SN Comprehensive Clinical Medicine最新文献

Increasing incidence of caesarean sections is a matter of concern globally. This surgical procedure carries its own risks and may lead to potential complications. Uterine incision necrosis is one such rarely encountered complication. The present manuscript describes this rare presentation and its subsequent management based on evidence-based medicine. Here, we report a case of multipara women who presented on a post-operative day (POD)5 of emergency cesarean section done outside with septic shock. On further evaluation based on clinical features, investigations and relevant imaging; patient underwent emergency exploratory laparotomy followed by total hysterectomy. Patient gradually improved and was subsequently discharged. This case report highlights the importance of timed surgical intervention in cases that are consistent with uterine incisional necrosis/dehiscence.

C-reactive protein (CRP) is an acute phase protein predominantly produced in the liver and regulated by pro-inflammatory cytokines. CRP belongs to the pentraxin family and is involved in the innate immunity due to its functional properties including complement activation, phagocytosis, and apoptosis. CRP exists in two conformationally different forms: pentameric CRP (pCRP) and monomeric CRP (mCRP), having distinctive bioactivities during inflammatory processes. CRP is a non-specific serum biomarker of infection, inflammation, and tissue damage. Cumulative evidence showed that increased CRP concentrations help in the diagnosis, prognosis, and treatment monitoring of many acute and chronic inflammatory diseases. Over the past three decades, numerous studies were focused on the analytical precision of high-sensitivity CRP (hs-CRP) assays and their ability to detect lower levels of circulating CRP. Furthermore, several data reported that elevated levels of hs-CRP strongly predict the risk of cardiovascular diseases; thus, individuals at high and intermediate risk could benefit from intensive lifestyle measures and preventive therapeutic strategies. Additionally, CRP was recently considered as a valuable indicator of COVID-19 severity and mortality. This narrative review is focused on discussing the clinical usefulness of standard CRP and hs-CRP in a wide range of inflammatory conditions, namely: cardiovascular diseases, infections including COVID-19, diabetes mellitus, metabolic syndrome, cancers, rheumatic diseases, neurological disorders, gastrointestinal diseases, periodontitis, chronic kidney disease, asthma, sickle cell disease, surgery, transplant rejection, depression, pregnancy, and systemic lupus erythematosus.

Femoral artery (FA) occlusion is a prevalent adverse event after catheter interventions, particularly in neonates and infants. Several treatments are available for FA occlusion, but the optimal approach remains unknown. Herein, we report three cases of infants with FA occlusion after catheter interventions, which were successfully treated by transcatheter revascularization. Case 1 is a 1-month-old boy with pulmonary valve stenosis who was treated with percutaneous transluminal pulmonary valvuloplasty. Case 2 is a 5-month-old boy with truncus arteriosus who underwent percutaneous transluminal angioplasty for pulmonary artery stenosis after intracardiac repair. Case 3 is a 3-month-old boy with pulmonary atresia and an intact ventricular septum treated with transluminal angioplasty for bilateral pulmonary artery banding site stenosis. All three cases were detected for FA occlusion within 1 day after the intervention and successfully recanalized by transcatheter angioplasty within four days after the intervention. Transcatheter revascularization can be used as potential treatment option for FA occlusion after the catheter procedure.

Petrous cholesteatoma is an entity of significant clinical ramifications especially concerning surgical risks it poses due to close proximity with vital skull-base neurovascular structures. Despite the challenges, surgical extirpation is still the treatment of choice. Conventional methods comprise external trans-mastoid routes through trans-labyrinth, retro-sigmoid, and middle cranial fossa. In this paper, we present a man native to Borneo, previously surgically treated for cholesteatoma who presented with a recurrence at the petrous apex. It was excised entirely via endoscopic trans-canal supra-labyrinth approach. Endoscopic removal is currently gaining favor amongst skull-base surgeons as more complex cases have been dealt successfully and reported worldwide. Nonetheless, it is an intricate procedure that requires a highly skilled and confident operator which demands experience.

While the factors contributing to probable sarcopenia are not well understood, its prevention is more important than addressing full-blown sarcopenia. We aim to explore risk factors for probable sarcopenia. We extracted the probable sarcopenia, general characteristics, disease-related attributes, and blood indicators from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2002. A total sample of 2294 participants were included in the analysis and 332 (14.47%) were identified as having probable sarcopenia. Binary logic regression demonstrated that age, sex, education attainment, presence or history of dizziness, difficulty with balance or falling during the past 12 months, and presence or history of weak or failing kidney or arthritis were statistically different in non-sarcopenia and probable sarcopenia groups. Age, sex, education attainment, experiencing dizziness, difficulty with balance or a history of falling within the past 12 months, and having a history of weak or failing kidneys or arthritis are risk factors for probable sarcopenia.

Maintaining quality of life among individuals suffering from glaucoma should be accounted as the most significant purpose for management of the disease. The effectiveness of glaucoma interventions is linked to receive information regarding the disease from sources external to their physician. This study aimed to develop an educational intervention and evaluate its effectiveness on improving visual function and glaucoma-related QOL assessed by patients’ perception. This trial was done as a single-center, observer-blinded, two-group randomized controlled trial. Eighty adults with glaucoma were randomized to receive either usual glaucoma care (control group) or an interventional education (intervention group). The duration of the intervention was 8 weeks. The outcomes were visional function and glaucoma-related quality of life. Outcome measures were assessed at baseline and at 8 weeks. Patients in the intervention group showed significant improvement in visional function and glaucoma-related quality of life. A series of paired t-tests (Table 3) were conducted to compare the level of visual functioning between the intervention group before starting the intervention (mean = 62.08, SD = 18.36) and at the end of 8 weeks (mean = 68.29, SD = 19.64) which showed a significant difference t(39) = 4.85, p = 0.000. In contrast, this analysis was not significant for quality of life. In order to control the effect of basic quality of life among the intervention group, an ANCOVA was conducted. For this ANCOVA, follow-up score of quality of life was included as the dependent variable, two groups as the independent variable, and baseline score of quality of life as the covariance. Our results showed that the level of quality of life among interventions had significantly (F (1, 77) = 4.33, p = 0.04) increased at the end of 8 weeks. In addition, a two-way ANOVA was conducted to assess the effects of the intervention on the level of visual function. Our results showed that the level of visual function among interventions had significantly (F (1, 77) = 18.28, p = 0.000) increased at the end of the 8-week intervention. We aimed to assess the effect of educational package in glaucoma-related quality of life. Participants in the intervention group showed significant improvements in visual function and glaucoma-related quality of life compared to patients in the control group.

We highlight an unusual side effect of medroxyprogesterone acetate (MPA) associated with reversible cerebral vasoconstriction syndrome (RCVS) in a young patient. We describe the case of a 36-year-old lady with a significant history of heavy menstrual bleeding (HMB) secondary to adenomyosis presenting with new onset migranous headaches and right upper limb weakness after being started on MPA treatment 2 months prior. Magnetic resonance imaging (MRI) of the brain revealed acute infarcts in the left frontal lobe and right parieto-occipital region while magnetic resonance angiography (MRA) demonstrated widespread luminal irregularities throughout the anterior and posterior circulations with more severe involvement of the proximal and mid-portion of the arteries. After stopping the MPA, her headaches and weakness resolved, and a repeat MRA 2 months later showed resolution of the multi-focal intracranial stenoses. The patient was diagnosed with RCVS secondary to MPA given the onset of headaches and strokes with multi-focal intracranial stenoses shortly after initiation of MPA and resolution of the clinical and radiological abnormalities after the drug was stopped. To the best of our knowledge, this is the first case of RCVS that has been associated with the use of MPA. Although the exact pathophysiology of RCVS has yet to be determined, this case might contribute to the understanding of its underlying mechanisms.