Meditation as primary intervention strategy in prevention of cardiovascular diseases

Heart diseases especially Hypertension, Coronary Artery Diseases (CAD) and stroke are the leading causes of death all over the world. Hostility, anxiety, depression and increased reactivity to mental stress have been strongly associated with hypertension and CAD. Mental stress or anxiety causes increased sympathetic activation and poor vagus nerve control over heart.  Imbalance between sympathetic and parasympathetic nervous system leads to vasospasm and has been associated with Hypertension, Coronary Artery Disease and Myocardial Infarction. Psychosocial stress has also been found to be responsible for imbalance in autonomic nervous system, causing sympathetic dominance over parasympathetic leading to acute coronary events. Meditation is a process of self-contemplation and purification of mind. Practitioner of meditation brings about desirable changes in their behaviour and lifestyle. During Meditation sympathetic activity is reduced and there is parasympathetic dominance over sympathetic. During meditation and after meditation person feels calm, quiet and relaxed. Meditation causes decrease in metabolic rate. The blood pressure may come to normal or falls, pulse rate comes to normal or low, vascular spasm if any, is reduced and myocardial perfusion increase. Thus meditation helps in preventing hypertension, coronary artery disease and other cardiac events.  This may be beneficial before a person gets coronary event and post-myocardial infarction.   In view of the beneficial effects of meditation, it may be introduced as primary intervention strategy in preventing Cardio-vascular Diseases. We did this review study to find out: (1) Can meditation bring about desirable changes in human mind and body in post-intervention group compared to control group? (2) Its effectiveness in prevention of heart diseases like hypertension, coronary events and post-MI complications. This review included all randomised controlled trials on patients above 18 years, both sexes, any setting with medication & meditation or meditation, Controlled group was on medication alone. Clustered and crossover studies were excluded

Advanced abdominal pregnancy with dead foetus: a case report

Abdominal pregnancy is a rare form of ectopic pregnancy in which the zygote implanted within the peritoneal cavity exception at ovaries, fallopian tubes and intra ligament spaces. The diagnosis is challenging and can be missed especially when the imaging facilities are not available in remote areas.A 35 years old, G3P2+0 was admitted to the hospital at 38+2 weeks of pregnancy with the chief complaint of reduced foetal movement for three days. She was taking regular antenatal care with the midwife at the rural health centre and uneventful until 37 weeks of pregnancy. On physical examination, the abdomen was distended, the foetal parts were easily palpable, no visible foetal movement and the foetal heart sound was not audible. Abdominal ultrasound scan identified the term foetus of abdominal pregnancy without foetal cardiac activity. The patient underwent laparotomy and dead, male foetus was extracted uneventfully. The placenta was attached to intestines and mesentery so that which was removed with great caution and secured haemostasis. The mother’s condition was stable throughout the operation and did not need to give the blood transfusion. The sutures were removed after 7 days and the healthy patient discharged from the hospital.Abdominal pregnancy is a rare condition and the diagnosis can be missed during the antenatal period and hence it is crucial to raise the awareness of health care personals especially in remote areas. The suspicious case of abdominal pregnancy should be referred to the experienced clinicians in the centres with diagnosis facilities

Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis – Meta-analysis

Traumatic endophthalmitis is a devastating condition that can occur following an open globe injury and result in loss of vision. The use of prophylactic antibiotics is empirical as most surgeons fear complications associated with the same. No systematic review has been performed in English on the role of intravitreal/intracameral antibiotics in preventing traumatic endophthalmitis. We searched for randomized controlled trials and controlled clinical trials comparing intracameral/intravitreal antibiotics with placebos on PubMed, Google Scholar, Science Direct, and Cochrane Library using keywords open globe/trauma/penetrating/perforating injuries endophthalmitis. The last search was on 5 May 2017. We included patients of all ages with open globe injuries who received intracameral/intravitreal antibiotics, regardless of the dose. Quality of the trials was assessed using Cochrane collaboration tools to assess the risk of bias. The main outcome measures were endophthalmitis and visual acuity. We included three trials. Overall, intravitreal/intracameral antibiotics were noted to significantly reduce the occurrence of endophthalmitis in open globe injuries (relative risk [RR] 0.19, 95% confidence interval [CI] 0.06–0.57). The use of intravitreal/intracameral antibiotics did not have an effect in improving visual acuity (RR 1.17, 95% CI 0.61–2.23). Two trials (Narang 2003; Soheilan 2001) were observed to have no significant effect on visual acuity while another trial (Soheilan 2007) did not list visual acuity as part of its objectives. Intracameral/intravitreal antibiotics reduce the risk of endophthalmitis in open globe injuries; although, there was no improvement in the visual acuity. We, therefore, recommend the use of intravitreal/intracameral injections in open globe injuries to prevent this devastating complication

Vitreous loss-causes, associations, and outcomes: Eight-year analysis in Melaka Hospital

BACKGROUND: Cataract surgery is associated with a variety of complications, one of which is vitreous loss. Doctors and policymakers should be aware about the precipitating factors, associations, and expected outcomes of vitreous loss. This study was, therefore, undertaken to set guidelines to improve the visual outcomes of patients. MATERIALS AND METHODS: A retrospective 8-year analysis was conducted from 2007 to 2014 using the national eye database. Demographic features, ocular comorbidities, grade of surgeon, type of surgery, and the associations with the occurrence of vitreous loss, and the final visual outcomes of these patients were studied. RESULTS: Out of 12,992 eyes, only 3.2% had vitreous loss, mostly aged <40 years. Pseudoexfoliation was the only ocular comorbidity causing vitreous loss. Medical Officers and Gazetting Specialists got more vitreous loss compared to specialists. Intracapsular cataract extraction, phaco convert to extracapsular cataract extraction (ECCE), ECCE, and phaco all had a significant vitreous loss. Vitreous loss was the most significant intraoperative complication causing poor vision and resulted in impaired or poor visual outcome. CONCLUSION: Vitreous loss occurred in almost all types of cataract surgeries, especially by junior surgeons, among those aged <40 years and significantly caused poor visual outcome compared to other complications. Pseudoexfoliation had higher occurrence of vitreous loss. Vitreous loss patients had impaired/poor visual outcome due to preexisting comorbidity and astigmatism. Patients at risk and junior surgeons should be closely monitored to improve outcomes. Further studies need to be done to see why and when the vitreous loss occurred

The Melaka Hospital cataract complications study analysis of 12,992 eyes

Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication

Comparative study on the measurement of learning outcomes after powerpoint presentation and problem based learning with discussion in family medicine amongst fifth year medical students

Background: Learning outcomes after traditional teaching methods were compared with problem-based learning (PBL) among fifth year medical students. Six students participated each in traditional teaching and PBL methods, respectively. Traditional teaching method involved PowerPoint (PPT) presentation and PBL included study on case scenario and discussion. Both methods were effective in improving performance of students. Postteaching, we did not find significant differences in learning outcomes between these two teaching methods. Aims: (1) Study was conducted with an intention to find out which method of learning is more effective; traditional or PBL. (2) To assess the level of knowledge and understanding in anemia/zoonotic diseases as against diabetes/hypertension. Settings and Design: All the students posted from February 3, 2014, to March 14, 2014, participated in this study. Six students were asked to prepare and present a lecture (PPT) and subsequent week other six students were asked to present PBL. Both groups presented different topics. Since it was a pre- and post-test, same students were taken as control. To maintain uniformity and to avoid bias due cultural diversity, language etc., same questions were administered. Materials and Methods: After taking verbal consent, all 34 students were given pretest on anemia and zoonotic diseases. Then lecture (PPT) by six students on the same topic was given it followed by posttest questionnaire. Subsequent week pretest was conducted on hypertension and diabetes. Then case scenario presentation and discussion (PBL) was done by different six students followed by posttest. Both the methods were compared. Statistical Analysis: Analysis was done manually and standard error of means and students t-test was used to find out statistical significance. Results: We found statistically significant improvement in performance of students after PPT presentation as well as PBL. Both methods are equally effective. However, Pretest results of students in anemia and zoonotic diseases (Group A) were poor compared to pretest results of students in hypertension and diabetes (Group B). The students who participated in presentation did not influence their performance as they were covering a small part of the topic and there were no differences in their marks compared to other students. Conclusions: We did not find significant differences in outcome after teaching between PBL and traditional methods. Performances of students were poor in anemia and zoonotic diseases which need remedial teaching. Assessment may influence retention ability and performance

Meditation as primary intervention strategy in prevention of cardiovascular diseases

Heart diseases especially Hypertension, Coronary Artery Diseases (CAD) and stroke are the leading causes of death all over the world. Hostility, anxiety, depression and increased reactivity to mental stress have been strongly associated with hypertension and CAD. Mental stress or anxiety causes increased sympathetic activation and poor vagus nerve control over heart.  Imbalance between sympathetic and parasympathetic nervous system leads to vasospasm and has been associated with Hypertension, Coronary Artery Disease and Myocardial Infarction. Psychosocial stress has also been found to be responsible for imbalance in autonomic nervous system, causing sympathetic dominance over parasympathetic leading to acute coronary events. Meditation is a process of self-contemplation and purification of mind. Practitioner of meditation brings about desirable changes in their behaviour and lifestyle. During Meditation sympathetic activity is reduced and there is parasympathetic dominance over sympathetic. During meditation and after meditation person feels calm, quiet and relaxed. Meditation causes decrease in metabolic rate. The blood pressure may come to normal or falls, pulse rate comes to normal or low, vascular spasm if any, is reduced and myocardial perfusion increase. Thus meditation helps in preventing hypertension, coronary artery disease and other cardiac events.  This may be beneficial before a person gets coronary event and post-myocardial infarction.   In view of the beneficial effects of meditation, it may be introduced as primary intervention strategy in preventing Cardio-vascular Diseases. We did this review study to find out: (1) Can meditation bring about desirable changes in human mind and body in post-intervention group compared to control group? (2) Its effectiveness in prevention of heart diseases like hypertension, coronary events and post-MI complications. This review included all randomised controlled trials on patients above 18 years, both sexes, any setting with medication &amp; meditation or meditation, Controlled group was on medication alone. Clustered and crossover studies were excluded

Medical students' reflection on the family planning services at primary health clinics in Malaysia

Context: Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community. Aims: The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia. Settings and Design: This was qualitative study. Subjects and Methods: This qualitative study used the data of the students' reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software. Statistical Analysis Used: Thematic analysis. Results: Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning. Conclusions: To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia

Essential Thrombocythemia Complicated with Acute Myocardial Infarction

Aims: Essential thrombocythemia or thrombocytosis is an uncommon disease. It involves an overproduction of megakaryocytes in the marrow. These platelets may not function normally and can cause a blockage in blood vessels and other complications. We report one case of essential thrombocytosis with different clinical presentations. Presentation of Case: A 50 year old gentleman came to Hospital and admitted with the diagnosis of Acute Myocardial Infarction. Further investigation via Full Blood Count revealed Essential Thrombocytosis. Management with PCI (Percutaneous Coronary Intervention) and discharged with hydroxyurea. Discussion: We treated our patients with aspirin and hydroxyurea. As similarly noted in follow up of blood complete picture shows that it reduced the platelet count and patient showed much improvement. Conclusion: This case is reported because it is not a common disease and to demonstrate that routine examination of blood complete picture is very important