Analysis and Impact of Evidence Based Medicine in the Process of Education and Decision Making in Medical Practice
Evidence Based Medicine (EBM) is one of the modern systems of collecting, recording and using information and data related to medicine. The research was conducted in 2018 in several health institutions (health centers and hospitals) in Sarajevo Canton. The sample was made up of family doctors and other clinical specialties. The research results suggest the doctors in BiH are familiar with the concept of Evidence Based Medicine (EBM) and in their everyday work they apply relevant contemporary knowledge, national and international guidelines for the treatment and disease therapy. The most significant obstacle to more efficient management of medical information and the implementation of EBM in practice is the perception it would require additional time and incur significant cash expenditures to the doctors. In the future, doctors will increasingly be demanded to use advanced tools and modern techniques supporting them to make the most effective treatments on the basis of their own experience.
ASSOCIATION BETWEEN SINGLE NUCLEOTIDE POLYMORPHISM RS4919510 (C>G) IN MIRNA-608 AND BREAST CANCER IN VIETNAMESE POPULATION
Breast cancer (BC) is a complex disease throughout the world and it is one of the most common cancer among women both in developed and developing countries. To enhance the survival of BC patients, genetic factors are used for early diagnosis because they are non-changed factors and present ability of cells to proliferate and metastasize. MiR-608 targets many genes which are vital for development, differentiation, motility, apoptosis and angiogenesis. The SNP rs4919510 (C/G) affects the processing of the pre-miRNA to its mature form and the ability to regulate target genes. This SNP has been demonstrated to relate to breast cancer in Chinese and Iranian population. Our study aimed to investigate the association between the SNP rs4919510 and BC in Vietnamese population. 106 cases and 101 controls were genotyped using optimized tetra-ARMs-PCR method, then statistical analysis was applied to examine the correlation of the SNP. The results show that this SNP is high polymorphism with the frequencies of minor allele C is 24.8% and major allele G is 75.2% in Vietnamese population. Statistic result revealed an obvious increased risk of BC among Vietnamese women when compared of heterozygote model and dominant model (CG vs. GG: OR=1.93, 95% CI: 1.09-3.45, p= 0.02; CC+CG vs. GG: OR=1.83, 95%CI: 1.05-3.17, p=0.03). Our study suggested that the polymorphism of rs4919510 may be associated with BC risk in Vietnamese individuals.
During routine educational dissection of the upper part of the abdominal cavity in a female cadaver (67 years old, Netherlands) a unique association of two rare biliary and vascular patterns was discovered. The gastroduodenal artery originated from the celiac trunk along with the right hepatic, gastric and splenic arteries, and gave origin to the accessory right and left hepatic vessels. The right hepatic artery took the course typical for the common hepatic artery; however, as a component of the portal triad, the artery was located behind the bile duct and portal vein. Next to the hilum of the liver, it branched off the cystic artery to the gallbladder and bifurcated into two segmental hepatic branches. The described hepatic vascular pattern was associated with the presence of an accessory aberrant cystic duct connecting the body of the gallbladder with the right anterior inferior segmental bile duct. The case is reported to emphasize the importance of a detailed preoperative investigation of the patients considered for open and laparoscopic procedures on the liver and gallbladder documenting the variability of both the biliary and vascular patterns.
Fracture of the penis is a misnomer, the cause being rupture of one or both of the tunica albuginea that covers the corpora cavernosa. It usually occurs following sexual intercourse or masturbation. Here we report 2 cases of penile fracture in our institution. Ultrasonography was done which confirmed the diagnosis. In both the cases, the urethra was intact. Exploration with evacuation of the hematoma and repair of the tunica albuginea was done.
During routine educational dissection of a cadaver (63-year-old, male, USA), an atypical course of the left inferior suprarenal vessels via the posterior pararenal space was discovered. Detailed analysis of the abdominal vascular pattern showed that the atypical inferior suprarenal artery represented a terminal branch of the left inferior phrenic artery. The last one branched off from the very beginning of the left renal artery, ascended between the fibers of the left crus of the diaphragm, then ran laterally giving off muscular branches and, finally, descended along the costal part of the diaphragm to the left posterior pararenal space. The terminal branch of the inferior phrenic artery pierced the retrorenal fascia and entered the perirenal space as an atypical left inferior suprarenal artery. It ran upward and medially crossing the anterior surface of the kidney to reach and supply the lower pole of the left suprarenal gland. The left inferior phrenic vein accompanied the artery taking a similar course. It received numerous tributaries passing via the posterior pararenal space, drained the inferior suprarenal vein, and opened into the left renal vein. Such anomalous pararenal vascular pattern is a challenge for surgeons performing open procedures on retroperitoneal organs, not to mention specialists employing minimally invasive laparoscopic techniques. The anatomical variation reported in this paper requires urgent attention of the related specialists.
Research on waste frying oil based lubricant base stocks production and trimethylolpropane (TMP) was investigated. Quality parameters were tested for the waste frying oil. The hydrolysis process was conducted to extract the free fatty acid from waste frying oil. TMP ester was produced via reaction between free fatty acids of waste frying oil and TMP at 130-140°C, for 5 hours with acid-catalyzed condition. Modification of TMP ester by epoxidation reaction followed by ring-opening reaction using a medium branch chain alcohol; 2-ethylhexanol. The TMP ester was reacted with hydrogen peroxide and formic acid at 45-55°C for 2½ hours during epoxidation process. Epoxidized TMP ester was reacted with 2-ethylhexanol in mol ratio of 1:2 to produce ether ester TMP. Concentrated sulphuric acid was used as a catalyst during ring opening and esterification processes. Ether ester TMP functional groups and chemical structure were identified using FTIR and NMR, respectively. Confirmation with FTIR has indicated sharp peak at 1742 cm-¹, proved the existence of ester group which confirmed the TMP ester formation during esterification and broad peak of 3456 cm-1 during ring opening indicated the formation of ether ester TMP. In ¹H NMR analysis, the signal of methylene proton in which the carbon attached to ether esters TMP existed at 4.0-4.1 ppm and for 13C NMR, the carbonyl ester signals existed in the range of 174.1 ppm. Several analyses were conducted on the ether ester TMP base stock such as hydroxyl value, viscosity value, pour point and flash point. It showed good low temperature behaviour with pour point at -40ºC and high thermal stability, flash point value exceeding 250ºC and viscosity value of 75 cP. The ether ester TMP produced is comparable with a commercial biolubricant in the market respectively.
UTIs typically cause women to have a severe urge to urinate, and to do so frequently. It’s also often very painful when they do, and many experiences a burning sensation in their bladder or urethra. Two common factors emerged in urine that had a better ability to resist bacterial growth: it had a high pH—one that’s more alkaline, in other words—and higher levels of certain metabolites formed by gut microbes. Physicians already know how to raise urinary pH with things like calcium supplements, and alkalizing agents are already used in the U.K. as over-the-counter UTI treatments. However, early on in an infection, cells produce a protein called siderocalin that blocks bacterial growth, including the growth of E. coli. Uncomplicated UTIs usually go away with drugs within two to three weeks, but in some cases, women may take antibiotics for 6 months or longer if their UTIs keep coming back. Most UTIs are caused by the bacteria Escherichia coli (E. coli), and recent surveillance data shows a significant rise in cases of UTIs caused by E. coli that are resistant to the antibiotics most commonly used to that treat them. Doctors say “It’s uncomfortable but not life-threatening, so women don’t go in”.
The expression “Home-based care” or basically home care might be characterized as a wide exhibit of various kinds of care gave in the home by a wide scope of gatherings. The continuum of various sorts of home-based care conveyed in the home shifts as far as various measurements, including sharpness, kind of care gave, and level of physician contribution. Home-based care incorporates both formal and casual individual care services, Medicare gifted home health, physician house calls, and even “emergency clinic at-home” services. Prescription related issues are essential among home care patients who take various drugs and have complex medical annals and medical issues. The destinations of home social protection organizations are to help individuals with improving limit and live with progressively noticeable opportunity; to propel the client’s optimal element of thriving; and to assist the patient with staying at home, keeping up a vital good way from hospitalization or admission to long haul care establishments. Home care is a game plan of care given by capable specialists to patients in their homes under the heading of a doctor. Home restorative services organizations join nursing care; physical, word related, and talk language treatment; and medical social organizations. Doctors may suggest patients for home therapeutic services organizations, or the organizations may be requested by relatives or patients. The extent of home human services benefits a patient can get at home is endless. Contingent upon the individual patient’s condition, care can reach out from nursing care to explicit medical organizations, for instance, research center workups. Essential investigations among home therapeutic services patients consolidate circulatory disease, coronary ailment, harm and hurting, musculoskeletal and connective tissue disease and respiratory disease.
Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP) and high FiO2
Case report of bronchoscopically guided percutaneous dilational tracheostomy in-patient with acute respiratory distress syndrome ventilated with high positive end-expiratory pressure (PEEP) and high FiO2.
Aim: To evaluate the color stability of dual cure and light cure resin cements immersed in coffee solution at different time periods (baseline, 3 days and 1 week). Materials and methods: The color stability of three light curing (Variolink Esthetic (VLC); Rely X Veneer (RLC) and Mojo Veneer (MLC)) and three dual curing (Variolink Esthetic (VDC); Rely X Ultimate (RDC) and Breeze (MDC)) resin cements were tested. A total of sixty disks (10 mm diameter and 0.5 mm thickness) were prepared using a silicone mold (n=10). The specimens were subjected to baseline color measurement using Commission Internationale de l’Eclairege L*a*b* (CIELAB) color space system with the help of a spectrophotometer (LabScan XE, HunterLab, VA, USA). Following baseline color measurements, the specimens were immersed in a staining coffee solution. The color measurement was repeated after 3 days and 1 week of immersion in coffee solution. All the data collected were statistically analyzed using repeated measures of Analysis of variance (ANOVA, P