International Journal of Medical Science and Clinical Research Studies

Prenatal Diagnosis of Anencephaly: A Case Report and Review of Literature

2024-11-04T10:18:56+00:00

Anencephaly is an inborn deformity of the central nervous system that results to the failure of closure of the cranial end of the embryologic neural tube, typically happens between the 23rd to 26th days after conception. It represents 40% of neural tube deformities, which is the second foremost cause of nervous system abnormalities after spina bifida. The occurrence rate is 1/1,000. Diagnosis is made by the 1st trimester ultrasound between the 11th and 14th week. Etiologies are multifactorial (toxic, metabolic, nutritional, iatrogenic and exceptionally chromosomal).

The importance of this case report is to highlight the role of imaging in the making prenatal diagnosis and thereby reiterating the usefulness of anomaly scan in pregnant women in our clime. Ultrasound is a non-ionizing imaging modality which is highly operator dependent and is repeatable.

Our case study is a 36-years-old woman Gravida 3 Para 1+2 (None Alive) at 24weeks 1day Gestation age (GA) who presented to the Radiology department for routine obstetric scan for the first time in index pregnancy. The obstetric ultrasound shows absence of the cranium in an active fetus with good cardiac activity (fetal heart rate =158bpm) with increase amniotic fluid in transverse lie. Frog eye sign was also appreciated. The placenta is sited anteriorly and not low lying. Femoral length (FL) measures 4.31cm with a GA of 24 weeks 1 day.

Bilateral Testicular Microlithiasis with Leydig Cell Hyperplasia: A Case Report

2024-09-23T03:26:39+00:00

Testicular microlithiasis is a rare finding in intratesticular pathology, and its association with Leydig cell hyperplasia is not widely reported. We present a case of such an association. 19-year-old male presented with bilateral testicular microlithiasis on ultrasound, and elevated tumor markers. Inguinal orchiectomy revealed Leydig cell hyperplasia. Discussion: Testicular microlithiasis is increasingly detected due to advancements in ultrasound technology, but its clinical significance remains unclear. Leydig cell hyperplasia, characterized by testicular nodules, is rarely associated with microlithiasis.

This case underscores the need for vigilance in evaluating testicular abnormalities, as severe microlithiasis and Leydig cell hyperplasia may mimic malignant lesions.

A Comprehensive Review of May-Thurner Syndrome: Pathophysiology, Clinical Manifestations, and Advanced Therapeutic Approaches

2024-11-04T11:33:20+00:00

May-Thurner Syndrome (MTS), also referred to as iliac vein compression syndrome, is an underrecognized vascular condition characterized by the extrinsic compression of the left common iliac vein by the overlying right common iliac artery. This mechanical obstruction predisposes patients to venous stasis, significantly increasing the risk of deep vein thrombosis (DVT) and chronic venous insufficiency. Although the precise prevalence of MTS remains uncertain due to its often asymptomatic presentation, the condition accounts for a considerable proportion of DVT cases in younger individuals, particularly women. This review aims to elucidate the pathophysiological mechanisms underpinning MTS, its clinical manifestations, diagnostic strategies including advanced imaging modalities, and both traditional and evolving therapeutic options. Emphasis will be placed on the use of endovascular techniques, such as stenting and catheter-directed thrombolysis, as well as the role of conservative management. Through a thorough analysis of current literature, this article will explore the long-term outcomes associated with different treatment approaches and the emerging role of precision medicine in tailoring therapies for patients with MTS.

Prevalence and associated factors of obesity among women of childbearing age in the communes of Bamako, Mali

2024-09-25T17:17:25+00:00

Background: Obesity and especially women's obesity is increasingly becoming a health problem in all countries, including low-income countries.

Objective: To assess the prevalence and associated factors of obesity among women of childbearing age in the communes of Bamako in Mali.

Methodology: Quantitative and analytical study using a questionnaire. The population of this study concerned obese women of childbearing age from the Communes of Bamako in Mali.

Results: This study included 384 women of childbearing age, more than half (59.3%) of whom were over 35 years of age. The prevalence of overweight among women of reproductive age in the district of Bamako was 30% and the prevalence of obesity was 27% at the time of the survey. The results reported a statistically significant relationship between body mass index and the following variables: age (p=0.04); education (p=0.03), consumption of sugary drinks (p=0.001); sleep duration (p=0.04), exercise (p=0.03) and history of obesity in the family (p=0.01).

Conclusion: This study provided clear evidence of an increase in overweight and obesity among urban women in the six communes of the Bamako district of Mali. It is therefore important to develop health promotion actions, focusing on healthy eating, physical activity, weight reduction in the district of Bamako, especially in the urban areas of Mali.

Quality of Life and Pulmonary Function after Lung Cancer Treatment: Systematic Review

2024-11-06T16:11:11+00:00

Introduction: Lung cancer is the leading cause of cancer-related death worldwide. Its treatment has a significant impact on the physical and psychological well-being of patients, resulting in a reduction in health-related quality of life (HRQoL) and pulmonary function.

Objective: To provide a detailed assessment of the available literature on the impact of lung cancer treatment on the quality of life and functioning of patients.

Methods: A systematic review was conducted using advanced searches in the databases The Cochrane Library Plus, PubMed, and Science Direct. The selected publications were thoroughly analyzed, and the PRISMA scale (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to display the selection process.

Results: A total of 51 articles were identified. Studies involving cancers other than lung cancer, or those that did not include questionnaires, spirometry tests, or the effects of physical exercise on patient outcomes, were subsequently excluded. After a full-text review, 11 articles met the previously defined criteria.

This literature review reveals that, in most of the studies examined, the quality of life of lung cancer patients tends to decline after treatment, reflecting the physical, emotional, and social challenges they face throughout the process.

Regarding lung function, the reviewed studies show that it deteriorates following treatment, resulting in a reduction in the patients’ respiratory capacity.

Conclusion: Although the results provide evidence of the impact of lung cancer and its treatment on various aspects of life, further research with larger sample sizes is necessary to validate these findings.

Efficacy and Safety of Sacubitril/Valsartan in the Management of Heart Failure with Preserved Ejection Fraction: A Comprehensive Review

2024-11-06T16:16:31+00:00

Heart failure with preserved ejection fraction (HFpEF) represents a significant clinical challenge due to its complex pathophysiology, limited therapeutic options, and growing prevalence, particularly in aging populations. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has emerged as a potential therapeutic intervention in HFpEF. While sacubitril/valsartan has demonstrated substantial benefits in heart failure with reduced ejection fraction (HFrEF), its role in HFpEF has been the subject of extensive clinical investigations. This review aims to evaluate the efficacy, safety, and clinical implications of sacubitril/valsartan in the treatment of HFpEF. We will discuss the pharmacological mechanisms of the ARNI combination, key clinical trials, and their outcomes, including the PARAGON-HF trial, and assess its impact on morbidity, mortality, functional status, and quality of life in HFpEF patients. Additionally, we will explore potential biomarkers for response to therapy and the relevance of phenotyping HFpEF subgroups to optimize therapeutic strategies.

The Nursing Training-Practice Gap: Which is This?

2024-11-08T14:54:24+00:00

Nursing training is a formally recognized program of study providing a broad and sound foundation in nursing sciences for the general practice of nursing. Nursing practice is the ways, means, methods, and manners nurses use to offer care professionally. Sometimes gaps exist between nursing training and practice. These gaps impede on better patient care and outcomes. This review is relevant in that the causes of the gaps have been exposed for use and the way forward in reducing the gap. The objectives of this review were; to expose the nursing training-practice gap, to explore the causes of the widening gap, and to describe strategies for bridging the gap. Sources of information included PubMed, Cochrane Library, Google Scholar, Web of Science Platform, organizations, and books. It has been observed that the nursing training-practice gap constitute a persistent universal nursing problem affecting patients, nursing students, novice and expert nurses and institutions and is widening. The causes of the widening nursing training-practice gap have been described to be; changing trends and pertain of diseases, lack of a bond between the training schools as an academic environment and the hospital as a clinical environment, liberalization of nursing education, discrepancies in applying theoretical knowledge to practice, inconsistencies between ideals and values, professional stress due to high workload, scarce supervision on nurses’ work, and unhealthy human attitudinal and behavioral factors. However, strategies to bridge the gap have also been provided to encompass, awareness creation, internships and apprenticeships in nursing training, preceptorship, facilitative supervision, continuous education, and evidence-based practice. This review is important in that nursing trainers, practitioners, and researchers could use the information for sensitization and reduction of the widening gap.

A Review of Preceptorship in Sustaining Nursing Training-Practice Congruence

2024-11-08T14:59:40+00:00

Preceptorship is a structured period during which a newly qualified practitioners is supported by an experienced professional to gain confidence and competence and transition from students to autonomous professionals. The nursing training-practice congruence is the harmony between theory from school and real practice. Preceptorship has been prescribed for maintaining this congruence since there frequently exist a nursing theory and practice discordance which jeopardizes patient care and outcomes. This review is relevant in that the concept, principles and the roles of the different actors of preceptorship have been explored. The objectives of this review were: to explore the concept of preceptorship, to outline the principles of preceptorship, to describe the roles of the actors of preceptorship, and to present the effectiveness of preceptorship in sustaining the nursing training-practice congruence. Sources of information included websites, journals, organizations, and text books. It was observed that preceptorship can take the forms of one-to-one, one-to-many, team and group approaches. The principles of preceptorship were, organizational culture, quality, preceptee empowerment, preparing preceptors, and preceptorship program. The roles of the preceptee included readiness to learn, active participation, engagement, accountability, being receptive to feedback, and attending meetings. The roles of the preceptor included induction, instructing, modelling, coaching, facilitating, supervision, and organizing meetings. The healthcare manager oversees the preceptorship program. Preceptorship is effective in increasing confidence, strengthening critical thinking, developing psychomotor, clinical and leadership skills, timely feedback, and enhancing communication and socialization. This review is important in that health care managers and employer could use the information to create preceptorship programs in the organizations.

Antibiotic Susceptibility Patterns and Mutations Associated with Isoniazid and Rifampicin Resistance in Non-Tuberculosis Mycobacterium Isolates from HIV-1 Infected and Uninfected Patients in Western Kenya

2024-10-28T07:55:59+00:00

Primarily among immunocompromised people, notably those living with HIV/AIDS, antimicrobial resistance (AMR) among non-tuberculous mycobacteria (NTM) has become a major public health issue. Though the main pathogen in such populations is Mycobacterium tuberculosis, the importance of NTM in causing AMR and complicating treatment plans is becoming more well known. Still, the causes of medication resistance in NTM especially in relation to HIV co-infection remain mostly unknown. This study sought to ascertain the antimicrobial susceptibility patterns of NTM isolates and identify genetic alterations linked with isoniazid and rifampicin resistance among HIV-1 infected and uninfected patients in Western Kenya. Adult HIV-1 infected individuals showing suspected pulmonary tuberculosis were subject to a cross-sectional analytical laboratory analysis. Samples of sputum were gathered; NTM isolates were grown and identified. The broth microdilution technique was used for antimicrobial susceptibility testing. Line probe tests aiming at the rpoβ, katG, and inhA genes helped to find genetic alterations linked to medication resistance. Of 167 participants, 59 NTM isolates were found; most often occurring species were M. intracellularae and M. fortuitum. Observed in 12.1%, 15.2%, and 15.2% of isolates respectively were resistance to isoniazid, rifampicin, and streptomycin. HIV-positive individuals had more frequent mutations in the rpoβ, katG, and inhA genes; medication resistance and HIV status had clear correlation. The study emphasises how different treatment resistance patterns and genetic alterations cause NTM infections in HIV-positive patients to be difficultly managed. Especially in resource-limited environments, these results highlight the importance of customised treatment plans and continuous monitoring of AMR in NTM.

A-28-Years-Old Man Received Kidney with Double Renal Arteries and Veins from Younger Sister: A Successful Laparoscopic Living Donor Nephrectomy

2024-11-09T11:18:53+00:00

A-28-years-old man living donor kidney transplant recipient received kidney from younger sister. The transplant team decided to leave the right kidney which had better function though left kidney had double renal arteries and veins. Laparoscopic left donor nephrectomy was done successfully. This is our first case of laparoscopic donor nephrectomy with double renal arteries and veins done in Aung Ban Hospital.

Eisenmenger Syndrome: Pathophysiology, Clinical Manifestations, and Contemporary Management Approaches in Advanced Cardiopulmonary Disease

2024-11-09T13:35:47+00:00

Eisenmenger syndrome, a complex and severe form of congenital heart disease, results from prolonged left-to-right shunting due to underlying cardiac defects such as ventricular septal defects, atrial septal defects, or patent ductus arteriosus, ultimately leading to irreversible pulmonary arterial hypertension and a reversal of the initial shunt. This syndrome represents the most severe spectrum of pulmonary vascular disease associated with congenital heart defects and is characterized by hypoxemia, erythrocytosis, and systemic cyanosis. Despite advances in early diagnosis and intervention in congenital heart disease, Eisenmenger syndrome remains a significant concern due to the irreversible nature of pulmonary vascular changes and associated multisystem complications. This article provides a comprehensive review of the pathophysiology, clinical manifestations, and the role of pharmacologic and non-pharmacologic therapies, including advanced palliative care, to improve patient quality of life. Emerging therapies such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclin analogs show promise in symptom management, though surgical interventions, such as heart-lung transplantation, remain reserved for selected cases. Given the high mortality associated with Eisenmenger syndrome, a multidisciplinary approach is critical in managing complications, improving patient outcomes, and supporting functional status.

Pseudo Renal Failure Secondary to Bladder Rupture due to Abdominal Trauma: Literature Review

2024-11-02T00:26:41+00:00

Rupture of the urinary bladder is an infrequent but potentially severe clinical event, commonly associated with abdominal trauma, though it can also occur spontaneously. These cases present diagnostic challenges due to nonspecific symptoms such as abdominal pain, nausea, and distension, which may delay treatment. The accumulation of urine in the peritoneum in cases of intraperitoneal rupture can lead to pseudo-renal insufficiency, characterized by increased blood creatinine and urea nitrogen without structural renal damage. This occurs due to the absorption of urinary solutes through the peritoneum, mimicking acute renal failure. Accurate diagnosis requires cystography through computed tomography to differentiate between intraperitoneal and extraperitoneal ruptures. Extraperitoneal injuries are usually managed with urethral catheterization, while intraperitoneal injuries often require surgical intervention. Timely treatment allows for the spontaneous reabsorption of urine in the peritoneum and normalizes serum levels within 24 hours, achieving recovery without long-term sequelae. Proper identification and management of this condition improve prognosis and reduce the risk of severe complications, making knowledge of this pathology essential in abdominal trauma contexts.

Clinical Perspectives on Tandem Spinal Stenosis: Addressing the Controversies in Surgical Management

2024-11-09T13:43:42+00:00

Introduction: Tandem spinal stenosis, characterized by narrowing at multiple spinal levels, often affects the cervical and lumbar regions and is linked to neurological deficits. Commonly stemming from degenerative or congenital changes, its prevalence increases with aging, especially for cervical myelopathy associated with lumbar stenosis. Diagnosis relies on imaging, with MRI offering precise evaluation of spinal compression and neural impact.

Review: This review examines tandem spinal stenosis management, noting ongoing debate on treatment approaches. While simultaneous decompression minimizes hospital time, staged surgery may reduce complications and tailor treatment to predominant symptoms. For patients with primary lumbar symptoms, cervical decompression has shown to alleviate lumbar issues due to motor pathway organization.

Conclusions: Tandem spinal stenosis requires early diagnosis and individualized treatment, especially as prevalence rises with an aging population. A tailored approach enhances therapeutic outcomes and supports better quality of life for affected patients.

Ulnar Nerve Decompression: A Case Report

2024-11-12T09:55:37+00:00

Cubital tunnel syndrome is a condition characterized by ulnar nerve dysfunction at the elbow due to a combination of compression, traction and friction. It is the second most common condition of the ulnar nerve, behind carpal syndrome. The incidence rate is 21 cases per 100,000 people per year. Although electromyographic abnormalities are present in 33% of carpal syndrome cases, individuals with cubital tunnel syndrome are four times more likely to experience severe symptoms, such as muscle atrophy and reduced sensation. If left untreated, the syndrome can lead to irreversible loss of sensation, muscle weakness, and posterior joint contractures.

A 54-year-old male with clinical manifestations presented for ulnar decompression. The procedure included medial and posterior ulnar nerve dissection, techno-epitrochlear olecranial dissection, ulnar nerve dissection, complete ulnar nerve dissection, and deformity in the arena region.

Research has shown that simple decompression can have comparable results to more extensive surgeries. In a prospective, nonrandomized study, 51% of men and 70% of women who received surgical treatment for ulnar tibial syndrome were referred for a simple procedure. However, the cause of continued pain after a basic procedure remains unclear. Transposition has been used to treat inseparable ulnar nerves in some series, but its efficacy in other cases remains uncertain.

Surgical Aortic Valve Replacement (SAVR) and Unexpected Complication: Critical Illness Related Corticoid Insufficiency (CIRCI). Case Report

2024-11-01T01:28:00+00:00

Cardiac surgery, particularly surgical aortic valve replacement (SAVR), presents high morbidity risks. This case report describes a 62-year-old male with severe aortic stenosis who developed critical illness-related corticosteroid insufficiency (CIRCI) following SAVR. Postoperatively, the patient exhibited persistent hypotension despite vasopressors, fever, and respiratory complications, along with metabolic disturbances and rapid atrial fibrillation. Adrenal insufficiency was confirmed by low cortisol levels, and hydrocortisone therapy led to clinical improvement. CIRCI remains a diagnostic challenge due to its subtle presentation, yet timely recognition is crucial in high-risk surgical contexts to prevent adverse outcomes.

Case Report: Mustardé Flap Perfom for Reconstruction of the Cheek in a Patient with Basal Cell Carcinoma in a Second Level of Care

2024-11-02T18:58:11+00:00

Basal cell carcinoma is the most common type of skin cancer, originating in the basal cells of the epidermis, the outermost layer of skin. It typically develops in areas frequently exposed to the sun, such as the face, neck, and arms.

BCC grows slowly and rarely metastasizes to other parts of the body, but if left untreated, it can cause significant local tissue damage.

It is present as a pearly or waxy bump, often with visible blood vessels. It may algo appear as a flat, scaly patch, sometimes with a rolled border.

Risk factors include prolonged UV exposure, fair skin a history of sunburns, and weakened immune system.
Treatment options include surgical excision, Mohs surgery, topical therapies, radiation, depending on the size, depth, and location of the tumor.
Prevention involves regular sun protection, such as using sunscreen and avoiding excessive sun exposure

Use of Esketamine in the Treatment of Depression: A Systematic Review of Clinical Evidence

2024-11-13T10:10:59+00:00

Introduction: Depression is a highly prevalent psychiatric condition and considered one of the leading causes of disability worldwide, affecting millions of individuals across different age groups and social contexts. Esketamine, a ketamine derivative, has emerged as a promising option for the treatment of resistant depression.

Objective: To synthesize the available evidence on the use of esketamine in depressed patients, focusing on its efficacy, safety, and possible limitations.

Methods: This study is a systematic review, classified as exploratory and descriptive. The research was carried out through bibliographic research in electronic databases on methods associated with SLR (Systematic Literature Review) and applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings).

Results: A comprehensive systematic search of the literature yielded a total of 1270 articles related to the topic addressed, of which 34 articles were eligible to compose this systematic review. Conclusion: With the advancement of research and the adaptation of health structures, the estimate has the potential to transform the management of resistance depression, significantly improving quality of life.