The 50 most-cited articles in Cureus, 2017

Antibiotics are the 'wonder drugs' to combat microbes. For decades, multiple varieties of antibiotics have not only been used for therapeutic purposes but practiced prophylactically across other industries such as agriculture and animal husbandry. Uncertainty has arisen, as microbes have become resistant to common antibiotics while the host remains unaware that antibiotic resistance has emerged. The aim of this review is to explore the origin, development, and the current state of antibiotic resistance, regulation, and challenges by examining available literature. We found that antibiotic resistance is increasing at an alarming rate. A growing list of infections i.e., pneumonia, tuberculosis, and gonorrhea are becoming harder and at times impossible to treat while antibiotics are becoming less effective. Antibiotic-resistant infections correlate with the level of antibiotic consumption. Non-judicial use of antibiotics is mostly responsible for making the microbes resistant. The antibiotic treatment repertoire for existing or emerging hard-to-treat multidrug-resistant bacterial…

About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers' awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.

Acute gastrointestinal obstruction can have a varied spectrum of clinical presentation and etiologies. It has been studied in detail and the management criteria have been well defined for the most part in our era. The etiologies are usually well defined. However, acute small bowel obstruction (SBO) due to intussusception caused by an inverted Meckel's diverticulum is a rare phenomenon that is often times missed on initial presentation and/or consequently until resected and visualized on pathological examination. We present a case of a 34-year-old presenting with symptoms and signs of acute intestinal obstruction and radiographic exam showing ileo-ileal intussusception. The patient failed to improve initially following conservative management and was taken to the operating room for small bowel resection which then revealed an inverted Meckel's diverticulum.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs with analgesic, anti-inflammatory, and antipyretic activity. Their effect is achieved by the reduction in synthesis of prostanoids. Inhibition of prostanoids is responsible for a substantial risk of adverse effects. The risk of side effects affecting the gastrointestinal tract and kidneys has long been known. The possibilities of blood pressure elevation and the development of congestive heart failure are also widely recognized. Increased incidence of acute myocardial infarction in clinical trials with rofecoxib drew attention to the potential cardiotoxicity of selective cyclooxygenase-2 inhibitors, and similarly, concerns have been raised regarding the cardiovascular safety of non-selective NSAIDs. The safety of NSAIDs with regards to cardiovascular events has been studied in recent years in a large number of retrospective and prospective clinical studies and meta-analyses. The results indicate that cardiotoxicity is a class effect, but the magnitude of the risk is widely variable between individual NSAID drugs. This article…

This study was undertaken to review the health care status in the Gulf Cooperation Council (GCC) member states, and explore current challenges and future opportunities. Available data was acquired using databases including PubMed, Embase, and Cochrane Library. The data gathered was then combined and the expert authors in the field discussed and propose strategies to overcome the challenges. There is an increase in both population and health care needs of GCC States citizens and migrant workers. The huge emigrant population challenges the capability of the already limited available health care resources. The region is faced with a quadruple disease burden that includes communicable and non-communicable diseases, mental health issues and accidental injuries. Recent advances in technology have made breakthroughs in diagnosis and treatment modalities but with an increase in overall health care cost. Innovative and cost-effective strategies are required to cater the health care needs of people living in the GCC states. Policy makers should emphasize the need to prioritize and strengthen…

Chronic renal failure (CRF) is the most prevalent, worldwide public health problem of the elderly population. The main cause of CRF is a damaged kidney. There are five stages of CRF based on the glomerular filtration rate (GFR), and stage 5 (GFR < 15 ml/min/1.73m2) is often called an end-stage renal disease (ESRD). In CRF, there is an accumulation of toxins and excess water due to compromised renal function. Dialysis is the preferred way to treat ESRD and remove accumulated toxins from the body. The cardiovascular risk associated with dialysis is 10 to 20 times higher in patients undergoing dialysis than in normal people. The inflamed kidneys and the process of dialysis also affect endothelial function, aggravating the risk of hypertension and cardiac problems. Therefore, both physicians and patients should be aware of the consequences of undergoing dialysis. There is an urgent need to educate CRF patients regarding facts about the disease, medications, dietary habits, and various measures required to manage the condition and lead a normal life. This paper attempts to delineate the…

Inflammatory bowel disease (IBD) is a chronic condition involving the inflammation of the colon and small intestine. IBD affects as many as 1.4 million people in the U.S. alone and costs the health care industry over $1.7 billion annually. Managing IBD normally requires invasive and often discomforting diagnostic tests. In an effort to alleviate the painful and costly nature of traditional diagnosis, there has been increasing research initiative focused on noninvasive biomarkers. PubMed, provided by the United States National Library of Medicine (NLM) at the National Institutes of Health, was utilized with the following search terms: 1) myeloperoxidase (MPO) 2), inflammatory bowel disease (IBD), and 3) neutrophils. The following terms were used interchangeably with search terms 1-3: 4) costs, 5) biomarkers, 6) review, and 7) etiology. In the context of IBD, myeloperoxidase (MPO), a lysosomal protein found in neutrophils, may serve as a viable biomarker for assessing disease status. Several studies demonstrated increased levels of neutrophils in patients with active IBD. Furthermore,…

INTRODUCTION: Networks of cytokines have been implicated in both forms of inflammatory bowel disease (IBD): Crohn's disease (CD) and ulcerative colitis (UC). While CD has associated with T-helper type 1 (Th1) immune responses, UC shows Th2 patterns. Recent studies reported that the inflamed intestinal regions in both CD and UC are significantly infiltrated with a newly described set of T helper, the Th17 cells. These cells have unique cytokine responses. These findings prompted us to further explore the cytokine profiles of CD and UC with a special focus on the Th2 and Th17 related mediators. METHODS: Cytokine transcripts were compared using real-time polymerase chain reaction (PCR) in both inflamed and non-inflamed mucosal specimens from patients with active CD (n=35) or UC (n=20) and without CD or UC (Control, n=54). RESULTS: In both CD and UC, interleukin (IL)-12 (p40), IL-18, IL-21 and IL-27 transcript levels were higher than in Control. The highest levels of cytokines were found in the diseased areas of CD and UC with only one exception; IL-12 (p40) in CD was more up-regulated…

Rapid Cycle Deliberate Practice (RCDP) is a novel simulation-based education model that is currently attracting interest, implementation, exploration and research in medical education. In RCDP, learners rapidly cycle between deliberate practice and directed feedback within the simulation scenario until mastery is achieved. The objective of this systematic review is to examine the literature and summarize the existing knowledge on RCDP in simulation-based medical education. Fifteen resources met inclusion criteria; they were diverse and heterogeneous, such that we did not perform a quantitative synthesis or meta-analysis but rather a narrative review on RCDP. All resources described RCDP in a similar manner. Common RCDP implementation strategies included: splitting simulation cases into segments, micro debriefing in the form of 'pause, debrief, rewind and try again' and providing progressively more challenging scenarios. Variable outcome measures were used by the studies including qualitative assessments, scoring tools, procedural assessment using checklists or video review, time to…

Onboard magnetic resonance imaging (MRI) guided radiotherapy is now clinically available in nine centers in the world. This technology has facilitated the clinical implementation of online adaptive radiotherapy (OART), or the ability to alter the daily treatment plan based on tumor and anatomical changes in real-time while the patient is on the treatment table. However, due to the time sensitive nature of OART, implementation in a large and busy clinic has many potential obstacles as well as patient-related safety considerations. In this work, we have described the implementation of this new process of care in the Department of Radiation Oncology at the University of California, Los Angeles (UCLA). We describe the rationale, the initial challenges such as treatment time considerations, technical issues during the process of re-contouring, re-optimization, quality assurance, as well as our current solutions to overcome these challenges. In addition, we describe the implementation of a coverage system with a physician of the day as well as online planners (physicists or dosimetrists)…

Background Marijuana is a widely used recreational substance. Few cases have been reported of acute myocardial infarction following marijuana use. To our knowledge, this is the first ever study analyzing the lifetime odds of acute myocardial infarction (AMI) with marijuana use and the outcomes in AMI patients with versus without marijuana use. Methods We queried the 2010-2014 National Inpatient Sample (NIS) database for 11-70-year-old AMI patients. Pearson Chi-square test for categorical variables and Student T-test for continuous variables were used to compare the baseline demographic and hospital characteristics between two groups (without vs. with marijuana) of AMI patients. The univariate and multivariate analyses were used to assess and compare the clinical outcomes between two groups. We used Cochran-Armitage test to measure the trends. All statistical analyses were executed by IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). We used weighted data to produce national estimates in our study. Results Out of 2,451,933 weighted hospitalized AMI patients, 35,771 patients with a…

The incidence of cancers is increasing and this is associated with an increase in the burden of the disease. Patients with cancer have to deal with reduced physical functioning, emotional instability, difficulty in concentrating, and an overall diminished feeling of well-being. This creates deficits that have not been well catered for by traditional cancer care, leading to an overall dissatisfaction with care and a reduced quality of life. This review aims at assessing the pattern of unmet needs in cancer patients and to provide information as to the factors that influence the perception of unmet needs. Studies directly focused on unmet needs in cancer patients which were retrieved from Medical Literature Analysis and Retrieval System Online (MEDLINE), Public/Publisher Medline (PubMed), PsychINFO, Excerpta Medica database (EMBASE), and Google Scholar; from the earliest records till 2016. Unmet needs in cancer patients have been measured with a wide variety of tools, with the supportive care needs survey (SCNS) being the most commonly used as a result of its strong psychometric…

This review article is an overview of the effectiveness of internet-based cognitive behavioral therapy (ICBT) in the treatment of psychiatric disorders. ICBT's effectiveness has been investigated in treating and managing conditions like depression, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. ICBT's role in the treatment of medical conditions such as diabetes mellitus with comorbid psychiatric illnesses was also explored. Furthermore, this study elaborates on its cost-effectiveness and its impact in rural areas. We conducted a thorough literature search using PubMed and Google Scholar with no restrictions on the date. ICBT's role in treating and controlling psychiatric illnesses has been established in the literature. From the data compiled, we conclude that ICBT is useful in treating mental health and medical illnesses with psychiatric comorbidities. It has also been found to be cost-effective for patients and society. ICBT is a…

Perceived social isolation (PSI) is a deficit in normal human social interaction, which has been associated with negative health outcomes. However, the precise mechanisms through which PSI influences human health are not fully known. This review aims at bringing out what is known about these pathways through which social isolation affects human health. We searched PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Psychological Information Database (PsycINFO), and Cochrane Library in addition to secondary references from primary journal articles for the most relevant and recent information concerning the research topic. The keywords used were perceived social isolation, loneliness, health outcomes, cardiovascular effects, neuroendocrine effects, depression, and cognitive decline, in animal and human populations. There are clear linkages between PSI and the cardiovascular system, neuroendocrine system, and cognitive functioning. PSI also leads to depression, cognitive decline, and sleep problems. The mechanisms through which…

Accessory ossicles of the foot and ankle are normal variants of bone development that usually remain asymptomatic. However, they may be involved in various disorders and become a source of pain such as in fractures, dislocations, degenerative changes, osteonecrosis, osteoarthritis, osteochondral lesions, avascular necrosis, and irritation or impingement of adjacent soft tissues. Hence, during the assessment of the situations above, knowledge about these little-known ossicles could be very important to reach the correct diagnosis. Recent studies in the literature have mostly focused on the most frequent 9-12 accessory bones. In this review, 24 types of accessory ossicle are described. These ossicles are accessory navicular bone, os peroneum, os trigonum, os intermetatarseum, os vesalianum. os subfibulare, os subtibiale, os calcaneus secundarius, os calcanei accessorium, os supratalare, os sustentaculi, os talotibiale, os tali accessorium, talus secundarius, os subcalcis, os cuboideum secundarium, os supranaviculare, os infranaviculare, os paracuneiforme, os intercuneiforme, os…

Wound matrix materials are used to improve the regeneration of dermal and epidermal layers in both acute and chronic wounds. Contemporary wound matrices are primarily composed of biologic materials such as processed xenogeneic and allogeneic tissues. Unfortunately, existing biologic wound matrices possess multiple limitations including poor longevity, durability, strength, and enzymatic resistance required for persistent support for new tissue formation. A fully-synthetic, resorbable electrospun material (Restrata Wound Matrix, Acera, St.Louis, Missouri ) that exhibits structural similarities to the native extracellular matrix offers a new approach to the treatment of acute and chronic wounds. This novel matrix is the first product to combine the advantages of synthetic construction (e.g. resistance to enzymatic degradation, excellent biocompatibility, strength/durability and controlled degradation) with the positive attributes of biologic materials (e.g. biomimetic architecture similar to human extracellular matrix (ECM), fibrous architecture optimized to support cellular migration…

Gastrointestinal amyloidosis (GIA), a protein deposition disorder, represents a complex common pathway that encompasses multiple etiologies and presentations. It represents a significant diagnostic and treatment challenge. The disease results from the deposition of insoluble extracellular protein fragments that have been rendered resistant to digestion. GIA can be acquired or genetic, and most commonly results from chronic inflammatory disorders (AA amyloidosis), hematologic malignancy (AL amyloidosis), and end-stage renal disease (Beta-2 amyloidosis). The deposition of these abnormal proteins interferes with gastrointestinal tract (GI) organ structure and function, most notably in the liver and small bowel. Presentation from GI involvement includes cirrhotic sequelae, abdominal pain, malabsorption, and GI bleeding. Diagnosis hinges on pathologic examination of affected tissue, with classic green birefringence under polarized light. Abdominal fat pad and rectal mucosal biopsy have been described as sites of higher sensitivity for diagnosis. Serum amyloid P scintigraphy is near 90%…

OBJECTIVE: The objective of our study is to assess the correlation between inferior vena cava (IVC) diameters, central venous pressure (CVP) and the IVC collapsibility index for estimating the volume status in critically ill patients. METHODS: This cross-sectional study used the convenient sampling of 100 adult medical intensive care unit (ICU) patients for a period of three months. Patients ≥ 18 years of age with an intrathoracic central venous catheter terminating in the distal superior vena cava connected to the transducer to produce a CVP waveform were included in the study. A Mindray diagnostic ultrasound system model Z6 ultrasound machine (Mindray, NJ, USA) was used for all examinations. An Ultrasonic Transducer model 3C5P (Mindray, NJ, USA) for IVC imaging was utilized. A paired sampled t-test was used to compute the p-values. RESULTS: A total of 32/100 (32%) females and 68/100 (68%) males were included in the study with a mean age of 50.4 ± 19.3 years. The mean central venous pressure maintained was 10.38 ± 4.14 cmH2O with an inferior vena cava collapsibility index of 30.68…

The pulmonary veins (PVs) are the most proximal source of arterial thromboembolism. Pulmonary vein thrombosis (PVT) is a rare but potentially lethal disease; its incidence is unclear, as most of the literature includes case reports. It most commonly occurs as a complica-tion of malignancy, post lung surgery, or atrial fibrillation and can be idiopathic in some cases. Most patients with PVT are commonly asymptomatic or have nonspecific symptoms such as cough, hemoptysis, and dyspnea from pulmonary edema or infarction. The thrombi are typically detected using a variety of imaging modalities including transesophageal echocardiogram (TEE), computed tomography (CT) scanning, magnetic resonance imaging (MRI), or pulmonary angiog-raphy. Treatment should be determined by the obstructing pathological finding and can include antibiotic therapy, anticoagulation, thrombectomy, and/or pulmonary resection. The delay in diagnosing this medical entity can lead to complications including pulmonary infarction, pulmonary edema, right ventricular failure, allograft failure, and peripheral embolism…

OBJECTIVES: According to a recent survey, Pakistan was ranked as the third highest country with malnutrition and the under-five child mortality. No realistic solution for this growing problem has been found despite the fact that the struggle to tackle the issue of malnutrition among young Pakistani children has been going on for the last several decades. The objective of our study was to look into the relationship between parental education and malnutrition in Pakistan and to make a recommendation to improve the nutritional condition of the children. METHOD: We carried a case-control study among 400 mothers from February 2016 to July 2016 in a primary health care center located in a peri-urban community in Pakistan. A self-constructed questionnaire comprising of 75 questions was used to collect the data. RESULTS: The mean age of mother was found to be 27.61 ± 5.130. The majority of the mothers were uneducated 168 (42.0%) while only 116 (29.0%) fathers were uneducated. About 226 (56.5%) of the children had a normal nutritional status while 102 (25.5%) had first-degree malnutrition,…

Sesame oil (SO) is a supplement that has been known to have anti-inflammatory and antioxidant properties, which makes it effective for reducing atherosclerosis and the risk of cardiovascular disease. Due to the side effects of statins, the current recommended treatment for atherosclerosis and cardiovascular diseases, the idea of using dietary and nutritional supplementation has been explored. The benefits of a dietary health regime have piqued curiosity because many different cultures have reaped health benefits through the ingredients in their cooking with negligible side effects. The purpose of this literary review is to provide a broad overview of the potential benefits and risks of SO on the development of atherosclerosis and its direction toward human clinical use. Current in vivo and in vitro research has shed light on the effects of SO and its research has shown that SO can decrease low-density lipoprotein (LDL) levels while maintaining high-density lipoprotein (HDL) levels. Current limitations in recent studies include no standardized doses of SO given to subjects and…

Introduction The objective of this study was to describe the most common clinical features associated with an acoustic neuroma diagnosis and to identify those features associated with larger tumour size at initial diagnosis. Methods The clinical information of 945 consecutive patients diagnosed with acoustic neuroma at a single centre between 1992 and 2015 was analysed. Clinical features were examined and the relationship between these features and tumour size (>2.5 cm) was analysed using descriptive statistics and logistic regression analysis. Statistical analysis was performed in R version 3.1.1. Results The most common presenting symptom was a unilateral hearing loss in 752 patients (80%), with a progressive pattern in 90% of these cases. The second most common presenting symptom was unilateral tinnitus, accounting for 6.3%, while ataxia, vertigo and headache accounted for 3.8%, 3.4% and 2%, respectively. The diagnosis of acoustic neuroma was an incidental finding in 20 patients (2.1%). Temporal analysis demonstrated a downward trend in the number of patients presenting with…

Introduction Podcasts have become increasingly popular as a medium for free open access medical education (FOAM). However, little research has examined the use of these extracurricular audio podcasts as tools in undergraduate medical education. We aimed to examine knowledge retention, usage conditions, and preferences of undergraduate medical students at a Canadian university interacting with extracurricular podcasts. Methods Students enrolled in the undergraduate medical program at McMaster University volunteered to participate in this study. Two podcasts were created specifically for the purposes of this study, and online tests and surveys were sent to participants to gather data regarding user preferences of podcasts. In addition, we recorded changes in topic test scores before and after podcast exposure. Results Forty-two students were recruited to this study. Participants who completed the assessments demonstrated an effect of learning. Podcasts of 30 minutes or less were preferred in the majority of participants who had a preference in duration. The top three activities…

Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated,…

Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short- and long-term complications. There is overwhelming evidence that assessment and management of sports-related concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the…

The main objective of this review paper is to study the comparison between transradial and transfemoral approach in catheterization. Transradial and transfemoral are two main approaches which are used as a diagnostic and therapeutic purpose in catheterization. The transradial approach in interventional cardiology is safe, effective, and feasible as compared to the transfemoral approach. The aim of this study is to compare pros and cons of transradial vs. transfemoral approach in catheterization. We conducted this systematic review on the role of transradial vs. transfemoral catheterization. The articles included real human data on interventional approaches. Reviews on these strategies were conducted in PubMed, medical literature analysis and retrieval system online (MEDLINE), Cochrane, Medscape and National Institute of Health. To maintain a high standard of review, studies published in all non-famous journals were excluded. Data collected from the studies have suggested that transradial approach has less bleeding complications, cost effective, decreased hospital mortality rate, and…

Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.

INTRODUCTION: Effective and timely communication is important for any surgical specialty to function. The use of smartphones is prevalent amongst doctors. Numerous smartphone applications offer the potential for fast and cost-effective communication. WhatsApp is a commonly used application that is free, easy to use, and capable of text and multimedia messaging. We report on the use of WhatsApp over a six month period in our unit. MATERIALS AND METHODS: WhatsApp communication between non-consultant members of an orthopaedic team over a six-month period was analysed. Both the phones and the WhatsApp application were password-protected, and patient details were anonymised. A series of 20 communications using the hospital pager system and the telephone system were also analysed. RESULTS: A total of 5,492 messages were sent during the six-month period and were part of 1,916 separate communication events. The vast majority of messages, 5,090, were related to patient care. A total of 195 multimedia messages were sent and these included images of radiographs and wounds. When using the…

Fluorescence in situ hybridization (FISH) is a macromolecule recognition technique, which is considered as a new advent in the field of cytology. Initially, it was developed as a physical mapping tool to delineate genes within chromosomes. The accuracy and versatility of FISH were subsequently capitalized upon in biological and medical research. This visually appealing technique provides an intermediate degree of resolution between DNA analysis and chromosomal investigations. FISH consists of a hybridizing DNA probe, which can be labeled directly or indirectly. In the case of direct labeling, fluorescent nucleotides are used, while indirect labeling is incorporated with reporter molecules that are subsequently detected by fluorescent antibodies or other affinity molecules. FISH is applied to detect genetic abnormalities that include different characteristic gene fusions or the presence of an abnormal number of chromosomes in a cell or loss of a chromosomal region or a whole chromosome. It is also applied in different research applications, such as gene mapping or the identification…

INTRODUCTION: Nursing is a professionally demanding job, and nurses are prone to develop musculoskeletal disorders. However, no data is available regarding its prevalence among Pakistani nurses. This study was conducted to document the pattern of work-related musculoskeletal disorders (WRMDs) in Pakistani nurses and their perceptions about contributing factors and management of WRMDs. METHODS: A questionnaire-based, cross-sectional survey was conducted in six hospitals in Lahore and Rawalpindi, which were selected using a convenient sampling technique. A four-part questionnaire comprised of demographic data, experience of musculoskeletal disorders, and perception of management and contributing factors of WRMDs was distributed among 150 nurses. One hundred and seventeen nurses returned completed forms. Data was analyzed using SPSS Statistics v20 (IBM, Armonk, New York, USA). Ethics review committee approval was obtained by CMH Lahore Medical College and the Institute of Dentistry, and informed consent was obtained. RESULTS: The prevalence of musculoskeletal disorders over a 12-month…

Obesity is a major health issue in the developed nations, and it has been increasingly clear that both genetics and environment play an important role in determining if an individual will be obese or not. We reviewed the latest researches which were carried out to identify the obesity susceptible genes and to identify the metabolic pathways having a central role in energy balance. Obesity is a heritable disorder, and some of the many obesity susceptible genes are fat mass and obesity (FTO), leptin, and Melanocortin-4 receptor (MC4R). Glucose metabolism is the central pathway for fatty acid synthesis, de novo generating the major substrate acetyl-CoA. Further knowledge of these genes and their complex interaction with the environment will help devise individual, family and community-based preventive lifestyle interventions as well as nutritional and medical therapies.

Asthma, a major public health issue, is one of the most common diseases affecting millions of population globally. It is a chronic respiratory disease characterized by increased airway inflammation and hyper-responsiveness. Vitamin D is of particular interest in asthma due to its immunomodulatory effects. Serum 25-hydroxyvitamin D is found to be associated with a wide range of pulmonary diseases, including viral and bacterial respiratory infections, asthma, and cancer. Several researches have reported positive associations between vitamin D and asthma. On the other hand, others have reported contrasting effects of vitamin D on asthma. This review provides an examination of current epidemiologic and experimental evidence of a causal association between vitamin D status and asthma or asthma exacerbations, including its probable protective mechanism. Most of the evidence regarding vitamin D and asthma is reported by observational studies. Therefore, results from the experimental trials of vitamin D supplementation are important as they can provide evidence for future recommendations…

Aim Social media (SoMe) platforms have become leading methods of communication and dissemination of scientific information in the medical community. They allow for immediate discussion and widespread engagement around important topics. It has been hypothesized that the activity on Twitter positively correlates with highly cited articles. The purpose of this study was to analyze the prevalence and activity of Trauma and Orthopaedic Surgery journals on Twitter, with the hypothesis that the impact factor is positively associated with the Twitter usage. Methods The top 50 Trauma and Orthopaedic Surgery journals, ranked by 2016 Impact Factor were analyzed. The Twitter profiles of each journal or affiliated society were identified. Other SoMe platforms used were also recorded. The Twitonomy software (Digonomy Pty Ltd, New South Wales, Australia) was used to analyze the Twitter profiles over a one-year period. The Twitter Klout scores were recorded for each journal to approximate the SoMe influence. The Altmetric scores (the total number of mentions via alternative metrics) were also…

We present a systemic review of available literature on the complications of deep venous thrombosis that develops in patients presenting with acute stroke. There are several pharmacological and physical treatment options available and used. We aim to summarize the management plans currently used at different centers. In conclusion, low-dose anticoagulant therapy for ischemic stroke is recommended. In the case of intracerebral hemorrhage, pneumatic sequential compression devices should be placed initially, followed by the administration of ultra-fractioned heparin on the next day, and then oral anticoagulant therapy to replace the heparin after a week in high-risk patients. Similar prophylactic treatment recommendations are used for subarachnoid hemorrhage.

Objective This study represents the first 10 year analysis of the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in the treatment of early low-risk prostate cancer. Materials and methods Two hundred and thirty males were treated with Cyberknife SBRT to a dose of 35 Gray (Gy) or 36.25 Gy in five consecutive days. All patients had a Gleason score of six and a PSA < 10ng/ml. Median follow-up is nine years. The median age was 69.5 years and median prostate specific antigen (PSA) was 5.6ng/ml. The treatment was delivered with homogeneous planning with a dose prescription of 82-87% of the maximum dose to cover the planning target volume (PTV). Results Ten-year biochemical disease free survival was 93% with either dose. Local control was 98.4%. Median prostate specific antigen (PSA) dropped to 0.1 by five years and has remained there. Toxicity was mild with 10% of patients having Grade two-three late urinary toxicity and 4% having the late grade two rectal toxicity. Mean Expanded Prostate Cancer Index Composite (EPIC) Quality of Life (QOL) scores declined initially for…

Triple-negative breast cancer (TNBC) is more aggressive and metastatic than other breast cancer types. Cytotoxic chemotherapy is presently the predominant systemic therapy for TNBC patients. This case report highlights the influence of metabolically supported chemotherapy (MSCT), ketogenic diet (KD), hyperthermia (HT), and hyperbaric oxygen therapy (HBOT) in an overweight 29-year-old woman with stage IV (T4N3M1) triple-negative invasive ductal carcinoma of the breast. The patient presented with an observable mass in her left breast detected during a physical examination in December 2015. Magnetic resonance imaging revealed a Breast Imaging Reporting and Data System Category 5 tumor and multiple lymphadenomegaly in the left axilla. A Tru-Cut biopsy led to the diagnosis of a triple-negative nuclear grade 2 invasive ductal carcinoma. The patient was admitted to ChemoThermia Oncology Center, Istanbul, Turkey in October 2016, and a whole body (18F)-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET-CT) scan revealed a 77 mm x 55 mm primary tumor in her left…

Energy drinks (EDs) are commonly used as a dietary supplement by young adolescents and adults. They are often used as a source of energy in order to enhance physical and mental performance. EDs contain a variety of substances, but caffeine is the main component. Safety has been the biggest concern associated with consuming EDs. Case reports, observational studies, and meta-analyses have been done in order to determine the effects of EDs on cardiovascular changes. The detrimental effects of EDs are cardiac arrhythmias, myocardial infarction, prolonged QT interval, aortic dissection, and death. In this article, we review case reports, observational studies, and meta-analyses of EDs and the risk of cardiovascular events and mortality. We also review active ingredients, pharmacokinetics, and the mechanism of action of EDs.

We have reviewed here the neuroanatomical and neuropsychological literature of the human brain and have proposed the various pain mechanisms that we currently know of. Essentially when tissue is damaged, peripheral nociceptors are activated continuously and prostanoids are hence produced. Nonsteroidal anti-inflammatory drugs (NSAIDs) and medications aim to target these prostanoids to treat the inflammatory component of pain. Normal pain tends to have a protective response. It is important for the nervous system to learn and recognize this painful stimulus earlier and quicker with repeated exposure to avoid tissue damage. This neuronal plasticity and gain in sensitivity result in sensitization of the nervous system, both centrally and peripherally and help in earlier detection of the pain sensation. However, persistent pain can become pathologic and will eventually result in the loss of protection pain offers to the body. Pain-related fear has been implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target…

The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient's most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of 'health', personalized and tailored to patient values. We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for…

BACKGROUND: Selective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated. OBJECTIVES: To evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR. METHODS: Adult patients who received SDR in childhood were surveyed. The survey questionnaire asked about demographic information, quality of life, health outcomes, SDR surgical outcomes, ambulation, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, and work status. RESULTS: Our study included 95 patients. The age that patients received SDR was between two and 18 years. The age at the time of survey was between 23 and 37 years (mean ± S.D., 30.2 ± 3.6 years). Post-SDR follow-up ranged from 20 to 28 years (mean ± S.D., 24.3 ± 2.2 years). Seventy-nine percent of patients had spastic diplegia, 20% had spastic quadriplegia, and one percent had spastic triplegia.…

As the concerns regarding Zika virus (ZIKV) are mostly of neurological disorders, especially in neonates and infants, other possible threats of the virus may have been overlooked. Our study focuses on the potential threat that ZIKV may pose to the heart like that of similar arboviral diseases. We conducted a literature search of multiple terms in March 2017 using the search engines, PubMed, Embase, and SCOPUS. Articles were then reviewed by two independent reviewers, adhering strictly to our review criteria. No discriminations were made whether the studies were conducted on human or non-human subjects. Three relevant studies were shortlisted and finalized. The nature of the studies is as follows: prospective observational multicenter study (n = 9), case report (n = 1), and animal studies (n = 5). The studies suggested an association between cardiovascular complications and ZIKV in the acute phase of the infection. We recognize the limitations of our study owing to the paucity of the sample size of our literature review. However, the significant findings have also proved the dire…

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.

Abaloparatide (previously known as BA058) is a synthetic 34-amino acid peptide and novel selective activator of parathyroid hormone receptor 1 (PTHR1) currently under development as a new anabolic agent in the management of osteoporosis. This paper reviews the profile and potential of abaloparatide in the treatment of postmenopausal osteoporosis. This paper is based on clinical trials and a PubMed search. Search terms used were "abaloparatide", "BA058", and "PTHrP". This review outlines the effects of this anabolic PTHR1 activator, which increases bone mineral density in patients at high risk for osteoporosis. The potential adverse effects of abaloparatide are also summarized. Abaloparatide has 41% homology to parathyroid hormone (PTH) (1-34) and 76% homology to parathyroid hormone-related protein (PTHrP) (1-34). The molecule was meticulously selected to retain stability and potent bone anabolic activity, and it has a limited effect on bone resorption (hence, a low calcium-mobilizing potential). Abaloparatide has shown promising results in a reduction of new onset vertebral…

Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n =277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%.…

Miller Fisher syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. Later, it was described in 1956 by Charles Miller Fisher as a possible variant of Guillain-Barré syndrome (GBS). Here, we write a case of a patient with atypical presentation of this clinical triad as the patient presented with double vision initially due to unilateral ocular involvement that progressed to bilateral ophthalmoplegia. He developed weakness of the lower extremities and areflexia subsequently. A diagnosis of MFS was made due to the clinical presentation and the presence of albuminocytologic dissociation in the cerebrospinal fluid (CSF) along with normal results of brain imaging and blood workup. The patient received intravenous immune globulin (IVIG), and his symptoms improved. The initial diagnosis of MFS is based on the clinical presentation and is confirmed by cerebral spinal fluid analysis and clinical neurophysiology studies. This case which emphasizes the knowledge of a rare syndrome can help narrow down the differentials to act…

Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices. PCOS is commonly associated with a high prevalence of insulin resistance and obesity; this association carries an increased risk of developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. Guidelines recommend lifestyle modification, metformin, hormonal contraceptives (HCs), and bariatric surgery as the main treatment options in obese patients with PCOS. Studies are being conducted to test the efficacy of existing treatment options as well as to discover new therapies. This review focuses on the most recent advances in this regard and highlights new hypotheses and emerging studies to give a picture of the latest therapeutic trends in the treatment of obese patients with PCOS. In this respect, much attention is given to the role of inositols, the mediators of insulin action. A deficiency of d-chiro-inositol containing inositol-phospho-glycans may be the basis of insulin resistance frequently seen in PCOS patients. Moreover, evidence…

Background and objectives To prevent the spread of infections in all healthcare settings, hand hygiene must be routinely practiced. Appropriate hand hygiene techniques can go a long way in reducing nosocomial infections, cross-transmission of microorganisms and the risk of occupational exposure to infectious diseases. World Health Organisation (WHO) has taken an incredible approach called "My Five Moments for Hand Hygiene" which defines the key moments when health-care workers should perform hand hygiene. We thus carried out a survey to assess knowledge of hand hygiene practices among undergraduate medical students. Materials and methods A cross-sectional survey was conducted among 523 Indian medical undergraduates. The questionnaire used was adapted from the WHO hand hygiene knowledge questionnaire for health-care workers and was distributed both, in print and online formats. The response to each question was examined using percentages. Results Nearly 57% (n=298) of medical students who participated in this study did not receive any formal training in hand hygiene. Only 27% (n=141)…

INTRODUCTION: Availability of accurate data pertaining to a population's dietary patterns and associated health outcomes is critical for proper development and implementation of related policies. This article is a first attempt to share the food patterns, amounts and diet quality among households (HH) in Qatar. METHODS: Data from the 2012-2013 Qatar National Household Income and Expenditure Survey (HIES) was used. This cross-sectional survey included 3723 HH (1826 Qatari HH and 1897 non-Qatari HH). Dietary data on monthly amounts food items available at HH according to the nationality was used. The food items were expressed in terms of grams per capita per day and aggregated into groups to examine the food patterns, energy, and adequacy. RESULTS: The overall average amount of purchased food at HH in Qatar was 1885 g/capita/day. Qatari HH purchased more food (2118 g/capita/day) versus non-Qataris (1373 g/capita/day); however, the percentages of the amounts purchased by food types were similar among both nationalities. Average daily energy (kcal) per capita was almost double among…

Purpose Abnormalities in serum magnesium levels have been seen in obesity and its related diseases. Our aim is to determine the mean magnesium levels in overweight and obese children as compared to the levels in normal weight controls to study its relationship with obesity and overweight. The study was done at a tertiary care hospital. Methods A case-control study was conducted at the Department of Pediatrics, Combined Military Hospital, Peshawar, over a 12-month period from August 7, 2015 to August 6, 2016. A total of 140 children between 2-14 years of age were included in the study. They were divided into two equal groups of 70 children each. Both of the groups were matched according to their age and sex. Children with a body mass index (BMI) greater than or equal to 85th centile and 95th centile were placed in the overweight and obese category, respectively, and termed as cases while the other 70 children with a BMI greater than or equal to 5th centile but less than 85th centile were categorized as the normal weight group and termed controls. The serum magnesium levels of both…

The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life. PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis. A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating…