Highlights on Medicine and Medical Research Vol. 12

Organ shortage transforming death into life, which is what organ transplants symbolize, needs the end of somebody life, a scientific miracle of our times, but as well a social problem. Prejudices or ignorance inhibits to offering life to another human being. The consequence of this conflicting situation is that patients waiting for transplantation, “unfairly” die every day. States and Social Security should be involved in this problem. Programming efficient education will be important for change social conduct towards organ donation. As well, several studies emphasize the persistence of an insufficient university medical teams training in transplantation. Organ shortage and waiting lists patients’ mortality is a failure of social communication on organ donation and transplantation. Proposals to review social and university education in current organ shortage crisis, might be an ethical duty for states health and education officials. Solidarity is a positive peoples feeling, nevertheless faced with death of a loved one; it does not seem to be an enough reason to justify authorization to donate. For many people, organ donation represents a perverse and unjustified action of mutilation. Considering the negative reactions that often can occur in the moment in which the alternative of deciding the donation of organs of a loved one is presented; we have proposed the inclusion in the social education plans the following concepts:

• Organ shortage is a health emergency.
• Throughout our lives, we might need organ or tissue transplantation.
• Our body after death is a unique source of health to be shared
• Organ donation meant to” share life” more than “to gift life”.
• Organ donation should be a social agreement.
• People should know the social risks involved in establishing economic incentives for donation.

This analysis is made to provide a basic knowledge of a vital medical crisis, and to suggest to decision makers of educational programs useful suggestions for this serious problem. In addition, and very particularly this work is directed to the Society, the main protagonist of this problem, requiring to receiving a correct and detailed information on the dilemma of the lack of organs, in quest that the donation decision will be an act of full awareness. A French philosopher, Jean Rostand has said "To dream you have to know".

The aim of this research is to determine in the anthropometrical indicators used here in this chapter the percentage of body fat, the body mass index  (BMI) and the waist - hip ratio (WHR), which introduce a correlation with the metabolic variables of heart rate, blood pressure (systolic and diastolic) and double product. The Bruce Protocol was updated to measure metabolic variables, and the Petroski formula was used to calculate the percentage of fat in a population of 69 subjects with an average age of 41.7 6.6 years. The data collected received statistical treatment by the “Statistical 5.0” program with correlation being made by the calculation of the simple coefficient of Pearson “r” by means of a statistical significance test (p < 0.05). Heart rate tended to be associated primarily with the strength of power, as well as the percentage of fat and BMI, according to the findings. Blood pressure and BMI had a strong relationship, particularly in the female group.  The WHR, which shows a correlation between the pattern of male body fat distribution (android) and blood pressure, was the anthropometrical measure that had significant associations with blood pressure in the male group. The BMI had a strong association with the double-product; we assume this is because this anthropometric measure is linked to the amount of body mass. Since the BMI is the only metric used here that includes lean mass in its values, this measure truly represents the function of the myocardium. Only the amount of fat was negatively associated with time spent on the treadmill; in other words, the higher the percentage, the less time spent on the treadmill.

Ocular Thelaziasis is a zoonotic disease of the eye. A nematode of the genus Thelazia causes this disease and it affects the conjunctival glands as well as the lacrimal ducts and lacrimal glands. Thelazia Species of Thelazia are transmitted by different species of flies known as Muscidae. This is a case report of ocular Thelaziasis in a 13-year-old female patient. On microbiological exexamination, species Thelazia callipaeda was confirmed. Thorough manual removal of the worms was done and the patient was kept on anti-helminthic medications to avoid recurrences.

The chapter examines issues of sexuality and conception, with a focus on ovarian insufficiency. Since psychosomatics comprise issues of psyche and soma in interaction, fertility can be viewed as highly influenced by intrapsychic and interpersonal factors. Societal influence must also be taken into account. Preconditions for conception, like psychosomatic resonance, can explain why ovarian stimulation and other technical approaches sometimes are not successful. Via case vignettes, relevant aspects are highlighted.

Although there is a connection between fertility and fibroid, no cause-and-effect relationship has been identified. The majority of the research comes from infertility clinics and referral hospitals. In a medical institution, a retrospective study was conducted with direct patients from a rural poor socioeconomic community.  The reproductive performance of 70 women with fibroids was compared to that of an equivalent number of age-matched women who attended Gynecological Outpatients. Women with fibroid have a fecundity of 2.46, compared to 2.56 in controls. While the rate of conception is marginally higher in women with sub mucous fibroids than in controls, the live birth rate is substantially lower. Pregnancy loss is nearly double in women with submucous fibroids compared to control women. Women with fibroids that were not submucosal did just as well as controls. As a result, we can deduce that women with submucous fibroids lose more pregnancies and try to have more conceptions in their attempt to have children. The relationship between fibroids and fertility and reproductive performances is well established.

Objectives: The aim of this study was to determine the rate of conversion and complications with laparoscopic myomectomy.

Material and Methods: It was a retrospective analysis of 43 laparoscopic myomectomy cases conducted at Vinayaka Missions Medical College & Hospital over the course of 28 months, from December 2015 to March 2018. Demography, myomectomy signs, position and number of fibroids, surgery performed, difficulties and complications encountered, and the need for conversion to open surgery were all examined.

Results: A total of 108myomas were removed on 43 patients. Patients undergoing laparoscopic myomectomy were 32.16 years old on average. Just one fibroid existed in 24 patients. Only 5 patients had fibroids more than 4 in number. In 8 patients the largest fibroid was less than 5 cms, 6-12 cms in 34 women. One patient had fibroid measuring 15 cm. Of the 108 fibroids removed 80 were intramural. There was only one conversion to Laparotomy. Two patients had excessive blood loss and 8 patients had to be transfused blood intra operatively or postoperatively.

Conclusion: Laparoscopic removal of the myomas is being witnessed as a safer technique apart from the other benefits related with the laparoscopic surgery. Our findings indicate that laparoscopy is a safe and successful treatment for myomectomy, also in fibroids with a diameter of 15 cm.

With rising of the general global population there also an increase in the number of elderly people which ultimately increase in the edentulism. Moreover, the elderly population is affected by systemic and metabolic diseases, most commonly being Diabetes Mellitus along with nutritional deficiency. Also, nutritional deficiency may develop due to the inability of the elderly population to chew food properly due to loss of teeth following various reasons and leading to complete or partial edentulism. This review is aimed to find a correlation between, edentulism, nutrition, and diabetes and can the treatment of edentulism has an effect on the improvement of nutritional status in diabetic patients.

The proton relaxation rate dispersion of paramagnetic ions in blood samples was studied in the frequency interval from 10 kHz to 10 MHz. with the Field cycling method. We applied, the samples were first magnetized by a relatively high magnetic field (0.5 T). By electronic means this field was rapidly (1 ms) reduced to a lower value in the interval 0.1 mT - 0.5 T, where the excited proton spin may relax during a time interval of about 3×T1max. Then the magnetic field is again quickly raised up to the higher level for the detection of the NMR-signal. The relaxation characteristics were analyzed by applying a model with three compartments of water proton-spin exchange. For each compartment we estimated a correlation frequency by fitting the dispersion curves to a sum of Lorentz distributions. We found that low concentrations of paramagnetic ions have a large influence on the relaxation rate dispersion in the low frequency region <10 MHz. This effect is suggested to be used for mapping of inorganic paramagnetic or organic free-radical compounds in medical applications as contrast agents and for tracing cellular activity by subtracting MR images recorded at high (>100 mT) and low (<10 mT) relaxation fields. Such sequences of images could be used to study the oxygen status and metabolism of the brain as well as the generation and distribution of reactive oxygen species (ROS). This technique called “Magnetic resonance Relaxation Dispersion Imaging” (MARDI) would be particularly suitable to analyze various neurological diseases such as stroke, MS, Alzheimer´s disease as well as brain tumor progression. It might also be suitable for imaging of tumour oxygenation and in vivo ROS distributions in radiation therapy, which could be used in dose planning and for analyzing and optimizing the effect of various radiation therapy regimes. An Overhauser-enhanced pre-polarized MRI system has been demonstrated for imaging studies of tumor hypoxia and red-ox status to be used as radiotherapy prognostic factors.

The most common paediatric neoplasm is haemangioma, which is a vascular lesion caused by excessive blood vessel proliferation. Haemangioma are congenital lesions that commonly affect newborns infants and children. They are generally benign and often resolve spontaneously. In 3 to 5% of cases, they can cause complications inherent to their size, to involvement of vital organs and to the concomitant coagulopathy like Kasabach-Merritt syndrome. Kasabach Meritt Syndrome (KMS) is a potentially fatal coagulopathy marked by an increasing haemangioma, extreme thrombocytopenia, and consumption coagulopathy. KMS is correlated with kaposiform hemangioendothelioma (KHE), tufted angiomas, and congenital haemangiomas in rare cases (CHs). Since Kasabach and Merritt identified the first case in 1940, nearly 200 cases have been published in the literature. More than 80% of cases develop within the first year of life. Early diagnosis and institution of treatment is associated with favorable outcome. Steroids are considered as the most effective 1st line treatment.

Introduction: The introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the spine and on the central nervous system, respectively to create programs for the prevention of these consequences. The goal of current article is to evaluate the impact of different physical modalities (including physiotherapy, ergotherapy, manual therapy, deep oscillation, lasertherapy, magnetic field) in the prevention and the complex rehabilitation of the onset of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones.

Material and Methods: We observed a total of 165 patients with cervical myofascial pain and headache, divided into 5 groups (of 33 patients each). The age of the patients was between 19 and 50 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 hours daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment, and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program (PT), including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients’ active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group, we added elements of manual therapy (MT - tractions, mobilizations, manipulations; and auto-mobilizations). In patients of the next groups, a paravertebral application of a preformed modality was added to the PT and the MT: in group 3 – Deep Oscillation (DO); in group 4 – lasertherapy (LT); in group 5 - magnetic field (MF). Statistical evaluation was performed by SPSS programme, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis).

Results and Analysis: All patients reported a significant decrease of the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups.

Discussion and Conclusion: Techniques of PT and MT are very useful for the prevention and the rehabilitation processus of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. The inclusion of preformed modalities (DO, LT, MF) in the complex prevention and rehabilitation program accelerates the effects on pain and spine mobility and ameliorate the stabilization of the results. We consider that every medical doctor - specialist in Physical and rehabilitation medicine, every physiotherapist and ergotherapist must adapt the general algorithm for the needs of the concrete patient.

15 patients after the middle of 2018, during the initial onset of the epidemic of identified Nipah viral infection (fruits borne virus) in adjacent state, presented with fever, acute coma, delirium, movement disorders, required referral to district headquarters hospital, for virology confirmation, and management. 135 mostly afebrile patients, who refused referral to government hospital, for virology confirmation, presented with symptoms of mainly subacute pan encephalitis, over the past 14 months; 90% presented with conglomeration of vertigo, staring, personality changes, imbalance in gait, difficulty to walk, bilateral drooling of saliva, tremors, confusion, altered sensorium, nausea, vomiting; 83% presented with dysarthria, 28% presented with symptoms of raised intracranial pressure-mimicking accelerated, malignant hypertensive emergencies, bradycardia, vomiting; decreased vision in 4.6%, myoclonic jerks in 58%, choreoathetosis in 8%. All of them could not afford INR 10000 for virology confirmation. Fruits borne viral subacute pan encephalitis, can present as subacute neurovascular syndrome, simulating ischemic stroke, mediated by Hapten triggered autoimmune angiopathy (blood borne) with resultant bilateral, asymmetrical multifocal, infarcts, cerebritis with consequent edema, requiring recognition, successful treatment with acyclovir, antiedema, antiepileptic measures and not antiplatelets, since the etiology is inflammatory and not degenerative. Promoting awareness to steam cook, pressure cook, cook with coconut oil (pie) fruits, steaming fresh fruit juices, before consumption will prevent incidence of fruits borne, tobacco leaves borne, and endemic viral infection. Economical screening card tests for Nipah fruits borne virus, will enable early detection, authenticate notification, early recognition treatment of subacute pan encephalitis presenting as neurovascular syndrome, mimicking ischemic stroke Global aborted blood pollution, contraceptive menstrual blood pollution, documented by rising environmental estrogen, beta human chorionic gonadotropins, alpha fetoprotein, favours emergence, virulence, drug resistance of microbes, including the recent fruits borne virus; global eradication of contraception, abortion (—non-evidence-based medical practice, without therapeutic indication, therapeutic protocols, therapeutic policies), to be replaced by global baby boom (promoting childbirth >10 - 20 children per family) will prevent further emergence, virulence of microbial infections, including Ni-pah, oncoming Ebola corona. Over the past 5 years, consumption of water living without scales, gills, fins,-toxin containing mammals, presented as cortical venous, sigmoid sinus thrombosis, in 3.5%, choreoathetosis in 12.5%, unresponsive but restless in 12.5%, quadriparesis, hemiparesis in 37.5% mimicking neurovascular syndrome, ischemic stroke; treatment with methylprednisolone, immunoglobulin reverted. This retrospective analysis includes consumption of water living with-out scales, presenting as neurovascular syndrome, as differential diagnosis to ischemic stroke.

Background: Universal concern is an increased prevalence of morbidity, mortality; with improper comprehension, the globe has implemented, non evidence-based medical practice, without therapeutic indication, therapeutic protocols, policies-contraception, abortion, annihilating human race by therapy, destroying germ cells with consecutive systemic inflammatory response syndrome, associated with decreased androgen oestrogen resulting in metabolic syndrome, increased neoplasms—due to lacuna of this comprehension—cholesterol was blamed, resulting in essential fatty acids deprived diet, promoting sunflower seed oil, refined oil, lipid-lowering agents prescription like water, for the past >40 years; the tragedy of this false concept of refined oil, essential fatty acids deprived diet, [against God-ordained marvelous cell metabolism, from cholesterol] resulting in degenerative diseases, defaulted genomic repertoire, as cause and effect phenomenon in the two following morbid, fatal case presentations; contraception, abortion is the culprit and not cholesterol which is the basic life moiety of cell membrane, cell metabol-ism governing steroid hormones-androgen oestrogen derived from cholesterol.

Case 1: 76-year-old male, vegetarian, presented with lethargy, hypotension, unexplained hyponatremia, on fludrocortisone for 2 years. MRI detected empty sella; hence hypopituitarism with cortisol deficiency, resulting in hyponatremia was considered and with hydrocortisone replacement, patient improved. Low levels of LDL, HDL, suggested chronic [>40 years] deprivation of diet containing essential fatty acids had resulted in degenerative—empty sella status with hypopituitarism.

Case 2: 17-year-old girl presented with headache, vomiting, feeble pulse; 6 months prior platybasia had been diagnosed and she had undergone corrective neurosurgery, to widen bi-laterally, narrowed, base of skull foramina, to prevent compression on the exiting neurovascular bundles; urgent CT scan of brain confirmed significant narrowing of foramen magnum, compressing brainstem; she expired within 30 minutes secondary to brainstem edema. Low levels of HDL, LDL confirmed, long term [~16 years] deprivation of essential fatty acids intake, leading to decreased steroid hormone synthesis—including oestrogen—the surveilling hormone for cell metabolism, including skull base, having resulted in progressive Platybasia, compressing brainstem.

Conclusion: Though both patients belonged to affluent society it was the sincere adherence to the false detrimental concept of essential fatty acids deprived diet, which was the cause and effect phenomenon of degenerative empty sella syndrome, ineffectual cell-bone metabolism presenting as platybasia. The basic concept of cholesterol esters, derived from essential fatty acids consumed in the diet is the basic moiety of cell metabolism, new cell formation, steroid hormone synthesis, genomic repertoire, is to be reiterated.

Congenital transmesenteric hernia is a relatively uncommon cause of adult intestinal obstruction.. It  is a type of internal hernia where the bowel loops are strangulated after they protrude through the defects in the mesentery. We describe a patient who presented to the emergency department with persistent abdominal pain after an emergency caesarean section and was later diagnosed with acute pancreatitis after computed tomography findings and elevated pancreatic enzymes. Her suffering was out of proportion to her pancreatitis diagnosis, and her condition quickly deteriorated, necessitating multiorgan care. A obstructed transmesenteric hernia was discovered after reimaging. Surgical intervention was needed right away for the patient. Internal hernia should be considered as one of the differential diagnoses for any atypical acute abdomen, and early intervention could save lives.

In-home patient monitoring plays an important role in the early detection and prevention of diseases. This paper presents the design of a wireless sensor network to monitor the patient in his/her home. Different body sensors are fitted on the patient's body to collect the body parameters like temperature, blood pressure, ECG and pulse rate. Currently, most of the monitoring systems use Personal Computer (PC) as a local database to store patient's body parameters before sending them to the hospital. Here the need for a PC is eliminated by mobile phone. The body parameters collected by sensors are confidential and are securely forwarded to the hospital. A variation of Ciphertext Policy Attribute-Based Encryption (CP-ABE) with double encryption technique is used to achieve security. When a patient moves away from the home, outdoor monitoring is also supported by the mobile phone because the mobile phone is always carried by the patient. Hence the mobile phone is used as a local database, eliminates the need for a PC and supports outdoor monitoring. Finally, real-time monitoring is implemented with the help of a temperature sensor. The sensing circuit consists of a temperature sensor, Analog to Digital Converter (ADC), Microcontroller, LCD and Bluetooth device. The laptop is designed as a hospital server using the mhotspot tool. Temperature readings are automatically forwarded to the android mobile of the patient. Then it is forwarded to the laptop using Wi-Fi communication and an immediate response is given to the patient's mobile phone.

Aims: The purpose of this study was to estimate the prevalence, severity and associations of dental anxiety in a sample of the adult population visiting comprehensive Rural Health Service Department, Ballabgarh, Haryana. Dental anxiety is a common problem both for dental practitioners and the people.

Settings and Design: The study was conducted in CRHSP Ballabgarh, Faridabad .The study was conducted in 5 weeks duration. Questionnaire based study was done using closed ended MODIFIED DENTAL ANXIETY SCALE (MDAS) questionnaire.

Methods and Material: A sample of 379 adults (age ranging between 15 to 60 years; mean age male = 35.89 ± 14.10 and female 35.01 ± 12.38). The Modified Dental Anxiety Scale (MDAS) is a brief, self-complete questionnaire consisting of five questions (Q1 to Q5) and summed together to produce a total score ranging from 1 to 5.

Statistical Analysis Used: SSP version 16 software, the percentage, means and standard deviation.

Results: The results revealed that females were more apprehensive, compare to men. Based on distribution of anxiety according to age group, males   between the age group 15 to 23 and 24 to 33 belonged fairly anxious group and only slight anxiety was observed in higher age group (44 to 53 yr). On the other hand, females were found to be very anxious at higher age group of 24-33 and 34-43.

Conclusions: It is recommended that dental education and health care services should be promoted to overcome the fear and anxiety factor.

Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke as a result of blood clots forming primarily in the left atrial appendage (LAA). Permanent administration of anticoagulants or interventional LAA occlusion are two preventive measures to avoid embolic events. In the past, physical LAA occlusion required either surgical excision or exclusion by suture or stapler. Nowadays, various clinical trials provide evidence about safety, effectiveness and therapeutic success of LAA occlusion using various interventional occluder devices. As the safety, clinical benefit, and cost-effectiveness of LAA occlusion have been demonstrated, the use of such implants has become a valuable alternative for stroke prevention in patients with contraindications to anticoagulation.

The thyroid gland is the primary metabolic regulator in the body. Thyroid hormones are required for normal organ development. Thyroid hormones in high concentrations may alter the metabolism of oxygen in cells and stimulate the production of free radicals.  Thyroid hormone has a pro-oxidant effect and increases the production of oxygen free radicals, resulting in a decrease in antioxidant state in hyperthyroidism when compared to normal and hypothyroidism. Thyroxin treatment causes oxidative stress as well. Immune suppression is caused by oxidative stress and hypothyroidism. It appears that thyroid gland plays a central role in generating generalized oxidative stress in diseased condition. Thyroid hormones play an important role in mitochondrial oxidative metabolism regulation. The aim of this study is to look into free radical scavenging activity, lipid peroxidation, and antioxidant status in patients with hyperthyroidism and hypothyroidism. In conclusion, our present study suggests a very high production of ROS and oxidative stress in patients with hypothyroidism and hyperthyroidism with enhanced lipid peroxidation and concomitant failure of antioxidant defense mechanisms.

There have been few experiments on the treatment of elderly women with low-risk breast cancer. Although their clinical behaviour is similar to that of younger patients, there is a tendency to undertreat them, which may increase the risk of local relapses and reduce their survival.  Even in low-risk patients, the rate of local recurrences after breast conserving surgery without adjuvant treatment (tamoxifen or radiotherapy) is high, approaching 20%, which is unacceptable. Despite the fact that tamoxifen and radiotherapy seem to have a similar impact in reducing local recurrence with similar overall survival, the combination of the two provides the best results with local relapses of less than 2%. Two studies that were designed specifically for elderly patients were published in recent years. Based on similar survival, these trials recommend omitting radiotherapy in patients with low-risk tumours treated with breast conserving surgery and tamoxifen, but with an increase in local relapses when radiotherapy is omitted, 10% at 10 years vs 2%. There is no evidence that tamoxifen treatment is less toxic in this group of patients who are typically poly-treated, and treatment compliance appears to be much lower than expected. This recommendation is highly contentious due to the reduction in the number of sessions in external radiotherapy with hypofractionation and the acceleration of partial breast irradiation, especially intraoperative radiotherapy with a single session. After breast conserving surgery, elderly patients may benefit from radiation therapy.

Background:  Since the early 1980s, some authors have described the use of mechanical staplers to create anastomosis in biliary surgery. However, the use of these devices did not spread in the following decades, and most centres now make hand-sewn anastomosis.

Methods: We gathered information retrospectively about the use of mechanical circular staplers for the development of hepaticojejunostomy at our institution from medical records, surgical registries, and computer aided databases.

Results:  Our institution conducted 11 stapled hepaticojejunostomies between 2012 and 2020 for both neoplastic and non-neoplastic diseases. The patient's average age was 74, and there were 5 men and 6 women in the group. The normal bile duct diameter was 19 mm on average prior to surgery. Total bilirubin was 6.95 mg/dL in preoperative blood samples. There were no problems during the procedure.  Minor postoperative complications occurred in two patients (18%) (1 wound dehiscence and 1 episode of melena requiring blood transfusions), but no significant complications occurred.There were no biliary fistulas or anastomotic dehiscence in any of the patients.Within 30 days of surgery, no one dies. The average period of stay after surgery was 13 days. Conclusions: Stapled hepaticojejunostomy appears to be a safe and successful procedure in selected patients, based on our limited experience.