Clinical Medicine Research

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

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Volume 10, Issue 4, July 2021

  • Author: Volha Pankevich

    Abstract: An adolescent girl presented to the emergency department with a history of abdominal pain, dribbling, and inability to pass urine for the last 24 hours. The initial observations and examination of respiratory, cardiovascular, ears, nose, and throat (ENT), central nervous system (CNS) and musculoskeletal systems were normal. No onset of menses reported by the patient. She was found to have a palpable distended bladder on abdominal examination. A catheter was inserted by the nurse, who reported no abnormalities. The physician did not perform a FAST scan nor conduct a genital examination. The patient was referred to the paediatrics department and the following day an ultrasound examination led to a diagnosis of haematometrocolpos. The patient was the referred to the obstetric and gynaecological department. Corrective surgery was conducted the following day and she was discharged on the fourth day. While the diagnosis and treatment were correct, had a FAST scan and/or genital examination been part of the initial work-up, diagnosis would have been made in the emergency department and an appropriate referral made directly to obstetric and gynaecological team. Rapid diagnosis and treatment would have benefitted the patient, reduced the risks of complications, and cut the length of stay in the hospital by as much as two days.

    Received: Jun. 10, 2021 Accepted: Jun. 28, 2021 Published: Jul. 2, 2021

    DOI: 10.11648/j.cmr.20211004.11 View: Downloads:

  • Authors: Cabello-Modesto Daniel, Garcia-Briones Alondra, Gutierrez-Villaseñor Alan Omar, Aguilar-Zapata Daniel, Romero-Gonzalez Juan Pablo, Gonzalez-Chon Octavio, Juárez-Hernández Eva, Santillan-López Gloria, Sosa-Garcia Jesus Ojino

    Abstract: Background: Since December 2019, the COVID-19 pandemic has caused the dead of 1 million people, from these critically ill patients have an increased risk of bacteremia. Material and Methods: This observational, retrospective, single-center study included 129 critically ill COVID-19 patients with a bacteremia. We studied the clinical characteristics, comorbidities, hospital and intensive care unit length of stay, days on invasive mechanical ventilation, maximum dose of norepinephrine and mortality. Results: From 129 patients were reported 17 patients (13.2%) with bacteremia. 35.3% were cataloged as a primary bacteremia. The source of secondary bacteremia was a ventilator associated pneumonia in 81.8%, central line-associated blood stream infection in 18.1% and urinary catheter infection in 9%. The patients with bacteremia, had a hospitalization stay of 23 days Vs. 20.5 days in the patients without bacteremia (p=0.19); 18 Vs. 13.5 days in the ICU (p=0.061); 15 Vs 11 days on IMV (p=0.053) and a maximum dose of norepinephrine of 0.28 Vs. 0.11 mcg/kg/min (p=0.02). We reported a 14.8% of mortality in patients with bacteremia vs. 12.7% in patients without bacteremia, odds ratio of 0.87 (p=0.75). Conclusion: Critically ill COVID-19 patients and bacteremia tend to increase the length of stay in the ICU and days on IMV with no change in mortality.

    Received: Jun. 19, 2021 Accepted: Jul. 1, 2021 Published: Jul. 6, 2021

    DOI: 10.11648/j.cmr.20211004.12 View: Downloads:

  • Authors: Stephanie Toscano Kasabkojian, Gabriela Pacheco de Oliveira, Francine Papaiordanou, Analia Luiza Porto Viana, Antonio Carlos Amedeo Vattimo, Andrea Bauer Bannach, Stevin Zung

    Abstract: Alzheimer´s disease (AD) and dementia have a probably multifactorial pathogenesis and, accordingly to several studies, human herpes simplex virus type 1 (HSV-1) infection may be related. The purpose of this review is to assess the updated clinical evidence towards the association between herpes infection and AD. We performed a PubMed/MEDLINE database research and included in this review randomized clinical trials on the subject of antivirals effectiveness and AD, and observational case-control studies and observational cohort studies regarding AD diagnosis (using clinical and/or histological methods) and HSV-1 detection (using molecular biology or immunohistochemical techniques). A total of 23 case-control and 3 cohort studies met the predetermined inclusion criteria. The results showed that AD was associated with HSV-1 in 22 of the 26 included studies, with most of them confirming that herpes infection is more prevalent in AD patients, when compared to control patients. A possible link between HSV-1 and AD was discussed and many different interpretations and hypothesis were considered. Evidence from observational studies suggests a possible relationship between the two conditions, but the role of HSV-1 infection in the pathogenesis of AD is not completely understood yet. Well-designed and large clinical trials are necessary to endorse this hypothesis and to consider the use of antiviral drugs as a potential alternative for prevention or reduction in the progression rate of AD in the future.

    Received: Jun. 10, 2021 Accepted: Jul. 1, 2021 Published: Jul. 9, 2021

    DOI: 10.11648/j.cmr.20211004.13 View: Downloads:

  • Authors: Bakary Dembélé, Abdoulaye Zié Kone, Yacouba Lazare Diallo, Sow Djénéba Sylla, Mody Traore, Mamadou Hema Ouattara, Ousmane Attaher, Boubacar Togola

    Abstract: Introduction: Pressure ulcers are skin lesions of ischemic origin linked to compression of the soft tissues between a hard surface and the bony protrusions. In 2016, 5.17% of patients developed preventable pressure ulcers in hospital. From this study, the Hôpital du Mali reinforced the care teams and involved carers in pressure ulcer prevention actions. The objective of this study was to assess the prevalence of pressure ulcers as well as prevention actions and their management in the emergency department. Method: This was a cross-sectional descriptive study from January 1 to December 31, 2020, based on the observation of the onset of pressure ulcers in patients. We included all patients hospitalized at the short-stay unit level. Results: of the 305 patients hospitalized during the period, 15 developed bedsores, or 4.9% prevalence rate. The sex ratio was 1.2. The average age of our series is 52 ± 14 years old, ranging between 21 and 87 years old. Seventy percent (70%) of pressure ulcers were discovered at stage I. Pressure ulcers located in the inter-gluteal folds were the most frequent with 90%. Conclusion: this study has enabled us to understand that the prevalence of pressure ulcers has decreased from 5.17% to 4.9% over the past four years. It encourages us to deepen the examination of the clinical, therapeutic and progressive peculiarities of this disease which is a credible indicator of the quality of care in a hospital structure.

    Received: Jul. 5, 2021 Accepted: Jul. 16, 2021 Published: Jul. 24, 2021

    DOI: 10.11648/j.cmr.20211004.14 View: Downloads:

  • Authors: Rivero-Jimenez Rene Antonio, Villegas-Valverde Carlos Agustin, Torres-Zambrano Gina Marcela, Abdelrazik Abeer, Haider Muhammad Touseef, Castillo-Aleman Yandy Marx, Ventura-Carmenate Yendry, Abdel Hadi Loubna, Bencomo-Hernandez Antonio Alfonso

    Abstract: Background and aims: Laboratory tests may play an important role in the follow-up of COVID-19 patients acting as indicators of risk for severity and death. This study aims to explore the significance of certain laboratory tests in the management of COVID-19 patients treated by an autologous novel stem cells cocktail plus standard care. Methods: The 69 hospitalized COVID-19 patients recruited in the experimental arm of a clinical trial [NCT04473170] were divided into moderate or severe groups as recommended by WHO. Initial and after 21 days of treatment, laboratory data were analyzed and compared for both groups. The variable association was analyzed using the symmetric Spearman correlation matrix. Multiple linear regression was used for biomarkers most described in COVID-19 by a multivariate study and disease severity association using relative risk (RR) to laboratory variables. Results: Positive and strong associations were evidenced between parameters related to coagulation and inflammation markers. We found the strongest positive relationship between the LDH enzyme and IL-6 (r=0.81), followed by D-dimer (r=0.70). The multivariate study showed a strong influence of D-dimer, IL-6, IgG, and ceruloplasmin on the increased LDH level, with a greater influence of the last (R=0.71, p<0.0001). RR showed a statistically significant and positive association with COVID-19 severity for WBC (RR=45.2); neutrophil/lymphocyte ratio (NLR) (RR=3.8); IL-6 (RR=1.6); lymphocyte/monocyte ratio (LMR) (RR=1.5); and RR=1.3 for platelets/lymphocyte ratio (PLR), ferritin, and LDH. Conclusions: Risk assessment of severity using this laboratory variable is important.

    Received: Jul. 11, 2021 Accepted: Jul. 26, 2021 Published: Aug. 2, 2021

    DOI: 10.11648/j.cmr.20211004.15 View: Downloads:

  • Authors: Nur Jahan Aktar, Milton Barua, Amanat Ullah, Abdus Sattar, Shoman Sarkar, Sujat Paul, Shofiur Rahman, Mitan Chakma, Mahmudul Islam Talukder, Mahatabur Rahman, Mohammad Faisal Kabir

    Abstract: Background: Dengue is a fast-emerging viral disease in many parts of the world, having a potential to present with a varied spectrum of clinical manifestations with atypical presentations being more frequent. This study was conducted to evaluate the clinical features, outcome and Cost of Illness (COI) of dengue cases admitted in a tertiary-care government hospital in Chattogram, Bangladesh. Methods & materials: It was a hospital based prospective observational study and was carried out in the Department of Medicine, Chittagong Medical College Hospital. All the consecutive serologically positive (NS1 antigen, IgM, IgG antibodies) dengue cases (age >12 years) admitted in the Department of Medicine of Chittagong Medical College Hospital from 1st August 2019 to 31st July 2020, were enrolled in the study. Severity of each dengue case was determined as per the recent WHO classification (2009) Clinical presentations of the cases were carefully assessed. In-hospital outcomes of the patients in terms of mortality, duration of hospital stay, need for ICU or other support were recorded. The COI questionnaire included three major cost components: direct medical costs (DMC), direct non-xiv medical costs (DNMC), and indirect costs (IC). Data analysis was done on the SPSS 23 version. Results: Out of 425 patients, the maximum number of dengue cases reported were males (76.9%) and belonging to the 21-30 years age group (38.8%). Fever was the main complaint in all the cases followed by headache (78%), myalgia (56%), persistent vomiting (44%). Of the 91.5% Dengue fever cases, 88.2% were classified as Dengue fever without warning signs and 3.3% with warning signs and 8.5% as severe dengue. Thrombocytopenia was present in 53.9% and leukopenia in 42.1% of cases. 3.3% of patients needed ICU admission and the mortality rate was 1.2%. The median total COI was BDT 8703 (IQR: 6240-11795) with median DMC of 3580 (IQR: 2525-4885), DNMC of 2000 (IQR: 1250-3225) and INMC of 2400 (IQR: 1045-4000). Conclusions: Overwhelming number of cases and their varied clinical presentations lead to an increase in hospitalization in this outbreak. Though the outcomes have been mostly favorable, the cost incurred as a result has been immense and has impacted households greatly, since most medical costs in Bangladesh are out-of-pocket expenses.

    Received: Jun. 30, 2021 Accepted: Jul. 12, 2021 Published: Aug. 9, 2021

    DOI: 10.11648/j.cmr.20211004.16 View: Downloads:

  • Authors: Eugene Gaudens Prosper Amaye Dieme, Yameogo Bonaventure, Cheikh Hameth Badji, Mamadou Dembele, Magatte Faye, Birame Ndiaye

    Abstract: Sigmoid volvulus is the torsion of sigmoid colon around its mesenteric axis. It is a common cause of colonic obstruction in our regions. It requires a prompt and emergency management due to the high risk of occurrence of strangulation. As for internal hernia, it is a protrusion of a hallow viscus through an intraperitoneal defect. Its incidence is very rare and the prevalence of intestinal obstruction for an internal hernia is very low. However, this condition is associated with a high mortality when strangulation of the viscus occurs. The peritoneal defect can be localized in multiples places. From the various locations of the peritoneal defect, transomental defect is one of the rarest. This transomental defect may be congenital or acquired. It is known that the small bowel, due to its high mobility, most of the time herniates and volvulates through the defect. But, a redundant sigmoid colon may herniate and volvulate through an omental defect. The occurrence of sigmoid volvulus though a transomental defect is very rare and few cases have been reported in the literature. This condition requires prompt diagnosis and emergency surgery. The preoperative diagnosis may be tricky. Frequently the diagnosis is made at surgery. We report a novel observation of sigmoid volvulus through a transomental (great omentum) hernia missed on investigations, delaying thus the treatment which is based on an emergency surgery.

    Received: Jul. 10, 2021 Accepted: Aug. 2, 2021 Published: Aug. 24, 2021

    DOI: 10.11648/j.cmr.20211004.17 View: Downloads:

  • Authors: Nanba Yoshifumi, Asonuma Yohei, Nagato Saki, Watanabe Juna, Asano Yuka, Takata Teruhiko

    Abstract: Purpose: Investigating using medicines in rehabilitation patient to understand risks predicted from the effects of those drugs to promote safe rehabilitation. Subjects & Methods: 1039 patients (age mean 75.6±16.91), 392 males (74.05±17.49) and 647 females (76.54±16.60), who receive PT, OT and ST at four medical institutions. The survey items included age, sex, prescribed medications, presence or absence of medication logbook and medical record. The drugs collected in the questionnaire were classified according to the general table of contents of pharmacotherapy specialized book in Japan. Results: 6477 prescription drugs (62 types) for 1039 patients. About 6.23 drugs were prescribed per patient. In order of appearance, Non-Steroidal Anti-Inflammatory drugs (NSAIDs) (742), Peptic ulcer treatment (740), Antihypertensive drugs (699), Laxatives (451), Antipsychotics, Antidepressants, Mood stabilizers and Psychostimulants (423), Infusions and nutritional products (365), Anti-anxiety drugs and Sleeping pills (282). Conculsion: One-third of the patients who participated in this study are at increased risk of falls due to the effects of the drug. Also, the risk of falls increases as the number of drugs increases. Taking more than 5 medications increases the risk of falls from 1.1 to 2.4. The study found that they were taking an average of 6.23 medications and were at high risk of falling. Importantly, PT, OT & ST are not pharmacological experts. We propose that therapists make efforts to understand how prescribed medications affect patients for rehabilitation safety.

    Received: Aug. 10, 2021 Accepted: Aug. 19, 2021 Published: Aug. 26, 2021

    DOI: 10.11648/j.cmr.20211004.18 View: Downloads:

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