Achievements and Challenges of Medicine and Medical Science Vol. 5

Background: Epidemiological data demonstrate that obesity is a strong cancer risk factor for recurrence and survival and is linked to more aggressive characteristics of the major common cancers. It is considered that high generalized tumor inflammatory infiltrate could be a good prognostic marker. At the same time, T-cells' role in actual human cancer remains largely unknown. In this aspect, it has to be noted that the publications concerning the evaluation of the prognostic value of CD8⁺-, CD45RO⁺-T lymphocytes in tumor and bone marrow (BM) under overweight and obesity are limited, especially in the clinical setting concerning gastric cancer.

Aim: This study determines whether CAA density as well as hypoxia in tumors affect the prognostic value of TILs and CD8+- and CD45RO+ cells in BM and evaluates their impact on disease outcome in patients with GC, stratified by body mass index (BMI).

Patients and Methods: Immunohistochemical and immunocytochemical examinations, ³¹P NMR spectroscopy, and statistical analysis were used.

Results: According to the findings, 39.5%, 46.4%, and 89.5% of patients with BMI<25, BMI>25<30, and BMI>30, respectively, had high CAAs (>M) in tumors. When tumors of patients with BMI<25, BMI>25<30, and BMI>30 were characterized by the high density of CAAs, a high number of CD8⁺-T cells was detected in 58.8.1%, 37.5% and 16.6% and CD45RO⁺-T cells in 57.8%, 41.4% and 30.7% of cases, respectively. Moreover, 82.4%, 87.5% and 92.3% and 83.6%, 65.6% and 93.2% of patients with BMI<25, BMI>25<30, BMI>30, respectively had CD8⁺- and CD45RO⁺-T cells in BM. Obtained results have shown that tumor hypoxia does not associate with the presence of CD8⁺- and CD45RO⁺-T cells in BM and, probably, does not influence their activity. Patients with obesity having a high density of CAAs in tumors but with slight in filtrating of TILs demonstrated unexpectedly better OS than patients with normal weight having significantly shorter OS. It may be suggested that the high density of CAAs in tumor play a key role in the OS of patients.

Conclusion: Obtained results have shown that the density of CAAs but not tumor hypoxia has a strong influence on the prognostic value of TILs as well on OS in patients with GC in according with BMI. No association was observed between the prognostic value of CD8⁺-T and CD45RO⁺- T cells in BM and OS of patients under obesity. Understanding the metabolic changes that occur in obese individuals may help to pave the way for more effective treatments for patients with gastric cancer having overweight.

Objectives: A dual sensory loss affects communicative situations and everyday functioning and increases the risk of social isolation. The purpose of the present study was to describe experiences of disabilities and factors affecting daily life from the perspective of adult persons with severe-to-profound hearing impairment in combination with severe vision impairment. Furthermore, the study also investigated which kind of support individuals with dual sensory loss received, and their experiences as citizens in the society.

Methods: The recruitment of patients with dual sensory loss was performed from 2018 to 2019 in consecutive patients at Karolinska University Hospital and at Sabbatsbergs Hospital, Stockholm, Sweden. The inclusion criteria were severe-to-profound hearing loss at 61 dB HL or more in the best ear in combination with severe vision impairment. Face-to-face interviews were conducted using a semi-structured interview guide. Semi-structured qualitative interviews were performed, analyzed, and categorized using content analysis.

Results: Fourteen interviews were performed, with an equal number of participants from both sexes. Mean age of the participants was 70.1 years (47–81 years). Analysis of the data resulted in 22 categories, six sub-themes and two main themes. Examples of some of the 22 categories that were identified: Different kind of Networks, Combination’s effects, Possibilities and Limitations, Technical tools, Companion service, and Strategies. Two main themes emerged as Isolation and The Ability to control one’s own daily life. Surprisingly, most of the participants did not think of their vision and hearing impairment as a combined disability. The interviews showed various kinds of strategies to handle daily life. The Deaf-blind–team unit was reported to offer excellent health care. Companion services for persons with disabilities proved to have become more difficult to get support from and created a lack of independence and control over their own lives. However, it was also obvious that the participants felt a positive outlook on life and were more solution-oriented in order to adjust their everyday life to their life-situation.

Conclusions: The combination of vision and hearing impairment demonstrated isolation, and the respondents in the study have a need for support in everyday life. At the same time, they struggle to have the ability to control their own lives. The study recommended that an individual with a combined hearing and vision impairment should immediately alert health care as these patients belong to an extremely vulnerable group. In the future, community-organized companion services should be investigated and reviewed to meet the needs of this patient group.

Despite many years of ET research, its pathophysiology remains unknown. Essential tremor (ET) is common and frequently affects quality of life. The case outlines a safe and novel approach to ET treatment that can either be trialed in treatment-refractory cases or used in tandem with traditional therapy. Although traditional pharmacotherapy is sometimes effective, patient factors, lack of efficacy, and poor adherence sometimes limit its efficacy. Furthermore, the pathophysiology of ET is not fully understood, but it is increasingly regarded as a highly heterogeneous disorder of cerebellar pathways underpinned by low gamma-aminobutyric acid (GABA) tone. This knowledge and review of recent data prompted the development of a multi-modal nutritional therapy approach to target three putative ET pathways: (i) diet (specifically adopting a Mediterranean diet); (ii) GABA tone (through oral supplementation); and (iii) L-tryptophan/vitamin B pathways (Triptobel oral supplement). The approach is illustrated here with the case of a 13-year-old boy with ET causing severe functional impairment. A full history revealed no exposure to toxins and there was no family history of ET or other movement disorders. He was prescribed a sugar-free, Mediterranean-style diet rich in whole grains as a carbohydrate source and rich in vegetables, fruit, olive oil, and fish. After two months of therapy, his tremor decreased significantly and he regained normal function. In conclusion, ET is a common disorder that affects quality of life and is often treatment-refractory. The case identifies and highlights several areas worthy of further investigation, particularly with respect to establishing the role of oral GABA and vitamin B/tryptophan supplementation in ET. Given the safety and positive health benefits of this novel nutritional therapy approach, it can be trialed in patients with ET either with or without concurrent traditional pharmacotherapy.

Background and Aim: Childbirth is one of the most desired, anticipated, and joyful experiences in women’s life. On the other hand, childbirth may be one of the most painful events experienced in a mother’s lifetime. Pain relief is nearly regarded as the right of patients in modern-day health care. Women undergo excruciating pain during normal vaginal delivery (NVD). However, the acceptance of labor analgesia (LA) has remained very poor. Labor pain relief remains a distant reality in developing countries. Many factors may affect the acceptance of LA.

Aim of the Study: The present study aimed to assess the correlation of previous exposure to such pain (parity) and school education with LA acceptance.

Methods: The present comparative study was conducted with a total of 400 consented participants. Consented women were enrolled in the study. A questionnaire was used to collect sociodemographic variables, acceptance/nonacceptance of LA, and the reasons for not opting for LA in upcoming delivery were noted. Participants were divided into primiparous, multiparous, and nulliparous (control). They were also grouped as per school education and compared taking illiterates as controls. Online open-source software was used which gave a sample of 70 in each group. Data are presented in absolute numbers. Fisher’s exact test is used for comparison; P < 0.05 was considered statistically significant.

Results: Effective analgesia during labor pain may contribute to better outcomes in high-risk expectant mothers. In this study, 17.5% multiparous and 38% primiparous participants were compared with 44.5% nulliparous women. Only 2.75% of participants were illiterate. Among all the participants, 69.50% were rural inhabitants and 81.50% believed in Hinduism. The finding shows that 87.14% multiparous, 84.21% primiparous, and 88.76% nulliparous women declined LA (P > 0.05). The desire to experience NVD without LA as a reason for nonacceptance was significantly less among primiparous and multiparous as compared to nulliparous (P < 0.0001), but not among literate and illiterate participants (P > 0.295 in all).

Conclusion: Previous labor pain significantly reduces the desire to experience NVD without LA, but still more than 80% parturient of any parity do not want LA due to one or more reasons. School education has no impact on LA acceptance. Ignorance, myths, and beliefs are also major contributors to the nonacceptance of LA.

Mindfulness was initially translated from the Indian term "Sati," which denotes awareness, attention, and memory. Mindfulness-Based Programs (MBP), particularly Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), highlight their efficacy in managing stress and preventing relapse in mental health disorders. These programs are recognized as third-generation therapies within Cognitive-Behavioral Therapy, emphasizing acceptance of internal experiences. This chapter examined neuroimaging studies that reveal mindfulness-induced neural changes in brain regions associated with cognitive control and emotional regulation, such as the prefrontal cortex and amygdala. Despite accessibility and holistic health improvements, the effectiveness of MBP can vary based on individual differences and practitioner expertise. Future research is needed to explore personalized mindfulness interventions and the integration of MBP with other therapeutic modalities to optimize outcomes and broaden accessibility.

The periodontal ligament (PDL) is a unique, vascularized fibrous connective tissue responsible for anchoring teeth to the alveolar bone, facilitating mechanical functions such as chewing and contributing to tissue homeostasis, wound healing, and regeneration. PDL mainly consists of fibroblasts that create a network of main fibers connecting the cementum of the tooth root to the alveolar bone. Recently, Periodontal Ligament Associated Protein-1 (PLAP-1)/Asporin, a member of the small leucine-rich proteoglycan (SLRP) family, has emerged as a significant protein in the PDL, playing a vital role in maintaining tissue balance and regulating bone morphogenetic protein (BMP) signaling. (PLAP-1)/Asporin inhibits BMP-2 signaling, crucial for preventing abnormal bone formation, such as ankylosis. Furthermore, (PLAP-1)/Asporin distinctive 16-aspartic acid N-terminal sequence is essential for preserving periodontal tissue homeostasis. While its involvement in diseases such as periodontitis, osteoarthritis, cancers, and heart failure is being explored, the precise role of (PLAP-1)/Asporin in periodontal health remains under investigation. Emerging evidence connects (PLAP-1)/Asporin to periodontitis, indicating that this protein may act as a protective factor for periodontal health; however, further research is needed to fully understand its role. (PLAP-1)/Asporin levels as a biomarker of disease may indicate periodontal disease and systemic inflammation, improving diagnostics and treatment monitoring. Insights into how (PLAP-1)/Asporin affects tissue responses could aid in creating new therapies for enhancing periodontal healing and systemic health. This review explores the structure, function, and regulatory characteristics of PLAP-1/Asporin, emphasizing its potential as a protective factor in periodontal health and its broader implications for systemic diseases. Understanding (PLAP-1)/Asporin multifunctional role could open new avenues for innovative therapeutic approaches targeting periodontal and systemic conditions.

Background: The field of cancer genetics has experienced unprecedented advancements over the past few decades, transforming the understanding of cancer biology and revolutionizing therapeutic approaches. This review aims to synthesize recent developments in cancer genetics, highlighting key discoveries, technological innovations, and their implications for precision oncology.

Methods: An extensive literature search was conducted, focusing on studies published in reputable journals. Key areas explored include the genetic basis of cancer, advances in genomic technologies, major cancer genomics projects, integration of genomics in therapeutics, immunotherapy, liquid biopsies, and the challenges and future directions in the field.

Results: Significant progress has been made in identifying oncogenes, tumor suppressor genes, and DNA repair mechanisms that drive cancer initiation and progression. Technological innovations such as next-generation sequencing, single-cell sequencing, and CRISPR-Cas9 genome editing have enabled comprehensive analyses of cancer genomes and functional validation of genetic alterations. Large-scale projects like The Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC) have provided invaluable genomic data resources. Integration of genomics into therapeutics has led to the development of targeted therapies and immunotherapies, improving patient outcomes. Liquid biopsies utilizing circulating tumor DNA offer non-invasive diagnostic and monitoring tools. However, challenges such as tumor heterogeneity, drug resistance, data integration, and ethical considerations persist.

Conclusion: Advances in cancer genetics have significantly enhanced our understanding of the molecular mechanisms underlying cancer and have led to the development of personalized therapeutic strategies. Ongoing research and technological innovations are essential to address current challenges and to further improve cancer prevention, detection, and treatment.

Background: Hearing impairment affects communication and reduces participation and inclusion in society on several levels. Hearing impairment can be mild (26–40 dB HL), moderate (41–70 dB HL), severe (71–90 dB HL), or profound (more than 91 dB HL). Audiological rehabilitation involves various professionals such as audiologists, hearing rehabilitation educators, welfare officers, psychologists, physicians, and technicians. To say that a patient has participated in group rehabilitation, the patient must have been taught in a group by several hearing care professionals.

Purpose: The purpose of this study was to identify and report demographic data of patients with severe to profound hearing loss, assess participation in audiological rehabilitation and analyze the benefits of various rehabilitation methods.

Materials and Methods: Data on 4286 patients with severe to profound hearing impairments registered in the Swedish Quality Register of Otorhinolaryngology over a period from 2006–2015 were studied. Demographic data, gender differences, audiological rehabilitation and benefits of the rehabilitation were analyzed. Statistical calculations were performed with the IBMVR SPSSVR Statistics version 24. The data from the general questionnaire and the QoL parameters were analyzed using unpaired t-tests, and the categorical data were analyzed using chi-square tests.

Results: The study comprises 50.3% (n=2157) males and 49.7% (n=2129) females, with a mean age of 69 years (SD 17.3). Group rehabilitation and visits to a hearing rehabilitation educator provided the most benefits in audiological rehabilitation. Only 40.5% of the patients received extended audiological rehabilitation, of which 54.5% were women. A total of 9.5% of patients participated in group rehabilitation, with 59.5% being women. Women also visited technicians, welfare officers, hearing rehabilitation educators, psychologists, physicians and ENT specialists and received communication rehabilitation in a group and fit with cochlear implants significantly more often than did men.

Conclusions: The study emphasizes the importance of being given the opportunity to participate in group rehabilitation and meet a hearing rehabilitation educator to experience the benefits of hearing rehabilitation. In the present study, significantly more women than men received audiological rehabilitation with various hearing care professionals. There is a need to offer extended audiological rehabilitation, especially in terms of gender differences, to provide the same impact for women and men.

Implications for Rehabilitation: Significantly more women than men with severe to profound hearing impairment receive audiological rehabilitation. Hearing impairment appears to have a significantly more negative impact on women’s quality of life than men’s. It is important to offer extended audiological rehabilitation to all patients with severe to profound hearing loss to obtain equal hearing health care regardless of gender.

Malaria remains a significant global health challenge, predominantly caused by the protozoan parasite Plasmodium falciparum. It is responsible for millions of deaths annually, with children being the most affected group. The study was conducted in Minna, the capital of Niger State in North Central Nigeria, with the objective of determining the seroprevalence of Immunoglobulin G (IgG) antibodies to P. falciparum in children. This cross-sectional study involved 93 children aged 6 months to 17 years, recruited from outpatient departments of selected healthcare facilities in Minna. Blood samples were collected for malaria parasite detection and Enzyme-Linked Immunosorbent Assay (ELISA) testing. The results show a high seroprevalence of IgG antibodies against P. falciparum antigens among children in Minna, indicating widespread exposure to malaria rather than protective immunity. Additionally, the presence of IgG antibodies in microscopically negative samples further indicates the potential for submicroscopic infections, which were confirmed by PCR. Parasite density did not significantly affect IgG responses, with seroprevalence reflecting exposure intensity rather than infection severity. Furthermore, there were no significant differences (P>0.05) in antibody responses across different age groups, suggesting that age does not play a significant role in the development of anti-malarial IgG responses. However, a significant difference (P<0.05) in seroprevalence was observed between males and females, indicating unequal exposure to P. falciparum between the sexes. This chapter provides a comprehensive analysis of the role of IgG antibodies in malaria immunity, highlighting the complex relationship between exposure, antibody production, and protection in children from malaria-endemic regions. The study emphasizes the importance of improving diagnostic tools and the need for further research into the immune responses that could lead to better control and prevention measures.

Amelogenesis Imperfecta [AI] is a heterogeneous disorder causing developmental defects in mineralization and structure of enamel with complex inheritance patterns. In this disorder, the enamel is hypoplastic, hypomineralized or both. AI is also known as hereditary enamel dysplasia, hereditary brown enamel and hereditary brown opalescent teeth. Three case reports of AI were discussed in this article that were diagnosed on the basis of clinical and radiographic features along with the complete review. In this case series, detailed case histories were recorded which revealed that none of the parents, siblings or relatives suffered from similar dental conditions, all the 3 types of AI presented with almost similar clinical features, posing a complicated scenario for diagnosing each of the types. The biggest challenge in rehabilitating patients with AI is to restore aesthetics as well as function and occlusal stability while keeping the treatment as conservative as possible. Thus, dentists should diagnose the condition as early as possible to offer early intervention and balance the decision by considering the social implications for these patients and intervening to relieve their suffering.

Dental pulp tissue exposed to mechanical trauma or cariogenic processes can result in infection of the root canal system and/or periapical tissues. Such endodontic infections are common and can be treated with root canal treatment. Successful disinfection and complete tissue regeneration are key goals in regenerative endodontics. Despite reported clinical successes, current regenerative endodontic procedures (REP) face limitations. To address these, a novel antibiotic and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed and evaluated for its antibacterial efficacy against multispecies endodontic bacteria and animal models.

The gel, synthesized from peptide amphiphiles, encapsulated ciprofloxacin (CF) and metronidazole (MN) alongside NO. Antibacterial effects were assessed using bacterial viability assays on endodontic microorganisms, including clinical samples. Additionally, pulp-dentin regeneration was evaluated in the beagle’s tooth model.

Results demonstrated that the antibiotics and NO-releasing biomimetic nanomatrix gel had a concentration-dependent antibacterial effect, with NO alone also showing significant efficacy. In vivo studies further indicated that the gel promoted tooth revascularization and root canal maturation.

This research suggests that the optimal concentration of the NO-releasing nanomatrix gel holds promise as a root treatment material for REP. Future studies will focus on refining growth factor incorporation and conducting larger-scale trials to confirm its efficacy and establish protocols for human clinical application.

Background: Serum thyroid hormone levels are extensively explored in trauma victims for severity of trauma and mortality of patients, especially in patients with severe traumatic brain injury. There is a scarcity of such studies for trauma to other parts of body systems or Polytrauma. The objective of the current study is to investigate the association of Serum-Free T3 and T4 hormones in patients with severe traumatic injury.

Methods: The Retrospective observational study was conducted at the Department of General Surgery, Pt. J.N.M. Medical College & Associated Dr. B.R. Ambedkar Memorial Hospital, Raipur, C.G. Total 77 patients were included in the study. Here, 68 (88.31 %) were males and 9 (11.68 %) were female patients. The patients with head, chest and abdominal trauma who sustained their injuries within 24 hours of admission, within the age group of 10-82 years were included. The levels of Free Thyroid hormones (FT3 and FT4) at admission, after 24 hrs and on 5^th day of admission were evaluated.

Results: On admission, the mean serum-free T3 in patients included in this study was 1.51 pmol/l (SD=0.18). After 24 hrs and on 5th day, mean FT3 was 1.47 pmol/l (SD = 0.14). The mean serum-free T4 value on admission, after 24 hrs and on 5th day was 0.71 pmol/l (SD=0.52). Till the 5^th day of assessment, 14 patients were discharged while 12 died in the course of treatment. No statistically significant association between FT3 levels and outcome could be seen (p=0.672). Similarly, no overall significant association for FT4 levels with outcome was observed (p=0.627). However, in 9 out of 12 patients who died, deranged FT4 level was found (75 %). Although the mean value for serum FT4 at admission, at 24 hours and after 5^th day was within normal limit, the measured individual serum FT4 levels were reduced in the patients according to the severity of trauma.

Conclusions: The role of hormone level in the prediction of outcomes in trauma victims has important mechanisms that remain an unexplored subject. The deranged FT4 levels have a significant association with the severity of trauma. The prediction of the status FT3 and FT4 levels of the patients paves the way for exploring the methods in the future which could be of clinical use for the patient’s management.