Journal International Archives of Medicine-
International Archives of Medicine, Volume 11; doi:10.3823/2572
Abstract:Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by an irregular and extremely rapid atrial electrical activation that causes loss of atrial mechanical function and important hemodynamic consequences. AF classification is important in both the therapeutic approach and the prognosis. Several classifications based on the ECG patch, epicardial or endocavitary records have been performed over time, but no classification can take into account all the characteristics of AF and especially associated diseases, which may be both the cause and consequence of arrhythmia. Aim: The aim of the study is to establish the current profile of the patient with atrial fibrillation in the new era of oral anticoagulant therapy and sinus rhythm restoration. Material and methods: The trial was conducted on patients with atrial fibrillation hospitalized between 01.10.2014-31.03.2015 at Institute of Cardiovascular Diseases ”Prof. Dr. G. Georgescu”, Iasi. Patients included in the study were analyzed according to age and sex, criteria for the clinical and paraclinic definition for atrial fibrillation. Results: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our clinic. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, and valvulopathy are common in patients with AF. Patients with AF are usually elderly patients with many associated diseases in whom sinus rhythm restoration treatment and anticoagulant therapy are difficult to establish. AF is one of the most common arrhythmias that complicates the evolution of acute myocardial infarction, association between dual antiplatelet therapy and anticoagulation treatment, increasing the risk of bleeding complications. Conclusions: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our hospital. The data obtained revealed that this arrhythmia occurs in a small number of cases as the only pathology of the patient, usually associated with numerous comorbidities. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, valvulopathy are common in our practice. Patient with AF is a patient who requires long-term anticoagulant therapy and in whom sinus rhythm recovery therapy is dependent on the precocity of presentation to the physician, as well as on the therapeutic resources of current medicine.
International Archives of Medicine, Volume 11; doi:10.3823/2571
Abstract:Background Telemedicine is particularly useful in rural areas where can facilitate access to specialised care in regions far from urban hospitals and can prevent unnecessary travel. The purpose of this research was to evaluate the degree of resolution of an asynchronous teledermatology service in the Bages County, comparing urban and rural primary care centres. Methods and findings A longitudinal descriptive study of referrals from 14 Primary Care Teams to a hospital dermatology service as a result of a previous referral to a teledermatology program was performed, comparing years 2015 and 2016 and urban with rural practices. Both in urban and rural areas there was an increase in referrals to the teledermatology service in 2016 compared to the previous year (12.9% and 0.3% respectively). In the two years analysed, referral rates to the teledermatology service per thousand inhabitants from rural centres was statistically much higher than that of urban centres (p
International Archives of Medicine, Volume 11; doi:10.3823/2569
Abstract:Background:Glioblastoma with oligodendroglioma component (GBMO) is a recently classified subtype of glioblastoma, which carries different clinical and prognostic outcomes, being frequently misdiagnosed. Both glioblastoma and GBMO are mainly seen in older ages, such as the 5th and 6th decades of life, being an extremely rare occurrence in children or adolescents and more frequent in male patients. Case report: A 15-year-old girl, presented with history of daily headache, not relieved by painkillers, vomiting, blurred vision and strabismus. Magnetic resonance imaging of the brain revealed expansive tumour on left temporo-occipital lobe. Patient was submitted to intracranial exeresis, along with histopathological examination: glial neoplasm with areas of pleomorphism, hyperchromatism, anaplasia, foci of oligodendroglial component, perinuclear halo and ramified capillaries, resembling oligodendroglioma, necrosis and intense mitotic activity. The immunohistochemical analysis revealed positive Glial Fibrillary Acidic Protein (GFAP), synaptophysin, Ki-67 (MindBomb E3 ubiquitin protein ligase 1 – MIB-1)and hyperexpression of Epidermal Growth Factor Receptor (EGFR), indicating GBMO. Subsequently, Fluorescence in situ Hybridization (FISH) showed 1p/19q codeletion and Isocitrate Dehydrogenase 1 (IDH 1) mutation, suggesting an oligodendroglioma component. Tumour resection was total and symptoms disappeared. Afterwards, she started adjuvant oral chemotherapy with temozolomide. Treatment was completed nine months after the diagnosis, with no greater symptoms or complications and complete remission. Conclusion: GBMO must be considered as a possible diagnosis when confronted with a malignant glioma with oligodendroglial tumour component, independent of age or genre. Necrosis upon histopathological examination has a strong relation to shorter median overall survival. IDH mutation and 1p/19q codeletion should be analyzed by immunohistochemistry. Total tumour resection, with adjuvant treatment (chemotherapy with temozolomide and radiotherapy), increases benefits and improves prognosis.
International Archives of Medicine, Volume 11; doi:10.3823/2570
Abstract:Background: Anatomical knowledge of the facial vasculature is crucial not only for anatomists but also for oral and maxillofacial surgery, plastic surgeon, otorhinolaryngologists. Access pathways, pedicled and free flap transfer, and explantation and transplantation of total faces are based on the proper assessment and use of the facial veins and arteries. The anatomical variations reported in the present study confirms the need for preoperative vascular imaging for sure good venous outflow for the free flap survival. Aims: The aim of the present study was to describe a rare anatomical variation of the common facial vein which not been previously described. Methods and Findings: Head and neck region were carefully dissected as per standard dissection procedure, studied serially during the years 2013-2017 in 15 males and 2 females, i.e. 34 sides, embalmed adults cadavers with different age group, in the laboratory of Morphology of the University of Pamplona. In 33 sides (97 %) of the cases the anterior facial vein (FV) terminated into the internal jugular vein via the common facial vein (CFV) as per standard anatomic description. The right common facial vein in one side (3%) was found to drain into the contralateral internal thoracic vein and contralateral pericardiophrenic vein. Remarkable communications with the external jugular vein, the internal jugular vein, the anterior jugular vein, and left brachiocephalic vein. The length of the right common facial vein from the level of its formation till its termination in the contralateral pericardiophrenic and internal thoracic vein was about 22.75 cm. The venous drainage pattern on the left side of the face was found to be normal. Conclusion: The existence of this anatomical variation among others supposes a double edge sword in the medical practice with its own opportunities and risks, especially in the surgical treatment; therefore, we need to study with more strictness these possibilities with the aim of facilitate this practices, and improve the life quality of our patients.
International Archives of Medicine, Volume 11; doi:10.3823/2568
Abstract:Background: The current study estimated (a) the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b) the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG) compared to the costs under the status quo. Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP) losses associated with the disability-adjusted-life-years (DALYs) lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries). Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61%) was attributable to maternal conditions, AIDS, tuberculosis (TB), malaria, neglected tropicald diseases (NTDs), non-communicable diseases and traffic injuries. Approximately half (47%) of this cost could be avoided (or saved) every year if the 3 (health) targets of the SDG were fully met. Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.
International Archives of Medicine, Volume 11; doi:10.3823/2567
Abstract:Aim: The objective of this study was to investigate the performance of experimental resinous adhesives containing different combinations of photoinitiators systems through the bending test. Material and Methods: Resinous adhesive formulations were prepared with monomer mixtures consisting of 50% by mass of bisphenol dimethacrylate glycidyl (BisGMA) and 50% by mass of triethyleneglycol dimethacrylate (TEGDMA). The photoinitiators were used, camphorquinone (CQ) and bis-alkyl phosphinic oxide (BAPO). The co-initiators were diphenyliodonium hexafluorophosphate (DFI) and the amine (dimethylamino methylmethacrylate - DMAEMA) in the 1:1 proportion by mass. The photopolymerizable initiator systems were dissolved in the organic matrix at 0.5% by mass concentrations, creating eight groups (G1- CQ, G2- CQ/amine, G3- CQ/DFI, G4- CQ/amine/DFI, G5- BAPO, G6- BAPO/amine, G7- BAPO/DFI, G8- BAPO/amine/DFI). Samples with 7.0 mm in length, 2.0 mm wide and 1.0 mm height were prepared (n=12). The curing light used was VALO – Ultradent and the curing time was 20 s. The samples were subjected to evaluation of bending test at three points at a speed of 1 mm/min to evaluate the flexural resistance (FR). Results: The results were submitted to analysis of variance with one criterion (p < 0,001) and multiple comparisons were performed using Tukey test. Systems with the photoinitiator BAPO showed higher or equivalent bending values that demonstrated by the conventional system containing CQ/amine. Systems with the DFI had higher flexural values in relation to those demonstrated by systems without the DFI to CQ. Conclusion: The use of systems with alternative photoinitiators and co-initiators allows to obtain superior properties to the conventional system, making these promising systems to act both in isolation as associated with conventional systems.
International Archives of Medicine, Volume 11; doi:10.3823/2565
Abstract:Anemia is one of the major complications of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) and is associated with left ventricular hypertrophy and also increases morbidity and mortality. Anemia in patients with CKD can be due to two major reasons; iron deficiency or erythropoietin insufficiency. Erythropoietin Stimulating Agent (ESAs) administration is the mainstay in treating anemia if the patient is iron sufficient. However, higher doses of ESAs have been associated with increased cerebrovascular and cardiovascular events. We conducted this study to see how much erythropoietin is required in our setting in iron sufficient patients to maintain hemoglobin(Hb) level and the effect of dialysis frequency on ESA doses. Methods and Findings: A cross-sectional study was conducted at the Department of Nephrology at Ziauddin University Hospital. Patients’ charts were reviewed for Hb levels and doses of ESA to maintain Hb between 10-12 mg/dl. Patients were excluded if they had iron deficiency, malignancy, were on immunosuppressive agents, had renal transplant, and with Hb >12 mg/dl or
International Archives of Medicine, Volume 11; doi:10.3823/2561
Abstract:Background: This article estimates non-health gross domestic product (GDP) losses associated with Disability-Adjusted Life Years (DALY) lost among 15-59 year olds (most productive age bracket) in Kenya in 2015. Methods: This study employs the lost output or human capital approach (HCA) to convert the DALYs lost from all causes into their monetary equivalents. The magnitude economic haemorrhage from each disease was obtained by multiplying the per capita non-health GDP in International Dollars by the total number of DALYs lost in a specific age group (15-29 years, 30-49 years, 50-59 years). Per capita non-health GDP equals per capita GDP minus total health expenditure in 2015. Data on DALYs and per capita total health expenditure were obtained from the World Health Organization and per capita GDP data was from IMF databases. Results: Kenya lost 9,405,184 DALYs among 15-59 years olds in 2015. That DALY loss caused a haemorrhage in GDP of Int$ 29,788,392,419. Approximately 48.6% of the GDP haemorrhage resulted from communicable diseases and nutritional conditions, 37.4% from non-communicable diseases, and 14.0% from injuries. Conclusion: There is need to augment domestic and external investments into national health systems and other systems that meet basic needs (education, food, water, sanitation, shelter) to reduce disease burden. Key words: Non-health GDP, economic haemorrhage, disability-adjusted life year (DALY)
International Archives of Medicine, Volume 11; doi:10.3823/2563
Abstract:Objective: Evaluate the performance of primary health care in control of leprosy in Teresina, Brazil from the perspective of users and professionals. Methods: This cross-sectional, descriptive study involved 25 healthcare users with leprosy and 34 professionals (physicians and nurses) working in 13 municipal health units within the urban area of Teresina. The data were collected from January to June, 2017, using the Instrument for Assessing the Performance of Primary Care in Leprosy Control Actions, a document based on the Primary Care Assessment Tool/PCATool Brasil which measures the presence and extension of essential and derived attributes from primary health care. Results: The mean scores obtained for the essential, derived and global attributes, through the perception of the users, were lower than 6.6, indicating that the primary health services in Teresina are not sufficiently oriented to carry out leprosy control actions, mainly in terms of access, integrality of services provided, family orientation and community orientation. The professionals showed a contrasting view, with averages exceeding 6.6 for all attributes and scores. The difference in perception between the groups was significant for all attributes except for coordination (Mann-Whitney U test, p = 0.479).The overall evaluation of quality was not influenced by the user’s clinical or socioeconomic variables, but rather by the organization/provision of services. Conclusions: The municipal health units within the urban area of Teresina must be strongly guided by primary health care attributes in order to reach higher levels of user satisfaction.
International Archives of Medicine, Volume 11; doi:10.3823/2556
Abstract:Background: To identify the body and health perception and its relationship with obesity in a group of young adults. Methods: This is an analytical study performed on 1,073 young adults from Fortaleza, Ceará, Brazil, through a questionnaire whose data were analyzed by descriptive statistics and logistic regression. The Ethics Committee approved the study under opinion nº 263.271/ 2013. Results: Results showed that women with obesity tended to perceive their condition more and evidenced greater body dissatisfaction than men. In addition, they were associated with obesity, self-perception of overweight and body satisfaction. Conclusion: Young people with obesity perceive their condition and are dissatisfied with it.