letter to the editor
Objective: This study aimed to conduct an evaluation of music therapy clinical trials
worldwide, to understand what trials have been conducted and to show the chronological
changes. Additionally, we sought to clarify issues related to providing clinical trial registration
Methods: We searched the International Clinical Trials Registry Platform (ICTRP) database for
“music therapy,” and identified the disease target for each article found.
Results: A total of 150 clinical trial studies were found in the ICTRP using the term “music
therapy.” In these trials, music therapy was used for improvement of social functioning in
schizophrenia and/or serious mental disorders, anxiety and depressive symptoms, and cancer
symptoms. Twenty-five clinical trials were actively recruiting. Sixteen of the 25 trials were
registered in the United States at ClinicalTrials.gov, of which 9 trials were conducted in the US.
Seven trials were conducted in other countries such as Spain, Taiwan, and China.
Conclusion: A search for music therapy clinical trials retrieved 150 trials from the ICTRP, and
the number of clinical trial registrations has increased yearly. Music therapy is widely used in
patients with various diseases, including Alzheimer’s disease, anxiety, and arthritic pain and
has the potential to improve certain disease outcomes, but there is not enough evidence to
substantiate its efficacy. It is important to enlighten researchers and pharmaceutical companies
on the proper management of the quality of such clinical trial information, as this is an important
Cancer immunotherapy has evolved enormously in the recent years with better understanding of immune reactions, immune microenvironment and immunosurveillance. Breast cancer is characterized by large heterogeneity, a fact which rather complicated the development and the approval of novel therapeutic options in comparison to the majority of other solid tumors since each subtype has required a unique scientific approach and different targets and goals. Triple negative breast cancer (TNBC) is considered the most aggressive of the breast cancer subtypes with limited treatment options and worse outcome compared to others. This article summarizes some of the early clinical studies and the recently presented phase III clinical study of immunotherapy checkpoint inhibitors in this difficult setting.
Keywords: Cancer; Immunotherapy; Triple negative breast cancer (TNBC); Breast cancer.
In most African countries, the elderly face challenges that affect their health and wellbeing and are more pronounced because of the systemic factors of inadequate health care, food insecurity and the general care. Increasing population of the elderly persons in Uganda is raising concern than ever before. The purpose of this paper to ascertain care available to the rural elderly persons and their role as carers for their grandchildren and implications on their wellbeing.
This was a qualitative study conducted among the rural elderly aged 60 years and above in eight purposively selected district that included Lira, Nebbi, Kampala, Luwero, Pallisa, Jinja, Mbarara, and Ntungamo. The study sample consisted of 101 elderly person from whom in-depth interviews were conducted. Data was analysed using qualitative thematic content analysis.
Rural elderly in Uganda face a lot of constraints that include access to healthcare and information, poor economic status, food insecurity and poor nutrition, and poor accommodation and housing conditions. Two broader themes emerged inductively from the analysis that include care available for the rural elderly and providing care to grandchildren. These themes generated several subthemes. Taking care of grandchildren crippled the elderly and reduced the economic benefits. That said some rural elderly were happy and felt fulfilled to care of the grandchildren despite the lack of resources.
The rural elderly in Uganda are living in doleful conditions with limited care and support. They need care but are the providers of care to the grandchildren. They are frails and may not afford to provide adequate care. They care for grandchildren many of whom are orphans and vulnerable yet they themselves need care. It is important the government and the community re-enforce this care not to put strain on elderly. The rural elderly unique challenges necessitates special targeting and mobilization of resources at the household, local, district and national levels.
Grandparents; Care; Orphans; Grandchildren; Skip-generation; Uganda.
To study the role of sound enhancer device in teleconsultation.
This study was conducted in the plastic surgery department in a tertiary care centre in the month of May-June 2019. A sound enhancer device was used with mobile phone for videoconferencing as form of teleconsultation by plastic surgery trainees in operation theatre and outpatient department. At the end of the study feedbacks were taken from the trainees.
It was found that on using the sound enhancer device, the sound quality improved and it was helpful in the teleconsultation sessions using videoconferencing.
The use of sound enhancer is a simple, cost-effective, innovative method of using a simple technology to aid in utilisation of teleconsultation facilities in a very non-sophisticated way.
Sound enhancer device; Teleconsultation; Telemedicine.
Cervical cancer is a common cause of cancer-related deaths in women worldwide, with a fatality rate second only to breast cancer. Human papillomaviruses (HPVs) are the main causative agents of cervical cancer, and are therefore obvious targets for vaccine development. Although two prophylactic HPV vaccines have been commercialized, therapeutic vaccines against HPVs have not been developed yet. Current vaccine technologies emphasize the power of small particles in targeting immune cells, and particles of 20-50 nm have been reported to induce optimal immune responses against a variety of pathogens and cancers.
We synthesized new nanoparticle-based vaccines against cervical cancer by using antigenic 8Qmin peptide epitope derived from HPV-16 E7 protein, a hydrophilic poly-(L-glutamic acid) (PGA) linker, and an 8-arm poly (tert-butyl acrylate) dendrimer-based delivery system (D8).
Four different peptides containing 8Qmin and PGA of different lengths were successfully synthesized with high yield and purity. These were then conjugated to alkyne-functionalized D8 by copper-catalyzed alkyne-azide cycloaddition “click” reaction. The conjugates self-assembled into nanoparticles, with decreased particle size corresponding to a greater number of Glu units. The four vaccine candidates were tested in C57 black 6 (C57BL/6) mice bearing well-established (7-day-old) tumors to examine their therapeutic effects.
Interestingly, only one conjugate delayed tumor growth, and montanide adjuvanted antigen, used as a positive control, failed to demonstrate any therapeutic effect.
Peptide-based subunit vaccine; Human papillomavirus; Polyglutamic acid; Therapeutic cancer vaccine; Polymer-peptide conjugate; Self-adjuvanting; Cervical cancer.
To study the role of bactiguard infection technology (BIP) in preventing Catheter-associated urinary tract infections. This study was conducted in a tertiary care centre in the Department of Plastic Surgery, JIPMER, Pondicherry, India in the month of August 2019. The study subject was a 55-year-old gentleman with Fournier’s gangrene and type 2 diabetes mellitus (DM). The Foley’s catheter with BIP technology was used and its role in preventing urinary tract infections (UTI) was studied over a period of 10-days. During the period of the catheter use in our subject, patient did not develop features of urinary tract infections. BIP technology is claimed to be effective in preventing Catheter-associated urinary tract infections but further studies in more individuals is required to validate the same.
Bactiguard infection technology (BIP); Catheter associated urinary tract infection (CAUTI); Biofilm.
opposite to the editorial
Recruitment in clinical research trials can be challenging in trials that are time-sensitive and/or are rare disease and critical care trials. One of the hurdles for recruitment in these types of clinical trials is due to the consent process, and the need to have consent of the patient within a certain timeframe, or the patient unable to consent for themselves. This paper will discuss the usage of the utilization of remote consent options for these trials.
Recruitment; e-consent; Remote consent; Clinical trials; Rare disease; Time-sensitive.
Circulating tumor cells (CTCs) are the precursors to metastases and increased numbers of CTCs in the peripheral circulation have been shown to correlate with decreased progression-free and overall survival. Although the current clinical utility has been focused on the prognostic significance, other clinical applications are being explored, such as determining if a patient is a candidate for treatment, determining the efficacy of treatment, evaluation for resistance to therapy, prediction of metastatic site, or as an early predictor of metastases. Current methodologies are based on quantifying CTCs and include technologies based on physical, immunological, and molecular techniques. However, these have limitations, of which most of them do not have the ability to perform morphological evaluation. Using morphological evaluation, CTCs in body fluids could be used for primary diagnosis in the setting of cancer of unknown primary (CUP) or in initial or early diagnostic scenarios. Additionally, cytological specimens have been shown to be useful for ancillary testing in patients when surgical resection specimens or biopsies are not available. Evaluation of CTCs should incorporate histological, immunehistochemical, and molecular characterization to enable clinicians to obtain the comprehensive diagnostic, prognostic and therapeutic information necessary to provide appropriate personalized care to cancer patients.
Circulating tumor cell (CTC); Circulating; Tumor cell; Cancer; Isolation; Detection; Metastasis; Prognosis.
CTC: Circulating tumor cell; RT-PCR: Reverse transcriptase-polymerase chain reaction; EMT: Epithelial-mesenchymal transition; MET: Mesenchymal-epithelial transition; TRAIL: Tumor necrosis factor-related apoptosis-inducing ligand; CEA: Carcinoembryonic antigen; CUP: Cancer of unknown primary; CAP: College of American Pathologists; AMP: Association for Molecular Pathology; ASCO: American Society of Clinical Oncology.
Differentiating between cystic lesions of pituitary gland may be challenging. Usual differentials are cystic pituitary adenoma (cPA) and Rathke’s cleft cyst (RCC). Diagnostic certainty of magnetic resonance imaging (MRI) is limited in the absence of usual suggestive features. Furthermore, RCC can co-exist with approximately 2% of pituitary adenomas. Over time, these cystic lesions may remain static, resolve spontaneously, or result in symptomatology relating to mass effect and/or hormonal disruption. In cases of an asymptomatic lesion being found incidentally, little is known about how it may progress, raising question whether to proceed with surgical management or follow-up. We a present case of a spontaneously resolving pituitary cystic lesion with imaging features more suggestive of cPA than RCC, for which watchful waiting proved a successful treatment strategy. The current case serves as a reminder that small cystic lesions can be followed-up with spontaneous resolution and should be offered active treatment only when clinically required.
Pituitary gland; Pituitary cystic lesion; Cystic pituitary adenoma (cPA); Magnetic resonance imaging (MRI).
Absorbable threads represent one of the most exciting breakthroughs in aesthetic medicine. The innovative composition of absorbable poly-L-lactic acid (PLLA)/caprolactone (PCL) threads enriched with hyaluronic acid (HA) has triggered the interest of aesthetic practitioners.
To compare the aesthetic outcomes of armouring procedures with absorbable PLLA/PCL threads versus the same procedure performed with PLLA/PCL/HA threads (APTOS, Tbilisi, Georgia threads).
Materials and Methods
Eight patients underwent thread insertion in the face (PLLA/PCL threads on one side and PLLA/PCL/HA threads on the other). Aesthetic outcome was determined subjectively by the patient after 7 days using a 5-point rating questionnaire. Wrinkles were evaluated objectively using 3D photosystem software after 7, 30, and 90 days.
Seven days after treatment there was significantly less pain, less swelling, less burning and a faster reduction of skin irregularities on the side treated with HA-enriched threads (all p<0.05). The side of the face treated with HA-enriched threads also demonstrated faster and more obvious improvement of wrinkles.
Absorbable PLLA/PCL threads have a reliable reputation for oval correction of the face and long-lasting biostimulation. The new HA-enriched threads shorten the post-procedure downtime, accelerate rejuvenation and provide more significant patient satisfaction.
Absorbable thread; Thread lifting; HA-enriched threads; Aesthetics.
The Lactobacillus is an industrially-important group of probiotic organisms that plays an important role in human health by inhibiting harmful and pathogenic bacterial growth, boosting immune function, and increasing resistance to infection. The aim of this study was to identify the probiotic bacteria Lactobacillus based on their phenotypic features and genotypic features. This study also shows the importance of probiotic bacterium, and the effects of their antibiotic resistance to human.
Six different brands were cultured on man, rogosa and sharpe (MRS) agar. The identity of the culture was based on the characteristics of the strains of Lactobacillus spp. which was characterized using their phenotypic features (cell morphology, Gram’s staining tests which are specific for Lactobacillus genus). The bacterial deoxyribonucleic acid (DNA) was extracted by two different methods, boiled cell method and cetyl trimethylammonium bromide (CTAB) method. Furthermore, the extracted DNA yields were compared to determine which gives the best yield. The bacterial genus was detected with using genus specific primers, specific to the Lactobacillus. All the isolates were further subjected to antibiotic resistance test using disc diffusion method against a total of 4 antibiotics (Erythromycin, Tetracycline, Vancomycin and Ampicillin) and the antibiotic resistant genes of tet(M) & erm(B), were analyzed by polymerase chain reaction (PCR).
Five isolates out of six samples (A to E) were found to exhibit multiple resistance against some of the most commonly used antibiotics. The isolates showed resistance toward tetracycline, erythromycin & vancomycin. Besides that, the isolates displayed a low-level of resistance toward ampicillin.
This study proves that antibiotic resistance is present in different species of probiotic strains, which may pose a food safety concern.
Lactobacillus; Probiotics; Antibiotics; Tetracycline; Vancomycin; Erythromycin; Ampicillin; Antibiotic resistance.
Deoxyribonucleic acid (DNA) microarrays are collections of DNA probes arranged on a base pair and the latest commercialized molecular diagnostic technologies that offer high throughput results, more sensitive and require less time. It is the most reliable and widely accepted tool facilitating the simultaneous identification of thousands of genetic elements even a single gene. Microarrays are powerful new tools for the investigation of global changes in gene expression profiles in cells and tissues. The different types of DNA microarray or DNA chip devices and systems are described along with their methods of fabrication and their use. The DNA microarrays assembly process is automatized and further miniaturized. DNA microarrays are used in the search of various specific genes or in gene polymorphism and expression analysis. They will be widely used to investigate the expression of various genes connected with various diseases in order to find the causes of these diseases and to enable their accurate treatment. Generally, microarray analysis is not only applied for gene expression studies, but also used in immunology, genotyping, diagnostics and sequence analysis. Additionally, microarray technology being developed and applied to new areas of proteomics, cancer research, and cellular analysis.
Application, DNA, Microarray, Principle.
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
The American diet is nutrient-poor and rich in unhealthy compounds like sodium, sugar, and saturated fats. Whether food has an effect on appearance has not been fully elucidated. The purpose of this prospective, single-armed study was to evaluate the impact of consuming two nutrient-dense functional foods, which are low in salt, sugar, and saturated fats, on hair, skin, and fingernail health.
Both subjective (self-reported questionnaires and photographs) and objective (i.e., salivary pH and skin hydration) tests were used to evaluate appearance. Weekly compliance with nutrient-dense foods, body weight, and quality of life assessment were also recorded.
Participants(n=28) consumed most of the nutrient-dense foods and remained weight stable, which was the goal of the study to exclude the effect of changes in body weight on appearance. Neither objective measurement of appearance showed significant improvements. Subjective measurements using questionnaires specific to hair, skin, and fingernails improved significantly over the 8-week study. Rating of photographs that the participants took of themselves improved significantly over the 8-weeks. These included reduced redness, decreased pore size, and better skin color. Using an acne-rating scale, a significant improvement was observed at week 8 compared to baseline. The quality of life parameters improved significantly including feeling of well-being, feeling full, having more energy, sleeping better, having less stress, and being more focused.
Inclusion of two nutrient-rich, functional foods in the diet improved the appearance of hair, skin, and fingernails. These foods were well-received and easy-to-prepare, leading to excellent compliance with the dietary protocol.
Appearance; Diet; Functional foods; Nutrient-dense foods; Hair; Skin; Nails.
Bystanders are an integral part of an emergency scene. Their presence on site makes them the immediate potential responders, who can provide life-saving assistance as well as various rescue actions. Research has shown that bystanders are willing to and are capable of helping, especially (but not limited to) when a leader emerges, as the help is rooted in a collective action. In this article, we suggest a new framework for understanding the effectiveness of bystanders help, based on the evolving social process between bystanders and first responders. As we show, the transition from no help, at the very first moment right after the emergency has occurred, to an effective coordinated response where first responders and bystanders act together, goes through engagement of bystanders. Further, first responders should acknowledge the social organization of bystanders, utilize and leverage it in order to optimize their efforts. This framework has important insights for policy makers when managing emergency and disaster situations with limited resources.
Bystanders; First responders; Mass casualty incident; Help; Emergency; Cardio-pulmonary resuscitation (CPR).
This case documents the treatment of a middle-aged woman with chronic, unresponsive adhesive capsulitis (frozen shoulder) using manipulation, active release therapy, and electronic acupuncture. She had not responded to typical physical therapy but did respond to active release therapy along with adjunctive manipulation and acupuncture. In our course of treatment we wanted to see if we could significantly improve pain-free range of motion and normal; function without using invasive treatments like surgery and manipulation under anesthesia. Over a course of five weeks, using a soft tissue manipulation technique known as active release technique along with electrified acupuncture and home exercises, we were able to increase her range of motion to near normal and her function to normal. She was not forced to miss any work because of the treatment and can now do all the things she needs to do for work.
Frozen shoulder; Adhesive capsulitis; Manipulation; Active release therapy; Non-invasive treatment.
This essay has emerged through my research engagements with life history as a research method in anthropology. It is based on the life events of a woman artist. The past few decades have brought an explosion of cultural criticisms and also explorations of women’s creative expressions across cultures. Some of the queries addressed are, how do external forces shape the creativity of female artists. Also, how do creative women respond to such forces? Creative women, then, have a unique relationship to their cultural contexts, as well as to the creative genre to which they respond. This essay also delves into myths related to insanity and women. It discusses creativity, as a mode of engagement with rigid social structures.
Life history; Women; Creativity; Body psyche; Insanity; Myths; Anthropology.
To evaluate the immunogenicity of a recombinant protein D from Haemophilus Influenzae (Hi) and the functional activities of the induced protein D antibodies in a mouse model.
Female Balb/c mice were immunised subcutaneously with recombinant protein D in the presence or absence of adjuvants and the serum immunoglobulin G (IgG) response to protein D was assessed by ELISA. The functional activity of the immune sera was evaluated in vitro using bactericidal assay against typeable Hi serotype b (Hib) and non-typeable Hi (NTHi) clinical isolates and in vivo using an infant rat bacteraemia model and a Hib clinical isolate.
A dose-dependent IgG response was induced in mice immunised with the recombinant protein D and this response was further increased by the adjuvants used [CPG, AlPO4 and Al(OH)3], with the latter showing the greatest effect on the antibody response. Immune sera were very effective in bactericidal assay against several Hib and NTHi clinical isolates, with a higher serum bactericidal titre against the NTHi than against the Hib isolates. This is possibly due to the lower expression of protein D on the Hib isolates used in our study, compared to the NTHi isolates. In addition, anti-protein D antibodies were partially protective in vivo infant rat bacteraemia model against a challenge with Hib Eagan strain.
Our results suggest that recombinant protein D is a good vaccine candidate against Hi and should be given in combination with other vaccine candidates to ensure complete protection against Hib and NTHi.
Haemophilus influenzae (Hi); Haemophilus influenzae serotype b bacteraemia; Rats.
This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-year-old girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails), which the child went through, remarkably improving their symptoms.
Unique difficulties and challenges can arise for rare diseases and orphan disease indications within a clinical trial. Some of the challenges encountered by trials that are working on rare diseases can include recruitment and enrollment. One of the explanations for the challenges that are encountered in rare disease trials is because of the trial design of study, where the investigational product is being compared to the placebo. This review paper discusses the usage of placebo and when other options could be taken into consideration while creating the protocol, specifically with consideration to rare disease studies. It is essential for the investigators and those designing the protocol to consider alternative options from the standard randomized controlled trial. The aim of this paper is to review alternative trial design options. The trial designs discussed in this review paper include crossover trials, single arm studies and historical data, and n-of-1 trials.
Recruitment; Enrollment; Placebo controlled; Clinical trials; Rare disease; Crossover trials; Single arm study;
Historical data; n-of-1 trials.
Perniosis or chilblain pernio is an inflammatory skin disease, typically located on acral skin surfaces secondary to prolonged exposure to cold temperatures and damp conditions. This disorder can appear as an idiopathic dermatosis, usually in young women, but occasionally it is associated with diseases such as anorexia, intestinal lymphoma, chronic myelomonocytic leukemia, monoclonal gammopathies, cryoproteinaemia, viral infections, as well as connective tissue diseases, especially lupus, picture that is known as chilblain lupus. We present a case of perniosis associated with Systemic Lupus Erythematosus and review the literature.
Chilblain lupus; Perniosis; Chilblain pernio; Rare cutaneous; Myelomonocytic leukemia; Systemic Lupus Erythematosus.
This case report illustrates a challenging case of worsening heart failure in a previously well-compensated patient with unclear etiology. Further workup revealed the patient’s cardiac resynchronization therapy-defibrillator (CRT-D) left ventricle (LV) lead was losing capture during positional changes. This case demonstrates the importance of device optimization, as well as electrocardiogram (ECG) monitoring to elucidate possible causes of acute systolic heart failure.
Cardiac resynchronization; cardiac resynchronization therapy (CRT); Systolic heart failure; Lead positioning;
Advanced heart failure.
brief research report
Previous literature has reported ill-effect of ototoxic drug on hearing and balance. Present study investigated awareness among medical doctors for the same.
A total of 55-medical doctors of multiple specialties from Assam, India participated in the present study. A total of 14 questions with Likert Scale based scoring pattern were framed and validated for the present study.
Outcome of the present study showed high awareness percentage about side effect ototoxic drugs was obtained, which was a satisfying outcome.
While low audiological referral and consultation awareness was identified as an area of concern.
Ototoxicity; Doctors; Assam; Awareness.
Everyday all of us use rechargeable solutions either its smartphones, televisions, or any other electronic devices. Faster streaming of these electronic devices to other external devices may be facilitated through wireless connectivity. Wireless streaming demands much more battery backup. With advancement of hearing aid technology many features exists in hearing aids which may facilitate better spectral information, improved speech understanding in presence of background noise and thus improving communication and quality of life of the users. The use of these advanced features often requires continuous uninterrupted power supply. Traditional disposable hearing aid batteries cannot be assured of their performance due to their inopportune time discharge. Recently rechargeable solutions in hearing aids have been discovered that can support long-lasting wireless streaming. Modern day rechargeable batteries are expected to be easy to charge which can last for longer duration with more reliability and durability. Rechargeable as a feature is added on over and boon. Rechargeable battery solutions based on its various benefits may support as boon for environment, hearing aid users and professionals (better counseling and more satisfied users). The aim of this article is to highlight the awareness of these different rechargeable solutions for the users and professionals. In addition mentioning in brief the superiority of Lithium ion battery which is widely accepted in rechargeable hearing aids.
Rechargeable hearing aids; Wireless streaming; Batteries for hearing aids; Li-ion batteries.
Low serum bicarbonate, with or without an elevated anion gap, can indicate metabolic acidosis. High anion gap metabolic acidosis is due to the unmeasured anions. Hypertriglyceridemia can also be associated with spuriously low serum bicarbonate levels due to lab interference. We present a 44-year-old woman who presented with anion gap metabolic acidosis in the presence of severe hypertriglyceridemia.
Hypertriglyceridemia; Acid-base disorders; Low serum bicarbonate; Metabolic acidosis.
Bone grafting is a surgical procedure that replaces missing bone through transferring bone cells from a donor to the recipient site and the graft could be from a patient’s own body, an artificial, synthetic, or natural substitute. Bone grafts and bone graft substitutes are indicated for a variety of orthopedic abnormalities such as comminuted fractures (due to car accidents, falling from a height or gunshot injury), delayed unions, non-unions, arthrodesis, osteomyelitis and congenital diseases (rickets, abnormal bone development) and are used to provide structural support and enhance bone healing. Autogenous, allogeneic, and artificial bone grafts are common types and sources of grafts and the advancement of allografts, synthetic bone grafts, and new operative techniques may have influenced the use of bone grafts in recent years. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone grafting and help bone tissue to regenerate completely. A bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs, and sternum. An ideal bone graft substitutes should be biologically inert, readily available, must possess osteogenic, osteoinductive and osteoconductive properties, provide mechanical support, easily adaptable in terms of size, shape, length and substituted by the host bone. Bone banks are the source of bone grafts and implants and necessary for providing biological material for a series of orthopedic procedures. Bone grafts and implants can be selected as per clinical problems, the equipment available and the preference of the surgeon. A search for an ideal bone graft is on and may continue time to time.
Application; Bone; Bone graft; Bone replacement; Bone bank; Principle.
Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP.
This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4 mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was defined as IOP<20 mmHg without acetazolamide.
Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was 18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients.
This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.
Glaucoma; Micropulse laser; Cyclophotocoagulation.
To describe our myositis cohort in-depth.
From January 2006 to December 2018, all newly diagnosed myositis patients were retrospectively enrolled in the study. We performed a subtype reclassification using the 2017 EULAR/ACR criteria, following the example of the EuroMyositis registry. Disease activity and damage were measured by the newest standardized assessment-tools for clinical studies. Comparisons between myositis subgroups were conducted using Fisher’s exact test.
We enrolled 32 patients (25 were female): six patients with dermatomyositis, six with polymyositis, eleven with overlap myositis, six with antisynthetase syndrome, one with autoimmune necrotizing myopathy, one with juvenile antisynthetase syndrome and one with juvenile dermatomyositis. The overall median follow-up period was 23-months (9-44.75). Interstitial lung disease (ILD) was most frequently seen in patients with antisynthetase syndrome. Patients with overlap myositis were more likely to have polyarthritis mimicking rheumatoid arthritis, reduced capillary density in the nail fold capillaroscopy and Raynaud syndrome. Ovarian cancer during the follow-up period occurred in two patients (one with polymyositis and one with dermatomyositis). Myositis-related death was reported in two patients: acute respiratory failure in autoimmune necrotizing myopathy and dysphagia-related complications in polymyositis. Cyclophosphamide, methotrexate and rituximab demonstrated a significant steroid-sparing effect. In 22 of 32 patients, the myositis subgroup classifications made on the basis of our opinion and the new EULAR/ACR classification criteria were different, showing strong disagreement, especially in the subtype polymyositis.
Our analysis highlights the heterogeneity in myositis subgroups and shows the steroid-sparing effect of cyclophosphamide, methotrexate and rituximab.
Myositis; Idiopathic inflammatory myopathy; Dermatomyositis; Antisynthetase syndrome; Overlap myositis; Rituximab.
CCP: Cyclic Citrullinated Peptide; CK: Creatine kinase; CYC: Cyclophosphamide; IIM: Idiopathic Inflammatory Myopathy; ILD: Interstitial lung disease; IMACS: International Myositis Assessment and Clinical Studies Group; MDI: Myositis Damage Index; MMT8: Manual muscle test 8; MTX: Methotrexate; MYOACT: MYOsitis disease ACTivity; RTX: Rituximab; TIF-1γ: Transcriptional factor-1γ.
Aim: Obesity is increasing globally by leaps and bounds and thus the incidence of type 2 diabetes mellitus (T2DM) along with it so much so that the term diabesity had to be coined. Earlier we had reviewed how to treat the both together and the role of empagliflozin to improve cardiovascular outcome trials (CVOT). Similarly T2DM and hypertension are pathophysiologically-related diseases which co-exist with a broader complex of metabolic diseases which co-exist possessing similar set of risk factors. Hence it is important to consider which antihypertensives are suitable that possess a positive effect on metabolic factors in cases of T2DM who require an antihypertensive.
Method: A systematic review was carried out using the PubMed search engine with the MeSH terms: “T2DM”; “essential hypertension; “cardiovascular (CV)”; “Complications of diabetes mellitus (DM) and antihypertensive”; “Antihypertensive preferred in T2DM subjects”; “Renin-angiotensin–aldosterone system inhibitors”; “Angiotensin converting enzyme inhibitors (ACEi)”; “Angiotensin receptor blockers (ARBs)”; “Dihydropyridine calcium channel blocker”; “β2 blockers”; “Diuretics”.
Discussion: Most diabetes mellitus (DM) subjects need a minimum of two antihypertensive drugs, combining a renin-angiotensinaldosterone system (RAS) inhibitor with a dihydropyridine calcium channel blocker seems to be the most indicated approach. But not all dihydropyridine calcium channel blockers have equivalent effects on metabolic parameters. Hence manidipine that causes positive effect on insulin resistance (IR) seems to be an effective option. We have reviewed how manidipine is superior to amlodipine with regards to improving IR, not seen with amlodipine, along with not causing excessive sympathetic nervous system (SNS) activation, pulse pressure and ankle edema or to much lesser extent than amlodipine. Therefore, manidipine needs to be the first addition to RAS inhibitors in case of DM’s having hypertension of the dihydropyridines calcium channel blockers. Further good blood pressure (BP) control been correlated with good CVs outcomes.
Conclusion: A RAS inhibitor is the first line of choice of drugs in a subject with T2DM who needs to be treated with empagliflozin for better CVOT outcome, and when a 2nd drug has to be added it is manidipine that is preferred over amlodipine. Plant products are proving to be having a lot of beneficial effects in DM, obesity and hypertension. Thus need for developing agents from plants will prove to be more cost effective in these chronic diseases where compliance is difficult to achieve with the use of common antiDM drugs and antihypertensives with the cost factor along with their side effects.
Type 2 diabetes mellitus (T2DM); Diabesity; Antihypertensives; Renin-angiotensin-aldosterone system (RAS) inhibitor; Dihydropyridines calcium channel blockers; Plant products.
Malrotation of the gut is rare in adults. We discuss the case of a 30-year-old primiparous woman who presented to the acute gynecology ward at 19-weeks’ gestation with ongoing nausea and vomiting throughout pregnancy. She attended on a number of occasions with the same symptoms and was trialed on a number of different antiemetics. Initial biochemical investigations were unremarkable, however, the patient started to develop signs of ‘abdominal obstruction’. A magnetic resonance image (MRI) of the pelvis showed evidence of duodenal obstruction secondary to malrotation which may be secondary to a fibrous (Ladd’s) band. She was treated laparoscopically via a Ladd procedure and had an uneventful recovery. Interestingly, the patient presented again in her second pregnancy with very similar symptoms and underwent another Ladd procedure, but via a laparotomy. This is an interesting, rare and unusual case of nausea and vomiting in pregnancy.
Ladd bands; Pregnancy; Nausea; Vomiting; Hyperemesis; Volvulus.
It was previously reported that diethylnitrosamine (DEN) enhanced liver cancer progression in ATT-MYC mouse model of liver cancer. Radiogenomics is a new tool in advanced science technology that gives information on tumor biology, non-tumor surrounding tissue, the degree of tumor size and presence of necrosis of cells especially with joined micro computed tomography – positron emission tomographys (CT/PETs).
To evaluate the correlation of gene expression and non-invasive microPET information of the liver tumors at different points of the stage of growth.
Exon array expression of the liver of ATT-MYC mice treated with DEN or butylated hydroxytoluene (BHT) compared to control non-transgenic mice were analyzed by array track and the current data were also compared to microarray expression of liver tumor of ATT-MYC mice.
The expression of genes responsible for glucose transport such as glut1, 3, 4, hk1, slc1a5, slc1a1, slc1a4, slc1a2, gp6c and gpc-1-3-4 were up-regulated significantly in DEN-treated transgenic mice immediately after end of treatment (p≤0.05), while glut2 (fold change 0.9503, p-value 0.4385) and hk2 (fold change 3.0589, p-value 0.0565) genes were increased not significantly immediately after end of treatment. Additionally, at 4.5-months of observation after the end of treatment slc1a5, slc38a2, glut1, glut4 and gpc3-4 genes had a significant fold change in liver tumor tissue in DEN treated mice when compared to BHT or control transgenic or non-transgenic one. While hk1, 2, slc5a1, slc1a4, glut2, glut3, g6pc and gpc-1 genes were increased non-significantly in the liver of treated mice when compared to control group at 4.5-months of observation after the end of treatment. Notably, c-myc, hif-1 and aldoa glycolytic genes were expressed significantly both time points of 4 and 8.5-months while ldhb, hk-2 and PKM2 were increased non-significantly in DEN treatment when compared to BHT/control non-transgenic animals.
There is a definitive correlation between genes responsible for glucose transport and 18F-Fluorodeoxyglucose (FDG) uptake in the early and advanced degree of liver carcinogenesis. This study of glucose pathway in Hepatocellular carcinoma (HCC) at different stages of early and advanced one is the potential for therapeutic anticancer therapy.
18-FFluorodeoxyglucose (FDG); MicroPET; Exon array expression; Hepatocellular carcinoma (HCC); Att-myc transgenic mice; Diethylnitrosamine (DEN), Butylated hydroxytoluene (BHT); Glucose metabolism.
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
Statins are widely used in the management or inhibition of several processes that lead to the development of cardiovascular diseases. Increased statin therapy has been related to the induction of type II diabetes (DM), a state which predisposes to cardiovascular disease (CVD). Statins are well-known to possess anti-inflammatory properties and the ability to disrupt de novo biosynthesis of cholesterol and lipid homeostasis has been implicated in the induction of inflammatory responses within pancreatic β-cells. Inhibition of β-hydroxy β-methyl glutaryl-CoA (HMG-CoA) results an increased level of low-density lipoproteins (LDL) receptors. Increased LDL receptor numbers will replenish exhausted intracellular supplies, resulting in higher levels of intracellular cholesterol. Therefore, stimulating immunological response and inflammatory reactions, disrupt the functional integrity of the β-cell via oxidation of the plasma-derived low-density lipoprotein. Despite the pleiotropic effects of statins on the pancreatic β-cell, they have also been reported to affect a number of other cell types associated with the development of diabetes. Inhibition of the biosynthesis of isoprenoid by statins has been associated with the down-stream regulation of glucose transporter (GLUT 4) in adipose tissues, which facilitates the uptake of glucose. This effect resulted in increasing resistance to insulin in the liver, muscle, and adipose tissue. Adiponectin, a plasma protein released by adipocytes, alters fatty acids and carbohydrate metabolism both in the muscle cells and liver. This process indirectly influences resistance to insulin by the attendant decrease in hepatic gluconeogenesis and to upregulate muscular β-oxidation and glucose uptake.
Cutaneous polyarteritis nodosa is a rarer variant of classic polyarteritis nodosa with unknown etiopathogenesis. It presents with skin, articular and nervous involvement, after systemic involvement is ruled out. This work reports the case of a 41-year-old male patient diagnosed with cutaneous polyarteritis nodosa with skin lesions, polyarthralgia and sensory axonal polyneuropathy.
Skin; Polyarteritis; Vasculitis; Biopsy; Immunofluorescence; Histology.
The aim of this prospective study is clinical and ultrasonographic evaluation of the pelvic floor in primiparous women after normal vaginal delivery with episiotomy and without episiotomy.
This is a cross-section study of primiparous women with a history of delivery at Tanta University Hospital from August 2018 to August 2019. The sample power was calculated based on avulsion (major and minor) in two groups (vaginal delivery with episiotomy and without episiotomy) of total forty-primiparous women with an interval after delivery (20 cases after normal vaginal delivery with episiotomy and 20 cases after normal vaginal delivery without episiotomy).
Twenty-four hours of delivery there was a highly significant difference between group A (with episiotomy) and group B (without episiotomy) regarding to ultrasound abnormalities, degree of tear, blood loss, hemoglobin concentration and clinical findings, while no difference regarding levator ani weakness. Two months later from delivery there was no significant difference between group A and group B regarding to ultrasound abnormalities and levator ani weakness while there was a difference between the two groups in regarding with clinical findings.
Normal vaginal delivery without episiotomy in primiparous women is better than normal vaginal delivery with episiotomy as there is no perineal tenderness, no dyspareunia. Low incidence of urinary, rectal incontinence, tear and perineal infection.
Clinical and ultrasonography; Primiparous; Normal vaginal delivery; Episiotomy.
Current image reconstruction techniques in computed tomography (CT) such as filtered back-projection (FBP) and iterative reconstruction (IR) have limited use in low-dose CT imaging due to poor image quality and reconstruction times not fit for clinical implementation. Hence, with the increasing need for radiation dose reductions in CT, the use of artificial intelligence (AI) in image reconstruction has been an area of growing interest.
The aim of this review is to examine the use of AI in CT image reconstruction and its effectiveness in enabling further dose reductions through improvements in image quality of low-dose CT images.
A review of the literature from 2016 to 2020 was conducted using the databases Scopus, Ovid MEDLINE, and PubMed. A subsequent search of several well-known journals was performed to obtain additional information. After careful assessment, articles were excluded if they were not obtainable from the databases or not available in English.
This review found that deep learning-based algorithms demonstrate promising results in improving the image quality of low-dose images through noise suppression, artefact reduction, and structure preservation in addition to optimising IR methods.
In conclusion, with the two AI-based CT systems currently in clinical use showing favourable benefits, it is expected that AI algorithms will continue to proliferate and enable significant dose reductions in CT imaging.
Computed tomography (CT); Artificial Intelligence (AI); Image reconstruction (IN); Machine learning (ML); Deep learning (DL); Dose reduction.
AI: Artificial intelligence; CT: Computed tomography; ML: Machine learning; DL: Deep learning; FBP: Filtered back-projection; IR: Iterative reconstruction; MBIR: Model-based iterative reconstruction; LDCT: Low-dose computed tomography; FDA: U.S Food and Drug Administration; ANN: Artificial neural network; DNN: Deep neural network; CNN: Convolutional neural network; CNR: Contrast-to-noise ratio; SNR: Signal-to-noise ratio.
India is a vast country with limited human resources. People living in remote areas often have limited access to healthcare facilities. To address this need and to increase healthcare awareness, health camps have been established. These camps are often supervised by junior physicians. Telemedicine, and in particular use of a digital stethoscope may provide better diagnosis and better consultation to the patient by senior physicians located remotely. This article highlights the clinical use of a digital stethoscope in such a health camp.
Health camp; Telemedicine; Digital stethoscope.
Patient centricity has led to the idea that drugs should answer medical needs not only defined by the medical bodies but relevant for the patients themselves. This implies that the diversity of the patients should be represented in clinical trials. Disparities in representation of diverse populations in clinical trials have been well-documented for several pathologies like arterial hypertension, diabetes but also in oncology. Today, Caucasian patients included in clinical trials represent at least 75% of the clinical trials population even in pathologies where minorities are largely more affected than Caucasians. Filling the gap in diversity is an important matter to ensure ethics, good practices, regulatory compliance, patient safety and scientific validity. To achieve their recruitment goals and being patient centric, sponsors and investigational sites need to pay attention of this problem and put in place specific strategies. Mistrust of patients of minority groups toward clinical research is one of the main barriers along with lack of access to clinical trials (low awareness, communication barriers, distance to investigational sites). Adapted communication, community-based strategies are some of the useful strategies directed to the patients. Investigators may not encounter diverse populations in their area or may not be aware of unconscious bias when identifying patients suitable for a clinical trial. Looking for referrals and raising awareness of the risk of bias with training on culturally sounded approaches could help investigators to recruit more diverse populations. Lack of awareness and costs may prevent sponsors to focus on diversity but ethics, benefits of data acquisition and patient centricity should be enough motivators to modify this trend. Patients, investigators and sponsors have their own barriers to tackle the lack of diversity in clinical trials. The cultural background of all stakeholders is an important factor in those barriers. Only multidisciplinary approaches including human sciences would help to define patient recruitment strategies that would mitigate the current lack of diversity.
Clinical trials; Patient recruitment; Diversity, Minorities.
Agenesis of the thyroid isthmus is a rare entity with a incidence rate of 0.5 and 10%. Thyroid isthmus agenesis could be associated with ectopic thyroid tissue or agenesis of the thyroid lobes. We discuss a case of a multinodular goitre which presented with morphological variations which was not detected on ultrasonography of the neck.
Thyroid; Head and neck; Isthmus.
Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria. Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria.
Proteinuria; Glomerular; Tubular; Nephritic; Nephrotic.
Giant cell myocarditis is a rare condition first described in 1905. It has a reported incidence range from 0.007% to 0.051%. It affects female and male individuals, equally, and usually occurs in young and middle-aged persons. The underlying aetiology of giant cell myocarditis is unknown but it is thought to be mediated by T-lymphocytes. Diagnosis is made via histological examination of myocardial tissue and is characterized by a mixed inflammatory cell infiltrate with multinucleated giant cells and cardiomyocyte necrosis, predominantly affecting the ventricles. The following report describes a rare case of giant cell myocarditis in a 71-year-old man with a history of hypertension and heart failure, who died while waiting to be seen in the emergency department. Autopsy findings revealed an enlarged, dilated heart with histologic features in keeping with giant cell myocarditis, along with features of heart failure. Diagnosis of giant cell myocarditis is less common in the elderly age group, possibly due to a less severe disease process in this age group and it may be misdiagnosed because older individuals may have other cardiovascular diseases (CVDs).
Myocarditis; Giant cell myocarditis; Autopsy; Elderly, Cardiovascular.
The purpose of this study was to investigate the different combination of testcrosses for morphological and yield relating traits and to investigate general combining ability of the inbred lines.
This research was conducted at The University of Agriculture Peshawar, Pakistan during 2016. Line x-tester analysis was used to test general combining ability (GCA) effects of 24 S4 lines of sweet corn. Alpha lattice design with two replications and two checks was used during the experiment. Research data were recorded on various flowering, morphological and yield parameters.
Highly significant variations were recorded among the testcrosses for the studied traits except anthesis silking interval (ASI), 100-kernel weight. Minimum days to tasseling (48-days) and silking (53.5-days) was exhibited by pop-syn-swt (9-4)×synthetic sweet. GCA effect was -2.14 for tasseling and -2.00 for silking. Maximum value (3.5-days) for ASI was recorded for Pop-synswt 1(8-3)×synthetic sweet, while GCA effect for ASI was -0.71. Lowest plant height (129.8 cm) was recorded for pop-syn-swt 1(3-3)×synthetic sweet, while GCA effect for plant height was observed to be -14.79. Maximum cob length (16.6 cm) was revealed by pop-syn-swt 1(12-2)×synthetic sweet. For cob length GCA effect of 1.01 was recorded. Maximum 100 kernel weight (31.3 g) was estimated for pop-syn-swt 1(2-1)×synthetic sweet. GCA effect of 1.85 was recorded for 100-kernel weight. Highest mean (7143.9 kg ha-1) for grain yield was recorded for pop-syn-swt 1(9-4)×synthetic sweet. GCA effect for grain yield was found to be 1370.93.
Generally a low GCA value, either positive or negative indicates that the mean of a parent does not largely vary from its offsprings. In contrast, high GCA value suggests that parent is either superior or inferior to the general mean and it has high heritability and less environmental effects. Based on the findings in this research, the above mentioned testcrosses can be included in future sweet corn breeding programs where early flowering and yield attributes is desired.
Sweet corn; General combining ability; Inbred lines; Line by tester; Yield; Flowering.
Internet addiction is a major health concern among undergraduate students; however, few studies have addressed modifiable behavioural factors associated with internet addiction in the context of Taiwan. This study aimed to investigate associations between physical activity and the risk of internet addiction among undergraduate students in Taiwan.
In 2017, we recruited 320 undergraduate students from Northern Taiwan to participate in a cross-sectional questionnaire-based survey. Physical activity was measured by the Taiwanese short-form version of the International Physical Activity Questionnaire, which evaluates an individual’s weekly levels of vigorous-intensity aerobic physical activity (VPA) and moderate-intensity aerobic physical activity (MPA). Internet addiction was measured by the Chen Internet Addiction Scale (CIAS).
For the 320 surveyed students, the average CIAS score was 53.3, and 18.13% of participants were at risk for internet addiction (defined as CIAS score >64). The results of the multiple regression analysis indicated that a routine of at least 150 min of MPA per week was negatively associated with risk for internet addiction (β=−4.39, 95% CI=[-8.10, -0.66]). No significant associations were observed between internet addiction and 75 min of VPA or 150 min of total physical activity per week. Among the 5 dimensions of the CIAS scale, MPA was negatively associated with tolerance symptoms, time-management problems, and interpersonal and health-related problems when a routine of 150 min per week was adopted.
A routine of 150 min of MPA per week was associated with a lower risk for internet addiction. Intervention efforts aimed at reducing undergraduate students’ problematic internet use should promote recommended levels of MPA. We also recommend longitudinal research on the effects of engaging in physical activity on the risk of internet addition.
Physical activity; Internet addiction; Undergraduate students.
The coronavirus disease-2019 (COVID-19) emergency has clearly shown the need to discover, test and produce a new vaccine but also in general the fragility of the current chain of clinical trials. Through this emergency, is it possible to look at the current clinical trial processes with new eyes? Is it possible to seize the opportunity for change and to have confidence in the possibility of their improvement? In this short article the authors wanted to give an optimistic answer to this question by pushing on the possibilities of innovation nowadays.
Clinical trials; Innovation; Covid-19; Digital transformation.
Hackensack Meridian Health, a large New Jersey network comprised of 17 hospitals, a medical school, and 200 ambulatory care centers, executes a large research program with approximately 1000 active human subjects studies. With the arrival of the coronavirus disease-2019 (COVID-19) pandemic, the Office of Research Administration was confronted with a series of challenges. These included minimizing face-to-face contact among research participants and staff, allocating limited resources to handle the influx of COVID-19 related proposals, providing human subjects protection training to the physicians and staff who were needed to run the clinical trials, adjusting bio-repository activities to meet the increased demand for samples, and disseminating all of the new regulatory and operational information to the thousands of researchers in the network. The network’s success in modifying its research program quickly and effectively to adapt to the changing landscape can be attributed, in large part, to the centralized nature of the research administration.
Research administration; COVID-19; Network.
Population knowledge and attitudes toward health insurance are important factors that facilitate health insurance coverage. National studies on these parameters are limited.
This study aims at assessing determinants of non-insurance in A-Duiem Administrative Unit and calculating as a secondary objective the household’s health insurance coverage.
The study was a descriptive cross-sectional community-based conducted in A-Duiem Administrative Unit, Sudan. It collected quantitative data from non-insured households and qualitative data by interviewing community leaders and conducting focus group discussions with community organizations members. Quantitative data analyzed using the Statistical Package for Social Sciences (SPSS) version 20, and the thematic analysis for the qualitative data.
The study interviewed 419 non-insured households’ heads and thirteen community leaders and conducted eight focus group discussions with sixty community organizations members. Around 37.9% (95% CI: 33.4-42.7) of the heads of the non-insured households did not know the health insurance, while only 2.4% (95% CI: 1.5-4.7) had good knowledge. The knowledge of non-insured community leaders and members of the community organizations was moderate. The study participants showed positive attitudes towards health insurance, as 97% (95% CI: 95.1-98.4) of the heads of the non-insured households wanted to join the health insurance and 65% (95% CI: 59.2-70.1) of them stated that they could pay its premium. Most of the community leaders and members of the community organizations had health insurance cards. Those who were not enrolled, have limited knowledge about health insurance while almost all believe they should join it. The study identified 52.4% of non-insured households (95% CI: 48.9-55.8). The study showed low health insurance coverage among families, despite their positive attitude. This is mostly attributed to poor awareness of the heads of the non-insured households about health insurance. The National Health Insurance Fund (NHIF) should address this gap through effective communication strategies using motivated community institutions.
Health insurance; Non-insured; Population coverage; Knowledge; Attitudes; Sudan.
Monitoring adherence to pre-exposure prophylaxis is a critical component of reaching ending the human immunodeficiency virus infection (HIV) epidemic goals in the US. Currently, providers still depend on “self-report” pre-exposure prophylaxis (PrEP) adherence, whereby providers ask their patients about their recent pill taking habits. There appears to be growing consensus across the HIV prevention community that “self-report” is an inadequate method of identifying that is in-need of additional adherence support services. In a recent survey, 97% of providers report utilizing self-reported adherence because it is convenient, but only 10% of these providers believe it is accurate. While “self-report” is convenient, evidence and testimonials from diverse stakeholders across the HIV prevention landscape indicate that there is a desire for more accurate, effective adherence monitoring methods. In this mini-review, we will briefly synthesize the emerging evidence and propose a solution to ensure all patients receive the support needed to protect them from HIV acquisition.
Pre-exposure prophylaxis; HIV; Adherence; Prevention; Self-report.
Recently a lot of attention has been focused on fast-tracking repurposed drugs for the treatment of a novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent leading to the devastating coronavirus disease-2019 (Covid-19). One of the first and most well-known examples is hydroxychloroquine (HCQ), which has been used for years as a treatment for malaria, rheumatoid arthritis and lupus. HCQ was rolled out as a miracle treatment for Covid-19, which was inexpensive, effective and causing few side-effects. However, its effectiveness in treating Covid-19 has recently been questioned leaving doctors and patients confused and desperate. Here the proposed mechanisms of action of HCQ are discussed and compared with an inexpensive, safe and effective alternative, which is derived from natural, healthy amniotic fluid.
Covid-19; SARS-CoV-2; Amniotic fluid; CytoSomes.
Although the negative pressure wound therapy (NPWT) is a time tested method of wound preparation, the role of NPWT with instillation and dwell time (NPWTi-d) in decreasing the downtime of wound preparation needs to be evaluated.
The objective of this study is assess the role of NPWTi-d in wound bed preparation.
Materials and Methods This study was conducted in a tertiary care center, after getting informed consent and ethical clearance. NPWTi-d was done on a 36-years-old female with no known co-morbidities admitted with infected raw area over the right below knee amputation stump and exposed bone who was not responding well to conventional wound dressing. NPWT was applied with the help of sterile polyurethane sponge and two tubes. The antimicrobial solution used was ionic silver solution, just enough to wet the sponge completely and up to the point when the transparent occlusive covering begins to lift. Negative pressure was applied at 125 mmHg. The wound was bathed with ionic silver solution and it was allowed to stay in the wound for 10-minutes, after every 2-hours of negative pressure application. This was continued for 1-week. The dressing was opened at the end of 1-week, wound irrigated with normal saline, exudate swabs for culture taken and debrided, following which fresh NPWTi-d was applied. This was repeated for the next 3-weeks.
By the end of third week, the wound became clean, fully covered with healthy granulation and the wound bed was ready to undergo the definitive wound cover procedure.
Negative pressure wound therapy (NPWT); Negative pressure wound therapy with instillation dwell time (NPWTi-d); Ionic silver solution; Wound bed preparation; Amputation stump.
The coronavirus disease 2019 (COVID-19) outbreak, started in the Hubei province of China in December 2019. On January 31, the World Health Organization (WHO) declared COVID-19 a worldwide pandemic. We wondered what countries in Africa and South-East Asia had done to prevent infectious disease, specifically, COVID-19, from impacting the population of specific countries in that region, and what disease control measures were successful. Expert reflections on findings could guide continued successful public health approaches in managing this complex infectious disease pandemic.
Using a scoping review, published papers, or program descriptions for specific geographic regions (i.e., Africa or Southeast Asia) were searched using specified key terms. Three targeted countries classified by World Bank as lower-middle-income in the two WHO selected regions [Africa (Sudan and Nigeria); Southeast Asia (India)] were reviewed with respect to COVID19 preparedness and response. Findings were organized, highlighting key points that seem particularly useful for regional learning. The evidence from each region was summarized in the aggregate to determine some common, noteworthy themes. COVID-19 epidemiologic data for these regions were also reviewed.
Our findings indicate experience from prior infectious disease outbreak seems to have prepared the selected countries in their preparedness for COVID-19 outbreak on various levels. Incidence of COVID-19 increased across the selected countries. WHO recommended basic public health strategies to reduce disease transmission was initiated by the selected countries at different levels. However, feasibility and lockdown practices raise public health concerns and questions across the target regions reviewed.
This scoping review and expert reflections uncovers important preparedness and responses to the COVID-19 pandemic in the selected WHO regions. Further exploration and possible public health strategic plans may be needed.
COVID-19 Pandemic; Health system; Preparedness and response; Sub-Saharan Africa; Southeast Asia; Developing countries.
A clinical study was conducted to evaluate fingerstick blood as a viable biological matrix for monitoring prescription and illicit drugs in a clinical setting on patients undergoing pain and addiction treatment. The current standard for monitoring patients’ medication use, misuse, and diversion is urine drug testing (UDT).
This study compared 632 paired urine and fingerstick blood specimens collected at three pain management clinics and one suboxone clinic for 35 drugs and/or metabolites. Plasma from the fingerstick blood was used for the analysis. The urine and plasma specimens were analyzed by validated liquid chromatography–tandem mass spectrometry (LC-MS-MS) procedures. The urine cutoff used by most pain testing laboratories were used to identify positive and negative drugs in urine. Limit of quantitation was used to identify positive and negative drugs in plasma. Drugs and/or metabolites were quantified in both urine and plasma using deuterium-labeled internal standards.
Results were tabulated for urine and plasma specimens for data analysis. The results showed that 8.7% of plasma specimens detected more drugs compared to the corresponding urine specimens, and 2.2% of the urine specimens detected a drug that was negative in the corresponding plasma specimen. Overall 89.1% of the specimens had complete agreement between urine and plasma specimens for detection. The observed Cohen’s Kappa value for overall drug detection was 0.96 an “almost perfect” agreement as characterized by Landis and Koch.
Based on the observed data, the authors conclude that plasma collected from fingerstick blood is a better matrix to monitor patients currently prescribed pain medications or patients currently undergoing medication-assisted opioid treatment compared to urine drug testing.
Fingerstick blood; Pain management; Prescription drugs; Opioids; Opiates; Illicit drugs.
Liposomes have been used for drug delivery since their discovery 60-years-ago. The advantages they provide as carriers have been recognised and exploited to improve the delivery of numerous drugs and eliminate harmful side-effects. Liposomal delivery has been tested for anticancer drugs, anti-tuberculosis drugs, variety of vaccines, just to list a few.
We developed a series of liposomal formulations with the addition of cholesterol and polyethylene glycol. The uptake of these formulations by human epithelial prostate cancer (PC-3) cells and mouse macrophages was examined and analysed by flow cytometry and confocal microscopy.
Among the liposomes tested, small anionic liposome vesicles (≤200 nm) prepared with egg phosphatidylglycerol as the main lipid were most effectively taken up by PC-3 cells and macrophages.
We produced a liposome formulation that can be used as a model system for the delivery of drugs and vaccines.
Liposomes; Drug delivery; Vaccines delivery; Egg phosphatidylglycerol; Polyethylene glycol.
Peripheral neuropathy is a type of neurological disorder in which patients with complex inherited neurological defects present significant phenotype in the peripheral nervous system. Hereditary amyloidogenic transthyretin (hATTR) neuropathy is typical polyneuropathy caused by single-nucleotide variants in the gene encoding transthyretin (TTR) and leads to transthyretin misfolding and systemic deposition of amyloid. One of the clinical hallmarks of hATTR neuropathy is polyneuropathy of the destruction of the somatic and autonomic peripheral nervous system, leading to loss of autonomy. Progressive amyloid accumulation also causes multi-organ dysfunction and death. There are many therapeutics that have been proposed and developed in these years. These therapies aim to reduce or eliminate hATTR from the plasma, stabilize the hATTR to prevent deposition, and dissolute the amyloid misfolding matrix. Recently, gene therapy strategy is being deployed to treat recessive genetic disorders by eliminating the expression of the mutated genes. Thus, gene-silencing approaches have been used to manage this amyloidosis neuropathy in the broad stages and produce some degree of improvement of this disease. Food and Drug Administration (FDA) approved Inotersen (an antisense oligonucleotide (ASO)) and patisiran (a small interfering ribonucleic acid (siRNA) for the treatment of hATTR polyneuropathy to suppress hATTR expression. Inotersen, a 2’-O-methoxyethylmodified ASO, which acts by reducing the production of transthyretin, and has been demonstrated to improve the quality of life in early hereditary transthyretin amyloidosis polyneuropathy. I here focus on the RNA-targeted therapy with particular emphasis on the molecular mechanisms by which antisense oligonucleotide can be designed to modulate transthyretin RNA function for being a novel therapy for hereditary amyloidosis neuropathy.
Peripheral neuropathy; Amyloidosis; Antisense oligonucleotide (ASO).
Sitting height (SH), sub ischial leg length (SILL) and the sitting height/leg length ratio (SH/SILL) are useful tools for assessing human body proportions. They are often used to detect the presence of abnormal growth, especially in school-aged children.
Our cross-sectional study was conducted among 1012 preschool children aged 2 to 6-years from Integrated Child Development Services (ICDS) scheme centers at Bali Gram Panchayat, Arambagh, Hooghly District, West Bengal, India. Anthropometric measurements like height, weight, SH were measured following standard protocol.
There was no age combined significant sex difference in any variable. However, age specific sex differences were there in few age groups. Highly significant (p<0.001) age variations existed in all variables. The body mass index (BMI) was significantly (p<0.01) negatively correlated with SILL (r=-0.443), SILLP (r=-0.302) and UTL (r=-0.346) in both sexes. It was significantly (p<0.01) positively associated with UTLP (r=0.302). Moreover, SILL was significantly positively correlated with UTL in both sexes (boys, r=0.821 and girls, r=0.871; p<0.01), whereas it was significantly negatively associated with UTLP (boys, r=-0.590 and girls, r=-0.552; p<0.01) in the participants.
Our results suggest that, in both sexes, there were significant age differences in SILL, SILLP, upper trunk length (UTL) and unified technology learning platform (UTLP). The BMI had significant associations with these variables in both sexes. Moreover, SILL had significant correlation with UTL and UTLP among the participants.
Sub ischial leg length; BMI; Upper trunk length; Sub ischial leg length percentage; Upper trunk length percentage.
Medical and psychological literature finds that empathy is crucial in the doctor-patient relationship, and that in the last 30-years there has been a decrease among college students, particularly medical students. After the passing of Hurricane María in Puerto Rico, many medical professionals migrated, leaving the island with fewer specialists to teach the remaining medical community. This is the first such study conducted with medical students in Puerto Rico. It examines the perception of empathy from the medical student perspective amidst the particular historical context of a national emergency.
Three instruments were used: The Jefferson Scale of Empathy (Student Spanish Version) (JSE-S), Arrogance Scale (AS) and Social Desirability Scale. A Non-Experimental Correlational Exploratory study was carried out with 200 medical students (55.5% female; 44.5% male), who were coursing third (45.5%) or fourth year (54.5%), from three major medical schools on the island. The students signed informed consents and also answered sociodemographic questions.
The JSE-S demonstrated an acceptable internal consistency reliability (α=0.79) with 11 items and three underlying factors. Female students showed higher empathy scores than their male counterparts (M=73.96 vs. M=70.22, p=0.001). The JSE-S and the AS were inversely correlated. Results support that social desirability is not statistically significant as a moderator between empathy and arrogance. Significant differences were found on arrogance scores pertaining to medical specialty and on religious background. Empathy and arrogance were unrelated to age, coursing year, income or university of precedence.
Raising awareness about the importance of empathy through positive role modeling, interpersonal dynamics and valuing the doctor-patient relationship through the formative years of medical school is recommended.
Empathy; Jefferson Scale of Empathy; Medical students; Puerto Rico; Arrogance; Social desirability.
The paper investigates the main ideas and solutions of healthcare systems in leading countries such as Switzerland, the Netherlands, Denmark, Sweden, Austria, France based on the international ranking indexes such as the United Nations Human Development Index, Genuine Progress Indicator (GPI), Blumberg’s Global Health Index, World Health Organization (WHO), The Healthcare Access & Quality Index (HAQ), the European Health Consumer Index (EHCI). In conclusion, the health of
society depends to a great extent on lifestyle and climate, where such countries as Spain and Italy have fewer sick people, and it results in a lower burden on healthcare. Unites States of America healthcare must compensate for lifestyle defects with intensive treatment and expensive medicines. This costs money and, what is worse, it doesn’t bring any noticeable progress. As evidenced by the dramas caused by the 2020 pandemic.
Healthy life; Healthy lifestyle; American healthcare; Healthcare indexes.
To examine the role of the Identafi® device in early diagnosis of the nature of oral lesions.
Buccal mucosal lesions that diagnosed Kreatosis were the most seem lesion in oral area.
It has been observed that the indentative device provides convenience to the physician in the early diagnosis of precancerous oral
lesions and some tissue formations that may be overlooked can be reached.
Identafi®; Oral lesion; Precancerous; Early diagnosis; Tobacco; Alcohol.
Equilibrium between cell survival and death is important for normal cell homeostasis and development and also for inhibiting pathologies particularly cancer. Anastasis is a natural cell recovery phenomenon that rescues cells from the brink of death or a mechanism by which cells recuperate from apoptotic lesions and return to its normal active and functioning state. Programmed cell death (apoptosis) was known to be an intrinsically irreversible cascade that commits cells to a rapid destruction. However,
recent studies have demonstrated the possibility of recovering dying cells even at the late stages. Anastasis uses the usual pro-metastatic and pro-survival factors to inhibit apoptotic progression. Epithelial mesenchymal transition (EMT) activation and its related modulators is not only linked with cellular metastasis and survivability but also widely associated with the stemness of cancer cells.
Anastasis; Programmed cell death; Cancer; Pro-metastatic factor; Pro-survival factor; Genetic instability; Cell cycle arrest.
Diabetes mellitus (DM), an epidemic non-communicable disease, is associated with macro- and micro-vascular complications which may result in sudden cardiac death at a young age. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) emerged as a new therapeutic option for managing DM with cardiovascular complications as well as diabetic patients with multiple risk factors. Three drugs in this class significantly reduced cardiovascular mortality and heart failure events, in both type 2 diabetes mellitus and non-diabetic patients with a reduced ejection fraction, to prevent heart failure related hospitalisation. Evidence of kidney protection was another major advantage provided in more than one study. We reviewed recent SGLT2-I related literature and discuss the benefits beyond the cardiac system.
Diabetes mellitus (DM); Cardiovascular disease; Sodium-glucose cotransporter-2 inhibitors (SGLT2-I); Renal protection.
Leg ulcers are a painful side-effect commonly seen in patients with long-term use of hydroxyurea. We describe an ulcer in a patient with sickle cell disease (SCD) with an 8-year history of hydroxyurea use. Wound care team used cadexomer-iodine topical
and collagenase to aid in healing. There are limited options for the treatment of these ulcers beside the cessation of hydroxyurea, a very effective drug in reducing painful sickle cell episodes. It is imperative to be aware of this complication to prevent expensive tests and further work up. Future study into alternative treatment of hydroxyurea-induced leg ulcers for sickle cell patients is necessary.
Leg Ulcer; Sickle cell disease (SCD); Hydroxyurea.
This article examines one key aspect of the Substance Abuse Subtle Screening Inventory (SASSI) Institute’s forthcoming third iteration of the Adolescent Substance Abuse Subtle Screening Inventory (SASSI-A3). Overall project aims were to revise the second version of the adolescent SASSI (SASSI-A2), and to update new symptom-related identifiers of substance use disorders in adolescents according to the diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5) guidelines.
We added new questions regarding cannabidiol (CBD) edible consumption and the extent of vaping to review and subsequently address these dangers in teens. Identifying these patterns will inevitably direct the course of subsequent clinical interviews and treatment planning. Early intervention is a critical component towards preventing possible negative outcomes for substance misusing teens.
This aspect of the research demonstrated a connection between a higher acknowledged usage pattern of teens in treatment versus teens not in treatment. Correlations between beliefs associated with marijuana legalization, marijuana usage by family and friends, tobacco use, connection between age at first use, and the onset of regular usage patterns were also shown to be significantly higher among teens in treatment.
Teens that begin using alcohol, drugs, and tobacco early in adolescence are more likely to engage in vaping and edible usage. They are also more likely to use at a more frequent rate. In addition, teens who are surrounded by family and friends who engage in marijuana use are more likely to be supportive of its recreational use and legalization. This acknowledged information on the SASSI-A3 can help direct treatment planning early in the counseling relationship and provide a gateway for bringing family in the treatment and education process.
Adolescents; Vaping; Edibles; Tobacco; Marijuana; Cannabis.
The current study examined the impact of a non-governmental organization’s academic tutoring and mentoring program on the social-emotional learning (SEL) and subjective well-being of 240 marginalized young women.
One-hundred-fifty-nine currently enrolled 7-12th grade students with a mean age of 16.39, SD=1.55; 40 students who were enrolled in college with a mean age of 20.25, SD=1.57, and 25 who had graduated from college with a mean age of 22.48, SD=2.16 and their leaders participated.
All participants completed in a survey that assessed the degree of participants’ locus of control, expectations of success (self-efficacy), current goals and career-related aspirations and their satisfaction with their relationships and life in general. Twenty-one of the participants and all leaders also were interviewed.
Regression analyses revealed that both the participants’ self-management and the leader’s locus of control were significant predictors of the participants’ internal locus of control. Congruent with interview findings, latent structural equation analysis revealed that three manifest variables of social-emotional learning, “self-management”, “social awareness”, and “self-efficacy” had direct positive effects on participants’ subjective well-being (i.e., their satisfaction with life and relationships).
Culturally sensitive approaches to mentoring and training are needed and helpful. Future research should be carried out to mitigate design limitations and further the current study’s addition to the body of research on social-emotional learning and well-being.
Self-management; Self-efficacy; Social awareness; Social-emotional learning (SEL); Internal locus of control; Life satisfaction; Relationship satisfaction; Subjective well-being (SWB).
Sirtuin 1 (SIRT1) inhibitors can reduce replication of many viruses with certain characteristics similar to those of coronaviruses, while the p53 protein is another important factor in the down-regulation of viral growth. Tenovin is a class of small molecules that inhibit Sirtuin 1 and 2, in addition to activating the p53 protein, by means of regulating the interactions used by coronaviruses as a self-defense mechanism. By blocking virus growth and continuous replication, with already tested antiviral medicines, the promise of coronavirus disease 2019 (COVID-19) eradication exists.
COVID-19; Coronavirus replication; SIRT1 inhibitors; p53; Tenovin.
This study analysed the sensitivity of the field size from variations in the target volume dimensions, depth, and position. The variations in the target volume analysis were used to determine the width of the field size. Thus, the quality control of the radiation beam can be obtained.
The computed tomography (CT) image of the IBA Dose 1 type of water phantom consists of 350 slices. Variations in the dimension of the target volume were modelled in 10×10×10 cm3, 10×12×10 cm3, 10.2×10×10.2 cm3, and 15×15×15 cm3. Beam parameters use one beam of irradiation on the central axis 0°, 6 MV energy, 100 cm source-skin distance (SSD), beamlet delta x, and y set to 0.1 cm. Dose distribution in the form of the XZ isodose curve and dose profile was used to observe the field size.
In this study, the isodose curve was successfully displayed in the XZ isodose curve. The field size’s sensitivity has been successfully reviewed from variations of the target volume, depth, and position. The target X and Z direction analysis is used in determining the width and length of the field size.
The analysis related to the field size sensitivity study was obtained from a relatively valid calculation. The field size was evaluated with variations in depth of 1.5 cm, 5 cm, 10 cm, and variations in positions of 10 cm, 12 cm, 14 cm, 18 cm, and 20 cm. This study will be used as a reference to validate the distribution of computational environment for radiotherapy research (CERR) dose in the future. Thus, the accuracy of the dose calculation can be obtained.
2D Dose Distribution; Sensitivity; Quality control; Treatment planning system; Radiation therapy dosimetry.
Merkel cell carcinoma (MCC) in an uncommon neuroendocrine neoplasia that originates in the skin in which testicular metastasis is atypical. There are only eight cases reported to date. A 65-year-old patient with a history of MCC in the right thigh who had been treated in 2015 with surgery, chemotherapy and radiation therapy; presented to hospital with pain and right testicular enlargement of one-month duration and with normal testicular tumor markers. An ultrasound study confirmed multiple hypoechoic nodular solid lesions compatible with neoplasia and orchiectomy was subsequently performed. The histological examination reported an immunohistochemical pattern compatible with a diagnosis of MCC. The patient received adjuvant immunotherapy with Avelumab. MCC rarely spreads to the testicle and, due to the shortage of studies, the best treatment of testicular metastasis remains uncertain; however, immunotherapy may be appropriate.
Merkel; Testicular metastasis.
Arterial embolization is used as one of the palliative procedure in the control of bleeding. We have demonstrated this procedure to be effective in the control of the bleeding in various malignancies in our center. This is our first case report in a teenaged nasopharyngeal cancer patient who had exhausted all his treatment as he had progressive disease and recurrent bleeding episodes from the recurrent neck nodal mass. This was controlled well with arterial embolization with no significant side effects.
Nasopharyngeal cancer; Recurrent nodal bleeding; Embolization.
The prevalence of diabetes mellitus is rising globally and even more in low and middle-income countries such as Nigeria. Optimal management of the disease is important to improve survival and prevent or delay its complications. Lifestyle management is a standard universal approach in optimizing the care given to diabetic patients. Dietary management is the central link in lifestyle modifications of individuals living with diabetes. Medical nutrition therapy (MNT) is a systematic therapeutic approach of assessing the nutritional needs of an individual, determining nutritional goals, counselling the clients on how to achieve the goals, prescribing and monitoring meal plans to achieve the goals. It is evidence-based, effective and highly recommended. All carers of the diabetes patient, including the health workers and the family members of the patients, need to have basic understanding of medical nutrition therapy but the efforts should be coordinated by licensed dietitians. There are evidences that adherence to prescribed calories is effective in the control of cardiovascular risk factors such as blood glucose, weight, lipid profile and blood pressure. However, prescription of calories should be based on thoughtful consideration of the nutritional needs, weight goal, personal preferences and tastes and cultural practices of individuals living with diabetes mellitus. Food pyramids give a graphical illustration on the recommended classes and servings of food. Six to eleven servings per day of carbohydrates, 3-5 servings per day of vegetables, 2-4 servings per day of fruit, 2-3 servings per day of dairy products and 2-3 servings per day of fish are the recommended proportions of the different classes of foods for an adult on an average of 2000 calories. Carbohydrate counting, taken with appropriate insulin dosing and physical activity, has been demonstrated to be effective in optimizing the glycaemic control of patients on multiple daily insulin injections. There are challenges in doing this in Nigeria due to lack of food labels. The caloric contents of common Nigerian foods are highlighted so as to help in achieving dietary goals.
Diabetes care; Dietary approach; Carbohydrate counting; Caloric content of Nigerian foods.
Cystic lymphangioma is a relatively frequent condition. However, the scrotum is one of the least common sites. The diagnosis is made with ultrasonography and the treatment of limited and circumscribed cases, is surgical excision or sclerotherapy where appropriate. We report the case of a 23-year-old boy who presented with asymptomatic scrotal vesicular lesions evolving over 6-years. Clinical and dermoscopic examination supported by ultrasound and histology were in favor of a microcystic lymphangioma.
Cystic Lymphangioma; Circumscriptum; Scrotum; Clinic; Dermoscopy.
Caesarean section (CS) rates have increased globally. The World Health Organization (WHO) recommends the use of the Ten-Group Robson classification as the global standard for assessing appropriateness of CS. Nepal has higher-than-global average rates of CS requiring further investigation into appropriateness.
This study aims to investigate the caesarean section rates at tertiary care center in Nepal and make analysis based on the group-10 classification.
A retrospective cross-sectional study was carried out from 2016 April -2017 March in Lumbini Zonal Hospital, Butwal, Rupendehi, Nepal. 3,817 women who birth over a 12-month period were analyzed using this classification. The caesarean rate, its indications were calculated and categorized into groups according to Robson’s 10-group classification.
Women with previous CS (Group 5) comprise the largest proportion (9.4%) of the overall 26.41% CS rate. The second largest contributor was a singleton nulliparous woman with cephalic presentation at term (6.6% of total 26.41%). Caesarean section rates in single breech pregnancies were very high (>65%). Robson’s Group 5 was the highest contributors to overall CS rate contributing 35% of all C-sections, followed by Group 2 (24%), and Group 1 (13%).
The ten-group classification helped to identify the main groups of the subjects who contribute the most to the overall caesarean section rate. This study results suggest that women with previous CS are at risk for having another CS delivery in subsequent pregnancies and therefore there is an urgent need for a dedicated vaginal birth after caesarean section (VBAC) clinic to support this such women to ensure CS are only done when indicated. Furthermore, reducing the CS rate for nulliparous i.e. Group 1 and 2 would, in the long-term, also reduce the size of Group 5 in the future.
Cesarean rate; Caesarean section; Robson’s group classification.
Patients with maxillary Kennedy Class I are frequent visitors to the dental office, the missing of posterior teeth makes the control of the movement of removable partial dentures difficult due to the axis of rotation and the different resiliencies between the supporting structures. The use of implants in association to the conventional metal frame denture provides favorable long-term stability and retention, good clinical outcomes in terms of occurrence of complications and maintenance. In this clinical case, a patient with a maxillary Kennedy Class I was rehabilitated using a 3 implants to support metallic removable partial denture. A three dimensional (3D) surgical guide was used for the well-placement of the strategic implants and ball attachments were tightened as connectors between implant and denture. The patient was satisfied after 4-years of follow-up and reported good occlusal stability, esthetic and functional satisfaction.
Dental implant; Distal extension removable partial denture; Kennedy Class I; Attachment denture.
Sudden cardiac arrest continues to have a high mortality rate. Out of hospital cardiac arrest (OHCA) has a poor outcome compared to those occurring in a healthcare setup due to lack of awareness and appropriate resources. The most common rhythm abnormality in OHCA is ventricular fibrillation which requires early defibrillation, ideally on the location.
A 19-years male was witnessed by lay bystanders to have become unresponsive following contact with an electric lighting pole on the road median in Chandigarh. A passer-by medical resident detected no pulse and initiated chest compression. Since there was no immediate return of spontaneous circulation and aetiology suggested a defibrillate rhythm. The patient was taken in the car and rushed to a tertiary care centre, 10-minutes away. Cardiopulmonary resuscitation (CPR) was interrupted during transport for lack of adequate personnel. Ventricular fibrillation was noted and shock was delivered along with inotropes. Around 26-minutes into the resuscitation, the patient had the return of spontaneous circulation. After post-cardiac arrest care in intensive care unit (ICU), he was extubated and discharged home in 1-week with full neurological recovery.
Recovery of full neurologic function could be explained by the alternating presence of stable and unstable cardiac rhythms and in part at least brought about by immediate attempts at resuscitation. The report seeks to review these aspects of emergency care besides highlighting the need for both immediate and accurate emergency medical services such as lay responder training, public access defibrillation and responsive transport systems for such patients.
Sudden cardiac arrest; Out of hospital cardiac arrest; Ventricular fibrillation; Early defibrillation; Electrical injury.
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes in fluid volumes.
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments performed. There was a weak correlation between change in body weight and change in estimated total body water volumes (R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to 4.8 L) for bioimpedance spectroscopy.
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid changes was poor, regardless of bioimpedance modality.
Body composition/physiology; Body fluid/physiology; Electric impedance; Extracellular fluid/metabolism; Renal dialysis.
A 59-year-old male presented with haematuria and was diagnosed with pleomorphic giant cell carcinoma of the urinary bladder, a very rare variant of urothelial carcinoma. The tumour was staged at pT2N3M1 and the primary tumour was removed by transurethral resection, and nodal metastases were treated with the standard systemic cisplatin and gemcitabine for urothelial cell carcinoma of the bladder. This treatment rendered the tumour clinically undetectable. Despite this treatment the patient developed brain metastases which were not found until the patient presented with neurological symptoms. This is the first recorded case of brain metastases from pleomorphic giant cell carcinoma of the urinary bladder recorded in the literature. CT imaging of the brain should be considered in the follow-up in patients with this tumour.
Urinary bladder; Brain metastases despite; Cisplatin and gemcitabine.
To read the digital imaging and communications in medicine (DICOM) images of brain and extract intensity values and build a three dimensional model for Monte Carlo n-particle transport (MCNP) code input file in purpose to study the average particle flux and deposited energy of X-Ray photons resulting at 120 kVp and 1 mAs (form point source) as function to DICOM pixel numbers in the brain tissues for a 29-year-old female patient using MCNP code and Matlab program to read the DICOM images.
The matrix laboratory (MATLAB) program was used to read the DICOM images and extract the intensity values in each pixel of the DICOM image corresponding to certain slice of the brain. These color levels are characteristic of different tissue, and have been relied upon to create the specific material in each volume element in MCNP input file.
Values of the deposited energy at surface of skin are high, so it is always necessary to be cautious when performing the examination to obtain acceptable images from the first time and without having to repeat the imaging again for the same case unless there are necessities for it.
Computed tomography (CT); X-ray; Voxel phantom; MCNP Code; Average particle flux; Matlab.
Decontamination is a critical medical counter measure in reducing toxic exposure following poisoning. Little is known on the effectiveness of this procedure and its impact in the context of preventing secondary exposure of healthcare workers and secondary contamination of facilities. Presented here is a case of dimethoate poisoning that required a prolonged period of skin decontamination to remove residual skin contamination.
A young gardener consumed dimethoate at the workplace witnessed by a colleague who called the emergency services immediately. Paramedics noted the patient to be drowsy with stable vital signs and 100% oxygen saturation. En-route to the hospital the patient vomited multiple times and was drenched in vomitus with a pungent odour. Upon arrival at the emergency department (ED), vital signs remained stable with a Glasgow Coma Scale (GCS) of 10. Due to gross external contamination from the vomitus and pungent odours emanating suggestive of chemical fumes off-gassing, the hospital decontamination shower was activated for patient decontamination. Staff donned protective suits and proceeded to disrobe and bag all the patient’s clothing before showering the patient for 10-minutes using soap and water. Post-decontamination a chemical agent monitor (CAM) were used to screen for residual chemicals following the hospital’s decontamination protocol. The chemical alarm was triggered twice, first around the left mastoid region and again just below the left breast. This required targeted re-showering for a further 10-minutes before patient was finally cleared of contamination. Subsequently, the patient was given atropine (2.4 mg) and pralidoxime (1 g) followed by an infusion at the intensive care unit (ICU). The patient made an uneventful recovery and was discharged 5-days later.
This case of dimethoate poisoning is notable for the prolonged period of skin decontamination to remove residual skin contamination and illustrates potential implications to patient and health care worker safety. Past mass casualty incidents involving
chemicals, such as the sarin attack in Tokyo, highlight the high incidence of secondary exposures amongst healthcare workers due to the lack of casualty decontamination. As a result, many hospitals have developed capacity to conduct rapid and timely decontamination at their premises to prevent further complications from secondary chemical exposure. However, the effectiveness of this process of decontamination needs further evaluation.
Contaminated casualty; Decontamination; Dimethoate; Poisoning; Hazardous material incident; Organophosphorus compounds.
The coronavirus disease 2019 (COVID-19) infection mainly affected elderly patients in many countries. The care of elderly
patients, especially in countries where the percentage of people over 65-years of age is significant, is an important public health problem now during the COVID-19 pandemic. In this review particular attention to the problem of proper nutrition of such patients was paid, which must be preceded by an appropriate assessment of their nutritional status. The important role of physical activity and adequate rehabilitation is highlighted. The care of elderly patients should be in line with the recommendations of the relevant scientific societies and international organizations in this respect.
COVID-19; Elderly people; Malnutrition; Food insecurity; Nutritional risk; ESPEN recommendations; Physical activity.
Caregivers, specifically parents, are ultimately responsible for the nutrition of children living in the household, in spite of the children’s preferences for food items. There have been no studies on the relationship between the nutritional knowledge level of Kuwaiti parents who grocery shop and their children’s nutrition. Therefore, this study was carried out to explore grocery shopping patterns of Kuwaiti parents in relation to their children’s eating habits.
A questionnaire was administered by 4 of the authors through face-to-face interviews with 100 Kuwaiti parents who grocery shop for their families. The questionnaire was designed to cover three main categories: demographics, parents’ nutritional knowledge, and children’s nutrition. Subjects were interviewed at random at 6 supermarket locations. Data were analyzed utilizing a SPSS statistical package and the Chi–Square test was used to examine the association between variables at the p<0.05 level of significance.
Demographic data of respondents showed that 92% were married, 66% were females, 61% were university graduates, and 84% allowed children to choose food items while shopping. Children’s age ranged from 2 to 18-years. Results indicated that the media was the main source of nutrition knowledge of participants. About 50% were familiar with food labels, 74% were shopping for nutrition claims and most parents (60%) were shopping for low-fat products. Analysis of data revealed several associations among demographics, nutrition knowledge of parents and nutrition of children.
This study is the first of its type to be carried out in Kuwait. It revealed several important aspects of parents’ background and awareness of nutrition as influencing factors on their grocery shopping. It is hoped that this line of research will be expanded, for the benefit of children’s health and avoidance of future nutrition-related diseases.
Children; Health; Kuwait; Nutrition interest; Nutrition knowledge; Parents.
In the realm of competitive athletics, numerous variables have been examined for predictive utility with respect to player selection/development and outcomes on the field. Notwithstanding important advances, the current predictors only account for a modest amount of variance in outcomes of relevance in the National Football League (NFL).
The primary objective of this study was to investigate the predictive validity of a new measure of athletic intelligence, the Athletic Intelligence Quotient (AIQ), which is based on the empirically supported Cattell-Horn-Carroll (CHC) Theory of Intelligence. The predictive validity of the AIQ was determined in relation to performance metrics from 146 NFL players across several seasons.
Hierarchical regression analyses indicate that specific AIQ factors accounted for a statistically significant increase in the explanation of variance beyond the current level of evaluation for several performance metrics (e.g., career approximate value; sacks, tackles, rushing yards). Further, specific factors of the AIQ are related to position specific statistics, offering the possibility that performance prediction can be focused in for the specific skills required by a given position.
Given the recent impact of analytics in professional sports, and the significant findings noted in the current investigation, the authors discuss the potential importance of the AIQ in the selection and coaching processes.
To date, only few United States (US) states have explicit regulations that allow minors to independently give consent for human immunodeficiency virus infection (HIV) prevention treatments. This manuscript will reflect upon key advocacy efforts leading to the revision of the Maryland Minor Consent Law, evaluate current human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) prevention laws for minors in U.S. states, and highlight resources for health advocacy.
Between 2018-2019, public health professionals in Baltimore, Maryland reviewed the Maryland Minor Consent Law and other adolescent consent laws within the U.S. The professionals advocated for a legal review of the gap by the State Senate and the Office of Attorney General.
In May 2019, the public health advocates were successful in their effort for a revision of the Maryland Minor Consent Law to include Treatment for the Prevention of HIV-Consent by minors. Upon their review of all adolescent consent laws within the U.S., they found that only eleven states currently have explicit language indicative of an adolescent’s ability to give consent for pre-exposure prophylaxis (PrEP).
This inquiry can change upstream factors such as laws, regulations, policies and institutional practices.
HIV, Prevention, Pre-exposure prophylaxis, Adolescents, Minor consent law.
The current article contains compilation of significant contributions done by theorists over the years about the phenomenon of perinatal loss. The objective of this paper is to provide information about important emotional and psychological consequences on parents who suffer stillbirth. This article addresses identity issues of the mother, father, and their relationship as a couple. It also provides information on the psychological, emotional, and legal aftermath of healthcare professionals who assist during the process of loss.
Patient-child; Healthcare professionals; Child death.
Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate.
To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category.
The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown.
No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients.
Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.
COVID-19, Dialysis, Diabetes, Prevention, Contagion.
Prostate cancer is generally multifocal, presenting a lesion with a dominant focus (index lesion) that is characterized by being the lesion with the greatest volume and the biological capacity of invasion to adjacent tissues and distant metastases. With the advent of focal therapy and organ preservation in prostate cancer, it is essential to know the real tumour volume and thus, avoid the persistence of disease after treatments with curative intent. The aim of this study is to correlate the results of the dominant tumour volume obtained from the multiparametric magnetic resonance imaging (MRI) of the prostate and the histopathology.
Material and Methods
A retrospective study was performed which included all radical prostatectomies (RP) with previous MRI. A comparative analysis was performed between the tumour volume obtained from the MRI and the histopathology.
A total of 46 patients were included in the study. The sensibility of the MRI in diagnosing the index lesion was 82.6%, highlighting that all tumours with a Gleason score ≥ 4+3 were diagnosed. The mean tumour volume in the MRI was 14.3 mm and in the histological result was 18.82 mm (p<0.05). The estimation tumour volume concordance was greatest in higher risk (International Society of Urological Pathology (ISUP)).
The MRI underestimates the real tumour volume of the prostate cancer index lesion when compared to the histological result of the surgical piece, being significantly lower in high-risk lesions.
Prostate cancer; MRI; Radical prostatectomy; Index lesion; Tumour volume.
Diabetes mellitus (DM) is a chronic debilitating condition affecting people worldwide and diabetic foot ulcers are also a common problem. The treatment of diabetic ulcers requires a multimodal approach. Adjuvant low-level laser therapy (LLLT) may be useful in lesions with protracted healing course but the evidence is still limited. In this study, we share our experience regarding the use of low-level laser therapy as an adjuvant treatment modality in a patient with diabetic foot ulcer.
Low-level laser therapy; Diabetic ulcer.
The study was conducted to determine the prevalence of hydatidosis, to identify the association between expected risk factors and occurrence of the disease, to investigate economic importance and to evaluate fertility and viability of the hydatid cyst in cattle slaughtered at the abattoir.
Materials and Methods
A cross-sectional study, which involves both ante-mortem and post-mortem examination, was conducted at Nekemte municipal abattoir from November 2015 to March 2016.
A total of 355 local cattle breed was randomly sampled and examined for the presence of hydatid cysts in the organs of the animals using the standard meat inspection procedures, 66 (18.6%) animals were found harboring hydatid cysts. Statistical analysis showed that there was a significant difference (p<0.05) between the prevalence of bovine hydatidosis in all risk factors with exception of sex of the animals. Among 207 hydatid cysts recorded, 93 (44.92%) were from lungs, 65 (31.40%) from livers, 4 (1.93%) from heart, 3 (1.44%) from kidney, 1 (0.48%) from spleen and 41 (19.8%) were in two organs from lung and liver. Fifty-seven (57) of these 207 cysts were randomly selected and subjected to fertility and viability test which revealed 19 (33.33%) as fertile, 25 (43.86 %) sterile and 13 (22.81%) calcified. Viability test proved 7 (12.28%) of 19 fertile cysts as viable and 12 (21.05%) of 19 fertile cysts as non-viable. Viability of cysts in different organs revealed that 5 (16.1%) and 2 (10%) of cysts from lungs and liver, respectively. The estimated financial loss during the study period both due to condemnation of organs and an in direct carcass weight loss from hydatidosis was 2,190,143.52 ETB.
The results of this study revealed that bovine hydatidosis was an economically important disease of cattle which need serious attention for prevention and control actions in and around Nekemte. Hence, establishment of well-equipped standardized abattoirs, prohibition of backyard slaughter, creation of public awareness, deworming and control of stray dogs are of paramount importance.
Abattoir; Cattle; Economic loss; Hydatidosis; Nekemte; Prevalence.
To describe age-sex differences in the duration from symptom onset to fatality as an outcome in coronavirus desease 2019 (COVID-19) patients.
The Mexican surveillance system database (up to 15th August 2020) of 70,515 death cases (45,053 males, 25,462 females) in COVID-19 was used for analysis. Age groups for pediatric patients were <1, 1-4, 5-9-years and for the adolescent and adult patients, each decade of life constituted an age group.
Proportionally more deaths occurred among male patients (64%). Median duration was eight days from onset of symptoms until death; mean value was approximately 10-days. Distribution by age groups showed females survived lower number of average days after the onset of symptoms. A tendency of rise in the number of days survived has been observed from infancy to adulthood and a subsequent decline after 70-years of age.
Female patients survived relatively lower number of days with infection until death, compared to males.
COVID-19; Infection; Sex difference; Survival; Death.
Sudden death is the principal cause of fatality in Chagas disease, afflicting to non-symptomatic patients younger than 50-years. For this, sudden death associated with chagasic malignant arrhythmias is underdiagnosed and their pathophysiological basis is poorly understood.
In this sense, this work aimed to analyze the histopathological alterations in cardiac structures specialized in the generation/conduction of action potential in an anatomopathological case of non-diagnosed sudden death living in a Chagasic endemic area.
The donor was a woman, 62-year-old, which ingressed without vital signs to the emergency room of “Antonio María Pineda” hospital, without any apparent antecedents of cardiac disease. The gross examination was normal, with no external evidence of structural/ischemic disease.
Microscopic examination revealed nodal like cell depopulation, microvascular disturbances, chronic myocarditis with mononuclear and mast cell infiltrate plus extracellular matrix reaction, and profuse damage of neural structures placed in nodal region. amastigote nest of Trypanosoma cruzi (T. cruzi) was detected.
These findings suggest a complex association among parasite persistence, sinus disease, micro-ischemia foci, and neural inflammation in the genesis of malignant arrhythmias of Chagas disease despite the absence of structural disease or massive necrosis. It is important to perform a protocol of examination for no explained sudden death cases in chagasic endemic countries, to avoid misdiagnosed of sudden death associated with Chagas disease.
Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or failure of the primary anastomosis. Also, severe caustic or peptic strictures, resistant to conservative treatment with medication and dilations, may require an ER. Numerous techniques with different organs and routes have been described, all with satisfactory results.
Our objective is to describe the experience obtained with partial gastric pull-up according to the Schärli principles (SGPA).
Materials and Methods
Medical records of patients who required a SGPA between October 1995 to June 2018 were reviewed. The analysis was observational, longitudinal, retro-prospective and descriptive. Epidemiological data, surgical aspects and postoperative complications of the patients were considered.
Seventy ER were performed with SGPA. The indication was esophageal atresia (EA) in 58 cases (44 long gap and 14 failure of the anastomosis), 10 caustic strictures, one peptic stricture resistant to conservative treatment and the other due to a retained foreign body. The age of the ER was on average 2-years and 9-months. The route was: posterior mediastinal (35), retrosternal (29) and transpleural (6); without a thoracic approach in 59 patients. The duration of the procedure was 4.7-hours on average. There were 13 cases of intraoperative complications, 8 cases of pneumothorax, 5 bleeding injuries (3 in the spleen, 1 liver and 1 cervical), and one injury to the cervical trachea. Anastomotic dehiscence was observed in 37 patients (52%), which closed spontaneously after an average of 17.8-days in all except one patient. Thirty-one patients (44%) developed anastomotic stenosis, requiring redo anastomosis in 6 cases; 37% developed dumping and 23% gastroesophageal reflux disease. There were 3 deaths (4.2%): all in EA patients with associated malformations, following a morbid postoperative period with infectious complications in intensive care at 10-days, 7 and 8-months after ER. Follow-up was an average of 8-years. All 67 living patients are currently tolerating oral feeding.
In our experience with ER using SGPA, we observed a high incidence of complications, generating a longer post-operative evolution and with greater morbidity than that described in other techniques. Given these results, we changed our strategy to complete gastric transposition, in order to reduce morbidity and improve the evolution of this complex group of patients.
Esophageal replacement; Partial gastric pull-up; Esophageal atresia; Caustic stricture.
A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation.
Tibial plateau; High energy; Fracture; Peroneal nerve entrapment.
Intracranial hygroma is a rare and probably missed complication of epidural analgesia secondary to accidental dural breech. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural (extra-arachnoid) collection following a lumbar epidural, administered in labour. Given the potential for progression to symptomatic neurological deficits, anesthetists should consider subdural hygroma when encountering patients with features of intracranial hypotension, or altered neurology following epidural. Pathophysiology, imaging and management are discussed.
Subdural hygroma; Epidural; Dural puncture.
Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it’s also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.
Ophthalmopathies; Congenital anophthalmia; Microophthalmia; Ocular surgery.
Maintenance of the airway and adequate ventilation are essential for the anesthetized patient and may be compromised in patients with pan-facial trauma, abnormal dentition, abnormal mandibular space, or presence of dental hardware. We present an unusual case of a patient with a lack of natural mandibular structure and exposed mechanical hardware with fistula complicating intubation and ventilation prior to surgery.
A 35-year-old male with a history of a self-inflicted gunshot to the left submandibular region approximately 6 years prior was scheduled for urgent mandibular hardware removal, closure of left facial fistula, and removal of several teeth. Pre-oxygenation and ventilation were complicated by extruding hardware and eroded skin, causing interference with a conventional facemask seal. The patient was pre-oxygenated using the SuperNO2VA™ nasal mask with which an adequate seal was achieved without use of a nasal trumpet and with a modified grip. Tracheal intubation via oral video laryngoscopy was successful, and the case proceeded uneventfully.
Adequate ventilation and airway maintenance can be difficult to achieve in patients with abnormal facial structure or mandibular mechanical hardware using conventional methods. The SuperNO2VA™ nasal mask can address airway issues for these patients peri-operatively.
Anesthesiology; Airway management; Difficult airway; Airway devices; Difficult intubation; Ventilation; Oxygenation; Facial trauma; Mask ventilation.
Pneumocephalus is a complication seen either after head trauma or post-neurosurgical procedure. It can be life-threatening if it turns into tension pneumocephalus. The presence of intracranial air indicates the presence of an open communication of cerebrospinal fluid. Air enters dura matter even without connection. Thin air flows upstream along the cerebrospinal fluid (CSF) pathway. Herein, we report a case of pneumocephalus in a 62-year-old female after epidural injection of Bupivacaine and Ozone for the treatment of a prolapsed disc. She was shifted to our hospital post-epidural injection for the management of severe headache. Though it is a rare complication, keeping this in mind will help to quickly diagnose, if need arises.
Pneumocephalus; Head trauma; CT; Thunderclap headache.
Mechanisms by which some plants with antihyperglycemic effects reduce postprandial hyperglycemiaare not fully elucidated. This study was designed to investigate some action mechanisms of extracts from stem bark of Citrus sinensis, seeds of Persea americana and bulbs of Allium sativum including in vitro inhibition of α-amylase and invertase; glucophagic capacity, absorption capacity on yeast cells and psoas tissues.
There is a need for an understanding of the genomic reality that realizes a connector between the genotype and the phenotype by addressing HOW the genotype actually manifests as the phenotype, as a function of the locus or the allele, mutated, variant or wildtype. That understanding is encompassed by the notion of the PRAXITYPE, which assembles and presents the available answers to the HOW!
Cancer is one of the leading causes of death in people with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), due to behavioral choices and overlapping risk factors.
The purpose of this report is to determine the long-term incidence of human papilloma virus (HPV)-associated cancer in women with pre-invasive cervical neoplasia, and compliance with medication and cancer screening recommendations.
HIV-infected women diagnosed with pre-invasive cervical neoplasia and an HPV-associated malignancy between 1995-2008 were identified. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, use of health navigators, and compliance.
Seventy-one subjects were identified with HIV infection, cervical dysplasia, and at least ten years’ follow-up. 17/71 (24%) were identified with an HPV-related malignancy. The mean age of those diagnosed with HPV-related malignancy was 39-years. Malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Uretha/Bladder-2, Oropharyngeal-3. Eight also had in-situ neoplasms: Cervix-4, Vulva-3, Oropharyngeal-1. Four subjects had 3 separate malignancies, and two others had 2 malignancies. Compliance with HAART correlated strongly with immunocompetence, response to therapy, use of patient navigators, and survival. Sixty out of saventy one (84.5%) subjects underwent screening mammography, 57/71 (80.3%) underwent colonoscopy, and 67/71 (94.3%) underwent pap smear testing. Compliance with screening compared favorably with the general population, and overall survival was similar.
Discussion and Conclusion
The long-term incidence and mortality from cancer in women with HIV and cervical dysplasia appears to be comparable to that seen in the general population, with the possible exception of oropharyngeal cancers. Compliance with cancer screening recommendations appears to be higher than in the general population. This suggests that structured primary care programs for HIV-infected women are effective in prevention/early diagnosis of cancer. Standardized screening programs for oropharyngeal cancers should be considered in this population.
Human immunodeficiency virus (HIV); Cancer; Human papilloma virus(HPV); Women; AIDS;
Highly active anti-retroviral therapy (HAART).
To evaluate the effectiveness of medial flap inferior turbinoplasty for the treatment of nasal obstruction in children.
Patients and Methods
This study was conducted at the ear nose throat (ENT) Department at Minia University Hospital, Minia, Egypt which include 40 children with bilateral nasal obstruction due to bilateral hypertrophied inferior turbinates that did not respond to medical treatment for 3 successive months in the form of (systemic antihistamines, systemic and local decongestant drugs and local corticosteroid spray) who attended the ENT outpatient clinic. All patients were subjected to turbinate reduction through medial flap inferior turbinoplasty.
Forty patients with bilateral hypertrophied inferior turbinates were assessed. Ninety days after surgery, 90% of patients transformed from severe or moderate degrees of nasal obstruction “pre-operatively” to mild degree or completely with no nasal obstruction; 80% of patients had grade I improvement in nasal obstruction and 14 patients had only grade II improvement; only
10% of patients had crustation.
Medial flap inferior turbinoplasty is safe and effective in the treatment of nasal obstruction in children with almost no complications was recorded.
Inferior turbinate hypertrophy; Inferior turbinoplasty; Nasal obstruction; Children.
The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnostic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx. Histopathological study of lymph node reveled an association of a tubercular adenitis and a metastasis of a squamous cell carcinoma.
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the commonly used solvents such as paints.
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters. Methodology In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with levels in the unexposed (sex and age-matched) participants.
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium (K+) and chloride (Cl-), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed compared to levels in the unexposed participants.
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity. Preventive measures should include limiting exposure and using antioxidant medications.
Spray painting; Toxicity; Workers; Kidney; Liver; Blood cells.
Abbreviations ALT: Alanine transaminase; ALP: Alkaline phosphatase; AST: Aspartate transaminase; eGFR: Estimated glomerular fitration rate; C-G: Cockroft-Gault; MDRD: Modification of diet in renal disease; Na+/K+/ATPase: Sodium potassium adenosine triphosphatase; PH: Hydrogen Concentration; PCV: Packed cell volume; RBC: Red blood cells; ROS: Reactive oxygen species; UA: Uric acid; Ur: Urea.
Introduction: Overt type 2 diabetes mellitus (T2DM) is a chronic progressive disease which is produced by the collusion of three metabolic defects-increased hepatic glucose production, impaired pancreatic β-cell insulin secretion and decreased insulin action. The measurement of plasma glucose 2 hours post-ingestion of 75 g of glucose during the oral glucose tolerance test (OGTT) may be used to classify individuals as normal glucose tolerant (NGT), impaired glucose tolerant, T2DM and T2DM with pancreatic β-cell failure.
Objectives: This study was undertaken primarily to show the importance of assessing the pancreatic β-cell function especially during the care of the diabetic patient.
Methods: A standard 75 g glucose tolerance test (OGTT) was administered to four groups of 8 subjects (4 male, 4 female). Blood was drawn every 15 minutes for 2 hours for the measurement of glucose, insulin and C-peptide and the measurement of the area under the curve (AUC(0→2)) over the 2-hour period.
Results: American Diabetes Association (ADA) criteria were used to classify the subjects. The normal glucose tolerant (NGT), had 2 h glucose 111±11 mg/dL, those with impaired glucose tolerance (IGT) had 2 h glucose 160±13 mg/dL. The 2 h glucose for the T2DM group was 258±27 mg/dL and those for the T2DM-PE group was 260±42 mg/dL. The AUC(0→2) for NGT group were 254±40 mg/dL/h, 112±61 μU/mL/h and 10.2±4.6 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the IGT group were 394±32 mg/dL/h, 160±48 μU/mL/h and 19.8±7.7 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the T2DM group were 474±62 mg/dL/h, 194±40 μU/mL/h and 13.4±4.7 ng/mL/h for glucose and insulin, and C-peptide, respectively. The AUC(0→2) for the T2DM-PE group were 481±80 mg/dL/h, 51±29 μU/mL/h and 7.2±2.8 ng/mL/h for glucose, insulin and C-peptide, respectively. There was no significant difference between the diabetic groups with respect to the glucose AUC(0→2) but a significant difference existed in the insulin AUC(0→2), (p<0.0001) mirrored by the fasting plasma insulin levels (30±8 μU/mL vs 14+8 μU/mL, for T2DM and T2DM-PE, respectively, p<0.0005). Although there was about a 300% increase in fasting insulin between the IGT and T2DM groups, the corresponding fasting C-peptide levels were only about 15%. This is probably due to differences in hepatic and renal functions in those two groups, the processes that control insulin and C-peptide levels in the body.
Conclusion: Although measurement of blood glucose appears adequate in the diagnosis of the diabetes, it seems that plasma insulin/C-peptide measurements could guide physicians in their choice of medications for the treatment of diabetic patients, especially when the pancreas begins to fail. To that end, larger studies are warranted to study the effects of hypoglycemic agents on hepatic insulin extraction and renal C-peptide excretion to ascertain the reliability of the plasma insulin and C-peptide levels.
Type 2 diabetes mellitus; Pancreatic β-cells; Oral glucose tolerance test; Pancreatic exhaustion.
Despite previous findings attesting to the syndemic nature of human immunodeficiency virus (HIV), chronic disease and mental illness coordination of these issues remains a significant barrier to initiating and maintaining the delivery of mental and physical health care to persons living with HIV (PLWH). These inequities are even greater when applied to rural settings, particularly in areas that are medically underserved. To date, there is scarce research regarding the lived experiences of African American PLWH
in rural settings. Constructivist grounded theory was used to analyze this qualitative data set. These discourses provide a rich narrative regarding effective systems of care, the context in which these processes take place and related constraints or limitations of the current systems.
In-depth interviews with 24 African American PLWH both inside (N=20) and outside (N=4) of care in rural Northwestern Virginia were conducted. Rural African American PLWH were queried about their perceptions of the provision of HIV health care services, barriers to linkages to care, retention of PLWH in care, and recommendations for improving HIV health care services for rural PLWH.
Participants offered insights on the linkages to health and mental health care consistent with the pattern recommended by the cascade of care (i.e. pre-screening, testing, refer to treatment, treatment and sustain treatment). Participants identified contextual factors, including traumatic events, medication (side effects), other chronic health issues, issues with the current health and mental health system, stigma, and lack of social support. We highlight PLWH’s recommendations for linking rural PLWH into care and sustaining that care.
We discuss the implications of these findings for programmatic development in the rural context.
Rural African Americans living with HIV; Barriers to HIV health care; Rural South; HIV lived experience.
One of the most common sphingolipidosis, Gaucher disease (GD) remains rare till date. A case report of a 56-year-old patient diagnosed with GD is presented herein. Her sister was known to have Gaucher disease. Her personal medical record consisted of splenectomy, anemia, recurrent infections, and bone lesions at a young age. Taking into consideration her personal and familial history, the clinical and paraclinical examinations, she was diagnosed with Gaucher disease which was confirmed with enzyme and gene testing. Upon introduction of specific enzyme replacement treatment for Gaucher patients,much evidence demonstrated the substantial improvement of hematological and visceral parameters. However, it has been observed that the bone tissue does not respond equally to the treatment.
• The physician should always investigate the splenomegaly of unknown etiology before deciding to do a splenectomy
• Bone lesions in Gaucher disease are sometimes irreversible, hence the importance of early diagnosis of this rare disease
Gaucher disease; Bone lesion; Splenomeagly.
GD: Gaucher disease; Hb: Hemoglobin; MRI: Magnetic resonance imaging; ERT: Enzyme replacement therapy.
Cardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Observed as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the longterm issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions.
We reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination.
Patent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required subsequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%).
Counseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these patients do not experience functional recovery and may require further interventions over time.
Vocal cord paralysis; Pediatric cardiovascular surgery; Pediatric aerodigestive disorders; Voice; Swallow; Gastrostomy.
To assess reasons for patients being lost-to-care (LTC) at an urban health center (Philadelphia, PA, USA) that provides access to oral tenofovir/emtricitabine(TDF/FTC) as pre- exposure prophylaxis(PrEP) to patients ages 13-30 years through a drop-in model of care.
Ninety-nine patients were identified as LTC based on not visiting a clinician in ≥4 months during the period April 2016-January 2017. Patients were contacted by phone/email to participate in a voluntary telephone survey regarding reasons for falling out of care. Results were analyzed descriptively.
Of the 99 patients preliminarily identified as LTC, 19 completed the survey. Reason(s) for becoming LTC included: 47%(9) relocation, 11%(2) transportation difficulties to/from clinic, 26%(5) financial/insurance problems, 5%(1) perceived medication side effects, 16%(3) trouble remembering to attend appointments regularly, 5%(1) difficulty with daily medication adherence, and 0% social stigma. Furthermore, 21%(4) remain at high-risk of HIV/STI acquisition after becoming LTC. The main study limitations are selection bias and small sample size, where the small sample size did not allow for statistical significance.
While the major cause for becoming LTC was relocation, these findings suggest 37% of LTC incidences may be preventable with additional/up-front support. Because 21% of LTC patients remain at high-risk of HIV/STI acquisition, proactive re-engagement initiatives are potentially useful.
HIV/AIDS; Pre-exposure prophylaxis; Retention and care; Socioeconomic factors; Adolescent Health; Lesbian/Gay/Bisexual/Transgender Persons.
Postpartum haemorrhage is the leading cause of maternal mortality and morbidity. The significant impact of postpartum haemorrhage (PPH) on maternal mortality can be reduced if timely measures are implemented. Transcatheter arterial embolisation (TAE) is an alternative therapeutic strategy for PPH.
We report a case of postpartum haemorrhage which was managed by transcatheter arterial embolization in lieu of hysterectomy to preserve fertility and menstruation in a 27-year-old patient.
The critical role of obstetrician, anaesthesiologist and interventional radiologist as a team, improve the quality of care and patient safety.
Postpartum hemorrhage (PPH); Peripartum hysterectomy; Transarterial embolisation.
Since the Sarin incident in the subways of Tokyo in 1995, there has been an unprecedented increase in the use of chemical agents on civilian populations internationally. This scourge of chemical terrorism has been relentless worldwide and is likely to continue to be a public health issue that needs to be addressed by the relevant authorities as part of national disaster preparedness and response. One aspect of chemical disasters involves the need for mass decontamination of chemically-contaminated casualties from the scene. The traditional role of hazardous materials civil defence experts in providing such decontamination of victims in the pre-hospital setting is limited by many factors. The presence of congestion in densely populated areas in a highly built up environment of modern-day cities, compounds the timeliness of putting up cordons and crowd control and hence delays the prompt set up of such mobile decontamination facilities close to the incident site. The expected side effect is an almost instantaneous influx of contaminated casualties to the nearest hospital in such situations, which drives the need for public hospitals to be ultimately capable of performing mass casualty decontamination as part of hazardous materials disaster preparedness. This review presents an innovatively designed rapidly deployable hospital-based decontamination facility that has served a tertiary care hospital in Singapore for the last 2 decades in being prepared for managing mass casualties arriving from a chemical disaster in a timely manner.
Decontamination; Chemical incident; Industrial disasters; Toxic industrial chemicals; Hazardous materials preparedness; Disaster contingency plans; Emergency preparedness.
The Breast Imaging-Reporting and Data System (BI-RADS) is a classification system aimed at standardizing risk assessment during breast ultrasound to ensure patient safety. BI-RADS is currently used in Uganda so as to standardize breast ultrasound reporting and enhance patient management.
This study aimed at exploring staff perceptions towards the use of the BI-RADS ultrasound characterization of breast masses.
It was an exploratory qualitative study that involved staff who perform breast ultrasound at Mulago Hospital in Uganda. Focus group discussions and individual interviews were conducted.
All staff used the BI-RADS system, however, some of them had a negative attitude towards BI-RADS. The three major themes that emerged were: standardization of breast ultrasound reporting for patient safety; need for more Continuous Professional Development (CPD) and challenges with the BI-RADS system.
The study demonstrated that the staff generally had positive perceptions and attitude of the BI-RADS system and felt that it was an efficient system for ensuring patient safety and further reduce mortality from breast cancer.
Breast imaging-reporting and data system (BI-RADS); Breast; Ultrasound; Staff perceptions.
Transcriptomics has allowed for a better understanding of disease, and the sequencing of individual genes is becoming a leading approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field of medicine and warrants further exploration.
Transcriptomics; Kidney disease; Principle cell; Intercalated cell; Notch signaling; Gene sequencing.
PC: Principle cell; IC: Intercalated cell, DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; mRNA: Messenger ribonucleic acid.
Pleomorphic adenomas are the most common benign parotid tumours in all populations. Management always consists of a curative superficial parotidectomy. However, rare cases described, in which these histological benign tumors metastasize to distant sites. We present an example of a recurrent parotid pleomorphic adenoma with a contralateral supraclavicular lymph node metastasis after several surgical interventions.
In this case, we reported reported a case of 29-years male with extensive metastasis in submandibular, submental and also very rarely seen contralateral supraclavicular lymph node metastasis. Parotidectomy with preservation of facial nerve and radiotherapy was given to the patient since the lesions were very aggressive.
The patient had several surgical interventions, so it is essential to do meticulous resection in the first surgery to prevent local recurrence and distant metastasis.
Pleomorphic adenoma; Metastasizing pleomorphic adenoma; Salivary gland benign neoplasia.
It is difficult for the elderly, those with complications, and those who live in remote areas to visit the hospital, and as a result, there are limits on the drugs they are able to use. It is therefore effective to prescribe such patients oral medications that have few adverse effects and in regimens that require few hospital visits. Clarithromycin can induce cell death by autophagy and it has a direct antitumor effect. There have been reports of the outcomes of Lenalidomide and Dexamethasone therapy with Clarithromycin which is administered orally and is safe on multiple myeloma. However, in Japan, there have been few studies. Here, we report on Clarithromycin, Lenalidomide and Dexamethasone therapy in our hospital.
We analyzed 7 patients with relapsed refractory or refractory multiple myeloma who were treated at this hospital between January 2012 and December 2014. The Clarithromycin, Lenalidomide and Dexamethasone therapy were administered in a 28-day cycle as follows: Clarithromycin 400 mg/day for 28-days, Lenalidomide 15 mg/day for 21-days, and Dexamethasone was administered in a dose of 20 mg once per week. The response criteria used were standard International Myeloma Working Group (IMWG) Uniform Response Criteria. and adverse events were graded according to the national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) Ver. 4. Statistical analysis was performed using Easy R (EZR).
The response to Clarithromycin, Lenalidomide and Dexamethasone therapy were selective catalytic reduction (sCR) in 2 patients, CR in 1 patient, per rectum (PR) in 3 patients, and standard deviation (SD) in 1 patient. Response rates of PR or better were observed in 86% of the patients. Duration of response was median 316-days (range, 160-522-days). Median oculus sinister (OS) period was 1,907 days. Median OS following discontinuation of the study was 1,385 days. Hematological adverse events were G1-2 anemia in 3 patients and G3-4 anemia in 1 patient. G1-2 thrombocytopenia was observed in 1 patient and G3-4 thrombocytopenia was observed in 1 patient. Leukopenia of G1-2 was observed in 6 patients but G3 was not observed. Non-hematological adverse events were G1-2 liver disorder in 6 patients, G1-2 skin rash in 3 patients, and G1-2 constipation in 2 patients. G4 adverse events were fainting and duodenal ulcer in 1 patient each.
Clarithromycin, Lenalidomide and Dexamethasone can be safely and effectively administered in the relapsed refractory multiple myeloma
Multiple myeloma; Bird; Clarithromycin, lethal dose (Ld).
Historically, natural products played a forceful role in human treatment ailments. Nowadays, natural products include a large part of current pharmaceutical agents, mostly in the field of cancer therapy. The main aim of this review is to provide a comprehensive summary of the most known natural product used as anticancer globally, including various other natural products. Many of these natural product appears to act through an anticancer mechanism. Overall, natural product research is a vigorous tool to discover novel biologically active components with unique mechanisms of action. Given the diversity of nature, it is sensible to indicate that chemical leads can be produced that are able to interact with most therapeutic targets. This review creates a solid foundation for further study these natural products with additional research and study.
Anticancer; Natural product; Plant compounds; Marine flora; Microorganisms; Venom.
A patient-centered approach is reasonable in candidates for carotid revascularization. The patient and their physician should discuss the available treatment options, including revascularization (either carotid artery stenting (CAS) or carotid endarterectomy (CEA)) with their physician. There remains uncertainty regarding the value proposition for revascularization (either CEA or CAS) in asymptomatic patients as a strategy to prevent stroke. Investigation continues into characterizing high-risk carotid plaque subsets, but until that data is available, physicians and patients should continue to strive to achieve the best outcomes with the information that is currently available. The other consideration in asymptomatic patients is that there is a cumulative benefit to revascularization that is dependent on life expectancy. However, the magnitude of the benefit of revascularization, over the longer term in the setting of multifactorial medical therapy, including statins, is not known.
Carotid endarterectomy; Carotid stent; Angioplasty; Embolic protection devices.
Severe psoriasis is associated with an enhanced risk of cardiovascular (CV) diseases. The potential impact of psoriasis on the prognosis following coronary revascularization (percutaneous coronary intervention (PCI) or surgical) is not well studied and sparse data available in literature points towards a grim long-term prognosis. The following two cases highlight this phenomenon. We also discuss the plausible reasons responsible for the poor prognosis and propose some possible mechanisms for the same.
This cartographic and analytical study, using the social network analysis method, aims to characterize sheep mobility from breeders producing lambs in the Middle Atlas Mountains to the fattening centers, passing through livestock markets in order to describe the exchange network, to identify the main mobility hubs and to secure the production of fattening lambs by improving the efficiency of the epidemiological surveillance system for “peste des petits ruminants” (PPR) in lambs producers of the Middle Atlas in Morocco.
Descriptive cross-sectional study within the framework of active epidemiological surveillance. It was carried out at a regional level, for mapping the movements of sheep and to analyze the network of exchange relating to this species by the Social Network Analysis (SNA) method in the middle atlas massif and in the zone of sheep fatteners to guide epidemiological surveillance efforts. A total of 807 breeders producing lambs, sheep fatteners and traders were surveyed, including 54 fatteners in fattening workshops (sampling fraction of 48.6%), 150 breeders and traders in livestock markets of Middle Atlas and 603 producing lamb breeders of this massif (sampling fraction at the massif level of 6.64%).
The study revealed a very strong commercial relationship between middle Atlas breeders and fattening zone breeders whose longrange outflows mainly converge towards urban consumption centers. The major strategic livestock markets of the middle Atlas proved to be key points in the articulation of the flows, as was the commune gathering the fatteners. Centrality indicators were used to identify the main trade hubs that contribute to the spread of diseases and to quantify their importance in the influence of sheep movement, while network cohesion parameters have shown that network is vulnerable to the spread of epidemics.
The results of this survey revealed the main commercial hubs at the Middle Atlas level and at the level of the province of fatteners, which represent a great risk of spreading sheep diseases over long distances rather quickly in event of an epizootic, but also representing the ability to control the spread through the control of the movement of animals at their level.
Ovine network; Epizotic of (Peste des Petits Ruminants); Mapping; Social network analysis; Hub; Betweenness; Degree; Strong component; Cutpoint.
The consequence of metastatic carcinoma cervix is regarded to be poor. We present three patients with carcinoma cervix who relapsed in the paraaortic nodes, lungs and vertebra. All of them had oligometastatic disease and were treated with chemotherapy to the lung lesion and radiotherapy to the bone lesion and paraaortic nodes. After more than 5-years they are disease free and on regular follow-up.
Carcinoma; Cervix; Oligometastasis; Paraaortic lymph nodes; Chemoradiation; Chemotherapy.
Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA)-induced coagulopathy rapidly and safely. However, its use in trauma-induced coagulopathy (TIC) in patients not using VKA drugs is yet to be elucidated. This article is a narrative review and analysis of the most recent literature to analyse consequences, and intended effects associated with this treatment modality in TIC. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product were reviewed in the articles. Some studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in victims of trauma. PCC may be a viable option for resuscitation in emergency and critical care in the management of severe hemodynamic deterioration induced by trauma, despite contradictory findings in the literature.
Blood coagulation factor; Trauma; Hemorrhagic shock; Exsanguinating hemorrhage.
Breast cancer is among the most common cancers affecting women worldwide, including Egypt. Age is a well-known determinant of breast cancer risk; however, more data is needed to better understand the importance of age on incidence of breast cancer in the Middle East. Being overweight or obese are also known risk factors—especially for post-menopausal women–however, these data are not available for women in developing countries.
The purpose of this study was to qualitatively explore the association between age, breast density, and demographic factors of breast cancer patients, across a spectrum of radiological breast diagnoses at a large Breast Imaging Clinic in Cairo, Egypt.
We explored the association between age, demographic factors, and Breast cancer incidence among 6,711 women undergoing mammographic screening over a consecutive period of 6-years. Data was collected from March 2007 until March 2013 and extracted
from an electronic data base system.
A total of 6,711 participants were included in this study. The median age of all patients was 46.1. Mean body mass index (BMI) of 28.5, where 34% of the patients were overweight and 32.4% were obese. Older women were more likely to be obese compared to younger women (38.4% vs 18.1%, p<0.001). Older females were more likely to have less dense breasts (ACR: A) compared to younger females (18.1% vs 8.7%, p<0.001). Women older than 40 had a higher confirmed number of breast cancer diagnoses compared with the younger age group (10.7% vs 3.5%, p<0.001). Women with breast cancer were more obese (p<0.001), had denser breasts (p<0.001), were post-menopausal (p=0.002), and more likely to be Muslim (p=0.0021). In the multivariate analysis, aforementioned factors were significant predictors for confirmed diagnosis.
To our knowledge this is the largest study to examine the association of radiological breast assessments on breast cancer incidence, obesity and demographic factors in Egypt. Although data shows the global burden of breast cancer is shifting to the developing world and affecting younger women at alarming rates, our data demonstrated a very low occurrence of breast cancer in both age groups.
Breast cancer; Breast radiological diagnoses; Phenotypic variations; Breast imaging-reporting and data system (BI-RADS).
Low-levels of gamma globulin are associated with a risk of infection, and complications of hypogammaglobulinemia are often observed in hematologic malignancies. In chronic lymphocytic leukemia (CLL), IgG≤600 mg/dL is reportedly associated with higher risks of infection. The objective was to determine the risks of hypogammaglobulinemia and infection in malignant lymphomas for which rituximab that targets B-cells is used.
A retrospective analysis of data from medical records of patients with malignant lymphomas treated with rituximab-containing therapy at our hospital between April 2014 and March 2016 was performed to assess the risks of infections through an evaluation of IgG levels and hospitalizations for and deaths due to infections in patients hospitalized with infections during this period.
From April 2014 to March 2016, 128 patients with malignant lymphomas received rituximab-containing therapy at our hospital, and 94 (61%) of these patients had IgG levels measured. These 94 patients were included in the analysis. The histological types were as follows: 30 had follicular lymphoma (FL), 17 had indolent non-Hodgkin’s lymphoma (iNHL), 42 had diffuse large B-cell lymphoma (DLBCL), and 5 had mantle cell lymphoma (MCL). The mean minimum immunoglobulin G (IgG) level in patients hospitalized for infection was 546 mg/dL and was 628 mg/dL in those not hospitalized (p=0.6). Although a significant difference was not observed, IgG levels tended to be low in hospitalized patients with infection. In addition, there were 4 patients with mean IgG levels that were 600 mg/dL or less in the 6-months immediately prior to hospitalization. Among these 2 died of infection.
Low-levels of gamma globulin are associated with a risk of mortality due to infections in malignant lymphomas.
Hypogammaglobulinemia; Malignant lymphoma; Rituximab.
CLL: Chronic lymphocytic leukemia; FL: Follicular lymphoma; iNHL: Indolent non-Hodgkin’s lymphoma; DLBCL: Diffuse large B-cell lymphoma; MCL: Mantle cell lymphoma; FN: Febrile neutropenia.
Nowadays intravitreal drug injection is the most frequent treatment for retinal diseases. Despite widely use endophthalmitis is already most feared complication of every intravitreal injection in each patient. In clinical setting topical antibiotics have been widely used as a precaution to prevent endophthalmitis however recent published evidence showed it to be unnecessary. Furthermore repeated use of topical antibiotics might give rise to antibiotic resistance in conjunctival flora and thus more aggressive endophthalmitis. Strict asepsis has been awarded as the main rule for endophthalmitis prophylaxis intravitreal injection.
Intravitreal injection; Steroid; Anti-vascular endothelial growth factor (VEGF); Topical antibiotic; Enodphthalmitis; Antibiotic resistance.
To make an account of published implant-related complications (IRC) by a systematic review of the literature.
A systematic search of Pubmed and Scopus databases and Google Scholar engine was performed with selection criteria to detect papers on IRC. We excluded unrelated papers and reviewed selected ones. We considered papers that did not explicitly state about occurrence or not occurrence of IRC as non-IRC reporting. Main outcome measures were the number of papers reporting on complications, IRC, and types of IRC.
After the search, selection, and addition, we studied 109 papers. Incidence of IRC was 4.5%, half required explantation. While 26 implant studies found IRCs (23%), 13 case reports on surgical complications, 8 (61.5%) of them reported IRC. Frequent complications were conjunctival erosion, blockage of the tube, migration to anterior chamber or damage to surrounding tissues.
Most papers did not report on IRC. Length or nature of studies may skew finding IRC. The incidence of IRC was 4.5%. Hard and sharp implants carry a greater risk of IRC and explantation.
Implant-related complications (IRC); Glaucoma surgery; Anterior bleb forming.
To gain insight into the areas that impact women with endometriosis.
A qualitative content analysis of an online survey.
Online questionnaire via Endometriosis UK.
Women diagnosed with endometriosis of any age range.
Free-text online questionnaire through Endometriosis UK completed by women. Results were analysed using NVivo version 9, qualitative analysis software. The software creates links between common words (codes), and these links allow data to be placed in nodes (called themes) which are then developed into categories. Content analysis was used to understand this data.
Main outcome measures
Impact of endometriosis on women’s lives.
In total, 1872 questionnaires were returned but not everyone was able to identify ten separate features that affected them. As such, 1872 women provided at least one area that affected them, 1800 provided two areas, 1770 provided three areas and 1600 provided four areas. The results show that the main areas of concern for these women were pain (53%), heavy menstrual bleeding (11%), low mood (8%) and the perceived lack of understanding displayed by other people (7%). Other important factors were fertility concerns, impact on employment, problems with the medical team and uncertainty. These then impacted on their daily life whereby some women felt “guilty” for not ‘being a normal mother’. A key term that resonated was that endometriosis is an “invisible disease”.
This analysis provides us with insight into the complex psycho-social factors that interact with bio-physical symptoms. Further research is required in sub-population groups such as teenagers and ethnic minority women to explore any differences in impact and how care can be guided accordingly.
Endometriosis; Impact; Qualitative methods; Quantitative methods; Online survey.
The liver is the most common site of uveal melanoma (UM) metastasis with approximately 50% of UM patients being affected. With no proven therapies that mitigate metastases the mortality rate is 85% within the first year after detection of the liver disease. In this study, we provide a mechanistic understanding of the de-regulation of the TP53-MDM2 pathway in UM, which plays a central role in tumor biology.
We investigated the TP53-MDM2 signaling pathway in the microenvironment of liver metastases taken from both a murine orthotopic xenograft and post-mortem metastatic UM human liver. These findings were studied in-depth using both primary and metastatic UM cell lines treated with the MDM2 antagonist Nutlin-3a and the sirtuin inhibitor and transcriptional activator of TP53, Tenovin-6.
De-regulation of the TP53-MDM2 signaling pathway is specific to the liver microenvironment, providing a survival mechanism for UM metastases. Tenovin-6, not Nutlin-3a, reduced UM cell survival by increasing the percentage of cell death and reducing the percentage of proliferating cells. Tenovin-6 increased acetylation of p53, reduced ubiquitination of the protein, and acted as a cell cycle regulator.
Our findings suggest that in patients with metastatic UM de-regulation of TP53-MDM2 signaling pathway promotes growth of the liver metastases and provides pre-clinical information on the potential of targeting of the TP53-MDM2 signaling pathway via Tenovin-6.
Uveal melanoma; Ocular tumors; Nutlin-3a; Tenovin-6; TP53; MDM2.
Pulmonary artery hypertension (PAH) ultimately leads to straining of the right ventricle and increases the risk of heart failure in affected patients. Its clinical presentation is similar to that of many other diseases thus delaying the diagnosis until the disease is far advanced. It remains one of the leading causes of death in adults with sickle cell anaemia (SCA) worldwide. It confers a high risk of death with two-year mortality rates as high as 40-50% even at modest elevation of pulmonary artery pressure. Median survival age after detection of the disease is said to be 25.6-months. Early detection of elevated pulmonary artery pressure in childhood and appropriate intervention by optimization of anti-haemolytic therapy may prevent the progression of this complication. The current writes up is a review of literatures on pulmonary artery hypertension among children with sickle cell anaemia. This will give information which will aid early diagnosis and treatment of pulmonary artery hypertension among children with sickle cell anaemia. This will ultimately improve the quality of life of children with sickle cell anaemia and reduce morbidity and mortality from the disease in adults and children living with sickle cell anaemia.
Sickle cell anaemia; Pulmonary artery hypertension; Children.