Medical Research Archives最新文献

{"title":"Laparoscopic Common Bile Duct Exploration for Stones at a Resource Poor Hospital in Trinidad & Tobago: A Retrospective Study","authors":"Shamir Cawich, Fawwaz Mohammed, Vijay Narayansingh","doi":"10.18103/mra.v11i8.4179","DOIUrl":"https://doi.org/10.18103/mra.v11i8.4179","url":null,"abstract":"exploration at the time of cholecystectomy because exploration is perceived to have low clearance rates. We routinely perform laparoscopic explorations for CBD stones at the Port of Spain General Hospital in Trinidad & Tobago. This retrospective study sought to document outcomes after laparoscopic CBD exploration. Methods: We identified all patients who underwent laparoscopic CBD exploration for stone extraction at the General Hospital in Port of Spain over a ten-year period from January 1, 2013 to January 30, 2023. The following data were extracted: demographic details, operating time, stone clearance rates, retained stone rates, conversions, complications. All data were entered into an excel database and the data were analyzed with SPSS version 20. Results: Intra-operative cholangiograms were performed in 49 patients, and CBD stones identified in 12 (25%) patients at a mean age of 48.7+/- 8.63 years. These patients underwent laparoscopic CBD exploration without prior endoscopic retrograde cholangio-pancreatography. The mean stone burden was 4.7+/-2.54 stones. Four (33%) patients had attempts at trans-cystic exploration, and they all required choledochotomies to complete CBD exploration. Eight patients had initial attempts at choledochotomy for stone extraction. The mean operating time for laparoscopic cholecystectomy, operative cholangiography and CBD exploration with duct clearance was 169.6+/-35.1 minutes. There were 2 (17%) conversions, 1 (8.3%) complication (bile leak) and no mortality. Stone clearance rate was 91.7% (11). The mean duration of hospitalization was 0.6 days. There were no instances of retained or recurrent CBD stones in this series. Conclusions: While laparoscopic CBD exploration does demand increased skill sets, such as laparoscopic suturing, mastering duct exploration techniques, interpreting biliary anatomy and operative cholangiography, we have shown that it is feasible in the resource poor Caribbean setting. Surgeons planning to perform laparoscopic CBD exploration should have a working knowledge of biliary anatomy and variations and the ability to suture laparoscopically.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135151734","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":"Assessing challenges and opportunities of treating breast cancer in Lesotho","authors":"Maseabata Ramathebane, Lineo Maja, Mopa Sooro, Molungoa Sello, Motselisi Mokhethi, Kabelo Mputsoe","doi":"10.18103/mra.v11i10.4583","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4583","url":null,"abstract":"Background: It has been estimated that, more than 60% of the new breast cancer cases and 70% of related deaths will be seen in Low-Middle Income Countries in the coming 20 years. In Lesotho, out of 228 women, 177 had heard about breast cancer while 72.9% had heard of breast cancer screening. Given limited treatment facilities and options in Lesotho, many patients die soon after diagnosis, before they are able to access treatment; to date this cannot be quantified. Another challenge that affects breast cancer management is treatment and travel-related costs, particularly for those not living close to the medical centre. Most patients are coming with advanced disease stage and are sent home for home-based care, some of which could have been prevented with early screening. Aim: The aim of study is to determine challenges faced by breast cancer patients, the cost to the health system and the opportunities this may bring to the country. Methods: A quantitative cross-sectional, prospective and retrospective study was conducted on 45 breast cancer patients who were initiated chemotherapy at the only cancer treatment centre in Lesotho; Senkatana oncology clinic located at the Botshabelo complex in Maseru. Results: The majority of patients were facing challenges of arranging transport to the doctor (83.3%, n=15), of being far from the healthcare facilities even if transportation was available (77.8%, n=14), paying for healthcare (83.3%, n=15), paying for transport (77.8%, n=14) and paying for diagnostic test (88.9%, n=16) in all ages. Majority of patients who presented for care and treatment late faced challenges more than those who presented earlier. Diagnostic and monitoring laboratory test constituted 64.5% of total direct medical costs followed by 24.7 % from chemotherapy. Conclusion: The challenges faced by breast cancer patients are of financial and practical nature and they get higher for patients who presented at advanced stage for care and treatment. In order to improve breast cancer care and treatment outcome at lower costs efforts for breast cancer awareness need to be intensified so that patients presented early at the health centers. In term of direct medical cost, the largest cost came from the diagnostic and monitoring laboratory tests.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134889857","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":"THE USE OF SURGICAL SUTURE AS AN IMPLANT PLACEMENT GUIDE – A RETROSPECTIVE OVER VIEW OF OVER TWO DECADES OF IMPLANT THERAPY","authors":"M. Lanka, M. Glenn, S. Sagrika, P. Tanvi, D. Zara","doi":"10.18103/mra.v11i10.4428","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4428","url":null,"abstract":"In the era of digital dentistry, positioning of implants can by designed with the help of CBCT and CAD CAM. Surgical guide can be made to direct the implant placement in bone. Although various researchers showed the importance of 3D planning but because of chances of errors at various levels of digital protocols may lead to deviations. Even no data is available to confirm the accuracy of GBR with digital workflow. This retrospective analysis of simple suture placement technique in anterior edentulous region will make clinicians to understand the positioning of drills, anatomical variations, directions and placements of implants, need of bone grafting and implant emergence.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134890113","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":"How Much Do We Know About the Mouse Respiratory Epithelial Stem Cells?","authors":"Christian Elmshaeuser, Ina Zoeller, Darisuren Anhlan, Ewald Beck, Bruno Peault, Olivier Tabary, Una Chen","doi":"10.18103/mra.v11i10.4522","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4522","url":null,"abstract":"Background-Purpose of this study: Tissue-specific stem cell lines are useful tools for cell biology studies. Information on respiratory tissue cell lines is limited. A doxycycline-regulated epithelial precursor cell line was established from the lung tissue of a tTAxSV40 Tag double transgenic mouse. In this study, we have characterized this cell line in vitro & in vivo, and found to mimic a rare subpopulation of club- and pneumocyte type II-dual cells. Methods: It was partially characterized using cell viability and death assays, H3-thymidine incorporation assay, chloride efflux assay, Western blotting of proteins secreted, RT-PCR assays for RNA isolated. In addition, immune-deficient SCID mice were used as hosts for implantation of this precursor cell line, and feed with/without doxycycline containing water. Immunofluorescent typing using different antibodies were used to characterize the implanted lung. Results: This cell line was found to mimic a rare subpopulation of club- and pneumocyte type II- dual cells with multiple phenotypes. Cell growth was doxycycline-regulated and observed only when doxycycline was omitted from the medium or present at concentrations up to 1 µg/ml, higher concentrations were inhibitory. ACT+ ciliated cells were found upon implantation into immune-deficient mice, in addition. Cell growth was doxycycline-regulated in vitro. When transplanted subcutaneously into immune-deficient mice, these cells migrated to the lung to form organized chimeric structures of donor and host origins, with club cells in the terminal bronchioles, ACT+ ciliated cells along the epithelial lining, and pneumocyte type II-cells in the alveolar interstices. No such homing of donor cells to the lung was observed when the implanted mice were fed doxycycline-containing water. Discussions-Conclusions: This lung stem cell line might be able to provide us with an insight into the differentiation pathway of lung epithelial cells as well as with some understanding of the nature of air trophic-pulmonary epithelial cells. The results of this study underline the possibility of a future application for somatic (stem / precursor) cells in tissue replacement and tissue engineering of the damaged lung. Its ability to secrete and deliver soluble protein, might be a potential novel way for drug delivery. In addition, stem cells are thought to proliferate and differentiate in response to a deficiency or as a result of injury. Successful migration to the target organ and subsequent maturation of these precursors could be attributed to a requirement of lung stem cells to search for an aerated environment. Our findings challenge some current concepts of stem cell biology.This lung stem cell line may become a rich source of cells for tissue engineering and cell-based therapy for lung injury. The route and protocol established for cell introduction into the lung may provide a novel alternative to delivery of soluble protein substances through the airways. This lung","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134891146","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":"An Insight into Emergent Ways of Stemming the Tide of Glaucoma Scourge","authors":"Timothy Oladosu, Aderonke Awoseemo","doi":"10.18103/mra.v11i10.4519","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4519","url":null,"abstract":"Glaucoma, the silent thief of sight remains a beglaring eye condition leading to optic nerve damage due to elevated pressure within the eye. It is one of the major irreversible blinding eye conditions in the world, perhaps devastating as it is mostly without symptoms till considerable vision is lost. This comprehensive article acclaim the silentious nature of this ailment; highlights the distinctive features of glaucoma among other eye disorders; provides practical measures to optimize one’s eye health; shares experiences and feedbacks from people with glaucoma; and identifies promising prospects of glaucoma diagnosis and management. The information therein aims to create awareness about the course and scourge of glaucoma to readers, as well as call the attention of the eye health practitioners to the perceived challenges encountered by patients with glaucoma with the aim of improving consumer’s outcome and quality of life.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134980362","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 Novel Technique to Temporize a Destructive Common Bile Duct Injury in an Unstable Poly-Trauma Patient","authors":"Emery Edmondson, Sean Ramras, Rebecca Jugo, Mohammad Ali, Meagan Kozhimala, Paul Fata, Colline Wong, Peter Zdankiewicz, Zhongqiu Zhang","doi":"10.18103/mra.v11i9.4264","DOIUrl":"https://doi.org/10.18103/mra.v11i9.4264","url":null,"abstract":"We report a case of a 26-year-old patient presenting as a polytrauma with multiple devastating injuries, including a 1 cm destructive injury to the common bile duct (CBD) along with a laceration to the inferior vena cava (IVC). Studies on temporization strategies for common bile duct injuries in the context of damage control surgery are scarce, and guidelines for management of such injuries are limited due to low quality evidence. Surgical treatment for injuries to the extrahepatic bile ducts are individualized based on location, severity, and stability. In stable patients with less than 50% circumference injuries and healthy common bile duct margins, definitive repair can be attempted primarily. Destructive injuries that encompass greater than 50% circumference in stable patients are more challenging and there is controversy surrounding early versus delayed biliary reconstruction. In this case, an adequately sized T-tube was not available, and closed suction drainage was dismissed due to potential complications with early reconstruction. Due to the patient's critical condition and extraordinary circumstances, a LeMaitre carotid shunt was used to temporize the common bile duct injury for 6 days, a technique not previously described. The patient was then reconstructed with a hepaticojejunostomy in Roux-en-y fashion with a favorable outcome. We believe that this method of temporization may be an especially useful tool in the armamentarium of the surgeon practicing in an austere environment.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135311349","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":"The high prevalence of COVID-19 in Diabetics: Unveiling the intricate interplay between viral and diabetic mechanisms","authors":"Dennis Mathew","doi":"10.18103/mra.v11i10.4540","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4540","url":null,"abstract":"Diabetics have an increased risk of contracting COVID-19 infection and tend to have more severe symptoms. This review explores the potential mechanisms underlying the high prevalence of COVID-19 infections in individuals with diabetes. It reviews the emerging evidence about the interactions between viral and diabetic pathways, particularly how diabetes physiology could contribute to higher viral reception, viral entry and pathogenicity, and the severity of disease symptoms. Finally, it examines the challenges we face in studying these mechanisms and offers new strategies that might assist our fight against current and future pandemics.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135360563","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":"Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome","authors":"Laura Donder, Vicky Maerens, Heidi Maertens, Kjell Fierens, Anneleen Stockman, Stefanie Buyser, Cedric Coucke, Yves Blomme","doi":"10.18103/mra.v11i10.4601","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4601","url":null,"abstract":"Objective: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) has been shown to reduce risk for stroke. The optimal surgical technique remains subject of debate. In the latest European Society of Vascular Surgery (ESVS) guidelines on the management of atherosclerotic carotid disease, routine patching is preferred to routine primary closure. However, there are no RCT’s evaluating selective patching strategies. This follow-up study aimed to assess long term complication rate and restenosis after carotid endarterectomy with selective patching. Methods: Two hundred thirteen consecutive carotid endarterectomies over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Patient population consisted of 141 procedures on males and 72 on females with mean age 73 years at the time of surgery (standard deviation (SD) 8.57, range 53-95). There was a follow-up of 89%. Postoperative risk factors were assessed such as hypertension, diabetes mellitus, coronary artery disease and smoking. Postoperative symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to the operative technique to evaluate patency of the carotid artery after carotid endarterectomy. Results: Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate was 3.76% postoperatively (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). There are no significant differences in results between the two groups (P= .09 and P= .05). In four cases patients experienced symptoms of cranial nerve damage postoperatively, two in each group. In one of the two cases in each group, the patient fully recovered and the other had persistent complaints (P-value= 1). None of the patients experienced amaurosis fugax during the 5-year follow up period. In five cases a patient had an ipsilateral cerebrovascular thrombosis in the group after patch angioplasty compared to zero in the primary closure group (P-value= .02). In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P-value = .70). One was caused by cerebral hyperperfusion syndrome within one month postoperative after patch angioplasty and none were caused by an ipsilateral ischemic stroke. Objective duplex ultrasoun","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135360569","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":"An Emerging Storm? Increased Health Inequities in the Context of Racialized Patriarchal Capitalism, Deaths of Despair and Covid-19","authors":"Carles Muntaner, Virginia Gunn, Seth Prins","doi":"10.18103/mra.v11i10.4414","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4414","url":null,"abstract":"his article discusses the gradual increase in Deaths of Despair in the United States, followed by a reversal in the increased life expectancy trend for a subset of the population. This phenomenon is examined in the context of pronounced social and health inequities linked to globalization and capitalism as well as the overall negative implications of the COVID-19 pandemic and subsequent socio-economic crisis, all having the potential to further worsen health and social inequities in the US but also globally. The development of effective and actionable solutions requires an in-depth understanding of the root causes linked to an overall decrease in population-level life expectancy. While focusing on the phenomenon of Death of Despair brings attention to the role of class in the creation of health inequities and increased mortality rates, this approach should be part of a larger examination of contributing factors. Scrutinizing the impact of other social location factors such as race, gender, age, sexual orientation and identity, migration, and citizenship status, along with their interaction is equally important. Research approaches that allow the stratification of analyses by population groups are needed to facilitate a better understanding of the observed decreases in population-level life expectancy. Such approaches require long-term and ongoing investments in research and the intentional collection of indicators that could reveal the breadth and depth of health and social inequities and the pathways through which they lead to increased mortality rates for various population groups. The sustained financial investment and efforts required to examine the causes of decreases in population-level life expectancy and to inform the implementation of protective policies that could reverse this trend have the potential to bring long-term societal dividends. An indirect outcome of the reduction of social and health inequities and the adoption of protective policies could be that individuals and populations regain their trust in social institutions and, as a result, enhance their active political participation through increased voter turnout and decreased political radicalization.","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446644","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":"Case report Liraglutid and insuline resistance","authors":"Stefan Farsky","doi":"10.18103/mra.v11i10.4614","DOIUrl":"https://doi.org/10.18103/mra.v11i10.4614","url":null,"abstract":"Weight reduction in patients with cardiovascular (CV) diseases and concurrent overweight or obesity brings a fundamental improvement in health and prognosis of such diseases, a proven reduction in mortality and morbidity, and is associated with a reduction in pharmacotherapy and the number of hospitalizations, therefore, it is also economically effective. With the current growing trend in population, obesity also becomes a population risk factor that is more significant than smoking, and a leading cause of preventable diseases. From this point of view, the availability of a new effective anti-obesity medication is very welcome, in particular, liraglutide elegantly interferes with the physiological mechanisms regulating food intake. In addition, it reduces the risk of developing diabetes and has anti- atherogenic effects. At the obese diabetic 2 type patients on insulin treatment often resistance develops and in spite of high insuline dosage inadequate control of glucose and HbA1c levels are obvious. We present the extreme case on this topic down: May 2013: first examination dated in our database of cardiology care dept. for out patients, 65 years old man, weight 144 kg, height 178 cm, waist circumferrence 143cm. His history: arterial hypertension since 1993, diabetes 2 type since 2008 on peroral treatment, paroxysmal atrial fibrilation since March 2013, diameter of the left atrium 50mm on ECHO, invasive coronarography negat. Therapy: telmisartan, metoprolol, nitrendipin, warfarin, propafenon, digoxin, spironolacton, statin. November 2013: effect of therapeutic lifestyle changes: regular sinus rhythm, weight 133kg, waist circumferrence 134cm, spironolacton substituted by eplerenon (asymetric gynecomastia), digoxin ex May 2014: weight 126kg, September 2014: atrial fibrilation, propafenon substituted by flekainid, then atrial flutter, switch from flekainid to amiodaron and digoxin, warfarin substituted by apixaban February 2015: sinus rhythm , weight 129kg December 2015: weight 140kg, BP 170/90 mmHg, atrial flutter with a-v blockage 4:1, ankle oedema on both sides, Hb 115g/l, urinary acid 499umol/l, creatinin 119 umol/l, added allopurinol, urapidil, furosemid May 2017: intensification of the diabetes treatment, added insulin application, dosage escalation during the next years, on ECHO: left atriium diameter 52mm, left ventricle diameter 62mm, systolic function of the left ventricle preserved, moderate mitral and tricuspidal regurgitation December 2017: sinus bradycardia 46/min, amiodaron and digoxin ex, sick sinus syndrom brady-tachycardia form, hepatomegaly July 2018: bariatric procedure contraindicated by surgeon because of age and health status December 2018: creatinin 169umol/l, urinary acid 652umol/l October 2019: weight 158 kg, hospitalisation for heart failúre, confirmed by increased NT- BNP level, therapeutic changes from sartan to ARNI, from warfarin to apixaban, increased furosemid dosage. February 2021: weight 159kg, O2 peripheral satura","PeriodicalId":18641,"journal":{"name":"Medical Research Archives","volume":"426 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446651","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}