Recent Developments in Medicine and Medical Research Vol. 16

ABSTRACT: Astronauts are at risk of losing 1.0-1.5% of their bone mass for every month they spend in space despite their adherence to high impact exercise training programs and diets high in nutrients, potassium, calcium, and vitamin D, all designed to preserve the skeletal system. This chapter reviews the basis of bone formation and resorption and details how exposure to microgravity or simulated microgravity affects the structure and function of osteoblasts, osteocytes, osteoclasts, and their mesenchymal and hematologic stem cell precursors. It details the critical roles that insulin-like growth factor-1 (IGF-1) and its receptor insulin-like growth factor-1 receptor (GF1-R) play in maintaining bone homeostasis and how exposure of bone cells to microgravity affects the function of these growth factors. Lastly, it discusses the potential of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), syncytin-A, sclerostin inhibitors, and recombinant IGF-1 (rIGF-1) as bone-saving treatments for astronauts in space and during colonization of the moon. IGF-1 and its receptor IGF1R play critical roles in all phases of bone formation, promoting both radial and linear bone growth.

Diabetes mellitus is a chronic metabolic disease that is associated with abnormal metabolism of carbohydrates, proteins and fat. It is usually associated with excretion of excess sweet urine known as glycosuria. Most anti-diabetes drugs are not just costly, but always go with high levels of drug toxicity. This study determined the anti- diabetic activity of seed milk extract in Alloxan-induced diabetic rats. The seed milk extract at a concentration of 100,200, 300 and 400 mg/kg body weight were orally administered to alloxan- induced diabetic rats for a period of fifteen (15) days. The oral glucose tolerance test was also carried out using animal experimental method. The phytochemical analysis of the milk extract revealed the presence of flavonoids, isoflavones, saponin, tannin, phytosterol, lignin and anthocyanidine at moderate concentrations. The acute toxicity test showed no lethality of Sphenostylis stenocarpa seed milk up to a concentration of 5000 kg/body weight. In oral glucose tolerance test, the S. stenocarpa seed milk extract exerted the highest response, similar to glibenclamide after 15 minutes and 30 minutes of administration compared with the control. The S. stenocarpa seed milk extract recorded the highest blood glucose- lowering effect after day 15 of treatment (p < 0.05) compared with the diabetic rats that were administered normal saline and 0.3 mg/kg body weight of glibenclamide. The seed milk extract of S. stenocarpa possessed anti-diabetic activity like the reference drug glibenclamide, and the results of this study revealed that the graded doses of the seed milk extract have blood glucose-lowering effect in a time and concentration-dependent manner.

Hereditary angioedema (HAE) caused by C1-esterase inhibitor deficiency is an autosomal-dominant disease caused by a mutation in the C1-inhibitor gene. It is rare disease that is often worsened during pregnancy and childbirth. HAE, though uncommon but if untreated it may lead to maternal death.  The case report presents the successful management of a 24 years patient, Gravida 2, Para 1, known case of hereditary angioedema (C1-Esterase Inhibitor Deficiency). This patient was managed with a multidisciplinary approach by an obstetrician, an immunologist, an anesthesiologist and a pediatrician. She had an uneventful antenatal period but soon after delivery developed rashes all over her body. The attack of HAE was successfully managed with fresh frozen plasma and close observation.

Introduction: Burkina Faso, management of breast cancer is still challenging due to usually late diagnosis. There are limited therapeutic choices and there are often complications making prognosis poor. The aim of the present was to describe the current clinical situation of breast cancer in women under 40 years old at Yalgado Ouedraogo University Hospital (Burkina Faso).

Aim: This research aimed to describe the current clinical situation of breast cancer in women under 40 years old in Burkina Faso.

Materials and Methods: Prospective cohort study of 58 cases of breast cancer confirmed by histopathology was conducted at Yalgado Ouedraogo CHU, from August 1st, 2014 to February 29th, 2016.

Results: Mean age of patients was 34.8 years (± 4 years). History of breast cancer was observed in 22.4% of cases. Invasive ductal carcinoma was diagnosed in 94.8% of cases. T3 and T4 tumors accounted for 20.7% and 38.0% respectively. Locally Advanced Carcinomas were found in 34.5% of cases. Fifty-three women had total mastectomy and among them, 34.5% margins of resection were infiltrated. Lymphocytic infiltrate and presence of vascular emboli accounted for 86.2% and 51.7% respectively. Based on Scarff-Bloom-Richardson classification, 38 patients were grade III. Hormone receptors was negative in 27/45 cases. Chemotherapy and radiotherapy were performed respectively in 98.3% and 48.3% of cases. The average survival of patients was 22.7 ± 2.8 months.

Conclusion: Despite treatment, the prognosis of breast cancer remains poor for young women in Burkina Faso. Several challenges remain to be addressed including promotion of early screening with genetic counseling, establishment of an effective technical platform and national subsidy for therapeutic care.

Alcohol-related liver disease (ALD) is one of the most prevalent forms of liver disease in the world. A better understanding of molecular mechanisms related to ALD is imperative toexplore therapeutic targets and improve liver health. Aryl hydrocarbon receptor (AhR) is a xenobiotic receptor that plays important role in hepatic detoxification response. However, the role of AhRin ALD remains unclear. In this work, we found that chronic alcohol consumption reduced AhR expression but induced AhRand NQO1 nuclear enrichment in hepatocytes of alcoholic hepatitis (AH) patients and ALD mice.AhRknockout exacerbated alcohol-induced liver injuryalong with reduction of NAD(P)H quinone dehydrogenase 1 (NQO1), indicating thatNQO1 expression is dependent on AhR.Interestingly, although NQO1 expression was dependent on AhR, NQO1 nuclear translocation was mediated by cellular NAD⁺/NADH ratio rather than AhR activation. Nuclear NQO1 supported NAD⁺-dependent enzymes function in ALD mice. NQO1 overexpression prevented alcohol-induced hepatic NAD⁺ depletion and reversed alcohol-induced liver injury. Pharmaceutical activation of AhR-NQO1 signaling by indole-3-carbinol (I3C) reversed alcohol-induced liver injury. In conclusion, our human and mouse studies demonstrate that AhR activation is a protective response to counteract alcohol-induced hepatic NAD⁺ depletion through induction of NQO1.The findings suggest that targeting the hepatic AhR-NQO1 pathway may serve as a novel therapeutic approach for ALD.

Bangladesh is a developing country where most of the people live in under a minimum level of EB and SES. Nowadays Autism is a growing condition in our country. Autism spectrum disorders are a collection of conditions characterized by stereo typed behaviors and narrow interests and pervasive problems with communication and social interactions. The present study assessed the Educational background and Socio–Economic status of Parents of Autism Spectrum Disorder (ASD)child. A total of 200 parents of 100 children with ASD (2-8 years old) were conveniently selected to collect data from existing data source of IPNA. Result shows that the incomes of most of the family of children with ASD are between 15000-30000 ranges. Mothers of children with Autism are studied up to only S. S. C. level where father’s educational level is Graduation.  We all know that mothers are the first instructor of the child, so EB effects on handling the ASD child, parental counseling and instruction for management. For collecting management tools SES is a very important factor also.

Metastatic bone disease is a common problem observed in oncology practice. In solid tumors, bone is a common site of metastases. In advanced cancer, bones are the third most common site of metastases after liver and lungs. The common primary sites causing bone metastases are breast, lung and prostate, urinary bladder, uterus, kidney, melanoma and thyroid. Metastases in skeletal are usually multiple, solitary metastases are observed only in 10% cases. Bone metastases cause pain directly through local invasion and indirectly through alteration of the remodelling activity of osteoblasts and osteoclasts. Radiotherapy is the most effective treatment for bone metastases.Pain flare is a common phenomenon in patients receiving palliative radiotherapy. Dexamethasone is a long acting steroid which has shown effectiveness in prevention of pain flare. The main objective of the study is to determine the role of dexamethasone in prevention of pain flares in painful bone metastases after radiotherapy.

Complete bile duct stone clearance after a bile duct exploration is essential to avoid problems due to retained/recurrent stones. While no single method is the best, the combination of bile duct exploration with choledochoscopy is associated with the least incidence of retained stones as per available literature. A cystoscope can be used effectively for choledochoscopy if a choledochoscope is not available. This article highlights the use of a cystoscope as a choledochoscope with case capsules as illustrative examples.

Facial paralysis affects all age categories and has devastating functional and psychological consequences. In selected cases, surgical treatment is the only treatment option and represents the major challenge to the facial reconstructive surgeon. The purpose of this book chapter was to review current principles of surgical management for this challenging population of patients. Various surgical approaches and techniques were described including reported outcomes. Although several factors affecting nerve regeneration has been described, their control still leads to unpredictable functional outcomes. Unreliable result prediction and lack of standardised outcome measures continue to be the main limitation in regards to timing and technique decision making. Our current review demonstrates that outcome results differences remain to be unclear and further research is warranted.

As we have found before, an opening of mitochondrial permeability transition (MPT) pore in its low conductance state takes place in hepatocytes of the Baltic lamprey (Lampetra fluviatilis L.) during reversible metabolic depression in the period of its pre-spawning migration when the exogenous feeding is switched off. The depression is observed in the last year of the lamprey life cycle and is mediated by reversible mitochondrial dysfunction (mitochondrial uncoupling in winter and the coupling in spring). The objective of the present study was to further underscore the mechanism(s) of the MPT pore induction in the lamprey liver, for which we used Ca²⁺ plus P_i (and/or laurate) and Cd²⁺ as the pore inducers. It was shown that Ca²⁺ plus P_i induced the high-amplitude swelling of the isolated “winter” mitochondria both in isotonic sucrose and ammonium nitrate medium, while both low and high Cd²⁺ did not produce the mitochondrial swelling in these assay media. Low Cd²⁺ enhanced the inhibition of basal respiration rate of the “winter” mitochondria energized by NAD-dependent substrates, whereas the same concentrations of the heavy metal evoked its partial stimulation on FAD-dependent substrates. The above mentioned changes produced by Cd²⁺ or Ca²⁺ plus P_i in the “winter” mitochondria were only weakly sensitive to cyclosporine A, CsA (a potent pharmacological desensitizer of the MPT pore) added alone and they were not sensitive to dithiothreitol (a dithiol reducing agent, DTT). Measuring trans-membrane potential of the “spring” lamprey liver mitochondria, we obtained that Cd²⁺ produced its decline on both types of the respiratory substrates under test that was significantly slowed down by CsA; besides, the membrane potential was partially restored by DTT. The revealed seasonal changes in action of different membrane permeability and electron transport chain (mitoETC) modulators, such as heparin, nupercaine, laurate, BSA, CsA, DTT, and heavy metals on the lamprey liver mitochondria function are discussed, as well as the reversible season-dependent disturbance of complex I (CI) activity of mitoETC (including its reverse electron transport), which points to the possible involvement of A/D conversion of CI in the MPT pore formation and/or regulation during the reversible metabolic depression of the animal, strengthening the physiological relevance of the phenomenon.

Appendiceal mucinous tumors are rare clinicopathological pathologies that trigger acute appendicitis. Cystadenoma is the most common type of these tumors, which is characterised by luminal dilatation and the production of significant amounts of mucin. A new instance of a large mucocele of the appendix with mucinous cystadenoma is presented. A 61-year-old woman was admitted with acute pain in the bottom right quadrant. Although ultrasonography and computed tomography (CT) indicated that it was a mucocele, she underwent an emergency procedure due to the severity of her suffering. Fortunately, there was no perforation, and the operation ended with an uneventful appendectomy with segmental cecal resection. The specimen was histopathologically determined to be a mucocele with mucinous cystadenoma with negative surgical margins. The patient was discharged on the sixth postoperative day, and a follow-up colonoscopy and abdominal CT were scheduled for six months after surgery. Appendicular mucocele is uncommon and difficult to detect before surgery, and it can be big, increasing the risk of perforation. The most dangerous complication of mucocele perforation is pseudomyxoma peritonei (PP). In most situations, an appendectomy with negative margins is required for optimal treatment. To avoid perforation of the mucocele, utmost care must be exercised during surgery.

Background: SSIs are hospital- acquired infections if the infection occurs within 30 days of an operating procedure, or one year if a device or foreign material is placed.

Methods: The present study was carried out by the Department of Microbiology, Mediciti Institute of Medical Sciences, Hyderabad, India. HICC data, Microbiology registers, OT data records for operational notes, MRD for history of case presentation before and after surgery, and re-admission data of all patients who underwent surgeries in this hospital, or who visited the OPD'S for follow-up with or without complaint, were all reviewed. Increased pain and redness around the wound, delayed healing, pus, a foul odour, or discharge from the wound or a tissue sample are all common concerns. The total number of surgeries conducted between January 2017 & Dec 2017 was n=2716 out of them n=1958 were major, & n=758 were Minor surgeries.

Results: For the year 2017, we had a total of 8 SSI cases at our centre. Total clean procedures were 505 (46.16 percent), with a percentage of SSI of 1.188 percent in clean surgeries and 589 (53.33 percent) with a percentage of SSI of 0.33 percent in clean-contaminated surgeries. Six are deep-seated SSI and two are superficial incision SSI. Deep-seated SSIs were reported in 8 of the cases – 5 were related to orthopedic cases and one was due to gen surgery — hernioplasty. There were two clean contaminated cases, both of which were superficial SSIs and both of which were caesarian sections. Staphylococcus spp., a gram-positive organism, was the most common (87.5 percent). The pathogens most likely to cause SSIs in our center were Coagulase-negative Staphylococcus spp., which were prevalent in the hospital environment, particularly OT.

Conclusion: In this study, the overall incidence of SSIs was 1.188 percent in clean surgeries and 0.33 percent in clean contaminated surgeries. One of the study's limitations was that we only looked at clean and clean-contaminated surgeries. As a result, results must be interpreted considering this constraint.

There are various types and causes of mesenteric ischemia, among them, superior mesenteric vein thrombosis is an infrequent and dubious disease. If a patient presents with a clinical picture of superior mesenteric vein thrombosis, the past medical history should be analyzed and the patient should be monitored for underlying disease.

In this section, we would like to present two female patients, aged 85 and 87 years, who underwent emergency operation due to acute abdomen and were diagnosed with superior mesenteric vein thrombosis, in the light of the literature. Despite minor differences, the picture was completely similar in both of our patients. While ileus was prominent in our 85-year-old patient, an excessive amount of melena was present in our 87-year-old patient. Although there were signs of ischemia in preoperative computed tomography sections, we were able to directly diagnose superior mesenteric vein thrombosis perioperatively. Intra-abdominal blood leakage and accumulation was present in both of our patients and bowel resection was inevitable in both patients. Although recovery was difficult in the postoperative period, we were able to discharge both of our patients without any mortality.

In conclusion, early diagnosis of mesenteric vein thrombosis, timely treatment, necessary surgical intervention and appropriate anticoagulation therapy are the most important elements of success in treatment and result in lower morbidity and mortality.