The nasal tent: an adjuvant for performing endoscopic endonasal surgery in the Covid era and beyond.

PURPOSE: To propose a cost-effective reproducible barrier method to safely perform endoscopic endonasal surgery during the Covid-19 pandemic. METHODS: This manuscript highlights the use of a clear, cost-effective disposable plastic sheet that is draped as a tent over the operating area to contain aerolization of particles. This is then connected to a suction to remove airborne particles and thus reduce transmission of the virus. CONCLUSION: The use of a nasal tent is a simple and affordable method to limit particle spread during high-risk aerolisation procedures during the Covid era and beyond.

Lingual Fibrolipoma - A rare clinicopathological entity.

Lipoma is a relatively common benign tumour occurring at sites of the body which are rich in adipose tissue. Due to sparsity of adipose tissue within the oral cavity, lipoma rarely presents in this region. Fibrolipoma of the tongue is a rare lesion. There are only 14 cases reported in the literature. An 85-year-old patient presented with a painless mass on the tongue interfering with eating. There were no risk factors for malignancy and no family history of malignant diseases. Although intraoperatively the lesion was locally infiltrative, histopathology revealed a rare benign fibrolipoma. Mainstay of treatment is surgical excision, but the lesion may pose a dilemma for Surgeons as difficulties associated with removal, due to the fibrous and adherent nature of the growth to surrounding tissue, may be mistaken for a cancerous growth.

Does the reporting of gastro-intestinal endoscopy meet the minimal terminology standard at King Edward VIII Hospital?

BACKGROUND: The Minimal Standard Terminology (MST) was developed to standardise endoscopic reporting. This study is aimed at assessing current reporting at a tertiary hospital and whether it meets this Minimal Standard Terminology. METHOD: This was a retrospective observational study of upper endoscopy reports between January and December 2014. The data extracted were compared to the current reporting standard listed in the MST. To assess and grade the quality of reporting we developed a Gastrointestinal Reporting Score, which incorporates MST variables in addition to demographic details, indication for endoscopy, report legibility, sedation and the use of classification systems to describe pathology. Variables were classified as blank, partially complete or complete and assigned a score of 1-3. The reports were graded according to their overall score for all variables (Max 40) into Grade A (> 36), B (28-36) and C (< 28). RESULTS: There were 100 patients of which 58 were female. Thirty-seven per cent were from the 60-75 year age group. Fiftyfour endoscopies were performed by trainee specialists. Junior and senior consultants performed 36 and 9 upper endoscopies respectively. Indications for upper endoscopy were stated in 51 reports. The use of pre-procedural sedation was not stated in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist and one by an unknown endoscopist whose name was illegible. Common classification systems for oesophagitis, gastropathy features, ulcer characteristics, and ulcer location are not routinely used. Based on the Gastrointestinal Reporting Score there were no Grade A reports, 16 Grade B and 84 Grade C reports. CONCLUSION: The MST is not routinely utilised in our setting and reports are incomplete. There is a need for optimal upper endoscopic reporting, incorporating the MST guidelines.

Medication Adherence and Health Insurance/Health Benefit in Adult Diabetics in Kingston, Jamaica.

OBJECTIVE: To determine the association between health insurance/health benefit and medication adherence amongst adult diabetic patients in Kingston, Jamaica. METHODS: This was a cross-sectional study. The target population was diabetics who attended the diabetic outpatient clinics in health centres in Kingston. Two health centres were selectively chosen in Kingston. All diabetic patients attending the diabetic clinics and over the age of 18 years were conveniently sampled. The sample size was 260. An interviewer-administered questionnaire was utilized which assessed health insurance/health benefit. Adherence was measured by patients' self-reports of medication usage in the previous week. The Chi-squared test was used to determine the significance of associations. RESULTS: Sample population was 76% female and 24% male. Type 2 diabetics comprised 93.8%. More than 95% of patients were over the age of 40 years. Approximately 32% of participants were employed. Approximately 75% of patients had health insurance/health benefit. Among those who had health insurance or health benefit, 71.5% were adherent and 28.5% were non-adherent. This difference was statistically significant (χ2 = 6.553, p = 0.01). Prevalence of medication non-adherence was 33%. CONCLUSIONS: AIn Kingston, diabetic patients who are adherent are more likely to have health insurance/health benefit (p = 0.01).

Limitations and plausibility of the Pliocene lignite hypothesis in explaining the etiology of Balkan endemic nephropathy.

BACKGROUND: Balkan endemic nephropathy (BEN) is a chronic, tubulointerstitial renal disease often accompanied by urothelial cancer that has a lethality of nearly 100%. INTRODUCTION: One of the many factors that have been proposed to play an etiological role in BEN is exposure to organic compounds from Pliocene lignite coal deposits via the drinking water in endemic areas. OBJECTIVES: The objective of this study was to systematically evaluate the role of the tenets of the Pliocene lignite hypothesis in the etiology of BEN in order to provide an improved understanding of the hypothesis for colleagues and patients alike. METHODS: A comprehensive compilation of the possible limitations of the hypothesis, with each limitation addressed in turn is presented. RESULTS: The Pliocene lignite hypothesis can best account for, is consistent with, or has the potential to explain the evidence associated with the myriad of factors related to BEN. CONCLUSIONS: Residents of endemic areas are exposed to complex mixtures containing hundreds of organic compounds at varying doses and their potentially more toxic (including nephrotoxic) and/or carcinogenic metabolites; however, a multifactorial etiology of BEN appears most likely.

Experience with a gonadotrophin-releasing hormone agonist prior to myomectomy--comparison of twice- vs thrice-monthly doses and a control group.

The aim of this randomised prospective study was to investigate the impact of preoperative gonadotrophin-releasing hormone agonist (GnRHa) compared with a control group with myomectomy. A total of 36 women (n = 36, group 1) with fibroids were randomised to receive either two monthly doses (n = 18/36, group 1a) or three monthly doses of goserelin (n = 18/36, group 1b) prior to myomectomy. The 32 women who received no treatment (group 2) comprised the controls. All patients had similar demographic features. There were no significant differences among the three groups with respect to: (1) mean intraoperative blood loss; (2) preoperative and postoperative blood transfusion or (3) length of hospital stay. The only advantage of administering GnRHa prior to myomectomy for symptomatic fibroids in our population was a higher haemoglobin level prior to surgery among the women who received three doses of the drug.

Organic compounds in water extracts of coal: links to Balkan endemic nephropathy.

The Pliocene lignite hypothesis is an environmental hypothesis that has been proposed to explain the etiology of Balkan endemic nephropathy (BEN). Aqueous leaching experiments were conducted on a variety of coal samples in order to simulate groundwater leaching of organic compounds, and to further test the role of the Pliocene lignite hypothesis in the etiology of BEN. Experiments were performed on lignite coal samples from endemic BEN areas in Romania and Serbia, and lignite and bituminous coals from nonendemic regions in Romania and the USA. Room temperature, hot water bath, and Soxhlet aqueous extraction experiments were conducted between 25 and 80 °C, and from 5 to 128 days in duration. A greater number of organic compounds and in higher concentrations were present in all three types of leaching experiments involving endemic area Pliocene lignite samples compared to all other coals examined. A BEN causing molecule or molecules may be among phenols, PAHs, benzenes, and/or lignin degradation compounds. The proposed transport pathway of the Pliocene lignite hypothesis for organic compound exposure from endemic area Pliocene lignite coals to well and spring drinking water, is likely. Aromatic compounds leached by groundwater from Pliocene lignite deposits in the vicinity of endemic BEN areas may play a role in the etiology of the disease. A better understanding of organic compounds leached by groundwater from Pliocene lignite deposits may potentially lead to the identification and implementation of effective strategies for the prevention of exposure to the causative agent(s) for BEN, and in turn, prevention of the disease.

Informal gold miners with mercury toxicity: Novel asymmetrical neurological presentations.

Mercury is a highly toxic heavy metal that may cause neurological, respiratory, gastrointestinal and dermatological illnesses. Previously described neurological manifestations of mercury toxicity are symmetrical, and include a pancerebellar syndrome, generalised seizures and encephalopathy. Mercury is used in the gold mining process, and in artisanal or illicit gold mining, often without necessary protection. Here we describe the cases of two artisanal gold miners from western Johannesburg, South Africa, who presented with atypical neurological manifestations of mercury toxicity. Patient 1 presented with focal seizures, an asymmetrical cerebellar syndrome and an acute encephalopathy. Patient 2 had unilateral cerebellar ataxia. Both patients had toxic mercury levels, with no other cause identified for their symptoms. Patient 1 responded well to chelation therapy, but patient 2 refused admission and further medical treatment. The neurological manifestations of mercury toxicity are typically symmetrical, whereas our two patients presented with markedly asymmetrical features. It is important to maintain a high index of suspicion for mercury poisoning, even in patients with atypical and unilateral or asymmetrical presentations. A prompt diagnosis and the commencement of early chelation therapy have the potential to produce good outcomes.

Arthroscopic Hip Capsular Repair Improves Patient-Reported Outcome Measures and Is Associated With a Decreased Risk of Revision Surgery and Conversion to Total Hip Arthroplasty.

Purpose: To perform a systematic review to assess the effect of capsular repair compared with nonrepair on patient-reported outcome measures (PROMs) and conversion to total hip arthroplasty (THA) after hip arthroscopy in patients with femoroacetabular impingement syndrome. Methods: We initially searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PubMed databases, as well as ongoing clinical trials (https://clinicaltrials.gov), on December 15, 2022. The eligibility criteria were randomized controlled trials (Level Ⅰ) and prospective comparative studies (Level II) of patients who underwent capsular repair and nonrepair via hip arthroscopy with a minimum follow-up period of 2 years. We registered this protocol a priori on PROSPERO (identification No. CRD42021239306). We assessed the risk of bias using the Methodological Index for Non-randomized Studies (MINORS) appraisal tool. Results: This review included 5 studies with a total of 639 patients (270 with capsular repair [average age, 35.4 years; 41% female patients] and 369 with nonrepair [average age, 37.3 years; 38% female patients]). In the included studies, surgical procedures consisting of labral repair and pincer or cam osteoplasty were performed via hip arthroscopy. The modified Harris Hip Score was measured in all the included studies, and the standardized mean difference in PROMs for capsular repair versus nonrepair in the included studies was 0.42 (95% confidence interval [CI], 0.20 to 0.63). A sensitivity analysis of randomized controlled trials achieved consistent results (standardized mean difference in PROMs, 0.31; 95% CI, 0.02 to 0.60). Capsular repair was not associated with a reduction in revision surgery (risk difference, -0.02; 95% CI, -0.06 to 0.03; 26 of 270 patients with capsular repair vs 42 of 369 with nonrepair) but was associated with a reduction in conversion to THA (risk difference, -0.05; 95% CI -0.09 to -0.01; 12 of 270 patients with capsular repair vs 38 of 369 with nonrepair). The average Methodological Index for Non-randomized Studies (MINORS) score in the included studies was 20. Conclusions: Patients who undergo capsular repair in conjunction with other arthroscopic hip preservation techniques have better PROMs and a lower incidence of THA conversion. Level of Evidence: Level II, systematic review of Level I and II investigations.

An atypical immune-inflammatory disorder secondary to breast implant exposure.

OBJECTIVE: The objectives of this investigation were to determine a diagnosis and identify the underlying etiology. CASE PRESENTATION: A 71-year-old female had experienced a constellation of symptoms stemming from the 1980s, including the following types: neurological, respiratory, gastroenterological, dermatological, skeletal, and ophthalmological. No correlation with an environmental (or other) factor could be found to account for the presence or exacerbation of unexplained signs and symptoms-except that the patient had been exposed to a series of silicone breast implants. Anatomical diagnosis: An atypical immune-inflammatory disorder caused by an originally exogenous noninfectious agent, i.e., breast prostheses, and diagnosed as prosthetic mammoplasty sensitivity syndrome (PMSS). SIGNIFICANCE: This case study underscores the risks of breast implantation using prosthetic devices. It shows the potential for adverse health effects following breast implantation in humans. It highlights the impact of social factors that has adversely affected the medical treatment of this subgroup of patients, and documents postimplantation psychiatric morbidity attributable in part to adverse physical health effects from exposure to breast implants. RELEVANCE TO CLINICAL PRACTICE: Patients that present with symptoms, have a history of breast implants, and no firm diagnosis of disease or disorder etiology attributable to their clinical signs and symptoms, laboratory, and/or imaging results must be considered for PMSS.

The origin and future of offshore medical schools in the Caribbean.

The Flexner Report of 1910 concluded that there were too many medical schools in the United States of America (U.S.A.). In the wake of this conclusion, Flexner recommended higher admission and graduation standards for medical schools, the expected impact being fewer medical schools and graduates. One unintended consequence of this recommendation was a male-only policy by some universities to accommodate the smaller numbers of males. There were privately owned medical schools, unaffiliated to any college or universities which were run primarily for profit. Degrees were usually obtained after only two years of study and laboratory and dissection exercises were not part of the training. The adoption of Flexner's recommendation resulted in medical education becoming more expensive; it also created opportunities for persons without the financial means or the matriculation requirements to find alternative training programmes among those "medical schools" which did not adopt Flexner's recommendations. This paper traces the further development of these "medical schools" to facilitate the need for more doctors in the context of global maldistribution of doctors which has resulted in many medically underserved areas, more so in developing countries (1).

Zinc oxide nanorods modified indium tin oxide surface for amperometric urea biosensor.

ZnO nanorods (ZnONR) grown onto indium-tin-oxide (ITO) coated glass surface using zinc nitrate hexahydrate/hexamethylenetetramine (HMT) in aqueous phase has been utilized for urea biosensor. Urease (Urs) was immobilized onto ZnONR/ITO at physiological pH via electrostatic interactions between Urs and ZnO to fabricate Urs/ZnONR/ITO bioelectrode. ZnONR/ITO electrode has been characterized using XRD, FE-SEM techniques and Urs/ZnONR/ITO bioelectrode using electrochemistry. The XRD and FE-SEM measurements confirm the formation of ZnO nanorods in wurtzite structure. Cyclic voltammetric and amperometric measurements on the Urs/ZnONR/ITO biolectrode for urea concentrations in the range of 1-20 mM reveal 0.4 microA mM(-1) sensitivity, with a response time of 3 seconds, and a detection limit of 0.13 mM. The Michaelis-Menten constant (Km) was calculated to be 9.09 mM. Results indicate that ZnO nanorods provide suitable microenvironment for urease immobilization and can be utilized in biosensor design and other biological applications.

Prosthetic mammoplasty sensitivity syndrome: a case for causation.

Treatment of patients experiencing adverse health effects following prosthetic mammoplasty has suffered from a lack of an acknowledgment of a causal relationship to their breast prosthetic devices. Case reports and case series showing an association between adverse health effects and breast implants have been routinely dismissed as anecdotal, and epidemiological studies have been considered necessary to prove causality. We show that epidemiological research is not necessary for establishing a causal relationship, and one properly documented case can be, in fact, all that is needed to show causation. Presently in the peer-reviewed literature there exists a substantial scientifically sound body of data showing an association between breast implants and adverse health effects. Ample evidence has shown that exposure to the five common types of breast implants outlined, i.e., silicone gel filled, saline filled, double lumen, polyurethane coated, and cohesive silicone, has caused adverse health effects in humans. Prosthetic mammoplasty sensitivity syndrome (PMSS) is the proposed term to describe the disease processes documented in the literature that has a causal relationship to breast implants.

Healthcare for the poor and dispossessed: from Alma-Ata to the Millennium Development Goals.

Healthcare models which recognize the equity principle have had to confront the challenge of providing healthcare for the poor and dispossessed. Healthcare premised on "human rights" strives to remove/ reduce barriers to access by a complete waiver of all fees in the public sector or various other subsidies to make healthcare more affordable. Social welfare programmes are held hostage to the vagaries of the economy and resource scarcity. The Alma-Ata's primary healthcare is inherently a health development strategy which embraces a wholistic approach to health and wellness. This strategy, by refocussing on the Millennium Development Goals, can therefore accommodate the innovations required to overcome the challenges posed by technological, financial, cultural and geographical factors to provide a better quality of life for all, but moreso for the poor and dispossessed.

Satisfaction with pharmacy services and its relationships with the control of selected chronic diseases.

OBJECTIVE: To assess the level of satisfaction with pharmacy services and whether satisfaction/dissatisfaction had any effect on two common chronic diseases. Proper control of chronic diseases requires a management regime which includes promotive, preventive, curative and rehabilitative services through primary, secondary and tertiary preventive intervention measures and a wide range of support services. METHODS: A cross-sectional descriptive study with both quantitative and qualitative components was designed to collect data from among all diabetic and hypertensive patients (n = 150) attending 3 health centres in the parish of St Thomas on the days that data were being collected. The questionnaires were interviewer administered. Qualitative data were obtained from focus group discussions which explored themes related to the objectives. RESULTS: Though there was overall satisfaction with the pharmacy services studied, the level of control of the two diseases was unsatisfactory. There was no relationship between hypertension control and satisfaction with pharmacy services while the relationship with diabetes mellitus control was limited to a very weak negative association with the rating of the pharmacists' instructions on how to take the prescribed medications. CONCLUSION: "Satisfactory Pharmacy Services" could be improved by the employment of additional staff improvement in how drugs are stocked, greater availability of generic drugs and more utilization of health cards.

The need for gender specific tobacco control strategies KAP survey findings on environmental tobacco smoke exposure among women in the reproductive age group.

OBJECTIVE: The study was done to assess knowledge, attitudes and practices of women within the child bearing age with regard to smoking and exposure to environmental tobacco smoke (ETS) on children's health. SUBJECTS AND METHODS: A cross-sectional study with quantitative and qualitative components was designed to collect data from women in the child-bearing age. The sample comprised of persons from the two largest combined family planning and antenatal clinics in Kingston, Jamaica. RESULTS: The women surveyed had a fair level of knowledge about ETS health risks, negative attitudes to smoking in general, and most supported a ban on smoking in public places. Significant knowledge differences existed between young and older women and between smokers and non-smokers. CONCLUSION: Women with the highest level of knowledge were the non-smokers: of the low knowledge score group (current smokers), 50% were in the 15-24-year age range. There is a need for more public education on smoking and the consequences of environmental tobacco smoke exposure on children's health.

Ethical issues in healthcare financing.

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

Iatrogeny: why patients come to harm.

latrogeny remains a constant challenge to all members of the health team who must be made aware from the onset of their roles and responsibility to their patients with particular reference to patients' rights and well-being. Physicians, as the acknowledged leaders of the health team, have the greatest role in this respect; their training and involvement in supervising and monitoring members of their health teams must reflect an acknowledgement of this responsibility. The protection of the legacy associated with the medical profession for ethical behaviour and acting in the patient's best interest remains a challenge which must be addressed in the face of changing societal dynamics where rights and responsibilities are in a constant state of evolution. Medical schools must be at the forefront of responding to these challenges and reflect this by constant review of their training programmes.

The relationship between healthcare services and the political economy with reference to the Jamaican experience.

The availability of and equitable access to, health services have challenged healthcare providers with a greater degree of urgency since the end of World War II. Prior to that time, concepts such as equity and social justice were just that, concepts but no real attempts were ever made to operationalize them. Goods and services were still produced and distributed based on market forces, that is, one's ability and willingness to pay for something. Health in that context was a service, some say a commodity, to be bought and sold, hence its availability was not necessarily commensurate with its accessibility.

Otorrhoea - a parotid connection.

SUMMARY: A 36-year-old patient presented with an 18-month history of intermittent right parotid swelling accompanied by otorrhoea. The symptoms started subsequent to a palm leaf injury to the right ear. At right parotidectomy, a fistula connecting the right external auditory canal and the right parotid was demonstrated. A small fibrotic mass probably due to a remnant of the palm leaf was found intraoperatively. The symptoms resolved completely after the mass was excised by superficial parotidectomy, and the fistula closed spontaneously.