New Frontiers in Medicine and Medical Research Vol. 3

Background: Adolescents make up roughly 21% of India's population.In 2006, the Government of India (GOI) created the adolescent reproductive and sexual health (ARSH) initiative in response to the unique needs of teenagers. In 2012, the first "Yuva clinic" in Bihar was created at Patna Medical College to provide services in accordance with ARSH protocols. The purpose of this study was to examine the biosocial and awareness profiles of adolescent clients in relation to the ARSH strategy and the utilisation of clinic services.

Methods: Using a semi-structured questionnaire, a cross-sectional study was conducted.

Results: A total of 1180 adolescents were studied (950 males and 230 females). Sixty-six percent of males and 74.8 percent of females lived in cities, and over 90 percent were unmarried. The vast majority came from the upper middle class.Females did not use alcohol or tobacco, but 66.6 percent and 86.7 percent of males did. More over 90% of those in attendance said they exercised regularly, with 36.8% of men and 58 percent of women having abnormal BMIs. Seventy-six percent were aware about nutrition, 24.06 percent were knowledgeable about reproductive and sexual health (RSH), and 64.74 percent were knowledgeable about ARSH services. Adolescents' awareness of nutrition, RSH, and available services was significantly linked to their location and socioeconomic status. Females knew a lot more about RSH than males did. Sixty-seven percent availed counseling services and 1.35% was referred, 50.6% came for clinical services out of which 69.8% remained unmet.

Conclusions: It is obvious from the encouraging numbers and widely heterogeneous profile of clients coming to the Yuva clinic that the ARSH clinic is a successful initiative. However, there are service gaps when it comes to ARSH methods. If these issues are addressed, the clinic is likely to attract more adolescents and fulfil its goals of improving their health and capacity to better deal with their various challenges.

Varicose veins of the lower limbs are dilated subcutaneous veins that are \(\ge\)3 mm in diameter measured in the upright position. The true incidence of varicose veins in our country is not known as majority of patients with mild to moderate varicosities do not report to the physicians and only patients with complications like eczema, ulceration and bleeding are seen in clinics and hospitals. These complications are a major cause of morbidity. Varicose veins have an estimated prevalence between 5% and 30% in the adult population with a female: male predominance of 3:1. Varicose veins can cause disability and affect the quality of life.

The search for a more effective means of prevention and for the perfect cure for this common condition continues. There has been a paradigm shift in past decade in treatment of varicose veins.

Several studies have shown that a combination of Endo venous Laser Treatment and Foam Sclerotherapy gives the best results in terms of cosmesis and recurrence.

The advantages of this procedure include ease, safety, cosmesis and durability.  

B-cell chronic lymphocytic leukemia (B-CLL) is one of the most common hematologic malignant diseases which had especially to the elderly. It is particularly interesting that, although known as apathologicalentity and studied for decades. Aim of this study is to present the latest researches in the field of molecular medicine, in terms of treatments in malignant hemopathies, emerged from the P53 gene deletion in human lymphoma genome. Method: In recent years proved that the best techniques in the investigation of malignant lymphocytes are the Flow Cytometry, Elisa, ICT and Fluorescence in Situ Hybridization (FISH). This method is used as an alternative to chromosomal banding, a conventional application in molecular medicine. Discussion: Recent, endogenous somatic gene therapy research is a basic of trial clinical and therapeutic trial. The DNA is used to treat a disease arising as a result of mutations in chromosomal regions. In the past few years, this method has been included in the treatment of CLL, acute lymphocytic leukemia, [ALL], or multiple myeloma [MM]. Conclusion: The frequencies of P53 gene mutations and deletion in CLL can be categorized as individual biomarkers in proteomic and genomic profile for this type of leukemia that can be implemented in targeted patient treatment of personalized medicine.

Background and Objectives: The present study was intended to study the spectrum of disease by aspiration cytology as well as evaluating its diagnostic utility in palpable head and neck lesion of Garhwal population in Uttarakhand.

Materials and Methods: Retrospective study conducted on 796 patients presented with palpable head and neck mass. FNAC procedure was done using 23-24 G needle. Smears were stained by Giemsa and Pap smear and special stains.

Results and Conclusion: Most common clinical presentation was cervical lymphadenopathy 67.8% and lesion was reactive lymphoid hyperplasia 33.3%. Metastatic carcinoma in cervical lymph node 58.57% was noted in majority of patient suffering from malignancy. FNAC proved to be fast, cost effective and reliable procedure for prompt diagnosis.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms with neuroendocrine phenotype. They range from well differentiated neuroendocrine tumors (NETs) to aggressive poorly differentiated neuroendocrine carcinomas (NECs). Esophageal neuroendocrine carcinomas (NECs) are rare and aggressive type of esophageal carcinoma with positive neuroendocrine immunohistochemical markers and usually involve lower esophagus. The esophageal NECs present most commonly with gastrointestinal symptoms such as dysphagia and/or abdominal discomfort. They have the potential for distant metastasis. The present case series delineate the recent classification of neuroendocrine neoplasm of esophagus. All the patients present with symptoms of dysphagia and ulcerative growth pattern with positive neuroendocrine immunohistochemical markers.

Cellulitis is a non-necrotizing inflammation of the skin and subcutaneous tissues that usually results from an acute infection. The gram-negative bacillus Pseudomonas aeruginosa causes a wide range of clinical illnesses. It is, however, most commonly linked to a hospital-acquired illness. We describe a case report of a 45-year-old Saudi man who developed vesiculous bullae, scaling, and sloughing of the overlying skin after initially experiencing redness and heat in the mid-right lower thigh. Though it was not a common suspect bacteria, Pseudomonas aeruginosa was detected from the case. It's possible that it's the result of a community-acquired infection.Patient was treated conservatively with intravenous antibiotics and local hygiene treatments such as Vaseline (bactigrass) dressing and topical antibiotics.Patient improved and discharged with complete resolution of cellulitis.

Objectives:

• Describe the pathophysiology of community-acquired infections.
• Review the laboratory tests used in the evaluation of community-acquired infections.
• Summarize the management of community-acquired infections.
• Outline the importance of improving care coordination among the interprofessional team to prevent transmission of infections and enhance the delivery of care for patients affected by community-acquired infections.

Calciphylaxis is a rare life-threatening condition characterized by progressive skin ischemia and extremely painful cutaneous necrosis and ulceration due to mural calcification and thrombosis of arterioles and capillaries in the dermis and subcutaneous adipose tissue. Most often this leads to sepsis and multi-organ failure with very high mortality. It is predominantly seen with end-stage renal disease (ESRD) patients who are on dialysis or who recently received a renal transplant. Therefore, it is associated with secondary or tertiary hyperparathyroidism.  This entity termed uremic calciphylaxis. A similar rare entity in a patient with normal kidney function termed non-uremic calciphylaxis. Here we review a rare extensive presentation of calciphylaxis due to primary hyperparathyroidism with normal renal function. Calciphylaxis is a catastrophic disease that carries high morbidity and mortality due to sepsis and multi-organ failure A strong clinical suspicion should be kept in any patients with painful necrotic eschar with normal kidney function. Serum calcium and serum Parathyroid hormone should be screened in such cases. Early identification and prompt multi-disciplinary management are mandatory to improve survival.

Loss of an eye can be caused by cancer, trauma, or congenital defects. The rehabilitation of an ocular defect can be done by using a stock prosthesis or by customising a prosthesis for the patient. A prosthesis fabricated by customisation offers more advantages than a stock prosthesis. A custom ocular prosthesis is fabricated by taking an impression of the socket and the tissue bed and allows better contouring of the prosthesis. Hence a custom prosthesis provides a better fit by positive adaptation to the tissue bed, is more comfortable to use and it also gives better cosmetic results compared to a stock eye prosthesis. Hollowing out the prosthesis further increases the patients comfort and adaptability. The main objective of this chapter is to describe a technique for fabricating a hollow ocular prosthesis with the help of a soap spacer.

This study describes the advantages of a strength and endurance training-based program in the early rehabilitation of patient with Limb Girdle Muscular Dystrophy (LGMD). Limb-Girdle Muscular Dystrophy-Type 2A (LGMD-2A) is an autosomal recessive disorder triggered by a mutation in the Calpain-3 gene (CAPN3) contributing to partial or complete protein deficiency. LGMD-2A is the most prevalent form of the disease in India, accounting for 47% of cases in the heterogeneous group. Here, we record a 22-year-old female with trouble walking due to proximal muscle weakness since one year and an elevated Creatine Phosphokinase (CPK) with abnormal muscle biopsy finding. The patient was granted an 8-week intervention & a prognosis was established.

Objective: The present study was undertaken to determine wound healing potential of Glyceryl trinitrate in wistar rats.

Materials and Methods: 18 male wistar rats were taken, divided in three groups, 6 rats per group Control (Normal saline), Glyceryl trinitrate, Ointment base. The nape of neck was shaved, they were starved overnight and on next day surgical intervention under general anaesthesia was done. 500 mm² excisional wound, circular in shape was created with scalpel blade. Topical application of drugs that is Glyceryl trinitrate, control and Ointment base was done since next day of wounding. Wound was traced with polythene paper and area was measured with help of planimeter on 6^th day, 10^th day, y and 14^th day.

Result: Two parameters were studied viz; wound contraction and period of epithelization. Glyceryl trinitrate has shown statistically signficant difference in wound contraction compared to control. Period of epithelization was also reduced significantly by Glyceryl trinitrate compared to Control and Ointment base treated groups.

The aim of writing this chapter is to bring the attention of clinicians to the condition “Spontaneous Gallbladder Perforation” which in acalculus cholecystitis or in diabetics and immunocompromised individuals although is a rare condition but has a high mortality rate. It can be difficult to make a diagnosis before surgery. We discuss two cases of gallbladder perforation that were discovered without any apparent radiological indication at the time of initial presentation. Since 1 day, a 45-year-old male patient has been complaining of diffuse abdominal pain. No other complaints/symptoms were found on a detailed history. This patient's exploratory laparotomy discovered a ruptured gall bladder with necrotic patches and 3 litres of bilious fluid in the peritoneal cavity. A 45-year-old woman with a history of diabetes, hypertension, and asthma arrived with diffuse abdominal pain. On laparotomy 2.5 litres of biloma with necrotic gall bladder was observed. Owing to rarity of gallbladder perforation, the condition is often misdiagnosed. Early diagnosis and immediate surgical intervention are the gold standard for decreasing the morbidity and mortality associated with perforation.

The renin angiotensin system (RAS) provides the most powerful regulation of blood pressure and angiotensin II is the primary mediator in this system. The binding of angiotensin II to AT₁ receptors produces a number of potentially harmful effects that include increase in blood pressure, progression of atherosclerosis, myocardial and vascular hypertrophy. Losartan was the first angiotensin receptor blocker (ARB) which was found to reduce the risk of stroke and new-onset diabetes along with a proven benefit in stroke. The present study was designed to evaluate the effects of losartan on different biochemical parameters.

Objective: To study effects of monodrug (Losartan) therapy on blood sugar, lipid profile, uric acid and serum electrolytes over a period of six months.

Methods: Twenty-nine newly diagnosed patients of either gender with essential hypertension were included in the study.  Baseline readings of lipid profile, serum electrolytes, fasting blood sugar and uric acid were recorded before starting losartan monotherapy and were repeated after six months. Results: After comparing the means, there was a significant increase in HDL cholesterol and a significant decrease in serum uric acid levels after six months of losartan therapy. No significant difference was found in blood sugar and electrolyte levels.

Conclusion: These findings suggest that losartan can be an attractive option for the treatment of hypertension and for metabolic syndrome.

Objective: To study the clinical features of primary central nervous system angiitis (PACNS) with case illustration and to review the current literature.

Background: Primary angiitis is a rare disorder and is difficult to diagnose and there are many mimickers.

Case Details: A 45year old female patient presented with headache, slurred speech and bilateral pyramidal signs on examination. There were lesions in the cranial imaging bilaterally with minimal enhancement. Based on the radiologist opinion, she was put on antitubercular treatment along with steroids by which there was substantial recovery. As the steroids were tapered five months later, there was recurrence of symptoms in the form of slurred speech and seizures. Repeated brain imaging showed recurrence of the lesions in the same areas. An open brain biopsy was suggestive of vasculitic pathology with transmural inflammation of the vessels and fibrinoid necrosis at a few places. A thorough work up for systemic vasculitic disorders was negative. Immunosuppression was initiated with corticosteroids and cyclophosphamide was instituted. There was good improvement in the follow up of two years. This study aims to review the current literature on diagnosis and treatment options of this enigmatic illness.

Introduction: Needle  phobia,  clinically  termed  as  belonephobia  is  a  sub-type  of  blood-injury-injection  phobia  (BII  phobia).  Heightened sensitivity to experimentally induced pain,  clinical  pain  and  pain-related  distress  is  greater  in  women  compared  with  men.  In reproductive age women, gonadal hormone  levels  also  have  a  substantial  impact  on  pain  perception  anffid  analgesic  response.  So, this study  was  conducted with  the  objective  to  compare  any  difference  in  pain  and  symptoms  felt  by  males  and  females  after  pricking  with  hypodermic  needles.

Materials and Methods: This longitudinal study was conducted in haematology laboratory of physiology department.  A total of  216 subjects  (120  females  and  96  males)  in  the  age  group  of  18  to  23  years  were  selected.  The  participants  were  asked  to  fill  up  the questionnaire  based  on  pain  and  phobia  associated  with  fingerpricking  on  first  and  tenth  exposure  with  hypodermic  needle.  Assessment of pain was done by rating on numerical pain rating scale (NPRS).

Results: Females reported more  fear  of  pain  due  to  fingerprick  compared  to  males  (68.3%  vs  49%,  P<0.05).  On first exposure  with  needle, females  reported  symptoms  of  sweaty,  palpitations  and  dizziness  significantly  more  than  males  (P<0.05).  On tenth exposure, shortness of breath was  more  in  males  than  females  (5.2%  vs  0.8%)  but,  there  was  no  significant  association  in  any  other  symptom  between  males  and females.  On tenth exposure, there was increase  in  mild  grade  of  pain  score  and  reduction  in  moderate  and  severe  grade  on  NPRS  (P<0.001) in  both  groups and  significant  reduction  was  more  in  females than  males  (P=0.01). 

Conclusion: It was concluded  that  females  were  more  needle  phobics  than  males  and  with  subsequent  exposures,  i.e.,  on  10th  exposure with  hypodermic  needle  there  was  reduction  in  pain  and  symptoms  after  finger-prick  in  both  groups.  Also, female students need more assistance during pricking.

Background: A significant proportion of patients diagnosed as heart failure have preserved ejection fraction. However, the differentiation between heart failure with reduced & preserved ejection fraction is difficult. The objectives of the study include:

1. To assess the BNP levels in both patients with Heart failure with preserved LV ejection fraction and those with reduced LV ejection fraction.
2. To study the correlation between the BNP levels and LVEF in both the groups and to ascertain whether BNP can be an useful tool in diagnosis of Heart failure with preserved LV ejection fraction].

Methods: The medical records of young patients (20–40 years) admitted during the two years 2014 & 2015 and diagnosed with Heart Failure were scrutinized in an attempt to determine the proportion of patients with preserved vs reduced ejection fraction and to assess the relationship between their Brain-type Natriuretic Peptide (BNP) levels & Left Ventricular Ejection Fraction (LVEF) in both the groups. 

Results: After Statistical analysis, it was found that around 36% of heart failure patients had preserved ejection fraction. There was a negative correlation between BNP levels & LVEF in both heart failure with reduced ejection fraction (HFrEF) as well as that with preserved ejection fraction (HFpEF). Majority of patients in HFpEF group were females. Mean BNP level in HFpEF group was significantly lower than that in the HFrEF group. 

Conclusion: Around one third of patients had Heart Failure with preserved systolic function, of which majority are females. There is a strong negative correlation between BNP levels and LVEF% in both the groups. Thus BNP levels can be used in the differentiation of HFpEF and HFrEF.

Physiologic and cognitive function in humans vary considerably with the circadian rhythm, which also regulates the sleep cycle. Sleep is an active, repetitive and reversible behaviour serving several different physiological functions. Medical students are a unique group of young adults whose academic commitments and lifestyle can have an impact on their sleep habits. The continual academic demand and choices concerning lifestyle might be the reason for irregular sleep/wake patterns and poor sleep quality among them. Sleepiness can be an apparent result of sleep deprivation and studies suggests a relationship between inadequate sleep during night and day time naps and its severity can be quantified subjectively using Epworth sleepiness scale

Objectives: To evaluate day time sleepiness using Epworth sleepiness score among medical students.

Materials and Methods: The study population included 130 first year MBBS students selected randomly based on their consent. Data was collected using Epworth sleepiness scale.

Results and Conclusion: The present study demonstrated the presence of excessive day time sleepiness among 45% of the students which is quite alarming as the number of subjects with day time sleepiness have been increased significantly compared to previous studies. Since a strong relationship is evident between good sleep quality and high academic performance, measures to improve the sleep quality among medical students need to be focused.

Psoriasis is uncommon in this part of the world, and the pustular variety is extremely rarer.. As a result, patients are frequently misdiagnosed by their doctors and present late to dermatologists, when issues have already developed.  We discuss the case of a 33-year-old woman who came to us with a two-year history of pustular eruptions on her hands and feet, pain and swelling in the affected joints, and subsequent abnormalities.Prior to her presentation, she had been misdiagnosed with skin tuberculosis and leprosy at several hospitals and treated as such with no effectiveness. A skin biopsy was performed when the patient was shown to us, and the tissue was sent for histopathology.She was diagnosed with pustular psoriasis and prescribed oral methotrexate. Except for the joint deformities, she reacted well to treatment and the lesions cleared up in a few weeks. This case illustrates the difficulties faced by psoriasis patients in a resource-constrained setting like ours, as well as the relevance of affordable medications like methotrexate in their treatment. This is especially true given the high cost and lack of availability of more advanced biologic drugs in this region.

The target was to avail the obstetrician armamentarium with an affordable ,convenient device that combines all therapeutic approaches in one equipment with a feasible utilization and high efficacy and safety with a pharmaco mechanical triad of functions. Described herein a Tranexamic Acid (TXA) - Coated or Eluted Uterine Balloon for use in an intra uterine location for primary management of postpartum haemorrhage (PPH).It enforces the tamponade effect of currently used non medicated uterine balloons with an additional inbuilt mechanism of local steady release of the antibrinolytic TXA into uterine cavity that has been evidenced to contribute to haemostasis in cases of PPH. The invention ushers a new era of utilizing the uterine balloon surface coat as a delivery vehicle for TXA. This can be achieved via different techniques including and not limited to matrix coating or eluting of nanoparticulate TXA in the outermost layer of the balloon .TXA coated or eluted balloon replenish non medicated balloons with a therapeutic modality of the TXA related – antifibrinolys is especially in hemorrhages known to be associated with coagulopathy. This potential for topical application of TXA rather than systemic administration of the drug avails the merit of avoiding TXA –related theoretical risk of thromboembolism. Moreover, drug coating of the balloon surface is not limited to TXA, but it may utilize other haemostatics and coagulants like thrombin, fibrinogen and activated F11v as well. Additionally, this invention offers an innovative solution for the technical difficulty of retaining the released drug inside an open hollow uterine cavity and its fast escape through the cervix by the co attached cervical shutter or "Barricade". The latter was designed to provide sustained residency and efficient drug transfer into the uterine cavity, thus contributing to a consistent and efficient TXA delivery at the site of action. Moreover, the cervical shutter exerts an additional function of extra counter pressure on the lower uterine segment which may be the bleeding site in cases of abnormally adherent placenta.

Background: Sudden cardiac death (SCD) in athletes during physical activity is rare. Sudden cardiac death (SCD) in a young athlete is a tragic event and is the leading medical cause of death in this population. The precise incidence of SCD in young athletes has been subject of debate, with studies reporting drastically different rates (1:917,000 athlete-years (AYs) to 1:3000 AYs) depending on the methodological design of the investigation or the targeted population.

Objectives: To evaluate the warning signs for SCD in young athletes and correlate them with electrocardiographic data.

Methods: This was a case-control, prospective study, and comparing athletes with sedentary individuals. The Sudden Cardiac Death Screening of Risk Factors (SCD-SOS) questionnaire was applied, and resting electrocardiography was performed.

Results: In total, 898 participants were included, 589 (65.6%) in the case group (athletes) and 309 (34.4%) in the control group (sedentary). Fainting episodes were significantly less frequent in athletes (odds ratio 0.252, p<0.001). Heart rates were not significantly different. The most common electrocardiographic findings were sinus arrhythmia, right bundle branch conduction disorder, and early repolarization.

Conclusion: Young athletes had a lower frequency of risk indicators for sudden cardiac death. There was a positive correlation between fainting reported by athletes and the duration of the QRS complex. SCD is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by the physiologic demands of forceful exercise. Up-to-date rates of SCD appear to be at least 4 to 5 times higher than earlier estimated, with men, African Americans, and male basketball players being at greatest risk. Evolving data suggest that the leading finding associated with SCD in athletes is a structurally normal heart (autopsy-negative sudden inexplicable death)