Dr. Ramesh Gurunathan
Genaral Surgery, Sunway Medical Center, Malaysia.

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ISBN 978-93-5547-961-7 (Print)
ISBN 978-93-5547-962-4 (eBook)
DOI: 10.9734/bpi/cimms/v8

This book covers key areas of Medicine and Medical Science. The contributions by the authors include x-ray radiography, computed radiography, cost benefit analysis, epidemiology, malaria, motor vehicle traffic accidents, methyl-donors, complementary therapy, cancer patients, diabetic complications, glycemic control, neuroimaging, depression, electroconvulsive therapy, magnetic resonance imaging, positron emission tomography, implant exposure, post-traumatic, pancreatitis, laparoscopic cystogastrostomy, Endoscopy, percutaneous drainage, breast cancer, pathogenesis, pathophysiology, carcinogens, healthy diets, enzyme supplement, snakebite, venom, post-mortem, reproductive health, obstetrical emergency, and maternal health. This book contains various materials suitable for students, researchers and academicians in the field of Medicine and Medical Science.


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Economic Analysis of Conventional Radiography Using Film and Computed Radiography

Usama Ali Rahoma, Pavan Kumar Chundi

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 1-13

Conventional radiography with film (CRF) has been used for diagnostic purposes for a long time now. The radiographers have found it to be a useful tool for assessing a variety of problems. Recent technological advancements have made it feasible to have digital solutions for radiography problems that are more cost-effective, environmentally friendly, and also have superior image quality in some applications than CRF. A computed radiography (CR) image is captured using imaging plates rather than a CRF. The latent image is stored in photosensitive phosphors on the imaging plate. This plate is then inserted into a reader and converted into a digital image. The ability to reuse the imaging plates is a significant advantage and cost-effective feature of this system, as opposed to photographic film, which can only capture a single image and cannot be reused. Computed radiography significantly reduces costs by eliminating the need for chemicals such as film developers and fixers, as well as the need for a storage room. It also helps to reduce the costs associated with waste disposal due to conventional radiography. The major disadvantages of using CR system include the initial cost, need for training and making the necessary changes for the new system. Apart from the initial cost of the CR System, based on the data collected from the center, from the year 2008 to 2012 (until June 2012) a total of 581,566 images were produced with the total cost incurred using film based system being USD 4,652,528. If the same number of images were produced using a CR system the total cost incurred would have been USD 82,600. Taking into consideration the cost of a new CR system to be USD 120,000 the overall cost of producing these images is USD 202,600. It is observed that an amount of USD 4,449,928 could have been saved over the period of 5 years starting from 2008 to 2012 by using the CR system at BMC. The system with a net positive difference is more cost advantageous than the alternative, according to the concepts of cost-benefit analysis. When compared to traditional x-ray radiography, computed radiography is unquestionably more cost-effective for usage at BMC, according to the results of the two analyses mentioned above.

Epidemiology Picture of Malaria and Knowledge, Attitude and Behavior of Patients Regarding Malaria in the Region of North India

Vishal Gupta, Mridula Mittal, Jaswant Kaur, Jaspreet Kaur

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 14-20

Malaria's rapid emergence and resurgence have become a threat to our society, increasing in both intensity and severity. It has devastating socioeconomic consequences in a developing country like India. Malaria is one of the most serious vector-borne diseases and has been a menace to society for thousands of years. There is an effort to study the knowledge, attitude, and behavior of people regarding Malaria. This will help in identifying the gaps in the measures adopted and the knowledge, attitude and of the population. Despite various surveillance and education programs, the available data only reflects trends, not the real disease burden. It has been discovered that very few studies on the epidemiology of malaria have been conducted in the northern part of the country, with very limited information on age and sex-specific seasonal prevalence of the disease. The people living in rural areas were found to be more vulnerable to malaria. The disease was found to be more prevalent among the lower socio-economic strata and young population leading to considerable adverse effects on health and the economy. It is also critical to investigate people's Malaria knowledge, attitude, and behavior. The current chapter provides an overview of the assessment of regional malaria trends, highlights progress toward global targets, and describes opportunities and challenges in controlling and eliminating the disease in the district of north India.

Epidemiological Study of Road Traffic Accident Cases Admitted in a Tertiary Care Hospital in Andhra Pradesh, India

Pravin N. Yerpude, Keerti S. Jogdand

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 21-30

The present descriptive study was conducted to know the various epidemiological factors related to road traffic accident cases admitted in a tertiary care hospital in Andhra Pradesh from 1st July 2008 to 30 th June 2009 Road accidents are human tragedy. They involve high human suffering and monetary costs in terms of ultimately deaths, injuries and loss of potential income. They are no longer accidental. Deaths from road traffic injuries (RTI), particularly motor vehicle traffic accidents (MVTA), have been described as a worldwide hidden epidemic affecting all sections of society. Total 436 RTA victims were included in the study. There were 87.61% male and 12.39% female accident victims. Labourers were the highest (36.01%) among the victims. The highest number of accidents took place in the month of January (14.45%) and on Sundays (19.26%). 31.36% pedestrians were injured by motorized two wheelers, 20.34% by truck. Among the drivers of different types of vehicles, Motorized two wheeler drivers were victims in 31.1% cases Out of 134drivers 17.16.9% were found to have consumed alcohol. Being knocked down was the common mode of accidents. The real pressure and motivation to improve driving skills can come only through licensing authorities by adopting stricter, more comprehensive and scientifically based test laying a stress on road rules, regulations and traffic control devices.

Investigating the Effect of Dietary Methyl-Donor Intake and Other Lifestyle Factors on Cancer Patients in Hungary

Eva Kiss, Anett Hajdu, Gertrud Forika, Magdolna Dank, Tibor Krenacs, Zsuzsanna Nemeth

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 31-52

Nutrition is an essential part of lifestyle and has an undeniable impact on health and disease prevention, including cancer. The incidence of cancer is increasing worldwide and in addition to inflammation related diseases, a significant number of them could be prevented by a suitable lifestyle.

Methyl-donors are part of the nutrition as micronutrients and have important roles in metabolic processes and DNA methylation through their participation in one-carbon cycles. Their appropriate level in the human body is important to stabilize a healthy metabolic balance and their deficiency can lead to several symptoms and diseases and has been also implicated in the severity of SARS-CoV-2 (COVID-19) infection. Nutrition therapy has already been recognized as an appropriate tool in the management of cancer-related fatigue as part of quality of life.

Breast cancer is a heterogenous disease and classified into subtypes basically by the expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2. The estrogen and progesterone receptor negative tumors are suggested to be more sensitive to non-hormonal factors included nutrition. Colorectal cancer has a complex etiology with risk factors of both genetic and environmental origin, including obesity and alcohol consumption. Based on the biological behaviour pancreatic cancer is an aggressive tumor with poor prognosis where risk factors also include such lifestyle factors as alcohol and smoking which cause systemic inflammation and promote tumor progression.

In this study, we aimed to explore the potential protective effect of methyl-donor intake in breast, colorectal and pancreatic cancer by following up patients. We found that around the recommended daily intake of methyl-donors (RDAs: methionine 1140mg/60kg, B6 1.3-2mg, B9 0.4mg) was effective in supporting the overall survival of breast and colorectal cancer patients. Additionally, a relatively higher amount was efficient in pancreatic adenocarcinoma patients possibly in line with the known poor absorption of vitamins in the small intestine in this type cancer. Smoking habit significantly and negatively correlated with the total intake of methyl-donors in pancreatic cancer patients, moreover, in colorectal cancer patients the folate as well as betaine intake significantly and positively correlated with IL-8 cytokine level.

Our results suggest that appropriate methyl-donor intake may be an appropriate accessory of conventional oncotherapy which may contribute to improve quality of life. Its support of cancer prevention and patients' survival needs further confirmation in large patient cohorts.

Determining the Levels of Vitamin D and Their Association with Complications of Type 2 Diabetes Mellitus

Sukhraj Kaur , Pashaura Singh Sandhu

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 53-64

This chapter aims to determine the Levels of Vitamin D and their Association with Complications of Type 2 Diabetes Mellitus. Type 2 diabetes mellitus is a noncommunicable disease characterised by hyperglycemia. It is connected to a number of small- and large-scale vascular problems. Vitamin D a stercosterol is an important molecule in the body that is involved in many skeletal and extraskeletal functions. The current study included one hundred diabetic complications patients and one hundred healthy people. Blood glucose, Glycated haemoglobin, lipid profile, and vitamin D levels were measured in all subjects.

Along with poor Glycemic control and deranged lipid profile in patients with complications of type 2 diabetes mellitus, levels of vitamin D were also significantly decreased in these patients as compared to controls. Moreover 73% of the patients were deficient in vitamin D.

Levels of vitamin D are significantly reduced in diabetic patients with complications. The role of Vitamin D in various extra skeletal functions may be one of the causes of these complications.

Advances in Neuroimaging Research of Electroconvulsive Therapy in Depression

Xin-Ke Li, Hai-Tang Qiu

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 65-84

The goal of electroconvulsive therapy (ECT) is to relieve disease symptoms by passing a small amount of electric current through the patient's head, inducing convulsions throughout the body.  Although its treatment mechanism is yet unknown, electroconvulsive therapy can significantly relieve the clinical symptoms of patients with serious depression. This review summarizes the recent progress in neuroimaging research on ECT for major depression. Due to the rapid advancement of neuroimaging technology, it is now necessary to investigate the neurobiological mechanisms underlying major depression from the perspectives of brain structure, function, and metabolism. Research has shown that electroconvulsive therapy can, to a certain extent, improve patients' brain function, metabolism, and even brain structure.  Currently, an increasing number of neuroimaging studies adopt various neuroimaging techniques including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), magnetic resonance spectroscopy (MRS), structural magnetic resonance imaging (sMRI) and diffusion tensor imaging (DTI) to reveal the neural effects of ECT. Based on the neuroimaging studies, this review suggests that the neurobiological mechanism of ECT may be to modulate the functional activity and connectivity or neural structural plasticity in specific brain regions to the normal level, to achieve the therapeutic effect.

Peroneus Brevis Muscle Flap as a Tissue Cover

Sanjay Gordhanbhai Vaghani , Ganesh Sadashiv Chaudhari

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 85-97

In this case series, authors have shared their experience with peroneus brevis muscle flaps, proximally or distally based to cover defects from lower mid leg to ankle region.

Reconstruction of the distal third of the leg is associated with the highest complication rate for local procedures because of the paucity of reliable local flaps, which is because of the limited amount of available local tissue. The mid-leg and ankle region is more prone to full-thickness soft tissue loss after trauma. Due to its placement in the subcutaneous plane and the shin region's unstable blood supply, implants utilised in osteosynthesis in this area are also susceptible to exposure. For the reconstruction of minor to medium-sized defects in this region, various approaches, such as local flap to free flap, are outlined. Literature also provides a good description of the peroneus brevis. In this case series which was done over the period of six years that includes 10 patients with post-traumatic as well as post orthopaedics surgical intervention defects in lower mid leg and ankle region. Patients were selected for proximally and distally based peroneus brevis muscle flap according to the location of defects. Data regarding age, sex, aetiological factor, size of defect, type of flap, survival of flap, donor site complications were recorded. Out of 10 patients, eight were males and two were females. Major aetiological factor was two wheeler road traffic accident. Majority of the patient had orthopaedic surgical intervention for fracture fixation prior to or along with flap surgery. A excellent, dependable, and relatively simple solution for minor to medium-sized soft tissue defect in the mid-leg and ankle region is the peroneus brevis muscle. Peroneus brevis muscle flap is highly recommended by authors for small- to medium-sized soft tissue defect.

A Case Report on Complicated Crown-root Fracture

Sudheer Kumar Prabhu , C. U. Vivek Chand , V. G. Sam Joseph, Mini K. John

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 98-105

The current study describes a young adult with a complicated crown fracture. Endodontic treatment of the involved teeth was followed by orthodontic extrusion with certain modifications, periodontal surgery to restore biologic width and achieve proper aesthetics, and the placement of definitive crowns. Traumatic injuries to the teeth and their structures are complicated and necessitate a thorough examination, accurate diagnosis, consideration of all factors involved, and a multidisciplinary approach for a successful treatment outcome. A 23-year-old male patient reported to the Department of Conservative Dentistry and Endodontics with a complaint of pain in broken upper front teeth. A fractured tooth presents a multifaceted problem which warrants a multidisciplinary treatment. A fractured tooth presents a multifaceted problem which warrants a multidisciplinary treatment. Interdisciplinary treatment approach holds true especially in multifaceted problems like traumatic tooth fracture. Every dental professional must be prepared to assess and treat efficiently. This study highlights the use of an anterior bite plane to enable simultaneous bite opening and tooth extrusion. Continuing with tooth extrusion in spite of hindrance from the opposing arch could result in misdirected forces, change in direction of tooth movement and/or unwanted tooth movement in the opposing arch.

Laparoscopic Pancreatic Pseudocystogastrostomy: A Case Study

Nezar A. Almahfooz

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 106-117

The most frequent consequences of both acute and chronic pancreatitis are pancreatic pseudocysts (PPC). Almost half of all cases resolve spontaneously, with the remainder requiring surgical intervention if symptomatic or complex. Open surgery and minimally invasive laparoscopic surgery are also alternatives for surgical intervention. However, endoscopic or percutaneous ultrasonic guided drainage is a possibility. Three examples of pancreatic pseudocysts (PPC) are given, all of which were treated fully via laparoscopic pancreatic pseudocystogastrostomy (LPPCG), with other possibilities explored [1].

Three cases of large pseudocyst of the pancreas are presented with a similar story and different age. All of them are presented as a complication of microlithiasis of gallbladder stones. All of them are presented as complications of gallbladder stone microlithiasis. Complete blood and biochemical tests were performed on the patients. The Ultrasonography was supplemented by an abdominal computerized tomography (CT) to determine the connection with the gastric wall. All were preoperatively prepared and had posterior pancreatic pseudocystogastrostomy laparoscopic stapling performed. The postoperative period was uncomplicated, and the patients had excellent resolution at 8 months, 2 years, and 6 years [2].

A minimally invasive surgery known as laparoscopic pancreatic pseudocystogastrostomy (LPPCG) has proven to be very effective in draining and resolving pancreatic pseudocysts. This small series investigation identified no complications or recurrences, while the literature mentions only a small number of complications and low recurrence. In order to determine that it is the best minimally invasive approach for the treatment of the pancreatic pseudocyst, we advise having a large number of instances that are identical.

Breast Cancer- An Overview of the Disease

Srinidhi Rai, D. Chaitra , Divya N. Pai , Neha Martin Honnalli

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 118-128

Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast and is the most common cause of cancer in women (excluding skin cancer), accounting for about one-third of all cancers in women. With 1 million new cases in the world each year, breast cancer is one of the most common malignancies in women and comprises 18% of all female cancers. Breast cancer is the second most prevalent cancer among Indian women, the first being cervical cancer. In women, almost one third (32%) of all cancers diagnosed are breast cancer. American Indian and Native Alaskan women have the lowest incidence, whereas white women have the highest incidence. Asian women have one-fifth to one-tenth the risk of breast cancer of women in North America or Western Europe. In India, 19 out of every 100,000 women suffer from breast cancer. The incidence of breast cancer has increased over the past four decades. This chapter aims to discuss the etiopathogenesis, clinical aspects, and diagnostic modalities of breast cancer.

Nutrition, Cancer Protection, and Prospect: A Review

Adegbusi Halid Sheriff

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 129-150

This article provides insight into some dietary and lifestyle habits that can be avoided and encouraged for preventing the development of cancers. This may inform the public the choice dietary and lifestyle habits for cancer prevention, and possible treatment. Dietary and lifestyle factors are important in cancer prevention and treatment because unhealthy diets and behaviors increase the risk of cancer onset while malnutrition negatively impacts the efficacy of cancer treatment. Cancers are complex and multifaceted in origin, but enormous risk factors such as tobacco smoking, high salt intake, excessive consumption of saturated fats, refined foods and sugar, alcohol, red meat and processed red meat, prolonged exposure to ultraviolet radiation, poisonous chemicals such as lead and benzene, and infections with human papillomavirus and hepatitis virus can prompt their development. Cancer incidence varies by gender, geography, socioeconomic status, and race. Cancer is caused by DNA mutations that include oncogenes, altered tumor suppressor genes, genes that govern apoptosis, incorrectly activated telomerase, and epigenetic changes. Cancerous cells exhibit enhanced replication, transcription, glycolysis, as well as a decreased need for growth factors and other alterations. About 30–40% of cancer cases can be avoided through healthy dietary practices as regular consumption of fruits, vegetables and spices like carrots, tomatoes, cruciferous vegetables, garlic and whole grains and flax seeds. These foods contain vitamins, minerals, phytochemicals, and antioxidants that are anticancer and shield DNA from damage. Enzyme supplements and a healthy lifestyle can be included in a healthy eating pattern. The strategy for overall cancer prevention, treatment, and cure can be better understood by understanding the molecular foundation of the disease.

Snake Envenomation: A Protracted Medicolegal Dispute

Saurabh Bhargava, Rajvinder Singh

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 151-159

Snakebite envenomation is a medical emergency that primarily affects the poor in tropical rural areas. The victims are typically agricultural and plantation workers who leave behind a large family in a deplorable state. Under Section 174 of the Code of Criminal Procedure (Cr.P.C.), 1973, the cause of death must be determined in suspicious fatal cases for a myriad of purposes, such as ruling out suicide, homicide, or accident, or to obtain insurance benefits. Fatal snakebite cases, unless proven beyond a reasonable doubt, can place an additional burden on the victims' families by preventing insurance claims from being processed. The detection and confirmation of snake venoms in post-mortem body exhibits is required in forensic toxicology because insurance companies and the government require confirmation of death by snakebite for proper insurance and financial welfare scheme disbursement. This highlights the critical need for tests to confirm snake venom in viscera samples. Snakebite deaths have long been a bitter legal dispute in India, owing to gaps in forensic confirmation and characterization of snake venom. This chapter discusses the current limitations of forensic science in the detection and confirmation of snake venoms, as well as provides recommendations for forensic laboratories to use in the detection and verification of the presence of snake venom antigens in post-mortem exhibits.

Mother and Child Health Support Project (MCHSP): A Partnership Mechanism with France for Development Facility in Senegal

Ndiaye Papa, Niang Khadim, Sonko Adrien

Current Innovations in Medicine and Medical Science Vol. 8, 12 November 2022, Page 160-170

The purpose of this chapter was to describe the MCHSP/PASME device, co-funded since 2014 by the State of Senegal and the French Development Agency / Agence Française de Développement (FDA/AFD) for five years.

The qualitative, cross-sectional, and descriptive study used four approaches: literature review, interviews with structural managers, data collection confirmed by the medical region (MR), and direct observations of construction and/or rehabilitation/extension sites. The objectives were threefold: j Strengthen the teams' capacities; Increase the supply and demand for family planning; l Improve the conditions for taking care of pregnancies, deliveries and newborns.

The physical setting included three of the 14 regions of Senegal: Louga in the north; Kolda and Sedhiou in the south, for a total of 14 of the 76 health districts in the country.

The institutional framework consisted of a central level (three bodies) and a regional level (two bodies). The logic model was built around resources and actions (primary targets) to generate outputs (secondary targets) whose effects add to the impact. For each responsibility centre, the implementation was based on an annual work plan (AWP) that was revised and consolidated by the national coordination unit (UCN), then verified by the steering committee before being presented to the French Development Agency (FDA/AFD) for its non-objection opinion. It has made a positive contribution to the evolution of various health indicators. This MCHSP/PASME is sufficient for making a greater contribution to Senegal's efforts to lower maternal and infant-juvenile morbidity and death.

The objective of this work was to identify prognostic factors for obstetrical emergencies received at the Regional Hospital of Saint-Louis. The one-year retrospective, cross-sectional, and descriptive investigation was based on the archives (July 1, 2017 - June 30, 2018). The absolute and relative frequencies of each qualitative variable were calculated using a confidence interval. Thus, were filled in: the socio-demographic profile of the woman, the conditions of evacuation, and the care. Out of 5822 collected files, there were 1364 evacuations (23.43%). The majority of women were under 25 years of age (42.53%), unschooled (60.92%), married (97.73%), low-income (96.68%), first-time pregnant (37.91%), prim parous (38.57%), with a full-term pregnancy (85.28%) and less than 4 prenatal consultations (56.02%).

The most common pathologies were dystocic (20.16%), hypertensive (18.40%), and hemorrhagic (8.65%). Medical treatment (72.87%) was dominated by vascular filling, antibiotic and antihypertensive medication, blood transfusion, and magnesium sulphate injection. Gynaeco-obstetrical treatment concerned 42 abortions, 834 deliveries and 303 caesareans; for a total of 1179 cases (86.44%). The surgery involved 22 laparotomies (including 7 hysterectomies), 5 perineal recoveries, and 3 others; for a total of 30 cases (2.20%). Hospitalization, on average 2.34 days, resulted in maternal mortality for 14 cases (1.26%) and perinatal mortality for 157 cases (13.81%). Improving the issue necessitates a more informed populace as well as a more coordinated network of "obstetric and neonatal emergency care / soins obstétricaux et néonatals d’urgence (SONU)" services: medical transport, sufficient and upgraded staff, better maternity and neonatology, correct filled databases.

The goal of this study was to provide the epidemiological and clinical characteristics of women received in emergency at the maternity unit of the regional hospital of Saint-Louis. In Senegal, reducing maternal mortality is one of the main priorities of the National Health Development Plan.

On the basis of the archives for a year, a retrospective, cross-sectional, and descriptive study was conducted (July 1, 2017 - June 30, 2018). Out of 5822 collected files, there were 1364 evacuations (23.43%). The majority of women were under 25 years of age (42.53%), unschooled (60.92%), married (97.73%), low-income (96.68%), first-time pregnant (37.91%), prim parous (38.57%), with a full-term pregnancy (85.28%) and less than 4 prenatal consultations (56.02%).

The most common pathologies were dystocic (20.16%), hypertensive (18.40%), and hemorrhagic (8.65%). Medical treatment (72.87%) was dominated by vascular filling, antibiotic and antihypertensive medication, blood transfusion, and magnesium sulphate injection. Gynaeco-obstetrical care included 42 abortions, 834 births, and 303 caesarean sections, for a total of 1179 cases (86.44%).

It is concluded that improving the situation requires a more educated population and a better organized network of “obstetric and neonatal emergency care (ONEC)” services (medical transport, sufficient and upgraded staff, better maternity and neonatology, correct filled databases).