Innovative Journal of Medical and Health Science <p><strong>Innovative Journal of Medical and Health Science [IJMHS], </strong>peer-reviewed and published monthly, is committed to publishing scholarly empirical and theoretical research articles that have a high impact on the medical &amp; health science field as a whole. <strong>IJMHS </strong>encourages new ideas or new perspectives on existing research. This journal has articles pertaining to the following fields of medical &amp; health science:</p> <p>General &amp; Introductory Medical &amp; Health Sciences, Basic Medical Health Sciences, Addiction, Allergy &amp; Clinical Immunology Andrology, Anesthesia &amp; Pain Management, Anatomy, Audiology, Cardiovascular Disease, Cellular &amp; Molecular Medicine, Consumer Health, Dentistry, Dermatology, Emergency Medicine &amp; Trauma, Endocrinology &amp; Diabetes, Gastroenterology &amp;Hematology, General &amp; Internal Medicine, Geriatric Medicine, Health &amp; Social Care, Health science, Hematology, Infectious Disease &amp; Microbiology, Brain, AIDS, Cosmetic Surgery, Implants, Medical Devices, Holistic Medicines, Intellectual Disability, Mental Health, Neonatology, Nephrology, Neurology, Nursing &amp; Midwifery, Nutrition &amp; Dietetics, Obstetrics &amp; Gynecology, Occupational Therapy, Oncology &amp; Radiotherapy, Ophthalmology &amp; Optometry, Pathology, Pediatrics, Pharmacology, &nbsp;Physiotherapy, Psychiatry, Public Health, Radiography, Renal Transplantation, Respiratory Medicine, Rheumatology, Sexual Medicine, Speech Therapy, Sports Medicine, Surgery &amp; Surgical and all other area covered in medical and health science.</p> <p><strong><em>&nbsp;</em></strong></p> en-US All paper submissions must carry the following duly signed by all the authors:<br />“I certify that I have participated sufficiently in the conception and design of this work and the analysis of the data (wherever applicable), as well as the writing of the manuscript, to take public responsibility for it. I believe the manuscript represents valid work. I have reviewed the final version of the manuscript and approve it for publication. Neither has the manuscript nor one with substantially similar content under my authorship been published nor is being considered for publication elsewhere, except as described in an attachment. Furthermore I attest that I shall produce the data upon which the manuscript is based for examination by the editors or their assignees, if requested.” (medical and health science) (santosh dutt) Mon, 28 Jan 2019 08:40:18 +0000 OJS 60 Student Perception of Peer Assisted Learning in a Clinical Environment: Experience at Melaka Manipal Medical College, Malaysia <p><strong><em>Context and Purpose: </em></strong><em>Peer Assisted Learning (PAL) is gaining traction as a supplement to conventional teacher-led teaching. The advantages of PAL include a more informal learning environment making it easier for learners to ask questions and clarify concepts. However, PAL may be insufficient as a stand-alone method of content delivery as the learners may feel that time is being wasted or that a trained teacher would better identify learner’s needs in knowledge and for examinations. This paper examines student perceptions of PAL in a clinical environment. </em></p> <p><strong><em>Setting:</em></strong><em> Melaka Manipal Medical College (MAHE), Melaka and Melaka General Hospital, Melaka, Malaysia</em></p> <p><strong><em>Methods:</em></strong><em> The study was conducted over one semester (six months). 129 students from the Final Year of the MBBS course acted as peer teachers to 120 students of the third year. The teaching was done in small groups of 10-12 students at a time. At the end of the semester, students were invited to answer a questionnaire regarding their perceptions. </em></p> <p><strong><em>Results:</em></strong><em> A majority of students in both the student and the peer teacher cohorts felt that PAL benefited them in various ways including improvement in communication skills, clinical skills, interpersonal relationships and better examination preparation. </em></p> <p><strong><em>Conclusions: </em></strong><em>PAL is a useful adjunct to teaching. It fosters team spirit and can fill in gaps in teaching or student needs which may occur by conventional teaching. However, caution should be exercised that PAL not replace a taught curriculum entirely as a student-led teaching session will necessarily be incomplete in terms of the breadth of the subject covered. We recommend PAL as part of a more comprehensive curriculum with regular feedback from both the student and the teacher cohorts to develop it further. </em></p> Nishikanta Verma*,Somsubhra De, Yashodhara BM., Manonmani V Copyright (c) 2019 Mon, 28 Jan 2019 00:00:00 +0000 Effect of Pulse rate on skipping Breakfast <p>Objective of the present study was to correlate blood grouping and skipping breakfast. A total of 200 subjects were involved in the present study. These subjects were associated with the Institute of Molecular Biology and Biotechnology of Bahauddin Zakariya University, Multan, Pakistan. These subjects were asked to estimate their pulse. Normal pulse rate ranges from 65-100. And pulse rate varies from person to person. It was concluded from the present study that people with higher pulse rate take their breakfast. And those with lower pulse rate skip their breakfast.</p> Muhammad Imran Qadir, Hira Qureshi* Copyright (c) 2019 Wed, 30 Jan 2019 00:00:00 +0000 Is there any effect of blood oxygen level on nail biting? <p>To correlate pulse rate with nail biting is the aim of current research. 200 subjects took part in current research, where their blood oxygen level calculated. The normal blood oxygen level was between 80 to 100 millimeters of mercury (mm Hg). It was concluded from the current research that blood oxygen level has no effect on nail biting.</p> Muhammad Imran Qadir, Hira Naeem Qureshi* Copyright (c) 2019 Wed, 30 Jan 2019 00:00:00 +0000 Assessment of Knowledge, Attitude and Practice of Health Care Providers towards the Prevention and Control of Multi Drug Resistant Tuberculosis at Nekemte Referral Hospital, Western Ethiopia <p>Background: Tuberculosis (TB) has existed for millennia and remains a major global health problem. Although it may be assumed that in general health care workers (HCWs) know about MDR-TB and its implications, several studies from around the globe have found that HCWs do not always exhibit sufficient knowledge, positive attitudes, and acceptable practices regarding preventing and treating MDR-TB. Methods: A cross sectional study was conducted by means of self-administered semi structured questionnaires that was provided to health care workers of NRH from March 10 to April 2, 2017. Using convenient sampling technique, from 155 health professionals’ 140 individuals returned the questionnaires. The data was analyzed using SPSS version 20. Descriptive statistics was used to determine frequency and percentage. Chi-square test was used to identify the relationships between dependent and independent variables (P&lt;0.05 and 95% CI). Results: The mean age of participants was 30.76+6.42 years. About 56.4% of the participants were males and majority of participants were Nurses (42.2%). Greater than half (59.3%) of respondents had good level of knowledge about MDR-TB and the overwhelming majority of them held positive attitude (60.7%) towards patients with MDR-TB. Overall 21%, 55%, 72.1% of respondents reported that they had their own copy of MDR-TB management guidelines, used the protective masks and were individually involved in educating patients about MDR-TB respectively. Respondents who had good knowledge about MDR-TB significantly wore their Protective masks than those with insufficient knowledge which was statistically significant (P=0.01). Based on the assessed level of knowledge, respondents with good level of knowledge reported they referred to the manual more than those with insufficient level (30.1% versus 19.3%, P=0.172). Conclusion: The finding indicates that the level of knowledge about MDR-TB did not influence the attitude and practices of respondents towards patients suffering from MDR-TB. Contrary to this good knowledge was positively associated with safer practices such as using protective masks, educating patients, and referring to the MDRTB guidelines manual. This situation needs to be remedied by making the guidelines available to all healthcare workers in Ethiopia.</p> Ginenus Fekadu*, Ayalesew Melese, Getu Bayisa Copyright (c) 2019 Wed, 30 Jan 2019 00:00:00 +0000 Asymptomatic hypoglycemia among children with acute lymphoblastic leukemia on maintenance therapy <p>Background: Knowledge of the adverse effects of maintenance chemotherapy , therapy in children with acute lymphoblastic leukemia being treated according to the MRC modified protocols. Objective: To figure out the asymptomatic hypoglycemia in a sample of children patients at a stage of maintenance therapy. Methods: Prospective study was carried out over 6 months from the 1st of January 2004 till the 30th of June 2004. A total sample of 30 patients aged between (1 and 15 years) with acute lymphoblastic leukemia were included in study who were treated at Basra Maternity and child teaching hospital, all of them were being treated according to MRC modified protocol and on maintenance therapy (6 mercaptopurina + methotroxate), 35 healthy children matched for age and sex randomly selected as control. Results: Hypoglycemia were seen is 18 (60%) of patients with leukemia, 10 (55.5%) females and 8 (44.4%) males. Blood glucose level &lt;3.33 mmol/L during 12 hours of overnight fasting. Conclusion: Hypoglycemia is the most common adverse effect in children with acute lymphoblastic leukemia on maintenance therapy.</p> Janan G. Hassan*, Ayad .A. Mohamed Copyright (c) 2019 Mon, 04 Feb 2019 00:00:00 +0000 Efficacy of Generic Bortezomib Used as a Part of CyBorD Regimen to Achieve Complete Response in Multiple Myeloma <p>Bortezomib is a preferred yet costly drug in multiple myeloma (MM) treatment. Thus, despite its benefits, bortezomib is substituted with cheaper options like thalidomide; sometimes compromising the efficacy of treatment. This case report of a 53-year old transplantation eligible MM patient from Colombia shows that substituting branded bortezomib with its generic version in the bortezomib, cyclophosphamide and dexamethasone (CyBorD) regimen can also help in complete remission. This case provides evidence that high quality generic drug is as safe and efficacious as the innovator product. Improving awareness about clinical and cost saving benefits of generic medications in oncology practices could make cancer treatment affordable for many patients in lower and middle-income countries (LMIC) like Colombia. Clinical usage of generic drugs similar to that of their branded/innovator counterparts is the need of the hour. Adequate policies along with transparent and ethical promotions must be implemented to ensure maintenance of high quality care at an affordable cost.</p> Kenny Galvez Copyright (c) 2019 Mon, 04 Feb 2019 00:00:00 +0000 Extemporaneous Compounding: Cautions, Controversies and Convenience <p>Pharmacists are only knowledgeable and skilled healthcare professionals dedicated to compounding and preparing medications to meet the unique needs of patients. The safe and effective extemporaneous compounding of prescription products for patients require in special care is fundamental to the pharmacy profession. But there are much to do for secundum artem. It is not at all economical for a pharmaceutical company to marketize a product in 10 different probable doses or in 5 different dosage forms to meet the needs of the entire range of individuals receiving therapy. Although development is a continuous process, companies are customizing features to meet the majority of patient needs, but the very nature of the process cannot meet all patient needs. The risk-benefit ratio of using traditionally compounded medicines is favorable for patients who require specialized medications that are not commercially available, as they would otherwise not have access to suitable treatment. However, if an FDA-approved drug is commercially available, the use of an unapproved compounded drug confers additional risk with no commensurate benefit. Published reports of independent testing by the FDA, state agencies, and others consistently show that compounded drugs fail to meet specifications at a considerably higher rate than FDA-approved drugs. Compounded sterile preparations pose the additional risk of microbial contamination to patients. In the last 11 years, three separate meningitis outbreaks have been traced to purportedly ‘sterile’ steroid injections contaminated with fungus or bacteria, which were made by compounding pharmacies. The 2012 outbreak has resulted in intense scrutiny of pharmacy compounding practices and increased recognition of the need to ensure that compounding is limited to appropriate circumstances. Purpose of The Study: The article aims to physico-chemical and economic considerations before compounding; factors and quality control issues; compounding support, training, chemical supplies, types of compounding (specially in hospital and ambulatory care compounding). It should aid to practice the extemporaneous preparation of basic and advanced formulations including pharmacopoeial and non-pharmacopoeial formulations encountered in pharmacy practice, together with requisite documentation, labeling, packaging and counseling requirements. Along with this, they have to study the analysis of formulations and their components and relate these to the clinical performance of medicines. This will help them to investigate, evaluate and report the physical characteristics of formulations including release kinetics and relate these to quality control and preformulation requirements; relate the application of quality control, quality assurance and the principles of good manufacturing practice to regulation of medicine production in home and abroad. Outline: Background; Introduction; Compounding Factors; Types of Compounding; Identifying Errors and Cause</p> AK Mohiuddin* Copyright (c) 2019 Wed, 30 Jan 2019 00:00:00 +0000 Saphenofemoral Arteriovenous Fistula as Hemodialysis access: PPUKM Early Experience <p>The biggest and difficult challenge in hemodialysis access is to maintain it over the time in the expanding number of patients with end-stage renal failure (1). There is little consensus discussed about the option available for small subset of patients repeated failures or unsuitable veins in published guidelines (1). So far, there have been few reports of saphenofemoral AV fistula (SFAVF) over the last 10-20 years because of previous suggestion of poor patencies and needling difficulties. Here, we describe our early clinical experience with SFAVF. The function and patency rate of accesses appeared to be similar like other mature arteriovenous fistula in the short-term, although further longitudinal studies are required.</p> R. Rosnelifaizur*,I. Aizat Sabri, Krishna K,Lenny SS,I. Azim, H. Hanafiah Copyright (c) 2019 Tue, 29 Jan 2019 00:00:00 +0000 Atypical Presentation of Central Venous Occlusion (CVO) Disease <p>We reported a case of 58 years old gentleman who known case of end stage renal failure and had history of Right IJC cannulation of venous access on 2012, presented with recurrent shortness of breath, chesty cough and intermittent fever. Otherwise he got no hemoptysis, no recent contact with PTB patients and no joint pain. The same presentation occurred last month with a pleural tapping was done and claimed it was a milky content. No further investigation was done at that moment. This current presentation noted a dullness in percussion up to midzone of right lung and reduce air entry on auscultation as well. The pigtail catheter was inserted over the right pleural space and it was confirmed as a chylothorax with a present of cholesterol in a pleural fluid analysis. Computed tomography of the thorax showed complete occlusion of the superior vena cava with an established collateral circulation. Lymphangiogram revealed lipiodol seen opacified lymph node and lymphatic vessels until the level of T3 on the right and T5 on the left. There was no obvious lipiodol opacification seen at the region of the right thorax. Effusion was improved after the instillation of fibrinolytic agent and the the chest radiograph shows improvement.</p> Rosnelifaizur R*,Aizat Sabri I, Krishna K,Lenny SS,Azim I, H Harunarashid Copyright (c) 2019 Tue, 29 Jan 2019 00:00:00 +0000