Medical Research and Its Applications Vol. 8

This chapter is dedicated to sleep impairment in attention deficit hyperactivity disorder. Attention Deficit Hyperactivity Disorder (ADHD) is a quite common neuropsychiatric ailment affecting all ages. Sleep impairment is associated with widespread regional changes in brain activity involved in sustained attention, distraction, impulsivity and memory, as shown by numerous objective methods. Sleep problems which are very common in children and adolescents without ADHD present as either insufficient or impaired sleep. The diagnosis of ADHD lacks a biological marker and is based only on clinical judgment. Therefore, overdiagnosis and underdiagnosis are not uncommon. Since it is a developmental disorder, the clinical characteristics vary with age, nevertheless. the majority of affected individuals exhibit the traditional "triad" of impulsivity, hyperactivity, and inattention. A number of comorbidities are associated with the disorder and in many patients, their presence imposes a negative effect on life quality which may be more prominent than that caused directly by the classical "triad". Although cases with the triad have been reported during the last 200 years, the concept of ADHD was solidified in 1987. It has taken some time for sleep disturbance to be identified as a significant comorbidity of ADHD. It is surprising that the DSM-5 did not mention sleep impairment in relation to ADHD. This study reviews the traits, prevalence, and potential cause of sleep disturbance in children and adults with ADHD.  Also, the bidirectional association between impaired sleep quality and ADHD is discussed in an attempt to clarify whether impaired sleep is an additional symptom of “pure” ADHD, is the sole result of associated comorbidities, or is the result of both.

Aim: This study aims to investigate the impact of platform switching on the trans-cortical section of bone adjacent to an endosseous dental implant in the posterior mandible region, under vertical and oblique forces.

Materials and Methods: Three-dimensional finite element models were constructed using ANSYS 13.0 software, employing Type II mandibular bone with cortical thickness ranging from 0.595 mm to 1.515 mm, encompassing a crestal region of 1.5 mm surrounding dense trabecular bone. The implant design featured a 5 mm restorative platform tapering down to 4.5 mm wide at the threads, with a length of 13 mm and an abutment height of 3 mm. Two scenarios were modeled: 1. An implant with a 5 mm diameter abutment representing a standard platform, and 2. An implant with a 4.5 mm diameter abutment representing platform switching. Vertical and oblique forces, simulating masticatory loads, were applied at 100 N and 15 degrees from the vertical axis, respectively. Von-Mises stress analysis was conducted.

Results: Under oblique forces, cortical stress in the conventional and platform switching models measured 59.329 MPa and 39.952 MPa, respectively. For vertical forces, cortical stress in the conventional and platform switching models was 13.914 MPa and 12.793 MPa, respectively. With a wider implant in the platform switching, a lower incidence of stress was found that was also concentrated away from the peri-implant bone surface which would cause less microdamage in the bone tissue, resulting in minimal crestal bone loss.

Conclusion: The study demonstrates that reducing abutment diameter (i.e., platform switching) leads to a measurable decrease in Von-Mises stress within the crestal region of cortical bone.

The present study highlights the understanding of Fibrinolysis Misconceptions. Tissue plasminogen activator (tPA) has been associated with therapeutic fibrinolysis for thirty years due to the unproven theory that fibrinolysis was caused by tPA alone. Streptokinase (SK), a non-specific activator, was replaced with tPA during development; nonetheless, comparative trials in acute myocardial infarction (AMI) revealed similar benefits for both drugs, with the exception that tPA dramatically increased intracranial hemorrhage (ICH). The tPA hypothesis was contradicted by gene deletion findings in mice, which showed that fibrinolysis required both tPA and urokinase plasminogen activator (uPA)and that uPA was the dominant activator. Clot lysis studies confirmed the findings and showed tPA and uPA to have complementary effects that functioned sequentially in fibrinolysis. In combination, starting with tPA, their effects were synergistic. A sequential combination was once tested in AMI, in which 101 patients were given a mini bolus of tPA followed by a pro-UK infusion. This resulted in a six-fold lower mortality and almost two-fold higher infarct artery patency rate than that in the best of the tPA trials. Despite publication of the study in a prominent journal, the combination was never retested, which is against standard practice which invariably repeats an unusually successful treatment result to see whether or not it was a fluke, and fibrinolysis with tPA remained the standard. With little evidence in support of this long-standing practice, a paradigm shift is long overdue. By using the biological complementary and synergistic properties of tPA and uPA in a sequential combination, fibrinolytic therapy can be made more effective and safer. This was already tested and validated in a clinical trial of AMI but its recognition and utilization awaits the paradigm shift referred to by Thomas Kuhn.

This clinical study has been carried out with the purpose of providing an overview of eye movement abnormalities in Parkinson's disease. The eye is a biological camera that has been endowed with us, and while tracking ocular movement is a simple activity, it offers valuable insights into the diagnosis of Parkinson's disease. While many of the abnormalities are generic, some are quite specific, such as progressive supranuclear palsy or oculogyric crisis in post-encephalitic Parkinson's disease. The eye symptoms of parkinsonism are vague.  Retina contains dopamine, hence ocular symptoms like astenopia are common in PD.  In the neurology outpatient department, a cohort of 100 patients diagnosed with Parkinson's disease and Parkinson's plus syndromes were meticulously examined. Demographic details, detained history, ocular signs and symptoms, ocular deviation, visual acuity, diagnosis, and management aspects are extracted from the medical records. Visual acuity by Snellen values. Ocular deviations were measured by prism cover test and ocular motility was carried out to evaluate the gaze limitation. A diagnosis of CI was made if the near point of convergence (NPC) value was larger than 10cm. Saccade and pursuit scores evaluated using the Northeastern State College of Optometry method were used to determine if they had lower than age-expected norms. Color vision was assessed using Ishihara pseudo isochromatic plates. Reading speed was measured in words per minute (WPM) based on reading a simple paragraph in an English magazine for a minute. The developmental eye movement (DEM) rate was calculated based on the time taken for the vertical and horizontal tasks on the DEM test. The protocol of eye movement examination was followed. The study highlights the significant burden of ophthalmologic symptoms in PD and emphasizes the importance of addressing these symptoms in the management of the disease. The Parkinsonian group of illnesses is distinct in that most of the time, eye movements are disturbed, providing us with important diagnostic information. The most commonly impacted are smooth pursuit fixations and saccades.

Famous researchers have long recognized the connection between vibration, energy, and information.

Albert Einstein and Max Plank in particular classified all energy transfers as oscillations. With the current findings on endothelial mechano-transduction, we can come closer to understanding the complex regulation of vital functions of life by mechanical forces. The undisturbed course of essential functions such as growth, blood pressure regulation, inflammatory sequence, and embryogenesis is bound to the absence of externally transmittable forces and endothelial integrity.

The recognition of various endothelial cell structures as mechano-sensors is simultaneously important for understanding vital regulations. The endothelial cell itself, which corresponds to a viscoelastic “tensegrity model”, is a mechano-sensor that adapts beat to beat to the current conditions in the blood flow in alignment with the effect of various physical forces.

Numerous endothelial mechano-sensors are identified, whereby the conserved structures of PIEZO channels for all organisms - from bacteria to mammals - have an outstandingly important role in numerous life processes, the decoding of which is still far from complete.

The present knowledge sheds new light on the importance of low frequencies. The endothelial cytoskeleton identified now as a low-pass filter, offers the possibility for mechano-transduction. There is strong evidence that parts of the energy transmission of low-frequency oscillations become irregular information at the endothelial level that interferes with the autochthonous control of the microcirculation. Recent studies confirm the importance of a balance of the NO metabolism due to a synchronized release at the right time, in the right place, and with the right quantity. Misinformation, caused by external forces, must inevitably lead to an increase in oxidative and oscillatory stress, the main reason for a loss of endothelial integrity with inflammation diseases like atherosclerosis. This could indicate the long-sought pathophysiological way in which infrasound and vibration can exert a stressor effect at the cellular level. Noise-exposed citizens, who live near infrastructures such as biogas installations, heat pumps, block-type thermal power stations, and bigger industrial wind turbines (IWT’s), show worldwide mainly a symptomatology associated with microcirculatory disorder.

Marine ecosystems, but also insects, appear to be particularly at risk from increasing emissions of very low frequencies. There is evidence for the increasing incompatibility of ever lower frequencies for all organisms and therefore for whole biodiversity.

Introduction: Asepsis is the state of not being infected or coming into touch with microbes. Surgical asepsis is a collection of certain techniques and procedures carried out in closely monitored environments with the intention of reducing pathogen contamination. It uses asepsis maximization and maintenance, infection prevention for patients, and pathogen containment.

Objectives: The present study finds out the effectiveness of structured teaching programme on knowledge and practice regarding surgical asepsis among 3rd-year B.Sc Nursing students.

Materials and Methods: The research approach and design adopted for this study is a quantitative pre-experimental one-group pre-test post-test design. The study was conducted at the Faculty of Nursing, Assam down town University among 3rd year B. Sc Nursing students. Fifty-seven (57 nos.) of 3rd year B. Sc. Nursing students were selected by using a non-probability purposive sampling technique. The tools used were a Self-Structured knowledge questionnaire (total no. of items was 20) and an observational checklist to assess knowledge and practice regarding surgical asepsis. Descriptive and Inferential statistics were used to analyze the data. The frequency and percentage were calculated to assess the knowledge and practice of the students.

Results: Results revealed that 46 nos. of students (80.70%) had average knowledge and 11nos. (19.30%) had good knowledge whereas in the post test after the implementation of the Structured Teaching Programme, 52nos. (91.23%) had good knowledge and 5nos (8.77%) had average knowledge regarding surgical asepsis. 54 nos. (94.74%) had moderate practice, 2nos of students (3.51%) had poor practice and 1 student (1.75%) had good practice and in the post-test after the Structured Teaching Programme, 54nos. (94.74%) had good practice and 3nos. (5.26%) had moderate practice regarding the two aspects of surgical asepsis (Hand Scrubbing and Gloving). The study showed highly significant differences between the pre-test and post-test of the study group at p<0.01 for overall total nurses’ practices concerning aseptic techniques in the operating room, this means there are high level of improvement in nurses’ practice for the study group between pre-test and post-test interventional program about aseptic techniques in operating room.

Conclusion: A structured teaching programme was found to be effective in improving the students’ knowledge which ultimately improves their practice in surgical asepsis. Nursing Curriculum among the students and staff, especially emphasizing its practice and maintenance will help to improve health and prevent infection among patients thus optimizing quality care.

Aim: This study aims to assess the average freeway space among fully dentate individuals during rest and occlusion across different facial forms.

Background: The freeway space (FWS), or interocclusal distance, is determined by the balance between the elevator and depressor muscles attached to the mandible, and the “elastic” nature of the surrounding soft tissue in natural dentition. Lower one-third of the face can have far-reaching effects on facial aesthetics, not only on the peri-oral areas but also on the entire face. Mandibular posture greatly depends on head posture.

Materials and Methods: Fifty subjects from each of three facial form groups- square, taper, and oval- with a complete set of maxillary and mandibular arch teeth, aged between 25 to 40 years, were included. Equal numbers of males and females were represented in all groups. Vertical height at rest and occlusion was recorded using standardized procedures and freeway space (FWS) was measured

Results: Statistical analysis of the collected data revealed mean and median values for each facial form: square (3, 2.32), taper (2.62, 2), and ovoid (2.68, 2), respectively. No significant differences were observed between these readings (P < 0.05). However, 9% of the individuals exhibited the FWS range of 5–6 mm with measurements ranging from 1 and 7 mm, respectively. Notably, the majority (56%) of the square facial form subjects displayed an FWS range of 3–4 mm.

Conclusion: This study provides insights into the average inter-arch space across various facial forms, indicating a measurement typically exceeding 3–4 mm. The future prospective of this study is that evaluating the FWS in edentulous patients with an increased number of subjects would definitely increase the clarity.

Background and Objective: Total knee arthroplasty (TKA) is an established surgical procedure that can relieve knee pain, enhance knee function, and improve the patient quality of life. The primary objective of this study is to clarify the long-term cumulative survival rate (CSR) and standardized mortality ratio (SMR) of rheumatoid arthritis (RA) and osteoarthritis (OA) patients who underwent total knee arthroplasty (TKA).

Method: Data for 325 RA and OA patients with 460 primary TKAs from 1997 to 2007 were reviewed. We divided the patients into \(\le\)70 years (u70) and \(\ge\)71 years (o71) groups. The follow-up duration in the RA group (n=118) was 12.8±4.8 years vs 13.0±4.1 years in the OA group (n=207). The Cumulative Survival Rate was estimated using the Kaplan–Meier method.

Results: The SMR of the female RA patients was 1.97 (95%CI 0.96-3.89) after 5 years and 4.59 (95%CI 3.44-6.10) after 20 years. The SMR in female OA patients was 0.41 (95%CI 0.17-0.93) after 5 years and 1.31 (95%CI 0.996-1.73) after 20 years.

The 20-year CSR of female RA-o71 patients was lowest with 9.6 (95%CI 0-26). There was no significant difference in CSR between the RA-u70 and OA-o71 groups. The CSR in the OA-u70 group was highest with 77.8 (95%CI 0.62-0.93). Cox proportional hazards model analysis of female patients showed that steroid-use [Hazard ratio (HR) 3.22, 95%CI 1.32-13.46], age (HR 1.09, 95%CI 1.05- 1.30), and rheumatoid factor (HR 1.002, 95%CI 1.00-1.01) were risk factors in the RA-u70 group.

In the RA-o71 group, steroid use (HR 4.71, 95%CI 1.35-16.7), age (HR 1.38, 95%CI 1.12-1.71) and C-reactive protein (HR 1.20, 95%CI 1.02-1.41) were risk factors, whereas in the OA group, only age at surgery (HR 1.10, 95%CI 1.033-1.163) was a risk factor.

Conclusion: The study concluded that CSR was higher in patients with OA versus RA. SMR of female patients was high in RA and low after 5 years in OA. RA-u70 patients had a similar cumulative survival curve as OA-o71. The CSR of RA-o71 patients was poor. The preoperative factors affecting survival differed between u-70 and o-71 in RA.

Dengue infection is increasingly recognized as one of the world’s emerging infectious diseases. Dengue/Dengue Hemorrhagic Fever (DHF) is an emergent disease in India. The present study was carried out with the aim of assessing knowledge regarding Dengue fever among the community in an urban slum area of Andhra Pradesh. This cross-sectional study was undertaken in an urban slum area of Urban Health Centre, Guntur, which is a field practice area of the Department of Community Medicine, Katuri Medical College and Hospital, Guntur. The present cross-sectional study was undertaken in an urban slum area of UHC, Guntur, Andhra Pradesh, India.

Out of 370 respondents, 291(78.65%) knew that dengue fever is transmitted by mosquitoes. Only 38(10.27%) persons could enumerate 3 symptoms of Dengue (fever, headache and bleeding). Regarding knowledge about breeding places, only 276 (74.59%) respondents knew about breeding places of mosquitoes. Regarding the source of information on Dengue fever, 191 (51.62%) came to know about Dengue fever through television. ). In the case of personal protection against mosquito bites, 274 (74.05%) respondents were relying upon Mats/coils and 63 (17.03%) were using bed nets. Despite good awareness of dengue fever, the adoption of mosquito control methods was poor in the area. Strengthening surveillance along with health education to the community and proper training of health personnel can go a long way in control of Dengue infection.

It is likely that a proportion of patients evaluated for transcatheter Patent Foramen Ovale (PFO) and ostium secundum Atrial Septal Defect (OS ASD) closure has actually different anatomical variants particularly common in the right atrium such as Eustachian valve (EV), Chiari network (CN), Thebesian valve and Crista Terminalis (CT). Notably, EV is usually considered to be a benign finding in the absence of associated cardiac anomalies, but it is frequently found in adult patients with septal abnormalities mainly PFO. Percutaneous PFO/OS ASD closure can be achieved safely and efficiently and nowadays represents a routine interventional procedure in the catheterization laboratory with two different clinical indications. PFO closure is usually effective in preventing recurrent embolic stroke/systemic arterial embolization having reduced the risk of recurrent stroke in patients with cryptogenic strokes in randomized clinical trials [1,2]. Of note, EV may actively facilitate the mechanism of paradoxical embolism by directing the blood from the Inferior Vena Cava (IVC) towards the interatrial septum via PFO into the left atrium. Therefore, the presence of such an anatomic variant may represent per se an increased risk factor for left circulation thromboembolism. OS ASD represents the second most common congenital heart defect, accounting for about 10% of all congenital heart defects in the adult population. ASD closure is indicated in patients with significant left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Transcatheter OS ASD closure using currently available devices has proven to be safe and effective in the majority of cases offering excellent closure rates and shorter hospital stays compared to surgery [3,4].

It is of paramount importance to identify by echocardiography imaging the EV and other anatomical variants in order to avoid misdiagnosis and complications when planning PFO/OS ASD percutaneous or surgical closure procedures where EV may interfere with a successful outcome.

Background: Oral and maxillofacial hemangioma is a benign vascular tumor that develops due to endothelial cell proliferation and occurs in and around the oral cavity. It consists of an abnormal overgrowth of tiny blood vessels. Hemangioma may not be present at birth but may appear at 6-month of life. It is a rare vascular tumor.

Objective: To present the clinical presentation, modalities of treatment and surgical outcome of hemangioma of the oral and maxillofacial region.

Materials and Methods: This is a retrospective study of all the patients that were treated from January 2009 to December 2023. Information was extracted from case files of patients. Data collected included: age at presentation, sex, location of the tumor, treatment given, findings and histological diagnosis.

Results: Twenty- six cases of hemangioma were seen in the oral and maxillofacial region during the period of study. Twelve (n=12, 46.2%) were males and fourteen (n=14, 53.8%). Male to female ratio was 1.0 to 1.2. Cheek (46.2%) was the commonest site of occurrence, and the floor of the mouth was the least (3.8%). The age ranged from 4 months to 39 years. Our diagnostic tool was the aspiration of frank blood from the tumor which had similar clotting time with the normal blood and our mode of treatment included: injection of sclerosants and excision of the fibrous tissues.

Conclusion: It is essential to treat the tumor as early as possible especially in large lesions with disfigurement or where it is complicated by hemorrhage or infection.

Introduction: Lymphangiomas are uncommon congenital malformations of the lymphatic system that involve the skin and subcutaneous tissues. They are regarded as malformations that arise from sequestrations of lymphatic tissue that fail to communicate with the normal lymphatic system during embryogenesis. They are rare vascular malformations,

Objective: To reveal the clinicopathologic features of head and neck lymphangiomas that underwent surgical resection in our health facility.

Materials and Methods: This is a retrospective study of all cases of lymphangiomas of the head and neck in children treated in our health facility over a period from January 2010 to December 2023.

Results:  Ten cases were treated, 6 were males and 4 were female at a ratio of 3:2. The ages of the patients ranged from 3-months to 6-years. The lesions were located in the face, oral cavity and neck regions. Lymphangioma recurred in two cases: but no malignant transformation was noted on histology.

Conclusion:  Lymphangiomas in the head and neck region are not uncommon in children, therefore, neonatal screening of newborns for such anomalies is essential for early diagnosis and planning of treatment.