In developing countries like ours, patients with End Stage Renal Disease present late requiring urgent haemodialysis. The femoral vein is commonly used in this situation, as access is easier and faster with few complications. Few cases of catheter fracture and migration have been reported. We aim at reporting a case of 26-year-old woman who presented with bilateral venous femoral catheters fracture and migration. Both were successfully removed via bilateral groin exploration and venotomy. We recommend early removal in order to avert life-threatening complications.
Background: The electronic prescribing system, either standalone or embedded in the electronic health record, is a powerful tool in the hands of healthcare providers, as it reduces half of medication errors caused by handwritten prescribing. Objective: This article synthesizes the international literature on electronic health records (EHRs), e-prescribing (EP) and medication errors (MEs) and provides a platform to World Health Organization Eastern Mediterranean Region (WHO-EMR) countries for implementing EHRs and EP in healthcare system. Methods: Computer searches of PubMed, MEDLINE, Quertle®, Google Scholar, Web Knowledge and International Pharmacy Abstract databases were conducted for the years 2000–2014 using several single- and combined-keyword strategies, with 184 articles retained for evaluation. Results: Although e-prescribing integrated with EHR reduces medication errors at all healthcare levels, decreases morbidity and mortality, enhances patient and healthcare provider satisfaction by reducing costs and improving quality of life, it produces different types of medication errors at various stages of the prescription process. An EHR with EP that has a clinical decision support system (CDSS), dose-limit range, drug–drug interaction alert protocols, and formulary decision support helps to improve EP and ensures greater patient safety and other multiple applications.
Conclusion: EHRs with EP systems should be implemented in healthcare systems for the sake of better quality healthcare and patient safety throughout the WHO-EMR countries especially in the Kingdom of Saudi Arabia. Evidently there is limited data in these countries and hence further studies are needed to assess impact of EHRs and EP system (EPSs) on medication errors, quality of healthcare, patient safety and outcome, morbidity and mortality rates, patients’ and healthcare providers’ acceptance, and especially its cost-effectiveness.
Aim: Isolated tubal torsion is a rare entity in young women. To represent a case of conservative laparoscopic treatment in isolated tubal torsion in a young patient. Presentation of Case: A 20-year-old virgin woman who had acute right lower quadrant of abdominal pain and nausea underwent diagnostic laparoscopy with subsequent detorsion of the involved fallopian tube in a tertiary care medical center. Discussion: The treatment modality of tubal torsion in most of the reported cases during initial surgery or at the time of recurrent torsion after detorsion was salpingectomy. Conclusion: Conservative treatment option that is laparoscopic detorsion which should be preferred especially in young patients to preserve the tubo-ovarian function.
Odontogenic myxoma is a rare benign tumor of ectomesenchymal origin, which can arise from dental papilla, follicle or periodontal ligament. Most commonly it arises from mandible followed by maxilla. We report a case of odontogenic myxoma in a 23 years old female who came with complaint of painless swelling in left mandible. CT scan revealed an expansile radiolucent lesion involving the left mandible body with cortical thinning and mild destruction at few places. Biopsy was done which was suggestive of odontogenic myxoma. Surgery was done and odontogenic myxoma was proved on the biopsy.
Objectives: To provide a descriptive case-series of patients who unexpectedly discontinued dual antiplatelet therapy (DAPT) within 14 days after percutaneous coronary intervention (PCI) (group A), and those who had taken measures for bleeding risk reduction before PCI (group B). Study Design: Case study. Place and Duration of Study: Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, between 2009 and 2011. Methods and Results: We retrospectively reviewed 346 patientsundergoing PCI in our hospital. In group A (n=12, 3.46%), 10 patients underwent emergent PCI including 3 cases of cardiopulmonary arrest. The procedures were 8 cases of bare metal stent implantation, 2 cases of drug-eluting stent (DES) implantation, and 2 cases of balloon angioplasty. The reasons for discontinuation included 6 cases of bleeding, out of which 4 cases involved pulmonary bleeding, and 3 involved sequential operation. The mean time of DAPT cessation was 3.3 days. The mortality rate of patients with pulmonary bleeding was 75%. In group B (n=9, 2.60%), 4 cases were emergent PCI and 5 were scheduled. Reasons for taking bleeding risk reduction measures included past history of bleeding, cancer, and poor adherence. The methods of bleeding risk reduction included avoidance of DES and the use of cilostazol, which resulted in noserious bleeding or thrombosis occurring. Conclusions: A descriptive case-series of patients who unexpectedly discontinued DAPT within 14 days and those who had taken bleeding risk reduction measures before PCI was provided. Our results imply that careful planning regarding the antiplatelet therapy and risk assessment for bleeding, including pulmonary bleeding, are warranted for patients undergoing PCI.
A 12-year-old child with bilateral congenital microtia and ear canal atresia was bilaterally implanted with a Vibrant Soundbridge (VSB) on the right side and a Bonebridge on the left side. Prior to these surgeries the child was using percutaneous bone conduction devices (BCDs) on a headband for more than 9 years. No complications occurred during the surgeries. Sound field audiological testing showed cumulative benefit when both devices were used simultaneously. Directional hearing was tested in a sound-attenuated room. To ensure that the subject could only use acoustic information to localize sounds, the test was performed in complete darkness. The ability to localize sounds was poor when listening with either the VSB or Bonebridge, but increased significantly when both devices were used simultaneously. To our knowledge this is the first case report about the bilateral implantation of a VSB and Bonebridge.
Aim: We reported a rare case of an anomalous origin of the left pulmonary artery (AOLPA) from the ascending aorta associated with pulmonary atresia and right sided aortic arch diagnosed at a relatively late age. Case: 13 year-old girl presented to our pulmonology clinic with complaints of cough and dyspnea. On chest X-ray cardio thoracic ratio was increased and shadow of the arch was not seen on the left. On her echocardiography pulmonary arteries couldn't be demonstrated. Computed tomography angiography was performed to the patient. Right sided arch aorta with pulmonary atresia associated with an anomalous origin of the left pulmonary artery from the ascending aorta with a well developed collateral blood supply to the right lung and coexisting pulmonary infection was detected. She was managed medically. She is on the first year of her follow up. Her medical status is stable. Conclusion: We presented a case of relatively rarely seen anomalous origin of the left pulmonary artery from the ascending aorta with a rarely seen association of pulmonary atresia and wanted to take attention to its presentation in a late childhood.
Anastomotic leakage and its consequences in gastrointestinal tract surgery, especially in low anterior resection, is a day major complication affecting morbidity and mortality rate. Early detection and prevention is crucial in order for sepsis to be avoided. There are well-defined risk factors influencing anastomosis healing. The patient’s status and operative conditions including surgical technique have been incriminated for dehiscence. The correct application of conventional operative principles is important. The outcome of anastomosis either handsewn or stapled is deemed to have no major difference. Novel compression anastomotic instruments have been proposed as an alternative option, yet without wide broad application and enough experience. There are innovative staple line reinforcement materials. Some topics such as proximal defunctioning stoma, pelvic tubes or the recently proposed transanal drainage tube are in debate for routine or selective use. Protective transverse colostomy does not affect the risk of leakage, but it reduces the septic consequences. Laparoscopic procedures have similar anastomotic leakage rate with open operations. There is no consensus on whether covering anastomosis with great omentum is necessary as protection or for mechanical bowel preparation. Novel promising perspectives exist as well as commonly accepted aspects. The combination of conventional techniques (handsewn or stapled anastomosis performance) with modern techniques may be proved effective in reducing anastomotic leakage rates.
Aims: To assess short and longer-term outcomes of ultrasound-guided glenohumeral corticosteroid injections for adhesive capsulitis. Study Design: A mixed prospective and retrospective study design Place and Duration of Study: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, between June 2011 and July 2012. Methodology: Using medical records, we first retrospectively identified patients who had received ultrasound-guided injections of lidocaine and triamcinolone for adhesive capsulitis We then assessed short-term follow-up outcomes (within 3 months of procedure) using medical record review and phone interviews. Longer-term follow-up (at least 3 months from the procedure) outcomes were determined by mailings and phone calls. Average and worst shoulder pain scores were measured on a visual analog scale. Shoulder ROM was measured in forward flexion, isolated abduction, and external rotation. Results: Patients presented an average of 5.1 (SD=4.1) months after onset of symptoms. Within three months of the injection, 55.9% (95% CI: 39.2%, 72.6%) of patients reported greater than 75% pain relief and 44.1% (95% CI: 27.4%, 60.8%) of patients reported greater than 75% ROM improvement. The percentage of patients who improved increased with increased duration of follow-up. At short-term follow-up (mean=2.1 months, SD=2.7), average pain decreased from 5.6 (SD=2.2) to 3.0 (SD=1.8) (p ≤ .001) and worst pain decreased from 7.8 (SD=1.2) to 4.3 (SD=3.2) (p ≤ .001). At longer-term follow-up (mean =10.4 months, SD=3.7), average pain decreased to 1.9 (SD=1.9) (p ≤ .001) and worst pain decreased to 2.9 (SD=2.3) (p ≤ .001). Conclusion: A majority of patients had significant pain reduction and functional improvement after an ultrasound guided glenohumeral corticosteroid injection for adhesive capsulitis. Our patients experience the majority of their pain and functional relief within the first three months after an ultrasound-guided corticosteroid injection with continued increase in relief in the longer-term.
Aims: To study the trends in admission for diseases of the appendix and to attempt to present a potential basis for the observed (complex) age-dependent trends and etiologies. Study Design: Longitudinal study of admissions relating to the appendix with analysis by age and gender. Place and Duration of Study: Admissions for diseases affecting the appendix for the residents of England over the period 2000/01 to 2012/13. Methodology: Retrospective application of age-standardized admission rates based on 2012/13 as the base year to determine what proportion of the increase in admissions is due to demography or to non-demographic forces. Synthesis of available literature covering diseases of the appendix to propose possible causes for the increase in admissions. Results: Based on admissions in 2012/13 diseases of the appendix cost the NHS in England around £107 million per annum (roughly £2 per head of population per annum). Admission rates peak at age 17 but have been increasing over the past 14 years in adults but not children. The rate of increase escalates with age and is more rapid in females. The trend for females shows far higher volatility than that for males and both show some degree of cyclic behavior. Depending on age, demographic change can only explain between 20% and 40% of the long-term increase. Social and health service factors are unlikely to explain this gap. Conclusion: An immune/infectious basis for increasing admission rates appears most likely. A possible role for the immune modulating herpes virus, cytomegalovirus (CMV), is discussed in the context of a potential linkage between infection with multiple agents (called the infectious burden) and the development of multiple morbidity. Both of which increase with age and are amenable to manipulation by CMV. The suggested mechanism may also provide insight into why the rates for admission of certain medical diagnoses are increasing far faster than due to demographic change.
Background: Discovery of novel biomarkers of prognosis and drug response remains an elusive, yet critical goal. Thus, accurate and rapid screening of an array of pertinent mutations/SNPs is an essential step in cancer management. Methods: Using a high-throughput multiplex PCR microarray technique, we simultaneously screened the mutational status/SNP of 32 hotspots in multiple genes for metastatic colorectal cancer (mCRC) from 126 formalin fixed paraffin embedded samples from 78 patients. The efficacy of the technology was validated by cross-comparison with conventional Sanger sequencing and pyrosequencing. The clinical outcome was corroborated to the mutational status to determine prognostic and predictive significance of the 32 loci. Results: In a statistically robust multivariate model, patients with the TT genotype of the MGMT gene (rs1625649) enjoyed a significantly longer survival (61.8 months) when compared to those with GG or heterozygous GT genotype (29.3 months) [HR 0.30; 95% CI: 0.10-0.89, P= 0.03], with a 70% reduced risk of death from mCRC. Conclusion: The rs1625649 SNP within MGMT is a novel and potentially valuable prognostic biomarker for mCRC patients.
Aim: Ferulic acid, a well known dietary phenolic antioxidant, possesses diverse pharmacological and biochemical effects, including anti-inflammatory, hepatoprotective, antidiabetic and anticancer properties. The present study explores the cytotoxic potential of ferulic acid using Hep-2 cell line by analyzing its effect on cell viability, reactive oxygen species generation, apoptotic induction, nuclear damage, DNA fragmentation and expression of apoptosis related proteins. Materials and Methods: The effect of ferulic acid (2.5, 5, 10, 20 and 40 µg/ml) on Hep-2 cells viability for 24 hr was determined by MTT assay. To substantiate the cytotoxic effect of ferulic acid, the intracellular ROS level was determined using DCFH-DA assay; apoptosis by dual staining; nuclear damage by DAPI staining; DNA fragmentation by using agarose gel electrophoresis; apoptosis related proteins by western blotting. Results: Ferulic acid significantly inhibited the Hep-2 cell growth in a dose dependent manner and ferulic acid treated Hep-2 cells exhibited features of apoptosis and increase in nuclear damage and DNA fragmentation. We also observed excess reactive oxygen species generation in ferulic acid treated Hep-2 cells. Apoptosis related proteins (p53, Bcl-2, Bax, Caspase 3 & Caspase 9) were significantly modulated in favour of programmed cell death in ferulic acid treated cells. Conclusion: We thus conclude that the cytotoxic potential of ferulic acid might be due to its role in apoptosis induction, excessive ROS generation and DNA fragmentation in Hep-2 cells.
Aims: To assess the association between FVL G1691A, FII G20210A, MTHFR A1298C, C677T and PAI-1 5G/675/4G gene polymorphisms among women with unexplained recurrent early spontaneous abortion (URESA) Materials and Methods: This study included two groups of Russian women: 50 currently non-pregnant women with a history of 2-5 unexplained recurrent early spontaneous abortion and unknown causes of miscarriages (URESA group), and 50 currently non-pregnant women with a history of having given birth to at least one live baby and without a history of spontaneous abortion, prematurity, stillbirth, eclampsia and other pregnancy complications (control group). Gene polymorphisms were detected by the technique of polymerase chain reaction-real time (PCR-RT). We have analyzed the frequencies, χ2 test, odds ratio (OR) and its 95% confidence interval (CI), Hardy-Weinberg equilibrium. Results: Significant association between heterozygotes genotype FVL 1691G/A and URESA was found (OR=3.1). Heterozygous genotype FII20210G/A was associated mainly with recurrent spontaneous abortions (4% vs 0%). The PAI-1 5G/4G genotype was significantly associated with URESA (OR=2.3). Heterozygotes with MTHFR 677C/T genotype had high risk of early recurrent pregnancy loss (OR=4.6). Heterozygotes with MTHFR 1298A/C genotype showed low association with pregnancy loss (OR=1.2). We did not observe increased risk of early pregnancy loss in mutant homozygotes with MTHFR 677C/C and 1298C/C genotypes (OR=1.0). The presence of the PAI-1 gene 5G/4G genotype together with the MTHFR 677C/T or MTHFR 1298A/C or FVL 1691G/A genotypes was found to be a risk factor for URESA (OR=4.5; OR=2.3, respectively). Combined PAI-1 5G/4G// FVL 1691G/A genotypes was detected only in patients (2% vs 0%). Women carrying combined PAI-1 5G/4G//MTHFR 677C/T//MTHFR 1298A/C genotypes had an increased frequency of recurrent early spontaneous abortion (OR=1.4). Conclusion: The genetic polymorphisms of FVL 1691G/A, FII 20210G/A, MTHFR 677C/T, MTHFR 1298A/C, and PAI-1 4G/4G, and the PAI-1 5G/4G genotypes are associated with URESA. The patients carrying combined heterozygous genotypes PAI-1 5G/4G//MTHFR 677C/T or PAI-1 5G/4G//MTHFR 1298A/C or PAI-1 5G/4G//FVL 1691G/A or PAI-1 5G/4G//MTHFR 677C/T//MTHFR 1298A/C have higher risks of URESA. These results might indicate a genetic influence on pathogenesis of URESA.
Background: In the Kenya primary health care (PHC) setting where most patients, including nearly 1.4 million HIV-infected people, seek medical care, PHC providers are expected to identify and manage HIV-related oral diseases during general consultations. This study aimed to assess the current knowledge of clinical officers and nurses in Nairobi East district of Kenya regarding HIV-related oral diseases and conditions. Design and Methods: A 40-item questionnaire was used in interviewing all 57 PHC providers in 2 administrative divisions in the district in a cross-sectional survey. Assessed categories were: knowledge about HIV-related oral lesions, clinical appearance of HIV-suspected conditions, knowledge about oro-pharyngeal candidiasis (OPC), general dental knowledge, common appearances of OPC, knowledge about periodontitis, causes of dental caries, frequency of general oral examinations and past training in oral health topics. The first 4 categories were confirmed as sub domains, with Cronbach’s alpha of 0.57, 0.54, 0.59 and 0.45 respectively. Results: All 57 PHC providers (15 clinical officers and 42 nurses) completed the questionnaire (response rate 100%). PHC providers did not routinely perform oral examinations. Their knowledge about HIV-related oral health topics and general oral health was found to be generally inadequate. Recommendations: A training module on HIV-related oro-facial lesions for Nairobi PHC providers, incorporating a practical session covering oral examinations, is recommended; especially in this high HIV-prevalence environment.
Solitary fibrous tumour (SFT) is a spindle cell neoplasm that rarely occurs in the kidney. It has been reported mainly in the pleura, but it can also arise from almost every organ. Benign SFT of the kidney has been described in several cases, even with metastatic lesions, but only seven cases of malignant SFT including this case have been documented; and only three cases out of seven had distant metastasis. Clinical features are indistinguishable from other renal neoplasms. Diagnosis is based on inmunohistochemical analysis, showing positive staining for CD34, as a key for diagnosis. We report two different cases, with very different behaviour; showing the wide spectrum of malignancy of this entity; with a comprehensive review of the literature.