New Horizons in Medicine and Medical Research Vol. 2

Tick borne diseases have become a public health crisis in endemic areas of the US and the world. It is important for health care professionals to be aware of the clinical manifestations, treatment and prevention of tick-borne diseases. Tick borne diseases include those transmitted by the lone star tick (Amblyomma americanum) which  include Ehrlichiosis, Rocky Mounted Spotted Fever (RMSF), Spotted fever rickettsiosis,  Southern Tick Associated Rash Illness (STARI), tularemia, Heartland virus as well as transmitting  alpha gal [1].The alpha gal epitope is not naturally present in humans (or apes) but is present in all other mammals. Exposure to lone star tick bites are associated with a delayed allergic reaction to mammalian meat due to development of antibodies to Galactose-alpha-1, 3-galactose or commonly known as alpha gal [1]. Although Lyme disease is the predominant tick- borne disease in the US which is transmitted by the Black Legged tick (Ixodes scalpularis), the alpha gal meat allergy sensitization caused by the lone star tick is increasing. This is attributed to the increase numbers of lone star ticks and their expansion into new geographic locations.  It is important to educate the public on signs of this allergy, treatment and how to mitigate exposure to tick bites [2,3].

The immune system performs defense, vigilance, and homeostasis functions. Pathological alterations of the system give rise to immunodeficiency, allergic and autoimmune diseases. Immunodeficiencies occur when the immune system is unable to develop an adequate response to deal with aggression from the external environment. When the immune system encounters and recognizes an environmental element as an aggressor and develops an exaggerated response, allergies occur. In autoimmune diseases, an aggressive response to the body's own structures is produced. Multiple causes and effector mechanisms are involved in these different pathological alterations of the immune response. The content of this text provides information directed to non-specialist physicians. The objective of this chapter is to briefly describe the clinical characteristics, diagnosis, and treatment of the main immunopathological diseases that are present in children and adolescents.

Purpose: To compare the efficacy and safety of intraocular pressure (IOP)-lowering travoprost 0.004 percent and travoprost 0.004 percent and beta-blocker 0.5 percent fixed combination ophthalmic solution in patients with open-angle glaucoma and ocular hypertension.

Methods: In this prospective, multicenter clinical trial, 62 patients were given either travoprost 0.004% (n = 31) or travoprost 0.004% and beta-blocker 0.50% (n = 31). Over a two-year period, efficacy and safety were compared across treatment groups. Each group's IOP reduction and adverse events were assessed at 3, 6, 12, and 24 months.

Results: Mean IOP at the first visit in the travoprost 0.004% group was 26.4 (SD ± 2.1), and travo- prost 0.004%/timolol 0.5% group was 26.3 (SD ± 2.1). Mean IOP after 24 months in the travoprost 0.004% group was 20.5 (SD ± 1.5) and travoprost 0.004%/timolol 0.5% group was 18.5 (SD ± 1.5). There were statistically sig- nificant differences in IOP in both eyes after third visit (after 1 year) and fourth visit (after 2 years).

Conclusion: Travoprost 0.004 percent/timolol 0.5 percent produced clinically relevant IOP reductions in patients with open-angle glaucoma or ocular hypertension that were greater than those produced by travoprost 0.004 percent alone after 2 years of treatment.

Trigeminal Neuralgia (TN) is the most frequent neuropathic facial pain with important consequences on quality of life of the affected patients. Neurovascular conflict (NVC) has been recognized as the cause of the classical form, but TN can be secondary to other diseases. In the idiopathic form of TN no NVC and other causes can be identified. However the exact cascade of events and pathways that lead to TN are not completely understood, even if recent studies suggests that an inflammatory environment may play role. The introduction of new magnetic resonance imaging (MRI) techniques, such as voxel-based morphometry, diffusion tensor imaging and three-dimensional time-of-flight magnetic resonance angiography has provided new insight about the TN pathogenesis. Moreover, the combination of these advanced MRI sequences with volume-rendering softwares and neuronavigation techniques showed a significant impact on the surgical outcome of patients submitted to microvascular decompression. In fact, TN management is pharmacological from the beginning, nevertheless TN can progressively become unresponsive to drugs necessitating multimodal treatment. Despite numerous available approaches, the results are not completely satisfying and the need for more effective drugs led to the development of new molecules and pharmacological protocols. Moreover, some patients may become drug resistant needing a surgical procedure or radiation treatment. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen and other rescue treatments, such as neuromodulation, may be required to handle the symptoms. These facts reflect the lack of a precise understanding of the TN pathogenesis. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, medical and surgical treatments and discuss the significant advances in all these fields.

The purpose of this study is to use bibliometric methods to analyze recent 10-year trends in immunotherapy research in breast cancer and consequently create a better under- standing of the current situation and trends of those research studies by analyzing their main characteristics. In recent years, many studies have focused on the host immune system and its relationship with tumor progression in a variety of solid tumors, including breast cancer. This study investigates recent trends of immunotherapy research in breast cancer and compares the contributions of research from different regions, institutions, and authors. A search of breast cancer and im- munotherapy studies that were published between 2010 and 2019—with different keyword combinations—was performed in the Web of Science database. Bibliometric data were collected for analysis. VOSviewer software was used to generate a figure for the keyword’s co-occurrence network, so as to implement network visualization analysis. A total of 1,041 publications were identified. The United States and China contributed to approximately 50% of the publications, 336 and 208, respectively. Both countries drove the increase in publications after 2015. A paper entitled “Pembrolizumab in patients with advanced triple-negative breast cancer: Phase IB KEYNOTE-012 Study” that was published in the Journal of Clinical Oncology by Nanda et al. was the most cited (715 citations). The keywords found in this research were grouped into four clusters: “mechanism,” “vaccination,” “PD-L1,” and “chemotherapy.” The terms “tumor-infiltrating lymphocytes” and “PD-1/PD-L1” are among the latest hotspots, which mostly appeared in 2017. Author keyword analysis revealed that recent trends in breast cancer immunotherapy focus on the triple- negative breast cancer subtype and PD-1/PD-L1 immune checkpoint pathway and inhibitors. This study analyzed global trends in immunotherapy research on breast cancer over the past 10 years and provided insight into the features and research hotspots of the articles in this issue.

Background: Left main  (LM) coronary artery dissection induced by Catheter is rare but requires immediate intervention. In this situation, the results of emergency percutaneous intervention (PCI) using DES to restore the flow in the left coronary artery are poorly known.

Study Objectives:  The objective of this study is to investigate the occurrence,, clinical and angiographic features as well as the longer-term outcomes of iatrogenic LM dissection. The strategy for coronary revascularization was emergency PCI using DES.

Methods: A study of all 24,995 coronary procedures performed in our institution (comprising 2 catheter-laboratories) during eight years in succession (1 april 2009- 1 april 2017). Cases of iatrogenic LM dissection were identified and thoroughly investigated, and clinical follow-up was obtained in all patients who experienced iatrogenic LM dissection.

Results: Catheter-induced dissection of the LM occurred in 20 patients, representing 0.08 % of the all procedures: 16/8,019 PCI (0.2%) and 4/16,976 diagnostic angiograms (0.02%).

Significant LM stenosis was present in 7/20 patients. There was no specific causative catheter found. Obstructive LM coronary artery dissection occurred in 5 patients, with 70% involving the distal LM. In 11/20 patients, hemodynamic status was immediately compromised. The LM PCI strategy included provisional stenting of the side branch following LM and main vessel stenting with final kissing inflation. Angiographic success was achieved in 18/20 patients, and the in-hospital outcome was free of events or re-intervention in these patients. PCI was unable to restore blood flow in two patients who died during the procedure. During follow-up repeat revascularization was required in 2 patients (1 CABG  ,1  re-PCI) but there were no other adverse events.

Conclusion: Catheter-induced LM coronary artery dissection is a rare complication with an overall incidence of less than one in 1000 coronary procedures, but a mortality rate of 10% in this study. Emergency PCI with DES is a safe and effective treatment with a favourable long-term outcome.

The present study was evaluate the aspects inherent to osteoporosis, correlating bone densities of sites in the maxilla and mandible, and in the cervical vertebrae, through computed tomography with multislice CT (Hounsfiled scale). Osteoporosis is a skeletal disease characterized by low bone mass, deterioration of the bone structure and an increased risk of fracture that also affects the bones of the jaws. Causes an increase in porosity that reflects the integration of quality and bone mineral density, hindering rehabilitation treatment with implants. Cervical osteoporosis affects the spinal vertebrae bones of the neck in particular the vertebrae bodies which form the spinal column. Your cervical vertebrae surround the spinal cord to protect it from damage. Cervical osteoporosis is a silent and gradual condition that emits no symptoms. The gold standard diagnostic tool is bone densitometry by dual energy x-ray absorptiometry (DXA), but the computed tomography (CT) also proves very effective in assessing bone quality through Hounsfield unit (HU). In this study, we evaluated the bone density of mandibular heads, regions of the teeth 13, 23, 36 and 46 and cervical vertebrae C1, C2 and C3, through Hounsfield scale CT scans, and correlated their values for diagnosis for possible evaluation of osteoporosis. We evaluated multi-slice CTs of patients who underwent both examinations of the maxilla and mandible. We use software to analyze and Efilm-investigated regions. The results show that the bone densities of the cervical spine (C1 and C3) were positively correlated with the mandibular heads (r = 0.2246, Pearson correlation coefficient), posterior region of the mandible (r = 0.2348,) and correlation with the anterior region of the maxilla (r = 0.40). Therefore we can conclude that there is a positive correlation between the cervical vertebrae and buccal sites, but this correlation is weak. Being that we found a moderate correlation of the cervical vertebrae with the anterior region of the maxilla was finded.

Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon condition, characterized radiologically by cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses, of unknown frequency resulting from brain injury due to large no of causes; especially in early life. Mostly presents early in life with seizures, learning difficulty, contralateral hemiparesis and facial symmetry. Here we present a case of 11 months old female child with developmental delay, visual abnormality, microcephaly and spastic hemiplegia. CT-brain done which was suggestive of infantile type of cerebral hemiatrophy or DDMS. DDMS is caused by an insult to growing brain either cerebrum in utero when maturation of calvarium has not been completed, or during early life due to damage to brain.

Background: Acute pain in the postoperative period has an incidence of around 80%, and nearly 86% have moderate to severe pain [1]. Enhanced recovery after surgery (ERAS) recommends the multimodal analgesic regimen to reduce the postoperative pain and improve the outcomes [2]. The multimodal analgesic regimen prioritises the reduction on dependence on opioid analgesia, and pain is addressed at different levels utilising different mechanisms of action, thereby alleviating pain and decreasing complications associated with any individual drug. Various methods (regional anaesthesia, nerve blocks, local infiltration) and medications including non opiate like Nonsteroidal anti-inflammatory drugs, paracetamol, Cyclooxygenase2 inhibitors, NMDA receptor antagonists, gabapentins, pregabalins, and alpha 2 receptor agonists and lastly opioids are incorporated into the treatment regimen as per requirement. Transdermal fentanyl patch provides steady state plasma levels after 12-24 hrs of application, thereafter the plasma levels are constant for the remaining 72 hours providing effective analgesia [3].

The primary objective of this study was to assess pain relief in the postoperative period with transdermal fentanyl patch in the opioid naïve patient and secondary objective was to assess any associated side effects.

Material and Methods: A total of 44 patients were divided into two groups. Groups were named as FP (Fentanyl patch) and P ( Placebo). The Patch was placed 10-12 hours before surgery and patient was monitored for 72 hours postoperatively for pain by NRS (Numeric Rating Scale). All of the patients were given Paracetamol and Diclofenac Sodium on a regular basis. If the NRS scale was greater than 5, tramadol was administered as a rescue analgesic. Data was analysed using Indostat services' Windows stat version 9.2.

Results: Over 72 hours, there was a statistically significant difference in Tramadol intake between patients in the FP group (19.44mg) and the P group (72.22mg). The Numerical Rating scale was also much lower in the FP group at 8,16,24,32,40,48,56,64 and 72 hours. Maximum difference in the pain score was observed at 24 hours for the FP group. There was no difference in the incidence of sedation, pruritus, respiratory depression, nausea and vomiting scores in the two groups.

Conclusion: Transdermal Fentanyl Patch of 25µg/hr when applied 10-12 hours before surgery provides effective postoperative pain relief after major abdominal surgery as a part of multimodal analgesia.

Castration-resistant (CR) prostate cancer (PCa) treatment options are limited. A substantial sub-population of CR PCa tumors can synthesize androgens for intracrine androgen receptor (AR) activation, inhibiting androgen biosynthesis could be an effective treatment option for these patients.

Study Objective: The androgen biosynthesis inhibitors simvastatin, atorvastatin, and ketoconazole were found to directly inhibit growth, migration, and colony formation of androgen-independent LNCaP C-81 cells that exhibit de novo androgen biosynthesis, with simvastatin being the most effective. Importantly, statins specifically enhanced growth suppression in combination with anti-androgen abiraterone acetate effects on CR PCa cells.

Conclusion: Statins can be combined with abiraterone acetate to improve anti-androgen therapy for CR PCa.

Sjögren’s Syndrome (SS) is one of the three most common autoimmune diseases in the world, characterized by an inflammation of the exocrine glands, specifically salivary and lachrymal glands. Primary SS (pSS) only affects these glands, while secondary SS is associated with other systemic autoimmune pathologies. SS is characterized, histopathologically, by an inflammatory lymphocytic infiltration leading to a progressive loss of the glandular secretory function.

It is more common in women (9:1 versus men), mainly around 50 years old, after the menopause.

The medical dentist role is very important in the diagnosis of pSS. In several cases he is the one who detects the first symptoms, in particular dry mouth, so called xerostomia.

The primary syndrome doesn`t have a painful development, being dry mouth and eye dryness the most prominent clinical characteristics. The majority of the oral evidences are consequence of salivary glands hypofunction: dental caries, periodontal disease or fungal infections. Along with hyposalivation and xerostomia, communication disorders can occur like dysphagia and pharyngeal dryness leading to difficulties in speech and voice fatigue.

This study is an updating of the impact of pSS in the patient`s life quality with a focus on voice and other communication disorders. There is a need for awareness of the speech problems associated with pSS referring the patients to proper professional help.

Extramedullary hematopoiesis (EMH) is a compensatory phenomenon that occurs when bone marrow function is insufficient to meet the circulatory demands. EMH is most commonly found in the reticuloendothelial system, such as the spleen, liver, and lymph nodes, as well as in para-osseous sites. EMH in the adrenal is uncommon, with fewer than ten cases reported, and presenting as a massive adrenal mass is extremely rare. We present two 38-year-old women who had -thalassemia since childhood. After excluding hormonal secretion, computed tomography (CT) revealed a giant right adrenal mass with heterogeneous density mimicking a tumour mass with moderate splenomegaly associated. An ultrasound-guided biopsy was performed, which revealed fibrocollagenous tissue with trilineage haematopoiesis in favour of adrenal EMH, ruling out malignancy. As a giant mass, the treatment consisted of excision surgery followed by iterative transfusions to prevent recurrence. In daily practise, practitioners should pay close attention to the differential diagnosis in any patient with chronic hematologic disorders suggestive of EMH, even if the location is unusual. To avoid unnecessary procedures, a confirmatory preoperative biopsy is recommended.

Dermatophytes are a genus of keratinophilic fungi that commonly cause infections of the skin, hair, and nails. Based on their ecology, they are classified as anthropophilic, zoophilic, or geophilic. Superficial dermatophytic infection of the genital region is called genital dermatophytosis, tinea genitalis or pubo-genital dermatophytosis. In this review, we would like to discuss briefly, the various clinical presentation of genital dermatophytosis, current changes in the taxonomy and nomenclature, introduction of new diagnostic techniques and briefly about some common dermatophytes and their sources. Also, there are serious concerns associated with the recent development of antifungal resistance among the dermatophytes. We are also facing the scenario of difficult to treat dermatophytosis. The changing life style, frequent visits to health club, close-fitting synthetic garments, promiscuous culture, keeping small pets such as cats and dogs are the possible contributing factors leading to increased incidence of dermatophytosis.

Until recently, superficial dermatophytosis, also known as tinea, was considered as a minor skin infection, which was easy to treat. There used to be rare outbreaks and epidemics of superficial dermatophytosis. Lately, there is a sweeping change in the clinical presentation due to extensive, atypical and recalcitrant dermatophytosis. Treating such infections poses a great challenge to the clinicians.

Dermatophytosis is a dermatophyte-caused superficial fungal infection of keratinized tissue (skin, hair, and nails) (fungus). Trichophyton, Epidermophyton, and Microsporum are three dermatophyte genera that cause it. The conventional methods of laboratory diagnosis have now been substantiated by molecular characterization. Earlier epidemics were usually due to anthropophilic dermatophytes. Now, zoophilic dermatophytes are also responsible for many outbreaks and epidemics. We need to be equipped with the tools to face the current scenario, because this depends upon the competence of the staff working in the state-of-the-art laboratories which is needed for the appropriate treatment and to study the epidemiology. Since dermatophytosis has public health importance, an appropriate diagnosis, source of infection and treatment is very crucial.

The objective of this article is to highlight the advantages of Wilckodontics in accelerating the local hard and soft tissue remodelling and thereby bring about a decrease in the time taken to complete the orthodontic treatment. The second objective is to minimise or remove the need of orthodontic appliances which can be cumbersome for the patient. Wilckodontics is also known as periodontally accelerated osteogenic orthodontics (PAOO). The periodontium is a dynamic tissue and regulation of its remodeling gives an edge in the traditional orthodontic treatment. The synergistic effort from the periodontic and orthodontic fields in the PAOO technique can shorten the conventional orthodontic treatment time to 3 to 9 months.This technique has roots in orthopedics, dating back to the early 1900s.It was only recently updated to help straighten teeth and correct bites. This page will help you grasp Wilckodontics indications, contraindications, and complexities.   

Low-grade Squamous Intraepithelial Lesion, High-grade Squamous Intraepithelial Lesion, and Cervical Cancer are the three most common cervix disease states after Human Papillomavirus infection. The objective of this study is to find a possible cure for Cervical Cancer by pin-pointing the genesis of all the three disease states of the cervix mentioned above. The genesis of all the three have been explained in this chapter using the Fooling of Homeostasis Hypothesis. According to this hypothesis, for cancers with stem cell origins, the would-be cancer cells just before turning cancerous undergo aggressive proliferation and aggressive apoptosis (at same rate) thereby leading to fooling of the homeostasis maintained by the surrounding healthy cells and immune cells. This hypothesis predicts that the possible cure for Cervical Cancer could be the use of chemicals ethanol-alcohol dehydrogenase and sodium metabisulphite.