Novel Research Aspects in Medicine and Medical Science Vol. 2

This retrospective study examines whether SE catheters improve the success rate or decrease the risks compared to Biosense Thermocool catheters (Biosense Webster Inc., Irvine, California) not employing sensor-enabled technology utilizing NavX EnSite Precision algorithms. EnSite Precision technology (Abbott, Chicago, Illinois) is a novel mapping and navigation system facilitating the visualization and manipulation of intracardiac catheters during arrhythmia ablation procedures. The mapping system employs electrical impedance and magnetic data in conjunction with Sensor Enabled (SE) catheters (Abbott, Chicago, Illinois) to provide more precise mapping and navigation. It is uncertain if this results in improved clinical outcomes.  Charts of 146 patients who underwent radiofrequency ablations for supraventricular and ventricular arrhythmias between 2016 and 2019 at the Beirut Cardiac Institute were reviewed and analyzed. SE catheters have the same success rates compared to standard catheters using the EnSite Precision mapping system. However, SE catheters were associated with a lower rate of transient conduction blocks. Further prospective studies should be conducted regarding this matter.

Idiopathic polymorphic ventricular tachycardia (IPVT) is a life-threatening arrhythmia triggered by short-coupled premature ventricular contractions (PVC) and is a rare cause of sudden death in patients with structurally normal hearts. It is a diagnosis of exclusion where ischemia and other structural heart diseases, in addition to channelopathies should be ruled out. Although an implantable cardioverter-defibrillator (ICD) is indicated to prevent sudden death, many patients require adjuvant antiarrhythmic drugs or ablation of PVCs initiating IPVT/VF.

We present the case of an elderly male patient with an infection-related plasmacytosis that mimicked a neoplastic process. For two distinct reasons, plasmacytosis may be regarded as having clinical significance: 1. It must be distinguished from a malignant plasmacytic illness. 2. Evaluation of its diagnostic and clinical relevance is necessary. Infectious diseases have the potential to produce an increase in the number of plasma cells in the blood. It may raise the possibility of a plasma cell neoplasm being present. Plasma cells reduce in the peripheral circulation before disappearing entirely.  Infections, malignancies, and autoimmune illnesses are just a few of the factors that can cause reactive plasmacytosis. In summary, regardless of the patient's age, laboratory doctors and clinicians should consider infection-related plasmacytosis in the differential diagnosis of plasma cell dyscrasia before moving forward with a thorough and invasive evaluation like BME and other pricey tests, especially in settings with limited resources.

Background: Ovarian cancer is the 2^nd most common cancer of gynaecological origin. Its prognosis is poor due to its presentation in the advanced stages and the 5-year survival rate is <50% with the available therapies. So, there is a constant need for new biological markers. The association between HER2/neu overexpression and ovarian cancer has been studied, but the results are still controversial. Therefore, this study was aimed at evaluating the association of HER2/neu with the clinicopathological features of epithelial ovarian cancers (EOC).

Objective(s):

1. To evaluate HER2/neu over expression as a prognostic marker for epithelial ovarian cancer.
2. To find out the association of HER-2/neu overexpression with chemotherapy response in epithelial ovarian cancer.

Methodology: It was a prospective study with a quantitative correlational study design of 90 epithelial ovarian cancer (EOC) cases presenting to Fauji Foundation Hospital, Rawalpindi between Nov 2018 to Oct 2019. Immunohistochemistry (IHC) was applied for HER2/neu expression and IHC 3+ patients were considered HER2 positive. The association of HER2/neu with clinicopathological factors of ovarian cancer e.g. stage, grade, pretreatment CA-125 levels and with chemotherapy response were assessed.

Results: Mean age of diagnosis was 53 ± 8.022 years. Mean pre-treatment CA-125 level was 1262 ± 1683 and 81.1% (n=73) had raised pre-treatment CA-125 levels.

Most of the patients presented with advanced stage i.e. stage III (56.7%, n=51) and high grade i.e. grade III (54.4%, n=49). Most common histological type seen was high grade serous carcinoma (51.1%). It was seen that 24.4% (n= 22) of the tumors over expressed HER2/neu, 65.6% (n=59) were HER2/neu negative, whereas 10% (n=9) were equivocal for HER2/neu expression. Overall, 72.2% patients had platinum sensitive disease. According to HER2/neu status, 20% HER2/neu positive patients had platinum sensitive disease & 3.3% had resistant disease whereas 47.8% HER2/neu negative patients had platinum sensitive disease & 10% were platinum resistant.

There was a statistically significant association of HER2/neu expression with grade (p 0.040) and pre-treatment CA-125 levels (p 0.032) whereas our study failed to show significant association between stage (p 0.383) and chemotherapy response (p 0.055).

Conclusion: Our study demonstrated that, like other tumors, HER2/neu was positive in 24.4% patients and its association with grade & pre-treatment CA-125 level was statistically significant, but we could not establish its association with chemotherapy response. However, this result needs to be validated in a larger study population and patients need to be followed up for longer duration to conduct survival analyses so as to establish HER2/neu as a prognostic marker for epithelial ovarian cancer.

Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand Goel-Harms fixation technique description. A series of 7 patients were operated using free hand technique, X-rays were used only after the positioning of the patient in ventral position with Mayfield and at the end before locking the lateral rods. The fixation C1-C2 was performed in free hand manner.

No complication was documented, in all cases CT scan revealed correct and safe screw positioning (Gertzbein grade A). Our purpose was not the follow up of these patients, because the follow up of the patients treated by Goel-Harms was reported in different articles before, the main goal is technique description and its popularization.

Using the anatomical landmarks and with a good preoperative planning, it is easy for the experienced surgeons to perform the technique in a free hand manner, avoiding X-ray exposure to the patient and the team. This technique is safe, reduce significantly the surgical time, the rate of complication in this small series is nil, but even though is not recommended as usual use for the surgeons with little experience in this field. The surgeons in the residency program could learn the technique from the seniors already practicing it. Understanding of the anatomic subtleties, the surgical duration of C1-C2 free hand fixation can be minimized, as well as blood loss, making this type of surgery very practical, effective and safe. Preoperative anatomic recognition for surgical planning and intraoperative additional measurements and tactile assessment ensures accurate C1 and C2 free hand screw placement and adequate length of the screws. The use of the drilling of the interarticular space C1-C2 and packing with bone graft from the spinous process of C2 vertebra with subsequent insertion of the spacer (screw from anterior cervical plate system, 12-14mm length) enhances the stability of the fixation and fusion rate.

Bipolar disorder poses significant challenges to the mental health community, and effective treatment strategies are crucial in managing this complex condition. This paper presents a comprehensive systematic review of treatment approaches for bipolar disorder, with a specific focus on synthesizing evidence from treatment guidelines and clinical trials. A systematic search was conducted using Google Scholar, yielding 375 relevant papers, during the period from June 1, 2022, to August 30, 2022.

The primary objective of this study is to provide an updated and rigorous evaluation of the existing treatment guidelines and clinical trial evidence for bipolar disorder. By examining a wide range of interventions, this review aims to offer clinicians and researchers valuable insights into evidence-based practices for the management of this disorder.

The findings of this review reveal essential treatment modalities for bipolar disorder. Lithium emerges as a critical pharmacological intervention for controlling and alleviating severe mood episodes. Additionally, olanzapine demonstrates efficacy in managing acute manic or mixed episodes of bipolar disorder. Moreover, Cariprazine shows promise in achieving better effectiveness or remission outcomes.  Lurasidone is highlighted for its potential in improving cognitive performance among individuals with bipolar disorder.

Furthermore, this study underscores the importance of addressing co-morbid conditions in bipolar disorder management. For instance, quetiapine is identified as an effective treatment for improving sleep quality and co-morbid anxiety. The combination of carbamazepine and lithium emerges as a preferable approach in managing psychotic mania with co-morbidity. Adjunctive olanzapine or lamotrigine is recommended for treating co-morbid anxiety, while mood stabilizers prove beneficial in addressing co-morbid bulimia. Moreover, fatigue treatment considerations suggest the implementation of a dawn simulator.

In terms of dietary recommendations, the review emphasizes the significance of adopting a healthy diet. Probiotics intake and attention to the balance of fatty acids are suggested to support overall well-being in patients with bipolar disorder.

In conclusion, this systematic review provides comprehensive insights into evidence-based treatment options for bipolar disorder. By evaluating the effectiveness of various interventions, it offers clinicians and researchers valuable guidelines to enhance the management of bipolar disorder effectively. The findings of this study highlight the critical role of treatment guidelines and clinical trials in advancing the knowledge base and improving outcomes for individuals living with bipolar disorder.

Minimally invasive surgery (MIS) refers to tissue sparing approach. There are many MIS techniques described for total hip arthroplasty (THA), each one of them having its advantages and disadvantages. In the present chapter the modified anterolateral minimally invasive surgery (ALMIS) technique for THA is described lucidly in a step-by-step manner offering valuable insight and intraoperative tips and tricks. In the modified ALMIS technique, the patient’s positioning differs, as includes removing the anterior leg support from the surgical table, allowing better exposure during femoral preparation that could lead to fewer intraoperative femoral fractures or misplacement of the femoral stem. Furthermore, during the approach, a few anterior fibers (approximately 25%) of the gluteus medius (GM) and the gluteus minimus (Gm) are elevated, enabling better visualization of the acetabulum. The ALMIS technique may be easily extended according to each case, is relatively easy to learn and there is no need for special MIS instrumentation.

This paper describes a mathematical model with Susceptible-Infected-Treatment under disease infection in prey population. Moreover, we assume that the prey species has a viral illness, dividing into classes of susceptible and infected populations. One technique of control is self quarantining to separate healthy prey from diseased prey, and another method is a treatment that lowers the disease’s mortality rate. The system’s several equilibria are examined, and their stability analyses around the interior equilibrium are discussed. Routh-Hurwitz stability criteria is used for local stability analysis. Through numerical analysis using a simulated set of parameter values, we have shown the analytical results using Maple programmes.

The aim of this review is to provide an overview of the current knowledge on the effects of smoking-related chemicals on fibrosis and inflammation, two important pathological features of PC. Pancreatic cancer (PC) is one of the most lethal cancers in the United States and Europe. The molecular mechanisms of PC are complex and poorly understood, and the available treatments are largely ineffective. Smoking is a well-known risk factor for PC, but how smoking contributes to PC initiation and progression remains elusive. Quitting smoking can significantly reduce the risk of developing PC. We also explore how smoking chemicals may modulate the activity of pancreatic stem cells, which are implicated in PC development and resistance to therapy. We highlight the potential molecular targets and biomarkers that could be used for early detection and treatment of smoking-induced PC. This review also suggests potential molecular targets and biomarkers that could be used for early detection and treatment of smoking-induced PC, which could improve the survival and quality of life of PC patients.

In this chapter, it is mention one of several electrical cardiac abnormalities called “the presence of short PR and QTc intervals together in the same ECG tracing.” ALSO CALLED “BREIJO’s MODEL (because it was Prof. Breijo-Marquez who described it for the first time in 2007). The human heart is an engine that has to work constantly at a frequency of between 60 and 90 cycles per minute) to keep you alive, and it has to be reliable and effective. To do this, it relies on a specialized network of cells called the cardiac conduction system. It’s also known as heart’s electrical system. Morbidity and a wide range of symptoms, from minor to those requiring immediate attention due to the possibility of sudden cardiac death, are caused by changes in the cardiac electrical system. Atrial fibrillation, which is the most common (although it is ‘always said’ that it is the most common, this is not correct, the most common alteration of the cardiac electrical system is SYNUSAL TACHYCARDIA, the Atrial fibrillation only is the most common symptomatic arrhythmia..) of these electrical abnormalities, is becoming more common as the average human age rises. A cardiac calibrator was used by four different cardiologists in blinded fashion to document a distinct ECG pattern, that of a short PR and QTc intervals together in the same ECG tracing (Breijo’s Model) from more than 25.0000 cases assessed for this condition (more than two thousand five hundred cases evaluated since 2.007 to date). Here, along with descriptions of their symptoms and ancillary tests, we report the clinical characteristics of 3500 individuals with verified short PR and QTc intervals in the same ECG trace ((Breijo’s Model) ) . Before deeming a given type of ECG tracing as normal, it must be thoroughly examined in individuals with suspicious symptoms.

The aim of this study was to determine the function of bioelements in human depression. In the randomized, prospective, observational trial, 311 adult participants (188 women and 123 men) underwent assessments for hair sodium and potassium; 192 were controls (83 men and 109 women), and 119 had significant unipolar depression (40 men and 79 women). Depression was diagnosed by the DSM-IV criteria, and hair sodium and potassium were analyzed by the inductively coupled plasma atomic emission spectroscopy (ICP AES). In the subgroup of 19 controls and 24 depressed subjects who attempted suicide (the gravest form of major depression), antidiuretic hormone (ADH) was assessed by using the standard laboratory ADH diagnostic kit. Significant gender differences were observed, since men have more hair Na and K than women (Na p < .01; K p < .02; Chi square test). The depressed subjects also have increased levels of hair Na and K, what indicate the negative balance of these electrolytes, since hair growth is unidirectional (p < .01 for both K and Na, Chi square test); ADH values were decreased in the suicidal subgroup (p < .01, Chi square test). These findings on negative Na and K balance and reduced ADH in depression are similar to those seen in astronauts during brief Apollo space missions. The issue arises as to whether the reported Earthly metabolic changes of body muscles in depressed subjects are a direct result of muscle inactivity, or if depression fatigue is mediated by the failure of some hypothetical, gravity dependent muscle mobility brain control "dynamostat" that operates in conjunction with the fluid regulation center that manifests its presence when being weightless in Space.

This chapter determine the effect of obese phenotype and the carbohydrate type resulted in alterations in brain composition in the obese phenotype of the congenic LA/Ntul//-cp rat, groups (n= 8 rats/group) of male littermate lean and obese rats were fed standardized isocaloric diets containing 54% (w/w) cornstarch (ST diet) or 54% (w/w) sucrose (SUC diet) from 1 until 10.5 ± 0.5 months of age. Malnutrition is a pervasive global public health issue that contributes to several dietary-related non-communicable illnesses. In low-income nations, adult nutrition is frequently overlooked. In low- and middle-income nations, both dual malnutrition (over and undernutrition) and nutrition transition exist. The current popular emphasis on low fat diets has resulted in an upwards shift in dietary carbohydrate consumption. The strain's obese phenotype exhibits hypertrophic-hyperplastic obesity during early postweaning development and early onset chronic hyperinsulinemia without NIDDM. The total fat, protein, and DNA of typical aliquots of dissected brain tissues were analyzed. When fed the SUC food as opposed to the ST diet, body weights of obese >> lean animals were higher in both genotypes. In rats fed the SUC diet compared to the ST diet, brain mass was somewhat smaller in lean individuals compared to fat individuals. Brain total Protein and DNA content of lean rats were > obese rats and were modestly Lower in SUC than ST fed rats in both phenotypes, but the percent of lipid content was proportional to brain mass. The decreased brain mass was characterized by proportionate decreases in total lipid, brain protein and brain DNA content and were further impaired when fed the insulinogenic sucrose diet. Total body fat mass of obese was significantly greater than occurred in lean littermates and was only modestly greater in SUC than ST fed rats in both phenotypes. These results indicate that brain growth and cellular development is impaired in the aging, hyperinsulinemia-prone obese phenotype of this strain, were further impaired when fed SUC than ST diets, and the decreased brain parameters were likely associated with development of a chronic neuronal inflammatory syndrome common to excessive fat accretion and obesity, resulting in premature brain senescence.