Medicine and Clinical Science (ISSN: 2690-5191) is an open access, peer-reviewed journal, which aims to publish data related to existing and recent development in the field of general medical research and clinical practice. The journal provides a platform for the medical practitioners, researchers, students and healthcare professionals to publish theoretical and experimental results. The Journal publishes data from all fields of medicine and clinical research. The journal accepts all types of articles such as research, reviews, mini-reviews, case reports, letters to the editor, and commentaries, reports, etc. providing a single forum for discussion. The journal follows strict double blind peer review process to provide unbiased recognition of the work. All the articles will be freely available online immediately after acceptance. Manuscripts could be submitted through our online portal or as directly to the editorial office as attachment to email at publications@scienceexcel.org
The Impact of the Gestational Period and Weight on Individual, Task and Environmental Constraints as Related to Perceived Confidence when Completing Ambulatory Tasks in Pregnant Women
Background: Pregnancy and the physical, sensory, perceptual, and motor changes that coincide with pregnancy can affect a person’s ability to perform basic activities of daily living (ADL’s) that involve ambulation. Previous research suggested that weight and gestational age (trimester) are factors that impact woman’s ability to ambulate through daily tasks, however, these issues require further investigation. Newell's model of constraints was used as a framework to shape the questionnaire investigating the ability to perform different ambulatory activities across various constraints. Thus, the purpose of this study was to examine whether variables such as pre-pregnancy weight (under vs. over 155 pounds) and trimester (before vs. after 26 weeks) had an impact on the ability and perception to perform different tasks requiring ambulation. Methods: Twenty pregnant or postpartum women (M = 29.7 years; SD = 3.6) were recruited and asked to complete a 15-item online survey exploring their abilities to complete a variety of daily tasks involving balance. Also, open ended questions were posed to gain qualitative insight into their experiences. A series of independent samples T-tests were used to analyse the data. Findings: The results revealed predominantly no statistical differences between the levels of the variables manipulated. At the descriptive level the women indicated that they were relatively comfortable performing the different tasks. However, the qualitative responses suggested that although they were capable, they expended a substantial amount of energy to avoid falling, resulting in fatigue and soreness. Also, they experienced overall mental anguish and feelings of being overwhelmed when performing even simple tasks involving gait. Conclusion: Overall, it was surprising that weight and gestational age, which intuitively should have an impact, did not have a more pronounced effect on the women’s confidence in performing ambulation tasks. Nevertheless, qualitative responses confirmed the challenging effects of pregnancy on the way women engage in activities of daily living
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Abdominal distension and vomiting in a lupus patient with a desire for pregnancy: think beyond the baby!]-\
Intestinal pseudo-obstruction (IPO) is a rare enteric motility disorder with clinical features of intestinal obstruction in the absence of mechanical blockage. IPO usually presents as recurrent, self-limiting episodes of abdominal distension, postprandial pain, nausea and vomiting. Over time, symptoms can persist, leading to gut stasis with bacterial overgrowth, malabsorption and malnutrition. We present a case of IPO related to systemic lupus erythematosus, treated with intravenous pulses of high-dose methylprednisolone. Nutritional testing should be provided as insidious progression to intestinal failure may go undetected at an early stage, especially in situations with increased nutritional requirements, like pregnancy.
Post-COVID-19 Vaccination Syndrome may be Associated with Autoaggressions
Amitriptyline plus hydrodistension versus hydrodistension alone for treating interstitial cystitis bladder pain syndrome
Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition that is difficult to diagnose and treat. The aim of this study was to investigate whether a combination treatment of amitriptyline after bladder hydrodistension is more beneficial for IC/BPS patient. Methods: Seventy-six patients’ dates diagnosed with IC/BPS were collected: the hydrodistension group (34 patients) and the combination group (42 patients), which received amitriptyline (25 mg ~ 50 mg/d) for 3 months following hydrodistension. The efficacy was evaluated at the 3rd and 6th months by using index scores. In addition, adverse events of amitriptyline and hydrodistension were recorded. Results: There was no difference in two groups at baseline. The ICSI, ICPI, AIS, SAS, OABSS, VAS and FVC scores improve significantly in the combination group than in the hydrodistension group at 3 months after hydrodistension . After 3 months of amitriptyline withdrawal, obvious improvement in the combination group was observed only for the AIS at the 6th month. At the 6th month, the indexes of the two groups still improved significantly compared with those recorded prehydrodistension; however, there was no difference in the improvement of maximum bladder volume in both groups before and after hydrodistension (P > 0.05). The adverse events of amitriptyline all were in the tolerable range. Conclusions: Hydrodistension under general anesthesia effectively relieved IC patients’ symptoms for at least 6 months. The three-month usage of amitriptyline alleviated the symptoms and problems more quickly and safely after hydrodistension in patients with IC/BPS
Anesthetic management of allergic hypersensitivity during a surgical procedure: A case report and literature review
Introduction: Perioperative anaphylaxis is a rare but serious, life-threatening condition that presents challenges in diagnosis and management. The incidence of severe perioperative reactions is estimated to be approximately 1:7,000–10,000. Case report: A 75-year-old patient underwent a surgical procedure due to adhesions of previous surgeries. She had a serious anaphylactic reaction in the intraoperative period, which was quickly addressed with fluid and adrenaline administration. Discussion: Proper management involves both immediate stabilization of the patient and identification of the causing agent. This identification is essential to avoid the recurrence of the event in other surgeries. A previous history of perioperative hypersensitivity reaction is the main risk factor for anaphylaxis.
Biomechanical analysis of quadruped movement in patients with spinal cord injury: A case series
Background: In the rehabilitation for patients with spinal cord injury, we often use developmental movement patterns of infants and Activity-Based Therapy. They include quadruped movement, but no reports of movement analysis on quadruped movement in patients with spinal cord injury. Objective: This study aimed to analyze quadruped movement in patients with paraplegia, and to summarize its characteristics. Methods: The quadruped movement of 3 patients with complete paraplegia were measured using a three-dimensional motion analyzer, and their characteristics were summarized. Results: All cases showed an ipsilateral rotation of the pelvis when moving the lower limbs. Case A rose the contralateral upper and lower limbs simultaneously. Cases B and C moved one limb at a time. Conclusions: Our results suggested that patients with spinal cord injury have an ipsilateral rotation of the pelvis when moving the lower limbs in quadruped movement. Also, it seems that, depending on the degree of disability, some cases were able to move the contralateral upper and lower limbs simultaneously, while others moved one limb at a time
Prenatal diagnosis and management of fetal arhinia during pregnancy in order to optimize neonatal outcome
Objectives: To discuss the prenatal diagnosis and management of fetal arhinia in order to optimize neonatal outcome Methods: This is a case report and discussion of the clinical management of fetal arhinia and review of appropriate literature Results: A fetus with arhinia diagnosed prenatally by ultrasound was managed optimally for neonatal outcome Conclusion: Prenatal diagnosis of arhinia is a rare congenital malformation that requires consultation and delivery at a specialized children’s hospital with the capability of immediate respiratory support at delivery..
Electrocardiography Diagnostic performance in the assessment of significant coronary artery disease and its anatomical site in comparison with coronary angiography among Nigerians: A pilot study
Introduction: Coronary angiography (CAG) is a useful diagnostic tool in patients with suspected CAD especially in patients that are at high risk. CAG is the gold standard for diagnosis of significant coronary stenosis. However, it can be associated with certain risks. The use of noninvasive assessment tools for predicting CAD is considered because it offers safety, patient convenience, and faster performance. The aim of the study was to assess the predictive value of 12-lead electrocardiogram (ECG) in patients with suspected coronary artery disease (CAD). Methods: 59 consecutive patients aged 40 to 98 years with new onset of chest pain that were referred to the cardiac catheterization laboratory of Bayelsa Specialist Hospital, Yenagoa October 2017 and November, 2018. At admission, a resting standard 12-lead ECG was recorded and the ECG changes were interpreted by the cardiologist. The ECG was recorded as normal or abnormal depending on regional changes in ST segment (ischemic-appearing ST depression or elevation), T-wave inversion (≥ 1 mm) and Q-wave appearance (≥ 0.04 s or ≥ 25% of R-wave amplitude). The III, aVF and II leads were used to detect RCA involvement; V2 or V3 and aVL to detect LCx involvement, and V2 or V3, V1, and V4 were used to detect LAD involvement. ECGs were taken at a paper speed of 25 mm/s and calibration of 10 mm. Results: ECG correctly detected significant stenosis in 21 out of 59 patients with an overall sensitivity per patient of 59.5% and specificity per patient of 59.1%. ECG had the highest sensitivity with LAD involvement LAD (37.3%) and RCA (25.8%), respectively. ECG had a probability of indicating coronary vessel disease in persons with the disease (positive predictive value) 71%, whereas, negative ECG findings were less likely to indicate the absence of disease (a negative predictive value = 46.4%. Similarly, ECG correctly classifying patients as having LAD, RCA, and LCx diseases (66.7%, 70%, and 66.7% respectively) as compared to its ability to correctly classify persons without the respective vessel disease (33.3%, 55.6%, and 55.6%). Among the patients, 59.3% were correctly identified Conclusions: ECG has low sensitivity and specificity for predicting coronary artery stenosis with accuracy ranged 59.5% and 59.1% based on coronary artery analysis.
Relationship Between Annual Airborne Pollen Levels And Occurrence Of Thyroid, Skin, Esophagus, Kidney And Ovary Cancers, And Leukemia, Multiple Myeloma And All Cancers: A Retrospective Study Based On The National Registry Database Of Cancer Incidence In J
Background: In Japan, pollen counts increased between 1977 and 1987, including three peaks (1978- 1980, 1982, 1984-1986) coinciding with Kawasaki disease (KD) outbreaks. Epidemiological findings have been gradually accumulated that KD and related specific intractable diseases and further cancers may be correlated to pollen exposure (PE). Methods and results: To elucidate the effects of PE on occurrence of thyroid, skin, esophagus, kidney and ovary cancers, and leukemia, multiple myeloma and all cancers, we evaluated the annual onsets of malignant tumors in relation to pollen counts using data from a national database. Increased rates of these cancers were observed during pollen counts increasing period between 1977 and 1987. Significant correlations were observed between the annual number of newly registered patients (nRPs) and the annual pollen levels (PL) measured with a lag of 2 years for skin and kidney cancers, 4 years for thyroid cancer, 6 years for skin, esophagus cancers, leukemia and multiple myeloma, 8 years for thyroid cancer, and 2,3 and 6 years for all cancers. Peaks of number of thyroid cancer in 2013, 1990 and 1980 are discussed about as compared with other cancers regarding effect of radioactive pollutants occurred from three nuclear plant accidents. Conclusion: Data suggest newly that the cumulative effects of PE within 2,3,4,6,8 years prior to diagnosis might possibly trigger incidence of eight cancers and malignant tumors.
Computational Nanomaterials Design: Towards The Realization of Nanoparticle Use in Radiotherapy - Case Study 1: Adsorption States of I on Au(111) Surface
Radioactive iodine (e.g. I-125, I-131) have been used for decades in the medical community for cancer treatment and imaging. Using gold nanoparticles as a carrier for iodine opens possibilities of new treatments for cancer and also for tracking cancerous cells. To design an optimized version of gold nanoparticle for such purpose, we need to understand the bonding mechanism and gauge the strength of such bonding. To this end we performed theoretical calculations on the adsorption state of iodine on gold (111) surface. The results show good adsorption of iodine to gold, most stably on the hollow sites. The bonding mechanism is via the hybridization of the 5p orbital of the iodine with the 6s and 5d orbitals of the neighboring gold atoms. These results act as a first step to designing an optimized gold nanoparticle that can be used in future radiotherapy treatments.
Measuring left-behind children’s discrimination perception in China: the development of discrimination perceptions of left-behind children Scale
With the advancement of urbanization in China, there are millions left-behind children whose parents left home to support families, experiencing lot of discrimination. The study aims to develop a scale measuring left-behind children’s discrimination perceptions (discrimination perceptions of left-behind children, DPLC) in China and investigate the discrimination perceptions of left-behind children using the DPLC scale. The data for 105 left-behind children were used to measure the reliability and analyze the items of the DPLC scale in the pre-test. The data for 402 left-behind children were used to verify the construct validity and internal consistency of the DPLC scale and investigate children’ discrimination perceptions of left-behind in China. This study reports the development process of the DPLC scale and presents a valid scale for measuring discrimination perceptions of left-behind in the future.
Relationship Between Annual Airborne Pollen Levels and Occurrence of Parkinson Disease, Amyotrophic Lateral Sclerosis, Myasthenia Gravis, Multiple Sclerosis, Spinocerebellar Degeneration, Huntington’s Disease, Shy-Drager Syndrome, Moyamoya Disease and Cre
Background: In Japan, pollen counts increased between 1977 and 1987, including three peaks (1978- 1980, 1982, 1984-1986) coinciding with triphasic Kawasaki disease (KD) outbreaks. Epidemiological findings have been then extensively accumulated that KD and related specific intractable diseases such as systemic vasculitis, collagen diseases, inflammatory bowel diseases, idiopathic dilated cardiomyopathy and further various cancers may be correlated to pollen exposure (PE). Methods and results: To elucidate the effects of PE on outbreaks of neurological intractable diseases (NIDs), we evaluated the annual occurrence of disorders in relation to pollen counts using data from a national database. Specifically, we evaluated the occurrence of Parkinson disease (PD), amyotrophic lateral sclerosis (ALS), Myasthenia Gravis (MG), multiple sclerosis (MS), spinocerebellar degeneration (SCD), Huntington’s disease (HUNTG), Shy-Drager syndrome, moyamoya disease and CreutzfeldtJakob disease (CJD). During 1975–2014, the 1984-86 peak of pollen scatter was the earliest big peak with which simultaneous increase in occurrence of PD, ALS, MG, MS, SCD and HUNTG coincided. Furthermore, simultaneous outbreaks of each NID coincided with subsequent ten peaks of pollen scatter till 2014. Our results showed statistically significant correlations for PD, ALS, MG, MS and SCD between the annual number of newly registered patients (nRPs) in the patient-registry year and annual pollen levels in the same patient-registry year. Significant correlations were also shown between the number of nRPs in the patient-registry year and annual pollen levels measured 3 years (PD), 6 years (PD, MG, MS, MMD), 9 years (PD, MS, MMD, CJD), 14 years (PD, CJD), and 16 years MG, MS, HUNTG and MMD before the patient-registry year. Conclusion: We assume that cumulative effects of PE during a decade or more before the diagnosis of NIDs might possibly trigger onset of NIDs when cumulative effects of PE as environmental stress overwhelmed immunoreactive threshold
Clinical, Biochemical, and Echocardiographic Characteristics of Severe SARS-COV-2 Infection: Correlates of In-hospital Morbidity and Mortality
Background: Patients with cardiovascular disease are more susceptible to coronavirus disease 2019 (COVID-19) and have worse outcomes when infected. While multiple studies have reported an association between biochemical myocardial injury and consequent adverse events, these studies have been limited by a lack of echocardiographic data. This study reports a comprehensive echocardiographic evaluation of patients with severe COVID-19 at a large quaternary care hospital in New Jersey. Methods: Clinical, biochemical, and echocardiographic features of consecutive patients with severe COVID-19 undergoing echocardiography were studied. Clinical outcomes data including length of stay, requirement of mechanical ventilation, and in-hospital mortality were collected. Results: 987 patients with confirmed COVID-19 infection were treated at our institution of which 197 consecutive patients (20%) underwent echocardiographic evaluation. The median age of the cohort was 64 years. 38% of these patients were females, 23% had known CAD, and 21% had CKD. 55% of patients required mechanical ventilation and 49% required vasopressors, representing a critically-ill patient population with significant mortality of 44% during the index hospitalization. There was a high prevalence of echocardiographic abnormalities including right ventricular dilation (30%) or dysfunction (23%), left ventricular dysfunction (24%), and pericardial effusion (14%). Multiple biomarkers including troponin T, pro-BNP, D-dimer and CRP were strongly associated with echocardiographic abnormalities and in-hospital mortality. On Cox regression analysis, age (HR 1.03/year),pre-existing CAD (HR 2.7), and mechanical ventilation (HR 2.64) were the strongest independent predictors of in-hospital mortality. Conclusions: Severe COVID-19 infection is accompanied by a significant burden of echocardiographic abnormalities that are strongly correlated with higher degrees of inflammation and biomarker elevation. Additional investigation is warranted in assessing the role of a biomarker-guided approach for early cardiac surveillance using echocardiography to further risk stratify patients and tailor adjunctive therapy
Functional and balance assessment in older adults
Introduction: The aging process is characterized by several processes of change, which lead to a decrease in physiological and functional capacities. Functional fitness in the elderly is of great importance for carrying out activities of daily living, allowing the detection of limitations that result from the aging process and thus preventing and reducing the various functional declines. Objective: To systematically review the existing scientific literature on what is the best way to assess functional fitness in the elderly. Method: Systematic review with search of all scientific articles, indexed in “PubMed”, since January 2010. Results: 323 articles were identified, of which only 8 were considered eligible for review. The studies analyzed showed some divergence in terms of the best way to assess functional capacity and balance. BESTest and the unstable board have been suggested as the best tests to measure balance. Conclusions: The assessment of balance is more adequately assessed by tests on a board and the fragility is better assessed by tests such as Timed Up and Go. The characteristics and individuality of the populations concerned must be the primary factor in determining which assessment to apply
Hydration and hypoxic-occlusion therapy (gel-wrap treatment) for hypertrophic scars and keloids
Keloids and hypertrophic scars are pathological fibroproliferative disorders characterized by excessive collagen deposition. The affected skin becomes raised and thickened, forming firm pink or red plaques. Common causes include trauma, burn, and surgery. Multiple studies on keloids and hypertrophic scars have been reported previously, leading to the development of various therapeutic approaches for them, most of which remain clinically unsatisfactory. In this study, three patients underwent the gel-wrap treatment: the gel (manufactured by ITO Co Ltd.) was applied to the lesion and the affected skin was wrapped with a polyvinylidene chloride film (Saran Wrap; Asahi Kasei Corporation). Satisfactory results were noted in all three cases. The gel-wrap treatment is more convenient and inexpensive than existing therapeutic approaches. Furthermore, reducing thymic stromal lymphopoietin seems crucial for the treatment of keloids and hypertrophic scars
Effect of Static Stretching on Dynamic Balance and Performance of the Saudi Recreational Football Players
Back ground There have been rather controversial reports that some sport performances are negatively affected by stretching. It is widely believed that pre-exercise static stretching reduces the risk of injury and enhances performance. Several studies reported that pre-exercise static stretching decreases maximal force production, jump height and speed. (Does static stretching has a negative influence on balance and/ or athletic performance?) Aim of study: To determine the effect of static stretching (SS) on static and dynamic balance (DB) and its influence on the performance of the Saudi recreational football players. Material & methods: 40 healthy male Saudi recreational football players, their mean age was 21 years old. Participants were randomly divided into two groups A (n=20) started dynamic balance first then the static balance, while group B (n=20) started the static balance test first and Intervention: Participants at each group were asked to preform static stretching exercises for each muscle group (hamstring, quadriceps, and gastrocnemius) three times. Holding period of SS was 30 seconds with 10 seconds rest. The static balanced (SB) test was measured using “Balance Master System”, while Modified Star Excursion Balance Tests was used to measure the DB. Group A started SB test first and group B started DB test first. Results: The results indicated statistically significant effect for groups (P= 0.017) and for the interaction between group and time (P= 0.001). However, the main effect for time was not significant (P= 0.533). Group B significantly showed better mean score of SB compared to group A in both period (P= 0.017). group B demonstrated slightly lower mean score immediately post stretching which, indicate an improvement of the SB while, group A demonstrated an increase in the mean score of the SB indicating low SB. Conclusion: Static stretching has an immediate (acute) positive effect on the static and dynamic balance of recreational football players. This effect decreased over time.
Elucidation of the mechanism of cognitive decline in mild cognitive impairment using causal discovery
Mild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Since MCI may increase risk of later developing dementia caused by Alzheimer's disease (AD) or other neurological conditions, it is important to detect and treat MCI early in order to prevent dementia. Causal discovery, which can visualize causal relationships (cause and effect) among data, has recently been attracting attention. One of its algorithms, the Linear Non-Gaussian Acyclic Model (LiNGAM), can extract causal relationships among variables from statistical data only, using probability distributions of variables that are generally non-Gaussian. In this study, we used LiNGAM to analyze gene expression data in the hippocampus of healthy subjects and of MCI patients, and also the Mini-Mental State Examination (MMSE) scores, which are used to assess cognitive decline. We found that cell adhesion molecule 4 (CADM4) gene regulates cognitive processes that are measured in terms of MMSE scores. Our results revealed a causal relationship between gene expression changes and MMSE scores, and allowed us to identify the genes responsible for cognitive decline..
Association Between Growth Differentiation Factor 15 (GDF15) and Glucose Metabolism in Patients With Acromegaly
Objective: To analyze the changes of serum growth differentiation factor-15 (GDF-15) and its influencing factors in patients with acromegaly, and to investigate its correlation with glucose metabolism. Methods: Sixty acromegaly patients were recruited from the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from July 2021 to September 2023, and thirty healthy persons matched in gender, age and body mass index as nomal controls were selected in the same period. To collect clinical and laboratory data, conduct statistical processing, and analyze the level changes and influencing factors of GDF-15. Results: Compared with nomal controls, the level of GDF-15 increased significantly in patients with acromegaly (P <0.05). After operation, the level of GDF-15 decreased gradually with the decrease of serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1). The level of GDF-15 decreased significantly at 3 and 6 months after operation compared with pre-operation level(P <0.05); Compared with 3 months after operation, the GDF-15 level decreased significantly at 6 months after operation(P <0.05). In univariate linear correlation analysis the GDF-15 was positively correlated with GH, IGF-1, FPG, HbA1c, FINS, HOMA-IR (r=0.503, 0.623, 0.427, 0.476, 0.345, 0.419, P <0.05) and negatively correlated with HOMA-β, AUCINS(r=-0.342,-0.261,P <0.05) in pre-operation patients with acromegaly. Multivariate linear regression analysis showed that IGF-1,HOMR-IR,HOMA-β and AUCINS were all identified as the positive predictors of the serum GDF-15 in patients with acromegaly (P <0.05). Conclusions: The level of serum GDF-15 increased in patients with acromegaly, and decreased significantly after operation. The serum GDF-15 was closely related to glucose metabolism in patients with acromegaly
Growth differentiation factor-15, Acromegaly
Extreme Lateral Interbody Fusion (XLIF) Including the Segment L5/S1 for Multi-level Lumbar Spondylodesis
Study Design: This is a single centre retrospective study of 24 cases of multilevel degeneration of the lumbar spine treated with the XLIF procedure including the level L5/S1. Objective: The purpose of this study is to report the feasibility of including the L5/S1 segment in treating the degenerative lumbar spine using the XLIF procedure and demonstrating the preoperative conditions necessary to do so. Summary of background data: In the last decades, more and more elderly patients suffer from pain and disability due to degenerative instability of the lumbar spine. Spinal fusion procedures, including XLIF, have proven good results despite significant complication and revision rates. Methods: 24 patients (mean age 66 years, range 32 – 89 years) who would be candidates for XLIF surgery at L5/S1 were included. Preoperative anatomical assessment of the iliac crest in relation to the L5/S1 disc space was performed. All patients were operated with the aid of neuromonitoring using a mini-invasive XLIF approach with direct visualisation of the psoas muscle. Complication rates, surgery time, and blood loss were calculated as well as clinical results using the VAS score preoperative, and at 6 weeks, 3 months and 1 year postoperative. Results: The mean postoperative VAS score improved from 7.8 preoperative to 3.1 at one-year followup. There was one case of pseudoarthrosis at the L5/S1 level. There were no new neurological deficits postoperatively. We report a total complication rate of 29%. Conclusion: The XLIF procedure for multilevel lumbar spine fusion is feasible at the L5/S1 level in patients with certain anatomical prerequisites, predominantly in females. The procedure should be done under direct visualization. The clinical outcome and revision rate is comparable to other multilevel fusion techniques.
Addressing the True Cause of Burnout in Healthcare
Chronic kidney disease (CKD) and cancer are two serious and increasingly prevalent diseases. They are interconnected in multiple ways and bidirectionally: cancer can directly or indirectly cause CKD through adverse effects of therapies; conversely, CKD can be a risk factor for cancer. Both conditions may coexist in a patient. The number of cancer patients undergoing hemodialysis is on the rise, presenting a growing challenge for oncologists, nephrologists, and pharmacists worldwide, as there are approximately one million hemodialysis patients. In hemodialysis patients, the concerns are twofold: their renal function is impaired, exposing them to the risk of overdosing and adverse effects. Simultaneously, careful planning of treatment administrations concerning dialysis sessions is necessary to avoid premature drug clearance by dialysis, preventing underdosing and consequently treatment inefficacy. In this article, we present a case of a patient with chronic renal insufficiency undergoing hemodialysis for 16 years, who developed breast cancer. Through this case, we illustrate the challenges encountered in managing such patients and provide a literature review summarizing recommendations.
The Relationship Between Annual Airborne Pollen Levels and the Occurrence of Uterine Cancer, Cervical Cancer, Corpus Uteri Cancer, Prostate Cancer, Bladder Cancer, Stomach Cancer, Cancer of the Gallbladder and Bile Ducts, Malignant Lymphoma, and Cancer of
Background: In Japan, pollen counts increased between 1977 and 1987, including three peaks (1978- 1980, 1982, 1984-1986) coinciding with triphasic Kawasaki disease (KD) outbreaks. Epidemiological findings have been extensively accumulated that KD since 2003 and, from 2018 related specific intractable diseases such as systemic vasculitis, collagen diseases, inflammatory bowel diseases, idiopathic dilated cardiomyopathy and further from 2019 various cancers such as lung, breast, pancreatic, skin and kidney cancers may be correlated to pollen exposure (PE). Methods and results: To elucidate the effects of PE on occurrence of other cancers, we evaluated the annual occurrence of disorders in relation to pollen counts using data from a national database. Specifically, we evaluated the occurrence of uterine cancer, cervical cancer, corpus uteri cancer, prostate cancer, bladder cancer, stomach cancer, cancer of gallbladder and bile ducts (GBB), malignant lymphoma (ML), oral and pharyngeal cancer (o-phar. cancers), laryngeal cancer. During 1975–2015, the 1978-80 and 1984-1986 peaks of pollen scatter was the earliest big peaks with which simultaneous increase in occurrence of uterine, cervical, bladder, stomach, GBB, o-phar. cancers and laryngeal cancers. Furthermore, simultaneous outbreaks of each cancer coincided with subsequent ten peaks of pollen scatter till 2015. Our results showed statistically significant correlations for o-phar cancers, laryngeal, prostate and stomach cancers between the annual number of newly registered patients (nRPs) in the patient-registry year and annual pollen levels in the same patient-registry year. Significant correlations were also shown between the number of nRPs in the patient-registry year and annual pollen levels measured 1 year (GBB), 2 years (prostate), 3 years (corpus uteri, stomach, ML), 5 years (uterine), 6 years (uterine, corpus uteri, prostate, bladder, GBB), 7 years (o-phar, laryngeal) and, 9 and 16 years (cervical) before the patient-registry year. Conclusion: We assume that cumulative effects of PE in many cases within about 6 years and more before the diagnosis of cancers might possibly trigger onset of cancers when cumulative effects of PE as environmental stress overwhelmed immunoreactive threshold. The authors would like to discuss the triggering effect of PE (the action of PE to induce a carcinogenic state in humans) on humans as a compromised host, in the preliminary stages of cancer development, in which human papillomavirus is thought to be involved in the pathogenesis.
Exploring the Functional Significance of Lysosomes in Cancer Drug Resistance
Chemotherapy stands as a primary therapeutic approach for tackling a spectrum of malignancies. Nonetheless, the emergence of resistance to chemotherapeutic agents poses a significant hurdle in achieving curative cancer treatments. Lysosomes, recognized as acidic cellular organelles predominantly engaged in intracellular digestion, have garnered increasing attention due to their implications in cancer biology. Notably, their relevance to cancer manifests in several ways: Firstly, the extracellular release of lysosomal enzymes actively promotes tumorigenesis. Secondly, the leakage of lysosomal hydrolases into the cytosol induces apoptosis. Lastly, weak chemotherapeutic bases, upon traversing the lysosomal membrane, become sequestered within lysosomes while adopting a cationic state. This sequestration of drugs within lysosomes diminishes their cytotoxic potential, restricts their availability at target sites, and contributes significantly to the development of drug resistance in cancer. This review comprehensively explores diverse mechanisms underpinning lysosomal drug sequestration and delves into their repercussions on the phenomenon of multidrug resistance in cancer. Furthermore, we delve into strategies aimed at surmounting drug resistance by leveraging lysosomes as subcellular targets, with the aim of reversing drug sequestration and thwarting drug resistance in the context of cancer therapy
Insights of Dementia in Persons With Intellectual Disability
Intellectual disability and dementia are age-dependent terms for a cognitive impair occurring during developmental age and in adulthood, respectively. Intellectually disabled people like any other people may develop dementia in adulthood. Thus, clinicians should learn to differentiate dementia-indicating signs from intellectual disability related cognitive deficiencies for an early diagnosis and treatment onwards. In intellectual disability, intellectual and adaptive skills of an individual are two standard deviations below the expected age-matched population, and dementia is characterized by a progressive cognitive decline. The cause of both disorders can be genetic, acquired or multifactorial. An increased risk of Alzheimer's disease in Down syndrome is well known unlike the development of dementia in other intellectual disability syndromes. This commentary discusses 1) how the dementia indicating signs present in intellectually disabled persons, 2) why it is important to distinguish dementia (and its causes) from intellectual disability and 3) why it is important to know the etiology of intellectual disability.
Intermittent Hydrarthrosis, Rare, Unknown, Underdiagnosed and Forgotten: First report in Gambia
The first report of intermittent hydrarthrosis (IH) was made by Perrin in 1845; However, despite the simplicity of the symptoms and signs that characterize it, it is considered a rare disease, presumably its pathophysiology is autoinflammatory and of uncertain etiology. According to the number of reports published to date, the description of new cases remains extremely low. The chronicity and periodicity of the attacks of joint swelling, the tropism for the affected joint, almost always the knee, as well as the complete recovery without sequela after each attack, constitutes its characteristic hallmark. The simplicity of the clinical picture is at the same time the greatest obstacle to establishing the definitive diagnosis. Considering that there are no diagnostic criteria, it is necessary to exclude all conditions with a similar pattern, making the list large and complex. During the review of the literature, no references of publications of black patients were found, nor reports on the African continent. We decided to present the first case of intermittent hydrarthrosis in The Gambia and to date in the entire subregion
DPP4 Valorphin Activate NR4As Pathway and OPA1 That Protect from CoQ10 Deficiency, OPA1 Dysfunctions and WMH
Deficiencies in Threonine (Thr), Tryptophan hydroxylase (Tph), Glutamate (Glu), Glutamine (Gln), and Leucine can result from increased polarizability in mTORC1 and its subunits. These deficiencies may lead to disorders in OPA1 repair, which can be a primary cause of Coenzyme Q10 (CoQ10) deficiency disease. CoQ10 is crucial for maintaining the inner mitochondrial membrane and is necessary for the synthesis of the glucocorticoid receptor (GCR). Mitochondrial damage or dysfunction can lead to the accumulation of pro-inflammatory molecules, which may cause mutations in subunits and proteins. Reduced levels of Tryptophan, Glycine (Gly), and Arginine (Arg) can result in decreased Proline synthesis, subsequently reducing tRNA levels. This, in turn, can impair mitochondrial OPA1 repair and function due to decreased GTPase activity. The reduced function of GTPase can lead to decreased IL-17 synthesis and the accumulation of pro-inflammatory molecules, resulting in a reduction in serotonin production, as well as decreased production of GCbeta, oxytocin, and Nrf2. These changes can lead to a decrease in the proliferation of megakaryocytes and, consequently, reduced hematopoiesis, which is associated with white matter hyperintensity. Opioid receptors play a role in producing powerful analgesia, contributing to the function of immune cells, and modulating acquired immune responses, including the function of lymphocytes. Tryptophan, Leucine, and Tyrosine kinases are crucial for activating mitochondrial OPA1 repairs, which are essential for CoQ10 synthesis. Tryptophan (TGG) is necessary for activating Proline, which is essential for both OPA1 function and tRNA production. Additionally, it plays a role in IL17 synthesis and the activation of the NR4As pathway, which includes the activation of GCs-beta, oxytocin, and Nrf2 production, respectively. Cytotoxic edema can result from uncontrolled or uncompensated cation influx, primarily sodium (Na+). This edema occurs due to high levels of potassium (K) and sodium (Na) binding toxicity, leading to coagulation and reduced ATPase and GTPase activity. It starts with a decrease in CoQ10 synthesis and an increase in Plasma Glial Fibrillary Acidic Protein (GFAP), resulting in decreased mineralocorticoid. Increased sodium and potassium binding, associated with decreased anions binding in biological molecules, can be due to reduced GTPase and OPA1 function. This reduction in anions function is the result of a primary Coenzyme Q10 (CoQ10) deficiency, leading to elevated GFAP levels in cognitively normal older adults at risk of Alzheimer's disease. Primary Coenzyme Q10 (CoQ10) deficiency is typically associated with multisystem involvement, including neurologic manifestations such as fatal neonatal encephalopathy with hypoxia, late-onset multiple-system atrophy-like symptoms, dystonia, spasticity, seizures, and intellectual disability. Autoimmune diseases and skin inflammatory disorders can start due to increased cation binding toxicity, which reduces ATPase and GTPase function, characterized by a deficiency in proper GTPase production, leading to a reduction in mitochondrial OPA1 function and a deficiency in GCs-beta synthesis via the NR4As pathway. GFAP is an important neuroinflammation biomarker, and an increase in its levels may indicate OPA1 dysfunction, a decrease in CoQ10, neuroinflammation, and a reduction in the NR4As pathway. The increase in GFAP during acute ischemic stroke can be initiated by increased cation binding to anions, leading to enhanced energy stability and decreased tRNA production, which is proline-dependent. This decrease in tRNAs and GTPase activity can result in a decrease in IL17 production, increased inflammation, decreased blood flow to the brain, and reduced oxygen supply to the brain, ultimately contributing to neuronal damage. A decrease in hemorphin (valorphin) reflects reduced lymphocyte function and a loss of cholinecontaining phospholipids (CCPLs). Valorphin contains Tyrosine, which is essential for kinases production, required for choline kinases synthesis, and crucial for activating tRNAs, serotonin, oxytocin, and Nrf2 via the NR4As pathway, all of which are essential for lymphocyte function and antiinflammatory growth. Nrf2 dysfunction, connected to NR4As and oxytocin dysfunction, plays a significant role in the pathogenesis of vascular cognitive impairment and dementia (VCID).
Diabetic Children: Be Dogmatic About Outcome and Flexible in Approach
Performance of the “Tropical Intensive Care Score” in the intensive care units of Kinshasa
Introduction: Several scores are used to assess prognosis in intensive care units (ICU). The Tropical Intensive Care Score (tropICS) has been proposed as an alternative in low income countries. Our objective was to assess the performance of tropICS in a few ICUs in Kinshasa. Methods: This was a multicenter cohort over the period 01/03 to 04/02/2021. The performance of "tropICS" was evaluated by analysis of the area under the ROC curve and calibration with the Lemeshow-Hosmer test. Results: A total of 249 patients with a mean age of 54 years with a sex ratio of 1.9 men to 1 woman were selected in four ICUs in Kinshasa. Medical (89%), surgical (8%) and traumatic (3%) conditions were the causes of admissions, with an average length of stay of 4 (2 to 7) days. The death rate was 38.2%. After analysis of the ROC curve, a tropICS value ≥ 3.8 predicted mortality with a sensitivity of 92.6%, a specificity of 77.9%, good discrimination with an area under the ROC curve of 0.85 (CI 0.80 - 0.90) and a poor calibration of with p < 0.05. Conclusion: tropICS is a simple and powerful tool for identifying high-risk patients and can be used in ICUs in Kinshasa
Schizophrenia - Efficient Diagnosis And Treatment With Resonance Therapy in Non-Elderly And Elderly Patients
With the help of resonance therapy, both diagnostics and therapy of schizophrenia are quite effectively carried out. Diagnosis of schizophrenia is mainly based on the process of testing on the device for resonance therapy - 1. frontal, temporal regions of the brain, 2. corpus callosum, 2. lateral basal nucleus, 3. thalamus, 4. cerebellum, 5. paralimbic area of the cerebral cortex, 6 lateral basal nucleus, 7. manifestation of multiple sclerosis. In schizophrenia, these brain formations are tested quite well, which indicates the degeneration of these formations. This helps the doctor in diagnosing the disease. In addition, the doctor tests the arteries of the brain, which in patients with schizophrenia are in a degenerated state. The treatment of this disease is also effectively carried out with the help of resonance therapy - highly potent drugs are made from the identified structural formations of the brain and the oranodrug of the arteries of the brain, which are taken by the patient and which lead to the fact that the symptoms of the disease are lost.
Can Leukoerythroblastic Activation Indicate Coronavirus Infection?
The complete blood counting (CBC) parameters can, to a considerable extend, indicate health status of any patient. The blood parameters of 22 Coronavirus male pandemic victims are compared with their counterpart of male healthy individuals using unequal ANOVA biostatistics software. A significant drop (p≤0.002) in the number of WBC and an insignificant decrease (p≤0.06) in the hemoglobin percentage (Hb%) were detected in the Coronavirus victims in comparison with the healthy individuals. Simultaneously, the total numbers of RBC showed a significant increase (p≤0.05) representing leukoerythroblastic activation, while the blood platelets (PLT) were significantly (p≤0.001) dropped, respectively in comparison with counterpart control and those of international controls. These variations and fluctuation in the blood parameters above or below the normal ranges would indicate a clear health disorders in the coronavirus victims. It is concluded that CBC could well be utilized as a prognostic tool in the clinical laboratories prior sophisticated and costly measurements i.e. Biochemical, PCR and immunological testes.