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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 13 | Issue 3
Page Nos. 137-180

Online since Wednesday, September 2, 2020

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REVIEW ARTICLE  

Functional restoration after peripheral nerve lesion: Nerve repair strategies, tendon transfer and free muscle transfer Highly accessed article p. 137
Christine Radtke
DOI:10.4103/HMJ.HMJ_43_20  
Traumatic peripheral nerve injuries are a major and frequent clinical problem, and surgical repair has challenges. For the achievement of optimal functional preservation and restoration of function, an early diagnosis with appropriate therapy is critical. In the European Union, over 300,000 cases of peripheral nerve injuries are reported annually. In addition to trauma, tumour infiltration or neuroma resection can result in severe peripheral nerve damage and even complete functional deficit of an affected extremity. While repair of the brachial plexus and long defect injuries has significantly improved over the past few decades, a number of challenges remain. The current gold standard in peripheral nerve surgical repair is the use of a tension-free end-to-end suture. When there is an extensive loss of nerve tissue with a resulting nerve gap, tension-free end-to-end-suture is not possible. In these cases, autologous nerve transplantation is performed. Updated technology including new microsurgical equipment and materials has expanded surgical options to reconstruct these highly complex nerve injuries. These surgical options include neurolysis, nerve grafting, neurotisation, tendon transfer and functional muscle transfer. Here, several surgical techniques will be presented that have consistently provided good results in our patients who require surgical reconstruction after nerve injury.
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ORIGINAL ARTICLES Top

Maternal mental health and infant feeding practices cohort protocol: Methodology and baseline characteristics p. 141
Hadia Radwan, Randa Fakhry, Wegdan Bani issa, Nivine Hanach, Reyad Shaker Obaid, Moez Al Islam E. Faris, Suad Al Marzooqi, Hessa Al Ghazal, Mahmoud ElHalik, Diana DSuza, Marwa Al Hilali, Rana Rayess, Noor Nazem Shihadeh, Cindy-Lee Dennis
DOI:10.4103/HMJ.HMJ_13_20  
Objectives: The objectives of the current work are to describe the maternal mental health and infant feeding practices cohort design and methodology and to report the baseline sociodemographic characteristics of the participants. Materials and Methods: This 6-month prospective cohort study recruited women from post-partum wards in hospitals in the United Arab Emirates (UAE). Participants were contacted at three timelines (at delivery, at 3- and 6-month postpartum). Questionnaires with validated tools were used to collect sociodemographic characteristics, maternal and infant anthropometry, breastfeeding practices, breastfeeding self-efficacy, postnatal depression and anxiety. Results: Four hundred and fifty-seven participants with their newborns were recruited. The majority were Emiratis and Arabs (71%), multiparous (77.2%) and not working (60%). About 7.7% of the infants had low birth weight and 3.9% were macrosomic. Most women received Kangaroo care (84.5%) and rooming-in (93.0%). Only 70% of the women initiated breastfeeding and 24.3% planned to breastfeed exclusively as long as possible. The prevalence of maternal post-partum anxiety was high (70%), and 25% of the participants had major/high depressive symptomatology. Overall, participants showed a high level of breastfeeding self-efficacy and the majority perceived receiving great support from parents, spouses, in-laws, family and friends. Conclusions: This article presents the design and methodology of one of the pioneer cohorts in the Middle East and Gulf region investigating maternal mental health and its relation to breastfeeding practices and providing recent evidence for the prevalence of PPD. The results of this study will highlight the significance of maternal psychosocial factors on breastfeeding practices in the UAE.
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Acid-neutralising capacity and pharmacoeconomic studies of commercially available antacids in the Qassim Region of Saudi Arabia p. 150
Danish Mahmood, Sulaiman Alnaseer, Bala Yauri Muhammad, Habibullah Khalilullah, Mahfoudh A M Abdulghani, Md Jamir Anwar, Sattam K Alenezi, Mohammad Haider, Nasra Elleban
DOI:10.4103/HMJ.HMJ_10_20  
Background: Antacids are common over-the-counter medications for relief in common dyspeptic symptoms. However, antacid use has decreased with the availability powerful acid suppressant medications such as histamine H2 blockers, proton-pump inhibitors and prostaglandin analogues. Of late, a resurgence in the usage of antacids has been noted because of the improved profiles of newer antacid formulations, for example, the addition of pain-relieving component, oxetacaine (a local anaesthetic), anti-flatulent (alginate base compounds), in some antacid preparations. Aims and Objectives: The study investigated the efficacy (in terms of acid-neutralising capacity [ANC]) and cost-effectiveness of commercially available antacid formulations (both liquid and solid formulations). Materials and Methods: ANC was carried out using simple titrimetric methods and cost-effectiveness of antacid preparations was based on cost (in Saudi riyal) per milliequivalents of the acid neutralised. Results: ANC/gram was highest for antacid A1 (Moxal Plus solid) and lowest for antacid A3 (Fawar effervescent powder). The ANC/gram varied greatly among different antacid products and it ranged from 3.48 to 13.18. In general, solid antacids showed a high ANC/gram compared to the liquid antacids. Furthermore, solid antacids were also found to be cost-effective compared to liquid dosage forms. In terms of efficacy, the newer antacid containing simethicone (A1) was found to be more cost-effective followed an antacid containing calcium carbonate (A2) and magnesium carbonate. Conclusion: In conclusion, mentioning ANC on antacid formulation labels may help to guide the choice of appropriate antacid, while cost-effectiveness study would govern the prescribing pattern of an antacid.
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Opinions of general practitioners on the barriers faced during care of cancer patients: A pilot study p. 156
Suresh Rao, Krishna Prasad, Sanath Hegde, Pratima Rao, Rajesh Shetty, Nikku Mathew Geevarghese, Manjeshwar Shrinath Baliga
DOI:10.4103/HMJ.HMJ_5_20  
Background: General practitioners (GPs) are an important component and are the backbone of health-care system in rural areas of India. For the first time, an attempt is made to understand the opinions and barriers faced by GPs in the care of cancer patients and survivors from India. Materials and Methods: This was a prospective study and was conducted with GPs who had registered for continuing medical education programmes conducted by Mangalore Institute of Oncology, a Superspeciality Hospital in the West Coast of Karnataka State in India. The GPs attending the programme were requested to fill a questionnaire that addressed their opinions and barriers in taking care of cancer patients. The accrued data were subjected to frequency and percentage. In addition, the data were stratified on the basis of domicile of practice (rural vs. city) and subjected to Chi-square analysis. P < 0.05 was considered statistically significant. Results: The results indicated that the majority of the GPs opined that they were more comfortable in caring for people with general illness. The GPs agreed that lack of diagnostic and treatment facilities, qualified workforce and coordinating with oncologists were of concern (P < 0.05–0.0001). They also opined that training and assistance by oncologists and specialists would be of help in the care of survivors residing in rural areas. Conclusions: The study, for the first time, addresses the opinion and barriers GPs face in the care of cancer patients in India. Although preliminary, the results will provide an important direction for the policy-makers and the health-care fraternity for developing more effective strategies towards the care of cancer patients, principal living in rural areas.
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CASE REPORTS Top

Desmoplastic small round cell tumour: A case report of a rare abdominopelvic malignancy p. 162
Farhan Asif Siddiqui, Bayan F Al-Ghadeer, Yusef Al-Marzooq, Othman Almohammedsaleh, Abdulmottaleb Al-Dandan
DOI:10.4103/HMJ.HMJ_48_19  
Desmoplastic small round cell tumour (DSRCT) is an aggressive, rare tumour mainly affecting young males. DSRCT and other small round cell tumours have some akin characteristics. It generally presents with non-specific features which can be easily missed. The possibility of DSRCT should always kept in mind whenever a patient presents with vague abdominal manifestations and radiological sign of diffusely spreading intra-abdominal malignancy. The authors take this opportunity to report a case of DSRCT occurring in a 22-year-old male, for its rare occurrence.
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Neuromesenchymal hamartoma of the small bowel – A true rare entity or non-specific changes? p. 166
Farhan Asif Siddiqui, Yusef Al-Marzooq, Jawad Al-Khalaf, Mohammed Yousef Al-Marzooq
DOI:10.4103/HMJ.HMJ_88_19  
Neuromesenchymal hamartoma of the small bowel is a rare hamartomatous lesion. It is well documented in the literature, but due to its very rare occurrence and non-specific clinical features, it can be easily missed. The primary question into debate is whether neuromesenchymal hamartoma a separate entity or just another phase of inflammatory diseases such as Crohn's disease. The authors take this opportunity to report a case of neuromesenchymal hamartoma occurring in the small bowel of a 46-year-old female, without any prior or associated chronic medical conditions, for its rare occurrence.
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Balloon angioplasty treatment in inferior acute coronary syndrome secondary to undiagnosed papillary fibroelastoma p. 169
Anas Mohmoud Abbas, Azan Salem BinBrek, Sam Codampallil Benny, Omar Yousef Al-Assaf
DOI:10.4103/HMJ.HMJ_6_20  
A patient presented with typical cardiac chest pain on electrocardiogram (ECG) was found to have a ST-elevation myocardial infarction. Coronary angiography found normal coronary arteries; however, the symptoms and ECG findings were cause by an undiagnosed papillary fibroelastoma externally occluding the coronary artieries. Treatment was done via a balloon angioplasty and later by surgery.
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Supernumerary maxillary canine in non-syndromic patient: A rare case report p. 172
Haif Abdulaziz Alqahtani, Wael M Talaat
DOI:10.4103/HMJ.HMJ_17_20  
Supernumerary teeth or hyperdontia are defined as any tooth or odontogenic structure developed in addition to the number found in a normal dentition. The literature describes the etiology of supernumerary teeth as multifactorial including both environmental and genetic factors. Early diagnosis is crucial to avoid the risk of complications, especially when combined with an earlier removal if needed. The supernumerary canine is an extremely rare finding especially when found as unilateral This case report presents a 42-year-old male patient, non-syndromic with the unique feature of unilateral supernumerary canine.
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LETTERS TO EDITOR Top

Closing the feedback gap: Making the students to act upon p. 176
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_81_19  
Feedback is an important dimension of learning and is bound to deliver effective gains. It is important to understand that feedback should be more work for the recipient than the provider. The given feedback should aim to close the gap between the work done by the students earlier and the actual expected level of performance. In fact, a wide number of techniques have been specified to close the feedback gap and any of these approaches can be tried by the faculty members based on their convenience and feasibility and the existing gaps can be closed. In conclusion, all the teachers should not only aim to give feedback but also ensure that the feedback gap is bridged. This essentially requires making the students to work in the right direction by triggering critical thinking and reflective behaviour.
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Improving the health and safety standards of sanitation workers: Global perspective p. 178
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/HMJ.HMJ_89_19  
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Radiographic assessment of cardiothoracic ratio in apparently healthy adults in Maiduguri p. 180
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/HMJ.HMJ_90_19  
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