Issues and Developments in Medicine and Medical Research Vol. 8

The objective of this study was to assess the spectrum of non neoplastic diseases and their microscopic findings in cases of non neoplastic nephrectomy specimen with clinicopathological correlation. This is a prospective and retrospective study conducted at a tertiary care hospital and teaching institute, department of pathology for duration of three years. The ethical committee clearance was obtained at the commencement of the study. The various indications for nephrectomy included conditions like calculus (in kidney, pelvi ureteric junction and ureter), hydronephrosis, and various miscellaneous conditions which included aplastic kidney, poor renal functioning, reflux disease etc. The present study showed that the right sided nephrectomy to be slightly more common than the left side in both male and female cases. About 57% males and 55% females cased had right sided nephrectomy. The study concludes that chronic pyelonephritis is the commonest non-neoplastic indication for nephrectomy.

Aim: The aim of this study was to investigate the correlation between Lateral pterygoid muscle (LPM) attachment type and Anterior disc displacement (ADD), disc degeneration or articular surface degeneration among the population of central India.

Methods: Patients with complaint of pain, clicking, locking in the Temporomandibular Joint (TMJ) region were evaluated. TMJ dysfunctions were classified as normal disc position, ADD with reduction and ADD without reduction. LPM attachment types to the condyle disc complex were classified into three different types. Statistical analysis was conducted using the R version 3.2.0. Statistical correlation analysis was used to investigate the correlation between TMJ dysfunction and LPM attachment types to the disc condyle complex, disc degeneration and articular surface degeneration.

Results: Of the 108 TMJ’S in 54 patients (42 males and 66 females, mean age 32.20 years) 25 TMJ’S(23.14%) were evaluated as normal in terms of disc status, 61TMJ’S (56.48%) had an ADD with reduction and 22 (20.37%) had ADD without reduction. Arthritis was seen in 104 TMJ’S (96.30%) suggesting a high prevalence (96.3%) of TMJ osteoarthritis among young patients (mean age 32.2 years). LPM attachment types to the disc condyle complex were Type I (87.03%), Type II (11.11%) and Type III (1.85%). Statistically significant difference was found between the type of LPM attachment and ADD (P value 0.0285). No statistically significant difference was found between LPM attachment type and disc degeneration or articular surface degeneration.

Conclusion: LPM attachment type is related to the pathogenesis of ADD, but not related to disc degeneration and articular surface degeneration. It can be concluded that lateral pterygoid muscle attachment type is related to the pathogenesis of anterior disc displacement and hence to the internal derangement of TMJ disorders.

New diseases have always been emerging and re-emerging and created panic and chaos among general public since ancient times. The current pandemic due to SARS-CoV-2 threatening the whole human race and due to this COVID-19 pandemic the fears, anxieties, stressors are dominating the communities of the globe. All media and channels have been discussing about all the kind of hopelessness like unavailability of effective treatment protocol, antiviral drugs and vaccines, there is panic all around the world. Among these uncertainties many institutions have been looking for the new ray of hope in the form of new antiviral drugs and vaccines against COVID-19. The humanities had faced such types of pandemics in the past and won the battle against these. Humanity and disease have always existed side by side [1]. Various pandemics e.g. influenza, plague, cholera and other infectious diseases have terrified the human from time to time but every time they have survived, won the battle, learnt a lesson and become better, stronger and creative. Until we get effective antiviral drugs and vaccines against COVID-19, the team PSM (Physical distancing, Sanitization of hands, equipment, surfaces, Masks) will work constantly against the COVID-19 and will play key role in stopping the transmission. The aims and objectives of this chapter are 1. To assess the problem of mental health and other dimensions of health during COVID-19 pandemic 2. To explore various ways to combat clinically the problem of mental health during COVID 19 pandemic.

In the absence of data indicating that older adults use information technology (IT) to communicate with health care providers or insurers, Medicare, private insurers, and health care providers have increasingly relied on websites and IT to communicate with patients. The FACETS (Functional Assessment of Currently Employed Technology Scale) evaluates a person's use of various information technologies (ITs). Research using FACETS has demonstrated that use of the internet and other IT declines significantly with increasing age beyond 60 years, especially for accessing health care. The default usage of IT for obtaining health care is being highlighted as a barrier to care in the context of the current COVID-19 problem. This chapter reviews the current status of FACETS findings in the context of the COVID-19 pandemic. Recommendations are made to improve access to care and to increase the use of FACETS to determine which media are most available to older adults for accessing health care.

Background: The most common causes of mechanical small bowel obstruction are postoperative adhesions and hernias. Commoner sites in the small bowel are the ileum and ileocaecal junction and jejunum is a rare site for obstruction and strictures. Other etiologies of small bowel obstruction include, diseases intrinsic to the wall of the small intestine, benign (like, inflammatory, ischaemic post-traumatic or post irradiation) or malignant strictures. Intramural hematoma and processes that cause intraluminal obstruction like intussusception, gallstones, foreign bodies etc also contribute. Ischaemic enteritis is a rare etiology, with only about 0.1 percent of cases being reported. Ischaemic strictures of the small bowel are a result of decreased blood supply to the small intestine. They necessitate surgical intervention to be managed.

Study Objectives: The main objectives were to study the importance of details of clinical and investigative modalities in diagnosis and management of ischaemic jejunal strictures which are rare causes of intestinal obstruction like in the case described.

Methods: The author presented a 40-year-old diabetic female with a 2-month history of upper GI obstruction. Her health records included a stroke, a myocardial infarction, and a transient episode of intestinal obstruction three years ago. Her investigations revealed that she had an occlusive distal jejunal stricture. The author researched various management options in the literature and chose the best one for her.

Results: An exploratory laparotomy was performed, along with resection and end-to-end anastomosis of the jejunal segment. The segment's histopathology revealed ischaemic enteritis with large vessel blockade causing stricture. The patient's postoperative recovery was uneventful, and she has been asymptomatic for two years now. 

Conclusions: Ischaemic enteritis results in small intestinal obstruction due to intestinal stricture in its chronic phase. The differential diagnoses cause diagnostic delay, as can missing the transient phase of early ischemia which gives a lead to diagnosis.

The present study aims to ascertain whether Upper lip bite examination (ULBT) can be incorporated in standard protocol of airway assessment along with other tests to increase predictive accuracy of difficult endotracheal intubation. The study was a single centre prospective randomised single blind comparative observational study which was carried out in Dr. D Y Patil medical college Kolhapur in period July 16-July17. In this study, we have achieved uniformity by conducting all tests by primary investigator and doing all laryngoscopies by senior resident so as to avoid inter-observer variation. Objective of our study was to compare modified Marampati test (MMT) and ULBT with regard to accuracy, PPV, NPV, specificity and sensitivity against laryngoscopic visualization by using gold standard CL grading. As both the tests were assessed by primary investigator it has reduced the risk of inter-observer variation to significant extent and this is the main strength of our study.

The present study aimed to determine the ratio of 2nd to 4th digit in professional body builders in comparison with controls. 2nd:4th digit ratio is known to be related to ethnicity. However, the magnitude of sex differences in 2^nd: 4^th is similar across ethnic groups. A total of 37 male body builders training at various gymnasiums who have participated in various competitions at national/international level were scanned and considered as cases. Studies conducted in sports like rugby, rowing and skiing which needs both cardiovascular efficiency and high-power output has shown a significant association between digit ratio and performance. It is concluded that male body builders had a significantly lower 2nd:4th ratio compared to the controls. Therefore, a lower right to left 2nd:4th ratio may be a good predictor of high athletic performance in males.

Objectives: Recently, a world-renowned neurosurgeon admitted at a world congress that the mortality rate of the most difficult tumour was 18% when he began operating, but it dropped to less than 5% in the next five years. We don't want to talk about it. It's the shadow side of science. How can we avoid these complications? The phrase "learning curve" is "politically correct," but at what cost? There is a lot of pain, death, and complications behind it. Do we need to hone our abilities with living patients? Is it moral? How many complex operations do we need to perform per year to keep our skills at a high level? Is there a sufficient number of training laboratories in hospitals?It is not available in thousands of mid centers. We would like to offer a vey simle method.

Methods: We have gradually introduced daily fresh cadaver dissections into our practise in three mid centres over the last 15 years. We look at the challenges that had to be overcome in centres that did not have an anatomy lab.

Results: The ethical and practical difficulties were negotiable, but the organization were not easy. Discussion: We should change of the postgraduate training methodology in intra and extracranial micro and endoscipic and endovascular surgery return to daily training like in sport. Fresh cadavers are available in every hospital. This would be the main tenet of the "nil nocere" surgical principle.

Acute intermittent porphyria is a rare autosomal dominant illness due to a mutation in the gene that codes for the porphobillinogen deaminase enzymes involved in heam biosynthesis. The disease causes acute attacks of neuropsychiatric dysfunction as well as neurovisceral manifestations such as acute abdomen. Due to hormonal changes, 54 percent of pregnant women experience an exacerbation of attacks in the form of seizures and acute abdomen. In general, the prevalence of acute intermittent porphyria is 1-2/200000. We present a case of a 36-year-old woman with G4P1L2A2 who presented with a pregnancy termination request at 10+4 weeks of gestation. Six months ago, the patient was diagnosed with acute intermittent porphyria with porphyric polyneuropathy. Her main symptoms at the time were acute abdominal pain, numbness, and weakness in all four limbs. Her urinary porphobillinogen and 5 ALA levels were elevated. Her brain CECT and nerve conduction studies were normal. She has been on Tablet Gabapentin 300 mg H.S. since then. She successfully terminated her pregnancy via suction and evacuation while under spinal anaesthesia, and she refused copper-T insertion. Only safe drugs were used during the procedure, and she was discharged with the recommendation of barrier contraception. As the acute attacks of porphyria are increased during pregnancy & carry high maternal & fetal mortality, it is important to prevent acute attack by avoiding precipitating factors including drugs.

A spontaneous hepatic haemorrhage (SHH) is a rare condition caused by a rupture of the hepatic parenchyma that occurs without any external cause. It is a surgical emergency because it causes intra-abdominal bleeding, which, if left untreated, can lead to haemorrhagic shock and death. The clinical presentation is frequently non-specific but emergent, necessitating rapid diagnosis and treatment, which frequently involves a number of services such as interventional radiology, hepatology, and surgery.SHH is a rare event that is most commonly caused by HCC and hepatic adenoma, but there are numerous other causative lesions that include all recognised benign and malignant hepatic tumours, including metastatic cancer. The mechanism of spontaneous bleeding is unclear, but there is evidence of compromised vascular integrity, at least in patients with HCC, and the condition is more common in patients with connective tissue diseases. SHH is diagnosed based on a clinical index of suspicion in patients with a known underlying condition.However, this is not always as straightforward as SHH is a rare complication in patients with connective tissue disease with no previous history of trauma.

The aim of this study was to evaluate the long term outcome of this rare complication of hepatic cirrhosis by closed monitoring of the liver function and abdominal computerized tomography scanning.

Spontaneous hepatic haemorrhage is one of acute abdominal emergency case with high morbidity and mortality rate. Emergency operation play an important role in managing this case.

We study the relationship between resistivity and specific heat. It is known that the resistivity of a conductor increases when its temperature increases. And the specific heat of a material is found as a function of temperature, so we calculated the resistivity from the specific heat and the temperature variation.

The resistivity of a conductor is determined as a function of specific heat, the resistance of a conductor is determined as a function of mass, temperature and specific heat; and the electric field is determined as a function of the specific heat.

The heart of zebrafish has been used as a simple, low-cost model to study development, structure and function of the heart from early to late stages of life. Also, it has been established as a model to study different cardiac pathologies generated through different methods. Cardiac pathologies include from functional disorders such as arrhythmia, to structural disorders such as hypertrophic heart disease; in many of them, genetic and molecular aspects have been associated. Noteworthy, some of these genetic and molecular factors have been invoked as causes of sudden cardiac death in humans. This adverse outcome is common in many cardiovascular pathologies and can occur at any age. Unfortunately, etiology and physiopathology of sudden cardiac death are unclear, so extensive research in this area is required. The purpose of the present review was to show the advantages of zebrafish model considering the genetic, molecular and physiological information available on cardiovascular development and function throughout its life cycle to study sudden cardiac death. For this review, a literature search was performed using the PubMed database and the search engine Google Scholar: the words sudden cardiac death, zebrafish, arrhythmias, cardiomyopathies were combined for this search.

An anterior cruciate ligament (ACL) injury is an important cause of rest in athletes. This injury usually occur while practicing sports and it is more common during competition than during training. In most cases, ACL injuries do not require external contact and they are associated with biomechanical risk factors that increase ACL tension. The increase of the hip flexion angle (HF) is included within these. The ACL requires cooperation of the periarticular musculature of the knee, muscle groups, hip stabilizers and CORE muscles; consequently, fatigue caused by exercise would alter the balance and put this ligament at risk.

The objective of the study is to determine the angular behavior for HF before and after a physical load (a standardized training) in children between 11 and 12 years old.

A non-randomized clinical study was carried out. The sample consisted of 50 soccer school students born between 11 and 12 years old. The angular behavior of HF was compared before and after performing a training session. The angular behavior was measured through the Drop Jump test (DJ), with data obtained by inertial sensors.

After the exercise, there was a significant increase in HF. It was concluded that the angular behavior of HF increases significantly in both extremities after training and that preventive measures must be applied for neuromuscular control of the hip.

Basically, the human hair consists of a follicle a.k.a root penetrating the skin and an outer skin structure commonly called the shaft. The hair follicle has been classified as a miniorgan having its own cells divisions; aging stages and also demonstrated to emit electromagnetic radiation. The intent of this manuscript is to demonstrate via in vitro experiments evidence of human inter-tissue electromagnetic energy transfer through a glass slide, namely from human blood tissue to the previously described miniorgan or follicle. The intrinsic biomagnetism of organs such as the brain and heart have been found to emit bioelectrical signals that could presently be displayed by instrumentation.

The mechanism behind this new finding was possible due to the introduction in 2015 of a tabletop optical microscopy method designed to display plants and animal tissue electromagnetic energy emissions. Essential to present finding is the described property of anisotropic crystals of full absorption of incoming electromagnetic radiation waves by Potassium Ferricyanide (K3Fe) which is an anisotropic crystal is an anisotropic crystal. For example, a single layer human blood smear was sandwiched (SDW) by a second glass slide. On the top slide of the SDW, a freshly plucked in toto human hair was then covered by drops diluted K3Fe. Control experiments had repeatedly shown orderly semicircular periodic crystals of K3Fe triggered by the electromagnetic waves emitted by the hair follicle. Prior experiments by this author, have hinted at a “bioelectromagnetic cross-talk” between the follicle and blood. This was seen when there was physical contact between the follicle and blood drops on a glass slide. In the present experiments there is no direct tissue contact, the blood tissue energy is transmitted through a 1 mm glass barrier. The data herein presented introduces Bioelectromagnetic Fields (BEMFs) energy from human blood onto a miniorgan. This energy is shown penetrating a 1 mm glass slide barrier. Further research is warranted to assess the physiological implications of the human blood tissue as a molecular and BEMFs energy source.

Due to the increasing concerns about the aesthetic and biocompatibility of dental restorations. Ceramic materials were developed in response to this increasing demand of tissue preservation, aesthetic and resistance to fracture. However a major drawback is their high clinical failure rate in posterior sites This publication describes the effect of thickness and type of material on the resistance fracture of ultra-thin ceramic restoration. The restorative phase of the treatment should not cause additional damage of the residual tooth structure. Ultrathin restorations (veneers, onlays, inlays) are considered as an alternative to traditional onlays and complete crowns. the technical aspects required for the success and the good prognosis of those new restorative design based on the control of tooth preparation with diagnostic wax-up, provisionalization, and the use of CAD-CAM technology.

Background: Isolated Adenocorticotropin Hormone (ACTH) deficiency is a rare disorder, characterized by secondary adrenal insufficiency with a low or absent cortisol production, normal secretion of other pituitary hormones and absence of structural pituitary defects.

Aims: The present study highlights to describe a premature baby who proved to have transient ACTH deficiency

Case Summary: The patient was the product of a 28 weeks gestation, clomiphen induced to a 40-year-old, gestational diabetic mother. He was ventilated for 30 days, and was diagnosed to have grade IV Retina of Prematurity (ROP). He suffered from recurrent attacks of hypoglycemic, blood sugar of 1.6 mmol/L, low serum cortisol 65 nmol/L (normal; 150-630), and ACTH of 1.5 pmol/L (normal; 1.6-13.9), with suppressed serum insulin and normal thyroid, growth hormone and gonadal functions. Magnetic Resonance Imaging (MRI) was unremarkable. He was started on hydrocortisone 2.5 mg twice daily for two years, which was then slowly tapered and stopped. Later Serum cortisol was 175 nmol/L, and ACTH of 5.5 pmol/L with a normal shot ACTH stimulation test.

Conclusions:   This case of a premature baby who presented with recurrent hypoglycemia had an isolated ACTH deficiency that proved to be transient. The pediatricians need to be aware of the existence of such condition.

In the wide area of medical image processing, Image segmentation is an important and challenging factor in automatic recognition system for medical images. Medical images acquired from different resources such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), etc that will be used for the diagnosis purpose. The purpose of this paper is to provide a comprehensive analysis for different brain tumor segmentation methods. Comparative analysis among these various segmentation conventions has been examined. This paper discusses the various image segmentation techniques K-Means Clustering, Watershed and Region Growing methods for detection of brain tumor from sample MRI images of brain.

Currently the health care system of whole world is dependent on allopathic system of medicine and surgery. This status of allopathic system didn’t come overnight. It has taken hundreds of years in its evolvement. In the past many systems of medicine existed and cured the global people. Although many systems developed and evolved in the restricted geographical areas and served the people but we cannot ignore the contributions of these regional systems of many past civilizations in the development of current and modern system of allopathic medicine and surgery. This topic is basically intended to highlight the various millstones in the evolution of modern system. It will also highlight the contributions of many systems of cure and prevention of diseases form many countries of the world. It is the primary effort of this chapter to identify the milestones in the development of modern system and contributions of many civilizations in the health sector. The ancient systems of treatment from all the parts of world can play important role as supplementary system of treatment and can reduce the cost of treatment, save time as these are more accessible and more popular locally. For example recently the Government of India and the public India have recognized the role of AYUSH i.e. Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy as the alternative systems of medicine. It is integrated in the health care delivery system of the country. Ayurveda offers programs to rejuvenate the body through diet and nutrition.  Although India has rich heritage of health care system form ancient times yet has never hesitated in taking the help form systems of medicine practiced in many countries and civilizations for the better health conditions of its people. We recently utilized the knowledge of Chinese medicine e.g. acupuncture, acupressure and we have taken help from Greek medicine also.

This study aimed to apply minimum-time variable-rate selective excitation (MinVER) to a presaturation pulse (PSP) with a high flip angle on 7 T time-of-flight magnetic resonance angiography (7T TOF-MRA), to attain a superior vessel- to-tissue contrast (VTCR), short acquisition time, and minor off-resonance effect. An altered PSP modified by using the 90° flip angle (FA)-MinVER was implemented in the 7 T TOF-MRA, and its performance was evaluated with a signal profile and vessel-tissue contrast ratios and compared to the conventional PSP and 45 FA-TOF. The 90 FA-MinVER showed a similar signal profile to that of the conventional PSP and improved the vessel-tissue contrast ratios (0.313 ± 0.80) compared to all conventional types (45 FA-TOF: 0.088 ± 0.84, 90 FA-TOF: 0.203 ± 0.72). Moreover, this noteworthy approach achieved substantially reduced total acquisition time (5 min and 55 s) with a short repeat-to-time (28 ms), indicating that at the 7 T TOF-MRA, the 90 FA-MinVER could be applied by default to suppress the venous signals regardless of individual human-dependent physiological effects and the specific absorption ratio constraint and with the rapid TOF-MRA imaging. Ultimately, its application could also help to observe subtle microvascular changes in the early stages and serve as key biomarkers in various vascular diseases.

New drug delivery systems (NDDS) are developed for improvement in efficacy of the drugs, provide maximum benefit to the patient and to minimize the adverse drug reactions. For local anaesthetics (LAs), the development of new effective delivery systems modulate the release rate, extend their anaesthetic effect , and helps to enhance their localisation as desired. The various routes of local anaesthetic delivery (epidural, peripheral, wound catheters, intra-nasal, intra- vesical, intra-articular, intra-osseous) are under innovation these days. Different methods such as include iontophoresis, electroporation, sonophoresis, and magnetophoresis are being used to enhance local anaesthetic permeation. Adjuvants are added to potentiate drug effects. The use of different delivery systems should help to keep the LA at the target site for longer periods prolonging the anesthetic or analgesic effect with an extended range of agents. New drug delivery systems for local anaesthesia provide better analgesia and anaesthesia by altering the sensory component mainly. Efficacy and tolerability of drugs is improved by these novel methods.

The present study aims to discuss different concepts and guidelines for endoscopic procedures and risk of aerosolization.  Aerosols are more likely to be inhaled by otolaryngologists during routine ENT examinations and endoscopic procedures. ENT endoscopy procedures are regarded as the most aerosol-generating procedures, and routine procedures are preferably avoided and postponed if not absolutely necessary or urgent at this time of Covid-19 pandemic. The small particle size and extended travel of airborne aerosols mandate the use of specific PPE and barriers by the health care workers to protect against transmission of Covid-19. Studies have recommended ENT endoscopy in awake patients with adequate topical preparation of local anaesthesia. Use of sprays should be avoided, instead, carefully placed pledgets should be used to provide adequate decongestion and anesthesia. Wearing a N95 mask with face shield or full PPE, thorough cleaning of entire endoscope after removal by standard disinfectants, decontamination of endoscopy room after each procedure, and proper disposal of contaminated waste products are some common guidelines advised by health authorities worldwide to date. The information and advices regarding different diagnostic and treatment procedures from different authorities is subject to change depending on ongoing local situation and developments of Covid-19 pandemic and we should strictly follow the national and local guidelines issued by concerned authorities and keep us updated on latest advices available.