Highlights on Medicine and Medical Science Vol. 16

Study Background: Depth of invasion, although being considered as an independent risk factor for occult lymph node metastasis in oral cavity cancers, is very difficult to obtain by frozen section or incisional biopsy, making neck dissection compulsory for its’ determination. Hence, in this study, we are trying to set a pre-operative radiological cut-off through which we can prevent or limit un-necessary neck dissections and thus, reduce the associated co-morbidities.

Aims: 1) To know whether the increase in the depth of invasion in oral cavity carcinoma assessed histopathologically and radiologically co-relates with neck node metastasis. 2) To accurately co-relate the radiological thickness at which neck dissection is required.

Methodology: A retrospective study has been conducted over thirty patients with oral cavity carcinoma (buccal mucosa and anterior two-thirds of the tongue) in the time period of April 2018 to December 2018 who were operated in our tertiary care hospital.

Results: Depth of invasion is relatable histopathologically and radiologically and is directly proportional to neck node metastasis. Pre-operative radiology is a reliable modality to rule out the need of neck node dissection.

Conclusions: Depth of invasion is directly proportional to the incidence of neck node metastasis and pre-operative radiology has been reliable to rule out the need of neck dissection and reduce its morbidity.

Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. Infantile hemangioma develops during the first weeks of life, usually builds up over 3 to 6 months, and then regresses very slowly over a period of 3 to 7 years. Three quarters of these hemangiomas are lobular and are not associated with malformations. On the other hand, the hemangiomas referred to as segmental may be associated with developmental abnormalities (PHACES and PELVIS/SACRAL syndromes).

The majority of infantile hemangiomas require no treatment. In 10 to 15% of cases, treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options.

Background: Today, surgical repair of aortic type A dissections is routinely mandatory but some complications remain despite technical advances over several decades. The most important complications are neurological deficits that have been quantified with an incidence of up to 25% in international trials. In this study, we focused on the postoperative outcome over a ten year period after surgical repair of type A dissections. A special focus has been put on specific complications, neurological outcome and technical advances with modern surgical techniques including cannulation strategy.

Methods: A cohort of 147 patients undergoing surgery since 2004 was studied in a retrospective analysis with 10 year follow-up. Analysis was performed using Cox-proportional hazard model focusing on more than 30 variables.

Results: Survival after 1y (5, 10y) was 98% (88%, 50%). Early mortality of all patients declined to 14% in the last years. 27% were female, with a higher age than men (+10y, mean, 64+10y). Gender did not influence survival. Survival probability (Log rank test) for the first postoperative year was 0.82/0.77 (female/male) for 5 years 0.70/0.71, and 0.46/ 0.50 for 10 years.

Preoperatively, the carotid arteries were compromised in 25% of patients. Neurological deficits were preoperatively present in 11% of patients. Of those, a percentage of one third (33%) was reversible. Postoperatively, major and minor neurological deficits could be seen in 22% of all patients. Over the time, the incidence of postoperative complications could be reduced (from nearly 27% to 10%). The vascular access via truncal cannulation technique showed a significant lower risk vs. all other cannulation sites (p=0.0168).

Conclusions: The incidence of neurological complications could be reduced, either as reversible preoperative deficits or postoperative new complications.

Neurological disorders with concomitant carotid obstructions should lead clinicians to an extensive diagnostic approach, i.e. spreading the diagnostic look towards supraaortic/brachiocephalic branches of the aorta. By establishing technical modifications and surgical advancements, we could achieve a 50% reduction of postoperative neurological deficits from nearly 20% to below 10% and also of mortality rates from nearly 30% to about 15%. This is reflected by a growing number of longtime survivors. Adopting modern perfusion techniques helps reducing the incidence of those disabilities that bear an enormous subjective medical and also economic burden.

Normal pregnancy outcome is expected in most women with epilepsy (WWE). Pre-pregnancy counseling should focus on educating the patient about her disease, controlling her seizure with the most appropriate and lowest possible dose of Anti-Epileptic Drug (AED) is the key to the successful maternal outcome in WWE. Prenatal care should ideally be provided by joint epilepsy obstetric clinic. On analyzing data from epilepsy pregnancy registers from various national registers it is evident that newer AEDs like lamotrigine and levetiracetam are associated with a lower risk of major congenital malformations. Sodium valproate and topiramate appear to carry an alleviated risk of major congenital malformation and should only be used in WWE of reproductive age group if seizures are not controlled on other AED’s. Lamotrigine and levetiracetam have evolved as first-line drugs in the management of WWE. Although trials on a larger number of cases are needed to validate the results. The purpose of this article is to provide an update on the management of WWE prior to and during pregnancy. In the article information is presented concerning seizure frequency in pregnancy, effects of epileptic seizure on the fetus occurrence of complications during pregnancy and delivery, the incidence of fetal congenital malformations, effect on intrauterine growth, infant developmental and behavioral outcome.  

Background: Acute appendicitis presents surgeons with a diagnostic dilemma due to a large range of differential diagnoses and, in certain cases, unusual presentation. The most prevalent modality of diagnosis, sonography, has a very low specificity and sensitivity. It puts a surgeon in a difficult situation, especially in an emergency. In acute appendicitis, incorporating clinical scoring into the diagnostic process has been proven to improve decision-making and lower the rate of negative appendectomy.

Methods: This prospective observational study aimed to assess the efficacy of the Alvarado and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) ratings in the pre-operative diagnosis of acute appendicitis, as well as the correlation between these scores and histopathological diagnosis.

For the study, 100 cases that met the inclusion and exclusion criteria were selected. A diagnosis of acute appendicitis was made based on a complete history and a thorough clinical examination. The RIPASA score was found to have a greater sensitivity for detecting acute appendicitis. The RIPASA and Alvarado scoring systems had a negative appendectomy rate of 11.5 and 19.2 percent, respectively, whereas sonography had a rate of 12 percent.

Conclusions: Clinical scoring is a fast, easy, reliable, non-invasive, repeatable, and safe diagnostic technique for acute appendicitis without additional cost or risks. This study found that RIPASA is a better grading system for acute appendicitis diagnosis than Alvarado.

Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genitalia and perineal tissues that can be fatal. Young men are the most typically affected, however it can also affect women and children. The use of broad spectrum antibiotics and surgical intervention with serial wound debridement is the main stay of treatment and critical determinant of prognosis.

It's a difficult undertaking to rebuild a soft tissue defect after it's been debrided. The goal of this studyis to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene.

Methods: This prospective study included all patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender presenting to our hospital. Age, gender, aetiology, predisposing variables, clinical characteristics, defect location, type of bacterial flora, reconstructive treatment performed, length of hospital stay, post-operative pain, patient satisfaction, and death, if any, were all investigated. The technique chosen was based on the severity of the defect, the availability of local tissue, and the patient's preferences.

Results: 31 patients underwent reconstructive procedures.

The participants ranged in age from 4 to 74 years old (mean 38.5). Pain, scrotal swelling, and fever were the most prevalent symptoms. Urogenital disorders were the most common cause. 10 patients were treated by split-thickness skin graft, 5 by secondary suturing, 2 by unilateral superomedial thigh flap, 4 by bilateral superomedial thigh flap, 5 by tensor fascia lata flap, 2 by medial thigh V-Y advancement flap, 2 with perineal artery flap and one case healed by secondary intention

Conclusion: This study reveals that the mainstays of treatment are earlier presentation, early diagnosis, and intervention with debridement and suitable antibiotics. Except in one case, soft tissue defects caused by wound debridement required surgical reconstruction, reducing morbidity, hospital stay, and patients' return to normal life.

Background: Lower limb venous anomalies are a reasonably common source of morbidity. Colour Doppler Ultrasound has become the research of choice to confirm the diagnosis of lower limb venous illness, despite clinical diagnosis being the cornerstone. The role of Colour Doppler ultrasound in various venous diseases of the lower leg was investigated in this study, and the sonographic findings were correlated to surgical and clinical findings.

Methods: This study included 100 patients of all ages and genders who presented with clinically suspected entities affecting the venous system of the lower limb.

Results: In the age group of 21-40 years, our study revealed a clear male preponderance (65%), with an incidence of 41%.Isolated varicose veins were the most common, accounting for 58%, followed by isolated DVT (29%), varicose veins with thrombophlebitis (5%), DVT with thrombophlebitis (5%), DVT with varicose veins (2%), and hematoma (1%). (1 percent). The results were 100 percent accurate and corresponded with surgery.

Conclusions: Due to its high feasibility, accessibility, and cost effectiveness, Colour Doppler Ultrasound is unique. Its dynamism is also used by a variety of manoeuvres performed by patients, radiologists, and machine parameters to cause variations in blood flow in order to arrive at a precise diagnosis.

Introduction: The most common cause of abdominal pain is appendicitis, which is an inflammation of the appendix vermiformis. In children, appendicitis is also a sign that they need emergency abdominal surgery. Appendicitis affects 1.66 out of 1000 children. Perforation occurs in 97 percent of cases of acute appendicitis, with a mortality rate of 5.1 per 1000 cases if detection is delayed. Lymphocytic tissue hyperplasia, one of the immunological reactions to infection, is the most prevalent cause of appendicitis. The lack of personal hygiene was one of the infection factors. The goal of this study was to determine the level of personal hygiene in children with non-complicated appendicitis. We'd look at how personal hygiene affects the occurrence of non-complicated appendicitis in pediatric patients.

Methods: This study used descriptive quantitative observational research at Moewardi General Hospital Surakarta.

Total sampling in appendicitis patients with 33 respondents was used as the sampling strategy. The personal hygiene scale questionnaire, which consists of 12 items, was used to assess patients.

The incidence of paediatric appendicitis was the dependent variable in this study, with personal hygiene level as the independent variable. For descriptive analysis, the data were statistically examined.

Results: The findings revealed that 51.5 percent of paediatric appendicitis patients had inadequate personal hygiene.

Conclusions: The patient with paediatric appendicitis had a poor degree of personal hygiene.

Vector borne diseases remain a major threat to human health and wellbeing, as an epidemiological group; inflict a terrible and unacceptable public health burden on human kind. The objective of this chapter seeks to review some vector borne diseases of blood origin based on their symptoms, medical laboratory diagnosis, treatment and prevention. The developed world has been fortunate to have escaped much of the terrible burden of mosquitoes and their arthropod allies inflict on humans in their countries. Endemics for diseases such as malaria and dengue fever, but the introduction of west Nile virus in the Western hemisphere demonstrated that we can no longer be complacent in the face of emerging and resurging vector borne disease. Unfortunately as the burden and threat of vector borne disease have increased, the International Public Health Institutions should increase their capacities to address them across the countries of the world especially with the use of integrated vector management (IVM) starting from Nigeria, Africa and other parts of the world.

Background:  The skin is a sensory organ that responds immediately to emotional stimuli and has a major function in tactile receptivity. The impact of vitiligo on the quality of life is highlighted. 

Methods:  This study comprised 100 patients with vitiligo. A survey was conducted based on the Hamilton Depression Score (HAM-D), which included 17 different questions.

Results: The patients in this study were mostly in their third to fifth decade. The average age is 42.Males accounted for 44, while females accounted for 56. On the HAM-D scale, 25(25%) of the patients exhibited no evidence of depression, 45(45%) of the patients showed Mild depression, 20(20%) of the patients showed Moderate depression, and 10(10%) of the patients showed Severe depression.

Conclusion:  Vitiligo is a secondary psychocutaneous illness with depression as the most common psychiatric co-morbidity. Vitiligo treatment should include both psychiatric counselling and specific treatment.

Gastrointenstinal bleeding also known as gastrointenstinal hemorrhage is all forms of bleeding in the gastrointenstinal tract from mouth to the rectum. Upper gastrointenstinal bleeding includes hemorrhage originating from above ligament of Treitz. GI bleeding can be potentially life threatening. Rapid assessment and resuscitation should precede diagnostic evaluation in unstable patients with acute severe bleeding. Upper GI bleed usually present with hematemesis, coffee-ground emesis or malena. Acute upper GI bleeding is assessed by risk scores such as Rockall Score and Glasgow Blatchford Score.

Aim: To study the Clinical aspects of Upper Gastrointenstinal Bleeding in a Tertiary Care Hospital.

Methods: Total 100 patients were included for a period of one year. Patients with age above 18 yrs and below 60yr of both sexes presenting with gastrointenstinal bleed were included. All the patients were stabilized & subjected to endoscopic procedure within 72 hrs. Severity was assessed by Rockall Score.

Result: In this study the most common clinical presentation is malena. Chronic liver disease is the most frequent associated co-morbid condition. There is an association of alcohol with that of upper GI bleed.

Conclusion: Upper GI Bleed is a common medical emergency. In this study conducted in a tertiary care hospital the most common presentation of upper GI bleed is malena. It is associated with the more incidence of duodenal ulcer. The frequent associated co-morbid condition is chronic liver disease. Alcohol shares a significant role in the onset of upper GI bleed.

Introduction: In order to provide adequate antenatal care, accurate gestational age assessment is critical.

Recent research suggests that, in addition to normal biometric indicators, kidney length should be considered when calculating the duration of pregnancy by ultrasonography.

Materials and Methods: A prospective cross-sectional study of 120 pregnant women was conducted in a single centre. Kidney length was assessed at two-week intervals between 24 and 40 weeks, in addition to usual biometric measures. A total of 240 renal vertical measurements were recorded, with the average of the right and left renal lengths being used to determine the final kidney length. The mean and standard deviations for each variable were determined using descriptive analysis. Pearson regression coefficients were used to find the association between gestational age and other foetal characteristics and to evaluate which regression model provides the best fit for prediction of gestational age.

Results: The length of the foetal kidneys grew longer as the pregnancy progressed (from 23.2 mm at 24 weeks to 40.1 mm at 40 weeks). The regression formula (gestational age = 2.195 + 0.942 X kidney length) demonstrated a good degree of correlation (R2 0.97, p<0.001, SE of prediction 4.7 ± 3.9), which was superior to other prediction models employing standard biometric parameters.  When femur length was included in a stepwise manner to multiple regression models with several conventional factors, there was a considerable improvement in forecasting gestational age. Conclusion: The current study found that foetal kidney length is a credible indication of gestational age between 24 and 40 weeks of pregnancy, and that it may be useful in pregnancies with incorrect dates, the absence of a dating scan, and women who conceived during nursing.

This review is aimed to compile available data on COVID-19 that is threatening the globe with a view to suggesting possible ways out of the pandemic disease. Emphasis is laid on the use of safe water in ameliorating the COVID-19 while the effects of corona virus (if any) on the safe water is discussed.

Safe water constitutes major resources to meet the requirements of basic hygiene that are necessary in curtailing the spread of COVID-19. This study reviewed COVID-19 Pandemic and its attendant problems. The role of safe water in ameliorating the deadly effects of COVID-19 is discussed. Literature search was the major methodology to this review. Results revealed that devastating Pandemics including Bubonic plague and small pox, killing 200 million and 56 million people respectively have been reported in literature. Only 83,600 deaths were reported globally due to COVID-19 as at April 2, 2020. Two main possible sources of the Pandemic are natural source and transmission through bats and/or pangolins. Respiratory droplets are believed to be the most common mode of coronavirus transmission. No vaccine has been developed for COVID-19. To mitigate the Pandemic; maintain social distancing, avoid hands shake/hugging; constantly wash your hands under running taps and rub hands with sanitizer. There is no current evidence that corona viruses are present in surface/groundwater but controlling the spread of the virus is closely related to water and sanitation. COVID-19 has negatively impacted humans’ health and the globe’s economy. Preventing COVID-19 is feasible if the global humans’ requirement for safe water is attained.

Aims: In this study we will raise the particularities of rheumatic mitral valve disease as well as its surgical management. We’ll evaluate which prognostic factors affected long term outcomes in mitral valve repair and replacement.

Methods: This study examines 1025 cases of patients who had mitral valve surgery at the Ibn Sina Hospital in Rabat, Morocco, between January 2, 2001 and April 5, 2012.

A clinical and paraclinical evaluation has been established prior to surgery.

Results: Mitral stenosis and functional tricuspid insufficiency are the most common valvular problems. In 93 percent of cases, the gesture was the first intervention, with mitral valve replacement in 90% of cases and plasty in 10% of cases.

Conclusion: These patients deserve a more precise assessment when choosing a surgical method that has a significant impact on post-operative outcomes. This research examines the criteria that promote mitral repair surgery in patients with rheumatic disease, as well as the efficiency of existing repair approaches against prosthetic valve replacement in developing nations.  

Detection of QRS complex is an important step for the analysis of heart rate variability. It has been proved that the algorithms based on the use of differentiation are efficient and hence can be used for the real-time analysis. At the same time, fractional order digital differentiators are gaining their interest in many areas of research. In this paper, an attempt is made to detect QRS complex by making use of the proposed transfer functions of digital differentiators. The transfer functions in s domain are obtained by making use of the Continued Fraction Expansion Method. The Bilinear Transform and Al-Alaoui Transform are used for the purpose of discretization. These filters are used for the detection of QRS complexes. The result has been proven to be comparable to the conventional techniques.

Ambulatory proctological surgery is becoming more popular due to time and financial constraints. Our research focuses on ambulatory proctological surgery as an innovative and cost-effective procedure. The first ambulatory anorectal surgery was performed in 1962 at the University of California, Los Angeles, and has since evolved through the years. The study comprised 30 patients who underwent elective anorectal operations with posterior perineal block at KLES hospital Belgaum between November 2004 and November 2005. All of the patients in the posterior perineal block group were ambulatory in less than half an hour after surgery, proving that ambulatory proctological surgery is a revolutionary procedure in today's practise. The majority of the patients experienced just minor discomfort following surgery. Urinary retention occurred in 16.7% of patients after surgery, however it was statistically insignificant. Within 24 hours of surgery, 86.67% of patients in the posterior perineal block group were discharged. According to our findings, ambulatory proctological surgery is recommended as a novel method of practise, particularly under posterior perineal block, because there is less post-operative pain and patients are discharged sooner, lowering costs and making healthcare more affordable.