Dr. Ravi Kumar Chittoria
Department of Plastic Surgery & Advanced Centre For Microvascular, Maxillofacial & Craniofacial, Laser Surgery, Tertiary Burn Care, Antiaging & Regenerative Medicine, Smile Train, Advanced Wound Care, Telemedicine, Cadaveric Organ & Tissue Transplantation, Skin and Tissue Banking.
Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER)(An Institute of National Importance under Ministry of Health & Family Welfare, Govt of India)Pondicherry-605006, India.
Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

ISBN 978-93-91215-46-0 (Print)
ISBN 978-93-91215-54-5 (eBook)
DOI: 10.9734/bpi/hmms/v3

This book covers key areas of medicine and medical science. The contributions by the authors include central nervous system, chronic renal failure, glomerular filtration rate, alanine transaminase, alkaline phosphatase, non-alcoholic steatohepatitis, right subcostal discomfort, embolization, Inferior mesenteric vein, Splenic vein, superior mesenteric vein, transplantation, bariatric surgery, gastrectomy, polyneuropathy, dysmenorrhea, nanoone technology, osteoarthritis, gout and antidepressant effects, food supplements, natural nutrition, health effects, natural products, aborted blood pollution, contraceptive menstrual blood pollution, ozone depletion, putrefaction of enormous fetuses, ethnobotanical record, drug profile, supraclavicular brachial plexus block, levobupivacaine, child psychological abuse, false accusations of child sexual abuse, family violence, high conflict separation and divorce’ parental alienation, endoscopy, gossypioma, intraluminal migration, retained surgical sponge, sepsis, procalcitonin, sensitivity, infectious disease, Hepatitis B virus, oral antiviral drugs, hepatitis e antigen, hepatitis e antibody, oral antiviral drugs, sleep quality, ratings of sleep, international sleep medicine. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


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NCCT Head Findings in Patients of Chronic Renal Failure with Altered Sensorium: A Prospective Study in a Tertiary Care Centre

Vinod Kumar, Achint Singh, Ritu Bhagat, Ahmar Javid Azad

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 1-7

Introduction: The central nervous system (CNS) is commonly impacted in uremics and has been studied in these individuals in many ways. Various theories about the origin of central nervous system tract lesions in chronic renal failure have been proposed from time to time. In the majority of studies, urea has been implicated. Hemodialysis patients are at high risk of cognitive impairment due to their older age and high prevalence of stroke and cardiovascular risk factors.

Aim: The goal is to investigate the NCCT Head findings in chronic renal failure patients.

Materials and Methods: This is a one-year prospective study undertaken at GMC, Jammu, a tertiary care centre, from November 2016 to October 2017. In our study, 64 patients were included, 36 of whom were males (56.25 %) and 28 of whom were females (43.75%). Patients ranged in age from 18 to 60 years old. Results: Out of 64 patients undertaken in our study, 8 patients (12.5%) had ischaemic stroke, 6 patients (9.37%) had haemorrhagic stroke while 2 patients (3.12%) had both the lesions.

Conclusion: In patients with chronic renal failure, neurologic symptoms have been documented frequently. CKD patients suffer from moderate to severe chronic cognitive impairment, which goes undiagnosed in the majority of cases.

Introduction: Ludwig et al. coined the name NASH. Non-alcoholic steatohepatitis (NASH) is a type of non-alcoholic steatohepatitis that includes steatosis, steatohepatitis, fibrosis, cirrhosis and complications.

Aim: The goal is to investigate the dietary, clinical, and other risk factors associated to NASH.

Materials and Method: The current study was conducted in 2010 at the Department of Medicine, GMC, Jammu, on 60 NASH patients during a six-month period.All NASH patients were examined for a variety of NASH-related risk factors. A complete clinical examination and a detailed history were recorded.

Results: Out of 60 patients, 28(46.66%) were males and 32(53.32%) were females. 85% of the patients were in the age group of 31-70 years.

Conclusion: In our study, non-vegetarians accounted for 73.33% (44/60) of patients, while asymptomatic individuals accounted for 26.6% (16/60). The most common symptom was right subcostal pain (69.33%). This study showed that obesity, hyperlipidemia and diabetes mellitus were significantly associated with the NASH.

Significance of Extra Hepatic Portal Vein Variations in Hepatopancreatic Surgeries

Neelesh Kanasker, Preeti Sonje, Janhavi Bankar, . Vatsalaswamy

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 14-23

Introduction: Knowing the variations in the portal vein's path is important when performing pancreas and duodenum surgeries.

It is also useful in the treatment of traumatic mesentery rupture. In surgical resection and transplantation, Awareness about the variations of the portal vein is vital, especially during pre-treatment planning, to lower the complication rates of the surgical and radiological treatments. Furthermore, a thorough understanding of portal vein variations is critical in assessing the technical feasibility of surgical interventions such as liver transplantation, portal vein embolization prior to hepatectomy, and postoperative care.

Aim: The goal of this study is to look at the anatomical variations of the portal vein, correlate the findings with clinical problems, and provide a good ontological explanation.

Materials and Methods: In this study, Twenty four cadavers embalmed in 10% formalin were procured from the department of anatomy and were dissected. Variations were cleaned and photographed with great care.

Results: The creation of the portal vein by the confluence of the superior mesenteric, inferior mesenteric, and splenic veins (1 case), as well as the inferior mesenteric vein terminating in the superior mesenteric vein (6 cases), were among the variations observed.

Conclusion: This research was undertaken with the intention of determining the approximate percentage of incidence of major variations in the formation of portal vein. Preventing severe intraoperative haemorrhage can thus be avoided by being aware of such variations before the major abdominal procedures.

Ataxia and Weakness after Sleeve Gastrectomy: A Case Report

Rajish Sanjit Kumar Shil, Ammar Fadhil Alomar, Mohammad Rashid Farooqui

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 24-28

Every year, the number of patients undergoing bariatric surgery grows, as obesity has become a leading cause of a variety of comorbidities. The frequency of complications associated with this procedure has been increasing. We present the case of a 32-year-old man who suffered ataxia and peripheral polyneuropathy after a sleeve gastrectomy operation, then developed progressive weakness in his extremities within 8 months of surgery and was admitted to the hospital for neurological consultation and care. This uncommon neurological complication might have been due to rapid weight loss and vitamin deficiency.  The case report focuses on the signs that bariatric surgeons should look for and how they should treat them.

Effectiveness of Nanoone Woman Underwear for Dysmenorrhea Management

Choo-Aun Neoh, Lan-Shiang Wu, Karen Neoh, Jessie Neoh, Kenny Chuang

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 29-36

The objectives of this research is to assess the efficacy of Nanoone Woman Underwear in the treatment of dysmenorrhea. The purpose of this study is to determine the observed change in menstrual pain intensity from baseline to after wearing Nanoone Woman Underwear in women with primary dysmenorrhea. The level of dysmenorrhea pain will be assessed using a VAS (visual analogue scale) ranging from zero (no pain) to ten (extreme pain). A VAS will be used to assess effectiveness at baseline, weeks 1-2, 5-6, and 9-10 of the study. The primary goal is to determine the mean change in menstrual pain intensity from baseline to the endpoint visit. The difference in mean change in menstrual pain intensity from baseline during each menstrual cycle will also be examined. Subjects would be requested to utilise the VAS scoring methodology to record their menstrual pain level on a given sheet every day during menstrual bleeding for three consecutive menstrual cycles in the house. Based on statistical analysis, the mean maximum pain level at the poster menstrual cycle was significantly lower than the prior menstrual cycle when compared to experienced menstrual pain intensity. In women with primary dysmenorrheal, the mean improvement in maximum pain level during the menstrual cycle was substantially lower after long wearing Nanoone Woman Underwear. As a result, after wearing Nanoone Woman Underwear for a long time, the extent of menstrual pain intensity improvement was greater.

Studies on Osteoarthritis, Gout and Antidepressant Effects of Platanus anatolius versus Platanus orientalis

Ibrahim Adnan Saraçoglu, Eda Büker

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 37-43

The Platanus genus belongs to the Platanaceae (Platanaceae) family, that comprises tall, thick-scaled tree species. The eastern plane (Platanus orientalis), or Ottoman plane, is an endemic plant of Anatolia, while the western plane (Platanus occidentalis) is an endemic species of North America. The pharmacological properties of Platanus orientalis include cytotoxic, cytostatic, astringent, antibacterial, and antiseptic effects. The London plane (Platanus hispanica) is the hybrid of both species. Eastern plane has been used for centuries in traditional Chinese medicine, Far Eastern countries and Iran for therapeutic purposes. The active compounds such as flavonoids [1], proanthocyanidin glycosides [2-4] penta-aromatic triterpenoids [5], tannin [6], phytol derivatives [7] and caffeic acid [8] which are found especially in plane leaf, are bioactive components that have a role in successful usage in traditional therapy.  The potential of plane leaf to treat osteoarthritis and gout is directly proportional to the bacterial population on it and the time of harvest.

Study of Food Supplements: Background, Present and Future

Ibrahim Adnan Saraçoglu, Eda Büker

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 44-50

The opinions of why the need for food supplements has changed throughout time are included in this study. In addition, the methods for producing dietary supplements were examined, as well as the advantages and disadvantages of each method. Food supplements and their role in natural nutrition, as well as their impact on human health, should be studied holistically rather than isolated from natural sources. Thousands of different chemical additives, microbial and biotechnological applications, and other technological processes turn a natural product into a malady. Many faults of research and development (R&D) project findings of dietary supplements might become more clearly known when studies are conducted with a holistic view.

Back ground: The period of contraception and abortion [mid-twentieth and early-twentieth centuries] saw a rise in the frequency of hail storms, tornadoes, flash floods, and tsunamis; as a result, an altruistic analysis of any link between increasing natural disaster trends and contraception, abortion, was planned for the past 4-5 decades, by analysing the environmental pollutant.

Methods: The occurrence of hail storms, flash floods, tornadoes, and tsunami, was timed with the gradual and stealthy implementation of global contraception and abortion. Environmental pollutants, including as estrogen, alpha feto [1] protein, and beta human chorionic gonadotropin, were measured in rivers and oceans and associated with the results. Three samples of river water around Cape Comorian were tested for Estrogen, as were four samples of sea water from four distinct seas: Indian Ocean, Arabian Sea, Bay of Bengal near cape, and Bay of Bengal near Union Territory. Estimation of Fetal, adult hemoglobin in sea water was attempted by routine hemoglobin electrophoresis. Estimation of alpha feto protein and \(\beta\) Human chorionic gonado tropin in river and sea water was undertaken

Results: Over the last 4-5 decades, there has been a 2.5-fold rise in hail storms, flash floods, tornadoes, [p<0.01] , and a 6-fold rise  [p <0.0005] in tsunami. Earlier estimates [1] of estrogen, alpha feto protein, beta human chorionic gonado tropin in rivers, oceans showed their presence as follows

Estrogen was detected in river water- 3-5pg/ml and sea water - 0.3-1pg/ml. Alpha feto protein was detected in sea, river water as <0.6ng/ml, \(\beta\) human chorionic gonado tropin was detected in sea and river water as <0.1miu/ml confirming further, aborted blood pollution of the sea, river. It was also in the rivers, which were diluted in the oceans. Hemoglobin could not be detected in water samples since the technology could only detect in grams, but oestrogen could only be estimated in pg.

Conclusion: Contraceptive menstrual blood pollution, or aborted blood pollution of the waterways, as demonstrated by estrogen, alpha fetoprotein, and beta human chorionic gonadotropin, depletes oxygen in rivers and oceans, which cannot be replaced by plants depleting ozone, combined with putrefaction of enormous fetuses [2] producing toxic, inflammable, explosive gases, resulting in increased trends of tornadoes, flash floods, hail storms, tsunamis.

Determining the Behaviour of Wild Plants’ Use in Meru, Kenya

Alfreda Kajira Ibui

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 60-66

The ethnobotanical record resulting from interactions between the Meru people and their wild plants shows a high reliance on medicinal and non-medicinal uses of these plants.  In this part of Africa, wild plants are increasingly being used for medicine, food, material, social purposes, construction, fuel, environmental beauty, and wind and dust breaks. In the fight against diseases and ailments, medicine made from wild plants is beginning to compete with conventional medicines. The availability of numerous plant species growing in the area, with which humans have interacted for centuries, highlights the dependence.

Indeed, the favourable climate for equatorial forests, where temperatures favour the development of numerous plant species, contributes to this region's status as a pharmacy in the making. A total of 567 plant specimens collected from three districts of the greater Meru area have been reported to be used to cure a variety of diseases as well as to meet other non-medicinal needs such as fruit, fuel, and materials. Data collected through structured interviews from respondents in the region reveal significant factors that play major roles in the lives of the people thus influencing their social and cultural behaviour. It is concluded that the use of medicinal plants in Meru as a complement to primary health care is observed and recorded among the people. The great knowledge of the people relating to useful plants and their medical properties was reported to stretch back in time to several generations.

Background: Osteoarthritis is a slowly progressive disorder associated with a hyaline cartilage loss. Non-steroidal anti-inflammatory drugs play a pertinent role in management of osteoarthritis.

Objectives: The study was carried out for the comparison of efficacy and tolerability of Aceclofenac and Diclofenac in patients of osteoarthritis of knee joint.

Material and Methods: It is a randomised parallel group double blinded study. The study included 60 patients of confirmed osteoarthritis of knee joint, 30 patients were given Aceclofenac and 30 patients were given Diclofenac after food for 8 weeks and the patients were evaluated and compared statistically for pain intensity by VAS Score, Joint tenderness, Swelling, Erythema, Pain on movement, Functional capacity and Overall Assessment on LIKERT Scale.

Results: Both the drugs caused marked improvements in the parameters of -Pain intensity, Joint tenderness, Swelling, Erythema, Pain on movement of OA knee joint but there was increased improvement in all the parameters with aceclofenac.

Conclusion: Aceclofenac is the NSAID of choice in the osteoarthritis of knee joint as compare to Diclofenac as it is found to be more efficacious. Although, no significant difference was found in adverse effect drug profile.

Studies on Dexmedetomidine as an Adjuvant to Levobupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

V. Waindeskar, K. Bhatia, S. Garg, J. Kumar, S. Songir, V. Singla

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 74-82

Background: Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks.

Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia. In our study, while the onset time of both sensory and motor blocks were shortened in the drug group, the duration of analgesia was significantly prolonged.

Materials and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine; and in group BD (n = 30), 30 ml of 0.325% levobupivacaine + 1 µg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded.

Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p< 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups.

Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.

A Worldwide Health Problem: Parental Alienation

Wilfrid von Boch-Galhau

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 83-91

Parental Alienation is a serious mental condition that professionals who work with children, adolescents and adults should know. Parental Alienation is to be found mainly in situations of high conflict separation and divorce, however it exists also in some other contexts. In this article two case examples are presented. The first case example shows parental alienation in a high conflict divorce situation, the second demonstrates institutionally induced parental alienation as a consequence of wrong child sexual abuse accusations by a mentally ill neighbour. Although about thousand three hundred professional articles, book chapters and books, and also empirical studies, exist meanwhile (see website https://ckm. vumc.org/pasg) from all over the world there is still not enough awareness of Parental Alienation in professional practise. Parental Alienation is a child protection issue and the child protection authorities and the courts have to act accordingly.

A Case Study of Migrating Gossypioma: Unforeseen Challenges

Parveen Malhotra, Vani Malhotra, Naveen Malhotra, Yogesh Sanwariya, Isha Pahuja, . Akshay

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 92-98

Retained sponge or any surgical device following an intra-abdominal surgery is known as Gossypioma, and it is one of the most common medico-legal issues. Clinical symptoms related to intra-abdominal Gossypioma may vary from mild abdominal pain to major complications including bowel or visceral perforation, obstruction. The illness can appear in a variety of ways, from asymptomatic to serious gastrointestinal consequences such as vomiting, abdominal pain, obstruction, perforation, peritonitis, and even death. Gossypioma transmural migration is a very rare occurrence that might result in bowel or visceral perforation, obstruction, or fistula formation. The stomach, ileum, colon, bladder, vagina, and diaphragm have all been reported to have transmural migration of an intra-abdominal Gossypioma. Only a few cases have been reported in the medical literature. We do, however, disclose the first case of the world's largest Gossypioma, a surgical mop measuring 26 x 23 cm that was successfully removed endoscopically. A 60-year-old man had an open cholecystectomy six months ago for symptomatic gall stones. After two weeks of operation intervention, he became symptomatic, complaining of abdominal pain and recurrent vomiting. A lump in the distal section of the stomach and duodenum was discovered on a barium swallow and an abdominal ultra ultrasonography, raising suspicion of gastric carcinoma. On upper gastro-intestinal endoscopy, a surgical mop that had totally migrated into the stomach and duodenum was seen. The surgical mop was successfully removed by endoscopy through the esophagus. The recovery of the patient was uneventful. Any surgical patient with unexplained chronic abdominal discomfort and vomiting should have transmural Gossypioma migration into the stomach investigated in the differential diagnosis. Endoscopy can be used for both diagnostic and therapeutic purposes. In cases of endoscopic failure or incomplete migration of Gossypioma into the stomach, surgery may be recommended.  

Procalcitonin as a Diagnostic Biomarker of Sepsis: A Prospective Study in a Tertiary Care Centre

Shefali Gupta, Pradeep Jaswani, Raj K. Sharma, Suraksha Agrawal, Narayan Prasad, Chinmoy Sahu, Amit Gupta, Kashi N. Prasad

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 99-110

Introduction: Sepsis is remains a prominent source of morbidity and mortality, despite advances in diagnostic methods. It's still hard to differentiate between sepsis and non-infectious disease conditions. The procalcitonin (PCT) test is beneficial for diagnosing sepsis, however the cut-off levels vary depending on the clinical context. The goal of this study was to determine the appropriate cut-off values for PCT with high sensitivity and specificity by correlating serum PCT levels with cultures. Methodology: This prospective study comprised 305 patients from various hospital wards; the patients were classified into group I: controls (n = 46), group II: Culture-negative sepsis (n = 76) and group III: Culture-positive sepsis (n = 196). Mean p value <0.05 was considered significant.

Results: In comparison to group I, PCT levels were significantly higher in groups II and III. In group II, the best cut-off point for PCT was 1.3 ng/ml with 87.30% sensitivity and 78.26% specificity (area under curve 0.86). In group III, the best cut-off value of 2.20 ng/ml with 98.47% sensitivity and 89.13% specificity was found (AUC 0.96).

Conclusion: Procalcitonin is a promising biomarker for bacterial sepsis diagnosis since it can differentiate culture-negative and culture-positive sepsis from non-infectious diseases.

Clinical Spectrum of Hepatitis B in India- A Retrospective Ten Year Study

Parveen Malhotra, Vani Malhotra, Usha Gupta, Yogesh Sanwariya, Isha Pahuja, . Akshay

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 111-120

Introduction: Hepatitis B virus (HBV) infection, a pan global health problem, has already effected one-third of the world population. India harbours around 40 million HBV carriers, thus accounting for 10–15% share of total pool of HBV carriers of the world. Every year over 100,000 Indians die due to illnesses related to HBV infection

Aims and Objectives: To study the Epidemiological profile and Clinical spectrum of patients with Hepatitis B virus infection.

Materials and Methods: This prospective study was done at Department of Medical Gastroenterology, PGIMS,Rohtak over a period of ten years i.e. 01.09.2010 to 31.08.2020, on HbsAg positive patients who reported on outdoor patient department or were admitted in various wards of hospital.

Conclusion: Hepatitis B is having certain hotspots in India like Haryana. The young males with rural background are most vulnerable because of unsafe needle & injection practices due to non-availability of proper health care facilities.

Middle Mesial Canal an Extra Entity: A Case Report

Sana Farooq

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 121-126

The primary objective of endodontic therapy is to achieve a three-dimensional obturation of the root canal space to remove the tissue debris, microorganisms and their by products after a proper biomechanical preparation of the pulp chambers. The missing canal of complex root canal morphology is major reason for endodontic failure. The use of magnification, illumination, recent advancements, diagnostic aids and techniques help in minimizing the incidence of missing a canal. This case report describes the rare management of a left mandibular first permanent molar requiring root canal treatment with an additional Middle Mesial Canal (MMC) in the mesial root. Clinicians experience and approach is a key factor in negotiation and management of these aberrant canal configurations. After a proper access cavity preparation, clinicians should spend time in examining the mesial sub pulpal groove to detect and negotiate additional canal.

Parental alienation is a significant mental illness that professionals working with children, adolescents, and adults should be aware of. Parental alienation is most common in high-conflict separations and divorces, but it can also occur in other circumstances. One case study involving two siblings is described in this article. It depicts parental alienation in the context of a high-conflict divorce, which could be overcome with a concerted intervention by child protective services and the family court, in collaboration with a trained psychologist. Despite the existence of over a thousand professional articles, book chapters, and books, as well as empirical research from all over the world (see website https://ckm.vumc.org/pasg), there is still a lack of awareness or even denial of parental alienation in professional practise. Stopping parental alienating behaviours is imperative for the promotion of the best interests of children and the health of families.

An Overview of Worldwide Sleep Disturbance

Kathy Sexton-Radek

Highlights on Medicine and Medical Science Vol. 3, 3 June 2021, Page 138-143

A perspective from the United States on sleep reports that twenty-five percent of adults report not getting sufficient sleep. Sleep in America Polls by the National Sleep Foundation findings indicate that adolescents reported getting, on average, six and a half of the nine hours sleep they need each night. With regard to work in America, it is estimated by the Centers for Disease Control National Institute for occupational Safety and Health reported that 41 million workers get less than six hours of sleep a night (i.e., 7 to 8 hours is recommended). Metabolic changes in the body (e.g., heart rate, insulin resistance, systolic blood pressure) occur with poor sleep quality. This phenomenon is referred to as cardio metabolic health vulnerability to restricted sleep. Health professionals (particularly Sleep Specialists) are able to identify the impact of sleep disturbances on their patients. This and other poor sleep conditions need to be detected and treated by a health care specialist. In adolescents, worldwide survey studies have identified sleep patterns delaying with increasing age, with Asian adolescent bedtimes later than North American and Europe yielding less total sleep time and more excessive daytime sleepiness.