Background Nemolizumab (CIM331) is a monoclonal antibody that binds the IL-31 receptor alpha component. This inhibits IL-31 from acting on neurons that constrains the initialization of the sense of pruritus in cases of atopic dermatitis. Aims To summarize the results of reported studies evaluating the role of nemolizumab and omalizumab in management of atopic dermatitis. Methods This is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized controlled trials, observational, and experimental studies which study role of nemolizumab in management of atopic dermatitis. Results The review included 8 randomized studies reported efficacy of both nemolizumab and omalizumab for management of atopic dermatitis. Conclusion Other studies with large numbers of patients with AD are necessary to define the adverse effects of both drugs in the treatment of AD.
Background Patients with COVID-19 with diabetes mellitus (DM) are reportedly more likely to develop severe clinical course and increased mortality. Aims We aimed to investigate the prevalence of newly diagnosed DM in COVID-19 patients and observe the association of underlying DM with increasing incidence of serious adverse events and mortality in COVID-19 patients. Methods We searched PubMed/Medline, Cochrane, Google Scholar, and Embase/Ovid for relevant articles that match our inclusion criteria. We assessed the quality of studies using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Our outcomes of interest were mainly the prevalence of ICU admissions and mortality. Results The pooled proportion of newly diagnosed DM in hospitalized COVID-19 patients was 44.5 per cent. We report that newly diagnosed diabetics indicate a poor prognosis of COVID-19 compared with non-diabetics or previously-known DM. We also show that COVID-19 patients with newly diagnosed DM are at increased risk of getting ICU admissions compared with patients with pre-existing DM. Conclusion We show that 44.5 per cent of hospitalized COVID-19 patients are likely to develop DM. We also confirm that DM worsens the prognosis of COVID-19 patients and raises the incidence rates of both ICU admissions and mortality. Key Words.
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) is a rare and poorly understood entity, defined as a generalised proliferation of pulmonary neuroendocrine cells arranged in scattered single cells, small nodules or linear patterns that do not invade beyond the bronchial epithelial basement membrane.The diagnosis of DIPNECH requires clinical, radiological and histopathology correlation. However, it is often diagnosed incidentally on histopathological examination of lung biopsy specimen performed for other reasons or discovered due to investigations for unexplained respiratory symptoms.In the first publication of a case series of DINPNECH and NECH in Australia, we describe seven histopathologically confirmed cases of DIPNECH or NECH. All patients were females, aged 57-70, mostly non-smoker. The most common presenting symptoms were dry cough and progressive dyspnoea. 71 per cent of patients had typical radiological findings with nodular changes.
A 30-year-old female presented two days post myomectomy with blurred vision due to myopic shift. She was found to have a shallow anterior chamber with normal intra-ocular pressures and no uveal effusion. This was thought to be medication induced and after suspending celecoxib her vision improved back to baseline.
BackgroundThe abolition of the Witchcraft Suppression Act of 1957 and the declaration of the Traditional Health Practitioners (THPs) Act (No 22 of 2007) was key in efforts to recognise THPs. Concerns over the safety of products, practices and therapies used by THPs attracted calls for regulations, giving birth to the 2015 regulatory framework.AimsThis paper aims to describe THP perceptions on their healing systems and the regulatory framework.MethodsThe qualitative research approach used involved focus group discussions sampled from five Kwazulu-Natal district municipalities. 50 Participants were recruited using district THP councils and a snowballing technique. Data collection tools included case summaries and a focus group discussion guide. Data was analysed using Braun & Clarke's six-phase thematic analysis framework (2017).ResultsThemes identified included THPs' recognition of traditional healing as an ancestral calling and this would complicate regulating them based on demographical requirements, that ancestors do not recognise. Most of the registration requirements were perceived as undermining African beliefs. THPs expressed that the registration requirements used colonization techniques to enforce registration and used registration as a tax collection instrument. Every participant acknowledged that registration would assist in their recognition and legitimization.ConclusionGenerally unhappy about the registration requirements, which will complicate their regulation. The issue of self-regulation would certainly warrant further research especially since obeying ancestors and ancestral spirits supersedes any law or order. For an appropriate THP regulation process, the perceptions, and recommendations of THPs would have to be catered for. If regulations fail to respect and recognise THPs, they could regulate them into oblivion. Therefore, further research to refine nuances from what has been shared from the studied FGDs is warranted.
BackgroundSeveral biomarkers were found to predict the severity and outcome of COVID-19 infection.AimsTo determine the associations between laboratory biomarkers with COVID-19 severity and outcome.MethodsA prospective study among confirmed COVID-19 patients aged 18 years old and above for biomarkers, and correlated with severity and mortality.ResultsOf 347 patients, 245 (70.6 per cent) were RT-PCR COVID-19 positive. Patients who were admitted to the ICU had higher levels of WBC count, lymphocytes, neutrophils, N/L ratio, Ddimer, potassium, phosphates, ferritin, CRP, ESR and cortisol, whereas patients who died were older, and had higher levels of N/L ratio, D-dimer, potassium, phosphates, ferritin, CRP, procalcitonin, cortisol, FBS, HbA1c, PTH and number of comorbidities compared to those who survived. Cortisol, FT3, and FBS were the most significant predictor for mortality and ferritin for ICU admission.ConclusionHigh cortisol and blood sugar and low FT3 were associated with higher mortality whereas low haemoglobin and lymphocytes and high N/L ratio, ferritin and D-dimer were associated with ICU admission among COVID-19 (+) patients. The first day biomarkers may provide clues for the eventual outcome and severity among COVID-19 patients. This will facilitate a more focused and aggressive intervention and early ICU admission.
BackgroundPreterm birth has been reported to affect normal physiological growth and development of preterm-delivered children. Whether preterm birth affects primary and permanent tooth eruption, is not yet determined.AimsTo identify whether preterm birth affects tooth eruption by reviewing scientific literature.MethodsMEDLINE, EMBASE, Cochrane library and reference lists of included studies were screened from January 1980 to November 2020. The study designs included both interventional and observational studies analysing peculiarities of tooth eruption in premature infants with no congenital syndromes. Risk of bias was assessed using NIH Quality Assessment tool for cohort, cross-sectional studies.ResultsTwelve articles were selected for data extraction after exclusion of 1709 irrelevant studies. Primary teeth eruption time in preterm children was delayed up to two months taking account of chronological age only. In most studies, after changing the age from chronological to corrected, the eruption of primary teeth was still delayed, but the difference was negligible. Catch-up growth occurs in 18 months and the difference in primary teeth eruption time remains insignificant. Very low birth weight and nonbreastfeeding were associated with delayed primary teeth eruption. One study found earlier eruption of first permanent molars and incisors, while other two stated lagging maturation of permanent teeth up to the age of nine years. The quality of evidence provided by the studies was low.ConclusionConsidering chronological age, primary teeth eruption time in preterm children was delayed and related to very low birth weight and non-breastfeeding. Data on eruption of permanent teeth were inconsistent; more detailed research is need.
Although early detection of breast cancer has increased over many decades, locally advanced breast cancers still occur, and they present a difficult clinical condition to manage. They often have significant associated symptoms, such as bleeding, pain and malodour, which can impact on quality of life. Unfortunately, there are often few curative options for their management.We describe the case of a patient with a fungating breast cancer managed with high dose palliative radiotherapy, achieving good, durable local control and symptomatic relief. This case report highlights the effectiveness of a treatment often underutilised.
BackgroundBreastfeeding is the natural way of feeding babies; it has many health benefits for mothers and their babies. Mothers can face some challenges during the process of breastfeeding, which, if not addressed by a physician with specific knowledge and expertise, could lead to the cessation of breastfeeding.Globally, breastfeeding education in the Family Medicine residency curriculum receives minimal attention for several reasons; some are related to the residents and other stakeholders, and some to financial aspects.AimsThe objective of this study is to explore the Family Medicine residents' opinions regarding the potential introduction of breastfeeding education to their curriculum.MethodsIn this exploratory qualitative study, data were gathered using focus groups of Family Medicine residents working within Primary Health Care centers in Saudi Arabia. Data were analysed using an iterative thematic approach.ResultsThirteen Family Medicine residents participated in the focus group. Three main themes were generated: Breastfeeding background and experience, the experience of breastfeeding education, the introduction of breastfeeding medicine aligned with residents' opinions. Residents acknowledge the lack and the inconsistent implementation of breastfeeding education in their curriculum; they acknowledge its importance. Residents are open to learning about breastfeeding to improve their practice, provided clear methods of teaching and evaluation exist. Residents highlighted the challenges that can face the implementation of such a program and possible solutions from their perspective.ConclusionThis study could raise the awareness of decision-makers about breastfeeding education and supports the introduction of a national-level policy to integrate it into Family Medicine residency programs in Saudi Arabia.
Rheumatic heart disease is an irreversible sequela of rheumatic fever which is a major cause of cardiovascular morbidity and mortality in developing countries. We report a case of a 22-year-old lady with underlying chronic rheumatic heart disease, underwent mitral valve repair, presented with a recurrence of acute rheumatic fever with new aortic regurgitation confirmed by echocardiography, upon defaulting oral penicillin prophylaxis. She was treated symptomatically and started on IV Penicillin 2.4MU for 14 days based on clinical suspicion of possible infective endocarditis although laboratory values were not suggestive. With the resolution of clinical symptoms and treatment completion, she was discharged with oral penicillin despite non-compliance and a referral to the tertiary cardiac centre for continuation of care. Medical management was continued without surgical intervention to date. There is no specific guideline available in Malaysia to manage rheumatic heart disease, therefore treatment relies on the physician's experience. Majority still prefer prescribing oral penicillin prophylaxis in Malaysia but the recommended choice of prophylaxis worldwide is IM penicillin. In my opinion, this patient should have been discharged with IM penicillin or, even better, initiated at the point of initial diagnosis. In this case report, we not only highlight the importance of secondary prophylaxis but also focus on the route of prophylaxis to halt the progression of the disease.
BackgroundThe incidence of hip fractures in elderly people is steadily rising. Hip fractures sometimes cause mortality especially within 30-days of the injury/incidence. Mortality varies according to the regions or institutes and its determination is clinically or socially important.AimsWe attempted this cross-sectional study to determine the 30-day mortality rate and its associated factors in elderly patients (>65) admitted to a tertiary center of Saudi Arabia for hip fractures.MethodsA non-probability consecutive sampling technique was used and determined the 30-day mortality rate and its associated factors on 130 patients.ResultsA 30-days mortality rate of 15.4 per cent (n=20). Patients (n=130) backgrounds were as follows. Male: female; 57.7 per cent (n=75) and 42.3 per cent (n=55) respectively, with age of 79.6 (SD: 8.5; range 65-88). Comorbidities were present: diabetes mellitus70 per cent (n=91), hypertension 81.5 per cent (n=106), and dyslipidaemia (n=43).ConclusionMortality was 15.4 per cent. Male gender, dementia, and place of fall influenced the 30-days mortality rate. Fracture type, medical comorbidities, and the causes of fall did not affect the mortality.
BackgroundRecent advance of endoscopic techniques has allowed surgeons to perform thyroidectomy via an incision placement at hidden places which lead to better cosmetic acceptability compared with conventional open thyroidectomy.AimsThis study was conducted to summarize the current evidence that compare open thyroidectomy with endoscopic thyroidectomy in treatment of papillary thyroid cancerMethodsAn electronic literature review, including PubMed, Google Scholar, and EBSCO that examining randomized trials of endoscopic thyroidectomy (ET), conventional open thyroidectomy (COT), and management of papillary thyroid carcinoma was carried out.ResultsThe review included 8 randomized studies that compare total endoscopic thyroidectomy versus conventional open thyroidectomy in treatment of papillary thyroid cancer. The findings showed endoscopic thyroidectomy had statically significant cosmetic appearance, less amount of blood loss and occurrence of transient hypocalcaemia than conventional open thyroidectomy in form of cosmetic outcome, amount lower blood loss.ConclusionThe current review showed that, ET has a better cosmetic outcome and lower blood loss compared with COT. While COT was associated with significantly low operation time, hospital stay, drainage time, amount of drainage fluid and transient recurrent laryngeal nerve (RLN) palsy.
Strongyloidiasis is an infection caused by the helminthic parasite Strongyloides stercoralis. It is endemic in rural regions of the tropics and subtropics areas. There are between 30 and 100 million an infected persons worldwide. Clinical manifestations of S. stercolaris range from asymptomatic to life-threatening and can be acute or chronic. Symptomatic disease can manifest in skin, the gastrointestinal (GI) tract and/or the respiratory system. Severe and disseminated infection can lead to serious complications. We report a case of strongyloidiasis in a 48-year-old male who presented with gastrointestinal symptoms and developed acute cholecystitis and deep venous thrombosis. Strongyloidiasis is uncommon in Saudi Arabia but must be considered for patients with gastrointestinal symptoms who recently arrived from an endemic area or will begin immunosuppressive therapy.
BackgroundRevascularization for patients who suffer multivessel coronary artery disease is a common procedure around the world. Taking United about 700,000 patients have multivessel coronary revascularization per year 1/4 of these patients are diagnosed with diabetes.AimsTo summarize the current evidence that compare CABG to PCI in multivessel coronary disease in form of cardiac death, stroke, MI and unplanned devascularization.MethodsThis is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining randomized trials of treatment of multivessel coronary disease to summarize the major RCT concerning this topic.ResultsThe review included five randomized studies that compare coronary artery bypass grafting and percutaneous coronary intervention. The findings showed that CABG show better result with less mortality rate.ConclusionThis review concluded that there revascularization in treating coronary artery disease could be conducted either by CABG or PCI, CABG show better result as it cause less death, MI and revascularization rates, but the usage of new additions such as second generation DES, can also improve the safety and efficacy of PCI when added to it.
Background People with neurological disorders are at an increased risk of severe COVID-19 infection and consequent mortality.1-4 Furthermore, patients with COVID-19 infection may develop severe neurological problems.5,6 We propose that community dwelling patients with neurological disorders and disability may succumb to the effects of the pandemic interventions such as social distancing and isolation - which are essential strategies to contain the spread of COVID-19.7 There is little data on the impact of COVID-19 on community neurology patients in the absence of direct infection with the virus.8,9 To our knowledge this is the first study on the impact of COVID-19 on community neurology patients in Australia who do not have COVID-19. The questionnaire was divided into four sections: (i) Section A consisted of demography and diagnostics. (ii) Section B six questions relating to life, relationships and both physical and mental health. (iii) Section C five questions regarding accessibility to goods and services. (iv) Section D allowed participants to comment on overall impact and areas of unmet needs from the pandemic (see appendix A). COVID-19 impact on daily life and family relationships had a substantial proportion of respondents scoring 4-6, representing some impact (30.1 per cent and 26.0 per cent, respectively) - whilst the other categories of partner and/or carers, employment and medical condition were reported to have some impact (score 4-6) in less than 20 per cent of respondents for all categories (16.9 per cent, 10.2 per cent and 12.4 per cent, respectively). [...]these three categories-partner and/or carers, employment and medical condition-had a larger proportion of respondents reporting no impact (43.2 per cent;63.6 per cent, and 62.4 per cent, respectively);whilst only 19.3 per cent of respondents reported no impact on daily life and 26.9 per cent on family relationships.
BackgroundCoronary artery bypass graft surgery (CABG) has been widely used for left main coronary artery disease (LMCAD). Percutaneous coronary intervention (PCI) has become an option for this condition.AimsTo summarize the current evidence that compare between CABG vs. PCI in regards to cardiac death, stroke, and myocardial infarction. MethodsWe searched randomized trials of treatment of LMCAD with PubMed, Google Scholar, and EBSCO.ResultsFive randomized studies were retrieved, which compared the efficacy between CABG vs. PCI in treatment of LMCAD.ConclusionPCI may be reasonable management of patients with LM stenosis involving distal bifurcation or with coexisting multivessel disease.
Background Health care providers often lack a comprehensive approach towards treating patients. The comprehensive care clinics course model in dental curriculum is an integrated course which mainly focuses on the comprehensive oral health care of a patient. However, students have fear, apprehension and stress as the course involves significant amount of documentation, management and coordination with the patient. Aims The aim of this study was to assess the students' feedback on several aspects of the Comprehensive Care Clinics course from two academic year cohorts. Methods The present study is a questionnaire based study which has been conducted by collecting the data from two cohorts 2018-19 and 2019-20 final year students from the Dentistry program. Results The respondents responded that the communication among the staff from various specialities in cohort 1 was excellent for 7.1 per cent, very good in 15.2 per cent, good for 14.7 per cent, fair for 6.5 per cent and poor for 1.6 per cent and in cohort 2 excellent for 6 per cent, very good for 12.5 per cent, good for 26.1 per cent, fair for 8.1 per cent and poor for 2.2 per cent. Conclusion The study concludes that the students strongly agree that there was a shortage of allocated time for the course, the students disagree about the outcome of the result. The students have responded to have ease of laboratory access for the cases and they expressed to have a good satisfaction about the overall score for the course in all respects.
BackgroundAnti-fibrinolytic medications decrease traumatic intracranial haemorrhage (ICH). Tranexamic acid (TXA) is an antifibrinolytic, which recently has shown effectiveness in management of traumatic haemorrhage.AimsTo summarize the randomized control trials (RCTs) that evaluates the efficacy of tranexamic acid administration in traumatic brain injury (TBI) patients.MethodsAn electronic literature review, including PubMed, Google Scholar, and EBSCO that examining RCTs, observational, and experimental studies which study the efficacy of TXA administration in (TBI) patients.ResultsThe current review included 7 randomized studies reported the efficacy of TXA in management of TBI. TXA limit secondary brain injury by preventing the expansion of ICH. Administration of TXA exhibited a tendency to decrease head trauma-related mortality.ConclusionTXA significantly lower the risk of ICU expansion m and prevent brain injury related deaths.
Background: The COVID-19 pandemic has had a worldwide impact. People with neurological disorders are at an increased risk of severe infection and consequent mortality. In this study we investigated the impact of COVID-19 on community neurology patients in the absence of direct infection with the virus to see if their wellbeing was affected. Aims: To determine whether and how the COVID-19 pandemic affected people with neurological disorders, in the absence of COVID-19 infection.
