The Journal of Medicine, Law & Public Health

Recurrence of Non-Hodgkin Lymphoma at the Insulin Injection Site: Case Report

Orhan Türken, Şükrü Yıldırım, Gözde Şanlı, Rahmi Çubuk, Ghayda Jarrar — Fri, 18 Oct 2024 00:00:00 -0700

This study sheds light on the effect of insulin, insulin-like growth factors (IGF), and their signalling receptors (IR and IGF-1R) on the progression of lymphoma. We report a case of a 64-year-old male with type 2 diabetes mellitus and a prior diagnosis of diffuse large B-cell non-Hodgkin lymphoma (DLBCL) treated with chemotherapy and local radiotherapy. Incredibly, four years post-treatment, the patient's DLBCL relapsed in the subcutaneous fatty tissue adjacent to the deltoid muscle of both the proximal left and right upper extremities, which were the sites he used to inject insulin. Insulin/IGF dysregulation can lead to tumour growth via angiogenesis. This mechanism is not limited to lymphoma and may contribute to the development of various types of cancer. While it is possible that DLBCL may have developed at the injection site either coincidentally, as a result of chronic inflammation, or potentially due to other factors that promote tumour growth, as we suggest in our case presentation, it is beneficial to emphasise the importance of tumour screening in diabetic patients, especially those receiving insulin injections. We therefore believe that regular screening of the insulin injection site should be included in routine consultations for these patients.

Long-Term Neurodevelopmental, Mental, and Cardiometabolic Health in Individuals Conceived with Assisted Reproductive Technology: A Literature Review

Saadia Ghafoor — Sat, 28 Sep 2024 00:00:00 -0700

Background: Assisted reproductive technology (ART) has revolutionised fertility treatments since 1978 and, while its immediate perinatal outcomes have been extensively studied, its long-term health effects require exploration.

Method: PubMed database was searched for studies spanning 2016 to 2023 to conduct this literature review of the long-term neurodevelopmental, mental, and cardiometabolic health of ART-conceived individuals.

Results: A total of 49 studies were included in this review. ART-conceived individuals revealed mostly positive neurodevelopmental and mental health impacts. However, children conceived via intracytoplasmic sperm injection (ICSI) demonstrated an increased risk of neurodevelopmental disorders, including autism spectrum disorder, intellectual disability, and psychological and neurological development delays, while frozen embryo transfer was linked to an increased risk of language delay. Additionally, children born via ART as multiples or prematurely showed an elevated risk of cerebral palsy. While ART generally demonstrated a favourable impact on cardiometabolic health, there were concerns about increased risk of high blood pressure, altered lipid profiles, obesity, insulin resistance, premature vascular aging, and adverse metabolic changes. Specifically, ICSI-conceived individuals were more prone to adiposity and insulin resistance, while frozen embryo transfer was associated with type 1 diabetes.

Conclusion: While ART-conceived individuals generally exhibit favourable health, specific subgroups may face elevated risks for certain neurodevelopmental disorders and long-term cardiometabolic issues, warranting further research. ART may be associated with metabolic alterations at a young age, potentially increasing the risk of chronic diseases such as metabolic syndrome, type 2 diabetes, and cardiovascular disease later in life. Continued long-term monitoring and targeted interventions are recommended to mitigate these risks.

Women’s Perception of a Midwife-Led Clinic: A Qualitative Study

Diana Lalithabai, Faheema Alsomali, Khalid AlGhamdi, Waad ALZahrani — Fri, 30 Aug 2024 00:00:00 -0700

Background: While maternal and child health care is a crucial component of every healthcare system, the burden on medical staff in caring for low-risk pregnant patients could be significantly alleviated by recruiting and maintaining a substantial number of midwives.

Objectives: This study aims to understand the perceptions of women recipients of antenatal services provided by midwife-led clinics (MLC).

Method: The study utilised a phenomenological approach with semi-structured interviews to gather information from participants regarding their perceptions of the MLC.

Results: Participants in the survey were women (n=13) who attended the MLC, the majority being over 30 years of age and graduates. The participants believed that the clinic was essential, and felt at ease with the midwife and the services. Most expressed satisfaction with the health education offered by the clinic on the subject of prenatal care, nutrition, exercise, and breastfeeding.

Conclusion: The participants in this study preferred midwife-led clinics because they allowed for better communication, answered queries, and provided significant emotional support. The participants felt comfortable with the midwife, who created a forum for discussion and clarification of doubts.

Maternal Near-Miss in a Tertiary Care Hospital: A Prospective Study From North India

Fiza Amin, Sabreen Wani, Shahnaz Taing, Tavseef Ahmad Tali — Fri, 27 Sep 2024 00:00:00 -0700

Background: Maternal near-miss is defined as a ‘woman who nearly died but survived a complication during pregnancy, childbirth or within 42 days of termination of pregnancy’. A sudden and unexpected event during pregnancy, childbirth, or even after delivery, is a risk that is faced by every pregnant woman.

Aim:This study aimed to establish the incidence of maternal near-misses, and to evaluate the clinical and epidemiological profile and causes of maternal near-miss.

Materials and Methods: This was an observational prospective study, conducted in Lalla Ded Hospital for a period of 18 months after obtaining ethical clearance. Women who fulfilled any of the WHO criteria for MNM were included in the study as maternal near-miss cases.

Results: The hospital witnessed 36,273 live births over the period of the study, of which 821 involved a near-miss. This equates to a MNM incidence ratio of 22.63 per 1000 live births. The mortality index in our study was 3.97%, and the near-miss to mortality ratio was 24.14:1. Haemorrhage was the leading cause of MNM (N=429 or 2.25%), followed by hypertensive disorders of pregnancy (N=280 or 34.10%). Anaemia was the most common associated factor and was present in 460 (56.03%)patients.

Conclusion: Early identification of risk factors for placenta accreta spectrum, hypertensive disorders of pregnancy, medical disorders complicating pregnancy, anaemia, previous Caesarean section, and multifoetal pregnancy, among others, and thereby prompt management of such conditions, plays a critical role in the optimal management of MNM.

Community Awareness and Engagement in Bleeding Control: A Cross-Sectional Study

Fri, 30 Aug 2024 00:00:00 -0700

Background: Road traffic accidents (RTA) account for 4.7% of all deaths in the Kingdom of Saudi Arabia (KSA), with rates ranging from 17.4 to 24 per 100,000 people over the past decade. This study aims to enhance community engagement and understanding of bleeding control methods to empower effective responses to bleeding in accident scenarios.

Method: This observational cross-sectional study evaluated the knowledge and willingness of the community to engage in bleeding control in the setting of medical emergencies. The study population was comprised of adults in Saudi Arabia who were over the age of 17 at the time of the research.

Results: A total of 392 participants took part in the research. Of these, 66.3% (n = 260) were willing to assist a stranger bleeding as a result of a motor vehicle accident. There was no significant gender difference among those with past experiences of assisting someone after an accident. Only 15.5% (n = 61) had certified training, while the majority (77%, n = 47) held bachelor's degrees. Interest in educational workshops on bleeding control was shown by 55.1% (n = 216), with 32% (n = 126) undecided. Regarding tourniquet use, 20.1% (n = 38) believed this to be safe.

Conclusion: This study highlighted the community's awareness of bleeding control and readiness to respond to bleeding situations after accidents. While more than half were likely to act, concerns about aggravating injuries, legal issues, and discomfort with blood were significant barriers, underscoring the need for public education and legal protection. Educational status, and particularly a bachelor's degree, was a stronger predictor of the likelihood to intervene than certified training. Significant knowledge gaps were noted with regard to tourniquet use, with few trusting their safety and many incorrectly applying them directly to the wound.