Current Practice in Medical Science Vol. 5

It is common practise to increase the occlusal vertical dimension in order to gain sufficient restoration space in the management of severely worn dentition. This contentious belief has sparked debate about its effects on the Odonto-stomatognathic system. There are basic uncertainties and existing incorrect beliefs about the perception of increasing the occlusal vertical dimension. Because of widely divergent views on the selection of an appropriate occlusal scheme for successful full mouth rehabilitation, reconstructing debilitated dentition is fraught with anxiety. For occlusal rehabilitation, there are several philosophies to follow, the most prominent of which being Hobo's philosophy and Pankey Mann Schuyler's philosophy. For full mouth rehabilitation cases, the Pankey Mann Schuyler concept provides a simple, systematic approach to follow. This article discusses a complete mouth occlusal rehabilitation case of a 38-year-old male patient who complained of pain in his left TMJ region and had considerable attrition on oral examination. The therapy was based on the Pankey Mann Schuyler concept, including an occlusal analysis using the Broadrick flag.

The present case report describe about Raynaud’s Phenomenon with High Eosinophil Count and Hypocomplementemia. The study carried out with a28-year old female patient presented with non-healing digit ulcer and Raynaud’s phenomenon. Upon investigation was found to have high eosinophil count alongside hypocomple- mentemia. This woman was identified with diffuse cutaneous systemic sclerosis and started on treatment; her other lab abnormalities were due to a concurrent helminthic infection. Renal causes including Membranoproliferative glomerulonephritis and Post-Infectious Glomerulonephritis. Rheumatological causes such as SLE, Cryoglobulinemia, Vasculitis (Polyarteritis Nodosa, Urticarial Vasculitis), and rarely Rheumatoid vasculitis. This patient is most likely to have the hypocom- plementemia in the context of her helminthic infection. This case suggests the possibility of having two different diagnoses presenting at once causing a clinical di- lemma.

Purpose: To assess the current Corneal Cross Linking techniques and their safety profile.

Methods: Collagen cross-linking (CXL) is a well-established procedure for halting keratoconus progression. Riboflavin instillation is followed by Utraviolet-A (UV-A) irradiation in all currently used protocols. Epithelium on and epithelium off techniques are currently used in clinical practice, including accelerated techniques using various amounts of irradiation. Certain complications have been reported following each technique.   

Conclusion: The variety of CXL protocols, provide the clinicians the ability to follow an individualized approach to each patient. Early and late complications should be addressed promptly.

Inadvertent intravenous administration of oral suspension, which is rarely addressed in routine practice, could contribute to potential patient harm. We received an incident report in which a patient had been accidentally administered an oral liquid formulation intravenously. The practice of preparing or dispensing oral liquids in parenteral syringes is the primary cause of this error. Additionally, the cognitive fatigue experienced during multi-tasking by staff personnel leading to a momentary lapse of concentration as well as the attachability of Luer connection of parenteral syringes to the needleless IV lines also contributes to the incidence. The fact is de-emphasized by the healthcare professionals, and therefore we consistently advise the staff to dispense and administer unit doses of oral liquids in oral syringes. Thus, dispensing and administration of commercially available or compounded oral preparations should be carried out in particular cups and oral syringes or other containers suitable for the particular preparation. For ensuring compliance with this practice, the availability of oral syringes in the hospital and those patient areas where liquid doses are orally administered is essential. Oral syringes are not available in Pakistan and nurses routinely use intravenous syringes for administration of oral liquids to avoid spillage of dose, especially in children or non-cooperative patients. The availability of oral syringes in hospitals could help to reduce inadvertent administration error of medicines.

The aim of the study was to evaluate how of cancer-associated adipocyte (CAAs) density affect the availability of disseminated tumor cells (DTCs) in the bone marrow (BM) of patients with gastric cancer (GC) at normal weight (BMI<25) as a manifestation of the process of metastasis. Excess of CAA density in tumors leads to instability of the tumor microenvironment stipulating the ability of tumor cells to disseminate with potency to form the metastasis. But such studies are mostly related to obesity and little is known about the possible the effect of CAAs on metastasis in patients at BMI <25 in particular with GC. Patients with GC were enrolled into the study and immunohistochemical methods of tumor tissue examinations were used. It was found that in patients with GC at BMI<25 having tumors characterized by excess of CAAs, frequency of DTC availability in BM was increased with a statistically significant probability (P <0.05). Obtained data have shown high risk of metastasis in patients with GC at BMI <25 who have tumors with high content of CAAs. Understanding the mechanisms of metabolic symbiosis between cancer cells and CAAs in GC patients at BMI<25 would be clinical relevance and warrants further investigation.

A vast evidentiary base of research with both observational and clinical trials supports that the pineal hormone melatonin, a powerful immunomodulator as studies have clarified, whose primary function is the regulation of the sleep-wake cycle, possesses an extraordinarily wide spectrum of anti-inflammatory, antioxidant, and antiapoptotic activity, with potential cytoprotective, neuroprotective, nephroprotective, cardioprotective, anti-hypertensive, anti-nociceptive, and antiviral effects, and with emerging evidence of benefit in neurocognitive disorders (especially but solely Alzheimer’s disease (AD)). In this commentary and short review, we explore the frontier edge of the emerging potential role of the chronobiotic agent melatonin, in both the treatment of SARS-2-CoV infection (COVID-19 disease), and its emerging role in neurocognitive health. Given the recognized dysregulated neuro-inflammatory processes that underlie SARS-CoV-2 infection, there is motivation for exploring melatonin’s deployment in the potential amelioration of some of the newly identified pathological neurocognitive sequelae, notably the cognitive impairment that is increasingly exhibited as part of the cluster known as post-acute sequelae of COVID-19 (PASC), aka “Long COVID”. In the process we review clinical evidence of benefit in these domains, suggesting the strong promise that melatonin appears to provide, with a highly favorable benefit/harm ratio of excellent tolerability, minimal toxicity, affordability, self-administrable, and sufficiently compelling evidence of efficacy as to be actionable, in the here and now. We conclude with a call to action to encourage and nurture further research in melatonin’s continually expanding range of benefits, and to support its informed deployment within the current treatment landscape.

Gangrene means tissue death caused by deficient or absent blood flow, often occurring in the extremities like toes, fingers, and limbs, developing from infection, inflammation, injury, and degenerative changes. Frostbite is one of the most common causes of dry gangrene; it is clinically defined as cold, black, dried out, and withered skin, which gradually fades over weeks or months. Debridement and amputation are the definitive treatments for gangrene in all systems of medicine. Although Dhillon and Singh (2003) claimed the successful treatment of tail gangrene in buffaloes, author have made an attempt to present a case study, conducted on a 65- year old female patient, afflicted with frostbite induced gangrene in her right index finger, treated with Unani drugs; Sharbat Banafsha and Arq Murakkab Musaffi Khoon as oral administration, and Marham Safed Kafoori as topical application, with the aim to evaluate the efficacy of drugs and to avoid surgery. Within 60 days of receiving Unani treatment, the patient had exceptional and admirable results. Finally, the frostbitten gangrenous area was debrided, healed, and repaired without the need for surgery.

Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is caused by fetal Mullerian-duct genesis failure, which results in a congenital insufficiency of the upper vaginal wall and a rudimentary to absent uterus. These patients present with primary amenorrhea, infertility as well as difficulty in coital activity. Although conception requires IVF and surrogacy but sexual life and coital satisfaction can be initiated with neovaginal construction by McIndoe Vaginoplasty. The primary goal of this study was to create a neovagina that would lead to a satisfying sexual life. Over the course of three years, seven patients with MRKH syndrome had modified McIndoe Vaginoplasty with split thickness skin grafts, and these patients were monitored for two years. All of the patients were given extensive information about the surgery, the risks involved, and the expected outcome. All of the patients were subjected to thorough examinations.

In all seven patients, the functional outcomes were satisfactory. There was no need for blood transfusion and no major complications. The average vaginal length was 7-9 cm and the average vaginal breadth was 3-4 cm. All patients' donor sites healed properly and without issues. If performed with competent surgical skills, modified McIndoe Vaginoplasty is a safe and effective technique to attain sexual happiness in patients with vaginal agenesis, with no donor site problems.

The present study highlights the Relationship between Necrotizing Periodontitis and Novel Corona Virus. Necrotizing ulcerative periodontitis (NUP) is a severe inflammatory periodontal disease caused by bacterial plaque that normally takes a short time to develop. Poor oral hygiene is thought to be a primary ecological stressor that causes dysbiosis in complex microbial populations in the mouth. This article introduces the possibility of patients suffering from Periodontitis at an increased risk of COVID-19 related adverse outcomes, possibly adding, after due clinical validation, to the existing list of conditions predisposing to developing severe forms of the disease. This study also introduces the possibility of patients suffering from Periodontitis at an increased risk of COVID-19 related adverse outcomes, possibly adding, after due clinical validation, to the existing list of conditions predisposing to developing severe forms of the disease.

The spread of SARS-cov-2, has been in continuous progression for over two years, and despite the many treatments proposed and vaccinations none of these has been able to eliminate the pathology.

In this work, we suggest for the first time the use of Pulmonary Surfactant (PS) replacement treatment in patients admitted to intensive care. Pulmonary Surfactant is commonly used to treat Acute Respiratory Distress Syndrome (ARDS) in premature babies, and it has demonstrated to be quite effective. Because ARDS, also known as hyaline membrane illness, shares many pathogenetic and symptomatological features with SARS-CoV-2 infection, it may be beneficial to utilize Pulmonary Surfactant as an adjunct to current therapies. Even medications with low absorption and bioavailability can be delivered straight into the most hidden alveolar locations using the surfactant we propose in our investigation.

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vascular lesion. FMD is presumed to have multifactorial origins including female hormones, chronic mechanical stress and tobacco smoking. The etiology of splenic artery aneurysm (SAA) is quite uncommon. Hematemesis, malaena, pancytopenia, and splenomegaly were found in an eighteen-year-old girl. A splenic infarct and a large splenic artery aneurysm were discovered on CT angiography. With increased periportal and lienorenal collaterals, the portal vein had cavernous metamorphosis. The SAA was microscopically shown to have intimal fibroplasia and medial dysplasia. Aneurysmectomy alleviated the symptoms of extrahepatic portal hypertension, demonstrating SAA to be the underlying cause. This is the first study to link fibromuscular dysplasia, splenic artery aneurysm, extrahepatic portal hypertension and hypersplenism.

The aim of this investigation is to study the effect of ANA on platelet endothelial activation and release of FGF-2. The natural history of essential thrombocythemia includes the development of myelofibrosis. ET's myelosuppressive medication may itself raise the likelihood of myelofibrosis transformation. The difficulty in treating ET is avoiding this risk. Activated thrombocythemic platelets are said to release fibroblast growth factor-2 (FGF-2). Anagrelide (ANA) is a myelosuppressive agent that inhibits the platelet function. The major concern regarding ANA is whether it do not increase the putative risk of transformation to myelofibrosis. In this study we report the results of a randomized group of patients with ET in treatment with ANA that after a follow-up of 5 years showed a reduction in the myelofibrosis. A likely explanation for this finding is the broader activity of ANA which also affects the platelet function. In the present study, we reported that ANA normalizes the FGF-2 levels through the inhibition of platelet endothelial activation improving the outcome of ET patients in terms of myeloproliferation and fibrosis.

The aim of writing this chapter is to spread knowledge about some stingray species that many times due to ignorance we can expose ourselves to accidents.

We rarely think that marine animals, large or small, can feel threatened by the human presence in their habitat. Sometimes out of ignorance we want to have some marine life animal in our hands, either because of its color or its appearance and sometimes they seem harmless. There are unpleasant surprises when trying to touch a sea urchin, it buries its stinger causing pain and subsequent infection that requires antibiotics for treatment. Little importance has been given to rayism, however, cases of stingray stings are not rare. A variety of manta rays abound on some Mexican beaches, some more poisonous than others.

An overview of the different species and their taxonomic classification, their venom and biochemical composition, diagnosis, and medical management, as well as therapeutic management of stings are given here. Some recommendations are also given to prevent accidents caused by these organisms. Special attention should be paid to those patients who have diabetes where wound repair is slow and there is a higher risk of infection.

The present study reports a case of a newborn baby with Down’s syndrome presented with cystic hygroma in his left arm and forearm. Cystic hygromas are the cystic variety of lymphangioma, common locations being cervico-facial regions and axilla. Respiratory distress, recurrent infections or cosmetic reasons are the main indications of the treatment.  A newborn male neonate with features of Down’s syndrome presented to the special care nursery (SCN) of our institution with complaint of swelling of left arm and left forearm on day-1 of life. The edema in the baby's left arm was treated with OK-432. However, at the age of five months, the patient had severe sepsis as a result of gangrene in his left arm and associated meningitis, resulting in his death.

Picibanil, also known as OK-432, has been used to treat cystic hygroma with great effectiveness for the past two decades. Although cystic hygroma has been associated with a nuchal lymphangioma, Turner’s syndrome, and Noonan syndrome, there is evidence that cystic hygroma occurs more frequently in Down’s syndrome. More case controlled studies should be conducted in the future to better understand the adverse effects of sclerosant therapy, which has the potential to be an optimal treatment for cystic hygroma.

After many months of the SARS-COV-2 pandemic, having an injectable medical device, whose effectiveness has been heavily questioned by prestigious scientific journals, and an effective drug therapy if implemented at the onset of the disease, we propose a new generation supplement that has demonstrated remarkable ability to contain SARS-CoV-2 infection and improve the clinical course of COVID 19.

To boost the absorption and bioavailability of the chemicals employed, the supplement is designed with trace elements and vitamins with proven immunostimulant efficacy, which are contained in the individual liposomes, which act as vectors and are thus defined as multifunctional.

We focus the discussion on the role of zinc as an effective immunostimulant and specific antagonist of the SARS-COV-2 virus.

The present chapter aims to study prevalence and attitudes towards tobacco use and training related to tobacco cessation. A cross-sectional survey of Armed Forces Medical Colleges was undertaken using an anonymous, self-administered questionnaire based on the Global Health Professions Student Survey (GHPSS). The GHPSS questionnaire was used to assemble and analyze data for various variables. Total of 107 students participated in the study. There is a significant association between not smoking and support for smoking ban in public places. Interventions directed at health care professional students can help the fight against tobacco. Smoking difficulties among medical students should be addressed through active interventions. The acquisition of effective smoking cessation skills should be incorporated and emphasized in skill-based medical school curricula.

The present study was undertaken to record normal value of median nerve Long Latency Reflexes (LLR) from Abductor pollicis Brevis (APB) of dominant hand among females. LLR is a transcortical reflex loop obtained on submaximal stimulation of a mixed nerve. LLR can be used to diagnose individuals with proximal nerve lesions and S1 radiculopathy in the clinic. Normal values of late responses like the H-reflex and F-wave in the upper limb have been recorded in studies.

The current observational study included 30 female participants aged 20 to 30 years old. The females who took part in the study were recruited in the early stages of their follicular development. By stimulating the median nerve while abducting the thumb, LLR was observed.

The findings of this study revealed that Mean \(\pm\) SD for APB LLR latency was 46.29 \(\pm\) 2.58 milliseconds (ms). Mean \(\pm\) SD for APB LLR amplitude was 208.21 \(\pm\) 58.45 microvolt (\(\mu\)V). As a result, the normal values of LLR latency and Abductor Pollicis amplitude Brevis of the dominant hand in healthy adult female volunteers aids in the diagnosis of neurological diseases.

The objective of this study is to determining the effect of mirror therapy on hand functions (fine + gross motor activity) in children with hemiplegic cerebral palsy. Cerebral Palsy (CP) describes “group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain” . The QUEST and Box and Block tests were performed on a 5-year-old female patient with hemiplegic cerebral palsy. Mirror therapy was used for 30 minutes per day, six days per week for three weeks. Activities performed by the right hand included-Grasps of cylindrical,spherical and hook pattern, Gripping activities with theraputty of green colour, Arrangement of peg board, Peg link activities, Transfer of objects. There were significant differences in pre- and post-treatment scores, indicating that mirror therapy had an influence on the use of the afflicted hand in daily activities.

Cardioplegia is administered via retrograde perfusion into the coronary sinus. We created a pig beating-heart model of self-myocardial retroperfusion (SMR) that used the venous pathway to boost the left ventricle's myocardial oxygenation. Then, in comparison to a single antegrade myocardial supply, we sought to assess if the combination of antegrade and retrograde myocardial perfusion with oxygenated blood may cause hemodynamic and cardiac responses. Eight pigs were assigned to receive SMR with antegrade physiological LAD perfusion at the same time. After closure of the left azygos vein (LAV), SMR was performed using a bypass line between the ascending aorta and the coronary sinus to provide selective retrograde perfusion of the great cardiac vein with oxygenated blood. Cardiac output (CO), maximal pressure in the LV (Pmax in-LV), stroke volume (SV), left ventricular ejection fraction (LVEF), diastolic durations (DD), heart rate (HR), and arterial systemic pressure were monitored with conductance catheters. These data were collected during the antegrade physiological myocardial perfusion (baseline period) and during a simultaneous antegrade and retrograde perfusion (SMR). SMR with simultaneous antegrade LAD perfusion showed inotropic properties with significant improvements in CO, SV, Pmax in-LV and LVEF (p<0.0001) compared with baseline values. Histology confirmed no evidences of tissular injuries. The selective retrograde perfusion of the great cardiac vein with oxygenated blood (SMR), paired with antegrade physiological LAD perfusion, demonstrated clear abilities to activate inotropic effects, bringing up new possibilities for cardiac assistance.

This paper represents a new automatic method of classifying the heart sound status using the loudness features of the heart sound. The method includes the following three main steps. First, the heart sound, which is usually found noisy, is heavily filtered by a 8^th order Chebyshev Type-II filter. The event synchronous method is later used to segment the filtered heart sound into the first heart sound, systole, second heart sound and diastole. In the second step, the loudness feature is represented using the mean rows of its spectrogram. The third step categorises the heart sound using the Gaussian Mixture Model approach.  With a success rate of 97.77 percent, the suggested method has been evaluated on a huge database of heart sounds containing over 3000 recordings. 

A dentigerous cyst is an odontogenic cyst that develops around the crown of an impacted or unerupted tooth. Unless infected, such a cyst is initially asymptomatic and can be detected only through routine radiographic examination. A 20 years old female patient reported to our clinic with chief complaint of swelling on the lower left side of her face which was present since 3 months. Slight tenderness was noticed on percussion with first and second molar and grade II mobility on left second molar. Radiographically, a dentigerous cyst should always be differentiated from a normal dental fol- licle. Dentigerous cysts are the most common cysts with this radiographic appearance. Radiographically, the cyst appears unilocular with well defined margins and often sclerotic borders but sometimes it may be multilocular in appearance and may also have a continuous cystic membrane.

Single-cell genomic analysis, a systemic review of single-cell methodologies involving genomic and proteomic studies, was published seventeen years ago. Single-cell approaches with downstream genomic and proteomic analysis have been applied to therapeutic disciplines such as molecular pathology, molecular genetics, forensic medicine, and biomarker development after years of arduous work. Furthermore, the dynamic cell-sorting technology, in conjunction with downstream cell culture and genomic analysis of stem cells for regeneration medicine and cancer stem cell differentiation, has made substantial progress in clinical fields. Furthermore, tissue level sampling combined with in silico analysis has been used in the treatment of advanced tumour disease. Recent advances in sorting homogeneous cells in vitro (or single cells technique), ex vivo (dynamic analysis or small number of cell cultures with downstream genomic analysis), and in silico (tissue level sampling with in silico analysis) have enabled physicians and scientists to apply one of these techniques with genomic analysis in their clinical areas of research. This manual will discuss recently established methods of clinical genomic analysis in vitro, in silico, and ex vivo in order to completely comprehend these modern approaches. In the review paper, Author also discusses how to apply these strategies in a variety of clinical settings. Eventually, the manual will address some of the issues that mixed cells from clinical specimens pose for clinical genomics analysis and diagnosis.