Problem For Most Patients Research Articles

Simultaneous induction of systemic hyperglycaemia and stress impairs brain redox homeostasis in the adult zebrafish

For diabetic patients it is crucial to constantly monitor blood glucose levels to mitigate complications due to hyperglycaemia, including neurological issues and cognitive impairments. This activity leads to psychological stress, called “diabetes distress,” a problem for most patients living with diabetes. Diabetes distress can exacerbate the hyperglycaemia effects on brain and negatively impact the quality of life, but the underlying mechanisms remain poorly explored. We simulated diabetes distress in adult zebrafish by modelling hyperglycaemia, through exposure to dextrose solution, along with chronic unpredictable mild stress (CUMS), and evaluated brain redox homeostasis by assessing reactive oxygen species (ROS) content, the antioxidant system, and effects on mitochondrial biogenesis and fission/fusion processes. We also evaluated the total, cytosolic and nuclear content of nuclear factor erythroid 2-related factor 2 (NRF2), a critical regulator of redox balance, in the whole brain and total NRF2 in specific brain emotional areas. The combined CUMS + Dextrose challenge, but not the individual treatments, reduced total NRF2 levels in the entire brain, but strongly increased its levels in the nuclear fraction. Compensatory upregulation of antioxidant genes appeared inadequate to combat elevated levels of ROS, leading to lowering of the reduced glutathione content and total antioxidant capacity. CUMS + Dextrose treatment also upregulated transcription factors implicated in mitochondrial biogenesis and dynamics with a predominance of fission, which is consistent with increased oxidative stress. In conclusion, this study highlights the close interplay between hyperglycaemia and psychological distress causing overriding oxidative stress in the brain, rendering the organism vulnerable to the development of disease complications.

Preoperative fasting for elective surgery in children

This review investigated preoperative fasting in children who need elective surgical interventions. Fifty publications included in the abstract databases PubMed and elibrary for the period from 2017 to 2023 were reviewed. For the analysis, we used articles on the effect of preoperative fasting on indicators of the cardiovascular system and water and carbohydrate metabolism and assessed the course of the perioperative period depending on the duration of refusal of solid food and liquids before surgery. The article presents historical information that formed the basis for the modern paradigm of refusal of solid food and liquids in the preoperative period, especially the negative consequences of prolonged refusal of food in the preoperative period, indicating the main ones, namely, euglycemic ketosis and ketoacidosis, which are common in children. Hypoglycemia due to food refusal before surgery is rare and is not a serious problem in most patients, except in children in the first year of life. In most cases, it has been demonstrated that the time of preoperative fasting significantly exceeds the recommended intervals and amounts to more than 10 hours, and 75% of patients experience a strong feeling of hunger. Infusion of dextrose solutions has not been found to reduce feelings of hunger and thirst before surgery. An increase in preoperative fasting time is often associated with improper organization of the process (35.1%), an increase in surgical time (34.1%), and surgical plan changes (20.9%). It is noted that the optimal volume of liquid that a child can drink before surgery is 3 ml/kg. Data indicates that preoperative fasting can cause arterial hypotension after induction of anesthesia, at the stage of preparing the surgical field. It has been demonstrated that a residual gastric volume of 1.25 ml/kg is a risk factor for aspiration during the induction of anesthesia. There is currently no convincing evidence of the negative effect of preoperative fasting on treatment outcome; however, clearly, the time to abandon clear liquids before elective surgery in children should be minimal.

Comparative clinical study of attenuation of hemodynamic response to laryngoscopy and endotracheal intubation using clinical assessment guidance versus neuromuscular block monitoring guidance

Background: The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients, except in cardiovascular or cerebral disease. Various anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. However administration of an additional drug may adversely affect hemodynamics of the patient or unnecessarily increase the depth of anesthesia. Hence a non pharmacological measure to reduce response is preferred. The purpose of this study was to compare the hemodynamic response during laryngoscopy and intubation when choice of the moment of intubation is directed by either clinical assessment and neuromuscular monitoring with train of four. Methods: A total of 60 patients were randomised into two groups. In Group M endotracheal intubation was done after train of four count became zero in adductor pollicis muscle. In Group C timing of intubation was determined clinically by assessment of jaw muscle relaxation. Changes in heart rate (HR), systolic BP (SBP), diasolic BP (DBP), mean arterial pressure (MAP), time between the administration of neuromuscular blocking agent and endotracheal intubation was recorded. Results were analysed by the analysis of variance and chi square test. Results: Heart rate, SBP, DBP and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and endotracheal intubation (P<0.05). The mean time required for onset of intubation was significantly shorter in Group C compared to Group M. Conclusion: The objective assessment of neuromuscular relaxation prior to endotracheal intubation provides better attenuation of hemodynamic responses. Keywords: hemodynamic response; laryngoscopy; endotracheal intubation; neuromuscular block

Literature Review: Terapi Nutrisi Pasien di Intensive Care Unit (ICU)

Malnutrition is a common problem in most patients admitted to the hospital, especially in the intensive care unit, so it requires energy. The prevalence of malnutrition in intensive care units is 78.1% in developing countries and 50% in developed countries, while as many as 75% of intensive care unit patients experience malnutrition. Medical nutrition therapy is needed to provide proper and adequate nutrition so as to improve the patient's quality of life. Enteral nutrition therapy can be given within 48 hours of admission to the intensive care unit via a nasogastric tube or an alternative if contraindicated. Parenteral nutrition therapy can be started after 3-7 days if the patient cannot tolerate enteral nutrition. The nutritional needs of patients in the intensive care unit depend on the severity of the disease and previous nutritional status, so that proper and adequate nutrition can improve the patient's prognosis and quality of life.

A Narrative of Oral Care in Palliative Patients.

Painful oral conditions represent a significant problem for most patients with a serious disease and palliative care needs. The main causes of such conditions may be associated with the underlying disease and its treatment, but primarily with adverse side effects of drugs. Oral conditions can lead to worsening of the illness and reduced quality of life. The objective of this narrative is to present an overview of oral care problems of this group, including present clinical practice. The evidence base for procedures and efficient products is weak. There is therefore an obvious need for research within this field.

Phytol and Heptacosane Are Possible Tools to Overcome Multidrug Resistance in an In Vitro Model of Acute Myeloid Leukemia.

Drug resistance is the ability of cancer cells to gain resistance to both conventional and novel chemotherapy agents, and remains a major problem in cancer therapy. Resistance mechanisms are multifactorial and involve more strictly pharmacological factors, such as P-glycoprotein (P-gp) and biological factors such as inhibitor of apoptosis proteins (IAPs) and the nuclear factor-kappa B (NF-κB) pathway. Possible therapeutic strategies for the treatment of acute myeloid leukemia (AML) have increased in recent years; however, drug resistance remains a problem for most pa-tients. Phytol and heptacosane are the major compounds of Euphorbia intisy essential oil (EO) which were demonstrated to inhibit P-gp in a multidrug resistant in vitro model of AML. This study investigated the mechanism by which phytol and heptacosane improve P-gp-mediated drug transport. Phytol suppresses the P-gp expression via NF-κB inhibition and does not seem to act on the efflux system. Heptacosane acts as a substrate and potent P-gp inhibitor, demonstrating the ability to retain the substrate doxorubicin inside the cell and enhancing its cytotoxic effects. Our results suggest that these compounds act as non-toxic modulators of P-gp through different mechanisms and are able to revert P-gp-mediated drug resistance in tumor cells.

Dry mouth in the seriously ill and dying.

Dry mouth constitutes a significant problem for most patients with grave illnesses and a need for palliative treatment. The main causes are pharmaceuticals, diseases and cancer treatment, which are often associated with increasing age. The condition may give rise to discomfort, pain, dysphagia, speech problems, increased caries activity, dehydration, malnutrition and loss of appetite. There are few evidence-based remedies against this condition. An apparently trivial problem like dry mouth may therefore cause deterioration of the clinical picture and a reduced quality of life.

PROBLEM OF GENITAL PROLAPSES AND THEIR CORRECTION BY NONSURGICAL METHODS

The aim: to determine the most optimal method of genital prolapse correction among the available nonsurgical methods from the perspective of differentiated approach. Materials and methods: using the methods of comparison, analysis and synthesis, we have compiled and processed the world's data from such major search databases as PubMed, EMBASE, Cochrane over the last ten years. Conclusions: the detection of genital prolapses at an early stage and the early nonsurgical treatment can prevent the disease progression, eliminate the symptoms, especially urinary problems in most patients, and improve the life quality.

The Importance of Clinical Examination in a Patient with Dysphagia: a Case Report

The aim of this paper is to emphasize the importance of careful history taking in patients with dysphagia. Dysphagia is defined as the difficulty in forming or moving the foods and liquids safely from the mouth to the stomach. Traditionally, swallowing can be divided into four stages: oral preparatory stage, oral stage, pharyngeal stage, and esophageal stage. However, it has to be emphasized that the division of swallowing into different stages is artificial and the act of swallowing should be considered as a whole process. Therefore, a careful history taking will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients. Although patients explain their disease-related symptoms undoubtedly, it is necessary for the clinicians to be aware of some other suspicious pathologies. Herein, we present the case of a patient with Schatzki ring (SR) who had a feeling “something stuck in the throat” during ingestion of solid foods.

Managing symptoms in hypothyroid patients on adequate levothyroxine: a narrative review.

The current standard of care for hypothyroidism is levothyroxine (LT4) monotherapy to reduce levels of thyrotropin (thyroid-stimulating hormone, TSH) within its reference range and amelioration of any symptoms. A substantial minority continues to report hypothyroid-like symptoms despite optimized TSH, however. These symptoms are not specific to thyroid dysfunction and are frequent among the euthyroid population, creating a therapeutic dilemma for the treating clinician as well as the patient. We present a concise, narrative review of the clinical research and evidence-based guidance on the management of this challenging population. The clinician may endeavor to ensure that the serum TSH is within the target range. However, the symptomatic patient may turn to alternative non-evidence-based therapies in the hope of obtaining relief. Accordingly, it is important for the clinician to check for conditions unrelated to the thyroid that could account for the ongoing symptoms such as other autoimmune conditions, anemia or mental health disorders. Systematic and thorough investigation of the potential causes of persistent symptoms while receiving LT4 therapy will resolve the problem for most patients. There may be some patients that may benefit from additional treatment with liothyronine (LT3), although it is unclear as yet as to which patient group may benefit the most from combined LT4 + LT3 therapy. In the future, personalized treatment with LT4 + LT3 may be of benefit for some patients with persistent symptoms of hypothyroidism such as those with polymorphisms in the deiodinase enzyme 2 (DIO2). For now, this remains a subject for research.

Research Advance on the Immune Escape of Acute Myeloid Leukemia--Review

Acute myeloid leukemia (AML) is a kind of malignant hematological disease with high mortality. Patients 5-year survival rate is less than 25% and that of elderly patients is lower than 10%. Although the standardized chemotherapy or hematopoetic stem cell transplantation can significantly improve the therapeutic efficacy for AML, but disease recurrence is still a difficult problem in most patients. Chemotherapy combined with immunotherapy has been regarded as the most promising treatment for AML in recent years, but immunotherapy is prone to immune escape, which has become an important factor affecting the therapeutic efficacy. Therefore, understanding the mechanism of immune escape of AML and taking corresponding measures in time to improve the therapeutic effect and reduce the recurrence of AML are of great significance. In this review, the important cells that cause immune escape, such as myeloid-derived suppressor cells (MDSC), natural killer cells (NK), and cell surface inhibitory receptor PD-1 (programmed death 1), which mediate immune escape of AML cells are summarized, so as to provide valuable reference for research to improve the effect of AML immunotherapy.

Chemotherapy-Induced Peripheral Neuropathy: Nursing Implications.

Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.

Advances in the Treatment of Acute Myeloid Leukemia: New Drugs and New Challenges.

The therapeutic armamentarium of acute myeloid leukemia (AML) has rapidly expanded in the past few years, driven largely by translational research into its genomic landscape and an improved understanding of mechanisms of resistance to conventional therapies. However, primary and secondary drug resistance remains a substantial problem for most patients. Research into the mechanisms of resistance to these new agents is informing the development of the next class of AML drugs and the design of combination regimens aimed at optimally exploiting therapeutic vulnerabilities, with the ultimate goal of eradicating all subclones of the disease and increasing cure rates in AML. SIGNIFICANCE: AML is a heterogeneous disease, characterized by a broad spectrum of molecular alterations that influence clinical outcomes and also provide potential targets for drug development. This review discusses the current and emerging therapeutic landscape of AML, highlighting novel classes of drugs and how our expanding knowledge of mechanisms of resistance are informing future therapies and providing new opportunities for effective combination strategies.

The effect of foot reflexology on constipation and quality of life in patients with multiple sclerosis. A randomized controlled trial

BackgroundConstipation is a major problem in most patients with multiple sclerosis (MS). The aim of this study was to investigate the effect of foot reflexology on constipation and quality of life in patients with MS. MethodsThis study was a randomized controlled trial, in which 63 patients with MS referred to Arak MS Society, Iran were participated (from May to Dec. 2018). In this study participants were selected according to inclusion criteria and randomly divided into intervention (n = 33) and control (n = 30) groups. In the intervention group, foot reflexology was applied twice a week for 6 weeks (each session lasted about 30−40 min). Data were collected using demographic questionnaire, Constipation Assessment Scale (CAS) and Short Form (SF) 36 Quality of Life (QOL) questionnaire. Finally, the data were analyzed using SPSS Ver. 16 and descriptive and inferential statistical tests. ResultsThe results of the study showed that severity of constipation and QOL score were not significant between the two groups before intervention (p > 0.05), but; after intervention, severity of constipation significantly decreased in the reflexology group (p < 0.05). Nevertheless, after intervention, the QOL was improved in the reflexology group compared to the control group but was not significant (p > 0.05). ConclusionThe results of this study showed that foot reflexology, as an effective intervention can be useful in management of constipation in patients with MS. Therefore, this intervention can be applied as a safe method for the decrease of constipation in MS patients.

Ventilator-Induced Diaphragm Dysfunction (Review)

Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy.

Sternal Reconstruction with the Omental Flap-Acute and Late Complications, Predictors of Mortality, and Quality of Life.

The omental flap is a reliable flap for the coverage of sternal defects. However, little is known about the predictors of mortality and the long-term outcome in such patients. We, therefore, performed a retrospective study from 2002 to 2013, including all patients who underwent sternal reconstruction with the omental flap. A total of 50 patients were identified and mean follow-up was 3.8 years. Patient data was collected from the charts and 14 patients were available for telephone interviews. The majority of patients suffered from deep sternal wound infections. There was no complete flap loss and an overall success rate was 96%. In-hospital mortality was 14% and overall survival over follow-up was 50%. Significant predictors of mortality were age > 65, American Society of Anesthesiologists' status, defect size, prolonged ventilation, and the need for tracheotomy. Postoperative quality of life was reduced compared with other cohorts, especially with regard to bodily function. Pain was also a major problem for most patients along with herniation. The omental flap is a safe option even in patients with severe comorbidities. However, based on the data in this study, we would recommend the omental flap as a reserve option rather than first-line treatment for sternal defects.

Excessive Weight Gain during the First Year of Peritoneal Dialysis Is Associated with Inflammation, Diabetes Mellitus, and a Rapid Decrease in Residual Renal Function.

ObjectivesSignificant weight gain is a potential problem in most patients starting peritoneal dialysis (PD); however, few studies have explored the clinical effects of increased body weight (BW) in these patients. We evaluated the effect of excess weight gain during the first year after PD on residual renal function (RRF).MethodsA total of 148 incident PD patients were analyzed in a longitudinal observational study. The mean duration of follow-up was 23.8 months. RRF was measured at baseline (within 1 month of starting PD) and thereafter at 6-month intervals for 2–3 years or until loss of RRF. BW was measured at the time of RRF measurement, and excess weight gain was defined as a BW increase over the median value (3.0%).ResultsThe median 1-year increase in BW was 2.3kg (IQR, 1.01–4.58) or 3.0% (IQR, 1.13–5.31). The mean slope of RRF decline was –0.068 ± 0.053 mL/min/month/1.73m2, and RRF loss developed in 48 patients at a mean follow-up time of 19.4 ± 6.8 months. Patients with BW increases > 3.0% showed significantly increased RRF decline rate compared to those without excess weight gain (p<0.001), and the BW increase (%/year) correlated significantly with higher hs-CRP levels and RRF decline rate. High systolic blood pressure, diabetes, large amount of proteinuria and excess BW gain significantly influenced the RRF decline rate. Also, it increased the risk of RRF loss by 4.17-fold (95% confidence intervals, 1.87–9.28; p<0.001).ConclusionsExcess weight gain during the first year of PD was closely linked to systemic inflammation, diabetes and rapid decline in RRF.

A Study of Signal-to-Noise Ratios for Monosyllabic and Sentence Recognition Threshold in Sensorineural Hearing Loss

A major problem for most patients with hearing impairment is understanding speech in background noise. In the current study, we investigated to search of threshold of speech recognition at various signal-to-noise ratios (SNRs) using the monosyllabic words and sentences. Three listener groups consisting of 7 normal-hearing, 20 listeners with mild degree of sensorineural hearing loss, and 20 listeners with moderate degree of hearing loss (HL) were participated in this study. The subjects listen to the target monosyllables or sentences at eight conditions of SNRs (ranging from –12 to 9 dB SNR). The SNR required for 50% word recognition was -2.13 dB, -1.22 dB and 0.55 dB for normal-hearing, mild, and moderate HL listeners. The SNR for sentence recognition was -2.86 dB, -2.31 dB and –1.85 dB for the same listener groups. The 50% recognitions for sentence were obtained at a significantly lower SNR than for monosyllabic word. Regardless of the stimulus type, SNR for speech recognition threshold by sensorineural hearing loss with moderate HL were significantly higher than normal and mild HL. The results can be useful for development of speech-in-noise recognition test and decision on efficient SNR in aural rehabilitation for hearing aid users.

Switching to cheaper drugs not a problem for most patients

Switching to cheaper drugs not a problem for most patients

High-Risk Multiple Myeloma: Different Definitions, Different Outcomes?

Multiple myeloma (MM) is a clonal plasma cell malignancy. Although MM is still not completely curable, it can be maintained at the level of a long-term chronic condition. Irrespective of the treatment strategy, relapse is still a major problem for most patients. Approximately 10% to 15% of all MM patients relapse early and have poor prognosis and outcome. Currently, there are many ways of identifying these high-risk patients using cytogenetics or molecular biology. Despite these various approaches to definition of high risk patients, a clear definition of high-risk MM has not been widely accepted. In this review, we discuss and compare various approaches, and their strengths and weaknesses in early identification of high-risk MM patients.