Medicine and Medical Research: New Perspectives Vol. 7

Circulating Tumor Cells (CTCs) refer to malignant cells that have separated from the main tumor and disseminated throughout the circulation. Circulating tumor DNA is specifically derived from the tumor and discharged into the bloodstream. Nowadays, scientists are devising instruments and methodologies to capture and detect these malignant cells more precisely and delicately from the blood of individuals with cancer, through the implementation of both physical and immunoaffinity-based methodologies, as well as positive and negative enrichment approaches all through separation. BTC encompasses a wide range of malignant neoplasms that are typically classified according to their anatomic location, including intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, gallbladder cancer, and cancer of the ampulla of Vater. Biliary Tract Cancer (BTC) is a malignant tumor that displays a high degree of ferocity and carries an unfavorable outcome. BTCs are the second most frequent type after Hepatocellular Carcinoma (HCC). Despite the challenges posed by BTC, there have been significant advances in identifying genetic mutations that can be targeted in affected patients. These breakthroughs have led to the creation of novel targeted therapies, with promising results in recent studies. Utilizing liquid biopsy, a non-intrusive technique for detecting tumor biomarkers from samples can provide valuable assistance in diagnosing and molecularly characterizing the tumor. Liquid biopsy has garnered mounting interest as a potential instrument for the diagnosis and treatment of cancer in recent times. The utilization of ctDNA analysis has the capability of providing timely identification of oncogenic mutations, timely detection, treatment surveillance, and identification of treatment resistance pathways in cancer management. This article presents a comprehensive review of the existing literature on the use of ctDNA in patients with BTC, with an emphasis on the latest innovative methodologies and future prospects for managing this extremely malignant disorder.

Ameloblastoma is a slow-growing locally aggressive, benign odontogenic epithelium with a greater tendency for recurrence and involves aggressive bone loss and teeth. It is believed to be derived from cell rests of the enamel organ, either remnants of the dental lamina or Hertwig's sheath, the epithelial rest of Malassez. An Unicystic Ameloblastoma (UA) represents an ameloblastoma variant, that's a cyst. They are often related to an unerupted third molar, with a peak incidence within the third and fourth decade of life.

The most common site of preference is the mandibular molar and ramus area than the anterior and premolar region. The article presents two case series of unicystic ameloblastoma of a 25-year-old female who had a localized swelling in the left side of the mandible which resembled a keratocystic odontogenic tumor clinically and radiographically. Based on histopathological examination the final diagnosis was unicystic ameloblastoma with the mural pattern. The second case report presented a 32-year-old female with a diffuse swelling in the left lower jaw which histopathologically revealed ameloblastoma with the plexiform variant. An incisional biopsy was done to get a definitive diagnosis for both cases. A postoperative panoramic radiograph was taken and was found to be satisfactory in both cases. The case series presented certain unique features of female predilection and a multilocular variant with mural and plexiform pattern unicystic ameloblastoma. Both patients were surgically managed more conservatively with enucleation and cauterization as cystic types are found to be less aggressive compared to solid variants of ameloblastoma. They were on a regular follow period postoperatively. It can be concluded that unicystic ameloblastoma with a mural growth pattern has a tendency for recurrence if inadequately managed surgically. Proper management avoids the propensity of recurrence rate.

A unique case report of a 54-year-old male who developed Takotsubo cardiomyopathy (TCM) following recent cocaine use presenting with cardiac arrest (CA) has been presented. Cocaine is a sympathomimetic agent that acts by inhibiting the reuptake of norepinephrine, dopamine, and serotonin through binding with each transporter resulting in an accumulation of these neurotransmitters in the postsynaptic terminal. Cocaine is used as an illicit substance responsible for the most common cause of drug-related death. It is a stimulant that acts on the sympathetic nervous system and cardiovascular system leading to exaggerated, prolonged sympathetic activity due to the accumulation of neurotransmitters. Congestive heart failure, myocarditis, arrhythmias, and coronary artery spasms are among the cardiovascular adverse effects of cocaine. In the absence of obstructive coronary artery disease, takotsubo cardiomyopathy (TCM) is characterized by transitory akinesis, dyskinesis, or hypokinesis of the left ventricular (LV) wall with or without apical involvement. Cocaine-induced TCM is an extremely rare condition emphasizing the need for its prompt diagnosis by physicians. A case report of a 54-year-old male brought to the emergency department (ED) after an out-of-hospital cardiac arrest (CA), found to have TCM in the setting of cocaine use, has been presented. Clinicians need to understand the association between cocaine use and the development of TCM as cardiomyopathy of this type can result in complete remission after discontinuing the offending agent. There are no standardized recommendations for pharmacological treatment and prevention of episodes of TCM and further studies/trials need to be done to answer questions regarding the clinical diagnostic criteria, etiology, pathophysiology, and management of this syndrome.

Categories: Cardiology, Internal Medicine, Substance Use and Addiction.

This review summarizes the evidence on nuclear receptors (NRs), such as glucocorticoid receptor, mineralocorticoid receptor, estrogen receptor, aryl hydrocarbon receptor, and peroxisome proliferator-activated receptor, in modulating the inflammasome activity and depression-associated behaviors. Major depressive disorder (MDD) is highly prevalent and is a significant cause of mortality and morbidity worldwide. Currently, conventional pharmacological treatments for MDD produce temporary remission in < 50% of patients; therefore, there is an urgent need for a wider spectrum of novel antidepressants to target newly discovered underlying disease mechanisms. Another important hypothesis of depression, several lines of evidence have established an association between MDD and the neuroimmune pathway, although some psychiatrists have argued about the causal relationship between inflammation and depression. Accumulated evidence has shown that immune inflammation, particularly inflammasome activity, plays an important role in the pathophysiology of MDD. This review provides evidence from an endocrine perspective to understand the role of activated NRs in the pathophysiology of MDD and to provide insight into the discovery of antidepressants with novel mechanisms for this devastating disorder. Cumulative studies have shown that activation of the NRs may directly change the activity of inflammasomes to modulate the levels of mature forms of caspase-1 and IL-1\(\beta\). Caspase-1-mediated programmed cell death and surface stability of the AMPA receptor in the hippocampus, are essential for depression-like behavior.

Aims: This study aims to evaluate the effects of customized zirconia barrier membranes produced for guided bone regeneration approaches on bone healing researched with histological and histomorphometric methods.

Study Design: In vivo experimental study.

Place and Duration of Study: The digital modeling and writing phase took place at Istanbul University Faculty of Dentistry, Department of Oral Implantology. The surgeries and sacrification procedures for the experimental animals were carried out in the operating rooms of the Surgery Department at the Faculty of Veterinary Medicine, Bursa Uludag University. The bone tissue samples obtained were histologically and histomorphometrically evaluated in the laboratories of the Pathology Department at the same university. The study started in August 2022 and ended in February 2024.

Methodology: The research involved using digital modeling to create zirconia barrier membranes suitable for a defect in the tibia bone. These membranes were designed using a 3D software system and transferred to the CAD/CAM software system in STL format. Zirconia discs (1400 Mpa) (Aconia BSM- D98x16, HT+, Germany) were then milled and sintered. The defects were covered using titanium mesh, titanium-reinforced d-PTFE, and zirconia barrier membranes, while one defect was left empty for the control group. At 3 and 6 weeks into the healing period, samples were obtained from each group after sacrificing the animals. Histomorphometric and histological analyses were conducted to evaluate new bone formation, the amount of remaining grafts, and tissue response parameters.

Results: The newly formed bone amounts of the zirconia barrier membrane, titanium membrane, and d-PTFE membrane groups were significantly higher than the control group in the 3rd and 6th weeks. The amount of residual graft progressed at a low level in both periods without any difference in the other groups except the control group. No foreign body reaction or necrosis was observed in any of the defects.

Conclusion: With the limitation of the study, it has been concluded that effective results can be obtained with zirconia barrier membranes in GBR procedures.

In 2007, the prevalence of high blood pressure (BP) was 36% in Niger according to a recent survey by the World Health Organization (WHO). Niger got involved in the May Measurement Month (MMM) campaign in 2017, 2018, and 2019 to gain an understanding of the prevalence of selected cardiovascular risk factors and high BP. The aim of this study was to screen for cardiovascular risk factors with particular focus on high blood pressure (BP) in Niger and thereby to raise awareness among the population of Niger about raised BP and the associated risk to health. The city of Niamey served as our study location during the month of May in 2017, 2018, and 2019. Volunteer adults aged \(\ge\)18 years, who completed a pre-established questionnaire were screened and had three sitting BP measurements taken. Hypertension was defined as a systolic BP \(\ge\)140 mmHg or diastolic BP \(\ge\)90 mmHg (based on the mean of the second and third BP readings) or being on antihypertensive medication. In this study, 2297 adults were screened, of which 42.9% were women and 57.1% were men. Of the 2297 screened, 33.2% were found to be hypertensive of whom only 26 (3.4%) were recorded as being on treatment. Approximately 30% of those screened were found to be obese or overweight. The MMM campaign in Niger highlights a large number of people with hypertension can be screened opportunistically. In the absence of systematic and population-based screening, the MMM campaign should be continued annually in order to raise awareness of raised BP and its complications among the population. High BP is a real public health danger, and this study finds alarming figures that highlight the need for improved policies for screening and management of hypertension. Raising awareness and improving the detection of hypertension remain essential to reduce the burden of cardiovascular disease.

Background: Cesarean section (CS) is a common surgical operation with expected complications representing major health problems. This necessitates improved recovery with reduced hospital stay. Discharge after planned CS has become an accepted practice, however, little is known about its health impact and patient perception.

Objective: The present study aimed to assess patient satisfaction and morbidity associated with early hospital discharge (24 hours) after planned elective cesarean section- El C/S in 2010.

Methodology: A descriptive study was done in Omdurman Maternity Hospital (OMH) in 2010. All women admitted for El C/S were counseled for discharge after 24 hours from C/S; those with medical or obstetrical problems necessitating admission for a longer time were excluded. Women who refused to be discharged were included as control after informed consent. All women were operated on by trained registrars or consultants under similar conditions and were followed till discharge from the hospital.

Results: Elective cesarean section had potential benefits for the mothers and their babies; such as reducing birth asphyxia, birth trauma, cord accidents, fresh stillbirth (FSB), and birth canal injuries to the mother, however, it is not without complications. Total number of deliveries in OMH during 2010 was 28975, 21022 (72.6%) delivered vaginally, 7953 (27.4%) delivered by cesarean section –C/S, El C/S were 3204 (11.1%) and Em C/S were 4749 (16.4%). Women included in the study were 1439, 716 (49.8%) were in the study group and 723 (50.2%) were in the control. Forty-one cases (2.8%) were readmitted after discharge, fifteen (1.1%) from the study group and twenty-six (1.8%) from the control. Twenty-four cases (1, 7%) due to wound infection, five (0.3%) with deep vein thrombosis- DVT, two with endometritis, and eight (0.6%) due to non-pregnancy-related infection. Although there is a slight increase in the rate of readmission, wound infection, and DVT in the control group, there is no significant difference between the two groups. In the study group, 613 (85.6%) were satisfied with a short stay, while in the control group, 269 (37.2%) were satisfied with a longer hospital stay after El C/S (PV = 0.0001) with a significant difference between the two groups.

Conclusion: Discharge after 24 hours following planned C/S can be performed on low-risk patients without affecting patient satisfaction and increase in maternal mortality or morbidity. More randomized trials are needed to assess the impact of standard care.

Introduction: Dengue fever is an arboviral disease caused by the dengue virus transmitted by the bite of female Aedes aegypti mosquitoes, affecting people worldwide and often causing pandemics in Southeast Asian countries. The global health disease burden of dengue has been found to be the highest among all arboviral diseases. Dengue viral infection symptoms range from flu-like illness to complications like pneumonia, hepatitis, neurologic symptoms like encephalitis, myopathy, Guillain–Barre syndrome, phrenic neuropathy, subdural hematoma, and cerebral vasculitis. The possibility of skeletal muscle invasion causing myositis is another rare entity.

Case Description: A case of dengue, with myositis presenting as muscle weakness, decreased power, and raised Creatinine Phosphokinase (CPK) level in a 6-year-old boy has been reported.

The boy suffered from Dengue viral fever diagnosed by positive NS1 antigen. Initially, the symptoms were like uncomplicated dengue fever but later he developed leg muscle pain and, a decreased range of movements. The Serum CPK level was increased and then the baby was diagnosed with myositis. Later with supportive treatment, he improved, the pain subsided, the power and tone of leg muscles increased and the serum CPK level came to normal. The child’s condition was self-limiting and hence he was treated as per standard dengue national management guidelines with antipyretics and regular monitoring of blood pressure, hematocrit, platelet count, and level of consciousness.

Conclusion: Myositis in the pediatric population is a rare entity and hence often neglected and undertreated. It can turn into permanent damage and deformity if not treated in time in long-term sequelae.

The present study examines whether teenage pregnancy is associated with an increased risk of maternal and neonatal complications compared to adults through a systematic literature review to help clinicians in their actions before and during pregnancy in adolescents. Adolescent pregnancy is still a common occurrence, mostly in developing nations. Because it is associated with both obstetric and perinatal outcomes, maternal age is an important factor to consider while managing obstetric patients. A literature review to address the obstetric results of pregnancy in teenage mothers was conducted. Articles for the last 5 years in different databases including ‘Pregnancy’, ‘Teenager’, ‘Adolescent’, ‘Complications’, and ‘Outcomes’ as keywords were reviewed. A total of 2260 articles were obtained after the initial search, but only 28 met the inclusion criteria and were therefore reviewed. The outcomes were divided into complications of pregnancy, childbirth, puerperium, and neonatal complications. It was found that there is an association between young maternal age and preterm birth, pre-eclampsia/eclampsia, fetal growth restriction, and stillbirth, among others. The results of this review indicate that there is an association between young maternal age and low birth weight, preterm birth, pre-eclampsia/eclampsia, anaemia, fetal growth restriction, stillbirth, and premature rupture of membranes. For the newborn, it was found that outcomes such as low APGAR scores and admission to intensive care were more frequent in teenage mothers. It is assumed that the risk is greater when taking into account other aspects such as the socio-economic and cultural impact on adolescents or the weight of parenting, data that do not arise from our research but should be the object of further studies. Finally, it is recommended that future research addressing adolescent pregnancy could help better understand this phenomenon and its implications.

Aims: The present study assesses the knowledge of Biomedical waste (BMW) categories, colour coding, transport, storage, and disposal of Biomedical waste among healthcare workers.

Background: Hospital waste (Biomedical waste) is dangerous due to its hazardous and infectious nature in comparison to other kinds of waste. Almost 75-90% of the waste produced by hospitals, nursing homes, etc. is non-risk in nature as it is generated from administrative and general housekeeping.

Materials and methods:  This cross-sectional study was conducted over the duration of 1 month, in the Multi-speciality Hospital, Pune, India. A predesigned questionnaire with closed-ended questions was used to conduct this study on HCWs. Data related to awareness and knowledge about various aspects of biomedical waste management were collected.

Results: Out of 100 HCWs, 40 doctors knew all BMW categories. 45 doctors and 40 nursing staff (a total of 85 HCWs) correctly answered questions on colour coding. Only 30 doctors and 21 nursing staff knew about BMW transport. 25 doctors and 18 nurses answered correctly about BMW storage and disposal. In our study, 60% of healthcare workers including doctors and nursing staff were aware of BMW categories. 85% of healthcare workers had knowledge about colour coding of biomedical waste.

Conclusion: Vigorous and repeated training and evaluation are needed to bridge the knowledge gaps among HCWs. Hands-on sessions on various aspects of BMW management under supervision need to be organised separately involving each category of HCWs as well as for the frontline staff (Pharmacists, billing, reception) in every healthcare organization to improve compliance amongst all stakeholders.

Background: Conscious sedation is a drug-induced depression of consciousness during which the patient responds to verbal commands either alone or accompanied by light tactile stimulation.

Objectives: This study aimed to estimate the concentration of nitrous oxide (N₂O) required for effective sedation in anxious children undergoing dental treatment and to assess behaviour, patient acceptance, parental satisfaction, postoperative complications, and ease of mask manipulation by the dentist during N₂O–O₂ sedation.

Materials and Methods: A total of 40 children aged 6–10 years requiring dental treatment were treated using N₂O sedation. Observations included the level of N₂O required for optimal sedation, patient behaviour, acceptance, clinical recovery score, and postoperative complications. Parental satisfaction was evaluated using a questionnaire post-treatment. The descriptive and inferential statistical data were analyzed using the IBM Corporation Statistical Package for the Social Sciences statistics for Windows, version 20.0.

Results: N₂O concentration ranged from 25 to 70% with a minimal rate of complication like nausea, vomiting, headache, and mild ambulatory difficulties. Sedation was highly effective with 25–50% N₂O concentration. Approximately 92.5% of children were fully cooperative, and the dentist was able to comfortably place the mask in 92.5% of cases. Significant improvement in patient behaviour with minimal complications was observed, and 100% of parents were satisfied with the treatment.

Conclusion: Inhalational sedation with N₂O using the Porter Silhouette mask results in effective sedation, increased patient comfort, and high parental acceptance in providing dental treatment.

Introduction: Syringomyelia is a neurological disease characterized by the presence of fluid-filled cavities within the spinal cord, resulting in progressive neurological deficits. Intramedullary hemangioblastomas are often accompanied by syringomyelia. However, holochordial syringomyelia is rare. The most common cause of syringomyelia remains Chiari disease, and only 10 cases of hemangioblastomas with holochordial syringomyelia have been described so far.

Case Report: A case of a 35-year-old patient with a two-month history of cervicobrachialgia at the C7-C8 root level, previously preceded by pain at the D1-D2 level, has been presented. Cervico-dorso-lumbar MRI revealed a medullar tumor with an uptake mural nodule at the conus medullaris level accompanied by an extensive syringomyelic cavity from C5 to L1 compatible with medullary hemangioblastoma. The patient underwent surgery for tumor resection with subsequent resolution of her painful symptoms. Syringomyelia is mainly associated with Chiari malformation and also with inflammatory pathologies, spinal attacks, trauma, and intramedullary tumors of the spinal cord.

Conclusion: The management of holochordal syringomyelia can be a great challenge. It is important to emphasize that surgical treatment is aimed at treating the origin of this syringomyelia and not the syringomyelia itself. It is mandatory to rule out the existence of Chiari syndrome as a first possibility, without forgetting the possibility of focal intramedullary spinal tumors as a cause of syringomyelia.

Introduction: Skin metastasis can be the presenting symptom of many malignant tumors. These signs occur a long time before the diagnosis of the primary tumors or their recurrence and sometimes after surgery. These initial cutaneous tumors may aid in the diagnosis of primary tumors.

Aim: This study was conducted to identify them and to establish the utility of Fine Needle Aspiration Cytology (FNAC) to diagnose these lesions. As FNAC is a simple, rapid, cost-effective, minimally invasive OPD procedure. No anesthesia or special equipment is needed and it can be practised in a small setup.

Materials and Methods: The study was conducted in a tertiary care center. Clinical history, presenting features, and FNAC findings of the cutaneous lesions were noted. Immunocytochemistry(ICC) and Immunohistochemistry (IHC) from cell block were done when necessary. These findings then corroborated with Histopathological diagnosis.

Results: This study includes the cases of cutaneous metastatic deposits from various primary visceral malignancies, Lung, Gastrointestinal tract, thyroid, ovary etc. at different sites. The sites of cutaneous metastasis are the chest wall, scalp, and anterior abdominal wall, all over the body. The patients underwent preliminary investigations and FNAC. After a diagnosis of neoplastic lesions, the patients were referred to the Radiology, surgery, and radiotherapy department for further management.

Conclusion: Metastatic skin lesions may develop due to lymphatic and blood spread. It may be the first presenting feature of the malignant tumor or its recurrence. This study also proves the efficacy of FNAC in ascertaining the nature of these lesions. The cytological features along with clinical findings and radiological imaging help the early recognition of the primary lesion or identification of recurrence and thus help the clinicians in planning appropriate management.