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Expert Opinion: Brivaracetam in Management of Epilepsy
A. V. Srinivasan,
Kumar Gaurav,
Arundhati Ghosh,
Sukhpreet Singh
Issue:
Volume 7, Issue 6, December 2021
Pages:
86-93
Received:
24 August 2021
Accepted:
16 September 2021
Published:
19 November 2021
Abstract: Epilepsy is prevalent with about 50 million patients affected worldwide. There are many treatment gaps in the management of epilepsy in India. Within Anti-epileptic drugs (AED), Brivaracetam, which is a high-affinity, selective, and reversible ligand for synaptic vesicle 2A is approved by the Food and Drug Administration for monotherapy as well as adjunctive treatment of focal seizures. A series of meeting occurring during April 2020 inviting neurologist across India as panel members, reviewed the efficacy and safety of brivaracetam and discussed the use of brivaracetam in clinical settings and the drivers and barriers for the use of brivaracetam in the management of epilepsy. Brivaracetam has good efficacy and tolerability as adjunctive therapy in the treatment of focal (partial onset) seizures in patients 16 years of age and older. Brivaracetam is safe for prolonged use in patients with epilepsy and in children with epilepsy. The most common adverse events with brivaracetam are related to central nervous system and include fatigue, dizziness, and somnolence; these may improve or resolve during treatment. A consensus was sought for the use of brivaracetam in epilepsy management in routine neurology practices Brivaracetam is a safer AED with lesser behavioral AEs, lack of cognitive impairment, and no clinically relevant drug-drug interactions or dose adjustment for renal patients.
Abstract: Epilepsy is prevalent with about 50 million patients affected worldwide. There are many treatment gaps in the management of epilepsy in India. Within Anti-epileptic drugs (AED), Brivaracetam, which is a high-affinity, selective, and reversible ligand for synaptic vesicle 2A is approved by the Food and Drug Administration for monotherapy as well as ...
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Quality of Life in Patients with Clinically Localized Prostate Cancer Managed with Modern Radiotherapy: Impact on Bowel Habit, Sexual Function and Urinary Symptoms
Isis Vargas,
Andrea Araujo,
Juan Guillermo Cataño,
Ricardo Sánchez,
Juan Carlos Galvis,
Valeria Restrepo-Parra
Issue:
Volume 7, Issue 6, December 2021
Pages:
94-98
Received:
17 August 2021
Accepted:
27 August 2021
Published:
23 November 2021
Abstract: Objective: The increase in the diagnosis of tumors in early stages, associated with similar life expectations among the different treatments, create a challenge for both patients and treating doctors when choosing the best therapeutic option. The objective is to assess the impact on the quality of life in the sexual, intestinal and urinary fields in patients with localized prostate cancer who received treatment with modern radiotherapy. Methods: Descriptive observational study in which the validated EPIC-26 and SF-36 surveys were applied in the period between December 2015 and November 2018, in order to assess quality of life in men with localized prostate cancer before and after modern radiation therapy. Results: Surveys were applied to 70 individuals. In the EPIC-26 survey, relevant changes in the quality of life for urinary incontinence were found, with a previous average score of 81.75 (100 - 12.5) versus a subsequent 72.99 (100 - 0). In the SF-36 Health Questionnaire it was found that there is no significant difference in the overall quality of life, with an average score of 77 (99 - 31) and 76.63 (100 - 39.58) respectively. Conclusion: There is a tendency to oversize the impact of radiotherapy on the quality of life when there is a curative intent in patients with localized prostate cancer. Our study only demonstrated a clinically relevant difference in urinary incontinence, which allows us to suggest that most of the alterations in the quality of life could be secondary to natural changes in aging.
Abstract: Objective: The increase in the diagnosis of tumors in early stages, associated with similar life expectations among the different treatments, create a challenge for both patients and treating doctors when choosing the best therapeutic option. The objective is to assess the impact on the quality of life in the sexual, intestinal and urinary fields i...
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The Nature of Changes in the Hemostatic System in Liver Cirrhosis
Tugushev Aliy Saitovich,
Cherkovska Olga Stepanivna
Issue:
Volume 7, Issue 6, December 2021
Pages:
99-110
Received:
31 August 2021
Accepted:
8 October 2021
Published:
23 November 2021
Abstract: The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very complex, since defects simultaneously occur both in the procoagulant system and in the anticoagulation system. Aim to study the factors and mechanism of the development of hemostasis imbalance in patients with liver cirrhosis based on the analysis of scientific literature, to determine the information content of existing laboratory tests for the study of hemostasis and the features of correction of hemostasis disorders depending on hyper- or hypocoagulation. It is generally accepted that cirrhosis results in a state of hypocoagulation with an increased tendency to bleeding. However, a number of publications do not support this opinion, and the interpretation of laboratory parameters is explained by the standard methodology, where the procoagulant and antifibrinolytic systems of hemostasis are insufficiently studied. Many researchers have established a state of hypercoagulability in liver cirrhosis, leading to intra- and extrahepatic thrombosis. The cause of bleeding, primarily from varicose veins of the esophagus and stomach, is not hypocoagulation as such, but rupture of varices due to hemodynamic disturbances with increased portal pressure, one of which is thrombosis. Accordingly, therapeutic tactics should be aimed, first of all, not at normalizing laboratory tests, but at eliminating the pathogenetic mechanisms of hemostatic imbalance that occur in liver cirrhosis. At the same time, drug correction should be directed not at individual links of the hemostasis system - pro or anticoagulant, but at the correction of hemostatic imbalance as a whole. Conclusions. To date questions about the nature of changes in the hemostasis system in liver cirrhosis, their relationship with hemorrhagic complications or thrombosis, the principles of drug correction remain open, requiring further research in this direction.
Abstract: The nature of violations of the hemostatic system in liver cirrhosis is complex, often unpredictable and concerns all its links – vascular-platelet, coagulation and fibrinolysis. It is now well established that patients with cirrhosis may experience both bleeding and thrombosis. The mechanisms of blood clotting disorders in this case are very compl...
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Orthopaedic Surgical Task-Shifting and Its Impact on Time-to-Surgery in Western Uganda
Michael Flores,
Daniel Kisitu,
Connor Peck,
Michael Amick,
Kristin Yu,
Adrienne Socci
Issue:
Volume 7, Issue 6, December 2021
Pages:
111-117
Received:
8 September 2021
Accepted:
14 October 2021
Published:
24 November 2021
Abstract: Background: High rates of orthopaedic injury in Uganda place large burdens on its few orthopaedic surgeons. Although “task-shifting” of procedures to other providers is practiced, its specific role in orthopaedic surgical care is not well documented. The current study assessed the prevalence of orthopaedic task-shifting, and its impact on time-to-surgery, at the Mbarara Regional Referral Hospital (MRRH) in Western Uganda. Methods: A retrospective cohort study was conducted. All orthopaedic cases recorded in the MRRH operating theatre logbook were analyzed (October 2018 to July 2019). Surgical indication, type of procedure, and operator were recorded. Permanent hospital records, when available, were used to verify logbook data and identify the initial date of hospital admission for each patient. Results: There were 203 patients who received orthopaedic surgery during the study period, with 159 having hospital admission dates. The single orthopaedist at MRRH performed the majority of orthopaedic procedures (61.6% of cases). Significant task-shifting was seen, both to other physicians (33% of cases) and orthopedic clinical officers (5.4%). The orthopaedist performed most hardware implantation procedures (80.8%), while other practitioners performed the majority of trauma cases, particularly conservative fracture management (92.7%). Overall, the average time from admission to surgery was longer for orthopaedists (11.2 days) than for other providers (4.2 days, p<0.001). Conclusions: The current study demonstrates high utilization of orthopaedic task-shifting, and its associated decreased time-to-surgery, at MRRH. This reinforces the role of task-shifting in resource-limited settings. Furthermore, it highlights the importance of continued training of non-orthopaedic providers in foundational orthopaedic surgical principles.
Abstract: Background: High rates of orthopaedic injury in Uganda place large burdens on its few orthopaedic surgeons. Although “task-shifting” of procedures to other providers is practiced, its specific role in orthopaedic surgical care is not well documented. The current study assessed the prevalence of orthopaedic task-shifting, and its impact on time-to-s...
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Prevalence of Virulence Genes and Associated Risk Factors of Helicobacter pylori Infection Among Adults in Gastric Cancer Risk Region of North Central, Nigeria
Azebi Ayibatari,
Raphael Peter Galleh,
Anowai Clementina Ogo,
Abbas Abel Anzaku,
Adamu Ishaku Akyala
Issue:
Volume 7, Issue 6, December 2021
Pages:
118-125
Received:
15 October 2021
Accepted:
3 November 2021
Published:
24 November 2021
Abstract: Introduction: Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and peptic ulcer diseases with associated risk factor of developing gastric cancer and mucosal-associated lymphoid tissue (MALT) lymphoma if left untreated. In this study, we evaluated the prevalence of virulence genes and associated risk factors of H. pylori among adults in a gastric cancer risk region of Nasarawa State, North central Nigeria. Methods: This was a descriptive cross-sectional study to determine H. Pylori status of 434 adults in gastric cancer high risk region of Nasarawa State from January to August, 2021. Associated risk factors and virulence genes (positive/β-(1, 3) galT of jhp0562, cagA, vacA, and hrgA) was evaluated from gastric biopsy specimens of dyspepsia patients. Results: The overall prevalence of H. pylori infection was 45.6% (198/434). The rate of infection was higher in male subjects (40.6%) than in female (23.8%); P<0.001) and higher significantly among adults with the following associated risk factors: unboil water, consumption of alcohol, low income, and Urban residency. Un-boiled water consumption and alcohol consumption were independent risk factors for H. pylori infection (odds ratio=7.48 vs OR=9.78 respectively). Of the 198 strains cultured, 76.9% carried Western-type cagA, with a higher proportion in Male (86.4%) than in Female (50.0%), P=0.05). Patients infected with East Asian-type cagA strains (P=0.027) have lesser inflammation scores in the antrum than those infected with the Western-type cagA strains. Conclusion: Our study revealed a high prevalence of H. pylori infection in Nasarawa State, with unclean water source, and alcohol consumption as significant risk factors for H. pylori infection. The incidence of gastric cancer in Nasarawa State is associated with circulating virulence genes of cagA, vacA, hrgA and jhp0562-positive/β-(1, 3) galT.
Abstract: Introduction: Helicobacter pylori (H. pylori) is the causative agent of chronic gastritis and peptic ulcer diseases with associated risk factor of developing gastric cancer and mucosal-associated lymphoid tissue (MALT) lymphoma if left untreated. In this study, we evaluated the prevalence of virulence genes and associated risk factors of H. pylori ...
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Hemophagocytic Syndrome Secondary to Cytomegalovirus Infection in a Patient with Human Immunodeficiency Virus
Elizabeth Castro,
María Cepeda,
Diego Ospina
Issue:
Volume 7, Issue 6, December 2021
Pages:
126-131
Received:
1 September 2021
Accepted:
22 November 2021
Published:
27 November 2021
Abstract: Hemophagocytic Syndrome (HPS) or Hemophagocytic Lymphohistiocytosis is characterized by a dysregulation of the immune system with activation of macrophages and T lymphocytes, the product of an uncontrollable and excessive inflammatory response to different stimuli. The case of a patient with a history of Human Immunodeficiency Virus (HIV) under current treatment is presented, a clinical picture of 10 days of evolution characterized by fever, anorexia and asthenia, on physical examination skin-mucosa paleness, dehydration, generalized lymphadenopathy, hepatosplenomegaly. Paraclinical tests are performed suggesting reactivation of infection by Cytomegalovirus (CMV), in addition, during its in-hospital evolution, marked pancytopenia is evidenced, with elevated ferritin values, a bone marrow biopsy is performed, observing proliferation of Histiocytes, the patient meets the diagnostic criteria for HPS proposed by the Histiocyte Society in 2004, treatment was instituted, however it presented a torpid evolution and reached death. It is concluded that the diagnosis of HPS is complex; it is usually overlapped by the underlying diseases, as is the case of this HIV patient with reactivation of CMV infection; both viruses by themselves are related to HPS; therefore, knowledge of the clinical and laboratory criteria of this entity is necessary to make an early diagnosis and establish timely treatment, thus reducing mortality.
Abstract: Hemophagocytic Syndrome (HPS) or Hemophagocytic Lymphohistiocytosis is characterized by a dysregulation of the immune system with activation of macrophages and T lymphocytes, the product of an uncontrollable and excessive inflammatory response to different stimuli. The case of a patient with a history of Human Immunodeficiency Virus (HIV) under cur...
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Research on Quality Evaluation Method of New Medical Achievements
Peng Ruan,
Manoch Prompanyo
Issue:
Volume 7, Issue 6, December 2021
Pages:
132-137
Received:
12 April 2021
Accepted:
10 May 2021
Published:
27 November 2021
Abstract: Objective: in order to explore the general quality evaluation model of new medical achievements. New drugs are the most common and main form of medical achievements. Mastering the quality evaluation indicator and quality evaluation model of new drugs will also have important reference value for other medical achievements. Methods: the quality characteristics of new drugs were analyzed by Delphi method or expert consultation method, and the quality evaluation indicator system was obtained. Then the weight coefficient of the indicator was calculated by analytic hierarchy process, and the mathematical model for quantitative analysis was obtained. And develop the technology to identify the quality of many medical achievements by using the percentage exchange algorithm and Bradford's law. Results: using the expert consultation method can get a high reliability of the quality evaluation indicator system, can implement a comprehensive quality evaluation of new medical achievements, and obtain a new quality evaluation model. Conclusion: the new quality evaluation model can fully display the level of medical achievements, and can also be used for the quality acceptance of new products and fair competition between similar products. Fair evaluation makes the evaluation results easily accepted by customers.
Abstract: Objective: in order to explore the general quality evaluation model of new medical achievements. New drugs are the most common and main form of medical achievements. Mastering the quality evaluation indicator and quality evaluation model of new drugs will also have important reference value for other medical achievements. Methods: the quality chara...
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Relationship of Pre-pregnancy BMI, Gestational Anaemia and Weight Gain During Pregnancy with Birth Outcomes of Selected Indian Women
Mythili V.,
Anusuya Devi K.,
Latha Maheswari S.
Issue:
Volume 7, Issue 6, December 2021
Pages:
138-145
Received:
29 July 2021
Accepted:
9 August 2021
Published:
29 November 2021
Abstract: Maternal weight before and throughout pregnancy is clearly tied to maternal and neonatal health outcomes, and excessive gestational weight gain (GWG) is linked to a diversity of short and long term maternal and child complications. The focus of this research is to determine the relationship between pre-pregnancy BMI and gestational weight gain in mothers and birth outcomes, as well as to investigate socio-demographic factors that influence pre-pregnancy BMIs and GWG, as well as the consequences of pre-pregnancy BMI and GWG on maternal and infant complications in Coimbatore. It’s a Prospective observational study using random sampling technique to select the 421 pregnant women between the ages of 18 and 35 visiting clinics and super speciality hospitals for pregnancy confirmation tests during August to April, 2021. Regression analysis was employed to evaluate the socio-demographic factors affecting pre-pregnancy BMI and GWG values and their effects on adverse maternal and infant complications. Multivariate logistic regression analysis revealed that age groups 26-30 years (OR: 0.652) and living in rural area (OR: 2.375) were risk factors in maintaining a normal pre-pregnancy BMI. An age range of 26-30 years (OR: 0.478), living in rural area (OR: 2.512) with nuclear family (OR: 0.599) were factors affecting GWG. Overweight pregnant women were lower to suffer anemia (OR: 1.935) and GDM (OR: 1.162) and higher to deliver low birth weight (OR: 1.996) compared to normal weight pregnant women and both inadequate and excessive GWG were not at the risk for low birth weights. Overweight before pregnancy is linked to a higher chance of having low-birth-weight babies, according to the study. Body weight control before and during pregnancy is indicated to reduce unfavorable pregnancy outcomes, particularly in pregnant women aged 21 to 30 years old and those women who reside in rural areas with nuclear families.
Abstract: Maternal weight before and throughout pregnancy is clearly tied to maternal and neonatal health outcomes, and excessive gestational weight gain (GWG) is linked to a diversity of short and long term maternal and child complications. The focus of this research is to determine the relationship between pre-pregnancy BMI and gestational weight gain in m...
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Coping Strategies for Patients with Multiple Sclerosis, and Their Relation with the Personality Profile
Rodrigo Noronha da Fonseca,
Charles Peter Tilbery,
Wilze Laura Bruscato
Issue:
Volume 7, Issue 6, December 2021
Pages:
146-154
Received:
21 October 2021
Accepted:
8 November 2021
Published:
7 December 2021
Abstract: The present work was the result of a research project to obtain the title of Master in Health Sciences at the Faculty of Medical Sciences of Santa Casa de São Paulo. Objective: To identify the coping strategies used by patients with SPMS, and their relation with the personality profile. Methods: This is a cross-sectional, descriptive, observational study with a quantitative approach. The sample consisted of 23 patients undergoing treatment at CATEM, ISCMSP. A Sociodemographic Form, the Factorial Personality Inventory II, and the Ways of Coping with Problems Scale were used. To analyze the results, we used descriptive and inferential analyses, and explored sociodemographic variables, personality characteristics, and coping resources with the use of statistical tests suitable for the study. Results: The results showed the predominance of females, aged 51 years, with an EDSS equal to 7.0 and in need of some type of support. Fantasy was the main coping resource used, with its components spirituality, religious beliefs, and faith. Aggressiveness was the main personality trait: it was not found to be an aspect related to activities having a hostile character, but rather to active tendencies towards the outside world and self-assertion; it might even be deemed constructive if we consider aggressiveness as a combative aspect, strictly related to survival. This inclination was confirmed as we went on to identify other relevant personality traits that are indicative of individuals who seek affection and external support, but also crave some degree of independence, autonomy, self-sufficiency, freedom, and dominance over their lives so that they can accomplish something with tenacity and perseverance as a way of personal satisfaction and overcoming limits. Conclusion: These findings make it evident that patients with SPMS can bring specific demands and needs in terms of a multidisciplinary therapeutic treatment.
Abstract: The present work was the result of a research project to obtain the title of Master in Health Sciences at the Faculty of Medical Sciences of Santa Casa de São Paulo. Objective: To identify the coping strategies used by patients with SPMS, and their relation with the personality profile. Methods: This is a cross-sectional, descriptive, observational...
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HELLP Syndrome with Unusual Features in a Rare Setting
Collins Amadi,
Bright Amadi
Issue:
Volume 7, Issue 6, December 2021
Pages:
155-160
Received:
23 November 2021
Accepted:
10 December 2021
Published:
24 December 2021
Abstract: HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is mostly reported among multiparous Caucasians in association with severe preeclampsia, hypertension, and proteinuria. It is rarely reported within Nigeria and the post-partum variant has never been documented among women of Nigerian origin in the literature to date. Herein, we report a very unusual case of HELLP syndrome in a very rare setting that developed eleven days post-partum without the usual features of hypertension and proteinuria in a 26-year-old G1P1. Upon presentation, she was promptly diagnosed and aggressively managed using standard protocols by a multidisciplinary medical team of specialists. She developed acute kidney injury (KDIGO stage 1) in the course of management of which she required conservative management. Remarkably, with supportive care, all the clinical and laboratory derangements, including hepatic and renal functions, normalized after seven days on admission. Her condition remained stable during weekly follow-up visits for four consecutive weeks. This case and its management protocols reinforce the need for a high index of clinical suspicion for this dreaded disorder and its prompt diagnosis/aggressive management even in very rare circumstances and settings.
Abstract: HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet) syndrome is a rare disorder exclusively associated with pregnancy. It occurs mostly during the antepartum period in about 70% of cases but could also occur during the post-partum period in about 30% of reported cases especially during the first 48 hours following delivery. The syndrome is ...
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