Hot Articles

Introduction: Toxoplasmosis is caused by Toxoplasma gondii, mandatory intracellular protozoan. It’s estimated that one third of the world population is infected with the parasite, a fact that makes it one of the most infectious parasites. Although 80-90% of the immunocompetent infected are asymptomatic, the disease stands out for being one of the main causes of retinochoroiditis, especially among the immunosuppressed. Case report: Patient, 17 years old, white, female, previously healthy, comes to primary care due to a counter-referral with ophthalmology. Patient presented low visual acuity for 6 months, being diagnosed with ocular toxoplasmosis. Standard treatment was started: sulfadiazine, pyrimethamine, folinic acid and oral prednisolone for 6 weeks. Serum antitoxoplasma titers were obtained indicating previous infection: positive IgG and negative IgM. A patient will face another treatment cycle, as the condition doesn’t improve, which includes high doses of systemic corticosteroids. The physical examination showed no changes. The ophthalmologist requested periodic control of patient’s blood pressure and glucose, extending the treatment. Conclusion: In immunocompetent individuals, ocular toxoplasmosis is a consequence of reactivation of a scar that contained a previously inactive cyst, only a minority comes from a new infection. It’s considered the most common cause of posterior uveitis, emphasizing the importance of this report. Ocular reactivation occurs due to a decrease in specific immunity and the peak incidence is at 29 years old. Young patients with ocular toxoplasmosis have higher risk of recurrence when compared to elderly. Antitoxoplasma serology isn’t necessary for treatment, which must be started as clinical diagnosis is established.

Background: Sunscreen companies recommend replacing your chemical sunscreen every year. Consumer inquiries about product integrity under excessive exposure to heat prompted the FDA to add a requirement statement to sunscreen products indicating a need to protect stored sunscreen from excessive heat and direct sun. If heat exposure indeed affects chemical sunscreen stability, then in some areas, replacement may be warranted earlier than a year. Methods: We examined real-life scenarios related to the storage of sunscreen containers inside vehicles sitting in natural sunlight to provide information about the stability of sunscreen active ingredients under real-life storage conditions. The active ingredients avobenzone, oxybenzone, homosalate, octinoxate, octisalate, and octocrylene in samples of sunscreens were examined after heat exposure over six months using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The calculated levels of each active ingredient were then compared between the non-heat exposed samples and the heat exposed samples using a paired t-test to look for decreases in active chemicals from heat exposure. Results: No important differences were seen for heat exposure in this study of 378 hours of temperatures above 37.8 °C, with an additional 292 hours of exposure to temperatures of 32.2-37.7 °C, and 3454 hours at 26.7-32.2 °C. Conclusions: This suggests such heat exposure does not result in degradation of the active ingredients of sunscreens with sun protection factors (SPF) of 30 and 50. This is important for individuals attempting to prevent sunburns and skin cancer.

Background and Aims: Effective post‑operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, Srinagar from October 2017 – December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi‑square test and students’ t‑test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value

The use of opioids as an anodyne for chronic pain was not prevalent before the 1980s1. Students in medical schools had learnt to avoid prescribing opioids, considered highly addictive for treatment of non-malignant chronic pain1. Yet, from the early 1990s, prescription opioids emerged as a widely accepted method of treating chronic pain and palliative care2. Previously, chronic pain was treated in multidisciplinary clinics with coordinated care which included physical exams, medication management, biopsychosocial evaluation, cognitive behavioral treatment, physical therapy, and occupational therapy2. Starting in the early 1990’s, under dubious antecedence, opioid analgesics were promoted as the proprietary remedy for chronic pain and received endorsement and support from care providers across the United States3. Non-cancerous chronic pain, as a phenomenon, was thus elevated to an ailment or a medical condition by its own right from its erstwhile status as a corollary to another medical condition. This led to an increase in opioid analgesic prescriptions, followed by a wide-ranging abuse by patients, converting opioid use disorder (OUD) to a problem of epidemic proportions4. Apart from the legal course of action initiated against Perdue Pharma, in 2020, the maker and distributor of Oxycontin that resulted in a $3.8 billion lawsuit settlement, in which Perdue Pharma pleaded guilty; since the recognition of this problem, new measures have been adopted to counter the opioid epidemic by clinicians. There has been a significant shift towards circumvention by physicians prescribing opioids for non-cancerous chronic pain. In a few instances, providers have resorted to putting a temporary moratorium on prescribing opioids to all non-cancerous chronic pain cases5. The Center for Disease Control (CDC) and various state agencies have passed protocols, installed prescription monitoring programs (PMPs), and created taskforces to rein in flagrant prescription practices by medical providers. Mental health counseling and alternative, non-prescriptive pain management procedures have been…

Hepatitis C infection is a growing public health issue in Malaysia. A large number of people living with hepatitis C virus (HCV) are unaware of the infection. The treatment complexity warrants a comprehensive understanding of this infectious disease to support planning for strategies to reduce the burden of disease associated with hepatitis C. This study aimed to summarise the epidemiology and risk factors attributable to hepatitis C acquisition in Malaysia based on local published articles. Published articles related to epidemiology and risk factors for hepatitis C infection in Malaysia between 2005 and 2017 were searched through several online databases. Related information from the Ministry of Health official website was also compiled. An increasing trend in the incidence and mortality rate of hepatitis C infection is noted over the last decades. In 2009, the national prevalence of people infected with HCV was approximately 2.5%, with the prevalence rate varying according to different high-risk groups. The most common genotypes reported are genotypes 3 and 1. Frequently reported risk factor for HCV acquisition is injection drug use. Other identified risk factors are being a blood product recipient, haemodialysis patient or participant in high-risk sexual activity. Nevertheless, a considerable number of patients had no known risk factors. The prevalence and burden of HCV-related disease are substantial and can be attributed to many factors. High-quality design studies are needed to provide stronger evidence of the risk factors for hepatitis C infection in local populations for future public health planning.

We report in the light of a literature review the results of 28 patients treated for Necrotizing Fasciitis (NF) at the extremities between 2012 and 2017 with a view to a prospective study with longer following up and a greater number of patients.

Objective: to evaluate the treatment efficacy of Tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) in the Teaching hospital campus of Lome. Patients and method: retrospective cross-sectional study, conducted in the outpatient department of the Hepato-Gastro-Enterology department of the Teaching hospital campus of Lome from January 2018 and December 2020. Patients with HBsAg were included. Outpatient patients having achieved at least HBeAg, anti-HBe antibody, anti-HCV antibody, anti-HBc IgG; viral load hepatic assessment; retroviral serology. Some patients had achieved actitest-fibrotest. Patients with abdominal pain, clinical signs of portal hypertension or hepatocellular insufficiency had achieved alphafetoprotein, protidogram, and abdominal ultrasound. These explorations made it possible to classify patients into different virological profiles. Results: More than sixty-four percent of the patients were male. The patients were asymptomatic at 97.37%. HBeAg was positive in 15.19% of patients. The viral load was detectable in 80.43% of cases with a value of 52000000 IU / ml +/- 280000000UI / ml. Ninety-five point twenty-four patients had an inflammatory activity less than 2 and 52.38% a fibrosis greater than 2 on the Metavir grid. The APRI and Fib-4 scores found a strong predictive value for fibrosis in 16.22% and 11.01% of cases, respectively. HBeAg negative chronic hepatitis was the most common virologic profile (58%). Cirrhosis was the most common complication (9.97%). Tenofovir was the therapeutic molecule used. At 12 months of treatment, HBe seroconversion was noted in 100% of cases, an undetectable viral load in 50% of cases and normalization of the hepatic balance in 84% of cases. No side effects of the treatment were reported Conclusion: TDF treatment shows high rate of complete virologic response in CHB patients. TDF is tolerable and safe during the 96 weeks of treatment period. Monitoring of HBV DNA level and drug adherence is important for achieving complete suppression…

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

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.

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…