Medical Science: Recent Advances and Applications Vol. 7

The Role of Molecular Biology in the Oral and Maxillofacial Surgical Practices

2025-06-30T11:30:47+00:00

Genetics is now widely recognised as one of the most influential fields in understanding the causes of human diseases and serves as a cornerstone in modern medical research. Recent advancements in molecular biology have significantly impacted the field of oral and maxillofacial surgery, introducing innovative techniques that enhance patient care. This chapter highlights a key application of molecular biology within this surgical speciality.

The evolution of genetics, rooted in Mendel’s foundational principles, has profoundly shaped our understanding of biology throughout the 20th century. The completion of the human genome sequence in 2004 marked a transformative milestone, enabling rapid and highly precise chromosomal analysis through technologies such as microarrays and next-generation sequencing. These developments have provided critical genetic insights applicable to clinical practice. To date, over 5,500 phenotypes have been identified with known molecular bases, and approximately 3,400 genes have been linked to phenotype-causing mutations. Genetics plays a pivotal role across all medical disciplines, influencing not only rare genetic disorders but also numerous common human diseases.

The foundation of modern genetics was established with the discovery of the DNA structure by James Watson and Francis Crick in 1953, although nucleic acids were first identified in 1849. During the 1960s, the decoding of DNA base sequences and the elucidation of the genetic code — the correspondence between DNA and protein sequences — represented another major scientific breakthrough.

This chapter also addresses the role of genetic counselling in helping individuals understand and adapt to the medical, psychological, and familial implications of genetic contributions. Molecular biology offers wide-ranging applications beyond human medicine, including the development of genetically modified, disease-resistant crops, the production of therapeutic proteins via transgenic animals, and DNA-based vaccine technologies.

Furthermore, the chapter explores the application of genetics in the detection, diagnosis, pathogenesis, aetiology, and potential therapeutic and preventive strategies for conditions affecting the maxillofacial region. Genetic research has not only deepened our understanding of disease mechanisms but also paved the way for innovative interventions, such as gene therapy and personalised medicine, which hold the promise of improved patient outcomes. As genetic technologies continue to evolve, their integration into clinical practice is expected to usher in a new era of precision medicine, particularly in the management of maxillofacial disorders.

Postpartum Rectus Abdominus Injury and Broad Ligament Hematoma: A Rare Case

2025-06-30T11:33:39+00:00

Trauma to a pregnant woman, irrespective of its intensity and the lack of any resulting shock, is a potential danger to both the mother and fetus. Severe damage to the right rectus abdominus muscle associated with a uterine broad right ligament hematoma is a rare complication of an accident during pregnancy. This study describes the case of a 31-year-old primiparous pregnant woman who had been a victim of a road accident at 28 weeks of pregnancy. The patient was struck by a car, with the impact occurring on the right anterolateral area of the patient’s abdomen. The pregnancy continued normally and the patient was ultimately delivered vaginally at 41 weeks of gestation. Despite the trauma, the baby was normally grown and had Apgar scores of 9 and 10 at 1 and 5 minutes of life. The patient underwent a laparotomy in the immediate postpartum period for a significant hemoperitoneum; this revealed the lesions and allowed treatment. The postoperative course was uneventful, and the patient was discharged on the 6^th postpartum day. The detachment and the damage of the rectus abdominus muscle associated with a hematoma of the right broad ligament, as observed in this patient, appear exceptional, as does the fact that they were of no real significance to the mother or her fetus until after delivery. This case highlights that the management and monitoring of a pregnant victim of a road accident (regardless of gestational age, the seat of the traumatic impact point and the importance of shock) must be performed in a specialised service. The complete and thorough initial examination and a methodical and rigorous para-clinical supervision in a specialised service are necessary to allow the early detection of any complications and to provide better overall care.

Serum Mucin1 and Cholesterol Ester Transfer Protein (CETP) Levels in Bangladeshi Cholelithiasis Patients and the Impact of Laparoscopic Cholecystectomy

2025-06-30T11:37:03+00:00

Background: Cholelithiasis, i.e., gallstone disease (GSD), is one of the most common gastrointestinal disorders. apolipoprotein A1 (ApoA1), In other studies, ApoE, Mucin1 and cholesterol ester transfer protein (CETP) were implicated with cholelithiasis. However, these results were variable and needed confirmation by further research.

Objective: This study evaluates the associations of Mucin1 and cholesterol ester transfer protein (CETP) between normal control subjects (NCs) and Cholelithiasis, i.e. gallstone disease (GSD) patients (Pts) preoperatively (I0) and postoperatively (II0) with laparoscopic cholecystectomy.

Methods: Adult Pts (N=55, Gender: 10 males, 45 females; Age range: 25-65 years, Mean age±SD: 45.5 ± 12.2 years) were those reported in our previous case-control prospective interventional studies carried out from October 2016 to March 2018 at MRU, MHWT, Uttara, Dhaka, Bangladesh. The patients with GSD were diagnosed as having cholelithiasis according to standard clinical and laboratory criteria as practised in the hospital. The lipid profile (TG, TC, LDL-C, HDL-C), Lp (a), ApoA1, ApoB100, ApoE, Mucin1 and CETP status in serum of NCs and Pts (I0, II0) and Pts-Bile (I0) were made by standard clinical laboratory methods using research/diagnostics kits from reputed companies and reported in the recent past. Recently, further advanced statistical analyses on these data were made according to the objectives of the present article, i.e. to obtain information regarding associations (correlations) between serum Mucin1 and CETP status among NCs and Pts (I0, II0) by using the SPSS programme version 26.

Results: Regarding associations (correlations) between Mucin1 and CETP status among NCs (I0) and Pts (I0) and Pts (II0), significant Pearson correlations were found for Pts-Mucin1 (I0) vs Pts-CETP (I0) (r=0.316, p=0.019), Pts-Mucin1 (Bile-I0) vs Pts-CETP (Bile-I0) (r=0.441, p=0.005), Pts-Mucin1 (II0) vs Pts-CETP (I0) (r=0.398, p=0.007), Pts-Mucin1 (I0) vs Pts-CETP (II0) (r=0.335, p=0.017) and NCs-Mucin1 (I0) vs Pts-CETP (Bile-10) (r=0.375, p=0.048). No significant correlations were observed between any of the other groups compared (P>0.05).

Conclusions: The observations on associations between Mucin1 and CETP among NCs and Pts (I0, II0) suggested their probable involvement in the aetiopathogenesis of the disease. Since GSD is one of the most prevalent diseases in gastroenterology, an appropriate diagnostic approach and management in clinical practice, such as medical treatment and surgical intervention depending on the patient’s condition, should be adopted. Considering the complexity of the molecular mechanisms in the formation of gallstones, further studies on GSD are certainly warranted, particularly involving a larger number of Bangladeshi patients in the future.

Vegetarian Diet, Ayurveda and an Integrative Nutrition Science

2025-06-30T11:41:30+00:00

The type of diet, i.e., vegetarian and non-vegetarian, has always been in a perplexing state among health-seekers as well as health care professionals. Nevertheless, vegetarianism and veganism diets are growing rapidly in popularity not only because of perceived health benefits, but also because of social justice and sustainability concerns. Two recent studies of the health effects of vegetarian diets reported conflicting results: the EPIC-Oxford study reported a significant increase in strokes among vegetarians compared to meat-eaters among a predominantly Caucasian cohort, while another, performed on Taiwanese Buddhists, reported significantly lower incidence of strokes among vegetarians. This was doubly puzzling given the pronounced decrease in cardiovascular events among the EPIC-Oxford group. In this article, we make a detailed comparison of the actual dietary intake of various food groups by the cohorts in these studies. We then use the nutritional principles of Ayurveda—traditional Indian medicine—to show how these apparently contradictory results may be explained. Systems of traditional medicine, such as Ayurveda, possess profound knowledge of the effects of food on physiology. Ayurveda extensively describes the effects of different foods on the body’s physiology, including meats and other non-vegetarian foods, which it actively recommends in certain conditions. Looking at the dietary intakes reported in this study from an Ayurvedic perspective is therefore informative. Ayurveda takes into account not just the type of food, but also multiple other factors such as taste, temperature, and time of consumption. Traditional cuisines have evolved hand in hand with such systems of medicine to optimise nutrition in the context of local climate and food availability. Harnessing the experiential wisdom of these traditional systems to create an integrative nutrition science would help fight the ongoing epidemic of chronic lifestyle diseases and improve health and wellness. Hence, Ayurveda is a promising weapon against chronic disease. Its extensive experience with holistic nutrition, together with that of other traditional systems of medicine, should be harnessed to create an integrative nutrition science to promote health and well-being.

Gilles-de-la-Tourette Syndrome in Childhood: A Comprehensive Review of Molecular, Neurobiological and Genetic Aspects

2025-06-30T11:44:35+00:00

Tourette syndrome is a neurodevelopmental disorder first described by Georges Gilles de la Tourette in 1885. This syndrome is characterised by repetitive, involuntary movements and vocalisations known as tics. Animals often exhibit repetitive and predictable behaviours. These repetitive actions can be learned and become habits, which can be advantageous from an evolutionary standpoint as they reduce cognitive strain and attentional resources. Repetitive behaviours can also be intentional and conscious, occurring without habit formation, especially in normal child development or certain neuropsychiatric conditions. When these behaviours disrupt social interactions and daily functioning, they may be considered pathological. Conditions such as Gilles de la Tourette syndrome (GTS) can manifest as compulsive, stereotyped, and ritualistic behaviours.

GTS is a congenital disorder of the nervous system and are chracterised by involuntary movements and also tic-like vocal or speech expressions. The dopaminergic and serotonergic pathways are believed to play an important role in the development of GTS. The striatum nucleus in the basal ganglia is believed to play a key role in regulating these repetitive behaviors through its connections with various areas of the cortex. However, the specific mechanisms within the striatum, including its organisation, cellular functions, and connections, are still actively researched. At the cellular level, post-mortem studies have found a reduced number of parvalbumin-expressing and cholinergic interneurons. There is extensive evidence that the dopaminergic signal transmission in the striatum is disrupted.

This study aims to provide an overview of Gilles de la Tourette syndrome with special focus on molecular aspects, treatment options and recent research with a focus on new targets to treat this rare hereditary disorder in childhood. A multidisciplinary treatment approach is necessary, including drug medication, psychotherapy or deep brain stimulation with focusing on recent research treating this rare disease in childhood sufficiently.

Advances in Neonatal Care: Latest Trends and Innovations in Neonatology

2025-06-30T11:47:21+00:00

Neonatology has witnessed transformative advancements over the past decade, significantly enhancing the survival and quality of life for preterm and critically ill newborns. This transformation is driven by the integration of advanced technologies such as artificial intelligence (AI), genomics, non-invasive monitoring, and regenerative medicine. This chapter explores these emerging innovations and their expanding role in clinical practice. AI and machine learning (ML) are becoming vital components in neonatal intensive care units (NICUs), supporting accurate predictions, real-time monitoring, and timely clinical decision-making. Breakthroughs in genomics have ushered in the era of precision medicine, enabling individualised treatment strategies tailored to each infant’s genetic profile. Meanwhile, non-invasive monitoring tools are enhancing the quality and safety of neonatal care by providing continuous physiological data without the risks associated with invasive procedures. As these technologies continue to evolve, they hold the promise of further improving neonatal outcomes and advancing care strategies that are finely tuned to the unique needs of newborns.

Negative Appendectomy Rates: An Update on Current Incidence Trends, Contributing Factors and Management Strategies

2025-06-30T11:49:40+00:00

The negative appendectomy rate is defined as the rate of a normal appendix, which is confirmed by histopathological diagnosis and generally accepted in the treatment of acute appendicitis to prevent complications like perforation. This rate varies according to countries in the western and eastern regions of the world. This study reviews current incidence trends, contributing factors, and strategies to reduce the negative appendectomy rate. A literature review was conducted using databases including PubMed, the Cochrane Database of clinical reviews, and Google Scholar, focusing on original articles, clinical trials, observational and cohort studies, and clinical reviews published between 1996 and 2023. In these studies, clinical scoring systems, inflammatory markers, and imaging were used to reduce the negative appendectomy rate. The introduction of computerised tomography has improved the diagnostic accuracy of acute appendicitis. As this rate has been progressively decreasing over the past few years, with better diagnosis of acute appendicitis, but the increased use of conservative treatment of acute appendicitis and laparoscopic appendectomy may have an impact on this rate.

Transforming Medical Education: Active Learning Strategies Tailored for Generation Z

2025-06-30T11:51:28+00:00

Adapting the medical curriculum to the needs of Generation Z may bridge the generational divides. Generation Z is the most diverse generation identified. With traits like tech-savviness, flexibility in learning, social relevance, creativity, self-expressiveness, predominant hands-on learners valuing practical skills, driven with immediate feedback, engaging learners, participatory, curious, collaborative, self-directed, preferring autonomy yet a short attention span, they demand comfortable, conducive learning environments that fulfil their learning goals. To create a more engaging environment, educators must transition from traditional instruction to facilitation. This manuscript discusses active learning strategies such as problem-based learning (PBL), team-based learning (TBL), flipped classrooms, and simulation-based activities, all of which align with the traits of Generation Z. By integrating these methods, the aim is to promote increased student participation, deeper understanding, and greater satisfaction for both learners and educators.

Quantification of Urine Albumin-Creatinine Ratio (uACR) by Point-of-Care Test and Its Comparison with Other Analytical Methods for Easy Detection

2025-06-30T11:53:47+00:00

Background: Chronic kidney disease (CKD) is a progressive condition affecting over 10% of the global population. Monitoring the urine albumin-to-creatinine ratio (uACR) is the gold standard for early detection and ongoing management of nephropathy. However, access to laboratory testing is limited in many community healthcare settings.

Objective: This study aimed to develop and evaluate the performance of MyACR, a simple, accurate, sensitive, and rapid point-of-care test (PoCT) device for measuring uACR, with the goal of facilitating CKD screening and monitoring in community settings.

Methods: MyACR uses spectrophotometric dye-binding (tetrabromophenol blue) and colourimetric Jaffe methods to quantify urinary albumin and creatinine, respectively. Urine samples were diluted 1:80 with distilled water and reacted with respective reagent mixtures. The creatinine reaction was incubated at 25°C for 30 minutes before analysis. Optical densities were measured at 625 nm (albumin) and 515 nm (creatinine). Calibration curves were established for albumin (0–60 mg/L) and creatinine (0–2 mg/dL), and analytical performance was evaluated in terms of linearity, accuracy, precision, and sensitivity. Clinical validation was conducted on urine samples from 20 CKD patients.

Results: Calibration curves demonstrated strong linearity, with correlation coefficients (R²) exceeding 0.997. The method demonstrated good intra- and inter-day accuracy (per cent deviation of mean value ≤ 5.42%) and precision (coefficient of variation ≤ 12.69%). The method was specific, without interference from blood components. The limits of quantification were 5 mg/L for albumin and 0.25 mg/dL for creatinine, based on spiked samples (n = 5). Comparison with hospital-based immunoassays showed a high correlation (R² > 0.98) and acceptable agreement (median %DMV = 3.48%, range: -17.05% to 21.64%).

Conclusion: MyACR demonstrated satisfactory analytical performance for the point-of-care measurement of uACR, offering a promising tool for early detection and monitoring of CKD in resource-limited settings. Further studies are warranted to assess its cost-effectiveness and clinical utility in large-scale, multisite community and home-based applications.

Evaluating PIV and Other Immune Inflammation Markers for Predicting Oncological and Survival Outcomes in Patients Following Radical Cystectomy

2025-07-05T07:01:55+00:00

Background: Bladder cancer, a frequently encountered urological malignancy, is a disease of complex management that imposes a significant burden on society, with an annual global diagnosis exceeding 430,000 men and women and occupying 10th place among the most common cancers worldwide. Bladder cancer arises from the transitional epithelium, with urothelial bladder cancer being the predominant subtype, representing over 90% of cases. Although considerable progress has been made in the management of high-risk and muscle-invasive bladder neoplasm in terms of new therapeutic techniques and new chemo/radiotherapy treatments, it remains a high-mortality tumour, with about 50% of patients developing distant metastasis. The outlook following radical cystectomy is contingent on histological traits like staging and grading of the tumour, metastatic condition, involvement of lymphatic nodes, histological variant, or lymph vascular invasion and vascular infiltration. It would be advisable to develop a prognostic model and preoperative risk stratification for those patients most at risk who might need further treatment after surgery. Although much research has been conducted on the use of blood biomarkers to improve the follow-up for these patients, there is still much confusion about this, and no biomarker is standard in the clinical setting. Our retrospective research aimed to examine the prospective added value of the pan-immune inflammation value (PIV) index and other known predictive factors and compare them with other inflammation indices for the oncological outcomes of patients treated with radical cystectomy (RC). Inflammation is widely acknowledged as a significant characteristic of cancer, playing a substantial role in both the initiation and advancement of cancers. This planned to compare pan-immune inflammation markers and other well-known markers (systemic immune inflammation index and neutrophil to lymphocyte ratio) to predict prognosis in individuals treated with radical cystectomy for bladder cancer.

Objective: The objective of the study was to compare PIV with two other biomarkers, SII and NLR, to provide essential insights into the potential association between PIV and adverse cancer-related events within a uniformly characterised and precisely characterised patient cohort.

Methods: The records of 314 patients who underwent radical cystectomy and lymphadenectomy at the hospital of the researcher from January 2016 to November 2022 were examined. In this retrospective analysis, preoperative PIV, systemic immune inflammation index (SII), and neutrophil–lymphocyte ratio (NLR) in 193 individuals managed with radical cystectomy for bladder cancer were focused on. Multivariable logistic regression assessments were performed to assess the predictive capabilities of PIV, SII, and NLR for infiltration of lymph nodes (N), aggressive tumour stage (pT3/pT4), and any non-organ limited disease at the time of RC. Multivariable Cox regression analyses were conducted to assess the predictive impact of PIV on Relapse-free survival (RFS), cancer-specific survival (CSS), and Overall survival (OS). Statistical analysis was performed using STATA/SE version 18 (StataCorp, College Station, TX, USA). With the ROC curve and the Youden index, the best cut-offs for each of the biomarkers analysed are determined.

Results: Individuals were divided into high PIV and low PIV cohorts using the optimal cut-off value (340.96 × 109/L) based on receiver operating characteristic curve analysis for relapse-free survival. In multivariable preoperative logistic regression models, only SII and PIV correlated with the infiltration of lymph nodes, aggressive disease, and any non-organ-confined disease. In multivariable Cox regression models considering presurgical clinicopathological variables, a higher PIV was associated with diminished RFS (p = 0.017) and OS(p = 0.029). In addition, in multivariable Cox regression models for postoperative outcomes, a high PIV correlated with both RFS (p = 0.034) and OS (p = 0.048). The key significance of the analysis resides in the potential benefit for practitioners as a supplementary indicator to assess the prognosis of Bladder cancer. This can improve the precision of risk assessment and contribute to more precise treatment-planning decisions, including the evaluation of adjuvant therapy, neoadjuvant therapy, or bladder-sparing therapies.

Conclusions: The study suggests that PIV and SII are two very similar markers that may serve as independent and significant predictors of aggressive disease and worse survival impacts on individuals undergoing radical cystectomy for bladder neoplasm. The ability to identify patients with an aggressive disease profile early on may guide tailored therapeutic interventions and improve overall clinical results. Further investigation and validation studies are justified to strengthen the applicability of these biomarkers and to explore their potential in personalized medicine and treatment optimisation.

Lead Levels in Blood: Insights from Autopsy Cases of Urban India

2025-07-05T07:09:49+00:00

Lead is a widely used heavy metal known for its toxic effects on the human body, with prolonged exposure leading to a condition known as plumbism. The generally accepted reference range for blood lead levels in humans is up to 25 µg/dL. This cross-sectional autopsy-based study aims to estimate blood lead levels in the population of South Delhi. A total of 250 blood samples were collected from autopsy cases at a tertiary care centre. From each case, 5 mL of blood was drawn, digested, and analysed using a Trace Metal Analyser (TMA) for accurate quantification of lead content. The study population included 173 males and 77 females. The mean blood lead level among males was found to be significantly higher at 16 µg/dL, compared to 0.41 µg/dL in females. Further age-wise analysis revealed that individuals in the 41–60 years age group had the highest mean blood lead concentration, measured at 20.73 µg/dL. These findings highlight a concerning level of lead exposure in specific demographic groups, particularly adult males and middle-aged individuals, underscoring the need for environmental and occupational health interventions in the region.

A Comprehensive Review of Thromboprophylaxis and Its Implications in Regional Anaesthesia

2025-07-05T07:15:37+00:00

Venous thromboembolism, comprising both Deep Venous Thrombosis and Pulmonary Embolism, is a chronic illness. VTE is an important cause of postoperative morbidity and mortality, especially when patients with co-morbid conditions (like obesity, coronary artery disease, or cancer) are on the rise. This necessitates the use of various thromboprophylaxis measures to prevent the occurrence of fatal VTE. However, the pharmacological thromboprophylaxis carries an inherent risk of bleeding, especially when the area of invasive work involves a potential space with a risk of non-compressible arterial puncture. During neuraxial anaesthesia, such bleeding into a closed space can result in spinal hematoma, which carries various neurological sequelae and requires urgent diagnosis and management.

The aim of the study is to review and analyse the relevant literature on the modalities of thromboprophylaxis, their mechanism of action and optimal management of such patients in the perioperative setting. In the perioperative setting, managing a patient on thromboprophylaxis therapy is still challenging, and with the introduction of various newer anticoagulants, management becomes more perplexing. In view of limited randomised trials pertaining to the thromboprophylaxis management in regional anaesthesia settings, a thorough knowledge of the mechanism and duration of action of these anticoagulant drugs, as well as recommended guidelines, is essential for the effective management of such patients.

Role of TNF-α Gene Polymorphism as a Biomarker of Diabetic Nephropathy: A Study among Patients of the Telangana Region, India

2025-07-05T07:20:35+00:00

Background: Diabetic Nephropathy (DN) is one of the complications in patients with prolonged diabetes. Diabetic nephropathy disorder is most commonly observed in patients with prolonged diabetes, even though other microvascular diseases due to diabetes are also observed. Among the genetic risk factors for DN, TNF-α, an anti-inflammatory cytokine, is proposed to act in a paracrine/autocrine manner and is hypothesised to be associated with insulin resistance. In the current study, the relationship of the G C variant of the TNF-α gene in patients, associated with other biochemical parameters, with DN was investigated.

Aim: The aim of the study was to investigate the inflammatory markers that are involved in the pathogenesis of diabetic nephropathy and could serve as predictive or diagnostic biomarkers.

Methods: Demographic factors of the study group were obtained by directly interviewing the study group. Biochemical and diagnostic parameters of the study subjects, plasma glucose levels (fasting and postprandial), and renal function tests (Urea, creatinine) were obtained from the patient’s records. Genomic DNA was extracted from peripheral blood samples of 50 type II Diabetes Mellitus (T2DM) and 50 non-diabetic control subjects.

The TNF-α (G C) polymorphism was analysed using polymerase chain reaction (PCR), followed by restriction fragment length (RFLP) polymorphism analysis.

Results: Using statistical analysis, it was possible to correlate demographic parameters with genotyping results, and it was found that 50% patients were GG homozygotes (wild type), 30% were GC heterozygotes, and 20% were CC homozygotes. This suggests that low-grade inflammation could be one of the determinants in the pathogenesis of insulin resistance and T2DM. Most of the patients (80%) in the hospital were not physically active, and these patients had much longer inpatient stays when compared to the patients who were involved in regular physical exercise. The control of inflammatory processes may be useful in the therapy of DN. As there is limited experience available for the inhibition of inflammatory cytokines in DN, it is beneficial to collect and mount evidence for the properties of inflammatory genes.

Conclusion: We conclude from this preliminary study that TNF-α G C genotypes may be a useful biomarker for the early diagnosis of T2DM patients with insulin resistance and nephropathy.