International Journal of Medical Science and Clinical Research Studies

Platelet Rich Fibrin Membrane as Nerve Guidance Conduit for Reconstruction Case with Nerve Repair Based Morphometric and Electrophysiologic Parameters: A Systematic Review and Meta-Analysis

Andi Muh. Octavian Pratama, Pratidina Wulandari, Asrofi S. Surachman — Fri, 17 May 2024 00:00:00 +0000

Introduction: Motor or sensory nerve injury is a major surgical and clinical challenge, often with disappointing results and impairing sensory and motor function. Now there are some studies to looking for ways to accelerate nerve regeneration. Platelet-rich fibrin (PRF) is made from an autologous platelet concentrate that contains progenitor cells that are essential for the healing process, along with neurotrophic factors and several growth factors. Additionally, PRF can be manufactured in the membrane form that can be wrapped around nerves in the form of tubes which tubulation has many advantages such as guiding growth within the tubular shape to improve regenerative capacity.

Methods: This systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic databases, including PubMed, Cochrane, Research Gate, Elsevier, and PRS Journal. Studies were selected and compared based on outcome measures like Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Statistical analysis was performed using a random- effect model, pooled standard mean difference and I² heterogeneity.

Result: Four randomized studies with analyzed 4 parameters, those are Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Pooled analysis for the outcome like Myelin Sheath Thickness, Axon Area, and Amplitude showed a significant result in groups with PRF. Pooled analysis for outcome of Nerve Conduction Velocity showed no significant difference between the groups with PRF and without PRF (SMD: 0.01; 95% CI: -0.64. 0.65) with P = 0.99.

Conclusion: This Meta-analysis shows that PRF membrane as nerve guidance conduit is promising method and can improve function outcome in nerve repair specially in Morphometric and Electrophysiologic parameters but outcome of Nerve Conduction Velocity showed no significant in this study.

Sweet Syndrome: A Comprehensive Review of Pathogenesis, Clinical Manifestations, Diagnosis, and Management Strategies

Fri, 17 May 2024 00:00:00 +0000

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare and inflammatory disorder characterized by fever, neutrophilia, and tender, erythematous skin lesions. The pathogenesis of Sweet syndrome involves an exaggerated immune response, with evidence suggesting a role for cytokines, particularly granulocyte colony-stimulating factor (G-CSF). Clinical manifestations vary widely, but commonly include abrupt onset of painful, raised plaques or nodules, often on the upper limbs, face, or neck. Histopathological examination reveals dense neutrophilic infiltrates in the dermis without evidence of vasculitis.

Diagnosis is primarily clinical, supported by histopathology and exclusion of other similar conditions. Treatment typically involves corticosteroids, which often lead to rapid resolution of symptoms. However, relapses are common, necessitating long-term management strategies. This review aims to provide a comprehensive overview of the pathogenesis, clinical manifestations, diagnosis, and management of Sweet syndrome, highlighting recent advancements and areas requiring further research.

Examining the Relationship between Quality of Life and Baseline Hemoglobin Level in Lung Cancer with Chemotherapy Treatment Using EORTC QLQ-LC13

Wed, 01 May 2024 00:00:00 +0000

Background: The effect of lung cancer and its various treatments on the overall well-being can be substantial. This study seeks to examine the correlation between quality of life and baseline hemoglobin (Hb) levels in lung cancer patients who are receiving chemotherapy.

Method: This study involved 30 patients with non-small cell lung cancer (NSCLC) who underwent platinum-based chemotherapy. Baseline Hb level were collected from medical records. The patients' quality of life was assessed using interviews utilizing the EORTC QLQ-LC13 questionnaire.

Result: Baseline Hb levels and pain relief after medication score was positively correlated (r=0.559, p=0.001). Baseline Hb levels and difficulty swallowing score was negatively correlated (r=-0.386, p=0.035). Determined cut-off point for the total score was 303.5. However, the correlation between Hb levels and overall quality of life was insignificant (r=-0.096, p=0.615).

Conclusion: According to the quality of life indicators in the questionnaire, there is a notable association between lower baseline Hb levels and reduced effectiveness of pain relief medication, as well as an increase in difficulty swallowing. However, the underlying cause for this correlation is unclear. On the other hand, the correlation between baseline Hb levels and the overall scores of quality of life in the questionnaire was not found to be significant.

Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review

Fri, 03 May 2024 00:00:00 +0000

Pulmonary embolism (PE) presents significant healthcare challenges and potentially life-threatening consequences, demanding a nuanced approach to management. This systematic review aimed to critically evaluate available pharmacological and nonpharmacological interventions for PE, analyzing their efficacy and safety in patients with cardiac comorbiditie, ranging from traditional anticoagulants like warfarin to novel direct oral anticoagulants (DOACs) or thrombolytic therapies is commercially available options with varying benefits and limitations. Nonpharmacological interventions, including catheter-directed therapies and embolectomy, provide alternative avenues, especially when thrombolysis is contraindicated despite advancements, and gaps persist, particularly in reconciling efficacy with safety profiles and optimizing resource allocation. Addressing these challenges necessitates a multidisciplinary approach, integrating clinical expertise with evidence-based practices. By exploring these interventions' intricacies and implications, this review aims to inform clinicians, researchers, and policymakers, fostering improved care pathways and better outcomes for patients facing the complex landscape of PE management.

Scalp Spinal Cell Carcinoma Managed with Resection and Ying Yang Flap

Sat, 04 May 2024 00:00:00 +0000

The second most frequent type of non-melanoma skin cancer is cutaneous squamous cell carcinoma (cSCC). We present the case of a squamous cell carcinoma of the scalp with surgical management and the importance of the Ying-yang flap. Ying-Yang flaps" are employed when there is stress on the incision, especially on the scalp and lower extremities.

Acute Infarct of Myocardium without Coronary Arterial Obstructive Disease in a Patient with Colon Cancer: A Case Report

Sat, 04 May 2024 00:00:00 +0000

We report a 40-year-old female with colon cancer, in its first session of treatment with capecitabine/oxaliplatin, who presented an event of acute coronary syndrome type myocardial acute infarction with ST inferior elevation in the first 30 days after initiation of adjuvant treatment, angiographically without lesions and echocardiographically presented impaired ventricular function. This case report illustrates myocardial damage induced by antimetabolites in an acute manner.

Efficacy of Honey-Based Wound Dressing Versus Hydrogel-Based Wound Dressing in Wound Healing Process: A Literature Review

Firda Rahmania, Ahmad Fawzy — Tue, 07 May 2024 00:00:00 +0000

Introduction: Wound dressing is a fundamental aspect of modern healthcare, encompassing a diverse range of materials and techniques aimed at optimizing the healing process while safeguarding against infection and further injury. By understanding the specific benefits of different types of wound dressings, healthcare professionals can optimize the healing process and improve patient outcomes

Methods: This literature review was compiled using information from various open access online databases. Data were collected and analyzed.

Results and Discussions: Honey dressing demonstrates superior efficacy compared to hydrogel dressing in wound management. Its multifaceted properties, such as potent antimicrobial activity, tissue regeneration promotion, and anti-inflammatory effects, render it a superior option for wound healing throughout all stages. Additionally, honey is more cost-effective than hydrogel and more easily accessible.

Conclusion: The efficacy of honey dressing surpasses that of hydrogel dressing in wound management. Honey's multifaceted properties, including its potent antimicrobial activity, ability to promote tissue regeneration, and anti-inflammatory effects, make it a superior choice for wound healing across all phases.

Considerations in Discoid Lupus: A Comprehensive Review

Wed, 08 May 2024 00:00:00 +0000

Discoid lupus erythematosus (DLE) is a chronic inflammatory skin condition that can lead to disfiguring scarring and pigmentary changes. This review article provides an overview of the epidemiology, pathogenesis, clinical manifestations, and treatment options for DLE. Special considerations in the management of DLE, including the role of photoprotection, topical and systemic therapies, and the importance of multidisciplinary care, are discussed. The impact of DLE on quality of life and psychosocial well-being is also addressed. A better understanding of the complexities of DLE can aid clinicians in providing comprehensive care to patients with this challenging condition.

The Significance of Quality in Health Services

Wed, 08 May 2024 00:00:00 +0000

Introduction: Businesses and organizations in the current period strive to thrive in a fiercely competitive environment by attracting a maximum number of consumers.

Purpose: This review study seeks to examine the definition of quality in health care with the goal of promoting health.

Materials and Methods: The methodology employed involved doing a comprehensive literature search of review and research studies in internationally recognized databases such as Medline, Pubmed, and Cinahl. The articles were excluded based on the criterion that they were written in a language other than English.

Results: The concept of health is intricate, making it challenging to establish a precise and unambiguous definition of excellence in healthcare. Quality in healthcare is an essential focus for scientists, organizations, and healthcare personnel, as well as for individuals who receive these services.

Conclusions: Undoubtedly, quality in health services is an increasingly demanding first-priority need.

Leukodytrophy in Children: 12 Cases

S. Esseddiki, I. Chahid, F. Harim, A. Abkari, A.A. Bousfiha — Mon, 13 May 2024 00:00:00 +0000

Introduction: Leukodystrophies are a rare geneLc disease characterized by damage of the myelin sheath. They represent a large number of diseases that are heterogeneous by their clinical and physiopathological aspects.

Material and Methods: We report 12 cases of leukodystrophies collected at the Neuropediatric Unit of Abderrahim Harouchi Mother and Child Hospital CHU Ibn Rochd, Casablanca, Morocco. Results: The average age of diagnosis was 2 years and 9 months, with a predominance of females (sex raLo:0.33). Consanguinity was found in 5 cases. The onset symptomatology was dominated by psychomotor regression, found in 8 paLents, and seizures in 4 paLents. Motor signs were in the foreground: pyramidal syndrome in 5 cases, hypotonia in 4 cases, tetraparesis in 1 case, dysarthria in 1 case. The lumbar puncture, carried out in 4 paLents, revealed hyperproteinorachy in 3 cases, glycorachy and cytological study were normal. We noLced a decreased level of Aryllsulfatase A in 6 cases. Imaging was performed in all paLents and showed diffuse white ma]er demyelinaLon. MRI allowed us to classify our cases and showed 7 cases of metachromaLc leukodystrophy, 1 case of cavitary leukodystrophy, 1 case of Refsum disease, 1 case of Canavan disease, 1 case of Cockaynes syndrome and 1 case of adrenoleukodystrophy. The electroneuromyogram showed a decrease in nerve conducLon velociLes in 2 cases. Molecular study was performed in one paLent finding a hyccin mutaLon.

Conclusion: The diagnosis of leukodystrophies is o_en difficult because of their clinical heterogeneity. The partnership of clinicians with geneLcists may be the key point to improve diagnosis and therapeuLc management.

Endocardial Fibroelastosis: A Comprehensive Review of Pathogenesis, Clinical Manifestations, Diagnostic Modalities, and Management Strategies

Tue, 14 May 2024 00:00:00 +0000

Endocardial fibroelastosis (EFE) is a rare and enigmatic myocardial disease characterized by the abnormal accumulation of collagen and elastin fibers in the endocardium, predominantly affecting the left ventricle. This comprehensive review aims to elucidate the pathogenesis, clinical manifestations, diagnostic modalities, and management strategies of EFE. EFE typically presents in infants and young children, although adult cases have been reported. The etiology of EFE remains elusive, with theories implicating genetic, infectious, and autoimmune factors. Clinically, EFE may manifest with symptoms of heart failure, arrhythmias, or sudden cardiac death. Diagnosis often involves echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy. Management strategies for EFE are primarily supportive, focusing on the management of heart failure symptoms and arrhythmias, with advanced cases necessitating heart transplantation. This review provides a comprehensive overview of EFE, highlighting the challenges in diagnosis and management and underscoring the need for further research to elucidate its pathogenesis and improve outcomes.

Risk Factors for Sepsis in Postoperative Patients

Wed, 15 May 2024 00:00:00 +0000

Sepsis is a severe acute infection that can lead to organ failure and mortality in 30-50% of patients. It ranks among the top 10 causes of mortality in the United States and has increased significantly since the 1970s. Postoperative sepsis, the primary type of sepsis, accounts for almost one-third of all sepsis cases.

Postoperative sepsis is a major cause of illness and death for hospitalized patients, often leading to multiple organ failure and mortality. A study found that patients aged 18 years or older who have undergone surgical interventions and have been hospitalized for at least 4 days after the operation have a higher likelihood of developing sepsis. The most prevalent complication after radical gastrectomy for stomach cancer is postoperative infection, which occurs through leukocyte depletion in transfusion patient.

Being male or over 65 significantly increased the likelihood of having postoperative sepsis. Sex hormones significantly influence the body's response to sepsis, and elderly individuals may be more susceptible due to deterioration of immune system function and age-related immunosenescence. Chronic renal illness, diabetes, and chronic heart failure have the highest risks of developing postoperative sepsis, ranked first, second, and third, respectively.

Dysfunctions in the cardiovascular and hematological systems also have the highest probability of leading to the development of postoperative sepsis. These findings suggest potential areas for future research to decrease the impact of the disease.

Hematophagocytic Syndrome in a Patient Co-Infected With HIV: A Case Report

Wed, 15 May 2024 00:00:00 +0000

Introduction: Hemophagocytic syndrome is a severe disease characterized by a state of systemic hyperinflammation with overproduction of cytokines. It can respond to genetic causes (primary) or be triggered by infections, drugs, neoplasms or autoimmune diseases. With increased mortality. We present the case of a patient with HIV who developed hemophagocytic syndrome during hospitalization.

Case presentation: We present the case of a male patient with human immunodeficiency virus who developed hemophagocytic syndrome with lymphadenopathies and biopsy report concluding the syndromic suspicion.

Conclusions: Our case report reflects the clinical and biochemical approach to hemophagocytic syndrome, in which the realization of a histopathological diagnosis was determinant to reflect the cause of the disease in question, we denote the importance of clinical suspicion in infrequent situations related to the patient with immunodeficiency.

Thoracic Wall Reconstruction with Thoracoabdominal Flap

Thu, 16 May 2024 00:00:00 +0000

Reconstructing the chest wall following substantial surgical removal is a challenging task for thoracic, oncologic, and reconstructive surgeons. Common indications include breast cancer, radionecrosis, and malignancies affecting fascia, muscle, and sometimes the ribs. Skin grafts are not a favorable choice due to their thinness and unsuitability of the recipient site. Over the past 30 years, a wide range of flaps have been created to achieve sufficient covering and protection of intrathoracic structures.The Tai and Hasegawa technique, developed in 1974, involves using a transverse fasciocutaneous flap taken from the same side of the body in the thoracoabdominal region. Davis and McCraw made modifications to this technique in 1977, and Brown and Vasconez in 1975 revealed the presence of musculocutaneous perforator branches originating from subcostal, intercostal, and lumbar arteries. Baroudi introduced a contralateral thoracoabdominal fasciocutaneous flap in 1978.In the 1980s, muscular and musculocutaneous flaps became widely accepted as the best method for reconstructing the chest wall. However, there have been limited comparison studies published, making it difficult to determine whether musculocutaneous flaps are preferable than fasciocutaneous flaps. Deo et al. (2019) proposed that the fasciocutaneous "thoracoabdominal" flap should be considered as the primary choice.The extended cutaneous thoracoabdominal flap is a straightforward and efficient surgery that can be completed in a single step. It is generally safe and rarely results in tissue death, and its generous mobility and "back-cut" incision facilitate advancement and rotation. However, it has drawbacks such as the inability to carry out an instant breast reconstruction and the presence of lengthy scars on the abdominal wall.

Endomyocardial Fibrosis Secondary to Chronic Eosinophilic Leukemia: Case Report

Thu, 16 May 2024 00:00:00 +0000

Endomyocardial fibrosis (EMF) is characterized by fibrosis of the endomyocardium of one or both ventricles and atrioventricular valves. Progressive fibrosis leads to irreversible restrictive cardiomyopathy, progressing to heart failure (HF), thromboembolic phenomena, and arrhythmias. It is one of the main complications of chronic eosinophilic leukemia (CEL), resulting from intense eosinophilic infiltration into cardiac tissue. This case is of a 34-year-old male patient with past medical history of CEL, who developed EMF and severe heart failure, NYHA (New York Heart Association) IV, and underwent endocardectomy and mitral and tricuspid valvuloplasty. After the procedure, he improved to NYHA II, initiated cardiovascular rehabilitation, and returned to daily activities.

Duodenal-Jejunal Stenosis as a Manifestation of Eosinophilic Gastroenteritis: A Case Report

Thu, 16 May 2024 00:00:00 +0000

Introduction: Eosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the stomach and small intestine. Its clinical manifestations depend on the extent, location, and depth of the inflammatory infiltrate. The pathogenesis remains unclear, but it may be related to food allergy or other hypersensitivity reactions in some patients. Untreated cases can cause intestinal stricture or perforation, making timely diagnosis and intervention essential.

Clinical case: A 13-year-old male adolescent was hospitalized due to symptoms suggesting intestinal obstruction or alterations in intestinal motility. Medical imaging revealed significant gastric distension and delayed gastric emptying. An endoscopic study showed a “snake-skin” pattern, duodenitis due to food stasis, a 2 cm ulcer, and stenosis in the duodenum. The biopsy confirmed EGE with significant irregular eosinophilic infiltration of the lamina propria. A panendoscopy was performed after steroid treatment without being able to assess the site of stenosis and perform pneumatic dilation. After completing the immunomodulatory management, a contrast-enhanced abdominal tomography was performed showed a significant decrease in the intestinal lumen, therefore an exploratory laparotomy with a lateral to lateral jejune-jejunal anastomosis was performed.

Discussion: EGE is a rare inflammatory disorder characterized by eosinophilic infiltration of the stomach and small intestine. Symptoms are based on the affected gastrointestinal tract segment. In this case, our patient presented intestinal obstruction symptoms with endoscopic biopsies and a histopathological study confirmed eosinophil infiltration. Treatment typically involves identifying potential triggers and corticosteroids to reduce inflammation and symptoms. However, in this case, a decrease in the intestinal lumen was observed, therefore an elective surgical resection was performed.

Conclusion: Eosinophilic gastroenteritis is a rare disorder that requires strong clinical suspicion to be diagnosed, which is why its knowledge is important. In this case, gastrointestinal symptoms, radiological and endoscopic images, in addition to the histopathological report, were key tools for integrating the diagnosis. Although management with steroids and immunomodulators was not successful, surgical management became an appropriate option as definitive treatment.