Psychometric Properties of Osteoporosis Knowledge Tool and Self-Management Behaviours Among Malaysian Type 2 Diabetic Patients

Osteoporosis is a major growing public health problem and it is clear that much needs to be done to bridge the gap between patients and practitioners. However, the educator must have a valid and reliable tool to evaluate the effectiveness of the teaching and learning that are done. Osteoporosis Knowledge Tool (OKT) provides an important strategy for healthcare professionals to start early intervention for patients who are at risk of osteoporosis. The aims of this study were to translate and examine the psychometric properties of the Malaysian version of the Osteoporosis Knowledge Tool (OKT-M) among 250 type 2 diabetes patients and to assess factors that affect diabetic patients’ osteoporosis knowledge. The OKT English version was translated and validated using the internationally accepted and recommended methodology. The sensitivity and specificity of OKT-M was calculated using receiver operating characteristic curve analysis. The face and content validity showed acceptable results. Internal consistency, test–retest reliability, mean difficulty factor and discriminatory power values were 0.72, 0.83, 0.47 ± 0.16 and 0.96, respectively. The cut-off point of the OKT-M to predict osteoporosis/osteopenia was 14 with optimal sensitivity (84.1 %) and specificity (85.5 %). Regression analysis revealed that health belief, self-efficacy and some demographic data had an impact on the OKT-M. The findings of this validation study indicate that the OKT-M is a reliable and valid tool with good psychometric properties in the Malaysian setting. The OKT-M is an appropriate tool for application in clinical setting to identify patients need for a bone health-promoting intervention regarding lifestyle behaviour changes.     

Prevalence of cerebral venous thrombosis with the use of oral contraceptive pills during the Holy month of Ramadan

Objectives:To identify the epidemiologic profile of cerebral vein thrombosis (CVT) among fasting women using oral contraceptive pills (OCPs) during the holy month of Ramadan.Methods:This retrospective study was conducted on all patients diagnosed with CVT and using OCPs from records at a tertiary care hospital in Riyadh, Saudi Arabia during 2016-2017. The study participants were categorized into 2 groups (an intermittently fasting group during the holy month of Ramadan and a non-fasting group).Results:Out of 108 female patients with CVT, 36.1% were secondary to OCP, of whom 41% participants were fasting. The most affected site was the transverse sinus. Holocephalic headache was more common amongst fasting group (68.8%) compared to non-fasting group (30.4%) (p=0.025). Dehydration (p=0.003) amongst the fasting group and protein S deficiency (p=0.027) in the non-fasting group were identified as the 2 prominent risk factors. Unfractionated heparin was the most common anticoagulant therapies used during the initiation phase for non-fasting (36.4%) and fasting groups (50%).Conclusion:All women who are using OCP should undergo formal written risk assessments for factors of CVT. Our study suggests that the negative effects of OCPs use might outweigh its benefits; thus, it should be prescribed with caution, more so in fasting patients.     

Use of Rigid Nephroscope for Laparoscopic Common Bile Duct Exploration—A Single-Center Experience

Background  

Increasingly, laparoscopic biliary surgeons are undertaking laparoscopic cholecystectomy and laparoscopic common bile duct exploration for patients with cholelithiasis and choledocholithiasis. In laparoscopic common bile duct exploration a flexible choledochoscope is ordinarily used, and with this instrument the surgeon usually fails to remove large impacted stones. In contrast with use of a rigid nephroscope it is possible to remove all common bile duct stones irrespective of size and degree of impaction. The present study evaluates the efficiency of rigid nephroscope for managing common bile duct stones laparoscopically.     

Venous air embolism during the use of a Nd YAG laser

We report a case of a 47-year-old female who suffered a cardiac arrest during sub-mucosal diathermy of the inferior turbinate using a Nd YAG laser. The possible causes of the cardiac arrest are discussed. Venous air embolism due to Nd YAG laser was thought to be the most likely cause in this case. Although venous air embolism has previously been reported during nasal sinus surgery and choanal atresia when using a Nd YAG laser, the occurrence of this complication during a relatively minor surgical procedure has not previously been reported. It is important, therefore, to raise the awareness of this life threatening complication during use of a Nd YAG laser regardless of the duration of surgery. We recommend the use of appropriate methods and techniques to avoid this life threatening complication during the use of Nd YAG laser even for relatively short procedures.     

CT Scan Diagnosis of Bleeding Peptic Ulcer after Gastric Bypass

Investigation of the bypassed stomach in patients with suspected peptic ulcer disease presents a major challenge to bariatric surgeons. Various methods have been suggested for visualization of the duodenum and bypassed stomach. These include endoscopy via percutaneous gastrostomy access, retrograde endoscopy and virtual gastroscopy using CT scan. We present a case of peptic ulcer bleeding diagnosed with the help of conventional CT scan. To the best of our knowledge, this is the second such case reported in the literature and the first in the bariatric population.     

Mild hypercapnia after uncomplicated heart surgery is not associated with hemodynamic compromise

OBJECTIVE: The aim of this study was to examine the effects of small changes in PaCO(2) on hemodynamic parameters after uncomplicated heart surgery with cardiopulmonary bypass. DESIGN: This was a prospective, randomized crossover study. SETTING: A large academic medical center. PARTICIPANTS: Twenty-four subjects who were scheduled for elective cardiac surgery were enrolled in this study. INTERVENTIONS: Each subject underwent the normal procedures that are associated with cardiac surgery. General anesthesia, including muscle relaxation, were continued in the immediate postoperative period. Measured tidal volumes and minute ventilation were kept constant for the duration of the study. Target PaCO(2) concentrations of 30, 40, and 50 mmHg were achieved by adding varying amounts of exogenous CO(2) gas to the inhaled oxygen. Various measurements were made at each target PaCO(2), including cardiac index, mixed venous oxygen saturation, blood pressure, heart rate, and pulmonary artery pressure. MEASUREMENTS AND MAIN RESULTS: Twenty-four patients were enrolled. Seven were withdrawn before commencement of the study. The cardiac index increased when the PaCO(2) was increased from 30 to 40 mmHg (p < 0.001) and remained unchanged between 40 and 50 mmHg. Mixed venous oxygen saturation increased (p < 0.001) with elevations in PaCO(2) up to 50 mmHg and decreased again when the PaCO(2) was returned to 30 mmHg. The blood pressure decreased (p < 0.001) with increasing PaCO(2). The pulmonary pressure increased (p < 0.001) with elevations in PaCO(2). No patient became hemodynamically unstable or had any arrhythmias. CONCLUSION: The findings of this study suggest that unless there is a specific contraindication to mild hypercapnia, such as pulmonary hypertension or hemodynamic instability, concerns about mild respiratory acidosis should not prevent weaning of sedation and mechanical ventilation after uncomplicated heart surgery.     

Incidence and clinical significance of distal embolization during percutaneous interventions involving the superficial femoral artery

OBJECTIVE: Distal embolization of plaque or thrombus may cause organ ischemia following percutaneous peripheral interventions. The purpose of this study was to evaluate the incidence and clinical significance of particulate embolization during percutaneous superficial femoral artery (SFA) intervention by monitoring with continuous Doppler ultrasound. The rate and timing of embolization at various phases of intervention such as guidewire crossing, balloon angioplasty, stent deployment, and directional atherectomy were analyzed and compared. METHODS: Sixty patients underwent SFA intervention. Of these 60 patients, 10 patients underwent percutaneous transluminal angioplasty (PTA) alone, 40 patients underwent PTA with stenting, and 10 patients underwent plaque excision with the SilverHawk atherectomy device (8) or Spectranetics excimer laser (2) with or without additional PTA or stent placement. A 4-MHz Doppler probe was used for continuous monitoring in the ipsilateral popliteal artery. Distal embolization was registered as embolic signals (ES). ES were quantitatively assessed during critical portions of the procedure including guidewire crossing, balloon angioplasty, stent deployment and/or atherectomy. ES during different phases of intervention were compared using analysis of variance (ANOVA). RESULTS: ES was noted in every patient during wire crossing, angioplasty, stent deployment and atherectomy. The average number of ES noted during guidewire crossing was 8, PTA was 12, stent deployment was 28, SiverHawk atherectomy was 49, and Spectranetics excimer laser was 51. The frequency of ES was statistically higher during stent deployment vs wire crossing or balloon angioplasty but equivalent to that generated by plaque excision. ES was observed more frequent during balloon angioplasty than during wire crossing. In one patient who was treated with the excimer laser, a single runoff vessel was occluded with embolic debris but patency was restored angiographically after thrombolysis. The patient went on to require below knee amputation. During follow-up, all patients with claudication reported improved symptoms and those with ulcers or gangrene demonstrated healing. The average increase in ankle-brachial index following intervention was 0.31. CONCLUSION: While ES were recorded at each step of SFA intervention, the frequency was greatest during stent deployment. Despite the frequency of these events, only one patient developed angiographically and clinically significant embolization. Thus, our findings do not support the routine use of protection devices during percutaneous SFA intervention.