Advanced Concepts in Medicine and Medical Research Vol. 1

The objective of this chapter is to highlight the advances made in the diagnosis and management of idiopathic scrotal calcinosis in contemporary times and emphasize points that allow for good aesthetic outcomes.

Idiopathic scrotal calcinosis is a rare benign condition that is characterized by the deposition of calcium in the scrotal dermis. This leads to the formation of a single or multiple calcified nodules of different sizes. It commonly begins in adolescence and early adulthood. Histologically, there is a granulomatous reaction to calcium deposits that contain multinucleated giant cells of the foreign body type appearing as dermal nodules. Patients most commonly present because of concern about cosmesis and itching. Diagnosis is mainly clinical and confirmed with histology of excised nodules. Surgery that involves the excision of the nodules either single or en-mass is the treatment approach, and it is to reduce symptoms and improve cosmesis. The preservation of an uninvolved scrotal median raphe allows the scrotum to assume normal configuration over time. There are reports of recurrence on follow up and patients need to be counselled appropriately.  Though newer modalities such as the use of carbon dioxide laser and the erbium: YAG Laser have been reported to offer a better aesthetic outcome compared with traditional surgery, comparative studies are needed to validate the observation.

The sample analysis for this investigation was performed in the private laboratory of the HMG Hospital in Rivers State, which is part of the University of Port Harcourt Teaching Hospital. Technological developments such as solid state circuitry, real time imaging, colour and power Doppler, transvaginal sonography and 3/4D imaging have been seized by clinical researchers to enhance the investigation and management of patients in areas as diverse as assessment of fetal growth and wellbeing, screening for fetal anomalies, prediction of pre-eclampsia and preterm birth, detection of ectopic gestation, evaluation of pelvic masses, screening for ovarian cancer and fertility management. A random sampling technique was employed to select the respondents, while the Taro-Yamene formula was used to calculate the sample size and data analyzed with SPSS version 20. The respondents were mainly aged 30 - 39 years, 12 (40.00%), mainly females, 20 (66.67%) and obese, 16 (53.33%). They were also mainly Christians, 25 (83.33%), of Ijaw descent 20 (66.67%) and civil/public servants, 13 (43.33%). The total cholesterol was the highest, 18 (60.00%), normal for triglyceride, 24 (80.00%), low for high density lipoprotein cholesterol, 22 (73.33%) and high for low density lipoprotein cholesterol, 14 (46.67%). Maximum liver span was statistically significant to triglyceride concentration; p-value (0.001) but not for total cholesterol; p-value (0.084), high density lipoprotein cholesterol; p-value (0.477) and low density lipoprotein cholesterol; p-value (0.317). Hepatic span is a predictive tool for the probable diagnosis of dyslipidaemia.

The chapter examines the viability of treating persons with Down syndrome (DS) physiologically rather than only via laboratory investigations. Human chromosomal or gene treatment is loaded with logistical and moral challenges. In every cell in the human body there is a nucleus, where genetic material is stored in genes. Genes carry the codes responsible for all of our inherited traits and are grouped along rod-like structures called chromosomes. Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21. To prevent DS, genome editing would have to be performed early on embryos. In vitro findings point toward the possibility of silencing extra chromosome 21 (C21) in later embryonic or foetal life, or even postnatally for some aspects of neurogenesis. These possibilities are beyond what is allowed today. Another approach is through regulating the overexpression of noxious genes on C21. Research with mouse models of DS is yielding promising results. Human applications have barely begun and are questioned on ethical grounds.

Introduction: The proper neurosurgical practice started in Sudan by Dr. Abusalih 1971. Before that the neurosurgical practice in Sudan was shouldered by general and orthopedic surgeons who only used to manage some simple neurosurgical problems. Despite the lack of proper diagnostic and operative equipment at that time, wide variety of neurosurgical problems have been adequately managed.

Objectives: To describe the effectiveness of diagnostic and operative methods, the quantity and quality of neurosurgical cases operated at that time and to assess the overall outcome of management.

Materials and Methods: Retrospective review of the cases records was mainly obtained from Dr. Abusalih book “Neurosurgery in Sudan in the seventies” besides contacting some doctors who attended that period.

Results: During the period between 1970 to 1980, 2315 neurosurgical cases were seen. Of these 88% were traumatic brain injuries, 3.8% brain tumors, 1.5% cerebrovascular malformations, 4.1% spinal cases and 2.6% extra-cranial and cranial masses.

Discussion: Most brain tumor cases improved postoperatively (68.5%). Most cerebral malformation cases were managed medically. For the spinal tumor cases all benign tumors showed complete recovery while malignant ones showed only partial recovery. The extra-cranial and cranial masses were mainly neoplastic 38.3% and congenital 31.7%. The commonest brain, spinal and extracranial masses were the meningioma.

Conclusion: Despite the lack of personnels and the advanced diagnostic and surgical tools, many neurosurgical problems have been adequately dealt with. The recognition of the first steps in the development of neurosurgery will help us to better appreciate the past and aid in its progress in the future.

Tuberculosis has many mechanisms that may lead to hypercoagulable state and can lead to thromboembolic complications. It may be a potentially life-threatening condition. The physician's awarness of this disease condition is important to an early diagnostic suspicion and prompt treatment to prevent fatal outcomes. Among the various complications reported to be caused by tuberculosis (TB), throm- bogenic potential is a rare entity. Here, we report a case of colonic tuberculosis in a 30-year-old male who developed left upper limb deep vein thrombosis (DVT). Ruling out other possible causes of DVT and improvement of the affected limb with antitu- bercular drugs led to conclusion that DVT was most probably due to TB.

The pathophysiology and genetic regulation of this process are both evaluated in this chapter along with the key mechanisms at play. Vascular calcification is highly associated with cardiovascular disease mortality, particularly in high risk patients with diabetes and chronic kidney diseases (CKD). In blood vessels, intimal calcification is associated with atherosclerosis, whereas medial calcification is a non-occlusive process which leads to increased vascular stiffness and reduced vascular compliance. In the valves, calcification of the leaflets can change the mechanical properties of the tissue and result in stenosis. For many decades, vascular calcification has been noted as a consequence of aging. Recent research suggests that arterial calcification is an independent cardiovascular risk factor (CRF) for morbidity and mortality. New studies have pointed out the existence of complex physiopathological mechanisms that flocks inflammation, oxidation, the release of chemical mediators, and genetic factors that promote the osteochondrogenic differentiation of vascular smooth muscle cells (VSMC).

This article's purpose is to "identify the various issues facing our phlebotomy units, to implement an improvement plan with efficient corrective actions, and to assess the relevance of those actions to phlebotomy by providing practitioners with precise recommendations on the implementation in place and carrying out their daily tasks." To collect a sufficient sample, a proper pre-analytical phase technique is crucial; regrettably, this stage is rife with hazards and mistakes. In this context, we conducted a survey using a questionnaire that was sent to the laboratory directors in the cities of Lubumbashi, Likasi, and Kolwezi in the Democratic Republic of the Congo. 3588 responses were validated and analyzed. Our results showed that the first line of the health level is more represented by Health Centers (HC), followed by Polyclinics, Reference Health Centers (RHC) and Hospitals Reference Generals (HRG). We have observed variations in the implementation of the reference standards on good sampling practice both in terms of general organization and in terms of risk management, for the staff and for the patient. What requires training, the establishment of a quality management system in phlebotomy units. 

The aim of the study is to determine the association of Vitamin D receptor (VDR) gene polymorphism and Prostatic Cancer. Prostate cancer affects men of all racial and ethnic groups and leads to higher rates of mortality in those belonging to a lower socioeconomic status due to late detection of the disease. There is growing evidence that suggests the contribution of an individual’s genetic profile to prostate cancer. Prostate cancer is becoming more common everywhere. The aetiology of prostate cancer has been linked to a variety of causes, including genetic, racial, and dietary factors. It has been demonstrated that vitamin D (calcitriol) has a role in cell development and differentiation, and its shortage is one of the etiological factors in prostate cancer. Vitamin D Receptor (VDR) and the enzyme 1 hydroxylase, which are necessary for the formation of calcitriol and its activity, are expressed by prostate epithelial cells. In certain epidemiological research, VDR gene polymorphism has been linked to prostate cancer, although there is a dearth of knowledge in the Indian setting. The Department of Biochemistry worked with the Department of Urology to evaluate three single nucleotide polymorphism (SNP) sites, FokI, TaqI, and ApaI, in 120 cases of prostate cancer. These cases were compared to 120 healthy first-degree relatives and 120 unrelated controls. When analysed, it was shown that prostate cancer patients had considerably lower rates of the Tt and Aa genotypes than healthy non-relative controls (p = 0.016 and 0.043, respectively). Tt genotype incidence is considerably lower in patients (p = 0.005) compared to first-degree relatives. With regard to FokI polymorphism, no meaningful correlation was discovered. The study reveals that heterozygous TaqI and ApaI polymorphism genotypes may be protective against the onset of prostate cancer.

Emerging scientific evidence has suggested that altered thyroid hormones can influence lipid metabolism and lead to dyslipidemia in hypothyroid patients. Inflammatory markers are also important factors to diagnose and prognoses the status of hypothyroidism. Hypothyroidism is a clinical syndrome resulting from the deficiency of thyroid hormones, which results from reduced secretion of both T₄ (thyroxine) and T₃ (triiodothyronine), irrespective of the cause, resulting in a generalized slowing down of metabolic processes. Numerous findings suggest that hypothyroidism was a highly influenced with TNF-\(\alpha\), IL 6, and IL 1. In this chapter, we review the role of inflammatory markers in hypothyroidism. It seems that for early diagnosis and prevention, these markers can be used in hypothyroidism in order to improve their prognosis.

The goal of the study was to shed light on the demographic differences of ovarian cancers in children and adolescents and to generate precise therapy guidelines. At the level of the genital system, ovarian neoplasm is the most frequent cause of morbidity and mortality. In the specialized literature, the coexistence of an inflammatory process is admitted from the early stages of the evolution of this pathology.It was a descriptive longitudinal study on 50 cases of adolescent girls and children undertaken in the Department of Obstetrics and Gynaecology from February 2018 to July 2019. After proper diagnosis, surgery was performed in all cases and depending upon histopathology and cytology, adjuvant chemotherapy was given in selected cases. Patients were followed up monthly till 6 months after discharge. The most common symptom was found to be abdominal pain (42%), most common sign abdominal mass (38%). Out of 50 cases, 12% were found to be malignant, all of germ cell origin. Epithelial tumors were found to be the most common ovarian tumors (52%) up to 20 years of age, out of which benign tumors had 48% epithelial origin. However, up to 10 years of age, germ cell tumors were found to be the most common (75%). Only 1 malignant case expired, belonging to mixed germ cell variety of advanced stage. Ovarian neoplasm is very difficult to treat, especially in children and teenagers since fertility preservation is required. The cornerstones of treatment include early detection, ideal therapy, rigorous follow-up, and psychological support for patients and family.

Primary leiomyosarcoma is an extremely rare entity constituting only 0.5–1% of all invasive renal tumors. It is frequently diagnosed after histological examination because it does not have any specific diagnostic features clinically and radiologically. At times, it is difficult to differentiate leiomyosarcoma from the sarcomatoid renal cell carcinoma even during histological examination as both tumors have spindle-shaped atypical cells. Moreover, some epithelial markers can be present in pure smooth muscle sarcomas, while some smooth muscle markers are positive in carcinomas. An extremely uncommon condition is leiomyosarcoma that develops in the renal pelvis. A patient with an obstructive stone-related left renal colic was admitted to hospital with a filling defect in the renal pelvis, which was initially misdiagnosed as a blood clot. After visual examination of the renal pelvis and a biopsy of the exophytic lesion, leiomyosarcoma was determined to be the cause. Laparoscopic radical nephrectomy was performed, histological and immunohistochemical examination confirmed the lesion to be a leiomyosarcoma with mixomatoid component. No adjuvant treatment was performed, and the patient remains healthy 6 years after surgery without recurrence. Herein we provide literature review, discussion of the diagnosis and treatment scenario of the patient with renal pelvis leiomyosarcoma with mixomatoid component.