Background:Large HCCs can often be associated with low levels of cirrhosis. However, inflammation is also regarded as a driver of HCC growth.Objectives:To compare patients with large >5 cm HCCs having high versus low serum inflammation parameters.Materials and methods:A Turkish patient HCC dataset with known survivals was retrospectively analyzed after dichotomization according to several clinical inflammation markers.Results:Amongst several parameters examined, only AST levels were significantly associated with elevated AFP levels and increased percent PVT and tumor multifocality. The dichotomization of the cohort according to high or low AST levels resulted in 2 subcohorts with a 5-fold difference in median survival. The 2 AST-dichotomised cohorts comprised patients with similar large-size HCCs, but which were significantly different with respect to serum AFP levels, percent PVT, and percent tumor multifocality.Conclusions:Two large-sized HCC phenotypes were identified. One had more aggressive HCC characteristics, higher inflammatory indices, and worse survival. The other had the opposite. Despite inflammation being important for the growth of some large tumors, others of a similar size likely have different growth mechanisms.
OBJECTIVES:The majority of HCCs present at an advanced stage in which potentially curative therapies cannot be used. Surveillance ultrasound has been found to increase the numbers of patients diagnosed with small tumors, but it is often not used. We aimed to try to identify widely-available and cheap potential serum markers for use in patients at risk for HCC.MATERIAL AND METHODS:A comparison was made of the complete blood count and liver function tests in a group of patients (n=114) with proven small HCCs (≤ 2 cm) and patients without HCC (n=506), all of whom were treated by liver transplantation in our Liver Transplantation Institute.RESULTS:Significant differences were found for blood levels of WBC, lymphocytes, total bilirubin and transaminases. Several 2-parameter combinations were assessed, but only the combination of total bilirubin and lymphocytes was found to be significantly different between patients with small HCCs and no HCC. Multivariate regression analysis showed significance only for total bilirubin levels and lymphocyte counts. The results were confirmed using a separate small cohort of non-transplant patients.CONCLUSION:The combination of elevated levels of total bilirubin and lymphocyte counts holds promise for identification of patients with chronic liver disease who are at risk for HCC.
BACKGROUND:Inflammation and its markers are considered prognostically important for many cancers, including Hepatocellular Carcinoma (HCC). However, it is not really clear which markers are the best. AIMS:To assess in a cohort of prospectively-evaluated HCC patients who were treated with liver transplant and whose survival was known, multiple commonly used inflammatory markers in relation to survival and to both clinical and tumor aggressiveness parameters. RESULTS:Amongst 330 transplanted HCC patients, CRP was found to be the only significant inflammatory marker for survival, on multivariate Cox regression analysis. NLR, PLR, GGT, AST, ALT and the Glasgow inflammation score were also found to be significant, but on univariate analysis only. CRP was significant in patients with both small (< 5 cm) and large HCCs and in patients with elevated or low Alpha-Fetoprotein (AFP) levels. Comparison of HCC patients with high (>2.5 mg/ dL) compared low serum CRP levels showed significant differences for blood levels of NLR, LMR, Hb, total bilirubin and liver transaminases, as well as Maximum Tumor Diameter (MTD) and percent of patients with Portal Vein Thrombosis (PVT). CONCLUSIONS:Elevated serum CRP levels were associated with significantly increased MTD and percent of patients with PVT and significantly worse overall survival in HCC patients who were treated by liver transplantation.
BACKGROUND:A characteristic of Hepatocellular Carcinoma (HCC) is to invade the portal venous system in the liver as a means of spread within the liver and systemically. The ensuing Portal Vein Thrombosis (PVT) is a poor prognosis parameter and often diagnosed radiologically pre-treatment. More limited Microvascular Portal Invasion (microPVI) is typically diagnosed on examination of tumors removed after treatment by resection or transplant. The biological characteristics and subsets of PVI are incompletely characterized.AIMS:To examine HCC patients with and without microPVI to understand the clinical relationships to other tumor and clinical characteristics and to survival.METHODS:A cohort of 270 liver transplant patients with HCC without macroscopic PVT that were available to us was examined. Patients with (165) and without (105) microPVI were compared for survival and clinical features.RESULTS:The mean survival of patients with and without microPVI was significantly different: 86.6 versus 110.5 months, p=0.007.The microPVI+ patients differed from microPVI- patients in having a significantly larger number of tumor nodules, tumor size and higher serum levels of both Alpha-Fetoprotein (AFP) and almost significant for higher Gamma-Glutamyl Transpeptidase (GGT, p=0.053). Survival in microPVI+ patients related significantly to serum GGT (p=0.006) but not to AFP levels. The incidence of microPVI increased with increase in tumor size and survival decreased significantly with increase in tumor size for microPVI patients. Increase in tumor size was also associated with significantly higher serum GGT levels in patients who were microPVI+, but not in those who were microPVI. Furthermore, patients with microPVI who had prolonged survival significantly differed from those with shorter survival in respect only to tumor size and serum GGT levels.CONCLUSION:These findings draw attention to a group of patients with microPVI who have long survival and to the usefulness of serum GGT levels in their evaluation and prognosis.
Spinal Cord Injury (SCI) is a devastating condition that often leads to permanent functional and neurological deficits in injured individuals. One of the most overlooked consequences of spinal cord injury is sexual functions, such as erectile and ejaculatory dysfunction. Mesenchymal stem cells (MSCs) have been reported as adjunctive treatment to SCI cases. Some animal studies reported both functional and conductivity improvement after MSCs application. Clinical studies on human has also been conducted in small basis, but so far showed equivocal results.
Background: Skull fractures are associated with a dural breach and are regarded as Neurosurgical emergencies to prevent potentially devastating infective complications. We aimed to quantify the discrepancy between pre-operative suspicion and intra-operative confirmation of a dural breach in 246 patients admitted over a 2 year period with skull fractures post assault. Materials and Methods: Retrospective data analysis of all patients that were admitted to the neurosurgical wards at our institution with skull fractures post assault from January 2015-December 2016 was performed. Medical charts were analyzed for pre-operative suspicion of a dural breach including the evidence for this suspicion, and operative confirmation of a dural breach. Management included simple suturing and antibiotics or surgery with antibiotic cover. Results: Of 246 patients treated, 234 (95%) were male and 12 (5%) were female. The mean age of subjects was 32 +/12 years. In terms of compound skull fracture management 23 (9%) were treated with simple suturing and antibiotics and 223 (91%) were treated surgically with antibiotics. Considering pre-operative suspicion of a dural breach in all 246 patients in 95 (39%) of cases a dural breach was suspected and in 151 (61%) a dural breach was not suspected. In the operative group of 223 patients a dural breach was confirmed in 109 (49%) of cases and excluded in 113 (51%) of cases. Conclusion: Although a dural breach was suspected in 95 (39%) of all 246 subjects using all available clinical and radiological evidence, in the operative group of 223 subjects a dural breach was confirmed in 113 (49%) of subjects. Hence the attending surgeon should have a low threshold for surgical exploration of skull fractures secondary to assault for fear of missing approximately 10% of dural breaches.
Opening the door: creating a questionnaire to facilitate communication between parents and physicians when infants and young children have feeding disordersOpening the Door: Creating a questionnaire to facilitate communication between parents and physicians when infants and young children have feeding challenges" has been accepted for publication in the Clinical Practice (therapy) considering the statements provided in the article as personal opinion of the author which was found not having any conflict or biasness towards anything.As the article was a perspective one, information provided by the author was considered as an opinion to be expressed through publication.
LVNC is a morphology that may be benign or may be a cardiomyopathy with potential for heart failure, ventricular arrhythmias and thromboembolic events. Additionally the various phenotypic expressions are heterogeneous and have the potential to transition from one morphological cardiomyopathy to another. This commentary gives a unique example of a transition from HCM to LVNC cardiomyopathy.
Methods: 27 spinal cord injured subjects are included in the study to evaluate the effect of wearing of an elastic abdominal strap on the restrictive syndrome. Two measures are made: the measurements of staged thoracic amplification and the measurement of the respiratory functional exploration without and with abdominal strap. Results: no effect on the respiratory functional exploration measurements (p-value>0.05), significant increase in chest expansion at the axillary and xiphoid level (p-value<0.05) and significant decreased in diaphragmatic amplification (p-value<0.05). Discussion: The use of an abdominal strap does not improve the parameters of the respiratory functional exploration in spinal cord injured and opposes the mechanical and physiology of breathing by minimizing the action of the diaphragm and increasing the thoracic perimeters whatever it is the level of the spinal cord injury from C5 to T12. Conclusion: The use of an elastic abdominal strap in spinal cord injured patients do not improve respiratory functional exploration parameters and leads to an increase in axillary and xiphoidal thoracic amplification and to a decreased of the abdominal diaphragmatic one.
Background: Sternotomy related pain is the main patients' frequent complaint after open heart surgery. Because of the deleterious effects of opioids, it is important to use an alternative way to effectively reduce pain including aromatherapy with analgesics. Aim of the study: This study aimed to evaluate the effectiveness of inhaled lavender oil on an intensity of sternotomy related pain and vital signs in patients who underwent open heart surgery. Subjects and Methods: Quasi-experimental research design was conducted on a convenient sample of 90 patients recruited from 9-bed open heart surgery intensive care unit affiliated to Al Manial university hospital and then assigned randomly to study and groups. The study group was exposed to lavender inhalation with morphine. While the control group of patients exposed to morphine only. Two questionnaires were utilized in data collection. The first one included baseline characteristics including demographic and medical data and the second one were as a visual analog scale to determine the pain intensity. Results: Significant statistical difference was found between the study and control group as the study group demonstrated lower pain intensity scores than the control group (at 5 minutes and, half an hour after). Recommendations: Utilize lavender oil inhalation in the early days of open heart surgery to decrease the consumption Lavender inhalation of opoids and analgesics.
Some heuristic discussion problems of modern oncology are presented, some of which are under development, and some are only in the future. But in any case, they are extremely important not only for oncologists, but also for specialists in related disciplines. There is a fairly steady trend: the aim of anti-cancer therapy are mainly tumor targets, which is confirmed in this way by the use of LAK-cells, NK-cells, CD8-T-Lph (lymphocytes), Mø (macrophages) armed, stem cells (hematopoietic in the treatment of malignant blood diseases), vaccine therapy, etc. Special words can be said about monAb (monoclonal Ab), with the help of which the targeted therapy is carried out, when they are not aimed at killing a cancerous tumor, as in CT, but at inhibiting its specific receptors-“targets.” In the past year, antibodies have been obtained against cells of the human immune system, which “cancel” inhibitory processes in it, making it difficult to fight a tumor, blocking cancer neutralizers of the immune system. It is very good; the targeted therapy is our future; however, at the later stages of cancer, the targeted therapy often does not work; besides, it is very expensive and effective in a limited group of patients. Now, monAb have been obtained which, using Fab-fragments, bind to tumor AG (antigen), CD3-AG of T-Lph, and by the Fc-fragment, to a NK-cell or Mø-i.e., 3 killers at once kill one target. This is another scientific breakthrough.
The paper provides an assessment of changes in the structural and energetic state of the associated water phase under the light radiation influence on the direction of its regulatory influence on the various human body systems. Based on the evaluation of the regulatory response of these body systems and the behavior of the biotest object, Escherichia coli K12 TG1, the associated water phase resonant states, which have a targeting effect on these human body systems and the control test object, will be established. The shifts of resonant (tonic and sedative) phase states under the influence of water photomodulation are estimated. The photomodulation influence establishes the long-term dynamics of changes in the structural and energetic state of the associated water phase, including the advanced current time, correlating with the reactions of the human body systems.
Background:The stomach is a very unusual site of metastasis from melanoma.Due to the few reports, we collected a case series in order to focus their endoscopic, clinical and biological features and to explore the therapeutic outcomes.Methods: We collected 9 consecutive cases of gastric localization of metastatic melanoma.Results: All patients presented a long, nonspecific and vague history of gastric symptoms often cured as gastritis.The endoscopic features included multiple smooth black spots, ulcerated polypoid lesions or a wide neoplastic infiltration.BRAF status was mutated in only 1 patient while an NRAS mutation was found in 3 cases.Palliative gastrectomy was performed in 4 of 9 patients resulting in a good control of symptoms.The median survival in patients underwent gastrectomy was 25 months vs 4 months in non-surgically treated patients. Conclusions:We emphasize that physicians should be aware of the possible gastric involvement in patients with a history of melanoma and should suggest to promptly perform an endoscopic evaluation in symptomatic patients.Gastrectomy should be offered to all patients for palliative intent and to allow to plan systemic therapies recently enhanced with new and more effective drugs.
A case of leiomyoma at gastroesophageal (GE) junction was identified in a male patient with uncontrolled hypertension and arrhythmia. Patient came with chief protestations of body pains, burping, stomach pain and uncontrolled hypertension. He was with oral medications like amlodipine 5 mg, pantoprazole 40mg, clopidogrel 75 mg, vitamin supplements and syrup antacid. His blood pressure was 150/100 mmHg. He has elevations of direct bilirubin-0.03mg/ dl and basic phosphate-192U/L. Esophagus endoscopy determines 23 × 22 mm size mixed echoic lesion with deformed cells at GE junction. His ECG demonstrates cardiac arrhythmias. Endoscopic ultrasonography and cardiac MRI identifies a mass from the submucosal layer at GE junction compressing the esophageal veins. Fibroids at GE junction were removed by thoracoscopy. Histopathological examination confirms leiomyoma with an impression of round mass lesion composed of bundle of spindle cells arranged like braid with minimal abnormal and enlarged nuclei. To his previous prescription ceftriaxone 500 mg and ibuprofen 400 mg were included
Aim: To investigate the effectiveness of a new guidewire (GW) manipulation technique of combination of Intravascular Ultrasonography (IVUS) and dual-lumen microcatheter guidance. Methods: A 67 years old man presented with stump-less Chronic Total Occlusion (CTO) lesion in proximal part of Left Anterior Descending (LAD) coronary. By the combination use of IVUS and a dual-lumen microcatheter guide GW manipulation, GW successfully crossed the lesion. The efficacy was evaluated by the CTO model. Test 1 was used to determine which catheter is more suitable to obtain support force for penetration: the conventional IVUS-guide with single-lumen microcatheter or new IVUS-guide with dual-lumen microcatheter. Bench test 2 compared the proximity between CTO GW and IVUS catheter with conventional IVUS-guide and the new technique. Conventional IVUS guidance involved using a single-lumen microcatheter and IVUS cathetein, two separate GWs. The new technique involved using IVUS catheter and a dual-lumen microcatheter in the same GW. The CTO GW was manipulated through the over-the-wire lumen of the dual-lumen microcatheter. Results: In test 1, the dual lumen microcatheter supported successful GW penetration, whereas the single lumen did not. In test 2, the CTO GW was manipulated more proximally to the IVUS catheter with the new technique than with conventional IVUS guidance. Conclusion: The new technique is practical, as it provides more support force and more proximal visualisation than conventional IVUS guidance.
Background: Because of rapid occurrence and ever-mutating attributes of MRSA infection that makes it difficult to detect and manage.Therefore, nurses need to be knowledgeable of MRSA. Aim:To assess the effectiveness of structured teaching programmer on knowledge and attitude regarding prevention and control of Methicillin-Resistant Staphylococcus aureus among medical-surgical and ICU nurses in Egypt.Material and Method: Pre/ post-quasi-experimental study design was conducted over a period of six months consisted of a random sample of 60 nurses worked in critical and medical-surgical settings at Al Manial university hospital in Egypt.Pre/post Knowledge and attitude questionnaires regarding MRSA were constructed by the researchers and their validity was examined by a panel of experts.Data was gathered and analyzed utilizing descriptive and inferential statistical tests. Results:The findings revealed the significant increase in nurses' knowledge after teaching program regarding definition, risk factors, pathogenesis, prevention, and treatment.Moreover, nurses' showed significant improvements in the attitude towards prevention and control of MRSA infection after exposure to educational program but showed no change regarding the concern of the workload affects their abilities to apply infection prevention guidelines and they still feel with danger when contacting with MRSA patients and they see that they should spend little time with MRSA patient. Conclusion:There was an improvement in nurses' knowledge and attitude responses regarding MRSA control and prevention after exposure to the educational programme.Recommendations: Develop and implement nurses' practical guidelines to prevent and control MRSA infection in a different health care setting.
Objective: Human Milk Banking (HMB), which is improved and supported as an extension of national breastfeeding policies in many countries, is not approved by the majority of the Muslim communities due to the ethical problems, traditional beliefs, and attitudes. The purpose of this study is to identify the attitudes and views of Turkish women who have children regarding Human Milk Banking.\ Methods: This study, which was conducted in the Family Health Centers located in the districts of Istanbul, is populationbased and descriptive design. The participants were 1055 volunteer women who had at least one child. Data were collected through a 32-item questionnaire developed by the researchers in line with the related literature, considering the cultural practices and beliefs. The participants were interviewed with face to face by the researcher in their homes. Results: Of all the participants, 62.8% had knowledge about the human milk banking project. However, 63.8% of them stated they would not donate their milk to a baby in an intensive care unit while they were breastfeeding their own child. In addition, 78.6% said they would not receive support from a human milk bank for their baby who might be in an intensive care unit or who might not have access to breast milk for some other reason. The most important issue related to human milk banking, as stated by 46.8% of the participants, is that it is inappropriate according to Islamic beliefs (babies are believed to become milk siblings). Hence, 57.2% of the participants think that a human milk banking project would not be approved in Turkey. Conclusion: In human milk banks to be established in Muslim countries, we need to ensure that the mothers' milk will not be mixed and also develop a model where both donor and recipient can exchange information about each other.
Atraumatic spontaneous retroperitoneal haemorrhage is a distinct clinical entity with potentially life-threatening complications.The commonest aetologies include ruptured aortic or visceral aneurysm, spontaneous rupture of the kidney and patients with coagulopathies.Spontaneous rupture of the kidney can occur due to underlying renal pathologies such as malignancy, angiomyolipoma, vascular malformation, vasculitis and infection.Approximately 5% of such cases occur without an identifi able renal pathology and are termed as 'idiopathic'.Idiopathic spontaneous rupture has been described among patients on chronic haemodialysis associated with acquired cystic disease of the kidney.We describe the extremely rare instance of a patient with a failed renal allograft and recently started on haemodialysis who suffered an idiopathic spontaneous rupture of his native kidney.
Background: Pain management for hospitalized patient requires nurses’ pain management competency. However; there is paucity of information on nurse’s pain management competency in Jimma Zone public hospitals. Objective: To assess nurses’ pain management competency and associated factors among nurses working in public Hospitals, Jimma zone, Oromia Regional State, South west Ethiopia. Methods: Institutional based cross- sectional study design was conducted on 310 nurses working in public hospitals, Jimma zone, from March 1-28, 2017. The study subjects were selected by simple random sampling technique using lottery method. Data was collected using standardized self-administered questionnaire. SPSS 20.0 version was used for data entry and analysis. Variables with p<0.25 in the bivariate analyses were entered into a multivariable regression analysis to identify the independent factors associated with nurses’ competency. Significant factors reported at P<0.05. Results: Respondents who were working at medical with [AOR=2.05(1,02,4.12)], Nurses’ who were working at surgical ward with [AOR=0.19(0.05,0.64)]and Nurse-Physician work relationship with [AOR=2.36(95%CI:1.36,4.08)] significantly associated with nurses’ pain management competency. Conclusion and Recommendation: The overall nurses’ pain management competency level in Jimma zone, Public hospital is very low. Among many factors contributed to the nurses’ patient pain management competency were nursephysician work relationship, presence of protocol and working unit. Those show that Jimma public hospitals should design strategy to improve pain management competency. Nurses’ pain management competency enhances utilization of protocols, that specifies pain management by unit and promote nurse-physician relation.
Background: Disturbed sleep is a common complaint in patients with Chronic Obstructive Lung Disease (COPD). Moreover, the factors affecting sleep quality of those patients remain unclear. The aim of this study: was to assess factors affecting sleep quality among patients with the chronic obstructive pulmonary disease. Material and Methods: A descriptive exploratory design was utilized and conducted at the intermediate respiratory care unit at Mansoura university hospital including a convenient sample of 60 patients of both sexes, able to verbalize their health status and who stayed more than two days at intermediate care unit. Patients' Demographic, Health Relevant Data, Pittsburgh Sleep Quality Index and factors affecting sleep quality instruments were utilized in data collection. Results: Most of the patients were married males, their age ranged between 50 and 69 years with a mean age of 61 and one-third of them were smokers. The majority of patients (80%) had the unsatisfactory level of sleep according to Pittsburgh Sleep Quality Index. The factors altered the patients' sleep included physiological factors such as the production of sputum and chest tightness. The most influential environmental factors included the movement of health care members, performing nursing procedures and administration of nebulizer sessions. The dietary factors included hunger. The influential psychological factors included patients' anxiety and fear of being alone. Finally, daily life habits as daytime naps and smoking. Conclusion and recommendations: It can be concluded that most of the patients had an unsatisfactory level of sleep and need to be improved. As well, further researches are highly recommended on a larger probability sample in different geographical hospitals in Egypt to ensure generalization of findings
