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Transmural ischemic bowel necrosis in a patient with Kabuki syndrome: a case report 歌舞伎综合征患者经壁缺血性肠坏死1例报告
Pub Date : 2023-09-20 DOI: 10.32457/ijmss.v10i3.2219
Jorge Gutiérrez González, Oscar Humberto Mendoza-Hernández, Juventino Tadeo Guerrero-Zertuche, Gustavo Dragustinovis-Hinojosa, Néstor Veriel Méndez-Huerta, Gerardo Enrique Muñoz-Maldonado
Kabuki syndrome (KS) is a rare genetic disorder in which mutations in the KMT2D or KDM6A genes result in a wide spectrum of clinical manifestations including development and growth delay; intellectual dysfunction; craniofacial dysmorphism; and various systemic structural and functional defects. We present the case of a 16-year-old male, diagnosed with KS in his infancy. He presented with acute diffuse abdominal pain, accompanied by distension, nausea and clinical data suggestive of intestinal obstruction. After radiological confirmation, focal intestinal necrosis was identified on exploratory surgery, so he underwent intestinal resection and ileostomy in shotgun. The final diagnosis was transmural intestinal ischemic necrosis with acute inflammatory process and serofibrinous peritonitis.
歌舞伎综合征(KS)是一种罕见的遗传性疾病,其中KMT2D或KDM6A基因突变导致广泛的临床表现,包括发育和生长迟缓;智力障碍;颅面先天性畸形;以及各种系统性结构和功能缺陷。我们提出的情况下,16岁的男性,诊断为KS在他的婴儿期。他表现为急性弥漫性腹痛,伴有腹胀、恶心和提示肠梗阻的临床资料。经影像学证实,探查手术发现局灶性肠坏死,故行霰弹枪下肠切除术及回肠造口术。最终诊断为经肠壁缺血性坏死伴急性炎症过程及浆液性腹膜炎。
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引用次数: 0
Vol. 10 No. 3 (2023): August, 2023 第十卷第三期(2023):2023年8月
Pub Date : 2023-09-20 DOI: 10.32457/ijmss.v10i3
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引用次数: 0
Comparative Efficacy of Tirzepatide, Teneligliptin, and Empagliflozin in HbA1c Reduction in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis 替西帕肽、替尼列汀和恩格列净降低2型糖尿病患者HbA1c的比较疗效:一项系统综述和荟萃分析
Pub Date : 2023-09-20 DOI: 10.32457/ijmss.v10i3.2263
Jordan Llerena-Velastegui, Fabian Delgado-Quijano, Martin Trujillo-Delgado, Cecibel Villacis-Lopez, Anthony Fernandez-Arcos, Gerson Santafe-Abril, Claudia Hurtado-Alzate, Karen Benitez-Acosta
This study’s objective was to evaluate the effectiveness of three different families of drugs (Empagliflozin [an SGLT-2 inhibitor], Tirzepatide [a GLP-1 receptor co-agonist], and Teneligliptin [DPP-4 inhibitor] used in the treatment of type 2 diabetes in lowering HbA1c levels in people with type 2 diabetes mellitus (T2DM). The effectiveness of different families of diabetic drugs was assessed using a meta-analytic approach. Data were gathered from a variety of research publications using ICTRP, CT.gov, and PubMed databases. The data were analyzed, and conclusions were drawn using forest plots. Teneligliptin (a DPP-4 Inhibitor) substantially lowered HbA1c levels in T2DM patients compared to other classes of T2DM drugs with a P-value of 0.0002 and 95% CI -0.63 [-0.97 to -0.30] after reviewing many pertinent articles. The pooled data analysis showed that Tirzepatide and Empagliflozin did not significantly lower HbA1c levels, with the P-value for Tirzepatide being P = 0.55 and for Empagliflozin, it was P = 0.64. According to our research, Teneligliptin may be more effective than Empagliflozin and Tirzepatide as a monotherapy for lowering HbA1c levels in T2DM patients. To corroborate these findings, further research studies are required.
本研究的目的是评估三种不同家族的药物(恩格列清[一种SGLT-2抑制剂]、替泽肽[一种GLP-1受体协同激动剂]和替尼格列汀[一种DPP-4抑制剂])在治疗2型糖尿病中降低2型糖尿病(T2DM)患者HbA1c水平的有效性。采用荟萃分析方法评估不同家族糖尿病药物的有效性。数据是从使用ICTRP、CT.gov和PubMed数据库的各种研究出版物中收集的。对数据进行分析,并利用森林样地得出结论。与其他类型的T2DM药物相比,Teneligliptin(一种DPP-4抑制剂)显著降低T2DM患者的HbA1c水平,p值为0.0002,95% CI为-0.63[-0.97至-0.30]。合并数据分析显示,替泽肽和恩帕列净对HbA1c水平无显著降低作用,替泽肽的P值为P = 0.55,恩帕列净的P值为P = 0.64。根据我们的研究,在降低T2DM患者的HbA1c水平方面,Teneligliptin可能比Empagliflozin和tizepatide更有效。为了证实这些发现,还需要进一步的研究。
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引用次数: 0
Minimal change disease associated with IgA nephropathy “a rare clinical spectrum”: Case report 与IgA肾病相关的微小变化疾病“罕见的临床谱”:病例报告
Pub Date : 2023-09-20 DOI: 10.32457/ijmss.v10i3.2212
Juan Santiago Serna-Trejos, Laura Carolina Neira–Ruiz, Stefanya Geraldine Bermúdez–Moyano, Jennifer Alejandra Hurtado-Leiton, Diego Andrés González-Sánchez
Minimal change disease (MCD) is one of the main causes of idiopathic nephrotic syndrome, manifesting with intense proteinuria leading to edema and intravascular volume depletion, characterized by the absence of alterations in light microscopy and the presence of effacement of the podocyte processes in electron microscopy. Although the cause is unknown, it is believed that due to an immunologic dysregulation and modifications of the podocyte and of the proteins that constitute the cytoskeleton of this one and of the filtration diaphragm, generating an alteration in the integrity of the glomerular basement membrane and, therefore, conditioning the presence of proteinuria. IgA nephropathy (IgAN) is the most common mesangial proliferative glomerulopathy in developed countries and one of the main causes of chronic kidney disease and renal failure in Asian population, characterized by the presence of mesangial IgA deposits. The clinical presentation is extremely variable, ranging from isolated dysmorphic microhematuria to chronic deterioration of renal function. We present a rare case of these two primary glomerulopathies concomitantly in one patient. This is intended to increase medical sensitivity in the diagnosis of the coexistence of these two primary glomerulopathies as atypical presentations in clinical practice.
微小改变病(MCD)是特发性肾病综合征的主要病因之一,表现为强烈的蛋白尿导致水肿和血管内体积减少,其特征是光镜下没有改变,电镜下存在足细胞过程的消失。虽然原因尚不清楚,但据信是由于足细胞和构成该细胞骨架和滤过膜的蛋白质的免疫失调和修饰,导致肾小球基底膜完整性的改变,从而调节了蛋白尿的存在。IgA肾病(IgAN)是发达国家最常见的系膜增生性肾小球疾病,也是亚洲人群慢性肾脏疾病和肾功能衰竭的主要原因之一,其特征是存在系膜IgA沉积。临床表现是非常多变的,从孤立的畸形微血尿到肾功能的慢性恶化。我们提出一个罕见的病例,这两种原发性肾小球病变同时在一个病人。这是为了提高医学敏感性,在诊断共存的这两种原发性肾小球病变作为不典型的表现在临床实践中。
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引用次数: 0
The Mediterranean diet as a healthy dietary model and its impact on the immune system and intestinal microbiota 地中海饮食作为健康饮食模式及其对免疫系统和肠道微生物群的影响
Pub Date : 2023-09-20 DOI: 10.32457/ijmss.v10i3.2242
Patricio Salazar, Adriana Pedreañez
The relationship between nutrition and immunity is very complex, because each phase of the immune response can be affected by the lack of essential nutrients such as vitamins and minerals. In addition, it has been described that the most prevalent non-communicable diseases worldwide, such as metabolic syndrome, diabetes mellitus, cardiovascular diseases and cancer, underlie the activation of inflammatory mechanisms, which can compromise immune functions, often caused or accompanied by alterations in nutritional patterns and intestinal microbiota. In this context, it is clear that diet is a key modulator of the immune system and much interest is emerging in the area of nutrition as a means of treatment and prevention. The Mediterranean diet has been widely described as positively influencing and is proposed not only as a potential tool in the clinical management of different diseases, but also for global health promotion. Therefore, the aim of this review is to address the current knowledge on the regulatory role of the nutritional components present in the Mediterranean diet on the immune system and the intestinal microbiota.
营养和免疫之间的关系非常复杂,因为免疫反应的每个阶段都可能受到维生素和矿物质等必需营养素缺乏的影响。此外,据介绍,世界上最普遍的非传染性疾病,如代谢综合征、糖尿病、心血管疾病和癌症,是炎症机制激活的基础,可损害免疫功能,往往引起或伴随营养模式和肠道微生物群的改变。在这种情况下,很明显,饮食是免疫系统的关键调节剂,营养作为治疗和预防手段的领域正在引起人们的极大兴趣。地中海饮食被广泛认为具有积极的影响,不仅被认为是不同疾病临床管理的潜在工具,而且还被认为是促进全球健康的潜在工具。因此,本综述的目的是解决目前对地中海饮食中营养成分对免疫系统和肠道微生物群的调节作用的认识。
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引用次数: 0
Long-term Plasmapheresis for Cholestatic Pruritus 长期血浆置换治疗胆汁淤积性瘙痒
Pub Date : 2023-09-07 DOI: 10.25259/ijrsms-2022-2-12
Erik Sanson, Luke J Richard, Margarita N German, William N Rose
Cholestatic pruritus is commonly associated with many hepatobiliary disorders and can be typically controlled with conventional treatment. Therapeutic plasma exchange (TPE) has shown success in improving untreatable cholestatic pruritus with great success. We report on the use of TPE to alleviate debilitating pruritus in one patient with a two-year history of chronic pruritus refractory to conventional treatment. The patient presented with an acute onset of diffuse pruritus that did not fully respond to first or second-line treatments, including bile acid sequestrants. Pruritus significantly affected her quality of life, interfering with daily activity, causing insomnia and weight loss. Due to the severity of her symptoms, biweekly TPE with 5% albumin infusions were initially trialed. Patient found symptoms to be much improved until about the fifth day after each TPE. TPEs were scheduled twice per week alternating with once per week. TPE appeared to be an effective treatment for this patient with chronic cholestatic pruritus. For our patient, TPE seemed to provide relief for about 3-5 days after each TPE.
胆汁淤积性瘙痒通常与许多肝胆疾病有关,通常可通过常规治疗加以控制。治疗性血浆交换(TPE)在改善无法治疗的胆汁淤积性瘙痒方面取得了巨大的成功。我们报告了使用TPE来缓解衰弱性瘙痒的一个病人,他有两年的慢性瘙痒难治性常规治疗史。患者表现为急性弥漫性瘙痒,对一线或二线治疗(包括胆汁酸隔离剂)没有完全反应。瘙痒症严重影响了她的生活质量,干扰了她的日常活动,导致失眠和体重下降。由于她的症状严重,最初的试验是每两周一次TPE加5%白蛋白输注。患者发现每次TPE后第5天症状有很大改善。tpe每周安排两次,每周一次交替进行。TPE似乎是治疗慢性胆汁淤积性瘙痒的有效方法。对于我们的患者,TPE似乎在每次TPE后约3-5天内提供缓解。
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引用次数: 0
Empty Nose Syndrome with Unilateral Ethmoidal Mucopyocoele – An Extremely Rare Presentation 伴有单侧筛窦黏液囊肿的空鼻综合征-一种极为罕见的表现
Pub Date : 2023-09-07 DOI: 10.25259/ijrsms-2021-5-7
Sama Rizvi, Rishita Kalra, V. K. Pathak, P. Nayak
Empty nose syndrome (ENS) is a poorly understood and rare iatrogenic disorder resulting from the destruction of normal nasal tissue. ENS is a recognized complication after turbinate excision. These patients suffer from endonasal crusting and dryness and a paradoxical sensation of nasal obstruction. These complications of ENS predispose these patients to recurrent sino-nasal infections. Here we have reported the case of a 20-year-old female with right-sided nasal obstruction and headache. On diagnostic nasal endoscopy (DNE), the right nasal cavity was devoid of all anatomical landmarks. A hidden ethmoidal mucopyocoele was identified on radiological evaluation . This was drained surgically. Patient’s symptoms improved drastically postoperatively. Despite the fact that occurrence of rhino-sinusitis is common in patients of ENS, a mucocoele or mucopyocoele has never been reported previously. To the best of our knowledge, this is the first ever reported case of ENS with ethmoidal mucopyocoele in a young, immuno-competent patient.
空鼻综合征(ENS)是一种罕见的医源性疾病,由于正常鼻腔组织的破坏而引起。ENS是鼻甲切除后公认的并发症。这些患者患有鼻内结痂和干燥以及鼻阻塞的矛盾感觉。ENS的这些并发症使这些患者易发生复发性鼻黏膜感染。我们在此报告一位20岁女性右侧鼻塞及头痛的病例。在诊断性鼻内窥镜检查(DNE)中,右鼻腔没有任何解剖标志。影像学检查发现一隐蔽性筛窦粘液囊肿。这是通过手术排出的。患者术后症状明显好转。尽管鼻鼻窦炎在ENS患者中很常见,但以前从未报道过粘液囊肿或粘液囊肿。据我们所知,这是首次报道的ENS合并筛窦黏液囊肿的年轻、免疫能力强的患者。
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引用次数: 0
Surgical Audit of Operated Patients in a Tertiary Care Hospital in Karachi, Pakistan 巴基斯坦卡拉奇一家三级护理医院手术患者的外科审计
Pub Date : 2023-09-07 DOI: 10.25259/ijrsms-2020-12-4
Huma Akhtar, H. H. Ahmed, Kanwal Irshad, Muhammad Jamaluddin
To audit operated patients in emergency and electively from 1st January 2018 to 31st December 2019 in all three surgical departments to know the outcome of the patients at a tertiary care hospital in Karachi, Pakistan.A retrospective study conducted in all three Abbasi Shaheed Hospital surgical units from 1st January 2018 to 31st December 2019. In this study total of 5079 patients were included who were admitted through emergency and surgical outpatient department. They were operated in emergency and elective theatres in all three surgical departments of Abbasi Shaheed Hospital. Data was collected on pre-designed performa from emergency and elective theatre, wards, High-dependency unit and Intensive care unit maintained registers by staff.A total of 5079 cases were operated during January 2018 to December 2019. Among all the age ranges 1282 belongs to the age range of 21-30 years. Amongst which 59.6% were males. The most common diagnosis made in elective patients was chronic calculous cholecystitis (25.8%) and an abscess in emergency (39.4%). The most common procedure performed in elective surgeries was combined laparoscopic and open cholecystectomy (26.8%) and incision and drainage in the emergency (39.4%). Elective surgeries were mainly performed by Associate Professors (28.7). While, emergency surgeries were mainly performed by post-graduate trainees (70.2%). Surgical unit II has performed most surgeries (39.5%). Elective procedure constitutes about (51.60%). Total 19 patients expired out of 350 patients who were shifted or admitted in surgical ICU and 12 patients got expired in all three wards. We have higher number of elective surgeries as compared to the emergency surgeries. Consultants have performed most of the elective surgeries. Emergency surgeries mostly by residents and senior registrars. We have zero mortalities in our elective surgeries in comparison with emergency surgeries. We call attention to conduct continuous audits at our hospitals and all levels of health care and demand from higher authorized personals to incorporate audit awareness our teaching. Along with it, proper database should be installed with updated records maintenance to improve the lack of health care.
在2018年1月1日至2019年12月31日期间,对所有三个外科部门的急诊和选择性手术患者进行审计,以了解巴基斯坦卡拉奇一家三级医疗医院患者的预后。回顾性研究于2018年1月1日至2019年12月31日在阿巴西沙希德医院所有三个外科单位进行。本研究共纳入5079例通过急诊和外科门诊就诊的患者。他们在Abbasi Shaheed医院所有三个外科的急诊和选择性手术室进行手术。工作人员从急诊和选择性病房、病房、高度依赖病房和重症监护病房收集了预先设计的表演数据。2018年1月至2019年12月共手术5079例。在所有年龄段中,1282属于21-30岁年龄段。其中男性占59.6%。择期患者最常见的诊断是慢性结石性胆囊炎(25.8%)和急诊脓肿(39.4%)。择期手术中最常见的手术是腹腔镜和开放联合胆囊切除术(26.8%)和急诊切开引流(39.4%)。选择性手术以副教授为主(28.7)。急诊手术以研究生培训生为主(70.2%)。第二外科单元进行的手术最多(39.5%)。选择性手术约占51.60%。350例外科重症监护室转移或入住患者中死亡19例,3个病区均死亡12例。相比急诊手术,我们有更多的选择性手术。大部分的选择性手术都是由咨询师完成的。急诊手术主要由住院医生和高级注册医生进行。与急诊手术相比,我们的选择性手术死亡率为零。我们呼吁注意在我们的医院和各级卫生保健机构进行持续的审计,并要求高级授权人员将审计意识纳入我们的教学。与此同时,应该安装适当的数据库,更新记录维护,以改善缺乏医疗保健的情况。
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引用次数: 0
Leukostasis Due to Acute Myeloid Leukaemia with Monocytic Differentiation that Resolved after Leukapheresis 白细胞分离后单核细胞分化急性髓系白血病所致的白细胞停滞
Pub Date : 2023-09-06 DOI: 10.25259/ijrsms-2022-2-6
Tom L Enright, Anthony H Bui, William N Rose
Even though the stakes of leukostasis are high, the data regarding the efficacy of leukapheresis for leukostasis is meagre. We report a patient with leukostasis due to acute myeloid leukaemia with monocytic differentiation who improved clinically after therapeutic leukapheresis, a rarely performed variation of therapeutic apheresis.
尽管白细胞停滞的风险很高,但关于白细胞分离对白细胞停滞的疗效的数据很少。我们报告一例急性髓系白血病伴单核细胞分化引起的白细胞淤滞患者,在治疗性白细胞采血后临床改善,这是一种罕见的治疗性白细胞采血的变化。
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引用次数: 0
Covid-19: Potential relationship of anosmia and ageusia in swallowing rehabilitation 2019冠状病毒病:嗅觉障碍和老年障碍在吞咽康复中的潜在关系
Pub Date : 2023-06-20 DOI: 10.32457/ijmss.v10i2.2218
Katherine Peralta-Arancibia, Roberto Rojas-Segovia, Rocío Fuenzalida-Inostroza, L. Fuenzalida
Anosmia and ageusia are prevalent symptoms in COVID-19 patients and can last for weeks. Sensory and olfactory functions perform an important role in swallowing. This article proposes the possible negative effect of the symptoms of anosmia and ageusia in the swallowing rehabilitation of dysphagia oropharyngeal and post-intubation in patients with COVID-19. It is important to consider that swallowing is a multisensory and pathological process, where taste and smell play a key role. In accordance with these factors, we propose future research incorporating objective evaluation methods of the affected senses in COVID-19 patients.
嗅觉缺失和老年痴呆是COVID-19患者的普遍症状,可持续数周。感觉和嗅觉功能在吞咽中起着重要的作用。本文提出嗅觉缺失和听觉障碍症状对COVID-19患者口咽吞咽困难及插管后吞咽康复可能产生的负面影响。重要的是要考虑到吞咽是一个多感官和病理过程,其中味觉和嗅觉起关键作用。根据这些因素,我们建议在未来的研究中纳入对COVID-19患者影响感官的客观评价方法。
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引用次数: 0
期刊
International Journal of Recent Surgical and Medical Sciences
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