SN Comprehensive Clinical Medicine最新文献

This study aimed to assess dyspnea, physical activity, muscle strength, and health-related quality of life in older adults diagnosed with chronic obstructive pulmonary disease (COPD) who are also considered frail. The study included volunteers aged 65 and over, diagnosed with COPD according to GOLD criteria. Individuals with COPD were divided into two groups according to the FRAIL Frailty Scale: frail (n = 32) and non-frail (n = 30). At the assessment stage, various tools were used to evaluate different aspects for all individuals, including respiratory function test for assessing respiratory functions, Modified Medical Research Council Dyspnea Scale (MMRC) for evaluating dyspnea, Saint George’s Respiratory Questionnaire (SGRQ) for assessing quality of life, FRAIL Frailty Scale and PRISMA-7 Frailty Scale for detecting frailty, Physical Activity Scale for Elderly (PASE) for evaluating physical activity, digital hand dynamometer for assessing quadriceps femoris muscle strength, and Jamar hand dynamometer for evaluating hand strength. Comparing the results of the Respiratory Function Test, SGRQ, PASE scores, and quadriceps femoris and handgrip strengths of frail and non-frail older adults with COPD was similar (p > 0.05), while frail and non-frail older adults with COPD showed statistical differences in the MMRC scores results (p < 0.05). MMRC score was worse in the frail group. Early diagnosis of COPD in frail older adults is very important for the health and quality of life of the patients. In order to prevent deterioration in frail COPD patients, both pharmacological and rehabilitative treatment methods should be started early.

Clinical trial number: NCT05811832.

Previous research suggested that physiological changes occurring during pregnancy, such as fluid retention and hormonal fluctuations, might influence the dimensions of peripheral nerves. Understanding these potential differences is important for accurately interpreting sonographic findings and diagnosing conditions related to median nerve compression or entrapment in pregnant women. The objective of this study is to compare pregnant and non-pregnant females’ median nerve cross-sectional area. This case–control analytical study was conducted at the Department of Radiology, Imran Idrees Hospital, Sialkot, for 9 months. A convenient sampling technique was used to collect the data. The calculated sample size was 155, comprising 76 pregnant and 79 non-pregnant females. Inclusion criteria: For cases: symptomatic and asymptomatic pregnant women in their third trimester aged between 18 and 45 years. For controls: non-pregnant women within the same age group without any symptoms of CTS were taken as the control group. One hundred and 55 females were included. Pregnant females had a larger median nerve in the right hand (13.13 mm²) compared to non-pregnant females (11.75 mm²), with a significant difference (P = 0.000). Similarly, pregnant females also had a larger median nerve in the left hand (12.83 mm²) compared to non-pregnant females (11.72 mm²), with a significant difference (P = 0.000). There was no significant difference in echogenicity between pregnant and non-pregnant females. The results suggest significant differences in mean measurements between pregnant and non-pregnant groups for both right- and left-hand median nerve cross-sectional areas, with a larger diameter in pregnant females than non-pregnant females.

Primary healthcare workers (PHC) are a vital component of healthcare delivery worldwide. Primary healthcare centers important pillars at all levels of the global health system with PHC worker turnover being a major cause of low coverage for PHC. Organizational behavior has been linked to PHC worker turnover. This study aimed to examine the determinants of turnover intention and its relationship between organizational behavior by key research issues, and key research trends. The study employed a systematic literature review and met analysis approach. Different electronic databases were used to obtain literature. These included PubMed/MEDLINE, Web of Science, and Scopus. The literature search was conducted using the Boolean operators “organizational behavior” AND “Primary health care workers” AND “turnover intentions” OR “turnover behavior” OR turnover. In addition, the medical subject heading is used in PubMed/MEDLINE. Studies were eligible for any study design, turnover among PHC workers and its determinants had to be explicitly reported in each included study. Data extraction and synthesis article extracted and reviewed by independent author. Factorial analysis through meta-analysis, all studies had the same factor, which was included in the review. Newcastle–Ottawa Scale was used for the quality of studies and I² was used to determine the heterogeneity. The study found that the prevalence of PHC health workers turnover was 42.5% and male [OR = 2.59 (95% CI 1.05, 5.20)], Physicians [OR = 2.31(95% CI 1.12, 6.82)], unsatisfied with the working environment [OR = 3.72 (95% CI 2.26, 8.65)], no motivations [OR = 3.76 (95% CI 2.10, 6.21)] and displeased with the management [OR = 4.71 (95% CI 2.37, 5.38)] and having no learning [OR = 5.16 (95% CI 3.48, 8.16)] were significantly related with turnover intention of the health professionals. This study found that different determinants were associated with high turnover of PHC workers and low quality of organizational behavior among them. From these findings, methodological, contextual, theoretical, and issue gaps were identified, together with gaps in the level of analysis and publication outlets.

Heavy chain deposition disease (HCDD) is a rare entity associated with monoclonal gammopathy of renal significance. It is characterized by deposition of monoclonal heavy chain, usually gamma type, along the glomerular and tubular basement membranes and vessel walls. If left untreated, the disease progresses to ESRD within 2 years with almost inevitable recurrence in renal allograft. Apart from kidney biopsy, the workup includes monoclonal immunoglobulin testing and clonal identification, which subsequently guide the treatment; however, these tests can be negative in 20% of cases. Free light chain (FLC) ratio is characteristically abnormal in all HCDD patients and can be used for disease monitoring and assessment of treatment response. Therapy for eligible patients includes clone-directed treatment used for multiple myeloma/B cell lymphoproliferative disorders. We report a patient who presented with nephritic syndrome, underwent extensive workup including two renal biopsies, and was initially misdiagnosed with IgA nephropathy. Retrospectively, after reaching ESRD, patient was diagnosed with alphaHCDD. No clone was detected and no monoclonal immunoglobulin found. Initially, abnormal FLC ratio normalized after reaching dialysis. No extrarenal manifestations were present. Taking everything into consideration, we opted for no treatment before cadaveric kidney transplantation but to proceed with transplantation, perform protocol biopsies and treat upon any sign of disease recurrence. HCDD with negative clonal and paraprotein identification can pose a diagnostic and therapeutic challenge. In our alphaHCDD ESRD patient, we decided to proceed with kidney transplantation without prior treatment. Long-term effectiveness of this approach remains to be seen.

The effects of acute cocaine toxicity on lung physiology and potential ventilation/perfusion (V/Q) mismatch in children is not well described. Herein, we report a case of V/Q mismatch and profound end-tidal CO₂ (EtCO₂) to serum partial pressure CO₂ (PCO₂) discordance occurring in a child who tested positive for cocaine, thought to be from cocaine-induced pulmonary vasospasm (dead space). This has not previously been described in the pediatric population. Clinicians should consider the possibility of cocaine-induced pulmonary vasospasm and V/Q mismatch in children with altered mental status and otherwise unexplained significant EtCO₂ and PCO₂ discordance.

Meningitis is a serious neurological condition caused by inflammation of the meninges due to infection. Meningitis typically triggers symptoms of severe headaches, high fever, and neck stiffness. In this case, we evaluate the effect of sumatriptan on meningitis-induced severe headache and the underlying pathophysiology. In this case report, we present a patient with no history of migraine with a meningitis-induced headache. The patient did not experience analgesic relief from paracetamol, ibuprofen, or tramadol, but significant relief was achieved after the administration of sumatriptan. While treating his headache, diagnostic interventions such as lumbar puncture were done, and PCR analysis of the cerebrospinal fluid identified varicella-zoster virus. The patient experienced a significant analgesic effect from sumatriptan, possibly due to constriction of the meningeal arteries, blocking of meningeal inflammation, or both.

This study aimed to investigate the advantages, disadvantages, working methods, and support needs of physicians practicing teleradiology from home in Japan, as well as to explore challenges related to the COVID-19 pandemic. We conducted semi-structured interviews with 15 physicians (12 radiologists and 3 neurosurgeons) engaged in teleradiology services. Participants were recruited through purposive sampling to ensure diversity in age, gender, and experience. Data were analyzed using inductive thematic analysis following Braun and Clarke’s six-step approach. Five main themes were generated: (1) the ability to work from home according to one’s lifestyle, allowing for better work-life balance; (2) reduced quality and efficiency of reading work, due to limited patient information and lack of immediate consultation; (3) self-management and reliance on available resources, including literature searches and networking with colleagues; (4) need for comfortable infrastructure facilities, such as high-quality monitors and stable internet connections; and (5) provision of resources to resolve questions and concerns, including platforms for peer discussions. Interestingly, no specific themes related to the COVID-19 pandemic were identified, suggesting that the challenges of teleradiology were not uniquely affected by the pandemic. While home-based teleradiology offers lifestyle flexibility, it presents challenges in maintaining work quality and efficiency. Physicians employ self-management strategies and rely on available resources to mitigate these challenges. The findings highlight the need for improved infrastructure and support systems to enhance the practice of home-based teleradiology in Japan. This study contributes to the growing body of literature on remote healthcare delivery and may inform policy decisions and best practices in diagnostic radiology both in Japan and internationally.

Stress fractures are relatively rare injuries. Femoral neck stress fractures are uncommon, while bilateral femoral neck stress fractures are much rarer. Herein, we aimed to report two cases of simultaneous bilateral femoral neck stress fractures in patients with a long-time history of opium addiction. To our knowledge, there are limited reports that describe bilateral femoral neck stress fractures due to opioid abuse-induced osteoporosis. We report simultaneous bilateral femoral neck stress fractures in two patients with long-standing opium addiction who suffered from a complete fracture following a simple fall. Both of them had a history of pain in the hip region that was neglected. Both patients used opium without any medical justification. Initial evaluation revealed bilateral femoral neck stress fractures in both patients. Patients underwent bilateral total hip arthroplasty. They were symptom-free in their last follow-up. Based on previous studies, opioid addiction can reduce bone density (approximately 20–25% of the bone mass) and induce osteoporosis. When the content of bone minerals and its elastic resistance is reduced, any normal or physiological stress applied to the bone can cause insufficiency fractures. Considering that these substances can block the patient’s pain, it is necessary to fully evaluate any bone discomfort in these patients to prevent any irreversible complications.

Dengue is a prevalent viral infection with diverse clinical manifestations. This study aims to examine the impact of low vitamin B12 levels in dengue patients, to explore the prevalence of serum vitamin B12 deficiency in dengue patients and its correlation with clinical manifestations, severity of thrombocytopenia, hospital stay, units of platelets transfused, and patient outcomes. This was conducted as a prospective cross-sectional study at MLNMC, Prayagraj, on 250 dengue patients. Among them, 189 tested positive for dengue serology. After excluding 5 patients, our detailed study focused on 184 subjects with serum vitamin B12 levels ranging from < 83 to > 2000 ng/ml. The prevalence of vitamin B12 deficiency among dengue cases was 37.0%. Notably, cases with vitamin B12 levels < 200 ng/ml were more likely to exhibit melena (20.6% vs. 6.9%) and epistaxis (10.3% vs. 0.9%) and conversely lesser incidence of joint pains (69.1% vs. 87.9%). MCV levels were significantly higher in cases with B12 levels < 200 ng/ml (96.78 ± 9.76 vs. 84.13 ± 7.14 femtolitres/cell). Platelet counts at presentation were significantly higher in cases with vitamin B12 ≥ 200 ng/ml (0.74 ± 0.43 vs. 0.56 ± 0.32 lacs/µl). Furthermore, cases with vitamin B12 < 200 ng/ml experienced higher rates of indoor admissions (92.6% vs. 75.0%) and longer hospital stays (4.38 ± 2.23 vs. 3.52 ± 2.60 days) and required more platelet transfusion units (4.63 ± 2.60 vs. 3.11 ± 1.99 days). Vitamin B12 levels play a crucial role in the clinical manifestations of dengue and are associated with increased severity of thrombocytopenia, prolonged hospital stays, and heightened requirements for platelet transfusion.

Preschool teachers in Japan often face mental health challenges due to high work stresses, and regulations enforced during the coronavirus disease 2019 (COVID-19) pandemic may serve to exacerbate these stressors. This can lead to further degradation of the mental health of preschool teachers. The study aimed to measure how new behaviors and regulations imposed during the COVID-19 pandemic affected the mental health of preschool teachers in Japan. The study surveyed 167 teachers from private Centers for Early Childhood Education and Care (CECEC), kindergartens, and nursery schools using the Patient Health Questionnaire-4 (PHQ-4). Spearman’s rank-order correlation and multiple regression analyses were conducted to analyze the relationship between various daily life reflections and anxiety and depression of preschool staff. Results indicated that employment worries among preschool teachers were positively associated with anxiety and depression. The factor of symptomatic students not attending school showed a negative relationship with anxiety and depression. The factors of bonding, distancing at meals, face masking, and having someone to talk to did not show significance in anxiety or depression among preschool teachers.