Research Trends and Challenges in Medical Science Vol. 3

Fetal Growth Restriction and Doppler Waveform: Current Research

2021-08-28T07:08:00+00:00

Fetal growth restriction (FGR) is defined as the estimated fetal weight less than the 10^th percentile for that gestational age on ultrasound study. There is no proven cure; management is reliant on a structured antenatal surveillance programme. Recent advances in ultrasound and Doppler have elucidated several mechanisms of growth restriction. Prediction of intrauterine hypoxia and acidemia can be done by Doppler study of fetal cardiovascular system.

In this chapter it is discussed how to analyse the uteroplacental and fetoplacental blood flow using Doppler ultrasound in growth-restricted fetuses with reference to flow velocity and waveform indices.

The Doppler ultrasound examination of the fetal cardiovascular system is mostly performed after 28 weeks of gestation in pregnancies with fetal growth restriction.

In the present chapter we highlight that preeclampsia and maternal anaemia have beed found to be the most important cause of fetal growth restriction. Abnormal Doppler indices in umbilical and middles cerebral artery statistically correlate with lower birth weights, higher rate of caesarean delivery, oligohydramnios, low Apgar scores, perinatal death and higher admission to neonatal intensive care unit. Reduced end diastolic flow or complete absence of it in the umbilical artery is associated with poor perinatal outcome. Cerebroplacental Ratio (pulsatility index of middle cerebral artery/pulsatility index of umbilical artery) less than 1 is a very sensitive and specific sign of fetal compromise.

Conclusion: Abnormal Doppler waveforms within the umbilical and middle cerebral arteries are indicative of redistribution of cerebral blood flow in fetal hypoxia. If there is reduced or low blood flow during diastole in umbilical arteries, the fetal perfusion becomes intermittent and fetal hypoxia develops. The blood flow redistributes to vital organs like brain and kidneys and the pulsatility index of middle cerebral artery falls in the fetus. The plausible explanation of it is, sympathetic activation in a hypoxemic fetus leading to increased cerebral perfusion. The ductus venosus flow gets reduced and reversed along with continued hypoxia.

Critical Overview of Multidisciplinary Treatment Approach of a Patient with Amelogenesis Imperfecta: A Case Report

2021-08-28T07:27:43+00:00

Introduction: Amelogenesis Imperfecta (AI) is a developmental disturbance, genomic in origin, which interferes with normal enamel formation of both primary and permanent dentitions in the absence of a systemic disorder. Three major categories can be recognized clinically, namely hypoplastic, hypomaturation and hypocalcified. Timely and comprehensive intervention is critical to spare the patient from psychological consequences of these disfiguring conditions.

Clinical Report: A 10-year-old boy was presented with dissatisfaction with appearance of his teeth sensitivity and poor masticatory efficiency. His medical history was noncontributory. Composite restorative material was selected as a suitable replacement of the defective structures because of its esthetics and high sustainability.

Treatment Objectives: The multidisciplinary approach was oriented toward achieving functional and esthetic rehabilitation of these teeth with minimal chair-side time.

Treatment Outcomes: The use of composite restorative material resulted in successful and satisfactory enhancement of the patient’s esthetic appearance, as well as protection against further wear and sensitivity thereby improving his functional demands. The longevity of the treatment outcome required meticulous maintenance of oral hygiene and patient compliance.

Conclusion: Management of a patient with AI is a challenge for the clinician. Treatment options vary considerably depending on several factors such as age of the patient, socioeconomic status, severity of the disorder, and most importantly, the patient’s cooperation. Composite restorative material is considered an excellent conservative transitional treatment for protection of AI weakened teeth.

Hypertension and Uterine Artery Waveform: Recent Perspectives

2021-08-28T07:30:15+00:00

Pregnancy Induced Hypertension is a multisystem heterogeneous disorder occurring in 4-7% of all pregnancies. Fetal villi in the intervillous space at fetomaternal interphase show ischemic, oxidative and immune mediated damage. This chapter outlines the relation between abnormal uterine artery flow and perinatal outcome in a tertiary care center. The relationship between uterine artery Doppler pulsatility index and adverse perinatal outcome is emphasized in this chapter.

Doppler ultrasound examination of the uterine arteries at 20-23 weeks gestation in women with singleton pregnancies is usually done at routine target scan. Pregnancy Induced Hypertension (PIH) was recorded in (3-7%) of all pregnancies.

High pulsatility index (>95^th percentile) as compared to low pulsatility Index is a good tool for the prediction of PIH (sensitivity 91.23% and specificity 99.06%, p<0.05).

Uterine artery Doppler has better detection rates for early onset PIH and Intrauterine Growth Restriction (IUGR). It also has high specificity in the prediction of preterm labor and abruption of placenta.

An Investigation of Bilateral Syndromic Syndactyly Treated by Release and Full-thickness Skin Grafting: A Case Report

2021-08-28T07:33:38+00:00

Syndactyly is one the commonest seen anomalies in hand or plasty surgery clinics nowadays. The timing and orderly steps of surgery dictate the surgery on syndactyly. The goal of surgery is non other than creation of a normal anatomical webspaces, a tension-free closure of soft tissue and return of functions to the fingers. Numerous surgical methods have been described, many of which involve the use of local ﬂaps to reconstruct the commissure and full-thickness skin grafts for coverage of the raw area. In this report, we described a bilateral syndromic syndactyly treated by release and full-thickness skin grafting from groin. Staged release of complex (four digit) syndactyly is utmost important and clinical result is very good.

Morphology and Morphometric Study of Human Placenta

2021-08-28T07:35:38+00:00

Human placenta, materno-fetal organ, plays a vital role in maternal-fetal physiology with numerous responsibilities. It is not merely a passive barrier between the maternal and fetal circulations but has many physiological functions like implantation, recognition of maternal pregnancy, fetal protection from immune attacks, exchange of respiratory gases, metabolites, nutrients, and waste products as well as the endocrine function and the metabolism of xenobiotics. Abnormalities in the placenta’s function can lead to dismal pregnancy outcomes.

The usual human term placenta is about 22 cm in diameter and 2.0 to 2.5 cm thick. It generally weighs about 475 g. The ratio between placenta weight and birth weight of the newborn. Placentas with less than 2.5 cm thickness are associated with intrauterine growth retardation (IUGR) of the fetus. Placentas more than 4 cm thick have an association with maternal diabetes mellitus, fetal hydrops and intrauterine fetal infections. The full-term, delivered placenta is, in more than 90% of the cases, a disk-like, flat, round to oval organ. In nearly 10%, it has abnormal shapes, such as placenta bilobata, placenta duplex, placenta succenturiata, and placenta membranacea. A well-developed placenta consists of a chorionic plate, which is of embryonic descent and of a basal plate whose essential layer is the decidua, a derivative of the endometrium. Between these two plates, there is a voluminous intervillous space. placental examination is necessary to understand the causes of perinatal deaths. Documentation of findings and submission of tissue for pathologic evaluation based on abnormal appearance or various maternal clinical disease is mandatory.

Brief Overview of High Cesarean Section Rates in Latin America, a Reflection of a Different Approach to Labor?

2021-08-28T07:47:50+00:00

Increasing rates of cesarean section, as high as 50% in some countries in Latin America, compared with the rest of the world, demand a closer analysis of its causes and implications. The significant morbidity for both mother and baby associated with cesarean section requires immediate action from national and international societies to confront the situation with specific solutions, including patient education. We recommend a consensus meeting of Latin American ACOG (American College of Obstetricians and Gynecologists) section members to address the issue and to consider adopting guidelines based on evidence and reflecting the realities of the countries involved.

Assessment of Microvessel Density and Angiogenesis in Endometrial Carcinomas

2021-08-28T07:57:38+00:00

Objective: To evaluate the role of angiogenesis in tumor growth by the assessment of microvessel density and to quantify angiogenesis as an important variable in endometrial cancers.

Materials and Methods: 103 cases of endometrial malignancies (epithelial tumors-76 cases, stromal tumors-07 cases and metastatic tumors-20 cases) were analysed for histological types, grades and features like depth of invasion and vascular invasion. Microvessel counts were performed by examining the microvessels thoroughly in terms of count, morphology and density after staining the tissues by hematoxylin & eosin stain, reticulin and immunostain CD34.

Results: On H&E stain - Microvessel density (MVD) in endometrial malignancy ranged from 3.0 - 13.5 and mean MVD was 8.78. On Reticulin stain - MVD ranged from 3.5 - 15.2 and mean MVD was 9.76. CD34 sections showed very small microvessels or even single endothelial cells with the highest total counts and the MVD ranged from 6.5-16.8 with Mean MVD of 11.7. The counts increased with the grade of the tumor in the absence of necrosis or haemorrhage. MVD counts also increased with the stage, being 8.12 in Stage I disease, 8.65 in Stage II and 10.8 in stage III disease. Atypical hyperplasia was found to be associated with epithelial tumors in 8 cases, making it a significant finding.

Conclusions: Role of angiogenesis assumes greater significance with increasing severity of lesions, higher grade and stage of the tumor and seems to have an important diagnostic and prognostic significance.

Research on Identification of Diagnostic Biomarker for Hepatocellular Carcinoma: A Proteomic Approach

2021-08-28T08:01:52+00:00

Hepatocellular carcinoma (HCC), a slow multistep process eventually starts from long-terminflammation to fibrosis and leads to malignancy. These variations cause several genes disrupted that play role many signaling pathways involved in HCC. Early diagnosis and treatment of hepatocarcinogenesis depend on efficient biomarker discovery. To date, only two specific markers of HCC are identified, AFP and AFP-L3, but assessment and validation of these markers are still left in large cohorts of patients. Proteomic approach aids to develop new promising biomarker for diagnosis liver cancer at early stage. In current chapter early stage biomarker (cAMP-dependent protein kinase inhibitor alpha (PKIA)) have been identified using one-dimensional electrophoresis (1DE) and 2DE followed by matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. This chapter alsohypothesized that PKIA is useful for detection of HCC at initial stage.

Correlation between Lycopene Intake and Blood Pressure in Healthy Adults from Celaya, Mexico: Advanced Study

2021-08-28T08:06:30+00:00

Aims: To identify if there is a correlation between lycopene intake and blood pressure levels in healthy adults of Celaya.

Study Design: Cross-sectional, observational, analytical study.

Place: All students registered at a public university in Celaya, Guanajuato, Mexico.

Methodology: To measure blood pressure, a humeral digital baumanometer with adult bracelet (Rossmax MG150f) was used. The measurement was performed three times with a two-minutes interval and the average systolic and diastolic blood pressure was obtained. The daily intake of lycopene was evaluated with a questionnaire of the frequency of consumption of meals. The µg of lycopene was estimated with a software related to the frequency of consumption of meals. Descriptive statistics were used for all variables. To identify the correlation and possible linear relationship between lycopene intake and blood pressure, Pearson r was calculated, linear regression equation, t-test, and P-value and confidence intervals at 95%.

Results: We included 446 participants (74.28% women, 25.78% men; between 18-51 years of age). The average systolic blood pressure was 108.30 mmHg, while the average diastolic blood pressure was 71.07 mmHg. The daily intake of lycopene was 6477.38 µg. However, there was no correlation or lineal relationship between lycopene intake and the measurement of systolic blood pressure (P=.93) and diastolic blood pressure (P=.5).

Conclusion: No correlation was found between daily intake of lycopene and blood pressure (P> .05) in this adult sample from Celaya, Mexico. Studies should be conducted with a different way of determining the intake or level of lycopene in the body.

Mobile Multimedia Messaging Service Teleradiology- in Otorhinolaryngological Emergencies: Brief Overview

2021-08-28T08:10:54+00:00

Introduction: The diagnosis of many otolaryngological emergencies is based on radiological investigations likex-rays and CT-Scans. The reliability of the mobile phone digital images of emergency radiological investigations send via multi-media messaging, a cheap and rapid modality for telemedicine, has not been explored for otolaryngological emergencies.

Objective: The present article explores its benefit as a tool for medical communication, especially for consultation by the resident doctors in situations where specialists are not immediately available.

Methods: Certain otolaryngology emergencies like faciomaxillary trauma, foreign bodies and infective emergencies, may need urgent imagingin the form of X-rays, Computed Tomography (CT-Scan) or Magnetic Resonance Imaging (MRI) for diagnosis. Various studies related to Mobile Multimedia Service (MMS) teleradiology in Otolaryngological emergencies were reviewed. The digital images of the radiographs viewed on an illuminated view box in Ear Nose and Throat (ENT) emergency, clicked under constant environment, including same resident doctor and cell phone with camera equipped with mobile multimedia message service (MMS) were sent via MMS to another phone of the same make and model, with blinding to avoid observer bias. The cell phone digital images (index test) have been compared with reporting of the actual radiograph films viewed on a view box (reference standard) with regards to their diagnostic accuracy.

Results: Mobile Multimedia Service (MMS) teleradiology has been found to have a diagnostic accuracy comparable to the actual radiographs (X-rays, CT-Scans, MRI) viewed on a view box or computer screen, for most of the otolaryngological emergencies except undisplaced fracture of nasal bones and surgical emphysema where the results were dependent on the technique of clicking the image and the resolution of the camera.

Conclusion: Mobile Multimedia Service (MMS) teleradiology is a cheaper, quick and more easily accessible solution in medical communication and it can be incorporated as a handy and readily available communication tool for handling otolaryngological emergencies as it would enhance the confidence in remote decision making and improve patient care in emergency settings.

The Role of Adjunctive Psychosocial Interventions in Augmenting Clozapine Response in Patients with Clozapine Resistant Schizophrenia: A Review and Illustrative Patient Histories

2021-08-28T08:12:47+00:00

A large proportion of patients with treatment-resistant schizophrenia continue to have persistent symptoms and psychosocial impairment despite adequate treatment with clozapine. This group of patients with clozapine resistant schizophrenia (CRS) constitutes about 40%-70% of those with treatment-resistant schizophrenia. These patients represent the most severely ill among those with schizophrenia with higher levels of symptom severity and disability, and greater socioeconomic burden. A large body of evidence has shown that when clozapine fails, augmentation of its response with antipsychotics or other medications is of little or no benefit for these patients. Augmentation with electroconvulsive therapy seems to hold some promise, but the evidence is limited. The benefits of psychosocial interventions in augmenting clozapine response in these situations has not been explored fully. A few trials of cognitive-behavioural therapy (CBT) have been undertaken, and their results do not seem to support the effectiveness of adjunctive psychosocial therapies in augmenting the efficacy of clozapine in these patients. Nevertheless, this chapter attempts to re-evaluate the evidence for the effectiveness of psychosocial interventions in CRS, by conducting a brief review of the area followed by illustrative histories of patients with CRS who benefitted from adjunctive psychosocial therapies. The results suggest that adjunctive psychosocial treatments could still have a role in potentiating clozapine response in CRS. However, psychosocial treatment modules that combine CBT with other treatment strategies such as individual support, stress management, and family interventions are more likely to be successful in augmenting clozapine response in CRS than CBT alone. Therefore, there is much scope for further research in this area.

The Dynamic Nature of Cardiac Biomarkers in Acute Non-fulminant Myocarditis

2021-08-28T08:25:27+00:00

Myocarditis and myocardial infarction share clinical similarity and daily diagnostic dilemmas. The recommended diagnostic tools today are cardiac MRI or myocardial biopsy. However, various medical centers have difficulty implementing this recommendation due to the unavailability of CMRIs or the risk of myocardial biopsy. Most often, these patients undergo diagnostic catheterization to rule out coronary disease. The need for a quick, non-invasive and inexpensive test to discriminate the two disease is essential. We provide a unique discriminating pattern of serum markers curve in acute.

Myocarditis and acute Non-ST myocardial infarction during acute phase. In acute myocarditis troponin progress moderately while CPK progress steeply, both to higher peak, resulting in lower troponin to CPK ratio in the first 48 hours of admission.

Optimizing Maternal and Perinatal Outcomes of Management of Early-Onset Severe Preeclampsia in a Resource-poor Setting in Nigeria

2021-08-28T08:27:39+00:00

Background: Preeclampsia in Nigerian women is considered to have a rapidly progressive clinical course. The timing of delivery when it occurs before 34 weeks gestation continues to elicit debate turn between the choice to protect the mother and a desire to improve the chance of survival of the fetus.

Aim: In the present study we sought to determine the most appropriate gestational age (GA) for delivery in severe preeclampsia occurring preterm to achieve optimal neonatal outcome, without giving room for undue maternal compromise.

Study Design: A retrospective cohort study.

Place and Duration of Study: Department of Obstetrics & Gynecology, University of Benin Teaching Hospital, Benin City, Nigeria between June 2012 and May 2014.

Methodology: Information on the sociodemographic characteristics, clinical management and outcome of women with severe preeclampsia was extracted from case records as well as the computerized departmental data bank, and analyzed using SPSS 20.0 and GraphPadInStat 3 software.

Results: We included 312 women in the study. The median GA at delivery was 35weeks. The incidence of eclampsia was 2.5% (102/4,106). Eclampsia occurred 1.5-fold, 1.6-fold and 1.6-fold more, respectively with proteinuria of ≥ 3+, severe anemia and mean arterial blood pressure ≥ 120 mmHg (P=0.00, P=0.00 and P=0.00, respectively). Eclampsia, severe anemia and proteinuria ≥ 3+ were associated with maternal mortality (14.7% vs 0, P=0.00; 28.5% vs 3.7, P=0.00; and 7.6% vs 0.8, P=0.00, respectively). Logistic regression analysis showed that delivery before 34 weeks gestation was associated with early neonatal death (P=0.00).

Conclusions: Severe preeclampsia occurring preterm is associated with significant perinatal mortality in our hospital. An approach of knowledgeable, evidence-based, selective conservative management up to 34 weeks gestation could improve fetal salvage rate while assuring maternal wellbeing.

Foley Catheter versus Vaginal Misoprostol for Labor Induction: Experimental Comparison

2021-08-28T08:33:02+00:00

Objectives: To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labor induction.

Materials and Methods: One hundred and four women with term gestation, with Bishop score<4 and with various indications for labor induction were randomly divided into two groups. In Group I, 25 g of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software.

Results: The induction to delivery interval was 14.03 ±7.61 hours versus 18.40 ±8.02 hours (< 0.01). The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups.

Conclusion: Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labor.

Blood Pressure Measurement with Digital Baumanometers

2021-08-28T08:40:22+00:00

Aims: Identify the correlation between systolic and diastolic Blood pressure measurement with digital arm and wrist baumanometers in young adults aged 18 to 40 at the Public University of Celaya, Guanajuato, Mexico.

Study Design: Observational, analytical, quantitative, correlational, diagnostics.

Place of Study: Public University of Celaya, Guanajuato, Mexico.

Methodology: We included 397 participants of an age range between 18 and 40 years; which 287 were women and 110 were men; with an average weight of 65.28 ± 15.08, and of stature 1.63 ± 0.09. Two types of digital, wrist and arm baumanometers were used to measure the systolic and diastolic blood pressure to observe the effectiveness of the values recorded during the measurement.

Results: The correlation between the 3 measurements of the systolic blood pressure was repeated in the first and third measurements (r = 0.46) and varied in the second (r = 0.39), in all three the value recorded by the highest arm baumanometer was found. In the 3 measurements of the diastolic blood pressure the correlation varied (r = 0.54, r = 0.50, r = 0.59); registering the highest value in the measurement with the arm baumanometer.

Conclusion: The correlation between the measurements with the baumanometers was not perfect, however it was good, it was considered that the measurement of blood pressure with the wrist baumanometer should be done with the wrist at the level of the heart; as well as movements of arm, hand or fingers will alter the result.

Educational Interventions in the Management of Overweight and Obesity in Adolescents

2021-08-28T08:44:09+00:00

Introduction: Overweight and obesity is a serious global health problem in minors related to multiple chronic degenerative or fatal diseases.

Aim: To analyze the results of available scientific studies of educational interventions in the management of overweight or obesity in adolescents.

Methodology: Those studies found in a database between 2014-2019 that performed intervention or management of overweight or obesity in a population between 6 and 18 years of age were included.

Results and Discussion: Fourteen studies met the inclusion criteria of which only three performed a probabilistic sampling being these more significant. Different types of interventions were identified from educational, cognitive-behavioural and physical activity promotion. The variables with the greatest significant difference were body composition and waist circumference, the Body Mass Index still has no significant difference.

Conclusion: Educational interventions achieve an important role in the management of overweight or obesity having significant changes in the short, medium and long term.

Allotransplantation Animal Study with Canine Model

2021-08-28T08:48:13+00:00

As reconstructive transplantation is gaining popularity as a viable alternative for upper limb amputees, it is becoming increasingly important for plastic surgeons to renew surgical skills and knowledge of this area. Forelimb allotransplantation research has been performed previously in rodent and swine models. However, preclinical canine forelimb allotransplantation studies are lacking in the literature. The purpose of this paper is to provide an overview of the surgical skills necessary to successfully perform forelimb transplantation in canines as ameans to prepare for clinical application. A total of 18 transplantation operations on canines were performed. The recipient limb was shortened at the one-third proximal forearm level. The operation was performed in the following order: bones (two reconstructive plates), muscles and tendons (separately sutured), nerves (median, ulnar, and radial nerve), arteries (two), and veins (two). The total mean time of transplantation was 5 hours ± 30 minutes. All of the animals that received transplantation were treated with FK-506 (tacrolimus, 2 mg/kg) for 7 days after surgery. Most allografts survived with perfect viability without vascular problems during the early postoperative period. The canine forelimb allotransplantation model is well qualified to be a suitable training model for standard transplantation and future research work.

A Previously Undescribed β+ Thalassemia Mutation (HBB:c.-122T>A) Identified in a Vietnamese Family

2021-08-28T08:50:47+00:00

Aims: To identify thalassemias in the population living in the Thua Thien Hue Province of Central Vietnam.

Study Design: The study was performed as part of an ongoing research collaboration between Universities of Sassari and Hue. The survey included nearly 200 individuals referred to Hue Medicine and Pharmacy College and PhuVang District Hospitals for hematological and clinical evaluation. First-level analysis and DNA studies were carried out to identify and define thalassemia defects.

Methodology: Complete blood count was measured. Serum ferritin concentration was used to determine iron-deficiency. Hemoglobin profile was defined by IEF and CE-HPLC procedures. Identification of the β-globin genotype was carried out by PCR and nucleotide sequencing of the β-globin gene. The occurrence of deletions or duplications in the HBB and HBA cluster was investigated by the Multiplex Ligation-Dependent Probe Amplification (MLPA) analysis. To assess the impact of a novel mutation on globin synthesis a K562 cell-based luciferase reporter assay was performed.

Results: Four β-globin gene mutations were found, three of which previously described. The unknown mutation affects the position -72 from the Cap site, located in the CCAAT box of the β promoter region. The variant is not associated with remarkable changes in red blood cells indices. The level of HbA₂ is slightly increased. The in vitro expression studies displayed that the mutation decreases the transcriptional activity of the β promoter by about 50%. This finding made possible to classify the mutation as a β⁺-thalassemic allele.

Conclusions: Although the mildness of the -72 mutation a severe phenotype resulting from a compound heterozygous state cannot be excluded. The complexity of the clinical manifestations resulting from the assortment of different β thalassemia alleles underlines the importance of identifying new or rare β⁺-thalassemic alleles, particularly in countries where a wide genetic variability exists.