Editor(s)

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

ISBN 978-93-91882-56-3 (Print)
ISBN 978-93-91882-63-1 (eBook)
DOI: 10.9734/bpi/nfmmr/v15

This book covers key areas of medicine and medical research. The contributions by the authors include trauma, injury severity score, new injury severity score, revised trauma score, trauma and injury severity score, prognosis, anterior crossbite, acrylic bite blocks, Caesarean section, postpartum hemorrhage, tissue abnormality, erythrocytes, sickle cell, osmolality, hemolysis, hemoglobin, glycophorin A, clinical findings, CNS activities, traumatic brain injury, stroke, cytotoxic brain tissue edema, proteins, adult brain injury, mesenteric vein thrombosis, AMI: acute mesenteric ischaemia, short case series, blood coagulation disorders, thrombectomy, thrombolysis, plasma exeresis, fillers, complication, pediatric age group, South India, eczemas, atopic dermatitis, psoriasis, COVID-19, paternal age, chromosomal aneuploidies, risk calculation, anterior cruciate ligament, adolescent, ligamentous tear, obesity, insulin resistance, comorbidities, type 2 diabetes, thyroid gland, fasting insulin, low carbohydrate diet, vitamin D, physical exercise, laser dental education, curriculum guidelines for laser education, laser turbulence, laser penetration, mechanisms of laser turbulence tissue interaction, septic shock, ureteroscopic stone removal, gram negative bacilli, microRNA, oncomiR, epigenetic modifications, miRNA processing, sequence variations, ceRNA, miRNA replacement therapy, liastolic dysfunction, atrial fibrillation, cardiac disease. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical research.

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### Chapters

##### Outcome Prediction in Elderly Trauma victims Based on Anatomical (ISS, NISS), Physiological (RTS) and Combined (TRISS) Trauma Scoring Systems

Krishna Moorthy

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 1-14
https://doi.org/10.9734/bpi/nfmmr/v15/4428F

Objectives: The accuracy of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in predicting mortality in cases of geriatric trauma is investigated in this study.

Design: The study was designed as a prospective observational study.

Materials and Methods: This was a prospective observational study of 200 elderly trauma patients admitted to a tertiary care hospital over an 18-month period. Data were collected from each patient on the day of admission in order to compute the ISS, NISS, RTS, and TRISS.

Results: The average age of the patients was 66.35 years. The most common mechanism of injury (94.0 percent) was a traffic accident, with a mortality rate of 17.0 percent. The predictive accuracies of the ISS, NISS, RTS, and TRISS for mortality prediction were compared using receiver operator characteristic (ROC) curves.  The Best cut-off points for predicting mortality in elderly trauma patient using TRISS system was a score of 91.6 (sensitivity 97%, specificity of 88%, area under ROC curve 0.972), similarly cut-off point under the NISS was score of 17(91%, 93%, 0.970); for ISS best cut-off point was at 15(91%, 89%, 0.963) and for RTS it was 7.108(97%,80%,0.947). There were statistical differences among ISS, NISS, RTS and TRISS in terms of area under the ROC curve (p <0.0001).

Conclusion: When compared to the ISS, NISS, and RTS, TRISS was the strongest predictor of mortality in elderly trauma patients.

##### Crossbite Treatment in Orthodontics – An Overview

Siddhartha Kaustav Konwar

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 15-19
https://doi.org/10.9734/bpi/nfmmr/v15/4224F

Anterior crossbite is an abnormal labiolingual relation in which the maxillary anterior or posterior teeth are locked behind the mandibular teeth causing malocclusion. It occurs in approximately 4–23 % of young children and may lead to mandibular and facial asymmetry. Therefore, early intervention is often necessary to create conditions for normal occlusal and facial development. Early orthodontic treatment would be beneficial to enhance skeletal and dental development, and correct deleterious habits such as digit sucking. Incorrect function and malocclusion in the early stages, especially transverse discrepancies, may lead to temporomandibular joint problems or facial asymmetry. Many treatment modalities are present to correct crossbite of which one simple method is described.

##### The Impact of Increasing Caesarean Section on Postpartum Hemorrhage in a Developing Nation: An Observational Approach

Shikha Madan, Neetu Sangwan, Smiti Nanda, Savita Singhal

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 20-27
https://doi.org/10.9734/bpi/nfmmr/v15/11422D

The study was undertaken to determine the impact of increase of caesarean section on postpartum hemorrhage in a developing nation. According to the WHO, PPH affects approximately 5% of all women who give birth. It is not only associated with nearly one quarter of all maternal deaths but also the leading cause of maternal mortality in low income countries [1]. The mortality rate of PPH is highest due to atonic uterus, most commonly in multiparous patients, however the mortality rates in patients with previous caesarean section complications with PPH cannot be ignored. These results strongly suggest the need of active management of atonic uterus and a contemplative decision of caesarean sections. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality.

##### Determining the Osmolality Threshold for Sickle Cell Erythrocyte Hemolysis

Victoria M. Richardson, M. T. Kay Woollen, William A. Anong

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 28-35
https://doi.org/10.9734/bpi/nfmmr/v15/1902C

Background: Fluid intake is critical for metabolic and physiological processes to function properly in a homeostatic environment. When compared to other cells, normal red cells are more resilient to fluctuations in serum osmolality, remaining intact when serum osmolality drops to as low as 190 mOsM from the 270-290 mOsM reference interval. The ability of the membrane to deform/reform under shear confers strong resistance to variations in serum osmolality to red cells. Although normal red cells are resilient, the osmolality threshold for hemolysis of abnormal red cells such as sickle cell blood remains unclear. The major goal of this research was to identify the osmolality threshold for sickle cell hemolysis in comparison to normal red cells.

Methods: Red cells were prepared and subjected to a solution of varied osmolality ranging from 290 to 65 mOsm of sodium chloride, as stated in the procedures section.

Following incubation, the supernatant and pellets were examined using western blotting techniques for haemoglobin (spectrometry) and glycophorin A (GPA) concentration.

Results: While normal red cells have an osmolality threshold of 190 mOsM, sickle erythrocytes have an osmolality threshold of 170-mOsM. Both cells ruptured rapidly -displaying an S-shaped-like “cooperativity” pattern. Complete (100%) hemolysis occurred at $$\le$$150-mOsM. The hemoglobin retained in pellets decreased to ~50% (normal red cells) and ~20% (sickle red cells) when solution osmolality drops to 65-mOsM.

Conclusion: Sickle cell erythrocytes are more resilient than normal red cells to serum osmolality changes. This research sheds light on how normal and sickle cell people react to variations in serum osmolality during dehydration and rehydration. Intravenous fluids are routinely used as adjuvant therapy to relieve pain and slow or reverse the sickling process. As a result, regulating electrolytes and fluid volume during acute pain episodes could help African Americans, who are disproportionately affected by sickle cell disease.

##### A Brief Study about Handedness in Writing

Sayee Rajangam, N. Leelavathy, R. N. Kulkarni

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 36-45
https://doi.org/10.9734/bpi/nfmmr/v15/3925F

Handedness is the preference of the hand during the process of writing. The aim and objective of the study is to report the information gathered from 160 1st year medical students. 13 were left- handed and the rest right handed. Among the males 7 were left- handed and 41 were right- handed. Among the female 6 were left and 102 right handed. Handedness was natural in its occurrence on the left in 85% and on the right in 98%. Main features: Left handers: Parental influence: 2, familial left handedness: 10, moderate body build: 12,  preference to learn by language and picture: 8, single and or multitask activities: 7, processing the information in 4 ways: analysis, linear, synthesis and visual: 8; Right handers: Parental influence: 3, familial left handedness: 31, moderate body build: 109, preference to learn by language and picture: 69, single task activity: 55, processing the information in 4 ways: 55;  Left male: learn by language and picture: 5, single and multitask activity: 4, processing the information by 4 ways: 6; Right male:  learn by language and picture: 21, preference to single and multitask activity: 15, processing the information by 4 ways: 16; Left female: learn by language and picture: 3,   preference to single and multitask activity: 4, processing the information by 4 ways: 2; Right female: learn by language and picture: 48, preference of one task activity: 41, processing the information by 4 ways: 37. Even though a pilot study, the significant finding of the study was handedness was natural.

##### Study on White Shark Protein Metabolism Model to Improve the Outcome of Cytotoxic Brain Tissue Edema and Cognitive Deficiency after Traumatic Brain Injury and Stroke

Hans von Holst, Pasi Purhonen, Daniel Lanner, Ramakrishnan Balakrishnan Kumar, Hans Hebert

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 46-57
https://doi.org/10.9734/bpi/nfmmr/v15/4002F

Increased intracellular water content defined as cytotoxic brain tissue edema is a serious secondary clinical complication to traumatic brain injury (TBI) and stroke and without knowledge to the etiology. Recently a hypothesis to the nervous tissue edema was presented suggesting that external dynamic and internal mechanical static impact forces caused protein unfolding resulting in an increased brain tissue water content. The hypothesis was confirmed by computer simulation tests. In this laboratory study we further evaluated the hypothesis by using the mature protein laminin LN521 upon the effects of both dynamic as well as static impact forces, respectively. Laminin was chosen as a representative protein due to it´s general and abundance presence in the cells. The treated laminin solutions were then analyzed with denatured electrophoresis and Electron Microscopy showing aggregation and fragmentation of the laminin structures. The present results confirm earlier hypothesis and computer simulation suggesting for the first time that dynamic impact force in an accident and increased mechanical static force in stroke unfold mature proteins having the potential to increase the intracellular water content defined as cytotoxic brain tissue edema. The clinical condition resembles the phenomenon when elasmobranchs including white sharks prevent their cells from too high hydrostatic pressure in the deep sea. Thus, the present laboratory study results and knowledge from marine physics may be considered to improve the clinical treatment and outcome of TBI and stroke patients.

##### Role of Proteins as New Molecular Markers for Analyzing Material Structures to Prevent Traumatic Brain Injuries

Hans von Holst, Pasi Purhonen, Daniel Lanner, Ramakrishnan Balakrishnan Kumar, Hans Hebert

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 58-67
https://doi.org/10.9734/bpi/nfmmr/v15/4003F

Development of new products for the prevention of traumatic brain injuries are mostly based on mechanical investigations. However, there is a demand for new and more sophisticated analyzes focusing on molecular levels to improve protective equipment. Recently we evaluated the mature protein laminin LN521 to find out the consequences to dynamic and semi-static impact and found substantial fragmentation and aggregation of the laminin structures. The objective in the present study was to analyze the effect of polymer materials to prevent the cell membrane protein Laminin from being denatured and, hence, reducing impacts to the head evaluated by using two different mechanical methods, denatured electrophoresis and electron microscopy. Thus, following dynamic impacts without and with the polymer materials the results showed a significant reduction of the force as well as the translational acceleration with up to over 50%. Also, in the present laboratory investigation the mature laminin was used following dynamic impact to find out if this molecule can serve as a complementary analyzer to mechanical methods when searching for optimal protective materials. The results showed that the polymer materials had the capacity to save the laminin structures from both fragmentation and aggregation as evaluated with denatured electrophoresis and electron microscopy. Therefore, proteins may complement today's calculation simulations and mechanical investigations in the search for improved protective systems to the skull bone and brain tissue. The present result shows that laminin structures may become a valuable method to further identify new structures on a molecular level in the search for improved protective materials to the brain tissue at physical exercise and at accidents.

##### A Retrospective Study on Mesenteric Venous Thrombosis in a Referral Hospital in East Africa

Richard Wismayer

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 68-78
https://doi.org/10.9734/bpi/nfmmr/v15/4369F

Introduction: Acute mesenteric venous thrombosis is a rare condition with the most common site of thrombosis development being the superior mesenteric vein. Patients predisposed to this condition tend to develop a disruption to Virchow’s triad of endothelial injury, stasis and hypercoagulability. In the acute form the presentation is with bowel ischaemia and so a diagnosis before bowel gangrene develops remains a challenge. The limited experience with this condition in the East African region shows that a delayed diagnosis due to limited investigative capacity results in patients’ experiencing acute renal failure and a high mortality. Therefore the objective of this paper was to describe the presentation and management of four patients with mesenteric venous thrombosis in a Referral Hospital in East Africa, followed by a review on the aetiology, clinical features and management of this condition.

Methods: A descriptive retrospective review of four patients over an 18-month period. Demographic and clinical data was extracted from the patients’ clinical files and manual analysis using a spreadsheet was performed.

Results: Over an 18-month period, four patients were reported. All patients had a delay in diagnosis with acute symptoms persisting for 5 days up to 21 days. Two patients died within 30-days post-operatively of complications which included short bowel syndrome and acute kidney failure. Two patients survived developing complications from short bowel syndrome and another the complications of acute kidney injury requiring haemodialysis.

Conclusions: A delay in diagnosis of acute MVT characterises this short case series. This resulted in all cases presenting with gangrenous bowel and hence the high mortality. Venous clot propagation is prevented with anticoagulation which is associated with decreased mortality and recurrence. Thrombolysis and thrombectomy should be considered in certain circumstances to prevent bowel of questionable viability. In the last four decades the mortality from MVT has decreased and currently stands at 10-20% however there is no sufficient literature in East Africa to make this judgement.

##### Case Report: The Correction of Post Filler Complication on the Lips (Old Granulomas) with Plasma Exeresis

Tsioumas, G. Sotirios

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 79-83
https://doi.org/10.9734/bpi/nfmmr/v15/11058D

The purpose of this article is to inform the medical audience about the treatment of difficult cases by implementing the Plasma Exeresis method. With the particular device of Plasma Exeresis the fourth state of matters, Plasma, is produced. In brief, Plasma Exeresis is a certified cordless micro-surgical hand-operated device. According to the histology results, Plasma Exeresis sublimates the epidermis without passing the membrane basal, shrinking the elastic fibers of the dermis, and produces collagen type III without the unwanted skin lesion. In particular, by using Plasma Exeresis with the above mechanism we are able to rectify the fibrosis and granules (and other medical lesions e.g. xanthelasmas, hemangioma, non-invasive blepharoplasty, papilloma, fibroma, benign tumors, etc.). Furthermore, it accelerates the damage repair, the wrinkles softening and the skin fibers regeneration. The case study discussed below can be characterized for its hard and challenging nature, bearing in mind that the damage was extensive. The patient was a woman, 55 years old, who had undergone an unsuccessful treatment in the past. The case takes place in Greece. The culprit was the application of lip fillers consisted of an unknown material. The adverse effects (granules) (See pictures below) were combined with depressive disorder which lasted for approximately 15 years. The granules were considered by many doctors (even plastic surgeons) insurmountable, however, the Plasma Exeresis method was eventually highly effective. Consequently, the Plasma Exeresis can be considered as an innovative method which can heal and restore problematic cases.

Study Objective: The objectives of this study, specifically on the lips, (further investigations have also been made on other aspects of the face), until recently could not be corrected after filler complication, for example nodules. Plasma Exeresis is able to provide a solution to rectify such complications where a solution was not available in the past.

##### Pattern of Dermatoses in Paediatric Age Group at a Tertiary Care Teaching Hospital in South India: An Epidemiological Study

Archana Mavoori, Deepthi Sriram, Sneha Pamar, Sudha Bala

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 84-94
https://doi.org/10.9734/bpi/nfmmr/v15/11235D

Background: Dermatoses in pediatric age group are associated with significant morbidity. Various dermatologic conditions affect children, depending on age, region and socioeconomic status. They are infections and infestations and other non-infective dermatoses like atopic eczema, pigmentary disorders, papulo-squamous disorders, hair disorders, genetic disorders, hemangiomas etc., These patterns of dermatoses varies from place to place due to differences in geography, climate, culture and socio-economic background. Prevalence of pediatric dermatoses in our country are around 9% to 35%. Of late, incidence of these dermatoses is on the rise accounting to 1/3rd of all OPD attendees being children. Epidemiological evaluation for skin disorders forms an important component of primary health care practice for all including children. COVID-19 has varied cutaneous manifestations in children. Various studies have been conducted recently on cutaneous manifestations of COVID 19.

Objective: Objective of this study is to know the pattern, incidence, prevalence, contributing factors and prognosis of dermatoses affecting paediatric age group attending Dermatology OPD of a tertiary care centre in south India.

Materials and Methods: This is a prospective study; various skin disorders were studied in 1360 paediatric patients up to 18 years of age attending the Dermatology OPD of a tertiary care teaching hospital in South India over a period of one year. Demographic data was taken followed by general, systemic and cutaneous examination that is followed by relevant investigations wherever necessary. The findings were recorded in a proforma for analysis and interpretation of data.

Results: There were 762 boys and 598 girls in total 1360 study population. The most common dermatoses were eczematous eruptions and dermatitis (22.57%), infections and infestations (20.8%), infestations (18.96%), hypersensitivity disorders (6.91%), papulo-squamous (1.61%) and pigmentary disorders (2.94%).  Acne was seen in 5.28% of children followed by urticaria (3.67%) Acne was seen in 10.44% and hair disorders in 2.21%. The study showed no statistical differences between sex and age.

Conclusion: This study conducted on epidemiological and clinical patterns emphasizes the need on training the physicians on management of common paediatric dermatoses for early treatment. The study of the epidemiological profile makes the diagnosis of paediatric dermatoses easy resulting in early identification and prevention. The huge numbers of paediatric dermatoses emphasize the need of recognising them as a health emergency in the community and awareness programmes may be conducted area wise to prevent them or to treat them appropriately.

##### Study about Paternal Age: an approach towards Considerable Confounding Risk Factor in Chromosomal Aneuploidies

Sayee Rajangam, Leelavathy Nanjappa, C. Lalitha

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 95-99
https://doi.org/10.9734/bpi/nfmmr/v15/3926F

The chromosomal aneuploidies associated with advanced  maternal age has been widely discussed  and debated over decades. The paternal age effect associated with aneuploidies was underreported with limited evidence which left room for analysis and discussion. The researchers in a retrospective study, observed the paternal age of three chromosomal aneuploidies from the Indian population. The paternal age was included in the patient data with confirmed karyotype. The paternal age was divided  into two groups: <30 years  and  >30 years. With the help of Linear regression analysis the correlation of paternal age with children born with aneuploidies was analysed. The researchers made an interesting observation: paternal age was statistically significant as a confounding risk factor in chromosomal aneuploidy in both age categories for Down and Turner syndrome. These findings highlighted the importance of taking a strategic approach to the treatment of couples who are at risk of cytogenetic abnormalities.  The correlation of chromosomal aneuploidies and the effect of young paternal age is an interesting factor raised and opened for further investigation and discussion to the future investigators.

##### Study on MRI Spectrum of ACL Tears in Pediatric Age Group: A Case Series

Shashi Sharma, Bharat Bhushan Sharma, Naresh Chander Arora, Manav Sethi, Neeru Kapur, Monu Sarin

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 100-111
https://doi.org/10.9734/bpi/nfmmr/v15/13029D

Background: Due to high outdoor activities, anterior cruciate ligament (ACL) injuries are common among adolescents. These ligamentous tears of knee are always associated with other injuries. We showed the range of injuries that we see in the pediatrics adolescent population. Various knee injuries, such as meniscal tears and bone marrow oedema, are not picked up by routine radiography. Magnetic resonance imaging (MRI) is critical in the development of this spectrum.

Methods: Five male patients aged 13 to 18 years (average age 15 years) who had various types of knee trauma, had undergone knee MRI scans and were evaluated for a variety of ACL tears and associated manifestations. The ACL, the menisco-femoral connection, or the medial collateral ligaments could all be involved in a focal injury. Bony avulsion fractures are also common in children due to their immature skeleton. According to the description of the specific injury, the study plays a significant role in management. Patients with a history of past knee injury or disease were excluded from the study.

Results: The majority of the patients were in pediatric adolescent group (average age 15 years). Left knee was injured in 60% as compared to right knee in 40% of the cases. Meniscal tears were involved in 20% cases but were 40% among those who were having bony injury. These were picked up only in MRI study while plain skiagram was normal. In 40% of the cases, the posterior cruciate ligament (PCL) was implicated.

Conclusion: In paediatric and adolescent children, ACL tears and accompanying injuries have a different spectrum and should not be diagnosed or treated in the same way as in adult cases. Because of epiphyseal nonunion in this age range, MRI assessment plays a critical role in the description of such traumatic injuries.

##### A Review on the Management of Insulin Resistance

E. Govers, E. Slof, H. Verkoelen, N. M. Ten Hoor-Aukema

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 112-128
https://doi.org/10.9734/bpi/nfmmr/v15/3475F

Introduction: the successes of interventions to obtain weight loss and prevent relapse are limited. Moreover, comorbidities like type2 diabetes mellitus, hypertension, hypercholesterolemia, hypertrigly-ceridemia and gout, have so far been treated as separate diseases, although mounting evidence shows that these morbidities are consequences of the failing metabolism due to insulin resistance.

Objectives: to build evidence that weight loss, by treating obesity, improves comorbidities and improves quality of life.

Results: treatment of obesity and its comorbidities is a multidisciplinary matter. It can be done in primary care. It should be widely recognized that a low carbohydrate diet and exercise are the two main aspects of treatment that lead to the desired result: considerable weight loss and diminishment of comorbidities, visible through improvement of blood parameters and improved quality of life. Because of the complexity of the diet a large role in management is fit for dietitians, supported by psychologists, physiotherapists and exercise trainers. Family physicians and nurse practioners need to be aware of the important role diet and lifestyle play. In insulin resistance medication is not the preferred treatment, it should be avoided as much as possible.

Conclusions: by diagnosing and treating insulin resistance in primary care, health professionals can change the prevalence and consequences of obesity and its comorbidities, thus reducing health care costs considerably. IR is best diagnosed by measuring fasting insulin levels. Measuring waist circumference and calculating BMI are additional instruments. Management should focus on weight loss through a low carbohydrate diet, with sufficient fat, protein, vitamins and minerals. Exercise is an essential part of management and relapse prevention. Persons that are insulin resistant may regain their health through these measures. They will always stay insulin resistant to a certain extent, and cannot eat normal quantities of carbohydrates that are commonly used and advised in general dietary guidelines.

##### Application of Turbulence Laser Medicine (TLM) in Dental Practice - A Novel Laser Education, Relevant for the Clinical Outcome

Julia Emilova Kamenoff

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 129-167
https://doi.org/10.9734/bpi/nfmmr/v15/4132F

Turbulence Laser medicine (TLM) is a non-invasive photodynamic therapy, which is characterized by a turbulent acceleration of the photobiomodulation in the human body, thus achieving excellent healing effect for short periods of time. The author is presented a new approach for Laser Dental Education based on Biological Medicine principles. The new educational program involves knowledge about laser biostimulation, photoinfrared photobiomodulation, Laser Eliminating Therapy as Allergy and Environmental Medicine, Immunological Allergies, Autonomic nervous System Hypersensitivity Allergy and alternative methods of Combined Laser Treatment. This new approach of teaching show how to build Model of Individual Optimum Laser Stimulation and require education on four level: First level – laser biostimulation and biomodulation, Second level – Healing effect of Infrared Laser beam, clinical application. Next third level involves skills on Laser acupuncture and Combined Laser Biosynergetics. The higher level of laser education gives information about Turbulence Laser Medicine clinical application. All levels of Laser training require workshops with different types of Dental laser machines. This new approach of education has been approbated in Department of Prosthodontics, Laser Educational center for post graduated education at Faculty of Dental Medicine, Medical University, Sofia. Results after the laser education show a great effectiveness.

Material and Methods:   During the last six years we have been completed  well controlled clinical trials based on the criteria of the American Academy of orofacial pain.  The study over the 600 patients (300 women and 300 men), mean age of 47 years was developed. Patients have been selected on the main clinical sign of TMJ pain and were divided into four main groups according to the type of PDT method .  Based on the action spectra, various wavelengths have been used for TMJ Photodynamic Therapy. Constant  dose and time of exposition, as well as various  range of frequencies have been applied.  In this way the Laser biostimulation response has been directly proportional to the total energy dose, depending of light intensity. Physiological and clinical effects of the followed “ active regions”– 660 – 680, 760 – 780, 810 – 830 and 904 – 987 nm have been valued by method of comparative analysis.

Methods Applied: LLLT - TENS - red surface laser acupuncture (LA), PIPBM – LA, Laser bioenergetics approach, Complex therapeutic program (CTP).

Results: evaluation will be demonstrated by comparative digital ortopantomograph analysis, EEG brain maps, VAS, a metric analysis of the level of the maximum active Mdndible opening and  EPST through electrophysiological signal evaluation of the patient’s body.

##### Emergency Management of Unexpected Life-Threatening Septic Shock in a Patient Undergoing Ureteroscopic Stone Removal: A Case Report

Nihar Ranjan Tripathy, Sabyasachi Tripathy

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 168-172
https://doi.org/10.9734/bpi/nfmmr/v15/1749F

We present a case of life-threatening septic shock undergoing ureteroscopic stone removal in the operation theatre just after the surgery. Patient was symptomatically diagnosed on the operation table and intensively managed to stabilize quickly without wasting time and later it was confirmed by investigations that it was a septic shock resulted due to Gram negative bacilli E. coli. There have been very few cases reported in the literature.

##### miRNA and Cancer

Susinjan Bhattacharya

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 173-184
https://doi.org/10.9734/bpi/nfmmr/v15/12373D

The microRNAs are small non coding RNA which plays important role in gene regulation. Problems in miRNA biogenesis can lead to translational repression and even cancer. MicroRNAs can either act as oncogenes or as tumour suppressors. There are many factors that regulate the function of microRNAs. A network of oncogene– miRNA– Tumor Suppressor Gene (TSG) affects not only the normal cellular process but also can lead to tumourigenesis. Thus understanding the regulatory factors and the network can help to revisit the discovery process of therapeutic targets in cancer.

##### Study on Left Ventricular Diastolic Dysfunction in Atrial Fibrillation Patients without Structural Cardiac Disease

Iosif Marincu, Iulia Vidican, Valentina Elena Avram, Madalina Timircan, Oana Suciu

New Frontiers in Medicine and Medical Research Vol. 15, 6 September 2021, Page 185-194
https://doi.org/10.9734/bpi/nfmmr/v15/13003D

Background: Hypertension and left ventricular hypertrophy (LVH) are most important contributors to left ventricular diastolic dysfunction (DD), left atrial remodeling and atrial fibrillation.

Objectives: The primary goal is to compare left atrial (LA) remodelling and left ventricular DD in patients with or without paroxysmal atrial fibrillation (PAF) and with or without essential hypertension (HTN).

Materials and Method: The study comprised 128 patients with normal left ventricular systolic function (LVEF$$\ge$$50%). They were divided into two groups based on the presence or absence of essential hypertension.  The normotensive individuals (n=65) were split into two groups: PAF (n=32) and control no-PAF (n=33).The hypertensive individuals were further split into two groups: PAF (n=32) and control no-PAF (n=31).

The patients in the control group were chosen to match the PAF groups in terms of gender, age, and weight. Resting 12 lead ECG, 24 hour Holter ECG monitoring, 24 hour blood pressure monitoring, and 2D Doppler echocardiography were used to evaluate the patients. The follow-up was done every six months for three years. The MedCalc 12.3.0.0 statistical software for Windows was used for the statistical analysis.

When the p-value was less than 0.05, the results were considered statistically significant.

Results and Conclusion: PAF patients have larger LA diameters. HTN causes an increase in supplemental LA.The number of PAF episodes has no effect on LA diameters. The gender of the patients has little effect on the statistical data, with larger diameters in PAF and HTN patients.