Open Access Review Article

Management of War Limb Injuries in the 21st Century

A. Katsaras

Asian Journal of Medicine and Health, Page 1-11
DOI: 10.9734/ajmah/2021/v19i330308

Background: War trauma includes some of the most complex injury entities that require complex techniques, often in austere settings. After body armor use and advanced resuscitation and evacuation plans, limb injuries and salvage has increased. In this article, we review the recent war injured care, regarding limb injuries.

Methods: Retrospective literature search in PubMed was conducted for articles after 2010, regarding initial limb salvage and advanced reconstruction after evacuation. 43 published articles and manuals were included in the review, so that the latest protocols be interpreted.

Results: Protocols of war surgery and extremity injuries have changed in modern warfare, as high energy weapons often cause severe limb injuries affecting multiple tissues. Of utmost importance is the thorough debridement and staged reconstruction, after optimization of injured tissue condition. In priority series, vascular, bony, nerve and soft tissue injuries have to be addressed. Reconstruction techniques must be adapted to each injury.

Conclusion: As weapons evolve and war conduction changes, medical care must constantly evolve, too, in order to meet the standard of care required to achieve extremity salvage and good functionality.

Open Access Original Research Article

Prevalence and Predictors of Use of Herbal Medication for Dermatological Conditions in South-South Nigeria

Bolaji I. Otike-Odibi, Enu Timipre, Dasetima Altraide

Asian Journal of Medicine and Health, Page 12-21
DOI: 10.9734/ajmah/2021/v19i330309

Aims:  To assess the prevalence of herbal use and factors that predispose (predictors). dermatology patients to the use of herbal preparations and medications at the Dermatology clinic of University of Port-Harcourt Teaching Hospital (UPTH), Port-Harcourt, Nigeria.

Study Design: A descriptive cross sectional design was used.

Place and Duration of Study: The Dermatology clinic in UPTH over a four-month period. (September 2020- December 2020).

Methodology: Data was collected using an interviewer administered questionnaire designed by the study researchers. It consisted of demographic characteristics, dermatologic history and participant’s awareness, use, duration of use, outcome, side-effects and cost of remedy to herbal medications as well as overall satisfaction.

Results: One hundred and seventy patients were recruited for the study over the four-month period. The age range was 1 to 75 years with mean age of 30.8years ±14.9   with a male to female ratio of 1:1.7. There were females 63.5%, with participants being mostly in their third decade 28.2%, single 65.3% with tertiary level of education 64.1%.  Most dermatologic lesions started as rashes 50.6%, itching 48.8% with the hands (48.2%) and the legs (47.6%) being the most affected parts of the body. 85% of participants were aware of herbal use and 37.6% had used them to treat dermatological lesions. Some herbs used include “gbogbonise”, ginger, garlic, paw-paw leaf, lemon, lime moringa and turmeric. Predictors for herbal use were lesions on the face and duration of skin lesions for (1-5 years).   

Conclusion: There is a high prevalence of herbal use for dermatologic conditions in this locality with a female preponderance. Healing of dermatological lesions with the herbs was not recorded.  Duration of skin lesion and lesion location on the face were identified predictors of herbal use for dermatologic conditions in this locality. This study is important because it shows that people are interested in herbal treatments and8 are looking for suitable alternatives to medicinal oral and topical therapies.   

Open Access Original Research Article

Infectious Waste Management in the Face of COVID-19 in a Rural Health Facility in Eastern Uganda

Okia David, Iramiot Jacob Stanley, Kagoya Kawala Enid, Nekaka Rebecca, Karungi Veronica, Musoki Drake, Oteko Alfred, Nakisuyi Janet, Aisu Emmanuel

Asian Journal of Medicine and Health, Page 22-36
DOI: 10.9734/ajmah/2021/v19i330310

Aim: This study aimed to assess Infectious Waste Management in face of COVID-19, among Health care workers in Rural Health Facilities in Amuria district, Eastern Uganda. Little evidence exists of the challenges that occur while implementing Infectious waste management in the face of COVID-19 in resource-limited settings in Eastern Uganda. Our findings will close this apparent research gap and inform current district and national policies in Infectious Waste Management.

Materials and Methods: We conducted cross-sectional survey in five health facilities in Amuria district, using modified CDC Infection Control Assessment Tool for health facility, and a validated structured questionnaire  to assess the knowledge of health care workers present on Infectious waste management in the face of COVID-19. Observation and in-depth interviews were also conducted in addition to assess the practice and attitude of staff towards infectious waste management.

Results: The five (100%) of the Health Facilities assessed in Amuria district lacked written infection prevention policies and procedures that are current, and are based on evidence-based guidelines. The facilities also had no competency-based training program that provides job-specific training on infection prevention policies and procedures to health care personnel. In terms of knowledge, Waste handlers had poor knowledge in infection control only 8.3% of the medical waste handlers could identify biohazard symbols and knew how infectious waste is segregated into the different categories at the point of generation. All (100%) of the health care workers were knowledgeable about the COVID-19 standard operating procedures.

Conclusion: The doctors, nurses, clinical officers, and laboratory personnel had good knowledge of infectious waste Management and were up to date with COVID-19 standard operating procedures. The Medical Waste handlers had poor knowledge of Infectious Waste Management and COVID-19 standard operating procedures. Medical Waste handlers also had a poor attitude, towards the use of personal protective gear while on duty. All the Medical Waste handlers were willing to be trained in Infectious Waste Management. The facilities assessed had no enabling environment for infection control (no policies and in-service training in infection control for staff).We recommend Medical Waste Handlers to be trained in infection control and prevention before and after they are employed.

Open Access Original Research Article

Alcohol Related Facial Injuries

Nwashindi Arthur, E. M. Dim

Asian Journal of Medicine and Health, Page 49-56
DOI: 10.9734/ajmah/2021/v19i330313

Aim: Consumption of alcohol plays a key role in traumatic injuries The capacity of alcohol to distort human cognitive ability and reasoning makes it an important factor in the causation of motor vehicle and interpersonal violence-related injuries The aim of this study was to investigate the role of alcohol in severe facial injuries in settings of motor vehicular crashes and interpersonal violence.

Study Design: A prospective study of 118 patients who suffered alcohol-related facial injuries.

Place and Duration of Study: The study was conducted at the University of Uyo teaching hospital Uyo, Nigeria over a 5-year period, from January 2007 to January 2021.

Methodology: The variables analyzed included socio demographics, nature of injury and sites of injuries. Alcohol Use Disturbance Identification Test (AUDIT test) was used to identify risks and damages of alcohol use and dependence. Data analysis was done using SPSS version 21.0. Multivariate analysis was carried out using binary logistic regression analysis, P = 0.05 was considered to be statistically significant.

Results: A total of 118 patients suffered alcohol-related facial injuries in the period of the study. There were 97 males and 21 females, giving a male to female ratio of 4:1 The mean age  of the patients’ population was  43 .The commonest age range involved in alcohol-related facial injuries was 29-38 years. Road traffic injuries were the commonest cause of facial injuries.  Medium risk alcohol consumption and male gender were identified as risk factors for  moderate and severe injuries  as well as for avulsive injuries.

Conclusion: Alcohol-related injuries often turn out severe, and the identifiable risk factors include male gender, high-risk alcohol consumption and road traffic crashes.

Open Access Original Research Article

Liver Profile of Artemether-lumefantrine-tinidazole in Healthy and Parasitized Mice

Elias Adikwu, Udeme Owunari Georgewill

Asian Journal of Medicine and Health, Page 57-63
DOI: 10.9734/ajmah/2021/v19i330314

Artemether/lumefantrine/tinidazole (A/L/T) has shown additive antiplasmodial activity; therefore its safety assessment is imperative. This study examined its hepatotoxic effect on healthy and diseased mice. Fifty four Swiss albino mice of n=6 were used. The mice were diseased with Plasmodium berghei ( ) and treated with T (28.6 mg/kg), A/L (2.3/13.7mg/kg) and A/L/T for 4 days, respectively. Healthy mice were treated with T (28.6 mg/kg), A/L (2.3/13.7mg/kg) and A/L/T for 28 days, respectively. After drug treatment; the mice were weighed and anesthetized. Liver samples were excised, weighed and evaluated for oxidative stress indices and histology. Blood samples were assessed for serum liver function indices. Treatment with T, A/L and A/L/T produced no significant (p>0.05) effects on all evaluated parameters in parasitized mice when compared to control. Significant decrease in body weight with significant increase in liver weight occurred in healthy mice treated with A/L (p<0.05) and A/L/T (p<0.01) when compared to control. Impaired liver function  characterized by significantly increased serum aminotranferases, alkaline phosphatase, lactate dehydrogenase, gamma-glutamyl transferase, and bilirubin levels with significantly decreased total protein and albumin levels occurred in healthy mice treated with T (p<0.05), A/L (p<0.01) and A/L/T (p<0.001) when compared to control. Significantly decreased glutathione peroxidase, superoxide dismutase, glutathione, and catalase levels with significantly increased malondialdehyde levels occurred in healthy mice treated with T (p<0.05), A/L (p<0.01) and A/L/T (p<0.001) when compared to control. A/L/T caused hepatocyte necrosis in healthy mice. The use of A/L/T for malaria treatment seems safe on the liver, but may impair liver function with prolonged use. 

Open Access Original Research Article

Breast Self Examination and Cancer Awareness among Female Staff in Federal Medical Center, Yenagoa, Bayelsa State (Knowledge and Practice)

Y. E. Oku, E. O. Orieno, N. O. Micah, E. U. Eric, I. William-Ebil, E. J. Akpan, J. O. Iyabi-Allagoa, E. A. Olowu

Asian Journal of Medicine and Health, Page 64-77
DOI: 10.9734/ajmah/2021/v19i330315

Breast self-examination (BSE) is a recommended technique in medical science for early detection of breast cancer. It is a simple technique with no specific equipment and no cost implication. It has been shown to improve breast health awareness and thus detect potential abnormalities in the breast.  It should be practiced by all women (or females known to be more at risk) from the moment the breast is developed.

The aim of this study was to assess the knowledge and practice of BSE in relation to breast cancer awareness among female staff in Federal Medical Center, Yenagoa, Bayelsa State.

Methods: A simple random technique was used to select a total of 411 female staff from different departments of the hospital. The data were collected using structured pretested questionnaire.  Descriptive statistical method and correlation method was employed to analyze the variables.

Results: The findings of this study revealed that 369(89.8%) had knowledge of BSE. It also revealed that 210 (51.1%) about half of the total number practice BSE regularly. Majority of the respondents, 187 (45.5%) heard of BSE through awareness programme. There was a statistical significant association between knowledge of breast self- examination and its practice.

Conclusion: The study revealed that majority of the respondents had knowledge of BSE but the practice of BSE was poor. Knowing when to perform, how to perform, position to perform and confidence of what to look for during BSE were seen as a major issue or objective determinant of successful examination, in this study.

Therefore, there is need for intensified sensitization programmes to address knowledge and the practice of BSE among females in Yenagoa, Bayelsa State.

Open Access Policy Article

Evaluating the Use of 90-90-90 for HIV Policy in the Asian Context

Richard M. Grimes, Deanna E. Grimes

Asian Journal of Medicine and Health, Page 43-48
DOI: 10.9734/ajmah/2021/v19i330312

UNAIDS recommends the 90-90-90 policy for controlling HIV infection (identify 90% of HIV cases, provide care for 90% of these, and have 90% of the treated achieve viral suppression). 90-90-90 requires an accurate measurement of HIV prevalence, which is impossible to achieve. Prevalence must be estimated. Customarily, 90-90-90 prevalence estimates are based on point estimates at the midpoint of a credible range of high and low estimates. This paper examines the effect of the high and low estimates on 90-90-90. We examined the impact on policy goal based on 90% of the point estimate, if the true prevalence were the credible range’s high or low estimate. This was calculated for 14 Asian Countries (Afghanistan, Cambodia, Indonesia, Iran, Kazakhstan, Laos Malaysia, Myanmar, Nepal, Pakistan, Philippines Thailand, Uzbekistan, Viet Nam) that UNAIDS estimated point prevalence of prevalence greater than 10,000 persons. If the low estimate for the 14 countries was the true prevalence, 11 of the countries could not achieve 90% of the point estimate because the low prevalence was less than 90% of the point estimate. The other three countries, would have to identify 97.5% to 99.0% of infected persons to achieve 90% of the point prevalence. If the true prevalence is the high estimate, twelve of the countries would have identified only 76.8% to 84.9 of the true prevalence. Afghanistan (26.0%) and Iran (40.8%) would have identified far fewer persons than the point estimate goal. Therefore 90-90-90 should be considered to be non-evaluable and should not be used for policy making.

Open Access Case Study

Disseminated Peritoneal Leiomyomatosis: A Case Report of an Incidental Finding During an Emergency Caesarean Section and a Review of the Literature

Awosusi, Babatope Lanre, Adegoke, Omolade Oluwafadekemi, Nwanji, Ifeanyichukwu Dupe, Oni, Fola

Asian Journal of Medicine and Health, Page 37-42
DOI: 10.9734/ajmah/2021/v19i330311

Aim: To present the case report of an incidental finding of disseminated peritoneal leiomyomatosis (DPL) found during an emergency caesarean section in a young Nigerian woman who presented with slow progress in labour and maternal exhaustion.

Presentation of Case: We present the case of a 35-year-old unbooked primigravida with previous myomectomy who presented with maternal exhaustion and slow progress in labour and subsequently had an emergency lower segment caesarean section. At surgery, multiple firm to hard nodules of varying sizes were seen scattered throughout the peritoneum. Histological examination and immunohistochemical analysis of the nodules showed features consistent with disseminated peritoneal leiomyomatosis. Clinical and radiological follow-up for 1 year was uneventful.

Discussion: DPL is a rare benign smooth muscle tumour that clinically and macroscopically simulates disseminated intra-abdominal or pelvic malignancy. It occurs predominantly in women of child bearing age and is mostly discovered incidentally. The occurrence of DPL in association with pregnancy and uterine leiomyomas was also corroborated in this index case as pedunculated and intramural uterine nodules were also seen during surgery.

Conclusion: Disseminated peritoneal leiomyomatosis is a rare benign disease which may be misdiagnosed as disseminated or metastatic intra-abdominal malignancy. Therefore, a high index of suspicion is required for accurate diagnosis and proper management.