The Immunitary role in chronic prostatitis and growth factors as promoter of BPH
Published on: 25th April, 2018
OCLC Number/Unique Identifier: 7666286870
In the actual medical therapy of BPH, we can see: antibiotics, alpha blockers, 5-ARI, fitotherapeutics/natural products (Serenoa repens) with different which display clinical activities and other molecules such as FANS (local or systemic dosage forms) cortisones and others. Relationship between immune systems and chronic prostatitis are strictly involved in BPH progression. A vicious cycle that involve chronic flogosis, tissue remodeling, grow factors, inhibition of apoptosis, and other phenomena. Observing BPH pathogenesis under an immunologic point of view make possible to search new pharmacological strategies, to improve actual therapy.
The aim of this work is to observe some relevant literature in our opinion related the management of BHP and its progression under a pharmaceutical and immunological point of view. A deep knowledge in the pharmaceutical properties of some molecules (antimicrobials, anti-phlogosis agents, Anti-androgenic agents, alpha blockers, 5-ARI and other treatments, techniques, interventions or instruments) can help the physicians to pick the right choice.
Fever is not a symptom in COVID-19: None of the diseases require fever as its symptom
Published on: 14th May, 2020
OCLC Number/Unique Identifier: 8603903069
We have been hearing for centuries that ‘fever is not a disease but a symptom’. Physicians say that fever is a symptom of diseases like flu to cancer.
Acute Appendicitis: Hispanics and the Hamburger Sign
Published on: 20th November, 2019
OCLC Number/Unique Identifier: 8405001290
Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis.
Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR).
Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia.
Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.
McArdle’s Disease (Glycogen Storage Disease type V): A Clinical Case
Published on: 31st December, 2018
McArdle’s Disease, or Glycogen Storage Disease Type V, is the result of a deficiency in one of the enzymes responsible for the metabolism of glycogen in the body. Individuals with this disease, lack or produce very small concentrations of the myophosphorylase or glycogen phosphorylase enzyme.
McArdle’s disease is a metabolic and recessive genetic disease caused by a mutation on the PYGM gene located on chromosome 11q13. This gene is responsible for the synthesis of the myophosphorylase (or glycogen phosphorylase) enzyme. It is the most common form of muscular glycogenesis. We present here the clinical case of a 35 years old woman diagnosed with McArdle’s disease at the age of 21 after a visit to a Neurologist. It was confirmed that the patient had shown symptoms of this disease at least 10 years before definitive diagnosis: intolerance to exercise, asthenia and muscular weakness. In this report we describe the different signs and symptoms of the disease, as well as the tests performed to confirm the diagnosis by muscle biopsy and genetic analysis. McArdle’s disease is classified as a rare disease and often its diagnosis is delayed due to a lack of knowledge about its symptoms and signs. Our intention is to make, with the description of our clinical case, the information about this disease more available to physicians to prevent future misinterpretations and delayed diagnosis. A medical documentary we have created on “McArdle’s Disease” can be seen in YouTube using the following links: https://youtu.be/HAhoZ7jxz7Q (English version) and https://youtu.be/uZopzSHOl20 (Spanish version).
What is the Cost of Measuring a Blood Pressure?
Published on: 11th October, 2018
OCLC Number/Unique Identifier: 7893702194
Rationale: Blood Pressure measurement has transitioned to the oscillometric method in most hospitals in the United States, however out-patient offices mainly use the auscultatory technique.
Objective: To determine time taken to measure blood pressure by an automatic oscillometric device compared to an auscultatory measurement device and to determine what each measurement costs.
Methods: Blood Pressures were measured in a single primary care office by medical assistants (MA) for patients seen for office visits. Timed measurements were performed using an automated oscillometric Welch Allyn Connex Vital Signs Monitor (WA) and manually using a Tycos device. A minimum of 400 readings were taken with each method.
Results: The average time to manually measure BP was 58.6 seconds, whereas the WA average was 39.8 seconds, 18.8 seconds faster (p<0.05). There was an improvement in measurement time with MA experience with the WA device (p<0.05). The average MA cost to measure a single BP using the manual method was $0.35 vs. the WA method ($0.24) or a savings of $0.11 per measurement. The improvement with experience of WA method reduced cost to $0.17 per measurement.
Conclusion: The oscillometric method saved 17cents per measurement potentially saving $1,119 per year for our primary care practice.
Strategic Plans for Diagnosis, Treatment & Control of Hypertension
Published on: 23rd November, 2018
OCLC Number/Unique Identifier: 7943259097
Two major challenges face the practicing physicians and medical community regarding the management of hypertension. First is accurate diagnosis and finding who is the truly hypertensive patient in need of life-long treatment. Second is to improve blood pressure control through addressing hypertension risk factors, adherence to treatment and frequent monitoring.
- Current Challenges in Management
o Accurate diagnosis of hypertension
o Improving blood pressure control
- What Do We Need For The Future?
Hypertension as a persistent public health problem. A position paper from Alliance for a Healthy Heart, Mexico
Published on: 3rd April, 2019
OCLC Number/Unique Identifier: 8062251564
Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnified one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the final pathologic end-points and explains why cardiovascular diseases occupy first place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.
Identification and resolution of drug therapy problems among hypertensive patients receiving care in a Nigerian Hospital - A pilot study
Published on: 1st October, 2020
OCLC Number/Unique Identifier: 8677986406
Background: An event involving drug therapy that actually or potentially interfers with the desired health outcomes is known as drug therapy problem.
Objective: The study aimed to identify and resolve potential drug related problems encountered among adult hypertensive patients receiving care in a Nigerian Tertiary Hospital. Methods: This was a prospective cross sectional study. The data were collected from the patients’ medical records using the Pharmaceutical Care Network Europe (PCNE) Classification tool Version 6.2 (PCNE, 2010). For each of the 171 medical records, the DTPs experienced within the study period were identified. Data were analyzed using the IBM Statistical Product and Service Solutions (SPSS) for Windows, Version 21.0 (IBM Corp, Version 21.0, and Armonk, NY, USA).
Results: Majority of the patients were above 65years of age 64(37.4%), while about half of the patients were females. A total of 644 drug therapy problems were identified. The major cause of DTP was prescribing error 189(29.3). Other causes of drug therapy problem identified in this study were inappropriate drug selection 122(18.9), no indication for drugs 52(8.1), inappropriate drug combination 87(13.6), new indication presented 61(9.5), dose too high 62(9.6), dose too low 44(6.8), wrong drug taken/administered 27(4.2). Majority of the interventions made were accepted 586(91.0%) while only 3(0.5%) of the interventions made were not accepted.
Conclusion: This study demonstrates that a pharmacist, with adequate training and support can play a vital role in identifying and resolving drug therapy problems. Also, there is a need for an educational intervention among prescribing physicians to update them regularly on hypertension guidelines.
States Care - The Cure for Patient Healthcare
Published on: 12th November, 2019
Clinical physicians believe they are drowning . . . because they are! Between complying with an ever-changing landscape of time-wasting federal regulations, avoiding Health Insurance Portability and Accountability Act violations, plus the entire billing process, who can keep up with the literature, study a patient’s medical history, or even talk with a patient?!?
Lifestyle Diseases and the Hair Growth Cycle: A multidisciplinary approach using Nourkrin® with Marilex®, a proteoglycan replacement therapy, for anagen induction and maintenance
Published on: 8th December, 2017
OCLC Number/Unique Identifier: 7317598559
Multiple studies have investigated the relationship between androgenetic alopecia and cardiovascular disease, including studies that have identified elevated rates of cardiovascular disease in patients with vertex hair loss, vertex and frontal hair loss, early onset hair loss and rapidly progressive hair loss. In addition, increased risks for hypertension, excess weight, abnormal lipids, insulin resistance, carotid atheromatosis and death from diabetes or heart disease have been reported in this population. Studies investigating an association between androgenetic alopecia and metabolic syndrome have yielded conflicting findings. Distinct guidelines for the detection and prevention of cardiovascular disease in individuals with androgenetic alopecia have not been established. In addition to the traditional risk factors for developing cardiovascular disease, included in the definition of the metabolic syndrome, several skin diseases have recently been shown to be markers of conditions relating to the patient’s overall health. Physicians should be aware of the possible connection between relatively frequent skin diseases, such as psoriasis and hair growth disruptions, including androgenetic alopecia and female pattern hair loss and cardiovascular disease. This review is concentrated on the association between insulin resistance, type 2 diabetes, abdominal fat, cardiovascular disease and hair growth disruptions as an early indicator of these underlying conditions. We have investigated the importance of robust primary clinical treatment measures to address the manifestation of hair loss due to a disruption caused by metabolic syndrome as an effective means to alleviate further stress induced hair loss, which can exacerbate the underlying cause.
How the COVID-19 outbreak affected physician-patient relationship
Published on: 17th November, 2020
OCLC Number/Unique Identifier: 8872699857
Physician-patient communication is the most basic element and vital skill of physicians in the diagnosis, treatment, and establishing diagnostic protocols. As the risks of contagion and viral infection are higher in physicians and health workers, front line soldiers inpatient care units, so they should establish strict protective measures. However, patients value greatly face to face and close relationships with their doctors, including facial interviews and physical examinations. So social and physical distancing between physician and their patients can be remarked as a bigger toll than the risk of COVID-19 contagious.
Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule
Published on: 19th March, 2021
OCLC Number/Unique Identifier: 8973613870
Systemic arterial air embolism (SAAE) is a rare but serious complication of CT-guided hook wire localization of pulmonary nodule usually with catastrophic and poor outcome. Hook wire needle localization is done pre-operatively by placing wire around or into the pulmonary nodule to provide the thoracic surgeon accurate location guidance of the target nodule for Video-Assisted Thoracoscopic Surgery (VATS) wedge resection with safety margins. Physicians should be aware of this possible complication during the procedure in order to rescue the patient promptly as it requires rapid diagnosis and management. We describe a 55-year-old male who underwent a CT-guided hook wire needle localization of left upper lobe lung cancer and left lower lobe pulmonary nodule prior to planned VATS wedge resection who developed altered mental status and bilateral lower extremities paralysis after wire placement was completed. His CT head demonstrated small air embolism in the left occipital area, confirming the diagnosis of cerebral air embolism and follow up CT and MRI of the head revealed multiple areas of brain infarction. In addition, he was diagnosed with anterior spinal cord syndrome (ACS), most likely due to anterior spinal artery ischemia from micro air embolism on the basis of clinical findings but with negative ischemic changes on MRI of the spinal cord. His mental status recovered but he remained paraplegic and transferred to inpatient rehabilitation service.
Factors influencing referral delay of cancer patients to an oncology unit in the Southern Region of Saudi Arabia
Published on: 20th August, 2021
OCLC Number/Unique Identifier: 9194011239
Introduction: Cancer treatment and prognosis depend heavily on early detection. Survival in the early stages is excellent for almost all types of cancer. Unfortunately, in Saudi Arabia, a large number of cancer patients present with advanced disease, resulting in a poor prognosis. There are three levels of delay in the management of cancer patients. The first level is the time between the first cancer-related symptoms and the presentation to the health facility, the second level is from the presentation to the diagnosis, and the third level is between the diagnosis and the treatment. This study aims to determine if there is a delay, at what level and to study the factors causing such delays.Materials and methods: Two hundred cancer patients who presented to the Armed Forces Hospital Southern Region, Oncology Department, were interviewed from January 1st to June 30th, 2018. The interviews were conducted by trained physicians familiar with the questionnaire’s contents. The questionnaire consisted of four sections: a demographic section and three more sections to identify factors causing the delay at the three levels from the patients’ perspectives. All data were analyzed using the SPSS version 20.0.Results: The mean patient age was 63 years. A total of 112 patients were female and 88 were male. The most common cancer type was breast cancer (27.5%). Among the patients, 61% were illiterate and 25.5% had elementary school degrees, 86% expressed little or no general medical knowledge about cancer. More women than men paid attention to cancer symptoms (70% vs. 54%). 75% of the patients presented to the first health facility after 2 months from the first appearance of symptoms (level 1 delay). Only 2% of the patients presented within one week. 50% of the patients received a diagnosis after visiting two health facilities. All patients were diagnosed at hospitals. 40% of patients used alternative medicines, 70% of whom thought this was the cause of their delayed presentations. 67% had their diagnosis confirmed within one month (level 2 delay), and 66% started their definitive treatment within one month (level 3 delay). 75% of the patients blame themselves for the delay. Educational level (p = 0.03), knowledge about cancer (p < 0.01), and the use of complementary and alternative medicines (CAM) (p = 0.01) were significantly associated with delayed presentation of patients to the health facility. Conclusion: There is a delay in the presentation of cancer patients (level 1) in the southern part of Saudi Arabia. Educational level, knowledge of cancer symptoms, and use of complementary and alternative medicines are the main causes. There were no delays in diagnosis and start of treatment (level 2,3).
Using the DFConhecimento instrument to assess Congolese healthcare professionals’ knowledge on sickle cell disease
Published on: 29th September, 2021
OCLC Number/Unique Identifier: 9278289343
Introduction: Despite advances in the management of sickle cell disease (SCD), gaps still exist in the knowledge of healthcare professionals (HCPs) about the disease. The objective of this study was to assess the knowledge of HCPs about SCD.
Methods: This is a cross-sectional study involving 465 HCPs (physicians and nurses) who responded to the DFConhecimento instrument questionnaire. Performance was tested in terms of average score and proportion of correct response for each questionnaire item topic.
Results: The average score for respondents was 4.6 ± 1.9 out of a total of 13 points. Proportions of professionals who responded well were greater than 58% in three topics (Neonatal screening program, Sickle cell conditions, and Sickle cell anemia genotype). In the other topics, rates of good response ranged from 11.6% to 46.0%. There was a statistical association between best performance and medical title: physicians were more knowledgeable than nurses (OR = 6.26; 95% CI: 2.69-14.56).
Conclusion: This study highlighted that knowledge of SCD among HCPs is very inadequate. This lack of sufficient information on SCD from HCPs indicates the need to develop continuing education programs.
Assessment of knowledge of acute kidney injury among non-nephrology healthcare workers in North-Kivu Province, Democratic Republic of the Congo
Published on: 6th April, 2022
OCLC Number/Unique Identifier: 9470693131
Background: Assessment of knowledge of acute kidney injury (AKI) among healthcare workers (HCWs) is necessary to identify areas of deficiency and key topics to focus on while organizing educational programs to improve AKI care. The objective of this study was to assess AKI knowledge and practice among health care providers in North Kivu province, the eastern Democratic Republic of the Congo. Material and methods: This was a cross-sectional study conducted in six public hospitals in North Kivu province using a self-administered questionnaire. Results: A total of 158 HCWs completed the survey, among them 66 (41.78%) were physicians. The mean age of respondents was 36.07 ± 10.16 years and the male gender was 56.33%. Only 12 (7.59%) of the respondents had a good knowledge of the definition and classification of AKI. The respondents’ mean scores were 6.76 out of a total of 18 about risk factors for AKI and 6.29 out of a total of 11 with regard to nephrotoxic drugs. Regarding practices, 28.48% of the respondents assess the risk of AKI in their patients in their daily practices; 31.65% report AKI in the patients’ medical history, and 33.54% call on a nephrologist specialist to get specialized advice. Conclusion: This study found considerable gaps in knowledge and practice regarding AKI among most of HCWs in North Kivu province.
The effect of frequency of sexual intercourse on coronary artery disease
Published on: 7th June, 2022
Background: Doubts about the safety of sexual activity are common among cardiac patients and physicians alike, and are often neglected during routine checkups or on discharge from the hospital following a cardiac event or invasive procedure. Although it varies from society to society, it is considered taboo by most patients, so it is reluctant to ask the doctor about sexual activity. Doctors, on the other hand, remain silent due to the lack of clear information about the effect of sexual activity on coronary artery diseases or the presence of doubts. It is ultimately set aside by professionals and their patients. The patient does not ask and the doctor does not answer. This study, it was aimed to investigate the effect of the frequency of sexual intercourse on coronary artery disease. Methods: After applying the exclusion criteria, the remaining 180 patients were included in the study. A self-administered survey was applied to the patients before coronary angiography and patients were assessed according to the presence of additional diseases, their demographic characteristics, and the frequency of sexual intercourse. Two experienced physicians evaluated the angiographic results. Firstly Patients were grouped as 90 patients with normal coronary anatomy and 90 patients with coronary artery disease. After this, Coronary artery disease severity was evaluated according to syntax score. Results: The mean age of the patients was 58 ± 12.5 years. The distribution of age is not reasonable. According to gender, the female/male ratio the proportion of men was higher in patients with coronary artery disease. İncidence of normal coronary anatomy increased as the frequency of sexual intercourse increased. P - value was 0.037 and the result was statistically significant. The frequency of sexual intercourse was found to be 4.2/per month. The relationship between the Syntax score and frequency of sexual intercourse was not statistically significant (p > 0.05).Conclusion: As a result of the study, it was seen that patients with more frequent sexual intercourse had more normal coronary artery anatomy, and those with coronary artery disease had single coronary artery disease than multiple vascular disorders. it was concluded that the incidence of coronary artery disease and coronary artery disease severity decreased as the frequency of sexual intercourse increased. Sexual intercourse might be a preventive factor in the development of coronary artery disease.
A witnessed intra-operative blood transfusion-related air embolism under epidural anaesthesia for vesicovaginal fistula repair
Published on: 21st June, 2022
OCLC Number/Unique Identifier: 9554643394
The transfusion is a normal life-saving procedure conducted commonly by the nurses at the prescription of the attending physician or the emergency physicians. It is generally a safe procedure if guidelines for processing and administering are carefully followed. Blood transfusion is an independent risk factor for morbidity and mortality and major complications arising from transfusion are generally rare. We present a case of a mild case of iatrogenic air embolism exacerbated by pressure infusion for a patient who had undergone an exploratory laparotomy for an iatrogenic fistula repair under epidural anesthesia.
Can infants develop meningitis in the absence of bacteremia in the first ninety days of life? A retrospective chart review
Published on: 4th July, 2022
OCLC Number/Unique Identifier: 9554569888
The overall incidence of meningitis in infants 0-90 days is low; however, it remains a serious cause of morbidity and mortality among affected patients. It is standard of care to perform lumbar punctures as part of the work-up of fever in the first four weeks of life and sick-looking babies up to the age of 90 days. This particular procedure is often refused by parents, and physicians are left to predict the possibility of meningitis based on blood culture results.The aim of this study is to determine whether it would be safe to rule out meningitis based on a negative blood culture in this age group.
The real-time information provision problem in assessing rehabilitation needs among athletes with overtraining syndrome
Published on: 12th August, 2022
One of the biggest challenges in sports medicine is the return-to-play decisions, making or breaking athletic careers. Since there are no protocols to guide team physicians and consultants for athletes with fatigue syndrome, illness, injury, or overtraining syndrome, real-time monitoring plays a crucial role in such cases. By monitoring a combination of performance (e.g., maximal lactate concentration, maximal heart rate at lactate threshold), physiological (e.g., resting heart rate and maximal heart rate), biochemical (e.g., glucose) and hormonal (e.g., cortisol) variables, there should be objective indices determining eligibility or disqualification for the ill or injured athletes, allowing rehabilitation practitioners to improve and adjust their plan accordingly on a real-time information provision basis.
Status of hemodialysis patients using complementary and alternative medicine practices during the COVID-19 pandemic
Published on: 31st August, 2022
The use of complementary and alternative medicine (CAM) applications increased by 39.3% of individuals with chronic diseases during the pandemic process in Turkey. For this reason, this descriptive study was conducted to determine the use of integrative and integrated medicine practices in hemodialysis patients during the COVID-19 pandemic. The population of the study consisted of individuals who were treated in a hemodialysis unit in the city center (n = 235). It was planned to include whole of the population by using the whole number method, but patients, who did not agree to participate in the study and did not meet the inclusion criteria of the study, were excluded from the sample and the study was conducted with 160 patients between 1 June and 1 September 2021. As a data collection tool, a questionnaire consisting of 30 questions including socio-demographic and disease characteristics of the patients was prepared by the researcher upon review of related literature. Considering the distribution of phytotherapy method (herbal treatment) usage frequency of integrative and integrated medicine applications of individuals before the COVID-19 pandemic and during the COVID-19 pandemic period, the most vitamins (21.8%), prebiotics (12.5%), and honey (%) 10.6), their use was found to be high. During the COVID-19 pandemic, the use of massage (40%), breathing exercises (30.0%) and spiritual therapy (28.7%) applications increased. As a result, it is seen that integrative and integrated applications are considered in the process of dealing with hemodialysis patients. Physicians need to be aware of and ask patients about their use of integrated and integrated health practices.
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