Dr. Syed A. A. Rizvi
Associate Professor (Tenured),
Department of Pharmaceutical Sciences, Hampton University School of Pharmacy (HUSOP), Flemmie P. Kittrell Hall, 121 William R. Harvey Way, Hampton, VA 23668, USA.

ISBN 978-93-91312-27-5 (Print)
ISBN 978-93-91312-35-0 (eBook)
DOI: 10.9734/bpi/hmms/v5

This book covers key areas of medicine and medical science. The contributions by the authors include treatment interrupters, non-adherence factors, high fibre diet, resection, primary anastomosis, risk factors, sigmoid volvulus, colostomy, sigmoid volvulus, non-linear analysis, bifurcation, eigenvalues, arrhythmias, action potential duration, electrocardiogram, cardiac arrhythmias, heart block, bradycardia, difficult vascular access, temporary pacing, transvenous pacing, fungal rhinosinusitis, mucormycosis, oxidative stress, antioxidant activity, antibacterial activity, cytotoxic activity, radical scavenging, fungal rhinosinusitis, urinary stress incontinence, fertility awareness method, complementary medicine,  integrative health, geriatric patient, attrition, abrasion, erosion, fussy eating, preschoolers, physical growth and neurodevelopment, physical activity, nutrition condition, breast neoplasms, phyllode tumor, breast ultrasonography, radical mastectomy. This book contains various materials suitable for students, researchers and academicians in the field of medicine and medical science.


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Factors Associated to Non-Adherence in Tuberculosis Treatment, Baringo County, Kenya: A Cross-Sectional Study

Ronald Omenge Obwoge, Richard K. Sang, Aurelius Wakube

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 1-7

Tuberculosis (TB) continues to be a major cause of high morbidity and mortality in Kenya. Kenya is among the 22 countries contributing 80% of global TB burden. The country has improved from number 13th to 15th among the 22 countries. The Kenya TB treatment defaulter rate is 15% [1].

The study was to determine the factors associated to non-adherence to TB treatment at individual, health care provider, facility and community levels.

A cross sectional descriptive survey study was conducted in Baringo County covering both urban and rural areas, Kenya. Data collection was done using developed self-administered questionnaire, interview schedules and checklist. Respondents were traced through TB patient defaulters registers and health workers. Convenience sampling was employed. Data was analyzed using SPSS version 20.

The study found that non adherence to treatment was associated by several factors namely: patient-related, health worker-patient relationship, health care delivery patterns and socio-cultural factors. They were noted to be associated both at intensive (46%) and continuation (54%). treatment phases. Amongst the smoking patients 45% associated it with non-adherence, those with drinking habit 58% associated it with non-adherence. 53% of patients associated it with walking distance to access the services, 41% of defaulters associated symptoms relieve during treatment made them not to adherence to treatment, and 52% associated their forgetfulness or carelessness with non-adherence.

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the incidence and the factors influencing the outcome of management of SV in Northern Uganda.

Methodology: This study had two parts. The retrospective study was to determine the incidence over a period of 2 years. In the one year prospective study to determine the factors influencing outcome, patients 13-years and above with SV were included and followed up to the 30th postoperative day. Ethical approval was obtained from the IRB of Gulu University. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality.

Results: The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. Data on 103 patients were analyzed; 18 (17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%.

The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.3018.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099).

Conclusions: The incidence of SV in Northern Uganda was 251.8 per 100,000 surgical population in 2 years. The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.

Nonlinear Analytical Approaches for Prediction of Alternans Mediated Cardiac Arrhythmias

Kanchan Kulkarni, Elena G. Tolkacheva

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 35-47

Cardiac alternans, an alternation in the action potential duration (APD), is suggested to be a precursor to lethal tachyarrhythmias such as ventricular tachycardia or ventricular fibrillation, which in turn can lead to sudden cardiac death. Linear methods for detection of alternans onset and suppression have shown limited success, predominantly due to presence of cardiac memory wherein APD prediction at any instant purportedly requires the knowledge of multiple previous APDs and diastolic intervals (DIs) to successfully characterize the present cardiac state. Taking into account the non-linear relationship between the APDs and preceding DIs, the transition from steady state to alternans has been captured successfully using non-linear analytical methods including bifurcation theory, principal component analysis and chaos control techniques. This chapter presents an overview of non-linear analytical approaches utilized for predicting the onset of alternans that hold potential to translate into preclinical modalities capable of alternans detection and control, thereby preventing fatal tachyarrhythmias and transition to sudden cardiac death. We present a preclinical evaluation using high resolution optical mapping of two novel techniques based on bifurcation analysis and eigenvalue decomposition to predict the onset of alternans. Furthermore, we correlate the spatial evolution of alternans with bifurcation parameters and dominant eigenvalues, providing a potential marker for alternans estimation.

Study on Left Ventricular Pacing: A Desperate Life-saving Measure in Emergency Situation

Ajaz Ahamad Lone, Mohd Iqbal Dar, Fayaz Ahamad Rather, Mohd Sultan Alai, Imran Hafiz, Jahangir Rashid Beigh

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 48-54

In the cath lab, transcutaneous or transvenous pacing of the right ventricle is performed as a  routine practise for patients with symptomatic bradycardia or complete heart block. Temporary transcutaneous or transvenous pacing is commonly the first intervention taught to cardiologists and intensivist, as it is one of the most important lifesaving interventions in cardiology. However, more and more patients are received with multiple comorbidities, critical condition, and difficult vascular access.

The goal of this study is to report a patient who had challenging venous access, tricuspid regurgitation, and a displaced right ventricular pacemaker temporary lead who was handled with emergent nonconventional left ventricular pacing while having coronary angiography.

Invasive Fungal Rhinosinusitis: A Brief Review

Sajad Majid Qazi, Aamir Yousuf, Sulmaz Reshi

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 55-67

"Fungal rhinosinusitis" as term describes fungal infection of the nose and paranasal sinuses. Fungal rhinosinusitis encompasses a wide variety of fungal infections based on wide spectrum of immune and pathological responses, that range from merely irritating the sinuses (allergic fungal sinusitis) to rapidly fatal disease (invasive fungal rhinosinusitis). Likewise fungal sinusitis has been classified as noninvasive and invasive type based on their pathophysiology and presentation. Symptoms spectrum can vary from simple rhinosinusitis, while on other extreme in immunocompromised it can cause significant morbidity and mortality. So much has been discussed and published on classifications, terminology management with early clinical suspicion, diagnosis and timely intervention medically and surgically that has proved beneficial. Given the current Covid-19 scenario and association with fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.

Pharmacological Activities of Ficus racemosa and Analysis of Its Major Bioactive Polyphenols by HPLC-DAD

Salma Akter Sumi, Md. Afjalus Siraj, Amir Hossain, Md. Sagir Mia, Seagufta Afrin, Md. Mustafizur Rahman

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 68-84

Objective: Oxidative stress leads to numerous physiological disorders including infectious diseases, inflammation, and cancer. The present study was carried out to investigate antioxidant, antibacterial, and cytotoxic activity of methanol crude extract of leaves and fruits of the Ficus racemosa (LCME and FCME, resp.) and to analyse its major bioactive polyphenols by HPLC-DAD. F. racemosa has various uses in traditional medicine in the subcontinent for treating an array of diseases.

Methods: Antioxidant capacity of the extracts was evaluated by DPPH free radical scavenging, reducing power, total phenolic, total flavonoid, total tannin content assay, superoxide radical, hydroxyl radical, and hydrogen peroxide scavenging assay. Identification and quantification of bioactive polyphenols were done by HPLC-DAD method. Antibacterial activity was tested by “disc diffusion” method. Brine shrimp lethality assay was carried out to check the cytotoxic potential.

Results: Both LCME and FCME showed DPPH scavenging ability and concentration dependent reducing power activity. They had phenolic content, flavonoid content, and tannin content. Both the extracts showed superoxide radical scavenging ability, hydroxyl radical scavenging ability, and hydrogen peroxide scavenging ability. HPLC analysis of LCME and FCME indicated the presence of significant amount of gallic acid along with other phenolic constituents.

Conclusion: Significant amount of gallic acid along with other phenolic constituents might have played an important role in the observed antioxidant, antibacterial, and cytotoxic activity.

The Fertility Awareness Method and Managing Stress Urinary Incontinence (SUI), an Advanced Study

Shihata Alfred, A. Brody Steven, Linderoth Birgit, Julia Barrett-Mitchell

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 85-94

 Background: Women's unmet reproductive health needs:

  1. There are limited options in hormone-free contraceptives.
  2. The fertility awareness method is the safest form of birth control, yet it is rarely used.
  3. Women endure stress incontinence silently.

Objectives: Provide women with one device for contraception, fertility awareness, and stress urinary incontinence.

Materials and Methods: The FemCap is an FDA approved contraceptive device that can fulfill the three basic reproductive health needs for women:

  1. The FemCap is a safe, effective, time-tested, barrier contraceptive device.
  2. Collect the fertile cervical mucus with the FemCap directly at the cervix, without mixing any other vaginal fluid.
  3. Pessaries have significant limitations such as displacement, erosion, or even ulceration and urethral obstruction. The FemCap shows marked similarity to the ring pessary. The rim of the FemCap function is the same as the ring pessary in that it supports the bladder neck. The outward flaring brim of the FemCap restores the anatomy of the urethra and the vagina. The bowl of the FemCap prevents the cervix from descending providing further support.

Results: The FemCap is a well-established barrier contraceptive device. In pilot studies, FemCap has proven to enhance fertility awareness methods and control stress incontinence in pilot clinical trials.

Conclusion: A multi-function device for contraception, fertility awareness, and stress urinary incontinence would save women time and money while improving their quality of life.

Undergraduate Module for Complementary Medicine and Integrative Health

Ahmed Tawfik El Olemy

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 95-112

Background: Medical education has undergone major transformation along with the change in concept of health and disease.

Objective: Increasing awareness, improving knowledge and acquiring skills of complementary medicine and integrative health for undergraduate medical students.

Methods: Complementary medicine and integrative health module was introduced during the year 2016-2017, for fourth year medical students at Dar Al Uloom University, Riyadh, KSA. The Methods of teaching and learning include interactive lectures, seminars, practical sessions, assignments, field visits, simulation, learning by doing (hands on training), case studies, problem based learning and self-directed learning. Topics covered during the course include; Introduction and overview of Complementary and Alternative Medicine (CAM), Epidemiology of CAM practices, Characteristics and comparison of CAM vs. Conventional Medicine, Integrative Medicine, Research models in CAM, Evidence based CAM, Medical ethics of CAM, Frauds and misconceptions related to CAM practices and products, Health education and communication in CAM, Manipulative and body based practices, Biological-based practices, Mind-body medicine, Energy based therapies, Whole medical systems; Traditional Chinese Medicine (TCM), Unani, Arabic or Hakim Medicine, Prophetic Medicine and Local traditional CAM therapies (Hijamah as a model), Acupuncture, Herbal Medicine, Naturopathy, Nutrition and food supplements, Apitherapy and Homeopathy.

Assessment of the Module: The course comprises two types of assessments; continuous and final assessment. Continuous assessments toke place throughout the course. They are mostly based on course work as follows; Seminar (10%), Assignments (10%), Field visit report (10%) and Mid-term exam (20%). A proportion of 50% was taken in the final assessment. A student who scored 60 or more deemed to have passed this course.

Conclusion: The feedback received was most supportive of the module and appreciative of the teachers, the information provided and skills gained and the way in which it was delivered.

Assessment of Type and Severity of Tooth Wear in Geriatric Patients: A Clinical Survey

Roseline Meshramkar, K. Lekhaq, Gouri V. Anehosur, Ramesh K. Nadiger

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 113-118

There has been an increasing interest in tooth wear in dental literature. Tooth wear is commonly found in every dentition. Problems associated with tooth wear in elderly is increasing. A clinical survey was conducted to assess the type and severity of tooth wear in Geriatric patients. A total of 148 patents were surveyed out of which 128 M 40 F with mean average age of 60-80 yrs. The history was recorded with a with a questionnaire. Depending on the feedback for all these questions were to categorize the patients into one of the following etiological categories. Attrition, Abrasion, erosion, combination of tooth wear and clinical examination was done to asses the type of tooth wear and the extent of tooth wear was assessed using smith and knight index.

Out of 148 patients all patients had tooth wear, 129 patients had attrition, 14 patients had abrasion, 5 patients had erosion and 82 patients had combination of tooth wear. 62 patients had Grade I, 38 patients had Grade II, 28 patients had Grade III, 3 Patients had Grade IV. It is very necessary to know the epidemiological survey of tooth wear in geriatric patients among Indian population.

Background: This study aimed to evaluate the prevalence of picky eating among preschoolers and to estimate the clinical association between eating behaviour and growth, physical activity, development, and health status.

Aims: The goal of this research study is to identify and find out the clinical impacts of picky eating behaviour on preschoolers and children aged schools in terms of their physical growth, neurodevelopment, nutrition and physical activity.

Methods: In this study, a structured questionnaire was used to perform a cross-sectional descriptive study of 800 parents of preschoolers aged 2–4 years in Kurdistan/Iraq. Data collected included: demographics, food preferences, eating behaviour, body weight, BMI, height, development, physical activity, and records of medical illness. Data from children defined as picky or non-picky eaters responses were analyzed and compared using standard statistical tests according to the parental' questionnaire.

Results: The mean age of the children was 2.85 years; among 800 participants, 620 (77%) were picky eaters. Compared with non-picky eaters 180 (23%), z-score of weight-for-age, height-for-age, and body mass index (BMI)-for-age in picky eaters was 0.91, 0.73, and 0.44 SD lower, respectively. There were significant variations of rates in the weight-for-age, height-for-age, and BMI-for-age percentiles <15, between picky and non-picky eaters (P = 0.04, 0.023, and 0.005, respectively). Certain findings were higher in picky as compared to non-picky preschoolers including negative social communication such as afraid of unfamiliar places 65% vs 13.3%, afraid of being lonely 14.6% vs 12.1%, poor physical activity 36.8% vs 17.7%, learning disability 16.2% vs 7%, attention deficit 11.8% vs 4.3%, speech delay 4.6% vs 3.3%, respectively).

Conclusion: The prevalence of picky eaters in preschool children was high, resulting in significant detrimental impacts on growth, nutritional status, development, physical activity and health status.

A Case Study on Giant Malignant Phyllodes Tumor of the Breast

Catarina Abreu Silva, Madalena Souto Moura, Mariana Gomes Afonso, Susana Lopes Rodrigues, Ana Catarina Silva

Highlights on Medicine and Medical Science Vol. 5, 10 June 2021, Page 133-137

Phyllodes tumor is a rare fibroepithelial tumor of the breast that account for less than 1% of all breast neoplasms [1]. Clinically, it is typically a large, smooth and fast-growing mass that forms from the periductal stroma of the breast [2]. Phyllodes tumor can be considered benign, borderline, or malignant and the percentage of malignant tumors ranges from 23 to 50%. This classification depends on histologic features, as the degree of stromal cellularity and atypia, mitotic count and stromal overgrowth [2].

In this review, we aim to characterize the main clinical and radiological findings of the phyllodes tumors, as well as the anatomopathological findings. We report a case of a huge malignant phyllodes tumor in a 62-year old woman who presented with a large breast mass with 10-month disease evolution time. The patient underwent total mastectomy and the pathology analysis revealed a malignant tumor.