Current Innovations in Medicine and Medical Science Vol. 3
This book covers key areas of Medicine and Medical Science. The contributions by the authors include gibson's affordance, joint awareness, knee proprioceptive system, knee synergy, instantaneous knee screw, jet ventilation, laser excision, apnoeic oxygenation, Covid-19, pandemic, gangrenous cholecystitis, interval cholecystectomy, laparoscopic cholecystostomy, palatal mucosa, adipocytes, lipoma, intra-oral, leukemia, patient-derived xenografts, gene expression, bioethics, clinical trials, clinical practice, nutrition, vitamins, minerals, immunity, inflammation, echocardiography normative data, m-mode parameters, waldenström’s macroglobulinemia, bing-neel syndrome, orbital involvement, cerebrospinal fluid, myelitis, recurrent myelitis, cardiac resynchronization therapy, exercise test, heart rate recovery index, radiation protection, radiography, diagnostic radiology, occupational safety, facial palsy, bilateral bell’s palsy, sinusitis, granulomatosis with polyangiitis, vasculitis, anticoagulation, cardiac thrombus, cardio-embolic stroke, and hemorrhagic stroke. This book contains various materials suitable for students, researchers and academicians in the field of Medicine and Medical Science.
Measuring the Knee Joint Awareness Cuts Across the Dichotomy of Subjective-Objective Outcome Measure
Can Gibson's affordance theory clarify objective versus subjective outcomes measurement and unify them? An affordance indicates the behavior potential, not the actual occurrence of that behavior as, for example, a straight walking path. As previously mentioned, possible displacement is called a "virtual displacement" A virtual displacement of the knee is an arbitrary, infinitesimal change compatible with the constraints and applied impressed forces. We found that the "virtual" refers to the displacement intentionally made in any kinematically admissible manner as manifested in the active touch and posture—variations in skin stimulation caused by surfaces are altered together by motor activity variations. At the knee joint, perceptual systems are active sets of organs operating to reach equilibrium through synergies.The combined action that the skin and the joints are both projected to the somatosensory area of the cortex, to the same location and the joint cannot even be imagined to deliver a flat map to the brain. The objective of this study is to suggest that the assessment process can be viewed in terms of action possibilities provided by the active sets of organs residing that can obtain and utilize information about the tissue environments in the knee proprioceptive system.
Copyright (c) 2022 Author(s). The licensee is the publisher (B P International).
Anaesthesia and Subglottic Airway Obstruction: A Case Study
We discuss the anaesthetic treatment and laser excision of a subglottic tumour that induced upper airway obstruction in this article. The presenting feature was Stridor. A thorough examination and good history will lessen the possibility of an incorrect or delayed diagnosis and enhance patient outcomes. This case report highlights the use of target-controlled infusions and jet ventilation (high-pressure source ventilation) in the surgical excision of a subglottic tumour and its inherent risks and dangers. Apnoeic oxygenation is a useful modality to prevent early desaturation in procedures that involve a shared airway. Constant vigilance, good communication between team members and adhering to best practice guidelines will ensure a safe outcome.
India's Regulatory Frames for Adoption of Repurposed Drugs as Covid-19 Treatment: A Recent Study Approach
Currently, there are no treatment options available for the fatal contagious disease, coronavirus disease 2019 (COVID-19). The COVID-19 disease caused by the SARS-CoV-2 coronavirus is a global public health emergency. The SARS-CoV-2-caused COVID-19 pandemic represents an unprecedented health threat, necessitating the quick development of antiviral treatments. Repurposing a medicine exemplifies a new strategy for drug development in order to investigate possible therapeutic benefits in clinical trials. The technique is applied to overcome the bottlenecks of financial support, time, and money in conventional drug development. Several innovative and data-driven approaches to identifying repurposable medication candidates have been proposed. Nevertheless, substantial technological and regulatory obstacles must be surmounted. Several medications were approved for the treatment of COVID-19 patients as a result of the repurposed SARS-CoV-2 treatments. For pharmaceutical businesses to receive a manufacturing licence from the drug regulator, it is crucial that they adhere to the regulatory rules and procedures. The Indian drug regulator, CDSCO, has specific criteria and procedures for getting a manufacturing licence for every new medicine, formulation, or vaccination. Clinical trials, formulation development, and commercial manufacturing all require regulatory authorization. After clinical trials and formulation development, particular forms and processes should be used to submit data to the Indian regulatory agency. The regulator will assess the information and the decision to proceed to the next phase. This article is the product of an exhaustive investigation into the regulatory framework that a pharmaceutical company must adhere to in order to sell repurposed pharmaceuticals. Generic brands have a distinct manufacturing process.
A Study on Laparoscopic Cholecystostomy in Gangrenous Cholecystitis with Localized Peritonitis
We report a case series of five patients who presented with features of gangrenous calculous cholecystitis and who underwent laparoscopic cholecystostomy. Gallstones are a fairly prevalent disease that afflict 10–20% of individuals in affluent nations, and 20% of patients have acute calculous cholecystitis when they first occur. 1 One of the serious side effects is gangrenous cholecystitis, which can happen in up to 40%2, 3 of patients with acute cholecystitis, and gallbladder perforation in 2-18% of cases. Six patients with gangrenous cholecystitis, i.e., five females and one male, underwent laparoscopic cholecystostomy. All the patients recovered from sepsis, and no complication was reported during or after the procedure and were discharged after a stay of 5–7 days. All the patients underwent elective laparoscopic cholecystectomy after 10–12 weeks and are doing well at 1-year follow-up. A gangrenous cholecystitis cholecystectomy carries a substantial risk of morbidity and mortality. To treat the patient's acute sepsis in this situation and prepare them for an elective laparoscopic cholecystectomy later on, laparoscopic cholecystostomy is a safe and reliable treatment. We may draw the conclusion that laparoscopic cholecystostomy is a safe treatment and should be made available to patients with GB perforation, particularly in those who are critically unwell and have concomitant illnesses.
Lipomas are the most frequent benign soft tissue tumours in the body, yet they are very uncommon in the oral cavity. Whenever they are seen in oral cavity; buccal mucosa, floor of mouth and tongue are the most commonly affected. Intraoral lipomas are characterised by benign, well-encapsulated swelling that is painless and has a yellowish colour. We present a case of an intraoral lipoma in which a 22-year-old girl came with a single well-encapsulated enlargement in the posterior region of the palate on the left side. The purpose of this book chapter is to emphasise the need for dentists to be aware of frequency of occurrence of intraoral lipoma so that prompt management can be done for the oral pathologies.
Priming Leukemia with 5-Azacytidine Enhances CAR T Cell Therapy: A Recent Study
Despite the success of chimeric antigen receptor (CAR) T cells in clinical studies, a significant proportion of responding patients eventually relapsed, with the latter correlating with low CAR T cell expansion and persistence. Using patient-derived xenograft (PDX) mouse models of CD19+ B cell acute lymphoblastic leukemia (B-ALL), we show that priming leukemia-bearing mice with 5-azacytidine (AZA) enhances CAR T cell therapy. AZA given 1 day prior to CAR T cell infusion delayed leukemia growth and promoted CAR T cell expansion and effector function. Priming leukemia cells with AZA increased CAR T cell/target cell conjugation and target cell killing, promoted CAR T cell divisions and expanded IFNy+ effector T cells in cocultures with CD19+ leukemia Nalm-6 and Raji cells. Transcriptome analysis revealed activation of diverse immune pathways in leukemia cells isolated from mice treated with AZA. We propose that epigenetic priming with AZA induces transcriptional changes that sensitize tumor cells to subsequent CAR T cell treatment. Among the candidate genes up- regulated by AZA is TNFSF4 which encodes OX40L, one of the strongest T cell co- stimulatory ligands. OX40L binds OX40, the TNF receptor superfamily member highly specific for activated T cells. TNFSF4 is heterogeneously expressed in a panel of pediatric PDXs, and high TNFSF4 expression correlated with increased CAR T cell numbers identified in co-cultures with individual PDXs. High OX40L expression in Nalm-6 cells increased their susceptibility to CAR T cell killing while OX40L blockade reduced leukemia cell killing. Conclusion: We propose that treatment with AZA activates OX40L/OX40 co-stimulatory signaling in CAR T cells. Our data suggest that the clinical use of AZA before CAR T cells could be considered.
Understanding the Basics of Research as a Beginner: A Highlighter
Health research is conducted for theoretical purposes and when we have some good evidence or effective outcome then we go for applied research. There are also prevention and therapeutic angles to doing health research as well, in the sense some of the preventive technologies as they emerge, they must be tested out through research methods before available. Research has advanced by leaps and bounds; scientific advancement is totally dependent on inquisitiveness and tireless teamwork coordination. The word research is so appealing to a novice that the student fraternity is overwhelmed by this activity. Regardless of the field, research is now an essential component of the educational system. There are other terminologies which are also employed; i.e Implementation Research and Translational Research. Many of the government programs get implemented and what is important to understand at this particular point of time is how these programs are functioning well and it is also therefore important to make mid-course corrections, if they are necessary or to decide in which areas you need specific angles of the programs to be strengthened and so on. This article is intended to raise basic awareness about research and its components, particularly among research-oriented students studying medical, paramedical, allied health sciences, and so on.
The Use of Nutrition in Preventing and Slowing Progression of COVID-19 Infection
Eating a plant-based, whole-foods diet is an important way to ensure the body obtains its daily requirements of nutrients to fight infections, including COVID-19. This book chapter reviews up-to-date literature of recommended vitamins, minerals, and anti-inflammatory nutrients to prevent and slow progression of COVID-19 infection. This information is important not only for the general population, but also for women and long-haulers with extended impacts of COVID-19 symptoms.
Normal Echocardiographic Reference Values in South Indian Adults
The goal of this study was to create age and gender-specific normative reference range values for echocardiography measures. A total of 336 people between the ages of 18 and 76 visited the cardiac medical check-up unit in a tertiary hospital; 111 healthy Indian adults were chosen from this group and studied retrospectively in a cross-sectional single-center study. Echocardiograms were performed on people who did not have cardiovascular disease, hypertension, diabetes, high blood pressure, or any other clinically visible illnesses. M-mode Echocardiography in the left parasternal long-axis view was used to measure aorta, left atrium, left ventricle in systole and diastole, right ventricle, interventricular septum, and posterior wall thickness This study presents a set of data with normal M-mode parameter reference ranges based on age and gender. As exclusive class intervals, 58 males and 53 females were divided into age groups ranging from 18 to 76 years. Age group above of 38 years Indians had higher volume in all the echocardiographic measurements are observed in this study. When we examined all of our healthy subjects, we discovered that the reference range of most echocardiographic parameters differed significantly from those utilised in western studies. The normal reference values for echocardiographic measurements derived from this study could be used for future reference in our local population.
Case Report on Bing-Neel Syndrome: A Challenging Diagnosis
Lymphoplasmacytic lymphoma/ Waldenström’s macroglobulinemia (LPL/WM) is a rare indolent B-cell lymphoproliferative disorder which is characterized by either with tumor infiltration or is due to the synthesis of monoclonal IgM. Bing-Neel syndrome is a rare neurologic complication of Waldenström’s macroglobulinemia, which is a result of infiltration of the central nervous system by clonal lymphoplasmacytes. We present a rare clinical case of a patient, who one year after the diagnosis of Waldenström’s macroglobulinemia, progressed with diverse neurologic presentation which included progressive bilateral deafness, vertigo, discoordination, low grade right lagophthalmos and also cerebrospinal fluid involvement. Based on the discovery of clonal B-cells in the cerebrospinal fluid by flow cytometry and magnetic resonance imaging, the diagnosis was made. Bing-Neel syndrome should be considered in patients with neurologic symptoms and a history of Waldenström’s macroglobulinemia, because it is a rare manifestation, which may occur at any time during the course of the disease and may be associated with poor outcome if not treated.
Anti TPO Antibodies and Neurological Disorders: Emphasis on Relapsing Myelitis Where Steroids Alone may Not be enough
The present study highlights the anti TPO Antibodies and Neurological Disorders of a 32 year female presented with longitudinally extensive transverse. Autoimmune neurological illnesses have been shown to be related with autoimmune thyroiditis myelitis (LETM) with negative workup for other demyelinating and autoimmune diseases, and positive for anti TPO antibody. The biopsy research on steroid responsive encephalopathy patients has demonstrated that antithyroid antibodies (anti thyroid peroxidase-TPO antibodies) might cause demyelination of the central nervous system. She was started with steroids and azathioprine and recovered completely over one month period, stopped treatment herself after 5 months, had relapse of myelitis and was put on immunosuppressive treatment, showing improvement. The second patient a 52 year female had recurrent attack of LETM with negative workup for other causes of LETM except positive anti TPO antibody. In her first attack she was given only steroids pulse. After relapse she was treated with steroids and cyclophosphamide pulse, and patient remained relapse free thereafter. So it suggests that in myelitis patients associated with anti TPO antibody steroids alone may not be sufficient and, such patients require long term immunosuppression. Our emphasis is that anti TPO may also predict recurrence and may be an independent marker of recurrence in patients with isolated transverse myelitis which needs further studies to confirm.
Assessment of Responsiveness to Cardiac Resynchronization Therapy: A Novel and Simple Exercise Approach
In this work, the heart rate recovery index (HRRI), a novel exercise test parameter, was evaluated as a potential predictor of cardiac resynchronization therapy response (CRT). We hypothesize that ET may be practical and applicable to study by analyzing the time ratio between the acceleration and deceleration of heart rate. Following implantation and every six months after that, patients who received a CRT device consecutively were monitored. The minimum and maximum heart rates, as well as the acceleration and deceleration periods, were used to measure an effort test (ET). The ratio of acceleration to deceleration time (AT/DT), or HRRI, was calculated and compared to the result. We used logistic regression to assess the predictive value of HRRI for responders and non-responders to CRT. The area under the curve (AUC) was computed to distinguish between positive and negative outcomes. A total of 109 patients (74 men, mean age 63.3 ± 9.8 years) were analyzed; permanent long-term fusion CRT pacing was possible in 65 patients. Patients were assigned to two groups: responders and non-responders (98/11 patients). During a mean follow-up of 36 months, 545 ETs were performed. HRRI was significantly higher in responders versus non-responders (3.16 ± 2 vs. 1.4 ± 0.5, p < 0.001). The optimal cutoff value for HRRI as a predictor of CRT response was 1.51 (area under the receiver operating characteristic (ROC) curve = 0.844). Responders had significant left-ventricular (LV) reverse remodeling (LV end-diastolic volume = 240 ± 90 mL vs. 217 ± 89 mL, p < 0.001) and higher LV ejection fraction (26 ± 5.8% vs. 35 ± 8.7%, p < 0.001). HRRI computation during routine ET is useful for the evaluation of responsiveness to CRT. The present study is the first to evaluate a novel parameter HRRI using HR behavior after cessation of exercise in patients with CRT; baseline and maximal HR could not predict CRT response, but the analysis of ET graphs in responders versus non-responders showed a better outcome corelated with improved response in heart HRR.
Performing Shielding Calculations for Diagnostic Radiology Based on NCRP Report 147 Methodology: A Review
The purpose of this work to provide a comprehensive review and effective tool for performing shielding calculations for diagnostic radiology reliably, cost-effective and a timesaving since the shielding is the most effective element in diagnostic radiology safety design. The recommendations of National Council on Radiation Protection and Measurements (NCRP) Report No. 49, which has been the main reference for the structural radiation shielding design of diagnostic X-ray facilities for a while, are most frequently used in structural radiation shielding calculations for X-ray diagnostic facilities. The NCRP Report 49 calculating technique has undergone numerous changes over time, rendering it virtually useless because it did not take into account developments in radiology technology. With the publication of NCRP Report No. 147, the approach was corrected by giving shielding designers the ability to, in part, specify efficient barriers to diagnostic radiation settings. The NCRP Report 147 methodology for calculating radiation shielding requirements depend greatly on the shielding design goals (P) where a proposed design limit for controlled and uncontrolled areas is reduced to NCRP Report 49 levels. Further, the methodology most likely uses the concept of “dose constraint” in radiation installations as shielding design goals for the purpose of safety and protection optimization for occupational workers and the public. The previous NCRP Report 49 uses a very conservative approach in the assumption and methodology, which in return yielded with barriers much thicker than what is required in diagnostic facilities. In this context, Federal Authority for Nuclear Regulation (FANR), the nuclear and radiological regulator for the United Arab Emirates, recently published software which developed by authors for performing radiation shielding calculations based on an algebraic computation model and the given fitting factors provided by NCRP Report No. 147. The International Atomic Energy Agency (IAEA), has taken interest to independently validate the codes of the software; and praise the functionality of the tool. The software performs shielding calculations in an effective, easy, and reliable way while being a cost-effective and a timesaving tool. The shielding is the most efficient component in an X-ray design because there are typically some time and distance restrictions because of the nature of diagnostic operations. The conservative assumptions made in the computation, such as neglecting attenuation by the patient and image receptor, overestimating the workload, occupancy, and field size, may result in actual dose values to persons being lower than dosage values.
Bilateral Facial Palsy Due to Granulomatosis with Polyangiitis: A Case Report
Granulomatosis with Polyangiitis (previously known as Wegener's granulomatosis) is a systemic autoimmune disease that can cause necrotizing vasculitis in small vessels and inflammation of blood vessels in the nose, sinuses, throat, lungs, and kidneys. In rare cases, it has been shown to involve the brain and cranial nerves as well. The objective of this study is about identifying and investigating for the causes of facial palsy, in order to initiate appropriate treatment strategy for secondary causes. We describe a case of granulomatosis with polyangiitis that was worsened by bilateral facial palsy brought on by lower motor neuron involvement of the facial nerve and that had a good response to immunosuppressive therapy. As this technique might effect the patient morbidity and mortality on early illness therapy, it is prudent to be alert in studying individuals with atypical systemic autoimmune disease presentations.
Therapeutic Dilemmas in Acute Ischemic Strokes and Concomitant Cardiac Thromboembolism: Case Series
Ischemic stroke is a leading cause of morbidity and mortality worldwide. Anticoagulation therapy in patients with cerebral ischemic events caused by cardiac emboli is no longer debatable. The issue is deciding when to begin. Because of a recurrence rate of 15 to 20% in the first few weeks after the initial event, direct anticoagulation with intravenous heparin followed by oral anticoagulants appears to be indicated. The objective of this study is about managing patients with acute ischemic strokes and risks of development of embolic events taking into account the risks of hemorrhagic complications while treating them. We present two cases of patients who had a cardio-embolic stroke due to cardiac thrombosis and were in a therapeutic quandary about when to begin anticoagulation treatment. Early anticoagulation treatment was associated with favourable clinical and neurological outcomes.