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Abstract Objectives This study aims to evaluate the characteristics and treatment response of patients with pityriasis lichenoides seen in the last 43 years in a pediatric dermatology service. Methods This was a retrospective, analytical, longitudinal study of patients under 15 years of age. The medical records were reviewed and data were presented as frequencies, means and variances. Student's t-test, Mann-Whitney test, Fisher's exact test, Pearson/Yates chi-square test and multivariate logistic regression model were used, with p < 0.05 considered. Results 41 patients were included, 32 (78.0%) with pityriasis lichenoides chronica (PLC), five (12.2%) with pityriasis lichenoides et varioliformis acuta (PLEVA) and four (9.8%) with clinical PLC without biopsy. The age range of school children and adolescents was 19 (46.3%) and 13 (31.7%) respectively and 27 (65.8%) were male. Two peaks of the highest frequency were observed between 2004 and 2006 (10 patients - 24.4%) and another between 2019 and 2021 (6 patients - 14.7%). There was remission in 71.9% (n = 23), with 56.6% (n = 17) of those who used antibiotic therapy and 80% (n = 4) of those who had phototherapy. The chance of remission was 13 times greater in patients with disease onset after 5 years of age. Conclusions The clinical form most commonly found was PLC mainly in school children and adolescents. The frequency peaks coincided with infectious outbreaks. The remission rate was satisfactory with antibiotic therapy, but higher with phototherapy. Remission was greater in patients with disease onset after 5 years of age.
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SUMMARY OBJECTIVE: The objective of this study was to evaluate the fear, anxiety, and knowledge level in women who underwent gynecological surgical procedures during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted on 188 women who underwent a gynecologic surgical operation in Muğla, Turkey. Data were collected by using demographics and obstetric detail form, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I (STAI-I). RESULTS: Most of the women perceived their surgical process as very urgent. Women felt fear mostly for being infected with the virus, and they were afraid of transmitting COVID-19 to another one. The COVID-19 knowledge scores of women who had undergone cancer surgery were statistically significantly higher than others (p=0.017). The STAI-I scores of women increased as their COVID-19 knowledge scores increased (p<0.05). CONCLUSION: This study demonstrated that women were afraid of COVID-19 infection during gynecological operation and due to hospitalization, sociodemographic characteristics affected the knowledge levels about COVID-19 infection, and the anxiety levels of the women. Planning appropriate interventions to decrease the fear and anxiety of women who undergo gynecological surgery during the pandemic is important to ensure that women adhere to their treatment and follow-up in the postoperative period.
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SUMMARY OBJECTIVE: The aim of our study was to determine the role of serum glucose-potassium ratio in predicting inhospital mortality in coronary care unit patients. METHODS: This study used data from the MORtality in CORonary Care Units in Turkey study, a national, observational, multicenter study that included all patients admitted to coronary care units between September 1, 2022, and September 30, 2022. Statistical analyses assessed the independent predictors of mortality. Two models were created. Model 1 included age, history of heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease. Model 2 included glucose-potassium ratio in addition to these variables. Multivariate regression and receiver operating characteristic analysis were performed to compare Model 1 and Model 2 to identify if the glucose-potassium ratio is an independent predictor of inhospital mortality. RESULTS: In a study of 3,157 patients, the mortality rate was 4.3% (n=137). Age (p=0.002), female gender (p=0.004), mean blood pressure (p<0.001), serum creatinine (p<0.001), C-reactive protein (p=0.002), white blood cell (p=0.002), and glucose-potassium ratio (p<0.001) were identified as independent predictors of mortality through multivariate regression analysis. The receiver operating characteristic analysis indicated that Model 2 had a statistically higher area under the curve than Model 1 (area under the curve 0.842 vs area under the curve 0.835; p<0.001). A statistically significant correlation was found between the inhospital mortality and glucose-potassium ratio (OR 1.015, 95%CI 1.006-1.024, p<0.001). CONCLUSION: Our study showed that the glucose-potassium ratio may be a significant predictor of inhospital mortality in coronary care unit patients.
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Cardiovascular disease (CVD) is the leading cause of death worldwide (WHO, 2017). In addition to the global and national morbidity and mortality burdens of the disease, it imposes a substantial economic burden on society. The American heart association predicts that by 2035, 45% of Americans will suffer from CVD with costs expected to reach $1.1 trillion annually. Clinical trials have demonstrated that a nut-containing diet low in saturated fat and cholesterol, while high in poly and monounsaturated fatty acids has a beneficial effect on plasma lipids and lipoproteins when compared with either a low fat or average American diet. Other bioactive compounds present in walnuts, including micronutrients, fiber, and phytochemicals, may also contribute to their cardio protective effect by reducing inflammation, improving vascular reactivity, and lowering oxidative stress. It has been demonstrated that the consumption of walnuts resulted in significant reduction in body mass index (BMI), percentage of body fat, increased lean body mass and an increased amount of water in the body. A large population cohort study also demonstrated a marked reduction in body weight and other anthropometric parameters in people on regular consumption of walnuts.
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Background: A large proportion of patients in developing countries have to pay out of pocket for their medications. The prices of different brands of the same medications vary considerably and may vary from one community pharmacy to another. This study was undertaken to evaluate the variation in costs of proton pump inhibitors (PPI) and histamine H2-receptor antagonists available in Libya. Methods: Prices of various brands of PPI and various formulations were collected from four community pharmacies in the city of Benghazi. Both cost ratio and percentage variation were calculated and compared for various brands of the same strength and number of tablets, capsules, injections, or syrups. Results: The highest cost ratio and percentage price variation were found with omeprazole 20 mg, followed by omeprazole 40 mg. Other significant cost variations (>100%) were seen with pantoprazole 40 mg, Downoprazol (omeprazole + sodium bicarbonate) 40 mg, and esomeprazole 40 mg. Ampoules of omeprazole, cimetidine, and ranitidine had cost ratios of 1:1.7, 1:1.7, and 1:1.8, and cost variation ratios of 71.4, 66.7, and 75, respectively. Variations in prices of PPI and histamine H2 antagonists from the same manufacturer between different community pharmacies were common. The highest percentage cost variation (100) was seen with omeprazole 20 mg. Conclusions: Due to political instability, the prices of all drugs are controlled by importing private companies and the owners of community pharmacies instead of governmental authorities, that leads to cost variations. Therefore, the health authorities exert strict control on pricing of medications.
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Background: To effectively manage diabetes, it is crucial to achieve optimal glycemic control by ensuring that A1C levels remain below 7.0%. This study aimed to investigate the impact of Nigella sativa oil (black seed oil, BSO) on glycemic control in alloxan-induced diabetic Wistar rats. Methods: Forty (40) male Wistar rats weighing 200-250 gm were randomly allocated into eight (8) groups of five (5) animals per group. Group 1 received normal saline as the normoglycemic control, while groups 2 to 8 were given alloxan monohydrate to induce hyperglycemia, following the method of Osikwe et al. Following the induction of hyperglycemia, group 2 received normal saline, group 3 received 200 mg/kg of metformin, group 4 received 2 mg/kg of glimepiride, group 5 received 2.5 ml/kg of BSO, group 6 received glimepiride and BSO, group 7 received metformin and BSO, and group 8 received BSO, glimepiride, and metformin. Results: The results showed that BSO significantly reduced fast blood glucose levels compared to the diabetic control group (p<0.05), lowered glycosylated hemoglobin to <7%, and improved pancreatic beta cell function. Conclusions: Black seed oil reduces fasting blood glucose, exhibits synergism with glimepiride, and improves pancreatic beta-cell function in alloxan-induced diabetic Wistar rats.
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Background: Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms among older males. Transurethral resection of the prostate (TURP) still remains the gold standard in the treatment of benign prostatic hyperplasia. However, its availability is not widespread in most public healthcare facilities across sub-Saharan Africa. This study was designed to describe and share our experience of TURP in a single centre. Methods: This is a retrospective evaluation of 64 patients who had TURP for bladder outlet obstruction secondary to enlarged prostate. The records of men who had TURP over a period of one year (January 2022-December 2022) were retrieved and reviewed. The pre-operative prostate specific antigen (PSA), pre-operative ultrasound measured size of prostate, resected weight of prostate, duration of surgery, duration of hospital stay, indication for TURP and complications were analysed. Results: Sixty-four patients had TURP done during the period under review. The age range was 50-90 years (mean 68.33), the pre-operative prostate gland weight was 76.78gm. The mean resected weight was 53.9gm. The pre-operative serum prostate specific antigen PSA had a minimum value of 1.5ng/ml and the maximum was 50.8ng/ml with mean value of 13.8ng/ml. The mean duration of surgery was 55.73 minutes and the mean duration of hospital stay was 3 days. The most common indication for TURP was lower urinary tract symptoms. We recorded four complications; capsule perforation, clot retention, hypotension and stress incontinence, 60 patients had no complications. Conclusions: Transurethral resection of the prostate is an effective surgical treatment for benign prostatic hyperplasia, it is associated notable improvement in the patient抯 quality of life and minimal complications.
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Deep soft tissue injuries around the thumb can significantly impair hand function if not managed appropriately. Various surgical options exist for treating these complex lesions, including microsurgical flaps, local flaps, and distant pedicled flaps. The dorsal metacarpal artery (DMCA) family of flaps belongs to the latter category. These versatile flaps can be designed as racquet-shaped, island, or bilobed flaps, utilizing the first DMCA alone or in combination with the second DMCA. In this review, we explore the surgical anatomy, techniques, and clinical applications of reversal DMCA flap (RDMA).
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We present the case of a 20-year-old male who presents multiple traumas of the abdomen 26 days prior to his return to the emergency room. Going again to evaluation with frank data of peritoneal irritation, since there is no hemodynamic commitment, a contrasted abdomen computed tomography (CT) scan is requested, finding a grade III splenic lesion, which is why he is admitted for emergency splenectomy. This case reports a splenic injury with the need for delayed splenectomy.
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Temporal clipping of the external carotid artery for tumor resection is rarely documented in our country; nevertheless, it proves to be an effective and safe alternative therapeutic approach for reducing blood flow to the tumor and facilitating complete resection. This study presents a clinical case of a patient with a large facial neurofibroma where this technique was successfully employed without complications.
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Severe anaemia in pregnancy is associated with high maternal and perinatal morbidity and mortality. The life-threatening complications associated with severe anaemia in pregnancy were averted in this case due to the astute management and multidisciplinary approach employed involving the hematologist, dietician, and obstetrician. We report a rare case of a 33-year-old pregnant woman with three living children who presented with severe anaemia, characterized by a hematocrit of 8% (haemoglobin of 2.5 g/dl) in her early second trimester of pregnancy. The peripheral blood smear revealed mixed nutritional deficiency anemia, while the bone marrow aspirate showed megaloblastic changes. She received blood transfusions, haematinics, vitamin supplements, and adequate nutrition. Following discharge, she attended weekly antenatal clinics with antenatal fetal surveillance until term. At term, she was induced and had vaginal delivery of a healthy baby. She was discharged healthy with her baby and had bilateral tubal ligation at 6 weeks postpartum for a completed family size. This case shows that the morbidities and mortalities associated with severe anaemia in pregnancy are preventable with good multidisciplinary clinical management. The severity of this anemia, her remarkable recovery, and successful outcome make this a rare and noteworthy case report.
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Background: The true incidence of pelvic organ prolapse (POP) using validated method of examination in a wider range of population of women needs evaluation in our setting. This study determined the prevalence of the different POP quantification (POPQ) stages of POP and correlated these stages with clinical symptoms alongside the determinants of POP among women in Ile-Ife, Nigeria.Methods: This was a cross-sectional study of consecutive, consenting four hundred women (aged 22-74years) attending the gynaecology, general outpatient, family planning, and well-woman clinics at Obafemi Awolowo university teaching hospitals complex, Ile-Ife, Nigeria between January 2016 and December 2016. Relevant biodata was documented in a purpose designed and pre-tested questionnaire, and the international consultation on incontinence questionnaire vaginal symptoms (ICIQ-VS) was administered. Data were analysed using IBM SPSS version 20.0. The prevalence of the different POPQ stages was determined. Logistic regression analysis was then performed to identify the significant determinants.Results: The study showed a prevalence of POPQ of 13% (stage 0), 85.3% (stage I), 1.3% (stage II) and 0.5% (stage III). Age, parity, menopausal status, chronic constipation, childbirth position, caesarean section and lifting of heavy objects were the identified significant determinants.Conclusions: There is a significant correlation between POPQ stage and the symptom 慺eeling of lump in the vagina�. Chronic constipation and lifting of heavy objects are modifiable significant risk factors in our study population.
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The fact that the integrity of the lower uterine segment (LUS) has not been routinely evaluated sonographically before deciding on the mode of delivery after caesarean section has deemed it fit that the lower uterine segment thickness (LUST) should be assessed. The authors carried out a scoping review in October 2023. Four databases were searched for peer reviewed articles that discussed evaluation of LUST and TOLAC. The year of publication, primary author抯 country of origin, sample size, study design, gestational age at ultrasonographic assessment, scanning route and key findings were extracted from the included articles. The articles identified were 625 while 250 were screened after removing duplicates and finally 30 articles were included in the review. The first authors of the included articles originated from 10 different countries and 30% of them were Indians. The most frequently used study designs in the articles were prospective cohort studies (63.3%). Majority of the key findings were as follow: Ultrasonography is the best modality for LUS assessment, LUST measurement is more reliable through vaginal scan; maternal age, body mass index and pregnancy related factors affect LUST and LUST of ?3.5 mm at term is safe for TOLAC. Maternal socio-demographic characteristics and past obstetric history affect the LUST and success of TOLAC. Ultrasonographic evaluation of the LUST at term is safe, needed before TOLAC and more reliable when conducted through vaginal route. The LUST influences the pregnancy outcome during TOLAC and a LUST cut-off value of ?3.5 mm is safe for TOLAC.
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Resumen Introducción : Las diferentes modificaciones estructu rales que han sido descritas en el corazón del deportista de alto rendimiento dependen de factores como la edad, el género, el tipo de deporte, la intensidad y el tiempo dedicados al entrenamiento. Objetivos : Evaluación de atletas de élite por medio de la ecocardiografía para la descripción de la estructura y la función cardíacas, y la comparación entre deportistas de resistencia cardiorrespiratoria y el resto de los deportistas. Métodos : Realizamos el examen ecocardiográfico en 224 deportistas de élite, 96 mujeres y 128 varones con edades de 15 a 38 años (21.7±5.3 años) y se dividieron en 2 grupos: "Grupo de Resistencia" (resistencia cardiorres piratoria) y "Grupo de no Resistencia" el cual incluyó al resto de los deportes. Se realizó la comparación univaria da de 14 variables ecocardiográficas entre los dos grupos. Resultados : En los hombres se identificaron valores estadísticamente significativos más altos en el grupo de resistencia para septum interventricular, pared posterior, grosor parietal relativo, índice de masa del ventrículo iz quierdo y aurícula izquierda. En las mujeres, el grupo de resistencia tuvo valores de frecuencia cardíaca más bajos con diámetro diastólico e índice de masa del ventrículo izquierdo, significativamente mayores. Conclusiones : La mayoría de las variables ecocar diográficas mostró valores mayores en los atletas de resistencia. En los hombres del Grupo de Resistencia, predominó la hipertrofia excéntrica con mayor incre mento en el grosor parietal y del diámetro de la aurícula izquierda, mientras que en las mujeres las variables indi caron hipertrofia excéntrica a expensas de un aumento del diámetro del ventrículo izquierdo, sin incremento del grosor parietal.
Abstract Introduction : The different structural modifications that have been described in the heart of the high-per formance athlete depend on factors such as age, gender, type of sport, and the intensity and time dedicated to training. Objectives : Evaluation of elite athletes through echo cardiography for the description of cardiac structure and function, and the comparison between athletes with cardiorespiratory endurance and the rest of the athletes. Methods : We performed the echocardiographic ex amination in 224 elite athletes, 96 women and 128 men aged 15 to 38 years (21.7±5.3 years) and they were di vided into 2 groups: "Endurance Group" (cardiorespira tory endurance) and "Non-Endurance Group" which included the rest of the sports. Univariate comparison between the two groups was performed by measuring 14 echocardiographic variables. Results : In men, statistically significant higher values were identified in the endurance group for interventricu lar septum, left ventricular posterior wall, relative wall thickness (RWT), left ventricular mass index and left atrial dimension. In women, the endurance group had signifi cantly lower heart rate values, and significantly higher left ventricular diastolic dimension with normal RWT. Conclusions : Most of the echocardiographic vari ables showed higher sample means in the endurance athletes. In the subgroup of men from the Endurance Group, eccentric hypertrophy prevailed with a greater increase in wall thickness, as well as in the diameter of the left atrium, while in women the variables indicated eccentric hypertrophy at the expense of an increase in left ventricle diameter, without increased wall thickness.
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Nivolumab es un anticuerpo monoclonal contra la proteína de muerte celular programada 1 (PD-1) y actúa como un inhibidor del punto de control inmunitario al interrumpir la interacción del receptor PD-1 con sus ligandos. Nivolumab se ha convertido en un tratamiento eficaz para cánceres avanzados como el melanoma. La colitis, la disfunción endocrina y la miastenia grave (MG) son eventos1 conocidos inducidos por nivolumab. Los eventos adversos neurológicos relacionados con el sistema inmunitario son raros y ocurren en < 1 % de los pacientes tratados en grandes ensayos clínicos2. En este estudio describimos un caso de neuropatía axonal distal después del tratamiento con nivolumab en un paciente con melanoma metastásico.
Nivolumab is a monoclonal antibody against the programmed cell death protein 1 (PD-1) and acts as an imune checkpoint inhibitor by disrupting the interaction of the PD-1 receptor with its ligands. Nivolumab has emerged as an effective treatment for advanced cancers such as melanoma. Colitis, endocrine dysfunction, and myasthenia gravis (MG) are known events1 induced by nivolumab. Immune-related neurological adverse events are rare, occurring in <1% of patients treated in large clinical trials. In this study, we describe a case of distal axonal neuropathy after nivolumab treatment in a patient with metastatic melanoma.
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Humans , Female , Middle Aged , Polyneuropathies/immunology , Antineoplastic Agents, Immunological/adverse effects , Nivolumab/adverse effects , Neoplasms/drug therapyABSTRACT
Chronic urticaria is a common disorder of unknown origin, which is often associated with normal routine laboratory values and no evidence of systemic disease. Cutaneous vasculitis is one of the rare presentation of chronic urticaria. We reported a 13-year-old female child, who presented to us with tender urticarial wheals all over the body, who on further evaluation was found to have positive anti-thyroid peroxidase antibodies and was diagnosed to have urticarial vasculitis.
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The word diabetic cystopathy (DC) refers to lower urinary symptoms due to diabetic neuromyopathy and is common in adults while very unusual in children with diabetes mellitus. This case report seeks to delineate a distinctive case concerning a 9-year-old boy who was diagnosed with DC due to detrusor muscle dysfunction confirmed by urodynamic studies, induced by type 1 diabetes mellitus of four years duration. DC should be considered in children with long standing urinary symptoms without urinary tract infection in type 1 diabetes mellitus even if it is rare condition.