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The clinical implications of new insights into the origins of epithelial ovarian cancer with emphasis on the British Columbia Ovarian Cancer Prevention Initiative 对上皮性卵巢癌起源的新见解的临床意义,重点是不列颠哥伦比亚省卵巢癌预防倡议
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173843
Dianne Miller
In the last ten years our understanding of the origin of epithelial ovarian cancer has changed. This includes the realization that the majority of High Grade serous cancers originate in fallopian tube epithelium and the majority of endometroid and clear cell cancer arise in foci of endometriosis. These new insights have profound implications of both prevention and treatment.
在过去的十年中,我们对上皮性卵巢癌起源的认识发生了变化。这包括认识到大多数高级别浆液性癌起源于输卵管上皮,大多数子宫内膜样癌和透明细胞癌起源于子宫内膜异位症的病灶。这些新的见解对预防和治疗都具有深远的意义。
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引用次数: 0
A case of severe autoimmune hepatitis associated with Graves' disease 严重自身免疫性肝炎合并格雷夫斯病1例
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173836
S. Bokhari, Patan Murthuza Khan, Ahmad Akl, Ali A AlTayib
Graves' disease is a common condition and is known to have a wide range of effects on a variety of organs. Hepatic dysfunction ranging from mild to severe due to direct effect of high circulating thyroid hormones as well as a deleterious effect of antithyroid medications (methimazole and propylthiouracil) has been well - documented in literature. However, severe autoimmune hepatitis (AIH) associated with Graves' disease is rare and limited to few case reports only. A 38-year-old woman presented with abdominal pain and yellowish discolouration of conjunctivae. On investigation, she was found to have Graves' disease and AIH. The liver histopathology showed typical features of AIH. She responded excellently to glucocorticoid therapy with normalisation of thyroid function and liver histology. The case is discussed with relevant literature review.
格雷夫斯病是一种常见的疾病,已知对各种器官有广泛的影响。由于高循环甲状腺激素的直接作用以及抗甲状腺药物(甲巯咪唑和丙硫脲嘧啶)的有害作用,肝功能障碍从轻度到重度都有文献记载。然而,与格雷夫斯病相关的严重自身免疫性肝炎(AIH)是罕见的,仅限于少数病例报道。女性,38岁,腹痛,结膜黄变。经检查,发现她患有格雷夫斯病和艾滋病。肝脏病理表现为AIH的典型特征。她对糖皮质激素治疗反应良好,甲状腺功能和肝脏组织学恢复正常。本文结合相关文献进行讨论。
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引用次数: 2
The epidemic of papillary thyroid microcarcinoma: An overview 甲状腺乳头状微癌的流行:综述
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173839
A. Alsaif
According to the World Health Organization, papillary thyroid microcarcinoma (PTmC) is a papillary thyroid cancer (PTC) measuring 10 mm or less in size. There has been a recent worldwide increase in the incidence of thyroid cancer, largely attributed to an increase in the incidence of PTC and more precisely to an increase in the incidence of PTmC. The management of PTmC continues to be an area of controversy and has resulted in wide differences in recommended management, ranging from observation to an aggressive approach with total thyroidectomy, central lymph node dissection and radioiodine ablation therapy. The aim of this review is to present some of the recently published studies discussing the clinical aspects of this disease (PTmC).
根据世界卫生组织的定义,乳头状甲状腺微癌(PTmC)是一种乳头状甲状腺癌(PTC),尺寸为10mm或以下。近年来,世界范围内甲状腺癌的发病率有所增加,主要归因于PTC发病率的增加,更确切地说,是由于PTmC发病率的增加。PTmC的治疗仍然是一个有争议的领域,并导致推荐的治疗方法存在很大差异,从观察到积极的全甲状腺切除术、中央淋巴结清扫和放射性碘消融治疗。本综述的目的是介绍一些最近发表的研究讨论该疾病(PTmC)的临床方面。
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引用次数: 0
The hypotensive and uricosuric effect of valsartan compared to losartan in gout patients 缬沙坦与氯沙坦在痛风患者中的降压和降尿效果比较
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173833
A. Bahnassi, A. Abuirmeileh, Ayman Abuirmeileh
Objective: Our objective was to investigate the possible relationship between previous or concurrent use of losartan or valsartan and gout in newly diagnosed patients. Materials and Methods: Thirty-two newly-diagnosed gout patients, whose blood pressure was controlled using losartan for at least 3 months were included. The study was divided into 3 stages; stage I where patients were controlled for 3 months using losartan (50 mg/day), stage II - where patients were switched from losartan to valsartan (80 mg/day) with their blood pressure controlled and maintained for another 3 months using valsartan instead of losartan and stage III - where patients were switched back to losartan (50 mg/day). All changes in clinical and biochemical parameters were reported. Results: There were no significant changes in biochemical parameters such as liver enzymes, serum levels of creatinine, sodium and bicarbonate. Serum levels of potassium and uric acid were elevated. Valsartan significantly increased potassium and uric acid levels at the end of stage II (P = 0.024). Since these adverse effects did not disappear after changing back to losartan at the end of stage III, we performed an additional 3-month follow-up stage. The subjects required a period of 6 months to return to levels seen at the end of stage I. Conclusion: Losartan showed a slightly higher hypotensive effect than valsartan in patients newly diagnosed with gout. It also resulted in lower uric acid levels.
目的:我们的目的是调查先前或同时使用氯沙坦或缬沙坦与新诊断的痛风患者之间可能的关系。材料与方法:采用氯沙坦控制血压3个月以上的新诊断痛风患者32例。研究分为3个阶段;I期,患者使用氯沙坦(50mg /天)控制3个月,II期-患者从氯沙坦切换到缬沙坦(80mg /天),血压得到控制并使用缬沙坦代替氯沙坦再维持3个月,III期-患者切换回氯沙坦(50mg /天)。报告临床及生化指标的变化。结果:肝酶、血清肌酐、钠、碳酸氢盐等生化指标无明显变化。血清钾和尿酸水平升高。缬沙坦在II期结束时显著增加钾和尿酸水平(P = 0.024)。由于在III期结束时改用氯沙坦后这些不良反应并未消失,我们进行了额外的3个月随访。受试者需要6个月的时间才能恢复到i期结束时的水平。结论:在新诊断为痛风的患者中,氯沙坦的降压效果略高于缬沙坦。它还会降低尿酸水平。
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引用次数: 1
Clinical Skills Testing Centre: A promising frontier 临床技能测试中心:一个有前途的前沿
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173834
F. Munshi
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引用次数: 0
Medical undergraduates and pathological internet use: Interplay of stressful life events and resilience 医学本科生与病理性网络使用:压力生活事件与心理弹性的相互作用
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173835
Amrita Chakraborti, P. Ray, Mehboob Islam, A. Mallick
Background: Being in the age of technological advancement, the human mind is under constant risk of being engulfed by social media leading to pathological internet use. Cyberworld serves as a buffer under stress by means of satisfying various needs of an individual in the form of entertainment, access to information, gaining recognition and maintaining relationships. Conversely, the morbid preoccupation of the internet was found to be averted by positive coping resilience and sense of self-efficacy under stressful condition. Objectives: To observe the pattern of internet use in medical students and to explore any possible relationship of internet use with stressful life event and resilience level. Materials and Methods: The study sample was drawn from medical undergraduates using semistructured questionnaire consisting of demographic profile, details of various aspects of internet use, internet addiction test questionnaire (IAT), resilience scale and student stress scale (SSS). Results: Almost all of the participants (n = 98) used the internet and social media. Mean age of the sample was 20.41 (±1.64) years, 64.3% were male and 35.7% female. On IAT, 80.6% students were moderate users, and 19.4% were problem users. IAT negatively correlated with resilience (r = −0.272, P = 0.007), whereas positively correlated with SSS total score (r = 0.330, P = 0.001) and total number of stressful life events (r = 0.335, P = 0.001). 30.6% of the students stated that a major life event had influenced their internet usage. In the linear regression model, life event appeared as a significant predictor of IAT score. Conclusion: Medical students acknowledge the role of the internet in surviving the enormous stress level brought on by various life events. At the same time, stressful life events could predict IA.
背景:在科技进步的时代,人类的思想不断面临被社交媒体吞噬的风险,导致病态的互联网使用。网络世界通过满足个人在娱乐、获取信息、获得认可和维持关系等方面的各种需求,在压力下起到缓冲作用。相反,在压力条件下,积极的应对弹性和自我效能感可以避免病态的沉迷于网络。目的:观察医学生网络使用模式,探讨网络使用与应激性生活事件和心理弹性水平的关系。材料与方法:采用人口统计资料、网络使用各方面细节、网络成瘾测试问卷(IAT)、心理弹性量表和学生压力量表(SSS)组成的半结构化调查问卷,抽取医学本科生为研究对象。结果:几乎所有的参与者(n = 98)都使用互联网和社交媒体。样本平均年龄20.41(±1.64)岁,男性64.3%,女性35.7%。在IAT测试中,80.6%的学生为中度使用者,19.4%为问题使用者。IAT与心理弹性呈负相关(r = - 0.272, P = 0.007),与SSS总分(r = 0.330, P = 0.001)和压力生活事件总数(r = 0.335, P = 0.001)呈正相关。30.6%的学生表示生活中的重大事件影响了他们的互联网使用。在线性回归模型中,生活事件出现为IAT分数的显著预测因子。结论:医学生承认互联网在各种生活事件带来的巨大压力中所起的作用。同时,有压力的生活事件可以预测IA。
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引用次数: 4
Review of management of pruritus in palliative care 姑息治疗中瘙痒症的处理综述
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173844
S. Alshammary, B. Duraisamy, A. Alsuhail
Pruritus or itch is an uncommon symptom observed in palliative care, even more uncommon in cancer patients. However, if a patient experiences pruritus, the 'itch-scratch' cycle can damage the skin integrity and can increase the susceptibility of patients to infection owing to their frail immune system. The outcome can be very distressing, dramatically impacting the quality-of-life of the patient. Moreover, since severe pruritus seen in patients with advanced disease can be associated with failure of different organ systems, pruritus must be assessed based on the underlying organ systems and the pathophysiology involved. Regardless of the cause of pruritus, general skin care is important. Depending on the origin of pruritus, specific approach and medications must be considered. Caution must be taken during management of pruritus since most cancer patients take pain medications that interact with some antipruritic medications. In addition to the complex and unclear nature of cutaneous and central pathogenesis of pruritus, treatment of pruritus is challenging.
瘙痒或瘙痒在姑息治疗中是一种罕见的症状,在癌症患者中更为罕见。然而,如果患者出现瘙痒,“痒-抓”循环会破坏皮肤的完整性,并且由于患者脆弱的免疫系统,会增加患者对感染的易感性。结果可能非常痛苦,极大地影响患者的生活质量。此外,由于疾病晚期患者出现的严重瘙痒可能与不同器官系统的衰竭有关,因此必须根据潜在的器官系统和所涉及的病理生理来评估瘙痒。不管瘙痒的原因是什么,一般的皮肤护理都很重要。根据瘙痒的来源,必须考虑具体的方法和药物。在处理瘙痒时必须谨慎,因为大多数癌症患者服用的止痛药会与一些止痒药物相互作用。除了皮肤和瘙痒的中心发病机制的复杂性和不明确的性质,瘙痒的治疗是具有挑战性的。
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引用次数: 7
Selecting the appropriate study design: Case–control and cohort study designs 选择合适的研究设计:病例对照和队列研究设计
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173842
A. Omair
This article discusses the observational analytic study designs, i.e., case–control and cohort studies. These two study designs are useful for testing a hypothesis to determine the association between a risk factor and a disease. The analysis for both the studies is based on the conventional 2 × 2 table with the disease status in columns and the risk factor status in rows. The case–control studies start from the disease status and compare the exposure to the risk factor(s) between the diseased (cases) and the not diseased (controls) groups. The odds ratio is determined to compare the proportion of exposed persons in the two groups. The cohort studies start from the exposure to the risk factor status and compare the incidence of the disease in the exposed and not exposed groups. The relative risk compares the incidence between the two groups. The 95% confidence interval is estimated for both studies to determine an actual association between the risk factor and the disease. The strengths and limitations of the two study designs differ based on the direction of the two designs. The case–control study goes backward from the disease status so is more useful for rare diseases and for evaluating multiple risk factors, but it cannot determine causality, and there are chances of recall bias affecting the results of the study. The cohort studies are generally prospective in design from the exposure status and can determine the causal association between the risk factor and the disease. However, the cohort studies are more expensive and require a longer time as well as a larger sample size; the loss to follow-up and misclassification biases can affect the results of the cohort studies.
本文讨论了观察性分析研究设计,即病例对照和队列研究。这两项研究设计对于检验假设以确定风险因素与疾病之间的关联是有用的。这两项研究的分析都是基于传统的2 × 2表格,以列表示疾病状况,以行表示危险因素状况。病例-对照研究从疾病状态出发,比较患病(病例)组和未患病(对照组)组对危险因素的暴露情况。比值比的确定是为了比较两组暴露者的比例。队列研究从暴露的危险因素状态出发,比较暴露组和未暴露组的发病率。相对危险度比较两组之间的发病率。估计两项研究的95%置信区间,以确定风险因素与疾病之间的实际关联。两种研究设计的优势和局限性取决于两种设计的方向。病例对照研究从疾病状态回溯,对罕见病和多危险因素评价更有用,但不能确定因果关系,存在回忆偏倚影响研究结果的可能性。队列研究一般从暴露状态设计前瞻性,可以确定危险因素与疾病之间的因果关系。然而,队列研究更昂贵,需要更长的时间和更大的样本量;随访缺失和错误分类偏差会影响队列研究的结果。
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引用次数: 9
Measurement of platelet function to determine the prevalence of aspirin non-responsiveness among Saudi type II diabetic patients 血小板功能测定以确定沙特II型糖尿病患者阿司匹林无反应性的患病率
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173837
S. Alahmari, Khaled M. Alayed, A. Malik, A. A. Abdel Gader, A. Albanyan, Yazeed Al-Shaikh
Introduction: Aspirin is widely used as either a primary or secondary preventive measure in of cardiovascular events however, platelets from diabetic patients are less responsive to aspirin and are unable to protect themselves from thrombotic events. Objective and Method: 180 diabetic patients were enrolled for measuring their platelet aggregation. The aim was to evaluate the prevalence of aspirin non-responsiveness among Saudi type II diabetic patients. Serum glucose level and other clinical data were collected to find out the possible determinant of reduced platelet sensitivity to aspirin. Results: The prevalence of aspirin non-responsiveness was 9.44%. A significant correlation between aspirin test and each of fasting blood sugar, HbA1c, cholesterol and platelet count was observed. In contrast, there was no correlation among aspirin non-response, body mass index, age or hypertension. Conclusion: The relationship between the levels of glucose in the blood and aspirin resistance relates the importance of controlling blood glucose in diabetic patients to guarantee better aspirin action. Regular examining of type II diabetic patients to determine the sensitivity of platelet to the antiplatelet therapy is necessary to protect them from the risks of cardiovascular complications.
阿司匹林被广泛用作心血管事件的一级或二级预防措施,然而,糖尿病患者的血小板对阿司匹林的反应较弱,无法保护自己免受血栓事件的影响。目的与方法:对180例糖尿病患者进行血小板聚集测定。目的是评估沙特II型糖尿病患者阿司匹林无反应性的患病率。收集血清葡萄糖水平和其他临床数据,寻找血小板对阿司匹林敏感性降低的可能决定因素。结果:阿司匹林无反应性患病率为9.44%。阿司匹林试验与空腹血糖、糖化血红蛋白(HbA1c)、胆固醇、血小板计数均有显著相关性。相比之下,阿司匹林无反应与体重指数、年龄或高血压之间没有相关性。结论:血糖水平与阿司匹林抵抗的关系提示糖尿病患者控制血糖以保证阿司匹林更好的作用。定期检查2型糖尿病患者,以确定血小板对抗血小板治疗的敏感性,以保护他们免受心血管并发症的风险。
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引用次数: 2
Medical students' perception of the reformed medical curriculum at King Saud University 医学生对沙特国王大学医学课程改革的看法
Pub Date : 2016-01-01 DOI: 10.4103/1658-600X.173838
M. Soliman, Khalid Alswat, F. Alsaif, S. Al-Nassar, N. Bayoumi, O. Leheta, Nehal Khamees, A. Al-Drees
Objectives: To evaluate the King Saud University (KSU) medical students' perceptions of the educational programmes' quality. Materials and Methods: A total of 289 medical students at KSU, College of Medicine were selected randomly from year 1 through year 5 and were invited to participate in a descriptive cross-sectional study design. A questionnaire was distributed to the students and collected on completion. The questionnaire measured the students' perceptions of the educational programmes and their competence, as well as their overall satisfaction with the training delivered and the feedback system. Results: About 60.5% of the students declared that the educational programmes provided them with the necessary knowledge while only 48.5% of students believed that it provided them with the necessary skills required. Only 34% of students stated that the intended learning objectives were known to them at the beginning of the courses. About half of the students indicated that the programmes actively involved them in the problem-solving process. Half of the students believed that the amount of basic science knowledge provided was enough; however, 39.5% of students (in their clinical years) believed that the amount of knowledge delivered in the basic science courses was inadequate. Only 18.4% of students considered that the basic science courses prepared them for a clinical clerkship. 17.7% of the students declared that the research activities improved their research skills. 47.3% believed that the research activities helped them in understanding community characteristics, 57.6% asserted learning the basics of medical statistics, 44.6% believed it helped them in using the available resources in solving community problems and 49.5% believed it helped them in learning as well as acquiring project management skills. 34% of the students participated in planning educational activities while 53.7% participated in evaluating these educational activities. 36.1% of students gave frequent feedback to the college. Only 30.2% of the students were satisfied with the overall quality of the educational programmes. Conclusion: The students' perception of the educational programmes was illustrated and important aspects were highlighted which needed to be addressed and revised in order to improve the quality of the curriculum.
目的:评价沙特国王大学(KSU)医学生对教育项目质量的看法。材料与方法:随机抽取KSU医学院一年级至五年级医学生289名,采用描述性横断面研究设计。向学生分发了一份问卷,完成后收集。该问卷调查了学生对教育课程的看法和他们的能力,以及他们对所提供的培训和反馈系统的总体满意度。结果:约60.5%的学生认为教育课程为他们提供了必要的知识,而只有48.5%的学生认为教育课程为他们提供了所需的技能。只有34%的学生表示,他们在课程开始时就知道预期的学习目标。大约一半的学生表示,这些课程积极地让他们参与解决问题的过程。一半的学生认为基础科学知识提供的数量是足够的;然而,39.5%的学生(在他们的临床年)认为在基础科学课程中传递的知识量不足。只有18.4%的学生认为基础科学课程使他们为临床实习做好了准备。17.7%的学生认为研究活动提高了他们的研究技能。47.3%认为研究活动有助他们了解社区特点,57.6%认为学习了医学统计的基础知识,44.6%认为研究活动有助他们利用现有资源解决社区问题,49.5%认为研究活动有助他们学习和掌握项目管理技巧。34%的学生参与策划教育活动,53.7%的学生参与评价教育活动。36.1%的学生经常向学院反馈。只有30.2%的学生对教育课程的整体质素感到满意。结论:说明了学生对教育计划的看法,并强调了需要解决和修改的重要方面,以提高课程质量。
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引用次数: 4
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Journal of Health Specialties
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