Highlights on Medicine and Medical Research Vol. 13

A Spondylo Epi (meta) Physeal Dysplasia: Hypocalcitonemia in Handigodu Disease

Mallikarjun Badadani — 2021-05-31

Handigodu Disease (HD) is a disorder of the osteoarticular system which is highly prevalent in several villages of two districts viz, Shimoga and Chikmaglur of the state of Karnataka, southern India. It is a rare and painful osteoarthritic disorder. The disease is known scientifically as Spondylo-epi-(meta)physeal Dysplasia, Autosomal Dominant variety, Handigodu syndrome. The International Classification of Skeletal Dysplasias has the same classification. In HD, there was no calcium homeostasis study. After an overnight fast, serum calcium, phosphorus, parathyroid hormone, and calcitonin levels were measured, as well as calcium and phosphorus urinary excretion for 24 hours. In HD, there was a decrease in calcitonin levels, which was associated with a decrease in serum total calcium and urinary calcium. The levels of parathyroid hormone, serum phosphorus, and urinary phosphorus in HD patients remain unchanged. Vitamin D3 levels were also found to be unchanged in HD patients. Because calcitonin has an antiresorption effect on bone, the observed low calcitonin in HD may indicate resorption of bone, which causes deformity and hypocalcaemia and hypocalciuria. The hypocalcitonemia without change in iPTH associated with hypocalcaemia could be due to a mutation in the Vit D receptor (VDR) or it could be an epiphenomenon.

A Review on Minimally Invasive and Robotic Esophagectomy

Marco Taurchini — 2021-05-31

Esophageal cancer is the eighth most common cancer worldwide, and surgical resection remains the gold standard, not just in terms of having the best chance of cure, but also in terms of providing the best palliation for dysphagia. Esophagectomy is a complicated procedure that is associated with considerable morbidity and mortality rates of 23–50% and 2–8% in Western countries, respectively. At the moment no gold standard techniques exist for esophagectomy. The technique chosen is influenced by various of factors, the most relevant of which are the tumor's location and the surgeon's experience. In high-volume centres, minimally invasive esophagectomy (MIE) has been found to reduce the rate of complications while providing the same oncological outcome as open esophagectomy. The addition of robotic technique to MIE is relatively new and is gaining widespread acceptance. Robotic assisted minimally invasive esophagectomy (RAMIE) is a safe and effective procedure with comparable short-term outcomes to conventional MIE. To see if there is any meaningful benefit to using the robotic technique, randomised studies are needed. Esophagectomy is a time-consuming and complicated procedure that has a high rate of morbidity and mortality.

A Case Report of Thyroid Aplasia Misdiagnosed as Failure to Thrive

I. O. Oluwayemi — 2021-05-31

Thyroid aplasia, a form of thyroid dysgenesis, is the most common cause of congenital hypothyroidism. Congenital hypothyroidism is one of the most preventable causes of mental retardation. The diagnosis of congenital hypothyroidism is challenging in our environment because of delay in diagnosis despite its debilitating effect on the intellectual development. We present a 10 year old girl who has been managed for failure to thrive, secondary to acyanotic congenital heart disease in the first year of life but later discovered on further evaluation to have congenital hypothyroidism (thyroid aplasia). She has since been on Levo thyroxine with remarkable linear growth but significant neurocognitive impairment.

Hormonal Responses to Exercise

Sarika Chaudhary — 2021-05-31

This chapter deals with stress hormones which are released into the blood in varying amounts and elicits a typical physiological response to different types and modes of exercises. The response of all the hormones to exercise is influenced by intensity, duration, type of exercise, gender and age. The effects are also variable on trained and non trained athletes. As the hormones are secreted in various pulses throughout the day in a circadian pattern, so the effects of diurnal variation have also been explained. Other than exercise, there are varieties of stimuli such as hypoglycemia, caffeine, hypoxia, glucagon, and hypercapnia which can greatly stimulate the response of hormones. The chapter has covered a wide range of literature on growth hormone, cortisol, testosterone and catecholamines and gives an insight of acute and chronic effects of aerobic, anaerobic, resistance and endurance exercises on these hormones.

Clinical and Microbiological Aspects of Perinatal Group B Streptococcal Disease – A Review

Allison Riddle — 2021-05-31

Background: Group B streptococci (GBS) continues to be a universal issue in inducing early onset sepsis in newborns. At the moment, the most effective strategy for reducing early-onset neonatal GBS disease is universal maternal screening for recto-vaginal GBS carriage at 35-37 weeks of gestation, combined with intrapartum antibiotic prophylaxis for colonized mothers. It has not shown a reduction in cases of late or late late-onset GBS infection, which tends to be initiated by environmental elements for newborns with prolonged hospital stays and extended contact with hospital staff. There is a concern whether greater antibiotic use in the peripartum period affects the incidence and antibiotic resistance profiles of GBS and other perinatally acquired bacterial infections; this issue remains unclear. Vaccines against GBS may out to be the most effective and long-term preventive option available.

Orthosurgical Correction of Unilateral Condylar Hyperplasia and Severe Facial Asymmetry: Case Series Study

Fayez Saleh — 2021-05-31

Purpose: The purpose of the present study was to emphasize the importance of thorough case analysis including all possible diagnostic measures of facial asymmetry prior to formulating an appropriate treatment planning and select the relevant treatment modality.

Patients and Methods: Six Patients, of different age and gender groups with severe facial asymmetry and unilateral condylar hyperplasia, were presented. Border line cases with suspected condylar growth (Age 18-25Y) were subjected to SPECT bone scan prior to orthosurgical intervention. The treatment procedure was selected according to: the condylar growth activity, severity of the dentofacial deformity and age of the patient. Some were treated with unilateral ramus osteotomy of the affected condyle, others with bilateral ramus osteotomy with or without genioplasty and the remaining needed bimaxillary surgery (Le Fort I maxillary osteotomy together with mandibular ramus osteotomy.

Results: Posttreatment records (Photos, Models, and radiographs) showed marked improvement in facial symmetry and normal occlusal relationship in 3Ds. The patients’ perception about their facial esthetics and functional occlusion was satisfactory.

Conclusions: Optimal oro-facial harmony and balance with normal functional occlusion were achieved. Collaboration between the healthcare team was a key factor in realizing treatment goals and patients’ contentment.

Insulin Resistance in Osteoarthritis and Type 2 Diabetes Mellitus

Elena V. Tchetina — 2021-05-31

Osteoarthritis (OA) and type 2 diabetes mellitus (T2D) are two of the most widespread chronic diseases. Diabetes is associated with an increased incidence of death and serious side effects, such as stroke, chronic kidney disease. Diabetes Mellitus is a metabolic disorder characterized by insulin resistance (IR) and pancreatic ?-cell dysfunction as a consequence of prolonged hyperglycaemia in the body. OA and T2D have common epidemiologic traits, are considered heterogenic multifactorial pathologies that develop through the interaction of genetic and environmental factors, and have common risk factors. In addition, both of these diseases often manifest in a single patient. Despite differences in clinical manifestations, both diseases are characterized by disturbances in cellular metabolism and by an insulin-resistant state primarily associated with the production and utilization of energy. However, currently, the primary cause of OA development and progression is not clear. In addition, although OA is manifested as a joint disease, evidence has accumulated that it affects the whole body. As pathological insulin resistance is viewed as a driving force of T2D development, now, we present evidence that the molecular and cellular metabolic disturbances associated with OA are linked to an insulin-resistant state similar to T2D. Moreover, the alterations in cellular energy requirements associated with insulin resistance could a?ect many metabolic changes in the body that eventually result in pathology and could serve as a unified mechanism that also functions in many metabolic diseases. However, these issues have not been comprehensively described. Here, we discuss the basic molecular mechanisms underlying the pathological processes associated with the development of insulin resistance; the major inducers, regulators, and metabolic consequences of insulin resistance; and instruments for controlling insulin resistance as a new approach to therapy.

Case Report on Modified Whale’s Tail Technique Using Amnion Membrane for Periodontal Regeneration in the Anterior Teeth with Diastema

Agraja Ganpat Patil — 2021-05-31

The most difficult aspect of periodontal regeneration in the anterior region is maintaining esthetics.

The Whale's Tail technique uses a new flap design that fulfils both of these goals while retaining the periodontal tissues' functional integrity.

The main complaint of a 46-year-old man was gum bleeding. 11 has a probing pocket depth of 7 mm mesially and clinical attachment loss of 8 mm, according to his periodontal evaluation.The whale's tail technique was used in this case to obtain a 4mm gain in clinical attachment level after 11 months utilising demineralized freeze-dried bone allograft (DFDBA) and Amnion membrane. In diastema cases, this approach successfully exhibits stable clinical outcomes in terms of managing anterior periodontal regeneration. Validation of these results will require long-term clinical trials. Whale’s tail technique combines the advantages of papilla preservation in esthetic cases as well as facilitates access to the underlying alveolar bone for regenerative purposes.

Impact of Sedentary Life Style on Anthropometric and Cardiovascular Parameters

M. K. Jayalakshmi — 2021-05-31

Aims: Physical inactivity is increasing among people of all ages in both developed and developing countries, due to an increase in sedentary lifestyles paired with an increase in the use of technology in daily life. A sedentary lifestyle contributes to a developing physical activity gap, or an imbalance between the requirement for and realisation of physical activity required for optimum health and functional ability. As a result, the purpose of this study was to observe the differences in specific anthropometric and cardiovascular parameters between sedentary and non-sedentary female individuals aged 25 to 55 years.

Methods: A total of 105 healthy female individuals were chosen at random from the Davangere city. Out of which 47 were sedentary and 58 were non-sedentary subjects. Anthropometric parameters such as weight, height, body mass index, waist circumference, hip circumference, waist to hip ratio were assessed. Cardiovascular parameters such as pulse rate, blood pressure were also assessed.

Results: Sedentary subjects had statistically significant increases in anthropometric and cardiovascular parameters as compared to non-sedentary subjects in our study.

Conclusion: Low levels of physical activity are linked to an increased risk of weight gain and a significant increase in blood pressure, according to this review. Although our study is by no means exhaustive, it provides a glimpse into the variety of adaptations /alterations in anthropometric parameters that occurs due to sedentary life style, even in the absence of overt disease. The anthropometric and cardiovascular parameters were increased in sedentary subjects but there was statistically significant increase after the age of 35 years.

DNA Repair Mechanism Operating during Cell Cycle Checkpoints in Eukaryotic Cells: A Briefly Review

M. Asimuddin — 2021-05-31

In this article, we have briefly reviewed the molecular mechanism involved in DNA damage and repair at various checkpoints of the cell cycle in eukaryotic cells. Eukaryotic cells have an ability to develop a response to DNA damage that can be caused by environmental factors such as chemicals, xenobiotics, free radicals, ionizing radiation (IR) or products of intracellular metabolism and also due to products of medical therapy. In response to these insults, the following reactions can take place in the cellular environment: (a) In the case of DNA damage, the protein machinery is activated and attaches itself to the site of the lesion which results in cell cycle arrest at the G1 to S phase (the G1/S checkpoint), DNA replication phase (the intra-S checkpoint), or G2 to mitosis phase (the G2/M checkpoint) until the lesion undergoes repair; (b) As there are many different lesions possible, the following DNA repair mechanisms are activated which include direct repair, base excision repair, nucleotide excision repair, mismatch repair, and double strand breaks (DSBs) such as, homologous recombination (HR) and non-homologous end-joining (NHEJ) repair. In HR, the most important emerging proteins are the tumor suppressor proteins BRCA1, BRCA2, and Rad51 which play an important role in maintaining the genomic integrity by protecting cells from double strand breaks. Therefore, it is important to identify the functional role of BRCA1 and BRCA2 proteins which will then be helpful in designing specific drugs in targeting solid tumors. Furthermore, interaction of Rad51 with BRCA2 protein complexes are essential for HR, which can be visualized by microscope as a foci and are thought to be representative sites where repair mechanism can take place. In addition, we have given special focus to the recent finding in the interaction of Rad51 with BRCA2 protein in double strand breaks by HR.

What the Photoreseptor Outer Segment Length Tells Us

Gamze Karatas — 2021-05-31

Recent advances in ocular imaging technology have successfully introduced novel analyses of retina morphology. It is the most common tool we use to show the Spectral domain optic coherence tomography retinal layers. There are four hyperreflective outer retinal lines on SD-OCT: external limiting membrane (ELM), inner segment ellipsoid (ISel, previously called the junction between the inner and the outer segments (IS/OS junction)), cone outer segment tips (COST), and retinal pigment epithelium (RPE). The PROS is located in between IS/OS and RPE. While measuring the PROS length, we only take measurements from the fovea where the cone cells are located. These cells are directly related to visual acuity and quality. In a database study on this subject ‘The difference in PROS length was not statistically significant neither for age nor for gender; females tended to have a lower PROS length than males and PROS length was slightly higher in the first two decades of life’ the data has been revealed. Also similar studies have been conducted for many diseases. We know that a retinal structure (PROS length) that gives so much information about vision and vision quality will be used more frequently in our daily practice in the future.

Early Functional Outcome of Ceramic on Ceramic Total Hip Replacement Using a 36 mm Diameter Femoral Head: An Advance Study

Sonu Mehta — 2021-05-31

At a tertiary care hospital, 30 patients with diseased hips were treated with uncemented total hip replacement with a 36 mm femur head and a ceramic on ceramic bearing.

The study included patients aged 30 and up, with the oldest patient being 75 years old. The most common reason for surgery was secondary osteoarthritis of the hip joint caused by femoral head avascular necrosis (21 patients). Other causes were primary osteoarthritis of the hip(3 patients), intermediate stage of avascular necrosis of femur head which had not progressed to the stage of osteoarthritis (2 patients), osteoarthritis post old history of trauma(2 patients), osteoarthritis post healed tuberculosis of the hip(1 patient), and ankylosing spondylitis (1 patient).

The patient was given a complete clinical and radiological assessment. Eight hours following surgery, all patients were instructed to perform isometric quadriceps activity. On the first post-operative day, patients were instructed to sit up and given knee bending exercises. On the first post-operative day, patients were encouraged to stand and walk non-weight bearing or partially weight bearing as tolerated. On the 12^th post-operative day, the sutures were removed. The average length of stay in the hospital was five days. The follow-up period lasted for 18 months. After 12 and 18 months post operation, patients were evaluated using the modified Harris Hip Score and the WOMAC score. All of the patients were followed up on a regular basis, and none of them were missed. During the research period, there were no complications. The mean Modified Harris Hip Score increased significantly from 26.6 pre operatively to 89.3 post operatively at 12 months and 90.0 at 18 months.

The mean WOMAC score has decreased significantly from 70.5 pre operatively to 14.8 post operatively at 12 months and 14.2 at 18 months. This demonstrates that an uncemented total hip arthroplasty with a 36 mm femur head and a ceramic on ceramic bearing can produce outstanding results. Total hip replacement is a permanent method of relieving pain in the hip due to various conditions.

Determining the Gender Differences in Cardiovascular Responses to Isometric Exercise in Normotensive Subjects

Prema Joshi K. — 2021-05-31

Introduction: There are various conflicting findings about the influence of gender on effect of isometric exercise on cardiovascular parameters.

Aim: The study sought to ascertain gender differences in cardiovascular responses to isometric exercise.

Materials and Methods: Handgrip exercises were performed on 25 normotensive females and 25 normotensive males (ages 20-25). The following parameters were studied – i) Maximum voluntary contraction (MVC), ii) Endurance time (ET), iii) Heart rate, systolic blood pressure, diastolic blood pressure and cardiac work was measured before and immediately after the handgrip exercise at 40% MVC. iv) all the above parameters were compared in between males and females.

Results: 1) When comparing males and females, MVC was substantially higher in males. 2) Females' endurance time was shown to be definitely higher than males'. 3) In both males and females, the heart rate, systolic blood pressure, diastolic blood pressure, and cardiac work increased significantly after hand grip training compared to before exercise.

Conclusion: Sympathetic activity is accelerated after isometric type of exercise. The responses are greater in males as compared to females.

Targeted Immunotherapy in Urological Malignancies

Abubakar Sadiq Muhammad — 2021-05-31

Targeted immunotherapy has revolutionized the treatment of urological malignancies. The approach tries to recapitulate the natural ability of the immune system to destroy cancer cells. This can be by use of non-specific agents such as recombinant Bacillus Calmette-Guerin (BCG) or use of specific agents such as immune checkpoint inhibitors (ICI) and anti-tumor vaccine. There was tremendous success in the use of BCG to reduce tumour recurrence and progression in non-muscle invasive bladder cancer (NMIBC). Of recent, immune checkpoint inhibitors are used to downstage muscle invasive (MIBC) to NMIBC or even achieved cure at the level of clinical trials. The ICI has shown a positive response in advanced renal cell carcinoma (RCC), castration-resistant prostate cancer (CRPC), refractory germ cell tumour of the testis. The ICI such as pembrolizumab, atezolizumab and ipilimumab achieved better response than sunitinib, a tyrosine kinase inhibitor; which is the standard of care in advanced RCC. Sipuleucel-T, an autologous prostatic acid phosphatase dendritic cell loaded vaccine, has been approved by US Federal Drug Administration Agency for CRPC. Immunotherapy is associated with manageable toxicity such as infusion reactions and immune-related adverse event which respond to the use of corticosteroids with or without cessation of the therapy.

Role of Multidetector Non-Contrast CT Scan in Estimation of Attenuation Value of Urinary Calculi and Predicting the Outcome of ESWL

Deepti Naik — 2021-05-31

Introduction: Urolithiasis is a common disease with an increasing incidence worldwide. Non- contrast computed tomography (NCCT) is the gold standard imaging modality for the patients presenting with acute renal colic. Extracorporeal shock wave lithotripsy (ESWL) has emerged as the treatment of choice for urolithiasis. The attenuation value in Hounsfield units evaluated by NCCT is reported to be a strong predictive factor for the successful outcome of ESWL.

Aim: To determine the attenuation value of urinary calculi by NCCT and to correlate it with the outcome of ESWL.

Materials & Method: This study is a prospective analytical study of 75 patients with urolithiasis who have undergone NCCT and ESWL at Ramaiah Medical college and hospitals, Bengaluru, Karnataka. The study period was from November 2013 to June 2015.

Results: The successful outcome post ESWL in different groups of attenuation value are 100% in group 1(<500HU), 92.6% in group 2(500-1000HU) and 33.3% in group 3(>1000HU). The failure rate was 7.3% in group 1 and 66.6% in group 3. The calculus density above 1000 HU decreases the rate of successful outcome post ESWL.

Conclusion: The attenuation value (HU) of the urinary calculi estimated by NCCT predicts the ESWL outcome thus identifying patients suitable to undergo ESWL.

A Case Study on Pellet Gun Injury

Pervaiz Majeed Zunga — 2021-05-31

Pellet gun inury can cause grevious and serious injuries especially of soft tissues and sensitive organs like eyes. Pellet gun used by law enforcement agencies have the potential to cause grevious or life threatening injuries as metallic projectiles fired at high speeds from pellet gun have potential to damage strongest structure likebone. The present case was observed in a series of patients who was hospitalized with pellet gun injury in the different consequences.

Alcoholic with Niacin Deficiency: A Case Study

Omar Farooq — 2021-05-31

The present case study demonstrates the alcoholic with niacin deficiency. Niacin deficiency can occur through genetic disorders, malabsorptive conditions, and interaction with certain medications. Alcohol use disorder is associated with increased malnutrition and can impair the conversion of tryptophan to niacin. A 45 year old male truck driver by occupation chronic alcoholic, normotensive, non-diabetic, with hyper pigmented dermatological lesions on dorsum of hands, neck, scalp labeled as psoriasis with topical treatment was brought to emergency casualty with fever for 15 days. Patient was managed as a case of febrile neutropenia without much improvement and his striking dermatological lesions and history of alcoholism warranted his management as pellagra.

Determining the Validation of Homegrown Stethoscope Simulator for Cardiopulmonary Training

Tarig Eltoum Yagoub Fadelelmoula — 2021-05-31

Background: Public protection is greatly enhanced by the knowledge of health care practitioners.

Advocates of simulation-based curriculum assert that this modality plays an especially significant role. Auscultation with stethoscope is an indispensable tool for optimal management of cardiopulmonary patients. However, the acquisition of sufficient training in cardiopulmonary auscultation is not straightforward because of the technical and ethical problems.

Aims: The aim of this study is to validate a homegrown stethoscope simulator for cardiopulmonary auscultation developed by the author and claimed to be of a low-cost and high-fidelity.

Materials and Methods: The hardware was built from a normal clinical stethoscope and a bluetooth headset, and the software is a single PowerPoint presentation slide with links to cardiopulmonary sounds’ audio tracts. The stethoscope simulator was verified by the inventor, and a panel of experts was asked to evaluate its value as a training tool, relevance to practice, physical attributes, realism of experience, ability to perform tasks, realism of material” and realism of auscultation sounds. The validity of this homegrown stethoscope simulator was assessed by a panel of experts. The members had a session on the simulator and how it works, allowed to physically examine the stethoscope simulator, instructed on how to use it, and then auscultated all its cardiopulmonary sounds. A survey was provided to each member of the panel, and they were asked to rate their responses using a 5-point Likert scale as follows: strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5).

Results: Experts in cardiology, respiratory medicine and respiratory care agreed upon the characteristics and attributes of this stethoscope simulator and the observed average of the “global assessment” of the stethoscope simulator was acceptable. The cost of fabrication of one simulator of this type was approximately 100 USD.

Conclusion: Primary evidence shows that this homegrown stethoscope simulator is a valuable instrument that can be built into bedside training and clinical experience labs to help undergraduate students understand and teach cardiopulmonary auscultation.