Spontaneous reporting of adverse drug reactions (ADRs) by health-care professionals is the basic method for the identification and prevention new and serious ADRs of marketed drugs. The contribution of nurses in this task can improve patient safety and reduce the extra financial burden associated with it. Although a total of 11% of ADRs in National Pharmacovigilance and Drug Safety Center were reported by nurses. The objectives of this review were to identify the possible factors that lead to underreporting of ADRs by nurses and define strategies that increase the reporting. This review has revealed various factors that influence the underreporting of ADRs and strategies to encourage reporting by nurses. Most of the identified factors are potentially modifiable. To overcome the underreporting of ADRs by nurses' main interventions should be based on education, motivation, and determination.

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Context: Grandmultiparity has been associated with increased adverse maternal and perinatal outcomes mostly in poor-resource settings. The question remains to what extent parity on itself contributes to unfavorable obstetric outcomes. There are limited studies that control for other predictor variables of maternal and perinatal outcomes in high parity pregnancies. Aim: This compared the adverse maternal and perinatal outcomes among grand multiparas with age-matched low parous counterparts to generate data for focused obstetric care. Subjects and Methods: An age-matched case–control study was performed on 2009–2014 data of all the high parity births in a second-tier mission hospital in a state capital city, Nigeria. Selected maternal and fetal outcome variables were compared between the women of high parity (para ≥5) and low parity (para 1–4). The primary outcomes were adverse maternal and perinatal variables. The statistical tests were done with statistical significance at <0.05. Results: The prevalence of grandmultipara was 2.52%, grand multiparity was significantly associated with lower educational attainment (odds ratio [OR] = 4.3, 95% confidence interval [CI]: 2.4–7.6), lower socioeconomic class (OR = 3.78, 95% CI: 2.28–6.28) and abnormal lie (OR = 10.48, 95% CI: 1.21–91.00), no significant association (P > 0.05) with stillbirths, low birth weight, macrosomia, preterm birth, chronic hypertension, gestational hypertension anemia, induction of labor, cephalopelvic disproportion/obstructed labor, and cesarean section. Conclusions: The prevalence of grandmultiparity was low at 2.52%. With the exception of abnormal lie, high parity was not associated with increased adverse fetal and maternal outcomes in this study.

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Langerhans cell histiocytosis (LCH) is a rare entity of an unknown etiology, usually reported in children. It commonly involves cranial bones mimicking an otological disease. We report a case of a 22-month-old Saudi boy who was referred to our Otolaryngology Department, in the North West Armed Forces Hospital, Tabuk, Saudi Arabia, as a case of complicated mastoiditis with a fistula that was resistant to conventional treatment. The patient underwent surgical exploration, and a biopsy confirmed the diagnosis of LCH X. The case was treated accordingly. LCH of temporal bone can be misdiagnosed and mismanaged. This, however, can be minimized by a high index of suspicion, appropriate radiological and histopathological examination.

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Background: India accounts for 21% death among under-five children but the profile of the children admitted in tertiary hospitals is poorly documented. We conducted secondary analysis of all hospital admissions in pediatrics wards for 1½ years to understand outcomes in different age groups. Methods: Data from October 2014 to March 2016 were retrieved and analyzed, with a focus on the age distribution at admission and death, duration of stay and outcome. Results: Almost 10% admitted children died and another 15% left the hospital before completing treatment. The analysis of 2135 deaths suggests that half of the children died within 24 h of admission. Death rate was highest among children on their 1^st day of life (39%), and it reduced gradually with increase in age. Infants share 71% of all the deaths. Conclusion: Maximum death within 1^st day of admission demands a further review of our referral system and health seeking behavior.

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Objective: The objective of the study was to assess the vestibular system among workers exposed to long-term noises.Design: This study design was a cross-sectional study. Setting: This study was conducted at Department of Otolaryngology, King Abdulaziz Special Hospital, Taif, Saudi Araia. Patients: The study involved two groups: long-term noise exposure group (N group), 126 workers, in a printing facility and a control group (Group C), 48 voluntaries, employee from a noise-free environment. Participants and Methods: Both groups had audiometrical and vestibular assessment using videonystagmograph (VNG) in a controlled environment. Results: Pure tone audiometry showed a significant reduction in N group high frequencies threshold compared with C group. Vertigo attacks were reported in 11 workers (24.4%) among the N group and VNG revealed six workers (13.3%) from N group diagnosed as peripheral insult while benign paroxysmal positional vertigo found in three workers (6.7%), while 36 workers (80%) in the same N group had normal “VNG” findings. Conclusion: Vestibular dysfunction may occur in workers with long-term chronic noise exposures.

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There are different causes of hydrocephalus. Lack of cerebrospinal fluid (CSF) absorption due to cerebral venous sinus thrombosis is one of the rare causes of hydrocephalus. We present a 47-year-old gentleman who had complaint of headache for 2 months. He was diagnosed as communicating hydrocephalus due to right transverse sinus and anterior part of superior sagittal sinus thrombosis. The patient was treated by CSF diversion procedure. There are only few cases have been published on hydrocephalus due to the same etiology.

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Background: Laparoscopic cholecystectomy (LC) is one of the most common surgeries performed by the surgeons on a daily basis. Male gender patients have always been considered as an independent risk factor which adversely affects the surgical outcome of LC. However, in recent time, so many conflicting reports have been published which have started to challenge this notion. The aim of this study is to analyze the effect of male gender on an outcome of LC after doing proper adjustment of other risk factors and different variables. Materials and Methods: This is a retrospective observational study for which data collected in respect to elective LC performed at Lady Hardinge Medical College, New Delhi, of the period from April 20, 2014, to April 30, 2016, have been analyzed. Results: The total number of cases found to be suitable was 670 (n = 670) out of which the number of females was 597 (89.10%) and males was 73 (10.89%). Mean/median age of males was 39.30 (±1.23) and females was 36.00 (±20). Median duration of operating time was 60 min and it was same (interquartile range - male = 45/female = 40) for both male and female groups (P = 0.035). In male group, 08.10% and in female group, 05.01% undergone conversion (P = 0.188). In both groups, median duration of postoperative hospital stay was 1 (±1) day (P = 0.137). Conclusion: After exclusion of all other risk factors said to affect the surgical outcome of LC, statistically, we have not found any significant difference between male and female gender in term of influencing the outcome of LC.

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Objective: The objective of this study is to determine the spectrum of pathologies of palpable breast lumps in females and their significance in different age groups in a setting where breast cancer (BCa) is prevalent in the younger population. This knowledge is crucial for modifications in the current screening programs. Materials and Methods: All needle biopsies for the complaint of breast mass felt by the female patients were retrospectively included over 4 years. Fisher exact test was used to determine the age of significant cancer risk. Results: Out of 140 cases met the inclusion criteria, 110 were BCa. The median age of BCa was 46 years. There was 68% positivity for BCa in cases belong to females below 40 years, and 75% in patients aged younger than 50 years. The age of 40 years old shows significant cancer risk. Conclusions: The results showed that almost 4 out of 5 females with palpable breast lumps subjected to needle biopsy had BCa. Although this risk is higher with increased age, BCa is a disease of young in the population under study. Review of the current preventive and management measures is critically needed.

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Objective: To determine the main factor that can aggravate course requirement stressor among dental students at College of Dentistry, King Saud University. Materials and Methods: A cross-sectional study was conducted in College of Dentistry in King Saud University, Riyadh, Saudi Arabia. This study included all undergraduate students, who finished their training in the clinics in 2012–2013. The data were collected using a paper-based questionnaire that utilized a 5-Likert scale. Results: The overall response was 80.4% (283/352). Students perceived that stress scale was more than moderate (6.5–7.6). Third-year students in operative dentistry course reported the aggravating factor (s) of course requirement stressor are “number of clinical requirements” and “availability of suitable patients” (57.5%) and in periodontics is “availability of suitable patients” (50.5%). Fourth-year students in removable prosthodontics reported the aggravating factor(s) is “availability of suitable patients” (56.3%), in fixed prosthodontics are “availability of well-equipped dental clinics” and “fluency of laboratory work” (52.4%), in operative dentistry is “number of clinical requirements” (61.3%), in periodontics are “number of clinical requirements” and “availability of well-equipped dental clinics” (48.5%), and in endodontics is “availability of well-equipped dental clinics” (53.3%). Fifth-year students in removable prosthodontics reported the aggravating factor(s) is fluency of laboratory work (60.9%), in fixed prosthodontics are “availability of well-equipped dental clinics” (60%) and “fluency of laboratory work” (60%), and in comprehensive dental clinic are “availability of suitable patients” and “fluency of laboratory work” (62.7%). Conclusions: Students reported that common aggravating factors for course requirement stressor are “number of clinical requirements,” “availability of suitable patients,” “availability of well-equipped dental clinics,” and “fluency of laboratory work.”

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Cellular angiofibroma (CA) is a rare benign tumor originating from the superficial soft tissues of the genital area. It occurs in both the genders with equal predilection. The sites involved by this tumor are vulva in females and inguinoscrotal region in males. Vaginal involvements have rarely been reported. We present a case of 57-year-old woman, presented with moderate postcoital bleeding. Vaginal examination revealed a tender mass in the left vaginal wall, measuring 1.5 cm. A clinical diagnosis of benign tumors (leiomyoma, angiomyofibroblastoma, and CA) or aggressive vaginal tumors was made. A complete local excision was done and sent for histopathological examination, confirming the diagnosis of a CA.

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Heterotopic pregnancy (HP) is a rare event combining intrauterine pregnancy (IUP) and extrauterine pregnancy. It can occur in the absence of any predisposing risk factors. We present three cases of HP managed in our department, two in a natural conception and the other following ovulation induction. The three cases had the same clinical presentation and surgical treatment. Preservation of the IUP was obtained in two cases. Unfortunately, the other case was aborted spontaneously on the 2^nd postoperative day. Only with an early diagnosis and adequate management, the IUPs will reach viability with a great chance of a favorable obstetric outcome.

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Ludwig's angina (LA) otherwise known as angina ludovici is a potentially life-threatening diffuse cellulitis of the neck, the floor of the mouth and submandibular regions bilaterally leading to airway obstruction. This condition during pregnancy and puerperium is rare. Many physiological changes occur through pregnancy and puerperium that place the mother at a higher risk of infection or deteriorating condition once infected. This change includes, reduced immune response resulting in potential faster progression of an infection. We report two cases of LA in third trimester of pregnancy and two cases during peurperium within 5 months at the Departments of Dental and Maxillofacial Surgery and Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Treatment modalities and challenges involved in their management were also discussed. Overall, three patients survived the disease, two cases of LA in pregnancy and one case of LA in the puerperium, one patient in the puerperium died due to overwhelming sepsis. The babies of both patients in the puerperium survived, although they came in with very low birth weight and failure to thrive. They were managed in the special care baby unit of the hospital. Management of LA in a resource and personnel scarce setting is demanding especially in special group of patients such as pregnancy and puerperium. Multidisciplinary approach in management is essential, especially in the antenatal period of the patient.

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The coexistence of urothelial carcinoma (UC) of renal pelvis and ipsilateral renal cell carcinoma (RCC) is remarkably rare. We present a case of an 80-year-old male who was admitted with a history of the left flank pain, painless hematuria, and passage of blood clot in urine. Computerized tomography revealed a solid mass in the left renal pelvis extending into the calyces and renal parenchyma which gave an impression of UC of renal pelvis. Left nephroureterectomy was performed for tumor in renal pelvis, and histopathological examination showed an infiltrating high-grade papillary UC of the renal pelvis with an incidental clear cell type RCC in the renal parenchyma. This is a rare case of combined renal malignancies in the same kidney. There are only 52 cases reported in English language literature till 2017.

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The clavicle is one of the earliest bones to ossify in utero. Their associated malformations are uncommon. The most common among them is pseudoarthrosis of the clavicle. However, the supernumerary clavicle is a rarity. It is often isolated, unilateral, and an accidental finding seen at adult age because it is asymptomatic; however, the case of a 3-month-old girl which was diagnosed much earlier because she had other associated malformations is reported.

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