Open Access Case Report

Appendiceal Endometriosis: A Case Report

Emmanuel Innocent, Ochigbo Adam, Yakubu Daniel, Wina Felix Markus

Asian Journal of Case Reports in Medicine and Health, Page 1-6

Introduction: Endometriosis is established as the presence of ectopic endometrial tissue, outside the lining of the uterine cavity. Endometriosis of the appendix is uncommon especially in our environment. A definitive diagnosis is customarily established following histo-pathological examination of the appendix. Complications include rupture and haemorrhage.

The Case:  A fifty-three years old female was admitted at the Jos University Teaching Hospital emergency unit, complaining of right lower abdominal pain of three days duration and abdominal distension of one week duration. The pain was associated with nausea, vomiting and fever (38.9°C). Abdominal examination showed generalised distension with guarding and tenderness especially at the lower abdomen with positive rebound tenderness. An exploratory laparotomy was done which showed copious pus in the peritoneal cavity. Appendectomy was done, and the peritoneal cavity was copiously lavaged.

Pathomorphology: Grossly, the appendix measured 6.5 by 1.7 by 1 cm with a lack lustre appearance and unremarkable serosa. Microscopically the muscularis propria show multiple islands of typical endometrial glands surrounded by a cellular endometrial stroma.

Conclusion: In conclusion, endometriosis of the appendix can imitate acute appendicitis and it should always be considered in the differential diagnosis of women complaining of nonspecific lower abdominal pain.

Open Access Case Report

Knowledge and Attitude of Nursing Mothers towards Umbilical Cord Care in Calabar Metropolis, Cross River State

I. E. Udosen, T. Olaoye, Emmanuel Okondu, G. E. Udosen, Dennis Amaechi

Asian Journal of Case Reports in Medicine and Health, Page 1-16

Aim: This study assessed the knowledge and attitude of nursing mothers towards umbilical cord care.

Methods: The study was a descriptive and cross sectional in design. 388 respondents were randomly selected using multistage sampling technique. Data was collected using a validated semi-structured questionnaire which was self-administered after a Cronbach-Alpha test was carried out giving a result on 0.713. It was analyzed using the statistical package for social science (SPSS) version 21 to generate descriptive (frequency tables, charts) and inferential statistics (Pearson’s chi-square).

Results: The result gotten from the study showed that the majority of nursing mothers who participated in the study were between ages 20-29 (37.6%) with a mean age of 29.7. majority of the mothers were married 304 (78.4%) with at least one child 181 (46.6%) with infants aged 1 week 301 (77.6%). Most respondents were Efik 202 (52.1%), most being Christians 329 (84.8%). Most mothers received more than 30,000 in income 174 (44.8%). Almost all the respondents 316 (81.4%) heard about umbilical cord care. Majority of the respondents 280 (72.2%) defined umbilical cord care as tying, cutting and cleaning with methylated spirit and cotton bud. However, half 210 (54.1%) of the respondents had not heard of Chlorhexidine digluconate and majority of the respondents 316 (81.4%) did not know it could be used to prevent infection. Virtually all mothers knew that it was important to clean the baby’s cord 386 (99.4%). Mother’s attitude towards care of the umbilical cord was positive with a result of 353 (91%).

Conclusion: The respondents had fair knowledge on cord care, positive attitude and good practice towards umbilical cord care. Poor knowledge can lead to prevalence of cord infection.

Open Access Case Report

Medical Identity Fraud in Health Insurance Schemes: Creating Awareness in Nigeria

O. E. Daramola, J. M. Abu, L. O. Daramola, T. M. Akande

Asian Journal of Case Reports in Medicine and Health, Page 1-6

Medical identity fraud, which includes medical identity theft and impersonation, is becoming a source of concern to many healthcare institutions. The cases reported in this study were medical identity impersonation, which involves knowingly giving one’s health insurance card to be used by another person to access medical services. Medical identity theft, which is uncommon in the Nigerian healthcare system, involves ‘stealing’ and using another person’s card or identifying information to access medical services without his/her knowledge. Medical identity fraud places financial losses on the healthcare system and can also result in medical error, misdiagnosis, mistreatment and patient safety challenges. The management and staff of healthcare facilities should be educated and trained on medical identity fraud prevention and detection. Further research on medical identity fraud in the Nigerian healthcare system is also recommended.

Open Access Case Study

Type 2 Myocardial Infarction- A Case Report

ASV Prasad

Asian Journal of Case Reports in Medicine and Health, Page 1-7

Type 2 MI (T2MI) was defined as myocardial infarction other than due to coronary artery disease (CAD), produced by disparity between supply and demand of oxygen .Cases were reported in literature where T2 MI was diagnosed even in presence of even 90 % block in coronaries, where  recent ischemic changes were shown to be not due to the CAD but to disparity between supply and demand of oxygen. There was considerable overlap with the classical type1 NSTE MI and T2 MI and distinguishing between the two was considered challenging. Though T2 MI constituted about 25% of all cases of MI, the centres reporting Type 2 MI ranged between 0-13% only. Type 2 MI, the new heterogeneous group, was officially recognised by the task force on the universal definition of MI in 2007. The scope and criteria were changing since it was defined in 2007.  Further, it appeared that -coronary cause of MI was more important than disparity between supply and demand of myocardial oxygen supply. For instance Sepsis, one of the important causes of T2 MI, could cause Type 2 MI by myocardial depression even in presence of normal oxygen perfusion.
A case reported   initially as NSTEMI, was retrospectively considered the possibility of T2MI. The reasons there of and the intricacies in the diagnosis of T2 MI are discussed in this article.

Open Access Case Study

Primary Cutaneous Malignant Melanoma with Papillary Features: A Case Report Signifying Morphologic Diversity in Malignant Melanoma

James J. Yahaya

Asian Journal of Case Reports in Medicine and Health, Page 1-7

Aim: The purpose of this work was to describe the way how primary cutaneous malignant melanoma can present with papillary features and hence mimicking malignant tumours which are commonly accompanied with papillary features such as papillary thyroid carcinoma.

Presentation of Case: The case reported in this article was of an African female aged 61 years who presented with a darkish small swelling on the dorsum of the right hand, slightly painful and tender for 3 months since its onset.

Discussion: Malignant melanoma as it is encountered in daily clinical practice ought to be deemed as being a malignant tumour that can sometimes show diverse histomorphological presentation including papillary features as it was in the case herein reported. This kind of presentation can lead to wrong diagnosis, thus, contributing to delaying of proper diagnosis and even jeopardizing the prognosis of the patient.

Conclusion: Malignant melanoma should be included in the differentials of malignant tumours presenting histologically with papillary features.