International Journal of Medical Science and Clinical Research Studies

Prenatal Diagnosis of Anencephaly: A Case Report and Review of Literature

Vivian Ndidi Akagbue — 2024-11-04

Anencephaly is an inborn deformity of the central nervous system that results to the failure of closure of the cranial end of the embryologic neural tube, typically happens between the 23rd to 26th days after conception. It represents 40% of neural tube deformities, which is the second foremost cause of nervous system abnormalities after spina bifida. The occurrence rate is 1/1,000. Diagnosis is made by the 1st trimester ultrasound between the 11th and 14th week. Etiologies are multifactorial (toxic, metabolic, nutritional, iatrogenic and exceptionally chromosomal).

The importance of this case report is to highlight the role of imaging in the making prenatal diagnosis and thereby reiterating the usefulness of anomaly scan in pregnant women in our clime. Ultrasound is a non-ionizing imaging modality which is highly operator dependent and is repeatable.

Our case study is a 36-years-old woman Gravida 3 Para 1+2 (None Alive) at 24weeks 1day Gestation age (GA) who presented to the Radiology department for routine obstetric scan for the first time in index pregnancy. The obstetric ultrasound shows absence of the cranium in an active fetus with good cardiac activity (fetal heart rate =158bpm) with increase amniotic fluid in transverse lie. Frog eye sign was also appreciated. The placenta is sited anteriorly and not low lying. Femoral length (FL) measures 4.31cm with a GA of 24 weeks 1 day.

Bilateral Testicular Microlithiasis with Leydig Cell Hyperplasia: A Case Report

Ramirez Corona Edmundo — 2024-11-04

Testicular microlithiasis is a rare finding in intratesticular pathology, and its association with Leydig cell hyperplasia is not widely reported. We present a case of such an association. 19-year-old male presented with bilateral testicular microlithiasis on ultrasound, and elevated tumor markers. Inguinal orchiectomy revealed Leydig cell hyperplasia. Discussion: Testicular microlithiasis is increasingly detected due to advancements in ultrasound technology, but its clinical significance remains unclear. Leydig cell hyperplasia, characterized by testicular nodules, is rarely associated with microlithiasis.

This case underscores the need for vigilance in evaluating testicular abnormalities, as severe microlithiasis and Leydig cell hyperplasia may mimic malignant lesions.

A Comprehensive Review of May-Thurner Syndrome: Pathophysiology, Clinical Manifestations, and Advanced Therapeutic Approaches

Christian Guadalupe Peña Gio — 2024-11-04

May-Thurner Syndrome (MTS), also referred to as iliac vein compression syndrome, is an underrecognized vascular condition characterized by the extrinsic compression of the left common iliac vein by the overlying right common iliac artery. This mechanical obstruction predisposes patients to venous stasis, significantly increasing the risk of deep vein thrombosis (DVT) and chronic venous insufficiency. Although the precise prevalence of MTS remains uncertain due to its often asymptomatic presentation, the condition accounts for a considerable proportion of DVT cases in younger individuals, particularly women. This review aims to elucidate the pathophysiological mechanisms underpinning MTS, its clinical manifestations, diagnostic strategies including advanced imaging modalities, and both traditional and evolving therapeutic options. Emphasis will be placed on the use of endovascular techniques, such as stenting and catheter-directed thrombolysis, as well as the role of conservative management. Through a thorough analysis of current literature, this article will explore the long-term outcomes associated with different treatment approaches and the emerging role of precision medicine in tailoring therapies for patients with MTS.

Prevalence and associated factors of obesity among women of childbearing age in the communes of Bamako, Mali

Ousmane Sy — 2024-11-05

Background: Obesity and especially women's obesity is increasingly becoming a health problem in all countries, including low-income countries.

Objective: To assess the prevalence and associated factors of obesity among women of childbearing age in the communes of Bamako in Mali.

Methodology: Quantitative and analytical study using a questionnaire. The population of this study concerned obese women of childbearing age from the Communes of Bamako in Mali.

Results: This study included 384 women of childbearing age, more than half (59.3%) of whom were over 35 years of age. The prevalence of overweight among women of reproductive age in the district of Bamako was 30% and the prevalence of obesity was 27% at the time of the survey. The results reported a statistically significant relationship between body mass index and the following variables: age (p=0.04); education (p=0.03), consumption of sugary drinks (p=0.001); sleep duration (p=0.04), exercise (p=0.03) and history of obesity in the family (p=0.01).

Conclusion: This study provided clear evidence of an increase in overweight and obesity among urban women in the six communes of the Bamako district of Mali. It is therefore important to develop health promotion actions, focusing on healthy eating, physical activity, weight reduction in the district of Bamako, especially in the urban areas of Mali.

Quality of Life and Pulmonary Function after Lung Cancer Treatment: Systematic Review

Gladys Teresa Medina Ruiz — 2024-11-06

Introduction: Lung cancer is the leading cause of cancer-related death worldwide. Its treatment has a significant impact on the physical and psychological well-being of patients, resulting in a reduction in health-related quality of life (HRQoL) and pulmonary function.

Objective: To provide a detailed assessment of the available literature on the impact of lung cancer treatment on the quality of life and functioning of patients.

Methods: A systematic review was conducted using advanced searches in the databases The Cochrane Library Plus, PubMed, and Science Direct. The selected publications were thoroughly analyzed, and the PRISMA scale (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to display the selection process.

Results: A total of 51 articles were identified. Studies involving cancers other than lung cancer, or those that did not include questionnaires, spirometry tests, or the effects of physical exercise on patient outcomes, were subsequently excluded. After a full-text review, 11 articles met the previously defined criteria.

This literature review reveals that, in most of the studies examined, the quality of life of lung cancer patients tends to decline after treatment, reflecting the physical, emotional, and social challenges they face throughout the process.

Regarding lung function, the reviewed studies show that it deteriorates following treatment, resulting in a reduction in the patients’ respiratory capacity.

Conclusion: Although the results provide evidence of the impact of lung cancer and its treatment on various aspects of life, further research with larger sample sizes is necessary to validate these findings.

Efficacy and Safety of Sacubitril/Valsartan in the Management of Heart Failure with Preserved Ejection Fraction: A Comprehensive Review

Pedro Luis Matus Rojo — 2024-11-06

Heart failure with preserved ejection fraction (HFpEF) represents a significant clinical challenge due to its complex pathophysiology, limited therapeutic options, and growing prevalence, particularly in aging populations. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has emerged as a potential therapeutic intervention in HFpEF. While sacubitril/valsartan has demonstrated substantial benefits in heart failure with reduced ejection fraction (HFrEF), its role in HFpEF has been the subject of extensive clinical investigations. This review aims to evaluate the efficacy, safety, and clinical implications of sacubitril/valsartan in the treatment of HFpEF. We will discuss the pharmacological mechanisms of the ARNI combination, key clinical trials, and their outcomes, including the PARAGON-HF trial, and assess its impact on morbidity, mortality, functional status, and quality of life in HFpEF patients. Additionally, we will explore potential biomarkers for response to therapy and the relevance of phenotyping HFpEF subgroups to optimize therapeutic strategies.

The Nursing Training-Practice Gap: Which is This?

Tatah Promise Yosimbi — 2024-11-08

Nursing training is a formally recognized program of study providing a broad and sound foundation in nursing sciences for the general practice of nursing. Nursing practice is the ways, means, methods, and manners nurses use to offer care professionally. Sometimes gaps exist between nursing training and practice. These gaps impede on better patient care and outcomes. This review is relevant in that the causes of the gaps have been exposed for use and the way forward in reducing the gap. The objectives of this review were; to expose the nursing training-practice gap, to explore the causes of the widening gap, and to describe strategies for bridging the gap. Sources of information included PubMed, Cochrane Library, Google Scholar, Web of Science Platform, organizations, and books. It has been observed that the nursing training-practice gap constitute a persistent universal nursing problem affecting patients, nursing students, novice and expert nurses and institutions and is widening. The causes of the widening nursing training-practice gap have been described to be; changing trends and pertain of diseases, lack of a bond between the training schools as an academic environment and the hospital as a clinical environment, liberalization of nursing education, discrepancies in applying theoretical knowledge to practice, inconsistencies between ideals and values, professional stress due to high workload, scarce supervision on nurses’ work, and unhealthy human attitudinal and behavioral factors. However, strategies to bridge the gap have also been provided to encompass, awareness creation, internships and apprenticeships in nursing training, preceptorship, facilitative supervision, continuous education, and evidence-based practice. This review is important in that nursing trainers, practitioners, and researchers could use the information for sensitization and reduction of the widening gap.

A Review of Preceptorship in Sustaining Nursing Training-Practice Congruence

Tatah Promise Yosimbi — 2024-11-08

Preceptorship is a structured period during which a newly qualified practitioners is supported by an experienced professional to gain confidence and competence and transition from students to autonomous professionals. The nursing training-practice congruence is the harmony between theory from school and real practice. Preceptorship has been prescribed for maintaining this congruence since there frequently exist a nursing theory and practice discordance which jeopardizes patient care and outcomes. This review is relevant in that the concept, principles and the roles of the different actors of preceptorship have been explored. The objectives of this review were: to explore the concept of preceptorship, to outline the principles of preceptorship, to describe the roles of the actors of preceptorship, and to present the effectiveness of preceptorship in sustaining the nursing training-practice congruence. Sources of information included websites, journals, organizations, and text books. It was observed that preceptorship can take the forms of one-to-one, one-to-many, team and group approaches. The principles of preceptorship were, organizational culture, quality, preceptee empowerment, preparing preceptors, and preceptorship program. The roles of the preceptee included readiness to learn, active participation, engagement, accountability, being receptive to feedback, and attending meetings. The roles of the preceptor included induction, instructing, modelling, coaching, facilitating, supervision, and organizing meetings. The healthcare manager oversees the preceptorship program. Preceptorship is effective in increasing confidence, strengthening critical thinking, developing psychomotor, clinical and leadership skills, timely feedback, and enhancing communication and socialization. This review is important in that health care managers and employer could use the information to create preceptorship programs in the organizations.

Antibiotic Susceptibility Patterns and Mutations Associated with Isoniazid and Rifampicin Resistance in Non-Tuberculosis Mycobacterium Isolates from HIV-1 Infected and Uninfected Patients in Western Kenya

Ronald Wamalwa — 2024-11-09

Primarily among immunocompromised people, notably those living with HIV/AIDS, antimicrobial resistance (AMR) among non-tuberculous mycobacteria (NTM) has become a major public health issue. Though the main pathogen in such populations is Mycobacterium tuberculosis, the importance of NTM in causing AMR and complicating treatment plans is becoming more well known. Still, the causes of medication resistance in NTM especially in relation to HIV co-infection remain mostly unknown. This study sought to ascertain the antimicrobial susceptibility patterns of NTM isolates and identify genetic alterations linked with isoniazid and rifampicin resistance among HIV-1 infected and uninfected patients in Western Kenya. Adult HIV-1 infected individuals showing suspected pulmonary tuberculosis were subject to a cross-sectional analytical laboratory analysis. Samples of sputum were gathered; NTM isolates were grown and identified. The broth microdilution technique was used for antimicrobial susceptibility testing. Line probe tests aiming at the rpoβ, katG, and inhA genes helped to find genetic alterations linked to medication resistance. Of 167 participants, 59 NTM isolates were found; most often occurring species were M. intracellularae and M. fortuitum. Observed in 12.1%, 15.2%, and 15.2% of isolates respectively were resistance to isoniazid, rifampicin, and streptomycin. HIV-positive individuals had more frequent mutations in the rpoβ, katG, and inhA genes; medication resistance and HIV status had clear correlation. The study emphasises how different treatment resistance patterns and genetic alterations cause NTM infections in HIV-positive patients to be difficultly managed. Especially in resource-limited environments, these results highlight the importance of customised treatment plans and continuous monitoring of AMR in NTM.

A-28-Years-Old Man Received Kidney with Double Renal Arteries and Veins from Younger Sister: A Successful Laparoscopic Living Donor Nephrectomy

Khin Phyu Pyar — 2024-11-09

A-28-years-old man living donor kidney transplant recipient received kidney from younger sister. The transplant team decided to leave the right kidney which had better function though left kidney had double renal arteries and veins. Laparoscopic left donor nephrectomy was done successfully. This is our first case of laparoscopic donor nephrectomy with double renal arteries and veins done in Aung Ban Hospital.

Eisenmenger Syndrome: Pathophysiology, Clinical Manifestations, and Contemporary Management Approaches in Advanced Cardiopulmonary Disease

Donaldo Emiliano Silva López — 2024-11-09

Eisenmenger syndrome, a complex and severe form of congenital heart disease, results from prolonged left-to-right shunting due to underlying cardiac defects such as ventricular septal defects, atrial septal defects, or patent ductus arteriosus, ultimately leading to irreversible pulmonary arterial hypertension and a reversal of the initial shunt. This syndrome represents the most severe spectrum of pulmonary vascular disease associated with congenital heart defects and is characterized by hypoxemia, erythrocytosis, and systemic cyanosis. Despite advances in early diagnosis and intervention in congenital heart disease, Eisenmenger syndrome remains a significant concern due to the irreversible nature of pulmonary vascular changes and associated multisystem complications. This article provides a comprehensive review of the pathophysiology, clinical manifestations, and the role of pharmacologic and non-pharmacologic therapies, including advanced palliative care, to improve patient quality of life. Emerging therapies such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclin analogs show promise in symptom management, though surgical interventions, such as heart-lung transplantation, remain reserved for selected cases. Given the high mortality associated with Eisenmenger syndrome, a multidisciplinary approach is critical in managing complications, improving patient outcomes, and supporting functional status.

Pseudo Renal Failure Secondary to Bladder Rupture due to Abdominal Trauma: Literature Review

José Emiliano González Flores — 2024-11-09

Rupture of the urinary bladder is an infrequent but potentially severe clinical event, commonly associated with abdominal trauma, though it can also occur spontaneously. These cases present diagnostic challenges due to nonspecific symptoms such as abdominal pain, nausea, and distension, which may delay treatment. The accumulation of urine in the peritoneum in cases of intraperitoneal rupture can lead to pseudo-renal insufficiency, characterized by increased blood creatinine and urea nitrogen without structural renal damage. This occurs due to the absorption of urinary solutes through the peritoneum, mimicking acute renal failure. Accurate diagnosis requires cystography through computed tomography to differentiate between intraperitoneal and extraperitoneal ruptures. Extraperitoneal injuries are usually managed with urethral catheterization, while intraperitoneal injuries often require surgical intervention. Timely treatment allows for the spontaneous reabsorption of urine in the peritoneum and normalizes serum levels within 24 hours, achieving recovery without long-term sequelae. Proper identification and management of this condition improve prognosis and reduce the risk of severe complications, making knowledge of this pathology essential in abdominal trauma contexts.

Clinical Perspectives on Tandem Spinal Stenosis: Addressing the Controversies in Surgical Management

Carlos Carreón-Cerda — 2024-11-09

Introduction: Tandem spinal stenosis, characterized by narrowing at multiple spinal levels, often affects the cervical and lumbar regions and is linked to neurological deficits. Commonly stemming from degenerative or congenital changes, its prevalence increases with aging, especially for cervical myelopathy associated with lumbar stenosis. Diagnosis relies on imaging, with MRI offering precise evaluation of spinal compression and neural impact.

Review: This review examines tandem spinal stenosis management, noting ongoing debate on treatment approaches. While simultaneous decompression minimizes hospital time, staged surgery may reduce complications and tailor treatment to predominant symptoms. For patients with primary lumbar symptoms, cervical decompression has shown to alleviate lumbar issues due to motor pathway organization.

Conclusions: Tandem spinal stenosis requires early diagnosis and individualized treatment, especially as prevalence rises with an aging population. A tailored approach enhances therapeutic outcomes and supports better quality of life for affected patients.

Ulnar Nerve Decompression: A Case Report

Rubén Hernández-Ordóñez — 2024-11-12

Cubital tunnel syndrome is a condition characterized by ulnar nerve dysfunction at the elbow due to a combination of compression, traction and friction. It is the second most common condition of the ulnar nerve, behind carpal syndrome. The incidence rate is 21 cases per 100,000 people per year. Although electromyographic abnormalities are present in 33% of carpal syndrome cases, individuals with cubital tunnel syndrome are four times more likely to experience severe symptoms, such as muscle atrophy and reduced sensation. If left untreated, the syndrome can lead to irreversible loss of sensation, muscle weakness, and posterior joint contractures.

A 54-year-old male with clinical manifestations presented for ulnar decompression. The procedure included medial and posterior ulnar nerve dissection, techno-epitrochlear olecranial dissection, ulnar nerve dissection, complete ulnar nerve dissection, and deformity in the arena region.

Research has shown that simple decompression can have comparable results to more extensive surgeries. In a prospective, nonrandomized study, 51% of men and 70% of women who received surgical treatment for ulnar tibial syndrome were referred for a simple procedure. However, the cause of continued pain after a basic procedure remains unclear. Transposition has been used to treat inseparable ulnar nerves in some series, but its efficacy in other cases remains uncertain.

Surgical Aortic Valve Replacement (SAVR) and Unexpected Complication: Critical Illness Related Corticoid Insufficiency (CIRCI). Case Report

Oliver Mayorga Luis Carlos — 2024-11-12

Cardiac surgery, particularly surgical aortic valve replacement (SAVR), presents high morbidity risks. This case report describes a 62-year-old male with severe aortic stenosis who developed critical illness-related corticosteroid insufficiency (CIRCI) following SAVR. Postoperatively, the patient exhibited persistent hypotension despite vasopressors, fever, and respiratory complications, along with metabolic disturbances and rapid atrial fibrillation. Adrenal insufficiency was confirmed by low cortisol levels, and hydrocortisone therapy led to clinical improvement. CIRCI remains a diagnostic challenge due to its subtle presentation, yet timely recognition is crucial in high-risk surgical contexts to prevent adverse outcomes.

Case Report: Mustardé Flap Perfom for Reconstruction of the Cheek in a Patient with Basal Cell Carcinoma in a Second Level of Care

José Alfredo Villanueva López — 2024-11-12

Basal cell carcinoma is the most common type of skin cancer, originating in the basal cells of the epidermis, the outermost layer of skin. It typically develops in areas frequently exposed to the sun, such as the face, neck, and arms.

BCC grows slowly and rarely metastasizes to other parts of the body, but if left untreated, it can cause significant local tissue damage.

It is present as a pearly or waxy bump, often with visible blood vessels. It may algo appear as a flat, scaly patch, sometimes with a rolled border.

Risk factors include prolonged UV exposure, fair skin a history of sunburns, and weakened immune system.
Treatment options include surgical excision, Mohs surgery, topical therapies, radiation, depending on the size, depth, and location of the tumor.
Prevention involves regular sun protection, such as using sunscreen and avoiding excessive sun exposure

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

Cristianne Confessor Castilho Lopes — 2024-11-13

Introduction: Depression is a highly prevalent psychiatric condition and considered one of the leading causes of disability worldwide, affecting millions of individuals across different age groups and social contexts. Esketamine, a ketamine derivative, has emerged as a promising option for the treatment of resistant depression.

Objective: To synthesize the available evidence on the use of esketamine in depressed patients, focusing on its efficacy, safety, and possible limitations.

Methods: This study is a systematic review, classified as exploratory and descriptive. The research was carried out through bibliographic research in electronic databases on methods associated with SLR (Systematic Literature Review) and applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings).

Results: A comprehensive systematic search of the literature yielded a total of 1270 articles related to the topic addressed, of which 34 articles were eligible to compose this systematic review. Conclusion: With the advancement of research and the adaptation of health structures, the estimate has the potential to transform the management of resistance depression, significantly improving quality of life.

Deep Vein Thrombosis in the Second Trimester of Pregnancy: A Case Report and Literature Review

Roselin Arlet May Román — 2024-11-16

Introduction: Deep vein thrombosis (DVT) is diagnosed in about 1 in every 500 to 2000 pregnancies. Pregnancy increases the risk of pulmonary embolism (DVT), a leading cause of maternal deaths and fetal death. Several risk factors include advanced age, multiple pregnancies, lower limb varicose veins, and obesity.

Clinical case: A 21-year-old with a 26-week pregnancy experienced sudden pain in her lower left limb, causing increased volume and difficulty walking. Doppler ultrasound revealed thrombosis in the common and deep femoral veins, thrombophlebitis of the great safenic vein, and soft tissue edema. A multidisciplinary approach was employed.

Discussion: Deep vein thrombosis (DVT) is a thromboembolic disease in pregnancy, affecting up to 50% of cases. Diagnosis involves high clinical suspicion, risk factors, time of gestation, venous Doppler ultrasound images, and D-dimer test. Treatment should be based on a comprehensive evaluation, considering thrombophilia type, history of DVT, and family history.

Conclusion: Early identification, biomarker use, and education about DVT symptoms are crucial for optimal treatment and preventing complications.

Determination of Conventional Hydric Balance, Bioimpedance Analysis, and Portable Ultrasound, and Their Agreement Level with Postoperative Complications in Oncological Patients Undergoing Abdominal Surgery at the General Hospital Zone 3 in Aguascalientes

Rocha Cabrera Cecilia Estefanía — 2024-11-16

Background: Cancer is a significant public health issue, leading to substantial losses in human life and economic resources. The immediate adverse effects of surgery and cancer treatment—such as pain, fatigue, fluid retention, and weakness—can be alleviated with appropriate interventions. Increasing evidence suggests that a patient’s physiological reserve capacity plays a crucial role in reducing perioperative complications. Among oncology patients, the overall rate of postoperative complications is high. In cases where extensive fluid therapy is administered, 41.3% of patients experience severe complications (Clavien-Dindo ≥ III).

Objective: To identify postoperative complications in oncology patients undergoing abdominal surgery and to correlate these complications with the level of edema assessed by conventional fluid balance, bioimpedance analysis, and portable ultrasound at General Hospital Zone 3 in Aguascalientes.

Materials and Methods: A prospective, comparative, analytical clinical trial was conducted in the General Surgery Department of the General Hospital of Zone 3, part of the Mexican Social Security Institute (IMSS), Aguascalientes.

Results: Based on sample size calculations, 28 patients were included. When analyzing the concordance between conventional fluid balance and portable ultrasound at 24, 48, and 72 hours, insignificant correlation was observed among the three methods. Similarly, the bioimpedance analyzer and portable ultrasound also showed insignificant agreement at these same intervals. Conclusions: This study employed three diagnostic methods—conventional fluid balance, bioimpedance analysis, and portable ultrasound. Our findings indicate no significant concordance among the three methods in determining postoperative complications in oncology patients undergoing abdominal surgery. Furthermore, no correlation was observed between positive fluid balance and the development of perioperative complications.

The Most Recent Information Regarding the Management of Stevens - Johnson syndrome And Toxic Epidermal Necrolysis.

Daniela Lizbeth Casillas Sandoval — 2024-11-16

The dermatological conditions known as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening conditions that are characterized by extensive epidermal necrolysis and sloughing. The incidence rates differ from one location to another, with the United Kingdom experiencing an annual incidence of 5.76 cases per million people between the years 1995 and 2013. In terms of mortality rates, females are more likely to be affected than males, with mortality rates ranging from 4.8-9% to 14.8-48%.

Providing patients with SJS or TEN with nonpharmacologic treatment consists of providing supportive care, managing fluid and electrolyte levels, controlling infections, and treating wounds. The identification and the elimination of the substance that is responsible for the condition is the most important component. Patients with SJS or TEN have lower fluid requirements than burn patients, so it is essential that they receive proper management of their fluid, electrolyte, and nutritional needs.

Antibiotics used as a preventative measure do not improve outcomes; however, infection prevention requires proper wound care and the use of antiseptic handling. The decision to pursue surgical debridement as a treatment option is contingent on the location of care where the patient is being treated. The role of surgical debridement has been the subject of debate. It has been demonstrated that anti-shear therapy, which entails the aspiration of blister fluid and the preservation of denuded epidermis, is effective in lowering mortality rates.

Because SJS/TEN is such a rare disease, there have been very few prospective studies conducted on the subject of pharmacologic treatment for the condition. There have been a number of different treatment regimens that have been reported, including corticosteroids, IVIg, cyclosporine, and TNF-alpha inhibitors; however, it is difficult to determine whether the remission of the disease was due to a particular treatment or whether it was the natural course of the disease.

Heterogeneity among Different Presentations of Psoriasis. A Review of the Broad Spectrum of Its Presentation

Daniela Lizbeth Casillas Sandoval — 2024-11-16

Various clinical manifestations can be seen in patients who suffer from psoriasis, which is a chronic inflammatory skin condition that is influenced by hereditary factors and the immune system's response. Although the global incidence of the disease is approximately 2%, the prevalence of the disease varies across geographical regions and ethnic groups. Psoriasis vulgaris, the most common cause of psoriasis, is characterized by red, itchy patches that are covered in silver-colored scales. This form of psoriasis primarily affects the scalp, limbs, and trunk. Inverse psoriasis, guttate psoriasis, pustular psoriasis, and erythrodermic psoriasis are some of the other clinical subtypes of psoriasis. Each of these subtypes has its own unique characteristics and adverse effects. In addition to its manifestations on the skin, psoriasis is linked to a number of other medical conditions that simultaneously manifest themselves. These conditions include hyperlipidemia, hypertension, coronary artery disease, type 2 diabetes, and obesity. Those who suffer from psoriasis are at a greater risk of developing cardiovascular disease, and the severity of the condition is correlated with the number of instances of diabetes and cardiovascular events. In addition, approximately forty percent of patients are affected by psoriatic arthritis, which frequently occurs in conjunction with nail involvement. Psoriasis patients have been the subject of recent research that has shed light on systemic inflammation and cardiovascular risk. These studies have utilized imaging techniques such as 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and nuclear magnetic resonance spectroscopy. Treatments that target IL-23 and IL-17 have demonstrated encouraging results; however, there are still concerns regarding the long-term efficacy and drug survival of these treatments. Psoriasis has a significant impact on the quality of life of patients, causing them to experience psychological distress that is comparable to that of cancer and depression. The treatment, on the other hand, has the potential to significantly alleviate symptoms and improve overall good health. The current research endeavors to broaden the range of treatment options, with a particular emphasis on identifying novel molecular pathways. In conclusion, although there has been significant progress made in understanding and treating psoriasis, there are still challenges surrounding the optimization of therapy selection and the management of the condition over the long term. It is necessary to conduct additional research in order to better understand the intricate genetic and immunological factors that contribute to the disease and to improve the outcomes of treatment for those who are afflicted with it.

Relationship between the Use of Agrochemicals and the Development of Prostate Cancer in the State of Santa Catarina

Tiago Taison Silveira — 2024-11-18

Prostate cancer (PCa) is considered the second most common type of cancer among men. It is a pathology that is commonly asymptomatic in the early stages, a factor that causes patients to seek medical help only when the disease is already at an advanced stage. Some risk factors have well-established bases, such as age, family history and obesity. However, new studies suggest a possible relationship with environmental and occupational factors, mainly in agricultural areas. It is believed that this fact may be related to exposure to pesticides, so that rural areas are the places where the population is most exposed. Thus, the objective is to identify the relationship between the main risk factors and the development of PCa and investigate a possible relationship with exposure to pesticides. Data regarding epidemiology were collected from the Hospital Cancer Records (RHC), while data regarding mortality were collected from the Mortality Information System (SIM). The information has national coverage and, as its main focus, the State of Santa Catarina, in the period from 2012 to 2022. After analysis, it was identified that the etiology of PCa, despite not being well defined, is compatible with what was described in the literature and has advanced age as the main risk factor. When analyzing data relating to occupation, there is a marked prevalence of cases in rural workers, which represents a third of cases, with a predominance in 8 of the 12 micro-regions.

Acute Abdomen in the Geriatric Patient

Gustavo Alejandro Paniagua Frausto — 2024-11-19

Introduction

Geriatric emergency department visits are most often for acute abdominal pain. More elderly patients with acute abdominal pain visit the ER as the elderly population grows. However, emergency physicians face more challenges. Elderly abdominal pain symptoms vary. However, disease manifestations, cognitive issues, and communication issues may delay diagnosis in elderly patients, increasing mortality. Indeed, early and accurate acute abdomen diagnosis in elderly patients greatly affects their outcomes.

Longitudinal Transverse Myelitis in a Case of Systemic Lupus Erythematosus: A Clinical Analysis and Review of the Literature

Cynthia Mariella Portales Rivera — 2024-11-19

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a relapsing-remitting course and multisystem involvement, including the central nervous system (CNS). Neuropsychiatric manifestations in SLE vary widely and may include psychiatric disorders, seizures, cerebrovascular diseases, neuropathy, and cognitive dysfunction. Among the rare but severe complications is transverse myelitis (TM), an inflammatory disorder of the spinal cord that can cause motor, sensory, and autonomic dysfunction. In SLE, TM has an estimated incidence of 0.5% to 1%, with TM as the initial presentation in 30-60% of cases. The pathogenic mechanisms of SLE-related TM are complex, involving autoimmune responses with autoantibodies such as anti-dsDNA and antiphospholipid antibodies, which contribute to vascular damage and inflammation. A 59-year-old female with a history of SLE presented to the emergency department with lower limb sensory alterations, sudden loss of gait, and dysautonomia. Neurological examination revealed motor strength 0/5 in the lower limbs, areflexia, and hypotonia, with sensory level at T10. MRI findings indicated ischemic spinal infarction from T4 to T12, suggestive of longitudinally extensive TM. Given the absence of compressive pathology and infectious causes, high-dose corticosteroids and plasma exchange were initiated based on European League Against Rheumatism (EULAR) guidelines.

A Rare and Complex Overlap of Toxic Epidermal Necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Case Report and Review of the Literature

Carla Brenda Chávez García — 2024-11-19

Toxic epidermal necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) are both life-threatening hypersensitivity reactions characterized by widespread cutaneous involvement and multiorgan damage. While these syndromes are distinct, overlapping cases are exceptionally rare and represent a diagnostic and therapeutic challenge due to their shared and divergent pathophysiological features. In this case report, we describe a 21-year-old male patient who developed overlapping TEN and DRESS following treatment with phenytoin, risperidone, and levofloxacin. The patient presented with widespread epidermal detachment, facial edema, lymphadenopathy, eosinophilia, and liver dysfunction. Clinical management required a multidisciplinary approach including prompt withdrawal of the offending drug, initiation of systemic corticosteroids and supportive care. This case highlights the critical importance of early diagnosis and tailored management in preventing severe outcomes. A review of the current literature on TEN-DRESS overlap syndrome is also provided, discussing potential immunological mechanisms, diagnostic criteria, and therapeutic strategies.

Removable Partial-Denture Construction in Patients with Diabetes Mellitus

F X Ady Soesetijo — 2024-11-19

Prosthetic rehabilitation with denture treatment is aimed at stomatognathic system restoration. Diabetes Mellitus (DM) patients who require Removable Partial Denture (RPD) therapy are found in many dental and oral health centers. DM patients with complex oral manifestations need to receive serious attention by the dentist. Initially, the patient's examination should begin by knowing the history of the disease, so that it can help determine the appropriate measures for the patient and the diagnosis of the disorders that occur in the oral cavity. The main issue is the decline in quality and quantity of periodontal tissue. Therefore, determining the denture design should consider the kind of denture support as well as the appropriate denture base materials. The successful treatment is largely determined by the mastery of theory, laboratory and clinical skills, as well as good cooperation between the dentist and their patient.

Microbiology of Acute Cholangitis and Cholecystitis and Antimicrobial Susceptibility

Carlos de Jesús Hernández López — 2024-11-20

Background: Acute cholecystitis and cholangitis are life-threatening if not treated promptly. Empiric antibiotic therapy is crucial, relying on local studies of bile culture for guidance.

Objective: To identify the microbiological and antibiotic susceptibilities of organisms in bile cultures of patients with acute cholangitis and cholecystitis.

Materials and Methods: Adults diagnosed with acute cholangitis and/or cholecystitis at the Hospital Regional ISSSTE Puebla (2022-2023) underwent bile aspiration via laparoscopy or open surgery. Microorganisms were isolated from bile cultures and antibiograms were obtained. Patients were classified according to severity according to the Tokyo Guidelines 2018.

Results: A total of 88 patients with bile cultures for cholangitis/cholecystitis were included. Fourteen percent of cultures showed no bacterial growth, and E. coli was the most common pathogen with significant antibiotic resistance. Multivariate analysis identified recent antimicrobial therapy (p <0.03), concomitant malignancy (p <0.001), and age >65 years (p <0.0001) as factors associated with resistant bacteria. Thirty-day mortality was 2.3%.

Conclusions: Empirical antimicrobial therapy based on TG 2018 was effective across all severity grades.

Loeffler’s Cardiac Syndrome: An In-Depth Review of Pathophysiology, Clinical Manifestations, Diagnostic Strategies, and Management Approaches

Donaldo Emiliano Silva López — 2024-11-20

Loeffler’s cardiac syndrome, a rare and often severe form of hypereosinophilic syndrome, is characterized by endomyocardial damage and restrictive cardiomyopathy secondary to eosinophilic infiltration and degranulation. This condition progresses through three distinct pathological phases: an acute necrotic stage, a thrombotic stage, and finally, an endomyocardial fibrotic stage, leading to significant cardiac dysfunction. The pathophysiological underpinnings are driven by eosinophil-mediated cytotoxicity, resulting in cardiac inflammation, endomyocardial fibrosis, and subsequent heart failure manifestations.

Clinical presentation varies based on the disease stage, ranging from nonspecific symptoms like fatigue and fever to advanced signs of congestive heart failure, thromboembolic events, or restrictive cardiomyopathy. The diagnosis of Loeffler’s cardiac syndrome requires a high index of suspicion, particularly in patients with persistent eosinophilia, and relies on multimodal imaging techniques, including echocardiography and cardiac magnetic resonance imaging (MRI), coupled with laboratory studies and endomyocardial biopsy when indicated.

Current treatment strategies focus on eosinophil-lowering therapies, including corticosteroids and cytotoxic agents, to prevent progression to irreversible fibrosis. In cases with established cardiac damage, therapeutic options may extend to surgical interventions, heart transplantation, or advanced heart failure management. This review synthesizes the latest insights into the pathophysiology, clinical features, diagnostic approaches, and therapeutic modalities of Loeffler’s cardiac syndrome, emphasizing the importance of early recognition and tailored intervention to optimize patient outcomes.

Clinical Performance of Hematological Indices as Predictors of Mortality in Patients with Severe Acute Pancreatitis of Biliary Origin in the General Hospital of Zone No. 3, of Aguascalientes, México

Macías Rodríguez José Isaac — 2024-11-20

Background: Acute pancreatitis is a common disease with a potentially high mortality rate, making early risk assessment essential for optimizing treatment.

Objective: To evaluate the clinical performance of hematological indices as predictors of mortality in patients with severe acute biliary pancreatitis admitted to General Hospital Zone No. 3 in Aguascalientes.

Material and methods: An instrumental, retrospective, and observational study was conducted at General Hospital Zone No. 3 in Aguascalientes, Mexico, from January 1, 2023, to March 31, 2024. The study included 25 patients over 18 years of age diagnosed with severe acute biliary pancreatitis. Clinical and demographic data were extracted from medical records. The performance of each index was assessed using ROC curves, with sensitivity, specificity, and predictive values calculated at various cutoff points. Fagan's nomograms were used to interpret pre-test and post-test probabilities of mortality.

Results: Among the 25 patients evaluated, 36% died. The neutrophil-to-lymphocyte ratio (NLR) demonstrated the best performance as a mortality predictor, with an area under the curve (AUC) of 0.823. The optimal cutoff point was 15.1, with a sensitivity of 78% and a specificity of 88%, confirming its ability to distinguish between patients who died and those who survived. The red cell distribution width (RDW) had an AUC of 0.747, with high sensitivity (89%) but lower specificity (56%) at a cutoff of 15.0, making it a moderately effective predictor. Conversely, the platelet-to-lymphocyte ratio (PLR) performed poorly, with an AUC of 0.451, indicating low predictive value for mortality.

Conclusions: The neutrophil-to-lymphocyte ratio (NLR) emerged as the most effective predictor of mortality in this population of patients with severe acute biliary pancreatitis, followed by the red cell distribution width (RDW), which also showed moderate capability in predicting adverse outcomes.

The Potential Effect of Daun Sirih (Piperaceae Leaf) on the Burn Wound Healing: A Literature Review

Elvita Rahmawati — 2024-11-20

Introduction: Burn injuries, particularly among children and the elderly, result from heat, chemicals, or electricity, leading to skin and tissue damage. The wound healing process involves several stages, and infections from bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus can complicate healing. While burns are typically treated with antiseptics, traditional remedies like Piper betle (Piperaceae) are commonly used in Indonesia. Compounds in Piper betle—including flavonoids, saponins, and tannins—possess antioxidant, antibacterial, and anti-inflammatory properties that may enhance burn wound healing.

Methods: This literature review synthesized data from various open-access online databases to evaluate the effects of Piper betle on burn wound healing.

Results and Discussion: Piper betle, a medicinal plant from the Piperaceae family, accelerates wound healing through several mechanisms. Flavonoids form complexes with proteins, damaging bacterial cells; saponins enhance collagen production, and tannins disrupt bacterial cell walls. Studies confirm that Piper betle reduces inflammation and fosters tissue regeneration via antioxidant activity. Animal trials demonstrate significant improvements in burn wound healing, including faster wound contraction and recovery.

Conclusion: Piper betle shows promise in accelerating burn wound healing due to its bioactive compounds. While existing studies support its effectiveness, further research is needed to assess the long-term safety and potential toxicity of Piperaceae-based treatments.