European Journal of Medical and Health Sciences European Journal of Medical and Health Sciences en-US <p>Authors retain the copyright of their work, and grant this journal the right of first publication with the work simultaneously licensed under a <a href="">Creative Commons Attribution 4.0 International License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> (Editor-in-Chief) (Support) Mon, 01 Jan 2024 07:21:10 -0500 OJS 60 Musculoskeletal Disorders among Dentists in the Private Sector <p><em>Objective</em>: To assess the prevalence of musculoskeletal disorders among dentists practicing in the private sector in the city of Agadir, Morocco.</p> <p><em>Materials and Methods:</em> We conducted a cross-sectional study among dentists in the city of Agadir after informed consent. An anonymous questionnaire containing 19 closed questions was distributed. Data entry and statistical analysis were performed using SPSS software at the Community Health, Epidemiology and Biostatistics Laboratory of the Faculty of Dentistry of Casablanca.</p> <p><em>Results</em>: 100% of doctors reported at least one musculoskeletal complaint. 19.42% of these musculoskeletal disorders were diagnosed and under treatment, 80.58% were undiagnosed, mainly affecting the neck, shoulders and lumbar region. 40% of dentists were diagnosed between 5 and 10 years of practice, 50% had been practicing for less than 10 years, 46.6% were overweight and 40.3% of the participants did not practice sports.</p> <p><em>Discussion</em>: The rate of dentists reporting musculoskeletal complaints is alarmingly high compared to rates recorded in the literature. Several factors linked to lifestyle and professional activity may explain the results found. Musculoskeletal suffering can also be amplified if the dentist does not respect ergonomics in his dental practice.</p> <p><em>Conclusion</em>: The rate of musculoskeletal disorders found in our population is alarming. Further studies are needed to evaluate ergonomic compliance to understand better the results of our study.</p> Sara Benfaida, Imane Hachami, Rayhana Chafik, Mouna Hamza, Anas Bennani Copyright (c) 2024 Sara Benfaida, Imane Hachami, Rayhana Chafik, Mouna Hamza, Anas Bennani Sun, 11 Feb 2024 00:00:00 -0500 HRpredict: Introducing a Web-Based Application for Heart Rate Prediction and Lifestyle Recommendations <p><em>Background</em>: Monitoring heart health requires early detection of deviations in HR, which makes it easier to detect and address heart irregularities at an early stage. Health remote systems when combined with artificial intelligence (AI) can assist in better health outcomes through early detection of heart problems.</p> <p><em>Aims</em>: Our main goal is to create a website application (Web-App) for web browser access, aiming to utilize a Random Forest (RF) machine learning (ML) model trained to predict the average heart rate (HR) over 10 days for different periods, and to enable lifestyle and activity recommendations.</p> <p><em>Method</em>s: The Web-App is created using Laravel, an open-source Personal Home Page (PHP) web framework that follows the model-view-controller (MVC) architectural pattern.</p> <p><em>Results</em>: This research resulted in a web-based ML model that can be used to predict future heart rates over a 10-day period which are utilized to establish average HR values, considering baseline and three distinct periods: morning, noon, and evening across the 10-day duration. Through this Web-App lifestyle, habit, activity, and 10-day reassessment recommendations are also provided.</p> <p><em>Conclusion</em>: The Web-App was designed to be accessed and used through a web browser, to provide lifestyle recommendations based on predicted HR readings. To determine the impact of users adhering to recommendations, further research is required.</p> Helana Lutfi, Thomas Spittler Copyright (c) 2024 Helana Lutfi, Thomas Spittler Wed, 14 Feb 2024 00:00:00 -0500 Confronting the Fear: Our Experience with Breech Vaginal Delivery-A Retrospective Analysis <p><em>Introduction</em>: Mode of delivery for term singleton breech presentation has been a raging topic of discussion for decades and continues to be so. The ‘Term Breech Trial’ was a big blow to vaginal breech delivery leading to a torrential increase in the rate of caesarean sections the world over. We intend to compare and evaluate the maternal and perinatal outcomes of vaginal versus caesarean section breech delivery so as to analyse the safety of vaginal delivery for breech presentation.</p> <p><em>Objectives</em>: Analyse and compare perinatal and maternal outcomes between vaginal versus caesarean deliveries of term or near-term singleton breech presentation.</p> <p><em>Materials and Method</em>s: Retrospective comparison between 30 vaginal breech deliveries (Group 1) and 252 caesarean deliveries (Group 2) done for singleton breech presentation between 36 weeks to 42 weeks, either in early or advanced labour conducted between January 2015-January 2022 at various Military Hospitals.</p> <p><em>Statistical Analysis</em>: The association between maternal and perinatal outcomes was estimated using the Chi-square test and Fisher exact test with P &lt; 0.05 considered statistically significant.</p> <p><em>Results</em>: No maternal complications were noted in Group 1 while in Group 2 surgical site infection and post-partum haemorrhage of varying degree, was noted in 14% cases and 7% cases respectively which was statistically significant. There was no significant difference noted between the groups with regard to neonatal outcomes or NICU admission.</p> <p><em>Conclusion</em>: Vaginal delivery for termsingleton breech is a reasonable option in well-selected patients at optimally equipped centres, in the hands of an experienced Obstetrician.</p> Soumen Das Poddar, Santhanam Sampath, Shikha Sharma, Mohammad Rasheed, Amarinder Singh, Ricky Saini Copyright (c) 2024 Soumen Das Poddar, Santhanam Sampath, Shikha Sharma, Mohammad Rasheed, Amarinder Singh, Ricky Saini Mon, 19 Feb 2024 00:00:00 -0500 Growth Hormone Receptor and PCSK9 Define a New Paradigm in the Initiation and Development of Chronic Kidney Disease as Revealed by Exome Sequencing on Illumina Platform <p>Chronic kidney disease is a combination of many vascular diseases involving mutations of many genes. Hypertension diabetes and atherosclerosis are the most common causes of kidney disease, with hypertension causing just over a quarter of all cases of kidney failure and diabetes causing one-third of them. Other much less common conditions that can cause CKD include inflammation, infections, genetic factors, or longstanding blockage to the urinary system (such as enlarged prostate or kidney stones). In many cases, the causes remained unknown, albeit the manifestation of the diseases with clear phenotypes and biochemical profiles. Heredity and genetic determinants play major roles in the initiation, development, and establishment of CKD. Kidney disease phenotypes can be dissected into many underlying causing candidates’ genes and many molecular genetics approaches are striving to lift the veil on this nagging disease. Recent studies using genetic testing have demonstrated that Mendelian etiologies account for approximately 20% of cases of kidney disease of unknown etiology. CKD is known to be plagued with many genes mutations like mutation in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and mutations in MYH9 and APOL1 genes, COL4A3, COL4A4, and COL4A5 genes playing important roles in the CKD picture. Genetic testing has modernized and revolutionized many areas of medical practices and diagnosis of many diseases and the field of nephrology is not an exception. The advance in Next-generation Sequencing, including whole exome sequencing has proven to be a powerful tool in personalized medicine and for potential noninvasive decryption for biomarkers in kidney disease thereby paving the way for better diagnostic purposes. In this regard, we run whole exome sequencing on whole blood genomic DNA from CKD patients. Bioinformatics analysis led us to uncover a total of more than 3000 single nucleotide polymorphisms (SNPs). To sort out these flurries of targeted SNPs, we undertook filtration using an R-algorithm in combination with the diseases association Clinvar database. This approach led us to 12 combined diagnostic missense variants scattered on different chromosomes. Combined missense reduction after FDR filtration with a Cellrate of 0.75 generated two missense variants located on PCSK9 and GHR genes on chromosomes 1 and 5 and lastly, reduction variants after Filtration by spliced region bring us to a single SNP located on the PCSK9 gene.</p> Edem Nuglozeh, Mohammad Feroze Fazaludeen, Sumukh Deshpande, Aymen Ahmed Warille, Mustafa Kürşat Şahin Copyright (c) 2024 Edem Nuglozeh, Mohammad Feroze Fazaludeen, Sumukh Deshpande, Aymen Ahmed Warille, Mustafa Kürşat Şahin Wed, 03 Jan 2024 00:00:00 -0500 User’s Perceived Attitudes and Acceptance Towards Wearable Devices in Healthcare <p>With the coronavirus (COVID-19) pandemic uncovering several structural problems within the German healthcare system, especially within the inpatient sector, rapid improvements were needed to strengthen the preventive industry of the healthcare system. To adequately cover prevention as well as aftercare needs, some telemedical solutions, such as wearables can strongly contribute to the preventive sector. Therefore, this research aims to understand users’ perceived attitudes and acceptance towards wearable devices in healthcare. Following the Technology Acceptance Model, the essential factors that influence user acceptance were assessed using an online survey involving 154 participants, students of the Deggendorf Institute of Technology. The results of this survey indicate that among the students’ technology acceptance is generally high, participants had a favourable attitude towards digital health technologies, a high perception of usefulness, and a heightened perception of ease of use. Only a minor of the participants have stated that they have certain concerns, mainly regarding data protection. This study however gives very little insight into what elderly people, people in the active workforce, or those suffering from chronic illness think of wearables and digital health as a whole. So further research including this demographic of people is suggested.</p> Lisa Gerold, Helana Lutfi, Thomas Spittler Copyright (c) 2024 Lisa Gerold, Helana Lutfi, Thomas Spittler Fri, 26 Jan 2024 00:00:00 -0500 Dietary Patterns and Metabolic Syndrome Risk in Adults Living with HIV: A Cross-Sectional Study in Lusaka District, Zambia <p><em>Background</em>: Metabolic syndrome, a cluster of cardiovascular risk factors, affects approximately 25% of the global population, with a significant impact on the 37,900,000 people living with HIV in 2017.</p> <p><em>Objective</em>: This cross-sectional study (April-July 2020) in Lusaka District aimed to assess dietary patterns and metabolic syndrome risk in 180 randomly sampled HIV-positive individuals (aged 18 and above) from three health facilities.</p> <p><em>Methods</em>: Participants underwent anthropometric measurements, blood pressure checks, and biochemical assessments. High prevalence rates were observed for factors like high waist-hip ratio (39%), high total cholesterol (52%), high triglycerides (46%), and high blood pressure (33%).</p> <p><em>Results</em>: Three dietary clusters (omnivorous, vegetarian, unclassified) showed no significant association with metabolic syndrome or its components (p &gt; 0.05).</p> <p><em>Conclusion</em>: While metabolic syndrome prevalence among HIV-positive individuals is low, there are notable occurrences of high blood pressure and predictors of non-communicable diseases. Commonly consumed foods did not show a significant association with metabolic syndrome predictors (p &gt; 0.05).</p> Peryson Kekelwa Kalaluka, Anatolii Tsarkov, Petro Petlovanyi, Richard Kunda, Simon Himalowa, Phoebe Bwembya, Chiza Kumwenda, Gabriel Mpundu, Crecious Phiri Copyright (c) 2024 Peryson Kekelwa Kalaluka, Anatolii Tsarkov, Petro Petlovanyi, Richard Kunda, Simon Himalowa, Phoebe Bwembya, Chiza Kumwenda, Gabriel Mpundu, Crecious Phiri Fri, 26 Jan 2024 00:00:00 -0500 Elevated Salivary IL-8 Levels in Patients with Aphthous Ulceration and Rheumatoid Arthritis: A Cross-Sectional Study <p><em>Background</em>: Aphthous ulcers (AU) and Rheumatoid Arthritis (RA) are conditions marked by inflammation, with Interleukin 8 (IL-8) playing a significant role in their pathogenesis. This study aims to evaluate the levels of IL-8 in saliva among individuals with AU, RA, both conditions and healthy controls, providing insights into its potential as a diagnostic biomarker and therapeutic target.</p> <p><em>Methods</em>: The study, endorsed by the Ethics Committee of the University of Kufa, College of Dentistry, Department of Oral Pathology, employed a descriptive, analytical, and cross-sectional approach. Participants included patients with AU, RA, both conditions and a control group, totalling 94 individuals. Exclusion criteria encompassed medication use, other systemic conditions, and lifestyle factors like smoking. Saliva and blood samples were collected for IL-8 concentration measurement using ELISA and for Rheumatoid Factor (RF) and anti-CCP analysis.</p> <p><em>Results</em>: Analysis showed the highest average salivary IL-8 levels in patients with both AU and RA (483.33 ± 141.20 pg/mL), followed by the RA group (338.57 ± 79.11 pg/mL), the AU group (381 ± 108.48 pg/mL), and the control group (213.69 ± 84.65 pg/mL). Significant differences in IL-8 levels were observed between these groups, with the combined AU and RA groups showing the highest concentrations. However, the variation in IL-8 levels between those who have both AU and RA and those with only RA was not statistically significant.</p> <p><em>Conclusion</em>: The study highlights a distinct elevation in salivary IL-8 levels in patients with AU and RA, particularly in those suffering from both conditions.</p> Karar Abdulzahra Mahdi, Dunya Malhan Hanweet, Muhassad H. Al-Mudhafar Copyright (c) 2024 Karar Abdulzahra Mahdi, Dunya Malhan Hanweet, Muhassad H. Al-Mudhafar Mon, 05 Feb 2024 00:00:00 -0500 Evaluating Radiation Exposure for Patients During Pelvic X-ray Exams in Dhaka Metropolitan Area, Bangladesh <p><em>Objectives</em>: This study aims to comprehensively assess Entrance Skin Dose (ESD) variability across diverse age groups in various diagnostic areas such as RGU, MCU, Fistulogram, Sinogram, and radiography of SI Joint, Coccyx, and Hip Joint in the pelvic region. The investigation delves into elucidating the range and mean ESD values while identifying factors contributing to fluctuations, enabling precise understanding and strategies for managing radiation exposure in pelvic X-ray examinations.</p> <p><em>Method &amp; Materials</em>: A qualitative research study took place in one of the hospitals in Dhaka City, Bangladesh, with participation from 138 patients. Radiation protocols in Dhaka City used consistent methods for diverse ages during X-ray examinations. Detailed data on Entrance Skin Dose for various exams like pelvic, SI joint, and fistulogram were meticulously collected and analyzed, aiding in understanding demographic-specific radiation variations.</p> <p><em>Result</em>: The diverse dataset of Entrance Skin Dose (ESD) measurements across varying age groups in pelvic X-ray examinations reveals a range of ESD values, highlighting fluctuations within specific ages. The overall mean ESD averages approximately 1.87, indicating a moderate consistency in radiation exposure across ages. Notably, certain age brackets, such as patients aged 24 and those in their early teens, exhibit higher ESD values, while others, like ages 15 and 72–76, showcase notable variability. These findings underscore the need for tailored imaging protocols and monitoring strategies in clinical practice.</p> <p><em>Conclusion</em>: In conclusion, this comprehensive examination underscores the intricate relationship between age, diagnostic areas, and the variability of ESD values, highlighting the need for nuanced approaches in healthcare management to ensure optimized patient outcomes while minimizing radiation exposure risks.</p> Mst. Umme Salma, Md. Abu Obayda, Israt Jahan Nawreen, Tanzila Parvin Copyright (c) 2024 Mst. Umme Salma, Md. Abu Obayda, Israt Jahan Nawreen, Tanzila Parvin Wed, 07 Feb 2024 00:00:00 -0500 Occupational Health Hazard Experiences of Doctors and Nurses at a Tertiary Hospital in Bangladesh <p><em>Objective</em>: This study aimed to explore the workplace safety experiences of health workers (doctors and nurses) at a tertiary hospital in Bangladesh.</p> <p><em>Materials and Methods</em>: This was a descriptive cross-sectional study among conveniently selected 305 registered physicians and nurses working in the designated tertiary hospital. After obtaining the written informed consent, data was collected using face-to-face interviews with a pre-tested, semistructured, interviewer-administered questionnaire from December 2021 to January 2022. Frequency and proportion described the variables.</p> <p><em>Result</em>: The mean age of the participants was 28.8 years. Female individuals constituted the majority, accounting for 69.2% of the total. Approximately 69.8% of individuals reported experiencing occupational health hazards. Psychological hazards were the most frequently reported (56.1%), followed by workplace-acquired health hazards (15.7%) and physical hazards (13.8%) among all participants. While 79.0% of the participants were aware of workplace health and safety, only 7.9% received safety training, and only 7.5% reported any occupational hazard to the hospital management.</p> <p><em>Conclusion</em>: Healthcare personnel adjust to several professional hazards in a complicated series of events, as the study shows. The complexity of the healthcare environment poses considerable psychological and health hazards. Although there is good preparedness and procedure awareness, the analysis shows some crucial resources and training still need to be improved. Therefore, some strategic actions are needed to improve healthcare professionals’ safety and well-being in the modern healthcare environment through crucial resources and training.</p> Adiba Sharmin Sikder, Azizur Rahman Sharaque, Naila Haque, Marzan Sultana, Irfan Nowrose Noor, Ummul Khair Alam, Sathi Dastider Copyright (c) 2024 Adiba Sharmin Sikder, Azizur Rahman Sharaque, Naila Haque, Marzan Sultana, Irfan Nowrose Noor, Ummul Khair Alam, Sathi Dastider Fri, 09 Feb 2024 00:00:00 -0500 c.202G > A/c.376A > G G6PD Polymorphisms Increase the Risk of Fungal Infections in Acute Myeloid Leukemia Patients <p><em>Introduction</em>: Patients with acute myeloid leukemia (AML) show a higher risk for several types of infections, including fungal infections (FI), which are one of the main causes of morbidity and mortality. Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme located in all cells that is very necessary in leukocytes for the production of basic and acid proteases that are used to destroy invading microorganisms. Our objective in this study was to evaluate whether polymorphisms in the G6PD gene concomitantly with FI are associated with clinical events and morbidity in patients diagnosed with AML and followed up at the Amazonas State Blood Center (HEMOAM), Manaus, Brazil.</p> <p><em>Materials and Methods</em>: The study population was randomly constituted of adults and children, of either sex, and any age, with a diagnosis of acute myeloid leukemia, all of whom were undergoing treatment at the HEMOAM. Molecular genotyping was performed using real-time PCR (qPCR) and subsequent Sanger sequencing to confirm the c.202G &gt; A/c.376A &gt; G polymorphisms.</p> <p><em>Results</em>: A total of 157 patients (91 (58%) males and 66 (42%) females) were involved in the study. The most prevalent AML subtype in the studied group was M3 in 63 patients (40.12%), followed by M5 in 33 patients (21.02%), M2 in 21 patients (13.37%) and M4 in 15 patients (9.55%), with a similar prevalence between genders. The prevalence of fungal infections was identical between genders; however, bruising (p = 0.004), vomiting (p = 0.016) and cardiac alterations (p &lt; 0.001) were higher in females, while persistent cough (p = 0.049) and diarrhea (p &lt; 0.001) were higher in males. A total of eighteen patients presents G6PD polymorphisms, with 8 (5.1%) of these for c.202GA/AA, 18 (11.5%) for c.376AG/GG and 4 (2.5%) for both polymorphisms concomitantly (c.202AA/c.376GG). However, the prevalence of death in patients affected with FI was much higher in those that have these polymorphisms (p &lt; 0.001).</p> <p><em>Conclusion</em>: We believe that the determination of G6PD polymorphisms will allow the development of monitoring strategies, and aid in early diagnosis and the appropriate and targeted treatment for AML. In addition, evaluating their activity may help to identify AML patients at a higher risk of FI, thus allowing the design of more intensive therapeutic and surveillance strategies.</p> Noeme Henriques Freitas, Cinthia Cristina Matheus Xerez Albuquerque, Mariana Pereira Lima, Nelson Abrahim Fraiji, Marilda Souza Gonçalves, José Pereira de Moura Neto Copyright (c) 2024 Noeme Henriques Freitas, Cinthia Cristina Matheus Xerez Albuquerque, Mariana Pereira Lima, Nelson Abrahim Fraiji, Marilda Souza Gonçalves, José Pereira de Moura Neto Mon, 12 Feb 2024 00:00:00 -0500 Comparison of the Effect of Ondansetron and Dexamethasone on Postoperative Shivering After Cesarean Section in Patients Undergoing Spinal Anesthesia <p><em>Background</em>: Shivering is one of the most common problems after spinal anesthesia, which can cause many complications. Various methods and drugs have been used to prevent and treat postoperative shivering. In the present study, the pretreatment effect of ondansetron and dexamethasone in reducing the incidence of shivering after elective caesarean section by the spinal method has been investigated.</p> <p><em>Methods</em>: In this study, 78 patients undergoing elective cesarean surgery who were eligible to enter the study were evaluated and randomly divided into two groups: 8mg of ondansetron and 4mg of dexamethasone 15 minutes before the end of surgery. Then, the incidence of shivering was measured at specific time intervals after surgery. Statistical analysis was done using SPSS software.</p> <p><em>Results</em>: The two groups were similar in terms of age, height, weight, and BMI (p-value &gt; 0.05). The incidence of shivering at the time of entering the recovery, 10, 20, and 30 minutes in the ondansetron group was 23.1%, 20.5%, 12.8% and 0% and in the dexamethasone, group was 20.5%, 15.4%, 5.2% and 0%, respectively. Statistical analysis showed that these differences are not significant at the significance level of 0.05. These two drugs have the same effectiveness in controlling shivering after cesarean section under spinal anesthesia (p-value &gt; 0.05).</p> <p><em>Conclusion</em>: Dexamethasone and ondansetron will be able to control shivering after caesarean section with spinal anesthesia.</p> Mohammad Saleh Sadeghi, Negar Vakili Razlighi, Hadi Vakili Razlighi Copyright (c) 2024 Mohammad Saleh Sadeghi, Negar Vakili Razlighi, Hadi Vakili Razlighi Mon, 12 Feb 2024 00:00:00 -0500 Spatial Tumor Heterogeneity in a Young Female with Lung Adenocarcinoma and Brain Metastasis <p>Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are the two different forms of lung cancer, the latter subtype accounts for approximately 85% of cases. Lung cancer is estimated to be the main cause of all cancer deaths, accounting for nearly 1,800,000 deaths globally in 2020.</p> <p>In this clinical case, we describe a female patient with non-specific symptoms over an approximate duration of one and a half years. Metastatic lung adenocarcinoma was diagnosed after the onset of severe neurological symptoms, brain surgery, and historical analysis of the large pathological brain mass. Following this, the tumor in the lung, which was small in size and the sole metabolically active site of the disease, was surgically removed. The recurrence in the brain and the onset of new neurological symptoms occurred rapidly—within three months, necessitating a second operation. Histological examination of the primary tumor and metastasis unveiled significant disparities–the primary tumor was moderately differentiated with PD-L1 expression (programmed death-ligand 1) within the range of 1 to 49%, while metastasis was poorly differentiated and PD-L1 negative, both absent of EGFR mutations (epidermal growth factor receptor) and ALK fusion (anaplastic lymphoma kinase). Following two brain operations, the patient underwent three-dimensional conformal radiation therapy (3DCRT). Subsequently, the initiation of systemic therapy was postponed by a two-month interval due to the activation of chronic hepatitis C virus infection.</p> <p>This case study contributes to the growing body of knowledge aimed at enhancing our grasp of tumor heterogeneity and dynamics of progression.</p> Ieva Krēsliņa, Evita Gašenko, Alinta Hegmane, Zanete Zvirbule, Signe Plāte, Santa Maksimova Copyright (c) 2024 Ieva Kreslina, Evita Gasenko, Alinta Hegmane, Zanete Zvirbule, Signe Plate, Santa Maksimova Fri, 26 Jan 2024 00:00:00 -0500 A Rare Case of Recurrent Dasatinib-Induced Chylothorax Years After Initial Treatment <p><em>Background</em>: Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome containing the BCR-ABL protein with deregulated tyrosine kinase activity. Tyrosine kinase inhibitors (TKIs) were developed to target this oncogene. Dasatinib, a TKI, has rarely been associated with spontaneous chylothorax. The majority occur within 1 year of dasatinib initiation and resolve after drug cessation. In contrast, we present a patient with CML on dasatinib therapy for 8 years who developed recurrent unilateral chylothorax even after cessation of dasatinib.</p> <p><em>Case</em>: A 57-year-old male with a history of CML on dasatinib therapy presented to the hospital for nausea and vomiting. A computed tomographic scan revealed a large right-sided pleural effusion with thoracentesis yielding 1.5 liters of chylous fluid. The patient’s hospital course was complicated by intracranial hemorrhage and subsequent admission to the intensive care unit. Dasatinib was stopped during this time. The patient experienced multiple recurrences of this effusion with significant output via thoracentesis and chest tube despite dietary changes. Lymphangiography was performed but revealed no evidence of thoracic duct leakage.</p> <p><em>Conclusions</em>: Chylothorax from dasatinib is rare, usually occurs within 1 to 2 years of treatment onset, and resolves with discontinuation. However as supported by this case and others, it may occur as late as 8 years from treatment onset and chylothorax may continually re-accumulate or persist up to 1 year from dasatinib cessation. It is imperative to rule out underlying thoracic duct disruption prior to attributing etiology to dasatinib as a misdiagnosis may result in treatment delays.</p> Brian Shaw, Norah Mubarak, Mustafa Nuaimi, Cosette Persall, Thomas Vollenweider, Ryan Shaw, Mario Madruga, Steve J. Carlan Copyright (c) 2024 Brian Shaw, Norah Mubarak, Mustafa Nuaimi, Cosette Persall, Thomas Vollenweider, Ryan Shaw, Mario Madruga, Steve J. Carlan Fri, 09 Feb 2024 00:00:00 -0500 Recognition of Chorioamnionitis on the Cardiotocograph (CTG): The role of the “Chorio Duck Score” <p>Chorioamnionitis refers to the inflammation of the chorion and amnion by the bacteria and their toxins as well as by the inflammatory cytokines. Therefore, it is a fetal disease with the bacteria, their toxins as well as the fetal immunological responses involving inflammatory cytokines (interleukins, interferons, and tumour necrosis factor-alpha) exerting their detrimental effects within the fetal compartment (i.e., amniotic fluid, fetal membranes, the placenta, and fetal tissues and organs). The vast majority of fetal inflammation occurs as a result of an ascending infection (i.e., entry of the bacteria from the maternal genital tract through the cervix). Therefore, maternal signs (tachycardia and pyrexia) may not be observed until the late stages of the disease. Cardiotocograph (CTG) trace was introduced into clinical practice in the 1960s as a tool to timely recognise ongoing fetal hypoxic stress so that immediate action could be taken to avoid hypoxic ischaemic encephalopathy (HIE) and/ or intrapartum hypoxia-related perinatal deaths. Unfortunately, the CTG was introduced into clinical practice without any prior randomised controlled trials, which resulted in panicking and reacting to the observed morphology of fetal heart rate decelerations, which reflect an ongoing fetal compensatory response to reduce the myocardial workload. A sudden and reflex reduction of the heart rate in response to ongoing intermittent hypoxic stress (i.e., repetitive compression of the umbilical cord or interruptions in uteroplacental oxygenation due to uterine contractions) would ensure a reduction in myocardial oxygen demand and maintenance of aerobic metabolism to avoid the onset of anaerobic metabolism and production of lactic acid within the myocardium. Lack of understanding of fetal compensatory responses resulted in the illogical approach of grouping arbitrary features into different categories and then randomly combining them to classify the CTG traces into “Normal, Suspicious, and Pathological”. The same parameters were used in fetuses with chorioamnionitis with an alternative, inflammatory pathway of neurological injury. The international consensus guidelines of physiological interpretation of CTG produced by 44 CTG experts from 14 countries in 2018 ensured a paradigm shift and recommended classification of CTG traces based on the type of fetal hypoxia and fetal response to stress, by applying the knowledge of fetal physiology whilst interpreting CTG traces. During the last 5 years, research has highlighted CTG features in fetal neuro-inflammation, which include an absence of fetal heart rate cycling, the ZigZag Pattern, and sinusoidal patterns. The proposed “Chorio Duck Score” is a scoring system based on recently published scientific evidence on CTG features in subclinical and clinical chorioamnionitis to enable timely diagnosis of fetal systemic inflammatory response syndrome (FIRS). This will help avoid the continuation of super-imposed hypoxic stress (i.e., progressive increasing frequency, duration, and strength of uterine contractions) on the background fetal inflammation, to prevent fetal neurological injury.</p> Edwin Chandraharan, Mareike Bolten Copyright (c) 2024 Edwin Chandraharan, Mareike Bolten Thu, 04 Jan 2024 00:00:00 -0500