International Journal of Clinical Research
Not a member yet
94 research outputs found
Sort by
The Major Factors Affecting Oocyte Quality in IVF Cycles: A Narrative Review
Get PDFBackground: The role of assisted reproductive technologies, including in-vitro fertilization [IVF], is increasing daily because of the significant rise in subfertility cases. Among women, the most observed causes of infertility are primary ovarian insufficiency and premature ovarian failure, accounting for 25% of cases, followed by tubal damage (20%) and uterine abnormalities (10%), all contributing to the increase in IVF cases among couples. The success of IVF depends on various factors; however, the role of oocyte quality and maturation level is considered a pivotal cardinal factor for the success rates of IVF.
Methods: A thorough literature analysis was performed using the following search terms: “Oocyte Quality” and “IVF cycle.” The databases searched included PubMed, Google Scholar, MEDLINE, Cochrane Library, and ResearchGate.
Discussion: IVF success rates especially depend on oocyte quality and level of maturation. Several factors affecting these two factors include obesity, which increases O2 and H2O2 levels resulting in elevated endoplasmic reticulum [ER] stress; Polycystic Ovary Syndrome [PCOS]; age; endometriosis; cyclic nucleotides used in IVF; thalassemia major which is associated with lower ovarian reserve and increased redox activity malignancies, and anti-neoplastic drugs, which may contribute to premature ovarian insufficiency. Various treatment options were proposed to improve oocyte quality and maturation level, including growth hormone [GH] supplementation alongside ovarian supplementation, autologous mitochondrial transfer, luteal phase ovarian stimulation, administration of MI-Melatonin-Vitamin D3, Duphaston, and putrescine supplementation.
Conclusion: With the rising number of subfertility cases, the importance of Assisted Reproductive Technologies [ART] is growing. The success rate of IVF on oocyte quality and level of maturation level, and few with several factors affecting these. Though numerous treatment options have been proposed to enhance oocyte quality and maturation, not all have been deemed beneficial
Mucormycosis as a Rare Infection in Lower Limb Necrotizing Fasciitis: A Case Report
Get PDFIntroduction: Necrotizing fasciitis is a severe, life-threatening infection that can be fatal and rapidly progressive. It is usually caused by polymicrobial infection, monomicrobial infection by group-B streptococci (GBS) or staphylococci, or by anaerobes like Clostridium difficile that presents as a gas gangrene or rarely by fungi. Fungal infections, though found in diabetic foot ulcers, remain extremely rare agents in necrotizing fasciitis, often causing severe morbidity and higher mortality than regular bacterial infections. Though severe, these infections are not often late to diagnose and very few reports exist citing their presence. With our case report, we present another rare manifestation of Mucormycosis in a foot wound.
Case Report: We present a 57-year-old diabetic male patient who presented with a rapidly progressing very painful right foot ulcer, with high-grade fever and fatigue that did not respond to surgical intervention and treatment with broad-spectrum antibiotics. Mucormycosis species were identified in wound cultures. The patient then underwent an amputation and was treated with liposomal Amphotericin B.
Conclusion: This report aims to further highlight that virulent fungal infections, especially mucormycosis, should be considered when suspecting or diagnosing necrotizing fasciitis. An extensive review of the literature with our newly added case would serve as an eye-opener on this pathogen in the setting of difficult-to-treat necrotizing fasciitis
The First Reported Case of Pulmonary Embolism and Deep Vein Thrombosis Associated with Intraductal Papillary Mucinous Neoplasm: A Case Report
Get PDFBackground: Reported cases of Intraductal papillary mucinous neoplasm (IPMN) are becoming more and more frequent. The risk of hypercoagulability associated with IPMN is not clearly established in the literature as it was only reported in four cases. Therefore, we present a unique case of a patient with IPMN who subsequently developed acute pulmonary embolism (PE) and deep venous thrombosis (DVT).
Case presentation: A 70-year-old healthy female patient complained of palpitation, chest pain, and dyspnea at rest. She had normal vital signs and findings on physical examination. Laboratory tests showed an increase in the D-Dimer level of 3,730 ng/mL fibrinogen equivalent unit (FEU). Bilateral DVT ultrasound (DVT-US) of the lower extremities was positive for acute calf DVT in the right lower extremity involving the soleal vein. CT-PE chest with IV contrast was remarkable for segmental and subsegmental pulmonary arteries thrombosis. She was started on a heparin drip and then transitioned to rivaroxaban for the treatment of PE and DVT. She was discharged in stable condition with outpatient follow-up.
Conclusion: IPMN of the pancreas is an exocrine pancreatic neoplasm often detected on Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). It is usually non-malignant but was found to be more prone to progress into cancer in contrast to the other types of pancreatic cysts. An increased risk of hypercoagulability with pre-malignant pancreatic lesions such as IPMN has not yet been well established. As far as we know, this case report is the first article presenting IPMN associated with both acute DVT and PE in a relatively healthy individual with no prior risk factor for hypercoagulability. Although there is scattered evidence suggesting an increased risk of thromboembolic events with IPMN, this unique case of DVT and PE associated with IPMN highlights the importance of close monitoring of these patients, especially those who have risk factors for thrombosis
Evaluation of postoperative pain in patients undergoing unilateral inguinal hernioplasty by Lichtenstein
Get PDFBackground: Lichtenstein's surgery is the most recommended technique in the treatment of unilateral inguinal hernias in men, due to its simplicity, speed, pain-free, and almost unrestricted return to physical activities. The evidence indicates that work and leisure activities can be resumed, by most patients, in three to five days after laparoscopic or conventional hernioplasties, without the risk of recurrences or complications. Nevertheless, chronic pain is the most common postoperative complication affecting about 30% of patients regardless of the surgical technique used. Predictive factors for chronic pain are young age, female gender, preoperative pain level, and postoperative pain intensity.
Aim: To evaluate the perception of postoperative pain in patients who have undergone unilateral elective inguinal hernioplasty using the Lichtenstein technique in order to define predictors of the development of chronic pain and to identify the average time to return to work and to normal physical activity.
Methods: Analysis of electronic forms applied to patients that underwent elective unilateral inguinal hernia repair by Lichtenstein at a state hospital in a small town in the interior of Brazil. The statistical analyses were processed using the software Statistical Package for Social Sciences (SPSS) version 22.0.
Results: Data from 38 participants were analyzed with an average of 41.45 (± 13.94) years. Most of them returned to work and to light physical activities 45 days after surgery. There was a positive correlation between the presence of pain 90 days after surgery and the development of chronic pain (Spearman correlation of 0,818 and p < 0.001).
Conclusion: Despite the small sample of this study, it awakens us to the consequences that Lichtenstein surgery can trigger for patients with inguinal hernia and the importance of good management and evaluation of postoperative pain in order to improve the quality of life of these patients
Epidemiology Of Uterine Fibroid Disease In Lebanon: A Case-Control Study
Get PDFBackground: Uterine leiomyoma (UL) are women’s most common pelvic tumors, benign in nature, growing during reproductive age, and presenting with abnormal uterine bleeding or pelvic pain and pressure. Many risk factors may contribute to UL, such as family history, obesity, and early menarche. Despite the fact that UL symptoms may improve using many medical or surgical treatments, the health-related quality of life (HRQoL) is considerably affected by their presence. Based on all of the above, we conducted this study which is to the best of our knowledge, the first of its kind in Lebanon aiming to assess the risk factors of UL among the Lebanese population and provide an overview of the diagnostic methods, treatment modalities, and HRQoL among patients.
Subjects & Methods: This is an epidemiologic case-control retrospective study, of 668 women of reproductive age, of different nationalities living in Lebanon, divided into 167 cases and 501 controls, conducted between January 2016 and February 2018, in Beirut, Lebanon, in Rafic Hariri University Hospital (RHUH) and Makassed General Hospital (MGH), using charts, questionnaires, and telephone calls. The statistical program Statistical Package for the Social Sciences 19 (SPSS-19) was used for data analysis. A multivariate analysis was also done. Two-sided data analysis was employed and statistical significance was considered for a p-value of ≤ 0.05.
Results: Risk factors of UL were older age (>40), early menarche, family history, oral contraceptives (OCP) use, high body mass index (BMI) (>29), and chronic diseases. Smoking and sports were protective factors. The highest effectiveness in diagnosis was attributable to pelvic ultrasonography (94.8% of cases), magnetic resonance imaging (MRI) (85.2% of cases), and hysteroscopy (77.8% of cases). Hysterectomy was the most used treatment method (83.8% of cases), followed by hysteroscopy (77.8%) and uterine artery embolization (UAE) (72.7%). Women with leiomyoma reported that their HRQoL is negatively affected by this condition.
Conclusion: This study showed many risk factors for UL, and the statistical significance of techniques for their diagnosis and treatment, in order to prevent their complications and decrease their impact on HRQoL
Uveitis as a Manifestation of Celiac Disease: A Population-Based Study
Get PDFIntroduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease.
Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease.
Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis.
Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory process prior to diagnosing uveitis as idiopathic.
Conclusion: In conclusion, we established that patients with celiac disease are at increased risk of developing uveitis after excluding and controlling for any confounding variables. In further studies, it could be interesting to investigate the impact of gluten-free diet in patients with celiac disease on the risk of developing uveitis
Untreated Atypical Left Femoral Shaft Fracture: A Case Report of Its Complication
Get PDFBackground: Bisphosphonate therapy is used to manage osteoporosis and decrease the risk of vertebral and hip fractures. These drugs act by suppressing osteoclast activity by inducing the inhibition of bone resorption and increasing bone mineral density. It has been shown that long-term use of bisphosphonate is correlated to a higher incidence of atypical femoral fractures.
Case report: This is a case report of an 81-year-old female, on bisphosphonate therapy for 12 years and with chronic left thigh pain for two and a half years who developed an incomplete atypical left femur fracture. What’s special about this case is that the fracture was ignored and then progressed after three months into a complete displaced spiral fracture that required surgical fixation.
Conclusion: The benefits of bisphosphonate treatment in preventing osteoporotic fractures outweigh the risk of the occurrence of these atypical fractures. Orthopedic surgeons as well as primary care physicians must keep atypical fractures in their differential diagnosis in patients presenting with prodromal symptoms and who are on long-term bisphosphonate therap
Effect of the Innominate Bone Horizontal Rotation on Acetabular Version: A Retrospective Radiological Study on a Middle Eastern Population
Get PDFBackground: The impact of acetabular horizontal rotation on the development of femoroacetabular impingement and subsequently osteoarthritis is well-studied in the literature. However, there is not a clear relationship between the rotation of the hemipelvis and the version of the acetabulum.
Purpose: The purpose of this study was to evaluate the influence of the rotation of the hemipelvis on the version of the acetabulum.
Methods: Through a retrospective study, three-dimensional reconstructions of high-resolution CT (computed tomography) scans of 154 patients receiving pelvic scans for non-orthopedic causes were selected from our institution’s database. The horizontal rotation of the different parts of the hemipelvis was evaluated using the following parameters: superior iliac spine angle (SIS), inferior iliac spine angle (IIS), roof edge angle (REA), equatorial edge angle (EEA) and ischiopubic angle (IPA).
Results: The results showed a significant positive correlation between the different angles of the innominate bone and the version of the acetabulum such as when the proximal innominate bone rotates, the cranial part of the acetabulum rotates in the opposite direction. Increased anteversion angles in females compared to males were also observed.
Conclusion: The observations suggest that, in an asymptomatic population, the acetabulum should not be considered a separate entity independent from the rest of the innominate bone and that the version of the acetabulum correlates with the rotation of the hemipelvis
Permanent Pacemaker Use in Transcatheter Aortic Valve Replacement: Real World Experience from the National Inpatient Sample
Get PDFBackground: Transcatheter Aortic Valve Replacement (TAVR) is associated with conduction abnormalities requiring permanent pacemaker implantation (PPMI). Data regarding predictors for PPMI following TAVR is scarce.
Methods: This is a retrospective study utilizing the 2017 National In-Patient Sample (NIS). Patients who underwent TAVR and PPMI during the same admission were identified using appropriate ICD-10 codes, as were patients with left bundle branch (LBBB), right bundle branch (RBBB), and first-degree AV delay (AVB). Patients were split into two groups based on PPMI. The groups were compared using univariate and multivariate analyses after adjusting for age, gender, race, comorbidities, insurance status, and Charlson comorbidity index (CCI). Secondary outcomes included factors influencing length of stay (LOS) and total charges incurred.
Results: In 2017, 54,175 (57.6% males) patients underwent TAVR. There were 8,067 patients with LBBB, 2,402 with RBBB, and 2,905 with AVB at baseline. A 4170 total of patients (55.2% males) required PPMI. Patients requiring PPMI were older (80.5 vs 79.6 years, p=0.001). On multivariate analyses, baseline RBBB, LBBB, hypertension (HTN), CCI 2, and CCI >/=3 predicted PPMI (aOR 4.82, p<0.001; aOR 1.63, p<0.001; aOR 1.21, p=0.013, aOR 1.53, p=0.022 and aOR 1.46, p=0.031 respectively). On multivariate analyses, patients who underwent PPMI had significantly higher LOS (aOR 2.18, p<0.001) and incurred higher total charges (USD 278,000 vs USD 204,920; p<0.001).
Conclusion: In this cohort, RBBB, LBBB, HTN, and increased CCI predicted PPMI after TAVR. Further studies are required to corroborate our findings
Iatrogenic Tracheal Injury During Endotracheal Tube Exchange in a COVID-19 Patient: A Case Report
Get PDFThe coronavirus disease 2019 (COVID-19) pandemic has increased the need for prolonged intubation and mechanical ventilation. Though a rare complication of mechanical intubation, tracheoesophageal fistulas (TEFs) are severe and life-threatening. We present a patient with COVID-19 pneumonia who developed an iatrogenic TEF suspected to have been acquired during traumatic reintubation. After optimizing her for surgery, management of the TEF included tracheostomy tube placement at the distal end of the tracheal injury and placement of a stent over the defect. CT scan later showed migration of the stent into the esophagus that required removal. Despite receiving supportive therapy, the patients’ status declined and the patient shortly expired. By increasing demand for prolonged mechanical ventilation, complicating intubations amid fears of transmission, and potentially causing inflammatory tracheal damage, COVID-19 creates heightened obstacles to intubation that may put patients at risk of acquiring tracheal injuries. Increased awareness of possible tracheal injuries should be made by considering the many risk factors