Journal of Clinical Trials

In clinical research, several studies use to perform on human subjects to evaluate the dependence of the disease occurrence with one or more parameters. Such studies are called 'Clinical trials', which are having great importance inmedical sciences.

Clinical Trials

Clinical trials mainly deals with biomedical, biochemical and behavioral tests on subjects but in some special cases commentary of care giver or parent plays crucial role in determining the actual scenario. The most crucial aspect of clinical results is its reproducibility and authenticity, which sometimes guide the fellow physician to postulate the therapeutic paradigm for a challenging issue. Pharmaceutical industries are the most dependent sector on clinical trial because, success in clinical trial only bring forward the 'Approved Drug'. Not only drug or medicine, various medical devices are also subjected to clinical trial and only successful device can be allowed to do business without any restrictions. Present ‘Journal of Clinical Trials’ accumulates all the relevant information on clinical research and provides a scope for communication of the articles related to clinical trials. Read more>>>>>

Strongyloides Hyperinfection in a Patient with Thymoma - A Rare Presentation of the Good Syndrome

We present the case of a 53-year old male from the Democratic Republic of Congo (DRC) who presented himself to his general practitioner with along-lasting infection of the upper airways that did not respond to antibiotictherapy.

Thymoma

A chest X-ray was performed and the patient was hospitalized because of a mediastinal mass. After CT-scan and a biopsy the diagnosis of a Thymoma Type AB Masaoka Stadium II was established. The surgical in toto thymectomy was performed without complications. A few days postinterventionally the patient presented with serious alteration of his general condition, constipation, vomiting after food intake and weight loss to now 35 kg, representing a BMI of 13.7 kg/m2. Symptomatic therapy was initiated and the patient was discharged. The patient was seen again by the thoracic surgeons for a follow up and removal of the surgical sutures. Because of a further alteration of his general condition and persistent gastrointestinal symptoms the patient was admitted to our clinic. To know more>>>>>>

Diagnosis of Macrovascular Complications in Diabetes Mellitus Using Arterial Stiffness Measured by the Cardio-Ankle Vascular Index

Arterial anti-aging treatment is important, but there had not been a good marker of arterial aging. One candidate of the markers was arterial stiffness. But, it has been difficult to measure proper arterial stiffness invivo, noninvasively.

Diabetes Mellitus 

Pulse wave velocity (PWV) which was reflecting arterial stiffness, was used for last 30 years, but was inherently changed at the blood pressure at measuring time. The cardio-ankle vascular index (CAVI) was recently developed marker reflecting arterial stiffness of the arterial tree from the origin of the aorta to the ankle. The conspicuous feature of CAVI is independency from the blood pressure at measuring time. CAVI increased with aging both in males than in females. So, CAVI could be a good marker reflecting arterial aging. Furthermore, CAVI showed high value in most of those with various risks of coronary artery disease, and especially high in those with diabetes mellitus and even with prediabetes condition. Diabetes mellitus is kwon to be a strong factor for arterial aging. Read more>>>>>>

The Plausibility of Universal Health Care in the United States

Though the United States is one of the wealthiest nations in the world, the disparities in income are only surpassed by the inequalities in access to health care. Because of the close tie between the health care crisis and the fiscalhealth of the country as a whole, proposals have been made to introduce universal health care, to adapt existing systems and to support efforts, including what has been deemed “ObamaCare” to move towards greater accountability in obtaining and maintaining health insurance for the millions of uninsured and underinsured. Though most countries in the developed world perceive health care as a basic human right, the United States has yet to determine a way of creating and funding a single-payer universal health care system that will address the inequalities that exist and provide a better option for preventative medicine, interventive medicine, and long-term care.

One of the central problems for this country is that our political process is divided ideologically and health care paradigms do not appear to address issues on both sides. While there is support for a national health program that would ensure access to the working poor, fiscal conservatives view this as a system that cannot be afforded and that would expand debt in an uncontrollable manner. In fact, there is a clear division between the patriarchal perspectives of the democrats and the growing Tea Party call for personal responsibility.(Read More)

An Oral Abscess as the Entrance Leading to Endocarditis: A Sexual Behavior Role.

The risk factors for infective endocarditis (IE) in the population are changing: the reported worldwideincrease in the incidence of IE has been associated with the widespread use of medical devices and procedures responsible of heath care associated infection. 

Endocarditis incurred by Streptococcus agalactiae in adults (nonpregnant females and men) has increased in recent years, even though the source of infection due to this bacterium and the portal of entry are unclear and not often well documented.Concerning the possible sexual port of entry in the cause of endocarditis, this mode of transmission should be suspected in a search of clinical history, especially in recurrent endocarditis.(Read more)

Corticosteroid Administration in COPD: Summary of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines 2017

Administration of Inhaled Corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease (COPD) has always remained controversial because of its questionable benefit in this disease. Although several clinicians believe that corticosteroids have little or no role in controlling inflammation in COPD, its use in stable to heavilyexacerbated COPD has been in practice especially in the developing countrieswhere COPD is often over diagnosed/ underdiagnosed or misdiagnosed. Neutrophils being the crucial players in inflammation in COPD, steroids are considered to have a less functional effect on this type of inflammation as steroids especially glucocorticoids has been shown to enhance the survival of neutrophils and increase their functional responsiveness. Therefore, such treatment might lead to incurring detrimental effects on the patients by enhancing the exacerbation.

Although some evidence have suggested that some drugs such as β2-agonists, methylxanthines (theophylline) or antibiotics (macrolides) may somewhat facilitate corticosteroid sensitivity in COPD, their functional aspects and clinical relevance are not quite clear. Moreover, since the effect of ICS may be modulated by these other add-on drugs, the effect of ICS alone in COPD has remained questionable. Most of the studies showed that ICS alone does not effectively reverse the progressive decline of FEV1 or mortality in patients with COPD. The TOwards a Revolution in COPD Health (TORCH) trial showed higher mortality among COPD patients treated with ICS alone than those who received ICS (Inhaled Corticosteroids) +LABA (Long acting β2-agonists).(Read more)

Selecting a Suitable Portable Oxygen Carrier for Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease: Difference between a Cylinder Cart and Backpack.

Long-term oxygen treatment (LTOT) has shown to increase survival in patients with COPD having chronic respiratory failure. It also appears to improve the health-relatedquality of life, increase exercise capacity, and reduce the number of hospitalizationsin patients with COPD. To obtain the maximum benefits of LTOT, patients with COPD are required to use their ambulatory oxygen systems at all times, even when outside. Therefore, ambulatory oxygen therapy is a common component of LTOT to maximize the number of hours per day of receiving oxygen as well as to maintain physical activity. Currently, LTOT users may choose among several portable oxygen devices (e.g., portable oxygen cylinders, portable oxygen concentrators, and liquid oxygen) and/or different transport carriers (e.g., cylinder cart, backpack, and shoulder bag). However, little is known about how to select a suitable ambulatory oxygen carrier for each patient with COPD having chronic respiratory failure.

Previous studies have suggested that differences among cylinder transport carriers affect the patient’s functional performance Pohle- Krauza et al. showed that the distance walked with a backpack was longer than that walked with a cylinder cart or shoulder bag in patients with COPD. In other studies on LTOT for COPD, Crisafulli et al. showed that patients with severe COPD could walk longer with a cylinder cart than those with a shoulder bag, while healthy controls could walk longer with a shoulder bag than with a cart. These results indicate that differences among ambulatory oxygen carriers can affect that patient’s performance in daily life. In addition, a proper carrier may depend on the pulmonary function of LTOT user.(Read More)

Safe Anesthesia Induction in Patients with Anterior Mediastinal Mass Using Muscle Paralysis

Available reports suggest that an anterior mediastinal mass causing more than 50% narrowing of the trachea and compressing the great vessels can cause further narrowing of the airway and cardiovascularcollapse after the administration of muscle relaxants. 

Accordingly, inhalation induction of general anesthesia or awake intubation is used to avoid the use of muscle relaxation.

The following two case reports describe the stepwise safe anesthetic induction of two patients with anterior mediastinal masses using total intravenous anesthesia followed by tailored positive pressure ventilation and administration of muscle relaxant.(Read more)

Are Platelet Rich Plasma Injections More Effective in Tendinopathy or Enthesopathy?

Tendinopathies are very common in athletes. Traditionally, the first management is conservative, including analgesics, anti-inflammatory drugs, and physical therapy. In the last decade,Platelet-richplasma (PRP) products have been increasingly used, but theireffectiveness is still controversial. PRP is a plasma gel with high concentration of platelets, higher than that present in the blood, as clinical benefits have been shown when this concentration is at least 1,000,000/μl in 5ml of plasma. 

There is evidence that PRP provide good excellent outcomes in patients with tendon disorders, but few studies have reported on the use of PRP in patients with insertional tendinopathies of the elbow and patellar tendon (jumper’s knee). The primary endpoint of this retrospective study is to assess clinical and functional outcomes of patients with tendinopathies of the main body of the tendon and insertional tendinopathies who had undergone local injections of PRP.(Read More)

Chronic Orofacial Pain: Burning Mouth Syndrome and Other Neuropathic Disorders

Chronic orofacial pain is a symptom associated with a wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions that affect a significant proportion of the population. While the collectiveimpact of the subset of the orofacial pain disorders involving neurogenic and idiopathic mechanisms is substantial, some of these are relatively uncommon. Hence, patients with these disorders can be vulnerable to misdiagnosis, sometimes for years, increasing the symptom burden and delaying effective treatment. This manuscript first reviews the decision tree to be followed in diagnosing any neuropathic pain condition, as well as the levels of evidence needed to make a diagnosis with each of several levels of confidence: definite, probable, or possible. 

It then examines the clinical literature related to the idiopathic and neurogenic conditions that can occasion chronic orofacial pain, including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders also are examined, even though they are not neurologic conditions, because they are common and can mimic symptoms of the latter disorders. For each of these conditions, the paper reviews literature regarding incidence and prevalence, physiologic and other contributing factors, diagnostic signs and symptoms, and empirical evidence regarding treatments. Finally, in order to improve the quality and accuracy of clinical diagnosis, as well as the efficiency with which effective treatment is initiated and delivered, criteria are offered that can be instrumental in making a differential diagnosis.(Read more)

Accidental Ethanol Ingestion in a 32 Day Old Infant.

We report a case of a 32 day old previously healthy male who presented to an outside hospital in the early morning with chief complaint of "not acting normal". The mother reported that she woke up at 4am and prepared a 4 ounce bottle of formula with Enfamil and water for the baby, andthe baby drank 3 ounces of the formula. Approximately an hour later, she observed that the baby was not acting right. The baby was having excessive oral secretions, shaking his arms up and down, and was agitated. 

The father later recalled that he had left clear undiluted gin that he had shared with his friend earlier that evening in a disposable water bottle on the nightstand next to the formula powder. Waking up in the middle of the night and mistaking it for water, the mother then used the alcohol while mixing the patient’s formula. The patient was immediately taken to an outside hospital.(Read more)

Mechanisms of Toxicity which Impact on Risk Assessment and Safety Evaluation.

Toxicology study aimed to understand the mechanisms of toxicity which impact on risk assessment and safety evaluation. Xenobiotic due to industrialization have hugeadverse effects on human and animal health. Toxicological studies are having great importance in marking the relationship between dose and its effects on the exposed organism. In the previous volume 2 issue 2 of the journal comprised of 4 research article and a short communication received across the globe.

Municipal effluents are complex mixtures of contaminants such as polycyclic aromatic and aliphatic hydrocarbons, heavy metals, pesticides and pharmaceutical along with microorganisms which are a major source of contamination to aquatic biota. The purpose of Gagnes study was to assess the effects of dietary zinc oxide nanoparticles in adult fathead minnows. For assessing the immunocompetence leucocyte viability, phagocytosis activity, oxidative stress and DNA strand breaks in gills methods were employed. The results reveals that ingested nanoparticles could affect the immune system of fish exposed to municipal wastewaters in comparison with non-exposed fish, and exposed fishes were more vulnerable to pathogenic microorganisms.(Read More)

Welcome Editorial Advances in Gynaecological Ultrasound

It gives me great pleasure to welcome our readers to an exciting issue of JBR Journal of Clinical Diagnosis and Research to start the New Year.The related articles on Advances in GynecologicalUltrasound will include screening and diagnosis of mullerian congenital anomalies, screening and diagnosis of uterine cancer, menopause and ultrasound in infertility.

Many debates surrounded the most appropriate approach of mullerian anomalies diagnosis. In congenital uterine anomalies 3D ultrasound is critical in reaching the correct diagnosis, by means of assessing the coronal plane of the uterus. Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. Unification defects seem to preserve fertility, but some are associated with miscarriage and preterm delivery. Arcuate uteri seem associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery.(Read More)

Preparation with Mechanical Bowel Cleansing or/and Oral Antibiotics or Nothing for Elective Colorectal Surgery: Two-Two-Arm Multicentre Randomised Controlled Studies (MECCLANT –C and –R Trials)

During almost all the 20^th century and practically based on observational studies and experts opinion, mechanical bowel preparation (MBP) has been considered as necessary prior to colorectal surgery, in order to remove gross faecal and bacteria colonic load and thus to prevent anastomotic leakage and reduce septic postoperative complications. 

However, several more recent randomised clinical trials, meta-analyses, systematic reviews and surveys have consistently shown that MBP does not prevent either anastomotic leakage or surgical site infection (SSI), and does not reduce immediate postoperative morbidity or. Furthermore, MBP is costly, time consuming, harmful and unpleasant for the patient, and also impedes implementation of enhanced recovery programmes. As a result of the aforementioned evidence,it is recommended that MBP for colorectal surgery must be abandoned.(Read more)

Very Late-Onset Neutropenia in a Japanese Schizophrenia Patient Treated with Clozapine

The patient was a 46-year-old Japanese man who had met the DSMIV diagnosis of schizophrenia, disorganized-type, for the prior 30 years. He had been on antipsychotic regimens since being diagnosed when he was 16 years old. He had been treated with therapeutic doses of sulpiride, haloperidol, levomepromazine, risperidone, olanzapine, aripiprazole, or lithium on several occasions, after which the treatments were stopped due to inadequate treatment response. 

After that, clozapine was started during his eighth hospitalization in 33-year-old in which he was brought to the hospital for persistent auditory hallucinations, monologia, persecutory delusion aggressiveness, and psychomotor excitement. (Read more)