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Blood urea nitrogen and creatinine ratio is an independent predictor for upper gastro-intestinal bleeding even in high prevalence chronic kidney disease population 血尿素氮和肌酐比值是上消化道出血的独立预测因子,即使在高患病率的慢性肾脏疾病人群中也是如此
Pub Date : 2021-01-01 DOI: 10.5455/im.46144
A. Jusoh, Ikram Ishak, A. Karim, Kushairi Zuradi, Izzat Awang
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引用次数: 0
Spontaneous coronary artery dissection presented as posterior ST-Elevation myocardial infarction. 自发性冠状动脉剥离表现为后路st段抬高型心肌梗死。
Pub Date : 2021-01-01 DOI: 10.5455/im.98288
E. Sdogkos, Antonios Papadopoulos, T. Konstantinou, I. Vogiatzis
A 48-year-old female, head nurse in a neighboring hospital, during her morning occupation at the hospital, felt an acute pain in the mid-chest, with radiation in her left shoulder. She was a non-smoker, with no cardiovascular history or predisposing factors for atherosclerotic disease, under treatment with thyroid hormone replacement due to hypothyroidism. Although a mild ST-segment depression was revealed at the 12-lead electrocardiogram left precordial leads, the appearance of an ST-segment elevation at the posterior leads V7, V8, and V9 was in favor of posterior – lateral ST-Elevation Myocardial Infarction (STEMI) [Figure 1].
邻家医院护士长A某,48岁,女,上午在医院上班时,感到胸部中部剧痛,左肩放射。患者不吸烟,无心血管病史或动脉粥样硬化性疾病的易感因素,因甲状腺功能减退而接受甲状腺激素替代治疗。虽然12导联心电图左心前导联显示轻度st段下降,但V7、V8和V9后导联出现st段升高有利于后外侧st段抬高心肌梗死(STEMI)[图1]。
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引用次数: 0
Investigation for medical and long-term care in Japan 日本医疗和长期护理调查
Pub Date : 2021-01-01 DOI: 10.5455/IM.75223
Yozo Takehisa
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引用次数: 2
Stereotactic radiotherapy for intramedullary spinal lesions 立体定向放疗治疗脊髓髓内病变
Pub Date : 2021-01-01 DOI: 10.5455/im.97473
Y. Mori
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引用次数: 0
Single-side open groin hernia repair with mesh or without mesh: Which is the best? 单侧开放式腹股沟疝补片与不补片:哪一种最好?
Pub Date : 2021-01-01 DOI: 10.5455/im.71060
M. Yeni, T. Kalaycı
Background: Groin hernia repair, which is a common operation performed by general surgeons, is still a controversial issue. Although some surgeons recommend mesh repair as the gold standard, the mesh also has its complications. In this study, it was aimed to investigate whether there is an advantage of using mesh in unilateral groin hernia operations. Methods: Patients who were operated on for groin hernia with open surgery at Erzurum Regional Education and Research Hospital, Erzurum, Turkey between 2019 and 2021 were selected for the study retrospectively. After collecting data of the patients, patients were divided into two groups according to mesh usage. Differences between the group in which mesh was used and the group without mesh were evaluated. Results: 173 patients were operated on with open surgery due to groin hernia, and 163 (94.2%) were men. The mean age of all patients was 51.29±18.24 (range from 19 to 91). 84 (48.6%) patients were operated on with mesh, while 89 (51.4%) patients were operated on without mesh. The use of mesh was more common in the elderly (p<0.001). Comorbidity (p=0.042) and the need for a drainage catheter (p<0.001) were higher in the mesh group. Concomitant spermatic cord lipoma (p<0.001), length of hospital stay was longer (p=0.002) and mean rank of leucocyte count was higher (p=0.023) in the non-mesh group. In addition, the use of mesh decreased testicular complications (p=0.029). Conclusions: The use of mesh in groin hernia surgery is more preferred in elderly patients and patients with the comorbid disease, while the leukocyte count is higher and the need for additional imaging is higher in repairs performed without the use of mesh. The presence of cord lipoma during surgery was higher in surgeries without mesh, and the need for a drainage catheter was higher in the mesh group. The hospital stay was longer in cases without mesh with longer postoperative follow-up. Also, the use of mesh in cases does not affect the overall morbidity and recurrence. We emphasize that groin hernia surgeries without mesh can be performed safely like repair with mesh.
背景:腹股沟疝修补术是普通外科医生常用的一种手术,但至今仍是一个有争议的问题。尽管一些外科医生推荐网状修复作为金标准,但网状修复也有其并发症。在这项研究中,目的是探讨在单侧腹股沟疝手术中使用补片是否有优势。方法:回顾性研究2019 - 2021年在土耳其埃尔祖鲁姆地区教育和研究医院接受开放式手术治疗腹股沟疝的患者。收集患者资料后,根据补片使用情况将患者分为两组。评估使用补片组和不使用补片组之间的差异。结果:173例因腹股沟疝行开腹手术,其中男性163例(94.2%)。所有患者的平均年龄为51.29±18.24岁(19 ~ 91岁)。有补片者84例(48.6%),无补片者89例(51.4%)。补片的使用在老年人中更为常见(p<0.001)。合并症(p=0.042)和需要引流管(p<0.001)在补片组较高。非补片组合并精索脂肪瘤(p<0.001),住院时间更长(p=0.002),白细胞计数平均排名较高(p=0.023)。此外,网状物的使用减少了睾丸并发症(p=0.029)。结论:腹股沟疝手术中使用补片更适合老年患者和有合并症的患者,而不使用补片的患者白细胞计数更高,需要额外的影像学检查。无补片组手术中出现脐带脂肪瘤的几率更高,补片组对引流管的需求也更高。未加补片者住院时间较长,术后随访时间较长。此外,在病例中使用补片并不影响总体发病率和复发率。我们强调无补片腹股沟疝手术与补片修补术一样安全。
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引用次数: 0
Recent perspectives for clinical inertia for diabetes mellitus 糖尿病临床惯性的最新研究进展
Pub Date : 2021-01-01 DOI: 10.5455/im.88573
H. Bando
Diabetes mellitus (DM) has been a chronic disease with high social, medical, economic, and health burdens. Across the world, type 2 DM (T2DM) patients were observed at 425 million in 2017 and will be 629 million in 2045 [1]. The main concern would be a rapidly growing number, related complications and adequate treatment in response to various situations [2]. Clinical inertia or therapeutic inertia was defined as the failure to intensify or initiate adequate treatment in accordance with evidence-based guidelines. It is often a key cause for persisting hyperglycemia in T2DM patients [3,4]. Diabetic inertia occurs when healthcare professionals recognize the clinical situation for uncontrolled glucose variability, but do not conduct proper treatment The recent consensus of the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) has been presented, indicating to evaluate and to modify the treatment regularly at the 3-6-month interval, when HbA1c values remain above the target level [6]. International Diabetes Federation (IDF), ADA, and Japanese Clinical Practice Guidelines (JCPG) have presented the recommendation of HbA1c level as <7.0% for the majority of T2DM adults [7-9]. On the other hand, the American Association of Clinical Endocrinologists (AACE) has supported a slightly strict HbA1c level of <6.5% for most diabetic patients [10]. ADA and JCPG recommend rather stringent goals <6.5% and <6.0% for selected patients if achievable without the history of significant hypoglycemia or other adverse effects [7,8]. However, when the case has found severe hypoglycemia, advanced cardiovascular or extensive complications, the goal will be the less stringent level of <8.0%
糖尿病(DM)是一种慢性疾病,具有很高的社会、医疗、经济和健康负担。在全球范围内,2017年2型糖尿病(T2DM)患者为4.25亿,到2045年将达到6.29亿。主要的关切将是迅速增加的数目、相关的并发症和针对各种情况的适当治疗。临床惰性或治疗惰性被定义为未能按照循证指南加强或开始适当的治疗。它往往是T2DM患者持续高血糖的关键原因[3,4]。美国糖尿病协会(ADA)和欧洲糖尿病研究协会(EASD)最近的共识表明,当HbA1c值保持在目标水平[6]以上时,应每隔3-6个月定期评估和修改治疗方案。国际糖尿病联合会(IDF)、美国糖尿病协会(ADA)和日本临床实践指南(JCPG)均建议大多数T2DM成人的HbA1c水平为<7.0%[7-9]。另一方面,美国临床内分泌学家协会(AACE)支持大多数糖尿病患者将糖化血红蛋白(HbA1c)控制在6.5%以下。ADA和JCPG建议,在没有明显低血糖史或其他不良反应的情况下,对选定的患者设定相当严格的目标<6.5%和<6.0%[7,8]。然而,当患者发现严重低血糖、心血管疾病进展或广泛并发症时,目标为<8.0%的较不严格水平
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引用次数: 0
Psychological and illness-related correlates of insomnia in mildly symptomatic Nigerian COVID-19 adult patients during self-isolation 尼日利亚COVID-19轻度症状成年患者自我隔离期间失眠的心理和疾病相关因素
Pub Date : 2021-01-01 DOI: 10.5455/im.82937
O. Aloba, T. Opakunle
Background: Globally, the advent of the COVID-19 pandemic has severely impacted the sleep quality of healthcare workers and healthy subjects. There is a dearth of studies on the extent and factors associated with insomnia among COVID-19 patients in Nigeria and Sub-Saharan Africa. Our aim in this study is to assess the extent and the illness-related and psychological correlates of insomnia in a cross-sectional sample of mildly symptomatic Nigerian COVID-19 adult patients. Methods: Nigerian COVID-19 patients (n=498) aged 18 years and above completed an online survey that consisted of sociodemographic and illness-related details, the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-8), suicidal ideation (item 9 of the PHQ-9) and the Brief Symptoms Rating Scale (BSRS-5). Results: Insomnia of varying degrees was present in 22.5%. Hierarchical linear regression analysis showed that the combination of psychological distress, suicidal ideation, and duration of self-isolation were significantly associated with insomnia (accounts for 86% of the variance on ISI scores). Conclusions: Our study revealed that insomnia is relatively common among the mildly symptomatic COVID-19 Nigerian adult patients. The associated factors may serve as a template for the development of insomnia improving interventions for mildly symptomatic Nigerian COVID-19 patients.
背景:在全球范围内,COVID-19大流行的到来严重影响了医护人员和健康受试者的睡眠质量。目前缺乏对尼日利亚和撒哈拉以南非洲地区COVID-19患者失眠的程度和相关因素的研究。本研究的目的是评估尼日利亚轻度症状COVID-19成年患者的横截面样本中失眠的程度、疾病相关因素和心理相关因素。方法:尼日利亚498例18岁及以上的COVID-19患者完成了一项在线调查,包括社会人口学和疾病相关细节、失眠严重程度指数(ISI)、广泛焦虑障碍量表(GAD-7)、患者健康问卷(PHQ-8)、自杀意念(PHQ-9第9项)和简短症状评定量表(bsr -5)。结果:22.5%的患者存在不同程度的失眠。层次线性回归分析显示,心理困扰、自杀意念和自我隔离持续时间与失眠显著相关(占ISI得分方差的86%)。结论:我们的研究显示,在轻度症状的尼日利亚COVID-19成年患者中,失眠是相对常见的。相关因素可作为针对尼日利亚轻度症状COVID-19患者制定改善失眠干预措施的模板。
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引用次数: 1
Rapid and severe worsening of diabetes in a heart transplant recipient after Johnson and Johnsons Janssen COVID-19 vaccine administration 一名心脏移植受者在强生公司注射COVID-19疫苗后糖尿病迅速严重恶化
Pub Date : 2021-01-01 DOI: 10.5455/IM.79278
Run Yu
The COVID-19 vaccines are usually safe, effective, and well-tolerated by the general population. After the COVID-19 vaccines are widely used, rare and potentially severe vaccine complications become more manifest. Here reported is a case of rapid and severe worsening of diabetes after the Johnson & Johnson's Janssen COVID-19 vaccine (J&J COVID vaccine) administration. A 55-year-old male heart transplant recipient with metformin (500 mg twice daily)-controlled mild diabetes started to have flu-like symptoms a few days after receiving the J&J COVID vaccine. His fasting glucose levels had ranged between 130-150 mg/dL (normal 65-99) before he received the J&J COVID vaccine. The fasting glucose rose to ~200 mg/dL one day after the vaccine administration and gradually rose to ~400 mg/dL over the next few weeks. He presented to the endocrine clinic urgently. Point-of-care fasting glucose was 382 mg/dL and A1c 13.0 (which was 6.7 six months before). Bicarbonate and anion gap were normal, insulin and C-peptide in the low normal range, and β cell autoantibodies negative. Multi-dosing insulin treatment was immediately started and the doses titrated up to insulin glargine 30 units daily and insulin lispro 10 units before each meal. He improved clinically with well-controlled glycemia. The rapid and severe worsening of his diabetes after the vaccination suggests that the J&J COVID vaccine could severely deteriorate diabetes control in some patient populations.
COVID-19疫苗通常是安全、有效的,并且对普通人群具有良好的耐受性。COVID-19疫苗广泛使用后,罕见和潜在严重的疫苗并发症变得更加明显。本文报告了一例强生公司的杨森COVID-19疫苗(J&J COVID疫苗)接种后糖尿病迅速严重恶化的病例。一名患有二甲双胍(500毫克,每日两次)控制的轻度糖尿病的55岁男性心脏移植患者在接种强生COVID疫苗几天后开始出现流感样症状。在他接受强生COVID疫苗之前,他的空腹血糖水平在130-150 mg/dL(正常65-99)之间。在接种疫苗后一天,空腹葡萄糖升高到~ 200mg /dL,并在接下来的几周内逐渐升高到~ 400mg /dL。他被紧急送到内分泌诊所。即时空腹血糖为382 mg/dL,糖化血红蛋白为13.0(六个月前为6.7)。碳酸氢盐和阴离子间隙正常,胰岛素和c肽处于低正常范围,β细胞自身抗体阴性。立即开始多剂量胰岛素治疗,剂量逐渐增加到每天30单位甘精胰岛素和每餐前10单位利斯普罗胰岛素。临床好转,血糖控制良好。他的糖尿病在接种疫苗后迅速严重恶化,这表明强生公司的COVID疫苗可能会严重恶化部分患者人群的糖尿病控制。
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引用次数: 2
Assessment of atrial conduction time by tissue doppler echocardiography and P-wave dispersion in patients with benign prostatic hyperplasia 组织多普勒超声心动图评价良性前列腺增生患者心房传导时间及p波离散度
Pub Date : 2021-01-01 DOI: 10.5455/im.92442
Ayhan Cosgun, Huseyin Oren
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引用次数: 0
Has gender attitude changed over time? Comparison of three generations 性别态度是否随时间而改变?三代比较
Pub Date : 2021-01-01 DOI: 10.5455/im.96358
B. Beyazgul, Fatma Koruk, I. Koruk
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引用次数: 0
期刊
International medicine (Antioch, Turkey)
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