British Journal of Healthcare and Medical Research

Efficacy, Safety, and Ergonomics of the EMS Swiss Lithoclast® Trilogy in Percutaneous Nephrolithotomy: A Review

Muhammad Ishfaq — 2024-11-06

Purpose: The Swiss Lithoclast Trilogy® is a novel percutaneous nephrolithotomy (PCNL) technology used for kidney stone fragmentation. It has a trifecta effect, including mechanical fragmentation, ultrasound lithotripsy, and suction to remove stone fragments. Some comparative studies have reported a higher stone-free rate, increased safety and lower operative time, yet robust evidence remains inconclusive. We reviewed studies investigating clinical safety, efficacy, and ergonomics of PCNL for treating renal stones. Methods: We reviewed 11 studies investigating Swiss Lithoclast® Trilogy for PCNL from 2017 until September 2024. eywords were used to search PubMed, Google Scholar, Scopus and Web of Science databases for relevant studies. After applying eligibility criteria and excluding animal and laboratory studies, 11 studies were included in this systematic review. Data was extracted for efficacy, safety, and ergonomics and analyzed to synthesize the results. Results: Out of 11, 2 were retrospective cohorts and 09 were prospective studies. The Swiss Lithoclast® Trilogy exhibited higher efficacy in stone fragmentation and clearance than traditional techniques. For mini PCNL, the stone fragmentation rate was reported up to 15.75 ± 20.81 mm³/sec. For supine PCNL, the stone fragmentation rate was 20.33 +/- 27.83mm³/sec. Lastly, Swiss Lithoclast® Trilogy was associated with high ergonomic satisfaction, and no significant complications. Conclusions: EMS Swiss Lithoclast Trilogy® for PCNL exhibits efficacy and safety with variable ergonomics. However, limited data are available and further prospective and randomized trials comparing EMS Swiss Lithoclast® Trilogy with equivalent technologies for PCNL are warranted to determine its role relating to the stone type and procedure.

Nurses’ Attitudes Toward Death and Associations with Background Characteristics

Julie Vognsen — 2024-11-06

In the United States, the majority of deaths occur in a medical facility. As such, the nurses’ attitudes toward death are crucial. Thus, this study examined nurses’ attitudes toward death and the impacts of demographic variables on their attitudes. The Death Attitude Profile-Revised (DAP-R) survey was used, including three subsets: Anxiety toward death (fear and avoidance), escape acceptance (death as a way to escape life’s troubles), and neutral acceptance (neither anxious nor too accepting). A demographic survey documented background characteristics, including gender, state of residence, year of experience, ethnicity, and area of nurse practice. There was a total of 168 participants, excluding missing data. Descriptive statistics and multiple regression analyses were conducted. This study found that nurses had low anxiety, moderate to high escape, and high neutrality to death. Year of experience and area of nurse practice (management versus extended care) showed statistically significant effects on the escape attitude. No overall predicting models showed statistically significant effects on nurses’ anxiety and neutrality attitudes toward death. More experienced nurses might have less anxiety, and Caucasian nurses might have less neutrality than other nurses. Further research is warranted.

Intestinal Transplant: A Myth In México

Morelos Adolfo García Sánchez — 2024-11-26

Thrombotic Thrombocytopenic Purpura, Case Report and Literature Review

Valeria G. Sonda-May — 2024-11-16

Background: Thrombotic thrombocytopenic purpura is a rare entity that represents a diagnostic challenge due to clinical manifestations that may be nonspecific. In addition, the diagnostic approach requires expensive and poorly accessible laboratory tests (for example, measurement of ADAMTS13 enzyme activity levels). The first reported case was in 1924, described by Eli Moschcowitz in a 16-year-old girl who died suddenly and in whom the post-mortem biopsy showed thrombi in the kidney, heart and spleen. It is estimated that TTP has an annual incidence of 1.5 to 6 cases per 106 inhabitants, with a prevalence of 10 to 15 cases per 106 inhabitants, and is more frequent in the female sex with a female/male ratio of 2:1. Thrombotic thrombocytopenic purpura (TTP) is characterized by the concomitant appearance of often severe thrombocytopenia, microangiopathic hemolytic anemia, and multiple organ involvement due to ischemia secondary to the formation of thrombi in various parts of the vascular system. The organs most frequently affected are the brain, heart, and kidneys. Currently, it has been identified that the pathophysiology is related to the alteration in the enzyme metalloproteinase with thrombospondin motifs 13 (ADAMTS13), which has protease activity that is responsible for cleaving the ultra-long multimeric chains of the von Willebrand factor (vWF). These alterations can be congenital (recessive mutations of the ADAMTS13 gene) or acquired (formation of antibodies against ADAMTS13). In this review we present the clinical case of a woman from Merida, Yucatan, Mexico, who was admitted to the internal medicine service due to the presence of tension-type headache and jaundice of more than 1 month of evolution. During her care in the emergency room, laboratory studies documented data of intravascular hemolytic anemia and thrombocytopenia, with no involvement of other organs. An approach to autoimmune hemolytic anemia was started, later she presented clinical worsening, neurological involvement (psychosis), increased hemolysis and thrombocytopenia, empirical treatment with steroids was started without response, she was later evaluated by hematology who, due to the clinical characteristics she presented plus the finding of schistocytes in the peripheral blood smear, an approach for PTT was started requesting ADAMTS13 activity levels, and empirical management with plasmapheresis was started, presenting a favorable response. Days later, the results of the studies were collected, reporting 0% ADAMTS13 activity, confirming the diagnosis of PTT.

Methods: A search was performed for literature related to the epidemiology, pathophysiology, clinical manifestations, diagnosis, differential diagnosis and treatment of thrombotic thrombocytopenic purpura, as well as literature related to thrombosis, hemolysis, hemolytic anemia, thrombocytopenia, thrombotic microangiopathy, von Willebrand factor in open access search engines and databases such as PubMed, Springer Link, Science Direct, Web of Science and others. Results: We found and analyzed 80 articles that met the search criteria, of which we selected 34 articles with the most relevant information, and with a publication period of less than 10 years. Conclusions: Thrombotic thrombocytopenic purpura is a rare but potentially fatal disease. Its true incidence is unknown, since the clinical presentation is varied with many pathologies that share the same characteristics. In addition, laboratory tests to confirm the diagnosis are not routinely available. A timely diagnosis can improve the prognosis and survival of patients. Currently, there are more therapeutic alternatives available, reducing mortality, which in the past was over 90%, with plasma exchange being the intervention with the greatest benefit.

Anaesthetic Management of Severe Head Injuries at Chu-Kara

Essohanam Mouzou — 2024-11-16

The aim of the study was to take stock of the management of severe head trauma (SCT) at the CHU-Kara. This was a retrospective descriptive and analytical study carried out in the surgical intensive care unit of CHU-Kara from 1 January 2021 to 31 December 2023. 185 patients were studied. The sex ratio was 4.6. The average age was 34.68±18.78 years. Farmers were most affected (28.97%), followed by pupils and students (22.76%). The majority of patients (63.78%) came from the outskirts of Kara. Road accidents were the main cause (86.49%). Two-wheelers were involved in 96.87% of cases. 64.52% of patients had not worn a helmet. All patients had received non-medical transport. On admission, 86.65% had a Glasgow score ≤ 8. Fever and hyperthermia were present in 42.16% of cases ; 32.05% had presented with hypoxaemia. Lesions associated with TCG were found in 28.11% of cases with limb involvement. Anaemia was found in 36.75% of cases. CT lesions were dominated by cerebral contusions in 27.56% of cases. 45.95% of patients were treated within one hour. 98.37% of patients were treated medically. Complications occurred in 5.41% of cases and mortality was 69.73%. MCTs had a high mortality rate. The introduction of emergency medicine would considerably reduce this mortality rate.

Exploring the Effectiveness of Integrated Care Models for Managing Mental Health Issues

Kelechi Nelson Adindu — 2024-11-06

The global rise in mental health issues has exposed limitations in conventional healthcare systems' ability to deliver comprehensive and integrated care for individuals with complex mental disorders. In response, integrated care models have emerged as promising solutions, combining primary healthcare, specialized mental health services, and social support networks. This research investigates the efficacy of these integrated approaches in addressing mental health concerns, with a particular focus on their capacity to enhance care accessibility, improve patient outcomes, and elevate overall service quality. The study examines various integration models, such as collaborative care and patient-centered medical homes, to assess their impact on reducing healthcare fragmentation, enhancing care continuity, and promoting holistic treatment strategies. Research methods include systematic reviews of existing literature, case studies, and interviews with both healthcare professionals and patients. Conclusively, the study's findings aim to consolidate insights from contemporary research and practical examples to determine optimal practices and obstacles in deploying integrated care for mental health treatment. Furthermore, it delves into the prospects of cutting-edge technologies and cross-disciplinary partnerships to boost the effectiveness of these frameworks. Ultimately, this research seeks to contribute to the development of more effective, person-centered mental health care systems.

Micro-elimination of Hepatitis C Virus Infection in Thalassemic Patients

Maria Tampaki — 2024-11-15

Background and objectives: We aimed to deploy an intra-hospital Hepatitis C Virus (HCV) micro-elimination project for thalassemic patients in collaboration with 2 pediatric departments and 4 transfusion units. This initiative took place between 2013-2022 and included various HCV regimens according to existing treatments and reimbursement criteria per period. Methods: HCV screening was performed at the Transfusion units and Pediatric departments. Following HCV diagnosis, thalassemic patients were referred to our Hepatology department for HCV-RNA and genotype examination, evaluation of liver fibrosis and finally to administer treatment. Results: In total, 119 patients were treated with direct-acting anti-viral agents (DAAs) in our center. SVR was achieved in 110/119 (92.4%) with the first line DAAs available. The SVR rates were not significantly associated with treatment experience, the presence of cirrhosis or liver iron concentration values. Treatment was generally well tolerated, and no significant interactions were recorded between DAAs and chelation agents or other co-medications. All patients who failed in the 1^st line DAAs received 2^nd line treatment and achieved SVR. Conclusions: Close collaboration between hematologists and hepatologists facilitates HCV diagnosis and access to effective and safe treatments for thalassemic patients. Micro-elimination projects for this population should be a priority on the road to Global HCV elimination.

Studies on the Haematinic Potentials of Mucuna pruriens in Mice

Peter Uchogu Ahmadu — 2024-11-06

Background: Ethnopharmacological study of Mucuna pruriens, a creeping and leguminous plant used in the treatment of anaemia in the eastern part of Kogi State, Nigeria was carried out. The aim was to evaluate the effect of aqueous extract of the leaves of M. pruriens on haematinic activities in mice. Method: Leaves of M. pruriens was extracted by maceration in water. Phenyl hydrazine 4 mg/kg was administered for four days. Mice were grouped and treated with normal saline 10 ml/kg (normal and anemic control), M. pruriens (100, 200 and 400 mg/kg) and Fersolate (0.0214 mg/kg) p.o for 7 days. Hematological parameters measurements were carried out before treatments, days 1, 7, 14 and 21. The red blood cell count (RBC), haemoglobin concentration (Hb), white blood cell count (WBC) and hematocrit (HCT) were analyzed as indices of anemia. Phytochemical fingerprint using HPLC chromatography and mineral contents were also carried out. Results: Plant extraction percentage yield was 15%. M. pruriens (aq) significantly (p<0.01) produced a 61% recovery from anemia at 400 mg/kg after 7 days of treatment and between 94 to 146.52 % 1 and 2 weeks after treatment at all test doses. Hb, and HCT levels also significantly increased especially at 100 and 200 mg/kg doses of M. pruriens compared to the anemic control both at 1 and 2 weeks after treatment. HPLC analysis showed the presence of alkaloids, glycosides, saponin, terpernoids, carbohydrates, chlorogenic acid, caaffeic acid, rutin, ferulic acid and resins. The extract also contained substantial amounts of vitamins B6, C and E, as well as folic acid and iron. Conclusion: These results provide some evidence to support the traditional use of M. pruriens leaves in the treatment of anaemia.

Report of a Case of Cowper’s Gland Syringocele in an Adult Male Patient

Hatem Abdulkareem Abdulmajeed — 2024-11-26

Cowper’s gland syringocele is a rare and often underdiagnosed condition characterized by cystic dilatation of the Cowper’s gland ducts, presenting with various radiological patterns. This report details a unique case of a giant Cowper’s gland syringocele in an adult male, highlighting the MRI findings and management outcomes.

Pneumomediastinum in a Patient with Systemic Lupus Erythematosus with Pulmonary Renal Syndrome: Pneumomediastinum in a Patient with Systemic Lupus Erythematosus with Anca-P+ Pulmonary Syndrome

Sandra Ivette López Aguilar — 2024-11-24

Mandatory Vaccination for Children by Government in Brazil

Giulio Tarro — 2024-11-15

Taking the cue from the title reported, Brazilian parents of children are obliged from January 2024 to vaccinate their children from 6 months to 5 years with three doses of "Pfizer anti-Covid serum". Anyone who opposes risks losing parental authority: all this happens without the issuance of a law, but through a technical note from the Brazilian Ministry of Health, which has included the anti-Covid vaccine as mandatory for children as previously reported. In this age group, 142 children have died in 3 years of the pandemic, while the total number of Brazilian children is over 18 million, or 0.00025% of the population. Moreover, we do not know if the children who died had other pathologies: in Germany, not a single child died of COVID during the pandemic period ( HTTPS://pubmed.ncbi.nlm.nih.gov/35962242/ ). According to President Lula, "we must criminalize those who do not vaccinate their children". Fines of thousands of euros, loss of state subsidies and even parental authority are foreseen.

Effects of Miglitol on Caloric Efficiency and Lipid Profiles in Obese Male SHR/Ntul//-cp Rats

Orien L Tulp — 2024-11-15

Elevations in plasma lipid profiles are a common observation in overweight, obese, hyperinsulinemic, and adult-onset diabetes. The effects of luminal inhibition of starch digestion on parameters of weight gain and plasma lipid profiles were determined in groups of adult obese male T2DM SHR/Ntul//-cp rats. Animals were fed a USDA-formulated, nutritionally complete diet containing 54% sucrose (SUC, CHO) component (Control) or the same diet containing a pharmacologic α-glucosidase inhibitor (1,5 dideoxy-1,5-[(2-hydroxyethyl) imino]-D glucitol; generic miglitol), 150 mg/kg diet, ad libitum for up to 8 weeks. Miglitol resulted in modest decreases in food intake and net weight gain. At the end of the study. heparinized bloods were collected for determination of plasma cholesterol, low-density lipoprotein (LDL) and high density lipoprotein (HDL) fractions. The miglitol-associated luminal inhibition of glucosidase activity resulted in 20% reduction in total cholesterol, and in both α- (LDL) and β-lipoprotein (HDL) fractions. These results indicate that simple inhibition of luminal α-glucosidase activity via miglitol may be a useful adjunct in the clinical management of hypercholesterolemia in states of obesity, T2DM and other glucose intolerant states, in addition to therapeutic applications in enhancing and improving glycemic control in man and animals.

Integrating Conventional and Holistic Medicine for Precision and Personalized Diagnosis in Medical Laboratory Science

Yashim-Nuhu Andrew — 2024-11-15

The implementation of the combination of conventional and alternative medicine swing the new style in laboratory science known as personalized diagnosis or precision. Traditional approaches to disease mechanisms, such as genomic(-), proteomic-, and metabolomic analyses are informative. Lifestyle, environmental and psychosocial factors are frequently neglected. By performing a full assessment of individual health, gaps that are missed by standard medicine can be filled in holistic treatment. A combined approach of these methods is beneficial for a wide-ranging comprehension to address the disease manifold and enables based diagnostic and therapeutic concepts. The model seeks to improve diagnosis and treatment outcomes by considering both molecular determinants of health & disease, as well as contextual actors. Validating this integrative combination of technologies with a focus on personalized medicine will further post progress in improving clinical treatment.