International Journal of Medical Science and Clinical Research Studies

Demographic Characteristics Associated with Bilateral Renal Lithiasis

Daniel García Flores — 2024-12-17

Bilateral renal lithiasis, characterized by the presence of kidney stones in both kidneys, poses significant clinical challenges. This condition is associated with a higher risk of chronic kidney disease (CKD), kidney tubular injury, metabolic disorders, and diminished health-related quality of life (HRQoL). Patients with bilateral stones experience more frequent stone events, a younger age of onset, and a higher prevalence of metabolic abnormalities such as elevated blood pressure and serum glucose. Demographic factors, including socioeconomic status, race, age, and gender, further influence the impact of this condition, with nonwhite ethnicities and lower-income groups reporting worse HRQoL. Untreated bilateral renal lithiasis significantly increases the risk of CKD progression, while advanced surgical approaches like bilateral synchronous percutaneous nephrolithotomy offer effective and safe management options. Addressing this condition requires a multifaceted approach that considers both medical interventions and social determinants of health.

The Impact of Gut Microbiota on Liver Diseases: Insights into Pathophysiology, Diagnosis, and Emerging Therapeutic Approaches

Yafte Soto Cervantes — 2024-12-17

The gut microbiota plays a pivotal role in maintaining metabolic homeostasis and immune regulation, with its dysregulation increasingly recognized as a critical factor in the pathogenesis of liver diseases. This review explores the intricate interplay between gut microbial composition and liver health, focusing on the gut-liver axis as a key mediator. The disruption of gut barrier integrity and subsequent translocation of microbial products, such as lipopolysaccharides and short-chain fatty acids, contribute to the progression of liver disorders, including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), and cirrhosis. The review also examines the implications of microbial dysbiosis in liver inflammation, fibrosis, and hepatocarcinogenesis, highlighting the diagnostic potential of microbiota profiling and biomarkers. Finally, emerging therapeutic strategies, such as probiotics, prebiotics, fecal microbiota transplantation, and precision microbiome editing, are discussed as promising avenues for intervention. Understanding the bidirectional relationship between the gut microbiota and the liver offers novel insights into disease mechanisms and opens the door for innovative therapeutic approaches in hepatology.

Gastrointestinal Stromal Tumor of the Cecum Manifested as a Clinical Picture of Acute Appendicitis: Case Report

Samantha Quintal Campos — 2024-12-02

Gastrointestinal stromal tumors are derived from the intersticial cells of cajal, most of them manifest with non- specific symptoms. A 62 old year male patient complained of right lower abdominal tenderness, surgical procedure revealed a tumor in the cecum. Complete resection was performed. Histology showed a GIST of the cecum. Accordingly , rare tumors of the cecum including GIST should be considered in the differential diagnosis of appendicitis.

Risk factors and Complications associated with Tuberculosis: Case series

Dr. Preeti Chhabria — 2024-12-02

Background: Tuberculosis (TB) remains a significant public health concern globally, with a disproportionate burden on females, particularly in India. This case series analysis explores the challenges and complications faced by 3 deceased females with TB, underscoring the need for tailored interventions.

Methods: We present three cases of Indian females diagnosed with TB at an advanced stage. All patients shared common attributes, including low body mass index (BMI), advanced disease, immunocompromised status, and delayed diagnosis. Clinical data, laboratory findings, and treatment outcomes were analyzed.

Results: Patients were diagnosed with Mycobacterium tuberculosis, but they exhibited poor prognostic factors such as hypoalbuminemia and anemia. Delayed diagnosis and initiation of appropriate treatment, coupled with the presence of comorbidities, and paucity of finances contributed to the disease severity and complications leading to death.

Conclusion: Indian females with TB encounter multifaceted challenges, delayed diagnosis and treatment initiation, coupled with the presence of comorbidities complicates the clinical course and severity. Early case detection, prompt initiation of appropriate treatment and managing health by targeting interventions that tackle socioeconomic determinants and gender-specific barriers, and prioritization of personal health over family needs will lead to improved treatment outcomes and a reduced overall disease burden.

Association between Neutrophil-Lymphocyte Ratio and Failure of Conservative Medical Treatment in Patients with Intestinal Obstruction Due to Abdominal Cancer

Márquez Lara, Massiel — 2024-12-03

Background: Intestinal obstruction due to abdominal cancer is a common clinical problem, with an overall incidence ranging from 3% to 15%, with colorectal cancer and ovarian cancer being the most frequent. The diagnosis of this condition primarily relies on the patient’s established history of abdominal oncological disease, as well as radiological and laboratory tests, which are key factors in decision-making regarding the choice between conservative or radical treatment. The importance of these decisions has led to the need for the development of new evaluation strategies to guide treatment in this group of patients.

Objective: To determine the association between the neutrophil-lymphocyte ratio and the failure of conservative medical treatment in patients with intestinal obstruction due to abdominal cancer.

Materials and Methods: An associative study was conducted at the General Hospital of Zone No. 3 of the Instituto Mexicano del Seguro Social, Aguascalientes, México, from January 2017 to January 2024. The study included patients aged 18 to 100 years with a diagnosis of abdominal cancer and intestinal obstruction. After approval from the Local Health Research Committee and the Ethics Committee in Health Research, a review of the census from the General Surgery department was conducted to identify patients who met the inclusion criteria. The variables collected for the study were: sex, age, diagnosis of intestinal obstruction, type of abdominal cancer, time of onset of intestinal obstruction symptoms, and neutrophil-lymphocyte ratio. The neutrophil-lymphocyte ratio was calculated from the sample and correlated with the clinical outcome in relation to the success or failure of the medical treatment. The data was entered into an Excel spreadsheet and analyzed using the IBM SPSS statistical software.

Results: Of the 14 patients with intestinal obstruction and abdominal cancer, 8 were treated surgically and 6 conservatively. It was observed that a neutrophil-lymphocyte ratio ≥ 4 was associated with a higher likelihood of requiring surgical resolution.

Conclusion: An elevated neutrophil-lymphocyte ratio (≥4) was found to be associated with a greater likelihood of requiring surgical treatment, while patients with a neutrophil-lymphocyte ratio ≤ 3.9 tended to be treated conservatively. These results suggest that the neutrophil-lymphocyte ratio could be a useful marker to guide therapeutic decisions, although further studies are needed to strengthen its predictive value.

Kallmann Syndrome: A Comprehensive Review of Pathophysiology, Clinical Manifestations, and Therapeutic Approaches

Jesus Miguel Valencia Correa — 2024-12-03

Kallmann Syndrome (KS) is a rare genetic disorder characterized by hypogonadotropic hypogonadism (HH) and anosmia or hyposmia due to a defect in the migration of gonadotropin-releasing hormone (GnRH) neurons and olfactory nerve fibers during embryonic development. This syndrome, first described in the 20th century, encompasses a complex interplay of genetic mutations affecting neuronal migration and neuroendocrine regulation. The condition presents a broad spectrum of clinical manifestations, from delayed or absent puberty to infertility, and is frequently associated with additional non-reproductive anomalies, such as sensorineural hearing loss, renal agenesis, or cleft palate. The genetic heterogeneity of KS involves several implicated genes, including KAL1, FGFR1, PROKR2, and CHD7, among others. Diagnostic evaluation typically requires a multidisciplinary approach, integrating genetic testing, hormonal assessments, and neuroimaging to confirm the diagnosis and evaluate associated anomalies. Therapeutic strategies primarily focus on hormonal replacement therapy to induce and maintain secondary sexual characteristics and fertility treatment options for individuals seeking reproductive outcomes. Emerging treatments and the potential use of gene therapy are under investigation, offering new hope for targeted interventions. This review aims to provide a comprehensive overview of Kallmann Syndrome, highlighting its pathophysiology, clinical spectrum, diagnostic challenges, and evolving therapeutic landscape.

Modified McLaughlin Procedure on Locked Posterior Shoulder Dislocation: A Case Report

Kenny Yulian — 2024-12-03

Posterior shoulder dislocation is a rare and often misdiagnosed case, and returning the stability of the shoulder and preventing recurrent dislocations are key in improving patient’s quality of life. A 67-year-old male presented with pain, stiffness, and deformity in his right shoulder for the past month. Shoulder and upper arm were in adduction and internal rotation, and abnormal mass of the humeral head was palpated on the posterior shoulder. Shoulder range of motion was severely limited. Modified McLaughlin procedure was performed, followed by immobilization for 2 weeks after surgery. The patient’s mid-term outcome following the modified McLaughlin procedure showed normal shoulder function, with no pain or limitations. This result is likely due to the more stable bony fixation achieved through bone-to-bone union provided by the modified McLaughlin procedure. There were no signs of nerve injury, and no avascular necrosis was observed on the shoulder radiograph.

Complications of Purse-String Closure Technique Vs Linear Closure in Patients with Stoma

Esperanza Guadalupe Carlock Gallegos — 2024-12-03

Background: A variety of surgical techniques have been proposed for abdominal wall closure in patients with stoma with the aim of reducing the incidence of surgical site infection. However, the ideal skin closure technique has not yet been determined. Surgical site infection was one of the most common postoperative morbidities of ileostomy and colostomy reversal and although several skin closure procedures have been developed to reduce the rate of surgical site infection and its associated comorbidities, the incidence rates nationally and internationally range between 2% and 41% and it has been reported that it can increase costs, prolong hospitalization time and affect the patient's quality of life.

Objetive: To compare the tabaco closure technique vs. linear closure in patients with stoma at the Regional General Hospital 01.

Materials and methods: Observational, analytical, retrospective study, information was collected from both outpatient and hospital records of patients with a stoma during the period 2022-2024, the evolution after stoma closure, its main post-surgical complications, type of wall closure technique, comorbidities, days of hospitalization and days of antimicrobial therapy. The data obtained were analyzed together with a methodological advisor in a specially created database and for statistical analysis, SPSS was used to create result graphs, as well as descriptive statistics.

Results: According to the inclusion criteria the total sample was 25 participants, the average age was 50.9 years predominating in the age range 51-66 years, according to sex with a higher frequency male 15 (60%), Regarding the type of stoma in greater presentation was the colostomy 13 (52%) and according to the technique used for stoma closure we found tobacco pouch 13 (52%) and linear 12 (48%) it was identified regarding the tobacco pouch technique did not have any complications in 11 (44%), in 2 (8%) presented dehiscence and regarding the linear technique 5 (20%) presented incisional hernia, followed by dehiscence 3 (12%), infection 2 (8%) and 2 (8%) presented no complications. According to statistical analysis SPSS Pearson Chi-Square was reported a value of 13.412 with significance p = 0. 004 for the association of the tobacco pouch technique and linear technique with complications..

Conclusion: The tabaco purse technique had fewer complications compared to the linear technique

Neurofibromatosis type 1 and High-risk Pregnancy: A Case Report

Orlando Jesus Sarmiento Haydar — 2024-12-03

Introduction: A high-risk pregnancy is the result of a disease present before pregnancy. Neurofibromatosis type 1 is a rare disease during pregnancy, autosomal dominant, with a mutation in the NF1 gene, on chromosome 17q11.2.

Clinical case: 38-year-old woman, Gestational age 1. Mother with neurofibromatosis type 1. The patient is hypertensive, diagnosed 7 years ago and currently treated with alpha-methyldopa 250 mg every 12 hours orally. She reports the diagnosis of neurofibromatosis type 1 since childhood. Without adequate prenatal control, with alterations in the Doppler ultrasound and complication of intrauterine growth restriction stage 1. A referral is made to third level of care and evaluation by maternal-fetal medicine

Discussion: Pregnancies in patients with neurofibromatosis are predisposed to obstetric complications due to the multisystemic nature of the disease. These patients have a higher incidence of spontaneous abortions, stillbirth, preeclampsia, intrauterine growth restriction (IUGR), oligohydramnios, premature birth and cerebrovascular complications.

Mortality of ST-Elevation Myocardial Infarction (STEMI) in Mexico: Current Trends, Challenges, and Strategies for Improvement

Donaldo Emiliano Silva López — 2024-12-03

ST-Elevation Myocardial Infarction (STEMI) remains a leading cause of cardiovascular mortality worldwide, with significant regional disparities. In Mexico, despite advances in healthcare systems and the availability of reperfusion therapies, STEMI continues to contribute substantially to cardiovascular-related deaths. This article reviews the mortality rates associated with STEMI in Mexico, focusing on epidemiological trends, barriers to optimal care, and regional healthcare inequalities. Key factors influencing outcomes include delayed diagnosis, limited access to percutaneous coronary intervention (PCI), socioeconomic determinants, and regional variability in healthcare infrastructure. Strategies to mitigate these challenges, such as strengthening prehospital care, expanding reperfusion networks, and addressing healthcare inequities, are discussed. This review underscores the urgent need for nationwide efforts to optimize STEMI management and reduce associated mortality.

Advancements in the Diagnosis and Surgical Management of Ebstein’s Anomaly: A Comprehensive Review

Donaldo Emiliano Silva López — 2024-12-03

Ebstein’s anomaly is a rare congenital heart defect characterized by the apical displacement of the septal and posterior leaflets of the tricuspid valve, resulting in atrialization of the right ventricle and significant hemodynamic disturbances. This anomaly often presents with a spectrum of clinical manifestations, ranging from asymptomatic cases to severe heart failure and cyanosis in neonatal life. The diagnostic process has been significantly enhanced by advancements in echocardiography, magnetic resonance imaging (MRI), and electrocardiographic techniques, enabling early detection and detailed assessment of structural abnormalities.

Treatment strategies for Ebstein’s anomaly are tailored according to the severity of the condition and patient age. While mild cases may be managed conservatively, severe forms necessitate surgical interventions, including tricuspid valve repair or replacement, bidirectional Glenn shunt, and occasionally the Fontan procedure. Novel approaches, such as cone repair, have shown promising outcomes in improving valve function and overall cardiac performance. This review article provides a detailed exploration of the pathophysiology, clinical manifestations, diagnostic advancements, and therapeutic options for Ebstein’s anomaly, with an emphasis on surgical innovations.

A Shift in Timing: The Role of Early Laparoscopic Cholecystectomy in Patients with Complicated Acute Cholecystitis – A Case Series

Min Nay Zar Wyke — 2024-12-03

Laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis due to its minimally invasive nature, which significantly reduces patient recovery times and postoperative complications. This case series presents four cases of acute cholecystitis, each managed successfully via laparoscopic cholecystectomy, without conversion to open surgery. The clinical outcomes and intraoperative findings underscore the effectiveness of laparoscopic techniques, even in complex cases such as empyema, gangrenous cholecystitis, and perforation with abscess formation. The discussion includes a review of the relevant literature, highlighting the advantages of early laparoscopic intervention in acute cholecystitis and addressing the challenges posed by severe inflammation. This case series emphasizes the importance of laparoscopic surgery as the preferred treatment modality for acute cholecystitis.

Application of Phosphodiesterase Inhibitors in Individuals with Penile Artery Occlusion

José Horlando Chávez Fraga — 2024-12-04

Penile artery blockage is a vascular disorder that may result in erectile dysfunction, profoundly impacting a patient's quality of life and psychological health. This thorough analysis examines the epidemiology and clinical importance of penile artery blockage, highlighting its significant effect on patients' sexual health. The theoretical framework examines the definition of penile artery blockage, analyzes contributory risk factors, addresses probable consequences, and provides contemporary therapy techniques. The discussion section assesses the application of phosphodiesterase inhibitors as a treatment modality for patients with penile artery blockage, including insights into their mechanisms of action, effectiveness, and safety profile. The finding underscores the significance of a tailored strategy for managing this illness, with phosphodiesterase inhibitors as a beneficial alternative.

Bile Duct Injuries: Comprehensive Review

José Horlando Chávez Fraga — 2024-12-04

Bile duct injuries (BDIs) are critical complications of surgical interventions involving the biliary tract, primarily occurring post-cholecystectomy. With an incidence of 0.3%–0.6%, BDIs represent a substantial clinical challenge, and approximately 400 cases are reported annually in the United States. Hepaticojejunostomy is the recommended treatment due to its efficacy in achieving durable biliary drainage with minimal stenosis. However, outcomes can be adversely influenced by factors such as biliary peritonitis, localized inflammation, sepsis, and the timing of repair. BDIs are more common in women in their forties, correlating with the higher incidence of cholelithiasis in this demographic.

Laparoscopic cholecystectomy is widely recognized as the most effective intervention for treating cholelithiasis, yet open cholecystectomy remains a viable option in resource-limited settings where laparoscopic technology or expertise is unavailable. Roux-en-Y hepaticojejunostomy is the preferred approach for long-term management of BDIs due to its reliable outcomes and low risk of stricture formation. Nonetheless, complications such as biliary leakage, cholangitis, and abdominal sepsis remain significant challenges in managing these injuries.

In our analysis, BDIs were predominantly observed in women in their forties, consistent with existing literature attributing this trend to the high prevalence of cholelithiasis. While global studies, such as those by Bobkiewicz et al., report that 82.6% of BDIs occur during laparoscopic procedures, our findings highlight a contrasting trend. Up to 62% of BDIs in our context were associated with open cholecystectomy, reflecting the continued reliance on open procedures in settings with limited laparoscopic resources. This discrepancy emphasizes the importance of adapting global surgical trends to local capabilities.

Rystedt et al. report that up to 89% of BDIs can be identified intraoperatively, underscoring the critical role of thorough intraoperative assessments and experienced surgical teams. The Bismuth classification remains a cornerstone for categorizing these injuries, with types II and III being the most prevalent in our specialized hepatopancreatobiliary (HPB) center.

BDIs are associated with a range of complications, including biliary fistula, jaundice, cholangitis, peritonitis, and abdominal sepsis. The morbidity rates vary significantly across institutions, with high-volume HPB centers reporting better outcomes due to specialized care. For instance, biliary leakage rates can be reduced to 5.7% in expert centers.

Postoperative factors such as drain placement have been associated with increased biliary leaks and complications, while operative time and intraoperative hemorrhage have shown no significant impact on outcomes. The timing of definitive repair remains a contentious issue, particularly in cases complicated by sepsis or biliary peritonitis.

Effective management of BDIs requires a multidisciplinary approach, prompt referral to specialized centers, and meticulous intraoperative techniques. Timely intervention in cases of sepsis and biliary peritonitis is critical to improving outcomes and reducing mortality rates.

Bile duct injuries, affecting 0.3%–0.6% of cholecystectomy procedures, are significant complications that demand specialized care. Hepaticojejunostomy remains the gold standard for repair, offering reliable long-term outcomes. While laparoscopic cholecystectomy is the preferred treatment for cholelithiasis, open procedures continue to play a role in resource-limited environments. The timely referral of patients to HPB centers and the adoption of a multidisciplinary strategy are essential for minimizing morbidity and enhancing survival rates.

Immunocryosurgery for Treatment of Locally Advanced BCC: A Case Report

Analy Gomez-Picos — 2024-12-06

BCC is the most common skin cancer (75%) in humans and the most common malignant tumor in the Caucasian population. The literature recognizes that 95% of BCCs are easy to treat surgically; however, when surgery is contraindicated due to patient or lesion-related conditions pharmacological and destructive therapies are reasonable alternatives. New therapeutic modalities, such as combined therapy, have been proven successful in the treatment of locally advanced and difficult-to-treat BCCs.

Building an Integrated Automated Accreditation Management Platform: Experience of a Large Tertiary Care Organization

Jomana Al Meshherawi — 2024-12-06

Background. Acquiring recognized accreditations is critical for healthcare organizations to demonstrate their competency and credibility. However, the journey can be daunting and time-consuming. Organizations striving to earn and maintain multiple accreditations with different requirements, standards, timeframes, and processes face significant logistical challenges. Integrating an automated accreditation platform facilitates the process.

Objective. This quality improvement project describes the steps to develop an Automated Integrated Accreditation Management Platform in a large tertiary care center.

Method. This quality improvement project was developed and implemented following an organizational performance improvement methodology called IACT that comprises four phases: Identify, Analyze, Change, and Transform. The Automated Integrated Accreditation Management Platform is designed to streamline the process of maintaining accreditation standards across the organization. It centralizes hospital-wide and departmental accreditation information, monitors compliance gaps with accreditation standards, and enables efficient tracking of progress on required tasks. It reduces manual efforts and ensures real-time monitoring of all accreditation statuses. The platform integrates with other organizational systems. The main dashboard gives access to three core components of the accreditation cycle management: 1) Accreditations Data Bank, 2) Compliance Gap Monitoring Module, and 3) Post-Survey Findings Tracking & Escalation Module.

Conclusion. The platform provides a centralized view of the accreditation compliance status and performance metrics, making relevant information accessible to all stakeholders. This transparency helps everyone understand how their contributions impact the accreditation efforts, and fosters shared accountability and commitment across the organization. Automating the accreditation readiness journey offers several benefits, including improving efficiency, accuracy, and consistency.

Bifid and Trifid Mandibular Canals: Are they Uncommon or Underestimated?

Georges Aoun — 2024-12-06

Anatomical variations of the mandibular canal (MC) such as bifid MC (BMC) and trifid MC (TMC) have been largely reported in the scientific literature. They are characterized by two or three accessory canals running roughly parallel to MC. BMC and TMC are incidentally detected during routine dental radiography, and their thorough understanding is necessary to the practitioner to avoid complications during dental procedures. This paper aims to review BMC and TMC and to provide basic knowledge for dental clinical procedures.

Interaction between Microglia and Mitochondrial Metabolism in the Development of Amyotrophic Lateral Sclerosis (ALS)

Leonel Witcoski Junior — 2024-12-06

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that primarily affects motor neurons, leading to muscle weakness and eventual paralysis. Although the precise mechanisms driving ALS are not yet fully elucidated, emerging evidence suggests a crucial role of neuroinflammation and mitochondrial dysfunction in disease progression. Microglia, the brain’s resident immune cells, play a central role in the neuroinflammatory response and undergo metabolic reprogramming during ALS, shifting from a homeostatic state to an inflammatory one. This reactivity is linked to mitochondrial dysfunction, which impairs energy production but allows microglia to maintain a pro-inflammatory phenotype through alternative pathways, such as glycolysis. This interaction between mitochondrial metabolism and microglial function exacerbates neuroinflammation, contributing to neuronal damage and accelerating ALS pathology. Mutations in genes like C9ORF72, SOD1, and TARDBP, commonly associated with ALS, also affect cellular processes such as RNA metabolism and mitochondrial function, further worsening the effects of the disease. This review explores the role of microglial mitochondrial metabolism in ALS, highlighting its importance in disease progression and identifying potential therapeutic targets to modulate neuroinflammation and metabolic dysfunction to slow ALS progression.

Adult Bladder Trauma Management

Carlos Rafael Hernández Álvarez — 2024-12-07

Bladder injuries occur in up to 10% of abdominal trauma cases, contributing to significant morbidity and mortality (10–22%). These injuries may result from blunt or penetrating trauma, as well as iatrogenic damage during surgical procedures. Accurate diagnosis and timely intervention are crucial to minimizing complications.

Bladder injuries are classified into extraperitoneal (EP), intraperitoneal (IP), or combined types. Mechanisms of injury vary, with blunt trauma, predominantly from motor vehicle accidents, accounting for 60–85% of cases, and penetrating injuries, such as gunshot wounds, comprising 15–51%. Evaluation includes clinical assessment, cystography, and CT imaging, supplemented by cystoscopy for iatrogenic cases. Management strategies range from conservative catheterization to surgical repair, depending on injury type and severity. EP injuries, the most common type (63%), are frequently associated with pelvic fractures, whereas IP injuries (32%) typically result from blunt trauma to a distended bladder. Conservative management with catheter drainage suffices for most EP injuries; however, IP injuries necessitate surgical intervention to mitigate risks such as sepsis and peritonitis. Outcomes are influenced by concomitant injuries, which are often more critical than the bladder injury itself.

Advanced imaging modalities, particularly CT cystography, offer high sensitivity and specificity for bladder injury diagnosis. While conservative management is preferred for minor injuries, indications for surgical repair include significant extravasation, ongoing urinary leakage, or associated injuries. Multidisciplinary approaches are essential for comprehensive trauma care.
Bladder injuries are rare but carry substantial risks if unrecognized or inadequately treated. Timely diagnosis, guided by clinical suspicion and imaging, coupled with appropriate management strategies, is essential to optimize outcomes and reduce complications.

Analysis of the Implementation of Minimum Service Standards (MSS) in Emergency Installation of Priscilla Medical Center Hospital

Anggita Dian Karera — 2024-12-07

The achievement of the Minimum Service Standards (MSS) indicators in the Emergency Department of the Hospital is still not optimal so that the services provided are not as expected. This study aims to explore the situation related to the input, process, and output of the implementation of MSS for emergency services at Priscilla Medical Center Hospital. This study uses a qualitative design with a case study approach. The research time is from September to November 2023 at the Emergency Department of Priscilla Medical Center Hospital. Data collection techniques are carried out through in-depth interviews, forum group discussion (FGDs), and document reviews. The results of the study indicate that the quality indicator policy at Priscilla Medical Center Hospital does not cover all MSS indicators, the quality of human resources is good but the number of general practitioners is not sufficient, facilities and infrastructure are not fully in accordance with standards, and monitoring and evaluation has not been running well. Planning, organizing, implementing and controlling the implementation of MSS in the Emergency Department of Priscilla Medical Center Hospital has not been optimal. The output results show that patient mortality ≤24 hours is still high.

Adequate Volume Restitution with Midodrine Versus Albumin in Patients with Refractory Ascites Undergoing Large-Volume Paracentesis: A Comparative Analysis

Gustavo Bastien Martinez — 2024-12-10

Large-volume paracentesis (LVP) is a cornerstone in the management of refractory ascites in cirrhotic patients, but it is associated with significant hemodynamic complications, including paracentesis-induced circulatory dysfunction (PICD). Current guidelines advocate for the use of albumin to mitigate these risks; however, its high cost and limited availability have prompted the exploration of alternative therapies such as midodrine, an α1-adrenergic agonist with vasoconstrictive properties. This study aims to compare the efficacy and safety of midodrine versus albumin in maintaining hemodynamic stability and preventing PICD post-LVP. We conducted a prospective, randomized trial involving patients with refractory ascites, evaluating hemodynamic parameters, renal function, and clinical outcomes. Our findings suggest that midodrine offers a cost-effective alternative to albumin with comparable efficacy in volume restitution, although certain patient subgroups may benefit more from specific interventions. Further research is warranted to optimize patient selection and treatment protocols.

Hybrid Therapies for the Management of Aortic Dissection: Bridging Open Surgery and Endovascular Innovation

Donaldo Emiliano Silva López — 2024-12-10

Aortic dissection is a life-threatening condition characterized by the separation of the layers within the aortic wall, leading to a false lumen with the potential for severe complications, including rupture, malperfusion, and death. The management of aortic dissection has evolved significantly, with hybrid therapies emerging as a promising approach, particularly for complex cases involving extensive aortic involvement or high surgical risk. Hybrid therapies combine open surgical techniques with endovascular interventions to optimize outcomes by leveraging the strengths of both modalities. This article provides a comprehensive review of the current state of hybrid therapies in aortic dissection management, including their indications, technical considerations, and clinical outcomes. We explore the role of hybrid procedures in both acute and chronic phases of aortic dissection, focusing on scenarios such as aortic arch and thoracoabdominal involvement. Additionally, we discuss patient selection criteria, advances in imaging for procedural planning, and the challenges of long-term surveillance. By synthesizing recent evidence, we aim to highlight the potential of hybrid approaches to improve survival and reduce morbidity in this complex patient population.

Atypical Uterine Leiomyoma: A Case Report and Literature Review

Viridiana Noemí Victoria Acosta — 2024-12-10

Introduction: Atypical leiomyomas are diagnosed histologically, showing pleomorphic atypical tumor cells with low mitotic counts and no coagulative necrosis. Surgical treatment is indicated when abnormal uterine bleeding or symptoms related to the size of the leiomyomas, infertility, or recurrent gestational loss are presented.

Clinical case: A 40-year-old woman with a history of menstrual changes, abdominal pain, and intermenstrual bleeding was scheduled for surgery. Pathology reported an atypical leiomyoma (23x18x13 cm) with myxoid degeneration.

Discussion: Uterine leiomyomas affect 70-80% of women in their reproductive age. Symptoms vary by size and location, including abnormal bleeding, pain, and pressure-related issues. This patient had a single pedunculated leiomyoma, no endometrial hyperplasia, negative cervical cytology, and uterine adhesions. Myomectomy was chosen to avoid organ damage.

Conclusion: Atypical leiomyomas are rare tumors diagnosed through biopsy and histopathological examination, displaying 10 mitoses per field and no necrosis. Immunohistochemical studies are necessary to distinguish them from leiomyosarcoma. Long-term follow-up after myomectomy is essential to monitor for recurrence.

Streptococcus Suis Meningitis: A Case Report from South India

Dr. Josekutty Mathew — 2024-12-11

Streptococcus suis is a zoonotic pathogen predominantly associated with occupational or dietary exposure to pigs or pork products. While cases are frequently reported from Southeast Asia, reports from India remain scarce. This case report highlights the clinical presentation, diagnosis, and management of S. suis meningitis in an immunocompetent individual from South India.

Clinical manifestations and neuroanatomical correlates of reversible impairment of cognitive functions in patients with normotensive hydrocephalus: Case Report

Érika Yánez-Ortiz — 2024-12-12

From a neuropsychological perspective, normotensive hydrocephalus NPH is characterized by cognitive impairment associated with the compression exerted by ventricular dilatation on the cingulate cortex and fronto-striatal circuits. The Rey-Osterrieth Complex Figure Test (ROCFT) is a neuropsychological assessment measure widely used by clinicians and researchers because of the wide variety of cognitive information it allows to estimate.

We present the case of young male patient with refractory structural epilepsy secondary to a childhood brain injury resulting from a metastasis of a renal tumor. Referred to Neuropsychology for behavioral changes and cognitive impairment; presenting atypical performance in the copying phase of the ROCFT.

Failures in visual integration and coding of the ROCFT copy show that, in cases of NPH, brain structures such as the cerebellum and posterior cingulum can also be compromised by the compression exerted by the cerebral hemispheres as they move due to ventricular dilatation. Failures in integration, planning, rotation and displacement of ROCFT elements have been reported in patients with secondary psychotic conditions and posterior cingulate tumors.

Failures in visual integration associated with NPH may be related to the involvement of more postero-caudal brain structures such as the cerebellum and posterior cingulum or to secondary psychosis.

Estrogen and Memory during the Perimenopause Period: A Critical Review

Jennifer L. Williamson — 2024-12-13

Menopause is an encompassing neuroendocrine aging process, marked by declining sex hormones, particularly estradiol, with significant consequences for cognitive brain function that will affect every woman who lives long enough to enter the phase. This critical review examines recent neuroimaging studies investigating the underlying biological mechanisms of cognitive changes during menopause, focusing on estrogen receptor density in the brain. Advanced neuroimaging techniques, such as 18F-fluoroestradiol (18F-FES) Positron Emission Tomography (PET), have provided novel insights into the distribution and density of estrogen receptors across different menopausal stages. Key findings reveal that estrogen receptor (ER) density in the brain increases progressively over the menopause transition, independent of age and plasma estradiol levels. Notably, higher ER density is associated with poorer memory performance and predicts mood and cognitive symptoms in postmenopausal women. These results suggest a potential compensatory mechanism in response to declining estrogen levels, offering a neurobiological explanation for cognitive changes observed during menopause.

Skin Graft Harvested from Hypertrophic Scar Tissues as a Treatment Option of Post Burn Popliteal Contracture: A Case Report

Grace Claudia — 2024-12-13

Background: Burn injuries can range from minor injury up to life-threatening medical problems. Scars and contractures of varying degrees may develop on a healed burn patient, causing problems in functional and aesthetic components. Surgery is indicated on contracture patients with limited range of motion on the affected limb.

Aims : This study aims to report a-33 year old female patient with popliteal contracture following a gas explosion at her home six months ago.

Case Presentation: The patient presented with diffused desmogen contracture of the left popliteal with limited range of motion, and hypertrophic scar tissue in some parts of her body, such as the posterior side of both thighs and both lower leg. The patient is unable to walk normally because her left knee cannot be straightened following the burn trauma. Surgical procedure was done to excise the contracture, and split thickness skin graft harvested from the hypertrophic scar of posterior left thigh was used to close the defect.

Result: Patient achieved satisfactory result following surgery. The patient demonstrated improved knee function, with the ability to walk normally without assistive device.

Conclusion: Closing defect after excision of contracture using skin graft from hypertrophic scar tissue offers the patient a good chance for release contracture without the risk of additional scar tissue.

Le Fort I-II Fracture Management: Case Based Literature Review

Grace Claudia — 2024-12-13

Introduction: Midfacial fractures are among the most severe injuries encountered in emergency settings due to the risk of functional impairment and facial deformities. The Le Fort classification remains the most commonly used system for categorizing these fractures. Treating Le Fort II fractures is particularly complex due to the involvement of the orbital and nasal bones, along with the critical need to restore proper occlusion. Achieving pre-trauma occlusion is often the most difficult aspect of treating facial fractures.

Case Presentation: This study reported a 28-year-old Asian male was brought to the Emergency Room of Bali Mandara General Hospital by a bystander following a motorcycle accident in which he struck a pedestrian. He was diagnosed with Le Fort I-II and a right orbital floor fracture. The patient underwent surgery, including open reduction and internal fixation using miniplates and screws. The procedure successfully restored the patient’s occlusion, and no reported postoperative complications.

Discussion: The diagnosis of Le Fort fractures is based on patient history, physical examination, and imaging studies. Identifying a pterygoid fracture is essential for diagnosing all types of Le Fort fractures. Prompt definitive treatment is critical to prevent long-term facial deformities.

Conclusion: Achieving proper occlusion is a marker of accurate alignment in managing facial fractures. Emphasizing functional restoration and deformity prevention significantly improves patient recovery and results.

Correction of Post Burn Severe Broad Type Neck Contracture using Multiple Z-Plasty: A Case Report

Grace Claudia — 2024-12-13

Background: Post burn contracture of the neck is one of the most common sequeles. The management of neck contracture is challenging because of both functional limitations and aesthetic apperance distortion of the patient. Besides affecting neck movement, neck contracture can also influence lower face function.

Aims : This study aims to report a-31 year old female patient with post burn contracture of the neck, following a kerosene lamp explosion that resulted in flame burn.

Case Presentation: The patient presented with a severe broad type neck contracture with complaints of limited range of motion in her neck and restricted mouth movement, accompanied by drooling caused by lower lip retraction, making it difficult to close her lower lip completely Surgical procedure was performed without excision of scar tissue. Multiple Z-plasty incisions were used to distribute the soft tissue and release the contracture.

Result: Patient achieved satisfactory result after surgery. The patient was followed up seven months and one year after surgery with improvement of her symptoms.

Conclusion: Multiple Z-plasty is a safe and realible procedure for releasing post-burn neck contracture. It serves as an effective surgical technique for treating post-burn neck contractures, allowing patients to avoid the need for grafts and preventing additional wounds from donor site harvesting.

Septic Nonunion of the Tibial Shaft with Bone Defect in a Gustilo-anderson Type II Open Fracture

Armando de Jesus Mendoza Kirsch — 2024-12-14

Introduction. Open fractures of the tibial shaft are mostly the result of high-energy trauma, the incidence is 17 to 21 per 100,000 inhabitants, represent 2% of all fractures and 36.7% of all long bone fractures in adults. More than 15% of tibial shaft fractures are classified as open, representing the most common open long bone injuries. The reported incidence of nonunion or delayed union of tibial shaft fractures after intramedullary nailing (IMN) ranges from 16% to 36%. Infection can complicate any stage of the fracture healing process and may contribute to nonunion in up to 38% of cases.

Case: A 64yo female with open fracture of the tibial shaft G-A II, initially treated with external fixators, then 3 internal fixations with IMN were performed at different surgical times due to complication of septic nonunion, managed with local and systemic antibiotics and tissue coverage.

Discussion: Some orthopedic surgeons prioritize bone union as the main treatment goal in septic nonunion and advocate retaining the implant with surgical cleaning and debridement of devitalized tissue, followed by suppressive intravenous antibiotic therapy. Conversely, others consider eradicating the infectious process as the most critical stage of treatment.

Conclusion: Pseudoarthrosis is one of the most devastating problems in orthopedic surgery. We consider it a priority to identify the pathogen associated with the nonunion for specific local and systemic antibiotic therapy associated with aggressive debridement surgery and stable fixation.

Intestinal Invagination Secondary to Vanek Tumor, A Rare Cause of Intestinal Obstruction in Adults: Case Report

Márquez Lara, Massiel — 2024-12-14

Introduction: Mechanical intestinal obstruction is a common surgical condition with a wide range of causes, including intrinsic intestinal problems such as intestinal invagination. This condition is extremely rare in the adult population and is mostly caused by neoplasms. The clinical presentation, although varied, is typically gradual and nonspecific. Among intestinal neoplasms, inflammatory fibroid polyps (IFPs) are very rare, constituting less than 0.1% of gastrointestinal tract polyps.

Case Presentation: We present a 48-year-old female patient who presented with abdominal pain lasting for 1 month, with a 4-month history of constipation. A CT scan showed findings suggestive of pseudo-obstruction secondary to intestinal invagination. After an emergency laparotomy, histopathological analysis reported a Vanek tumor in the terminal ileum.

Discussion: Intestinal intussusception in adults is a rare condition, often caused by benign tumors that act as lead points. Inflammatory fibroid polyps (IFP), commonly located in the ileum, are such tumors. The symptoms are typically nonspecific, making early diagnosis challenging. In the presented case, a laparotomy was performed to address the obstruction and resect the tumor, which was histologically confirmed as an IFP. This case highlights the importance of considering these tumors in the differential diagnosis of adult intussusception and the need for timely surgical intervention.

Conclusion: IFPs should be considered in the differential diagnosis of adult intussusception, especially in cases of chronic, non-specific symptoms and intestinal obstruction.

Exploring the Role of Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in the Management of Cardiogenic Shock: Pathophysiological Insights and Therapeutic Potential

Donaldo Emiliano Silva López — 2024-12-14

Cardiogenic shock remains a critical condition characterized by profound myocardial dysfunction leading to end-organ hypoperfusion and high mortality rates despite advances in supportive therapies. While traditional management focuses on inotropes, vasopressors, and mechanical circulatory support, recent evidence suggests that metabolic modulation could provide additional benefits. Dipeptidyl peptidase-4 (DPP-4) inhibitors, primarily used in type 2 diabetes mellitus, have demonstrated cardioprotective effects through pleiotropic mechanisms, including anti-inflammatory, endothelial-protective, and metabolic-modulating actions. This review examines the potential utility of DPP-4 inhibitors in the context of cardiogenic shock, emphasizing their mechanisms of action, experimental and clinical data, and the feasibility of integrating these agents into the current therapeutic paradigm. We highlight gaps in knowledge and propose directions for future research to determine the clinical efficacy of DPP-4 inhibitors in this high-risk population.

The Role of Artificial Intelligence and Machine Learning in Decision-Making in the ICU

Dr Ketan Kargirwar — 2024-12-14

Artificial Intelligence (AI) and Machine Learning (ML) are revolutionizing critical care. In the Intensive Care Unit (ICU), timely and accurate decisions are crucial. AI and ML can enhance decision-making by predicting adverse events, personalizing treatment plans, and improving diagnostic accuracy. Early warning systems, powered by AI, can detect conditions like sepsis and acute respiratory distress syndrome early on. AI-driven decision support systems provide real-time recommendations, optimizing resource allocation and ensuring adherence to best practices.

While AI offers significant benefits, challenges like data privacy, bias, and ethical considerations must be addressed. Ensuring transparency, accountability, and fairness in AI algorithms is essential.

The future of AI in the ICU is promising. Advancements in AI and ML, coupled with collaborative human-AI approaches can further improve patient outcomes. By addressing ethical concerns and fostering responsible AI development, healthcare providers can harness the power of AI to optimize critical care.

Clinical Application of Autologous Fat Graft and Dermis-Fat Graft in Patients with Cleft Lip and Palate Deformities: A Case Series

Grace Claudia — 2024-12-16

Cleft lip and palate patients require multiple surgeries from childhood to adulthood to improve both function and aesthetics. Primary surgery may not completely resolve a cleft, residual scarring, asymmetry, nose deformity, or palatal fistula, can sometimes remain, leading to insecurity and social withdrawal. This study reports five cases of patients aged 7-13 years old with prior cleft lip and palate surgeries, treated with autologous materials for lip, nasal, or palatal repair, based on individual needs at Bali Mandara General Hospital, Denpasar, Bali, Indonesia. The first two patients had functional lips but were dissatisfied with scars and poor lip contour. Treatments included dermis-fat grafts, fat transfer injections, and/or scar revision. The third and fourth patients had Pittsburgh Type V palatal fistulas with nasal leakage and hypernasal speech, managed with dermis-fat grafts to close the fistulas. The fifth patient had a nasal deformity due to absent of primary correction and underwent nasal dorsal augmentation with a dermis-fat graft. All patients expressed improved appearance, function, and confidence postoperatively, with no complications during follow-up. Autologous materials such as autologous fat grafting and dermis-fat are reliable, versatile approach, and cost effective for improving lip contour, closing oronasal fistulas, and correcting nasal deformity.

Epidemiology of Burn Patients at Bali Mandara General Hospital Treated With Emergency Management of Severe Burns Protocol: A Retrospective Study

Grace Claudia — 2024-12-16

Background Burns are one of the most common injuries resulting from heat or radiation, electricity, and chemicals. Bali Mandara General Hospital is a new government hospital operated in October 2017. The hospital implemented the Ministry of Health Regulation’s Guideline which applies the Emergency Management of Severe Burns to manage burns cases.

Aim The current study aims to determine the epidemiological burn patients at Bali Mandara General Hospital, and emphasize the importance of burn management strategies.

Methods A hospital-based, single-center, and retrospective study was conducted from November 1^st, 2017 to June 30^th, 2022 at Bali Mandara General Hospital. Demographic and clinical information were extracted from hospital medical records. Data is collected and analyzed using Microsoft Office Excel and SPSS Statistic version 26. Correlation between ABSI score and length of hospital stay were examined.

Results A total of 142 burn patients were included in this study; including 56 (39,43%) moderate – severe burn patients, 35 (62.50%) are male and 21 (37.50%) female, out of which are 33 (82.5%) patients with burn time-admission gap < 24 hours. The major proportion of burn patients are adults (18-65 years old) - 110 (77.46%) patients with an average age of 27±17.72 years. The most common total body surface area (TBSA) of burn ranged from 1 to 10%. The major proportion of moderate – severe burn patients are adults (42 patients, 38.18%). There were 40 (71.42%) patients undergoing surgical procedure. Scald and flame contributed equally for the amount of moderate to severe burns (21 patients, 37.50%). Average length of hospital stay was 8.3 days, ranging from 3 to 15 days. Seventeen (42.50%) patients have low mortality risk. Spearman’s correlation between ABSI score and length of stay resulted in a coefficient of 0.48, indicating a moderate correlation.

Conclusion Scald is the most common cause of burn injury in all burn patients and male dominated in this study. ABSI score and length of stay has positive correlation in our study.

Retrospective Study of Maxillofacial Traumatic Injury Pattern on Plastic Surgery Unit at Bali Mandara General Hospital

Grace Claudia — 2024-12-16

Introduction Trauma is a major cause of morbidity and mortality, often accompanied by maxillofacial injuries in a significant portion of patients. Maxillofacial trauma represents a serious public health problem and their epidemiology varies between populations. Bali Mandara General Hospital is a new government hospital operated in October 2017, that provides care for plastic surgery patients, including maxillofacial trauma patients. The current study aims to investigate the pattern of maxillofacial traumatic injuries, and management of maxillofacial traumatic injuries by our plastic surgery service.

Methods A hospital-based, single-centered study was conducted from January 1^st, 2018 to December 31^st, 2022 at Bali Mandara General Hospital. Medical records of maxillofacial patients undergoing surgical procedure were retrospectively reviewed Data is collected and analyzed using Microsoft Office Excel and SPSS Statistic version 26.

Results A total of 107 maxillofacial patients who received treatment for maxillofacial trauma in the departments during the study period were included; 76 (71.02%) are male and 31 (28.97%) female. The majority of patients belonged to the 21-30 years age group (27 patients, 25.23%). The mean age for the group was 32.26±17.31 years, ranging from 1 to 83 years. Soft tissue injuries (64; 29.63%) and maxilla fracture (35; 16.20%) were the two most common site of maxillofacial injuries. The most common associated injuries was upper extremity injuries (11; 30.56%), followed by lower extremity injuries (9; 25.00%). The most common surgical management were ORIF (61; 28.64%) and debridement (54; 25.35%).

Conclusion Young age and males were predominantly affected. Maxillary fracture was the most frequent maxillofacial fracture. Maxillofacial trauma was often associated with upper extremity injuries. ORIF was the most surgical common management.