Current Progress in Medicine and Medical Research Vol. 1

This chapter aimed to determined the contraceptive use and its determinants in married women of reproductive age group in urban slum area of maharashtra, India. The contraceptive behaviour of the population in reproductive age group has got an important role to play in deciding the population size of a particular country. There are many factors which decides the contraceptive behaviour of males and females.  A community-based cross-sectional study was conducted in slum area catered by Urban Health Training centre under Dept of Community Medicine of Solapur city, Maharashtra, India. Total 420 married women aged between 15 to 45 years participated in the study. Information was collected by pre-designed, pretested proforma by interview method. The use of contraceptives in married women is higher as compared to the findings of NFHS-3. Use of spacing methods are low. There is huge knowledge application gap between awareness and use of contraception.

This chapter describe a Triage proposal to be applied in prehospital interventions by the psychiatric ambulance dependent on the Alvear Hospital and under current legal regulations. Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The study of prehospital emergency interventions with the psychiatric ambulance of our hospital was carried out through the evolutions carried out in the "Ambulance Duty Book". The triage proposal included the internationally used criteria related to time, the reason for the intervention, the clinical presentation and the proposed approach modality. The triage system is a tool that allows for the systematisation of approaches against the variety of causes for consultation and presentation of mental pathologies in the emergency room, in addition to fostering greater interventional effectiveness, system homogeneity, and consensus among the health effectors.  The application of triage in mental pathologies is based not only on the response time, but also on the resources that a device has to respond to them. In the particular case of prehospital ambulance emergencies, we consider it useful and that the scenarios (of the pathology and the environment) are propitious for the implementation of this type of strategy.  It is concluded that the implementation of this proposal is useful for the clinical detection and risk management of psychiatric pathologies in the prehospital context, since it allows systematizing the interventions according to the resources of each health system.

This chapter assess knowledge and practice of modern contraception in rural area of district Bareilly, Uttar Pradesh, India. The acceptance of contraceptive methods varies within societies and also among different castes and religious groups. The factors responsible operate at the individual, family and community level with their roots in the socio-economic and cultural milieu of Indian society. An important indicator for lowering maternal and neonatal morbidity and mortality is family planning awareness and proper contraceptive use. It is crucial for promoting the reproductive health of women in underdeveloped nations.  This was a community based cross-sectional study conducted on 458 randomly selected eligible couples in a rural area of Bareilly.

A pre- structured questionnaire was used to collect information about knowledge of family planning methods, source of knowledge and current practices along with reasons of nonuse of contraception. Present study showed that main source of knowledge of contraceptive among study participant was health worker i.e. 90.83%, followed by mass media 75.33%, followed by doctors in multiple response answers. The appropriate statistical analysis was done to present the results.

It was observed that 48.03% eligible couples had adopted one or the other modern contraceptive measure. Female sterilization was the most common method used.

Women with less education need ongoing instruction and frequent communication about the significance of contraception. The results of this study will aid in the creation of programmes that will enhance knowledge and services while lowering negative effects and unintended pregnancies.

This chapter describes the microstructural and functional results of three highly myopic eyes that underwent macular surgery for myopic foveoretinal detachment (FRD).

High myopia is a major cause of legal blindness in industrialized countries. In the United States, it affects nearly 2% of the general population aged 12 to 54 years. Up to 34% of patients with pathologic myopia (PM) have myopic foveoschisis (MF), the first stage of myopic traction maculopathy (MTM), which naturally progresses to form FRD or macular holes (MHs) with or without macular hole retinal detachment (MHRD) in highly myopic eyes.

Three highly myopic patients (age = 52.3 ± 11 years) with significant vision loss were evaluated by an ophthalmologist and underwent preoperative examinations. We retrospectively reviewed symptomatic eyes that underwent   successful fovea-saving internal limiting membrane peeling (FSIP) macular surgery for chronic myopic FRD at the Retina Department of Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations including spectral domain (SD) and swept source (SS) optical coherence tomography (OCT), autofluorescence evaluation, and automated microperimetric macular examination.

In this report, despite surgical reattachment of the FRD within the first months, chronic separation of the photoreceptors and the presence of stagnant SRF in contact with the retinal pigment epithelium (RPE) were considered causes of photoreceptor damage. There was a substantial difference between the best-corrected visual acuity (BCVA) before and after surgery in all three cases. Surgery was associated with significant improvement in visual acuity, as confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR; mean ± SE) was 0.83 ± 0.15, and the postsurgical value was 0.43 ± 0.52 (p = 0.00065). The MF/FRD evaluation was 7.3 ± 3.5 months, with a mean postoperative follow-up time of 14 ± 4.08 months. At postoperative follow-up, postoperative multimodal imaging revealed an abnormal microstructural foveal SS-OCT pattern without signs of MH development. Using a stable central foveal fixation site and an anomalous retinal sensitivity analysis map, macular microperimetry confirmed subclinical reduced macular threshold sensitivity. Suble atrophic changes in the retinal pigment epithelium (RPE) were detected using autofluorescence imaging. Despite the successful microstructural disappearance of the myopic macular detachment, the last multidisciplinary functional and structural assessment demonstrated different subclinical macular alterations.

Retinitis pigmentosa (RP) represents a collection of hereditary retinal disorders typified by progressive photoreceptor cell degeneration, resulting in visual impairment and potential blindness in severe cases. Although RP pathogenesis has primarily been attributed to genetic mutations, emerging evidence indicates the significant role of oxidative stress in disease progression. Oxidative stress denotes an imbalance between reactive oxygen species (ROS) production and the retina's antioxidant defense mechanisms. This chapter endeavors to delve into the intricate involvement of oxidative stress in RP and its impact on disease etiology and progression. Gaining a comprehensive understanding of the complex interplay between oxidative stress and genetic mutations yields invaluable insights into disease mechanisms and paves the way for potential therapeutic interventions. Further research is imperative to elucidate the precise mechanisms underlying oxidative stress in RP and develop targeted antioxidant-based therapies to mitigate disease progression and safeguard vision in affected individuals.

The brain requires constant oxygenation and nourishment. It requies high  oxygen at rest almost one fifth of the body’s total oxygen requirement. It is also very sensitive to oxygen and cell death can occure within minutes due to ischemia. The blood supply of brain is derived from the internal carotid  arteries and the vertebral arteries. The vertebrobasilar system is formed by two vertebral arteries and one basilar artery. Both the vertebral arteries normally arise from the subclavian arteries and variations in the origin of vessels is important for all diagnostic and surgical procedures in the head and neck region. During our routine dissection on 70 years old donated embalmed male cadaver, we observed unusual origin of the left vertebral artery from the Arch of Aorta. No other associated congenital anomaly was observed. The photographs of the unusual origin of the vertebral artery were taken for proper documentation. This unusual branching pattern of the arch of aorta is of great significance for clinicians and mainly surgeons operating on the neck and thoracic region.

This chapter aimed to evaluate the effectiveness of preoperative education in improving short-term postoperative outcomes in hysterectomy women. Hysterectomy is the surgical removal of the uterus performed either through the abdomen or the vagina to treat a number of conditions, including heavy or painful periods, fibroids, and prolapse. A quasi-experimental study was conducted in the District Tertiary Care Hospital in Salem, Tamilnadu, India. Subjects were selected with convenience sampling technique for the experimental group (n1=200) and control group (n2=100) respectively. Demographic proforma and flow chart to note down physiological vital parameters and other parameters were tools used. Results showed there was no significant difference revealed in physiological vital parameters (p>0.05) except for inspiratory capacity. The experimental group ambulated earlier (30.33±8.594) as compared to the control group (41.56± 6.960) and these differences were statistically significant (p<0.001). The mean length of stay was more in the experimental group (17.65±3.587) as compared to the control group (14.31±3.349). There was a drastic improvement in inspiratory capacity in the postoperative period seen among subjects in the experimental group as compared to the control group. Women will be guided to understand postoperative care after hysterectomy, to facilitate participation in postoperative self-care activities, and to prevent potential complications by structured education about perioperative care and postoperative exercises in the preoperative period.

Background: During the COVID epidemic, musculoskeletal disorders have steadily increased for students of allied health sciences taking online classes.

Objectives: To investigate the association between timed internet exposure and musculoskeletal health in allied health sciences students who have just a basic understanding of the etiology and prevention.

Methods: Students in allied health science institutions who took online programs were given an online questionnaire, and those who consented to participate were included. The standardized Nordic questionnaire was utilized, along with a demographic section and the number of hours spent in online classes.

Result: The Nordic questionnaire for cervical spine and upper extremity in 7 days of exposure was statistically significant, with 66.3% reporting discomfort.

Conclusion: Musculoskeletal disorders grew as students spent more time in front of computers/mobile phones for long periods of time for their lessons. It is caused by further initial exposure.

Objective: To update Sagar et al. systematic review and meta-analysis on exercise-based rehabilitation in heart failure.

Methods: MEDLINE, OVID and cross references were searched for randomized clinical trials published between February 2013 to August 2018 on exercised-based cardiac rehabilitation. Trials with at least 6 months follow up were included if with exercise training program alone or as a component of comprehensive cardiac rehabilitation program compared with groups without exercise prescription.

Results: A total of 43 randomized clinical trials involving 11,989 patients predominantly with reduced EF and NYHA class ll-lll were included in the study. Exercise training program prescription in heart failure patients was shown to reduced the all-cause mortality (RR=0.76; 95%CI= 0.66, 0.87; P= 0.001), all cause hospitalization after 12 months (RR=0.70; 95% CI= 0.52, 0.96; P= 0.02) rehospitalization due to heart failure (RR= 0.49; 95% CI= 0.44, 0.55; P= <0.0001) and improvement in quality-of-life scores (RR= -0.36; 95% CI= -0.58, -0.14; P= 0.002).  All-cause mortality and  hospitalization admission after 12 months follow up showed significant benefits with exercise therapy program, particularly on exercise setting(p=0.026) and exercise dose (p=0.013), respectively, as revealed by the univariate meta-regression results.

Conclusion: Exercise therapy either in center or home based has  been shown to benefit heart failure patients in reducing the risk of all-cause mortality up to 12 months, hospital admission up 12 months, and gave better quality of life. The new studies included have further strengthened the findings of previous studies that an exercise therapy program provides benefit to heart failure patients, either as an “alone” intervention or together with a cardiac rehabilitation program; and that the setting and dose of an exercise therapy program provide significant impact in reducing the risk of all-cause mortality and hospitalization after 12 months follow up, respectively.

This chapter highlights the Feasibility of crossed Intralaminar Screws for fusion of the Cervicothoracic Junction and the Thoracic spine: Initial experience in an Iberic Department, surgical technique description. Intralaminar screws have been shown to be a biomechanically salvage technique in the thoracic spine, especially in long cervicothoracic, thoracic and thoracolumbar fixation. The goals of this article are to demonstrate our initial experience and the range of indications for thoracic crossed intralaminar screws. Pathologies affecting the cervicothoracic junction and thoracic spine have never been easy to treat. Finding a replacement for pedicle screws in thoracic spine surgery is necessary due to anatomical variations and the recurrent failure of pedicle screw insertion. The interlaminar crossed screws is a well-known and secure method for fusion in cervical spine, but in the thoracic spine and in the cervicothoracic junction there are insufficient clinical data to support this technique, until now. The use of crossed intralaminar screw in the thoracic region is an underestimated technique; this free hand technique is a fast, efficient and alternative method of transpedicular fixation and this technique at different thoracic levels appears to be a useful tool in the armamentarium of the spinal surgeon. The patients follow up is to be published in future articles.

This chapter evaluate the identification of the epidemiological patterns of HM in the Republic of Moldova and the evaluation of their global epidemiological trends and disease burden issues. Hematological malignancies (HM) are a public health problem. The pattern and distribution of diagnosed hematological cancers vary depending on age, sex, geography, and ethnicity suggesting the involvement of genetic and environmental factors for the development of these diseases.

This is an epidemiological, observational, cross-sectional and big data analytics study. The diagnosis was proved in all cases by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The qualitative type researches were performed and enriched by the narrative synthesis of the data from the specialized international bibliographic sources and official statistics concerning HM. The chapter summarized and systematized the primary studies, dedicated to the epidemiological landscape and global disease burden of HM. In order to obtain the scheduled objectives, the scientific medical publications were searched via  GoogleSearch, PubMed, Z-library, NCIB, Medscape, Hinari database, by the keywords: “hematological malignancies”, “chronic leukemias”, “malignant lymphomas”, “epidemiological patterns”, “incidence”, “mortality”, “disability-adjusted life-years”, “disease burden”, “COVID-19 infection”, “management”. Forty-six relevant primary sources were identified and selected, according to the significance of the impact score under the scientific and reproducible approach to the disuted subject, with the subsequent data extraction, evaluation and interpretation. Intending to minimize the erratum, a copy of the data extraction sheet was initially formed, sharing all the elements to be extracted from the primary studies. The decrease of the incidence of HM in 2020 as compared to 2016 and 2017 can be explained by labor population migration and the impact of the COVID-19 pandemic on patients’ addressability. The average age of men was 54.7 years, of women – 57.9 years. In both gender groups, the patients aged between 50 and 79 years prevailed (males – 65%, females – 72.5%), partially fitting the category of a workable population. The gender analysis of morbidity showed that the male's rate was 51.5%, the female's rate – 48.5% in 2019. Within 2 years males were 50.4%, females – 49.6%.  In the recent epidemiological context, the association of COVID-19 infection with HM proved to be of scientific and practical interest, taken into account an apparently immunocompromised status of patients with lymphoproliferative and  myeloproliferative neoplasms.

The epidemiological study found that the Republic of Moldova had a slightly lower HM morbidity than countries in West Europe, primarily as a result of the migration of a workable population.  The patients with chronic leukemias and malignant lymphomas, male gender and age categories of 50-79 years constituted the global epidemilological landscape. The narrative analysis of the literature has proved that patients with HM may experience a considerable disease burden with negative impact on their employment status, working productivity, annual household income and epidemiological susceptibility.

This chapter aimed to assess the feasibility and then report the short, medium and long-term results of Taylor flap reconstructions after abdomino-perineal amputation extended to the posterior wall of the vagina, taken by the tumor mass. The essential physical and psychosocial features of hospitals are studied in relationship to various hospital inhabitants’ objective and perceptive health outcomes. These environmental features are interrelated and affect healing.

We describe and analyze below two cases of perineal reconstruction by modified Taylor flap.

Two of our patients underwent abdominoperineal amputations in 2020 due to malignant melanoma of the anal canal and lower rectum adenocarcinoma, respectively. These patients underwent rectus abdominis musculocutaneous flap reconstruction pedicled on the inferior epigastric vessels and with a transverse skin paddle. .

Our two patients underwent a posterior colpectomy associated with abdominoperineal amputation, which improved the quality of life of the patients, in particular an almost normal sexual activity in the medium and long term. the Taylor flap represents the reference technique for covering large pelvic-perineal losses of substance, particularly in enlarged APAs.

The postoperative follow-up was simple with an average hospital stay of 09 days. Abdominoperineal healing completed with a median of 19.5 days.

The implementation of modified Taylor flaps allowed for both patients' psychological comfort in connection with satisfying sexual activity as well as a complete and quick perineal healing.    

In this chapter, we ought to find out the functional outcome of Talipes Equinovarus in adults. Neglected clubfoot by definition is untreated equino-cavo-adducto-varus in older children, adolescents or even adults. Untreated severe clubfoot rarely exists today in developed countries, except in some migrants from low- and middle-income countries. The study was conducted at Bashaer University Hospital and Future Hospital in Khartoum, Sudan. All surgeries were done by the same foot and ankle surgery team in both hospitals. Data was collected using a questionnaire and the functional outcome has been assessed using the American Orthopedic Foot and Ankle Society Score (AOFAS). This score was measured before surgery and one year after surgery. Results: the mean age was 19.9 ± 4.7 years. Males were 25 (62.5%) and females were 15 (37.5%). The mean preoperative AOFAS score was 37.7 ± 7.1 (poor). This score improved to 80.7 ± 13.7 (good to excellent), two years after surgery. However, this indicates a significant change in the functional outcome after the operation (p-value < 0.05). The complexity of the multi-planar foot deformity requires early intervention, good surgical planning, and the choice of the appropriate soft tissue and or bone procedures. Excellent postoperative functional outcome was found among patients aged 18 - 23 years 18 (50%) p-value: 0.021. The majority of patients 36 (90%) were fully satisfied with the operation, 2 (5%) partially satisfied and 2 (5%) were unsatisfied.

The functional outcome of this operation is comparable to other procedures like triple Arthrodesis, double osteotomies, and gradual corrections by external fixators.