2,383 research outputs found

    Evaluation of the Surgical and Pharmacological Treatment of Diabetic Foot Infection: A Retrospective Study

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    BACKGROUND: Diabetic foot infection is a major cause of patient disabilities and lowers limb amputations, with high treatment costs and hospitalisation requirements. AIM: Aim of this study was to evaluate surgical wound care plus antibiotic effects in the treatment of mild and moderate diabetic foot infections. METHODS: This retrospective study involved 60 patients with diabetic foot infections with or without osteomyelitis. The patients were categorised as group 1 mild and group 2 moderate. Both groups were treated using local wound debridement and the systemic administration of antibiotics. Group 1 (16) patients were treated with two regimens of oral antibiotics in two regimens, A (amoxicillin/clavulanate + metronidazole) and B (clindamycin + metronidazole), for 10-14 days. Group 2 (42) patients were treated with oral plus intravenous antibiotics in two regimens, A (ampicillin + cloxacillin + metronidazole) and B (lincomycin + metronidazole), for 6 weeks. The patients followed-up with local wound care specialists for 3 months to evaluate the treatment outcomes (cure, improvement, or failure). RESULTS: Group 1 had an 80% cure rate under regimen A and a 100% cure rate under regimen B. Group 2 regimen A patients had a 61.5% cure rate and 11.53% improved, while regimen B patients had a 68.75% cure rate and 12.5% improved. Failure in both regimens was 23.8% in 20 patients with osteomyelitis, while 35% were cured and 20% improved during the study period. CONCLUSION: Local surgical wound care for 3 months with antibiotic regimens for 6 weeks resulted in good response and cure rates, with lower costs and fewer instances of hospitalisation. Intravenous lincomycin and oral metronidazole achieved higher cure responses for moderate diabetic foot infections

    On the Epidemiology and Statistical Analysis of HIV/AIDS Patients in the Insurgency Affected States of Nigeria

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    BACKGROUND: The effect of insurgencies on a nation regarding the economy, education, health and infrastructure cannot be overemphasised. AIM: This research is therefore focused on analysing the incidence of HIV/AIDS disease in states affected by the activities of the Boko Haram insurgency in Nigeria. MATERIAL AND METHODS: The data collected refer to the period from 2004 to 2017, reporting information on 16,102 patients and including the age, gender, year of diagnosing and status of the patients. Descriptive, Chi-square test of independence and Correlation analyses were performed using Statistical Package for Social Sciences (SPSS) version 20. RESULTS: It was discovered that the majority of those living with HIV/AIDS in these Boko Haram ravaged areas are females between the age group of 30 years to 39 years. Reported cases of HIV/AIDS started increasing significantly from age 20, and the highest number of reported cases of HIV/AIDS was recorded in the year 2017. CONCLUSION: The status of the patient was found to be dependent on both the gender and age of the patients’ treatment, though the strength of the linear relationship between status and age is not significantly different from zero

    Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction

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    AIM: To determine the value of the combination of thin-section 3 mm ‎coronal and standard ‎axial DWI and their impact in facilitating the diagnosis of ‎‎acute brainstem infarction. METHODS: A cross-sectional study conducted from the 1st of April 2017 to the end of February 2018 on 100 consecutive patients (66% were male, and 34% were female) with isolated acute ischemic infarction in the ‎brainstem. The abnormal MRI findings concerning the ischemic lesions were interpreted on standard axial 5 mm and thin-section coronal 3mm DWI. RESULTS: The mean age of the studied group was 69.2 ± 4.3 for male and 72.3 ± 2.5 years. The standard axial DWI can diagnose 20%, 6.7% and 6.7% of the infarctions in midbrain, pons and medulla oblongata respectively, while both axial and thin coronal sections together can diagnose 80% of midbrain infarctions, 93.3% of pons infarctions and 93.3% of medulla oblongata infarctions. Furthermore, the thin section coronal 3 mm section can diagnose very smaller ischemic lesion volume in comparison to the standard axial 5mm section (3.4 ± 0.45 / cm3 versus 4.6 ± 0.23 / cm3, P < 0.001) CONCLUSION: The addition of thin-section coronal DWI can facilitate the detection of brainstem ischemic lesions. We suggest its inclusion in the stroke MRI protocol

    Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

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    AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies. CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis

    Lamivudine-Induced Liver Injury

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    BACKGROUND: Lamivudine is a nucleoside analogue antiretroviral drug, known for its low toxicity at clinically prescribed dose. However, the toxicity or mechanism of toxicity and target tissue effects during prolonged administration of higher doses were hardly given sufficient laboratory attention. AIM: The present work was designed to investigate the biochemical and histopathological changes in the liver of rat administered with prolonged doses of lamivudine. MATERIAL AND METHODS: Lamivudine in multiple doses of five ranging from 4 mg/kg to 2500 mg/kg were administered, in vitro, by injection into the air-sac of 10–day old fertile embryonated eggs of Gallus domesticus. Also, female rats of the Wistar strain received oral doses, up to 500 mg/kg singly or repeatedly for 15 or 45 days, respectively. Spectrophotometric techniques were employed to monitor activities of the aminotransferases (ALT and AST), γ–glutamyltransferase (GGT) and total protein concentration in serum while activities of glutathione S–transferase (GST), GGT and superoxide dismutase (SOD) as well as concentrations of malondialdehyde (MDA) and protein were determined in liver. Histopathological studies were carried out on liver. Data were analysed using ANOVA and were considered significant when p < 0.05. RESULTS: The LD50 for the drug calculated from the incubation experiment was 427 mg/kg. Total serum protein concentration significantly reduced while enzymes activities significantly increased at 500 mg/kg only among the repeat-dosed rats. Hepatic GGT, GST and SOD activities as well as MDA concentration were significantly elevated at 20 mg/kg. Histopathological studies showed multifocal lymphoid cell population in the liver sinusoid of the chicken and hydropic degeneration of hepatocytes were recorded among rats repeatedly exposed to the drug respectively at doses ≥ 100 mg/kg

    Case Series of Pre-Operative Endovascular Embolization of Nasopharyngeal Angiofibroma Using Polyvinyl Alcohol Foam Particle: A Single Centre Experience

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    BACKGROUND: Nasopharyngeal Angiofibroma is a rare neoplasm in the sphenopalatine foramen. This tumour is histologically benign, but clinically malignant because it can erode the bone and surrounding structures, such as the pterygopalatine fossa, paranasal sinuses, and nasal cavity. It is a highly vascular tumour, sometimes from multiple Feeding arteries, and tends to bleed easily. CASE PRESENTATION: In these cases, series, we reported four cases of nasopharyngeal angiofibroma in children and one case in an elderly patient. The diagnosis was made by history taking, physical examination and Cerebral MSCT Angiography, as well as Digital Subtraction Angiography (DSA). After identification of the Feeding artery, we performed transarterial embolisation using polyvinyl alcohol (PVA) foam particles. CONCLUSION: Preoperative embolisation in the highly vascular tumour, such as nasopharyngeal angiofibroma, is very useful to reduce peri-operative complication of surgery. This procedure can reduce blood loss during resection of the tumour and gives better outcomes

    Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

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    BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed

    Giant Bowen’s Disease on the Face: Case Report and Review of the Literature

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    BACKGROUND: Giant Bowen’s disease is a rare and unusual clinical manifestation. Presenting as extensive scaly erythematous patch or plaque, it gives rise to a wide spectrum of dermatological differential diagnoses. CASE PRESENTATION: We report a patient with giant Bowen’s disease on the face that was successfully treated with topical 5 % imiquimod. A review of the literature was made with the aim to analyse and compare the findings in it with our observation. CONCLUSION: We present this case to draw attention to the importance of the self skin examination in the elderly population. Also, to prevent development to invasive squamous cell carcinoma from Bowen’s disease, we recommend mandatory dermoscopic examination on every long-standing erythemosquamous lesion

    Measles Outbreak in Pediatric Oncology Patients at Hue Central Hospital

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    AIM: Measles outbreak in the immunocompromised population is a big challenge to interrupt endemic transmission. This study aimed to investigate of measles in pediatric oncology patients and find the reason behind the outbreak. METHODS: A descriptive study was conducted on 11 pediatric oncology patients with measles. We collected demographic, epidemiological, and clinical data. Most of suspected measles cases were done measles immunoglobulin M test and clinical data were followed up and analyzed by SPSS. RESULTS: From April 20, 2018, to July 10, 2019, a total of 11 patients with malignancies were notified to develop measles in Hue. Of these 11 patients with the median age of 4.0 years (range: 1–9 years), two patients had not received any dose of measles vaccine, five patients received two doses, and four patients had received 1 dose of measles vaccine; all patients had fever with the median fever of 39°C (range: 38.5–39.5), the median fever duration was 7 days. All patients had cough and rash, three patients had pneumonia complication and two patients had elevated liver transaminase levels. All patients had hospital visits or were hospitalized before measles onset, with the median time: 10 days (range: 7–24 days); all patients were likely to expose each other. All 11 patients recovered. CONCLUSIONS: The measles outbreak was occurred among children with cancer, especially for children without prior measles vaccine or without two prior doses. Moreover, even children received two prior dose vaccine, their immunocompromised status caused them to be infected. There was not a different area for outpatient and inpatient in the hospital, so measles transmission occurred

    Correlation of Muscle Invasion in Bladder Cancer with Cell Adhesion Properties and Oncoprotein Overexpression Using E-Cadherin and HER2/neu Immunohistochemical Markers.

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    BACKGROUND: Most of bladder cancers are proven to be of urothelial origin (transitional cell carcinomas). Above 75% of them are of non-muscle invasive bladder cancer (NMIBC) type at presentation and the remainder are MIBC. Recent studies suggest that both are most probably two different categories based on both the histopathological and molecular features. The comprehensive understanding of the biomarkers expression in both categories will help in understanding the molecular event underlying each of them and may provide possible chances for targeted therapeutic options. AIM: This study aims to study the differential expression of both E-cadherin and human epidermal growth factor receptor-2 (HER2) in the two categories of bladder cancer NMIBCs and MIBCs. MATERIALS AND METHODS: A total of 40 blocks were collected retrospectively from cases of cancer bladder, segregated as 20 cases NMIBCs and 20 cases MIBCs, subjected for E-cadherin and HER2 immunostaining. RESULTS: E-cadherin showed positive expression in 65% of cases of NMI group and in 10% of the MI group, with high statistical significance (p &lt; 0.001). Regarding HER2, positive expression was seen in 25% of NMI cases and in 90% of MI cases, with statistical significance (p &lt; 0.001). Comparison of the results of both markers and their correlation per case showed that 90% of tumors with muscle invasion were E-cadherin negative and HER2 positive. CONCLUSION: The significant association of loss of E-cadherin immunohistochemistry expression and positive HER2 overexpression in MIBC versus NMIBC figured out more differences between the two categories and added to the understanding of their biology. The possibility of validation of HER2-targeted therapy in MIBC cases is now strongly suggested
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