Medical Science: Recent Advances and Applications Vol. 8

Evaluating the Efficacy of Microbubble as Local Drug Delivery System in Endodontic Management: An In-vitro Study

2025-07-16T10:56:28+00:00

Background: Microbubbles (MBs) are gas or vapour-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Endodontics is one area where microbubble technologies are gaining popularity in medicine and dentistry. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity. The European Society of Endodontists and the American Association of Endodontists recommend the use of antibiotic pastes made of two or three different antibiotics, or calcium hydroxide (CH) paste, to eliminate intracanal microbial colonies. Triple antibiotic paste (TAP) is traditionally prepared by diluting minocycline, metronidazole, and ciprofloxacin using propylene glycol. Despite the excellent efficacy of clindamycin-modified TAP (mTAP) against endodontic infections, concerns remain regarding the penetrability of these antibiotic pastes.

Objectives: This study aimed to examine whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant.

Materials and Methods: This study was conducted at SRM Kattankulathur Dental College and Hospital. An Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. Group 1 received TAP (metronidazole, ciprofloxacin, and minocycline; vehicle: propylene glycol at 1: 1: 1 ratio, while Group 2 was treated with Triple antibiotic-infused Microbubble. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. GraphPad Prisma 8.3 Software (GraphPad Software Inc., La Jolla, CA) was used to perform the statistical analysis.

Results: After 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP).

Conclusion: In this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. The possible explanation for the improved efficacy of triple antibiotic-infused MBs is due to the microbubble size, which facilitates the drug’s deeper delivery into the dentinal tubules. Within the limitations of the study, it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered a novel technique for local drug delivery systems in endodontic management.

Therapeutic Management and Prognostic Factors of Upper Gastrointestinal Bleeding at Sikasso Regional Hospital

2025-07-16T11:02:19+00:00

Introduction: Upper digestive haemorrhage (UDH) is one of the main digestive emergencies and remains a major cause of morbidity and mortality in Mali. UDH is defined as any bleeding from the mouth following efforts to vomit (hematemesis) or from the anus (melena) whose lesion is located upstream of the angle of Treitz.

Study Aim: The aim of this study was to describe the therapeutic profile and outcome of patients suffering from upper digestive haemorrhage.

Methodology: This was a prospective study carried out in the internal medicine department of the Sikasso Regional Hospital from August 2022 to July 2023. All adult patients presenting with upper digestive haemorrhage and having given their consent were included. A descriptive analysis of the study sample was carried out. Data were analysed using SPSS version 21 software. The significance level was set at 5%.

Results: Sixty-three patients were enrolled. The mean age was 49.7 ± 18.99 years, with a male-female sex ratio of 2.2. The hospital frequency of upper digestive haemorrhage was 8.99%. Ruptured oesophagal varices (37.5%) and peptic ulcer (25%) were the main etiologies. Pharmacological treatment was dominated by proton pump inhibitors (85.7%). Hemostasis endoscopy accounted for 3.17%. The evolution was marked by hemorrhagic arrest (69.84%), recurrence of haemorrhage (11.11%) and death (19.04%), the main cause of which was hemorrhagic shock (58.3%). The study found no statistically significant relationship between prognosis and etiologies (P = 0.11) and length of hospital stay (P = 0.18).

Conclusion: This study shows that the hospital frequency of upper digestive haemorrhage and its lethality remain high at the Sikasso regional hospital, despite under-frequentation. Hemostasis endoscopy remains a challenge for Sikasso Hospital. A holistic strategy of communication and community aware- awareness-raising, combined with adequate technical facilities, will help to improve patient care and outcomes.

Understanding Mechanical Low Back Pain: A Physiotherapeutic Perspective

2025-07-16T11:10:50+00:00

Mechanical Low Back Pain (MLBP) represents a prevalent musculoskeletal disorder that significantly affects individual well-being and workforce productivity. This chapter provides an in-depth examination of the anatomical and biomechanical contributors to MLBP and presents a structured, physiotherapy-centred framework for its evaluation and management. Emphasis is placed on multimodal treatment strategies—including manual therapy techniques, therapeutic exercise programs, pain management modalities, and ergonomic training. The chapter also explores the importance of functional rehabilitation and patient education in promoting long-term recovery and preventing recurrence. Through a holistic and evidence-informed approach, physiotherapists can effectively restore mobility, reduce pain, and empower patients to maintain spinal health and active lifestyles.

Morphological Evaluation of Pterygoid Hamulus Through Computed Tomography

2025-07-16T11:13:37+00:00

The pterygoid hamulus, a small hook-like projection of the sphenoid bone, can be a source of pain in the pharyngeal region. In some cases, it may also cause swelling and discomfort in the palate. Hereby by the authors present a case report of a 38-year-old male presenting with palatal swelling with dull pain in the palatal or oropharyngeal region and mild pain at the site of swelling. He also complained about referred pain to the ear, throat, temporomandibular joint (TMJ), or maxillary region. On palpation, he complained about the tenderness over the hamular region, and intraorally, the hamulus was palpable.

A CT scan of the facial skeleton revealed elongation of both the medial and lateral plates of the pterygoid processes. The patient was counselled properly and responded well to the conservative mode of treatment.

Myofascial Release in Musculoskeletal Physiotherapy: Anatomical Foundations, Mechanisms, and Clinical Application

2025-07-16T11:16:40+00:00

Myofascial release (MFR) is a manual therapy approach used to address fascial restrictions that contribute to musculoskeletal pain and limited mobility. This chapter aims to provide a concise overview of the anatomy and function of fascia, explain the pathophysiological basis of fascial dysfunction, and discuss the principles and clinical techniques of MFR. It highlights common indications and precautions, along with current evidence supporting its role in improving the range of motion and reducing pain. While emerging research supports MFR as an adjunct in musculoskeletal rehabilitation, variability in protocols and limited long-term data indicate the need for further studies.

Effect of SARS-CoV-2 Virus S1 Protein binding to ACE2 on ENaC Regulators in Cultured Adult Human Fungiform (HBO) Taste Cells

2025-07-23T10:09:07+00:00

Early, but often prolonged, symptoms of COVID-19 infection are the loss of taste, smell, and chemesthesis. The SARS-CoV-2 spike protein contains two subunits, S1 and S2. S1 contains a receptor-binding domain, which is responsible for recognizing and binding to the ACE2 receptor, a component of renin-angiotensin-aldosterone system (RAAS). We hypothesize that S1 binding to ACE2 receptor can alter the balance between the two major RAAS pathways ACE₁/Ang II/AT₁R and ACE₂/Ang-(1–7)/MASR1, leading to changes in ENaC expression and responses to NaCl in salt-sensing human fungiform taste cells. To test this hypothesis, we used molecular techniques to demonstrate that G-protein-coupled estrogen receptor (GPER1), transient receptor potential cation channel subfamily V member 1 (TRPV1) and components of RAAS are expressed in \(\delta\)-ENaC-positive cultured adult human fungiform (HBO) taste cells. Our results suggest that RAAS components function in a complex with ENaC and TRPV1 to modulate salt sensing and thus salt intake in humans. Our results further show that the binding of a mutated S1 protein to ACE2 decreases ACE2 expression in HBO cells.

Examining the Impact of Cocaine Exposed Spermatogonia on the Behaviour and Executive Functions of Naive Offspring: A Nature Vs Nurture Perspective

2025-07-28T09:40:00+00:00

In recent decades, much of Western society has been plagued by abuse of refined cocaine, which has become a major public health problem, currently impacting over 20 million adults and adolescent youth. In the USA, it currently impacts over 20 million adults and adolescents aged 12 and above, with a similar, alarming prevalence in other global populations. In chronic use, cocaine contributes to dopaminergic euphoria and aberrant behaviour, and may contribute to epigenetic damage to gene expression in unsuspecting offspring. The study aimed to investigate the effect of chronic cocaine use by males on the offspring of naïve females. In order to conduct the study, groups of 60-day old lean LA/Ntul//-cp rats were reared from weaning on standard Purina chow and house water, and administered 0 (Controls), 30 (Low Dose), or 60 (High Dose) mg/kg body weight of cocaine HCL daily for 90±2 days to fully encompass the duration of spermatogenesis. Opiate treated males were then mated with 82±3 day-old normally reared naive virgin females of the same strain that had never previously been exposed to cocaine or to a mating partner. Behavioural activity of each dosage level was assessed by subjecting the offspring post-weaning at 21 days of age with a Stoelting activity wheel and a Calvin Hall open access exploratory field test. In addition, offspring were tested only once, so as to preclude the chronological opportunity for learned behaviour following repeated trials, and to provide support for the contributions of nature vs. nurture in determining the outcome of offspring impacted by preconception opiate exposure. Offspring of pups were found to exhibit dose-related decreases in Stoelting wheel activity, with the greatest decrease at the highest dose administered (p=<0.01). Cocaine treatment resulted in a latency in onset of exploratory activity at both dosage levels, and decreased exploratory activity in both inner squares and outer squares at the low dose group. In contrast, the High Dose group demonstrated an increase in outer square exploration and in the total numbers of squares explored compared to the Low Dose groups or Controls. During the early stages of neurogenesis, epigenetic errors due to chemical or nutritional injury present at fertilisation may survive thereafter and, as occurred in this study, likely impact the behaviour of the offspring later in life. These results suggest that male cocaine exposure during spermatogenesis may result in longstanding dose-related behavioural changes in the offspring of naive females and may predispose them to potential cocaine stimulant-linked behavioural changes upon weaning, adolescence and later stages of life.

Effect of Hypertension with Its Severity on Brainstem Auditory Evoked Potentials

2025-07-28T09:42:44+00:00

Background: Hypertension is one of the most important public health problems worldwide. Central nervous system dysfunctions are common in these patients due to micro-infarctions caused by arteriolar spasm of cerebral blood vessels. Though hypertension is a silent disease, it doubles the risk of coronary heart disease (CHD), congestive heart failure (CHF), stroke, renal failure, and peripheral arterial disease. Thus, it affects almost all organ systems of the body and contributes to major morbidity and mortality. This will lead to hypoperfusion, subcortical white matter demyelination, and cognitive decline. The Brainstem auditory evoked potentials (BAEP) are far-field subcortical electrical potentials which provide an objective electrophysiological method for assessing the auditory pathway from auditory nerve to the brainstem.

Aim: The aim of the study was to assess the effect of increasing severity of hypertension on the brainstem auditory pathway, among patients with essential hypertension.

Methods: A total of 75 subjects aged 30 to 60 years were included in the study. Patients having systolic BP ≥140mmHg and diastolic BP≥90mmHg were included in this study as the study group. Blood pressure was measured by using a mercury sphygmomanometer. Among them, 25 were healthy age and sex matched controls (Group I), 25 were stage 1 hypertensives (Group IIa), and 25 were stage 2 hypertensives (Group IIb) as per JNC 7 criteria. The absolute latencies I, III, V and interpeak latencies (IPL) I-III, III-V, I-V were recorded by using Neuroperfect EMG 2000 system with installed BAER, and data were statistically analysed using Student's unpaired t test.

Results and Discussion: All the hypertensive (Group IIa and IIb) patients were found to have significantly prolonged absolute latency of wave III, V and IPL III-V, I-V as compared to that of normal healthy controls. The wave V latency was prolonged as the severity of hypertension increased. Intergroup comparison among hypertensive patients (Group IIa and IIb) revealed a significant prolongation of absolute latency of Wave III, V and IPL III-V, I-V. The results of the present study are consistent with several studies where BAEP wave latencies and inter-peak latencies were found to be prolonged in hypertensive patients when compared to healthy controls. The results suggest the involvement of the auditory pathway at the level of the inner ear and the auditory pathway up to the medulla, and also that the auditory processing time along the auditory pathway prolongs as the severity of hypertension increases.

Conclusions: The results show that there exists a sensory deficit along with synaptic delay across the auditory pathway in hypertensive patients, and the sensory deficit progresses with the severity of the disease. So, it is recommended that an integrated work of otorhinolaryngologists and audiologists, along with cardiologists, is necessary to improve the quality of care in the therapy and rehabilitation of these patients.

Stem Cells in Neurocancerology: The Case of Teratocarcinoma and Glioblastoma

2025-07-28T09:46:10+00:00

Background: Neural stem cell research is a promising field when considering brain disease and glioblastoma therapy. Efficient strategies for glioblastoma treatment were established targeting oncoproteins or growth factors (i.e. IGF-I, AFP) present during embryonic and fetal development of nervous system tissues originating from neural stem cells.

Methodology and Results: In a preclinical experiment, the PCC4 stem cells (derived from teratocarcinoma), which give rise to neoplastic neural cells, were transfected in vitro with the anti-IGF-I vectors (antisense and triple helix approaches). This strategy completely hindered the synthesis of the IGF-I and converted the stem cells into immunogenic cells (expressing MHC-I and B7), inducing an in vivo anti-tumour effect. This strategy was successfully applied to glioblastoma therapy. The anti-IGF-I strategy was recently combined with nanotechnology. The application of nanotechnology in stem cell research is based on the use of nanoparticles (NP) for targeted therapeutics, including gene therapies. NP (i.e. theranostic iron oxide) and IGF-I target related signal transduction pathways that lead to cancer cell apoptosis. Other studies have demonstrated that NP loaded with chemotherapy selectively killed cancer stem cells while sparing normal cells.

Conclusion: Stem cell- and immunotherapies, including anti-IGF-I gene therapy combined with nanotechnology targeting glioblastoma, are in permanent progress.

Integrative Teaching in Plastic and Reconstructive Surgery

2025-07-28T09:56:21+00:00

Plastic surgery has undergone a remarkable evolution, expanding beyond traditional reconstructive techniques to include a wide spectrum of surgical and non-surgical procedures. The growing complexity of patient care and the heightened emphasis on holistic, patient-centred approaches have necessitated a re-evaluation of educational strategies in the field. Integrative teaching models are emerging as a response to these evolving demands, aiming to harmonise conventional surgical instruction with complementary therapies, interdisciplinary collaboration, and progressive pedagogical methods. This comprehensive review explores the principles, practices, benefits, and challenges of integrative teaching in plastic surgery. Emphasising structured curricula, interdisciplinary exposure, mind-body interventions, simulation-based training, and evidence-driven innovations, the review underscores how integrative teaching can cultivate technically proficient, empathetic, and adaptable plastic surgeons capable of meeting the multifaceted needs of modern patients. The chapter will provide an overview of integrative teaching to the residents and young teachers of Plastic and Reconstructive Surgery.

Multiple Characteristics of Mouth Opening in Temporomandibular Joint Disorders

2025-07-28T10:01:24+00:00

The Temporomandibular Joint (TMJ) of the human body is a complex joint. Its movement is primarily controlled by the muscles of mastication along with other structures of the head and neck. Restricted mouth opening in itself is a symptom of TMJ disorders. TMJ arthritis is one of the common disorders found in this joint. Radiological investigations, including MRI, are beneficial in the diagnosis of TMJ Dysfunction. It is the most prevalent type of musculoskeletal disorder with different clinical features. Most common presentation is the limited mouth opening (LMO), which could be arthrogenic or myogenic in nature. This further leads to activity limitation of the subject suffering from this disorder. Use of the metal ruler to measure the limited mouth opening is a common assessment method, along with other simple and complex procedures to accurately measure the mouth opening at TMJ. The treatment of TMJ issues frequently entails a multidisciplinary strategy that includes behavioural, physical, and pharmaceutical therapies. Physiotherapy, cognitive behavioural therapy, occlusal splints, analgesics, and non-steroidal anti-inflammatory medications (NSAIDs) are common forms of treatment. Thus, mouth opening, an important function of TM Joint mostly affected by all TM Joint Disorders, is also an important indicator that diagnosis and management are necessary to prevent activity limitation.

Medicolegal Autopsies: Role of Histopathology in Discovering Interesting and Incidental Findings

2025-08-02T12:14:02+00:00

Introduction: An autopsy, also known as a post-mortem examination, is a highly specialised surgical procedure and consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury. Autopsy is the gold standard to ascertain cause of death, particularly in settings with suspicious, sudden, obscure, unnatural, litigious or criminal deaths and with research and evaluation in the medical field.

Aims and Objectives: The aim of this study was to determine the histopathological findings related or unrelated to the cause of death and to highlight various incidental and interesting gross and microscopic findings in autopsies.

Materials and Methods: This was a retrospective study of 7 years where organs of a total of 53 medicolegal postmortems were examined for histopathological lesions, from 2008-2014 in the Department of Pathology, Bidar Institute of Medical Sciences (BRIMS), Bidar, Karnataka, India. The commonest cause of death was pulmonary oedema. The most common incidental finding was atherosclerosis, which was associated with high-risk factors of alcohol consumption and smoking.

Results: Autopsy cause of death and contributing findings were based on the gross and microscopic findings combined with information collected from the autopsy surgeon and Department of Forensic Medicine and Toxicology, Bidar Institute of Medical Sciences (BRIMS), Bidar. Among various histopathological findings, the commonest microscopic finding was pulmonary oedema followed by fatty liver, and the commonest incidental finding was atherosclerosis.

Conclusion: In conclusion, atherosclerosis was found to be the commonest incidental finding which led to ischemic heart disease (IHD), left ventricular hypertrophy (LVH) and sudden death in the 20- 40 years age group in males. This was associated with a history of habitual alcohol consumption and smoking, both of which are high-risk factors contributing to the development of IHD. Incidental histopathologic findings may not be found to influence the cause of death but nonetheless reveal many interesting facts related to epidemiology, which help in academic and research purposes. The significance of a careful postmortem examination can be summed up in the old saying “the dead teach the living”.