Clinical Medicine Research

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

Archive Home / Archive

Volume 10, Issue 3, May 2021

  • Authors: Jane Nakibuuka, Haddy Nalubwama, Elizabeth Nambalirwa, Olivia Namusoke, Jayne Byakika-Tusiime, Martha Sajatovic, Elly Katabira

    Abstract: Although Stroke is largely preventable, it remains a major public health concern in Uganda which calls for inquiry into the factors impeding its prevention and management in both urban and rural settings. This study explored barriers to secondary stroke prevention and care based on lived experiences of stroke survivors, their care takers and key stakeholders, to provide a broader picture of key areas that require modification to achieve successful stroke prevention and care programs. A total of 31 participants (stroke survivors, care takers, key stakeholders) stratified by age and sex were engaged in in-depth and key informant interviews in urban and rural populations of Wakiso district in central Uganda. Interviews were audio recorded and transcribed verbatim. Transcripts were analyzed thematically using inductive and deductive approaches. Three major domains emerged from the interview data: 1) Patient level barriers (inadequate stroke knowledge, financial impediments, post-traumatic stress disorder, pill burden, adamancy when feeling better), 2) Community level barriers (limited social support, stigmatization), 3) Health system level barriers (scarcity of human resources and drugs, poor patient-health worker relationship, poor access to healthcare, lack of stroke rehabilitation centres and equipment). Rural participants especially insisted on improving stroke awareness and access to healthcare to improve prevention and care programs. In conclusion, stroke prevention and care program interventions must address barriers at individual and community levels where increased stroke awareness should be emphasized and at health system level where access to healthcare facilities, human resource and equipment are improved to meet stroke specific needs.

    Received: Apr. 6, 2021 Accepted: Apr. 19, 2021 Published: May 8, 2021

    DOI: 10.11648/j.cmr.20211003.11 View: Downloads:

  • Authors: Lima Ryane Vieira, Lopes Reginaldo Guedes Coelho, Pereira Ana Maria Gomes, Bray-Beraldo Fernando, Gazzo Cláudia, David Simone Denise, Martins João Alfredo, Pinto Fernando Campos Gomes

    Abstract: Objectives: Considering the prevalence of endometriosis in reproductive-age women and its negative impact on life quality, the authors of the present research intended to evaluate the impact of clinical treatment on the sexual function of patients with deep infiltrating endometriosis treated at the Endometriosis and Chronic Pelvic Pain Clinic of HSPE-FMO. Methods: A prospective and comparative observational study was conducted between May 2015 and July 2019 in which data from 43 patients with presumed deep endometriosis were analyzed, including age, parity, surgical and obstetric history and Female Sexual Function Index (FSFI questionnaire). Statistical analysis was performed using multiple regression in order to compare the variables. Results: The mean age of the women who were studied was 39.16 years; all patients were symptomatic and most had rectosigmoid endometriosis (65,1%). The median FSFI total score before treatment was 25.06, with 60,5% of the women classified as having a sexual dysfunction. There was a risk for sexual dysfunction to become permanent following clinical treatment when this dysfunction was established previously. The Poisson multiple regression showed that sexual dysfunction before treatment was associated with a lower FSFI total score after treatment and dysfunction before treatment had a direct correlation with final score smaller than 26.55. Considering the FSFI total scores before and after clinical treatment, there was no significant difference in the improvement rate between groups. Conclusions: Most patients did not show improvement in sexual function after clinical treatment.

    Received: Apr. 11, 2021 Accepted: Apr. 29, 2021 Published: May 14, 2021

    DOI: 10.11648/j.cmr.20211003.12 View: Downloads:

  • Authors: Qi Long, Zhao Heng Liu, Jie Niu, Hao Ge Liu, Xiao Feng Gu, Qing Lu Pang, Fang Cao, Yang Jiao

    Abstract: Objective: Oxidative stress with reactive oxygen species (ROS) generated from exogenous oxidants and pollutants exposure is involved in the pathogenesis of Idiopathic pulmonary fibrosis (IPF). Number 2 Feibi Recipe (Number 2 FBR) is a traditional Chinese herbal formula which can attenuate the lung injury induced by PM2.5. The present study is to explore the effect and mechanism of Number 2 FBR on bleomycin (BLM)-induced pulmonary fibrosis in C57BL/6Cnc mice. Method: Bleomycin-induced C57BL/6Cnc mice were treated with Number 2 FBR and Sulforphane for two weeks. HE and Masson trichrome staining were performed to evaluate pathological changes in lung tissues. The extent of lung fibrosis was evaluated with fibrosis scores, collagen volume fraction, and hydroxyproline concentration. Levels of SOD and 8-iso-PGF2α in lung tissues were measured by using commercial assay kits. The levels of Nrf2, SOD, GSH-Px, and TGF-β1 relative protein and mRNA in lung tissues were measured by real time PCR and Western blot respectively. Results: The results showed that Number 2 FBR ameliorated bleomycin-induced pathological changes, collagen deposition and significantly decreased fibrosis scores, collagen volume fraction, and hydroxyproline concentration in the mice lungs. Additionally, Number 2 FBR inhibited the expression of 8-iso-prostaglandin F2α (8-iso-PGF2α) and transforming growth factor beta1 (TGF-β1), and increased the expression of Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2), superoxide dismutase (SOD) and Glutathione peroxidase (GSH-Px) in lung tissues. Conclusion: Number 2 FBR has an effect of anti-fibrosis by regulating the lung oxidants and antioxidants balance.

    Received: Apr. 15, 2021 Accepted: May 8, 2021 Published: May 14, 2021

    DOI: 10.11648/j.cmr.20211003.13 View: Downloads:

  • Authors: Clemens Stiegler, Tanja Seel, Claus Schaefer

    Abstract: The aim of this study was to identify clinical and laboratory characteristics with impact on outcome of patients with SARS-CoV2-Infection in a secondary care center in Germany. Therefore, a total of 69 hospitalized patients with COVID-19, detected with positive Multiplex real-time PCR result, were recruited from March 2020 to May 2020 to investigate the influence of comorbidities, demographic information and laboratory parameters on outcome. Data of routine laboratory examinations of 57 patients were collected at admission to detect prognostic factors. Mean age of patients was 70.0 years (21-99 years, median 74.0 years, SD 16,9). 28 patients (40,6%) had a severe course of disease (death and/or need for intensive care medicine), 20 patients (29%) died. LDH > 460 U/l (p=0.004, OR 12.99, 95% CI 2.23-75.67), Diabetes mellitus (p=0.021, OR 9.53, 95% CI 1.14-64.48) and Troponin T > 38 pg/ml (p=0.026, OR 6.04, 95% CI 1.24-29.43) were associated with occurrence of severe illness in multivariate analysis. Elevated Troponin T > 38 pg/ml (p=0.002, HR 8.22, 95% CI 2.19 – 30.88) and Diabetes mellitus (p=0.05, HR 3.14, 95% CI 1 – 9.85) were also associated with death. Patients with these conditions should be monitored closely.

    Received: Apr. 30, 2021 Accepted: May 19, 2021 Published: May 27, 2021

    DOI: 10.11648/j.cmr.20211003.14 View: Downloads:

  • Authors: Anna-Maria Borissova, Jordan Vlahov, Alexander Shinkov, Lilia Dakovska, Boyana Trifonova

    Abstract: The WHO and many other diabetes organizations recommend performing OGTT at fasting plasma glucose ≥ 6.1 ÷ 6.9 mmol/L mmol/L, but ADA indicates a lower cut-off for this parameter - ≥ 5.6 ÷ 6.0 mmol/L mmol/L. Aim: We decided to evaluate the role of baseline glucose tolerance for the development of Diabetes or Prediabetes over time by a prospective study of the changes in glucose tolerance 5 years after the last nationwide cross-sectional study in Bulgaria. Material: The study included 204 subjects from a total of 2033 tested 5 years ago. These 204 individuals were selected among those with a fasting plasma glucose (FPG) 6.1 – 6.9 mmol/L (Group 1) and FPG ≥ 5.6 ÷ 6.0 mmol/L (Group 2) found during the screening in 2012. As a part of the screening in 2017, a standard OGTT was performed (WHO’1999) and HbA1c was determined. Methods: Plasma glucose was measured in all the studies by an automated glucose-oxidase analyzer (Glucose Analyzer II, Beckman Coulter, Inc). HbA1c was determined by immunoturbidimetric method after hemolysis of a whole blood sample. Results: Half of the subjects with FPG 6.1 - 6.9 mmol/L in 2012 had Diabetes during the follow up, 31% remained in the Prediabetes group and 19% had Normal glucose tolerance (NGT) in 2017. Among the subjects with FPG ≥ 5.6 - 6.0 mmol/L in 2012, 24.7% had Diabetes in 2017, 34.6% - Prediabetes and 40.7% had NGT. The difference in the Diabetes prevalence between the two groups was significant – 50% vs. 24.7% (T=2.443, P < 0.02). In 5 years’time, 29.9% of the Individuals who had FPG ≥ 5.6 - 6.9 mmol/L in 2012, became Diabetics, 33.6% became Prediabetics and only 36.3% had NGT. In 57% (35/61) of the diabetics the disease was newly diagnosed and in about 2/3 of the cases it was decompensated (HbA1c ≥ 7%). During the 5-year period, Diabetes was diagnosed in 26 (42.6%) persons and 34.6% of them were in metabolic decompensation under treatment. Conclusion: The most important conclusion from our screening from 2017 is that ¼ people with FPG ≥ 5.6 – 6.0 mmol/L after a few years became diabetics, so systematic efforts should be directed towards this border group.

    Received: May 22, 2021 Accepted: Jun. 9, 2021 Published: Jun. 16, 2021

    DOI: 10.11648/j.cmr.20211003.15 View: Downloads:

  • Authors: Suining Li, Xiaoshen Zhang, Hua Lu, Jiawen Huang

    Abstract: Background: Computed Tomography Angiograph (CTA) is the golden standard for diagnosing aortic dissection (AD). However, echocardiography has some advantages over CTA in screening aortic root dissection. Objective: In this report, we present 2 cases of aortic root dissection not found by CTA but by echocardiography. Method: Two middle-aged male patients were admitted to our hospital due to similar symptoms of chest distress. Diastolic murmurs can be heard in the aortic valve second auscultation area. CTA showed aortic artifacts and no dissection signs. The preoperative echocardiography showed that the aortic root was dissected together with aortic valve, and then aortic regurgitation (AR) was formed during diastole. AD was considered. Result: The patients underwent Bentall operation with extracorporeal circulation through femoral arteriovenous cannula. extracorporeal circulation through femoral arteriovenous cannula. The patients were diagnosed as DeBakey type II AD with severe AR during operation. Both of them recovered and were discharged smoothly after the operation. Conclusions: The diagnostic significance of CTA may be limited in some localized aortic root dissections. At this point, we can improve the accuracy of the diagnosis by echocardiography.

    Received: Jun. 7, 2021 Accepted: Jun. 21, 2021 Published: Jun. 25, 2021

    DOI: 10.11648/j.cmr.20211003.16 View: Downloads:

  • Authors: Liang Xiaodong, Duan Rubing, Ji Peng, Shen Binglian, Mo Ganwen, Guo Jianghua, Liao Yongbin

    Abstract: The relationship between sperm DNA fragmentation and in vitro fertilization (IVF) outcome was uncertain today. In the past, researchers studying the pregnancy outcome of IVF, mainly base on fresh embryo transplantation cycle, recently, cumulative live birth rate was consider as a new indicator of IVF successful rate which is used to evaluate the pregnancy outcome by fresh or thawed transferred embryos until live birth or use up all embryos in one oocyte collection cycle, is more comprehensive. The purpose of this research is to investigate the relationship between sperm DNA fragmentation and cumulative live birth rate. 1019 couples who were assisted by IVF in our center from Jan 2012 to Dec 2016 were studied according to inclusive criteria, and divided into four groups by DNA fragmentation index (DFI), which were determined by sperm chrome structure assay (SCSA), then the fertilization rate, No. of Embryo available and cumulative live birth rate between the groups were analyzed. Cumulative live birth curve was plotted to study the time to reach live birth, and Cox regression model was used in order to find out the factors affecting pregnancy outcome. Study results showed no significant difference in cumulative live birth rate between the four groups, but DFI ≥40% group were significantly lower than the other three groups. In the cumulative live birth curve figure, except the high DFI group, the curve of the other three groups is relatively close. Cox regression model suggest that DFI was not the main factor affecting pregnancy outcome. Further studies in these patients with oligozoospermia showed that when DFI increase, a decrease trend was appeared in cumulative live birth rate, and spend more time to reach live birth studied by the live birth curve. Cox model showed that DFI was the impact factor of pregnancy outcome in oligozoospermia patients. In conclusion, abnormal sperm DNA fragmentation have a negative impact on cumulative live birth rate in patients with oligozoospermia, but further research was still needed.

    Received: May 26, 2021 Accepted: Jun. 17, 2021 Published: Jun. 26, 2021

    DOI: 10.11648/j.cmr.20211003.17 View: Downloads:

All Issues