Clinical Medicine & Research最新文献

{"title":"Cardiac Involvement and Absence of Asthma – What is Phenotype Specificity of EGPA: A Case Report","authors":"J. Fijołek, E. Wiatr, K. Błasińska, D. Piotrowska-Kownacka, K. Roszkowski-Śliż","doi":"10.3121/cmr.2022.1683","DOIUrl":"https://doi.org/10.3121/cmr.2022.1683","url":null,"abstract":"Eosinophilic granulomatosis with polyangiitis (EGPA) typically is characterized by asthma, blood eosinophilia, and extrapulmonary manifestations. Asthma is a major EGPA symptom affecting almost all patients, but cardiac involvement is one of the most serious manifestations, responsible for 31% of deaths. Two recently defined phenotypes of EGPA, according to the patient’s antineutrophil cytoplasmic antibody (ANCA) status, differ significantly in clinical features and prognosis. We share a case of EGPA characterized by atypical manifestation without any evidence of asthma, in whom extensive cardiac involvement was the dominant manifestation of vasculitis. This case demonstrates the difficulties associated with phenotyping EGPA and highlights the importance of cardiac magnetic resonance imaging (CMRI) in definitive diagnosis.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86992190","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 of the Efficacy of Therapeutic Maneuvers in Posterior Canal Benign Paroxysmal Positional Vertigo","authors":"S. Yetişer, Z. Salturk","doi":"10.3121/cmr.2022.1686","DOIUrl":"https://doi.org/10.3121/cmr.2022.1686","url":null,"abstract":"Benign paroxysmal positional vertigo (BPPV) is associated with significant functional impairment with the change of head position with respect to gravity. Therapeutic maneuvers provide relief of symptoms; however, some patients may have persistent symptoms and can be significantly disabled. The aim of this study is to review the critical factors that may have an impact on outcome. Six main categories that may possibly affect the outcome of therapeutic maneuvers in patients with posterior canal (PC) BPPV were selected. A review of the 1095 articles on therapeutic maneuvers in patients with PC BPPV was conducted by means of a search in PubMed, Embase, and Scopus databases between 1989 and 2020. We documented 14 articles about the comparative analysis of success rate of Semont and Epley maneuvers, 7 articles about the comparative analysis of success rate of therapeutic maneuvers and no treatment or sham maneuver, 7 articles about the comparison of success rate in treatment of traumatic and idiopathic cases, 12 articles about the comparison of outcome of repositioning maneuvers with or without postural restrictions, 12 articles about the comparison of success rate of medication and therapeutic maneuvers, and 9 articles about the comparison of vestibular exercises and therapeutic maneuvers. In conclusion, therapeutic maneuvers provide better outcome as compared to no treatment or sham maneuver. Epley maneuver has greater success rate than Semont maneuver. Traumatic cases are prone to develop more recurrences than idiopathic cases and have lower rate of symptom resolution. Body restrictions following successful repositioning maneuver has no impact on recurrence. Medical therapy or vestibular exercise alone is not an alternative to therapeutic maneuvers. However, the rate of residual dizziness is low when the vestibular exercises are combined.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73937191","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":"Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery.","authors":"Callum Robertson, Victoria Wilson, R M Dominic Meek, Robert Carter","doi":"10.3121/cmr.2022.1668","DOIUrl":"10.3121/cmr.2022.1668","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the effect of tourniquet time less than or in excess of 120 minutes on foot surgery wound healing.</p><p><strong>Null hypothesis: </strong>A tourniquet time of over 120 minutes will not affect wound healing in foot surgery.</p><p><strong>Design, setting, participants and method: </strong>A retrospective comparative cohort analysis was performed on 96 patients undergoing complex hindfoot surgery in a large central teaching hospital. Fifty-five patients receiving tourniquet pressure for >120 minutes and 41 receiving <120 minutes of tourniquet pressure were identified from electronic case records. The primary outcome was surgical wound healing. Secondary outcomes were discharge date and complication rate.</p><p><strong>Results: </strong>There was no significant difference in reported time for wounds to heal in the <120-minute or >120-minute cohort. There were no other significant differences in secondary clinical outcomes and no significant variations in patient demographics.</p><p><strong>Conclusion: </strong>This study suggests that tourniquet times from 2 to 3 hours in foot and ankle surgery with pressures up to 300 mmHg are not associated with a significant effect on wound healing.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544197/pdf/0200141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anthropometric Measures for the Prognosis of Obstructive Sleep Apnea in Obese.","authors":"Laura Souza Lagares, Ramon Souza Lino, Eric Simas Bomfim, Felipe Almeida Santos, Ciro Oliveira Queiroz, Lélia Lessa Pinto, Luiz Alberto Bastos Almeida, Clarcson Plácido Santos","doi":"10.3121/cmr.2022.1679","DOIUrl":"10.3121/cmr.2022.1679","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to identify, among the different anthropometric indicators, the one that shows higher discriminatory power for the prognosis of Obstructive Sleep Apnea Syndrome (OSAS).</p><p><strong>Design: </strong>Observational cross-sectional study PARTICIPANTS: Obese individuals elective to bariatric surgery METHODS: A study based on data of 758 patients aged ≥ 21 years old, of both sexes, in the pre-operatory stage of the surgical procedure of gastric bypass. Obstructive sleep apnea and obstructive sleep hypopnea were evaluated and classified through the apnea-hypopnea index, which was obtained through the examination of polysomnography. Variables were divided into two groups: individuals with and without OSAS. As predictors, measures of body mass index (BMI), neck circumference (NC), and waist circumference (WC) were used.</p><p><strong>Results: </strong>The area under the ROC curve was used to check the sensitivity and specificity. All evaluated anthropometric indicators showed statistical significance. WC: area of 0.62 (CI 95%: 0.58 - 0.67), NC: area of 0,68 (CI 95%: 0.64 - 0.72) and BMI: area of 0.58 (CI 95%: 0.54 - 0.63).</p><p><strong>Conclusion: </strong>The investigated anthropometric indicators performed as good predictors of OSAS. However, NC seems to be the best anthropometric indicator for the prognosis of OSAS in obese individuals when compared to BMI and WC.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544195/pdf/0200147.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery","authors":"Callum Robertson, V. Wilson, R. Meek, R. Carter","doi":"10.3121/cmr.2022/1668","DOIUrl":"https://doi.org/10.3121/cmr.2022/1668","url":null,"abstract":"Objective: The aim of this study was to compare the effect of tourniquet time less than or in excess of 120 minutes on foot surgery wound healing. Null hypothesis: A tourniquet time of over 120 minutes will not affect wound healing in foot surgery. Design, Setting, Participants and Method: A retrospective comparative cohort analysis was performed on 96 patients undergoing complex hindfoot surgery in a large central teaching hospital. Fifty-five patients receiving tourniquet pressure for >120 minutes and 41 receiving <120 minutes of tourniquet pressure were identified from electronic case records. The primary outcome was surgical wound healing. Secondary outcomes were discharge date and complication rate. Results: There was no significant difference in reported time for wounds to heal in the <120-minute or >120-minute cohort. There were no other significant differences in secondary clinical outcomes and no significant variations in patient demographics. Conclusion: This study suggests that tourniquet times from 2 to 3 hours in foot and ankle surgery with pressures up to 300 mmHg are not associated with a significant effect on wound healing.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88353309","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":"Meperidine-Ketorolac Combination Provides Better Analgesia than Meperidine Alone in Postoperative Patients.","authors":"Nelly N Umukoro, Shola S Jamgbadi, Erdoo S Isamade","doi":"10.3121/cmr.2022.1628","DOIUrl":"10.3121/cmr.2022.1628","url":null,"abstract":"<p><strong>Background: </strong>Our study objective was to assess if multi-modal analgesia with meperidine-ketorolac combination provides superior analgesia or reduces opioid requirement following surgery compared to Meperidine alone.</p><p><strong>Design: </strong>Double-blind randomized controlled trial.</p><p><strong>Setting: </strong>Postoperative pain control in orthopedic ward after spinal anesthesia.</p><p><strong>Patients: </strong>American Society of Anesthesiology (ASA) risk I or II (ASA I/II) patients who had lower limb implant surgery (88) at our center from September 2014 to July 2015.</p><p><strong>Interventions: </strong>Patients were randomly assigned to receive either 1 mg/kg of intravenous (IV) meperidine and 30 mg of IV ketorolac (treatment group) or 1 mg/kg of IV meperidine (control group) post-surgery, administered every hour for the first 6 hours during the first 24 hours post-surgery. In addition, patients received intravenous meperidine on an 'as needed basis' during the first 24 hours of the postoperative period.</p><p><strong>Measurements: </strong>Outcomes were time-to-first analgesia request postoperatively; cumulative opioid dose in first 24 hours post-surgery; frequency of side effects; and patient satisfaction with pain relief using a Likert scale. Numerical rating scale (NRS) pain scores hourly for the first 6 hours, then the 8th, 12th, 16th, 18th and 24th hour post-surgery were assessed.</p><p><strong>Results: </strong>There was a significant delay in time of first request for analgesia (460 min vs 225 min; <i>P</i>=0.03) and a reduction in opioid consumption in 24 hours (299 mg vs 325 mg; <i>P</i>=0.01) in the meperidine/ketorolac group compared with the meperidine alone group which were both statistically significant. Patient satisfaction with pain relief was better in the treatment group (<i>P</i>=0.01). Additionally, there were fewer side effects in the treatment group than in the control group but this was not statistically significant.</p><p><strong>Conclusions: </strong>Adding ketorolac to meperidine reduced postoperative pain, reduced patient daily opioid requirement, increased patient satisfaction with pain relief, without increasing the frequency of side effects. Therefore, IV ketorolac addition to opioids may be a reasonable option in multimodal analgesic protocol.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544193/pdf/0200133.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10455929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Oral Immunotherapy in Patients with Sesame Anaphylaxis using Omalizumab.","authors":"Fereshteh Salari, Mohammad Hassan Bemanian, Morteza Fallahpour, Seyed Alireza Mahdaviani, Sima Shokri, Majid Khoshmirsafa, Farhad Seif, Mohammad Nabavi, Saba Arshi","doi":"10.3121/cmr.2022.1730","DOIUrl":"10.3121/cmr.2022.1730","url":null,"abstract":"<p><strong>Objective: </strong>Sesame allergy is the most prevalent allergy to seeds. Oral immunotherapy (OIT) is defined as continuous consumption of an allergen at special doses and time. Omalizumab (Anti-IgE) increases tolerance to allergens used in OIT. This study evaluated the effectiveness of a new sesame OIT protocol in patients with sesame anaphylaxis in combination with omalizumab.</p><p><strong>Methods: </strong>In this prospective open-label interventional trial study, 11 patients with a history of sesame anaphylaxis were enrolled after confirmation by oral food challenge (OFC) test. At baseline, skin prick test (SPT) and skin prick to prick (SPP) test were performed. Serum sesame-specific IgE (sIgE) levels were measured. The maintenance phase was continued at home with daily sesame intake for 4 months. At the end of month 4, the OFC and above-mentioned tests were repeated to evaluate the treatment effectiveness.</p><p><strong>Results: </strong>All 11 patients who underwent sesame OIT after 4 months could tolerate a dietary challenge of 22 ml tahini (natural sesame seed, equal to 5,000 mg of sesame protein and higher) and the average of wheal diameter in the SPT and SPP tests significantly decreased after desensitization.</p><p><strong>Conclusion: </strong>This OIT protocol may be a promising desensitization strategy for patients with sesame anaphylaxis. Also, omalizumab appears to have reduced the severity of reactions.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544196/pdf/0200125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10455931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cinema's Terrifying Realities: Pandemics, Zombification, and SARS-COV-2.","authors":"Dennis Henkel, Eelco F M Wijdicks","doi":"10.3121/cmr.2022.1742","DOIUrl":"10.3121/cmr.2022.1742","url":null,"abstract":"<p><p>Contagion is a function of the properties of the pathogen, social interactions, and personal relationships in the society it attacks. Filmmakers in the horror genre were inspired by the idea of rabies as a virus that could mutate into something more dangerous. Fictional epidemics of scavenging undead were often attributed to encephalitis caused by rabies or a mutated rabies virus. During the early months of the SARS-COV-2 pandemic, there was a spike in streaming of <i>Contagion</i> that portrays a viral infectious disease modeled after a bat virus that spreads at an alarming rate, unleashing a global public panic and a clueless governmental response. We wanted to trace how filmmakers used rabies pathology as source material for their plots. We searched internet film databases and reviewed fictional films that utilized this plot device. Many dystopic, rabies-induced pandemic scenarios - mostly from the zombie genre - reveal parallels to the COVID-19 pandemic. Many zombie films, despite their absurd premise, anticipated the realities of future pandemics.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544194/pdf/0200121.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10455930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Vasoconstrictor-Induced Non-Occlusive Mesenteric Ischemia of Colon: A Systematic Review.","authors":"Umer Farooq, Daniel Alcantar, Zahoor Ahmed, Ayokunle T Abegunde","doi":"10.3121/cmr.2022.1726","DOIUrl":"10.3121/cmr.2022.1726","url":null,"abstract":"<p><strong>Background: </strong>Nonocclusive mesenteric ischemia (NOMI) is due to mesenteric arterial hypoperfusion from several causes, such as hypovolemia, heart failure, shock, vasoconstrictors, and severe liver or renal disease. Vasoconstrictor-induced NOMI is usually iatrogenic or associated with cocaine use.</p><p><strong>Objectives: </strong>Anecdotal reports suggest that cocaine-induced NOMI has the highest mortality among vasoconstrictors. This review aims to compare the outcomes of colonic NOMI secondary to cocaine versus other vasoconstrictors.</p><p><strong>Methods: </strong>We conducted a systematic search of MEDLINE from inception through October 2016 to find articles on colonic NOMI. The study's primary outcomes were mortality and hospital length of stay (LOS), while secondary outcomes included the need for surgery. We reported descriptive statistics as percentages or median and interquartile range (IQR). We compared continuous data with the Mann-Whitney test and categorical data with Fisher's exact test; <i>P</i> < 0.05 was statistically significant.</p><p><strong>Results: </strong>Of the 59 studies, 20 case reports and 3 case series (n= 27 patients) met the inclusion criteria. There was no difference in mortality between cocaine-induced NOMI and non-cocaine NOMI (<i>P</i>=1.0). There were statistically significant differences between cocaine and non-cocaine vasoconstrictor-induced colonic NOMI regarding surgery (60% vs. 5.8%, <i>P</i>=0.03) and median LOS (7 days vs. 4 days, <i>P</i>=0.04).</p><p><strong>Conclusion: </strong>Cocaine-induced NOMI and non-cocaine NOMI both appear to have a relatively high but similar mortality rate, but the former is associated with increased requirement for surgery and LOS; prompt recognition of this clinical entity is required to improve outcomes.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544191/pdf/0200164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10456210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Health Care Costs in Understanding Patient Preferences of Providers.","authors":"Anna Breiburg,&nbsp;Ware G Kuschner","doi":"10.3121/cmr.2022.1762","DOIUrl":"https://doi.org/10.3121/cmr.2022.1762","url":null,"abstract":"","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242730/pdf/0200069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}