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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 8 | Issue 4
Page Nos. 189-348

Online since Wednesday, December 28, 2022

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EDITORIAL  

What's new in academic international medicine? Improving the state of representation in the neurosurgical workforce p. 189
Christian N Schill, Frank J Cedeño, Doron Rabin
DOI:10.4103/ijam.ijam_106_22  
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ORIGINAL ARTICLES Top

A 5-year analysis of admissions, seasonal variation, and patient outcomes in rural Nigeria: A retrospective observational study p. 193
Azeez Oyemomi Ibrahim, Tosin Anthony Agbesanwa, Shuaib Kayode Aremu, Segun Matthew Agboola, Olabode Muftau Shabi, Babatunde Adeola Afolabi
DOI:10.4103/ijam.ijam_60_21  
Introduction: In low- and middle-income countries like Nigeria, there is an observed paucity of data on the admission pattern and patient outcomes in health facilities. Few related studies were conducted in the urban centers, but none from the rural areas where the majority of the populace resides. This study is to ascertain the demographic profile, seasonal variations, yearly distribution, admission pattern, and treatment outcomes at the accident and emergency department (AED). Materials and Methods: A retrospective survey was used to review the data of patients admitted to the AED of the institution between January 2015 and December 2019. The data obtained were analyzed using SPSS Version 20.0. The results were presented in descriptive and tabular formats. Results: Five thousand nine hundred and forty-four patients were studied with a mean age of 49.8 ± 19 years. There were 53.9% males and 46.1% females. Many (60.1%) were admitted from April to October. There were 58.9% medical and 41.1% surgical cases. Among the medical cases were 18.6% noncommunicable and 18.5% communicable diseases. Out of 5944 patients, 9435 disease patterns were diagnosed with infectious diseases 15.5%, and orthopedic 14.4% being the most frequently diagnosed medical and surgical cases, respectively. The treatment outcome revealed that the mortality rate was 3.7%. Conclusions: The number of admissions increased over 5 years. Although most patients were treated and discharged successfully, the number discharged against medical advice was high. Therefore, appropriate hospital and community interventions should be implemented to improve admission outcomes. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge, and Systems-based practice.
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Compliance rate of anti-rabies vaccination in patients presenting with an animal bite p. 199
Rathijit Pal, Vaishnavi Vegiraju, Darpanarayan Hazra, Ankita Chowdary Nekkanti, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/ijam.ijam_54_22  
Introduction: To prevent rabies in animal bite victims, complete postexposure prophylaxis (PEP) with an anti-rabies vaccination (ARV) is essential. This study was done to determine the compliance rate of ARV in patients with animal bites who presented to the emergency department (ED) during the COVID-19 pandemic. Materials and Methods: This was a prospective observational study done on patients presenting to the ED with a history of animal bites over 1 year (May 2020–June 2021). Categorical variables were presented as percentages, and quantitative variables were summarized using mean and standard deviation (SD). Results: A total of 122 animal bite (World Health Organization [WHO] Category II and III) victims presented to the ED during the study. The mean age of the cohort was 38.12 (SD: 16.4) years with a male (n = 67: 54.9%) preponderance. Based on the physiological stability, a majority were triaged as priority III (n = 119; 97.5%). Most patients presented with dog bites (n = 88; 72.1%), followed by cat (n = 14; 11.5%) and rat bites (n = 13; 10.7%). Two-thirds were unprovoked (n = 82; 67.2%) and were caused by stray animals (n = 62; 50.8%). More than half (n = 65; 53.3%) of the bites were WHO Category III bites. All Category II and III patients had received the first dose of ARV at our center and category III patients received immunoglobulin local injection as well. Noncompliance to ARV was seen in almost a quarter (n = 32; 26.2%) of patients of which forgotten dates (n = 11; 34.4%) were the most common cause. There was no significant statistical variable to determine the cause of noncompliance. Conclusion: Unprovoked bites by stray dogs were the cause of a majority of the animal bites. Compliance with PEP remains low at two-thirds of the total. The most common cause of noncompliance to ARV was due to forgotten dates. The following core competencies are addressed in this article: Medical knowledge, Systems-based practice, Practice-based learning and improvement.
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Nutritional assessment of birth outcomes of gestational diabetic mothers in Gaza Strip, Palestine: A retrospective case-control study p. 205
Ihab A Naser, Mona R Shaat, Mahmmoud H Taleb, Ahmed A Najim
DOI:10.4103/ijam.ijam_153_21  
Introduction: Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. Numerous studies have dealt with risk factors of GDM, while others studied the health complications associated with GDM. This study aimed to investigate the association between GDM and nutritional birth outcomes in Gaza Strip, Palestine. Materials and Methods: The study utilized the case−control design where 44 GDM mothers and 44 non-GDM mothers were recruited. The study was conducted at the obstetric departments at Al-Shifa Maternity Hospital in Gaza and Mubarak Maternity Hospital in Khan Yunis. Data collection included anthropometric measurement and hematological indicators and other pertinent information through a structured questionnaire. Results: The result reported that the mean age of GDM pregnant women and non-GDM was 31 ± 11.5 and 23 ± 6.75 years, respectively. 13.6% had anemia, 20.5% had previous delivery of macrosomic baby, 15.9% had hypertension, and 11.4% were obese. In addition, 63.6% of GDM mothers had a family history of diabetes and 18.2% had a family history of GDM. 43.2% of GDM mothers delivered by cesarean section (CS) and 13.6% of GDM mothers had a premature delivery. Assessment of dietary intake indicated that 40.9% of GDM mothers have breakfast regularly. The neonatal median birth weight was 3.22 kg for babies of GDM mothers and 3.30 kg for babies of non-GDM mothers, and the median length was 52 cm versus 50 cm; 6.8% of neonates of GDM mothers had low Apgar score. Neonates of GDM mothers expressed significantly lower blood sugar (P = 0.039), lower albumin (P = 0.037), and higher soluble surface receptors – surface transferrin receptor (P = 0.017), but there were no statistically significant differences in the other hematological parameters. Conclusion: The study reflected a significant association between GDM and lower blood glucose, serum albumin, and iron status. Furthermore, the study reflected a significant association between GDM and CS delivery and neonatal hypoglycemia. The study emphasized the need to integrate clinical nutrition services in maternity departments and antenatal clinics and encourage physical activities during pregnancy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.
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Emergency medicine resident involvement in emergency medical services p. 213
Natalie C Akers, Bryan R Wilson, Adam M Ray
DOI:10.4103/ijam.ijam_116_21  
Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience >50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.
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CASE REPORT Top

Esophageal melanosis due to mishri usage: A case with uncommon finding and rare etiology p. 217
Muppa Indrakeela Girish, Amol Sonyabapu Dahale, Debabrata Banerjee, Prasad Bhate, Abhijeet Karad
DOI:10.4103/ijam.ijam_67_22  
Esophageal melanosis (EM) is a rare disease of the upper digestive system. We present a case series of two patients with EM who presented with dysphagia and had the habit of mishri consumption. Endoscopy showed black-pigmented spots involving the upper and mid esophagus. EM due to mishri consumption was a rare presentation as there were no cases reported till date. The following core competencies are addressed in this article: Patient care, Practice-based learning and improvement, Medical knowledge.
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CONFERENCE ABSTRACTS AND REPORTS Top

Conference proceedings: Fourth annual women in medicine summit: An evolution of empowerment 2022 Highly accessed article p. 221
Marah N Kays, Michelle Fernando, Mysa Abdelrahman, Deborah D Rupert, Parul Barry, Shikha Jain
DOI:10.4103/2455-5568.365559  
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The Seventh Annual Academic International Medicine Virtual Congress and Scientific Forum, June 9–12, 2022: Building a Stronger Future p. 321
Michael S Firstenberg, Annelies De Wulf, Mayur Narayan, Taryn Clark, Andrew Miller, Stanislaw P Stawicki
DOI:10.4103/ijam.ijam_104_22  
As the COVID-19 pandemic continued to fade, first glimpses of “post-pandemic normal” began to emerge in the late 2021 and early 2022. This new hope came with a positive new momentum – an opportunity to transform and reinvent. Yet given a high degree of uncertainty extending well into 2022, the American College of Academic International Medicine made a strategic decision in the late 2021 to move forward with Virtual 7th Annual Congress and Scientific Forum (AIM 2022). The theme of this year's meeting was “Building a Stronger Future” and reflected the early post-pandemic optimism. Primary organization of the meeting was facilitated by the Sarasota Memorial Health Care System, Sarasota, Florida, with substantial contributions provided by Northwell Health, Long Island, New York. The Scientific Forum once again took place virtually, enabling participants from around the globe to present their research. A summary of these efforts and outcomes is provided in this article. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice.
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