Journal of Medical Research and Innovation (JMRI)
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A systematic review and utilization study of digital stethoscopes for cardiopulmonary assessments
Full text linkObjectives: The demand for cardiopulmonary assessment via real-time live streaming is prevalent in remote communities of British Columbia, Canada. Digital stethoscopes enable remote assessments, but the difference in quality compared to conventional assessments is unknown. Objectives were to explore published literature for real-time remote audio and video streaming of cardiopulmonary assessments via digital stethoscopes, and evaluate the quality of digital stethoscopes for remote cardiopulmonary assessments as compared to conventional stethoscopes in a Cardiac Virtual health Assessments (CaViAs) project.
Materials and Methods: CaViAs included evaluation of quality and utility of three digital stethoscope devices, three digital platforms/applications, three noise-cancelling headsets, and two Internet-enabled devices with one technical operator and one evaluator. A comprehensive search for “digital stethoscope*” was conducted in PubMed, Science Direct, CINAHL, TRIP, Open Grey and ClinicalTrials.gov in February 2021 for relevant peer reviewed studies. Studies were screened for eligibility and inclusion based on population, intervention, comparator, outcome and study design criteria and utilizing Preferred Reporting Items for Systematic reviews and Meta-Analysis, and assessed for methodological quality using Critical Appraisal Skills Programme for Randomized Controlled Trials. Studies were eligible if they included adult humans undergoing cardiopulmonary assessment with digital stethoscopes compared to conventional stethoscopes to test the audio quality and ease of use of digital stethoscopes via real-time remote audio and video streaming across a distance.
Results: Of 238 articles identified, only one study of poor methodological quality was found that fulfilled all inclusion criteria. This study rated the quality of digital stethoscopes as good or very good. In the CaViAs project, the Eko Duo digital stethoscope in combination with the Eko ECG application, streamed between two Cisco DX 80 devices, and using the Plantronics Voyager 8200 performed the best. Limitations included having only one reviewer for title and abstract screening and data extraction; hearing is subjective; a validated tool for quality testing was not used; and auscultation in general has several limitations.
Conclusion: There is a gap in literature to help inform decision-making in choosing digital stethoscopes that are best for real-time virtual remote outreach for cardiopulmonary assessments. For best results, digital stethoscopes should be used in conjunction with equipment that optimize audio and ease of use.
This article was published by Scientific Scholar and has been archived here. DOI of the article is 10.25259/JMRI_2_2021
Acute pancreatitis following Pfizer-BioNTech COVID-19 vaccine
Full text linkThe coronavirus disease of 2019 (COVID-19) discovered in China in early December 2019. The Saudi Food and Drug Authority approved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020, and on May 10, 2021, Pfizer-BioNTech was given emergency authorization for use of the vaccine in children aged 12 to 15 years. Saudi Arabia’s Ministry of Health started the vaccination phase for ages 12 to 18 years for the Pfizer-BioNTech COVID-19 vaccine on June 27, 2021. An insulin-dependent diabetic 15-year-old female patient admitted to the medical ward diagnosed with acute pancreatitis nine days after being administered her first dose of the Pfizer-BioNTech COVID-19 vaccine. She presented with an amylase level of 340 U/L, lipase level of 937 U/L. She was discharged after eight days of hospitalization with no complications. Medical investigations were unable to link the diagnosis to any known etiology. Medical journals have reported numerous cases of acute pancreatitis in the adult population after Pfizer-BioNTech COVID-19 vaccination. We believe that our case is the first to present with acute pancreatitis after the first dose of the Pfizer-BioNTech COVID-19 vaccine in a teenager population
Design and efficacy of a novel low-cost ventilator: A feasibility study on artificial lungs
Full text linkObjectives: The emergent need for ventilators amidst the COVID-19 pandemic has catalyzed the production of innovative ventilator designs in hopes to optimize supply, manufacturing, ease of use, and cost in disaster situations. We created a novel and low-cost ventilator called QuantumAir, which uses “choked flow” to perform volume assist-control ventilation.
Methods and Material: To evaluate the efficacy and safety of QuantumAir, we tested the ventilator across eight test cases on a lung simulator, with each test case trial lasting for at least 24 breath cycles. Delivered tidal volumes, peak inspiratory pressures, and plateau pressures were measured, and linear regression models were used to assess for non-inferiority of the QuantumAir ventilator as compared to that of a Food and Drug Administration (FDA)-cleared ventilator.
Results: For each of the test cases, the standard deviation for the tidal volumes delivered during the 24 measured breaths on the QuantumAir ranged from 0.11 to 0.80 mL. The QuantumAir was found to be non-inferior to the FDA-cleared ventilator for both delivered tidal volumes and plateau pressures across all test cases and non-inferior for peak inspiratory pressures in six of the eight test cases.
Conclusion: Although future in vivo studies are still needed, our data shows promise to offer a more affordable solution to mechanical ventilation in resource-limited situations, as was experienced during the peak of the COVID-19 pandemic
The kaleidoscope of autoimmunity: A report of 10 cases of multiple autoimmune syndrome
No full textDear Sir,
Multiple autoimmune syndrome has been defined as the coexistence of at least three autoimmune disorders in a single patient.[1] Dermatological autoimmune disorders, especially vitiligo, take a special seat in the setting of multiple autoimmune syndrome.[2] There is strong evidence to suggest that the various autoimmune disorders have a common origin and share similar pathophysiological mechanisms. Therefore, the presence of one autoimmune disorder in an individual makes him/her susceptible to the development of other autoimmune disorders.[3] Herein, we report 10 cases of multiple autoimmune syndrome that presented to the dermatology department of our hospital.
The patients’ details are shown in [Table 1]. Females made up majority of the cases in our series with seven patients while there were only three male patients. The age of the patients ranged from 19 to 60 years. Seven patients had three autoimmune disorders, two patients had four, and one patient had five coexisting autoimmune disorders. Autoimmune thyroid disease was the most common disorder in our case series which was present in seven patients. The diagnoses of vitiligo, psoriasis, alopecia areata, and lichen planus were confirmed with clinical examination and dermoscopy along with histopathological examination. In addition to these, specific antibody testing was carried out for systemic sclerosis, systemic lupus erythematosus, pemphigus vulgaris, and bullous pemphigoid. Triiodothyronine, tetraiodothyronine, thyroid-stimulating hormone, and antithyroid peroxidase antibody levels were carried out for autoimmune thyroid disease while fasting blood glucose, serum insulin levels, and serum C-peptide levels were measured for type 1 diabetes mellitus. The diagnosis of rheumatoid arthritis was based on clinical, radiological, and immunological testing.
Disorders with an autoimmune pathogenesis occur with increased frequency in patients already suffering from another autoimmune disease.[4] The term polyautoimmunity has been proposed for this association of autoimmune disorders. This term also encompasses the probable common origin of these disorders.[5] Multiple autoimmune syndrome showcases the kaleidoscope of autoimmunity with at least three autoimmune disorders being present in a single patient. The presence of one autoimmune disease should alert one to watch for presence or subsequent development of another one.
To sum up, this study indicates that autoimmune hypothyroidism, type 1 diabetes mellitus, and rheumatoid arthritis are the most common systemic associations of the autoimmune dermatological disorders. Hence, a patient presenting with features of skin autoimmunity must be investigated for these conditions.
Declaration of patient consent
Patient’s consent not required as patient’s identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest
Do older adult cancer survivors experience worse health-related quality of life in comparison to middle-aged cancer survivors? A secondary data analysis of the 2014 behavioral risk factor surveillance study
Full text linkObjectives: The primary aim of this paper was to examine the potential differences in health-related quality of life (HRQOL) between middle-aged (45–64 years old) and older adult (65 years and older) cancer survivors utilizing the contextual model of health-related quality of life.
Methods and Materials: The author conducted a secondary data analysis of the 2014 behavioral risk factor surveillance system cancer survivorship module survey. Only respondents age 45 and older were included, resulting in n = 5656.
Results: Older adult cancer survivors reported significantly better physical and mental HRQOL than middle-aged cancer survivors. In regard to physical HRQOL, respondents who were older adults, employed, completed treatment, and exercised recently were more likely to report good physical HRQOL. Respondents with comorbid conditions and those with greater years since diagnosis were more likely to report poor HRQOL. In regard to mental HRQOL, respondents who were older, married, or had completed treatment were more likely to have good mental HRQOL. Respondents who were unemployed, had experienced financial cost as a barrier to care, had stroke or chronic obstructive pulmonary disorder, or a history of depression were more likely to report poor mental HRQOL.
Conclusion: Older adult cancer survivors experience better mental and physical HRQOL compared to their middle-aged counterparts. Efforts to improve HRQOL in cancer survivors should include middle-aged adults as well as cancer survivors who are unmarried, still in treatment, or have comorbidities. Greater research is needed to better understand how age differentially affects HRQOL in persons with a cancer history.
This paper was published by Scientific Scholar and has been archived here
Acute inflammatory transverse myelitis post-Pfizer-BioNTech-COVID-19 vaccine in 16-year-old
Full text linkCoronavirus disease 2019 (COVID-19) originated in China in early March 2019. Saudi Food and Drug Authority approved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020, and on May 10, 2021, Pfizer-BioNTech was given an authorized emergency use in 12–15-years-old children. Saudi Arabia’s Ministry of Health started Pfizer-BioNTech COVID-19 vaccination for 12–18-years-old on June 27, 2021. Here, we have a case of a 16-year-old female admitted to the medical ward diagnosed with acute inflammatory transverse myelitis after 2 weeks from second dose of the Pfizer-BioNTech COVID-19 vaccine. The diagnosis was based on normal laboratory workup but significant radiological findings. She was discharged after a full recovery. There are multiple cases of post-vaccine acute inflammatory transverse myelitis shared by medical journals, but due to lack of literature review for the teenager population, we think our case may be the first case of acute inflammatory transverse myelitis following second dose of Pfizer-BioNTech COVID-19 vaccine in this population
Genome plasticity and its role in leishmania adaptation and drug resistance
Full text linkObjectives: This literature review aims to summarize the current knowledge regarding the genome plasticity observed within the genome of the Leishmania parasite, and to discuss how genome plasticity contributes to the adaptation of the parasite and to development of a drug resistant state.Materials and Methods: The search terms “Leishmania” and “genome plasticity”, were used to search the PubMed database for relevant papers, published between the years 2000 and 2020.Results: Aneuploidy within the Leishmania genome allows for drug resistance and adaptation to the environment. In addition copy number variation promotes the up regulation of genes conferring drug resistant capabilities to the parasite. Conclusion: Drug-resistant Leishmania mutants display differential patterns of chromosomal somy when compared to wild-type strains. Highlighting a role for mosaic aneuploidy in the development of drug resistance. Leishmania parasites in the amastigote life cycle stage display differential gene copy numbers compared to parasites in the promastigote life cycle stage. Suggesting that copy number variation contributes to parasite adaptation to the environment. *This paper was published by Scientific Scholar and has been archived here.
An interesting case of duplicated common bile duct and its sequelae
Full text linkThe objective of this case report is to highlight the unusual variant of duplicated common bile duct which has important consequences for future operative planning and subsequent medical surveillance for the patient
A novel approach of harvesting concentrated plasma-rich fibrin (PRF) with increased platelet count
Full text linkObjectives: Platelet-rich fibrin (PRF) is an autogenous biomaterial, considered as the second-generation platelet concentrates rich in blood cells and growth factors entrapped in the fibrin matrix, which makes it as an ideal material with wound healing abilities. Studies have reported high harvest of cells using anticoagulants but the present study employs two different protocols to efficiently separate the platelet-rich layer at low centrifugal forces without the use of anticoagulants. Methods and Materials: Blood samples were collected with the consent of 20 volunteer donors. Ten blood samples were tested in each of the protocols studied, that is, protocol 1–200 g for 8 min (higher rpm and time) and protocol 2–60 g for 5 min (lower rpm and time). From the 12 ml of blood samples collected, 2 ml of blood was utilized for whole blood study; the remaining 10 ml was transferred into falcon tubes subjected to different rpm.Results: The present study employs a novel method to investigate segregation of cell types following low-grade centrifugation. One milliliter sequential pipetting technique was used to analyze number of leukocytes and platelets following centrifugation at two different g-forces. The protocols followed in the present study had 2–3-fold increase leukocytes concentration and 10–12-fold increases in platelet concentrations in the layers than the whole blood sample without the use of anticoagulants. Conclusion: The study concludes that protocol 1 was more efficient in harvesting platelets with less concentration of leukocytes, which is considered more suitable for various medical applications
The yearly peak age of the onset of major depressive disorder over the past 5 years at a general hospital in Saudi Arabia
No full textObjectives: Patients with major depressive disorder (MDD) do not exhibit usual mood swings and emotional reactions to difficulties in life. Patients with MDD experience specific symptoms such as decreased mood, loss of interest, and suicidal thoughts, particularly those with moderate, severe, or recurrent MDD. Depression can become a severe health condition, and MDD can lead to significant morbidity and mortality, and functional impairment. A total of 260 million people are diagnosed as having MDD worldwide, with a global prevalence of 3627 per 100,000 individuals.
Methods and Materials: This cross-sectional study recruited 2894 patients who were interviewed at a psychiatric clinic and were diagnosed as having MDD from January 1, 2016, to December 31, 2020, at Hera General Hospital, Makkah, Saudi Arabia. From the hospital’s health information system, we extracted the following data using the patient arrival report for psychiatric clinics.
Results: The mean age of MDD onset was 43 years in Saudi Arabia with a peak age between 35 and 40 years and an average age between 43 and 46 years.
Conclusion: The mean and peak ages of MDD onset in Saudi Arabia differ from those in other countries. Our findings can help set a screening age for depression in the Saudi population in primary healthcare centers