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Efficacy of Phloroglucinol Tamsulosin Combination Therapy for Medical Expulsion of Lower Ureteral Calculi and Influence on Patients’ Cys-C Level 间苯三酚-坦索罗辛联合治疗输尿管下段结石药物排出的疗效及对患者Cys-C水平的影响
Pub Date : 2021-04-16 DOI: 10.11648/J.AJCEM.20210901.14
Yutong Li, B. Pan, Guo Chen, Ying Wu
Objective: Phloroglucinol is a myotropic, non-atropine and non-papaverine smooth muscle antispasmodic which directly acts on the smooth muscles of the gastrointestinal tract and the urogenital tract with no anticholinergic effect, no symptoms like xerostomia, visual impairment, dysuria, hypotension, increased heart rate, and arrhythmia etc. To investigate the efficacy of phloroglucinol tamsulosin combination therapy for medical expulsion of lower ureteral calculi and influence on patients’ Cys-C level. Methods: Equally randomized 136 patients with lower ureteral calculi in our hospital into mono therapy group (phloroglucinol alone) and combination therapy group (additional tamsulosin was advised). The expulsion rate, expulsion time, stone diameter and levels of IL-10, CRP, NGAL, Cys-C, KIM-1 were compared between two groups, also with the effectiveness and the rate of adverse reactions. Results: The combination therapy group showed higher expulsion rate (P<0.05) and shorter expulsion time (P<0.05) than that of the mono therapy group and the stone diameter was slightly larger as well (P<0.05). Also, patients under combination treatment had elevated IL-10, CRP, NGAL, Cys-C and KIM-1 levels and a better overall response rate (P<0.05) while it was associated with a slightly higher rate of adverse reactions (P>0.05). Conclusions: Phloroglucinol tamsulosin combination therapy had clear advantages on medical expulsion of lower ureteral calculi in respect of higher expulsion rate and elevated IL-10, CRP, NGAL, Cys-C and KIM-1 levels with larger stone diameter in a shorter time.
目的:间苯三酚是一种肌促性、非阿托品、非罂粟碱的平滑肌止痉药,直接作用于胃肠道和泌尿生殖道平滑肌,无抗胆碱能作用,无口干、视力障碍、排尿困难、低血压、心率加快、心律失常等症状。目的探讨间苯三酚-坦索罗辛联合治疗输尿管下段结石药物排出的疗效及对患者Cys-C水平的影响。方法:我院输尿管下段结石患者136例,随机分为单药治疗组(单用间苯三酚)和联合治疗组(加用坦索罗辛)。比较两组患者排尿率、排尿时间、结石直径及IL-10、CRP、NGAL、Cys-C、KIM-1水平,以及疗效和不良反应发生率。结果:联合治疗组排痰率明显高于对照组(P0.05)。结论:间苯三酚- tamsulosin联合治疗输尿管下段结石医学排出优势明显,排出率较高,结石直径较大,IL-10、CRP、NGAL、Cys-C、KIM-1水平在较短时间内升高。
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引用次数: 0
Infection Control Impact on Patient with Tuberculosis Chroretinitis in KSA Hospital Based Analysis KSA医院结核性视网膜炎患者感染控制效果分析
Pub Date : 2021-02-25 DOI: 10.54730/abm.2021.030104
Mohammed Ahmed Garout, Emad Emad Algahdaly, Magda Ramadan Abdultawab, Rana Mohammed Garout, Raha Mohammed Garout
Tuberculosis (TB) is an infectious disease responsible for significant morbidity and mortality worldwide. WHO estimates that one third of the world’s population is currently infected, with 9 million new cases occurring annually, leading to 3 million deaths per year, the disease affects the ocular anterior segment, the posterior segment, and adnexa. , The intraocular manifestations of TB include “mutton fat” keratic precipitates, posterior synechiae, vitreous snowballs, snow banking, retinal vasculitis, choroiditis, serpiginous-like choroiditis, and panuveitis] A definitive diagnosis of intraocular TB requires culture data, and direct demonstration of Mycobacterium tuberculosis in smears and via polymerase chain reaction (PCR) of intraocular fluid, The purpose of this study is to describe the ocular manifestations, diagnosis and treatment of tuberculosis and to emphasize the fact that ocular tuberculosis may occur in the absence of systemic clinical activity and may mimic several clinical entities The current study is an observational consecutive case series of patients diagnosed with intraocular tuberculosis managed at a hospital. Study the prevalence of ocular TB in cross section eye care center Magrabi hospital Jeddah, KSA, from June 1, 2013 to December 31, 2015. diagnosis of ocular TB is often presumed in the presence of suggestive ocular findings in combination with any of the following: Systemic findings consistent with TB infection, Positive interferon gamma release assay, Positive tuberculin skin test in asymptomatic individuals, Acid-fast bacilli (AFB) on direct smear or culture of MTB from ocular samples, Polymerase chain reaction (PCR), Fluorescein angiography (FA), RESULTS: 86 of 2542 patients for examination of retina in retina clinic were diagnosed as suspected tuberculosis chroretinitis, 20 percent of them had conformed diagnosed as TB. out Of 86, 24 (27.9%) had at least one episode of oculacomplaints, 7 patients were conformed with PCR. CONCLUSION: The diagnosis of presumed ocular tuberculosis remains a clinical challenge, although interferon-γ release assays they currently lack the specificity to distinguish between latent tuberculosis infection and active tuberculosis. molecular diagnostic PCR may be valuable in our ability to establish an earlier etiologic diagnosis and institute appropriate antimycobacterial therapy and ensure from implementation of infection control measurements.
结核病(TB)是一种传染性疾病,在世界范围内造成了严重的发病率和死亡率。世卫组织估计,目前世界上有三分之一的人口受到感染,每年有900万新病例发生,每年导致300万人死亡,这种疾病影响眼球前段、后段和附件。【TB的眼内表现包括“羊脂肪”角状沉淀、后粘连、玻璃体雪球、雪堆、视网膜血管炎、脉络膜炎、丝状样脉络膜炎和全葡萄膜炎】眼内结核的明确诊断需要培养数据,并通过涂片和眼内液的聚合酶链反应(PCR)直接证实结核分枝杆菌,本研究的目的是描述眼部表现。并强调眼结核可能在缺乏系统性临床活动的情况下发生,并可能模仿几种临床实体。目前的研究是对在一家医院管理的诊断为眼内结核的患者的连续观察性病例系列。对2013年6月1日至2015年12月31日沙特吉达Magrabi医院横截面眼保健中心眼结核患病率进行研究。眼部结核的诊断通常是在伴有以下任何提示性眼部检查的情况下进行的:与结核感染一致的全身检查,干扰素γ释放试验阳性,无症状个体结核菌素皮肤试验阳性,眼部样本直接涂片或培养MTB时发现抗酸杆菌(AFB),聚合酶链反应(PCR),荧光素血管造影(FA),结果:在视网膜门诊2542例视网膜检查患者中,86例诊断为疑似结核性视网膜炎,其中20%确诊为结核。在86例患者中,24例(27.9%)至少有一次眼部不适,其中7例符合PCR。结论:眼结核的诊断仍然是一个临床挑战,尽管干扰素γ释放检测目前缺乏区分潜伏性结核感染和活动性结核的特异性。分子诊断PCR可能在我们建立早期病原学诊断和制定适当的抗细菌治疗以及确保感染控制措施的实施方面具有价值。
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引用次数: 0
The Philosophicum-Model Project of Philosophy of Medicine in Medical Education and Practice in Germany Perspective Article 德国医学教育与实践中的哲学-医学哲学模式项目透视文章
Pub Date : 2021-02-25 DOI: 10.54730/abm.2021.030101
Jonas Daub, Hans Christoph Aster, Hannah Gauger, Till Gallasch, Michael Schmidt, Johann Heinrich Koenigshausen, T. Bohrer
Medical and philosophical thinking belong together, cannot be separated neither in scientific theory nor in practice, and only the symbiosis of both can face the challange to reflect the basic phenomenon of both of these desiciplines: human life itself. No patient expects to be treated exclusively on the basis of the latest scientific results, but also wants to be perceived by his doctor as an unique individual. It is the doctor’s specific task to embed the scientifically developed diagnoses therapeutically into each individual patient’s biography. Furthermore such a perspecitve increases patient safety and it enables a future of trust in the doctor-patient relationship. The „Philosophicum“ is a model project in Germany that brings together philosophers, physicians and students to do research and education in the broad and enriching intersection of medicine and philosophy. Based on many years of experience, we are convinced that a structured philosophical education can substantially improve medical studies and subsequently doctors‘ work. Medical anthropology and hermeneutics are necessary and also teachable. The preparation should start early in the medical education and should be strengthened by bedside training while interacting with the patient. This requires philosophically interested and trained doctors and students. Exactely for that reason we favor integrating a philosophicum into the medical eduacation and practice.
医学和哲学思想是相辅相成的,无论是在科学理论还是在实践中都是不可分割的,只有两者的共生才能面对反映这两个学科的基本现象的挑战:人的生命本身。没有病人希望自己的治疗完全基于最新的科学成果,但也希望被医生视为一个独特的个体。医生的特殊任务是将科学发展的诊断以治疗的方式嵌入到每个病人的传记中。此外,这样的观点增加了患者的安全,并使未来的信任医患关系。“哲学”是德国的一个模范项目,它将哲学家、医生和学生聚集在一起,在医学和哲学的广泛而丰富的交叉领域进行研究和教育。根据多年的经验,我们相信,有组织的哲学教育可以大大改善医学研究,进而改善医生的工作。医学人类学和解释学是必要的,也是可教的。准备工作应在医学教育早期开始,并应在与患者互动时通过床边培训加强。这需要对哲学感兴趣并受过训练的医生和学生。正是由于这个原因,我们赞成将哲学融入医学教育和实践。
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引用次数: 0
Central Diabetes Insipidus in a Patient with Stiff Person Syndrome 中枢性尿崩症伴僵硬人综合征1例
Pub Date : 2020-08-26 DOI: 10.54730/abm.2020.020404
Fatima Zarzour, Abir Bou Khalil, B. Khalil
Background: Central diabetes insipidus (CDI) is a rare hypothalamic-pituitary disease due to the deficiency of arginine vasopressin (AVP) synthesis of which more than one third of etiologies are unidentified. Autoimmunity is associated with one third of patients with apparently idiopathic CDI. The most common antibody detected in auto immune CDI is autoantibodies to AVP-secreting cells (AVPcAb). Stiff-person syndrome (SPS) is a rare neurological disorder with features of an autoimmune disease. It is characterized by fluctuating muscle rigidity in the trunk and limbs and a heightened sensitivity to stimuli. It is well known that SPS is associated with multiple auto immune endocrinopathy including auto immune diabetes and auto immune thyroid disease. The association between SPS and CDI is not well documented in the literature. Case information: We report a case of 51 year old female who developed CDI while being treated for SPS unmasked by high dose steroids. Result: Anti amphiphysin is the only antibody detected in our patient. Animal studies showed a high expression of amphiphysin in anterior and posterior pituitary gland, data in human are still vague .One theory is that anti-amphiphysin antibodies attack the amphiphysin molecules in the AVP secreting cells and inhibit release of AVP. Conclusion: This antibody could hint towards the autoimmune cause of CDI.
背景:中枢性尿囊症(CDI)是一种罕见的下丘脑-垂体疾病,由于精氨酸加压素(AVP)合成不足,超过三分之一的病因不明。自身免疫与三分之一的明显特发性CDI患者有关。在自身免疫性CDI中检测到的最常见抗体是avp分泌细胞自身抗体(AVPcAb)。僵硬人综合征(SPS)是一种罕见的神经系统疾病,具有自身免疫性疾病的特征。它的特点是躯干和四肢肌肉僵硬波动,对刺激高度敏感。众所周知,SPS与多种自身免疫性内分泌疾病有关,包括自身免疫性糖尿病和自身免疫性甲状腺疾病。SPS和CDI之间的关系在文献中没有很好的记录。病例信息:我们报告一例51岁女性在接受高剂量类固醇治疗SPS时发展为CDI。结果:抗amphiphysin是本例患者唯一检测到的抗体。动物实验表明,amphiphysin在垂体前叶和垂体后叶中高表达,在人体内的数据尚不清楚。一种理论认为,抗amphiphysin抗体攻击AVP分泌细胞中的amphiphysin分子,抑制AVP的释放。结论:该抗体可能提示CDI的自身免疫性病因。
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引用次数: 0
Degree of Control and Main Complications of Hyperthyroid Pregnant Women in a Real Life Experience with Methimazol 甲巯咪唑对甲亢孕妇控制程度及主要并发症的影响
Pub Date : 2020-06-26 DOI: 10.54730/abm.2020.020305
Díaz Arizmendi Diana Elizabeth, Mendieta Zerón Hugo
Hyperthyroidism is one of the main endocrinopathies during pregnancy. The aim of this project was to identify the degree of control of hyperthyroid pregnant women based on the recommendations of the American Thyroid Association (ATA) in a real situation without the availability of propylthiouracil. This was a descriptive, retrospective and longitudinal study, including medical files of pregnant women with hyperthyroidism between 18 and 35 years. They were classified as having "Adequate" control if their thyroid profiles were within the recommendations of the ATA and had no adrenergic symptoms; and were categorized as having "Inadequate" control if they were not stabilized with monotherapy, or if they required high doses of antithyroid drugs or beta-blockers or showed serious complications including the need of an Intensive Care Unit (ICU) for mothers or neonates. The Chi square test was performed between treatment groups during the third trimester and the complications of pregnant women or neonates. A total of 173 hyperthyroid pregnant women were studied with an average age of 21 ± 4.7 years. Of the 33 patients with hyperthyroidism who received monotherapy with methimazole until the end of pregnancy, 23 (69.69%) were classified as having "Adequate" control. In a real life situation there is delay in the diagnosis of hyperthyroidism during pregnancy but even without propylthiuracil, an “Adequate” control can be reached in up to 20.53% of cases based on a methimazole monotherapy.
甲状腺功能亢进是妊娠期主要的内分泌疾病之一。该项目的目的是根据美国甲状腺协会(ATA)的建议,在没有丙硫脲嘧啶可用的实际情况下确定甲状腺功能亢进孕妇的控制程度。这是一项描述性、回顾性和纵向研究,包括18至35岁甲状腺功能亢进孕妇的医疗档案。如果他们的甲状腺特征在ATA的建议范围内并且没有肾上腺素能症状,他们被归类为“充分”控制;如果单药治疗不能稳定,或者需要大剂量的抗甲状腺药物或受体阻滞剂,或者出现严重的并发症,包括需要母亲或新生儿的重症监护病房(ICU),则被归类为“控制不足”。在妊娠晚期治疗组与孕妇或新生儿并发症之间进行卡方检验。173例甲状腺功能亢进孕妇,平均年龄21±4.7岁。33例甲亢患者在妊娠结束前接受甲巯咪唑单药治疗,其中23例(69.69%)被归为“充分”控制。在现实生活中,妊娠期间甲状腺功能亢进症的诊断有延迟,但即使没有丙基硫脲嘧啶,在甲巯咪唑单药治疗的病例中,也可以达到20.53%的“充分”控制。
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引用次数: 0
The Relationship Between Resting Heart Rate and Age in Adult Nigerians 尼日利亚成年人静息心率与年龄的关系
Pub Date : 2019-12-26 DOI: 10.54730/abm.2019.010504
Oko-Jaja Richard I., Shamsuddin Chowdhry Pracha, Omair A. Mohiuddin
Background: Resting heart rate is related to cardiovascular mortality as well as to all-cause mortality. It is therefore important to know whether resting heart rate changes with age in adults. The aim of this study was to determine the relationship between heart rate and age in adult Nigerians. Methods: It was a retrospective study on adult Nigerians attending a University Teaching Hospital in Nigeria. All the needed data were retrieved from the medical records. Heart rate was calculated from the electrocardiogram and correlated with age. Results: There were 99 cases aged between 20 and 54 years and comprised of 60 males and 39 females. The mean heart rate was 73.40±13.16 beats/minute. Across the various decades, the mean heart rate in beats per minute was 73.46±10.70 in the third decade, 75.52±12.16 in the fourth decade, 72.38±13.91 in the fifth decade, and 71.60±18.77 in the sixth decade of life (p=0.770). Heart rate correlated negatively and weakly with age (r=- 0.034, p=0.736). There were more cases of sinus bradycardia than sinus tachycardia, but the proportion of cases with heart rate outside 60 beats per minute to 100 beats per minute was small. Conclusion: This study showed that resting heart rate did not change with age in young adult and middle-aged Nigerians who had no clinical evidence of heart disease. A greater proportion of them were in normal sinus rhythm.
背景:静息心率与心血管死亡率和全因死亡率有关。因此,了解成人静息心率是否随年龄变化是很重要的。这项研究的目的是确定尼日利亚成年人的心率和年龄之间的关系。方法:对在尼日利亚某大学教学医院就诊的尼日利亚成年患者进行回顾性研究。从医疗记录中检索到所有需要的数据。心率由心电图计算,并与年龄相关。结果:99例患者,年龄20 ~ 54岁,男60例,女39例。平均心率为73.40±13.16次/分钟。各年龄层的平均心率(次/分)第三个10年为73.46±10.70次,第四个10年为75.52±12.16次,第五个10年为72.38±13.91次,第六个10年为71.60±18.77次(p=0.770)。心率与年龄呈弱负相关(r=- 0.034, p=0.736)。窦性心动过缓多于窦性心动过速,但心率在60 ~ 100次/分之间的比例较小。结论:本研究表明,在没有心脏病临床证据的尼日利亚年轻人和中年人中,静息心率不随年龄变化。大部分患者窦性心律正常。
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引用次数: 0
Contribution of Scanner in the Breast Cancer Extension Assessment in the Radiology Department of CNHU-HKM in Benin 扫描仪在贝宁CNHU-HKM放射科乳腺癌扩展评估中的贡献
Pub Date : 2019-10-26 DOI: 10.54730/abm.2019.010403
Yekpe Ahouansou Patricia, Adjadohoun Sonia, Lokossou Symphorose, Ngamo Gabriel, Lokossou Andreas, Kiki Miralda, Akanni Djivèdé, Biaou Olivier
Objective: Breast cancer is the most common female cancer in the world. The prognosis depends on whether metastasis is present or not. The objective of this study was to provide an overview of the CT scan aspects identified during the evaluation of breast cancer extension in the Radiology department of the Teaching University Hospital of Hubert Koutoukou Maga (CNHU-HKM) in Cotonou in Benin. Materials and methods: It was a descriptive study with retrospective collection, conducted from January 1, 2018 to January 31, 2019 (13 months), in the Radiology department of CNHU-HKM. It focused on patients referred for a chest-abdominal-pelvic computed tomography (PET) scan, as part of an extension assessment for breast cancer. Results: During the period of the study, 40 chest-abdominal-pelvic CT scans were compiled, of which 38 (95%) were women and 02 men (5%), and among which 23 were metastatic, accountings for a prevalence of 57.5%. The average age was 51.22±16.33 with extremes of 30 and 83 years old. Among our patients, 32 (80%) had undergone a CT scan for an initial diagnostic of extension assessment, and 08 (20%) for the therapeutic response assessment. According to the TNM classification, T4 tumors accounted for 27.5% (11 cases). Lymph node involvement was found in 18 cases (43.90%), accounting for 12 (30%) of N1 and 6 (15%) of N3. The most commonly found metastatic sites were the lung in 25% followed by the pleura and the liver with equal percentages (10%). The metastases CT scan aspect was typically a carcinomatous lymphangitis appearance; fluid pleural effusions; hypodenses, hypovascular nodules hepatics; osteolytic or mixed bone damage and peritoneum, especially fluid effusion associated with peritoneal nodules. Conclusion: The frequency of breast cancer metastases is high in Benin. The most commonly found metastatic sites on scanner in descending order are the lungs, liver and bones.
目的:乳腺癌是世界上最常见的女性癌症。预后取决于是否存在转移。本研究的目的是概述在贝宁科托努Hubert Koutoukou Maga教学大学医院(CNHU-HKM)放射科评估乳腺癌扩展时确定的CT扫描方面。材料和方法:回顾性收集描述性研究,于2018年1月1日至2019年1月31日(13个月)在CNHU-HKM放射科进行。该研究的重点是接受胸腹盆腔计算机断层扫描(PET)的患者,作为乳腺癌扩展评估的一部分。结果:研究期间共收集胸腹盆腔CT扫描40例,其中女性38例(95%),男性02例(5%),其中转移性23例,占57.5%。平均年龄为51.22±16.33岁,极端年龄为30岁和83岁。在我们的患者中,32例(80%)进行了CT扫描以进行扩展评估的初步诊断,08例(20%)进行了治疗反应评估。按TNM分类,T4肿瘤占27.5%(11例)。淋巴结累及18例(43.90%),其中N1 12例(30%),N3 6例(15%)。最常见的转移部位是肺(25%),其次是胸膜和肝脏(10%)。转移性CT扫描表现为典型的癌性淋巴管炎;胸腔积液;低密度,低血管性结节性肝炎;腹膜溶骨性或混合性骨损伤,尤指伴有腹膜结节的液体渗出。结论:贝宁地区乳腺癌转移率高。扫描仪上最常见的转移部位由大到小依次是肺、肝和骨。
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引用次数: 0
Risk Factors and Impact of Diagnostic Delay in Patients with Inflammatory Bowel Disease in Bangladesh 孟加拉国炎症性肠病患者诊断延迟的危险因素和影响
Pub Date : 2019-10-26 DOI: 10.54730/abm.2019.010404
Chanchal Kumar Ghosh, S. M. Ali Hasan, Md Abdur Rahim Miah
Background and Aims: A delay in the diagnosis of inflammatory bowel disease (IBD) is a risk of developing complications and surgery. This study was done to evaluate the factors and impact of diagnostic delay on IBD patients in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Gastroenterology of a tertiary care center in Bangladesh. Diagnostic delay was defined as the period from symptom onset to diagnosis of IBD. Results: Of the total 112 IBD patients 50 (44.6%) had Crohn’s disease CD and 62 (55.4%) had ulcerative colitis (UC). Males (67.9%) were predominant in the study. The median diagnostic delay was longer for patients with CD compared with patients with UC (median 24 versus 12 months; P-value 0.025). Rectal bleeding as presenting feature and male gender were negatively and positively associated with the longer diagnostic delay of IBD respectively (P-value <0.05). Of the patients with CD 14 (28%) had a history of IBD-related surgery and 7 (14%) had a history of perianal fistula. The presence of intestinal strictures, surgery, and perianal fistula at the time of diagnosis was significantly associated with long diagnostic delay for CD. Conclusion: Absence of rectal bleeding as presenting symptoms and also the male gender were the significant factors related to the longer diagnostic delay of IBD in our study. Long diagnostic delay is associated with an increased rate of complications in IBD, especially in CD.
背景和目的:炎症性肠病(IBD)的诊断延迟是发生并发症和手术的风险。本研究旨在评估孟加拉国IBD患者诊断延迟的因素和影响。方法:这项横断面研究是在孟加拉国三级保健中心的消化内科进行的。诊断延迟定义为从症状出现到诊断IBD的时间。结果:112例IBD患者中有50例(44.6%)合并克罗恩病,62例(55.4%)合并溃疡性结肠炎(UC)。男性占67.9%。与UC患者相比,CD患者的中位诊断延迟时间更长(中位24个月对12个月;假定值0.025)。直肠出血为表现特征,男性与IBD诊断延迟时间较长呈负相关,男性与IBD诊断延迟时间较长呈正相关(p值<0.05)。CD患者中有14例(28%)有ibd相关手术史,7例(14%)有肛周瘘史。诊断时存在肠狭窄、手术和肛周瘘与CD诊断延迟较长时间显著相关。结论:在我们的研究中,没有直肠出血作为表现症状以及男性是IBD诊断延迟较长时间的重要因素。长时间的诊断延迟与IBD的并发症发生率增加有关,特别是在CD中。
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引用次数: 0
The Lag Time of Diagnosis of Axial Spondyloarthritis: A Bangladesh Perspective 诊断轴型脊椎关节炎的滞后时间:孟加拉国的观点
Pub Date : 2019-10-26 DOI: 10.54730/abm.2019.010405
Abu Tahir Muhammad Tanveer Has, M. Abdul Alim
Background & Objective: The lag time of diagnosis of axial spondyloarthrits varies from country to country. The aim of this study was to find out the lag time of diagnosis of axial spondyloarthritis in Bangladesh based on the patients visiting the morning Rheumatology OPD of a tertiary-care hospital. Materials & Methods: This study was conducted in the Department of Rheumatology of Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from October, 2018 to December, 2019. Ninety six patients with axial spondyloarthritis were recruited and they were enquired about their ages, places of residence, educational qualifications and duration of axial pain as well as peripheral pain. The participants also underwent estimation of ESR by Westergren method. Results: Mean age of the participants was 39.98 years. The mean and median lag times of diagnosis were 58.17 and 36 months respectively. The lag time of diagnosis followed a nonnormal (right-skewed) distribution. There was no significant difference between males and females (p≈0.921), between rural and urban participants (p≈0.221), between those with and without peripheral involvement (p≈0.387) as well as between those with and without elevated ESR according to Mann-Whitney U test. But the median lag time in those who were highly educated, ie. those who completed at least a bachelor degree was significantly (p≈0.016) shorter than that in those who were not highly educated. Conclusion: There is a considerable median delay in the diagnosis of axial spondyloarthritis in Bangladesh. Further research is required to identify the factors contributing to the delay so that those can be addressed to shorten the lag time.
背景与目的:各国对轴型颈椎病的诊断滞后时间不同。本研究的目的是通过对孟加拉国某三级医院风湿病科门诊上午就诊的患者进行分析,找出诊断轴型脊柱炎的滞后时间。材料与方法:本研究于2018年10月至2019年12月在孟加拉国达卡Savar的伊纳姆医学院和医院风湿病学系进行。收集96例轴性脊柱炎患者,询问其年龄、居住地、学历、轴性疼痛及周围性疼痛持续时间。用Westergren法估计ESR。结果:参与者平均年龄39.98岁。平均诊断滞后时间58.17个月,中位诊断滞后时间36个月。诊断滞后时间呈非正态(右偏)分布。根据Mann-Whitney U检验,男性和女性之间(p≈0.921)、农村和城市参与者之间(p≈0.221)、有无外周受累者之间(p≈0.387)以及有无ESR升高者之间无显著差异。但是中位数滞后时间出现在那些受过高等教育的人身上。那些至少完成了学士学位的人比那些没有受过高等教育的人明显(p≈0.016)短。结论:在孟加拉国,轴性脊柱炎的诊断有相当大的中位延迟。需要进一步的研究来确定造成延迟的因素,以便能够解决这些问题以缩短延迟时间。
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引用次数: 0
The Obstinate Refractory and Resistance Hypertension 顽固性、难治性高血压
Pub Date : 2019-06-26 DOI: 10.54730/abm.2019.010202
Raj Kamal Choudhry, Amrendra Kumar Singh
Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.
顽固性高血压(RHTN)相对常见,估计在接受治疗的高血压患者中患病率为10-20%。它的定义是血压(BP) >140/90 mmHg,在耐受的情况下,接受≥3种抗高血压药物治疗,包括利尿剂。难治性高血压是严重降压治疗失败的一种新表型。提出的难治性高血压的定义,即血压>140/90 mmHg,并使用≥5种不同的降压药物,包括利尿剂和矿皮质激素受体拮抗剂(MRA),一直应用不一致。与RHTN相比,难治性高血压似乎没有RHTN那么普遍。本文综述了目前关于这种新表型与RHTN的相关知识,包括定义、流行、机制、特征和合并症,包括心血管风险。在RHTN患者中,过量的液体潴留被认为是RHTN发展的常见机制。最近,有证据表明,难治性高血压可能更多的是神经源性病因,由于交感神经活动增加,而不是过多的液体潴留。RHTN的治疗建议通常基于利尿剂的使用和加强,特别是长效噻嗪类利尿剂和MRA的联合使用。根据现有的研究结果,这种方法似乎不是控制难治性高血压患者血压和有效交感神经抑制的成功策略,可能需要药物和/或基于设备的方法。
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Advanced Biomedicine
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