Advanced Concepts in Medicine and Medical Research Vol. 4

In this study we intend to present a case of a rare complication of diverticular disease. The diagnosis is primarily made by CT because the symptoms are vague. To prevent perforation or other consequences, a surgical resection is the advised course of action. In this case, a 74-year-old woman complained of intestinal obstruction and an acute abdomen and went to the emergency department. Physical examination showed a distended abdomen, diffusely painful on palpation, with a positive Blumberg sign, no hernias.  An abdominal computed tomography (CT) discovered a mesenteric collection with 60mm and air-fluid level compatible with an abscess, adjacent to a small bowel loop. An emergency laparotomy was done, which disclosed a 6cm cystic formation dependent on the sigmoid colon in the antimesentery border, which was removed en bloc with the neighboring colon.  It was identified by the specimen as a type 2 diverticulum.  After a typical postoperative period, the patient was discharged.

This chapter aims to determine mean platelet volume (MPV) and platelet count (PC) in diabetics (type2) and non-diabetics and to determine correlation of MPV and platelet count with fasting blood sugar. Increased MPV is emerging as an independent risk factor for thromboembolism, stroke and myocardial infarction. The majority of Diabetes Mellitus deaths are caused by micro- and macro vascular complications of the disease. Larger platelets with larger mean platelet volume are more prone to thrombosis. Over the course of three months, this prospective investigation included 100 participants with type II diabetes and 50 non-diabetic controls. The results showed that diabetics had a significant rise in MPV value. The MPV test, which is simple and affordable, can be used as a useful tool to monitor patients for thrombogenicity, particularly in those with altered blood glucose metabolism.

Fine Needle Aspiration Cytology (FNAC) is an important diagnostic procedure used for rapid evaluation of a multitude of lesions. One of the common uses is for diagnosis of the underlying pathology of enlarged lymph nodes. The study's goal was to look at the pattern of diseases seen on Fine needle aspiration (FNA) of enlarged superficial lymph nodes in a tertiary hospital in Hyderabad from January 2014 to August 2016, as well as to determine the patient profile who underwent this surgery at our hospital.

To ascertain the age and sex distribution of the patients as well as the distribution of pathologies identified on FNA evaluation of the lymph nodes, data pertaining to the patients who underwent FNA evaluation of superficial lymph nodes from January 2014 to 31 August 2016 at a tertiary hospital located in Hyderabad, Telangana, were analyzed.

The majority of the patients who underwent FNA evaluation of lymph nodes were females (61%; 156 out of 253 patients). The bulk of the patients were between the ages of 20 and 50. The most common diagnosis in our dataset (49.8%; 126 instances out of 253 FNA examinations) was reactive lymph node hyperplasia. The second most common diagnosis (37.15%; 94 out of 253 FNA assessments) was granulomatous lymphadenitis.

The disease causing enlarged superficial lymph nodes can be accurately diagnosed by fine needle aspiration examination, which is quick, simple, relatively non-traumatic, and reliable in the hands of experts. The two most frequent causes of enlarged lymph nodes in our series were granulomatous lymphadenitis and reactive lymph node hyperplasia.  

This chapter aims to test the efficacy of instructional module for caregivers on recovery of TBI patients. Traumatic brain injury (TBI) is a silent public health epidemic and a major cause of disability, morbidity, and mortality worldwide. It is characterized by a breakdown in the normal function of the brain caused by collision, blow, and jolt to the head-neck-spinal cord, possibly leading to temporary or permanent impairment.

The study was performed at the Neuro-Surgery Department of Post Gradu- ate Institute of Medical Education and Research (PGIMER), Chandigarh, India. A total of 82 patients with 41 each in experimental and control groups and their caregivers were included in the study. The effectiveness of the intervention was evaluated based on the frequency of deep vein thrombosis, deep chest infection, eye infection, bedsores, wound infection, constipation, urinary tract infection, and length of stay in both groups.

 Fever, constipation, and length of stay dramatically decreased in the experimental group. In the experimental group, lower rates of chest infections, bedsores developing, wound infections, and urinary tract infections were also seen. This study was performed to teach the caregivers using demonstrations and an instructional module. It aimed at facilitating caregivers to perform the routine procedures regarding care of dependent head injury survivors.

The objective of the study was to establish semiological differences associated with primary dysmenorrhea in female university students from a University in Peru.

Dysmenorrhea is a condition that manifests itself before, during and after menstruation and is accompanied by very intense pelvic pain.

Women experience menstrual cramps, which decreases their quality of life. Those who begin their menstrual cycles with these symptoms assume that it is normal and that specialized medical assistance is not necessary.

Medical professionals have established general practice guidelines on clinical disorders of the menstrual cycle, However, there are no specific recommendations that effectively support the timely diagnosis and treatment of primary dysmenorrhea. The particularity of our research is that the symptoms they can vary depending on the altitude of 3870 meters above sea level, so it is necessary to continue with experimental and comparative research.

Two females reported to our Glaucoma Clinic with complaints of blurred vision & pain along with signs suggestive of malignant glaucoma post phacoemulsification cataract surgery with foldable PCIOL, operated elsewhere. B-scan showed posterior segment within normal limit, so ruled out suprachoroidal haemorrhage. I  treated them first with YAG peripheral iridotomy (PI) & peripheral anterior hyaloidotomy through peripheral PI with antiglaucoma medications (AGM) & topical Atropine assuming the case to be of malignant glaucoma. But in follow up, anterior chamber (AC) was found to be shallow with one haptic of foldable IOL in sulcus tilting forward seen in dilated pupil under the effect of topical atropine responsible for causing condition masquerading as malignant glaucoma. Then, the cases were treated by redialing of foldable PCIOLs in bag in both the cases. Post redialing, there was improvement of visual acuity along with reformation of AC with normal depth & intraocular pressure (IOP) was also under control without AGM.

This chapter aimed to know the incidence rate of AKI and its associated risk factors among the NICU patients to depict the disease burden and its impact. Acute kidney injury (AKI) is a clinical syndrome that complicates the course and worsens the outcome in a significant number of hospitalised patients. Recent advances in clinical and basic research will help with a more accurate definition of this syndrome and in the elucidation of its pathogenesis. Neonates who suffer hypoxic ischemic encephalopathy often develop multiorgan failure, which impacts virtually every organ system. The findings suggest that the incidence of neonatal AKI would have been even higher if more rigorous AKI surveillance protocols were implemented. The most common cause for neonatal admission in our NICU was perinatal asphyxia followed by neonatal sepsis. The findings are limited by our definition of AKI, which relies on SCr changes to diagnose AKI in addition to the fact that we did not take urine output as a marker of AKI.

This chapter aimed to evaluate the performance and limitations of frozen sections in the intraoperative evaluation of thyroid, breast, gastric, ovarian, central nervous system and lower extremities biopsies. Frozen section is a specimen of tissue that has been quick-frozen, cut by microtome, and stained immediately for rapid diagnosis of possible malignant lesions. A specimen processed in this manner is not satisfactory for detailed study of the cells, but it is valuable because it is quick and gives the surgeon immediate information regarding the malignancy of a piece of tissue. Frozen section plays an important role in the management of surgical patients yet it must be used prudently to avoid the indiscriminate usage of this important technique.

A cross-sectional study of frozen sections was done over a period of one and half year. All Intraoperative frozen sections of breast, thyroid, and gastric, ovarian, central nervous system tumours performed at Asram medical college, Eluru over a period of one and half years from 2013 to 2014 were studied. Fine needle aspiration cytology, frozen and biopsy performed for various tumours in thyroid, breast, gastric, ovary, CNS and lower limb were studied.

Out of 21 cases, 19 cases of frozen sections coincided with histopathological diagnosis and 20 cases of fine needle aspiration cytology coincided with histopathological diagnosis. In our study diagnostic accuracy for breast specimens was 50%.False negative result in frozen section in our study was that of intraductal/in situ carcinoma of breast.

Frozen section aides the surgeon to choose the best therapeutic approach and in rapid diagnosis of a pathological process. Newer techniques like MRI scan, CT scan, optical imaging, intra-operative cytology, and immunohistochemistry techniques are also helpful in diagnosing cancers.

The objective of this chapter was to find out the prevalence of mucocele or empyema in chronic cholecystitis using cholecystectomy findings and histopathological reports. Cholecystitis is the sudden inflammation of gallbladder. If this condition persists over time, such as for months, with repeated attacks, or if there are recurrent problems with gallbladder function, it’s known as chronic cholecystitis. This observational cross-sectional study was conducted in Surgical Ward 1, Jinnah Postgraduate Medical Center from December 2019 to December 2021 for two years. Patients who were diagnosed with acute cholecystitis, mucocele, or empyema on clinical examination and ultrasonography were excluded from the study. The laparoscopic cholecystectomy was performed, and the surgical results were recorded. Gall bladder samples were sent for histology after being checked for mucocele and empyema. Chronic cholecystitis is usually due to cholelithiasis but incidentally, other pathologies are found. Chronic cholecystitis is also a risk factor for carcinoma. The finding of mucocele was confirmed on histopathology. Gallbladder was not palpable in this study as compared to the abovementioned study. Cholecystectomy becomes difficult due to impacted stone at cystic duct. It was determined that prolonged cholecystitis could result in empyema, mucocele, and strawberry gall bladder, making cholecystectomy challenging in such circumstances.

This chapter delves into the intricate management of humeral shaft fractures in adolescents, a distinct and often challenging subset of pediatric fractures. While non-operative approaches have historically yielded excellent results in children, adolescents present unique complexities due to their rapid growth. These challenges may result in complications such as malalignment, angulation, and malrotation, necessitating operative interventions. The traditional approach of open reduction and internal fixation with plates and screws, while effective, is not without its limitations. Soft tissue dissection, scarring, and complications pose concerns, making it imperative to explore alternative techniques. This chapter centers on one such alternative—closed intramedullary K-wire fixation. The method employs stainless steel K-wires introduced into the humeral shaft through minimally invasive techniques, mitigating many drawbacks associated with traditional open procedures. Through a comprehensive examination of the closed intramedullary K-wire technique, this chapter outlines its advantages and clinical outcomes. Notably, this technique minimizes blood loss, preserves the integrity of soft tissues, and maintains the fracture hematoma, thereby fostering early bridging callus formation. The results of a study conducted at Jawaharlal Nehru Medical College & Hospital, AMU, Aligarh, between 2012 and 2014, are presented, demonstrating a 97.5% union rate and minimal complications. In conclusion, closed intramedullary K-wire fixation emerges as a promising alternative for managing adolescent humeral shaft fractures. The technique offers a safe, cost-effective, and efficient approach, ensuring stability while preserving soft tissue integrity. It enables early bridging callus formation, early initiation of physiotherapy, and optimal functional outcomes, making it a valuable addition to the orthopedic surgeon's toolkit for addressing this challenging fracture type.

This chapter aim to study epidermal growth factor receptor expression by immunohistochemistry in diagnosed cases of Non- small cell carcinomas of lung at our institute and to determine the value of EGFR test by immunohistochemistry in predicting response to targeted therapy and clinical outcome. Tumours with amplified EGFR are more likely to have a significant component of solid growth, association between EGFR amplification. Lung cancer is one of the top causes of cancer fatalities in men and women alike. Non-small cell lung carcinomas, which account for the vast majority of lung malignancies (about 75%), have proven challenging to treat due to a poorly known pathological mechanism. Recent advances in cell signaling networks that control cell survival have revealed genetic and regulatory flaws that inhibit cell death, enhance cell division, and drive tumorogenesis. A two-year retrospective and prospective investigation of bronchial samples that were diagnosed as non-small cell carcinoma at our institute, together with the patients' responses to targeted therapy and the expression of the epidermal growth factor receptor immunohistochemical marker. The finding showed that Out of twenty- nine (29) cases of lung malignancies majority were Non -small cell carcinomas- twenty- seven cases (27), of which adenocarcinomas were seventeen (17) cases topped the list, followed by squamous cell carcinomas (5) cases, malignant epithelial lesions (3) cases and poorly differentiated carcinomas (2) cases. There were two (2) cases of small cell carcinomas. Fifteen cases of non-small cell carcinoma had EGFR mutations, and twelve patients were put on Gefitinib and Erlotinib targeted therapy. All twelve of them responded favorably to chemotherapy. The majority of non-small cell carcinomas of the lung, including all adenocarcinomas in non-smokers, have mutations in the epidermal growth factor receptor (EGFR). Patients' clinical outcomes could be anticipated. Targeted chemotherapy produces a noticeable effect.

This chapter aims to determine the effectiveness and reliability of CBNAAT in the diagnosis of extra pulmonary tuberculosis (EPTB) cases in comparison to AFB smear. Tuberculosis is still a major public health issue around the world. Mycobacterium tuberculosis is thought to infect one-third of the world's population. The two types of clinical manifestation of tuberculosis (TB) are pulmonary TB (PTB) and extrapulmonary TB (EPTB). While pulmonary tuberculosis is most common presentation, extrapulmonary tuberculosis is also an important clinical problem. Diagnosing extrapulmonary tuberculosis continues to be a challenge due to the paucibacillary nature of the samples collected from inaccessible sites and variable clinical presentation of the disease. Various direct and indirect methods of testing are available for diagnosing extrapulmonary tuberculosis accurately. Two of these tests which are routinely performed and are easily accessible are AFB smear and CBNAAT. AFB smear test is a method of visualization of acid-fast bacilli under microscope whereas CBNAAT is a cartridge-based nucleic acid amplification test that has long been used to diagnose pulmonary tuberculosis (PTB).

The study is a retrospective descriptive study conducted at MGM Hospital Aurangabad, Maharashtra, India. The study used data from January 2017 to July 2018. Data from 166 patients with probable extrapulmonary TB were obtained. The efficacy of CBNAAT in the diagnosis of EPTB was compared to that of AFB smear.

AFB smear and CBNAAT were performed on samples taken from 166 suspected EPTB patients. Lymph node, pus, pleural fluid, tissue, CSF, gastric lavage, cystic fluid, peritoneal fluid, ascitic fluid, colonic fluid, synovial fluid, and urine samples were collected. In AFB smear results, 17 cases were positive for TB bacilli while 149 tested negative. In the CBNAAT results, 25 cases were positive for TB bacilli whereas 141 tested negative. Eight cases were AFB smear negative but CBNAAT positive in a comparison examination.

The simplicity and quick response time of CBNAAT make it a valuable tool for diagnosing EPTB cases. For the diagnosis of cases with EPTB, CBNAAT is more useful than AFB smear. However, other diagnostic tools should be taken into consideration along with CBNAAT for better diagnostic yield overall.

This chapter provides a detailed account of diagnostic complexities faced with misdiagnosed coccydynia leading to chronic pelvic pain, with a specific objective to contribute to medical literature and emphasizing the importance of early diagnosis and early management to improve patient outcomes and quality of life. Coccydynia is a disabling condition characterized by pain in the coccyx region of the spine. Persistent discomfort in the perineal region, known as chronic pelvic pain, typically lasts longer than six months and can have either visceral or somatic origins. It doesn't react well to traditional painkillers. We report a case of a 42-year-old female suffering from severe chronic pelvic pain for the previous 15 years, for which she had been prescribed multiple analgesics including opiates and she underwent multiple surgeries without any relief. She was a misdiagnosed case of coccygeal fracture which caused chronic pelvic pain for the past 15 y, and when treated with ganglion impar neurolysis gave her complete pain relief. Coccyx is a delicate and mobile bone which is supported by the sacrococcygeal ligament and has more chances of sprain. Trauma to the coccyx due to body positioning while being seated can also cause chronic sprain over the coccyx.  At her one-month follow-up, she had NRS 1/10 and was completely pain-free.When making a differential diagnosis for chronic pelvic discomfort, especially in females who are fertile, coccydynia needs to be taken into account.

This chapter aimed to estimate the level of lipoprotein(a) in diabetic chronic renal failure patients and to correlate with healthy controls. Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. But, even controlling the cause might not keep kidney damage from progressing.

A metabolic condition with an alarming global prevalence is diabetes mellitus. If left unchecked, lipoprotein and other atherogenic variables might cause illnesses such chronic renal failure (a).

A total of 60 CRF patients attending a private medical college and hospital in a sub-urban region of Chennai participated in the study. The sample size was calculated according to the prevalence of CRF in South-India. Lipoprotein(a) was estimated by immunoturbidimetric method and the other parameters by their respective methods in biochemistry auto- analyzer. The study resulted that long term glycemic control was significantly proportional to the Lp(a) concentration in controls-Group A and Group B- diabetics with CRF. This suggests that long term glycemic control is directly related to the complications of diabetes. Lp(a) inhibits binding of plasminogen (PLG) to the cell surface by accumulating in the vessel wall.

It is revealed that there is a positive correlation of lipoprotein(a) levels with the duration of diabetes and was progressive with the diabetic complications. The present study observed that there is positive correlation of Lp(a) concentration with the duration of diabetes and is progressive with the diabetic complications.

This chapter explores the different aspects of research in malaria including risk factors, diagnosis, treatment, molecular and functional studies, mainly focusing on publications from the last five years. Plasmodium knowlesi is a zoonotic malaria parasite that has gained increasing medical interest over the past two decades. This zoonotic parasitic infection is prevalent in Southeast Asia and causes many cases with fulminant pathology.

In almost all of Southeast Asia's countries, as well as among visitors returning from these nations, human instances of human knowlesi have been recorded since the 2004 revelation of a significant concentration of cases in Sarawak. There are several factors leading to the increase of reported P. knowlesi cases. These include better diagnostic capacity, decreasing human malaria cases which in turn reduces relative immunity, increased awareness to P. knowlesi and close proximity of humans with natural reservoir hosts or infected vectors due to changes in human land use. Microscopy is the gold standard for malaria diagnosis but has its limitations as ring forms of P. knowlesi resemble P. falciparum and trophozoites and schizonts resemble those of P. malariae, and hence cannot be reliably differentiated. In-depth population genetic studies for both human and primate isolates are needed to shed light on possible human-to-human transmission of P. knowlesi and more importantly for us to understand the disease epidemiology and to guide knowlesi infection control. 

We evidence in this work an EEG Mapping procedure able to reveal the normal functional mechanisms of the neocortex and their disturbance in pathology. The EEG power of Delta, Theta, Alpha, Beta and th Delta+Theta/ Alpha + Beta power coefficients  are compared in prcentages between testing and rest, between  0% and 250% (standard scales). The percentage of 100% denotes the lack of EEG reaction. Thus, Maps may be compared both horizontally (between patients) and lonitudinally (in time). In comparison with MRI, EEG Mapping does not need the use of magetic fields and radio waves, or the injection of a contrast material.

Human anatomy forms the foundation for clinical medicine: Thus its place in the medical school curriculum deserves careful attention. In an attempt to provide guidance to decision-makers involved in clinical anatomy curriculum development at the medical school level, the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) developed this document, which defines the contours of a gross anatomy curriculum leading to the M.D. or D.O. degree. The main body of the document sets forth the anatomical concepts as well as the subject matter a student should master prior to graduation from medical school. Gross anatomy dissection is still a crucial topic in graduate and medical school. The nature and content of gross anatomy, which was historically regarded as a core course in the first year of medical education in MBBS, MD, DO, and some PhD and Graduate curricula as well as in other disciplines of selective graduate education and non-allopathic medical programs, have been significantly impacted by emerging challenges in the pedagogy of delivering medical education in the past ten years. A seemingly ever-increasing emphasis on additional modules in molecular biology, emerging pharmacotherapeutics and pathophysiology content have resulted in a condensation and apparent erosion of previously allotted classroom and laboratory hours in the gross anatomy curriculum. In addition, an imposition of financial constraints and a decreasing availability of sufficient cadaver donations to support gross anatomy dissection labs has also occurred in some locations. An innovative clinically focused cadaveric anatomy program is described which has improved the delivery and content retention of medical and graduate students and has become one of the most sought-after modules in the revised clinically oriented curriculum and has been deemed highly relevant to current medical education and graduate studies.