Medicinski arhiv最新文献

Background: Diabetes Mellitus is a metabolite disorder with parameters of high blood sugar levels. In the management of diabetes can be used the drug metformin is the gold of choice to achieve a therapeutic effect and rarely causes side effects of the drug, but it still has debate view. However, if used in excessive doses for patients with kidney disease, it will be contraindicated with side effects such as lactic acidosis.

Objective: This study aims to evaluate the side effect of Metformin for diabetic kidney diseases (DKD) patients.

Method: This study used the Narrative Review Method that was obtained from 2011 to 2021, in the English language from PubMed, Google Scholar, and Cochrane Library.

Results: Metformin is at the forefront of the treatment of type 2 diabetes mellitus (DM2). Metformin is likely to have lactic acidosis-related adverse effects in chronic kidney disease (CKD) patients, such as increased arterial lactate. Lactic acidosis is defined as an increase in arterial lactate with an indicator of more than five mmol/L and an arterial blood pH of less than 7.35. Metformin-induced lactate levels are considered to be below the parameters. DKD risk factors can be conceptually classified as several susceptibility factors, initiation factors, and developmental factors. The two most prominent risk factors are hyperglycemia and hypertension.

Conclusion: Metformin can increase lactate levels in CKD patients but is still below the parameters of lactic acidosis. This study may have some weaknesses and requires further prospective research to validate the results.

Background: Squamous cell carcinoma (SCC) is a common cancer of the oral cavity. It mainly affects patients aged over 50 with male-to-female ratio 2:1. Most of the cases of oral SCC are linked to tobacco and alcohol use.

Objective: In this report, we present a case of a 67-year-old male with a mass on the posterior-lateral border of the tongue.

Case report: In this report, we present a case of a 67-yearold male with a mass on the posterior-lateral border of the tongue. Being heavy smoker and alcoholic since a young age, he was at high-risk of developing oral cancer. After thorough clinical, histopathological, and imaging assessments a poorly differentiated stage III (T3, N1, M0) SCC was confirmed. He underwent left hemiglossectomy with marginal mandibulectomy and radical neck dissection followed by radiation therapy.

Conclusion: SCCs of the tongue can be often asymptomatic and identified at advanced phase leading to a poor prognosis. Therefore, their early diagnosis/management, and regular postoperative follow-ups are mandatory for better treatment outcome and recurrence prevention.

Background: Poguntano (Picria fel-terrae Merr) is a traditional herb commonly used as a blood glucose lowering agent in Indonesia. However, the effectiveness of the herb has not yet been established.

Objective: This systematic review and meta-analysis aim to review the hypoglycemic effect of Poguntano extract in lowering plasma glucose levels.

Methods: We conducted a literature search using peer-reviewed databases for relevant articles on Poguntano extract in animal models of diabetes. The effect size was pooled using a random effect model.

Results: Two animal studies were included in the systematic review and meta-analysis. There was a significant difference in plasma glucose levels between diabetic control and rats treated with Puguntano extract (MD: 28.77; 95%CI: 6.20-51.34; p=0.01). There was no significant difference between non-diabetic control and Poguntano extract.

Conclusion: Poguntano extract lowers the blood glucose levels in diabetic rats compared to control.

Background: Improved access and treatment are critical to controlling the problem. Molecular diagnostic tests, although available, are not feasible in developing countries. Where available, these tests require state-of-the-art laboratories and are not cheap. One alternative to molecular diagnostics is the use of acute phase protein values. This protein is a protein whose levels will increase or decrease in plasma in response to injury or inflammation.

Objective: This study aimed to analyze the kinetics of granulomas and the role of IFN-γ and IP-10 in the pathology of tuberculosis in a rat model.

Methods: Sixty Wistar rats were divided into four groups, namely the control group (without MTB induction) and the MTB-induced group (observations at week-3, week-6, and week-12 post infection). Induce tuberculosis with bacterial strain H37Rv ATCC 27294.

Results: The number and size of the granuloma increased to a peak at week 6 and was consistent for weeks 6 and 12 post-infection. The kinetics of granulomas were consistent with IFN-γ and IP-10 levels.

Conclusion: It was concluded that the model of tuberculosis infection by the H37Rv ATCC 27294 strain in Wistar rat found granuloma characteristics and IFN-γ and IP-10 patterns in similar kinetics, so that there was involvement of these molecules in TB pathology. Thus, tuberculosis infection of the H37Rv ATCC 27294 strain in rats can serve as a model for rapid tuberculosis study and display a complete pathological phase.

Background: Axillary lymph node (ALN) involvement in breast cancer (BC) is considered to be a significant factor in determining the diseases' extent at the moment. The spreading capacity of cancerous cells may linearly correlate with its activity level, which in turn alter the coagulation function as commonly represented by fibrin degradation biomarker i.e., D-dimer. Although ALN metastatic status is eventually should be perceptible in physical examinations or other diagnostic modalities, an additional marker to estimate the lymph node extent should be considered in the pre-operative sessions.

Objective: To provide the correlation between elevated D-dimer level and ALN metastatic status positivity among BC patients.

Methods: This cross-sectional study was conducted at the Teaching Hospital of Universitas Sumatera Utara by retrieving outpatients' medical records from June 2018 to January 2019, encompassing 111 female patients. The ALN involvement status was recorded along with plasma D-dimer level in which the value of 500 ng/mL was considered to be elevated.

Results: From the 102 eligible participants, 47.1% and 70.6% were confirmed with elevated D-dimer level and ALN involved respectively. Further analysis of those variables demonstrated a considerable diagnostic performance for sensitivity (64.4%), specificity (79.1%), PPV (80.9%), NPV (61.8%), accuracy (70.6%) and statistically significant results (P = .001).

Conclusion: Elevated D-dimer level may be influenced by cancerous spread capacity in the lymphatic system, as it also eventually correlated with coagulation system dysregulation. Therefore, it is suggested that the role of D-dimer measurement is recommended to be explored further in BC diagnostic workup.

Background: Streptococcus anginosus group (SAG) may be unrecognized or misidentified in the Clinical Microbiology Laboratory resulting in under-reporting. Consequently, their role as genuine pathogens remains underestimated.

Objectives: The aim of this study is to suggest a reasonable identification approach that is suitable for laboratories of limited resources, to detect any possible emerging antimicrobial resistance, and to assess the genuine clinical spectrum of infections that are caused solely by SAG.

Methods: Our research included 190 bacterial isolates from 190 patients. The isolates were examined by colonies' morphology, odor, hemolytic pattern on 5% sheep Blood agar and Gram staining. Lancefield serogrouping was determined by agglutination test. Antimicrobial susceptibility testing (AST) was performed by disc diffusion method. The isolates were subjected to automated identification and AST by Vitek 2 compact instrument. The collected patients' data included age, gender, clinical condition and/or site of infection, and probable predisposing factor.

Results: All isolates produced minute-sized colonies that consistently generated distinct odor. The isolates showed variable hemolytic patterns, and the majority (74.7%) were non-hemolytic. The isolates showed different Lancefield serogroups, and the commonest was group F (54.2%). A total of 188 (98.9%) isolates were identified by Vitek 2 compact instrument at ≥95% confidence. The isolates showed high rates of antimicrobial susceptibility, however the highest rate of antimicrobial resistance was detected to gentamicin (60.5%). A total of 98 (51.6%) strains were isolated from superficial non-invasive skin and soft tissue infections, 67 (35.3%) strains from deep invasive and sterile body fluids' infections, and 25 (13.1%) strains from upper respiratory tracts' infections.

Conclusion: a combination of phenotypic characteristics could still represent a reasonable Laboratory identification battery. There was no significant emerging antimicrobial resistance detected. A broad genuine spectrum of clinical infections that are caused solely by SAG was reported in our institution.

Background: Metabolic acidosis is defined by reduced serum bicarbonate level; this reduction can be from the addition of acid, reduced acid excretion, or loss of alkali. Starvation acidosis is one of the differential diagnoses of high anion gap metabolic acidosis (HAGMA).

Objective: We report a rare case presentation of HAGMA associated with Liraglutide and low carbohydrates diet.

Case presentation: A 27-year-old female patient presented to the Emergency Department (ED) with a complaint of nausea and vomiting for two days. She was following a strict low carbohydrate diet for three months to reduce her weight as her body mass index (BMI) was 30 kg/m3. Her bedside investigations were significant for HAGMA. The patient was seen by the endocrine service and was admitted as a case of starvation ketoacidosis (SKA) vs. euglycemic diabetic ketoacidosis (DKA). The patient was treated with D10W 250 cc/hr with insulin infusion, her the anion gap was closed after 5 hours. She was discharged home as SKA secondary to diet with the possibility of drug superimposing the starvation state. She was given a follow-up clinic regularly to monitor her clinical status.

Conclusion: This case highlights the possibility of a HAGMA as a rare complication of a low carbohydrate diet with the possibility of Liraglutide injection attribution in developing such critical complication. Further studies are needed to evaluate the safety of a low carbohydrate diet and the effect of Liraglutide injection on these patients following this diet.

Background: Bladder cancer is still a burden on the world of oncology medicine, which every year affects about 3.4 million people globally with 430,000 new cases per year. It is the fourth most common cancer in men and eighth most common women malignancy in the world. This makes bladder cancer a "silent killer" and it needs appropriate treatment planning. Single immediate instillation of chemotherapy after transurethral resection of the bladder (TURB) is recommended by EAU guideline, but its use remains a controversy.

Objective: Study aimed to analyze benefit of intravesical chemotherapy following TURB in terms of recurrency of non-muscle invasive bladder cancer (NMIBC).

Methods: Systematic review and meta-analysis of randomized controlled trials comparing the efficacy of a single instillation after TURB with TURB alone in NMIBC (pTa-pT1) patients was conducted. Studies searched throughout Medline, PubMed, Embase, and Cochrane in December 2018. Keywords were intravesical chemotherapy, combination, transurethral resection, bladder cancer. Inclusion criteria were RCT studies, subjects in study were treated single immediate chemotherapy instillation after TURB compared to TURB alone in patient with pTa-pT1 urothelial carcinoma of the bladder. Trials with additional treatment prior to first reccurence were not eligible. Studies using recurrence rate as dependent variable. From 361 studies, in total 11 studies were eligible for this meta-analysis.

Results: From those 11 studies, it is shown that intravesical chemotherapy using Epirubicin and Mitomycin-C following TURB showed significant decrease of recurrence rate of bladder cancer even to progression of the disease compared to TURB alone (p<0.05) with pooled Risk Ratio were 0.69 and pooled heterogeneity (I²) were 26.6%.

Conclusion: This meta-analysis study showed that combination therapy of intravesical chemotherapy after TURB is superior to TURB alone in showing the recurrence rate of NMIBC.

Background: While salivary gland tumors constitute 5-6% of all head and neck tumors, they constitute 2-3% of all trunk tumors. About 3.8 per 100,000 of parotid tumors are diagnosed in the US each year, about 1300 to 1600 cases. The salivary gland cancer rate is 0.9 per 10000. The frequency of salivary gland tumors varies according to localization.

Objective: In our study, we aimed to evaluate retrospectively the histopathological results, incidence, surgical treatment modalities and complications of parotid tumors operated in our clinic.

Methods: We examined the patients who were operated for parotid gland tumor. The files of 136 patients who were admitted to the Otorhinolaryngology department of Dicle University Medical Faculty Hospital between January 2010 and April 2020 due to a parotid mass and underwent parotidectomy and whose pathology results were reported as benign or malignant parotid tumors were retrospectively scanned and included in the study. Patients' age, gender, FNAB cytology result, type of surgery, histopathological results after surgery and complications after surgical treatment were recorded.

Results: A total of 136 patients, 73 (53.7%) male and 63 (46.3%) female, were included in the study. The mean age of the patients was 48.26±17.37 (min=14, max=83) years. Superficial parotidectomy was performed in 108 (79.4%) patients and total parotidectomy was performed in 28 (20.6%) patients. According to the histopathological results after surgery, 108 (79.4%) benign tumors and 28 (20.6%) malignant tumors were diagnosed. Accordingly, pleomorphic adenoma (47.8%) was the second most common with 65 patients, followed by Whartin tumor (25.7%) with 35 patients. The sensitivity (sensitivity) of FNAB was 85.2%, and the specificity (specificity) was 96.2%. The accuracy of FNAB was found to be 94.0%.

Conclusion: Good identification of the parotid mass preoperatively, together with both FNAB and radiological imaging methods, gains much more value in differentiating malignant and benign pathologies. While superficial parotidectomy is mostly sufficient in benign tumors, total parotidectomy-radical parotidectomy in malignant tumors and neck dissection should be considered in high-grade tumors even if there is no neck metastasis. Patients should be evaluated for RT and CT according to the tumor type after surgery.

Background: As the incidence of intracranial infections increase due to diagnostic procedures improvement, more real-life data is needed to reach a more solid informed management approach.

Objective: This study aims to describe and analyse clinical features of intracranial abscesses patients treated at a tertiary hospital in North Jordan during a 10-year period.

Methods: We retrospectively identified 37 patients treated at King Abdullah University Hospital (KAUH) from 2011 to 2020 in Irbid, North Jordan. Treatment consisted of either aspiration, open craniotomy excision (OCE) or conservative therapy. Extracted variables included demographic data such (age, gender), clinical presentation, lab findings, radiological findings as well as management plan. Retrieved data was compared between the patients who underwent a single operation and those who underwent reoperation after the initial procedure.

Results: Thirty-seven patients with 55 intracerebral abscesses were identified, 29 of whom had intraparenchymal brain abscesses, 4 patients had epidural empyema, and 4 had subdural empyema. The mean age was 28.8 (± 20.7) years, with a male predominance (78.4%). Sixteen patients underwent open craniotomy excision (OCE), 14 patients were treated by aspiration and 7 patients were treated conservatively. When comparing the single operation and the reoperation groups, there was no statistically significant difference across variables.

Conclusion: Our study presents valuable insight from a tertiary hospital in north Jordan on intracranial abscesses and empyemas. Our findings confirm that good recovery can be established after aspiration or OCE in the majority of patients. Similar results were obtained when comparing the SOP and the ROP groups.