The advancement of human progress hinges on the ability to identify limitations and develop innovative solutions, particularly in the field of healthcare. While modern medicine has made significant strides in treating various illnesses, it often fails to address the root causes of diseases, impeding the recovery process for many patients. To overcome this challenge, healthcare professionals require a more comprehensive and integrative approach to healthcare that combines rational and logical thinking. Rationality offers a systematic and evidence-based method for understanding and treating diseases, providing healthcare professionals with a strong foundation for developing treatment plans. However, rational thinking has limitations in terms of our observational abilities, which can lead to misdiagnosis and ineffective treatments. On the other hand, logical thinking provides a more creative and flexible approach to problem-solving, which is particularly useful in addressing complex and multifaceted health issues. This approach enables healthcare professionals to think outside the box, consider alternative solutions, and tailor treatment plans to individual needs. By combining rational and logical viewpoints, healthcare providers can enhance their comprehension of a patient's condition, resulting in more favourable treatment results. Halalopathy, which employs a merged thought process, has been introduced to tackle the challenges and limitations of modern medicine. Halalopathy is a holistic healthcare approach that integrates rational and logical thinking, providing a more comprehensive understanding of illness prevention and disease at a physicopsychological level.
We report a rapidly fatal case of 29-year-old man who presented with typical features of sepsis along with thyrotoxicosis. Presence of thrombotic lesions in his lower extremities led to the assumption that the source of infection could be endocarditis. However, transthoracic echocardiography did not confirm the preliminary diagnosis. Report of facultative anaerobic Gram-positive bacilli seen in the Gram stain of positive blood culture prompted initiation of treatment with ceftriaxone, vancomycin and metronidazole. Thyrotoxicosis was managed with propranolol, propylthiouracil, Lugol’s iodine and hydrocortisone. Diagnostic criteria for thyroid storm and infective endocarditis and therapy of Lactobacillus sepsis with a possible cause of death in the present case are discussed.
Background: Earlier, we discovered the possibility of potentiation of the therapeutic effects of small (threshold) doses of CNS agents by phenylephrine and adrenaline, while eliminating their side effects. However, the question of the possibility of potentiation by phenylephrine and other CNS potentiators of high therapeutic doses of CNS agents remained unstudied. This study is devoted to the research of this problem. Objective: The aim of the study was to investigate the effect of the threshold dose of phenylephrine on the antidepressant effect of amitriptyline and the anticonvulsant effect of diazepam, as well as their side sedation in high doses. Method: The experiments were carried out on the animated models of depression (Porsolt test) and epilepsy (clonic pentylenetetrazole (PTZ)-induced seizures), resistant to antidepressants and antiepileptics even at high therapeutic doses. Side sedative effect of substances was evaluated in the "open field" test. Results: We established that the stimulation of gastric vagal afferents with phenylephrine, when administered orally at threshold doses, potentiates the anticonvulsant effect of diazepam and the antidepressant effect of amitriptyline in high therapeutic doses to the maximum level that is impossible in their application by themselves, and at the same time eliminates their side sedation. Conclusion: A synergistic effect of phenylephrine and CNS drugs on the peripheral and central links of the vagal stress-protective reflex is discussed. It is assumed that the potentiation of therapeutic effect by phenylephrine and the elimination of side effects of the CNS agents occurs as a result of strengthening the vagal stress-protective reflex, eliminating the drug stress.
Aims:The aim of this study was to evaluate the value and accuracy of longitudinal strain in detection of coronary artery disease compared to coronary angiography. Results:The left ventricular longitudinal strain-speckle tracking showed evidence of stenosis of left anterior descending artery, circumflex artery and right coronary artery in (86.1%), (76.4%), and (84.7%) respectively.For the stenosis in left anterior descending artery, the current study showed that the longitudinal strain was a good predictor for presence of significant stenosis with a sensitivity of (93.8%), specificity (75%) and accuracy (91.7%) compared with coronary angiography.For the stenosis in right coronary artery, the left ventricular longitudinal strain had a sensitivity of (93.5%), specificity of (70.0%) and accuracy of (90.3%) compared with coronary angiography. Conclusion:Speckle-tracking echocardiography technique has a good performance and validity in detection of coronary artery stenosis with good agreement with angiography.
Meckel-Gruber syndrome, which is firstly described by Friedrich Meckel and Georg B. Gruber, is an autosomal recessive disorder that is characterized triad of occipital encephalocele, bilateral renal dysplasia and polydactyly. Because of the genetic heterogeneity, multiple organs can be affected. The worldwide incidence varies from 1 in 13,250 to 1 in 140,000 live births. We have reported a male baby born at 37-week gestation, who has occipital encephalocele, polydactyly and cystic dysplasia of both kidneys. As a result of these clinical findings, Meckel-Gruber Syndrome is suspected for his baby. This study is presented to draw attention to the Meckel Gruber Syndrome which has high risk of recurrence and early diagnosis by ultrasonographic screening can be confident.
Multi-detector CT (MDCT) has considerable advantage over single-detector helical CT in the form of the shorter acquisition time, greater coverage and superior image resolution. It can be used to systematically evaluate the cardiovascular anatomy, morphologic features of thoracic vessels such as aorta, systemic veins and pulmonary vessels and relationship between the upper lobe bronchi and pulmonary arteries, coronary artery, valves, systemic veins. In diffuse lung diseases, this technique can increase nodule detection and help differentiate between small nodules and vessels. MDCT with three-dimensional (3D) volume rendering provides a unique perspective on thoracic anatomy and disease. MDCT allows shorter acquisition times, greater coverage and superior image resolution. In vascular imaging, this technique provides image quality that equals or surpasses that of conventional angiography. Its use has expanded to aid in diagnosis and surgical planning. In this article we present a pictorial review of the current applications of MDCT in diseases of the thorax.
Background: Recent studies suggested that Hepatitis C Virus (HCV) patients may suffer from insulin resistance (IR), lipid profile abnormalities and poor virological response to the antiviral treatment. The beneficial effects of aerobic exercise have been a matter of controversy in the field of HCV management.Objective: This study aimed to measure the impact of aerobic exercise training on insulin resistance, lipid profile abnormalities and virological response in type 2 diabetic patients with chronic hepatitis C.Materials and Methods: Eighty non-hypertensive, non-cirrhotic chronic HCV infection Saudi patients with high Triglycerides (TG), Total cholesterol (TC) and Low Density Lipoprotein Cholesterol (LDL-c) & non-insulin dependent diabetic with insulin resistance. Patients were divided in to two equal groups. The first group received aerobic exercise training, three sessions per week for three months in addition to their antiviral treatment. The second group (B) received only their antiviral treatment.Results: The mean values of Homeostasis Model Assessment-Insulin Resistance-index (HOMA-IR), TC, LDL-c, TG, virologic response and Body Mass Index (BMI) were significantly decreased in group (A), where the mean value of High Density Lipoprotein Cholesterol (HDL-c) was significantly increased, while there were no significant changes in group (B) Also; there was a significant difference between both groups at the end of the study.Conclusion: Treadmill walking exercise training is an effective treatment policy to improve insulin resistance, lipid profile abnormalities and virological response in type 2 diabetic patients with chronic hepatitis C.
Background & Objective: Chronic B viral hepatitis is a major health problem worldwide. Several studies have reported that obesity is important risk factors altered immune system response in individuals with no underlying causes of liver disease. This study was to examine the correlation between body mass index, serum alanine aminotransferase activity and immunologic response in obese hepatitis B Saudi patients.Subjects and Methods: One hundred fifty Saudi male patients with hepatitis B viral infection (HBV); their age ranged from 30 to 45 (38.64 +/- 7.12) years. Patients were divided in to two equal groups according to their body mass index: Group (A): Included patients with HBV, their body mass index (BMI) was greater than 30 kg/m(2) (the obese group). Group (B): Included patients with HBV, their BMI between 20 and 24 kg/m(2) (the normal-weight group).Results: An elevation of serum alanine aminotransferase (ALT) activity was found to be associated with increased BMI, also we observed an elevation with regard to the normal weight group in the parameters of white blood cells, neutrophils, monocytes, CD3, CD4 and CD8 for group A. CD3, CD4 and CD8 correlated with BMI only as a total amount, as well as with all measured parameters of blood count.Conclusion: Obesity adversely affects the immunological response and rate of disease progression in HBeAg-negative chronic hepatitis B viral infection. Body weight control is important in the management of patients with chronic hepatitis B viral infection.
Main causes of drug-related antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis are antithyroid drugs. It is known that ANCA-positive vasculitis occurs after long term use of the drugs and develops in 4-6.5 percent of the patients. Herein, we present a female patient with propylthiouracil (PTU)-related ANCA-positive vasculitis, mimicking appendicitis and familial mediaterian fever (FMF), which developed after long-term drug usage.
Introduction:Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance (IR). Adipokines include fat-secreted proteins such as leptin or adiponectin and fat- or liver-derived cytokines such as tumor necrosis factor-α (TNF-α) and interleukin 6 (IL-6) are considered to play an important role in the pathogenesis of the metabolic syndrome, including NAFLD.Material and Methods:One hundred Saudi patients with NAFLD (45 males and 55 females) with NAFLD diagnosed by ultrasonographic findings, our group includes one gender, age and body mass index (BMI) matched hundred healthy volunteers. Adiopkines and parameters of glucose control of all participants were detected.Results:Serum glucose, insulin, aspartate aminotransferase(AST), alanine aminotransferase (ALT), aspartate aminotransferase /alanine aminotransferase ratio (AST/ALT), serum levels of total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), serum TNF-α and L-6 levels were significantly higher in patients with NAFLD when compared to control group. However, serum high density lipoprotein cholesterol (HDL-C) and adiponectin levels were significantly lower in patients with NAFLD when compared to control group. Moreover, serum levels of adipokines showed an association with insulin resistance.Conclusions:Within the limit of this study non-alcoholic fatty liver disease is associated with adipokines alteration that is correlated with abnormal glucose control and insulin resistance.Objective:The present study aimed to explore the role of adipokines in the pathogenesis of NAFLD and correlate them with glucose control.
Introduction:To evaluate the personality and temperament traits in patients with chronic hepatitis B in comparison to healthy subjects and to determine whether there is a relation between personality trait and level of anxiety or depression.Material and Methods:This was a case-control study in which 67 patients who had been under follow-up with diagnosis of chronic hepatitis B and 103 aged-matched healthy subjects were included. Study participants were asked to complete three self-report questionnaires— Temperament and Character Inventory (TCI) to define personality traits, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to evaluate presence and severity of depression and anxiety.Results:Total and sub-scale scores of five out of seven dimensions of TCI—reward dependence, persistence, self-directedness, cooperativeness, and self-transcence—were significantly higher in Group 1 than Group 2. Total BDI and BAI scores were significantly higher in Group 1 than Group 2 .Significantly more patients had a BDI score of 17 or over in Group 1 than Group 2. There was no significant correlation between total scores of TCI dimensions and total BAI or BDI scores except weak correlations between harm avoidance or self-directedness and total BAI or BDI scores.Conclusions:In terms of personality trait, patients with chronic hepatitis B exhibit higher reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence from healthy population. The personality traits of patients should be considered during the management of hepatitis B in order to optimize treatment outcome and to prevent development of new mental health problems during the course of the disease.
Cyanide is one of the oldest poisons. It has recently been introduced into industrial use in the gold enrichment process in gold mines. A 36-year-old man engaged in silver polishing business was brought to our emergency department by his colleagues with impaired consciousness and foamy saliva expectoration after accidentally drinking a sip of water mixed cyanide used for silver polishing. His general status was poor, and he was unconscious upon admission. The patient was administered the antidote three hours after his admission and extubated 11 hours after admission. His vital signs gradually returned to normal. On follow-up his urine color turned red; therefore, a second consultation was made with the poison information center, which recommended administering a second dose of antidote. After doing so, the patient gradually recovered, and he was discharged with normal liver enzymes, normal consciousness, and good overall status on 4th day of admission.
Obesity is a major risk factor for renal disease and can cause de novo glomerulopathy. The characteristic finding of obesity-induced renal injury includes glomerular hypertrophy, glomerular basement membrane thickening, mesangial matrix expansion, and increased renal inflammation. These changes may lead to albuminuria, a progressive impairment of renal function, glomerulosclerosis and tubulointerstitial fibrosis. The mechanisms of obesity-related glomerulopathy (ORG) are not well understood however, several mechanisms acting singly or in combination have been suggested as excess excretory load, excess renal sodium retention and insulin resistance (IR) and hyperinsulinemia, increased monocyte chemoattractant protein 1 (MCP-1) expression, Lipotoxicity in proximal tubular cells, increased inflammatory cytokine production such as Interleukin (IL) IL-6, IL-1, and tumor necrosis factor (TNF-alpha). Activation of NF kappa B transcription, increase Leptin levels, reduction in plasma adiponectin expression with its anti- inflammatory effects, decrease nitric oxide (NO) level, increase reactive oxygen species (ROS) generation, Hyperlipidemia, and increases in plasma renin activity, angiotensinogen, angiotensin-converting enzyme activity, and circulating AngII. Many lines of treatment are suggested for ORG as Peroxisome proliferator-activated receptors (PPAR) Agonistic, Statins, anti- inflammatory therapy, and antioxidants are under trial. Weight loss decreases of proinflammatory factors, increase of anti- inflammatory molecules and reduces oxidative stress state in obesity, which may protect renal function. This review discusses recent data about ORG, the characteristics of pathogens and possible interventions to prevent kidney injury in obesity.
Chorioangioma is the most common tumor of the placenta. Since these tumors generally have small sizes, they cannot be detected during the routine ultrasonography (USG) examination and might not present any symptom. When they become larger in size, they can cause various maternal and fetal complications. We presented a patient whose obstetric USG examination revealed a placental mass compatible with chorioangioma and who had preterm delivery at the 34th gestational week. The size of the mass increased rapidly in last four weeks. The pathological examination indicated that the placental mass was 9x8 cm in size and compatible with angiomatous type chorioangioma.
Background: The risk of endothelial dysfunction and insulin resistance is higher in type 2 diabetes mellitus (T2DM) which could be modulated with exercise training. However, to our knowledge, there is no clinical studies have addressed which exercise specific type is superior in modulating biomarkers of endothelial dysfunction and insulin resistance for T2DM.Objective: This study aimed to determine the differences in response of biomarkers of endothelial dysfunction and insulin resistance to aerobic versus resistance exercises in type 2 diabetic patients.Materials and Methods: Eighty obese type 2 diabetic patients participated in this study and were included into two groups, group (A) received aerobic exercises; where group (B) received resistance exercises for 12 months.Results: The mean values of Inter-Cellular Adhesion Molecule (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1), tissue plasminogen activator (tPA), E-selectin, glycosylated hemoglobin (HBA1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) were significantly decreased in both groups at the end of the study. However, the mean values of ICAM-1, VCAM-1 and t-PA antigen were more significantly reduced in group (A), while the mean values of HBA1c and HOMA-IR were more significantly reduced in group (B) and there were significant differences between both groups at the end of the study.Conclusion: Resistance exercise appears to be more beneficial than aerobic exercise for improving insulin resistance in T2DM. Also, aerobic exercise appears to be more beneficial than resistance exercise for improving endothelial function in T2DM.
Rosai Dorfman disease is a rare disorder of histiocytes, which present as massive cervical lymphadenopathy. Here we describe a case of extranodal Rosai Dorfman disease involving the spinal cord. The patient presented with subacute progressive spastic paraparesis and numbness of both lower limbs. MRI of the spine showed an extradural mass extending from C3 to L1 level causing compressive myelopathy. Biopsy of the lesion was done through a D1 D2 laminectomy and the histopathology was consistent with Rosai Dorfman disease. We treated our case with one month steroids which resulted in clinical improvement and radiological resolution of the lesion.
Cardiac myxomas are mostly arising from interatrial septum, particularly from fossa ovalis, back and front atrial wall and appendix. However, 10% of myxomas arise from atypical locations. This report presents a rare case of atypical location of extracardiac myxoma in a case of sudden death.A 43-year old female suddenly dies at home. At autopsy, three masses attached each other were observed in pericardial fat tissue localized between right atrium, vena cava superior wall, and right ventricle. Three masses, as a lobulated single mass, were 7x2x1 cm, 5x5x2 cm, 3x2x0.5 cm in size, respectively. Masses were observed to surround right coronary artery for a segment of 7 cm. Cardiac dissection revealed that mass infiltrates epicardial site of right atrium and ventricle wall but not infiltrated to myocardium and heart cavities. Histopathological and immunohistochemical findings were compatible with a rarely seen atypically localized extracardiac myxoma on right atrial epicardium.
Objective: To evaluate and compare the efficiencies of cytologic test methods conventional Pap smear (CVS) versus Thin Prep liquid-based cytology technique (TPT) in the histologic diagnosis of the precancerous lesions of the cervix and cervical cancer.Materials and Methods: We selected randomly 1203 non-gravid women who were admitted to gynecology and menopause out-patient clinics of our hospital in the study. The cervical smear tests of all women were evaluated both using the conventional Pap smear and the TPT. Cytological examinations were compared according to their adequacy for evaluation. The evaluation of samples were performed and compared according to The Bethesda System.Results: The two screening methods were statistically compatible for evaluating the samples (kappa=0,379 and p<0,001). The diagnosis interpreted by CPS and TPT methods were synchronous and this was also statistically significant (kappa=0,829 ve p<0,001).Conclusion: Our cytohistologic diagnoses and samples' adequacy interpreted with CVS and TPT were statistically significantly synchronous.
Objective: The objective of the study is to compare the socio-demographical characteristics of patients with psychotic disorders that engage or dont engage in violent behavior against individuals, and to conduct a research on the degree of affinity of the victims of violence with the patient and on factors that could affect violence.Methods: All patients (151 patients) that were treated during the last year, diagnosed with psychotic disorder. The patients were compared in two groups; these who engaged in violent acts and these who did not. Furthermore, patients in the violent group were separated into two groups; one consisting of the patients who engaged in violent behavior against immediate family members, hence the immediate violence group, and the patients who didn't engage in violence against immediate family members, hence the distant violence group.Results: It was determined that 56% of the patients with psychotic disorder have attempted violence, out of which 75% were engaged in violent behavior against their immediate relatives. It was determined that patients who attempted violence were primarily those diagnosed with paranoid schizophrenia and chronic schizophrenia. It was observed that patients that did not receive regular psychiatric therapy attempted in violence more than others.Conclusion: Patients with active psychotic symptoms should be treated in early stages and precautions should be taken against to decrease attempts at violence.
