Editor(s)
Dr. Pietro Scicchitano
Department of Cardiology, Hospital “F. Perinei” Altamura (BA), Italy.

ISBN 978-93-5547-194-9 (Print)
ISBN 978-93-5547-195-6 (eBook)
DOI: 10.9734/bpi/rdmmr/v12

This book covers key areas of Medicine and Medical Research. The contributions by the authors include perinatal outcome, fetal growth restriction, middle cerebral artery Doppler sonography, leukemia, mixed phenotype, therapeutics, autism, lipid diet, sociability, aberrant vascularization of vitreous, ambiguity of vitreoretinal interface, internal limiting membrane maturation, mis-retinalization, psudo-retinalization, retinopathy of prematurity, rhesus alloimmunization, intravenous immunoglobulin, middle cerebral artery peak systolic velocity, mindfulness, mindfulness-based interventions, cancer, breast cancer, death anxiety, Peripheral angioplasty, systemic heparinization, risk factors, restenosis, model building, multivariate statistics, proportional hazards regression, SAS programming, statistical computation, dopamine, nucleus of the solitary tract, dorsal motor nucleus of vagus, noradrenaline, dopamine-$$\beta$$-hydroxylase, down’s syndrome, congenital heart disease, nutritional status, Agouti related peptide, feeding behavior, Neuro-peptide Y neurons, Pro- opiomelanocortin neurons, Reactive oxygen species, Graves´ disease, urgent thyroidectomy, hyperthyroid, Bio-active titanium, Low intensity ultrasound waving, Simulated body fluid, Magnetic Resonance Imaging, Refractive Index, Apparent Diffusion Coefficient Artificial Neural Network, Support Vector Machine, Chronic periodontitis, metabolic syndrome, systemic diseases, biomarker, melanocytes, micro biopsies, fine needle aspiration biopsy, core needle biopsy, telomerase reverse transcriptase, brain, neuron, neurodegenerative disease, cutaneous vasculitis, paradoxical effect, biotherapy, rheumatoid arthritis. This book contains various materials suitable for students, researchers and academicians in the field of Medicine and Medical Research.

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### Chapters

##### A Review on Minimally Invasive Right Colectomy from Conventional Laparoscopic Resection to Robotic-Assisted Surgery

Paolo Moroni, Carmen Payá-Llorente, Lelde Lauka, Elisa Reitano, Riccardo Memeo, Paschalis Gavriilidis, Francesco Brunetti, Aleix Martínez-Pérez

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 1-14
https://doi.org/10.9734/bpi/rdmmr/v12/14160D

Robotic-assisted abdominal surgery was introduced with the aim to overcome the drawbacks of the conventional laparoscopic approach. The present narrative review focuses on the comparison between laparoscopic and robotic-assisted approaches for right colectomy (RC) on the short and long-term outcomes, costs, and learning curve. Main technical aspects related with the use of robotic assistance for this specific procedure are further discussed. The introduction of the latest generation optics (3D, 4K) and more ergonomic tools can be considered a bridge towards technical facilitation. Minimally invasive RC is considered technically challenging due to the particularities of the right and middle colic vascular anatomy. Robotic RC has not yet widespread due to the high costs and operating times. However, its use may result in advantages regarding the short term clinical outcomes and facilitates the acquisition of basic surgical skills, speeding up the learning curve of minimally-invasive colorectal surgery.

##### Retrospective Evaluation of Nd: An Approach to YAG Laser Application with Visual Analog Scale in the Treatment of Dentin Hypersensitivity

Ersin Ulker, Rasul Guliyev, Tugrul Kirtiloglu, Naciye Izgu Bagci

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 15-23
https://doi.org/10.9734/bpi/rdmmr/v12/2884E

Background: Dentin hypersensitivity (DH); It is a common oral complaint characterized by a sharp pain in dentin a response to tactile, thermal, evaporative, or osmotic stimuli, which cannot be explained by another oral pathology. The treatment of DH is difficult due to the difficulties in determining the pain intensity and the change in pain threshold from patient to patient. Therefore; clinical examination together with a good anamnesis to be obtained from the patient is very important in determining the treatment method. Many desensitizing products and techniques with different effect mechanisms have been used in the treatment of DH, which has more than one treatment option. Today, lasers have been used to increase the success of DH treatment. Although different types of lasers are used in DH treatment, it has been reported that Nd: YAG laser may be more effective in reducing patient pain compared to other laser types.

Objectives: The aim of this study was to evaluate the effect of Nd: YAG laser on dentin sensitivity treatment by comparing the pre-treatment and first year control VAS value records.

Materials and Methods: Records of 16 (13 females, 3 males) patients were examined, Nd: YAG laser treatment was performed for DH, and the data of 90 teeth were analyzed using the records taken with the VAS scale at the beginning and at the first year.

Results: Compared to the beginning, there was a statistically significant decrease in DH in the first year after treatment (p <0.001).

Conclusion: Nd: YAG laser irradiation could reduce the symptoms of DH; thus, and it may be viable alternative for the treatment of this condition.

##### Study on Surgical Treatment for Peritrochanteric Diseases

Dante Parodi, Javiera González-Bahamondes

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 24-29
https://doi.org/10.9734/bpi/rdmmr/v12/13895D

Arthroscopy is becoming increasingly important in the management of different hip diseases and with its development, peritrochanteric diseases have become a focus of attention.

Conservative management is the initial treatment even though it is described as having questionable results. Alternatively, we have used surgical management for those patients who underwent through conservative treatment with poor results. We have developed an arthroscopic surgical treatment that includes the partial release of the iliotibial band and the resection of the bursa, showing satisfactory results. The objective of this article is to describe the surgical technique that we have used.

##### Determination of Blood Serum Lead and Cadmium Level during Pregnancy in Gas Flaring Communities of Bayelsa State Nigeria

Solomon M. Uvoh, Arthur N. Chuemere, Charles Nnamdi Ngaikedi, E. Kiridi Emily Gabriel

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 30-36
https://doi.org/10.9734/bpi/rdmmr/v12/5098F

This research study determines and compare the level of serum lead and cadmium among pregnant and non-pregnant women living in selected gas flaring communities in Bayelsa State, Nigeria. Two hundred apparently healthy pregnant women and one hundred non-pregnant as control were randomly selected as participants for this study. The prevalence of elevated serum lead (>0.1ppm) above the world health organization permissible range among the non-pregnant and pregnant subjects was (2%) and (5%) while that of cadmium (>0.0012 ppm) was (11.33%) and (19.66%) respectively. However the total prevalence of elevated heavy metals in the blood of non-pregnant and pregnant subjects was (6.66%) and (12.33%).The study reveal a non-significant increased concentration of Lead level among the non-pregnant control group (0.07 ppm) to that of the pregnant (0.05 ppm) with no difference in their cadmium (0.01 ppm) level. The study reveal a non-significant slight increase in the level of Lead among the pregnant test group (0.06 ppm) during their third trimester when compared with those in their first and second trimesters (0.05 ppm) with cadmium blood level of (0.02 ppm) among those in their third trimester. This research study have been able to confirm that the longer the duration of exposure to gas flares in years the higher the concentration of lead and cadmium in the serum of pregnant and non-pregnant women in Bayelsa state, Nigeria.

##### Study of Anatomical Justification of Coracoacromial Arch Impingement Due to Diverse Morphology of Acromion Process by Radiographs

Aruna Y. Yadav, Vaishali A. Mane, Supriya P. Satpute

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 37-47
https://doi.org/10.9734/bpi/rdmmr/v12/5224F

In addition, we can see that the Coracoacromial arch distance is much smaller in Type III acromion than in other types of acromion. Beglani claims that the P value is 0.000. According to Edelson and Traitz, the P value for coracoacromial arch is also 0.001, indicating that it is highly significant. The p value is not significant in normal radiographs of patients without shoulder pain.

##### Comparative Evaluation of the Synbiotics, Antibiotics and Analgesics in Post Extraction Healing of Tooth Sockets

Shweta Singh, S. Sahana, Sulabh Kumar, N. K. Gupta

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 48-52
https://doi.org/10.9734/bpi/rdmmr/v12/4514F

Background: In the current scenario, the emergence of antibiotic resistance and its side effects have limited their use in a range of prophylactic options. Indeed, some new strategies and alternative therapies, such as herbal medicines and laser therapies, have already reduced the use of antibiotics to prevent/cure health problems or oral diseases. Many authors are currently attempting to demonstrate the influence of synbiotics in the maintenance of oral health, so this study was conducted to examine the use of synbiotics and their benefits in the post-extraction tooth socket.

Aim: The aim of this research is to study the Clinical effectiveness and cost-effectiveness of synbiotics over antibiotics and analgesics in post extraction of tooth socket

Materials and Methods:  This research is a randomised controlled trial, parallel group, multicenter trial comparing the effectiveness of synbiotics in post-extraction socket healing that was conducted in three locations in Lucknow, India, including the BBD dental college of dental sciences. There were three groups of 80 patients each. On the third, fifth, and seventh days, the primary outcome measures were observed in each group.

Results: In terms of the evaluated parameters, we discovered a significant difference between the three groups. Table 1 show the age and gender distribution. Wound-related complications such as bleeding, swelling, and gut flora disturbance at the surgical site were more prevalent in groups 2 and 3 than in group 1, which was found to be statistically significant with p values of 0.02, 0.01 and 0.01. Table 5 show the cost analysis of the study subjects during treatment, with statistically significant results obtained between groups 1 vs group 2; group 1 vs group 3; and group 2 vs group 3 at p 0.01.

Conclusion: Since this was a novel approach to comparing post-extraction wound healing, and the results demonstrated a definite positive effect by synbiotics. Synbiotics hold a promise in improving oral health. Further research with a larger sample size and a different formulation would be recommended before putting the product into clinical use.

##### A Rare Case of Deep Vein Thrombosis in Upper Extremity

Mohammed Adnan Sheerazi, Furqan Mohd. Akram Khan

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 53-57
https://doi.org/10.9734/bpi/rdmmr/v12/14093D

Deep vein thrombosis(DVT) in the upper limb is less common than in the lower extremities. There were no institutional screening measures in place for patients at risk of upper-limb deep vein thrombosis. As a result, the purpose of this case report is to discuss the characteristics of upper limb deep vein thrombosis.

##### A Descriptive Study on Assessment of the Preoperative Health Status Based on ASA PS versus ABCK

I. M. Bula-Bula, P. Kabuni, J. Kimbien, A. Sikyala, M. Ilunga, J. Athombo, P. Kimpanga, F. Lepira, M. Mbuyi, M. Kilembe

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 58-65
https://doi.org/10.9734/bpi/rdmmr/v12/14297D

Introduction: The ASA score presents the disadvantage of being subjective and its inter-individual concordance rate is criticized by several authors. This study aims at assessing the concordance between ABCK score and ASA score.

Methods: It is a descriptive study conducted from 1st December 2013 to 30th August 2014 in Three hospitals of Kinshasa city: Hôpital de l’amitié sino- congolaise, Hôpital Saint Joseph and Hôpital Marie Biamba Mutombo. All patients admitted for pre-anaesthesia consultation during the period of the study were assessed using ASA score and ABCK score. Were excluded from the study all pregnant women and children.
Informed consent was obtained from all participants. The conformity of the new score with the ASA score was assessed using the kappa of Cohen test.

Results: 768 patients out of them 449 women and 319 men were examined. The sex ratio was 1.4 in favour of women. The average age was 39.4 ±
16.8 years. Low blood pressure and anaemia were the main complications during and post surgery operations and were mostly found in stages 3 and 4 for the 2 scores.
Blood transfusion was frequent in stages 3 and 4 for the 2 scores. Mortality tends to increase with the patient’ stage in the 2 groups (ASA: X2 = 25.98; p< 0.001 and ABCK: X2 = 29.70; p < 0.001). The risk of death was not related to the score used (p = 0.31 as per Fisher for class 3 and X2 = 0.52; p = 0.24 for class 4). And, there was an excellent concordance with a Kappa at 0.86 between ABCK and ASA (p < 0.001).

Conclusion: Even if there is a correlation between ABCK and ASA, it would be very interesting to do a larger study with patients from obstetrics and paediatric surgery who were not included in this study for the goal of generalising the outcomes of this new score.

##### Study on Phytoestrogen and Gut Micro-Biome Composition of Women with PCOS

K. Gayathri, V. Supriya

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 66-75
https://doi.org/10.9734/bpi/rdmmr/v12/13152D

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 15% of reproductive aged women. Affected women exhibits the clinical features such ovulatory dysfunction, insulin resistance hyperandrogenism and obesity. Etiology still remains unclear but genetic and lifestyle factors contributing to the etiology of PCOS has been evidenced by many research studies. However its exact pathogenesis needs to discovered. The gut micro biota plays an important role in human health. Occurrence of altered gut micro biome composition and dysbiosis has been observed among women with PCOS. Phytoconstituents like phytoestrogen- a plant derived nutritive bioactive compound which mimics the similar structure and activity of estrogen hormone. It aids in alleviating the symptoms of PCOS without any adverse effects such as improve the ovulation and to reduce blood glucose. It also helps to improve the gut micro biome composition by increasing alpha and beta diversity. The main objective of this chapter is to explore the innumerable findings between the association between the Phytoestrogens, PCOS and gut micro biome composition.

##### Effectiveness of Mifepristone in the Treatment of Uterine Leiomyoma

Alla Satyanarayana Reddy, Aruna Giri

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 76-82
https://doi.org/10.9734/bpi/rdmmr/v12/14262D

Aim: The present study was carried out to evaluate efficacy of 3 months of oral mifepristone in decreasing the severity of symptoms and in decreasing uterine and fibroid volume.

Methods: This was a prospective study conducted at prathima institute of medical sciences in Obstetrics and Gynaecologt department, karimnagar, Telangana Fifty symptomatic patients with fibroids received 25 mg of mifepristone daily for 3 months and baseline data regarding Hb value, PBAC score (pictorial blood loss assessment chart), VAS (visual analogue scale), Uterine volume and Fibroid volume were compared with those recorded at the end of 1st month, 3rd month and 3 months after stoppage of mifepristone.

Results: Treatment with Mifepristone significantly reduced mean PBAC score to 95% after 1 month, 98% after 3 months and 58% compared to the pre-treatment value. Mean VAS score was reduced to 67% after 1 month, 72% after 3 months and 47% after 3 months of stoppage of drug to pre-treatment value. Mean uterine volume was reduced 24% after 1 month, 44% after 3 months and 35% in post treatment follow up patients compared to pre-treatment value. Mean baseline fibroid volume was reduced to 25% after 1 month, 54% after 3 months and 40% in post treatment follow up patients. Though all these parameters slightly raised after stopping mifepristone, significantly reduced compared to baseline values. Haemoglobin was raised by 2.12 gm/Dl from baseline at the end of 3rd month of therapy but slightly decreased compared to values of 3rd month treatment. Baseline endometrium was 7.4 mm which was increased to 8.24 mm after 3 months of treatment, it has come down to the baseline value which shows that endometrial thickness during treatment was transient. 12% of patients became amenorrhoeic after treatment but menstruation was resumed in 32.78% patients in post treatment follow up patients. There were minimal side effects during the course of study.

Conclusion: Low dose oral Mifepristone 25 mg for 3 months significantly reduced Menorrhagia, backache, dysmenorrhoea and other associated symptoms, decreased uterine and fibroid volume and improved Haemoglobin levels with minimal side effects.

##### The Four Prominent Indicators of Diagnostic Testing: Consistency among their Values Reported in Saudi Medical Journals

Hamzah Abdul Majid Serag, Ali Muhammad Ali Rushdi

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 83-98
https://doi.org/10.9734/bpi/rdmmr/v12/2664E

We provide a novel method for validating any purported set of the four most prominent indicators of diagnostic testing (Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value), by observing that these indicators constitute three rather than four independent quantities. This observation has virtually been unheard of in the open medical literature. We defined two functions, which serve as consistency criteria, since each of them checks consistency for any set of four numerical values claimed to be the four basic diagnostic indicators. Most of the data we came across in various Saudi medical journals met our criteria for consistency, but in a few cases, there were obvious unexplained blunders. We relate our present findings to the more general issue of detection and ramifications of flawed, fabricated or wrong data. We observe that the research field handling the detection of flawed data is still in its infancy, and hope that this field will reach maturity very soon.

##### A Comparative Approach on Intra-operative Microscope-integrated Indocyanine Green Angiography

Amit K. Ghosh

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 99-107
https://doi.org/10.9734/bpi/rdmmr/v12/5094F

Microscope integrated Indocyanine green (ICG) video angiography with its analysis by color mapping and graphic diagram is a safe, easy, simple, real-time, cost-effective method of intraoperative vascular assessment during cerebral aneurysms, cerebral AVM/AVF, spinal AVM/AVF, brain tumours and vascular bypass.

It has some limitations where combination of microvascular doppler, endoscopy, electrophysiology and intraoperative DSA may be useful.

This study is a review of ICG angiography and its analysis in different surgeries by different centres as well as comparison with other intraoperative modalities of assessment of vascular status.

##### Study on the Effects of Health Guidance for Men with High Risks of Metabolic Syndrome

Setsumi Kudo, Akiko Yamasaki, Itsushi Takai

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 108-111
https://doi.org/10.9734/bpi/rdmmr/v12/11602D

The study intends to clarify the effect of health guidance provided by an occupational health nurse for six months for male workers identified with high risks of metabolic syndrome at workplace health check. The subjects were 73 males out of 137 total workers who went through the health check, and one health nurse intervened throughout the study period. The effect of guidance was measured by the changes in attendance persistency, abdominal girth, weight, improvements in eating and exercising habits, their eagerness to improve lifestyle, etc. Data analysis was performed by X2 test.

The participants’ average age was 48.0, and they mainly involved deskwork. The guidance attendance persistency was 57.5%, and among the 42.5% dropouts, 35% discontinued due to overwhelming workload. At the beginning, the averages of abdominal girth and weight were 91.7cm and 76.0kg respectively. After six months, they were reduced by 2.0cm in girth and 1.4kg in weight. The lifestyle improvement rate was 55.0% in diet and 25.0% in physical exercise, with the diet improvement rate significantly high (P<0.01). As for their willingness for lifestyle improvement, 55.0% participants, more than two times the initial rate, expressed their intention to improve it within half a year. It is necessary to restart metabolic syndrome prevention by setting a new goal as well as to provide their families with information from workplaces in order to ensure their continued cooperation.

##### Impact of Health Education Intervention on Uptake of Random Screening for Cervical & Breast Cancers among Rural Women in Villages of Gurgaon Cluster, Haryana, India: A Cross-Sectional Study

P. Cheena Chawla, Anil Kumar Chawla, Seema Chaudhary

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 112-119
https://doi.org/10.9734/bpi/rdmmr/v12/14328D

Rural women's treatment-seeking behaviour and uptake for preventative screening for breast and cervical cancers are influenced by disease awareness and socio-cultural practices. This study was conducted to investigate rural women's awareness and knowledge of cervical and breast cancers, as well as their attitudes and uptake for primary screening for these diseases in Gurgaon villages selected at random by our financial partner, DLF Foundation, Gurgaon. A cross-sectional study was conducted on 603 women, ages 21 to 65, who attended women's cancer awareness and screening camps, where they received random primary screening for breast and cervical malignancies. A total of 235 women (39%) were examined for cervical and breast cancers out of 603 women who participated in various camps hosted in various villages within Gurgaon between 2014 and 2016. In addition, 365 women (61%) were taught how to perform a self-breast assessment. Out of 235 people evaluated, 88 (37.44 percent) were discovered to have genital infections, for which they were provided free medicines. Out of 235 screened women, 99 (42%) were suspected of having cervical or breast abnormalities and were referred for further testing (46 women for Pap smear, 33 women for USG Abdomen, and 20 cases for Mammography) to confirm the disease and provide treatment recommendations. Only 38 cases, on the other hand, followed the follow-up protocol. Specially designed, easy-to- understand leaflets (in Hindi) on the four women’s cancers (Endometrial Cancer, Breast Cancer, Ovarian Cancer and Cervical Cancer) were distributed to all participating women. The most important finding was that rural women had little knowledge of cervical and breast cancer screening and were completely unaware of the symptoms, risk factors, and preventive screening for these malignancies. In order to reduce the burden of cervical and breast cancers in India, effective education and large-scale primary screening are required. It was discovered that low family finances and lack of transportation make it difficult for women to get to health centres while they are experiencing the distressing symptoms of these diseases. The study found that cancer awareness programmes, as well as on-site primary screening for cervical and breast cancers using simple, cost-effective approaches, will benefit rural women greatly, given the majority of them never get these malignancies screened.

##### Labor Pattern in South Indian Population: A Retrospective Study

Chitra Bhat, Seetha Panicker

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 120-127
https://doi.org/10.9734/bpi/rdmmr/v12/13121D

Aim:  Labor dystocia is one of the most common reasons for a lower segment cesarean section (LSCS). Recent research has revealed a significant shift in the rate of cervical dilatation and labor progression. There are no large studies to assess labour in this ethnic group, so this study was conducted to discover labour behaviour in women experiencing spontaneous labour in South India.

Materials and Methods:  In our teaching hospital, a retrospective study was conducted. Labor was managed according to protocol, and a partogram was maintained. Data were extracted and analysed from case records.

Results: Labor progress was much slower than what was thought of. There was wide variability in the duration of labor. In contrast to friedmannscurve, all women did not follow a pattern of 1 cm/hr of cervical dilatation. Though the mean time to progress from 3 cms to 10 cms was 5 hours, even after 19 hrs of waiting women have delivered.

Conclusion: Many women took time up to the 95th percentile and some even crossed three times the median time to deliver. In contrast to friedmannscurve, all women did not follow a pattern of 1 cm/hr  of cervical dilatation. Though the mean time to progress from 3 cms to 10 cms was 5 hours, even after 19 hrs of waiting women have delivered.

##### A Case Series of Seizures in Pediatrics with COVID-19 Disease

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 128-135
https://doi.org/10.9734/bpi/rdmmr/v12/2843E

In December 2019, the outbreak of coronavirus started in China, and after a while, it spread worldwide. These diseases can appear with respiratory and gastrointestinal symptoms in pediatrics, but neurological symptoms like seizures are uncommon. Furthermore, there is no specific data about the nervous system manifestation in children. This case series study is aimed to diagnose COVID-19 in children with nervous system manifestation. Seizures in the context of coronavirus infection are likely to be more severe and are life threatening in children predicting poor prognosis.

##### Studies on Low Dose Magnesium Sulfate in Eclampsia in a Tertiary Care Hospital

Alla Satyanarayana Reddy, Manjula Sivaramakrishnan

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 136-143
https://doi.org/10.9734/bpi/rdmmr/v12/14259D

Eclampsia is a major obstetric problem that can cause significant morbidity and even death in both the mother and the child. The Pritchard regimen is a well-known anticonvulsant strategy that has shown to be effective in the treatment of eclampsia. A low-dose MgSO4 regimen is being tested to decrease MgSO4 toxicity in low-weight Indian women. The low dose protocol consists of a loading dose of 4 gm MgSO4 slow IV, followed by a maintenance dose of 2 gms MgSO4 slow IV every three hours; continued for 24 hours after delivery or 24 hours after the last convulsion, whichever is later; If a convulsion occurs during treatment, an additional dose of 2 gms of MgSO4 is given slow IV in addition to the regular dose.

In the years 2017 and 2018, 123 women were diagnosed with eclampsia. 69 women were hospitalised for eclampsia, 15 of whom developed eclampsia after admission, and 39 women were referred for management from other hospitals. Antenatal or antepartum eclampsia affected 60% of the women. One-third of the women experienced postpartum eclampsia, with the rest suffering from intrapartum eclampsia. 40% of women had a blood pressure of less than 160/110 mm Hg, while 60% had a blood pressure of more than 160/110 mm Hg. Two-thirds of the 81 direct admissions experienced eclampsia at or after 37 weeks; 60% had unassisted vaginal delivery; 1/6 had instrumental vaginal delivery; and 1/4th of the women were terminated by LSCS. Thirteen of the 81 women were admitted with absent FH; five experienced intrapartum foetal death; 90 percent of the 63 live deliveries had a fair Apgar score; 10% had a poor Apgar score at 5 minutes of delivery; and three babies died prematurely. One woman had eclampsia with 10 fits, went into coma and died. Others are on their way to being discharged. The low-dose MgSO4 regimen is just as effective as Pritchard's. When compared to the Pritchard regimen, maternal and foetal morbidity and death were essentially same in the low dosage regimen.

##### Determination of Foley`S Bulb for Cervical Ripening in Induction of Second Trimester Abortion

Alla Satyanarayana Reddy, B. G. Harish Babu

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 144-149
https://doi.org/10.9734/bpi/rdmmr/v12/14261D

A study was conducted on fifty-six women who came for termination of pregnancy between 14 and 20 weeks of gestational age to examine the efficacy and safety of Foley's bulb in combination with Misoprostol in the management of second trimester abortion, with a special focus on cervical damage. The procedure used was an inflated Foleys bulb with traction pressure over the internal cervical os and Misoprostol 400 mcg vaginally every four hours.  Induction abortion interval, doses utilised, additional techniques used, side effects, and complications observed were all documented. There was a 100 percent success rate with few side effects, no severe problems, and no cervical injury. The results are compared to similar research in the literature.

##### Evaluating the Role of Sildenafil on Endometrial Characters in Ovulation Induction Cycle

Alla Satyanarayana Reddy, A. Vikram Arun

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 150-155
https://doi.org/10.9734/bpi/rdmmr/v12/14264D

Sildenafil promotes endometrial development by causing vasodilation by relaxing the smooth muscles of blood vessels. Improving endometrial thickness is one of the cornerstones of infertility treatment.

Aim of the Study: To evaluate the role of Sildenafil on endometrial characters in ovulation induction cycle.

Materials and Methods: A total of 50 infertile women with thin endometrium were allocated into two groups at random. Group A included 25 women who received clomiphene citrate 50 mg daily from D2 to D6, as well as estradiol valerate 2 mg thrice daily from D2, and Group B included 25 women who received clomiphene citrate 50 mg daily from D2 to D6, estradiol valerate 2 mg thrice daily from D2, and sildenafil citrate 25 mg vaginally thrice daily from D7 to the day of ovulation trigger. Trans-vaginal ultrasound was performed on alternate days beginning on D8 of the cycle to monitor follicular development and endometrial characteristics. Once the dominant follicle reached >18 mm, an HCG trigger was administered. Three cycles of ovulation were studied in total.

Results: Endometrial character monitoring in all ovulation-induced cycles revealed a significant improvement in Group B.

The mean endometrial thickness in Group B was 10.2±1.6 mm compared to8.53±1.4 mm in Group A; the tri laminar pattern was 93.54 percent in Group B compared to 40.29 percent in Group A; the zone 4 endometrium was 79.03 percent in Group B compared to 26.86 percent in Group A; and the clinical pregnancy rate per cycle was 20.96 percent in Group B compared to 13.45 percent in Group A.

Conclusion: The addition of vaginal Sildenafil to estradiol valerate has a significant effect on endometrial characteristics and clinical pregnancy rates in ovulation induction cycles.

##### Study about Cardiac Anesthesia as Super-specialty: A Clinical Approach

Manjula Sarkar

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 156-160
https://doi.org/10.9734/bpi/rdmmr/v12/1953C

Development of cardiac anesthesia and its progress is albeit a short duration but a rapid one. Basically, this picked up a pace in late 90’s even though it came into existence during 1950’s. Coronary artery bypass grafting (CABG) is the core of cardiac surgery which has revolutionized the life of patients with critical and multiple coronary artery disease. Apart from cardiac output monitoring, cardiac anesthesia care has been benefitted by cerebral tissue oxygen monitoring too. Cardiac surgery was notorious for the humongous requirement of blood and its products. This also led to wastage of these precious assets apart from transfusion related serious health hazards. Bleeding and deranged coagulopathy, are very common in cardiac surgeries.

##### Agenesis of Right Lobe of Liver: A Rare Case Report

Vasudha Ravindra Nikam, Balkrishna Shankar Kitture

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 161-165
https://doi.org/10.9734/bpi/rdmmr/v12/14470D

Agenesis of the right lobe of the liver is a rare condition defined as the absence of liver tissue on the right side with preservation of the middle hepatic vein in the absence of previous disease or surgery. Agenesis of the right hepatic lobe is a rare congenital defect that is discovered by chance during a radiologic test. We discuss a case of a 22-year-old woman who presented with abdominal distension and was suspected of having liver cirrhosis. She was evaluated, and imaging investigations indicated the absence of the right lobe of the liver. Agenesis of right lobe of liver is an extremely rare congenital anomaly.

##### Descriptive Study on COVID-19 Infection in Children: A Case at the Security Forces Hospital (SFH)-AL Riyadh-Saudi Arabia

Elsharif A. Bazie, Abdulkarim Alanazi, Wejdan Hamed Abdullah Alshammari, Fahad Mishal Alharbi, Faisal Ahmed Alghamdi

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 166-172
https://doi.org/10.9734/bpi/rdmmr/v12/2656E

Coronaviruses (CoV) are RNA respiratory viruses that present with a wide range of symptomatology which range from common cold to severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). In December 2019 a new strain was discovered in China named Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), named “COVID-19” by World Health Organization (WHO). COVID-19 was predominantly more prevalent among adults more than or equal to 15 years of age in the early stages of the outbreak, and the proportion of confirmed cases among children was relatively small.

Objective: To study the prevalence and clinical presentation of COVID-19 among children attended pediatrics emergency department.

Results: from 1st March to 30th of June 2020. During the study period, a total of 223 patients with age between 16 days and 12 years were diagnosed as positive COVID-19. Male were 52%. Fever was found in 39.9%, cough in 14.3%, and diarrhea in 3.6%.

Conclusion: our study gives a clue to the clinical presentation of COVID-19 in pediatric populations.

##### Rethinking Death Education as Part of Public Health Policy

João Carlos Macedo

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 173-179
https://doi.org/10.9734/bpi/rdmmr/v12/12549D

Death and dying are still taboo subjects in today's society. In most western countries, people die mostly in hospitals, surrounded by health professionals and high technology, but with no real humanisation of care. This transfer of death from the home to hospitals, which began in the 1960s of the last century, has brought social and cultural consequences for the way we deal with the end of life. We will have to save the work of some experts, like Elisabeth Kübler-Ross (1926-2004), to consider the need for death education. Based on the work of this paradigmatic author and other studies over time, we present a set of proposals for implementing death education as part of public health policy.

##### Unilateral Inflammatory Linear Verrucous Epidermal Naevus of the Face and the Oral Mucosa. A Rare Case

Dorsaf Touil Oueslati, Wahbi Ben Salah, Douki Nabiha

Recent Developments in Medicine and Medical Research Vol. 12, 2 November 2021, Page 180-187
https://doi.org/10.9734/bpi/rdmmr/v12/1529B

Epidermal nevi are a group of hamartomatous lesions of the skin consisting of an overgrowth of the normal components of the epidermis and adnexal structures. The clinical manifestations include yellowish-brown, granular or papillomatuous plaques typically arranged in a linear or whorled configuration following Blaschko's lines. These lesions are usually observed at birth and they enlarge slowly during childhood. Then, they tend to stabilize by adolescence [1]. Epidermal nevus syndrome (ENS) is a condition where the epidermal nevi are associated with the involvement of other organ systems notably neurological, ocular, cardiovascular and urological developmental abnormalities. It has been reported that 30% of individuals with epidermal nevi have additional syndrome symptoms [2,1]. Oral involvement is extremely rare [3]. and only few cases have been reported in the literature.

The aim of this paper was to report the case of a 9-year-old patient with inflammatory linear verrucous epidermal nevus of his right cheek with an intra-oral involvement of his buccal mucosa. To discuss different treatment modalities and possible outcomes.