Dr. Wan Mazlina Md Saad
Department of Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Malaysia.

ISBN 978-93-91473-79-2 (Print)
ISBN 978-93-91473-84-6 (eBook)
DOI: 10.9734/bpi/hmms/v14

This book covers key areas of medicine and medical science. The contributions by the authors include tunga penetrans, ectoparasite, glycaemic status, lipid profile, meditation, Type 2 diabetes mellitus,  leptin, metabolic syndrome, obesity, oral hygiene, sequence learning, brushing technique, female epispadias, congenital anomalies, female hypospadias, urethral anomalies, gestational age, ultrasound placental grading, epithelioid trophoblastic tumor, immunohistochemistry, intermediate trophoblastic cells, ectopic breast tissue, fibroadenoma, caesarean section, mifepristone, glaucoma, diagnosis, artificial intelligence, genetics, maximal electroshock, losartan telmisartan, renin angiotensin system, dermo-Hemodialysis, traditional cupping therapy, blood syndrome, idiopathic/non- treatable illnesses, COVID-19 pandemic, vaccine, endorphins, endometrial biopsy, fibroid, malignancy, sickle cell disease, genetic counselling, media parenting, media education, psychology, chromosomal abnormalities, infertility, recurrent spontaneous abortions, nutrient foramina, clinical manifestation, respiratory syndrome. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


Media Promotion:


Tungiasis, a Nuisance to the Marginalized Population of Developing Countries

Sureshkumar P. Nair

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 1-7

Lack of resources or because of negligence, providing high-quality health care remains unattainable in many developing countries. This may be because of the lack of interventions or planning to reduce health care problems. Parasitic diseases are markers of poverty. Tungiasis is not an exception. Tungiasis is a neglected disease that is of high prevalence in Ethiopia, Nigeria, Kenya, and many other Sub-Saharan countries, Trinidard, Tobago, and Brazil.  This article is written by referring to different research articles and besides, the author's research experience also contributes much to enrich the topic. Prior ethic sanctions were obtained from Jimma University, Ethiopia for conducting the studies. Photos were taken after getting written consent from the studied subjects. Tungiasis is an inflammatory skin disease caused by the infection of a female parasite, Tunga penetrans. The infections result in a lesion at the site of infection followed by inflammation, pain, and severe itching.  This infection is characterized by a black dot around a swollen reddish area with a white hallow around. The hypertrophy of the parasite results in the desquamation of skin epithelium. Removal of the parasite using thorns or unsterile needles may result in secondary infections. Different studies revealed that Ethiopia is an endemic area of this disease. Tungiasis is a zoonotic disease and in different countries, the reservoir varies. In Ethiopia, different studies revealed that sheep is the most favorite animal reservoir.

Raja Yoga Meditation in Glycaemic Status in Type 2 Diabetes Mellitus

Mrunal Phatak, Tara Chawla, Pallavi Phatak

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 8-19

In the current times, stress affects most of the persons either directly or indirectly. In modern times; stress either physical, mental or psychological has received a great attention as a causative and or exaggerating factor for many diseases diseases like diabetes, hyperthyroidism or hypothyroidism, Cushing’s disease etc. Meditation is a behavioral intervention which can be easily learnt and practiced by persons of all age groups and physical condition. Meditation has been proven to alter autonomic regulation of homeostatic mechanisms and cause positive effects on human physiology. In the cross-sectional study conducted on 60 patients of Type 2 diabetes mellitus, 30 patients practicing Raja Yoga meditation for more than 5 years and 30 patients not practicing meditation. We found significant reduction in blood glucose and glycated haemoglobin levels in practitioners of meditation. Lipid profile, total cholesterol and serum triglycerides too showed significant decline in practitioners of meditation. Thus we found that meditation has a beneficial effect in maintaining autonomic equilibrium in type 2 diabetes mellitus.

An Opinion on the Art of Dealing with the Patient

Dilip Kr. Goswami

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 20-22

Physicians are being honoured as the most honourable personalities in the society. To specify their position in the society it is said that, they are like the Gods "Vaidya Bhagawan". They are honoured not only by the common people but also by the kings. The tradition of appointing "ROYAL PHYSICIAN - RAJAVAIDYA" is being continued since time immemorial. Since a physician gives "life and freedom from suffering" to a diseased person he/she is considered to be the person earning the spiritual peace "DHARMA".

But, with all the honour and respect, the physicians have many precautions to be followed during their practice as simultaneously with the honour they are susceptible to dishonour and defamation. Hence the art of dealing with the patients should be earned by each and every physician.

Background: Central obesity, hypertension, dyslipidemia, hyperglycemia, and insulin resistance are all symptoms of metabolic syndrome, which is a progressive illness. Patients with metabolic syndrome have a higher risk of death from coronary heart disease, stroke, vascular dysfunction, and other causes. Obesity is one of the most serious epidemics of modern day, and the hormone leptin plays a critical role in body weight and energy balance management. The present study was planned to elucidate the relevance of leptin as a biomarker in the metabolic syndrome.

Methods: A total of 355 people were chosen from the ESIC hospital's Okhla OPD, Department of General Medicine, with 196 men and 159 women suffering from type 2 diabetes mellitus and metabolic syndrome. The data was gathered over the course of a year, from June 2018 to July 2019. The patients' Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), lipid profile, Insulin (fasting), and leptin levels were tested after a baseline clinical and anthropometric evaluation. Results: Female patients with type 2 diabetes and metabolic syndrome had significantly higher blood sugar fasting, blood sugar postprandial, lipid profile, leptin, and insulin levels than male patients. Conclusions: According to the findings, leptin has a substantial relationship with metabolic syndrome and could be utilised as a biomarker for early diagnosis of the disease.  

Evaluating the Change in Skills Observed with a Novel Brushing Technique Based on Sequence Learning Using Video Bio-Feedback System in Children

B. Nandlal, Raghavendra Shanbhog, Brinda S. Godhi, B. S. Sunila

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 31-36

Background: Amongst young children an easy but adequately effective fones or horizontal scrub methods have often been advocated and is employed. Fones technique is indicated for young children and others who do not have the proper muscle development for the more complex techniques.  Our observation is that children practicing this technique concentrate more on front buccal surfaces of the teeth and neglect inner surfaces of teeth. To overcome this problem modification in technique is required.

Aim: The aim of the study is to describe the brushing technique based on sequence learning principle and to evaluate change in skills observed after teaching and practicing this technique with video bio-feedback system.

Methods: The process of brushing starting from dispensing of the paste on brush till completion of brushing was video recorded for each child in a standardized way by expertise before and 12 weeks after the training of new brushing method. Data brushing skills were collected and was statistically analyzed.

Results: Overall change observed in learning skills of children with new brushing method as compared to innate method in both maxillary and mandibular arch showed statistically significant improvement with new brushing method (p<0.001).

Conclusion: For children tooth brushing should be presented as a habit and an integral part of the daily hygiene routine. Brushing technique based on sequence learning principle technique can be recommended as a novel method of brushing for children.

Studies on Female Urethral Anomalies in Pediatric Age Group in India

Nikhil A. Patil, Siddangouda B. Patil, Vinay S. Kundargi, Ashok N. Biradar

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 37-42

Female urethral anomalies such as epispadias and hypospadias have been rarely reported in the literature. Clinical diagnosis of female urethral anomalies is significant for management. Diagnosis may be missed leading to mismanagement of the clinical condition.

Background: The current study is based on the Grannum placenta grading system. It is widely known that placental maturation is accelerated in PIH patients, and the emergence of a grade 3 placenta before 37 weeks may indicate placental malfunction, which is linked to low birth weight newborns, IUGR meconium stained fluid, and a low APGAR score. As a result, this study was carried out to focus on placental grading at various stages of pregnancy in order to forecast and prevent greater obstetric and foetal impairment, as well as to compare the outcomes.

Methods: To determine the placental grading and biophysical profile of all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college in Bangalore, obstetric scans were undertaken.

These women were monitored for obstetric and foetal outcomes till delivery.

Results: In group 1, 17 patients (50%) had a grade 3 placenta, while group 2 has 39 individuals (59%) with a grade 3 placenta. Grades 1 and 2 were merged and compared to grade 3 for statistical analysis, yielding a P-value of 0.198, which was not statistically significant. Between the two groups, there was no statistically significant difference in age or gravidity. Medical problems were more common in group 2, which lasted between 37 and 40 weeks. PIH problems were also more common in group 2.The 34-36 weeks group had a higher number of LSCS (n=19 versus 14), but the difference was not statistically significant. Group 2 had a higher rate of IUGR and IUD, however this was not statistically significant. Group 1 had a mean birth weight of 2 kg, while group 2 had a mean birth weight of 2.7 kg. Group 2 had the most linked medical conditions.

Conclusions: Hypertensive women's placental maturation is accelerated, resulting in maternal and foetal problems. As a result, women who have rapid placental maturity on ultrasound should be thoroughly examined and treated properly.However, we believe that larger randomised trials are required.

Epithelioid Trophoblastic Tumor – Case Study with Review of Literature

Sumalatha Kasturi

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 49-55

Epithelioid trophoblastic tumor (ETT) is a rare chorionic type intermediate trophoblastic cell neoplasm. It's a type of neoplasm that affects women of reproductive age and usually occurs after a pregnancy. ETT can arise in both intrauterine and extrauterine locations, and it's easy to confuse it with other conditions such squamous cell carcinoma, placental site nodule, and placental site trophoblastic tumour. Metastasis and death has been reported. Hence, proper diagnosis of this tumor is necessary to avoid delay in proper treatment and to avoid unnecessary, excessive treatment. This tumor is chemoresistant and surgical treatment is considered sufficient for ETT. We present a case of ETT in a 36-year-old woman who came with abdominal pain, vaginal white discharge, and a cervical mass. The objective of this study is to have a thorough knowledge of this entity as it is rare, has distinct histology and immunohistochemistry profile and to avoid delay in the proper treatment.

Ectopic breast tissue fibroadenoma is a rare illness.Along the milk line, ectopic breast tissues can be seen.In ectopic breast tissue, malignancy is more common than fibroadenoma. Ectopic breast tissue with or without a nipple areola complex can be found.We present a case of a 20-year-old woman who had an ectopic breast tissue fibroadenoma in the anterior chest wall with no nipple areola complex. Excision and biopsy were performed on the patient. The fibroadenoma of the ectopic breast tissue was verified by histopathology.This case was described because of its rarity and to emphasise the need of checking EBT for any abnormalities as part of routine breast screening.

Introduction: The obstetrician faces a big hurdle while inducing labour in a previous caesarean section(CS). Globally rates of induction of labour in women with previous CS are decreasing. Whenever a pregnancy must be terminated for obstetric reasons, the trend is toward elective repeat caesarean sections. Vaginal birth is associated with less complications as compared to repeat CS more so in population like ours where multiparity is more common. Therefore, a need for an agent with better outcome in terms of vaginal birth is desirable.

Aim of Study: The study was aimed to evaluate the efficacy of Mifepristone for cervical ripening and induction of labour in previous caesarean cases. It was also aimed to assess induction delivery interval and maternal and fetal outcomes.

Methods: This was a prospective study carried out in a tertiary care centre in North India on fifty two term pregnant females with previous one caesarean section admitted for labour induction for various indications. They were randomly divided into two study groups of twenty six each. Group A females received tablet Mifepristone and group B females received placebo.

Results: There was no difference between both groups in age, period of gestation and Bishop score at induction. Most common indication of induction was post dated pregnancy in both groups. When compared to the control group, there was a statistically significant difference in induction to onset of labour with Mifepristone. In the mifepristone and control groups, the time gap between induction and onset of labour was 24 hrs 7 min and 37 hrs 3 min, respectively. Mean induction delivery interval was 33 hrs 1 min and 46 hrs 9 min in cases and control group, but this was not statistically significant. Twenty one patients (80.7%) delivered vaginally in the mifepristone group as compared to 15(57.6%) in the control group.

Conclusions: This study showed that Mifepristone is simple and effective method in term women with previous LSCS for IOL with a favourable outcome and its use provides an interesting new alternative to classic uterotonic agents when induction is necessary in previous LSCS cases.

Glaucoma Perspective: From Back to Future

Amal Moustafa Elbendary

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 69-73

Glaucoma diagnosis represents a dilemma that cannot be addressed by relying on a single diagnostic tool or evaluation of a solitary marker. Conventional, subjective methods including nerve fiber layer photography and visual field analysis were associated with inconsistency in diagnosis. The advent of optical coherence tomography (OCT) enabled objective evaluation of numerous relevant structures including peripapillary retinal nerve fiber layer (RNFL), neural rim area, optic disc margin, and ganglion cell complex. The newly introduced OCT angiography enabled detection and evaluation of perfusion, blood flow, and vessel density at different vascular beds. The recent application of artificial intelligence (AI) and genome-wide association studies (GWAS) made it possible to optimize glaucoma care at an earlier stage with deeper insight.

Determining the Evaluation of Anticonvulsant Activity of Angiotensin Receptor Antagonists in an Animal Model

Asha Dattatraye Jadhav, Rakesh Jadhav, Sudhir Padwal, Anand Kale, Swapnil Jadhav, Prakashchandra Gade

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 74-82

Background: Epilepsy is a common chronic illness in clinical practise, and some research suggests that the renin-angiotensin system in the brain may be involved in seizure upregulation.

Aims: The purpose of this investigation was to see if angiotensin II AT1 receptor antagonists have anticonvulsant activity in experimental mice.

Methods: Losartan (50 mg/kg), Telmisartan (30 mg/kg), and Candesartan (20 mg/kg) were given intraperitoneally to mice and their anticonvulsant activity was assessed using the maximal electroshock (MES) and Pentylenetetrazol induced seizures (PTZ) seizure techniques. For the MES method, phenytoin was used as the standard, while for the PTZ method, diazepam was used as the standard. Motor impairment of performance was assessed by the inverted screen test and spontaneous motor activity with digital actophotometer.

Results: Losartan's anticonvulsant effectiveness was demonstrated in MES and PTZ models. In MES-induced seizures, Telmisartan and Candesartan showed anticonvulsant effect, but not against Pentylenetetrazol-induced seizures. Losartan at dose 50 mg/kg prolonged the mean latency to convulsion (p<0.01) and mean number of convulsions also significantly reduced (p<0.05) convulsions in the mice.  The mean latency to convulsion was significantly prolonged with Telmisartan and Candesartan at doses of 30 mg/kg and 20 mg/kg, respectively (p<0.05).  There was no substantial motor impairment with any of the test medicines, such as angiotensin receptor antagonists. Conclusions: Losartan, Telmisartan, and Candesartan are angiotensin receptor antagonists that have been shown to have anticonvulsant activity in PTZ and MES seizure models. Because the specific mechanism of action of its anticonvulsant activity is unknown, more research is needed to test it in a variety of other anticonvulsant animal models.

This article is about a new medical therapy, Dermo-Hemodialysis to replace the common, randomly performed traditional non-scientific methods such as Wet cupping therapy as the treatment of choice for a new illness named "Bad Blood Syndrome", a syndrome described with its treatment for the first time in Medicine which can explain and resolve many idiopathic and non-treatable illnesses as well as unusual or unexpected complications after a simple surgical procedure (*).

The presence of the Bad Blood in any organ can compromise the functions of that organ, the system, hence the whole body, therefore the presence of such blood will compromise the immune system which is the main reason of disease prolongations or deaths due to illnesses in most patients or sudden death in normal people. Dermo-Hemodialysis is the best treatment for the current COVID-19 pandemic and it can save the world from this global crisis especially at the present time when the vaccine is still not promising to effectively end this pandemic or others in the future.

Background: Present study highlights the association between symptomatic patients of fibroids and its coexistence with pathologies like endometriosis, adenomyosis, polyp, endometrial hyperplasia, and carcinoma. The aim was to evaluate the role of endometrial biopsy before surgery.

Objectives: To determine the association between symptomatic patients of uterine fibroids and its coexistence with other uterine pathologies like endometriosis, adenomyosis, endometrial hyperplasia, endometrial carcinoma, and endometrial/cervical polyp. To evaluate the role of endometrial biopsy before undergoing operative management like hysterectomy/myomectomy.

Methods: An Observational Cohort research was undertaken on women who had fibroid surgery or who had just been diagnosed with fibroid. There were 150 women in total. The histopathology reports of patients who had already been operated on were analysed to see if there was an association between uterine pathology and fibroid. Ultrasonography findings were noted in prospective instances, and patients with leiomyoma had biopsy and reports were analysed for the association. A Chi-square test was done to establish a relationship between a qualitative variable, and p-value <0.05 considered significant.

Results: Out of 150,24.6% had adenomyosis,14% had endometrial hyperplasia in which 2% had atypia and 12% without atypia,8.6% had a cervical polyp,5.33% had an endometrial polyp, 4% had endometriosis, while 42.7% had no association.

Conclusion: This study discovered an increasing tendency of leiomyomas along with uterine diseases. Early detection of endometrial diseases based on clinical history and imaging helps identify high-risk individuals who require a biopsy to rule out malignancy, thus avoiding routine D and C, which is done for every case.

Background: People with sickle cell disease (SCD) seek health care services quite often, as the condition is associated with high morbidity and mortality. The emergence of the COVID-19 pandemic has imposed diversion of health care attention and resources from the usual demands. COVID-19 cases have occupied health care facilities, providers, as well as care planners. This has affected the already dire state of SCD management in Sub-Saharan Africa (SSA). It is necessary to look at options that have been examined and demonstrated to reduce the prevalence of SCD. The purpose of this review is to present prospects and methods that could be useful in reducing prevalence of SCD.

Study Objective: To review literature and targeting studies, presentations and information on control of SCD.

Methodology: The aims of the review were to document and discuss the methods that have been applied to reduce the prevalence of SCD so as to prospect for use in SSA. A review of the literature and targeting studies, presentations and information on control of SCD. The sources used were PubMed, PubMed Central, Google Scholar, and African Index Medicus. Bases of selection were any aspect of control of SCD by educational, counseling, awareness, prevention, testing and providing information. This article has explored, discussed and presented these prospects.

A Cross-Sectional Study on Media Parenting in Rural Part of India and Its Impact on Children

Bishnupriya Sahoo, Rupali Malik, . Richa, Daksh Yadav, Satya Kiran Kapur, Pankaj Abrol

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 115-128

Background: Media and gadgets are increasingly being used in urban as well as rural pockets both among adults as well as children. Excessive use is a concern due to its various negative consequences.

Objectives: To assess: i) pattern, duration, types of media screen exposure and reason for use of media by children, ii) assess the parental knowledge, attitude and ability as a media mentor for their children and iii) impact of media usage on school performance. The study showed, two third of children themselves decided the media content without any absolute knowledge about healthy and appropriateness of the chosen one.

Study Design: Qualitative cross sectional study.

Participants: Two hundred children <18 years, who were visiting the hospital for OPD services along with their parents.

Intervention: A predesigned questionnaire for data collection.

Results: The mean age for child media exposure was found to be 6.4± 3.8 years. Media use on school-days was 1.9 against 2.7 hours on holidays by children. Media contents were mostly cartoon and mobile games with television and mobile being the commonest mode. Poor school performance was associated with media use of 2 hours in school days amongst > 5 year old children [HR =1.38 (95CI= 1.01-1.89), p=0.04]. Many parents knew about few bad consequences of media but unable to regulate in absence of proper knowledge and awareness.

Conclusion: Proper media parenting is an unmet need not only in urban but also in rural areas. Media use during school-days should be discouraged. Interventions like parental media education with involvement of paediatrician, school teacher, psychologist and policy makers’ will be needed.

Cytogenetic Abnormalities Found in Patients with Infertility and Recurrent Spontaneous Abortions

Mirela Mackic-Durovic, Dunja Rukavina

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 129-135

The primary purpose of this study was to determine the frequency and types of chromosomal aberration in infertile couples. First-trimester pregnancy loss, as well as infertility, is a prevalent issue among many couples, and the main reason they investigate is their chromosomes in that case. Two hundred and sixty-six couples came to the Center for Genetics of Medical Faculty-University of Sarajevo for chromosomal cytogenetic analysis due to infertility or a more significant number of spontaneous abortions. A karyotype has been made to each couple, using GTG technique from cultures of lymphocytes from peripheral blood. The overall incidence of chromosomal abnormalities was 15 out of 266 couples (9%). They were divided by primary diagnose as couples with recurrent spontaneous abortions 107 and infertility couples 159. The first group has found chromosomal changes in four males and one female, whereas, in the second group, it has found chromosomal changes at seven females and three males. Structural and numerical chromosomal changes did not differ from relevant updated references from other countries and were the leading cause for infertility and recurrent spontaneous abortions. This study illustrates the incidence and distribution of chromosomal abnormalities among couples with recurrent miscarriage and infertility. Genetic testing and counseling are essential for couples with an abnormal karyotype before deciding about further reproductive options.

Determining the Morphological Variations of Nutrient Foramina in Upper Limb Long Bones

Mamta Sharma, Rajeev Prashar

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 136-141

The nutrient artery is the principal source of blood supply to a long bone and is particularly important during its active growth period in the embryo and foetus as well as during the early phase of ossification. The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult upper limb long bones. The study was performed on 40 upper limb long bones which include 40 humerii, 40 radii, 40 ulnae. The bones were obtained from department of anatomy Punjab institute of medical sciences, Jalandhar. The variations were found in number and location of nutrient foramen in different upper limb bones. In humerus double and triple foramina were found. In radius and ulna double foramina were observed at the maximum. Absence of nutrient foramen was observed in radius. The knowledge about these foramina is useful in surgical procedures.

A Review on Current Status of SARS-CoV-2 (2019-nCoV): Its Diagnosis and Challenges

Bhagat Singh, Dheer Singh, Kamal Pant, Ramakant Yadav, Raj Kumar, Rajesh Verma, Renu Singh, Satender Saraswat

Highlights on Medicine and Medical Science Vol. 14, 20 July 2021, Page 142-158

The worldwide pandemic of Covid-19 is a major source of concern because it has an impact on everyone's life, whether directly or indirectly. As a result, inter-personal and social interactions have changed significantly. Up to 19th April 2021, there have been 140,886,773 confirmed cases of COVID-19, including 3,012,251 deaths as reported to World Health Organisation (W.H.O.), out of total confirmed cases only America shares 59,757,984 cases and India 15,061,919 cases. A total of 792,796,083 vaccine doses have been administered globally till 18th April 2021. Repeated emergence and global transmission, large numbers of infected people, infection and mortality among Health Care Workers (HCWs), and increased risk in vulnerable/susceptible groups have all been major sources of concern. We have summarized all the updated information on SARS-CoV-2 (2019-nCoV) including epidemiology, clinical manifestation, laboratory diagnosis, vaccine development, preventive measures and present as well as future challenges.