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Jun 2026 DOI 10.14302/issn.2694-2283.jsem-26-6247
Background Ankle sprains are among the most common injuries in sports, often characterized by high recurrence rates despite appropriate local treatment. Traditional approaches primarily focus on the injured joint, with limited attention to proximal biomechanical factors that may predispose athletes to injury. Objective To propose a functional, longitudinal kinetic chain model in which sacroiliac joint dysfunction may act as a predisposing factor for ankle sprain/strain injuries in athletes. Methods This paper presents a clinical hypothesis based on biomechanical reasoning and observational findings. The proposed model describes how sacroiliac joint dysfunction, particularly posterior innominate rotation (PI), may lead to pelvic obliquity and functional leg length discrepancy. These changes may induce compensatory femoral external rotation and foot toe-out, altering ground contact mechanics during gait and running. Results (Hypothesis) The altered alignment and loading pattern may increase the vertical impact force and modify the ground reaction vector on the functionally shorter limb, resulting in reduced mechanical stability at the ankle during heel strike or foot contact. Over time, this may increase susceptibility to inversion or eversion injuries, manifesting clinically as recurrent sprain/strain. Conclusion Ankle sprains in athletes may, in some cases, represent the distal expression of a proximal biomechanical imbalance. Incorporating assessment of the sacroiliac joint and the longitudinal kinetic chain into routine clinical evaluation may improve injury risk identification and contribute to more effective prevention strategies. Further research is needed to investigate this proposed relationship.
May 2026 DOI 10.14302/issn.2574-4518.jsdr-25-5773
Introduction Sleep quality is a fundamental determinant of human health and well-being. Modified Intravascular Laser Irradiation of Blood (ILIB), a non-invasive therapeutic modality, has emerged as a potential intervention for sleep-related disturbances. Proposed mechanisms include reduced blood viscosity and platelet aggregation, activation of superoxide dismutase, increased oxygen bioavailability, enhanced microcirculation, elevated serotonin levels, and decreased cortisol concentrations—physiological processes intricately involved in sleep regulation, mood modulation, and the stress response. Objective To evaluate the effects of Modified Intravascular Laser Irradiation of Blood (ILIB) on sleep quality in individuals with self-reported sleep disturbances. Methods A randomized, placebo-controlled clinical trial was conducted with participants who reported poor sleep quality. Subjects were randomly assigned to one of two groups: the intervention group received ILIB using a 660 nm red laser, while the control group received a placebo treatment (light emission with sub-therapeutic power, <1 mW). Both groups underwent the same treatment schedule. Sleep quality was assessed at baseline and after six treatment sessions using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results Participants in the ILIB group showed statistically significant improvements in the primary outcome of global sleep quality. PSQI scores decreased from 10.24 at baseline to 6.47 post-treatment. ESS scores showed a non-significant change from 10.44 to 10.12. These results suggest enhanced overall sleep quality and reduced sleep latency, although the observed reduction in daytime sleepiness did not reach statistical significance. Conclusion Modified Intravascular Laser Irradiation of Blood appears to be a promising non-invasive approach for improving sleep quality. The clinical outcomes observed are comparable to those reported in both pharmacological and behavioral sleep interventions, particularly in terms of PSQI improvements. These preliminary findings support the need for further research to clarifyunderlying mechanisms, optimize treatment parameters (e.g., dosimetry and duration), and expand outcome assessments to include biomarkers and polysomnographic data.
Feb 2026
Keratinocytes are pivotal in mediating cutaneous inflammation. Identifying anti-inflammatory factors within these cells holds promise for developing novel therapeutic strategies to manage skin inflammation. Transcription factor EB (TFEB) has recently emerged as a key regulator linking cellular energy metabolism to inflammatory processes, primarily through its influence on autophagy and NF-κB signaling. However, whether TFEB activation exerts anti-inflammatory effects in keratinocytes remains unclear. In vitro inflammation model was established in HaCat cells by incubation with proinflammatory mediators LPS and IL-1β. Cell viability and TFEB expression and phosphorylation were measured. The effect of TFEB activation by C1 and adenoviral TFEB overexpression on the expression of proinflammatory genes including COX-2, MCP-1 and IL-6 were detected. Also, IκBα protein level were determined. TFEB phosphorylation is increased while TFEB total protein expression is inhibited by treatment with LPS and IL-1β. Pharmacological activation of TFEB by compound C1 and TFEB overexpression suppressed the expression of COX-2, MCP-1 and TNF-α induced by LPS and IL-1β. TFEB overexpression increased basal IκBα expression and restored IκBα level under LPS treatment. TFEB knockdown reduced TFEB expression and lowered basal expression level of COX-2, MCP-1 and TNF-α. Our findings indicate that TFEB activation can mitigate inflammatory gene expression in keratinocytes triggered by LPS and IL-1β. This implicates TFEB as a significant novel modulator of cutaneous inflammation, highlighting its potential as a therapeutic target. Targeting TFEB could thus be a viable strategy for developing new treatments for chronic inflammatory skin conditions.
Feb 2026
Objective The landscape of non-small cell lung cancer (NSCLC) has changed due to liberalized utilization of computed tomography, developments in immunotherapy and targeted treatments, and guidelines encouraging sublobar resections. We analyzed the implications of these advances for surgical procedures over a 16-year period. Methods The National Cancer Database was used to identify NSCLC incident cases from 2004 to 2020. Histology, stage, grade, and treatment were analyzed using descriptive statistics and logistic regression. Results 2,028,553NSCLC patients were identified. Each year was associated with an increase in Stage I for NSCLC (OR1.05, 95%CI 1.05-1.05) and histological subtypes (adenocarcinoma: OR1.03, 95%CI 1.03-1.04; squamous: OR1.02, 95%CI 1.02-1.02; neuroendocrine: OR1.11, 95%CI 1.11-1.12), with no change in adenosquamous histology. A similar increase was observed for well- or moderately-differentiated histology (OR1.04, 95%CI 1.04-1.04). The proportion of patients receiving chemotherapy decreased (OR0.98, 95%CI 0.98-0.98), while more patients were treated with immunotherapy or targeted therapy, including an increase of 14% using immunotherapy or targeted therapy as first-line treatment. There was a decrease in the likelihood of receiving pneumonectomy (OR 0.91, 95%CI 0.91-0.91). Despite guidelines advocating sublobar resections, these procedures only increased by 1.1% per year. Conclusions Over the 16-year study period, there was a significant trend towards diagnosis of Stage I NSCLC. The most pronounced change in treatment patterns has been more patients receiving immunotherapy and less chemotherapy. Despite a promising decrease in pneumonectomies, the frequency of sublobar resections remains stagnant, indicating limited uptage in current practice.
Dec 2025 DOI 10.14302/issn.2574-612X.ijpr-25-5849
Bipolar disorder is a chronic condition marked by episodes of mania and depression, significant functional impairment, and challenges with treatment adherence. Current guidelines highlight the importance of both medication and psychosocial approaches in treatment. This review explores the primary psychosocial interventions for bipolar disorder. Psychoeducation helps recognize early symptoms, improves medication compliance, and prevents relapses. It is simple to implement and cost-effective. Family-Focused Therapy (FFT) enhances family communication, reduces emotional expression, and lowers the frequency of depressive episodes. Interpersonal and Social Rhythm Therapy (IPSRT) supports maintaining social stability by addressing disturbances in biological rhythms. Cognitive Behavioral Therapy (CBT) decreases depressive symptoms and boosts treatment adherence by restructuring automatic thoughts. Additionally, cognitive and functional rehabilitation programs improve attention, memory, and executive functioning. Peer support groups and digital e-health tools, though supportive, have limited evidence of effectiveness. In summary, multicomponent psychosocial interventions serve as a valuable addition to medication, helping to prevent relapses, improve functioning, and enhance quality of life in individuals with bipolar disorder.
Nov 2025 DOI 10.14302/issn.2476-1710.jdt-25-5775
A number of developmental factors increase risk for adolescent rumination. This particular kind of repetitive negative thinking pattern often begins in the context of familial stressors and parental modeling. Though rumination can be effectively targeted with rumination-focused cognitive behavioral therapy (RF-CBT), it is unknown whether caregiver-child co-rumination (1) affects caregiver views of their child’s psychopathology, (2) or interferes with youth rumination- focused treatment. The present study uses data from a randomized clinical trial of RF-CBT to examine whether caregiver-child co-rumination, or caregivers’ own rumination patterns, are associated with bias in parental perception of their adolescent’s depression symptoms. We also examine if co-rumination scores at baseline moderate rumination scores for youth at treatment termination, and whether treatment effects dampen or decay more significantly post-treatment among youth with higher caregiver-child co-rumination. Youth (N = 76) were randomized to either 10-14 sessions of RF-CBT (n = 38) or treatment as usual (TAU; n = 38) and completed interviews and surveys at pre-treatment baseline, post-treatment, and 3-, 6-, 9-, and 12-month follow up. Results indicate that neither caregiver rumination nor co-rumination scores bias caregivers’ views of their child’s depression symptoms. In terms of reduction in child’s rumination scores, estimated treatment effects were larger for patients with higher baseline co- rumination scores, and there was no statistically significant difference in treatment effect decay over time in high versus low co-rumination groups. Results indicate co-rumination overall does not dampen the effect of RF-CBT, and those experiencing the highest levels of co-rumination may benefit most from treatment.
Nov 2025 DOI 10.14302/issn.2470-0436.jos-25-5503
Purpose Create a new diagnostic and therapeutic framework for patients with Exudative Age-Related Macular Degeneration (ARMD) and choroid imaging biomarkers of non-neovascular choroidal pathology who have persistent neovascular exudation during the course of monotherapeutic interventions. Methods Retrospective, longitudinal case series study of 25 eyes from 23 patients with the referral diagnoses of treatment resistant Exudative ARMD who had persistent neovascular exudation despite various monotherapies. Inclusion criteria required choroidal imaging biomarkers of non-neovascular pathology including a thickened subfoveal choroid (greater than 300 microns) and vessels (subjectively dilated choroidal vessels in Haller’s layer) on Optical Coherent Tomography (OCT), choroidal neovascularization on IVFA and OCT Angiography (OCTA), as well choroidal leakage noted on indocynanine green videoangiography (ICG). Treatment consisted of OCTA and ICG - Directed Photodynamic Therapy (PDT) Triple Therapy, hereafter described as Combination Therapy, to areas of choroidal hyperpermeability and choroidal neovascularization. Combination therapy consisted of an anti-Vascular Endothelial Growth Factor (VEGF) intravitreal injection on Day 0 followed by half-fluence PDT and 2 mg intravitreal triamcinolone acetonide on Day 3-14. Results All study patients had treatment resistant Exudative ARMD defined as persistent subretinal and/or intraretinal fluid during their course of monotherapeutic interventions. Complete resolution of all exudation occurred in 23 eyes (92.0%) at 8 weeks. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. The mean vision at baseline was 0.46 ± 0.42 LogMAR, best corrected visual acuity (BCVA). 8 weeks after treatment, the vision was 0.35 ± 0.38 LogMar, an improvement of over one line, and this was maintained at one year. The baseline central subfield thickness (CST) was 296.4 ± 136.1 microns and improved by 111.4 ± 105.4 microns at 8 weeks after treatment. Treatment duration was negatively associated with the Caucasian race. Conclusions Patients with subretinal and/or intraretinal fluid secondary to Exudative ARMD should have a complete baseline multimodality imaging study to confirm the presence of neovascularization and whether choroidal hyperpermeability coexists. This study shows that patients with Exudative ARMD and persistent neovascular exudation despite monotherapuetic interventions often have choroidal biomarkers of non-neovascular choroidal pathology and that ICG and OCTA-directed PDT Triple Therapy resulted in complete resolution of all exudation in 92.0% of patients at 8 weeks with a reduction in central subfield thickness (CST) of 111.4 microns. The vision improvement at 8 weeks was 0.11 ± 0.38 LogMar and was sustained over 1 year. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. Additionally, this study shows that the treatment that addresses both pathological processes is successful and should be considered as a primary protocol when the biomarkers are present at baseline or as a secondary protocol if indeed the neovascular leakage is persistent despite monotherapy. Summary Patients with an Exudative ARMD with persistent neovascular exudation despite anti-VEGF monotherapy and who have imaging biomarkers of non-neovascular choroidal pathology often have two pathophysiological processes: choroidal hyperpermeability and angiogenesis. A proposed framework provides the rationale for OCTA and ICG-directed PDT Triple Therapy which successfully resolves 92% of the leakage that was persistent after various monotherapeutics.
Nov 2024 DOI 10.14302/issn.2470-0436.jos-24-5321
Purpose The conventional irradiation technique in corneal crosslinking for keratoconus is characterized by a free irradiation path and parallel light rays directed to the corneal surface. This can cause treatment failures resulting from the steep and irregular corneal curvature as well as from eye and head movement. Here we present a a new and improved irradiation technology for corneal crosslinking (CXL) in keratoconus to avoid such treatment failures. Materials and Methods The presented technology is characterized by a closed irradiation channel which is lined inside with a diffusely reflecting layer and which is mounted to the eye via a suction ring. The effective intensity transferred to a curved photodetector representing the curved cornea of some 7 mm radius was measured for both, the conventional and the new technology. The results were compared with related calculations. Results The UV-A irradiation transferred to a curved cornea of some 7 mm central radius varies across the irradiated area by a factor of 2 for the conventional technology. At a distance of already 2 mm from the vertex the transferred UV-A intensity falls below 2/3 of the central intensity which might affect the effectivity of the treatment. The new technology can keep the intensity transferred to the cornea at a constant level across the entire irradiated area. Conclusion The new irradiation technology can considerably improve the energy transfer to the cornea since the effective intensity at the cornea becomes independent from the corneal shape, the eye movement and the head movement, respectively. This may probably reduce the failure rate of corneal crosslinking in the future.
Oct 2024 DOI 10.14302/issn.2691-5014.jphn-24-5310
Cystic neck masses are uncommon in children, and a minority of them are soft. Internal jugular vein phlebectasia (IJVP) is a rare cause of soft neck cysts. It presents usually as a unilateral soft neck mass of changing size. In most cases it is unilateral, right sided and predominantly in males. Imaging study modalities are diagnostic and helpful for observation and follow up. In the vast majority of cases, it decreases in size with time requiring only conservative treatment. However, surgery might be necessary in large or complicated phlebectasia. IJVP is underdiagnosed or misdiagnosed especially in pediatrics, with few cases documented in medical literature. To improve awareness of presentation and management-plan of this rare case, the authors present an extremely rare case of huge left internal jugular phlebectasia in a 14 year-old boy worsened and complicated over years of wait and see approach that needed surgical treatment.
Aug 2024 DOI 10.14302/issn.2470-0436.jos-24-5162
Introduction Cystoid macular edema (CME) is a sight-threatening condition caused by fluid accumulation in the macula due to blood-retinal barrier disruption. Various factors, including drug reactions, can lead to retinal fluid leakage. Leflunomide, a disease-modifying anti-rheumatic drug, marked significant progress in managing rheumatoid arthritis. Although effective, Leflunomide has rarely been linked to CME. This report presents a unique case of Leflunomide-induced CME, adding to the limited literature on this subject. Methods We report the case of a 75-year-old female with rheumatoid arthritis treated with Leflunomide, presenting with bilateral CME and reduced visual acuity (VA). Comprehensive ophthalmic evaluations, including VA tests, fundus examination, and optical coherence tomography, were conducted. Results The patient presented with CME and decreased VA in both eyes for several months. She had undergone cataract surgery 20 years prior and was using topical nepafenac, dorzolamide, and dexamethasone. Initial VA was OD 20/50 and OS 20/40. VA improved with treatment, but CME recurred upon discontinuation. The patient had been on Leflunomide for one year. After consulting with the Rheumatology department and considering a previous case of bilateral Leflunomide-induced CME, the drug was discontinued. CME resolved without recurrence or the need for topical treatment. At her final visit, VA was OU 20/25. Conclusion This case highlights Leflunomide as a potential, though rare, cause of CME. It emphasizes considering systemic medications in CME diagnosis. Timely discontinuation of Leflunomide may resolve CME and prevent further visual impairment. Further studies are needed to understand this rare side effect comprehensively.
Jun 2024 DOI 10.14302/issn.2574-450X.jom-24-5114
Objective We aimed to assess outcomes in patients undergoing sequential intragastric balloon (IGB) treatment for obesity. Methods Consecutive patients who underwent treatment between May 2014 and February 2023 were identified. We recorded outcomes including: weight at 3-monthly intervals, progression to definitive bariatric procedure and morbidity. Results 45 patients were identified. Median weight loss with first IGB was 15.2kg (8.8%). 11 patients (26.7%) had a second IGB, with median weight loss of 3.3kg (1.9%). 21 patients (46.7%) were suitable for definitive surgery after first IGB treatment. One further patient (2.2%) was suitable for surgery after a second IGB. During first IGB, median weight loss was observed during the each of the first three quartiles (months 0-3: 10.1kg; months 3-6: 2.3kg; months 6-9: 4.2kg). There was a median 2kg weight gain during months 9-12. Conclusions Greatest weight loss was achieved during first IGB treatment. Sequential IGB treatment did not lead to beneficial weight loss or progression to surgery. Weight loss with first IGB was not uniform across the 12 month period of treatment, with net weight gain during the last quartile.
May 2024 DOI 10.14302/issn.2379-7835.ijn-24-5098
This prospective randomized double-blinded multicentric study aimed to assess the efficacy of a new nutraceutical in controlling itch and skin lesions caused by flea allergy dermatitis (FAD) and compare it with another oral product of proven efficacy. Forty-three dogs, of different age, breed and sex, with FAD were included and divided into two groups: 24 received product A and 19 product B. Both groups received the same antiparasitic treatment. A modified canine atopic lesion index (mCADLI) and pruritus visual analogic scale (pVAS) were recorded at days 0, 30 and 60. pVAS was evaluated both by the examining veterinarian (vpVAS) and the owner (opVAS). Results obtained were compared between the two groups at each time point. In both groups of dogs, a significant decrease of mCADLI, vpVAS and opVAS at day 30 and 60, compared to day 0, was observed. At baseline, the mCADLI scores of Group B were significantly higher than Group A (95% CI: -4.0 to 0.0, p < 0.05), with no differences at D30 and D60 (not significant, p > 0.05). In Group B, significantly lower values of vpVAS were observed at D30 compared to Group A (95% CI: -2.5 to 0.0, p < 0.05), but not at D60 (not significant, p > 0.05). The median values of pVAS in Group B were lower compared to Group A at both D30 (95% CI: -2.5 to 0.4, p < 0.01) and D60 (95% CI: -3.0 to 0.3, p < 0.05). Both nutraceuticals can be useful to control discomfort, skin lesions and pruritus due to flea allergy dermatitis and can be a valuable replacement for antipruritic drugs antihistamines, steroids or Il-31 inhibitors.
Mar 2024 DOI 10.14302/issn.2572-3030.jcgb-24-4970
Melanoma treatment has improved significantly with the development of immune checkpoint inhibition (ICI), which has greatly enhanced the survival rates of patients with metastatic melanoma. However, a significant number of patients do not respond well to ICI treatment and experience progression. This highlights the critical need for practical means to track melanoma patients' response to ICI. To address this issue, the patterns of circulating miRNAs were studied in liquid biopsies of melanoma patients. These miRNAs have the potential to provide essential information regarding the cancer stage, progression, and the presence of PD-L1 in tumor tissue. A sophisticated flow cytometric test was used to measure up to 63 different miRNAs at once. The study identified a combination of nine miRNAs that are capable of distinguishing between different stages of melanoma, particularly stage IV. Additionally, five miRNAs were pinpointed which are downregulated in patients who do not respond to ICI treatment. Furthermore, two miRNAs were found that correlate to the level of PD-L1 in tumor tissue, and low levels of miR-150-5p were linked to poorer overall survival. These findings suggest that circulating miRNAs could serve as valuable markers to predict the effectiveness of ICI, provide insights into the cancer's stage and PD-L1 status, and ultimately help physicians make better treatment decisions in the future. However, further research is needed to confirm these findings and establish their clinical usefulness.
Mar 2023
Moyamoya disease is a very rare chronic circulatory occlusive disorder of the blood vessels of the brain, in which patients complain of headache, seizure, weakness, and sometimes paralysis. A 5 years old female child with a complaint of headache and seizure was admitted elsewhere and during the treatment, she was diagnosed with Moyamoya disease. Further, she went to AIIMS Patna, where the neurosurgeon advised Digital Subtraction Angiography (DSA) and after the final diagnosis, they suggest the surgical intervention of the brain. During the search for an alternative treatment, they consulted my center for Unani treatment. We advised a semiliquid Unani polyherbal formulation containing Gule Banafsha (Viola odorata), Ustukhuddoos(Lavandula stoechas), and Nilofer (Nymphaea alba Linn) for three months. After the completion of the treatment schedule, she went for DSA again in Patna AIIMS and they find that there is no sign of occlusion in the blood vessels of the brain. The patient has no complaints and the report also showed that she gets improved.
Mar 2023 DOI 10.14302/issn.2692-5257.ijgp-22-4071
Oral ulceration is a common disorder of the oral mucosa with individuals regularly presenting to primary care practitioners seeking advice and treatment. Diagnosis of oral ulceration remains a challenge for clinicians due to the overlap in clinical presentations and the diverse aetiological processes that can be involved in their development. A recent study evaluating general medical practitioners’ attitudes towards oral examination identified problems in clinicians’ confidence in differentiating between benign and malignant ulcers, with a lack of knowledge and training being cited as contributing factors. This article aims to provide an overview of the diagnosis and management of oral ulceration, providing a framework to guide clinical decision-making in a primary care setting.
Sep 2022 DOI 10.14302/issn.2639-3166.jar-22-4247
The greater wax moth considered one of the most worldwide-spread pests of the bee wax. This Study was designed to investigate the insecticidal activity of Carumcarvi, Eculaptus camaldulensis and Nigella sativa against 3rd larval instar of G.mellonellathrough laboratory screening. Five concentrations (5%, 7.5%, 10%, 12.5% and 15%) of each plant extract were used in this experiment. Mortality (%) was recorded after 24, 48, 72 and 96 hrs post treatment. The results showed C. carvi, E. camaldulensis and N.sativahave insecticidal activity against 3rd_ instar larvae of G. mellonella. The highest concentration (15%) caused 90% ,86.7% and 80% larval mortality after 96 hrs for C. carvi,E. camaldulensis and N.sativarespectively. The statistical analysis revealed that there is a significant difference (p< .001) between all treatments and control. The results also clearly demonstrate that the C. carvi are significantly more toxic than E. camaldulensis and N. sativa, whereas the LC50 values were 5.4% forC. carvi,6.0% for E. camaldulensis and 6.2% for N. sativa.
May 2022 DOI 10.14302/issn.2576-9383.jhhr-22-4146
Early active mobilisation and rehabilitation in the intensive care unit (ICU) is being used to prevent the long-term functional consequences of critical illness, sepsis patients need early rehabilitation treatment. Individualized rehabilitation is a safe and effective approach for patients with sepsis. This review aimed to introduce the necessity of rehabilitation for patients with sepsis in the ICU, the composition of the rehabilitation team, the time to begin rehabilitation, the focus of rehabilitation, and the main approaches.
Mar 2022 DOI 10.14302/issn.2641-5518.jcci-22-4096
Introduction Benign duodenocolic fistula (DCF), also known as a non-malignant fistula between the duodenum and colon, with or without cecum-involvement, is an unusual complication of different gastrointestinal (GI) diseases 12. Case This is a case of a 28-year-old Filipino female who presented with periumbilical pain for five months, with associated anorexia, fever, and weight loss. Biopsy showed chronic granulomatous inflammation with caseation necrosis and Langhan’s type giant cells consistent with tuberculous etiology (Figure 6 and Figure 7). Category I Anti-TB treatment for six months was started and the service planned to repeat both colonoscopy and CT-scan after the initial round of anti-TB treatment. Conclusion Benign duodenocolic fistula in the form of extrapulmonary TB is a rare GI finding that is triggered by inflammatory processes. Proper management in this case was to treat the underlying TB infection which is endemic in the Philippines.
Feb 2022
Using samples of small cell lung tumors, a research team led by biologist Dr. Raymond discovered two new ways to induce tumor cell death. By activating ferroptosis, one of two subtypes of tumor cells can be targeted: first, iron-dependent cell death due to oxidative stress, and second, oxidative stress. Therefore, cell death can also be induced in a different way. Both types of cell death must be caused by drugs at the same time to eliminate the majority of the tumor mass. It is currently in clinical trials for cancer treatment. Auranofin, which inhibits the production of protective antioxidants in cancer cells, has been used to treat rheumatoid arthritis for decades. Future clinical trials using this combination therapy will determine the extent to which this targeted treatment option improves the prognosis of small cell lung cancer patients. It is currently in clinical trials for cancer treatment. Lung cancer is the leading cause of cancer death in the United States. Despite evidence of molecular abnormalities in biological specimens, progress in this disease is hampered by the lack of diagnostic markers useful for clinical practice. The majority of patients with lung cancer are still diagnosed at an advanced stage, when prognosis is poor. This article reviews new strategies being studied for the early detection of lung cancer. These strategies involve new methods of imaging (including low-dose computed tomography CT scanning), DNA analysis, and proteomic-based techniques. These strategies have not only improved our understanding of lung cancer but show promise in offering better survival to patients with this deadly disease. Of paramount importance in the search for methods of early detection is the need for the identification of the ideal population to screen, a multidisciplinary approach, and validation of promising techniques.
Oct 2021 DOI 10.14302/issn.2643-6655.jcap-21-3922
This study aimed to evaluate acceptance and commitment therapy (ACT) effectiveness in reducing high-risk behaviors and elevating problem-solving strategies in adolescents with addiction susceptibility in cyberspace. This study is longitudinal with quantitative methods of data collection and analysis. The target community in this research was 60 female students randomly selected from a Persian high school in Iran. Participants were randomly divided and placed equally into the experimental and control groups. The participants’ entry criteria were gender, aged from 15 to 18 years, addiction susceptibility, and high-risk behaviors cut-off points. Eight training sessions of ACT were presented in cyberspace for the experimental group between the pre-test and post-test intervals. Data collection instruments were the Iranian youth risk-taking scale, problem-solving strategies, and Iranian adolescents’ addiction susceptibility questionnaires. Participants were followed up after two months. The results using multivariate analysis of among subjects ANOVA showed ACT significantly influenced high-risk behaviors and its’ sub-scales except for the violence (p < .001).Furthermore, ACT affected the problem-solving strategies and its’ sub-scales instead of control, creativity, and confidence (p < .001). According to the findings, ACT decreased high-risk behaviors such as drug abuse, smoking, and unprotected sexual behaviors. These changes might be due to decreased helplessness and avoidance as well as increased acceptance and tendency to solve problems. Instead, problem-solving strategies were improved through ACT cyber treatment.
Aug 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3924
This study measures the impact of chloroquine (CQ) therapy in reducing SARS-CoV-2 viral load in infected individuals and hence its transmissibility by describing changes in nasopharyngeal SARS-CoV-2 RNA kinetics in patients receiving standard of care (SOC) or CQ +/- ritonavir-boosted lopinavir (LPV/r). The nasopharyngeal (NP) samples were collected from mild COVID-19 patients admitted at Bamrasnaradura Infectious Diseases Institute between March and April of 2020. These patients either received SOC, or a high dose of CQ with loading dose, or high dose of CQ plus LPV/r. The samples were tested at AFRIMS using a quantitative RT-PCR assay. Levels of CQ in the plasma were measured 6 days post initiation of their treatment. In some instances, viral isolation was attempted to determine SARS-CoV-2 viability. Analyses of the clinical outcomes showed that CQ +/- lopinavir did not contribute significantly to decreasing the number of days with detected SARS-CoV-2 RNA. Viral NP GEs declined faster in the CQ group, but benefits diminished rapidly with delays in treatment initiation. Funding Global Emerging Infections Surveillance, Armed Forces Health Surveillance Branch (GEIS-AFHSB) for all research-related activities at the AFRIMS
Jun 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3862
COVID-19 is a new infectious disease, which needs to explore the clinical value of white blood cell count and lymphocyte to provide help for diagnosis and treatment.COVID-19 cases were Selected that admitted to 2 hospitals in Guizhou, China. WBC and LYM in the 1st day, in the 4th day and in the 7th day after onset were collected. There were not any differences in The WBC and LYM in the 4th day and the 7th day between the two groups.WBC and LYM in the 1st day in the moderate group were lesser than in the mild group. WBC and LYM were no dynamic changes in the mild group. In moderate group, WBC and LYM in the 1st day were lesser than in the 4th day. The levels in the 4th day and the 7th day were no differences. The conclusion was In the early stage of COVID-19, the WBC and LYM in moderate patients were significantly decreased within 4 days after onset, and could be restored to normal level after 4-7 days. However, no dynamic changes were observed in mild patients within 7 days.
Jun 2021 DOI 10.14302/issn.2639-3166.jar-21-3817
Helicoverpaarmigera is one of the most destructive pests of field crops worldwide. The Study was designed to investigate through laboratory screening the insecticidal activity of Ricinus communis, Cassia occidentalis and Bacillus thuringiensis var. Kurstaki (Btk) and their combinations against 2nd larval instar of H. armigera. Five concentrations (4%, 6%, 8%, 10% and 12%) of each plant extract and (0.62, 1.25, 2.5, 5, and 10 mg/ml) of Bt were used in this experiment. Mortality (%) was recorded after 24,48,72 and 96 hrs post treatment. The results showed that R. communis, C. occidentalis and Btkhave insecticidal activity against 2nd instar larvae of H. armigera. The highest concentration (12%) caused 80% and 70% larval mortality after 96 hrs for R. communis and C. occidental respectively. The statistical analysis revealed that there is a significant differences between all treatments and control. Additionally, all combinations (plant/plant or plant/Bt) increased the mortality %. The results also clearly demonstrate that the R. communis are significantly more toxic than C. occidental where the LC50 values were 6.4 % for R. communis and 8.1% for C. occidental. On the other hand LC50 value for Bt was 0.41 mg/ml. The binary mixture of R. communis and C. occidental have a potentiation effect after 48 hrs. Regarding the mixture of Bt and plant extracts the results revealed that R. communis and Bt mixture induced a potentiation effect whereas C. occidental and Bt mixture induced a an additive effects.
Apr 2021 DOI 10.14302/issn.2689-2855.jan-21-3771
Ascorbic acid is a water-soluble vitamin (Vitamin C) essential for both the plants and animals for the metabolic process. In this study, the liquid chromatography-mass spectrometry (LC-MS) analytical technique was used to characterize the structural properties and isotopic abundance ratio to evaluate the effect of the Trivedi Effect®-Consciousness Energy Healing Treatment on L-ascorbic acid compared to the control sample. The ascorbic acid sample was divided into control and treated parts. Only the treated part received the Trivedi Effect®-Consciousness Energy Healing Treatment remotely by a well-known Biofield Energy Healer, Mahendra Kumar Trivedi. The control and treated samples showed a chromatographic peak at retention time (Rt) 1.8 minutes exhibited the deprotonated molecular ion peak at m/z 175 (M-H)- (calculated for C6H7O6-, 175.02) in the mass spectra. The peak area of the treated sample (12817614.01) was significantly increased by 8.81% compared to the control sample (11779918.9). The LC-MS based isotopic abundance ratio of PM+1/PM (2H/1H or 13C/12C or 17O/16O) in the treated ascorbic acid was significantly increased by 23.22% compared with the control sample. Thus,13C, 2H, and17O contributions from (C6H7O6)- to m/z 176 in the treated ascorbic acid were significantly increased compared with the control sample. The increased isotopic composition of the treated ascorbic acid might have altered the neutron to proton ratio in the nucleus. The changes in isotopic abundance could be due to changes in nuclei possibly through the interference of neutrino particles via the Trivedi Effect®-Consciousness Energy Healing Treatment. The increased isotopic abundance ratio and peak area of the treated ascorbic acid may increase the intra-atomic bond strength and its stability. This novel ascorbic acid after the Trivedi Effect®-Consciousness Energy Healing Treatment would be very useful to design more efficacious pharmaceutical formulations against scurvy, obesity, cardiovascular diseases, hypertension, rheumatoid arthritis, Alzheimer's disease, cancer, etc.
Apr 2021 DOI 10.14302/issn.2576-6694.jbbs-21-3773
L-tryptophan is an essential α-amino acid, necessary for the normal growth in newborns, nitrogen balance in adults, protein synthesis, precursor of serotonin, melatonin, niacin, and albeit inefficiently in human, also the precursor of indole alkaloids and auxins in plants. This current study was designed to investigate the impact of the Trivedi Effect®-Biofield Energy Healing Treatment (Blessing) on the structural properties and the isotopic abundance ratio of L-tryptophan using LC-MS analytical technique. L-tryptophan sample was divided into two parts, one part of L-tryptophan was considered as the control sample (no Biofield Energy Treatment was provided), while the second part was treated with the Trivedi Effect®-Consciousness Energy Healing Treatment/Blessing remotely by a renowned Biofield Energy Healer, Dahryn Trivedi and termed as the treated sample. The mass spectra of both the control and treated samples with respect to the chromatographic peak at retention time (Rt) 2.1 minutes exhibited the mass of the molecular ion peak adduct with hydrogen ion at m/z 205.08 (calcd for C11H13N2O2+, 205.1), along with low molecular fragmented mass peaks at m/z 188, 159, and 102 for C11H12N2O2+, C10H11N2+, and C8H6+, respectively were also observed. The isotopic abundance ratio of PM+1/PM (2H/1H or 13C/12C or 15N/14Nor17O/16O) in the treated L-tryptophan was significantly increased by 35.93% compared with the control sample. Hence,the 13C, 2H, 15N, and 17O contributions from C11H13N2O2+ to m/z 206.08 in the treated L-tryptophan was significantly increased compared to the control sample. It could be hypothesized that the changes in the isotopic abundance and mass peak intensities due to the modification in nuclei possibly through the interference of neutrino particles using the Trivedi Effect®-Consciousness Energy Healing Treatment. The Biofield Energy Treated/Blessed L-tryptophan with increased stable isotopic abundance ratio might have changed the physicochemical properties with higher force constant in the molecule. The new form of treated L-tryptophan would be a better and more stable in the supplements, nutraceutical, and pharmaceutical formulations, which would be advantageous for the prevention and treatment of pellagra, depression, kynurenine. It could also maintain the normal label of tryptophan and avoid increase of its metabolite, lower the neurotoxin and a metabotoxin behavior, glutaric aciduria type I (glutaric acidemia type I) disorder, eosinophilia-myalgia syndrome (EMS), incurable and sometimes fatal flu-like neurological condition, etc. As tryptophan is the precursor for the plant hormones like indole alkaloids and auxins, hence, this treated L-tryptophan would be advantageous for the improvement of yield, productivity, and quality of crops and other plants.
Dec 2020 DOI 10.14302/issn.2329-9487.jhc-20-3611
Objective To understand the present status of high blood pressure in Jiangxi adults including the prevalence rate, overall awareness, and hypertension treatment. Methods a total of 7,200 adult participants (over 18 years old) lived in Jiangxi were recruited using a stratified sampling method. Blood pressure was measured for all the participants and a questionnaire survey was conducted. A 24-hour urine sample was also collected to understand urine sodium and potassium levels. Results Our findings revealed that the measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 125.9 mmHg (95% CI, 124.85-126.95) and 79.2 mm Hg (95% CI, 78.15-80.25). The prevalence of hypertension among the enrolled adults was 27.43% (95% CI, 26.38%–28.48%). Among the affected participants, less than 30% of them (95% CI) were aware of their hypertension condition, and only 28.56% (95% CI) were under anti-hypertension medications. The mean salt intake converted from urinary sodium was 10.92±4.07 g and the mean±SD of 24-h urinary sodium and potassium excretion were 185.51±65.44 mmol and 25.98±9.16 mmol, respectively. The high-salt condiments was determined to be the main source of sodium in the region. Conclusion Findings from this study form the baseline information to understand the hypertension condition in the region and indicate a possible solution for hypertension prevention through avoiding high-salt condiments.
Dec 2020
Background In Brunei Darussalam, cancer has been the leading cause of death, and breast cancer as the leading cause of death among women. With a nationally-funded cancer treatment, it is essential to determine the survival rates among breast cancer patients which can serve as a basis for comparison across timelines with the end view of improving healthcare delivery, hence, survival among the patient population. Methods This study was conducted from January – May 2019. Medical records data were abstracted for breast cancer patients treated between years 2011-2016 in a tertiary specialist cancer center. Kaplan-Meier Product Limit estimation was used for the over-all observed survival rates within 5 years after diagnosis. STATA Version 15 was used for statistical analysis. Ethical approval was obtained. Results Over-all, five-year breast cancer survival rates was favorable at 88.89%. . Survival rates according to TNM staging showed lowest at stage IV at 59% five-year survival. Survival rates according to age at the time of diagnosis showed favorable survival across age groups except for age groups 30-39 years and 80 years old and above. Survival rates according to treatment combinations were highest in surgery (mastectomy) and hormonal therapy. Conclusions The Center’s 5-year breast cancer survival rates were relatively high and comparable to survival figures of developed countries. The Center’s high survival rates could have been related to the ‘treatment factors’ due to the following: prompt treatment of early stage breast cancer stages, responsive coordination, government-funded cancer treatment which allowed patients uninterrupted, free access to standard treatment.
Nov 2020 DOI 10.14302/issn.2766-8630.jrnm-20-3594
Purpose The purpose of this study was to assess the efficacy (overall survival, local control, progression free survival (PFS) and toxicities between two dimension (2D) and three dimension (3D) CT guided brachytherapy without using interstitial needles in cervical cancer patients. Material and Methods A retrospective case-control study was performed in Figo stage IB-IVA cervical cancer patients treated between March 1990 and August 2018. Concurrent chemoradiation using external beam radiotherapy followed by brachytherapy (BT) was the treatment method used in all patients. Clinical endpoints were overall survival, local control, progression free survival, acute toxicities and late toxicities. Results A 102 cervical cancer patients were included,52 patients have been treated with 2D and 50 patients with 3D using CT scan brachytherapy without interstitial needles. Baseline characteristics were similar between both groups. External beam was used in all patients during concurrent chemoradiation period before brachytherapy. All patients completed the treatment. Similar 3-year overall survival and local control was reported between 2D and 3D techniques. Overall 3-year survival rate was 95.7% in 2D and 91.8% in 3D brachytherapy (P value = 0.188). Local control at the 3 year follow up was 88.6% in 2D and 93.3% in 3D (P value = 0.571). Progression free survival was better in 2D rather than 3D (86.13% in 2D vs 27.4% in 3D, p value = 0.006). No grade 3 or 4 toxicity in 3D technique was observed whereas there are 1.9% of grade 3 acute GI toxicity and grade 3 late GI and GU toxicities in 2D technique (7.7% and 5.8 %). The 3D brachytherapy significantly reduced acute grade 2-3 GI side effect and grade 2-3 late GU side effect (acute GI 25% in 2D vs 4% in 3D, late GU (56% in 2D vs 16% in 3D). Conclusion Using CT guided 3D brachytherapy in treatment of cervical cancer showed similar outcomes in survival and local control but reduced toxicity compared to the 2D technique. Disease progression including metastasis was found better in the 2D brachytherapy technique. CT guided brachytherapy helped reduce dose to organs at risk and long term follow up for survival outcome and toxicities was needed.
Nov 2020 DOI 10.14302/issn.2328-0182.japst-20-3618
Metronidazole is an antibiotic and useful for the antibacterial and antiprotozoal medication. This study was performed to investigate the impact of the Trivedi Effect®-Biofield Energy Healing Treatment on the structural properties and the isotopic abundance ratio of metronidazole using LC-MS and GC-MS spectroscopy. Metronidazole sample was divided into two parts, one part of metronidazole was considered as control (no Biofield Energy Treatment was provided), while the second part was treated with the Trivedi Effect®-Consciousness Energy Healing Treatment remotely by a renowned Biofield Energy Healer, Alice Branton and termed as a treated sample. The LC-MS spectra of both the samples of metronidazole at the retention time (Rt) 2.61 minutes exhibited the mass of the protonated molecular ion peak at m/z 172 M+H+ (calculated for C6H10N3O3+, 172.07). The LC-MS based isotopic abundance ratio of PM+1/PM (2H/1H or 13C/12C or 15N/214N or 17O/16O) in the treated metronidazole was significantly increased by 8.24% compared with the control sample. Thus,13C, 2H, 15N,and17O contributions from (C6H10N3O3)+ to m/z 173 in the treated sample were significantly increased compared with the control sample. The GC-MS based isotopic abundance ratio of PM+1/PM in the treated metronidazole was significantly increased by 5.92% compared with the control sample. Hence,13C, 2H, 15N, and217O contributions from (C6H9N3O3)+ to m/z 172 in the Biofield Energy Treated sample were significantly increased compared with the control sample. However, the isotopic abundance ratio of PM+2/PM in the treated metronidazole was significantly decreased by 18.2% compared with the control sample. Hence,18O contributions from (C6H9N3O3)+ to m/z 173 in the treated sample were significantly decreased compared with the control sample. The isotopic abundance ratio of PM+1/PM (2H/1H or 13C/12C or 15N/14N or 17O/16O) and PM+2/PM (18O/16O) in the treated metronidazole was significantly altered compared to the control sample. From the results, it can be hypothesized that the changes in isotopic abundance and mass peak intensities could be due to changes in nuclei possibly through the interference of neutrino particles via the Trivedi Effect® - Consciousness Energy Healing Treatment. The new form of treated metronidazole would be better designing novel pharmaceutical formulations that might offer better therapeutic response against bacterial and protozoal infection in the vagina (bacterial vaginosis), stomach (giardiasis, trichomoniasis, pseudomembranous colitis), joints (pelvic inflammatory disease), liver, skin, brain, and respiratory tract, aspiration pneumonia, rosacea, intra-abdominal infections, lung abscess, fungating wounds, periodontitis, amoebiasis, oral infections, etc.
Jul 2020 DOI 10.14302/issn.2576-6694.jbbs-20-3419
Lead removal efficiency of the bacterial strain, Bacillus subtilis (MTCC 2423) was tested with 200, 400, 600, 800 and 1000 ppm of lead in minimal broth for a period of ten days. Samples were tested for the level of lead every two days in each concentration and maximum removal was observed after six days of treatment. With the increase in lead concentration, both biomass and lead removal efficiency showed an increase. When tested with immobilized, dead and live cells, maximum removal was observed for immobilized cells. Among the sugars tested, monosaccharide sugars enhanced the biomass of B. subtilis during lead treatment and the results are discussed.
Jun 2020 DOI 10.14302/issn.2372-6601.jhor-20-3372
Immune thrombocytopenia currently called under its’ new name, immune thrombocytopenic purpura (ITP) is a disease characterized by thrombocytopenia, in which the body attacks its own platelets due to the disorders in immune system. The pathophysiology of this disease includes increased platelet destruction and most megakaryocyte production in bone marrow. The most common clinical manifestation of ITP is mild or severe progressive bleeding that could result in death. ITP is generally named as primary or secondary ITP according to thrombocytopenia severity, disease duration, bleeding status and secondary occurrence of the disease. Currently for diagnosis, despite the blood count, antiglobulin test and laboratory tests that can detect platelet-bound antibodies, they are not enough for definitive diagnosis. Like the difficulty in diagnosis, ITP treatment is quite complicated which varies depending on age, characteristics and risk of the patient. It is classified as first, second and third-line treatment options. Also, depending on the condition of patients, combined treatment might be an option which increases the complexity of the treatment. Unfortunately, discussions related to different clinical applications in diagnosis and treatments continue recently. For this reason, we considered that preparation of a review containing recent updates in diagnostic approaches and treatment options in ITP will be remarkable and beneficial for physicians interested in this subject.
Dec 2019 DOI 10.14302/issn.2690-6759.jpar-19-3081
Malaria and typhoid fever are two endemic infectious diseases in developing tropical countries including Burkina Faso. There are two distinct infectious diseases with many similar clinical signs. In each sanitary area, it is important to describe the "typhomalaria" epidemiology to elaborate adequate diagnosis algorithm and efficient treatment protocol. A cross-sectional study was carried out from July to October 2014 in the lab department of University Hospital Souro SANOU, Bobo-Dioulasso. All microscopy positive malaria during the study period was included. Serodiagnosis of Widal and Felix was performed systematically in all Plasmodium spmalaria cases. Titers of antibodies anti-agglutinin O equal or higher than 1/400 and/or 1/800 for anti-agglutinin H antibodies were considered positive for Salmonella sp. A total of 283 malaria cases were included in this study, majority falciparum malaria. In this malaria cases, 91 patients were seropositive for Salmonella sp. "Typhomalaria" co-infection prevalence was 34.3% (CI 95% (28.8%; 40.1%)). The patient with the normal hemoglobin rate had the highest prevalence of co-infection (46.7% versus 30.9; p=0.02). Malaria and typhoid fever co-infection was high (approximately 1/3 of malaria cases) in University hospital of Bobo-Dioulasso. This study revealed the need to explore typhoid fever in malaria confirmed cases, especially in persistent fevers and non-anemic situation despite adapting antimalarial treatment.
Nov 2019 DOI 10.14302/issn.2379-7835.ijn-19-3083
Background In November 2014, the World health Organization (WHO), in collaboration with United Nations Children's Fund (UNICEF), and the World Food Programme, produced interim guidelines (iGL) on providing nutritional support to patients in Ebola treatment units (ETUs). They have been translated into French and issued by the Ministry of Health, UNICEF and WHO in adapted versions to be used in the current outbreak in the Democratic Republic of the Congo (DRC). This paper evaluates the use and usefulness of the 2014 iGL in the West Africa and current DRC Ebola virus disease (EVD) outbreaks and identifies experiences and lessons learned from practitioners on the operational aspects of nutritional care and support in ETUs. Methods Key-informants (n=26), from 12 organizations (Non-Governmental Organizations, United Nations, Red Cross Red Crescent Movement) were interviewed who were actively engaged in the nutritional and/or clinical care of EVD patients. Results There was a consensus among key-informants that the 2014 iGL initially served a guiding purpose. However, the vast amount of learning from the 2014-2016 and current EVD outbreaks indicates that the interim guidelines need to be revised. Practitioners struggled to find operational solutions for nutritional care, and the challenges were plentiful, especially regarding 1) the different perceptions of the importance of nutritional care among ETU staff; 2) the difficulties around food preparation and distribution for EVD patients; 3) how to take into account the patients’ dietary preferences; 4) the nutritional care needed in relation to specific EVD symptoms; 5) who assumed roles in nutritional care in ETUs; 6) if and how feeding support was organized; 7) whether malnutrition needed to be addressed and how; and 8) whether the intake of specific nutrients could contribute to improved treatment outcomes. Information from the key-informants interviews resulted in numerous lessons learned and recommendations for nutritional support during current and future outbreaks. Conclusions This investigation underscored the importance of documenting experiences of practitioners on nutritional care in emerging infectious diseases for which limited scientific evidence exists and for which interim guidelines are produced to fill in knowledge gaps. It also emphasized the importance of nutritional care in ETUs during treatment.
Oct 2019 DOI 10.14302/issn.2574-450X.jom-19-2852
Obesity can be defined as a condition of abnormal or excess fat accumulation in adipose tissue, to the extent that health may be impaired. Fennel is one of the oldest spice plants which widely grows in arid and semi-arid and due to its economic importance and pharmaceutical industry usage. This plant has anti-inflammatory and analgesic effect and is effective in gastrointestinal disorder treatment. The aim of the present study was to evaluate the phytochemical characteristics and therapeutic properties of this medicinal plant. The current study demonstrates that the alteration induced by high fat diet causing changes in blood parameters. These changes are exhibited through a decrease in RBCs, Ht, Hb and platelet and these changes could be due to oxidative stress, which lead to lipid peroxidation in RBCs membranes, auto oxidation of hemoglobin. As regards the total WBCs, lymphocytes and monocytes showed marked decrease. While a distinct increase in the percentage of neutrophils and eosinophil. The present, demonstrates that rats treated with (fennel), (ator) and (fennel with ator) exposure provided significant protection to the altered hematological variables. The effect of the treatment with fennel and ator more effect than fennel only and ator only. The finding of this study indicates that the concentration of Malondialdehyde (MDA) and Myeloperoxidase (MPO) in liver homogenates of the fennel and ator group significant decrease than group (3) and group (4) and the obese group. There is a growing awareness that obesity is a prime risk factor for the development of dyslipidemia profile and that oxidative stress may play a role in various adverse effects of obesity.
May 2019 DOI 10.14302/issn.2574-4526.jddd-19-2770
Introduction In France 33% of patients didn’t take care of hepatitis C because there were no diagnosed. Drug injection was main contamination route of hepatitis C virus (HCV) in France. French guidelines were to treat all inmates and drug users, even fibrosis level. Access of HCV screening, care and treatment in drugs users, prisoners and homeless was low in France. They were considered as difficult to treat populations. All these patients need specific support. Hepatitis Mobile Team (HMT) was created in July 2013 to increase screening care and treatment of hepatitis B and C patients. HMT was composed of hepatologist, nurses, social workers and health care worker. Objective increase outreach screening care treatment access and cure of our target population. Patients and methods Target population was drugs users, prisoners, homeless, precarious people, migrants and psychiatric patients. We proposed part or all of our services to our 42 medical and social partners: HCV HBV screening by DBS (dried blood test); outside DBS and FIBROSCAN in converted van; Outreach open center; Drug users information and prevention, Free blood tests in primary care;, Staff training; Social screening and diagnosis; Mobile liver stiffness Fibroscan in site; Advanced on-site specialist consultation; Easy access to pre-treatment commission; Low cost mobile phones for patients; Individual psycho-educative intervention sessions; Collective educative workshops; Peer to peer educational program; Specific one day hospitalizations. All services were free for patients and for partners. Results from 2013 July to 2018 December, we did 8382 DBS for 5382 people (3053 HCV DBS) and 2302 Fibroscan*. HCV new positive rate was 21.3%. Our HCV active file was 651patients included these 24.8% new patients screened by DBS; 98% realized HCV genotype, HCV viral load and FIBROSCAN. DAA treatment was proposed to 96%; 95% started treatment, 4% were lost follow up or refused treatment. After treatment, there was 7 relapse and 3 reinfections by drug injection and cured rate of 94%. Sociological evaluation showed that 4 program qualities for patients: free access, closeness (outside hospital), speed (of the results) and availability (of nurse and social workers). Conclusions: Specific follow-up of drugs users and other HCV high-risk patients including screening, early detection, diagnosis and treatment increase rate of treated and cured patients, with low rate of relapse and reinfections.
May 2019 DOI 10.14302/issn.2328-0182.japst-19-2738
Rationale Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Prevalence of viral hepatitis C (HCV) is higher in prison environment in France than in the general population and is estimated to be 4,8%. The impact in prison environment is little-known as based on local studies. Inmate health care falls under USMP (prison setting medical unit), hospital specific units as by the january 18, 1994 law. Access to antiviral c treatment for inmates has always been difficult in France, would it be for interferon and ribavirin or use of protease inhibitors, with less than 20% of treated patients. French recommendations for HCV screening recommend systematic screening of inmates. The arrival of all oral therapies by direct antiviral agents (DAA) with shorter treatment times was an opportunity for doctors to propose a treatment and the patient to accept it. In 2014, the French guidelines recommended that HCV carriers in prison should systematically be treated independently of the stage of fibrosis. Objective of the Study PH8 Our objective was to evaluate the completion rate of an 8-week antiviral C treatment by sofosbuvir / ledipasvir regimen in non-cirrhotic genotype 1 patients in deprivation of liberty and achieve sustained virological response (SVR) and to measure the effectiveness of an 8-week treatment (by protocol analysis). Methodology prospective non-interventional multicenter trial among inmates with chronic hepatitis C genotype 1 with METAVIR fibrosis score F0 to F2 and who will receive a daily combination of sofosbuvir / ledipasvir for 8 weeks. Results 6 prison medical units included 115 consenting patients: there were 81% men, mean age 41 years (21 to 64 years). Route contamination was drug injection for 85%. HCV genotype was 1a for 74%, 1b for 24% and 2% none differenciated 1. Fibroscan mesure was available in 89 patients (mean score 3,5 KPa). Fibrotest was available in 37 patients with mean value 0.21. Eleven patients had Fibroscan and Fibrotest; 69% of patients were F0, 22% F1 and 9% F2. Average time between diagnosis and start of treatment was 3 weeks. We are sure that 109 patients (95%) completed DAA 8 weeks treatment; only 2 stopped DAA treatment before 8 weeks and 4 had no follow up after end of detention. HCV viral load was measured at W2 for 90 patients (78%), at W4 for 92 patients (78%), at end of treatment for 92 patients (78%), one month after treatment for 90 patients (78%) and 3 months after for 95 patients (93%). Only one viral load was positive, one month after treatment. Patient was retreated by sofosbuvir / velpastasvir. All HCV viral load 3 months after treatment negative; one patient took DAA only 6 weeks was cured. Conclusions In these study PH8, we observed completion rate of 94% for included patients in patient with 8 weeks ledipasvir/sofosbuvir regimen; data missed for only 4 patients and one relapsed. Short DAA treatment was efficient in prisoners and could be preferred in specific population.
Apr 2019 DOI 10.14302/issn.2329-9487.jhc-19-2714
Progressive increase of cardiovascular disease (CVD), with a rising costs for the society, is driving to focus on risk’s factors reduction. The importance to prevent acute events and to reduce mortality and morbility have risen the sound of the correct life style indications as the primary approach for hypertension. The new classification of hypertension has amplified an high-value of the role of the physical activity especially in the initial phase of the disease when the potential positive impact of the regular physical activity can permit to avoid the use of the pharmacological treatment. The numbers of the hypertensive subjects is increasing everywhere; however the awareness of the presence of the disease is not so frequent. Although some risk factors, such as age and hereditary factors cannot be changed, on the contrary lifestyle’s modification can prevent the CVD and hypertension. Sports Medicine physicians agree that healthcare providers need to focus on preventive and lifestyle aspects of cardiovascular care to promote individual and population health. A dedicated approach to prescribe the amount of weekly physical activity at moderate intensity can allow to control the blood pressure values avoiding the assumption of antihypertensive drugs. Aerobic and resistance exercises need to be individually established by dedicated models tailored on the basis of the specific characteristics of the people involved. Sports and Exercise Medicine can contributes to manage and to tailor the amount of programmed physical activity starting from the ”exercise prescription” guidelines.
Apr 2019 DOI 10.14302/issn.2688-5328.ijp-19-2717
Objective The current clinical case series assess the clinical outcome of the use of low-level laser in the treatment of painful pediatric fractures not solidly consolidated and re-modelled after casting for a standard of 4-6 weeks Materials and Methods The patient cohort consisted of 17 consecutive unselected patients in pediatric age group with delayed fracture consolidation and/or undesirable angulation despite casting for a standard period of 4-6 weeks in whom the parents refused any surgical intervention and/or bone grafting options. All subjects were referred from other medical centers after inadequate healing of the fracture ends upon repeating the x ray after the cast was off at the 4-6 weeks mark. Low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases were administered with a view of enhancing bone healing and/or re-modelling since both previous clinical and basic science studies on LLLT showed a stimulatory effect on fracture healing. Results All patients had solid union, mean time for union for upper and lower limb fractures were 6 and 10 weeks respectively. The calculated p value is statistically significant at p < 0.05. No patient defaulted follow up. All parents were satisfied with the clinical and radiological result of the LLLT treatment. Conclusion LLLT was found not only to enhance bone healing potential but in fact improved bone re-modelling when used in the proper wavelength and energy density in pediatric upper and lower limbs fractures, thereby also rapidly resolve the intolerable pain in paediatric fracture population
Mar 2019 DOI 10.14302/issn.2690-4721.ijcm-19-2616
Introduction Ultrasound technology has previously been applied for cataract removal and tennis elbow treatment. Recent data supports the use of ultrasonic debridement in the treatment of diabetic foot ulcers. No data is available concerning the potential antibacterial properties of a clinical grade, lower energy ultrasound probe. We investigated the effect of a ultrasonic probe with respect to P gingivalis bacterial viability. Methods A Tenex Tx1 probe with standard settings for clinical use was used for this study. A Gram negative (Porphyromonasgingivalis) bacteria, known for its pathological activity, was investigated. The bacteria was cultured in an anaerobic broth, re-suspended to achieve a consistent bacterial count, and 5ml of this re-suspension was placed in a test tube for testing. Each tube was sonicated with the Tx1 probe for varying lengths of time (10, 30, 60, 120 seconds). The sonicated was diluted and plated on blood-agar plates, followed by incubation for 48 hours at 37°C in an anaerobic growth chamber. The number of colony forming units were counted, on each plate and the anti-bacterial effect was calculated. A one way analysis of variance was performed for statistical analysis. Results A significant time-dependent antibacterial effect was demonstrated with sonication. When comparing the kill rate between the control and 120 seconds of sonication P Gingivalis had a 64% kill rate. This was the only statistically significant time comparison achieved, although the trend for all the time intervals was a reduction in the colony forming unit counts. Conclusion This study demonstrates that a clinically available ultrasonic probe (Tenex Tx1) has an antibacterial effect against the gram negative anaerobic bacterial species P gingivalis. Complete deactivation was not achieved, and there was a variation in effect dependent on the time of active sonication, with greater sonication times leading to greater kill rates. This data may partially help to explain the ability for ultrasonic debridement to result in the healing of long standing diabetic ulcers, that have been recalcitrant to other forms of treatment.
Feb 2019 DOI 10.14302/issn.2578-8590.ipj-19-2623
Neosaxitoxin (NeoSTX) is a specific high-affinity inhibitor of voltage-dependent sodium channels, which has shown excellent results as a local anesthetic in various pathologies and post-operative protocols, since it effect is long-lasting and have virtually no side effects.The aim of this study was to analyze the effect of NeoSTX as an epidural anesthetic in female cats, undergoing ovariohysterectomy, compared to Lidocaine in a randomized and double-blind study. Two groups of 11 female cats were randomly in the NeoSTX group and the lidocaine group. They were administered, respectively, a single dose of NeoSTX (0.5 μg / kg) or lidocaine (4 mg / kg, 2%) by epidural via. Using the UNESP-Botucatu pain assessment scale, which considers multiple behavioral and physiological factors, the epidural anesthetic effect of NeoSTX and lidocaine was evaluated, up to 240 min after the ovariohysterectomy procedure. NeoSTX no altered the peripheral blood pressure during the cut of uterine cervix, and generated lower values on the pain scale as compared to the lidocaine treatment. None of the cats anesthetized with NeoSTX required an extra dose of pain-relieving drugs (2 mg / kg of tramadol) during the first 150 min after surgery, whereas nine cats from the lidocaine group did need an extra dose of analgesic. NeoSTX is a powerful pain blocker, with a long-lasting anesthetic effect when administered by an epidural procedure. Therefore, NeoSTX emerges as a promising alternative to conventional anesthetics for the treatment of postoperative pain.
Feb 2019 DOI 10.14302/issn.2377-2549.jndc-18-2507
Hydroxypropyl β-Cyclodextrin (HPBCD) used in food, pharmaceutical, chemical industries, as well as environmental, and agriculture engineering. But the major issue related to HPBCD is the low solubility profile. In this study, the influence of the Consciousness Energy Healing Treatment (the Trivedi Effect®) on the physicochemical properties of HPBCD was evaluated using spectroscopic and calorimetric analytical techniques. The test sample (HPBCD) was divided into control sample and treated sample. The control sample did not receive the Biofield Energy Treatment. Whereas, the treated sample received the Biofield Energy Treatment remotely by a renowned Biofield Energy Healer, Dahryn Trivedi. The particle size values of the treated sample were decreased by 3.28%(d10), 1.36%(d50), 0.45%(d90), and 1.04%{D(4,3)}; therefore, the specific surface area was increased by 1.9% compared with the control sample. The evaporation temperature of the treated HPBCD sample was significantly decreased by 19.89%; however, the latent heat of evaporation and latent heat of fusion were significantly increased by 56.27% and 47.41%, respectively compared with the control sample.The total weight loss in the treated HPBCD was decreased by 5.11%; whereas, the residue amount was significantly 309.67% more compared to the control sample.The results indicated that the Trivedi Effect® might have produced a new form of HPBCD which may show better thermal stability, solubility, dissolution rate, and bioavailability. This new form of HPBCD would be more useful for improvement of solubility of the lipophilic drug, preparation of cholesterol free food products, weight loss supplements, anti-obesity medication, stabilize volatile and unstable compounds, and other manufacturing industry using it as a raw material.
Jan 2019 DOI 10.14302/issn.2641-4538.jphi-18-1973
Introduction Adherence to ART is a challenge among pregnant women living with HIV/AIDS. This has an effect on the health of the mother and the unborn child. While studies have been done, it has shown that adherence during pregnancy is a challenge Virological and clinical success depend critically on high adherence to ART because with low adherence. The success of expanded ART coverage in improving health outcomes depends on adherence to treatment. During pregnancy, a compromised Virological response to ART also increases risk of mother-to-child transmission (MTCT) of HIV. This study was carried out to determine factors that influence adherence to antiretroviral therapy among HIV positive pregnant women in Lusaka district of Zambia. Methodology This was a qualitative study which used a case study approach. Data was collected through in-depth interviews. The collected data was analysed using a thematic analytical approach. Results 17 pregnant women living with HIV /AIDS in Lusaka had Challenges with adherence to ART. The study explored factors related to adherence to ART among pregnant women living with HIV/AIDS. ART adherence was found to be low. The findings call for the need to reduce on social stigma. The results confirmed that there is low adherence to ART among pregnant women living with HIV /AIDS in Lusaka. Conclusion Adherence to ART among pregnant women living with HIV/AIDS is a challenge for Zambian pregnant women. Improved levels of adherence to ART is hampered by fear of social stigma, and fear of being blamed by partners if they disclosed their status. Stigmatisation needs to be addressed because nearly all the participants expressed this factor. There is need to address the HIV/AIDS stigma very seriously in order for society to look at HIV/AIDS like any other illness.
Jan 2019 DOI 10.14302/issn.2470-5020.jnrt-18-2555
Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P<0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.
Jan 2019 DOI 10.14302/issn.2379-7835.ijn-18-2469
Background Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are categorized as omega-3 poly unsaturated fatty acids (PUFAs) that are present in fish oil, etc. DHA and EPA omega-3 PUFAs have a well-established fasting serum triglycerides (TG) lowering effect that may result in normal lipidemia in hyperlipidemic patients. In general, omega-3 PUFAs, such as DHA and EPA, can be ingested easily, and because they are highly safe, they are assumed to be suitable for controlling fasting serum TG in the serum of those who do not require drug treatment. To the best of our knowledge, however, almost all systematic reviews on the effects of omega-3 PUFAs on lowering fasting serum TG are directed at patients fulfilling the diagnostic criteria of dyslipidemia. Objectives To review and confirm the preventive effect of omega-3 PUFAs against hypertriglyceridemia or the effect on nondrug treatment in patients with a mild disease, a systematic review was conducted to determine whether there was a fasting serum TG-lowering effect in subjects without disease and those with a slightly higher triglyceride level who consumed DHA and/or EPA orally compared to those with placebo or no intake of DHA and/or EPA. Search Methods We evaluated articles from searches of PubMed (1946-February 2016), Ichushi-Web (1977-February 2016), and J Dream III (JST Plus, 1981-February 2016; JMED Plus, 1981-February 2016). The keywords were set as follows: “DHA” or “docosahexaenoic acid” or “EPA” or “eicosapentaenoic acid” and “TG” or “triglyceride” or “triglycerol” or “triacylglycerol” or “neutral lipid.”. In addition to the literature group obtained by the database search, we included participants not suffering from any disease (i.e., excluding mild hypertriglyceridemia). Eligibility Criteria Before the test selection process, the following inclusion criteria were defined. Participants were healthy men and women including those with mild hypertriglyceridemia (fasting serum TG level, 150-199 mg/dL [1.69-2.25 mmol/L)). Intervention was defined as orally ingested DHA and/or EPA. Comparison was made to placebo intake or no intake of DHA and/or EPA. Results were measured for the fasting serum TG level. The test design was RCT, and quasi-RCT. Data Abstraction Various characteristics were extracted from original reports using a standardized data extraction form, including the author of the study, research year, research design, subject characteristics (sex, age, sample size), period, dose of DHA and/or EPA (mg/day), and comparison group. Main Results We identified 37 documents for review. Among the 37 reports used to integrate literature results, 25 revealed a decrease in fasting serum TG level due to the oral ingestion of DHA and/or EPA. Sixteen studies on subjects without disease and 21 on subjects with slightly higher fasting serum TG levels were separated and stratified analysis was conducted. Ten of the 16 (normal TG participant) and 15 of the 21 studies (slightly higher TG participant) respectively, indicated that at least 133 mg/day of DHA and/or EPA intervention provided a statistically significant decrease in the fasting serum TG level between an intervention group versus a placebo group.
Jan 2019 DOI 10.14302/issn.2639-3166.jar-18-2502
The compound 1,4-dimethylnaphthalene, originally isolated from dormant potatoes, is currently in use as a commercial sprout inhibitor. Growers and processors report a reduction in fungal infections in potatoes treated with DMN resulting in increased yields. To assess the effects of DMN on fungal growth a culture of Fusarium oxysporum was isolated from potato tubers and identified via DNA fingerprinting using the 18ITS ribosomal region. Growth of F. oxysporum was inhibited by 31% after four days of exposure to DMN but overall rate of spore germination was not affected by DMN treatment. The growth of additional fungi, including Alternaria alternata, Aspergillus niger, Epicoccum nigrum, Gnomoniopsis smithogilvyi, Phoma medicaginis, and Pythium ultimum was inhibited by DMN as was suppression of sporulation in A. niger. These results suggest that DMN is fungistatic at the application levels examined.
Jan 2019 DOI 10.14302/issn.2572-3030.jcgb-18-2527
As remarkable advances have been made in immunotherapies, the overall goal of immunotherapy has become the selection of patients and evaluating the benefits of treatment. One of the major obstacles to develop immunotherapies is the lack of effective immune monitoring. Monitoring of key changes in the immune system during immunotherapy (immunomonitoring) provides important insights into efficacy as well as the immune mechanisms of response at the molecular and cellular levels. Immunomonitoring techniques include traditional immunoassays that use specific antibodies to recognize the analytes of interest, new high-throughput immunoassays that target immune cells and nucleic acids, and less classical immunogenomic approaches that rely on genome-wide profiling and computational analysis on various types of clinical samples. Substantial progress has been made in the application of immunomonitoring strategies to pre-clinical and clinical studies, especially for patients with cancer and infectious diseases. Current and emerging immunoassays performed in clinical practice will be examined herein, and immunogenomic approaches that complement these techniques will be highlighted and compared with traditional methods. Finally, we will discuss several new computational methods for analyzing gene signatures for immunomonitoring, including gene expression data profiling by microarray, the nCounter technique, regular RNA-seq, and single-cell RNA-seq. Novel immunomonitoring techniques, especially immunogenomic approaches, will continue to be developed to facilitate assessment of immunotherapeutic response and predict patient outcomes in cancer and infectious disease.
Dec 2018 DOI 10.14302/issn.2641-5526.jmid-18-2488
Background: Triple Negative Breast Cancer (TNBC) is a type of breast cancer with very bad prognosis. Predicting the histological grade (HG) and the lymph nodes metastasis is crucial for developing more suitable treatment strategies. Methods: We present the main clinical and pathological variables to predict the histological grade and lymph nodes metastasis via novel machine learning techniques. These variables are currently being used for prognosis and treatment in medical practice. This analysis was performed using a database of 102 Caucasian women diagnosed with TNBC. The results were cross-validated using random simulations of this dataset. Results: HG was predicted with an accuracy of 93.8% using a list of 6 prognostic variables with significant implications: Ki67 expression, use of Oral contraceptives, Col11A1 expression, Col11A1 score, E-cad truncated and Tumor size. The lymph nodes metastasis was predicted with an accuracy of almost 85% using only 6 prognostic variables: Vascular invasion, Tumor size, Perineural invasion, Age at diagnosis, Ki67 expression, and Col11A1 score. This analysis also served to establish the median signatures of the groups with and without lymph node metastasis, and proved the existence of a kind of small-size tumors (around 2.15 cm) with lymph node metastasis but not showing vascular and perineural invasions and higher protein Col11A1 score. Besides, these signatures proved to be very stable. Conclusions: The additional information conveyed by the prognostic variables found in these two classification problems provides new insight about the genesis and progression of this disease and can be used in medical practice to improve decisions in patient diagnosis and further treatment.
Dec 2018 DOI 10.14302/issn.2379-7835.ijn-18-2491
Objective: To evaluate the efficacy and safety of a novel tomato-based food supplement on the lower urinary tract symptoms (LUTS) of patients with benign prostatic hyperplasia (BPH). Methods: Twenty patients with BPH were enrolled in this observational study. They were assigned to consume daily a sachet of Lycoprozen® (5 grams) dissolved in water for two months. Results: All patients successfully completed the Lycoprozen scheduled regimen and the IPSS (International Prostatic Symptom Score) questionnaire before and after treatment. No side effects due to treatment were noticed. In this preliminary study, we have found that Lycoprozen® significantly reduced the LUTS severity (paired t-test, two-tailed p value < 0.0001). The IPSS mean values before and after the treatment were 16.95+6.0 SD (range 31-6) and 12.2+4.9 SD (range 20-2), respectively. Conclusions: Based on these data, Lycoprozen® may represent a suitable alternative option for the treatment of symptomatic BPH patients which worth of further testing in a phase 2 prospective randomized double blind placebo controlled study. The treatment was without side effects and acceptance among patients was high.
Nov 2018
Pre-adipocytes are the precursors with the potential to make new fat cells during adipose tissue expansion. Nevertheless, the pre-adipocytes behaviors, and their possible roles in energy homeostasis have long been overlooked. Our previous study implicates that interleukin-4 (IL-4) plays a positive metabolic role by promoting insulin sensitivity and inhibiting lipid accumulation. Besides, abundant evidence shows the involvement of matrix metalloproteinase-2 (MMP-2) in the process of adipose tissue expansion. The present study aimed at examining the cross talk among glucose, insulin and IL-4 on regulating MMP-2 expression and activity in 3T3-L1 pre-adipocytes. Effects of insulin and/or IL-4 on MMP-2 expression and activity were examined in pre-adipocytes under euglycemic or hyperglycemic environment by RT-PCR and gelatin zymography, respectively. Our results revealed that glucose level is a pre-requisite for pre-adipocytes responding to insulin and/or IL-4 treatment. In high glucose-containing environment, short-term acute insulin treatment (AI) and long-term chronic insulin exposure (CI) showed opposite regulation to MMP-2 expression and activity. Interestingly, the dominant MMPs regulatory role of CI under euglycemic condition was attenuated in cells exposed to high glucose concentration. Our results suggest pre-adipocytes may participate in the process of increasing adiposity, diabetic onset and diabetic complications through ECM alterations resulted from the insulin- and/or glucose- mediated changes of MMP-2 activity. The present study uncovers novel observations regarding pre-adipocytes behaviors.
Sep 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2185
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with Parkinson's disease (PD), but more studies about gait and functionality are needed. We aimed to understand whether short-term DBS treatment will can relieve the symptoms of PD patients, specifically we examined its effect on motor-cognitive-complication parameters, fine motor skills and daily living activity (DLA) of these patients. Method: Ten patients from Mustafa Kemal University Neurosurgery Department were recruited. The assessments were made twice, first time preoperatively, which was within one week prior to the surgery, second time postoperatively, which was 55-65 days post treatment. The motor scores, DLA scores, mental scores and complication scores were measured with Unified Parkinson's Disease Rating Scale (UPDRS), fine motor skills measured with The nine-hole peg test (9-HPT), balance measured with Berg Balance Scale (BBS) and falling risk measured with Timed Up and Go Test (TUG). Results: 10 patients (5 female, 5 male) aged between 40-60 (mean=49.44±6.69 years) were included in the study. Duration of the disease’s mean was 5.60 years. We found significant difference between pre-op and post-op results in UPDRS DLA, UPDRS motor, UPDRS complication, UPDRS total score and TUG tests (Table 2). There was no significant difference between preop-postop assessment in UPDRS mental, BBS and 9-HPT results (p>0.05). Discussion: Balance, walk and fine motor impairment occurs almost always in Parkinson’s disease and resulting in difficulties with daily living activities. We found that DBS has positive effect on PD complications, balance and walking abilities. PD patients that have falling risk and multiple motor symptoms may have benefit from DBS.
Aug 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2258
We present a case of a 77-year-old male patient who was treated in our outpatient clinic for memory disorders because of episodic confusion and retrograde amnesia. The patient reported having symptoms repeatedly following intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents (Ranibizumab and Bevacizumab) as a treatment for wet macular degeneration. EEG showed a localized deceleration that intensified under prolonged voluntary hyperventilation. Symptoms resolved after the intraocular Anti-Vascular Endothelial Growth Factor treatment was stopped and anticonvulsive treatment with lamotrigine was begun. This case is important in that it describes a potential association between intraocular treatments with Anti-Vascular Endothelial Growth Factor Agents and seizures. Symptoms occurred in temporal correlation with intraocular treatment. Clinicians should be aware of this potential side effect on intraocular treatment with Anti-Vascular Endothelial Growth Factor Agents in patients with high risk for seizures.
Aug 2018 DOI 10.14302/issn.2640-690X.jfm-18-2252
Background: Feeding problems are common in autism. Parents are frequently worried about the health status of their children, which may be threatened by some consequent nutritional deficiencies. Despite this, feeding behaviours remain little explored by clinicians working with children with autism spectrum disorders and researches are lacking especially in Tunisia. Aims: To evaluate the frequency and the types of feeding problems in children with autism spectrum disorders. Settings and Design: A comparison was made between 57 children with autism spectrum disorders and 57 control groups regarding the feeding problems. Parents completed the children’s eating behavior inventory (CEBI). Autism severity is evaluated using the Childhood Autism Rating Scale. The SPSS statistical package, version 20.0 was used. Results: According to the CEBI, children with autism spectrum disorders showed more feeding problems than the control group (82.4% versus 56.1%, p=0.002). In fact, the parents of these children observed more pica habits on their children compared to the control group (p=0.000). They also observed more selectivity for starchy foods compared to the control group (p=0.000). The more the autistic symptoms were severe, the more children exhibited feeding problems (p=0.02). Conclusions: Our findings suggest that feeding problems are more common in children with autism. Clinical implications trigger the need for clinicians to provide the necessary assessment and treatment.
Mar 2018 DOI 10.14302/issn.2639-1716.jn-18-1993
Cardiovascular disease and lung cancer are two of the most common causes of death in the United States. The cardioprotective benefits of statin class drugs is predominantly mediated through the inhibition of 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase, decreasing available mevalonate, and thus limiting in vivo cholesterol biosynthesis. Mevalonate and its metabolites have significant roles in cellular membrane synthesis, which is dysregulated during tumorigenesis, and is therefore a potential source for anti-tumor effects of statins. Similarly, dysregulation of cellular signaling is a hallmark of tumorigenesis. In vitro studies of EGFR, RAS, and AKT signaling pathways in cancer cells can all be reformed back to states more indicative of normally functioning cells when treated with statins. Statins have also been shown to exert beneficial properties in the presence of chemotherapeutic medications and radiation therapies by modulating the deleterious effects of reactive oxygen species, decreasing tumor cell resistance, and minimizing damage to surrounding native tissues. There is abundant of in vitro evidence to support the beneficial effects of statins on lung cancer patients. Prospective studies to determine the value of statin therapy on lung cancer prevention could lead to a significant change in lung cancer treatment.
Feb 2018 DOI 10.14302/issn.3070-5835.jcpn-18-1956
This pilot study aimed to determine the knowledge, beliefs and attitudes of Turkishpatients on in-center hemodialysis about home hemodialysis (HHD) and their related factors. A cross-sectional study was performed among 32 patients on in-center hemodialysis in a tertiary hospital in Turkey. Data were collected by using a questionnaire form including sociodemographic and disease-related characteristics and knowledge, beliefs and attitudes about HHD. Data analysis were performed using descriptive statistics and the Chi-square test. While the majority of the patients (65.6%) reported having knowledge about HHD, only 34.4% of them had ever considered it. The most common perceived benefits of HHD were minimized wasted time (71.9%) and more time spent with family (71.9%). The most common perceived barrier to HHD was also housing constraints (90.6%). The results of this study highlight the importance of recognizing knowledge, beliefs and attitudes toward HHD in patients on in-center hemodialysis for increasing the use of the treatment.
Feb 2018 DOI 10.14302/issn.2640-690X.jfm-17-1900
Background PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast. Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite important disease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead to increased patient’s satisfaction and decrease fear of cancer breast. Objective Discuss different methods for management of PMPS with less side effects, adequate analgesia, improvement of quality of life, and better patient satisfaction in the future. Methods Treatment approaches include both pharmacological interventions and non-pharmacological strategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment. Conclusion Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanyl intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.
Dec 2017 DOI 10.14302/issn.2640-6403.jtrr-17-1818
If a wound progressively heals or the healing process is impaired is basically influenced by the surrounding milieu. This is reflected by the wound fluid. Its specific composition triggers the migration, proliferation and differentiation of dermal and epidermal cells which so far was not sufficiently examined in 2D cell culture models. The influence of the different wound entities was analyzed on a newly implemented three dimensional in-vitro model, which improved the transferability to the in-vivo situation. The influence of pooled wound fluids from patients suffering from acute or chronic wounds were investigated within a time period of 10 days after wound application. Histological and immunohistochemical analyses were performed addressing the impact of AWF and CWF on regeneration, such as cell proliferation, fibroblast activity and cell migration. AWF slightly stimulated fibroblast migration while CWF inhibited their activation and migration. The CXCR4- immunopositive population was continuously decreased compared to the control and AWF treatment. The expression of FAP was enhanced under AWF and medium. In keratinocytes CWF massively stimulated cell proliferation initiating on day six after injury. The presence of 10% CWF inhibited fibroblast activation and migration and induced the degradation of the collagen matrix. Keratinocytes were stimulated to proliferate, resulting in healing inhibiting hyperplasia. Transferred to human wounds, no effective wound closure would be achieved because of the de-regulation of pro-proliferative and migration-stimulating factors and a degraded extracellular matrix. This newly implemented 3D study model represents a novel appropriate in-vitro system for studying healing mechanisms and potential therapeutic applications.
Nov 2017 DOI 10.14302/issn.2575-1212.jvhc-17-1764
Leishmaniasis treatment monitoring is an important problem, since patient’s frequently present clinical signs improvements with positive indirect immunofluorescence (IFI) titers of anti-Leishmania antibodies, thus making difficult the clinician understand the therapy efficacy. The study aimed 1) to identify over a short period of 30 days, which of the main changes on the serum proteinogram fractions in patients treated with meglumine antimoniate and allopurinol, can be pointed as indicator to classify patients as slower or faster responsive to treatment. A sample of 56 dogs (n=56) with leishmaniasis diagnosis was followed-up for clinical condition, proteinograms and titers of anti-Leishmania antibodies during the treatment period considering three different time points: M0 (diagnosis moment), M1 (15 days after therapy start), and M2 (30 days after therapy start). Two groups of patients were considered according to their clinical condition evolution rate: faster recovery group (FRG) and slower recovery group (SRG). Statistical significant results were considered for p-value <0.05. Statistically significant differences in proteinogram variations between FRG and SRG were registered for TPs (p= 0.03), and for the fractions β (p=0.04), γ (p=0.04), amongst M0 and M2.The PT, β and γ-globulin fractions of proteinogram, in association with patient clinical assessment evolution should be considered as an indicator and a simple way to appoint the efficacy response of the patients to the therapy.
Oct 2017 DOI 10.14302/issn.2574-4526.jddd-17-1497
Volvulus occurring during pregnancy is a rare complication, still potentially lethal nowadays for both the mother and child due to several, early arising complications. We report here a case of small bowel volvulus in a 28 weeks and 4 days, 29 years-old, pregnant woman with a past medical history of appendectomy in her childhood. Patient presented in emergency department with abdominal pain and abnormal hepatic tests. Cholangio-MRI suggested bowel obstruction due to volvulus that was confirmed by gastroscopy (showing the obstruction) and intestinal MRI. Patient was first treated by laparoscopy but, due to a very complicated abdominal status with the presence of several adhesions of the small bowel, surgery was changed to an open laparotomy, which allowed discovery and repositioning of small bowel malrotation and removal of adhesions. Both patient and the foetus were healthy after surgery and the patient was then discharged. In the light of this particularly rare case of small bowel volvulus due to malrotion, we will describe the pathology of bowel obstruction and more particularly volvulus during pregnancy and discuss its diagnosis and treatment.
Aug 2017 DOI 10.14302/issn.2379-7835.ijn-17-1710
Background: High number of patients suffering from autism spectrum disorders utilize dietary intervention methods, especially gluten-free/casein-free diet. In contrast with its’ extensive usage no sufficient and consistent data exist to support its’ efficiency and safety. Objective: The main aim of this systematic review is to provide a general look to the efficiency and safety of gluten-free/casein-free diet treatment for autism spectrum disorders. Method: Studies used in this systematic review are gathered from 3 online databases (PubMed, Embase and the Cochrane Library). Inclusion criteria are established for study selection. Articles published in a peer-reviewed article between 1990 and 2016 in English about our topic of interest and conducted with patients under the age of eighteen (18) are selected and further analyzed (“Level of Evidence” and “Grade of Recommendation” criteria are utilized). Results: Even though some studies with high values of “Level of Evidence” claim that gluten-free/casein-free diet is beneficial for patients suffering from autism spectrum disorders, studies with lower risk of bias demonstrate otherwise. Since studies such as case reports and cohort studies may contain bias associated with small sample size, absence of clear assessment methods, lack of randomization and short treatment period we suggest that there is no sufficient data to support gluten-free/casein-free diet treatment. Conclusion: Due to controversial outcomes from studies that have different “Level of Evidence” we speculate that efficiency of gluten-free/casein-free diet might be related to individual genetic differences. Therefore, studies conducted with large study groups could not provide statistically significant data to support this treatment option. Further studies should be conducted, especially in the field of genetics, in order to test our hypothesis.
Aug 2017 DOI 10.14302/issn.2379-8572.joa-17-1602
Background: Dental infections, salivary gland lesions, neoplasms and developmental abnormalities can cause oral cutaneous fistulae, fistulae of the neck and intraoral fistulae. Published case reports deliver the same message; that these lesions are misdiagnosed and treated late and ineffectively and this remains a significant on-going problem. Aim: It is important to reiterate the management and diagnosis of this condition, despite the fact that it is already well documented in the current literature as patients are still being subjected to unnecessary treatment. Design and Setting: We performed a retrospective review of 5 consecutive dental sinus infections between June 2013 and January 2014 that were misdiagnosed initially. Information was extracted from the medical case notes of 2 male and 3 female patients with an age range from 12-87 years. Method: The medical records of all 5 patients were analyzed, medical photography was taken and the patients were followed up regularly in our clinic. Results: Each patient presented with a non-healing lesion and all were treated with either oral or topical antibiotics. Patients were eventually referred to the craniofacial department where they all received an orthopantomogram and underwent dental extraction, which led to complete healing. Conclusion: Cutaneous facial sinus tracts of odontogenic origin are often initially misdiagnosed which leads to prolonged and inappropriate treatment. Correct diagnosis and treatment will result in predictable and rapid healing and thus it is essential to record these case series, to ensure that medical professionals are aware of the presenting symptoms, which can often be very subtle.
Aug 2017 DOI 10.14302/issn.2578-2371.jslr-17-1669
Aims: To describe the clinical, biological and evolutionary features of mono infected patients treated with tenofovir in Togo. Method: It is a descriptive, prospective study. Patients were treated with Tenofovir Disoproxil Fumarate (TDF). The inclusion criteria were: active chronic HBV (HBs Ag-positive for more than 6 months, high aminotransferases, the HBV –DNA ≥ 2000 IU / ml for HBeAg negative or ≥ 20 000 IU / ml for HBeAg positive and significant fibrosis) and absence of HCV, HDV, or co-infection HIV. Results: Among patients with HBV in our department, only 10.68% were treated with TDF. The mean age of patients was 33.01±9.81years. There was male predominance (68%). The circumstances of discovery were mainly during blood donation (65.3%) and a routine checkup (14.7%). Clinical examination was normal in most of cases (86.7%) apart from hepatomegaly (9.3%) and icterus (4%).) The HBeAg was negative in 89.3%; the average DNA was 7.56 ±8.01 log10 IU/ml. Abdominal ultrasonography was performed in all patients and we found hepatomegaly (18.67%), splenomegaly (10.67%), and ascites (5.3%). The assessment of fibrosis and activity had enabled to find a fibrosis higher or equal to 2 in 12 cases (48%) and an activity higher or equal to 2 in 9 cases (36%). The clinical and virologic outcome was marked by an undetectable viral load (HBV-DNA˂10 IU/l) in 89.3% of the patients after 1 year of treatment. Conclusion: TDF had helped to find out an undetectable viral load in in 89.3% of the patients after one year of treatment.
Aug 2017 DOI 10.14302/issn.2476-1710.jdt-17-1673
Ketamine’s potential as a fast-acting reagent to treat MDD, especially treatment-resistant depression has caught much attention recently. Although much has been learned about the biological mechanisms underlying ketamine’s effect, there are a few critical issues remained to be resolved. This mini review will briefly discuss several controversial issues that warrant further studies, regarding the molecular, physiological, psychopharmacological, and behavioral effects of ketamine. Understand how ketamine works as an anti-depressant will open the door to better understanding of MDD and its treatment.
Aug 2017 DOI 10.14302/issn.2473-1005.jdoi-17-1486
Background: Furcation involvement is characterized by periodontal disease invading furcation regions of multi-rooted teeth. Treatment modalities are scaling and root planning and surgical management such as osteoplasty or ostectomy, odontoplasty, bicuspidization, root resection and hemisection. Periodontally compromised maxillary molars generally have poor prognosis because of inter radicular loss of attachment, and difficulty in access and treatment. Root resection is procedure by which one or more of the roots of a tooth are removed at level of furcation while leaving crown and the remaining roots in function. Case: A 58 year-old female patient applied to Periodontology clinic with complaints of sensibility and gingival recession in teeth number 16 and 26. Both teeth were completely exposed due to severe attachment loss in distobuccal root. There was also second degree mobility on the right molar and third degree mobility on the left molar teeth. Flapless root resection were planned after root canal therapy. After local anesthesia, distobucal roots were resected by high speed rotary motor with adequate irrigation at the level of the furcation roof. A small cavity was prepared and retrograded with glass ionomer cement. A platelet-rich fibrin membrane was obtained from patient’s blood and stitched to the distal surface of right first molar. Left first molar area was left uncovered. Recovery was followed on 2nd, 8th week and 6th month. When healing was compared between left and right sides, no mobility was observed and a slight redness and swelling was observed on the right side at 2nd week. At 8th week, there was no difference in clinical appearance. At 6th month, all complaints of the patient were gone and prognosis of the teeth was good.
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-16-1354
Tanzania is among the developing countries experiencing rapid growth of an ageing population, which has an implication in healthcare expenditure especially in resource poor settings where majority of elderly people cannot afford to pay for the cost of accessing health services. The country has developed the Tanzania National Health Policy (2007) and National Ageing Policy (2003), which, among other things, recognize the importance of having a healthcare system that provides free basic services to the vulnerable elderly population. This study aimed at exploring health service providers’ and managers’ perspectives on the factors facilitating or prohibiting access to health services among elderly people in Tanzania. The study adopted a qualitative approach and data were collected using semi-structured interviews. A total of 24 in-depth interviews were conducted with district healthcare managers, heads of public healthcare facilities, and health service providers. The data generated were analysed for themes and patterns. The results show that Tanzania’s healthcare system has made some efforts to implement the national exemption policy to ensure better access to health services for the elderly. Some of these efforts include: having in place a system to identify and exempt elderly people from paying for health services and giving them special priority during treatment. However, there are some barriers hindering elderly people’s access to health services. Among others include: lack of specific consultation rooms and doctors for serving the elderly, and lack of sufficient drugs and other medical equipment in most government-owned healthcare facilities. In summary, the healthcare system has created a good environment for the implementation of exemption policy aiming at enhancing accessibility of health services among the elderly population in the country. However, such environment cannot function effectively without addressing the identified barriers. It is recommended that the government should allocate adequate human and non-human resources to the healthcare system to enable it to function effectively, including the provision of health services to the elderly.
May 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1503
Introduction Bacterial meningitis complicates rarely pituitary macroadenomas. The aim of our systematic review is to study the features of the association between bacterial meningitis and pituitary macroadenoma. Methods We conducted a literature search in both MedLine and Google Scholar database from 1967 to October 2016 and reviewed all cases described of the association between bacterial meningitis and pituitary macroadenoma apart from any surgical act and without pituitary apoplexy. Results We found 14 articles describing 16 patients aged of 22-69 years old with a male predominance (sex ratio 4.3). Two patients (12.5%) had a well-documented clinical history of pituitary macroadenoma prior to the diagnosis of bacterial meningitis. Rhinorrhea has been found as the most common symptom through six patients (37.5%). Through the CSF culture, bacterial meningitis among patients suffering of pituitary macroadenoma commonly was due to Streptococcus pneumoniae. The examination in 18.75% of cases revealed signs related to pituitary macroadenoma (ophthalmoplegia and blindness). Six patients (37.5%) had received a treatment by dopaminergic agonist alone and 4 patients (25%) were treated with dopaminergic agonist associated with surgical treatment. Surgical treatment consisted of closure of the osteomeningeal breach in 12.5% (2/16) and tumor resection in 31.25% (5/16). Three patients (18.75%) had benefited tumor resection without prior agonist treatment. The mortality was 12.5% (2/16). Conclusion Our systematic review shows that bacterial meningitis represents a rare initial symptom leading to the diagnosis of invasive pituitary macroadenoma.
Apr 2017 DOI 10.14302/issn.2372-6601.jhor-17-1463
Melanoma is considered to be a very aggressive cancer due to its rapid growth, early and multiple metastases and limited response to standard treatment. Many researchers have hypothesized that the combination of radiation therapy and immunotherapy in the treatment of melanoma primary tumors and metastases improves the efficiency of these methods as compared to their use separately. Therefore, combined therapy is an increasingly popular topic in radiation oncology. Although the mechanism of immune response to ionizing radiation remains unclear, known are the factors involved in the immune response, including NK and CD8(+) T cells. Many studies have demonstrated the importance of inflammatory factors, primarily cytokines, in the response to ionizing radiation. In turn, many cytokines released in an irradiated organ, such as tumor necrosis factor α (TNFα), interleukins IL1 and IL6 and transforming growth factor beta (TGFβ), can induce the production of significant amounts of reactive oxygen species that are associated with the induction of DNA damage in tumor cells. In relation to anticancer immunotherapy, the clinical data obtained to date can encourage future studies combining radiation therapy and the inhibitors of cell division checkpoints in the treatment of advanced melanoma. In a recent study, melanoma cell lines became more sensitive to radiation after BRAF inhibition, which provides a potential synergistic mechanism of BRAF inhibitor (BRAFi) combined with radiation therapy for better effects of treatment. In this article, we present a systematic review of the literature on the use of the combination of radiation therapy and immunotherapy in the treatment of melanoma.
Mar 2017 DOI 10.14302/issn.2476-1710.jdt-16-1262
Background. Emotional deterioration is frequently found in patients with chronic kidney disease, but some patients are affected by depressed mood without fulfilling the criteria of a depressive disorder. Those patients might rather suffer from an apathy symptom. Apathy as a symptom of a medical disease is accompanied by loss of motivation and interest, cognitive impairments, and emotional distress. Our study tested how groups of apathetic and depressed chronic kidney disease patients responded to a single haemodialysis session on measures of mood. Methods. 21 haemodialysis patients were assigned to subgroups (depressed, apathetic only, without depression and apathy) according to clinical relevant cut-offs. Sensitive questionnaires were administered to monitor mood state in general and mood changes before and after a single haemodialysis session in the chronic kidney disease patients. The results were compared to 20 age-matched healthy controls receiving no treatment. Results. Fortheen dialysis patients had eighter apathy or depressen and seven had neighter apathy nor depression. Mood state was seriously affected in all haemodialysis patients with depressed patients showing the largest effect compared to healthy controls. Patients with apathy and patients without apathy and depression were comparable in their mood state. We observed a positive mood change after the haemodialysis only in patients without apathy and depression. Their mood state improved significantly and reached nearly the level of healthy controls. Conclusions. The absence of a short-term mood change in apathetic dialysis patients makes them comparable to dialysis patients with depression. We argue that apathetic patients lack the probable mood brightening effect of the haemodialysis. The lack of emotional improvement by dialysis sessions could also lead to decreased adherence of the patients. Hence, apathy seems to be a serious symptom in chronic kidney disease that is worth to be considered at least in the diagnostic process. Accompanying psychotherapeutic care for these patients would be desirable
Feb 2017 DOI 10.14302/issn.2374-9431.jbd-17-1429
Objectives: To observe pregnancy outcomes in gestational diabetes mellitus (GDM) under treatment. Methods: Pregnant mothers (N=191) diagnosed with GDM (n=91, age: 27.44±4.91yr; body mass index, BMI: 26.88±4.16 kg/m2; mean±SD) on the basis of WHO 2013 criteria were compared with non-GDM (n=100, age: 26.01±4.81yr, BMI: 25.53±3.77 kg/m2, mean±SD) for pregnancy outcome irrespective of gestational age. HbA1c was also measured in all mothers. Gestational hypertension, preeclampsia, premature rupture of membrane (PROM), hydramnios, recurrent urinary tract infection (UTI), recurrent moniliasis, intrauterine growth retardation (IUGR), intra uterine death (IUD), mode of delivery, birth weight, birth injury, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome (RDS), congenital anomaly were recorded at every trimester. 160 mothers (GDM=75, non-GDM=85) could be followed for outcomes to the end of pregnancy. All the GDM mothers were offered standard treatment throughout pregnancy period. Results: HbA1c was significantly higher in GDM than that in non-GDM (5.42±0.61 vs. 4.98±0.44%, mean±SD; p<0.001).Outcome events in GDM and non-GDM were: gestational hypertension- 3.6% vs. 2.3% (p=0.621), preeclampsia- 2.4% vs. 0% (p=0.150), PROM- 4.9% vs. 0% (p=0.037), hydramnios- none in any group, recurrent UTI- 12.3% vs. 4.7% (p=0.073), recurrent moniliasis- 0.0% vs. 2.3% (p=0.165), caesarian section- 85.3% vs. 72.9% (p=0.056), small for gestational age (SGA)- 26.4% vs. 36.7% (p=0.246), large for gestational age (LGA)- 1.4% vs. 0%, p=0.246, IUGR- 2.3 vs. 2.5% (p=0.952), neonatal hypoglycemia- 2.7% vs. 0.0% (p=0.130), hyperbilirubinemia- 12.0% vs. 11.8% (p=0.963), RDS- 0.0% vs. 2.4% (p=0.181) and birth injury- 0.0% vs. 1.2% (p=0.346), congenital anomaly- 4.0% vs. 1.2% (p=0.254) and abortion- 1.3% vs. 0.0% (p=0.286). Preterm delivery (12.0% vs. 7.1%, p=0.285) and caesarean section (85.3% vs. 72.9%, p=0.056) were more in GDM. Conclusions: Despite treatment, adverse events were relatively higher but non-significant in GDM.
Feb 2017 DOI 10.14302/issn.2474-3585.jpmc-16-1103
Background : DOTS is the current international strategy for tuberculosis control endorsed by the World Health Organization and the International Union against Tuberculosis and Lung Diseases. Maharashtra achieved full coverage under RNTCP in October 2003. The programme was launched in Nagpur in the last quarter of 2002. Three years after its launch, it is the ideal time to assess the performance of programme to identify the operational challenges. Methods: This is a cross sectional study carried out in 'Sadar Tuberculosis Unit' of Nagpur Municipal Corporation with the objective to study performance of some aspects of RNTCP. Programme performance was explored through laboratory records review and non participant observations of all four designated microscopy centres. DOT centres were observed for accessibility, identifiability and the facilities provided to patients visiting for treatment. Performance of some operational aspects of RNTCP was assessed using standards, norms, procedures etc described in programme guidelines. Results: It was observed that the TB unit was manned with RNTCP- trained supervisory team. Three of four microscopy centres were established in multispecialty health facilities. Adequate space for sputum microscopy was available at two centres. Laboratory technician was available at three centres. Separate tables for smearing and staining were available at three centres. Sink, staining racks, spirit lamp, binocular microscope and drugs in patient - wise boxes were available in all four centres. Laboratory registers were completely and correctly filled in all centres. No false positive or false negative error was found in rereading of AFB smears. Conclusions: It is concluded that the performance of the programme at the unit is satisfactory. Still some aspects of the programme components need to be strengthened at microscopy centres for better performance of RNTCP.
Dec 2016 DOI 10.14302/issn.2372-6601.jhor-16-1070
Introduction: Post-transplant lymphoproliferative disease (PTLD) is a collection of conditions associated with abnormal proliferation of lymphoid tissues in patients after solid organ transplants (SOT). Its clinical presentations are quite variable and non-specific. Otolaryngological signs and symptoms, manifested as adenotonsillar hypertrophy or cervical lymphadenopathy, may guide to early detection and treatment. Methods: We conducted a retrospective review of all pediatric SOT recipients with the diagnosis of PTLD, age 0-18, between 2005 and 2014 at the Loma Linda University Children’s Hospital. The patient’s age, type of organ transplant, immunosuppression, head and neck signs and symptoms, imaging modality, EBV status, histology as well as treatment regimen information were recorded. Results: A total of 21 pediatric patients were included in this retrospective review with a history of solid organ transplant and a diagnosis of PTLD. The most commonly associated type of transplanted organ is heart (57.1%), followed by kidneys (33.3%) and liver (9.5%). Neck swelling (28.6%) was the main head and neck complaint while one patient developed upper airway obstruction with respiratory distress. Cervical lymphadenopathy was found in 66.7% and tonsillar hypertrophy in 9.5% of the patients. Monomorphic PTLD (46.2%) was the most common pathological diagnosis, followed by reactive hyperplasia (30.8%), Hodgkin lymphoma (15.4%) and polymorphic PTLD (7.7%). Majority of the PTLD patients were treated with rituximab and cyclophosphamide combination therapy with and without prednisone. Conclusion: Adenotonsillectomy and cervical lymph node biopsies are easy to perform with low complication rates. They serve an important role in the armamentarium in the early detection of PTLD in its early stage, allowing prompt treatment and prevention of further progression.
Dec 2016 DOI 10.14302/issn.2379-7835.ijn-16-1390
Objectives: To evaluate the efficacy of a weight loss programme and the factors that predict successful adherence of the treatment. Methodology: A retrospective chart review of 500 overweight outpatients (427 women, 73 men), mean age 41.7 years (range: 18–81) and mean BMI of 31.44 kg/m2 (range: 25.09–51.33), treated at an obesity specific clinic. A programme involving a hypocaloric Mediterranean diet was prescribed, along with suggestions for leisure exercise and daily activity. The weekly follow-up continued until the weight loss goal was reached (‘completion’ group) or the patient discontinued the programme (‘dropout’ group). Key Results: Those that completed the programme achieved a mean weight loss of 10.6 kg (12.9% percentage loss of initial body weight) and a mean body fat mass loss of 26.8%. Factors predictive of completion were: gender (males higher completion), previous dietary programmes (predictive of dropout), initial percentage of fat mass (higher percentage, lower completion), age (younger age, lower completion) and hypothyroid disease (predictive of dropout). Conclusions: A hypocaloric Mediterranean diet and moderate exercise could help to reduce body weight and body fat in overweight patients. Treatment completion of self-selected and self-paying patients is low, and appear to be more effective for men, persons with a low percentage of fat mass, older age groups and those who have not made other previous diets.
Nov 2016 DOI 10.14302/issn.2474-9273.jbtm-16-1273
Background: Many people with mental illness rely on family and friends for support and to help them in their activities of daily living. At all points in the care of ill relatives, caregivers need information to deal with the patient’s care and treatment demands. Methods: This was a descriptive study carried out in a Public owned mental health out-patient clinic. The study consisted of fifty participants, who voluntarily completed a questionnaire regarding their knowledge about their ill relatives’ mental illness and treatment. Results: Majority (62%) were female, and (28%) were parents (66%) has primary level education, (76%) had no knowledge about illness of relatives, (84%) did not know the diagnosis (76%) had poor knowledge of medication, and (84%) could not recognize the side effects of medication. Conclusion: The need for information and education of family caregivers about ill relatives’ mental illness, and the important role of medication regimen in the control of symptoms of the disorders. Education on medication and other treatment strategies should be tailored towards each family caregiver’s understanding and level of education.
Nov 2016 DOI 10.14302/issn.2574-450X.jom-16-1268
Human obesity is now universal and has drawn serious attention of international academia to unravel its pathophysiology and treatment. In recent years, efforts are being made to understand the complex physiology of both white and brown adipose tissue in detail with relevance to obesity. A large number of secretions from the white fat called the adipokines have been recognized that play a definitive role in obesity and its disorders. Innumerable regulators grouped mainly under the transcriptional, hormonal and signaling factors that govern the thermogenic functions of brown fat have been worked out. Based on these revelations, strong suggestions have been made for treating obesity specially by targeting the brown fat as it plays a key role in energy expenditure as well as through behavioral, pharmacological, physiological and surgical approaches. Such findings have been reported in a nutshell in this communication
May 2016 DOI 10.14302/issn.2473-1005.jdoi-15-730
Objectives: Periodontal disease is associated to widespread systemic inflammation, and further to both cardiovascular morbidity and mortality. Data from intervention studies demonstrated the beneficial effects of periodontal therapy in reducing vascular diseases. The present study was aimed to explore whether low-level Laser therapy as an adjunct to scaling and root planning reduces serum levels of inflammatory cytokines. Material and Methods: Thirty patients were enrolled. All recruited participants underwent blood sampling and dental inspection for periodontal indexes measurement. Plaque index, gingival index and probing depth were employed as measures of periodontal disease. Afterwards, patients underwent scaling and root planning plus low-level Laser therapy. Inflammatory biomarkers and periodontal indexes were measured before treatment and twenty weeks after treatment. Results: Plaque index, gingival index and probing depth largely improved at the follow-up visit, resulting more than halved from the baseline. Furthermore, a significant reduction of serum interleukin-1 beta has been observed (1.1 SD 2.1 vs 0.5 SD 1.3, P = 0.04), whereas serum interleukin-6 levels remained substantially unchanged. Blood C-reactive protein levels decreased at the follow-up, but not reaching statistical significance. Conclusions: therapy addressed to a local improvement of periodontal disease gives a reduction of systemic inflammation, possibly beneficial for cardiovascular health.
Apr 2016 DOI 10.14302/issn.2379-7835.ijn-16-943
Unlike developed countries, monitoring of the alimentation quality is important in developing countries. In recent years, several methods of assessing food consumption using simple tools the 24-hour diet recall have been proposed. This individual dietary diversity score (IDDS) is a simplified method for assessing the quality of diets, defined as the number of food groups represented in the diet over a period of time. We conducted an individual qualitative food consumption survey based on the 24 hours recall method. It was an Interviewer-administered questionnaire was used to collect information.The classification terciles of Dietary Diversity score was obtained from the 14 food groups recommended by FAO. 200diabetic and 200 hypertensive patients regularly followed in the same hospital (University hospital of Treichville) were included in this study without any distinction about treatment. The average of individual dietary diversity score was to 5.6 ± 1.58 for diabetic against 6 ± 1.94 food groups consumed the day before by hypertensive. Hypertensive patients in our study seemed o better diversity their diet with 8% of them who had a high score against 0.5% for diabetic. The food groups most consumed by our population were cereals, white tubers, other vegetables, fish and oils and fats at the expense leafy vegetables, vitamin A fruits, other fruits and legumes, nuts and seeds. In terms of anthropometric factors, we found the influence of waist circumference on food diversification in diabetic and not from hypertensive. Considering the importance of dietary diversity to nutrition and health, these results show the need to mobilize efforts for ensuring that people have better access to and knowledge about adequate nutrition. Despite the fact that this study has to be performed and that comparisons with other countries are required to harmonize the methodology, our results show the interest of the use of a simple tool to assess the quality of the food within the population. Using of this tool is certainly a future solution for a rapid diagnostic of diets quality.
Dec 2015 DOI 10.14302/issn.2372-6601.jhor-15-799
Objective: Hospital construction work, among other environmental factors, is a risk factor for invasive aspergillosis (IA). Methods: We retrospectively surveyed the incidence of IA in hematology-oncology patients before and during hospital construction and studied the effectiveness of prophylactic oral itraconazole (ITCZ) treatment. We compared the rates of galactomannan (GM)-positive cases and probable IA cases among 224 patients discharged before the start of construction work and among 67 patients hospitalized within two months after the start of the construction work. Results: Our results showed that, during the 12 months before the construction work was started, only four patients were GM-positive, and one had a probable diagnosis; in contrast, among patients hospitalized within two months from the start of the construction work, seven patients were GM-positive, and four had a probable diagnosis. Therefore, we started to administer oral ITCZ to 40 patients with hematological diseases. Although the construction work continued, after the ITCZ prophylaxis, no new probable cases of IA were detected. Conclusion: From our experience, GM surveillance among hematological patients is necessary during hospital construction work, and the administration of ITCZ to prophylactically prevent IA is suggested upon detection of an increase in GM-positive patients.
May 2015 DOI 10.14302/issn.2574-4496.jtc-13-347
Primary thyroid leiomyosarcoma, is extremely rare, with only 19 cases reported in the literature to date. Onset of the tumor, which usually develops in only one lobe of the thyroid, is sudden and the tumor spreads rapidly to surrounding tissues. Preoperative differential diagnosis is extremely difficult. The long-term prognosis for the patient is extremely poor and unrelated to treatment. Indeed, thyroidectomy and neck dissection followed by adjuvant chemotherapy and/or radiation therapy have not been shown to affect rate of recurrence and long-term survival. The authors describe the case of a patient with leiomyosarcoma of the thyroid gland and review the relevant literature, considering the differential diagnoses and alternative treatment strategies.
May 2015 DOI 10.14302/issn.2372-6601.jhor-14-493
In autologous hematopoietic stem cell transplantation patients for whom granulocyte-colony stimulating factor fails to mobilize a sufficient number of peripheral blood stem cells, plerixafor proposes an option for successful rescue mobilization. This paper evaluates the efficacy of plerixafor to mobilize peripheral blood stem cells (PBSCs) in patients who failed previous mobilization with G-CSF alone, by retrospectively analysing the PBSC results from lymphoma and myeloma (MM) patients between 2006 and 2011. Patients were classified according to the CD34+ cells/kg yield collected by apheresis: < 2 x 106 CD34+ cells/kg was considered collection failure, whereas ≥ 5 x 106 CD34+ cells/kg was considered good mobilization. 797 patients underwent one or more apheresis. The first mobilization success rate was 82%; 140 patients proved to be poor mobilizers. Suboptimal first mobilization was significantly associated with age >50 years (p=0.005) and the absence of chemotherapy in prior PBSCs stimulation (p=0.04). 149 rescue protocols were used in the 140 poor mobilizers, and 71 patients received plerixafor. In univariate analysis the remobilization rate without plerixafor was 42% and increased to 65% when plerixafor was added. In multivariate analysis, plerixafor administration reduced the PBSC remobilization failure risk by a half (OR=0.47). The median value of CD34+ cells/kg in transplants increased from 1.43 (range, 014.03) without plerixafor to 3.85 (range, 0–18.25; p=1 x 10-4) with plerixafor. There were more good mobilizers after plerixafor use (35% with plerixafor versus 15% without plerixafor; p=0.005). Plerixafor efficacy was similar for lymphoma (60% remobilization) and MM (80%; p=0.12). These data show that plerixafor was effective in poor mobilizers and that it synergized with G-CSF to improve the quantity of collected PBSCs. Plerixafor also increased transplant feasibility by 23%. While the clinical results of this study are promising, economic data were not taken into account and there is a need for real work concerning the cost-effectiveness of this treatment. We propose a subsequent study in which the economic efficacy of plerixafor’s use is evaluated based on the financial aspects of the treatments received by the cohort evaluated in this paper.
Mar 2015 DOI 10.14302/issn.2379-8572.joa-14-611
Vocal fold scarring is a clinical problem without reliable treatment. Tissue engineering of a vocal fold replacement is an exciting potential treatment for vocal fold scars that involve multiple layers of the vocal fold. Human adipose-derived stem cells (ASC) were previously used to produce a promising vocal fold cover layer replacement. However, relevant in vivo studies are needed before human application, and implanting the human cells in animal larynges would introduce significant risk and data confounding. We therefore report here the development of a construct based on rabbit ASC with the potential for use in pre-clinical implantation studies. Rabbit ASC were isolated and cultured in a three-dimensional fibrin matrix to create an implantable construct resembling the vocal fold mucosa. Key differences between the human cell and the rabbit cell models are highlighted.
Nov 2014 DOI 10.14302/issn.2379-8572.joa-14-418
This double-blind randomized studyevaluates the efficiency of the Quick Liberatory Rotation maneuver (QLR) in solving signs and symptoms of Posterior Canal BPPV in a short time follow-up comparing the efficiency of QLR vs. a sham maneuver (“Fake QLR”).The study was performed at an input-output tertiary center for balance disorders.From January to September 2012, 200 patients with signs and symptoms of Posterior Canal BPPV respected the inclusion criteria in the study. The diagnosis was based on observation with binocular infrared videonystagmoscopy of the paroxysmal torsional and upbeat nystagmus evoked through the Dix-Hallpike test (DHT). Patients were divided in two groups, 100 in the group treated by QLR (Group 1) and 100 in the control group treated by “Fake QLR” (Group 2). Before the treatment, they self-evaluated a Visual Analogue Score on their vertiginous complaints (V-VAS). Patients were controlled one hour after the treatment by a blinded examiner about the first phase of the study through DHT, the Straight head-hanging positioning test and the Head Roll test in supine position and assessed again with V-VAS. Patients with a persisting positive Dix- Hallpike test were subsequently treated through QLR. The main outcome measure is the number of patients treated through QLR or “Fake QLR” with a negative DHT one hour after the first treatment. At the post-procedure check, 79 patients from Group 1 presented a negative DHT with little or no subjective symptoms, whereas all the patients of Group 2 presented persistence of a positive DHT. The presence of the secondary nystagmus during QLR (“liberatory” nystagmus) was significantly correlated with a negative DHT at the post-procedure control. In Group 1 pre- and post-treatment V-VAS differences were significant; post-treatment V-VAS differences were significant in Group 1 vs. Group 2. In a short time follow-up QLRis an effective treatmentfor Posterior Canal BPPV when compared to a sham maneuver.
Jun 2014 DOI 10.14302/issn.2572-3030.jcgb-13-366
Objective: To utilize the effectiveness of MR-Enterography as a potential investigating marker for the diagnosis of Crohn’s disease. Conclusion: This article reviews the technique of performing MR enterography which aids in the diagnosis of Crohn’s disease, it also serves accurate information about the severity of the disease and complications of it that may guide for the surgical or medical treatment.
Jun 2014 DOI 10.14302/issn.2372-6601.jhor-14-378
Progressive multifocal leukoencephalopathy (PML) is a rare complication associated, inter alia, with rituximab-based lymphoma treatment. PML diagnosis is made easier with the criteria recently published by the American Academy of Neurology. Unambiguous diagnosis of PML can be achieved by demonstration of the histopathological triad comprising:(1) demyelination, (2) bizarre astrocytes and (3) enlarged oligodendroglial nuclei together with detection of viral particles by electron microscopy. However, symptoms of PML may be similar to those observed during lymphoma progression into the central nervous system (CNS). Here we report the case of a patient with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP who developed clinical signs indicating PML. Intravital diagnostic methods failed to yield an unequivocal diagnosis of PML or lymphoma progression in the CNS. However, a post-mortem examination of brain biopsy specimens performed by electron microscopy demonstrated lesions typical for PML and the presence of viral particles. In addition, immunohistochemical assays identified a massive infiltration of lymphoma cells. The case thus suggests either the extremely rare coexistence of two complications: lymphoma CNS infiltration and PML or induction structural CNS lesions by lymphoma infiltration indistinguishable from PML. The presented findings thus highlight the need for a further review of the current diagnostic criteria for PML.