Dr. Pietro Scicchitano
Department of Cardiology, Hospital “F. Perinei” Altamura (BA), Italy.

ISBN 978-93-5547-607-4 (Print)
ISBN 978-93-5547-608-1 (eBook)
DOI: 10.9734/bpi/nhmmr/v6

This book covers key areas of Medicine and Medical Research. The contributions by the authors include Ocular problem, senile cataract,  STI patients, Stem cells, wound healing, cancer therapy, posterior uveitis, Juvenile Idiopathic Arthritic, Human Papillo MAVIRUS DNA, human breast cancer,  Presepsin, sepsis severity, procalcitonin, C-reactive protein,  Down syndrome, klinefelter syndrome, pre-natal diagnosis, sex chromosome abnormality, triple x syndrome, turner syndrome, anxiety, stress, Karyotypes,  behavioural abnormalities, mental retardation, Artificial intelligence, cervical cancer, thyroid cancer, Magnetic resonance imaging, Computed Tomography, Medical image analysis, deep learning models, Glioma, survivin, Bcl-2 protein, apoptosis, malignancy, glial cell tumor, anti-apoptotic, Chlamydia trachomatis, Alveolar capillary dysplasia, diffuse lung disease, interstitial lung disease , and irreversible pulmonary hypertension. This book contains various materials suitable for students, researchers and academicians in the field of Medicine and Medical Research.


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The present study aimed to assess the frequency of systemic and ocular co-morbidities among the cataract surgery patients in our college and research institute over a period of 12 months. The cross-sectional study was carried out by descriptive analysis of medical records of 448 cataract patients who underwent cataract surgery in our college and research institute between July 2015 and June 2016 by a single surgeon (GK). The results of this study indicate a high prevalence of Non-Communicable Disease in patients operated for cataract surgery in our region and ocular co-morbidities among them. This would be helpful in planning and allocating the resources for effective management of cataract patients. A meticulous preoperative examination and postoperative follow-up might lead to better results and improved quality of life for cataract patients.

Determination of Sero-Prevalence of Chlamydia Trachomatis in Sti Patients

Atul R. Rukadikar, Charushila Rukadikar

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 7-12

Chlamydia trachomatis is the leading cause of sexually transmitted infections (STIs). Chlamydial infections, if left undiagnosed and untreated, can have irreversible consequences. Infected patients act as a source of infection for their partners. The present study was undertaken to determine the prevalence of genital Chlamydia and its association with bacterial flora in STI patients attending STI clinics, to identify C. Trachomatis Antigen by Immunochromatography, to detect C. Trachomatis Antibody (IgG) By ELISA and to detect possible association of C. Trachomatis with other Bacterial Flora.

Methods: Standard procedures were used to collect genital discharge specimens (Endocervical, Vaginal) and blood from 226 patients. Conventional methods were used to isolate and identify bacterial flora. Patients were tested for the presence of Chlamydia trachomatis antigen and antibody using an Immunochromatographic assay (Biomerieux) and an ELISA (Novatech, Germany).

Results: Giemsa staining revealed 'inclusion bodies' in 69/226 (30.53 percent) of the 226 patients. Chlamydia trachomatis was discovered to be the most frequently associated with Candida albicans (29.41 percent). Of 180 samples, 102/180 (55.66%) were positive for IgG by ELISA. Of 50 samples, 07/50 (14%) were positive for Chlamydia trachomatis antigen by immunochromatographic assay. Results of both the test were evaluated.

Conclusion: Although tissue culture is the gold standard for detecting Chlamydia trachomatis, serological assays are much simpler, sensitive, and fast. Chlamydia co-infection with other STIs emphasises the importance of early laboratory diagnosis and specific treatment.

The objectives of this study are to explore the interrelationship between wound healing and cancer. This opinion article highlights the mechanism of wound healing and the impact of wound on cancer evolution and cancer therapy. Wound healing requires the proliferation and the terminal differentiation (TD) of progenitor stem cells (PSCs). PSCs are pluripotent stem cells that can be differentiated into a variety of cells to help with wound healing. Compounds implicated in chemo-surveillance and cachexia have a significant impact on wound healing. Wound triggers the production of prostaglandins (PGs) which play an essential role to promote the proliferation of PSCs at the initial stage of the wound. At the final stage of wound healing, chemo-surveillance comes into play to induce TD of PSCs. The functionality of chemo-surveillance dictates the success of wound healing. The functionality of chemo-surveillance is usually intact in healthy people, so wounds typically heal nicely without having to put up any efforts. Wound also triggers production of tumor necrosis factor (TNF) which is responsible for the display of cachexia symptoms leading to the collapse of chemo-surveillance. TD of PSCs will be impaired, allowing PSCs to evolve into cancer stem cells (CSCs). It takes only a single hit to silence TET-1 enzyme to convert PSCs to become CSCs, which is well within the reach of PSCs because MEs of PSCs are abnormally active like cancer cells (CCs) due to association with telomerase. Wound healing and evolution of cancer are so closely related to involve PSCs as the critical common elements. Cancer can arise if a wound is not healed properly. Following a successful wound healing process is the best method for cancer treatment. Cachexia symptoms must be eliminated, chemo-surveillance must be restored, CSCs must be eradicated, differentiation blockade must be eliminated, and oncogenes and cancer suppressor genes must be removed. Wound-healing metabolites are the best candidates to meet these needs.

Determination of Unilateral Posterior Uveitis in a Young Suspected Juvenile Idiopathic Arthritic Male

Gandhi Priyanka, Hussain Faraaz Syed, Shah Abha

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 21-26

The aim of this study was to create awareness about the importance of regular ophthalmic consults in suspected and diagnosed cases of JIA. A 15 y/M was referred from Paediatrics department to rule out uveitis in a suspected case of Juvenile idiopathic arthritis(JIA). He had no ocular complaints. There was history of left eye amblyopia since childhood and usage of thick glasses since 10 years. There was no history of ocular trauma, procedure or any systemic illness. Best corrected visual acuity(BCVA) was 6/9 in RE and 6/24 in LE recorded using Snellen’s chart, color vision and Amslers grid test were within normal limits in both eyes. The anterior portion was examined and found to be within normal limits. In both eyes, the posterior segment revealed myopia, with mild vitreous degeneration in the right eye and vitreous debris, inflammatory debris, perivascular sheathing, and snowbanking in the superotemporal and inferior quadrants in the left eye, but no active macular edoema. Systemic workup was done and the patient was started on oral steroids and immunosuppressant. The presenting feature of posterior uveitis, unilateral involvement, and asymptomatic nature of this case highlight the necessity of screening suspected JIA cases for early detection and management of ocular sequelae. JIA-associated uveitis rarely presents with complaints, a high index of suspicion is indicated in these cases due to poor prognosis and high rate of complications.

Study about Oncogenic Human Papillomavirus in Breast Cancer: An Approach towards Molecular Prevalence in a Group of Congolese Patients

Luc Magloire Anicet Boumba, Dimitri Malanda Mboungou Moudiongui, Parfait Christy Nganga , Donatien Moukassa, Jean Félix Peko

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 27-34

Background: Since the Band’s work of in 1990, several studies have suggested a possible link between the pathogenesis of breast cancer and viral infection. Infection with a cancer-causing agent HPV is one of the viruses that has been linked to breast cancer cases all over the world.

Objective: The purpose of this study was to look for HPV DNA in archived paraffin-embedded breast cancer cases at the University Hospital of Brazzaville and to look for a link between viral HPV infections and clinicopathological features.

Methods: A total of 40 formalin-fixed paraffin-embedded (FFPE) biopsies were collected retrospectively, and all available data was recorded. Real-time PCR using GeneXpert technology (Cepheid®, Sunnyvale, USA) was used to detect and genotype HPV.

Results: The average age was 51.1 ± 11.4 years (range 22 - 75 years; median was 47).  In total, HPV DNA was found in 6 (15%) of the breast carcinoma samples. The most common genotype, HPV-16, was found in 83.7 percent of all samples. There was no significant difference between HPV porting and clinicopathological features(p>0.05). However, a statistically significant difference was observed between HPV infection and SBR grade (p=0.05).

Conclusion: Our study found a high prevalence of HPV-HR in Congolese women with breast cancer. Future case-control studies are required to better characterise the potential role of HPV in the incidence of breast cancer in Congo.

Usefulness of Presepsin Concentrations for Differentiating Sepsis Severity

Ajete Aliu-Bejta , Anita Atelj, Mentor Kurshumliu, Shemsedin Dreshaj, Bruno Barsic

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 35-45

Objectives: Prompt identification and appropriate treatment of sepsis is crucial for better disease outcome. Different sepsis biomarkers are widely used for rapid diagnosis of sepsis. The diagnostic accuracy of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) in discriminating sepsis severity and their relationship with the Sepsis-related Organ Failure Assessment (SOFA) score were investigated in this study.

Methods: During two time periods, 100 septic patients from two university clinical centres were enrolled in the study. Sepsis stratification was done using new Sepsis-3 definitions. During the illness, biomarkers and the SOFA score were assessed four times. The presepsin was measured using a sandwich ELISA kit. To evaluate the changes in biomarker concentrations and SOFA score values during the illness and to estimate the differences between severity groups, a generalised linear mixed effects model was utilised. The correlation of biomarkers with SOFA score was investigated using multivariate analysis.

Results: Patients with septic shock (n=34) had significantly higher presepsin concentrations on admission compared to patients with sepsis (n=66), mean ±SD: 128.5±47.6 ng/mL vs. 88.6±65.6 ng/mL, respectively (p<0.001). Concentrations of PCT and CRP did not differ significantly between sepsis severity groups. A strong correlation of presepsin with SOFA score was also found (p<0.0001).

Conclusions: In the research groups, presepsin demonstrated an excellent diagnostic ability to distinguish septic shock from sepsis. PCT and CRP were unable to distinguish the severity of sepsis.

Determining the Role of Prenatal Diagnosis in Parents with Sex Chromosomal Aneuploidy: Review Article

K. Pritti , M. Vineet, R. Priyankur, P. Hetvi

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 46-53

Sex chromosome aneuploidy is described as a numeric abnormality of an X or Y chromosome and includes 45,X (Turner syndrome); 47,XXY (Klinefelter syndrome); 47,XXX; and 47,XYY karyotypes.  Individuals with the numbers 47,XXX and 47,XXY are normally viable, but there is a chance that they will have a cytogenetically aberrant child.  Turner and Klinefelter syndromes are commonly associated with infertility, but in a few cases, those who were able to give birth to a normal child, and some babies were born with similar or another chromosomal abnormality.

Triple X syndrome affects 0.1% of live-born female newborns. The majority of these newborn babies have a normal phenotype, with only a few cases of congenital malformations having the 47,XXX karyotype. Although these female patients appear to be mostly fertile, there appears to be an enhanced risk of having a cytogenetically abnormal child; the extent of this danger cannot yet be ascertained; prenatal diagnosis and genetic analysis is thus recommended. We present a rare case of a triple X woman with a history of Down syndrome child who was advised to have a prenatal diagnosis in her subsequent pregnancy, as well as a review of other relevant articles to determine the role of prenatal diagnosis in parents with sex chromosomal abnormality.  Genetic counseling for sex chromosomal abnormality (SCA) females, should address reproductive issues, specifically POF and the risk of transmission.

Determining the Effects of Serotonin Transporter Gene Polymorphism on Mood during the Period before the Competition in Japanese Ballet Dancers

Kanaka Yatabe , Kohei Ashikaga , Ryota Muroi , Naoko Yui , Satomi Kasuya, Shu Somemura , Fumiko Terawaki, Ko Sato, Kazuo Yudoh, Hisao Miyano, Hiroto Fujiya

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 54-68

The purpose is to investigate the association between polymorphism in serotonin transporter gene and state-trait anxiety, and to explore the possibility of 5-HTTLPR being used as an objective predictor of mental state in Japanese ballet dancers under the stress conditions.  Participants were 25 elite student ballet (Elite) dancers with future potential and 19 pro-ballet (Pro) dancers. We administered two psychological questionnaires (STAI: State-Trait Anxiety Inventory; BRUMS: Brunel Mood Scale) to the participants on a typical day and on one of stressful days. The frequency of the 5-HTTLPR genotype in the dancers was as follows: s/s, 64.7%; s/l, 35.3%; l/l, 0%. There was only significant difference in STAI scores on before-competition between s/s and s/l genotypes. In this study, the Trait-Anxiety scores of Elite dancers were significantly higher than those of the Pro dancers (P<0.028). The main effects were significant of genotypes in the BRUMS scores (P<0.035) and of Pro/Elite groups (P<0.002); the 5-HTTLPR has played a certain role in the background of state-trait anxiety, and the psychological test scores were strongly influenced by occupational factors. We can predict the status of BRUMS before the competition by examining the Trait-Anxiety in Elite. Dance level (Elite versus Pro) appears to have far more robust effects on dancer mental status than does 5-HTTLPR genotype. The association between Trait-Anxiety scores on a typical day and BRUMS scores under stress was also studied. Our findings reveal that Elite dancers with high Trait-Anxiety on a usual day are more likely to feel apprehensive, unhappy, confused, furious, and weary on the day of competition.

Cytogenetics in Mental Retardation: An Overview

Anupam Kaur

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 69-76

It is important to ascertain the cause of mental retardation, so that recurrence risk can be reduced and where MR is transmissible, prenatal diagnosis and proper genetic counseling could be provided. The paper highlights the importance of cytogenetic investigations in detecting abnormalities like rings, and mosaics that may be missed even with the CMA assays. Mental retardation is defined as an inadequate development of mental capacities and related behavioural problems. It is the most common neuropsychiatric illness in all civilised societies, affecting 2.5-3.0% of the population. Chromosomal abnormalities are the important cause of mental retardation. In the first report from North India cytogenetic investigations were carried out on 143 mentally subnormal individuals that were referred to the Centre for Genetic Disorders, Guru Nanak Dev University, Amritsar, India, during 1996 to 2002. These cases were referred mainly as suspected Down syndrome, delayed milestones, mental retardation, etc. The age group of the patients ranged from 1 month to 18 years. Interestingly, maximum number of patients i.e., 58/143 (40.5%) were the firstborns and the average maternal age was 27.6 years. Free trisomy 21 was found to be the most frequent autosomal aberration, both amongst males and females (45.4% males, 18.8% females). Free trisomy was seen in 92/143 (64.3%) cases while translocations were seen in 2.7% cases. The latter included 45,XY,+t(13;14), 46,XY,+t(14;21), 45,XX,+t(14;21)   and   46,XX,+t(14;21)   karyotypes. The cytogenetic analysis in patients with intellectual disability (ID)/MR should nowadays be applied when aneuploidies are suspected, and Array Comparative Genomic Hybridization should be used as the first-line genetic test for patients with ID/MR, especially non-syndromic cases.

Diagnosis of the Medical Images Using a Three-Dimensional MRI and CT Reconstruction Algorithm: A Study Protocol for a Randomized Controlled Trial

Tudor Florin Ursuleanu , Andreea Roxana Luca, Liliana Gheorghe, Roxana Grigorovici , Stefan Iancu, Maria Hlusneac, Cristina Preda, Alexandru Grigorovici

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 77-81

Prognostic signs in the cervix, tumour size, parametric invasion, pelvic lateral wall, and lymph node invasion can all be effectively assessed by MRI and CT. CT has a high-density resolution and can clearly show organs and soft tissue structures with small density differences. Despite the importance of MRI and CT in cervical cancer and thyroid cancer assessment, radiologists continue to confront hurdles due to the technical and interpretive pitfalls of MRI. Furthermore, precise thyroid cancer diagnosis and staging (using MRI and CT imaging) allows for the development of a successful treatment plan. The dosimetry of radioactive iodine therapy and the evaluation of the therapeutic impact both require precise thyroid volume measurements. Thyroid size has become a criterion in the selection of patients for minimally invasive surgery in surgical intervention. Our research is unique in two ways: first, we validate the computer assisted diagnostic (CAD) method in a clinical study; and second, we use various network topologies specified above, that have produced impressive outcomes in the activities of image model recognition, and we specialise this network mix by requalifying the last layers with field specific images-MRI and CT scan.

Deep Learning Application for Analyzing of Medical Images

Tudor Florin Ursuleanu, Andreea Roxana Luca, Liliana Gheorghe, Roxana Grigorovici, Stefan Iancu , Maria Hlusneac , Cristina Preda , Alexandru Grigorovici

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 82-130

All of the research publications describe, emphasise, and classify one of the constituent aspects of deep learning models (DL) employed in medical image interpretation, but they do not provide a unified picture of the importance and impact of each constituent on DL model performance. Deep learning (DL) has experienced an exponential development of medicine, but applications in interpretations of medical imaging are in continuous development.  Our paper is unique in that it takes a unitary strategy to the constituent elements of DL models, such as data, tools used by DL architectures, or specifically constructed DL architecture combinations, and highlights their "key" features for completing tasks in current applications in medical image interpretation. Future study could focus on the utilisation of "key" properties particular to each ingredient of DL models, as well as the correct determination of their correlations, with the goal of improving the performance of DL models in the interpretation of medical pictures.

Apoptosis is regulated by a number of factors, the mechanism of which is unknown. Bcl-2 is a well-known mediator of apoptosis. Survivin is also a recently discovered noble family inhibitor of apoptosis protein (IAP), which suppresses apoptosis via a different route than the Bcl-2 family. Survivin and Bcl-2 have been expressed in several human cancers. The purpose of the study was to characterize survivin and Bcl-2 expression in glial cell tumors, and investigate correlation to pathological malignancy and anti-apoptotic properties. Fifty-eight patients who had been surgically resected glial cell tumors were evaluated in this study. The pathological types of glial cell tumors were categorized according to the World Health Organization classification (WHO). Survivin was characterized in 60.3%, and Bcl-2 was expressed in 43.1% of glioma samples. Co-expression of survivin and Bcl-2 was observed in 25.9% of tumor specimens. Survivin expression in astrocytic tumors was significantly associated with pathological grade (P < 0.05); however, Bcl-2 was not (P > 0.05). Anti-apoptosis in patients with survivin, Bcl-2, or co-expression was detected in 91.4%, 92.0%, and 100%, respectively. These studies suggest that survivin expression correlates with pathological grades of gliomas. In addition, the expression of survivin or Bcl-2 also has a potent anti-apoptotic property in gliomas. Our results indicate that survivin or Bcl-2 may be potential targets to induce apoptosis of gliomas.

Determination of Epidemiological Markers and Seroprevalence of Chlamydia Trachomatis in Female Sti Attendees

Atul R. Rukadikar , Charushila Rukadikar

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 140-147

The present study was attempt to determine the seroprevalence of chlamydia trachomatis and its association with various epidemiological markers. Sexually transmitted infections are most commonly caused by Chlamydia trachomatis (STIs). Undiagnosed and untreated chlamydial infections might have permanent consequences. Patients who are infected act as a source of infection for their partners. The goal of this study was to find out what epidemiological signs and seroprevalence of genital Chlamydia there were in female STI patients who went to STI clinics. The seroprevalence of chlamydia trachomatis, as well as age, marital status, history of sexual contact, and contraceptive use, were evaluated in 226 clinically suspected cases of Sexually Transmitted Infection (STI) patients attending a STI clinic. Using an ELISA(Novatech, Germany) test, patients were checked for the presence of chlamydia trachomatis IgG antibody . By ELISA, chlamydia trachomatis seroprevalence was revealed to be 55.66 percent for IgG. Sexually active people were more likely to have genital Chlamydia (21-30 years). Patients who were married (53.75 percent), had a history of sexual interaction (61.25 percent), and were taking oral contraceptive pills as a contraceptive strategy (63.93 percent) had the highest prevalence. Although tissue culture is the gold standard for detecting chlamydia trachomatis, serological assays are significantly more straightforward, sensitive, and quick. The need of early laboratory diagnosis and appropriate therapy for Chlamydia and other STIs is highlighted by the co-infection of Chlamydia with other STIs.

A Case Series of Congenital Alveolar Capillary Dysplasia with New Associations and Literature Review

R. R. Nandyal, D. Parham, Z. Yu , M. Escobedo

New Horizons in Medicine and Medical Research Vol. 6, 9 April 2022, Page 148-159

We report six cases of autopsy proven (unrestricted) ACD- MPV from a single institution during a seven year period (January 2007 to January 2013). Congenital Alveolar capillary dysplasia with misalignment of the pulmonary veins (ACD-MPV) is a rare and a lethal cause of neonatal respiratory failure and severe hypoxemia, secondary to persistent pulmonary hypertension (PPHN). It is refractory to all standard medical therapies including High Frequency Ventilation (HFV), inspired Nitric Oxide (iNO), and Extracorporeal Membrane Oxygenation (ECMO). According to the Online Mendelian Inheritance in Man (OMIM), it is caused by heterozygous mutation in the FOXF1 gene on chromosome 16q24. Newer study has suggested that two other genes can cause (ESRP1) or function as modifiers (PLXNB2) of the ACDMPV phenotype. Most reported cases of ACD-MPV had multiple congenital non-lethal anomalies. Pathology slides were read and confirmed by pediatric pathologists of two different university hospitals. Novel findings include an association with previously undescribed congenital anomalies and a sibling with congenital alveolar dysplasia without capillary dysplasia. All patients presented in the newborn period, with severe hypoxemia and echocardiogram (Echo)-confirmed PPHN. The vast majority of ACDMPV cases continue to be diagnosed by autopsy, after the infants have been subjected to extreme degree of intensive care. ACD-MPV needs to be considered as a diagnostic possibility when ECMO fails.