Editor(s)

Dr. Triki Mohamed Amine
Department of Orthopaedic Surgery, Sahloul University Hospital, Sousse, Tunisia.

ISBN 978-93-91882-83-9 (Print)
ISBN 978-93-91595-95-1 (eBook)
DOI: 10.9734/bpi/hmms/v18

This book covers key areas of medicine and medical science. The contributions by the authors include foetal organ development, precursor cells, stem cells, regenerative medicine, reparative surgery, surgical experimental models, heart repair, oesophagus defect reconstruction, diabetes treatment, tuberculosis, antitubercular therapy, brain metastases, radiotherapy, knowledge-based planning, stereotactic, radiosurgery, thalassemia, child health, dentin hypersensitivity, hydrodynamic theory, odontoblasts, congenital anomalies, cholelithiasis, cholecystectomy, gallstones, laparoscopy, ultrasonography, maternal mortality, maternal death review, direct obstetric causes, Eustachian tube, tympanoplasty, Toynbee test, pathogenetic factors, contraceptive menstrual blood pollution, contraception reversal, fragmented germ cells, germ cell`s replant, reduced endogenous estrogen, rising environmental estrogen, two subsets of people- with and without contraception, mycobacteria, Lichtenberg figure, diagonistic diligence, titanate coupling agent, silane coupling agent, aqueous oral environment, hydrolytic degradation, dental composite, pneumothorax, pulmonology, thoracic surgery,  lymphangioleiomyomatosis, pulmonary emphysema, diabetic nephropathy, fistula, morbidity, abdominopelvic mass, mucinous cystadenocarcinoma, malignant ovarian tumour,  music therapy, preoperative anxiety, accessory left vertebral artery, duplicate origin of the left vertebral artery, vertebral artery variation, head and neck vascular variations, juvenile nasopharyngeal angiofibroma, vascular tumor. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.

Media Promotion:

### Chapters

##### FOETAL Organ Implantation into Adult Animals: A Model for In vivo Culture of Stem Cells?

V. P. Coulic, V. N. Novikov, F. Mboti, P. Delrée

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 1-22
https://doi.org/10.9734/bpi/hmms/v18/2425F

Background: Presently stem cell implantations are more and more developed and applied in clinics as alternative and complementary solutions to adult organ transplantation because of the growing demand and capacities to provide these interventions, while lack of donors is patent. But some limitations of stem cell use remain (for instance integration within the recipient organism of engineered tissues and organoids obtained in vitro from stem cells). The use of foetal organ implantation into adult animals may be an alternative for in vivo study of stem cell development and evaluation of the host participation to this process. The objectives of this work were to try different foetal organ implantations into adult animals (part I) and to evaluate their use for repairing experimental lesions of some adult organs (part II).

Material and Methods:

Part I: In > 650 experiments on rats and mice, different sites of foetal organ syngeneic implantation were proposed. Physiological (electric activity, motor and secretion activity) and morphological (per illumination, ultra sound and magnetic imaging, optic and electron microscopy) methods were used for implant development evaluation during up to 12 months.

Part II: Foetal heart and foetal digestive organs were tested for both oesophagus circular defect and heart thermic lesion repair (38 and 29 rats).Trials with foetal pancreas implantation were provided in rats with diabetes induced by Streptozotocin and/or protein deficit and in a small pilot group of diabetic patients.

Result:

Part I: After a “dedifferentiation” phase, foetal organ implants could grow following ontogenetic pattern but – at least in our experimental conditions - some of them were not able to re-organize as a whole functional adult organ. The factors enhancing or limiting the organoid formation are considered.

Part II: Foetal heart implants were proved to enhance heart lesion morphological and functional repair. Foetal oesophagus, stomach or intestine fragments combined with chitosan flaps ensured a complete restoration of the oesophagus wall after oval or segmental resection. Implantation of foetal pancreas was able to reverse Streptozotocin induced diabetes and to prevent chronic glucose disorders following protein deprivation in rats. In patients temporary positive influence was noted.

Conclusion: Implantation of different foetal organs into syngeneic adults may constitute a valuable model for theoretical studies of in vivo stem cell differentiation and organoid growth. The ear implantation site deserves special attention. Some interesting applications are possible and worthwhile to be discussed and developed.

##### Study on Cutaneous Tuberculosis: Issues in the Diagnose

Y. Corona Hechavarria, T. La O Rivera Maria, L. Olaechea Varona, Esema Christopher, Ahmad Ashfaq

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 23-31
https://doi.org/10.9734/bpi/hmms/v18/11038D

Liquen scrofulosorum, also known as tuberculosis cutis lichenoides, is a rare tuberculid that presents as lichenoid eruptions of minute papule, is an uncommon disease and easily misdiagnosed. The lesions are usually asymptomatic, closely grouped, skin colored to reddish-brown papules, often perifollicular. The eruption usually is associated with a strongly positive tuberculin reaction. Diagnosis of the lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. A report a case of lichen scrofulosorum in an adult male with a florid medical history is done with the objective of determinate the effectivity of the antitubercular therapy, was revealed the promptly responded to antitubercular therapy of the patient with a complete clearance of the lesions after one month.

Background: This case highlights the uncommon easily misdiagnosed but readily treatable case of lichen scrofulosorum.

##### Training and Evaluation of a Knowledge-Based Model for Automated Treatment Planning of Multiple Brain Metastases: An Advanced Study

Vishruta A. Dumane, Tzu-Chi Tseng, Ren-Dih Sheu, Yeh-Chi Lo, Vishal Gupta, Audrey Saitta, Kenneth E. Rosenzweig, Sheryl Green

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 32-45
https://doi.org/10.9734/bpi/hmms/v18/10941D

Aim: Volumetric modulated arc therapy (VMAT) has been utilized to plan and treat multiple cranial lesion metastases using a single isocenter due to its ability to provide steep dose gradients around targets as well as low doses to critical structures. VMAT treatment is delivered in a much shorter time compared to using a single isocenter for the treatment of each lesion. However, there is a need to develop methods to reduce the treatment planning time for these cases while also standardizing the plan quality. In this work we demonstrate the use of RapidPlan, which is a knowledge-based treatment (KBP) planning software to plan multiple cranial SRS cases.

Methods: 66 patient plans with 125 lesions (range 1-4, median 1) were used to train a model. In addition, the model was validated using 10 cases that were previously treated and chosen randomly. The clinical plans were compared to plans generated by RapidPlan for target coverage and critical organ dose.

Results: Coverage to the target volume, gradient index (GI), conformity index (CI) and minimum dose to the target showed no significant difference between the original clinical plan versus the plan generated by KBP. A comparison of doses to the critical organs namely the brainstem, brain, chiasm, eyes, optic nerves and lenses showed no significant difference. Target dose homogeneity was slightly better with the clinical plan, however this difference was also statistically insignificant.

Conclusion: This work demonstrates that KBP can be trained and efficiently utilized to help decrease the treatment planning time while standardizing and optimizing treatment plan quality.

##### An Exploratory Qualitative Study on Indonesian Mothers' Needs and Concerns about Having a Thalassemic Child and Its Treatment

Henny Suzana Mediani, Ikeu Nurhidayah, Ai Mardhiyah, Ramdan Panigoro

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 46-56
https://doi.org/10.9734/bpi/hmms/v18/10008D

Thalassemia is a major genetic blood disorder that considered as a public health problem in Indonesia. Yet, little is known about affected individuals thalassemic children and parents overall experiences with and perceptions of thalassemia mayor in Indonesia. This study aimed to explore the concerns, beliefs, feelings and needs of mothers' who have a thalassemic child. A total of (N=24) mothers' were chosen as participants. Focus Group Discussion (FGD) was carried out to better elucidate the mothers' perceptions of their needs and concerns. A semi-structure focus group moderator’s guide corresponding to the research questions was developed. To gain in-depth understanding, questions were divided in four major domains which were (i) Perceptions about child disease, (ii) Knowledge about thalassemia and its treatment, (iii) Thalassemia impact on child and family, and (iv) Needs and future concerns. Transcripts were thematically coded according to the research themes that emerged from the data, and the themes were further sorted into subthemes. The finding of this study indicates significant impact of thalassemic children on their families in terms of emotional well-being, financial burden and social impact. Mother’s education level was very low about Thalassemia. Mother also expressed their needs for more information about thalassemia and its treatment, social, professional support, and financial support. Results of this study provided a portrait of the reality that thalassemia has a significant impact on children and their families. A holistic approach should be carried out while caring with thalassemic children and their families. Nurses and health care professionals should explore the feelings, concerns and needs of mothers' who have thalassemic children and eventually provide appropriate care plans that alleviate their suffering.

##### Role of Odontoblast TRPC5 in Dentin Hypersensitivity

Tushar Bhople, Priyanka Zille Bhople

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 57-62
https://doi.org/10.9734/bpi/hmms/v18/10718D

Dentin hypersensitivity (DH) is a relatively common painful condition among dental problems for which several treatment options have been tested. Although many studies have been performed regarding the diagnosis and treatment of DH, dental professionals are still confused about the definite diagnosis and treatment. The neurosensory mechanisms for dentin hypersensitivity are still unclear. According to the hydrodynamic theory, DHS is related to fluid movements within exposed dentinal tubules. Although, this theory cannot explain for all pain associated with DHS. TRPC5 also known as transient receptor protein 5 (TRP-5) is a protein that in humans is encoded by the TRPC5 gene. In this chapter we will study the role of odontoblasts when equipped with the cold-sensor TRPC5 along with TRPA1, can lead to sensitivity.

##### A Cross-sectional Study of Congenital Anomalies in a Tertiary Care Hospital in North East Region, India

Kangjam Radhesana Devi, R. K. Praneshwari Devi, Jyoti Priya, Ahanthembi Sanaton, Leimapokpam Roshan Singh, Lalhlimpuii Murray

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 63-71
https://doi.org/10.9734/bpi/hmms/v18/3032F

Background: Congenital anomalies are described as structural and functional abnormalities, including metabolic problems, apparent at birth, and are a significant source of morbidity and mortality in infants. These birth defects are caused by poor embryogenesis or intrinsic anomalies in the development process, and they are linked to a number of risk factors.

Methods: Our research took place at the Regional Institute of Medical Sciences in Imphal over the course of a year and a half, from May 2016 to October 2017. The study's goal was to determine the prevalence of congenital malformations and the proportions of various types of congenital defects.Maternal age, religion, parity, gestational age, baby's sex, outcome, and birth weight were all investigated.

Results: There were 91 congenital anomalies in total, out of 13658 births.Congenital anomalies were found in 0.66 percent of the population.Cleft lip was the most prevalent congenital defect (17.6%), followed by CTEV (13.2%), and was more common in male term newborns. These were most common in the maternal age group of 18-24 years (34.1%), followed by 30-34 years (26.4%), and women of parity P0-P2.

Conclusions: Stillbirths and infant mortality are frequently caused by congenital abnormalities. At 18-20 weeks, a level II targeted scan should be performed to detect anomalies and lower the prevalence. There should be comprehensive education in the community about common congenital abnormalities, their outcomes, and possible treatment options.

##### Cholelithiasis and Its Management: A Clinical Study

C. P. Mohan, J. Kabalimurthy, R. Jayavarmaa

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 72-77
https://doi.org/10.9734/bpi/hmms/v18/2278F

Background: The study was carried out to investigate the clinical presentation, incidence, and variations in presentation among different age/sex groups, as well as the various modes of management of Cholelithiasis.

Methods: From October 2016 to September 2018, this study was undertaken in our hospital's department of general surgery on 50 patients who arrived with symptoms and signs suggestive of gallstones and were confirmed as Cholelithiasis based on radiological and laboratory evidence.  The management of the disease, and postoperative complications and histopathological evaluation of the specimen were done and the results were correlated with various other studies.

Results: Between the ages of 17 and 79, the most people are afflicted.Almost all of the patients had dyspepsia and right hypchondrial discomfort.The diagnosis of cholelithiasis was confirmed in 100% of the patients by USG abdomen.In our study, the average age of the patients was 48 years. Gallstones of various types were the most common.Cholesterol stones are next on the list, followed by pigment stones.52% of the patients were female. All the 50 patients were treated surgically, 39 open cholecystectomy and 11 laparoscopy cholecystectomy. All 50 gall bladders sent for HPE, out of which 49 reported as chronic cholecystitis and 1 reported as adenocarcinoma.

Conclusion: Cholelithiasis is most usually found as incidental finding on ultrasonography, especially in the fourth or fifth decade of life.Surgery was planned for the symptomatic individuals after USG confirmation. The procedure of choice is laparoscopic cholecystectomy.

##### Study on Reducing Maternal Mortality from Direct Obstetric Causes during 2013 in Sudan

Umbeli Taha, Salah Ismail, Elmahgoub AbdAlla, Kunna Abd Alilah, Sawsan Eltahir, Salman Mirghani

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 78-87
https://doi.org/10.9734/bpi/hmms/v18/9491D

Despite global commitments to improving maternal health, measuring, monitoring, and comparing mortality estimates remains difficult. This study was conducted in Sudan in 2013 to assess maternal mortality from direct obstetric causes (obstetric haemorrhage, hypertensive disorders, and sepsis) after appropriate interventions.

Since 2009, Sudan has been conducting facility and community-based MDR (maternal death review). MDRCs (Maternal Death Review Committees) were established at the national and state levels.Each state, health facility, and locality was assigned a focal point.MD (maternal deaths) were notified by phone, and all notified maternal deaths were reviewed using a structured format. Recommendations have been developed to reduce MM (maternal mortality) caused by obstetric haemorrhage, hypertensive disorders, and sepsis.Management protocols, care provider training, and the availability of necessary requirements for these cases have all been approved and implemented in all states. The reported MD were reviewed and analysed with SPSS, version 18.0, and the resulting MMR (maternal mortality ratio) was compared to years 2010-2012 to assess improvement. In 2013, 1,110 maternal deaths were reported out of a total of 645,881 LB (live births).The MMR was 172/100,000 LB, with variations between states. There were 937 maternal deaths in facilities (84.4 %) and 173 deaths in the community (15.6 %). Direct obstetric deaths were 678 (61.1%), mainly due to haemorrhage 311 (28.0%), hypertensive disorders 116 (10.5%) and sepsis 110 (9.9%). Indirect causes were 432 (38.9%), mainly due to hepatitis and anemia. Most of the hospital deaths 707 (75.5%) were admitted late from home and 559 (59.7%) died within 24 hours.  MDs from hypertensive disorders and sepsis have significantly decreased, while MDs from haemorrhage have remained persistently high compared to 2010-2012.The main causes of maternal deaths are home birth, late presentation, a lack of blood, and a poor referral system. MDs from hypertension and sepsis have decreased significantly, whereas MDs from haemorrhage have remained persistently high.

##### Evaluating the Eustachian Tube Function in Chronic Suppurative Otitis Media in Reference to its Treatment Outcome

Sucheta Gupta, Mohit Goel, Padam Singh Jamwal

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 88-99
https://doi.org/10.9734/bpi/hmms/v18/2967F

Background: Tubal malfunction is the most important factor in the development and persistence of otitis media. When the Eustachian tube malfunction persists, the most carefully performed surgery will fail because the initiating   pathogenetic factors of Eustachian tube function and middle ear ventilation are still present. Measurement of the Eustachian tube function is therefore an important part of the medical and surgical evaluation of the middle ear disease.

Aims:

The study was undertaken to find out Eustachian tube function in safe type of chronic suppurative otitis media and to study the comparison of graft uptake in normal, partially impaired and grossly impaired Eustachian tube function in safe type of chronic suppurative otitis media.

Methods:

• The present prospective study was conducted in the department of otorhinolaryngology and Head and Neck surgery, SMGS Hospital, Jammu w.e.f November 2016 to October 2017. The study was conducted after taking approval of institutional Ethics committee. The patients attending ENT outpatient department were enrolled in the study. Patients were diagnosed clinically and also audiometrically by Pure Tone Audiometry and impedance audiometry. Eustachian tube function test- TOYNBEE test was done in all the patients. An equal number of patients with normal, partially impaired and grossly impaired Eustachian tube function were considered for surgery.

Results: Out of 20 patients with normal Eustachian tube function, 19(95%) showed graft uptake. Out of 20 patients with partially impaired Eustachian tube function, 18(90%) showed graft uptake. Out of 20 patients with grossly impaired Eustachian tube functions 13(65%) showed graft uptake. Comparison of mean values of pre and post- operative AB gap with respect to normal, partially impaired and grossly impaired Eustachian tube functions .Comparison is highly significant statistically with (p< 0.001).

Conclusion: ETF testing by impedance audiometry is a simple non-invasive method of testing the ETF. As seen in our study, functioning Eustachian tube is an important requirement for optimum outcome of myringoplasty. Testing the functions of Eustachian tube before surgery provides a possibility of predicting the possible outcome of myringoplasty / tymapanoplasty. This is also concluded that a partially functioning Eustachian tube should not be considered to be a contraindication to these surgeries as in many of these cases graft uptake and AB –gap closure was good (90%).

##### A Retrospective Analysis of Prevalence of Liver Diseases and Fragmented Germ Cells with Reduced Endogenous Estrogen Including Prevalence of Hepatitis B Virus and Rising Environmental Estrogen

Elizabeth Jeya Vardhini Samuel

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 100-108
https://doi.org/10.9734/bpi/hmms/v18/2397F

Background: Increased global incidence of liver illness, including hepatitis B, C virus infections, and nonalcoholic steatotic hepatitis, during the era of contraception and abortions [20th, 21st centuries] implemented as family welfare programmes. In 1998 and 1994, rising oestrogen particles were observed in the air and water, respectively.

Objectives: The altruistic association of contraception, abortion [if any], and rising liver diseases, hepatitis B and C viral infections, and rising environmental estrogen was sought.

Methods: In 2012, a retrospective analysis of the prevalence of liver diseases in 350 patients aged 20-35 years, 35-50 years, and >50 years, based on data collected by convenient, stratified random sampling from various geographical locations between 2003 and 2012, and its relationship with contraception, abortion, and other factors, was carried out;simultaneously, serum estrogen levels obtained from 105 patients, was also analyzed.

Estrogen levels were measured in four sea water samples and three river water samples.

In order to detect foetal and adult haemoglobin, electrophoresis of haemoglobin in sea water was attempted. In sea and river water samples, alpha fetoprotein and $$\beta$$ human chorionic gonadotropins were measured. Results: 15-24 fold increase in liver diseases was seen in contraceptive users of >20years to >50 years with a p value of <0.0005.Fig.-1~100% increase in viral infections is prevalent with a p value of <0.0005; Fig.-2.

With a p value of <0.0005; endogenous estrogen was lowered below normal in 61 percent of contraceptive users, and 25 percent of contraceptive users had low normal serum estrogen; Fig. 3. River water had 3-5 pg of estrogen, whereas sea water contained just 0.3-1 pg, implying that estrogen carried by rivers is diluted in the sea. There were no visible bands on a routine haemoglobin electrophoresis that measured in grammes. Alpha feto protein was measured in sea, river water as <0.6ng; $$\beta$$ human chorionic gonadotropins were estimated in the sea, river water as <0.1miu/ml

Due to decreased production of endogenous oestrogen, a low-cholesterol diet has been associated to a 50 percent rise in degenerative disorders such as liver disease and osteoporosis.

Conclusion: The concept has been acquired contraception, abortion status, with smashed fragmentation of germ cells by prohibition from traversing their  normal  path,  consequent  reduced  endogenous  estrogen:  androgen,  results  in  defaulted  genomic  repertoire,    deranged  cell metabolism, rise prevalence of liver disease, including non alcoholic steatotic hepatitis,[fatty change liver] and increased in infectious diseases including hepatitis B, C virus aided by aborted blood, contraceptive menstrual blood pollution of the air, water, evidenced by rising environmental estrogen.[unless blood is spilt estrogen-which is a hormone secreted directly into the blood, circulating in the blood, cannot reach the environment].

As a cause and effect phenomenon, contraception reversal decreased liver disorders; decreased aborted blood, reduced contraceptive menstrual blood environmental pollution, will reduce microbial incidence and virulence; while pregnant with 4200 pg. The placenta secretes Estrogen, and a healthy immune system removes the hepatitis B virus. Condom use, by achieving contraception, perpetuates the disease and reduces the carrier status of Human Immunodeficiency Virus, Hepatitis B and C viruses.

##### Genotypic Characterization of Drug Resistant Mycobacterium tuberculosis and Non- Tuberculous Mycobacteria in Clinical Samples from Presumptive Residents in Rivers State, Nigeria

G. Mac-Fiberesima, S. D. Abbey, C. K. Wachukwu, O. Azuonwu

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 109-123
https://doi.org/10.9734/bpi/hmms/v18/8908D

Tuberculosis is a life-threatening infectious disease that is responsible for the death of most people all over the world. It is characterized by coughing, fever, night sweats and loss of weight due to the pathology of Mycobacterium tuberculosis that causes the disease. In some cases, other forms of the bacterium belonging to the genus Mycobacteria known as Non-Mycobacterium tuberculosis mimic the infection in immunocompromised and comorbid individuals. Characterization of these bacteria is significant in the diagnosis and management of tuberculosis.

##### Diagnostic Diligence

Joseph L. Lewis III, MFS

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 124-127
https://doi.org/10.9734/bpi/hmms/v18/2569F

This article emphasises the importance of diagnostic diligence in forensic pathology/death investigation, and is thus directly relevant to diagnostic procedural standards and practises in emergency care facilities for more obscure or rare types of injury.  A generic scenario is drawn upon from the authors academic experiences in order to depict this in

an accurate and validly weight manner. The author claims that the roads less travelled concerning other than average diagnostic procedure in emergency and/or first responder care in situations delineated such as this one are a weak point in the nature of quality that can be statistically measured in emergency care by precedent of the rarity of certain types of injuries. This is explored in mild depth through scenario depiction and pathological evaluation

according to the knowledge of the author. The scenario can be viewed as a type of question, the answer as a type of diagnosis, and the discussion/conclusion demonstrates the article's overarching point or claim in its relevant concerns aboutscarcely encountered trauma and/or injury types.

##### Titanate Couplers for Dental Composites Construction

Nidal W. Elshereksi, Mariyam J. Ghazali, Andanastuti Muchtar, Che H. Azhari

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 128-148
https://doi.org/10.9734/bpi/hmms/v18/1775C

Silane coupling agent is a dominant coupler that is extensively used in dental applications to promote adhesion among the components of dental composites.  Due to their similar ordered structure, silica-based fillers are easily silanized. In the aqueous oral environment, however, silane is hydrolytically degraded and bonds inefficiently to non-silica fillers. Therefore, the enhancement of hydrolytically stable dental composites is an essential goal in the research on dental materials. The composites using titanate coupling agents (TCAs) have increased interfacial bonding, homogeneous filler dispersion, and mechanical characteristics. Titanates also have better hydrolytic stability in wet environments, which is something to keep in mind while making dental composites. The inclusion of a little amount of titanates can increase the composites' moisture resistance. This chapter reviews the effects of the instability of silanes in moisture on the performance of dental composites and presents TCAs as alternative couplers to silanes for constructing dental composites.

##### Borderline Pneumothorax: A Review

T. Horváth, P. Moravcík, K. Hudácek, K. Brat, V. Can, M. Dia, D. Ivanecká, J. Ivicic, V. Kališ, A. Kodýtková, J. Kratochvílová, A. Krenek, L. Majercák, Z. Merta, L. Mitáš, P. Penázová, P. Petr Dostalova, M. Plutinsky, R. Rindoš, M. Sochor, P. Vysloužil, Z. Kala, J. Vomela

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 149-152
https://doi.org/10.9734/bpi/hmms/v18/8530D

Extraordinary demanding cases necessitate a creative solution that is supported by mature experience and discerning intuition. All of this is based on a single principle: patients benefit. Full-blown versatility is the result of previous and subsequent sharing and trade. Pneumothorax in a breastfeeding mother, brachial plexus injuries suffered by lysis of apical adhesions, autologous fascia lata assistance of pulmonary plication in developed pulmonary emphysema, dorsal chest tube insertion through the first intercostal space, persistent pneumothorax in a brass band musician, effective conservative treatment by chest tube as a substitute to thoracoplasty, talc slurry solution in elderly man with life threatening pneumothorax from advanced lung cancer decay cavity, and in young woman afflicted by lymphangioleiomyomatosis (LAM) are briefly discussed.

##### Renal Function in Type 2 Diabetes Patients in Ile-Ife, Southwest Nigeria: A Clinicopathological Study

Akinbodewa Ayodeji Akinwumi, Okunola Oluyomi, Adelusola A. Kayode, Sanusi Abubakr Abefe, Arogundade Fatiu Abiola, Ikem T. Rosemary, Akinsola Adewale

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 153-164
https://doi.org/10.9734/bpi/hmms/v18/2232D

Aims: To determine the prevalence and clinico-pathological correlates of diabetic nephropathy among type 2 diabetics in Southwest Nigeria.

Study Design: Descriptive, cross-sectional.

Place and Duration of Study: Renal Unit, Medicine Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Southwest Nigeria.

Methodology: Percutaneous ultrasound-guided renal biopsy was carried out in 40 consenting type 2 diabetic adults out of 88 patients in stages 3 and 4 chronic kidney disease using the Kidney Disease Improving Global Outcomes classification.

Results: Eighty eight (48.1%) of the one hundred and eighty three subjects with mean age of 58.05(±6.10) years had clinical Diabetic Nephropathy. The duration of diabetes was 9.55(±4.1) years. Median protein excretion was 0.55 g/day. Mean estimated Glomerular Filtration Rate was 45.1(±12) ml/min. Thirty nine renal (97.5%) tissues showed glomerular basement membrane thickening.

There was a positive correlation between the systolic blood pressure and severity of glomerular lesions (r=0.480, p=0.002), interstitial changes (p=0.602, r<0.001) and vascular lesions (0.429, 0.006). The diastolic blood pressure correlated with glomerular lesions (r=0.500, p=0.001), interstitial changes (0.479, 0.002), vascular lesions (p=0.431, r=0.006), nodular glomerulosclerosis (r=0.333, p=0.036) and diffuse glomerulosclerosis (r=0.372, p=0.018). Urinary protein excretion correlated with severity of glomerular lesions (r=0.457, p=0.003), vascular changes (r=0.483, p=0.002) and diffuse glomerulosclerosis (r=0.407, p=0.009). Diabetic retinopathy correlated positively with severity of glomerular lesion (r=0.406, p=0.009) and diffuse glomerulosclerosis (r=0.547, p<0.001).

Conclusion: The prevalence of diabetic nephropathy among type 2 diabetics in Ile-Ife is high. Glomerular basement membrane thickening was the most prevalent renal pathology. There was a positive correlation between blood pressure, protein excretion, retinopathy and renal histology. The management of diabetes mellitus should be multidisciplinary once diagnosis is made especially in developing countries.

##### Determining the Psychiatric Morbidity among Subjects with Vesicovaginal Fistula in Abakaliki, South East Nigeria

David N. Nweke, Monday N. Igwe, Richard Uwakwe

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 165-173
https://doi.org/10.9734/bpi/hmms/v18/2487E

Background: Vesicovaginal fistula (VVF) imposes enormous challenges on those affected. VVF leaves a devastating effect on a woman’s personal hygiene, self-esteem, interpersonal relationships and environment thereby disrupting the woman’s health Subjects may have difficulties in coping and as a result may manifest specific mental disorders.

Objective: This study determined the psychiatric morbidity and socio-demographic correlates in subjects with VVF.

Materials and Methods: One hundred consecutive subjects with VVF were recruited from the National Obstetric Fistula Centre, Abakaliki Nigeria. A socio–demographic and clinical history questionnaire was used to assess the socio-demographic characteristics of subjects. The General Health Questionnaire version-28 (GHQ–28) was used to screen for psychiatric morbidity with a cut-off point of $$\ge$$ 5 indicating psychiatric caseness. All subjects with a score of 5 or more on GHQ-28 were interviewed using the Present State Examination (PSE) component of Schedule for Clinical Assessment in Neuropsychiatry (SCAN).

Results: The prevalence of psychiatric morbidity among subjects with VVF was 48%. Specific psychiatric disorders identified were major depression- 37%, generalised anxiety disorder- 4%, dysthymia- 5%, somatoform disorder- 1% and social phobia- 1%.

Conclusion: Psychiatric morbidity may co-occur with vesicovaginal fistula. This may hinder complete recovery even after fistula repair. Early detection and treatment of the psychiatric disorders are advocated. It is recommended that health personnel working in such settings be trained to identify subjects with mental health problems and make appropriate referrals.

##### Large Mucinous Ovarian Cystadenocarcinoma in a Young Female: A Rare Case Presentation

Akansha Singh, Ankita Dadhwal, Ashok Verma, Swati Agarwal

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 174-181
https://doi.org/10.9734/bpi/hmms/v18/2929F

The writers describe a case of big ovarian mucinous cystadenocarcinoma aggravating a young pregnancy in a young woman. Ovarian mucinous adenocarcinoma is an uncommon type of ovarian tumour that develops from the ovary's surface epithelium.A 25-year-old woman with abdominal distension presented to the hospital 9 days after giving birth. USG findings reveal a massive solid cystic mass beginning from the pelvis and extending up to the epigastrium, measuring 36 x 14 cm.MRI pelvis shows a heterogeneous hyperintense solid cystic mass lesion with a bunch of grapes appearance in the intraperitoneal space, extending cranially up to the epigastrium and caudally into the pelvis, causing anterior uterus displacement. Also, the bowel loops are displaced to the back. The lesion is cystic with a solid component and multiple internal echoes for the most part.

##### Effectiveness of “Naik Becak” Song as Music Therapy for Preoperative Anxiety by Nursing Approach: An Advance Study

Riksa Wibawa Resna, Muslika Linda Suwarno

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 182-189
https://doi.org/10.9734/bpi/hmms/v18/9950D

Statement of the Problem: Surgery is a stressful event that is often connected with a variety of foreign procedures that the patient will undergo during surgery, as well as different hazards to life safety procedures and actions arising from anaesthesia. Anxiety that occurs in patients with pre-surgery may have an impact on the physical changes that would hold over the implementation of surgery such as increased blood pressure and emotional instability. Music is one way that is believed to lower anxiety levels. Indonesia has a wealth of cultural songs that very much. One of the songs known by Indonesian people is the delightful children's song known as "naik becak". This song describes the picture of how fun the mood of a child when doing recreation using a pedicab. With the theme song that describes the fun atmosphere, the researchers hope to bring the mood of patients who will undergo surgery to be happy.

Aims: This study is intended to look at the effectiveness of music or song therapy to decrease the patient's level of anxiety in facing surgery.

Methodology and Theoretical Orientation: Using an experimental quasi design with a one group pre-test and post- test design, the researchers conducted anxiety-level assessment to all patients who would perform elective surgery.

Findings: From total patients undergoing elective surgery showed that 96% patients had decreased anxiety level with mean rank 23.81, sum-rank 1071.5 and p-value 0.000. Patients who experienced an anxiety drop felt that the song "naik becak" was played out to make them feel good and bring fond memories of their pleasant childhood.

Conclusion and Significance: subjects feel the benefits of melody medicine is conducted in the form of a decrease in the level of anxiety before undergoing surgery. Recommendations are using music medicine in the management of patients with anxiety.

##### Study on Five Cases of an Accessory Left Vertebral Artery on the Aortic Arch

Guinevere Granite, Kerrie Lashley, Gary Wind

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 190-209
https://doi.org/10.9734/bpi/hmms/v18/11507D

Vascular variations of the head and neck are common, but often go unnoticed because they generally do not present clear clinical symptoms. Lack of awareness of the presence and location of such variations may result in iatrogenic complications or even fatalities. Physicians and surgeons should be cognizant of such variations given their potential clinical significance.

Vertebral artery variations are prevalent in both number and origin, but documented infrequently in the literature. Each of the five case studies described here: a White 65-year-old male (Case 1), a White 89-year-old female (Case 2), a White 80-year-old female (Case 3), a White 96-year-old female (Case 4), and a White 95-year-old female (Case 5), presented with an accessory left vertebral artery originating from the aortic arch, between the left common carotid artery and the left subclavian artery. This is the most common place for variations of this type in the literature. All five cases, however, also presented with a left vertebral artery branching from the left subclavian artery. For Cases 1 and 3, the accessory left vertebral artery coursed cranially and entered the foramen transversarium at the C5 level. For Case 2, it entered at the C3 level. For Cases 4 and 5, it entered at the C4 level. With a prevalence rate of 7.81%, among a population of 64 donors randomly selected and undergoing cadaveric review, this anatomical variant illustrates the potential frequency, and thus, the clinical importance of extensive anatomical understanding of head and neck vascular variations.

##### Juvenile Nasopharyngeal Angiofibromas: Clinico-Radiological Evaluation

Bharat Bhushan Sharma, Shweta Sharma, Shashi Sharma, Akriti Sharma, Mir Rizwan Aziz

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 210-221
https://doi.org/10.9734/bpi/hmms/v18/10032D

Background: Juvenile nasopharyngeal angiofibroma (JNA) is also known as bleeding fibroma since it is highly vascular tumour.. This is a benign tumour that is locally aggressive and bleeds in prepubescent and young adults. The tumour expands due to the potential space available in the nasopharyngeal area without much of the resistance JNA requires early and accurate diagnosis by cross sectional modalities with the background setting of  clinical symptomatology. This will helpful in early management and can avoid various future complications.

Case Presentation: We present two cases of JNAs where the role of contrast enhanced computed tomography (CECT) is highlighted. These  two examples of adolescent nasopharyngeal angiofibromas (JNAs) were diagnosed at at differing stages with the help of CECT reformatted reconstructed 3D images..

Conclusion: We lay a high value on the clinico-radiological evaluation in concluding the diagnosis. The adequate pre-operative radiological staging is required for the surgical management

##### Aggressive Vertebral Hemangioma in Early Adolescent Age Group: Atypical Presentation with Computed Tomography and Magnetic Resonance Imaging Appearance

B. B. Sharma, Shashi Sharma, Meghna Varma, Vinod Bende

Highlights on Medicine and Medical Science Vol. 18, 14 August 2021, Page 222-228
https://doi.org/10.9734/bpi/hmms/v18/9846D

Vertebral hemangiomas (VHs) are vascular abnormalities of the vertebrae may be asymptomatic until maturity. Young people often come with unexplained back pain, which can be difficult to diagnose. We discuss the case of a 15-year-old female who had long-term, unexplained upper back pain in the dorsal region. After ruling out various infective and malignant pathologies, she was diagnosed with aggressive VH and treated with decompressive therapy. The importance of imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) in such situations is highlighted in this case.