Dr. Georgios Tsoulfas
Associate Professor,
Department of Surgery, Aristoteleion University of Thessaloniki, Thessaloniki, Greece.

ISBN 978-93-91215-30-9(Print)
ISBN 978-93-91215-38-5(eBook)
DOI: 10.9734/bpi/hmms/v2

This book covers key areas of medicine and medical science. The contributions by the authors include medication, drugs, drug expiry, drug efficacy, math anxiety, timed exams, grade level, content, teacher’s practices, cognitive, social interaction, autologous germ cells replant effect, increasing environmental estrogen, decreased endogenous estrogen, contraception, gastric cancer, bone marrow, tumor hypoxia, disseminated tumor cells, NMP spectrometry, global contraception, aborted blood pollution, contraceptive menstrual blood pollution, global hypoxia, global warming, global recession, autologous germ cell replants, contraception reversal, defaulted genomic repertoire, deranged cell metabolism, human cataract, cervicarthrosis, epidemiology, cervical lordosis, cervicarthrosis DRC, anti-phospholipid antibody syndrome, thrombosis, acoustic trauma, artillery weapon, noise dose, diet supplementation, gluten intolerance, digestive troubles, spinal canal dimensions, discectomy, MRI spine, adipocytes, neoplasms, megameatus intact prepuce, surgical management options, hemispheric dominance, auditory acuity, microparticle immunoassay process, latex-enhanced turbidimetric immunoassay. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


Media Promotion:


Drug Expiry Debate: An Approach to Myth and Reality

Dan Gikonyo, Anthony Gikonyo, Duncan Luvayo, Premanand Ponoth

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 1-6

Hospital, nursing homes, and retail pharmacies and consumers toss away and more so hospitals alone discard over $800 million in drugs annually. If we can modify to work around it, so that it will be beneficial to the African and Asian continent, especially more so in the peripheral outreach health centres in Africa where availability and storage of medicines are a challenge. The cost implications of these studies are staggering and has shown that each dollar spent to demonstrate longer than labelled drug stability could translate to $94 saved on repurchasing these products.

The objectives of this research were to determine if the content of mathematics as a whole (not distinct math themes as in Algebra, 2D geometry, 3D geometry, trigonometry, complex numbers, probability, etc) is statistically and significantly associated with student’s anxiety; and to examine the extent of the association between teacher’s practices, through cognitive and social interactions, and student’s math anxiety. Student’s gender was not a factor tackled by the study thus gender specific differences in classes and levels towards math anxiety were not tested. In addition, the study did not compare the impact of math anxiety on students in middle schools to that of students in the secondary level. The study utilized a two-phase design labelled as an explanatory design “descriptive quantitative data collection followed by a qualitative design through structured interviews to further understand and interpret the data collected from the quantitative findings”. The instrument employed for data collection was a 5 Point-Likert scale survey questionnaire of standardized items developed by the universities of Georgia, Southampton, New Hampshire and Windsor Scholarship, and the Theo Wubbels and Jack Levy’s Student Questionnaire of Teacher Interaction. The statistics used for the data collected concerning the study were descriptive and inferential statistics (the mean, the standard deviation, the mode and the median), and the Pearson’s Chi-Square test. Through the study results, the researcher concluded that math content as a whole is statistically and significantly associated with student’s math anxiety in the intermediate and secondary levels which indicates that the current curriculum is built on knowledge and not proper understanding of the subject material and that the content of mathematics in diverse classes is stuffed to the limit that it may cause students daily anxiety thus their math specific deficits cannot be properly dealt from one class to another, and that teacher’s practices represent a main reason that influences student’s math anxiety; and even-though, some of these practices derived from weak to moderate to strong association with student’s anxiety, the researcher deduced that items concerning teacher’s practices in lower levels should be seriously treated for it may be causing students math anxiety that may probably keep up with them in later stages. Teachers should identify their teaching approaches, methods, strategies and techniques for student’s successful learning environment in the intermediate and secondary levels and for sure in lower classes.

Background: Era after contraception witnessed increased prevalence in chronic obstructive pulmonary disease(COPD), drug resistant tuberculosis, lung cancer. Consequently, COPD is associated with a significant economic burden, including hospitalization, work absence, and disability.

Objectives: Altruitic association between contraception, rising environmental estrogen, respiratory diseases [if any] is sought after.

Methods: Randomized sampling of 20-35 years,35-50 years, 50-70 years, >70 years was done with bioinformatics analysis.

Results: 4 fold increase in respiratory pathologies in contraceptive users than people without contraception; chronic obstructive pulmonary disease showed 75-80 fold increase in contraceptive users, of which ~40-fold increase in smokers with contraception , 40 -50 fold increase in people with contraception but nonsmokers in 35-50 years, 50-70 years age groups; Tuberculosis destroying lungs, tuberculous pneumonia of entire lung , inspite of antituberculous (drug resistance )treatment was seen in people with contraception by 15-30 fold increase; Lung Cancer was seen with 5-15 fold increase in contraceptive users in 20-50 years age group.

Conclusion: The concept is contraception, abortion has resulted in innocent aborted blood, contraceptive menstrual blood stained environmental pollution with hypoxia(obnoxious inhalational, exogenous stimuli), evidenced by rise in environmental estrogen; combined with smashed fragmentation of millions of germ cells every day, decreased endogenous estrogen resulting in defaulted genomic repertoire of every cell, leading to increase in prevalence of degenerative, neoplastic, autoimmune diseases, including respiratory pathologies; contraception reversal to autologous germ cell replant effect, restored hormonal surveillance, regresses diseases of all systems, including respiratory system; prohibition of abortions will decrease the aborted blood environmental pollution, thereby will decrease lung cancers, pulmonary diseases, tuberculosis.

CXCR4 Expression in Gastric Cancer and Bone Marrow

Dmitry Osinsky, Larissa Bubnovskaya, Irina Ganusevich, Lesya Mamontova, Sergej Merentsev, Sergej Osinsky

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 33-48

CXCR4 is a chemokine receptor specific for stromal-derived factor-1 (SDF-1 a, CXCL12) that regulate a variety of cell functions and involved in the spread and progression of a variety of different tumors. Accumulating evidence suggests that CXCR4 and SDF-1a expression is useful for evaluating the risk of gastric cancer progression, however, their influence on the occurrence and development of gastric cancer (GC) requires further investigation. In the present study there was provided analysis of the association of CXCR4 expression both in GC and bone marrow (BM) with clinical characteristics using immunohistochemistry, immunocytochemistry, NMR-spectroscopy and zymography as well as overall survival (OS) of 65 patients with GC. It was shown that CXCR4 was expressed in 78.5% of GC specimens and correlated with tumor hypoxia (p<0.05), VEGF expression (p<0.01) and gelatinases activity (p<0.05). CXCR4-positive cells in GC was detected in 80% of patients with disseminated tumor cells (DTCs) in BM. CXCR4 expression in BM was positively associated with DTCs, especially in patients with M0 category.

Overall survival (OS) of patients with CXCR4-positive tumors was poorer than that of patients with CXCR4-negative tumors (p=0.037). CXCR4 expression in BM was not associated with OS.

Risk of unfavourable outcome is increased in patients with M0 category and with both CXCR4-positive BM and DTCs (p = 0.03).

 New age contraception and abortion [20th, 21st centuries] witnessed new age global environmental threats such as global hypoxia, global warming, global recession, disappearance of birds, fish, islands, tsunamis, tornadoes, cyclones, and earth quakes.  ‘Estrogen like particles are in the rise in the air, waters, identified as pollutant`, was published in 1998, 1994 respectively; global abortion summary informed of 863,000,000 surgical reported abortions, from 1923 to 2010; environmental pollution with estrogen has to come from spilt blood. The amount of Estrogen in seven river water and sea water samples was determined. Using routine haemoglobin electrophoresis, it was attempted to estimate foetal haemoglobin in sea water. It was intended to measure alpha fetoprotein and human chorionic gonadotropins in river and sea water. Estrogen was found in river water- 3-5pg/ml and sea water - 0.3-1 pg/ml.  Fetal hemoglobin could not be detected as visible bands, by routine hemoglobin electrophoresis, capable of detecting values in grams. Alpha feto protein was detected in sea, river water as <0.6 ng/ml, B human chorionic gonado tropin was detected in sea and river water as <0.1miu/ml. The concept is Estrogen hormone is secreted into the blood directly, circulates in the blood, bathes, nurtures every cell, influences cell metabolism, cell cycle; unless blood is spilt, estrogen cannot enter the environment. The concept is that contraceptive menstrual blood contamination, aborted blood pollution, equates to increasing Estrogen pollution throughout the environment. Aborted blood, contraceptive menstrual blood with its high affinity for oxygen, depletes oxygen, [unlike emissions of alive people which can be replaced by plants,] to result in global hypoxia, ozone layer depletion, global warming, cyclones, floods, tsunamis, tornadoes, hurricanes, earthquakes resultant disappearance of birds, grapes, sea food, islands. Abortions and contraceptives have resulted in fewer clients, consumers, people, passengers, and students than providers, resulting in a horrible global recession, because investment is for, on, by, and from the people. God ordained self sustaining ecology and economy are disrupted by global contraception, abortion.

Background: Era of contraception, abortions, [20th, 21st centuries] implemented as family welfare schemes witnessed, increase in prevalence of dementia, psychosis, stroke, Parkinson’s disease, cerebral tumors, myoclonus, seizures and Neuroleptic malignant syndrome.

Objectives: altruistic association of contraception [if any], with increasing dementia, stroke, Neuroleptic malignant syndrome, psychosis, cerebral tumors, Parkinson`s disease in younger age was sought after.

Methods: In 2012, retrospective analysis of, prevalence of stroke, in 350 patients of 20-35 years, 35-50 years, >50 years age groups, from data collected by convenient, stratified random sampling, from different geographical locations, between 2003-2012 and its association with presence, absence of contraception, abortion was undertaken; simultaneously, serum estrogen levels obtained from 105 patients, was also analyzed. Retrospective analysis of data of 279 patients who had presented with stroke, cerebral tumors, tuberculous meningitis, Parkinson’s disease, myoclonus, seizures over 1989-2012 was undertaken. Data of another group of 318 patients presenting with psychosis including suicides, dementia, behavioral disorders spread over 1989 to 2012, of whom ~100 were college students with behavioral disorders, was also analyzed retrospectively for significant association of contraception status, cholesterol deprived diet and prevalence of neuropsychiatric disabilities. Cholesterol deprived diet was recommended along with contraception. Steep rise in incidence of Neuroleptic malignant syndrome e.g. 15 patients within 6 months in 2007 was identified in young women after tubectomy [p <0.0005].

Results: With no difference attributable to geographical location the results revealed. [a] Cholesterol deprived diet was associated with behavior disorders, including suicides as >100 fold increase in <20 years college students [p <0.0005]; chronic cholesterol deprived diet without contraception was associated with 10 fold increase in psychosis, dementia among 35->50 years with a p value of <0.0005[b]Contraception with cholesterol deprived diet showed 30- 40 fold increase in psychosis starting from younger age itself 20->50 years with a p value of <0.0005 and 30 fold increase in dementia in >50 years with a p value of <0.0005. [c]Neuroleptic malignant syndrome was seen with absolute increase in patients with tubectomy [p<0.0005]. [d]stroke, tumors, encephalitis, Parkinson`s disease, myoclonus, were seen with ~15 fold increase in contraceptive users with a p value of <0.0005. [f] Contraception reversal with essential cholesterol, fatty acids rich diet cured demyelination, behavior disturbances.

Conclusion: The concept is Contraception, abortion preventing normal path traversed by germ cells, with smashed fragmentation of germ cells, consequent reduced endogenous estrogen: androgen, resultant defaulted genomic repertoire, deranged cell cycle, cell metabolism, degeneration of neuronal cells, neurotransmitters and cholesterol deprived diet with reduced myelin synthesis, hormone synthesis, neurotransmitter synthesis leading to ~40 fold increase of neuronal diseases with a p value of <0.0005 in young age itself. Since dopamine is inherently reduced by deranged cell metabolism after contraception, Neuroleptic: anti psychiatric drugs by further dopaminergic blockade precipitate the fatal Neuroleptic malignant syndrome; contraception reversal, with cholesterol rich diet enables therapies effective and prevents further deterioration of neurological pathologies, can prevent increasing prevalence of Neuroleptic malignant syndrome.

Human Cataract in Non-coastal Districts

Aleyamma Kuruvilla

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 70-76

 A six-year study was conducted to compare the prevalence of cataract in Kottayam and Pathanamthitta in Kerala state, India. From April 2005 to March 2011, a hospital-based study was performed to determine the prevalence of cataracts in the overall population, gender prevalence, and prevalence in different age groups. The information was gathered from the ophthalmology departments of district hospitals and two private hospitals in Pathanamthitta and Kottayam districts, as well as the Directorate of Health, Thiruvananthapuram. The burden of blind is more in remote rural community of developing countries. With three out of every four Indians residing in the rural areas, there is a concentration of blindness in agriculture dependent communities in India. Cataract prevalence among the total population in Kottayam district was significantly increased from 0.34% to 0.51% (p=0.000157), but in Pathanamthitta district prevalence significantly decreased from 0.40 % to 0.36% (p=0.0024). Gender prevalence is significantly higher in females in Kottayam (61.6%, 0.0000326) as well as in Pathanamthitta (59%, 0.00014) than in males, suggest that females have more cataract. A significantly highest prevalence recorded in the age group of 71-80 years in Kottayam (36.6%, 0.000072) and Pathanamthitta (33.6%, 0.000312) as compared with all other age groups. Prevalence of congenital cataract (0-15) is very less in Kottayam (1.2%) and Pathanamthitta(0.9%).  The decrease in the prevalence rate in Pathanamthitta district is attributed to a decrease in the population.Only by developing effective strategies to low the incidence of blinding cataract can cataract blindness in Kerala be effectively managed. The current analysis of cataract prevalence in Kerala may shed light on the severity of cataract incidence in the state to some extent.

Influences of Gravity Constraints on the Epidemiological and Clinical Impact of Cervicarthrosis

K. G. Meya, M. B. Nsitwayizatadi, B. K. H. Nkakudulu, B. Miangindula, M. Mabanza, M. Nkoy, W. Okito, D. V. Sali, J. M. Mbuyi Muamba

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 77-83

Background: More than 50% of people aged 40 years suffer from cervicarthrosis, This disease constitutes a public health problem. For this the decade 2001-2010 was declared by the WHO as “decade of the bones and joints”.

Objective: To determine the epidemiological and clinical profile of the Congolese patients suffering about cervical arthrosis and to study the evolution of modification of cervical lordosis with a view to improving physical treatment.

Methods: This case study was conducted at the University clinics of Kinshasa during the year 2011 to 2016. 35 patients’ male and female, suffering about cervical arthrosis, were included. The different angulations of the cervical lordosis measured with an appropriate software. The height of the cervical spine measured by a caliper was 14 cm on average. The load exerted by the head on the cervical spine is directly function of lordosis and the height of the vertebra was calculated.

Results: Of the 35 patients, 34.3% men and 65.7 women. Age ranged from 30 to 80 years and the highest incidence of cervicarthrosis was between 61 and 65 years (20%). The clinic was dominated by cervical pain (80%) and irradiated pain in 37%. Other signs (blurred vision, headache, dizziness) were poorly represented. For radiographic signs: cervical lordosis was eliminated either decreased in 91% of cases, followed by inter-somatic pinching (68%), ductal stenosis (62%) and osteophytosis in only 20% of cases. However, osteoarthritic myelopathy is extremely rare (2%). Variation of the head load (in Kg) on each vertebra of the cervical spine from C1 to C7 and from 0 to 45° depending on the level of the vertebra and the degree of cervical lordosis. The force increases from C1 to C7 and from 45° to 0° following an arithmetic progression.

Conclusion: This chapter has just highlighted the importance of the cervical lordosis spine in the diagnosis of cervical arthrosis and showed the important role of cervical lordosis in the variation of head load on each vertebra. Cervical arthritis is a severe degenerative disease that affects the cervical region.

Anti-Phospholipid Antibody Syndrome Presenting with Seizure and Atrial Mass: A Case Report

Rajish Sanjit Kumar Shil, Amal Abdallah Al Dhuhoori, Vipin Mughilassery Thomachan, Jamal Ali Teir, Renganathan Radhakrishnan

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 84-91

Antiphospholipid antibody syndrome (APS) has a broad spectrum of thrombotic and non-thrombotic clinical manifestations. Diagnosis requires a set of clinical criteria of thrombosis along with persistently positive anti-phospholipid antibody tests. In this report, we are presenting a case of APS, who is a 38 years old male, presented with complains of seizures and found to have stroke, which on further investigation revealed to have been caused possibly from a left atrial mass. High index of suspicion is required for the diagnosis of APS in young patients, who present with various neurological and cardiovascular manifestations, mostly secondary to thrombosis. APS usually is classified as primary and secondary, respectively, according to the absence or presence of an underlying disease as well as other autoimmune, malignancy, or drug-induced disorders.

Risk of Acoustic Trauma Associated With Artillery Weapon Gunners

Sigit Sasongko

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 92-98

The military is a high-risk environment for occupational deafness. Acoustic trauma is a sensorineural hearing disorder caused by impulsive loud noise with a frequency range of 2-6 kHz. This study aims to assess the occurrence of acoustic trauma on a Howitzer 105 gunner. Indonesian military currently doesn’t have hearing conservation program. The work environment of the armed forces places military personnels to be at risk of suffering occupational hearing loss caused by the use of main equipments for system of defense as one of the skill requirements.

The research used a prospective period method from July 7 to July 10, 2014, with the focus being new recruit soldiers in the Indonesian Army's Artillery Academy. The subjects were divided into two groups: Exposed (17 gunners) and non-exposed (stae the number of subjects). Subjects' identities, medical histories, and symptoms after firing were all reported on a questionnaire. The Integrating Sound Level Meter and Real Time Analyzer were used to measure the sound intensity and frequency. Pure tone audiometry was used to assess hearing function. Fisher Exact test was used to determine the value of the data (p<0.05) The findings of this study revealed that the sound pressure level of a Howitzer 105 artillery weapon totaled 148.6 dBA with a frequency that decayed to 60 dBA for 2 seconds, while the impulsive sound intensity received at a distance of one metre exceeded the 1998th National Institute for Occupational Safety and Health (NIOSH) criteria. Acoustic trauma on the gunner without ear protection is significant at 23.5% (p0.05), with symptoms of tinnitus and temporary hearing disorders (1 day) being only 6% and not significant (p>0.05).

Probiotic-based diet supplementation is among potential treatments of Autism Spectrum Disorders (ASDs) because of the existing gut microbiota profile-mental health relationships. In order to conceive personalized probiotic supplements to an autistic adult within a family of neurotypical father, mother and sister, a gut microbiota profiling and comparison has been carried out through fecal sample analyses. The latest 16S rRNA technology has been used for microbial determination at the species level (Mymicrozoo analysis, The Netherlands). Less microbiota diversity and an uncommon higher Streptococci/Lactobacilli abundance ratio have been revealed in the autistic adult compared to his relatives. These results have been discussed in relation to his digestive issues.

Correlation of Canal Dimension with Neurological Status and Surgical Outcome in Lumbar PIVD: A Recent Study

Shafiq Hackla, Farid Hussain Malik, Saumyjit Basu, Anil Kumar Gupta

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 106-116

Introduction: Symptomatic lumbar PIVD is major of disability and absteenism from work. The symptom of a disc herniation is determined by a variety of factors, including the level of the disc, its point, and the percentage canal compromise induced by the disc, among others. We present the findings of a prospective study on the relationship between spinal canal dimension and neurological status and surgical outcome in lumbar PIVD.. Whereas lumbar disc herniation in adult is largely secondary to degenerative disc disease as evidenced by operative findings and by routine pathological examination of specimens removed, often with large sequestrated fragments, disc herniation in adolescents is usually seen after severe injury.

Methods and Material: The research included 41 patients who were followed for an average of one year from May 2011 to December 2015. The study included patients with cauda equina syndrome, back or leg pain that persisted for more than 6 weeks despite conservative care, and patients with progressive motor weakness and leg symptoms. Patients with age > 60 years, traumatic disc prolaspe.and spondylolethesis with disc prolapse were excluded from the study. The dimensions of the spinal canal after a prolapsed disc in the AP and transverse dimension  were noted On an MRI scan.Symptoms were evaluated according JOA SCORE and ODI SCORE at preoperative, 1, 3, 6, and 12 months follow up. The Pearson correlation coefficient was used to create the correlation.

Results: The patients were 37.62 years old on average. The mean anteroposterior canal dimension was 6.72mm while in transverse, it was 14.20mm in AP, mean preoperative JOA score was (7.46±3.45) and (10.75±4.26) in group 1 and 2 respectively with the p-value of 0.068 but the postoperative JOA score was almost the same (27.09±3.4) and (27.37±5.09) in both the groups with the p-value of 0.855. In transverse group, mean preoperative JOA score was (6.45±4.05) and (11.2±2.14) in group 1 and 2 respectively with the p-value of 0.004 and the postoperative JOA score was (27.09±4.78) and (28.1±3.1) in two groups with the p-value of -5.78. Only the preoperative transverse group had a significant p-value of 0.004. Mean preoperative ODI score in AP group was higher (37±7.11) in group 1 as compared to group 2(30.62±9.13) with p-value of 0.39 but the final postoperative ODI score (9.3±10.8) and (8.87±8.9) was almost the same in both groups with p-value of 0.926. Mean preoperative ODI score in transverse group was (37.27±7.55) and (31.66±8.52) in group 1 and group 2 respectively with p-value of 0.122 but the final postoperative ODI score (11.36±12.85) and (6.7±4.76) was almost the same in both groups with p-value of 0.294. Since the p-values in both groups are insignificant, it can be confidently inferred that the decrease in canal dimension is irrelevant to the patients' symptomatology.

Conclusion: Keeping in view the above findings, it can be safely concluded the canal compromise by the prolapsed disc alone is not related to the patient’s symptoms. There are other factors like position of prolapsed disc in relation to nerve root, stage of disc herniation, etc. which are important in overall symptomatology of prolapsed disc.

A Rare Case of Intraoral Palatal Lipoma

Anuya Satyaprakash Gupta, Girija Amit Ghate

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 117-122

Lipomas are the most common benign neoplasms that arise from adipose cells in the human body. Intraoral lipomas are uncommon, accounting for less than 5% of all head and neck cancers. Nonetheless, lipoma should be treated as a differential diagnosis of oral cavity swellings. In the case of intraoral lipoma, surgical excision is the mainstay of treatment. The commonest site of an intraoral lipoma is buccal mucosa due to the abundance of fat, followed by the tongue, lips, floor of the mouth and gingiva, making palate the rarest due to lack of adipose tissue.  The lipoma was shown to originate from the soft palate in this case study.It was surgically excised in toto and histopathological examinations were performed to determine a definitive diagnosis. This case is being documented because a lipoma with an intraoral origin is unusual, and even more so when it occurs in the palate.

A Review of Surgical Management Options of Megameatus Intact Prepuce

Muhammad Ujudud Musa, Abdulkadir Abubakar, Bashir Yunusa, Abubakar Sadiq Muhammad

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 123-134

Introduction: Hypospadias is a continuum of different variants, and megameatus intact prepuce (MIP) is an uncommon form of glandular hypospadias seen in around 3-6% of hypospadias. Surgical options in the management of megameatus intact prepuce depends on multiple scenarios and is multifactorial, hence the different surgical options with different outcomes. The aim of this article is to review the surgical management options of these rare variant of hypospadias called megameatus intact prepuce.

Materials and Methods: We look for information on the following platformsGoogle Scholar, PubMed Central (PMC), PubMed, AJOL and EMBASE for articles on Megameatus intact prepuce, and the last search was on 14th May, 2021, using the keywords surgical management options of megameatus intact prepuce and the relevant articles were reviewed to extract the surgical options of managing megameatus intact prepuce variant of hypospadias from the experts.

Results: The surgical management of MIP is aimed at restoring function and cosmesis, and several surgical techniques, including the glanular approximation procedure (GAP), the pyramid procedure, the cutaneous advancement procedure, the tubularised incised plate (TIP), the tubularised Urethral Plate Urethroplasty (TUPU), the Mathieu technique, and the subcutaneous frenulum flap with many modifications, have been described.

Discussion: MIP is rare and was first described by Juskiewenski and co in 1983, several researchers have reported on various surgical treatment options with varying results,, Elbatarny et al observed GAP in seventeen patients with MIP over a five-year span in 2011, with an excellent outcome in 14 patients and a subjective score of 1 in two patients, with one patient expressing disappointment with the outcome. M. Sanal et al. identified an excellent outcome in seven cases with GAP.

Conclusion: The surgical management options for megameatus intact prepuce are many, with varying modifications and results, necessitating a urologist's knowledge of as many procedures as possible in order to achieve a desired aim in treating this group of patients with an unusual anomaly.

Background: The mobile phone has become one of the most frequently used technological innovations in contemporary times. Mobile phones have various applications which have been found useful in the healthcare sector. Its use in improving outcomes in the management of cancer in Nigeria has been documented.

Aims: Mobile/cell phone use has become an important socio-medical means of communication. The reason people use a particular ear to answer phone calls more frequently may be associated with hemispheric dominance/ handedness. We aim to determine association between hemispheric and or auditory dominance in laterality in mobile phone use.   

Study Design:  This was a three- month prospective cross-sectional study involving all consenting medical and paramedical respondents.

Place and Duration of Study: Hospital community in the University of Benin Teaching Hospital (UBTH), Benin City , Nigeria, between 15th March to 15th June 2018.

Method: A modification of the Edinburgh handedness inventory (EHI) was the survey tool. Information retrieved included social demographics, hand most commonly used for activities like writing and picking of phone calls and ear used for phone conversation and the reasons. Data was analyzed using SPSS 19.0

Results: Of the 300 questionnaires distributed, 234 (78%) were completed by the respondents. There were 120(51.3%) males and114 (48.7%) females.  Age ranged from 18 - 80years. A total of 201(85.9%) were right handed, 16(6.8%) left handed and 14(6.0%) ambidextrous. One hundred and fifty four (66%) routinely use their right hand to pick phone calls, 50(21.4%) left and 27 (11.5%) use both hands.

A total of 141(60%) receive calls with the right ear, 60 (25.6%) with left, and 31(13.2%) had no preference.  Reasons advanced for the use of any particular ear included convenience 173 (73.9%), and better acuity 35(15%). Forty two (17.9%) agreed that the use of cell phone made them aware of their poor hearing in a particular ear. Using Pearson’s two tailed test of significance the probability of a right hander using the right hand to pick a phone call and placing it on the right ear is 0.99 or 99%, Vis a Vis left hander.

Conclusion: There appears to be an association between hemispheric dominance and laterality when using the mobile phone. This research not only identified the association between hemispheric and auditory superiority in cell phone use, but it also showed that mobile phone apps could be a valuable method for detecting hearing loss.

Vitamin D deficiency and Its Link with Inflammatory Markers in Women

Deepa Gupta, Neelima Singh

Highlights on Medicine and Medical Science Vol. 2, 24 May 2021, Page 145-151

Aim: Nowadays the ‘‘sunshine’’ vitamin attracts full attention toward its anti-inflammatory role that is much beyond its classical role in bone metabolism. Vitamin D deficiency is a major health issue that affects people of all ages, especially elderly women. With increasing age, women are at high risk of several metabolic diseases. This study aims to determine the levels of serum vitamin D and inflammatory markers in premenopausal and postmenopausal women.

Methods: A total of 500 female subjects were included in the study, with 400 pre- & postmenopausal women were considered as cases while 100 subjects were considered as control healthy women. Serum Vitamin D was estimated by chemiluminescent microparticle immunoassay method. Inflammatory markers, Interleukin-6 (IL-6), and highly sensitive C-reactive protein (hs-CRP) were assayed in serum by using standard immunoassay method. Serum Estradiol (E2) was estimated by the competitive immunoassay method in all studied female subjects. Data were analyzed by using SPSS software, version 22.0.

Result: Serum Vitamin D levels were significantly decreased while inflammatory markers were significantly increased (p<0.001) in pre-and postmenopausal women as compared with control healthy women. Serum estradiol was also significantly decreased in postmenopausal women. We also found a significant negative correlation between vitamin D deficiency and inflammatory markers in both pre-and postmenopausal women.

Conclusion: Vitamin D deficiency is more common in postmenopausal women than in premenopausal women. In postmenopausal women, low-grade systemic inflammation is linked to an increased risk of cardiovascular disease, diabetes, and metabolic syndrome.