Effects of exercise on wall shear stress in male and female patients with coronary heart disease
Published on: 21st April, 2023
Coronary heart disease (CHD) seriously endangers human health, and there are obvious gender differences in incidence rate and prognosis, which are related to the evident differences in anatomical structure, physiological characteristics, and wall shear stress between males and females. In recent years, cardiac rehabilitation has been proven to be safe and effective in controlling the progression and improving the prognosis of CHD. Thereinto, exercise therapy is the central link of cardiac rehabilitation. Exercise can significantly affect vascular endothelial function by regulating wall shear stress. Based on previous research, this paper will briefly review the influence of exercise on wall shear stress in male and female patients with CHD, in order to provide a reference for formulating personalized cardiac rehabilitation programs and further improve the prognosis of CHD.
Does change in cervical dilation after anesthesia impact latency after cerclage placement?
Published on: 24th April, 2023
Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.
Minimally invasive cytoreductive surgery in advanced ovarian cancer: A nonselected consecutive series of robotic-assisted cases
Published on: 28th April, 2023
The gold standard for advanced-stage ovarian cancer surgery entails exploration via a midline vertical laparotomy. Studies have shown that minimally invasive surgery (MIS) can be a safe and effective method for the surgical management of early ovarian cancer. In some cases, MIS can also be selectively used for cytoreductive surgery in cases with advanced-stage ovarian cancer. The robotic platform has the potential to provide similar outcomes to the laparotomy-based standard of care in advanced complex surgery while accelerating recovery, minimizing morbidity, and reducing perioperative complications. The primary objective of this study was to evaluate surgical and perioperative outcomes in patients with advanced ovarian carcinoma who underwent robotic-assisted cytoreduction. A chart review of a nonselected consecutive series of all patients undergoing surgical management of advanced ovarian cancer between 7/1/2017 and 12/31/2021 was conducted. All patients that were diagnosed with Stage III to IV ovarian cancer between the timeframe underwent robotic-assisted cytoreductive surgery at two urban community teaching hospitals in Los Angeles. Twenty-five patients were identified and included in this study. All surgeries were performed by a single surgeon. Optimal or complete CRS was achieved in 96% of the patients (24 of 25 cases). Seven (28%) underwent primary cytoreduction (PCRS) and 18 (72%) underwent interval cytoreduction (ICRS). The estimated median blood loss was 100 mL (25-500 mL), the median operative time was 5.9 hours (3.1-10.5 hours), and the conversion rate to open laparotomy was 0%. There were no intraoperative complications and the readmission rate within 30 days was 4% (1 patient) for ileus, which was managed conservatively. Currently, 64% of the patients in the case series remain alive. The median survival has not been reached. The median follow-up is 4.08 years. Results presented from this nonselected, consecutive case series illustrate how a minimally invasive robotic approach can be safely used in place of the standard exploratory laparotomy for ovarian cytoreduction.
The lateralization pattern has an influence on the severity of ankle sprains
Published on: 28th April, 2023
Study design: Descriptive study.Background: Many risk factors contributing to ankle sprains have been studied in medical literature with coordination and balance being two of the major endogenous factors described. These are influenced by lateralization – a developmental and adaptive ability determined by the asymmetrical construction of the human brain, with cross-laterality referring to mixed limb dominance.Objectives: To determine whether cross lateralization is a risk factor for the severity of ligamentous injuries in ankle sprains since no data is yet available on such correlation. Methods: Two hundred forty-four patients with acute ankle sprains (136 men and 108 women) were prospectively evaluated between April 2006 and March 2009. The mean age was 30 (ranging from 18 to 76). Clinical and ultrasonographic examinations were performed on the study subjects. Laterality was then assessed by the Coren questionnaire and the AOFAS score was calculated. Patients with syndesmotic injuries and fractures were excluded from the study. Those qualified were divided into straight and crossed groups, according to their laterality type. Results: One hundred forty-four patients displayed straight lateralization, while cross-laterality was found in 100 subjects. Patients in the crossed group experienced more multi-ligamentous injuries than those in the straight group (p = 0.02). Following trauma, a higher AOFAS score was attributed to subjects that displayed a straight lateralization pattern, in comparison to subjects presenting with crossed laterality (p = 0.04).Conclusion: Crossed lateralization is associated with higher severity of ligament injuries in ankle sprains and may be considered a risk factor for calcaneofibular ligament injuries.
Quality and quantity of bone at intraoral graft donor sites in type 2 diabetic patients versus healthy controls: A cone-beam computed tomography study
Published on: 28th April, 2023
Objectives: This study aimed to compare the quality and quantity of bone at intraoral autogenous graft donor sites in type II diabetes mellitus (DM) patients versus healthy controls using cone-beam computed tomography (CBCT). Materials and methods: This case-control study was conducted on CBCT scans of 50 DM patients and 50 healthy controls between 20-70 years. Maximum height, width, length, and volume of harvestable bone at the symphysis, ramus, palate, and tuberosity were measured bilaterally. The Hounsfield unit (HU) was also calculated to assess bone quality. The two groups were compared regarding the quality and quantity of harvestable bone using an independent t-test. The effect of confounders was analyzed by the regression model (alpha = 0.05). Results: DM patients had significantly lower harvestable bone volume at the symphysis, ramus, and tuberosity than healthy controls (p < 0.001) but this difference was not significant at the palate (p = 0.957). Also, bone quality was significantly lower at the symphysis, ramus, palate, and tuberosity in DM patients (p < 0.001). Conclusion: Diabetic patients had significantly lower bone quality and quantity at intraoral graft donor sites than healthy controls. Mandibular symphysis had higher bone volume and density than ramus, palate, and tuberosity for graft harvesting in diabetic patients.
Effectiveness of levocetirizine in treating allergic rhinitis while retaining work efficiency
Published on: 25th April, 2023
The manifestation and severity of Allergic rhinitis symptoms show diurnal variation which negatively impacts the patient’s quality of life, day-to-day activities, and productivity at the workplace. The symptoms worsen at night or early morning and therefore administration of levocetirizine towards evening may be more acceptable. Consequently, the present study evaluated the effectiveness of evening Levocetirizine administration on 24-hour symptom control, Physical and mental health, and daytime somnolence in patients with allergic rhinitis the study was a prospective, open-labeled, single-arm, two-center, observational study among patients with allergic rhinitis. Levocetirizine was prescribed as 5 mg or 10 mg once a day evening oral dose for at least 7 days before sleep. The 24-hour total nasal symptom scores (TNSS) for self-reported signs and symptoms of allergic rhinitis were recorded. Additionally, study evaluations included the SF-12 scale (Quality of Life), Stanford Sleepiness Scale (degree of sleepiness), and work productivity and activity impairment (WPAI) questionnaires. These evaluations were performed at baseline (Day 0) and at scheduled intervals of Day 1 (24-hour), Day 3, and Day 7. Results demonstrated that evening administration of Levocetirizine facilitates 24-hour symptom control while having no significant effect on daytime somnolence, daily activities, and the work productivity of patients.
Evaluation of catheter related bacteremia in patients with end stage renal disease on hemodialysis
Published on: 25th April, 2023
Infections are common complications among patients on chronic hemodialysis. Hemodialysis patients with a catheter have a 2- to 3-fold increased risk of hospitalization for infection and death compared with patients with an arteriovenous fistula or graft [1].
Patient’s perception of the benefits of long-term opioids: Reinforcement associated with short-term effects
Published on: 3rd May, 2023
The appropriateness of opioid therapy for patients with Chronic Non-Malignant Pain (CNCP) has been questioned by a variety of researchers and policy makers [1-3]. One comprehensive review concluded that the benefits of such therapy for pain relief and functional improvement are modest at best and that opioid therapy is associated with significant harms including various symptoms (e.g., headache, nausea, sedation), development of opioid use disorder, fractures and death from overdose [3].
Results of a prospective strategy for focused Minimally Invasive Parathyroidectomy (MIP)
Published on: 3rd May, 2023
Neck exploration for primary HPT is the standard operation in which 4 parathyroid glands are identified and one abnormal parathyroid gland is removed. This is recommended for all patients with primary HPT. We hypothesized that most patients with primary HPT have a single abnormal parathyroid gland (adenoma) and parathyroid imaging studies will identify it and support a focused minimally invasive parathyroidectomy (MIP). This can be combined with ioPTH monitoring making bilateral exploration unnecessary. This paper reports a 93.4% success rate in 249 consecutive prospective patients with primary HPT over a 15-year period with a short operating time and few complications. The findings suggest that this alternate surgical MIP approach should be the procedure of choice for HPT patients.
Clinical characteristics of patients with respiratory disease and probable COVID-19 at the General Hospital Zacatecas Mexico
Published on: 4th May, 2023
Introduction: The spread of SARS-CoV-2 cases grew exponentially. In Mexico, it focused mainly on containing the disease and adopting activities and actions to mitigate it. Hospital reconversion was a fundamental strategy in the management of care for patients with COVID-19.Objective: To know the clinical characteristics of patients admitted with respiratory disease and probable COVID-19 in the Zacatecas General Hospital “Luz González Cosío” México.Material and methods: Descriptive, cross-sectional, and analytical study, at the General Hospital, from March 2019 to September 2021; using data from the Respiratory Disease Surveillance System. Data from patients admitted with a diagnosis of some pathology of respiratory disease and probable COVID-19 were analyzed.Results: We included 2,678 diagnosed with respiratory disease and a mean age; of 47.6 ± 21.6 gender distribution was almost equal; women 1,344 (51.0%). positive result to COVID-19 by PCR; 1,654 negatives; 900 and 124 without result. 193 (7.0%) required mechanical ventilation. The presence of comorbidities was evaluated; type 2 diabetes mellitus, systemic arterial hypertension, obesity, alone and together. Also the association of the age factor, as well as the lethality index; was 531 (19.6%).Discussion: What has been published in other studies about comorbidities and their influence on the severity of COVID-19 is confirmed, disagreeing on the case fatality rate; 20.7% against what was reported; 17.6% in other countries for COVID-19 hospitalized. An age variable was used as a risk factor with a cut-off point > 45 years; (FRE), obtaining; RR 3.42 (95% CI 2.79 to 4.19) and an odds ratio of 4.015 in binary logistic regression analysis. Reported male mortality (OR = 1.45; 95% CI: 1.41–1.51) according to our OR results; 1,45.Conclusion: The present study shows how certain chronic diseases influenced respiratory disease to present a serious state, regardless of the positive or negative result of COVID-19.
Peripheral perfusion index in critically ill COVID-19 and its association with multiorgan dysfunction
Published on: 8th May, 2023
Introduction: Severe cases of COVID-19 presented a high incidence of multi-organ dysfunction syndrome (MODS) during their evolution. This was attributed to a theoretical cytokine storm, where microcirculatory disorders would play a fundamental role, causing these patients to present a sepsis-like pattern as observed in sublingual microcirculation studies. The evidence in this regard is controversial. The Peripheral Perfusion Index is a reliable method to continuously and non-invasively assess the microcirculatory bed, which assesses the pulsatile (PPI) component of the plethysmographic pulse curve.Methods: We conducted a prospective observational study to evaluate the behavior of the PPI in patients with severe respiratory failure due to SARS-CoV-2 and its association with SDOM.Results: We evaluated 60 patients with APACHE II 14.6 ± 4.4 and SOFA 4.7 ± 2.1. 55% of the patients presented SDOM. Perfusion monitoring showed IP values of 5.32 ± 1.87 that were associated with normal lactate levels of 1.49 mmol/L (min 0.89/ max 2.20 mmol/L). The PPI values between the living and the dead did not show a significant difference (p = 0.854) or the presence of SDOM.The PPI values between the patients who presented renal failure, hemodynamics, or perfusion disorders were determined by the presence of hyperlactatemia, and for those who did not present these characteristics, no statistical difference was found; neither when stratified by PaFiO2 ratio. Mortality was 55%.Conclusion: In our series of patients with severe pneumonia due to COVID-19, we found high PPI values, which would correspond to a pattern of capillary recruitment, and the associated organ injury could not be substantiated by this phenomenon.
Role of Inflammatory Markers in Predicting Severity in COVID-19 Patients at Tertiary Care Hospital, Ujjain (M.P.)
Published on: 12th May, 2023
Originating from China in 2019, the novel Coronavirus Disease 2019 (COVID-19) pandemic had badly affected most of the world causing immense morbidity and mortality. The disease in moderate to severe cases was characterized by intense inflammation leading to ARDS and hypercoagulable states leading to thrombo-embolism and mortality.Aim: This study aimed to explore the association of inflammatory biomarkers with COVID-19 disease severity in our hospital which became a dedicated COVID hospital during the pandemic.
Security and performance of remote patient monitoring for chronic heart failure with Satelia® Cardio: First results from real-world use
Published on: 15th May, 2023
Background: Since 2019, remote patient monitoring (RPM) for patients with chronic heart failure (CHF) has been supported by the European Society of Cardiology. However, real-world data on the use of such solutions has been limited and not primarily based on patient-reported outcomes. The aim of this study was to describe the Satelia® Cardio solution in France within the French ETAPES funding program and assess the security and performance of its clinical algorithm.Methods: A retrospective observational study was conducted on CHF patients monitored by RPM through Satelia® Cardio. From September 1, 2018, to June 30, 2020, patients were included if they had completed over six months of follow-up. The risk of a possible CHF decompensation was categorized by the system in three levels: green, orange and red. The algorithm security and performance were assessed through the negative predictive value (NPV) of the prediction of hospitalization of a patient within seven days.Results: In total, 331 patients were included in this study with 36,682 patient self-administered questionnaires answered. Patients were mostly males (70.4%) and had a mean age of 68.1 years. The mean left ventricular ejection fraction (LVEF) was 35.4% (± 12.3) and 73.3% of patients had a LVEF ≤ 40%. The questionnaire response rate was 90.9%. A green status was generated for 95.3% of answers. There were 4.5% (n = 1,499) orange alerts and 0.2% (n = 74) red alerts. Overall, 92.1% of patients had at least one CHF related hospitalization and 31.7% (n = 105) of these cases were non-scheduled. The NPV at seven days was 99.43%.Conclusion: Satelia® Cardio is a feasible, relevant and reliable solution to safely monitor the cohorts of patients with CHF, reassuring cardiologists about patient stability.
Myocardial fibrosis in aortic stenosis: comparison between clinical data, laboratory, echocardiography, and cardiac magnetic resonance
Published on: 16th May, 2023
Introduction: Patients with aortic stenosis often develop hypertrophy and fibrosis, regardless of symptoms. Cardiac Magnetic Resonance (CMR) represents the gold standard for the evaluation of fibrosis despite numerous limitations: cost, availability, atrial fibrillation, claustrophobia, kidney failure or inability to apnea.Purpose: The aim is to validate the role of echocardiographic parameters, such as Global Longitudinal Strain (GLS), as early markers of fibrosis. Clinical and laboratory data, particularly B-type Natriuretic Peptide (BNP), were also analyzed.Material and methods: In our study we recruited 33 patients with severe aortic stenosis, correlating echocardiographic values of GLS with the qualitative analysis of Late Gadolinium Enhancement (LGE) and the quantitative analysis of T1 mapping of CMR.Results: 70% of patients with an alteration of GLS had LGE+. Univariate logistic regression shows that the factors associated with the presence of LGE on CMR are hypertension (p = 0.043), GLS (p = 0.032), and elevated BNP values (p = 0.021); for GLS, Odds Ratio (OR) is 5 so the chance of finding fibrosis on CMR increases 5 times in presence of an altered GLS. The multivariate analysis confirms the association with impaired GLS values (p = 0.033) and hypertension (p = 0.025), but not with elevated Pro-BNP values.Conclusion: In patients with severe aortic stenosis, the association between GLS, LGE, and T1 mapping can help identify earlier those patients with structural changes caused by the disease, who could benefit from early intervention. It remains to be established how the presence of these alterations has a role in determining the intervention time and the outcome of these patients.
Nasal cytology in patients with previous SARS-CoV-2 infection: occurrence of atypical lymphocytes
Published on: 31st May, 2023
SARS-CoV-2 is a new pandemic infection that affects at the beginning the upper respiratory system, and, successively, all the organisms, due to cytokine storm, with serious consequences that can reach death. The aim of this work was the observation of the nasal mucosa of enrolled 60 patients, resulting negative for two weeks to the molecular swab for SARS-CoV-2, versus the control group. Rhino-fibroscopy and nasal cytology of nasal mucosa were performed for both the investigated groups. The observation of the samples showed the occurrence of plasmablastic lymphocytes and Downey II lymphocytes type. The former type of lymphocytes was prevalent against the second one, probably because of an immunological “scar”. The rhino-fibroscopy showed a “pseudo ischemia of nasal submucosa” at pre and pericranial levels, not occurred in the control group.The occurrence of atypical lymphocytes in the nasal smear was analog to that observed in the blood peripheral smear, probably caused by mechanisms of local immune reaction and dysregulation like those observed in other virus infections. Our findings suggest that the nasal mucosa study through the nasal cytology, can represent an important predictive tool of the SARS-CoV-2 infection.
Particularities of COVID-19 infection in chronic hemodialysis patients in Sub-Saharan Africa: experience from Senegal (West Africa)
Published on: 23rd May, 2023
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in China and has rapidly become a major global health concern. Patients with end-stage renal disease receiving dialysis treatment are very exposed to the SARS-CoV-2 during their frequent visits to healthcare facilities and immune induced by uremia. The aim of our work was to describe the particularity of COVID-19 infection in hemodialysis patients in sub-Saharan Africa and in Ziguinchor, south of Senegal, particularly. To do this, we conducted a monocentric prospective study over a period of 16 months at the Ziguinchor hemodialysis center and compared our results to a study that focuses on the seroprevalence of SARS-CoV-2 in chronic hemodialysis patients. We found a low prevalence of COVID-19 infection while the majority of our patients were in contact with the virus.
The evolving landscape of ENT disorder treatments: Recent advances and innovations (2019-2021) – A Commentary
Published on: 17th November, 2021
The field of Otolaryngology-Head and Neck Surgery (ENT) has seen tremendous progress in the development of advanced treatments for various ENT disorders in recent years. This progress has been driven by advances in technology and research, which have led to the development of new and improved surgical techniques, medications, and devices. As a result, patients with ENT disorders now have more treatment options than ever before, and the quality of care that they receive has improved significantly.
The prognostic value of p53 and WT1 expression in cancer: new molecular insights and epigenetics explanations lead to a new medical hypothesis
Published on: 1st June, 2023
This is a literature review study focusing on the expression of p53 and WT1. Both the p53 and WT1 proteins are tumor suppressors, which means that they play a role in preventing the progression into cancerous ones. If these proteins are altered or deleted, they lose the ability to carry out their role, which might result in the development of cancer. The primary objectives of this study were to review the literature regarding the expression of both p53 and WT1 and to investigate their prognostic significance; and to discuss our new hypothesis regarding the ratios of expression of WT1/p53, as well as our model regarding acute myeloid leukemia. In brief, the objectives were to make the focus in the suggested hypothesis as well as collecting the supportive literature. According to the findings of the current research, the level of expression of WT1 and p53 can indicate either a favorable or unfavorable prognosis for cancer patients. Further, we demonstrated that the expression, not just as a quality variable but also as a quantity variable, may have a more substantial explanation in the progression of tumors than we had previously thought. According to the theory that was derived from this research, if the expression of WT1/p53 (the expression is given as a ratio) is somewhere around 4, then p53 acts as though it were wild type and offers protection against tumors. In order to verify this idea, we need to do additional study.
Oral hygiene status: The critical parameter in orthodontic patient
Published on: 2nd June, 2023
Aim: The aim of this study was to evaluate the oral hygiene status of patients with fixed mechanotherapy appliances.Methods and materials: The following indices were used to evaluate the oral hygiene status of patients in orthodontic treatment: Gingival Bleeding Index (GBI), Plaque index (PI) and OrthoPlaque Index (OPI) at three intervals.T0 (day 1), T1 (15 days), T2 (30 days) for a period of one month.Results: 10 patients (15-30 years old) were selected for the study from among the orthodontic patients treated at the Department of Orthodontics & Dentofacial Orthopedics, AIDSR, Adesh University. Results showed that the mean PI decreased significantly from T0 to T1 & then from T1 to T2, GI decreased significantly from T0 to T1, but then, no significant difference could be found in GI from T1 to T2, OPI decreased significantly from T0 to T1, but then, no significant difference could be found in OPI from T1 to T2. No significant difference was observed between male and female patients for the PI, GI and OPI.Conclusion: Inadequate oral home care among orthodontic patients may increase their risk of gingivitis during treatment. As a result, oral hygiene instructions and a hygiene maintenance program must not be overlooked during orthodontic treatment.
Dorsal intraspinal B-cell Non-Hodgkin lymphoma in two patients
Published on: 8th June, 2023
Non-Hodgkin Lymphoma is rarely diagnosed as spinal cord compression syndrome. Caused by an epidural mass, this complication is often encountered in the late stage of the disease. We report two cases presenting symptoms of low thoracic spinal cord compression due to an epidural tumor on the MRI. Possible complications that may occur and how to prevent adverse events during surgery are essential. This case is of special interest for being a low-incidence pathology in a rare location. The case is of high interest because of the importance of resecting the lesion to prevent sequels and the complexity of its management and highlights the importance of considering the diagnosis of this event.
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