Current Trends in Medicine and Medical Research Vol. 4

It is Time that Health Authorities Promote the Use of the Ozone as a Biological Modulator in the Treatment of the Chronic Oxidative Stress Diseases

2021-07-24T04:23:48+00:00

Ozone is a very reactive gas and is toxic for the respiratory system but, under precise rules, it can be therapeutically useful for human disease with a chronic oxidative stress. Ozone is an extremely versatile drug and the therapeutic range has been precisely defined to exclude acute and chronic toxicity. It is remarkable that the majority of patients report a feeling of wellness using prolonged ozone therapy. Particularly in chronic skin infections and ulcers, which affect millions of patients, the use of parenteral and topical ozone applications is far more effective than conventional medications for enhancing healing, simply because ozone disinfects, oxygenates and stimulates cell proliferation. The critical point remains an exhaustive clinical evaluation of ozone therapy in the outlined diseases. Orthodox medicine remains skeptical because multi-center and extensive clinical trials are not yet available owing to the lack of sponsors. An unfavorable combination of factors such as a wrong dogma, the fact that ozone is one of the worst troposphere pollutants and past misuse of ozone have led to a poor consideration of ozone therapy. However, basic and clinical work, developed during the last two decades, clarified both the biochemical and molecular mechanisms of action of ozone in biology and medicine. A judicious dose of ozone dissolved in blood immediately triggers a cascade of well defined chemical compounds acting on multiple cellular targets according to well-known biochemical and molecular pathways. Ozone therapy is proving to be very useful in the dry form of age-related macular degeneration (AMD), cardiovascular diseases, chronic obstructive pulmonary disease (COPD), cerebral diseases and healing disorders, where conventional medicine appears insufficient and too expensive. It is time that World Health Authorities abandon prejudice and skepticism and start to take advantage of an integrative medical application able to help the majority of world population. Among complementary medical approaches, ozone therapy is known all over the world but it is not yet practiced correctly everywhere because of the incomplete knowledge by improvised ozone therapists. However, on the basis of basic and small clinical studies performed in the last two decades, it has become clear that ozone, in very small dosages, behaves as a real drug and the biochemical and molecular mechanism of action are well within orthodox medicine. Ethical Committees are sometimes reluctant to give permission for clinical trials because they prefer pharmaceuticals able to pay huge sums for insurance and all clinical tests. The few and small National Associations of ozone therapy, in comparison to the Pharmaceutical Industries, which register an annual business of many billion dollars, have no financial power and are unable to support expensive clinical studies.

Arterial Stiffness in Systemic Lupus Erythematosus and Its Correlation with Disease Severity: A Case Control Study

2021-07-24T05:46:10+00:00

Introduction: Arterial stiffness is an emerging field of interest in atherosclerosis. Patients with systemic lupus erythematosus (SLE) are predisposed to have premature atherosclerosis.
Aims: To compare the arterial stiffness among patients with SLE and non-SLE controls. The study also compared arterial stiffness among SLE patients in relation to disease activity (SLEDAI) and end organ damage (SLICC index).
Study Design: Case control study.
Place and Duration of Study: Patients attending rheumatology clinic and those admitted to medical wards of the Internal Medicine and Nephrology departments of Government Medical College Hospital, Thiruvananthapuram.
Methodology: 53 SLE patients and 53 non-SLE controls were studied. Data was obtained in a structured format. Arterial stiffness indices were obtained by measuring the brachial ankle pulse wave velocity (baPWV). The SLEDAI Score and SLICC Damage index were measured in the SLE group. Age-matched controls were obtained from the general population.
Results: SLE patients had higher brachial ankle pulse wave velocity (baPWV) than the control nonSLE population (1194.9 ± 169.6 cm/s vs 1008.5 ± 62.5 cm/s; p<0.001), Mean arterial stiffness index (ASI) among SLE patients was significantly higher than that of control (26.2 ± 3.9 mm Hg vs. 23.7 ± 3.7 mm Hg, p=.001), mean augmentation index(AI) among SLE patients was significantly higher when compared with the control non-SLE population (13.9± 6.7% vs 6.2 ± 1.7%, p<0.001). Patients with SLE-related end organ damage (SLICC index =1) had baPWV elevated over those with SLICC index=0 (1234.5 ± 181.5 cm/s.1 vs 1124.1 ± 121.1 cm/s, p=.021). No significant difference was observed between the mean ASI among the patients with SLICC index =1 and those with SLICC=0. (26.9 ± 4.1 mm Hg vs 24.8 ± 3.3 mm Hg, p=.070), and mean AI among SLICC index =1 was significantly higher than that of SLICC index =1 (15.6 ± 6.7% vs 11.1 ± 5.8%, p= .017). Patients with high disease activity (SLEDAI =6) had baPWV of 1278.9 ± 131.0 cm/s (95%CI 1229 cm/s.1-1328.7 cm/s) vs (1093.4 ± 156.5 cm/s; 95% CI 1027.3 cm/s -1159.4 cm/s p<0.001) when compared with those having low activity (SLEDAI<6).
Conclusion: Patients with SLE had increased arterial stiffness. End organ damage and high disease activity among SLE patients correlated to increased arterial stiffness, and is contributory to an increased risk of atherosclerosis.

Ethical Challenges of Biobanks and Pathology Research in Egypt

2021-07-24T05:52:08+00:00

Background: Biobanking today plays a key tool in biomedical research. Establishment and proper running of biobanks in developing countries is confronted with a number of challenges of legal, ethical, and financial nature. Considering that there are no guidelines or regulations to control biobanking in Egypt; major ethical issues arise and are often managed by research ethics committees (RECs). Pathologists are the custodians of tissue samples in different universities and hospitals; they have an important role in advancement of scientific research. So, they have to equip themselves adequately to manage the evolution of pathology work towards integration of biomarker analysis in clinical research and to deal with the ethical and legal issues of biobanks in Egypt.
Objective/ Aim: The purpose of this review is to highlight the current situation of human tissue research and biobanking in Egypt with Comparative policy of other countries. We will address the role of pathologists and the difficulties and challenges facing the process of initiating biobanks and give some recommendations that might help different stakeholders for establishing biobanks in Egypt.
Conclusion: Egypt is one of the developing countries which are in need to implement biobanks to improve the quality of research. The review highlights the different challenges facing biobanks in Egypt, mainly: lack of legislations, consent form, public trust, tissue transfer and commercialization. It also discuss the role of pathologists and research ethics committees in establishing and maintaining the work in these biobanks; and to make every effort for the interests of the participants, community and scientific progress, hopefully for good future of biomedical research in Egypt.

Demyelinating Disorders of the Nervous System Due to Osmotic Disequilibrium

2021-07-24T05:55:16+00:00

Introduction: In central nervous system (CNS), oligodendrocytes form myelin. In peripheral nervous system large proportions of axons are unmyelinated, instead they are ensheathed by non myelinating schwann cells and arranged in Remak bundles. Osmotic demyelination (ODS) syndrome is a neurologic disorder that can occur after rapid correction of hyponatremia. Acute hypernatremia results in sudden shrinkage of brain cells leading to parenchymal or subarachnoid hemorrhages and/or subdural hematomas mainly in pediatric patients.
Aim: Our aim is to present a case of hypernatremia which has led on to a flaccid quadriparesis due to brain stem demyelination. Rapid correction of hypernatremia as a cause for pyramidal tract demyelination is not documented in the literature.
Presentation of Case: A 53 year old male was brought to the emergency services with suspected stroke. He was treated with intravenous mannitol and oral glycerine from the primary health centre. We detected hypoglycemia (blood sugarwas 50 mg/dl-Ref range: =70 mg%) and dextrose was given intravenously. Subsequently the patient went into a hypernatremic state with serum sodium 170 milli equivalents /liter which was corrected rapidly. This was corrected over 48 hours to 140 milli equalents/litre. The rate of correction exceeded 0.62 millimols/liter/hour (Ideal: 0.5 mmol/L/h). On the 6th day the patient developed acute quadriparesis. Magnetic resonance imaging (MRI) of brain revealed bilateral symmetric demyelination of the corticospinal tracts. Over six months the neurological deficit improved with complete resolution of the changes in previous MRI.
Discussion: Osmotic Demyelination Syndrome (ODS) has been a recognized complication of rapid correction of hyponatremia. Experiments in animals and clinical experience suggest that correction of chronic hyponatremia should be kept at a slow rate to combat this complication. The characteristic sites include pons and basal ganglia. Such a complication has not been described due to rapid correction of hypernatremia. This is probably the first case report in the literature where acute onset of quadriparesis resulted from demyelination of the pyramidal tract consequent to a rapid correction of hypernatremia. We had to wait about 6 months for the patient to obtain a complete functional recovery and the neuro imaging was repeated after 6 months to confirm the disappearance of the initial findings thus implicating rapid correction of hypernatremia as the cause of his morbidity.
Conclusion: This is the first time extrapontine reversible myelinolysis due to rapid correction of hypernatremia has been documented. To prevent this potentially fatal complication it will be prudent if hypernatremia is corrected slowly. Osmotic Demyelination Syndrome (ODS) can occur with rapid correction of hyponatremia or hypernatremia. The first of its kind our report highlights the importance of rate of correction of Sodium in the brain which may functionally interfere with the rapidly conducting fibers rich in oligodendrocytes resulting in transient or permanent neuronal dysfunction.

Prediction of Stature from Hand Anthropometry: A Comparative Study in the Three Major Ethnic Groups in Nigeria

2021-07-24T05:58:14+00:00

Introduction: Forensic anthropology is a branch of physical anthropology which interacts with other disciplines pertaining to the understanding of crime and its investigations. Many human features have been used to estimate stature from skeletal remains and body parts owing to the established relationship between stature and different parts of the body.
Aims: The study was carried out to establish standard anthropometric values for stature estimation by using hand length in the three major ethnic groups in Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: University of Maiduguri, Borno State, Nigeria between January - April 2010.
Methodology: A total of 407 right hand dominant students (210 males and 197 females) aged 18 – 35 years who were purely of Hausa, Igbo and Yoruba origin by both parents and grandparents, are included in this study. Each person has been studied for measurements of stature, hand length and handbreadth.
Results: No significant difference was observed in stature and hand dimensions between the Igbos and Hausas. However the Yorubas are significantly shorter and have shorter hands than the Igbos and the Hausas. The males are significantly taller than the females in all the three tribes and have longer hands than the females in the Hausas and Igbos. Both the sexes of Yorubas are significantly shorter than the Hausas and have significantly shorter hands than the Hausas and Igbos when comparison was made between same sexes. The Yoruba females have shorter but wider hands than the Hausa females. No significant difference was observed in stature and hand dimensions between the Hausas and Igbos when compared between same sexes. Regression equations for estimation of stature were formulated for each ethnic group and both sexes.
Conclusion: The study supports the fact that variations are present not only between races but also among ethnic groups, thus formulae derived for one ethnic group and both sexes may not be applicable to other ethnic group and sex. This study therefore provides standard anthropometric values and regression equations for the three major ethnic groups in Nigeria.

Screening the Thyroid before Initiating Treatment for Acromegaly?

2021-07-24T06:04:27+00:00

Aim: To present a case of acromegaly with coexisting thyrotoxicosis and to emphasize the relevance of screening the screening the thyroid before initiating treatment for thyrotoxicosis.
Presentation of the Case: A 55-year-old lady presented with palpitations, and weight loss of two months’ duration. She also noted her fingers and toes had swollen up, inability to incise properly since two years. Upon examination, she had morphological features clinically diagnostic of acromegaly. Her thyroid was enlarged was on investigation found to have biochemical evidence of thyrotoxicosis. Fine needle aspiration cytology of the thyroid yielded colloid goiter. Insulin like growth factor-1 was elevated. Serum growth hormone after an oral glucose tolerance test was elevated. Magnetic resonant imaging (MRI) of the brain revealed a hypo enhancing focal lesion of size 11X10X12 mm at the pituitary region with delayed contrast enhancement suggestive of pituitary adenoma. Patient was started on anti-thyroid medications and referred to higher centre, and is awaiting surgery for pituitary adenoma.
Discussion: Among patients with acromegaly the incidence of thyroid diseases is around 78% and it has the most common presentation being nodular thyroid disease as the initial presentation. It is uncommon to see patients presenting with symptoms of thyrotoxicosis initially, who had florid morphological features of acromegaly. The prevalence of toxic nodular goiter to the tune of 14.3% in acromegaly. Goiters seen in acromegaly were euthyroid or autonomous, are due to the elevated growth hormone levels independent of TSH action. In about 13 to 17%, thyroidectomies were performed before acromegaly was diagnosed. When patients with acromegaly presents with a weight loss should arouse the possibilities of thyroid cancer or hyperthyroidism.
Conclusion: Screening the thyroid is important, as inadvertent thyroidectomies were performed before acromegaly was diagnosed. When acromegaly co-exists with thyroid dysfunction, the burden of cardiovascular abnormality should be addressed especially, to reduce the morbidity and mortality rate.

Ectopic Prostate in the Uterine Cervix / Female Genital Tract Including Vagina and Vulva: A Review of the Literature

2021-07-24T06:07:17+00:00

Background: Men are known to have prostate glands but not women. The thought of prostate gland occurring in the female genital tract in women would be petrifying to all clinicians and people who are not aware of its biological behavior. Ectopic prostate in the uterine cervix (EPIUC) and the female genital tract (FGT) is very rare.
Aim: To review the literature on EPIUC/FGT and to document its biological behavior.
Methods: Information obtained from 17 references, was used to provide the literature review on EPIUC/FGT.
Results: Few cases of EPIUC/FGT have been reported at ages ranging between 21 and 82 years EPIUCs/FGTs may be diagnosed incidentally in biopsies of the cervix/vagina/vulva, or in hysterectomy specimens or they may mimic leiomyomas. Histological examination of cervical biopsies or of the cervix in hysterectomy specimens tends to reveal ducts and acini some papillary or cribriform, with prominent squamous metaplasia EPIUCs/FGTs which does show positive Immunohisto-chemical staining for prostate specific antigen (PSA), prostatic-specific acid phosphatase (PSAP [PAP]), high molecular weight keratin (for basal cells). EPIUCs reported so far have exhibited benign behavior.
Conclusions: Information obtained from the literature would indicate that EPIUCs / FGTs are rare and so far have exhibited benign behavior. Clinicians should report cases of EPIUC/FGT in order to establish whether or not EPIUCs/FGTs may or may not develop into carcinomas in the future. Ectopic prostate in the uterine cervix and the female genital tract is very rare and pathologists and gynaecologists may not be familiar with this entity because of its rarity. The differential diagnoses include: adenocarcinoma in situ, adenoid basal carcinoma of the cervix and minimal deviation adenocarcinoma of the cervix. It is important for pathologists, gynaecologists and all clinicians to be aware of the presence of ectopic prostate in the uterine cervix, vagina and vulva in order that an accurate diagnosis is made and in order to avoid unwarranted radical surgical treatment.

The Morphological Basis and Laws of Autopsy Interpretation: Exploring the Relationship between the Basic Medical Sciences, Anatomical Pathology and Clinical Practice

2021-07-24T05:02:46+00:00

The discipline of Morbid Anatomy or Anatomical Pathology is a bridge between the basic medical sciences and the clinical sciences [1]. It is clinico-pathologic discipline which deals with the identification of lesions, interpreting them correctly at the macroscopic and microscopic levels and relating them appropriately to known diseases within the context of the index patient [2]. Lesions are the structural alterations seen in tissues as a result of the assault of the injurious agent or pathological process. Thus, anatomical pathology establishes the basis for the ‘dis ease’ or discomfort in patients. The human cell is known to be the most basic unit of life and the tissue is constituted by cells having related functions. Injurious agents affect cell structure and ultimately the physiology and therefore the cell is the natural habitat of the disease processes. Histopathology seeks to interpret the changes in the cell to define the aetiology, evolution and progression of disease. An afflicted cell continues to perform its functions at various degrees of capability as it finds itself able to adapt to negative situations and maintain homeostasis. Each cell’s preserved structure guarantees preserved biochemical constitution and therefore its routine physiological functions. A compromise in structure without resolution or failure of homeostasis automatically leads to poor biochemistry of the cells and poor functioning. Tissues with related or complementary functions constitute organs and organs with related functions and contributory physiological relationships constitute organ systems which essentially make up the whole human being. The relationship between anatomy, biochemistry and physiology is interminable and inseparable though disease causing agents violate this union.

Brucellosis of Testis and Epididymis: An Update of the Literature

2021-07-24T06:10:43+00:00

Background: Brucellosis is a zoonotic disease which has the ability to afflict a number of organs and tissues. Brucellosis epididymoorchitis (BEO), a complication of human brucellosis, can emanate in complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar with the disease entity which may lead to delay in the diagnosis.
Aim: To review the literature on BEO, in order to document its presentation, diagnosis, management and outcome following treatment as well as update the literature related to the disease.
Methods: Various internet data bases were used to obtain literature on BEO.
Results / Literature Review: BEO (epididymitis plus or minus orchitis) is a complication of an infection caused by brucella species which can be transmitted via contact through the respiratory tract, skin, or conjunctiva, and through the gastrointestinal tract pursuant to ingestion of unpasteurized milk/milk products or raw infected meat. BEO does in endemic areas affect 2% to 20% of patients who have been afflicted by brucellosis but the disease can also be encountered sporadically globally in non-endemic areas. BEO could at times be bilateral. The manifestation of BEO is non-specific and it could be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess. Ultrasound scan and MRI scan findings are not specific to BEO. Diagnosis of BEO may be established by (a) history of contact, (b) cultures from blood/epididymal aspirations, (c) various types of laboratory studies including: (I) Culture, (II) PCR, and (III) serology. Laboratory test criteria for the diagnosis of Brucellosis is divided into (I) those for presumptive diagnosis and (II) those for confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for about six weeks but at times orchidectomy or drainage of testicular collection may be necessitated for persistence of symptoms or suspicion of a tumour / testicular abscess. Relapses of brucellosis can occur hence careful follow-up of patients is required.
Conclusions: BEO can occur anywhere globally. A high index of suspicion is thus required from clinicians in order to establish early diagnosis of the disease. Most cases of BEO can be effectively treated with combination chemotherapy for about 6 weeks. Clinicians should be aware that brucellosis epididymo-orchitis, brucellosis epididymitis and epididymo-orchitis exist and this condition could be unilateral or bilateral, though more commonly encountered in brucellosis endemic areas because of global travel the disease entity may be encountered sporadically globally.

Risk Factors for Developmental Dysplasia of the Hip in New-borns and Infants

2021-07-24T06:13:26+00:00

Aims: To identify the association between potential risk factors with developmental dysplasia of the hip in neonates.
Study Design: A cross-sectional study.
Place and Duration of the Study: Laboratory of Lifestyle, Division of Health Sciences and Engineering, Campus Celaya Salvatierra, University of Guanajuato Mexico, between June 2014 and February 2015.
Methodology: We include 100 newborns, 36 male and 64 females with age between 4 and 28 days old. Data on birth weight, family history of hip dysplasia, obstetric presentation, mode of delivery, swaddling was obtained. The diagnosis of hip dysplasia hip ultrasonography with Graf technique was confirmed. For association Chi squared and p value, for the effect was calculated Odds Ratio and confidence intervals at 95%.
Results: It was found that obstetric presentation and swaddling were associated with developmental dysplasia of the hip (p <0.05) with OR of 5.32 and 4.91 respectively, and the association was confounded by area of residence with OR adjusted 2.94.
Conclusion: It was conclude that the most important risk factors for developmental dysplasia of the hip in this population were obstetric presentation and excessive swaddling

Noninvasive Antenatal Diagnosis of Fetal RhD Status

2021-07-24T06:16:10+00:00

Introduction: Fetal cell-free nucleic acids within the blood stream of a pregnant woman come from fetal genetic material which can be acquired by simple venipuncture that reduces any risk to a minimum. Fetal cell-free DNA can be detected in the mother's blood stream in the 5 gestation week at the earliest. That enables fetal genotyping at the earliest possible stage of pregnancy which is best done in the 12 th gestation week.
Aim: To determine fetal RhD status at RhD negative pregnant women where the father is a heterozygote, Dd.
Materials and Methods: The research includes 1540 RhD negative pregnant women, out of which at 30 of them the RhD fetal status had been detected by a PCR technique from the mother’s plasma. The RhD fetal status was confirmed after delivery by serologic analysis at 27 newborn babies. All research patients were submitted to serologic immunohematology testing: blood group typing of red blood cell antigens, screening of irregular anti-red blood cell antibodies. Fetal RhD status was determined by the plasma of RhD negative pregnant women using the real-time PCR technology in the period from the 12 th gestation week until the 31 gestation week. The biological fathers of all 30 fetuses were phenotyped as heterozygote to the RhD antigen. The results showed that 30% of the fetuses are RhD negative, and 70% are RhD positive.
Conclusion: The noninvasive fetal RhD genotyping is not only one precious tool in the management of RhD alloimmunised pregnancies, but it also allows antenatal anti-D immunoglobulin prophylaxis exclusiveness for only non-immunized RhD pregnant women carrying RhD positive fetus. Taking into consideration that 30% of the RhD negative pregnant women that carry a RhD negative fetus receive antenatal RhIG prophylaxis with no absolute need for it.
At RhD alloimmunised pregnant women the noninvasive genotyping of the fetal blood group enables an easy and safe method in determination of a fetal risk from a hemolytic disease, and at the same time evading a vast laboratory and clinical monitoring of RhD antigen-negative fetal cases.

Can We Predict Preeclampsia?

2021-07-24T05:21:57+00:00

Hypertensive disorders in pregnancy are a leading cause of peripartum morbidity and mortality. Preeclampsia is a heterogeneous maternal syndrome. Large studies have pointed out the association of impaired spiral artery remodeling at the fetomaternal interphase in preeclampsia, but how exactly is the fetomaternal dialogue mediated and what are the biomarkers to detect the subclinical disease in various subsets of high-risk pregnancies is still a challenge. These biomarkers can finally be used to diagnose renal function (Kallikreincreatinine ratio), vascular resistance (uterine artery Doppler), coagulation disorders (platelet volume, fibronectin, prostacyclin, thromboxane, oxidant stress (lipid peroxidase, 8-isoprostane, antioxidants, anticardiolipin antibodies, homocysteine, serum uric acid), vascular adaptation (Placental growth factor, Vascular endothelial growth factor, s-flt, s-eng) and markers of placental function and ischemia (placental CRH, CRH bp, activin, inhibin, hCG).Post partum preeclampsia can be predicted by identifying the factors preventing the excretion of sodium, puerperal diuresis and shift of intravascular fluid into the extra vascular compartment compartment(atrial natriuretic peptide in the first week after delivery, natriuresis and inhibition of aldosterone, angiotensin II, vasopressin). Preeclampsia is a heterogeneous disease. The late onset preeclampsia at or near term has low fetal and maternal morbidity. But the early onset preeclampsia (1%) of all preeclampsia has significant risks. Prediction of risks and identification of subclinical disease is mandatory. The majority of at risk groups in multigravida are chronic hypertension, pregestational and gestational diabetes, age and multiple fetuses. Whereas, in primi only 14% have these risks. This suggests that there are multiple underlying etiologies of different clinical presentations. A clinical algorithm based on clinical, biochemical and ultrasound markers is outlined. Post partum eclampsia can be predicted and monitored with central venous pressure and pulmonary capillary wedge pressure. The maternal syndrome (proteinuria, edema and hypertension) also has differences in time of onset, severity and organ system involvement as highlighted in several studies. These clinical subpopulations need to be identified and preeclampsia predicted with rigorous definition of different biomarkers of different clinical phenotypes. The future endeavors should be to identify subclinical disease in various clinical phenotypes with these potential biomarkers in prospective longidunal studies.

Panoramic Overview of the Autopsy

2021-07-24T05:24:55+00:00

The dissection of dead bodies for medical purposes that is postmortem examination dates back to ages. The human body is vulnerable to various ailments because of its genetic constitution and its immediate environment. The interaction of genetic and environmental forces cause and moderate the severity of diseases, leaving clinicians highly perplexed in some situations. Postmortem therefore becomes necessary to unravel medical mysteries especially remembering that no two patients are exactly the same and there is virtually no impossibility in medicine. Over the centuries, the autopsy remains the ultimate revealer of secrets and best means to understand hitherto obscure pathophysiological processes.