Emerging Research in Medical Sciences Vol. 2

“Black Ink” Sonographic Pattern as a Predictor for Invasive Papillary Thyroid Microcarcinoma: A Case Report

2021-08-04T05:58:04+00:00

Background: This study investigated the utility of the Sonographic pattern "Black Ink" with BRAF mutation testing of thyroid fine-needle aspiration cytology specimens for the risk papillary thyroid microcarcinoma (PTMC).

Case Presentation: We describe a case of a 41-year-old Caucasian woman affected by a ultrasonography “Black Ink” papillary thyroid microcarcinoma (PTMC) of the left lobe of the thyroid gland with very tiny size (Ø 0.4 cm). The characteristics, with the Diagnostic Imaging using Ultrasonography (US), Superb Micro-Vascular Imaging (SMI), fine-needle-aspiration cytology (FNAC) and mutation analysis are here discussed. There are more rare subtypes of thyroid cancer as papillary microcarcinoma "Black Ink" that even if small, are invasive and there is why the need to early diagnosis to avoid their aggressive behavior is needed. Nowadays, focusing on the size, the cut-off for non-occult tiny tumors has dropped to 0.3 cm. This value is of great relevance.

Conclusion: Ultrasonography, FNAC and BRAF molecular study have proven to be the most sensitive diagnostic combination for the early detection of thyroid cancer. Despite the size of this micro-lesion, the Black Ink ultrasonographic pattern associated with malignant cytology at FNAC represents an important biological risk factor and could still be a predictor of the PTMC and risk for neck lymph node metastases.

Haemostatic Disorders in Sickle Cell Disease Subjects in Nigeria: A Review of Literature

2021-08-04T06:09:54+00:00

Background: Sickle cell disease (SCD) is an autosomal recessive disorder that is characterised with chronic anaemia and painful crisis. SCD is associated with hypercoagulability or prothrombotic state that can predispose to thromboembolic complications with increasing morbidity and mortality.

Aim: This study aimed to show the various documented haemostatic disorders and possible thromboembolic complications among SCD subjects in Nigeria.

Methods: A comprehensive literature search was performed using the internet search engines linked to academic databases including Pubmed, Google Scholar, Ebsco, Hinari, Scopus, etc. Studies involving hemostatic disorders in Nigeria were thoroughly searched, and the references of such articles were also searched for any probable relevant information.

Findings and Conclusion: There is a paucity of information on this subject in Nigeria, and there are inconsistencies in the available studies.

Haemostatic disorders in sickle cell disease are conditions that are associated with increased mortality and morbidity. Further research on the level of natural anticoagulant is required to verify the correlation between haemostatic disorders and thromboembolic complications in SCD subjects in Nigeria.

Investigation of the Boundary Layer Blood Flow and the Initial Factors of Atherosclerosis by the Magnetic Resonance Imaging

2021-08-04T07:45:51+00:00

Aim: study the blood flow and vessel wall viscoelastic alterations at the boundary layer and initial factors of atherosclerosis.

Study Design: Magnetic resonance angiography with the follow up flow quantification was carried out voluntary on the healthy persons.

Place and Duration of Study: MRI department of the Institute of Clinical Medicine in Tbilisi Rep. Georgia, between September 2012 and July 2017.

Methodology: In 12 healthy men (18-52 years of age) at the different sites of the aorta peak velocity, net flow, flow acceleration has been investigated by Magnetic Resonance Angiography. Blood radiodensity (HU) were studied (CT) in different sites of the aorta and vena cava.

Results: In the aortic arch in the end systole blood flow separates into the opposite directed streams resulting in the wave superposition. At the outer curvature of the isthmus, flow acceleration in the initial diastole is 6.26 times higher than that in systole. Net flow from systole to diastole increases 2.5±0.5 folds. From the end systole to the initial diastole there is a plateau on the net flow graph. At the outer curvature of isthmus, group wave at the boundary reflection, changes in phase at 180°. At the same time flow wave oscillation frequency at the outer curvature is two times higher (1.6Hz.) than that at the inner (0.8Hz).

Conclusion: During the heart cycle, blood motion at the boundary layer, forms the surface wave and facilitates the blood structural rearrangement and flow. At the end systole, at the outer curvature of the isthmus, pulse pressure at the reflection is in the resonance with the end systolic pressure drop. Amplitude of the wall stress increases. Forming standing wave leads to the dissipation of the wall’s mechanical energy. Here, at the initial diastole, group wave, due to the wave reflection, and frequency dispersion, facilitates to the structural rearrangement/denudation of the vessel wall.

Claustrophobia during Magnetic Resonance Imaging (MRI): Cohort of 8 Years

2021-08-04T07:59:08+00:00

Objective: To calculate rate of claustrophobia in our population with further stratification.

Materials and Methods: This study was conducted in Aga Khan University Hospital (AKUH) Karachi. All patients undergoing Magnetic Resonance Imaging (MRI) for various indications, from 1^st January 2006 to 31^st December 2013 were enrolled. All cancelled MRI exams were retrieved from Radiology Information System (RIS) and rate of claustrophobia was calculated from total requested patients and separately from all cancelled exams. The MRI exams were performed on 1.5 and 3 Tesla machines. Claustrophobia rate was further analyzed in subgroups on the basis of age, gender, techniques, timings and body area covered and Odds ratios were calculated.

Results: In eight years, 76,254 patients underwent MRI exams. Out of total scans performed, 417 patients were found to be claustrophobic with rate of 0.53% making 14.32% of total cancelled exams due to various reasons.

Conclusion: Though claustrophobia rate is acceptable in our set up, it contributes to a significant proportion in all cancelled exams.

Food Hygiene and Safety Training Intervention of Food Handlers in a Metropolis in South-Eastern Nigeria

2021-08-04T08:06:49+00:00

Background: Training of food handlers to improve their food hygiene and safety knowledge, attitude and practice is of paramount importance in the prevention and control of food borne diseases. The World Health Organization has stressed on the same for reducing chances of food contamination. The study was conducted with aim of assessing the effectiveness of training on knowledge, attitude and practice of food hygiene and safety among food handlers in a metropolis in South-eastern Nigeria.

Methodology: This study was quasi-experimental in design and was conducted in 3 phases-baseline survey, intervention (training/retraining) and post-intervention survey. The study participants were selected by simple random sampling technique using a table of random numbers. Data were collected with pre-tested semi-structured questionnaire administered to managers, cooks and servers. Statistical analyses (proportions, means with standard deviations, chi-square test) were carried out using SPSS version 20.

Results: At baseline, respondents’ overall knowledge, attitude and practice of food hygiene and safety were similar in the study and control groups (p = 0.54, 0.53, 0.06 respectively).There were no statistically significant differences in the overall knowledge, attitude and practice of food sanitation in the control group between the beginning and end of study (p = 0.40, 0.36, 0.87 respectively). In the study group, there were significant increases in the knowledge, attitude and practice of food hygiene after intervention (p < 0.01, < 0.01, < 0.01 respectively). Respondents’ overall knowledge, attitude and practice of food hygiene and safety differed significantly between the groups post-intervention (p < 0.01, < 0.01, < 0.01 respectively).

Conclusion: The study has demonstrated the effectiveness of training in improving food handlers’ knowledge, attitude and practice of food hygiene and safety. It is therefore recommended that management of restaurants, regulatory agencies and government should provide regular training to food handlers.

Nbia-neurodegeneration with Brain Iron Accumulation: A Rare Case Report with Review of Literature

2021-08-04T08:12:04+00:00

NBIA (Neurodegeneration with Brain Iron Accumulation) is a rare disorder with varied age group of presentation but mostly detected in childhood. It is a progressive disease with basic extra-pyramidal symptoms and an autosomal recessive nature. The incidence is found to be very low depending on the various subtypes in this group, most common being PKAN (Pantothenate Kinase Associated Neurodegeneration). We here highlight a case of a 16 years old male, radiologically proven as NBIA and currently on regular follow up at our institute.

Long-Term Monitoring of Arterial Blood Pressure and Pulse: Assessment of Influence of External Factors on Readings

2021-08-04T08:17:30+00:00

The research is based on long, regular observations of blood pressure and pulse - the heart rate (more than 18 years). The values of these readings are taken from the diary of self-control, which is kept by a patient, one of the authors of this publication, a man born in 1940. Such effective control over the patient's condition, implemented in our case, ensuring its normal vital activity, makes it possible to investigate the influence of external factors on the hemodynamics of the body and the manifestation of the marked temporal characteristics.

A difference between the morning and evening series was noted. The characteristics of evening monitoring readings are more balanced. Spectral analysis allows for a more detailed analysis and comparison of the data. Seven-day component is clearly seen in evening series being modulated with three-year period for the pulse. The morning series are characterized by a “lunar” component with the ~27.35-day period. The absence of a weekly period in the morning readings indicates a rapid (moment of sleep) relaxation of the body from the rhythmic stress of the past day. The manifestation of the "lunar" response can be associated with an increased sensitivity of the body during and after the sleep.

The analysis of pulsatile blood pressure, i.e. the difference between SBP and DBP, provides for more options for assessing the state of the body. Correlation relationship between morning and evening data are also attracted. A comparison with the results are performed, the relationship with the Wolf numbers is discussed.

Hepatitis B Core IgM Detection in Neonates Born to HBsAg and HBeAg Positive Mothers in Maiduguri, Nigeria

2021-08-04T08:21:01+00:00

Hepatitis B virus is a serious global public health problem and is endemic in Africa, including Nigeria. Infection of pregnant women during the second and third trimester poses a threat of 10 and 90% respectively for vertical transmission. A total of ninety two blood samples from consenting pregnant women were screened for HBsAg and HBeAg using ELISA kit (Cortez Diagnostic Inc, USA). Cord blood samples collected from five neonates of women positive for HBsAg and HBeAg were screened for HBcIgM using the same test kit. Questionnaire was used to collect data on demography, history of blood transfusion and presence of tribal mark from the pregnant women. Overall prevalences of 8.7% (8/92) and 5.4% (5/92) for HBsAg and HBeAg seromarkers, respectively were obtained. Mean age of the pregnant women was 25.75 with 27.2% within 20–24 years and 28.3% within 25–29 years, however this distribution was not statistically significant (p= 0.6840). Fifty percent (50%) of HBsAg positive women were within the age group of 25–29 years while 80% of HBeAg positive women were within the age group of 20 - 24 years. Blood transfusion (p= 0.002791) and tribal mark (p=0.00265) were found to be associated with acquisition of the virus. Eighty percent (80%: 4/5) of the neonates screened from HBsAg and HBeAg positive women were reactive for HBcIgM. The prevalence of surface antigen in this study suggests the endemicity of hepatitis B virus in the study area while the presence of both surface and envelope antigens in pregnant women portend infectivity. These results suggest the utmost need for establishment of a sustainable intervention measure that would protect not only pregnant women but women of childbearing age in order to mitigate spread of the virus. Screening for other hepatitis B virus seromarkers besides HBsAg before blood transfusion is also advocated.

Overview of Medical Research Ethics Committee, National Research Centre of Egypt

2021-08-04T10:52:45+00:00

Background: Globally, ethical issues in research are becoming of major importance, being well established in developed countries with little information about research ethics committees (RECs) in Africa. It is essential to promote the efficiency of the ethics review committee to protect participants and guarantee the successful implementation of good clinical research.

Objective/aim: To describe the establishment, structure, function, operations and outcome of the Medical Research Ethics Committee (MREC) of the National Research Center (NRC) of Egypt.

Methods: The committee established its regulatory rules for human and animal research ethics based on the Declaration of Helsinki 2000–2008 and WHO regulations 2000–2011.

Results: There were 2532 protocols revised in 13 years (2005- 2018), with average of 195 protocols reviewed annually. 88 workshops and training courses had been held in the NRC during the years 2006–2018 with total no of 2325 trainees.

Conclusion: Since 2005, the MREC in NRC Egypt has built up considerable experience of evaluating the ethical issues arising within the field of medical research.

Screening for Oral High-risk Human Papillomavirus (HPV) among a Pediatric Patient Population

2021-08-04T10:56:17+00:00

Introduction: Human papillomavirus (HPV) is a known cancer-causing virus that has been primarily linked to cervical cancers. Recent studies have shown that HPV may also induce cancer in other tissues, including oral epithelia and mucosa. To determine the presence of oral HPV infection among pediatric patients, salivary samples were assessed to determine oral prevalence of high-risk HPV.

Methods: Using existing pediatric saliva samples from pediatric clinic patients (aged 6 - 16 years), this retrospective study involved isolating DNA for PCR screening for both high-risk strains of HPV (HPV16, HPV18). A total of n=98 patient samples were available for analysis.

Results: Demographic analysis of these samples revealed the majority were derived from females (63.2%) and mostly from Hispanics (54.1%). DNA was successfully isolated from 95.9% of samples (n=94/98) with an average concentration of 142.5 ng/uL. PCR screening demonstrated only a subset of patient samples harbored high-risk strains, HPV16 (n=9) and HPV18 (n=6), which represents 15.9% of the total sample population - and were concentrated among the older patients (>13 years old).

Conclusions: Although this retrospective study does not have a sufficient sample size to provide more robust analysis of other risk factors (race, sex, sociodemographic), these results to demonstrate that oral HPV infection may be successfully detected among a pediatric population. As more studies demonstrate oral HPV infection in children, these data are of significant value to other dental, medical, oral and public health professionals who seek to further an understanding of oral health and disease risk in pediatric populations.

Dental Considerations in Patients with Down Syndrome

2021-08-04T10:59:15+00:00

Approximately one out of every 600-1,000 births results in an extra chromosome of the twenty first group called Trisomy 21 or Down syndrome. Usually most of the dental treatment for persons with Down syndrome can be carried out in a general dental office with relatively minor adaptations. In undergraduate dental training there is usually little or no exposure to treating such patients and the general practitioners may be hesitant to treat these patients with confidence. This chapter summarizes the unique characteristics associated with Down syndrome that influence dental care and treatment of this population.

Relevance of Brain Stem and Visual Evoked Potentials in Diagnosis of Central Demyelination in Guillain Barre Syndrome

2021-08-04T11:01:38+00:00

Aims: Guillain Barre Syndrome (GBS) is an auto-immune mediated demyelination polyradiculoneuropathy. Clinical features include progressive symmetrical ascending muscle weakness of more than two limbs, areflexia with or without sensory, autonomic and brainstem abnormalities. The purpose of this study was to determine subclinical neurological changes of CNS with GBS & to establish the presence of central demyelination in GBS.

Study Design: A prospective study to find out early Central demyelination in clinically diagnosed patients of GBS. Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India, between January 2014 and June 2015.

Methodology: The patients were referred from the Department of Medicine to our Department for electro-diagnostic evaluation. The study group comprised of 40 subjects (20 clinically diagnosed GBS patients and 20 healthy individuals) aged between 6-65years. Brain stem and visual evoked potentials were done in both groups using RMS EMG EP Mark II machine. BAEP parameters included the latencies of waves I to IV, inter-peak latencies I-III, III_IV & I-V while VEP included latencies of P100 waves.

Results: Statistically significant increase in absolute peak and inter-peak latency in the GBS group as compared to the control group was noted. Prolongation of latency of P100 wave latency in both the right and left eyes was also recorded in the GBS group.

Conclusion: Results of evoked potentials reflect impairment of auditory and visual pathways probably due to focal demyelination in Schwann cell derived myelin sheaths that cover the extramedullary portion of the auditory nerves and also due to demyelination of optic pathways. Prolonged central conduction time in BAEPS & VEPS suggest the subclinical auditory and optical involvement in GBS. Early detection of the sub-clinical abnormalities is also important as timely intervention reduces morbidity and mortality.

An Unusual Cause of Upper Gastrointestinal Bleed: A Case Report and Brief Review of Literature

2021-08-04T11:05:32+00:00

A case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a negativeoesophago-gastroduodenoscopy she was bleeding profusely with hemodynamic decompensation. Doppler coeliac trunk showed a supra pancreaticcystic lesion with yin-yang pattern of blood flow confirming a pseudo aneurysm involving the superior and inferior pancreatioduodenal arterial arcade using digital subtraction angiography. The conversion of a pancreatic pseudo cyst into a pseudo aneurysm is potential lethal complication because, when rupture occurs, mortality rises up to 40%. She was diagnosed to have pancreatic pseudocyst, psedoaneurysm and haemosuccus pancreaticus with wirsungorrhagia and was offered arterial embolization following which she improved. Patients with chronic calcificpancratitis (CCP) could remain silent and can present with normal amylase and lipase. Complications such as pseudo cysts orpseudoaneurysms can be asymptomatic. The pancreas should be considered a possible site of hemorrhage in CCP in cases of refractory upper gasrtrointestinal haemorrhage. We highlight the importance of looking for causes other than bleeding duodenal/gastric ulcer/oesophageal varices in case of a refractoryhametemeis giving the patient option of a nonsurgical modality of treatment and it’s reducedrisks. The effectiveness of embolisation for bleeding psuedoaneurysms is emphasized.

Cardiac Metastases from Hepatocelluar Carcinoma-Can It be Identified Early?

2021-08-04T11:10:09+00:00

A number of diseases may cause right a trial mass. Primary cardiac tumors range from0.002 to 0.25%. Intra cardiac manifestation and pulmonary embolism of hepato cellular carcinoma (HCC) is a very rare finding and uncommon even at autopsy. Here we describe the case of a 32-year-old Asian man who was referred for shortness of breath lasting for a month, along with unproductive cough. He was a manual laborer with a history of diabetes, alcoholism, and smoking. Clinically he was diagnosed as having pulmonaryembolism. Echocardiogram showed a mass in the right atrium. Magnetic resonance imaging showed that he had a large mass in the right atrium extending down into the inferior vena cava. Further evaluation showed that he had chronic liver disease with portal hypertension and was hepatitis B surface antigen-positive, indicating hepatitis B infection. He underwent excision of the mass, and the pathological report showed metastasis of HCC with multiple vascular emboli in the lungs. As this is the second reported case of this kind in the literature, we highlight the need of screening at least6-monthly all patients with chronic liver disease, hepatitis B and C virus infection for the early detection of HCC.

Traditional Cautery: A Narrative Review on Modern Cauteries through Old Window

2021-08-04T11:15:15+00:00

Background: Traditional cautery is a well-known healing practice used in many diseases in diverse cultures of the world since ancient times. Traditional healers, practitioners and professionals continuously improved several structural and procedural perspectives of this practice over centuries. However, numerous modern cauteries and related devices used in modern surgery began to be developed by Bovie and Harvey in late 19^thcentury.

Objective: This critical review describes briefly modern cauteries (new lights) used in modern surgery that work on the same principles of traditional cautery (old window).

Methods: E-searches of relevant data (2000-2019) published in PubMed, MEDLINE, Google Scholar, ScienceDirect and OvidSP databases were made using the Boolean operators and keywords. Finally, 91 articles were retained for this narrative review.

Results: Several important components of traditional cautery were progressively developed and improved by traditional healers and professionals and this developmental process continued in modern surgery since 1988. Heating of traditional cautery by fire was replaced by electric current in innumerable modern cautery devices that generate variable energy power density for effectively destroying diseased tissue together with other related functions with minor adverse effects and complications.

Conclusion: Although electrocautery and electrosurgery units with wider applications in medical and other sciences use electric current in different ways to produce energy for cutting and removing the intended unwanted tissue in modern surgical settings around the world, traditional cautery mother of modern cauteries is still used by healers mainly in the eastern world. Both are associated with adverse effects and complications, and this perspective is calling for future research to rectify the associated technical snags in modern surgery.

Male Genital Self-mutilation: Looked through the Prisms of the Sociocultural Insights and Repercussions

2021-08-04T11:17:56+00:00

Complete genital self-mutilation (GSM), mostly a non-suicidal behavior, is a rare occurrence among patients with psychotic and non-psychotic disorders. This case report is on a patient who, in the shadow of severe bizarre psychotic manifestations with overwhelming socio-cultural contents, completely self-mutilated his external genitals with a sharp blade. Emergency surgical and psychiatric management improved his condition over 4 weeks. In the light of this case, the psychodynamic, biological and socio-cultural meanings and etiologies of GSM are explained and discussed with relevant international literature on male genital self-mutilation.