International Journal of Research in Medical Sciences
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Treatment of well-differentiated invasive squamous cell carcinoma of the skull and reconstruction by ultrathin anterolateral thigh flap
Full text linkInvasive squamous cell carcinoma is an aggressive form of skin cancer that requires radical surgical treatment and reconstruction. This article presents a clinical case of a 74-year-old patient with well-differentiated invasive squamous cell carcinoma of the skull, treated with surgical resection and reconstruction using an ultrathin anterolateral thigh flap. Reconstruction with an ultrathin anterolateral thigh flap is an effective therapeutic option that can offer numerous benefits and advantages for patients, improving their quality of life and their ability to carry out daily activities. This reconstructive technique allows for the restoration of the shape and function of the skull and face, minimizes morbidity and complications, and enhances facial aesthetics. Timely and effective treatment of invasive squamous cell carcinoma through reconstruction with an ultrathin anterolateral thigh flap can significantly improve the patient's survival and quality of life. In conclusion, the ultrathin anterolateral thigh flap is an excellent reconstructive option for patients with scalp defects secondary to extensive oncological resections
Investigating the effects of vitamin D3 on clinical outcomes in newly diagnosed acute myeloid leukemia
Full text linkBackground: Acute myeloid leukemia (AML) is a hematologic malignancy with poor prognosis. This study investigates the effects of vitamin D3 supplementation on clinical outcomes in newly diagnosed AML patients. To evaluate the impact of vitamin D3 on remission rates, overall survival and quality of life in AML patients.
Methods: A hospital-based prospective cross-sectional study was conducted from January to December 2017, involving 145 newly diagnosed AML patients. Participants were divided into an intervention group receiving standard chemotherapy with oral vitamin D3 supplements and a control group receiving only chemotherapy. Clinical and biochemical assessments, including serum vitamin D3 levels, were performed at baseline and monthly for six months. Outcomes measured included remission rates, overall survival and quality of life scores.
Results: The intervention group exhibited higher complete remission rates (69.4% vs. 56.2%, p=0.035) and improved overall survival (median survival of 18.2 months vs. 12.5 months, p=0.045). Quality of life scores were significantly better in the intervention group across multiple domains. Serum vitamin D3 levels increased significantly after three and six months of supplementation (p<0.001). The incidence of adverse effects was similar between groups.
Conclusions: Vitamin D3 supplementation positively influences remission rates, overall survival and quality of life in newly diagnosed AML patients, suggesting its potential role as an adjunct therapy. Further large-scale, multi-center trials are needed to confirm these findings and explore the mechanisms behind the effects of vitamin D3 on AML
Ultrasonographic approach to diagnosing coarctation of the aorta: case report
Full text linkCoarctation is the narrowing of the isthmus or aortic arch. It accounts for approximately 8% of all congenital heart defects; it is a cause of morbidity and mortality if not diagnosed early. Although it is a common congenital cardiac defect, it remains one of the most challenging cardiac defects to diagnose prenatally. Which is why the objective of this case report is to present a prenatal diagnosis of coarctation of the aorta and show how prenatal diagnosis with proper counseling can optimize management, and that learning about the ultrasonographic characteristics that raises suspicion of coarctation of the aorta and referring the patient to a maternal fetal medicine-specialist is a fundamental key to the diagnosis
The effect of antiplatelet drugs on the management of cardiovascular diseases
Full text linkCardiovascular diseases (CVDs) are the leading global cause of mortality, necessitating innovative strategies for prevention, diagnosis, and treatment. Antiplatelet drugs play a vital role in mitigating adverse atherothrombotic events by inhibiting platelet aggregation, crucial for managing conditions such as myocardial infarction, ischemic stroke, and peripheral artery disease. Platelets, essential for haemostasis, also contribute to thrombus formation in vascular injury and disease. Their activation is triggered by stimuli like collagen, thrombin, and adenosine diphosphate (ADP). Antiplatelet drugs target these pathways to prevent arterial thrombosis. Key classes of antiplatelet agents include cyclooxygenase inhibitors, P2Y12 receptor antagonists, glycoprotein IIb/IIIa inhibitors, and phosphodiesterase inhibitors. Aspirin, a COX-1 inhibitor, irreversibly blocks thromboxane A2 production, effectively reducing recurrent cardiovascular events, though its role in primary prevention is tempered by bleeding risks. P2Y12 inhibitors, such as clopidogrel, prasugrel, and ticagrelor, suppress ADP-mediated platelet activation, with newer agents providing consistent efficacy but higher bleeding risk. Dual antiplatelet therapy, combining aspirin and a P2Y12 inhibitor, is the standard for acute coronary syndrome and post-PCI management. Challenges, including bleeding and resistance, underscore the need for personalized approaches using pharmacogenomics. Ongoing research aims to develop safer, targeted therapies, including thrombin receptor blockers and novel combination regimens
Evolution of breast reconstruction in a tertiary care hospital in Mexico
Full text linkBackground: This study was performed to analyze the trends in breast reconstruction techniques over time, focusing on their evolution and comparing them with findings from previous studies.
Methods: This retrospective study analyzed breast reconstruction procedures performed at the Plastic Surgery Department of the General Hospital of Mexico from January 2019 to December 2023. A total of 105 patients were included, focusing on patient demographics, procedure types, common histological subtypes, observed complications and trends in reconstruction techniques within the hospital and nationally.
Results: The study included 105 patients with a mean age of 49 years, the 41–50 age group being the most prevalent (38.1%). A total of 105 reconstructive procedures were performed: latissimus dorsi flap in 69 patients (65.7%), TRAM flap in 21 patients (20%) and DIEP flap in 7 patients (6.7%). For alloplastic reconstructions, tissue expanders were used in 38 cases (36.2%) and implants in 36 cases (34.3%). Most patients (81.9%) had no complications; necrosis was the most common complication (6.7%). Radiotherapy was administered to 43 patients (41%), while 68 patients (64.8%) underwent chemotherapy. The most common oncological cause was ductal carcinoma (65.7%).
Conclusions: Breast reconstruction at the General Hospital of Mexico has evolved toward safer and more effective procedures, tailored to the specific needs of each patient. The use of alloplastic methods and latissimus dorsi flaps predominates, reflecting global trends in breast reconstruction and highlighting progress in local surgical practices
Evaluation of thrombocytopenia in systemic lupus erythematosus patients in a tertiary care hospital: clinical implications and prognostic significance
Full text linkBackground: Thrombocytopenia is a common hematological complication in systemic lupus erythematosus (SLE), associated with increased disease severity and adverse outcomes. This study aimed to evaluate the clinical implications and prognostic significance of thrombocytopenia in SLE patients at a tertiary care hospital in Bangladesh.
Methods: A cross-sectional study was conducted at the Sir Salimullah Medical College Mitford Hospital with 42 SLE patients. Data were collected on demographic characteristics, medical history, risk factors, clinical assessments, laboratory findings, and treatment outcomes. Statistical analyses were performed to identify associations between thrombocytopenia, disease severity, and outcomes.
Results: The study population was predominantly female (73.81%) and aged 25-34 years (52.38%). Thrombocytopenia was present with a mean platelet count of 54,523±648.97/μl, and symptoms included easy bruising (35.71%) and petechiae (45.24%). Severe disease activity was observed in 80.95% of patients, with frequent hospitalizations and poor prognostic outcomes significantly associated with thrombocytopenia (p<0.05). Shorter disease duration correlated with more severe symptoms (r=0.52, p=0.018), and fewer disease flares were linked to better prognoses (r=0.49, p=0.015). Standard therapies yielded limited improvement, with 30.95% showing improvement, 33.33% experiencing no change, and 35.71% worsening.
Conclusions: Thrombocytopenia is a significant marker of disease burden and poor outcomes in SLE patients. Comprehensive monitoring and personalized management strategies are essential to address its clinical and prognostic implications, particularly in resource-constrained settings
Prophylactic fibulotomy during external fixation for tibia fractures: a retrospective study on reducing nonunion incidence
Full text linkBackground: Tibial fractures are prevalent long bone injuries that can result in nonunion, especially when treated with external fixation. Prophylactic fibulotomy has been suggested to improve fracture healing. This study evaluates the effectiveness of prophylactic fibulotomy in reducing nonunion rates in patients undergoing external fixation for tibial fractures.
Methods: A retrospective cohort study was conducted at the National Orthopaedic Hospital, Igbobi, Lagos, Nigeria, analyzing patient records from January 2022 to December 2024. Associations between prophylactic fibulotomy and postoperative complications were assessed using chi-square tests, while t-tests compared time to union between fibulotomy and non-fibulotomy groups. A p value of less than 0.05 was considered statistically significant.
Results: The study included 60 patients, predominantly males (53.3%) aged 40 years and above (58.3%). Distal fractures were most common (36.7%). Union was achieved in 70.0% of cases, with a significant association between fibulotomy and union status (χ²=18.367, p<0.005). The mean time to union was 15.8±1.4 weeks for patients who underwent fibulotomy, compared to 18.2±1.8 weeks for those who did not, indicating a significant difference (t=-5.179, p<0.05).
Conclusions: Prophylactic fibulotomy during external fixation of tibial fractures is associated with higher union rates and shorter time to union, suggesting it may be a beneficial adjunctive procedure in managing tibial fractures requiring external fixation
Incidence of Rh alloimmunisation and its effects on pregnancy outcome in a tertiary care hospital
Full text linkBackground: Red cell alloimmunization results from transplacental passage of maternal antibodies that destroy fetal red cells. The aim of the study is to determine incidence, maternal and perinatal outcome in Rh negative pregnancy.
Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Shri Lal Bahadur Shastri Medical College, Mandi, Himachal Pradesh for period of one year from 01 January 2024 to 31 December 2024. All the pregnant women admitted in labour ward with Rh negative pregnancy were included in the study.
Results: The incidence of Rh negative pregnancy was 6.1% in one-year study period. Most common age group was 26-30 years comprising 42.8% cases. Majority of the patients were multipara (53.57%). Only 1.78% Rh negative pregnant women had positive indirect Coombs test. One patient was delivered at 34 weeks of gestation, 3 (1.33%) at 36 weeks and 220 (98.21%) at term (37-40) weeks of gestation. About 10.71% neonates had neonatal jaundice, 87.05% neonates had uneventful neonatal outcome.
Conclusions: Early detection, timely intervention and motivation of the Rh negative patients can prevent maternal, fetal and neonatal complications
Pancreatic cancer in the United States: a retrospective study of incidence patterns
Full text linkBackground: The seventh most common cause of cancer-related deaths globally is pancreatic cancer. The 5-year survival rate for pancreatic cancer is about 12%, despite advances in its identification and treatment. The present study thus aims to perform an age, gender, race, and state-wise distribution trend analysis of pancreatic cancer incidence in the US from 1999 to 2020.
Methods: The present study is a retrospective research study conducted using the CDC-WONDER database to investigate trends in pancreatic cancer incidence by age, gender, and race from 1999 to 2020. The data was extracted on 18 May 2024, based on temporal trends, demography, and exported to a Microsoft excel sheet. Statistical analysis was done using R version 4.3.1. The figures/graphs were created using GG plot 2, version 3.5.0.
Results: From 1999 to 2020, pancreatic cancer occurred in 919,317 individuals (0.0137%) out of a population of 6,722,531,044, with a crude rate of 13.7 per 100,000. The highest incidence was observed in individuals over 75 years (38.63%), followed by the 65-74 age group (29.02%). Both males and females showed nearly equal incidence rates, while Whites had the highest incidence (83.76%), followed by African Americans (12.22%). Temporal trends indicate increasing incidence overall, particularly among the elderly and Whites, with state-wise highest incidences in California, Florida, and New York.
Conclusion: In summary, the incidence of pancreatic cancer has been increasing for years. Analysis of pancreatic cancer epidemiology and modifiable risk factors can help to determine the preventive measures to reduce pancreatic cancer among the population worldwide
HELLP syndrome: critical insights from a post-cesarean involving rapid hemoglobin drop
Full text linkHELLP (Hemolysis, elevated liver enzymes and low platelets) syndrome is a severe form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count. It can lead to significant maternal morbidity and mortality if not promptly diagnosed and treated. A 32-year-old female, G2P1A0L1, at 38 weeks gestation, presented with labor-like pain, vaginal leaking, lower limb edema, and high blood pressure. She was diagnosed with severe preeclampsia and underwent an emergency cesarean section. Post-operatively, her hemoglobin dropped from 13 g/dL to 6 g/dL despite blood transfusions. Imaging and tests excluded internal bleeding but revealed mild pleural effusion and pelvic fluid collection. Liver function tests revealed thrombocytopenia and increased liver enzymes, which led to a diagnosis of HELLP syndrome. Supportive treatment with fresh frozen plasma, platelets, and packed RBCs was administered. Early identification and treatment of HELLP syndrome is necessary in patients with severe preeclampsia and notable postoperative hemoglobin reduction. Supportive treatment led to clinical improvement and normalization of this patient's hemoglobin levels, blood pressure, liver enzymes, and platelet counts