New Horizons in Medicine and Medical Research Vol. 11

Text neck syndrome has emerged as an epidemic during COVID-19 pandemic. Because of lockdown and work from home many young persons and school going students were working online and for long period. Due to long working hours and faulty neck postures, incidence of text neck syndrome is increasing especially in COVID-19 pandemic period. This article highlights this important public issue and gives insight about etiology, incidence, pathophysiology, symptoms and signs, treatment and prevention of text neck syndrome. It also gives comprehensive treatment approach for text neck syndrome including importance of life style modification, yoga, pranayam, reversal of modifiable risk factors etc. preventive aspect is given equal weightage with treatment in this article.

Lichen Simplex Chronicus (LSC) is a skin condition that affects the psychosocial and functional well-being of patients. Severe pruritus, sleep problems, anxiety, and depression are all linked to it.

The aim of the study is to assess the impact of LSC on patients’ quality of life (QoL) with a standardized dermatology-specific quality of life instrument- Dermatology Life Quality Index (DLQI).

The current QoL-study includes 190 out-patients who have been diagnosed with LSC. It is part of a larger LSC research project. In addition to the DLQI questionnaire, demographic data and disease-related variables were obtained. Individuals with psychiatric illnesses and/or antidepressants were not allowed to participate. The DLQI is made up of ten questions (Q1 to Q10) organized into six domains.

The total DLQI score reported by the LSC-patients is 8.58 \(\pm\) 3.348. Consequently, LSH moderately affects the QoL of the patients. Patients scores were significantly high for Q1 (symptoms), Q9 (sexual difficulties) and Q10 (treatment) (p< 0=001). No significant relationship could be found between patients’ QoL and disease-related (duration and stage) and social characteristics (urban/rural and level of education)(p=0.194).Specific for our patients was high score for Q10 (treatment) (median 2.00,range 1.00-2.00) (p< 0=001). This is the first study of its kind in our country, with the goal of determining the influence of LSH on patient QoL in both male and female patients. The DLQI has proven to be a simple and effective questionnaire approach for use in routine clinical practice.

Background: Dental structure and posture are closely linked to each other and now this is well known. Literature provides many articles to support this claim. The aim of this work is therefore not to provide yet another proof, but rather to highlight a peculiar characteristic of the case presented: a singular procedural asepsis, which makes it a particularly significant case. Nevertheless, this work aims to sensitize the operators who perform postural analyzes in relation to two aspects considered very important: 1 - the modification of the postural structure even in the absence of specific pathologies; 2 - the importance of maintaining procedural asepsis so that one does not fall into the risk of deductive automatisms, but always seeks unconditionally the origin of the disharmony that has emerged.

Materials and Methods: The study began in 2020 and ended in 2021. The subject involved was a young woman of about 37 years old, weighing 52Kg and 1.58m tall, at the first postural analysis performed on 2020 January the third. Subsequently, two other postural analysis were performed, 13 months and 22 months after the first respectively. For the postural analysis, an identical protocol was followed in the three analysis performed.

Results: Observing the results obtained in the three analysis, it can be deduced that approximately 63% of the controlled parameters (12 out of 19) underwent modifications, even if not all of them could be related to the variation of the dental setting.

Conclusion: The study, even within the limits of its design, highlights how the different systems that make up the human body are interdependent and an action performed on one of them can be found as a modification of the initial state of others.

Autologous fat grafting (AFG) is gaining popularity in both aesthetic and reconstructive procedures, since the body of evidence for its use has expanded.

We sought to review contemporary harvesting and processing techniques for AFG in the craniofacial region.

We conducted a survey in four European nations to assess the clinical impact of oncological risk. We identified no major geographical differences in harvesting and processing techniques between the German-speaking and English-speaking groups. The probability of AFG's pro-oncologic conduct is discussed by half of our respondents. AFG harvesting and processing techniques don’t considerably vary by geography. Further research into the oncologic risk potential of AFG in head and neck tumor sites is needed, especially because there is no outstanding paper on the subject.

Clinical decision making and assessment skills are salient elements of rapid response afferent limb. Hence, clinical competence along with the ability of the nurse to recognize signs of clinical deterioration, interpret gathered assessment data to arrive with sound clinical judgement promptly is considered cornerstone to activate RRT (rapid response team) and attain positive patient outcome. This study aimed to identify competence of nurses in crisis response in terms of conducting clinical assessment and decision-making model used by nurses in activating the RRT; determine the factors that affect the nurses’ decision to activate RRT; determine the reason of referrals in different areas/ units and prevalence of RRT activation as compared to code blue; determine the impact of RRT; and design or enhance current RRT protocol. Both quantitative and qualitative method is utilized. The data generated in this study suggest that senior nurses have showed confidence and ability to detect signs of clinical deterioration that empower them to activate RRT when needed. Whereas, junior nurses usually confirm clinical assessments with senior nurses before deciding to activate RRT and intervening. Nurses in the study used both intuitive and analytical decision-making model. Nurses’ clinical acumen, emotional responses, and impact and influence of RRT are the identified themes. Knowledge of the criteria is considered as one of the triggers to act and activate RRT. Albeit clear institutional guidelines and well-defined criteria abridge process of decision making and determine immediate action; hence, increases positive patient outcome. Enhanced RRT pathway combines patient relative participation, incorporation of MEWS in the activation criteria, and curtailing the pathway of reaching the responsible physician.

Renal arteriovenous malformations (AVMs) or arteriovenous fistulas (AVFs) represent an important group of entities for diagnostic consideration due to high morbidity associated with the disease. It is uncommon cause of hematuria. For safe and effective treatment it is important to evaluate radiographic findings and type of AVM in detail.  The purpose of this book chapter to highlight main types of AVM, clinical presentation, imaging modalities and treatment options.  

The purpose of this study was to evaluate the effects of Candesartan and Ramipril on liver fibrosis in patients with chronic hepatitis C.

A total of 64 individuals with chronic hepatitis C and liver fibrosis participated in this randomized controlled prospective research.  Participants were randomized into three groups; group I (control group; n=21) which received traditional therapy only, group 2 (Ramipril group; n=21) which received traditional therapy plus 1.25 mg/day oral Ramipril and group 3 (Candesartan group; n=22) which received traditional therapy plus 8 mg/day oral Candesartan.

The three study groups had statistically identical demographic and laboratory data at the start. After treatment, the three study groups showed significant decrease in liver stiffness, serum levels HA and TGF-\(\beta\)1, and indices of liver fibrosis as compared to baseline data (p<0.001). Patients on Ramipril and Candesartan exhibited significant improvement in all evaluated parameters six months following treatment when compared to the control group. In addition, when compared to Ramipril, the Candesartan group demonstrated a significant reduction in liver stiffness, biomarkers, and fibrosis indices.

Ramipril and Candesartan were well tolerated and effective in treating liver fibrosis in chronic hepatitis C patients with hepatic fibrosis. Candesartan, an AT1-R antagonist, sustained anti-fibrotic activity better than Ramipril, suggesting that it could be a safe and effective treatment for liver fibrosis in individuals with chronic liver disease. 

The importance of including patient-reported outcome (PRO) instruments in evaluating the assessment of clinical outcomes is becoming more widely recognized, with a growing emphasis on the patients' perspective. Clinicians have attempted to link PROs to objective outcomes, resulting in unique data for patient care management. Traditionally, objective and patient-reported outcomes (such as the Knee Injury and Osteoarthritis Outcome Score (KOOS)) have been thought of as two separate constructs that cannot be directly compared.

Can Gibson's affordance theory specify more about objective versus subjective outcomes measurement and unify them? At the knee joint, perceptual systems are active sets of organs operating to reach equilibrium through synergies—the combined action that the skin and the joints are both projected to the somatosensory area of the cortex, to the same area, and the joint cannot even be imagined to deliver a flat map to the brain. Under these assumptions, this study demonstrates how a specific method for assessing knee proprioception could resolve the outcome measure separated by the objective-subjective divide.

The objective of this study is to suggest that the assessment process can be viewed in terms of action possibilities provided by the active sets of organs residing that can obtain and utilize information about the tissue environments in the knee proprioceptive system.

Organoids are multicellular, three-dimensional (3D) tissue models that resemble there In vivo tissue. The recent production of 3D structures from primary endometrial cells is driving new investigations of this crucial tissue utilizing precise pre-clinical models for human uterine endometrium. To improve on these 3D models, we sought to evaluate ECM hydrogels derived from decellularized pig endometrium (EndoECM) in preparing and improving current human endometrial organoid culture systems. To accomplish so, we created three lines of human endometrial organoids and cultivated them in optimal and suboptimal culture expansion conditions with or without soluble supplement EndoECM (0.1 mg/mL). The epithelial origin, long-term chromosomal stability, and stemness features of the resulting organoids were all confirmed. Finally, we used proliferation rates and immunohistochemistry approaches to estimate their proliferation potential under various culture conditions. The relevance of a bioactive environment for the maintenance and growth of human endometrial organoids is demonstrated by our findings.  

The aim of the study was to investigate the effect of apigenin (AP) on acute pancreatitis (ACP) by measuring the values of interleukin-6 (IL-6), interleukin-18 (IL-18) and resistin (R) in serum and CD45 as well as high mobility group box 1 protein (HMGB1) in intestinal tissue using a rat experimental model. 126 male Wistar rats were used, divided in three groups: Sham (S), Control (C) and Apigenin (Ap). The S group underwent laparotomy and closure of the abdominal wall. The C group underwent ligation of the pancreatic duct to induce acute pancreatitis. The apigenin group after induction of ACP, received AP. Blood and intestinal tissue were collected. Following AP administration, IL-6 and IL-18 in serum decreased as well as HMGB1 and CD45 in intestinal tissue. In contrast R remained at low levels in the Ap group. In a bilio-pancreatic duct ligation experimental model of ACP, AP treatment appears to protect intestinal and serum parameters, lowering the severity of ACP. As a result, giving this substance to humans could reduce the damage to the organs affected in the early stages of ACP.

Thunbergia laurifolia or Rang Jued has been used as an herbal tea and folk medicine as a detoxifying agent. Cd contamination is globally widespread and a serious public health problem. The endogenous antioxidant enzyme activities and malondialdehyde (MDA) production of the crude dried extract of T. laurifolia leaves, using cell models including murine macrophage (RAW264.7), human embryonic kidney (HEK293), and human hepatocellular carcinoma (HepG2) as a tested cell model were aimed to determine. In addition, the cytotoxicity including anti-cadmium (Cd) activity in all cells was measured. The experimental design was divided into 3 groups with combined, pre-, and post-treatments for investigating the anti-Cd toxicity, and cell viability was assayed with an MTT test (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide). The crude extract exhibited a low cytotoxicity and increased catalase (CAT) and glutathione peroxidase (GPx) activities by decreasing malondialdehyde (MDA) levels in HEK293 and HepG2 cells. In addition, the combination therapy effect was found when CaNa₂EDTA, a chelating agent was tested. Therefore, it was concluded that the crude extract can protect against Cd-induced oxidative stress in cells. Furthermore, using the crude extract or drinking the herbal tea together with a chelating agent should have an efficacy advantage over using the individual crude extract or the chelating agent.

Stillbirths constitute a major part of perinatal death, and India has the highest absolute number of stillbirths. Women in the most deprived groups are at the highest risk for stillbirths, for example poorer women, with little education, those living in rural areas and not currently working. The focus of this research was to assess our institute's stillbirth rate, as well as the aetiology and risk factors for stillbirths. During the study period of one year, all stillbirths delivered at or above 28 weeks of gestation or weighing more over 1000gms in P.D.U. Medical College and Hospital, Rajkot were included. The institute's stillbirth rate was investigated. Indicators of socio-economic deprivation were strongly associated with increase in stillbirths. 70% cases belonged to rural region and 48% cases were referral cases. 67.2% stillbirths were found in multigravida women . 57.01% stillborn babies were males, 34.71% of stillborns had extremely low birth weight and were pre-term. 54.78% stillborns were macerated. Aetiology of stillbirth was unknown in 24.8% cases. Antepartum haemorrhage contributed 19% cases, asphyxia -16.8% cases and pre-eclampsia-12.1% cases of stillbirth, in our study. The reduction of stillbirths can be aided by focusing on modifiable risk factors, thorough screening, prenatal and intrapartum supervision, and timely referral to a tertiary care center.

An immunocompromised patient with a known history of cerebrovascular accident (CVA) with right-sided hemiparesis of long duration, type 2 diabetes mellitus, and hypertension presented with signs of rhabdomyolysis and later acute kidney injury (AKI). He subsequently developed Guillain Barre syndrome.

Initially, haemodialysis was followed by plasmapheresis. After haemodialysis, the patient presented with multiple episodes of vomiting and weakness of all limbs. A culture showed growth of Enterococcus faecalis, and on Day 6, a bloodstream infection with Candida kefyr and a urinary tract infection with Enterococcus faecalis was diagnosed. We report a rare case of bloodstream infection due to C. kefyr. The patient recovered and was discharged successfully with continuous follow-up for the next six months.

Two case series of Dissociative Dysphonias at the interface of Departments of Paediatrics, ENT and Psychiatry are being described here. One case is of dysphonia plica ventricularis and emotional dysregulation who presented to the Paediatrics department. And another case is of dissociative dysphonia with delusional disorder presenting to the ENT department.

Dysphonia plica ventricularis (DPV) is a type of functional dysphonia (FD) which can be caused by several reasons. DPV- emotional type is seen secondary to emotional crisis which is equivalent to psychogenic/dissociative dysphonia. Here we describe a case of DPV secondary to emotional dysregulation with an underlying emotionally unstable personality disorder. Crisis intervention and emphasis on regular compliance to treatment has been discussed.

Dissociative dysphonia is less commonly seen in general population. Previous literature has focused on interplay of dysphonia mainly in schizophrenia or schizoaffective disorders. Here we discuss a unique case of delusional disorder with dissociative dysphonia. The challenges in the evaluation and management are discussed.

The aim of this study is to analyse the distribution of risk factors of preterm birth in tertiary centre of Gujarat and the burden as well as outcome of preterm births in the institute. The proportion of preterm birth amongst advanced maternal age women is significantly higher than adult aged women. In the research, 100 women experiencing preterm labor or a preterm termination of pregnancy were enrolled. They were assessed by a medical history, physical examination, and ultrasound. All of the patients were given corticosteroids. The researchers looked at maternal risk factors, obstetric outcomes, and perinatal outcomes up to discharge. Preterm birth can be prevented, checked for, and treated by specialized antenatal programs for anemia, malnutrition, infection, and high-order pregnancy.

Women's reproductive system undergo cyclic modifications that might be viewed as teleological preparation of the female genital tract for fertilization and pregnancy. These cyclical fluctuations are also linked to cyclically changing ovarian steroid levels. Estrogen is thought to have extensive impacts across the brain regions involved in emotional and cognitive states. This study aimed to observe the effects of gonadal hormones on auditory and visual reaction time across various phases of menstrual cycle. The study was carried out on 30 healthy female volunteers having regular menstrual cycle belonging to the age group of 17-20 years studying in the first year MBBS at a tertiary care Institute using pitch change 1000 Hz reaction timer. The auditory and visual reaction times were found to be longer during the mid-proliferative phase compared to the premenstrual and mid-secretary phases in this investigation. The varying amounts of ovarian hormones over the regular monthly cycle affect auditory and visual reaction time, and this fact should be taken into account when evaluating women's neurological and behavioural abilities.

Ansa subclavia is a nerve fiber joining middle and inferior cervical ganglion. The cord from middle cervical ganglion curves inferiorly the first part of subclavian artery medial to vertebral artery and joins the inferior cervical ganglion. The Ansa subclavia is developmentally preserved and carried forward from rats, guinea pigs, the porcine species and dogs to human beings.  Commonly, Ansa subclavia is electrically stimulated in animal models to modulate stimulatory cardiac sympathetic input in Physiologically studies. In elaborative English language literature search only two studies found describing the anatomy of the Ansa subclavia. The aim of this chapter, is to consolidate information related to the gross/applied anatomy and functions of the ansa subclavia and to bring out associated significance.

The aim of the present study was to describe the clinical profile and the outcome of our PICU patients, and also to highlight the probable modifications that can be done which will lead to better outcome of critically ill children. The principle objective of Pediatric critical care is not only to decrease the mortality, but also to restore the child who is suffering from a life threatening condition to health with minimum pain anxiety and complications and to provide comfort and guidance to the child’s family. This is a Hospital based, retrospective, descriptive study, in a tertiary care centre in puducherry, south India. Children admitted and treated in PICU in pediatric department from January 2019 - December 2019 in Sri venkateshwara medical college hospital and research center, Puducherry, were the participants. This study has shown respiratory illness and infectious diseases as the most common clinical profile observed. The outcome noted was, out 345 patients admitted to paediatric ICU, 303 (87.8%) were discharged. About 37 (10.7%) patients went against medical advice and 5 (1.4%) patients were referred at parents request. The study would like to recommend for further detailed prospective studies in future, with emphasis on the awareness of the most common and emerging rare etiology of patients admitted to PICU.

A 31-year-old patient initially presented to another clinic with symptoms of moderate fever, throat pain, and widespread myalgia. The patient's COVID-19 test showed positive, indicating that he had the virus. Because the patient's chest CT scan was normal and showed no signs of COVID-19 consolidation, he was given antibiotics and an antipyretic and sent home with strict home isolation instructions. The same patient presented to the Emergency Department for the second time. His symptoms were much worse this time. He had severe shortness of breath, an exacerbated cough, and, most importantly, acute tiredness and exhaustion, as evidenced by his overall appearance. The patient was obviously quite sick, with tachycardia and tachypnea. He required immediate oxygen support because his oxygen saturation levels were only 85%. His neck veins were also significantly congested, and he exhibited an elevated JVP. He exhibited distant heart sounds and bibasilar crackles on chest auscultation. The liver's left lobe was palpable. However, there was no evidence of ascites or fluid retention elsewhere in the body. He had sinus tachycardia, according to his ECG results. On the ECG, there was obvious ST-segment elevation, which persisted despite the diagnosis of myocardial ischemia. The previous chest X-ray, which was initially normal, revealed cardiomegaly. The data supported the conclusion that the heart played an important role in the equation. This was eventually shown to be a classic case of acute fulminant myocarditis caused by COVID-19. The diagnosis took some time, but because to the patient's prompt arrival at the Emergency Department, he was admitted, assessed, and treated before any other issues arose. Although patients with pre-existing or a predisposition to developing heart conditions are more inclined towards such outcomes, it can affect almost anyone owing to the complicated nature of the virus itself.

Therefore, this case study aims to reflect on all of the possible aspects of this case to make it easier for others to understand and diagnose such cases conveniently. This case report deals with the presenting features as well as the possible treatment options that could be given to such patients who develop fulminant myocarditis as a possible consequence of COVID-19 infection.