Current Practice in Medical Science Vol. 1

Pregnancy is considered to be a physiological process but many women lose their lives during the process of pregnancy and child birth due to complications. These complications need to be anticipated, prevented and managed appropriately so as to avert a maternal death. A maternal death cannot occur suddenly and in most of the cases it is preceded by some events which if not recognised timely and managed appropriately lead to maternal death.

A woman’s lifetime risk of death varies depending on the facilities available and the standard of Obstetric care she receives. Maternal mortality ratio (MMR) has been used since decades to report and compare the maternal health care globally.  MMR has dropped by 38% from base line in 2017 with the improvement of health care services and the goal for 2030 is set to every country to achieve a further reduction in MMR so that no country should have an MMR of more than 140 per 100,000 live births. To recognize and treat the complications appropriately there emerged criteria for severe maternal morbidity and maternal near miss. These are used interchangeably but there are subtle differences. Morbidity indices are used in recent literature and research to compare the standard of care across the World.  Maternal near miss ratio and mortality index are the two important   indicators that reflect the maternal health and give scope for improvement. This chapter deals with the indicators of severe maternal morbidity and maternal near-miss and their utility.

Preamble: The dream of every pregnant woman and the prospective mother is to give a healthy child to the family, bring up the child in to an adult and thus contribute the development of the Nation and   propagation of human race. Mother is the Nucleus of the family and thus it is very important to save her life in the process of child bearing and rearing.

Throughout his professional career, the author underlines how his early traumas have become an unconscious moving agent and a constructive coping method. Without any conscious awareness or knowledge, he sorted out not only the patients' but also his own traumas and deficiencies when transferring its energy into healing ways. It is an interesting parallel process while he is getting elder and more experienced he is more and more conscious to find out the patients’ earliest, finally the prenatal period of their traumas, when and where saying in a symbolic sense, he thinks of starting working through interventions. Meanwhile, he will be cleansed of his own traumas and deficiencies in an unconscious manner. He will be able to accumulate more and more healing power by doing both jobs.

Biomedical waste is dangerous because of two factors: infectivity and toxicity. 75-90 percent of trash generated by health care facilities is considered non-hazardous, but the remaining 10-25 percent is considered hazardous and could cause a variety of health problems. Virtuoso biomedical waste management improves the environment for medical and surgical patients. So time to time it is required to do assessment surveys or studies regarding awareness about hospital waste disposal, amongst various cadres of hospital personnel, to correct practices.   A cross sectional analytical study was undertaken to educate first-year medical students about biomedical waste management and handling abilities in order to improve their skills and analyze their knowledge gain in preparation for a future career as a competent physician or surgeon. Out of 150 students, 131 were present. 68 were males & 63 were females. Mean age was 21.33 with standard deviation of ±3.745. Mean marks obtained were 3.09 ±1.15 (out of 5). ANOVA statistics revealed an insignificant p value, indicating that all participants gained knowledge in an unambiguous pattern. It was concluded that medical undergraduates who are equipped with basic medical skills at an early stage will be more efficient in their future pursuits.

The current study sought to assess the role of uterine artery blood velocity waveforms, Systolic/Diastolic ratio (S/D), Pulsatility Index (PI), Resistance Index (RI) as predictor of perinatal outcome in intrauterine growth restriction (IUGR) pregnancies in the second and third trimesters.  50 cases of IUGR were investigated in the study group during the second and third trimesters. Ultrasonography biometry was performed first, followed by Uterine artery Doppler sonography. The S/D ratio, PI, and RI values in the uterine artery decreased from the second to the third trimester in both the control and study groups, but the decline was slower and the values were higher in the study group than in the control group. Thus the present study predicts that,(a) S/D ratio greater than 2.6 and RI greater than 0.58 was found to be abnormal. b) Disappearance of diastolic notch in III trimester is normal where as persistence of notch is abnormal. Doppler ultrasound is an useful noninvasive tool for assessing fetomaternal and uteroplacental circulations. The uterine artery measures were useful in predicting IUGR pregnancy outcomes.

Dengue fever has myriad complications- some immunological. A middle aged female patient presenting with features of lupus nephritis being triggered post dengue fever infection was followed up for 10 years with periodic assessment of laboratory parameters. Keeping in mind the endothelial dysfunction resulting out of COVID-19 infection and COVID-19 vaccination, we assessed this patient with the non-invasive endothelial function testing device (Angio defender). Though the COVID-19 infection or two doses of COVID-19 vaccines (COVAXIN) did not result in any flare up of the primary disease, still the angio defender revealed a moderate risk of CVD.

The present study was carried out to assess the pattern of knowledge and awareness of teenage pregnancies in a Semi-urban area of Rivers state, Nigeria. Pregnancies among teenagers and teenage motherhood are also causes for concern around the world. The vast majority of teenage pregnancies take place in low and middle-income countries with inadequate health-care resources. As a result, complications during pregnancy and the postpartum period (42 days after birth) are the second leading cause of death among females aged 13 to 19 globally. Alcohol and drugs that weaken inhibition may lead to an increase in unintended sexual encounters. If that's the case, it's unclear whether the drugs themselves cause kids to engage in riskier behavior, or whether drug users are more likely to engage in sex. Based on previous research on factors associated with adolescent pregnancy in developing countries, it has been revealed that early sexual start, poor sexual education, and socio-cultural influences are all associated with first adolescent pregnancy. The study showed a relatively poor knowledge of teenage pregnancy especially among sexually active female adolescents. Sexual education and increased awareness are recommended to curb the spread of teen pregnancy in this region.

A 38-year-old man with irritable bowel syndrome (IBS) went to the clinic with significant central abdominal pain and a severe rash. The patient went to the Emergency Department (ED) the day before coming to the clinic for the same issues. The abdomen pain was colicky, according to the patient. There were no other symptoms such as nausea, vomiting, or GI bleeding, but he had an upper respiratory tract infection three weeks prior, after which he began to experience these symptoms. His ailment was treated with medication and cleared up quickly. The ED personnel had looked into the cause, including a CT abdomen with contrast, but all of the findings came back clear. At the time, his serum creatinine level was somewhat elevated. On clinical examination, the patient had severe tenderness in his abdominal region. The rash was extensive, reddish, raised, and purpuric in nature and had spread all over his lower limbs and hips on both sides. The upper limbs were also involved up to the forearms.

All the lab investigations conducted on the patient were normal, including CBC, Creatinine, Serum C3, C4, and the rheumatoid factor. CRP was found to be elevated and positive occult blood was seen in the stool of the patient.

The patient was diagnosed with abdominal angina based on a combination of the foregoing medical symptoms and testing. The symptoms followed a standard pattern: occult blood in the stool, purpuric rash, stomach pain, and renal involvement, all of which were preceded by a proven upper respiratory tract infection (URTI). The patient was later discovered to have all of the symptoms of immune-mediated IgA vasculitis (Henoch-Schonlein Purpura) and was treated accordingly.

The following sections of this case study will explore how the patient was diagnosed, treated, and managed accordingly to save his life. By doing so, this case will serve as an important study material for all concerned physicians and doctors to know what to do in case they encounter such a patient in their own clinical setting. The case explores in detail all the aspects that led to the final diagnosis of the patient, thus clarifying how doubts should be dealt with while encountering such confusing cases.

Hypertensive disorders of pregnancy rank among the leading causes of maternal morbidity and mortality. Situations where hypertensive disorders are found complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection, that contribute greatly to maternal morbidity and mortality.

Severe hypertension increases the mother's risk of heart attack, cardiac failure, cerebral vascular accidents, and renal failure [3].  The fetus and neonate also are at increased risk from complications such as poor placental transfer of oxygen, fetal growth restriction, preterm birth, placental abruption, stillbirth, and neonatal death.

Significant advances have been made in the management of the conditions leading to evidence based recommendations and guides. With etiology poorly understood and no efficient predictive tools, reduction in maternal morbidity and mortality hinges on early detection and prompt and efficient management

Conclusion: Increased knowledge about hypertensive disorders in pregnancy among health care personel and more awareness of the conditions amomg the general populace especially women of reproductive age is essentially are essential in reducing the associated morbidity and mortality.

A 30-year-old woman presented to OPD with an abdominal tumor. The tumour was diagnosed as pappilaryadenocarcinoma using Fine needle aspiration cytology (FNAC). FNAC is used to take cells from palpable nodules in organs or tissues. The mass had been removed by b/l excision. On laparotomy, a wide ligament tumor was discovered. Malignant high grade mixed sex cord stromal tumor(granulosa and fibroma type) was discovered by HPS and IHC.

Etiology, Pathogenesis, Evaluation and Management of Depression in Cancer Patients: Depression is very common among cancer patients as is a common psychiatric complication of cancer treatment and thus an important risk factor for suicide. Diagnosis with any type of cancer is a traumatic experience and is responsible for high mental stress. When compared to the general population, cancer patients suffer thrice from depression. Depression leads to poor quality of life. The somatic changes of depression may be dismissed mostly by clinicians as side effects of cancer treatment. Patients having a history of depressive illness tend to have recurrence when diagnosed with cancer. Diagnosing depression is a challenging task in cancer patients as the symptoms of depression may mimic symptoms that are caused by cancer or its treatment methods. Treating depression among cancer patients should be of utmost priority as an early resolution of depression in cancer patients significantly prolongs median survival time. A combination of psychosocial and pharmacological interventions can be used to treat depression in cancer symptom control, maintaining supportive relations and involving friends & family are the first steps in managing a suicidal patient. Early management of depressive symptoms improves the quality of life among cancer patients.

The goal of this study was to look at the epidemiological, clinical, and prognostic aspects of maternal mortality in Yaounde. We did a descriptive cross-sectional analysis using retrospective data to collect maternal fatalities according to WHO definitions. from January 1 2017, to December 31, 2019, in two tertiary centers of Yaounde: The Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH).

208 maternal deaths were identified during the study period, with 4/5 (78.4%) coming from referral instances. The MM ratio was 1532.8 per 100,000 live births (LB) vs. 609.5 per 100,000 live births at YCH and YGOPH respectively. The Main causes where haemorrhage (49%) followed by hypertensive diseases and their complications (21.2%), maternal mortality was associated with 50% of cases of foetal or neonatal deaths (57.4% in YCH vs 28.3% in YGOPH, P < 0.001). Health service systems were related to MM.

Since 2017, the maternal mortality ratios in YCH and YGOPH maternities have increased dramatically. The most common causes of MM were bleeding and hypertensive disorders. These factors can be avoided. If we wish to drastically lower the maternal death rate, we must enhance our health systems.

Pleomorphic adenoma is the most common benign epithelial neoplasm of the lacrimal gland. Complete surgical excision with capsule is the treatment choice. Incomplete excision may result in malignant transformation. The aim of the case report is pleomorphic adenoma of ectopic lacrimal should be considered as differential diagnosis in orbital mass for success treatment. This is the case report of a 63-year-old lady with pleomorphic adenoma of the ectopic lacrimal gland in the superomedial part of the orbit. The tumor was removed by complete surgical excision with its capsule through anterior orbitotomy.

The present study find out if there was a correlation between children diagnosed with COVID-19 and their nutritional status. Nutrition plays a critical impact in children's immunity and immunoregulation. The chance of contracting an infection is quite high in malnourished and underweight children, as we discovered in our study by examining COVID-19 susceptibility in children and correlating it to their nutritional state. . This is the first case series from India on COVID-19 in children from a single center. This series describes the various features in COVID-19 in children with and without comorbidities primarily focusing on the nutritional profile. Our Tertiary Childrens hospital had 46 COVID positive children admitted in 2020, the nutritional status analysis, showed that there were four children 8.6% (n=4) in Obese category, 19.5%, nine (n=9) children were Overweight, 17.39 %, 8 children Underweight (n=8) and 25 children were 54.3% well nourished. This case series describes the various features in COVID-19 in children with and without co-morbidities primarily focusing on the nutritional profile. This is the first single centre case series globally on COVID-19. Our cohort showed no significant relation between COVID-19 and the nutritional status. swathe study shows an equal distribution of COVID-19 in children irrespective of their nutritional status at admission.

High-Sensitive C-reactive Protein (hs-CRP) is a well-known inflammatory and cardiovascular disease (CVD) marker. Non high density lipoprotein cholesterol (n-HDL-C) concentration in blood is strongly associated with long-term risk of atherosclerotic CVD. Hs-CRP and atherogenic lipids are suggested to be a central feature of cardiovascular disease (CVD), particularly among smokers. Smoking for long duration seems to be correlated with high level of hs-CRP, plasma cholesterol and LDL-C. The aim of study is to evaluate the plasma levels of hs-CRP, lipid profile, and magnesium in a group of university students with habitual smoking. This cross-sectional study included eighty current smoking males. The latex immune turbidimetric method was used to estimate plasma hs-CRP, and chemical methods were used to estimate plasma lipid profile and magnesium using a spectrophotometer (Biosystem 310). A test group of students who smokes for ten years or more had a significant increase in means of plasma hs-CRP,  total cholesterol, LDL-C  (P value< 0.05), while there was a significant decrease in means of plasma HDL-C (P value <0.05). The findings showed that cigarette smoke was linked to significant alterations in hs-CRP and atherogenic lipids, both of which are risk factors for cardiovascular disease in young male smokers.

Abdominal pregnancy (AP) is a rare and potentially dangerous type of ectopic pregnancy (EPs). In developed countries, AP is relatively uncommon. Authors present a case of a haemorrhagic abdominal pregnancy complicated by hypovolaemic shock at 15 weeks of amenorrhea with a positive result. The goal of this chapter is to describe the disease's epidemiological, clinical, therapeutic, and prognostic characteristics.

Clinical outcomes are used on a daily basis in the practice of head and neck oncology. Clinical outcome assessments can be classified into categories, according to who makes the report: clinician-reported outcome assessment (health professional), observer-reported outcome assessment (caregiver), and patient-reported outcome assessment (patient or proxies).

We listed the following critical factors for successful implementation based on a decade of experience: institutional approval and support, inclusion of all first-line caregivers, uniformity of team objectives and institutional proposals, team formation and training, promotion of defined workflow in daily clinical practice, and ongoing monitoring and analysis.

The experience obtained with routine assessment of Health-Related Quality of Life allowed a much broader and inclusive understanding of its importance in the course of the disease.

Patients with head and neck cancer see questionnaires as an important part of their treatment plan because they know that these patient-centered outcomes will be used to improve healthcare quality – which is also our major goal.

The present study was aimed to compare the results of Bone marrow aspiration (BMA) and Bone marrow trephine biopsies (BMB) and by that to prove the complementary role of both techniques to each other. The evaluation of many haematological and non-hematological illnesses requires a bone marrow investigation. Bone marrow aspiration and bone marrow biopsy are the two most common methods utilised for diagnosis, and they complement each other when done simultaneously. This retrospective study reviewed a total number of 74 cases of bone marrow examination received in  the department of pathology of our institution from Jan 2019 to August 2020. All aspirations were stained by Giemsa and iron stain while all biopsy were stained by routine H&E stain. Reticulin stain and IHC markers were used as and when required. Bone Marrow examination play a key role in case of various hematological as well as non hematological diagnosis. Bone marrow aspiration and biopsy using standard staining procedures, fixation, embedding and cutting techniques, generally complement each other with the aspirated smear being primarily used for cytologic details while biopsy sections mainly useful for cellularity, fibrosis, architectural pattern, metastatic deposits and from the same tissue we can go for Immunohistochemistry. While performing BMA and BMB simultaneously, good technique should be kept in mind to maximise material yield and limit patient discomfort by not repeating the procedure due to insufficient material, as this is a somewhat uncomfortable invasive procedure.

Cervical cancer (CC) is the fourth most prevalent disease among women and the seventh most common cancer worldwide, with 528,000 new cases reported in 2012. Cervical cancer has fallen in relative importance, despite the fact that the annual number of cases has increased: it was the second most prevalent disease in women in 1975. Furthermore, the incidence and mortality of CC varies significantly across low- and middle-income countries (LMIC). In low-resource settings, cost-effective alternatives to conventional pap smear screening are needed to detect cervical cancer. The study objectives are 1)to study the utility of various screening methods like conventional pap smear. In low and middle income countries (LMIC), many new strategies are being implemented to improve detection at a low cost. Manual liquid based cytology (MLBC), HPV testing, cell block with marker studies, and ascetic acid ocular inspection are the tests covered (VIA). National screening programs in LMIC nations should implement the various methodologies.

According to Sathya Sai Baba, an Indian philosopher, educationist and philanthropist, human values have their derivative from the concept of divinity. In other words, human values are the characteristics of God in human condition. He postulated the five human values, viz: Love, Truth, Right Action, Peace, Non-Violence. Within each value, there is a range of sub-values and they are expressed in medical ethics values. Medical ethics, on the other hand, is a system of moral principles that apply values to the practice of clinical medicine and in scientific research. These values include the respect for autonomy (self-determination), non-maleficence (non-violence), beneficence (charity), justice (equity). Sai Baba points out the subtle difference between human values and ethics, namely, that ethics is a system conceived by humans without underpinning the role that divinity plays. The five basic principles, when combined with their sub-values, encompass a full vision of human potential, namely, the fulfilment of the intellect's quest for truth, the channelling of the will into satisfying expression through right conduct, the resolution of human emotion and interaction conflicts in the pursuit of inner and outer peace, the expansion of the heart in the flow of love, and the realisation of perfection. Human values in medicine entail ensuring that clinical and management methods are consistent with widely accepted ethics standards, norms, and expectations, in addition to serving as a moral benchmark for physician-patient relationships. In recent years, scientism as a goal has frequently resulted in the abandonment of the inherent humanism in medical practise, resulting in the science of medicine taking precedence over the art of medicine. The pedagogy of Sai Baba’s value-based healthcare helps to elicit the human values inherent in every human being.

This study investigated the effects of therapeutic dosages of acetaminophen (APAP) combined with light-moderate levels of alcohol on kidney function while adjusting for variables including hypertension, diabetes, and obesity that could make the kidney more susceptible to APAP and/or alcohol toxicity. The study was a secondary data analysis of the 2003–2004 National Health and Nutrition Examination Survey (NHANES)  Odds ratios (OR) and 95% confidence intervals (CI) comparing the likelihood that individuals who ingested therapeutic doses of APAP and light-moderate amount of alcohol, compared to those who did not, would have kidney dysfunction were generated from multiple logistics regression models by further controlling for potential predisposing factors namely hypertension, diabetes and obesity. Statistically significant increased odds of renal dysfunction were noted among re-spondents who reported use of therapeutic doses of APAP and light-moderate amount of alcohol [OR(95% CI) = 1.64(1.28–2.10) self-report, 2.18(1.81–2.63) SCr, 4.60(3.03–7.00) BUN, 3.14(2.42–4.07) GFR, and 1.71(1.36–2.14) ALBCR)] even after adjusting for hypertension, diabetes and obesity [Adjusted OR (95% CI) = 1.78 (1.22–2.58) self-report, 2.05 (1.07–3.92) GFR].  The toxic effects of APAP and alcohol on the kidney were hypothesized. The threshold doses at which these effects begin to occur are unknown. The findings of this study suggest that even therapeutic doses of APAP and light-moderate amount of alcohol could be health pro-blematic if consumed concomitantly. This study highlights a very important public health concern as many adults are potentially exposed to both APAP and alcohol. The findings may have potential health policy implications. We further explored the potential impact of factors such as hypertension, diabetes, and obesity that may predispose the kidney to APAP and/or alcohol toxicity.