All Articles in October, 2021

Effects of secondary hyperparathyroidism treatment on hemoglobin levels and erythropoietin doses in hemodialysis patients

Published on: 15th October, 2021

Aim: Secondary hyperparathyroidism (SHPT) is an often underestimated cause of anemia in hemodialysis (HD) patients. The aim of this study was to assess the effect of pharmacological correction of SHPT on anemia and erythropoiesis-stimulating agents (ESAs) need. Methods: For the purpose of this retrospective pre-post observational study, we selected 55 HD patients, receiving HD at one single center, in the period from January 2005 to December 2020. The follow-up (F-U) lasted 12 months. The selection criteria were parathormone (PTH) levels > 300 pg/ mL, and hemoglobin (Hb) levels < 11 g/dL, despite treatment with ESAs. Parametric and non-parametric tests were used when appropriate. In the light of exploratory nature of the study, the limited sample size and in consideration of the pre-post-design, no further adjustment for potential confounders is performed. Results: The hemoglobin levels throughout the study were correlated to serum PTH (r = -.257, p < 0.01). At the end of the F-U, in the 40 patients whose PTH levels decreased ≥ 30% (responders group) Hb levels increased from 10.3 ± 0.5 g/dL to 12.2 ± 1.1 g/dL (p < 0.001), and ESAs doses decreased from 141 ± 101 IU/kg/b.w./week to 94 ± 76 IU/kg/b.w./week (p < 0.05). On the contrary, in the non-responders group Hb levels did not change 10.3 ± 0.5 gr/dL at baseline and 10.1 ± 1.1 gr/dL at F-U (P = NS), and the mean doses of ESAs increased from 144 ± 75 IU/kg/b.w./week to 218 ± 145 IU/kg/b.w./week (P = NS). Conclusion: Adequate control of SHPT is associated with concomitant improvement of anemia and decrease in ESAs need. Future endeavors are required to confirm these preliminary results. 
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Awareness level on the relevance of forensics in criminal investigation in Nigeria

Published on: 15th October, 2021

The main aim of forensic science is to gather intelligence to enable the judge to credible and logical decisions in the court by means of scientific approach through evaluation of evidence for the administration of justice, and country around the world now considers forensic methodology as the gold standard for criminal investigation. Therefore, the present study examined the level of awareness on the relevance of forensics in criminal investigation in Nigeria. The design used in this study is the survey research design and the sample size of this study was a total of one hundred personnel of law enforcement and the judiciary. The study adopted descriptive statistics which involves the use of frequency and percentage. The result of the present study revealed that the participants were distributed socio-demographically as follows; there was an observable higher number of male participants (68%) relative to the female participants (32%), As per age distribution, a larger population of the participants were found to be > 40 years of age with 55%, and it was observed that age between 35-39 years ranked the least with 15%. On educational level, the result of the present study revealed that majority of the participants possesses a bachelor’s degree as the highest level of educational qualification with 75% from a pool of 100% of participants. The present study further examined responses on the relevance of forensics in criminal investigation, and the result revealed an inadequate level of awareness on the relevance of forensics in criminal investigation. Therefore, the study recommends that the Nigerian Police Force and the Judiciary should collaborate with Universities running programs on forensics for trainings.
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Coexistence of common gallstones and sinusoidal obstruction syndrome: Case report and review of the literature

Published on: 15th October, 2021

Purpose: The sinusoidal obstruction syndrome (SOS) of the liver is an obliterative vasculitis that involves the terminal branches of the hepatic venules and sinusoids. When it is not treated, it will be a serious risk of mortality. Here, we aim to present our patient who has been associated with recurrent cholangitis attacks due to cholelithiasis and choledocholithiasis and is associated with sinusoidal obstruction syndrome with the literature.Description of the case: A 30 years old male patient had complaints of abdominal pain and nausea for a long time. The patient had a history of choledocholithiasis and cholangitis attacks. Although ERCP was performed and a stent was placed in the biliary tract, his jaundice did not disappear. Liver function tests were high. Tumor markers were negative.Methods: We could not make a definitive diagnosis with imaging methods and biopsy and we planned surgery. We performed segmental liver resection and biliary diversion in the surgery. Histopathological examination of the resected liver tissue was compatible with SOS.Conclusion: Many studies have been done on the etiology of SOS and different causes have been revealed. Accompanied with clinical findings, a definitive diagnosis is made with the exclusion of the presumptions considered. Surgery can be performed for both diagnostic and therapeutic purposes. If patients with elevated liver function tests and bilirubin have long-term abdominal pain, SOS should be bear in mind.
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Prognosis factors for dengue shock syndrome in children

Published on: 15th October, 2021

Background: Varied clinical manifestations, complex pathogenesis, and different viral serotypes make it difficult to predict the course of dengue disease. Many studies have been conducted on the prognostic factors for the occurrence of dengue shock syndrome (SSD), but all use the 2017 World Health Organization (WHO) guidelines. Aim: This study aims to determine the prognostic factors for the occurrence of SSD based on WHO guidelines in 2011. Method: Retrospective study using medical record data of pediatric patients aged 0 to <18 years with a diagnosis of dengue fever dengue (DHF), SSD, and expanded dengue syndrome (EDS) that meet WHO criteria in 2011 at the reputable database from 2017 to December 2020. Independent variables, namely gender, age, nutritional status, secondary dengue infection, leukopenia, abdominal pain, gastrointestinal bleeding, hepatomegaly, and plasma leakage. Shock is the dependent variable. Multivariate analysis using logistic regression analysis. Results: Subjects who met the study criteria were 145 patients, 52 (35.8%) of whom had SSD. Five of 52 SSD patients went into shock during hospitalization. The bivariate analysis yielded significant factors including, malnutrition, overnutrition and obesity, gastrointestinal bleeding, hemoconcentration, ascites, leukocytes 5,000 mm 3, encephalopathy, enzyme elevation heart, and overload. The results of multivariate analysis showed that hemoconcentration variables and elevated liver enzymes were factors of SSD Prognosis. Conclusion: Hemoconcentration and elevated liver enzymes are prognostic factors for SSD. 
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Observation of telepsychiatry service in a teaching hospital of eastern Nepal during COVID-19 pandemic

Published on: 14th October, 2021

Considering the geographical complexity and adversity, online communication and consultation are viable method in Nepal. The COVID-19 pandemic has accelerated the already starting trend of use of these technologies in medicine. In BPKIHS, telemedicine efforts were already initiated; lockdown rather warranted its maximum use. Here is an account of the observation made in telepsychiatry service provided by a consultant psychiatrist of its department of psychiatry. It is an institute-based observation noted for all the telepsychiatry consultations in 9 random duty days of the COVID-19 pandemic. Basic necessary information was noted down in a semi-structured proforma, like: socio-demographic, clinical information and advice provided. There were 104 subjects; 73 follow-up and 31 new: 60 male and 44 female cases. Clients of multi-ethnic groups were the most from urban, then semi-urban and least from rural areas. More consultations were for young age-groups and from nearby districts of Sunsari. Mood, somatic (sleep), anxiety were the top presenting complaints and 8/104 clients had suicidal symptoms. Maximum follow-up cases were improving. The most common diagnoses were: Mood (Depression and Bipolar), Anxiety, Psychosis and Substance use disorders. Most common treatment advices included: Antidepressants, Antipsychotics, Benzodiazepines and Counseling/psycho-education. Telepsychiatry is a viable method of delivering service even during the pandemic. 
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Risk co-factors inducing malignant transformation of oral lichen planus: A literature review of clinical studies

Published on: 14th October, 2021

Oral lichen planus (OLP) is an autoimmune chronic inflammatory disease. The potential risk of malignant transformation in OLP remains controversial. The aim of the present study was to review original clinical studies published in indexed databases, which assessed the potential risk cofactors which were implicated in the malignant transformation of oral lichen planus. We focused our search to include most of the studies that reported malignant transformation of oral lichen planus using different combinations of the following key indexing terms: oral lichen planus, malignant transformation, smoking, alcohol, chronic inflammation, candida, human papillomavirus (HPV), hepatitis C virus (HCV) and immunosuppression. The animal studies were excluded from our study. Despite a dearth of studies on this topic we have identified consumption of tobacco and/or alcohol, the presence of erosive and/or atrophic areas, infection with candida, HCV, HPV, and immunosuppression as significant cofactors. Patients with OLP with these risk co-factors are at risk of malignant transformation should, therefore be followed up for an extensive period or even for life.
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Effects of melatonin on liver and lung tissues of animals with bile duct ligation-induced hepatopulmonary syndrome

Published on: 13th October, 2021

The objective was to assess the antioxidant effect of melatonin (MLT) on liver and lung tissues of animals with bile duct ligation (BDL)-induced hepato-pulmonary syndrome (HPS). A model of BDL-induced biliary cirrhosis was used in male Wistar rats. Results suggest that MLT has an antioxidant effect on liver and lung tissues in animals with BDL-induced HPS by higher activity of antioxidant enzymes in the group HPS treated with MLT and the histological analysis of lung parenchyma showing decreased damage in this same group, including other analysis described below.
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A Genetic study in assisted reproduction and the risk of congenital anomalies

Published on: 12th October, 2021

In vitro fertilization is one of the most common and effective procedure for thousands of couples worldwide who want to have a child and are unable to do so for various reasons. Diverse studies show that couples who conceive naturally after one year of trying had newborns with an increased risk of prematurity and low birth weight, compared with couples who conceived before completing one year of trying. Children from assisted reproduction (AR), have a 30% increased risk of prematurity and low birth weight, compared with children from infertile fathers. Regarding the conflicting results the present study aimed to record the frequency of genetic, congenital anomalies in children and adolescents who had examined in the last decade to the Clinical Genetics Clinic of the National and Kapodistrian University of Athens whose mothers had undergone assisted reproduction. The research process was conducted at the "Aghia Sofia" Children's Hospital based in Athens. However, the cases that were studied came from all over Greece. Initially, the researcher recorded the cases that came to the clinic of Clinical Genetics and whose conception occurred after technical assisted reproduction. After telephone communication and the consent of the parents, a live appointment was scheduled. In this meeting-interview all the provisions of the investigation and the protocol were asked and some elements of the medical history of the cases were confirmed. The total sample included 230 children and adolescents. The resulting data were recorded on a printed form/questionnaire. Then, they were registered electronically in the program SPSS 25.0 (Statistical Package for Social Sciences) with a specific unit code for each case/patient, followed by the processing and statistical analysis of the data as well as the recording of the results. The gender of the participants was male for 118 participants (51.3%) and 112 females (48.7%). Mean and standard deviation (SD) of maternal, paternal (at the time of delivery) age was equal to 36.38 (5.94) and 39.94 (6.58) respectively. The observed abdormalities were 35.53% psychomotor retardation, 23.68% facial abnormalities, 23.68% spinal cord abnormalities, 21.05% morphological abnormalities, 20.61% short stature, 19.74% developmental disorders, 19.30% heart disease, 16.67% neurological diseases, 14.47% genetic syndromes, 11.40% genital abnormalities, 8.33% limb abnormalities, 7.46% dermatological abnormalities, 6.14% eye abnormalities, 6.14% hypothyroidism, 5.70% endocrine disorders, 5.26%otolaryngology abnormalities, 2.63% disease of kidney, intestine, 2.19% vascular malformations. Regarding the karyotype chromosome analysis by G-banding technique, from the 230 children in: 24 (10.43%) a pathological result was found, in 158 children (68.70%) it was found normal (46, XX or 46, XY by case) without other findings, while in 48 children (20.87%) the test was not performed for various reasons. Regarding the results of molecular analysis (DNA) from the 230 children, in 50 (21.74%) a pathological finding was found, in 56 children (24.35%) no abnormalities were found and in 124 children (53.91%) no molecular analysis was performed for various reasons. In conclusion, the sample of this descriptive study is characterized as uniform in terms of the method of assisted reproduction since 96.24% had followed the classic IVF. Full-term pregnancy was associated with the appearance of malignancy and head morphological abnormalities (64.6%), normal pregnancy was associated with genetic syndromes (18.2%) and facial abnormalities (11.1%). It is recommended the screening oocyte and sperm donors in order to help protect the safety and health of donors, recipients, and future offspring. The present study confirms the association of the presence of congenital anomalies after in vitro fertilization (IVF). However, the absolute risk of developing severe dysplasias after an IVF procedure is limited.
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Diffuse large B-cell Lymphoma mimicking as cholangiocarcinoma in a young male presenting with obstructive jaundice

Published on: 12th October, 2021

The involvement of bile duct in lymphoma is considered to be very rare and is usually a sequela of a disseminated disease [1]. In contrast to secondary involvement, primary non-Hodgkin’s lymphoma arising from the bile duct is extremely rare and presents with obstructive jaundice [2,3]. Non-Hodgkin’s lymphoma (NHL) accounts for 1% - 2% of all cases of malignant biliary obstruction [4]. Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic lymphoma. The first case of Non-Hodgkin lymphoma arising from bile duct was described by Nguyen in 1982 [5]. Most common extra nodal involvement of NHL is abdomen. Although, involvement of the stomach, pancreas or common bile duct is not common [6]. We present to you a case of 31year old male who presented to us with obstructive jaundice and was later diagnosed as Diffuse Large B-Cell lymphoma.
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A validated method for coumarin quantification in Meliloti herba and its ethanolic extracts using micellar thin-layer chromatography

Published on: 12th October, 2021

A micellar thin-layer chromatography method for the quantitative determination and validation of coumarin in Meliloti herba and its ethanolic extracts was developed and validated. For achieving good determination, the mobile phase of 5 x 10-4 mol/L Tween-80 in a mixture propanol-2 – water (5:95 v/v) was used. Densitometric determination was carried out at 275 nm. The calibration curve was linear in the range of 0.1-2.5 μg per band. The proposed method is simple, rapid, precise and accurate; replacing hazardous solvents by greener ones correspond to the modern requirements in “Green chemistry” concepts. The obtained data can be used for the routine analysis of coumarin in medical plant and extracts. 
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Bilateral corneal ulcer and hypovitaminosis A: a case report

Published on: 11th October, 2021

Vitamin A is a fat-soluble discovered in 1913. Hypo-vitaminosis A can cause blindness by various mechanisms. The aim of this case report is to emphasize the severity of Vitamin A deficiency and its local consequences on the eyes causing corneal ulcerations, abscess and even blindness.
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A case of resistant hypercalcemia in a peritoneal dialysis patient with underlying Vitamin A toxicosis

Published on: 7th October, 2021

Hypercalcemia in End Stage Renal Disease on Dialysis, is a frustrating complication for both medical staff and patients, and it may lead to vascular calcification, Calciphylaxis, and even aggravating cardiovascular disease, even in the absence of risk factors which can lead to early death [1], and correcting Hypercalcemia even in the absence of hyperphosphatemia is out most important to improve co-morbid conditions and reduce mortality, most common causes in end stage renal disease, includes high calcium dialysis bath, high dietary intake of Calcium rich food, exogenous intake of calcium products, or excessive intake of Vitamin D, underlying Sarcoidosis, rare causes need to be explored in resistant cases, including Vitamin A toxicosis, as being presented in this case.
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Effect of chitosan and silicon oxide treatments on postharvest Valencia Late (Citrus × sinensis) fruits

Published on: 6th October, 2021

The efficacy of chitosan and silicon oxide to prevent postharvest weight loss and fungi infection in 'Valencia Late' oranges was tested. Three silicon oxide concentrations (0.1%, 0.2%, 1%) were applied as preharvest treatments. Chitosan treatments were performed at the same concentrations in postharvest fruit. Preharvest applications were carried out by tractor spraying, while fruit were submerged for 30 seconds in baths with the chitosan concentrations in the postharvest applications. In both cases, a positive control (water treatment) and negative control (fungicide) were included. Treated fruit were stored in a chamber to simulate commercial storage conditions (4 ºC, 90% RH) for 9 weeks. After this time, the weight loss and damage caused by fungi due to natural infection were evaluated. Both silicon oxide and chitosan applications were effective in controlling natural infection by Penicillium species but had no positive effect on weight loss.
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COVID-19 and rhino-orbital mucormycosis – a case report

Published on: 5th October, 2021

There is a constant rise in cases of rhino-orbital mucormycosis in people with Coronavirus disease 2019 (COVID-19). Generally, Mucormycosis develops in immunosuppression or debilitating diseases. In cases having head and neck involvement, the mold enters the respiratory tract with further involvement of nose and sinuses and there is consecutive progression into orbital and intracranial structures. Diabetes Mellitus (DM) is an independent risk factor for both severe COVID-19 and mucormycosis. The clinical examination and direct smears are helpful for early diagnosis of the disease and timely intervention. For the better prevention and management of such opportunistic infections in COVID-19 patients, it is prudent to establish prophylactic treatment protocols along with rational use of corticosteroids. We here report a case of Rhino-orbital Mucormycosis infection caused by Rhizopus oryzae in a COVID-19 patient with Diabetes Mellitus.
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