Pathophysiology and Complications of Portal Hypertension in Liver Cirrhosis | Chapter 7 | Medical Science: Recent Advances and Applications Vol. 5

Portal hypertension is responsible for most of the complications that mark the transition from compensated to decompensated cirrhosis, namely variceal haemorrhage, ascites and hepatic encephalopathy. Portal hypertension also seems to be pathogenetically closely linked to the development of pulmonary complications seen in liver disease: hepatopulmonary syndrome and porto-pulmonary hypertension.

 

Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and rupture. Ascites results from sinusoidal hypertension (portal hypertension) and sodium retention, which is, in turn, secondary to vasodilatation and activation of neurohumoral systems. The predictive value of noninvasive methods such as fibroscan, spleen size, portal vein diameter, and transient elastography in the diagnosis of oesophagal varices remains to be established. Hepatorenal syndrome results from extreme vasodilatation with extreme decrease in effective blood volume and maximal activation of vasoconstrictive systems, renal vasoconstriction, and renal failure, which is probably an indirect effect of the changes in splanchnic circulation. Spontaneous bacterial peritonitis, a frequent precipitant of the hepatorenal syndrome, results from deficient immunity and mucosal defences, resulting in pathological gut bacterial translocation. Hepatic encephalopathy results from portosystemic shunting and hepatic insufficiency, leading to the accumulation of neurotoxins, mainly ammonia, in the brain. The development of portal hypertension and its complications has important prognostic value. Management of portal hypertension needs to be individualised to attain maximum benefit and appropriate utilisation of scarce resources.

 

 

Author (s) Details

Harshal Rajekar
Medicover Hospitals, KLE, Bhosari, Pune, India.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5542

Risk-benefit Analysis of Antidepressants Use during Breastfeeding to Treat Postpartum Depression | Chapter 6 | Medical Science: Recent Advances and Applications Vol. 5

 

Postpartum depression is classified as a major depressive disorder, and the causes are not well known. Postpartum depression affects approximately 14.5% of women, and it can affect both mother and infant. Therefore, rapid attention and treatment are imperative. The causes of postpartum depression are not well known; but there are many factors that may increase the risk of developing the disease. Women should be carefully evaluated after childbirth for depressive or anxiety symptoms with adequate screening tools and methods to avoid diagnostic errors; especially when dealing with women who present risk factors. The pharmacological approach often represents one of the most realistic options for treatment. However, women may be reluctant to take antidepressants because of the fear of adverse effects on the infant, since most drugs pass into breast milk. The objective of this review is to evaluate the risk-benefit of using antidepressants during breastfeeding to treat postpartum depression.

 

An electronic search was performed by using the PubMed database from January 2001 through December 2010. The search was limited to articles in the English language and to articles that relate to human research. Manual searches of bibliographies were also conducted to identify additional pertinent studies.

 

The use of antidepressants that do not appear in infants’ plasma, for which use during breastfeeding is better documented and at standard therapeutic doses is recommended, such as sertraline and paroxetine. Fluoxetine has a long half-life, which can lead to a long infant exposure through breast milk, and citalopram can cause adverse effects in infants exposed through breast milk. Therefore, citalopram and fluoxetine should not be used as first-line treatments. If these drugs are used by a nurse, they should take the lowest effective dosage, and their infants should be monitored. 

 

This study focused on emphasising the importance of postpartum depression treatment, always considering its repercussions for the breastfed infants. Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk.

 

Author (s) Details

Leal, Vânia
Pharmacy Department, Coimbra Health School, Polytechnic University of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal.

 

Fonseca, Ana Paula
Pharmacy Department, Coimbra Health School, Polytechnic University of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal and H&TRC - Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, S. Martinho do Bispo, 3046-854 Coimbra, Portugal.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5520

A Review of FTIR Spectroscopy Used in COVID-19 Analysis | Chapter 5 | Medical Science: Recent Advances and Applications Vol. 5

The worldwide risk that the coronavirus pandemic presents to millions of people is widespread. The cause of this pandemic, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was initially determined in Wuhan, the capital of Hubei province, and it has since spread to other parts of the world. Early coronavirus identification improves the possibility of infection treatment and inhibits the virus's transmission. The early detection and diagnosis of COVID-19 has made extensive use of spectroscopic methods, including infrared spectroscopy. Fourier transform infrared spectroscopy can identify changes in the biochemical events occurring in cells before and after a viral infection. It detects molecular vibrations caused by shifts in the electric dipole moment in chemical bonds, which are brought about by light absorption in the electromagnetic spectrum's 400–5000 cm-1 infrared region. However, because each spectral detection category uses a different detection technique, their sensitivity and specificity change. This review focuses on recent uses of FTIR spectroscopy in the detection of COVID-19.

 

Author (s) Details

Andrei A. Bunaciu
S.C. AAB IR Research S.R.L., Bragadiru – Ilfov District, 077025, Romania.

 

Hassan Y. Aboul-Enein
Pharmaceutical and Medicinal Chemistry Department, Pharmaceutical and Drug Industries Research Division, National Research Center, Cairo 12622, Egypt.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5474

Physiological Correlation and Connection Between Cortical Spreading Depression of Leao and Epileptic Seizures| ChaPhysiological Correlation and Connection Between Cortical Spreading Depression of Leao and Epileptic Seizures| Chapter 4 | Medical Science: Recent Advances and Applications Vol. 5pter 4 | Medical Science: Recent Advances and Applications Vol. 5

Background: Epilepsy is a chronic neurological disease characterised by recurrent episodes of involuntary movement called seizures. Seizures are the physical representation of excessive and disorganised electric impulses of the neurons.

 

Objectives: The discovery of cortical spreading depression (CSD) 80 years ago, by Leao, was intimately connected to epilepsy research performed. In this study, it is found that monitoring of brain hemodynamics, metabolic, ionic and electrical activities are very similar in the two pathophysiological events. Here, the study presents the coupling between epilepsy and cortical spreading depression while monitoring mitochondrial NADH together with other brain physiological parameters in real time in vivo.

 

Methods: Rats and Mongolian gerbils were used in three models of induction of epilepsy, namely injection of Metrazol, exposure of the rats to hyperbaric oxygenation in a pressure chamber and using a strain of gerbils that are developing seizures spontaneously. Brain oxygen levels, mitochondrial NADH, extracellular potassium levels, DC steady potential and EEG in the very slightly anaesthetized animals were monitored. Preliminary monitoring of neurosurgical patients was performed in the current study.

 

Results: The effects of locally applied Metrazol were tested in awake animals. The Metrazol (100 mg/ml) was applied epidurally using the cannula. The most typical response to Metrazol occurs 3-5 min after the administration of the drug. The effects of Metrazol on brain metabolism and its impact upon the oxidation-reduction state of NADH are of great interest. The results could be summarised as follows: 1. In almost all animal models tested, cortical spreading depression was developed and recorded 1-3 minutes after seizure activity. 2. The mitochondrial NADH redox state was more oxidised during the two events. 3. The oxidation of NADH during the CSD was 3-4 times relative to the seizure interval. 4. The increase in extracellular potassium levels was also 3-4 times higher during the CSD event. 4. The monitored head-injured patient provided results that were in very high correlation with the animal studies' results.

 

Conclusions: Under the two recorded events, a clear correlation between the process of oxygen(energy) demand or consumption and oxygen(energy) supply was found. The results suggest that the accumulation of extracellular potassium during the epileptic activity is probably the trigger for the development of CSD in the 3 models used as well as in the neurosurgical patient tested.

 

Author (s) Details

Avraham Mayevsky
The Mina & Everard Goodman Faculty of Life Sciences and the Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 5290002, Israel.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5448

 

Revisiting Psychiatric Comorbidity: Concepts and Challenges | Chapter 3 | Medical Science: Recent Advances and Applications Vol. 5

Psychiatric comorbidity is a reality that cannot be ignored. The concept of comorbidity was transposed from medicine to psychiatry in the 1980s. Since then, psychiatry has witnessed a tremendous growth in the research on comorbidity. However, comorbidity has proved to be a double-edged sword. Psychiatric comorbidity has important diagnostic and treatment implications. It is a guiding principle for organising psychiatric classifications. On the other hand, despite the large amount of research, the nosological and diagnostic aspects of psychiatric comorbidity remain unresolved. Both underestimation and overestimation of comorbidity have led to problems that have challenged the very basis of psychiatric classifications and diagnostic practices. Future research focusing on identifying patterns of comorbidity and adopting more nuanced diagnostic approaches in clinical settings could be helpful.

 

Author (s) Details

Subho Chakrabarti
Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

 

 

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Comparative Evaluation of Hydrogen Peroxide and Povidone-Iodine as Intra-operative Scolicidal Agents for Hydatid Cyst Management | Chapter 2 | Medical Science: Recent Advances and Applications Vol. 5

Background: Pulmonary echinococcosis is caused by the small tapeworm Taenia echinococcus, which commonly produces hydatid cystic disease of the liver. As hydatid cysts enlarge, they compress the surrounding parenchyma, damaging the surrounding tissues by mechanical and toxic factors. Secondary bacterial infections complicate the picture in 10 to 25% of cases, with either spontaneous or traumatic rupture in 5-10% of the cases.

 

Objectives: A prospective randomised study designed to compare results of intra-operative applications of povidone-iodine with those of hydrogen peroxide during surgery for hydatid cysts.

 

Methods: This study includes 160 patients with pulmonary and/or hepatic univesicular hydatid cysts who were admitted between 1st March 2004 through 29th February 2008, at the Unit of Chest Surgery, Hadhramout University Hospital, Almukalla, Yemen. Group A consisted of 80 patients for whom hydrogen peroxide was used; Group B consisted of 80 patients for whom Povidone-Iodine, was used. Each cyst was examined both macroscopically and microscopically to identify the effects of the used scolicidal agent on the wall. Postoperatively, patients received Albendazole as a scolicidal drug for one year. Follow-up times ranged between 48 and 84 months. Chest x-rays and abdominal ultrasound examinations were performed every six months to detect any recurrences. Sample and data percentages, mean, and the standard deviation were used to report data variations, using a bivariate analysis (SPSS Ltd, Quarry Bay, Hong Kong)

 

Results: There was no perioperative mortality in either of the two groups. Group A: one case of postoperative prolonged airleak and two cases of wound infection. No recurrences were reported. Mean hospital stay was 5.5 ± 1.1 days. Group B: two cases of prolonged air leak, three cases of persistent cough and hemoptysis, one developing bronchopleural fistula that healed (air leak ceased after 19 days), two cases of wound infection, one had subphrenic abscess, nine cases of recurrences, one on the diaphragmatic pleura, two with deep chest wall cysts at sites of thoracostomy tubes, four intraperitonial recurrences, two in the same liver lobe. Recurrences occurred in 11% of the subjects (9/80; p value = 0.028). The mean hospital stay was 9.6 ± 1.5 days. On histologic examination of Group A, the cyst wall lost its integrity, lustre and viability and became friable. In Group B, the cyst wall maintained most of its lustre, integrity, and viability and did not become friable. Moreover, microscopic examination of sections in the wall of cysts postoperatively showed that in cysts injected with 10 % Povidone-Iodine, the inner layer of cyst wall contained not only germinal pyknotic cells, but also some cells with nuclear fragmentations (karyorrhexis). 

Conclusions: Hydrogen peroxide is a more effective and safer scolicidal drug than Povidone-Iodine, as shown by the differences in mean duration of hospital stay and postoperative recurrence rate significance. Statistical significance of recurrent cases among patients treated with povidone iodine indicates that it is inferior to hydrogen peroxide in this study. However, further research needs to be performed using higher doses of Albendazole for much longer periods, up to several years. The study recommends that Albendazole be administered in high doses in all cases of recurrence that develop during the first year. The impact of this infectious disease in endemic areas is such that continuous, focused research is warranted.

 

Author (s) Details

Hamdy D. Elayouty
Department of Cardiothoracic Surgery, Suez Canal University, Egypt, and Hadhramout University, Yemen.

 

Ali M. Baterfy
Department of General Surgery, Faculty of Medicine, Hadhramout University, Yemen.

 

Soliman H. Alkamash
Department of General Surgery, Faculty of Medicine, Suez Canal University, Egypt.

 

Ahmed H.Dosoky
Suez Canal University, Egypt.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5233

Managing Pregnancy and Delivery in a Patient with Von Willebrand Disease: A Case Report of Tailored Hemostatic Care | Chapter 1 | Medical Science: Recent Advances and Applications Vol. 5

 

Introduction: It is a lifelong bleeding disorder in which your blood doesn't clot properly. People with the disease have low levels of von Willebrand factor, a protein that helps blood clot, or the protein doesn't perform as it should due to a deficiency of Von Willebrand factor (VWF), either qualitative or quantitative. Both men and women are equally affected, and clinical presentation is more severe in females of reproductive age, and it is potentially life-threatening, particularly during labour and early puerperium.

 

Aim of Study: To ascertain the importance of Von Willebrand Disease in Pregnancy and its multidisciplinary approach for management.

 

Materials and Methods: The case of a 35-year-old Primigravida woman who had Von Willebrand disease diagnosed before she became pregnant, was described.

 

Results: The institutional recommendation for addressing this condition includes getting and keeping  ready Von Willebrand factor and factor VIII (FVIII) for administration throughout the caesarean delivery and in the postpartum period.   This was ensured so as to increase Von Willebrand factor levels, and hence successful management of intrapartum and postpartum complications, along with preventing the need for blood and blood products transfusions and subsequent haemorrhagic shock. Though it was not administered throughout the stay of patient in the hospital.

 

Conclusion: This case highlights the importance of following institutional protocol for ascertaining the presence of hemostatic agents during labour and early puerperium. Management of females with this illness throughout the antenatal, intrapartum and postpartum period, with the combined consultation of a multidisciplinary team comprising obstetricians, haematologists, and other medical specialists, is recommended. Since it is an inherited disorder, preconceptional counselling through to antenatal screening is recommended.

 

Author (s) Details

Rohina S. Aggarwal
Department of Obstetrics & Gynaecology, Institute of Kidney Disease and Research Centre (IKDRC – ITS), Ahmedabad, Gujarat, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/4089