Recent Developments in Medicine and Medical Research Vol. 14

Objectives: We addressed retrospectively the results of polyintrasynovial infiltration with Rifamycin SV, related to 658 patients with different forms of arthritides. The objective was to verify whether this treatment, in addition to treating synovitis, had the ability to induce the remission of extrarticular signs of diseases.

Methods: The patients were subdivided according to the treatment schedule:

 -The group of arthritides (374) in which patients were subjected to infiltration on only one big joint

with the aim to cure the individual synovitis;

-those (189) in whom the treatment had been extended from one to weekly infiltration of three or four big joints;

 -the group of patients (95) in which only the small joints were treated.

Each of 1,364 joints, 727 big and 637 small, had been infiltrated once a week for 10 weeks and all         patients were followed for three years.

Results: The individual synovitis showed a significant correlation with the kind of arthritides, the presence of radiological damage and dimension of joints. Patients in whom three or four joints were weekly infiltrated showed the remission of extra articular manifestations in psoriatic arthropathy and the clinical improvement and normalization of inflammation markers in many patients with rheumatoid arthritis. These changes occur very slowly, sometimes months after the end of 10 weeks of infiltrations.

Conclusions:The outcome of synovitis was related to anti-proliferative and cytolytic properties of Rifamycin SV. The remission of extrarticular manifestations of arthritides should be sustained by complex immunological mechanisms that Rifamycin SV indirectly might have activated only when it was infiltrated by the intrasynovial route. The therapeutic effects of intrasynovial Rifamycin SV established very slowly during and, mainly, after the end of infiltrations.

The deformity in idiopathic scoliosis (IS) is three dimensional and effective correction should involve all three planes. Recently, the biofeedback method has been implemented in the treatment of scoliosis. The aim of this study was to evaluate the effectiveness of an innovative biofeedback SKOL-AS® postural training among children with scoliosis.

The target population for this study was 28 patients (25 girls and 3 boys) aged between 5 and 16 years old diagnosed and treated with low-grade progressing scoliosis.

The postural diagnosis consisted of anthropometric measurements, posterior–anterior X-ray imaging, SpinalMeter® postural assessment and the angle of trunk rotation (ATR) assessment. The SKOL-AS® treatment comprised of 24 sessions conducted in lying and sitting positions, two times a week for three months.

The study indicated that the postural training resulted in the decrease in the ATR value (pre- vs. post-exercise in younger: 5.5\(^{\circ}\) vs. 3.0\(^{\circ}\) and older patients: 5.2\(^{\circ}\) vs. 3.0\(^{\circ}\)). The increase in height of the subjects seemed to confirm a positive elongation effect of SKOL-AS® treatment. In the posterior view, a statistically significant decrease in shoulder asymmetry in the sitting position in younger children has been observed. In the anterior view, the changes in the head position (based on mouth and eye symmetry) have been observed. The statistically significant increase in acromion–heel, acromion–iliac crest and posterior superior iliac spine (PSIS)–heel length values has been shown in younger children on the left side of the body. After treatment, older subjects had higher acromion–iliac crest and PSIS–heel values on the left side of the body. On the right side only PSIS–heel length was higher. In  a sitting position, only a small increase in acromion–iliac crest length value has been observed.

This study has established that the SKOL-AS® biofeedback method could teach good postural habits and teach patients the auto-correction of the spine in all three planes.

We are facing an escalating global health problem, whereby the suffering from cancer-related illnesses is vastly increasing. It is more than a medical crisis: as cancer knows no geographical, cultural or religious boundaries, it is a human, economic and social issue. This global crisis has given us an opportunity to overcome our modern culture of individualistic isolation and to begin learning how to help ourselves by helping others, by opening ourselves to a shared language of compassion and hope.1

Healthcare professionals (and especially, nurses) are well-positioned to promote better communication skills, mutual respect and, perhaps eventually, peace. The Middle East Cancer Consortium (MECC) exemplifies a living model for promoting open communication and sharing of information in times of strife.

Our approach is to bring together oncology nurses from diverse religions, ethnic backgrounds and different communities throughout the Middle East, with a common goal to implement, expand and improve palliative care programs in the region. We learned that suffering may become a shared language, as very few of us would refuse to alleviate a dying enemy’s suffering. Central to MECC gatherings are sessions where nurses learn from each other about how to communicate with patients and their families as well as how to convey empathy.

The personal story recounted here reveals that the powers of science and medicine go hand-in-hand with the capacity for empathy and trust. Utilizing this approach, MECC participants have successfully ventured into the hostile territories of prejudice, politics and ideology.

Background: The purpose of this study was to compare maternal and perinatal outcomes in a trial of labour after caesarean (TOLAC) and an emergency repeat caesarean delivery (ERCD).

Design: A one-year prospective observational study at a tertiary care centre.

Methods: Selection of candidates for Vaginal Birth after caesarean section (VBAC) was based on the 2010 American College of Obstetricians and Gynecologists’ (ACOG) recommendation. The maternal outcome was measured using the VBAC success rate, maternal complications, and the number of days spent in the hospital. The perinatal outcome was measured using the 5 minute Apgar score and the need for neonatal intensive care unit (NICU) admission.

Results: Vaginal delivery was trialled on 250 patients. The success rate for VBAC was 169/249. (67.9 percent). Repeat CS was required for 80/249 (32.1%) of the patients. Cases with a Bishop score greater than 6 had a higher rate of vaginal delivery (89.6%) than cases with a Bishop score \(\le\)6 (17.4 %) (p=0.01). Spontaneous labour had better VBAC success rate (91.8%) than induced labour (55.5%) (p=<0.01). 8/12 (66.6%) subjects with history of previous vaginal deliveries delivered vaginally. In comparison to 3/80 from repeat CS, 5/169 VBAC babies had a poor 5-minute Apgar score.

Conclusions: VBAC has the advantages of a shorter hospital stay, less morbidity, and lower costs. Given that foetal morbidity and mortality from TOL are comparable to that of women labouring without a scar, TOL may be encouraged. Women can be given TOL with careful monitoring and taken for emergency LSCS on minimal indication, and this may be the best solution to managing a previous CS in labour.  

Poly cystic ovarian syndrome (PCOS) is a common endocrine condition in reproductive-age women. Chronic anovulation, hyperandrogenism, and polycystic ovaries are the typical triad of PCOS symptoms. Its biochemical characteristics include insulin resistance and metabolic abnormalities. Vitamin D is now linked to insulin sensitivity, diabetes mellitus type 2 and gonadal activities, in addition to its classical involvement in bone and calcium metabolism. Vitamin D may be a missing link between insulin resistance and PCOS.

Vitamin D levels are low in PCOS women, and vitamin D supplementation may be beneficial in the treatment of PCOS. This assumption, however, has not been proven consistently in clinical studies.

A study was conducted in a rural medical college in south India to determine the relationship between PCOS and vitamin D. BMI and vitamin D levels were measured in 120 women with PCOS and 60 age-matched non-PCOS women. Vitamin D deficiency was discovered in 60.8 percent of PCOS women and 61.7 percent of control women. Only 11.7 percent of the PCOS group and 13.3 percent of the control group have vitamin D levels greater than 30 ng/ml. The mean vitamin D levels in 120 PCOS women, 68 non-obese PCOS women, and 52 obese PCOS women were 18.94, 19.2, and 18.6 ng/ml, respectively. The mean vitamin D levels in 60 non-PCOS women, 39 non-PCOS non-obese women, and 21 non-PCOS obese women are 18.4, 19.0, and 17.3 ng/ml respectively. These differences are not statistically significant. Hence it is concluded that, vitamin deficiency is in the community at large, not in any way specifically important in PCOS and BMI.

Aims: To examine the attitudes and practices of physicians and pharmacists towards bush medicine (including personal use) and explore the factors influencing their attitudes. Also, to determine whether a video educational intervention impacted attitudes.

Introduction: The term 'bush medicine’ is used throughout the Caribbean to describe medicinal plants which are commonly used by traditional healers and is considered to be one aspect of traditional medicine.

Study Design: This was a cross-sectional study of registered physicians and pharmacists.

Place and Duration of Study: A total of 274 persons participated: 134 pharmacists attending their first Continuing Pharmacy Education (CPE) of 2015 and 140 physicians attending their annual Medical Scientific Conference.

Methodology: A pre-tested, self-administered questionnaire was distributed and collected, a video intervention was shown, and a post-intervention questionnaire was administered. Data were analysed using latent class cluster analysis, and the best-fitting model was determined using mainly the Bayesian Information Criterion (BIC). Logistic and multinomial regression and Fisher's exact test were also employed to investigate associations with demographic variables and the impact of the intervention.

Results: Most of the participants (56.4%) were 20-30 years old, and the majority (52%) had five years or less professional experience. Pharmacists displayed a more positive attitude to bush medicine than physicians. Most (99%) believed that patients should inform their physician/pharmacist about their bush medicine use, but only 53% routinely requested this information. More than half (52%) had personally used bush medicine, but only 38% had ever recommended its use. More than 90% believed that clinical trials should be conducted with bush medicine before it is used, and 88% were interested in further training. Ethnicity, years of professional experience and type of profession influenced attitudes and the intervention led to an improved outlook regarding bush medicine.

Conclusion: Overall, most participants had some misgivings about bush medicine but were willing to learn more and were interested in clinical trials. Evidence-based clinical research and training at the tertiary level or future continuing education sessions should be implemented using the content in the video as a template.

A segmentally broken (three part) interlocking femoral nail with broken interlocking screw can be challenging to remove. We describe a novel technique for extraction of an unusual two level broken cannulated anterograde femoral nail to treat the delayed union with exchange nailing.

This is the first reported case of a three-part broken intramedullary interlocking nail with broken distal locking screws, where the broken hardware was removed without opening the facture site or the knee. This technique is simple and does not require specialized equipment. We used a higher diameter and a longer nail for fixing the fracture and achieving the union. The surgical technique and review of literature is presented.

Muscles are notoriously variable, and it is quite common to discover muscular anomalies during routine dissection of the human body. The anterior group of muscles is typically divided into three layers: superficial, intermediate, and deep. The forearm of an 86-year-old embalmed female cadaver was dissected in the department of Anatomy, Punjab Institute of Medical Sciences Jalandhar, during standard upper-limb dissection for medical students. Two variants were noted in this case.  Initially, the ulnar nerve in the anterior compartment of the forearm passed through the flexor digitorum profundus muscle before connecting to the flexor carpi ulnaris. Second, there was an accessory muscle with a short belly that was merging with the flexor pollicis longus muscle's tendon. Both variations were found bilaterally. In practise, being aware of man's anatomical variability may prevent surgical errors and inspire new methods of restoration. A thorough knowledge of anatomic variants of nerve will assist the surgeon in avoiding inadvertent placement of retractors that can result in direct injury to the nerve or indirectly through traction.

Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system (CNS) that strikes in early adulthood. Despite several US FDA-approved medications, the treatment options for multiple sclerosis are limited. The main objective of this study was focused on plant bioactive constituents play an important role in the treatment of spasticity in Multiple sclerosis disease.  Many people with MS look into herbal treatments to help them control their MS and treat their symptoms. According to surveys, up to 70-80 percent of people with MS have tried plant products or bioactive compounds for their MS. Patients with MS who use herbal products may open up new avenues for research. Diet, omega-3 fatty acids, and antioxidants are the most commonly used phytotherapies. Bioactive plant compounds such as flavonoids, vitamin-c, lipoic acid, and vitamin D supplementation, among others, were found to be the most promising anti-inflammatory and neuroprotective agents in both relapsing and progressive forms of MS. Polyphenols, terpenes, alkaloids, anthocyanidine glycosides, plant amines, volatile oils, and other natural compounds will play an important role in the treatment of multiple sclerosis in the future.

Type I Diabetes Mellitus (T1DM) is an autoimmune pathology that occurs when auto-reactive cytotoxic CD8+ T-cells destroy native pancreatic insulin producing \(\beta\) islet of Langerhans cells reducing endogenous insulin levels. The objective of this chapter is to provide the reader with a summary of recent advances that provide new perspective on the future of autoimmunity as it relates to regenerative medicine and diabetes.  Stem cells were previously thought to play a pivotal role in the re-population of diseased pancreatic \(\beta\) cells but recent studies now indicate that the regenerative capability of these insulin producing cells remains intact even years after initial diagnosis. Thus, emphasis shifted from investigating re-population techniques using splenic or exogenous grafting stem cells to abating the initial autoimmune process to prevent further islet cell destruction by auto-reactive cytotoxic CD8+ T-cells. Tumor necrosis factor alpha (TNF- \(\alpha\)) is believed to play a role in therapeutic options for diabetics, as there is reason to believe that TNF-\(\alpha\)  is capable of inducing apoptosis in selectively autoreactive CD8+ T-cells. Furthermore, the next generation of ultrasensitive c-peptide assays shed light on the true functional status of \(\beta\) islet cells and conclude that the decline in function occurs over decades and not months as was previously thought. Trials involving using mycobacterial adjuvants have shown that not only mice, but also diabetics remain euglycemic for a long period after administration. All these concepts and discoveries pave the way for future clinical trials and the discovery of more curative diabetic treatment options.

Surgery is used to treat symptomatic uterine fibroids. The medical management involves Tranexamic acid, OC pills, Progesterone, LNG IUS, GnRH analogues, as a temporary measure pre operatively.  SPRMs (Selective Progesterone Receptor Modulators) are a new class of drugs for medical use. Ulipristal acetate is an SPRM that has been clinically approved for the treatment of fibroids.

The research was carried out at a tertiary care hospital in South India. The study's subjects are fifty women with fibroids and menorrhagia who are awaiting definitive surgery or pre-operative treatment to prepare them for surgery or who want medical treatment. Blood loss was measured using the PBAC scale at the start of treatment. Ultrasonography was used to determine the number and size of the fibroids. Associated symptoms were documented. For three months, urlipristal acetate 5 mg was administered daily. At three months of treatment, blood loss, amenorrhoea, and fibroids volume were all measured. The side effects were documented. They were followed for another three months to see if their menstrual cycle had resumed. The average blood loss was reduced by 88%. Amenorrhoea affected 82 percent of women. The volume of the fibroids was reduced by 28.2 percent. There were no bad side effects. Hot flushes were experienced by two amenorrhic women. 47 returned to menstruation after 30-40 days, and the bleeding was normal or slightly less. There was relief from dysmenorrhea and fibroids' pressure symptoms. The study's findings were compared to those of other studies. In terms of controlling menorrhagia and shrinking fibroid size, a 5 mg dose of ulipristalis is just as effective as a 10 mg dose.

Personalized therapy is gaining high attention due to more specific targeted approach as compared to the other conventional therapeutics. In recent decades a significant success has been seen in controlling certain sub-types of leukemia by employing precision medicines. This chapter summarizes how personalized therapies are incredibly recognizing specific tumor antigens and playing a significant role in controlling hematological disorders, especially acute myeloid leukemia (AML). We have described progress in biosimilar antibody engineering and CAR T-cell engineering in controlling relapsed AML. Moreover, the combined effect of immune checkpoint targeted therapy has been also discussed in further strengthening the efficacy of biological drugs. In addition to this, we have explained how epitranscriptomics could be used as a potential “intracellular checkpoint” target in improving the efficacy of immune cells under the tumor microenvironment. Epitranscriptomics is defined as a physiological changes or modifications in the cells by targeting m6A-modifiers (writer/editor, remover/eraser and reader/effector) without changing RNA/DNA sequence. Targeting these machineries could have high therapeutic value in controlling early progress of the disease and can be reformable into druggable candidate. Taken together, we have highlighted the advancement in personalized therapy by demonstrating the role of bi-specific biosimilar antibodies, CAR T-cell therapy and epitranscriptomics in prolonging the survival of AML patients.

Bacterial plaque is the principle cause of initiation of gingivitis and periodontitis. Removal of this bacterial plaque is essential for maintainence of healthy periodontium. The amount of plaque accumulation is dependent upon the degree of roughness of the tooth structure.  Conventional methods employed for removal of plaque had certain drawbacks like loss of healthy tooth structure causing increased dentinal hypersensitivity, time-consuming procedure, could cause gingival lacerations and gingival bleeding, need to sharpen the instruments, operator fatigue. The air-powder abrasive system produces desired removal of plaque and other debris, surface smoothness with less operator fatigue and prevent loss of tooth structure thereby decreasing incidence of hypersensitivity and gingival tissue lacerations. Nowadays, powders with different compositions, particle sizes and applications are available. The choice of the abrasive powder depends on the device used, the operator’s choice, the type of deposit to be removed and the medical contraindications. Hence, the newer minimally abrasive air powder polishing system is an effective alternative to conventional oral prophylaxis.

Introduction: Histiocytic Sarcoma is a rare neoplasm which causes less than 1 percent of all malignancies of hematologic origin. The biological behavior of this neoplasm resembles that of lymphoma, however its cell line is histiocytic and anon-lymphoid. Thereafter, the malignant cell of the histiocytic sarcoma shows morphological and immune-phenotypic characteristics of the histiocyte of mature origin. In the most recent 2016 revision, the WHO classified histiocytic sarcoma inside the macrophage along with other histiocytosis and stroma derived dendritic cell tumors.

Case Report: A 70-year-old female with Histiocytic sarcoma of the left proximal tibia which presented as a solitary lytic lesion with pain in the left knee for 3 months. We here in describe a rare differential to a solitary lytic bone lesion without constitutional symptoms which was treated by our own conventional method. Conclusion: Though Histiocytic Sarcoma is a rare bony lesion; we should be aware of its presence and perform biopsy and immunohistochemistry in all lytic bone lesions.

Conclusion: Though Histiocytic Sarcoma is a rare bony lesion; we should be aware of its presence and perform biopsy and immunohistochemistry in all lytic bone lesions.

Heterotopic pancreas (HP) is the presence of pancreatic tissue in anomalous location without any anatomic, vascular or neural continuity with the main body of the pancreas. HP is mostly located in the upper gastrointestinal tract. Most patients are asymptomatic. Epigastric pain is the most common symptom in symptomatic patients. It is rare to be diagnosed and accidentally discovered during surgery. EUS is a good way to study the structure of the submucosal lesions like HP. Patients without symptoms can be observed while symptomatic patients should have HP resected. We have a case of a female who had a chronic abdominal epigastric pain. Investigations revealed a submucosal mass which was diagnosed a HP. She had also sludge in the gallbladder. We performed local resection to resect HP totally from the stomach with clear margins laparoscopically as well as cholecystectomy in one procedure. Our patient was fully recovered.  

Objectives:

-Overview of Heterotopic Pancreas (HP).

-Study a case of pancreatic heterotopia mass in the stomach.

Background: Hyperthyroidism denotes to hyperfunctioning of thyroid gland. It is generally accompanied by alterations in erythropoiesis. The precise mechanism remains unclear.

Study Objectives: The present study was conducted to know the association of thyroid disorders and abnormalities in hematological parameters.

Conclusion: Alterations in thyroid status produces changes in serum ferritin and has an impact on other hematologic parameters too. Thyroid hormones directly influence iron metabolism by affecting ferritin levels. Although, on one hand raised free iron levels are toxic for body and acts as marker of oxidative stress, on the other side hyperferritinemiaplays a protective role against this increased oxidative stress seen in hyperthyroidism.