Roya Mehdikhani, G. Olyaei, M. Hadian, Saeed Talebian Moghaddam, A. Shadmehr
Background: Myofascial trigger points are most commonly occurs in the upper trapezius, which is the highest sensitive muscle in the body. Joint Analysis of Electromyography (EMG) Spectrum and Amplitude (JASA) method was applied to evaluate the occurrence of muscular fatigue during consecutive gripping exertions. Methods: 64 right handed subjects took part in this study. Prior to the fatigue test, the maximal voluntary contraction was measured three times. A force gauge was used for force measurement while recording with a monitor. Measurement was initiated with a Maximum Voluntary Contraction (MVC) force of the trapezius. Results: After accomplishing fatigue protocol, they showed signs of exhaustion; however, they were not subjectively evaluated for fatigue. As the protocol aimed at assessing muscle fatigue, a force level of 80% MVC was induced. Conclusion: As revealed by the plots, the lower left quadrant could be defined as having an ‘‘force reduction’’ rather than a ‘‘fatigue’’ trait based on the natural pushing up characteristics based at the JASA plot definition, muscle fatigue or force reduction become manifested by way of above 90% of the 20 dots after fatigue test. Through the JASA method, researchers could gain insight in to the muscular fatigue condition as well as the possible underlying mechanisms.
{"title":"Assessment of Upper Trapezius Muscle Fatigue in Subclinical Myofascial Pain Syndrome Participants Versus Healthy Control by JASA Method","authors":"Roya Mehdikhani, G. Olyaei, M. Hadian, Saeed Talebian Moghaddam, A. Shadmehr","doi":"10.52916/jmrs224085","DOIUrl":"https://doi.org/10.52916/jmrs224085","url":null,"abstract":"Background: Myofascial trigger points are most commonly occurs in the upper trapezius, which is the highest sensitive muscle in the body. Joint Analysis of Electromyography (EMG) Spectrum and Amplitude (JASA) method was applied to evaluate the occurrence of muscular fatigue during consecutive gripping exertions. Methods: 64 right handed subjects took part in this study. Prior to the fatigue test, the maximal voluntary contraction was measured three times. A force gauge was used for force measurement while recording with a monitor. Measurement was initiated with a Maximum Voluntary Contraction (MVC) force of the trapezius. Results: After accomplishing fatigue protocol, they showed signs of exhaustion; however, they were not subjectively evaluated for fatigue. As the protocol aimed at assessing muscle fatigue, a force level of 80% MVC was induced. Conclusion: As revealed by the plots, the lower left quadrant could be defined as having an ‘‘force reduction’’ rather than a ‘‘fatigue’’ trait based on the natural pushing up characteristics based at the JASA plot definition, muscle fatigue or force reduction become manifested by way of above 90% of the 20 dots after fatigue test. Through the JASA method, researchers could gain insight in to the muscular fatigue condition as well as the possible underlying mechanisms.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43785970","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: Though total Knee replacement has proved to be a rewarding surgery for patients with end stage knee arthritis, errors in surgical technique leading to malalignment of components can lead to early failure. The aim of this study was to increase the accuracy in identifying the centre of ankle joint which is the first step in achieving a proper tibial cut for a well placed tibial implant. Technique: We propose a simple, reproducible technique to locate centre of ankle under image intensifier. Results: The above technique was used in 30 patients who were operated by two surgeons during a period of 6 months from January 2022 to June 2022. Post-op measurements of the alignment of tibial implant were done electronically on computer and physically on X-rays. 21 of the 30 cases (70%) had good placement of the implant within 1 degree of ideal alignment and 9 (30%) within 2 degrees. Discussion: A correct proximal tibia cut for a well aligned tibial component is achieved with the help of precise application of the cutting jigs. Extramedulalry jigs used to make the proximal tibia cut have to be aligned parallel to the axis of the tibia and centred over the midpoint of talus. Several methods have been proposed by various authors to locate centre of the ankle joint. However, at present there is no consensus on the best method. Even computer navigation relies on accurate feeding of anatomical reference points which is done manually. Conclusion: Our technique is precise, accurate, repeatable, objective and less time consuming. It adds value to achieving the final aim of a good implant position. The technique has a dual advantage as it gives a better estimate of not only the centre of the ankle but also the centre of the distal tibial mechanical axis.
{"title":"A Small Step to Improve Tibial Alignment in Knee Replacement","authors":"Ninad Godghate","doi":"10.52916/jmrs22s202","DOIUrl":"https://doi.org/10.52916/jmrs22s202","url":null,"abstract":"Introduction: Though total Knee replacement has proved to be a rewarding surgery for patients with end stage knee arthritis, errors in surgical technique leading to malalignment of components can lead to early failure. The aim of this study was to increase the accuracy in identifying the centre of ankle joint which is the first step in achieving a proper tibial cut for a well placed tibial implant. Technique: We propose a simple, reproducible technique to locate centre of ankle under image intensifier. Results: The above technique was used in 30 patients who were operated by two surgeons during a period of 6 months from January 2022 to June 2022. Post-op measurements of the alignment of tibial implant were done electronically on computer and physically on X-rays. 21 of the 30 cases (70%) had good placement of the implant within 1 degree of ideal alignment and 9 (30%) within 2 degrees. Discussion: A correct proximal tibia cut for a well aligned tibial component is achieved with the help of precise application of the cutting jigs. Extramedulalry jigs used to make the proximal tibia cut have to be aligned parallel to the axis of the tibia and centred over the midpoint of talus. Several methods have been proposed by various authors to locate centre of the ankle joint. However, at present there is no consensus on the best method. Even computer navigation relies on accurate feeding of anatomical reference points which is done manually. Conclusion: Our technique is precise, accurate, repeatable, objective and less time consuming. It adds value to achieving the final aim of a good implant position. The technique has a dual advantage as it gives a better estimate of not only the centre of the ankle but also the centre of the distal tibial mechanical axis.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41911504","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}
M. Alkhatieb, Rahaf Alrayiqi, Omar A. Alsulami, Ziyad M. Albassam, Sahal Wali, Haifa Alnahdi
Objectives: To determine the common pathogens isolated from DFI to administer appropriate antibiotic treatment, followed by surgical interventions. Methods: A retrospective study was performed on 260 patients who presented with diabetic foot at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2014 to September 2020. All patients underwent swabs and tissue culture for microbiological evaluation. Patient medical records were reviewed to collect demographic and clinical data, including Glycated Hemoglobin (HgA1C), Diabetes Mellitus (DM) type, duration of diabetes, swab, tissue culture, type of surgery, and type of isolated organism. Results: Escherichia coli was the most common organism isolated from the feet of diabetic patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus agalactiae, and Pseudomonas aeruginosa. Amputations were significantly higher in patients who did not have Staphylococcus aureus or Pseudomonas aeruginosa infection, with no significant relationship between amputation and any other isolated organisms. A significant negative correlation between patient age and HgA1C level was discovered, as well as a significant positive correlation between HgA1C and the number of minor amputations. Patients with major and minor amputations had a significantly higher percentage of non-Multidrug Resistance (MDR), whereas patients with MDR had a significantly higher rate of infection with Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus. Conclusion: DM is a metabolic syndrome that affects all the body systems and impacts both morbidity and mortality. The most common organism isolated from the feet of diabetic patients was Escherichia coli, followed by Staphylococcus aureus. Ulcer specimens should be collected for culture and identification of causative organisms. Preventive measures such as good glycemic control, appropriate foot care, targeted antibiotic therapy, and patient education can reduce the incidence of amputation.
{"title":"Common Pathogens Isolated from Infected Diabetic Foot Ulcers at King Abdulaziz University Hospital, Saudi Arabia: A Retrospective Study","authors":"M. Alkhatieb, Rahaf Alrayiqi, Omar A. Alsulami, Ziyad M. Albassam, Sahal Wali, Haifa Alnahdi","doi":"10.52916/jmrs224084","DOIUrl":"https://doi.org/10.52916/jmrs224084","url":null,"abstract":"Objectives: To determine the common pathogens isolated from DFI to administer appropriate antibiotic treatment, followed by surgical interventions. Methods: A retrospective study was performed on 260 patients who presented with diabetic foot at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2014 to September 2020. All patients underwent swabs and tissue culture for microbiological evaluation. Patient medical records were reviewed to collect demographic and clinical data, including Glycated Hemoglobin (HgA1C), Diabetes Mellitus (DM) type, duration of diabetes, swab, tissue culture, type of surgery, and type of isolated organism. Results: Escherichia coli was the most common organism isolated from the feet of diabetic patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus agalactiae, and Pseudomonas aeruginosa. Amputations were significantly higher in patients who did not have Staphylococcus aureus or Pseudomonas aeruginosa infection, with no significant relationship between amputation and any other isolated organisms. A significant negative correlation between patient age and HgA1C level was discovered, as well as a significant positive correlation between HgA1C and the number of minor amputations. Patients with major and minor amputations had a significantly higher percentage of non-Multidrug Resistance (MDR), whereas patients with MDR had a significantly higher rate of infection with Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus. Conclusion: DM is a metabolic syndrome that affects all the body systems and impacts both morbidity and mortality. The most common organism isolated from the feet of diabetic patients was Escherichia coli, followed by Staphylococcus aureus. Ulcer specimens should be collected for culture and identification of causative organisms. Preventive measures such as good glycemic control, appropriate foot care, targeted antibiotic therapy, and patient education can reduce the incidence of amputation.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47408577","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}
Z. Teli, Shehnaz R. Kantharia, Aayushi Kantharia, R. Kantharia
Schwannoma is a benign, encapsulated and a slowly growing peripheral neural sheath tumor that arises from the schwann cells. 25-40% of Schwannomas occur in the head and neck region and of which 1-12% are seen in the oral cavity. The most common subsite in the oral cavity is tongue followed by the palate and buccal mucosa. The most commonly involved nerves include hypoglossal, lingual, tympanic, glossopharyngeal, vagus and the superior laryngeal nerves. The common presentation is a painless nodule or a swelling depending on the site of presentation. The preoperative diagnosis of schwannoma is usually suggested by Fine Needle Aspiration Cytology (FNAC) and is confirmed by histo-pathologic examination. The extent, exact location and relation with surrounding structures is delineated by imaging in the form of Ultrasound scanning, Computed Tomography (CT) scan or an Magnetic Resonance Imaging (MRI). However, MRI is the imaging modality of choice as it provides better soft tissues details with precision along with the nerve of origin. Surgical excision is the treatment of choice. Recurrence is insignificant and has very rare chances of malignant transformation.
{"title":"Head and Neck Schwannomas: Interesting Case Series with Review of Literature","authors":"Z. Teli, Shehnaz R. Kantharia, Aayushi Kantharia, R. Kantharia","doi":"10.52916/jmrs224083","DOIUrl":"https://doi.org/10.52916/jmrs224083","url":null,"abstract":"Schwannoma is a benign, encapsulated and a slowly growing peripheral neural sheath tumor that arises from the schwann cells. 25-40% of Schwannomas occur in the head and neck region and of which 1-12% are seen in the oral cavity. The most common subsite in the oral cavity is tongue followed by the palate and buccal mucosa. The most commonly involved nerves include hypoglossal, lingual, tympanic, glossopharyngeal, vagus and the superior laryngeal nerves. The common presentation is a painless nodule or a swelling depending on the site of presentation. The preoperative diagnosis of schwannoma is usually suggested by Fine Needle Aspiration Cytology (FNAC) and is confirmed by histo-pathologic examination. The extent, exact location and relation with surrounding structures is delineated by imaging in the form of Ultrasound scanning, Computed Tomography (CT) scan or an Magnetic Resonance Imaging (MRI). However, MRI is the imaging modality of choice as it provides better soft tissues details with precision along with the nerve of origin. Surgical excision is the treatment of choice. Recurrence is insignificant and has very rare chances of malignant transformation.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44076500","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}
The Medicare Program is the second-largest insurance program in the United States, with approximately 64 million beneficiaries and total expenditures of over $839 billion in 2021 [1]. There are two separate trust funds in the Medicare Program, namely the Hospital Insurance Trust Fund (HI Trust Fund) and the Supplementary Medical Insurance Trust Fund (SMI Trust Fund); both trust funds are held by the U.S. Treasury [2]. The first trust fund covers hospital in-patient expenses; and the second trust fund covers medically necessary services by medical doctors and doctors of osteopathy, preventive services, brand-name prescription drugs, and generic drug coverage [3,4]. Prior to the COVID-19 pandemic, the latest financial calculations projected that the HI Trust Fund would be insolvent by the year 2026. It is a fact that the Medicare HI Trust Fund has never been insolvent because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the HI Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the Federal budget as the number of beneficiaries and the per capita healthcare costs increase each year [5]. Uncompensated care refers to uninsured patients who receive care upon hospital emergency room admissions but not ever paying the hospital bill after discharge or death. Uncompensated care is the kryptonite of hospital financing because it is unpredictable and can easily destabilize the monies that hospitals depend on to cover overhead expenses. Nationwide, hospitals protect themselves against the uncertainty of uncompensated care by drastically overcharging prices to different patients receiving the same or similar medical procedures at the very same hospital locations. For all intents and purposes, the creation of Obamacare failed to address this kryptonite. However, it is a fact that the legal system places limitations upon what the federal government can do to deal with this Achilles’ heel of the American healthcare system. State governments truly hold the power to effect change towards the future of healthcare in 2030, both private healthcare and government-sponsored healthcare. Since 1970, one state has proactively protected its statewide healthcare system against the dangers of uncompensated care: Maryland. It is the only state in the entire nation to receive a federal waiver from the U.S. Centers for Medicare & Medicaid Services (CMS) because their specific design for accounting for a plethora of poor patients. This effort started with a group of hospital administrators meeting for coffee on a consistent basis to brainstorm the solution from their collective hospitals. Driven by the pride to help their communities, their involvement with the Maryland government led to the creation of the Maryland Health Services Cost Review Commission (Maryland HSCRC). This impartial governme
{"title":"Medicare in 2030 Irretrievably Broken","authors":"B. Pettingill, F. Tewes","doi":"10.52916/jmrs224082","DOIUrl":"https://doi.org/10.52916/jmrs224082","url":null,"abstract":"The Medicare Program is the second-largest insurance program in the United States, with approximately 64 million beneficiaries and total expenditures of over $839 billion in 2021 [1]. There are two separate trust funds in the Medicare Program, namely the Hospital Insurance Trust Fund (HI Trust Fund) and the Supplementary Medical Insurance Trust Fund (SMI Trust Fund); both trust funds are held by the U.S. Treasury [2]. The first trust fund covers hospital in-patient expenses; and the second trust fund covers medically necessary services by medical doctors and doctors of osteopathy, preventive services, brand-name prescription drugs, and generic drug coverage [3,4]. Prior to the COVID-19 pandemic, the latest financial calculations projected that the HI Trust Fund would be insolvent by the year 2026. It is a fact that the Medicare HI Trust Fund has never been insolvent because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the HI Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the Federal budget as the number of beneficiaries and the per capita healthcare costs increase each year [5]. Uncompensated care refers to uninsured patients who receive care upon hospital emergency room admissions but not ever paying the hospital bill after discharge or death. Uncompensated care is the kryptonite of hospital financing because it is unpredictable and can easily destabilize the monies that hospitals depend on to cover overhead expenses. Nationwide, hospitals protect themselves against the uncertainty of uncompensated care by drastically overcharging prices to different patients receiving the same or similar medical procedures at the very same hospital locations. For all intents and purposes, the creation of Obamacare failed to address this kryptonite. However, it is a fact that the legal system places limitations upon what the federal government can do to deal with this Achilles’ heel of the American healthcare system. State governments truly hold the power to effect change towards the future of healthcare in 2030, both private healthcare and government-sponsored healthcare. Since 1970, one state has proactively protected its statewide healthcare system against the dangers of uncompensated care: Maryland. It is the only state in the entire nation to receive a federal waiver from the U.S. Centers for Medicare & Medicaid Services (CMS) because their specific design for accounting for a plethora of poor patients. This effort started with a group of hospital administrators meeting for coffee on a consistent basis to brainstorm the solution from their collective hospitals. Driven by the pride to help their communities, their involvement with the Maryland government led to the creation of the Maryland Health Services Cost Review Commission (Maryland HSCRC). This impartial governme","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71107413","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 and Aim: Soft tissue augmentation by fat injections has become the most commonly done cosmetic procedure in the early years. It is being widely used for the improvement of the nasolabial folds. The present study was done to evaluate patient satisfaction after fate injections. Materials and Methods: The prospective and randomized controlled trial study was conducted on 524 consenting patients. Fate injection (2.5 ml) on each groove was injected under a local block with lidocaine 2% added epinephrine 1/300000. Patient satisfaction was evaluated at 14, 21, 45, and 90 days. A photographic record was maintained. Any side effects experienced by the patients were recorded. Results: All the patients were satisfied after two weeks, and more than 80% were happy with this. The majority of the patients were happy at 21 days, and the satisfaction was maintained at 90 months. Conclusion: Fat is a very safe and effective modality and also rarely complication for improving the nasolabial fold. This could prove to be a very useful tool for fate atrophy in the nasolabial fold. The patient's expectations after the procedure are very good or well satisfied and happy.
{"title":"Patient Satisfaction with Fat Transfer for Improvement of the Nasolabial Folds","authors":"S. Reza Mousavi","doi":"10.52916/jmrs224079","DOIUrl":"https://doi.org/10.52916/jmrs224079","url":null,"abstract":"Background and Aim: Soft tissue augmentation by fat injections has become the most commonly done cosmetic procedure in the early years. It is being widely used for the improvement of the nasolabial folds. The present study was done to evaluate patient satisfaction after fate injections. Materials and Methods: The prospective and randomized controlled trial study was conducted on 524 consenting patients. Fate injection (2.5 ml) on each groove was injected under a local block with lidocaine 2% added epinephrine 1/300000. Patient satisfaction was evaluated at 14, 21, 45, and 90 days. A photographic record was maintained. Any side effects experienced by the patients were recorded. Results: All the patients were satisfied after two weeks, and more than 80% were happy with this. The majority of the patients were happy at 21 days, and the satisfaction was maintained at 90 months. Conclusion: Fat is a very safe and effective modality and also rarely complication for improving the nasolabial fold. This could prove to be a very useful tool for fate atrophy in the nasolabial fold. The patient's expectations after the procedure are very good or well satisfied and happy.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44557966","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}
Addajou Tarik, Rokhsi Soukaina, Mrabti Samir, Benhamdane Ahlame, Sair Asmae, Berrida Reda, Elkoti Ilham, Rouibaa Fedoua, B. Ahmed, S. Hassan
Background: Klatskin's tumour is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications. The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure. Methods: This is a retrospective and analytical study of 75 patients, conducted between July 2009 and August 2021, including all patients admitted with Klatskin's tumour and for whom endoscopic drainage was indicated. Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis. Results: The average age of our patients was 62.67 years with a male predominance of 68%. Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases. Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases, by a metal prosthesis in 45.2% and by nasobiliary drain in 4.1% . Forty-seven percent of patients had dilatation of the stenosis prior to prosthesis placement. Causes of stenting failure were primarily related to failure of papilla catheterisation, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumour. In multivariate analysis and by adjusting the studied parameters, namely the age, gender, bismuth tumour type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and the bismuth tumour classification affect the success rate. Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p<0.001]. However, tumours classified as bismuth IV [OR=8; p<0.001] or bismuth IIIa [OR=5; p=0.004] were associated with a risk of endoscopic treatment failure. Conclusion: Our study suggests that the presence of metastatic hilar cholangiocarcinoma classified as bismuth IV or bismuth IIIa appear to be associated with failure of endoscopic biliary drainage, whereas endoscopic dilatation prior to prosthesis placement appears to be associated with success.
{"title":"Endoscopic Biliary Drainage in the Palliative Treatment of Klatskin Tumours: Outcomes and Factors Associated with Success or Failure","authors":"Addajou Tarik, Rokhsi Soukaina, Mrabti Samir, Benhamdane Ahlame, Sair Asmae, Berrida Reda, Elkoti Ilham, Rouibaa Fedoua, B. Ahmed, S. Hassan","doi":"10.52916/jmrs224078","DOIUrl":"https://doi.org/10.52916/jmrs224078","url":null,"abstract":"Background: Klatskin's tumour is a cholangiocarcinoma that develops from the right or left bile ducts and the upper part of the main bile duct. They are usually diagnosed at an advanced, inoperable stage, and have an extremely poor prognosis. Biliary drainage is proposed in palliative situation and carries a high risk of infectious complications. The aim of our work is to report the results of endoscopic biliary drainage as well as the factors associated with its success or failure. Methods: This is a retrospective and analytical study of 75 patients, conducted between July 2009 and August 2021, including all patients admitted with Klatskin's tumour and for whom endoscopic drainage was indicated. Factors associated with the success or failure of endoscopic treatment were studied by logistic regression analysis. Results: The average age of our patients was 62.67 years with a male predominance of 68%. Cholangiocarcinoma was classified as bismuth IV in 50.6% of patients, bismuth IIIa in 30% of patients, bismuth IIIb in 13% of patients and bismuth II in 6% of patients. Sixteen percent of patients had liver metastases. Endoscopic drainage was successfully performed in 81.3% of patients by plastic prosthesis in 32% of cases, by a metal prosthesis in 45.2% and by nasobiliary drain in 4.1% . Forty-seven percent of patients had dilatation of the stenosis prior to prosthesis placement. Causes of stenting failure were primarily related to failure of papilla catheterisation, failure to pass the guidewire through the stenosis, or duodenal invasion by the tumour. In multivariate analysis and by adjusting the studied parameters, namely the age, gender, bismuth tumour type, presence of metastases and endoscopic dilatation of the stenosis, only the presence of metastases, endoscopic dilatation of the stenosis and the bismuth tumour classification affect the success rate. Indeed, endoscopic dilatation of the stenosis prior to stenting increases the success rate fourfold. Prosthesis increases the success rate by a factor of 4 [OR=4; p=0.01], whereas the presence of metastases decreases this rate by 65% [OR=0.35; p<0.001]. However, tumours classified as bismuth IV [OR=8; p<0.001] or bismuth IIIa [OR=5; p=0.004] were associated with a risk of endoscopic treatment failure. Conclusion: Our study suggests that the presence of metastatic hilar cholangiocarcinoma classified as bismuth IV or bismuth IIIa appear to be associated with failure of endoscopic biliary drainage, whereas endoscopic dilatation prior to prosthesis placement appears to be associated with success.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41449534","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}
Today, in India, there are about 12,780 post-graduate seats in Master of Surgery of which there 1600 seats are in General Surgery offered by various Government and private medical colleges in India. There is a matter of grief situation that each year less number of undergraduates opting for the General Surgery branch. The foremost reason of it is that the amount of hardwork and stress which a trainee undergoes is incomparable to any other branch. Practicing General Surgery is not an easy job to have for anyone especially in an overpopulated country like India. Secondly, it is not a terminal branch as super-specialization in various disciplines is being offered after completion of postgraduation in General Surgery. So, again toiling for straight 3 years in General Surgery, a fresh Post Graduate (PG) has to again prepare hard to get into any Super-Specialty (SS) branch of his interest as only about 200 seats are being offered in various surgical super-specialty branches across the country. Finding General Surgery a hard road to walk, most undergraduates opt for less tiring branch which may also happens to be a terminal branch. The higher education in medical field is quite a costly affair owing to a few number of Government colleges offering the PG and SS seats. They may cost up to or more than one crore in many of the private medical colleges. To add to this is the ever increasing caste based reservation policy of the Government which is not doing justice to many according to many of the experts and educationists. All these factors result in many seats remaining vacant in the mentioned branch especially in SS across the country. Though the Government has established a new commission i.e. National Medical Commission (NMC) to look after the lacunae in the country’s medical education system, still there is lot that has to be done in this field. There aren’t sufficient faculty posts in the department of General Surgery and surgical super-specialties bearing burden over the system to look after increasing patient burden. General Surgery is the backbone of every institution and hospital which at present is overstressed thanks to the laid-back approach in policy making. Surgeon also has to face burnt of medico-legal proceedings every now and then in our country. Government is thumping it's back of opening more number of medical colleges in different states across the country but the fact is that nothing is on their agenda to improve the actual quality of medical education whatsoever is there. There is no concept of wet lab in surgery department even in various premium institutes of the country. There has not been any mentioning of arranging cadaveric dissection courses in the curriculum of post graduation. No fruitful research has come out from ages in the said department from so called research medical institutes. System has made the PG students to think each second about finishing off with their mandatory thesis work and pass the final exit examination
{"title":"Is General Surgery as Specialsed Medical Branch Getting Extinct in Country?","authors":"Naveen Kumar","doi":"10.52916/jmrs224077","DOIUrl":"https://doi.org/10.52916/jmrs224077","url":null,"abstract":"Today, in India, there are about 12,780 post-graduate seats in Master of Surgery of which there 1600 seats are in General Surgery offered by various Government and private medical colleges in India. There is a matter of grief situation that each year less number of undergraduates opting for the General Surgery branch. The foremost reason of it is that the amount of hardwork and stress which a trainee undergoes is incomparable to any other branch. Practicing General Surgery is not an easy job to have for anyone especially in an overpopulated country like India. Secondly, it is not a terminal branch as super-specialization in various disciplines is being offered after completion of postgraduation in General Surgery. So, again toiling for straight 3 years in General Surgery, a fresh Post Graduate (PG) has to again prepare hard to get into any Super-Specialty (SS) branch of his interest as only about 200 seats are being offered in various surgical super-specialty branches across the country. Finding General Surgery a hard road to walk, most undergraduates opt for less tiring branch which may also happens to be a terminal branch. The higher education in medical field is quite a costly affair owing to a few number of Government colleges offering the PG and SS seats. They may cost up to or more than one crore in many of the private medical colleges. To add to this is the ever increasing caste based reservation policy of the Government which is not doing justice to many according to many of the experts and educationists. All these factors result in many seats remaining vacant in the mentioned branch especially in SS across the country. Though the Government has established a new commission i.e. National Medical Commission (NMC) to look after the lacunae in the country’s medical education system, still there is lot that has to be done in this field. There aren’t sufficient faculty posts in the department of General Surgery and surgical super-specialties bearing burden over the system to look after increasing patient burden. General Surgery is the backbone of every institution and hospital which at present is overstressed thanks to the laid-back approach in policy making. Surgeon also has to face burnt of medico-legal proceedings every now and then in our country. Government is thumping it's back of opening more number of medical colleges in different states across the country but the fact is that nothing is on their agenda to improve the actual quality of medical education whatsoever is there. There is no concept of wet lab in surgery department even in various premium institutes of the country. There has not been any mentioning of arranging cadaveric dissection courses in the curriculum of post graduation. No fruitful research has come out from ages in the said department from so called research medical institutes. System has made the PG students to think each second about finishing off with their mandatory thesis work and pass the final exit examination","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44461728","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}
Medical errors often lead to injury and sometimes death, as these serve as the basis for all medical malpractice claims in the United States. In 2021, over 250,000 deaths occurred as a direct result of medical errors [1]. However, one New England Journal of Medicine article reported that in 2016 a comprehensive study which analyzed 15 years of malpractice claims concluded: “Just one out of every 100 U.S. doctors is responsible for 32% of all malpractice claims that result in monetary payouts to patients” [2]. The majority of human errors that occur in medicine are unintentional. Consequently, the challenges in medical malpractice policymaking center on the interactions of three relevant systems, each with its own complex rules and regulations: health care, tort, and insurance [3].
{"title":"Proven Solution to Reducing Medical Malpractice Claims Nationwide","authors":"B. Pettingill, F. Tewes","doi":"10.52916/jmrs224076","DOIUrl":"https://doi.org/10.52916/jmrs224076","url":null,"abstract":"Medical errors often lead to injury and sometimes death, as these serve as the basis for all medical malpractice claims in the United States. In 2021, over 250,000 deaths occurred as a direct result of medical errors [1]. However, one New England Journal of Medicine article reported that in 2016 a comprehensive study which analyzed 15 years of malpractice claims concluded: “Just one out of every 100 U.S. doctors is responsible for 32% of all malpractice claims that result in monetary payouts to patients” [2]. The majority of human errors that occur in medicine are unintentional. Consequently, the challenges in medical malpractice policymaking center on the interactions of three relevant systems, each with its own complex rules and regulations: health care, tort, and insurance [3].","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46292452","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}
I. Ali, Javeria Anees, Faiza Hassan, Rabiya Siraj, Muhammad Ayub Mansoor, A. Khan
Sialolithiasis account for the most common disease of salivary glands. The majority of salivary gland calculi involve the submandibular duct and rarely in its parenchyma. This is common benign disease may cause the acute or chronic sialadenitis. Sialolith can be single, multiple, unilateral or bilateral. Patient can presents with history of swelling and pain. Giant sialolithiasis is not a common condition mainly occur in submandibular duct. Here we discuss the unusual giant submandibular duct calculus in adult male patient, its Computed Tomography (CT) scan appearance and post-surgical findings.
{"title":"Unusual Giant Calculus of Left Submandibular Duct","authors":"I. Ali, Javeria Anees, Faiza Hassan, Rabiya Siraj, Muhammad Ayub Mansoor, A. Khan","doi":"10.52916/jmrs224075","DOIUrl":"https://doi.org/10.52916/jmrs224075","url":null,"abstract":"Sialolithiasis account for the most common disease of salivary glands. The majority of salivary gland calculi involve the submandibular duct and rarely in its parenchyma. This is common benign disease may cause the acute or chronic sialadenitis. Sialolith can be single, multiple, unilateral or bilateral. Patient can presents with history of swelling and pain. Giant sialolithiasis is not a common condition mainly occur in submandibular duct. Here we discuss the unusual giant submandibular duct calculus in adult male patient, its Computed Tomography (CT) scan appearance and post-surgical findings.","PeriodicalId":73820,"journal":{"name":"Journal of medical research and surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46683280","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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