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

{"title":"Simpsons paradox in the correlations between excess mortality and covid-19 injections: a case study of iatrogenic pandemic for elderly Australians","authors":"","doi":"10.33140/mcr.07.047","DOIUrl":"https://doi.org/10.33140/mcr.07.047","url":null,"abstract":"Background: Conflicting findings in correlation studies between COVID-19 injections and excess deaths have been published. Negative correlations with 2021 data appear to justify the official claim that COVID-19 injections reduce illness and death and therefore should be prioritized for vulnerable elderly (over-75s) Australians. This claim needs to be reviewed including 2022 data. Method: Simpson’s Paradox is illustrated to explain how the negative correlations, supporting injection effectiveness can come from 2021 data, while positive correlations, suggesting injection ineffectiveness, have come from inclusion of 2022 data. Excess deaths of Australian elderly in the COVID pandemic are analysed in detail for their statistical significance. Results: Negative correlations from 2021 data are refuted in this paper as false causality, because the results have insufficient temporal separation between cause and effect. Strong positive correlation (69 to 74 percent) in Australian data is confirmed when the effects of excess mortality are lagged optimally by 21 weeks after COVID-19 injections [1]. A strong statistical signal (2.5 standard deviations) is shown in this paper in the mortality of elderly Australians, who suffered the greatest relative harm from the injections, even when adjusted for agedependent high expected mortality. Conclusion: Earlier epidemiological evidence that COVID injections reduce illness and death is now methodologically invalidated, and the claim that the injections are beneficial for the vulnerable is refuted. The injections explain the mystery of significant numbers of non-COVID excess deaths. The Australian pandemic is shown to be iatrogenic particularly for the elderly, who have suffered disproportionate harm. Deliberately ignoring this clear evidence is tantamount to iatrogenic geronticide.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135806167","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":"Examination of plasmodium parasites in bone marrow puncture fluid for the diagnosis of imported-malaria in patients from the Yunnan Province, China","authors":"","doi":"10.33140/mcr.08.06.01","DOIUrl":"https://doi.org/10.33140/mcr.08.06.01","url":null,"abstract":"Background: Some suspected malaria individuals who have returned to Yunnan from Africa have been delayed antimalarial treatment due to not detection out Plasmodium infection in their peripheral blood. Methods: The fever patients with a history of exposure to malaria endemic areas and suspected malaria episodes accepted the detection of the Plasmodium infection in bone marrow fluid by microscopy and gene testing. Results: Plasmodium in bone marrow fluid were found in all of five patients, including four patients with Plasmodium negative and one patient with Plasmodium falciparum positive in peripheral blood. The proportion of found ring stage, large trophozoites, schizonts, and stage III-V gametocytes accounted for 28.3%, 38.3%, 4.8%, 11.5%, 16.5% and 0.8%, respectively. The erythrocyte count and hemoglobin concentration of the five cases post-treatment merely increased to the lower end of the normal range. Platelet count returned to the normal range, increasing by 466%, 378%, 252%, 168% and 35%, respectively. There were four to five B-cell antigenic epitopes along pLDH peptide chains of the infected strains in the five cases. Of note, the sequence of “211-EEVEGIFDR-220” was only detected in P. vivax strain, whereas the sequence of “207-LISDAE-213” was unique for P. falciparum strain. Conclusion: Examination of the Plasmodium in bone marrow puncture fluid could make up for the missed diagnosis of malaria that solely relies on peripheral blood.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135674486","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":"Achievements in virus research","authors":"","doi":"10.33140/mcr.08.03.01","DOIUrl":"https://doi.org/10.33140/mcr.08.03.01","url":null,"abstract":"This paper brings a brief survey of the achievements in virology as published from the second half of 20th century til now. In beginning, the virus research has been performed at framework of microbiology and/or closely by related biological disciplines, such as parasitology, pathology, mycology and/or cytology. The reason why virologists have been involved in many related scientific disciplines, has been, in addition, because viruses infect not only great many mammalian species, but also lower vertabrates (such as birds and reptiles) and/or certain plants. Even though there could be difficult to assess such great variety of scientific information, a great proportion a great proportion of authors at least has attempted doing with success. Needless to mention that though precise origin of viruses has not been cleared till now, they have probably sequestrated from cellular organelles and then sequently underwent to own (rather independent) evolution","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135424192","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 retrospective case-control study for assessing the risk factors for development of diabetic kidney disease among people with type 2 diabetes in Tamil Nadu and Puducherry","authors":"","doi":"10.33140/mcr.08.02.02","DOIUrl":"https://doi.org/10.33140/mcr.08.02.02","url":null,"abstract":"Objective: To understand the associated risk factors in the progression of Diabetic Kidney Disease among the Type 2 Diabetes individuals in Tamil Nadu and Puducherry. Research design and methods: Clinical and socio-demographic data was collected, digitized, and analyzed for 482 participants diagnosed either with Diabetic Kidney Disease (DKD) or Type 2 Diabetes (T2D). The study was analyzed by using descriptive statistical analysis SAS version 9.4. Results: Out of 482 participants, 422 fulfilled the eligibility criteria. Gender, age, T2D duration, and comorbidity are the major risk factors that are found to be associated with DKD in population understudy. We also found inclination towards usage of insulin among DKD participants rather than oral diabetic medications. Metformin (Biguanides) was the most used oral diabetic medication among the T2D participants. Conclusion: Together, these data describe the risk pattern among participants with DKD at regional level that is integral in early and proper management of the disease.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135683291","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":"Delta virus predominates and potentially predicts liver cirrhosis among co-infected hepatitis b and hepatitis d virus patients in pakistan","authors":"pKamran Shafiq Waqas Javed, Smaha Waseemp","doi":"10.33140/mcr.08.01.03","DOIUrl":"https://doi.org/10.33140/mcr.08.01.03","url":null,"abstract":"Background: High prevalence of Hepatitis Delta virus (HDV) has been reported from some pockets in Pakistan. Typically, Hepatitis B (HBV) and HDV co-infection could cause severe hepatitis leading to cirrhosis at an early age. We aim to study the clinical outcomes of HBV/HDV co-infection compared to HBV mono-infection in a Punjabi, Pakistani population. Methods: The retrospective data on all HBV positive patients was extracted from Hepatitis Prevention and Treatment Program (HPTP) of Pakistan Kidney and Liver Institute in Punjab, Pakistan. Majority (32/50) of the HBV/HDV co-infection were identified from Rajanpur clinic of HPTP. Pre-treatment liver tests, HBV-DNA viral load, HDV-RNA viral load; AST to Platelet ratio (APRI) and Fibrosis-4 (Fib-4) were calculated from standard equations. Cirrhosis was based on APRI (≥1.5) or/and Fib4 (≥1.45). HBV-DNA level ≤ 2,000 IU and ≥20,000 IU were categorized as low and high viral load respectively. Results: 57 (53%) patients were HBV mono-infected and 50 (47%) were co-infected with HDV. Mean age was 36.2±12.99 in the entire cohort and was not different between the two groups. Older age correlated to a higher APRI and Fib-4 scores in both groups. The two groups were predominantly male, 75% in HBV and 76% HBV/HDV co-infected patients. Sharing of toothbrushes was reported to be significantly higher by HBV mono-infected patients; p 0.005. Other risk factors were equally prevalent. 78% of HBV mono-infected and 79% HBV/HDV co-infected patients had ≤ 20,000 IU/ml HBV-DNA. While 56% and 44% had ≤ 2,000 IU/ml HBV DNA levels respectively. APRI and Fib-4 scores were significantly higher in HBV/HDV coinfected; p 0.01. The cirrhosis was diagnosed in 29 patients in HBV/HDV co-infected group, while no patient had cirrhosis in HBV mono-infected group. Within HBV/HDV co-infected group, mean HDV-viral load was significantly higher compared to HBV viral load; p 0.05. Mean HBV-DNA and HDV RNA levels in non-cirrhotics were 326411 and 35358369; and in cirrhotics 3340429 and 31867418 IU/ ml, respectively. 4 patients had undetectable HBV viral load and one of them had cirrhosis. 10 patients were cirrhotics with ≤ 2,000 IU/ml of HBV-DNA. The mean HDV RNA level in these 10 patients was 63, 000000 IU/ml. Mean HDV viral load was one log higher in patients with ≤20,000 IU/ml HBV-DNA compared to those with ≥ 20,000 IU/ml HBV-DNA viral load. Conclusion: Overall mode of transmission of HBV and HBV/HDV infections are similar in Punjab. More patients had higher liver fibrosis scores in HDV/HBV co-infected groups. The significantly low level of HBV, in the co-infected population especially cirrhotic patients indicates that liver disease is driven by HDV rather than HBV infection among co-infected Pakistani patients and Peg-interferon alone might be the best treatment option for them.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135898208","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":"Intraoperative radiotherapy for early breast carcinoma-dissertation project with literary review","authors":"","doi":"10.33140/mcr.07.1.01","DOIUrl":"https://doi.org/10.33140/mcr.07.1.01","url":null,"abstract":"Breast cancer (BC) is a socially significant illness. Radiotherapy (RT) is an important part of the complex treatment of early BC after a breast preserving surgery (BPS). Partial breast irradiation (PBI) has been established as a suitable treatment option for appropriately selected women with early stage BC by numerous clinical trials dating back to the 1990s. Risk¬ adapted single¬ dose targeted intraoperative radiotherapy during lumpectomy (TARGIT ¬IORT) is a method of PBI for early BC. In this literary review, we will present the therapeutic capabilities of intraoperative radiotherapy (IORT) for early BC, the necessary patients’ selection, as well as the advantages and disadvantages of this combined with surgery radiotherapeutic approach. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses, as well as prior to oncoplastic reconstruction to improve accuracy of adjuvant radiation delivery, or when used as a boost in higher risk patients to improve tumor control. The expected contributions from this research project are: 1) For the first time in Bulgaria to use IORT in the treatment of early breast cancer.;2) Local control and early toxicity for patients receiving IORT in comparison with whole breast irradiation with or without boost.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80126630","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":"Thyroid storm induced congestive heart failure","authors":"","doi":"10.33140/mcr.07.1.02","DOIUrl":"https://doi.org/10.33140/mcr.07.1.02","url":null,"abstract":"Background: Uncontrolled thyrotoxicosis is known to lead to a state of prolonged tachycardia that may then progress to the onset of reversible congestive heart failure. Case: The patient is a 36-year-old female with a history of Asthma, bilateral ovarian benign cysts, chronic goiter presented due to persistent cough, wheezing, and shortness of breath for about two days duration, echocardiogram had been done for respiratory failure, showing reduced ejection fraction, diastolic dysfunction, and dilated cardiomyopathy. She was subsequently admitted to the MICU for treatment of respiratory failure due to asthma exacerbation. Then began feeling symptoms of anxiety, palpitations, tremulousness, facial flushing. Evaluation of her labs showed elevated T3 at >650, elevated T4 at 22.6, with diminished TSH level at 0.01. The patient was diagnosed with thyroid storm in consideration of lab values with clinical features. TSI was ordered, which returned at 674. Endocrinology was consulted; the patient added a history of tremors for three weeks and weight loss of about 5 pounds over several months, with symptoms of generalized anxiety and dysphagia; she also reported diarrhea in the past weeks. She refers to a family history of goiter in her aunt. The recommendation from an endocrinology perspective was to obtain TSI level and ESR, continue methimazole. The patient was clinically stabilized, discharged on medications for heart failure and methimazole. However, she developed a rash on methimazole, and this was stopped. The patient went for radioactive iodine ablation, and a repeat echo showed an improvement of her ejection fraction. The patient was asymptomatic at a one-year cardiology follow-up, and cardiology medications were discontinued. Conclusion: Hyperthyroidism is a known cause of congestive heart failure secondary to tachycardia-induced cardiomyopathy if untreated. After the proper treatment, this heart failure can be reversed if tachycardia is controlled.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88198696","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":"Integrative chemo-immune-radiological treatment of HER2 positive breast cancer combined with a review of potential microRNAs involved and analysis of experimental results from sub-THz vibrational spectroscopy","authors":"","doi":"10.33140/mcr.06.12.06","DOIUrl":"https://doi.org/10.33140/mcr.06.12.06","url":null,"abstract":"In this paper we present the results of a Breast Cancer study by integrative analysis of a NIH approved treatment for HER2 positive breast cancer. This study is combined with analysis of Micro-RNA involvement from application of sub-THz spectroscopy for visualization of molecules circulating in blood by measuring saliva. The combination of Taxol-Generic Name-Paclitaxel (PT-J9267) and Trastuzumab-ANNS 0/0 and KadcylaTM (Genetic Name Ado-Trastuzumab Emtansine) were used in 3-stages of combined chemotherapeutic and immune-treatments followed by Radiation treatment. The goal of using PT was to stop spread of the disease to other organs outside of the breast and under arm lymph nodes, as well as to shrink the size of the tumor to facilitate surgery and radiology in continuation of the treatment. Trastuzumab (TZ) was added to PT in the 2nd step to prevent the development of chemoresistance. Intravenous infusion of Kadcyla was used mainly to prevent metastasis. Integrative analysis of microRNA participation was conducted based on literature review and sub-Terahertz vibrational spectroscopy measurements of absorption spectra from samples taken weekly before and after each treatment, using Vibratess’ spectrometer. The results from sub-THz spectroscopy in this work demonstrate dramatical modification of spectroscopic signatures from patient samples following disease development and the initial steps in the course of treatment. These changes reflect the deep global regulation (reduction) of the initially participating microRNAs amounts and changes in the microRNAs contributing to the spectra.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73843330","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":"Isolated acute renal infarction in an obese patient","authors":"","doi":"10.33140/mcr.06.12.05","DOIUrl":"https://doi.org/10.33140/mcr.06.12.05","url":null,"abstract":"Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events. Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90304836","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 role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation","authors":"","doi":"10.33140/mcr.06.12.03","DOIUrl":"https://doi.org/10.33140/mcr.06.12.03","url":null,"abstract":"Background: New advances have been made in medicine, but the incidence and prevalence of chronic obstructive pulmonary disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and betareceptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1- selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88011769","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}