The Difficult Diagnosis of Hypophosphatemic Rickets-A Review of 8 Clinical Cases
Anna-Maria Borissova,
Yordan Vlahov,
Seiji Fukumoto,
Yuichiro Shimizu,
Todor Zahariev,
Valentin Govedarski,
Svetoslav Dimitrov,
Radina Ivanova,
Milena Nikolova,
Boyana Trifonova
Issue:
Volume 9, Issue 5, September 2020
Pages:
97-102
Received:
3 August 2020
Accepted:
18 August 2020
Published:
14 September 2020
Abstract: Hypophosphatemic rickets is a rare, usually genetic disease associated with decreased phosphate reabsorption in the proximal renal tubule and vitamin D resistance. Several genetic mutations have been discovered, the most common being the X-linked PHEX mutation with high fibroblast growth factor 23 (FGF23) circulating levels. The hypophosphatemic type osteomalacia is usually hereditary or tumour-induced (TIO). In the past 20 years, we have discovered, treated and followed up overall 8 cases of the disease-3 women and 5 men, aged 18 to 52 years. In all patients the diagnostic process was long (a mean of 2-3 years) and involved multiple clinical consults, laboratory evaluations: Biochemical Standard Research, Hormonal Tests [PTH, 25 (OH) D, 1,25 (OH) 2D], Specialized Research (FGF23), Instrumental Research (Ultrasonography of whole body; Computed tomography; Magnetic resonance imaging; DXA examination with an assessment of T-score and Z-score of spine/hip). All of these studies aimed at ruling out different neurological, hematological, oncological, rheumatic, gastroenterological, urological, nephrological diseases and conditions. One of the patients had Fanconi syndrome, five had X-linked hypophosphatemia (XLH) and two had TIO. In the last two patients, we found a high level of FGF23 secreting a small lung neoplasm in the first case and a mesenchymal tumor in the median upper part of the right thigh in the second case. The surgical removal of the tumor mass lead to a fast decrease in FGF23 levels and correction of metabolic disturbances. We present clinical cases with hypophosphatemic rickets/osteomalacia and discuss the etiopathogenesis and treatment of this rare disease. Historically until now phosphate supplementation and therapy using analogs of highly active vitamin D (calcitriol, alfacalcidol, paricalcitol) have been used to manage conditions involving hypophosphatemia. In recent years there has been a progression of clinical trials for monoclonal anti-FGF23 antibodies for the treatment of XLH. These monoclonal anti-FGF23 antibodies may have potential for treating other conditions associated with FGF23 overactivity. However, clinical trials to support that possibility are not available at present.
Abstract: Hypophosphatemic rickets is a rare, usually genetic disease associated with decreased phosphate reabsorption in the proximal renal tubule and vitamin D resistance. Several genetic mutations have been discovered, the most common being the X-linked PHEX mutation with high fibroblast growth factor 23 (FGF23) circulating levels. The hypophosphatemic ty...
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Effective Adaptation of Music Intervention in the Psychological Management of Late Life Depression in Nigerian Communities
Issue:
Volume 9, Issue 5, September 2020
Pages:
103-113
Received:
22 August 2020
Accepted:
1 September 2020
Published:
28 September 2020
Abstract: Depressive symptoms in late life has been a global phenomenon affecting older adults mental health stability and general well-being. Studies on the psychological management of the disorder in Nigeria have variously adopted therapies that exerts cognitive, sensory and motor abilities of the elderly thereby generating very minimal results. The pre-test, post-test, control group quasi experimental design with a 3x5x3 factorial matrix was adopted for the study. A total of sixty-four (64) participants were purposively selected from two randomly selected local government areas in Ibadan. Participants were further randomly assigned into an experimental group-Music Intervention Group (34) and the Control Group (30). Data was subjected to Analysis of covariance (ANCOVA). There was a significant main effect of treatment on late life depression (F=17.554, p<.05, η2=.290). Music Intervention (x̃=20.17) effectively managed late life depression vis-a-vis those in the control group (x̃=7.832). There was no significant main effect of personality traits and health locus of control on late life depression. The study ascertained the effective adaptation of music intervention in the psychological management of late life depression of community dwelling older adults, thereby adding to existing literature on music intervention for future research. This contribution is an advancement to late life depression study and management in Nigeria. Findings from the study can be adopted in both community and clinical studies of depression.
Abstract: Depressive symptoms in late life has been a global phenomenon affecting older adults mental health stability and general well-being. Studies on the psychological management of the disorder in Nigeria have variously adopted therapies that exerts cognitive, sensory and motor abilities of the elderly thereby generating very minimal results. The pre-te...
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Post Operative Pain Management Knowledge, Attitude, Practice and Associated Factors Regarding Among Nurses’ Working in Jimma Medical Center, South-West Ethiopia, 2019
Abiru Neme Negewo,
Gugsa Nemera Germossa,
Bontu Mathewos,
Girma Bacha Ayane
Issue:
Volume 9, Issue 5, September 2020
Pages:
114-122
Received:
2 June 2020
Accepted:
15 June 2020
Published:
26 October 2020
Abstract: Introduction: Effective post-operative pain management can lead to comfort, better mobility, improved recovery, and shorter stay in hospital. However, though few studies were done in this area, the extent to which nurses practice post-operative pain management and their level of knowledge and attitude regarding pain is not well documented in the study setting. Objective: To assess post-operative pain management knowledge, attitude, practice and associated factors among nurses working at Jimma medical center, south-west Ethiopia, 2019. Methods: Institution based quantitative cross-sectional study design was conducted on 203 nurses working in surgical Gynecology maternity and labor ward, operation theater, ophthalmology units of Jimma Medical Center. Data was collected by using pretested structured self-administered questionnaire and entered SPSS version 21 for analysis. Descriptive statistics (frequency percentage mean and standard deviation) was computed. Chi-square test was done to determine the association between dependent and independent variables. Significant associations were declared at P value less than 0.05. Results: The finding of this study revealed that 88.8% of nurses had poor knowledge and attitude regarding pain and 23.5% had good post-operative pain management practice. Prior training on pain management and reading of medical books were significantly associated with knowledge and attitude regarding pain whereas working unit and prior training on pain were found to be significantly associated with post-operative pain management practice. Conclusion and recommendation: Nurses knowledge and attitude regarding post-operative pain management practice in Jimma Medical Center are generally low. Prior training and reading books are significantly associated with the level of nurses’ knowledge and attitude whereas; training and working units are significantly associated with post-operative pain management practice. Jimma Medical center should provide an in-service training and avail reading books to improve nurse’s knowledge, attitude and practice toward post-operative pain management.
Abstract: Introduction: Effective post-operative pain management can lead to comfort, better mobility, improved recovery, and shorter stay in hospital. However, though few studies were done in this area, the extent to which nurses practice post-operative pain management and their level of knowledge and attitude regarding pain is not well documented in the st...
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