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Jun 2026 DOI 10.14302/issn.2766-8681.jcsr-26-6296
Jisoli Yahula ManyasaniCorresponding author
Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.
Apr 2023 DOI 10.14302/issn.2641-5518.jcci-23-4554
Botchorishvili IngaCorresponding author
This report details sequential rare complications arising from a vascular stent infection. Clinical course, microbiology, and imaging are outlined, with emphasis on early recognition and multidisciplinary management. Lessons for device surveillance and antimicrobial stewardship are highlighted.
Oct 2022 DOI 10.14302/issn.2576-9359.jot-22-4303
Morteza Bagheri SeyedCorresponding author
Department of Radiology, School of medicine, Iran University of Medical Sciences
Background Doppler ultrasonography can evaluate vascular and renal parenchymal disorders. In this study, color Doppler patterns in transplanted kidneys were compared with histological diagnosis to develop diagnostic models for transplanted kidney failure. Method 45 kidney transplant patients participated in this prospective study (16 suffered acute tubular necrosis (ATN), and 29 had transplant rejection). All patients had color-Doppler ultrasonography to measure kidney parameters and Doppler indices. Serum creatinine levels also assessed the transplanted kidney's function. Result Ultrasound showed a significant difference between the two groups in iliac and interlobar PSV. The ROC analysis showed a high diagnostic value of the iliac artery PSV, in distinguishing ATN from kidney transplant rejection. Serum creatinine level correlated directly with transplanted kidney volume, renal cortical thickness, and transplanted kidney length, and inversely with interlobar artery PSV and EDV. In graft rejection patients, the only significant inverse correlation was found between serum creatinine level and PSV of the iliac artery and EDV of the intrelobar artery. Discussion and conclusion The iliac artery PSV can differentiate between ATN and rejection after renal transplantation. Evaluation of renal metric parameters along with PSV and EDV of the interlobar artery (in patients with ATN) and iliac artery and interlobar artery (in transplant rejection) help determine renal dysfunction.
Apr 2022 DOI 10.14302/issn.2379-7835.ijn-22-4155
Salissou Seck Mbaye MBAYECorresponding author
Cardiology Department of the Yalgado Ouédraogo University Hospital, Ouagadougou (Burkina Faso)
The diabetic is most of the time admitted in emergency for acute complications. An inventory of these complications will guide promotional programs aimed at preventing the occurrence of these complications. This study was conducted with the aim of identifying acute complications and decompensation factors in diabetics admitted in emergency to the Souro Sanou University Hospital Center (CHUSS).It was an observational study, of descriptive transversal type, with prospective collection for 4 months. It concerned diabetics admitted to the medical and surgical emergency departments of the CHUSS. A total of 90 diabetics were included in the study. The average age was 58.81 ± 14.7 years. Type 2 diabetes accounted for 85.6% of cases. The diagnosis of diabetes was known in 74.4% of cases. The reasons for consultation were dominated by impaired conscientiousness and fever, 54.4% and 50% respectively. Metabolic complications were found in 44.4% of patients. They were dominated by hypoglycemia, which accounted for 55.3% of cases. Dietary error was the main decompensation factor in cases of hypoglycemia and was reported in 71.4% of cases. Metabolic complications are common in diabetics admitted in emergency at the CHUSS. Decompensation factors are mostly preventable.
Mar 2022 DOI 10.14302/issn.2641-5518.jcci-22-4096
Iñaki L. Garcia JulianCorresponding author
Gastroenterology Fellow, De La Salle University Medical Center
Introduction Benign duodenocolic fistula (DCF), also known as a non-malignant fistula between the duodenum and colon, with or without cecum-involvement, is an unusual complication of different gastrointestinal (GI) diseases 12. Case This is a case of a 28-year-old Filipino female who presented with periumbilical pain for five months, with associated anorexia, fever, and weight loss. Biopsy showed chronic granulomatous inflammation with caseation necrosis and Langhan’s type giant cells consistent with tuberculous etiology (Figure 6 and Figure 7). Category I Anti-TB treatment for six months was started and the service planned to repeat both colonoscopy and CT-scan after the initial round of anti-TB treatment. Conclusion Benign duodenocolic fistula in the form of extrapulmonary TB is a rare GI finding that is triggered by inflammatory processes. Proper management in this case was to treat the underlying TB infection which is endemic in the Philippines.
Jan 2022
PrachiCorresponding author
Senior Resident, Department of Pathology, Dharamshila Narayana Super speciality Hospital, New Delhi
This case report describes plasma cell pleocytosis occurring after bone marrow transplantation for multiple myeloma. The authors outline clinical presentation, cerebrospinal fluid findings, and differential diagnosis, emphasizing the need to consider hematologic relapse or CNS involvement in post‑transplant patients with neurologic symptoms. Management considerations and follow‑up strategies are discussed.
Sep 2019 DOI 10.14302/issn.2578-2371.jslr-19-3028
Sabbah.MCorresponding author
Gastroenterology Department, Habib Thameur Hospital Tunis
Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease. Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality.
Apr 2019 DOI 10.14302/issn.2379-7835.ijn-19-2579
Ghayour-Mobarhan MajidCorresponding author
Metabolic Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Objective Postmenopausal women are at an increased risk of Cardiovascular Disease. We aimed to investigate whether this risk differed between individuals with a naturally occurring and other reasons for menopause within a large population-based Iranian sample. Study Design A total number of 1763 postmenopausal women (defined by amenorrhea for more than a year, or FSH > 30-40 mIU/ml), 900 of them with a natural menopause and 863 of them with other reasons for menopause caused by (hysterectomy without oophorectomy or one side oophorectomy, hysterectomy with oophorectomy or two side oophorectomy without hysterectomy) were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Biochemical and hematological risk factors were measured in all the subjects and the data were analyzed by SPSS software version 20 Results There was a significant difference in the presence of cardiovascular disease in the natural menopause group compared with other reasons for menopause group (p<0.05). There was also a meaningful difference between the prevalence of depression and anxiety in the natural menopause individuals compared with other reasons for menopause group (p<0.05). Discussion High prevalence of CVD, depression and anxiety in other reasons in menopause women were observed among Mashhad urban females. It should be considered as a noticeable message. Furthermore, studies are necessary to determine different parameters between evaluating CVD, depression and anxiety among menopauses women.
Mar 2019 DOI 10.14302/issn.2641-5518.jcci-19-2692
Vijiala SergiuCorresponding author
Department of Cardiology, Centre Hospitalier du Valais Romand, Sion Hospital, Switzerland
Percutaneous device closure of atrial septal defects (ASD) has proven to be safe and it is nowadays the standard treatment for ASDs. Immediate or late device embolization is a rare but potential complication of every attempted ASD device closure. We report a case of asymptomatic Amplatzer Septal Occluder into the left ventricular outflow tract (LVOT) detected by routine transthoracic echocardiography 3 months after successful implantation in a stable patient.
Jun 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1540
Mwanakasale VictorCorresponding author
Copperbelt University, School of Medicine, Ndola, Zambia.
Introduction Schistosoma haematobium infection is acquired early in life with the peak prevalence and intensity of infection occurring in the second decade of life in endemic areas. The aim of this study was to establish any association between S. haematobium infection and development of inguinal hernia in school age children in a S. haematobium highly endemic area in Zambia. Methodology An analytical study was conducted at St Paul’s Mission Hospital, Nchelenge, Luapula province, Zambia. Hospital operating theatre records were reviewed for inguinal hernia repair operations in school age children. Results There were 45 inguinal hernia repair operations conducted in male school age children presumed to be infected with S. haematobium between July 2010 and July 2015. The mean age of these children was 9.6 years while the age range was from 6 years to 14 years. The overall prevalence of S. haematobium in school age children in the area ranged from 89.5% to 95.5% during this period. Conclusion Inguinal hernia is a probable complication of S. haematobium infection in school age male children.
Apr 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1425
Damelan KombateCorresponding author
University of Lome (Togo)
Lemierre’s syndrome is rare jugular thrombosis associated with an oropharyngeal infection. The jugular thrombosis is from septic origin. This often happens in young males subjects. We described Lemierre’s syndrome in a 46 year-old man with a chronic ethmoidal sinusitis associated to the left jugular thrombosis extended to the transverse sinus with a partial recanalisation after three months of oral anticoagulant therapy.
Aug 2016 DOI 10.14302/issn.2470-5020.jnrt-16-1200
Alhashemi HashemCorresponding author
Physical Medicine & Rehabilitation consultant, Department of Medicine, KAMC Jeddah, Assistant Professor at KSAU-HS
Objective: To assess mortality, medical complications, and care indicators among stroke patients admitted to general medical units at King Abdulaziz Medical City-Jeddah-Saudi Arabia. Methods: This retrospective cohort study included all adult patients (>16 years) admitted to KAMC-Jeddah between January 1, 2014, and June 30, 2015, with acute stroke. Data regarding in-hospital stroke mortality and medical complications (pressure ulcer, pneumonia, venous thromboembolism dysphagia, and wheelchair dependency) and stroke care indicators (time-to-CT, carotid imaging, lipid profile, physical therapy, swallowing assessment, nutritional assessment, and length of stay) were collected. Results: Patients included were 208. Acute stroke mortality was 19%, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units. The incidence of pressure ulcers, pneumonia, and venous thromboembolism was 17%, 14%, and 3%, respectively. Pneumonia (odds ratio OR, 5.5; P = 0.002; 95% confidence interval CI, 1.9–16), abnormal troponin level (OR, 4.4; P = 0.002; 95% CI, 1.7–11),hemorrhagic stroke (OR, 3.9; P = 0.015; 95% CI, 1.3–12), and pressure ulcers (OR, 3.0; P = 0.036; 95% CI, 1.1–8.0) were significantly associated with increased mortality. Median time to CT scan was 117 minutes. Carotid imaging was performed for 67% of ischemic stroke patients, and 65% underwent fasting lipid profile assessment. Assessment by nutritionist, physiotherapist, and swallowing therapist was done for 90%, 76%, and 53% of stroke patients respectively. The median length of stay was 12 days. Conclusion: Acute stroke mortality was 19 %, while wheelchair dependency, and dysphagia on discharge were 39% and 56% respectively in general medical units at KAMC Jeddah. Pneumonia, abnormal troponin, hemorrhagic stroke, and pressure ulcers are associated with increased mortality. Future research is needed to compare outcomes of stroke care between general units and specialized stroke units nationally.
Jul 2026 DOI 10.14302/issn.2470-0436.jos-26-6357
Awan MuhammadCorresponding author
Herpes zoster ophthalmicus (HZO) is a manifestation of varicella-zoster virus (VZV) reactivation involving the ophthalmic division of the trigeminal nerve, carrying significant risk of vision-threatening complications. Diplopia in HZO is often attributed to cranial nerve palsy, although orbital myositis remains a rare and underrecognized cause. We present a 79-year-old male who developed right-sided headache, binocular diplopia, and a V1 vesicular rash two weeks after receiving the recombinant zoster vaccine. Examination revealed restriction of extraocular movements without a localizing cranial nerve pattern, raising suspicion for orbital myositis. Neuroimaging was unremarkable, and VZV polymerase chain reaction confirmed the diagnosis of HZO. The patient received antiviral therapy and was discharged in stable condition after three days. This case highlights HZO presenting with suspected orbital myositis in temporal association with vaccination and underscores the need for vigilance for uncommon neuro-ophthalmic manifestations, as early recognition and treatment are essential to prevent vision-threatening complications. Given the patient's advanced age, this case also emphasizes the possibility that age-related immunosenescence may contribute to VZV reactivation and the development of HZO-related ocular complications. Potential therapeutic approaches targeting age-related immune dysfunction are also considered.
May 2026 DOI 10.14302/issn.2578-8590.ipj-26-6121
Bitsch Poulsen MariaCorresponding author
Aims Cardiac autonomic neuropathy is currently an untreatable progressive complication of type 1 diabetes (T1D). Impaired microcirculation is a suspected cause of nerve degeneration in TID. We investigated whether cardiovascular autonomic reflexes often used as indices of nerve functions, are associated with indices of microcirculatory function in young adults with T1D compared with non-diabetic controls. Methods In a cross-sectional study, 15 adults with T1D and 15 age-matched controls (20-40 years) underwent standardized cardiovascular autonomic reflex tests. Continuous recordings of electrocardiogram, cardiac vagal tone, beat-to-beat blood pressure and transcutaneous tissue oxygen (tcpO₂) and carbon dioxide partial pressures (tcpCO2) were done. Results Despite preserved baroreflex, parasympathetic, and sympathetic functions assessed using cardiovascular reflex tests, the individuals with T1D exhibited reduced baseline tcpO2 compared to the controls (37.5±3.75 vs. 49.6 mmHg). During the Valsalva manoeuvre, individuals with T1D exhibited a reduced systolic blood pressure response in phase I (31±10 vs. 43±18 mmHg) and early phase II (-1±15 vs. -18±17 mmHg), and an increased systolic (31±15 vs. 18±14 mmHg) and diastolic (45±11 vs. 33±16 mmHg) response in late phase II compared to controls. The early phase II diastolic response was inversely associated with baseline tcpO2. Conclusion The altered hemodynamic response to the Valsalva manoeuvre is suggestive of possible reduced arterial elasticity, higher vascular resistance, and splanchnic sympatho-vagal imbalance in T1D despite normal autonomic reflex ratios. The concomitant evidence of reduced tissue oxygenation and altered hemodynamics may represent early signs of dysautonomia but require longitudinal validation.
Apr 2026 DOI 10.14302/issn.2994-6743.ijstd-25-5899
W. Ruddock MarkCorresponding author
Background Sexually transmitted infections (STIs) continue to rise globally, with >1 million new cases reported daily in 2020. In England, newly diagnosed STIs increased by 23.8% in 2022 compared to 2021. Many infections remain asymptomatic yet contribute to infertility, pregnancy complications, and neonatal morbidity. While routine screening often focuses on Chlamydia trachomatis, broader detection is limited by laboratory turnaround times and restricted test panels. Methods We analysed 6003 home-collected urine and/or swab samples submitted for sexual health screening in the UK. Samples were tested in the laboratory for 10 bacterial and viral pathogens. A total of 5859 urine and 1627 swab samples were processed, with paired samples assessed for diagnostic agreement. Results The most common infections detected in urine were Ureaplasma urealyticum (12.1%), Mycoplasma hominis (8.6%), and Chlamydia trachomatis (2.4%). Swabs showed similar prevalence, with Ureaplasma urealyticum (11.6%) most frequent, followed by Mycoplasma hominis (10.4%) and HSV-2 (4.4%). Paired urine–swab samples demonstrated strong agreement, though swabs improved HSV detection. Conclusions Ureaplasma urealyticum was the most prevalent STI detected, yet only Chlamydia trachomatis is routinely screened in England. Comprehensive laboratory testing of home-collected samples could reduce the hidden burden of STIs, infertility, pregnancy complications, and neonatal infections, while offering confidential and accessible diagnostics.
Feb 2026 DOI 10.14302/issn.2641-5518.jcci-26-5982
Philip Taah-AmoakoCorresponding author
Introduction A retained surgical towel in the abdomen is a serious postoperative complication and the most avoidable. Known as “gossypiboma”, it may migrate into adjoining cavities like the stomach, small bowel, colon, vagina, urinary bladder, pericardium, and urethra. Case Report A 32-year-old male presented with complaints of abdominal pain, 4 months after a laparotomy for complicated appendicitis. Initial history and presentation gave an impression of a lower urinary tract obstruction. However, symptoms progressed with signs of bowel obstruction and investigations pointed to a possible retained foreign body. This was confirmed on laparotomy with indications of a transmural migration during the period of evaluation. The report discusses the pathophysiology and manifestations of a migratory surgical gossypiboma. Conclusions A rare case of gossypiboma displaying transmural migration is reported. This showed an initially peritoneally placed sponge that migrated into the intestinal lumen with the sudden presentation of obstructive symptoms. Routine practice of the World Health Organization Surgical Safety Checklist can significantly prevent these incidents.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5886
Y. Talbert PatriciaCorresponding author
Objective Diabetes poses significant public health challenges, with many individuals remaining undiagnosed and at risk of complications. This study aimed to evaluate the performance of decision tree ensemble methods for predicting diabetes onset using the Framingham Heart Study Teaching Dataset and to explore sex-specific risk patterns relevant to AI-driven interventions. Methods We analyzed data from 11,627 participants, incorporating demographics, vital signs, smoking status, medication use, and laboratory measures. Random Forest classifiers were developed to predict diabetes incidence at approximately 6-year (Period 2) and 12-year (Period 3) follow-ups. Class imbalance was addressed using undersampling, oversampling, and the Synthetic Minority Over-sampling Technique (SMOTE). Results The models demonstrated robust performance, achieving an Area Under the Curve (AUC) of 0.856 in Period 2, and moderate predictive ability in Period 3 (AUC = 0.732 in males, 0.786 in females). Key predictors included glucose level, BMI, systolic blood pressure, age, and heart rate. Notably, differences emerged in predictive accuracy between men and women, suggesting potential sex-specific vulnerabilities that merit further study. Conclusion Machine learning approaches, particularly Random Forests, show promise for medium- and long-term diabetes risk prediction, supporting early identification and intervention efforts. Future work should focus on hyperparameter tuning and explainability techniques, such as SHapley Additive exPlanations (SHAP) values, to improve model precision, interpretability, and fairness. Equity-focused strategies remain critical to ensure AI-driven tools benefit diverse populations and do not exacerbate existing disparities in diabetes care.
Dec 2025 DOI 10.14302/issn.2381-862X.jwrh-25-5447
J. Factoriza OliviaCorresponding author
Objective This study aimed to explore the respondents’ reproductive health profiles, examining the physiological and psychosocial perimenopausal symptoms affecting productivity, and identifying occupational needs. It also determined the relationship between menopausal symptoms and the productivity and occupational needs of peri-menopausal women. Methodology A descriptive cross-sectional design was used, surveying 50 women over 40 years old with a validated four-point Likert scale instrument. The instrument undergone content validation, reliability test, and ethical approval. Survey was administered personally and online using purposive sampling. Statistical treatments included weighted mean, F-test, T-test, Pearson r correlation, and ranking. Key results The majority of participants had their first menstruation between 11 to 15 years old and experienced regular menstrual cycles. Most had one child, with an equal number of cesarean and normal deliveries, and reported no pregnancy complications. The study found that participants seldom experienced physiological and psychosocial menopausal symptoms. They agreed on the occupational needs during the perimenopausal period. It was found that physiological symptoms were influenced by factors such as early menarche, cesarean delivery, and pregnancy complications. Additionally, psychosocial symptoms varied based on menstrual status, the number of children, and pregnancy complications, with those experiencing earlier menstruation or complications reporting more intense symptoms. The study revealed a significant relationship between both physiological and psychosocial perimenopausal symptoms, which negatively impacted productivity and increased occupational needs. Women with higher menopausal symptoms expressed a greater need for workplace policies that support perimenopausal women, highlighting the need for tailored workplace interventions for this demographic. Future Direction The study recommends including pap smears and mammograms in annual exams for peri-menopausal women, offering awareness seminars on managing perimenopausal symptoms to reduce workplace disruptions, and suggests future research exploring additional variables affecting perimenopausal women’s health and productivity
Dec 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5515
Rao AnaghaCorresponding author
Background Peripheral neuropathy (PN) is a common and debilitating complication in people living with HIV (PLHIV). While HIV itself contributes to neuropathy, certain antiretroviral therapy (ART) drugs, particularly nucleoside reverse transcriptase inhibitors (NRTIs) such as stavudine (d4T) and zidovudine (AZT), are known for their neurotoxic effects. Objectives To evaluate the impact of ART on HIV-associated peripheral neuropathy (HIV-PN) and to determine whether certain ART regimens increase the risk or severity of neuropathy. Materials and Methods A cross-sectional study was conducted among 158 HIV-positive patients. Neuropathy was diagnosed using clinical criteria, Total Neuropathy Score (TNS), and nerve conduction studies (NCS). Patients were grouped based on their ART regimen, and statistical analysis was performed to assess the association between ART type and peripheral neuropathy severity. Results It was noted that patients on older NRTIs (stavudine, zidovudine) had significantly higher rates of peripheral neuropathy (p=0.002) and tenofovir-based regimens were associated with lower peripheral neuropathy prevalence (p=0.01). There was a significant correlation between the duration of ART exposure and peripheral neuropathy severity (p<0.001), suggesting a cumulative neurotoxic effect. Conclusion Older ART regimens, particularly stavudine and zidovudine, significantly contribute to HIV-PN. The study supports the WHO recommendation to phase out neurotoxic ART and highlights the importance of early ART regimen optimisation to prevent long-term neurological complications.
Dec 2025
Waine ArnoldCorresponding author
Background Intravenous Fluids use during surgery is a common practice for many reasons. However recent evaluation of perioperative abdominal surgery patients have poised many issues. Mostly on the type of fluid and quantity of volume usage on major abdominal surgery. Many studies into this aspect of perioperative fluid usage have been done, and volume definition have been accrued either restrictive (Maintenance fluid of less than 1.75 Liters) or liberal or standard (Maintenance fluid between 1.75 Liters to 2.75 Liters) usage. The outcome was assessed to ascertain the best patient recovery without complications from the two fluid regime. Result/Discussion After PRISMA exclusion criteria, there were eight randomized control studies assessed to provide a summary, comparing all the studies using either restrictive fluid or liberal fluids used in major abdominal surgery. Post operative complications and the length of hospital stay were assessed as the major outcomes end points and the cumulative result favored those with restrictive fluid usage. Conclusion Although the restrictive use of fluids in abdominal surgery is favored from the measured outcomes, there are inherent cofounders and heterogenicity in the eight studies that require more detail studies involving multiple study centers and population.
Nov 2025 DOI 10.14302/issn.3070-5657.je-24-5272
Passan ShrutiCorresponding author
Ovarian Hyperstimulation Syndrome (OHSS) is a significant complication that can occur during fertility treatments, particularly in the context of assisted reproduction technologies (ART) such as In-vitro fertilization (IVF). It is characterized by enlarged ovaries and the accumulation of fluid in the abdomen and sometimes the chest, which can lead to various degrees of discomfort and, in severe cases, life-threatening complications. The incidence of clinically significant OHSS is 2-3%, however, milder forms of OHSS might develop in up to 20-30% of all IVF patients.
May 2025 DOI 10.14302/issn.2694-2283.jsem-25-5529
Al-saeed NawafCorresponding author
Background Septic arthritis is a potentially limb or life-threatening joint infection that requires prompt recognition and intervention to reduce morbidity and mortality. While intra-articular joint injections are commonly performed for osteoarthritis and other arthropathies, they carry a rare but significant risk of iatrogenic infection, particularly when performed in the presence of unrecognized joint or periarticular infection. Case Presentation We report a case of a 52-year-old female with a history of traumatic brain injury and chronic right knee pain who developed severe knee swelling, pain, and systemic symptoms following an intra-articular corticosteroid injection performed without ultrasound evaluation/guidance. Post-procedure, she presented with fever, elevated inflammatory markers, and purulent knee effusion. Operative washout revealed a purulent tract extending from the knee joint capsule to the lateral thigh. Cultures from joint aspiration and intraoperative samples grew Streptococcus dysgalactiae. Blood cultures were negative. The patient reported frequent cat scratches to the affected knee and described an unusual sensation of the injection needle tracking laterally during the joint injection. She was treated with surgical drainage and a four-week course of amoxicillin, with full clinical recovery. Discussion This case highlights an unusual presentation of septic arthritis with extra-capsular extension likely due to iatrogenic needle tracking during joint injection. The causative organism, S. dysgalactiae, is an uncommon pathogen in septic arthritis, and the presumed source was contiguous spread from untreated cellulitis, possibly related to cat scratches/bites. The absence of predisposing comorbidities and negative blood cultures further support a local rather than hematogenous source. The case emphasizes the importance of thorough clinical evaluation and consideration of infection prior to joint injections, as well as the potential benefits of ultrasound guidance to minimize procedural complications. Conclusion Careful history, physical examination, and appropriate imaging are essential prior to joint interventions to avoid iatrogenic complications. This case illustrates the rare but serious risk of extra-capsular extension of septic arthritis following intra-articular injection and emphasizes the need for vigilance in identifying underlying infection before proceeding with invasive procedures.
Dec 2024 DOI 10.14302/issn.2641-4538.jphi-24-5358
Kar SonaliCorresponding author
Background Injuries, particularly unintentional ones, are a neglected public health concern and are preventable or avoidable. Children in urban slums are especially vulnerable due to hazardous living conditions, inadequate supervision, and lack of safe sojourns or play areas. Since these injuries result in seeming spontaneous recovery, appropriate care being initiated by the primary care giver is questionable. Objective To assess the burden of unintentional injuries of unintentional injuries in pre-school going children aged 2-6 years in urban slums of Bhubaneswar, Odisha. To compare the knowledge of the 1st level care post-injury among the primary care givers against standardized prescribed care. Methods A cross-sectional descriptive observational study was conducted for over 2 years in urban slums under the Bhubaneswar Municipal Corporation (BMC), the capital city of Odisha. A total of 285 children aged 2-6 years, whose mothers consented to participate, were included in the study. Data regarding the type of injury and its management, as well as, associated socio-demographic factors, were collected using a pre-designed, pre-tested questionnaire. Descriptive statistics was used to derive the burden of unintentional injuries in children. The knowledge of the 1st level of care to be given after the common injuries was assessed among all the primary caregivers to detect the treatment and care gap. Results The majority of primary respondents were mothers aged 21-30 years (82.1%), The frequency of an episode of unintentional injury (occurrence in last 3 months) in the study population was found to be 58%. The most common type of injury reported was skin lacerations or tears, common site being in the upper and lower limbs. Males were more affected as compared to females (54.64 %) The reporting of unintentional injuries among the children was found to have significant association with the occupation of the father. Fathers who were unemployed or working as unskilled labor, their child’s probability of reporting an unintentional injury was found to be high, with p value coming to be statistically significant. Conclusion The study highlights the complex interplay of sociodemographic factors influencing unintentional injuries among children in urban slums and the need to create awareness among the primary caregivers, about the immediate management, so that chronic complications may be averted. It is difficult to avert injury as this age group is agile and nowadays supervision is challenging. Still, the knowledge of management would not just empower the caregiver, but also the growing child, who can attend to their younger siblings or themselves, whenever they get injured next. Further research with larger sample sizes is warranted to validate these findings and develop effective prevention strategies.
Aug 2024
Balachandra ShivaiahCorresponding author
Ambulatory blood pressure monitoring is widely used in pediatric patients to identify hypertension and its complications. Previous studies correlating obesity and hypertension using ABPMs showed increasing blood pressure loads with increasing BMI. However, BMI percentiles are more reliable indicators of obesity in children. Our study aimed to describe the association between BMI percentiles and systolic and diastolic blood pressure load using ABPM in children and adolescents. Retrospective analysis of ABPMs (Welch Allyn) was performed on a total of 115 patients between 7 and 18 years of age who were referred for elevated BP without a diagnosis of hypertension at our institution from Jan 2011 to Oct 2013. Patients were divided into 4 groups based on BMI percentile: <94th percentile, 94–98th percentile, 98–99th percentile, and >99th percentile. Analysis between blood pressure loads and BMI percentiles revealed greater mean systolic and diastolic loads with increasing BMI percentiles, but the P value was not statistically significant. Analysis of the systolic loads between children from different racial backgrounds revealed higher values in African American children than in Hispanic and Caucasian children, but the P value was not statistically significant.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Dangwe Temoua NaibéCorresponding author
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Jan 2024 DOI 10.14302/issn.2374-9431.jbd-23-4842
Wissam Younes SamerCorresponding author
Over the past 20 years, the number of persons with diabetes has more than doubled globally. The purpose of this review article is to investigate the connection between certain vitamins and diabetes. Diabetes patients have been found to have decreased amounts of certain antioxidant vitamins including A, C, and E, presumably as a result of the requirement to control oxidative stress brought on by problems with glucose metabolism. Retinol-binding protein has regulatory and adipocytokine function. Thiamine, pyridoxine, and biotin levels are also decreased in diabetics. Studies have shown that it restricts the absorption of several nutrients, such as vitamins B9 and B12, thus diabetics must frequently replenish these vitamins. Low vitamin D levels increase the risk of developing diabetes and associated complications, such as cardiovascular disease. Although some studies indicate that vitamin K supplementation can enhance glucose metabolism, it is not known if vitamin K supplementation can prevent or repair oxidative damage. Numerous studies have demonstrated the detrimental consequences of excessive vitamin supplementation. The association between a few nutrients—specifically, vitamins A, D, C, B3, B6, B9, Zn, B12, E, B1/K, and irons—and the already mentioned pathways implicated in diabetes—as well as their potential regulatory activity—will be analyzed in the review that follows.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Dangwe Temoua NaibeCorresponding author
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Sep 2023 DOI 10.14302/issn.2576-9383.jhhr-23-4713
Bhoite RachanaCorresponding author
A global increase in incidence of chronic liver disease (CLD) indicated the necessity of dietary and lifestyle modification. Low glycemic index (GI) diet was reported to have a significant role in controlling diabetes caused by liver dysfunction. The International Standards Organisation (ISO) has standardized the determination of GI of a food in healthy individuals. This study aimed to estimate GI value of a high protein, energy dense liver nutritional supplement. This cross-over randomized controlled study randomly allotted 15 participants to consume either reference food 27.5 gm glucose (glucose monohydrate) or 77 gm nutritional supplement (equivalent to 25 gm of available carbohydrates); switching to another arm was done after 3 days wash-out period. After overnight fast, blood samples were collected at 15, 30, 45 and 60 minutes post-consumption of s upplement or reference food. The GI was calculated from the incremental area under the blood glucose response elicited by the nutritional supplement as a percentage of the response after consumption of 27.5 gm of glucose (glucose monohydrate) by the same participant using a standard formula. Mean GI of the nutritional supplementwas estimated as 11.4 ± 2.4.With the consumption of this nutritional supplement, the blood glucose levels were reduced at all postprandial time points, compared to the reference food. The liver nutritional supplement tested has a low GI, and comparatively slower and more sustained blood glucose response. Therefore, it can be used in patients with CLD to prevent CLD-associated metabolic complications and improve health outcomes and quality of life.
Sep 2023
Stenberg DanielCorresponding author
Groove pancreatitis (GP) is a rare type of segmental chronic pancreatitis that affects the anatomical area between the pancreatic head, the duodenum, and the common bile duct, referred to as the groove area. Most patients with groove pancreatitis are males aged 40–50 years with a history of alcohol abuse. The prevalence of this condition was not determined due to rarity of cases.The clinical symptoms commonly reported were weight loss, upper abdominal pain, postprandial vomiting, and nausea due to duodenal stenosis. It is considered difficult clinically and radiographically to distinguish this form of chronic pancreatitis from other differential diagnoses of inflammatory conditions or malignancies affecting the pancreas or adjacent structures to that groove area. We report a challenging case of GP in an asymptomatic female patient during routine gastric ulcer screening. Our objective is to draw attention to this rare and atypical type of chronic pancreatitis and the importance for early detection on screening EGDs prior to its symptomatic sequelae and complications.
Sep 2023 DOI 10.14302/issn.2381-862x.jwrh-23-4601
Ali Jemal SamrawitCorresponding author
Background The novel coronavirus COVID-19 has created massive challenges to public health worldwide. Pregnant women are an immune-depressed status which makes pregnant women generally more vulnerable to COVID-19 infection and severe illness. The present preventive measure practices have gaps. Therefore, the current study aimed to present accurate and latest information regarding preventive measures for COVID-19 infection among pregnant women. Methods and materials Institution-based cross-sectional study design was conducted on 422 pregnant women in public hospitals in Addis Ababa using a pretested structured questionnaire. Face-to-face interview on pretested and structured questions was conducted to collect the data between January 12 and February 15, 2022. The collected data were entered into Epi data version 4.4.2.2 and exported to SPSS window version 25 for analysis. Descriptive statics and multivariable logistic regression were analyzed. Odds ratio with a 95% confidence interval and p-value ≤ 0.05 were declared statistical significance independent variables. Result A total of 418 pregnant women participated, and the response rate was 99.05%. About 417 (99.8%) pregnant women reported never hearing about COVID-19. Of those who heard about COVID-19, only 49% and 54.3% had good knowledge and had good practice towards COVID-19 infection respectively. Age (26-30yrs (AOR=0.46, 95%CI: 0.014,0.12), no education (AOR=0.23, 95%CI: 0.099-0.52), Primary school (AOR=0.199, 95%CI: 0.104-0.4) and Secondary school (AOR=0.282, 95%CI: 0.14-0.55), divorced (AOR=0.15, 95%CI: 0.065-0.34) and widowed (AOR=0.16, 95%CI: 0.024-1.03)) were factors that associated with knowledge towards COVID-19 infection. Age (30-35yrs (AOR=0.334, 95%: 0.115-0.97) and >36yrs (AOR=0.28, 95%CI: 0.11-0.69)), no education (AOR=0.06, 95%CI: 0.019-0.18), being a civil servant (AOR= 0.28, 95%CI: 0.122-0.66), divorced (AOR=0.042, 95%CI: 0.01-0.18), having >4 family size (AOR=0.334, 95%CI: 0.169-0.66), no previous complication of pregnancy outcomes (AOR=0.019, 95%CI: 0.01-0.061), chronic health problem (AOR=14.66, 95%CI: 0.457-39.4) and two ANC visit (AOR=5.704, 95%CI: 2.41-13.5) were factors that associated with the practice towards COVID-19. Conclusion In this study area, only half of pregnant women had good knowledge and good practice about covid-19 infection prevention measures.
Jan 2023 DOI 10.14302/issn.2474-7785.jarh-23-4432
Marks RayCorresponding author
Background Many older adults remain vulnerable to COVID-19 infections. They are also often at risk for frailty and poor health outcomes. Aim This exploratory review examines the correlates of long COVID and frailty and their association insofar as the older adult’s wellbeing may be jeopardized. Methods and procedures Articles that emerged between January 1 2022 and 2023 in major electronic data bases that addressed the current topic of interest were sought using the key words: Long COVID and Frailty. Those deemed relevant were duly downloaded, analyzed and summarized in narrative form. Results A high proportion of older adults can be expected to remain vulnerable to COVID-19 long term impacts, plus new variants of infection, along with frailty as both an outcome and mediator. Many too are at risk for persistent long COVID-19 complications and a low life quality if more concerted preventive and rehabilitation efforts to avert frailty early on are not forthcoming in a timely manner. Conclusion Prompt and continuing frailty assessments of older adults at risk for COVID-19 or recovering from this disease, especially those with long COVID manifestations who are frail or may become frail are strongly indicated.
Jan 2023 DOI 10.14302/issn.2329-9487.jhc-22-4362
PIO MachihudeCorresponding author
Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and Methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4315
Nazempour AnahitaCorresponding author
OB/Gynecologist, fellowship of infertility and IVF, Sarem fertility and infertility research center (SAFIR), Sarem women’s hospital, Tehran, Iran.
Background Polycystic ovary syndrome (PCOS) is a serious multifactorial disorder. This study intended to assess the effect of cinnamon supplementation on estradiol level, and fasting- and two-hour (2 hpp) insulin and sugar levels in women with PCOS. Material and Methods This study was a double-blinded randomized clinical trial (RCT), conducted between January 2019 until December 2020, at Gynecology Clinic Sarem Women’s Hospital in Tehran, Iran. Patients with PCOS, 130 subjects (65 person/ group) were diagnosed using Rotterdam diagnostic criteria. All participants received daily treatment consisting of 1500 mg metformin and 1000 mg cinnamon per day for 12 weeks. An evaluation of serum AMH level was conducted before and after the completion of therapy. Results Cinnamon supplementation significantly reduced the estradiol, fasting glucose and 2hpp glucose, fasting insulin and 2 hpp insulin, BMI and weight levels after intervention. The highest reduction was observed in fasting glucose, 2 hpp insulin, and estradiol groups after intervention (P<0.05). There was a significant difference between the means of BMI (P<0.01), fasting sugar (P<0.01), and 2 hpp glucose (P<0.01) before and after intervention. Conclusion Cinnamon supplementation, as a safe herbal product, can be prescribed with metformin to improve the symptoms and complications of PCOS.
Sep 2022
K Al Miraj ACorresponding author
Research Assistant, Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU)Dhaka, Bangladesh.
Background Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients worldwide. In the developing countries like Bangladesh it has been increasing with time. Due to life style, food habits and urbanisation. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Materials and Methods From July 2020 we included 152 patients with IHD purposively in Cardiology department of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh undergone PCI who were divided into 2 groups according to age: e” 75 years (n = 51) and <75 years (n = 101). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint was Renal impairment, MI, LVF, emergency revascularization and death. Results Very elderly patients were more frequently male (86.2%) and nonsmoker at present (41.1% vs. 63.3%, p=0.003), had higher prevalence of hypertension (60.7% vs. 50.4%, p<0.13), and more often presented with NSTEMI (54.9% vs. 23.7%, p<0.001). Elderly group had higher incidence of TVD and LM disease (37.2% vs. 26.7% and 9.8% vs. 2.9%, p=0.07) and more incidence of ostial (17.6% vs.5.9%,p=0.007) and calcified lesions (31.3% vs. 14.8%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (96% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.8% vs.5.9%, 7.8% vs.3.9%, 5.8% vs.5.9%, 9.8% vs. 4.9% and 5.8%vs.3.9%,p=0.07), whereas emergency revascularization were higher in younger group (5.8% vs. 6.9%, p=0.07). Conclusion Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.
Mar 2022 DOI 10.14302/issn.2641-5518.jcci-22-4097
Iñaki L. Garcia JulianCorresponding author
Gastroenterology Fellow, De La Salle University Medical Center
Malignant melanoma the most common malignancies associated with GI involvement. They usually manifest clinically at an advanced stage of neoplasm. Surgery is also recommended for palliative treatment of GIT metastases. A case of a 67-year-old male diagnosed with malignant melanoma for 7 months had burning epigastric pain and bloatedness. Esophagogastroduodenoscopy showed multiple flat lesions. Biopsy findings were consistent with malignant melanoma. Malignant melanoma has an early tendency to metastasize and has a high mortality rate due to its complications. In patients with malignant melanoma since Gastrointestinal involvement is now being documented as part of metastatic work up esophagogastroduodenoscopy is suggested as an important tool in the treatment and patient’s +outcome. Although metastases to the stomach is rare, it is essential to be thorough and include an upper endoscopy to rule out metastatic disease, especially in symptomatic patients.
Jan 2022 DOI 10.14302/issn.2641-5518.jcci-21-3959
EKMEZ MuratCorresponding author
Sultangazi Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey
COVID-19 epidemic, described as a community health emergency by the World Health Organization, began in December 2019. COVID-19 is a source of deep vein thrombosis (DVT) because of hypercoagulation, blood stasis, and endothelium injury complications. This study reports a 26-year-old pregnant woman with coronavirus hospitalized with a left ovarian vein (LOV) thrombosis at Sultangazi- Haseki Training and Research Hospital in Istanbul. Risk classification for DVT disease is of crucial importance for the forecast of coronavirus.
Oct 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3951
kaur BaljinderCorresponding author
Dept of Pediatrics, Government Medical College, Rajindra Hospital, Patiala..
This article has been retracted on July 20, 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2692-1537.ijcv-25-5866) In December 2019, a novel coronavirus, now named as SARS-CoV-2, caused a series of acute atypical respiratory diseases in Wuhan, Hubei Province, China. The disease caused by this virus was termed COVID-19. The virus is transmittable between humans and has caused pandemic worldwide. The number of death tolls continues to rise and a large number of countries have been forced to do social distancing and lockdown. In humans, COVIDs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. in our study , we consider the symptomatology , complications and mortality patterns of this disease in children.
Aug 2021 DOI 10.14302/issn.2372-6601.jhor-21-3903
B Katakkar SureshCorresponding author
Arizona Hematology Oncology, Tucson Arizona USA
A 61 years female patient with known diagnosis of the breast cancer in remission for more than 10 years has Renaud’s disease. During her work up for lupus and lupus anticoagulant which both were negative a prolonged thrombin time was noted which was done by mistake. She has no history of bleeding or thrombosis and last recent surgery was 5 years ago for spinal stenosis and was uncomplicated. Her clinical examination is normal without evidence of any spontaneous bruises but colder hands. The thrombin time was greater than 125 seconds on two different occasions and correction of it by addition of normal plasma was down to 56 seconds and was thus incomplete. Her prothrombin time and PTT were normal and there was no evidence of FDP or D-Dimers. There was no evidence of circulating heparins. The fibrinogen level was normal. The para proteinmia was excluded by normal serum protein electrophoresis and by immunofixation . Thus it is felt that this patient has dysfibrinogenemia or hypo dysfibrinogenemia without bleeding or thrombotic complication. The literature review shows approximately 55% of dysfibrinogenemia patients do not have bleeding or thrombotic complications.
Aug 2021 DOI 10.14302/issn.2379-8572.joa-21-3913
Mohamed Bofares KhaledCorresponding author
Professor of otorhinolaryngology Omar Almoukhtar University, Elbyda, Libya
This article has been retracted on 20 January 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2379-8572.joa-25-5850) Back ground and Objectives Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. Hence the tonsils and peritonsillar tissues are highly vascular zone that supplied by direct branches of external carotid artery thus the post-tonsillectomy bleeding remains one of significant issues in relation to this widely performed procedure. The post-tonsillectomy bleeding needs frequently to be postulated for its incidence, prevalence, etiology, predisposing factors, management and prevention. This subject constitutes one of most risky aspects that increase wariness of the surgeons regarding this commonly conducted procedure. Although there are huge numbers of presentative literatures coming from American as well as western institutes that tried to put guidelines for purpose of prevention and management of post-tonsillectomy bleeding but broadly at our middle-east region and locally at our Libyan society we found for some extent difficulties to apply all these guidelines. For this reason this issue has been take the wider spectrum of ENT surgeons’ concentration, discussions, and researches. Therefore this study was conducted prospectively and for long time to confirm the possible predisposing factors that could be responsible for increasing the risk of post-tonsillectomy bleeding at our region and in the same time to illustrate the concluded recommendations to prevent the occurrence of this important complication. Patients and Methods 2880 patients aged from 8 months to 85 years presented at ENT department-AL-hawari ENT and urology teaching center- Benghazi-city – Libya as well as AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city – Libya at period in between September 2003 to March 2015 as cases of chronic adeno-tonsillitis and solitary acute as well as chronic related palatine tonsillar disease with variable patterns of indications for tonsillectomy namely snoring and apnea attacks, recurrent attacks of acute tonsillitis, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, mal-occlusive dental deformity, unilateral enlarged tonsils, post-traumatic avulsed tonsils, history of quinsy abscess and persistent halitosis. All patients were assessed intra-operatively and post-operatively too for any evidences of primary, reactionary, or secondary hemorrhage in relation to wide spectrum of factors as patient's demographic, medical, and socio-habitual factors, in addition to technical as well as post-operative care factors. Results This presenting study confirmed that the most common type of post-tonsillectomy bleeding was the secondary variety (71%) as compared to primary (22%) and reactionary (7%) among all presented post-tonsillectomy bleeding cases. Although through this presenting serial study there were multifactorial pre-dispositions elucidated for secondary post-tonsillectomy hemorrhage but as general poor post-operative care can be considered as the cornerstone for the pathogenesis of this significantly raised incidence of secondary post-tonsillectomy bleeding this may be in form of inadequate patient's hydration and nutritional supply (47%), poor patient's antibiotic compliance (23%), and child's maternal negligence (19%). The time of surgery was found to be another important pre-disposing factor for post-tonsillectomy bleeding, it was postulated that the incidence of reactionary as well as secondary post-tonsillectomy hemorrhage significantly increased at summer and autumn seasons (69%) as compared to other seasons. The place of surgery was another interesting proposed studied factor among this serial presentation it was observed that the incidence of post-tonsillectomy bleeding among patients who operated at AL-hawari ENT and urology teaching center-Benghazi-city significantly higher (63%) than that among cases who interfered at AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city. Conclusion Generally speaking, post-tonsillectomy bleeding is considered as one of important issues in ENT and one of significant post-tonsillectomy complications which may create a critical morbidity that may rarely extend to post-operative mortality. Hence the most common pattern of post-tonsillectomy bleeding is the secondary type; however this type of post-tonsillectomy hemorrhage is pre-disposed and induced by many factors. Most of these factors are treatable and curable thus the prophylaxis against this significant complication can be achievable.
Jul 2021 DOI 10.14302/issn.2766-8681.jcsr-21-3885
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
Sepsis is a systemic inflammatory response to a confirmed or suspected infection. The transition from sepsis to septic shock causes high rate of mortality. The aim of this experiment was to evaluate the anti-inflammatory potential of the Biofield Energy Treated (Blessed) Proprietary Test Formulation and Biofield Energy Healing (Blessing) Treatment per se to Sprague Dawley rats on Cecal Slurry, LPS, and E. coli-induced systemic inflammatory response syndrome (SIRS) model. In this experiment, various proinflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-10, IL-12, 1L-17, and interferon-γ (IFN-γ) were analysed using ELISA. A test formulation was formulated including minerals (magnesium, zinc, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, vitamin E, cyanocobalamin, and cholecalciferol), Panax ginseng extract, β-carotene, and cannabidiol isolate. The constituents of the test formulation were divided into two parts; one section was defined as the untreated test formulation, while the other portion of the test formulation and three group of animals received Biofield Energy Healing Treatment remotely for about 3 minutes by a renowned Biofield Energy Healer Mr. Mahendra Kumar Trivedi. The level of TNF-α was significantly reduced by 40.50%, 85.36% (p≤0.01), 50.66% (p≤0.01), 87.38% (p≤0.01), and 58.63% (p≤0.01) in G5 (Cecal Slurry, LPS, and E. coli + Biofield Energy Treated test formulation), G6 (Cecal Slurry, LPS, and E. coli + Biofield Energy Treatment per se to animals from day -15), G7 (Cecal Slurry, LPS, and E. coli + Biofield Energy Treated test formulation from day -15), G8 (Cecal Slurry, LPS, and E. coli + Biofield Energy Treatment per se + Biofield Energy Treated test formulation from day -15), and G9 (Cecal Slurry, LPS, and E. coli + Biofield Energy Treatment per se animals + untreated test formulation) groups, respectively as compared to the disease control (G2) group. Additionally, the level of IL-1β was decreased by 17.04%, 15.56%, and 12.59% in G6, G8, and G9 groups, respectively as compared to the untreated test formulation (G4) group. The level of IL-6 was significantly (p≤0.001) reduced by 36.18%, 50.24%, 43.25%, 52.69%, and 38.23% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2 group. The level of IL-10 was altered by 70.53%, 49.25%, 60.18%, 41.54%, and 58.89% in G5, G6, G7, G8, and G9 groups, respectively as compared to the G2 group. Moreover, the level of IL-12 was decreased by 30.24%, 31.67%, 29.82%, 45.77%, and 50.54% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2. The level of IL-17 was reduced by 48.75%, 59.61%, 59.28%, 62.49%, and 58.65% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2. IFN-γ expression was reduced by 49.56%, 24.09%, 23.7%, 56.98%, and 44.94% in G5, G6, G7, G8, and G9 groups, respectively than G2. Overall, the data suggested anti-inflammatory potentials of the Biofield Energy Treated test formulation and Biofield Energy Treatment per se along with preventive measure on the animal with respect to various inflammatory conditions that might be beneficial various types of systemic inflammatory disorders specially sepsis, trauma, septic shock or any types of injuries. Therefore, the results showed the significant slowdown the inflammation-related disease progression and its complications in preventive treatment groups viz. G6, G7, G8, and G9.
Jul 2021 DOI 10.14302/issn.2329-9487.jhc-21-3848
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
Study was aimed to evaluate effect of Biofield Treated Proprietary Formulation and Biofield Treatment per se on cardiac performance on NG-nitro-L-arginine methyl ester hydrochloride (L-NAME) and high fat diet (HFD)-induced cardiovascular disorders in Sprague Dawley rats. Nine groups were assigned, in which four were preventive maintenance groups. The constituents of test formulation were divided into two parts; one section was defined as the untreated test formulation, while the other portion of the test formulation and three groups of animals received Biofield Energy Healing Treatment remotely for about 3 minutes by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. Systolic blood pressure (SBP) was significantly (p≤0.001) decreased by 13.39%, 14.65%, 17.74%, 14.36%, and 14.69% in the G5, G6, G7, G8, and G9 groups, respectively as compared to disease control (G2) group. Diastolic blood pressure (DBP)was significantly (p≤0.001) reduced by 25.95%, 24.41%, 30.79%, 24.67%, and 25.23% in G5, G6, G7, G8, and G9 groups, respectively than G2. Heart rate (HR) was significantly (p≤0.05) reduced by 6.58%, 8.06%, and 6.99% in G7, G8, and G9 groups, respectively than G2. Total leucocyte count (TLC) count was increased by 12.8% and 17.45% in G5 and G8 groups, respectively than G2 group. Neutrophils and lymphocytes were increased by 60.11% (G8) and 11.49% (G5), respectively than G2. Eosinophils were reduced by 11.11%, 20%, and 15% in G6, G7, and G9 groups, respectively than G2. Total cholesterol was significantly decreased by 22.64% (p≤0.05), 15.78%, 25.56% (p≤0.05), 22.56%, and 34.27% in G5, G6, G7, G8, and G9 groups, respectively than G2. Triglyceride was significantly (p≤0.001) reduced by 34.55%, 43.29%, 55.23%, 28.57%, and 37.28% in G5, G6, G7, G8, and G9 groups, respectively than G2. VLDL level was also significantly (p≤0.001) reduced by 80.81%, 83.61%, 86.82%, 79.19%, and 81.63% in G5, G6, G7, G8, and G9 group, respectively; while LDL was reduced by 20.32% (G9) group than G2. Atherogenic index (AI) was significantly (p≤0.001) decreased by 78.36%, 83.21%, 84.68%, 74.06%, and 72.98% in the G5, G6, G7, G8, and G9 groups, respectively than G2. The level of uric acid (UA) was significantly (p≤0.001) decreased by 57.51%, 52.36%, 45.49%, 43.78%, and 40.77% in the G5, G6, G7, G8, and G9 groups respectively, as compared with the G2 group. Serum glutamate pyruvate transaminases (SGPT) was significantly (p≤0.001) decreased by 45.96%, 48.01%, 37.19%, 37.69%, and 42.93% in the G5, G6, G7, G8, and G9 groups, respectively than G2. Creatine kinase myocardial band (CK-MB) level was significantly reduced by 10.19%, 21.97% (p≤0.01), 10.47%, and 16.94% in the G5, G6, G7, and G9 groups, than G2. Overall, the data suggested significance improvement of heart-related hematology, hepatic, and lipid parameters with respect to various pathological conditions that might be beneficial various types of cardiovascular disorders. Therefore, the results showed the significant slowdown the cardiovascular disease progression and its complications/symptoms in the preventive treatment groups viz. G6, G7, G8, and G9.
Jul 2021 DOI 10.14302/issn.2471-2140.jaa-21-3864
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
The aim of this experiment was to assess the antioxidative potential of the Biofield Energy Treated/Blessed Proprietary Test Formulation and Biofield Energy Treatment/Blessing per se to the animals on NG-nitro-L-arginine methyl ester hydrochloride (L-NAME) and high fat diet (HFD)-induced cardiovascular disorders in Sprague Dawley rats using various functional biomarkers. A test formulation was formulated including minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, vitamin B9, vitamin B12, and vitamin D3), cannabidiol (CBD) isolate, Panax ginseng extract, and β-carotene. The test formulation’s constituents were divided into two parts; one part was denoted as the untreated, while the other part and three group of animals received Biofield Energy Healing/Blessing Treatment remotely for about 3 minutes by a renowned spiritual leader, Mr. Mahendra Kumar Trivedi. The expression of superoxide dismutase (SOD) was elevated significantly by 198.46%, 208.73%, 191.73%, 211.75%, and 198.82% in the G5 (L-NAME + HFD + the Biofield Energy Treated test formulation), G6 (L-NAME + HFD + Biofield Energy Treatment per se to animals from day -15), G7 (L-NAME + HFD + the Biofield Energy Treated test formulation from day -15), G8 (L-NAME + HFD + Biofield Energy Treatment per se plus the Biofield Energy Treated test formulation from day -15), and G9 (L-NAME + HFD + Biofield Energy Treatment per se animals plus the untreated test formulation) groups, respectively than disease control group (G2). Moreover, the level of glutathione peroxidase (GPx) was significantly increased by 61.94%, 118.49%, 82.96%, 141.89%, and 262.02% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2 group. Lipid peroxidase (LPO) was decreased by 14.21%, 30.98%, 38.66%, and 32.67% in the G6, G7, G8, and G9 groups, respectively than G2 group. Additionally, the level of myeloperoxidase (MPO) was decreased by 28.46%, 10.87%, 12.41%, and 13.35% in the G6, G7, G8, and G9 groups, respectively than G2. Further, the level of oxidized low density lipoprotein (LDL) was reduced by 65.38%, 65.11%, 71.53%, 79.26%, and 66.57% in the G5, G6, G7, G8, and G9 groups, respectively than G2. Besides, in heart tissues, the level of catalase (CAT) was significantly increased by 68.20%, 63.69%, 126.03%, 124.54%, and 112.23% in G5, G6, G7, G8, and G9 groups, respectively than G2 group. Moreover, in kidney tissues, the level of CAT was significantly increased by 22.48%, 23.43%, and 10.95% in the G6, G7, and G9 groups, respectively than G2. Overall, the data suggested a significant antioxidant activity by increasing the levels of SOD, CAT, GPx, and reducing the levels of LPO, MPO, and oxidized-LDL in various tissue fluids and that might be beneficial for cardiovascular disorders. Therefore, the study outcomes showed the significant slowdown the oxidative stress-related cardiovascular disease progression and its complications in the preventive treatment groups viz. G6, G7, G8, and G9.
Jul 2021 DOI 10.14302/issn.2471-2140.jaa-21-3846
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
The aim of this experiment was to assess the antioxidative potential of the Biofield Energy Treated/Blessed Proprietary Test Formulation and Biofield Energy Treatment/Blessing per se to the animals on NG-nitro-L-arginine methyl ester hydrochloride (L-NAME) and high fat diet (HFD)-induced cardiovascular disorders in Sprague Dawley rats using various functional biomarkers. A test formulation was formulated including minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, vitamin B9, vitamin B12, and vitamin D3), cannabidiol (CBD) isolate, Panax ginseng extract, and β-carotene. The test formulation’s constituents were divided into two parts; one part was denoted as the untreated, while the other part and three group of animals received Biofield Energy Healing/Blessing Treatment remotely for about 3 minutes by a renowned spiritual leader, Mr. Mahendra Kumar Trivedi. The expression of superoxide dismutase (SOD) was elevated significantly by 198.46%, 208.73%, 191.73%, 211.75%, and 198.82% in the G5 (L-NAME + HFD + the Biofield Energy Treated test formulation), G6 (L-NAME + HFD + Biofield Energy Treatment per se to animals from day -15), G7 (L-NAME + HFD + the Biofield Energy Treated test formulation from day -15), G8 (L-NAME + HFD + Biofield Energy Treatment per se plus the Biofield Energy Treated test formulation from day -15), and G9 (L-NAME + HFD + Biofield Energy Treatment per se animals plus the untreated test formulation) groups, respectively than disease control group (G2). Moreover, the level of glutathione peroxidase (GPx) was significantly increased by 61.94%, 118.49%, 82.96%, 141.89%, and 262.02% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2 group. Lipid peroxidase (LPO) was decreased by 14.21%, 30.98%, 38.66%, and 32.67% in the G6, G7, G8, and G9 groups, respectively than G2 group. Additionally, the level of myeloperoxidase (MPO) was decreased by 28.46%, 10.87%, 12.41%, and 13.35% in the G6, G7, G8, and G9 groups, respectively than G2. Further, the level of oxidized low density lipoprotein (LDL) was reduced by 65.38%, 65.11%, 71.53%, 79.26%, and 66.57% in the G5, G6, G7, G8, and G9 groups, respectively than G2. Besides, in heart tissues, the level of catalase (CAT) was significantly increased by 68.20%, 63.69%, 126.03%, 124.54%, and 112.23% in G5, G6, G7, G8, and G9 groups, respectively than G2 group. Moreover, in kidney tissues, the level of CAT was significantly increased by 22.48%, 23.43%, and 10.95% in the G6, G7, and G9 groups, respectively than G2. Overall, the data suggested a significant antioxidant activity by increasing the levels of SOD, CAT, GPx, and reducing the levels of LPO, MPO, and oxidized-LDL in various tissue fluids and that might be beneficial for cardiovascular disorders. Therefore, the study outcomes showed the significant slowdown the oxidative stress-related cardiovascular disease progression and its complications in the preventive treatment groups viz. G6, G7, G8, and G9.
Jul 2021 DOI 10.14302/issn.2576-6694.jbbs-21-3819
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
The present study aimed to evaluate the effect of the Trivedi Effect®- Biofield Energy Treated/Blessed Test formulation/item (TI) composed of minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (ascorbic acid, pyridoxine HCl, alpha tocopherol, cyanocobalamin, and cholecalciferol), Panax ginseng extract, CBD isolates, and β-carotene on elasticity of skin, heart, muscle, and neuronal cells in the H9C2 (rat cardiomyocytes), C2C12 (mouse myoblast cells), HaCaT (human keratinocytes), and SH-SY5Y (human neuroblastoma cells) cell line in DMEM medium. The test formulation constituents were divided into two parts; one section was defined as untreated test formulation (UT), while the other portion of test formulation received Biofield Energy Healing/Blessing Treatment (BT) by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. The test items were treated with Biofield Energy Healing/Blessing Treatment and divided as Biofield Energy Treated/Blessed (BT) and untreated (UT) test items. MTT data showed that the test formulation in various concentrations was found as safe and nontoxic in the tested concentrations with viability range from 73% to 307%. Young’s modulus (YM) is a measure of cell stiffness, a decrease in YM value indicates increase elasticity of the cells and vice-versa. YM in H9C2 cells were decreased by 9.6% and 66.1% in the BT-DMEM + UT-TI group at 0.1 and 1 µg/mL respectively, as compared with untreated test group. However, C2C21 cells showed increased YM by 443.9% at 1 µg/mL in the UT-DMEM + BT-TI group, while 869.6% increased YM in the BT-DMEM + UT-TI group at 1 µg/mL as compared with untreated test group. However, 314% increased YM was reported in the BT-DMEM + BT-TI group at 1 µg/mL as compared with the untreated test group. However, the value of YM was significantly decreased in the HaCaT cell line by 247.7% (at 1 µg/mL), 225.8% (at 0.1 µg/mL), and 97.9% (at 1 µg/mL) in the UT-DMEM + BT-TI, BT-DMEM + UT-TI, and BT-DMEM + BT-TI group respectively, as compared with the untreated group. In addition, YM was significantly decreased in the SH-SY5Y cell line by 92.6%, 18.1%, and 26.6% at 1 µg/mL in the UT-DMEM + BT-TI, BT-DMEM + UT-TI, and BT-DMEM + BT-TI group respectively, as compared with the untreated group. Overall, the results showed the significant decreased YM among the SH-SY5Y, HaCaT, and H9C2 cells, while it was increased in the C2C21 cell line. Thus, the mechanical properties of cells such as cellular function, including shape, motility, differentiation, division, and adhesion to its surrounding extracellular matrix were improved. Overall, it can be useful in many disease progressions with improved cellular elasticity and its associated complications/symptoms.
Jun 2021
Akonu Adom Mensah Forson KwesiCorresponding author
University of Cape Coast, Ghana
The purpose of this study was to investigate the effects of extracts of Tridax procumbens leaves a traditional medicinal plant, on α-amylase activities in vitro. The air-dried aerial parts of Tridax procumbens leaves were extracted with Petroleum ether and Ethanol. The results of both enzyme inhibition activities were found in a dose-dependent manner. The strongest activity of α-amylase inhibition was found in Petroleum ether extract (IC50 = 10.436 mg/mL) followed by ethanol extract (IC50 = 12.65 mg/mL) compared with acarbose having an IC50 value of 0.044 mg/mL. All extracts from this plant possess potent α-amylase activity inhibition which may offer a better therapeutic strategy to minimize postprandial hyperglycemia and its complications.
Jun 2021 DOI 10.14302/issn.2574-4488.jna-21-3847
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
The aim of this study was to evaluate the impact of Biofield Energy Treated/Blessed Proprietary Test Formulation and Biofield Energy Treatment/Blessing per se on kidney biomarkers on L-NAME and high fat diet (HFD)-induced cardiovascular disorders in Sprague Dawley rats. In this experiment, the functional kidney biomarkers such as epinephrine/adrenaline, inducible nitric oxide synthase (iNOS), angiotensin-II, C-reactive protein (CRP), and renin were measured using ELISA assay. A test formulation was formulated including minerals (magnesium, zinc, copper, calcium, selenium, and iron), vitamins (vitamin C, vitamin B6, vitamin B12, vitamin B9, and vitamin D3), cannabidiol (CBD) isolate, Panax ginseng extract, and β-carotene. The components of the test item were divided into two; one section was defined as the untreated test formulation, while the other part and three group of animals received Mr. Mahendra Kumar Trivedi’s Biofield Energy healing/Blessing remotely for about 3 minutes. The results showed that the level of adrenaline was reduced by 31.62%, 19.58%, 34.32%, 37.07%, and 29.87% in the G5 (L-NAME + HFD + the Biofield Energy Treated test formulation), G6 (L-NAME + HFD + Biofield Energy Treatment per se to animals from day -15), G7 (L-NAME + HFD + the Biofield Energy Treated test formulation from day-15), and G8 (L-NAME + HFD + Biofield Energy Treatment per se plus the Biofield Energy Treated test formulation from day-15), and G9 (L-NAME + HFD + Biofield Energy Treatment per se animals plus the untreated test formulation) groups, respectively as compared to the disease control group (G2). Moreover, the level of iNOS was reduced by 56.76%, 49.51%, 61.79%, 57.63%, and 62.44% in the G5, G6, G7, G8, and G9 groups, respectively, as compared to the disease control group (G2). Additionally, the level of angiotensin-II was decreased by 41.09%, 34.92%, 60.65%, 53.28%, and 60.09% in the G5, G6, G7, G8, and G9 groups, respectively, as compared to the G2 group. The level of CRP was decreased by 47.21%, 38.89%, 59.81%, 55.52%, and 64.02% in the G5, G6, G7, G8, and G9 groups, respectively as compared to the G2 group. Besides, the level of renin was decreased by 20.27%, 20.13%, 12.99%, and 25.73% in the G5, G7, G8, and G9 groups, respectively as compared to the G2 group. Overall, the data suggested significance improvement of vital functional kidney biomarkers of the Biofield Energy Treated/Blessed test formulation and Biofield Energy Treatment per se along with preventive measure on the animal with respect to various pathological conditions that might be beneficial various types of cardiovascular disorders. Therefore, the results showed the significant slowdown the inflammation-related cardiovascular disease progression and its complications/symptoms in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated/Blessed Test formulation groups (viz. G6, G7, G8, and G9).
May 2021 DOI 10.14302/issn.2470-5020.jnrt-21-3843
R. Plasencia AndrésCorresponding author
Department of Neurointerventional Radiology at Clínica Internacional de San Borja, Lima, Peru
Background Perimedullary arteriovenous fistulae, or type IV spinal cord arteriovenous malformations, are very rare and not well-known lesions. This paper aims to present our endovascular experience with these lesions. Methods We report our experience with 4 patients with perimedullary arteriovenous fistulae, subtypes b and c (macrofistulae), exhibiting severe neurological impairment. The patients were treated with endovascular embolization. Results Complete fistula eradication was achieved in all of them. One complication occurred. We discuss the natural history, pathophysiology, clinical presentation, prognosis and embolization techniques, along with the angiographic and clinical outcomes. Conclusion Our experience with endovascular embolization as an upfront treatment allowed us to eradicate these lesions in a safe and effective way, arresting the clinical worsening and reversing partially or completely the neurological injury in most of our cases.
May 2021 DOI 10.14302/issn.2766-8681.jcsr-21-3783
Yilmaz MuratCorresponding author
Department of Neurosurgery, Dokuz Eylul University Medical Faculty, Izmir, Turkey
Background Klippel-Feil Syndrome (KFS) is described as the clinical triad of short neck, low posterior hairline, and limitation of neck mobility. Objective Topresent our clinical experience with KFS patients who also had adjacent segment disease (ASD) and to propose a novel classification system for these patients. Methods This retrospective study was performed in the neurosurgery department of our tertiary care center. Data were gathered using the medical records of 22 KFS patients (10 males, 12 females) with ASD. Diagnosis was confirmed with imaging modalities including X-ray, computerized tomography, and magnetic resonance imaging. Clinical and radiological findings as well as therapeutic outcomes were noted. Results The average age of our series was 56.09 (range: 41 to 67) years. The operative technique was selected as for our novel “Yilmaz-Yucesoy Classification System”. Accordingly, one patient (4.54 %) received non-surgical treatment (Yilmaz-Yucesoy Grade 1), six cases (27.27 %) underwent anterior cervical arthroplasty, seven patients (31.81 %) underwent anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 3). Eight patients (36.36 %) with cervical spinal instability had anterior cervical discectomy or corpectomy and fusion with cervical cage and plate (Yilmaz-Yucesoy Grade 4). No mortality or remarkable complications were detected. Conclusion Appropriate and timely recognition and classification of patients with KFS and ASD based on our newly proposed “Yilmaz-Yucesoy Classification System” yielded promising treatment outcomes. However, further prospective, randomized, controlled trials are warranted on larger series to validate our preliminary results.
Mar 2021 DOI 10.14302/issn.2470-5020.jnrt-21-3755
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
A novel proprietary test formulation was designed which included minerals, vitamins, β-carotene, cannabidiol isolate,and Panax ginseng extract. This present study was evaluated the impact of the Trivedi Effect® on novel proprietary test formulation in male Sprague Dawley rats, fed with vitamin D3 deficiency diet (VDD). The novel test formulation was divided into two parts; one part was defined as untreated test formulation, while the other part was defined as the Biofield Energy Treated sample, which received the Biofield Energy Healing Treatment by renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. The level of 25-OH Vit. D3 was measured in brain homogenate, which was found to be increased by 20.13%, 24.12%, 45.86%, 14.79%, and 29.96% in the G5 group treated with Biofield Treated test formulation, Biofield Energy Treatment per se to the animals (G6), 15 days pre-treatment of Biofield Energy Treated test formulation (G7), Biofield Energy Treatment per se plus Biofield Energy Treated test formulation from day -15 (G8), and untreated test formulation to the Biofield Energy Treated animals (G9) groups respectively, as compared with the disease control (G2) group. Brain acetylcholine (ACh) level was increased by 61.33% in the G7 group as compared with the untreated test formulation (G4) group. The expression of interleukin-6 (IL-6) was significantly reduced by 43.44% (p≤0.01), 30.93%, 21.42%, 45.99% (p≤0.01), and 60.85% (p≤0.01), respectively as compared with the G4. Lung pro-inflammatory cytokine tumor necrosis factor alpha (TNF-α) level was significantly reduced in the G5, G6, G7, and G8 by 24.86%, 32.55% (p≤0.01), 30.12% (p≤0.01), and 42.69% (p≤0.01), respectively, as compared with the G4 group. Altogether, the Biofield Treated test formulation and/or per se treatment to the animals significantly improved the levels of active form of vitamin D3 metabolite (25-OH Vit D3) and neurotransmitter (ACh); consequently significantly lowered the expression of proinflammatory cytokines (IL-6 and TNF-α). Therefore, the energized test formulation or per se treatment could be effectively useful against neuronal damage and inflammation for the management of brain disorders such as Alzheimer’s disease, dementias, brain cancer, epilepsy and other seizure disorders, mental disorders, and Parkinson’s. Thus, the results showed a significant slowdown of disease progression and all other disease-related complications/symptoms in the preventive Biofield Energy Treatment group per se and the Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) as compared to the disease control group.
Feb 2021 DOI 10.14302/issn.2641-4538.jphi-20-3683
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
Women in Rwanda are still suffering from overweight and obesity and health-related complications. However, little is known about overweight/obesity prevention knowledge and factors associated with overweight/obesity prevention among women. The aim of this study was to determine knowledge and factors associated with overweight and obesity prevention among women attending Kibagabaga Hospital in Rwanda. A quantitative descriptive cross-sectional design was conducted among women aged 20-45 years that was selected randomly. A structured questionnaire was used to collect data from 384 women seeking health care at the hospital during the study period. SPSS version 21 was used for data analysis; descriptive statistics was used to assess women’s knowledge related to overweight/obesity. Logistic regression was used to determine the factors associated with overweight/obesity prevention, the level of significance was set at 5%. Approval to conduct the study was obtained from the University and Hospital. The majority 35.4% of study participants were aged between 30-34 years. Women who live in urban area dominate the study (76.3%), the majority of study participants were married (60.9%). The study revealed that the 22% and 62% of women had higher level and moderate knowledge respectively. In terms of overweight/obesity prevention practices, we found that 67% mothers had adequate practices towards overweight and obesity prevention. The age of 35-39, and unemployment were found to be significantly associated with overweight/obesity prevention practices. Cost-effective health education focusing on women, physical activity and social support to reduce the socio-cultural constraints that promote overweight/obesity are necessary to combat this epidemic.
Feb 2021 DOI 10.14302/issn.2766-8630.jrnm-21-3713
BR JoshiCorresponding author
Department of Radiology and Imaging, TU Teaching Hospital, Maharajgunj, Kathmandu
Introduction Multislice computed tomography examinations performed 3 to 4 days after the onset of symptoms is the imaging procedure of choice in acute pancreatitis, which is mainly done for evaluating the complications. Due to radiation exposure and cost, alternative scoring systems like Ranson’s score and Glasgow’s score were devised but were cumbersome. The serum amylase and lipase were found to increase with progression of disease. The objective of this study was to evaluate the association of acute pancreatitis by modified CT scoring system with the serum levels of amylase and lipase. Material and Methods In hundred patients presenting with acute pancreatitis, the severity of pancreatitis was recorded using the modified CT severity index. The serum amylase and lipase levels were recorded and correlated with modified CT severity index score. Results Among 100 patients studied, 46%, 40% and 14% had mild, moderate and severe grades of pancreatitis respectively by modified CTSI score. No significant correlation was found between the levels of serum amylase (r = -0.104, p = 0.301) and lipase (r = -0.177, p = 0.079) with the modified CT severity index in patients with acute pancreatitis. Conclusion The serum level of amylase and lipase had non-significant correlation with the modified CT severity index score and thus did not indicate severity of pancreatitis.
Jan 2021 DOI 10.14302/issn.2692-1537.ijcv-20-3685
Elkhenany HodaCorresponding author
Department of Surgery, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt.
The current uncontrollable outbreak of novel coronavirus (COVID-19) has unleashed severe global consequences in all aspects of life and society, bringing the whole world to a complete halt and has modeled significant threats to the global economy. The COVID-19 infection manifests with flu-like symptoms such as cough, cold, and fever resulting in acute respiratory distress syndrome (ARDS), lung dysfunction, and other systemic complications in critical patients are creating panic across the globe. However, the licensed vaccine has started to show up; some resulted in side effects that would limit its possibility in some circumstances as allergic personnel, for example. Moreover, the production and approval of new drugs is a very complicated process and takes a long time. On the other hand, stem cells have gone the extra mile and intensively investigated at preclinical and clinical studies in various degenerative diseases, including infectious ones. Stem cells are proposed as a broad-spectrum therapeutic agent, which may suppress the exaggerated immune response and promote endogenous repair by enhancing COVID-19 infected lung microenvironment. Also, stem cells have different application manners, either direct transplantation, exosome transplantation, or drug delivery of specific cytokines or nanoparticles with antiviral property by engineering stem cells. This review discusses and summarizes the possible emerging role of cell-based therapy, especially stem cell therapy, as an alternative promising therapeutic option for the treatment and control of novel COVID-19 and its potential role in tissue rejuvenation after COVID-19 infection.
Jan 2021 DOI 10.14302/issn.2474-7785.jarh-21-3702
Marks RayCorresponding author
Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
Background Older adults with hip joint osteoarthritis, a major cause of chronic progressively disabling highly painful functional experiences, may require a surgical joint replacement procedure known as total joint arthroplasty surgery. Objective This review aimed to address the question of whether there an association between hip joint arthroplasty infection rates and prevailing pre or preoperative vitamin D levels that warrants consideration in efforts to prevent or minimize infection related hip arthroplasty complications among older adults particularly during the current ongoing COVID-19 pandemic. Methods PUBMED, SCOPUS, and WEB OF SCIENCE articles related to the topic and published between January 2016-2021 were searched, examined, and summarized. Results Older adults with hip joint osteoarthritis and low vitamin D serum levels who undergo total hip joint arthroplasty surgery may be at higher risk for post-operative infections than those with adequate vitamin D serum levels. Conclusion More research to verify whether efforts to screen for, and maximize vitamin D levels, before and after surgery, as indicated, may be helpful in the context of minimizing total hip joint arthroplasty surgery infection susceptibility and severity among older vitamin D deficient severely disabled hip osteoarthritis cases.
Sep 2020 DOI 10.14302/issn.2693-1176.ijgh-20-3545
Ezinna E EnwerejiCorresponding author
Department of Public Health, College of Medicine, Abia State University, Uturu, Nigeria
Public health professionals working in rural communities are aware of the health disparities which result from lack of physicians, limited services, and income during the pandemic. Also they are aware that some populations are more vulnerable than others. People in the rural areas are experiencing problems on their physical, social and economic life styles because the pandemic is exacerbating some inequities. Individuals especially women and children in the rural areas are facing barriers in accessing health care services due to lack of resources and availability of health care providers in the communities. With COVID-19, women are less likely to seek services, including sexual and reproductive health services. Such services may be postponed to limit exposure to COVID-19 infection. This is particularly disturbing because in addition to the women maintaining their own health, they are also responsible for taking care of the mental, emotional and physical health needs of their families as well as all domestic responsibilities. As such, women in rural settings face special challenges as a result of these significant roles they play. Therefore, the impacts of COVID-19 are exacerbated on women by virtue of their sex and the roles they play in the family. This is a qualitative study that reviewed the reports of the 36 health care professionals under the aegis of members of COVID-19 committee working in partnership with state government to control, prevent and cushion the effects of COVID-19 in the society. This study is therefore, a summary of the observations of the COVID-19 committee members made up of 10(27.8%) females and 26(72.2%) males. The study focused on exploring how individual lifestyles in the rural areas have been affected in the face of COVID- 19 pandemic by identifying the vulnerabilities in social, political and economic systems which can amplify the impacts of the pandemic. Findings showed that preventive measures like lockdown and social distancing rules, wearing of face mask, hand washing with soap, and environmental cleanliness were not observed. The study noted that health seeking behaviours, sexual and marital life including income, education, employment and social interactions were all negatively affected. Most hospitals were battered and health care professionals boycotted the hospitals for fear of being infected. It was found that lack of health workers in the hospitals caused a good number of individuals to engage in self-medications. Also most pregnant women delivered their babies at home and few with traditional birth attendants. Some of the women who had deliveries at home experienced complications during and after delivery. Unfortunately, the report showed that governments’ financial supports to these women and their family members were insignificant as the government was more concerned with mitigating the spread of COVID-19 than assisting women to have safe deliveries. Therefore, the vulnerable groups especially women, children, and the elderly who experienced threats to their safety and wellbeing as a result of the services that were disrupted during the pandemic, should be assisted so as not to lose their lives to preventable diseases.
Aug 2020 DOI 10.14302/issn.2641-7669.ject-20-3529
Wen XianjieCorresponding author
Department of Anesthesiology, the Second People`s Hospital of Foshan City, Foshan, Guangdong Province, China.
Background Local anesthetic neurotoxicity is a common complication in clinical anesthesia, which can cause permanent nerve damage in severe cases. The T-type calcium channel is an important channel for regulating the excitability of neurons. Normally, extracellular calcium ions enter the cell through the T-type calcium channel to change the excitability of neurons. When the intracellular calcium is overloaded, it can cause cell damage. Aims To investigated the roles of T-type calcium channel in the SH-SY5Y cells injury induced by the bupivacaine. Methods The SH-SY5Y cell culture model was used to observe the effect of T-type calcium channel blocker NNC55-0396 on the neurotoxicity of bupivacaine hydrochloride by MTT methold,flow cytometry, Western blotting and other methods. Results The results show that NNC55-0396 can block the T-type calcium channel of SH-SY5Y cells, improve the decrease of cell viability caused by bupivacaine hydrochloride, reduce the level of intracellular calcium ion, reduce the expression of Cleavedcaspase-3, and reduce cell apoptosis. Conclusion The above results indicate that the T-type calcium channel is involved in the SH-SY5Y cell damage caused by bupivacaine hydrochloride, and blocking the T-type calcium channel can reduce the neurotoxicity of bupivacaine hydrochloride.
Aug 2020 DOI 10.14302/issn.2694-2275.jzr-20-3435
Radwan EHCorresponding author
Damanhour University, Faculty of Science, Zoology department, Egypt
Background Nephrotoxicity is a complication due to the effect of some toxic chemicals on kidney. Current study planned to screen the effect of Trigonella foenumaqueous seeds extracts on EDTA induced nephrotoxicity. Trigonella foenum known for its various medicinal properties is also a natural antioxidant and a free radical scavenger with no documented evidence as a nephron-protective agent. Objective To investigate the protective effects of aqueous seed extracts of Trigonella foenum. Material and Methods The present study was used 40 male albino rats (Rattus albinus) with weight of (150 ± 10) g with divided into four groups: control gp; EDTA gp (95 mg/kg); Trigonella foenum gp (500 mg/kg) and EDTA + Trigonella f oenum gp by gastric tube daily for 4 weeks. Blood urea, creatinine, GFR, creatinine clearance, MDA and GPx analyses and microscopic examination of kidney were performed. Results In the present study, Blood samples were taken from all groups and concentration of serum urea, creatinine, GFR, Creatinine clearance, MDA and GPx were determined. Histopathological observations were observed in kidney tissue. Data were analyzed using analysis of variance (ANOVA). EDTA induced an increase in urea and creatinine as well as there was a decrease in the concentration of GFR and creatinine clearance. The level of MDA was increase while the concentration of GPx was decrease in the serum of EDTA group. The aqueous extracts of Trigonella seeds significantly prevented renal damage by normalizing increased levels of renal markers. The correction of oxidative stress biomarkers was consistent with amelioration of the histopathological changes induced by EDTA. Hence, it is suggested that ameliorative effect of aqueous extract of Trigonella foenumagainst EDTA induced nephrotoxicity. Conclusion The present data suggest that aqueous extract of Trigonella foenum exhibits reno-protective effect in EDTA induced renal damage.
Aug 2020 DOI 10.14302/issn.2474-7785.jarh-20-3425
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
The study was aimed to investigate the potential benefits of the Consciousness Energy Healing Treatment (the Trivedi Effect®) per se and Biofield Energy Healing treated novel test formulation in male Sprague Dawley rats for their antiaging activity by monitoring aging biomarkers such as brain-derived neurotrophic factor (BDNF), silent information regulator-1 (SIRT-1), and klotho protein. The test formulation was distributed into two parts. First part did not provide any Biofield Energy Treatment was denoted as the untreated sample, however the second part was received Biofield Energy Healing Treatment by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi and defined as the Biofield Energy Treated sample. In this experiment, nine groups (n=10) were assigned, in which four were preventive maintenance groups. Among them, three groups of animals were also received Biofield Energy Healing Treatment per se (at day -15). BDNF was significantly increased by 25.83%, 19.35%, and 14.67% in the Biofield Energy Treated test formulation (G5), Biofield Energy Treatment per se at day -15 (G6), and Biofield Energy Treatment per se to animals plus Biofield Treated test formulation from day -15 (G8), respectively as compared to the disease control (G2) group. Moreover, expression of SIRT-1 protein was increased by 14.63% in the G5 group than the untreated test formulation (G4) group. Additionally, SIRT-1 activity was increased by 39.7%, 32.5%, 15.9%, and 136% in the G6, Biofield Energy Treated test formulation at day -15 (G7), G8, and Biofield Treatment per se (day -15) to animals plus untreated test formulation (G9) groups, respectively than the G4 group, while it was increased by 57.3% in the G9 group as compared to the G2 group. Besides, Klotho protein in kidney homogenate was significantly increased by 16.67% in the G5 group as compared to the G2 group. Altogether, the results showed a significant improvement of longevity mediators and antiaging biomarkers in the preventive maintenance groups. Therefore, results envisaged the significant slowdown of aging-related disorders and other complications in the preventive Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease control group and could be utilized against various aging-related disorders like Alzheimer's disease, hypertension, osteoporosis, cataracts, type 2 diabetes, cancer, etc. along with it could be used to extend the life-span, stress and immune-related disorders.
Jul 2020 DOI 10.14302/issn.2379-7835.ijn-20-3488
Boukerrouche AbdelkaderCorresponding author
Department of Digestive Surgery, Hospital of Beni-Messous, University of Algiers, Algiers, Algeria.
Esophagectony remains a high-risk surgical procedure. Esophageal cancer is often associated with a weight loss. The best nutritional condition is crucial for successful oesophageal surgery. The increased septic complications and costs have limited the wide use of total parenteral nutrition. Currently, enteral nutrition is the preferred nutrition method following esophagectomy. However; jejunostomy-tube was associated with rare major complications that may lead to discontinuing nutrition. Choosing an enteral feeding route after esophagectomy depends greatly on the surgeon preference. The safety and benefits of early oral feeding on outcomes after major gastrointestinal surgery have been well documented. However, the surgical community is still reticent about initiating early oral feeding after esophageal surgery. Despite the limited number of published reports, comparative trials have clearly shown the feasibility, safety with no increase in morbidity rate.In this brief review, we tried to discuss the different routes of nutritional support after oesophagectomy with providing the current insights on early oral feeding.
Jun 2020 DOI 10.14302/issn.2474-3585.jpmc-20-3416
Sarper Erikci VolkanCorresponding author
Sağlık Bilimleri University, Department of Pediatric Surgery, Tepecik Training Hospital, Izmir, Turkey
Plastic bronchitis (PB) is a rare disease characterized by the presence of mucofibrinous plugs which may occlude and conform the shape of tracheobronchial tree. These casts are exteremely cohesive. Most common presenting symptoms include cough, fever and dyspnea and if the cohesive casts occlude the airway totally life-threatening complications and even death may occur. The aim of treatment is to remove the casts and adress the symptoms. In this study a 6-year-old boy with PB is presented. In addition to medical treatment obstructing casts were removed via rigid bronchoscope. It is aimed to review the clinical and radiographic features and choices of treatment in this disease.
May 2020 DOI 10.14302/issn.2575-7881.jdrr-20-3343
Hussen Abdelrhman AmgedCorresponding author
Assis Professor, Department of Hematology and Immunohematology, Omdurman Islamic university / Sudan
Background Anemia of chronic disease is anemia found in certain chronic disease states, is typically marked by the disturbance of iron homeostasis or hypoferremia. Chronic renal failure is currently known as Chronic Kidney Disease (CKD) or Chronic Renal Insufficiency (CRI) implies long-standing, progressive and irreversible renal parenchyma disease resulting in diminished renal function up to 40 to 60%. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. This disease may also be identified when it leads to one of its recognized complications such as cardiovascular disease, anemia, or pericarditis. Methods Sysmex kx21 used to CBC and the Cobase411 used to iron profile. Enzyme-Linked immunoassay (ELISA) was used to determine the level of serum hepcidin. Sample preparation and PCR detection of HAMP DNA Polymorphisms: Restriction digestion of PCR products was done using Fast Digest. (Figure 1). Results Serum hepcidin levels higher in patients with anemia of chronic kidney disease compared with healthy controls mean. The polymorphisms of the hepcidin gene promoter in Sudanese patients with ACKD showed that the hepcidin HAMP AA genotype 70, AG 23, and GG 7 in 100 patients dialysis-dependent and AA 83, AG 17 and GG 0, and the allele A are more frequent in patients affected by ACKD. Significant statistical association observed between the hepcidin level and end-stage kidney disease. Conclusion This study evaluates for the first time the association between anemia of chronic kidney disease and hepcidin genes promoter polymorphisms and show that the hepcidin HAMP AA genotype and the allele A are more frequent in patients affected by ACKD, further investigation is needed, our data support the hypothesis and hepcidin HAMP are important in the pathophysiology of ACKD.
Apr 2020 DOI 10.14302/issn.2693-1176.ijgh-20-3269
Nasim Habibzadeh SeyedehCorresponding author
PhD student in Sport Science, School of Health and Life Sine, Department of Sport Science, Teesside University, United Kingdom
Abdominal obesitywith a big belly is one of the worse type of morbid obesity that is associated with different health failure outcomes. Central obesity leads to an increased risk of health complications such as metabolic syndrome, hypertension, insulin resistance,type 2 diabetes, heart disease and various cancers. Abdominal obesity also can specifically cause to spinal nerve pain and backache. Depression and disability are other subsequent hazards of central fatness. More importantly ,excessive central body fat ultimately contributes in all-causes of early mortality. In regards to this, individuals with abdominal obesity is urgently needed to reduce central obesity using behavior modifications. Changes in diet and performing some exercise in everyday living are essential steps.
Apr 2020 DOI 10.14302/issn.2641-4538.jphi-20-3296
Rezapour BarataliCorresponding author
Department of Public Health, Faculty of Health, Assistant Professor, PhD in Health education and promotion, Urmia University of Medical Sciences, Urmia, Iran
Preventable factors such as infectious diseases (pneumonia, diarrhea, and malaria), malnutrition and neonatal complications are still the leading cause of child mortality worldwide 1 In 2013, it is estimated that 6.3 million babies born worldwide died before the age of 5, and approximately 9.2% of these deaths were due to diarrheal diseases 23 in simple, accessible ways, and effective treatment can reduce diarrhea-related mortality and make hospital admissions unnecessary, and the role of mothers is the most important 4. Since the presentation of Oral Rehydration Therapy (ORT) in 1979, mortality has reduced. Diarrhea has had a steady downward trend 5. If mothers who have children under 5 years of age, used correctly ORS, they could easily resolve the problem of dehydration in acute diarrhea 6. Mothers didn’t use correctly ORS because of their Low literacy and lack of knowledge and wrong attitude about ORT7. Some health care workers provide mothers’ required equipments, regardless of their educational needs, and mothers may not use ORS. In this study, health workers identified mothers' educational needs and subsequently they trained them about using ORS at home in acute diarrhea in children under 5 years of age.
Feb 2020 DOI 10.14302/issn.2329-9487.jhc-21-3743
Elqatni M.Corresponding author
Département de Médecine Interne, Hôpital Militaire d'Instruction Med-V, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V- Rabat- Maroc.
A case report of a common iliac artery aneurysm revealing underlying Behçet’s disease. It reviews diagnostic clues, vascular complications, and multidisciplinary management.
Jan 2020 DOI 10.14302/issn.2474-9273.jbtm-19-3157
Jana SnehasisCorresponding author
Trivedi Science Research Laboratory Pvt. Ltd., Thane (W), Maharashtra, India.
Sleep biomarkers in brain such as melatonin, BDNF (Brain-derived neurotrophic factor), PGD2 (Prostaglandin D2), leptin, orexin-A, and acetylcholine were evaluated in the unpredictable chronic stress (UCS) rodent model in the presence of Consciousness Energy Healing Treated (the Trivedi Effect®) novel test formulation in male Sprague Dawley (SD) rats using ELISA assay. The test formulation was consisted of minerals (Zn, Fe, Cu, Se, Ca, Mg), vitamins (C, E, B6, B12, D3), β-carotene, ginseng, and cannabidiol isolate. The test formulation constituents were divided into two parts, one part of each ingredient was distinct as the untreated test formulation, while the other portion of the test formulation and a group of animals received Biofield Energy Healing Treatment by a renowned Biofield Energy Healer, Mr. Mahendra Kumar Trivedi. The level of melatonin in groups viz. G5 (Biofield Energy Treated Test formulation) and G7 (15-days pre-treatment of Biofield Energy Treated Test formulation) was significantly increased by 17.6% (p≤0.01) and 16%, respectively as compared with the disease control group (G2). Brain-derived neurotrophic factor (BDNF) level in brain was increased by 5.2% in G7 group as compared with the G4. Prostaglandins D2 (PGD2) level was significantly (p≤0.001) increased by 12.7%, 18.1%, 23.7%, and 30.7% in the G6, G7, G8 (15 days pre-treatment of Biofield Energy Treated Test formulation to the Biofield Energy Treatment per se rats), and G9 (untreated test formulation to the Biofield Energy Treatment per se to the rats) groups, respectively as compared with the G2. The level of leptin after Biofield Energy Treatment and with the test formulation was altered. However, orexin-A level was significantly decreased by 37.1% (p≤0.05), 32.6%, 40.5% (p≤0.05), 44.4% (p≤0.05), and 28.2% in the G5, G6, G7, G8, and G9 groups respectively, as compared with the G2. Similarly, acetylcholine (Ach) level was significantly (p≤0.001) decreased by 42.5%, 49.2%, 40.1%, 47.9%, and 45% in the G5, G6, G7, G8, and G9 groups, respectively as compared with the G2. Overall, the results showed the significant slowdown the stress-related disease progression and its complications/symptoms in the preventive in the Biofield Energy Treatment group per se and/or Biofield Energy Treated Test formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease group. The Trivedi Effect® showed increased level of melatonin and decreased levels of insomnia related brain biomarkers which might be helpful to induce better sleep in human.
Dec 2019 DOI 10.14302/issn.2641-5518.jcci-19-3133
Sanikidze TamarCorresponding author
Tbilisi State Medical University, Tbilisi, Georgia
To demonstrate that percutaneous coronary intervention (PCI) may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of multivessel coronary artery disease including left main coronary artery (LMCA) quadrifurcation. Methods For safety reasons, PCI was done in 2 separate sessions (staged PCI). Stenting of the LMCA quadrifurcation was performed using different stenting techniques in combination: modified balloon mini crush stenting technique was used - for LMCA and intermediate artery (IMA) stenting; modified balloon crush stenting technique was used for LMCA, circumflex artery (CX) and first obtuse marginal branch (OM1) stenting; provisional stenting technique was used for CX stenting, followed by sequential kissing balloon post-dilatation technique between LMCA and every branch; proximal optimization technique (POT) was performed in the LMCA. Left anterior descending artery (LAD), intermediate artery, circumflex artery, first obtuse marginal branch, left main coronary artery and its quadrifurcation were stented with 5 drug-eluting stents (DES) (Resolute Integrity, Medtronic); right coronary artery (RCA) was stented with 3 bare-metal stents (BMS) (Rebel, Boston Scientific). Results The interventions ended without complications, the ejection fraction increased from 35% to 48%, congestive heart failure functional class decreased to class I. Subsequent coronary angiography, eight months after the last PCI, revealed patent stents with mild, nonsignificant restenosis. More than three years after the intervention, the patient has no complaints (according to MACE). Conclusions It should be considered that in case of the selection of suitable patients and the use of the appropriate revascularization technique, LMCA quadrifurcation lesion can be successfully treated with PCI.
Oct 2019 DOI 10.14302/issn.2641-5518.jcci-19-3039
Sanikidze TamarCorresponding author
Tbilisi State Medical University, Tbilisi, Georgia
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.
Jun 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2750
Konadu-Yeboah DominicCorresponding author
Orthopaedic and Trauma Surgeon, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Part-Time Lecturer, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Purpose Foot injuries are common in low- and middle-income countries and continue to increase in incidence due to the surge in the use of motorcycles as means of transport.Yet, there is scanty data on the incidence and outcomes of treatment of open injuries to the foot in the developing world.We aimed to determine the incidence and functional outcomes of open foot injuries that are treated in a teaching hospital in Ghana. Methods We used a structured questionnaire to record the type of open foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the hospital for treatment as well as the type of treatment instituted. Recruited patients were followed up for six months, complications resulting from the injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using a questionnaire-based visual analogue outcome scale of the American Foot and Ankle Society. Regression and chi-square analysis were used to evaluate potential associations. Results Over a four-month period, a total of 81 cases of open injuries to the foot were recorded. Out of this figure, 55 patients (67.9%) were males and 26 (32.1%) were females. It was found, that 66.7% aged between 19 and 49 years, 76.5% of the injuries occurred on the road and 29.7% was motor cycle related. Pedestrians are the most afflicted (61.7%). The treatment outcomes of traumatic amputations, open phalangeal fractures, dorsal skin degloving and lacerations were good. Gustillo-Anderson grade IIIB open fractures with associated plantar skin degloving had the worst outcomes with residual pain on weight bearing, bigger foot, inability to wear previous shoes and inability to tiptoe on the affected foot. Conclusions Open injuries to the foot are common in Ghana and exert a significant health burden, particularly on active young males. Long term disability may occur, even after adequate treatment of open fractures involving the foot.
Apr 2019 DOI 10.14302/issn.2641-5518.jcci-19-2700
S Lane AndrewCorresponding author
Cardiovascular Ultrasound Laboratory, Department of Intensive Care Medicine, Nepean Hospital, PO Box 63, Penrith NSW 2751
Rheumatic heart disease is becoming far less common in the developed world, and therefore expsoure to its complications are been seen less by clinicians. With the increasing ease of world travel, patients with less commonly seen medical conditions are increasingly presenting to Hospitals requiring management of their complications. We present a case of an elderly lady who was a tourist in Australia, who presented with complications of her rheumatic heart disease, and her subsequent radiological and echocardiographic investigations were a significant surpirse for her treating clinicians.
Feb 2019
P Dargan DallanCorresponding author
Mersey Regional Burns and Plastic Surgery Centre, Whiston Hospital, Warrington Road, Prescot, Merseyside, L35 5DR, United Kingdom
Background: Chest wall deformities may be managed with skeletal manipulation, which risks life-threatening complications. Custom-made prostheses are a less invasive surgical option, manufactured from silicone elastomer using 3D computed tomographic reconstruction and 3D-printed thoracic models. Methods: All patients undergoing custom-made implants between January 2010 and March 2017 were identified from the prosthetic department records. A retrospective review of the clinical records was performed. Mean follow up period was 1.8 years. A comparison was made with our earlier results from 1995 to 2009. Results: Twenty-six patients underwent insertion of custom-made implants for chest wall deformity. Pectus excavatum was present in 50% (n=13), and Poland syndrome 42% (n=11). All 11 female patients underwent 3D reconstruction and 3D printed models, and 3 of 15 males. Four underwent simultaneous bilateral breast augmentation, and three had staged breast augmentation. Seroma occurred in 27% (n=7), and hypertrophic scar in 12% (n=3). The reoperation rate was 23% (n=6), including autologous fat graft in two patients. Surgical suction drains were used in 42% (n=11) patients, of whom 36% (n=4) developed seroma, compared with 17% (n=2) of those without drains (p=0.08). Conclusions: Custom-made prostheses are an effective and safe option for patients with chest wall deformities. The majority have a short postoperative inpatient stay (81%) and are satisfied with the outcome (77%). Seroma was the commonest complication (27%), and drains did not reduce seroma risk. Single dose intravenous antibiotic prophylaxis is adequate. A minority of patients opt for further aesthetic procedures.
Feb 2019 DOI 10.14302/issn.2572-3030.jcgb-19-2581
Khan AshrafCorresponding author
Departments of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA 01605, USA
We report the case of a 75 year-old female with past history of ampullary adenocarcinoma presenting with a rapidly enlarging breast mass, initially misclassified on fine needle aspiration as a probable sarcoma, which was ultimately diagnosed as melanoma on resection in the absence of a known cutaneous primary lesion. Next-generation sequencing (NGS) of the tumor revealed a mutation in the Smoothened oncogene (SMO) of unknown significance and wild-type BRAF. To our knowledge, SMO mutation in melanoma of any site has not been previously reported, though the effectiveness of SMO inhibitors has been studied in both in vivo and in vitro models of melanoma. Currently, these inhibitors have not been studied in SMO mutant melanoma. The patient declined further therapy after resection due to multiple comorbidities. She expired two years after presenting with the breast mass from complications of high grade urothelial carcinoma.
Jan 2019 DOI 10.14302/issn.2574-450X.jom-18-2484
H. Radwan EmanCorresponding author
Faculty of Science, Damanhour University, Egypt.
Obesity is associated with a number of serious medical complications, which are often referred to as the “insulin resistance syndrome”. The aim of the present study was performed to investigate the possible interaction between a conventional drug used for management of cholesterol and traditional herbal remedies on the obesity. This was carried through out: through estimation of blood test; Estimation of serum tests; Determination of oxidative stress biomarkers and the antioxidant enzymes activities in the liver were assayed; Histopathological examination of the liver and kidney of adult male albino rats were done. In the present study, the serum levels of the total protein and albumin in the obesity group (7.1± 0.2) and (4.78 ± 0.19); respectively were significantly (p ≤ 0.05) more than those of the control group (6.5±0.1) and (3.95± 0.1).The administration of (fennel group) revealed significant (P<0.05) decrease in the serum levels of the albumin and total protein (4.38± 0.1) and (6.65± 0.2); respectively as compared to the obesity group (4.78 ± 0.19) and (7.1± 0.2(. The total cholesterol of the group(5) (fennel and ator) after two weeks from a high fat diet than treatment with fennel and Ator through six weeks equal 142.86±5.9, 100.4±8.68, 93.29±5.99, 87.1±11.28, 80.4±21.55, 78.1±6.7 and 77.1±6.87; respectively. The present study showed a significant (P<0.05) increase in the activities of ALT, AST and ALP in the obesity group which recorded as (60.5±11.45), (57.25±6.3) and (845.0±49.47); respectively as compared to the control group (28.25±1.7), (38.5±3.87) and (537.0±41.5); respectively. The fennel group caused significant decrease in the activities of these enzymes (41.0± 2.9), (42.25+3.2) and (717.75+48.6); respectively compared to the obesity group. Ator group showed a significant decrease in the activities of these enzymes (40.0±2.16), (42.5±3.1) and (679.25±41.16); respectively compared as obesity group. The activity of AlT, AST and ALP in the fennel and ator group (32.75±2.5), (40.5±2.38) and (601.25±17.5); respectively were near to the control group.
Jan 2019 DOI 10.14302/issn.2471-7061.jcrc-18-2446
Youssef HaneyCorresponding author
Consultant Colorectal Surgeon, University Hospital Birmingham Good Hope Hospital
Introduction: Cardiac complications are a major cause of perioperative morbidity and mortality in patients undergoing colorectal cancer surgery. A quick and reliable system for predicting postoperative cardiac morbidity is needed to predict cardiac events in order to improve outcome in surgery. The aim of this study was to investigate the role of the biochemical marker NT-proBNP in the prediction of postoperative all-cause mortality, cardiac-related mortality and cardiovascular events in patients undergoing colorectal cancer resections. Methods: 100 consecutive patients undergoing colorectal cancer surgery were prospectively recruited. Blood samples were taken preoperatively, 24h, 48h and 5-7 postoperative days to measure NT-proBNP levels. The predictive power of NT-proBNP levels was assessed using Receiver Operating Characteristics (ROC) curves. Results: Cardiac-related morbidity and mortality was 9%. Of eleven deaths, 5 were cardiac-related. Preoperative NT-proBNP was a good predictor of death with ROC area under curve (AUC) of 0.83 (95% C.I. 0.673, 0.993) a strong predictor of cardiac death with AUC of 0.914 (95% C.I. 0.823, 1.000) and a good predictor of cardiac complications with AUC of 0.875 (95% C.I. 0.757, 0.993). NT-proBNP levels 24 hours and 48 hours postoperatively were also strongly predictive of postoperative cardiac morbidity and mortality. Conclusion: Pre- and postoperative NT-proBNP have a role in predicting postoperative death and cardiac complications. This may have significant implications in the planning of postoperative care for high-risk patients.
Jan 2019 DOI 10.14302/issn.2470-0436.jos-18-2494
Stonecipher KarlCorresponding author
Clinical Associate Professor of Ophthalmology, University of North Carolina, Medical Director, The Laser Center, Greensboro, North Carolina, Medical Director, Physicians Protocol, Medical Director, Laser Defined Vision
This review is designed to look at a prospective evaluation of the use of the femtosecond laser and manual incision standard cataract surgery in one center with one surgeon focusing on visual outcomes and complications. Multiple studies support both benefits, risks, alternatives, and differences between manual capsulotomy combined with standard manual incision cataract surgery and cataract surgery employing the femtosecond laser in conjunction with routine phacoemulsification. The purpose of this study was to evaluate early postoperative outcomes using a prospective evaluation of cases from one surgeon over the course of two years from 2015-2017. The first group of cases involves 2134 eyes comparing phacoemulsification time in seconds (PT), ultrasound time in seconds (UT), and cumulative delivered energy (CDE). The second group of cases involves 1913 eyes that were Lens Opacification Classification III similar and without other ocular or lenticular abnormalities. Finally, a subgroup from the latter group (n=150) were evaluated over the course of two days and postoperative 3-hour examinations (visual acuity) were compared.
Nov 2018
Shiau Ming-YuhCorresponding author
Department of Nursing, College of Nursing, Hungkuang University, Taichung, Taiwan.
Pre-adipocytes are the precursors with the potential to make new fat cells during adipose tissue expansion. Nevertheless, the pre-adipocytes behaviors, and their possible roles in energy homeostasis have long been overlooked. Our previous study implicates that interleukin-4 (IL-4) plays a positive metabolic role by promoting insulin sensitivity and inhibiting lipid accumulation. Besides, abundant evidence shows the involvement of matrix metalloproteinase-2 (MMP-2) in the process of adipose tissue expansion. The present study aimed at examining the cross talk among glucose, insulin and IL-4 on regulating MMP-2 expression and activity in 3T3-L1 pre-adipocytes. Effects of insulin and/or IL-4 on MMP-2 expression and activity were examined in pre-adipocytes under euglycemic or hyperglycemic environment by RT-PCR and gelatin zymography, respectively. Our results revealed that glucose level is a pre-requisite for pre-adipocytes responding to insulin and/or IL-4 treatment. In high glucose-containing environment, short-term acute insulin treatment (AI) and long-term chronic insulin exposure (CI) showed opposite regulation to MMP-2 expression and activity. Interestingly, the dominant MMPs regulatory role of CI under euglycemic condition was attenuated in cells exposed to high glucose concentration. Our results suggest pre-adipocytes may participate in the process of increasing adiposity, diabetic onset and diabetic complications through ECM alterations resulted from the insulin- and/or glucose- mediated changes of MMP-2 activity. The present study uncovers novel observations regarding pre-adipocytes behaviors.
Oct 2018 DOI 10.14302/issn.2379-7835.ijn-18-2228
Kishan Gupta BalCorresponding author
Senior Professor, In-charge Medical ICU, Department. of Medicine, S.P. Medical College, Bikaner.
Introduction: Organophosphate (OP) pesticide poisoning is a major challenging public-health problem in developing countries. Vitamin D deficiency is pandemic, yet it is the most under-diagnosed and under-treated nutritional deficiency in the world and it has been reported to be clinically correlated with psychiatric illness and manifestation of severe systemic inflammatory response syndrome like ARDS. Thus vitamin D deficiency may affect clinical course and outcome in cases of OPP. Aim: To evaluate status of 25 hydroxyvitamin D (25(OH)D) level in OP poisoning and its correlation with outcome of such patients. Materials and Methods: Serum 25(OH)D levels were measured at the time of hospitalization by electro-chemiluminescent Assay in 96 patients (76 male and 20 female) suffering from OP poisoning. Diagnosis of OP poisoning was made by history of poisoning including container of the poison brought by patient’s relative, clinical examination and measurement of serum butyrylcholinesterase activity. All patients were evaluated as per Performa and follow up till discharge. Results: Mean level of 25(OH)D in our cases was 24.57±9.91ng/ml and 66.7% had low levels of 25(OH)D. Our study shows linear relationship between 25(OH)D level and duration of hospital stay. All cases of OP poisoning who developed severe manifestations like ARDS, Intermediate syndrome (IMS) were having significant 25(OH)D deficiency. Our study also shows lower levels of 25(OH)D were associated with poor outcome (11.27±3.21vs 27.02±8.54, p<0.001). Conclusion: Vitamin D deficiency in OP poisoning is associated with longer hospital stay, more requirement of ventilator support and high prevalence of complication (ARDS and IMS) and poor outcome. Awareness of 25(OH)D level in patients with OP poisoning may be important to improve outcome.
Sep 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2185
Yilmaz AtillaCorresponding author
Hatay Mustafa Kemal University Medicine Faculty Neurosurgery Department, Hatay, Turkey.
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with Parkinson's disease (PD), but more studies about gait and functionality are needed. We aimed to understand whether short-term DBS treatment will can relieve the symptoms of PD patients, specifically we examined its effect on motor-cognitive-complication parameters, fine motor skills and daily living activity (DLA) of these patients. Method: Ten patients from Mustafa Kemal University Neurosurgery Department were recruited. The assessments were made twice, first time preoperatively, which was within one week prior to the surgery, second time postoperatively, which was 55-65 days post treatment. The motor scores, DLA scores, mental scores and complication scores were measured with Unified Parkinson's Disease Rating Scale (UPDRS), fine motor skills measured with The nine-hole peg test (9-HPT), balance measured with Berg Balance Scale (BBS) and falling risk measured with Timed Up and Go Test (TUG). Results: 10 patients (5 female, 5 male) aged between 40-60 (mean=49.44±6.69 years) were included in the study. Duration of the disease’s mean was 5.60 years. We found significant difference between pre-op and post-op results in UPDRS DLA, UPDRS motor, UPDRS complication, UPDRS total score and TUG tests (Table 2). There was no significant difference between preop-postop assessment in UPDRS mental, BBS and 9-HPT results (p>0.05). Discussion: Balance, walk and fine motor impairment occurs almost always in Parkinson’s disease and resulting in difficulties with daily living activities. We found that DBS has positive effect on PD complications, balance and walking abilities. PD patients that have falling risk and multiple motor symptoms may have benefit from DBS.
Jun 2018 DOI 10.14302/issn.2372-6601.jhor-18-2139
S. Afriyie-Mensah JaneCorresponding author
Department of Medicine and therapeutics, School of Medicine and Dentistry, College of Health Sciences university of Ghana, Accra, Ghana.
Pulmonary hypertension (PH) has become an increasingly recognized complication in sickle cell anaemia (SCA) and is a major cause of morbidity and mortality. Though the burden of SCA in sub-Saharan Africa is high, there is paucity of data on SCA-associated PH with little or no attention given to it in routine patient care. The current study therefore sought to determine the prevalence of PH and its associated risk factors among adult patients with SCA. This was a cross-sectional study involving 76 clinically stable, hydroxyurea-naive participants. We obtained socio-demographic and clinical history. Measurement of Tricuspid Regurgitant jet Velocity (TRV) was obtained via transthoracic echocardiography and lung function was assessed using spirometry and pulse oximetry. Other investigations were complete blood counts, free plasma haemoglobin, serum urea and creatinine. Twenty-five (32.9%) of study participants had elevated TRV (≥ 2.5m/s) on Doppler echocardiography, which was suggestive of raised pulmonary artery systolic pressure. There were significant associations between elevated TRV and steady-state haemoglobin (p < 0.001), blood urea level (p = 0.030), presence of chronic leg ulcers (p = 0.043) and oxygen saturation (p < 0.001) and these may be identifiable and modifiable risk factors for selective screening with echocardiography in a resource poor setting.
May 2018 DOI 10.14302/issn.2381-862X.jwrh-18-2074
Olukemi Bello OluwasomidoyinCorresponding author
Department of Obstetrics and Gynaecology, University College Hospital.
Objective: To determine the prevalence and risk factors of non-fistulous urinary incontinence (UI) among non-parturient women at University College Hospital, Ibadan, Nigeria. Methods: A hospital based cross sectional study of 500 non-parturient women presenting with non- fistulous gynaecological symptoms at the University College Hospital, Ibadan. An interviewer administered questionnaire was used to obtain information. Data were analyzed using SPSS version 20. Data analysis involved descriptive statistics, bivariate and multivariate analysis to determine the risk factors of urinary incontinence. Results: Mean age was 36.61 (SD=10.1) years and almost all (83.2%) were married. Prevalence of urinary incontinence is 21.4%. Majority (40.6%) had symptoms of stress urinary incontinence and 8.0% had urge urinary incontinence. Only 19.6% of those who leaked urine in the last one month sought medical attention despite visiting the hospital for other ailment(s), while of those that had ever leaked urine, 13.1% of them ever sought medical attention. Risk factors for UI were age at first delivery (OR=21.21, 95%CI=2.179-206.478), marital status (OR=0.142, 95%CI=0.044-0.454), chronic illness (OR=3.987, 95%CI=2.147-7.405) and history of prolonged labour (OR=3.111, 95%CI=1.584-6.110). Conclusion: UI is not uncommon in Nigeria. The identified predisposing factors were low age at first delivery, history of prolonged labour and chronic illness. There is need to sensitize women of the symptoms and complications associated with urinary incontinence as well as its prevention and need to seek medical care if they have the symptoms.
Apr 2018 DOI 10.14302/issn.2578-8590.ipj-18-2018
Hinzpeter JaimeCorresponding author
Medical Doctor, University of Chile, Clinical Hospital, Santiago Chile
Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.
Mar 2018 DOI 10.14302/issn.2642-9241.jrd-18-1958
Ba T TaCorresponding author
Military Hospital 103
Background Bronchoscopic lung volume reduction (BLVR) has been applied in COPD patients with heterogeneous emphysema. In this first clinical trial in Vietnam, we evaluated the safety and initial results of BLVR by one-way valve in COPD patients with severe emphysema. Methods We performed a prospective, nonrandomized, single center longitudinal study in 30 stable COPD patients with heterogeneous severe emphysema on CT-scanner, the average age of 65.17 years old, FEV1≤35 %pred., TLC ≥ 100 %pred., RV ≥ 150 %pred. and 6MWT < 450 meters. The Zephyr one-way bronchial valves (PulmonX, Redwood City, CA, USA) with the size of 5.5 mm and 4mm were placed in lobar or segmental bronchi via flexible bronchoscopy. 28 patients were placed only one valve, 1 patient with two and 1 patient with three valves. 23 valves with the size 5.5 mm diameters and 10 valves with the size 4.0mm used. All patients received optimal medical treatment at the time of procedure and during the study period. Outcomes will be assessed at 3 months after treatment include the changes of clinic, and lung function, the occurrence of complications. Results After 3 months, mean CAT scores decreased significantly compared with before procedure (17.73 ± 3.53 vs 20.10 ± 3.58) (p<0.05), with the median change of 2.73 points and the improvement more than 2 points in 76.67% of patients. 6 MWT increased at 3 months with mean 32.13 meters, 93.33% of the patients increased 6MWT, 46.67% of the patients increased 6MWT more than 26 meters. MRC decreased with the median change of 0.5 score. VC decreased by a mean 0.2 (L) (0.42 - 0.02), FEV1 increased by a mean 0.05 (L) (0.04 - 0.05) but not statistically significant (p>0.05); FVC increased by a mean 0.14 (L) (0.01 - 0.28), RV decreased by a mean 0.62 (L) (1.05 - 0.2), TLC decreased by a mean 0.52 (L) (0.77- 2.4) with statistically significant (P<0.05). The early complications were 13.33%, the later complications were 23.34% of the patients. Conclusions The unilateral bronchoscopic lung volume reduction with one-way valve (mainly one valve) in treatment of heterogeneous severe emphysema in stable COPD patients in Viet Nam have shown that this procedure is safe with encouraging initial results.
Feb 2018
Ba T TaCorresponding author
Military Hospital 103
Lung transplantation is an established treatment option for patients of end-stage lung diseases. Leading indications include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis and bronchiectasis, pulmonary arterial hypertension. Living donor lung transplantation (LDLT) was indicated for patients who experience a decline in physical condition and have limited life expectancy and had the better result than from brain dead. The first case of LDLT in Vietnam is 7 year olds boy with difuse congenital bronchiectasis, chronic respiratory failure and cor pulmonale. The right and left lower lobes from father and relative uncle are implanted in a recipient in place of whole right and left lung. The initial result of this recipient showed that lung function recuperated quickly and had no early complications. After 12 months surgery, the recipient had normal physical exercise capacity, subclinical tests in normal limits and no respiratory symptoms, opportunistic infection.
Feb 2018 DOI 10.14302/issn.2766-6204.jmpt-17-1913
NF TepeneuCorresponding author
Department of Pediatric and Adolescent Surgery, General Hospital Klagenfurt, Austria
The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%). The mechanism of injury varies, but the most commonly described mechanism involves a fall on an outstretched hand with varus, valgus or rotational force or a combination thereof. The vectors of force and the degree of chondro-osseous development dictate the type of injury incurred. A review of the literature was conducted to see the most frequent injuries and complications.
Jan 2018 DOI 10.14302/issn.2470-5020.jnrt-17-1926
Nagel SimonCorresponding author
Department of Neurology, University of Heidelberg, Germany
Since the first description in 2013, 39 cases of anti-DPPX-encephalitis have been described. Main features of this autoimmune encephalitis characterized by antibodies against the potassium-channel-associated regulatory protein DPPX are gastrointestinal symptoms, cognitive dysfunction and signs of CNS hyperexcitability. While the majority of patients responds to immunotherapy relapses are frequent and often successfully treated with rituximab. Here we report another case of anti-DPPX-encephalitis presenting with the above mentioned triad. However, this is the first case of anti-DPPX-encephalitis in the context of a connective tissue disease combined with cerebral arteriopathy along with brain parenchymal lesions that we interpreted as a secondary, CTD-associated cerebral vasculitis. While the latter resolved under immunosuppressive treatment, comprising glucocorticosteroids, cyclophosphamide, rituximab and plasmapheresis, deterioration of the CTD and multiple infectious complications finally led to the patient's death. As histological evidence for cerebral vasculitis is lacking, other differential diagnoses for the observed cerebral arteriopathy, especially reversible cerebral vasoconstriction syndrome, have to be considered.
Jan 2018
Sharaf Ala’aCorresponding author
North Bristol NHS Trust, Bristol Urological Institute.
Ileal conduit has been considered the urinary diversion of choice following radical cystectomy although orthotopic bladder substitution is gaining popularity. Urinary diversions are associated with complications including stone formation in up to 54%. We report the management of the largest ileal conduit stone reported in the literature.
Nov 2017 DOI 10.14302/issn.2574-4526.jddd-17-1792
Angelou AnastasiosCorresponding author
Department of Surgery, Laiko Hospital, School of Medicine, University of Athens, Athens, Greece
Objectives: Bariatric surgery has been established as the cornerstone of treatment of morbid obesity with good immediate and long-term results. Nutrient deficiencies though, can be an important long-term complication and may lead to hematological, metabolic and especially neurological disorders which are not always reversible. Thiamine (vitamin B1) deficiency has been reported both after restrictive and malabsorptive procedures. The aim of this study is to review all cases that presented with Wernicke Encephalopathy after sleeve gastrectomy. Methods: A review of the literature was conducted to evaluate all sleeve gastrectomies performed till today and caused Wernicke encephalopathy to the patients. Demographic data, operative parameters, postoperative outcomes were collected and assessed. Results: A total of 13 studies, including 13 patients were analyzed. Patients ranged in age from 17 to 55 years. The onset of Wernicke encephalopathy occurred as early as 3 weeks after surgery to as late as 60 weeks after surgery. When symptoms of Wernicke encephalopathy developed, patients had lost from 19 kg up to 60 kg of body weight. Conclusions: Micronutrient deficiencies and particularly B1 deficiency can occur after LSG, although rarely. Preoperative nutritional assessment and postoperative follow-up plan, should signs of Wernicke’s encephalopathy be traced, is recommended in all patients.
Oct 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1758
U MazumderCorresponding author
Department of Obstetrics and Gynaecology, Dhaka Medical College, Dhaka , Bangladesh,
Background: The nature of placenta previa can be unpredictable and harsh on the mother and baby. These complications are often unpredictable, unpreventable and often leave the labour ward team in a dilemma. This Obstetricians' nightmare is fortunately a rare complication. The frequency of placenta previa at the time of delivery average 1/200 births i.e. 0.5%. Placenta previa is still an important cause of maternal and fetal death in our country. The risk factors are Advanced Maternal age, Multi parity, Previous Cesarean Section, Multiple gestation, Previous Abortions, Previous intrauterine surgery, placenta previa in previous pregnancy, Smoking. Objective: Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa with previous caesarean section. Methodology: This cross sectional study was conducted from July 2012 to June 2015 in Obstetrics and Gynaecology department, Dhaka Medical College hospital. 100 patients of placenta previa were included in this study. Non-probability purposive sampling method was used for selection of patients. Results: In this study, Socio-demographic profiles, Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa were assessed. The frequency of placenta previa associated with previous cesarean section was 61%. In demographic profiles of the patients in this study - with a history of previous caesarean section, 78.7% patients were in the age group 26-35. Multiparity was predominant on scarred uterus group (63.9%). Here, demonstrated that > 2 previous history of caesarean section was associated with 80.3% of placenta previa. Regarding maternal outcome, complications like massive haemorrhage, ureteral injury, bladder injury, wound infection, DIC, maternal and perinatal mortality were more in the scarred patients than in the unscarred patients. In our study, 29.5% of morbid adhesion of placenta observed in scarred uterus. Conclusions: There is significant association of placenta previa with previous cesarean delivery. So, Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the Obstetricians' nightmare.
Oct 2017 DOI 10.14302/issn.2574-4526.jddd-17-1497
Darouichi M.Corresponding author
Medical institute radiology and gynecology ,Genrva,Switzerland.
Volvulus occurring during pregnancy is a rare complication, still potentially lethal nowadays for both the mother and child due to several, early arising complications. We report here a case of small bowel volvulus in a 28 weeks and 4 days, 29 years-old, pregnant woman with a past medical history of appendectomy in her childhood. Patient presented in emergency department with abdominal pain and abnormal hepatic tests. Cholangio-MRI suggested bowel obstruction due to volvulus that was confirmed by gastroscopy (showing the obstruction) and intestinal MRI. Patient was first treated by laparoscopy but, due to a very complicated abdominal status with the presence of several adhesions of the small bowel, surgery was changed to an open laparotomy, which allowed discovery and repositioning of small bowel malrotation and removal of adhesions. Both patient and the foetus were healthy after surgery and the patient was then discharged. In the light of this particularly rare case of small bowel volvulus due to malrotion, we will describe the pathology of bowel obstruction and more particularly volvulus during pregnancy and discuss its diagnosis and treatment.
Oct 2017 DOI 10.14302/issn.3070-5657.je-17-1513
GELEN VolkanCorresponding author
Kafkas University, Turkey
Changes to proinflammatory cytokines as a result of gestational diabetes mellitus (GDM), and the pregnancy complications that these changes can cause, are of vital importance to the effective prevention and optimal management. Interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α) are cytokines that are associated with gestational diabetes. Therefore, the aim of this review is to draw attention to the relationship between gestational diabetes and these diseases
Sep 2017 DOI 10.14302/issn.2576-9359.jot-17-1594
Seguchi OsamuCorresponding author
Department of Transplantation, National Cerebral and Cardiovascular Center, Japan
Constrictive pericarditis (CP) represents a rare complication after heart transplantation (HTx), resulting from various postoperative events such as mediastinitis, pericardial effusion, or allograft rejection. We describe our recent experience with managing an HTx recipient who developed atypical patterns of CP predominantly involving the right ventricle. A 52-year-old male who had received heart transplantation 2.5 years before was admitted to our institution because of progressive symptoms of heart failure. The patient had experienced acute rejection twice post-HTx, both with International Society for Heart and Lung Transplantation grade 1R, undergoing an additional endomyocardial biopsy other than those performed during regular check-ups. On admission, echocardiography revealed paradoxical septal motion and a large cystic-like mass with a thick capsule in front of the right ventricle. Right heart catheterization revealed elevation of right atrial pressure, with severely reduced cardiac index. Magnetic resonance imaging revealed both seroma and a thick cystic-like capsule tightly adhered to the right ventricle. CP was suspected despite the atypical patterns of presentation. Seroma was removed through exploratory lateral thoracotomy, without improvement in symptoms, which was only achieved via subsequent pericardiectomy involving resection of the thickened parietal pericardium, removal of effusion fluid, and further excision of diffusely thickened visceral pericardium and epicardium. The patient is currently recovering uneventfully. The possibility of CP after HTx should be considered despite the rarity of this condition and HTx recipients should be closely monitored using various imaging modalities because CP typically demonstrates non-specific symptoms and physical findings of heart failure, with high mortality.
Aug 2017 DOI 10.14302/issn.2379-8572.joa-16-1368
Kumar Singh RahulCorresponding author
Department of otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur-342005, Rajasthan, India
We report a case of cholesteatoma associated with unilateral congenital aural atresia (CAA) and microtia, resulting in extracranial complication. A 13-year-old girl presented with right ear purulent discharge from pre and post auricular area with mastoid tenderness. On clinical examination, she had right grade II microtia with pre-auricular skin tag and healed scar tissue in periauricular region. On High Resolution Computerized Tomography (HRCT) scan of temporal bones, there was CAA of right ear with extensive cholesteatoma in middle ear cleft. The cholesteatoma was subsequently removed by radical mastoidectomy with uneventful post-operative period. Cholesteatoma associated with CAA may remain undiagnosed in early childhood resulting in life threatening temporal and intracranial complications.
Aug 2017 DOI 10.14302/issn.2690-4721.ijcm-17-1676
W. Taylor-Robinson AndrewCorresponding author
School of Health, Medical & Applied Sciences, Central Queensland University, Brisbane, QLD 4000, Australia
Malaria is a mosquito-transmitted infectious disease caused by intracellular protozoan parasites of the genus Plasmodium. In the absence of prompt and appropriate treatment contraction of primary infection by a human being often represents a medical emergency since it may progress rapidly to life-threatening complications. Exposure to parasites activates the immune system resulting in, among other effects, the release of reactive oxygen intermediates (ROI). This has the potential to induce oxidative damage, thereby causing cellular destruction, and hence to have a severe effect on vital organs of the body. Overexpression of ROI leads to immunosuppression and is a causal factor in the development of malaria-related disease symptoms. However, the body possesses various defence mechanisms, notably including the production of antioxidants, which are capable of reducing the cellular effects of ROI. Antioxidants are either sourced exogenously from the diet or synthesized through different intracellular mechanisms. Antioxidants that include glutathione peroxidase, catalase, EDTA and vitamin C suppress the initial production of ROI. Others such as uric acid, superoxide dismutase and vitamin E may also inhibit potentially damaging products of ROI metabolism. Current anti-malarial drugs often have damaging side-effects, as exemplified by memory impairment following treatment for cerebral malaria. Recent studies have explored the potential use of antioxidants alone or in combination with anti-malarials as a therapeutic means to negate Plasmodium-induced oxidative stress and its associated metabolic complications. It is indicated that when utilized in an adjuvant capacity antioxidants of natural and synthetic origin may improve anti-malarial therapy by causing less damage to the host during malaria infection.
Aug 2017
Fernandes Pires CatarinaCorresponding author
Adjunct Professor of Pediatrics, Federal University of Piauí, Brazil
Objectives: To identify the clinical epidemiological characteristics of patients with juvenile idiopathic arthritis (JIA) monitored at the Lucidio Portella Children’s Hospital (HILP) in northeastern Brazil and to ascertain the frequency and forms of presentation, the most affected joints, the most common joint involvement for each form, the frequencies of positive rheumatoid factor (RF+) and positive antinuclear antibodies (ANA+) in the various forms of presentation, and the most common complications. Methods: A study was conducted with 74 medical records of patients with JIA monitored at HILP between January 2010 and January 2013. Descriptive statistics were used for statistical analysis. Results: JIA was predominant in females with a mean age at onset of 5.2 years and a median disease duration of two years. The most frequent initial form of presentation was oligoarticular (63.5) arthritis, and the most affected joint was the knee (86.4%). The knee was most affected by oligoarticular arthritis, the wrist, knee, and ankle were affected by RF+ polyarticular arthritis, and the knee, ankle, and cervical spine were affected by systemic arthritis. RF+ was observed in 8.5% of the oligoarticular arthritis cases. ANA+ were present in 27.7% of the oligoarticular cases, in 22.2% of the systemic arthritis cases, and in 11.1% of the RF+ polyarticular arthritis . The most common complications were deformities (20.3%) and uveitis (14.9%). Conclusion: The findings for JIA patients in a referral hospital in northeastern Brazil were consistent with the literature regarding most of the evaluated criteria.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1666
P. Storey PhilipCorresponding author
USC Roski Eye Institute, University of Southern California
Purpose: To evaluate early versus late immunomodulatory therapy (IMT) for patients following initial diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Methods: Retrospective review including all VKH patients seen 5/1/2014 to 4/1/2016 at LAC+USC. Early IMT was defined as starting an immunomodulatory agent within 3 months of corticosteroid initiation. Results: Twenty-seven patients were included, of whom 15 received early IMT and 8 received late IMT. Early IMT patients trended toward greater improvement in vision compared to late IMT (logMAR 0.59 vs. 0.11; p=0.14) with no differences in ocular complications including ocular hypertension (p=0.53) and cataract (p=1.0). Patients receiving early IMT averaged 0.93 recurrences versus 2.13 recurrences for late IMT (p=0.092). Of patients successfully taper off oral corticosteroids, the early IMT group was tapered in an average of 8.3 months versus 19.8 months for late IMT (p=0.0019). Conclusions: Early IMT in VKH may allow for shorter duration of corticosteroids with similar visual outcomes, ocular complications, and disease recurrences.
Jul 2017 DOI 10.14302/issn.2379-7835.ijn-17-1607
PhadkeMCorresponding author
Senior Advisor, Govt;
Background Severe acute malnutrition (SAM) is rampant in the children of hilly and inaccessible tribal region of Nandurbar, Maharashtra in India. It is estimated that nearly 5% of the children under five years have SAM. Objectives To assess the therapeutic efficacy of 3 types of nutrition protocols administered largely at home in SAM children from Nandurbar, Maharashtra. Methodology This study is a part of a larger three arm open label trial using 3 therapeutic feeds i.e. C-RUTF (Centrally produced ready to use therapeutic food), L-RUTF (locally prepared ready to use therapeutic food) and ARF (locally prepared amylase rich food) in children of SAM who attended the health facility and completed the treatment protocols for 8 weeks (All ‘per protocol patients’) and were between 1 to 3 years of age. The larger study included children aged 6 months to 59 months who were given same therapeutic feeding protocol. Findings A total of 450 SAM babies between 12-36 months. attended the outpatient therapeutic program during the period of July 2014 to December 2015 and completed the given protocol of therapeutic feeding program. 242(53.7%) were males and 208(46.2%) females. Out of these, 150 received C-RUTF, 150 received L-RUTF and 150 received ARF. Out of C-RUTF group 83(55.3%) recovered, in L-RUTF 70(46.7%) recovered and from ARF group 69(46.0%) recovered. The difference was statistically significant.(p=0.03) Total recovery rate was 49.3% in comparison to another under publication study by our group on 3418 children aged 6 months to 59 months, where recovery was 36.8%. Average weight gain per day was 3.54 ± 2.36 g/kg/day, 2.61 ± 2.12 g/kg/day, 2.60 ± 1.50 g/kg/day in the 3 arms respectively. Conclusion This study proves that domiciliary treatment with 3 types of therapeutic feeds gives recovery rate of 49.3%, there by meaning that SAM Children without complications can be treated at home with visit to health facility once a week. Of all the therapeutic feeding protocols C-RUTF had best recovery rates (55.3%) compared to others, the difference being statistically significant. Average weight gain per kg per day inC-RUTF group was 35.8 % higher than the other 2 groups.
Jun 2017 DOI 10.14302/issn.2574-4526.jddd-17-1557
Kidd Leong HoieCorresponding author
Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
Background and Aims: Establishing the degree of fibrosis is important in determining the prognosis of patients with chronic liver disease. Acoustic Radiation Force Impulse Imaging (ARFI) has been validated as a reliable method to estimate liver fibrosis. It remains unclear if ARFI readings may be a useful way to stage patients with established cirrhosis and predict the development of complications. The aim of this study was to determine if ARFI liver stiffness measurements correlate with the severity of liver disease in patients with cirrhosis, and predict the development of complications and decompensation. Methods: All patients attending our institution who had a prior clinical diagnosis of cirrhosis and an ARFI liver stiffness measurement (LSM) over 26 months were included. Area under the receiver operating characteristic (AUROC) curves were calculated for ARFI detection of any complication, any varices, medium or large varices, moderate or severe ascites, encephalopathy, Child Pugh Grade B or C and MELD ≥15. Results: ARFI LSM did not correlate with complications: any complication (AUROC 0.672), any varices (0.631), medium or large varices (0.610), moderate or severe ascites (0.681), Child Pugh B/C (0.691) or MELD ≥15 (0.711). Hepatic encephalopathy did correlate with higher LSM (0.854), but only in a small number of cases. Conclusion: ARFI in patients with cirrhosis does not correlate with the presence of portal hypertension or decompensated liver disease.
Jan 2017 DOI 10.14302/issn.2379-8572.joa-16-1364
Suat BiliciCorresponding author
Istanbul Training and Research Hospital, Otorhinolaryngology Department
Objectives The aim of this study was to compare the functional outcomes (including swallowing, respiration and phonation) of supraglottic horizontal laryngectomy (SGHL) and supracricoid partial laryngectomy (SCPL). Methods The clinical and pathological data were evaluated for 36 previously untreated patients who were diagnosed with laryngeal carcinoma and underwent SGHL or SCPL at the Department of Otorhinolaryngology-Istanbul Training and Research Hospital from 2010 to 2016. Removal of the nasogastric tube, decannulation and hospitalisation times were recorded in both groups and postoperative complications were noted. Results The SGHL group contained 15 patients and the SCPL group contained 21 patients (14 cases of cricohyoidoepiglottopexy (CHEP) and 7 cases of cricohyoidopexy (CHP)). The mean age of the subjects was 57.4 years in the SGHL group, and 59.7 in the SCPL group. Patients in the SGHL group were decannulated after 65.2 days, whereas the average decannulation time was 72.6 days in the SCPL group. This difference in decannulation time between the groups was not statistically significant (p>0.05). The mean hospitalisation time was 23 days, with no statistically significant difference between the groups (>0.05). The nasogastric tube was removed from the patients after 37.9 days in the SGHL group and after 35.8 days in the SCPL group. No statistically significant difference was determined in the time to start feeding between the groups (p>0.05). Surgical wound infection, the occurrence of pharyngo-cutaneous fistulas and rupture of the pexy sutures were complications. Conclusion Functional outcomes of SCPL were similar to those of patients who underwent SGHL. The preservation of the hyoid bone is the most important consideration for preserving the swallowing function.
Dec 2016 DOI 10.14302/issn.2372-6601.jhor-16-1070
Sisi TianCorresponding author
Introduction: Post-transplant lymphoproliferative disease (PTLD) is a collection of conditions associated with abnormal proliferation of lymphoid tissues in patients after solid organ transplants (SOT). Its clinical presentations are quite variable and non-specific. Otolaryngological signs and symptoms, manifested as adenotonsillar hypertrophy or cervical lymphadenopathy, may guide to early detection and treatment. Methods: We conducted a retrospective review of all pediatric SOT recipients with the diagnosis of PTLD, age 0-18, between 2005 and 2014 at the Loma Linda University Children’s Hospital. The patient’s age, type of organ transplant, immunosuppression, head and neck signs and symptoms, imaging modality, EBV status, histology as well as treatment regimen information were recorded. Results: A total of 21 pediatric patients were included in this retrospective review with a history of solid organ transplant and a diagnosis of PTLD. The most commonly associated type of transplanted organ is heart (57.1%), followed by kidneys (33.3%) and liver (9.5%). Neck swelling (28.6%) was the main head and neck complaint while one patient developed upper airway obstruction with respiratory distress. Cervical lymphadenopathy was found in 66.7% and tonsillar hypertrophy in 9.5% of the patients. Monomorphic PTLD (46.2%) was the most common pathological diagnosis, followed by reactive hyperplasia (30.8%), Hodgkin lymphoma (15.4%) and polymorphic PTLD (7.7%). Majority of the PTLD patients were treated with rituximab and cyclophosphamide combination therapy with and without prednisone. Conclusion: Adenotonsillectomy and cervical lymph node biopsies are easy to perform with low complication rates. They serve an important role in the armamentarium in the early detection of PTLD in its early stage, allowing prompt treatment and prevention of further progression.
Dec 2016 DOI 10.14302/issn.2372-6601.jhor-16-1330
Ferrarini IsaccoCorresponding author
Section of Hematology, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
Immune thrombocytopenia (ITP) is a rare but well-recognized post-allogeneic hematopoietic stem cell transplant (HSCT) autoimmune complication for which a standard treatment approach is lacking. Herein we report on an adult patient affected by high-risk acute myeloid leukemia (AML) who developed a post-HSCT ITP. Due to the refractoriness to first-line therapies the patient underwent the thrombopoietin (TPO) mimetic Eltrombopag obtaining the ITP resolution. We also discuss the clinical course of ITP in post-HSCT setting and pros and cons of different therapeutic strategies, focusing on the emerging role of TPO mimetics.
Nov 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1271
S. J. B. TougooumaCorresponding author
Introduction The cardiovascular complications have became the 3rd cause of death and the 4th reason for hospitalization of the patients infected by the HIV. The objective of this work was to determine the frequency of asymptomatic myocardial ischemia among patients infected by the HIV receiving antiretroviral therapy. Patients and Methods It was a descriptive cross-sectional study which was conducted in November 2015. The patients infected by HIV1 receiving antiretroviral treatment, with asymptomatic myocardial ischemia were included in the study and they were followed up in the HIV clinic of the in Infectious diseases service of the University Hospital Souro Sanou of Bobo-Dioulasso(CHUSS).. The includes patients benefited from a collection of cardiovascular risk factors, and of two measurements of the blood pressure in a sitting position after 10 minutes of rest and an electrocardiogram 12 derivations after rest. Results A total sample of 123 patients infected by HIV1 was selected, with a median age of 42 years (IQR: 36-50). It was composed of 79% of female. The cardiovascular risk factors found were distributed as follows: HTA (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%), diabetes (0.8%). All the known hypertensive cases (5.7%) were insufficiently treated. The median duration of exposure to the antiretroviral therapy was 5.3 years (IIQ: 3-7.7). The disorders of the repolarization were observed in 26 cases (21.13%). They were divided into under epicardic ischemia in 20 cases (16.26%), under endocardic lesion in 2 cases (1.63%) and after-effect of necrosis in 4 cases (3.25%). The Left ventricular hypertrophywas observed in 12 cases (9.76%) and all of them were hypertensive patients. QTc was lengthened among 7 patients (5.69%) independently of the class of antiretroviral therapy administrated. Conclusion In this study about patients infected by HIV1, it emerges that asymptomatic myocardial ischemia is frequent. It would be advisable to reinforce its tracking by using more powerful tests of ischemia, in order to better specify its gravity in this population with an increased cardiovascular risk.
Oct 2016 DOI 10.14302/issn.2574-4526.jddd-16-1153
Umair MasoodCorresponding author
A 69 year old female with a history of pancreatic mucinous cystadenoma (treated with Whipple procedure) and recently presumed liver cirrhosis presented to the hospital with melanotic stools. The source of the bleeding was initially thought to be secondary to upper gastrointestinal (GI) varices due to portal hypertension from the liver disease. Upper endoscopy found no active bleeding and confirmed grade 2 gastric varices with gastric wall edema. Due to persistent symptoms and inability to locate the exact source, she went to the operating room for possible transjugular intrahepatic portosystemic shunt (TIPS) but was not found to have any porto-systemic gradient. Instead, she was found to have an isolated stenosis of the left gastric vein, which was treated with balloon angioplasty and eventual splenectomy. Upper GI varices usually occur due to portal hypertension from liver disease. Extra hepatic causes are much rarer. We report a case of upper GI bleed from gastric varices secondary to left gastric vein stenosis rather than portal hypertension. The stenosis was due to a rare complication of a Whipple procedure. The case is unique as there are no reported cases of gastric varices secondary to left gastric vein stenosis.