Nevin Manimala

World J Clin Cases. 2024 Jul 16;12(20):4041-4047. doi: 10.12998/wjcc.v12.i20.4041.

ABSTRACT

BACKGROUND: Obstructive sleep apnea hypoventilation syndrome (OSAHS) in children is a sleep respiratory disorder characterized by a series of pathophysiologic changes. Statistics in recent years have demonstrated an increasing yearly incidence.

AIM: To investigate the risk factors for OSAHS in children and propose appropriate management measures.

METHODS: This study had a case-control study design. Altogether, 85 children with OSAHS comprised the case group, and healthy children of the same age and sex were matched at 1:1 as the control group. Basic information, including age, sex, height, weight and family history, and medical history data of all study participants were collected. Polysomnography was used to detect at least 8 h of nocturnal sleep. All participants were clinically examined for the presence of adenoids, enlarged tonsils, sinusitis, and rhinitis.

RESULTS: The analysis of variance revealed that the case group had a higher proportion of factors such as adenoid grading, tonsil indexing, sinusitis, and rhinitis than the control group.

CONCLUSION: A regression model was established, and glandular pattern grading, tonsil indexing, sinusitis, and pharyngitis were identified as independent risk factors affecting OSAHS development.

PMID:39015923 | PMC:PMC11235552 | DOI:10.12998/wjcc.v12.i20.4041

World J Clin Cases. 2024 Jul 16;12(20):4074-4081. doi: 10.12998/wjcc.v12.i20.4074.

ABSTRACT

BACKGROUND: Breast cancer (BC) is the second leading cause of tumor-related mortality after lung cancer. Chemotherapy resistance remains a major challenge to progress in BC treatment, warranting further exploration of feasible and effective alternative therapies.

AIM: To analyzed the quality of life (QoL) and survival of patients with BC treated with integrated traditional Chinese and Western medicine (TCM-WM).

METHODS: This study included 226 patients with BC admitted to the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine between February 2018 and February 2023, including 100 who received conventional Western medicine treatment (control group) and 126 who received TCM-WM treatment (research group). The total effective rate, side effects (alopecia, nausea and vomiting, hepatorenal toxicity, and myelosuppression), QoL assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), 1-year overall survival (OS), recurrence and metastasis rates, and serum inflammatory factors [interleukin (IL)-6, IL-10, and tumor necrosis factor alpha] were comparatively analyzed.

RESULTS: The research group showed statistically better overall efficacy, EORTC QoL-C30 scores, and 1-year OS than the control group, with markedly lower side effects and 1-year recurrence and metastasis rates. Moreover, the posttreatment levels of serum inflammatory in the research group were significantly lower than the baseline and those in the control group.

CONCLUSION: Overall, TCM-WM demonstrated significantly improved therapeutic efficacy while ensuring drug safety in BC, which not only improved patients’ QoL and prolonged survival, but also significantly inhibited the inflammatory response.

PMID:39015919 | PMC:PMC11235521 | DOI:10.12998/wjcc.v12.i20.4074

World J Clin Cases. 2024 Jul 16;12(20):4206-4216. doi: 10.12998/wjcc.v12.i20.4206.

ABSTRACT

BACKGROUND: Colorectal polyps are frequently observed in patients with type 2 diabetes mellitus (DM), posing a significant risk for colorectal cancer. Metformin, a widely prescribed biguanidine drug for type 2 DM, has been suggested to have potential chemoprophylactic effects against various cancers.

AIM: To explore the correlation between colorectal polyps and metformin use in type 2 DM patients.

METHODS: Type 2 DM patients were categorized into polyp and non-polyp groups. Following this, all patients were categorized into the type 2 DM-metformin, type 2 DM-non-metformin, and non-type 2 DM groups. Based on the baseline colonoscopy results, we performed pairwise comparisons of the incidence of colorectal polyps among the three groups. Additionally, we analyzed the relationship between colorectal polyps and the duration of metformin use and between the size and number of polyps and metformin use. Simultaneously, we focused on the specific pathological types of polyps and analyzed their relationship with metformin use. Finally, we compared the incidence of polyps between metformin and non-metformin groups according to the interval colonoscopy results.

RESULTS: The rate of metformin use in patients with colorectal polyps was 0.502 times that of patients without colorectal polyps [odds ratio (OR) = 0.502, 95% confidence interval (CI): 0.365-0.689; P < 0.001]. The incidence of colorectal polyps did not differ significantly between the type 2 DM-metformin and non-type 2 DM groups (P > 0.05). Furthermore, the correlations between the duration of metformin use and the incidence of colorectal polyps and between the size and number of polyps and metformin use were not statistically significant (P > 0.05). Metformin use did not affect the incidence of colorectal polyps during interval colonoscopy (P > 0.05).

CONCLUSION: Metformin use and colorectal polyp incidence in type 2 DM patients showed a negative correlation, independent of the hypoglycemic effect of metformin.

PMID:39015918 | PMC:PMC11235560 | DOI:10.12998/wjcc.v12.i20.4206

World J Clin Cases. 2024 Jul 16;12(20):4191-4198. doi: 10.12998/wjcc.v12.i20.4191.

ABSTRACT

BACKGROUND: Tuberculosis (TB) is a chronic respiratory infectious disease that considerably jeopardizes human health, and there is no effective vaccine suitable for its prevention in the entire population.

AIM: To investigate the promotion of medication adherence and disease cognition in patients with drug-resistant (DR-)TB using detailed nursing management.

METHODS: In total, 114 patients with DR-TB who were diagnosed and treated at our hospital between January 2019 and January 2023 were included in this study. Patients in the control group (n = 57) were managed with conventional nursing care, while those in the observation group (n = 57) were managed with detailed nursing care. Medication adherence, disease awareness scores, medication safety, and nursing satisfaction were compared between the two groups after the intervention.

RESULTS: The post-intervention medication compliance rate was 91.23% in the observation group and 75.44% in the control group, with the former being 15.79% higher than the latter (P < 0.05). There was no statistically significant difference in the disease awareness scores between the two groups before the intervention; the disease awareness scores of the observation group were significantly higher than those of the control group after the intervention (P < 0.05). The incidence of gastrointestinal reactions, joint swelling and pain, hearing loss, electrolyte disorders, and liver and kidney function abnormalities were lower in the observation group than those in the control group. The total nursing satisfaction of the observation group was higher than that of the control group (P < 0.05).

CONCLUSION: Implementation of detailed nursing management for patients with DR-TB can effectively improve medication adherence, enhance awareness of the disease, ensure safety of medication, and improve satisfaction with nursing care.

PMID:39015906 | PMC:PMC11235556 | DOI:10.12998/wjcc.v12.i20.4191

World J Clin Cases. 2024 Jul 16;12(20):4166-4173. doi: 10.12998/wjcc.v12.i20.4166.

ABSTRACT

BACKGROUND: Severe pneumonia is a common severe respiratory infection worldwide, and its treatment is challenging, especially for patients in the intensive care unit (ICU).

AIM: To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.

METHODS: We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1, 2021 and December 31, 2023. We compared and analyzed the respiratory mechanical indexes [airway resistance (Raw), mean airway pressure (mPaw), peak pressure (PIP)], blood gas analysis indexes (arterial oxygen saturation, arterial oxygen partial pressure, and oxygenation index), and serum inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT), cortisol (COR), and high mobility group protein B1 (HMGB1)] of all patients before and after treatment.

RESULTS: Before treatment, there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups (P > 0.05). However, after treatment, the respiratory mechanical indexes of patients in both groups were significantly improved, and the improvement of Raw, mPaw, plateau pressure, PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group (P < 0.05). The serum CRP and PCT levels of patients were significantly decreased, and the difference was statistically significant compared with that of nursing group alone (P < 0.05). The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.

CONCLUSION: The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators, blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

PMID:39015892 | PMC:PMC11235529 | DOI:10.12998/wjcc.v12.i20.4166

World J Clin Cases. 2024 Jul 16;12(20):4256-4264. doi: 10.12998/wjcc.v12.i20.4256.

ABSTRACT

BACKGROUND: Dyslipidemia is a common complication in patients with diabetes mellitus (DM) that increases the risk of cardiovascular disease. Genetic polymorphisms have been implicated in the development of dyslipidemia.

AIM: To investigate the association between polymorphisms of candidate genes involved in lipid metabolism and dyslipidemia in Chinese patients with DM.

METHODS: A cross-sectional study was conducted on 1098 Chinese patients with DM recruited from multiple healthcare centers. Demographic and clinical data were collected, and dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Genomic DNA was extracted from blood samples and genotyping for selected polymorphisms of candidate genes (APOE, LPL, CETP, and others) was performed using PCR and DNA sequencing techniques. Statistical analyses were performed using logistic regression models adjusted for potential confounding factors.

RESULTS: The study population consisted of 578 males (52.6%) and 520 females (47.4%), with a mean age of 58.4 ± 12.2 years. The prevalence of dyslipidemia was 64.8%. Significant associations were found between dyslipidemia and the APOE rs7412 T/T, APOE rs429358 C/C, LPL rs328 G/G, and CETP rs708272 G/G genotypes after adjusting for covariates. Subgroup analyses showed generally consistent associations across subgroups, although some variations in effect sizes were observed.

CONCLUSION: This study identified significant associations between genetic polymorphisms of APOE, LPL, and CETP genes and dyslipidemia in Chinese patients with DM.

PMID:39015887 | PMC:PMC11235528 | DOI:10.12998/wjcc.v12.i20.4256

Front Psychiatry. 2024 Jul 2;15:1352288. doi: 10.3389/fpsyt.2024.1352288. eCollection 2024.

ABSTRACT

INTRODUCTION: After the war in Syria, many people were forcibly displaced, and many others migrated to foreign countries. Many Syrians have been exposed to traumatic negative lifeexperiences during this process. In this context, this study was carried out to investigate the effects of pre- and post-migration traumatic experiences and living difficulties on the development of post-traumatic stress disorder (PTSD) in Syrian refugees who have been residing in Turkey for more than five years.

METHODS: The sample size of this cross-sectional study consisted of 200 Syrian refugees. Research data were collected using a self-report questionnaire. Refugees’ depression and anxiety levels were assessed with The Hopkins Symptom Checklist-25 (HSCL-25), and post-traumatic stress disorder (PTSD) symptoms were assessed with the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5). Logistic regression models were created to assess the effects of pre- and post-migration traumas, adverse events, and other sociodemographic variables, including age and gender, on PTSD.

RESULTS: The study unveiled a high prevalence of PTSD (55.5%), depression (33.5%), and anxiety(4.5%) among participants. Notably, male refugees and those exposed to armed conflict exhibited a significantly higher frequency of PTSD. In contrast, depression was more prevalent among female participants. Pre-migration traumatic experiences, especially near-death situations, were identified as significant predictors of PTSD. Interestingly, while pre-migration traumatic experiences were higher, post-migration living difficulties also emerged as a concern, with factorslike “inability to return home in emergencies” and “worries about losing ethnic identity” beinghighlighted. Path analysis further revealed that pre-migration traumatic experiences indirectly contributed to PTSD by exacerbating post-migration living difficulties.

DISCUSSION: Syrian refugees in Turkey, even after long-term residence, exhibit high rates of PTSD, depression, and anxiety. While pre-migration traumas play a pivotal role, post-migration challenges further compound their mental health issues. These findings underscore the need for holistic, long-term mental health interventions that address both past traumas and current living difficulties.

PMID:39015884 | PMC:PMC11250486 | DOI:10.3389/fpsyt.2024.1352288

Cureus. 2024 Jun 15;16(6):e62453. doi: 10.7759/cureus.62453. eCollection 2024 Jun.

ABSTRACT

Introduction Adenoid tissue is part of the first line of immunity of the upper aero-digestive tract. It is located in the postero-superior wall of the nasopharynx behind the choana. Adenoid hypertrophy, a common childhood disorder, significantly contributes to the pathogenesis of otitis media with effusion (OME), which is the leading cause of hearing impairment in young children. This condition can result in delayed speech, poor academic performance, and language development issues. Assessing the size of the adenoids and their correlation with OME is crucial, as undiagnosed cases can lead to complications such as atelectasis of the tympanic membrane and cholesteatoma. Clinical examination of the nose alone is often insufficient, and children do not cooperate for nasal endoscopy. Therefore, a lateral radiograph of the skull is considered the most reliable method for assessing the adenoid size. The size of the adenoids can affect Eustachian tube patency, which is reflected in the results of impedance audiometry. This study aimed to correlate the size of adenoids with impedance audiometry findings. Methods This cross-sectional observational study was conducted in the Department of Otorhinolaryngology of a tertiary care hospital from October 1, 2022, to March 31, 2024. A sample size of 50 patients was taken for the study. The inclusion criterion of selection of the patients included patients aged 3 to 15 years, who suffered from recurrent attacks of upper respiratory tract infections, particularly those with adenoid facies confirmed by X-ray with a non-perforated tympanic membrane. Exclusion criteria encompassed patients below 3 or above 15 years, and those with acute or chronic suppurative otitis media, craniofacial anomalies, or nasal pathologies like polyps. Adenoids were graded using X-ray imaging of the nasopharynx, and correlations between the adenoid size and impedance audiometry findings, such as middle ear pressure and compliance, were analyzed. Results The study assessed the relationship between the adenoid size and impedance audiometry findings, focusing on middle ear pressure and compliance, as well as the occurrence of OME. The results indicated a significant decline in middle ear pressure with increasing adenoid grades. Specifically, adenoid grade 1 had an average pressure of -3.50 daPa, while grade 4 had the lowest average pressure at -119.72 daPa. This trend was statistically significant with a p-value of 0.00042. Similarly, compliance values also decreased with higher adenoid grades. Grade 1 had an average compliance of 0.64 ml, whereas grade 4 had the lowest average compliance at 0.28 ml. This relationship was statistically significant, as indicated by a p-value of 0.0048. Additionally, the analysis showed that a significant majority of patients with enlarged adenoids also presented with OME, highlighting a strong association between adenoid hypertrophy and this condition. Conclusion The study concluded that larger adenoids were associated with lower middle ear pressure and reduced compliance. Additionally, a significant majority of patients with enlarged adenoids also had OME. This underscores the importance of evaluating adenoid hypertrophy in the context of OME due to its potential impact on childhood hearing and development.

PMID:39015869 | PMC:PMC11250518 | DOI:10.7759/cureus.62453

Cureus. 2024 Jun 16;16(6):e62481. doi: 10.7759/cureus.62481. eCollection 2024 Jun.

ABSTRACT

INTRODUCTION: Cerebral palsy (CP) is a complex pathological entity that affects muscular control, coordination, proprioception, fine and gross motor abilities, position, stability, and, in some cases, cognition. This study aimed to compare the effects of whole-body vibration therapy (WBVT) in weight bearing and non-weight bearing positions for the upper and lower extremities on balance and cervical joint position sense in children with spastic CP.

METHODS: A randomized controlled trial was carried out on 60 hemiplegic children with spastic CP aged 5-15 years. Following randomization, all participants were allocated into six equal-sized groups based on the application of WBVT for upper extremities, lower extremities, or both simultaneously in either weight-bearing or non-weight-bearing positions. Pediatric balance scale (PBS) and laser tracker system were used to assess functional balance and cervical joint position sense.

RESULTS: One-way analysis of variance for Inter-group analysis showed a statistically significant difference among all groups in PBS and cervical joint position sense (p<0.05).

CONCLUSION: WBVT was found to be beneficial in improving balance and cervical joint position sense in both weight-bearing and non-weight-bearing positions for the upper and lower extremities in children with cerebral palsy. However, the simultaneous application of WBVT in weight-bearing positions for both upper and lower extremities showed the most significant improvements in improving both balance and cervical joint position sense, indicating the most efficacious position of this treatment approach in children with cerebral palsy.

PMID:39015866 | PMC:PMC11251659 | DOI:10.7759/cureus.62481

Cureus. 2024 Jun 16;16(6):e62477. doi: 10.7759/cureus.62477. eCollection 2024 Jun.

ABSTRACT

Introduction Data regarding clinical outcomes after transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with sarcoidosis is lacking. This study aims to clarify the clinical outcomes of TAVR vs SAVR in patients with sarcoidosis. Methods Data was collected from the National Inpatient Sample database from 2016-2019 using validated ICD-10-CM codes for sarcoidosis, TAVR, and SAVR. Patients were divided into two cohorts: those who underwent TAVR and those who underwent SAVR. Statistical analysis was performed using Pearson’s chi-squared test to determine clinical outcomes of TAVR vs SAVR in patients with sarcoidosis. Results The prevalence of sarcoidosis was 0.23% among total study patients (n=142,420,378). After exclusions, the prevalence of TAVR was 650 (49%) and SAVR was 675 (51%) in patients with sarcoidosis. Patients who underwent TAVR were on average older (74 vs 65 years old, p=0.001), and more likely to be female (57 vs 40%, p<0.001) compared to patients who underwent SAVR. The TAVR cohort had higher rates of congestive heart failure (CHF) (77.7 vs 42.2%, p=0.001), chronic kidney disease (CKD) (42.3 vs 24.4% p=0.001), anemia (5.4 vs 2.2%, p=0.004), percutaneous coronary intervention (PCI) (1.5 vs 0%, p=0.004), and hypothyroidism (31.5 vs 16.3%, p=0.001) compared to the SAVR cohort. Inpatient mortality post-procedure was higher in the SAVR cohort compared to the TAVR cohort (15 vs 0, p=0.001). Regarding post-procedure complications, respiratory complications were more common in the SAVR cohort (4.4 vs 0%, p=0.001), while TAVR was associated with a higher incidence of permanent pacemaker (PPM) insertion (2.15 vs 0.8%, p=0.001). There was no statistical difference in the development of acute kidney injury (AKI) (0.8 vs 1.5%, p=0.33), AKI requiring hemodialysis (0 vs. 0.7%, p=0.08), or stroke (0.8 vs 0.7, p=1) post-procedure between the two cohorts. Conclusion This study found that in the sarcoidosis population, TAVR was associated with reduced mortality, shorter hospital length of stay, and lower hospitalization costs in comparison to SAVR.

PMID:39015863 | PMC:PMC11251442 | DOI:10.7759/cureus.62477