Emerging Research in Medical Sciences Vol. 3

Adjunctive Therapeutic Effects of Zinc Supplementation in Tuberculosis Treatment among Adults in Calabar, Nigeria

Regina I. Ejemot-Nwadiaro — 2020-01-07

Tuberculosis (TB) is a contagious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is the leading killer from a single infectious agent worldwide, especially in Asia and Africa. Each year globally, about 1.3 million people die of TB. Majority of the cases are pulmonary TB (PTB) with approximately 15% being extra pulmonary (ETB). The infection is an insidious; chronic process which may take several weeks or months to become clinically patent. The symptoms of PTB include cough, chest pain and hemoptysis. Systemic symptoms of TB include fevers, chills, night sweats, easy fatigability, loss of appetite and weight loss. Tuberculosis has long been associated with malnutrition. Micronutrients including Zinc; deficiency is considered to be the most frequent cause of secondary immunodeficiency and infection related to morbidity such as tuberculosis. Zinc deficiency affects the host defences in a variety of ways. It results in decreased phagocytosis and leads to a reduced number of circulating T-cells and reduced tuberculin reactivity, at least in animals. In vitro cellular killing by macrophages was found to be reduced during zinc deficiency and rapidly restored after zinc supplementation. This article aimed to describe the convalescence of patients with tuberculosis who received Zinc supplementation in comparison to those that did not during the course of tuberculosis treatment in Calabar, Cross River State, Nigeria.

Eligible patients (81) out of the 182 assessed were randomized to receive anti-TB drug regimen plus oral administration of individual zinc, 25 mg daily for 60 days (intervention group), while the control group received anti-tuberculosis drug regimen only for 60 days. Both qualitative and quantitative data were collected. Clinical examination, Karnofsky performance scale index, direct sputum examination, anthropometric measurements and blood collection for haematological and zinc assessment were carried out before and 2 months after anti-TB treatment began. The mean serum zinc levels at 2 months of TB treatment were significantly higher in the intervention group (14.4 ± 0.37 µmol/L) in comparison with the control (12.9 ± 0.37 µmol/L); (p = 0.004). A significant difference (p = 0.010) in the serum concentrations of zinc was observed between the two groups when adjustments were made for TB-HIV co-infection. Risk reduction of about 41% for acid fast bacilli (AFB) positivity (RR: 0.59; 95% CI 0.23 to 1.46) was observed after 2 months of anti-TB treatment in favour of the intervention group. There was a significant improvement in the haematological parameters as evidenced by significant higher proportion of patients in the intervention group than the control group with values above the lower ranges for these parameters. Therefore, irrespective of HIV status in individuals with TB, zinc supplementation significantly increases clinical outcomes, haematological parameters, improves nutritional status as proxied by anthropometric indices and leads to faster sputum smear conversion. The article adds to the growing body of evidence in support of the beneficial role of zinc in TB control.

Analysis of Renal Stones by FT-IR Spectroscopy: A Helpful, Simple and Accurate Tool

Liliana V. Muschietti — 2020-01-07

Aims: To investigate, by infrared spectroscopy (FT-IR), the chemical composition of urinary calculi obtained from patients of Buenos Aires, Argentina.

Duration of Study: The composition of the urinary calculi was evaluated in a retrospective study from March 1993 to December 2018.

Methodology: Infrared spectra of the urinary calculi were recorded in a Bruker IFS-25 FT-IR, Bruker Alpha-T and in a Nicolet 380 FT-IR spectrophotometers. We included 542 urinary stones (331 from men and 211 from women). The samples were obtained by spontaneous passage, shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy.

Results: Calcium oxalate (both in pure or mixed samples) was detected in 396 cases (73.06%). Anhydrous uric acid and struvite+apatite (7.56%) were both observed most frequently, followed by carbonate apatite + amorphous Ca-phosphate (2.58%) and cystine (2.03%). For some chemical compounds, a significant gender-related difference was found. Applying the second derivative spectra allowed to distinguish between the presence of whewellite, weddellite and their mixture. 73% of recurrent urinary stones were of the same chemical composition.

Conclusion: FT-IR analysis of urinary calculi over a period of 25 years gave an outlook of the prevalence of certain stone components in patients from Buenos Aires, Argentina, which in some cases were found to be gender-related. The results obtained are in accordance with statistics from other industrialized countries, except for uric acid (13.61%), even pure or combined in other forms, which was more frequent than the world prevalence (up to 10%). FT-IR spectroscopy combined with the second derivative method of analysis proved to be a powerful tool to discriminate mixed oxalates whose composition only differed in one water molecule.

Evaluation of Bilateral Asymmetry in the Humerus of Human Skeletal Specimen

Samuel S. Dare — 2020-01-07

Several studies have established a relationship between morphological and behavioural asymmetry making investigations of bilateral bone asymmetry an attractive and important research area. The purpose of this study was to investigate bilateral asymmetry patterns of skeletal specimen from five geographical locations (Rwanda, Burundi, Congo, Kenya and Uganda) at Galloway Osteological Collection, Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences at Makerere University.

The angle of torsion and retroversion, mid shaft circumference, length and weight of 232 pairs of humeri were determined. A Torsiometer was used to measure the angle of torsion in degrees according to Krahl and Evans 1945, a tape was used to measure the mid shaft circumference at the level of the apex of the deltoid V and the length in cm was determined. An osteomeric board was used to measure the length of the humerus in centimeters. A weighing balance was used to measure the weight of the humerus in grams.

The analysis of humeral asymmetry with respect to parameters of the human skeletal specimen at the Galloway Osteological collection Mulago revealed bilateral asymmetrical status observed in the angle of torsion, length, weight and mid-shaft circumference. Our result mostly showed lateralization to the right in all the parameters investigated except the torsion angle which is to the left.

Our investigation revealed that humeral torsion is inversely proportional to weight, length and mid-shaft circumference of the humerus. This study established the existence of bilateral asymmetries in the humeri of all the geographical regions investigated with more asymmetry observed in the male compared with the female.

Knowledge and Awareness of Anthrax among the Community People at High, Medium and Low Risk Areas of Bangladesh

K. H. M. Nazmul Hussain Nazir — 2020-01-07

A cross-sectional survey was conducted to assess information about the awareness, attitudes and management practice towards Anthrax. Administrative areas of Bangladesh had been classified as high, medium, and low risk anthrax areas by assessing the risk of anthrax from reports published in daily newspapers and journals. The selected high, medium and low risk areas were Kushtia, Pabna and Mymensingh, respectively. The animal owners and family members, butchers, affected people by cutaneous anthrax were considered as the key informants. Data of management practice including feeding, awareness of zoonosis; vaccination and formal education were collected using interview-questionnaire method. A total data of 622 was collected and uploaded to the data collection tools “Magpi” and the data analysis was carried out using Epi Info™. We found a great worry about educational status in our study sites. Among the interviewers, we found about Half of people had no formal education (46.46%, 289/622). Farmers in the high risk districts significantly more aware of anthrax compared to those from medium-(p=0.000) and low-(p=0.000) risk districts. Knowledge of zoonosis of Anthrax and vaccination of Anthrax were also very poor among the people from low and medium risk areas. For treatment purpose, most of the farmers (about 98%) of high and low risk areas depend on village doctors. We also found that Improper washing of grass-(p=0.000) and flood-(p=0.000) were significantly responsible for Anthrax outbreaks. Finally we suggest, proper washing of grass, increase awareness towards zoonosis of Anthrax and vaccination, proper treatment by veterinarian should be insured to reduce Anthrax outbreak in Bangladesh.

A Facility-based Assessment of Internalized Stigma among Patients with Severe Mental Illnesses in Maiduguri, North-Eastern Nigeria

Abdu W. Ibrahim — 2020-01-07

Introduction: Public stigmatization of mental illnesses might lead to the internalization of the stigma by persons with mental illness (PWMIs) which might also lead to erosion of self-esteem and negative consequences on treatment outcome. This study assessed the prevalence of internalized stigma and analyzed its socio-demographic and clinical predictors among PWMIs in a sub-Saharan African mental health facility.

Methods: Patients with schizophrenia, bipolar disorder and severe depression (n = 370) were randomly interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri. They completed the sociodemographic and clinical proformata, Oslo social support scale, and an adapted version of the internalized stigma of mental illness scale (ISMI).

Results: A total of 83 subjects (22.5%) met the study's criterion score for high internalized stigma. The independent predictors of high internalized stigma were; poor social support (Odds ratio, OR = 4.501, 95% CI = 2.423 - 8.363, p ≤ 0.001), supernatural aetiological beliefs (OR = 3.916, 95% CI = 2.322 - 6.606, p ≤ 0.001), seeking for unorthodox treatment (OR = 3.637, 95% CI = 2.073 - 6.308, p ≤ 0.001), full insight (OR = 3.595, 95% CI = 2.141 - 6.036, p ≤ 0.001), and presence of extra pyramidal side effects (OR = 12.201, 95% CI = 6.827 - 21.805, p ≤ 0.001).

Conclusion: Extra pyramidal side effects, poor social support and misconceptions about the aetiology of mental illnesses were the strongest predictors of internalized stigma among the subjects. The use of second generation antipsychotic medications, the engagement of members of the patients' social support base and the incorporation of psycho-educational programmes to dispel 'myths' about the aetiology of mental illnesses in sub-Saharan Africa are hereby recommended.

Gangrenous Gut in a Pregnant Woman: A Case Report

Verner Orish — 2020-01-07

Gangrene of the intestines is a rare complication in pregnancy. Intestinal obstruction and ischemic bowel diseases are common causes of gangrene of the intestines in pregnancy. Adhesion bands can cause intestinal obstruction while arterial occlusion, venous thrombosis, and vasculitis are some causes of ischemic bowel disease. We present a case of small intestinal gangrene in a 30-year-old woman in her third pregnancy, diagnosed during an emergency cesarean section with extensive gangrene of the ileum and jejunum caused by band formation at the illeo-caecal junction. This case, despite the unfortunate catastrophic outcome, highlights the subtle challenges of managing rare obstetric complication in resource-limited settings.

Association of Adiponectin and Leptin with Coronary Atherosclerosis Severity Indices in Metabolic Syndrome Patients

Kanchan Vohra — 2020-01-07

Adipose tissue is considered as an active endocrine organ that releases a large number of adipokines modulating blood pressure, glucose and lipid metabolism, inflammation, and atherosclerosis. Atherosclerosis has been found linked with various traditional and novel risk actors. This chapter describe the updated review of published literature and present research findings describing the linkage of extent and severity of coronary atherosclerosis with two of the adipokines, adiponectin and leptin, as novel risk factors in metabolic syndrome (MetS) patients. A pilot, Case-control study was carried under Sadbhavna Medical and Heart Institute, Patiala and, Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, between January to December 2013. MetS patients (n=55) with age ≥18 years, undergoing angiography for diagnosis and/or interventional treatment of atherosclerosis and 25 matched control subjects were recruited. Evaluation of traditional and novel cardiovascular risk factors (adipose-derived hormones) and their association with angiographic-derived presence and degree of atherosclerosis indices (number of blocked vessels, severity index, and extent index) was carried out. Low serum adiponectin and high total cholesterol level were found as the independent predictors of atherosclerosis for number of blocked vessels. For extent and severity index, low adiponectin level was the only significant and independent predictor. Leptin and adiponectin/leptin (A/L) ratio could not prove as significant predictors (p≥0.05). Based on the results, it was concluded that Total cholesterol, adiponectin, leptin and A/L ratio might play a vital pathogenic role not only in the occurrence, but also in the severity, extent, number of vessels blocked complexity in MetS.

Peptide Based Tuberculosis Treatment: A Million Dollar Question

Ameer Khusro — 2020-01-07

Tuberculosis (TB) is a deadly tropical disease that is mainly caused by Mycobacterium tuberculosis. The pathogen is known to invade and replicate inside the host’s macrophage. Due to the emerging dilemma of multi-drug resistant TB and extensively-drug resistant TB, the exigency for finding new TB drugs is an obligation now. Among the propitious anti-tubercular agents studied in the past few decades, peptides from diversified sources have been substantiated to be persuasive with multiple advantages such as low immunogenicity, selective affinity to bacterial negatively charged cell envelopes and most importantly divergent mechanisms of action. This chapter highlights the role of prime peptides exploited from several other unplumbed sources as anti-tubercular agents.

The Paradigm of Occupational Diseases Observed in Education Professionals in Brazil

Karen Oliveira Gomes — 2020-01-07

The magisterium has always been considered by law as a painful activity, which causes physical or psychological wear and tear on the organism, due to the repetition of psychological movements, pressures and tensions that affect the worker emotionally. Decree 53.831 / 64 framed the role of teacher as painful. This article aims to discuss the main occupational diseases verified in teachers in Brazil and as specific objectives to describe how the workload of teachers can contribute to the development of occupational diseases and to verify in the literature, prevention and safety measures that have been used and published. The results show that occupational diseases in teachers are common in the teaching environment, where the mental and emotional ones are among the majority for this class, later the diseases of the locomotive apparatus, which demonstrate that working long hours without valorization or adequate remuneration can generate health damages.

A Literature Review of Physical Therapy for Pregnant Low Back Pain

M. Y. Li — 2020-01-07

This study aims to review recently published clinical presentation on the effectiveness and impact of current therapy for low back pain (LBP) during pregnancy. This would help to build an information background and determine the necessity for future research on the development of an effective means for reducing pregnant low back pain.

Up Scaling Mental Health and Psychosocial Services in a Disaster Context: Lessons Learnt from the Philippine Region Hardest Hit by Typhoon Haiyan

Boris Budosan — 2020-01-07

In the aftermath of typhoon Haiyan which struck Philippines in 2013, the World Health Organization Philippines in collaboration with the Philippine government acted to improve access to mental healthcare in affected regions. Eastern Visayas with population 4, 3 million had merely four psychiatrists and seven generalists providing mental health care. It was selected as a model region for integration of mental health care into primary and secondary care. This study was carried out to evaluate the intervention’s success in strengthening mental health services in Eastern Visayas with particular regard to availability, accessibility and affordability of these services. Between June 2014 and March 2015, 1038 community workers were trained in psychosocial care and support and 290 non-specialized healthcare providers received training on assessment and management of mental health conditions including on-the-job supervision. By the end of the March 2015, 155 of 159 or 97.5% of primary healthcare units, 21 of 24 District Hospitals (87, 5%) and all eight provincial hospitals had a doctor and a nurse trained in assessment and management of mental health conditions. The supervised sessions in each locale benefited 50 to 200 patients per location. Regional Medical Centre added a 10 bed inpatient unit for the mentally ill. All provincial hospitals developed the capacity to admit 2 to 4 patients for acute psychiatric care and additional capacity was established in at least 6 district hospitals. In addition, services were enhanced to include access to and use of psychotropic medicines, cross-sectoral collaboration and a clinical referral pathway from the community to the tertiary level. This study demonstrates the feasibility of an intervention in a resource poor context, post-disaster, to improve access to mental healthcare care services over a relatively short period of time. The remote follow-up of this intervention three years later showed that the intervention was also to a great extent sustainable.

Neuroleptic Malignant Syndrome: Looked at from the Diagnostic and Therapeutic Perspectives in a General Hospital Setting

Naseem Akhtar Qureshi — 2020-01-07

Neuroleptic malignant syndrome is a rare life-threatening condition, usually induced by typical and atypical antipsychotics. A middle-aged woman with bipolar disorder and acute back pain due to multiple falls was admitted to the trauma ward of a general hospital. After 3 days, she suddenly developed signs and symptoms of neuroleptic malignant syndrome possibly caused by injectable haloperidol given intramuscularly as “pro re nata” (as the medication needed), although the additional role of olanzapine could not be ruled out. A 3-day delayed diagnosis of neuroleptic malignant syndrome led to serious complications, which could be prevented by its prompt management contingent on its early diagnosis, even in the absence of certain diagnostic criteria. Although she improved substantially with treatment interventions and continued to have dialysis, she died later due to renal complications. The mental health professionals must avoid administering antipsychotic medications as needed among such vulnerable psychiatric patients admitted to general hospitals across the board.

Complementary Medicine, Breast Cancer, and Pain

A. M. Tacón — 2020-01-07

Aims: The purpose here was to investigate for the first time effects following five-weeks of a complementary medicine intervention or mindfulness-based intervention (MBSR) in cancer patients with chronic pain. Specifically, psychological inflexibility in pain, pain self-efficacy, and expressive suppression were investigated for the first time in breast cancer patients with cancer-related pain.

Study Design: One group pre-post intervention design.

Place and Duration of Study: Lubbock, Tx medical center, spring 2010.

Methodology: Sample: The sample consisted of 46 participants with 36 women in stage II (78%) and 10 (22%) in stage III with a mean age of 55 years. The MBSR intervention was held in a hospital counseling center for 1.5 hours/week for eight-weeks, with preliminary data collected at five weeks (reported here), at the end of the full program three weeks later, and three months post the 8-week program. Preliminary data here were collected on standardized instruments before (pre) and after (post) the five-week point of the eight-week MBSR program to evaluate intervention effects on the following: Psychological inflexibility in pain, pain self-efficacy, emotional regulation of suppressive expression, and pain intensity.

Results: Psychological inflexibility in pain scores prior to the program (M=60.05, SD=14.22) decreased significantly by the end of five-weeks of the program (M=57.68, SD=13.46) (t=3.76, P = 0.01); Pain self-efficacy prior to the program (M=20.61, SD=11.47) increased significantly by the end of the five-week period of the mindfulness intervention (M=22.47, SD=10.63) (t=3.11, P < 0.05); Emotional regulation strategy of suppression before the program (M=22.77, SD=7.75) dropped significantly by the end of the five-week mark (M=19.63, SD=8.43) (t=3.68, P = 0.01); lastly, pain intensity prior to the beginning of the intervention (M=33.67, SD=8.48) did not change significantly by the end of the five-week mark (M=32.86, SD=8.20) (P > .05).

Conclusion: These findings after five weeks of the intervention should be interpreted cautiously, for replication and future research need to be conducted at this time period. The results, however, provide data in the neglected area of cancer patients with cancer related pain and the possibility of effective yet shortened mindfulness interventions.

Early Breastfeeding Initiation (EBFI)

Gladys Mugadza — 2020-01-07

The objective of the paper was to describe the concept Early Breastfeeding Initiation (EBFI). Early breastfeeding initiation (EBFI) is recommended within the first hour following giving birth as a simple strategy in enhancing neonatal health and survival. Despite the clear definition by [WHO] on EBFI, some variations still exists across board on what exactly EBFI initiation is. The variations have compounded negatively on neonatal outcomes hence the need to describe EBFI by assigning measurable attributes for standardization of operations in maternity units. A literature review of 39 articles was conducted between the years 1999 to 2016 in a period of two weeks from the 1^st to the 15^th of July 2016. The following search engines were used: Cochrane data base, Journal of human Lactation, Pub - med and MEDLINE. EBFI has been inconsistently described within the same health profession. Taking into cognizant the attributes of EBFI and applying them in the maternity units has a potential of averting neonatal deaths by a significant percentage.

Vascular Endothelial Growth Factor Study of Placenta in Preeclampsia

Jayavelan Ramkumar — 2020-01-07

Preeclampsia is defined as new onset hypertension and albuminuria in previously normotensive pregnant women after 20 weeks of pregnancy. There is no cure; management is reliant on a structured antenatal surveillance programme and antihypertensives. Recent advances in immune histochemistry study of placenta have elucidated an increased Vascular Endothelial Growth Factor (VEGF) expression in various placental bed disorders like recurrent pregnancy loss, preeclampsia, fetal growth restriction, preterm and abruption placenta. Increased release of VEGF family proteins has been attributed to atherosis and placental hypoxia. However, some studies have found normal VEGF concentrations in placenta in these disorders of feto-maternal interphase. This chapter aims to analyse the VEGF expression in placental biopsy from preeclampsia and normotensive pregnancies.

VEGF density is more in the placentas from preeclampsia pregnancies as compared to placenta from a normal pregnancy. The mean weight of placenta is smaller in preeclampsia group. Additionally, the fetal capillaries are also small in diameter and lumen was collapsed. The pulsatility index of uterine artery supplying the placenta is also higher in preeclampsia pregnancies. The high velocity blood flow can mechanically damage the tender fetal villi floating in the intervillous space. This damage collapses the fetal capillaries as evidenced by the smaller diameter of fetal capillaries in the placental biopsy.

Placental hypoxia in cases of preeclampsia is a potent stimulus for VEGF expression. Nevertheless, the increased VEGF expression should be seen in the light of collapsed fetal vessels in a small placenta.