Parents' experience of caring for children with type 1 diabetes in mainland China: A qualitative study

paythelady.612 shared this article with you from Inoreader Parents' experience of caring for children with type 1 diabetes in mainland China: A qualitative study Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2478-2486. doi: 10.12998/wjcc.v9.i11.2478. ABSTRACT BACKGROUND: Parents of children with type 1 diabetes mellitus (T1DM) are under heavy caregiving stress, and parental caregivers' experience can affect the health outcomes of children with T1DM. AIM: To describe the true inner feelings of parents caring for children with T1DM. METHODS: Descriptive research methods were used to classify and summarize parents' experience when adapting to the role of caregivers for children with T1DM. The data was sorted and analyzed using content analysis. Themes of parents' experience caring for children with T1DM were refined, and their feelings were deeply investigated. RESULTS: A total of 4 themes and 12 subthemes were identified: (1) Desire for information (disease-related information, home care information, and channels of information acquisition); (2) Skill guidance needs (insulin injection t echniques, skills required for symptom management, and skills for parent-child communication); (3) Seeking emotional support (family support, peer support from other parents of children with T1DM, and professional support); and (4) Lack of social support (needs for financial support and needs for social security). CONCLUSION: Exploring the true experience of parents caring for children with T1DM is of great significance for helping them adapt to their role as caregivers. Nurses should provide professional guidance in terms of information, skills, emotion, and social support to parental caregivers. PMID:33889613 | PMC:PMC8040164 | DOI:10.12998/wjcc.v9.i11.2478 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations

paythelady.612 shared this article with you from Inoreader Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2433-2445. doi: 10.12998/wjcc.v9.i11.2433. ABSTRACT BACKGROUND: The Black/African Ancestry (AA) population has a higher prevalence of type 2 diabetes mellitus (T2DM) and a higher incidence and mortality rate for colorectal cancer (CRC) than all other races in the United States. T2DM has been shown to increase adenoma risk in predominantly white/European ancestry (EA) populations, but the effect of T2DM on adenoma risk in Black/AA individuals is less clear. We hypothesize that T2DM has a significant effect on adenoma risk in a predominantly Black/AA population. AIM: To investigate the effect of T2DM and race on the adenoma detection rate (ADR) in screening colonoscopies in two disparate populations. METHODS: A retrospective cohort study was conducted on ADR during index screening colonoscopies (age 45-75) performed at an urban public hospital serving a predominantly Black/AA population ( 92%) (2017-2018, n = 1606). Clinical metadata collected included basic demographics, insurance, body mass index (BMI), family history of CRC, smoking, diabetes diagnosis, and aspirin use. This dataset was combined with a recently reported parallel retrospective cohort data set collected at a suburban university hospital serving a predominantly White/EA population (87%) (2012-2015, n = 2882). RESULTS: The ADR was higher in T2DM patients than in patients without T2DM or prediabetes (35.2% vs 27.9%, P = 0.0166, n = 981) at the urban public hospital. Multivariable analysis of the combined datasets showed that T2DM [odds ratio (OR) = 1.29, 95% confidence interval (CI): 1.08-1.55, P = 0.0049], smoking (current vs never OR = 1.47, 95%CI: 1.18-1.82, current vs past OR = 1.32, 95%CI: 1.02-1.70, P = 0.0026), older age (OR = 1.05 per year, 95%CI: 1.04-1.06, P < 0.0001), higher BMI (OR = 1.02 per unit, 95%CI: 1.01-1.03, P = 0.0003), and male sex (OR = 1.87, 95%CI: 1.62-2.15, P < 0.0001) were associated with increased ADR in the combined datasets, but race, aspirin use and insurance were not. CONCLUSION: T2DM, but not race, is significantly associated with increased ADR on index screening colonoscopy while controlling for other factors. PMID:33889609 | PMC:PMC8040183 | DOI:10.12998/wjcc.v9.i11.2433 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Immunoglobulin D-λ/λ biclonal multiple myeloma: A case report

paythelady.612 shared this article with you from Inoreader Immunoglobulin D-λ/λ biclonal multiple myeloma: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2576-2583. doi: 10.12998/wjcc.v9.i11.2576. ABSTRACT BACKGROUND: Immunoglobulin D (IgD) multiple myeloma (MM) is a rare subtype of MM and commonly occurs in younger subjects but at a later stage of the International Staging System (ISS) when admitted. As a special type of IgD myeloma, IgD-λ/λ biclonal MM is rarer. Its serum protein electrophoresis and serum immuno-fixation electrophoresis (IFE) might find no anomalies even if the bone marrow (BM) examination is performed. Thus, it is easy to miss the diagnosis. CASE SUMMARY: A 62-year-old man diagnosed as IgD-λ/λ myeloma (ISS stage III) was admitted with fatigue and weight loss. The physical examination suggested an anemic face, a few moist rales at the left lung base, and mild concave edema in both lower extremities. Laboratory examinations showed the elevated creatinine levels, β2-microglobulin, lactic dehydrogenase, and erythrocyte sed imentation rate, while the decreased neutrophils, granulocytes, and hemoglobin. In the serum protein electrophoresis, there appeared two inconspicuous M-spikes. Serum IFE indicated an over-representation of lambda light chain and yielded two monoclonal bands in λ region, but only one corresponding heavy chain band in the antisera to IgD region. The BM histology and BM cytology both supported the diagnosis of IgD-λ/λ myeloma. CONCLUSION: This case highlights the differential clinical manifestations and laboratory findings of IgD-λ/λ myeloma to help minimize the chance of misdiagnosis. PMID:33889623 | PMC:PMC8040188 | DOI:10.12998/wjcc.v9.i11.2576 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Relationship between mismatch repair protein, RAS, BRAF, PIK3CA gene expression and clinicopathological characteristics in elderly colorectal cancer patients

paythelady.612 shared this article with you from Inoreader Relationship between mismatch repair protein, <em>RAS</em>, <em>BRAF</em>, <em>PIK3CA</em> gene expression and clinicopathological characteristics in elderly colorectal cancer patients Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2458-2468. doi: 10.12998/wjcc.v9.i11.2458. ABSTRACT BACKGROUND: Colorectal cancer (CRC) is common in elderly patients. Mismatch repair (MMR) protein deletion is one of the causes of CRC. The RAS (KRAS/NRAS), BRAF, and PIK3CA genes are important gene targets in CRC treatment and are closely related to the prognosis and survival of patients. However, little is known regarding the relationship between the expression of MMR, RAS, BRAF, PIK3CA and the clinicopathological features in CRC patients. AIM: To analyze the relationship between the expression of MMR, RAS, BRAF, PIK3CA and the clinicopathological features in CRC. METHODS: A total of 327 elderly patients with CRC were enrolled, and immuno-histochemistry was used to detect the MMR protein. Real-time quantitative polymerase chain reaction was used to detect the RAS (KRAS/NRAS), BRAF, and PIK3CA genes. The clinicopathological data of the patients were recorded and analyzed by SPSS 19.0 statistical software. RESULTS: In 327 elderly patients with CRC, the rate of MMR protein loss was 9.79% (32/327), and the deletion rate of four MMR proteins (MSH2, MSH6, MLH1, PMS2) was 1.83% (6/327), 3.06% (10/327), 7.65% (25/327), and 7.65% (25/327), respectively. There were no significant differences between MMR protein deletion and sex, pathological type, tumor morphology, differentiation degree or lymph node metastasis (P > 0.05), but there was a significant difference between MMR protein deletion and tumor diameter and tumor location (P = 0.048/P = 0.000). The mutation rates of the KRAS, NRAS, BRAF and PIK3CA genes in elderly CRC patients were 44.95% (147/327), 2.45% (8/327), 3.36% (11/327) and 2.75% (9/327), respectively; the KRAS gene mutation was closely related to tumor morphology (P = 0.002) but n ot to other clinicopathological features (P > 0.05), and there were no significant differences between NRAS gene mutation and clinicopathological features (P > 0.05). The BRAF gene mutation showed a significant difference in pathological type, tumor location, differentiation degree and lymph node metastasis (P < 0.05), but was not correlated with sex, tumor size and tumor morphology (P > 0.05). The PIK3CA gene mutation showed no significant differences in the above clinicopathological characteristics (P > 0.05). Significant differences were observed between MMR protein deletion and KRAS, BRAF, and PIK3CA gene mutations in elderly CRC patients (P = 0.044, P = 0.000, P = 0.003, respectively), but there was no significant difference between MMR protein deletion and NRAS mutation (P > 0.05). CONCLUSION: In elderly CRC patients, the tumor is mainly locat ed in the right colon, and the deletion rate of MMR protein is higher when the tumor diameter is greater than or equal to 5 cm; the deletion rate of MLH1 and PMS2 is more common; the mutation rate of KRAS gene is higher than that of the NRAS, BRAF and PIK3CA genes, the BRAF gene mutation has different degrees of correlation with clinicopathological characteristics; when the MMR protein is deleted, the BRAF and PIK3CA gene mutations are often present, and the KRAS gene mutation rate is low. PMID:33889611 | PMC:PMC8040173 | DOI:10.12998/wjcc.v9.i11.2458 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

paythelady.612 shared this article with you from Inoreader Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2584-2594. doi: 10.12998/wjcc.v9.i11.2584. ABSTRACT BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a "falls" sign on POCUS played a pivotal role in the early diagnosis of EPN. CASE SUMMARY: A 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfa ll. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN. CONCLUSION: This case indicates that a "falls" sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside. PMID:33889624 | PMC:PMC8040185 | DOI:10.12998/wjcc.v9.i11.2584 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Melatonin for an obese child with MC4R gene variant showing epilepsy and disordered sleep: A case report

paythelady.612 shared this article with you from Inoreader Melatonin for an obese child with <em>MC4R</em> gene variant showing epilepsy and disordered sleep: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2688-2695. doi: 10.12998/wjcc.v9.i11.2688. ABSTRACT BACKGROUND: Abnormalities in the melanocortin receptor 4 (MC4R) gene often lead to obesity, but are rarely associated with other conditions such as epilepsy and sleep disorder. CASE SUMMARY: Here, we present a case of a male obese child with a heterozygous variant in MC4R (c.494G>A, p.Arg165Gln) inherited from his father, who presented with disordered sleep and abnormal facial movements. Examination through melatonin rhythm testing and electroencephalography led to a diagnosis of sleep disorder and epilepsy, as his melatonin rhythm was markedly distorted and the electroencephalography revealed epileptic discharges. He received treatment with an antiepileptic drug; however, the therapy was ineffective and the sleep disorder appeared to be deteriorating. Subsequently, we initiated adjuvant treatment with melatonin. Upon re-examination, his body mass index had decreased, the sleep disturbance had resolved, and his seizures were well controlled. Electro-encephalography review was normal, and a typical melatonin rhythm was restored. CONCLUSION: We concluded that, in addition to causing obesity, abnormalities in the MC4R gene may contribute to the development of sleep disorders and epilepsy, and that melatonin can be used as an adjuvant therapy to alleviate these symptoms. PMID:33889637 | PMC:PMC8040176 | DOI:10.12998/wjcc.v9.i11.2688 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Minimally invasive treatment of forearm double fracture in adult using Acumed forearm intramedullary nail: A case report

paythelady.612 shared this article with you from Inoreader Minimally invasive treatment of forearm double fracture in adult using Acumed forearm intramedullary nail: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2595-2601. doi: 10.12998/wjcc.v9.i11.2595. ABSTRACT BACKGROUND: Currently, open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture. However, open reduction is associated with a high risk of complications. This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail. The patient experienced good follow-up outcomes. The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture. Few studies have reported on the use of this approach for the treatment of fractures. CASE SUMMARY: A 23-year-old male patient was admitted to hospital after 5 h of pain, swelling, and limited activity of left forearm caused by a careless fall. Physical examination showed stable basic vital signs, swelling of the left forearm, and severe pain when pressing on the injured part of the forearm. Further, friction was felt at the broken end of the bone; the skin was not punctured. Movement of the left hand was normal, and the left radial artery pulse was normal. Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius. The fracture was located in the upper third of the radius, with significant displacement on the fracture side. Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture. After analyzing the fracture pattern, age, and other patient characteristics, we chose an Acumed nail for treatment and achieved good follow-up outcomes. CONCLUSION: Acumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes. PMID:33889625 | PMC:PMC8040186 | DOI:10.12998/wjcc.v9.i11.2595 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic nomograms for predicting overall survival and cause-specific survival of signet ring cell carcinoma in colorectal cancer patients

paythelady.612 shared this article with you from Inoreader Prognostic nomograms for predicting overall survival and cause-specific survival of signet ring cell carcinoma in colorectal cancer patients Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2503-2518. doi: 10.12998/wjcc.v9.i11.2503. ABSTRACT BACKGROUND: Signet ring cell carcinoma (SRCC) is an uncommon subtype in colorectal cancer (CRC), with a short survival time. Therefore, it is imperative to establish a useful prognostic model. As a simple visual predictive tool, nomograms combining a quantification of all proven prognostic factors have been widely used for predicting the outcomes of patients with different cancers in recent years. Until now, there has been no nomogram to predict the outcome of CRC patients with SRCC. AIM: To build effective nomograms for predicting overall survival (OS) and cause-specific survival (CSS) of CRC patients with SRCC. METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Multivariate Cox regression analyses were used to identify independent variables for both OS and CSS to construc t the nomograms. Performance of the nomograms was assessed by concordance index, calibration curves, and receiver operating characteristic (ROC) curves. ROC curves were also utilized to compare benefits between the nomograms and the tumor-node-metastasis (TNM) staging system. Patients were classified as high-risk, moderate-risk, and low-risk groups using the novel nomograms. Kaplan-Meier curves were plotted to compare survival differences. RESULTS: In total, 1230 patients were included. The concordance index of the nomograms for OS and CSS were 0.737 (95% confidence interval: 0.728-0.747) and 0.758 (95% confidence interval: 0.738-0.778), respectively. The calibration curves and ROC curves demonstrated good predictive accuracy. The 1-, 3-, and 5-year area under the curve values of the nomogram for predicting OS were 0.796, 0.825 and 0.819, in comparison to 0.743, 0.798, and 0.803 for the TNM staging system. In addition, the 1-, 3-, and 5-year area under the curve values of the nomogram for predicting CSS were 0.805, 0.847 and 0.863, in comparison to 0.740, 0.794, and 0.800 for the TNM staging system. Based on the novel nomograms, stratified analysis showed that the 5-year probability of survival in the high-risk, moderate-risk, and low-risk groups was 6.8%, 37.7%, and 67.0% for OS (P < 0.001), as well as 9.6%, 38.5%, and 67.6% for CSS (P < 0.001), respectively. CONCLUSION: Convenient and visual nomograms were built and validated to accurately predict the OS and CSS rates for CRC patients with SRCC, which are superior to the conventional TNM staging system. PMID:33889615 | PMC:PMC8040180 | DOI:10.12998/wjcc.v9.i11.2503 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report

paythelady.612 shared this article with you from Inoreader <em>Klebsiella pneumoniae</em> infection secondary to spontaneous renal rupture that presents only as fever: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2602-2610. doi: 10.12998/wjcc.v9.i11.2602. ABSTRACT BACKGROUND: Spontaneous renal rupture is a rare disease in the clinic. The causes of spontaneous renal rupture include extrarenal factors, intrarenal factors, and idiopathic factors. Reports on infection secondary to spontaneous renal rupture and the complications of spontaneous renal rupture are scarce. Furthermore, there are few patients with spontaneous renal rupture who present only with fever. CASE SUMMARY: We present the case of a 52-year-old female patient who was admitted to our hospital. She presented only with fever, and the cause of the disease was unclear. She underwent a contrast-enhanced computed tomography (CT) scan, which showed that the left renal capsule had a crescent-shaped, low-density shadow; the perirenal fat was blurred, and exudation was visible with no sign of calculi, malignancies, instrumentation, or trauma. Under ultrasound guidance, a pigtail catheter was inserted into the hematoma, and fluid was drained and used for the bacterial test, which proved the presence of Klebsiella pneumoniae. Two months later, abdominal CT showed that the hematoma was absorbed, so the drainage tube was removed. The abdominal CT was normal after 4 mo. CONCLUSION: Spontaneous renal rupture due to intrarenal factors causes a higher proportion of shock and is more likely to cause anemia. PMID:33889626 | PMC:PMC8040190 | DOI:10.12998/wjcc.v9.i11.2602 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2524-2532. doi: 10.12998/wjcc.v9.i11.2524. ABSTRACT BACKGROUND: Giant cell tumor (GCT) is a benign lesion and rarely involves the patella. This disease is characterized by a relatively high recurrence rate after primary treatment. En bloc resection has been a predominant option for recurrent GCT. However, total patellectomy can lead to disruption of the knee. Therefore, exploration of functional reconstruction of the extensor mechanism is worthwhile. CASE SUMMARY: A 54-year-old woman presented with right knee pain and swelling, and was diagnosed as having a GCT in the patella following curettage and autograft. Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture. Based on the combination of histological, radiological, and clinical features, a diagnosis of recurrent GCT in the patella was made (Campanacci grade III). After a multidisciplinary team discussion, three-dimensional (3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism. The patient was followed for 35 mo postoperatively. No evidence of local recurrence, pulmonary metastasis, or osteoarthritis of the right knee was observed. The active flexion arc was 0°-120°, and no extension lag was detected. A favorable patellar tracking and height (Insall-Salvati ratio 0.93) were detected by radiography. CONCLUSION: We depict a case of a GCT at the right patella, which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement. The patella normal reconstruction, the precise-fit articular design, and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up. PMID:33889617 | PMC:PMC8040175 | DOI:10.12998/wjcc.v9.i11.2524 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.