Editor(s)

Dr. Ravi Kumar Chittoria
Department of Plastic Surgery & Advanced Centre For Microvascular, Maxillofacial & Craniofacial, Laser Surgery, Tertiary Burn Care, Antiaging & Regenerative Medicine, Smile Train, Advanced Wound Care, Telemedicine, Cadaveric Organ & Tissue Transplantation, Skin and Tissue Banking.
Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER).
(An Institute of National Importance under Ministry of Health & Family Welfare, Govt. of India) Pondicherry-605006, India.
Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

ISBN 978-93-91473-63-1 (Print)
ISBN 978-93-91473-95-2 (eBook)
DOI: 10.9734/bpi/hmms/v17

This book covers key areas of medicine and medical science. The contributions by the authors include hair regrowth, Wound healing, Wnt signaling, WD-Aptamer, anti-oxidation, vitamin C, ROS, DNA aptamer, inflammatory effects, lymphedema, chronic oedema, complex decongestive physiotherapy, manual lymph drainage, granulomatous, mastitis, tuberculous, malignancy, abscess, sinuses, histopathology, pregnancies, gestational diabetes, placenta, prognosis, disseminated tumor cells, bone marrow, non-small cell lung cancer, morphology, flow cytometry, cancer stem cells, subpopulations of T-cells, abnormal uterine bleeding, endometrium, histopathology, parotid cyst, mammary analogue secretary carcinoma, salivary gland tumors, total conservative parotidectomy, post-operative radiotherapy, Vitamin C binding aptamer, oxidation, oxidative stress, antioxidation, broad ligament pregnancy, ectopic pregnancy, laparotomy, ultrasonography, prostate cancer, statistics, epidemiology, mortality, risk factors and prevention, supercritical fluid, decellularization, perimenopause, teratoma, torsion, ovarian tumours, malignancy, ademolus classification of hypoglycemia, ademolus hypoglycemic index, hypoglycemia, continuous glucose monitoring, hemothorax, Video-assisted thoracoscopic Surgery. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.

 

Media Promotion:


Chapters


Negative Regulation of Wnt/\(\beta\)-catenin Signaling is Blocked by Wnt Signaling Component Protein Dishevelled1 Binding Aptamer (WD-Aptamer): A Recent Study

Sooho Choi, Ji Hyun Kim, Yunseok Heo, Eun-Sun Kim, Solip Choi, Weontae Lee, Jeong Hoon Kim

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 1-8
https://doi.org/10.9734/bpi/hmms/v17/2840F

Dishevelled1 (Dvl1), which plays an important role in Wnt/\(\beta\)-catenin signaling, consists of three domains. DIX domain for Dvl1 polymerization, DEP domain for binding of Dvl1 to other signal transduction molecules, and PDZ domain for binding to the membrane bound receptor Frizzled. CXXC5 is one of several proteins that bind to Dvl1, and when these two proteins bind together, they negatively regulate the Wnt/\(\beta\)-catenin signaling. Wnt/\(\beta\)-catenin signaling plays a crucial role in bone formation, hair regrowth, and wound healing.

Here, we developed Wnt signaling component protein Dvl binding Aptamer (WD-Aptamer), a DNA aptamer that specifically bind to Dvl1_PDZ domain. WD-Aptamer that binds to Dvl1_PDZ domain was developed through an in vitro method of selection referred to as Systematic Evolution of Ligands by EXponential enrichment or “SELEX.” The WD-Aptamer binds to Dvl1_PDZ domain with high specificity and affinity, yielding an estimated Kd of 284.8 nM.  The binding of CXXC5 and Dvl1 is inhibited by WD-Aptamer and negative regulation of Wnt/\(\beta\)-catenin signaling is blocked.

Investigating the Effects of Oxidative Stress Prevention Using DNA Aptamer (Aptamin C®) in Keratinocyte

Sooho Choi, Yoonjeong Hwang, Taejun Kim, Jeong Hoon Kim

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 9-16
https://doi.org/10.9734/bpi/hmms/v17/2795F

Oxidative stress is one of the leading causes of various diseases. Oxidative stress conditions occur when reactive oxygen species (ROS) levels exceed cell defense mechanisms. Antioxidants are effective against ROS, a major factor in oxidative stress. Antioxidants play important roles in our body by scavenging free radicals, thereby preventing them from damaging biological molecules. Vitamin C is essential for various physiological functions such as the synthesis of collagen and neurotransmitters, and it is a major antioxidant. Although vitamin C is widely used in cosmetic and therapeutic products, it easily undergoes oxidation by air, pH, temperature, and UV light, thereby decreasing its potency as an antioxidant and reducing the shelf-life of products containing vitamin C. To overcome this drawback, we developed Aptamin C®, an innovative single-strand DNA aptamer that maximizes the antioxidant efficacy of vitamin C by binding to its reduced form and delaying its oxidation. To investigate the effect of Aptamin C® and vitamin C complex on human skin, we performed both in vitro and clinical tests. We observed that the Aptamin C® and vitamin C complex had effective ROS-scavenging and anti-inflammatory effects.

Lymphedema Management – A Clinical Approach

Naveen Narayan, Vikram Ramamurthy

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 17-23
https://doi.org/10.9734/bpi/hmms/v17/11341D

Background: Lymphedema is a chronic lymphatic system condition characterised by reduced lymphatic return and swelling of the affected area. Despite the fact that it is a significant cause of morbidity, little is known about the epidemiology and impact of this illness on patients or health systems. Management of lymphedema primarily aims at reducing or halting progression of swelling and to prevent associated infection. The condition is treated with a combination of moisturisers and emollients, compression bandages, isotonic exercise, and regular massage. The idea of stimulating lymphatic drainage with external physical means has a good physiological basis. However, given the lack of proof on relative effectiveness of approaches now available, relying on a single strategy alone is improbable.

Objective: The aim of the study was to study lymphedema clinically and institute treatment accordingly and study the outcome of same.

Methods: The study comprised 33 patients who presented with lymphedema at a plastic surgery department. Congenital lymphedema patients were not included in the study. Each patient's treatment was adapted to their specific needs. At 1, 3, 6, and 9 months, patients were assessed for the efficacy of the treatment they had started. Complex decongestive physiotherapy (CDP), the use of elasto-compressive bandages, and multi-layered lymphedema bandages (MLLD), as well as limb elevation, attentive skin care, and remedial physiotherapy, were all used in the treatment.

Results: There were 12 males and 20 females among the 33 patients. Upper-extremity lymphedema affected 11 patients, lower-extremity lymphedema affected 21 patients, and scrotal lymphedema affected 1 patient. Conservative treatment, Pneumatic Compression, Complex Decongestive Physiotherapy (CDP), or Miller's Debulking Procedure were all used on the patients. Both volumetric assessment and patient satisfaction were considered to assess the outcome of treatment. Necessary changes were done in the treatment thereafter.

Conclusion: Lymphedema is a debilitating disease that affects the patient's physical and mental well-being. The patient should also be involved in the management. The patient's psychological needs should also be addressed. Treatment should be individualised to the individual, and changes should be made as needed. In the absence of a definitive therapy, a holistic approach will be used.

Granulomatous Lobular Mastitis: A Clinicopathological Study

Sapna Goel, Kanwar Singh Goel

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 24-32
https://doi.org/10.9734/bpi/hmms/v17/11336D

Background: Granulomatous Lobular Mastitis is a rather rare condition.This illness has similarities to malignancy and TB. Granulomatous inflammation with multinucleated giant cells and epithelioid histiocytes characterises this condition. Lobules are the focus of the inflammation. The goal of this study is to review the clinical and pathological characteristics of eight cases with granulomatous lobular mastitis, as well as to review relevant literature.

Methods: This is a prospective observational study. A total of eight patients were looked at. Investigations have been completed. For seven days, the patient was given Erythromycin 250 mg qid, Tinidazole 500 mg bid, and steroids for two months.Oral steroids were administered after the tumours were removed, sinuses were excised, and abscesses were emptied. A six-month follow-up was conducted.

Results: The patients were mostly multiparous and breastfeeding, and their ages ranged from 18 to 36.The lesion was diagnosed as malignant in three patients and benign in five others.The majority of the patients were on oral contraceptive tablets. Suppuration was identified in three cases, while sinuses were discovered in two others. A granulomatous inflammation centred on the lobules was discovered on histopathological investigation.

Conclusion: To avoid misunderstanding with malignancy, TB, fungal infection, sarcoidosis, mammary duct ectasia, cystic abnormalities in the breast with over palpation, and puerperal mastitis with over palpation, the diagnosis of granulomatous lobular mastitis should be established very carefully. Despite the fact that it is an uncommon disease, pathologists and surgeons must have a thorough grasp of it in order to improve its detection.

A Detailed Morphology and Histological Study of Placenta in Normal and Diabetic Pregnancies

Durgesh Singh, Shashi Prabha Singh, Priti Sinha, Neha Gupta, Rakesh Sharma

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 33-40
https://doi.org/10.9734/bpi/hmms/v17/2985F

Introduction: Pregnancy in a diabetogenic condition is caused by many physiological changes that promote insulin resistance. The placenta is a key organ for the developing foetus, and it is also the most accessible organ of the human body. By the third trimester of a typical pregnancy, glucose tolerance has decreased, but insulin levels in the blood have increased.

Aim: The placenta of a normal pregnancy is compared to the placenta of a diabetic pregnancy to determine the pregnancy's outcome.

Methods and Materials: The current study was a case-control study using 50 placenta specimens with intact umbilical cords gathered from the Department of Obstetrics and Gynecology.

Results: There was some variation in the form and weight of the placenta. The mean placenta weight in the control group was 452.80 grammes with a standard deviation of 140.93 grammes, while it was 406.00 grammes with a standard deviation of 210.31 grammes in the case group. The Random blood sugar of mother in control group was significantly higher than cases (t=2.91, p<0.01).

Conclusion: In complicated pregnancies, there was a tendency for placental weight and new-born weight to increase when compared to normal pregnancies, according to the current study. In diabetes pregnancies, this indicated earlier diagnosis and adherence to the treatment plan.

This study investigated the effect of selected interventions on reduction of holistic symptoms and prognosis among patients with head and neck cancer. A quasi experimental pre-test post-test design was adopted with random sampling technique (random allotment of weeks: Group I-patient admitted in 1st and 3rdweek and Group II patient admitted in 2ndand 4th week).The sample of the study consisted of 200 patients (100 patients in Group I and 100 patients in Group II).Patients in the both the groups were given interventions, Group I receivedcounseling(day 1 and day7),financial support, oral care for 6 days(1-6 days) and Group II received counseling(day 1 and day 7), financial support, oral care with music therapy for 6 days(1-6 days).Pretest was done on the 1st day and posttest was done on the 7th day for both the groups. Data was collected with Structured questionnaire by using interview schedule to assess the socio demographic data and clinical data, Symptom checklist with 20 items to check physiological, psychological and spiritual symptoms, Universal pain assessment scale to assess the severity of pain, Sleep and physiological parameter assessment tool to evaluate sleep, blood pressure and pulse rate, Modified University of Washington quality of life questionnaire with 20 divisions to assess the quality of life, Radiation mucositis scale (standardized) to assess the intensity of the ulcer. Analysis was done using both descriptive and inferential statistics. Resultsshowed Group II received music therapy had significant reduction of physiological symptoms (Mean score on day 7 is 11.20 and paired‘t’ test 20.638, P value <0.001) than Group I (Mean score on day 7 is 13.82 and paired ‘t’test 14.296, P value<0.001) and psychological symptoms (Group II Mean score on day 7 is 3.32 and Group I Mean score on day 7 is 6.49, F test 167.395, P value 0.001).Oral care along with music therapy had influenced oral mucositis(In Group II on day 1, 62% had ulceration, whereas on 7th day no one had ulceration. The average mean duration of sleep of the patients in Group II(Mean score on day 1 is 4.13, day 7 is 4.41) than Group I (Mean score on day 1 is 4.41 and on day 7 is 7.02).This showed music therapy had increased duration of sleep in Group II patients. The average mean score of quality of life of patients in Group 1 (day 1 is 26.6, day 7 is 29.44) and Group 2(day 1 is 29.44,day 7 is 51.74),F test 16.48,P value <0.001.It shows music therapy had significant influence on quality of life of life in Group II than patients in Group I. The average mean score of pain level of patients in Group I (Day 1 7.76 and day 7 6.28), GroupII (Day 1 6.28 and day 7 2.51) ANCOVA F value is 1098, P value <0.001).This showed the effectiveness of music therapy in reducing the pain. Thus the study concluded music therapy in addition to counseling; financial support and oral care had significantly reduced the holistic symptoms, systolic and diastolic blood pressure, pain, oral mucositis and significantly increased the duration of sleep and quality of life.

Bone Marrow Involvement in Non-Small Cell Lung Cancer

Stilidi Ivan, Kononetz Pavel, Chulkova Svetlana, Tupitsyn Nikolay

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 55-68
https://doi.org/10.9734/bpi/hmms/v17/9701D

Disseminated tumor cells (DTCs) in the bone marrow (BM) have been shown to be progenitors to distant metastases. The discovery of DTCs in non-small cell lung cancer (NSCLC) will provide crucial information on the characteristics of metastasis, as well as the potential for discovering new targets for NSCLC treatment. The goal of the study is to see if DTC can be detected in BM and to determine the incidence of BM involvement in NSCLC patients, as well as their impact on the BM lymphocyte population. Morphological and immunological approaches were used to examine 62 bone marrow samples from NSCLC patients. DTCs analysis was performed using flow cytometry (FACS Canto II, the USA, Kaluza Analysis v2.1 software), monoclonal antibodies to CD45, EPCAM, CD133, lymphocyte populations CD3, CD4, CD8, CD19, CD20, CD16, CD27, directly labeled with various fluorochromes were used. The EPCAM+CD45- (DTCs) in the BM were found in 43.5% of patients (threshold level: 1 cell per 10 million myelocaricytes). The CD133+EPCAM+CD45-cells were found in 33,3% (9/27) cases. The presence of DTCs had no relationship to tumour size, lymph node status, or tumour stage. DTCs were detected at the highest rates in stages IA and IIA: 60.7 percent and 58.3 percent, respectively. In adenocarcinoma, BM involvement was found in 45 percent of cases, while in squamous cell carcinoma, it was found in 37 percent of samples (p = 0.501).  DTCs were observed to be more common in highly differentiated tumours (p = 0.023). There are no significant connections between the presence of DTCs in the BM and myelogram parameters. A decrease in the number of granulocytic lineage cells was observed in 4% of BM involvement (p = 0.036). A significant increase in the level of subpopulations of CD16 + CD4-NK-cells (p = 0.002), CD27 + CD3 + T-cells (p = 0.015) with BM damage was revealed.

Conclusion: It has been proven that DTCs can be detected in the BM of NSCLC patients.43.5 percent of the participants were from the BM. Even in the early stages of NSCLC, DTCs are found. There was a link discovered between BM involvement and the degree of tumour differentiation. Adenocarcinoma of the lung had a higher rate of BM involvement than squamous cell carcinoma of the lung. A relationship between DTCs and BM lymphocyte populations was revealed: subpopulations of CD16 + CD4-, CD27 + CD3+.

Histopathological Evaluation of Endometrial Tissue in Abnormal Uterine Bleeding: A Recent Study

Ritu Bhagat, Chiterlekha Kundal, Subhash Bhardwaj, Vinod Kumar

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 69-74
https://doi.org/10.9734/bpi/hmms/v17/10442D

Background: The abnormal uterine bleeding can be caused by a wide variety of disorders and it is one of the commonest complaints leading to endometrial sampling. It may represent a normal physiological state and observation alone may be warranted. Alternatively, the bleeding can be a sign of a serious underlying condition necessitating aggressive treatment.

Aim: To evaluate the causes of abnormal uterine bleeding and to determine the various patterns of endometrial curettings in abnormal uterine bleeding in different age groups.

Material and Methods: The study was conducted in the histopathology section of the Department of Pathology GMC Jammu. Study material included all endometrial curettings and endometrial biopsy specimen received in the histopathology section.

Results: Age of patients ranged from 14 to 75 years. In this study maximum number of cases were in age group 31-40 years i.e.188 cases (40.43%).Various patterns on histopathology were secretory endometrium (170 cases) the commonest followed by proliferative endometrium (99 cases), endometrial hyperplasia (42cases), products of conception (27 cases). 6 cases of endometrial carcinoma and 4 cases of squamous cell carcinoma were reported.

Conclusion: Histopathological examination of endometrial tissue in patients of abnormal uterine bleeding shows a wide spectrum of changes ranging from normal endometrium in various hormonal cycles to malignancy. So it is a major diagnostic tool in evaluation of abnormal uterine bleeding.

Study on Mammary Analogue Secretary Carcinoma: A Rare Salivary Gland Tumor

Shashikant Anil Pol, Surinder K. Singhal, Nitin Gupta, Himanshu Bayad

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 75-78
https://doi.org/10.9734/bpi/hmms/v17/2846F

Introduction: Mammary analogue secretary carcinoma are salivary gland tumours that are histologically similar to breast secretory carcinomas. It mainly affects adults between the ages of 45 and 65. Clinically, it is typically a slow-growing, low-grade malignancy with a good prognosis.

Objective: To study the clinicopathological features of mammary analogue secretary carcinoma of salivary glands.

Case Report:  We are reporting a case of a 47-year-old female who has been complaining of swelling behind her left ear for the past 7 years.It grew slowly, painlessly, and persistently. On examination, 4 x 3 cm swelling was present just below left ear lobule. It was nontender, firm, irregular in shape with smooth surface with slight mobility and overlying skin pinchable. A benign tumour with cystic alteration was found using fine needle aspiration cytology (FNAC).A lobulated hypodense lesion measuring 24 x 35 x 32 mm with internal septations and wall enhancement was found on a contrast enhanced computed tomography scan at the expected site of the superficial and deep lobes of the left parotid gland. Histopathology revealed secretory analogue mammary carcinoma after the patient underwent left complete conservative parotidectomy. She was then given post-operative radiation. Patient is being followed up on a regular basis and is currently disease-free.

Conclusion:  Mammary analogue secretory carcinoma is often a low-grade malignancy with a favourable prognosis. The presence of S-100 protein and mammaglobin is confirmed by immunohistochemistry.

Recent Advances in Dermatology Using DNA Aptamer “Aptamin C” Innovation: Oxidative Stress Prevention and Effect Maximization of Vitamin C through Antioxidation

Sooho Choi, Jeongmin Han, Ji Hyun Kim, A-Ru Kim, Sang-Heon Kim, Weontae Lee, Moon-Young Yoon, Gyuyoup Kim, Yoon-Seong Kim

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 79-88
https://doi.org/10.9734/bpi/hmms/v17/2796F

Introduction: By protecting cells from oxidative stress, Vitamin C (also known as L-ascorbic acid) plays an important role in reducing Reactive Oxygen Species (ROS) and promoting cell regeneration. Despite the fact that Vitamin C is widely utilised in cosmetic and medicinal industries, there is substantial evidence that it is easily oxidised by air, pH, temperature, and UV light when stored [1, 2].  Vitamin C deficiency diminishes its antioxidant activity and shortens the shelf life of products containing Vitamin C as a component.To combat vitamin C deficiency, we created Aptamin C, a revolutionary DNA aptamer that maximises the antioxidant activity of vitamin C by attaching to the reduced form of the vitamin and delaying its oxidation.

Methods: ITC analysis was used to determine the Binding of Aptamin C to Vitamin C. 0.2 mM Vitamin C was administered 25 times in 2\(\mu\)l aliquots into the 1.8 ml sample cell containing Aptamin C at a concentration of 0.02 mM in an ITC experiment. Using the origin programme for ITC v.5.0, the data were fitted to a one-site binding isotherm.

Results:  In vitro and clinical testing were carried out to see how Aptamin C and the Vitamin C complex affected human skin.We discovered that a compound of Aptamin C and Vitamin C was considerably efficient in reducing wrinkles, lightening the skin, and increasing moisture. In a clinical trial, participants who were given the compound saw a significant reduction in skin irritation and itching.

Conclusion: These findings suggested that Aptamin C, a novel and revolutionary molecule, might be used as a crucial cosmeceutical agent for a variety of skin disorders.

A Case Report on Full Term Broad Ligament Pregnancy

Vidhi J. Shah

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 89-93
https://doi.org/10.9734/bpi/hmms/v17/2997F

A broad ligament pregnancy is a very rare ectopic pregnancy that has a significant maternal and perinatal fatality rate.It's considerably more unlikely that such pregnancies will carry to term. Although ultrasonography can help with diagnosis, it is usually done via a laparotomy.G2P1 presented to us with abdominal pain at 39 weeks of pregnancy, which was an unbooked case. Ultrasonography revealed a live foetus with severe intrauterine growth restriction (estimated foetal weight of 1.98 kg), transverse lying, severe oligohydramnios, and full placenta praevia on ultrasound.Patient was taken for the caesarean section. Intraoperative diagnosis of left broad ligament pregnancy was made, foetus was removed alive and broad ligament along with placenta, left fallopian tube and ovary was excised. Post-operative period was uneventful. A high index of suspicion and prompt therapeutic intervention are necessary to prevent adverse fetal and or maternal outcome.

Global Development on Causes, Epidemiology, Aetiology, and Risk Factors of Prostate Cancer: An Advanced Study

Bandar T. Alenezi, Mohammed H. Alsubhi, Xi Jin, Gang He, Qiang Wei, Youqiang Ke

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 94-117
https://doi.org/10.9734/bpi/hmms/v17/11228D

As the second most recurring cancer in men globally, prostate cancer is a major concern to men’s health. It is estimated that approximately 1.3 million new cases are diagnosed every year, those cases are leading to the casualties of nearly 360,000 men during 2018, which represents about 3.8% of all male cancer related deaths. Increasing of age among men can be correlated with global prostate cancer incidence and mortality, with the average age of diagnosis is 66 years old. Prostate cancer is usually asymptomatic or with minimal symptoms in the early stages of the disease, during this period there is minimal to no need of treatment. At early stage, the symptoms of prostate cancer are similar to those observed in prostatic hypertrophy. But in more advanced stages of prostate cancer, more painful symptoms may appear. Elevated levels of Prostate Specific Antigen (PSA) are the main marker used to detect prostate cancer. The disease can be confirmed with a biopsy of the prostate gland. In this work, we try to review the prostate cancer’s causes, epidemiology, aetiology, and risk factors globally, as we think that it is a pivotal way to keep update our understanding on this increasingly important health threat to men.

Tissue-engineering was important which combine medical applications and engineering materials. An extraction process was employed to remove the tissue and cellular molecules from porcine skin in this study via pretreatment of supercritical fluid a designed combined procedure of supercritical fluids of carbon dioxide and protease treatments at low temperatures. Varying porosities of the decellularized tissues were then created using protease reagent treatments.  The author studied characterizations of the designed decellularized scaffolds derived from porcine skins via supercritical fluid and protease reagent treatments.

A Case Report on Torsion of Dermoid Cyst in a Perimenopausal Woman

Kondareddy Radhika, Sonam Singh, M. Munikrishna

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 123-128
https://doi.org/10.9734/bpi/hmms/v17/2977F

The present case study explores the Torsion of dermoid cyst in a perimenopausal woman. Mature cystic teratomas account for 20% to 30% of all ovarian tumours.They are most commonly found in patients between the ages of 20 and 40, and they are usually asymptomatic.Incidence of malignancy is high in perimenopausal and postmenopausal group. The authors describe a case of dermoid cyst torsion that presented unusually in a 45-year-old perimenopausal lady with acute abdominal pain. A 45-year-old perimenopausal lady complained of 8-hour-long lower stomach ache and 3-4 episodes of vomiting.Abdominal examination revealed a regular, firm to cystic, tender abdomino- pelvic mass corresponding to the size of 28 weeks gravid uterus by palpation. A right ovarian cyst measuring 12.9x12.8x10.1 cm was discovered on abdominal ultrasonography. A total abdominal hysterectomy was performed, as well as bilateral salpingo oopherectomy.A histopathological study revealed the presence of a mature cystic teratoma. Although mature cystic teratomas are uncommon after 40 years of age, especially in perimenopausal women, and are usually malignant in that age group, it might present at an unusual age of 45 years and be benign, as in this case.

Study on Ademolus Hypoglycemic Index

Adegbenga B. Ademolu

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 129-145
https://doi.org/10.9734/bpi/hmms/v17/2992F

Introduction: The ADEMOLUS HYPOGLYCEMIC INDEX (AHI) is proposed in this article as a mathematical representation of a hypoglycemic episode in a patient with recurrent hypoglycemia over a three-month period.

Methodology: This is a retrospective analysis of 65 hypoglycemia episodes (HE) that occurred in six randomly selected diabetes mellitus patients from 86 case files analysed at the Lagos State University Teaching Hospital in Ikeja, Lagos, Nigeria.  

The data was examined using the Ademolus Hypoglycemia Classification and the 2018 ADA/EASD Hypoglycemia Classification to determine hypoglycemia. The proposed mathematical formula was used to derive AHI from the HE. The data was analysed using SPSS version 23.

Results:  The ADEMOLUS HYPOGLYCEMIC INDEX was used to investigate 65 hypoglycemic episodes in six diabetic patients. All six individuals experienced a succession of hypoglycemic episodes over the course of three months. Using both the ACH and the ADA/EASD classifications, Patient 1 had an AHI of 0.53. Discussion: In patient 1 her AHI was not in the severe range. In patient 3, in the last quarter of 2016, her AHI was 0.60, in the first quarter of 2017, her AHI was zero, then between June, July and August 2017 her AHI was 0.64. At this point in the patient's care, it would be prudent to assess the aetiological reasons in this diabetic patient with chronic kidney disease who suffers recurrent hypoglycemia, as it was six months ago. The formula can be programmed or computerized into a device like a calculator and/or a designed webpage calculator on ADEMOLUS HYPOGLYCEMIC INDEX can be developed.

Conclusion: The Ademolus Hypoglycemic Index (AHI) is useful for tracking chronic or long-term recurrent HE in diabetic and non-diabetic patients.

The Surgical Treatment of Hemothorax: Which Videothoracoscopic Approaches?

Stefano Sanna, Angelo Ciarrocchi, Alessio Campisi, Desideria Argnani, Sara Mazzarra, Stefano Congiu, Fabio Davoli, Franco Stella

Highlights on Medicine and Medical Science Vol. 17, 22 July 2021, Page 146-157
https://doi.org/10.9734/bpi/hmms/v17/9752D

Hemothorax, whether spontaneous or related to thoracic trauma lesions, is treated using basic principles that are well-accepted by trauma and cardiothoracic surgeons. Only a small percentage of patients require a tube thoracostomy; for the rest, a nonoperative technique is appropriate and safe. Only a small percentage of patients require surgical intervention due to retained hemothorax, persistent bleeding or incoming complications (i.e. pleural empyema or entrapped lung). Early in the 1990s, significant technological advancements led to an increase in diagnostic and therapeutic indications for Multi-port Video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing for earlier diagnosis, total clot removal, and better tube placement, with less morbidity, reduced post-operative pain, and a shorter hospital stay. Even if there is no agreement in the Literature about the timing for draining hemothorax, best results are obtained when the drainage is performed within the first five days after the onset. An important evolution of traditional multi-port approach is represented by uniportal approach, with the same results of open surgical technique and the real advantage of a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures such as lobectomies or bronchial sleeve and vascular reconstructions. Many authors have confirmed the advantages of single-port technique compared with multi-port in term of better post-operative pian control, easier surgical approach and better cosmetic results, but longer and harder learning curve.