Current Topics in Medicine and Medical Research Vol. 12

“Aharnish Sevamahe” vguÊ’k lsokegs “Eternally in Service of Mankind at every moment”. This is the motto of my life.

India will be the largest producer of Medical Graduates. In other words every Indian medical graduate will be responsible for the health of the world. We in India are keen on improving the state of affairs of Medial Education in our Country and health services for every citizen of our country.

Being prepared for change is an attribute of the educated and enlightened. Illiterate in the 21st century, are not always those who cannot read or write; but more often they are those who do not want to ‘change’ or do not want to accept change. Medical Education has seen tremendous change in both content and delivery. The system is in place and people in the hierarchy of transforms in the education system have time and again incorporated the subtle changes necessary.

So if we need to stand before the growing demands of the complexities of these changes, we need not make many efforts to change the system as much the attitude of people towards this change.

MicroRNAs (miRNAs) are small, non-coding RNA species that are highly evolutionarily conserved, from higher invertebrates to man. Up to 1000 miRNAs have been identified in human cells thus far, where they are key regulators of the expression of numerous targets at the post-transcriptional level. They are implicated in various processes, including cell differentiation, metabolism, and inflammation. miRNA biogenesis involves the stepwise processing of a precursor primary miRNA (pri-miRNA) molecule by the nuclear RNase III Drosha and the cytosolic RNase III Dicer that eventually results in the incorporation of the so-called “guide strand” deriving from a transitory intermediate RNA duplex into the macromolecular RNA-induced silencing complex (RISC) which silences gene expression through hindering the translation of its mRNA target(s). An expanding list of miRNAs is known to be involved in the pathogenesis of common, non-autoimmune inflammatory diseases. Interestingly, osteoarthritis (OA) is now being conceptualized as a metabolic disease, as there is a correlation among hyperuricemia and metabolic syndrome (MetS). Experimental evidence suggests that metabolic deregulation is a commonality between these different pathological entities, and that miRNAs are key players in the modulation of metabolic routes. In light of these findings, this review discusses the role of miRNAs in OA and gouty arthritis, as well as the possible therapeutic targetability of miRNAs in these diseases.

The psychology of chess players has called the attention of several researchers for more than a century. There is a notable lack of scientific works with a plausible hypothesis about Bobby Fischer´s paranoid psychosis and its relationship with his prodigious performance. In this brief theoretical work, a new conceptual model is proposed to explain the psychosis of American chess player Bobby Fischer. Based on the pioneering work of psychoanalysts, we introduce the concept of sinthome, taken from the Lacanian topology of the Borromean knot, with its three registers: Real, symbolic and imaginary [RSI], and its fourth stabilizer knot at the breaking of the symbolic. Here we call it chess-sinthome to designate the antipsychotic role fulfilled the ultra-competitive chess, in life and in the minds of some great players. This category of chess sinthome that was brought to our analysis by lacanian theory could be presented as a new second-generation paradigm to explain Bobby Fischer´s psychosis, after the pioneering works were already studied. The ability to predict its clinical appearance in the near future shall be a fascinating perspective.

The back pain is a frequent problem of patients in orthopedics, neurology and other departments. In our opinion – the causes of the pain are connected with various illnesses or anatomical disorders of the spine such as hiperlordosis of lumbar spine, or scoliosis.

There are also other causes of back pain like spondylolisis, spodylolithesis, prolapsed nucleus pulpous, oncology symptoms but in the article we focus on the causes of special types of scoliosis and group of patients with “hiperlordosis of lumbar spine” as the causes of “back pain syndromes”. The back pain syndromes are mostly connected with the pathological changes in the anatomy of the spine – deformity of axis, changes of “intervertebral joints” and shortenings (contractures) of the soft tissues – ligaments, capsules, fascias, muscles of the spine. In our research we found that etiology of scoliosis is connected with biomechanical factors – “permanent standing ‘at ease’ on the right leg” and walking / gait, which is described in next chapters.

Background: Lumbar burst fractures are common spinal injuries that cause severe instability with kyphotic deformities and neurological complications requiring surgical decompression and reconstruction with spinal instrumentation for unstable burst fracture, but there is controversy about the optimal surgical approach anterior, posterior or combined approach. The mechanism of retropulsion of bone fragments from the fractured endplates into the spinal canal is accepted by many to be the high energy transferred to the vertebral body during major trauma leading to increased risks of neurological complications and kyphotic deformities.

Objectives: To assess the efficacy & safety of anterolateral approach in decompression and reconstruction with spinal instrumentation for lumbar burst fractures. Subjects & Methods: A retrospective study including 16 patients, 10 males and 6 females with lumbar burst fractures and anterior compression treated operatively by anterolateral approach for corpectomy and single level fusion by using expandable cage or mesh cage loaded with bone graft and plat with screws. The clinical and radiological follow up after discharge from the hospital ranged from 12 to 24 months.

Results: All patients improved regarding the Frankel score more than one grade after surgery, except 2 cases of grade A didn’t improve. Mean preoperative visual analogue scale was 7.4 improving to 0.9 postoperatively. The mean Local kyphosis improved from 8.8° before surgery to ?1° after surgery.

Conclusions: Anterolateral approach is feasible, effective, and safe approach for unstable lumbar burst fractures. Angular deformity is successfully corrected when the anterior approach is used. Corpectomy with anterior approach and grafting is an effective treatment modality. Anterior approach not only provides successful correction of angular deformity by reconstruction of anterior and middle columns with fusion, but also it helps to improve the neurological status in patients with neurological deficits by safe and efficient decompression of the spinal canal. All of these are approved by our results.

Bitter Kola (Garcinia kola) is highly valued in Herbal / African folk medicine because of its varied and numerous uses which are social, economic and medicinal, thus making it an essential ingredient in African medicine. The study reviews some related literature on the action of bitter kola on diabetes. Medicinal plants such as Bitter kola are believed to be an important source of kolavirons and flavonoids as phytochemical components with potential therapeutic benefits for diabetes and other ailments. Bitter kola has antiinflammatory, analgesic, molluscidal, anti-atherogenic, antioxidant and hepatoprotective properties and should not be totally ignored in medical conditions including diabetes. From our published work, the serum glucose concentration of treated diabetic rats was significantly reduced (P > 0.05) compared to the serum glucose concentration of untreated diabetic rats and that of the controls. The reduced serum glucose concentration and that of concentrations of the lipid profile parameters attributed to the anti-diabetic and anti-hyperlipidemic activities of the bitter kola seed extract. The reduced glucose concentration could be due to the activity of bitter kola seed extract against inflammation and reactive oxygen species (ROS) of free radical on the pancreatic beta cells. This chapter shall be useful to researchers interested in authenticating the hidden truth which has not been scientifically validated about bitter kola especially with regards to diabetes.

Objective: To investigate the autophagy-inducing effect of Compound Berberine (CBBR) on CNE2 nasopharyngeal carcinoma (NPC) cells and its possible intervening targets in P13K/AKT/mTOR signaling pathway via an experimental study.

Methods: CNE2 cells at exponential growth phase were taken as the target cells in this study. IC₅₀ concentration for CBBR was determined by MTT assay at firstly. Then, 3 different concentrations of CBBR, i.e. 0.25 mg^.mL^-1, 0.50 mg^.mL^-1 and 1.00 mg^.mL^-1 around the concentration of IC₅₀, were taken for following intervention experiments respectively. Fluorescein labeling method was utilized to assay the inducing effect of CBBR on the autophagy of CNE2 cells, followed by Western blot procedure to explore the changes of key messenger molecules in the autophagy-related signaling pathway of P13K/AKT/mTOR, both combined with 3-MA block test in a comparative way and carried out through detecting the expressive levels of Beclin 1, LC3-? and LC3-? as well as the ratio of LC3-?:LC3-?.

Results: IC₅₀ of CBBR was determined at the level of0.5mg^.mL^-1. The inducing effect of CBBR on autophagy of CNE2 cells was shown occurred in various modes, not only a simple concentration-dependent tendency, with its effect minimal at the concentration of 0.25mg^.mL^-1 and maximal at the concentration of 0.50mg^.mL^-1, while only a little remarkable higher at the concentration of 1.00mg^.mL^-1 than that of 0.5mg^.mL^-1. Although its inducing effect was weakened a little following the pretreatment by 3-MA, the effect combined with CBBR was still significantly higher than that of simply blocked by 3-MA. Moreover, changes in the expressive levels of Beclin1, LC3-? and LC3-? as well as LC3-?:LC3-? all showed a tendency corresponding to the changed autophagic features of CNE2 cells (P<0.05 or P<0.01), given more supporting evidences for the inducing effect of CBBR on autophagy of CNE2 cells.

Conclusions: CBBR can bring about inhibiting effect on the proliferating activity of CNE2 cells through inducing increased autophagic activity via intervening targets in P13K/AKT/mTOR signaling pathway, and this effect could not be completely blocked by the antagonist 3-MA. It might be possible that activated autophagic progress by some factors, such as miR-125b via activation of CXCL 12/CXCR4 axis, could function epigenetically as a mediator to cause epithelial-mesenchymal transition (EMT), promote tumor cell invasion, and induce chemical drugs resistance by contraries and CBBR could be utilized to inhibit the proliferating activity of NPC cells via intervening such a linking target as well.

Deep seated cutaneous fungal Infections are a rare entity in surgical practice and are very often under diagnosed. Presently they are also categorised as Type IV Necrotising Fasciitis.

Aim: The aim of this paper is to sensitise clinicians to the nature and rapid lethality of deep seated fungal infections, and discuss the various methods at our disposal to deal with these peculiar cases.

Discussion: Here we describe a deep seated cutaneous fungal infection in an immunocompetent patient and the challenges we faced during the course of his management. Due to the nature of presentation, atypical symptoms, co morbid conditions that cause immuno-compromise and slow but aggressive progression of the disease, the associated mortality is high.

Conclusion: The onus is on the clinicians to diagnose a fungal etiology early and start appropriate anti fungal measures. A high index of suspicion, early aggressive rehabilitation and use of empirical antifungals, while cultures are awaited, may prove lifesaving in patients with a deep seated cutaneous fungal infection.

In daily practice, we encounter many patients with calculi in various part of the urinary tract. However, it is rarely a peculiar foreign body such as clips, pins, electric wires and coins are found which masquerades as a calculus. Such patients often have associated psychiatric or sexual illnesses with autoeroticism which compels them to insert such foreign objects into the urinary tract. These can be extracted by an endoscopic approach usually, but seldom open approach may be required. A strong male predominance is observed in cases with self insertion of foreign bodies into the urinary tract.

The clinical presentation of breast cancer along its evolution has changed in the last years and this fact has led to the need for new imaging techniques. A novel aspect is the molecular imaging and the use of different radiolabeling compounds in order of show and characterize it in the daily practice. In this paper we review the clinical aspects that we believe are of greatest interest.

Hemifacial hyperplasia, a congenital malformation symbolized by prominent unilateral overdevelopment of facial of the hard and soft tissues. The afflicted side grows swiftly than the non-affected side, creating a notable asymmetry that probably involves the skeleton and teeth, as well as all components of the associated soft tissues. Identified at birth, this disease progresses towards puberty and thought not to progress further. There is no single theory to explain the etiology adequately. Only deformities of facial tissues including teeth and their related tissues in the jaw, are key findings for correct diagnosis of CHH.

Central venous catheters (CVCs) are used in intensive care units (and, increasingly, in other locations) to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor haemodynamic status. Numerous complications like ventricular dysrhythmias and bundle branch block are well recognized complications during central venous access procedures, as was the case with our patient. The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems, although rarely it may induce arrhythmias as well [1]. Herein we present a case of peripheral central venous catheter induced supraventricular tachycardia in a young patient of acute lymphoblastic leukemia.

Keratoconus (KCN) is a bilateral ectatic corneal disorder, frequently asymmetric, with progressive thinning of cornea resulting in protrusion, progressive irregular astigmatism, and visual deterioration. An early detection of KCN by using the topographical and tomographical evaluation of Pentacam device is of major importance.

Corneal collagen cross-linking (CXL) is the standard procedure for KCN therapy. The final effect of CXL technique is the strengthening of the cornea, with the goal to slow down or arrest the progression of KCN, thus avoiding, or at least delaying the necessity of keratoplasty. CXL is a promising procedure with low risk profil.  It is known that the conventional “epi-off” cross-linking has a long-term efficacy in stabilizing progressive KCN. Lately, an accelerated “epi-off” CXL procedure was introduced.

We concluded that both standard and accelerated “epi-off” procedures are efficient and safe, resulting in a stabilization of keratoconus.

Pillar pain is one of the most common complications after carpal tunnel surgery and has an occurrence from 7% - 61%. 61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tunnel surgery. All of the patients underwent endoscopic carpal tunnel release. 15 of the patients also took the nerve support supplement NeuroGen^® as part of their perioperative treatment. The supplement group demonstrated a significantly lower amount of pillar pain (VAS) at initial follow up compared to the control group (1.13 and 4.05 respectively). 46% (7/15) of the supplement group were completely free of pillar pain compared to only 9% (4/46) of the control group at the first follow up. 53% (8/15) of the NeuroGen^® group did not require any pain medications compared to 35% (16/46) of the control group. The Nerve supplement NeuroGen^® significantly reduces pain after carpal tunnel surgery. This decrease in pain results in less post-operative medication required and an earlier return to activity. Further studies will evaluate the effectiveness of the supplement on nerve regeneration after surgical decompression.

Fibro-osseous lesions are a heterogeneous group of benign lesions of unknown etiology affecting the jaws and other craniofacial bones, which are characterized by the replacement of normal bone by fibrous tissue, which contains a newly formed, mineralized product. The origin of cemento-ossifying fibroma is not clearly understood and have been categorized under various sub-groups. These most ill-defined and confusing lesions are categorized under “benign mesenchymal odontogenic tumours”. It is considered as relatively most rare, benign, slow growing, non-odontogenic intra bony neoplasm.