Dr. Suprakash Chaudhury
Department of Psychiatry, Dr. D.Y. Patil Medical College Hospital & Research Center, Pune, India.

ISBN 978-93-91595-50-0 (Print)
ISBN 978-93-91595-58-6 (eBook)
DOI: 10.9734/bpi/nfmmr/v4

This book covers key areas of medicine and medical research. The contributions by the authors include echocardiography, pregnancy, heart disease, maternal mortality, practice management, successful dental practice, ermatoglyphics, Turner's syndrome, finger prints, Ulnar loops, fetal maturity, gestational age, histometry, means epidermal thickness, pleural effusion, ovarian cancer, Meigs’ syndrome, hydrothorax, dengue hemorrhagic fever, pregnancy, thrombosis, corneal opacity, disposable sleeves, microbial load, microorganisms, luminal endothelial membrane, g-protein coupled receptors, metalloproteases, luminal endothelial solutes exclusion zone, coronary artery disease, cardiology, atherosclerosis, arteriosclerosis, free radicals, non-pathogenic bacteria, meropenem, amoebic liver abscess, children, liver abscess, pyogenic liver abscess, coagulopathy, morbidity, magnetic resonance imaging, adherent placenta, Nitabuch’s layer, Placental villi, haemorrhage, fertile period, fertile window, fertility-awareness, infertility, blood transfusion, national blood policy, drugs and cosmetics act, blood donors, blood and blood components, breast feeding, satisfaction, infant satisfaction, blifestyle and maternal body image, hamartoma, mammary, pseudocapsule, elastosonography, COVID-19 pandemic, corona ‘Solidarity’ trial, severe acute respiratory syndrome, freyer’s suprapubic trans-vesicle prostatectomy, Foley’s balloon pressure traction, blood loss, drug metabolism, glutathione S-transferase, human immunodeficiency virus, genetic variants. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical research.


Media Promotion:


Recent Study of Screening Echocardiography in Asymptomatic Pregnant Women

T. Gomathi, V. Thendral

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 1-7

Introduction: Heart disease is more prevalent in women of childbearing age. In unbooked and newly diagnosed heart disease complicating pregnancy, heart disease is the leading cause of maternal mortality and morbidity. The signs and symptoms of pregnancy may confuse with the signs and symptoms of heart disease.  Over the last decade, the utility of echocardiography as an imaging technique has increased significantly. The echocardiogram is the gold standard and definite diagnostic tool for diagnosing heart disease. Our goal is to use screening echocardiography to detect heart disease in asymptomatic pregnant women.

Materials and Methods: This study included 300 pregnant women in all trimesters of their pregnancy. The study period at Government Kilpauk Medical College runs from October 2016 to January 2017. Those with a history of heart disease were barred from participating. All patients underwent conventional M mode, 2D, and Doppler echocardiography.

Results: Out of 300 study population 65% (n-195), 23% (n-69)and 12% (n- 36) patients were in first, second and third trimester respectively. We found that 6.3% (n-19) of patients had either congenital or acquired heart disease. Among this, acquired heart disease burden is about 63% (n-12) and congenital heart disease is 37% (n-7). In congenital heart disease, Mitral valve prolapse 42.8% (n-3) atrial septal defect 28.5% (n-2), valvular pulmonary stenosis 14.2% (n-1) and coarctation of aorta 14.2% (n-1) were diagnosed. In acquired heart disease rheumatic heart disease found in all patients (100% (n-12). Among the Rheumatic etiology isolated stenotic lesion in 50% (n-6,) isolated regurgitant lesion in 33.3% (n-4) and combined lesion in 16.6% (n-2) were identified in the study population.

Conclusion: According to our findings, screening echocardiography will undoubtedly aid in the detection of heart disease and the reduction of heart disease-related mortality. Even in the absence of cardiopulmonary symptoms, this will justify routine cardiac evaluation.

Recent Study on Strategic Planning of a Dental Clinic in India

Shalu Jain

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 8-13

One is usually conflicted between pursuing a career in academia or starting their own practise after completing undergraduate or postgraduate degrees. Due to the fact that finding a job in the dental industry is extremely tough in today's market, the best option left is to create one's own business. Despite the fact that it appears to be a simple activity, it is not. It covers all of the necessary stages and obstacles to starting a successful dentistry practise in India. The majority of research on practise management is available in the literature, but there is relatively little published information on how to start and grow a dental practise. As a result, every new dentist should be knowledgeable of all the important details that must be followed strategically step by step while starting a dental practice.

Recent Study on Dermatoglyphic Ulnar Loops in Turner’s Syndrome

Aruna Y. Yadav, Supriya P. Satpute, Swati More

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 14-20

The purpose of this research was to compare the ulnar loops of dermatoglyphics in Turner's syndrome females and control females. The present study used bilateral rolled finger prints and palm prints from 40 Turner's syndrome patients. They were between the ages of 14 and 20. Clinical examination and chromosomal analysis were used to make the diagnosis, and patients with the 45 XO karyotype were chosen. Normal healthy females between the ages of 14 and 20 were chosen as controls. Ulnar loops became more common in the I3 and I4 areas. It is extremely important in this area.

Background: The estimation of fetal epidermal thickness has clinical significance for dermatological investigation and diagnosis of fetal prematurity.

Objective: We aimed to collect baseline data of fetal epidermal thickness and secondarily to study the correlation of gestational age (GA) from epidermal thickness.

Materials and Methods: Thirty fetuses were selected for the study aged from 11 to 40 weeks. They were divided into six groups at a 4-week interval. The mean epidermal thickness was measured at four sites such as the abdomen, interscapular region, scalp, and palm. The histometric analysis was done with the help of amscope 5MP Aptina MT9P001.

Results: The mean age of gestation was 25.67 ± 8.45 weeks. The mean epidermal thickness of the abdominal, interscapular, scalp, and palmar region was 21.9 ± 12.9 µm (3.41–42.48), 111.21 ± 74.39 µm (7.9–214.51), 27.58 ± 13.26 µm (11.7–46.2), and 139.73 ± 96.40 µm (7.3–280.51), respectively. The growth pattern of the epidermis of the different region was significantly variable based on the ANOVA (P = 1.98E-13 P < 0.05 significant) and paired t-test of interregional comparison.

Conclusions: The epidermal thickness has a significant positive correlation with GA and anatomical sites. We emphasize that epidermal thickness is a newborn maturity marker at birth.

A Brief Study on Meigs’ Syndrome

Divya Khanduja, N. C. Kajal

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 30-36

Meigs’ syndrome is an uncommon presentation, where a benign ovarian neoplasia presents along with ascites and pleural effusion. About 1% of ovarian neoplasia can present as Meigs syndrome. As similar presentations can be seen in many metastatic malignancies. Early detection and management of the condition leads to a good prognosis and better survival.

Objectives of study:

  • Identify the etiology of Meigs’ syndrome.
  • Evaluation of Meigs’ syndrome.
  • Management options available for Meigs’ syndrome.

Determination of Dengue in Pregnancy, Maternal and Fetal Outcome: A Case Series from Zonal Hospital in India

Tina Singh, S. M. Singh, M. M. Paprikar

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 37-43

Background: Dengue is a vector borne disease with various grades of severity. Pregnancy is a high-risk group and is prone for complications of dengue haemorrhagic fever.

Aims: The aim of this study was to evaluate the clinical profile of pregnant patients with dengue and to assess the maternal and fetal outcomes of dengue in pregnancy.

Methods: All pregnant patients reporting to the hospital with fever and serologically confirmed dengue infection were included in the study. Clinical and laboratory data of patients were collected. The cases were followed up till their delivery to monitor the effect of dengue. An account of the mode of delivery in these patients was made. The neonates were evaluated and followed up till 6 weeks of life.

Results: A total 100% patients reported with fever and serologically confirmed dengue infection. 15% had severe thrombocytopenia requiring platelet transfusion. 31% required ICU care and 15% needed mechanical respiratory support due to severe complications of dengue. NICU admission rate was 30% but there was no major neonatal complication or vertical transmission noted. A high index of suspicion should be maintained by the clinician with an aim to identify infection early, start supportive treatment and evaluate for complications. In-patient care should be provided for feto-maternal monitoring.

Conclusions: The progression of dengue infection in pregnancy was rapid leading to major complications. Close materno-fetal monitoring and timely obstetric care are essential to ensure a favorable pregnancy outcome.

An Overview on Etiology of Corneal Blindness

K. Kalaivani

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 44-52

Aim: To screen for people with corneal blindness, to identify the etiology and to assess the risk factors for corneal blindness in Puducherry Union Territory.

Materials and Methods: About Fifty patients with corneal opacity and with the visual acuity less than 6/60 clinically, aging between five years to eighty years were enrolled for this study. A detailed history regarding the etiology, nature of injury, pervious corneal disease or ocular surgery was recorded for each patient. External eye examination and slit lamp biomicroscopic examination to assess the size, site and depth of corneal opacity, presence of vascularization or ghost vessels and the anterior segment pathology was performed. Visual acuity was recorded using the Snellen’s chart and intra ocular pressure was measured with applanation tonometer.

Results: Mean age of the study population was forty two years; Twenty seven patients were male and remaining twenty three were female; Seventeen people had bilateral involvement, nineteen had right eye and fourteen had only left eye involvement. Study population includes farmers, laborers, students, housewives, mason and others. Twenty one patients were found to have infective etiology; fourteen had injury, rest had postsurgical, nutritional and degenerative causes.

Conclusion: Infective keratitis is the leading cause of corneal blindness in this study, trauma being the next cause. Occupation is an important risk factor. Health awareness and safety measures can help to reduce the incidence of corneal blindness.

A Protective Barrier in Dental Clinics: Disposable Mobile Sleeves

Sanchi Gupta, Manisha Lakhanpal Sharma, Vandana Srivastava, Manu Dhillon

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 53-57

Aim: To evaluate the presence of microorganisms on mobiles phones in dental clinics, as a possible nidus for infection and to suggest the use of disposable sleeves to reduce the level of microorganisms in the dental clinics.

Materials and Methods: An observational study was conducted, on two groups, study group (group I) and control group (group II), having 25 mobile phones. Before entering the dental clinics, the mobiles phones were cleaned with an alcohol based disinfectant under aseptic conditions. Then, the mobile phones in group I were covered with an autoclaved disposable sleeve having a chemical indicator and group II were left uncovered. After five hours, swabs were obtained from the surfaces of mobile phones of both group I and group II. The swabs were cultured and incubated on blood agar for twenty four hours and evaluated for their microbial load.

Results: The sample taken from the sleeve showed growth of microorganisms whereas, there was no growth on mobile surface of group I. On the contrary, the mobile surface of group II showed significant microbial load.

Conclusion: Mobile phones can act as a fomite in dental setup and the use of disposable sleeves can effectively curtail any cross contamination of microorganisms, thereby, serving as a protective barrier. Therefore, these sleeves act as yet another protective barrier in dental clinics. a simple, economical and easily procurable mobile sleeve can make a pertinent difference in the clinics.

Study on Cardiac Ischemia and Ischemia/Reperfusion Cause Wide Proteolysis of the Coronary Endothelial Luminal Membrane: An Approach to Possible Dysfunctions

Blanca Arroyo-Flores, Erika Chi-Ahumada, Erika Briones-Cerecero, Alma Barajas-Espinosa, Sandra Perez-Aguilar, Ana Barba de la Rosa, Maureen Knabb, Rafael Rubio

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 58-69

Background: Ischemia and ischemia-reperfusion (I/R) are common clinical insults that disrupt the molecular structure of coronary vascular endothelial luminal membrane (VELM) that result in diverse microvasculature dysfunctions. However, the knowledge of the associated biochemical changes is meager. We hypothesized that ischemia and I/R-induced structural and functional VELM alterations result from biochemical changes. First, these changes need to be described and later the mechanisms behind be identified.

Methods: During control conditions, in isolated perfused rat hearts VELM proteins were labeled with biotin. The groups of hearts were: control (C), no flow ischemia (I; 25 min), and I/R (I; 25 min, reperfusion 30 min). The biotinylated luminal endothelial membrane proteins in these three different groups were examined by 2-D electrophoresis and identified. But, it must be kept in mind the proteins were biotin-labeled during control.

Results: A comparative analysis of the protein profiles under the 3 conditions following 2D gel electrophoresis showed differences in the molecular weight distribution such that MWC > MWI > MWI/R. Similar analysis for isoelectric points (pHi) showed a shift toward more acidic pHi under ischemic conditions. Of 100 % proteins identified during control 66% and 88% changed their MW-pHi during ischemia and I/R respectively. Among these lost proteins there were 9 proteins identified as adhesins and G-protein coupled receptors.

General Significance: I and I/R insults alter MW-pHi of most luminal glycocalyx proteins due to the activation of non-specific hydrolyzing mechanisms; suspect metalloproteases and glycanases. This makes necessary the identification of hydrolyzing enzymes responsible of multiple microvascular dysfunctions in order to maintain the integrity of vascular endothelial membrane. VELM must become a target of future therapeutics.

The True Cause of Coronary Artery Disease; Cholesterol is Irrelevant

David Rowland

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 70-75

This report is a synthesis of 22 studies which concludes that coronary artery disease is caused by free radical damage to tumor suppressor genes, which mutation allows cells to proliferate out of control to create benign mini tumors between the endothelium lining and the smooth muscle walls of arteries.  As these tumors grow, they cause tiny tears in the endothelium that are patched with interlacing filaments of fibrin. This rough scar tissue traps minerals (especially calcium), heavy metals, macrophages, and cellular debris. The final smooth layer of cholesterol that is applied over this arterial plaque plays no causal part in its development.  Recent studies indicate that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels which indicate they were not at high risk for a cardiovascular event, according to current national cholesterol guidelines.  Thus, there is no causal relation between serum cholesterol levels and coronary artery disease.  

A Case Report on Group “G” B-Hemolytic Streptococcus, a New Important Causative Organism of Localised Intra-Abdominal Abscess

Shiv Chopra, V. K. Aneja, Raman Sardana, Leena Mehndiratta

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 76-80

Group “G” Streptococcus is an ubiquitous non-pathogenic commensal organism found in the skin, throat, gut, appendix and the female genital tract. As per our review of the available literature we present the first reported case of localized intra-abdominal abscess caused by Group g streptoccoccus (GGS) also seen first time in our institution which is a rare but an important cause when after the requisite Surgical procedure-drainage and antibiotic regimens the post-operative pyrexia/symptoms do not settle down with rising counts then one should start thinking about upgrading the antibiotics to meropenem+ciprofloxacin/vancomycin/teichoplanin along-with the existing anaerobic cover. In our case blood cultures were negative, only the pus culture-liquid subcultures grew large colony gram positive cocci on the 1st postoperative day with further identification as Group G Streptococcus (GGS) with the sensitivity pattern on the 3rd postoperative day identified the organism as large-so a very good microbiology department team is necessary which in our case was instrumental in the management of our patient with a very high index of suspicion. This case is being reported for the reason of its rarity. Especially reported in patients who are diabetics/ malignancies/respiratory infections/immunosuppressed/chronic leg ulcers/pet dogs at home it is gaining importance as an organism for causing deep-seated abscesses in the body especially the abdomen which are usually multiple or as peritonitis. Another important reason mentioned in literature for immediate and urgent drainage of abscess caused by GGS infections is that this may lead to a very serious streptococcal toxic shock syndrome having a very fulminant and rapid downhill course with GGS bacteremia having a high 30 days mortality rate of to 15%.

Management Issues in Paediatric Liver Abscesses

Digamber Chaubey, Anand Pandey, Piyush Kumar, Archika Gupta, Jiledar Rawat, Ashish Wakhlu, Shiv Narain Kureel

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 81-86

Background:  With evidence of increasing incidence, Liver abscesses remain an important cause of morbidity in children. Evaluation of the clinical profile and management outcomes of pediatric liver abscess would guide evidence-based management.

Objectives: To determine how physical characteristics of Paediatric liver abscesses guide intervention and eventual treatment outcome.

Methods: A retrospective, observational, cohort study was conducted on all LA patients managed from February 2011 to August 2016. Data regarding symptoms, possible predisposing factors, method of diagnosis, any interventions, and duration of stay were collected and analyzed. Sonographic characteristics of the lesion guided management in the study.

Results: Thirty two patients with a mean age of 5.52 years were managed during this period. The clinical features were fever (25, 78%), pain in right hypochondrium (19, 59%), abdominal distension (4, 12.5%), subacute intestinal obstruction (2, 6.25%), and peritonitis (2, 6.25%). Three patients experienced abscess rupture. In three patients, conservative treatment was successful. In five individuals with a size of less than 100ml, USG guided needle aspiration was effective. In 21 patients with bigger lesions, pigtail insertion was required. In three individuals, a laparotomy was performed. One patient died as a result of severe sepsis and coagulopathy. All of the other patients were released.

Conclusions: LA is an important cause for morbidity in children. It could lead to rupture and death if it isn't treated. High suspicion, early screening, and proper intervention in form-tailored management may yield positive outcomes.

Wilson’s disease is a worldwide inherent genetic disorder which leads to copper deposition in various tissues. Recently, Wilson’s disease is classified according to onset of symptoms into early-onset and late-onset Wilson. Magnetic resonance imaging of the brain revealed characteristic bilateral putamena and midbrain tegmental T2 hyperintensity “Face of giant Panda” sign which are reliable imaging features of Wilson’s disease. The objective of this chapter was to review the clinical and magnetic resonance brain imaging changes in late-onset Wilson’s disease.

A Review on Placenta Accreta Spectrum (PAS)

Amrita Singh, Sonali Sonam

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 94-103

Placenta accrete spectrum including accrete, increta & percreta can lead to massive hemorrhage resulting in severe morbidity & mortality. The present review has been done to create an awareness about its increasing incidences and management plans at different health strata. For the last three decades it has shown a dramatical rise all over the world. The incidence of placenta accreta spectrum has increased from 1 in 4017 during 1980’s to 1 in 533 from 1982 to 2002.

Background: Infertility is one of the most stressful situations a couple can face.Anxiety, despair, tension, loss of self-esteem, guilt, and grief may be exacerbated by medical procedures in these couples. However, most occurrences of infertility may be related to a physiological cause in the male or woman, according to various research. Previous research has revealed that poor fertility period awareness among couples seeking help at infertility clinics may be a contributing cause of infertility.The real practises and attitudes regarding reproductive awareness in this group of patients are unknown, and they must be investigated.

Aim: The purpose of this paper is to present the findings of a study on fertile period awareness, as well as their knowledge, attitude, and practise among infertile couples seeking fertility treatment. Design: This is a questionnaire-based cross-sectional study. The study lasted six months, from June to December 2017, and involved couples who visited the infertility clinic at Smt Kashibai Navale Medical College and General Hospital in Pune.

Results: A total of 246 out of 280 surveys were administered (response rate =87.8%). In their attempts at conception, 60% of individuals (n=147) believed they had timed intercourse within the fertile window of the menstrual cycle, but only 36% (n=52) could precisely identify this window.

Although 23 percent of the participants in this trial (n=56) had previously received therapy, 50 percent were unaware of the fertile window. Due to various factors, only 15% (n=38) of the 246 couples were actually practising fertile period, and the majority of them were unaware of or did not rely on the notion of fertile period. Almost 94 % of them believed that they should receive fertility-awareness education when they first report trouble in conceiving to their doctor.

Conclusion: Most couples seeking help at infertility clinics were unaware of the fertile window of the menstrual cycle, and only a few were able to precisely identify it, suggesting that a lack of fertility knowledge could be a contributing factor in infertility.

Study on Ethical and Legal Aspects of Blood Transfusion

Parul Garg, Ishwer Tayal

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 110-117

The practice of Transfusion Medicine involves a number of medico legal and ethical issues because blood comes from human beings and is a precious resource with limited shelf life. Legal Guidelines play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical guidelines pave the way for quality services.Objective of this paper is to update doctors with legal and ethical aspects of blood transfusion.

A Hospital Based Study on Perception and Satisfaction Regarding Breast Feeding among Breast Feeding Mothers

Pradeep Tarikere Satyanarayana, P. Vimarshitha, S. R. Sheela, Krithika Raj

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 118-127

Background: As stated by World Health organization (WHO), Breast feeding is an important tool which ensures child health and survival making a special note that nearly 2 out of 3 are not exclusively breast fed and a mere 41 % are exclusively breast fed for 6 months. “The satisfying feeling obtained during breastfeeding resulting from cooperation between the mother and the infant to fulfill desires or needs” is called Breastfeeding satisfaction. The study was started with the objective to assess maternal breast feeding satisfaction and to assess factors influencing maternal breast feeding satisfaction among mothers who are breast feeding in a tertiary care hospital

Methodology: This is a hospital-based study conducted in the Department of Obstetrics & Gynecology, Sri Devaraj Urs Medical College, SDUAHER, Kolar from December 2019 to August 2020 for a period of 9 months. The sample size was determined using data from a previous study.

Results: There were 270 mothers in the study, with 82 (30.3 percent) having completed high school, 110 (40.7 percent) being between the ages of 21 and 25, 184 (68.07 percent) being Hindus, 125 (46.2 percent) belonging to Upper middle class of Modified BG Prasad's classification 2019, 199 (73.6 percent) having delivered by normal delivery, and 142 (52.7 percent) having more than one child. Out of 270 breast feeding mothers, 214(79.3%) has satisfactory knowledge, 148(54.8%) had satisfactory Attitude and only 47(17.4%) had satisfactory practice. Mothers with a higher level of education, having more than one kid, being a stay-at-home mom, and those who gave birth via normal delivery all had statistically significant higher ratings.

Conclusion: Breast feeding satisfactions were influenced by education, working position, the number of children, and family members, and were unsatisfactory in many segments.

Hamartoma of Breast: An Under-Recognised Entity

Sushrut Fulare, Satish Deshmukh, Shriniket Sawarkar

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 128-134

Introduction: Breast hamartoma is an uncommon, benign, slow growing lesion found in all age groups in female patients after puberty. This pathological entity has a reported incidence of 1.2% of benign lesions and 4-8% of benign breast tumors in women. A hamartoma is a benign tumour made of an abnormal mixture of normal tissues and cells from the area in which it grows. Mammary hamartoma is a rare type of breast tumor that is composed of the same elements as normal mammary tissue. This condition is very rare in men.

Conclusion: Breast hamartomas are rare benign lesions that may have rapid growth leading to breast disfigurement and must be addressed vigilantly either by close observation or early intervention. Ultrasound has a significant role in diagnosis whereas the role of fine-needle aspiration is questionable [1].

Study on Chloroquine and Hydroxychloroquine in SARS-Cov-2: Repurposing the old Drugs against Today’s Deadly Disease

Kavita M. Jaiswal, Sujata Dudhgaonkar, Latesh Raghute, Mahek S. Kewalramani, Lohit S. Vaishnao

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 135-143

Introduction: Chloroquine (CQ) and Hydroxychloroquine (HCQ) has received huge momentum as possible treatment for COVID-19. In India the drug is approved for prophylaxis of asymptomatic health workers treating suspected or confirmed COVID-19 cases, and asymptomatic household contacts of confirmed patients. The U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorization (EUA) of HCQ to treat COVID-19.

Materials and Methods: Here we present the database of trials with these compounds in COVID-19.

Discussion: Early 15 registered clinical trials of CQ and HCQ in COVID -19 positive patients in China, showed that the drugs were superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course. Some studies had no positive results including a multinational registry analysis of HCQ with or without a macrolide for treatment of COVID-19 published online in Lancet on 22nd May 2020.The study showed that there was decreased in-hospital survival and an increased frequency of ventricular arrhythmias when HCQ was used for treatment of COVID-19.In the light of this publication the WHO temporarily paused the HCQ arm of its ‘Solidarity’ global clinical trial on 26th May 2020 and trials with HCQ /CQ for COVID were also suspended. The Lancet paper was in controversy until finally on June 4th 2020 the article was retracted by authors.

Conclusions: Until we get results of WHO fast track ‘Solidarity’ clinical trial and other randomized clinical trials repurposing these drugs remains questionable.

The use of Modified Technique in Freyer’s Prostatectomy to Achieve Hemostasis

Swapnil Madankar, Vijay Kanake

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 144-148

Background: The ratio of open surgery to endoscopic resection varies greatly among different countries like India. Despite its reputation as the gold standard, TURP remains out of reach for the great majority of rural residents due to a lack of experience and equipment. Persistent bleeding from the prostate bed is one of the most serious side effects after open prostatectomy. This study aims to establish a strategy for achieving full hemostasis in open prostatectomy by applying traction to the Foley's catheter, compressing the venous plexus and avulsed prostate arteries at the bladder neck with the inflated balloon, and so minimising blood loss.

Methods: Freyer's suprapubic trans-vesicle prostatectomy was used to treat 130 patients of BPH. The bladder mucosa is repositioned beneath the balloon, which is filled with 60 mL of normal saline, and traction is provided to the catheter and maintained for 24-48 hours by strapping the catheter to the patient's thigh.

Results: The average blood loss was 20.9 ml, demonstrating that Foley's balloon pressure traction approach at the bladder neck is effective in attaining hemostasis in open prostatectomy patients.

Conclusions: In almost all of the patients treated, the balloon pressure approach is an efficient way to achieve hemostasis and avoid blood transfusion.

Study on the Role of ABCB1 and Glutathione S-transferase Gene Variants in the Association of Porphyria Cutanea Tarda and Human Immunodeficiency Virus Infection

Priscila Ayelén Pagnotta, Viviana Alicia Melito, Jimena Verónica Lavandera, María Laura Buscalia, Victoria Estela Parera, María Victoria Rossetti, Johanna Romina Zuccoli, Ana Maria Buzaleh

New Frontiers in Medicine and Medical Research Vol. 4, 4 August 2021, Page 149-169

Porphyrias are a group of metabolic disorders due to alterations in heme biosynthesis. Porphyria Cutanea Tarda (PCT) is a hepatic cutaneous Porphyria resulting from an acquired or inherited deficiency of Uroporphyrinogen decarboxylase. Triggering factors are involved in the onset of this disease. In Argentina, PCT is strongly associated to infection with human immunodeficiency virus (HIV); however, whether the onset of this disease is associated with HIV infection and/or the antiretroviral therapy has not been determined. Our investigation was focused to study the involvement of genetic variants in the development of Porphyrias. In this work, the aim was to evaluate the role of ABCB1 and GST genetic variants in the association between PCT and HIV. This article summarized the main reports about the role of drug metabolism in the onset of PCT, in particular those related with cytochrome P-450 gene variants. Moreover, we extensively described our results about the involvement of ABCB1 transporter and Glutathione S-transferases (GSTs) variants in the association PCT-HIV. We centered our investigation on the ABCB1 gene variants: Exon 12 (rs1128503, NM_000927.5: c.1236C>T), exon 21 (rs2032582, NM_000927.5: and c.2677G>T/A) and exon 26 (rs1045642, NM_000927.5: and c.3435C>T), that affect drug efflux. The genotypification of GSTT1 null, GSTM1 null and GSTP1 (rs1695, NM_000852.4: and c.313A>G), gene variants that alter activity, modifying xenobiotics levels was also analyzed. The high frequency of c.3435C>T (PCT and PCT-HIV) and c.1236C>T (PCT) suggested that the onset of PCT was not specifically related to HIV infection or antiretroviral therapy for these variants. c.2677G>T/A frequencies in the PCT-HIV patients were higher compared with the other groups, suggesting that a mechanism involving antiretroviral therapy had a role in this association. PCT-HIV patients also had a high frequency of GSTT1 null and low frequency for GSTM1 null variants; thus, the genetic basis for PCT onset may involve a combination between the absence of GSTT1 and the presence of GSTM1. When the gene variants studied were analyzed in a whole, PCT-HIV patients had more risk alleles than Controls, PCT or HIV groups. In conclusion, genes encoding for proteins involved in the flow and metabolism of xenobiotics may influence the PCT-HIV association, providing novel insights into the molecular basis of the association between PCT and HIV.