Dr. Sevgul Donmez
Faculty of Health Sciences, Gaziantep University, Turkey.

ISBN 978-93-91312-52-7 (Print)
ISBN 978-93-91312-57-2 (eBook)
DOI: 10.9734/bpi/hmms/v9

This book covers key areas of medicine and medical science. The contributions by the authors include biliary tract, cystic duct, cystic malformation, kidney disease, clear cell renal cell carcinoma, micro vessel density, Fuhrman grade, histopathology, ultrasound, liver lesions, benign tumor, malignancy, color Doppler method, cytopenia, hemolytic anemia, leukopenia, lymphopenia, pediatric systemic lupus erythematosus, thrombocytopenia, gestational diabetes mellitus, normoglycemia, dysglycemic and postpartum, immunity, immune proteins natural, local infectious disease, electrical storm, ventricular tachycardia, ventricular fibrillation, implantable cardioverter-defibrillator, catheter ablation, drug utilization, prescribing pattern, antibiotics, lubricants, antibiotics, attention deficit hyperactivity disorder, stimulants, tricyclic antidepressants,  therapeutic activity, infectious pathologies, vaccination, coronary heart disease, acute coronary syndrome, left ventricular dysfunction, psoriasis,  inflammatory skin disease, liver fatty acid-binding protein, hepatocellular carcinoma, hepatocellular adenoma, immune-histochemical staining, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, obesity, histology. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


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Aim: The purpose of this test is to look for cystic malformations in the cystic duct.

Methods: Over the course of two years, we discovered ten cases of cystic malformation of the cystic duct in patients who had their abdominal complaints evaluated in our radiology department with ultrasonography, multidetector computed tomography, or magnetic resonance imaging. Radiological diagnosis of cystic malformation of the cystic duct was done on the basis of a dilated, nonvascular cystic structure near the porta hepatis, and visualization of a clear communication with either the gallbladder, normal caliber cystic duct and/or common bile duct (CBD) on at least one imaging modality.

Results: The cystic duct had saccular dilatation in four of ten cases.Six of the patients showed fusiform dilatation of the cystic duct, with two of them having just mild fusiform dilatation.Two of the patients exhibited CBD dilatation, whereas the third had cystic duct calculi and malignancy. Conclusion: The cystic duct malformations should be recognised as a different type of choledochal cyst and included to Todani's classification as type VI cyst.

Prognostic Factors and Postoperative Survival in Clear Cell Renal Carcinomas. A Histopathological Diagnosis

P. Colaci, A. L. Errecalde, A. M. Inda, M. Garcia

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 8-17

Introduction: Clear cell Renal Cell Carcinoma (ccRCC) is the most common type of Renal Cell Carcinoma that occurs in adults and it has the worst prognosis among the common epithelial tumors of these organs. This neoplasm is characterized by a high blood supply. With this in mind, we have used the CD34, an endothelial antigen that has been used to highlight the microvessel density (MVD), as a direct marker of neoangiogenesis degree.

Objective: To establish the correlation between CD34 and other prognostic factors like Fuhrman nuclear degree and tumoral size.

Material and Methods: Tumour samples from 17 patients with histopathology diagnosis of ccRCC were examined by immunohistochemical staining for CD34. The CD34 expression was analyzed by Anova and Student Newman Multiple Comparison Test and Tuckey as a post-test, and finally, we used a Spearman Correlation to compare with the other prognostic factors analyzed and Kaplan Meier survival analysis for the disease-free survival of the patients.

Results and Conclusion: There is a negative correlation between the MVD and the Fuhrman nuclear grade, whereas R = -0,46; and p < 0,05 and there is a positive correlation between the MVD and the maximum tumour diameter, whereas R = 0,47 and p < 0,05. In conclusion, we found that a high MVD is related to a low Fuhrman nuclear grade and a high tumour size. The possible significance of this study can be that in fact, we need more than one parameter to predict the biological behavior of the ccCCR.

Differential Diagnosis of Focal Hepatic Lesions Using Ultrasound Confirmed with Histopathology: Recent Advancement

Rania Mohammed Ahmed, Sharifah Alkathiri, Waad Altalhi, Hatun Eid, Manar Alshalawi, Sara Alotaibi

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 18-30

Advances in imaging technology over the past decades have contributed to better characterization of hepatic lesions. This study aims to differentiate focal hepatic lesions from their ultrasound (U/S) features and compared the obtained results with histopathology. A descriptive retrospective study of 100 patients who had focal hepatic lesions were reviewed during the period from 2012 to 2019 at King Abdul-Aziz Specialist Hospital, Taif, KSA. The inclusion criteria were Adults Saudi patients, ages 18 and above. LG-9 and Philips ultrasound machines with 3.5 MHz transducers were used in this study. Age group (55 to 80 years) represented 44%, mean age was 49 years, 92% were married. Regarding shape of the lesions during U/S scan, 47% of irregular outline were malignant (p=0.00), 93% of the rounded lesions were benign (p=0.00),86% of well-defined lesions margins were benign in histopathology, 61% ill-defined margin lesions were malignant and 73% of hyperechoic lesions were hemangioma (p=0.02). Regarding nature of hepatic lesions during U/S, 87% of solid lesions were malignant (p=0.03), while 89% of cystic lesions were benign. 61% of hypoechoic lesions were malignant. 80% from vascular lesions under color Doppler were benign. U/S sensitivity and specificity were 93.5 and 98%, respectively. U/S is a useful tool in differentiation cystic hepatic lesions from solid (p=0.03). Comparable studies with large samples must be done in Taif region to provide data base for hepatic lesions. Most of selected hepatic lesions with suspicious features were confirmed as malignant in histopathology with high degree of sensitivity and specificity.

Hematological Involvement in Pediatric Systemic Lupus Erythematosus

María-Soledad Ayala, Ximena Norambuena, Alfonso Loosli, Arnoldo Quezada

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 31-40

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystemic involvement with a variable clinical course. Hematological involvement is frequent and both morbidity and mortality, as well as the increased risk of infection and decreased survival rates have been significantly related with such compromise. The objective of this study was to describe the hematologic alterations in pediatric patients with SLE at the time of diagnosis.

Methods. A retrospective descriptive study of patients with SLE controlled in the Immunorheumatology outpatients centre of Exequiel Gonzalez Cortes Children´s Hospital, Santiago, Chile was conducted. Thirty-three clinical files were reviewed, and demographic and clinical data were obtained.

Results. Thirty patients met the inclusion criteria, 22 females, mean age 11.6 years (range 5 to 14). The prevalence of hematological compromise was 60% (n = 18). The most frequent hematological alteration was lymphopenia in 14 patients, followed by autoimmune hemolytic anemia (HA) in 11, leukopenia in 10, and thrombocytopenia in 3 patients. The association between different hematological alterations showed lymphopenia with leukopenia in 50% of the patients (n = 9) and HA with lymphopenia in 8 patients. The most frequent extra-hematological manifestations in patients with hematological alterations was skin involvement in 26/30 patients, followed by kidney involvement in 25, articular in 22, and serositis in 17.

Conclusions. Hematological involvement in this series of pediatric SLE was frequent and this is included in traditional and current diagnostic criteria. In a group of patients, it can be the first manifestation, and this requires a differential diagnosis and careful monitoring. In other cases, it may be a manifestation of severe SLE that requires vigorous treatment.

Most of the women with GDM have clinical manifestations indicating a risk for type 2 diabetes (T2D). Present evidence signifies that T2D can be withhold or delayed by intensive lifestyle adjustments and through medications, predominantly those that ameliorate insulin resistance. Glucose tolerance test in the postpartum period to detect diabetes or evaluate diabetes risk is the mandatory clinical management step. All patients should be properly monitored for increasing glycemia indicative of progressive \(\beta\)-cell deterioration. Combination of fasting glucose and glycosylated hemoglobin measurements are suggested for this purpose. Monitoring should be instigated at least annually and should be continued frequently if glycemia is rising and/or impaired. Lifestyle alterations are recommended to diminish the risk for T2D. Breastfeeding is also very essential for the profound short-term and long-term health benefits of the infant, encouragement and facilitation to the breastfeeding women reduces the risks for subsequent obesity and glucose intolerance also

A Review on Mucosal Immunology of Human Head

Ibrahim M. S. Shnawa

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 52-58

Human head immunity is of tripartite nature. Natural, cross-road ,and adaptive.It houses four immune functioning components. Common mucosal immune system, mononuclear cell system, systemic transudent cellular entities and systemic transudent humoral immune proteins. Such human head immune oriented settings are helpful in combating local infectious insults.

Electrical Storm and ICD Therapy: An Overview Update

Antônio da Silva Menezes Júnior, Ana Luisa Adorno de Lima, Roberta Gomes da Mata, Dayanne Cardoso Teixeira

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 59-73

An electrical storm (ES) is a ventricular arrhythmia (VA) consisting of the occurrence of three or more ventricular tachycardias (VT) per day, separated by five-minute intervals, or the presence of unceasing VT, even with the optimization of antiarrhythmic drug therapy. The objective of this chapter is to promote an overview update of electrical storm in patients with ICD Therapy. Data revealed that 84 out of 1274 patients with an implantable cardioverter-defibrillator (ICD) developed ES during follow-up. The incidence of ES in patients with ICD can reach 20% during the first 134 days after implantation. The pathophysiological mechanism is not well understood, because ES can be caused by several clinical conditions and through several different mechanisms, including VT and ventricular fibrillation (VF), global acute ischemia, and myocardial dysfunction. Patients with ES have a threefold greater risk of sudden cardiac death (SCD). The treatment is multimodal and consists primarily of emergency sedation, ventilation, neuraxial modulation, drug therapy (beta-blockers, amiodarone, sotalol, class I anti-arrhythmic drugs), and catheter ablation (CA). CA is a rescue procedure performed when there is little or no response to drug therapy. This approach is performed by first mapping the local and then choosing between approaches (endocardial or epicardial) and the different CA methods, which mainly include radiofrequency ablation, irrigated radiofrequency ablation, pulsed radiofrequency ablation, alcohol ablation, and cryoablation.

Aim:  To evaluate the utilization of the drugs in the ophthalmology outpatient department.

Materials and Methods: Present study was conducted at ESIC medical college and PGIMSR Ophthalmology Department. Total 700 prescriptions were collected from 700 patients and prescriptions were analyzed for total and an average number of drugs per prescription, duration of treatment, dosage form, drug encounter with antibiotics and another group of drugs also percentage of drugs prescribed by generic names.

Results: After analyzing the prescriptions, the average number of drugs per prescription was 2.14 and the range of drugs prescribed were varied from 1-5. Total drugs prescribed were 1502 with 7 different dosage forms. Most commonly prescribed were antibiotics (28.14%) followed by antihistamines (14.285) and vitamins and minerals (14.28%). Thirdly ocular lubricants were frequently prescribed (12.12%). Fluoroquinolones (moxifloxacin) were very commonly prescribed in antibiotics. The common prescription writing errors were very minimal.

Attention deficit hyperactivity disorder (ADHD) is the most common behavioral disorder in children. ADHD may disable the patient throughout life. Diagnosis of ADHD is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). ADHD is a costly health problem, and various drugs, including psychostimulants, tricyclic antidepressants (TCAs), bupropion, pemoline, clonidine, and atomoxetine, have been used to treat it. Atomoxetine and psychostimulants are the most commonly prescribed drugs for pediatric ADHD with similar efficacy. Serious adverse events with atomoxetine have been reported. A mild psychostimulant agent, modafinil, is not approved by the US FDA to treat ADHD, but it is prescribed off-label for this condition. Concurrent psychiatric illnesses like insomnia, tics, post-traumatic stress disorder (PTSD), and aggression require additional consideration to manage a person with ADHD.

Determination of Eruptive Fevers in the Infectious Diseases Department of Ouagadougou CHU-YO, Burkina Faso from 2005 to 2019

Savadogo Mamoudou, Diallo Ismaël, Sondo K. Apoline

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 91-95

Infectious pathologies of cutaneous expression constitute a major problem of public health in tropical environment.

Objective: Describe the epidemiological, clinical, therapeutic and evolutionary aspects of eruptive fevers in the Infectious Diseases Department of CHU YO.

Patients and Methods: The study took place in the Department of Infectious and Tropical Diseases at the Yalgado Ouedraogo University Hospital Center. This was a descriptive retrospective study of cases of eruptive fever, hospitalized in the department from January 1, 2005 to December 31, 2019. 

ResultsDuring the study period, the prevalence of eruptive pathologies was 5%. The average age of patients was 16 years with extremes of 01 and 73 years. The most represented age group was 01-14 years old (53.1%) with a sex ratio of 1.4. Only 27.2% of patients were up-to-date with measles vaccine. The association fever and cough was the most frequently found syndrome (26.2%). The most common elemental lesions were maculopapular (46.2%), followed by vesicular lesions (10%). The pathologies involved were dominated by measles (50.8%), herpes (19.2%), chickenpox (14.6%), HIV infection (6.3%), meningitis (6.1%).

The average duration of hospitalization was 7.5 days with extremes of 01 and 26 days. The lethality was 4.6%.

Conclusion: Measles and chickenpox are still responsible for outbreaks in communities in Burkina Faso. It is important to increase awareness about vaccination against these febrile eruptive diseases.

Study on Correlation between Troponin-I Level with Left Ventricular Systolic Dysfunction after First Attack of Non-ST Segment Elevation Myocardial Infarction

Mahmood Hasan Khan, Mirza Md. Nazrul Islam, Md. Shafiqul Islam, Kaisar Nasrullah Khan, Md. Shamim Chowdhury, Reazur Rahman

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 96-106

Background: Coronary Heart Disease (CHD) is the most common type of heart disease, and it has been identified as the single most important cause of early death in the developed world. It's critical to recognise a patient with ACS because the diagnosis prompts both triage and care. CHD is responsible for more than half of all cardiovascular incidence in individuals. cTnI is a myocardium-specific tissue marker that has proven to be a highly sensitive and specific marker for AMI. After an ACS, the best predictor of death is ventricular function. It is a myocardial damage marker that also offers information on systolic function, diagnosis, and prognosis.

Objective of the Study: The study sought to determine the effect of LVEF on elevated Troponin-I levels in patients experiencing their first attack of NSTEMI.

Method:  From December 2015 to November 2016, a cross-sectional analytical study was carried out in the cardiology department of Mymensingh Medical College Hospital. Considering inclusion and exclusion criteria, a total of 130 first-time NSTEMI patients were included. The sample population was divided into two groups: Group–I: Patients with first attack of NSTEMI with LVEF: <55%. Group–II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and Troponin-I levels were correlated using Pearson’s correlation coefficient test.

Result: In this study mean Troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79 ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p < 0.05). Patients with a high Troponin-I level had a low LVEF, while those with a low Troponin-I level had a preserved LVEF, according to echocardiography. According to the findings, patients with highest level of Troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of Troponin-I had preserved systolic function (LVEF \(\ge\) 55%). It was also discovered in our research that the levels of Troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level \(\ge\)6.6 ng/ml is a very sensitive and specific marker for LV systolic dysfunction.

Conclusion: The research team was able to determine that the greater the Troponin-I level, the lower the LVEF level, and hence the more severe the LV systolic dysfunction in NSTEMI patients with their first attack.

Evaluation of Vitamin D Status, Selenium & CRP Level in Psoriasis

S. Sumathi, S. Vinod Babu, K. Karthikeyan

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 107-115

Background: Psoriasis is an inflammatory skin disease that is associated to a number of clinical conditions. It results from a combination of genetic predisposition and environmental factors, which together provoke sensitization of the immune system. We aim to explore the status of serum vitamin D, selenium and CRP levels in patients with psoriasis and their association with the severity of the disease.

Materials and Methods: There were 50 psoriasis cases and 47 healthy people in this hospital-based case-control research. The levels of serum VD, selenium, and CRP were measured, as well as the general demographic data.

Results: VD levels are considerably lower in psoriasis (p< 0.005) according to statistical analyses. Obesity was found to be more common among psoriasis patients than controls in the demographic factors.The levels of selenium and CRP in the serum did not differ significantly between the two groups.

Conclusion: We conclude that vitamin D deficiency is strongly associated with psoriasis. Vitamin D supplementation can help with psoriasis management as well as obesity reduction. Serum selenium and CRP levels have shown very little significance in our study.

The Importance of Liver Fatty Acid-Binding Protein Downregulation in Hepatocellular Carcinoma

Masafumi Inoue, Yoshihisa Takahashi, Takeshi Fujii, Masanobu Kitagawa, Toshio Fukusato

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 116-134

Aim: The purpose of this study was to see how important it was for the expression of liver fatty acid-binding protein (L-FABP) to be downregulated in hepatocellular carcinoma (HCC).

Methods: Immunohistochemical labelling for L-FABP was performed on tissue microarrays from 146 instances of HCC. For each L-FABP-negative HCC, further immunohistochemical staining was performed using a representative whole-tissue section to confirm the downregulation of L-FABP expression and to assess the intratumoral heterogeneity of the staining pattern. Histological slides were examined and clinical data was gathered from the clinical files. On the tissue microarrays, immunohistochemical staining for cytokeratin (CK) 7, CK 19, \(\beta\)-catenin-catenin, glutamine synthetase (GS), and serum amyloid A (SAA) were also done. L-FABP-negative and L-FABP-positive HCC patients were compared in terms of clinicopathological characteristics. Furthermore, L-FABP and GS gene expression in HCC and cholangiocarcinoma (CC) cell lines were analyzed using real-time reverse transcription polymerase chain reaction. Mutation analysis of HNF1A (encoding hepatocyte nuclear factor 1 (HNF1)\(\alpha\)) was performed for L-FABP-negative HCC cases.

Results: Sixteen (10.9%) of the 146 HCC patients tested negative for L-FABP. When we examined the correlation between the downregulation pattern of L-FABP and tumor size, most cases of smaller HCC (\(\le\)2 cm in diameter) exhibited focal downregulation, while most cases of larger HCC (> 2 cm in diameter) exhibited diffuse downregulation. The correlation was statistically significant (P = 0.036). When the HCC was smaller, the L-FABP-negative area often corresponded to a “nodule-in-nodule” appearance. Among the small HCC cases, tumor differentiation was significantly lower, and the frequency of intratumoral inflammation was significantly lower in L-FABP-negative cases than in L-FABP-positive cases (P = 0.032 and P = 0.009, respectively). The frequency of positivity for b-catenin and GS staining was significantly higher in L-FABP-negative cases of small HCC than in L-FABP-positive cases of small HCC (P = 0.009 and P = 0.000, respectively). Among six HCC cell lines examined, four showed higher expression of L-FABP, and the remaining two cell lines showed lower or no expression of L-FABP. Two of the 16 L-FABP-negative HCC cases possessed a mutation in exon 4 of HNF1A.

Conclusion: In smaller HCC, L-FABP downregulation probably occurs because of phenotypic changes during tumor progression. Moreover, this downregulation correlated with tumor differentiation and intratumoral inflammation.

Overview of Pediatric Nonalcoholic Fatty Liver Disease with a Focus on Histology

Yoshihisa Takahashi, Toshio Fukusato

Highlights on Medicine and Medical Science Vol. 9, 9 July 2021, Page 135-146

Nonalcoholic fatty liver disease (NAFLD) is a condition in which excessive fat builds up in the liver of a person who has never drank excessive alcohol. This disease includes simple steatosis and nonalcoholic steatohepatitis (NASH). The hepatic manifestation of the metabolic syndrome is known as NAFLD/NASH. Pediatric NAFLD has risen in recent years, along with an increase in the frequency of childhood obesity. The frequency of pediatric NAFLD is believed to be between 2.6 and 9.6 percent, and it is linked to sex, age, and ethnicity. The "two-hit" concept is largely recognised when it comes to the aetiology of NAFLD, and oxidative stress is assumed to play a key role in the second hit. Despite the importance of clinical symptoms, laboratory data, and imaging results, liver biopsy remains the gold standard for diagnosing NAFLD/NASH. In addition, liver biopsy is essential for assessing the degree of necro-inflammatory change and fibrosis in NASH. There are two forms of steatohepatitis (type 1 and type 2 NASH), with type 2 NASH being present in up to 51% of juvenile NAFLD patients. We and others have seen, however, that type 1 and 2 patterns frequently overlap. Despite the fact that medication has been investigated in clinical trials, diet and exercise remain the foundation of NAFLD/NASH treatment.