Highlights on Medicine and Medical Science Vol. 13

The malignant tissues, by the virtue of their expansion increased ionic movements producing magnetic fields of higher intensity than the benign ones. In our studies the biomagnetic activity of prostatic carcinomas was found lower compared to breast carcinomas. These results could be explained by the lower angiogenic activity of prostate carcinomas, in comparison to other malignancies. In this chapter we describe the probable diagnostic value of biomagnetic activity measurements in evaluating prostate lesions.

Background: An important source of debate in orthopaedic practices is the choice of performing simultaneously, staggered or staged bilateral total knee arthroplasty (BTKA). Many studies are available which compare Bilateral simultaneous Vs staged TKA in terms of functional outcome. But still there are no studies which include staggered BTKA (Done in a single hospital stay) and compared their functional outcome, associated complication with a 90 day readmission rate.

Methods: A retrospective review of 300 TKAs patients who underwent bilateral TKA. Patients were divided into three groups with 100 patients each in simultaneous, staggered, staged group. We use hospital electronic health records database to compare the complication and readmission rates in all three groups. Functional outcome was evaluated preoperatively using knee society score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Knee score (OKS) Kujala score and range of motion (ROM).

Results: The study consists of 234 females and 66 males, among which maximum females were in a simultaneous group while male where more in staggered group. Mean age group in our study was 62.25%. ASA score of 3 was significantly more in staged group. Patient in the staggered group had a better KSS and Kujala score with better range of motion and less readmission and complication rate. Simultaneous BTKA had slightly higher complication rate.

Conclusion: This study demonstrates that there is not big significant in functional outcome when comparing simultaneous, staged and staggered bilateral TKA, but still staggered group shows better postoperative functional outcome.

Introduction: Hidradenocarcinoma is a rare aggressive tumor arising from sweat glands that may occur from preexisting hidradenoma or most frequently appears de novo. It occurs most often in old patients and is located in the head, neck and trunk in the majority of time. this tumor is also characterized by a high potential of local recurrence, metastasis and poor outcome. This tumor is often radiotherapy and chemotherapy resistant. We report herein an observation of a good clinical response with a long disease control under capecitabine in metastatic hidradenocarcinoma.

Presentation of Case: We report a case of a 77-year-old man with a metastatic hidradenocarcinoma to the bone and lymph nodes who was operated 7 years ago for an hidradenoma of the right foot. He was treated with capecitabine based chemotherapy with good tolerance and obtention of partial response during 10 months. After that, his disease progressed and he died 1 year after diagnosis.

Conclusion: Hidradenocarcinoma is a cancer with a poor prognosis. Because of its low prevalence and high rate of recurrence, its treatment is still controversial. Our good result demonstrates that adjunction of chemotherapy in metastatic forms is effective for a better control and long overall survival.

Background: The term “Abnormal Uterine Bleeding (AUB)” is used for abnormal genital tract bleeding that accounts for 10-15% of all outdoor patient visits in Gynecology department. Common causes of AUB include endometrial polyps, endometrial hyperplasia, sub mucous fibroids and anovulation. Accurate diagnosis of AUB can reduce the incidence of un-necessary surgical interventions and hysterectomies.

Aims & Objectives: Aim of this study is to evaluate the usefulness of transvaginal sonography (TVS) in comparison to hysteroscopy in patients of AUB.

Materials and Methods: A prospective and comparative study was carried out in the Department of Obstetrics and Gynecology over a period of one year in 100 patients attending the OPD with AUB. TVS and hysteroscopy were done in all the patients presenting with AUB and further procedure was done according to the need.   Results were analyzed to check the performance of TVS pick up rate in relation to hysteroscopy and biopsy report was taken as gold standard.

Results: Grossly it seems hysteroscopy is closure to tissue diagnosis, but p-value is not significant.

Conclusion: Combination of all the three modalities is helpful in accurate diagnosis of AUB etiology and better management of the patient by reducing unnecessary hysterectomies.

Background: The success rate of Tympanoplasty for the management of Chronic Suppurative Otitis Media (CSOM) ranges from 35% to 92%. A number of factors, such as age of patient, size and site of perforation, status of ear, ossicular status and surgical technique influence the success rate. The objective of this study was to assess the prognostic value of MERI in predicting the outcome of tympanoplasty in CSOM.

Methods: A one-year prospective observational study was conducted on 50 patients. The subjects were all cases of CSOM in the age group of 18-55 years with conductive hearing loss who underwent tympanoplasty with or without cortical mastoidectomy. The role of MERI was analyzed as a prognostic indicator.

Results: Graft uptake was successful in 92 percent of cases (n = 46). 32 of the 46 cases had a mild MERI score, ten had a moderate MERI score, and four had a severe MERI score. It was observed that higher MERI score correlated with lower rate of graft uptake.

Conclusion: Our study comprised of 50 patients of safe CSOM who were categorized into mild, moderate and severe on the basis of pre-operative MERI score. All of the patients had tympanoplasty with or without cortical mastoidectomy, and the surgical outcome was determined to be substantial in terms of graft uptake. Higher the MERI score, lower was the graft uptake rate, whereas lower the MERI score, higher incidence of graft uptake was seen. Thus, preoperative MERI can be a useful tool to ascertain the prognosis of tympanoplasty.

One recent study analyzed epidemiological data of the coronavirus disease-2019 (COVID-19) from 17 countries within the first 90 days of lockdown in Wuhan, China. However, it is important to understand the current global situation for precautionary measures. The present study aims to analyze the global epidemiology of the COVID-19 pandemic from 212 countries until the end of 2020. In this population-level observational study, we sourced data from 212 countries from worldometers.info until December 31, 2020. The data was analyzed for epidemiological factors, including the case rates, active cases, recovery rates, severe cases, mortality, and case fatality. Although the worldwide recovery rate is 70·78%, the mortality and case fatality rates are 0·02% and 2·18%, respectively. The prevalence of cases is high in Andorra (10·41%), and the rate of active cases is high in Martinique (97·69%), France (90·12%), and Belgium (90·09%). Although Guinea-Bissau (50%), Antiqua and Barbuda (16·67%), and Saudi Arabia (13·81%) also show a high number of cases, the recovery rate is around 90%. In Yemen, both severe cases (24·21%) and case fatality rates (29·06%) are high; however, the recovery rate is just above the average of 66·41%. Macao, Marshal Island, New Caledonia, and Singapore have a 100% recovery rate. The recovery rate is high worldwide, and the mortality rate is lower. However, the severity of the disease is high in Yemen. These results provide continuous surveillance of the COVID-19 pandemic for the worldwide scientific community.

Background: The comprehensive knowledge of the normal and variant arterial anatomy of the upper extremity is of great significance to the vascular radiologist and surgeons for accurate diagnostic interpretation as well as in the smooth conduct of interventional and surgical procedures on the upper extremity.

Anatomical knowledge of the anomalous branching pattern of the brachial artery is critical during percutaneous arterial catheterization to prevent issues from accidental damage to the anomalous blood vessel, and knowledge of the variations is critical for plastic surgeons who use flaps for reconstructive surgery. Knowledge of higher division of brachial artery is also important for all cases of traumatic amputation and revascularization techniques. It has to be remembered that the bifurcation of the brachial artery is the commonest site for embolism and a higher bifurcation would result in a larger area of ischemia than expected and the higher division seeks a greater clinical significance.

Materials and Methods: The current investigation involved 50 upper limbs of both sexes from an embalmed adult human cadaver used for undergraduate dissection at Mandya Institute of Medical Sciences in Mandya.

Results: The normal brachial artery was discovered in 42 specimens, accounting for 84 percent of the total.

Variations were found in 8 specimens (16%); five of these had trifurcation of the brachial artery into the radial, ulnar, and radial recurrent arteries (10%); one specimen had double profunda brachii artery (2%); one specimen had high origin of the radial artery (2%); and one specimen had high division of the brachial artery in the proximal third of arm (2%).

Conclusion: Physicians, cardiologists, vascular surgeons, and interventional radiologists need accurate anatomical knowledge of the brachial artery and its branching pattern, as well as their variations.  The study of these variations and their awareness aids in the prevention of iatrogenic blood vessel injuries, the management of accidental/traumatic injuries to arteries in the upper limb, and during diagnostic procedures (like arteriograms).

The most common cause of morbidity and mortality in cirrhotic patients is portal hypertension and bleeding from gastroesophageal varices.Portal hypertension is initiated by increased intrahepatic vascular resistance and a hyperdynamic circulatory state. The latter is distinguished by a high cardiac output, increased total blood volume, and splanchnic vasodilatation, all of which result in increased mesenteric blood flow. The splanchnic and hepatic vascular beds are both targeted by pharmacological management in cirrhotic portal hypertension. Drugs that target the components of the classical renin angiotensin system (RAS), such as angiotensin converting enzyme inhibitors and angiotensin II type receptor 1 blockers, are expected to reduce intrahepatic vascular tone by reducing extracellular matrix deposition and contractile cell vasoactivity, and thus improve portal hypertension. Off-target effects such as systemic hypotension and renal failure have been observed with these medications. As a result, non-selective b-blockers (NSBBs) are the current therapeutic mainstay for preventing variceal bleeding and enhancing patient survival by lowering portal pressure.. These NSBBs function by lowering cardiac output and splanchnic vasodilation, however most patients do not get an adequate therapeutic response, and a large percentage of patients are unable to tolerate these medications. Although statins have been demonstrated to reduce portal pressure and overall mortality in cirrhotic patients when administered alone or in combination with NSBBs, further randomised clinical trials with larger patient populations and specific clinical end points are needed. Recent findings from studies looking into the potential use of blockers of alternate RAS components to inhibit splanchnic vasodilation in portal hypertension provided compelling evidence that could lead to the development of drugs targeting the splanchnic vascular bed to inhibit splanchnic vasodilation in portal hypertension. This review outlines the mechanisms underlying the pathogenesis of portal hypertension and attempts to provide an update on currently available therapeutic approaches in the management of portal hypertension, with a focus on how the alternate RAS could be manipulated in our quest for safe, specific, and effective novel therapies to treat portal hypertension in cirrhosis.

This article reports the case of a 47 years old female patient with pyogenic granuloma, which was surgically managed. However, to our knowledge, there is no report of a PG arising from nasopharynx to date. The etiology of pyogenic granuloma (PG) is unclear; it is a reactive tumor-like lesion arising by various stimuli. On October 15th, 2018, a 47-years old Saudi female presented with nasal obstruction for one month. The patient's complaint was associated with on/off epistaxis, headache and allergic symptoms. On examination, she had pedunculated nasopharyngeal lesion. Radiological studies revealed a right nasal cavity mass, a lesion in the nasopharynx without extension to the adjacent structures. Removal of the lesion by nasoscope and cauterization of the base were done. Histopathology revealed vascularized granulation tissue with ulcerated epithelium and fibrinous exudates. Nasopharyngeal pyogenic granuloma is rare. It is one of the differential diagnosis of nasal bleeding.

Background: Trigeminal neuralgia (TN) is a rare kind of face pain.

It's characterised by a rapid onset of acute electric shock-like facial discomfort that's centred along the fifth cranial nerve's sensory distribution.

Although many patients respond to medicinal treatment, when PTS symptoms become intractable and drugs are no longer effective, patients must seek surgical decompression. Our study aims to review about the correlation of vascular compression radiologically and during surgery and micro vascular decompression for trigeminal neuralgia and its outcome along with the review of literature. 

Methods: It's a retrospective study that looked at 40 people who were diagnosed with TN between July 2009 and July 2015.

All of the patients have undergone MVD.

We looked at demographic information, clinical presentation, surgical findings, complications, and long-term follow-up.

Results: The median age of onset of TN is 50.4 years, with five age groups ranging from 24 to 89 years, with a 65.5 percent female preponderance over men.

The ratio of right to left in the distribution of location was 1.5:1.

The study found no evidence of mortality.

Three patients in the study population experienced complications.

Three patients exhibited facial hyposthesia, one had V3 paresis, and one had CSF otorrhoea, all of which were resolved with LP drainage.

Except for one patient who had prolonged discomfort, all of the patients improved satisfactorily.  Conclusions: To summarise, microvascular decompression (MVD) is the surgical method of choice for medically refractory TN patients who are surgically fit.

MVD has the highest rate of long-term patient satisfaction and the lowest rate of pain recurrence of all the currently known surgical procedures.

Objective of the Study: To observe the efficacy of the online questionnaire in assessing the risk of Polycystic Ovary Syndrome (PCOS) in young women.

Background: PCOS is a rising morbidity among young women around the world. Exogenous variables such as irregular menses, hirsutism, and obesity have been linked to this condition.In the Indian population, there are few standardised self-assessment measures based on easily observable characteristics that can assist patients effectively determine their PCOS risk.

Methods: The survey questionnaire was filled out by undergraduate women between the ages of 18 and 22 who were enrolled on a university campus. The self-assessment test consisted of 19 questions with binary answers of "yes" or "no." Each "yes" received one point, while each "no" received zero, for a total of 19 points.

The scores of women with irregular menses (the test group) were compared to those of women with normal menses (the control group) (control group).

The significance between the groups was calculated using Welch's adjusted t-test at 5%.

The existence or absence of PCOS was established by the clinical examination.

Results: The study enlisted the participation of 1,544 women. According to the findings, 262 (24.8 percent) of young women have an irregular menstrual cycle. The average total score of the control group was 3.07±2.35, while the average total score of the women with irregular menses was 5.93±2.86. On clinical examination using Rotterdam criteria, 21 out of 28 females who scored high were diagnosed with PCOS.

Conclusions: The risk of PCOS can be assessed using the self-assessment test. This test has a sensitivity and accuracy of 75% when it comes to predicting the existence of PCOS.

Background: Children frequently suffer fractures of the lateral condyle of the humerus. They may require surgical reduction and fixation with Kirschner wires(K-wires) if they are displaced or unstable. These may be passed through the skin and left exposed or buried subcutaneously.

Aims and Objectives: The study was carried to determine the preferable method of K-wire placement (buried vs exposed) wrt lateral condylar fractures managed by K-wire fixation.

Materials and Methods:  From January, 2019 to March,2020, a prospective study was conducted in the department of orthopaedics at my college. A total of 37 individuals were involved in the research.

Results: Patients were followed for three months, with outcomes based on union, infection, carrying angle at the elbow, and range of motion (ROM) as measured by clinico-radiological methods.

Conclusion: The buried wire group had a higher rate of union than the exposed wire group, and the wires could be removed under local anaesthetic, avoiding any significant procedures. The risk of infection is also lower, making this a preferable option than the exposed cohort.

Introduction: The use of first trimester screening including nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), free-beta subunit human chorionicgonadotrophin (f\(\beta\)hCG) to detect aneuploidy has become an integral part of prenatal care. Estimation of serum PAPP-A levels have also been studied extensively regarding other predictability for adverse perinatal outcome. This study which is a case control study also tries to establish the association between low PAPP-A levels among the pregnant woman and adverse maternal foetal outcome.

Objectives:

Primary Objective: To determine the association of low PAPP-A level in the first trimester of pregnancy with the adverse maternal and foetal outcomes.

Secondary Objective: To estimate the predictive values of low PAPP-A level in predicting adverse perinatal outcomes.

Methods: This is a case -control study done during August 2017-May 2018 in the women delivered at the Department of OBG at Mehta Multispecialty Hospitals India Pvt. Ltd. Women delivered in the labour room who had a first trimester screening of PAPP-A level.were explained about the study after getting informed consent (Annexure II & III), questionnaire which include detailed antenatal history, mode of delivery and details of the baby data, entered into the annexure II. Depending upon the outcome, the subjects are classified as case group or control group. Out of the study sample of 264 subjects, 88 patients who were reported to have complication were taken as cases and 176 patients with no complications are taken as control and both the case and control group study were undertaken.

Results:

• The study had revealed that there is no statistically significant association of factors such as maternal age, parity, marital history, family history and previous obstetric complication between the case and control groups.
• Mode of conception (ART, IUI, Ovulation induction) than spontaneous conception, significantly represented more number in case group compared to control group which is proved statistically (p < 0.05).
• In case group, 78% had deliveries < 37 weeks and 18% had term deliveries and the difference was statistically significant with the control group
• In our study there is high incidence of PIH & Pre-Eclampsia (17%), followed by Preterm (9.1%) and IUGR (6.8%) with normal outcomes in 66.7%.
• In our study, out of 264 deliveries, LSCS rate is higher compared to the normal delivery. The percentage of normal delivery is 28%, while LSCS deliveries were more than 72%.
• In our study Low PAPP-A level (<0.5MoM) shows high incidence of PIH & Preeclampsia, followed by IUGR and Preterm. When PAPP-A level >0.5MoM, normal outcome is more than the adverse outcome. The difference in the PAPP-A levels is statistically significant.
• In women with low PAPP A level, low birth weight found statistically significant when compared with < 0.5 PAPP A level. NICU admission & APGAR not found to be statistically significant. LBW babies prevalent high in low PAPP A level.
• In the present study, the sensitivity of PAPP A levels in identifying the complicated outcomes was 17.04% and the specificity was 98.85%. The positive predictive value of predicting the complications was 88.23% and negative predictive value of 70.44%.

Conclusion: Thus from the above study, it is as curtained that the low PAPP-A levels confirmed during first trimester of pregnancy is associated with adverse maternal and fetal outcome such as PIH, preeclampsia, preterm, IUGR & LBW. Hence the obstetrician should be alert and watchful whenever encountering patients with low PAPP-A levels which can also help on self to be prepared.

Diabetes Mellitus (DM) and one of its types; type 2 diabetes mellitus (T2DM) is more prevalent from adolescent across the globe, invariable of heredity and age. Diet restriction shall cope up and help body metabolism to absorb the required nutrition and eliminate the junk out of body under healthy diet. Masking of insulin action on target cells leads to insulin resistance (IR) and decreased insulin sensitivity (IS) resulting in increased glycated products such, glycated hemoglobin, glycated albumin and other glycated macromolecules called Advanced Glycation End products. Along with AGE and diabetic profiling, BMI, insulin and lipid profiling may help elucidate the correlation between CML and glucose metabolism in diabetics and diabetic nephropathy cases. CML is formed by Glycoxidation and lipoxidation. Thereby, objectives of this study includes correlation of CML with important diabetic and insulin profile to give a supporting evidence for labelling CML as harmful molecule. Basic renal profiling was performed to assess kidney functioning and finding its relation with CML. CML positively correlated with HbA1c, TG and HOMA IR and negatively correlated with QUICKI in group 2 signifying increased damage to tissues due to collective action of glucose, lipid and insulin resistance. Monitoring plasma CML regularly during follow up along with HbA1c may help keep track on plasma glucose status and its deleterious effects on tissues thereby preventing erosion of tissue and vascular lining.

While millions of men have been circumcised cumulatively under the mass male circumcision campaigns for the prevention of HIV, the uptake of male circumcision (MC) is below the set targets. This suggests that prevention of HIV is not a convincing motive for circumcision to the majority of men. Notably some men are undergoing male circumcision for other psychosocial motives, rather than the primary public health motive of preventing HIV transmission. These motivations have not been explicitly studied in order to determine their potential impact on the HIV prevention strategy of male circumcision. This study aimed at assessing the psychosocial motives for undergoing male circumcision in Swaziland and determines their potential impact on the success of the mass male circumcision strategy. A qualitative study design was used, in which in-depth individual face-to-face unstructured interviews were conducted with 17 men seeking health care services at the Family Life Association of Swaziland clinic in Mbabane, Swaziland. All men aged 18 years and above were eligible. Results indicate that some men are undergoing circumcision primarily for psychosocial reasons rather than for HIV prevention. These psychosocial motives include: giving in to pressure from public health advocates, sexual partners and peers; to perceived sexual benefits of the procedure; to demonstrate one’s manhood, as well as to utilise the free and readily available male circumcision services. However, subsequent safe post-MC sexual behaviour is not guaranteed. Nevertheless, it was recommended that these motives be emphasised in the mass male circumcision campaigns, along with appropriate health education, in order to complement HIV prevention in promoting uptake of male circumcision and ensuring safe post-circumcision sexual behaviour.

The Human Immune Deficiency Virus has been able to threaten the human population all over the world for the last four decades. Presently, an alarming number of people are living with HIV/AIDS and a huge number are getting infected every year. Though global trends show a gradual decline in the number of HIV infected persons since 2010, yet, the numbers are alarming enough to send chills down the spine of human race. Among the different modes of HIV transmission, blood transfusion is one of the important routes by which people may acquire the infection. The risk of HIV infection through blood transfusion depends on several factors. Proper and effective screening of blood is therefore mandatory. Non-remunerated and voluntary blood donation services are to be stressed upon. So, utmost caution and more effective advanced screening techniques along with training and orientation of the counselors is the call of the hour to decrease the spread of HIV infection through blood transfusion.