Advanced Concepts in Medicine and Medical Research Vol. 10

Takayasu's Arteritis (TA) is a disease of uncertain cause with an annual incidence of 1.2 to 2.3 cases per million people. Takayasu arteritis is a rare and chronic granulomatous vasculitis that affects major elastic arteries, primarily the aorta and its main branches, as well as the pulmonary and coronary arteries, and is defined histologically by an inflammatory cell infiltrate affecting all layers of the arterial wall. Takayasu arteritis targets the aorta and its branches and is still of unknown aetiology. It often affects female patients under 50 years of age. A relationship between Takayasu arteritis and tuberculosis has been suggested for a long time. The cause of TA is unknown, but a link between TA and tuberculosis (TB) has been proposed. Mikito Takayasu, a Japanese ophthalmologist, described the first instance of Takayasu's arteritis in 1908. Despite the link to tuberculosis and the resemblance of granulomatous lesions in both diseases, the precise involvement of Mycobacterium tuberculosis in the aetiology of TA remains uncertain.

Depression has been identified as one of the commonest mental-health problems in SCD, with prevalence rates as high as 27% - 46% reported [1]. While psychological therapies have been found to be beneficial in mild to moderate depression, their use as non-pharmacological methods amongst adolescents in sub-Saharan Africa, particularly Nigeria, is still at its infancy. This chapter determines the effect of behavioural activation therapy on depression in adolescents living with Sickle Cell Disease attending out-patient clinic at the Lagos State University Teaching Hospital, Lagos, Nigeria. The study was conducted in Lagos State University Teaching Hospital, Lagos, Nigeria, between November 2017 to February 2018 (4 months) among adolescents living with SCD and depression attending out-patient clinic. The participants were a sample of consenting adolescents (12 - 17 years) with SCD who had mild to moderate depression. We excluded those with severe depression on anti-depressant medications. The participants were divided into two groups, the treatment group and wait list (control) group. A randomized control trial (RCT) was conducted among participants assigned to treatment (30) versus control (30) group. A manualized behavioral therapy programme developed was delivered to the treatment group. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 23. Pair T-test was used to compare the two groups across continuous variables, pre- and post-intervention. Analysis of Covariance (ANCOVA) was used to deter- mine treatment effects controlling for baseline scores. After the inter- vention, the mean depression score reduced from 22.13 ± 3.08 to 13.02 ± 4.56 while Paediatric quality of life score increase from 62.57 ± 17.85 to 67.90 ± 7.99 in the treatment group (BDI, p < 0.001; PedsQL, p = 0.045). However, the pre- and post-intervention mean depression scores in the control group showed insignificant reduction from 22.23 ± 3.24 to 21.60 ± 2.75 and mean PedsQL from pre-intervention scores of 59.67 ± 12.60 to 56.73 ± 8.94 post intervention (BDI, p = 0.388; PedsQL, p = 0.242). From multivariate analysis (ANCOVA), only the Quality of Life scores ceased to show any significant effect of the intervention.

In conclusion, the effect of behavioral activation therapy (BAT) in adolescents with SCD and mild to moderate depression using a randomized controlled trial has been developed. The results reflected that BAT resulted in significant improvements in self-reported rating of depressive symptoms (effect size 2.1) and depression literacy suggesting efficacy of BAT in alleviating depressive symptoms in this cohort, however the QoL scores initially appeared to have had a positive change but ceased to be so after controlling for possible confounders.

This chapter aims to analyse the histopathological spectrum of Central nervous system (CNS) tumours irrespective of age in a single institution. CNS tumors are a distinct and heterogeneous group of neoplasms that include both benign and malignant neoplasms. Because of their variable presentation and overlapping morphological features, these tumors are challenging to diagnose. Immunohistochemistry aids in the resolution of diagnostic challenges in challenging instances. The age distribution of CNS tumours is said to be bimodal. Males are involved more frequently, meningiomas being exception.

This  one year prospective study was conducted, at the department of pathology, ASRAM from 2016 to 2017. Neurosurgical specimens were formalin-fixed and paraffin-embedded and stained with Haematoxylin and eosin. Immunohistochemical markers were used in specific cases like S-100, CD-45, etc. In our investigation, 72 brain neoplasms were examined.

The findings showed that  Neuroepithelial tumours (25) were most common, followed by meningothelial tumours (22), tumours of sellar origin(12), tumours of cranial and paraspinal nerves(5), metastatic tumours(4) and others (4). The current study emphasizes the histological variability of CNS tumors in different age groups. The greatest incidence of CNS tumors was observed in the fourth to fifth decade. After the age of 40, meningiomas and astrocytomas were prevalent tumors. Among astrocytomas, GBM was the most prevalent. Immunohistochemistry was useful in difficult instances.

Prostate cancer is the 2^nd most commonly occurring cancer in males contributing major in the incidence and mortality of males due to cancer. Despite the advancements in the diagnosis as well as treatment of prostate cancer, 1.4 million new cases and more than 375,000 deaths from this malignancy were reported in 2020 all over the globe. Incidence of prostate cancer are 3-times more in developed countries as compared to the developing countries. Recently, the landscape of timely diagnosis and treatment of prostate cancer is changing with the progress in modern science and technology. For the diagnosis of solid tumors, computed tomography (CT), Scintigram and bone scans are being practiced conventionally for clinical uses. Although chemotherapy has always been the essential modality in ensuring prolonged survival of the patients but precision medicine including the use of prostate specific membrane antigen (PSMA) and PARP inhibitors based radionucleotides will offer new opportunities for treating advanced and metastatic prostate cancer. Overall, there are considerable improvements in the area of prostate cancer research that is helping in continuous evolution of novel agents and treatment modalities. In this direction, approaches like PSMA-PET theranostics can help in providing a potential modality for both diagnosis and therapy as well.

This chapter highlights about the value of medical thoracoscopic guided parietal pleural biopsy in the etiological diagnosis of exudative moderate to massive pleural effusions at a rural tertiary care centre of north India. Medical thoracoscopy has been shown to be an efficacious procedure in diagnosing unexplained exudative pleural effusions with excellent safety. Pleural biopsy under direct vision can be successfully and safely used for etiological diagnosis. This was a cross sectional study conducted in male and female patients between 18 to 70 years of age of undiagnosed and moderate to massive exudative pleural effusions. Undiagnosed pleural effusion was defined as failure to achieve a diagnosis by initial pleural fluid analysis including pleural fluid adenosine deaminase (ADA) levels <70 U/L and at least three pleural fluid analysis negative for malignant cells. The study was conducted upon 90 patients with exudative moderate to massive pleural effusion, who required intercostal drainage (ICD) for management. Exudative pleural effusions were also smear negative for acid fast bacilli (AFB) and malignant cytology.

Thoracoscopic pleural specimens were diagnostic in 86 patients out of a total 90 patients (95.5%). Histopathological examination of thoracoscopic specimens revealed, Malignancy- in 31 cases (34.4%), Inflammatory 28 (31.11%), Tuberculosis in 25 patients (27.8%) and Sarcoidosis in two cases (2.22%). Four patients (4.4%) were still inconclusive on histopathology. Thus, thoracoscopic pleural biopsy is considered gold standard in diagnosis of malignant pleural effusion and tubercular pleural effusion. The safety and diagnostic yield of a medical thoracoscopic guided pleural biopsy are both good. Therefore, doctors should only use it after receiving the appropriate training.

Introduction: Anxiety and depression are the most prevalent mental disorders in the world, close to 50% of the international disease burden due to psychiatric disorders and substance use. Research with university students show psychiatric disorders ‘rates around 15 to 25%. This chapter highlights the prevalence as well as determinants of the two major mental health diseases among health science students. It estimates anxiety and depression prevalence rates in Faculty of Health Sciences’ students, at Lúrio University in Nampula, Mozambique, and associated determinants, during the Covid-19 pandemic.

Students experience mental health stress and interfere with their higher education very often due to their creating biased training environments and unfavourable life condition. Population’ depressive disorders prevalence is around 7%, but these disorders’ incidence increased due to the SARS-CoV-2 pandemic, impairing individual’s functional and psychosocial lives, and increasing the risk of major depressive disorder if not recognized and treated.

Descriptive study, (21) cross-sectional quantitative, applying an indirect questionnaire from August to October 2020 to a students’ universe enrolled at the FHS of UniLúrio in Nampula, during the year 2020: 1,050 students. To have a representative sample, the number was calculated with a 95% confidence interval and a margin of error of 5%, considering the estimated prevalence (unknown) equal to 50%, obtaining 282 subjects. The selection of the sample was based on the students' accessibility to the digital questionnaire on their smartphone, as well as on their voluntary participation, aged 18 years or over, enrolled in the courses of Dentistry, Medicine, Nursing, Nutrition, Pharmacy, and Optometry, who attended the first to sixth year of graduation and who signed an Informed Consent Form (ICF). The Faculty of Health Sciences students’ random sample in Nampula answered the survey from August to October 2020, in a declared Public Calamity period due to Covid-19 pandemic. Results were analysed with Statistic Package for Social Science with a confidence interval of 95% and an error margin of 5%, using Q² test to determine statistically significant associations.

In the study, 276 students answered the survey, 50% of each gender, aged from 17 to 51 years, 60% coming from Nampula province, showing high rates of anxiety, depression and co morbidity, respectively 42.3, 34.3 and 25.9%, with a statistically significant association with bad relationships with friends, not enough sleep, trauma, lost and family antecedents.

Conclusion: We confirmed the high prevalence of mental disorders in the Mozambican population, probably aggravated by governmental restrictive measures due to SARS-CoV-2 pandemic, implementing distance digital learning. FHS students have high prevalence rates of anxiety (42%) and depression (34%), mental disorders impacting patient – health student relation, limiting academic achievement and quality of life. These disturbances are accentuated by an insufficient amount of sleep (RR>2), low BMI, poor interpersonal relationships or traumatic or family history, as expected. The Covid-19 pandemic may have aggravated the incidence of these disorders.

These results are important to allow the University to launch preventative activities and to promote therapeutic options, to grant the teaching–learning system success.

This chapter highlights to improve the treatment and standards of care for cataract and refractive surgery in Germany and to offer a tool for benchmarking through the establishment of a reference database in Germany where surgeons could record and analyze their own outcomes. Cataract is the world's leading eye disease that causes blindness. Standards for cataract surgery are developing worldwide. The revolution of cataract surgery has never stopped and has been going on, from early intracapsular cataract extraction (ICCE) via extracapsular cataract extraction (ECCE) to current phacoemulsification (PCS) and even femtolaser-assisted cataract surgery. The German registry for cataract surgery was established in 2014. The main aim of this registry was to improve cataract surgery outcomes. The Annual Report on Cataract Surgery Germany (ARCSG) started in 2014.  Ophthalmic surgeons across Germany were invited to contribute data on their cataract surgeries. Data collection includes data in quality control and benchmark tools on preoperative, intraoperative and postoperative parameters.  The analyzed data included parameters of surgical technique, implanted intraocular lens (IOL), refractive and visual outcomes. During the year of 2018, the German registry included 10,035 lens exchange surgeries and the complete follow-up was available for 9,882 lens extractions. Our data revealed a complete follow-up for 9,882 lens extractions. Visual and refractive outcomes are the ones that will allow comparing our results to other reported results as a measure of quality control. Approximately one third of the patients were between 76 and 80 years old and 60.6% of the cases had a best-corrected distance visual acuity (CDVA) before surgery of 0.5 or better. Parabulbar anesthesia was reported in 60.4% of the cases and phacoemulsification with implantation of a posterior chamber IOL was the chosen method in 92.2% of the cases. The power of the implanted IOL was between 21.0-22.9D in 29.4% of eyes. Surgical complications were reported in only 413 cases. After surgery, a CDVA of 0.5 or better was achieved in 90.8% of the cases. Most of the operated patients (64%) had a residual refractive error within ±0.5D (95% confidence interval 63.2–65.1). Our results show that the registry was implemented successfully with results comparable to the ones reported in EUREQUO. The enthusiasm for AI and machine learning is high, but one should bear in mind that the quality of the data output fully depends on the quality of data input and the proper data processing. This involves expertise, manpower and considerable costs.

HIV/Hepatitis C co-infections are common and represent major public health problems as it affects between 2 and 3 million people worldwide This study developed based onnon-invasive tests using biomarkers was conducted on patients co-infected with HIV and HCV. This chapter focuses on evaluating the degree of hepatic involvement using APRI and FIB 4 scores in liver damage in those co-infected with HIV/HCV in Côte d'Ivoire. This study qualitative method of semi-directive interviewing was used to interview that was conducted from September 2019 to November 2019Serological tests were performed to analyze the data. APRI and FIB 4 scores were calculated for each patient from biological data obtained by COBAS C311 (Roche Hitachi, Japan). Statistical analyses were performed using GraphPad and MED-CALC software.
The study involved 30 patients (men) of middle age (25 - 52 years), with extremes ranging from 0.67 to 8 for APRI and 0.201 to 22 for FIB 4. A predictive APRI and FIB4 score of significant hepatic fibrosis was observed in 23% of patients; however, 46% and 54% of patients for the APRI and FIB 4 score, respectively, would not have significant fibrosis. An APRI and FIB4 score not included in the classification limits of the type of fibrosis hepatitis was observed in 31% and 23% of patients, respectively. The findings of this study revealed that APRI and FIB-4 good discriminatory capacity in the diagnosis of liver cirrhosis in people living with hepatitis C in accordance with other research.
The study showed that APRI or FIB 4 score demonstrated good discriminatory capacity to classify patients into the different stages of liver fibrosis, as about 70 and 77%, respectively, of the patient population could be classified in the stages of hepatitis C fibrosis based on the interpretation of their criteria.

This chapter demonstrates the use of the narrow mesh for the treatment of inguinal hernia.  Some 20 million operations are performed worldwide each year. This study  relates to inguinal hernia repair, and more particularly to a preshaped inguinal hernia prosthetic material, polypropylene, 6×2.5 centimeters in size, that has a lateral semicircular non-encircling cord locating structure in order to protect the spermatic cord and that it is interposed between the conjoined tendon and the inguinal ligament in such a way as to repair the hernia and at the same time to reconstitute the physiology of the inguinal canal. The Narrow Mesh, interposed between the inguinal ligament and the conjoint tendon, reduces the tension on the suture line by advancing medially the inguinal ligament. Clinical studies were affirmed to evaluate the proposed claims of efficacy and safety and the prospective of a better outcome of the use of the Narrow Mesh for the repair of inguinal hernia.

This chapter describes managing low tongue posture in open bite by a composite habit breaking appliance. Tongue dysfunction in form of altered tongue rest posture and tongue tip protrusion during swallowing, go along with anterior open bite malocclusion in majority of cases. After determining that an aberrant tongue posture is the cause of open bite, orthodontists should categorize tongue posture by examining the morphological characteristics of the malocclusion. Vertical orientation of tongue at any given posture deserves equal consideration to that of its forward thrusting potential. In cases with low tongue rest posture, blocking mechanism such as cribs, may not alone be effective, as it also requires upward elevation of tongue to achieve normal rest posture.  On the other hand, tongue stimulator appliances, namely bluegrass appliances and tongue practice beads, as well as myofunctional therapy, require a great deal of patient engagement to become clinically effective in modifying tongue behavior. We endeavour to find therapeutic potential of hybrid approach; that combines forward tongue restriction and vertical elevation via a composite habit breaking appliance (CHBA), in patients having low forward resting posture of tongue. A case report has been presented to exemplify the idea.

Background: Pregnant women are more susceptible to iron deficiency anemia (IDA), which is still a major global health concern. IDA is associated with unfavorable consequences for the mother and the newborn. Therefore, iron status during pregnancy may be assessed by a variety of laboratory assays, the most commonly used being serum ferritin (SF) and hemoglobin (Hb). Treatment for IDA frequently involves intravenous iron.

Objectives: To assess iron isomaltoside 1000's effectiveness in treating IDA in patients with obstetrics and gynecological conditions.

Materials and Methods: The study included fifty IDA-positive pregnant women from the start of the second trimester until a few days before birth. Over at least fifteen minutes, each of the ladies got 1000 mg of iron isomaltoside 1000. The following tests were used to determine the efficacy: packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), polymorphs, lymphocytes, eosinophils, monocytes, red cell distribution width (RDW), serum total iron-binding capacity (TIBC), serum ferritin, serum iron, and reticulocytes count. Severe iron deficiency (ID) is defined as ferritin levels less than 30 \(\mu\)g/L, whereas mild-moderate ID is defined as ferritin levels between 100 \(\mu\)g/L and greater than 30 \(\mu\)g/L.

Results: Mean age of women with IDA was 35.14±7.183 which ranged from 22 to 53 years. Significant improvement in mean hemoglobin (8.64±0.85 vs. 12.86±0.97, P <0.001), platelet count (115.11±161.22 vs. 3.13±0.68, P <0.001), polymorphs (70.9±34.36 vs. 50.62±6.39, P = 0.0001), lymphocytes (32.24±9.70 vs. 39.68±7.64, P = 0.0001), PCV (31.40±4.46 vs. 39.72±2.56, P = 0.023), MCV (74.51±8.23 vs. 87.14±3.05, P = 0.021) , MCH (23.71±3.77 vs. 31.62±2.10, P = 0.012), MCHC (27.56±2.81 vs. 34.90±2.30, p=0.001), RDW (18.48±3.02 vs. 13.94±1.62, P = 0.004), TIBS (397.1±74.53 vs. 273.86±31.55, P = 0.024), serum ferritin (32.19±78.18 vs. 85.96±21.74, P <0.001), serum iron (46.40±14.89 vs.  108.32±21.38, P <0.001) and reticulocytes (1.84±0.79 vs. 1.07±0.29, P <0.001) after 27^th day treatment with Iron isomaltoside 1000 compared to baseline.  Iron Isomaltoside 1000 was also able to improve severe ferritin level to mild-moderate ferritin level in a span of 27 days.

Conclusion: Iron isomaltoside 1000 is a useful medication for gynecological and obstetric patients. On standard IDA options, a notable improvement was noted.

Nutrition and metabolism modify epigenetic codes such as histone methylation or acetylation and DNA methylation mediated by bioactive nutrients and gut microbial factors via influencing the gut–brain axis, which modulate neuronal activity and behavior.

This chapter discusses epigenetic aberrations related to diet and gut microbiome alterations in major psychiatric diseases such as schizophrenia, bipolar disorder, and autism. Here, this study first discussed modifications to the structure and makeup of gut microbiome and their role in brain functional changes in serious mental illnesses. Afterwards, potential interactions among maternal diet, environmental factors, nutrition, and gastrointestinal microbiome, and their roles in the pathogenesis of mental illnesses via epigenetic changes were discussed. This study also provided an overview of the association between the gut microbiome, oxidative stress, and inflammation affecting epigenetic mechanisms. Additionally, this chapter presented underlying mechanisms which mediate the influence of gut microbiome, probiotics, and psychiatric drugs on mental health via microbiome-epigenetic modifications. Finally, it was concluded that disease pathogenesis is linked to changes in the microbiome structure/composition by perturbing the microbiome–gut-brain axis functions. Further research is needed to obtain greater insights on abnormally transmitted microbiomes on infant health, to mitigate the origins of neurodevelopmental diseases at early ages.

This chapter focuses on merits of student- centered learning in anatomy. Anatomy plays a crucial role in several medical specialties. Anatomy holds significance not only in clinical practice but also in medical research and advancements. Research studies frequently rely on the analysis of anatomical structures to comprehend disease mechanisms, develop new treatments, and advance medical technology. Its role in research is vital for driving transformation and progress in the medical field. It is impossible to overstate the clinical importance of anatomy in undergraduate medical education. Because medical professionals examine and work with the human body on a daily basis, anatomy studies in one way or another will always be crucial to safe medical practice. It is necessary for core knowledge of anatomy to be assimilated by all doctors in order to practice medicine safely. It may be true that most doctors do not need to dissect a cadaver or study a prosection in order to practice, but if they do, it can improve their understanding and this surely has to be of benefit both for the safety of the patient and satisfaction of the doctor as a professional.  Teacher-centered learning is different from student-centered learning in that the former refers to methods of instruction where students are allowed to take charge of learning activities, actively participate in class discussions, create their own learning projects, investigate subjects that pique their interest, and generally help to design their own coursework.

In place of the prior lecture-based format, we should create and implement an instructional design that emphasizes the integration of student-centered pedagogy and active learning. Students' attitudes and performance will improve over time as a result of these adjustments. Although the changes to be implemented may require a significant time commitment in the first year, it will essentially be a “one time investment” because it will not require extra effort to teach the revised model in the future. Furthermore, it will not only provide a model for revision of an individual course but can also provide a catalyst for institutional reform.