Highlights on Medicine and Medical Science Vol. 13最新文献

{"title":"Study On Cirrhotic Portal Hypertension: An Approach from Pathophysiology to Novel Therapeutics","authors":"L. Gunarathne, Harinda Rajapaksha, N. Shackel, P. Angus, C. Herath","doi":"10.9734/bpi/hmms/v13/9900d","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/9900d","url":null,"abstract":"The most common cause of morbidity and mortality in cirrhotic patients is portal hypertension and bleeding from gastroesophageal varices.Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is distinguished by a high cardiac output, increased total blood volume, and splanchnic vasodilatation, all of which result in increased mesenteric blood flow. The splanchnic and hepatic vascular beds are both targeted by pharmacological management in cirrhotic portal hypertension. Drugs that target the components of the classical renin angiotensin system (RAS), such as angiotensin converting enzyme inhibitors and angiotensin II type receptor 1 blockers, are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and contractile cell vasoactivity, and thus improve portal hypertension. Off-target effects such as systemic hypotension and renal failure have been observed with these medications. As a result, non-selective b-blockers (NSBBs) are the current therapeutic mainstay for preventing variceal bleeding and enhancing patient survival by lowering portal pressure.. These NSBBs function by lowering cardiac output and splanchnic vasodilation, however most patients do not get an adequate therapeutic response, and a large percentage of patients are unable to tolerate these medications. Although statins have been demonstrated to reduce portal pressure and overall mortality in cirrhotic patients when administered alone or in combination with NSBBs, further randomised clinical trials with larger patient populations and specific clinical end points are needed. Recent findings from studies looking into the potential use of blockers of alternate RAS components to inhibit splanchnic vasodilation in portal hypertension provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilation in portal hypertension. This review outlines the mechanisms underlying the pathogenesis of portal hypertension and attempts to provide an update on currently available therapeutic approaches in the management of portal hypertension, with a focus on how the alternate RAS could be manipulated in our quest for safe, specific, and effective novel therapies to treat portal hypertension in cirrhosis.","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"4 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114123209","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}

{"title":"Abnormal Uterine Bleeding (AUB)-Pandora Box- Diagnostic Evaluation by Transvaginal Sonography (TVS), Hysteroscopy and Histopathology as Gold Standard","authors":"Monika Jindal, Monika Gupta","doi":"10.9734/bpi/hmms/v13/3022f","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/3022f","url":null,"abstract":"Background: The term “Abnormal Uterine Bleeding (AUB)” is used for abnormal genital tract bleeding that accounts for 10-15% of all outdoor patient visits in Gynecology department. Common causes of AUB include endometrial polyps, endometrial hyperplasia, sub mucous fibroids and anovulation. Accurate diagnosis of AUB can reduce the incidence of un-necessary surgical interventions and hysterectomies. \u0000Aims & Objectives: Aim of this study is to evaluate the usefulness of transvaginal sonography (TVS) in comparison to hysteroscopy in patients of AUB. \u0000Materials and Methods: A prospective and comparative study was carried out in the Department of Obstetrics and Gynecology over a period of one year in 100 patients attending the OPD with AUB. TVS and hysteroscopy were done in all the patients presenting with AUB and further procedure was done according to the need.   Results were analyzed to check the performance of TVS pick up rate in relation to hysteroscopy and biopsy report was taken as gold standard. \u0000Results: Grossly it seems hysteroscopy is closure to tissue diagnosis, but p-value is not significant. Conclusion: Combination of all the three modalities is helpful in accurate diagnosis of AUB etiology and better management of the patient by reducing unnecessary hysterectomies.","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116015712","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}

{"title":"Study on Functional Outcome, Complication and Readmission Rate in Bilateral Simultaneous Versus Staggered Versus Staged Total Knee Replacement","authors":"Vishal Pusshkarna, A. Reddy","doi":"10.9734/bpi/hmms/v13/2946f","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/2946f","url":null,"abstract":"Background: An important source of debate in orthopaedic practices is the choice of performing simultaneously, staggered or staged bilateral total knee arthroplasty (BTKA). Many studies are available which compare Bilateral simultaneous Vs staged TKA in terms of functional outcome. But still there are no studies which include staggered BTKA (Done in a single hospital stay) and compared their functional outcome, associated complication with a 90 day readmission rate. \u0000Methods: A retrospective review of 300 TKAs patients who underwent bilateral TKA. Patients were divided into three groups with 100 patients each in simultaneous, staggered, staged group. We use hospital electronic health records database to compare the complication and readmission rates in all three groups. Functional outcome was evaluated preoperatively using knee society score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Knee score (OKS) Kujala score and range of motion (ROM). \u0000Results: The study consists of 234 females and 66 males, among which maximum females were in a simultaneous group while male where more in staggered group. Mean age group in our study was 62.25%. ASA score of 3 was significantly more in staged group. Patient in the staggered group had a better KSS and Kujala score with better range of motion and less readmission and complication rate. Simultaneous BTKA had slightly higher complication rate. \u0000Conclusion: This study demonstrates that there is not big significant in functional outcome when comparing simultaneous, staged and staggered bilateral TKA, but still staggered group shows better postoperative functional outcome.","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"14 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134163715","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}

{"title":"Study on Polycystic Ovary Syndrome Risk: Efficacy of Self-Assessment Test","authors":"J. Taneja, T. Arora, Anju Jain, Chandra Mansukhani, Latika Bhalla, Sarita Nanda","doi":"10.9734/bpi/hmms/v13/11007d","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/11007d","url":null,"abstract":"","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127602574","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}

{"title":"Study on Metastatic Clear Cell Hidradenocarcinoma: An Approach towards Response to Chemotherapy and Long Disease Control","authors":"M. Ayadi, Feryel Letaief, Khadija Meddeb, A. Mokrani, Y. Yahyaoui, N. Chrait, H. Rais, K. Bellil, A. Mezlini","doi":"10.9734/bpi/hmms/v13/2888f","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/2888f","url":null,"abstract":"Introduction: Hidradenocarcinoma is a rare aggressive tumor arising from sweat glands that may occur from preexisting hidradenoma or most frequently appears de novo. It occurs most often in old patients and is located in the head, neck and trunk in the majority of time. this tumor is also characterized by a high potential of local recurrence, metastasis and poor outcome. This tumor is often radiotherapy and chemotherapy resistant. We report herein an observation of a good clinical response with a long disease control under capecitabine in metastatic hidradenocarcinoma. \u0000Presentation of Case: We report a case of a 77-year-old man with a metastatic hidradenocarcinoma to the bone and lymph nodes who was operated 7 years ago for an hidradenoma of the right foot. He was treated with capecitabine based chemotherapy with good tolerance and obtention of partial response during 10 months. After that, his disease progressed and he died 1 year after diagnosis. \u0000Conclusion: Hidradenocarcinoma is a cancer with a poor prognosis. Because of its low prevalence and high rate of recurrence, its treatment is still controversial. Our good result demonstrates that adjunction of chemotherapy in metastatic forms is effective for a better control and long overall survival.","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114666369","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}

{"title":"A Review on MVD for Trigeminal Neuralgia","authors":"Renuka S. Melkundi, S. Melkundi","doi":"10.9734/bpi/hmms/v13/2889f","DOIUrl":"https://doi.org/10.9734/bpi/hmms/v13/2889f","url":null,"abstract":"Background: Trigeminal neuralgia (TN) is a rare kind of face pain. \u0000It's characterised by a rapid onset of acute electric shock-like facial discomfort that's centred along the fifth cranial nerve's sensory distribution. \u0000Although many patients respond to medicinal treatment, when PTS symptoms become intractable and drugs are no longer effective, patients must seek surgical decompression. Our study aims to review about the correlation of vascular compression radiologically and during surgery and micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature.  \u0000Methods: It's a retrospective study that looked at 40 people who were diagnosed with TN between July 2009 and July 2015. \u0000All of the patients have undergone MVD. \u0000We looked at demographic information, clinical presentation, surgical findings, complications, and long-term follow-up. \u0000Results: The median age of onset of TN is 50.4 years, with five age groups ranging from 24 to 89 years, with a 65.5 percent female preponderance over men. \u0000The ratio of right to left in the distribution of location was 1.5:1. \u0000The study found no evidence of mortality. \u0000Three patients in the study population experienced complications. \u0000Three patients exhibited facial hyposthesia, one had V3 paresis, and one had CSF otorrhoea, all of which were resolved with LP drainage. \u0000Except for one patient who had prolonged discomfort, all of the patients improved satisfactorily.  Conclusions: To summarise, microvascular decompression (MVD) is the surgical method of choice for medically refractory TN patients who are surgically fit. \u0000MVD has the highest rate of long-term patient satisfaction and the lowest rate of pain recurrence of all the currently known surgical procedures.","PeriodicalId":146175,"journal":{"name":"Highlights on Medicine and Medical Science Vol. 13","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114689782","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}