Office skills for the general practitioner

No Abstract

Office skills for the general practitioner

Eye disorders are relatively common. Often the initial presentation is to a general practitioner. With a few basic tools for eye examination, a general practitioner would be able to conduct an adequate ophthalmic examination and appropriately refer cases requiring specialist care.Assessment of visual acuity using a snellen chart and a pinhole can exclude refractive errors. A penlight is an inexpensive yet indispensable tool in the assessment of pupillary response, external structures as well as the anterior segment of the eye. Superficial ocular foreign bodies are relatively common. With a good technique for eyelid eversion, these foreign bodies can be easily removed. Using fluorescein stain and cobalt blue light one can appreciate corneal epithelial defects.Glaucoma is a sight threatening condition that can be effectively screened for, by using a schiotz tonometer and appropriate referrals made if the intraocular pressure is > 21 mmHg or if the optic disc is cupped.Direct ophthalmoscopy may be difficult but with a systematic approach and a few simple guidelines one would be able to adequately evaluate the posterior segment.For full text, click here:SA Fam Pract 2006;48(7):20-2

CHALLENGES IN POST GRADUATE GENERAL SURGERY TRAINING IN TANZANIA: A TRAINEE’S PERSPECTIVE

v\u3e General Surgery residency training is a complex vigorous program which includes long working hours and complex surgical cases, in order to develop and attain the knowledge and the skills the trainee needs by the end of the program. Worldwide, general surgery programs have high attrition rates and residents have identified challenges which may be work related, related to social wellbeing and/or the residency program structure. Tanzania has public and private institutions providing general surgery residency training and although most have a quality assessment program the data is not readily available. Each institution has its personalized curriculum with its unique mode of delivery, with a variety of trainee numbers and different learning environments. Understanding the challenges from a trainee perspective in our local context can help identify pitfalls and improve the quality of program deliver

Using Mirror Therapy for Stroke Rehabilitation

In the United States, strokes are known to kill over 140,000 people every year and effect mobility in more than 50 percent of stroke survivors (Centers for Disease Control and Prevention, 2020). It is a debilitating disease that befalls when blood vessels transporting nutrients to the brain are disrupted by a blood-clot or rupture of a vessel. While many rehabilitative therapies are available to those who have suffered from a stroke, there is one therapy that may benefit stroke survivors more than just conventional therapies. Mirror therapy (MT), a therapy that utilizes a mirror box to create an optical illusion, may be one way to help survivors to recover their lost motor functions. MT can aid rehabilitation by using a mirror to produce a reflection of a person’s unaffected limb in place of the affected limb when performing tasks. When the unaffected extremity is shifted, the mirror image allows the brain to believe that the affected limb is moving. These optical illusions allow the patients to feel as if their two extremities are moving symmetrically. This literature review focuses on how mirror therapy is utilized in practice today and if it should be incorporated as a conventional therapy for stroke rehabilitation. Peer reviewed journal articles have been dissected from the databases CINAHL Complete and MEDLINE. Through the review process, it was revealed that while mirror therapy on its own did not show any significant changes in overall motor functionality, mirror therapy in combination with conventional therapy has the potential to have statistically significant results

Estimating the Economic Burden of Diabetes Mellitus in Kenya: a Cost of Illness Study

Diabetes mellitus is one of the non-communicable diseases that depletes the wealth of any individual directly and indirectly due to the cost associated with treating the illness and its complications. The study aims to estimate the economic burden of Diabetes mellitus in Kenya from a societal perspective using a cost-of-illness approach. The study’s results and findings for the economic burden of diabetes mellitus in Kenya relied on the cost of illness approach. The approach identifies and measures all the costs of Diabetes mellitus, including direct and indirect costs. The 552,400 adult cases reported in 2019 resulted in a total economic cost of USD 372,184,585, equivalent to USD 674 per diabetes mellitus patient. The total direct costs accounted for the highest proportion of the overall costs at 61% (USD 227,980,126), whereas indirect costs accounted for 39% of the total economic costs (USD 144,204,459). Costs of medicines accounted for the highest costs over the total economic costs at about 29%, followed by the income lost while seeking care at 19.7%. Other costs that accounted for more than 10% of the total costs include productivity losses (19%), diagnostic tests (13%), and travel (12%). The rest of the cost categories accounted for less than 5%. Efforts should be made to reduce the costs of these medicines to enhance care. The high indirect costs reported, majorly in income lost by patients while seeking medical care, are 19%. Access to affordable health services such as diabetes mellitus education, regular blood glucose screening initiatives, and increasing local manufacturing of medicines can reduce the economic burden of diabetes mellitus and increase the health outcomes of the population and their contributions to society

Postoperative subcutaneous emphysema following percutaneous nephrolithotomy: A rare complication

Percutaneous Nephrolithotomy (PCNL) is a common urological procedure performed for complicated upper urinary tract stones. The advantages of PCNL include lower morbidity and mortality rates and quicker recovery compared to traditional open surgery. A number of complications have been reported which can be life threatening. Here we present a case of 71 years old lady, who developed subcutaneous emphysema following PCNL

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

Introduction and importance Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted

A case report of minimally invasive percutaneous ultrasound guided tuberculous iliopsoas abscess drainage in an immunocompromised patient

Introduction and importance: Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach. Case presentation: 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment in a sub-Saharan Africa. Clinical discussion: We concur with the recommendation to analyse fluid for tuberculosis in at risk individuals with minimally invasive procedures via interventional radiology as an adequate first line diagnostic and treatment option of psoas abscess. Ultrasound guided catheter placement and drainage successfully drained the abscess by day 10 similarly seen as the average duration in a case series from India. Conclusion: The importance of the role of interventional radiology in treatment for complex abdominal pathologies in sub-Saharan Africa with its ability to diagnose and treat via minimally invasive procedures at highest precision and lowest risks and complications while maintaining a high level of suspicion for tuberculosis as the underlying etiology is highlighted

Out-patient neurological disorders in Tanzania: Experience from a private institution in Dar es Salaam

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa. Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD). Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively reviewed and analyzed. Neurological disorders are categorized according to the international classification of diseases version-11(ICD-11). Results: Of the 1186 patients seen in a period of 2 years, there were 597 (50.4%) females and 588(49.6%) males, with median age (IQR) of 38 (30.0–52.0) and 42 (33.0–54.5) years respectively (p = 0.001). Headache disorders (27.0%); disorders of the nerve root, plexus or peripheral nerves (23.4%); epilepsy (9.3%), cerebrovascular disorders (8.9%); movement disorders (3.6%) and disorders of cognition (3.5%) were the primary neurological conditions encountered. Musculoskeletal disorders (7.5%) and mental/behavioral disorders (5.4%) were other conditions seen in the clinic. Conclusion: The pattern of neurological disorders in this cohort mirrors that of high-income countries. However, the manpower to tackle these conditions pales in comparison. Increasing the neurology workforce and paying extra attention to non-communicable disorders in SSA is advocated

Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review.

BACKGROUND: Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. METHODS: We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. RESULTS: Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. CONCLUSION: The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned