Novel Research Aspects in Medicine and Medical Science Vol. 4

The study aimed to assess the potential of DNI, CRP, and IL-8 as predictive markers for sepsis in non-COVID-19 patients. Conducted within a Bulgarian ICU through a prospective non-interventional clinical follow-up, the research focused on patients with and without sepsis.
DNI is a significantly critical marker for developing sepsis (Exp (B)=1.329, p= 0.007). DNI has an association with developing sepsis (r=0.363, p=0.001). ROC analysis showed a DNI value of 1.4 (the best cut-off value of 1.4), with 73% sensitivity and 87% specificity (AUC 0.764, 95% CI 0.650-0.878, p=0.0001). CRP is a significant marker for the severity of infection and shows the likelihood of sepsis events (Exp(B)=1.016, p=0.0001). The ROC curve results demonstrate that CRP, with 82% sensitivity and 76% specificity, predicts sepsis development (AUC 0.885, 95% CI 0.813-0.956, p -0.0001). There is a correlation, indicating an IL-8 increase as a marker for sepsis (r = 0.461. P = 0.0001). IL8 was significantly higher in septic groups than in the control group (t=3,537, p<0.001). Our findings demonstrate the reliability of DNI, CRP, and IL-8 as robust indicators with a strong predictive capacity for sepsis development among non-COVID-19 patients. Vigilant monitoring of these markers can significantly contribute to the early identification of at-risk individuals, enabling timely interventions and appropriate treatments.

Theobjective of this study was to establish a correlation between pathology and radiology diagnosis. Teratoma, as a real neoplasm, contains multiple structures foreign to the originating sites. This study describes a 4-year-old child with a rare instance of sublingual cystic teratoma in the mouth cavity with unusual magnetic resonance imaging (MRI) findings. The MRI revealed a well-marginated lesion in the oral cavity floor, with a strong signal on T2-weighted imaging and an iso signal on T1-weighted imaging, as well as a thick wall and wall enhancement following intravenous contrast injection. The MRI results were linked to an oral cavity congenital cyst with a high proteinaceous substance, indicating an infected ranula. The patient had experienced two failed stages of treatment. Finally, The cyst was surgically removed. The histopathological section of the excised specimen demonstrated a cyst line by epidermoid stratified squamous epithelium and ciliated respiratory mucosa, compatible with maturing cystic teratoma.

Subglottic stenosis can be defined as the narrowing of the upper airway, which lies between the vocal folds and the lower border of the cricoid cartilage. Causes of subglottic stenosis can be either congenital, acquired, or idiopathic. Tracheostomy is often necessary to protect the airway. Recently, encouraging outcomes in the use of balloon dilatation for subglottic stenosis led us to effectively treat a 37-year-old male patient with complains of dyspnea and loud breathing. Although subglottic stenosis is not rare, it presents a difficult dilemma for otolaryngologists. Because several treatment methods are accessible, management involves experience in selecting the correct applicant for the proper form of treatment. Balloon dilatation is a relatively new therapy option for subglottic stenosis. Although an examination of the literature reveals that this is utilized in the Western world.

The purpose of this chapter is to give a review of the literature as well as a case of endovascular replacement of Aortic PSAs following aortic valve replacement. Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. The Aortic Pseudoaneurysm (PSAs) is a frequent complication that has been documented following heart surgery. Endovascular therapy for this condition is still controversial in terms of safety and effectiveness. However, because surgical therapy of aortic PSAs is associated with significant mortality and morbidity and is not always possible, percutaneous closure has been proposed as an alternative.

The objective of this study is to bring up exceptional importance of methylation enzymes (MEs) in the regulation of cell replication of differentiation to subject these enzymes to double allosteric regulations and to pay attention to destabilization of abnormal MEs as a critical allosteric regulation of cancer therapy. MEs are a ternary enzyme complex consisting of methionine adenosyltransferase (MAT)-methyltransferase (MT)-S-adenosylhomocysteine hydrolase (SAHH), which play an essential role to regulate cell replication and differentiation in response to allosteric regulation. MEs are subject to double allosteric regulations, one at the individual enzymes and another at the enzyme complex.  On the individual enzymes, SAHH is the receptor of steroid hormones or related allosteric regulators which dictates the optimum of growth and differentiation. Allosteric regulators play an essential role to maintain biological optimum to avoid hazardous extreme often to result in the display of clinical symptoms. On the enzyme complex, the association with telomerase changes kinetic properties of MAT and SAHH to alter the regulation in favor of growth. Primitive stem cells such as embryonic stem cells (ESCs) and progenitor stem cells (PSCs) express telomerase.  Cells with abnormal MEs have a great advantage on growth. The nature creates chemo-surveillance as an allosteric regulation to destabilize abnormal MEs to keep cells with abnormal MEs under control.

Wound healing requires the proliferation and the terminal differentiation of PSCs. The functionality of chemo-surveillance dictates the success of wound healing. If the functionality of chemo-surveillance has been damaged due to pathological conditions, then the terminal differentiation of PSCs will be affected to result in very serious illnesses such as tissue fibrosis, dementia and organ failure.  Wound unhealing can also force PSCs to evolve into cancer stem cells (CSCs) through silencing of TET-1 enzyme to escape contact inhibition that limits the proliferation of PSCs. The proliferation of CSCs cannot heal the wound because of the collapse of chemo-surveillance, which are then forced to progress to fast growing cancer cells (CCs) by the activation of oncogenes and/or the inactivation of suppressor genes. Obviously, the best approach of therapies of illnesses due to wound unhealing is to restore the functionality of chemo-surveillance.  CDA formulations are, therefore, the best drugs for cancer therapy to fulfill cancer moonshot and to win the war on cancer.

The aim of this study is to explore the clinical significance of bronchodilator reversibility in patients with restrictive patterns of spirometry. In restrictive disorders, this is less common than in obstructive airway disease, which is characterized by reversibility on bronchodilator medication as evaluated by pulmonary function testing. In our study, 30 individuals with restricted spirometry who significantly responded to bronchodilators were included. Restriction was characterized by reduced FVC and FEV1, normal FEVI/FVC, and an improvement of 12% and 200 ml in FEV1 and FVC following bronchodilator therapy. The body plethysmography measurements of the diffusing lung capacity, spirometry, clinical history, treatment history, X-ray features, and lung volume for each patient were noted. The mean age was 48.60, + 14.06 years, the majority of the patients were male 70 % and 22.23, + 3 .59 was females BMI which was slightly higher than males .40% were smokers, with shortness of breath as the most common symptom, followed by cough, wheeze and chest pain. Asthma was the most commonly diagnosed medical condition and most of them were on bronchodilators. The mean post-bronchodilator FEV1% and FVC% were 66.88, + 24.28 and 70.95, + 24.99, with a reversibility of 12.91%. The FEV1/FVC% was 96.80, +16.95. The mean TLC was normal whereas the RV, TLC, and RV/TLC were increased. It might have determined that reduced elastic recoil, which results in early airway closure, air trapping, and low lung volumes, may be the source of post-bronchodilator reversibility in patients with restrictive spirometry. Although there are not many of these individuals, if they are symptomatic, bronchodilator treatment might be beneficial.

The purpose of the study is to assess the variables that can affect the success of ESWL in Indian patients with upper urinary tract calculi. 300 adult patients who had ESWL for renal and upper ureteral calculi measuring 5 to 20 mm were enrolled in the study program between 2018 and 2020. Urolithiasis is a common condition, and it accounts for a large number of hospital visits. It is frequently preventable by modification of risk factors and has numerous treatment options. The effectiveness of extracorporeal shock wave lithotripsy (ESWL), one of the therapeutic options for renal and upper ureteric calculus, relies on a number of variables. Patients with >2 calculi, the presence of distal ureteric obstruction and renal anomalies were excluded. The clinical outcome of ESWL was assessed by factors like site, size, location and density. After statistical analysis, a p-value \(\le\)0.05 was taken as the level of significance. The overall success rate was 79.3%. While there was no statistically significant correlation observed with the quantity and distribution of the calculi, there was a statistically significant correlation between the size, density, and presence of stents and the clearance rate. In patients with renal and upper ureter calculi that are less than 10 mm in size and less than 1000 HU in density, ESWL should be thought of as the primary therapeutic option. Before deciding on a course of therapy, it is crucial to take into account variables such stone size, density, and placement.

Spot-morning-spot (SMS) smear microscopy has long been the conventional method for tuberculosis (TB) diagnosis, but its requirement for multiple visits to health facilities poses inconvenience for patients. This book chapter presents a comprehensive study that aims to investigate the sensitivity, specificity, and predictive values of a "proposed same-day" strategy for one-day TB diagnosis, as compared to the standard SMS method, with culture as the reference standard. The study was conducted on a total of 180 TB-suspected patients. The proposed same-day method involved the collection of an additional sputum sample at least one hour after the first sample, in addition to the standard SMS samples. Both samples underwent culture testing, and data analysis was performed using Open Epi data and Mc Nemar’s tests for comparison.

The sensitivity of the conventional SMS method was 81.8% (95% CI: 65.6-91.4), while the proposed same-day method exhibited a sensitivity of 75.8% (95% CI: 58.9-87.2) with Ziehl-Neelsen (ZN) staining (P-value = 0.298). Furthermore, both methods demonstrated identical specificity at 100% (97.1-100) with a P-value of 1.00. Similarly, for light-emitting diode fluorescence microscopy (LED-FM), the sensitivity was 84.9% (69.1-93.4) and 81.8% (65.6-91.4) in the conventional and proposed methods, respectively, with no significant difference in sensitivity (P-value = 0.568). The specificity for LED-FM was also comparable between the two methods, with a P-value of 0.155.

The findings suggest that with extensive and comprehensive training for laboratory technicians and technologists, it is feasible to diagnose pulmonary tuberculosis (PTB) in one day using the proposed same-day strategy.

Chronic granulomatous disease (CGD) is a fatal inborn error of immunity due to defective respiratory burst in phagocytes resulting in recurrent bacterial and fungal infection. It has to be suspected when in early infancy children presents with recurrent bacterial,fungal infection in the form of pneumonia,deep seated abscess.In Indian setting in tubercular infections presenting as persistent pneumonia CGD has to be considered.It is screened by Dihydro rhodamine assay and confirmed by molecular genetic testing.Prophylactic antibiotics, antifungal administration, aggressive management of infections and its complicationare key for longterm survival.Hematopoetic stem cell transplantation (HSCT) remains only curative treatment at present and future lies in gene therapy.

Type-I Melanoma Antigen Genes (MAGE-I) are expressed in a variety of tumor tissues and correlate with poor prognosis. At molecular level, MAGE-I proteins behave as tumor drivers by interfering with major tumor-associated signaling pathways. In this chapter we review the main oncogenic function of selected MAGE-I proteins to highlight the relevance of specific MAGE-I gene identification in human tumor samples for potential clinical interpretation.

The objective of the present chapter is to present clinical cases, in which an esthetic and conservative posterior endocrown was used to restore a mandibular molar that had undergone endodontic treatment and extensive coronal destruction and to assist clinicians in making decisions on when and whether endocrowns are an appropriate restorative option with a predictable outcome for extensively damaged endodontically treated teeth. The restoration of endodontically treated teeth (ETT) is a topic that has been widely and controversially discussed in the dental literature, and clinical opinions on this subject has been based on empirical philosophies due to the weak link between available scientific data and inconclusive clinical studies. After endodontic treatment, tooth lose their mechanical characteristics and become fragile due to the removal of pulp and surrounding dentin tissues. Endocrown which is a single partial restoration could be considered as a good alternative for restoring molars having large coronal destruction and presenting post endodontic treatment difficulties. The main objective of an endocrown is to achieve a bonded biomimetic reconstruction, i.e., minimally invasive to root canals. The clinical procedure that involves the Endocrown fabrication may be considered less complex, more practical, and easier to perform when compared with that of conventional crowns with post and core. This chapter highlights three different case reports of badly mutilated endodontically treated teeth, effectively managed by means of endocrown-type restorations fabricated with both metal-free and metal ceramic-based prosthesis with a 3 year follow-up period.

This study aimed to evaluate IP IMRT with field-in-field FP IMRT in patients undergoing adjuvant radiation after a modified radical mastectomy (MRM) for breast cancer. In the treatment of breast cancer, radiotherapy has been an essential component of the multimodality strategy. Dose distribution was improved by newer methods such as three-dimensional radiation. Intensity-modulated radiation (IMRT) improved homogeneity much further. The purpose of this study was to evaluate dosimetric characteristics and clinical results of inverse planned IMRT (IP IMRT) and field-in-field forward planned IMRT (FP IMRT) in patients with breast cancer receiving post-modified radical mastectomy (MRM) adjuvant radiation. Fifty patients with breast cancer who had MRM and needed adjuvant radiation were randomly randomized to one of two groups (25 each) using IP IMRT and FP IMRT procedures. The recommended dose was 50 Gy spread out over five weeks in 25 portions. In IP IMRT, five to seven tangential beams were employed for the chest wall, nodal volumes were set at appropriate angles using beam optimization, and the analytical anisotropic technique was used to calculate. In order to ensure uniform dose distribution to the planned target volume (PTV), minimize hot spot areas, and restrict exposure to the ipsilateral lung and contralateral breast, two opposing tangential fields were developed for FP IMRT. The dosimetric parameters in terms of PTV are better for IP IMRT plans compared to FP IMRT plans (V95%: 92.3% vs 75.2%, p = 0.0001; D90%: 47.4 Gy vs 42.9 Gy, p = 0.0001; D95%: 44.9 Gy vs 37.1, p = 0.0004). The ipsilateral lung (V10Gy: 71.9% vs 41%, p = 0.00001; V20Gy: 42.14% vs 36.35%, p = 0.03; V40Gy: 17.31% vs 26.95%, p = 0.00004; Dmean: 20.91 Gy vs 17.88 Gy, p = 0.01) and contralateral lung (V5Gy: 31.8% vs 0.1%, p < 0.00001; V10Gy: 6.2% vs 0.08%, p = 0.0001) received statistically significant lesser doses in terms of low dose parameters in FP IMRT. In the heart, the dosimetric parameter V5 was significantly lower for FP IMRT (61.7% vs 9.7%, p = 0.00001) along with Dmean (10.92 Gy vs 4.01 Gy, p = 0.001). Similarly, LAD parameters showed comparable high dose volumes (V40Gy: 21.02% vs 16.26%; p = 0.29) in both groups and a trend toward reduction in mean dose (17.1% vs 9.2%; p = 0.05) in FP IMRT group, although low dose volumes were higher in IP IMRT group. In contralateral breast, doses in smaller volumes were better for FP IMRT plans (V0.5Gy: 59.7% vs 43.8%, p = 0.01; V0.6Gy: 54.07% vs 37.6%, p = 0.007; V1Gy: 40.9% vs 22.1%, p = 0.001; V2Gy: 28.7% vs 9.4%, p = 0.00003; V5Gy: 12.07% vs 4.2%, p = 0.0001). In esophagus, statistically significant lower doses were seen only in terms of Dmean (10.29 Gy vs 5.1 Gy; p = 0.03) with FP IMRT. No significant difference in terms of skin reactions and dysphagia was seen in both the groups. Both IP IMRT and FP IMRT offer benefits and drawbacks, and the superiority of one approach over the other cannot be proved in this study. The decision to choose one approach over another can also be influenced by patient-related criteria such as the risk of loco-regional recurrence vs the danger of radiation-induced sequelae.

Objective: This comprehensive review examines the impact of diverse scientific approaches employed over the past two decades in the treatment of T1 high-grade bladder cancer. The aim is to assess their influence on clinical outcomes through a systematic review.

Literature Search Methodology: Through a systematic approach, a literature review spanning 2000 to 2020 was conducted across various databases including PubMed, Medline, and Embase. This review focuses on randomized controlled trials (RCTs), clinical trials, research and review articles, and original contributions that address the diagnosis and management of non-muscle invasive bladder cancer (NMIBC) within the last two decades. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and PICOS criteria (Population, Intervention, Comparators, Outcomes, and Study Design), we identified and sourced over 573 studies. Ultimately, 85 articles were selected for analysis, encompassing 19 prospective trials, 44 RCTs, original and research articles, a review article, and clinical trials. Retrospective studies were intentionally excluded to minimize bias.

Results: The review delves into the role of biomarkers in early NMIBC patient identification for predicting recurrence and progression. Notably, P-cadherin expression and other markers show promise in recurrence and progression prediction. Risk stratification emerges as a pivotal tool to enhance NMIBC patient outcomes, although refinements are still necessary.

Studies underscore the positive impact of fluorescence diagnostic cystoscopy (FDC) and Photodynamic diagnosis (PDD) on recurrence-free survival, although their influence on progression and overall outcomes is less evident. Consensus points to intravesical BCG therapy as the most transformative treatment for altering high-grade T1 disease trajectories, particularly in terms of progression. Re-TURBT after 2-6 weeks is increasingly endorsed by international societies. Its potential to enhance survival is debated, as it offers improved sampling for pathologic reading and detection rates.

While numerous articles underscore the benefits of early cystectomy for NMIBC patients, contrasting viewpoints suggest that cystectomy could potentially result in excessive treatment. The consensus underscores the necessity for well-defined selection criteria, as postponing cystectomy for NMIBC is associated with a more unfavorable prognosis in comparison to timely surgical intervention.

Conclusions: This comprehensive review evaluates the outcomes attributed to scientific advancements in managing NMIBC patients over the past two decades. Variability in outcomes among T1 bladder cancer patients arises from tumor heterogeneity and clinical staging. Despite advances in diagnosis, risk stratification, and management, larger studies are required to better comprehend and tailor treatment for this patient subset, with the goal of minimizing both over-treatment and under-treatment.

The goal of this article is to describe surgical ethics and to outline the principal moral dilemmas that surgeons must resolve. Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others.Surgeons must have a moral compass in their armamentarium which guide their decisions and actions. Surgery is an ethical practice and therefore surgeons should display surgical competence and diligence in their academic and medical activities. Surgeons should be trustworthy from a moral and ethical standpoint and should be skilled in the science and art of surgery. Surgeons must act as ethical models for society, surgeons in training, and fellow colleagues in the place he/she works. A guide used for discussion in surgical ethics should be based on the four-box approach and principalism to clinical ethics. Proximity, surgery-rescue, aftermath, ordeal and presence are five categories of relationships and experience that are important.

The goal of this work is to increase nursing care in the handling and processing of ophthalmic materials, therefore lowering the risk of endophthalmitis following surgical operations. Enophthalmitis is the word used to describe a condition characterized by inflammation restricted within the eyeball that is caused by bacterial infections, which is one of the most dreaded consequences after invasive ocular surgeries. This is an integrative review clearly and concisely structured, based on fundamental studies and definitions so that it is possible to assimilate the subject to be addressed, with the central objective of nursing care in the processing of ophthalmic materials, in order fo reduce cases of eye infection. Favorable surgical procedures, including infection avoidance, are the foundation for favorable postoperative outcomes. Health Conclusion- The solution of the article is to focus nursing's attention, directing a fresh view to the issue discussed, and arousing more interest in ophthalmology, which is underappreciated by nursing.