Recent Developments in Medicine and Medical Research Vol. 2

Management of segmental tibial fracture is a challenging condition for orthopaedic surgeon due to high energy trauma and which is associated with high complication rates. We treated 36 tibial segmental fractures (25 male, 11 female) with a mean age of 35 years (range 20-65 years). The coincidence of segmental tibial fractures with segmental fibular fractures gives an excellent outcome in our series with Ilizarov technique and apparatus, although this appear more injury than segmental tibial fracture.

Anthrax is an anthropozoonosis due to a negative gram bacillus called Bacillus anthracis, palpebral localisation is rare in clinical practice and poses a problem of differential diagnosis, we report the case of a 5 year old girl who presented an under palpebral pustule evoluated into peri orbital ulceration with necrosis making suspect a palpebral localizations of anthrax the patient is complicated by CIVD associated with a hemorrhagic stroke [meningeal hemorrhage associated with a cerebral hematoma], the evolution was was unfavorable with the death of the patient.

Résumé: La maladie du charbon est une est une anthropozoonose due à une bacille gramme négative appelé Bacillus anthracis ,l’atteinte palpébrale est rare en pratique clinique et pose un problème de diagnostic différentiel, on rapport le cas d’une jeune fille de 5ans qui a présentai une pustule sous palpébrale évoluent en ulcération périorbitaire avec nécrose faisant suspecter une localisation palpébrale de la maladie du charbon la patiente s'est compliqué de CIVD associée à un AVC hémorragique [hémorragie méningée associée à un hématome cérébrale] avec une mauvaise évolution .

The current study included 1200 young adult unmarried girls between the ages of 18 and 35 who lived in the Haryana and Punjab regions. Subjects from two sects of these two locations, Jat and Baniya, were studied. The purpose of this study was to investigate the relationship between anthropometric measurements and blood pressure in young unmarried girls and to determine the efficacy of anthropometric indicators as predictors of high blood pressure. Weight, BMI, WC, WHR, and WHtR were revealed to have a significantly significant positive connection with SBP and DBP. WC and BMI are highly correlated. Each is useful in predicting cardiovascular risk.  In this study, it was discovered that BMI, WC, WHR, and WHtR can be utilised as blood pressure predictors in Haryana and Punjab. WC was found to be a better predictor of DBP in Punjabi Baniya females with a variation of 25% and in Haryanvi Baniya females with a variance of 10% when seen especially in endogamous groups. With 19 percent variance, BMI was found to be a strong predictor of SBP in Punjabi Baniya females, while WHtR was found to be a strong predictor of DBP in Punjabi Jat Sikh females with 21 percent variance.

An Inflammatory Myofibroblastic Tumour (IMT) is a rare disease entity. The IMT was first observed in pulmonary site. The IMT can involve any site of the body and the most common site are lung, liver and gastrointestinal tract. . It usually develops in children or young adults, but can affect people of any age. Clinically the IMTs are painless indurated mass /swelling of relatively short duration with signs and symptoms depending on the site of the tumor ranging from asymptomatic to nonspecific respiratory symptoms, fever, or pain.  The underlying cause of IMTs is poorly understood. IMTs are classified as tumours with an intermediate biological potential, in that local recurrences may occur and there is a rare possibility of distant metastasis. IMT is always in debate about its inflammatory origin or being a tumour, and also is benign or malignant and also regarding the adjuvant treatment. Despite the pathologic findings and their apparent prognostic implications, most affected individuals, regardless of the primary site, have had favorable clinical outcomes. Here a case of a primary stomach IMT in an adult man is presented with a review of the literature.  

Purpose: Human heat shock protein is made up of eight homologous chaperones, six of which are present in the reticulum and mitochondria and the other two in the cytosol and nucleus. These proteins have tissue-specific expression, implying that they have different biological functions. This paper compares salivary Heat shock protein 70 levels in healthy people to those in patients who are undergoing radiation.

Materials and Methods: 40 individuals reporting to the department of oncology with head and neck cancer for radiotherapy were included in the experimental group and compared with 40 healthy individuals .Saliva and serum samples were collected and were analysed for Heat shock protein 70 levels with ELIZA (enzyme linked immunoassay for HSP 70) and statistical analysis was done with independent student ‘t’ test. P<0.05 was considered statistically significant.

Results: There was a significant increase in Serum Heat shock protein 70 levels in Experimental group (6.525 ng/ml) in comparison with the control group (3.170 ng/ml). Salivary Heat shock protein 70 shock showed significant levels in experimental levels (5.694 ng/dl) compared to control group (2.641 ng/dl).

Conclusion: Salivary and serum Heat shock protein 70 showed a significant increase in individuals undergoing radiotherapy for head and neck cancer, thus is an efficient cell stress marker.

Equitable access to safe abortion is part of the corpus of human rights. Providing women with access to safe abortion means protection and realization of one of their fundamental human rights. However, around the world, even nowadays, women face not only legal obstacles, but as well stigmatization and conviction against fulfillment of the right to abortion. Where abortion is illegal, women often seek unsafe abortion service and face serious consequences. Provision of safe, legal abortion and family planning are essential for life free of violence, discrimination and degrading treatment. In North Macedonia there a multiple type of barriers and large inequalities related to the accessibility and availability of reproductive health care services. Women with low socio-economic status are mostly affected. The need for contraception has not been met and reproductive health care services are unevenly distributed across the country. The brief study indicates the need for appropriate information for family planning, sexuality education, equal and equitable treatment and access to medical services for all women.

Primary Hyperparathyroidism (PHPT) is an endocrinological disease with parathormone (PTH) and calcium elevation. It is the most common form of hypercalcemia in the adult community. The frequency of the disease is increasing gradually and there are improvements in its diagnosis and treatment. The aim of this article is to approach the current  diagnosis, treatment and follow up of the disease.

Aim: To compare the outcome of preoperative administration of single-dose ketorolac, ibuprofen 400mg, and placebo on postoperative pain in teeth with irreversible pulpitis and apical periodontitis.

Introduction: It is well recognized that, in general, preoperative pain is the principal factor in determining the level of postoperative pain. The occurrence of postoperative pain of mild intensity is not an occasional event even when endodontic treatment has followed suitable standards.

Methodology: A total of 54 patients (29 women and 25 men), 18 to 60 years of age with 54 eligible teeth consented to participate in the study, were divided into three groups (n = 18) according to the type of preoperative drug administrated, as follows: Group A: ketorolac 10mg, Group B: Ibuprofen 400mg, and Group C: A placebo (capsule filled with sugar). The data were analyzed with a chi-square test, one-way ANOVA. The Kruskal-Wallis nonparametric test was applied to compare the incidence of postoperative pain. The level of significance adopted was 5% (p = 0.05).

Results: On Days 1 and 3, preoperative administration of analgesic resulted in lower pain levels than the placebo. On Days 5 and 7, however, while preoperative administration of analgesic still resulted in less pain than the placebo, there was no significant difference between the analgesic and placebo (p= 0 .05). Ketorolac and Ibuprofen 400 mg showed clinically significant relief in pain for the next three days compared with the placebo. In addition, no significant differences were demonstrated between ketorolac and ibuprofen 400 mg (Table 3).

Conclusion: A single dose of ketorolac was as effective or as safe as NSAID for the relief of pain after operations on postoperative pain in teeth with symptomatic apical periodontitis.

Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it’s also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report management of a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling with objective to describe the anaesthesia challenges faced during the intraoperative and postoperative period. Detailed preoperative workup of the patient helps to anticipate, understand and manage the intra-operative complications that may arise during the course of surgery.

Pancreaticopleural fistula (PPF) is an uncommon and serious complication of chronic pancreatitis. PPF needs to be included in the differential diagnosis of recurrent and large pleural effusions especially in middle-aged men with a history of alcohol consumption. The diagnosis requires a high index of suspicion, since the patients present typically with the pulmonary symptoms related to the pleural effusion rather than pancreatitis. Patients may initially present with dyspnea, or chest tightness, with or without a history of abdominal pain or steatorrhea. Computer tomography (CT) of the abdomen or magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis. Conservative, surgical, or endoscopic management treatment modalities are available. Patients with PPF receive conservative treatment initially and are subjected to surgery or ERCP treatment if their condition does not fully respond. 

Objectives of Study:

• Identify the Pancreaticopleural fistula (PPF), the rare cause of recurrent pleural effusion.
• Evaluation of PPF in patients with chronic pancreatitis, presenting with recurrent pleural effusions.
• Management options available for PPF.

We report a case of a 54 year old Asian woman referred to our hospital for a subcutaneous right breast swelling for the last one year. No other systemic symptoms were present and a mild hypereosinophilia was found in routine blood tests .To rule out any neoplastic lesion and reach a specific diagnosis, Excision biopsy of the lesion under local anaesthesia was performed, Histopathological examination showed lymphoid infiltrates with prominent reactive germinal centres along with infiltration by eosinophils and vascular proliferation, a diagnosis of Kimura’s disease of breast was made. The patient was put on symptomatic treatment and clinical follow up revealed complete regression of the swelling and disease. This case has been reported due to its extreme rarity and highlights the need for including Kimura’s disease in the differential diagnosis of subcutaneous breast swellings. Knowledge of Kimura’s disease, its clinical appearance, course and histopathology puts the clinician in a better position to diagnose.  Long-term follow-up should be mandatory for Kimura’s disease.

Background: The prevalence of incisional surgical site infections varies widely over the world. In affluent European countries, the overall SSI rate is 3/100 surgical procedures, while in the United States, it is 2.6/100 surgical procedures.

Aim: The goal of this study was to determine the incidence of incisional surgical site infection (ISSI) in obstetric and gynaecological surgeries, as well as the risk factors, microbiological spectrum, antibiotic sensitivity, and hospital stay impact.  

Methods: A prospective observational study was done under the Department of Obstetrics and Gynecology, Era’s Lucknow medical college and hospital. All consecutive patients who underwent caesarean section, vaginal delivery with episiotomy, laparotomy, and hysterectomy were included in this study. Laparoscopic surgeries were excluded.

Results; In this series of 646 surgeries, 6.18% developed ISSI. In the category of major surgeries, the ISSI rate was 8.89%. Amongst the 185 episiotomies 1.6% gaped. Anemia, diabetes mellitus, excess body weight, emergency or elective surgery, rapid built up of hemoglobin with blood transfusion, previous caesarean scar and tobacco intake were the risk factors identified. Coagulase negative staphylococcus was the dominant microbe. Antibiotic sensitivity to linezolid was found in 50% of the ISSI cases followed by amikacin, clindamycin and some others. The mean hospital stay was 13 days while the maximum was 26 days.

Conclusion: The study established the current status of incisional surgical site infections, identified the risk factors, the microbial spectrum, the antibiotic sensitivity and the need for further studies using a preventive approach.

Prosopis cineraria (L.) Druce fam: Leguminosae, Synonym Prosopis spicigera, known locally as Khejri, Janti & Sami, is a deep-rooted, nitrogen fixing and multipurpose tree endemic to the hot deserts of India, which is contributing to the ecological stability of the region and providing extensive support to human beings, livestock and the nutrient deficient soils. It is the state tree of Rajasthan and Telangana. It is also the national tree of the United Arab Emirates. Prosopis has been found to contain 5-hydroxytryptamine, apigenin, isorhamnetin-3-diglucoside, l-arabinose, quercetin, tannin and tryptamine. Patulitrin, a glucoside of patuletin has been isolated from its flowers. Seeds contain fixed oils (4.5%), fatty acid such as palmitic acid, stearic acid, oleic acid and linoleic acid. It is used traditionally for treatment of various ailments such as helminthiasis, leprosy, dysentery, bronchitis, asthma, leucoderma, piles, wandering of the mind and tremors of the muscles. The phytochemical, pharmacological, traditional and therapeutic importance of the plant is discussed herein.

Epithelioid sarcoma is a rare highly aggressive soft tissue sarcoma with a high incidence of local recurrence and metastasis. It is a tumor of uncertain histogenesis & poses a diagnostic difficulty as it is often misdiagnosed as other benign or malignant condition. Usually occurs in the distal extremities of young adults as a as a subcutaneous or deep dermal mass. We present the case of 49-year-old malepresenting with chief complaints of pain and gradually progressive swelling on right 3rd toe since 3 months. Based on clinicoradiological evaluation suggestive of malignancy, an amputation of toe was done. Histopathological & Immunohistochemical findings suggestive of Epithelioid sarcoma. The patient was referred to the oncology centre for further management where he was advised wide excision followed by radiotherapy. No regional or distant metastasis was found.

The vulval/labial leiomyomas are rare tumours and are considered to arise from smooth muscle cells within the round ligament remnants in the labia majora, erectile tissue and blood vessel walls. We present the case report of a 33 year old parous woman who presented with history of a painless swelling in the vulval region and discomfort for 3 years. Patient underwent surgical excision of the lesion in the vulval area. The histopathological diagnosis was suggestive of benign leiomyoma. There are fewer than hundred and twenty cases of vulval smooth muscles tumours reported in literature [1, 2]. Since many other vulval lesions have similar presentations, it poses a difficulty in distinguishing leiomyoma from other lesions. Surgical excision is the only curative treatment for vulvar leiomyomas [3]. Therefore it is recommended that these lesions are surgically excised and sent for histopathological examination for the confirmation of diagnosis. This case report helps to take into account other differential diagnoses of vulval masses.

Atypical polypoid adenomyoma (APA) is a rare and benign endometrial polypoid lesion typically found in fertile age [1]. Atypical polypoid adenomyoma (APAM) is an uncommon uterine lesion composed of complex endometrioid glands with frequent squamous morular metaplasia and fibromuscular stroma [2]. Atypical Polypoid Adenomyoma was found on histopathological examination of endometrial tissue with polyp in a woman with abnormal uterine bleeding.  Atypical Polypoid Adenomyoma as it is uncommon we present this case report. A 38 year old woman who presented with excessive vaginal bleeding with endometrial polyp underwent dilation and curettage and the histopathological examination of the endometrial polyp was consistent with ‘Atypical Polypoid Adenomyoma’ with extensive morular metaplasia.  Immunohistochemical marker CD10 was done to establish the diagnosis of morular metaplasia. Patient subsequently underwent total abdominal hysterectomy. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer [1].

Colorectal anastomosis leak is a frequent complication in general surgery which is related to significant morbidity and mortality. Nowadays, several approaches are utilized, frequently invasive for the patient. Nevertheless, a golden standard strategy for anastomotic leak management has not been identified. We present a case of an anastomotic fistula after left laparoscopic colectomy for diverticular disease, managed by the suture of the anastomosis dehiscence and drainage. We choose this approach due to the reduced operative time, reduced morbidity and mostly to avoid the confection of a colostomy. Still, this surgical solution should be applied for well selected patients and further studies are necessary to validate this approach.

The over 9 million deaths in 2018, and 10 million in 2020, worldwide, due to cancer, indicates that the current standard of treatments is inadequate; there is an urgent and critical need for additional/alternate physical therapies. Towards this, electroporation-based chemotherapy, known as Electrochemotherapy is emerging. This involves application of high intensity, short duration pulses at the tumor site, which enhances the biopotential across the phospholipid bilayers of the cell plasma membrane and hence opens up pores for enhanced uptake. The electric field intensity and distribution is shaped by the electrode geometry, size, material and the tissue treated.

In this research, we investigated the influence of different electrodes on the electric field intensity and distribution. For this purpose, platinum and surgical steel needle array hexagonal and pentagonal electrodes were used. ANSYS, the industry standard software that uses finite element method was used to study the electric field distribution, intensity and contour. Both, healthy tissue and tumor tissue were used to identify the electric field intensity and distribution using these various electrode configurations and materials, for unipolar and bipolar voltages were studied.

The results indicate that the electric field distribution, both in magnitude and pattern is similar for both electrodes, for both configurations and materials, which is desired from the clinical aspect. The electric field intensities for the hexagonal and pentagonal needle electrodes were 1280V/cm and 1180V/cm respectively in the case of tumor tissue (correlating well with the desired level of 1200V/cm). They were 835V/cm and 843V/cm for these electrodes in the case of healthy tissues. The values were same in the case of bipotential and negative voltages too.

Purpose: The aim of this study is to evaluate the effectiveness of gel topical anaesthesia in second surgeries of dental implants to find the cover screw which has been submerged; to check if there are significant differences in the perception of pain between the different treated areas of the oral cavity, as well as to study the thickness and the type of oral mucosa in which the gel topical anaesthesia is effective.

Material and Methods: 13 partially and completely edentulous patients with 30 implants in total were included in the study. Those submerged dental implants whose cover screw was not submerged in a depth higher than 2-4 mm were selected. In the event of the gel topical anaesthesia not being effective, reinforcement with conventional infiltrative anaesthesia was made. Pain was measured with Visual Analogue Scales (VAS), and the gum thickness with periodontal probe.

Results: The 66.67% of the sample needed reinforcement through conventional anaesthetic infiltration. No statistically significant differences were found in the comparison of pain with different gum thickness, implant localization in the oral cavity, although a higher feeling of pain was actually observed in those patients who were firstly subjected to a second-stage surgery (p<0,05).

Conclusions: The use of gel topical anaesthesia cannot be considered as the sole treatment to eliminate the feeling of pain, but as a coadjuvant to infiltrative anaesthesia. No significant differences have been found between the different treated areas of the oral cavity, nor in the thickness or type of oral mucosa.

Aim: The aim of the present study was to investigate the long-term changes of craniofacial structures, teeth and soft-tissues after extended fixed oral rehabilitation over a period of 23 years.

Background: Oral rehabilitation has to fulfill high claims to aesthetics and function but also should provide long-term stability. lf an extended fixed dental rehabilitation is planned a detailed diagnosis including cast and clinical functional analysis, axiography, muscle and temporo-mandibular joint (TMJ) evaluation, cephalometric analysis, and a careful treatment planning is essential.

Materials and Methods: A total of 15 selected patients (13 women, 2 men; mean age 42.04±10.05 years) obtained extended fixed dental restorations by utilization of the principles of the occlusal concept of sequential guidance with front-canine- dominance. The measurements were based on lateral cephalometric roentgenograms which were taken shortly, 10, 15 and 23 years after dental rehabilitation of each participant of the study. The lateral roentgenograms were traced and distances were measured with a digital calliper.

Results: The data showed an increase of 2.67 mm of the lower face height (PP-Me), the distance between the palatal plane and the incisal edge of the upper central incisor (PP-ls) increases by 1.49 mm, implying a downward movement of the upper incisors. Corresponding to these changes in the upper jaw, the distance from palatal plane to the incisal edge of the lower central incisor increases by 1.10 mm, vertical overbite increases by 0.39 mm, and the distance between Sella and Gnathion increases by 4.99 mm. The lip seal slides downward by 3.31 mm on average over 23 years after rehabilitation.

Conclusion: Significant changes in the lower face can be estimated which are in harmonious accord with the natural changes in the adult aging craniofacial complex.

Fine needle aspiration with cell blocks can diagnose lung cancers in high-risk patients. As ancillary study is important for lung cancer diagnosis, sub typing and prediction of targeted therapy response, it is important that cell block made have good cellularity and morphology. Inadequate cellularity of Cell blocks (CBs) is a common problem due to lack of standardization of cell block preparatory methods.  Here we describe the novel cell block preparation technique for pulmonary cytology specimens in which sediments from centrifuged aspirates were collected on layered filter papers followed by application of partially melted 2% agarose gel on cell button. Out of 41 cell blocks, 22 cases of lung cancers were sub typed without immunohistochemistry. Immunohistochemistry was done in 14 cases for sub typing. Four cases showed only benign respiratory epithelium with fibrosis. We found adequate cellularity in all cases (100%), however, confirmatory diagnosis could not be given in 4 (9.7%) cases.