International Journal of Medical Science and Clinical Research Studies

Hybrid Management of Taussig-Bing Syndrome in Neonates: An Innovative Approach to Optimize Outcomes in Complex Congenital Heart Disease

2025-01-17T11:07:26+00:00

Taussig-Bing syndrome, a rare and complex congenital cardiac malformation characterized by double outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD), poses significant challenges for neonatal management. Traditional surgical approaches often involve extensive cardiopulmonary bypass procedures and staged correction, which may increase perioperative risk and prolong recovery. Hybrid strategies combining surgical and interventional cardiology techniques have emerged as an innovative alternative to address the unique anatomical and physiological complexities of this condition.

This article explores the rationale, methodology, and outcomes of hybrid management for neonates with Taussig-Bing syndrome. We detail preoperative planning, intraoperative strategies, and postoperative care, emphasizing the role of multidisciplinary collaboration. The use of stenting, banding techniques, and minimally invasive surgical corrections is evaluated alongside advanced imaging modalities to enhance procedural success. Current evidence and case reports are reviewed to provide a comprehensive overview of this evolving paradigm. Our findings suggest that hybrid management offers a promising avenue for improving survival and reducing morbidity in neonates with Taussig-Bing syndrome, underscoring the need for further research and refinement of these techniques.

Characteristics of Vitiligo Patients in Dermatology and Venereology Outpatient Clinic Unit at Bali Mandara General Hospital 2021-2022

2024-12-23T01:46:26+00:00

Vitiligo is a depigmentation disorder characterized by the distinct macules or depigmented patches, which are often asymptomatic. Age and geographic location have an impact on the prevalence of vitiligo. This condition affects 0.5-2% of the global population and is caused by a combination of factors, including clinical symptoms and therapeutic outcomes. Methods: The research material was taken from the medical record of vitiligo patients in the Outpatient Clinic Dermatovenerelogy Bali Mandara General Hospital from 2021-2022. The data were analyzed descriptively using SPSS program version 26 for Windows. Result: This study collected 198 visits from vitiligo patients at the Bali Mandara General Hospital Dermatovenereology outpatient clinic. The predominant gender is female (55.1%), with late adolescents comprising 36.4%, students accounting for 38.4%, and the development of vitiligo occurring within 1-5 years for 54% of cases; 63.1% of patients lacked a familial history of vitiligo. The predominant clinical kind is non-segmental vitiligo (59.1%), and the most frequently used treatment is excimer light phototherapy (85.9%). Conclusion: Vitiligo patients at Bali Mandara hospital, Denpasar, mostly female aged 17-25 years old, with non-segmental vitiligo . The most common therapies given are excimer light phototherapy.

Bone Marrow Puncture (BMP): The Initial Step in the Management of Myelodysplastic Syndromes (MDS)

2025-01-02T11:25:13+00:00

Myelodysplastic Syndromes (MDS) encompass a variety of bone marrow disorders characterized by insufficient production of healthy blood cells. Myelodysplastic Syndromes (MDS) represent a cluster of bone marrow conditions where there's a deficiency in generating a sufficient quantity of healthy blood cells. Patients with MDS often exhibit an asymptomatic nature. The clinical manifestations of MDS vary widely depending on the cellular line involved. Infections, bleeding, and anemia are common features of the MDS, while unusual findings include hepatomegaly, splenomegaly and lymphadenopathy. However, the situation changes when the patient progresses to acute myeloid leukemia (AML), leading to a transformation into thrombocytosis. During the process of improving the general condition, on the third day of treatment, the patient experienced a deterioration and unfortunately passed away. The lack of medical and healthcare personnel in Indonesia and the unequal distribution of them are the reasons why patients with rare cases are still far from obtaining their health rights. An important challenge in clinical practice involves distinguishing between primary myelofibrosis and other conditions, as misidentification can delay treatment, potentially leading to patients not receiving necessary healthcare and possibly resulting in fatalities.

The Influence of Health Literacy on Diabetes Prevention Behaviors in Sai Mai District Communities, Bangkok

2024-12-26T08:32:33+00:00

This research aimed to 1) assess health literacy levels 2) evaluate diabetes prevention behaviors and 3) analyze the influence of health literacy on diabetes prevention behaviors among residents in Sai Mai District communities, Bangkok. This cross-sectional survey research included 317 participants aged 35 years and above, selected through stratified random sampling. Data were collected from June to September 2024 using questionnaires with content validity and reliability (Cronbach's alpha coefficient = 0.87). Data were analyzed using descriptive statistics and multiple regression analysis.

The results showed that the majority of participants had moderate levels of health literacy (65.3%) and diabetes prevention behaviors (58.7%). Factors significantly influencing diabetes prevention behaviors included education level (β = .325, p < .001), health information accessibility (β = .298, p < .001), self-management (β = .276, p < .001), age (β = .245, p < .01), and income (β = .198, p < .01). These variables collectively explained 52.3% of the variance in diabetes prevention behaviors (R² = .523). The findings can be applied to develop appropriate health literacy promotion programs and diabetes prevention behaviors suitable for the community context.

The Interplay between Hyperaldosteronism and Heart Failure with Preserved Ejection Fraction: Pathophysiological Insights and Therapeutic Implications

2025-01-04T11:03:25+00:00

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by preserved left ventricular systolic function, diastolic dysfunction, and systemic inflammation, often coexisting with metabolic and hemodynamic disorders. Primary hyperaldosteronism (PHA), a condition marked by excessive aldosterone secretion, is increasingly recognized as a pivotal contributor to the pathophysiological mechanisms underpinning HFpEF. This review explores the intricate relationship between hyperaldosteronism and HFpEF, emphasizing the role of aldosterone in myocardial remodeling, endothelial dysfunction, and systemic inflammation. Additionally, it highlights emerging evidence on aldosterone antagonists as potential therapeutic agents in mitigating HFpEF-related morbidity. By integrating clinical findings with molecular insights, we aim to elucidate how hyperaldosteronism exacerbates HFpEF phenotypes and propose strategies for targeted management. This synthesis underscores the need for tailored interventions in patients with concomitant hyperaldosteronism and HFpEF.

Innovative Strategies in the Management of Hypoplastic Left Heart Syndrome: A Multidisciplinary and Translational Approach

2025-01-04T11:07:37+00:00

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients.

Objectives: This article explores emerging strategies for HLHS management, including stem cell therapy, tissue engineering, genomic medicine, hybrid procedures, and long-term monitoring protocols facilitated by artificial intelligence (AI).

Methods: A comprehensive review of contemporary literature was conducted, focusing on the translational application of novel therapies and their integration into current staged palliation frameworks.

Results: Early-stage studies demonstrate promise for stem cell therapies and myocardial regeneration in improving ventricular function. Advances in 3D printing and bioengineering have facilitated patient-specific surgical planning and the development of biocompatible grafts. Furthermore, AI-driven algorithms provide personalized risk assessment and optimized perioperative management strategies.

Conclusions: The integration of multidisciplinary and translational approaches offers an opportunity to redefine HLHS management, potentially improving survival and quality of life for affected individuals. However, further clinical trials and international collaboration are essential to establish these novel therapies as standard of care.

Single Isolated Umbilical Artery in A Healthy Newborn: Case Report

2025-01-07T08:30:46+00:00

Introduction: The umbilical cord (UC) typically contains two arteries and one vein. The presence of a single umbilical artery (SUA) is the most common anomaly associated with the umbilical cord and is linked to various congenital conditions. However, SUA can also appear as an isolated condition (ISUA), occurring without any accompanying fetal structural or chromosomal abnormalities.

Clinical case: The case involves a 37-year-old primiparous patient with inadequate prenatal care. She presents to our medical unit for the first time at 38.2 weeks of pregnancy, experiencing latent phase labor and presentation dystocia. The patient has been diagnosed with SUA since 21.5 weeks of gestation. The pregnancy was resolved through an abdominal delivery, resulting in the birth of a healthy newborn.

Discussion: Pregnancies involving fetuses with SUA are associated with an increased risk of various malformations, including renal, cardiac, nervous system, and gastrointestinal issues. These pregnancies may also lead to complications such as a small fetus for its gestational age, fetal growth restriction, abortion, preterm birth, and perinatal death. However, as illustrated in this case, SUA can occur without resulting in any adverse perinatal outcomes.

The Role of Convolutional Neural Network (CNN) Based on Dermoscopy Imaging for Early Detection of Melanoma: A Systematic Review

2024-12-27T16:34:30+00:00

Background: AI systems for melanoma detection have shown considerable potential. Although, dermoscopy has become a widely utilized non-invasive method for diagnosing skin tumors. However, the variability in diagnosis caused by subjective interpretation of dermatological findings can affect both accuracy and consistency. Therefore, we conducted this study to review the accuracy, sensitivity, and specificity of Convolutional Neural Network (CNN) based on dermoscopy imaging in diagnosing melanoma.

Method: This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. We limited the studies from 2019 until 2024. All studies that assessed diagnostic accuracy of CNN in diagnosing melanoma were analyzed. QUADAS (Quality Assessment of Diagnostic Accuracy Studies) is used to assess the quality of diagnostic accuracy studies.

Results: Eleven studies were eligible to be included in this study. The Area Under Curve (AUC) among the studies varied between 81.3% and 92.6%. Sensitivity varied between 69.1% and 94.2%. Specificity varied between 65% and 84.63%.

Conclusion: The AUC, sensitivity, and specificity showed good results compared to dermoscopy alone. However, the usage of artificial intelligence was as an adjunctive tool, not as a replacement for dermatologists.

Revision Arthroplasty Versus Open Reduction Internal Fixation for Distal Femur Periprosthetic Fractures: A Systematic Review

2024-12-29T12:38:42+00:00

Abstract

Introduction Distal femur periprosthetic fractures are a challenging complication following total knee arthroplasty (TKA). Primary surgical approaches are Revision Arthroplasty (RA) and Open Reduction Internal Fixation (ORIF). RA replaces unstable prosthetic components, while ORIF preserves the prosthesis. This review aims to evaluate the outcomes of RA and ORIF.

Method This review followed PRISMA 2020 guidelines. Literature search was conducted across PubMed, Scopus, and Google Scholar. Data extraction and bias assessment were performed independently.

Results Literature search resulted in 376 papers. After screening, 12 studies were included with a total of 526 patients, with 302 patients treated with ORIF and 224 with RA. ORIF patients showed a fracture union rate of 94.2% and RA patients 94.9%. Average time to union was 15.9 weeks for ORIF and 14.1 weeks for RA. Complication rates were 10% for ORIF and 10.3% for RA. Reoperation rates were 4.1% for ORIF and 4.5% for RA. Mortality rates were slightly higher in RA group (3.8%) compared to ORIF group (3.4%). ORIF patients scored higher on KSS but lower on OKS compared to RA patients.

Discussion RA shows faster time to fracture union compared to ORIF, attributed to RA’s load-sharing design which supports early weight-bearing without compromising fracture stability or healing. Literature suggests that early mobilization may reduce morbidity and enhance ambulatory recovery. Complication, reoperation, mortality, and functional scores were similar in both groups.

Conclusion Both ORIF and RA offer distinct advantages, depending on factors such as prosthetic stability and bone quality. Further researchs are required to establish proper guidelines.

Giant Mesenteric Cyst of The Large Bowel: Case Report

2024-12-19T22:06:10+00:00

Introduction: Mesenteric cysts are rare, benign intra-abdominal cystic lesions that arise from the mesentery, the tissue fold attaching the intestines to the abdominal wall. They can develop from the duodenum to the rectum. Mesenteric cysts have various histological origins, with lymphangiomas being more common in children and mesothelial cysts in young to middle-aged women. While they can remain asymptomatic, they may also cause complications such as intestinal obstruction or perforation. Complete resection is the preferred treatment due to its lower recurrence rate.

Case Presentation: A 48-year-old female with a medical history of systemic arterial hypertension, allergies, hysterectomy, appendectomy, cesarean section, right axillary lipoma resection, and a cyst in the left zygomatic region, presented in June 2021 with dull, constant pelvic pain. Over time, her symptoms progressed to include volume increase, fatigue upon sitting, constipation, and hand tremors. Imaging studies revealed a large cystic lesion extending from the left ovary. In January 2024, an abdominal ultrasound showed a complex ovarian cyst (O-RADS 4). Surgical exploration revealed a mesenteric cyst associated with the sigmoid colon, which was resected along with a distal segment of the descending and sigmoid colon, preserving the left colic artery. The patient recovered well postoperatively, with proper colostomy function.

Discussion: Mesenteric cysts are benign tumors that can occur throughout the gastrointestinal tract, most commonly in the small bowel mesentery. Their clinical presentation can range from asymptomatic to acute abdominal pain secondary to complications such as intestinal obstruction or cyst rupture. Diagnostic imaging typically involves ultrasound, CT, and MRI. Surgical resection is the treatment of choice to prevent recurrence. The prognosis following complete cyst excision is favorable, with no reported recurrences.

Conclusion: Mesenteric cysts present a diagnostic challenge due to their wide range of symptoms. The recommended treatment, as supported by literature, is complete resection to minimize recurrence. Our case followed this approach, and the patient showed a positive clinical outcome

Fistulous Communication Between the Left Atrium and Coronary Sinus: A Rare Case from Nepal

2025-01-07T10:01:13+00:00

Left atrium and coronary sinsus fistulous connection is rare anonaly with devastating consequence leading to alteration in hemodynamic of blood flow. We present a case of 50 years old male who presented for evaluation of chest pain whose TMT was positive for reversible ischmia and coronary CT showed abnormal connection between coronary sinus and left atrium.

Computed Tomography Pattern of Non-Traumatic Intracranial Hemorrhage in Tertiary Hospital of Nepal-A Cross Sectional Study

2024-10-23T15:25:37+00:00

Objective: We aimed to study the pattern of non-traumatic intracranial hemorrhage on Computed Tomography in tertiary hospital of Nepal.

Methodology: 180 cases of intracranial hemorrhage (108 male and 72 female), diagnosed on computed tomography and aged >18 years were enrolled in the study. Cases with known history of trauma and previous intracranial hemorrhage were excluded. CT scan of head was performed in 128 slice Multidetector Philips CT scan Machine using 120 kV and auto mA with multiplanar reconstruction on dedicated workstation. Size and site of hematoma was noted. Intracranial hemorrhage was classified into different types- intraparenchymal, intraventricular, subarachnoid, subdural and epidural. Presence or absence of perilesional oedema was noted separately. SPSS 20 was used for the entry and analysis of the collected data.

Result: Mean age of the study population was 64.6 years ranging from 19 years to 92 years. 60% were male and 40% were female. The most common type of non-traumatic intracranial hemorrhage was intraparenchymal (91.1%) followed by intraventricular (5.6%), subarachnoid (2.2%) and subdural (1.1%). Perilesional oedema was seen in 69.4 % of intracranial hemorrhage. The age group with maximum cases (53.3%) of intracranial hemorrhage was >60 years followed by 50-60 years.

Conclusion: Intraparenchymal type was the most common type of non-traumatic intracranial hemorrhage as seen on computed tomography. Male gender and older age were significantly associated with intracranial hemorrhage.

The WALANT Technique in Osteotomy and Bone Elongation for Brachymetatarsia: A Case Report

2025-01-06T05:46:56+00:00

Introduction: Brachydactyly (BD) is considered a genetic malformation that can cause disproportionately short fingers and toes. The incidence ranges from 0.0% up to 0.05%, with a predilection for females. On the other hand, the Walant anesthetic technique is safe and effective and uses epinephrine, lidocaine, and sodium bicarbonate.

Case presentation: A 50-year-old female diagnosed with BD was scheduled for an elective osteotomy with a bone elongator. During the procedure, we used the Walant technique, which does not require intravenous sedation or supplementary oxygen.

Clinical discussion: Hand surgery is one of the most common procedures and usually requires the use of a tourniquet for hemostatic control, creates pain and makes the use of sedation necessary. In this case, we explained how the Walant technique can be beneficial in cases with BD.

Conclusion: The Walant technique proves anesthesia and avoids the use of tourniquet and sedation, decreasing surgical times, optimizing surgical supplies, and decreasing costs and post-anesthetic recovery. It can be used as a first-line anesthetic option in selected procedures, including tendon repairs and carpal tunnel release.

Reviewing the Potential Use of Curcumin Extract for Topical Therapy Supporting Burn Wound Healing

2024-12-25T05:58:37+00:00

Introduction: Wound dressing is a fundamental aspect of modern healthcare, encompassing a diverse range of materials and techniques aimed at optimizing the healing process while safeguarding against infection and further injury. By understanding the specific benefits of different types of wound dressings, healthcare professionals can optimize the healing process and improve patient outcomes

Methods: This literature review was compiled using information from numerous open access web databases. Data were compiled and analyzed.

Results and Discussions: Curcumin has the ability to improve burn wound healing. Curcumin can reduce inflammation by inhibiting proinflammatory cytokines. It also helps cell proliferation, and has an antimicrobial effect, therefore it speeds up burn wound healing and prevents keloid formation.

Conclusion: Curcumin has potential activity in speeding up burn wound healing, thanks to its anti-inflammation, antioxidant, and antimicrobial activity. However, due to low solubility in water of curcumin and its instability, further research must be done to find out better form for curcumin

Pregnancy Favism and Severe Hemolytic Anemia in a Patient with Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: A Case Report

2025-01-07T02:44:37+00:00

Introduction: Favism is a genetic disease-causing hemolytic anemia in Mexico, primarily due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Factors triggering favism include infections, pregnancy, certain drugs, and eating beans. The disease is inherited recessively and is more common in men. Diagnosing and managing favism during pregnancy is crucial, as it can lead to severe hemolytic anemia and neonatal jaundice.

Case presentation: A female patient, aged 18, presented with severe anemia and thrombocytopenia during her 20-week pregnancy. During pregnancy, the patient experienced jaundice and anemia at 21.5 weeks of gestation. Despite not presenting evidence of bleeding, transfusions were performed due to critical hemoglobin levels. G6PD deficiency was confirmed at 9 days of hospital admission, indicating severe hemolytic anemia.

Clinical discussion: The hemolytic crisis in a pregnant woman with favism was triggered by pregnancy and repeated infections of candidiasis. Clinical symptoms of hemolysis were confirmed through G6PD and Coombs tests, and blood transfusion was recommended to prevent complications. The patient's hemoglobin was monitored for signs of active intravascular hemolysis, and a folic acid tablet was recommended during the crisis. Post-crisis management involved periodic controls of hemoglobin, hematocrit, lactate dehydrogenase, and bilirubin.

Conclusion: Favism, a prevalent condition in Mexico, should be considered in patients with a family history of hemolytic anemia or compatible symptoms. Early diagnosis and proper management are crucial to prevent complications in the mother and fetus. A multidisciplinary approach, genetic counseling, and medical education are essential for effective management.

Recurrent Urinary Tract Infections with Multidrug Resistance Bacteria in a 50-Year-Old Man Living Donor Kidney Transplant Recipient with Adult Polycystic Kidney Disease: The Issues for Native Nephrectomy

2025-01-15T12:07:50+00:00

A 50-year-old man with polycystic kidney disease had living donor kidney transplant. Simultaneous right sided native nephrectomy was done to give a space for graft kidney. He developed three episodes of urinary tract infections within 2 months after transplant; one episode was associated with septic shock and rise serum creatinine. Two urine culture results taken two weeks apart revealed Klbsiella pneumoniae. It was sensitive to amikacin and resistant to nearly all antibiotics including quinolone, imepenum, colistin, cefepime and tigecycline. The remaining left native kidney was removed as the cysts were nidus to hide bacteria; no more recurrence after second nephrectomy.

Cutaneous Metastasis of Endometrial Adenocarcinoma: An Unusual and Dramatic Presentation of two Cases

2024-12-30T20:09:30+00:00

Skin metastases from endometrial adenocarcinoma, particularly cutaneous lymphangitis carcinomatosis, are rare. We present two cases of endometrial adenocarcinoma that recurred as lymphangitic carcinomatosis after presumed complete resection. Case 1 is a 71-year-old woman with a history of breast adenocarcinoma, who developed painful erythematous lesions and a verrucous plaque in the pubic area three months after surgery for endometrial adenocarcinoma. A skin biopsy confirmed carcinomatous lymphangitis, and she died four months later. Case 2 is a 56-year-old woman with stage IIB endometrioid adenocarcinoma, who developed erythematous plaques and lymphedema on the left thigh a year after treatment. A biopsy confirmed cutaneous lymphangitis carcinomatosis, and she died five months later. Cutaneous lymphangitis carcinomatosis is an uncommon form of skin metastasis, typically seen in breast cancer but rarely in endometrial adenocarcinoma. Early recognition is essential, as it can mimic benign dermatologic conditions. The prognosis is poor, with treatment often being palliative and ineffective. These cases highlight the importance of considering skin metastasis in patients with a history of gynecological cancer presenting with new cutaneous lesions.