Perspective of Recent Advances in Medical Research Vol. 12

Tumor necrosis factor-alpha (TNF-\(\alpha\)) is a pleiotropic cytokine that creates a favourable environment for malignant cells so they can evade the immune system, survive, and resist treatment. It has been demonstrated that it is ectopically produced in the tumour microenvironment by leukemic and immunological cells, fostering a favourable environment for the growth and development of malignant cells. Considering the varied role and different expression pattern of TNF-\(\alpha\) in acute leukemia and its clinical relevance, we monitored the level of TNF- \(\alpha\) in acute leukemia patients and its correlation with disease outcome.

Serum levels of TNF- \(\alpha\) were measured in 90 diagnosed cases of acute leukemia along with 10 controls using a Diaclone Human ELISA kit (solid phase sandwich ELISA) at the time of diagnosis and after induction chemotherapy to observe the effect of chemotherapy on TNF-\(\alpha\) levels.

At the time of diagnosis, T-acute lymphoblastic leukaemia cases had significantly higher TNF-\(\alpha\) levels than the Control, followed by acute myeloid leukaemia and B-acute lymphoblastic leukaemia. A significant reduction in serum TNF-\(\alpha\) level was seen in acute leukemia patients after induction phase chemotherapy (P<0.05). The levels were considerably reduced (P<0.001) in the majority of acute leukemia cases after the induction phase, while high TNF-\(\alpha\) levels were positively correlated with incomplete remission status in the remaining cases.

Acute leukaemia progresses and relapses as a result of TNF-\(\alpha\). In patients with acute leukaemia, high levels are associated with leukocytosis, elevated blast numbers, and worse survival. Monitoring of TNF-\(\alpha\) may be helpful in acute leukemia patients in view of available anti -TNF-\(\alpha\) therapy.

Ventilator-associated pneumonia (VAP) is one of the most common infections in intubated patient receiving mechanical ventilation in intensive care unit (ICU). A study was done to compare the incidence of VAP in critically ill patients receiving oral care with and without manual teeth brushing and the application of moisturizers to the mouth besides routine oral chlorhexidine care. We conducted a prospective randomized control study, comprised of 220 ICU patients between 18 and 65 years of age, and of either sex. The patients were divided into two groups of 110 each. Care for one group (Study group) consisted of chlorhexidine wash, tooth brushing, and moisturizing gel over gums, buccal mucosa, and lips. The other group of patient was treated with chlorhexidine wash only. The oral assessment was done at 4, 6, 8, and 12 hours using the Beck Oral Assessment Scale (BOAS). Pneumonia was assessed based on abnormal chest x-rays, fever, chest auscultation, endotracheal culture report, and the incidence of VAP, and mortality was observed. Abnormal chest x-rays, positive auscultatory findings, fevers, and positive culture reports were significantly reduced in study group compared to these measurements in control group. The incidences of VAP and mortality were also significantly lower in study group compared with the incidences in control group. It was concluded that Conventional method of oral care with chlorhexidine could be replaced with adding teeth brushing and application of moisturizing lotion with routine oral care. It has additional advantage in the prevention of VAP in mechanically ventilated patient with significant decrease in length of ICU stay and mortality.

Introduction: Illicit drug consumption and its associated criminal activities have reached alarming proportions in recent years. To overcome this crisis, a new decentralization trend of laboratory confirmatory methods has received considerable attention from scientists to suit points of care (POC). The typical confirmatory standards for drug analysis are gas chromatography-mass spectrometry (GC-MS), and Liquid chromatography-tandem-mass spectrometry (LC-tandem-MS). Nonetheless, these techniques employ large laboratory equipment, extensive sample preparation, and long analytical time that are inappropriate for in-field drug testing.

Aim: Discuss the recent advances in illicit drug portable analytical devices at POC.

Results: The current progress in portable drug analytical devices is primarily attributed to the emergence of various miniaturized platforms. This review focuses on miniature ambient ionization MS, electrochemical sensors (screen printed electrodes, aptasensors, and nanosensors), paper-based systems (lab on paper/ Lab on a chip), handheld ion mobility spectrometer (IMS), portable Raman spectroscopy (surface-enhanced Raman scattering-SERS) and portable near-infrared (NIR) spectroscopy.

Conclusion: Miniature ambient ionization MS is very rapid with no required sample preparation; however, it is more expensive than other alternatives. Electrochemical sensors are quick, inexpensive, and sensitive devices, but selectivity can be affected by shelf life and storage conditions. Despite lab on paper being easy, rapid, and requiring minimal amounts of reagents, it has lower sensitivity and selectivity when compared to other instrumental detectors. Consequently, the most appropriate portable devices for in situ accurate drug analysis are handheld IMS, which is highly sensitive, selective and rapidly identifies compounds including isomers, and portable Raman, and NIR spectroscopies for their reasonable costs, easy, and quick real-time analysis within seconds, in addition to their coupling with novel smartphone applications.

The study aims to identify some potential herbals with anti-Mucorales (antifungal) properties.

Antifungal and anti-Mucorales drugs are still scarce in the modern healthcare system's arsenal. This has led to a higher mortality rate in the affected population, particularly following the COVID-19 pandemic. Mucormycosis is a rare but serious fungal infection of the skin, sinuses, lungs, and brain, caused by a group of ubiquitously present molds called mucormycetes. Although its occurrence is sporadic, the manifestation can be life-threatening under several medical conditions and the associated risk factors. A comprehensive literature search was conducted across the PubMed database, LILACS, the Cochrane Register of Controlled Trials, Google Scholar and others using key words COVID-19, SARS CoV-2, Mucormycosis, Rhizopus, vaccine, steroids, antifungal drugs and herbals. Full texts of the retrieved articles published in English were accessed.

A handful of medicinal plants such as Satureja khuzestanica Jamzad, Thymus danensis and Thymus carmanicus, Thymus vulgaris L, Lavandula angustifolia, Mentha piperita and some species of pepper such as Piper sp., Piper tuberculatum and P. hispidum have all shown to have a promising antifungal effect on Mucorales fungus. Extensive and intensified research should be carried out to identify further, design and develop new and safer antifungal drugs that can be powerful in treating mucormycosis.

The present study aims to assess the dose going to these unspecified regions termed as pseudo-OARs and if delineation of these structures and prescribing a proper dose constraint will reduce the dose to the oral mucosa without compromising the quality of the treatment plan.

A frequent and potentially serious side effect of radiation therapy for head and neck cancer is oral mucositis. When mucositis is severe, it can be painful, make chewing and swallowing difficult, and lead to treatment failures that can result in local recurrence or a drop in overall survival.

A total of 10 head and neck cancer patients (six carcinoma buccal mucosa cases and four carcinoma oropharynx) who had been treated by IMRT were selected for the retrospective study. The pseudo-OAR consisted of anterior oral mucosa, part of mandible and maxilla, which was adjacent to the PTV in oropharynx and contralateral buccal mucosa patients. The dose constraint given to the pseudo-OAR was Dmean \(\le\)30 Gy. Statistical significance was calculated by using a paired t-test. A p- value of <0.05 was considered as statistically significant.

The dosimetric parameters of PTV were comparable in both the IMRT arms. The pre-specified objective was fulfilled with both the study arms. The dose homogeneity and conformity was also similar. The dosimetric parameters of other OARs were within the prescribed dose constraints. The Dmean value of the pseudo-OAR in arm I was 31.28 Gy ± 3.55 Gy and 7.87 Gy ± 9.11 Gy in arm II and the p -value was significant (p=0.001), whereas the Dmax in arm I was 61.82 Gy ± 5.91 Gy and 61.23 Gy ± 5.54 Gy in arm II (p=0.6). The dose to the pseudo-OAR in IMRT arm II was reduced drastically by 75%, which was statistically significant. This study emphasises how crucial it is to identify the oral mucosa as a pseudo-OAR in head and neck cancer patients receiving radiation treatment. Clinical studies must optimise dose constraints, which will likely reduce the prevalence and severity of oral mucositis.

Gentamicin, used for the treatment of serious gram-negative infections, has a narrow therapeutic index. This property may lead to several side effects, thus, therapeutic drug monitoring (TDM) is important in gentamicin therapy.

This chapter aims to report the pharmacokinetics of gentamicin when using a once-daily dosing regimen.

The patient, a 78-year-old male, weighed 78 kg and was 1.75 m tall. He was brought into the hospital with a wound infection brought on by chronic limb ischaemia. A once-daily dosing of gentamicin (360 mg by infusion over 30 minutes) in combination with flucloxacillin was prescribed to this patient. A gentamicin blood sample was taken every day for four days: Day 1 = 1.4 mg/L, Day 2 = 2.1 mg/L, Day 3 = 2.1 mg/L, Day 4 = 1.6 mg/L. The patient’s serum creatinine was 88 µmol/L during the four days. To determine the dosage and interval for gentamicin administration, the Hartford nomogram was employed. A once-daily dosing regimen of gentamicin can lead to the clinical and bacteriological cure of infection. In addition, the Hartford nomogram is a reliable tool for keeping track of gentamicin's once-daily dose schedule.

We here in report a case of CCD that was not previously diagnosed because of the extremely low incidence of this disorder.

A rare congenital autosomal dominant skeletal disorder called cleidocranial dysplasia (CCD) affects the skull. Human RUNX2, which can be found on the short arm of chromosome 6p21, has heterozygosity of mutations that cause the disorder. One per million live births is the incidence of CCD. About 40% of patients with the condition experience spontaneous onset of CCD, and one in three of these patients has unaffected parents. The most prevalent features associated with CCD are aplastic or hypoplastic clavicles, supernumerary teeth, failed eruption of permanent teeth, and a hypoplastic maxilla.

A 13-year-old Caucasian boy was referred to the ortho- dontic    clinic   of   the   School   of   Dentistry, Aristotle University, Thessaloniki, Greece.  The patient was subsequently diagnosed with CCD based on the clinical examination, panoramic X-ray, anterior-posterior and lateral cephalogram, and chest radiograph findings. The details of this case are herein reported because of the extremely low incidence of this disorder. The overall treatment goal is to establish functional occlu-sion   and   an aesthetic   facial and   dental   appearance.

Sometimes this disorder causes psychological problems for the patients; therefore, proper motivation and sup- port are important.

The aim of current study was to investigate potential of PTS-ZN NSs formulation on ameliorating cytotoxicity, pro-apoptotic and oxidative stress potentials of PTS in MCF-7 cells. PTS-ZN NSs were synthesised using the liquid-liquid phase separation method. The formulations developed were evaluated in terms of particle size analysis, encapsulation efficiency, and in vitro diffusion. Cytotoxicity, uptake, cell cycle progression, Annexin-V assay, apoptotic genes mRNA expression, and biochemical assays were also performed. Five formulations of PTS-ZN NSs (P1-P5) were prepared according to liquid–liquid phase separation method to diminish the use of solvents. The study indicated that apoptosis in MCF-7 cells was confirmed and augmented through caspases dependent signaling pathways and inhibition of CDK1 activity due to use of ZN-NSs in delivery of PTS in comparison with free PTS. Promising research outcomes included high EE% nanocomposites, 36 h extended PTS diffusion, a synergized cytotoxicity profile, enhanced MCF-7 cells uptake, ameliorated apoptosis induced potential, enhanced mRNA expression of CASP3, CASP7 and CDK1 genes and significant oxidative stress.

Background: Uterine Fibroids, also known as Leiomyoma, are the commonest benign tumors Of the uterus. Treatment of uterine fibroids could be conservative management, Medical treatment, surgical treatment and radiological treatment.

The surgical treatment could be Hysterectomy, Myomectomy (abdominal, vaginal, laparoscopical) This article is aimed at highlighting the commonest surgical treatment of uterine fibroid in Rivers State University Teaching Hospital. (RSUTH) and certain outcomes or sequelae associated with these surgeries.

It is a common surgical option for women who wish to preserve their uterus and those hoping to have more children.

Methods: This was a retrospective cross-sectional study of all abdominal myomectomies done in this RSUTH between January 2017 to December 2021. The data collected were analysed using SPSS version 20 after a review of the theatre register, anaesthesia charts, patient case notes, and the gynaecological ward records.

Results: A total of 540 women had surgery for uterine fibroids. Of common complications were fever, massive intraoperative haemorrhage (>1.5L), intestinal obstruction (paralytic ileus), iatrogenic bowel injury and anaesthetic complications. No death was recorded.

Conclusion: One of the most popular treatments for symptomatic uterine fibroids is abdominal myomectomy. Despite the possibility of major perioperative difficulties, the results are typically positive. Therefore, the proper safety measures should be implemented to reduce these issues.

Alpha blockers are being commonly used as adjuvants in the medical management for the expulsion of ureteral stones. The present randomized study aims to evaluate the efficacy of Tamsulosin and Silodosin as medical therapy in the management of symptomatic distal ureteral stones.

Methods: In this randomized control study the 120 patients enrolled were allotted to three groups. Patients in group 1 received tablet Tamsulosin 0.4 mg/day, group 2 received tablet Silodosin 8mg/day and group 3 served as the control group. Parameters noted were the blood pressure, stone position (% of expulsion in each group), adverse events noted and number of hospital visits. All patients were followed up weekly for a period of 28 days.

Results: Study showed that both Tamsulosin (80% success) and Silodosin (85 %success rate) are equally efficacious when compared to the control group. Group 1 and Group 2 required less of pain killers and also had less frequent hospital admissions due to painful episodes as compared to the control group. Usual adverse reaction seen with alpha blockers like orthostatic hypotension and retrograde ejaculation were reported by some subjects in the test groups.

Conclusions: Both the drugs appear to be effective in the medical management of distal ureteral stones.ButTamsulosin scores over Silodosin as it’s well tolerated and with good stone expulsion rates.

Cerebral circulation is typically divided into anterior and posterior. The posterior cerebral circulation is supplied by the vertebrobasilar (VB) system which later connects with the anterior circulation via the posterior communicating arteries towards the circle of Willis [1]. This system serves as a critical arterial supply to the cervical spinal cord, brainstem, cerebellum, occipital lobes, and inner ear; therefore, understanding the anatomy and clinical significance of the VB system is critical when evaluating patients with posterior neurological síndromes, vertigo and hearing loss.

Posterior brain ischemia represents approximately 20% of all cerebral infarctions and dizziness is one of its most common manifestations [2]. Early diagnosis and treatment of ischemic events in the posterior circulation can save lives, prevent long-term disability and reduce healthcare costs, however, this remains more difficult to do than with other types of strokes [3].

This chapter aims to address the general anatomy of the posterior circulation and the importance of balance and hearing assessment when evaluating a patient with a possible ischemic event in this region.