Annals of Medicine and Surgery最新文献

Background: Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair - a mesh-free technique - offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment.

Materials and methods: With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up.

Results: Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P < 0.0001), and lower costs. Recurrence rates were comparable across both groups.

Conclusion: While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings.

Thoracic aortic aneurysm/dissection (TAA/D) is a complicated vascular disorder with galloping development and high mortality. Phenotype switching plays an important role in the pathological process of TAA/D. Previous studies indicated the potential correlation between the expression level of lncRNA RP11-465L10.10 and MMP9 involved in the development of TAA/D. Here, our results showed that RP11-465L10.10 and MMP9 were highly increased in TAD patient tissues, which was consistent in Ang II-induced vascular smooth muscle cell (VSMC) phenotype switching. However, the effects and underlying mechanism of RP11-465L10.10 on VSMC phenotypic switching remain uncertain. Therefore, the expression of SM22α, cell proliferation, and migration were investigated when ectopically expressed RP11-465L10.10 in VSMCs. The results showed that RP11-465L10.10 overexpression decreased SM22α expression and facilitated VSMC proliferation, migration, and MMP9 expression. Furthermore, the NF-κB signaling pathway was enriched in transcriptome data analysis, indicating that NF-κB signaling may be involved in RP11-465L10.10-induced VSMC phenotype switching and MMP9 expression. In conclusion, this study demonstrated that RP11-465L10.10 induces VSMC phenotype switching and MMP9 expression via the NF-κB signaling pathway, suggesting that RP11-465L10.10 might be a potential therapeutic target for TAA/D treatment.

Radiofrequency ablation (RFA) has become a cornerstone in treating cardiac arrhythmias, offering a minimally invasive approach to managing conditions such as atrial fibrillation, ventricular tachycardia, and other rhythm disorders. The historical evolution of RFA, from its early inception to its current state, underscores the technological advancements that have significantly enhanced its efficacy and safety. Global trends indicate a steady increase in the adoption of RFA, with notable research contributions from North America, Europe, and Asia. Comparative studies reveal outcome variability driven by differences in patient populations, procedural techniques, and healthcare infrastructures. Despite its success, RFA faces challenges, including complications related to the procedure, patient selection, and long-term efficacy. Emerging technologies, such as integrating artificial intelligence and enhanced imaging modalities, hold promise for overcoming these barriers and further refining the procedure. Gaps in current research are identified, particularly in understanding the long-term outcomes of RFA and its application in complex arrhythmias. The critical role of RFA in modern cardiology is emphasized, along with the potential for future innovations that could expand its therapeutic utility. This synthesis of the latest evidence provides valuable insights for optimizing the use of RFA in managing cardiac arrhythmias.

Introduction: A benign osteoma is a non-cancerous bone tumor in the external ear canal that can cause hearing loss. Treatment may require surgery if symptoms arise.

Case presentation: A 14-year-old child severed right ear pain, thick discharge, and hearing loss for a week after unsuccessful treatment elsewhere. Examination showed swollen ear canal and purulent discharge. After antibiotic treatment, thick debris remained. The osteoma was excised through its pedicle to minimize the risk of recurrence.

Clinical discussion: Osteomas are benign ear growths that can cause hearing loss and blockage. Severe symptoms may require surgery, with the endoscopic transcanal method being effective for osteomas. Blockage can also occur from wax buildup or foreign bodies, potentially leading to cholesteatoma. Osteomas are typically asymptomatic and identified through CT scans, predominantly located in the external auditory canal (EAC). Surgery is advised for symptomatic cases, while regular check-ups are recommended for asymptomatic patients.

Conclusion: Additional research is necessary to fully comprehend the causes and optimal treatment strategies for benign osteoma in the EAC.

Background: World Health Organization recommends in patient therapeutic feeding program as a standard treatment protocol for the management of complicated severe acute malnutrition. This program has been decentralized to public hospitals in Ethiopia. Early recovery is a performance indicator for severe acute malnourished children for the therapeutic feeding.

Objective: The aim of the study was to assess time to recovery and its predictors among children aged 6-59 months admitted with severe acute malnutrition to inpatient therapeutic feeding centers at hospitals in west Shoa zone, Ethiopia.

Methods: Institution based retrospective cohort study was conducted on 428 children aged 6 to 59 months admitted with Severe Acute malnutrition cases at selected hospitals in West Shewa zone from January 1, 2017 to December 30, 2021. A total of 428 charts were selected using a systematic random sampling method and 395 of them were used for the final analysis. Kaplan-Meier estimates and survival curve were used to estimate the survival time, log-rank test was used compare survival time between groups of categorical variables, and Cox-proportional hazard model was used to identify significant predictor of the time to recovery. P value <0.05 was considered statistically significant.

Results: The nutritional of recovery rate was 81.27% (95% CI; 77.09-84.83) with a median nutritional recovery time of 15 days (IQR; 10). The predictors of time to recovery were having HIV (AHR = 0.31, 95% CI, 0.14-0.66), Tuberculosis (AHR = 0.25, 95% CI, 0.16-0.38), not breast feeding until 24 months (AHR = 0.29, 95% CI, 0.22-0.41), partially vaccinated for age (AHR = 0.43, 95% CI, 0.31-0.61), Admitted during production season (AHR = 0.49, 95% CI, 0.37-0.67) and not took deworming (AHR = 0.60, 95% CI, 0.48-0.75) were associated with longer periods of nutritional recovery time.

Conclusion and recommendations: Both percentage of recovery and the recovery time were within the acceptable minimum standards. But special attention has to be given to children who having HIV, Tuberculosis, breast feeding less than 24 months, partially vaccinated for their age, children admitted during production season and not supplementing with deworming during inpatient management. The health workers with different stages of health administer must increase the awareness of breastfeeding, fully vaccination and ways of preventing communicable disease.

Background: Adherence to long-term secondary preventive therapies is vital for improving outcomes in patients recovering from acute coronary syndrome (ACS). This study aims to quantify the extent of non-adherence to these therapies in Iraq and identify the main factors contributing to this issue, addressing a research gap in the Eastern Mediterranean region.

Methods: This cross-sectional study was conducted from June 2023 to March 2024 in Cardiology Ward of Azadi Teaching Hospital and the Duhok Heart Center, Duhok, Kurdistan Region of Iraq, enrolling 400 patients diagnosed with (ACS). The Adherence in Chronic Diseases Scale (ACDS) was utilized to categorize patients into high, intermediate, or low adherence groups. The study questionnaire comprised three sections including clinicodemographic data, adherence assessment based on the ACDS, and patient-reported reasons for non-adherence.

Results: The study revealed that the mean age of the participants was 65.78 ± 11.8 years. Within the sample, 24% reported low adherence, 39% reported medium adherence, and only 37% exhibited high adherence. Significant associations were observed between low adherence and older age (P = 0.026), lower education levels (P = 0.0051), and the presence of endocrine disorders (P = 0.029). Conversely, higher adherence was found among patients taking 3-5 different medication classes (P = 0.0003) and those who underwent coronary interventions (P = 0.014). The primary reason for non-adherence was forgetfulness (89.5%).

Conclusion: The study concludes that a substantial portion of ACS patients in Iraq show low adherence to secondary preventive therapies. To increase adherence among patients with ACS, strategies should be developed to improve medication adherence and promote healthy behaviors simultaneously, Forgetfulness and lack of follow-up are the primary reasons for non-adherence.

Introduction: Hydatid illness is caused by the parasite tapeworm Echinococcus. Spinal hydatid disease without visceral involvement is a rare condition. Symptoms of spinal hydatid disease are not specific and typically stem from spinal cord compression. Back pain is common, while radicular pain is observed in 25% to 95% of patients. Paraparesis is noted in 25% to 77% of individuals.

Case presentation: We present a case of an isolated spinal hydatid cyst in the lumbar spine in a 13-year-old girl presented with progressive bilateral lower limb paraparesis. The radiological, laboratory, and clinical findings were consistent with a diagnosis of brucellosis. However, the symptoms persisted despite treatment, and it was later revealed through surgery and pathological examination that the child had isolated hydatid cysts in the vertebrae.

Discussion: While primary spinal hydatid cysts are rare, the incidence of these lesions might be higher if cases that resembled other cystic lesions on radiological scans but were conservatively managed, especially in endemic regions, are considered. When determining a surgical approach, it is important to consider hydatid disease as a possibility for certain bone cystic lesions.

Conclusion: Hydatid cysts should be considered in any child with a history of paralysis, especially if the child comes from an endemic area. In our case, the child was initially diagnosed with brucellosis, but it was later found that isolated hydatid cysts in the vertebrae caused the paralysis.

Objective: To assess the efficacy and safety of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors in reducing major adverse cardiovascular events (MACE) in statin-intolerant patients, focusing on low-density lipoprotein cholesterol (LDL-C) reduction and cardiovascular outcomes.

Methods: A systematic review and meta-analysis were conducted according to the PRISMA guidelines. Randomised control trails (RCTs) and observational studies from PubMed, Cochrane Library, and Web of Science databases were included. Independent reviewers extracted the data, and the analyses were performed using fixed- and random-effects models. Heterogeneity was evaluated using the I² statistic and publication bias was assessed using Egger's test.

Results: Fifteen studies involving 69-18 924 participants were included. PCSK9 inhibitors reduced LDL-C levels by 50-70% and lowered the risk of MACE by 12% (OR 0.88). Minimal heterogeneity (I² = 0%) indicated consistency across studies. Subgroup analysis showed greater efficacy in high-risk populations (e.g., acute coronary syndrome and familial hypercholesterolemia). Adverse events were mild, with minimal muscle-related side effects.

Conclusion: PCSK9 inhibitors are effective and safe alternatives for LDL-C reduction and cardiovascular risk mitigation in patients with statin intolerance. Their efficacy, favorable safety profile, and consistency across studies highlight their potential for managing dyslipidemia, particularly in high-risk groups. Further research on long-term outcomes is required.

Crovalimab, a new promising drug for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) has emerged. This marks a significant advancement in the treatment of PNH and potentially other complement-mediated disorders. PNH is characterized by complement-mediated hemolysis, thrombosis, and bone marrow failure, leading to severe morbidity and mortality in affected individuals. PNH arises from a somatic mutation in the PIGA gene, leading to the loss of glycosylphosphatidylinositol (GPI)-anchored proteins on blood cells, making them vulnerable to complement-mediated destruction. Crovalimab is a new anti-C5 recycling antibody that offers a promising treatment by being administered subcutaneously every 4 weeks at a low volume. Clinical trials such as COMMODORE 3 have shown crovalimab's effectiveness and high tolerability in PNH patients who have not previously used a C5 inhibitor. Crovalimab has been proven effective in maintaining hemoglobin levels, reducing the need for transfusions, and improving patient outcomes by inhibiting terminal complement activation.

Background: Propranolol is widely recognized as a nonselective β-adrenergic receptor blocker known to enhance uterine activity in both pregnant and non-pregnant women. Prolonged labor and serious concerns about maternal and neonatal health prompted us to investigate medical issues. The aim of this systematic review and meta-analysis was to assess the effect of propranolol on cesarean deliveries during prolonged labor.

Methods: A systematic search was conducted in databases including PubMed, Cochrane CENTRAL, Science Direct, Google Scholar, Embase, and Web of Science from inception to 1 November 2023. We included randomized clinical trials that evaluated maternal and neonatal outcomes in patients receiving intrapartum propranolol during prolonged labor. Unadjusted risk ratios with 95% confidence intervals were calculated using a fixed-effects model. The I² statistic was used to measure and assess heterogeneity. The primary outcome was cesarean delivery rate, and secondary outcomes included Apgar score, cord arterial pH, neonatal birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and composite maternal and neonatal morbidity.

Results: Of the 704 identified articles, six were included in the meta-analyses. There was a significant difference in cesarean deliveries between propranolol and placebo (RR 0.80, 95% confidence interval 0.59-1.09, P = 0.02). In addition, there was no significant difference between study groups in secondary outcomes.

Conclusion: In this meta-analysis, a notable reduction in cesarean rates was observed when propranolol was given to women in prolonged labor. The results of this meta-analysis show that the use of propranolol safely reduces the need for cesarean deliveries due to labor arrest disorders.