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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/192/340-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/191/339-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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 5^th gestation week at the earliest. That enables fetal genotyping at the earliest possible stage of pregnancy which is best done in the 12^th 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 12^th 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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/190/338-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/189/337-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/188/336-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/187/335-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/185/333-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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.

Read full article: http://bp.bookpi.org/index.php/bpi/catalog/view/43/186/334-1

View Volume: https://doi.org/10.9734/bpi/ctmmr/v4

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