Medical archives (Sarajevo, Bosnia and Herzegovina)最新文献

Background: Levetiracetam (LEV) is a broad spectrum second-generation antiepileptic drug (AED).

Objective: The objective of the study was to investigate the efficacy and safety of levetiracetam for childhood epilepsies.

Methods: This is single, tertiary centre observational, prospective study, that included paediatric patients who were treated with levetiracetam at Paediatric hospital University Clinical Centre Sarajevo, during the period of 15 years (2008-2022). Inclusion criteria were: paediatric patients age > 1 month, diagnosed with epilepsy according to International League Against Epilepsy. After the introduction of levetiracetam, each patient has been followed up at least 12 months. According to the outcome the patients were divided into 5 groups: seizure reduction >50%, seizure reduction <50%, complete seizure freedom, the same number of seizures and increased number of seizures. From these groups two intergroups have been formed: responders (seizure reduction >50% and complete seizure freedom) and non-responders (seizure reduction <50%, the same number of seizures and increased number of seizures).

Results: The study enrolled 259 patients (141 female and 118 male), with mean age 7 years (3,0-12.0). Comorbidities were present at 129/259 (49.8%) patients. After 12 months of treatment, 25/259 (9.7%) patients had seizure reduction >50%, 30/259 (11.6%) patients had seizure reduction <50%, 154/259 (56.5%) patients had achieved seizure freedom, 31/259 (12%) patients had same number of seizures, while 19/259 (7.3%) patients had increased number of seizures. Seizure frequency between responders and non-responders, before treatment and after 12 months of treatment was statistically significant (p<0.001).

Discussion: Non responders had the best outcome with ditherapy (30/79; 38%), while responders had the best outcome with monotherapy (161/180;89.4%).

Conclusion: Levetiracetam is efficient antiepileptic drug for different types of epilepsies in childhood, used as mono, di or polytherapy.

Background: Anaphylaxis is known as an acute, severe hypersensitivity reaction that rapidly initiates after exposure to a triggering agent. It is a life-threatening condition, and early recognition and swift intervention are crucial to saving patients' lives. Objective: The objective of this study is to assess the ability of certified non-critical care physicians to recognize, manage, and dispose cases of anaphylaxis.

Methods: A survey consisting of 19 questions was developed by expert emergency consultants to evaluate physicians' knowledge regarding the recognition, management, and disposition of anaphylactic episodes. Responses were collected through in-person surveys conducted with physicians from various specialties and varying clinical experience levels at a tertiary care center in the Eastern Province of Saudi Arabia.

Results: In this cross-sectional study, a total of 173 physicians completed the survey, with 81.5% being consultants and 18.5% specialists. Only 5.2% correctly identified all three proposed anaphylaxis clinical scenarios, 16.8% identified two scenarios correctly, and 51.4% identified only one scenario. While 42.8% recognized the first-line management of anaphylaxis, only 24.3% and 24.9% knew the correct epinephrine dose and route, respectively. Regarding the disposition of patients experiencing an anaphylactic episode, 61.9% of responders opted to dispose the case to the emergency department.

Conclusion: Our study reveals a knowledge gap among non-critical care physicians practicing in a tertiary care center concerning the identification and management of anaphylaxis. Raising awareness of this life-threatening condition is imperative to address this serious issue.

Background: Active case finding (ACF) is an alternative strategy to accelerate the identification of TB cases among the migrant population.

Objective: This study aimed to synthesize the evidence for the effectiveness of ACF TB in migrants.

Methods: This study uses the PRISMA model as a method of searching for journal articles in the databases of Google Scholar, ProQuest, EBSCO, ScienceDirect, Elsevier, and PubMed, as well as other sources such as textbooks and reports from 2017 to 2021 with the keywords "tuberculosis" AND "active case finding" AND "migrant". The search revealed 371 articles, of which 26 met the criteria for further discussion.

Results: Most studies show that the TB incidence among migrants is higher than in the local population. Factors leading to increased cases include lack of knowledge about the symptoms, high mobilization, social isolation, economic problems, and medication adherence that impact an advanced stage. Furthermore, it is also influenced by the low quality of health services, including accessibility, health facilities, health workers, and information. Therefore, Active Case Finding (ACF) is more effective in identifying cases of TB in the risk groups. This was conducted on migrants with increased notifications followed up with treatment.

Conclusion: ACF is effective approach in screening and diagnosing TB in the migrant group.

Background: The association between obstructive sleep apnea (OSA) and cognitive decline among older adults is a still a topic of debate. Objective: The aim of this study was to determine the association between risk of OSA and cognitive function among Saudi older adults.

Methods: This was a cross-sectional community-based study conducted between July and October 2022. Participants were recruited from gathering areas where older adults are likely attending such as district centers, waiting areas of shopping malls, and mosques. Questionnaires were completed using face-to-face interviews. The questionnaire included questions of sociodemographics, sleep pattern and health status. A validated Arabic version of Athens insomnia scale, STOP-BANG questionnaire, and St. Louis University mental status (SLUMS) questionnaire were used. A multi-Linear regression model was used to determine the association between cognitive functions and OSA.

Results: A total of 343 participants were recruited in this study, of which 86% were male. The mean age was 65±9 years. 65% of participants with high risk of sleep apnea were diagnosed with either dementia or mild cognitive impairment (MCI). Most of the participants who were illiterate (83%) had dementia, while only 4% of participants with higher education had dementia.

Conclusion: Dementia and mild cognitive impairment is prevalent among Saudi older adults with high risk of OSA. Clinicians and patients should be aware of the risk of developing dementia in patients with OSA, especially if remain untreated.

Background: The molecule known as Interleukin-8 (IL-8), a chemotactic leukocyte, has been found to have a crucial role in the perpetuation of the inflammatory environment that is associated with hepatitis B virus (HBV) infection, as well as in the development of liver cirrhosis and cancer.

Objective: The aim of this study was to carefully examine the role of IL-8 in the inflammatory reaction and to compare the levels based on the severity of liver cirrhosis.

Methods: The study was conducted from February 2018 to September 2018 at the Gastroenterohepatology Division, Internal medicine Department, Faculty of Medicine, Universitas Sumatera Utara. The study was designed as an analytic comparative, cross-sectional study. The liver cirrhosis patients who participated in this study met the inclusion criteria and provided informed consent.

Results: A total of 70 patients were included in the study, from which we identified 1 individual with child-pugh A, 28 individuals with child-pugh B, and 41 individuals with child-pugh C. The serum level of IL-8 was found to be 98 (11-320) (pg/ml). The IL-8 levels between child-pugh B and C patients did not exhibit any noteworthy differences during our analysis (p = 0.109, p>0.05).

Conclusion: There is no notable inequality in the levels of IL-8 across different stages of liver cirrhosis.

Background: Hyperglycemia conditions in diabetes mellitus (DM) can turn on pro-inflammatory cytokines like IL-6 and TNF-α. These cytokines play a role in insulin resistance and the development of DM complications. People in Indonesia have used Phaleria macrocarpa to treat diabetes, but the leaf of this plant has not been studied to see if it can reduce inflammation.

Objective: This study aims to analyze the effect of ethanolic extract of Phaleria macrocarpa leaves (EEPML) in serum IL-6 and TNF-α levels of diabetic rats.

Methods: This study was an experiment with a post-test-only control group design. Thirty 8-week-old male Wistar rats were used in the study. They were split into six groups: K1 was the normal control group; K2 was the DM control group; K3, K4, and K5 were given EEPML at doses of 125, 250, and 500 mg/KgBW; and K6 was given metformin 45 mg/KgBW orally once a day for 14 days. A high-fat diet and a 30 mg/KgBWi.p injection of streptozotocin were used to make the diabetic rat model. ELISA method for measuring serum IL-6 and TNF-α levels. The Kruskal-Wallis and the Mann-Whitney test were used to examine the differences between the groups.

Results: There were significant differences between treatment groups in the mean levels of serum IL-6 (p=0.017), but there were no significant differences in the mean levels of serum TNF-α (p>0.05).

Conclusion: Administration of Phaleria macrocarpa leaf ethanol extract 125 mg/KgBW reduced serum IL-6 levels but could not significantly reduce serum TNF-α levels in diabetic rats.

Background: Decreasing the number of Emergency Department patient visits for treatment, especially in non-urgent cases, is an international healthcare goal. The same applies for pediatric emergency rooms where the utilization of ED is much more than adults.

Objective: We aim to measure the length of stay for all pediatric patients and examine the factors influencing it.

Methods: A retrospective chart review study was conducted at the pediatric ED of King Fahd Hospital in the Eastern Province of Saudi Arabia. The study included all patients presented to the pediatric ED, between January 1, 2018, and December 31, 2018, aged from 1 day to < 14 years old. Data included patient's age, sex, season in which the patient presented in, chief complaint, time of presentation, and whether admission to the hospital ward was collected.

Results: The total number of patients was 37,613. The median LOS was 100, interquartile range (IQR) = 53 - 272 minutes. Male pediatric patients were (55.12%). Among all patients, (32.04%) were toddlers, followed by school aged children (25.05%). The ER received more patients during the winter months followed by summer (32.92% and 24.72%, respectively). Fever was the most common complaint for all patients combined. For prolonged LOS patients, the most common complaints were respiratory related (23.44%). Pre-school children and school aged children were found to have a 5.49% and a 7.93% increased LOS when compared to toddlers (95% CI = 2.52 - 8.53, and 95% CI = 5.01 - 10.93, respectively). Summer was associated with a statistically significant increased LOS (% change = 28.92, 95% CI = 25.53 - 32.40). Morning shift was found to have a 7.89% increased LOS when compared to the evening shift. The highest increase in LOS was attributed to haematology related complaints (% change = 108.32, 95% CI = 85.69 - 133.71).

Conclusion: Several pediatric LOS predicting factors have been identified; morning arrival, and presentation during summertime. Systemic factors such as staffing, and infrastructure can be modified and may affect the length of stay of patients. The implementation of these strategies and the evaluation of their impact on the length of stay in the pediatric emergency department require further investigation.

Background: The Increasing in type-2 diabetes mellitus (T2DM) needs to solve comprehensively and holistically. Patients with T2DM should have self-coping due to lifestyle modification. Abdominal fat accumulation can release pro-inflammatory cytokine that leads TLR-2 and TLR-4 to the response. These two kinds of toll-like receptors exist on the monocyte surface membrane which is an innate immunity cell.

Objective: The aims of this study were to get the profile of physical activity, metabolic state, and mononuclear cell response to the expression of the TLR2 and TLR4 genes in T2DM patients.

Methods: It was a descriptive-analytic study with a cross-sectional study design. Thirty-two eligible patients with inclusion criteria participated as subjects. All subjects answered questions by IPAQ, and checked metabolic state with body composition analysis. The TLR2 and TLR4 gene expression was determined with quantitative Real- Time PCR.

Results: This study result found that most T2DM patients were in a highly active category in which most of their activity was walking (light intensity). The average abdominal circumferences were 91.81 ± 15.4 cm, body fat percentage was 29.5 ± 8.8%, and fasting blood sugar was 187.07 ± 67.03 mg/dl. Mononuclear cells number were normal. The expression of the TLR2 gene was lower by 0.71 fold and TLR4 gene expression was lower by 0.9 fold compared with non-DM (p<0.05). By chi-square test, there was a positive correlation between TLR2 gene expression with fasting blood glucose (p=0.011, and a positive correlation between the abdominal circumference and TLR4 gene expression (p=0.011).

Conclusion: Type-2 Diabetes mellitus patients in primary health care keep walking as their physical activity to maintain blood glucose. Patients need to do moderate to vigorous exercise regularly to reduce body fat percentage especially abdominal fat to reduce Toll-like receptor gene expression, so insulin resistance and blood glucose level might decline to normal.

Background: Aplasia cutis congenita is a heterogeneous disorders group with a rare reported incident of 0.5 to 1 in 10,000 births. ACC can be associated with physical defects or syndrome that may help in diagnosis, prognosis and further evaluation of the patient. Trisomy 13 is one of the most common fetal life limiting diagnosis which is associated with ACC of membranous type scalp.

Objective: In this article, we report cases of aplasia cutis congenita of the scalp with dura and bone defect and exposed sagittal sinus in newborn diagnosed to have trisomy 13. It emphasizes the importance of ACC associated syndrome which is having high mortality prior to surgical intervention.

Case presentation: The patient was born at 35 weeks of gestation. Her physical examination revealed a newborn girl with dysmorphic facial features including widely separated eyes, downward slanting of the palpebral fissure, microphthalmia, retrognathia, and low seat ears. She had area of loss of scalp skin and skull bone with seen brain tissue and sagittal sinus were exposed that was measure 6 by 5 cm in size. Additionally, she had a clenched fist and overlapping fingers and rocker bottom feet. Laboratory investigations include basic labs and the TORCH screen was negative. On the 9th day of life, a chromosomal analysis showed a female karyotype with three copies of chromosome number 13 in all 20 metaphase cells counts.

Conclusion: The patient was managed conservatively. However, a multidisciplinary team agreed on do not resuscitate with no further surgical intervention as survival rate of trisomy 13 is poor.

Background: The treatment strategy for non-muscle invasive bladder cancer (NMIBC) has not changed significantly over the past 30 years. Chemotherapeutic agents (mitomycin-C, epirubicin, etc.) and BCG (Bacillus Calmette-Guerin) immunotherapy are used as adjuvant intravesical therapy.

Objective: To compare the difference between adjuvant chemotherapy and adjuvant immunotherapy in their efficacy of reducing the number of tumor recurrences.

Methods: In this prospective clinical study, which included 99 patients with NMIBC from March 2018.-March 2023., we publish the results for all risk groups of patients treated with intravesical chemotherapy Epirubicin or with BCG immunotherapy, after TURBT (Trans urethral resection of bladder tumor) within 1 year. Patients were stratified into 2 groups. The first group was treated with Epirubicin (1 dose within 24 hours of surgery, then 6 weekly instillations and 3 maintenance doses), and the second group was treated with BCG (2-3 weeks after TURBT 6 weekly instillations, and 3 maintenance doses). The monitoring period was 24 months.

Results: In patients treated with intravesical chemotherapy, recurrence occurred in 9 patients (17.64%), and in patients treated with BCG, recurrence occurred in 7 patients (14.58%). A similar incidence of disease recurrence was observed in both groups (p=0.787).

Conclusion: The results of our study show a similar therapeutic response by risk groups of patients treated with chemotherapy and immunotherapy. Since BCG production will cease in the future, the task of urologists is to introduce intravesical chemotherapy into wider use and to modernize it as a safe and effective method of adjuvant treatment for non-muscle-invasive bladder cancer.