Clinics and Practice最新文献

Introduction: Snakebite envenomation is recognized by the World Health Organization (WHO) as a neglected tropical disease. In Colombia, snakebites are frequent due to the diversity of ecosystems and snake species, and children represent a particularly vulnerable population. Objective: This study aimed to characterize the epidemiological and clinical behavior of snakebite envenomation in the pediatric population and to identify factors associated with its severity through the application of a multinomial logistic regression model. Methods: An exploratory analysis was conducted on 170 pediatric patients reported to the Public Health Surveillance System (SIVIGILA) and treated at San Jerónimo Hospital in Montería (HSJ). Sociodemographic and clinical data were collected, and a multinomial logistic regression model was applied to identify risk factors associated with the severity of envenomation. Results: Most cases occurred in children over 12 years of age (51.8%), and males were the most affected. The lower limbs were the most common site of the bite (87.6%). Bothrops was the main genus responsible. Non-medical practices, such as herbal poultices and potions, were reported in 28.2% of cases. Clinically, moderate envenomation was the most frequent (48.2%), with edema (88%) and pain (92%) as the main local manifestations, and nausea (36%) and vomiting (32%) as systemic manifestations. Cellulitis was the most common complication (24%). Student's t-test showed a significant difference between complications and hospital stays lasting 3 to 7 days. The multinomial logistic regression explained 75% of the severity variability and showed that prior non-medical practices increased the risk of severe cases. Conclusions: Snakebite envenomation in children remains an important public health problem. The statistical model showed that non-medical practices are associated with a higher degree of severity.

Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the following: generic conditions with established protocols (control group), specialist-diagnosed diseases, women's diseases, and psychiatric diseases. Diagnostic incidence was calculated across 25 geographical clusters, and variability was measured using the coefficient of variation (CV). To test systematic differences, multivariate linear regression models were adjusted for socio-demographics and healthcare system proxies. Results: The final sample for analysis consisted of 617,222 women aged 15 to 65, with a mean age of 43. The results did not reveal significant variability between generic and specialized diseases, but women's and psychiatric diseases showed consistently higher CVs in all models (p < 0.05), indicating that approximately 20% to 30% of the clinical variation observed in these groups was unexplained. Conclusions: Although we cannot establish causality, these findings may suggest that cultural taboos and gender biases likely contribute to unjustified clinical variation, highlighting cultural bias as a plausible explanatory factor.

Background: Clinical procedures involving the tibial nerve (TN) are complex procedures due to its deep anatomical position and the variability of its course in the retromalleolar region. Few studies have described the ultrasound characteristics of the TN in vivo. This study aims to describe the ultrasound position of the TN and its relationship with the posterior tibial artery (PTA) at the retromalleolar level, evaluating the influence of sex, weight, height, and body mass index (BMI). Methods: A cross-sectional ultrasound study was performed on 100 volunteers. Anthropometric variables were recorded. Ultrasound measurements included the TN perimeter, distance from the medial malleolus to the TN center, depth, and spatial relationship with the PTA. Statistical analyses included Student's t-test, ANOVA, Chi-square test, and Pearson's correlation coefficient, with a significance level of p < 0.05. Results: The mean distance from the TN to the medial malleolus was 2.17 cm, and its mean depth was 0.91 cm. The most common anatomical pattern was Type I (TN posterior to the PTA) (60%). Sex influenced TN position, with men showing greater distances from the medial malleolus to the TN center (2.42 vs. 1.99 cm) and women showing greater depth from the skin surface to the upper edge of the tibial nerve perimeter (0.94 vs. 0.86 cm). Weight (p = 0.004), height (p < 0.001), and ankle circumference (p = 0.006) correlated significantly with TN location, whereas BMI did not (p = 0.253). Conclusion: These findings provide clinically relevant reference data that may improve the precision and safety of different tibial nerve procedures.

Background: The psychosomatic effects of stress are risk factors for a range of dental and systemic diseases. This study used the massive Japanese national statistics database to clarify the association of psychological stress with subjective symptoms and conditions requiring hospital visits. Methods: Anonymized data from 93,690 respondents of the 2019 Japanese survey were provided for this study. From these data, those of 29,777 respondents aged 40-89 years were classified into stress groups based on their responses to the Kessler Psychological Distress Scale (K6). The response rates for symptoms and diseases were compared and analyzed using contingency tables and binomial logistic regression. Results: The items with the largest odds ratios in the univariate analysis were depression/other mental disease (7.60), followed by irritability (6.86) and health perception QOL (6.31). Among those with subjective symptoms, the proportion in the high-stress group was higher (15.1%), with a univariate odds ratio of 3.17. The results of the binomial logistic regression analysis, with subjective QOL as the dependent variable, were as follows: The explanatory variables with the highest adjusted odds ratios were stress group classification (3.14), followed by feeling physically tired (2.44) and sleep satisfaction (2.22). The stress group was associated with subjective symptoms, such as irritability and depression/other mental diseases, as well as with social factors, such as household structure and work hours. These results suggest the existence of specific symptoms, diseases, and environmental factors associated with high stress. Conclusions: The results suggest that stress may have a substantial impact on quality of life in later life. Therefore, healthcare measures for older adults should focus on the symptoms and diseases that tend to be associated with stress to mitigate their effects.

Background: Primary Sjogren Disease (pSD) is a chronic autoimmune disease characterized by a classic triad of keratoconjunctivitis sicca, xerostomia, and polyarthritis. The primary pathological feature of pSD is lymphoplasmacytic infiltration in glandular epithelial tissue, often affecting the salivary and lacrimal glands, leading to classic sicca symptoms (ocular and oral dryness). Sjogren Disease (SD) can be categorized as "primary" when occurring independently or "secondary" when accompanying another autoimmune connective tissue disorder such as rheumatoid arthritis, systemic lupus erythematosus, or systemic sclerosis. Additionally, systemic disease is common in pSD and can manifest with kidney dysfunction resulting in nephrolithiasis and distal renal tubular acidosis (dRTA). Methods: This report details a case series drawing patients from the literature as well as patients from our institution which serves to demonstrate key points in clinical hallmarks. We utilize a literature search with key words Sjogren Disease, nephrolithiasis, renal tubular acidosis, and nephrocalcinosis in addition to pSD patients with concomitant nephrolithiasis at our institution to characterize clinical and serologic findings as well as treatment modalities. Results: We find well demonstrated clinical hallmarks such as female predominance and presence of dRTA amongst the cohort of pSD patients. We also find that further research on pSD serologies could prove beneficial in risk stratifying those most likely to develop renal disease and nephrolithiasis. Furthermore, we review signs, symptoms, pathophysiology, and management of SD with added emphasis on associated renal disease including nephrolithiasis and dRTA. Conclusion: Overall, pSD associated renal disease remains an area of ongoing research and further study on patient serologies may aid clinicians in better serving and surveilling patients at risk of systemic involvement.

Background: Adverse reactions to tattoo pigments are increasingly recognized, yet severe systemic complications remain rare and poorly characterized. Red tattoo ink, in particular, is associated with delayed hypersensitivity reactions, but widespread manifestations affecting multiple organ systems have not been documented. This case report aims to describe an unusual constellation of erythroderma, alopecia universalis, anhidrosis, and vitiligo triggered by red tattoo ink and to highlight the diagnostic and therapeutic challenges associated with such reactions. Case presentation: This case report describes a 36-year-old Caucasian male who developed erythroderma, alopecia, anhidrosis, and vitiligo as complications of a red ink tattoo, marking a rare and previously unreported case of such extensive reactions. Four months after getting the tattoo, the patient began to develop itchy eczematous changes, which progressed to erythroderma over several months, along with alopecia universalis and anhidrosis. Results: After months of ineffective treatment with glucocorticosteroids, cyclosporine, methotrexate, and acitretin, patch tests confirmed hypersensitivity to possible components of the red tattoo ink, prompting surgical removal of the inflamed tattoo fragments. Unfortunately, aside from resolving the erythroderma, this did not improve the patient's clinical condition, and he developed vitiligo. Only after the complete removal of the red tattoo ink from the same series that caused the sensitization and the use of immunosuppressive and immunomodulatory drugs, including JAK inhibitors, was hair growth restored and the progression of vitiligo halted, but with no effect on anhidrosis. Conclusions: This case highlights the challenges in managing systemic reactions to tattoo ink and the importance of thorough evaluation and treatment strategies.

Background: Airway stenting is an alternative therapy for patients with complicated esophagectomy.

Case presentation: A 60-year-old man with clinical stage IIIA esophageal cancer underwent neoadjuvant chemotherapy followed by robot-assisted subtotal esophagectomy with cervical esophagogastrostomy and jejunostomy. During surgery, both bronchial arteries were ligated to facilitate esophageal mobilization. Bronchoscopy on the first postoperative day showed no abnormalities; however, by the second postoperative day, the patient developed pneumonia and septic shock, requiring mechanical ventilation. On the fifth postoperative day, bronchoscopy revealed extensive epithelial injury extending from the trachea to both main bronchi, indicating ischemic airway damage. He was diagnosed with airway necrosis and referred to our respiratory department. Serial bronchoscopic examinations and suctioning of the sloughed epithelium were performed, and a tracheostomy enabled weaning from mechanical ventilation. By the twenty-fourth postoperative day, bronchoscopy revealed the accumulation of large, hardened secretions within the trachea, carina, and both main bronchi, resulting in airway narrowing and a high risk of asphyxiation. A silicone Y-shaped airway stent was inserted to maintain patency. Following stent placement, airway secretions progressively decreased, and the patient was discharged on the sixty-third postoperative day. The stent was removed six months later, with no recurrence of airway or respiratory complications.

Conclusion: This case illustrates a rare but severe complication of extensive airway necrosis, likely caused by intraoperative bronchial artery ligation and dissection of the tracheal membranous portion. Although preservation of the bronchial arteries and meticulous surgical technique are essential preventive strategies, such complications may be unavoidable. In cases of extensive airway necrosis, airway stenting can serve as an effective therapeutic option to prevent obstruction and support recovery.

Background/Objectives: Upper extremity deep vein thrombosis (UEDVT) is a harmful complication of elective upper limb surgeries. Different strategies are employed to prevent this condition. The aim of the review is to quantify the effectiveness of various preventive interventions and investigate correlated factors that affect the incidence of UEDVT (upper extremity deep vein thrombosis). Methods: We performed a systematic search using the PubMed, EBSCO, Ovid, EMBASE, Cochrane, and Google Scholar databases. Randomized controlled trials (RCTs), prospective or retrospective cohort studies, or case-control studies were examined. We included adult patients over 18 years old undergoing elective upper limb surgery and receiving Prophylactic measures for Upper Extremity Deep Venous Thrombosis. Results: After a literature search and quality assessment, 6 studies were included. All the studies were of good quality but significantly heterogeneous in terms of sample size, population size, treatment modalities, and baseline characteristics. In these studies, the reported incidence of symptomatic venous thromboembolism (VTE) varied widely, ranging from 0.41% to 13%. However, thromboprophylaxis did not have a significant impact on the rates of deep vein thrombosis (DVT). Certain factors such as older age and trauma as the cause of surgery were identified as notable risk factors for symptomatic VTE. Conclusions: This systematic review highlights the complexity of preventing upper extremity deep vein thrombosis (UEDVT) following elective upper limb surgeries. The reported incidence of symptomatic VTE varies considerably across studies, and thromboprophylaxis was not associated with a significant reduction in its rates. The evidence is characterized by substantial heterogeneity in patient populations and surgical contexts. More research is needed to better understand the role of thromboprophylaxis in preventing DVT.

Background/Objectives: Periodontal diseases are highly prevalent worldwide, causing progressive destruction of the alveolar bone and eventual tooth loss when not treated. Despite advances in conventional periodontal therapies, complete tissue regeneration remains limited. This review aims to evaluate the efficacy, safety, and clinical relevance of stem cell-based tissue engineering approaches for regeneration of periodontal bone lesions. Methods: Following PRISMA guidelines, a systematic search was conducted across multiple databases, resulting in the inclusion of 17 studies in humans that met predefined PICO criteria. The study protocol was registered on PROSPERO (CRD420251229271). These studies assessed various stem cell sources, including dental and bone marrow-derived cells among others, both on their own and in combination with scaffolds or growth factors. Results: Most studies reported favorable outcomes in terms of clinical attachment gain, radiographic bone fill, probing depth reduction, and implant stability. No major adverse effects were noted, indicating good safety. However, results varied based on cell type, culture protocols, and defect characteristics. Conclusions: Stem cell therapy shows strong potential for periodontal regeneration, with outcomes that may potentially surpass those of conventional methods in selected cases. Further standardization, cost reduction, and long-term clinical trials are essential to confirm these findings and support their integration into daily dental practice.

Inguinal hernia represents a multifactorial condition driven by extracellular matrix (ECM) dysregulation, collagen imbalance, and oxidative stress. Across studies, a consistent reduction in the collagen I:III ratio, coupled with altered expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), underpins weakened fascia and hernia susceptibility. Aging further impairs ECM remodeling through fibroblast senescence, cross-linking deficits, and elastic fiber attrition, while oxidative stress and inflammation amplify tissue degradation and impair repair mechanisms. Evidence from clinical and experimental studies underscores the interplay between surgical technique, mesh choice, redox balance, and recurrence risk. Understanding the combined impact of aging and oxidative stress provides a mechanistic framework for targeted therapeutic and surgical strategies aimed at preventing hernia development and recurrence.