Hot Articles


    Background: Many interventions have been used to treat post-acne scars, with various degrees of efficacy and adverse reactions. Multimodal approach can achieve better results for improving the physical appearance that even if minor may result in significant distress and reduced quality of life. Objective: To compare the efficacy of subcision with fractional carbon dioxide (CO2) laser and subcision with microneedling fractional radiofrequency (RF) in treating post-acne scars and to study their adverse effects. Methods: In this prospective, interventional clinical study, a total of 64 patients with post-acne scars were enrolled. The patients were randomly allocated into two groups of 32 patients each, in which group A was treated with subcision plus fractional carbon dioxide laser (CO2) and group B was treated with subcision plus microneedling fractional radiofrequency (RF) every 6 weeks for a total of four sittings. An objective score was calculated for each patient using the Goodman and Baron scale to evaluate the outcome every visit during treatment and then 3 months after completion of therapy. Results: In group A, the percentage reduction in the mean objective scores was found to be 64%. In group B, the percentage reduction in mean objective scores was found to be 42%. Most of the changes were seen in the boxcar and rolling types of scars. Conclusions: Subcision and fractional CO2 laser were considered superior over subcision with microneedling fractional (RF) technique for the treatment of post-acne scars. Boxcar and rolling types of scars showed a high response to treatment than icepick scars

  • Analysis of chosen factors affecting the incidence of a brain stroke – a preliminary report

    The risk of stroke is directly proportional to the occurrence of hypertension and the simultaneous occurrence of other risk factors. The main goal was to find out which age group was most at risk of having a stroke. The study was performed among 138 people randomly chosen from Michałowo borough in the Białystok county.The examined were divided into the following 5 age group. The following measurements were performed: arterial blood pressure, blood glucose level, total cholesterol and its fractions level, triglycerides level, sodium and potassium level, prothrombine time, activity. Additionally, a patient’s history was taken and an author’s survey questionnaire was completed. Due to the small number of men surveyed (13 persons), statistically significant analysis of data within this group cannot be carried out. An analysis was made, broken down by age, of data obtained after examining 125 women. People in age group III are most at risk of developing stroke. People in the IV and V age groups are those who are at risk of having a stroke or who have had a stroke. People in groups 1 and 2 are at moderate risk of stroke. In the III age group people are the most at risk of having a stroke.

  • Carnitine status before and after paracentesis in patients with ascites and liver cirrhosis and improvement of subjective symptoms by intravenous administration of carnitine ― Initial study

    Introduction: Recently, carnitine has been reported to be useful for improving blood ammonia and cognitive function in cirrhotic patients with subclinical hepatic encephalopathy In Japan, levocarnitine has become available, and there have been several reports in which the carnitine concentration was first measured and whether symptomatic patients improved or not . And, the examination of symptomatic state around the ascites centesis was also carried out. Method: Total carnitine concentration was measured in 5 cirrhotic patients undergoing ascites drainage during our hospital ambulatory, and after ascites drainage, intravenous administration of ercarnitine was conducted to examine whether or not the symptoms improved. Carnitine concentrations were measured before and after dialysis in four non-dialysis patients and one dialysis patient. Oral carnitine was administered in 3 patients (1 dialysis patient) because symptoms of cramps were noted, but in 2 cases. It was administered only after ascites drainage. Case presentation: The case was in a 55 year-old male. The chief complaint was persistent ascites, cramps and general malaise. The patient had a medical history of treatment with radiofrequency ablation (Radiofrequency: RFA) for hepatocellular carcinoma. The patient had been followed up at another hospital for chronic liver cirrhosis type C. Interferon therapy was performed for liver cirrhosis, resulting in a virological complete response (sustained virological response: SVR). The ascites storage was obvious, but the round was repeated from 2 to 3 times a week of golf. Because of frequent leg cramps during and at the end of golf, patients were given branched-chain amino acid preparations and liver protection drugs as oral medications. In a patient with liver cirrhosis, improvement of hepatic encephalopathy associated with decreased carnitine level and decreased ammonia were reported, and deterioration of muscle symptoms associated with carnitine deficiency in a dialysis patient was also reported [1-3]. Therefore, [4] Carnitine concentration and acylcarnitine/free carnitine…

  • A hypoechoic, tumor-like lesion in the pancreatic head and neck on endoscopic ultrasonography may be due to a high-grade pancreatic intraepithelial neoplasia/carcinoma in situ

    High-grade pancreatic intraepithelial neoplasia (HG PanIN)/carcinoma in situ (CIS) in the pancreatic body and tail can induce parenchymal atrophy through chronic inflammatory changes presenting as a Hypoechoic area on EUS (Hypocho) or focal pancreatic parenchymal atrophy (FPPA) on computed tomography (CT) and magnetic resonance imaging (MRI). We herein discussed two patients with a hypoechoic area in the pancreatic head and neck on EUS resembling pancreatic ductal adenocarcinoma (PDAC). The lesions consisted of dense fibrosis and fat infiltration with pancreatic parenchymal atrophy around the HG PanIN/CIS in the main pancreatic duct (MPD), which penetrated the lesion and showed mild stenosis and upstream dilation. CT and MRI were unable to visualize the lesions. A specimen was obtained from one lesion by fine-needle aspiration under EUS (EUS-FNA) guidance for histopathological and cytological analysis, but the tests returned negative for adenocarcinoma. However, serial pancreatic-juice aspiration cytologic examination (SPACE) revealed adenocarcinoma in both lesions, prompting surgical resection. Histopathological examination revealed non-invasive HG PanIN/CIS in the MPD surrounded by dense fibrosis and fat deposition in the area of parenchymal atrophy. The CIS was restricted to the area of parenchymal atrophy.These two cases are noteworthy in illustrating a hypoechoic area appearing on EUS as a tumor-like lesion resembling PDAC. EUS-FNA has recently been used histopathologically to diagnose a pancreatic lesion. However, in the present and similar cases, EUS-FNA can only reveal secondary changes due to CIS unless the pancreatic duct covered by the CIS is accidentally punctured. We should bear in mind that CIS can appear as a hypoechoic area resembling PDAC on EUS, and that SPACE is the best method for diagnosing CIS in such cases.

  • Metabolic Alterations Of Patients With Acquired Immunodeficiency Syndrome

    Objective: To evaluate the metabolic changes in patients with acquired immunodeficiency syndrome. Methods: This is an observational analytical cross-sectional study that was carried out with 120 patients on regular use of antiretroviral therapy, from May to July 2018. The metabolic changes were determined through the collection of biochemical parameters: CD4, CD4 absolute, CD8, absolute CD8, hemoglobin, High-Density Lipoprotein, Low-Density Lipoprotein, triglycerides, and fasting blood glucose. Results: The lipid profile, in most individuals, showed serum values ​​of total cholesterol, triglycerides, and Low-Density Lipoprotein, within the normal range, while the serum levels of High-Density Lipoprotein were decreased by 53.6%, being related to the mean time disease of 8.7 years (± 6.1). As for hematological indices, 62 and 60 (80.5% and 77.9%) of the patients had adequate serum hemoglobin and hematocrit values, however, it was observed that those who had anemia lived with the virus for a longer time (9.27 years ± 6.89). When observing the parameters related to the immune system, it was seen that CD4 levels were low in 38% of patients, adequate absolute CD4 in 56.5%, increased CD8 in 90.7%, and absolute CD8 in 63%. Conclusion: It is known that metabolic changes, such as the decrease in serum levels of High-Density Lipoprotein are common in patients with the virus, as well as, it is known that the survival of these individuals is being prolonged by antiretroviral therapy, which can result in exposure important risk factors for cardiovascular disease. Emphasizing the importance of nutritional monitoring in this population.

  • Socioeconomic Profile Of Patients Living With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Followed In A School Hospital In Recife-PE

    Objective: Describe the socioeconomic profile of patients living with the human immunodeficiency virus in a Teaching Hospital in Recife-PE. Methodology: A cross-sectional study, carried out between April and November 2019. Identification, demographic and socioeconomic data were collected. The study was approved by the Research Ethics Committee of the Instituto de Medicina Integral Professor Fernando Figueira, under CAAE: 10262919.7.0000.5201. Statistical analysis was performed using SPSS version 13.0. Results: The sample consisted of 81 patients, with an average age of 37 years ± 11.3 years and 56.8% of females. The family income was 1714.9 ± 1533.5 reais and 46.8% of the individuals had some type of income. It was also possible to verify that, most of the patients had electric light (98.8%), water source by the public network (79.0%), mineral water (71.6%), television (95.1%), and internet (82.4%). Almost half of the individuals (46.9%) used the pit as a sanitary sewer. Conclusion: It can be concluded that the human immunodeficiency virus affects both individuals with low purchasing power and those who have better socioeconomic conditions.


    Aim: The reported case involved a complicated diagnostic path, not only because of the usual difficulties specific to chronic urticaria but, also because the trigger was a T-cell large granular lymphocytic leukemia (T-LGLL), a rare type of leukemia with an indolent course whose etiology is still not well known. This leukemia is also known for its propensity to cause autoimmune diseases. The aim of this study was to identify whether the muscle damage was caused by dermatomyositis or by T-LGLL. Methods: After elevated muscle enzyme levels had been discovered magnetic resonance imaging (MRI) revealed muscle damage. Consequently, a muscle biopsy was performed in a targeted manner. In addition to muscle biopsy, transmission electron microscopy and anti-CN1A antibody testing were performed. Results: MRI of the lower limbs and pelvic girdle indicated moderate fibroadipose substitution in many muscles, moderate edema in others. No involvement of the shoulder girdle and upper limbs. Histological examination of the muscle fibers showed an “inflammatory myopathy with isolated phagocytotic fibers.” Inclusion-body myositis, which is known to be associated with chronic T-LGLL was excluded. On the same biopsy transmission electron microscopy confirmed inflammatory myopathy and anti-CN1A antibodies were positive. DNA extracted from the muscle of the micro-rearrangement for the y-chain of the TCR identified on the DNA extracted from peripheral blood was positive. Conclusions: Conclusions: Chronic urticaria was an indication of immunoproliferative disease. Myositis was the pathology due to T-LGLL, and dermatomyositis was excluded.

  • Colon Irrigation Bowel Preparation Supports Multiple Clinical Benefits in Over 8,000 Patients

    This retrospective clinical study evaluates an FDA-cleared high-volume colon irrigation bowel prep (BP) for colonoscopy, performed under standard operating procedures with Austin Gastroenterology (AG, Austin, TX). Patient related outcomes in 8,364 procedures, prescribed by 33 physicians in 4.5 years, demonstrated no serious adverse events and excellent satisfaction rates. The high level of adequacy using this BP far exceeds national benchmarking thresholds for adequate colon preparations. Adequacy rates remain high even when considering poor BP risk factors and patient noncompliance with ancillary pre-preparation regimens. Our analysis demonstrates that this colon irrigation BP has excellent Boston bowel preparation scores (BBPS), associated with high-level adenoma detection rates (ADR) and sessile serrated polyp (SSP) detection rates. ADR and SSP are inversely related to the patient’s post-colonoscopy interval colorectal cancer (CRC) risk, and are similarly related to an inadequate BP. Both modeling data and performance characteristics strongly suggest that this colon irrigation BP is highly safe, effective, and will reduce the costs and risks related to inadequate BP. This, accordingly, leads to significantly improved quality outcomes, savings to the healthcare systems, and a reduction of the patient’s burden.

  • A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

    A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.


    Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral…