Recent Advances In Management Research Articles

Recent Advances in Management of Diabetic Nephropathy

Diabetic nephropathy (DN) is not only the most common cause of end-stage renal disease world-wide but also increases the risk of mortality up to fourteen times compared to normoalbuminuric diabetic patients. After a long time of inertia, recent advances in the management of diabetes have added a valuable share to the effort of prevention and slowing the progression of DN. Beyond their hypoglycemic effects, dipeptidyl peptidase-4 inhibitors, and sodium glucose transporter 2 inhibitors have shown unique renoprotective mechanisms in both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Advances in this field included, in addition, the introduction of many anti-oxidant and anti-inflammatory agents that proved in experimental and in vitro studies to add significant impact on development and progression of DN. Most of these agents are still waiting for clinical studies to confirm their safety and efficacy. Beside their role in improving plans of management, the new discoveries have improved our understanding of the pathogenesis of DN. This review will cover the updates in established and potential therapeutic modalities that would improve the management of DN after discussing the pathogenic pathways that help in understanding the mechanism of action of these different treatments.

Maxillofacial Injuries Due to Road Traffic Accidents in Saudi Arabia: A Review of Incidence, Demographic Factors & Prevention Strategies

<p><strong>Background</strong>: World Health Organization has estimated that nearly 25% of all injuries fatalities worldwide are a result of road traffic crashes with 90% of the fatalities occurring in low and middle income countries. Trauma in Saudi Arabia is a major public health problem with increasing rates of mortality and morbidity.</p><p><strong>Objectives</strong>: To review the incidence of maxillofacial injuries due to road traffic accidents in Saudi Arabia and to highlight the etiological factors, the current preventive strategies and suggestions to reduce such injuries.</p><p><strong>Material and Methods</strong>: This review was conducted through literature search over a period of 25 years. The key words included in the search include road traffic injuries, maxillofacial trauma, Saudi Arabia. The search was conducted through search engines and which included Google, science direct, pub med. A total of 56 reference articles and web pages were reviewed. 31 of these references are cited in this review. The demographic factors involved in road traffic accidents, the existing legislation in the country as cited in the literature, primary care system and recent advances in management are highlighted in this review article.</p><p><strong>Conclusion</strong>: Trauma is a preventable cause of death, morbidity, depression and unemployment. Simple measures such as seat belt legislation, traffic monitoring, creation of awareness among youth will significantly bring down loss of lives. This will create a better society to live and enjoy life.</p>

Maxillofacial Injuries Due to Road Traffic Accidents in Saudi Arabia: A Review of Incidence, Demographic Factors & Prevention Strategies

Background : World Health Organization has estimated that nearly 25% of all injuries fatalities worldwide are a result of road traffic crashes with 90% of the fatalities occurring in low and middle income countries. Trauma in Saudi Arabia is a major public health problem with increasing rates of mortality and morbidity. Objectives : To review the incidence of maxillofacial injuries due to road traffic accidents in Saudi Arabia and to highlight the etiological factors, the current preventive strategies and suggestions to reduce such injuries. Material and Methods : This review was conducted through literature search over a period of 25 years. The key words included in the search include road traffic injuries, maxillofacial trauma, Saudi Arabia. The search was conducted through search engines and which included Google, science direct, pub med. A total of 56 reference articles and web pages were reviewed. 31 of these references are cited in this review. The demographic factors involved in road traffic accidents, the existing legislation in the country as cited in the literature, primary care system and recent advances in management are highlighted in this review article. Conclusion : Trauma is a preventable cause of death, morbidity, depression and unemployment. Simple measures such as seat belt legislation, traffic monitoring, creation of awareness among youth will significantly bring down loss of lives. This will create a better society to live and enjoy life.

Clinico-Aetiological Study of Severe and Very Severe Pneumonia in Two Months to Five Years Children in a Tertiary Health Care Centre in Odisha, India.

Pneumonia is a major cause of mortality under five-year-old children. In spite of recent advances in management, there is paucity of data on clinical, aetiological profile of severe and very severe pneumonia among under five-year-old children in developing countries. To determine the clinico-aetiological factors of severe and very severe pneumonia and its outcome in children aged two -months to five-years in a tertiary health care centre in Odisha, India. This was a prospective observational study. All the patients between two-months to five-years age admitted to SCB Medical College, Cuttack, Odisha, India, were screened for features of severe and very severe pneumonia based on WHO diagnostic criteria, over a one year period. Out of 10300 patients admitted to our hospital during the study period; 141 cases were included in the study. Their clinical parameters were recorded and were followed up till discharge or death. Continous variables were analyzed using Student t-test or Mann-Whitney U test whereas categorical data were analyzed using Pearson Chi square test or Fischer Exact test. Out of 141 patients included in the study, cough, tachypnea and chest retractions were present in 100% cases while fever in 97.1% (137) cases. In 17% (24) cases, bacterial pathogen was isolated. Most common organism being Staphylococcus aureus 8.51% (12) followed by Streptococcus pneumonie 6.4% (9). Higher mortality 11.34% (16) was found among patients presenting after three days of illness (p=0.048). About 17% (24) patients developed complications. Common complications were sepsis 5.6% (8), CCF 4.2% (6) and empyema 4.2% (6). Higher mortality 22 (15.6%) was observed in very severe pneumonia group (p=0.003). The incidence of severe and very severe pneumonia was higher in infancy. Rainy and winter season were associated with higher incidence of disease. Bottle feeding practice and smoking were significantly associated with more severe disease. Death rate was high among patients admitted to hospital after three days of onset of illness, so early referral is indicated for better outcome.

Imaging the Abdominal Manifestations of Cystic Fibrosis.

Cystic fibrosis (CF) is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis.

Monitoring outcomes in intrahepatic cholangiocarcinoma patients following hepatic resection.

Intrahepatic cholangiocarcinoma (iCCA) is one of the fatal gastrointestinal cancers with increasing incidence and mortality. Although surgery offers the only potential for cure in iCCA patients, the prognosis is not optimal with low overall survival rate and high disease recurrence. Hence, adjuvant therapy is generally recommended in the management of high-risk patients. Identifying factors associated with disease recurrence and survival of the iCCA patients after resection will improve understanding of disease prognosis and help in selecting patients who will benefit from surgical resection or stratifying them for clinical trials. Despite development of new methods for early detection of tumor recurrence, effective prognostic models and nomograms, and recent advances in management, significant challenges remain in improving the prognosis of iCCA patients.

Seizure clusters: A common, understudied and undertreated phenomenon in refractory epilepsy.

Epilepsy is widely prevalent globally and has emerged as a well-studied neurological condition in the recent past. Seizure clusters, a type of seizures, and several aspects pertaining to the etiopathogenesis and management of clusters are yet to be elucidated. This review is an attempt to recapitulate the current understanding of seizure clusters based on the research that has been performed on seizure clusters. This article will provide a comprehensive review of various aspects of clusters, and discusses definitions, prevalence, risk factors, impact on quality of life, approved treatment modalities, and recent advances in management.

The 2015 Pregnancy Summit, London, UK.

Pregnancy Summit, Cineworld, The O2, London, UK, 29 September to 1 October 2015 The 2015 Pregnancy Summit was held over 3 days from 29 September to 1 October at Cineworld, The O2, London, UK. The event brings together a multidisciplinary faculty of international researchers and clinicians to discuss both scientific and clinical aspects of pregnancy-related issues in an informal setting. The goal of the meeting was to provide delegates with an update of recent advances in management of pregnancy-related conditions, to present research data and to discuss the current attitudes and practices in relevant topics. An extensive range of topics were discussed, from preeclampsia and treatment of hypertension, to the psychological impact of termination of pregnancy and feticide. This report will summarize a selection of the lectures presented.

Recent Advances in the Management of Pediatric Short Bowel Syndrome: An Integrative Review of the Literature

Short bowel syndrome is the most prevalent cause of pediatric intestinal failure. Recent advances in nutritional and surgical management of these patients have lead to an overall improvement in mortality. We review the short- and long-term management strategies, as well as the potential complications in short bowel syndrome patients.

Fistula in Ano - Recent Advances in Management

Fistula in ano commonly develops as a chronic sequela to an asymptomatic or symptomatic abscess in an anal canal gland, i.e. cryptoglandular in origin [1]. It occurs in upto one third of patients who undergo drainage of an anorectal abscess [2]. Complex, recurring fistulas could develop secondary to trauma, infection, radiation or chronic granulomatous infections (tuberculosis, actinomycosis) [3].

Recent advances in management of gout

통풍은 퓨린대사의 이상으로 체내에 과잉축적된 요산이 결정화되면서 관절과 관절 주위 조직에 재발성 발작성 염증 을 일으키는 질환으로 심한 관절통과 관절의 변형으로 삶의 질을 저하시키는 만성전신성질환이다[1]. 통풍은 고통스런 관절염뿐만 아니라 고혈압, 이상지질혈증, 복부비만, 당뇨 병으로 특징지어지는 대사증후군과 관련이 높음이 입증되고 있으며 우리나라 통풍 환자들의 현실도 예외는 아니다[2,3]. 그에 따라 통풍 환자에게는 다양한 질병이 동반되고 많은 약 물이 복합적으로 사용되면서 질병에 의한 합병증과 약물에 의한 부작용으로 인해 수명이 단축될 수 있다는 보고가 나오 고 있다[4]. 또한 이에 따른 경제적인 부담도 다른 질병에 비 해 많이 소모되고 있으며 전 세계적으로 통풍 환자의 수가 증가하여 이제 미국에서는 통풍이 류마티스관절염을 제치고 가장 흔한 염증성관절염으로 등극되어 있는 것이 통계적으 로 증명되고 있다[5]. 통풍은 임상적으로나 병리학적으로 복 잡하고 심각한 질환이지만 그 치료와 예후의 중요성이 전 세 계적으로 저평가되고 있으며 우리나라에서도 제대로 치료를 받고 있는 통풍 환자들이 절반에도 미치지 못하고 있는 형편 이다[6]. 그러나 통풍은 적절히 치료를 받으면 통풍발작을 충분히 예방할 수 있고 통풍의 심각한 합병증도 줄이거나 늦 출 수 있다. 그러므로 의사와 환자들에게 통풍의 치료와 관 리에 대한 중요성이 더욱 강조되어야 한다. 여기에서는 통풍 의 치료에 대해 정리하여 소개하고자 한다. 통풍관리의 최신지견

Recent advances in management of allergic rhinitis in Egypt

Recent advances in management of allergic rhinitis in Egypt

Efficacy of Spirulina (Tahlab) in Patients of Type 2 Diabetes Mellitus (Ziabetus Shakri) - A Randomized Controlled Trial

Aims: Diabetes mellitus (DM) (Ziabetus Shakri) is a common metabolic disease affecting 150,000,000 people worldwide. Despite the recent advancements in management of Diabetes its relative co-morbidities and mortality is ever increasing globally. Unani scholars had claimed the effectiveness of several anti-diabetic drugs in the classical texts in the management of DM, but it lacks scientific documentation. Hence, a clinical trial was contemplated to evaluate the efficacy of test drug Tahlab (Spirulina) in patients of type 2 DM. Methods: The study was a single blind randomized standard control conducted on 40 patients of type 2 DM. 30 subjects were allocated to test and 10 to control group. Test group received 7 grams of Tahlab powder twice a day, and control group received Metformin (500 mg) 1 tablet twice a day for a period of 45 days. Subjective and objective parameters were assessed at 0, 15th, 30th, 45th day. Results: The Mean score for FBS in test group has declined from 245.53 to 204.87 and PPBS from 345.73 to 303.67 respectively. The Mean score for FBS in control group has declined from 227.60 to 191.80 and PPBS from 329.60 to 282.80 respectively. Intergroup comparison revealed test drug to be similar to that of control drug in reducing FBS and PPBS. HbA1c and urine sugar remained unaltered in both groups. The results were assessed statistically using two tailed student t test, paired proportion test and Fischer exact test. Conclusions: The study revealed that the test drug is safe and equally effective when compared to control drug.

Prognostic Implication of Strain Analysis in Patients with ST-Segment Elevation Myocardial Infarction: One More Evidence for Ever-Debatable Topic.

REFER TO THE PAGE 128-134 What is essential is invisible to the eye - the Little Prince - Despite recent advances in management, patients with acute ST-segment elevation myocardial infarction (STEMI) are still at increased risk for adverse outcomes, even after a timely revascularization.1),2) Therefore, early risk stratification for such patients is of clinical importance. STEMI involves remodeling of the left ventricle (LV); and diseased LV is associated with future adverse outcomes. In this issue of the Journal, Na et al.,3) in their research using 2-dimensional strain technique, demonstrated that global longitudinal strain (GLS) can predict adverse remodeling in patients with STEMI; GLS value, along with left ventricular end-diastolic volume, deceleration time of mitral inflow, and CK-MB level, independently predicted adverse remodeling of the LV, whereas global circumferential strain, net twist, and twist/untwist rate did not. Many studies have reported on the prognostic power of GLS.4),5),6) A strongpoint of this study is the relatively large (n = 208) and homogenous study sample (acute STEMI patients who were treated with a timely successful reperfusion therapy and underwent echocardiographic evaluation for strain analysis within 24 hrs after treatment). In addition, the authors' hypothetical explanation for the data (i.e., GLC, but not global circumferential strain, is a predictor for LV remodeling) in the discussion section of the article seems reasonable. However, this study should not be regarded as the final answer to the many questions and there is skepticism regarding the eye-catching echocardiographic technique. In routine clinical practice, we still resort to mainly visual assessment of myocardial wall motion based on two-dimensional echocardiography when assessing LV performance. Strain analysis is supposed to be objective, however there are many obstacles to its wide application in clinical practice, including the issue of reproducibility, time-consuming off-line analysis, good quality echo-images, which are not always easy to obtain, as well as issues regarding vendor-specific differences: reproducibility issues.6) Despite these limitations, there are copious research data supporting the unique strongpoints of strain analysis, and the current research by Na et al.3) sheds light on strain analysis for early prediction of adverse LV remodeling in STEMI patients and would at least provide a robust background for further investigation to determine the clinical usefulness of the ever-developing echocardiographic technique.

Glucagonoma and Glucagonoma Syndrome: A Case Report with Review of Recent Advances in Management.

The rarity of glucagonoma imposes a challenge with most patients being diagnosed after a long period of treatment for their skin rash (months-years). Awareness of physicians and dermatologists of the characteristic necrolytic migratory erythema often leads to early diagnosis. Early diagnosis of glucagonoma even in the presence of resectable liver metastases may allow curative resection. Herein, we present a typical case of glucagonoma treated at our center and review the literature pertinent to its management.

Hydatid disease of lung

Background: Hydatid cyst is zoonosis caused due to Echinococcus species - Cestode parasite, Echinococcus granulosus. In developing countries like India, Iran, China and Mediterranean countries it is still remains a major problem. It can involve any organ and can mimic almost any pathological condition. Complication associated rather than disease itself, are difficult to treat. Objectives of the study was to study the clinical presentation of hydatid disease of lung, its management and its complications. Methods: All patients diagnosed as hydatid disease mainly by X-ray, USG or CT scan and then treated either operatively or non-operatively were included in this study. Pulmonary function test and pre-operative incentive spirometry started. Patients were operated after a preoperative Albendazole therapy for 28 days in dose of 10mg/kg and postoperatively all patients were put on Albendazole three course of 28 weeks each with 1 week gap in between. The choice of surgical procedure was guided by site, size of the cyst and associated complications. Thorough post-operative care and chest physiotherapy and nebulization started. The patients were followed up for a period of 6 months. Results: Total 26 patients were studied in a period of 3 years. Maximum number of patients presented with cough (83.34%). X-ray was most commonly used diagnostic modality, and CT scan was done in all patients for confirmation of diagnosis. The mostly right side was involved in all patients. Most of the lung cysts were single and unilateral. Total cystectomy with intercostal drainage was the most common modality of treatment. Broncho-pleural fistula with pus discharge was the most common intra-operative complication. All the patients had respiratory complications in postoperative period which are managed conservatively. Conclusions: Lung Hydatid is a severe systemic manifestation of Hydatid disease. Complications are life threatening. Management of lung hydatid disease requires both surgical and intensive respiratory management. With recent advances in management, outcome has improved over years.

Recent Advances in Management of Pediatric Food Allergy.

Many children now suffer with a food allergy, immunoglobulin E (IgE) and/or non-IgE mediated. Food allergies have a significant impact on the child’s quality of life, as well as that of their family, due to the resultant dietary restrictions and the constant threat of a potentially life-threatening reaction. At present, there is no cure for food allergies, but there are exciting advances occurring in the management of IgE mediated allergies, including a more active approach to management with anticipatory screening testing, early introduction of common food allergens, active tolerance induction, use of biologics and active risk management. These areas will be discussed in this review.

Recent Advances in Management of Acquired External Punctal Stenosis

Acquired external punctal stenosis (AEPS) denotes anatomical narrowing of lacrimal punctum, which clinically manifests as epiphora. AEPS may be asymptomatic in a patient with dry eye. Under conditions of normal or excessive tear production; AEPS can produce symptomatic epiphora, which is an indication for intervention. Chronic blepharitis and idiopathic stenosis are the most common etiological factors. Preventable punctal stenosis in patients on long term taxanes or 5- fluorouracil occurs due to systemic absorption of these drugs and secretion in tears. In such cases, AEPS may be prevented by prophylactic lacrimal intubation. AEPS may have associated canalicular stenosis in 45% of cases. This review deals with the etiology, clinical diagnosis and management of AEPS, which has evolved over the years from the earliest description of simple punctal dilatation to present day use of monocanalicular and bicanalicular silicone stents.

Recent advances in management of the HIV/HCV coinfected patient.

Chronic hepatitis C virus (HCV) is a global epidemic, affecting approximately 150 million individuals throughout the world. The implications of HCV infection have been magnified in those who are infected with both HCV and the HIV as liver disease progression, liver failure and liver-related death are increased, particularly in those without well-controlled HIV disease. The development of direct-acting antiviral agents for HCV that allow shorter treatment periods with increased efficacy and decreased adverse events have greatly changed the outlook for HCV-infected individuals. With these advancements, growing treatment options for the coinfected population have also come. This review will address pharmacotherapy issues in the HIV/HCV coinfected population.

Recent advances in management of phaeochromocytoma

Pheochromocytoma (PCC) and paraganglioma (PGL) are the neuroendocrine tumours that arise in adrenal medulla or extra adrenal sympathetic and parasympathetic paraganglia. Paraganglia are small organs that mainly consist of neuroendocrine cells derived from the embryonic neural crest that have the ability to synthesize and secrete catecholamines. Sympathetic PGLs are usually located in the chest, abdomen, or pelvis while parasympathetic PGLs are distributed along parasympathetic nerves in the head, neck, and upper mediastinum, also referred to as head and neck PGL (HNP). PCC/PGLs can be either functional (sympathetic) or non-functional (parasympathetic) based on catecholamine synthesis and secretion. In children diagnosed with hypertension, up to 1.7% have a catecholamine-secreting neoplasm. The majority of these tumours in childhood are PCC/PGLs. Incidence rates of PCC/PGLs are estimated at 0.3 cases per million per year or less. Approximately 10 –20% of these cases are diagnosed during childhood. Approximately half of the apparently sporadic PCC/PGLs that present in patients younger than 18 years are due to an identifiable germline mutation and this increases up to 70% in children less than 10 years of age. Hereditary tumor syndromes associated with PCC include Von Hippel-Lindau (VHL) disease, multiple endocrine neoplasia 2 (MEN-2), the familial PGL syndromes and rarely, neurofibromatosis (NF) type 1. Recently, many other genes are found to be involved in pathogenesis of PCC/PGLs. Hereditary PCC/PGLs are often multifocal and, in the case of PCC, frequently bilateral. Children usually present becauseof symptomatic catecholamine hypersecretion or, less often, due to tumor mass effects (e.g. pain), or as an incidental radiographic finding, or because of family screening. At present, the diagnostic test of choice is the measurement of fractionated plasma and/or urine metanephrines (metanephrines and normetanephrines). A four-fold increase above the reference range is associated with an almost 100% probability of the presence of a catecholamine-secreting tumor. 123I-metaiodobenzylguanidine(MIBG) is a highly specific test that can confirm the catecholamine-secreting nature of a tumor, localize tumors not seen with cross-sectional imaging, and identify other sites of disease as well as metastasis. Because MIBG testingis not 100% sensitive, particularly in some genetic mutations, recently other functional scans have been studied in the evaluation of PCC/PGL: 18F fluorodihydroxyphenylalanine (DOPA) positron emission tomography (PET), 18F fluorodopamine (FDA) PET,18F fluorodeoxyglucose (FDG) PET. Surgical resection is the mainstay in the treatment of PCC/PGLs. It should be done after adequate alfa and beta adrenergic blockade to minimize the hemodynamic fluctuation during surgery. Laparoscopic adrenalectomy is the preferred procedure for most PCC. Laparotomy should be considered in patients with large PCC and/or a concern for underlying malignancy based upon the clinical presentation or radiographic appearance of the tumor. In the setting of bilateral PCC, cortical-sparing procedures should be considered for the adrenal with the least tumor bulk. The cortical-sparing approach is particularly attractive in young children and children at risk for noncompliance with lifelong glucocorticoid and mineralocorticoid replacement. The surgical approach for removal of a PGL depends upon the location of the tumor but in selected cases can also be performed laparoscopically. Patients with unresectable malignant tumors or distant metastatic disease can usually be treated symptomatically with adrenergic blockade. Radiation therapy or radiofrequency ablation can help with symptomatic metastatic disease, and IV bisphosphonates can be considered bony metastases, particularly in patients with bone pain or lesions that increase the risk of pathological fracture. Systemic treatment modalities are only palliative in nature and include 123I-MIBG therapy, peptide receptor radiotherapy (PRRT) and chemotherapy. PCC/PGLs can have unpredictable behavior and metastasize late in the clinical course. In addition, children in particular are at risk for the development of metachronous tumors. This makes long-term follow-up mandatory in children with PCC/PGL.