British Journal of Healthcare and Medical Research

A Landmark Crime of Poisoning

Giovanni Meledandri — 2024-12-20

The account of Germanicus' death plays out in Roman history as a true detective story. The affair contains more than one mysterious aspect and only through the words of the historians who have handed down the story is it possible to propose an interpretation of what happened. The paper proposes a critical, textual medical and legal analysis of the ancient sources aimed at formulating a contextualized hypothesis on poisoning as the most likely cause of Germanicus' sudden death, thus eliminating him from succession to the Roman Empire and paving the way for Caligula. Julius Caesar Germanicus died on Oct. 10^th 19 C.E., in Epidaphne near Antioch of Syria, under mysterious circumstances, at the age of 33, during the Principate of Tiberius. He himself invoked poisoning. The results of the analysis supported the venom hypothesis, which is basically recognized and endorsed by all the four quoted authors. In conclusion, the hypothesis that Germanicus fell victim to a criminal plot that used the crime of poisoning to exclude him from the succession looks to be textually supported.

Demographic and Clinical Characteristics Differentiating Patients Referred for Diagnostic Spirometry and Diagnosed with or without Chronic Obstructive Pulmonary Disease

Maura Alicia Flores Uzcanga — 2024-12-12

Introduction: Patients who, from the perspective of the family physician, require spirometry to confirm or rule out Chronic Obstructive Pulmonary Disease (COPD) must meet clinical criteria that differentiate them from those who do not appear to need it. Objective: To identify the demographic and clinical characteristics that differentiate patients referred for spirometry during 2022–2023 who were diagnosed with or without COPD. Materials and Methods: This was an observational, retrospective, cross-sectional, and comparative study including 455 patients who underwent spirometry for suspected COPD. This suspicion was based on respiratory data, including three variables—cough, dyspnea, and expectoration—combined into an algorithm. These variables, along with other clinical and demographic data, were compared between patients diagnosed with and without COPD using a logistic regression model (LRM). This model identified, through odds ratios (OR) and 95% confidence intervals (95% CI), the differences between both groups and assessed whether the algorithm influenced the indication to perform spirometry. Results: 29.2% of the patients were diagnosed with COPD through spirometry. The final logistic regression model identified the smoking index as a significant factor, with categories moderate (10 to 20 packs/year, OR 3.88, 95% CI 2.16–6.95), intense (21 to 40, OR 1.95, 95% CI 1.03–3.65), and high (≥ 41, OR 11.54, 95% CI 4.55–29.23). Additionally, the presence of cough (OR 2.18, 95% CI 1.36–3.46) also showed significant differences between patients with and without COPD and influenced the indication to perform spirometry. Conclusions: The smoking index and cough were significantly different factors between patients with and without COPD and influenced the indication to perform pre-diagnostic spirometry. The algorithm, however, did not have a significant impact on this indication.

Homeopathy in the Treatment of Cancer: A Hope That Must Be Nurtured

Giulio Tarro — 2024-12-12

Homeopathy is a clinical methodology discovered by the Saxon physician Samuel Hahnemann and is based on the law of similarity according to which "like cures like", therefore, substances are administered to the patient in small "ultradiluted", "infinitesimal" doses, taking into account that such substances, in high doses, in healthy individuals produce symptoms similar to those that must be fought in the patient. Homeopathy, over the course of about two centuries, has been harshly criticized because it uses excessively diluted doses and, even, drugs that do not contain any chemical active ingredient. In the ultradiluted homeopathic solution the active ingredient disappears, but it is conceivable that it is "memorized" by the solution, in fact, some scientific studies on the so-called "memory of water" explain, at least in part, the reasons why homeopathic drugs are effective. The effectiveness of homeopathic medicines has also been found in the treatment of cancer and some experiments, in vivo and in vitro, are truly enlightening because they highlight the cytotoxic effects of homeopathic ultradilutions on cancer cells. Although the experiments and scientific research on homeopathy must be further explored, although homeopathic medicines cannot replace chemotherapy, although the evidence must be completed with other evidence, some scientific studies allow us to seriously reflect on the therapeutic potential of homeopathic medicines, medicines that can be used in the treatment of serious diseases, including cancer. This is why we believe that homeopathy, in the treatment of cancer, is a hope that must be nurtured.

A Comparative Study of Topiramate and Botulinum Toxin in Reducing Migraine Disability in Patients with Chronic Migraine

Erick-Eduardo Solís-Tun — 2024-12-12

Background: Chronic migraine (CM) is a highly debilitating neurological condition that requires effective treatment. Topiramate and botulinum toxin are widely used for management and prevention. However, comparative data on treatment escalation in patients with treatment-resistant CM and incobotulinum toxin A (inco-BTX-A, Xeomin®) remain limited. The Migraine Disability Assessment (MIDAS) questionnaire is a valuable tool for objectively quantifying the impact of migraines on daily functioning. This study aimed to conduct a comparative analysis of topiramate and inco-BTX-A in terms of their effectiveness in reducing disability associated with treatment-resistant CMs. Methods: This comparative, observational study evaluated the effectiveness of topiramate and botulinum toxin in reducing MIDAS scores in patients with CM who had previously failed initial treatments. Patients were divided into three groups: group 1 (topiramate to inco-BTX-A), group 2 (non-steroidal anti-inflammatory drugs/NSADIs to topiramate), and group 3 (NSAIDs to inco-BTX-A). Data collection included demographic features and MIDAS scores before and after treatment. Results: A total of 96 patients were included, with a predominance of female patients (85.41%). Group 1(n=39) showed a significant reduction in MIDAS scores 4.1 ± 2.88, t-statistic = 8.89 (p < 0.05). There was no significant difference between Group 2 (n=39) and Group 3 (n=18), with a p-value of 0.0545. Conclusions: Topiramate and inco-BTX-A effectively reduced MIDAS scores in patients with CM, particularly in those with treatment resistance. While groups 2 and 3 showed similar outcomes, inco-BTX-A demonstrated a more significant effect in group 1, suggesting its potential as an effective treatment for treatment-resistant CM.

Compliance of Hospitals in Saudi Arabia with National and International Medical Gas Pipeline System Maintenance Guidelines

Amir Altinawi — 2024-12-06

The aim of this study has two folds. Firstly, to investigate the extent to which hospitals in Saudi Arabia adhere to CBAHI (Saudi Central Board for Accreditation of Healthcare Institutions) standards regarding maintenance of medical gas pipeline systems (MGPS). Secondly, to determine if different hospitals implement the MGPS check-points required by CBAHI in a similar manner with respect to timeframe of performing the check-points. A cross-sectional survey was conducted during field visits to 11 hospitals biomedical engineering offices. A paper-based questionnaire was developed to collect all the relevant information. The study results showed that 99% of the check-points specified by CBAHI are implemented fully by all the 11 hospitals. There was only one hospital that failed-short of checking the system alarm of the pipeline system, and another hospital that failed-short of checking for leak-signs in joints of liquid oxygen plant. There were large variations in time-periods of actually performing the required check-points among hospitals. The study suggests modification on CBAHI standards regarding maintenance and operation of MGPS that incorporate timeframe for performing each check-point to guarantee an efficient and safe MGPS.

Sex Assignment and Re-Assignment in Patients with Steroid 5-Alpha Reductase Type Two Deficiency: The Psycho-Social, Religious and Cultural Challenges

Nasir A. M Al-Jurayyan — 2024-12-01

Background: Steroid 5-alpha reductase type two deficiency (5 ARD 2) is a rare autosomal recessive disorder of sexual development. The lack of the enzyme, 5 -alpha reductase, that converts testosterone to dihydro testosterone, results in the external genitalia that may be appear atypical, normal to ambiguous external genitalia. Materials and Methods: A retrospective review of patients with 5 - alpha reductase type two deficiency were included. A coordinated multidisciplinary team of specialists were involved. Psych -social, cultural and religious factors were analyzed. Results: Four patients, from three families, among 12 patients, who were diagnosed with 5-alpha reductase type two deficiency in 46 XY disorders of sex development were wrongly assigned female sex at birth due to abnormal external genitalia. Their age ranged between birth to 12 years. Signs of virilization which occurred at 12years of age in one patient led to the diagnosis of the other. The other two patients were diagnosed during the investigation of ambiguous genitalia. The cultural factor was the commonest factor among others, influencing sex reassignment. Level of parental education had no role. Conclusion: Sex assignment remains one of the most clinically challenging and controversial in 46XY disorders of sex development (DSD), in particular that due to steroid 5-alpha reductase type two deficiency. Cultural factors are important, among psychosocial, and religious factors. Given the complexity of the disorder, it is also important to involve a multidisciplinary team of experts in the management.

Occlusal Diagnosis and Treatment for A Patient with Unconscious Mouth Opening Disability: A Case Report

Kengo Torii — 2024-12-20

An occlusal analysis was performed on a patient with unconscious mouth opening disability, and abnormal occlusion was found. Occlusal splint therapy was performed, however, this was ineffective. After that, occlusal position correcting therapy was performed, and the opening disability disappeared. As a result of occlusal analysis, it was speculated that the patient's opening disability was due to contracture of the masticatory muscles.

Goiter with NIFTP Lesion Associated with An Accessory Thyroid as An Uncommon Anatomical Variant: Insights from A Case and Review of The Literature

Amine Bachar — 2024-12-20

Thyroidectomy is a usual surgery done by surgeons around the world, its difficulty remains in the anatomical variation of the cervical region and the multiple aspect of the thyroid pathology. In this optic we report a rare multinodular goiter with an accessory thyroid associated with a NIFTP lesion. This unique association make a double challenge firstly in surgery and secondly in the fellow up.We present the experience of our department and a review of the literature to draw attention of surgeons and pathologists about these variant of embryology and pathology.

Intraoperative Cardiac Arrest: An Algorithm to Address the Synchronous Underlying Pathology

Ali Mahmood — 2024-12-20

Intra-operative cardiac arrest (IOCA) is a rare yet feared complication. It has been reported with diverse range: from 0.8/10,000 cases to 21/100,000 cases. [1,2,3] The immediate mortality and subsequent 30 days mortality are paramount, from 62% to 75%, respectively. [1,2] Patients that had incurred an operation due to trauma had an even worse prognosis, in some studies. [4] Elective cases, where the arrest was addressed with a resuscitation algorithm, unobstructed communication, and teamwork between the surgery and anesthesia teams, fared the most favorable outcomes. [5] Some literature has even reported that the use of CPR, when necessary, was a poorer prognostic indicator. [6] Often successful resuscitation and rescue of the patient from IOCA is performed before the surgeon has had the opportunity to address the pathology that originally scheduled the patient for an operation. There is not an established algorithm of how or when to take the patient back to the operating room to address the underlying pathology. We propose an algorithm where a successfully resuscitated patient, without sustaining a myocardial infarction (MI), can be appropriately worked up, managed, undergo prophylactic cardiac protection, and return to the operating room for a successful operation.

Regulation of Muscle Contraction and How Mutations in the Muscle Proteins Cause Heart Disease: The Laboratory Techniques Involves Molecular Biology, Protein Expression, Purification and Characterization Using Biochemical and Biophyisical Techniques

Ugochukwu Obinna Maluze — 2024-12-01

The expansion of the causative mutations to the rigid thin filament changed the description of hypertrophic cardiomyopathy (HCM) from an illness of the cardiac motor to a syndrome of the cardiac sarcomere and significantly extended the gasp of the potential molecular pathogenic mechanism. An interesting hypotheses concerning disease mechanism posted that the diverse medical prognoses in the familial type of HCM may possibly be related to mutations in self-regulating protein machinery of the sarcomere (Frank et al, 1968). The journal of the novel study in 1990 establishes the inherited association of the beta-myosin and tropomyosin heavy chain genetic material to familial type of hypertrophic cardiomyopathy (HCM). The current studies conducted by some researchers elaborated on the various genetic alterations inside the genes encoding for the sarcomeric cardiac proteins, alpha tropomyosin, troponin T, and myosin protein components. The regularity of gene alteration in the alpha tropomyosin protein (TPM1) is lesser, contributing to 5% of FHC. Currently, the D175N gene mutation has been recognized in various unrelated populations, signifying that this spot could be an abnormal gene “hot spot” for the disease. In this project research, a wild type of normal protein and mutant genetic proteins (E180G and D175N) which are clinically involved in familial hyper cardiomyopathy (FHCM) were produced. Having in mind that the main effect of mutations E180G and D175N are mainly related to the thermal stability of the protein; this research will also investigate the differences between the thermal stability of wild type and mutated protein types using a Dye base fluorescent method of analysis. Dye based fluorescent method was used to monitor protein folding as a function of temperature for wild type tropomyosin and for HCM mutant E180G and D175N proteins. The column chromatography method of purification was used to purify the wild type and mutated proteins, and the protein bands were separated using gel electrophoresis methods. A similar assessment of folding stability and structural reports of several authors was in consistency with this present report which suggested that such mutations might alter protein folding. The results agree with previously published reports on the impaired function of expressed E180G and D175N mutations suggesting that the biochemical defects of the motor domain may affect myosin filament assembly in the sarcomere. For future prospects, future biochemical analysis of several other FHC mutations will be needed to establish a definite correlation between the enzymatic impairment between different mutants and their clinical phenotype of heart disease.

Efficacy, Safety, and Ergonomics of the EMS Swiss Lithoclast® Trilogy in Percutaneous Nephrolithotomy: A Review

Muhammad Ishfaq — 2024-11-06

Purpose: The Swiss Lithoclast Trilogy® is a novel percutaneous nephrolithotomy (PCNL) technology used for kidney stone fragmentation. It has a trifecta effect, including mechanical fragmentation, ultrasound lithotripsy, and suction to remove stone fragments. Some comparative studies have reported a higher stone-free rate, increased safety and lower operative time, yet robust evidence remains inconclusive. We reviewed studies investigating clinical safety, efficacy, and ergonomics of PCNL for treating renal stones. Methods: We reviewed 11 studies investigating Swiss Lithoclast® Trilogy for PCNL from 2017 until September 2024. eywords were used to search PubMed, Google Scholar, Scopus and Web of Science databases for relevant studies. After applying eligibility criteria and excluding animal and laboratory studies, 11 studies were included in this systematic review. Data was extracted for efficacy, safety, and ergonomics and analyzed to synthesize the results. Results: Out of 11, 2 were retrospective cohorts and 09 were prospective studies. The Swiss Lithoclast® Trilogy exhibited higher efficacy in stone fragmentation and clearance than traditional techniques. For mini PCNL, the stone fragmentation rate was reported up to 15.75 ± 20.81 mm³/sec. For supine PCNL, the stone fragmentation rate was 20.33 +/- 27.83mm³/sec. Lastly, Swiss Lithoclast® Trilogy was associated with high ergonomic satisfaction, and no significant complications. Conclusions: EMS Swiss Lithoclast Trilogy® for PCNL exhibits efficacy and safety with variable ergonomics. However, limited data are available and further prospective and randomized trials comparing EMS Swiss Lithoclast® Trilogy with equivalent technologies for PCNL are warranted to determine its role relating to the stone type and procedure.

Exploring the Effectiveness of Integrated Care Models for Managing Mental Health Issues

Kelechi Nelson Adindu — 2024-11-06

The global rise in mental health issues has exposed limitations in conventional healthcare systems' ability to deliver comprehensive and integrated care for individuals with complex mental disorders. In response, integrated care models have emerged as promising solutions, combining primary healthcare, specialized mental health services, and social support networks. This research investigates the efficacy of these integrated approaches in addressing mental health concerns, with a particular focus on their capacity to enhance care accessibility, improve patient outcomes, and elevate overall service quality. The study examines various integration models, such as collaborative care and patient-centered medical homes, to assess their impact on reducing healthcare fragmentation, enhancing care continuity, and promoting holistic treatment strategies. Research methods include systematic reviews of existing literature, case studies, and interviews with both healthcare professionals and patients. Conclusively, the study's findings aim to consolidate insights from contemporary research and practical examples to determine optimal practices and obstacles in deploying integrated care for mental health treatment. Furthermore, it delves into the prospects of cutting-edge technologies and cross-disciplinary partnerships to boost the effectiveness of these frameworks. Ultimately, this research seeks to contribute to the development of more effective, person-centered mental health care systems.

Studies on the Haematinic Potentials of Mucuna pruriens in Mice

Peter Uchogu Ahmadu — 2024-11-06

Background: Ethnopharmacological study of Mucuna pruriens, a creeping and leguminous plant used in the treatment of anaemia in the eastern part of Kogi State, Nigeria was carried out. The aim was to evaluate the effect of aqueous extract of the leaves of M. pruriens on haematinic activities in mice. Method: Leaves of M. pruriens was extracted by maceration in water. Phenyl hydrazine 4 mg/kg was administered for four days. Mice were grouped and treated with normal saline 10 ml/kg (normal and anemic control), M. pruriens (100, 200 and 400 mg/kg) and Fersolate (0.0214 mg/kg) p.o for 7 days. Hematological parameters measurements were carried out before treatments, days 1, 7, 14 and 21. The red blood cell count (RBC), haemoglobin concentration (Hb), white blood cell count (WBC) and hematocrit (HCT) were analyzed as indices of anemia. Phytochemical fingerprint using HPLC chromatography and mineral contents were also carried out. Results: Plant extraction percentage yield was 15%. M. pruriens (aq) significantly (p<0.01) produced a 61% recovery from anemia at 400 mg/kg after 7 days of treatment and between 94 to 146.52 % 1 and 2 weeks after treatment at all test doses. Hb, and HCT levels also significantly increased especially at 100 and 200 mg/kg doses of M. pruriens compared to the anemic control both at 1 and 2 weeks after treatment. HPLC analysis showed the presence of alkaloids, glycosides, saponin, terpernoids, carbohydrates, chlorogenic acid, caaffeic acid, rutin, ferulic acid and resins. The extract also contained substantial amounts of vitamins B6, C and E, as well as folic acid and iron. Conclusion: These results provide some evidence to support the traditional use of M. pruriens leaves in the treatment of anaemia.

Nurses’ Attitudes Toward Death and Associations with Background Characteristics

Julie Vognsen — 2024-11-06

In the United States, the majority of deaths occur in a medical facility. As such, the nurses’ attitudes toward death are crucial. Thus, this study examined nurses’ attitudes toward death and the impacts of demographic variables on their attitudes. The Death Attitude Profile-Revised (DAP-R) survey was used, including three subsets: Anxiety toward death (fear and avoidance), escape acceptance (death as a way to escape life’s troubles), and neutral acceptance (neither anxious nor too accepting). A demographic survey documented background characteristics, including gender, state of residence, year of experience, ethnicity, and area of nurse practice. There was a total of 168 participants, excluding missing data. Descriptive statistics and multiple regression analyses were conducted. This study found that nurses had low anxiety, moderate to high escape, and high neutrality to death. Year of experience and area of nurse practice (management versus extended care) showed statistically significant effects on the escape attitude. No overall predicting models showed statistically significant effects on nurses’ anxiety and neutrality attitudes toward death. More experienced nurses might have less anxiety, and Caucasian nurses might have less neutrality than other nurses. Further research is warranted.

Effects of Miglitol on Caloric Efficiency and Lipid Profiles in Obese Male SHR/Ntul//-cp Rats

Orien L Tulp — 2024-11-15

Elevations in plasma lipid profiles are a common observation in overweight, obese, hyperinsulinemic, and adult-onset diabetes. The effects of luminal inhibition of starch digestion on parameters of weight gain and plasma lipid profiles were determined in groups of adult obese male T2DM SHR/Ntul//-cp rats. Animals were fed a USDA-formulated, nutritionally complete diet containing 54% sucrose (SUC, CHO) component (Control) or the same diet containing a pharmacologic α-glucosidase inhibitor (1,5 dideoxy-1,5-[(2-hydroxyethyl) imino]-D glucitol; generic miglitol), 150 mg/kg diet, ad libitum for up to 8 weeks. Miglitol resulted in modest decreases in food intake and net weight gain. At the end of the study. heparinized bloods were collected for determination of plasma cholesterol, low-density lipoprotein (LDL) and high density lipoprotein (HDL) fractions. The miglitol-associated luminal inhibition of glucosidase activity resulted in 20% reduction in total cholesterol, and in both α- (LDL) and β-lipoprotein (HDL) fractions. These results indicate that simple inhibition of luminal α-glucosidase activity via miglitol may be a useful adjunct in the clinical management of hypercholesterolemia in states of obesity, T2DM and other glucose intolerant states, in addition to therapeutic applications in enhancing and improving glycemic control in man and animals.

Micro-elimination of Hepatitis C Virus Infection in Thalassemic Patients

Maria Tampaki — 2024-11-15

Background and objectives: We aimed to deploy an intra-hospital Hepatitis C Virus (HCV) micro-elimination project for thalassemic patients in collaboration with 2 pediatric departments and 4 transfusion units. This initiative took place between 2013-2022 and included various HCV regimens according to existing treatments and reimbursement criteria per period. Methods: HCV screening was performed at the Transfusion units and Pediatric departments. Following HCV diagnosis, thalassemic patients were referred to our Hepatology department for HCV-RNA and genotype examination, evaluation of liver fibrosis and finally to administer treatment. Results: In total, 119 patients were treated with direct-acting anti-viral agents (DAAs) in our center. SVR was achieved in 110/119 (92.4%) with the first line DAAs available. The SVR rates were not significantly associated with treatment experience, the presence of cirrhosis or liver iron concentration values. Treatment was generally well tolerated, and no significant interactions were recorded between DAAs and chelation agents or other co-medications. All patients who failed in the 1^st line DAAs received 2^nd line treatment and achieved SVR. Conclusions: Close collaboration between hematologists and hepatologists facilitates HCV diagnosis and access to effective and safe treatments for thalassemic patients. Micro-elimination projects for this population should be a priority on the road to Global HCV elimination.

Mandatory Vaccination for Children by Government in Brazil

Giulio Tarro — 2024-11-15

Taking the cue from the title reported, Brazilian parents of children are obliged from January 2024 to vaccinate their children from 6 months to 5 years with three doses of "Pfizer anti-Covid serum". Anyone who opposes risks losing parental authority: all this happens without the issuance of a law, but through a technical note from the Brazilian Ministry of Health, which has included the anti-Covid vaccine as mandatory for children as previously reported. In this age group, 142 children have died in 3 years of the pandemic, while the total number of Brazilian children is over 18 million, or 0.00025% of the population. Moreover, we do not know if the children who died had other pathologies: in Germany, not a single child died of COVID during the pandemic period ( HTTPS://pubmed.ncbi.nlm.nih.gov/35962242/ ). According to President Lula, "we must criminalize those who do not vaccinate their children". Fines of thousands of euros, loss of state subsidies and even parental authority are foreseen.

Thrombotic Thrombocytopenic Purpura, Case Report and Literature Review

Valeria G. Sonda-May — 2024-11-16

Background: Thrombotic thrombocytopenic purpura is a rare entity that represents a diagnostic challenge due to clinical manifestations that may be nonspecific. In addition, the diagnostic approach requires expensive and poorly accessible laboratory tests (for example, measurement of ADAMTS13 enzyme activity levels). The first reported case was in 1924, described by Eli Moschcowitz in a 16-year-old girl who died suddenly and in whom the post-mortem biopsy showed thrombi in the kidney, heart and spleen. It is estimated that TTP has an annual incidence of 1.5 to 6 cases per 106 inhabitants, with a prevalence of 10 to 15 cases per 106 inhabitants, and is more frequent in the female sex with a female/male ratio of 2:1. Thrombotic thrombocytopenic purpura (TTP) is characterized by the concomitant appearance of often severe thrombocytopenia, microangiopathic hemolytic anemia, and multiple organ involvement due to ischemia secondary to the formation of thrombi in various parts of the vascular system. The organs most frequently affected are the brain, heart, and kidneys. Currently, it has been identified that the pathophysiology is related to the alteration in the enzyme metalloproteinase with thrombospondin motifs 13 (ADAMTS13), which has protease activity that is responsible for cleaving the ultra-long multimeric chains of the von Willebrand factor (vWF). These alterations can be congenital (recessive mutations of the ADAMTS13 gene) or acquired (formation of antibodies against ADAMTS13). In this review we present the clinical case of a woman from Merida, Yucatan, Mexico, who was admitted to the internal medicine service due to the presence of tension-type headache and jaundice of more than 1 month of evolution. During her care in the emergency room, laboratory studies documented data of intravascular hemolytic anemia and thrombocytopenia, with no involvement of other organs. An approach to autoimmune hemolytic anemia was started, later she presented clinical worsening, neurological involvement (psychosis), increased hemolysis and thrombocytopenia, empirical treatment with steroids was started without response, she was later evaluated by hematology who, due to the clinical characteristics she presented plus the finding of schistocytes in the peripheral blood smear, an approach for PTT was started requesting ADAMTS13 activity levels, and empirical management with plasmapheresis was started, presenting a favorable response. Days later, the results of the studies were collected, reporting 0% ADAMTS13 activity, confirming the diagnosis of PTT.

Methods: A search was performed for literature related to the epidemiology, pathophysiology, clinical manifestations, diagnosis, differential diagnosis and treatment of thrombotic thrombocytopenic purpura, as well as literature related to thrombosis, hemolysis, hemolytic anemia, thrombocytopenia, thrombotic microangiopathy, von Willebrand factor in open access search engines and databases such as PubMed, Springer Link, Science Direct, Web of Science and others. Results: We found and analyzed 80 articles that met the search criteria, of which we selected 34 articles with the most relevant information, and with a publication period of less than 10 years. Conclusions: Thrombotic thrombocytopenic purpura is a rare but potentially fatal disease. Its true incidence is unknown, since the clinical presentation is varied with many pathologies that share the same characteristics. In addition, laboratory tests to confirm the diagnosis are not routinely available. A timely diagnosis can improve the prognosis and survival of patients. Currently, there are more therapeutic alternatives available, reducing mortality, which in the past was over 90%, with plasma exchange being the intervention with the greatest benefit.

Anaesthetic Management of Severe Head Injuries at Chu-Kara

Essohanam Mouzou — 2024-11-16

The aim of the study was to take stock of the management of severe head trauma (SCT) at the CHU-Kara. This was a retrospective descriptive and analytical study carried out in the surgical intensive care unit of CHU-Kara from 1 January 2021 to 31 December 2023. 185 patients were studied. The sex ratio was 4.6. The average age was 34.68±18.78 years. Farmers were most affected (28.97%), followed by pupils and students (22.76%). The majority of patients (63.78%) came from the outskirts of Kara. Road accidents were the main cause (86.49%). Two-wheelers were involved in 96.87% of cases. 64.52% of patients had not worn a helmet. All patients had received non-medical transport. On admission, 86.65% had a Glasgow score ≤ 8. Fever and hyperthermia were present in 42.16% of cases ; 32.05% had presented with hypoxaemia. Lesions associated with TCG were found in 28.11% of cases with limb involvement. Anaemia was found in 36.75% of cases. CT lesions were dominated by cerebral contusions in 27.56% of cases. 45.95% of patients were treated within one hour. 98.37% of patients were treated medically. Complications occurred in 5.41% of cases and mortality was 69.73%. MCTs had a high mortality rate. The introduction of emergency medicine would considerably reduce this mortality rate.

Pneumomediastinum in a Patient with Systemic Lupus Erythematosus with Pulmonary Renal Syndrome: Pneumomediastinum in a Patient with Systemic Lupus Erythematosus with Anca-P+ Pulmonary Syndrome

Sandra Ivette López Aguilar — 2024-11-24

Intestinal Transplant: A Myth In México

Morelos Adolfo García Sánchez — 2024-11-26

Report of a Case of Cowper’s Gland Syringocele in an Adult Male Patient

Hatem Abdulkareem Abdulmajeed — 2024-11-26

Cowper’s gland syringocele is a rare and often underdiagnosed condition characterized by cystic dilatation of the Cowper’s gland ducts, presenting with various radiological patterns. This report details a unique case of a giant Cowper’s gland syringocele in an adult male, highlighting the MRI findings and management outcomes.

Exploring the Therapeutic Effects of Noninvasive Brain Stimulation on Motor Function, Cognition, and Quality of Life in Parkinson's Disease: A Systematic Review

Ahmad O. Alokaily — 2024-12-12

Background: Parkinson's Disease (PD) significantly impacts both cognition and quality of life, posing a substantial burden on patients and healthcare systems. However, there is hope on the horizon. Noninvasive brain stimulation (NIBS) has emerged as a potential therapeutic intervention with the power to mitigate these effects. While the evidence regarding its efficacy remains fragmented, the potential it holds is promising. Objective: The present review explores the effects of noninvasive brain stimulation on cognition and quality of life in patients with Parkinson's disease (PD). Methods: A comprehensive search was carried out in electronic databases to find pertinent articles on noninvasive brain stimulation, such as Transcranial direct stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), in patients with PD. The methodological quality of the included studies was checked using the PEDro scale. Results: A total of 11 studies were finally included in the studies published between 2012 and 2023. Results indicated that a complex relationship exists between cognition and noninvasive brain stimulation. Additionally, possible therapeutic benefits apart from cognition were identified when examining the quality of life in patients with PD. Conclusion: The present review highlights the complex relationship between quality of life and cognitive functioning. In addition, it summarizes the studies performed on noninvasive brain stimulation in PD. These therapies also proved potent in improving general well-being and cognitive domains. More research is needed to determine the best procedures and interventions with suitable therapeutic outcomes.

Meta-Analysis of Psychometric Measures in Autism Assessment Tools Across the Lifespan

Gwendolyn Barnhart — 2024-12-06

There are a myriad of tools that are used for mental health professionals to diagnose individuals with autism/ autistic people, however, there are a lack of tools that professionals can use to assess where a person’s strengths and challenges lie. The purpose of this meta-analysis was to garner and understanding of the measures available to providers as well as assess the limitations. Attention was focused on the sub-domains in each measure to ascertain patterns in categorical applications. A table of measures available regarding autism symptomology was created which included categorical sorting. This process was one of the first steps taken to create another measure that focused on strengths and challenges of those on the autism spectrum.

Integrating Conventional and Holistic Medicine for Precision and Personalized Diagnosis in Medical Laboratory Science

Yashim-Nuhu Andrew — 2024-11-15

The implementation of the combination of conventional and alternative medicine swing the new style in laboratory science known as personalized diagnosis or precision. Traditional approaches to disease mechanisms, such as genomic(-), proteomic-, and metabolomic analyses are informative. Lifestyle, environmental and psychosocial factors are frequently neglected. By performing a full assessment of individual health, gaps that are missed by standard medicine can be filled in holistic treatment. A combined approach of these methods is beneficial for a wide-ranging comprehension to address the disease manifold and enables based diagnostic and therapeutic concepts. The model seeks to improve diagnosis and treatment outcomes by considering both molecular determinants of health & disease, as well as contextual actors. Validating this integrative combination of technologies with a focus on personalized medicine will further post progress in improving clinical treatment.