ResearchPad - miscellaneous https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Recurrent Venous Thromboembolism in a Patient with Klippel-Trenaunay Syndrome Despite Adequate Anticoagulation with Warfarin]]> https://www.researchpad.co/article/elastic_article_11582 Klippel-Trenaunay syndrome (KTS) is a rare genetic condition defined by capillary malformation, venous malformation, and soft tissue and bony overgrowth. Due to venous malformations, individuals are predisposed to intravascular coagulopathy leading to thrombosis and thromboembolism. However, anticoagulating these patients long-term remains a challenge because of the presence of capillary malformations that increase bleeding risk. We present a rare case of a 30-year-old Caucasian male with KTS and history of gastrointestinal bleeding who has been on anticoagulation since the age of 7 and has had three different inferior vena cava filters placed during his lifetime. At presentation, he had dyspnea with stable vital signs. His prothrombin time/international normalized ratio was 37.3 and 3.2, respectively and chest computed tomography showed bilateral segmental pulmonary embolism (PE). He was treated with heparin drip and his home anticoagulation was switched from warfarin to apixaban at the time of discharge for better anticoagulation optimization. KTS is a condition associated with venous thromboembolic complications that can be difficult to manage. PE should remain on the top of the list of differential diagnoses in patients with KTS presenting with dyspnea even if laboratory findings suggest an alternate diagnosis.

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<![CDATA[Association of Oxidative Stress and Production of Inflammatory Mediators Matrix Metalloproteinase-9 and Interleukin 6: Systemic Events in Radicular Cysts]]> https://www.researchpad.co/article/elastic_article_10535 Background

Matrix metalloproteinase-9 (MMP-9) and antioxidants are associated with the pathogenesis of cysts and may initiate and sustain the formation of new capillaries.

Objective

The objective of this study was to determine the association of oxidative stress and the production of inflammatory mediators MMP-9 and interleukin 6 (IL-6) in systemic events in radicular cyst growth.

Materials and methods

Fifty patients (34 men, 16 women) with periapical granulomas and radicular cysts were included in this cross-sectional study. Twenty subjects (12 men, eight women) with no signs of periodontal diseases were recruited as controls. Blood serum levels of MMP-9, IL-6, superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GPx) were recorded. We also recorded body mass index (BMI) and tumor necrosis factor-alpha (TNF-alpha) levels.

Results

The mean age of the test group patients and control patients was 45.9 and 48.8 years, respectively. The BMI of test group patients (23.77± 3.88 kg/m2) was higher than that of the controls (27.98 ± 3.88 kg/m2; p ≤ 0.000). Levels of serum MDA (p ≤ 0.033), IL-6 (p ≤ 0.041), TNF-alpha (p ≤ 0.004), and MMP-9 (p ≤ 0.033) were significantly increased in patients as compared with control values. SOD (p ≤ 0.003) and GPx (p ≤ 0.033) levels were significantly reduced in patients as compared with controls.

Conclusion

Oxidative imbalance and the increased production of inflammatory mediators may be associated with systemic events in radicular cysts. Bone-resorbing mediators and proinflammatory cytokines that were evaluated in the study (MMP-9, IL-6, C-reactive protein, TNF-alpha) were also elevated in the serum of the ailing group, thus documenting a well-established role for these circulating biochemical variables in the course of the progression and pathogenesis of radicular cyst development.

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<![CDATA[Stringent Emission Control Policies Can Provide Large Improvements in Air Quality and Public Health in India]]> https://www.researchpad.co/article/Nb1098b2b-f8d1-46e9-80dc-86448468f6a3 Air pollution is a major risk factor for human health in IndiaPopulation aging and growth will increase the disease burden due to exposure to particulate air pollution even under no emission changeStringent emission control reduces mortality rate in 2050 below 2015 levels although total premature mortality increases

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<![CDATA[A Preliminary Report Showing Spinosad and Fluralaner Are Able to Incapacitate Cimex lectularius L., the Common Bed Bug]]> https://www.researchpad.co/article/N107cefe5-6479-4a9c-9b8b-5d09cbf6dd3f Cimex lectularius L., the common bed bug, is a hematophagous human ectoparasite. The veterinary drugs, spinosad and fluralaner, were studied for their ability to incapacitate C. lectularius when administered in a blood meal using an artificial feeding system under laboratory conditions. Tested drug doses were based on the reported peak blood levels in animals given the drugs. Spinosad at doses 1,000 ng/mL or higher resulted in 75% or greater bed bug incapacitation (defined as death or immobility). Fluralaner at doses 500 ng/mL or higher had 100% bed bug incapacitation. Both drugs were significantly more effective than controls at these doses (< 0.001).

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<![CDATA[A Post-operative Masquerade: Simulation-based Scenario Challenging Clinical Clerks to Recognize an Atypical Presentation of Myocardial Infarction]]> https://www.researchpad.co/article/Nc3ce8615-483b-47ec-8ec0-99acf94eb142 Post-operative myocardial infarctions (MI) are a challenging diagnosis due to the alterations in the presenting complaint compared to an acute MI. Patients may be asymptomatic due to their anesthetics and sedatives from their operation which may create clinical confusion. As such, there is an increased risk for delayed administration of reperfusion therapies in this patient population which has shown to increase morbidity and mortality. It is anticipated that the difficulty of recognizing a post-operative MI would be exacerbated for clinical clerks due to their lack of clinical experience and overstimulation. Fortunately, the use of simulation-based learning has been proven to be a useful teaching tool to help clinical clerks manage medical problems in a controlled environment. This technical report describes a simulation case designed to enhance the recognition and response to a post-operative MI by a third-year clinical clerk. In this scenario, a 56-year-old male accountant presents with shortness of breath while recovering in the orthopaedic ward 12 hours following a total knee replacement (TKR). The clinical clerks are expected to conduct an independent follow-up prior to finishing their shift during which the patient begins complaining of shortness of breath. The clerk is required to order an electrocardiogram (ECG) for further analysis which reveals an anterior ST-segment elevation. Once recognized, a request for the crash cart and patient handover to the senior physician are expected.

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<![CDATA[Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: A Case Report]]> https://www.researchpad.co/article/N639c0ff9-cd2b-4087-812b-9f5c94c4730b

Sudden sensorineural hearing loss (SSNHL) is most often defined as a rapid hearing loss of ≥ 30 decibels across at least three contiguous audiometric frequencies over a time of ≤ 72 hours. Cupping therapy has been practiced across the world for thousands of years. Cupping therapy is practiced by creating suction inside cups that are placed on predefined skin areas. Our case is a 48-year-old female with a four-year history of Meniere’s disease, recurrent tinnitus, episodes of dizziness attacks, and fullness of the right ear. The patient developed sudden sensorineural hearing loss. She received conventional treatment and wet cupping therapy as a complementary integrative treatment. After the integrative management protocol was completed, pure tone audiometry tests revealed significant hearing improvement across almost all frequencies. To the best of our knowledge, this case presentation is the first reported case of this type. A positive effect of cupping was reported in our case as an integrative complementary treatment. Large, well-designed quality clinical trials to evaluate the efficacy and safety of wet cupping therapy (WCT) as a complementary treatment of SSNHL is highly recommended.

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<![CDATA[Comparison of CLIF-C ACLF Score and MELD Score in Predicting ICU Mortality in Patients with Acute-On-Chronic Liver Failure]]> https://www.researchpad.co/article/N2c1b0026-bcb9-4476-b37f-d4964e0c2137

Introduction

Acute-on-chronic liver failure (ACLF) is a serious complication of liver cirrhosis which presents with hepatic and/or extrahepatic organ failure and often needs admission to an Intensive Care Unit (ICU). This condition typically needs organ support and carries a high mortality rate. ICU care may not benefit these patients. There are many scores to assess prognosis in these patients, such as the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na), the chronic liver failure organ failure (CLIF-OF) score, the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and the Child-Turcotte-Pugh classification. This study was conducted to compare CLIF-C ACLF and MELD scores for selecting patients at risk of high mortality, as ICU care to these patients in the absence of liver transplantation may be of no value.

Methods

The data of 75 patients admitted to the ICU of Shifa International Hospital in Islamabad were prospectively analyzed. CLIF-C ACLF and MELD scores were calculated at admission and then at 24 and 48 hours after the ICU stay. Data were analyzed with the assistance of SPSS. Mortality was the primary outcome.

Results

Comparison of both scores showed that a CLIF-C ACLF score ≥ 70 at 48 hours predicts mortality more accurately, with an area under receiver operating curve (AUROC) of 0.643 (confidence interval [CI] 95% 0.505-0.781; p=0.046) which was significantly higher than MELD scores of 30,40 and 50 at 48 hours. Organ failure and the need for supportive care were strong predictors of mortality (p= < 0.05).

Conclusion

We concluded that a CLIF-C ACLF score ≥ 70 at 48 hours and organ failure are better predictors of mortality and that ICU care in these patients does not benefit them. Definitive therapy in the form of liver transplantation may have a promising role, if considered early.

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<![CDATA[Efficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Randomized, Double-blind, Placebo-controlled Study]]> https://www.researchpad.co/article/Nbe49d8a2-d159-48f2-8114-3733d98e0106

Background

Ashwagandha is an excellent adaptogen that is being used since ancient times in Ayurvedic medicine. Traditionally, it is used for various ailments and general well-being, including the treatment of geriatric patients. Managing quality of life (QoL) remains a challenge for the elderly population, especially joint pain management, sleep, and general well-being. With a growing global elderly population, QoL management with efficient medication and supplementation is the major healthcare requirement.

Objective

The objective of this study was to assess the safety, efficacy, and tolerability of Ashwagandha (Withania somnifera (L.) Dunal.) root extract on the improvement of general health and sleep in elderly people.

Methods

This 12-week, prospective, randomized, double-blind, placebo-controlled study was conducted on individuals of either gender aged between 65-80 years. Participants were randomized to receive Ashwagandha root extract at a dose of 600 mg/day (n = 25) orally, or identical placebo capsules with the same dose (n = 25) for 12 weeks. Efficacy was assessed using the WHOQOL-BREF questionnaire, sleep quality, mental alertness on rising, and Physician’s Global Assessment of Efficacy to Therapy (PGAET). The safety and tolerability were assessed using the clinical adverse events reporting and Patient's Global Assessment of Tolerability to Therapy (PGATT).

Results

Statistically significant (P<0.0001) improvement was observed in the Ashwagandha treatment group compared to the placebo. The mean (SD) total score of WHOQOL-BREF improved from 140.53 (8.25) at the baseline to 161.84(9.32) at the end of the study. The individual domain scores were also improved. At baseline, the sleep quality and the mental alertness on rising were comparatively low in both the groups. However, upon intervention, a significant increase in the quality of sleep (P<0.0001) and mental alertness (P<0.034) was observed in the Ashwagandha treatment group when compared to the placebo group. Overall improvement was observed for the general wellbeing, sleep quality, and mental alertness in the study population. The experimental group population displayed good tolerability to the test product and it was reported as safe and beneficial by the study participants. 

Conclusion

The study outcomes suggest that Ashwagandha root extract was efficient in improving the QoL, sleep quality, and mental alertness as self-assessed by the elderly participants. The recommended dose used in this study could be effective for the elderly population. 

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<![CDATA[European Immunization Week 2020: European Vaccination Information Portal launched]]> https://www.researchpad.co/article/Nc2bf267c-f84a-4b87-84ba-ef6024cb6fb4 ]]> <![CDATA[An Epidemiological Study on COVID-19: A Rapidly Spreading Disease]]> https://www.researchpad.co/article/N2dfaebb4-3c3d-4280-b015-2585216d55f6

Background

The outbreak of the novel coronavirus disease in 2019 (COVID-19) caused a major public health crisis worldwide and challenged healthcare systems across the six continents. The high infectivity of the disease led many governments to adopt strict regulations and measures with the aim of containing its spread. The purpose of this study is to assess the incidence, severity, and territorial expansion of COVID-19.

Methods

Data from the World Health Organization was screened, and COVID-19 situation reports were extracted from January 21 up till March 14 (inclusive). Our data included the total number of cases, total number of new cases, total number of cured cases, and total number of related deaths. Percentage change of cases over the days of our study were calculated using the Joinpoint regression, with a significance level set at greater than 0.05.

Results

The total number of COVID-19 cases reached 156,622, with 5,845 subsequent deaths. China, Italy, and Iran have the highest number of cases worldwide. During the first 22 days, the incidence rate of COVID-19 increased significantly to reach 1.81 cases per million persons (p<0.001). That was followed by a significant decrease over the next 11 days (p<0.001) to reach 0.071 cases per million persons. A steady rise then followed, which saw a significant increase in incidence rate to 1.429 cases per million persons (p<0.001). Percentages of death and cured cases varied across the different countries; nevertheless, death percentages have generally been decreasing since the start of the crisis.

Conclusion

Adopting precautionary regulations such as social isolation, increasing sanitation, and employing strict quarantine measures have proved to be beneficial in containing the virus. Further research needs to be conducted to help discover therapeutic modalities and improve outcomes.

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<![CDATA[Updated rapid risk assessment from ECDC on coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK]]> https://www.researchpad.co/article/Nc0d2e4e9-5a02-4d96-b4dd-c1ff33293275 ]]> <![CDATA[The Efficacy of Pralidoxime in the Treatment of Organophosphate Poisoning in Humans: A Systematic Review and Meta-analysis of Randomized Trials]]> https://www.researchpad.co/article/Ne5b30dbd-9653-4faa-b412-737f33071b4b

Introduction

The benefits of atropine in the treatment of acute organophosphate (OP) poisoning has been well established, while that of oximes is still uncertain. Pralidoxime is the most often used oxime worldwide. In vitro experiments have consistently shown that oximes are effective reactivators of human acetylcholinesterase enzyme, inhibited by OP compounds. However, the clinical benefit of pralidoxime is still unclear. A recent meta-analysis has found that pralidoxime provides no significant improvement in outcome and rather may cause harm while increasing the economic burden in low-income communities where its use is the most prevalent.

Objectives

This study aimed to provide an updated evaluation of the efficacy of pralidoxime in addition to atropine alone in the treatment of patients with acute OP poisoning in terms of mortality, need for ventilator support, and the incidence of intermediate syndrome. The intermediate syndrome is a clinical syndrome that occurs 24 to 96 hours after the ingestion of an OP compound and is characterized by prominent weakness of neck flexors, muscles of respiration, and proximal limb muscles. 

Materials and methods

We searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov databases until January 2019 for randomized controlled trials (RCTs) in the English language that evaluated the use of pralidoxime in individuals of any age, gender or nationality presenting with an alleged history of OP intake. The primary outcome was mortality. Secondary outcomes were the need for ventilator support and the incidence of intermediate syndrome. The risk of bias in included studies was assessed using the tool recommended by the Cochrane Handbook of Systematic Review of Interventions. Treatment/control differences in these outcomes across included studies were combined using risk ratios (RR).

Results

Six randomized controlled trials (n = 646) fulfilled the inclusion criteria, including one further trial missed from the most recent systematic review. The risk of bias varied across studies, with Eddleston 2009 being of the lowest risk and Cherian 2005 being of high risk. The risk of mortality (RR = 1.53, 95% confidence interval (CI) 0.97 to 2.41, P = 0.07) and the need for ventilator support (RR = 1.29, 95% CI 0.97 to 1.71, P = 0.08) were not significantly different between the pralidoxime and the control group. There was a significant increase in the incidence of intermediate syndrome in the pralidoxime group (RR = 1.63; 95% CI 1.01 to 2.62, P = 0.04).

Conclusions

Based on our meta-analysis of the available RCTs, pralidoxime was not shown to be beneficial in patients with acute OP poisoning. Our findings are consistent with the other literature.

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<![CDATA[Artificial Intelligence: A New Paradigm in Obstetrics and Gynecology Research and Clinical Practice]]> https://www.researchpad.co/article/N7ef2c76f-3dbf-4e4a-85f0-fabf2997b208

Artificial intelligence (AI) is growing exponentially in various fields, including medicine. This paper reviews the pertinent aspects of AI in obstetrics and gynecology (OB/GYN) and how these can be applied to improve patient outcomes and reduce the healthcare costs and workload for clinicians.

Herein, we will address current AI uses in OB/GYN, and the use of AI as a tool to interpret fetal heart rate (FHR) and cardiotocography (CTG) to aid in the detection of preterm labor, pregnancy complications, and review discrepancies in its interpretation between clinicians to reduce maternal and infant morbidity and mortality. AI systems can be used as tools to create algorithms identifying asymptomatic women with short cervical length who are at risk of preterm birth. Additionally, the benefits of using the vast data capacity of AI storage can assist in determining the risk factors for preterm labor using multiomics and extensive genomic data. In the field of gynecological surgery, the use of augmented reality helps surgeons detect vital structures, thus decreasing complications, reducing operative time, and helping surgeons in training to practice in a realistic setting. Using three-dimensional (3D) printers can provide materials that mimic real tissues and also helps trainees to practice on a realistic model. Furthermore, 3D imaging allows better depth perception than its two-dimensional (2D) counterpart, allowing the surgeon to create preoperative plans according to tissue depth and dimensions. Although AI has some limitations, this new technology can improve the prognosis and management of patients, reduce healthcare costs, and help OB/GYN practitioners to reduce their workload and increase their efficiency and accuracy by incorporating AI systems into their daily practice.

AI has the potential to guide practitioners in decision-making, reaching a diagnosis, and improving case management. It can reduce healthcare costs by decreasing medical errors and providing more dependable predictions. AI systems can accurately provide information on the large array of patients in clinical settings, although more robust data is required.

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<![CDATA[Estimating the Mobility of the Michaelis Sacral Rhombus in Pregnant Women]]> https://www.researchpad.co/article/N0d8afa16-227b-48c6-a5b0-7716e3e14b67

Pelvic mobility is the cornerstone of an adequate birth canal for safe childbirth, and midwives invite pregnant women to assume loading positions to facilitate delivery. Biomechanics asserts that pelvic space changes in shifting positions from erect to the squat position. The current standard practice in obstetrics and osteopathy provides a qualitative observational assessment of the dimension of Michaelis sacral rhombus in shifting positions; a previous report presented a clinical method and instrument to estimate the pelvic range of motion through finger contact on bone landmarks. The present study aims to match the measurement of the diameters of the sacral area of Michaelis from skin marks with the amount from bone landmarks. Methods estimate the sacral area from 100 pregnant women in the late trimester, considering the dimension of the diameters, the range of motion, and the patterns of mobility. Differences resulted in the methods: measuring the skin marks in shifting positions revealed a not significant difference between starting position and squat position. The measurements through the finger contact on the bone landmarks seem to be adequate to estimate pelvic mobility fulfilling the expectation from biomechanics literature.

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<![CDATA[The New Global Threat. Severe Acute Respiratory Syndrome and Its Impacts. Tommy Koh, Aileen Plant, Eng Hin Lee. Singapore: World Scientific Publishing Company, 2004, pp. 356, $17.00 (PB) ISBN: 9812386688]]> https://www.researchpad.co/article/Nc36855c4-93c0-48cb-8727-245a735f8e4d ]]> <![CDATA[Machaon, Son of Asclepius, the Father of Surgery]]> https://www.researchpad.co/article/N9c349d49-5749-4363-9981-29aad1939e39

The first description of organized surgical care is given in Homer’s epic poem “Iliad’’, even though evidence of performing surgical operations can be traced back to the history of ancient civilizations. Machaon (ca. 1300 BC), the son of Asclepius, was described as a skillful and confident therapist, whose lineage ensured a unique training. He lived in an era when the reality was shaped by myths, and natural phenomena were ruled by the will of the Olympian gods. It was at that time when philosophers and scientists rediscovered the world that surgery was born. We review and present Machaon’s story, as he is not only the first documented surgeon ever mentioned in written records in Greek history, but he also proved himself to be a valiant soldier at the battlefield, during the Trojan War. It is no wonder that the life of such a charismatic man, living in a place and time of prosperity and steady evolution of both the scientific and the spiritual world, became a demigod patron of surgical treatment and a landmark in the history of medicine.

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<![CDATA[Increased Risk of Esophageal Cancers Among Men in Taiwan]]> https://www.researchpad.co/article/N97b43d7e-de37-49df-a03f-b4acfaf262ce

Despite increased research, the risks of developing esophageal cancer and of death from this disease, especially among men, have increased worldwide. The goals of this review include an assessment of male predominance of esophageal cancer and an analysis of its high mortality rates. Determination of the genetic and environmental factors associated with esophageal cancer may help explain its male predominance and help design more effective treatments of this disease. 

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<![CDATA[Updated rapid risk assessment from ECDC on the outbreak of COVID-19: increased transmission globally]]> https://www.researchpad.co/article/N022a0ca0-57df-4294-9a26-ea7b75fa875d ]]> <![CDATA[Latest assessment on COVID-19 from the European Centre for Disease Prevention and Control (ECDC)]]> https://www.researchpad.co/article/Nec3798c6-2a29-4231-9635-1192a4366b7f ]]> <![CDATA[Latest updates on COVID-19 from the European Centre for Disease Prevention and Control]]> https://www.researchpad.co/article/Nd708c8d7-c846-4a9e-b119-3c4c5a3b50bb ]]>