Medicinski arhiv最新文献

Background: Lower limb peripheral artery disease (PAD) is the main risk of diabetes mellitus which result to high mortality rate. Approximately, 50% of patients who receive several treatments have passed away or lost limbs at a year's follow-up. Secretome of hypoxia mesenchymal stem cells (S-MSCs) contains several active soluble molecules from hypoxia MSCs (H-MSCs) that capable inducing anti-inflammatory and vascular regeneration in PAD.

Objective: In this study, we investigated the therapeutic potential of S-MSCs in improving dynamic function and angiogenesis of PAD diabetic rats.

Methods: The PAD was established by the incision from the groin to the inner thigh and distal ligation of femoral arteries in rats with diabetes. Rats were administered with 200 µL and 400 µL S-MSCs that successfully filtrated using tangential flow filtration (TFF) system based on various molecular weight cut-off categories intravenously. ELISA assay was used to analyze the cytokines and growth factors contained in S-MSCs. Tarlov score were examined at day 1, 3, 5, 7, 10 and 14. The rats were sacrificed at day 14 and muscle tissues were collected for immunohistochemistry (IHC) and gene expression analysis.

Results: ELISA assay showed that S-MSCs provides abundant level of VEGF, PDGF, bFGF, IL-10 and TGFβ. In vivo administration of S-MSCs remarkably enhanced the Tarlov score. S-MSCs improved angiogenesis through enhancing VEGF gene expression and significantly increasing CD31 positive area in muscle tissue of PAD diabetic rats.

Conclusion: Our findings suggest that S-MSCs could improves dynamic function and angiogenesis in PAD diabetic rats.

Background: Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood.

Objective: We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection.

Case presentation: A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest.

Conclusion: It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality.

Background: Congenital fibrosis of extraocular muscles ( CFEOM) is a group of genetically defined eye-moving disorders. The syndrome is clinically characterized by congenital non-progressive ophthalmoplegia caused by dysinervation of the cranial nerves with or without ptosis. As a main sign of a CFEOM, extraocular muscles get shrunken and fibrotic, which makes surgery more technically demanding and the result more unpredictable, which makes the treatment challenging and highly customized. Our paper presents variations of the clinical picture and treatment cases of CFEOM1.

Objective: To outline the importance of the clinical examination with the exact measurement of deviations for the patients with ocular fibrosis and passive duction test under general anesthesia, establishing them as the main criteria for treatment.

Methods: We treated seven patients (14 eyes) with CFEOM1. The decision of the treatment was based on the measurement of the eye position in the primary position (PP), the severity of compensatory head position (CHP), restriction of motility, and passive motility test performed before surgery in general anesthesia. In 3 cases, patients were treated conservatively with the treatment of refractive error and amblyopia. However, in 4 patients, CHP and position of the eyes in PP were not acceptable, motility was severely impaired, and patients underwent surgery. The first surgery was performed on eye muscles: recession of inferior rectus muscle (IRM), anteposition, and resection of superior rectus muscle (SRM). As a second step procedure, ptosis surgery was performed. When the muscle was too tight, and it wasn't possible to have a satisfying result with conventional surgery, we used a tissue expander to improve the position and motility of the affected eyes.

Results: In all operated cases, CHP has significantly improved and the position of the eyes in PP.

Conclusion: Exact eye and head position measurements and a passive motility test during general anesthesia should guide the surgery. In the case when conventional surgery is not possible, implantation of a bovine pericard is a safe and effective method.

Background: Cat Intensive care unit (ICU) delirium is a significant complication that increases the mortality, morbidity, and length of stay for critically ill patient.

Objective: The aim of this study was to assess the critical care nurse's knowledge of ICU delirium and the effectiveness of an educational program about the recognition and assessment of ICU delirium on critical care nurse's knowledge.

Methods: A quasi-experimental single group pre-test-post-test design was conducted using delirium knowledge assessment questionnaires.

Results: The median post test score of overall nurses' knowledge was 76.2 (range 19.1-95.2) compared to the median pre-test score of 38.1 (range 14.3 - 61.9) indicating a significant change in nurses' knowledge after conducting the educational program (p<0.001).

Conclusion: Critical care nurses' knowledge of ICU delirium was low before the intervention and increased significantly after delivering an educational program.

Background: Chronic kidney disease (CKD) patients suffer renal and cardiovascular problems and early death. In 2016, 13.4% of all ages globally had CKD. Kidney disease, diabetes, and hypertension have a microvascular component. Diabetic retinopathy (DR) and diabetic nephropathy (DN) commonly occur concurrently, indicating that the same mechanisms may be at action in the eyes and kidneys. Chronic kidney disease (CKD) has been a tough medical problem because of late signs and late treatment. Retinal vessels are a non-invasive technique to examine systemic microvasculature. Novel predictors may enhance microvascular disease risk categorization, leading to better therapy. Retinal vascular diameter and retinopathy are reported most often. Numerous investigations have linked this condition to kidney or other systemic disorders. The retinal microvasculature was linked with both the incidence and prevalence of renal illness in this investigation. We wanted to determine whether retinal microvasculature might be utilized to diagnose renal disease.

Methods: Initial searching found 625 papers, of which 542 articles were rejected due to primary screening unrelated titles and/or abstracts. There were a total of 81 papers selected for full-text evaluation and due to insufficient data provided and duplication, we got 5 papers to enter the next step.

Results: In five investigations, retinal microvascular symptoms correlated with albuminuria. All studies connected retinal vascular diameter with albuminuria. As a categorical variable, CRAE narrowed. There was a U-shaped relationship between CRAE and albuminuria in quintiles 1 and 5. There were relationship between albuminuria to a larger CRVE and a narrower CRAE. Studies relate AVR to albuminuria were associated as well.

Conclusion: Our investigation demonstrated retinal vascular symptoms are linked to renal illness. Retinopathy correlates with CKD and ESRD in diabetic and nondiabetic individuals. Evidence linking retinal vascular width to early renal disease implies fundus photography might be a useful screening technique for CKD patients. Insufficient evidence links retinal vascular diameter to kidney-related morbidity and death. Future studies should stratify by age, gender, obesity, hypertension, ethnicity, and others.

Background: Physical exercise is a process of increasing contraction of skeletal muscles involving several organ systems to increase energy formation and it is one of the pillars for the management of type 2 diabetes mellitus (TDM2). T2DM affects the expression of the TGF-β gene.

Objective: This study aims to determine the effect of moderate intensity continuous training and slow interval training in expression of TGF-β gene in wistar rats T2DM model.

Methods: A moderate intensity continuous training physical activity given to the diabetic rat group in the form of running on a treadmill with a running speed of 20 m/min for 30 minutes while the slow type interval training physical activity given to the diabetic rat group was in the form of running on a treadmill with a running speed of 20 m/minute for 10 repetition sessions, with a duration of 2 minutes per session with interspersed active breaks for 1 minute. TGF-β gene expression was measured using real-time methods.

Results: The results in the continuous group, TGF-β significant decreased p < 0.05. In the interval group, TGF- β insignificant decreased p > 0.05. Moderate intensity continuous training was insignificantly better at decreasing the expression of the TGF-β genes.

Conclusion: This research concluded that there is an effect of moderate intensity continuous training and slow interval training on the expression of TGF-β genes in wistar rats T2DM.

Background: Bleeding Worldwide, approximately 300,000 infants are born annually with neural tube defects (NTDs), which carry a high risk of morbidity and mortality.

Objective: The aim of the study was to describe the experience with NTD patients born at a tertiary academic center.

Methods: A retrospective record review of all neonates with NTD admitted to the neonatal intensive care unit over six years.

Results: Out of the 39 patients identified, 32 (82.1%) were diagnosed antenatally. Most NTD cases were of the myelomeningocele 26 (66.7%) type. The most common site of the myelomeningocele was lumbar, and the thoracolumbar site had the worst prognosis.

Conclusion: Early detection of the disease allows better planning of delivery and treatment decisions. Nevertheless, understanding the magnitude of the problem necessitates adopting public health prevention strategies for better outcomes.

Background: Prostate cancer (PCa) is one of the most common types of cancer among men. Mutations and accumulation of chromosomal deviations are correlated with the development and aggressiveness of PCa. Cell cycle checkpoint pathways and DNA repair mechanisms are reported to deviate in cancers. Mammalian checkpoint kinase 1/2 (CHEK1/CHEK2) genes act as key signal transducers inside the genomic integrity checkpoints. CHEK1 and CHEK2 gene mutations were reported in a few different types of cancers. In PCa, CHEK2 mutations were studied, but CHEK1 gene variations were not well investigated.

Objective: This study aimed to investigate the occurrence of variations in the CHEK1 and CHEK2 genes in PCa in the Jordanian population.

Methods: Formalin-fixed paraffin-embedded PCa specimens of radical prostatectomy surgical procedures from 74 Jordanian patients were subjected to DNA extraction, polymerase chain reactions and Sanger sequencing to screen the mutations in selected exons of CHEK1 and CHEK2 tumor suppressor genes.

Results: The presence of F281L (T/C) (1.4%) homologous missense point mutation in the kinase domain of the CHEK2 gene and P188P (1.4%) silent point mutation in the kinase domain of the CHEK1 gene. In addition, the 1100delC mutation was not detected in the studied PCa specimens.

Conclusion: In line with previous reports, the presence of CHEK2 mutation with a frequency of 1.4% supported the possible role of genetic variants of this gene in the development of PCa. No 1100delC mutation was detected in this study. No association was found in this study between CHEK1 mutations and the development of PCa. Further studies are needed with larger cohorts along with a screening of more exons in order to shed more light on the frequency of CHEK2 gene mutations and their role in the development of PCa in Jordan.

Background: Due to the extensive workload and clinical demands of nursing education, undergraduate nursing students are particularly prone to depression.

Objective: to assess the level of depression and its sociodemographic and academic determinants among undergraduate nursing students.

Methods: A descriptive, cross-sectional analysis of 258 nursing students recruited from a college of nursing at Saudi university. The data collection instruments used were a Patient Health Questionnaire-9, and the Rosenberg Self Esteem Scale. An analysis of variance and a regression analysis were conducted to examine the effects of self-esteem and sociodemographic and academic factors on the depression level.

Results: The majority of students (64.0%) had a normal level of self-esteem but (31%) had moderate depression levels. Nursing students who were less than 23 years old were more likely to suffer from depression, and those who did not prefer nursing as a profession and believed that learning courses and study schedules were rigid were significantly more depressed than those who did not. Depressive symptom was predicted by stress during study time (В = .308, p = .000), preferred nursing as profession (В = -.171, p = .004), Grade Point Average (В = -.168, p = .005), and gender (В = .124, p = .035).

Conclusion: In general, nursing students had a moderate level of depression. The factors identified in this study need to be evaluated further in order to assist in the early detection and control of depression in this significant population and reduce the negative consequences associated with the condition.

Background: Proximal femoral fractures (PrFF) are one of the most common causes of emergency admission in the elderly population. The majority of patients have pre-existing conditions that get worsened by unplanned surgery.

Objective: Purpose of this article was to evaluate if a is single shot of dexamethasone with levobupivacaine administered intrathecally reduces postoperative pain and cognitive complications in patients with proximal femoral fractures.

Methods: The study was performed at a level II trauma center which is a part of a teaching hospital with a catchment population of around 300,000 patients, the first author's affiliation. Around 500 PrFF are performed yearly in the center. All participants gave oral and written informed consent before randomization.

Results: In total, 60 patients with a PrFF, ASA status 2 or 3 were randomized into two groups for spinal anaesthesia as DLSA study group (received 8 mg of dexamethasone and 12.5 mg of 0.5 % levobupivacaine) or LSA control group (received 12.5 mg of 0,5 % levobupivacaine). Postoperative cognitive disturbance was evaluated using simplified Confusion Assessment Method (CAM) scale, pain intensity was measured using Visual Analogue Scale (VAS) and blood samples for defining cortisol concentrations were taken before and after the surgical procedure. The primary outcomes were effects of intrathecal dexamethasone on plasma cortisol affecting cognitive disturbances. Secondary outcomes included pain scores and length of hospital stay. The DLSA group demonstrated a reduced incidence of postoperative cognitive dysfunction (POCD), p=0.043, longer analgesia duration, p<0.001, decreased cortisol levels and shorter hospitalization p=0.045. Intrathecal dexamethasone was the only significant predictor of postoperative delirium, OR 7.76, p=0.019.

Conclusion: Single shot intrathecal administration of dexamethasone with levobupivacaine used in anaesthesia for proximal femoral fractures reduces the stress response by decreasing plasma cortisol concentrations prolonging analgesia. Complications such as delirium and POCD occurred with significantly lower frequency allowing better postoperative rehabilitation and shortening the hospitalization.