Review Article
Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery
Issue:
Volume 12, Issue 3, June 2024
Pages:
26-32
Received:
24 July 2024
Accepted:
20 August 2024
Published:
30 August 2024
DOI:
10.11648/j.ajim.20241203.11
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Abstract: Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.
Abstract: Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately...
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Research Article
Effect of Dihydropyridine Calcium Channel Blockers (CCB) on the Progression of Diabetic Nephropathy in Aranyaprathet Hospital, Sakeaw Province, Thailand
Teerapon Pattanapisansak*
Issue:
Volume 12, Issue 3, June 2024
Pages:
33-39
Received:
20 July 2024
Accepted:
24 August 2024
Published:
11 September 2024
Abstract: Importance From Thailand, has standardized therapeutic drugs of Calcium channel blockers (CCB) in reduce the progression of chronic renal failure in diabetic and hypertension that is advantages for use in patients. However, use of Amlodipine that is more accessible and also a drug used by all community hospitals to treat patients, inexpensive and highly effective. Objective To study effective of Dihydropyridine Calcium channel blockers (CCB) on kidney function (eGFR), urinary protein creatinine and sugar blood level. Design, Setting, and Participants This study is retrospective cohort study by study in patients with diabetic nephropathy. By study in patients with diabetes nephropathy with stage 3 or higher and receiving Dihydropyridine Calcium channel blockers (CCB). Exposures Dihydropyridine Calcium channel blockers (CCB) in reducing the complications of diabetic nephropathy which is consistent with Strategy No.2 Providing quality and excellent health services. And literature reviews in Thailand have not found empirical evidence that mean Calcium Channel can reduce the complications of diabetic nephropathy. Main Outcomes and Measures The effectiveness of Dihydropyridine Calcium channel blockers (CCB) increases the complications of diabetic nephropathy. Results In volunteer, female patient proportion was 69.0%. Average age was 69.3 (± 9.69), minimum age is 40 years, maximum age is 97 years. Most patients were between 60-79 years, follow by 40-59 years follow by16.8% and more than 80 years 16.1%. In congenital disease, kidney disease, kidney failure, diabetes and hypertension are 100%, follow by 24% obesity and 0.2% cancer. The effect of Dihydropyridine Calcium channel blockers (CCB) on kidney function (eGFR), urine microalbumin and creatinine when compare with use drug CCB 2 groups including Amlodipine and Amlodipine+enalapril/losartan/valsartan. Found that volunteer that received CCB drug compare with month 3 and 12, the level of eGFR decreases (t=1.085) and Urine Microalbumin increases (t=1.496) by statistically significance (P = 0.002) and Dihydropyridine Calcium channel blockers (CCB) on Fasting blood sugar compares with month 3 and 12, Fasting blood sugar (t = 0.566) and HbA1C (t=0.677) was typically decreased significantly (P < 0.005). Conclusions and Relevance Calcium channel blockers (CCBs) was decline kidney function (decrease eGFR) and CCB leads to the decrease of eGFR and provides monitoring of CCB use, as this may lead to the decrease of kidney function.
Abstract: Importance From Thailand, has standardized therapeutic drugs of Calcium channel blockers (CCB) in reduce the progression of chronic renal failure in diabetic and hypertension that is advantages for use in patients. However, use of Amlodipine that is more accessible and also a drug used by all community hospitals to treat patients, inexpensive and h...
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