Medical Science: Updates and Prospects Vol. 2

Pathologic and Immunophenotypic Characterisation in Canine Splenic Lymphoma

Mohanapriya, T — 2025-12-06

This chapter provides a comprehensive overview of the pathological and immunophenotypic characterisation of canine splenic lymphoma, focusing on detailed diagnostic approaches and subtyping through integrated analysis of gross, cytological, histopathological, and immunohistochemical features in both biopsy and necropsy specimens.

Background: Lymphoma constitutes the third most common malignant neoplasm, accounting for approximately 7-24% of all canine neoplasms and 83% of all canine hematopoietic malignancies. The aetiology of canine lymphoma (cL) is multifactorial, and environmental factors play a pivotal role.

Aim: This study aimed to characterise canine splenic lymphoma through a comprehensive evaluation of gross, cytological, histopathological, and immunophenotypic features in both biopsy and necropsy specimens, and to distinguish primary splenic lymphomas from splenic involvement in multicentric disease.

Methodology: The study was conducted in the Department of Veterinary Pathology, Madras Veterinary College, India, for one year (June 2011 to June 2012). An observational, descriptive investigation was undertaken on confirmed cases of canine splenic lymphoma submitted for routine diagnostic evaluation. Eight canine cases were diagnosed as splenic lymphoma, comprising six multicentric diffuse large B-cell lymphomas (DLBCL) and two primary splenic B-cell lymphoblastic lymphomas (B-LBL). Specimens were obtained from surgically excised splenic biopsies and post-mortem examinations. Grossly, all spleens exhibited marked splenomegaly, with weights ranging from 120 to 560 g. Patient data revealed a mean age of 8.56 years, with no sex predilection and representation from multiple breeds. Cytological and histopathological classification was performed according to the updated Kiel and World Health Organisation (WHO) criteria. Immunohistochemical analysis employed a Pan T-cell marker (CD3) and a B-cell marker (CD79a) to determine lineage.

Results: The age recorded in this study ranges from 3.5 to 12 years with mean of 8.2 years, and found equal distribution of sex. All cases demonstrated a CD3-negative/CD79a-positive immunophenotype, consistent with high-grade B-cell lymphoma. Six cases represented splenic involvement in multicentric lymphoma, whereas two were classified as primary splenic lymphomas. The cytological study of lymphoma revealed a homogenous clonal population of lymphoblasts with lymphoglandular bodies with variation in multiple nucleoli and scanty basophilic cytoplasm. Histology showed the white and red pulps were completely substituted by B-LBL neoplastic cells. Cells showed anisokaryosis, prominent nuclei, and chromatin margination. Neoplastic cell showing nuclear indentation with a large, single, prominent nucleolus. Histomorphological features corresponded to their cytological classification, and gross lesions were characterised by diffuse enlargement and loss of normal splenic architecture.

Conclusion: The integration of gross pathology, cytology, histopathology, and immunohistochemistry enables accurate subtyping of canine splenic lymphoma, with CD3 and CD79a serving as reliable markers for lineage determination. In this series, high-grade B-cell lymphoma was the predominant subtype, underscoring its clinical relevance and the value of immunophenotyping in routine diagnostic practice. Canine lymphoma is a treatable neoplasm with single-agent or multiple-agent chemotherapy; thus, the early diagnosis ensures longer survivability with appropriate therapy.

Incidental Identification of Krukenberg’s Tumour (KT): A Histopathological Perspective

Kriti Chauhan — 2025-12-06

Krukenberg’s tumour (KT) is a metastatic ovarian malignancy characterised by bilateral ovarian enlargement and a nodular pattern of infiltration on radiology. KTs can be synchronous, where the metastasis is discovered within 3 months of the diagnosis of the primary tumour, or metachronous, where the metastasis is found after 3 months, frequently after the completion of initial therapy. This case report discusses an incidental diagnosis of Krukenberg’s Tumour (KT). A 48-year-old female was incidentally diagnosed with a Krukenberg tumour, involving the entire uterus, uterine leiomyomas, bilateral ovaries and fallopian tubes without any gross enlargement or cystic change in the ovaries. The patient underwent surgery to alleviate the symptoms associated with multiple uterine fibroids detected on ultrasound. She underwent a total abdominal hysterectomy with removal of both the adnexa, along with myomectomy. However, when the ovaries are not enlarged, and complaints of abdominal discomfort or pain are attributable to a fibroid, the possibility of a Krukenberg tumour is seldom considered. Under such circumstances, histopathology examination serves as the only tool to clinch the diagnosis because of its characteristic microscopic features. Recognition of KT is of paramount importance, as it alters both the management approach and prognostic outlook. Furthermore, it is also crucial to exclude mimics, especially tumours with mucinous differentiation, using ancillary techniques like special stains, immunohistochemistry and previous historical details for confirmation.

Odontogenic Keratocyst (OKC) in a 7-Year-Old Child: A Case Report

Wissam Sharrouf — 2025-12-06

Odontogenic keratocyst (OKC) is a developmental cyst that occurs in the jaw. While it is commonly associated with Gorlin syndrome in pediatric patients, its occurrence alone is rare. Moreover, cases in children under 10 without Gorlin syndrome are exceptional in the documented literature. OKC is typically treated through enucleation and curettage, occasionally in conjunction with peripheral ostectomy. For larger OKCs, clinicians often perform marsupialisation to decompress the cysts. In this report, we present a case of a 7-year-old boy with an OKC in the mandibular body, who received conservative treatment through marsupialisation. This case contributes valuable insight into the management of OKCs in young patients.

Anatomy and Clinical Significance of Arachnoid Villi and Arachnoid Granulation

Rajani Singh — 2025-12-06

The brain is a very important part of the human body as it is the seat of intelligence, judgement, memory and all activities of the human body are controlled by the brain. It is protected by three membranes, viz, outer dura mater, middle arachnoid mater and inner pia mater. The space between the arachnoid mater and pia mater is the subarachnoid space, filled with cerebrospinal fluid. The cerebrospinal fluid is a very essential component as it acts like a cushion for the brain, protecting it from various types of shocks, trauma and during movements of the head and neck.

The main feature of arachnoid mater is the presence of arachnoid villi, which are protrusions of arachnoid mater along with the subarachnoid space through dura mater into the dural venous sinuses. These arachnoid villi absorb the cerebrospinal fluid into the venous sinuses. As age advances, the arachnoid villi enlarge to form arachnoid granulations, which may erode the cranial bone, forming arachnoid pits. The arachnoid granulations may be misinterpreted as venous sinus thrombosis or an extradural mass in MRI and CT scans. Hence, normal and varied anatomy of arachnoid villi and arachnoid granulations is of paramount importance. The chapter highlights the formation of arachnoid villi and arachnoid granulations, their clinical implications, along with a brief history.

Current Evidence on the Image Quality and Diagnostic Effectiveness of Metal Artefact Reduction Algorithms in Dental CBCT: An Overview

Seershika Reddy Y — 2025-12-06

Dental cone-beam computed tomography (CBCT) has significantly enhanced diagnostic capabilities in maxillofacial imaging, offering high-resolution, three-dimensional views with relatively low radiation exposure. Compared with computed tomography, CBCT generally delivers a lower radiation dose when producing images for equivalent diagnostic objectives. However, the presence of metallic objects such as implants, restorations, and orthodontic appliances often introduces image-degrading artefacts that compromise diagnostic accuracy. Various metal artefact reduction (MAR) algorithms have been developed to counteract these limitations. In recent years, various post-processing methods have been developed to minimize the impact of metal artefacts in CBCT. Despite these advances, the clinical effectiveness of MAR in dental CBCT remains unclear. Most existing studies are in vitro, relying on phantoms or extracted specimens under controlled conditions that do not fully replicate the complexity of in vivo imaging. There is a critical need for well-designed clinical studies which can determine when and how MAR algorithms truly enhance diagnostic outcomes in different dental applications. This review synthesizes current evidence on the diagnostic effectiveness of MAR algorithms in dental CBCT, emphasizing their methodological principles, clinical outcomes, and limitations across different imaging contexts.

Management of Perforated Peptic Ulcer: A Review of Operative and Non-operative Approaches

Kumar H.R. — 2025-12-06

Perforated peptic ulcer represents the second most prevalent complication associated with peptic ulcer disease, and its management is categorised into surgical and non-surgical approaches. Surgical intervention encompasses the closure of the ulcer utilising an omental patch, which can be executed through either open or laparoscopic techniques. In cases of larger ulcers, surgical resection in the form of partial gastrectomy is performed. Non-surgical treatment modalities include the administration of intravenous antibiotics, endoscopy, and stent placement, primarily reserved for patients deemed unsuitable for surgical intervention. Eradication of Helicobacter pylori is another area where intervention may enhance clinical outcomes and reduce the risk of ulcer recurrence. It is imperative that the surgical treatment of a perforated peptic ulcer is not delayed, as postponement can lead to increased mortality. This review aims to examine the role of laparoscopic surgery in the management of perforated peptic ulcers. Additionally, it explored the significance of non-operative treatment and the eradication of Helicobacter pylori in the management of perforated peptic ulcers.

Advancing Healthcare Delivery through Telemedicine and Remote Patient Monitoring: A Comprehensive Review

Vajrala Leela Lakshmi — 2025-12-06

Telemedicine and remote patient monitoring (RPM) solutions represent a paradigm shift in healthcare delivery, harnessing the power of digital technologies to improve patient care, enhance accessibility, and reduce costs. Telemedicine facilitates virtual consultations, digital health platforms, and real-time diagnostics, allowing healthcare professionals to interact with patients across geographic barriers. RPM, on the other hand, enables continuous tracking of patient health metrics such as heart rate, glucose levels, and blood pressure through wearable and connected devices, promoting proactive management of chronic diseases and reducing hospital readmissions. Recent advancements, including artificial intelligence (AI) for predictive analytics, wearable biosensors, and high-speed 5G networks, have expanded the scope and efficiency of telemedicine and RPM. These solutions proved invaluable during the COVID-19 pandemic, ensuring continuity of care while minimising physical contact. However, challenges persist, including concerns around data security, interoperability, regulatory barriers, and disparities in access to technology. This review explores the evolution, benefits, and challenges of telemedicine and RPM, while addressing their potential to transform global healthcare systems. It highlights key innovations, regulatory considerations, and the need for equitable access to bridge healthcare gaps. By integrating these technologies into routine care, the future of telemedicine and RPM holds the promise of improved patient outcomes, cost efficiencies, and greater resilience in healthcare systems worldwide.

Comprehensive Clinical Insights into the Diagnosis, Management and Complications of Pickwickian Syndrome

Harsahaj Singh Wilkhoo — 2025-12-06

The aim of this study is to provide a comprehensive and up-to-date synthesis of the clinical understanding of Pickwickian Syndrome, with a focus on its diagnosis, management, and associated complications. Pickwickian Syndrome, or Obesity Hypoventilation Syndrome (OHS), is a serious obesity-related respiratory disorder defined by chronic daytime hypercapnia (PaCO₂ > 45 mmHg), obesity (BMI ≥ 30 kg/m²), and exclusion of other hypoventilation causes. It arises from a complex interplay of impaired ventilatory drive, leptin resistance, and mechanical respiratory restriction, often coexisting with obstructive sleep apnea (OSA) in nearly 90% of cases. OHS leads to chronic hypoxemia, pulmonary hypertension, and cor pulmonale if untreated. Diagnosis relies on arterial blood gas analysis, polysomnography, and exclusion of alternative etiologies. A key diagnostic feature is chronic hypercapnia (PaCO₂ >45 mmHg), often accompanied by compensated metabolic alkalosis due to renal bicarbonate retention. There may also be hypoxemia (PaO₂ <70 mmHg), particularly in more severe cases. Management requires a multidisciplinary approach emphasising weight reduction, lifestyle modification, and positive airway pressure (PAP) therapy—CPAP for OHS with OSA and BiPAP for persistent hypercapnia. Bariatric surgery offers substantial improvement in severe cases. Pharmacologic agents like acetazolamide and medroxyprogesterone serve limited roles. Early recognition and adherence to therapy markedly improve outcomes, reducing mortality from 30% to under 10%. Despite advancements, OHS remains underdiagnosed and undertreated, highlighting the need for greater clinical awareness, digital monitoring integration, and personalised management strategies.

Advances in the Surgical Management of Achalasia Cardia: A Review

Kumar H.R. — 2025-12-06

Achalasia cardia, an oesophageal dynamic disorder, is a relatively rare primary motor oesophageal disease characterised by the functional loss of plexus ganglion cells in the distal oesophagus and lower oesophageal sphincter. The management of Achalasia Cardia can be divided into medical and surgical management. This chapter synthesises the literature findings to examine the various surgical procedures available for achalasia cardia, focusing on their respective advantages and potential complications. The surgical management of achalasia cardia has undergone significant advancements over the past decade, particularly following the introduction of Heller's myotomy. Currently, laparoscopic Heller's myotomy, often accompanied by partial fundoplication, is regarded as the gold standard for the surgical treatment of achalasia cardia. Additionally, robotic Heller's myotomy is gradually gaining prominence with the advent of robotic surgical techniques. In contrast, thoracoscopic myotomy is now infrequently performed, and esophagectomy is reserved for patients with end-stage achalasia cardia. The choice of surgical approach is typically individualised, taking into account the patient’s condition and risk profile.

Quality of Root Canal Fillings Performed by Dental Undergraduates: A Radiographic Study

Mohammed Mustafa — 2025-12-06

Background: Epidemiologic surveys consistently show that the technical quality of root fillings is strongly associated with periapical status at the population level, underscoring obturation quality as a key determinant of treatment outcome.

Aim: The study aimed to assess the radiographic quality of root canal obturation performed by undergraduate dental students at the College of Dentistry, Prince Sattam Bin Abdulaziz University, focusing on obturation length, taper, and density.

Materials and Methods: In this retrospective review, intraoral periapical (IOPA) radiographs from 400 root canal–treated teeth managed by 4th- and 5th-year students (2016–2018) were evaluated in 2019 by an experienced endodontist. Straight (head-on) and shift/SLOB views were used when required. Technical quality was classified for length (adequate/underfilled/overfilled), taper (adequately tapered/irregular–anomalous), and density (homogeneous/irregular with voids) using predefined criteria. Associations with year of study and tooth group (anterior, premolar, molar) were analysed using the Chi-square test (α = 0.05).

Results: A total of 400 completed root canal treatments met the eligibility criteria and were included in the analysis. Of these, 149 cases were treated by 4th-year students and 251 by 5th-year students. By tooth group, the sample comprised 143 anterior teeth (35.8%), 70 premolars (17.5%), and 187 molars (46.8%). For patients treated by fourth-year BDS students, 63.5% demonstrated adequate obturation, whereas 36.5% exhibited deficiencies related to obturation quality. In contrast, patients treated by fifth-year BDS students demonstrated adequate obturation in 71.0% of cases, with 29.0% categorised as inadequate. A statistically significant difference was observed in the length of root canal obturation (P = 0.001). Additionally, the frequency of adequate obturation was significantly higher in anterior teeth than in premolars and molars.

Conclusion: 5th-year students demonstrated better control of length and fill density, whereas 4th-year students achieved a higher proportion of adequate taper, particularly in simpler cases. Technical deficiencies clustered in molars, with underfilling and intra-fill voids being most common. Targeted simulation on multi-rooted/curved canals, reinforced protocols for working-length determination and cone fitting, and close chairside supervision are likely to improve outcomes.

Clinical Significance: Routine radiographic audit of student cases pinpoints teachable gaps—especially for molars—guiding curricular refinements that elevate the technical quality of undergraduate endodontics.

Determining the Seroprevalence and Correlates of Hepatitis B Virus Infection among Pregnant Women at Primary Healthcare Facilities in Nasarawa State, Central Nigeria

Samuel Ebuga Emiasegen — 2025-12-06

Background: Hepatitis B virus (HBV) infection of pregnant women causes significant maternal and perinatal morbidity and mortality, with some strains much worse than others. HBV is transmitted through blood and body fluids. The infection causes acute or chronic liver diseases, which are a global public health concern. An estimated 257.5 million people were chronically infected worldwide in 2022, with 1.2 million new infections yearly. Its overall prevalence is around 3.2% which varies significantly by region, with the highest prevalence in the Western Pacific and African regions. Nigeria is still considered one of the highly endemic countries with an estimated prevalence of around 9.5% to 13.6% with Nasarawa State in the central region.

Aim: This study was conducted to determine the prevalence and correlates of infection among pregnant women attending antenatal clinic (ANC) at Primary healthcare facilities in Nasarawa State, Nigeria.

Methodology: Three hundred and thirty-eight (338) participants were enrolled in this cross-sectional study using a systematic sampling method. Blood samples were collected by venipuncture, processed, and tested using a combo kit with five Sero-markers of HBV. Statistical Package for Social Sciences (SPSS) version 27 software was used for analysis.

Results: The prevention of HBV infection among pregnant women remains a major source of concern because of the risk of horizontal and vertical transmission of the disease. The findings showed the prevalence of HBV in this study was 8.3%. Only 12.7% had immune antibodies, while 0.6% showed evidence of occult HBV infection. Age group ≤ 25years (P = .03) was significantly associated with the infection. Higher prevalence was found among women who are polygamists (12.5%), Christians (8.7%), Single (20.0%), had only a primary level of education (9.5%), in Business (16.0%), and whose husbands are farmers (12.2%).

Conclusion: The prevalence of HBV in this study was 8.3%. The younger age group were associated with HBV infection in the study area. The low number of women with immunity raises a need to advocate for HBV screening and vaccination campaigns in Nasarawa State and Nigeria, while the presence of occult HBV infection raises concern of possible mother-to-child transmission if intervention is not provided. Enhanced HBV infection sensitisation, routine screening at ANC, early vaccination and youth-focused prevention strategy in the community are recommended. The findings in this study are limited by the absence of molecular confirmation of the results, which requires future studies.

Impact of Orthodontic Treatment on Body Mass Index, Self-esteem and Food Habits

Sangeetha M. Gnaneswar — 2025-12-06

Body mass index (BMI) is a simple, inexpensive, and widely accepted measure for assessing nutritional status and overall health. It is calculated from an individual’s weight and height and is used globally to classify underweight, normal weight, overweight, and obesity. The World Health Organisation (WHO) recognises BMI as a universal standard for monitoring population health and obesity trends. In children and adolescents, BMI is interpreted using age- and sex-specific percentiles, commonly referred to as BMI-for-age. Beyond being a physical health indicator, BMI also reflects aspects of psychological well-being, as body weight and self-perception are closely interrelated. During orthodontic treatment, patients often experience temporary discomfort, pain, and chewing difficulties following appliance placement or adjustments. To minimise such issues and prevent appliance breakage, orthodontists usually recommend a soft or semi-solid diet. While these dietary modifications help reduce pain and maintain appliance integrity, they may restrict the intake of certain foods, leading to potential changes in nutritional balance. Prolonged adherence to such a diet can influence energy intake, metabolism, and weight, thereby affecting a patient’s BMI. In orthodontics, monitoring BMI has become increasingly relevant, as dietary changes, discomfort, and adaptation throughout treatment may alter patients’ nutritional status over time. Additionally, patients with severe malocclusion often report low self-esteem due to dissatisfaction with their dental appearance. This chapter discusses the longitudinal changes in BMI, food habits, and self-esteem among patients during the first year of orthodontic treatment, offering insights into the interplay between nutrition, physical transformation, and psychological adjustment. It also incorporates findings from a study conducted by the authors on the same topic, providing evidence-based perspectives on how orthodontic treatment influences these parameters over time.

The Importance of Continuous Glucose Monitoring in Managing Diabetes Mellitus

A. Manov — 2025-12-06

Background: Continuous Glucose Monitoring (CGM) is arguably the most important technological advance in diabetes management over the past 15 years. It gives patients and healthcare providers real-time data on blood glucose trends. Most research on CGM has been done in specialised clinics, and there is little awareness of studies using CGM in a general internal medicine residency clinic.

Aim: This study aimed to assess whether continuous glucose monitoring (CGM) can be safely integrated into an Internal Medicine Residency Clinic.

Methodology: This is a 4-year retrospective extension study conducted in an Internal Medicine Residency Clinic, not solely in a specialised Endocrine clinic managing Diabetes Mellitus Type 1 and Type 2 in patients using 3-4 insulin injections daily and self-monitoring their blood glucose (SMBG) four times a day. The study was extended by an additional year to increase the sample size and statistical power and to evaluate whether longer-term CGM use results in a sustainable reduction in HbA1c, which also functions as a glucose management indicator. Initially, 51 patients were followed for 3 years, and now the study includes an extra year of data. Subsequently, 40 more patients were added. Additionally, the reduction in the glucose management indicator (GMI) was assessed. In total, 91 patients were monitored. Internal medicine and transitional year residents transitioned patients from SMBG to CGM devices to improve blood glucose monitoring due to uncontrolled diabetes. Each patient was assigned to a specific resident, who was initially trained by an endocrinologist to interpret CGM data and adjust insulin treatments accordingly. These residents contacted their assigned patients by phone every two weeks to adjust treatment as needed.

Results: Shapiro-Wilk's test indicated that the post-intervention data did not violate the normality assumption (p = .063), while the pre-intervention data did (p = .003). Participants’ A1c levels before the intervention were higher (M = 10.29, SD = 2.22) compared to after the intervention (M = 7.04, SD = 1.11). Levene’s test showed equal variances between pre- and post-intervention periods (p = .07). Regarding participants’ blood glucose levels, a significant mean decrease of 89.62, 95% CI [-102.76, -76.48], t(91) = -13.547, p < .001, d = 1.83 was observed. To summarise the findings, the mean HbA1c (GMI) decreased by 3.24%, the average blood sugar dropped by 89 mg/dL, and the mean Time in Range (TIR) increased by 45%.

Conclusion: The study highlights the potential of CGM to enhance medical residents’ education, a potential that larger prospective trials will further investigate. Expanding CGM use across US residency programs could raise the standard of diabetes care nationwide.