Dr. Shigenori Ito
Division of Cardiology, Sankuro Hospital, Toyota, Japan and Director of Japan Cardiovascular Imaging Core Laboratory, Japan.

ISBN 978-93-5547-547-3 (Print)
ISBN 978-93-5547-548-0 (eBook)
DOI: 10.9734/bpi/cpms/v4

This book covers key areas of Medical Science. The contributions by the authors include Colorectal cancer, low-income developing country, curative surgery, adjuvant chemotherapy, antioxidant, lipid, toxicology, skin disorder, immune system, Inflammatory cells, Blunt ocular trauma, choroidal fracture, microperimetry, multifocal electroretinography, multimodal functional evaluation, OCT biomarkers, photoreceptor toxicity, posttraumatic choroidal neovascularization, pneumatic displacement, submacular hemorrhage, traumatic submacular hemorrhage, visual field chromatic testing, Magnetic resonance imaging, human leukemia, radiology, septic arthritis, Anisometropia, visual acuity, aniseiconia, Anaemia, Acromion process, coracoid process, glenoid process, morphometry, shoulder replacement, SARS-CoV-2, cardiovascular diseases, peptide sharing, molecular mimicry, cross-reactivity, Immunologic imprinting, Protein capsid, nanoparticle, cancer diagnosis, cancer treatment, site-specific delivery, mucosal delivery, non-invasive delivery, Environmental factors, neuro-pharmacogenomics, Salivary glands, submandibular glands, Fetal growth, Valsalva’s maneuver, Eustachian tube dysfunction, nasal balloon autoinflation, Meditation, anxiety. This book contains various materials suitable for students, researchers and academicians in the field of  Medical Science.

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Surgery for Colorectal Cancer Improves Survival in Uganda: A Cohort Study

Richard Wismayer, Julius Kiwanuka, Henry Wabinga, Michael Odida

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 1-14

Colorectal carcinoma (CRC) incidence and mortality rates are rising in Uganda and other developing low-income nations in Sub-Saharan Africa, while CRC rates are dropping in high-income industrialized countries. In Uganda, many people with CRC do not have access to curative surgery or oncological care. To analyze the impact of surgery and oncology care on CRC in the resource-limited environment of a low-income developing nation, we compared the survival results of patients who underwent curative surgery and, if necessary, adjuvant chemotherapy to those who did not. The study included people who were diagnosed with CRC between January 1, 2008, and December 31, 2018. The Kampala Cancer Registry and medical records from Ugandan hospitals were linked for these patients. The researchers wanted to know if the individuals had had curative surgery and adjuvant treatment. Our outcome variable was survival at 3 years. The log-rank test was used to calculate and compare survival. A total of 247 patients were involved in the study. There were 177 (71.66 %) patients who received curative surgery and 70 (28.34 %) who did not. Curative rectal cancer surgery had a better survival than no curative surgery (p=0.003). Curative colon cancer surgery tended to have a better survival than no surgery (p=0.137). Curative surgery and adjuvant chemotherapy showed better survival than no surgery with no adjuvant chemotherapy (p=0.007). Curative surgery, if necessary, paired with adjuvant chemotherapy, improves survival in a resource-constrained situation. As a result of the increasing burden of CRC, the findings of our study serve to support the extension of CRC care by upgrading surgery and oncology infrastructure in resource-limited areas.

Since the 1980s, the authors have been researching anti-ageing, oxidation, and antioxidants. They discovered that lipids are some of the most common raw materials in foods, cosmetics, and the human body, and that this would be a good area to investigate autoxidation, whether to prevent spoilage or to slow ageing.

The scientists chose a few lipids for an autoxidation investigation and put them up against typical pro-oxidants and antioxidants, as well as a potential antioxidant candidate, along with a short-term toxicity assessment. The lipids were exposed to increased temperatures in the presence of several pro-oxidants, some typical commercial antioxidants, and the antioxidant candidate, as well as a control. Following that, the authors analyzed the lipids for oxidation by-products and conducted a short-term toxicity investigation. Lipids that have been kept in iron, copper, or other heavy metals, or that have been contaminated with such metals, are prone to autoxidation. Aluminium appears to provide lipids an induction period and does not speed up autoxidation like other metals. When compared to antioxidants like vitamin E, BHA, BHT, and PG, the antioxidant candidate dithiooxamide appears to be a capable antioxidant with no short-term toxicity in a limited sample study, which was far below the LDLo and LD50 conducted on rats and mice using dithioxamide in other later published research. The findings suggest that lipids should steer clear of iron, copper, and other heavy metals, and that the antioxidant candidate dithiooxamide, in small doses, could be effective for external lipid applications.  

An Overview on Rosacea and Its Treatment

Dipti Gohil, Dixit Patel, Nirmal Shah

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 44-52

Rosacea is chronic inflammatory skin disorder characterised by flushing, redness on centre  face, erythema, pustules, and telangiectasia. The theory of pathophysiology is unknown although, the disordered of innate immune system can caused rosacea. Moreover, inflammation and environmental factors can be responsible for dermatological condition. There are four types of rosacea have been seen with various symptoms. There are the inducing factor such as, demodex, H. Pylori, and Ultraviolet rays. The topical alpha agonist is approved by FDA for treating rosacea. Potent vasoconstrictor loaded topical gel (0.33%) can be used to reduce erythema because of class. The combination therapy can be cured the disease including herbal therapy and laser therapy.  

Non-tPA Pneumatic Displacement of Traumatic Submacular Hemorrhage Treated by Gas-Vitrectomy: A Case Report with Multimodal Imaging Postoperative Analysis

Tatiana Urrea-Victoria, Miguel A. Quiroz-Reyes, Erick A. Quiroz-Gonzalez , Miguel A. Quiroz-Gonzalez

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 53-67

Our case report aimed to describe the anatomic and functional outcomes of a middle-aged male patient undergoing gas-vitrectomy for the displacement of a submacular hemorrhage and discuss the multimodal imaging postoperative findings. This chapter is developed as an elaborated version of a published paper and includes the case report of a 34-year-old man who was struck by a stone on his right eye. He was diagnosed with a traumatic submacular hemorrhage and a large paramacular retinal tear. The patient underwent a non-tPA gas-vitrectomy within three days of the accident. A multimodal evaluation, including best-corrected visual acuity, spectral-domain optical coherent tomography (SD-OCT), 10-2 and 30-2 chromatic automated central campimetry, microperimetry, and mfERG examinations, was performed six months after the accident. The multimodal imaging tests demonstrated an abnormal foveal SD-OCT pattern with a tear at the level of the retinal pigment epithelium. Campimetry demonstrated low levels of retinal sensitivity, and microperimetry and mfERG revealed a subnormal retinal response and a reduction in N1- and P1-wave amplitudes. The visual evoked potential responses were normal. Proper management of the pneumatic displacement of a significant submacular hemorrhage and the complete release of vitreoretinal traction at the tear level yielded a favorable anatomical prognosis. The multidisciplinary examination at six months revealed a structurally and functionally abnormal macula.

A powerful imaging approach for detecting the origin of a stroke and brain imaging is magnetic resonance imaging (MRI7). Ultrahigh frequency-based MRI, which employs a 7 Tesla magnet and is being developed by SIEMENS for enhanced human imaging, is another type of MRI. This research looks into these MRIs. This article presents a different approach known as "interval monitoring," which tries to detect tumor malignancy changes faster. The conceptual background and computer implementation of the proposed method are presented, and its application is demonstrated using an empirical example from image-based photo science, the American Cancer Registry. Because patient survival is the initial stage in cancer treatment, many cancer registries employ this strategy on a regular basis, which is a good thing. This is an important aspect of its treatment. Traditional methods of calculating cumulative survival, on the other hand, indicate changes in prognosis only after a large amount of time has passed. The GMPLS algorithm locates cancer in a sequence of MRI images after filtering and skeletonization. When calculating the cancer equation, this research saves time and money. A statistical approach is used to produce the desired matrix, and the matrix inverse offers us a real-time mathematical equation that is unique for each patient. If the person has an injury or died, further survivor analysis is performed. This research aims to develop a one-of-a-kind mathematical model of a cancer patient, as well as a real-time graph of cancer health and a survivor function that predicts death.

Antioxidant Levels and Inhibition of Cancer Cell Proliferation In-vitro by Extracts from Peltophorum pterocarpum Collected in Vietnam

Dao Cuong To, Phi Hung Nguyen, Kim Thuong Pham Van, Loi Huynh, Manh Hung Tran

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 77-90

Peltophorum pterocarpum is native to tropical South-Eastern Asian countries and is a popular ornamental and deciduous tree. This study aims to evaluate low-density lipoprotein oxidation and cytotoxic activity against cancer cell lines of 70% ethanolic extracts of P. pterocarpum leaves (LPP) and stem bark (SPP). The results showed that both LPP and SPP inhibited Cu2+-mediated low-density lipoprotein and also inhibited the generation of thiobarbituric acid reactive substances in a dose-dependent manner. In addition, SPP exhibited significant cytotoxicity against MIA PACA2, A549, KG, HL-60, and CRF-SBA with IC50 values ranging from 118.5 to 255.0 µg/mL. Meanwhile, LPP showed cytotoxic activity against KG, HL-60, and CCRF-SBA with IC50 values ranging from 146.0 to 228.1 µg/mL. SPP also mediated cytotoxicity in HL-60 and CCRF-SBA cells through the activation of the apoptosis pathway. These findings suggested that SPP could help humans avoid developing and progressing atherosclerosis and leukemia.

Variant Accessory Lobe of Liver

Sharadkumar Pralhad Sawant, Shaheen Rizvi

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 91-97

Many anatomists have studied the morphological aspects of the liver in considerable detail due to the intricacy of liver function and its importance to life. The presence of auxiliary lobes or livers is one of the less prevalent variances. Accessory lobes are normally asymptomatic and are linked to the liver by a peritoneal fold or a hepatic tissue bridge.

The aim is to study the morphology of the liver to document the presence of accessory lobe.

50 adult human livers were obtained from donated embalmed cadavers (42 male & 8 female) in the Department of Anatomy at K. J. Somaiya Medical College, Sion, Mumbai, all ranging between age groups of 65 to 75 years. Only cadavers, whose clinical history excluded liver diseases, were used for the study.

5 specimens showed the presence of an accessory lobe on the under surface of the liver.

An accessory lobe is a very rare occurrence and hence when present becomes clinically important. Injury to the accessory lobe or its vascular pedicle might result in bleeding into the abdominal cavity. Accessory lobes need attention when there is torsion of the vascular pedicle or metastasis occurring in them. Torsion of the accessory lobes is a surgical emergency. Knowledge of the presence of an accessory lobe of liver is useful for radiologists and surgeons in diagnosing, surgical planning and avoiding iatrogenic injuries of the accessory lobe.

Musculoskeletal System in COVID

Vijaya Mohan , Shyam Gopal

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 98-102

In the current covid 19 epidemic, and its treatment, the entire presentation of various diseases has changed. The treatment of covid 19 in this epidemic has disrupted many people's immune systems and promoted the spread of an uncommon bacterial infection. In clinical settings, Spingomonas Paucimobilis is an uncommon source of illness, but covid or its treatment has resulted in the establishment of rather infrequent infections.

A 59-year-old woman came to the outpatient clinic complaining of right hip pain and limping for the past month. She was diagnosed with an intraosseous abscess and septic arthritis of the hip caused by Sphingomonas Paucimobilis. With timely intervention and antibiotics, she was able to fully recover.

In this period of the Covid 19 pandemic, every symptom should be taken seriously and investigated, and prompt diagnosis and treatment are essential to avoid disastrous consequences.  

Determining the Relationship between Anisometropia as Well as Visual Acuity, Aniseikonia and Stereopsis in the Absence of Strabismus

David Tayah, Marcelo Tannous, Youssef Sabba Tayah, Milton Ruiz Alves

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 103-112

The present study sought to determine the relationship between anisometropia type and its effects on monocular and binocular best-corrected vision acuity (BCVA), aniseikonia, and stereopsis in the absence of strabismus.

The study comprised 162 people with anisometropia and healthy eyes who had never received amblyopia treatment or had eye surgery. According to spherical and cylindrical components and spherical equivalent, they were divided into the spherical hyperopic anisometropia (SHA, n = 31), spherical myopic anisometropia (SMA, n = 45), astigmatic or cylindrical hyperopic anisometropja (CIIA, n = 22), and astigmatic or cylindrical myopic anisometropia (CMA, n = 64) groups. Patients without anisometropia (NA, n = 188) were classified under the control group. Anisometropia was studied for its impact on monocular and binocular BCVA, aniseikonia, and stereoacuity.

The NA group had a significantly lower Logiv4AR of BCVA in the t`ro eyes than the SHA, SMA, CMA, and CHA groups. Moreover, the SMA group had significantly lower Logiv4AR of BCVA than the CIIA group (p < 0.05). However, there was no significant difference bet\veen the groups in terms the descriptive values of anjseikonia (p = 0.052). The SMA groups had significantly lower stereoacuity values in logio arc seconds than the CMA (p < 0.05) and SHA (p < 0.05) groups. There was a significantly positive correlation in the anisometropia group between ahiseikoria and stereoacuity values in logl0 arc seconds (r = 0.160; p = 0.041). The type of anisometropia and low monocular and binocular BCVA were associated with stereopsis.

Cross-sectional Study of Waist Circumference in School Children

Kharat Vidya, Puranik Medha

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 113-119

Our goal was to examine and get anthropometric measures of body waist circumference in school-aged adolescent boys and girls aged 9 to 12 years old from various socioeconomic groups using a cross-sectional survey. Increased Waist circumference has an association with Diabetes, Metabolic syndromes in School going adolescent Boys and girls .Some School–aged children could be divided into different categories using Waist circumference as an important parameter especially with an association with Anaemia. In all age categories, we found that the waist circumference of the higher income group (HIG) was significantly higher than that of the lower income group (LIG). In HIG, females had a larger waist circumference than males of the same age groups. The evaluation might be used to depict the growth patterns of males and females aged 9 to 12 years old, which could be influenced by social and economic changes in a society. This evaluation method could potentially be beneficial in the field for studying the prevalence of malnutrition, which includes obesity, as well as providing an additional measure of undernutrition in large population samples. This study has not only a high socio-economic significance but also easy evaluators of metabolic health illness.

An Anatomical Study on Acromion, Coracoid and Glenoid Processes of Scapula

Gyanaranjan Nayak, Sitansu K. Panda, Prafulla K. Chinara

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 120-128

The current study involves the measurement of different dimensions of the three processes of scapula as well as determination their morphology.

The shape of the acromion plays a crucial role in impingement syndrome and the pathophysiology of rotator cuff disorders. Many surgical procedures involving the shoulder joint require the coracoid process. When developing glenoid components for total shoulder replacement, the dimensions of the glenoid process are critical. The current study was a descriptive study and included 42 unpaired human  scapulae  available  in  the departmental museum of Anatomy of a Medical College in Eastern India. Acromion morphology appears to have a predictive value for determining success of conservative or surgical treatment of shoulder joint impingement. Various open surgical and arthroscopic access to the shoulder revolve around coracoid process. So, its morphometry is of pivotal importance in surgeries involving shoulder joint. The current study will be of immense help in orthopaedic surgeries on the shoulder joint and in biomechanical engineering  for  designing  implants  for total shoulder replacement.

The results will be highly relevant in orthopaedic surgery and manufacturing shoulder prosthesis.

This study aimed at defining the possible role of molecular mimicry and immunologic memory as mechanisms that might link the SARS-CoV-2 infection/immunization to cardiovascular diseases (CVDs).

Human proteins that, when affected, associate with CVDs were investigated for pentapeptide immune determinants that are shared with SARS-CoV-2 spike glycoprotein (gp). 

Comparative sequence analyses reveal that SARS-CoV-2 spike gp and human proteins related to CVDs share a high level of peptide sharing; the shared peptides have immunological potential as they are also part of experimentally validated SARS-CoV-2 spike gp-derived epitopes, and the majority of the shared peptides are found in infectious pathogens to which the human population has been exposed in general.

Peptide sharing and cross-reactivity most likely represent, respectively, the molecular platform and the basic mechanism linking exposure to SARS-CoV-2 and CVDs, with the past history of the individual’s infections having a main role in determining and specifying the immune response as well as the pathologic autoimmune sequelae.

BioCapZ: A Highly Efficient Capsid-Based Nano-Platform for Non-Invasive Theranostics Delivery

Mo. A. Baikoghli, Chun-Chieh Chen, R. Holland Cheng

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 140-147

Through nanotechnology, progressively, drug delivery, cancer treatment, and vaccination are moving towards personalization. With personalized and precision medicine being one of the major focus points of nanotechnology and nanopharmacological studies these days, there is a great need for an efficient nanocarrier delivery system with no toxicity and high capacity for modularization. Several nanocarrier systems have been introduced comprising both natural and synthetic material; however, overcoming biological barriers, toxicity, targeting accuracy, and encapsulation efficiency remain a challenge. Here we summarize the latest breakthroughs of protein-capsid-based nanocarrier, BioCapZ, as a nano-platform for non-invasive delivery for vaccines, gene editors, imaging agents, and theranostics.

Integration of Omics in Mental Disorders: Understanding Molecular Connectivity from Prediction to Prevention

Elizabeth Heroux, Aminata Musa, Jae-Hyeon Cho, Diane E. Heck, Hong-Duck Kim

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 148-155

A variety of environmental factors, including stressors, contribute to mental disease. Unmet medical outcomes and monitoring platforms in the field of mental illnesses currently necessitate the implementation of sensitivity associated with key biomarkers in the detection, evaluation, and validation processes. The use of omics in mental disorders and in a health care assessment platform, which is based on macromolecule-dependent data analysis such as bioinformatics, has the potential to increase the identification of risk genes and treatment options by validating the functional efficacy of drugs or recovery status of brain function using behavioral assessment and metabolomics, which includes a neuro-pharmacogenomics study. This concept may appear futuristic, but it is great. If multiple databases around the world continue to grow, increasing the likelihood of identifying a strand, health professionals such as clinicians and lab scientists will be able to predict the likelihood of a disease outbreak, drug addiction, and synaptic malfunction, as well as the likelihood that a treatment will work. Although practical adoption may take some time, the therapeutic alternative, which comprises biological and synthetic products, will be well worth the wait. In this paper, we give a short review of mental disease with unknown etiology by visualizing risk genes and functional vulnerability in molecular diagnostic developments utilizing the Omics platform.  The future perspective of using the Omics platform shed light on the venue in biomarker exploration, innovation, and evaluation of assessment procedures in a clinical setting for the treatment of mental health disorders looks promising.  

An Overview of Salivary Gland Neoplasms in a Tertiary Care Centre, India

S. Muthuchitra, V. Saravanaselvan, R. Malarvizhi

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 156-167

Due to their prevalent affliction and earlier presentation, the parotid and submandibular glands are of significant concern.  Swelling, discomfort, and nerve palsies in the region or over the gland are common symptoms. Ultrasonogram and computer tomogram studies aid in study of the extent and surgical planning of tumor. Salivary gland disorders though common, neoplasms are restricted to older age group with increasing incidence as age increases.  Over the years, our tertiary care centre, which includes both general surgeons and otolaryngologists, has seen cases of salivary gland neoplasms, with both surgical interventions. We want to look at the demographics and types of neoplasms that have been seen in our otorhinolaryngology department recently.   

Fetal Growth Patterns with Customized Growth Charts in South India

Badanahatti Radhika, Vavilala Suseela, Praveen Kumar Nirmalan

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 168-175

We conducted this study to determine the diagnostic effectiveness of these customized GROW charts to predict abnormal fetal growth pattern in an antenatal population attending an advanced tertiary care perinatal hospital in south India.

Serial SFH of pregnant women with singleton babies booked for antenatal care up to 22 weeks was measured from 24 weeks of gestation and plotted on customized growth charts that were developed using the gestation related optimal weight (GROW) software During the prenatal period, ultrasound was used to determine fetal development patterns, which were then validated at birth using a neonatal growth classification. Using sensitivity, specificity, area under the ROC curve, and likelihood ratio tests, the diagnostic effectiveness of SFH was compared to ultrasound and neonatal classifications.

The study included 666 pregnant women who presented at the antenatal clinics from January 2010 to October 2010. On ultrasound examination, 564 (84.6%) fetuses were AGA, 78 (11.7%) fetuses were LGA and 19 (2.9%) were SGA and 5 (0.8%) showed crossing centile from higher to lower pattern. On serial SFH measures, 426 (64.0%) of the fetuses were normal growth, 180 (27.0%) were excessive growth and 40 (6.0%) were slow growth. Serial SFH measures had a positive likelihood ratio of 4.7 (8.5 for USG) for the identification of SGA and a negative likelihood ratio of 0.06 for the detection of LGA.

The SFH measurements plotted on a customized GROW curve have the potential to become a low-cost screening tool for identifying fetuses with abnormal growth patterns. Before being used on a larger scale, the diagnostic efficiency of SFH plotted on customized growth charts needs to be improved further by developing appropriate customized growth charts for India.

Auto-inflation Methods and a Proposed Classification of the Eustachian Tube Patency

S. E. Stangerup, M. Klokker, S. Vesterhauge , P. Rea, J. Harcourt

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 176-182

The Valsalva maneuver is recommended to clear a negative middle ear pressure. We describe two methods to improve the efficacy of auto-inflation procedures. The subjects of the study comprise 134 passengers, examined after flight.

Methods: after a flight, passengers were offered an ear examination, including otoscopy and tympanometry. If the middle ear pressure after flight were negative, the passengers were asked to perform a Valsalva maneuver after which tympanometry was repeated. If still negative, an extended Valsalva maneuver was performed. If still negative, the passenger was instructed to perform auto-inflation using a nasal balloon, after which tympanometry was repeated.

Results: among the 134 ears with initial negative middle ear pressures, 19 ears (14%) normalized the middle ear pressure after Valsalva’s maneuver. In the 115 passengers with a remaining negative pressure, the pressure was equalized to zero or positive pressure in 53 ears (46%). In the 62 ears with a remaining negative middle ear pressure after both Valsalva and extended Valsalva maneuver, 43 subjects (69%) could normalize the middle ear pressure after nasal balloon inflation. Nineteen subjects out of 134, still had a negative pressure after all the autoinflation procedures.

The Role of Yoga in Management of Cancer

Sunder Singh, Monica Verma , Vivek Kaushal, Abhishek Soni

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 183-189

Yoga: It is essentially a spiritual and discipline based art and science which connects our body and mind with our pure soul. The word ‘Yoga’ is derived from the Sanskrit root word ‘Yuj’ which means ‘Join’. Since ages yoga has been in practice worldwide. It is a state of freedom which means ‘Mukti’ or ‘Moksha’. It is a therapy to overcome all the pains and sufferings of human beings. In ancient time, various diseases were treated with the help of yoga and pranayam and even today disease like cancer can be treated with the help of this yoga therapy. Pranayam and yoga are proving a blessing for the people who are in stress or in deep pain or suffering from any serious disease. It has magnified results and even many researches have been done to prove its benefits. Multiple studies have shown that yoga can have positive effect on our body in numerous ways. It is a complementary therapy which has been used with conventional medicines to treat so many sufferings and diseases. Life of cancer patients is very serious, painful and depressed, as they face a drastic change in their life and they had never thought of about this change. All these situations results in anxiety, depression, fatigue, anger and even in worst conditions the patient loses hope to live. Nausea, vomiting, insomnia and pain also results in overall discomfort in his life. These conditions bring major decrease in the quality of life of that patient. Yoga and meditation therapy has shown progress in reducing the symptoms of cancer, its complications and complications of therapy.

Lymphatic System and Tuberculosis Affection

Deepali Rahul Gaikwad

Current Practice in Medical Science Vol. 4, 22 June 2022, Page 190-197

The lymphatic system is part of the immune system, and complementary to the circulatory system. Lymph nodes are among the most common sites of extra pulmonary tuberculosis. Lymph nodes being sites of initiation of adaptive immune system, also serve as niches of Mycobacterium Tuberculous growth and persistence. Superficial Tuberculous lymphadenopathy may present as isolated tuberculous infection or may represent underlying important organ involvement in vicinity or even disseminated Koch’s. Diagnosis of superficial Tuberculous lymphadenopathy recommends thorough investigations considering strong role of lymphatic system in systemic illness.