Presence of bone pain and anemia in elderly patients should alert the clinician to investigate along the lines of MM. Majority of patients have osteolytic lesions on X-ray and pathological fractures, and benefit from melphalan based combinations in situations where facilities for transplant are not available.
Background:Developing countries like face dire shortage of medical manpower due to brain drain. Young doctors intending to specialize usually prefer certain specialties and sub-specialties to the neglect of others. This creates avoidable gaps in health care delivery.Aim:The aim of the following study is to determine the choices of career and reasons for those choices among young medical doctors.Subjects and Methods:A cross-sectional study of fresh interns using a pre-validated 13 item questionnaire was done at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu Nigeria.Results:A combination of the various surgical specialties was the most common choice made in 29/110 26.4% of the respondents. The top four specific choices were pediatrics 28/110 (25.5%), internal medicine 11/110 (10%), obstetrics and gynecology 10/110 (9.1%) and public health 8/110 (7.3%). The most common factor influencing choice of specialty was interest in 86/109 (78.9%) of the respondents. A higher proportion of males 24/69 (34.8%) compared with females 4/41 (10%) chose a specialty because of brighter prospect (P = 0.01).Conclusion:The most frequently chosen specialties by young interns were a combination of surgical specialties, internal medicine, pediatrics and obstetrics and gynecology. Interest was the most common reason for choice of specialty although males are significantly influenced by brighter prospects.
Background:Anticoagulation is an essential lifesaving management practice indicated for arterial, venous and intracardiac thromboembolism.Aim:This study was undertaken to examine the utilization of anticoagulation services in University of Nigeria Teaching Hospital, Enugu (UNTH) Nigeria.Materials and Methods:This retrospective study involved assessing data from folders of subjects on anticoagulation and monitoring in UNTH, Enugu. Patients’ profile, risk factors, diagnosis, indication for oral anticoagulation, anticoagulant used; target, monitoring, outcome and complications of anticoagulation were recorded.Results:A total of 26 patients over a period of 5 years were on anticoagulation and laboratory monitoring done in UNTH. The mean age of the patients was 53.4 years and more females than males were on anticoagulation and monitoring (F14:M12). The most common indications for anticoagulation include deep venous thrombosis/pulmonary embolism, congestive heart failure with atrial fibrillation and mitral valve disease with atrial fibrillation. Desired clinical outcome was achieved in eight patients 8/26 (30.8%). Minor bleeding was the only complication reported in three patients 3/26 (11.5%).Conclusion:The absence of diagnostic tools and anticoagulation monitoring clinics and the apprehension of adverse effects have combined to make this lifesaving treatment inaccessible to many patients in Nigeria.
In conclusion, patients with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention.
Background:Assessment of patients prior to cytotoxic chemotherapy usually includes absolute neutrophils count. Other cellular markers of susceptibility to infection as well as immunocompetence include the T Helper lymphocyte count. In cancer patients, decrease in these lymphocytes has been observed to be associated with decreased overall survival.Aim:To assess the degree of CD4 lymphopenia encountered during cytotoxic chemotherapeutic treatment for cancer and evaluate the differences observed for the various drug combinations.Subjects and Methods:Eighty patients with various histologically diagnosed malignancies had their CD4 lymphocyte counts carried out at days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed with breast cancer 36/80 cases (45%), non-Hodgkin's lymphoma 8/80 cases (10%), Hodgkin's lymphoma 13/80 cases (16.3%), multiple myeloma 7/80 cases (8.8%), colorectal carcinoma 6/80 cases (7.5%), and other malignancies 10/80 cases (12.5%). CD4 lymphocyte count was done using the Partec Cyflow® 2000 CD4 cell counter, and their socio-demographic data of the patients were assessed using a questionnaire.Results:The mean (sd) CD4 lymphocyte count pre- and post-chemotherapy was observed to be 567 (341) cells/μLand 349 (207) cells/μL while the median values were 454 cells/μLand 349 cells/μL respectively. There were significant differences in CD4 lymphocyte counts after chemotherapy compared to the pre-chemotherapy values.Conclusion:Epirubicin combinations used in breast cancer patients as well as (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ABVD regimen used in treatment of Hodgkin's lymphoma were found to be significantly less lymphotoxic than other chemotherapeutic combinations. These drugs or their combinations may be less immunotoxic than other known regimen used for these malignancies.
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