Clinical Medicine Research

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

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Volume 10, Issue 6, November 2021

  • Authors: Chelsea Day, Andrea Diebel, Oluwaseun Oke, Jo-Ann Nesiama

    Abstract: While hospitalization rates in rural versus urban pediatric firearm injuries nationwide has been previously investigated, studies highlighting the differences across the spectrum of pediatric care are limited. The purpose of this study is to describe the epidemiology of pediatric firearm injuries in a North Texas level 1 trauma center in rural versus urban settings and supplement knowledge for injury prevention. Retrospective review of the trauma registry was done to identify children 0-18 years of age admitted to the Emergency department, inpatient service, or clinics between 2009-2019 for firearm injuries. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on data collected and stratified by location of injury; rural vs urban. Demographic data, type of firearm used (air propelled or powder propelled), shooter relationship, and injury severity scores were also collected. A chi-square analysis was conducted to determine associations and logistic regression analysis to determine the odds ratio of associations. A total of 247 patients met study criteria. Males accounted for 73% of all victims, of which 58% were in urban areas. Stratified by race, 36% of patients were Hispanic, followed by 30% White (p<0.001). Patients were slightly younger in rural areas 8.2±3.74 compared to their urban counterparts 9.2±4.34 (p=0.129). Air propelled firearms were used most often in both rural (52.2%) and urban (54.2%) areas (p=0.808). Black children were 3.6 times (CI: 1.8-7.5) more likely to sustain injuries from powder propelled firearms as compared to their White counterparts (p<0.001). Most shooters in both rural and urban areas were family members (57.5% and 39.7% respectively: p=0.112). Most injuries were unintentional; 95.6% of rural and 74.5% of urban injuries (p<0.002). Most injuries were classified as minor according to the injury severity score: rural 42.2% and urban 71.1%. However, injuries occurring in rural areas had a higher percentage in the moderate (28.9%), serious (11.1%) and severe (17.8%) categories respectively (p<0.001). In conclusion, firearm injuries occurred mostly in urban areas. The mean age of the patients was younger than 10 years. Additionally, injuries were often unintentional, caused by family members. More seriously injured children were in rural areas. This highlights the importance of firearm education to families with children.

    Received: Sep. 20, 2021 Accepted: Oct. 15, 2021 Published: Nov. 5, 2021

    DOI: 10.11648/j.cmr.20211006.11 View: Downloads:

  • Authors: Raad Sami Jabbar Albayati, Waleed Mohammed Ali, Sunbul Adnan Muhammed Baqer

    Abstract: Background: Diabetic retinopathy is one of the main causes of preventable blindness, so early detection and diagnosis play a great role to prevent uneventful blindness. Aim of the study: To determine the prevalence of diabetic retinopathy and specify risk factors among Gurgur diabetic patients. Method: A descriptive cross-sectional study was conducted among diabetic patients at Baba Gurgur Diabetic Center from November 2019 to May 2020. The study included 750 patients who, and the target was to determine the prevalence and the risk factors for Diabetic Retinopathy. Result: A 750 diabetic participants were involved in this study, with 55 years mean of age ranging from 23 to 80 years, (54.9%) were male, and (45.1%) were female. A (15.3%) patients were found with signs of Diabetic Retinopathy and (84.7%) with no signs of Diabetic Retinopathy, there was no significant relationship between male and female ratio in our study, DR increases significantly with age, below 30 years we didn’t record DR and gradually increase the percentage of DR with age, most of the patients were in the age group 50 and more. There was a significantly high level of mean HbAc1 (10.3) among the DR group in comparison to (8.5) in the non-DR group. Also, hypertension in our study group play a role in developing DR, a significantly high percentage of hypertension in the DR Group 60.9% patients in comparing to 42.5% patients in the non-DR Group was hypertensive, and regarding smoking also there was a strong relationship to the DR as we found 30.4% of the DR group were smokers in comparing to 22% in the non-DR group. Regarding the type of diabetes, we noticed significant relation with type I diabetic, 22.6% patients in group A have Type I diabetes in comparison to 16.2% patients in Group B, while in our study there was no relation of DR to the education level of the diabetic patients. Conclusion: Affair prevalence of Diabetic Retinopathy among Iraqi diabetic patients founded. High levels of HbA1c, hypertension, type I Diabetes, duration of Diabetes, and smoking are strongly correlated with diabetic retinopathy.

    Received: Jul. 27, 2021 Accepted: Aug. 9, 2021 Published: Nov. 10, 2021

    DOI: 10.11648/j.cmr.20211006.12 View: Downloads:

  • Authors: Yang Yang, Lifeng Chen, Lei Wu, Jiarui Yao, Na Wang, Xiaoqing Su, Dongmei Li, Lina Han, Weiping Wu, Dehui Huang, Tianyu Jiang, Zhenfu Wang

    Abstract: The wide array of clinical manifestations of dopa-responsive dystonia (DRD) or Segawa disease and the prevalence of numerous DRD-associated mutations in guanosine triphosphate cyclohydrolase 1 (GCH1) gene makeDRD diagnosis challenging. Methods: In this study, we assessed the clinical and genetic characteristics of two Chinese families with 3 DRD probands. Clinical assessment of DRD-related symptoms was conducted for all participants. All 6 exons of GCH1 were assessed by genetic analyses for individuals with heteroduplex DNA as compared that of controls. Results: The median DRD-onset age was 24 years and the female to male ratio of DRD patients was 8:1. Six out of eight (75%) patients responded to levodopa therapy. The data indicated that the GCH1 sequence had a novel point mutation resulting in T to C transition at position 80 in exon 1 of the cDNA sequence (c.80T>C), which resulting in an amino acid change (L27P) of GCH1 in the probands and their mother in the first DRD family. Conclusion: A novel GCH1 mutation (c.80T>C) was identified in the DRD patients in the first family. Our findings indicate that both clinical symptom assessment and genetic testing should be employed for improving DRD diagnosis.

    Received: Oct. 27, 2021 Accepted: Nov. 12, 2021 Published: Nov. 19, 2021

    DOI: 10.11648/j.cmr.20211006.13 View: Downloads:

  • Authors: Jawad Kadhem Manuti, Ali Ghafil Alwan, Muhammed Jassim Abd Ali

    Abstract: Background: Many factors can alter the response to erythropoietin treatment and approximately 5–10% of patients present an evident resistance in response to erythropoietin therapy. These include: iron deficiency, inflammation, infections, malignancy, dialysis, blood loss, hyperparathyroidism, aluminum toxicity and vitamin B12 or folate deficiencies. Objective: To evaluate and search for causative factors that predispose to Anemia resistance to erythropoietin therapy in End stage renal failure patients on regular hemodialysis. Patients and methods: This is descriptive prospective study enrolling 350 patients with End stage renal disease on regular hemodialysis, during January 2019 to January 2020 at Al-Emamain Al-Kadumian Medical City / Nephrology unit. 117 (44 female and 73 male) patients enrolled in this study whom met the inclusion criteria: Hgb level below 11 mg / dl despite adequate erythropoietin dose, regular adequate HD, Iron and folic acid supplementation. Amonthly bases measurement of CBC, CRP, S. Albumin, S. Ca, S. Phos, S. PTH, S. Ferritin and Transferrin Saturation were obtained. Results: 39% of patients have anemia resistance to erythropoietin. 48.7% of cases were taking Angiotensin converting enzyme inhibitors or angiotensin receptor blockers while 51.3% not. Hemoglobin level was significantly affected with ACEi or ARBs drugs use 8.20±1.17 mg/dl with drug use versus 8.95±0.82 mg/dl without ACEi or ARBs (p value <0.001). Hemoglobin level average was 7.85±1.01 mg/dl in female patients while 8.99±0.87 in male patients (p value<0.001). The mean WBC 7799 ± 2278 ×103/mm3 shows negative effect on Hgb level (p value < 0.001), The Hgb level was negatively corelated with serum ferritin level (mean S. ferritin 592.9577 ± 270.707ng/ml) (p value 0.031). CRP level negatively corelate with Hgb level (p value< 0.001) while Albumin Level Positively corelated (p value < 0.001). Regarding Parathyroid, S. Ca and S. Pho level impacts on Hgb level shows negatively correlate of Hgb with PTH (mean 691.7144±324.66 pg/ml)(p< 0.001) and S. Pho (mean 5.4637 ± 1.01585 mg/dl) (p value 0.024) and positive correlate with S. Ca (8.40744± 0.660188 mg/dl) (p value 0.023). Conclusion: The level of hemoglobin response to erythropoietin is significantly affected by Gender (female require higher dose), ACEi and ARBs treatment, WBC, CRP, Serum Albumin, Serum Calcium, Serum Ferritin, Serum Phosphorus and Serum Parathyroid hormone.

    Received: Jun. 20, 2021 Accepted: Jul. 2, 2021 Published: Nov. 23, 2021

    DOI: 10.11648/j.cmr.20211006.14 View: Downloads:

  • Authors: Yesenia Esmeralda Ochoa, Linda Summers, Stephanie Lynch, Conni DeBlieck, Karen Kopera-Frye

    Abstract: Asthma action plans should be standard practice amongst asthmatics. According to a new report from the American Academy of Pediatrics, a lack of AAP implementations could lead to increased asthma-related hospitalizations. Many written AAPs are written at a seventh to ninth grade reading level leading to less control of asthma symptoms, potentially resulting in increased asthma-related hospitalizations. A pictorial-based curriculum and its benefits will be discussed, along with background information concerning the implementation of such intervention and desired goal to increase asthma control. Implementation of a Pictorial Asthma Action Plan and Curriculum to improve Asthma Control utilizing “Iggy and the Inhalers'' by Booster Shot Media was conducted in a predominantly Spanish speaking and low income-based population. Iggy and the inhalers have published results of implementing their Pictorial Asthma Action Plan and Curriculum and improved outcomes documented on their site. The objective of implementation was to determine whether incorporating a pictorial based approach would improve control and knowledge amongst students with asthma in a special population. All identifiable participant information was kept private per site guidelines with exception to age and grade range and demographic information. Sixteen children participated in the implementation. Nine participants scored in the "well controlled" category while seven participants were "not controlled" according to ACT guidelines. Overall, five of seven (71%) improved their asthma control enough to bring them into the "controlled" state according to the ACT. Of those who improved, 16 (81%) improved with the Asthma Knowledge test. Conclusion: By utilizing appropriate educational methods, you can also increase participation and engagement, which results in increased compliance and control. Control and knowledge of asthma were improved because of this implementation project. Recommendation is that a PAAP curriculum should be promoted system wide.

    Received: Jul. 15, 2021 Accepted: Jul. 28, 2021 Published: Dec. 2, 2021

    DOI: 10.11648/j.cmr.20211006.15 View: Downloads:

  • Authors: Shi Xiuyan, Jiang Juan, Wu Xuechun, Zhou Wensheng, Wang Fei, Sun Jiangjie

    Abstract: Objective to investigate the prevalence and the related risk factors of Melasma in Nanjing female gas station workers. Methods The 677 women workers of general conditions, living habits and behaviors, menstruation and fertility situation, career, genetic conditions, Melasma prevalence data were collected in the form of questionnaires. After investigation, multivariate analysis was applied to the risk factors of Melasma. Using SPSS statistical software 22.0, inspection level is p = 0.05. P <0.05 indicates that the difference was statistically significant. Results A total of 677 female workers in the Nanjing gas station participated in the survey: 479 were confirmed Melasma and the prevalence is 70.6%. Analysis of related factors of Melasma, older patients with Melasma increased risk of OR=1.624 (1.383-1.906); The risk of Melasma increased in mothers and/or sisters. The OR values of mother, sister, mother, and sister were 2.151 (1.082-4.277), 4.17 (1.403-12.398), 4.079 (1.386-12.007), respectively. The length of the menstrual cycle was negatively correlated with Melasma OR = 0.623 (0.414 – 0.938); the risk of Melasma in one abortion was lower than that in two abortions (OR = 0.564, 0.335-0.95). The risk of Melasma in the cesarean section was lower than that in spontaneous delivery (OR = 0.607, 0.404-0.913). Conclusion The prevalence of Melasma among female workers in Nanjing gas station is related to age, heredity, length of the menstrual cycle, the number of abortions, and mode of birth.

    Received: Nov. 16, 2021 Accepted: Nov. 27, 2021 Published: Dec. 6, 2021

    DOI: 10.11648/j.cmr.20211006.16 View: Downloads:

  • Authors: Mohammed Hussien Sado, Nebiyou Fasil, Abebe Bekere

    Abstract: Introduction: Health care-associated infections (HCAIs) poses a real and serious threat to both the patients and health care workers. A significant number of patients acquired health care associated infections worldwide, and this has devastating effect on both the patient and the health system. It is estimated that more than 1.4 million people worldwide are suffering from infections acquired in hospitals. Even though infection prevention plays a key role in preventing and reducing the rate of healthcare associated infection, little is known about current staffing and structure of infection prevention and control programs. Objective: To assess Infection prevention practice and associated factors among healthcare providers in Bishoftu Referral Hospital south east Ethiopia from Dec 4, 2019 to Dec 20, 2019 G.C. Methodology: Institution based cross-sectional study was conducted to assess practice towards infection prevention and associated factors in Bishoftu Referral Hospital. The data was collected using structured self-administered questionnaire and supported by an observational check list. Infection prevention practice was calculated using 22 items and median was used a cut-off point to generate a binary practice outcome. The data was entered into EPI info 7 and then exported to SPSS version 20 for data management and analysis. Bivariate and Multivariable logistic regression analysis was carried to assess significance of determinants. Results: One hundred fifty eight (158) health care professionals were included in the study. This study showed that 60.4% of Health Care Providers had safe infection prevention Practice (95% CI (51.9%, 68.2%). Among the determinant factors, working in emergency ward [AOR=4.327, 95% CI (0.412, 45.464)], knowing the presence of infection prevention committee [AOR=7.629, 95% CI (1.580, 36.831)] and being a midwife [AOR=16.39, 95% CI (1.074, 250.171)] were significantly associated with safe infection prevention practice. Conclusion and Recommendation: The findings of this study show that around 40% of healthcare professional didn’t adhere to safe infection prevention. Working wards, infection prevention committee and profession were factors significantly associated with infection prevention practice. The hospital should give emphasis for all working wards to increase adherence to infection prevention practice.

    Received: Oct. 24, 2021 Accepted: Nov. 18, 2021 Published: Dec. 9, 2021

    DOI: 10.11648/j.cmr.20211006.17 View: Downloads:

  • Authors: David Ovadya, Sireen Abuakar, Kevin Felner

    Abstract: Background: Most of severe COVID-19 patients who survive the intensive care remain mechanically ventilated and require weaning and further rehabilitation. Objectives: This study compares the characteristics and outcomes of severe mechanically ventilated COVID-19 patients admitted to a weaning facility. In addition, the study describes patterns of weaning experienced during the three waves of COVID-19 in Israel. Methods: Clinical, demographic and outcome data was gathered retrospectively for 70 severe mechanically ventilated patients. Univariate analysis was performed to explain the variability in outcome variables. Results: Weaning success was 94% with mean weaning duration of 13±17 days. None of the demographic and clinical variables examined influenced the weaning duration, however patients with morbid obesity and/or diabetes were found to have shorter total duration on mechanical ventilation, hereby suggesting the presence of an obesity paradox. Extra corporal membrane oxygenation (ECMO) was used in 29% of the patients, and didn’t influence the weaning duration in spite being associated with higher rate of pleural complication. There were three main weaning patterns seen in different overlapping levels in the cohort patients: low capacity extra pulmonary pattern, fibrotic-bullosic pulmonary injury pattern and nonspecific interstitial pneumonitis pattern. Conclusions: The current study shows a high success rate of weaning, independent on comorbidities and previous ECMO use.

    Received: Nov. 10, 2021 Accepted: Dec. 8, 2021 Published: Dec. 24, 2021

    DOI: 10.11648/j.cmr.20211006.18 View: Downloads:

  • Authors: Gina Marcela Torres-Zambrano, Carlos Agustin Villegas-Valverde, Antonio Alfonso Bencomo-Hernandez, Loubna Abdel Hadi, Dhanya Adukkadukkam, Rene Antonio Rivero-Jimenez, Yasmine Maher Ahmed, Yandy Marx Castillo-Aleman, Yendry Ventura-Carmenate

    Abstract: Introduction: The COVID-19 pandemic presented an unprecedented challenge to identify effective drugs and means for their prevention and management. It is more difficult in severe cases due to complications in various vital organs such as the kidneys. Methods: An analytical study was carried out within the framework of the clinical trial “SENTAD-COVID Study” (, NCT04473170), whose objective was to describe acute kidney injury (AKI) in severe patients with COVID-19 and its relationship with clinical outcomes. A novel stem cells treatment for COVID-19 patients using an autologous peripheral blood nonhematopoietic-enriched stem cells cocktail was developed by the research team of the Abu Dhabi Stem Cells Center and applied at four Abu Dhabi Health Service Company hospitals. The sample consisted of the severe COVID-19 recruited patients: 20 in the experimental arm (Group A) and 24 controls (Group B). Both groups received COVID-19 standard treatment. Results: 29.5% of the patients studied suffered AKI. Mortality was lower in group A compared to the control group (20% vs. 30%, respectively), group A showed 25% AKI while group B 35%, sepsis was significantly lower in the treated group A compared to controls (25% vs. 35%; p=0.0095) Hazard Ratio=0.38, (95% CI: 0.16–0.86), given a Number Needed to Treat=2.5 patients. Group A had a significant reduction in inflammation markers at 25 days compared to the day of recruitment: C-Reactive Protein (median: 207.05 mg/L vs. 27.30 mg/L), IL-6 (median: 355.80 pg/L vs. 35.87 pg/L), and group A was the only one that presented a better proportion of patient with the recovery to normal values of the Neutrophil/Lymphocyte Ratio at 25 days, from 100% to 71.42% p=0.0108. Conclusions: One-third of the patients studied suffered AKI, group A patients showed a clear tendency to improve compared to controls, suggesting that the proposed therapy promotes healing and early recovery in severe COVID-19, which might be related to the anti-inflammatory effect of cellular therapy.

    Received: Nov. 11, 2021 Accepted: Dec. 2, 2021 Published: Dec. 24, 2021

    DOI: 10.11648/j.cmr.20211006.19 View: Downloads:

  • Authors: Wanting Li, Jinying Wang, Zhuoming Chen

    Abstract: As a kind of congenital myopathy (CM), central core disease (CCD) is mainly characterized by low muscle tension, slow progressive or static proximal limb weakness. CM can be characterized by no symptoms to be unable to walk independently in the clinic, pathological changes can be manifested as only significant type 1 muscle fiber dominant type to typical central axial space structure, and there are also many genetic ways. Duchenne muscular dystrophy (DMD) is a common congenital myopathy, which is mainly manifested in the typical pathological changes of early progressive myasthenia and muscular dystrophy. Both CCD and DMD show similar clinical symptoms and their serum creatine kinase can be increased, which is often difficult to distinguish them through clinical characterization and laboratory examination. In this study, we report the clinical and genetic characteristics of two patients with progressive muscle weakness with elevated creatine kinase. They are the product of a first-cousin marriage and seek medical treatment due to asymptotic walking difficulties, muscle atrophy, joint contracture, scoliosis, and elevated creatine kinase levels. It was previously suspected as Duchenne muscular dystrophy. After that, the patient's DNA was sequenced by whole-exome sequencing (WES), and all coding regions were investigated. It was found that a new heterozygous missense mutation c.5092g > A in the RYR1 gene. Similar mutations have not been reported in the literature before. Bioinformatics software predicts that they have the possibility of pathogenesis, which is highly correlated with CCD. The purpose of this case is to report a new heterozygous mutation of the RYR1 gene, summarize the similarities and differences of clinical manifestations, genetic characteristics, and pathological changes of CCD and DMD, and provide a new idea for its differential diagnosis.

    Received: Nov. 28, 2021 Accepted: Dec. 14, 2021 Published: Dec. 29, 2021

    DOI: 10.11648/j.cmr.20211006.20 View: Downloads:

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