Recent Developments in Medicine and Medical Research Vol. 4

Post coronavirus disease of 2019 (COVID-19) secondary fungal infections are increasingly being reported in various parts of the world.COVID-19 is independently associated with invasive pulmonary aspergillosis. It is utmost important to carefully follow the post COVID-19 recovered patients with chest radiology to prevent the invasive fungal infection and its related complications and mortality associated with the disease. Hare we present the case of aspergilloma in post COVID-19 patients.

Introduction: Filariasis has been known from antiquity. Elephantiasis-painful, disfiguring swelling of the legs and genital organs-is a classic sign of late-stage disease. The genus is named after Wucherer, a Brazilian physician who reported microfilariae in chylous urine in 1868. Lymphatic filariasis is a devastating disease and it is found in more than 80 countries across the world [1,2]. Approximately 1 billion people across the world are at risk. It affects countries like south and Central America, West and East Africa, East Mediterranean, Southeast Asia, and Western Pacific. W bancrofti accounts for 90% of all filariasis cases in the world [3].

National Filaria Control Programme launched in 1955 has operational, training and research components [4]. The main strategies of which were the vector control, detection and treatment of filarial cases and delimitation of endemic areas. This program continues to be in place, in addition to the program to eliminate LF in India. Measurement of microfilaremia is a well-recognized gold standard for demonstrating the impact of interventions but is not an optimal method of monitoring or surveillance because of requirement of nocturnal blood collection and relatively less insensitive test for infection [5].

Materials and Methods: This study was carried out in Govt General Hospital & Filaria Clinic, Guntur District of Andhra Pradesh, and Ethical Permission for the study was obtained

90 samples were collected from those attending the Government General Hospital with signs and symptoms of filariae they were designated as Group I [Test]. 10 normal serum samples Group II [Normal Controls] and 10 serum samples Group III [Endemic Normal] from normal individuals in the endemic pockets identified by filarial control program officers which were detected smear negative were collected as controls

Results: The results of ELISA were compared with the microfilariae detection by slide method, it was found that the only 2 cases each in the male and female, a total of 4 cases were detected by the slide methods rest all the cases were detected as negative. With ELISA method it was found that the total numbers of positive cases were 53 and total numbers of negative cases were 37 in the test group I. The comparison of the same results with the normal control samples revealed that all the cases were reported as negative by slide method however by ELISA 7 out of total 10 cases were detected with the antigens and antibodies to microfilariae.

Discussion: We in the present study tried to compare the results obtained by conventional slide method of detection of filarial versus the ELISA method; we found that ELISA was far superior in detecting the filariae antigen, antibodies where the conventional slide methods failed to identify the microfilariae

Conclusion: ELISA is superior & cost effective in detection of all cases of microfilariae.  Since conventional methods may not able to reliably identify microfilariae in all samples, it is recommended that ELISA be used to detect the presence of microfilariae, particularly in Endemic areas.

Periodontitis is a condition that causes the periodontal tissues to deteriorate. Clinical or surgical therapies are widely established as a necessary step in the re-establishment of periodontal tissue health. The introduction of newer biomaterials has increased the number of treatment options accessible and improved the long-term prognosis of teeth with periodontal disease. The convergence of physical and biological components of material science is known as biomaterial science. Biomaterials include bioinert, bioactive and bioresorbable materials. The progression in the field of material science is phenomenal progressing from macro particles to nano particles. They are made up of organic or inorganic materials and are derived from vital or non-vital bone sources. The majority of these biomaterials have structural, mechanical, and biofunctional limits, and their performance is determined by patient factors such as age, defect size, and compliance. The numerous advances in biomaterials and their uses in periodontal therapy are reviewed in this chapter.

This research was conducted on 12 old patients of both sexes at the Prince Rashid military hospital between July 2003 and July 2004. Under spinal anaesthetic, an open reduction for a femur fracture neck was performed using only 1ml plane bupivacaine 0.5 percent at the L2-L3 intervertebral regions.

During the contraction phase of the myocardium the cardiac muscle reaches its maximum state of activation near end-systole at point (P_m, V_m) on the PV-loop. The tangent to the PV-loop at (P_m, V_m) is known as the end-systolic pressure-volume relation (ESPVR). An important feature of this study is the introduction of the active pressure generated by the myocardium in the mathematical formalism describing the ESPVR (also known as the isovolumic pressure P_iso by physiologists). This mathematical formalism is used with the aim of deriving useful relations between the ejection fraction (EF), the parameters describing the ESPVR, and the areas under the ESPVR. These relations give new insight in the mechanics of ventricular contraction, it is shown that the EF is just one of several indexes that can be used in order to quantify and describe the ventricular function. Also bivariate (or multivariate) analysis of data appears to be superior to univariate analysis of data in order to assess the state of the myocardium. Criteria to study the problem of heart failure with preserved ejection fraction (HFpEF) are derived and discussed. Attention is also given to the way the ventricular geometry affects the calculation of the EF. Applications to clinical data are presented that show the consistency of the mathematical formalism used.

Background: Obesity is a major health hazard in developed and developing countries. It is proved to be a co-morbid condition in various metabolic, cardiovascular and pulmonary disorders. Only few studies have carefully examined the relationship of lung functions with body composition among middle aged obese.

Objectives: To explore the relationship between body composition and their influence on pulmonary functions among obese middle aged subjects.

Methods: 100 obese healthy subjects of age 35-55 years were included in the study. BMI, Body fat percentage (BF %), Fat Mass (FM) were estimated and Fat Free Mass (FFM) was calculated using predicted equations. All the recordings were done at same time of the day, 10am to 12noon. at ambient temperature and environment and respiratory parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), FEV₁/FVC, Peak Expiratory Flow Rate (PEFR), Mean forced expiratory flow during the middle of FVC (FEF_25-75%), Maximum Voluntary Ventilation (MVV) were assessed. Unpaired t-test Pearson’s correlation coefficient were used to analyze the variables. 

Results: Mean BMI of study subjects was 31.9±1.78 kg/m². A non-significant inverse correlation of FM with FVC and FEV₁ was observed. The Correlation coefficient of FM and FEV_{1 /} FVC ratio showed a negative non-significant relation. There was no relation between FM and FEF_25-75%. A significant positive correlation was observed between FM and PEFR among obese subjects. The correlation of FFM with FEF_25-75% and MVV was significantly positive (r = +0.65 and r = +0.94 respectively). P values \(\leq\) 0.05 were considered statistically significant.

Conclusions: Pulmonary functions are more closely associated with fat distribution than with the extent of obesity. It is important to take into account the body composition instead of BMI alone while determining early changes in lung functions among middle aged obese.

Introduction: Cosmetics are mostly dispersed compounds that are used topically to wash, scent, or improve one's appearance. Although the majority of adverse reactions to cosmetics are minor and typically involve skin changes, the number of documented adverse reactions is extremely low, probably owing to underreporting. The regulations for cosmetic products primarily address the safety of products that may be used by large populations of healthy consumers.

Methods: To achieve the study's goal, we interviewed 500 volunteers and collected questionnaires about hair dye use, the prevalence and characteristics of adverse cutaneous reactions, and reporting of subsequent measures taken by the volunteers.

Results: The response rate came in around 78 percent. A total of 360 people presented a history that was consistent with hair dye dermatitis. Edematous skin reactions are seen in 65% of cases, allergic dermatitis in 49% of cases, and both types of reactions are seen in 30% of instances.

Discussion: Despite the fact that our experience with reporting adverse effects of cosmetics is limited to a small geographic area, it implies that an effective and trustworthy monitoring mechanism should be in place.

After considering some fundamental aspects of isovolumetric contractility measurements it has been made clear why the first method of contractility measurement and the recent revival of this method fail. However, on the base of these fundamental aspects an alternative method is suggested which is related to a recently evaluated biomechanical model of the urinary bladder.

Computational simulations of biological systems are an intrinsic element of engineering in medicine, allowing physicians the ability to visualize the pathophysiology behind a disease. Many biomedical applications require fluid–structure interaction analyses. Due to the inherent complexity of biological applications, which often include fluids and structures interacting together, the development of computational fluid–structure interaction models is necessary to achieve a quantitative understanding of their structure and function in both health and disease. Furthermore, the relationship between biological structures and the fluid that surrounds them is an integral part of their function. Hence, we contend that the use of fluid–structure interaction models in computational studies of biological systems is practical, if not necessary. The goal is to develop computational models to predict all human biological processes. These models are meant to guide us through the multitude of possible diseases affecting our organs and lead to more effective methods for disease diagnosis, risk stratification, medical management, and therapy. This chapter discusses the intricacies of computational medical research, namely concerning patient specificity and the validation of computational methods used.

In the formation of nerves, variations are very common. They might be either pre- or post-fixed. The presence of neural roots with varying thicknesses or the absence of neural roots is also common. The main objective of the study was to observe the prefixed and postfixed pelvic nerves and their clinical sigbificance. Except for the obturator nerve, the pelvic nerves run along the posterior pelvic wall. The obturator nerve is located on the lateral side of the pelvic wall. Extraperitoneally, against the posterolateral walls of the pelvis, are located the pelvic nerves. The Lateral Femoral Cutaneous nerve, Femoral nerve, Genitofemoral nerve, Obturator nerve, and the Lumbosacral trunk are all somatic nerves in the pelvis. Variations in the level of these nerves' roots are relatively common, and these variations are significant for surgeons, orthopaedic surgeons, and neurosurgeons during various surgeries. The formation and level of division of parietal pelvic nerves showed a variety of variances, which are detailed in the study.

Background: Frontal encephalocele is less common than occipital encephalocele. Frontal encephalocele is protrusion of brain content through defect in frontal bone. Meninges and part of frontal lobe was protruding through defect in this case. Its management is typical and different approach for repair. We introduce ventriculo peritoneal shunt first to reduce the size of swelling and manage the hydrocephalus.

Case Report: Encephalocele is a congenital anomaly that causes the brain component to protrude through the cranial defect.  We are reporting a case of frontal encephalocele in three month old male child. The swelling was skin covered.

Conclusion: Frontal encephalocele is a rare entity. A case of congenital frontal encephalocele, an uncommon neural tube defect, is described.

Despite breakthroughs in tuberculosis (TB) laboratory detection over the last 30 years, only a small part of the global population has benefited. The World Health Organization (WHO) recommends using nucleic acid amplification tests (NAAT) to detect tuberculosis rather than smear microscopy since NAAT can detect TB with greater precision, especially in patients with paucibacillary illness and HIV-positive persons. A variety of molecular TB detection assays are now being developed and reviewed, some for use in reference laboratories and others for peripheral medical care settings and point-of-care. There has been an increase in the number of molecular tests designed, manufactured, and implemented in countries with a high TB burden, and some are specifically intended for use in locations close to the patient. NAAT with next-generation sequencing may deliver faster findings than standard phenotypic culture in drug susceptibility testing. Furthermore, the results of tests that detect or quantify cytokines released during the inflammatory process in latent tuberculosis infection (LTBI), such as the Interferon-Gamma Release Assay (IGRA), or that quantify IL-6 or other cytokines, depend, as do tuberculin skin tests (TST), on the prevalence of TB in the tested population. We review recent advances in TB detection tests and anti-TB drug resistance in this paper.

Purpose: The purpose of this study was to establish normative values for active lumbar movement in children five, seven, nine, and 11 years of age and to find the confounding factors that affect the lumbar range.

Methods: End range active flexion, extension, and right- and left-side bending of the lumbar spine were measured for 400 normally developing children (200 girls, 200 boys) using dual inclinometric technique. Means were determined for each motion by age and sex. Group relationships were explored.

Results: Normative values for lumbar spine cardinal plane movements were identified. Flexibility levels were defined using percentiles as poor (<25th), moderate (between 25th and 75th), good (between 75th and 95th), and very good (>95th) respectively. The mean values for forward flexion, extension right and left lateral flexions for all participants was 55.9+17, 21.8+6, 15.2+5.1 and 14.9+5 in degrees respectively.

Conclusion: Normative data for cardinal plane movements of the lumbar spine provide therapists with a baseline for assessing spinal mobility of children of these ages. Increasing age was associated with decreasing spinal flexibility without gender bias. These values can be used in clinical practice.

Extrapulmonary Tuberculosis [EPTB] affects mainly lymph nodes, pleura, central nervous system, bones, gastrointestinal tract and genitourinary tract. Most commonly it presents as isolated lymphadenopathy and also as effusion in the body cavities. Tests to diagnose EPTB include Fine Needle Aspiration Cytology [FNAC], Acid Fast Bacilli [AFB] demonstration by Zeihl-Neelson [Z-N] stain and Cartridge Based Nucleic Acid Amplification Test [CBNAAT]. A retrospective record based study was conducted by taking the data of 100 clinically suspected EPTB patients who had undergone FNAC, CBNAAT and Z-N stain in Mandya Institute of Medical Sciences, Mandya, Karnataka. The study was conducted for a period of four months from March 2018 to June 2018 after taking approval from the Institutional Ethics Committee. The study showed 47 cases with FNAC findings favouring EPTB. Out of these 47 cases, 30 cases were CBNAAT positive. CBNAAT was positive in 5 cases out of 53 cases with negative FNAC findings. Among 35 CBNAAT positive cases, only 13 cases were AFB positive. To conclude, CBNAAT is rapid, accurate and simple test for early diagnosis of EPTB because of its high specificity and positive predictive value. CBNAAT can also detect the cases missed by FNAC and Z-N stain.

Fertility gap is the difference between preferred and observed rates. Preferred fertility rates have a predictive value in forecasting the future course of fertility in any community. The present study aimed at detecting gap, if any, among mothers in Mosul, at the north of Iraq; and defining the underlying reasons behind their preference. Across-sectional design was adopted; during which 1302 mothers at child-bearing age who had at least two living children were interviewed during their attendance to one of the included primary health care centers. Gap between mean of preferred and observed age at marriage is 0.5 year (r=0.2, p=0.000). High parity was reported among 27.8% that was not correlated with maternal preference. Regarding birth interval, almost a year-gap was reported between observed and preferred interval (r=0.3, p=0.000).

Social motivations were the main encouraging factor in preference of teenage marriage (94.0%) and short birth interval (67.8%); while economic reasons inspired 43.1% of mothers to prefer high parity.

Health education about comprehensive family life is recommended for constructing health fertility behaviors within religious and social contexts.

Objective: The purpose of this study was to see if there was any referred medial scapula pain from C6 or C7 cervical spinal stenosis. Scapula pain of neurologic origin is currently thought to be primarily mediated by C5 via the dorsal scapular nerve. Dorsal root ganglion neurons with dichotomising axons are present in several species and are considered to play a role in referred pain. An interventional spine clinic observed a number of patients with medial scapula pain who did not have C5 stenosis, but many of these patients had C6 or C7 stenosis.

Methods: The charts of 278 patients seen in an interventional spine clinic over an 11 year period from 2008 to 2018 who were diagnosed with cervical radiculopathy based on location of pain were reviewed. 135 of these had cervical MRI imaging. Data was collected to evaluate for a correlation of the level of cervical stenosis with the location of pain at the medial border of the scapula.

Results: Patients with ipsilateral medial scapula pain had 0.0% incidence of stenosis at C4, 29.5% at C5, 64.6% at C6, 49.2% at C7, 0.0% at C8, and 80% with either C6 or C7 stenosis.

Conclusion: This is the first report of referred pain to the medial scapula from cervical stenosis at the C6 or C7 levels. The mechanism of referred pain is reviewed and a plausible and testable neurologic explanation for these observed findings is presented.

Background: Perinatal asphyxia is one of the major problems of neonates and there exists a significant contribution to the neonatal morbidity and by this entity. It is recognized as a common and critical cause of preventable cerebral injury. Predicting the outcome of perinatal asphyxia is critical but dreadful. The Apgar score has a limited role in predicting the immediate outcome, such as HIE, and the long-term neurological sequelae observational error may occur in APGAR. However, the biochemical parameters can be relied on. The diagnosis and grading of asphyxia can be difficult especially if relevant information at the time of delivery is not available  The purpose of this study was to evaluate the urinary uric acid/creatinine ratio (UA/Cr) as a non-invasive marker for perinatal asphyxia and to correlate its absolute value to the degree of perinatal asphyxia.

Objectives:

1. To validate Urinary Uric acid to Urinary Creatinine ratio as a marker of perinatal asphyxia
2. To validate Urinary Uric Acid to Urinary Creatinine ratio as a marker of degree of perinatal asphyxia
3. To define cut off value of Urinary Uric acid to Urinary Creatinine ratio to diagnose perinatal asphyxia

Methods: Between November 2017 and May 2019, 42 asphyxiated and 42 non-asphyxiated newborns were included in this prospective case control research done in the Pediatrics Department of Shri Ram Murti Smarak Institute of Medical Sciences. Detailed history and assessment were for all the enrolled newborns. Spot urine samples were sent in for uric acid and creatinine determination. The findings were documented, and statistical analysis was carried out.

Results: Urinary uric acid to creatinine ratio is a non-invasive, early, and simple biochemical marker of birth hypoxia that biochemically supports severity grading and clinical diagnosis by APGAR score.

Conclusions: The urinary uric acid and creatinine ratio allows for the immediate and early detection of asphyxial injury, as well as the assessment of its severity and potential for short-term morbidity or mortality.

Oral submucous fibrosis (OSMF) is a more common chronic premalignant disease. It's mostly caused by chewing betel quid. The progressive hyalinization of the submucosa is a distinguishing feature of OSMF. The fact that it affects the entire mucosa contributes to its resistance and progression. It produces a gradual decrease in mouth opening, which might spread to the pharynx. It is a potentially malignant condition that causes connective tissue fibrosis. Although medical treatment is only symptomatic, optimal doses of injection with corticosteroids, hyaluronidase, and local anaesthesia demonstrated a significant reduction in clinical symptoms. The objective here is to research the means of medical therapy as an adjuvant in reducing the stage of OSMF and by then lowers the necessity of the surgical management or to enhance the success of the surgical management. We present a case of OSMF that was treated in a similar manner and yielded better results than either agent used separately. An increase in mouth opening with a decrease in burning sensation was the most significant outcome of the treatment.

Essential Thrombocythemia (ET) is a myeloproliferative neoplasm characterized by high platelet count and platelet activation linked to angiogenesis. It is reported that vascular endothelial growth factor (VEGF) promotes platelet activation and that activated platelets release VEGF. Anagrelide (ANA) represents a emerging drug which decresaes platelets and inhibits platelet activation.

Therefore, were studied platelet count, platelet factor 4 (PF4) levels, as indicator of platelet activation, and corrected platelet VEGF (VEGFPLT), as indicator of angiogenesis-related platelet activation, in ET patients treated either with hydroxyurea (HU) and interferon-a (IFN-a) or ANA in combination with antiaggregants. Before treatment all patients had high platelets and higher PF4 and VEGFPLT than controls. After treatment all patients had decreased platelets whereas PF4 and VEGFPLT were elevated in the HU and IFN-a group compared with controls and normal in the ANA group. There was no correlation between PF4 and platelets whereas a positive correlation there was between PF4 and VEGFPLT.

These results, if confirmed in larger studies, might indicate that ANA has anti-platelet and anti-angiogenic properties.

The latest psychopharmacological study showed effectiveness of a novel non-D2-receptor-binding drug, SEP-363856, for the treatment of schizophrenia. The compound is trace amine-associated receptor 1 (TAAR1) full agonist and also 5-hydroxytryptamin 1A (5-HT 1A) receptor partial agonist. I found the TAAR1 ligand neuron, D-neuron, in the striatum and nucleus accumbens (Acc), a neuroleptic acting site, of human brain, though failed to find in the homologous area of monkey brain. To study human D-neuron functions, total of 154 post-mortem brains, and a modified immunohistochemical method using high qualified antibodies against monoamine-related substances, was applied. The number of D-neuron in the caudate nucleus, putamen, and Acc was reduced in post-mortem brains with schizophrenia. The reduction was significant (p<0.05) in Acc. I proposed “D-cell hypothesis of schizophrenia”, that NSC dysfunction-based D-neuron reduction is cellular and molecular basis of mesolimbic dopamine (DA) hyperactivity, progressive pathophysiology and prospectiveness of TAAR1 medicinal chemistry.