Clinical Condition Research Articles

Characteristic Features of Bimaxillary Proclination: A 5-Year Review in Najran, a Saudi Arabian Sub-population.

Background Bimaxillary proclination (BP) has been described as a clinical condition depicted by proclined upper and lower incisors with an amplified lip incompetence. The current study aimed to investigate the prevalence and characteristic features of bimaxillary proclination in Najran. Methods This was a retrospective study to appraise bimaxillary proclination in an orthodontic specialist clinic and research complex in Najran, Saudi Arabia from January 2018 to December 2022. Patients requesting orthodontic treatment for malocclusion were evaluated. Data retrieved include: age, gender, presence of bimaxillary proclination, and facial profile of affected patients. IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp) was used for analysis. Results were presented as simple frequencies and descriptive statistics. Results Three hundred and twenty-six (326) patients sought treatment for different types of malocclusion out of which 277 (84.9%) had bimaxillary proclination. There were 123 (44.4%) males and 154 (55.6%) females with an M:F ratio of 1:1.3. Age ranged from 6 to 55 years with a mean SD of 22.6 ± 8.98. More females had bimaxillary proclination. The majority of the patients with bimaxillary proclination had convex facial profiles and a Class I relationship(241 (73.9%) and (135 (48.7%)), respectively. Conclusion Bimaxillary proclination is a common orthodontic health issue with high prevalence in the Najran region. Female preponderance was observed. Most of the patients have a Class I Angle's relationship.

Risk factors of Community Acquired Pneumonia: A Cross-sectional study at Kushtia Medical College hospital

Community acquired pneumonia (CAP) a serious childhood clinical condition caused by bacteria, virus or fungi. It is promptly responsible for mortality and morbidity. The aim of the study is to evaluate the etiological factors of CAP patients. This study which was comparative cross-sectional, starting from at indoor and outdoor division of Paediatrics, Kushtia Medical College Hospital. In this study, 180 patients were enrolled. Among them, 90 respondents were suffering from CAP (case), on the other hand, 90 respondents were not suffering from pneumonia (control). It is found that, 46.1% respondents were less than 12 months. Among the respondents, 62.2% respondents were male. Out of 180 respondents, 33 case (18.3%) respondents were completely immunized. In case of control respondents, more patients were completely immunized comparing to pneumonic patients. Majority of the patients (65.6%) didn’t have positive history of previous hospitalization in due to any causes. In this clinical study, majority of cases underwent C/S procedure (37.2%) whereas, 44.4% cases had mature child-birth. To determine all the etiological factors causing CAP, it is a must to increase the clinical studies and raise social awareness against this public health life threatening problem.

Effectiveness of Pulse Intravenous Infusion of Methylprednisolone on Pain in Patients with Lumbar Disc Herniation: A Randomized Controlled Trial

Background: Lumbar disc herniation (LDH) can cause pain in the lower back and leg, as well as numbness or weakness in the affected area. Various steroids, including methylprednisolone, are currently used for treatment. Objectives: This study aimed to compare the effectiveness of pulse intravenous infusion of 500 mg methylprednisolone with common non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain and improving the clinical condition of patients with lumbar disc herniation. Methods: This clinical trial, registered under code IRCT20211116053077N1, included an experimental group (37 patients) and a control group (35 patients). Pain assessments were conducted before treatment, and at one, two, and three weeks, as well as one and six months after treatment. The control group received common painkillers (diclofenac sodium tablets 100 mg), while the experimental group received a single dose of 500 mg methylprednisolone sodium succinate (intravenous injection in 500 cc normal saline). Pain scores were analyzed using SPSS 16 and statistical tests such as ANOVA, independent t-tests, and repeated measures ANOVA. Results: Prior to intervention, the mean (SD) pain score was 8.7 (3.57) in the experimental group and 8.17 (0.66) in the control group (P > 0.76). Six months after methylprednisolone injection, the mean (SD) pain score in the experimental group was 1.56 (0.83), compared to 6.48 (0.91) in the control group (P = 0.000). Analysis of variance indicated that methylprednisolone significantly reduced pain in patients with LDH (P = 0.000, F = 660.668). Conclusions: Given the effectiveness of intravenous pulse infusion of 500 mg methylprednisolone compared to common NSAIDs in relieving pain and improving clinical outcomes for patients with lumbar disc herniation, the use of this drug is recommended for pain reduction in these patients.

Characteristics of people diagnosed with dementia vs lung cancer and cardiovascular disease at commencement of community palliative care: a population–based study

BackgroundMost people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD).MethodsThis is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients’ functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively.ResultsOverall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms.ConclusionCommunity palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.

Clinical characteristics of 217 Chinese cases with depersonalization/derealization disorder

Depersonalization/derealization disorder (DPD) is a prevalent yet inadequately understood clinical condition characterized by a recurrent or persistent sense of unreality. This study aims to provide insight into DPD through descriptive and comparative analyses involving a large group of Chinese participants. The socio-demographic details (age, gender proportion, education, occupational status, marital status), depersonalized and dissociative symptom characteristics (symptomatic factors or subscales of the Cambridge Depersonalization Scale and the Dissociative Experiences Scale), development trajectory (age of onset, potential precipitating factors, course characteristics), treatment history (duration of delayed healthcare attendance, duration of delayed diagnosis, previous diagnoses), and adverse childhood experiences of the DPD patients are presented. Comparisons of anxiety and depressive symptoms, alongside psychosocial functioning, between DPD participants and those diagnosed with generalized anxiety disorder, bipolar disorders, and major depressive disorder were conducted. The analysis highlights a higher male preponderance and early onset of DPD, symptomatology marked by derealization, notable impairment in psychosocial functioning, and prolonged periods of delayed healthcare attendance and diagnosis associated with symptom severity. Furthermore, noteworthy relationships between adverse childhood experiences and symptom levels were identified. The findings substantiate the view that DPD is a serious but neglected mental disorder, urging initiatives to improve the current condition of DPD patients.

Successful Management of Ischemic Stroke : A Case Report and Literature Review

Introduction: Stroke is a clinical condition characterized by the sudden onset of focal (or global, in cases of coma) neurological symptoms that persist for over 24 hours or result in death, with no clear cause other than a vascular issue. Case Description: Male, 62 years old, with chief of complaint of mouth dropped to the right since 1 day before admission. Complaints made the patient speak more difficult, slow and unable to form sentences. Physical examination show parese CN. VII UMN dextra. Siriraj score -5 and Head NCCT show cerebral infarction in the internal capsula interna. Patient was diagnosed with ischemic stroke. Discussion: The use of a scoring system can be useful when there are no brain imaging facilities that can clearly distinguish the causative pathology of stroke. criteria for diagnosis of ischemic stroke are symptoms of global neurological deficits or one / several focal neurological deficits that occur suddenly with evidence of brain imaging images (CT scan or MRI). The most common differential diagnosis is hemorrhagic stroke. Conclusion. Early recognition and appropriate treatment is important to cure acute ischemic stroke to achieve good quality of life and prevent further infarct to brain tissue. Keyword: Craniotomy, Brain Metastases, Hepatocellular Carcinoma

Central Sleep Apnea in Children-10 Years Experience at a Tertiary Sleep Laboratory.

Central sleep apnea (CSA) is a rare condition in children; however, it can cause significant morbidity if not diagnosed early. We aimed to increase the knowledge about CSA in children by describing the clinical characteristics of children diagnosed with CSA at our sleep center. We retrospectively reviewed 1263 polysomnographies (PSG) performed between 2012 and 2023 at our tertiary sleep center and evaluated the clinical characteristics of the patients with CSA. Underlying diseases, clinical symptoms, sleep parameters, and short-term management of the patients were recorded. Of the 1263 patients aged between 1 month and 18 years, 122 (9.65%) had CSA, with 54.9 % (n = 67) of them being female. Only 56.6% (n = 69) of the patients' parents had reported a symptom indicating sleep-disordered breathing. The most common underlying disease was genetic, including Down and Prader-Willi syndromes, followed by neurological diseases . Obstructive sleep apnea was detected in addition to CSA in 103 of the patients (84.4%). Bi-level positive airway pressure with a backup rate was the most common treatment modality. While CSA is a rare clinical condition in children, it occurs more commonly in those with an underlying disease. Awareness of the disease and timely referral of the patients for sleep studies are critical to prevent long-term sequelae.

Unexpected Grave’s-induced acute myocardial infarction in a young female, a literature review based on a case report

IntroductionMyocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the heart due to hyperstimulated thyroid function.Case presentationThe patient was a 36-year-old woman who presented with left-sided chest pain, dyspnea, palpitation, and tremor. The initial evaluation showed evidence of myocardial ischemia (positive high-sensitivity troponin) caused by a hyperactive thyroid gland. The treatment for myocardial infarction, along with anti-thyroid medications, improved the patient’s condition and subsided the symptoms. The coronary angiography revealed no pathologic finding, and the hypokinetic left ventricle, observed in the first echocardiogram, was resolved. The patient was discharged with an excellent clinical condition, and after the 4-month taking of a calcium channel blocker and tapering carbimazole, the thyroid function became normal, and her symptoms resolved completely.ConclusionPatients without evident risk factors for ischemic heart disease, such as non-diabetic, nonsmoker, and young individuals who presented with acute coronary syndrome, should be evaluated for a potential background reason for the imbalance between the oxygen demand and supply of the myocardium. The presence of palpitation, weight loss, tremors, insomnia, and anxiousness, along with ischemic signs, should make the physician think about the probability of the hyperthyroid-induced cardiovascular disorder.Clinical key pointThe initial presentation of hyperthyroidism might be accompanied by severe cardiac symptoms. When the demographic features are not aligned with usual ischemic heart disease, other probable symptoms and signs should be investigated, and thyroid function should be checked. The control of thyroid hyperactivity would result in the resolution of both cardiac and non-cardiac symptoms.

Compressive Syndrome of the Ostio-fibrous Tunnel at Carp Level - A literary review

CTS tunnel syndrome is characterized by compression of the median nerve inside the carpal tunnel, at the level of the wrist. This disease still has unknown etiology, but it presents itself in a secondary way when related to other pathologies. Compression of the median nerve in the carpal tunnel occurs in most cases of nonspecific chronic flexor tenosynovitis, and it can also occur in many other nosological entities or lesions that occupy space in the tunnel. The prevalence of ostiofibrous tunnel compression syndrome at the carpal level is estimated to be between 4% and 5% of the population, ranging from 51 to 125:100,000, and it occurs more frequently in females, especially between 40 and 60 years of age. The main clinical manifestations include paresthesia in the territory of median nerve sensitivity (particularly in the thumb, index, middle and radial aspect of the ring finger), hyperesthesia (less frequent hypo or anesthesia), wrist pain that may radiate to the fingers, hands, elbows, and in some cases, even the shoulder (such symptoms may disappear with movement of the limb or massage). Diagnosis must be clinical, based on the patient's history and physical examination. For the physical examination, the Tinel and Phalen tests can be used. Complementary tests are used to make a diagnosis, the most recommended being: electroneuromyography (ENMG), magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). Treatment can be conservative or surgical. The conservative way consists of adopting techniques to alleviate symptoms, such as pain control through wrist orthoses for immobilization, injections and medication, alternative therapies and physiotherapy. Surgical treatment aims to decompress the median nerve and reduce pressure on the carpal tunnel. This approach is adopted when conservative treatment does not lead to an improvement in the clinical condition within 6 to 8 weeks. This paper aims to review the medical aspects of ostiofibrous tunnel compression syndrome at the level of the carpus. The methodology used is analytical in nature through a literature review. The data extracted in the research were from the US National Library of Medicine (PubMed) with the descriptors: median nerve, wrist and carpal tunnel syndrome, according to the Health Sciences Descriptors (DeCS). To perform the crossing of these, the Boolean operator AND was used. 43 articles were found and after inclusion and exclusion criteria, 36 articles were used. Those used for inclusion: articles in English, Portuguese or Spanish, between June 2015 and July 2021, and that were available in full and for free online access. Studies that did not address the relevant concept for achieving the objective were excluded; repeated studies; according to criteria of methodological quality. Thus, the medical evaluation must be performed in a specific way, making it essential to collect the clinical history, physical exams and complementary exams in order to choose to improve conservative therapy and, later, surgical, if necessary. These facts will allow a greater therapeutic success, allowing the greatest well-being to the patient.

Is Chronic Pelvic Inflammatory Disease an Exclusively Medical Gynecological Disease, or It May Be a Surgical Challenge?

Pelvic inflammatory disease is an infectious condition affecting women’s upper genital tract, including the uterus, fallopian tubes, and ovaries. It primarily arises from an infection that spreads upward from the lower genital area. The relationship between chronic pelvic pain and coexisting conditions is a key focus in its diagnosis and treatment. This type of pain is also considered a form of reflex dystrophy, involving both neurological and psychological components, the first line treatment consists in antibiotherapy. For patients with complex or severe pelvic abscesses, surgical intervention may be considered in selected cases. The primary surgical techniques employed are open and laparoscopic surgery, both aimed for abscess removal. MRI or Doppler ultrasonography may be employed when there is a suspicion of adnexal torsion, adenomyosis or deep pelvic endometriosis, especially if the ultrasound results are unclear or inconclusive Laparoscopic surgery has increasingly become favored by both healthcare professionals and patients. Moreover, laparoscopy has emerged as the most valuable tool for diagnosing chronic pelvic pain. The approach to treating pelvic abscesses in women of reproductive age depends greatly on clinical assessments, individual patient factors, and the desire to preserve fertility. However, laparoscopy may present technical difficulties in patients with severe pelvic abscesses, particularly those with extensive adhesions or a closed-off pelvic area, requiring advanced surgical expertise. Women with associated conditions such as endometriosis often experience a more severe form of pelvic inflammatory disease, which is less responsive to antibiotics and more frequently requires surgical resolution. The surgical treatment should be performed individualized to the clinical condition of the patient and the time of intervention must be carefully chosen.

Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review

<b><i>Introduction:</i></b> The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews specifically addressing this topic. <b><i>Methods:</i></b> This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies. <b><i>Results:</i></b> Six studies were included – 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents – aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/fissure (1–17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25% within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without significant adverse events, at the cost of a 40% recurrence rate. <b><i>Conclusions:</i></b> All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges previous concerns regarding significant bleeding after office-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam sclerotherapy, a minimally invasive technique that has previously been shown to be more effective than RBL in the general population and in patients with bleeding disorders.

Minimizing unnecessary brain magnetic resonance imaging in pediatric endocrinology: a retrospective cohort analysis.

Brain magnetic resonance imaging (MRI) is mandatory or highly recommended in many pediatric endocrinological conditions to detect causative anatomic anomalies and rule out neoplastic lesions. However, MRI can also show findings associated with the underlying clinical condition, as well as unrelated "incidentalomas". These latter findings are often abnormalities with a high incidence in the general population for which there is no clear literature regarding their management, especially in pediatric patients. The present study aimed to evaluate the number of unnecessary performed MRIs in pediatric endocrinology. Retrospective analysis on 584 MRI scans performed in 414 patients (254 growth hormone deficiency, 41 other causes of short stature, 116 central precocious puberty). The MRI scans were completely normal in 67% of the individuals, and the prevalence of individuals who underwent more than one MRI was 18%, with no significant differences among the groups. The overall prevalence of incidentalomas was 17%. Among 170 repeated MRI scans, 147 (86%) were not required according to a dedicated protocol. Only five patients (four GHD, one Noonan) correctly repeated the MRI. All the repeated MRI scans did not reveal any progression in the findings. If we include the MRIs performed in cases of OCSS other than Noonan syndrome (n=32) and girls with CPP older than 6 years (n=89), an additional 121 MRIs could have been avoided, leading to a total number of unnecessary MRIs to 268 (46%). Only a few specific neuroimaging findings in endocrinologic pediatric patients warrant further investigation, while too often repeated imaging is carried out unnecessarily. We advocate the importance of guidelines to reduce costs for both the healthcare system and patients' families, as well as to alleviate physical and psychological distress for patients and caregivers.

Effective Extracorporeal Treatment of Metformin-Associated Lactic Acidosis using Continuous Venovenous Hemodiafiltration.

The prevalence of type 2 diabetes mellitus has surged globally. Metformin is recommended as the first-line oral treatment. However, metformin-associated lactic acidosis (MALA) is recognized as a rare but potentially dangerous complication. The pathogenesis of MALA is multifactorial, primarily resulting from the interference of metformin with mitochondrial function and hepatic gluconeogenesis, leading to lactate accumulation. Risk of MALA escalates with impaired kidney function, poorly controlled diabetes, fasting, and liver dysfunction. A 57-year-old woman with diabetes and hypertension presented with prolonged gastrointestinal symptoms. During this episode she continued using metformin. She had severe metabolic acidosis and acute kidney injury. Continuous venovenous hemodiafiltration was initiated, resulting in significant clinical improvement and normalized arterial blood gas parameters within 16 hours. The pharmacokinetic properties of metformin facilitate efficient elimination via hemodialysis and/or hemofiltration. Continuous venovenous hemodiafiltration emerges as effective for MALA treatment. In the case described the calculated metformin clearance during continuous venovenous hemodiafiltration was notably higher than reported values, possibly due to residual renal clearance. Clinical improvement occurred despite elevated metformin levels, suggesting a lack of correlation between metformin levels and patient outcomes. Comorbidities rather than metformin levels guide treatment decisions in MALA. This case underscores the efficacy of continuous venovenous hemodiafiltration in the treatment of MALA, suggesting its potential as a standard therapeutic approach. However, further research is needed to elucidate the complex interplay between metformin levels, clinical presentation, (extracorporeal) treatment modalities and outcome in MALA. Continuous venovenous hemodiafiltration seems to be an efficient and effective treatment to eliminate metformin in patients with metformin-associated lactic acidosis.The metformin level does not seem to correlate with the clinical condition of the patient.For a comparison between the effectiveness of different renal replacement therapies in metformin-associated lactic acidosis, more research is needed.

Risk factors of cardiac arrest during a percutaneous coronary intervention performed with rotational atherectomy - analysis based on a Large National Registry.

Rotational atherectomy (RA) is traditionally administered for patients with heavily calcified lesions and is thereby characterized by a high risk of the performed intervention. However, the prevalence characteristics of cardiac arrest are poorly studied in this group of patients. We aimed to evaluate the frequency and risk factors of cardiac arrest during percutaneous coronary interventions (PCI) performed with RA and preceding coronary angiography (CA). Based on the data collected in the Polish Registry of Invasive Cardiology Procedures (ORPKI) from 2014 to 2021, we included 6522 patients who were treated with RA-assisted PCI. We scrutinized patient and procedural characteristics, as well as periprocedural complications, subsequently comparing groups in terms of cardiac arrest incidence with the use of univariable and multivariable analyses. Thirty-five (0.5%) patients suffered from cardiac arrest during RA-PCI or preceding CA. They were characterized by significantly higher rates of prior stroke, acute coronary syndromes (ACS) as indications and higher Killip class (P < 0.001) at the admission time. Among the confirmed independent predictors of in-procedure cardiac arrest, the following can be noted: factors related to patients' clinical characteristics (e.g., older age, female sex, and disease burden), periprocedural characteristics (e.g., PCI within left main coronary artery [LMCA]), and periprocedural complications (e.g., coronary artery perforation and no-reflow phenomenon). Severe clinical condition at baseline, expressed by ACS presence and Killip class IV, as well as RA-PCI performed within LMCA and other periprocedural complications, were the strongest predictors of cardiac arrest during RA-assisted PCI and CA.

Medication Adherence and Health Outcomes: A Public Health Perspective

Medicine is a two-edged sword: while it can treat a patient's illness, when applied carelessly, it also has the potential to do more harm than good. Ensuring that patients receive appropriate medication for their clinical condition at the appropriate time, by the appropriate channel, and in the appropriate doses should be the top priority for any healthcare system. Polypharmacy can be helpful because numerous morbidities are common, but it can also have unintended harmful effects. The co-morbidity-polypharmacy score uses the patient's physiological age rather than their chronological age to predict how their therapy will turn out. Any departure from the medication's intended therapeutic impact may be regarded as a drug-related issue. The purpose of this study was to examine the effects of clinical pharmacist interventions on drug-related issues in prescriptions for polypharmacy as well as the cost-benefit analysis of clinical pharmacy services. The particular goals were to recognise and address drug-related issues, find out how well health care providers received clinical pharmacist interventions, analyse the cost-benefit of clinical pharmacy services, and create and suggest a clinical pharmacists intervention form to standardise and record drug-related issues.

COMPARAÇÃOENTRECIRURGIAABERTAEMINIMAMENTEINVASIVAPARA ÚLCERAPÉPTICAPERFURADA

This study conducts a systematic review comparing open surgery and laparoscopic repair techniques for perforated peptic ulcer. The research was performed using PubMed and ScienceDirect databases, covering studies published in the last five years. Nine articles directly comparing the two surgical techniques were included, evaluating factors such as hospitalization time, postoperative complications, wound healing time, and infection rates. The results suggest that laparoscopic surgery offers several advantages, including reduced hospital stay and faster recovery, while open surgery remains relevant in specific cases. The analysis highlights the importance of selecting the surgical technique based on the patient's clinical condition and the surgeon's expertise, with laparoscopy emerging as the preferred approach in most cases. This study aims to provide evidence that can guide surgical practice, promoting better outcomes and a more patient-centered approach to the management of perforated peptic ulcers.

Volume-based structural connectome of epilepsy partialis continua in Rasmussen's encephalitis.

Rasmussen's encephalitis is a rare, progressive neurological inflammatory with hemispheric brain atrophy. Epilepsy partialis continua (EPC) is a diagnostic clinical condition in patients with Rasmussen's encephalitis. However, the incidence of EPC in the natural course of Rasmussen's encephalitis is only about 50%. The majority of experts hold the belief that EPC is associated with dysfunction in the motor cortex, yet the whole pathogenesis remains unclear. We hypothesize that there is a characteristic topological discrepancy between groups with EPC and without EPC from the perspective of structural connectome. To this end, we described the structural MRI findings of 20 Rasmussen's encephalitis cases, 11 of which had EPC, and 9 of which did not have EPC (NEPC), and 20 healthy controls. We performed voxel-based morphometry to evaluate the alterations of grey matter volume. Using a volume-based structural covariant network, the hub distribution and modularity were studied at the group level. Based on the radiomic features, an individual radiomics structural similarity network was constructed for global topological properties, such as small-world index, higher path length, and clustering coefficient. And then, the Pearson correlation was used to delineate the association between duration and topology properties. In the both EPC and NEPC groups, the volume of the motor cortex on the affected side was significantly decreased, but putamen atrophy was most pronounced in the EPC group. Hubs in the EPC group consisted of the executive network, and the contralateral putamen was the hub in the NEPC group with the highest betweenness centrality. Compared to the NEPC, the EPC showed a higher path length and clustering coefficient in the structural similarity network. Moreover, the function of morphological network integration in EPC patients was diminished as the duration of Rasmussen's encephalitis increased. Our study indicates that motor cortex atrophy may not be directly related to EPC patients. Whereas atrophy of the putamen, and a more regularized configuration may contribute to the generation of EPC. The findings further suggest that the putamen could potentially serve as a viable target for controlling EPC in patients with Rasmussen's encephalitis.

Otomycosis, Review

The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal. It appears to be a highly prevalent clinical condition seen in otorhinolaryngology outpatient departments worldwide. Most Aspergillus and Candida species are the etiological microorganisms that form biofilm inside the ear canal. The development of otomycosis can be caused by improper self-cleaning, self-medication, and the insertion of needless instruments into the ear canal. Ear pain, discharge from the ears, and hearing loss are the main signs of otomycosis. Therefore, in order to take a percussive action during the primary stage of infection, the correct diagnosis is imperative. However, special medical attention is required, particularly in patients with low immunity, when infection spreads to a mastoid area with a suppurative condition. The purpose of this thorough review is to raise awareness of the importance of good health education and self-hygiene in order to maintain a healthy lifestyle. The majority of cases of otomycosis affect one ear, and immunocompromised patients are more likely to experience bilateral involvement. The most often mentioned risk factors include swimming, applying mustard oil to ears, overusing antibiotic ear drops, using Q-tips, wooden sticks, metal pickers, and self-cleaning of ears with these items. Staphylococcus aureus is the most frequently implicated bacterium in cases of concurrent otomycosis. In order to lower the incidence of otomycosis, this literature review emphasizes the necessity of education in order to eliminate the previously mentioned predisposing risk factors.

Identification of Microbiota Causing Bromhidrosis in the Axillary

Bromhidrosis is a clinical condition defined by an uncomfortable or unpleasant body odor. Since the apocrine glands are only active during puberty, most bromhidrosis occurs in the apocrine glands in the armpit and occurs when apocrine gland secretions approach the skin's surface, where they undergo various biochemical reactions caused by the presence of microbiota in the axillary skin, resulting in odor in the axilla. This research aims to identify microbiota species in the axilla that can cause bromhidrosis. A laboratory experimental research design with purposive sampling is used in this study. In this study, 60 samples were collected from students aged 15 to 18 years old at a high school in Medan, and the samples were analyzed at the University of North Sumatra Hospital's Microbiology Laboratory. All samples were taken from the right axillary skin swab, a Gram stain was performed, and the identified microbiota isolates were identified. The results of skin smear culture revealed a Gram-positive cocci group in 59 samples (98.3%) and a Gram-positive bacilli group in only one sample (1.7%). The microbiota responsible for bromhidrosis was identified as Staphylococcus hominis spp. hominins (30.4%), Staphylococcus epidermidis (27.8%), Staphylococcus aureus (16.5%), Kocuria kristinae and Staphylococcus haemolyticus (6.3%), Staphylococcus lugdunensis and Staphylococcus saprophyticus. The most common microbiota that causes bromhidrosis in the axilla is Staphylococcis hominis spp. Hominis, Staphylococcus epidermidis, and Staphylococcus aureus.

The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position: an in-depth analysis of detection, management, and outcomes of 1000 consecutive cases

OBJECTIVE The overall benefit of employing a sitting/semisitting position for neurosurgical procedures remains under criticism due to concerns for additional risk, especially the risk of intraoperative venous air embolism (VAE). The aim of this single-center cohort study was to evaluate the frequency and severity of VAEs and associated complications in patients undergoing neurosurgery in the lounging position. METHODS From 2010 to 2020, 1000 patients, including 172 patients with a patent foramen ovale, underwent surgery in the lounging position for different neurosurgical pathologies. All patients were monitored intraoperatively using continuous transesophageal echocardiography (TEE). The anesthesia team documented any observed incidences of VAEs and scored their severity according to the Tuebingen classification system (TCS) for VAE (TCS-VAE). The patients’ clinical condition, radiological findings, and hospital course were subsequently analyzed to assess complications in a retrospective analysis of prospectively collected data. RESULTS In the cohort of 1000 patients, 5 underwent cervical spine surgery and 995 underwent suboccipital craniotomy. VAE was detected by TEE in 51.4% (95% CI 48.4%–54.5%) of patients, with synchronous changes in end-tidal CO2 (grade 2–5 TCS-VAE) noted in 10.2% (95% CI 8.3%–12.3%). None of the patients presented with hemodynamic instability (grade 5 TCS-VAE). Patients with high-grade VAEs were significantly older (p = 0.02) and had lower BMIs (p = 0.001) than the respective mean value of the cohort. VAE grade was not associated with any of the outcome measures such as Karnofsky Performance Scale score, duration of ventilation, length of intensive care unit stay, and length of hospital stay. Postoperative acute respiratory distress syndrome (ARDS) was diagnosed in 0.3% (95% CI 0.0%–0.7%, n = 3) of all cases, and ARDS was associated with perioperative VAE grade (p = 0.001). No patient suffered a new permanent neurological deficit due to a paradoxical VAE. CONCLUSIONS In this large cohort, the risk of an intraoperative VAE during neurosurgery in the lounging position was assessed, and contrary to the general perception in the field, no permanent sequelae or fatal adverse events attributable to VAEs were observed. Furthermore, the overall incidence of ARDS was very low. This study clearly establishes that experienced interdisciplinary teams can safely use the lounging position for neurosurgical procedures.