Nigerian Journal of Clinical Practice最新文献

Background: Musculoskeletal symptoms are common in chronic kidney disease, which negatively affects quality of life.

Aim: We aimed to evaluate the relationship between osteoporosis and fibromyalgia in hemodialysis patients.

Methods: The study included 170 patients on hemodialysis for more than 3 months. Demographic characteristics, complete blood count, and biochemistry values were recorded. Bone densitometry was measured by X-ray dual-energy absorptiometry. T score ≤ -2.5 was reported as osteoporosis. Groups were formed as those with and without lumbar osteoporosis and those with and without femoral neck osteoporosis. For fibromyalgia assessment, the widespread pain scale and symptom severity scale were recorded based on the American College of Rheumatology data. A fibromyalgia impact questionnaire was used to determine the level of physical disability (FIQ). P < 0.05 was considered significant.

Results: A total of 170 patients, with a median age of 55 years, were studied. Females constituted 52.4% of the participants. Age and ferritin levels were higher in patients with lumbar and femoral neck osteoporosis than in patients without osteoporosis. Body mass index (BMI) and parathormone levels were lower in patients with femoral neck osteoporosis. Fibromyalgia score was significantly higher in patients with lumbar and femoral neck osteoporosis, and there was a negative correlation. Age (P < 0.002) and ferritin (P < 0.001) were found to be associated with lumbar osteoporosis. Similarly, age (P < 0.001), BMI (P < 0.013), and ferritin (P < 0.015) were found to be associated with femoral neck osteoporosis.

Conclusion: Fibromyalgia score was high in patients with both lumbar and femoral neck osteoporosis. The fibromyalgia score is an essential guide for early diagnosis, guidance to treatment, and prevention of complications.

Background: Despite advances in treatment, tuberculosis (TB) remains a significant public health issue. Vitamin D is crucial for the host's immune response against Mycobacterium tuberculosis.

Aim: This study aimed to investigate the relationship between vitamin D levels and factors determining TB clinical course.

Methods: We examined 91 patients with TB admitted to Yedikule Chest Diseases Hospital from 2021 to 2022. We investigated the association between vitamin D levels and the prevalence of radiological lesions, duration to sputum and culture conversion, resistance to isoniazid and rifampicin, and patients' age.

Results: Results showed that 84.60% had low vitamin D levels (<20 ng/mL), particularly in those with radiologically progressive pulmonary TB (P = 0.002). As the age increased, vitamin D levels were observed to be lower (P = 0.002). However, no significant associations were found between vitamin D levels and resistance to isoniazid and rifampicin (P = 0.327 and Pp = 0.150, respectively), or between pulmonary and extrapulmonary TB (P = 0.607). No significant relationship was found between sputum and culture conversion time and vitamin D levels (P = 0.509 and P = 0.671, respectively). We identified no critical correlation between the duration of sputum and culture conversion and vitamin D levels (P = 0.509 and P = 0.671, respectively).

Conclusion: In the study, vitamin D levels were consistently low among our patients with TB, and this was particularly associated with widespread radiological lesions. Our study is a real-world investigation highlighting the vitamin D deficiency in TB and underscores the significance of vitamin D in treatment outcomes.

Background: The spleen undergoes variations in its dimensions during pregnancy. Splenic morbidities can also affect pregnancy.

Aim: This study was aimed at investigating by means of ultrasound, the normal splenic dimensions throughout gestation in healthy pregnant women and to ascertain any relationship between it and other parameters such as age, weight, height and parity.

Materials and methods: The study comprised 100 pregnant subjects and 100 controls. The splenic dimensions and foetal biometry, where appropriate, were measured for assessment of gestational age (GA). Comparison of splenic dimensions between study groups and controls was made. Data analysis was done using Statistical Package for Social Sciences 22 (SPSS). Results were displayed using appropriate statistical methods. For all statistical tests, P < 0.05 was significant.

Results: The mean age of the pregnant subjects was 31.3 ± 3.9 years, while that of the non-pregnant controls was 30.1 ± 5.7 years. The mean splenic length, width, thickness and volume for pregnant subjects were 10.3 ± 1.17 cm, 5.1 ± 0.74 cm, 5.2 ± 0.69 cm and 147.3 ± 45.03 cm3, respectively. The mean splenic length, width, thickness and volume for controls were 9.6 ± 1.00 cm, 4.3 ± 0.35 cm, 4.7 ± 0.33 cm and 104.0 ± 21.65 cm3, respectively. Pregnant subjects were observed to have higher mean splenic length, width, thickness and volume (P = 0.001). There was increase in splenic dimensions with increasing GA.

Conclusion: Pregnant subjects had significantly higher splenic dimensions compared to non-pregnant subjects. A statistically significant increase in length, throughout pregnancy, was also observed.

Background: Urologists can encounter difficulties when dealing with ureteral stone impaction. However, reliable preoperative indicators of stone impaction are scarce.

Aims: We aimed to determine ureteral wall thickness (UWT) as an independent predictor of intraoperative stone impaction, to detect if any patient or stone-related factors predict impaction and to ascertain whether impaction affected intraoperative/postoperative outcomes.

Methods: We prospectively studied 83 patients who underwent ureterorenoscopic lithotripsy for ureteral stones between October 2023 and March 2024. UWT measurement was done preoperatively on non-contrast computed tomography. Clinical predictors of stone impaction were analyzed by univariate and multivariate analyses. Receiver operator characteristic (ROC) curve analysis was performed to identify the optimal cutoff for independently predicting impaction. We also analyzed intraoperative and postoperative outcomes with respect to impaction.

Results: Out of 83 patients, 46 (55.42%) had impacted stones. Gender, stone laterality, stone size, area, Hounsfield unit, degree of hydronephrosis, duration of symptoms, and UWT had significant association with stone impaction on univariate analysis. When these factors were subjected to multivariate analysis, only UWT and stone area had significant association with impaction. We determined a UWT cutoff of 3.45 mm and a stone area cutoff of 28.62 mm2 for predicting impaction based on ROC analysis. Our study showed that impaction increased the overall duration of the procedure and affected stone clearance rates.

Conclusion: Based on our study, high UWT is associated with a higher risk of stone impaction, prolonged duration of procedure, and lower stone clearance rates.

Objectives: Allo-Hematopoietic Stem Cell Transplantation (HSCT) offers a curative option for relapsed and refractory multiple myeloma in younger aged and fit patients with high-risk cytogenetic properties.

Material and methods: This study retrospectively enrolled the medical data of 30 patients who had undergone allogeneic stem cell transplantation at the Gazi University Adult Stem Cell Transplant Unit between 2005 and 2020.

Results: Before allo-SCT, 6 (20.0%) patients were in complete remission; 8 (26.6%) had a partial response; 14 (46.6%) had progressive disease, and 2 (6.6%) had stable disease. Overall survival (OS) at 1, 2, 3, and 5 years post-transplant were 45%, 36.3%, 31.7%, and 22.7%, respectively; transplant-related mortality (TRM) was 25.0% at 100 days. While the 5-year OS was 11.7% in the group with less than PR according to the pre-transplant disease status, it was found to be statistically significant as 45.8% in the group with CR or PR (P = 0.001). TRM was significantly higher in patients with less than PR compared has CR or PR at pre-transplantation (100% vs. 43.7% P = 0.01). Like these findings, PFS was shorter in patients with less than PR compared has CR or PR at pre-transplantation (6.2 vs. 77.1 months, P = 0.01).

Conclusions: We found longer OS and PFS in patients with a complete response before allo-SCT. This shows that the depth of response before allogeneic stem cell transplantation is effective on 100-day TRM in multiple myeloma patients. Allo-HSCT may be a therapeutic option in MM patients who relapse/refractory after auto-SCT, particularly after achieving the least partial response.

Background: The hamstring muscles play a crucial role in posture and movement, with interventions such as stretching and myofascial release commonly used to improve flexibility and muscle function. Emerging evidence suggests that targeting the hamstrings may influence distant structures like the masseter muscle through myofascial connections, highlighting the need for studies investigating these systemic interactions.

Aim: To assess the immediate effects of hamstring stretching alone or combined with myofascial release of the hamstring muscle on masseter muscle activity, pressure pain threshold, active mouth opening, hamstring flexibility, and forward head flexed posture in recreationally active participants.

Methods: Thirty healthy young adults aged 18-25 years participated in this study. They were randomly assigned to two groups: one receiving static hamstring stretching and the other receiving stretching plus myofascial release. Masseter muscle activity was measured using surface electromyography. Pressure pain threshold (PPT), hamstring flexibility (maximum hip flexion and active knee extension), maximum mouth opening (MMO), and forward head posture [tragus-to-wall distance (TWD)] were assessed before and after the interventions.

Results: Treatment led to significant improvements in masseter muscle electromyography (EMG) activity (Group I: Right P = 0.001, Left P = 0.002; Group II: Right P < 0.001, Left P = 0.003) and active knee extension in both groups (Groups I and II: Right P < 0.001, Left P < 0.001), reflecting significant enhancements in muscle activity and flexibility. Mild improvements were also noted in masseter PPT (Group I: Right P = 0.037, Left P = 0.042; Group II: Right P = 0.035, Left P = 0.041), although MMO and TWD remained stable, indicating no significant changes posttreatment. Comparative analysis revealed no significant differences between the groups in response to interventions across all measured parameters, demonstrating that both groups experienced similar improvements and confirming the efficacy of the treatments administered.

Conclusion: The study found that the treatments significantly improved masseter muscle activity and knee extension flexibility, with mild enhancements in pain thresholds. However, there were no significant effects on jaw opening (MMO) or posture (TWD). The lack of significant differences between the groups suggests that both treatment protocolsare equally effective. These findings indicate the potential for incorporating the interventions into clinical practice to improve musculoskeletal function in both the jaw and lower limbs.

Background: There is little research on the anti-inflammatory efficacy and safety of tobramycin dexamethasone+pranoprofen eye drops in treating endophthalmitis.

Aim: To appraise the efficacy and safety of tobramycin dexamethasone+propranolofen eye drops in the treatment of endophthalmitis.

Methods: The degree of corneal edema, foveal thickness, score of anterior chamber (AC) flares, best corrected visual acuity (BCVA), fasting blood glucose, inflammatory indexes of serum and aqueous humor, and adverse reactions were observed every week.

Results: After the intervention with tobramycin dexamethasone+pranoprofen eye drops, corneal edema and foveal thickness reduced, BCVA improved, and the inflammatory markers in serum and aqueous humor decreased. Moreover, the incidence of adverse reactions in the tobramycin dexamethasone+pranoprofen group was lower than that in the control group and the fluorometholone group (P < 0.05).

Conclusion: Tobramycin dexamethasone+pranoprofen eye drops can inhibit inflammation better, recover vision faster, and make the incidence of adverse reactions lower in treating cataract patients complicated with DM developing endophthalmitis induced.

Background: Rifampicin, an antibiotic used in the treatment of tuberculosis has raised concerns about its potential liver and kidney toxicity.

Aim: This study aimed to evaluate the protective effects of Aloe vera against hepatorenal toxicity induced by rifampicin in male Wistar rats.

Methods: Thirty rats were divided into six groups (n = 5): group A (control), group B treated with rifampicin, groups C-E treated with varying doses (50, 100, and 200 mg/kg) of Aloe vera alongside rifampicin as well as a group F treated with furosemide and rifampicin for a total of 30 days. Alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), creatinine, urea, and histopathological changes were evaluated. One-way analysis of variance and Tukey's post hoc tests were applied with a significance level of 5%.

Results: Results showed 98.28%, 107.66%, and 334.66% increase in ALT, AST, and ALP levels of group B (Rifampicin only) compared with the control group. In contrast, groups treated with Aloe vera showed significantly lower ALT, AST, and ALP levels as the dose increased from 50-200 mg/kg. A value of 2.23 Mg/dL content as a lipid peroxidation marker was observed in group B in comparison to the control group indicating oxidative stress while animals treated with Aloe vera at 50, 100, and 200 mg/kg showed decreased levels of MDA (1.53, 1.13, and 0.80 Mg/dL respectively) in comparison to group B. A decrease in CAT and SOD levels in the rifampicin-only treated animals was observed while there was an increase in CAT and SOD levels in animals treated with Aloe vera and furosemide concomitantly with rifampicin. Creatinine and urea levels increased significantly in group B and reduced as Aloe vera was introduced at 50, 100, and 200 mg/kg respectively. Histopathological analysis confirmed liver and kidney tissue damage in rifampicin only and progressive regeneration in groups treated with Aloe vera as the dose increased to 200 mg/kg.

Conclusion: The results of this study indicate that Aloe vera has a protective effect against rifampicin-induced hepatorenal toxicity in a dose-dependent manner by mitigating oxidative stress and improving liver and kidney function markers.

Aim: The correlation between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) with prognosis has been observed in different types of adult sarcomas. However, there is insufficient evidence in pediatric tumors. Our study aimed to examine if alterations in these characteristics serve as prognostic indicators in juvenile sarcomas.

Methods: A cohort group of 138 patients including Ewing sarcoma (n = 62), osteosarcoma (n = 52), and rhabdomyosarcoma (n = 24), the most common pediatric sarcomas diagnosed and treated in our institute between January 2006 and December 2022, were retrospectively evaluated. Pre-treatment values of NLR, PLR, and LMR were calculated for all patients. These values were then evaluated about overall survival (OS) and disease-free survival (DFS), along with other established prognostic variables.

Results: In terms of area under the ROC curve (AUC) values, NLR and LMR in osteosarcoma, NLR and PLR in Ewing sarcoma, and NLR in rhabdomyosarcoma were statistically significant. In patients with osteosarcoma (OS), NLR ≥ 3 and LMR < 5.3 were found to be an independent prognostic factor for overall survival in multivariate analysis (HR, 2, 95% [CI], 1.1-8; P = 0.049 and HR, 2.1, 95% [CI], 1.3-8.3; P = 0.046, respectively). Furthermore, positive surgical margins were found to be an independent prognostic factor in OS patients (HR, 2.7, 95% CI, 1-9.2; P = 0.045). In multivariate analysis, cut-off values of NLR ≥ 2.1 and PLR ≥ 194 were determined as prognostic factors for overall survival in patients with Ewing sarcoma (ES) (HR, 2.2, 95% [CI], 1-6.8; P = 0.048, HR, 3.2, 95% [CI], 1.1-9; P = 0.035, respectively). Metastatic disease was found to be correlated with poorer overall and disease-free survival rates in patients with ES. The hazard ratio for overall survival was 4 (95% confidence interval: 2.1-17.4; P = 0.03), while the hazard ratio for disease-free survival was 2.3 (95% confidence interval: 2-4.9; P = 0.024). In the rhabdomyosarcoma (RMS) group, surgical margin positivity and NLR ≥ 4.6 were associated with worse overall survival rates in univariate analysis (HR, 4, 95% CI, 1.6-27.2; P = 0.029 and HR, 2.2, 95% CI, 1.05-6.9; P = 0.046, respectively).

Conclusion: Our study revealed that elevated NLR hurt OS and DFS in patients with osteosarcoma and Ewing sarcoma. Low LMR and high PLR were also associated with poor prognosis in these diseases, even in the presence of heterogeneity. In the rhabdomyosarcoma group, however, none of the markers provided a significant prognostic contribution.

Background: Benign epilepsy with centrotemporal spikes (BECTS) is a common form of epilepsy in childhood. In some patients with BECTS, electrical status epilepticus in sleep (ESES) may develop, and ESES can also be present in children with different types of structural brain lesions. In children with BECTS and ESES, where conventional magnetic resonance imaging (MRI) findings are normal, the results of microstructural examinations of the thalamus may differ.

Aim: The main aim of this study was to investigate brain anatomical differences in patients with BECTS using MRI-Cloud, a more objective and quantitative evaluation method, which has been done for the first time in the literature.

Methods: We included 27 patients with BECTS and 27 healthy controls in this study. We analyzed subcortical gray matter volumes of patients diagnosed with BECTS for the first time via the "MRI-Cloud" method. Limitations of our study were the small sample size.

Results: Total relative thalamic volume was significantly lower in patients with ESES than in healthy controls (P < 0.001), and the total relative thalamic volume was significantly lower in patients with ESES than in patients with BECTS without ESES (P < 0.001). Thalamic volumes were reduced in the ESES group compared to the control group, with both right and left thalami showing significantly lower volumes (P < 0.001). In addition, patients with ESES had markedly smaller thalamic volumes than those with BECTS and without ESES (right and left thalami, P < 0.001).

Conclusion: In this study, we emphasize the contribution of volume analysis and the MRI-Cloud method in detecting microstructural changes at the thalamic level in patients with ESES even when conventional MRI findings are normal.