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

{"title":"Accessibility of primary healthcare in low and middle income countries: a systematic review","authors":"","doi":"10.33140/mcr.06.08.04","DOIUrl":"https://doi.org/10.33140/mcr.06.08.04","url":null,"abstract":"Background: Accessibility to healthcare is the capability of a population to obtain a specified set of healthcare services. There is a direct link between the distance patients travel to access health and the reduction of ill health and suffering in a country. This has an important impact on the quality of life of people. Objective: To find the spatial or geographic determinants of accessibility of primary healthcare provision in low and middle income countries during last two decades. Methods: Systematic review was done according to PRISMA guidelines. Data bases used were Google scholar, PubMed and Science direct. We found ten different studies from eight different economic groups of countries. Accessibility of primary healthcare in low and middle Income countries published during the period of last two decades were included using the key words like Spatial Accessibility;Geographical Accessibility; Primary Health Care; Primary Care; Low and middle income countries. The countries included were Afghanistan, Bangladesh, Bhutan, Democratic Republic of Congo, India, Indonesia, Sudan, Mozambique /Rural Africa. Two studies each from India and Mozambique (Rural Africa) were included. The categorization as low and middle income counties was as per World Bank classification. Results: We found that accessibility to primary healthcare was worse in low income countries like Afghanistan, Mozambique and South Sudan where more than two third of the population lived in underserved or difficult to access areas while rest of the countries, which come under category of lower middle income countries, more than half of the population lived in underserved or difficult to access areas.] Conclusion: Health care ease of access is a single most important component for equitable and adequate health system. Guaranteeing a healthcare system which is easily accessible to the people is a basic consideration for public health policy makers, policy implementers and academicians.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85317858","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":"Ibrutinib induced atrial fibrillation complicated with massive hemoptysis","authors":"","doi":"10.33140/mcr.06.08.02","DOIUrl":"https://doi.org/10.33140/mcr.06.08.02","url":null,"abstract":"Background: The oncologic patient faces multiple adverse effects with cytotoxic medications, from tissue damage and intoxications that could be evident from muscle damage, neurologic to cardiac toxicity. Case: This is a case of a 79-year-old female who presented to our ED with the complaint of hemoptysis for one day, denied any associated cough, fever, chills, chest pain, SOB, nausea, vomiting, or abdominal pain. No history of trauma. Her medical history includes hypertension, uterine cancer status post-resection. The patient denied prior similar episodes, family history of similar complaints. Chest X-ray showed extensive bilateral infiltrates and cardiomegaly. CT chest ruled out pulmonary em-bolism but showed extensive multifocal pneumonia vs. ARDS, lymphoproliferative changes. While in the ED, the patient started having bloody nasal secretions noted, requiring nasogastric lavage revealing dark blood secretions, and then started having massive hemoptysis and rapidly decompensated requir-ing endotracheal intubation hypoxic respiratory failure. An emergent bronchoscopy was performed, which showed suspected alveolar hemorrhage (Figure 1). The CBC showed severe anemia requiring multiple transfusions due to active bleeding (Table 1). The patient was admitted to ICU. The patient’s PCP was contacted to obtain further information that reported a new history of atrial fi-brillation on rivaroxaban recently started, CLL on ibrutinib, and Coombs Hemolytic Anemia. The hospital course was complicated by distributive shock and ARDS. She was covered with broad-spectrum antibiotics and required fresh frozen plasma due to persistent bleeding. The patient improved after anticoagulation and ibrutinib were held. The patient was eventually extubated, required physical therapy for deconditioning, and then was discharged. Conclusion: This case represents clear evidence of how an appropriate assessment on time and the collateral gath-ering of medical history could impact the outcome of our patients. The literature review has shown new-onset atrial fibrillation and bleeding events related to ibrutinib. Given the risk for bleeding with rivaroxaban, their combination could present with massive alveolar hemorrhage that could become fa-tal if not recognized early.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91156705","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":"Giant cell glioblastoma in childhood-Pathohistological and immunohistochemical analysis, forecast and complex treatment","authors":"","doi":"10.33140/mcr.06.07.06","DOIUrl":"https://doi.org/10.33140/mcr.06.07.06","url":null,"abstract":"A six year old child is presented with giant cell glioblastoma multiforme. The importance of pathohistological and immunohistochemical analysis is discussed for the diagnosis of this rare pathohistological subtype glioblastoma in childhood. The Magnetic Resonance Image Characteristics, unfavorable prognosis and high cancer cell resistance to radiotherapy (RT) and chemotherapy (Ch) are also highlighted. The risk of local recurrences and tumor progression is high, despite the complex treatment, including visibly total tumor surgery, postoperative RT and adjuvant Ch. By this pediatric clinical case of childhood giant cell glioblastoma multiforme, we emphasize the emerging need to optimize early diagnostics and the multidisciplinary healing approach.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88255122","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 corona returns to israel-this thime with the indian triple mutant 2delta","authors":"","doi":"10.33140/mcr.06.07.05","DOIUrl":"https://doi.org/10.33140/mcr.06.07.05","url":null,"abstract":"The biggest threat: “Not only in Israel-the” Delta”variant worries the world [1-5] report. ‘Delta’ variant evolves to form ‘Delta Plus’, is there a cause to worry? Covid-19 The ‘delta’ variant of COVID-19-a version first detected in India- has evolved to form the ‘delta plus’ or AY.1 variant. Scientists say it has acquired a mutation associated with escaping immunity, but there is no cause for concern yet.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89141078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Antioxidant Have an Effect on Scavenger Receptors Action","authors":"","doi":"10.33140/mcr.06.07.02","DOIUrl":"https://doi.org/10.33140/mcr.06.07.02","url":null,"abstract":"Today’s lifestyle has changed in comparison with the past. Using junk foods and unhealthy foods leads to increasing the risk of heart attacks. Atherosclerosis is an inflammation disease made by many factors that lead to cardiovascular diseases (CVD). Macrophages, endothelial cells, OX-LDL, and some oxidants such as reactive oxygen species (ROS) are the reasons for this transformation, and they have an important role in causing cardiovascular disease. Hyperlipidemia is a major reason for atherosclerosis. Increase in the use of fatty food and fast food can lead to a rise in the risk of atherosclerosis. Macrophages are special cells derived from monocytes and can make plaque which led to increased risk of atherosclerosis. Curcumin is one of important ant inflammation can reduce the risk of CVD. Some studies illustrate that a class SRs, SR-AI and SR-AII, and 2 members of the B class, CD36 and SR-BI, involved in atherosclerosis process. Some studies strongly suggest that oral antioxidants are effective in atherosclerosis treatment, most of them have been unsuccessful except probucol. The aim of this study is illustrating that how curcumin as antioxidant can effect on atherosclerosis proses and scavenger receptor’s activation.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83279718","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 Impact of exposure to screen during COVID-19 Lockdown on the General health of students in Punjab, Pakistan","authors":"","doi":"10.33140/mcr.06.07.04","DOIUrl":"https://doi.org/10.33140/mcr.06.07.04","url":null,"abstract":"Background: Since Covid-19 was declared a pandemic and a worldwide lockdown was imposed, it was predicted that there would be an increase in screen usage, especially among students, which could potentially have a lot of negative symptomology associated with it. Objective: The objective of our study was to determine the extent of screen exposure among medical students during lockdown and to study the symptoms that they faced due to it along with their frequency. Methods: In our descriptive cross-sectional study, we distributed the specifically designed questionnaire through online media to the concerned population, in order to gather important data about the physical and mental symptoms experienced by the medical students as a result of excessive screen exposure. Results: Of the 400 participants, 93.75 % reported an increase in screen time during the lockdown. As a consequence of increased screen usage, 207 (51.75%) of the participants reported headache, 267 (66.75%) reported fatigue, 283 (70.75%) reported eye strain, 121 (30.25%) reported dry eyes, 143 (35.75%) reported blurry vision, 154 (38.5%) reported teary eyes, 154 (38.5%) reported ear ache, 247 (61.75%) reported neck and back stiffness and 148 (37%) participants agreed to having experienced fingers and hand fatigue. We also established that increasing screen time was associated with a progressive decrease in physical activity (p=0.11) and increase in food consumption (p=0.002). A significant association was also recorded with weight gain (p=0.03). We found that the students previously diagnosed with a refractive error were more likely to complain of eye strain (p=0.004) and those diagnosed with migraine experienced more screen related headache (p=0.001). Of the 11 symptoms related to mental health in the questionnaire, students with screen usage of less than 4 hours marked a median of 2 symptoms, those with screen time of 4-8 hours marked a median of 4 symptoms and those with a screen usage >8 hours ticked a median of 5 symptoms. Students who had been diagnosed with anxiety or depression in the past checked an average of 5.24 symptoms while those with no such diagnosis had only 3.51 symptoms on average. Conclusion: The results proved a potential impact on the general health of the medical students. A significant increase in weight was observed along with other serious short and long term effects on their physical and mental wellbeing.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77184959","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":"Remembering the footsteps of five distinguished ophthalmologists from the present in the era of the COVID-19 pandemic","authors":"","doi":"10.33140/mcr.06.06.14","DOIUrl":"https://doi.org/10.33140/mcr.06.06.14","url":null,"abstract":"We have reported that 40 specific intractable diseases and 24 types of cancer and malignancies as well as Kawasaki disease may be triggered by pollen in our previous papers. Further, we reported in 2021 two articles regarding relation of outbreak of Influenza and COVID-19, and pollen exposure. In this paper, five distinguished ophthalmologists will be considered and described. Mikito Takayasu was the first person to report the discovery of Takayasu’s arteritis, one of the vasculitis syndromes, which may be a pollen-induced disease as well as Kawasaki disease. Next, Einosuke Harada, Alfred Vogt and Yoshizo Koyanagi are considered and described as the reporters of Vogt-Koyanagi-Harada disease. The fifth ophthalmologist is Li Wenliang who was the first person in the world to report the outbreak of SARS-COV-2 infection. Many people are still unaware of the fact that exposure to pollen can lead to many diseases. The author hopes that those who are involved in medical care will consider the scientific facts, keep their eyes open, and use this knowledge in their daily activities, although clear proof in experimental medicine is craved.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84298161","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":"Remembering the footsteps of five distinguished ophthalmologists during the COVID-19 pandemic(epidemic)","authors":"A. Awaya, Y. Kuroiwa","doi":"10.33140/mcr.06.06.014","DOIUrl":"https://doi.org/10.33140/mcr.06.06.014","url":null,"abstract":"We have reported that 40 specific intractable diseases and 24 types of cancer and malignancies as well as Kawasaki disease may be triggered by pollen in our previous papers. Further, we reported in 2021 two articles regarding relation of outbreak of Influenza and COVID-19, and pollen exposure. In this paper, five distinguished ophthalmologists will be considered and described. Mikito Takayasu was the first person to report the discovery of Takayasu’s arteritis, one of the vasculitis syndromes, which may be a pollen-induced disease as well as Kawasaki disease. Next, Einosuke Harada, Alfred Vogt and Yoshizo Koyanagi are considered and described as the reporters of Vogt-Koyanagi-Harada disease. The fifth ophthalmologist is Li Wenliang who was the first person in the world to report the outbreak of SARS-COV-2 infection. Many people are still unaware of the fact that exposure to pollen can lead to many diseases. The author hopes that those who are involved in medical care will consider the scientific facts, keep their eyes open, and use this knowledge in their daily activities, although clear proof in experimental medicine is craved.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84675244","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 Application of the Novel “Six-Step Teaching Method” In the Teaching Management for the Nursing Interns","authors":"","doi":"10.33140/mcr.06.06.08","DOIUrl":"https://doi.org/10.33140/mcr.06.06.08","url":null,"abstract":"Objective: To study the application of the novel “Six-Step Teaching Method” in the teaching management for the nursing interns. Methods: Seventy nursing interns in the year of 2018 and 2019 practiced in The Fourth Hospital of Shijiazhuang were selected and divide into control group and observation group. The control group received the traditional teaching method for nursing practice, and the observation group was given the new “Six-Step Teaching Method” for nursing practice. The novel “Six-Step Teaching Method” includes the teachers showing the operation, the teacher guiding the interns operation, the interns independent operation, the interns self-evaluation, the evaluation between of teachers and interns, and the head nurses’ appraisal. After the interns practiced 10 months, the theoretical achievement, the practical operation skills achievement, the satisfaction between the teachers and interns each other and adverse events happened in the interns of two groups were recorded and compared. Results: Compared with the control group, the theoretical achievement increased by 29.82% (P<0.05) and the practical operation skills achievement increased by 22.60% (P<0.05). The satisfaction of teachers to interns of each other was raised 13.40% and 19.83%, respectively. The adverse events happened in interns was lowered by 62.50% in the observation group, as compared with control group. Conclusion: The novel “Six-Step Teaching Method” can raise the theory and practice level, enhance the satisfaction between the teacher and the nursing interns and lower the adverse events happened. These results suggested that the novel “Six-Step Teaching Method” has a good practical value in the teaching management for nursing interns and is worth for application in the clinic.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85053755","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":"Clinical Prognosis of AKT2 and COX2 Mutation on Colorectal Cancer","authors":"","doi":"10.33140/mcr.06.06.07","DOIUrl":"https://doi.org/10.33140/mcr.06.06.07","url":null,"abstract":"Cancer has become one of the most mortal diseases in the world. It was estimated in 2018 18.1 millions new cancer cases. The colorectal cancer (CRC) is the third most common type of cancer in men and the second in women around the world [1]. The incidence risk in the occidental population is 5% to 6%, and it can increase to 15% to 30% when a first degree relative has the diagnoses. In hereditary predisposition cancer syndrome like the Lynch syndrome it can grow up to 80% [2].","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88996569","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}