULTS: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs' response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution.

    CONCLUSION: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

  16. Seger S, Nasharuddin NNB, Fernandez SL, Yunus SRBM, Shun NTM, Agarwal P, et al.
    Pan Afr Med J, 2020;37:151.
    PMID: 33425184 DOI: 10.11604/pamj.2020.37.151.21716
    Introduction: irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder. The medical programme is among the most challenging and stressful undergraduate programmes which may predispose to higher rates of IBS. This study sought to determine the prevalence of undiagnosed IBS and the factors associated with IBS among medical students in a Malaysian private university.

    Methods: a cross sectional study was conducted among the medical students from semester 6 to semester 9 (year 3, year 4 and year 5) of a Malaysian private university. The questionnaire consisted of 2 main sections. Section A was on demographic data and section B consisted of the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI) and the Rome IV Questionnaire for IBS. Association between the factors gathered and IBS was assessed using the Chi-Square test. Variables with a p-value of less than 0.2 in the univariate analysis were entered into a multivariate analysis model.

    Results: number of students who responded were 190 (56.3%) were females, 66.3% were Chinese and 37.9% were from semester 9. Twenty-eight (14.7%) students had symptoms consistent with a diagnosis of IBS. Depression was found to be significantly associated with IBS (adjusted OR: 4.749, CI: 1.809-12.470).

    Conclusion: this study suggests that IBS is common among Malaysian medical students. There was a significant association between IBS and depression.

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