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Mid-Term Follow-Up after Arterial Switch Operation for Complete Transposition of the Great Arteries
No full textPurpose: Transposition of the Great Arteries has to be surgically corrected by an arterial switch operation. This complex surgical procedure has the potential for significant short- and long-term complications like dilation of the neo-aortic root, coronary and pulmonary artery (PA) stenosis. The aim was to determine a suitable follow-up algorithm for mid-term follow-up.Material and Methods: 26 patients (mean age 10±2 years) were examined using echocardiography, ECG-gated Computed Tomography Angiography (CTA) and functional Magnetic Resonance Imaging (MRI) with flow, cine and pulmonary perfusion measurements.Results: CTA was capable to visualize coronary arteries in all cases. Coronary stenosis did not occur. Echocardiography failed to visualize the coronary arteries in 81%. CTA revealed moderate PA stenosis (25-50% lumen reduction) in 41% and severe stenosis (>50%) in10%. Visualization of pulmonary arteries was possible by echocardiography in only 45%. Correlation between MR-pulmonary perfusion abnormalities and PA stenosis were not present. Doppler-echocardiography showed mild flow acceleration in the main PA (mean pressure gradient 34mmHg) in 4 patients, while MRI found an increased velocity in 9 patients. 10 patients had neo-aortic root dilatation detected with CTA. On echocardiography 8 patients had mild, 4 had moderate aortic valve insufficiency. On MRI amount of aortic valve insufficiency was too small to be quantified. Conclusion: Branch stenosis of the PA was the leading complication 10 years after surgery, coronary stenosis did not occur. Value of Echocardiography is minor in the visualization of coronary arteries and PA morphology and it is recommended only for the assessment of cardiac and valvular function. Additionally, CTA is method of choice for visualization of coronary arteries and PA morphology. In this study the value of MRI for assessment of the complete morphology was limited, but improves with technical advance
Effects of Short Term Interferential Current Stimulation on Swallowing Reflex in Dysphagic Patients
No full textWe have previously shown that surface interferential current (IFC) stimulation at the sensory threshold significantly increases the number of swallows. In the present study, we evaluated the effects of IFC stimulation at the sensory threshold on the swallowing reflex of dysphagic patients (7 male and 5 female, Age, 75.8 ± 5.3 years) by videofluoroscopic (VFS) measurements. Each subject underwent three series of VFS examination, before, during, and after the IFC stimulation. We tested three food types, juice, jelly, and biscuits, however, only juice consistency resulted in significant changes in temporal measurements of VFS parameters before, during and after IFC stimulation. For juice consistency, IFC stimulation shortened the pharyngeal response duration (the duration from the hyoid bone beginning maximum elevation to its return to the resting position, before IFC: 1.37 ± 0.31(SD) s vs. during IFC: 1.17 ± 0.29 s, p<0.001) without changing the amount of anterior and vertical displacements of the hyoid bone. The duration from the onset of elevation of the soft palate to return to the resting position was also significantly shortened by the IFC stimulation (before IFC: 0.72 ± 0.16 s vs. during IFC: 0.64 ± 0.19 s, p=0.035), suggesting that pharyngeal motor activation sequence as a whole was shortened by the IFC stimulation. No painful and/or uncomfortable sensations were reported. We conclude that surface interferential current stimulation has a potential to be an alternative mode of therapeutic electrical stimulation for dysphagic patients
Tuberculosis and Diabetes: About 260 Cases
No full textThe diabetes (DT) is associated with a greater risk of developing an infectious disease. Thus the association between diabetes and tuberculosis (TBK) is well-known. We conducted a cohort study of a random sample of 260 TBK patients diagnosed and supervised in 3 tuberculosis centers and respiratory diseases (CDTMR) in Casablanca, between February and September 2014, which aimed to specify the prevalence of diabetes among TBK patients, and describe the clinical and evolutionary characteristics of this association.Patients and Methods: The diabetes screening of all the patients was performed using a capillary glycémie (CG), if the rate of glycerin on an empty stomach is ≥1 .26 g/l or at any time of day≥ 2 g/l, an A1C test was performed, so it was considered diabetic, any patient who has been already known as diabetic or having a HbA1c≥ 6.5%. Variables such as the type of TBK, the clinical and radiological characteristics were collected and analyzed (Epi Info).Results: The prevalence of the diabetes was about 36% (94), 64% are known as diabetics and 36% are recently diagnosed. The domination was male with an average age of 50 ± 14.97. Radiologically, the basic damage and diffuse lesions were significantly associated with the existence of a diabetes compared to non-diabetic patients (p = 0.0001). Regarding the therapeutic results, we detected a higher relapse rate (21%, p=0.01), a failure rate of 12% (p = 0.01) and 7% of resistance (P: 0.02). Health-giving was significantly associated with non-diabetic persons (TND)(P <0.0001).Conclusion: We noticed a high prevalence of diabetes among TBK patients. The diabetic patients have most severe forms of tuberculosis; atypical locations and often widespread radiological abnormalities often extended.Â
Adrenal Metastases from Thyroid Cancers: Three Personal Cases and Literature Review
No full textIntroduction: Adrenal glands are not a common site for thyroid cancer (TC) metastases. Our aim was to report three adrenal masses, which are likely to be metastases from aggressive thyroid cancers.Case Reports: Case1: a woman aged 57 harboring an anaplastic TC staged T4b, N1b, M0, consulted for severe fatigue. Clinical examination noted skin hyper pigmentation and a large thyroid mass. Hormonal assessment showed adrenal insufficiency, thyroglobulin =1.4ng/ml. Radiological exploration demonstrated diffuse metastases with two large adrenal tumors (AT) which did not fix radioiodine. According to the context AT were likely to be metastases. She died one month later.Case 2: a woman aged 56 was referred for oncocytic papillary TC with pulmonary and bone metastases. Thyroglobulin was 450ng/ml. Total body scan showed diffuse metastases with adrenal localizations. Those did not fix radioiodine. Adrenals’ fine nodule aspiration confirmed the thyroid origin. One year later, she is still alive, but with a profound degradation of her general condition.Case 3: a 53 year-old woman was sent for a suspect thyroid nodule. Radiological explorations showed diffuse metastases, except for adrenals ones. After surgery, the papillary TC was confirmed (stage T4N1M1, thyroglobulin=450ng/ml). Some months later a right adrenal mass appeared. That one did not fix radioiodine. The patient died 2 years later.Conclusion: The three observations seem worth to be reported for their rarity and for the possible association to adrenal insufficiency. That one may worsen the poor prognosis as adrenal metastases are observed in aggressive forms
Serum Level of Interleukin-17 in Autoimmune Hepatitis in Children
No full textBackground/Aims: Autoimmune hepatitis (AIH) is a chronic, generally progressive inflammatory disease of the liver that affects both adults and children. Th17 cells can produce multiple cytokines including IL-17A (also known as IL-17), IL-17F, IL-21 and IL-22. IL-17, a major effector cytokine of Th17 cells, is involved in mobilizing, recruiting, and activating neutrophils and leads to massive tissue inflammation. IL-17, a major effector cytokine of Th17 cells, is involved in mobilizing, recruiting, and activating neutrophils and leads to massive tissue inflammation. The aim is to estimate the serum level of Interleukin-17 (IL17) in children with autoimmune hepatitis (AIH) to investigate its possible role in the pathogenesis of AIH.Patients and Method: Ninety children, sixty of them were recruited from the outpatient and inpatient clinics of Pediatric Hepatology department – National Liver Institute from October 2011 till October 2012 and thirty of them were volunteers from a school. Investigated for the diagnosis of chronic liver diseases and serum level IL17.Results: IL-17 serum level was significantly higher in AIH group than CLD and control groups. It was significantly higher in non-responders AIH than responders. IL-17 level at cutoff value of 99.95 pg/ml can discriminate between AIH and non-AIH groups with 96.7% sensitivity, 95% specificity, 90.9% positive predictive value (PPV), 100% negative predictive value (NPV) and 96.6% accuracy.Conclusion: IL-17 serum level was significantly higher in children with autoimmune hepatitis (AIH). New lines of treatment can emerge targeting Th17 cells and IL-17 in order to reduce the ongoing autoimmune inflammatory process in the liver and to prevent progression of fibrosis
New Technology in Colorectal Cancer-a Boon or a Bane
No full textBetter patient care in today’s world is almost synonymous with newer technology. Newer technology in the form of latest gadgets used for diagnostics, preoperative work up; per-operative care and post operative smooth recovery have become the part and parcel of our standard day to day quality care and any practitioner, nowadays, refusing to incorporate these gadgets in his day to day practice is labeled as orthodox and an outdated clinician.We as service providers need to be technology friendly and at the same time try to use these gadgets for quality care and cure. We have to be the ones guiding the technology rather than being guided by the technology. But probably many a times that may not be true in day to day practice with most of us. With the result we have allowed the technology to be our bad master rather than utilizing its services as a good servant and probably in the name of better care many a times the new technology is used abusively rather than genuinely and the ultimate impact may not only be financial but even the physical; and the sole sufferer is the end user; that is the patient. I will in my article try to weigh the pros and cons of this theme and try to come out with a balanced conclusion for the worthy readers
An Unusual Case of Appendicitis: “Trauma†Appendicitis?
No full textAcute appendicitis is a frequent clinical entity around the world being the most common abdominal surgical emergency. Even though its principal etiology is luminal obstructive, there are cases of non-obstructive appendicitis where we can find abdominal trauma. We present a case of a 61 years old patient with complaints of abdominal pain over the past ten months and weight loss of 25 kilograms with history of a car accident. He also had a CT scan where an inflammatory process at intestinal level was reported. After doing an exploratory laparotomy, appendicitis in the mesoileum was found performing an appendectomy. After the symptoms reappeared, the patient was intervened once again performing an ileal resection in the same region and five days later after a dehiscence, an ileostomy was performed in the same place of the last anastomosis. Eight months later the ileostomy was closed and the gastrointestinal transit was reestablished. Nowadays, the patient in his last control one year later was healthy
Prognosis of Renal Function, Risk of Dialysis and Mortality in HIV Patients Developing Moderate Impaired Renal Function During Treatment with Tenofovir or Abacavir
No full textBackground: Impaired renal function is a concern in HIV-infected patients treated with tenofovir. We undertook this study to investigate the prognosis ofrenal function, risk of dialysis and mortality in HIV patients developing moderately reduced renal function while on tenofovir or abacavir.Methods: From a population based cohort of Danish HIV patients, we identified all patients who for the first time had an estimated glomerular filtration rate (eGFR)<50 ml/min per 1.73 m2 while on tenofovir or abacavir. We calculated median eGFR and the fraction of patients with eGFR<60 ml/min per 1.73 m2 during followup in the two groups. Cox regression was used to estimate unadjusted and adjusted mortality rate ratios (MRR).Results: We identified 61 patients on tenofovir and 55 on abacavir who developed impaired renal function. Throughout the 2-year study period, the tenofovir group contributed with 87.6 years and the abacavir group with 79.4 years of follow-up. We found no difference between the groups regarding median eGFR or proportions of patients having eGFR <60 ml/min per 1.73 m2 over time. Five patients in the tenofovir group and two in the abacavir group initiated dialyses within two years after study inclusion. Our study did not indicate that the tenofovir group had increased risk of death (adjusted MRR=0.66, 95% CI: 0.37-1.17).Conclusions: Within the current clinical setting, we were not able to detect a statistical significant difference in renal outcome and mortality between patients developing reduced renal function while on tenofovir or abacavir
Formulation and Evaluation of Mucoadhesive Thermosensitive in situ Gel of Tenofovir Disoproxil Fumarate for Pre-Exposure Prophylaxis Against HIV
No full textPre-exposure prophylaxis (PrEP) is one of the best preventive strategies in protection against HIV/AIDS. The present research approach is development of novel topical thermosensitive mucoadhesive in situ gel for intravaginal use. Tenofovir disoproxil fumarate (TDF) has been loaded in the formulation and cold method was followed to prepare the various formulations. Pluronic® F-127and Pluronic® F-68 polymers were used. Hydroxypropylmethyl cellulose (HPMC E50) was added in some of the formulations as a mucoadhesive and viscosity enhancing polymer. Drug-polymer compatibility studies were carried out prior to formulation. The formulations were evaluated for clarity, gelation temperature (tgel), pH, rheology, drug content, spreadability, force of mucoadhesion, retention time, in vitro release, release kinetics and curve fitting. Formulation A3 was found as the most suitable formulation based on the evaluation parameters, as it exhibited the desired properties. The release kinetics studies suggested that A3 followed Higuchi model. Formulation A3 was subjected to accelerated stability studies at 40 oC ± 2 oC /75% RH ± 5% RH for 6 months. The results indicated that it remained stable for 6 months. The study concludes that due to the ease of application, mucoadhesion and prolonged contact time, patient compliance may be improved and better protection achieved
Compulsory Treatment for Anorexia Nervosa in Israel: Clinical Outcomes and Compliance.
No full textObjective: Anorexia nervosa (AN) is associated with high morbidity and mortality rates, sometimes requiring compulsory treatment when patients refuse treatment despite life-threatening complications. Compulsory treatment of AN patients involving legal commitment is controversial in Israel, both ethically and legislatively. This study aimed to conduct a comprehensive retrospective examination of patient records to compare compulsory versus voluntary admissions regarding illness severity, admission, hospitalization, and outcomes.Method: Participants were 51 voluntary and 28 committed patients with severe AN admitted to a major Israeli ED department in 2003-2013. Demographic, clinical, physical, historical, and outcome data were collected through patients’ charts.Results: No significant group differences emerged between the groups in most variables. Two main differences were found: Committed patients had higher rates of comorbid personality disorders (33% vs. 10%) and significantly more disturbed nutrition patterns (44% vs. 26%) than voluntary patients. The two groups showed similar treatment outcomes in terms of weight gain (M = 9.7 kg), mortality rate (7.6%), and rehabilitation after hospitalization (15.2%).Conclusions: Results indicate that compulsory treatment may be as beneficial as voluntary treatment, both in the short and long term. After their initial resistance, compulsory patients were found to comply with the treatment and remain in the ED center to the same extent as those admitted voluntarily. Thus, compulsory hospitalization may reduce such patients' guilt about accepting nutrition and treatment. Compulsory treatment for severe life-threatening AN may save lives and should be implemented more commonly and earlier