Article of the Year 2022
Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United StatesRead the full article
International Journal of Clinical Practice is a general medical journal. It gives special priority to work that has international appeal. The journal’s original, varied and independently peer-reviewed articles and features attract the interest of clinicians in a wide variety of therapeutic areas.
Chief Editor, Dr. Angela Vinturache, is a practicing obstetrician and gynaecologist and currently a Clinical Lecturer at the University of Alberta. Her research areas include developmental physiology, and maternal and child health epidemiology.
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Fluoroscopy Is Essential in Retrograde Intrarenal Surgery
Objective. This study aimed to investigate the necessity of using fluoroscopy in retrograde intrarenal surgery (RIRS). Material and Methods. A total of 612 patients who underwent RIRS for kidney stones were evaluated and divided into two groups. Group 1 routinely underwent the operation with fluoroscopy due to opaque stones (n: 504). In group 2, the procedure was performed without fluoroscopy because of nonopaque stones (n: 108). Both groups were assessed for stone size, location, and number. Success and complication rates were compared between the two groups. Conclusion. This study was designed with the thought of not using fluoroscopy in RIRS patients with nonopaque stones and having the same stone-free rates in opaque stones. In the statistical analysis, there was no difference between the groups with and without scope for stone side, size, localization, and number; likewise, the complication rates developed in the comparison of both groups, stone-free rates, and hospital stay were the same. Discussion. Advances in the calibration of instruments, the development of optical systems, and improvements in imaging system resolution have gradually reduced the need for fluoroscopy in RIRS. This study provides further evidence that fluoroscopy is unnecessary in RIRS procedures, thereby eliminating unnecessary radiation exposure.
Empowering Medical Students: Harnessing Artificial Intelligence for Precision Point-of-Care Echocardiography Assessment of Left Ventricular Ejection Fraction
Introduction. Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making. Aim. To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for assessing the left ventricular ejection fraction (LVEF) of patients admitted to a cardiology department. Methods. Eight students underwent a 6-hour didactic and hands-on training session. Participants used a hand-held ultrasound device (HUD) equipped with an AI-based tool for the automatic evaluation of LVEF. The clips were assessed for LVEF by three methods: visually by the students, by students + the AI-based tool, and by the cardiologists. All LVEF measurements were compared to formal echocardiography completed within 24 hours and were evaluated for LVEF using the Simpson method and eyeballing assessment by expert echocardiographers. Results. The study included 88 patients (aged 58.3 ± 16.3 years). The AI-based tool measurement was unsuccessful in 6 cases. Comparing LVEF reported by students’ visual evaluation and students + AI vs. cardiologists revealed a correlation of 0.51 and 0.83, respectively. Comparing these three evaluation methods with the echocardiographers revealed a moderate/substantial agreement for the students + AI and cardiologists but only a fair agreement for the students’ visual evaluation. Conclusion. Medical students’ utilization of an AI-based tool with a HUD for LVEF assessment achieved a level of accuracy similar to that of cardiologists. Furthermore, the use of AI by the students achieved moderate to substantial inter-rater reliability with expert echocardiographers’ evaluation.
Identification of Crotonylation Metabolism Signature Predicting Overall Survival for Clear Cell Renal Cell Carcinoma
Background. Immunotherapy shows promise in treating cancer by leveraging the immune system to combat cancer cells. However, the influence of crotonylation metabolism on the prognosis and tumor environment in ccRCC patients is not fully understood. Methods. We conducted various systematic analyses, including prognosis and cluster analyses, to investigate the role of KAT2A in immunotherapy. We used qRT-PCR to compare KAT2A expression in cancer and adjacent tissues and among different cell lines. Additionally, we employed Cell Counting Kit-8, wound healing, and Transwell chamber assays to assess changes in the proliferative and metastatic ability of A498 and 786-O cells. Results. We identified three clusters related to crotonylation metabolism, each with distinct prognosis and immune characteristics in ccRCC. We categorized CT1 as immune-inflamed, CT2 as immune-excluded, and CR3 as immune-desert. A new system, CRS, emerged as an effective predictor of patient outcomes with differing immune characteristics. Moreover, qRT-PCR revealed elevated KAT2A levels in ccRCC tissues and cell lines. KAT2A was found to promote ccRCC and correlate significantly with immunosuppressive elements and checkpoints. Reducing KAT2A expression hindered ccRCC cell growth and metastasis. Conclusion. Our study highlights the critical role of crotonylation metabolism in cancer development and progression, particularly its link to poor prognosis. CRS proves to be an accurate predictor of patient outcomes and immune features in ccRCC. KAT2A shows strong associations with clinical factors and the immunosuppressive environment, suggesting potential for innovative immunotherapies in ccRCC treatment.
Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study
Purpose. Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. Results. A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. Conclusion. During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient’s age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.
Diabetes Mellitus and HIV Infection among Newly Diagnosed Pulmonary Tuberculosis Patients in the North West Region of Cameroon: A Cross-Sectional Study
Objective. To determine the prevalence rate of HIV and diabetes among tuberculosis (TB) patients and also the comorbidity rate. Design. Cross-sectional study. Setting. This study was carried out at the Tuberculosis Reference Laboratory, Regional Hospital Bamenda, North West Region of Cameroon, from January 2017 to December 2019. Participants. 1115 cases of pulmonary tuberculosis aged ≥14 years (mean 42.5 ± 15.28 years). Methods. Sputum samples collected were acid-fast stained and examined macroscopically as well as inoculated for culture. A chest X-ray was performed for further confirmation of TB diagnosis. After the TB diagnosis was done, fasting blood glucose, 2 h-PG test, HbA1c, and biochemical enzymatic tests were performed for the diagnosis of diabetes. Rapid strip test and enzyme-linked immunosorbent assay were used to diagnose HIV infection. Interventions. No intervention was done during the period of study. Outcome Measures. The prevalence of TB/HIV and TB/HIV/DM, signs and symptoms, imaging results, and bacteriology status among TB/HIV, TB/HIV/DM coinfected, and comorbidity cases. Results. Of 1115 participants, 38.57% had TB/HIV, and 5.83% had TB/HIV/DM. Among TB/HIV/DM cases, 20.39% had a cough for more than 2 weeks [; OR (95%CI): 4.866 (3.170–7.404)], and 35.71% had a fever for at least 2 weeks [; OR (95%CI): 7.824 (5.336–11.36)]. The majority of TB/HIV/DM patients (77.42%) had chest pain for at least 2 weeks [; OR (95%CI): 114.3 (59.78–207.1)]. 7.41%, 14.18%, and 9.09% of TB/HIV/DM, respectively, had chest abnormality, positive smear, and positive culture (p = 0.018). Significant differences were observed between signs and symptoms, imaging results, bacteriology, treatment history for TB cases and those with HIV and/or DM, and those without HIV and/or DM coinfection and comorbidity. Conclusion. This study reports a high prevalence of DM comorbidity and HIV coinfection among active TB patients in the North West Region of Cameroon as well as TB/HIV/DM comorbidity.
The Effect of Various Combinations of Peripheral Nerve Blocks on Postoperative Pain in Laparoscopic Cholecystectomy: A Comparative Prospective Study
Objectives. Most patients who undergo laparoscopic cholecystectomy (LC) experience moderate to severe pain in the first 24 hours after surgery. The transversus abdominal plane (TAP) is currently used for post-LC analgesia. Posterior, subcostal, or rectus sheath TAP blocks are the conventional approaches used. The aim of the current study was to compare the efficacy of combinations of various peripheral blocks on pain intensity and the use of pain killers, shortly after LC. Methods. This was a prospective, double-blind study, in which 200 patients who were about to undergo a LC procedure were recruited and randomized into 4 groups: patients receiving one of the following: TAP block alone, subcostal Tap block alone, subcostal TAP block with a TAP block, or subcostal TAP with a rectus sheath block. The intensity of pain (VAS score) and the use of painkillers were monitored in the recovery unit and in the department for up to 24 hours after surgery. Results. Pain levels decreased with time from 3.6 ± 3.2 at 30 minutes to 0.9 ± 2.0 at 24 hours after the surgery. Nevertheless, no difference between the various block types groups was noted. The percentage of patients who consumed analgesic medications decreased over time, from 83% at 30 to 21% at 24 hours after surgery. The mean/median number of medications consumed by each of the patients was lower among the patients who received a combination of 2 blocks compared to those who received a single one (mean/median of 2.7/3 and 2.8/3 for the TAP or subcostal TAP blocks, respectively; 2.5/2 and 2.3/2 for the subcostal TAP + TAP or subcostal TAP + rectus sheath blocks, respectively). Conclusion. A combination of peripheral nerve blocks reduced the use of analgesic consumption during the 24 hours after LC surgery, compared to standalone blocks.