Search results for: non-chest trauma patients

Authors: Karuna Sutthibenjakul, Sunisa Chatmongkolchart

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Background: Postinduction hypotension is common and occurs more often in elderly patients. We aimed to determine risk factors for hypotension after induction among elderly patients (aged 65 years and older) who underwent elective non-cardiac surgery under general anesthesia. Methods: This cohort study analyzed from 580 data between December 2017 and July 2018 at a tertiary university hospital in south of Thailand. Hypotension is defined as more than 30% decrease mean arterial pressure from baseline after induction within 20 minutes or the use of vasopressive agent to treat low blood pressure. Intraoperative parameters were blood pressure and heart rate at T0, TEI, T5, T10, T15 and T20 (immediately after arrival at operating room, time after intubation, 5, 10, 15 and 20 minutes after intubation) respectively. Results: The median age was 72.5 (68, 78) years. A prevalence of post-induction hypotension was 64.8%. The highest prevalence (39.7%) was at 15 minutes after intubation. The association of post-induction hypotension is rising with diuretic drug as preoperative medication (P-value=0.016), hematocrit level (P-value=0.031) and the degree of hypertension immediately after arrival at operating room (P-value<0.001). Increasing fentanyl dosage during induction was associated with hypotension at intubation time (P-value<0.01) and 5 minutes after intubation (P-value<0.001). There was no statistically significant difference in the increasing propofol dosage. Conclusion: The degree of hypertension immediately after arrival at operating room and increasing fentanyl dosage were a significant risk factors for postinduction hypotension in elderly patients.

Keywords: risk factors, post-induction, hypotension, elderly

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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Authors: S. Tebibel, R. L. Bouchouka, C. Mechati, S. Messaoudi

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The stomach cancer or gastric cancer is an aggressive cancer with a significant geographic disparity. The decrease in frequency is attributed to refrigeration, which has several beneficial consequences, increased consumption of fresh fruits and vegetables, reduced consumption of salt, which was widely used as a food preservative, and less contamination of food by carcinogenic compounds. The infection with Helicobacter pylori is responsible for progressive inflammatory changes in the gastric mucosa usually evolving into stomach cancer in 80% of cases. Methodology: This epidemiological and analytical study concerns 65 patients (46 men and 19 women) with gastric adenocarcinomas with an average age of 56.5 years and a male predominance with a sex ratio of 2.4. Results and Discussion: In this series, the clinical symptoms are dominated by epigastralgia (72.31%), vomiting (27,69%), and slimming (24,62%). The FOGD (Oeso-Gastro Duodenal Fibroscopy) performed in the 65 patients revealed a predominance of the antro-pyloric localization in 19 cases (i.e., 29.23%) and anulcerative budding appearance in 33 subjects (50,77%). Histologically, the moderately differentiated adenocarcinoma is found in 30.77% of patients, followed by well differentiated adenocarcinoma with 26.15% of patients. The immunohistochemical study revealed a positive labeling of half of the T cells by anti-CD3 AC, and a positive labeling of anti-CD20 AC in a diffuse and intense manner, with the presence of CD20-positive lymphoepithelial lesions compatible with CD20 a low grade MALT non-Hodgkin's lymphoma. Conclusion: This framework of analysis revealed some risk factors for gastric cancer, such as food, hygiene, Helicobacter pylori infection, smoking and family history.

Keywords: cancer, Helicobacter pylori, immunohistochemistry, stomach

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Authors: Haleh Dadgostar, Faramarz Akbari, Hosien Vahid Tari, Masoud Solaymani-Dodaran, Mohammad Razi

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Introduction: There are a number of exercises-protocols have been applied to improve low back pain. We compared the effect of supervised exercise therapy and home-based exercise therapy among patients with nonspecific chronic low back pain. Methods: 70 patients with nonspecific chronic low back pain were randomly (using a random number generator, excel) divided into two groups to compare the effects of two types of exercise therapy. After a common educational session to learn how to live with low back pain as well as to use core training protocols to strengthen the muscles, the subjects were randomly assigned to follow supervised exercise therapy (n = 31) or home-based exercise therapy (n = 34) for 20 weeks. Results: Although both types of exercise programs resulted in reduced pain, this factor decreased more significantly in supervised exercise program. All scores of fitness improved significantly in supervised exercise group. But only knee extensor strength score was increased in the home base exercise group. Conclusion: Comparing between two types of exercise, supervised group exercise showed more effective than the other one. Reduction in low back pain severity and improvement in muscle flexibility and strength can be more achieved by using a 20-week supervised exercise program compared to the home-based exercise program in patients with nonspecific chronic low back pain.

Keywords: low back pain, anthropometric parameters, supervised exercise therapy, home-based exercise therapy

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Authors: Pierre Mintom, Armel Assiene Agamou, Leslie Toukem, William Dakam, Christine Fernande Nyangono Biyegue

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Context: Hyperuricemia, the presence of high levels of uric acid in the blood, is a known precursor to the development of gout. Recent studies have suggested a strong association between hyperuricemia and disorders of lipoprotein metabolism, specifically hypercholesterolemia. Understanding the factors associated with these conditions in gout patients is essential for effective treatment and management. Research Aim: The objective of this study was to determine the prevalence of hyperuricemia, hypercholesterolemia, and the double burden of hyperuricemia-hypercholesterolemia in the gouty population. Additionally, the study aimed to identify the factors associated with these conditions. Methodology: The study utilized a database from a survey of 150 gouty patients recruited at the Laquintinie Hospital in Douala between August 2017 and February 2018. The database contained information on anthropometric parameters, biochemical markers, and the food and drugs consumed by the patients. Hyperuricemia and hypercholesterolemia were defined based on specific serum uric acid and total cholesterol thresholds, and the double burden was defined as the co-occurrence of hyperuricemia and hypercholesterolemia. Findings: The study found that the prevalence rates for hyperuricemia, hypercholesterolemia, and the double burden were 61.3%, 76%, and 50.7% respectively. Factors associated with these conditions included hypertriglyceridemia, atherogenicity index TC/HDL ratio, atherogenicity index LDL/HDL ratio, family history, and the consumption of specific foods and drinks. Theoretical Importance: The study highlights the strong association between hyperuricemia and dyslipidemia, providing important insights for guiding treatment strategies in gout patients. Additionally, it emphasizes the significance of nutritional education in managing these metabolic disorders, suggesting the need to address eating habits in gout patients. Data Collection and Analysis Procedures: Data was collected through surveys and medical records of gouty patients. Information on anthropometric parameters, biochemical markers, and dietary habits was recorded. Prevalence rates and associated factors were determined through statistical analysis, employing odds ratios to assess the risks. Question Addressed: The study aimed to address the prevalence rates and associated factors of hyperuricemia, hypercholesterolemia, and the double burden in gouty patients. It sought to understand the relationships between these conditions and determine their implications for treatment and nutritional education. Conclusion: Findings show that it’s exists an association between hyperuricemia and hypercholesterolemia in gout patients, thus creating a double burden. The findings underscore the importance of considering family history and eating habits in addressing the double burden of hyperuricemia-hypercholesterolemia. This study provides valuable insights for guiding treatment approaches and emphasizes the need for nutritional education in gout patients. This study specifically focussed on the sick population. A case–control study between gouty and non-gouty populations would be interesting to better compare and explain the results observed.

Keywords: gout, hyperuricemia, hypercholesterolemia, double burden

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Authors: Ayman M. Mansour

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In this paper, we propose an intelligent system that is used for monitoring the health conditions of Patients. Monitoring the health condition of Patients is a complex problem that involves different medical units and requires continuous monitoring especially in rural areas because of inadequate number of available specialized physicians. The proposed system will Improve patient care and drive costs down comparing to the existing system in Jordan. The proposed system will be the start point to Faster and improve the communication between different units in the health system in Jordan. Connecting patients and their physicians beyond hospital doors regarding their geographical area is an important issue in developing the health system in Jordan. The propose system will provide an intelligent system that will generate initial diagnosing to the patient case. This will assist and advice clinicians at the point of care. The decision is based on demographic data and laboratory test results of patient data. Using such system with the ability of making medical decisions, the quality of medical care in Jordan and specifically in Tafial is expected to be improved. This will provide more accurate, effective, and reliable diagnoses and treatments especially if the physicians have insufficient knowledge.

Keywords: GSM, SMS, patient, monitoring system, fuzzy logic, multi-agent system

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Authors: Farhad Fakoursevom

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Heart disease is one of the diseases which is found in abundance today. Various types of surgeries, such as bypasses, angiography, angioplasty, etc., are used to treat patients. People may receive such surgeries, some of which are invasive and some non-invasive, throughout their lives. People might cope with pre-surgery anxiety and stress, which can disrupt their normal life and even reduce the effects of the surgery, so the desired result can not be achieved in surgery. Considering this issue, the present study aimed to do a comparative assessment of people who received sedatives before surgery and people who did not receive sedatives. In terms of the purpose, this is an applied research and descriptive survey in terms of method. The statistical population included patients who underwent surgeries in the specialist heart hospitals of Mashhad, Iran; 60 people were considered as a statistical population, 30 of them received sedatives before surgery, and 30 others had not received sedatives before surgery. Valid and up-to-date articles were systematically used to collect theoretical bases, and a researcher-made questionnaire was used to examine the level of stress and anxiety of people. The questionnaire content validity was assessed by a panel of experts in psychology and medicine. The construct validity was tested using the software. Cronbach's alpha and composite reliability were used for reliability, which shows the appropriate reliability of the questionnaire. SPSS software was used to compare the research results between two groups, and the research findings showed that there is no significant association between the people who received sedatives and those who did not receive sedatives in terms of the amount of stress and anxiety. The longer the time of taking the drugs before the surgery, the more the mental peace of the patients will be. According to the results, it can be said that if we don't need to have an emergency operation and need more time, we have to use sedative drugs with different doses compared to the severity of the surgery, and also in case of a medical emergency such as heart surgery due to a stroke, we have to take advantage of psychological services during and before the operation and sedative drugs so that the patients can control their stress and anxiety and achieve better outcomes.

Keywords: sedative drugs, stress, anxiety, surgery

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Authors: Lei Zhou, Dan Li, Ruiqi Ren, Chao Li, Yali Wang, Daxin Ni, Zijian Feng, Timothy M. Uyeki, Qun Li

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Since the first human infections with avian influenza A(H7N9) virus were identified in early 2013, 1533 cases of laboratory-confirmed A(H7N9) virus infections were reported and confirmed as of September 13, 2017. The fifth epidemic was defined as starting from September 1, 2016, and the number of A(H7N9) cases has surged since the end of December in 2016. On February 18, 2017, the A(H7N9) cases who were infected with highly pathogenic avian influenza (HPAI) virus was reported from Southern China. The HPAI A(H7N9) cases were identified and then an investigation and analyses were conducted to assess whether disease severity in humans has changed with HPAI A(H7N9) compared with low pathogenic avian influenza (LPAI) A(H7N9) virus infection. Methods: All confirmed cases with A(H7N9) virus infections reported throughout mainland China from September 1, 2016, to September 13, 2017, were included. Cases' information was extracted from field investigation reports and the notifiable infectious surveillance system to describe the demographic, clinical, and epidemiologic characteristics. Descriptive statistics were used to compare HPAI A(H7N9) cases with all LPAI A(H7N9) cases reported during the fifth epidemic. Results: A total of 27 cases of HPAI A(H7N9) virus were identified infection from five provinces, including Guangxi (44%), Guangdong (33%), Hunan (15%), Hebei (4%) and Shangxi (4%). The median age of cases of HPAI A(H7N9) virus infection was 60 years (range, 15 to 80) and most of them were male (59%) and lived in rural areas (78%). All 27 cases had live poultry related exposures within 10 days before their illness onset. In comparison with LPAI A(H7N9) case-patients, HPAI A(H7N9) case-patients were significantly more likely to live in rural areas (78% vs. 51%; p = 0.006), have exposure to the sick or dead poultry (56% vs. 19%; p = 0.000), and be hospitalized earlier (median 3 vs. 4 days; p = 0.007). No significant differences were observed in median age, sex, prevalence of underlying chronic medical conditions, median time from illness onset to first medical service seeking, starting antiviral treatment, and diagnosis. Although the median time from illness onset to death (9 vs. 13 days) was shorter and the overall case-fatality proportion (48% vs. 38%) was higher for HPAI A(H7N9) case-patients than for LPAI A(H7N9) case-patients, these differences were not statistically significant. Conclusions: Our findings indicate that HPAI A(H7N9) virus infection was associated with exposure to sick and dead poultry in rural areas when visited live poultry market or in the backyard. In the fifth epidemic in mainland China, HPAI A (H7N9) case-patients were hospitalized earlier than LPAI A(H7N9) case-patients. Although the difference was not statistically significant, the mortality of HPAI A (H7N9) case-patients was obviously higher than that of LPAI A(H7N9) case-patients, indicating a potential severity change of HPAI A(H7N9) virus infection.

Keywords: Avian influenza A (H7N9) virus, highly pathogenic avian influenza (HPAI), case-patients, poultry

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Authors: Trunov V.O., Ryabov A. B., Poddubny I.V

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Introduction: cystic and solid pancreatic tumors have a relevant and disruptive position in many positions. The results of the treatment of children with tumors and pancreatic cysts aged 3 to 17 years for the period from 2008 to 2019 on the basis of the Morozov State Children's Clinical Hospital in Moscow were analyzed. The total number of children with solid tumors was 17, and 31 with cysts. In all children, the diagnosis was made on the basis of ultrasound, followed by CT and MRI. In most patients with solid tumors, they were located in the area of the pancreas tail - 58%, in the body area - 14%, in the area of the pancreatic head - 28%. In patients with pancreatic cysts, the distribution of patients by topography was as follows: head of the pancreas - 10%, body of the pancreas - 16%, tail of the pancreas - 68%, total cystic transformation of the Wirsung duct - 6%. In pancreatic cysts, the method of surgical treatment was based on the results of MRCP, the level of amylase in the contents of the cyst, and the localization of the cyst. Thus, pathogenetically substantiated treatment included: excision of cysts, internal drainage on an isolated loop according to Ru, the formation of pancreatojejunoanastomosis in a child with the total cystic transformation of the Wirsung duct. In patients with solid pancreatic lesions, pancretoduodenalresection, central resection of the pancreas, and distal resection from laparotomy and laparoscopic access were performed. In the postoperative period, in order to prevent pancreatitis, all children underwent antisecretory therapy, parenteral nutrition, and drainage of the omental bursa. Results: hospital stay ranged from 7 to 12 days. The duration of postoperative fermentemia in patients with solid formations lasted from 3 to 6 days. In all cases, according to the histological examination, a pseudopapillary tumor of the pancreas was revealed. In the group of children with pancreatic cysts, fermentemia was observed from 2 to 4 days, recurrence of cysts in the long term was detected in 3 children (10%). Conclusions: the treatment of cystic and solid pancreatic neoplasms is a difficult task in connection with the anatomical and functional features of the organ.

Keywords: pancreas, tumors, cysts, resection, laparoscopy, children

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Authors: Kusmayadi Ita Nursita, Sundoro Ali

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Cleft lip and palate are one of the most common congenital abnormalities in the face. It could happen to anyone, but mostly affect Asian population including Indonesia. Factors that influence the occurrence of cleft lip and palate vary from genetic to environmental factors. Children with cleft lip and palate will often have various problems such as airway disorders, eating disorders, speech and language developmental disorders, hearing disorders and psycho-social disorders, one of which is caused by appearance disorders. During his life, the child will experience multidisciplinary surgery and non-surgical treatment and can be accompanied by a psychological and financial burden on himself and his family. In Indonesia, there are no detailed scientific data on the prevalence and characteristic of cleft lip and palate patients. It was mainly caused by the absence of a national level organization, differences in geographical location, and the absence of national guidelines. This study aimed to describe the characteristic and prevalence of cleft lip and palate patients in Bandung Cleft Lip and Palate Center from 1 January 2016 to 31 December 2017. A total of 560 patients were included in the study. The highest percentage of cases are left unilateral cleft lip and palate with higher number of female patient and labioplasty as the most often surgical procedure to be conducted in Bandung Cleft Lip and Palate Center. In order to improve quality of life in patients with cleft lip and palate, early recognition and early treatment based on actual comprehensive data should be conducted. The data from Bandung Cleft Lip and Palate Center as one of the largest center of cleft lip and palate in West Java Indonesia hopefully could provide a big step of further comprehensive data collection in Indonesia and for the better overall management of cleft lip and palate in the future.

Keywords: cleft lip, cleft palate, characteristic, prevalence

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Authors: Mahmoud Ghazy, Ahmed R. Z. Baghdadi

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Background: With the perceived pain and poor function experienced following total hip Arthroplasty (THA), patients usually feel un-satisfied. Methods: Thirty patients with THA (group I) and thirty indicated for arthroplasty but weren’t operated on yet (group II) participated in the study. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and III respectively. The Berg Balance Scale (BBS), Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four weeks pre- and post-operatively and three months post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-12th weeks) programs. Results: group I had significantly lower TUG and SC time compared with group II four weeks and three months post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly four weeks and three months post-operatively compared with four weeks pre- operatively in group. But no significant differences in BBS scores four weeks and three months post-operatively in group I compared with group II. Interpretation/Conclusion : Patients with THA still have defects in proprioception, so they needs more concentration on proprioception training.

Keywords: dynamic balance, functional performance, hip arthroplasty, total

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Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese

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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.

Keywords: advance directives, community-based, pocket card, primary care clinic

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Authors: Aneal Khan, Elleine Allapitan, Desmond Koo, Katherine-Ann Piedalue, Shaneel Pathak, Utkarsh Subnis

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Background: Disease management of metabolic, genetic disorders is long-term and can be cumbersome to patients and caregivers. Patient-Reported Outcome Measures (PROMs) have been a useful tool in capturing patient perspectives to help enhance treatment compliance and engagement with health care providers, reduce utilization of emergency services, and increase satisfaction with their treatment choices. Currently, however, PROMs are collected during infrequent and decontextualized clinic visits, which makes translation of patient experiences challenging over time. The GRIT study aims to evaluate a digital health journal application called Zamplo that provides a personalized health diary to record self-reported health outcomes accurately and efficiently in patients with metabolic, genetic disorders. Methods: This is a randomized controlled trial (RCT) (1:1) that assesses the efficacy of Zamplo to increase patient activation (primary outcome), improve healthcare satisfaction and confidence to manage medications (secondary outcomes), and reduce costs to the healthcare system (exploratory). Using standardized online surveys, assessments will be collected at baseline, 1 month, 3 months, 6 months, and 12 months. Outcomes will be compared between patients who were given access to the application versus those with no access. Results: Seventy-seven patients were recruited as of November 30, 2021. Recruitment for the study commenced in November 2020 with a target of n=150 patients. The accrual rate was 50% from those eligible and invited for the study, with the majority of patients having Fabry disease (n=48) and the remaining having Pompe disease and mitochondrial disease. Real-time clinical responses, such as pain, are being measured and correlated to disease-modifying therapies, supportive treatments like pain medications, and lifestyle interventions. Engagement with the application, along with compliance metrics of surveys and journal entries, are being analyzed. An interim analysis of the engagement data along with preliminary findings from this pilot RCT, and qualitative patient feedback will be presented. Conclusions: The digital self-care journal provides a unique approach to disease management, allowing patients direct access to their progress and actively participating in their care. Findings from the study can help serve the virtual care needs of patients with metabolic, genetic disorders in North America and the world over.

Keywords: eHealth, mobile health, rare disease, patient outcomes, quality of life (QoL), pain, Fabry disease, Pompe disease

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Authors: Abdolamir Allameh, Seyyed Mortaza Haghgoo, Adnan Khosravi, Esmaeil Mortaz, Mihan Pourabdollah-Toutkaboni, Sharareh Seifi

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Non-Small Cell Lung Carcinoma (NSCLC) is associated with a number of gene mutations in epidermal growth factor receptor (EGFR). The prognostic significance of mutations in exons 19 and 21, together with serum levels of EGFR, amphiregulin (AR), and Transforming Growth Factor-alpha (TGF-α) are implicated in diagnosis and treatment. The aim of this study was to examine the relationship of EGFR mutations in selected exons with the expression of relevant ligands in sera samples of NSCLC patients. For this, a group of NSCLC patients (n=98) referred to the hospital for lung surgery with a mean age of 59±10.5 were enrolled (M/F: 75/23). Blood specimen was collected from each patient. Besides, formalin fixed paraffin embedded tissues were processed for DNA extraction. Gene mutations in exons 19 and 21 were detected by direct sequencing, following DNA amplification which was done by PCR (Polymerase Chain Reaction). Also, serum levels of EGFR, AR, and TGF-α were measured by ELISA. The results of our study show that EGFR mutations were present in 37% of Iranian NSCLC patients. The most frequently identified mutations were deletions in exon 19 (72.2%) and substitutions in exon 21 (27.8%). The most frequently identified alteration, which is considered as a rare mutation, was the E872K mutation in exon 21, which was found in 90% (9 out of 10) cases. EGFR mutation detected in exon 21 was significantly (P<0.05) correlated with the levels of its ligands, EGFR and TGF-α in serum samples. Furthermore, it was found that increased serum AR (>3pg/ml) and TGF-α (>10.5 pg/ml) were associated with shorter overall survival (P<0.05). The results clearly showed a close relationship between EGFR mutations and serum EGFR and serum TGF-α. Increased serum EGFR was associated with TGF-α and AR and linked to poor prognosis of NSCLC. These findings are implicated in clinical decision-making related to EGFR-Tyrosine kinase inhibitors (TKIs).

Keywords: lung cancer, Iranian patients, epidermal growth factor, mutation, prognosis

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Authors: Vasilis C. Hristidis, Ricardo Caceda, Ji Soo Kim, Brian Bronson, Emily A. Hill

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Objective: Leave passes to provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Though providing day passes was once a relatively common practice, there is relatively little data describing their safety and efficacy. Methods: This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. Results: During the study period, ten patients with primary psychotic or mood disorders received 12 passes for either housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or elopements. One patient experienced severe agitation and engaged in non-suicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Conclusions: Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.

Keywords: passes, inpatient, psychiatry, inpatient leave, outcome

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Authors: Andrea Gatti, Federica Coppotelli, Ma Primavera, Laura Palmieri, Umberto Tarantino

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Aim of study: Scientific literature is scarce of studies and reviews valuing the pros and cons of the paratricipital approach for the treatment of humeral shaft fractures; the lateral paratricipital approach is a valid alternative to the classical posterior approach to the humeral shaft as it preserves both the triceps muscle and the elbow extensor mechanisms; based on our experience, this retrospective analysis aims at analyzing outcome, risks and benefits of the lateral paratricipital approach for humeral shaft fractures. Methods: Our study includes 14 patients treated between 2018 and 2019 for unilateral humeral shaft fractures: 13 with a B1 or B2 and a patient with a C fracture type (according to the AO/ATO Classification); 6 of our patients identified as male while 8 as female; age average was 57.8 years old (range 21-73 years old). A lateral paratricipital approach was performed on all 14 patients, sparing the triceps muscle by avoiding the olecranon osteotomy and by assessing the integrity and the preservation of the radial nerve; the humeral shaft fracture osteosynthesis was performed by means of plates and screws. After surgery all patients have started elbow functional rehabilitation with acceptable pain management. Post-operative follow-up has been carried out by assessing radiographs, MEPS (Mayo Elbow Performance Score) and DASH (Disability of Arm Shoulder and Hand) functional assessment and ROM of the affected joint. Results: All 14 patients had an optimal post-operative follow-up with an adequate osteosynthesis and functional rehabilitations by entirely preserving the operated elbow joint; the mean elbow ROM was 0-118.6 degree (range of 0-130) while the average MEPS score was 86 (range75-100) and 79.9 for the DASH (range 21.7-86.1). Just 2 patients suffered of temporary radial nerve apraxia, healed in the subsequent follow-ups. CONCLUSION: The lateral paratricipital approach preserve both the integrity of the triceps muscle and the elbow biomechanism but we do strongly recommend additional studies to be carried out to highlight differences between it and the classical posterior approach in treating humeral shaft fractures.

Keywords: paratricepital approach, humerus shaft fracture, posterior approach humeral shaft, paratricipital postero-lateral approach

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Authors: Rojith K. Balakrishnan

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Spontaneous tumour lysis syndrome is a constellation of electrolyte abnormalities and an acute renal failure which occurs in the setting of rapid cell turnover prior to the administration of cytotoxic chemotherapy. While spontaneous tumour lysis well-described in patients with Burkitt lymphoma, it is thought to occur less commonly in patients with other hematological malignancies. We present a case of forty-year-old female who presented with features of acute renal failure, on further evaluation turned out to be a newly diagnosed acute myeloid leukemia with spontaneous tumour lysis best of our knowledge only three cases of AML with spontaneous tumour lysis has reported world wide.

Keywords: AML, tumour lysis, renal failure, myeloid leukemia

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Authors: Anne-Loes K. Warps, Rob A. E. M. Tollenaar, Pieter J. Tanis, Jan Willem T. Dekker

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Anastomotic leakage after colorectal cancer surgery remains a severe complication. Early diagnosis and treatment are essential to prevent further adverse outcomes. In the literature, it has been suggested that earlier reintervention is associated with better survival, but anastomotic leakage can occur with a highly variable time interval to index surgery. This study aims to evaluate the time-interval between rectal cancer resection with primary anastomosis creation and reoperation, in relation to short-term outcomes, stratified for the use of a defunctioning stoma. Methods: Data of all primary rectal cancer patients that underwent elective resection with primary anastomosis during 2013-2019 were extracted from the Dutch ColoRectal Audit. Analyses were stratified for defunctioning stoma. Anastomotic leakage was defined as a defect of the intestinal wall or abscess at the site of the colorectal anastomosis for which a reintervention was required within 30 days. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay and readmission. The association between time to reoperation and outcome was evaluated in three ways: Per 2 days, before versus on or after postoperative day 5 and during primary versus readmission. Results: In total 10,772 rectal cancer patients underwent resection with primary anastomosis. A defunctioning stoma was made in 46.6% of patients. These patients had a lower anastomotic leakage rate (8.2% vs. 11.6%, p < 0.001) and less often underwent a reoperation (45.3% vs. 88.7%, p < 0.001). Early reoperations (< 5 days) had the highest complication and mortality rate. Thereafter the distribution of adverse outcomes was more spread over the 30-day postoperative period for patients with a defunctioning stoma. Median time-interval from primary resection to reoperation for defunctioning stoma patients was 7 days (IQR 4-14) versus 5 days (IQR 3-13 days) for no-defunctioning stoma patients. The mortality rate after primary resection and reoperation were comparable (resp. for defunctioning vs. no-defunctioning stoma 1.0% vs. 0.7%, P=0.106 and 5.0% vs. 2.3%, P=0.107). Conclusion: This study demonstrated that early reinterventions after anastomotic leakage are associated with worse outcomes (i.e. mortality). Maybe the combination of a physiological dip in the cellular immune response and release of cytokines following surgery, as well as a release of endotoxins caused by the bacteremia originating from the leakage, leads to a more profound sepsis. Another explanation might be that early leaks are not contained to the pelvis, leading to a more profound sepsis requiring early reoperations. Leakage with or without defunctioning stoma resulted in a different type of reinterventions and time-interval between surgery and reoperation.

Keywords: rectal cancer surgery, defunctioning stoma, anastomotic leakage, time-interval to reoperation

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Authors: Vichayada Laohapiboolkul

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Introduction: As the legal use of cannabis is being widely accepted throughout the world, medical cannabis has been explored in order to become an alternative cure for patients. Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are natural cannabinoids found in the Cannabis plant which is proved to have positive treatment for various diseases and symptoms such as chronic pain, neuropathic pain, spasticity resulting from multiple sclerosis, reduce cancer-associated pain, autism spectrum disorders (ASD), dementia, cannabis and opioid dependence, psychoses/schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, and Tourette's disorder. Regardless of all the medical benefits, THC, if not metabolized, can lead to mild up to severe adverse drug reactions (ADR). The enzyme CYP2C19 was found to be one of the metabolizers of THC. However, the suballele CYP2C19*2 manifests as a poor metabolizer which could lead to higher levels of THC than usual, possibly leading to various ADRs. Objective: The aim of this study was to investigate the distribution of CYP2C19, specifically CYP2C19*2, genes in Thai patients treated with medical cannabis along with adverse drug reactions. Materials and Methods: Clinical data and EDTA whole blood for DNA extraction and genotyping were collected from patients for this study. CYP2C19*2 (681G>A, rs4244285) genotyping was conducted using the Real-time PCR (ABI, Foster City, CA, USA). Results: There were 42 medical cannabis-induced ADRs cases and 18 medical cannabis tolerance controls who were included in this study. A total of 60 patients were observed where 38 (63.3%) patients were female and 22 (36.7%) were male, with a range of age approximately 19 - 87 years. The most apparent ADRs for medical cannabis treatment were dry mouth/dry throat (76.7%), followed by tachycardia (70%), nausea (30%) and a few arrhythmias (10%). In the total of 27 cases, we found a frequency of 18 CYP2C19*1/*1 alleles (normal metabolizers, 66.7%), 8 CYP2C19*1/*2 alleles (intermediate metabolizers, 29.6%) and 1 CYP2C19*2/*2 alleles (poor metabolizers, 3.7%). Meanwhile, 63.6% of CYP2C19*1/*1, 36.3% and 0% of CYP2C19*1/*2 and *2/*2 in the tolerance controls group, respectively. Conclusions: This is the first study to confirm the distribution of CYP2C19*2 allele and the prevalence of poor metabolizer genes in Thai patients who received medical cannabis for treatment. Thus, CYP2C19 allele might serve as a pharmacogenetics marker for screening before initiating treatment.

Keywords: medical cannabis, adverse drug reactions, CYP2C19, tetrahydrocannabinol, poor metabolizer

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Authors: Arunima Datta, Prathama Guha Chaudhuri, Ashis Mukhopadhyay

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Background: Acceptance and commitment therapy (ACT) is one of the newer forms (third wave) therapy. This therapy helps a cancer patient to increase acceptance level about their disease as well as their present situation. Breast cancer patients are known to suffer from depression and mild cognitive impairment; both affect their quality of life. Objectives:The present study had assessed effect of structured ACT intervention on cognitive function and acceptance level among breast cancer patients who were undergoing chemotherapy. Method: Data was collected from 123 breast cancer patients those who were undergoing chemotherapy were willing to undergo psychological treatment, with no history of past psychiatric illness. Their baseline of cognitive function and acceptance levels were assessed using validated tools. The effect of sociodemographic factors and clinical factors on cognitive function was determined at baseline.The participants were randomly divided into two groups: experimental (ACT, 4 sessions over 2 months) and control group. Cognitive function and acceptance level were measured during post intervention on 2months follow-up. Appropriate statistical analyses were performed to determine the effect on cognitive function and acceptance level in two groups. Result: At baseline, the factors that significantly influenced slower speed of task performance were ER PR HER2 status; number of chemo cycle, treatment type (Adjuvant and neo-adjuvant) was related with that. Sociodemographic characteristics did not show any significant difference between slow and fast performance. Per and post intervention analysis showed that ACT intervention resulted in significant difference both in terms of speed of cognitive performance and acceptance level. Conclusion: ACT is an effective therapeutic option for treating mild cognitive impairment and improve acceptance level among breast cancer patients undergoing chemotherapy.

Keywords: acceptance and commitment therapy, breast cancer, quality of life, cognitive function

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Authors: Matheesha Herath, Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore

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Background: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. It is unknown whether the acute surgical unit (ASU) model affects the management and disclosure of these findings. Methods: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings and communication of the findings to the patient and to their general practitioner (GP). Results: 1,214 patients underwent emergency appendicectomy; 465 in the traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the traditional and ASU group with regards to communication of the findings to the patient (p=0.44) and their GP (p=0.27), and there was no difference in the rates of appropriate management (p=0.21). Conclusions: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during an appendectomy.

Keywords: acute care surgery, appendicitis, appendicectomy, incidental

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Authors: Yu-Wen Lin, Li-Ni Liu

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Introduction: Fatigue is the most common symptoms experienced by cancer patients undergoing chemotherapy. Patients receiving anticancer therapies develop a higher proportion of fatigue compared with patients who do not receive anticancer therapies. Fatigue has significant impacts on quality of life, daily activities, mood status, and social behaviors. A warm-water footbath (WWF) at 41℃ promotes circulation and removes metabolites resulting in improving sleep and relieving fatigue. The aim of this study is to determine the effectiveness of WWF for relieving fatigue with cancer patients undergoing chemotherapy. Materials and Methods: This is a single-center, prospective, quasi-experimental design study in the oncology ward in Taiwan. Participants in this study were assigned to WWF group as experimental group and standard care group as a control group by purposive sampling. In the WWF group, the participants were asked to soak their feet in 42-43℃ water 15 minutes for consecutive 6 days at one day before chemotherapy. Each participant was evaluated for fatigue level by the Taiwanese version of the Brief Fatigue Inventory (BFI-T). BFI-T was completed for consecutive 8 days of the study. The primary outcome was compared the BFI-T score of WWF group to the standard care group. Results: There were 60 participants enrolled in this study. Thirty participants were assigned to WWF group and 30 participants were assigned to standard care group. Both groups have comparable characteristic. The BFI-T scores of both groups were increased associated with the days of chemotherapy. The highest BFI-T scores of both groups were on the day 4 of chemotherapy. The BFI-T scores of both groups were decreased since day 5 and significantly decreased in WWF group on day 5 compared to standard care group (4.17 vs. 5.7, P ＜ .05). At the end of the study the fatigue at its worse were significantly decreased in WWF group (2.33 vs. 4.37, P ＜ .001). There was no adverse event reported in this study. Conclusion: WWF is an easy, safe, non-invasive, and relatively inexpensive nursing intervention for improving fatigue of cancer patients undergoing chemotherapy. In summary, this study shows the WWF is a simple complementary care method, and it is effective for improving and relieving fatigue in a short time. Through improving fatigue is a way to enhance the quality of life which is important for cancer patients undergoing chemotherapy. Larger prospective randomized controlled trial and long-term effectiveness and outcomes of WWF should be performed to confirm this study.

Keywords: chemotherapy, warm-water footbath, fatigue, Taiwanese version of the brief fatigue inventory

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Authors: James Jin, Weisi Xia, Runzhe Gao, Alain Vandal, Darren Svirkis, Andrew Hill

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Background: Post-haemorrhoidectomy pain is concerned by patients/clinicians. Minimizing the postoperation pain is highly interested clinically. Combinations of topical cream targeting three hypothesised post-haemorrhoidectomy pain mechanisms were developed and their effectiveness were evaluated. Specifically, a multi-centred double-blinded randomized clinical trial (RCT) was conducted in adults undergoing excisional haemorrhoidectomy. The primary analysis was conveyed on the data collected to evaluate the effectiveness of the combinations of topical cream targeting three hypothesized pain mechanisms after the operations. Methods: 192 patients were randomly allocated to 4 arms (each arm has 48 patients), and each arm was provided with pain cream 10% metronidazole (M), M and 2% diltiazem (MD), M with 4% lidocaine (ML), or MDL, respectively. Patients were instructed to apply topical treatments three times a day for 7 days, and record outcomes for 14 days after the operations. The primary outcome was VAS pain on day 4. Covariates and models were selected in the blind review stage. Multiple imputations were applied for the missingness. LMER, GLMER models together with natural splines were applied. Sandwich estimators and Wald statistics were used. P-values < 0.05 were considered as significant. Conclusions: The addition of topical lidocaine or diltiazem to metronidazole does not add any benefit. ML had significantly better pain and recovery scores than combination MDL. Multimodal topical analgesia with ML after haemorrhoidectomy could be considered for further evaluation. Further trials considering only 3 arms (M, ML, MD) might be worth exploring.

Keywords: RCT, primary analysis, multiple imputation, pain scores, haemorrhoidectomy, analgesia, lmer

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Authors: Evgenia Papathanasiou, Georgios Kokkotis, Georgios Axiaris, Theodoros Argyropoulos, Nikos Viazis, Olga Giouleme, Konstantinos Gkoumas, Αnthia Gatopoulou, Αggelos Theodoulou, Georgios Theocharis, Αngeliki Theodoropoulou, Μaria Κalogirou, Pantelis Karatzas, Κonstantinos Κatsanos, Theodora Kafetzi, Κonstantinos Κarmiris, Αnastasia Κourikou, Ιoannis E Κoutroubakis, Christos Liatsos, Gerassimos J. Mantzaris, Νicoletta Μathou, Georgia Bellou, George Michalopoulos Αikaterini Μantaka, Penelope Nikolaou, Μichael Oikonomou, Dimitrios Polymeros, George Papatheodoridis, Εvdoxia Stergiou, Κonstantinos Soufleris, Εpameinondas Skouloudis, Μaria Tzouvala, Georgia Tsiolakidou, Εftychia Tsironi, Styliani Tsafaraki, Kalliopi Foteinogiannopoulou, Konstantina Chalakatevaki, Αngeliki Christidou, Dimitrios K. Christodoulou, Giorgos Bamias, Spyridon Michopoulos, Εvanthia Zampeli

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Background: Inflammatory bowel disease (IBD) commonly affects female patients of reproductive age, making the interaction between fertility, pregnancy and IBD an important issue in disease management. The effect of disease activity on the outcome of pregnancy and its impact on neonatal growth is a field of intense research. Close follow-up of pregnant IBD patients by a multidisciplinary team improves maternal and neonatal outcomes. Aim – Methods: Α national retrospective study of pregnancies in women with IBD between 2010-2020 was carried out in 22 IBD reference centers in Greece. Patient characteristics such as disease profile, type of treatment, and disease activity during gestation were analyzed in correlation to the method of delivery, pregnancy outcomes, as well as breastfeeding and offspring health. Results: Two-hundred and twenty-three pregnancies in 175 IBD patients were registered in the study. 122 with Crohn’s disease (CD). Median age during diagnosis was 25.6 years (12-44), with median disease duration of 7.4 years (0-23). One-hundred and twenty-nine patients (58%) were recorded during their first pregnancy. Early pregnancy termination was reported by 48 patients (22%). Pregnancy as a result of in vitro fertilization (IVF) occurred in 15 cases (6.7%). At the beginning of gestation, 165 patients (74%) were under treatment: 48 with anti-TNF agents (29%), 43 with azathioprine (26%), 101 with 5-aminosalicylic acid formulations (61%) and 12 with steroids (7%). We recorded 49 cases of IBD flares (22%) during pregnancy. Two-thirds of them (n=30) were in remission at the onset of the pregnancy. Almost half of them (n=22) required corticosteroid treatment. Patients with ulcerative colitis (UC) were in greater risk of disease flare during pregnancy (p<0.001). All but 3 pregnancies (99.1%) resulted in uncomplicated delivery. In 147 cases (67.1%), cesarean delivery was performed. Two late fetal deaths (0.9%) were reported, both in patients with continuously active disease since the beginning of pregnancy. After delivery, 75 patients (34%) presented with a disease flare, which was associated with active disease at the beginning of pregnancy (p <0.001). Conclusion: The majority of female, Greek IBD patients, had a favorable pregnancy outcome. Active inflammation during gestation and UC diagnosis were associated with a negative impact on pregnancy outcomes. The results of this study are in favor of the continuation of IBD treatment during pregnancy.

Keywords: pregnancy, ulcerative colitis, Crohn disease, flare

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Authors: Barnali Saha

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Dalit writing is the interventionalist voice of the dispossessed subaltern in the cultural economy of the society. As such, Dalit writing, including Dalit poetry, considers the contradictions that permeate the socio-cultural structure historically allocated and religiously sanctioned in the Indian subcontinent. As an epicenter of all Dalit experiences of trauma and violence, the poetics the Dalit body is deeply rooted in the peripheral space socially assigned to it by anachronistic caste-based litigation. An appraisal of Dalit creative-critical work by writers like Sharan Kumar Limbale, Arjun Dangle, Namdeo Dhasal, Om Prakash Valmiki, Muktibodh and others underscore the conjunction of the physical, psychical and the psychological in their interpretation of Dalit consciousness. They put forward the idea that Dalit poetry is begotten by the trauma of societal oppression and therefore, Dalit language and its revitalization are two elements obdurately linked to Dalit poetics. The present research paper seeks to read the problematization of the Dalit agency through the conduit of the Dalit voice wherein the anatomical category of the mouth is closely related to the question of Dalit identity. Theoretically aligned to Heidegger’s notion of language as the house of being and Bachelard’s assertion of a house as an ideal metaphor of poetic imagination and Dylan Trigg’s view of the coeval existence of space and body, the paper examines a series of selected poems by Dalit poetic voices to examine how their distinct Dalit point of view underscores Dalit speech and directs our attention to the historical abstraction of it. The paper further examines how speech as a category in Dalit writing places the Dalit somatic entity as a site of contestation with the ‘Mouth’ as a loaded symbolic category inspiring rebellion and resistance. And as the quintessential purpose of Dalit literature is the unleashing of Dalit voice from the anti-verbal domain of social decrepitude, Dalit poetry needs to be critically read based on the experience of the mouth and the patois.

Keywords: Dalit, poetry, speech, mouth, subaltern, minority, exploitation, space

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Authors: Shima Mahmoudi, Babak Pourakbari, Setareh Mamishi, Mostafa Teymuri, Majid Marjani

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Although cytokine analysis has greatly contributed to the understanding of tuberculosis (TB) pathogenesis, data on cytokine profiles that might distinguish progression from latency of TB infection are scarce. Since PE/PPE proteins are known to induce strong humoral and cellular immune responses, the aim of this study was to evaluate the diagnostic potential of interleukin-2 (IL-2) as biomarker after specific antigen stimulation with PE35 and PPE68 for the discrimination of active and latent tuberculosis infection (LTBI). The production of IL-2 was measured in the antigen-stimulated whole-blood supernatants following stimulation with recombinant PE35 and PPE68. All the patients with active TB and LTBI had positive QuantiFERON-TB Gold in Tube test. The level of IL-2 following stimulation with recombinant PE35 and PPE68 were significantly higher in LTBI group than in patients with active TB infection or control group. The discrimination performance (assessed by the area under ROC curve) for IL-2 following stimulation with recombinant PE35 and PPE68 between LTBI and patients with active TB were 0.837 (95%CI: 0.72-0.97) and 0.75 (95%CI: 0.63-0.89), respectively. Applying the 12.4 pg/mL cut-off for IL-2 induced by PE35 in the present study population resulted in sensitivity of 78%, specificity of 78%, PPV of 78% and NPV of 100%. In addition, a sensitivity of 81%, specificity of 70%, PPV of 67% and 87% of NPV was reported based on the 4.4 pg/mL cut-off for IL-2 induced by PPE68. In conclusion, peptides of the antigen PE35 and PPE68, absent from commonly used BCG strains, stimulated strong IL-2- positive T cell responses in patients with LTBI. This study confirms IL-2 induced by PE35 and PPE68 as a sensitive and specific biomarker and highlights IL-2 as new promising adjunct markers for discriminating of LTBI and Active TB infection.

Keywords: IL-2, PE35, PPE68, tuberculosis

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Authors: Dyna Ann C. Sevilles, Noel J. Belonguel, Jarungchai Anton S. Vatanagul, Mary Jeanne O. Flordelis, Grace G. Anota

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Guillain Barre syndrome is an acute inflammatory polyradiculoneuropathy causing progressive symmetrical weakness which can be debilitating to the patient. Early diagnosis is important especially in the acute phase when treatment favors good outcome and reduces the incidence of the need for mechanical ventilation. Electrodiagnostic studies aid in the evaluation of patients suspected with GBS. However, the characteristic electrical changes may not be evident until after several weeks. Thus, studies performed early in the course may give unclear results. The aim of this study is to associate the symptom onset of patients diagnosed with Guillain Barre syndrome with the EMG NCV results and determine the earliest time when there is evident findings supporting the diagnosis. This is a retrospective descriptive chart review study involving patients of >/= 18 years of age with GBS written on their charts in a Tertiaty hospital in Cebu City, Philippines from January 2000 to July 2014. Twenty patients showed electrodiagnostic findings suggestive of GBS. The mean day of illness when EMG NCV was carried out was 7 days. The earliest with suggestive findings was done on day 2 (10%) of illness. Moreover, the highest frequency with positive results was done on day 3 (20%) of illness. Based on the Dutch Guillain Barre Study group criteria, the most frequent variables noted were: prolonged distal motor latency in both median and ulnar nerves(65%) and both peroneal and tibial nerves (71%); and reduced CMAP in both median and ulnar nerves (65%) and both tibial and peroneal nerves (71%). The EMG NCV findings showed majority of demyelinating type (59%). Electrodiagnostic studies are helpful in aiding the physician in the diagnosis and treatment of the disease in the early stage. Based on this study, neurophysiologic evidence of GBS can be seen in as early as day 2 of clinical illness.

Keywords: Acute Inflammatory Demyelinating Polyneuropathy, electrophysiologic study, EMG NCV, Guillain Barre Syndrome

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Authors: Siddarth Kannan

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Objectives: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are innovative interventions in order to treat various neuropathic pain disorders such as post-stroke pain. While each treatment has a varying degree of success in managing pain, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised. The aim of this study was to compare the effect of pain relief offered by MCS and DBS on patients with post-stroke pain and to assess if either of these procedures offered better results. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to June 2023 were included (last search date 25 June 2023). Meta-analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using the Visual Analogue Scale (VAS). Data analysis of descriptive statistics was performed using SPSS (Version 27; IBM; Armonk; NY; USA). R statistics (Rstudio Version 4.0.1) was used to perform meta-analysis. Results: Of the 478 articles identified, 27 were included in the analysis (232 patients- 117 DBS & 115 MCS). The pooled number of patients who improved after DBS was 0.68 (95% CI, 0.57-0.77, I2=36%). The pooled number of patients who improved after MCS was 0.72 (95% CI, 0.62-0.80, I2=59%). Further sensitivity analysis was done to include only studies with a minimum of 5 patients in order to assess if there was any impact on the overall results. Nine studies each for DBS and MCS met these criteria. There seemed to be no significant difference in results. Conclusions: The use of surgical interventions such as DBS and MCS is an upcoming field for the treatment of post-stroke pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done in order to determine the appropriate surgical intervention for post-stroke pain.

Keywords: post-stroke pain, deep brain stimulation, motor cortex stimulation, pain relief

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Authors: Amar Ranjan, Julieana Durai, Pranay Tanwar

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Background &Introduction: Ovarian cancer is one of the most common malignant tumor in the female. 70% of the cases of ovarian cancer are diagnosed at an advanced stage. The five-year survival rate associated with ovarian cancer is less than 30%. The early diagnosis of ovarian cancer becomes a key factor in improving the survival rate of patients. Presently, CAl25 (carbohydrate antigen125) is used for the diagnosis and therapeutic monitoring of ovarian cancer, but its sensitivity and specificity is not ideal. The introduction of HE4, human epididymis protein 4 has attracted much attention. HE4 has a sensitivity and specificity of 72.9% and 95% for differentiating between benign and malignant adnexal masses, which is better than CA125 detection.  Methods: Serum HE4 and CA -125 were estimated using the chemiluminescence method. Our cases were 40 epithelial ovarian cancer, 9 benign ovarian tumor, 29 benign gynaecological diseases and 13 healthy individuals. This group include healthy woman those who have undergoing family planning and menopause-related medical consultations and they are negative for ovarian mass. Optimal cut off values for HE4 and CA125 were 55.89pmol/L and 40.25U/L respectively (determined by statistical analysis). Results: The level of HE4 was raised in all ovarian cancer patients (n=40) whereas CA125 levels were normal in 6/40 ovarian cancer patients, which were the cases of OC confirmed by histopathology. There is a significant decrease in the level of HE4 with comparison to CA125 in benign ovarian tumor cases. Both the levels of HE4 and CA125 were raised in the nonovarian cancer group, which includes cancer of endometrium and cervix. In the healthy group, HE4 was normal in all patients except in one case of the rudimentary horn, and the reason for this raised HE4 level is due to the incomplete development of uterus whereas CA125 was raised in 3 cases. Conclusions: Findings showed that the serum level of HE4 is an important indicator in the diagnosis of ovarian cancer, and it also distinguishes between benign and malignant pelvic masses. However, a combination of HE4 and CA125 panel will be extremely valuable in improving the diagnostic efficiency of ovarian cancer. These findings of our study need to be validated in the larger cohort of patients.

Keywords: human epididymis protein 4, ovarian cancer, diagnosis, benign lesions

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Authors: R. H. Begaydarova, B. Zh. Kultanov, B. T. Esilbaeva, G. E. Nasakaeva, Y. Yukhnevich, G. K. Alshynbekova, A. E. Dyusembaeva

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Background: The level of middle molecules of peptides (MMP) allows to evaluate the severity and prognosis of the disease and is a criterion for the effectiveness of the treatment. The detection the products of lipidperoxidation cascade, such as conjugated dienes, malondialdehyde in biological material, has an important role in the development of pathogenesis, the diagnosis and prognosis in different parasitic diseases. Purpose of the study was to evaluate the state of endogenous intoxication and indicators of lipid peroxidation in patients with giardiasis before and after treatment. Materials and methods: Endogenous intoxication was evaluated in patients with giardiasis in the level of middle molecules of peptides (MMP) in the blood. The amount of MMP and products of lipid peroxidation were determined in the blood of 198 patients with giardiasis, 129 of them were women (65%), 69 were men (35%). The MMP level was detected for comparison in the blood of 84 healthy volunteers. The lipid peroxidation were determined in 40 healthy men and women without giardiasis and history of chronic diseases. Data were processed by conventional methods of variation statistics, we calculated the arithmetic mean (M) and standard dispersion (m). t-test (t) was used to assess differences. Results: The level of MMP in the blood was significantly higher in patients with giardiasis in comparison with group of healthy men and women. MMP concentration in the blood of women with Giardia was 2.5 times greater than that of the comparison groups of women. The level of MMP exceeds more than 6 times in men with giardiasis. The decrease in the intensity of endogenous intoxication was two weeks after antigiardia therapy, both men and women. According to the study, a statistically significant increase in the level of all the studied parameters lipid peroxidation cascade was observed in the blood of men with giardiasis, with the exception of the total primary production (NGN). The treatment of giardiasis helped to stabilize the level of almost all metabolites of lipid peroxidation cascade. The exception was level of malondialdehyde, it was significantly elevated to compare with the control group and after treatment. Conclusion: Thus, the MMP level was significantly higher in blood of patients with giardiasis than in comparison group. This is evidence of severe endogenous intoxication caused by giardia infection. The accumulation of primary and secondary products of lipid peroxidation was observed in the blood of men and women. These processes tend to be more active in men than in women. Antigiardiasis therapy contributed to the normalization of almost all the studied indicators of lipid peroxidation in the blood of participants, except the level malondialdehyde in the blood of men.

Keywords: enzymes of antioxidant protection, giardiasis, blood, treatment

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