Journal of Internal Medicine Research & Reports
Journal of Internal Medicine Research & Reports is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Internal Medicine Research & Reports. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of Research, Review, Case Reports, Analysis, Magazines, Editorials, Opinion, Communications, Mini-Review, Short Communications, Picturized, Book Review, Video Type and Power Point Presentations (PPTS). Articles can be submitted through online from https://www.onlinescientificresearch.com/submit-online or can send through an e-mail with attachment for internalmedicine@onlinescientificresearch.info
The kidney plays a central role in lipoprotein(a) catabolism, acting as a “cemetery for lipoprotein(a)” through uptake, fragmentation, and excretion. Direct human evidence comes from Kronenberg et al., who found significant arteriovenous differences in lipoprotein(a) levels between the aorta and renal vein, demonstrating active renal uptake. Clinical evidence from renal replacement therapy further supports this role: lipoprotein(a) levels decrease rapidly after kidney transplantation but remain unchanged with hemodialysis, indicating that functioning renal tissue, not filtration, drives lipoprotein(a) metabolism. Animal studies by Reblin et al. provided mechanistic insights, showing rapid clearance of injected human lipoprotein(a) in rats, with apolipoprotein(a) localized in proximal tubular cells and fragments detected in urine. This supports the idea that the kidney fragments lipoprotein(a) before excretion. Kostner & Kostner proposed a model where circulating lipoprotein(a) undergoes proteolytic cleavage in the kidney, producing apolipoprotein(a) fragments that may themselves be biologically active and contribute to lipoprotein(a)’s atherogenicity. Clinical observations confirm that chronic kidney disease alters lipoprotein(a) metabolism. Patients with proteinuria or amyloidosis show elevated lipoprotein(a), often correlating with urinary albumin excretion, highlighting the kidney’s regulatory role. The mechanism of elevation varies by disease: in proteinuria and peritoneal dialysis, hepatic synthesis is upregulated, while in hemodialysis, impaired catabolism predominates. These abnormalities likely amplify the already high cardiovascular risk in chronic kidney disease, particularly in individuals with genetically determined small apolipoprotein(a) isoforms. Despite advances, the precise site and mechanisms of lipoprotein(a) clearance remain unclear. However, the consensus is that reduced clearance, not increased production, drives lipoprotein(a) accumulation in kidney disease. Understanding renal processing of lipoprotein(a) may provide therapeutic opportunities, with future strategies aiming to inhibit lipoprotein(a) assembly or enhance apolipoprotein(a) fragmentation to mitigate cardiovascular risk.
Copyright (c) 2025 Journal of Internal Medicine Research & Reports
The Circle of Willis as a Functional Unit: Myth or Reality
Background: The Circle of Willis (COW) has historically been regarded as a crucial collateral pathway ensuring cerebral perfusion during arterial obstruction. However, its true role as a functional unit remains debated, given the frequent anatomical variations and inconsistent clinical protection against ischemic events. Methods: This review integrates historical accounts, anatomical and morphological studies, hemodynamic analyses, computational modeling, and clinical observations. Evidence was synthesized to evaluate the structural variability of the COW, its hemodynamic behavior, and its clinical relevance in cerebrovascular disease. Results: Anatomical investigations show that a complete and symmetric COW is relatively rare, with hypoplasia and absence of key segments being common. Hemodynamic studies and computational simulations demonstrate that collateral efficiency depends on vessel diameter, branching geometry, pressure gradients, and vascular compliance, rather than anatomical presence alone. Clinical findings reveal paradoxes: patients with a morphologically intact COW may still experience severe ischemia, whereas incomplete variants may maintain adequate perfusion through alternative collateral routes. Conclusion: The COW should be viewed as a conditional, context-dependent reserve system rather than a continuously active circulatory safeguard. Its collateral role emerges predominantly under pathological stress and is constrained by individual vascular geometry and hemodynamic conditions. Advances in imaging and patient-specific computational modeling hold promise for bridging the gap between morphology and functional competence, with potential to improve risk stratification and therapeutic decision-making in cerebrovascular care.
Risk Factors Associated with Sudden Unexpected Death in Epilepsy (Sudep): A Systematic Literature Review
Introduction: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality in patients with epilepsy, particularly those with refractory forms. Mechanisms involve cardiovascular autonomic dysfunction linked to generalized tonic–clonic seizures (GTCS). Despite the identification of multiple risk factors, methodological inconsistencies hinder generalization and development of effective preventive strategies. Objectives: This review aims to identify and synthesize current evidence on risk factors associated with SUDEP, clarify discrepancies, detect knowledge gaps, and propose foundations for preventive clinical measures. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines. We included observational studies and clinical trials published in English or Spanish, retrieved from PubMed, Embase, and The Cochrane Library. Methodological quality was assessed using validated tools. Out of 348 records, 26 studies met the inclusion criteria. Results: Recent GTCS episodes were strongly associated with higher SUDEP risk (OR = 26.81; 95% CI: 14.86–48.38). High seizure frequency and lack of night supervision increased the risk even further (OR = 67.10; 95% CI: 29.66–151.88). Poor adherence to antiepileptic treatment also emerged as a significant risk factor (OR = 2.75; 95% CI: 1.58–4.78). Discussion: GTCS frequency and treatment adherence are critical in SUDEP risk. Implementing night monitoring and adherenceenhancing strategies may help reduce incidence. However, limitations such as heterogeneous SUDEP definitions and small sample sizes underline the need for robust, prospective research to refine prevention efforts.
Prevalence of Alcohol use Disorder among Healthcare Professionals in FMC Yenagoa
Introduction: Alcohol is a distinctive and profoundly habit-forming substance with numerous motives or reasons associated with its usage. Concerns about the growing prevalence of alcohol use disorder among medical professionals worldwide have heightened in recent years. Considering the enormous negative impact of AUD on the health of healthcare professionals and the critical role they play providing healthcare services to the public generally, it is therefore imperative to access the prevalence of alcohol use disorder among healthcare professionals in FMC Yenagoa. Methodology: This study involved 394 healthcare professionals and it was carried out using a descriptive cross-sectional survey among healthcare professionals in FMC Yenagoa to gather information about the prevalence of alcohol use disorder and the factors influencing alcohol use. The data obtained was analyzed using The Statistical Package for Social Sciences (IBM SPSS) version 25. Results: The findings showed that 152(40.0%) of the participants were males and 229(60.0%) were females. 240(63%) participants were between the ages of thirty and above and 229(60%) were married. 172(50%) of the respondents reported having an alcoholic beverage 2-4 times each month and 69(20%) reported having one or more times per week. The findings also showed 60% of the respondents did not face the risk of alcohol dependency, but 40% of them did. 30% of the respondents were at danger of alcohol misuse/abuse, whereas the majority of respondents (70%) were not. The study also revealed a 20% prevalence of Alcohol Use Disorder. Conclusion: This study assessed the prevalence of Alcohol Use Disorder (AUD) among healthcare professionals in Federal Medical Centre (FMC), Yenagoa. The study further reported that AUD was significantly associated with age of <30, male sex, being married, spending 4 or less hours at work, 0-10 years of experience in healthcare. This shows that there is need for an intervention.
Adverse Effects ARIA (ARIA-E and ARIA-H) in Aducanumab and Lecanemab According to APOE Genotype: Systematic Review of the Literature
Introduction: Alzheimer’s Disease (AD) is characterized by cerebral accumulation of β-amyloid (Aβ) plaques and tau tangles, leading to progressive cognitive decline. Monoclonal antibodies targeting Aβ, such as aducanumab and lecanemab, have demonstrated plaque reduction and slowed clinical deterioration by 25–40%, but their use is complicated by Amyloid‐Related Imaging Abnormalities (ARIA), Manifesting as Vasogenic Edema (ARIA-E) and microhemorrhages or siderosis (ARIA-H). Objective: To systematically review the incidence and characteristics of ARIA-E and ARIA-H in patients treated with aducanumab or lecanemab, stratified by APOE ε4 genotype. Methods: A systematic review of Randomized Clinical Trials (RCTs) was conducted. PubMed, Embase, Web of Science, CENTRAL, and Scopus were searched through June 2025 for RCTs reporting ARIA adverse events by APOE genotype. Trials involving adult AD or mild cognitive impairment patients with documented APOE status and imaging‐assessed ARIA were included. Data extraction and Cochrane RoB 2.0 bias assessment were performed by two independent reviewers, with narrative synthesis of ARIA incidence and management strategies. Results: Four RCTs met inclusion criteria. In phase 3 CLARITY-AD (lecanemab), overall ARIA-E incidence was 13.6%; among APOE ε4/ε4 homozygotes it rose to 34.5% versus 6.9% in non-carriers (principal result), with most cases mild/moderate and resolving within 3–6 months. Symptomatic ARIA-E occurred in 3.3% and serious events in 1.1% of all treated patients. Discussion: APOE ε4 carriage, especially homozygosity, markedly elevates ARIA risk with anti-Aβ antibodies. Pre-treatment genotyping is recommended to tailor safety monitoring: ε4/ε4 individuals may benefit from slower dose titration, more frequent MRI surveillance during the first 6–12 months, and stricter criteria for treatment interruption. These strategies aim to optimize therapeutic benefit while minimizing ARIA-related harm.
Stroke Subtypes and Outcomes in Hypertensive Patients at the Rivers State University Teaching Hospital, Port Harcourt, Nigeria
Introduction: The global burden of stroke is increasing alarmingly, with hypertension reported as the most prevalent risk factor. The aim of this study was to assess stroke among patients with hypertension as well as the factors associated with 30 days mortality at the Rivers State University Teaching Hospital. Materials and Methods: This was a hospital-based descriptive cross-sectional study of adult hypertensive patients who received a clinical diagnosis of a stroke between January 2022 to December 2023. Sociodemographic, clinical and brain imaging data and were recorded, along with mortality at 30 days. Data was analysed by using SPSS version 25. Results: A total of 311 patients were admitted with a diagnosis of stroke of which, 249 (80.1%) were hypertensive. The mean age of the hypertensive stroke patients was 60.7±12.1years, 140(56.2%) were women and 226(90.8%) of these patients were aware of their hypertensive status. Brain imaging revealed that 194(77.9%) patients had an ischaemic stroke while 55(22.1) had a haemorrhagic event. At the end of 30 days, 62(24.9%) persons died and there was a significant relationship between increasing age and mortality (p=0.021), while the mean systolic blood pressure was significantly higher in the hypertensive patients that died (p=0.045). Conclusion: Hypertension is a major risk factor for stroke morbidity and mortality. Urgent measures are needed to improve on blood pressure control as these may potentially reduce stroke occurrence rates in hypertensive subjects.
Does Nutrition Cause Cancer? Is Newtrition Prevention and Treatment?
It is both outrageous and startling that the World’s collective consciousness regarding public health and epidemiology research in general and cancer has explicitly been held captive and, more frequently, willfully captivated by greedy geopolitical alignment.
Our Experience with the Eras Program in Children with Hirschsprung Disease
Background: The ERAS program has only recently been applied to children, with the main obstacle being the complexity of pediatric surgeries. Children have their own unique physiological response to surgery, including being more vulnerable to dehydration and hypothermia, having a lower tolerance for intraoperative blood loss, and an increased risk of anesthesia complications. However, the use of ERAS has been limited in the pediatric population due to a clear lack of evidence. We have used components of ERAS in our pediatric patients undergoing surgery for Hirschsprung disease. Purpose of the Study: To evaluate the safety and efficacy of accelerated surgery (ERAS) combined with laparoscopy in the treatment of Hirschsprung disease in children. Material and Methods of Research: The study was conducted on 76 children with Hirschsprung’s disease who underwent elective surgery with bowel pull-down in the period from 2011 to 2024 in the surgical clinic and in the bases of the AMU. The patients were divided into two groups: the ERAS program combined with laparoscopy (study group, n=38) and the laparoscopic surgery with conventional perioperative management (control group, n=38). Postoperative bowel function recovery, hospital stay, hospital costs, complications were compared, and postoperative recovery was monitored for four weeks. Research Results: There were no significant differences in intraoperative blood loss and operative time between the ERAS group and the control group (both P>0.05). Recovery of bowel movements occurred earlier in the ERAS group, but the difference was not statistically significant (P=0.062). Hospital stay was shorter [(5,77±0,8) days versus (14,2±2,8) days], and hospitalization costs were significantly lower in the study group than in the control group. Conclusions: • The ERAS protocol is applicable to pediatric Hirschsprung disease surgeries with shorter hospital stay and fewer complications, especially in the form of SSI. We recommend using the maximum number of components based on our experience to obtain optimal results. • Accelerated surgery combined with laparoscopy in the treatment of Hirschsprung’s disease in children is safe and effective.
Beer Potomania: A Literature Review of an Underrecognized Cause of Severe Hyponatremia
Beer potomania is a rare but significant cause of severe hyponatremia, often misdiagnosed as syndrome of inappropriate antidiuretic hormone secretion (SIADH). It is characterized by excessive beer consumption and insufficient dietary solute intake, leading to impaired renal water excretion and dilutional hyponatremia. The pathophysiology involves reduced osmotic load, altered antidiuretic hormone (ADH) regulation, and compromised renal handling of free water. The clinical overlap with SIADH presents diagnostic challenges, necessitating a thorough dietary and biochemical evaluation. This review discusses the mechanisms, differential diagnosis, and management strategies for beer potomania, emphasizing the need for gradual sodium correction to prevent osmotic demyelination syndrome (ODS) and addressing underlying alcohol use disorder to reduce recurrence.
Hydrotherapy Interventions for Muscle Recovery in Athletes: A Narrative Review
Background: Hydrotherapy, leveraging water-based interventions, has garnered interest in sports medicine for its potential to enhance muscle recovery in athletes. This narrative review aims to synthesize current evidence regarding the effectiveness of various hydrotherapy interventions and their physiological underpinnings in promoting muscle recovery. Research Problem and Aim: Despite the growing body of literature, there remains a need for a consolidated understanding of how specific hydrotherapy modalities contribute to muscle recovery, including the mechanisms involved and practical applications for athletes. This review seeks to clarify these aspects. Methodology: A comprehensive literature search was conducted across electronic databases such as PubMed, Embase, and Cochrane Library, using keywords related to hydrotherapy and muscle recovery in athletes. Only articles published in English that focused on hydrotherapy interventions and their effects on muscle function, performance, and recovery perceptions were included. Results: The findings indicate that hydrotherapy interventions, including cold water immersion, contrast water therapy, ice massage, aquatic exercise, and cryotherapy, effectively reduce muscle edema, inflammation, and pain, leading to improved muscle function and performance. Specifically, cold water immersion and contrast water therapy show significant benefits in enhancing recovery measures, while localized interventions like ice massage target specific muscle groups. Implications: These results underscore the utility of hydrotherapy in athletic recovery protocols. Practitioners should tailor hydrotherapy interventions based on individual athlete needs, optimizing temperature, duration, and modality to maximize recovery outcomes while minimizing risks.
Pathophysiology, Risk Factors, and Advances in the Management of PepticUlcers: A Comprehensive Review
Peptic ulcers, characterized by mucosal erosion in the stomach or duodenum, continue to pose significant health challenges worldwide. This comprehensive review explores the pathophysiology of peptic ulcers, including the roles of Helicobacter pylori, acid secretion, and mucosal defense mechanisms. We examine key risk factors such as NSAID use, smoking, alcohol consumption, and genetic predisposition. Advances in diagnostic techniques, including endoscopy, biopsy, and non-invasive tests like urea breath tests and stool antigen tests, are discussed, alongside recent improvements in molecular diagnostics and imaging. The review also covers current management strategies, focusing on pharmacological treatments like proton pump inhibitors (PPIs) and H2 receptor antagonists, as well as surgical interventions for complicated cases. Emerging treatment modalities, such as novel drugs, probiotics, and minimally invasive surgical techniques, are highlighted. Additionally, the paper identifies future research directions, including the exploration of new therapeutic targets, enhanced diagnostic tools, and the impact of gut microbiota on ulcer formation. By integrating recent advancements and identifying gaps in current knowledge, this review aims to provide a comprehensive understanding of peptic ulcers and inform future research and clinical practice.
Copyright (c) 2024 Journal of Internal Medicine Research & Reports
A circadian rhythm of serum thyrotropin (TSH) has been demonstrated by measurements performed on the majority of blood from 6 healthy young adults, 3 males and 3 females. The serum TSH level decreased from 8 am to 2 pm. The difference between the morning and midday levels was very visible. There was no correlation between meals and TSH level variations. The circadian rhythm of serum TSH is not only of physiological interest but also has practical implications where collecting blood for TSH determination is best done at 11:00 a.m. when the TSH level has fallen to the daytime amount. The mechanism of decreasing TSH levels in the blood within 24 hours is still not fully studied.
Nephrotoxicity of Iodinated Contrast Drugs: A Comparative Analysis of Old Versus New, Ionic Versus Non Ionic Agents, Dose Effects, and the Impact of Relative Dehydration in Stroke Patients
Stroke is a type of cerebrovascular disease that impairs the functionality of the brain due to disturbance in the blood supply to the brain. There is approximately 1 stroke every 40 seconds, amounting to it being a leading cause of serious long-term disability [1]. It accounts for about 140,000 deaths annually with an incidence rate of 795,000 each year, necessitating need for prompt and accurate diagnosis and intervention. Stroke can either be hemorrhagic or ischemic in nature. Hemorrhagic stroke is when there is rupturing of blood vessels in the blood vessels in the brain and its majorly treated by reducing blood pressure in the brain or use of ‘pro-hemostasis’ medications. Ischemic stroke is when there is occlusion of the blood vessels supplying blood to the brain leading to shortage (hypoxemia) or no supply of blood supply (hypoxia) in the brain. It is majorly treated with thrombolytic medications that break down clots and must be administered early to prevent risk of dangerous bleeding or use of mechanical thrombectomy.
Skin Delivery and Innovative Carrier’s Effectiveness
The skin serves as the body first protecting barrier against the external attacks of chemicals and microorganisms. On the other hand, it is an obstacle to penetration and transdermal delivery of any substance applied on its surface. Thus, a need to report some news on the skin composition for a better understanding of the transdermal delivery mechanisms of topical products applied on its surface. Therefore, due to the actual increased use of topical drugs, cosmetics, and diet supplement treatments, further feasibility research studies have been carried out to extend the knowledge of the percutaneous absorption ‘rules and means. These studies are retained necessary to control the release through the skin layers of various selected active ingredients, loaded and carried out by different vehicles. The paper will focus on the effectiveness of innovative tissue carriers that, are able to deliver active ingredients throughout the skin layers, are made by a very low consumption of water, and are free of chemicals also. In conclusion, these novel eco-sustainable carriers, resulting skin- and environmentally friendly, might be used as innovative vehicles in substitution of the normal emulsions that, made by the use of preservatives, emulsifiers, fragrances, and other chemicals may often cause allergic and/or sensitization phenomena, consuming a great quantity of water also.
The Clinical Challenge of Distinguishing between Happy Heart and Broken Heart Syndromes
Takotsubo Cardiomyopathy (TC), or stress-induced cardiomyopathy, is an acquired cardiomyopathy which is famously attributed to tragic or stressful life events. Triggers for TC are notable to be physical or emotional, with surgery and death of a loved one as examples. More recently and considerably less common, TC has been recognized following joyous events, which has been referred to as the Happy Heart Syndrome (HHS). Here we describe a case of HHS in a 62-year-old female who presented to an emergency department with chest pain and shortness of breath precipitated by receiving good news about the recovery of her critically ill husband. Furthermore, we discuss the diagnostic challenges in identifying the trigger and categorization of this condition.
Possibilities of Skin Autofluorescence Reflecting the Characteristics of Diabetes Mellitus in Childhood
Objective: To measure skin autofluorescence in children and adolescents suffering from type 1 diabetes mellitus and evaluate its relationship with gender, age, experience and chronic complications of the disease. Materials and Methods: The study group included 47 children and adolescents with type 1 diabetes. Autofluorescence of the skin from the inner surface of the shoulder and nail of patients was measured using an original compact spectrofluorimeter based on the STS-VIS OCEAN OPTICS © USA microspectrometer with UVA excitation. Statistical analysis was carried out using StatsoftStatistica 12.0 software. The data is presented as a two-dimensional array. The UV LED signal was averaged and smoothed using the moving average method with a 10 nm window. Then the spectra were renormalized taking into account the found coefficients. The result of applying additional normalization is a decrease in the standard deviation. Results and Discussion: Significant differences were revealed in the skin fluorescence spectra of children of different ages. between age groups (5-7) and (8-12) is most significant in the region of the alpha band of oxyhemoglobin (540 nm) (p <0.005). When using I-normalization, the NADH peak region (p < 0.02) is significant with increasing disease duration. When studying the influence of gender factors on the level of skin autofluorescence, the most significant differences are found in the area of only the isosbestic points of deoxy and oxyhemoglobin 442 nm (p<10-7) and 491 nm (p<10-8). Significant differences in skin autofluorescence at the reference length were also obtained waves in the autofluorescence spectrum of 500 nm correspond to p<10-14, depending on the presence of complications. Conclusion: In Russia, as well as throughout the world, there is an increase in the incidence of type 1 diabetes mellitus. For early diagnosis of changes in carbohydrate metabolism and complications of the disease, a simple, accessible, non-invasive research method is needed. Taking into account the results of our study, when creating non-invasive methods for monitoring the state of carbohydrate metabolism, it is necessary to take into account gender and age characteristics, experience and the presence of complications of type 1 diabetes mellitus.
AI Applications in Pediatrics: Past, Present, and Future
In pediatric medicine, Artificial Intelligence (AI) currently remains as a novel area for research and development. Most AI applications created for adults are often complicated to fully transfer over to pediatrics due to several limiting factors. These factors include physiological differences, lack of data, and unknown implications. Nevertheless, applications in adult medicine have influenced extensive reviews for algorithms that show significant potential in pediatrics. As pediatric data gradually increases, several AI algorithms for adults can be fine-tuned to provide similar accuracies and sensitivities for diagnosing specific pediatric diseases. This chapter will discuss the pioneering applications of AI in medicine as well as current and arising applications or subspecialties. Areas of discussion encompass precision medicine, oncology, cardiology, radiology, chatbots, neurology, and ophthalmology. AI algorithms within these domains range from assistance with diagnoses, shorter waiting times, to continuous monitoring. Common benefits exhibited by many applications include increased accuracy, time and cost efficiency, patient compliance, and flexibility. For example, medical wearable technology and chatbots are two AI applications that can provide certain patient care in both outpatient and inpatient settings. These algorithms are convenient to use and offer continuous monitoring when a provider may not be readily available. Furthermore, other topics explored in this chapter relate to common concerns for using AI in pediatric medicine and education for health professionals, parents, and children. Most apprehension pertains to the misuse of data and quality of care. Reviewing these concerns is crucial for AI to exponentially flourish in medicine. Without established comprehension, hesitance and distrust may prevail over the promising potential AI can offer. Education and training can help alleviate these common misunderstandings by explaining how AI can affect both medicine and health care. Moreover, learning environments can allow health professionals, parents, and children to openly communicate their concerns that could guide ethical frameworks for developing AI applications. Analyzing these past, present, future applications, and related concerns can help demonstrate how AI will transform pediatric medicine.
The Association between Urinary Alcohol Metabolites on Hepatitis C Treatment and Response
Background: Direct-acting antiviral (DAA) medications for the treatment of chronic hepatitis C virus (HCV) infection has achieved higher rates of sustained virologic response (SVR) with shorter treatment durations and no alcohol abstinence prerequisite. Previous therapies required alcohol abstinence for at least 6 months. Methods: Our retrospective cohort study in Veterans with chronic HCV infection presenting for care at the Joseph Maxwell Cleland Atlanta VA medical center (AVAMC) between 1/1/2015 – 11/29/2017 examined the relationship between alcohol use, DAA initiation, and SVR. Results: The cohort included 1763 people that were mostly males (97%) with a mean age of 63 years and 70% Black. In multivariate analysis, the odds of receiving DAA were 0.7 (95% CI: 0.674, 0.9; p=0.0013) in those with “detectable” alcohol metabolites compared with those who had “undetectable” alcohol metabolites. The odds of achieving SVR were 0.7 (95% CI: 0.5, 1.0; p=0.0525) in those with “detectable” alcohol metabolites. Overall, 86% of patients who received DAA therapy achieved SVR. Conclusions: Alcohol use categorized using urine alcohol metabolite testing, during the study period was associated with a significantly lower odds of receiving DAA therapy but had no statistical significance on the odds of achieving SVR. While patients with chronic hepatitis C should be counseled on the risks of alcohol use, it is not associated with lower likelihood of achieving SVR and should not preclude the initiation of DAA therapy
Navigating Diagnostic Challenges: Chronic Anemia Leading to the Diagnosis of Gastric Antral Vascular Ectasia (GAVE) in the Absence of Typical Symptoms
Gastric antral vascular ectasia (GAVE) is a rare acquired vascular dysplasia usually associated with portal hypertension or CREST syndrome. Here we present a case of a 62-year-old female with no significant related comorbidities who presented to our clinic due to severe acute on chronic anemia. On initial review of systems, the only complaint the patient had was fatigue, shortness of breath and being lightheaded. Patient denied hematochezia or melena, no hematemesis or other gastrointestinal complaints, no history of NSAIDs or aspirin use. Initial labs were significant for iron-deficiency anemia with hemoglobin of 8.5 g/ dL. Recent colonoscopy was non diagnostic for the cause of anemia as well. Due to unrevealing previous workup patient was referred to gastroenterologist and undergone esophagogastroduodenoscopy (EGD) with findings of ecstatic vessels in stomach antrum suggestive of GAVE, successfully treated with argon plasma coagulation. Total in a span of 4 years due to recurrence of anemia patient required 3 EGDs, while GAVE was successfully treated each time with argon plasma coagulation. Due to absence of gastrointestinal (GI) complaints patient was recommended to have regular laboratory workup to monitor for silent blood loss. This atypical presentation of upper GI bleeding warrants physicians to refer patients to gastroenterologists to perform EGD for further evaluation and treatment in cases of unknown etiology of iron deficiency anemia even in the absence of gastrointestinal (GI) complaints and non-revealing previous GI workup with colonoscopy
Review on Virulence and Diagnostic Methods of Mareks Disease Virus in Chickens
Marek’s Disease is a highly contagious oncogenic and neuropathic disease of chickens caused by Marek’s Disease Virus which is a highly cell-associated Alpha herpes virus that replicates in chicken lymphocytes and establishes a latent infection within T cells. Evolution of Marek’s Disease Virus towards higher virulence have been a concern over the years from mild to virulent, very virulent and very virulent plus. Mareks Disease is diagnosed by clinical examination of infected chickens accompanied with demonstration of postmortem lesions. The technique for diagnosis of infection with Marek’s Disease Virus involves isolation and identification of Marek’s Disease Virus from infected tissues. Virus isolation is usually by virus propagation in cell culture and identification/ quantification by cytopathic changes. Further confirmatory diagnosis of Marek’s Disease Virus can be done by serological test such as Agar Gel Immuno Diffusion Test and Enzyme Linked Immuno Sorbent Assay and molecular based technique such as Polymerase Chain Reaction. High-throughput sequencing technology which is a second-generation sequencing, provide the possibility to rapidly obtain the full sequence of pathogen genome at once for studying virus evolution and development of novel vaccines. Mareks Disease can be controlled by live-attenuated vaccines. In Ethiopia, reports coming from various regions of the country indicated that Marek’s Disease possesses a great threat to the flourishing young poultry industry.
Copyright (c) 2023 Journal of Internal Medicine Research & Reports
Effect of an Internet-Hospital-Community-Home Linked Health Management Model in Patients with Osteoporotic Vertebral Compression Fractures Who Received Conservative Treatment: A Quasi-Experimental Study
Objective: To evaluate the effect of an internet-hospital-community-home (IHCH) linked health management model in the management of patients with osteoporotic vertebral compression fractures (OVCF) who undergoing conservative treatment. Methods: This quasi-experimental study enrolled patients with OVCF who undergoing conservative treatment and visited to xx hospital between April 2022 and September 2022. Patients were divided into two group based on their time of visit to receive the IHCH linked health management (IHCH group) or routine management (control group). The outcomes were activities of daily living (ADL) scores, quality of life [measured by SF-36 Health Survey (SF36) scores], functional disability [measured by Roland-Morris Disability Questionnair (RMDQ) score], pain assessment [measured by Visual Analog Scale (VAS) score] at acute stage, 1 month, 3-month, 6 months after intervention; and pressure injuries, medication adherence, and health service satisfaction at 6 months after intervention. Results: Sixty-two patients completed the follow-up, with 31 cases in each group. The baseline information between the two groups were comparable (all P>0.05). After intervention, repeated measures ANOVA showed that the ADL (P time < 0.001, P group = 0.045, P time x group < 0.001), SF-36 (P time < 0.001, P group = 0.008, P time x group < 0.001), and RMDQ scores (P time < 0.001, P group = 0.014, P time x group < 0.001) in IHCH group were significantly improved compared to the control group, which were interacted with time. Furthermore, at the 6-month follow-up, the IHCH group exhibited significantly lower incidence of pressure injuries [2 (6.67) vs 8 (26.67), P = 0.038], higher medication adherence [16 (53.33) vs 9(30.00), P = 0.031], and greater satisfaction with health services [Total satisfaction: 27 (90.00) vs 19 (63.33), P = 0.015] compared to the control group. Conclusion: The IHCH linked health management model might improve the effectiveness of conservative treatment for OVCF patients, reduce the occurrence of complications, and enhance satisfaction with health services.
Osteoporotic Vertebral Compression Fractures
Internet-Hospital-Community-Home Linked Health Management Model
Plasmodium Falciparum Malaria and Concomitant High-Risk Pulmonary Thromboembolism: Case Report
The authors describe a case of a patient admitted due to a previous condition of osteomyoarthralgia, headache, fever, malaise, which worsened with sudden onset dyspnea, chest pain, syncope, the plasmodium test was positive, the EKG performed at the Emergency department presented the classic pattern of acute cor pulmonale (S1Q3 T3 ). The echocardiogram demonstrated changes compatible with pulmonary thromboembolism. Chest X-ray showed an increase in the cardiothoracic index and dilation of the right pulmonary artery (Fleischner ‘s sign). Computed angiotomography (angioCT) of the chest confirmed the diagnosis, showing the presence of thrombi in the main, segmental and subsegmental branches. The patient underwent fibrinolytic therapy and progressed favorably
Hypoxic Respiratory Failure Due to Three Hits: Pulmonary Embolism, Rasburicase-Induced Methaemoglobinaemia And Haemolytic Anaemia In A Patient with Previously UndiagnosedGlucose-6-Phosphate Dehydrogenase Deficiency
We present a 35-year-old male patient who developed hypoxic respiratory failure from three concurrent pathologies–acute pulmonary embolism, methemoglobinemia and oxidative haemolytic anaemia from previously undiagnosed glucose-6-phosphate dehydrogenase deficiency, precipitated by rasburicase therapy for tumour lysis syndrome following chemotherapy for non-Hodgkin’s lymphoma. Hypoxia resolved upon treating all pathologies, highlighting the need to consider these rare differential diagnoses.
Review on The Impact of Climate Change on Approach to Epidemiology of Livestock Diseases Control
The livestock sector globally is highly dynamic. In developing countries, it is evolving in response to rapidly increasing demand for livestock products. In developed countries, demand for livestock products is stagnating, while many production systems are increasing their efficiency and environmental sustainability. Currently, the world is facing a number of challenges, of which Global climate change is a priority area. Agriculture and livestock are amongst the most climate sensitive economic sectors in the developing countries. Climates comprises many factors including temperature, rainfall, humidity, winds and altitude hat can have both direct and indirect effects on animal production and health. It can also affect the quality and quantity of feedstuffs such as pasture, forage and grain and the severity and distribution of livestock diseases and parasites. Infectious diseases of animals are of huge socioeconomic and public health importance. The earth’s temperature has risen at an average of 0.3 to 0.7 °C since 1900 & 20-30% of all vertebrate animals are expected to get extinct if the average temperature rises by 2-3 °C. The early consequences of global climate change (GCC) are well documented. However, future impacts on ecosystem health, and on the health of humans, domestic animals, and wildlife, are much less well understood. A two-pronged approach must be adapted to tackle the alarming situation arising out of climate change impacts. Adaptation may involve the measures for future adaptation to the disease onslaught and the Mitigation focuses on reducing the level of agents/factors leading to the climate change. One health concept in one health triad needs to be followed in spirit to avert the otherwise sure to come impacts of climate change.
Evaluation of Solitary Rectal Ulcer Syndrome from Twenty-Four Iraqi Patients
Background: Solitary rectal ulcer syndrome (SRUS) is a rare benign rectal disorder that can present with bleeding, mucus passage, straining during defecation, constipation, rectal prolapse, and a feeling of incomplete evacuation. It is characterized by a combination of clinical findings, histological abnormalities, and symptoms. Since patients frequently come with lesions that are neither solitary nor ulcerated, the nomenclature of the syndrome is deceptive. Multiple factors may be implicated in the etiology and pathogenesis of the illness, which is usually linked to pelvic floor abnormalities. Objectives: To study the distribution of age and sex for this syndrome among a sample of Iraqi patients and to further characterize this syndrome in our population. Materials and Methods: A retro-prospective, descriptive single-center study with this research design was carried out at the Baghdad Gastroenterology and Hepatology Teaching Hospital involved reading reports from (1784) lower gastrointestinal endoscopies (sigmoidoscopy and colonoscopy) performed at the Baghdad Gastroenterology and Hepatology hospital over the course of fourteen months. Of those, twenty-four patients who met the requirements for the clinical, endoscopic, and histological diagnosis of SRUS were examined and monitored. Results: Sixteen patients were female and eight patients were male, mean age was (26.5±9.69), mean duration of symptoms until diagnosis was 12.083 months ±11.5. The most frequent symptom was bleeding per rectum (95.8%).All patients(100%) were subjected to several treatment options, they were advised on normal defecatory behavior and bowel habits, Sulfasalazine enema1-2gm/day for(3-6 months),sucralfate enema(2gm/day for 3months), only four patients(16.6%)ended with endoscopic treatment and two patients(8.3%)ended with surgery. Conclusion: SRUS is a chronic, benign disorder in young adults, often related to straining or abnormal defecation. SRUS remains a well-defined but nonspecific entity with varied presentation, characterized by a rectal lesion caused by straining during defecation. Clinicians, surgeons, and pathologists should be aware of the features of SRUS so that it is not confused with other conditions.
Ileal Conduit Necrosis Secondary to Spontaneous Retroperitoneal Hematoma
Case Presentation: A fifty-nine years old woman with previous muscle-invasive bladder cancer treated five years prior in another medical center with radical cystectomy and Bricker’s ureteroileostomy diversion, presented to the Emergency Room (ER) describing general discomfort, diarrhea, arterial hypotension and tachycardia. After conducting an imaging test, ileal conduit ischemia and mesenteric ischemia was diagnosed secondary to retroperitoneal hematoma. Ileal reservoir resection, resection of the ischemic intestine, and bilateral cutaneous ureterostomy were performed. Relevance: In patients with previous urinary diversion and acute abdominal pain, it is imperative to dismiss conduit involvement. Clinical Implications: In cases of acute abdomen with history of urinary diversion, physical examination and imaging tests can detect if the ileal reservoir has been compromised and, therefore, guide the adequate therapeutic approach. Conclusions: Identifying the complications of the urinary diversion in early stages in order to treat the underlying cause is advisable.
GAD-65 Antibody Mimics Cocaine Induced Limbic Encephalopathy
Glutamic Acid Decarboxylase 65-kilodalton isoform (GAD-65) is associated with cocaine induced limbic encephalopathy mimicking GAD-65 limbic encephalopathy in humans. A 20-year-old white female presented with a clinical picture of a limbic encephalopathy and a positive ANA. She has a hypermobility disorder with dysautonomia with POTS. Her workup revealed a GAD-65 antibody greater than 250 nmol/L, a normal lumbar puncture, and a normal brain MRI. Her GAD-65 associated limbic encephalopathy was treated with IVIG 2 g per kilogram per month. She received three treatments with no improvement. Due to arthralgias, a soft tissue rheumatic pain, she was referred to pain management. The patient admitted to using cocaine. Her IVIG was discontinued. A repeat test for GAD-65 antibody remained elevated. After a stint in drug rehabilitation and cessation of cocaine her symptoms of limbic encephalopathy abated and GAD-65 normalized. This is the 1st case report of GAD-65 antibody mimicking cocaine induced limbic encephalopathy. While GAD65 related autoimmune neuropathies are rare, one must consider cocaine toxicity as a mimic of both autoimmunity and immune neuropathies, including the spectrum of GAD-65-related disorders.
Evaluation of the Anti-Inflammatory Activity of the Leaf Extract and Fractions of Ipomoea Quamoclit in Albino Wistar Rats
Background: Medicinal plants have been shown to contain intrinsic active ingredients that can be used for curative purpose for some diseases. Ipomoea quamoclit is one of such ethnomedicinal plants of reported health benefits. Aim of Study: This study was aimed at evaluating the anti-inflammatory activity of ethanol extract and fractions of the leaves of Ipomoea quamoclit Mill. Materials and Methods: Ipomoea quamoclit leaves were harvested and extracted with 80% ethanol by cold maceration for 48 hours and the crude extract was fractionated to obtain n-hexane, n-butanol and ethyl acetate fraction, respectively. The crude extract and its fractions were screened to unveil the resident phytochemical constituents. The ethanol extract was tested for acute toxicity (LD50). The systemic acute inflammation of the crude extract and fractions of Ipomoea quamoclit was studied using the water (fluid) displacement method after inducing inflammation with egg albumin, using rats. The effect of the crude extract and fractions of Ipomoea quamoclit on arthritis was studied using the formaldehyde-induced arthritis model in rats. Results: The results of the qualitative phytochemical evaluation of the plant confirmed the presence of these phytoconstituents such as alkaloids, flavonoids, saponins, tannins, steroids, terpenoids, glycosides, carbohydrates, proteins, and coumarins. There were no deaths recorded for acute toxicity study for both phases of the test. In the acute anti-inflammation assay, significant (P<0.05) anti-inflammatory activities were observed from the 5th hour for the ethyl acetate fraction (150 and 400 mg/kg) and the butanol fraction (400 mg/kg). The anti-arthritic activity of the crude extract (150 mg/kg), ethyl acetate fraction (150 and 400 mg/kg), n-hexane fraction (150 mg/kg) and butanol fraction (150 and 400 mg/kg) was obvious from the second day after administration. By the 10th day the crude extract (50, 150, and 400 mg/kg) and ethyl acetate fraction (150 and 400 mg/kg) brought about a significant reduction of chronic inflammation (arthritis) in the test animals to normal basal levels. Conclusions: This study thus provides scientific information and validates the ethnobotanical use of Ipomoea quamoclit leaves in management of diseases and inflammation inclusive. The findings of this study also reveal that potentially Ipomoea quamoclit could be a source of pharmacologically active compounds of pharmaceutical importance.
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Frequency and Predictors of COVID-19 Worsening Among Patients Initially Managed on An Outpatient Basis: An Observational Study in Sfax Governorate; Tunisia
The COVID-19 pandemic is a crisis of mismatch between resources and infection burden. It has caused high utilization of healthcare resources including hospitalization [1]. In Tunisia, Since the discovery of the index case of COVID-19 in Marsh 2020, the spread of the virus has expanded exponentially due to community-based human-to-human transmission. The impact of the pandemic has put the spotlight on serious problems that the Tunisian healthcare system suffers from including strained health institution. COVID-19 symptoms are variable ranging from no symptom to severe symptoms and need hospitalization [2]. Factors other than severity of symptoms could increase the risk of hospitalization and mortality. Indeed, elderly people and those with underlying health conditions are at higher risk of COVID-19 hospitalization, and even death [3,4]. Nevertheless, other studies show controversial results [5,6]. Some of the worsening of the disease occurs early, but the vast majority of respiratory distress tables are observed late [7]. Thus, patients who initially had been managed on an outpatient basis may require late hospitalization or may even die. However, studies about COVID-19 ambulatory patients are under-described in the literature and the majority of studies on COVID 19 related hospitalization and death have been based on hospital samples. Knowledge of factors associated with the COVID-19 hospitalization and death is critical in implementing preventive measures and minimizing direct medical and indirect costs of COVID-19. In this regard, this study aimed to determine the factors associated with the worsening of COVID-19 among patients who at first had been managed on an outpatient basis.
COVID-19 Severity Among Non-Vaccinated Pregnant Women During the Delta Wave in Tunisia: A Retrospective Monocentric Study
Introduction: Pregnant women are vulnerable to SARS-CoV2 infection, particularly with the Delta variant. The aim of our study is to describe the COVID-19 syndrome among non-vaccinated pregnant women during the delta wave and to investigate risk factors for severe forms. Methods: In this study, we included all non-vaccinated pregnant women who tested positive for COVID-19 and who required hospital admission at any stage of gestation during the Delta wave in the maternity of Sfax, Tunisia. Patients were divided into 2 groups according to the mode of delivery in case of completed pregnancies and according to the severity of the disease. Severe COVID-19 is considered when the pregnant woman requires advanced oxygen support or intensive care unit referral. We performed univariate and multivariate logistic regression models to investigate the predictors of severe maternal outcomes among infected pregnant women. The significance level was set top ≤ 0.05. Results: one hundred patients were included. Severe adverse outcomes were observed in 23 patients (group1). The mortality rate during the Delta wave was 6%. The mode of delivery had not influenced the maternal and perinatal outcomes. Age >35 years old [OR 3.16, 95% CI 1.13- 8.84], BMI>30 kg/m2 [OR 2.63, 95% CI 1.0 -6.95], preeclampsia [OR 4.0, CI 95% 1.04- 15.32], dyspnea [OR 7.55, 95% CI 2.62- 21.7], cytolysis [ OR 4.6, 95% CI 1.48- 14.2], and lung injury in CT Scan > 50% [OR9.6, 95%CI 1.48-62.1] were significantly associated with an increased risk of severe maternal outcomes. Conclusions: During the delta wave in Tunisia, non-vaccinated pregnant women seem to be at higher risk of severe maternal outcomes and maternal deaths. The main risk factors for severe outcomes were age 35, obesity, preeclampsia, cytolysis, and severe lung damage in the CT scan.