Issues and Developments in Medicine and Medical Research Vol. 11

The study's main goal is to report anatomic variation in the sciatic nerve in cadaveric dissection. During routine undergraduate dissection in a middle-aged male cadaver, we discovered that the sciatic nerve divided in the buttock into the common peroneal and tibial nerves. The common peroneal nerve then pierced the piriformis muscle, dividing it into two parts, and the tibial nerve passed beneath the muscle.  The common peroneal nerve descended laterally in the thigh, giving a branch to the short head of the biceps femoris and then distributing to the muscles and skin on the anterolateral aspect of the leg and the dorsum of the foot. While still in the buttock and upper part of the thigh, the tibial nerve descended medially and gave branches to the upper part of the hamstring muscles arising from the ischial tuberosity. It continues into the leg and foot, supplying muscles and skin on the back of the leg and the sole of the foot.  Coccygodynia and sciatic pain have been linked to abnormal relationships between the piriformis muscle and the sciatic nerve; therefore, being aware of such variation can help to assessment.

Infertility is a serious clinical, social, and economic concern. Infertility affects not only one's ability to have children, but also one's emotional, psychological, social, and familial well-being. It affects approximately 15% of reproductive-age couples. For many years, it was assumed that the majority of reproductive issues could be attributed to the female partner, but recent research has shown that nearly 40-50 percent of infertility is caused by a male factor. Male factor infertility has been associated with a variety of abnormalities, including sperm number, motility, and morphology. Seminal analysis is the primary investigation for men despite being a poor predictor of sperm function and male fertility. ICSI (Intra cytoplasmic sperm injection) is the most recent development in the treatment of male infertility enabling couples who were previously deemed infertile to produce offsprings.  As a result, the risk of genetic infertility increasing in future generations, as demonstrated by male infertility, exists. Thus, identifying genetic factors in infertile couples has become good practice for appropriate management of the infertile couple.

In this chapter, we present a review of the SARS-CoV-2 and COVID-19 presence among the Mexican population. We also show the effect of pneumonia in people with COVID-19 whose outcome was fatal so far.

For all age groups, pneumonia is one of the leading causes of death among patients diagnosed with COVID-19. It is more frequent because SARS-CoV-2 uses the ACE receptor to enter epithelial cells primarily in the respiratory tract.  All ages, from the Mexican population, had pneumonia as a significant risk factor to die due to COVID-19.

In the Mexican population under 19 years of age, a positive correlation and linear relationship between pneumonia and Case Fatality Ratio r=0.79, CFR(%)=0.02 + 0.29 cases with pneumonia(%), t=0.68, P-value=.0001.

In conclusion, pneumonia is a leading cause of death in patients with COVID-19.

Labor, an important event, is marked by the fear of pain. It is desirable to have a painless and quick labor. The goal of an obstetrician is to deliver a healthy baby and mother. Methods for reducing the active phase of labor are encouraged. Prolonged labour results in a significant rate of feto-maternal morbidity. It is necessary to reduce the duration of labour without risking the feto-maternal interests. Much of the art of good obstetric care involves the delicate balance of avoiding cesarean delivery and its complications. Various strategies were used to try to speed up the labour process. The compounds hyoscine-n-butyl bromide, scopolamine, and valethamate bromide have all been extensively researched. The purpose of this study was to compare the effects of Drotavarine hydrochloride and a combination of Hyoscine-N-butyl bromide and Valethamate bromide on active phase duration and feto-materal side effects. A total of 200 women were separated into two groups of 100 each. Group A received Drotavarine hydrochloride 40mg I/M, 2 doses 2 hours apart(2^nd if required). Group B given combination of Hyoscine-N-butyl bromide 40 mg and Valethamate bromide 16mg I/M, 2 doses 2 hours apart(2nd if required). 98% delivered vaginally. 2% (LSCS) in each group and excluded. Mean no. of doses 1.36±0.48 (Group A), 1.83±0.37 (Group B) p value <0.001 HS. Mean rate of dilatation (cms/hr) was more in Group A(3.81±1.52) than B (2.29±0.64) p value<0.001 HS. Mean Active phase was 112.70±53.09 mins in Group A and 171.44±57.24 min in B, p value<0.001 HS. Drug-delivery interval was 45.10±63.22 min (groupA) and 202.09±60.35 min (Group B) p value <0.001HS. There are no significant feto-maternal side effects.  Drotavarine and combination drugs are safe to shorten the duration of active phase.

Aim: Study of the reproductive organs at long-term administration of letrozole, the steroid aromatase inhibitor, followed by its withdrawal in young male rats and ones with age-related involution of reproductive organs.

Materials and Methods: The trials were conducted on Wistar rats aged 5 months to 15 months, who were gavaged with letrozole every other day at a rate of 1 mg/kg b. w for 3 months and then 2 months after it was stopped. Immunoassays were used to determine the levels of testosterone and estradiol in the blood plasma. The concentrations of spermatozoa in epididymal washes were measured. The testicles and accessory sexual glands were weighed, and the gonads and ventral prostate morphology were investigated.  The results of the study were compared with those of control animals of corresponding age.

Results: The ratio of testosterone to estradiol in the blood plasma of aged rats increased as a result of letrozole treatment. The average amount of spermatozoa in the epididymis increased by 28%. The histological analysis demonstrated that Leydig cells were functionally activated, with considerable delays in involutive changes in their number and shape. Some of the Leydig cells showed symptoms of functional depletion. When compared to control rats, letrozole increased the relative weights of the coagulation gland by 40 percent, seminal vesicles by 31 percent, and the ventral prostate by 33 percent. There were no signs of difference between letrozole-treated and control animals two months following letrozole cessation. The effects of letrozole were nearly undetectable in young rats.

Conclusions: Letrozole administration to male rats with age-related involution of the reproductive system increases testosterone/estradiol ratio in blood plasma, the spermatozoa content in epididymises and the weights of androgen-dependent accessory sexual glands. This is followed by a slowing of age-related morphological changes in the gonad and prostate gland. The effects of letrozole on reproduction are reversible.

The object of the study was to investigate the impact of gold nanoparticles (AuNP) on male rat reproductive system, and human normal and malignant prostate using xenografts and cell culture models, as well as the effect of cerium dioxide nanoparticles (CeO₂NP) on the testes and fertility in aging male rats. Presence of polydispersed colloidal solution of AuNP (10-50 nm) in the LNCaP culture medium at a final concentration of 10 \(\mu\)g/ml inhibited cell growth, while the monodispersed solution of AuNP (20 nm) had no effect. The polydispersed colloidal AuNP solution arrested the growth of human PCa xenografts in mice, when administered parenterally at a dose range of 0.64-6.4 \(\mu\)g/kg b.w. The selectivity of the the nanopreparations effect on the prostate malignant epithelium is confirmed by its destruction and a decrease in the epithelial-stromal ratio on histological preparations of the xenografts. There was no significant damaging effect of poly- and monodispersed AuNP solutions on the testes and accessory sexual glands of rats when administered for up to two weeks. The stimulating effect of administered orally a low dose of CeO₂NP (1 mg/kg b.w.) on testosterone secretion and spermatogenesis, proliferative and secretory processes in the prostate of aging male rats was found. However, fertility of animals reduced in comparison with the control group due to immaturity of a part of the spermatozoa. The mechanisms of the stimulating or damaging effects of metal nanoparticles and their salts on normal and malignant tissues require further research in order to evaluate their therapeutic potential and toxicity.

The facial nerve enters the parotid gland high up on its posteromedial surface and runs forward and downwards behind the mandibular ramus after exiting the skull at the stylomastoid foramen. It divides into superior (temporofacial) and inferior (cervicofacial) trunks within the parotid substance, resulting in five primary peripheral branches extending out across the face. These branches diverge within the parotid gland and leave by its anteromedial surface, medial to anterior margin, to supply the muscles of facial expression. The face of an 86-year-old embalmed female cadaver was dissected during standard dissection of the head and neck region for medical undergraduates in the Department of Anatomy, Punjab Institute of Medical Sciences, Jalandhar, India. Following the fine dissection, we found a variance in the branching pattern of the facial nerve on the right side of the face, as well as the similar pattern on the left. In parotid surgery, the challenge for head and neck surgeons is to remove the tumour while maintaining the functional and anatomical integrity of all branches of the facial nerve. As a result, surgeons must be aware of the variances in order to do successful surgery.

Cardiovascular Disease (CVD) includes a wide range of conditions that affect the heart and the blood vessel which is the most common and prevalent disease in India, as well as globally. According to WHO, CVD mortalities were estimated to be 17.9 million, which would increase to 24.2 million by 2030. CVDs are diagnosed using transthoracic Echocardiography techniques which can help doctors to diagnose heart and blood vessel diseases & conditions in adults and children. The timely diagnosis of CVDs patients is the most challenging and complicated task for the medical fraternity. This study illustrates the effectiveness of visualization in exposing and conveying the essential facts in a large CVD dataset using Tableau. Data visualization is among the utmost important components of working with various data analytics solutions, which may be useful in supporting diverse tasks in cardiovascular disease, like tracking the geographic distribution of diseases, analyzing disease prevalence, reviewing medical records, predicting outbreaks, and identifying populations at risk. The objective of this study is to describe the demographic patterns of the CVD database using Tableau. It was applied to 12721 records with a sex-wise distribution of echocardiography records found that 7511 (59%) of the reports were for male patients and 5210 (41%) of the reports were for female patients at Cardiology Department, JSS Hospital in the year 2016. This work has provided a first evaluation of the most spread solutions existing in the CVD data visualization landscape. Based on the result we can analyze and visualize; men seem to be more susceptible to cardiovascular diseases than women. Above 39 years of age are more prone to the development of cardiovascular diseases and more records are reported in the age group 60-80. The study on the CVD data analysis using Tableau can help in speeding up the process of comprehending large and complex data.

Introduction: Small bowel volvulus(SBV) is a benign gastrointestinal surgical condition characterised by torsion of a segment of the small bowel along its mesenteric axis. Because the clinical presentation is similar to acute mesenteric ischaemia, obtaining a preoperative clinical diagnosis is difficult. As a presenting surgical cause of small bowel obstruction in developing countries, it has contributed significantly to the burden.The purpose of this case report was to discuss a typical case of small bowel volvulus in a developing country and emphasise the significance of resuscitation and early surgical intervention.

Presentation of Case: A 35-year-old woman was admitted to the hospital after complaining of colicky central abdominal pain for three days. She described a long period of fasting followed by a sudden ingestion of food. Her abdomen was moderately distended with minimal tenderness on physical examination. The results of the laboratory tests were normal, and a plain abdominal X-ray revealed features suggestive of small bowel obstruction. Following resuscitation, the patient was taken to the operating room for a laparotomy, where SBV was discovered. The omental band adhesion was cut, the volvulus was untwisted, and the small bowel was all viable. The patient's postoperative recovery was uneventful.

Discussion: SBV is more common in Africa, Asia, and the Middle East than in the Western world. Secondary SBV is more common in older people, whereas primary SBV is more common in children. The most common symptoms of SBV are abdominal pain, distention, and vomiting.  The mortality rate due to SBV has been found to be decreasing with early diagnosis due to abdominal CT scanning. This decrease in mortality is due to a decrease in the incidence of SBV gangrene.

Conclusions: Small bowel volvulus should be considered a likely diagnosis in a patient with stomach discomfort and symptoms of small bowel obstruction because of the high mortality and varied presentation. SBV morbidity and death can be reduced with early surgical intervention.

Some of the main goals of the anaesthesia plan for tracheoesophageal fistula (TEF) repair is to provide good analgesia and a smooth post-operative recovery. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance to anaesthetic drugs associated with congenital heart disease, and the preterm baby. Regional anaesthesia has been shown to be both safe and effective. This article describes the successful TEF repair of a one-day-old baby using caudal epidural analgesia in conjunction with GA. As a result, management of every TEF case with caudal block demonstrates excellent hemodynamic stability, postoperative pain relief for successful recovery, and increased baby survival.  Caudal epidural analgesia may be employed usefully with general anesthesia in neonates.

Cervical cancer ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, with an estimated 570,000 cases and 311,000 deaths in 2018 worldwide, as found by globocan 2018 estimates. Also the incidence with deaths being high in low to middle income group countries is because of poverty, ignorance and limited screening programmes in these countries. The present write up is an attempt to suggest methods of screening with their advantages and limitations. The various screening methods followed by us and suggested are conventional pap smear CPS, liquid based cytology (low cost manual liquid based cytology) LBC, HPV Testing, cellblock CB with immunomarker and (visual inspection with acetic acid). VIA All these method will help to detect preneoplastic and neoplastic conditions of cervix at low cost and thus reduce mortality and morbidity in low resource countries.

HA/Alumina and HA/MgO nanocomposites were successfully prepared by using the hydrothermal method for the first time at 250°C. The mechanisms of composite formation, crystallite size, crystallinity, morphology, were studied HA/Alumina and HA/MgO nanocomposites. XRD and FTIR investigations showed an intermolecular interaction between HA/Alumina and HA/MgO. The formation of HA/Alumina and HA/MgO nanocomposites are polycrystalline in nature. Mg incorporation into HA_P stimulates osteoblast proliferation. Mg acts similar to a growth factor during the early stages of osteogenesis and promotes bone formation. It confirmed in TEM analysis. TEM images further ascertained that HAP/Alumina was formed in a short nanorod shape and HA/MgO nanocomposites show nanocluster like morphology. The FTIR measurement shows the appropriate vibrational spectra of HA/Alumina and HA/MgO nanocomposites. The UV–VIS measurements show the band–gap of HA/Alumina and HA/MgO nanocomposites. This study provides a platform for further research on the HA/Alumina and HA/MgO nanocomposites for biomedical applications.

Aortic root and mitral valve involvement are common in Marfans Syndrome . As the rate of cardiovascular complication are high, early assessment by routine echocardiography and its progression should be seen.

Purpose: An assessment of the effectiveness of progenitor mesenchymal stem cell as injections and as part of a polymer hydrogel for the wounds healing in old animals.

Materials and Methods: Fixed-size wounds (average area of 135.8 mm2) were modelled on the backs of 9-month-old white Wistar rats. On the modelling day, mesenchymal stem cells (MSC) isolated from a human umbilical cord were injected into the wounds once (SC group). In other animals, MSC were applied externally on a regular basis as one of the components in the polymer hydrogel (Polymer sc group). The systemic effect of the cells was evaluated by examining intact contralateral wounds on the opposite side of the same animal's back (control sc and Control Psc groups, respectively). The intact reference wounds belonged to the Control 0 group. The wound area was studied in dynamics. Descriptive microscopy was supplemented by an assessment of the collagen fibers' maturity, the epidermal layers, and the number of fibroblasts and leukocytes in different parts of the wounds.

Results: MSC application, both local and systemic, resulted in improved wound regeneration. The method and location of application had no effect on the dynamics of wound healing during the acute inflammatory phase (up to 3 days). Polymer_sc was ultimately found to be the most effective. MSC's anti-inflammatory effect was confirmed by a reduction in leukocyte infiltration in wound centres (Polymer_sc and SC groups) and edges (all groups, with the greatest extent in the Polymer_sc group). The Control_Psc group, particularly the Polymer_sc group, was affected by the proliferative phase, which manifests itself as accelerated growth in fibroblast number and collagen production.

Conclusion: MSC applications improve and accelerate wound healing in a variety of ways, even in old animals. The best performance was achieved in the Polymer_sc group.

The Declaration of Montréal of the International Pain Summit of the International Association for the Study of Pain (IASP) identifies that chronic pain is a serious chronic health problem and access to pain management is a fundamental human right. The objective of current work was to formulate principles of physical analgesia or physical modalities for pain reduction and to present basic methods and mechanisms. We consider pain management as an important part of rehabilitation algorithms in patients with neurologic and rheumatologic diseases, orthopedic and traumatic conditions.

To compare the adequacy of combined lumbosacral plexus block over subarachnoid block and epidural in terms of motor, sensory blockade, surgeon and patient satisfaction and time for first rescue analgesia for unilateral elective hip surgeries.

Study Objective: To determine the outcome of using combined lumbosacral plexus block in comparison with epidural and subarachnoid block, its effectiveness, safety and complications related to the procedure.

Materials and Methods: A single centred randomized, single-blinded study, conducted between May 2017 to October 2018, on 60 patients undergoing elective unilateral hip surgeries with 20 patients in each group (group I -combined lumbar and sacral plexus block, Group II - Epidural & Group III- Subarachnoid block). Patients belonging to the American Society of anaesthesiologists, physical status 1 & 2, aged between 18 – 60 years were enrolled for the study and distributed randomly into one of the three groups. Adequacy of block in terms of motor and sensory blockade, patient and surgeon satisfaction and time for the first analgesia were noted.

Results: Among 60 patients, the block was adequate in group III, compared to group II and group I. The total duration of analgesia was significantly higher in group I (338.5 ± 44.51), compared to group II (135.5 ± 11.45) and group III (141.0 ±17.44). The total doses of analgesic required in the first 24 hours were low in group I when compared to group II and group III.

Conclusion: Combined lumbosacral plexus block, is a good and safe alternative to neuraxial block for patients undergoing unilateral hip surgeries, with good patient, surgeon satisfaction and prolonged postoperative pain relief.

Thrombotic Thrombocytopenic Purpura (TTP) is a genetic haematological disorder characterised by a lack of "Von Willebrand factor cleaving protease" as well as severe thrombotic microangiopathy that results in microangiopathic hemolytic anaemia. Several records are used to support the following disease, which occurs at various ages and has varying degrees of severity. Patients with hereditary TTP are high risk pregnant population.  In this study, a pregnant woman of 25 years is examined, her blood parameters are checked, and therapies are administered based on the results. Pregnant women had a substantially increased probability of carrying the inherited TTP, according to the recommended outcome. At the time of pregnancy, all haematological units must be properly screened, and psychological evaluation is also necessary.

Background: The individual psychological status is another risk factor in threatened preterm delivery.

Aims: To determine how depression, anxiety, and stress influence pregnancy outcome and condition of the newborn, and the impact of progesterone therapy on pregnant woman’s psychological status in threatened preterm delivery.

Methods: Forty-one pregnant women with the signs of threatened preterm birth and forty controls during their third trimester filled out three questionnaires: the socio-economic survey, the Depression, Anxiety and Stress Scale (DASS) and the Edinburgh Postnatal Depression Scale (EPDS). Five days after the introduction of progesterone therapy the study group filled the DASS and EPDS again. The outcomes were the gestational week at delivery, birth weight of the neonate and admission to the neonatal intensive care unit.

Results: Higher scores on DASS and EPDS predicted a delivery in earlier gestational weeks. High anxiety scores during pregnancy were associated with lower birth weight of the neonates. Pregnant women with high anxiety and stress scores more often delivered neonates who were admitted to the intensive care unit. The values of scores on the DASS and EPDS were significantly lower on the fifth day after the introduction of progesterone therapy.

Conclusion: The symptoms of depression, anxiety, and stress are associated with preterm delivery, newborns’ lower birth weight and admission to the intensive care unit. The introduction of progesterone therapy can postpone preterm delivery by positively influencing the psychological status of a pregnant woman.

Introduction: Angiomatous antrochoanal nasal polyp (AAP) is a rare and distinct variation of a sinonasal polyp that can be mistaken for a sinonasal malignancy, juvenile nasopharyngeal angiofibroma, or a simple antrochoanal polyp due to its ability to erode bone and cause epistaxis. It accounts for about 5% of all nasal polyps.

Typically, there is extensive vascular proliferation and ectasia with deposition of pseudoamyloid and presence of atypical stromal cells. The extensive reparative and reactive changes are the results of this pseudoneoplastic entity of these polyps. The lesion can often present late, therefore causing both diagnostic and management difficulties. AAP has tendency bleeding and eroding bone. Such rare cases are presented here with a review of the literature about its features and management.

Case Report: We describe two cases of angiomatous antro­ choanal polyp (AAP) which is a rare variant of sinochoanal polyp. Cases presented with complain of recurrent unilateral epistaxis and nasal obstruction. CT findings revealed erosion of bony walls. The mass in the nasal cavity was reddish pink in color. Endoscopic sinus surgery was performed and a final diagnosis of the angiomatous antrochoanal polyp was made based on the histopathology report.

Management: Complete resection was performed through an endoscopic medial maxillectomy approach while open lateral rhinotomy approach was kept a reserve in case the tumor is not dealt completely via an endoscopic approach. A preoperartive biopsy was taken which was reported as an inflammatory polyp but the surgical specimen was reported as an AAP.

Discussion and conclusion: Very few studies are available on this topic and hence we find little material in the textbook. Being a rare pathological entity, ANP can cause a significant diagnostic dilemma. Clinical, radiological and pathological data are usually complimentary and together provide a definitive diagnosis. The awareness of the existence of such tumors should always be there. Differential diagnosis includes antrochoanal polyp, juvenile angiofibroma, malignancy, papilloma, and hemangioma.

The current focus of Crohn’s disease therapy has been long sclerosed. Biologics produce temporary remissions in 40% of cases. They have yet to induce permanent remissions. FDA’s reliance on clinical validation through comparative, placebo controlled, double-blinded studies has created an impediment to acceptance of divergent alternated therapies as being within the standard of care. In so doing, FDA has basically has surrendered the therapeutic dialogue of Crohn’s disease to those who can pay from such studies.