Prof. Aurora Martínez Romero
Clinical Biochemistry, Juarez University, Durango, Mexico.

Short Biosketch

ISBN 978-81-19217-69-4 (Print)
ISBN 978-81-19217-68-7 (eBook)
DOI: 10.9734/bpi/rhdhr/v7

This book covers key areas of disease and health research. The contributions by the authors include national health systems, social epidemics, multinational drug firms, clinical pharmacy, pharmacovigilance, pharmacoepidemiology, atherogenic index of plasma, cardiovascular disease, lipid profile, auditory system, vestibular system, noise induced hearing loss, anemia, drug usage trends, fuzzy taxonomic structures, chronic obstructive pulmonary disease, teratogenicity, emerging infections, mirror neurons, psychomotor skills, eclampsia, late preterm birth, neonatal outcomes, psychological problems, parainfluenza virus, reverse transcription, bronchopneumonia, cervical lymphadenopathy, tuberculosis, lymphoma, metastasis, HIV/AIDS education, meningioma, meningothelial cells, civilisation diseases, silent inflammations, autoaggressions, mitochondriopathy, dyslipidaemia, omicron virus, inferior alveolar nerve block, mandibular anaesthesia, mandibular foramen, hematoma, Sjogren's syndrome, ophthalmology, rheumatology. This book contains various materials suitable for students, researchers and academicians in the field of disease and health research.


Media Promotion:



Global Health Systems: Challenges amidst Trying Times

J. Warren Salmon

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 1-12

This chapter introduced several texts that provide background, while attempting to provoke readers' consideration of a variety of issues to ponder. More study of global health systems may open greater possibilities for reform to benefit all national health systems from successes found in improved performance. No easy tasks lie in our immediate future. The social learning from those experiences could have aided a better global response to the COVID-19 outbreaks but have fallen short due to lower priority. Several public health scholars have engaged in conceptualizing global health systems within an international health framework with attempts to make greater sense of the varying paths and approaches those nations have chosen over time.

Association of Atherogenic Index and Oxidized-LDL as a Strong Independent Risk Predictor of CHD in Young Smokers

Meera Shivasekar, Dinesh Nath, V. M. Vinodhini

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 13-24

Introduction: cigarette smoking is an environmental risk factor for cardiovascular disease and induces changes in lipid profile by the oxidation of lipids, particularly LDL. Hence the need for determine ox-LDL and its association with atherogenic indices in the risk of cardiovascular risk. The study aimed to determine oxidized-LDL and atherogenic indices in relation to cigarette smokers

Methods:  This case-control study included 240 individuals in which cigarette smokers were (n=120) and were compared with (n=120) non-smokers. The ox-LDL, APO-A1, and APO-B were performed using Enzyme-linked Immune Sorbent Assay (ELISA) and atherogenic risk ratios were calculated.

Results: The study shows that ox-LDL was a significantly increased in smokers and also significant increase in TC, TGL, and LDL was observed. When compared to nonsmokers, smokers had considerably higher atherogenic risk indices. Pearson correlation tests revealed that ox-LDL and AIP were substantially and positively linked with non-HDL, CRI- Castelli's risk Index-I, CRII- Castelli's risk Index-II, AC-Atherogenic Coefficient, CI-Cholindex, and APO-B- Apolipoprotein B (p<0.001). And was inversely associated with APO-A1 and HDL-C (p<0.001). The unadjusted odds ratios for ox-LDL and AIP in the univariate logistic regression analysis were 1.861 (95% confidence interval: 1.347-2.375), p<0.001, and 1.782 (95% confidence interval: 1.490-2.131), P.001), respectively. Multivariate logistic regression analysis demonstrated that ox-LDL and AIP were independent risk factors for CHD in young smokers.

Conclusion: In smokers, ox-LDL and atherogenic indices appear to be strong independent risk predictors for CHD than conventional lipid parameters.

Evaluating the Vestibular Function in Chronic Noise Exposure Subjects

Hany Aly Mohany Ibrahim

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 25-36

This chapter aims to evaluate vestibular function in subjects with chronic noise exposure. It is well known that noise can cause vestibular disturbances; Haberman first identified this effect in 1890 in tinkers who had occupational hearing loss. The study included eighty subjects who were divided into 2 groups: 60 subjects exposed to noise in laundry with mean age 41.53±11.15 (study group) and 20 subjects not exposed to noise with mean age 38.60±6.48 (Control group). This study demonstrated elevated hearing threshold at audiometric frequencies 2-8 KHz (pv <0.001) and speech discrimination (pv <0.001). Moreover, there was a favorable link between the length of exposure and the effects on the auditory and vestibular systems. According to this study, noise has an evident impact on the auditory and vestibular systems.

Patterns of Pregnant Anaemic Women's Drug Use

Rajesh Hadia , Rahul Trivedi, Cyril Sajan, Varunsingh Saggu, Sunil Baile , Sunil Kardani , Hemraj Singh Rajput

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 37-46

Anemia is a prevalent disease among pregnant women in the country. This research aimed to analyze drug usage patterns and improve drug selection for anaemic pregnant women. The study involved 300 pregnant women aged 17-38 in their first to ninth month of pregnancy. Medical records were analyzed, and drug prescriptions were assessed. Of the participants, 176 had iron deficiency anemia, 99 had sickle cell anemia, and 20 had folate deficiency anemia. The rest had vitamin B12 deficiency, hemolytic anemia, or beta-thalassemia. The average number of drugs given per patient was 3-4, with a monthly cost of 920.68 Rs. The most commonly prescribed drugs were vitamin C and multivitamin B complex (MVBC). However, vitamin C is a Category C drug that may be harmful to the fetus, followed by MVBC. The research showed that anaemia was common in the second trimester, with one-third of the patients having sickle cell anaemia. According to the data, vitamin C, calcium, and MVBC were the most commonly prescribed drugs, despite the risks they presented to the fetus according to USFDA criteria. Thus, it is crucial to evaluate drug safety before prescribing them to pregnant women. Overall, this study highlights the importance of careful drug selection to ensure the safety of both the mother and the fetus in anaemic pregnant women.

Fuzzy Logic-Based Medical Decision System for Diagnosing Chronic Obstructive Pulmonary Disease

Gurpreet Singh Popli, Praveen Arora

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 47-57

This paper proposes a fuzzy logic-based medical decision system for diagnosing COPD, which utilizes fuzzy sets to represent the severity of symptoms, medical history, and test results, and fuzzy rules and reasoning to generate a diagnostic result as output. The proposed system aims to provide a more accurate and nuanced understanding of a patient's condition, which could help doctors track changes in the patient's condition and adjust treatment accordingly. The proposed study involves collecting data from a sample of COPD-diagnosed patients and developing and testing the fuzzy logic-based medical decision system. It is essential to note that fuzzy logic-based medical decision systems should be used in conjunction with other medical expertise and tools to ensure the best possible patient outcomes. A fuzzy logic-based medical decision system for COPD diagnosis has the potential to improve the accuracy and efficiency of COPD diagnosis, leading to better patient outcomes and quality of life.

Emerging Infections in Pregnancy: An Updated Review

Subhashis Das, . Nikhil, Gaurav Khichariya , T. Amrutha, Snigdha Sinha

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 58-66

Teratogenicity of numerous infections which develop during pregnancy is well known. Emerging infections are defined as the infections which has increased over the past 10 years or are bound to increase at threatening levels in future. Investigating the effects of emerging infection is vital to ensure that pregnant women are adequately evaluated, suggested and treated but the same is quite difficult and challenging on many aspects. Final impact of emerging infections on fetus is very difficult to ascertain and it is variable as it depends on the etiological factor and gestational time of developing the infection. Some subjects will be asymptomatic clinically or will have nonspecific clinical picture even when the embryo has severe disease making diagnosis more complicated. Current article discusses on evaluation of teratogenicity of emerging infections and how early detection can reduce the severity of infections in pregnancy.

Significance of Mirror Neurons in Surgical Skills Training: A Novel Perspective

Maya Jamkar, Shweta Telang, Arun Jamkar

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 67-79

This paper propounds the potential utilization of cognitive functioning of Mirror neurons to the psychomotor domain of surgical skill enhancement. This will not only open new concepts in skill learning for apprentice surgeons but will also the surgical proficiency of skilled surgeons. Italian researchers discovered in the early 1990s that the monkey brain contains a special class of cells that fire when it sees or hears an action and when it performs the same action on its own. These cells were dubbed "Mirror Neurons." Following human research, it was discovered that the human brain has multiple mirror neuron systems that specialise in carrying out and comprehending actions, intentions, emotions, and behaviour.

The available scientific literature provides substantial evidence that Mirror neurons offer the basis to grasp the actions and intentions of others through direct imitation without the need for any conceptual reasoning. The discovery of Mirror neurons has added a new light to the understanding of culture, empathy, philosophy, language, imitation and autism.

The present paper gives a brief overview of the myriad applications of the concept and mechanism of mirror neurons. Here, we present an innovative concept of harnessing the functional mechanism of Mirror neurons to the domain of psychomotor surgical skill development essential for surgeons. We have illustrated this concept by extracting references and thought-models from previous works. However, none of the previous works have demonstrated the utility of application of Mirror mechanism in surgical training.

There are very few studies conducted on the neonatal outcomes of eclamptic women in a rural sociodemographic situation prevailing in India. In view of this, the objective of this study was to identify as well as to assess the importance of neonatal outcomes of eclamptic mothers in a rural community. Thus, a prospective, cross-sectional, observational, and epidemiological study was conducted on two statistically matched groups in a tertiary care government teaching hospital catering rural agro-based population of Eastern India during April 2012–March 2013. One group of study included neonates born to 100 consecutive eclamptic mothers, while the other included neonates delivered to 100 non-eclamptic (control) mothers.  The majority of eclamptic mothers were unbooked, primigravidae (86%), in late teens (66%), belonging to socioeconomic Class IV (92%) of modified Kuppuswamy scale (2007). About 72% of neonates were born with one or more adverse neonatal outcomes (p<0.001). Neonatal outcomes as observed in this study were prematurity (40%, p=0.001), low birth weight (LBW) (60%, p<0.001), intrauterine growth restriction (IUGR) (12%, p=0.032), and birth asphyxia (33%, p=0.016), while hypoxic-ischemic encephalopathy, early-onset sepsis, early neonatal death, and stillbirth were not found to be statistically significant. Late preterm births were also significant (p=0.004). This study validates that eclampsia is a significant cause of considerable neonatal morbidity in terms of preterm, LBW, IUGR, and birth asphyxia in the rural population. It is identified as a substantial risk factor for late preterm delivery as well.

With the arrival of an aging society and the acceleration of globalization, industrialization, and urbanization, there are more and more empty nest elderly. It is expected that by 2030, the elderly population in China will be nearly 300 million, and the proportion of empty nest elderly households will reach 90%. The living conditions of empty nest elderly people are not only related to their physical and mental health, but also to the stability of the country and social development. The aim of this study is to explore the status of happiness and social support of empty nesters in Guangdong Province and analyze the relationship between the above two variables. Totally 1148 empty nesters (776 males, 734 females) from 5 cities in Guangdong province are selected by stratified random sampling and conducted with Memorial University of Newfoundland Scale of Happiness (MUNSH), Social Support RatingScale (SSRS), Mini-Mental State Examination (MMSE) and a self-edited questionnaire on the general information. The survey results indicate the following 3 points. First, The total score of MUNSH is (10.20±6.37). Second, the total score and the scores of the 3 dimensions of objective support, subject support, the use of support in SSRS are (30.79±5.51), (9.24±2.37), (19.38±4.95) and (9.22±2.15) respectively. Third, multiple variable linear regression show that the following 9 factors (\(\beta\)=.217, .316, .152, .587, .513, .146, .166, .114, .198 respectively, all P< .05) are positively associated with the total score of MUNSH, like living mode, marital status, educational level, health status, pensions level, frequency of children visiting, whether like to play old-type poker or mahjong, whether keep pets, and social support total score. Some items are negatively correlated with MUNSH scores (\(\beta\)=-.413, -.521, -.130, -.077, all P< .05), such as self-rated loneliness degree, whether worry about medical expenses, housing problems, whether need to get the day-care orlegal aid services. It is therefore suggested that the physical health, personal economic condition, leisure interest, children’ care, and social support may be related factors of subjective well-being among empty-nest elderly.

Death of a Patient Aged 2.5 Years after Infection Cause Parainfluenza Virus Type 1: A Case Report

C. Tecu, M. E. Mihai, V. I. Alexandrescu , E. Lupulescu

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 107-113

The objective of this chapter is to show the possibility that infection with parainfluenzae virus (PIV) type 1 can causes death. Parainfluenza viruses have been linked to a variety of ailments, including otitis media, pharyngitis, conjunctivitis, croup, tracheobronchitis, and pneumonia. In this work, we disclose the discovery of parainfluenzae virus PIV 1 as the causative agent of bronchopneumonia and cardiorespiratory failure that led to the death of a 2.5-year-old child. The severity of illness is greatest in children aged 2-4 years.

The patient was admitted to the hospital with a diagnosis of SARI (Severe Acute Respiratory Infection), but she died a few hours later. Laboratory tests (total WBC and differential, serum immunoglobulins, liver transaminases, urinalysis, blood sedimentation rate) were normal, and the patient had no associated disorders. We first examined the sample (a right lung fragment) for the presence of influenza viruses A and B (including pandemic H1N1) because the patient became unwell during the 2009-2010 pandemic season. Following the negative discovery of influenza viruses, we analyzed the sample for the existence of other respiratory viruses. At the same time, we looked to see if the samples had respiratory bacteria. The Real-time PCR method for detection of A/H1N1 pandemic virus and the Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for detection of other non-influenza viruses (respiratory syncytial virus, human metapneumo virus, PIV 1, 2 and 3, Coronaviruses 229E and OC43) were used as diagnostic methods. In addition, the probable bacterial etiology of the infection (Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumoniae,  and Chlamydophila pneumoniae) was tested using the Kit RV/PB18 ASE Detection (Seegene). The study found that even though the patient had  no history of chronic illnesses, she died from bronchopneumonia caused by PIV type 1.

Tuberculosis and Cervical Lymphadenopathy: Treatment and Diagnosis

Farzeen Tanwir, Saima Mazhar, Tauqeer Bibi , Anum Baqar , Ahmed Bin Khalid Khan, Yasmeen Mahar , Arsalan Khalid , Hira Ijaz, Maryam Faiz Quereshi, Areeba Younus, Mahail Khan, Mariya Azam Khattak, Kashmala Zakir , Imran Ahmed, Shahkamal Hashmi, Sadia Ahmed

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 114-127

This study aims to determine the prevalence of tuberculosis in cases of cervical lymphadenopathy as well as the common presentations and aetiologies of cervical lymphadenopathy. 

 Lymphadenopathy is a common clinical finding in a patient seeking oral health care. It may be in a localized, limited, or generalized form. Malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions are considered as the causes for cervical lymphadenopathy. Unexplained cervical lymphadenopathy is a cause of concern for physician and patient because sometimes it could be the manifestation of an underlying malignancy. Tuberculous cervical lymphadenopathy usually presents with multiple lymph node enlargement without constitutional sign. Fine needle aspiration and excisional biopsies are usually done to make a definitive diagnosis. Commonest presentation may be neck swelling (92%), followed by fever, cold abscess, non-healing ulcer, discharging sinus, anorexia and weight loss.

The study was conducted from July 2010 to august 2013 at the surgery department of Ziauddin Medical University hospital Karachi, Pakistan. Inclusion criteria included all patients with cervical lymphadenopathy. The data was analyzed by Statistical Package for Social Sciences (SPSS) version 17.

In total 220 patients were recruited to participate at the beginning of the study while only 175 patients remained in the study till the investigations were done. Hence study comprised of total 175 participants with response rate of 79.5%. Age range of the participants was 13-69 years that included146 (83.4%) females and 29 (16.6%) males. The maximum patients were in 21-30 years of age group followed by 11-20 years.

Cervical lymphadenopathy is prevalent in Pakistan, with most likely diagnosis as Tuberculosis, as seen in majority of the cases. Neck mass, headache and fever are the most frequent presentation of cervical lymphadenopathy. A good follow-up culture is also required to monitor the need for additional diagnostic tests in the setting that a patient fails to respond to appropriate initial therapy.

The present study investigated a peer education activities increasing students’ learning about HIV/AIDS and safe sex practice in one Chinese Normal University as well as to identify the key factors contributing to the success of students' learning about HIV/AIDS prevention and safe sex practices through the peer education program.. Yunnan Normal University has been recognized for its successful HIV/AIDS education and prevention efforts among Chinese universities. This single-case study aimed to explore the university's peer education activities and methods in order to provide guidance for other universities in developing their own education plans. Data was collected through semi-structured interviews, observations, and document reviews of six teachers with over five years of experience in HIV/AIDS education or safe sex education, and nine fourth-year students. To prevent HIV/AIDS from spreading and protect university students, HIV/AIDS educators and experts organized educational methods to promote HIV/AIDS education in Chinese universities. The findings revealed that healthy living perspectives and sexual morality were the essential components of HIV/AIDS education in Chinese universities, and that establishing a good relationship between educators and learners was vital to eliminating any embarrassment when teaching sensitive knowledge. One of the best strategies for delivering HIV/AIDS education has also been found to be planning activities led by qualified peer educators. For universities looking to create effective HIV/AIDS education programmes, this study offers helpful insights. Other Chinese colleges desiring to build and implement their own effective HIV/AIDS education programs should benefit from the findings, which suggest that the HIV/AIDS Peer education organized activities could be used as instructional guides for those institutions.

Clinicopathological Evaluation of Meningiomas: Experience from a Tertiary Care Hospital

Jigna Prakashbhai Patel , Trupti Rajeshbhai Jansari, Rutik Thorat

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 142-152

The present study highlights the incidence, anatomical location, sex and age Predilection, histological variants and grading of meningiomas based on WHO 2016 classification to correlate clinical features and radiological findings with those of histopathological findings. Meningiomas are the most common non-glial tumours of the central nervous system, accounting for between 16 and 20% of all intracranial tumours.

This grading helps in predicting their behaviour and deciding treatment strategy. Meningiomas comprise 15%–20% of all primary intracranial tumors. They are twice as common in females as compared to the male population, but a reverse male-to-female preponderance of 3:1 has been reported in the malignant form. The incidence increases with age with peak incidence between the ages of 40 and 60 years. A slight drop after the 8th decade has been noted. They are generally benign tumors, and most patients are cured after surgery and remain free of recurrence.

This case series was conducted at Dhiraj Hospital and Shrimati Bhikiben Kanjibhai Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth. The biopsy specimens of all the enrolled patients (diagnosed with meningioma by the neurosurgeons and radiologists) sent to our department over a period of November 2016 to July 2018 were included.

Total 30 meningioma tumors were included in the study. Most of them were intracranial, predominantly involving the posterior fossa of brain, females and the 41 – 60 age group. The most common histological subtype was psammomatous followed by meningothelial. Majority (93.33%) were benign grade I tumors. In 90% cases radiological diagnosis matched exactly with the histopathological diagnosis.

Aggressive behaviour and a high risk of recurrence are associated with a small number of histological features and variants. To increase accuracy and reproducibility, it is crucial to grade and diagnose these tumours histopathologically accurately.

Are Silent Inflammations Responsible for Chronic Civilisation Diseases?

Doepp, Manfred

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 153-160

Inflammation is an evolutionarily conserved process characterized by the activation of immune and non-immune cells that protect the host from bacteria, viruses, toxins and infections by eliminating pathogens and promoting tissue repair and recovery. Chronic silent inflammations are the killer diseases number one. These include immune system dysfunction with regulations disorders, autoaggressions, allergies, and as an underlying disease, mitochondriopathy. For about 2 years, we have been noticing more and more frequently that patients have antibodies against mitochondrial RNA and/or DNA. A connection with the mRNA vaccinations may exist. Unvaccinated persons also exhibit this phenomenon. One can think of "vaccine shedding". In parallel, a population spike protein infestation is underway. These affect the ACE2 receptors of many organs, including the heart muscle. Therefore, the frequency of myocardial weaknesses is increasing.

We have developed a means of treatment that has been known for 2000 years. It is a tincture of frankincense, myrrh and colloidal gold. There was a significant decrease in antibody titers in affected patients. It seems that the autoimmune processes respond positively to these ingredients. Against the spike proteins problems we developed a tincture containing esp. dandelion extract and pine needle extract. For the prevention of heart failure, strophanthin/ouabain has been shown to be best (3 mg gastric juice-resistant capsules). These three agents are also effective in post covid or long covid symptoms.

Lipid Profile among Art Treated and Untreated Patients in HIV Positive Cases: A Comparative Study

Doddigarla Zephy, Lingidi Jhansi Lakshmi, Muhamed Faizal

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 161-169

This chapter aims to find out the lipid profile pattern in treated HIV patients after shorter period of time with ART (First line of treatment i.e. zidovudine, lamuvudine and Nevirapine) and comparing them against HIV infected untreated individuals and controls within our locality. HIV Seropositive patients on HAART or untreated have dyslipidaemia. In untreated HIV infection, the majority of the ATP is used in the reverse transcription process to achieve host cell morphism. The dyslipidaemia in ART untreated or in ART treated HIV infected individuals is an important factor in cardiovascular disease risk factors in HIV infected individuals.  Subject field of HIV Seropositive cases (n=84) and age and sex matched healthy non-HIV cases as controls (n=47). Comparison between the HIV infected (n=42), HIV infected ART treated (n=42) and controls were significant (p 0.000) for fasting cholesterol, triacylglycerols (p 0.000) and HDLc (p 0.000) and LDLc (p 0.000). When TAG compared controls to HIV-infected ART-untreated individuals, the differences were negligible. Statistical significance in between sexes within untreated patients' lipid profile in HDLc (35 ± 3.8 against 37.4 ± 3.5) and LDLc (48.0 ± 8.3 against 38.0 ± 7.2). ART treated or untreated in HIV Seropositive subjects showed altered lipid profile when compared to apparently healthy controls in our report.  HIV-positive individuals should be routinely checked for lipid abnormalities whether they are receiving ART or not, and a careful anti-retroviral treatment plan should be prescribed. This will unquestionably aid in the future management of dyslipidemia in HIV seropositive patients.

From MERS to COVID-19 and Omicron: Recent Evolution of RNA Coronaviruses

George P. Einstein, Orien L. Tulp

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 170-177

The purpose of the study is to briefly review the evolution and development of the MERS, SARS. and COVID-19 coronaviruses. One alarming finding about COVID-19 is that people with SARS-CoV-2 infection can spread the virus to others while asymptomatic and frequently before they have manifested overt symptoms of disease. Additionally, once infected, the virus may attack multiple organs and tissues, including the brain, cardiovascular system, lungs, and other organs in its new host. The recent emergence and identification of the Delta, Omicron and other variants continue to spread globally, often despite prior vaccination and boosters with any of the currently approved vaccines or with natural immunity from previous infection.

Inferior Alveolar Nerve Block: A Review of Alternate Techniques

Amrutha B.

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 178-190

The aim of this present review was to describe anatomical variations of inferior alveolar nerve that could be encountered during surgical procedures there by avoiding surgical complications. 

Most common method for obtaining mandibular anaesthesia in dental practice is inferior alveolar nerve block though it has been estimated to have only 80 to 85% of success rate. The mandibular nerve and its branches are traditionally anesthetized by depositing anaesthetic fluid in the area of the mandibular foramen.  This widely used procedure eliminates all somatosensory perception of the mandible, mandibular teeth, floor of the mouth, ipsilateral tongue, and all but the lateral (buccal) gingivae. The inferior alveolar nerve is known to present with anatomical variations prior to the nerve entering the mandibular canal, as well as along its course within the mandibular canal. In the case of difficulty-to-anesthetize patients, the inferior alveolar nerve can be especially tough.  A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. In such situations the alternatives to inferior alveolar nerve block described in this article can be successfully utilised with the best knowledge and skill of the operators.

Persistent Xerophthalmia in a Patient with Rheumatological Disease and Priiviary Sjogren's Syndrome: Case Report from Northern Brazil

Camile Smith de Oliveira Brito , Horlando Juniorsantos LagesAlcantara, Joao de Joao Oliveira Leitao Limeira, Julie Souza da Silva , Sebastiao Barreto Falcao Neto , Joao Vlctor Oliveira de Melo , Youssef Sabba Tayah , David Tayah , Milton Ruiz Alves

Research Highlights in Disease and Health Research Vol. 7, 19 May 2023, Page 191-196

This case study aims to contribute to the literature in order to highlight the importance of this collaboration between medical specialties. A female patient R.N.N. F, age 66, from the city of Manaus, with a previous diagnosis of sjogren's syndrome in regularfollow-up bythe Rheumatology team at the Araujo Lima outpatient clinic and referred to the Ophthalmology sector for complementary evaluation related to visual discomfort. The fundoscopy performed in the patientwas within normal limits, but the symptoms experienced by her proved to be an important clinical finding, which has ratified the need for regular and multidisciplinary follow-up. This report unequivocally demonstrates that even in the face of tests considered within the expected limits for a given population, the clinical presentation can be specific and particular for each analyzed individual. Early screening exams should contemplate the patient in a holistic and individualized way whenever possible.