Clinical Medicine Research

ISSN Online: 2326-9057 ISSN Print: 2326-9049

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Volume 8, Issue 1, January 2019

  • Authors: Vijay Kumar Sharma, Antony Abraham Paulose, Parvendra Singh, Nishi Sonkhya

    Abstract: Objective: In patients with solitary thyroid nodules, first approach is to confirm whether the nodule is benign or malignant. Commonly available investigations used in the evaluation include thyroid hormone assays, fine needle aspiration cytology (FNAC) and ultrasonography (USG) among others. These procedures are not without drawbacks. The present study was undertaken to compare the diagnostic efficacy of USG and FNAC in correlation with histopathology in euthyroid patients having solitary thyroid nodule. Study Design: A prospective study was carried out on 48 euthyroid cases of solitary thyroid nodule attending the Department of ENT, SMS Medical College & Hospital, Jaipur, during the period of March 2016 to November 2017. All patients underwent ultrasonography and fine-needle aspiration cytology. The results of FNAC and USG were correlated with post surgical histopathogical examination (HPE) of the specimens to evaluate their sensitivity and specificity by statistical methods. Results: Ultrasound was 87.5% sensitive & 92.50% specific in the detection of malignancy in solitary thyroid nodules while the fine needle aspiration cytology had a sensitivity of 87.50% & specificity of 100% in the same regard. Conclusion: It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignancy nodules.

    Received: Apr. 26, 2018 Accepted: May 14, 2018 Published: Feb. 25, 2019

    DOI: 10.11648/j.cmr.20190801.11 View: Downloads:

  • Authors: Hermann Prossinger, Hubert Hetz, Alexandra Acimovic, Reinhard Berger, Karim Mostafa, Alexander Grieb, Heinz Steltzer

    Abstract: During treatment in an intensive care unit (ICU), traumatic brain injury (TBI) patients sometimes suffer an increase in intracranial pressure (ICP). An increase beyond a currently unknown and to-be-determined threshold is very often life-threatening and requires intervention by the clinical staff. Because this threshold value is considered unknown, ‘conventional wisdom’ of practitioners argue it to be 20 mm Hg. No published studies include statistical methods that could supply a rigorous outcome for the threshold value. Here, we use a clustering algorithm (K-means clustering) to find three-dimensional clusters of the 984 triples of ICP, temperature and patient state index (PSI, a proxy for sedation level). The algorithm outputs three clusters and two gaps. One gap separates two clusters from a third and is almost planar, and perpendicular to the ICP axis (implying a threshold across all temperatures and all sedation levels); the other is perpendicular to the temperature axis, which terminates at the aforementioned gap. The first gap provides a statistically rigorous threshold of 13.625 mm Hg for ICP intervention. The second gap defines a threshold temperature (36.5°C). The gap between the two temperature regimes does not continue into Cluster 3, implying that the intervention threshold for ICP is independent of temperature.

    Received: Jan. 21, 2019 Accepted: Feb. 22, 2019 Published: Mar. 12, 2019

    DOI: 10.11648/j.cmr.20190801.12 View: Downloads:

  • Authors: Li Luo, Xing Tu, Wei Liu, Xuexia Zhang, Yilin Liu, Wenyan Zhao, Junhua Yang, Mengxia Wang, Jing Liu

    Abstract: Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe brain disease that often leads to death or irreversible sequelae. The aim of this study was to determine the effect of a naturally active drug (grape seed proanthocyanidin extract [GSPE]) on the expression of autophagic proteins in a mouse model of neonatal hypoxic-ischemic brain injury. In this study immunofluorescence staining and Western blotting were used to detect the expression of autophagy markers (LC3II and beclin1) in the brains of neonatal mice with hypoxic-ischemic brain injuries after GSPE administration. Our study showed that GSPE pre-treatment down-regulates LC3II and beclin-1 expression, thus GSPE may be a potential drug for the treatment of HIE.

    Received: Jan. 31, 2019 Accepted: Mar. 11, 2019 Published: Mar. 25, 2019

    DOI: 10.11648/j.cmr.20190801.13 View: Downloads:

  • Authors: Liu Tianyu, Long Xiaoqi

    Abstract: This study was designed to explore the role of MiR203 promoter methylation in the process of Barrett’s esophagus carcinogenesis. RT-PCR was used to detect the expression levels of miRNA-203 in Barrett’s esophagus, esophageal cancer and normal esophageal mucosa cell lines, before and after the treatment of demethylation. MiR203 promoter methylation levels in these cell lines were measured by Methylation Specific PCR (MSP). Immunohistochemistry was used to test the expression and distribution of K-Ras, a target of miR203, in esophageal cancer, BE and normal esophagus tissues. The following results were found based on the above methods. MiR203 expression levels were reduced obviously in Barrett esophagus and esophageal cancer cells than normal esophageal cells, the difference was statistically significant (P=0.003). After demethylation treatment, miR203 expression levels were significantly increased in Barrett's esophagus and esophageal cancer cells, the differences were statistically significant (P=0.03). MSP results showed that miR203 promoter changed to be low-methylation or non-methylation after demethylation treatment. In conclusion, MiR203 in Barrett's esophagus and esophageal cancer cells reduced expression is related to its Promoter methylation, miR203 promoter methylation throughout the carcinogenesis of Barrett's esophagus, it may become a key molecular biomarker in process of Barrett esophagus cancerous, and may become the prevention and treatment targets of Barrett esophagus carcinogenesis.

    Received: Nov. 13, 2018 Accepted: Jan. 11, 2019 Published: Apr. 1, 2019

    DOI: 10.11648/j.cmr.20190801.14 View: Downloads:

  • Authors: Carol Valinejad, Steven Lang

    Abstract: Background: Pain problems can act as a barrier to individuals recovering from psychological trauma following receiving appropriate psychological therapy. Therefore, it would be prudent of therapists to treat pain problems in clients prior to embarking on trauma informed therapy to increase the chances of therapy being more clinically and cost effective. Objective: This article aims to provide practice-based evidence to demonstrate how a client’s pain problems were affecting her recovery from severe psychological trauma following a serious accident, and how psychological pain management work prior to her starting trauma informed therapy assisted her to overcome the barrier of pain to her recovery. Method: The client was offered psychological pain management intervention based on the gate theory of pain prior to embarking on trauma focussed cognitive behavioural therapy to treat her post trauma symptoms following a serious accident. The gate theory argues that psychological factors have potential to open a gate to the pain system causing an increase in pain perception. According to this model, once these factors are addressed it will lead to improvement in pain perception. Result: Guided imagery techniques were utilised to assist the client to resolve emotional factors in connection with her pain which resulted in further recovery of her pain perception. Following recovery in this the client was able to experience increase emotional capacity as well as mobility to receive trauma focussed cognitive behavioural therapy to reduce her psychological trauma symptoms. Conclusion: This case study was able to demonstrate that treating clients pain problems prior to treating psychological trauma has potential to be clinically and cost effective. It is recommended that further research be done in this area.

    Received: Oct. 16, 2018 Accepted: Apr. 9, 2019 Published: May 9, 2019

    DOI: 10.11648/j.cmr.20190801.15 View: Downloads:

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