Australasian Medical Journal
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Correlation between pH studies and oesophageal multichannel intraluminal impedance in the evaluation of typical gastro-oesophageal reflux
Get PDFBackground [In additional to accepted 24-hour ambulatory pH studies, multichannel intraluminal impedance testing is thought to improve pre-operative assessment and aid diagnosis of atypical reflux-related symptoms. While a measure of concordance between the results of these two tests is expected, as both aim to detect the same phenomenon of reflux, the actual concordance between pH study results and impedance values in typical reflux-related symptoms is unknown.] Aims To assess the correlation between pH studies and impedance testing in patients with typical reflux symptoms. Methods 100 consecutive patients undergoing oesophageal physiology testing for typical reflux symptoms of heartburn or regurgitation were reviewed. All patients were required to cease acid suppressant and promotility agents at least 7 days prior. Pre-study localisation of the lower oesophageal sphincter was made manometrically. All patients were encouraged to ingest a refluxogenic challenge meal during the study period. Reflux episodes noted during meal times were excluded. Pearson’s correlation co-efficient was calculated for catheter-based 24-hour pH results compared to 8-channel intraluminal oesophageal impedance values. Common descriptors of association between the two tests’ results were calculated. Results Correlation between Demeester composite score and total number of impedance detected reflux events was r = 0.4015. The positive predictive value of impedance for Demeester score > 14.72 was 83%. The sensitivity of abnormal impedance testing for detecting abnormal Demeester score was 15.63% and the specificity was 94.4%. Conclusion There is poor correlation between 24-hour pH results and impedance scores. Therefore, the utility of impedance assessment for typical reflux symptoms is poor
Hemodynamic Monitoring In Critically Ill Patients in Paediatric ICU
Get PDFBackground: Monitoring hemodynamics in septic shock in pediatric age group. Aim of study was to compare the effects of dopamine, nor-epinephrine and epinephrine. Results: Sixty patients were divided into three groups according to vasoactive drug used dopamine, adrenaline or noradrenaline and subjected to measure cardiac functions by echocardiography Differences between three groups were significant regarding vital data (MAP) and echocardiography parameters (EF & FS & SV) and blood gases and oxygenation paramaters (P-valu
Clinical value of 3D printing and virtual reality tools in pre-surgical planning of pancreatic cancer resectability
No full textBackground Pancreatic cancer has a high mortality rate and the only definitive management currently available is tumour resection. A patient-specific 3D model such as 3D-printed and virtual reality may be useful as an adjunct planning tool to the standard preoperative planning stages of pancreatic cancer resections. Aim This study aims to assess the clinical value of patient-specific 3D printed models and virtual reality visualisation in pre-surgical planning of pancreatic cancer resectability. Methods A CT scan of an anonymised pancreatic cancer case was selected with images post-processed segmented, and converted into a 3D printed model as well as a virtual reality visualisation. Both were presented to a group of 6 clinicians who specialise in the diagnosis and treatment of pancreatic cancer. Expert opinions were obtained by asking the participants to complete questionnaires on the clinical value of these models as a preoperative planning adjunct. Results Five out of six (83%) participants agreed that the virtual reality tool was of more valuable compared to the 3D printed model when it comes to preoperative planning of pancreatic cancer resections. Similarly, 83% also agreed the virtual reality was more useful in understanding the depth perception and spatial relationship between anatomical structures. There is potential for patient-specific 3D models to increase surgical safety, overcome minute anatomical discrepancies and plan complex surgical procedures. Conclusion This study demonstrates the clinical value of patient-specific models (3D printed and virtual reality) in the preoperative planning stages of pancreatic cancer resection. The models enhance understanding of the tumour’s location and its relation to the surrounding anatomy. The models offer the option of manipulating the anatomy in a 3D plane, either tactilely (3D printed) or via controllers (virtual reality). Future research could include assessing the clinical value of 3D models in pancreatic cancer patients with complex anatomical discrepancies.
Factors Associated with Treatment Failure of Interstitial Lung Disease among Patients in KSA: A Systematic Review
Get PDFBackground: Interstitial lung disease (ILD) is a heterogeneous group of lung disorders characterized by inflammation and fibrosis of the lung interstitium. The treatment of ILD is complex, and failure to respond to therapy is associated with poor outcomes. The aim of this systematic review is to identify the factors associated with treatment failure of ILD among patients in the Kingdom of Saudi Arabia (KSA). Methods: A systematic search of the literature was conducted using electronic databases, including PubMed, Scopus, and Embase. Articles published between January 2010 and December 2021 that met the inclusion criteria were reviewed. The search strategy included a combination of keywords and medical subject headings (MeSH) terms related to ILD and treatment failure. Results: A total of 4 studies met the inclusion criteria and were included in this systematic review. The studies included 1,477 patients with various types of ILD. The factors associated with treatment failure of ILD among patients in KSA include older age, male gender, disease severity, comorbidities, smoking, and abnormal pulmonary function tests. The most commonly used medications were corticosteroids, azathioprine, mycophenolate mofetil, and cyclophosphamide. Some studies reported the use of newer agents, such as pirfenidone and nintedanib, with varying degrees of success. Conclusion: This research suggests early diagnosis, tailored treatment programs, and a multidisciplinary strategy comprising pulmonologists, rheumatologists, radiologists, and pathologists to enhance ILD therapy in KSA. To enhance ILD outcomes and quality of life, future research should investigate ILD mechanisms and create more effective treatment techniques. This systematic review helps doctors and policymakers in KSA and other countries manage ILD better
Prevalence of Breast Tumors and Methods of Prevention: A Cross-sectional Study
Get PDFBackground: Breast cancer is one of the most prevalent forms of cancer in women and one of the most severe and significant public health concerns in developing nations. This study aimed to determine the prevalence of breast tumors and women’s preventive behavior. Methods: A descriptive, correlational cross-sectional design was employed for this study. The study was conducted at (jeddah). Participants were selected during the period from September to November 2022. Population of this study were adult women (Aged >18 years) at KSA. Study instruments consisted of the following domains sociodemographic data, anthropometric measurements, information related to menstrual cycle and pregnancy, obstetric history, family history, practices of breast self-examination, procedures of early detection and knowledge, attitude and practice assessment for methods of prevention. Results: The study included 420 women of different ages. Breast cancer was found among 82 women (19.5%). The mean age among all study participants was 33.96 + 14.79 years with median age of 28 years. More than half of study participants had normal BMI (n= 220, 52.4%) while third participants were overweight (n= 136, 32.4%). Among participants, 18.1% had a history of post-partum complications, 38.3% had undergone previous surgery, 1.4% had experienced vascular moles, 18.6% had a history of fibroid uterus, 6% had cervical polyps, and 5% had endometriosis. Table 3 presents obstetric history among study participants. More than half of study participants underwent previous hysteroscopy (n= 235, 56%). On the other hand, 81 women had a family history of breast cancer (19.3%). Most of women in this study perform self-examination of the breast (n= 300, 71.4%) and 102 women underwent fine needle aspiration procedure (FNA) (24.3%). The FNA result was positive among 81 women. Furthermore, 124 women underwent mammography (29.5%) and the result was positive among 67 participants. Breast cancer is found among 82 women (19.5%). Women in this study agreed that they should have clinical breast examination at any time (n= 191, 45.5%) while other women believed they should have this examination in certain circumstances such as mastodynia (n= 61, 14.5%), history of benign breast tumors (n= 38, 9%), obesity (n= 37, 8.8%) and family history of breast cancer (n= 32, 7.6%). Conclusion: Breast cancer prevalence was 19.5%. Urban residency was predominant, with varying educational levels. Marital status, income, family size, and work differed among participants. Chronic conditions and diverse anthropometric measurements were observed. Obstetric history showed early marriage and delivery ages, limited abortions, and varied complications. Family history indicated links to chronic diseases and cancers. Participants exhibited awareness about breast cancer risk factors and methods for early detection
Glucagon-Like Peptide 1 Receptor Agonist and Cancer. Meta-analysis and Review
Get PDFAbstract
Background:
Diabetes is a medical condition known and diagnosed when the human body does not use the insulin hormone effectively. This causes blood sugar levels to rise. There are 2 diabetes types. Oral hypoglycemic drugs are used in the treatment of type 2 diabetes mellitus (T2DM) while insulin used in treatment of type 1 diabetes.
Method:
Medline and Clinical Trials were searched to identify randomized controlled trials that reported cancer events in T2DM patients treated with glucagon like peptide 1 receptor agonists (GLP 1RAs). Odds ratio (OR) with 95 percent Confidence Interval (CI) was calculated for overall cancer (primary outcome), thyroid cancer and compare the results with pancreatitis.
Results:
A total of 11 eligible trials were identified. The OR for overall thyroid cancer associated with GLP 1RAs was 0.004 (95 percent CI 0.003–0.005;
