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

{"title":"Labor Induction in Case of Fetal Growth Restriction (FGR)","authors":"","doi":"10.33140/mcr.08.10.02","DOIUrl":"https://doi.org/10.33140/mcr.08.10.02","url":null,"abstract":"Clinicians consider a range of variables when formulating decisions regarding the diagnosis, monitoring plan, and ultimately the decision to recommend the delivery of a growth-restricted fetus. The differential diagnosis of a pathological fetal growth pattern is initially considered via the history, a physical and laboratory examination of the pregnant person, as well as a comprehensive fetal ultrasound examination. These factors allow a broad distinction between pre-existing disease in the pregnant person, constitutionally small normal growth, placenta-mediated Fetal Growth Restriction (FGR), and intrinsic fetal disease. Most commonly, pathological growth restriction is mediated by underlying placental diseases, of which maternal vascular malperfusion is the most common, and often results in co-existent hypertension. A program of combined monitoring of the pregnant person and fetus, comprising hypertension assessment, and serial fetal ultrasound, including Doppler studies is then instituted, and may be combined with biochemical markers, such as Placental Growth Factor, for greater clinical precision. Recommendations on timing to deliver the growth-restricted fetus worldwide are converging, with similar guidance from clinical practice guidelines informed by high-quality Randomized Controlled Trials (RCTs) and large cohort studies. In most instances, it is reasonable to recommend delivery of all growth-restricted fetuses by approximately 38 weeks. Timing of delivery should take into consideration both short-term neonatal outcomes and long-term outcomes at school age. Mode of delivery is based on many factors, and induction of labor is a safe approach, especially after 34 weeks. Mechanical methods of induction may be preferred to pharmacologic methods, although both have a role and the choice of method is based on individualized assessment. Elective Cesarean birth thereby bypassing fetal stress during labor, is recommended in preterm growth-restricted fetuses with signs of adaptive fetal compromise, especially when ductus venosus flow is abnormal, or a contraction stress test is positive.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135302586","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":"Dyslipidemias and Obesity","authors":"","doi":"10.33140/mcr.08.10.08","DOIUrl":"https://doi.org/10.33140/mcr.08.10.08","url":null,"abstract":"The studies that initially suggested the association between obesity, dyslipidemia and coronary heart disease were population-based studies, in which the predictive factors for coronary heart disease were investigated. In a later study of this same Framingham group, it was suggested that obesity was an independent risk marker for coronary artery disease. Other reports showed that also in obese individuals the elevation of the fraction of low-density lipoprotein-LDL and the reduction of the fraction of high-density lipoproteinHDL had a positive correlation with the risk of coronary heart disease. It was also observed that triglyceridemia would have a positive correlation with the risk of coronary heart disease. Hypertriglyceridemia in the obese results from greater synthesis and less removal of triglyceride-rich lipoproteins. In the obese individual, the greater supply of free fatty acids supplied to the liver promotes the greater production of very low-density lipoprotein particles-VLDL cholesterol rich in triglycerides. The hyperinsulinemia observed in metabolic syndrome contributes to the increased formation of these particles in the hepatocyte. For the treatment of dyslipidemia associated with obesity, the patient should receive guidance to lose weight, through an adequate diet and physical exercises. Regarding the diet, there is a controversy about which carbohydrate content it should contain, since, once the fat content is decreased, an increase in the carbohydrate content may occur, favoring hyperinsulinism and postprandial hyperglycemia. In individuals undergoing a strict weight losing diet, a transient phase of increased triglyceride and total cholesterol levels and decreased HDL-cholesterol levels may occur. In some cases, it is necessary to use lipid-lowering medications, the choice of which will depend on the type of lipid alteration found and the patient's response to treatment","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135302589","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":"Vitamin B6, Magnesium, and Vitamin D: The Triple Play","authors":"","doi":"10.33140/mcr.08.10.04","DOIUrl":"https://doi.org/10.33140/mcr.08.10.04","url":null,"abstract":"Vitamin B6, magnesium, and vitamin D are important antioxidants. Mg is a required cofactor for the synthesis of vitamin D and the active forms of vitamins B1,2,3,5,6,9,12 (seven of the eight B vitamins). Five of the seven (and magnesium) are critical to the methylation cycle, compromised by MTHFR (methylene tetrahydrofolate reductase) variants, present in the majority of Caucasians and Asians. Homocysteine (Hcy), a powerful pro-oxidant, is upregulated in these variants. Oxidative stress compromises mitochondrial function, required for the synthesis of the active form of vitamin D. Pyridoxal phosphate (P5P or PLP), the active form of B6, enhances the intracellular entry of magnesium and is required for the synthesis of the antioxidants melatonin and glutathione, oft called the “mother” of all antioxidants. Deficiencies of P5P and vitamin D are associated with decreased gut microbiota diversity and short chain fatty acids, e.g., butyrate, as seen in Long Covid (LC) and Chronic Fatigue Syndrome (CFS). This suboptimal gut microbiome reflects the continuing decline in the nutritional value of the Western diet. The interdependencies of and associations between P5P, magnesium, and 1,25(OH)2D, the active form of vitamin D, are explored.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135302584","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":"Intensity Modulated Radiotherapy For Recurrent Spine Aneurysmal Bone Cyst In Adolescence-Case Report And Review of Literature","authors":"","doi":"10.33140/mcr.08.10.07","DOIUrl":"https://doi.org/10.33140/mcr.08.10.07","url":null,"abstract":"Aneurysmal bone cysts are rarely diagnosed aggressive benign bone tumors that require CT and MRI imaging and strict histopathological analysis. This clinically and histologically benign tumor is mainly diagnosed in children and adolescents in the long bones of the limbs, but in 12%-30% it is localized in the spine. Since the value of external beam radiotherapy (EBRT) for aneurysmal bone cyst (ABC) has not been well defined, we present our observations and treatment outcome after the realization of intensity modulated radiotherapy (IMRT) up to total dose 30 Gy for recurrent spine aneurysmal bone cyst in adolescent age. In this article, for the first time in the world medical literature, an MRI imaging finding after performed IMRT in recurrent ABC is presented. Our observations lead to the conclusion, that radiation therapy is an effective treatment method for relapsed or inoperable disease, achieving not only a symptomatic pain-relieving effect, but also a significant tumor reduction and restoration of the bone structure.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135302585","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":"Microscopic Prevalence of Intestinal Parasites in Gastrointestinal Disordered Patients in Wasit Province, Iraq","authors":"","doi":"10.33140/mcr.08.09.05","DOIUrl":"https://doi.org/10.33140/mcr.08.09.05","url":null,"abstract":"Background: Intestinal parasites (IPs) have been a big concern for low-income countries as they are the major cause of high morbidity and mortality. Aims: Identification the prevalence of IPs in gastrointestinal disordered patients, with estimation relationship of these pathogens to hematological and some epidemiological parameters. Materials and Methods: A total of 200 individuals with a history of abdominal pain, anal itching, colic, diarrhea, dysentery, and nausea or vomiting were selected, and asked to obtain of fecal and blood samples. Traditional microscopic methods were used to detect the parasites; while, Automated Hematology Analyser was served for blood counting. Results: There were 59.5% positive patients with intestinal parasites; in which, 68.91% with single infection (particularly Entamoeba histolytica, Enterobius vermicularis and Giardia lamblia), and 31.09% with mixed infections (particularly Enterobius vermicularis and Ascaris lumbricoides as well as Giardia lamblia and Entamoeba histolytica). Concerning risk factors, significant higher values of positivity were showed in patients of 3-7 years old, males more than females, and in rural more than urban areas. Regarding hematology, insignificant variation was recorded between infested and non-infested individuals, but macrocytic type of RBCs was highly prevalent in infested individuals. Subsequently, macrocytic type was increased significantly prevalent in patients with Ascaris lumbricoides; while, normocytic and microcytic types were seen in Balantidium coli. In patients with mixed infections, macrocytic type was recorded significantly in patients having Enterobius vermicularis and Ascaris lumbricoides as well as in those having Giardia lamblia and Entamoeba histolytica; while, microcytic type was identified in patients with Enterobius vermicularis and Ascaris lumbricoides, and those with Enterobius vermicularis, Giardia lamblia and Balantidium coli. However, normocytic type was seen significantly in patients with Entamoeba histolytica and Balantidium coli; Entamoeba histolytica and Enterobius vermicularis; and Giardia lamblia and Entamoeba histolytica. Conclusions: The findings imply that intestinal parasites among gastrointestinal patients were prevalent as single or mixed infections. Age, sex and areas were related significantly with the existence of parasitic infection, in addition to the effect of these parasites on shape of RBCs. However, annual surveillance appears of great importance to detect the prevalence of intestinal parasites in different individuals.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931257","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 Spectrophotometric Approach for Estimating Nimodipine by Oxidative-Coupling Reaction with 4-Aminoantipyrine in its Tablet and Biological Fluids","authors":"","doi":"10.33140/mcr.08.09.06","DOIUrl":"https://doi.org/10.33140/mcr.08.09.06","url":null,"abstract":"This study involves the development of a speedy, artless, selective and precise spectrophotometric methodology for the determination of nimodipine in the aqueous medium. The proposed approach was dependent on the oxidation and coupling reaction of nimodipine with 4-aminoantipyrine using KIO3 as an oxidizing agent. A yellow-brown product was fashioned at room temperature which gave a band with maximum absorption at 464 nm. Calibration plot was linear and adheres to Beer's law within the concentration range 1.0- 35 μg/ml with an excellent coefficient of determination (R2=0.9992). The values of molar absorptivity and Sandell's sensitivity were planned and established to be in the consequence of 1.2679x104 l/mol.cm. and 0.033 μg/cm2, correspondingly. The mole ratio of the achieved product has been measured between nimodipine and 4-aminoantipyrine was evaluated to be 1:1. The detection limit (LOD) and quantitation limit (LOQ) were expected and found to be 0.01774 and 0.05914 μg/ml, correspondingly. The recoveries percentage were obtained in the range 97.38%-103.61% while, the precision (RSD) was in the range 0.96%-3.18% depending on the concentration level. The recommended approach was applied successfully to estimate nimodipine in its tablet and in the biological fluids, no intrusions were noticed from the shared excipients additives present in the commercial pharmaceutical formulation.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931258","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":"Drivers for People’s Affairs","authors":"","doi":"10.33140/mcr.08.09.07","DOIUrl":"https://doi.org/10.33140/mcr.08.09.07","url":null,"abstract":"Each individual is interested in selling and buying products to ensure a prosperous social, professional, and emotional life for themselves and their dear ones. Selling their goods or services gives them the financial power to purchase other necessary articles or services for continuous improvement in their life quality, as no one can possess or produce everything.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931256","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":"Risk Factors for Patients with Hepatitis B and C in Hemodialysis Unit","authors":"","doi":"10.33140/mcr.08.09.04","DOIUrl":"https://doi.org/10.33140/mcr.08.09.04","url":null,"abstract":"Background: Risk factors for HCV, HBV transmission are blood transfusions and surgeries before 1992, intravenous drug use, contaminated parenteral drugs and other invasive non-medical procedures (tattooing, piercing). Based on these risk factors, high-risk groups are: multiramified patients (i.e., hemophiliacs), health personnel, intravenous drug users, inmates, individuals with high-risk sexual behaviors (early sex life, high number of sexual partners and prostitution). Other populations at risk are patients on extracorporeal circulation system, such as end-stage kidney disease patients on hemodialysis program. Study aim: To determine risk factors for patients with hepatitis B and C in hemodialysis unit. Methodology: A descriptive study design was conducted at Al-Najaf city in the southern region of Iraq in Al-Sadder Medical City and Al-Hakim General Hospital from February 20th, 2023, to May 23th, 2023, in order to assess risk factors for patients with hepatitis B and C in hemodialysis unit. The methodological strategies for data collection used an assessment questionnaire survey. Results: As the study shows, that the risk factors that cause the most infection are hemodialysis sessions, contact with infected persons, and injected medication, while the lowest risk factors to spread infection are children born with infected hepatitis and unprotected sexual contacted. Conclusion: The study concludes that the first leading risk factor for infection is the hemodialysis session, while the contact with infected persons and contaminated injections of medication comes in the second place. Recommendations: Careful monitoring and strict adherence to infection control procedures among patients undergoing hemodialysis treatment, including commitment to sterilization of hemodialysis devices and the use of all preventive measures when starting the hemodialysis procedure.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931259","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":"Assessment of the Performance of selected Special Care Newborn Units (SCANUs) in Bangladesh: A cross Sectional Study","authors":"","doi":"10.33140/mcr.08.09.03","DOIUrl":"https://doi.org/10.33140/mcr.08.09.03","url":null,"abstract":"Background: Government of Bangladesh initiated the Special Care Newborn Units (SCANU) in 2011 at selected district hospitals followed by its scale up in other districts with support from UNICEF and other partners. The objective of the study was to assess the performance of those SCANUs in Bangladesh. Methods: A cross-sectional study approach was applied for assessment of the performance of SCANU facilities compared to facilities without SCANU. Fifteen facilities with SCANUs and five facilities without SCANUs were selected from eight divisions of the country for the study. The selected SCANU and Non-SCANU facilities were of secondary level hospital with similar patient flow and workload. Quantitative data were collected from direct observation of the 20 facilities and interviews with 678 caregivers using a field-tested questionnaire. Caregivers were mothers of the infants (<59 days old) who were admitted and stayed for at least one day in those hospitals. Analysis was done using Stata version 15.1 and presented in tabular, graphical and numerical measures of central tendency and dispersion. Result: The results of the assessment found that 60% of SCANU facilities had KMC care services and 27% of SCANU facilities had rooming in services and special sick baby ward services but no such services was available in non-SCANU facilities. Equipment in the SCANUs such as resuscitation bag and mask, radiant warmers, phototherapy machines and to a large extent CPAP machines and Oxygen blenders were mostly available and functioning optimally. More than half of the SCANUs still need to have oxygen blenders, CPAP machines and transcutaneous bilirubinometers since they were not found/functional during the assessment. Majority of SCANU facilities 60%-80% reported no stock-outs of critical medications like dexamethasone, ceftriaxone and gentamicin which are critical for management of preterm and sick babies. A web-based online ‘Individual Case Tracking’ system has been developed for online reporting from all SCANUs by the Health Management Information System (HMIS) of the Directorate General of Health Services (DGHS). UNICEF was supporting its linkage to the district health information system (DHIS-2). There was a statistically significant difference between SCANUs and non-SCANUs with respect to the proportions of admissions. SCANUs are acting as referral destination for sick and small newborns as 41%-45% of the admitted newborns were either were born at home or in other facilities. Conclusion: The assessment findings will be helpful for country strategy for improving newborn care through expansion of SCANU expansion throughout the country","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931069","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":"MTHFR and LC, CFS, POTS, MCAS, SIBO, EDS: Methylating the Alphabet","authors":"","doi":"10.33140/mcr.08.08.05","DOIUrl":"https://doi.org/10.33140/mcr.08.08.05","url":null,"abstract":"Long Covid (LC), Chronic Fatigue Syndrome (CFS), Postural Orthostatic Tachycardia Syndrome (POTS), Mast Cell Activation Syndrome (MCAS), Small Intestine Bacterial Overgrowth (SIBO), and Ehlers-Danlos Syndrome (EDS) are all loosely connected, some poorly defined, some with overlapping symptoms. The female preponderance, the prominence of fatigue and chronic inflammation, and methylenetetrahydrofolate reductase (MTHFR) abnormalities may connect them all. Indeed differential methylation may lie at the root. Two-EDS and MTHFR-are genetic. But epigenetic factors may ultimately determine their phenotypic expression. Oxidative stress, overloaded mitochondria, an antioxidant and nutrient shortfall, and suboptimal gut microbiome appear to be the primary determinants. A deep dive into the folate and methionine cycles is undertaken in an attempt to connect these syndromes. The active forms of vitamin D and vitamins B2,3,6,9,12 are shown to be biochemically integral to optimal methylation and control of the epigenome. Their status largely determines the symptoms of abnormal MTHFR in all its phenotypes. The wider implications for aging, cancer, cardiovascular disease, neurodegenerative disease, and autoimmune disease are briefly explored.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136215061","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}