Pub Date : 2020-07-10DOI: 10.33552/accs.2020.02.000542
D. Oniciu
Elevated hepatic lipogenesis and inflammation are associated with the progression of non-alcoholic steatohepatitis (NASH) and cardiovascular disease. Gemcabene, a small molecule in development for dyslipidemia, reduces plasma very low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and C-reactive protein (CRP) in animal models and humans. An analysis of the clinical information available for gemcabene and translational research substantiates the potential of gemcabene as a therapeutic agent for NASH. Specifically, gemcabene showed positive effects in clinical trials in severe hypertriglyceridemia and in subsets of obese, diabetic patients, particularly reductions in triglycerides, cholesterol and proatherogenic and inflammation markers. In nonclinical models, gemcabene showed significant improvement in non-alcoholic fatty liver disease (NAFLD) activity and fibrosis scores and affected beneficially the hepatic expression of many lipid regulating and inflammatory genes.
{"title":"Gemcabene as a Potential Therapeutic for NASH: Lessons Learnt from its Clinical Trials in Dyslipidemia","authors":"D. Oniciu","doi":"10.33552/accs.2020.02.000542","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000542","url":null,"abstract":"Elevated hepatic lipogenesis and inflammation are associated with the progression of non-alcoholic steatohepatitis (NASH) and cardiovascular disease. Gemcabene, a small molecule in development for dyslipidemia, reduces plasma very low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and C-reactive protein (CRP) in animal models and humans. An analysis of the clinical information available for gemcabene and translational research substantiates the potential of gemcabene as a therapeutic agent for NASH. Specifically, gemcabene showed positive effects in clinical trials in severe hypertriglyceridemia and in subsets of obese, diabetic patients, particularly reductions in triglycerides, cholesterol and proatherogenic and inflammation markers. In nonclinical models, gemcabene showed significant improvement in non-alcoholic fatty liver disease (NAFLD) activity and fibrosis scores and affected beneficially the hepatic expression of many lipid regulating and inflammatory genes.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116381540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-06DOI: 10.33552/accs.2020.02.000540
A. Handa
Male patients over the age of 65, presenting with acute abdominal pain should be managed as a potential ruptured abdominal aortic aneurysm (AAA), until proven otherwise. Ruptured AAA is a commonly missed life-threatening diagnosis. This paper aims to recap over the diagnosis and management to aid doctors in training in their decision making.
{"title":"ABCD…Airway, Breathing, Circulation (and don’t forget Differentials)","authors":"A. Handa","doi":"10.33552/accs.2020.02.000540","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000540","url":null,"abstract":"Male patients over the age of 65, presenting with acute abdominal pain should be managed as a potential ruptured abdominal aortic aneurysm (AAA), until proven otherwise. Ruptured AAA is a commonly missed life-threatening diagnosis. This paper aims to recap over the diagnosis and management to aid doctors in training in their decision making.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130611300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.33552/accs.2020.02.000539
O. Taha
Early may contribute to anemia in infancy thus it can deprive the infant of 60 to 100 ml of whole blood representing 30-50 mg/kg of iron. The umbilical cord milking is a safe technique. Aim of the study: The aim of the study to assess the effects of umbilical cord milking as compared with early cord clamping on hematological parameters (hemoglobin, packed cell volume, bilirubin and ferritin) among term and near term neonates. Materials & methods: This study was carried out as randomized, controlled clinical trial. The subjects were divided randomly into two groups (200 neonates who the cord was milked after cutting and clamping at 25 cm from the umbilicus as a study group and 200 neonates who were received early cord clamping without milking as a control group) in term and near term infants. Results: the hemoglobin level significantly increased in study group at 12, 48 hours and 6 weeks of birth (16.9, 16.9 &15.5 gm/dl) as compared with control group (16.2, 16.2 &15.0 gm/dl) and serum ferritin level significantly increased in study group at 6 weeks of birth (135.4 μg/ml) as compared with control group (128.8 μg/ml). The hematocrit level at 12 and 48 hours after birth was significantly higher in study group (p= 0.016). Serum bilirubin was slightly elevated in study group but there were not any infants of them needed phototherapy. Conclusions: Umbilical cord milking improved hemoglobin and iron status in term and near term neonates.
{"title":"Assessment of Umbilical Cord Milking on the Outcome of Term and Preterm Infants, Controlled Clinical Trial","authors":"O. Taha","doi":"10.33552/accs.2020.02.000539","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000539","url":null,"abstract":"Early may contribute to anemia in infancy thus it can deprive the infant of 60 to 100 ml of whole blood representing 30-50 mg/kg of iron. The umbilical cord milking is a safe technique. Aim of the study: The aim of the study to assess the effects of umbilical cord milking as compared with early cord clamping on hematological parameters (hemoglobin, packed cell volume, bilirubin and ferritin) among term and near term neonates. Materials & methods: This study was carried out as randomized, controlled clinical trial. The subjects were divided randomly into two groups (200 neonates who the cord was milked after cutting and clamping at 25 cm from the umbilicus as a study group and 200 neonates who were received early cord clamping without milking as a control group) in term and near term infants. Results: the hemoglobin level significantly increased in study group at 12, 48 hours and 6 weeks of birth (16.9, 16.9 &15.5 gm/dl) as compared with control group (16.2, 16.2 &15.0 gm/dl) and serum ferritin level significantly increased in study group at 6 weeks of birth (135.4 μg/ml) as compared with control group (128.8 μg/ml). The hematocrit level at 12 and 48 hours after birth was significantly higher in study group (p= 0.016). Serum bilirubin was slightly elevated in study group but there were not any infants of them needed phototherapy. Conclusions: Umbilical cord milking improved hemoglobin and iron status in term and near term neonates.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129491390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-22DOI: 10.33552/accs.2020.02.000538
Mehssani Z
Trans radial approach (TRA) has gained popularity over the trans femoral access (TFA) and has become the default option for coronary procedures around the world, as it has less bleeding access site complications and it is associated with a lower degree of adverse clinical events rate. However, in some situations, the trans radial arterial access could be unsuccessful. We present a case of a 66 years old man with history of aortobifemoral bypass surgery admitted in our department for an ACS and neither TFA nor TRA access were possible.
{"title":"Safety and Efficacy of Transbrachial Access for Coronary Procedures: Case Report and Review of Literature","authors":"Mehssani Z","doi":"10.33552/accs.2020.02.000538","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000538","url":null,"abstract":"Trans radial approach (TRA) has gained popularity over the trans femoral access (TFA) and has become the default option for coronary procedures around the world, as it has less bleeding access site complications and it is associated with a lower degree of adverse clinical events rate. However, in some situations, the trans radial arterial access could be unsuccessful. We present a case of a 66 years old man with history of aortobifemoral bypass surgery admitted in our department for an ACS and neither TFA nor TRA access were possible.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127762951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-24DOI: 10.33552/accs.2020.02.000537
Supraja Thunuguntla
Dialysis Access Associated Steal Syndrome (DASS) reported incidence is low, (6.2%) [1]. Symptoms are dialysis induced hand pain, coldness, numbness, sensory loss which can lead to inevitable digital gangrene and amputation if the diagnosis is delayed. Duplex arterial ultrasound and electromyography (EMG) can help differentiate DASS from Ischemic monomelic neuropathy (IMN), a variation of DASS. Treatment options are individualized based on the location of the AV fistula, severity of presentation, presence of anatomical anomalies of involved vasculature. Comprehensive review of literature demonstrates this outcome of finger gangrene in young patients with ESRD is primarily associated with pre-existing diffuse vascular disease [2].
{"title":"Dialysis Access Steals and Leads to Limb Ischemia","authors":"Supraja Thunuguntla","doi":"10.33552/accs.2020.02.000537","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000537","url":null,"abstract":"Dialysis Access Associated Steal Syndrome (DASS) reported incidence is low, (6.2%) [1]. Symptoms are dialysis induced hand pain, coldness, numbness, sensory loss which can lead to inevitable digital gangrene and amputation if the diagnosis is delayed. Duplex arterial ultrasound and electromyography (EMG) can help differentiate DASS from Ischemic monomelic neuropathy (IMN), a variation of DASS. Treatment options are individualized based on the location of the AV fistula, severity of presentation, presence of anatomical anomalies of involved vasculature. Comprehensive review of literature demonstrates this outcome of finger gangrene in young patients with ESRD is primarily associated with pre-existing diffuse vascular disease [2].","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128545602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-17DOI: 10.33552/accs.2020.02.000536
B. Gill
Euthanasia is a deliberative intervention embracing the determination of ending a life so as to alleviate awkward and unbearable suffering. It is only taken into consideration when by the person is mentally competent. With the advance of medical knowledge, there is a better understanding of the prognosis of dementia. Individuals’ diagnosed with dementia often expresses that they do not want to be a burden to their family members as the disease progress and often expresses they want to end their life before they are not able to take care of themselves. The aim of this paper is to critique the feasibility and ethical considerations of euthanasia among individuals diagnosed with dementia using ‘MORAL’ ethical decision-making model. Patient (individual diagnosed with dementia), caregiver, nurses and physician should be included in order to have a deeper understanding of the euthanasia ethical dilemma. Different options such as treatment available, type and strategies appropriate for the dementia case, appropriate ethical theories in the dementia case (beneficence and autonomy). Then, it is essential to review and “look back” at the case. In order to enhance the possibilities of euthanasia among individual with dementia, advance directives on euthanasia could be an option.
{"title":"Ethical Consideration of Euthanasia for People Diagnosed with Dementia","authors":"B. Gill","doi":"10.33552/accs.2020.02.000536","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000536","url":null,"abstract":"Euthanasia is a deliberative intervention embracing the determination of ending a life so as to alleviate awkward and unbearable suffering. It is only taken into consideration when by the person is mentally competent. With the advance of medical knowledge, there is a better understanding of the prognosis of dementia. Individuals’ diagnosed with dementia often expresses that they do not want to be a burden to their family members as the disease progress and often expresses they want to end their life before they are not able to take care of themselves. The aim of this paper is to critique the feasibility and ethical considerations of euthanasia among individuals diagnosed with dementia using ‘MORAL’ ethical decision-making model. Patient (individual diagnosed with dementia), caregiver, nurses and physician should be included in order to have a deeper understanding of the euthanasia ethical dilemma. Different options such as treatment available, type and strategies appropriate for the dementia case, appropriate ethical theories in the dementia case (beneficence and autonomy). Then, it is essential to review and “look back” at the case. In order to enhance the possibilities of euthanasia among individual with dementia, advance directives on euthanasia could be an option.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116919320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-28DOI: 10.33552/accs.2020.02.000534
S. Bierbower
TBI is a type of CNS injury that results after a blunt force is applied to the head, and it affects about 1.7 million cases in the USA every year. The more common events that lead to a TBI are vehicle collisions, domestic violence, falls, sports, and war [1]. Depending on the severity, a TBI can result in permanent disabilities, and in extreme cases, it is fatal. Some of the symptoms seen after a TBI are lumped together in what is termed PTSD. Symptoms typically include behaviors such as depression, anti-social behavior, impulsivity, and fear/anxiety. Additionally, TBI injuries have shown symptoms that are closely related to Parkinson’s and Alzheimer’slike symptoms. TBI related symptoms do not occur in a short timeframe, on the contrary, these often arise months or years after the injury has occurred, making the initial assessment of injury difficult [1-3]. A TBI occurs in two phases; the first phase is known as the primary injury or the initial injury. The second phase, referred to as the secondary injury consists of cellular processes that are activated after the initial injury and can persist for hours, days, and months after the initial impact [1,4]. Cellular processes such as nitric oxide formation, inadequate blood flow, imbalance of ions, neurotoxicity, and excitotoxicity compose the secondary injury and lead to tissue death. As a consequence, secondary injury contributes to the damage by affecting a larger area than the primary injury [4,5]. There is currently no treatment for this type of injury; there are only preventive measures such as wearing helmets or wearing seatbelts while driving. Thus, this review paper focused on estrogens’ neuroprotection mechanism on traumatic brain injury.
{"title":"Understanding the Underlying Neuroprotective Role of Estrogen in TBI Neuropathophysiology","authors":"S. Bierbower","doi":"10.33552/accs.2020.02.000534","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000534","url":null,"abstract":"TBI is a type of CNS injury that results after a blunt force is applied to the head, and it affects about 1.7 million cases in the USA every year. The more common events that lead to a TBI are vehicle collisions, domestic violence, falls, sports, and war [1]. Depending on the severity, a TBI can result in permanent disabilities, and in extreme cases, it is fatal. Some of the symptoms seen after a TBI are lumped together in what is termed PTSD. Symptoms typically include behaviors such as depression, anti-social behavior, impulsivity, and fear/anxiety. Additionally, TBI injuries have shown symptoms that are closely related to Parkinson’s and Alzheimer’slike symptoms. TBI related symptoms do not occur in a short timeframe, on the contrary, these often arise months or years after the injury has occurred, making the initial assessment of injury difficult [1-3]. A TBI occurs in two phases; the first phase is known as the primary injury or the initial injury. The second phase, referred to as the secondary injury consists of cellular processes that are activated after the initial injury and can persist for hours, days, and months after the initial impact [1,4]. Cellular processes such as nitric oxide formation, inadequate blood flow, imbalance of ions, neurotoxicity, and excitotoxicity compose the secondary injury and lead to tissue death. As a consequence, secondary injury contributes to the damage by affecting a larger area than the primary injury [4,5]. There is currently no treatment for this type of injury; there are only preventive measures such as wearing helmets or wearing seatbelts while driving. Thus, this review paper focused on estrogens’ neuroprotection mechanism on traumatic brain injury.","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"35 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114006469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-13DOI: 10.33552/accs.2020.02.000533
R. Khojaly
Ramy Khojaly*1,2, Gozie Offiah3, Ruairi MacNiocaill2, Claire Condron3, Arnold Hill3 and May Cleary2,4 1Department of Surgery, Orthopaedic surgery, clinical lecturer, Royal College of Surgeons in Ireland, Ireland 2Department of Orthopaedic surgery, University Hospital Waterford, Ireland 3Department of Surgery, Royal College of Surgeons in Ireland, Ireland 4Department of Orthopaedic surgery, University College Cork, Ireland
Ramy Khojaly*1,2, Gozie Offiah3, Ruairi MacNiocaill2, Claire Condron3, Arnold Hill3 and May cleary2,4 1爱尔兰皇家外科学院整形外科临床讲师，爱尔兰2沃特福德大学医院整形外科3爱尔兰皇家外科学院整形外科4爱尔兰Cork大学学院整形外科
{"title":"Does PROM Always Reflect the Reality? Our Experience with the Olerud-Molander Ankle Score (OMAS) in the Ongoing Ankle Fracture p-RCT (DoWeCAST)","authors":"R. Khojaly","doi":"10.33552/accs.2020.02.000533","DOIUrl":"https://doi.org/10.33552/accs.2020.02.000533","url":null,"abstract":"Ramy Khojaly*1,2, Gozie Offiah3, Ruairi MacNiocaill2, Claire Condron3, Arnold Hill3 and May Cleary2,4 1Department of Surgery, Orthopaedic surgery, clinical lecturer, Royal College of Surgeons in Ireland, Ireland 2Department of Orthopaedic surgery, University Hospital Waterford, Ireland 3Department of Surgery, Royal College of Surgeons in Ireland, Ireland 4Department of Orthopaedic surgery, University College Cork, Ireland","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128288603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-13DOI: 10.33552/accs.2019.02.000531
K. Mattoo
{"title":"Lip Pit without a Pit - A Case Report","authors":"K. Mattoo","doi":"10.33552/accs.2019.02.000531","DOIUrl":"https://doi.org/10.33552/accs.2019.02.000531","url":null,"abstract":"","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125203794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-07DOI: 10.33552/accs.2019.02.000530
K. Mattoo
{"title":"Conscience - An Endangered Human Value?","authors":"K. Mattoo","doi":"10.33552/accs.2019.02.000530","DOIUrl":"https://doi.org/10.33552/accs.2019.02.000530","url":null,"abstract":"","PeriodicalId":151968,"journal":{"name":"Archives of Clinical Case Studies","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115064623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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