Dr. Darko Nozic
Clinics of Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia.

ISBN 978-93-90768-34-9 (Print)
ISBN 978-93-90768-36-3 (eBook)
DOI: 10.9734/bpi/rtcms/v8

This book covers key areas of medical science. The contributions by the authors include  psoriasis, skin disease, emotional dysregulation, psychological factors, environmental pollutants, sperm quality, male reproduction, reprotoxicity, diabetic retinopathy, optical neuropathy, autoantibodies, toxic metabolites, macular degeneration, vaginal delivery, model of duality, reciprocity, Instantaneous Axes of the Knee, antibiotic prophylaxis, lactose intolerance, milk and dairy consumption, milk consumption habits, antioxidant activity, phenolic compound, macro-microelements, Mullerian adenosarcom,, uterus, tamoxifen use, tumor occurrence, hybrid intervention, endarterectomy, femoropopliteal revascularization, endovascular treatment, extraluminal angioplasty, selective stenting, peripheral arterial disease, meningeal signs, diagnostic; meningitis, reatment, tocopherol, nephrotic syndrome, immunostaining, ocular trauma, traumagram, pregnancy, vertical transmission. This book contains various materials suitable for students, researchers and academicians in the field of medical sciences.


Media Promotion:


Psoriasis: The Analysis of Emotional Experiences of the Skin

Mento Carmela, Clara Lombardo, Nicholas Ian Whithorn

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 1-6

The psoriasis is an inflammatory skin disease, chronic and relapsing, characterized by erythematous patches covered by a silvery-white scaly layer, mainly located on elbows, knees, sacral area and scalp. In the literature it emerged that it is associated with a particular difficulty in understanding and communicating one's own and others' emotions, a discomfort that manifests itself mainly on the body. People with psoriasis have an alteration in their body image and this affects the quality of life. The psoriasis as well as other dermatological disorders also seem to be associated with psychological problems, for instance depression, anxiety, sleep disorders and various conditions such as states of strong concern, stress and low self-esteem. In conclusion, this complex of emotional and physical issues highlights the need a multidisciplinary approach to treating both physical and emotional disorders, in a combined treatment to ensure a better quality of life for the patient. The work aims to examine the psychological aspects and consequences of psoriatic patients, in particular, problems related to the regulation and expression of emotions.

Effects of Environmental Pollutants on the Male Reproductive System

Emre Salabas, Seda Karabulut, Selma Yazar, Tulay Irez

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 7-38

Exposure to environmental pollution has been associated with adverse health problems and its impact on the reproductive organs and gametes. In addition, limited research has been done to examine the relationship between air pollution and male reproductive outcomes, particularly semen quality. We conducted a systematic review (until September 2020) to assess the impact of environmental and occupational exposure to environmental pollution on semen quality. Epidemiological studies focusing on environmental pollution and male reproduction, PubMed, Medline, Google documents were identified by scanning the literature bases. Numerous studies evaluating the effects of environmental pollutants (PM2.5, SO2, NOx, O3, Phalats, Cadmium, lead, Endocrine distrubing chemicals, electromagnetic contamination, temperature increase) on main semen parameters (sperm concentration, motility, morphology), spermatogenesis, DNA fragmentation and semen toxicology, endocrine parameters were included. When the studies were evaluated, it was seen that there were important results supporting the evidence that environmental pollution can affect sperm DNA fragmentation, morphology and motility, and the spermatogenesis process.

In summary, most studies have concluded that indoor and outdoor pollution affects male fertility. Cell culture and molecular studies will further reveal the importance of the subject.

Plasmapheresis in Ophthalmology

V. A. Voinov, K. S. Karchevscy, O. V. Isaulov

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 39-51

Loss of sight is one of the most severe disabling factors in human. The total number of such people is known to account for millions worldwide. The significant spread of such diseases, which affect millions of people all around the world, shows the problem to be urgent. In North America alone more than 1 million are completely blind and about 14 million have some degree of sight loss. There are many different diseases that lead to sight loss such as diabetic retinopathy, senile macular degeneration, various types of autoimmune retinopathy, optic nerves damage and many others. As a rule, they cannot be corrected with glasses, and not always amenable to drug therapy. Often the cause of these diseases is accumulation of various autoantibodies and other metabolites, the molecules large size of which does not allow them to be excreted by the kidneys and the fact of their accumulation indicates impossibility of their removal with help of drug therapy. It makes us resort to such method of their direct removal from the body as plasmapheresis and the aim of this study is to justify its use in ophthalmology.

Assessing the Predictors of Delivery at the Expected Date of Confinement among Women in Yenagoa, Southern Nigeria

Ikobho Ebenezer Howells, Addah Ojanerohan Abednigo

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 52-61

Background: The expected date of confinement is calculated using Naegle’s rule that is 280 days or 40 weeks of gestation, but it is observed that most women tend to deliver between 38 and 42 weeks. Unfortunately, only a few women deliver exactly on the expected date of confinement, the reason remains mostly unknown.

Objective: The objective of this study is to determine the percentage of women in Yenagoa that can deliver on their expected date of confinement, using the Niger Delta University Teaching Hospital as a case study. It would also determine whether maternal age, parity, tribe, body mass index, birth weight and fetal sex have a significant influence on the date of delivery.

Materials and Methods: A retrospective observational study of 3,420 pregnant women who were admitted in labour, and delivered at term in the delivery suite of the department of obstetrics and gynaecology, Niger Delta University Teaching Hospital, in Southern Nigeria. The study was carried out from 1st January 2009 to 31st December 2012. A total of 2380 booked parturients living in Yenagoa, whose last regular menstrual period was documented in their case notes, including those who had an early first-trimester ultrasound scan, were selected. Data concerning their expected dates of confinement and the actual dates of delivery were retrieved. Also retrieved were maternal age, parity, tribe, birth weight, and fetal sex. Others include maternal height and weight at booking; these were used to calculate the body mass index. The data was analyzed after that.

Results: Majority of the women in Yenagoa 85.0% delivered at term, and only a handful 7.4% delivered on the expected date of confinement. Delivery on this date was associated with low body mass index, (BMI of 18.5 kg/m2) and male babies p = 0.006. Nulliparous women were twice more likely to deliver on the EDC than multiparas, Odds Ratio = 2.44, P = 0.002, and women with average maternal age of 25-29 years were 4 times more likely to deliver on the EDC than women ? 35 years, Odds Ratio = 4.93, p =0.0003. Women from Yoruba living in Yenagoa delivered more on the EDC than any other tribe in Nigeria.

Conclusion: Although majority of the women in the study delivered at term, only a handful delivered on their date of EDC, therefore the exact date of childbirth was difficult to predict. From our study, biological variables of the would-be mother and ethnicity stand out as some of the best predictors of delivery on the date of confinement among women living in Yenagoa, Southern Nigeria.

A Critical Study on the Duality of Functional Knee Axes and Foot Contact

Wangdo Kim

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 62-71

Estimating the functional knee axis (FKA) is crucial to correctly implanting a prosthesis and accessing joint kinematics. The correct estimation of the patient-specific joint axis of the knee is crucial for achieving a reliable assessment of musculoskeletal kinematics and dynamics Researchers have reported on the KFA mainly with regard to manual management of flexion-extension movements performed passively without any voluntary actions. Active touch and movement refer to what is ordinarily called touching—variations in skin stimulation caused by surfaces are altered together by motor activity variations. This fact is worth noting because it is often neglected that locomotion and its surfaces form an inseparable pair. The objective of this study was to confirm the distinction between touching and being touched. We were particularly interested in measuring the instantaneous axes of the knee (IAK) during locomotion. We propose the invariant structure of the knee as an attempt to distill a kind of higher-order simplification of a knee model relative to the enormous complexities of the biological systems of a human joint. This principle attempted to distill a kind of higher-order simplification relative to the enormous complexities of analytical anatomical objects and the practice of biomechanical engineering, which are sometimes confused.

Prevention of UTI in Children with CAKUT: A Medical Challenge

Nneka Chioma Okoronkwo

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 72-81

Background: Urinary tract infection (UTI) is commoner in children with Congenital anomalies of the kidney and urinary tract (CAKUT) than in the general paediatric population. Recurrent UTI as a result of CAKUT may predispose children to renal scarring, hypertension and CKD. Prevention of UTI in this group of patients is advocated, but achieving this has become a medical challenge in view of the controversy surrounding use of prophylactic antibiotic.

Methods: This was a 10 year retrospective review of Children with CAKUT who were placed on prophylactic antibiotics over a certain period, at an Academic Hospital in Johannesburg. The rate of UTI, the types of causative organisms isolated and the efficacy of prophylactic antibiotics in preventing UTI were documented.

Results: One hundred and thirty four (134) patients with CAKUT were analyzed. Thirty six (36) of them had been started on prophylactic antibiotics after the diagnosis of CAKUT was made. There was a statistically significant association between the use of prophylactic antibiotics and the rate of UTI (p < 0.001). Patients who were not on a prophylactic antibiotic were five times more likely to have a UTI than those who were on a prophylactic antibiotic (OR = 5.21, P = 0.001, 95% CI: 1.9906 – 13.6277). Patients who were on prophylactic antibiotics showed an altered pattern of isolated bacteria, with Klebsiella pneumoniae being the most common organism isolated, rather than E. coli, when compared to the group that were not on prophylactic antibiotics. There was a statistically significant association between the type of bacteria isolated and the use of antibiotic prophylaxis (p= 0.031).

Conclusion: Antibiotic prophylaxis was very effective in decreasing the rate of UTI in our cohort of patients with CAKUT.

This study was conduct to determine the gastrointestinal symptoms after the consumption of milk and dairy products, lactose intolerance status and knowledge with Pre-school Teacher Education departments students at a Foundation University. After eating of the lactose containing food, symptoms can happen between 30 minutes and 2 hours. Diarrhea, bloating, nausea, borborygmi, flatus and abdominal pain are gastrointestinal symptoms that almost always present in lactose intolerant patient. The study was carried out with 200 female students on a voluntary basis. A data information form with 22 questions was applied to the participants. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) program was used for statistical analysis. General information, milk, milk products and foods that may contain lactose consumption frequencies, gastrointestinal symptoms such as abdominal pain, diarrhea, gas, bloating in the stomach, stomach cramping, vomiting and nausea after consumption of milk and fermented milk products like yoghurt, kefir, cheese were obtained via data information form. Monthly consumption of milk and dairy products of the participants, total energy, calcium, lactose amounts were calculated. It was observed that the students consumed cheese and yoghurt more. Among those participating in the study, the rate of those who were diagnosed with a health care provider and had lactose intolerance was found to be 1%, while those who are suspected of lactose intolerance were 36%. It was found that 76.3% of the students who thought that they had lactose intolerance started to feel the symptoms later. The rate of lactose intolerance in patients with chronic disease compared to patients without chronic disease was found to be statistically significantly higher. When evaluated according to lactose intolerance after drinking milk, the distribution of the severity of the cases of abdominal pain, diarrhea, gas passing, stomach bloating, cramping and nausea show statistically significant difference. When the patients with and without lactose intolerance were compared, monthly calorie, lactose and calcium values from ayran and cheese were found to be statistically significantly lower in patients with lactose intolerance. The individuals, who feel gastrointestinal symptoms after milk consumption, can be directed to fermented milk products. It is very important to identify people with symptoms of lactose intolerance and take the precautions accordingly in order to maintain a healthy and quality life. It was seen that most of the students who experienced symptoms of lactose intolerance were not diagnosed and it was seen that the society should be made aware of this issue.

Critical Evaluation of Antioxidant and Phenolic Content of Edible Plants

Hülya Demir, Gökhan Biçim

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 95-101

Today, there is a growing interest in nutritional awareness and a selective preference towards a healthy and balanced diet. A number of varieties of vegetables are good sources of essential components in human nutrition, providing vitamins, minerals, and fibre in general. Furthermore, chemical substances specific for given vegetables are responsible for various effects in the living organisms. It is reported that the increased consumption of plants reduces the risk of developing several diseases including cardiovascular diseases, cancer, stroke, degenerative diseases, as well as, providing a reduction in the risk of functionality loss emerging with increasing age. For instance, natural antioxidants are the commonly known components of vegetables, neutralizing free radicals in the human body. The aim of the research was to evaluate antioxidant activity and phenolic content in leaves of three common Urtica dioca L., Rumex acetosella L., and Chenopodium album L. The antioxidan activity of these plants varied from 117.99 to 1273.83 µMTE/g. Urtica dioica L. had the highest antioxidan activity (1273.83 µMTE/g) followed by Rumex scutatus L.(225.09 µMTE/g) while the lowest value was observed in Chenopodium album L.(117.99 µMTE/g). The highest phenolic compound was determined in Urtica dioica L.(0.811 mMGAE/g), and the lowest phenolic compound was found in Rumex scutatus L. (0.481 mMGAE/g). The results obtained in this study indicate that wild Urtica dioca L., Rumex acetosella L., and Chenopodium album L. could be an important dietary source because of its good antioxidant and phenolic content properties. In this respect, the study contributed to the literature and it is thought that it could lead to further studies.

This study was conducted to determine the mineral contents and some nutritional properties of five wild edible plants ( Malva neglecta Wallr., Urtica urens L., Rumex crispus L., Rumex scutatus L., and Chenopodium album L.) growing in the grasslands of Eastern Anatolia Region of Turkey and are consumed as vegetable. Moisture (%), total ash (%), pH, and ascorbic acid (mg/100 g) content of the plants ranged from 74.8 to 88.38%, 8.72 to 15.75%, 5.50 to 6.93, 42.68 to 146.40 mg/100 g, respectively. Mineral analysis showed that the wild plants contained considerably high amounts of sodium (21.82-60.93 mg/100 g), magnesium (60.41-77.63 mg/100 g), potassium (557.53-1025.80 mg/100 g), calcium (154.75-340.30 mg/100 g), phosphorus (41-93 mg/100 g), manganese (0.44-1.18 mg/100 g), iron (12.62-53.20 mg/100 g), cupper (0.28-0.67 mg/100 g), zinc (0.40-1.44 mg/100 g). The present study has revealed that these wild plants could contribute significantly to the dietary requirements of the people the Eastern Anatolia region. These plants can use for enrichment of diets with low mineral content. Their consumption could help in alleviating the problem of malnutrition at negligible cost; therefore, their cultivation and utilization should be encouraged. Further study is needed to determine how best to exploit its food value promote human health.

Mullerian Adenosarcoma of Uterus Following Tamoxifen Use- A Case Report

Himleena Gautam, K. K. Kathar, Papari Goswami

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 111-117

Mullerian adenosarcoma is a rare tumor. Around 200 cases have been reported till date. This tumor usually occurs in peri or postmenopausal women and asymptomatic presentation is rarely reported. Use of tamoxifen has been considered to be a risk factor for this tumor occurrence. We here report a woman who was referred due to detection of a suspected malignant mass on PET scan, which was done to follow up the patient after treatment of breast cancer. Patient had history of tamoxifen use for 5years. But she was asymptomatic. Total abdominal hysterectomy with bilateral salphingo-oophoectomy was done. Histological examination confirmed the diagnosis of mullerian adenosarcoma. Post-operative course was uneventful and radiotherapy was given later in a nuclear medicine centre. This article wishes to emphasize the importance of recognizing this tumor for both gynecologists and pathologists. Uterine adenosarcoma has variable survival rate depending on its sarcomatous component, lympho-invasion, and myoinvasion. This patient showed no lymph invasion and no myoinvasion, which account for her good prognosis. Oncologists and gynecologists should be aware that this tumor can occur in patients with history of tamoxifen use, as a positive correlation has been seen in reported cases.

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

Vlad-Adrian Alexandrescu, Thibault Barriat, Sophie Schoenen, Elisa Antonelli, Mircea Popitiu, Inès Zekhnini

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 118-140

Background: The present chapter focus on eventual clinical benefit of hybrid revascularizations gathering common femoral artery (CFA) endarterectomy coupled to femoropopliteal endovascular recanalization in high-risk ASA Class 3-4 patients having severe infrainguinal multilevel occlusive disease.

Materials and Methods: From January 2009 until November 2019, a series of 205 hybrid infrainguinal interventions performed in 178 ASA Class 3-4 patients (Rutherford category 2-6 ischemic presentations) were retrospectively analyzed. Patient demographics, specific risk factors, technical characteristics, parallel to patency, limb salvage and survival results were examined during a mean 44.9 months of follow-up. In the whole, long (>15 cm) and intermediate (5-15 cm) CTO were present in 198 (96%) of all ischemic limbs, in parallel to severe CFA atherosclerotic disease. Two or three runoff tibial trunks were evinced in 172 (84%) cases, while moderate-to-severe arterial calcifications were present in 78 (38%) cases.

Results: Inasmuch the surgical approach was successful in all cases, the endovascular step of all hybrid interventions was technically rewarding in 190 (93%) cases. The postoperative ABI improved (> 1.5) in 75% of cases, while clinical presentations gained at least one Rutherford category in 182 (89%) limbs. The postoperative 30-day mortality rate noted in this specific “high-risk” group of patients was 3.3%. The mean hospital stay was 6.2 days (3-14 days).

Primary patency estimates revealed 88% (95% CI 84% to 91%) and 66% (95% CI 56% to 75%) at 12 and 60 months, while limb salvage was 93% (95% CI 88% to 95%) and 80% (95% CI 72% to 86%) at the same time intervals, respectively.

Global risk factors alike smoking (p=0.003) and female gender (p=0.001), together with CTOs length (>15 cm / p=0.016), severe calcifications (p=0.049), poor tibial runoff (p=0.018, and p=0.001 for 1, and 0 permeable trunks), the GLASS/FP grade “4” lesions (p=0.039), and the stent length (>6 cm / p=0.001), showed parallel negative influence on primary patency.

Conclusion: Hybrid infrainguinal revascularization may offer beneficial option for treatment options in high-risk ASA 3-4 patients. Careful patient selection and technique planning appear essential for achieving appropriate arterial reconstruction and limb salvage outcome.

Validity of Meningeal Signs in Suspected Meningitis

Munish Kumar

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 141-147

Background: Meningitis, an inflammation of meninges, a common medical emergency. Meningeal signs like Kernig’s sign, Brudzinski’s sign and neck rigidity are used specifically to assess a patient’s with suspected meningitis. It has been proposed that in patients with meningitis, passive flexion of the neck stretches the nerve roots through the inflamed meninges, leading to pain and flexion movements of lower extremities. However, these signs are not pathognomonic for meningitis. The aim of study is to validate the meningeal signs in 75 adults with suspected meningitis.

Methods: Seventy-five patients admitted to our tertiary hospital with suspected meningitis were selected and divided into two groups: Patients with meningitis (n=62) and Patients without meningitis (n=13). Meningitis was considered to be present if the CSF WBC count was ? 6/cmm. The three meningeal signs Kernig’s sign, Brudzinski’s sign and nuchal rigidity noted in each patient prior to lumber puncture. The sensitivity, specificity and P-value calculated.

Results: Demography and clinical presentation of patients with meningitis (n=62) were similar to those without meningitis (n=13). Meningeal signs - Of the 62 patients with meningitis (WBCs/cmm of CSF ? 6) who were examined prior to lumbar puncture, neck rigidity in 46 (74.2%), Kernig’s sign in 37 (59.68%) and Brudzinski’s sign in 18 (29.03%) patients. None of the meningeal signs shown to have statistical significance (P<0.001). Kernig’s sign had a sensitivity of 60% and specificity, 85% whereas Brudzinski’s sign had 29% and 92% respectively. Sensitivity and specificity for nuchal rigidity were 74% and 77% respectively.

Conclusion: The study suggest that Kernig’s and Brudzinski’s signs are not sensitive for detecting meningitis and therefore, if not present, it can’t exclude the diagnosis of meningitis. Nuchal rigidity is the only meningeal sign with clinical usefulness. A larger number of patients need to be studied with standardization of clinical method for elicitation of meningeal signs.

Correction of Chronic Hypoxia and Apoptosis in Nephrotic Children

Ievgeniia Burlaka

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 148-156

Objectives: The objective of this paper was to study the levels of cellular hypoxia, apoptosis and dependence of these factors on the value of kidney function impairment; to evaluate possible protective effects of the treatment with antioxidant agent tocopherol in children with nephrotic syndrome.

Background: Hypoxia-related disorders play an important role in irreversible tissue damage via activation of certain secondary processes. Nephrotic syndrome (NS) consists of peripheral edema, heavy proteinuria, and hypoalbuminemia, often with hyperlipidemia.

Methods: An examination of renal biopsies of 53 patients (aged 10 to 15 years) with nephrotic syndrome done. Conventional clinical investigations, immunochemistry, immunoblotting were used in this study.

Results: We show that children with nephrotic syndrome have high level of marker of cellular hypoxia HIF-1?. Levels of the latest depends on the level of kidney function impairment and proteinuria. The sclerosis progression which is a sign of irreversible kidney damage is accompanied by gradual increase of the proapoptotic factor Bax expression. An applied treatment composes conventional scheme and tocopherol showed an improvement in hypoxia level, proapoptotic factor Bax expression.

Conclusion: Hypoxia-induced disorders in nephrotic children presented by disturbances in apoptosis controlling system can be attenuated by the antioxidants application. Further study of the molecular mechanisms which preserve kidney in nephrotic children and non-toxic nephroprotective agents, including antioxidants are important issues in nephrology field.

Recent Advancement on Construction of Ocular Traumagram

Bhartendu Shukla

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 157-161

An article on ‘A model for quantification of ocular trauma’ [1] was published by the author recently. However, there was problem about the construction of ocular traumagram which was on the basis of measuring the magnitude of ocular trauma. Hence a detailed methodology for construction of ocular traumagram is presented for easier comprehension.

A Short Review on HIV and Pregnancy

C. Sofoudis

Research Trends and Challenges in Medical Science Vol. 8, 5 February 2021, Page 162-166

The incidence and existence of human immunodeficiency virus concerning women of reproductive age continues to increase globally. The care of HIV-infected women is not simple and must be focused on including the current and future health of these women, the minimization of the risk of maternal–infant transmission and the maintenance of the well-being of the fetus and neonate. Great attention must be given to mother to child transmission and to postpartum care. Many maternal and obstetrical factors can affect the vertical transmission. The answer to this problem is the optimal medical and obstetrical care.