Editor(s)

Dr. Shigenori Ito
Division of Cardiology, Sankuro Hospital, Toyota, Japan and Director of Japan Cardiovascular Imaging Core Laboratory, Japan.

ISBN 978-93-90888-48-1 (Print)
ISBN 978-93-90888-49-8 (eBook)
DOI: 10.9734/bpi/hmmr/v7

This book covers key areas of medicine and medical research. The contributions by the authors include recurrent abortion, immune antibody, gut microorganism, sequencing, autism, cavity structure effect, synergin, quantum vortex ring, multiple sclerosis, magnetic therapy, quantum analysis, phytotherapy, tharmacodynamics, immune checkpoint inhibitors, Immune-related adverse events, cytotoxic T-lymphocyte associated antigen, programmed cell death protein, programmed death-ligand, immune-mediated colitis, antifertility, antispermatogen, testicular marker enzymes, esophageal cancer, epidemiology, mortality rates, renal cell carcinoma, vascular endothelial growth factor, hypoxia inducible factor, immunohistochemistry, prognosis, cholecystectomy, laparoscopic surgery, Alpha-glucosidase inhibitor, biopeptides, blood glucose, glycemic control, hyperglycaemia, milk peptides, postprandial, prediabetes, type 2 diabetes, cystadenoma, leiomyoma, dermoid cyst, old-novel bio-medicine, novel-modern physiotherapies, ovarian cancer, peritoneal carcinomatosis, multimodal treatment, chemotherapy, lymphadenectomy. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical research.

 

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Chapters


Background: This study aimed to analyze the changes in gut microorganism of patients with positive immune antibody associated recurrent abortion using 16s rRNA gene sequencing microbiome assay.

Methods: The fecal samples from 20 recurrent abortion women with positive immune antibody (positive group) and 20 with negative immune antibody (negative group) were collected. After 16s rRNA gene sequencing, the obtained raw reads were performed quality filtering to obtain the clean tags and then classified into microbial genomes. All effective tags were clustered into operational taxonomic units (OTUs) and the representative sequence was selected for the annotation of taxonomic information, followed by alpha and beta diversity analyses.

Results: A total of 43,116 OTUs were obtained in all 40 samples. Bacteroides had the highest relative abundance in the positive group. In the negative group, Bacteroides, Erysipelotrichaceae_UCG-003, Faecalibacterium and Prevotella_9 had high relative abundance. Alpha diversity analysis results showed that the community richness, community diversity, and phylogenetic diversity in the positive group were higher than that in the negative group. Prevotella_9, Enterococcus, Megasphaera and Anaerostipes presented significant differences between negative and positive groups.

Conclusion: The present study for the first time investigated the gut microbiome involved in positive immune antibody associated recurrent abortion via 16s rRNA gene sequencing microbiome assay. The genera that were significantly differential between positive and negative groups may serve as therapeutic targets for positive immune antibody associated recurrent abortion.

A Novel Hybrid Approach to Children with Autism Spectrum Disorders: Recent Advancement

Vasil Kaniskov, Iliyan Iliev

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 15-23
https://doi.org/10.9734/bpi/hmmr/v7/1911F

Objective: The objective of our research and this paper is to provide a sufficient treatment, mainly symptomatic, of autism spectrum disorders which remain terra incognita to contemporary neural science. Children with Autism Spectrum Disorders (ASD) require a comprehensive multimodal approach.

Approach: In our experiment, we used the ‘cavity structure effect’ and the pharmacochemical effects of plant-derived metabolites to stimulate and ‘functionally correct’, as much as possible, the nerve system of children up to 7 years of age, diagnosed with autistic disorders.

Main Results: Under the beneficial impact of the above-mentioned physical and chemical phenomena, an improvement in the overall performance of the examined patients was observed.

Significance: This paper should serve as an initial theoretical and, to a certain extent, practical basis for more extensive research and appropriately designed clinical studies.

Research on Phytotherapy and Physiotherapy in Multiple Sclerosis

V. L. Kaniskov, I. E. Iliev

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 24-35
https://doi.org/10.9734/bpi/hmmr/v7/1912F

Background: Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system (CNS). Its cause is still unknown but it is connected to certain demyelination of the axons in the brain and spinal cord. Despite the medical advances, in the 21st century, multiple sclerosis remains an incurable disease. In order to stop the MS progression, we should concentrate our efforts on reversing the process of demyelination and on improving the transmission of nerve impulses along CNS.

Methods: The effects of a treatment with a daily intake of an alcohol extract of snowdrop or a snowdrop-derived drug containing nivaline and other biological active substances (BAS) and an alcohol extract of Atropa belladonna or Atropa belladonna-derived drug combined with regular electro-magnetic physiotherapeutic procedures were analysed in patients with MS.

Results: The daily administration of nivaline and atropine in combination with regular electromagnetic physiotherapeutic procedures showed potential to reverse the course of MS manifesting itself with a clinical remission of patients with MS.

Conclusion: Our findings suggest that the treatment regimen proposed here possesses the potential to stop the process of demyelination in the CNS and stimulate the process of remyelination in MS patients thus achieving a state of clinical remission. The existing medical theories and practices, and the phytotherapy and physiotherapeutic schemes are successfully applied as a scientific method for a single and/or combined treatment for MS.

New Perspective on Quantum Analysis of Pharmakodynamics in Phytotherapy

V. L. Kaniskov, K. Krastev

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 36-58
https://doi.org/10.9734/bpi/hmmr/v7/1913F

Pharmacodynamics deals with drugs’ mode of action and effectiveness. We explore the interactions between drug molecules and biological structures. Pharmaceuticals’ action can be divided into two types: Structurally specific and non-specific. The quantum analysis we introduce with a Similarity Principle (SP), provides an opportunity for a theoretically and practically applicable profound (at the level of elementary particles) elucidation of interaction mechanisms between medicinal substances and biological structures.

Objectives: This paper aims to create a single universal mechanism explaining drug action at a micro-level where no difference between animate and inanimate nature exists and in the process of exploring phytotherapeutic effects on diseased cells to find a universal answer to the questions asked here.

Methods: We introduce the quantum analysis as a scientific method to analyze these problems. Quantum objects are nucleus and particles. Under “quantification” we understand the occupation of precisely defined values. We call quantum the minimal value of change of any quantity (physical or of another kind). The quantum is also identified by the quality of energy, radiated or absorbed by the micro particles of matter during the smallest possible change of its state. The similarity principle is an inseparable part of this analysis.

Results: Medicinal substances must bind to the functionally impaired biological structure. According to modern pharmacology, this process takes place because of the so-called affinity. Cells with the biologically active substance (mx mass) of the medicinal substance approach and interact with the functionally impaired cells of the biological structure (Mx mass) because of the gravitational force of attraction. An exchange is performed at particle level-exchange of functional and sovereign quanta of life. Thus, a healing process occurs.

Conclusion: The new perspective of cell division, autophagy, and apoptosis, could show the way for a workable antiviral and anticancer defense of biological structures.

A Comprehensive Review on Immune Checkpoint Inhibitor-induced Colitis

Aniruddh Som, Rohan Mandaliya, Dana Alsaadi, Maham Farshidpour, Aline Charabaty, Nidhi Malhotra, Mark C. Mattar

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 59-76
https://doi.org/10.9734/bpi/hmmr/v7/8121D

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target down-regulators of the anti-cancer immune response: Cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its ligand programmed death-ligand 1. IMC is one of the most common adverse effects associated with checkpoint inhibitors.  The immune system has an important role in recognizing and eliminating tumors.

ICIs also transformed the treatment of a wide range of cancers. However, several immune-related adverse effects have been recorded, most of which occur when the immune system becomes less inhibited and affect various organs, including the gastrointestinal tract, causing diarrhoea and colitis. The incidence of immune-mediated colitis (IMC) ranges from 1%-25% depending on the type of ICI and if used in combination. Endoscopically and histologically there is a significant overlap between IMC and inflammatory bowel disease, however more neutrophilic inflammation without chronic inflammation is usually present in IMC. Corticosteroids are recommended for grade 2 or more severe colitis while holding the immunotherapy. Infliximab helps between one-third to two-thirds of patients who are steroid refractory. Vedolizumab has recently been shown to be effective in steroid and infliximab-resistant situations. If immunotherapy is permanently stopped in grade 4 colitis, the decision in grade 3 colitis is debatable.

Aims: The present chapter was undertaken to assess the antispermatogenic and antifertility efficacy of ethanolic extract of Trigonella foenum-greacum seeds. It is one of the most widely used plants in various indigenous systems of medicine for the treatment of different ailments.  

Methodology: Aqueous solution of the extract (250 mg/kg b.wt/day) when administered orally for 45 days to adult male albino rat (Duckray strain).

Results: Seeds extract caused inhibition of spermatogenesis as well as inability to mate with normal untreated female rats of proven fertility. There occurred a significant decrease in absolute and relative weights of testis and seminal vesicle and increase in epididymal weight, whereas of ventral prostate and coagulating gland remained unchanged. Sperm concentration and motility in the cauda epididymis was also decreased. Increased incidence of separation of head and tail pieces of spermatozoa was seen in the epididymal smear. Histologically, testis of experimental animals showed arrest of spermatogenesis at the secondary spermatocytes stage and there was deposition of cellular debris in semineferous tubular lumen. The spermatids were not properly developed and interstitial cells were very sparse and degenerated. However, there was no evidence of damage to the spermatogonia. Oral treatment of extract did not affect the body weight of animals. Quantitative estimation of marker testicular enzymes, e.g., sorbitol dehydrogenase showed a significant decrease whereas lactate dehydrogenase and gamma-glutamyl transpeptidase levels were significantly increased.

Conclusion: These results suggest that T. foenum-greacum, may induce male infertility in rats, therefore, should be considered further as a potential male antifertility agent.

Prevalence of Esophageal Cancer in the Countries of Central and Eastern Europe: Epidemiology and Problems of Complex of Treatment and Care

Nadiya Dubrovina, Valery Boyko, Russell Gerrard, Sergiy Savvi, Petro Zamiatin, Denis Zamiatin, Ivica Gulášová, Yurii Tovkach, Nataliia Yemelyanenko, Bohdana Banul

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 86-104
https://doi.org/10.9734/bpi/hmmr/v7/1789F

In this chapter the problems of the prevalence of esophageal cancer and the distribution of mortality rates from this disease are considered in the countries of Central and Eastern Europe. The rates of mortality from esophageal cancer are analyzed by statistical methods, econometrics, spatial and time series analysis. A study is carried out of the features of the tendencies of mortality rates from esophageal cancer in six EU countries and in Ukraine. The problems of the prevalence of esophageal cancer and the spatial distribution of mortality rates from this disease are considered using as examples the NUTS 2 regions in six countries of Central and Eastern Europe (Austria, Germany, the Czech Republic, Poland, Slovakia and Hungary). The spatial distribution of the rates of mortality from esophageal cancer is analyzed. It allows us to determine more and less epidemiologically affected regions and to carry out more detailed studies on the link between the mortality rates from esophageal cancer and various factors. It is emphasized that various factors, such as the environmental situation, socio-demographic characteristics of the population, culture and nature of nutrition, the general health status of the population, the availability of resources and the level of healthcare in the region should be took into account for development of complex of treatment and care and for the programs for the prevention of prevalence of esophageal cancer.

Research on the Prognostic Role of Vascular Endothelial Growth Factor in Renal Cell Carcinoma

Deepika Chandrasekaran, R. Padmavathi, Sandhya Sundaram, N. Kathiresan

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 105-121
https://doi.org/10.9734/bpi/hmmr/v7/1672C

Background: Renal cell carcinoma is the most lethal urological cancer. 60 to 70% RCCs are localized cases where the gold standard treatment is nephrectomy. 20% of cases are advanced at the time of diagnosis. The treatment protocol of such cases remains unsatisfactory as they are chemo and radio resistant. Vascular Endothelial Growth Factor is the key mediator of angiogenesis in renal cancers. Inactivation of von Hippel-Lindau gene leads to the production of Hypoxia Inducible Factor-1?. Following this VEGF-A becomes highly expressed in the carcinoma tissue. This results in tumour genesis by promoting distant metastasis, uncontrolled growth, and resistance to apoptosis. Thus targeting VEGF plays a potential role in the treatment of RCC.

Methods and Materials: This study was conducted using 150 tissue blocks of histopathologically proven RCC patients. The Ethics Committee, Sri Ramachandra Institute of Higher Education & Research (Deemed University) granted the ethical clearance. VEGF was analyzed by Biotin Streptavidin Immunoperoxidase method. Q scoring was done.

Statistical Analysis: Chi square test and Fischer Exact test was done to assess the comparison between the VEGF expression in tumour cells and their characteristic features like histology, grade and stage. SPSS (version 20.0) was used. P value <0.05 was considered significant.

Aim: To assess the expression of Vascular Endothelial Growth Factor in Renal Cell Carcinoma cases and its role as a potential biomarker. Results: 96.6% of the RCC cases were VEGF positive in the tumor area, whereas cells in the adjacent normal tissue area expressed weak staining. Tumour angiogenesis was reported to be the significant predictor of prognosis in RCC.

Conclusion: Inhibition of VEGF can cause normalization of per­meability, improve the host immunity and access for treatments like chemotherapy.

Management of Symptomatic Gall Stones in a Tertiary Care Health Facility in Southern Nigeria: A Recent Study

Promise N. Wichendu, A. Dodiyi-Manuel, Kelechi Ikonwa

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 122-128
https://doi.org/10.9734/bpi/hmmr/v7/2445E

Background: Gall stone disease is one of the most common problems affecting the digestive tract. The disease spectrum ranges from silent stones to symptomatic stones with its various complications. The disease is relatively uncommon among people of the black race being unknown amongst the Bantu and Masai tribes of Africa. Surgery remains the main stay of treatment for symptomatic gallstone disease as other methods of therapy are largely unsatisfactory. Open surgery was once the only option surgically but with the advent of minimally invasive techniques laparoscopic cholecystectomy has now become the gold standard of surgical care.

Aim: Although not common in this environment there is a need to evaluate the age and sex prevalence, types of stone prevalent here, varying modes of clinical presentation and spectrum of the disease as well as treatment modalities adopted in this institution.

Methods: This is a retrospective review of all cases done in this institution within a sixteen-year period. The case files of these patients were retrieved and relevant information extracted using a proforma. The results were analysed using SPSS VERSION 22.

Results: The collated information showed that gall stone disease is commoner in females with a male female ratio of 1: 5.6 the most preponderant age group was 41-50 years, commonest mode of presentation was recurrent right hypochondrial/epigastric pain. Commonest stone type was mixed contrary to what obtains in Europe and North America.

Conclusion: This study established that gall stone disease is overwhelmingly preponderant in females in this locality and continue to be treated here by open surgery.

Postprandial Effects of a Proprietary Milk Protein Hydrolysate Containing Bioactive Peptides in Prediabetic Subjects: A Recent Study

Tina Sartorius, Andrea Weidner, Tanita Dharsono, Audrey Boulier, Manfred Wilhelm, Christiane Schön

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 129-146
https://doi.org/10.9734/bpi/hmmr/v7/7617D

Milk proteins have been hypothesized to protect against type 2 diabetes (T2DM) by beneficially modulating glycemic response, predominantly in the postprandial status. This potential is, among others, attributed to the high content of whey proteins, which are commonly a product of cheese production. Milk is comprised of two protein fractions, the slowly digestible casein and the fast-digestible whey fraction However, native whey has received substantial attention due to its higher leucine content, and its postprandial glycemic effect has not been assessed thus far in prediabetes. In the present study, the impact of a milk protein hydrolysate of native whey origin with alpha-glucosidase inhibiting properties was determined in prediabetics in a randomized, cross-over trial. Subjects received a single dose of placebo or low- or high-dosed milk protein hydrolysate prior to a challenge meal high in carbohydrates. Concentration-time curves of glucose and insulin were assessed. Incremental areas under the curve (iAUC) of glucose as the primary outcome were significantly reduced by low-dosed milk peptides compared to placebo (P = 0.0472), and a minor insulinotropic effect was seen. A longer intervention period with the low-dosed product did not strengthen glucose response but significantly reduced HbA1c values (P = 0.0244). In conclusion, the current milk protein hydrolysate of native whey origin has the potential to modulate postprandial hyperglycaemia and hence may contribute in reducing the future risk of developing T2DM.

Dermoid Cyst with Its Closest Differential Diagnosis in Perimenopaual Women

Rajshree Dayanand Katke

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 147-156
https://doi.org/10.9734/bpi/hmmr/v7/1711F

Huge abdomino –pelvic masses presenting to the gynecology outpatient department are very common in developing countries like India. Hence the knowledge of differential diagnosis of such masses is important which includes dermoid cyst, sero-mucinous cystadenoma and leiomyoma. Approximately 25-30% of all ovarian tumors are of Germ cell origin and of these, of which 95% are benign. 10-20% of these masses constitute benign cystic teratomas (Dermoid cyst).

2017 Update on Ovarian Cancer Peritoneal Carcinomatosis Multimodal-Treatment Considerations: A Brief Review

Evgenia Halkia, George Chrelias, Charalambos Chrelias, Jesus Esquivel

Highlights on Medicine and Medical Research Vol. 7, 10 May 2021, Page 163-172
https://doi.org/10.9734/bpi/hmmr/v7/7824D

Ovarian cancer peritoneal carcinomatosis requires a multimodal-treatment approach. Current treatment considerations are analyzed in this update and include the management of recurrent malignant ascites and the understanding of its pathophysiology, the role of peritoneal washing cytology in detecting peritoneal metastases, capsular invasion and ovarian cancer histologic type, interpretation of pretreatment Ca-125 levels at different time points of ovarian cancer therapeutic management, characteristics of 10-year survivors of high-grade ovarian cancer, and the role of lymphadenectomy in ovarian cancer peritoneal carcinomatosis. This update also includes current considerations on the role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer peritoneal carcinomatosis as well as relevant ongoing phase III randomized controlled trial protocols. The results of the study showed that patients with advanced ovarian cancer who undergo a complete resection need not also undergo systematic lymphadenectomy.