New Frontiers in Medicine and Medical Research Vol. 1

Serum Zinc Level Estimation- Comparision between Normal Control and in Leprosy Patients: Clinical Presentations

Pramila Jain — 2021-08-02

Mycobacterium leprae causes leprosy, which is a chronic infectious disease. It mostly affects the body's cooler portions, such as the skin and peripheral nerves. Leprosy causes a variety of biochemical and immunological alterations in the body, as well as trace metals including zinc, copper, and magnesium. Zinc is the second most abundant trace element in the body, after iron. This study aimed to correlate with clinical manifestations wherever possible and to look into the level of serum zinc in leprosy patients. A total of 63 people with newly diagnosed leprosy were included in the study.The cases were then divided into clinical subgroups and compared to the controls. Venous blood samples were taken, and serum zinc levels were estimated using serum. The majority of patients (26.9) had Intermediate Leprosy, while the minority (1.58) had Histoid Leprosy. Pure tuberculoid and indeterminate leprosy patients had the lowest serum zinc levels, whereas pure lepromatous and Erythema nodosum leprosum patients had the highest, indicating that leprosy patients with higher bacterial loads had lower serum zinc levels. This suggests that there could be a correlation between serum zinc levels and bacillary load.

Study of Migrations as a Public Health Issue

Obradovic Zarema — 2021-08-02

Migrations are temporary or permanent changes of place of residence, and migrants are persons who temporarily or permanently leave their home or their country, depending on whether they are migrations inside or outside the country. The reasons for migration are different: economic, political, natural disasters and wars. About 3.6% of the world’s population lives outside their place of residence, and the number of migrants is constantly increasing, and it is estimated that in 2050 there will be 405 million migrants in the world. Migrations are the displacement of people, but also the mobility of cultures, health habits and epidemiological factors and risks, and contribute to the increase in the number of infectious and non-communicable diseases among migrants and the local population in the countries they pass through or continue to live in.

The aim is to point out the importance of migration as a public health problem that affects migrants, but also the local population.

Methods: Review of scientific literature and reports of relevant institutions on the impact of migration on the occurrence of the disease in population.

Results: Migrants are all ages, except very old people, they are of both sexes, but there are more men who leave their country of birth for different reasons. A special problem are children who migrate unaccompanied by a parent or guardian. The occurrence of diseases in migrants is influenced by: personal characteristics of migrants, reasons for migration, ways of migration, the season in which migrations occur, hygienic and sanitary conditions in the areas through which migrants pass and conditions at the final destination. Economic migrations have the least impact on health because they happen according to plan, migrants travel with adequate transportation, have accommodation and work at their final destination. Unplanned migrations caused by wars, natural disasters, or some political reasons have a great negative impact on health. The health of these migrants is at great risk because they travel by unsafe means of transport, without documents, including health identification cards, cross the borders illegally and stay illegally in the countries of transit and the host country. This category of migrants does not have adequate accommodation, nor adequate access to health care, they are under constant stress which affects the onset of the disease. Migrants live in groups, so infectious diseases are easily spread among them, and they are also transmitted to the local population. Due to the inadequate approach to health care, the diagnosis of diseases, infectious and especially non-infectious, is made late in migrants, so treatment is often delayed. Linguistic and cultural barriers are a big problem for migrants in exercising their rights.

Conclusion: Migration is a significant public health problem today and should be addressed in a systematic way with the involvement of whole community.

Screening for Mitochondrial A1555G Mutation among Assortative Mating Hearing Impaired Families in South India: Some Vital Insights

Pavithra Amritkumar — 2021-08-02

Unravelling the mechanism of non-syndromic hearing loss (NSHL) through genetic studies have till date been perplexed by several factors such as genetic heterogeneity, multiple phenotypes, consanguinity and marriages between hearing impaired persons. A1555G mutation in the MT-RNR1 gene has been identified to be one of the most common mitochondrial mutations in several populations and it has been associated with both NSHL as well as aminoglycoside induced ototoxicity.

Objective: A detailed study was carried out to screen for the prevalence of mitochondrial A1555G mutation among assortatively mating hearing impaired families from South India.

Subjects and Methods: Owing to the variable phenotypic expressivity of this mutation, all the available family members (hearing and hearing impaired) in 106 assortatively mating hearing impaired families, (60 DXD and 46 DXN mating type), comprising of 616 members in all (277 HI individuals and 339 normal hearing family members) were screened for the presence of A1555G mutation by PCR-RFLP method. Mitochondrial A1555G mutation in the 12SrRNA gene was screened by PCR-RFLP method and confirmed by direct sequencing of entire 12SrRNA gene using suitable primers. Additionally, all the individuals carrying the A1555G mutation, along with their family members were screened for GJB2 gene mutations by direct sequencing method.

Results: On screening 616 members belonging to 106 assortatively mating families for A1555G mitochondrial DNA mutation, we found seven members in a family with variable phenotypes ranging from normal hearing to moderately severe hearing loss, having this mutation with clear matrilineal transmission.

Conclusions: A1555G mutation in the 12SrRNA gene has been identified to be one of the most common mitochondrial mutations and it has been associated with both non-syndromic hearing loss as well as aminoglycoside induced ototoxicity. This is the first report from India on the prevalence of A1555G mutation in normal hearing individuals indicating the impending need to screen this common mitochondrial mutation on a large scale not only among the hearing impaired families but also in the normal hearing Indian population.

An in vivo Study of the Feasibility of Different Methods after Debonding of Orthodontic Brackets

Juhi Yadav — 2021-08-02

Aim: The objective of this study is to evaluate and compare the levels of discomfort thorough Visual analogue scale (VAS) experienced during debonding using three different methods, as well as the adhesive remnant index (ARI) scores.

Materials and Methods: 50 female patients from a single clinic were studied in the study, with a mean age of 24 years and 5 months. Lift-off debonding instrument, straight cutter and Howe plier were the three methods used to study during debonding of orthodontic appliances. Discomfort levels were measured using a visual analogue scale at the end of debonding in each quadrant (VAS). ARI was used to investigate the remaining adhesive on the enamel surface.

Results: The Straight cutter technique resulted in much greater pain scores. The Lift off debonding instrument method was the least discomfort causing method .The three approaches utilised by ARI yielded significantly varied findings.

Conclusion: When the Lift off debonding instrument method was utilised, the patients showed the least amount of discomfort.

A Rare Case Report of Acute T-cell Lymphoblastic Leukaemia Presenting with Cutaneous Involvement in a Child

Lohit Kumar Kalita — 2021-08-02

Primary cutaneous involvement in T-cell lymphoblastic leukemia is rare in childhood. We present a case of 6-year- old girl admitted to our hospital because of multiple skin lesions. She was looked pale and weak. Generalized lymphadenopathy was present. Complete blood count revealed 216,000/mm³ white blood cell count. Peripheral blood smear showed 80% lymphoblasts. Bone marrow aspiration revealed 96% blastic cells with immunophenotype and morphological characteristics of acute lymphoblastic leukemia (T-ALL) which was confirmed by flowcytometry. ALL BFM -95 remission induction treatment protocol was started. Skin lesion remained same after two month of the cytotoxic therapy. The symptoms became more aggressive and she died after 4 months of treatment.

Determination of Portal Vein Diameter and Velocity Using Ultrasound

Maram Mohammed Fathi Ahmed — 2021-08-02

This study was conducted to establish standards of normal portal vein diameter and portal venous velocity via ultrasound and can be helpful in early detection of portal hypertension as well as to have indigenous index for healthy Sudanese correlate with body characteristic based on age, gender, weight, height and abdominal circumference (AC) .Importance of the study to help in diagnosis portal hypertension in early stage to avoid the complication. As well as to reduce the cost and time of examination. The data was collected, analyzed by using Statistical Packaged for Social Studies (SPSS). Duplex ultrasound examinations were performed in Khartoum Bahri Hospital, Khartoum State during the period )from may 2015 to December 2015(, on 100 patients (49 male and 51 female ) with normal abdominal scan (hypertension, DM and patient who has chronic liver disease are exclusion criteria).The analysis of the results found that the most age group ranged between (20 to 29) years forming (33%) of the sample volume, the most body weight ranged from (60 to 69) Kg forming (38%),the hight of the body from (160 to 169) cm in (39%),the abdominal circumference between (70-79)cm in (30%)of patients. In result we found the portal vein diameter increase with age and weight but the values are similar in male and female. No significant correlation was detected between portal vein diameter, height and abdominal circumference (AC). Highly significant correlation was detected between portal vein diameter and portal vein velocity of patient (increase velocity with decreasing diameter), these was expected and goes with previous study. The study also found that there was significant correlation between Sudanese portal vain diameter and velocity and international standard.

The study recommended further study to correlate normal portal vein diameter and velocity with liver size.

Determination of External Ear Indices by Digital Photometry among Adult Population

Swati Sarjerao More — 2021-08-02

Background: External ear is a defining feature of the face as it contributes to facial aesthetics by its appearance and symmetry. Its shape and size is influenced by age, sex and ethnic origin. Features of auricle had long been recognized as an important anthropological variable for studying racial variability and for identifying few genetic abnormalities at an early stage of life. Out of all available methods to study external ear indices, digital photometry is most convenient and useful method.

Objectives: To study external ear indices using digital photometry among adult population.

Methods: The present cross sectional study consisted of 500 adult subjects between 20 to 30 years of age. Patients with malignancies, previous surgery or trauma to the earlobe, or congenital earlobe anomalies were excluded. Ear features were then captured using a digital camera mounted on stand. Various soft tissue landmarks were tagged on the photo and the various tagged points were connected on the photo. Different parameters on right and left ear were measured. The indices like auricular, lobular and conchal were computed. The measurements were statistically analyzed by calculating their mean and standard deviations.

Results: There were 250 women and 250 men. Oval shape of auricle was more common both in males as well as in females. Auricular and conchal index in males as well as females on right and left side were statistically insignificant. These indices were significantly different in both genders. Lobular index in males on right and left side was statistically not significant, but was significant in females. Gender wise lobular index on right side was statistically significant.

Conclusion: The result of the present study also can be used in the field of Forensic Science for excluding criminals. Ear Biometrics is a promising new passive approach to Human Identification system used for screening people. This knowledge will be useful in designing a new identification tool-‘Ear Biometrics’

Study on Association of Serum Uric Acid, Homocystine and Ferritin among Amyotrophic Lateral Sclerosis Patients in Bangladesh

Md. Raknuzzaman — 2021-08-02

Background: Amyotrophic lateral sclerosis (ALS) is a disease that involves the death of neurons that regulate voluntary muscles. It is also known as motor neuron disease (MND) or Lou Gehrig's illness.A link between serum uric acid, homocystine, and ferritin and amyotrophic lateral sclerosis may exist.

However, we do not have adequate information on these topics. Objective: The main objective of this study was to evaluate the association of serum uric acid, homocystine and ferritin with amyotrophic lateral sclerosis.

Materials and Methods: From January 2010 to December 2011, a case-control research was done in the department of neurology at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh. After the study was completed, the 76 individuals were divided into two equal groups, each with 38 participants. There were 38 ALS patients in group I (case group) and 38 healthy adults in group II (control group). Data was collected using pre-designed questioners, which were then processed and analysed with SPSS version 11.5.

Results: In this study approximately 11% of patients in case group and 5.3% participants in control group (Each of 15.8%) were former smoker only. In case group the mean (±SD) uric acid level was 4.27±1.41 mg/dL whereas it was 4.27±1.41 mg/dL in control group and we found a significant correlation between both the groups (p value > 0.05). In analyzing the association of uric acid with gender of case group we found s significant correlation as the p value was less than 0.05. We found reading of serum uric acid lower in female. In this study, serum uric acid level is inversely correlated with duration of illness and positively correlated with ALS functional rating scale.

Conclusion: Amyotrophic lateral sclerosis patients had lower serum UA levels than healthy individuals and it was significantly lower in female ALS-patients than that of male ALS-patients. Uric acid levels in case group were positively correlated with the ALSFRS-R (severity) and negatively associated with duration of illness. UA levels could be considered as a biomarker of disease progression in the early phase of ALS.

A Review on Brain Metastases Prognostic Scoring Systems

Erkan Topkan — 2021-08-02

Brain metastases (BMs) represent the most common intracranial tumors, and nearly 25% of all cancer patients are diagnosed with this poor prognostic disease condition somewhere during their treatment course. Depending on the potential patient's general well-being status, the main prevailing treatment options typically incorporate palliative radiotherapy, chemotherapy, targeted agents, immunotherapy, best supportive care, and less frequently surgery in select patients. Past investigations demonstrated the probability to stratify BM patients into particular prognostic gatherings according to the credible combinations of multiple patients- and tumor-related features: the prognostic scoring systems. Such frameworks may serve usefully in the accurate prediction of survival outcomes and the appropriate selection of the best-fit treatment elective. In this present review, we intended to survey the advantages and disadvantages of the broadly recognized on-the-spot prognostic scoring systems for BMs and their clinical merits.

A Brief Study on Rectus Sheath Hematoma

Sonal Dube — 2021-08-02

Rectus sheath hematoma (RSH) is rare but potentially life threatening complication following any surgical procedure. The non specific nature of entity, lower incidence of disorder and acute presentation may possess difficulty in timely recognizing the condition. It can present as a relatively mild problem to life threatening condition. Relatively rare in incidence deserves a special place of this condition, so that every young doctor is aware about the condition. This is an attempt to raise the awareness about this condition as fast and timely intervention may prove to be life saving step.

Fiducial Marker-Guided Radiotherapy Practices in Prostate Cancer Treatment

Cenk Ahmet Sen — 2021-08-02

The fiducial marker application technique in prostate radiotherapy is an effective accompanying radiotherapy method in reducing acute and chronic side effects of radiotherapy, safely administering higher doses and contributing to local and overall survival without discomforting the patient. It is minimally invasive and safe. It can be easily tolerated by patients. It is an important technique that should be performed in cooperation with Radiation Oncology and Urology / Radiology Clinics, which have the necessary infrastructure. This paper aimed to provide general information about the types and application techniques of fiducial markers.

A Review of Literature on Mrkh Syndrome

Nidhi Jain — 2021-08-02

Primary amenorrhea is described as the inability to reach menarche until the age of 14 in the lack of normal secondary sexual characteristics, or until the age of 16 in the absence of secondary sexual characteristics. Gonadal pathology is the most common cause of primary amenorrhea, followed by MRKH syndrome. MRKH syndrome is an uncommon congenital condition characterised by aplasia of the uterus and vaginal wall. It happens when the Müllerian duct fails to grow properly.It occurs once every 4500 female births. Primary amenorrhea affects mostly girls. It is defined by the presence of normal secondary sexual features, a normal 46 XX genotype, normal ovarian function in the majority of cases, and a missing or undeveloped uterus and upper part (2/3) of vagina. It is divided into two types: type A is an isolated condition, and type B is linked to various renal, skeletal, and cardiac anomalies. Psychological counselling and vaginoplasty are among the options for treatment. Vaginoplasty can be performed using a variety of non-surgical and surgical methods. The authors present a review of the literature on the embryology, etiopathogenesis, work-up, and therapy of MRKH syndrome.

Varied Uses of Bone Allograft in Plastic and Reconstructive Surgery: A Case Series of 13 Patients

Vikas Singh — 2021-08-02

Background: The availability of safe, clinically useful, and cost-effective bone allografts have led to modifications in surgical therapy, as well as a rise in demand for bone allografts grafts for use in plastic surgery reconstruction. They are an appealing alternative to bone autograft because their supply is less limited, they allow structural restoration of the skeleton, and their surfaces promote bone formation.

Case Series: We provide a case series of 13 patients who were treated with freeze-dried bone allografts. The FDA and the Bone Banks both advised that all grafts meet certain parameters. The objective evaluation of graft volume persistence was achieved using radiography, whereas the subjective estimation of graft volume was obtained through patient response throughout a one-year period of follow-up. Objective of this study was to establish the clinical use of bone allografts in various reconstructive surgeries and compare its utility with bone autografts.

Conclusion: Bone allografts can be used in any type of bone surgery, from minor defects to major bone loss following tumour resection. Without donor-site morbidity, freeze-dried allograft bone is a safe and equal alternative to bone autograft.

Study of Fibroepithelial Lesions of Breast at a tertiary Care Centre- an Audit, Clinicopathological APPROACH and Comparison with WHO Grading

Deepti Yadav — 2021-08-02

Background: Mammary fibroepithelial lesions cover a wide range of malignancies, from indolent fibroadenoma to the potentially fatal phyllodes tumor (PT). The morphological assessment criteria used for classification are typically difficult to apply, and there is no consensus on what constitutes a sufficient resection margin. The current study objectives were to investigate the histopathological spectrum of fibroepithelial lesions of the breast at a tertiary care centre, to stratify and classify various fibroepithelial lesions into fibroadenomas and PT, and to reclassify all confirmed cases of PT seen during the study period using standard histopathological WHO criteria.

Methods: Between January 2016 and August 2019, records and slides of fibroepithelial lesions of the breast obtained at the department were retrieved and reviewed.

Results: During this time, 891 fibroepithelial lesions of the breast were discovered. There were 826 (92.7%) cases of fibroadenoma and its variations, 34 (3.8%) cases of fibroadenomatoid mastopathy, and 31 (3.5%) cases of PT. Eight (25.8%) of all PT were borderline, four (12.9%) were malignant, and the remaining (61.3%) were benign.

Conclusions: Fibroepithelial tumours of the breast are a diverse group of lesions that range in severity from benign fibroadenoma to malignant PT. Various subtypes have overlapping histologic characteristics, and transformation and progression to a more malignant phenotype are possible. As there are significant clinical disparities among subtypes, precise pathologic categorization is critical for proper management. Despite the fact that some immunohistochemical markers may be helpful in this differential diagnosis, histomorphology is still the gold standard.

A Case Report on Urothelial Carcinoma in the Ureteral Stump of a Nefrectomized Patient by Kidney Exclusion

J. F. L. Tadeu Campos — 2021-08-02

Upper urinary tract urothelial carcinoma is a rare and possibly fatal disease. It sometimes affects the ureter, and it's even unusual in the ureteral stump of a patient who has had a nephrectomy for benign disease.The example of a male patient who underwent total left nephrectomy due to renal exclusion is described here. He was diagnosed with a urethral tumour of the ureteral stump after three years due to an episode of hematuria, and he had ureterectomy and bladder cuff excision. The ureteral stump being involved by a urothelial tumour is an incredibly rare occurrence that is usually linked with a poor prognosis due to the delay in detection caused by atypical presentation. Hematuria is the most prevalent symptom. Because there is no renal unit and hence no hydronephrosis, pain is uncommon.Although rare, primary tumours in the ureteral stump should be remembered, and a high level of diagnostic suspicion should be maintained to avoid diagnosis in the advanced stages. Our objective with this paper was to report a rare presentation of a urothelial carcinoma and to alert physicians.

Acute Pediatric Bacterial Meningitis Due to the Rare Isolate, Pseudomonas putida: A Case Report

Grishma V. Kulkarni — 2021-08-02

Acute bacterial meningitis (ABM) is a medical emergency that necessitates prompt diagnosis and aggressive treatment. Despite the availability of newer, more effective antibiotics, ABM and its consequences continue to attack people in India, with fatality rates ranging from 16 to 32 percent. The purpose of this case report is to describe the rare isolation of Pseudomonas putida from a sample of cerebrospinal fluid.Apart from that, the author underlines the necessity of correctly identifying the organism and thus selecting the most appropriate antibiotic from the susceptibility profile in order to allow for early recovery and improve the patient's result and survival.

Clinical Profile and Outcomes of Acute Kidney Injury Patients in an Intensive Care Unit in India: A Retrospective Study

Vivek S. Narayan Pillai — 2021-08-02

Background: In developing countries, there is a scarcity of epidemiology and outcome data on acute kidney injury (AKI). The current single-site study aims to define the clinical profile of AKI in patients admitted to intensive care units at a tertiary care institution in Mangalore, India, by attempting to identify the presenting symptoms, etiologies, treatment methods, and disease prognosis.

Methods: Between October 2001 and October 2003, 70 AKI patients with a serum creatinine level greater than 1.4 mg/dl and blood urea greater than 53 mg/dl were enrolled in this retrospective study at Wenlock district hospital, Mangalore, KMC hospital Attawar, Mangalore, and KMC hospital, Jyothi circle, Mangalore.

Results: Amongst the enrolled patients, 45.7% of patients were in the 40-60 years age group, 49 males with no significant (p=0.412) gender difference. The most common presenting symptom was decreased micturition, which was present in 47.1 percent of patients, and the most common aetiology of AKI was sepsis, which was also associated with the highest (17.1 percent) mortality. The mortality rate for patients who had conservative treatment (n=52) was 42.8 percent, while the mortality rate for those who received hemodialysis (n=18) was 4.2 percent. The overall survival rate in the study was 52.9%.

Conclusions: The epidemiological data in this study is consistent with prior studies in India, with hemodialysis appearing to have better disease outcomes than conservative therapy.

Primary Aldosteronism Due to a Sub Centimeter Unilateral Adrenal Adenoma: A Case Report

Andre Manov — 2021-08-02

Primary hyperaldosteronism is a cause of at least 10% of hypertension in patients with diagnosis of essential hypertension. The screening and diagnosis of the disease are critical, because patients with the disease have much more cardiovascular and renal complications than patients with essential hypertension. We are presenting the patient with a diagnosis of resistant hypertension for a long time. We thought about primary hyperaldosteronism and proved it and treated it accordingly. The diagnostic algorithm of the disease is described.

Intrauterine Fetal Demise - A Tragic Event: An Approach to its Epidemiology, Causes and Methods of Induction

Anupama Dave — 2021-08-02

Background: Fetal death is a tragedy that causes parents and caregivers great grief. The majority of newborns are born healthy, but occasionally something goes wrong and a baby dies while still in the womb. The goal of this study was to learn more about the incidence, epidemiology, and aetiology of intrauterine foetal death. In addition, the efficacy of misoprostol and dinoprostone as inducing agents in these situations should be investigated.

The demographic and clinical characteristics of the patients were noted. Induction delivery interval of inducing agents was compared.

Results: At our centre, the rate of IUFD was found to be 50 per 1000 deliveries. The primary causes were unbooked cases, primigravidas, and preterm with abruption, which had a significant frequency in low socioeconomic strata. In these circumstances, misoprostol was proven to be more successful at terminating the pregnancy. Misoprostol had a 9.64-hour induction delivery interval, while dinoprostone had a 12.63-hour induction delivery interval.

Conclusions: Many causes of intrauterine deaths are preventable, such as abruption hypertensive disorders, which can be avoided with proper antenatal care. Socio-demographic factors such as low socioeconomic status, teenage pregnancy, poor nutrition, and a lack of health education should be considered as predisposing factors for prenatal deaths. Misoprostol is less expensive and has a shorter induction delivery interval; it can be used safely in IUFD instances.