Panoramic Overview of the Autopsy | Chapter 13 | Current Trends in Medicine and Medical Research Vol. 4

The dissection of dead bodies for medical purposes that is postmortem examination dates back to ages. The human body is vulnerable to various ailments because of its genetic constitution and its immediate environment. The interaction of genetic and environmental forces cause and moderate the severity  of  diseases,  leaving  clinicians  highly  perplexed  in  some  situations.  Postmortem  therefore becomes necessary to  unravel  medical  mysteries  especially remembering that  no two patients are exactly the same and there is virtually no impossibility in medicine. Over the centuries, the autopsy remains  the  ultimate  revealer  of  secrets  and  best  means  to understand hitherto  obscure pathophysiological processes.

Author(s) Details

Akinwumi O. Komolafe

Department of Morbid Anatomy and Forensic Medicine, Obafemi  Awolowo University, Ile-Ife, Osun State, igeria and Department of Morbid Anatomy and Forensic Medicine, Obafemi  Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

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Can We Predict Preeclampsia? | Chapter 12 | Current Trends in Medicine and Medical Research Vol. 4

Hypertensive  disorders  in  pregnancy  are  a  leading  cause  of  peripartum  morbidity  and  mortality. Preeclampsia is a heterogeneous maternal syndrome. Large  studies  have  pointed  out  the  association  of  impaired  spiral  artery  remodeling  at  the fetomaternal interphase in preeclampsia, but how exactly is the fetomaternal dialogue mediated and what are the biomarkers to detect the subclinical disease in various subsets of high-risk pregnancies is  still  a  challenge.  These  biomarkers  can  finally  be  used  to  diagnose  renal  function  (Kallikrein-creatinine ratio), vascular resistance (uterine artery Doppler), coagulation disorders (platelet volume, fibronectin,  prostacyclin,  thromboxane,  oxidant  stress  (lipid  peroxidase,  8-isoprostane,  antioxidants, anticardiolipin  antibodies,  homocysteine,  serum  uric  acid),  vascular  adaptation  (Placental  growth factor, Vascular endothelial growth factor, s-flt, s-eng) and markers ofplacental function and ischemia (placental  CRH,  CRH  bp,  activin,  inhibin, hCG).Post  partum  preeclampsia  can  be  predicted  by identifying the factors preventing the excretion of sodium, puerperal diuresis  and shift of intravascular fluid into the extra vascular compartment compartment(atrial natriuretic peptide in the first week after delivery,  natriuresis  and  inhibition  of  aldosterone,  angiotensin  II,  vasopressin).  Preeclampsia  is  a heterogeneous  disease.  The  late  onset  preeclampsia  at  or  near  term  has  low fetal  and  maternal morbidity. But the early onset preeclampsia (1%) of all preeclampsia has significant risks. Prediction of  risks  and  identification  of  subclinical  disease  is  mandatory.  The  majority  of  at  risk  groups  in multigravida  are  chronic  hypertension,  pregestational  and  gestational  diabetes,  age  and  multiple fetuses. Whereas, in primi only 14% have these risks. This suggests that there are multiple underlying etiologies  of  different  clinical  presentations.  A  clinical  algorithm  based  on  clinical,  biochemical  and ultrasound markers is outlined. Post partum eclampsia can be predicted and monitored with central venous  pressure  and  pulmonary  capillary  wedge  pressure.  The  maternal  syndrome  (proteinuria, edema  and  hypertension)  also  has  differences  in  time of  onset,  severity  and  organ  system involvement as highlighted in several studies. These clinical subpopulations need to be identified and preeclampsia predicted with rigorous definition of different biomarkers of different clinical phenotypes. The  future endeavors  should  be  to  identify  subclinical  disease  in  various  clinical  phenotypes  with these potential biomarkers in prospective longidunal studies.

Author(s) Details

Dr. Jayavelan Ramkumar

Department of Cardiothoracic Surgery, Sri Ramachandra Medical College and University, Chennai-600116, India.

Dr. Nidhi Sharma

Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai-602105, India.

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Noninvasive Antenatal Diagnosis of Fetal RhD Status | Chapter 11 | Current Trends in Medicine and Medical Research Vol. 4

Introduction: Fetal cell-free nucleic acids within the blood stream of a pregnant woman come from fetal  genetic  material  which  can  be  acquired  by  simple  venipuncture  that  reduces  any  risk  to  a minimum. Fetal cell-free DNA can be detected in the mother’s blood stream in the 5th gestation week at the earliest. That enables fetal genotyping at the earliest possible stage of pregnancy which is best done in the 12th gestation week.

Aim: To  determine  fetal  RhD  status  at  RhD  negative  pregnant  women  where  the  father  is  a heterozygote, Dd.

Materials and Methods: The research includes 1540 RhD negative pregnant women, out of which at 30 of them the RhD fetal status had been detected by a PCR technique from the mother’s plasma. The RhD fetal status was confirmed after delivery by serologic analysis at 27 newborn babies. All research patients were submitted to serologic immunohematology testing: blood group typing of red  blood  cell  antigens,  screening  of  irregular  anti-red  blood  cell  antibodies. Fetal RhD status was determined by the plasma of RhD negative pregnant women using the real-time PCR technology in the period from the 12th gestation week until the 31 gestation week. The biological fathers of all 30 fetuses were phenotyped as heterozygote to the RhD antigen. The results showed that 30% of the fetuses are RhD negative, and 70% are RhD positive.

Conclusion: The noninvasive fetal RhD genotyping is not only one precious tool in the management of  RhD alloimmunised  pregnancies,  but  it  also  allows  antenatal anti-D immunoglobulin  prophylaxis exclusiveness for only non-immunized RhD pregnant women carrying RhD positive fetus. Taking into consideration that 30% of the RhD negative pregnant women that carry a RhD negative fetus receive antenatal RhIG prophylaxis with no absolute need forit. At RhD alloimmunised pregnant women the noninvasive genotyping of the fetal blood group enables an easy and safe method in determination of a fetal risk from a hemolytic disease, and at the same time evading a vast laboratory and clinical monitoring of RhD antigen-negative fetal cases.

Author(s) Details

Dr. Emilija Velkova

Institute for Transfusion Medicine of the Republic of Macedonia, Republic of Macedonia.

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Risk Factors for Developmental Dysplasia of the Hip in New-borns and Infants | Chapter 10 | Current Trends in Medicine and Medical Research Vol. 4

Aims: To identify the association between potential risk factors with developmental dysplasia of the hip in neonates.

Study Design: A cross-sectional study.

Place and Duration of the Study: Laboratory of  Lifestyle,  Division  of  Health  Sciences  and Engineering, Campus Celaya Salvatierra, University of Guanajuato Mexico, between June 2014 and February 2015.

Methodology: We include 100 newborns, 36 male and 64 females with age between 4 and 28 days old.  Data  on  birth  weight,  family  history  of  hip  dysplasia,  obstetric  presentation,  mode  of  delivery, swaddling was obtained. The diagnosis of hip dysplasia hip ultrasonography with Graf technique was confirmed. For association Chi  squared and p  value, for the effect was  calculated Odds  Ratio and confidence intervals at 95%.Results:It was found that obstetric presentation and swaddling were associated with developmental dysplasia  of  the  hip  (p  <0.05) with OR  of  5.32  and  4.91  respectively,  and  the  association  was confounded by area of residence with OR adjusted 2.94.

Conclusion: It was conclude that the most important risk factors for developmental dysplasia of the hip in this population were obstetric presentation and excessive swaddling.

Author(s) Details

Dr. Nicolas Padilla-Raygoza

School of Medicine, University of Celaya, Mexico.

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Brucellosis of Testis and Epididymis: An Update of the Literature | Chapter 09 | Current Trends in Medicine and Medical Research Vol. 4

Background: Brucellosis is a zoonotic disease which has the ability to afflict a number of organs and tissues.  Brucellosis  epididymoorchitis  (BEO),  a  complication  of  human  brucellosis,  can  emanate  in complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar with the disease entity which may lead to delay in the diagnosis.

Aim: To review the literature on BEO, in order to document its presentation, diagnosis, management and outcome following treatment as well as update the literature related to the disease.

Methods: Various internet data bases were usedto obtain literature on BEO.

Results  /  Literature  Review: BEO (epididymitis  plus  or  minus  orchitis)  is  a  complication  of  an infection  caused  by  brucella  species  which  can  be  transmitted  via  contact  through  the  respiratory tract, skin, or conjunctiva, and through the gastrointestinal tract pursuant to ingestion of unpasteurized milk/milk products or raw infected meat. BEO does in endemic areas affect 2% to 20% of patients who have been afflicted by brucellosis but the disease can also be encountered sporadically globally in non-endemic areas. BEO could at times be bilateral. The manifestation of BEO is non-specific and it could be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess. Ultrasound  scan  and  MRI  scan  findings  are  not  specific  to  BEO.  Diagnosis  of  BEO  may  be established by (a) history of contact, (b) cultures from blood/epididymal aspirations, (c) various types of laboratory studies including: (I) Culture, (II) PCR, and (III) serology. Laboratory test criteria for the diagnosis  of  Brucellosis  is  divided  into  (I)  those  for  presumptive  diagnosis  and  (II)  those  for confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for about six weeks but at times orchidectomy or drainage of testicular collection  may be necessitated for persistence of symptoms or suspicion of a tumour / testicular abscess. Relapses of brucellosis can occur hence careful follow-up of patients is required.

Conclusions: BEO can occur anywhere globally. A high index of suspicion is thus  required  from clinicians in order to establish early diagnosis of the disease. Most cases of BEO can be effectively treated with combination chemotherapy for about 6 weeks. Clinicians should be aware that brucellosis epididymo-orchitis, brucellosis  epididymitis  and  epididymo-orchitis  exist  and  this  condition  could  be unilateral or bilateral, though more commonly encountered in brucellosis endemic areas because of global travel the disease entity may be encountered sporadically globally.

Author(s) Details

Mr Anthony Kodzo-Grey Venyo MB ChB FRCS(Ed) FRCSI FGCS Urol. LLM

Department of Urology, North Manchester General Hospital, Manchester, United Kingdom.

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The Morphological Basis and Laws of Autopsy Interpretation: Exploring the Relationship between the Basic Medical Sciences, Anatomical Pathology and Clinical Practice | Chapter 08 | Current Trends in Medicine and Medical Research Vol. 4

The  discipline  of  Morbid  Anatomy  or  Anatomical  Pathology  is  a  bridge  between  the  basic  medical sciences  and  the  clinical  sciences [1]. It  is  clinico-pathologic  discipline  which  deals  with  the identification  of  lesions,  interpreting  them  correctly  at  the  macroscopic  and  microscopic  levels  and relating them appropriately to known diseases within the context of the index patient[2].Lesions are the structural alterations seen in tissues as a result of the assault of the injurious agent or pathological process. Thus, anatomical pathology establishes the basis for the ‘dis ease’ or discomfort in patients. The human cell is known to be the most basic unit of life and the tissue is constituted by cells having related functions. Injurious agents affect cell structure and ultimately the physiology and therefore the cell is the natural habitat of the disease processes. Histopathology seeks to interpret the changes in the cell to define the aetiology, evolution and progression of disease.  An afflicted cell continues to perform  its  functions  at  various  degrees  of  capability  as  it  finds  itself  able  to  adapt  to  negative situations  and  maintain  homeostasis.  Each cell’s preserved structure guarantees preserved biochemical constitution and therefore its routine physiological functions. A compromise in structure without resolution or failure of homeostasis automatically leads to poor biochemistry of the cells and poor functioning. Tissues with related or complementary functions constitute organs and organs with related  functions  and  contributory  physiological  relationships  constitute  organ  systems  which essentially  make up the whole human being. The relationship between anatomy, biochemistry and physiology is interminable and inseparable though disease causing agents violate this union.

Author(s) Details

Akinwumi O. Komolafe

Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria and Department of Morbid Anatomy and  Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.

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Screening the Thyroid before Initiating Treatment for Acromegaly? | Chapter 06 | Current Trends in Medicine and Medical Research Vol. 4

Aim: To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize the relevance of screening the screening the thyroid before initiating treatment for thyrotoxicosis.

Presentation of the Case: A 55-year-old lady presented with palpitations, and weight loss of two months’ duration. She also noted her fingers and toes had swollen up, inability to incise properly since two years. Upon examination, she had morphological features clinically diagnostic of acromegaly. Her thyroid was enlargedwas on investigation found to have biochemical evidence of thyrotoxicosis. Fine needle  aspiration  cytology  of  the  thyroid  yielded  colloid  goiter.  Insulin  like  growth  factor-1  was elevated.  Serum  growth  hormone  after  an  oral  glucose  tolerance  test  was  elevated.  Magnetic resonant imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size 11X10X12 mm at the pituitary region with delayed contrast enhancement suggestive of pituitary adenoma. Patient was started on anti-thyroid medications and referred to higher centre, and is awaiting surgery for pituitary adenoma.

Discussion: Among patients with acromegaly the incidence of thyroid diseases is around 78% and it has  the  most  common  presentation  being  nodular  thyroid  disease  as  the  initial  presentation.  It  is uncommon  to  see  patients  presenting  with  symptoms  of  thyrotoxicosis  initially,  who  had  florid morphological features of acromegaly. The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly.  Goiters  seen  in  acromegaly  were  euthyroid  or  autonomous,  are  due  to  the  elevated growth  hormone  levels  independent  of  TSH  action.  In  about  13  to  17%,  thyroidectomies  were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism.

Conclusion: Screening the thyroid  is  important,  as  inadvertent  thyroidectomies  were  performed before acromegaly was diagnosed. When acromegaly co-exists with thyroid dysfunction, the burden of cardiovascular abnormality should be addressed especially, to reduce the morbidity and mortality rate.

Author(s) Details

Dr. C. Rajasekharan

Department of Medicine, Medical College Hospital, Thiruvananthapuram, Kerala, 695011, India.

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Ectopic Prostate in the Uterine Cervix / Female Genital Tract Including Vagina and Vulva: A Review of the Literature | Chapter 07 | Current Trends in Medicine and Medical Research Vol. 4

Background: Men are known to have prostate glands but not women. The thought of prostate gland occurring in the female genital tract in women would be petrifying to all clinicians and people who are not aware of  its biological  behavior. Ectopic prostate in the uterine cervix (EPIUC) and the female genital tract (FGT) is very rare.

Aim: To review the literature on EPIUC/FGT and to document its biological behavior.

Methods: Information  obtained  from  17  references,  was  used to provide the  literature  review  on EPIUC/FGT.

Results: Few cases of EPIUC/FGT have been reported at ages ranging between 21 and 82 years EPIUCs/FGTs  may  be  diagnosed  incidentally  in  biopsies  of  the  cervix/vagina/vulva,  or  in hysterectomy specimens or they may mimic leiomyomas. Histological examination of cervical biopsies or  of  the  cervix  in  hysterectomy  specimens tends  to reveal  ducts  and  acini  some  papillary  or cribriform,  with  prominent  squamous  metaplasia EPIUCs/FGTs which  does show positive Immunohisto-chemical  staining  for  prostate  specific  antigen  (PSA),  prostatic-specific  acid phosphatase (PSAP [PAP]), high molecular weight keratin (for basal cells). EPIUCs reported so far have exhibited benign behavior.

Conclusions: Information obtained from the literature would indicate that EPIUCs / FGTs are rare and so far have exhibited benign behavior. Clinicians should report cases of EPIUC/FGT in order to establish whether or not EPIUCs/FGTs may or may not develop into carcinomas in the future. Ectopic prostate  in  the  uterine  cervix  and  the  female  genital  tract  is  very  rare  and  pathologists  and gynaecologists  may  not  be  familiar  with  this  entity  because  of  its  rarity.  The  differential  diagnoses include:  adenocarcinoma  in  situ,  adenoid  basal  carcinoma  of  the  cervix  and  minimal  deviation adenocarcinoma of the cervix. It is important for pathologists, gynaecologists and all clinicians to be aware  of  the  presence  of  ectopic  prostate  in  the  uterine  cervix,  vagina  and  vulva  in  order  that  an accurate diagnosis is made and in order to avoid unwarranted radical surgical treatment.

Author(s) Details

Mr Anthony Kodzo-Grey Venyo MB ChB FRCS(Ed) FRCSI FGCS Urol. LLM

Department of Urology, North Manchester General Hospital, Manchester, United Kingdom.

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Prediction of Stature from Hand Anthropometry: A Comparative Study in the Three Major Ethnic Groups in Nigeria | Chapter 05 | Current Trends in Medicine and Medical Research Vol. 4

Introduction: Forensic anthropology is a branch of physical anthropology which interacts with other disciplines pertaining to the understanding of crime and its investigations. Many human features have been  used  to  estimate  stature  from  skeletal  remains  and  body  parts  owing  to  the  established relationship between stature and different parts of the body.

Aims: The study was carried out to establish standard anthropometric values for stature estimation by using hand length in the three major ethnic groups in Nigeria.

Study Design: Cross-sectional study.

Place and Duration of Study: University of Maiduguri, Borno State, Nigeria between January -April 2010.Methodology:A total of 407 right hand dominant students (210 males and 197 females) aged 18 –35 years who were purely of Hausa, Igbo and Yoruba origin by both parents and grandparents, are included in this study. Each person has been studied for measurements of stature, hand length and handbreadth.

Results: No significant difference was observed in stature and hand dimensions between the Igbos and Hausas. However the Yorubas are significantly shorter and have shorter hands than the Igbos and the Hausas. The males are significantly taller than the females in all the three tribes and have longer hands than the females in the Hausas and Igbos. Both the sexes of Yorubas are significantly shorter  than  the  Hausas  and  have  significantly  shorter  hands  than  the  Hausas  and  Igbos  when comparison was made between same sexes. The Yoruba females have shorter but wider hands than the Hausa females. No significant difference was observed in stature and hand dimensions between the Hausas and Igbos when compared between same sexes. Regression equations for estimation of stature were formulated for each ethnic group and both sexes.

Conclusion: The study supports the fact that variations are present not only between races but also among  ethnic  groups,  thus  formulae  derived  for  one  ethnic  group  and  both  sexes  may  not  be applicable  to  other  ethnic  group  and  sex. This  study  therefore  provides  standard  anthropometric values and regression equations for the three major ethnic groups in Nigeria..

Author(s) Details

A. I. Numan

Department of Human Anatomy, College of Medical Sciences, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria.

M. O. Idris

Department of Human Anatomy, College of Medical Sciences, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria.

J. V. Zirahei

Department of Human Anatomy, College of Medical Sciences, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria.

D. S. Amaza

Department of Human Anatomy, College of Medical Sciences, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria.

M. B. Dalori

Department of Human Anatomy, College of Medical Sciences, University of Maiduguri, P.M.B.1069, Maiduguri, Borno State, Nigeria.

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Demyelinating Disorders of the Nervous System Due to Osmotic Disequilibrium | Chapter 04 | Current Trends in Medicine and Medical Research Vol. 4

Introduction: In central nervous system (CNS), oligodendrocytes form myelin. In peripheral nervous system large proportions of axons are unmyelinated, instead they are ensheathed by non myelinating schwann cells  and  arranged  in  Remak  bundles.  Osmotic  demyelination  (ODS)  syndrome  is  a neurologic disorder that can occur after rapid correction of hyponatremia. Acute hypernatremia results in  sudden  shrinkage  of  brain  cells  leading  to  parenchymal  or  subarachnoid hemorrhages  and/or subdural hematomas mainly in pediatric patients.

Aim: Our aim is to present a case of hypernatremia which has led on to a flaccid quadriparesis due to brain  stem  demyelination.  Rapid  correction  of  hypernatremia  as  a  cause  for  pyramidal  tract demyelination is not documented in the literature.

Presentation  of  Case: A 53 year old male was brought to the emergency services with suspected stroke. He was treated with intravenous mannitol and oral glycerine from the primary health centre. We detected hypoglycemia (blood sugarwas 50mg/dl-Ref range: ≤70 mg%) and dextrose was given intravenously. Subsequently the patient went into a hypernatremic state with serum sodium 170 milli equivalents  /liter  which  was  corrected  rapidly.  This  was  corrected  over  48  hours  to  140 milli equalents/litre. The rate of correction exceeded 0.62 millimols/liter/hour (Ideal: 0.5 mmol/L/h). On the 6th  day  the  patient  developed  acute  quadriparesis.  Magnetic  resonance  imaging  (MRI)  of  brain revealed  bilateral  symmetric  demyelination  of  the  corticospinal  tracts.  Over  six  months  the neurological deficit improved with complete resolution of the changes in previous MRI.

Discussion: Osmotic Demyelination Syndrome (ODS) has been a recognized complication of rapid correction of hyponatremia. Experiments in animals and clinical experience suggest that correction of chronic hyponatremia should be kept at a slow rate to combat this complication. The characteristic sites  include  pons  and  basal  ganglia.  Such  a  complication  has  not  been  described  due  to  rapid correction of hypernatremia. This is probably the first case report in the literature where acute onset of quadriparesis resulted from demyelination of the pyramidal tract consequent to a rapid correction of hypernatremia. We had to wait about 6 months for the patient to obtain a complete functional recovery and the neuro imaging was repeated after 6 months to confirm the disappearance of the initial findings thus implicating rapid correction of hypernatremia as the cause of his morbidity.

Conclusion: This  is  the  first  time  extrapontine  reversible  myelinolysis  due  to  rapid  correction  of hypernatremia has been documented. To prevent this potentially fatal complication it will be prudent if hypernatremia  is  corrected  slowly.  Osmotic  Demyelination  Syndrome  (ODS)  can  occur  with  rapid correction of hyponatremia or hypernatremia. The first of its kind our report highlights the importance of rate of correction of Sodium in the brain which may functionally interfere with the rapidly conducting fibers rich in oligodendrocytes resulting in transient or permanent neuronal dysfunction.

Author(s) Details

Dr. C. Rajasekharan

Department of Medicine, Medical College Hospital, Thiruvananthapuram, Kerala, 695011, India.

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