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Essential Thrombocythemia in Pregnancy: A Case Report 妊娠期原发性血小板增多症:病例报告
Pub Date : 2023-12-29 DOI: 10.24018/ejmed.2023.5.6.1978
Agnes Indah Nugraheni, Ketut Ratna, Dewi Wijayanti, I. Wayan, Losen Adnyana
Essential thrombocythemia is a hematological problem that occurs during pregnancy. Diagnosis of essential thrombocythemia is difficult because it is a diagnosis of exclusion and there is a higher frequency of thrombocythemia due to other causes. A 26-year-old female patient with G1P0000 gestational weeks 30–31 came to the gynecology clinic after laboratory examination with thrombocyte count of 1,128,000 μL. There were no complaints of dizziness, nausea, vomiting, tingling, or fever. She was fatigue with compos mentis consciousness, with blood pressure 110/70 mmHg, heart rate 85 times/minute, respiratory rate 20 times/minute, and temperature 36.5 °C. Head to toe examination was within normal limits. An obstetric status examination was obtained. Fundal height: 3 fingers below the xiphoid process (31 cm, with estimation fetal weight by McD formula 2945 grams) and fetal heart rate 134 times/minute. Blood smear shows leukocytosis and thrombocythemia suspected myeloproliferative disorder (MPD), an essential thrombocythemia. She was tested for the JAK2V617F mutation but no mutation was detected. Doppler ultrasound test shows umbilical artery (RI: 0.69; PI: 0.95; S/D ratio: 2.76) and middle cerebral artery (RI: 0.74; PI: 1.48; S/D ratio 3.88). She was consulted to hematooncologist and was given aspirin 80 mg per day, Cal-95 1 tablet per day, and prenatal vitamins. Evaluation of patients with essential thrombocythemia includes a complete blood count, bone marrow biopsy, and genetic testing to evaluate gene mutations to obtain the appropriate diagnosis and therapy to prevent from its complication such as thrombosis during pregnancy, bleeding during pregnancy, gestational hypertension, preeclampsia, eclampsia, prematurity, placental abruption, intrauterine growth retardation and stillbirth.
原发性血小板增多症是一种发生在妊娠期的血液病。原发性血小板增多症的诊断比较困难,因为它是一种排除性诊断,而且由其他原因引起的血小板增多症的发病率较高。一名 26 岁的女性患者,孕周为 30-31 周的 G1P0000,在接受实验室检查后,血小板计数为 1 128 000 μL,来到妇科门诊就诊。她没有头晕、恶心、呕吐、刺痛或发烧的主诉。她神志清醒,疲乏无力,血压 110/70 mmHg,心率 85 次/分,呼吸频率 20 次/分,体温 36.5 °C。从头到脚的检查都在正常范围内。进行了产科状况检查。宫底高度:剑突下 3 指(31 厘米,根据 McD 公式估计胎儿体重 2945 克),胎心率 134 次/分钟。血涂片显示白细胞增多和血小板增多,疑似骨髓增生性疾病(MPD),一种原发性血小板增多症。她接受了 JAK2V617F 基因突变检测,但未发现突变。多普勒超声检测显示脐动脉(RI:0.69;PI:0.95;S/D 比值:2.76)和大脑中动脉(RI:0.74;PI:1.48;S/D 比值:3.88)。她接受了血液肿瘤专家的会诊,每天服用阿司匹林 80 毫克,每天服用 1 片 Cal-95,并服用产前维生素。对原发性血小板增多症患者的评估包括全血细胞计数、骨髓活检和基因检测,以评估基因突变,从而获得适当的诊断和治疗,防止其并发症,如孕期血栓形成、孕期出血、妊娠高血压、子痫前期、子痫、早产、胎盘早剥、宫内发育迟缓和死胎。
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引用次数: 0
Heart Dominated by Solitary Coronary: A Case Report 单支冠状动脉支配的心脏:病例报告
Pub Date : 2023-12-28 DOI: 10.24018/ejmed.2023.5.6.1982
Anwar Nabeel Jafri, Mohammed Hassan Muaidh Alqarni, Mohammad Al Shehri
The prevalence of coronary artery anomalies has been detected in 0.6% to 1.5% of coronary angiography. They are found since birth but usually with no significant symptoms and it does not generally manifest as myocardial ischemia however, malignant outcomes have been reported. Single coronary arteries are rare congenital anomalies in which the entire circulation for the heart is supplied by a coronary artery originating from a single ostium. It is challenging to recognize the anomaly of the patient’s coronaries, experiencing percutaneous coronary intervention (PCI) procedure, undergoing coronary artery surgery, or receiving a prosthetic valve replacement. In our case, we document a patient who underwent PCI for multi-vessel coronary lesions and in whom the atypical origin of the single left coronary artery, with the right coronary artery (RCA) emerging from the distal left circumflex artery (LCX), which was previously undetected.
冠状动脉异常的发病率在冠状动脉造影中占 0.6%至 1.5%。冠状动脉畸形从出生时就会被发现,但通常没有明显症状,一般也不会表现为心肌缺血,但也有恶性结果的报道。单支冠状动脉是一种罕见的先天性畸形,整个心脏的血液循环都由一根冠状动脉供应,而这根冠状动脉只起源于一个骨膜。在患者经历经皮冠状动脉介入治疗(PCI)手术、接受冠状动脉手术或接受人工瓣膜置换术时,识别其冠状动脉异常是一项挑战。在我们的病例中,我们记录了一名因多支冠状动脉病变而接受 PCI 手术的患者,他的单支左冠状动脉起源不典型,右冠状动脉(RCA)从左侧环状动脉(LCX)远端冒出,而这在以前是未被发现的。
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引用次数: 0
Organ Shortage, Waiting Lists, and Mortality: Inadequate or Discussed Social Education? 器官短缺、候诊名单和死亡率:社会教育不足还是讨论不足?
Pub Date : 2023-12-28 DOI: 10.24018/ejmed.2023.5.6.1958
Felix Cantarovich
Amongst the significant advances in current medicine, the successful transplantation of organs is undoubtedly of particular social interest. However, the increase in patients on waiting lists, as well as the consistent and sometimes frequent mortality of those patients, hoping for an organ that, unfortunately, will not arrive, has caused a health crisis called the “organ shortage”. This severe health emergency requires a deep analysis of the potential reasons for the social ambivalence toward organ donation, particularly in the case of the death of a loved one. The possibility that misinformation and the lack of public knowledge are fundamental barriers to consent requires an analysis of the current educational programs with the aim of improving the awareness of the general population. Negative consent to donation is particularly frequent in cases of the death of a loved one. Considering the significant social importance of consent, mainly in the case of deceased donors, the review of social programs should prioritize all the potential alternatives to improve people’s acknowledgment of the organ shortage crisis. New proposals, which might create further doubt and produce complex reactions at all levels of society, should be presented correctly in transplantation program reviews. Every proposal requires a didactic discussion by experts in social sciences on people’s consent in the case of deceased organ donation.
在当前医学的重大进步中,器官移植的成功无疑具有特殊的社会意义。然而,由于等待器官移植的病人越来越多,而且这些病人在等待器官移植的过程中不断死亡,有时甚至经常死亡,这就造成了被称为 "器官短缺 "的健康危机。这种严重的健康紧急状况要求我们深入分析社会对器官捐赠(尤其是在亲人去世的情况下)态度暧昧的潜在原因。错误信息和公众知识的缺乏可能是阻碍同意捐献的根本原因,因此需要对当前的教育计划进行分析,以提高普通民众的意识。在亲人去世的情况下,不同意捐献的情况尤其常见。考虑到同意捐献(主要是已故捐献者)的重要社会意义,对社会计划的审查应优先考虑所有可能的替代方案,以提高人们对器官短缺危机的认识。新的建议可能会在社会各个层面引起进一步的质疑和复杂的反应,因此应在移植计划审查中正确地加以介绍。每项建议都需要社会科学专家就人们对已故器官捐献的同意问题进行说教式讨论。
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引用次数: 0
Evaluation of the Antimicrobial Potential of Cashew Nut Shell Liquid Extract (Anacardium occidentale) against Enterococcus faecalis Strains 腰果壳液体提取物(西洋柿)对粪肠球菌菌株抗菌潜力的评估
Pub Date : 2023-12-27 DOI: 10.24018/ejmed.2023.5.6.1926
Elaine Bezerra De Oliveira, Vanessa Beatriz Jales Rego, Samara Crislâny Araújo de Sousa, Vitória Freitas de Araújo, Layla Beatriz Barroso de Alencar, Vinícius Rocha Lima Santos, José Lucas Medeiros Torres, Maria Alice Araújo de Medeiros, Millena De Souza Alves, Bernadete Santos, Maria Denise Leite Ferreira, Abrahão Alves de Oliveira Filho
The resistance of microorganisms present in the root canal system is a problem associated with the failure of endodontic treatments. Therefore, the search for treatments based on herbal extracts has been an alternative to prevent persistent endodontic infections. The aim of this in vitro study was to evaluate the antimicrobial potential of cashew nut shell liquid extract (E-CNSL) against Enterococcus faecalis strains. The antimicrobial activity was evaluated using the agar well diffusion method. Petri dishes containing Mueller Hinton agar were inoculated on the surface by the microorganism using a swab, then 20 μL of the E-CNSL solution at concentrations of 500 μg/mL and 1000 μg/mL was aseptically deposited in the wells of the inoculated media. The plates were incubated at 37 °C for 24 hours. All the strains studied showed an inhibition halo ≥6 mm at both concentrations of the extract. Therefore, the extract of cashew nut shell liquid (A. occidentale) showed a potential antimicrobial effect against E. faecalis strains.
根管系统中微生物的抗药性是导致牙髓治疗失败的一个相关问题。因此,寻找以草药提取物为基础的治疗方法已成为预防顽固性牙髓感染的一种替代方法。这项体外研究的目的是评估腰果壳液体提取物(E-CNSL)对粪肠球菌菌株的抗菌潜力。抗菌活性采用琼脂井扩散法进行评估。用拭子将含有穆勒欣顿琼脂的培养皿接种到微生物表面,然后将 20 μL 浓度分别为 500 μg/mL 和 1000 μg/mL 的腰果壳提取物溶液无菌滴入接种培养基的孔中。平板在 37 °C 下培养 24 小时。所研究的所有菌株在两种浓度的提取物中都出现了≥6 mm的抑制晕。因此,腰果壳液(A. occidentale)提取物对粪肠球菌菌株具有潜在的抗菌作用。
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引用次数: 0
Anterolateral Foramen Magnum Meningioma: Case Report and Literature Review 前外侧孔脑膜瘤:病例报告和文献综述
Pub Date : 2023-12-26 DOI: 10.24018/ejmed.2023.5.6.1810
Sadam Tawfik, A. Laaidi, Abdelhamid Jehri, Jihane Limi, Saad Hmada, Abdessamad Naja, A. Lakhdar
Meningiomas are benign tumors dependent on arachnoid cells. Localization to the foramen magnum is rare and represents a surgical challenge. Surgical planning is crucial to choose an optimal approach and to avoid morbidity. We report a case of anterolateral meningioma of the craniocervical junction in a 49-year-old female patient with complaints of progressive weakness of the right arm for the past 6 months. Magnetic resonance imaging showed an extramedullary intradural tumor with dural insertion regarding the body of C1 vertebrae. The patient underwent surgery via suboccipital approach with a C1 laminectomy and a Simpson grade 2 resection was performed. The patient improved postoperatively and returned to her daily activities. We perform a literature review to discuss the considerations for the optimal surgical strategy for the approach of foramen magnum meningiomas.
脑膜瘤是一种依赖于蛛网膜细胞的良性肿瘤。脑膜瘤位于枕骨大孔的情况非常罕见,是一项手术挑战。手术规划对于选择最佳方法和避免发病至关重要。我们报告了一例颅颈交界处前外侧脑膜瘤病例,患者女性,49 岁,主诉过去 6 个月右臂进行性无力。磁共振成像显示该肿瘤为髓外膜内肿瘤,硬膜插入C1椎体。患者接受了枕下入路手术,进行了 C1 椎板切除术和辛普森 2 级切除术。术后患者病情好转,恢复了日常活动。我们进行了文献综述,讨论了枕骨大孔脑膜瘤最佳手术策略的注意事项。
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引用次数: 0
Enormous Myelomeningocele of a Newborn: Case Report and Review of the Literature 新生儿巨大髓母细胞瘤:病例报告和文献综述
Pub Date : 2023-12-26 DOI: 10.24018/ejmed.2023.5.6.1809
Sadam Tawfik, Jihane Limi, A. Laaidi, Salma Lahlou, Abdessamad Naja, Abdelhamid Lakhdar
The myelomeningocele, is a serious pathology with heavy consequences putting at stake the vital prognosis of the child, it is a congenital malformation resulting from a defect of closure of the neural tube. We report the case of a 25 days old newborn, in whom the antenatal diagnosis of myelomeningocele was confirmed by morphological ultrasound. The particularity of our case is the very low age of intervention as the enormous size of the myelomeningocele. Many congenital malformations of the central nervous system can be associated with this pathology going from the malformation of Arnold Chiari to the heterotopia, the discovery of this malformation imposes a complete malformative assessment, and a medical-surgical management. The main postoperative risk is the sepsis which is all the more serious and mortal that the age is young of the child at the time of the intervention.
脊髓膜膨出症是一种严重的病变,其严重后果危及患儿的重要预后,是一种因神经管闭合缺陷而导致的先天性畸形。我们报告的病例是一名出生 25 天的新生儿,经形态学超声检查确诊为髓母细胞瘤。我们这个病例的特殊之处在于干预年龄非常小,而髓鞘膜膨出的体积却非常大。中枢神经系统的许多先天性畸形都可能与这种病变有关,从阿诺德-奇亚里氏畸形到异位畸形,这种畸形的发现要求进行全面的畸形评估和内外科治疗。术后的主要风险是脓毒症,由于干预时患儿年龄较小,脓毒症就显得更加严重和致命。
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引用次数: 0
Pituitary Apoplexy: An Update Review of the Literature 垂体性脑瘫:最新文献综述
Pub Date : 2023-12-25 DOI: 10.24018/ejmed.2023.5.6.1520
R. Momoh
Since its first description more than a century ago, pituitary apoplexy remains a neuroendocrine emergency with significant relevance today. Its early recognition, confirmation and initiation of treatment is important to avert adverse morbidity or mortality. Rare cases of pituitary apoplexy in pregnancy, post-open-heart surgery and complicating a pituitary tuberculoma have been reviewed in the body of this article.
自一个多世纪前首次描述垂体中风以来,垂体中风至今仍是一种具有重要意义的神经内分泌急症。早期识别、确认和开始治疗对避免不良发病率或死亡率非常重要。本文回顾了妊娠期、开颅手术后以及垂体结核瘤并发垂体性脑垂体功能减退的罕见病例。
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引用次数: 0
Telemedicine for Nursing Homes: An Innovative Solution in the Val-de-Marne Region (France) 养老院远程医疗:瓦尔-德-马恩省(法国)的创新解决方案
Pub Date : 2023-12-21 DOI: 10.24018/ejmed.2023.5.6.1965
Issa Dekmak, N. S. ElGerges
Introduction: Telemedicine is an innovative solution that enables the remote care of patients through digital technology. This method is particularly interesting for nursing homes (EHPAD) that accommodate often frail elderly individuals requiring constant medical monitoring. The aim of this thesis is to verify the relevance of telemedicine as a tool for teleconsultation and tele-expertise within nursing homes. Objectives: To determine whether telemedicine can be considered an effective means for teleconsultation and tele-expertise within nursing homes. The secondary objective is to assess the implementation of telemedicine in these establishments, and the skills and obstacles of the caregiving teams regarding the use of telemedicine. Results: Numerous nursing homes lack the necessary equipment and human resources for telemedicine. However, the implementation of a concerted medical project, adequate support, and training, as well as enhanced communication among stakeholders, can promote the development of telemedicine as a tool to improve the quality of care for the elderly in nursing homes. Conclusion: Telemedicine can be a relevant solution for enhancing the medical care of the elderly in nursing homes, but its application is limited by a lack of specialized equipment and human resources. To address these gaps, it is recommended to establish concerted medical projects, improve training and practices, enhance communication among stakeholders, and reconsider logistics. These recommendations could enable better adoption and utilization of telemedicine in nursing homes, thereby benefiting patients, caregivers, and establishment management.
简介远程医疗是一种创新解决方案,可通过数字技术实现对病人的远程护理。这种方法尤其适用于养老院(EHPAD),这些养老院通常收容需要持续医疗监护的体弱老人。本论文旨在验证远程医疗作为养老院远程会诊和远程专家工具的相关性。目标:确定远程医疗是否可被视为疗养院远程会诊和远程专家的有效手段。次要目标是评估远程医疗在这些机构中的实施情况,以及护理团队使用远程医疗的技能和障碍。研究结果许多疗养院缺乏远程医疗所需的设备和人力资源。然而,实施协调一致的医疗项目、提供充足的支持和培训,以及加强利益相关者之间的沟通,可以促进远程医疗的发展,使其成为提高养老院老年人护理质量的一种工具。结论远程医疗可以成为加强疗养院老人医疗护理的相关解决方案,但由于缺乏专业设备和人力资源,其应用受到了限制。为弥补这些不足,建议建立协调一致的医疗项目,改进培训和实践,加强利益相关者之间的沟通,并重新考虑物流问题。这些建议可使养老院更好地采用和利用远程医疗,从而使患者、护理人员和机构管理者受益。
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引用次数: 0
Assessment of Frozen Semen Quality and Conception Rate in Cow 奶牛冷冻精液质量和受孕率评估
Pub Date : 2023-12-21 DOI: 10.34104/ejmhs.023.02440255
This study was conducted in Sadar upazila at Dinajpur district and Ejab Alliance Limited at Thakurgaon district of Bangladesh from March 2017 to February 2018 to investigate the frozen semen quality and conception rate in cow. Total 60 frozen semen straw were collected from six different companies (CCBDF, Ejab, AD, DAIC, Lal-Teer and BRAC) at first week of every month and subsequently up to next ten months. Straw was collected from the dealer of different companies at Upazilla Veterinary Hospital, VTH-HSTU, Dinajpur and Ejab Alliance Limited Breeding Station, Thakurgaon. Then the straw was kept in liquid nitrogen cane and transfer to the laboratory of Ejab Alliance Limited for evaluation. The frozen semen straws were thawed at 35-37˚C for 60 seconds and pooled. The post-thaw motility and morphology of spermatozoa were compared and recorded among different season, preservation time, companies and area. Post-thaw motility and number of normal spermatozoa slightly varied on preservation time. Higher motility and number of normal spermatozoa were 73±0.00 and 83±0.75 found in winter season but lowest in summer season and that was 73±0.40 and 82.2±0.47, respectively. The motility and number of normal spermatozoa of BRAC semen were 75±2.27 and 84±1.77 and the values was higher among other companies with lowest in Lal-Teer which were 72±1.61 and 79±3.52, respectively. The conception rate was statistically higher (p<0.05) in winter (65%) season, 6 months’ storage duration (66%), using BRAC semen (76.5%) and at the area of sadar, Dinajpur (62%). The conception rate was somewhat lower in summer (60%) season, 10 months of duration (62%) using Lal-Teer (53.2%) semen and at the area of Ejab Alliance Ltd. (57%) Thakurgaon.
本研究于2017年3月至2018年2月在孟加拉国迪纳杰布尔县萨达尔乡和塔库尔贡县的Ejab联盟有限公司进行,旨在调查奶牛冷冻精液的质量和受孕率。在每个月的第一周和随后的十个月内,从六家不同的公司(CCBDF、Ejab、AD、DAIC、Lal-Teer 和 BRAC)共收集了 60 份冷冻精液秸秆。秸秆是从迪纳杰布尔的乌帕兹拉兽医医院(Upazilla Veterinary Hospital)、VTH-HSTU 和塔库尔冈的埃贾布联盟有限公司育种站的不同公司的经销商处收集的。然后将秸秆保存在液氮罐中,并转移到 Ejab Alliance Limited 的实验室进行评估。将冷冻的精液秸秆在 35-37˚C 的温度下解冻 60 秒后集中。比较并记录不同季节、保存时间、公司和地区精子的解冻后活力和形态。解冻后精子的活力和正常精子的数量因保存时间而略有不同。冬季正常精子的运动能力和数量较高,分别为 73±0.00 和 83±0.75;夏季正常精子的运动能力和数量最低,分别为 73±0.40 和 82.2±0.47。BRAC精液中正常精子的活力和数量分别为75±2.27和84±1.77,在其他公司中数值较高,最低的是Lal-Teer,分别为72±1.61和79±3.52。据统计,冬季(65%)、贮存 6 个月(66%)、使用 BRAC 精液(76.5%)和迪纳杰布尔萨达尔地区(62%)的受胎率较高(P<0.05)。使用 Lal-Teer 精液(53.2%)的夏季(60%)、10 个月存期(62%)和 Ejab Alliance Ltd. (57%)Thakurga 地区的受孕率略低。(Thakurgaon地区(57%)。
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引用次数: 0
Assessing Pancytopenia in Leukemia Patients through flow Cytometry and ELISA to Evaluate the Complete Blood Counts and Cluster of Differentiation Markers 通过流式细胞术和酶联免疫吸附法评估白血病患者的全血细胞减少症和分化标志物群
Pub Date : 2023-12-17 DOI: 10.34104/ejmhs.023.02370243
To diagnose cases involving pancytopenia or leukopenia, a comprehensive assessment of various factors is necessary, including blood count, peripheral blood, and bone marrow analysis, immunophenotyping, and cytogenetics. This study aims to examine the complete blood count parameters and CD markers in Sudanese patients with leukemia and pancytopenia, utilizing flow cytometry and ELISA techniques. This study is a laboratory-based addressing the assessment of the target population (acute Leukaemia with pancytopenia) by complete blood count, flow cytometry, and ELISA techniques. The research group was comprised of patients who were diagnosed with acute leukemia and had pancytopenia before undergoing treatment. Another group of patients with acute leukemia but without pancytopenia was also included. In addition, there was a control group consisting of healthy individuals who volunteered for the study. Essentially, the control group was made up of healthy individuals who were not affected by acute leukemia or pancytopenia. In our study, we enrolled a total of 150 participants, comprising three groups: 50 cases of acute leukemia, 50 patients with acute leukemia who subsequently developed pancytopenia, and 50 healthy volunteers. The majority of participants were female, constituting 56% of the sample (84 individuals), while the most prevalent age group represented was individuals aged 65, accounting for 43.3% of the participants. Our analysis revealed a statistically significant correlation between age and both leukemia and leukemia with pancytopenia, with a p-value of 0.00. Furthermore, the presence of either AML or ALL also exhibited a substantial association with the disease, indicated by a p-value of 0.00. Specifically, the use of a flow cytometer allowed us to identify the presence of CD3 with a p-value of 0.00 and CD4 with a slightly higher p-value of 0.04. Improvement of patient management by introducing effective tools for predicting prognosis is the key to success in managing diseases. We recommend that flowcytometry be used routinely to diagnose leukemia and leukemia with cytopenia in patients at all stages of the disease.
要诊断全血细胞减少症或白细胞减少症,必须对各种因素进行综合评估,包括血细胞计数、外周血和骨髓分析、免疫分型和细胞遗传学。本研究旨在利用流式细胞术和 ELISA 技术,检查苏丹白血病和全血细胞减少症患者的全血细胞计数参数和 CD 标记物。该研究以实验室为基础,通过全血细胞计数、流式细胞术和 ELISA 技术对目标人群(急性白血病合并全血细胞减少症)进行评估。研究组由被诊断为急性白血病且在接受治疗前患有全血细胞减少症的患者组成。另一组是患有急性白血病但没有泛血细胞减少的患者。此外,还有一个由自愿参加研究的健康人组成的对照组。基本上,对照组由未患急性白血病或泛血细胞减少症的健康人组成。在我们的研究中,我们共招募了 150 名参与者,包括三组:50 个急性白血病病例、50 个急性白血病患者(随后发展为全血细胞减少症)和 50 个健康志愿者。大多数参与者为女性,占样本的 56%(84 人),而 65 岁是最普遍的年龄组,占参与者的 43.3%。我们的分析表明,年龄与白血病和白血病伴全血细胞减少症之间存在统计学意义上的显著相关性,P 值为 0.00。此外,急性髓细胞性白血病或全血白血病也与该疾病有很大关系,P 值为 0.00。具体来说,使用流式细胞仪可以识别 CD3 的存在,p 值为 0.00;CD4 的存在,p 值稍高,为 0.04。通过引入预测预后的有效工具来改善患者管理是成功管理疾病的关键。我们建议将流式细胞术常规用于诊断处于疾病各个阶段的白血病和伴有全血细胞减少的白血病患者。
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引用次数: 0
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