Prof. John Yahya I. Elshimali
Professor of Pathology and Oncology, UCLA School of Medicine & Charles R. Drew University of Medicine and Science, California, USA.

Short Biosketch

ISBN 978-81-968656-9-6 (Print)
ISBN 978-81-968656-6-5 (eBook)
DOI: 10.9734/bpi/acmmr/v11

This book covers key areas of medicine and medical research. The contributions by the authors include female infertility, selective tubal catheterization, pregnancy rate, tubal function, salpingography, hysterosalpingography, musculoskeletal disorders, morbidity, Intrathoracic rib, supernumerary rib, intercostals fusion, axial skeleton, cholangiocarcinoma, herbal medicine, anticancer activity, hepatic malignancy, congenital intrahepatic biliary stones, metastatic disease, chemotherapeutics, tumoroids, tumor growth, fibroblasts, cancer-associated fibroblasts, carcinoma cell-based extracellular matrix, cytokines, clinical exposure, psychomotor, Bohlman technique, rialto implant, spondylolisthesis, porokeratosis of Mibelli, cornoid lamella, squamous cell carcinoma, pseudoepitheliomatous changes, HADHA gene, mutation, mitochondrial trifunctional protein deficiency, fatty acid oxidation disorder, neuromuscular disease, neuropathy, neuromyopathy, Otic ganglion; pterygopalatine ganglion, ciliary ganglion, submandibular ganglion, cranial parasympathetic fibers, anatomical models, cadaveric specimens, mental health, competency-based medical education, specific learning objectives, CBME strategies, rare autoimmune disease, retinal detachment, Vogt-Koyanagi-Harada disease, central nervous system. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical research.


Media Promotion:


Early Clinical Exposure (ECE) as an Effective Learning Tool in Anatomy

Sharadkumar Pralhad Sawant, Shaheen Rizvi

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 1-10

Early Clinical exposure (ECE) is a teaching learning methodology, which fosters exposure of the medical students to the patients as early as the first year of medical college.  One of the basic science courses in the undergraduate medical program is anatomy, which serves as the basis for future physicians' education. In addition to having a broad curriculum, some students find the topic to be difficult and uninteresting. Many educators believe that studying anatomy in a setting similar to the ones in which it will be used will make the subject more engaging.

The new Competency based Curriculum has introduced a restructured curriculum and training program for undergraduate teaching with emphasis on early clinical exposure, integration of basic and clinical sciences, clinical competence and skills and new teaching learning methodologies. This according to NMC, will lead to a new generation of medical graduates of global standards. Under the current structure, students are only exposed to clinical subjects in their second year of undergraduate study. On the other hand, it has been shown that during clinical placements, students struggle to remember fundamental ideas. The NMC has recommended that in order to remedy this situation, students should be introduced to clinical difficulties from their first year of undergraduate study. As medical education continues to advance, it is the endeavour of educators as well as MCI, to attempt to prepare students for their professional lives. ECE helps to improve understanding, develop problem solving skills & increases interaction. Retention of knowledge is better due to integration of basic science and clinical science and development of self directed learning skills.

Herbal Approaches to Cholangiocarcinoma: A Systematic Review

Kesara Na-Bangchang , Tullayakorn Plengsuriyakarn, Juntra Karbwang

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 11-47

Cholangiocarcinoma (CCA) is a malignant bile duct cancer of epithelial cells with high morbidity and mortality. The growing incidence of cholangiocarcinoma (bile duct cancer) and limited treatment options stimulate a pressing demand for research and the development of new chemotherapeutics against cholangiocarcinoma. This chapter highlights the role of herbal medicine in Cholangiocarcinoma control by using a systematic review approach. This study also aimed to systematically review herbs and herb-derived compounds or herbal formulations that have been investigated for their anti-cholangiocarcinoma potential. Systematic literature searches were conducted in three electronic databases: PubMed, Science Direct, and Scopus. The studies were initially screened by titles and abstracts to exclude irrelevant articles and duplication. One hundred and twenty-three research articles fulfilled the eligibility criteria and were included in the analysis (68 herbs, isolated compounds and/or synthetic analogs, 9 herbal formulations, and 119 compounds that are commonly found in several plant species). The most investigated herb was Atractylodes lancea (Thunb.) DC. (Compositae) and Curcuma longa L. (Zingiberaceae). Only A. lancea (Thunb.) DC. (Compositae) has undergone the full process of nonclinical and clinical develop- ment to deliver the final product for clinical use. The extracts of A. lancea (Thunb.) DC. (Compositae), Garcinia hanburyi Hook.f. (Clusiaceae), and Piper nigrum L. (Piperaceae) exhibit antiproliferative activities against human cholangiocarcinoma cells (IC50 < 15 µg/mL). Cucurbitacin B and triptolide are herbal isolated compounds that exhibit the most promising activities (IC50 < 1 µM). A series of experimental studies (in vitro, in vivo, and humans) confirmed the anti-cholangiocarcinoma potential and safety profile of A. lancea (Thunb.) DC. (Compositae) and its active compounds atractylodin and \(\beta\)- eudesmol, including the capsule pharmaceutical of the standardized A. lancea (Thunb.) DC. (Compositae) extract. Future research should focus on the full development of the candidate herbs to deliver safe and effective products for cholangiocarcinoma control.

Future research should be geared toward the full development of the candidate herbs until the delivery of final products that are safe and effective for CCA control.

Dynamic Fibroblasts Turn a Tumoroid to a Tumor

Girdhari Rijal

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 48-73

Tumoroids are the cancer-cell derived tumor-like organoids generated in the lab with or without using of 3D scaffolds. Whereas, a tumor tissue is a result of in vivo multi-cellular complex organization that supports cancer cells and other tumor-associated cells (TACs), for example, fibroblasts & endothelial cells, for the participation and the coordination to establish the suitable physio-dynamic environment for a tumor growth. Since creating such an environment in lab through in vitro culture is still a challenge, the implantation of tumoroids into the animal tissues to generate tumors becomes common practice. Predominantly presence of the fibroblasts in the histology sections of a solid tumor indicates that tumor cannot establish the progressive growth without fibroblasts. Following implantation, tumor cells in a tumoroid signal the local tissue microenvironment to recruit fibroblasts and other TACs. Actively participation and transformation of fibroblasts to cancer-associated fibroblasts (CAFs) ultimately lead to the shifting of a tumoroid to a tumor. This book chapter therefore discusses about fibroblasts and CAFs, and their role to establish the tumor from an implanted tumoroid into the animal tissue.

Novel HADHA Mutation Causes Mitochondrial Protein Deficiency and Neuromuscular Disease

Amit Vatkar , S. Joshi Nishigandha , Smita Patil , Mumtaz Shariff

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 74-78

Mitochondrial trifunctional protein deficiency (MTP deficiency) is a rare genetic disorder affecting oxidation of long-chain fatty acids. It typically causes severe neonatal symptoms like heart/liver disease, hypoglycemia, and metabolic acidosis. It can also gradually present with peripheral neuropathy, episodic rhabdomyolysis, and vision loss. Progressive peripheral neuropathy is an irreversible complication. We report a unique case of a 5-year-old boy with slowly worsening limb weakness. Genetic analysis revealed a novel homozygous HADHA mutation causing his MTP deficiency, representing the first described occurrence in India. Exome sequencing comprehensively analyzed genes. The patient exhibited sensorimotor axonal neuropathy with secondary muscle atrophy, reflecting neuromyopathy. Our study provides further insight into genotype-phenotype correlations in mitochondrial trifunctional protein deficiency.

Porokeratosis is a clonal expansion of keratinocytes which differentiate abnormally but not completely neoplastic in nature. The various types of porokeratosis are characterized by a thin column of parakeratosis, the cornoid lamella, the active border of lesion.

Porokeratosis is listed as a rare disease by Orphanet and the Office of Rare Diseases (ORD) of the National Institute of Health.

Mibelli described the classical form that bears his name (1893). The diagnosis is confirmed by histopathological examination. It may be complicated by development of cutaneous malignancies, like squamous cell carcinoma (most common in linear variant) [1].

Etiopathogenesis of porokeratosis include Ultraviolet light exposure, extensive radiation therapy, immunosuppression, transplant procedures, immunodeficiency syndromes, chronic renal failure, chronic liver disease, infections, hematological malignancies including lymphomas, HIV infection and hepatitis C virus infection [2]. Recent theories suggest that abnormalities in the mevalonate pathway are responsible for the pathogenesis of porokeratosis. Abnormalities in the genes MVD (mevalonate decarboxylase), mevalonate kinase, PMVK (phosphomevalonate kinase), FDPS (farnesyl diphosphate synthase) and solute carrier family 17 member 9 (SLC17A9) have been found to be pathogenic in porokeratosis [3].

This case report addresses a rare case of giant porokeratosis of Mibelli showing features of pseudoepitheliomatous changes raising suspicion of future malignant transformation possibility that was treated with surgical excision of lesion coupled with systemic and topical therapies even though the patient was lost to follow-up.

A Case Report on Seven Accessory (Supernumerary) Thoracic Ribs in Left Thoracic Wall

Sunita Bharati, Brij Raj Singh , Ujwal Gajbe , S. Swayam Jothi , Manisha Nakhate

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 87-93

Ribs are protective ribbon-like bony elements normally present within the chest wall and are few of the most imaged structures in the clinical practice. Common rib anomalies include cervical ribs, bifid ribs, rib dysplasia, and intercostal fusion. The term “intrathoracic rib” signifies abnormal location of a rib within the thoracic cavity.An intrathoracic rib is a rare and benign congenital anomaly of the thoracic cage. Rib anomalies are relatively common and affect almost one percent of the general population A Female cadaver had seven supernumerary intrathoracic ribs on the left side. Its location in the posterior mediastinum with lack of attachment to adjacent ribs (intercostal fusion) were unusual features. Most commonly accessory ribs are associated with right side but in the present study it was observed on left side. The case is suggestive of left seven intrathoracic ribs (left seven supernumerary ribs), and hypoplastic left lung. Clinical significance of these anomalies are usually silent throughout life time& detected incidentally by imaging. These should be kept in mind in differential diagnosis of thoracic pathology.

Use of Rialto Sacroiliac Fusion Implant for Trans-Sacral Fixation (Bohlman Technique) for High Grade L5 Listhesis Treatment: A Series of Cases

Marcel Sincari , Eduardo Mendes, Luciano Guerra, Mark-Daniel Sincari

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 94-111

The article begins with a brief biography of Sr. Henry Bohlman, a great orthopedist and person with strong impact on modern Medicine and Spine surgery. Using the original Bohlamn technique with small modifications (instead of fibula graft used Rialto implant and performing posterior fixation L4-S2) we treated surgically two young females with high grade L5 listhesis and a case of postoperative pseudarthrosis after lumbosacral fixation with success. The detailed, staged surgical technique is described, also with description of pitfalls and their avoidance.

Methods: The patients were followed up during 2 year and 9 months and 2 year and 7 months, the third patient´s follow up is shorter, because is a recent case.

Results: Two young females of 18 years old with isthmic listhesis L5 were submitted to fixation L4-S2 and trans-sacral, trans-dical fusion with Rialto implant by Bohlman technique with partial reduction of listhesis. Both had resolution of the pain and has maintained a good clinical outcome at 1 years and 9 months and another one at 1 year and 7 months follow up. The third case, 79 years old male, was a postoperative pseudarthrosis L5-S1 solved with the use of the same type of trans-sacral implant, associated with S2 SAI screws.

Conclusions: Circumferential fusion is a robust arthrodesis with a low risk of pseudarthrosis, fusion without reduction is advised in patients with a balanced pelvis, acceptable global sagittal balance, few neurological symptoms. Partial reduction may be achieved during the fixation after posterior bonny elements removal of L5 vertebra. In-situ fixation can be augmented with trans-sacral Rialto implant.

Effectiveness of Selective Tubal Catheterization in the Management of Female Infertility due to Proximal Tubal Obstruction in Togo

Adjénou K. E. , Sabi Couscous H. , Ndouandju Saha , Sonhaye Lantam , Amadou Abdoulatif, Adambounou Kokou, Agoda Koussema K.

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 112-124

Introduction: The problem of fertility is growing nowadays not only in western countries but also in other areas as even in developing countries the couples postpone childbirth well over the age of 30 in order to focus on their careers and financial stability.

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction.

Methods: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative \(\beta\)-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after failure of spontaneous tubal opacification. 

Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified; 62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%.

Conclusion: It is concluded that selective tubal catheterization has an objective and satisfactory therapeutic value. In a context where its indications are only shared with other techniques with subjective results such as hydrotubation, it remains the first-line treatment of infertility by proximal tubal obstruction.

Prevalence, Demographic and Non-Demographic Risk Factors of Work-Related Musculoskeletal Disorders among Healthcare Workers in Five Referral Hospitals in the City of Douala, Cameroon: A Cross Sectional Study

Meh Kum Basil, Bopda Mtopi Orélien Sylvain , Mekoulou Ndongo Jerson , Franklin Chu Buh, Bika Léle Claude Elysée , Ayina Ayina Clarisse Noël, Assomo Ndemba Peguy Brice , Bongue Bienvenu , Mandengue Samuel Honoré , Emmanuel Sako Haddison

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 125-149

Introduction: Recent investigations suggest that environmental, psychosocial, non-specific job stressors such as work overload, and shift work could have a negative influence on the musculoskeletal systems of healthcare workers leading work-related musculoskeletal disorders (WRMSDs). This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon.

Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires; data on the demographics and risk factors were collected using a well-designed questionnaire while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. The collected data was then cleaned and analyzed with the help of SPSS version 26 and as well as confidence interval calculator to calculate confidence intervals and odds ratios. Chi-square test was used to evaluate associations within groups and multivariate logistic regression was done to evaluate the risk factors associated with WRMSDs.

Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for  Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 80.8% (21) for Physiotherapists (PT) and 78.8% (41) for Medical Doctors (MD). There was a significant difference (X= 17.651; p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9% (133/561), while Healthcare workers form NBDH where 3 times less likely (AOR = 2.91; 95% CI: 1.32-6.41; p = 0.001) to have WRMSDS than the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% (330/561) with the lowest at the elbows 11.2 % (63/561).

The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p < 0.001), knees (p = 0.006) and ankle/feet (p = 0.047). Working on the same position (AOR = 2.90; 95% CI = 1.74-4.83; P = 0.001), working with vibrating objects (AOR = 1.94; 95% CI = 1.10-3.40; P = 0.022) and job stress (AOR = 1.91; 95% CI = 1.14-3.20; P = 0.014) were non-demographic risk factors associated with WRMSDs.

Conclusion: The general prevalence of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are; lower back, neck and upper back. Working on the same posture, working with vibrating objects, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals. Improving the working conditions, increase in staff, increased financial and administrative motivation may be key remedies to reduce the prevalence of WRMSDs among healthcare workers in Douala-Cameroon hospitals.

Neuroanatomy: The Parasympathetic Ganglia of the Head and Neck

Georges Aoun

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 150-158

There are four parasympathetic ganglia located within the head: the ciliary, the otic, the pterygopalatine, and the submandibular. They are related to cranial nerves that have parasympathetic activities, such as the oculomotor (CN III), the facial (CN VII), and the glossopharyngeal (CN IX) nerves. This chapter reviews the anatomy and physiology of these ganglia.

A Multidisciplinary Approach to Learning Anatomy

Sharadkumar Pralhad Sawant , Shaheen Rizvi

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 159-168

This chapter highlights the other teaching methodologies for teaching gross anatomy. Anatomy has been a cornerstone of medical education for hundreds of years. But lately, over the last few years, Anatomy in undergraduate education has been undergoing a lot changes. Methods of teaching, methods of assessment, methods of cadaver procurement, embalming methods etc. all have undergone metamorphosis.  Since anatomy is the foundation of medical science in India, first-year undergraduate health science students are taught it practically in every subject. It is a well-known truth that learning the fundamentals of anatomy is a need for learning any other area of medicine. All medical professionals must have a basic knowledge of Anatomy so as to ensure safe medical practice. Traditionally Anatomy teaching consists of didactic lectures as well as dissections or prosections as per the requirement of the course.In an effort to include new content into their curricula without sacrificing core anatomy knowledge, medical colleges are evaluating alternative approaches to teaching gross anatomy in order to make the subject more engaging and inspiring for students.

CBME: Wrath of Promises and Perils

Nirmala Anand , Dhruv Uday Goltekar , Rajesh Shenoy

Advanced Concepts in Medicine and Medical Research Vol. 11, 29 December 2023, Page 169-180

The major Aim of CBME introduction for the Indian Medical Graduates is full of challenges and innovations in medical education, specifically focusing on competency-based medical education (CBME) in India. CBME aims to address mental health concerns among medical students by transforming traditional teaching methods, emphasizing practical application, personalized learning, and integration of subjects. This research underscores challenges like inadequate faculty training, sustaining student engagement in the pandemic, and hurdles to self-directed learning. It explores diverse teaching methods, such as small group teaching and problem-based learning, highlighting both their effectiveness and challenges, particularly in intricate subjects like neuroanatomy, was deemed essential for a comprehensive understanding of anatomy. Additionally, the importance of assessment methods, challenges in accessing educational resources, and the need for faculty training in innovative teaching techniques were discussed. Overall, the passage delves into the complexities of modern medical education and the ongoing efforts to enhance its effectiveness.

This chapter discuss about clinical features, diagnosis, and management of Vogt-Koyanagi-Harada disease. Vogt-Koyanagi-Harada disease (VKHD), initially described as an uveomeningoencephalitic syndrome, is a systemic granulomatous autoimmune disease that targets melanocyte-rich tissues, such as the eye, inner ear, meninges, skin and hair. VKHD is difficult to diagnose because its clinical presentation is variable and multisystemic which often leads to late diagnosis and treatment allowing the appearance and progression of the disease sequelae. We report a 35-year-old female presented to our hospital with chief complaints of pain, redness, and progressive diminution of vision in both eyes for 2 years.  Early referral to tertiary centers should be the golden rule, as delay in initiation of treatment can lead to secondary complications such as serous retinal detachment, cataract, glaucoma, choroidal.