Dr. Takashi Ikeno
National Cancer Center Hospital East, Clinical Research Support Office, Japan.

Short Biosketch

ISBN 978-81-19217-58-8 (Print)
ISBN 978-81-19217-60-1 (eBook)
DOI: 10.9734/bpi/namms/v2

This book covers key areas of medicine and medical science. The contributions by the authors include blood safety, voluntary donors, transfusion services, severe acute respiratory syndrome, hematological changes, platelet-lymphocyte ratio, neutrophil-lymphocyte ratio, splenic trauma, non-operative, splenectomy, abdominal CT scan, mirror neurons, invasive candidiasis, mortality, echinocandins, breast cancer, steroid receptors, Vitamin D receptor (VDR) gene polymorphism, myeloid dendritic cells, flow cytometry, plasmacytoid dendritic cells, obesity, insulin resistance, metabolomics, overnutrition, glucocorticoid ablation, pressure ulcer, bedsore prevention, pressure ulcer management, flap reconstruction, lymphadenectomy, surgical complications, lipomas, primary benign neoplasm, medical malpractice, provider-patient relationship, laparoscopic surgery, cecocutaneous fistula, post appendicectomy complications, appendicocutaneous fistula. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


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Reflection of Challenges in Blood Safety Practices: An Overview

Subhashis Das, Nikhil , Gaurav Khichariya , T. Amrutha , Snigdha Sinha

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 1-7

Whole blood collection has increased in past 10 years but it has failed to keep in pace with the increased demand. Nation’s blood safety has improved with 99% of whole blood donations obtained from voluntary non-remunerated donors. Nevertheless, unmet clinical demand for blood along with the augmented incidence of human immunodeficiency virus and syphilis in general population possess new challenges to transfusion services. To make sure a safe, efficacious along with appropriate adequate blood supply, constant efforts are needed to recruit and retain adequate number of voluntary blood donors [low-risk] and also efforts should be made for efficacious donor prescreening, blood testing procedure, strengthening patient blood management with Hospital transfusion committee of the Hospital.

Assessment of Hematological Changes in COVID-19: An Update

Subhashis Das , Nikhil , Gaurav Khichariya , T. Amrutha , Snigdha Sinha

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 8-14

The aim of the study is to assess hematological changes in COVID-19 Subjects and compare the leukocyte variation between ICU and Non-ICU group. Haematological changes have been demonstrated in COVID-19 patients COVID-19 subjects shows varying degrees of leukopenia and lymphopenia. Haematological changes in COVID-19 helps in predicting severity and prognosis of the disease. Published literature advocates that neutrophilia, lymphopenia are prognostic parameters as they are generally observed in severe cases. Combination of haematological parameters such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) is increased in COVID-19 subjects as compared to healthy controls in studies done by et al studies. Identical results were obtained in current study There is shortage of data with respect to role of eosinophils in COVID-19. It is observed that eosinopenia is noted is associated with severe COVID-19 disease. In Current research we observed the haematological profile in COVID-9 subjects and correlated with severity and prognosis of the disease. Predicting the severity and prognosis can help in treating at the earliest and will prevent further progression of the disease.

Blunt Abdominal Trauma with Splenic Injury in Uganda: A Case Study

Richard Wismayer

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 15-26

The aim of this study was to report on a case of splenic trauma that presented in a Regional Referral hospital in Uganda and discuss the management of this condition. The spleen is the most commonly injured viscus in blunt abdominal trauma. Abdominal pain with left upper quadrant tenderness or signs of peritonitis in a patient with history of trauma is the most common presentation of this condition. A 43-year-old gentleman was admitted to Masaka Regional Referral Hospital after having been involved in a road traffic accident (RTA). On examination his Glasgow coma score was 15, the airway was intact, his chest was clear and his pulse rate was 120 bpm-1 and blood pressure (BP) 90/60 mmHg. He complained of generalised abdominal pain and nausea.An examination of the abdomen revealed widespread abdominal tenderness, especially in the upper abdomen. He had a 9g/dl haemoglobin level, and the A&E Department's FAST ultrasound scan revealed fluid in the splenorenal angle.   The high incidence of splenic injuries in this age group may be due to high-risk activities at an economically active age. A splenectomy was carried out and there were no other associated injuries of the liver or bowel and other intra-abdominal organs were intact. He had a smooth postoperative recovery and remained hemodynamically stable after surgery. On the fourth post-surgery day, he was let go from the surgical ward. After discharge from the hospital poor follow-up visits is also a concern. Health education programmes in our setting is therefore necessary to prevent post-splenectomy complications in particular post-splenectomy sepsis.

Mirror Neurons Linkages to Design Communication Skills Training Models for Doctors

Maya Jamkar, Shweta Telang-Chaudhari, Arun Jamkar

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 27-36

Mirror neurons were initially discovered in the early 1990s. Multiple specialized ‘mirror neuron systems’ have been shown in studies to comprehend the intents, actions, feelings, and behavior of others through direct imitation and action understanding, without the need for any cognitive processing. Research has demonstrated how Mirror neurons contribute to the imitation-based learning of new skills. This ability to ‘observe and imitate’ actions forms the foundation of the importance of ‘supervised observation and practice’ in the development of communication skills. Effective use of Mirror neuron philosophy has been demonstrated in surgical skill training for psychomotor training. This chapter provides a framework for communication training based on previously established theories to suggest how the Mirror mechanism may be actually applied in teaching doctors to communicate effectively. The five "Mirroring" strategies described here may be useful to improve doctor-patient communication. The computational model based on conversational AI (Artificial Intelligence) has been proposed for enhancing AI-based Communication skills training for doctors. These tools can translate spoken or written language in real time, making communication more effective. The authors believe that better communication skills in doctors will definitely improve overall patient and physician satisfaction, ensure adherence to therapy, and enhance patient trust in the practitioner.

Challenges in the Diagnosis of Invasive Candidiasis

Jagdeesh Natesan , Suganthini Krishnan

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 37-46

This review provides a brief overview of the evolution of candida diagnostics, difficulties in interpreting test results, their strengths and limitations, and guide clinicians interpret test results from a clinical perspective. Invasive candidiasis (IC) is an important cause of nosocomial blood stream infections and deep tissue infections, associated with a high mortality of ~30%. Early diagnosis and timely initiation of antifungal therapy is crucial. Most advanced blood culture systems detect a dismal 50% of IC, and cannot be relied upon as sole diagnostic tools. Hence it is imperative that non -culture based diagnostic tests are developed, validated and standardized to enhance the diagnostic sensitivity of IC. The last three decades have witnessed the introduction of several different diagnostic tests, most of which haven’t been successful. Additionally, it gives medical professionals a manual for how to interpret test results from a clinical standpoint so that they can use antifungal medications wisely. 

Such a strategic approach would definitely facilitate early diagnosis and treatment of IC and decrease mortality in these patients.

The present study has been designed to develop new anti-diabetes drugs. Defects in insulin secretion in vivo lead to hyperglycemia, type 1 diabetes mellitus (DM), and either insufficient insulin secretion or insulin resistance, which induces type 2 DM. Although several anti-type 2 DM drugs are available, to our knowledge, anti-type 1 DM drugs have not been developed. Amines have been studied as candidate drugs against type 1 DM, because other basic compounds, such as carbonates (NaHCO3 and NaCO3), accelerate glucose consumption in cultured cells. We evaluated more than 20 chemical compounds, including pharmacological drugs, in cultured cells. Among these, 2-amino-1-phenylethanol (2-A-1-PET) and 2-amino-N-cyclohexylethanol (2-A-N-CET) significantly accelerated glucose consumption, which was followed by lactate production in cells. Moreover, treatment with 2-A-1-PET reduced glucose levels in rats. In cells, both 2-A-1-PET and 2-A-N-CET abolished the effects of DM-inducing drugs, such as streptozotocin and alloxan, and nicotinamide, on glucose consumption, whereas both 2-A-1-PET and 2-A-N-CET exerted additive effects with vanadium, carbonates, or concanavalin A on glucose consumption.

This book chapter aims to analyze in a systematic way that the association of VDR allelic variants with breast cancer risk among patients from various populations. It  have highlighted the new insights of the current understanding of molecular mechanisms of the VDR gene polymorphisms related to breast cancer risk and also examined the interaction between VDR polymorphisms and steroid hormone (estrogen, progesterone, and androgen) receptors and their modifying effects on breast cancer risk, cancer severity, progression rate, and disease outcome. This analysis has revealed that Fok1, Bsm1, Apa1 were to some extent associated with breast cancer risk, Taq1 shows no association, and Cdx2, poly(A), Tru91 gene polymorphisms may be susceptible for breast cancer development.  Breast cancer is a compilation of distinct malignancies that manifests in the mammary glands. Carcinomas make up the majority of breast cancers while sarcomas such as phyllodes tumors and angiosarcomas are rarely seen. Vitamin D receptor (VDR) transcriptionally modifies its target genes involved in cell proliferation, differentiation, and apoptosis in a ligand-dependent manner, conferring a protective function against the development and spread of cancer. Numerous polymorphisms exist in the VDR gene's coding and regulatory regions.  (BsmI, Fok1, Taq1, Apa1, Cdx2, poly (A), etc.) that modulate its transcription, translation, and mRNA stability. Despite this, research in this area has not yet led to many conclusions. Vitamin D via VDR acts in a multitude of ways on cancer cell biology, including the cell cycle regulation, apoptosis, invasion, and metastasis, as well as angiogenesis, it has brought together a wide-ranging impact on tumor development under its domain. The study therefore advise that future research on genetic variations of the VDR gene be combined with the evaluation of the status of steroid hormone receptors in breast cancer due to the paucity of studies and inconsistent results.

Oral diseases are one of the most crucial common diseases in veterinary medicine, but clinical symptoms are usually subtle. In addition, many oral disease in veterinary patients cause significant local and systemic health problems and mostly displays with significant pain in Veterinary patients, however, this is the evident that with the increased demand of medications or treatment for companion animals, with significant treatment for oral diseases.

Purpose: The goal of this study is to provide insight into the leading edge of oral and maxillofacial surgery in order to provide a more detailed picture of recent practices and challenges in clinical circumstances that you meet on a daily basis. Methods and Materials: A series of publications containing new information on a wide range of subjects in biomaterials and regenerative research in periodontology, oral surgery, and dentistry, ranging from basic sciences to clinical applications.

Results: The findings showed that over the past ten years, numerous studies have concentrated on the molecular, cellular, and pharmacological aspects of the biomaterials utilized to progress oral and maxillofacial surgery.

Conclusion: As a result, patients will receive first-rate medical services with less morbidity and treatment. The field of maxillofacial surgery has advanced more. The outcome of surgical treatments depends heavily on preoperative planning, thus academics have concentrated on enhancing it in recent years.

Methodology for Flow Cytometric Analysis of Dendritic Cell Subsets in Pregnant Women with Early Onset Pre-eclampsia

Aarthi Sundararajan, Rohit Jain , Kranti Vora , Senthilkumar Natesan , Vidhi Vaidya

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 98-116

Pre-eclampsia (PE) is a pro-inflammatory disease associated with pregnancy. The only known remedy is to deliver the fetus and placenta. Hypertension and proteinuria after the 20th week of pregnancy are clinical indicators of PE. Early onset pre-eclampsia (EOPE), a severe variant of PE, is defined as clinical signs appearing before 34 weeks of pregnancy. Human dendritic cell (DC) subtypes (CD1c+, CD141+ myeloid DCs, and plasmacytoid DCs) are intricately implicated in the inflammatory process and are considerably changed in a variety of proinflammatory illnesses. These alterations provide value for monitoring DC subsets as potential biomarker(s) and as targets for immunotherapeutic treatment. The main objective of the study is to delineate how the three DC subsets are altered quantitatively and functionally in blood and decidua of EOPE patients, compared to normal pregnant women.

DC subsets play an important role in normal pregnancy by facilitating effective trophoblast migration and invasion and establishing an anti-inflammatory milieu of immunotolerance. In contrast, a detailed examination of the makeup and function of DC subsets in the proinflammatory milieu of EOPE pregnancy is required. In this regard, the developed methodology examines how DC subsets differ (quantitatively and functionally) in EOPE patients versus normal pregnant women. The multiparametric flow cytometry method is used to determine alterations in the profile of DC subsets in the blood and decidua of EOPE patients. Normal pregnant women are included as controls.

Identifying possible biomarkers will be based on an understanding of alterations in the profile of DC subsets in blood samples from EOPE patients. The basis for creating innovative immunotherapeutic techniques targeting various DC subsets or their products for the treatment of EOPE will similarly be variations in the profile of DC subsets in the decidua of EOPE patients. Overall, the methodology will support the development of future large-scale, prospective clinical trials with a focus on developing approaches for the early detection and treatment of EOPE in pregnant women.

Glucocorticoid Ablation Attenuates Insulin Resistance and Improves Glucose Tolerance in the Obese LA/Ntul//-cp RAT

Orien L. Tulp, Aftab R. Awan, George P. Einstein

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 117-130

The counterregulatory effects of glucocorticoids and insulin that commonly occur in obesity result in the development of insulin resistance and impaired glycemic responses to dietary carbohydrates. Both adipose tissue and skeletal muscle are dependent on insulin actions to bring about glucose uptake, and the combined hormonal effects contribute to disordered processes of energy metabolism in insulin dependent tissues that generally correspond to the magnitude of insulin resistance. To determine the effects of glucocorticoid inhibition on typical insulin-mediated glycemic processes in obese rats, groups (n=6 -12 rats/phenotype) of normally reared longevity-prone congenic lean and obese animals were fed a Purina chow diet from 6 to 9 weeks of age, and overfed with the Chow diet plus a highly palatable cafeteria diet from 9 to 12 weeks of age. The congenic LA/Ntul//-cp rat strain expresses the obese trait soon after weaning but remains glucose intolerant but non-diabetic thereafter. Subgroups of obese animals were subjected to bilateral adrenalectomy (ADX) at 6 weeks of age to remove glucocorticoid contributions to glycemic parameters. At 6, 9, and 12 weeks of age, each treatment group achieved weight gain (WG) and glucose tolerance (OGT). At 6 and 9 weeks of age on the chow diet, WG on ADX-obese rats was equivalent to that of their lean littermates, but was twice that of their lean littermates from 9 to 12 weeks of age. following 30 to 60 minutes, OGT responses and the area under the OGT curve were impaired but not diabetic in obese animals of all ages, and reverted to those of lean rats following ADX. At 12 weeks of age, the insulin to glucose ratio (I:G) was consistent with insulin resistance in obese rats but not in ADX-obesity or lean rats. At 9 and 12 weeks of age, ADX led to the normalization of OGT and glycemic indices in the obese phenotype. These findings support normalizationof typical insulin-mediated components of glycemic parameters and glucose uptake in peripheral tissues following glucocorticoid ablation of congenic obese rats, and suggest that the counterregulatory effects of insulin and glucocorticoid hormones may be contributory to the impaired glycemic responses in the obese phenotype of the LA/N//-cp (corpulent) rat and are consistent with a receptor-mediated element in the development of insulin resistance and glucose uptake in peripheral tissues commonly associated with the early development of obesity in this strain.

Pressure Ulcers: Risk Factors, Prevention and Surgical Management

Mohd Altaf Mir, Prince Kumar, Rajesh Maurya, Jaya Jain, Sakshita Pal, Beena Kumari

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 131-144

This chapter provides an evidence-based approach to the prevention and management of pressure ulcers, a common healthcare challenge that can lead to serious complications for patients. The chapter reviews the causes and risk factors of pressure ulcers and emphasizes the importance of early identification and prevention. The chapter also discusses the latest research and best practices for the management of pressure ulcers, including wound assessment and treatment, pain management, and infection prevention. In addition, the chapter highlights the role of interdisciplinary collaboration and patient-centered care in the prevention and management of pressure ulcers. The contributions of this chapter lie in providing healthcare professionals with practical recommendations and strategies for improving patient outcomes and reducing the burden of pressure ulcers on healthcare systems.

The Management of Chylous Ascites: Description of a New Technique Regarding a Clinical Case

Hugo Otaola-Arca, Patricio Vargas, Marcelo Orvieto, Carmen Niño-Taravilla , Hugo Bermúdez

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 145-158

Chylous ascites (CA) is a rare postoperative complication that can lead to malnutrition and immunodeficiency. As a result, surgical interventions are reserved for patients who are refractory, and the primary success factor for these interventions is locating the point of leakage, which is frequently difficult. Most CA cases were managed conservatively in the literature, with a minority treated with surgical intervention.  We present the case of a 56-year-old man who developed chylous ascites following a laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. At first, the patient was managed with dietary changes and drainage placement. Following that, lipiodol lymphography, percutaneous embolisation of the leakage point, and total parenteral nutrition were established. Ultimately, after identifying the leakage point with methylene blue injection through an inguinal node, the patient underwent laparoscopic repair. The procedure was completed successfully, and no complications were reported.

To improve the results of surgical repair of refractory chylous ascites in a subset of patients, intranodal methylene blue injection can be a beneficial technique for pinpointing the source of leakage.

Mandibular Intraosseous Lipoma – Rare and Confusing Lesion

Shareef Araidy, Michael V. Joachim, Ibrahim Shajrawi, Imad Abu El-Naaj

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 159-168

Background: Lipomas can occur anywhere on the body and can be clinically mistaken for other soft tissue lumps. The head and neck are uncommon places for them to occur. Lipomas may undergo varying degrees of involution, with areas of fat necrosis, cyst formation and dystrophic calcification . The most common form of treatment for lipomas is surgical removal, while other options for the condition include liposuction and steroid injections.

 This chapter aims to present our experience in intraosseous lipoma and review the literature related to it.

Case Report: A 38-year-old woman who was initially referred by her dentist because of myofascial pain is detailed in the current study. A mass that was discovered by chance (8*5mm) was successfully removed and identified as an intraosseous lipoma. Excellent painless outcomes and no functional or neurological impairment were caused by the procedure. Both clinically and radiographically, the tumor showed involvement of the inferior alveolar canal. Such unusual tumor traits have never before been documented, disproving earlier hypotheses on the causes of this uncommon malignancy.

Conclusion: According to the current case description, this tumor is a real primary benign neoplasm with a definite origin.

Preventing Health Care Provision Errors: Medical Ethics and Clinical Documentation

Geneva M. Edwards

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 169-181

The concept of the standard of care is often discussed among healthcare providers, and yet, not understood by many. Healthcare providers are held to a higher standard than the general members of the public. This higher standard affects both their clinical and personal lifestyle when they are not at work. The field of legal medicine covers a wide range of topics related to law, medicine, ethics, human rights, and individual rights. This area of expertise is required in the healthcare industry because it is the responsibility of healthcare professionals to always act in the best interests of their patients.  If healthcare professions fail to meet this duty they can and will be charged in a court of law. Medical malpractice is defined as the legal cause of action that arises when a healthcare professional fails to uphold the standard of care in their field, harming a patient in the process. This can happen when a patient suffers harm as a result of a healthcare professional's negligence. Negligence is a common medical malpractice claim, involving inappropriate, unqualified, or sub-standard care provision of a patient by a physician, dentist, nurse, pharmacist, or other healthcare professional. When a healthcare provider does not meet the standard of care, they have breached their contract with their patient.

Carelessness is a by-product produced of providers who do not take the time or have enough time to perform their necessary duties in healthcare provision. There are a few sure ways providers can be successful in avoiding mishaps of healthcare provision. The best research and clinical expertise must be reviewed by a large number of healthcare professionals in order to help them meet patients' needs beyond the scope of optimal care delivery and help them avoid any mishaps along the way.  This chapter has only touched the surface in preventing mishaps in healthcare provision. More research in depth is required to help us understand how to deal with inadequacies when caring for patients.

Management of Cecocutaneous Fistula Following Appendicectomy by Laparoscopic/Minimally Invasive Approach

Himanshu Shekhar, Prasanna Kumar Reddy, Raghavendra , T. G. Balachandar

New Advances in Medicine and Medical Science Vol. 2, 23 May 2023, Page 182-188

The management of appendicitis with appendicectomy is very common in surgical practice. A very rare and recognized complication of appendicitis and appendicectomy is the formation of an enterocutaneous fistula. The management of enterocutaneous fistula varies depending on the output of the fistula, its location, the severity of the disease and the patient's characteristics etc. They can be managed conservatively or surgically. Traditional surgical management requires laparotomy with bowel resection and anastomosis. Here, we describe a 43-year-old gentleman who had cecocutaneous fistula on the background of an earlier open appendectomy. He had laparoscopic fistula excision with stapler wedge resection of the affected bowel. With advances in minimal invasive surgery, laparoscopic approach is preferred option nowadays due to early recovery and decreased morbidity. With this paper we also reviewed the management of enterocutaneous fistula.