Dr. Giuseppe Murdaca
Clinical Immunology Unit, Department of Internal Medicine, University of Genoa, Italy.

ISBN 978-93-91312-50-3 (Print)
ISBN 978-93-91312-51-0 (eBook)
DOI: 10.9734/bpi/hmms/v8

This book covers key areas of medicine and medical science. The contributions by the authors include gastrointestinal stromal tumors, tyrosine kinase inhibitors, platelet-derived growth factor receptor \(\alpha\), metallic foreign body, nasopharynx, infant, ENT clinics, plain radiographs, anesthesia, therapeutic activity, vaccine, probiotics, commensal yeasts, lympho-proliferative disease, choroidal fissure cyst, arachnoid nature, non-contrast computerized tomography, pancreatic adenocarcinoma, adenocarcinoma, cancer, radiology, atherectomy, endovascular revascularization, morbidity, hormones, hypothyroidism, hyperthyroidism, biologics bacteriotherapeutics classes, heterogeneous, macromolecules microbiome, upper gastrointestinal hemorrhage, GI bleeding, mortality, endoscopic procedures, fragmented germ cells, germ cell`s replant, reduced endogenous estrogen, global contraception, abortion, contraception reversal, pathogenesis, contraception reversal, smashed fragmentation of germ cells, reduced endogenous estrogen, germ cells replant effect, autologous germ cells replant, adenomyoma, small intestine, biliary obstruction, intussusception, hamartoma, heterotopic pancreas, protein induced by vitamin K absence or antagonist II, hepatocellular carcinoma, heptode carcinoma, pancreatic cystic neoplasm, diagnostic intervention, fine-needle biopsy. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical sciences.


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Recent Study on Therapeutic Targets in Gastrointestinal Stromal Tumors

Jia-Qing Zhu, Wen-Bin Ou

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 1-23

Gastrointestinal stromal tumours (GISTs) are the most prevalent kind of gastrointestinal mesenchymal tumour . Gain-of-function mutations in KIT or plateletderived growth factor receptor (PDGFRA) cause the carcinogenesis of GISTs, resulting in constitutive activation of the tyrosine kinase and its downstream signalling cascades. The KIT/PDGFRA inhibitor imatinib is the standard of therapy for patients with metastatic GISTs, and oncogenic KIT or PDGFRA mutations are attractive therapeutic targets for the treatment of GISTs. However, clinical resistance to imatinib and other tyrosine kinase inhibitors develops in the majority of GIST patients. Five mechanisms of resistance have been characterized: (1) acquisition of a secondary point mutation in KIT or PDGFRA; (2) genomic amplification of KIT; (3) activation of an alternative receptor tyrosine kinase; (4) loss of KIT oncoprotein expression; and (5) wild-type GIST. Sunitinib is being used as a second-line therapy for individuals who have failed imatinib, and regorafenib has been approved for patients who have failed both imatinib and sunitinib . Phase II/III trials are currently in progress to evaluate novel inhibitors and immunotherapies targeting KIT, its downstream effectors such as phosphatidylinositol 3-kinase, protein kinase B and mammalian target of rapamycin, heat shock protein 90, and histone deacetylase inhibitor. ETV1, AXL, insulin-like growth factor 1 receptor, KRAS, FAS receptor, protein kinase c theta, ANO1 (DOG1), CDC37, and aurora kinase A have all been identified as potential targets. These candidates should be tested in the clinic as potential new GIST treatment targets.

A Case Report of U-Shaped Metallic Foreign Body in the Nasopharynx of an Infant

Chijioke C. Anekpo, Anthony J. Edeh

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 24-28

As opposed to foreign bodies in the ear and nose, foreign bodies in the nasopharynx is rare in Ear, Nose, and ENT clinics. It's possible that it'll go unnoticed at first. The diagnosis necessitates a high level of suspicion [1]. In an infant's nasopharynx was lodged by a U-shaped metallic foreign substance. Plain radiography skull views, including the nasopharynx, were used to diagnose the foreign body. It was successfully removed via the oral route under general anaesthesia and without complications.

Research on Dendritic Cell Based Vaccine for Human Tuberculosis

Ibrahim M. S. A. W. Shnawa

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 29-36

The update notion of vaccine holds the concept that it is helpful both for prophylactic and therapeutic purposes. One more thing, now vaccines serves both for communicable infectious and noninfectious diseases. Several classes of vaccines are being known in common medical use. Among which cell based vaccines.  DC based vaccines acts both vaccine and vaccine immunoadjuvant biologics .Experimental DC based vaccine were currently known for viral, bacterial, fungal and protozoal diseases. The present chapter was devoted for DC based vaccine to human tuberculosis disease.

Probiotic Technology

Ibrahim Mohamed Saeed Shnawa

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 37-43

Probiotics are vaccine allied biologics, vaccine adjuvants ,oral vaccines ,vaccine prim-boost and, vaccine delivery systems .They are formed from commensal bacteria and commensal yeasts .Such candidate preparation are developed and evaluated in a way similar to that of vaccine development and evaluations with less stringent control measures . They can be of therapeutic and preventive uses both for infectious and lympho-proliferative diseases.

Choroidal Fissure Cysts in Children-Dilemma in Follow Up

Shashi Sharma, B. B. Sharma, Manav Sethi, Puneet Gupta

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 44-52

Background: Choroidal fissure cyst is a developmental variant that is characterised by a small cyst in the choroidal fissure. These are cysts that are specific to a specific location and can be neuroglial, neuroepithelial, or arachnoid in nature. In routine radiological cross-sectional imaging studies, these are considered incidental findings. There is dilemma in follow up of these cysts because of their asymptomatic nature or of some vague complaints and invites a lot of debate on their follow-up. Methods: Five children aged 10 to 16 years who presented to the outpatient department with a vague headache, vertigo, or unexplained seizures underwent non-contrast computerized tomography (NCCT) or magnetic resonance imaging (MRI) of the head to rule out any intracranial pathology. Results: Three of the cases had pure cysts in the brain, while the other two had tuberculomas of various sizes and types that resembled cystic appearances. One of the brain cyst cases involved a 14-year-old female, and NCCT head findings revealed a small cyst in the right choroid fissure.  On multiplanar and multisectional plain MRI, this was later confirmed as a choroidal fissure cyst. The other two cystic pathologies were vesicular cysticercosis and posterior fossa arachnoid cyst. The other two were tuberculomas with ring enhancement, as confirmed by MR spectroscopy.  

Conclusion: The case of the choroidal fissure cyst required special attention due to the patient's and clinician's concern for the follow-up. We reviewed the literature for the fate and follow up of these types of case

Study on Simulators of Pancreatic Adenocarcinoma: An Approach to Avoid Misdiagnosis

Atanas Dimitrov Hilendarov, Alexandar Asenov Georgiev, Lyubomir Georgiev Chervenkov

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 53-62

To present examination finding of neoplastic, inflammatory and benign pancreatic as well as non-pancreatic processes that can simulate pancreatic adenocarcinoma. Adenocarcinoma of the pancreas (PA) is one of the most aggressive malignancies, the fourth leading cause of cancer-related deaths in the Western world. Focal fatty infiltration is usually most pronounced in the head of the pancreas and at contrast enhancement in CT usually appears as a region with reduced contrast matherial amplification compared to normal pancreatic tissue simulating PA. Imaging of a hypoathenuating lesion in the head of the pancreas corresponds to adenocarcinoma in most cases. However, radiologists should be careful, because a false positive diagnosis can lead to unnecessary surgery, which is not without complications.

Recent Advancements in Role of Endovascular Revascularization Procedures in Chronic Limb Ischemia Involving Superficial Femoral Artery

Amol Rathod, Vivek Ukirde, Saurabh Joshi, Ashank Bansal, Arvind Borde, Akshay Gursale, Sagar Satpute, Rajiv Hira

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 63-69

PVD (Peripheral vascular disease) of the lower extremities is a major source of morbidity and affects 10 million individuals in India, with the superficial femoral artery being the most common site of involvement. Peripheral artery disorders can be treated using a variety of endovascular procedures. We provide a case series of 35 patients who presented with peripheral vascular disease and were treated with a variety of endovascular techniques including angioplasty, atherectomy, and stenting. At the one-month and six-month follow-up visits, all of the patients had shown significant clinical improvement. Endovascular revascularization procure is an useful treatment for lower limb atherosclerotic arterial disease. Also, long term follows up data is needed for better outcome.

Association of Acid and Alkaline Phosphatase among Thyroid Patients: A Brief Study

B. Dharani Priya, U. Prathyusha

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 70-76

Thyroid gland secretes thyroid hormones and malfunctioning of these hormones results in thyroid disorders. They are one of the most more prevalent endocrine disorders in world and occupy next to diabetes. The most frequent and common types of thyroid disorders are hypo and hyperthyroidism. Many risk factors are associated with these diseases such as abnormal iodine concentration and certain biochemical markers. The present study is aimed to understand the association of acid and alkaline phosphatase enzymes with thyroid disorders. The present study shows elevated levels of acid phosphatase among the hypo and hyper thyroid patients than the controls. Whereas alkaline phosphate levels are observed low in hypothyroid patients than the controls but in case of hyperthyroid its concentration is nearer to normal levels in both the patients and controls. The related literature correlation is discussed elaborately in introduction and in the results.

Recent Development: Vaccine Allied Biologics

Ibrahim M. S. A. W. Shnawa

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 77-84

There were heterogeneous preparations of biologics that have shown vaccine like potentials. Currently they are gathered in a group-wise fashion in a way similar to that of vaccine classes. Such group can be designated as Therapeutic vaccine allied biologics TVAB.TVAB can ensemble at least in five classes available both for experimental level and to a lesser extent to the level of clinical use. These classes are; cellular secretions, receptor-anti-receptor check point inhibitors, subunite macromolecule, commensal microbiome and bacteriotherpeutics. The proposed classes were evaluated by both vaccine criteria and as group specific special evaluation. Collectively, this is being a state of developing a novel classification system for the vaccine allied biologics.     

Endoscopic Management of Upper GI Bleed: A Review

Hallal Mahmoud, Matar Rasha, Sanyour Joyce

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 85-91

Upper gastrointestinal hemorrhage, common problem worldwide, had an estimated annual incidence of 40-150 cases per 100 000 populations. Several scores are validated for risk stratification than can aid clinical decision for urgent intervention and triage patients to in-hospital vs out-of-hospital management. Two most widely validated score were Glasgow Blatchford Score (GBS) and Rockwall score. A retrospective analysis in more than 400 000 patients with NVUGIB reported an increase mortality in patients who underwent endoscopy after 24 hours. Cyanoacrylate (CYA) Spray is a spray technique that can be used as an alternative method in emergent settings for uncontrollable GI bleeding.

Background: Era of contraception, abortions, [20th, 21st centuries] implemented as family welfare schemes witnessed, increased prevalence of hernias, uterine descent, fibrous adhesions presenting as colic abdominal pain, retroperitoneal fibrosis, intestinal obstruction and volvulus.

Objectives: Altruistic association of contraception [if any], with increasing hernias, uterine descent, fibrous adhesions progressing to retroperitoneal fibrosis, volvulus, intestinal obstructions were sought after.

Methods: In 2012, retrospective analysis of, prevalence of hernia, uterine descent, in 350 patients of 20-35 years, 35-50 years, >50 years age groups, from data collected by convenient, stratified random sampling, from different geographical locations, between 2003-2012 and its association with presence, absence of contraception, abortion was undertaken; simultaneously, serum estrogen levels obtained from 105 patients, was also analyzed.

In ~2000-2012 clinical practice 25 patients were detected to have fibrous adhesions, related intestinal obstruction, volvulus and retroperitoneal fibrosis; they were analyzed for the correlation with status of contraception, hysterectomy and cholesterol deprived diet.

Results: 3-6 fold increase in hernia was seen in contraceptive users of >20years to >50 years with a p value of <0.0025 in 20-35 years, p value of <0.0005 in 35-50 years and the p value of <0.02 in >50 years: Fig. 2.

8- 9 fold increase in prevalence of fibrous adhesions in contraception users of >20 years to 50 years was seen with a p value of <0.0005 and 2 fold increase in retroperitoneal fibrosis and volvulus was seen in people using contraception and after hysterectomy with a p value of <0.025: Fig. 1.

Endogenous estrogen was reduced below normal in 61% of contraceptive users, 25% of contraceptive users had low normal serum estrogen with a p value of <0.0005: Fig. 3.

Cholesterol deprived diet; due to decreased synthesis of endogenous estrogen androgen also was associated with 50% increase in degenerative diseases including volvulus with fibrous adhesions.

Conclusion: Concept is acquired contraception, abortion status, with smashed fragmentation of germ cells, reduced endogenous estrogen: androgen, results in defaulted genomic repertoire, deranged cell cycle, cell metabolism, with increased degenerative pathologies including hernia, uterine descent and fibrous adhesions progressing to volvulus, retroperitoneal fibrosis, intestinal obstruction and metabolic syndrome.

Contraception reversal declined the diseases as a cause and effect phenomenon; corrective surgeries coupled with tubal recanalisation: contraception reversal was effective without recurrence and complications by restoration of genomic repertoire-figure supplementary file

Studies on Increasing Prevalence of Osteoporosis, Hypothyroidism and Endogenous Oestrogen

Elizabeth JeyaVardhini Samuel

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 101-109

Background: Women were expressing disabling low back aches and weight gain attributing to puerperal sterilization, when contraception implementation as Family Welfare Program was progressing between ~1983 and ~1989. Hence we sought to identify any correlation existing with contraception.

Methods: We performed a retrospective analysis of prevalence of osteoporosis and hypothyroid status, in 350 patients of 20 - 35 years, 35 - 50 years, >50 years age groups, from data collected by convenient, stratified random sampling of different geographical locations, between 1995-2012. We also analyzed its association with presence or absence of contraception and abortion. Simultaneously, serum estrogen levels obtained from 105 patients were also analyzed.

Results: ~15 - 25 fold increase in osteoporosis was seen in contraceptive users with a p value of <0.0005 among >20 - >50 years age group; we also found a 6 fold increase in hypothyroidism among contraceptive users aged >35 years [p < 0.0005], 3 fold increase in hypothyroidism among >20 years age group [p < 0.02] and 1.5 fold increase in >50 years age group [p < 0.025]. Endogenous estrogen was reduced in 61% of people using contraception with a p value of <0.0005.

Conclusion: Concept is that contraception prevents traversal of normal path by germ cells, resulting in smashed fragmentation of germ cells, and consequent decreased endogenous estrogen or androgen leading to defaulted genomic repertoire, deranged cell cycle and cell metabolism resulting in metabolic syndrome, with consequent increase in osteoporosis and hypothyroid status.

Background: 20th 21st centuries after implementation of contraception, abortion, witnessed unexplained increased prevalence of renal diseases.

Objectives: Altruistic correlation of increase in prevalence of renal diseases – metabolic syndrome, with implemented contraception as probable etiology, [if any] is sought after.

Methods: In 2012, retrospective analysis of, prevalence of renal diseases in 350 patients of 20-35 years, 35-50 years, >50 years age groups, from data collected by convenient, stratified random sampling, from different geographical locations, between 2003-2012 and its association with presence, absence of contraception, abortion was undertaken including many variables; simultaneously, serum estrogen levels obtained from 105 patients, was also analyzed.1989-2012 clinical practice detected 403 patients with varied diseases after consumption of fish without scales, gills of which 97 patients had nephritis and they were also analyzed for correlation with status of contraception.

Results: Contraception was associated with 2.5-4 fold increase in renal diseases among 20-50 years [p<0.0005] and 1.5 fold increase among >50 years age group [p <0.025]; consumption of fish without scales, gills [prawns, crabs, shell fish] together with contraception was associated with 30- 40 fold increase in renal diseases, among 20 years to >50 years [p <0.0005].

Conclusion: Concept is contraception results in smashed, agonizing fragmentation of germ cells, the germ cells not being permitted to traverse the normal path, with negative feed back to the hypothalamic pituitary axis and resultant decreased endogenous estrogen or androgen resulting in defaulted genomic repertoire, deranged cell metabolism, cell cycle resulting in increased degeneration with consequent atrophy, sclerosis, metabolic syndrome; fragmented germ cells are recognized as foreign, leading to autoimmunity with resultant inflammation, fibrosis resulting in this 275% increased prevalence of diseases including renal pathology; after hysterectomy, orchidectomy 500% increase in prevalence of diseases is observed.

Contraception reversal declined the diseases, consequent to restored normal path traversal of germ cells, return of hormones by 79.9% [of corresponding normal for age] as a cause and effect phenomenon.

Current Advanced Studies on Adenomyoma of the Small Intestine

Yoshihisa Takahashi, Toshio Fukusato

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 121-132

The gastrointestinal tract adenomyoma is an uncommon benign tumor-like disease. The second most common site is the small intestine, which commonly occurs in the periampullary region, although the lesion can also occur in the jejunum and ileum. While Vaterian adenomyoma is most commonly identified in adults, juvenile patients account for more than half of all documented instances of jejunal and ileal adenomyoma. The periampullary adenomyoma generally causes biliary obstruction or abdominal pain, whereas the jejunal and ileal adenomyoma generally causes intussusception or is discovered accidentally during surgery or autopsy. Histopathological study is critical in adenomyoma diagnosis since endoscopic and radiographic examinations show non-specific results. Adenomyoma is a pathological condition in which glandular structures of varying sizes are surrounded by interlacing smooth muscle bundles. The pathogenesis of adenomyoma is thought to be either a kind of hamartoma or a pancreatic heterotopia. Despite the fact that restricted resection is the most appropriate therapy, pancreaticoduodenectomy is frequently performed when the lesion arises in the periampullary region due to a preoperative misdiagnosis as a carcinoma. As a result, it's critical that physicians and pathologists keep up to date on the condition to prevent making incorrect diagnoses that lead to unneeded surgery.

Advanced Studies on Protein Induced by Vitamin K Absence or Antagonist II-Producing Gastric Cancer

Yoshihisa Takahashi, Tohru Inoue, Toshio Fukusato

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 133-147

Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a possible hepatocellular carcinoma (HCC) specific marker, however it may also be generated by a limited number of stomach malignancies. PIVKA-II-producing stomach cancer has been recorded in 16 instances so far, two of which were reported by us and all of which were found in Japan. In virtually all instances, serum alpha-fetoprotein (AFP) levels are also elevated. In roughly 80% of instances, liver metastasis is found, and portal vein tumor thrombus is detected in roughly 20% of cases. It's often difficult to tell the difference between a metastatic liver tumor and HCC. Almost all cases appear to be advanced stomach cancer macroscopically. In many cases, a hepatoid pattern is present, as well as a moderately to poorly differentiated adenocarcinoma component. Immunohistochemical staining is frequently used to confirm the generation of PIVKA-II and AFP. The presence of liver metastasis influences treatment and prognosis, and individuals with liver metastasis have a poor prognosis. PIVKA-II may be generated by tumor cells during hepatocellular metaplasia.

Pancreatic Cystic Lesions- Imaging Based Classification and Proposal for Therapeutic Guidelines

A. Hilendarov, K. Velkova, A. Nedeva, E. Simova, P. Stefanov, A. Todorov, D. Psomas

Highlights on Medicine and Medical Science Vol. 8, 6 July 2021, Page 148-158

Introduction: Cystic lesions of the pancreas are increasingly being recognized due to the widespread use of cross-sectional imaging. Therefore, it is important to characterize cystic neoplasms and to distinguish cystic neoplasms of the pancreas from pseudocysts.

Aim: To propose an classification system of the cystic pancreatic lesions that is based on the morphologic features of the lesion This system can be helpful in characterizing lesions, narrowing the differential diagnosis, and making decisions regarding the treatment of affected patients.

Materials and Methods: The study comprised 56 individuals (27 men and 29 women) with cystic pancreatic lesions as their final diagnosis. The following materials were used: Ultrasonic equipment with 3.5 and 7 MHz linear, convex and biopsical transducers, MDCT investigations were done with a 16-slice scanner. During the pancreatic and portal venous phases of contrast enhancement, images are taken . The “Chiba” needles 18, 20, 22, 23G, automatique aspiration system, methods of guiding the interventional procedures.

Results and Discussion:  At least two cuts imaging survey modalities, including as US, CT, or MRI, were performed on all 56 patients in this investigation. The most common preoperative diagnostic examination was US scan - 56 patients (100% ), MDCT studies have been conducted in 49 (87.50%) and MRI in 13(23.21%). More than half of patients surveyed (37) have underwent some type of interventional procedure: 25-FNA and 29-FNAB, as part of the examination. 34 patients of all 56 patients because of histological evidence of malignancy after the FNAB for cystic lesions of the pancreas were operated. Comparing the diagnostic results of US examination with those of MDCT examination and histological verification we estimated the power of the diagnostic imaging methods for cystic lesions of the pancreas. The specificity of 68.75%, sensitivity 79.48%, accuracy 75.00%, positive predictive value 86.11% and negative predictive value 55% were obtained. The power increased after applying invasive procedures with immunohistochemical analysis of CEA and P- 53. In patients with clear symptoms and / or clear imaging features of malignant or premalignant cystic neoplasm, the need for surgery was confirmed by histological verification in 34 (60.71%) of cases.

Conclusions: Cystic mucinous tumours of the pancreas might have been discovered and correct operational procedures might have been performed with fewer diagnostic exams if the proposed methodology had been employed.