Detecting Pneumothorax on Chest Radiograph Using Segmentation with Deep Learning
Published on: 9th July, 2024
Introduction: Pneumothorax is a life-threatening condition that requires prompt recognition and therapy to prevent deterioration. Radiologist workload often precludes rapid assessment of the usual diagnostic modality, the chest radiograph, particularly after hours. The aim was to develop a deep learning model using a segmentation-based Deep Convolutional Neural Network (DCNN) to detect pneumothorax on chest radiographs to provide rapid and accurate pneumothorax diagnosis.Methods: This is a retrospective study of spontaneous pneumothorax at a single center, containing 130 positive and 70 negative radiographs. Subsequent manual contour mapping was performed to draw a mask of the pneumothorax. These image pairs were used to train a DCNN model (a modified AlexNet) after pretraining on the ImageNet dataset.Results: The DCNN achieved an accuracy of 0.83, with sensitivity of 98.1%, and specificity of 68.5%.Conclusion: This segmentation-based DCNN accuracy is comparable to previous categorization-based CDNN models, despite using a smaller sample size for training, while including the benefits of visual representation for clinician feedback. Segmentation-based DCNNs show promise in the development of accurate and clinically useful models for medical imaging.
Severe Alcoholic Hepatitis-optimizing Medical Management: Whether we need a Liver Transplant
Published on: 9th July, 2024
Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed.Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.
Beta-1 Receptor (β1) in the Heart Specific Indicate to Stereoselectivity
Published on: 10th July, 2024
The β1 receptor is one of the three beta receptors present in the human body, namely β1, β2, and β3. The β1 receptor is predominantly located in the heart, where it plays a crucial role in regulating the heart rate and the force of contraction, thereby increasing the cardiac output and the efficiency of blood pumping throughout the body. This receptor is targeted by a variety of pharmaceutical agents known as beta-blockers, which are commonly used in the treatment of cardiovascular conditions such as hypertension, angina, and arrhythmias.The β1 receptor exhibits stereoselectivity, meaning that different enantiomers (chiral molecules) of beta blockers can have varying levels of effectiveness and side effects. This study focuses on the stereoselectivity of the β1 receptor and the clinical implications of this property. It includes an examination of various β1 blockers, such as propranolol (a non-selective beta blocker), and selective β1 blockers like atenolol, bisoprolol, nebivolol, metoprolol, esmolol, acebutolol, and betaxolol. Each of these drugs has a unique chemical structure, with specific functional groups that contribute to their selective action on the β1 receptor.Furthermore, the β2 receptor, which is mainly present in the bronchi and bronchioles, is responsible for bronchodilation, and the β3 receptor, found in the bladder, helps reduce urinary urgency. Understanding the distinct locations and functions of these receptors allows for the development of targeted therapies with minimal off-target effects.This review highlights the importance of stereoselectivity in the development and use of β1 blockers, discussing their chemical structures, pharmacological activities, and therapeutic uses. It also explores the potential for future research and development of more selective and effective β1 receptor agonists and antagonists, which could offer improved therapeutic outcomes for patients with cardiovascular diseases.This study underscores the significant role of the β1 receptor in cardiovascular health and provides insights into the ongoing advancements in beta-blocker therapy. By delving into the stereoselectivity and specific actions of these drugs, the research aims to enhance the understanding and optimization of β1 receptor-targeted treatments in clinical practice.
B-ultrasound-guided Intrahepatic Infusion of Autologous Bone Marrow Cells for Decompensated Cirrhosis
Published on: 12th July, 2024
Objective: To study the therapeutic effect of B-ultrasound-guided intrahepatic infusion of autologous bone marrow nucleated cells on decompensated cirrhosis. Methods: To observe the clinical treatment of 75 cases of decompensated cirrhosis. Among them, 30 cases received routine liver protection and diuretic treatment. 45 cases were treated by percutaneous transhepatic infusion of autologous bone marrow nucleated cells under the guidance of B ultrasound. There were no significant differences in liver function and blood routine indexes between the two groups before treatment (p > 0.05). Results: The indexes of liver function and blood routine at different time periods of 1 month, 3 months, 6 months, and 12 months in the conventional treatment group did not change significantly. 6 cases died of liver failure within 1 year, the fatality rate was 20%. The indexes of liver function and blood routine of percutaneous liver transhepatic infusion of autologous bone marrow nucleated cells at 1 month, 3 months, 6 months, and 12 months under the guidance of B-ultrasound were significantly better than those of the conventional treatment group (p < 0.05). One case died of gastrointestinal bleeding in the group of percutaneous transhepatic infusion of autologous bone marrow nucleated cells guided by B ultrasound, with a fatality rate of 2.5%. Compared with the conventional treatment group, there were significant differences (p < 0.05). Conclusion: Conventional drug therapy has no obvious effect on decompensated cirrhosis. Intrahepatic infusion of bone marrow nucleated cells can significantly promote liver function reconstruction in decompensated cirrhosis.
Disposable Diapers in Infancy and Their Potential Detrimental Impact on Male Fertility in Adulthood
Published on: 22nd July, 2024
The overall human fertility rate has been continuously declining across the globe for a number of reasons. This review summarizes data, which proposes that the use of disposable diapers for newborns and infants may incur reproductive harm in adulthood. More than 70 years ago, a disposable synthetic waterproof baby diaper was developed, mainly to reduce the burden of working mothers. Modern diapers feature the same original design, which contains one unit of disposable material wrapped around the perineum to collect urine and feces. This design results in an increase in internal area temperatures by 2-4 °C, which can be detrimental to the function and development of reproductive cells. Moreover, the standard diaper template promotes the free passage of feces, including fecal bacteria, to the genitals, which can lead to urogenital infection and reproductive impairments. The available clinical data suggest that diaper use during infancy may have a negative impact on fertility after puberty. There is a critical need for additional studies to better assess the impact of diapers on reproductive health.
Current Practices for Severe Alpha-1 Antitrypsin Deficiency Associated COPD and Emphysema
Published on: 26th July, 2024
Alpha-1 antitrypsin deficiency is a genetic disorder that can lead to chronic obstructive pulmonary disease and emphysema. Although it is the most well-studied genetic risk factor for emphysema, data is still scarce. Traditionally, medical therapy is similar to standard chronic obstructive pulmonary disease patients. Over the past several decades, enzyme augmentation therapy has emerged as a highly utilized alpha-1 antitrypsin-specific therapy. It has become the standard of care for severe alpha-1 antitrypsin deficiency despite unclear effects on a multitude of clinical outcomes. Significant data supports interventional therapies, including lung volume reduction surgery and bronchoscopic lung volume reduction, for chronic obstructive pulmonary disease patients without alpha-1 antitrypsin deficiency. These interventions have less robust data in the treatment of alpha-1 antitrypsin-induced chronic obstructive pulmonary disease. This review will explore the data regarding various treatment options for severe alpha-1 antitrypsin deficiency associated with chronic obstructive pulmonary disease and emphysema.
Extracorporeal Shock Wave Combined with Traditional Chinese Medicine Bone-setting Manipulation for External Humeral Epicondylitis: A Randomized Clinical Trial
Published on: 23rd July, 2024
Objective: The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock waves combined with traditional Chinese medicine bone-setting manipulation for external humeral epicondylitis. Methods: Ninety-two patients with external humeral epicondylitis were randomly divided into an observation group and a control group. Patients in the control group were treated with extracorporeal shock waves while those in the observation group with traditional Chinese medicine bone-setting manipulation based on the control group. Patients in both groups were evaluated by the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) before and after treatment. The inflammatory factors such as IL-6, IL-10, TNF-ɑ, and clinical outcomes were contrasted before and after treatment. Results: There were statistically significant differences in VAS score, MEPS score, and DASH score between the two groups before and after treatment (p < 0.05). The observation group exhibited a more pronounced improvement in each score compared to the control group. Post-treatment, the inflammatory factors of both groups were significantly lower than pre-treatment levels (p < 0.05), with the observation group showing a more noticeable decrease. The overall effectiveness of the observation group was higher than that of the control group, and the difference was statistically significant (p < 0.05).Conclusion: The combination of extracorporeal shock wave therapy and traditional Chinese medicine bone-setting manipulation can effectively alleviate pain symptoms and improve dysfunction caused by external humeral epicondylitis, while also reducing inflammatory factor expression. This combined treatment may prove more effective than extracorporeal shock wave therapy alone.Clinical Trial: Registration: ChiCTR2200066075.
Pure Red Cell Aplasia - Post Major ABO Incompatible Allogenic Stem Cell Transplantation Role of Ibrutinib
Published on: 24th July, 2024
Pure Red Cell Aplasia (PRCA) is a well-recognized complication of Major ABO-incompatible allogeneic stem cell transplantation. It is featured by anemia, Reticulocytopenia, and the absence of erythroblasts in a normal-appearing bone marrow biopsy. The mechanism for PRCA is presumed to be the persistence of recipient isoagglutinins, produced by residual host B lymphocytes or plasma cells, which probably interfere with the engraftment of donor erythroid cells. Several risk factors for PRCA have been reported, such as the presence of Anti-A Isoagglutininsbefore transplantation, reduced intensity conditioning, absence of Graft Versus Host Disease (GVHD), sibling donor and Cyclosporin A(CsA) as GVHD prophylaxis. PRCA is not a barrier to going ahead with Hematopoietic Stem Cell Transplantation (HSCT). There are many therapeutic options however few recover spontaneously, among the available options include high-dose steroids, Erythropoietin(EPO), Plasma exchange, Donor lymphocyte Infusion (DLI), treatment with Rituximab, Bortezomib, Daratumumab and tapering or discontinuation of immunosuppression. All these options have variable success in the literature ranging from 30% - 70%, Non-responders become red cell transfusion dependent and their quality of life is impaired. We are reporting a novel therapeutic option, Ibrutinib as an armamentarium in treating the PRCA post-HSCT, which works by blocking the Bruton Tyrosine Kinase (BTK) pathway thereby inhibiting the host B cell isoagglutinins production and good clinical response.
Screening for BK Virus Infection in Kidney Transplant Recipients at Mohamed V Military Teaching Hospital
Published on: 25th July, 2024
After kidney transplantation, BK polyomavirus reactivation can manifest as nephropathy in 1% to 10% of patients. PCR testing of urine and blood is commonly used to screen for BK polyomavirus nephropathy. The study aims to detect BK virus infection in kidney transplant patients to prevent tubulointerstitial nephropathy and graft loss. This retrospective study includes 26 patients who underwent kidney transplants between January 2019 and December 2023. We diagnosed BK virus infection by performing real-time PCR on blood and urine samples. BKV DNA was detected in 3 patients. Reducing immunosuppressive therapy led to negative PCR results and favorable clinical and biological outcomes in these 3 patients.
Sinonasal Myxoma Extending into the Orbit in a 4-Year Old: A Case Presentation
Published on: 30th July, 2024
Background: Sinonasal myxomas are exceptionally rare benign tumors in pediatric patients. This report presents the case of a 4-year-old boy diagnosed with a sinonasal myxoma extending into the right orbit.Case presentation: The patient’s clinical presentation included moderate-angle esotropia and ocular torticollis. Advanced imaging revealed an expansile lesion in the right posterior ethmoid cavity with orbital involvement. The differential diagnosis considered included malignancies such as rhabdomyosarcoma and lymphoma, as well as benign neoplasms and inflammatory changes. A biopsy confirmed the diagnosis of sinonasal myxoma. The patient underwent a wide local resection performed by a multidisciplinary team, leading to a confirmed histopathological diagnosis of sinonasal myxoma.Conclusion: This case highlights the diagnostic challenges and the importance of thorough clinical and radiologic evaluation in pediatric patients with unusual ocular symptoms. The report underscores the need for a multidisciplinary approach in managing rare neoplasms such as sinonasal myxomas.
Physical Performance in the Overweight/Obesity Children Evaluation and Rehabilitation
Published on: 31st July, 2024
Introduction: Childhood obesity is one of the current themes of medical research, being considered not so much a multidimensional condition but primarily a real problem of worldwide interest.The aim of our randomized study was to evaluate and compare the effects of physical exercise associated with an educational program on clinical-functional status in overweight and obese children.Material and method: Participants were children hospitalized, through the emergency service, in the Pediatric Department, Craiova Municipal Clinical Hospital, between June and November 2023. 93 overweight and obese children, aged between 2 and 16 years, were evaluated (clinical, paraclinical and functional) by a multidisciplinary team and randomized into the control group (group C – 63 children) and the study group (group S – 30 children). After the resolution of the acute digestive or respiratory disease, the children in group S underwent a program to restore their functional status, based on educational measures (following the 5-2-1-0 rule) and physical exercises, for 12 weeks. Anthropometric data were measured (height, weight, body mass index); physical performance wasevaluated by gait analysis (we used the BTS G – WALK / BTS G – SENSOR 2 system, BTS Bioengineering Corp, Italy) with the determination of four parameters – the Timed Up-and-Go (TUG) test, the symmetry index, the walking test six minutes (6 MWT) and walking cadence or average cadence (steps/min) in both groups of children.The results were obtained by analyzing the differences in values obtained in the two moments T1 (initial) and T2 (after three months). The proportion of girls and boys was approximately equal within obesity class in each study group. Although we did not obtain statistically significant differences between the monitored parameters, between the two groups, for the two evaluation moments, the children in Group S had a clearly favorable evolution for physical performance parameters, whose average value was improved in T2. Anthropometric data did not change.Conclusion: The present study confirms the effectiveness of the multimodal (educational-kinetic) program for the physical performance of overweight/obese children. The sustained running of the program at home, with the involvement of the family and the school environment, is essential for the well-being of these children, with a favorable impact on the quality of life later.
Reliability and Diagnostic Performance of Transient Hepatic Elastography in Chronic Hepatitis C during the Training Phase
Published on: 2nd August, 2024
Chronic infection with the hepatitis C virus (HCV) is estimated to affect 58 million people worldwide and around 700,000 individuals in Brazil. Various non-invasive markers of hepatic fibrosis have been proposed, such as transient hepatic elastography (THE) using FibroScan®. However, the reliability of the performance, by operators in the training phase is undetermined, which hinders its applicability in clinical practice. Objectives: The present study aimed to evaluate the impact of training an inexperienced operator to perform the examinations using FibroScan® in patients with chronic hepatitis C. Specifically, the frequency of unreliable results throughout the training was assessed. Methods: This is a cross-sectional study with retrospective data collection including compensated chronic hepatitis C patients who underwent the examinations using FibroScan® between March 2014 and December 2016, performed by two researchers. Included patients were divided into two groups based on the operator's experience in the examination: the Experienced Examiner (EE) group and the Examiner in Training (ET) group, with the latter divided into two phases: phase 1, consisting of the first 100 examinations, and phase 2, comprising subsequent examinations. For the reliability analysis, parameters such as success rate (SR), interquartile range (IQR) to median (Md) ratio (IQR/Md), and reliability criteria of Castéra, et al. and Boursier, et al. were used. Results: Between March 2014 and December 2016, 771 adult HCV-infected individuals were evaluated and divided into EE group (n = 161), ET phase 1 (n = 100), and ET phase 2 (n = 158), showing similar demographic, clinical, and laboratory characteristics. SR and IQR/Md ratios were similar among EE, ET phase 1, and ET phase 2 groups. The proportion of reliable results was comparable in all three groups, using Castéra, et al. reliability criteria (92.5%, 92.0%, and 97.5%, respectively) and Boursier, et al. criteria (96.9%, 95.0%, and 98.1%, respectively). Conclusion: A short training period (up to 100 examinations) seems to be sufficient for them to have good clinical applicability in the hands of an operator with initial experience in the method
Imaging Challenge in Recurrent Spontaneous Coronary Artery Dissection (SCAD): A Case Report
Published on: 8th August, 2024
Spontaneous Coronary Artery Dissection (SCAD) represents a significant cause of acute coronary syndrome (ACS) in patient populations with low-risk cardiovascular profiles and, therefore can be sometimes underdiagnosed. On the other hand, it often preserves the typical clinical presentation of ACS which makes coronary artery angiography (CAG) execution mandatory. A 62-year-old woman with a history of recurrent SCAD presented to the emergency department for a new episode of acute chest pain with troponin elevation. CAG revealed an ambiguous angiography image suggesting a sub-occlusive type 2 SCAD involving the distal segment of the left circumflex artery. The patient was managed conservatively due to the absence of ongoing ischemia or hemodynamic instability. At the seven-day follow-up, a computed tomography coronary angiography (CTCA) was performed to better assess SCAD and detect concomitant associated arteriopathies. Optimized medical therapy was prescribed at the discharge and at one-month follow-up, no recurrence of symptoms was referred.
Required Elements for Next-generation Prognostic Index beyond Left Ventricular Ejection Fraction in Heart Failure
Published on: 12th August, 2024
Many reports are showing no differences in prognosis between patients with Heart Failure (HF) with preserved and reduced ejection fraction. All-in-one analysis with a multivariable model, including clinical characteristics, blood test, comorbidity, and echocardiographic indices, on clinical outcomes in patients with HF has not been performed rarely in previous studies. We have to accept the need to be more comprehensive in the outcome analysis of patients with HF and consider the intricate interplay of multiple variables in patient outcomes.
Defibrillation of Atrial Fibrillation is not Associated with Increased Risk of Ventricular Fibrillation – The VCD-Trial (Clinical Trial of Electrical Therapy for Atrial Fibrillation using R-wave Guided Cardioversion Versus Defibrillation)
Published on: 19th August, 2024
Background: Because of a possible risk of induction of Ventricular Fibrillation (VF) by defibrillation of atrial fibrillation (AF) postulated by LOWN and coworkers, synchronized cardioversion is used worldwide. This prospective, randomized study assessed the efficacy and safety between R-wave controlled cardioversion and defibrillation of AF at 2 study centers in Cologne, Germany. Hypothesis: Defibrillation is not significantly different from cardioversion primarily in the occurrence of VF or sustained Ventricular Tachycardia (VT) and secondarily in restoring sinus rhythm, inducing non-sustained VT, asystole, or bradycardia.Methods: 146 patients at an outpatient practice and 122 at the university hospital were randomized to cardioversion (n = 140) or defibrillation (n = 124).Results: Cardioversion was successful in 92.1% of cases and defibrillation in 87.1%. The difference in efficacy was not statistically significant. In n = 1 patients receiving defibrillation, VF occurred after the first shock (200J) and immediate defibrillation (200J) restored sinus rhythm. In the n = 1 case, asystole occurred during cardioversion which terminated spontaneously. In n = 1 patients cardioverted and n = 2 who were defibrillated, sinus bradycardia occurred requiring Atropine in two cases. There were no thromboembolic events within 10 days. N = 9 patients reverted to AF within two hours. No patients died. Conclusion: Electrical conversion of AF can be performed with similar results and low risk with both R-wave-triggered cardioversion and defibrillation. In particular, defibrillation with higher energies (> 100J) can be performed as effectively and safely without a statistically significant increased risk of VF or VT. There was no difference in efficacy and risk between electrotherapy performed in the outpatient and inpatient settings.
Clinical Case of Successful Therapy for the Patient with Autism by use of Fetal Stem Cells
Published on: 19th August, 2024
More than 60 million persons all over the world are living with the diagnosis of “Autism”, in accordance with the UNO. According to the WHO, almost every hundredth child is a sufferer of ASD. Such figures emphasize globalization of the problem, and its impact not only on the child’s family but also on the economies of entire countries.Autism diagnosis is difficult and based on the general symptoms in kids. Today, the neuroimaging techniques (methods of functional Magnetic Resonance Imaging (MRI) and MRI tractography), Electroencephalography (EEG), evoked cognitive potentials and dynamic monitoring of the results help with an objective evaluation of stem cell therapy.Treatment options in modern pharmacology and rehabilitation psychotherapy for ASD kids are limited. Therapy methods do not ensure a full integration into social life and personality awareness. To alleviate likely problems in society, different therapeutic approaches exist that might reduce the manifestation of the various autism symptoms. FSC therapy is one such innovative method that has recently become enough popular.We inform about the clinical case of successful treatment using fetal stem cells for a child with autism followed by the period of 1-year follow-up showing significant clinical results. Over one year, the positive changes that had been proved by the ATEC questionnaire, the EEG results, and MRI-tractography were noted by the patient’s family. As emphasized in the clinical case report, fetal stem cell therapy is a promising and efficient treatment for children with autism. All that was sufficiently confirmed by the results acquired because we saw an overall improvement in this patient.
Durable Response to Pembrolizumab and Lenvatinib in a Patient with Chemotherapy-refractory Cholangiocarcinoma
Published on: 18th July, 2024
Cholangiocarcinoma (CCA), a rare malignancy originating from bile duct epithelial cells, often presents a challenging prognosis due to its rarity, delayed diagnosis, and early recurrence post-curative-intent treatments. Additional complexities include difficulties in achieving R0 resection during surgical intervention and the lack of effective second-line treatments following the failure of first-line regimens, particularly in unresectable advanced cases.In this case study, we demonstrate a durable response to a combination regimen of pembrolizumab and lenvatinib in a patient with distal CCA. Despite the regimen’s interim median Progression-Free Survival (PFS) of 6.1 months (95% CI, 2.1-6.4), our patient achieved a clinical and radiological PFS of approximately two years. The underlying mechanisms, potentially involving the upregulation of immune response pathways through undisclosed means or influenced by lenvatinib’s activation of T cells, might augment the sensitivity to PD-1 antibodies like pembrolizumab, contributing to the patient’s sustained response over two years.This case also highlights the significance of the patient’s initial good health condition, multidisciplinary care, and the potential impact of molecular subtyping on treatment selection in a patient with distal CCA who underwent numerous diagnostic procedures, intricate surgical interventions, and subsequent treatment regimens over seven years. Additionally, we underscore significant landmark trials and emerging combination therapies, including chemotherapies, immunotherapy, and targeted treatments in this report.
The Effect of Shoulder Immobilization Position on Outcomes Following Rotator Cuff Repair: A Scoping Review
Published on: 20th August, 2024
Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS).Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies.Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.
Resolution of Chronic Bacterial Prostatitis with Bacteriophage-antibiotic Therapy
Published on: 22nd August, 2024
Chronic bacterial prostatitis is a commonly diagnosed genitourinary infection that presents significant challenges both in diagnosis and treatment. In an upcoming era of antibiotic resistance, and limited therapeutic options it becomes imperative to revise current guidelines and to provide more effective treatment strategies. At the Eliava Phage Therapy Center (Tbilisi, Georgia) we utilize bacteriophage therapy as an alternative approach against chronic bacterial infections. Bacteriophages, viruses that target and lyse specific bacterial cells, can be used as a stand-alone treatment or in conjunction with antibiotics. We present a case report of a patient with prostatitis caused by Escherichia coli infection, who prior to addressing our clinic, has been receiving antibiotic therapy without any positive effect. Our approach of combined use of antibiotics and phages was successful not only in complete clinical improvement but also in total bacterial eradication. This outcome shows the potential of bacteriophage therapy as a valuable adjunct to conventional antibacterials in the management of prostatitis.
Contrast Echocardiography for the Detection of a Giant Right Coronary Artery Aneurysm: A Useful Diagnostic Tool
Published on: 22nd August, 2024
Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1. Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2. The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3. Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis.
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