Editor(s)
Dr. Sevgul Donmez
Faculty of Health Sciences, Gaziantep University, Turkey.

ISBN 978-93-5547-705-7 (Print)
ISBN 978-93-5547-706-4 (eBook)
DOI: 10.9734/bpi/cpms/v7

This book covers key areas of Medical Science.  The contributions by the authors include Menopause, malignancy, cervix,  endometrium, Coracoid, coraco-glenoid, morphometry, subcoracoid impingement syndrome, Dentistry,  nursing, skills, cholangiocarcinoma, immunomodulatory activity, B-eudesmol, Multidetector computed tomography, blunt trauma, penetrating trauma, Carotid, dissection, stroke, hutchinson-gilford progeria, Cervical cancer, knowledge, attitude,  Anticancer activity, breast cancer cell, DNA damage, killing tumor cells,   gynecomastia, pathogenesis,  Infectious diseases, kidney diseases, pediatric nephrology, nephronia, renal abscess,  Tibial nerve, common peroneal nerve, sciatica, piriformis syndrome, Cerebral Palsy, physiotherapy, Otogenic tetanus, sevoflurane, labetolol, foreign body, and Unintentional injury. This book contains various materials suitable for students, researchers and academicians in the field of  Medical Science.

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### Chapters

##### A Brief Study about Menopause and Gynaecological Malignancy

Sabera Khatun, Jannatul Ferdous

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 1-11
https://doi.org/10.9734/bpi/cpms/v7/7125F

Premature menopause can occur as a result of cancer treatment. Cervical cancer is the most common gynaecological cancer. Persistent HPV infection is more common in postmenopausal women. In postmenopausal women, HPV vaccination has no role in primary cervical cancer prevention. Cervical cancer symptoms in postmenopausal women are unfortunately non-specific and related with co-morbidities. As a result, each sign of cervical cancer in a postmenopausal woman should be investigated thoroughly. Among all gynecologic cancers, ovarian cancer is the leading cause of death. The majority of postmenopausal women with ovarian cancer present with ambiguous symptoms and are in an advanced stage of the disease at the time of presentation. In the United States, endometrial cancer is the most frequent gynecologic malignancy. The majority of endometrial carcinomas are detected early and have a favourable prognosis. Though vulvar and vaginal cancers are uncommon, they are common in postmenopausal women. Any postmenopausal woman who has been itching for a long time, has a pervaginal discharge, or has a vulva or vaginal ulcer should be evaluated thoroughly. So main objective of this writing is to aware the gynaecological oncologists about the special aspects of gynaecological cancers in menopausal woman.

##### Coracoid Process in Adult Human Scapula in Eastern Odisha Population: A Morphometric Analysis

Saurjya Ranjan Das, Sreepreeti Champatyray , Gyanaranjan Nayak , Sitansu Kumar Panda

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 12-22
https://doi.org/10.9734/bpi/cpms/v7/16816D

The present study measure the dimensions of the coracoid process of the scapula. The coracoid process is a projection that protrudes superolaterally from the upper border of the skull, resembling a bird's beak. It has a significant impact on shoulder function.

The present study comprised of 104 adult dry scapulae of unknown age and sex, obtained from the Department of Anatomy of Institute of Medical Sciences & SUM hospital.

The dimensions recorded were breath, length, height, thickness and types of coraco-glenoid space by using digital vernier calipers. These parameters were compared on both the sides.

The most predominant coraco-glenoid space was found to be the round bracket (Type I). Statistically insignificant difference was noted in all four parameters between right and left. Though all the four parameters have higher values on right side in comparison to left side but the difference was statistically insignificant. The results are as such length of coracoid- 39.91±3.16 mm; width of coracoid- 14.00±2.03 mm; tip thickness of coracoid- 8.32±1.87 mm; height of base coracoid- 22.87±3.55 mm; width of base of coracoid- 10.50 ±2.64 mm;

The various scapular dimensions obtained in this study will also be useful in comparative anatomy and manufacturing prosthetic products. The current study will be of immense help in orthopedic surgeries on the shoulder joint and in biomechanical engineering for designing implants for total shoulder replacement.

##### Identification of Dental Problems of Adolf Hitler and Eva Braun

Xavier Riaud

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 23-33
https://doi.org/10.9734/bpi/cpms/v7/3140A

Forensic dentistry is a specialist branch of forensic sciences in which dental skills are put at the service of judicial systems mainly for investigative purposes for criminal acts or to identify victims of mass/natural disasters or structurally altered human remains. Its global evolution and modernization requires a comprehensive view of applications and available tools.

##### A Brief Description on OSCE- Objective Structured Clinical Examination

Pauline Sharmila

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 34-41
https://doi.org/10.9734/bpi/cpms/v7/16930D

OSCE is an examining process which is objective and unbiased. The characteristics, components and significance are listed out. Features like professionalism, communication skills, clinical skills etc., can be assessed here. The roles and responsibilities of the teacher/ facilitator before, during and after OSCE are explained in detail. This evaluation system is widely followed all over the world in nursing and medical profession to demonstrate the clinical proficiency and also to get registered as Nurses in many countries abroad.

##### Immunomodulatory Activities of Atractylodes lancea (Thunb.) DC

Inthuon Kulma, Luxsana Panrit, Tullayakorn Plengsuriyakarn , Wanna Chaijaroenkul , Siriprapa Warathumpitak , Kesara Na-Bangchang

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 42-68
https://doi.org/10.9734/bpi/cpms/v7/16949D

In vitro and In vivo research have shown that Atractylodes lancea (Thunb) DC. (AL) and its bioactive components -eudesmol and atractylodin could be used to treat cholangiocarcinoma. The study aimed to evaluate the immunomodulatory activity of AL in human subjects. The modulatory effects of AL and b-eudesmol and atractylodin on TNF$$\alpha$$ and IL6 expression in PBMCs were measured using real-time PCR. Blood samples were taken from 48 healthy subjects after they were given a single or numerous doses of the standardised AL extract capsule formulation or a placebo. Serum cytokine profiles, lymphocyte subpopulations (B lymphocytes, CD8+ cytotoxic T lymphocytes, CD4+ T-helper lymphocytes, and NK cells), and cytotoxic activity of PBMCs against the cholangiocarcinoma cell line CL-6 were evaluated using cytometric bead array (CBA) with flow cytometry analysis. AL extract at almost all concentrations significantly inhibited both TNF$$\alpha$$ and IL6 expression in Con A-mediated inflammation in PBMCs. Only IL6 expression was significantly reduced by $$\beta$$-Eudesmol at all doses. At the lowest dose, atractylodin considerably decreased the expression of both cytokines, whereas at the highest concentration, only IL6 expression was significantly inhibited. The administration of AL at a single oral dose of 1,000 mg appeared to decrease IFNg and IL10 and increase B cells, while significantly increasing NK and CD4+ and CD8+ cells. At 24 hours after dosage, there was a trend of increasing cytotoxic activity of PBMCs (relative to placebo). At 24 hours after dosage, AL at successive doses of 1,000 mg for 21 days tended to reduce the production of all cytokines while significantly suppressing IL17A production. By 24 hours, there was a trend of increased cytotoxic activity in PBMCs, but this trend stopped at 48 hours. The findings support AL's immunomodulatory properties in humans. This activity, together with AL's direct effect in triggering apoptosis in cholangiocarcinoma cells, implies that it could have a role in CCA regulation.

Trial Registration: Retrospectively registered on 17 October 2020 [Thai Clinical Trials Registry (TCTR: www.clinical trials.in.th) Number TCTR20201020001]

##### Multidetector Tomography in Cases with Major Chest Trauma

Atanas Hilendarov, Gergiev Alexander , Cherenkov Lyubomir, M. U. Plovdiv

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 69-81
https://doi.org/10.9734/bpi/cpms/v7/3381B

This article summarizes the place of Multidetector computed tomography (MDCT) in the diagnosis, examination technique and findings in injuries of the major chest trauma patients.

The most efficient imaging technique in this area is MDCT. Its advantages include especially high speed and high geometric resolution at any plane. With the use of this technique, we may accurately produce multiplanar and three-dimensional (3D) reformations while viewing sizable portions of the body with the fewest motion artefacts possible.

MDCT allows us to view diagnosis significantly more accurate. A total of 112 individuals are examined in the emergency department. The intrathoracic organs are injured, as well as the chest. Rib fractures are the most frequent traumas in 56 (or 50%) of the 112 individuals in our study. Injuries to blood vessels as well as fractures of the scapula, sternum, extra pleural hematomas, pneumothorax, hemothorax, pulmonary contusions, laceration of the trachea and bronchi, rupture of the oesophagus, and hemothorax are also documented. Due to its benefits, MDCT has risen to the top of the list for treating acute chest trauma patients.

##### A Case Report on Carotid Artery Dissection in Hutchinson-Gilford Progeria

Víctor González-Maestro, Einés Monteagudo-Vilavedra , Jorge Rodríguez-Antuña , Marta Lendoiro-Fuentes , Maria Soledad Brage Gomez, Elena Maside Mino

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 82-89
https://doi.org/10.9734/bpi/cpms/v7/7143F

Strokes in children have their own epidemiology and aetiology, and they are frequently misdiagnosed. They exhibit some risk factors that must be recognised, much like the adult population. There are several different aetiologies and morphologies associated with cerebral arteriopathies as the cause of paediatric ischemic stroke.

We report the case of a 5-year-old  HGP (missense mutation—de novo— c.1822G > A in heterozygosis, LMNA gene). The patient was identified during the first year of life and had clear phenotypical characteristics. There were no additional pertinent comorbidities. Right hemiparesis with at least four hours of evolution, the inability to open the hand, and a minor decline in consciousness (pedNIHSS 5-6) led to his admission to the emergency room. Angio- and cranial-CT scans revealed evidence suggestive of left carotid dissection. On anticoagulant and antiplatelet treatment, agreement was obtained on the use of conservative medical management. The right lower limb hemiparesis and hand paresis both resolved within the first few days of the patient's treatment, and one month following discharge.

Carotid dissection is indicated by the clinical symptoms, the genetic mutation's vascular phenotype, and the positioning of the radiological findings on a particular vascular morphology. Spontaneous dissections occur under a predisposing risk factor or disease  and are an unusual finding in patients with Hutchinson-Gilford's Progeria.

##### Cervical Cancer among Women Attending a Tertiary Care Hospital in Perambalur, India

R. H. Dandekar, . Varadheswari, . Sharanya

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 90-105
https://doi.org/10.9734/bpi/cpms/v7/2976A

The present study was conducted to estimate the prevalence of cervical cancer among women attending a tertiary care hospital. Also it revealed their knowledge, attitude and practice regarding cervical cancer. Cervical cancer prevalence can be decreased by having a positive attitude toward premalignant cervical lesion screening. The study population consisted of 74 women who were OBG patients at a tertiary care hospital in Perambalur. To determine the prevalence, Pap smear tests were administered to all the women. To evaluate the women's knowledge, attitudes, and practices surrounding cervical cancer, a questionnaire was created and interviews were conducted with them. The participants' attitudes regarding cervical cancer screening were favourable in 83.78 percent of cases. Most participants weren't getting their cervical cancer checked. Only 1.35% was found to have good screening practice on cervical cancer with 1.35% of the women having irregular.  The study found that although half of the women participants had some level of knowledge about cervical cancer, the community had a very low screening rate.

##### Anticancer Activity of PHCUMN in Breast Cancer Cells through the Stabilization of Non-covalent Bonds

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 106-114
https://doi.org/10.9734/bpi/cpms/v7/16605D

The synthesis of antitumor active compounds is a major focus of interest in many research groups in the world. We want to offer less toxic and more effective treatments. Today, the attention of the scientific community is focused on agents, that are more natural. The molecule PHCUMN1 (a derivative of heteroaromatic amino acid complexes), displays activity against cancer cells. The mechanism of anticancer was investigated responsible for this medicament in cells of breast cancer (in vitro testing).

PHCUMN is responsible for a dose-dependent decrease and unattached growth of cancer cells MCF-7. We investigated the anti-proliferative potential of PHCUMN in breast cancer cell lines. It also clarified the mechanism of action of PHCUMN in preclinical models of breast cancer. We investigated the anti proliferative ability of PHCUMN against cancer cell. We wanted to elucidate the mechanism and potency of PHCUMN in preclinical studies on cancer cell. PHCUMN has been shown to have a good effect in killing cancer cell. The percentage fragmentation laterally shows the destruction of cancer cell.

PHCUMN showed good efficacy in killing cancer cells. This is done without a visible influence on normal cancer cells the percentage of Fragmentation and nuclear shrinkage clearly shows the apoptosis of tumor cells.

According to mentioned results, we can draw conclusion that PHCUMN has potential to effect against cancer cell. The intermolecular electrostatic interaction between the side chains of DNA nucleobases with PHCUMN – stabilized the complex. The complex PHCUMN has been evaluated from the following equilibrium: DNA+ PHCUMN $$\rightleftarrows$$ DNA-PHCUMN , which lies predominantly on the right site.

##### A Mini-review on Childhood Gynecomastia

Nasir A. M. Al Jurayyan

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 115-124
https://doi.org/10.9734/bpi/cpms/v7/7164F

Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Enlargement of the male breast tissue, known as gynecomastia, is a typical finding in boys during childhood. Although the majority of cases are benign and self-limiting, they could be an indication of a systemic disease or even drug-induced. Rarely, it may represent male breast cancer. Understanding its pathogenesis is crucial to distinguish a normal developmental variant from pathological cases. In conclusion, this review will highlight the pathophysiology, etiology, diagnosis and various medical and surgical therapies.

##### Soldiers without Conscience: Why States Need to Regulate Killer Robots

James E. Archibong

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 125-139
https://doi.org/10.9734/bpi/cpms/v7/3373B

The phenomenon of artificial intelligence (AI) has significantly advanced military technology in the 21st century, by facilitating the development of lethal autonomous weapons (LAWs), also christened ‘killer robots.’ These weapon systems can select and hit targets on their own, without any meaningful human control, which has generated serious ethical issues as to their propriety. In another setback, the law of armed conflict, otherwise referred to as international humanitarian law (IHL) does not cover killer robots as such weapons were once dismissed as science fiction. The unresolved ethical issues and legal vacuum has been the subject of endless debates by governments, the United Nations (UN), civil society groups, and scholars. While some have called for their outright ban, others argue that the benefits of retaining them outweigh the disadvantages. Using existing literature on the subject, this paper analyses both sides of the debate in the light of current realities. It has been found that there are ethical and legal issues that require global attention and resolution; unregulated employment of killer robots portends danger for humanity, as this can trigger a new arms race; and States are unwilling to prohibit them for strategic reasons. It advocates the adoption of a new global treaty to address the myriad of issues associated with autonomous weapon systems, and a strong monitoring and supervisory role for the UN.

##### Assessment of Acute Nephronia and Renal Abscesses in Children: A Case from Quito, Ecuador

Adriana Arnao, Maria Augusta Guerrero , Nathaly Arias , Piedad Villacis, Katia Rivas, Mariana Flores , Jhoana Rivera, Jack Saltos , Gloria Soto , Jorge García, Edison Aymacaña , Diego Bonilla , Marcelo Merizalde , Cristina Garzón

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 140-151
https://doi.org/10.9734/bpi/cpms/v7/15840D

The objective of this study is to publically speak about this pathology to avoid morbidity and mortality in children, due to the lack of national and international epidemiological data. Renal abscess and nephronia are uncommon childhood illnesses with uncertain global frequency. Nephronia is a condition that exists between pyelonephritis and renal abscess. Prompt diagnosis is critical for reducing morbidity and mortality (sepsis, renal injury, death). Although scientific advances have made these entities more visible, they may still remain undiagnosed. Nephronia and renal abscess must be considered in the differential diagnosis in all patients with persistent fever, abdominal pain, leukocytosis, elevated inflammation biomarkers and/or torpid clinical evolution. Patients with this condition need prolonged intravenous antibiotic therapy and may need surgery to treat them, typically when the lesions are larger than 3 to 5 cm and are accessible to percutaneous draining after intravenous antibiotic therapy alone fails. The study describe five cases of pediatric patients from four private hospitals in Quito, Ecuador followed during a one-year period. In each case, persistent fever, abdominal pain, severe leukocytosis, and/or increased inflammatory biomarkers were the main reasons the diagnosis was suspected. Only one of them had a history of urinary tract deformity, although another had a malformation that was discovered upon admission. Every instance was microbiologically isolated. They all made a full recovery. There have been no previous reports of these disorders in pediatric children in our nation, and there is little data worldwide.

##### An Unusual Bifid Piriformis Muscle with High Division of Sciatic Nerve

Rashmi C. Goshi

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 152-155
https://doi.org/10.9734/bpi/cpms/v7/16980D

The sciatic Nerve can rarely be separated into tibial and common fibular Nerve within the Pelvis. In these circumstances, the common fibular nerve and tibial nerve exit the pelvis in distinct ways. This Objectives of this study is to know the variation in piriformis muscle and division of sciatic nerve. The variant discovered by MBBS students during normal dissection of a 30-year-old male cadaver at the JJM Medical College in Davangere, Karnataka, India. The difference is On the right side of a 30-year-old male cadaver, there is a high division of the sciatic nerve. The bifid piriformis's two divisions are where the common peroneal nerve is situated, whereas the tibial nerve runs beneath the inferior piriformis. Understanding this variance is crucial for treating sciatic nerve entrapment that causes nondiscogenic sciatica, and it also necessitates a review of the piriformis syndrome.

##### Overview of Cerebral Palsy in Children

Edwin Dias, S. Sonali , Akshay Dias

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 156-166
https://doi.org/10.9734/bpi/cpms/v7/3041B

Cerebral palsy is a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non progressive disturbances that occurred in the developing fetal or infant brain .The risk factors include antenatal, perinatal, postnatal causes like maternal infection,eclampsia, toxoplasmosis ,rubella, twin birth, low birth weight, difficult delivery and head trauma during the first few years of life. About 2% of cases are believed to be due to an inherited genetic cause. According to European data, the average frequency of Cerebral palsy is 2.08 per 1000 live births.

The different types of subtypes have been described on the specific problems present as spastic, dyskinetic, ataxic forms. The classification is also done as spastic diplegia, monoplegia, hemiplegia, double hemiplegia based upon body parts involved. The integrated approach is suggested in management of cerebral palsy which involves specially physiotherapy occupational therapy, speech therapy. The treatment strategies need to be functional goal oriented. Muscle tone optimization, prevention of contractures, improvement in positioning and hygiene and provide good handling to reduce abnormal movement patterns, is the key to improve quality of life in cerebral palsy. The multidisciplinary team including the child and family members should be counseled regarding benefits if serial evaluation, early intervention and encouraged to follow treatment planning.

##### Study about Otogenic Tetanus: An Approach towards Anesthetic Management

Jyoti V. Kulkarni, Anil Shriniwas Joshi

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 167-173
https://doi.org/10.9734/bpi/cpms/v7/6182F

Introduction: Tetanus is a disease caused by endotoxins, tetanolysin and tetanospasmin released from Clostridium tetani which affects motor inhibitory neurons. Patients with tetanus may need emergency surgical intervention particularly in otogenic tetanus whish was secondary to foreign body in ear. The challenge for anaesthesiologist lies in control of autonomic dysfunction and muscle spasticity. Though general anaesthesia with nondepolarizing muscle relaxant is a better choice, use of sevoflurane as a sole anaesthetic agent for short surgical procedures can be used safely.

Objective: Aim of reporting this case is to discuss safety of sevoflurane as an anaesthetic agent for short surgical procedure in patient with tetanus. Also we want to discuss about challenges for anaesthetic management of patient with tetanus.

Case Report: We have covered the anaesthetic care of a 5-year-old boy with otogenic tetanus who was scheduled for the removal of a foreign body  from his left ear in this article. With trismus, fever, muscle spasms, and difficulties swallowing for the previous four days, he was admitted    to the infectious ward. He received 2500 IU/day of injectable immunoglobulin        and a 5000 IU bolus of intramuscular tetanus toxoid. Cefixime and intravenous diazepam (6 mg every three hours) were administered. He was assigned  to have a foreign body in his left ear removed on the second day of his admission. Premedicating with fentanyl and diazepam was administered intravenously. Sevoflurane, nitrous oxide, and oxygen  were utilised for general anaesthesia. He experienced hypertension and tachycardia during and after surgery, which were managed with intravenous labetalol.

Conclusion: For surgical procedures like cleaning and debridement of wounds, removal of foreign bodies, or incision and drainage of abscesses in cases of tetanus, volatile anaesthetic agents can be utilised safely. However, it is advised to utilise nondepolarizing muscle relaxants. Sevoflurane was only utilised in one case, thus more research is needed to validate its efficacy and safety. Beta-blockers can be used to treat autonomic hyperactivity; intravenous labetalol is the preferred medication.

##### Parental Supervisory Behavior for Unintentional Injuries among under 9 Age Group Children: A Cross-sectional Study

Pradeep Tarikere Satyanarayana , Muninarayana C., V. Bhoomika

Current Practice in Medical Science Vol. 7, 25 July 2022, Page 174-187
https://doi.org/10.9734/bpi/cpms/v7/16290D

Background: According to the World Health Organization (WHO), unintentional injuries were responsible for over majority of deaths and millions of disability-adjusted life-years with over Lower middle income countries being the major contributor. Unintentional injuries are can be easily prevented in terms of both morbidity and mortality by simple prevention measures. Unintentional injuries can happen both in outdoor and indoor settings putting the child at risk equally in both circumstances. Fatal injuries are those which require medical attention and forms only the tip of the iceberg. For every child who dies of Unintentional injury, there are many more who suffer non-fatal injuries with varying degree of disability which goes either unnoticed or underreported.

Materials and Methods: This was a community-based cross-sectional study carried out for a period of 3 years from May 2019 to April 2022. Three Primary health centers of Kolar, Karnataka were randomly selected which were Aavani, Sugutur and Vemgal. 10 villages from each PHC area were selected and probability proportionate to size sampling was applied. Parental supervisory behaviour was assessed using the parent supervision attributes profile questionnaire prepared by Morrongiello BA and Corbett M was used.

Results: Study showed that falls were very common followed by bruises and cuts among children aged under 9 years. Mothers who had attended Primary schooling had higher scores in the fate domain, Mothers who work for wages and their children with history of burns and animal bites had higher scores in the Protectiveness domain. Mother with her child having history of fall had higher scores in Risk Tolerance domain and Mothers with their children having history of Cuts and Grashes and also animal bites in had higher scores in Supervision domain.

Conclusion: Parents both father / mother along with guardians must be educated regarding easily preventable measures to avoid unintentional injury.