Emerging Research in Medical Sciences Vol. 4

Colorectal cancer (CRC) is the third most common cause of cancer death in the world. The incidence rate (ASR) and age distribution of this disease differ between most of African-Middle-Eastern (AMAGE) and North America and Europe for many reasons. However, in all areas, “CRC” is considered as one of the most preventable cancers, because it might develop from variant processes like polyps and IBD in addition to the genetic pathogenesis which became very well known in this disease. We tried in this paper to review all the possible reasons of the differences in incidence and age between the west and AMAGE. Also we reviewed all the mutations that lead to the hereditary and familiar clustering of this disease with the correlations with the surrounding food and environment of different areas. Then, we focused on the precancerous pathology of this disease with special focusing on early detection depending on new endoscopy technology and most important genetic studies. We lastly reviewed the evidence of some of the surveillance and put suggestions about future surveillance programs and how important those programs are on the psychological aspect of the patients and their families.

Sickle cell disease (SCD) results from a homozygous missense mutation in the β-globin gene that leads to polymerization of hemoglobin S. Its clinical manifestations can be critical with considerable morbidity and mortality. SCD can be treated using bone marrow transplantation, but is restricted to only those patients having an appropriately matched donor. Hence, gene therapy, involving the patient’s own cells, either by gene insertion or gene editing is a primary therapeutic option to cure SCD. However, only a few clinical trials have been performed with genetic therapy for treating SCD. In recent years, significant progress has been made in the area of gene therapy for treating monogenic hemoglobin disorders. Numerous therapies are currently in clinical trial stages or in preclinical stages. The safety and efficacy of gene therapy has been greatly improved with the initial use of γ-retrovirus vectors, followed by next-generation lentivirus vectors and latest gene editing techniques. Although the clinical interpretation of gene therapy has been successful, it involves certain limitations including complex cellular abnormalities, inadequate transgene expression and challenges in achieving effective and persistent inhibition of polymerization of hemoglobin S. This review intends to discuss gene therapy strategies specific to SCD, present state of the field and current status of the gene therapy clinical trials.

Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgery patients in Nigeria. This was a prospective study in patients booked for surgery in 2014. Biodata, medical history, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01 respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.

Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of post-transfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours post-transfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) P = 0.516, but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs (P = 0.237 and 0.063, resp.). We concluded that, in stable non-haemorrhaging and non-haemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, post-transfusion PCV is 12 hours after red blood cell transfusion.

Objective: To compare the safety and efficacy of 2 transcutaneous stimulation techniques, transcutaneous pulsed radiofrequency (TPRF) versus transcutaneous electrical nerve stimulation (TENS), in chronic shoulder tendonitis.

Design: A prospective, randomized, double-blind clinical trial.

Setting: Academic pain service of a city hospital.

Subjects: Fifty patients with sonography-confirmed shoulder tendonitis.

Methods: Fifty patients were randomly allocated into two groups for electrical stimulation treatment with 3-month follow-ups: Group 1 (n=25), TENS; Group 2 (n=25), TPRF. Both groups underwent either treatment for 15 minutes every other day, three times total. Our primary goals were to find any treatment comfort level, adverse event, and changes in Constant-Murley Shoulder (CMS) scores. The secondary goals were finding the changes in pain, enjoyment of life, and general activity (PEG) scores.

Results: For primary goals, no adverse events were noted throughout this study. No differences were found between groups for treatment tolerability (3.20±0.87 vs. 2.16±0.75). Statistically significant lower PEG scores was noticeable with the TPRF group after the course (12.73±5.79 vs. 24.53±10.21, p=0.013). Their statistical significance lasted for 3 months although the difference gap diminished after 1 month. CMS scores were significantly higher in the TPRF group (70.84±6.74 vs. 59.56±9.49, p=0.007) right after treatment course but the significance did not last.

Conclusions: In treating chronic shoulder tendinitis using two transcutaneous stimulation techniques, both TPRF and TENS are safe and effective. TPRF is superior to TENS.

Background: Enhanced recovery after surgery (ERAS) is a group of changes in perioperative care that represent a fundamental shift from the traditional management of the gastrointestinal (GI) surgical patient.

Objective: To compare the results of applying enhanced recovery after GI resection in children versus the traditional methods.

Patients and Methods: This prospective study included 60 patients who underwent GI resectional surgery between February 2016 and February 2017 at our institution. The patients were divided into two groups: Group A (30 patients) was managed with ERAS protocol and group B (30 patients) was managed with traditional methods. All the patients underwent standard hand-sewn technique of GI resection reanastomosis. The protocol of ERAS included no routine nasogastric tube, early diet advancement, minimization of narcotic analgesics, early ambulation and physical rehabilitation.

Results: The most frequent cause of GI resection reanastomosis surgery was intussusception (33.3% in group A and 36.7% in group B). Patients in group A had a significant lower frequencies of postoperative fever (33.3 vs. 66.7%, P < 0.01) and chest infection (26.7 vs. 60%, P < 0.01). Moreover, group A showed a significant shorter postoperative length of hospital stay (4 ± 1.2 days in group A vs. 7.1±2.05 days in group B, P<0.001).

Conclusion: Adopting ERAS protocol for resectional GI surgery in pediatric patients should be encouraged as it is results in lower incidences of postoperative fever and chest infection and is associated with less postoperative length of hospital stay.

Type 2 diabetes mellitus is a chronic degenerative disease that belongs to the group of metabolic diseases, which is characterized by the presence of hyperglycemia, due to a failure in insulin secretion. Internationally, this condition represents a serious public health problem, since there are comorbidities that are also public health problems that favor the appearance of this health condition. Type 2 diabetes mellitus, being a metabolic disease, modifies a series of biomarkers or also called biochemical parameters that are determinants to achieve a diagnosis and follow-up of people who have this disease, for example: Fasting glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and glycosylated hemoglobin (HbA1c); the increase of these parameters in blood indicates the alteration of the different metabolic pathways and normal physiology of the organism due to the increase in hyperglycemia and insulin resistance. Other parameters that are also of important consideration are the presence of arterial hypertension which is a pressure equal to or greater than 140 mmHg of systolic pressure and a pressure equal to or greater than 90 mmHg; Another easy-to-use tool is the body mass index (BMI), which helps to quickly classify the degree of obesity of a patient with normal weight, overweight or obesity. There are multiple causalities that favor the appearance of this health condition, some risk factors are smoking, overweight or obesity, physical inactivity, glycosylated hemoglobin (HbA1c), hypertension, dyslipidemias and unhealthy lifestyles.

Background: Maxillary midline diastema (MMD) is generally regarded as a symbol of beauty in Nigeria. The desperation to look beautiful has caused many individuals to seek the creation of artificial midline diastema and that often comes with undesirable side effects.

Aim: To determine the prevalence of artificially created maxillary midline diastema (MMD) and its complications in a selected Nigerian population.

Methods: A cross-sectional study using a semi-structured questionnaire as the instrument for data collection was done among patients attending a private clinic in Owerri, the capital of Imo state in Nigeria over 18 months. The data were retrieved from the questionnaires and analysed using the SPSS version 20.

Results: 141 respondents were comprising 58(41.1%) males and 83(58.9%) females, giving a male to female ratio of 1:1.4. The prevalence of artificially created MMD was 34.0% with increased frequency in: the 21-30 years age group; among the females and in respondents with a tertiary level of education. Majority of the respondents (69.5%) desire MMD and 20.8% of those without it wanted it created through cosmetic dentistry. Twenty of the 48 respondents with artificial MMD had it done to enhance personal beauty and aesthetics. The commonest complication was tooth sensitivity (44.8%), followed by toothache (41.4%).

Conclusion: The prevalence of artificially created MMD was 34.0% in this study and it is commoner in females and younger age group. The commonest complication was tooth sensitivity. Enhancement of personal beauty and aesthetic was the major reason for having it done.

Cardiovascular diseases (CVD) are known to have the highest proportion of mortality in Slovakia and university students could be at a risk despite their level of education about health. The aim of the study is to investigate the environmental risk predictors (sedentarism, cigarette smoking, stress, fast food consumption) associated with parameters of overweight, obesity and prehypertension. The study popoulation consisted of 33% of all university students (N=102), 23.5% males and 76.5% females attending Faculty of Health Care at Slovak Medical University in all study programmes (nurses-34%, paramedics-45%, laborants-11%, physiotherapists-12%) in the first (46%), the second (27.4%) and the third (25.5%) year study. Subjects were measured for anthropometric parameters (weight, height, body fat percentage for abdominal skinfold for body fat, waist and hip circumference, pulsation, blood pressure). Total results indicate 16% of prehypertension, 20.6% of overvalues of BMI, 14.7% of overweight and 4.9% of obesity and 17.6% of abdominal obesity by assessment of waist circumference. 70.6% of CVD family history was recorded. The prevalence of cigarette smoking was confirmed with 24.5% probands. University students showed a rather high prevalence of stress (69.6%), fast food consumption (37.25%) and physical inactivity (37%). The highest overvalues of BMI (26.5%) and 11.8% of obesity, overvalues of WHtR (17.6%), prevalence of sedentarism (60.6%) and body fat composition (56%) was determined in females studying nursing. Males showed higher prevalence of prehypertension and overvalues of BMI (33.3%), overweight (29.2%) and WHR (12.5%) and waist circumference (13.6%), WHtR (12.5%) and higher prevalence of cigarette smoking (29.2%) than females who confirmed higher prevalence of stress (74.4%), physical inactivity (39.71%) and fast food consumption (41%) and cigarette smoking (23.2%), higher against the latter published data. The first year students seemed to be at the highest risk CVD. They were the most hypertensive (21.7%) and showed the highest prevalence of cigarette smoking (34%), stress (74.5%) and fast food consumption (51%) of all. Sedentarism was detected among third year students (48.1%), who also demonstrated the frequent overvalues of BMI (7.4%), high WHtR(18.5%) and family history of CVD (88.9%). By gender, significant differences were examined in high blood pressure (p=0.002), weight, height and waist (p<0.001). Significant relationship was proved between gender and prehypertension (p=0.008) and obesity (p=0.043). A certain relationship was analyzed between academic year and cigarette smoking (p=0.044), physical inactivity (p=0.001) and fastfood consumption (p=0.024). Significant differences were shown for different study programm and pulse (p=0.008) and height (p=0.023).We found significant differences beween all studied groups in stress (p=0.04), physical inactivity (p=0.001), fastfood (p=0.024), respectively.

Further research is needed to examine lipid profiles and investigate other association with CVD risk factors among other groups of university students in Slovakia, although they are well educated in medical sciences but they need to apply the knowledge into their life style.

This study investigated the color stability of reline resin after two methods of disinfection i.e microwave disinfection and chemical disinfection. A stainless steel mold with a breakaway compartment (10 mm in diameter by 0.7 mm thickness) was made to fabricate specimens of various resins. Each material was mixed according to manufacturer’s instructions and applied into the mold. Prior to color stability testing, specimens were cleaned in distilled water for 20 minutes to kill any microorganisms that may had contaminated the discs during fabrication. And then specimens were immersed in Sodium Perborate Monohydrate 200 ml of solution for 15 days and micro waved for 15 days so that it is comparable to chemical disinfection soaking. The color stability of each specimen was measured again using spectrophotometer and values were obtained. The data of ∆E, ∆L, ∆b, ∆a were analysed by 2 way repeated measures ANOVAs test. Significant statistic changes in color parameters ∆L, ∆a, ∆b of the reline resin DPI, Ufi Gel Hard and Kooliner were observed when dentures were disinfected by Sodium Perborate Monohydrate 2% solutions. The color stability of the reline resin was influenced by time, regardless of disinfection or non disinfection. This can be attributed to bleaching (whitening) effect of reline material. Discoloration of resin based materials may be caused by intrinsic or extrinsic factors. Intrinsic factors are related to internal alterations in material resulting from physicochemical reactions or residual monomer oxidation with time. Thus the initiator, quantity and type of monomer and the polymerisation efficiency can affect the color stability of resin based materials. The color stability deviation value ∆E significantly increased to maximum for chemical disinfectant, least for Control group and intermediate for microwaved group. Ufi Gel showed the highest deviation ∆E and Control Group showed the lowest deviation according to results.

Although the levator scapula muscle is surrounded with the deep cervical fascia as a single muscle unit, the muscle can be separated into a number of muscle slips at the proximal cervical attachment. Originally the muscle was described as having 3 muscle slips at its cervical origin. More recent textbook reports have now adopted 4 slips of origin as normal. Each muscle slip coming from a different cervical vertebra. Levator scapulae muscles are important in myofascial pain syndrome, which is one of the leading causes of neck- and shoulder pain. Surgically it can also be used to overcome trapezius muscle paralysis. Anatomical variations of the levator scapulae are important and therefore clinically relevant. With this cadaveric study, we have investigated the morphometric differences in 46 levator scapulae muscles from 23 cadavers. Measurements of the proximal- and distal attachments and the total length of the muscles were taken. Three muscle slips at the origin were reported in 7 cases. Four slips of origin were reported in 28 cases. Five slips of origin were reported in 10 cases and the first case of six muscle slips of origin was reported in one cadaver in this study. Many differences were also observed between the muscles on the two sides.

Perilunate dislocation and fracture dislocations are rare injuries corresponding to 10% of all carpal injuries. Usually come with high energy trauma, with associated injuries representing 61%. Volar lunate dislocation or fracture- dislocation accounts to 3% of perilunate injuries. We present a case of a 42 years old polytrauma male, transmitted in our department 48 hours after a car accident with a trans-scaphoid volar lunate dislocation. During operation the lunate was displaced volarly to the ulnar side of the wrist, forward to styloid process of distal ulna, while the scaphoid fracture appeared at waist with comminution and the proximal pole of scaphoid protruded under the dorsal capsule. Carpal injuries are often missed out in polytrauma patients and these injuries are underestimated because of the severity of the other visceral or extremity lesions. Untreated or improperly treated those injuries, leads to serious morbidity and loss of function. Therefore good functional prognosis with decreased percentage of complications can be achieved following early recognition and early open surgical repairing ligamentous complex.

The styloid process is a sharp bony projection, at the base of the skull, and part of the temporal bone. Muscles and ligaments are attached to this process, but they are rarely of any clinical significance unless the styloid process is fractured or severely elongated or structures attached to it becomes ossified. Pathology of the styloid process is referred to as Eagle’s syndrome. This was after the first publication by Eagle [1] in which he reported a 4% prevalence of elongated styloid processes in the cohort that he investigated. Later studies reported a much higher percentage of elongated styloid processes.

The aims of this study was to investigate the mean length of the styloid process and compare this with what is accepted as the “normal” length after the publication by Eagle. The study also looked at evidence of asymmetry between the two sides within the same specimen. Comparing the lengths between different sexual groups, were also investigated.

Forty five styloid processes from 28 different individuals were measured for comparison. The sample group consisted out of 18 male- and 10 female subjects. The lengths of the styloid processes varied from 7.17 – 50.54 mm, with a mean of 27.48 mm. This mean length of 27 mm supports the claim by Eagle that the “normal” length of the styloid process is around 25 mm.

Ten out of 25 individuals (40%) exhibited “elongated” styloid processes measuring over 25 mm. These findings were higher than those reported by Eagle. Elongated styloid processes are clinically important in order to make the correct diagnosis if there is problems in the neck.

In our investigation the styloid processes were on average 0.87mm longer on the right side and 3.12 mm longer in male specimens.

The study was carried out in Eagle Island River, located in Mgbuosimini community, Port Harcourt, Nigeria. In this study, the concentration of Nickel (Ni) in sediments and periwinkles (Tympanotonus fuscatus) were determined from 25 sample stations in Eagle Island River. The portion of the periwinkle that was assayed was the edible part. The assay was carried out using Atomic Absorption Spectrophotometer (AAS). The mean±SD of Ni concentrations in sediments and periwinkles were 2.77±1.05 mg/kg and 6.25±1.98 mg/kg respectively. The mean concentration of Ni was higher in periwinkles than in sediments. The correlation coefficient between Ni concentrations in sediment and periwinkle was 32.7%. Following the increasing industrial activities and waste disposal in the water body, the need to regularly determine the concentrations of this heavy metal in the water, aquatic lives and sediments is imperative in order to uphold environmental and human health protection.

Background: Musculoskeletal complications are responsible for up to 80% of indications for presentation to the hospital by sicklers during their life time. It is important to know when to expect the complications and the treatment options available.

Methods: A retrospective study was conducted involving all sickle cell anaemia patients treated between June 2012 and May 2017 at Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria. The data collected included age, sex, complications, anatomic site, stage of disease and treatment. Data obtained were analyzed using the software Statistical Package for Social Sciences for Windows version 15.0 (SPSS, Inc; Chicago, Illinois) and presented as frequencies (%) and mean values (SD) as appropriate, P < 0.05 was taken as statistically significant.

Results: Thirty one out of 85 sicklers presented with 53 musculoskeletal complications giving a prevalence rate of 36.4%.There were 18 males and 13 females with mean age of 14.2±1.03 years. Those ≤ 20 years had more complications than those 21 years and above, P=0.0001. The femur was involved in 20(37.7%) and avascular necrosis 17(20.1%) was the most common complication followed by septic arthritis 13(15.3%) and chronic osteomyelitis 8(9.4%). The mean Haemoglobin concentration 7.5±0.5 mg/dl of the patients with AVN was higher than those without it, P=0.02. Conservative treatment was employed in treatment of 40(75.7%) of the complications while others had arthrotomies and arthroplasties.

Conclusion: Avascular necrosis, osteomyelitis and septic arthritis are the most common orthopaedic complication among sicklers in Makurdi. They occur predominantly in the younger age group and many are amenable to conservative treatment.

Background: The visual and auditory systems are vital for the optimal development of a child. However recent studies have shown that the incidence of visual problems in the deaf is higher than in their hearing counterparts. This study is aimed to find out if this is so in our locality.

Aim: To screen for ocular abnormalities among students in a deaf school in Nigeria.

Materials and Methods: A cross sectional survey of students in a school for the deaf was carried out. Demographics as well as visual acuity, penlight eye examination, intraocular pressure, dilated fundoscopy and refraction of consenting respondents were documented where applicable.

Results: A total of 114 deaf students were seen comprising 48(42.1%) males and 66(57.9%) females. Mean age was 15.14±3.91 .A total of 110 (96.5%) subjects had vision ≥6/18 while the rest (n=4; i.e.3.5%) had low vision between < 6/18 and 6/60. Significant causes of low vision include optic atrophy of unknown cause, cupped discs from untreated chronic glaucoma and macular scarring.

Conclusion: There should be routine eye evaluation for all hearing-impaired and deaf persons so that timely treatment can be offered for treatable conditions in order to avoid loss of vision, which is the sense heavily relied upon in this group of individuals. No significant plans are in place to address this at the moment. It is encouraged that policy makers should please seek prompt and adequate delivery of these services to this population.