Incidence and features of heparin-induced thrombocytopenia in mechanical heart valves and immunologic cardiac diseases
Published on: 5th January, 2022
OCLC Number/Unique Identifier: 9391755940
Background: Heparin-induced thrombocytopenia/thrombosis (HIT/T) is characterized by a fall in platelet count 5-10days after starting heparin therapy and is diagnosed with specific 4-T clinical features and laboratory tests. This complication is relatively common in Cardiothoracic surgery patients. Objective: To evaluate the positive and negative predictive value of various HIT laboratory tests and assess any correlation between HIT, the underlying diagnosis, underlying procedure, and mechanical cardiac devices. Patients and methods: The patient’s medical records were correlated with two laboratories HIT diagnostic tests, the pan-specific screening test with IgG, IgA, and IgM antibodies, followed by HIT specific IgG ELISA. Results: Total n = 80 patients were assessed, 48% (n = 38) were HIT screen pan-specific negative and 50% (n = 40) were HIT pan-specific positive and 2 cases were inconclusive. 17% (n = 14) were both pan-specific and specific HIT IgG ELISA positive. There were 5 atypical cases. One patient had Eosinophilic myocarditis and was HIT ELISA IgG neg. Argatroban was given on clinical grounds with successful recovery. One patient with Sarcoidosis had an aggressive course and received IV Immunoglobulin (IVIG) but succumbed secondary to liver failure. One patient progressed to gut ischemia and had surgical intervention but succumbed. Two patients with mechanical heart valves were on Argatroban but relapsed and responded to IVIG therapy. Conclusion: Our study indicates that 9/16 (> 50%) HIT-positive patients had valve replacement or cardiac devices suggesting that like knee arthroplasty there is a high incidence of HIT in patients with mechanical heart valves and cardiac devices and this warrants further prospective study.
Age, smoking, hypertension, and aortic aneurysm: Interactions and risks
Published on: 6th January, 2022
OCLC Number/Unique Identifier: 9391753907
Background/Aim: Aortic aneurysm is the bulging of a weakened portion of the aorta. The aorta is the major blood vessel that feeds blood (carrying oxygen, nutrients and water) to the tissues of the body. When a portion of the wall of the aorta becomes weak, blood pushing against the vessel wall can cause it to bulge like a balloon (aneurysm) leading to aortic dissection (a tear in the wall of the aorta that can cause life-threatening bleeding or sudden death). Blood pressure is the force arterial blood exerts on the wall of the artery. When this pressure is consistently high above 140/100 mmHg it is referred to as hypertension. As an individual gets older over time, physiological functions of the body depreciate leading to some abnormalities. Smoking is the consumption of tobacco mostly by inhalation of the smoke that is produced from burning the tobacco. This review article examines the close interactions between age, smoking, hypertension and aortic aneurysm, with a view to understanding mechanisms by which these factors predispose a patient to an aortic aneurism. It is also to observe if these factors interfere with treatment and recovery from aneurysms. Conclusion: After careful review, it is observed that age and smoking are risk factors for hypertension, and together with hypertension, the three factors predispose an individual to high risk for aortic aneurysm.
Spinal cord involvement in tuberculous meningitis: a case report and brief review of literature
Published on: 15th March, 2022
Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.
The surrey county lunatic asylum-an overview of some of the first admissions in 1863-1867
Published on: 31st May, 2022
In the 19th Century in much of Western Europe and North America the number and size of asylums increased hugely. In London, there was a wave of new asylums built in response to the 1808 County Asylums Act and the 1845 Lunacy Act, which required publicly funded care for those deemed mentally unwell. One such asylum was the Surrey County Lunatic Asylum which was built on the grounds which now house Springfield University Hospital in South West London.This paper describes the admission records from Surrey County Lunatic Asylum, between 1863-1867, from information stored in the London Metropolitan Archives. Although the terminology is different from that of today’s, the picture the records paint is of an institution aiming at recovery rather than long-term incarceration which can be how asylums are now remembered. This more nuanced view is starting to be discussed more in public conversations about the topic. The optimism this may imbue is tempered by the shocking number of patients who died within the institution.
Incidence, risk factors, and outcomes of acute kidney injury among hiv positive medical admissions at the Bamenda Regional Hospital
Published on: 16th June, 2022
OCLC Number/Unique Identifier: 9538011570
Background: There is a paucity of data on the burden of acute kidney injury (AKI) in hospitalized HIV-infected patients in Sub-Saharan Africa in the “test and treat” era.Objectives: To study the incidence, risk factors, and outcomes of AKI among HIV-positive medical admissions in a secondary hospital.Materials and methods: We prospectively screened adult HIV-positive patients who gave their informed consent and were admitted to the Bamenda Regional Hospital for AKI from February to June 2020. We excluded participants with Chronic Kidney Disease (CKD) Stage 5 and those with confounders of serum creatinine. On admission and after 2-7 days, we extracted a venous blood sample from each participant to evaluate serum creatinine and diagnose AKI. The participants were then followed up on until they were discharged or died. We measured the need for dialysis, access to dialysis, and renal recovery at three months for patients with AKI. The amended KDIGO 2012 criteria were used to define and classify AKI. The University of Bamenda’s institutional review board provided ethical approval.Results: A total of 206 participants (39.8% men) were enrolled, with a mean (SD) age of 45.71(13.13) years. On enrolment, 89.8% (n = 185) of the participants were on combination antiretroviral therapy (c-ART), with 81.6% (n = 151) on tenofovir-containing regimens. The WHO HIV clinical stages 3 and 4 were present in 81.5% (n = 168) of the individuals. The most common reason for hospitalization was opportunistic infections (69.8%; n = 142). AKI was found in 30.6% (n = 63) of the patients, with 58.7% (n = 37) of them being classified as KDIGO stage 3. A total of 12 (42.9%) participants out of the 28 in need, were dialyzed. AKI was independently associated with use of traditional medicines (aOR = 2.9; 95% CI 1.4-6.3; p = 0.006), WHO HIV stages 3 and 4 (aOR = 4.1; 95% CI 1.1-15.7; p = 0.038), hypotension (aOR = 3.3; 95% CI 1.4-7.8; p = 0.008) and low haemoglobin level ≤ 8.0 g/dl (aOR = 3.5; 95% CI 1.7-7.4; p = 0.001). The AKI group used to have a significantly higher mortality rate (42.9% vs. 16.1%; p < 0.001). Renal recovery was complete in 66.7% of the 30 survivors at three months, partial in 13.3%, and no recovery in 20% of the survivors.Conclusion: Despite the growing use of combination antiretroviral medication, significant immunosuppression is still common in hospitalized HIV-positive patients, increasing the risk of AKI and worsening prognosis. In this high-risk population, early detection of AKI with renal function monitoring may improve results.
Addiction and leadership: How authentic and transformative leaders are emerging from the adversity of substance use disorder
Published on: 7th July, 2022
OCLC Number/Unique Identifier: 9575224206
Objectives: This novel study explores the leadership traits held by people with substance use disorder. The purpose of this study is to help advance understanding of the positive qualities people with substance use disorder possess which can produce positive societal and organizational benefits once that person enters recovery. Additionally, this understanding can provide insight into effective treatment approaches that incorporate personal attributes that are present within active addiction. Methods: A qualitative methodology was used which included semi-structured interviews, observations, and a focus group which allowed the researcher to conduct a thematic coding analysis. The participants came from diverse backgrounds and included participants from multiple regions across the United States. Leadership was defined as having various dimensions of effective leadership that are found in both Transformational and Authentic Leadership Theories. Results: The findings revealed that people in addiction possess numerous leadership traits which position them for effective leadership and are further enhanced during their recovery journey. The top three traits which emerged from the data indicate that people in recovery from addiction are authentic, tenacious, and empathetic. Additionally, those in recovery have strong abilities to empower and inspire others and demonstrate posttraumatic growth which helps establish significant bonds of trust and commitment among followers. Conclusion: The impact of this study will change how people view addiction. Identifying the hidden treasures of leadership which are present in those struggling with addiction could illuminate recovery pathways that help identify purpose and value. This would not only advance treatment opportunities but greatly assist organizations that need strong leadership. People with substance use disorder have all the right tools to become effective leaders, and this understanding can help mitigate the stigma associated with addiction and paint it in a more positive light.
The “manna” extracted from the ash trees still cultivated in Sicily from mythical food to pharmaceutical and nutraceutical resource
Published on: 30th August, 2022
“Manna” is the product obtained from the solidification of the elaborate sap that comes out of the incisions made during the summer season on the stem and on the main branches of some species of the genus Fraxinus (Oleaceae). The cultivation of manna ash trees dates back to ancient times in Sicily and elsewhere ash trees – known as sacred trees, a symbol of abundance and therefore auspicious – was increasingly widespread until the middle of the last century. Subsequently, however, the crop underwent a progressive decline, remaining relegated to restricted areas of Sicily, in particular in the Madonie district (Palermo, Italy). In this brief review, the essential characteristics of the manna and the ash trees from which it is extracted are summarized. The aspects of the current productivity of manna in the Sicilian territory and the implications of a potential recovery and increase of an ancient craft, ash tree cultivation, are also reported in a perspective of sustainable development and green economy for the Mediterranean area and beyond. Finally, the authors remember what has been done to ensure the conservation not only of the active cultivation of manna ash but also of all the relative agro-biodiversity. The conservation of the living germplasm of the ancient cultivars recovered in the Madonie area (Palermo, Sicily) represents one of the most qualifying results.
Shoulder recovery for head and neck cancer patients after unilateral neck dissection: a pilot exploratory study
Published on: 28th September, 2022
An established side-effect of neck dissection (ND) for head and neck (HNC) tumour management includes shoulder dysfunction (SD), which can impact quality of life (QOL). Shoulder strength and range of movement (ROM) are key parameters to be monitored in SD. However, such evaluations are not routinely conducted in the clinical setting. The aim of this study was to evaluate objectively the impact of ND on shoulder functions. Methods: This is a pilot exploratory study in a tertiary cancer centre. Five participants with unilateral ND and advanced HNC, completed the study. Outcome measures consisted of self-reported QOL questionnaires, C2–T1 dermatomes and shoulder ROM and strength testing. Data was collected at baseline, 1.5-months after surgery and 6-months after diagnosis (after adjuvant treatment completion). Results: Most outcome measures on the surgically affected side were negatively impacted post-operatively, with varied recovery seen at follow-up. Sensory loss was noted at C3–4 dermatome levels. Shoulder ROM and strength was reduced on the surficial side for all participants, with some recovery after six months except for two participants.Conclusion: Results of SD after ND are diverse and unique to each patient. Findings from this pilot study indicate that regular rehabilitation/exercise may facilitate recovery of shoulder function post HNC surgery. However, customised rehabilitation may yield better outcomes. Future studies with a larger sample are indicated to validate the findings of this study.
Recovery of craniofacial proportions using the Nuvola Op System protocol
Published on: 9th December, 2022
The stomatognathic apparatus is currently understood as a complex functional unit in its muscular, skeletal, dental, and neurological parts; in particular, it is now commonly acknowledged that the craniofacial district is connected to the type of occlusion not only functionally but also morphologically. Occlusion is the result of the adaptation of dental organs that can adapt through the periodontium and cranial bones through sutures, with the “neurological direction” of the function and tone of the perioral, lingual, and craniocervical muscles
Postpartum as the best time for physical recovery and health care
Published on: 2nd January, 2023
Aim: The current paper presents a subjective symptom survey regarding postpartum discomfort (Study 1) and a case study on postpartum care using the program developed based on the survey results (Study 2). Thereafter, health care during the postpartum period is discussed.Methods: Study 1 analyzed 1638 postpartum women who completed the Subjective Fatigue Symptom Scale (SFSS) over the period from June 2012 to December 2019. Study 2 detailed the case of a 33-year-old primiparous woman who answered questions regarding the rehabilitation care program.Results: The 1638 subjects included in Study 1 had a mean age of 32.4 ± 8.2 years and a mean postpartum duration of 4.3 ± 2.3 months. Subjective symptoms included lower back pain, shoulder stiffness, sleepiness, wanting to lie down, yawing, and eye strain. The case included in Study 2 showed certain psychological and physical changes following the exercise program. The results of Study 1 showed that motor system discomfort, such as stiff shoulders and lower back pain, occurred in women across all postpartum stages. Our results demonstrated that care and exercise geared toward improving motor system function are imperative after childbirth. Meanwhile, the results of Study 2 imply that our rehabilitation program based on postpartum physical conditions had positive psychological and physical effects.Conclusion: Taken together, our results suggest that continuing rehabilitative care based on the physical condition during each postpartum stage facilitates improvement in mothers’ physical and psychological discomfort.
Rhabdomyolysis in a pregnant woman: A case report
Published on: 16th January, 2023
Hyperemesis gravidarum may prompt hypovolemia and significant electrolyte anomalies. Hypokalemia is one of the most common abnormalities. When practical, it may lead to rhabdomyolysis. We report a rare case of rhabdomyolysis in a 24 years old pregnant woman due to hyperemesis gravidarum. She had a profound weakness. Physical examination and laboratory findings showed a need for the hospital admission. Aggressive rehydration and electrolytes were the definite treatment. Her serum creatinine kinase (CK) concentration during entry was 80,01 units/L.Continuous rehydration led to complete recovery clinically. On discharge, she had normal laboratories.
Three-phase partitioning for isolating peroxidase from lemon peels
Published on: 21st March, 2023
Background and objective: Peroxidase is an oxidoreductase that uses different compounds as substrates and thus can be utilized for different applications. The goal of this work is to isolate peroxidase from lemon peels using Three-Phase Portioning (TPP). Methods: TPP was set by adding varying amounts of salts and alcohol and the enzyme activity recovery was measured for each variable. Different parameters were optimized successively in order to achieve the highest enzyme activity recovery including salt type, salt concentration, pH, alcohol/crude extract ratio and type of alcohol and then, combining all optimized conditions together.Results: Salt that gave maximal recovery was sodium potassium tartrate, optimal salt concentration was 15%, optimal pH was 8, optimal alcohol/crude extract ratio was 1 and t-butanol was preferred to 1-butanol. Efficiently, upon combining all optimized factors, an activity recovery of 175% was obtained.Conclusion: This protocol provides an easy, feasible method to efficiently isolate peroxidase from lemon peels using TPP.
Effectiveness of massage chair and classic massage in recovery from physical exertion: a pilot study
Published on: 24th March, 2023
Quick and cost-effective recovery is foundational to high-quality training and good competition results in today’s sports. The aim of the research was to elucidate the effects of hand and massage chair massage on the biomechanical parameters of muscles of lower limbs and back, indicators of Pain Pressure Thresholds (PPT) and subjectively perceived fatigue. A total of 32 female recreational athletes (18 – 50 years old) were assigned to a hand massage, massage chair, or lying down the group. They were measured for muscle biomechanical properties (MyotonPro), PPT (Wagner Instruments) and subjectively perceived fatigue (VAS scale) before and after fatigue tests and treatment. The recovery procedure and subjective satisfaction with treatment were rated on a Likert scale. Changes in the median value of m. rectus femoris and m. gastrocnemius stiffness with treatment showed that hand massage could be more effective in reducing stiffness, as compared to chair massage. Hand massage may have benefits for recovery from physical exertion, but due to the individuality of subjects, detailed methodological studies are needed to evaluate the effects of massage chair vs. hand massage.
Economic feasibility of using agricultural wastes for catalyst development
Published on: 24th March, 2023
Resource recovery provides an opportunity to transform limited and abundant materials in form of waste into biobased products. In the production system, this technique could offer an economic means to utilize wastes to generate valuable products which are fundamental to a sustainable economy.
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.
Collegiate athlete with unilateral swollen arm after exercise
Published on: 8th June, 2023
A collegiate football player presented to the athletic training room with the complaint of intermittent left upper extremity swelling. Deep vein thromboses as well as abnormalities of the cervical spine were ruled out initially. He was referred to a vascular surgeon and diagnosed with McCleery Syndrome after evaluation of the thoracic outlet with dynamic ultrasound testing. He was treated surgically for decompression of his venous thoracic outlet syndrome and has since made a full recovery.
Evaluation of Biostimulants Based on Recovered Protein Hydrolysates from Animal By-products as Plant Growth Enhancers
Published on: 3rd July, 2023
Free amino acids-based biostimulants are gaining momentum in Europe for sustainable agriculture. They stimulate plant growth, improve crop productivity, and reduce reliance on harmful fertilizers. Enzymatic hydrolysis is used to develop biostimulants from animal by-products, such as greaves and protein-rich wastewater from processed animal proteins. The effectiveness of enzymatic hydrolysis depends on selecting the appropriate conditioning stage for the by-products, yielding protein in the range of 86% to 97%. These protein hydrolysates, with optimal amino acid compositions, are evaluated as biostimulants. Promising results show growth improvements of 17% to 31% in Chinese cabbage and lettuce seeds. The optimal dilution concentration ranges from 0.05% to 0.3%, depending on the protein hydrolysate used. The findings highlight the potential of these biostimulants to enhance plant growth and productivity while reducing environmental impact by replacing chemical fertilizers. They offer sustainable alternatives for promoting environmentally friendly practices in agriculture.
Clinical and Epidemiological Profile of Reversible Acute Kidney Injury with Full Recovery: Experience of a Nephrology Department
Published on: 10th October, 2023
Purpose: Acute kidney injury (AKI) is a real public health problem due to its severity and gravity. In a 2013 meta-analysis, Susantitaphong, et al. estimated the incidence of AKI worldwide at between 10% and 20%. In the latter study, no African studies were included, given the lack of data in the literature. Our objective was to identify the clinical and paraclinical epidemiological characteristics of patients with AKI.Patients and methods: We conducted a retrospective study including patients who had AKI with recovery of normal renal function hospitalized in a nephrology service between 2002 and 2015.Results: Our population consisted of 107 men and 107 women with a median age of 61 years (IQR 43-73.25) of which 42.1% were multitargeted. Functional AKI represented the predominant mechanism of AKI retained in our study with a rate of 53.2% with dehydration as the main etiology for 108 patients (50.46%). Organic cause was retained in 38.8% of patients, with acute tubular necrosis (ATN) as the most frequent etiology (37.35%). Kidney disease improving global outcomes (KDIGO) stage 3 was the stage retained for 115 patients included in our series, 31 of whom required extra renal purification. During their hospitalization, 78.5% of the patients presented a persistent AKI (duration of the episode > 7 days). A glomerular filtration rate (GFR) lower than 60 ml/min/1.73 m² at discharge was found in 119 patients and 10 patients had a GFR higher than 90 ml/min/1.73 m². After 3 months from discharge, 77.5% of patients had a GFR between 60 and 90 ml/min/1.73 m².Conclusion: Our results give us an idea of the epidemiological and clinical characteristics of patients who have had acute renal failure with recovery of normal renal function and enable us to better recognize patients at risk in order to avoid such complications. AKI remains a major issue and knowing its epidemiological and clinical characteristics will allow its prevention.
Case – Late Presentation of Invasive Keratinizing Squamous Cell Carcinoma
Published on: 27th December, 2023
Penile cancer, a rare but highly morbid disease, primarily manifests as squamous cell carcinoma (PSCC) originating from the squamous cells of the glandular and preputial skin. Late-stage diagnosis is common due to social stigma, psychological barriers, and nonspecific initial symptoms, resulting in poor overall survival rates, especially in metastatic cases. This case report illustrates a 38-year-old man with advanced metastatic PSCC, showcasing severe systemic manifestations and delayed presentation of the disease. Despite aggressive treatment options, the patient opted for palliative care, succumbing to the disease months after his diagnosis. Risk factors for PSCC include HPV infection, phimosis, chronic inflammation, and lifestyle factors, with higher prevalence in regions of low socioeconomic status. The psychological and sexual burden of penile cancer is significant, impacting patients’ well-being, mental health, and quality of life. In conclusion, efforts to reduce the stigma associated with penile cancer are crucial to prompt early diagnosis and treatment initiation. Encouraging seeking medical attention for symptoms can enhance the chances of recovery and minimize the need for invasive treatments. Addressing the psychosocial impact of the disease is imperative for holistic patient care.
The Cortisol Connection: Weight Gain and Stress Hormones
Published on: 28th March, 2024
Weight gain can be good or bad for health. Benefits include increased health for overweight people, disease or surgical recovery, and more. Health concerns, joint and musculoskeletal disorders, respiratory issues, metabolic abnormalities, cardiovascular health, psychological impact, reduced mobility, digestive troubles, hormonal changes, and cancer risk are negative impacts. Weight gain outcomes depend on heredity, weight distribution, and health. Maintaining a healthy weight needs a balanced diet, regular exercise, and stress management. A doctor or nutritionist can offer personalized weight management advice. Stress chemicals like cortisol trigger weight gain. ACTH stimulates adrenal glands to release cortisol, which increases hunger, fat storage, insulin resistance, and muscle loss. Understanding how stress hormones like cortisol affect weight gain is vital to reducing chronic stress’s health risks. Stress reduction, a balanced diet, regular exercise, proper sleep, social support, and professional treatment can mitigate these outcomes. Ultimately, stress hormones like cortisol can cause weight gain, but a holistic strategy tackling physical and psychological stress can help people maintain a healthy weight.
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