Four Tendinous Slips of Flexor Hallucis Longus Tendon: A Case Report.

Interindividual variability presents a rich field of study in medical sciences. During a cadaveric dissection at Louisiana State University Health Sciences Center, a rare anatomical variation was discovered in the pedal anatomy of a female cadaver. Medical students, while dissecting the sole of the foot, identified a variant tendinous structure. This aberrant tendinous slip from the flexor hallucis longus (FHL) extended to the lateral four tendons of flexor digitorum longus (FDL) along the plantar aspect of the foot. The discovery suggested that the FHL shares a functional relationship with the FDL. Application of tension to the FHL was found to result in simultaneous flexion motion in the lesser toes, from the second to the fifth digit. The presence of this anatomical variant holds considerable importance for surgical interventions, especially as a potential graft source in tendon reconstructions, warranting its documentation in this report.

Novel Variations in the Celiac and Hepatobiliary Arterial Anatomy: A Cadaveric Case Report.

The celiac trunk and hepatobiliary anatomy often display variations in origin and branching patterns. A particularly rare variant involving the cystic artery giving rise to a common trunk for the supraduodenal and an aberrant right gastric artery, with an additional accessory right gastric artery originating from the splenic artery, has not been previously documented. We report a unique variation in the branching pattern of the celiac trunk and the cystic artery revealed during routine dissection of the hepatobiliary region of a male cadaver at Louisiana State University, Health Sciences Center, Shreveport. In this case, the cystic artery originated from the gastroduodenal artery and gave rise to a common trunk of an aberrant right gastric artery and the supraduodenal artery. Additionally, the cadaver lacked a proper hepatic artery, and an additional (accessory) right gastric artery originated from the splenic artery. This report is the first documented instance of such combined variations in the celiac and hepatobiliary arterial anatomy. Recognizing potential variations in these anatomies is crucial for radiological and surgical interventions in the hepatobiliary area to avoid iatrogenic hemorrhage or biliary complications.

Anatomical Variant of the Lateral Circumflex Femoral Artery: A Cadaveric Case Report.

The lateral circumflex femoral artery (LCFA), a branch of the deep femoral artery (DFA), supplies the muscular and fascial anatomy of the anterior thigh. An undocumented variation of the LCFA was discovered during a dissection of the lower extremities. The LCFA is a vital vessel that can be used in coronary artery bypass grafts (CABGs) and reconstructive and bypass surgical procedures. On the other hand, the LCFA is susceptible to iatrogenic damage during surgeries involving the hip joint and procedures such as femoral nerve blocks. Knowledge of variations in the origin and course of the LFCA, like many other anatomical structures, is an important concept that physicians and health care providers must be aware of when performing anterior thigh procedures. This case report shows an interesting duplication of the LCFA, the first originating superiorly from the common femoral artery (CFA) and the second from the deep femoral artery (DFA) inferiorly. Both LCFAs exhibited typical trifurcation into ascending, descending, and transverse branches.

Rates of Laser Trabeculoplasty by Ophthalmologists and Optometrists: A Comparative Analysis of the CMS Medicare Public Use File.

Purpose: To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA. Methods: This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015-2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p<0.05. Results: The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p<0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p<0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p<0.001), and number of LTP services billed (p<0.001) were observed relative to ophthalmologists. Conclusion: The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.

Biodegradable nanofiber coated human umbilical cord as nerve scaffold for sciatic nerve regeneration in albino Wistar rats.

BACKGROUND: Human umbilical cord (hUC) is encompassed by a mucoid connective tissue called Wharton's jelly (WJ), made of hyaluronic acid, collagen, and stromal cells to support the blood vessels of hUC. This study was aimed to determine the in vitro neuronal differentiation of WJ-derived mesenchymal stem cells (WJMSCs), and in vivo axonal regeneration potential of nanofiber coated human Wharton's jelly as a neuronal graft after sciatic nerve injury in immunosuppressed albino Wistar rats. MATERIALS AND METHODS: Wharton's jelly-derived mesenchymal stem cells could be differentiated to neuron-like cells by inducing with neuronic supplementing media. The test animal's axotomized nerves were implanted with trimmed human umbilical cord devoid of vascularity and nanocoated with electro-spun poly-l-lactic acid nanofibers. The control animals were bridged with native sciatic nerve reversed and sutured. Post-surgical functional recovery was studied by walking track, pinprick, muscle weight, and sweating quantification. At the end of the 4th week, the animals were euthanized, and magnetoneurography was performed. The explanted grafts were quantified by immunohistochemistry for immuno-rejection, neural scarring, neural adhesion axon regeneration, fibre diameter, myelin thickness, and G-ratio. The sciatic function index values were similar by walking track analysis for both the test and control groups. RESULTS: The animals had functional and sensation recovery by the end of 2 weeks. No mortality, signs of inflammation, and acute immune rejection were observed post-surgery. CONCLUSIONS: The hUCWJ devoid of vascular elements can be a perfect peripheral nerve graft, and we hypothesis that the cryopreserved hUC could be an ideal resource for axonal regeneration in the future.

A Compilation of Drug Etiologies of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse reactions that affect the mucocutaneous surfaces by causing necrosis and detachment of the epidermis. The difference between SJS and TEN is in the percentage of the body surface area (BSA) affected. TEN is known to affect greater BSA than SJS. The pathogenesis of SJS/TEN is attributed to drug-specific cell-mediated cytotoxic reactions that directly and indirectly lead to keratinocyte apoptosis through mediators. Clinical presentation begins with influenza-like symptoms, with the disease affecting the skin, oral, ocular, and urogenital regions most frequently. Although SJS/TEN is mainly due to various drugs, infection and vaccination can also induce SJS/TEN. This review outlines a compilation of all drugs implicated in SJS/TEN cases based on studies, mainly in case reports and other study types. Drug classes implicated in SJS/TEN cases include antibiotics, anticonvulsants, antineoplastics, analgesics, and diuretics, among others. There is no fully established diagnostic modality for SJS/TEN; treatment is done mainly by withdrawing the offending agent. In addition to withdrawing the offending agent, a multidisciplinary care team is essential in managing these patients. Several pharmacologic modalities have also been proposed in treatment, but there is still insufficient evidence for the efficacy of one against the other.

Facilitating Active Collaborative Learning in Medical Education; a Literature Review of Peer Instruction Method.

The call for educational reform by the Carnegie Foundation for the Advancement of Teaching marked a pivotal juncture in the trajectory of medical education in the United States. The call underscored the imperative for educational restructuring to equip forthcoming physicians with the requisite skills to engage in lifelong learning. Among the several active teaching methods is the Peer Instruction (PI), a brainchild of Eric Mazur, empowering students to steer their own education and wield knowledge adeptly into real-world scenarios. In this review paper, we delve into the core elements of PI which involves the combination of four dynamic pedagogical approaches which are: Just-in-Time Teaching, ConcepTest, Audience Response System, and Think-Pair-Share technique. PIs effectiveness notwithstanding, it is not exempt from limitations such as its flexible implementation, lengthy time, the level of expertise required for instructional design, among others. While Peer Instruction has become increasingly popular among educators across other disciplines, with proven educational benefits with positive outcomes, PIs footprint in gradate and postgraduate medical education remains inchoate, evidenced by a paucity of scholarly references. This underscores a crucial gap - despite its proven potency in fueling engagement and learning, PI still lacks formal recognition and acknowledgement as a distinct instructional method in medical education. Within these boundaries, the promise of heightened education and amplified engagement beckons further exploration of PI as a medical educational model, warranting more consideration and research.

Illuminating Hope for Mental Health: A Drug Review on Lumateperone.

This drug review provides a comprehensive analysis of a novel antipsychotic called lumateperone, marketed as Caplyta. Lumateperone gained FDA approval in 2019 for treating schizophrenia and later, in 2021, for treating bipolar depression. The review begins by delving into lumateperone's mechanism of action, which involves the partial agonism of the dopamine D2 receptor as well as its unique effects on the dopamine transporter, N-methyl-D-aspartate (NMDA) receptor, and serotonin transporter. Additionally, the study examines lumateperone's distinctive pharmacokinetics. Moreover, this review assesses lumateperone's metabolic profile and highlights its favorable outcomes regarding mean body weight, BMI, and waist circumference, surpassing those of other second-generation antipsychotic medications. The study explicitly emphasizes the efficacy and safety of lumateperone in treating schizophrenia and bipolar depression associated with bipolar I and II disorders. An extensive investigation of multiple clinical trials provides compelling evidence of lumateperone's advantages over existing antipsychotic medications. The review also acknowledges the limitations of lumateperone compared to other antipsychotics. In conclusion, this drug review underscores the importance of further research to uncover the additional limitations of lumateperone while acknowledging its promising benefits and potential for advancing treatment options.

An Introduction and Brief Overview of Psychoanalysis.

The field of psychology has been shaped by the views and perspectives of Sigmund Freud and his former students: Carl Jung, Alfred Adler, Erik Erikson, and Karen Horney. These psychologists and their respective schools of thought provide distinct views on psychology and influences on personality and psychosocial development. The foundation for psychoanalysis was laid by Freud, his work on the unconscious mind, and his emphasis on early childhood experiences. His students also made substantial contributions that expanded, sharpened, and challenged his theories. This review will begin by highlighting the work of Sigmund Freud; it will then compare his theories with the theories of his students. This review will introduce and bring attention to the most important figures of psychoanalysis and give a brief overview of their theories.

Exosomes as biomarkers and therapy in type 2 diabetes mellitus and associated complications.

Type 2 diabetes mellitus (T2DM) is one of the most prevalent metabolic disorders worldwide. However, T2DM still remains underdiagnosed and undertreated resulting in poor quality of life and increased morbidity and mortality. Given this ongoing burden, researchers have attempted to locate new therapeutic targets as well as methodologies to identify the disease and its associated complications at an earlier stage. Several studies over the last few decades have identified exosomes, small extracellular vesicles that are released by cells, as pivotal contributors to the pathogenesis of T2DM and its complications. These discoveries suggest the possibility of novel detection and treatment methods. This review provides a comprehensive presentation of exosomes that hold potential as novel biomarkers and therapeutic targets. Additional focus is given to characterizing the role of exosomes in T2DM complications, including diabetic angiopathy, diabetic cardiomyopathy, diabetic nephropathy, diabetic peripheral neuropathy, diabetic retinopathy, and diabetic wound healing. This study reveals that the utilization of exosomes as diagnostic markers and therapies is a realistic possibility for both T2DM and its complications. However, the majority of the current research is limited to animal models, warranting further investigation of exosomes in clinical trials. This review represents the most extensive and up-to-date exploration of exosomes in relation to T2DM and its complications.

Hyperostosis Fronto-Parieto-Occipitalis: A Cadaveric Case Report.

Hyperostosis of the skull is a rare bone dysplasia described in disorders such as hyperostosis cranialis interna (HCI) and hyperostosis frontalis interna (HFI). Other syndromes presenting with hyperostosis include Morgagni-Stewart-Morel (MSM) and Troell-Junet. HCI is an abnormal hyperostosis of most endosteal skull and calvarium surface regions. A more specific hyperostosis, HFI, is an unusual bone growth based on its volume and porosity; it is primarily located bilaterally on the frontal portions of the calvarium. However, the hyperossification does not cross the superior sagittal sinus. Upon cadaveric dissection, we found hyperossification beyond the frontal area, extending to the parietal and occipital bones with the significant characteristic of no midline interference. Hyperossification results in gross indentations on the corresponding frontal, parietal, and occipital hemispheric brain tissues. This report discusses possible differentials for this rare cadaveric finding of frontal, parietal, and occipital bone hyperostosis. This case report includes some major characteristic features indicative of HCI and HFI with some interesting variations and features suggestive of MSM and Troell-Junet syndromes. Due to the lack of patient history and medical records, no further conclusions about clinical differentials, symptoms, or causative syndromes could be drawn; further research needs to be conducted on HCI, HFI, and related syndromes to understand their presentations better.

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by pain, numbness, and impaired function of the hand due to compression of the median nerve at the level of the wrist. Although CTS can develop from repetitive strain, injury, or medical conditions, there are also congenital and genetic risk factors that can predispose individuals to the condition. With respect to anatomical factors, some individuals are born with a smaller carpal tunnel, which increases their susceptibility to median nerve compression. Variations in specific genes, such as those encoding proteins involved in extracellular matrix remodeling, inflammation, and nerve function, have also been linked to an increased risk for CTS. CTS is associated with a high cost of health care maintenance and loss of work productivity. Therefore, it is vital that primary care physicians fully understand the anatomy, epidemiology, pathophysiology, etiology, and risk factors of CTS, so they can be proactive in prevention, diagnosing, and guiding proper treatment. This integrated review also provides insights into how biological, genetic, environmental, and occupational factors interact with structural elements to determine who is most likely to acquire and suffer from CTS. Keeping health practitioners abreast of all the factors that could impact CTS should go a long way in decreasing the health care and socioeconomic burden of CTS.

Cariprazine for Treating Schizophrenia, Mania, Bipolar Depression, and Unipolar Depression: A Review of Its Efficacy.

This drug review presents a comprehensive review of Cariprazine, a medication that received FDA approval in 2015 for treating schizophrenia and bipolar disorder. The paper begins by exploring Cariprazine's mechanism of action, which involves modulating dopamine and serotonin receptors. Additionally, the review assesses Cariprazine's metabolic profile and notes its low potential for weight gain and metabolic side effects. The study examines Cariprazine's efficacy and safety in treating various psychiatric disorders, such as schizophrenia, bipolar maintenance, mania, and bipolar depression. A meticulous analysis of clinical trials is included, demonstrating Cariprazine's potential advantages over existing medications used for these disorders. Additionally, the review covers Cariprazine's recent approval as an adjuvant treatment for unipolar depression. Furthermore, the paper examines the limitations of Cariprazine, such as the absence of head-to-head trials comparing it to other commonly used medications for these disorders. The paper concludes by emphasizing the need for more research to establish Cariprazine's position in treating schizophrenia and bipolar disorder and determine its comparative effectiveness with other available treatments.

De Quervain's Disease: A Discourse on Etiology, Diagnosis, and Treatment.

Since Fritz De Quervain first postulated stenosing tenosynovitis within the radial dorsum of the wrist, much research has been conducted to provide further insights. De Quervain's Disease (DQD) is a condition that affects the tendons that control the movement of the thumb, specifically the abductor pollicis longus and extensor pollicis brevis. Numerous studies have shown that structural divergence from normal anatomy is partly related to contingency for developing DQD. Even though this condition was discovered many years ago, its exact etiology remains a subject of debate. Two schools of thought exist, one that contends an inflammatory-mediated pathway and the other degenerative changes. Substantial evidence exists for both theories, thus necessitating further studies into the etiology of DQD. Classically, Finkelstein's and Eichhoff's tests have been used as the physical examinations of choice for clinically diagnosing this condition. However, these tests have been shown to have low specificity, hence, the emergence of the wrist hyperflexion and abduction of the thumb test. Evidence also suggests that ultrasonography may become a critical diagnostic tool, especially to identify anatomical variations before invasive treatment, reducing the risk of further complications. The management of DQD is typically conservative, with escalation to steroid injections before surgery is indicated. Future research into this disease should focus on establishing a clearer picture of how anatomical variations and other pathological and occupational factors may interplay to bring about this condition. While current research has suggested possible novel approaches for diagnosing and treating DQD, more studies are required to gain greater insights into the effectiveness of these interventions.

A Unique Three-Tendinous Head Reverse Palmaris Longus: A Case Report.

The Palmaris longus (PL) is a fusiform muscle that is part of the superficial flexors on the anterior compartment of the forearm. It originates from the common flexor tendon at the medial epicondyle of the humerus and inserts at the flexor retinaculum. The Palmaris longus has been reported to present in multiple variations. Some of these variations include agenesis, reversal, and multiple bellies of the muscle. The Palmaris longus is clinically significant as a landmark for carpal tunnel syndrome steroid injection, hand anesthesia, and used as a surgical graft. Medical students at the University of Medicine and Health Sciences, St. Kitts and Nevis, encountered a unique variation of the PL during cadaver dissection. This article explores the exclusiveness of a three-tendinous head reverse PL and what makes it unique compared to similar findings in other reports.

Lurasidone for Treating Schizophrenia and Bipolar Depression: A Review of Its Efficacy.

Lurasidone is an antipsychotic medication that blocks dopamine D2 and serotonin 5-hydroxy-tryptamine (5-HT)2A receptors and affects other serotoninergic and noradrenergic receptors. It has rapid absorption and linear pharmacokinetics. The rates of metabolic syndrome for patients taking lurasidone are comparable to placebo groups. Lurasidone is a safe and effective treatment for patients with acute schizophrenia and bipolar depression. It has been found to improve the brief psychiatric rating scale and other secondary measures in schizophrenic patients and reduce depressive symptoms in bipolar I depression. The once-daily administration of lurasidone is generally well-tolerated and does not cause clinically significant differences in extrapyramidal symptoms, adverse effects, or weight gain compared to a placebo. However, lurasidone's effectiveness in combination with lithium or valproate has been mixed. Further research is needed to determine optimal dosing, treatment duration, and combination with other mood stabilizers. Long-term safety and effectiveness and its use in different subpopulations should also be evaluated.

Unusual Origin of the Posterior Circumflex Humeral Artery: A Case Report.

Prior knowledge of possible variations in human anatomy is essential for basic medical and clinical training. Many surgeons can avoid uncharacteristic situations by having sources and availability of resources that document potential irregularities in human anatomy. In this case, a human cadaver is identified as having an altered origin of the posterior circumflex humeral artery (PCHA). While it usually stems from the axillary artery, this cadaver had a left-sided PCHA originating from the subscapular artery (SSA) and continuing into the quadrangular space. This irregularity of the PCHA from the SSA is not commonly discussed in the literature. Physicians and anatomists need to be fully aware of this possibility and be prepared for any unexpected differences in anatomy during procedures.

The Diagnostic Challenges Associated with Type 2 Myocardial Infarction.

The diagnostic challenges associated with type 2 myocardial infarction (T2MI) evolve around an extensive evidence base. T2MI is a type of MI that occurs secondary to ischemia due to increased demand or decreased oxygen supply. This classification has been used for the last 5 years, yet there is little understanding of the characteristics and clinical outcomes. According to a survey, T2M1 can be caused mainly by different factors such as anemia (31%), sepsis (24%), and arrhythmia (17%). Other associated factors, such as age and gender, also play a part in the disease. The pathology behind T2MI is the rise and fall of cardiac troponin values with at least one value above the 99 percentile and evidence of an imbalance unrelated to coronary thrombosis. The diagnosis of the condition is evidence-based backed up with imaging techniques. The treatment of T2MI may involve blood pressure management, administration of blood products, heart rate control, and respiratory support. Depending on the clinical presentation, coronary evaluations can be used to assess the likelihood of coronary artery disease (CAD). If indicated, the MI guidelines may apply to CAD. If it shows, the MI guidelines may use electrocardiography findings of ST-segment elevation myocardial infarction (STEMI) or non-STEMI. However, the absence of CAD indicates that the benefits of cardiovascular risk reduction strategies with T2MI remain uncertain.

Fabrication and Electrospinning of 3D Biodegradable Poly-l-Lactic Acid (PLLA) Nanofibers for Clinical Application.

Poly-L-lactic acid (PLLA) is a biodegradable synthetic polyester synthesized by polymerization or polycondensation. PLLA hydrolytically degrades into lactic acid, a biocompatible metabolic by-product, making it suitable for clinical applications. PLLA scaffolds or nanofibers have been used in various regenerative medicine and drug delivery applications. These scaffolds impart biocompatible properties of high surface area, hydrophobicity, native extracellular properties, and mechanical strength for an organ system. Moreover, PLLA nanofibers hold great promise as drug delivery systems, where fabrication parameters and drug-PLA compatibility greatly affect the drug release kinetics. In this chapter, we present the protocols to fabricate, electrospinning, and validation of 3D PLLA nanofibrous scaffolds for tissue engineering application and offer perspectives on their future use.

A Unique Communicating Arterial Branch between the Celiac Trunk and the Superior Mesenteric Artery: A Case Report.

BACKGROUND: Many anatomical variations have been associated with the Celiac Trunk, of which most are classified as being asymptomatic. CASE PRESENTATION: In this article, we describe yet another anatomical variation involving the Celiac Trunk, Superior Mesenteric artery and the Inferior Pancreaticoduodenal Artery during routine cadaveric dissection. We identified a fourth branch of the Celiac trunk (quadrification) that communicated with the Superior Mesenteric artery at the point of origin of the Inferior Pancreaticoduodenal artery which we concluded to be the Anterior Inferior Pancreaticoduodenal artery. CONCLUSION: This anastomosis could be essential in the case of occlusion between the Celiac Trunk and the Superior Mesenteric artery.