Myriam Boueri, Marita Saliba, Joe Haydamous, Maria Pia Amanzo Vargas, Yaser Hamam, Rana Al Ashkar, Sophie Nicolas Moujally, Shahzaib Maqbool, Hala El Bab, Ali Mourad, Obey Albaini
Background: The role of assisted reproductive technologies, including in-vitro fertilization [IVF], is increasing daily because of the significant rise in subfertility cases. Among women, the most observed causes of infertility are primary ovarian insufficiency and premature ovarian failure, accounting for 25% of cases, followed by tubal damage (20%) and uterine abnormalities (10%), all contributing to the increase in IVF cases among couples. The success of IVF depends on various factors; however, the role of oocyte quality and maturation level is considered a pivotal cardinal factor for the success rates of IVF. Methods: A thorough literature analysis was performed using the following search terms: “Oocyte Quality” and “IVF cycle.” The databases searched included PubMed, Google Scholar, MEDLINE, Cochrane Library, and ResearchGate. Discussion: IVF success rates especially depend on oocyte quality and level of maturation. Several factors affecting these two factors include obesity, which increases O2 and H2O2 levels resulting in elevated endoplasmic reticulum [ER] stress; Polycystic Ovary Syndrome [PCOS]; age; endometriosis; cyclic nucleotides used in IVF; thalassemia major which is associated with lower ovarian reserve and increased redox activity malignancies, and anti-neoplastic drugs, which may contribute to premature ovarian insufficiency. Various treatment options were proposed to improve oocyte quality and maturation level, including growth hormone [GH] supplementation alongside ovarian supplementation, autologous mitochondrial transfer, luteal phase ovarian stimulation, administration of MI-Melatonin-Vitamin D3, Duphaston, and putrescine supplementation. Conclusion: With the rising number of subfertility cases, the importance of Assisted Reproductive Technologies [ART] is growing. The success rate of IVF on oocyte quality and level of maturation level, and few with several factors affecting these. Though numerous treatment options have been proposed to enhance oocyte quality and maturation, not all have been deemed beneficial.
{"title":"The Major Factors Affecting Oocyte Quality in IVF Cycles: A Narrative Review","authors":"Myriam Boueri, Marita Saliba, Joe Haydamous, Maria Pia Amanzo Vargas, Yaser Hamam, Rana Al Ashkar, Sophie Nicolas Moujally, Shahzaib Maqbool, Hala El Bab, Ali Mourad, Obey Albaini","doi":"10.38179/ijcr.v3i1.277","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.277","url":null,"abstract":"Background: The role of assisted reproductive technologies, including in-vitro fertilization [IVF], is increasing daily because of the significant rise in subfertility cases. Among women, the most observed causes of infertility are primary ovarian insufficiency and premature ovarian failure, accounting for 25% of cases, followed by tubal damage (20%) and uterine abnormalities (10%), all contributing to the increase in IVF cases among couples. The success of IVF depends on various factors; however, the role of oocyte quality and maturation level is considered a pivotal cardinal factor for the success rates of IVF. Methods: A thorough literature analysis was performed using the following search terms: “Oocyte Quality” and “IVF cycle.” The databases searched included PubMed, Google Scholar, MEDLINE, Cochrane Library, and ResearchGate. Discussion: IVF success rates especially depend on oocyte quality and level of maturation. Several factors affecting these two factors include obesity, which increases O2 and H2O2 levels resulting in elevated endoplasmic reticulum [ER] stress; Polycystic Ovary Syndrome [PCOS]; age; endometriosis; cyclic nucleotides used in IVF; thalassemia major which is associated with lower ovarian reserve and increased redox activity malignancies, and anti-neoplastic drugs, which may contribute to premature ovarian insufficiency. Various treatment options were proposed to improve oocyte quality and maturation level, including growth hormone [GH] supplementation alongside ovarian supplementation, autologous mitochondrial transfer, luteal phase ovarian stimulation, administration of MI-Melatonin-Vitamin D3, Duphaston, and putrescine supplementation. Conclusion: With the rising number of subfertility cases, the importance of Assisted Reproductive Technologies [ART] is growing. The success rate of IVF on oocyte quality and level of maturation level, and few with several factors affecting these. Though numerous treatment options have been proposed to enhance oocyte quality and maturation, not all have been deemed beneficial.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136113474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Necrotizing fasciitis is a severe, life-threatening infection that can be fatal and rapidly progressive. It is usually caused by polymicrobial infection, monomicrobial infection by group-B streptococci (GBS) or staphylococci, or by anaerobes like Clostridium difficile that presents as a gas gangrene or rarely by fungi. Fungal infections, though found in diabetic foot ulcers, remain extremely rare agents in necrotizing fasciitis, often causing severe morbidity and higher mortality than regular bacterial infections. Though severe, these infections are not often late to diagnose and very few reports exist citing their presence. With our case report, we present another rare manifestation of Mucormycosis in a foot wound. Case Report: We present a 57-year-old diabetic male patient who presented with a rapidly progressing very painful right foot ulcer, with high-grade fever and fatigue that did not respond to surgical intervention and treatment with broad-spectrum antibiotics. Mucormycosis species were identified in wound cultures. The patient then underwent an amputation and was treated with liposomal Amphotericin B. Conclusion: This report aims to further highlight that virulent fungal infections, especially mucormycosis, should be considered when suspecting or diagnosing necrotizing fasciitis. An extensive review of the literature with our newly added case would serve as an eye-opener on this pathogen in the setting of difficult-to-treat necrotizing fasciitis.
{"title":"Mucormycosis as a Rare Infection in Lower Limb Necrotizing Fasciitis: A Case Report","authors":"Hilal Abdessamad, Jacques Mokhbat","doi":"10.38179/ijcr.v3i1.281","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.281","url":null,"abstract":"Introduction: Necrotizing fasciitis is a severe, life-threatening infection that can be fatal and rapidly progressive. It is usually caused by polymicrobial infection, monomicrobial infection by group-B streptococci (GBS) or staphylococci, or by anaerobes like Clostridium difficile that presents as a gas gangrene or rarely by fungi. Fungal infections, though found in diabetic foot ulcers, remain extremely rare agents in necrotizing fasciitis, often causing severe morbidity and higher mortality than regular bacterial infections. Though severe, these infections are not often late to diagnose and very few reports exist citing their presence. With our case report, we present another rare manifestation of Mucormycosis in a foot wound.\u0000Case Report: We present a 57-year-old diabetic male patient who presented with a rapidly progressing very painful right foot ulcer, with high-grade fever and fatigue that did not respond to surgical intervention and treatment with broad-spectrum antibiotics. Mucormycosis species were identified in wound cultures. The patient then underwent an amputation and was treated with liposomal Amphotericin B.\u0000Conclusion: This report aims to further highlight that virulent fungal infections, especially mucormycosis, should be considered when suspecting or diagnosing necrotizing fasciitis. An extensive review of the literature with our newly added case would serve as an eye-opener on this pathogen in the setting of difficult-to-treat necrotizing fasciitis.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87981053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rami A. Ayoubi, Dany k. Aouad, M. Darwish, Joseph Maalouly, Gerard Hajj, Mohammad Daher, Alexandre Nehme
Background: The impact of acetabular horizontal rotation on the development of femoroacetabular impingement and subsequently osteoarthritis is well-studied in the literature. However, there is not a clear relationship between the rotation of the hemipelvis and the version of the acetabulum. Purpose: The purpose of this study was to evaluate the influence of the rotation of the hemipelvis on the version of the acetabulum. Methods: Through a retrospective study, three-dimensional reconstructions of high-resolution CT (computed tomography) scans of 154 patients receiving pelvic scans for non-orthopedic causes were selected from our institution’s database. The horizontal rotation of the different parts of the hemipelvis was evaluated using the following parameters: superior iliac spine angle (SIS), inferior iliac spine angle (IIS), roof edge angle (REA), equatorial edge angle (EEA) and ischiopubic angle (IPA). Results: The results showed a significant positive correlation between the different angles of the innominate bone and the version of the acetabulum such as when the proximal innominate bone rotates, the cranial part of the acetabulum rotates in the opposite direction. Increased anteversion angles in females compared to males were also observed. Conclusion: The observations suggest that, in an asymptomatic population, the acetabulum should not be considered a separate entity independent from the rest of the innominate bone and that the version of the acetabulum correlates with the rotation of the hemipelvis.
{"title":"Effect of the Innominate Bone Horizontal Rotation on Acetabular Version: A Retrospective Radiological Study on a Middle Eastern Population","authors":"Rami A. Ayoubi, Dany k. Aouad, M. Darwish, Joseph Maalouly, Gerard Hajj, Mohammad Daher, Alexandre Nehme","doi":"10.38179/ijcr.v3i1.164","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.164","url":null,"abstract":"Background: The impact of acetabular horizontal rotation on the development of femoroacetabular impingement and subsequently osteoarthritis is well-studied in the literature. However, there is not a clear relationship between the rotation of the hemipelvis and the version of the acetabulum.\u0000Purpose: The purpose of this study was to evaluate the influence of the rotation of the hemipelvis on the version of the acetabulum.\u0000Methods: Through a retrospective study, three-dimensional reconstructions of high-resolution CT (computed tomography) scans of 154 patients receiving pelvic scans for non-orthopedic causes were selected from our institution’s database. The horizontal rotation of the different parts of the hemipelvis was evaluated using the following parameters: superior iliac spine angle (SIS), inferior iliac spine angle (IIS), roof edge angle (REA), equatorial edge angle (EEA) and ischiopubic angle (IPA).\u0000Results: The results showed a significant positive correlation between the different angles of the innominate bone and the version of the acetabulum such as when the proximal innominate bone rotates, the cranial part of the acetabulum rotates in the opposite direction. Increased anteversion angles in females compared to males were also observed.\u0000Conclusion: The observations suggest that, in an asymptomatic population, the acetabulum should not be considered a separate entity independent from the rest of the innominate bone and that the version of the acetabulum correlates with the rotation of the hemipelvis.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75014097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Boustany, Marc Mardelli, Somtochukwu Onwuzo, Alyssa R. Coleman, A. Almomani, Imad Asaad
Introduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease. Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease. Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis. Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory pro
{"title":"Uveitis as a Manifestation of Celiac Disease: A Population-Based Study","authors":"A. Boustany, Marc Mardelli, Somtochukwu Onwuzo, Alyssa R. Coleman, A. Almomani, Imad Asaad","doi":"10.38179/ijcr.v3i1.250","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.250","url":null,"abstract":"Introduction: The prevalence of celiac disease (CD) in the United States population has been estimated to be 0.71%, or 1 in 141, with the prevalence in first- and second-degree relatives of those affected being 4.55% and 2.59% respectively. Due to the multitude of ways in which this disease may initially present, it is important to screen for CD to avoid the potential consequences of inadequately managed disease. Many ophthalmic conditions have also been implicated as extraintestinal manifestations of CD, including uveitis. Despite several studies and case reports suggesting a positive correlation between CD and uveitis, there has yet to be a nationwide study in the United States quantifying this relationship. Therefore, the aim of this study is to conduct a large-scale multi-center population-based study to assess whether there is a statistically significant increased risk of uveitis in individuals with celiac disease.\u0000Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States consisting of data accumulated from 1999 to September 2022 was utilized to construct this study. We excluded patients with a history of autoimmune diseases, cataract surgery, or any type of eye infection. We included a subgroup of patients with a diagnosis of “uveitis” for further analysis. The risk of developing uveitis was calculated using a univariate logistic regression. A multivariate analysis was also done to account for confounding variables including African American ethnicity, male gender, sexually transmitted diseases, and celiac disease.\u0000Results: 70,632,440 patients were screened and a cohort of 46,895,750 individuals was selected for the final analysis after accounting for inclusion and exclusion criteria were met. The incidence of uveitis in patients with celiac disease in the past 3 years was 280 per 100,000 people. The prevalence of uveitis in the US population from 1999 to September 2022 was 150 per 100,000 people (0.15%). In order to adjust for confounding variables, a multivariate regression analysis was performed and showed an increased risk of being African-American (OR: 3.20%; 95% CI: 3.14-3.26) and male (OR: 1.13%; 95% CI: 1.12-1.16); and having a diagnosis of celiac disease (OR: 3.80%; 95% CI: 3.35-4.28) and sexually transmitted diseases (OR: 4.12%; 95% CI: 3.96-4.29) in patients with uveitis.\u0000Discussion: Recent population-based studies demonstrated that the prevalence of CD in the United States is much greater than previously thought, such that a trend of underdiagnoses is suspected to have occurred for several years. Many newly diagnosed uveitis cases, 48%, have been classified as idiopathic uveitis even after a complete workup was done. Several studies have been published in which a correlation between uveitis and CD is reported. The findings of this study further emphasize the importance of a thorough workup to evaluate for an underlying inflammatory pro","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80288235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. A. Zeid, Giuseppe Salfi, Reem M A Mansour, M. N. Jardak, H. Khan, M. Abuassi, Tara Boustany, Somtochukwu Onwuzo, A. Boustany
Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a tumor of the pancreas that has a 5-year survival rate as low as 7.8%. In cases of chronic pancreatitis, it is sometimes challenging to rule out neoplastic changes, as mass-forming pancreatitis (MFCP) that can occur secondary to long-lasting inflammation can commonly mimic the presentation of pancreatic ductal adenocarcinoma. The clinical picture, laboratory, and radiological imaging of PDAC and MFCP may sometimes overlap, resulting in a higher incidence of misdiagnosis and unnecessary surgery. Aim: We aim to describe the various tools available to help physicians distinguish between mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma. Methods: A literature search was conducted on “PubMed” using the following terms: pancreatic carcinoma, mass-forming chronic pancreatitis, and pancreatic mass. Several articles discussing imaging modalities including ultrasound, CT-scan, and MRI; and laboratory markers including cancer antigen 19–9 (CA 19-9), carcinoembryonic antigen (CEA), glypican-1 (GP-1), low-density lipoprotein receptor (LDLR), and K-RAS, were reviewed. Discussion: Despite their similar presentations, the management of MFCP and PDAC is very different. The similarity in history, clinical symptoms, and imaging findings can lead to unnecessary procedures. In this review, we examined several modalities that physicians might use to avoid any misdiagnosis. Conclusion: Although none of these tests alone has been shown to be superior to the others, a potential suggestion might be to use a combination of these tests to allow a reliable diagnosis.
胰腺导管腺癌(PDAC)是一种胰腺肿瘤，其5年生存率低至7.8%。在慢性胰腺炎病例中，有时很难排除肿瘤改变，因为继发于长期炎症的团块形成性胰腺炎(MFCP)通常可以模仿胰腺导管腺癌的表现。PDAC和MFCP的临床、实验室和影像学有时可能重叠，导致更高的误诊发生率和不必要的手术。目的:我们的目的是描述各种可用的工具，以帮助医生区分肿块形成的慢性胰腺炎和胰腺导管腺癌。方法:在“PubMed”中检索文献，使用以下术语:胰腺癌、形成肿块的慢性胰腺炎和胰腺肿块。几篇讨论成像方式的文章，包括超声、ct扫描和MRI;并对癌抗原19-9 (CA 19-9)、癌胚抗原(CEA)、甘聚糖-1 (GP-1)、低密度脂蛋白受体(LDLR)、K-RAS等实验室标志物进行了综述。讨论:尽管他们的表现相似，但MFCP和PDAC的管理非常不同。病史、临床症状和影像学表现的相似性可能导致不必要的手术。在这篇综述中，我们研究了医生可能用来避免误诊的几种模式。结论:虽然这些测试中没有一个单独优于其他测试，但一个潜在的建议可能是使用这些测试的组合来进行可靠的诊断。
{"title":"Differentiating Between Mass-forming Chronic Pancreatitis and Pancreatic Ductal Adenocarcinoma: A Challenging Clinical Approach","authors":"H. A. Zeid, Giuseppe Salfi, Reem M A Mansour, M. N. Jardak, H. Khan, M. Abuassi, Tara Boustany, Somtochukwu Onwuzo, A. Boustany","doi":"10.38179/ijcr.v3i1.244","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.244","url":null,"abstract":"Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a tumor of the pancreas that has a 5-year survival rate as low as 7.8%. In cases of chronic pancreatitis, it is sometimes challenging to rule out neoplastic changes, as mass-forming pancreatitis (MFCP) that can occur secondary to long-lasting inflammation can commonly mimic the presentation of pancreatic ductal adenocarcinoma. The clinical picture, laboratory, and radiological imaging of PDAC and MFCP may sometimes overlap, resulting in a higher incidence of misdiagnosis and unnecessary surgery.\u0000 Aim: We aim to describe the various tools available to help physicians distinguish between mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma.\u0000Methods: A literature search was conducted on “PubMed” using the following terms: pancreatic carcinoma, mass-forming chronic pancreatitis, and pancreatic mass. Several articles discussing imaging modalities including ultrasound, CT-scan, and MRI; and laboratory markers including cancer antigen 19–9 (CA 19-9), carcinoembryonic antigen (CEA), glypican-1 (GP-1), low-density lipoprotein receptor (LDLR), and K-RAS, were reviewed.\u0000Discussion: Despite their similar presentations, the management of MFCP and PDAC is very different. The similarity in history, clinical symptoms, and imaging findings can lead to unnecessary procedures. In this review, we examined several modalities that physicians might use to avoid any misdiagnosis.\u0000 Conclusion: Although none of these tests alone has been shown to be superior to the others, a potential suggestion might be to use a combination of these tests to allow a reliable diagnosis.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80245346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anand Muthu Krishnan, S. Kadavath, Gurukripa N. Kowlgi, Akshay Goel, Fangcheng Wu, A. Jha, Daniel D. Correa de Sa, Rony N. Lahoud
Background: Transcatheter Aortic Valve Replacement (TAVR) is associated with conduction abnormalities requiring permanent pacemaker implantation (PPMI). Data regarding predictors for PPMI following TAVR is scarce. Methods: This is a retrospective study utilizing the 2017 National In-Patient Sample (NIS). Patients who underwent TAVR and PPMI during the same admission were identified using appropriate ICD-10 codes, as were patients with left bundle branch (LBBB), right bundle branch (RBBB), and first-degree AV delay (AVB). Patients were split into two groups based on PPMI. The groups were compared using univariate and multivariate analyses after adjusting for age, gender, race, comorbidities, insurance status, and Charlson comorbidity index (CCI). Secondary outcomes included factors influencing length of stay (LOS) and total charges incurred. Results: In 2017, 54,175 (57.6% males) patients underwent TAVR. There were 8,067 patients with LBBB, 2,402 with RBBB, and 2,905 with AVB at baseline. A 4170 total of patients (55.2% males) required PPMI. Patients requiring PPMI were older (80.5 vs 79.6 years, p=0.001). On multivariate analyses, baseline RBBB, LBBB, hypertension (HTN), CCI 2, and CCI >/=3 predicted PPMI (aOR 4.82, p<0.001; aOR 1.63, p<0.001; aOR 1.21, p=0.013, aOR 1.53, p=0.022 and aOR 1.46, p=0.031 respectively). On multivariate analyses, patients who underwent PPMI had significantly higher LOS (aOR 2.18, p<0.001) and incurred higher total charges (USD 278,000 vs USD 204,920; p<0.001). Conclusion: In this cohort, RBBB, LBBB, HTN, and increased CCI predicted PPMI after TAVR. Further studies are required to corroborate our findings.
{"title":"Permanent Pacemaker Use in Transcatheter Aortic Valve Replacement: Real World Experience from the National Inpatient Sample","authors":"Anand Muthu Krishnan, S. Kadavath, Gurukripa N. Kowlgi, Akshay Goel, Fangcheng Wu, A. Jha, Daniel D. Correa de Sa, Rony N. Lahoud","doi":"10.38179/ijcr.v3i1.219","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.219","url":null,"abstract":"Background: Transcatheter Aortic Valve Replacement (TAVR) is associated with conduction abnormalities requiring permanent pacemaker implantation (PPMI). Data regarding predictors for PPMI following TAVR is scarce.\u0000Methods: This is a retrospective study utilizing the 2017 National In-Patient Sample (NIS). Patients who underwent TAVR and PPMI during the same admission were identified using appropriate ICD-10 codes, as were patients with left bundle branch (LBBB), right bundle branch (RBBB), and first-degree AV delay (AVB). Patients were split into two groups based on PPMI. The groups were compared using univariate and multivariate analyses after adjusting for age, gender, race, comorbidities, insurance status, and Charlson comorbidity index (CCI). Secondary outcomes included factors influencing length of stay (LOS) and total charges incurred.\u0000Results: In 2017, 54,175 (57.6% males) patients underwent TAVR. There were 8,067 patients with LBBB, 2,402 with RBBB, and 2,905 with AVB at baseline. A 4170 total of patients (55.2% males) required PPMI. Patients requiring PPMI were older (80.5 vs 79.6 years, p=0.001). On multivariate analyses, baseline RBBB, LBBB, hypertension (HTN), CCI 2, and CCI >/=3 predicted PPMI (aOR 4.82, p<0.001; aOR 1.63, p<0.001; aOR 1.21, p=0.013, aOR 1.53, p=0.022 and aOR 1.46, p=0.031 respectively). On multivariate analyses, patients who underwent PPMI had significantly higher LOS (aOR 2.18, p<0.001) and incurred higher total charges (USD 278,000 vs USD 204,920; p<0.001).\u0000Conclusion: In this cohort, RBBB, LBBB, HTN, and increased CCI predicted PPMI after TAVR. Further studies are required to corroborate our findings.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86498032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Remy Mckey, Rima Charara, Mohamad Hussein El Sayed, A. Bahr
Introduction: Cocoon syndrome is an uncommon cause of intestinal obstruction caused by the formation of a fibrous band around small intestines, thought to be caused by chronic peritoneal inflammation and associated with several conditions such as liver cirrhosis and liver transplantation. Case Report: We present a case of a 72-year-old male patient who had liver transplantation three years ago for liver cirrhosis. He had an acute presentation of intestinal obstruction where a computed tomography (CT) scan showed dilated bowel loops and signs of intestinal ischemia, which warranted surgical laparotomy where the diagnosis of cocoon syndrome (sclerosing encapsulating peritonitis) was made and was then treated by adhesiolysis. No immediate or postoperative complications were documented and his life was back to normal. Conclusion: Therefore, an abdominal cocoon is a challenging diagnosis and should be considered in front of intestinal obstruction, especially in those with risk factors such as liver transplantation.
{"title":"Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature","authors":"Remy Mckey, Rima Charara, Mohamad Hussein El Sayed, A. Bahr","doi":"10.38179/ijcr.v3i1.231","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.231","url":null,"abstract":"Introduction: Cocoon syndrome is an uncommon cause of intestinal obstruction caused by the formation of a fibrous band around small intestines, thought to be caused by chronic peritoneal inflammation and associated with several conditions such as liver cirrhosis and liver transplantation.\u0000Case Report: We present a case of a 72-year-old male patient who had liver transplantation three years ago for liver cirrhosis. He had an acute presentation of intestinal obstruction where a computed tomography (CT) scan showed dilated bowel loops and signs of intestinal ischemia, which warranted surgical laparotomy where the diagnosis of cocoon syndrome (sclerosing encapsulating peritonitis) was made and was then treated by adhesiolysis. No immediate or postoperative complications were documented and his life was back to normal.\u0000Conclusion: Therefore, an abdominal cocoon is a challenging diagnosis and should be considered in front of intestinal obstruction, especially in those with risk factors such as liver transplantation.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91193425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Lichtenstein's surgery is the most recommended technique in the treatment of unilateral inguinal hernias in men, due to its simplicity, speed, pain-free, and almost unrestricted return to physical activities. The evidence indicates that work and leisure activities can be resumed, by most patients, in three to five days after laparoscopic or conventional hernioplasties, without the risk of recurrences or complications. Nevertheless, chronic pain is the most common postoperative complication affecting about 30% of patients regardless of the surgical technique used. Predictive factors for chronic pain are young age, female gender, preoperative pain level, and postoperative pain intensity. Aim: To evaluate the perception of postoperative pain in patients who have undergone unilateral elective inguinal hernioplasty using the Lichtenstein technique in order to define predictors of the development of chronic pain and to identify the average time to return to work and to normal physical activity. Methods: Analysis of electronic forms applied to patients that underwent elective unilateral inguinal hernia repair by Lichtenstein at a state hospital in a small town in the interior of Brazil. The statistical analyses were processed using the software Statistical Package for Social Sciences (SPSS) version 22.0. Results: Data from 38 participants were analyzed with an average of 41.45 (± 13.94) years. Most of them returned to work and to light physical activities 45 days after surgery. There was a positive correlation between the presence of pain 90 days after surgery and the development of chronic pain (Spearman correlation of 0,818 and p < 0.001). Conclusion: Despite the small sample of this study, it awakens us to the consequences that Lichtenstein surgery can trigger for patients with inguinal hernia and the importance of good management and evaluation of postoperative pain in order to improve the quality of life of these patients.
{"title":"Evaluation of postoperative pain in patients undergoing unilateral inguinal hernioplasty by Lichtenstein","authors":"Diogo Milioli Ferreira, M. Franciss","doi":"10.38179/ijcr.v3i1.101","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.101","url":null,"abstract":"Background: Lichtenstein's surgery is the most recommended technique in the treatment of unilateral inguinal hernias in men, due to its simplicity, speed, pain-free, and almost unrestricted return to physical activities. The evidence indicates that work and leisure activities can be resumed, by most patients, in three to five days after laparoscopic or conventional hernioplasties, without the risk of recurrences or complications. Nevertheless, chronic pain is the most common postoperative complication affecting about 30% of patients regardless of the surgical technique used. Predictive factors for chronic pain are young age, female gender, preoperative pain level, and postoperative pain intensity. \u0000Aim: To evaluate the perception of postoperative pain in patients who have undergone unilateral elective inguinal hernioplasty using the Lichtenstein technique in order to define predictors of the development of chronic pain and to identify the average time to return to work and to normal physical activity.\u0000Methods: Analysis of electronic forms applied to patients that underwent elective unilateral inguinal hernia repair by Lichtenstein at a state hospital in a small town in the interior of Brazil. The statistical analyses were processed using the software Statistical Package for Social Sciences (SPSS) version 22.0. \u0000Results: Data from 38 participants were analyzed with an average of 41.45 (± 13.94) years. Most of them returned to work and to light physical activities 45 days after surgery. There was a positive correlation between the presence of pain 90 days after surgery and the development of chronic pain (Spearman correlation of 0,818 and p < 0.001). \u0000Conclusion: Despite the small sample of this study, it awakens us to the consequences that Lichtenstein surgery can trigger for patients with inguinal hernia and the importance of good management and evaluation of postoperative pain in order to improve the quality of life of these patients.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83449053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Uterine leiomyoma (UL) are women’s most common pelvic tumors, benign in nature, growing during reproductive age, and presenting with abnormal uterine bleeding or pelvic pain and pressure. Many risk factors may contribute to UL, such as family history, obesity, and early menarche. Despite the fact that UL symptoms may improve using many medical or surgical treatments, the health-related quality of life (HRQoL) is considerably affected by their presence. Based on all of the above, we conducted this study which is to the best of our knowledge, the first of its kind in Lebanon aiming to assess the risk factors of UL among the Lebanese population and provide an overview of the diagnostic methods, treatment modalities, and HRQoL among patients. Subjects & Methods: This is an epidemiologic case-control retrospective study, of 668 women of reproductive age, of different nationalities living in Lebanon, divided into 167 cases and 501 controls, conducted between January 2016 and February 2018, in Beirut, Lebanon, in Rafic Hariri University Hospital (RHUH) and Makassed General Hospital (MGH), using charts, questionnaires, and telephone calls. The statistical program Statistical Package for the Social Sciences 19 (SPSS-19) was used for data analysis. A multivariate analysis was also done. Two-sided data analysis was employed and statistical significance was considered for a p-value of ≤ 0.05. Results: Risk factors of UL were older age (>40), early menarche, family history, oral contraceptives (OCP) use, high body mass index (BMI) (>29), and chronic diseases. Smoking and sports were protective factors. The highest effectiveness in diagnosis was attributable to pelvic ultrasonography (94.8% of cases), magnetic resonance imaging (MRI) (85.2% of cases), and hysteroscopy (77.8% of cases). Hysterectomy was the most used treatment method (83.8% of cases), followed by hysteroscopy (77.8%) and uterine artery embolization (UAE) (72.7%). Women with leiomyoma reported that their HRQoL is negatively affected by this condition. Conclusion: This study showed many risk factors for UL, and the statistical significance of techniques for their diagnosis and treatment, in order to prevent their complications and decrease their impact on HRQoL.
背景:子宫平滑肌瘤(UL)是女性最常见的盆腔肿瘤，性质为良性，生长于育龄期，表现为子宫异常出血或盆腔疼痛和压力。许多危险因素可能导致UL，如家族史、肥胖和月经初潮提前。尽管使用许多药物或手术治疗可以改善UL症状，但与健康相关的生活质量(HRQoL)会受到它们的很大影响。基于以上，我们进行了这项研究，据我们所知，这是黎巴嫩第一个旨在评估黎巴嫩人口中UL风险因素的研究，并概述了患者的诊断方法、治疗方式和HRQoL。对象与方法:这是一项流行病学病例对照回顾性研究，研究对象为居住在黎巴嫩的668名不同国籍的育龄妇女，分为167例和501例对照，于2016年1月至2018年2月在黎巴嫩贝鲁特的拉菲克哈里里大学医院(RHUH)和Makassed综合医院(MGH)进行，采用图表、问卷调查和电话。使用统计程序SPSS-19 (statistical Package for The Social Sciences 19)进行数据分析。还进行了多变量分析。采用双侧资料分析，以p值≤0.05为差异有统计学意义。结果:老年(bbb40)、月经初潮早、家族史、口服避孕药(OCP)使用、高体重指数(BMI) (bbb29)、慢性病是UL发生的危险因素。吸烟和运动是保护因素。盆腔超声检查(94.8%)、磁共振成像(85.2%)和宫腔镜检查(77.8%)的诊断效率最高。子宫切除术是最常用的治疗方法(83.8%)，其次是宫腔镜(77.8%)和子宫动脉栓塞(UAE)(72.7%)。患有平滑肌瘤的女性报告说，她们的HRQoL受到这种情况的负面影响。结论:本研究显示了UL的多种危险因素，对其诊断和治疗技术具有统计学意义，可预防其并发症，降低其对HRQoL的影响。
{"title":"Epidemiology Of Uterine Fibroid Disease In Lebanon: A Case-Control Study","authors":"Zeinab El Mawla, Youssef Berthe, Pascale Salemeh","doi":"10.38179/ijcr.v3i1.113","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.113","url":null,"abstract":"Background: Uterine leiomyoma (UL) are women’s most common pelvic tumors, benign in nature, growing during reproductive age, and presenting with abnormal uterine bleeding or pelvic pain and pressure. Many risk factors may contribute to UL, such as family history, obesity, and early menarche. Despite the fact that UL symptoms may improve using many medical or surgical treatments, the health-related quality of life (HRQoL) is considerably affected by their presence. Based on all of the above, we conducted this study which is to the best of our knowledge, the first of its kind in Lebanon aiming to assess the risk factors of UL among the Lebanese population and provide an overview of the diagnostic methods, treatment modalities, and HRQoL among patients.\u0000Subjects & Methods: This is an epidemiologic case-control retrospective study, of 668 women of reproductive age, of different nationalities living in Lebanon, divided into 167 cases and 501 controls, conducted between January 2016 and February 2018, in Beirut, Lebanon, in Rafic Hariri University Hospital (RHUH) and Makassed General Hospital (MGH), using charts, questionnaires, and telephone calls. The statistical program Statistical Package for the Social Sciences 19 (SPSS-19) was used for data analysis. A multivariate analysis was also done. Two-sided data analysis was employed and statistical significance was considered for a p-value of ≤ 0.05.\u0000Results: Risk factors of UL were older age (>40), early menarche, family history, oral contraceptives (OCP) use, high body mass index (BMI) (>29), and chronic diseases. Smoking and sports were protective factors. The highest effectiveness in diagnosis was attributable to pelvic ultrasonography (94.8% of cases), magnetic resonance imaging (MRI) (85.2% of cases), and hysteroscopy (77.8% of cases). Hysterectomy was the most used treatment method (83.8% of cases), followed by hysteroscopy (77.8%) and uterine artery embolization (UAE) (72.7%). Women with leiomyoma reported that their HRQoL is negatively affected by this condition.\u0000Conclusion: This study showed many risk factors for UL, and the statistical significance of techniques for their diagnosis and treatment, in order to prevent their complications and decrease their impact on HRQoL.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86690514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diego Guacaneme, Edgar Aguirre, E. Isaac, Erick Vink, L. Cabrera, Diego F Salcedo, Jonathan Cardoso, D. González
Background: Omentum necrosis is a rare cause of acute abdomen. Its main etiologies are torsion on its axis, hypercoagulability, and intra-abdominal infections. Its clinical diagnosis is difficult since its symptoms resemble other abdominal pathologies, so diagnostic confirmation when the pain is present in the right abdomen, which occurs most frequently, is usually intraoperative Surgical treatment is more effective than conservative management in reducing hospital stays and does not require follow-up. Case Report: We present the case of a 45-year-old male suspected to be infected with SARS-CoV-2, which potentially triggered hypercoagulability with necrosis of the greater omentum and mesenteric ischemia, requiring multiple surgical interventions. Conclusion: It is a rare cause of acute abdomen and to the best of our knowledge, the description of the first case of necrosis of the omentum secondary to COVID-19.
{"title":"Omental Necrosis and Mesenteric Ischemia Secondary to Hypercoagulability Due to COVID-19: A Case Report","authors":"Diego Guacaneme, Edgar Aguirre, E. Isaac, Erick Vink, L. Cabrera, Diego F Salcedo, Jonathan Cardoso, D. González","doi":"10.38179/ijcr.v3i1.89","DOIUrl":"https://doi.org/10.38179/ijcr.v3i1.89","url":null,"abstract":"Background: Omentum necrosis is a rare cause of acute abdomen. Its main etiologies are torsion on its axis, hypercoagulability, and intra-abdominal infections. Its clinical diagnosis is difficult since its symptoms resemble other abdominal pathologies, so diagnostic confirmation when the pain is present in the right abdomen, which occurs most frequently, is usually intraoperative Surgical treatment is more effective than conservative management in reducing hospital stays and does not require follow-up.\u0000Case Report: We present the case of a 45-year-old male suspected to be infected with SARS-CoV-2, which potentially triggered hypercoagulability with necrosis of the greater omentum and mesenteric ischemia, requiring multiple surgical interventions.\u0000Conclusion: It is a rare cause of acute abdomen and to the best of our knowledge, the description of the first case of necrosis of the omentum secondary to COVID-19.","PeriodicalId":73437,"journal":{"name":"International journal of clinical research & trials","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80243566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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