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   Table of Contents - Current issue
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May-June 2018
Volume 38 | Issue 3
Page Nos. 91-136

Online since Friday, June 1, 2018

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ORIGINAL ARTICLES  

Prioritizing factors affecting the hospital employees' productivity from the hospital managers' viewpoint using integrated decision-making trial and evaluation laboratory and analytic network process p. 91
Ardalan Feili, Amir Khodadad, Ramin Ravangard
DOI:10.4103/jmedsci.jmedsci_140_17  
Objectives: This study aimed to identify and prioritize factors affecting the hospital employees' productivity from the viewpoint of hospital managers working in the teaching hospitals affiliated to Iran, Shiraz University of Medical Sciences, in 2017. Materials and Methods: This was an applied, cross-sectional, and descriptive-analytical study conducted in 2017 in all teaching hospitals affiliated to Iran, Shiraz University of Medical Sciences. After identifying factors affecting hospital employees' productivity using the results of previous studies, all hospital managers (56 managers) were selected as the study population using census method to prioritize the factors. The decision-making trial and evaluation laboratory (DEMATEL) and analytic network process (ANP) techniques were used for analyzing the collected data through Excel 2010 and Super Decision 2.8. Results: Fifteen factors affecting employees' productivity were determined using the results of previous studies which were classified into four clusters. The results of DEMATEL technique showed that “employees' attitude toward the organization” was the most affecting factor (r = 11.928) and also the most affected factor (c = 12.120), as well as the most important factor affecting the employees' productivity (r + c = 24.048). In addition, the results of ANP showed that the cluster of “leadership and management styles” (relative weight [RW] = 0.274) and its factors, especially “involving employees in the decision-making processes” (L1) (RW = 0.102) and “delegation of authority to the employees” (L2) (RW = 0.100) were the most important factors affecting the employees' productivity. Conclusion: According to the results, adopting an appropriate leadership style and providing participatory management, involving the employees in the hospital decision-making processes, etc., had significant effects on the increases in the employees' motivation and productivity.
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Effects of Colocasia esculenta leaf extract in anemic and normal wistar rats p. 102
Silas Anayo Ufelle, Kenechukwu Chibuike Onyekwelu, Samuel Ghasi, Charles Ogbonna Ezeh, Richard Chukwunonye Ezeh, Emmanuel Anayochukwu Esom
DOI:10.4103/jmedsci.jmedsci_80_17  
Background and Objective: Colocasia esculenta is a tropical plant primarily grown for its edible starchy corm. It is a food staple in African, Oceanic, and South Indian cultures and is believed to have been one of the earliest cultivated plants. This study was aimed at investigating the hematological effects of C. esculenta leaf extract in anemic and normal Wistar rats. Materials and Methods: Wistar rats (n = 30), aged 2–3 months, weighing 160–220 g, were categorized into five groups (A to E). Groups A and B were orally induced with 1.35 mg/kg bodyweight of methotrexate for anemia. Graded doses of the extract were administered to Groups A to D (A = 300, B = 600, C = 300, and D = 600 mg/kg bodyweight) for 14 days. Group E served as control. Blood samples (3.0 ml) were collected on days 8 and 15 into tri-potassium ethylenediaminetetraacetic acid containers and analyzed using an hematological autoanalyzer (Sysmex KX-21N) following manufacturer's guidelines. Results: The acute toxicity test revealed an oral LD50of 6000 mg/kg bodyweight. On day 8, Groups A and B revealed significant decrease (P < 0.005) in hemoglobin (Hb), hematocrit (Hct), and red blood cell (RBC) count compared to that of control. On day 15, Group B revealed significant increase (P < 0.005) in total white blood cell (TWBC) count; Groups C and D revealed significant increase (P < 0.005) in Hb, Hct, RBC, and TWBC compared to that of control. Conclusions: This study revealed dose- and time-dependent increase in Hb, Hct, and RBC in normal Wistar rats and leukocytosis in both normal and anemic Wistar rats by crude methanolic extract of C. esculenta leaves. These indicate hematopoiesis in normal Wistar rats.
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Dosimetric effect of the gantry rotations of a novel trunk phantom using an area integration algorithm p. 107
Michael Onoriode Akpochafor, Akintayo Daniel Omojola, Muhammad Yaqub Habeebu, Samuel Olaolu Adeneye, CB Madu, ME Ekpo, Moses Adebayo Aweda, Temitope Aminat Orotoye
DOI:10.4103/jmedsci.jmedsci_113_17  
Background: Treatment planning systems (TPSs) have proved to be a useful tool in predetermining how a treatment outcome will be in radiotherapy. The accuracy of any TPS to calculate dose to any arbitrary point within a material is largely dependent on the mathematical algorithm used. Aims: The purpose of this study was to design a local trunk phantom and use the phantom to check the percentage dose accuracy of the Area Integration Algorithm of a Precise PLAN 2.16 TPS if it is in agreement with results obtained from manufacturer's verification by varying the gantry angle and whether it is within ± 5% International Commission on Radiation Units and Measurements (ICRU) minimal limit. Materials and Methods: The study was executed with a locally designed phantom made of Plexiglas with six insert and an ionization chamber port. The phantom was simulated using a HiSpeed NX/i computed tomography scanner and Precise PLAN 2.16 TPS for application of beam setup parameters. The mimicked organs for the inserts were: 25%–75% Glycerol-Water for liver, pure carboxyl methyl cellulose was used for lungs, 30%–70% Glycerol-Water for muscle, 40%–60% Glycerol-Water was used for adipose, pure Sodium hypochlorite was used for bone and pure sodium laureth sulfate (Texapon) for kidney. Results: The maximum percentage (%) deviation with a large field for six inhomogeneous inserts and with bone only homogeneous inserts were 3.4% and 2.9%, respectively. The maximum % deviation with a small field for six inhomogeneous inserts was 3.2%. The % deviation between the solid water phantom and the locally designed phantom was 3.5%. Conclusion: The Area Integration Algorithm has shown an overall accuracy of 4% below 5% ICRU minimal limit. There was no statistically significant difference in field sizes and in inhomogeneity/homogeneity, respectively. Variation exists in % deviation for small field size with parallel opposed field between our verification and the manufacturers.
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Serum procalcitonin levels of patients with candidemia hospitalized in Intensive Care Units p. 113
Mohammad Reza Yazdani, Farzin Khorvash, Atousa Hakamifard
DOI:10.4103/jmedsci.jmedsci_97_17  
Objective: Fungal infections are a main reason for mortality of critically ill patients in Intensive Care Units (ICUs). Recently, fungal infections have been on rise. Lack of a specific marker for fungal infections has led to some problems in diagnosing these infections. Scant data exist on serum procalcitonin (PCT) levels in high-risk patients with invasive fungal infections, such as ICU patients. Materials and Methods: In this prospective study conducted in 2014–2015 in Al-Zahra Hospital, Isfahan, Iran, 64 people were investigated. The PCT levels of the patients were measured at 0, 24, 48, and 72 h as well as 7 and 14 days of the ICU stay. Moreover, a blood sample was taken from each person every 3 days and examined for positive BACTEC Candida fungal culture. Results: Nine (15%) patients had candidemia. The mean serum PCT level was not significantly different between the patients with and without candidemia at admission and 24, 48, and 72 h of the ICU stay (P > 0.05), but was significantly different on 7 and 14 days of the ICU stay (P < 0.001). Conclusion: This study demonstrated that the serum PCT levels increased significantly in the patients with candidemia hospitalized in ICUs. Therefore, serum PCT, as a marker, can be relied on, in addition to other symptoms and factors, for taking a decision about the initiation of treatment with antifungal drugs. Besides that, further studies with larger sample size are recommended to examine the predictive value of PCT for invasive fungal infections.
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Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients p. 117
Shen-Hua Lu, Kuang-Huei Chen, Ying-Chieh Pan, Szu-Nian Yang, Yuan-Yu Chan
DOI:10.4103/jmedsci.jmedsci_132_17  
Objective: In this study, we investigated the incidence rate and risk factors related to falls among acute psychiatric inpatients in a regional hospital. Methods: We included 521 patients who were admitted to the acute psychiatric ward in Taoyuan Armed Forces General Hospital from January 2015 to January 2016 and analyzed their medical records within a 1-year period. We compared differences between the fall and nonfall groups in demographic characteristics, psychiatric diagnoses, medication use, psychotic symptoms, and Timed Up and Go scores. Chi-square tests were used for comparison of categorical variables and t-test was used for continuous variables. Results: A total of 521 patients with an average age of 38.9 years were included in our study; 167 (32.1%) patients were female. Among the inpatients in our study, 3.07% were fallers. Patients with female gender, older age, psychotic symptoms, and use of more types of medication, especially mood stabilizers, laxatives, and other classes of medications, were significantly more likely to experience falls (P < 0.05). Conclusion: Determining the risk factors for falls in an acute psychiatric ward is useful for clinical care. As we identified patients in a high-risk group, fall prevention can be performed to help them to avoid possible injury. However, further studies are needed to determine more quantitative measures to evaluate or predict the risk of falls in acute psychiatric units.
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The glycemic control of adult population in Nauru p. 122
Li-Ju Ho, Ruei-Yu Su, Chieh-Hua Lu, Yu-Hui Lee, Chun-Jui Huang, Chang-Hsun Hsieh
DOI:10.4103/jmedsci.jmedsci_12_18  
Aims: The first aim of the present study is to evaluate the current glycemic control and characteristics of overall and newly diagnosed diabetes mellitus (DM) population from two cohorts population (2011–2012 and 2014–2015). Furthermore, the hemoglobin A1C (HbA1C) levels of newly diagnosed in these two cohorts population will be also compared to HbA1C levels on 2013 in subjects of previous diagnosed DM ongoing therapy. Settings and Design: This is a retrospective observational cohort study. Subjects and Methods: All of the data come from the Nauru Diabetes Registry database from Nauru Public Health Center from 2011 to 2015. All patients with their HbA1C will be analyzed and compared between year of 2011–2012 and 2014–2015. Statistical Analysis Used: Descriptive results of continuous variables will be expressed as means ± standard deviation. We use unpaired t-test for comparisons of quantitative variables. A two-tailed P < 0.05 was considered statistically significant. The statistical analyses will be performed using the program SPSS (Chicago, Illinois, USA; version 18.0). Results: A total of 614 patients were enrolled for the analysis with mean age of 49.8 year old and mean diabetic duration of 10.1 years. The mean age of onset of DM is 40.4 year old. The female population had long duration of DM than male population. The overall HbA1C levels are slightly greater in 2014–2015 than 2011–2012 without statistical significance (10.9% ± 2.7% and 10.6% ± 2.2%, respectively). The HbA1C levels also do not differ among DM patients with regular outpatient visits. The mean HbA1C of newly diagnosed DM is significant higher in 2014-15 than that in 2011-2012 (11.5% ± 2.4 and 10.6% ± 2.1%, respectively, P = 0.039), but not different from HbA1C levels in 2013 in DM patients who received ongoing treatment (10.9% ± 2.3%). Furthermore, HbA1C worsened significantly in 2 of the 15 districts between 2011–2012 and 2014–2015. Conclusions: Nauru has a high prevalence rate with early onset and inadequately controlled diabetes. It needs to propose strategy to early detect and improve glycemic control early to prevent future diabetic complications.
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CASE REPORTS Top

Infected dentigerous cyst associated with a horizontal impacted ectopic supernumerary tooth induced by trauma to the maxillary incisors: A rare case report p. 127
Treville Pereira, Subraj Shetty, Amit Date
DOI:10.4103/jmedsci.jmedsci_127_17  
Dentigerous cyst is known to be caused by the accumulation of fluid between the epithelium and the crown of an unerupted tooth. Its size increases by the expansion of the follicle, and it is attached to the neck of the tooth. These cysts are often associated with impacted third molars and maxillary canines and rarely with supernumerary teeth. In the present paper, we report a case of a dentigerous cyst associated with an impacted ectopic supernumerary tooth. This cyst was missed initially due to a failed root canal treatment associated with the nonvital maxillary central incisor. This case of a cystic lesion can create a dilemma between radicular and dentigerous cyst. The pathogenesis of the ectopic tooth, differential diagnosis, and management are also discussed.
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Perioperative hemodynamic management of refractory hypotension in a patient with giant hepatic cysts complicated by compression of the inferior vena cava p. 131
Wei-Cheng Tseng, Hou-Chuan Lai, Teng-Wei Chen, Zhi-Fu Wu
DOI:10.4103/jmedsci.jmedsci_118_17  
Surgery is the treatment of choice for compression of the inferior vena cava (IVC) in patients with polycystic liver disease (PCLD). However, hemodynamic instability may develop after induction of anesthesia and during maintenance when compression of the IVC causes a decrease in venous return and may persist until reduction of the volume of the cysts or liver. Perioperative hypotension should be treated promptly by titration of anesthetic drugs, fluid therapy, transfusion, intravenous administration of a vasopressor, and postural modification depending on the etiology. However, regardless of the method(s) chosen, placement in the left lateral decubitus position is crucial for increasing venous return in patients with compression of the IVC. Herein, we report the case of a male patient with PCLD and compression of the IVC who developed refractory hypotension after induction of anesthesia. A dramatic improvement in his hemodynamic status was noted immediately after he was placed in the left lateral decubitus position. The patient's critical hemodynamic state was then able to be managed until his hepatic cysts were drained, and there were no sequelae.
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Delayed bowel stricture complicating superior mesenteric vein thrombosis p. 135
Yen-Lien Chou, Tien-Yu Huang
DOI:10.4103/jmedsci.jmedsci_15_18  
Superior mesenteric thrombosis is a rare disease of acute abdomen; many risk factors have been identified including arrhythmia, deep vein thrombosis, and hematologic or rheumatologic causes. Image study is more helpful than laboratory test. The standard therapy is anticoagulant (unfractionated heparin or low-molecular-weight heparins) administration, but there is still low possibility to need surgery for the complications such as bowel stricture or ischemic bowel disease. We describe the case of acute abdominal pain, the computed tomography showed superior mesenteric thrombosis, and the patient received the therapy with unfractionated heparin and the procedure of superior mesenteric arteriography with intravascular thrombolytic therapy. However, the complication of delayed bowel stricture occurred, which was proved by upper gastrointestinal series. Then, he was cured by surgical intervention with segmental resection of small bowel.
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