Death and Dying in the ICU- The Chamber of Torture

When patients get sick and seek medical attention, they expect doctors will help them get back to “normal”. Contrary to what many television shows depict, many ICU patients are those with chronic or incurable diseases; often in the terminal stage.

When you walk through the ICU what you actually see are patients connected to ventilators, dialysis machines, numerous IV pumps and restraints to prevent them from removing all that equipment. Families seldom see their loved ones attempting to remove their endotracheal tube, or grimacing as nursing staff adjust those tubes that have been placed into the lungs or stomach, or when they are being treated for bed sores from prolonged immobilization.

Patients too often suffer in vain attempts to prolong life, because of the mandate to “do everything.” Death and dying does not happen to us, but to someone else”. We have a “replacement mentality” and therefore “Americans not only don’t want to die, they are unwilling to accept the reality of death”. Fact is we all are going to die.

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Combined Ultrasound and Electric Field Stimulation Aids the Healing of Chronic Pressure Ulcers

All around  the  world  geriatric population  is increasing. This is accompanied by its unique  problems including issues of senescence and  frailty, and  at  times  complicated  by  multi-morbidities.  For  a graceful ageing it’s about  time that  we start  to explore meaningful newer  ideas, concepts  and  research  that  is aimed  towards  helping geriatric population.

Journal of Gerontology and Geriatric Research is perhaps doing a yeoman’s service for the mankind and for the geriatric research. Our  journal has come a long way from its inception, and from its first online open access issue in March 2012.The current issue has a bouquet of interesting original peer reviewed researches, short communications, commentaries, review articles, case reports, and letters to editor.

The views expressed are of the authors, and as an editor it is my privilege to guide you through  this latest edition of our journal. I would like to thank all the authors for their nice contributions, and wish them the very best. To read the complete article, please click on the links below.

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Prevalence and Associated Factors of Uterine Rupture During Labor among Women Who Delivered in Debre Markos Hospital North West Ethiopia

Uterine rupture causes high maternal and neonatal mortality in many rural setting in the world. Uterine rupture accounts for about 8% of all maternal deaths. Method and Materials: Facility based cross sectional study design was employed to assess the prevalence and associated factors of uterine rupture.

The data were abstracted from the cases registered during 2010 and 2014 in delivery registers, operating theater registers and patients’ case files of obstetrics ward of Debre Markos Referral Hospital North West Ethiopia. A total of 880 cases were selected by using systematic sampling method.

Result: A sample size of 880 cases was selected after a review of 5-year patients’ records (approx. 16,100 registered delivery cases) from Debre Markos Referral Hospital maternity ward. Among these selected cases, 854 (97.2%) cases were responded for the study. Prevalence of uterine rupture was identified in 81 (9.5%) cases.

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PCOS Patients Needs Much More than Just Pills from Doctors

The discussions by doctors at a local gynecological conference, suggest a strong Apathy towards patients suffering from polycystic ovarian syndrome (PCOS). PCOS has always been an interesting subject to me, so I make it a point to attend and take part in several PCOS related panels in medical conferences.

It is quite evident from all the researches that life style modifications like diet, Exercise and weight reduction play a vital role in the longterm management of PCOS.

As the patients are prone to anxiety and depression, psychological assessment is crucial, along with the physical treatment and dedicated counselors can make a big difference in the outcome of the treatment

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Holistic Approach to Complex Cancer Pain

Cancer pain is a major cause of disability and suffering at the end of life. Cancer pain affects a significant number of patients at the end of life. This case report seeks to highlight some of the complexities associated with managing cancer pain in terminally ill patients.

Nearly 74% of patients with advanced/metastatic cancer will suffer from pain at the end of life. Alarmingly up to 42-51% of these patients will endure suboptimal control of this symptom. It is imperative that patients with difficult pain syndrome are recognised early. This case report spotlights attempts to effectively address complex cancer pain.

Mr S is a 52 year-old gentleman who had enjoyed his independence and mobility despite a long history of hypertension, dyslipidaemia, and ischaemic heart disease. He is a divorcee and stays with his sister. His siblings described him as a cheerful and optimistic person.

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Synthesis and Study of 5[(Phenylsulfonyl)Amino]1,3,4 Thiadiazole 2 Sulfonamide as Potential Anti Pertussis Drug Using Chromatography and Spectroscopy Techniques

Pertussis is a respiratory transmitted disease affecting approximately 23% of the worlds’ population. It is causes by Bordetella Pertussis. The emergence of Multiple Drug Resistant (MDR) Pertussis has focused the attention of the scientific community thought the world on the urgent need for new anti-Pertussis drugs.

In pursuit of this goal, our research efforts are directed toward the discovery of new chemical entities that are effective as anti-Pertussis drugs. During recent years, there have been intense investigations of different classes of 1,3,4- thiadiazole-2-sulfonamide compounds and derivatives such as 5- [(Phenylsulfonyl)amino]-1,3,4-thiadiazole-2-sulfonamide many of which are known to possess interesting pharmaceutical, biological, biochemical and biomedical properties suchlike anti–microbial, anti– Pertussis and anti–inflammatory activities.

It should be noted that the purity of the synthesized compound was confirmed by High Performance Liquid Chromatography (HPLC) and also Thin–Layer Chromatography (TLC).

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When Heart Failure has to do with Past Abdominal Surgery

A 70-year-old woman, with a past medical history of permanent atrial fibrillation, cholecystectomy for symptomatic gallstones and obesity (54 kg/m2 body mass index), was admitted to the hospital for rapidly increasing dyspnea (NYHA class III). At admission, heart rate was 110 beats per minute(bpm) and blood pressure was 125/73 mmHg. Physical examination revealed clinical signs of right heart failure including major peripheral oedema, hepatomegaly, bilateral pleural effusion, and ascites with no signs of portal hypertension or hepatocellular insufficiency.

On the first transthoracic echocardiogram, preserved left ventricular ejection fraction with normal diastolic function was noticed. Interestingly, a major dilatation of the right ventricle, the right atrium, and the inferior vena cava (45 mm) were observed. Systolic pulmonary artery pressures were estimated as high as 60 mmHg with the tricuspid regurgitation, and cardiac index was increased, reaching 4.8 L/min/m2. Pulmonary assessment on the six-minute walk test was satisfying at 255 meters, and a small restrictive impairment was documented on a pulmonary function test (assigned to obesity). Finally, no perfusion defect was found on the ventilation/perfusion lung scan.

Assessment of Superordinate Categorization in 2-4 years Typically Developing Children

Classification is a powerful cognitive process, allowing us to organize a great deal of information efficiently and flexibly. When we form classes, we highlight important similarities among objects and events, treating very different items as equivalent for certain purposes, since a particular item could be a member of many different classes.

For example, an apple can be classified under ‘fruit’, ‘food’, ‘physical object’, etc. These classes are hierarchically organized and they honor inclusion relations.

Taxonomic categorization involves classification of items into groups based on similarities in the characteristics, structure, origin etc of the stimuli.In taxonomic categorization, it is often expected that items in a group have a strong association between them.

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Frequency and Etiology of Community-Acquired Bloodstream Infection in Hospitalized Febrile Children

Bloodstream infection is a severe problem that needs immediate attention and treatment as it can lead to morbidity and mortality. Fever is often the most common reason for presentation to the hospital in developing countries.

Most patients with febrile illness have selflimiting viral infections, but some have a serious bacterial infection that needs urgent and appropriate antimicrobial therapy advance in blood culture technique have resulted in efficient and reliable techniques for detection of bacterial and fungal pathogens.

Blood stream infection is a cause of high mortality especially if caused by multidrug-resistant bacteria. Bacteriologic culture to isolate the offending pathogen and knowledge about sensitivity pattern of isolates remains the mainstay of definitive diagnosis and management of bloodstream infection.

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Use of Smokeless Tobacco in Medical Students and Hypertension

Tobacco is being used in various forms including cigarette, shisha, cigar and bidi smoking and smokeless tobacco. Smokeless tobacco constitutes various forms of tobacco i-e paan/ betel quid, tobacco with lime, naswar, gutka, qiwam, tobacco tooth powder, minpuri, areca nut (supari).

Qiwam consists of thick paste of boiled tobacco mixed with powdered spices such as saffron, cardamom, aniseed and aroma, while paan/ betel quid is a mixture of the leaf of the Piper betle vine, aqueous calcium hydroxide paste [slaked lime].

Smokeless tobacco is commonly used in South Asia, where it has become part of South Asian culture. Furthermore, South Asia is a major producer and exporter of tobacco and over one-third of tobacco consumed in South Asia is smokeless.

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Practice Management Role in Monitoring Family Medicine Residents Adherence to ACGME-I Standards in Qatar

One of ACGME-I requirements was the practice management curriculum, Practice management curriculum is an essential tool, which can help in several ways, Besides training schedule, physician alert system, and several other innovative aspects of monitoring resident’s performance and prearranged activities, this will also reflect with equal measure on any training institute as well.

Practice management report is a tool used to evaluate practice activity and productivity for each resident. It also monitors their practice performance progression.

individuals/practice productivity which includes total number of patient visits seen by the resident in continuity care clinics , total number of visits to hospitalized patients, patient visits distribution by gender, patient visit distribution by age , patient visits distribution by presenting illness, and chart (SOAP) documentation.

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Top 15 Tips on Becoming an Effective Medical Simulation Performer

Medical simulation has become an important platform for medical education by allowing learners to be exposed to rare but challenging clinical and social situations in a targeted, simulated learning environment.

While high-fidelity simulation incorporates advanced programming software with life-like manikins that can blink, sweat, or even bleed, technology’s ability to replicate real-time human interactions remains limited.

The use of human actors/standardized patients can add significant constructive tension and realism to a case, and permits exploration of complex patient-provider dynamics.

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Tessier 30 Facial Cleft- Median Cleft of Upper and Lower Lip, Lower Alveolus and Mandible, Ankyloglossia and Cervical Teratoma

Cleft lip and palate are common, whereas median mandibular clefts are extremely rare anomaly found in cleft no. 30 in Tessier’s classification. This anomaly was first time reported by Couronne in 1819. So far upto 70 cases have been described in history.

Associated anomalies are lower lip hemangioma, facial anomalies, ankyloglossia, cleft palate, cervical dermoid cyst, hyoid bone agenesis, laryngeal cartilage malformation, epiglottis aplasia, cardiac malformation and chromosomal abnormalities, which further worsen the prognosis.

Failure of union of the first branchial arch in midline results in lower midline facial cleft defect whereas failure of fusion of the lower branchial arch elements are thought to lead to associated deformities of the neck.

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Perhaps its Time to Move on to Individually Tailored and Focused Treatment in the Aged Population

Geriatric population is increasing by the day, and what’s more worrisome are the accompanying morbidities with aging. Multimorbidity seems to be a common presentation in the aged which usually leads to polypharmacy, and that again is a growing concern. As we had said many years ago, it’s not that the aged are looking forward to increased longitivity.

They are probably more interested to remain fit enough so as to carry on with their daily chores, as was opined by us. Since one size will never fit all, therefore, based on the multi-morbidities an individually tailored approach may perhaps be more helpful. With the decline of the bodily functions and physiology as we age, there can be so many different medical and physical disabilities.

There can be all sorts of combinations of problems, some apparent and many unapparent, which will require all the skills and expertise from a Geriatrician or from the treating physician. May be a revisit and a fresh look at all the problems from head to toe might help in pruning down the list of diagnosis, which in turn could also help to curtail inadvertent polypharmacy.

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Geriatric Depression and Cognitive Impairment

More than 350 million people are affected by depression making it one of the most common disorders in the world. It is the biggest cause of disability, and as many as two-thirds of those who commit suicide have the condition.

But although depression is common, it is often ignored.Depression in older adults is a very common condition that creates a major problem for public health. A high percentage of this population is under-diagnosed in primary care.

It has been demonstrated that depression is associated with cognitive impairment due to vascular factors, degenerative process, or emotional compromise. Moreover, it could be also related with social and psychological distress situations, or co-morbid clinical diseases (chronic diseases, cancer, neurological diseases, etc.)

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Promoting Palliative Care to Cancer Patients in the Republic of Kazakhstan

In his recent book, Palliative Care: The 400-Year Quest for a Good Death , [1] Harold Vanderpool traces the emergence of medical palliation to a proclamation by Sir Francis Bacon in 1605 challenging physicians to offer and continually improve palliative medical care and treatment for dying persons.

Florence Nightingale also contributed significantly to the evolution of what we call palliative care today, although the period of 1895 to 1959 – a time of great advances in medicine – unfortunately led to less appropriate care for the dying, though it contributed to discussions about the ethics of treating the dying. The following period (1960-1981) is described as a time of momentous transition.

The influence of Elisabeth Kübler-Ross and Cicely Saunders emerged, solidifying palliative care concepts in the US and UK, and thereafter worldwide.In 2015 the WHO added palliative care to its family of factsheets for the first time.

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Comparison of Hormones, Lipoproteins and Substrates in Blood Plasma in a C57bl6 Mouse Strain after Starvation and a High Fat Diet

Metabolic syndrome, the complex of conditions that put humans to risk for coronary heart disease and type-2 diabetes, is increasingly common in Western countries. In North America, it is estimated that over 50 million American people or 20% of the US population are affected.

In addition, the numbers of cases are also increasing in Europe.Obesity is a strong factor involved in metabolic syndrome, and some researchers claim metabolic syndrome is in itself closely linked to the metabolic derangement called insulin resistance in humans.

Early signals of emerging obesity might be found in the blood, which functions as the body’s transport medium by carrying nutrients, lipids and waste products between cells.

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Preparing for the Rise in Alzheimers Disease Cases: A Proposal for Training Support Personnel

As the baby-boomer generation continues to age, the number of Alzheimer’s disease cases is expected to double in the next decade. The functional disability and need for clinical management associated with this trend will outstrip our current workforce.

Making the correct diagnosis and prescribing cognitive enhancing drugs is relatively easy compared to the time and effort required to educate and support caregivers and help them cope with the complications of neurocognitive disorders such as depression, psychosis, agitation, and growing dependency for basic function.

Ninety five percent of these patients will be managed in home settings that will require time and effort from family members who are traditionally women that manage their own family with children as well as their aging parents, many of whom also work themselves to make ends meet financially. Social service agencies will therefore figure large in this equation to provide day care and in-home help.

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A Validated Method for Titanium Implant Anchorage Analysis using Micro CT and Biomechanical Testing

The use of uncemented titanium endosseous implants for restorative dentistry and orthopaedic surgery has been the standard of care for several decades. Endosseous implantation using uncemented titanium prostheses is commonly performed in trabecular bone sites such as the jaws, vertebrae and ileum.

Still, the mechanisms involved in this fascinating and unique interaction between a living tissue and foreign substance are poorly understood. An important reason for the absence of sufficient mechanistic information is the lack of robust experimental models combined with solid tools to analyze structurefunction relationships of the implant-bone system.

Qualitative and quantitative ex vivo analysis of peri-implant tissues is typically done by means of light microscopy using thin histological sections following implant removal or thicker ground sections which contain the implant and undecalcified bone. These techniques are labor-intensive and thus time-consuming.

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Challenges to Palliative Care in Pediatric Patients

The incidence of cancer is rising in pediatric population since last decade. In 2016, about 10,000 children are projected to be diagnosed of cancer in United States.

Though five-year survival in most of the pediatric cancer patients is more than 80% now, cancer remains the most common cause of mortality after trauma in age group 5-14 years. The growing population of pediatric cancer survivors warrants parallel rise in the palliative care.

As per the World Health Organization (WHO) palliative care is, ‘An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.

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Serum Biomarkers for Sepsis

Sepsis is defined as the presence of a serious infection that correlates with systemic and uncontrolled immune activation. It is associated with high mortality, largely due to multi-organ failure. Sepsis could be extremely dangerous in infants, elderly population, immunocompromised and critically ill patients.

Early diagnosis and prompt appropriate intervention is essential to halt the progression of sepsis and improve survival. A positive blood culture is the commonly used assay in sepsis diagnosis. However, this diagnostic tool has its limitations as culture is time dependent resulting in delay. Furthermore, positive blood cultures may not be present in many patients with sepsis.

In recent years, serum lactate testing in sepsis has become popular and it is being used in many centers to expedite early treatment and to monitor response of the therapy. Researchers have been working for quite some time to identify a "perfect biomarker" for early diagnosis of sepsis.

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Influence of the Implant Prosthetic Restorations Components on the Stress Values and Distribution in Surrounding Bone - Finite Element Analysis Study

Currently the implant-prosthetic therapy is widespread and has a great success regarding the rehabilitation of edentulous patients. Although in many studies it has been reported a high rate success for this type of treatment, in daily practice is very difficult to avoid failures that consist in different complications such as mechanical or aesthetic ones, resulting in relatively short term or late loss of the dental implants.

This is the reason why the researchers’ concern has been focused on finding the appropriate ways to increase the success rate of the implant prosthetic therapy. Randomized clinical trials and in vitro studies such as the finite element analysis are necessary to assess the efficiency of the biomaterials and of the biomechanical aspects of all the components, including the surrounding bone.

The success or failure of the implant-prosthetic treatment is influenced by the stresses developed in the periimplant bone and the stress values and distribution that depend both on the implant and the bone characteristics.

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Challenges to Palliative Care in Pediatric Patients

The incidence of cancer is rising in pediatric population since last decade. In 2016, about 10,000 children are projected to be diagnosed of cancer in United States. Though five-year survival in most of the pediatric cancer patients is more than 80% now, cancer remains the most common cause of mortality after trauma in age group 5-14 years.

The growing population of pediatric cancer survivors warrants parallel rise in the palliative care. As per the World Health Organization (WHO) palliative care is, ‘An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness.

Through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’. Notably contemp orary thoughts advocate the integration of curative and palliative approaches in pediatric patients.

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Malaria: What are the Needs for Diagnosis, Treatment and Control?

Malaria is caused by infection with obligate intracellular, singlecelled protozoa of one of the four species of plasmodium, Plasmodium falciparum , Plasmodium vivax , Plasmodium ovale and Plasmodium malaria.

Recent human cases due to Plasmodium Knowles were reported.  Of these, P. falciparum and P. vivax are the most predominant epidemiologically. Malaria is transmitted when a competent vector, the different species of female anopheles mosquitoes, take a blood meal from somebody already infected with malaria.

About 400 species of Anopheles mosquitoes have been described and approximately 30 of these species are potential vectors of malaria that affect humans.Malaria is the world’s most deadly and life-threatening parasitic disease.

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Developing and Validating Sequential Sampling Plans for Integrated Pest Management on Stored Products

The tendency to manage insects in stored products is the replacement chemical control measures by cost-effective nonchemical alternatives. Integrated Pest management (IPM) is an approach to pest control that uses cost-benefit analysis in making decisions. IPM programs include the study of factors regulating insect distribution and abundance and sampling to make inferences about insect populations.

A good IPM must balance the cost of a sampling program with higher profit of reducing pest infestation. Sampling methods as absolute sampling is very expensive and in countries where the manpower is costly is usually replaced by traps. Relative sampling costs less but is still expensive, because usually traps need to be replaced either because they are consumables or damaged.

The first step of sampling is predicting mean variance to determine the number of samples needed. The implementation of a sampling program must attach a threshold of the economic injury level, the limit from that the insect density causes the reduction of the market value of the product and the needs to make a decision of using control measures.

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Promoting Palliative Care to Cancer Patients in the Republic of Kazakhstan

The 400-Year Quest for a Good Death , [1] Harold Vanderpool traces the emergence of medical palliation to a proclamation by Sir Francis Bacon in 1605 challenging physicians to offer and continually improve palliative medical care and treatment for dying persons.

Florence Nightingale also contributed significantly to the evolution of what we call palliative care today, although the period of 1895 to 1959 – a time of great advances in medicine – unfortunately led to less appropriate care for the dying, though it contributed to discussions about the ethics of treating the dying. The following period (1960-1981) is described as a time of momentous transition.

The influence of Elisabeth Kübler-Ross and Cicely Saunders emerged, solidifying palliative care concepts in the US and UK, and thereafter worldwide. In 2015 the WHO added palliative care to its family of factsheets for the first time. To date, however, palliative care is largely absent from the global health dialogue and consequently is not practiced in most of the developing world, even though cancer is a leading cause of morbidity and mortality worldwide.

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Does Elevated Alpha-fetoprotein During Pregnancy Protect Against Breast Cancer Later in Life?

Elevated levels of maternal serum alpha-fetoprotein (sAFP) during pregnancy have long been associated with a reduced risk of breast cancer in women later in life. Since the decade of the late 1990’s and early 2000’s, investigators have reported that elevated sAFP levels during pregnancy were associated with a future reduction in breast cancer risk in both pre-and postmenopausal women.

An initial study by Richardson et al., using stored frozen maternal serum samples, reported that a reduced risk of postmenopausal breast cancer was associated with high third trimester sAFP levels in women younger than 28 years at first pregnancy. Having been stored for at least 20 years, Richardson re-assayed the frozen/thawed maternal sAFP samples from women with presently confirmed breast cancer.

A subsequent report by Danish investigators, using the country of Denmark’s national medical records as a resource, confirmed and extended the earlier studies of Richardson to include second trimester sAFP levels in premenopausal women up to age 38 years. A later study by Vatten et al. further confirmed both earlier reports of sAFP and future breast cancer risk and extended their finding to include cord serum AFP, ethnicity, and pre-eclampsia. 

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Cadaver Dissection in Anatomy: The Ethical Aspect

Ethical constraints in relation to a cadaver do not cross the mind of medical professionals as it may seem strange to devote attention to the value to be ascribed to the dead body or to ethical issues surrounding the dead body or a cadaver.

After all, it appears that there are few ethical issues surrounding dead bodies in comparison with living bodies, whereas in living people the ethical constraints are undoubtedly present. The most important book in the history of medicine is an anatomical treatise published in 1543, ‘De humani corporis fabrica’, based on dissections of the human body.

The illustrations in the seven volumes of this work by Andreas Vesalius are exquisite for their beauty, complexity and humanity.Prior to Vesalius anatomical texts were based largely on dissections of animals. Leonardo Da Vinci not being an anatomist had made beautiful pictures of the human body. His paintings were very descriptive and the entire anatomy of the human body was given a three dimensional approach with his art. In ancient ages cadavers were exhumed by unlawful means to study human anatomy.

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Reproductive and Sexual Anatomy

The vagina is a deflated tube that is 5 to 10 centimeters in length and 1.9 cm in width. It has the ability to expand and stretch when necessary. For example, during sexual intercourse, the vagina swells to approximately 10 to 20 centimeters in length and 6 cm in width.

It also forms the "birth canal" and drains blood during menstruation. The vagina normally contains various yeast and bacteria, which is necessary to maintain its health. During intercourse, the vagina produces a slippery clear discharge that acts as a lubricant with a noticeable smell. The distal part of the vagina constricts by the levator ani muscles.

 Above the pelvic floor, the vagina is much more capacious and distensible. The Bartholin glands are a pair of mucus-secreting glands, approximately 1 cm in diameter and drain through a narrow duct that is approximately 2.5 cm in length in the posterior wall of the vagina. They release secretions that moisten of the vagina and release additional moisture when a woman becomes sexually aroused.

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Management of Depression and Uses of Natural Medicine

Depression is a debilitating mental problem that could affect any one. Women are more prone to a depression than men. Unmarried, middle aged, being disabled or unemployed, and family history of depression are some of the few factors that can make a person more susceptible to a depression. Use of herbal medicine is so common in everyday life that we cannot deny that it is important. Store shelves are full of various products that are used in depression.

Given that not all brands are equal. There is a different in quality, purity and content of each product. Herbal medicines are considered a health food and are therefore not regulated by the Food and Drug Administration (FDA) as a drug. While supporting clinical data regarding herbal medicines in depression are ambiguous, primary care providers may often be asked about the safety, effectiveness and side effects of these products.

The purpose of this article is to review conventional treatment and provide information about the safety, product selection, drug interaction and the side effects of herbal medicines that have strong evidence in the treatment of depression. Herbal medicines with weak or lack of evidence are not discussed.

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Personalized NanoMedicine : Not Just a Tool but towards an Excellence

Over the decades, immense research in Biomedicine has been provided an accurate and deep understanding related to lethal diseases such as Cancer, HIV and Myocardial infarction; however, the complexity of disease and difference from individual to individual, it is difficult to diagnose at early stage and treatment. To fulfill the gap personalized medicine has been introduced, which is defined as ‘tailoring or monitoring of diagnosis and therapies to the genetic profile of an individual’.

In recent past, there is an increased interest in Nanotechnology and nanomedicine, which refers to the study of phenomena and the manipulation of matter at the atomic and molecular level. The vision of this technology is to improve productivity, health care, human potential and sociality issues such as higher limits of sustainable development. Nanoscience, evolved to the next levels and used as potential environmental monitoring agents like nanostructured gas sensors and for medical applications, particularly as drug delivery systems.

 Personalized nanomedicine is designing of novel nanomaterials with increased binding affinity, controlled navigation, sustained release of drug, good biocompatibility, and maximum therapeutic potential which are crucial for effective theranostic approaches. It may defined as  combining noninvasive imaging with targeted drug delivery seems to hold significant potential for personalizing nanomedicine-based chemotherapeutic interventions, to achieve delivery of the right drug to the right location in the right patient at the right time.

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Prolonged QT Intervals in Isolated ACTH Deficiency: Case Report and Mini Review of Literature

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency with low or absent cortisol production, normal secretion of pituitary hormones except ACTH and the absence of structural pituitary defects. The clinical features include various symptoms such as vomiting, abdominal pain, myalgia, joint pain, severe hypotension, and hypovolemic shock due to glucocorticoid deficiency.

Glucocorticoid replacement is required for the symptomatic patients. Since the reports in the 1950s, ECG abnormalities such as flat or inverted T waves, prolonged QT intervals are known to occur in adrenal insufficiency. There are six reports suggesting that sudden cardiac arrest occurs in IAD due to prolonged QT intervals.

Although ECG abnormalities are modulated after hydrocortisone replacement, the mechanism by which hydrocortisone may affect ECG still remains unclear. Here we report a case of IAD whose ECG abnormalities were reversed with hydrocortisone replacement, suggesting a role played by glucocorticoids in the modulation of QT intervals. Also we show the characteristics of the six cases of IAD with QT prolonged intervals causing lethal arrhythmia.

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