British Medical Journal (Clinical research ed.)最新文献

{"title":"A Students’ Health Centre Design for Qatar","authors":"","doi":"10.33140/mcr.05.11.02","DOIUrl":"https://doi.org/10.33140/mcr.05.11.02","url":null,"abstract":"Introduction: School health services have the purpose of ensuring that all students are ready to learn by ascertaining that they are in good health. More than 2.3 billion school-aged children have been reported to spend a third of their days in the school environment1. Such findings underscore the need to establish school health centers (SHCs) that exclusively promote students’ physical, social, and psychological health of school children, yet currently non-existent in the State of Qatar. Aim: The present paper aims to propose the establishment of SHCs in Qatar, and to envision the impact of these comprehensively and uniquely designed Student Health Care Centers (SHCs) for school children health and wellbeing in Qatar. Student’s Health Center Design: Qatar prioritizes student’s health as part of its high-quality health care services. Qatar’s student health will benefit from establishment of comprehensive school health center services. Recommendation: This paper presents an SHC design that may be used in the State of Qatar. Identical SHC design may be applied in other countries also to improve the health, and quality of life among school children by creating a platform for rendering multidisciplinary health care services and health promotion to school children.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81810828","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":"Lamivudine Revisited: Long-Term Treatment of Relatively Low-Viremic Hepatitis B Patients on Higher-Dose Lamivudine","authors":"","doi":"10.33140/mcr.05.11.03","DOIUrl":"https://doi.org/10.33140/mcr.05.11.03","url":null,"abstract":"Hepatitis B virus (HBV) is a significant global health problem with more than 350 million people chronically infected. Currently it is believed that HBV is responsible for 50% of hepatocellular carcinoma (HCC) worldwide [1-3]. While a cure for HBV is still needed, several oral drugs that suppress viral replication exist. In the United States, six nucleos(t)ide analogues that have been approved at different time periods include lamivudine (1998), adefovir (2002), entecavir (2005), telbivudine (2006), tenofovir disoproxil fumarate (2008) and tenofovir alafenamide (2016).","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78230413","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":"Complications Versus Lawsuits !","authors":"","doi":"10.33140/mcr.05.11.05","DOIUrl":"https://doi.org/10.33140/mcr.05.11.05","url":null,"abstract":"Not every medical claim or lawsuit is necessarily result of a complication or a malpractice. This is especially true in Plastic surgery practice. It was interesting to compare serious surgical complications and mortality risk in various specialties. Gastric bypass surgery, a very popular bariatric procedure designed to treat obesity carries a mortality risk of 0.3% within a month (1:333 cases). Laparoscopic cholecystectomy carries a mortality risk of 0.15% or (1:666) within a month of the surgery as well. Whereas Liposuction as a sole procedure (probably the most common aesthetic operation globally) carries a mortality risk of 1:5000 based on one of the most critical reviews on this issue (Grazer et al. PRS 2000; 105:436-66).","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91553469","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":"Successful Reduction of SARS-CoV-2 Viral Load by Photodynamic Therapy (PDT) Verified by QPCR – A Novel Approach in Treating Patients in Early Infection Stages","authors":"","doi":"10.33140/mcr.05.11.04","DOIUrl":"https://doi.org/10.33140/mcr.05.11.04","url":null,"abstract":"Background: The Covid-19 pandemic is affecting Global Health and the world‘s economy dramatically since early 2020. After a temporary slowdown in summer 2020 the infection numbers and death rates have been increasing again in recent months leading to various restrictions of social and economic life in many countries. Latest developments of new vaccinations seem to be promising; however large-scale production and worldwide distribution logistics take time while questions such as length of immune protection, long-term side-effects etc. are remaining unclear at this point. Furthermore, vaccination is a preventive approach and not a therapy for acutely infected patients. Thus, there are still therapies needed to help people with Covid-19 Infections. The objective of this study was to evaluate if Photodynamic Therapy (PDT) with Riboflavin and a specially designed light treatment kit would be able to fill this gap and to help people in early stages of infection. This may lead to a relief of the hospitals and intensive care stations. Methods: This study was made up of two groups with 20 patients each with the experiment (verum) group receiving Photodynamic Therapy and daily testing and a control group receiving conventional care plus testing. All patients in both groups had positive Covid-19 test results at the beginning of the study being in an early infection stage with mild symptoms like fever, dry cough, headache, hard breathing, fatigue etc. QPCR tests with CT-viral load were performed on day 1, 2, 3, 4, 5 and 7 in the experiment group and on day 1, 3, 5 and 7 in the control group. Results: All 20 patients in the experiment group showed significant improvement in clinical symptoms and viral load assessment within the 5 days of PDT treatment. 14 out of 20 patients had a negative QPCR test after 5 days of treatment with PDT while the other 6 patients also showed significantly reduced viral load. 20 patients in the control group with conventional care were tested 3 times within 5 days and no significant improvement could be seen clinically or in viral load assessment. Conclusion: In this primary study the potential of Photodynamic Therapy (PDT) against SARS-CoV-2 could be shown in early infections stages. PDT proved to be successful in improving clinical symptoms, lowering viral loads and in preventing hospitalisation and intensive care treatments. This treatment is easy to perform, cost effective and can be done at home. It can be used for prevention after contact with infected people or in case of positive testing but also in early cases with mild to moderate clinical symptoms.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82766943","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":"“Double Headed” – Primary Giant Intracranial Melanoma","authors":"","doi":"10.33140/mcr.05.10.13","DOIUrl":"https://doi.org/10.33140/mcr.05.10.13","url":null,"abstract":"A16 years old male admitted to the hospital complaining of headache, loss of vision and swelling of the upper part of the scalp. With four months’ history of headache, weightloss, gradual loss of vision and rapidly growing mass on his scalp. His past medical history was unremarkable. There is no known consanguinity or family history of melanoma or atypical melanocytic nevus. Magnetic Resonance Imaging of the brain demonstrated ahuge heterogeneous enhancing mass in the left fronto-parietal lobe","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76543048","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":"Exceptional Design for an Adult Oral Health Screening Program, Qatar","authors":"","doi":"10.33140/mcr.05.10.12","DOIUrl":"https://doi.org/10.33140/mcr.05.10.12","url":null,"abstract":"Introduction: As a result of an increased life expectancy and reduced fertility, it is anticipated that by 2050 about half of the world’s population will be aged 60 years and above. This increased longevity has posed a challenge of adding health to life as progressive improvements in older people’s health that translate to longevity may be stalled. Physiological aging is usually associated with multiple chronic diseases, frailty, polypharmacy, and the loss of dependency and autonomy for daily living activities. Besides, reduced dexterity, impaired vision, and lower tactile associated with physiological aging pose an increased risk to oral hygiene. Furthermore, older adults, especially those with cognitive impairment, have more compromised oral health. Aims and Objectives: The aim of this heuristic designed project is to screen all adult patients, including those with a history of chronic diseases living and seeking dental services at the public sectors and other sectors in Qatar. To improve the treatment of oral health diseases, the overall oral health of older adults, and to develop a data repository of oral diseases in the elderly population under one national umbrella for the first time in Qatar. Project Design: This project is consisting of two tests, pre-test, and post-test design. The use of this design will allow us to understand the oral health challenges in Qatar. This screening’s expected outcome will reveal the critical factors and challenges that affect the oral health logistic system. It will also help in improving and identifying all oral health problems. Help in testing whether Qatar’s older population’s oral health screen effectively reduces the risk of poor oral health among this group. Oral health screening will be implemented as a regular intervention that will be delivered using the Oral Health Assessment Tool (OHAT) such as tongue, lips, saliva, dental pain, natural teeth, gums and oral tissue, and dentures. Expected Outcomes: The project is anticipated to support the practical application and real operational status of healthcare settings. Besides, it is anticipated that this project will optimize the chances for maximum impact once the program is implemented. Furthermore, it is expected that the project will include an essential part for decision making, evaluation, and justifications and will also hold key evaluation features for program impact and monitoring. Another expected outcome of this project is its ability to document programs effectively and identify significant opportunities for improvement with collected data. Finally, it is expected that this project will result in a model outline that will be implemented in both Qatar and across the globe to help merge the public sector and other sectors’ dental health data on a national level. Recommendation: Since the number of adults with a history of chronic diseases and have oral conditions is still unknown in Qatar due to the lack of a database, the authors recommend th","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89762701","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":"Q Kidney Risk Calculator- Useful Tool in Hospitals and Community","authors":"","doi":"10.33140/mcr.05.10.11","DOIUrl":"https://doi.org/10.33140/mcr.05.10.11","url":null,"abstract":"A kidney health check was conducted over a day in two private hospitals (Peninsula Private Hospital and Beleura Hospital) in 2017. 243 participants enrolled in this study. The study population were mobile inpatients, members from the public and health workers (nurses, doctors, allied health workers and administrative staff). Method: A Q risk calculator was used to assess the risk of developing moderate and severe chronic kidney disease (eGFR <60 mls/min) and end stage renal failure over the next 5 years. All participants consented prior to being involved in the study. Results: The majority was aged 65 to 75 years old (aged population). 18% of the participants were diabetic, 18% had cardiovascular disease, 37% were hypertensive, 5% were smokers, 28% of the participants were overweight and obesity was seen in 25%. Diabetic females are five times higher risk than non-diabetic females in developing chronic kidney disease stage 3 and 4. Male diabetics are three times more at risk than non-diabetic men in developing moderate to severe chronic kidney disease. However diabetic men are five times higher risk than normoglycaemic men in progressing into end stage renal failure Females with cardiovascular disease are five times higher risk than women with no cardiovascular disease in developing moderate to severe chronic kidney disease. Men with cardiovascular disease are three times higher risk than men with no cardiovascular disease in developing moderate to severe chronic kidney disease. Hypertensive women are ten times higher risk than normotensive women in developing moderate to severe chronic kidney disease. Interestingly hypertensive men are four times higher risk than normotensive male in developing end stage renal failure Obese men are three times higher risk than normal weight men in developing moderate to severe chronic kidney disease. Underweight females are three times at risk than normal weight females in developing moderate and severe chronic kidney disease. Summary: Qrisk questionaire is a quick and easy tool to assess risk of developing chronic kidney disease. Participants with diabetes, hypertension and cardiovascular disease have a higher risk of developing moderate and severe chronic kidney disease over the next 5 years. Overweight (body mass index 25 to 29.99), obese patients (body mass index more than 30) and interestingly underweight females with body mass index 18.5 or less have a higher risk of developing moderate and severe chronic kidney disease.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88273086","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":"Scholastic and Cognitive Achievement Following Adenotonsillectomy in Children with Obstructive Sleep Apnea","authors":"","doi":"10.33140/mcr.05.10.10","DOIUrl":"https://doi.org/10.33140/mcr.05.10.10","url":null,"abstract":"Objective: To evaluate the effect of adenotonsillectomy (AT), in children with Obstructive Sleep Apnea (OSA), on the cognitive and scholastic achievement. Study Design: Prospective study Sitting: Tertiary care hospital (Minia university hospital) Subjects and Methods: 50 children were selected, complaining of symptoms of (OSA) and seeking adenotonsillectomy compared to another control group of 50 children without symptoms of OSA. The study sample were subjected to clinical evaluation where hypertrophied palatine tonsils and Adenoid were the cause of OSA. Polysomnography, audiological evaluation were done and All 50 children underwent a battery of neurocognitive tests including process-oriented intelligence scales (Stanford Binet Intelligence scale and Illinois Test of psycholinguistic ability) pre and post adenotonsillectomy to reveal the effect of (AT) on the cognitive and scholastic achievement of those children. Results: Children with OSA had lower scores in neurocognitive tests (Illinois test and Stanford Binet intelligent scale), as well as. In Academic performance in comparison to the control group. After 8 months from AT, the children with OSA demonstrated highly significant improvement in IQ, Mental age, auditory perceptual assessment (APA), PLA of VSM (Visual sequential memory), AA (Auditory association) VA (Visual association), AC (Auditory closure), VC (Visual closure), GC (Grammatic closure) and SB (Sound Blending). Conclusions: School performance and Neurocognitive functions are worsened in children with Adenotonsillar hypertrophy, this effect is reversible as improvement occurred after their removal.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77475680","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 Immune-modulating Diet Maintains Food Intake during Cancer Chemotherapy","authors":"","doi":"10.33140/mcr.05.09.07","DOIUrl":"https://doi.org/10.33140/mcr.05.09.07","url":null,"abstract":"An immune-modulating diet (IMD), an enteral diet enriched with immunonutrition and\u0000 whey-hydrolyzed peptides, has been shown to bring an improvement of prognosis by\u0000 suppressing inflammation after surgery or under stress. In this study, we have\u0000 experimentally and clinically examined the effect of the IMD in cancer chemotherapy. In\u0000 experiments using colorectal cancer cell-transplanted mice, the mice fed with the IMD in\u0000 combination with anti-cancer agent showed significantly to maintain their body weight\u0000 excluding tumor, and to reduce plasma interleukin-6 (IL-6) levels compared with the\u0000 control group. Furthermore, normal mice fed with the IMD elevated the level of plasma\u0000 ghrelin, in particular acyl ghrelin. An clinical trial for a patient with malignant\u0000 lymphoma revealed that the acyl/desacyl ghrelin ratio and total calorie intake was\u0000 increased when the patient was supplemented with the IMD in conjunction with\u0000 chemotherapy. These results suggested that the supplementation of the IMD during cancer\u0000 chemotherapy might enable to maintain the food intake of the patients through elevating\u0000 their acyl ghrelin levels","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79970352","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":"Hypofractionated External Beam Irradiation with Single HDR Iridium 192 Boost in the Treatment of intermediate and High Risk Prostate Cancer Patients Initial acute and late side effects","authors":"","doi":"10.33140/mcr.05.10.07","DOIUrl":"https://doi.org/10.33140/mcr.05.10.07","url":null,"abstract":"Purpose: Dose escalation has been shown to improve biochemical outcome in the treatment of prostate cancer. The use of precision radiotherapy whether using IMRT, proton’s or other appropriate means have been utilized in an effort to reduce side effects while engaging in dose escalation. However, it is well known that best way to ensure precision delivery of radiation is with the use of brachytherapy. In prostate cancer the use of HDR brachytherapy exploits the low α/β ratios. We sought to evaluate our combination of moderate hypofractionated external beam irradiation with a single HDR boost in terms of acute/late toxicity in patients with intermediate and high risk prostate cancer. Method: 69 patients whose age range from 49 to 83 (med = 69 y.o.) years old were offered treatment utilizing the combination of moderate hypofractionated external beam irradiation and single HDR boost. The external beam irradiation consists of 17 fractions of 250 cGy per fraction, which using BED evaluation most closely approximated our previous more conventionally delivered external beam (23 fractions/200 cGy per fraction) irradiation in this setting. All patients were treated with either 3D conformal or IMRT; within 2 weeks of completion of external beam irradiation a single 1500 cGy iridium 192 implant was delivered. Our dose constraints have been previously published but our stated goal was to delivered 98% of the dose to the prostate treatment volume identified by ultrasound. 29 patients received ADT at the discretion of the treating Urology team. Follow up has been maintained on all patients and has ranged from 11 to 53 months (median 37 months). Results: Assessment of acute / late toxicity was assessed using the RTOG/EORTC criteria. Overall 36/69 (52%) developed ACUTE GI toxicity. 49% developed Gr I/II while two patients developed Gr III. 14.5% reported late GI toxicity, all were GR I / II. Without surprise 98% reported acute GU toxicity. Of these 67/69 had Gr I/II with a single patient reporting GR III. However, after 6 months only 8 (11.5%) had persistent GR I/II issues. An additional patient went on to develop GR III toxicity. Conclusion: While further follow up will be required before definitive statements can be made regarding the oncologic effectiveness of this treatment combination, the early toxicity profiles are very encouraging. We continue to offer this treatment regimen for select intermediate/high risk prostate cancer patients.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77470724","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}