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Preanalytical Variables Influence the Accuracy of Glucose Testing for Diagnostic Purposes
No full textBackground: The accuracy of test outcomes is essential for the quality of patient care. To demonstrate the effect of processing delays on glucose levels, we evaluate the stability and decline of glucose in whole blood samples obtained in EDTA vacutainers, which are stored at varying temperatures, as well as the rate of glucose degradation in different color-coded vacutainers.Methods: Whole blood collected via venipuncture into the vacutainer was carefully mixed to ensure homogeneity. In the temperature study, glucose concentrations were measured at the outset and subsequently at 30-minute intervals in samples preserved at different temperatures. For the study involving color-coded vacutainers, glucose levels in the specimens were assessed initially and at various intervals.Results: In general, the concentration of glucose in stored whole blood decreased over time. The decline was most significant in the specimen kept at 37 °C when compared to those stored at 24 °C and at ice (0 °C). In the color-coded analysis, all vacutainers, with the exception of the gray top, exhibited a statistically significant decrease in glucose levels. The gray top vacutainer retained as much as 94.7±2.0% of its original glucose concentration even after a duration of 24 hours.Conclusion: The gray top vacutainer preserves glucose levels to ensure diagnostic precision in situations where a delay in specimen processing is anticipated
Overview, Infrastructural Challenges, Barriers to Access, and Progress for Rwanda’s Healthcare System: A Review
Get PDFThe purpose of this review is to provide an overview of Rwanda’s healthcare system, an understanding of the infrastructural challenges and barriers to accessing care for Rwandans, and areas where Rwanda has made progress in its healthcare system. We examined the literature published on Rwanda’s healthcare system and social determinants of health. We analyzed government data over the past fifteen years to understand the progress that the healthcare system has made. We developed criteria for selecting articles for our review. The rebuilding of Rwanda’s healthcare system was done through community-based healthcare, government insurance, and a robust public health system. The public health system was built on private-public partnerships, community-based health workers, and international partnerships, like Human Resources for Health. While Rwanda continues to improve its healthcare system, the urban-rural divide, human resource constraints, and challenges with system infrastructure are consistent issues which plague it. Altogether in the aftermath of one of the most horrific genocides in recorded history, Rwanda’s progress serves as a beacon of hope and model for capacity-building
Time-Course Effects on Kidney Function in Patients Undergoing Laparoscopic Cholecystectomy
Get PDFBackground: Laparoscopic cholecystectomy is one of the most common elective surgical procedures and is a minimally invasive technique used to treat gallbladder diseases. Objectives: This study aimed to evaluate the time-course effects of laparoscopic cholecystectomy on urine output and kidney function. Methods: Using a quasi-experimental design, 21 patients scheduled for laparoscopic cholecystectomy at Ali Ibn Abi Taleb Hospital in Zahedan (Iran) were selected. Blood samples for renal function tests were collected at three time points, and kidney function was assessed at four intervals. Data were analyzed using repeated-measures tests before and after the intervention. Results: The findings indicate that laparoscopic cholecystectomy did not affect urine output or kidney function in the studied patients. Conclusions: Although variations in BUN levels were observed during surgery, creatinine levels remained unchanged. Therefore, laparoscopic cholecystectomy appears to be a safe surgical procedure with respect to renal function. The duration of surgery did not influence renal function tests, kidney function, or urine output
Preparing for Universal Coverage: Challenges for South Africa’s Public Health System
Get PDFSouth Africa’s healthcare system has undergone extensive reforms since the end of apartheid, yet significant disparities rooted in racial and socioeconomic inequities persist. Historically, apartheid policies directed resources toward a private healthcare system exclusive to the white minority, marginalizing the public sector serving Black South Africans. Today, these inequities endure, with public healthcare remaining under-resourced and strained, affecting maternal, child, and adolescent health outcomes and exacerbating the prevalence of noncommunicable (NCDs) and communicable diseases (CDs) among lower-income populations. This study explores South Africa’s ongoing health challenges, examining the social and environmental determinants of health and the complex interplay between poverty, housing, water access, and disease burden. Recent government efforts, such as the National Health Insurance (NHI) scheme, aim to unify public and private sectors and improve access to healthcare services for all citizens, but challenges in implementation, funding, and public trust remain significant. Findings suggest that achieving health equity requires strengthened policies, targeted local interventions, and a comprehensive approach to environmental health. Through a critical analysis of governance, disease burden, and healthcare reforms, this study underscores the need for sustained commitment to address structural healthcare disparities in South Africa
Surgical Anatomy of the Trigeminal Nerve: From the Cisternal Part to the Trigeminal Ganglion and Surgical Involvement
Get PDFIntroduction: The objective of the study is to briefly present the surgical anatomy of the cisternal segment of the trigeminal nerve and its neurovascular relationships. Materials and Methods: Three previously fixed heads of adult male cadavers of different ages underwent a macroscopic and microscopic anatomical examination. During the dissection of the root territory, photos were taken tracing the nerve from its apparent origin to the trigeminal ganglion. Results and discussion: The descriptive and functional anatomy of the segment selected for the study were understood and detailed. The photos taken were used as a support to reproduce the nerve pathways, first illustrating the descriptive anatomy of this part of the nerve and the associated neurovascular anatomical structures, then its functional anatomy highlighting its two sensory and motor contingents. A brief reflection, which focused on the surgical management of trigeminal neuralgia, highlighted the importance of knowledge of anatomical landmarks in mastering microsurgical approaches. Conclusion: The use of dissection of the cisternal segment of the trigeminal nerve on cadaveric specimens in order to detail a root part that is difficult to access during surgical interventions, constitutes a practical and useful alternative for better preoperative assessment and mastery of surgical procedures without major complications
Navigating Contemporary Strategies in Endovascular Management of Descending Thoracic Aortic Dissection: A Comprehensive Review of the Literature
Get PDFIntroduction: Acute aortic dissection (AD) is the deadliest form of acute aortic syndromes (AAS). Mortality is significant; around 80% in the highest-risk individuals. The challenge in managing AD is pronounced, especially with the high-risk open surgical approach. Endovascular aortic stent grafts offer a less invasive alternative. We retrospectively reviewed literature from 2004 to 2023 on type B AD endovascular management and focused on the newest patient series since the last meta-analysis (after January 2011).Materials and Methods: Identified from PubMed Central were two consensus papers, two randomized controlled trials, two historical articles, five meta-analyses, 31 clinical trials, and 50 review papers in English. Nineteen patient series from January 2011 onward were included, excluding non-English publications, duplicate reports and papers dealing only with type A AD or only with true thoracic aortic aneurysms (TAA).Results: Among 4235 patients in 19 publications, 69.2% had type B AD. Thoracic endovascular aortic repair (TEVAR) was performed in 90.5% of patients, with a 5.9% 30-day mortality rate. Complications included type I-II (and sometimes III) endoleaks (11.1%), stroke (5.5%), and paraplegia or paraparesis (3.2%). The need for re-intervention was around 17.7%, and the mean follow-up time was 36.4 (±20.7) months.Conclusion: This review highlights TEVAR's technical success, potential advantages, complications, and survival rates for type B AD patients with its long-term efficacy still undetermined
Systemic Scleroderma: Clinical Features and Management in Oral Surgery – A Case Report
Get PDFIntroduction: Systemic scleroderma is a rare autoimmune disease characterized by progressive fibrosis of connective tissue and vascular damage. It frequently affects the skin, internal organs, and oral cavity. Oral manifestations—including microstomia, xerostomia, telangiectasias, gingival alterations, and mandibular bone resorption—are common and significantly impact masticatory function, nutrition, oral hygiene, and dental care. Case Report: We report the case of a 45-year-old female patient diagnosed with systemic scleroderma in 2010, who presented for oral cavity rehabilitation. Extraoral examination revealed a characteristic scleroderma facial appearance and microstomia. Intraoral findings included poor oral hygiene, buccal telangiectasias, an atrophic and depapillated tongue, and gingival inflammation with signs of periodontitis. Panoramic radiography revealed mandibular bone resorption and widening of the periodontal ligament spaces. Conclusion: This article highlights the oral and extraoral clinical signs of systemic scleroderma and discusses the precautions necessary for the management of patients with this condition in oral surgery
Veneers on Devitalized Teeth: The Role of Adhesive Dentistry in Aesthetic and Functional Therapies
Get PDFDevitalized teeth present a unique challenge in aesthetic dentistry, often exhibiting aesthetic issues such as color variations, shape changes, or structural fragility. In response to these challenges, dental veneers emerge as a promising solution to restore both the aesthetics and functionality of devitalized teeth. While chemical teeth whitening is the primary treatment approach for dental discolorations, some prove resistant, occasionally necessitating prosthetic interventions. This article aims to explore the application of ceramic veneers as an aesthetic and conservative solution to address the challenges associated with devitalized teeth. We will delve into the procedural steps, technological advancements, and clinical considerations guiding this contemporary practice in aesthetic dentistry
A Case of Penile Necrosis in a Patient with Simultaneous Fournier’s Gangrene and Priapism
Get PDFFournier’s gangrene (FG) is a necrotizing fasciitis of the perineal and genital areas, characterized by severe complications and a high level of mortality. The occurrence of concurrent priapism is extremely rare and carries a very poor prognosis. Here, we report a case of a 74-year-old male patient with no medical history who presented with FG of the scrotum and penis associated with simultaneous priapism. He was given intravenous antibiotic therapy, cavernous aspiration, and surgical debridement. In the following days, the penis became completely necrotic. A total penectomy was performed with a perineal urethrostomy following complete wound closure. There are only a few documented cases in the medical literature of simultaneous Fournier’s gangrene and priapism. As a result, there is no established protocol for managing this rare occurrence. When gangrene extends to the penis, cavernous aspiration is not recommended as it tends to exacerbate penile necrosis in the majority of cases. However, early administration of broad-spectrum antibiotic therapy, surgical debridement, and urinary diversion are necessary to prevent necrosis and sepsis
Endobronchial Hamartoma - A Case Report: Hamartochondrome endobronchique - A propos d’un cas
No full textEndobronchial hamartochondromas, benign tumors originating from peribronchial mesenchymal tissue, are exceptionally rare, comprising only 1.4% of pulmonary hamartomas. We present a clinical case involving a patient with symptomatic hamartochondroma, presenting with cough and thoracic pain. Thoracic computed tomography revealed middle lobe atelectasis associated with an endobronchial protrusion, while bronchoscopy demonstrated a tumor arising from the middle lobar bronchus, extending into the right intermediate bronchus. Despite inconclusive findings from bronchial biopsy histopathology, a multidisciplinary consensus led to surgical intervention, confirming the diagnosis through anatomopathological examination. In conclusion, prompt resection, whether surgical or endoscopic, is imperative to mitigate bronchial obstruction complications and prevent the misidentification of malignant lesions