Medicine and Medical Research: New Perspectives Vol. 5

Introduction: The relation between neonatal factors and the timing of eruption of primary teeth has not been studied prospectively among Indian preterm infants. The eruption of the first primary teeth is a normal physiological process. The eruption of primary teeth is significantly influenced by prenatal and neonatal variables as well as dietary deficiencies throughout pregnancy. The eruption of primary teeth is predominantly influenced by neonatal variables, including birth weight, intensity of neonatal sickness, gestational age (GA), and degree of prematurity.

Aims: The present study evaluates the influence of neonatal factors on the eruption of primary teeth in children born preterm.

Materials and Methods: A prospective longitudinal cohort study design was adopted. A total of 150 subjects were recruited by simple random sampling. Each child was followed up from birth up to 36 months. An intraoral examination was done and the teeth present in each visit were recorded. Data were statistically analyzed and interpreted.

Descriptive statistics, t-tests for independent samples, and Pearson’s chi-squared tests were applied. Tooth showing a statistically significant difference in mean age of eruption between term and preterm categories was studied for the effect of maternal and neonatal characteristics on eruption using multivariate regression analysis.

Results: The mandibular central incisor was the first tooth to erupt. A significant determinant of the eruption of mandibular incisor in term children was found to be parity, weight for GA, and complementary feeding, whereas, for preterm children, significant determinants were parity, birth weight birth length, weight for GA, and complementary feeding. Children born second had delay in the eruption of all primary teeth compared to the first child in both the groups. This effect was statistically significant for mandibular incisors in both term and preterm groups and statistically insignificant for all the other teeth suggesting that parity affects only the eruption of first primary teeth.

Conclusion: Neonatal factors, such as birth weight, birth length, weight for GA, and introduction of complementary feeding have a strong significant association with the eruption of primary teeth. The findings of this study will guide the preventive management of oral health in preterm children.

Clinical Significance: The findings of this study will guide the preventive management of oral health in preterm children.

Background: Several studies have shown that human immunodeficiency virus (HIV) maintains residual replication in the lymph nodes of patients with undetectable viral load in peripheral blood despite highly active antiretroviral therapy (HAART). In other words, while the virus is eliminated in the peripheral blood by antiretroviral drugs, it continues to infect and replicate in new cells in the lymphoid tissue. This shows that the treatments used today against HIV do not achieve the total elimination of the virus in the body.

Other studies demonstrated that the concentrations of antiretrovirals at the lymph node level were lower compared to the concentrations in peripheral blood, not reaching optimal levels to stop viral replication. Additional investigations in intestinal mucosa showed that HIV RNA can be detected in the intestine of patients with successful HAART, suggesting that the intestinal mucosa is a cellular reservoir where HAART inhibits viral replication but does not eradicate the virus, therefore that it is necessary to carry out more in-depth studies in order to improve the understanding of the pathogenesis of HIV at the level of the intestinal mucosa. The above-captioned issues motivated the present investigation in search of micro- and nanoscale findings with a possible therapeutic approach.

Objective: The present study aimed to determine the ultrastructural findings on Rectal Mucosa (RM) of patients with HIV/AIDS and anorectal pathologies (ARP), at micrometric and nanometric scales.

Materials and Methods: 5 patients were evaluated, 18 - 55 years old, with ARP (HIV co-infection with HPV, n = 4, and HIV-negative patient with HPV infection) (control n = 1), who were referred to the Coloproctology Unit of the HUC, and subjected to rectoscopy and biopsy. RM samples were identified, placed in a sterile plastic bottle with 1 mL of 2% glutaraldehyde, and immediately transported for routine processing of fine cut (60 - 90 nm) to be evaluated via Transmission Electron Microscopy (TEM). They were fixed with Karnovsky solution with Millonig phosphate buffer (pH 7.4 and 320 mOsm) and post-fixed with OsO4 under the same conditions of pH and osmolarity.

Results: Ultrastructural findings, at 10-6 scale: 1) Intestinal mucosa: vacuoles of mucus of different sizes that seem to be fused. 2) Smooth muscle cells: loss of definition of contractile myofilaments mass. 3) Unmyelinated axons and terminals of Schwann cells (SC): Edema and loss of their plasma membranes in some areas of association with axon terminals as well as abundant collagen fibers associated with SC. Ultrastructural findings, at 10-9 scale: 1) Smooth muscle cells: folded wrapper cores and edema of mitochondria and rough endoplasmic reticulum cisterns (RER). 2) Myelinated axon terminals: Loss of synaptic vesicles. 3) Fibroblasts: One observes mitochondria and cisterns of RER with alterations. All these alterations can generate intestinal and anorectal dysfunction in these patients. The use of nanotechnology can be very useful for the therapeutic approach to HIV, offering unique advantages, such as improving the bioavailability, water solubility, stability, and targeting capacity of antiretroviral drugs, especially in those difficult sites for an effective therapeutic approach.

Conclusions: HIV causes changes in rectal and muscular mucosa despite HAART treatment with undetectable viral load. Nano-drugs could play an important role in drug delivery in sites where conventional ART has limited access, so as to achieve sufficient concentrations to execute optimal therapeutic responses and virus eradication in anatomical and intracellular sites.

A circumvallate placenta is a form of extrachorial placenta with a raised placental margin in an annular shape. Circumvallate placenta often causes persistent vaginal bleeding beginning in the first trimester, preterm premature rupture of membranes (PPROM), preterm delivery, and placental abruption, thus being associated with poor pregnancy outcomes. A case of circumvallate placenta is reported here, which led to preterm premature rupture of membranes (PPROM) and leakage in a mother at 17 weeks of gestation. She was the second gravida with a 10-year-old healthy daughter. The mother underwent amniocentesis after the triple marker test showed an increased risk for trisomy 21. Difficulty in aspirating amniotic fluid was encountered due to the abnormal placental structure, which was not known at the time of the invasive procedure. The mother experienced leaking 7 days post-procedure, followed by miscarriage. Autopsy examination revealed that the placenta was circumvallate, which not only caused difficulty in aspirating the amniotic fluid but also could be the cause of PPROM, a well-known complication of the circumvallate placenta. This is the first case where difficulty in aspirating amniotic fluid was encountered. The circumvallate placenta group shows poor pregnancy and delivery outcomes. The circumvallate placenta may lead to vaginal bleeding during the second trimester, PPROM, and preterm delivery. This study highlights that examining the placenta is very important to identify the cause of events in certain situations; circumvallate placenta or abnormal placenta can be suspected in cases where hindrance is encountered (not able to aspirate amniotic fluid even if the needle is visible in the amniotic sac) during amniocentesis.

Obesity has become a global health concern, with its prevalence rising dramatically in recent decades. This book chapter examines the complex relationship between leptin, inflammation, and obesity, synthesizing current research to provide a comprehensive understanding of their interconnected roles in metabolic health. Leptin's crucial function in regulating energy balance and metabolism was first explored, highlighting its connection to adipose tissue mass and its impact on appetite control and energy expenditure. This book chapter delves into the inflammatory aspects of obesity, discussing how excess adipose tissue contributes to a chronic low-grade inflammatory state, which in turn leads to various metabolic dysfunctions and related health complications. A key focus is placed on the dual role of leptin as both a metabolic regulator and a pro-inflammatory cytokine, elucidating how leptin dysregulation links obesity to inflammation and subsequent metabolic disorders. The chapter also considers the implications of leptin resistance in obesity and its contribution to sustained inflammation. Finally, potential therapeutic targets emerging from this intricate interplay were discussed, offering perspectives on managing obesity-related complications through interventions targeting leptin signaling and inflammatory pathways. This comprehensive analysis aims to enhance our understanding of the leptin-inflammation-obesity axis and its significance in developing effective strategies for obesity management and prevention of associated metabolic disorders.

Augmented reality (AR) and virtual reality (VR) are technologies that enhance the perception of reality by superimposing computer-generated images, sounds, or other sensory enhancements on a user's real-world environment. AR and VR training in medical education is crucial as it allows students to practice complex procedures in a safe and controlled environment, improving their skills and confidence. AR and VR training in nursing education has shown promise in memory retention, independent learning, critical thinking, decision-making, skill development, better patient outcomes, and job satisfaction. However, challenges such as potential motion sickness, difficulty adapting to the virtual environment, and the need for additional training are still present. Nurse educators face challenges such as the cost of implementing the technology, the need for ongoing technical support, and the time required to develop and maintain high-quality virtual simulations. Despite these challenges, the use of AR and VR in nursing education shows great promise in enhancing learning experiences and improving patient outcomes.

Ovarian torsion is a rare but critical gynaecological emergency. This manuscript aims to provide a review of the current understanding of ovarian torsion, its clinical presentation, diagnostic modalities, management strategies, and outcomes. This review aims to enhance awareness among healthcare providers and improve the timely diagnosis and management of this potentially devastating condition. A torsed ovary poses significant diagnostic and therapeutic challenges, particularly in infants and young children. It requires prompt recognition and intervention in order to prevent irreversible damage to the ovary and subsequent implications for fertility and overall reproductive health. The ovary twists on its ligamentous support, obstructing blood supply to the organ which potentially results in ischaemia and necrosis of ovarian tissue. While simple ovarian cysts are common, true ovarian neoplasms are definitely rare in infancy and unusual in childhood. A variety of treatment options are available like pre-natal or post-natal cyst aspiration, observation and surgery. Both open surgical and laparoscopic approaches are feasible. Laparoscopy has emerged as a gold standard for the diagnosis of ovarian torsion and masses. The surgical choices vary from ovary-sparing procedures like detorsion alone or detorsion combined with an oophoropexy; ovarian cystectomy; fenestration and de-roofing of cyst to more radical approaches like salpingo-oophorectomy, which obviously entails loss of the organ. The treating surgeon or the gynaecologist is faced with the following three questions: is the organ viable? can it be a malignancy? and which treatment option will be best suited for the individual case. This makes the topic not only interesting for discussion but valuable for future scientific research.

The case of a 12-year-old girl with a single painful genital ulcer lesion in the context of CMV infection is presented, primary cause and the management of the disease are discussed. Lipschutz ulcers (LU) are presented as a highly inconvenient situation that an unsullied girl may suffer. They are painful lesions on the genital mucosa of females accompanied by fever and lymphadenopathy. The primary cause of the disease remains unknown. Causative factors that have been proposed to be associated with the disease include infections due to viruses or bacteria. Such as Epstein-Barr (EBV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV) and influenza type A viruses, adenoviruses, Salmonella SARS-COV-2 or vaccination. The case of a 12-year-old female with a genital single Lipschutz ulcer in the context of CMV infection is presented. The ulcer was made more complicated by cellulitis and rapid necrosis. Finally, the ulcer was replaced by an eschar on the 4th day of hospitalization. This includes a discussion of the differential diagnosis, the therapy, and the primary clinical symptoms. The current investigation used PCR to confirm the connection between Lipschutz ulcer and systemic Cytomegalovirus infection. Using symptomatic treatment (antimicrobial, antiviral) did not improve the ulcer's healing process; but, following surgical intervention, the ulcer healed considerably better. Follow-up management did not reveal a relapse. Further studies are needed to investigate the precipitating factors for the presence of LU. Surgical consultation should be immediately considered when symptoms of relapse appear. The surgical intervention combined with the administration of antibiotics also annihilates the risk of superinfection and complications of vulvar cellulitis.

Alzheimer’s Disease is a cognitive degenerative disease that has no known cure. A cause of this disease is the buildup of beta-amyloid and tau tangling. While cognitive damage to the brain is progressing, the limbic part of the brain continues to function. We can apply this fact to help us make progress toward reversing the effect of Alzheimer’s Disease. For example, an attempt can be made to train a subject to utilize the Limbic part of his brain to recall what he forgot or to acquire new knowledge. An attempt has been made to do so by applying aromatherapy, cognitive learning, and food therapy. This article discusses methods of restoring a subject that is effective and involves no medication in Stage 1 Treatment while the medication is added in Stage 2 treatment. In addition, this article will also mention resources that would further enhance healing.

The coronavirus disease 2019 (COVID-19) continues to pose an unprecedented challenge for the entire world and the healthcare system. The role of D-dimer and troponin-I as markers of thrombosis or procoagulant state in COVID-19 infection has been under investigation since the inception of this disease. Different theories have been proposed elucidating the pathophysiological mechanisms attributing to high mortality and morbidity in COVID-19 infection. Out of them, thrombosis and procoagulant state have managed to earn the maximum limelight. The main objective of our study was to assess the risk and occurrence of thrombotic events (both venous and arterial) among hospitalized patients including the intensive care unit (ICU) and non-ICU admissions with confirmed COVID-19 infection. An observational study was conducted based on data from randomly selected 349 hospitalized patients with COVID-19 infection in a community-based hospital in New York City during the first wave of the COVID-19 viral surge in March 2020. Diagnoses were made during the inpatient clinical care, as screening for thrombotic events is not a standard method. The statistical analysis involved non-normally distributed continuous variables that were described as the median and interquartile range (IQR) while mean and standard deviation were used to describe normally distributed continuous variables. The primary outcome in our study was defined as the thrombotic events that included myocardial infarction (MI), deep venous thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE). The study correlated the association of thrombotic events with the level of biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or both. The association of D-dimers and troponin-I with thrombotic events was measured using both univariate and multivariate Cox proportional hazard (PH) regression analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml) and were categorized as a high-risk group. Eighty-nine patients developed thrombotic complications (evidence of more than one thrombotic event was found in several patients). Two-hundred seventy-one (77.65%) patients had no documentation of thrombosis. The in-patient mortality rate among patients in our study group, with a high risk of thrombotic events was 44.87% (35/78) as compared to 38.80% (104/271) in patients without any thrombotic events. The incidence of thrombotic events included myocardial infarction (MI; N=45; 12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis (DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding the management of the complications that arise in the course of this viral illness. Although D-dimer, sepsis, and microvascular thrombosis are associated with mortality, current data are inconclusive for the use of therapeutic doses of anticoagulation for these findings. With the resurgence of the COVID-19 wave, it is imperative to focus on optimal diagnostic and prophylactic strategies to prevent thromboembolic events and potentially improve survival in COVID-19 patients.

Background: Ovarian epithelial tumors primarily originate from the surface epithelium of the ovary. These tumors account for around 60 percent of all ovarian malignancies. The epithelium has the inherent ability to differentiate into serous, mucinous, endometrioid, clear cell, or transitional epithelium, and therefore can give rise to benign, borderline, or malignant tumors of these types. The combined outcome of serous and mucinous tumors accounts for approximately 30% of all ovarian malignancies. Approximately 20 to 50 percent of serous tumors have bilateral characteristics, with the majority of these being borderline tumors. However, it is exceedingly rare for both ovaries to simultaneously contribute to primary tumors with different histology. This recent presentation focuses on a case of bilateral ovarian cystadenomas with serous and mucinous histotypes. Based on our extensive understanding, this particular case is only the second one of its nature to have been documented in the existing body of literature.

Case Presentation: This case report provides a detailed description of the clinical features, diagnostic methods, and outcome of a patient who had both periampullary distal cholangiocarcinoma and mucinous cystadenocarcinoma of the ovary. This case emphasizes the significance of taking into account uncommon combinations of tumors and brings attention to the diagnostic difficulties and restricted therapeutic choices in such instances.

Conclusions: This case report also provides an outline of the present indication on periampullary distal cholangiocarcinoma and mucinous cystadenocarcinoma, particularly concentrating on biological features, histological characteristics, and available data guiding current and upcoming therapeutic approaches for these rare, and still barely known, tumors.

During the routine dissection of an approximately 55-year-old male cadaver, we observed the following variations in the branches of aorta, presence of an accessory renal artery on the right side, right testicular artery arising from the accessory renal artery and obturator artery from the posterior division of internal iliac artery. The right accessory renal artery to the lower pole originated from the lateral part of the abdominal aorta about 0.5 cm from the origin of the right renal artery. Routine dissection in Anatomy gives a lot of variations in cadavers and it provides a sound indication to surgeons. Such variations especially in blood vessels are important during operative, diagnostic and endovascular procedures. These observations have implications for abdominal and pelvic surgeons and are of academic interest to anatomists. Surgeons dealing with kidney transplantation and obturator hernia need to be aware of these observations.

An anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus, with an interarterial course, has been associated with an increased risk of myocardial ischemia and sudden death. The prevalence of coronary artery anomalies in patients undergoing coronary angiography ranges from 1% to 5% [1]. This variation depends on the population studied and the definitions used to categorize the anomalies. Their detection is crucial due to their potential to cause life-threatening events. As the exact pathophysiology of AAOCA is not well understood, the clinical management is also not well defined. With the increased use of non-invasive imaging, the diagnosis of AAOCA is increasing and the association of anomalous origin and atherosclerotic disease is becoming a more important topic.

Several studies have been done to find a true “denominator” causing ischemia and sudden cardiac death (SCD). The pathophysiological mechanisms taken into account include ischemia caused by mechanical compression exerted on the artery tract with an abnormal course, its geometric alterations (including a slit-like ostium, acute take-off angle, and proximal narrowing) and histopathological changes in the vessel wall.

This chapter is given as an example of a rare case of AAOCA chronic total occlusion (CTO). A 40-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to typical chest pain and positive myocardial scintigraphy. ICA demonstrated CTO of an anomalous right coronary artery (ARCA) originating from the left side of the ascending aorta with an interarterial course. During the procedure, an unexpected rupture of the coronary artery occurred after dilatation with a small balloon at low pressure. The complication was an opportunity for food for thought. Coronary artery perforations are rare but life-threatening procedural complications that are usually caused by predisposing anatomical and procedural factors. Based on this complication, this study hypothesized that the arterial wall might be fragile due to pathological alterations, potentially contributing to the pathophysiology of coronary malignancy. Recent studies conducted on small samples have shown the presence of histopathological alterations (such as elastic fiber alterations, mural fibrosis, and smooth muscle disarray) in patients with anomalous aortic origin of a coronary artery [2]. However, further autopsy studies, including larger samples, are needed to understand the histopathological changes associated with coronary anomalies and an increased risk of SCD.

Hepatobiliary tuberculosis is an uncommon manifestation of tuberculosis. It can be associated with pulmonary tuberculosis (TB) or tuberculous enterocolitis (TEC). Hepatic TB can be manifested as hepatic tuberculoma, diffuse liver infiltration or liver abscess. Tubercular liver abscess is the rarest form of hepatic tuberculosis, liver may be involved as part of miliary tuberculosis or as local tuberculosis. Being a rare entity here we report a case of tubercular liver abscess associated with pulmonary tuberculosis.

Background: Laparoscopic surgery is normally performed under general anaesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. In the study group, following evidence that spinal anesthesia is safe compared to general anesthesia, spinal anesthesia has become the preferred technique for this procedure.

Aim: This retrospective study highlights laparoscopic cholecystectomy under thoracic spinal anesthesia.

Methods: A total of 505 laparoscopic cholecystectomy patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T8 to T11, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with two doses of 0.5% bupivacaine hyperbaric plus 25 µg of fentanyl, until reaching the sensitive level of T3. The study evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications.

Results: All 505 patients developed spinal anesthesia. Neither the dose of hyperbaric solution of 0.5% bupivacaine nor the addition of fentanyl affected the onset of sensory block. The duration of the sensory block was greater than the motor block with a hyperbaric solution. Bradycardia occurred in 16 (3.1%) patients and was not correlated with the level of thoracic puncture. Hypotension occurred in 82 (16.2%), with no significant association with the dose of local anesthetic. None of the 505 patients had the maximum degree of lower limb motor block, with significant differences in terms of dose. Paresthesia was observed in 28 (5.5%) without significant differences between needles. All paresthesias were transient and without residual sequelae. The creation of the pneumoperitoneum is an essential component of laparoscopic procedures. The insufflation of gas into the peritoneal cavity and increased intraabdominal pressure can cause several cardiocirculatory and pulmonary effects.

Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery, without neurological sequelae. TSA provides hemodynamic stability with low need for vasopressors, without the appearance of hypoxemia or hypercarbia, without the need for an orogastric tube, and moving from the operating table to the stretcher without assistance, and with excellent analgesia for up to 6 hours and can be used on an outpatient basis.

Introduction: Various analgesic management strategies have evolved, often the regional analgesic techniques being favored over the systemic administration of opioids. Most anesthesiologists use thoracic epidural, which has a 0.75% incidence of accidental perforation. However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury.

Aim: The main objective of this retrospective study was to evaluate the incidence of paresthesia and neurological complications, as well as cardiocirculatory changes after thoracic spinal anesthesia.

Methods: This retrospective study of patients undergoing thoracic spinal anesthesia evaluated the following parameters: needle types, needle insertion, puncture position (sitting or lateral decubitus), thoracic puncture level, presence of cerebrospinal fluid (CSF) in the needle hub, type of anesthetic, latency, motor block, incidence of bradycardia and hypotension, paresthesia (duration) and neurological complications. This study conducted a retrospective audit, between January 2007 and December 2019. This study reviewed the record sheets of patients who experienced paresthesia for thoracic spinal anesthesia with two types of needles of the same gauge, isobaric and hyperbaric 0.5% bupivacaine and puncture in the sitting or left lateral position, and median and paramedian insertion.

Results: Paresthesias occurred in 5.9% of patients. In this observation, 41 patients experienced a paresthesia with cut needle compared with 43 patients with a pencil point, without statistical difference. All paresthesias were transient and lasted a maximum of three days. No sequelae neurologic were observed in all patients during this study. Bradycardia occurred in 3.1% of the patients and hypotension in 13.2% of the patients, easily corrected by the use of atropine and vasopressor.

Conclusion: All 84 paresthesias observed in this study were associated with free flow of CSF when the stylet was removed from the needles. No association was found between the type of spinal needle and the incidence of paresthesias. This study with 1,406 patients showed that thoracic spinal anesthesia is safe and without neurological sequelae, with a puncture between T8 and T11. If the anesthetist has an adequate knowledge of the relevant modern anatomy, physiology and pharmacology, safe and satisfactory anesthesia can easily be obtained to the mutual satisfaction of the patient, surgeon and anesthetist.