Innovations in Medicine and Medical Research Vol. 2

Detailed Study on Pattern of Cancer Pain in Patients Admitted at a Tertiary Care Centre in Northern India- A Prospective Observational Study

Anshika Arora — 2020-04-03

Aims: Pain being the commonest symptom in cancer, its prevalence and pattern needs to be studied. The aim of this study was to evaluate the prevalence and pattern of cancer pain in admitted patients.

Study Design: Prospective observational study.

Place and Duration of Study: This study was carried out at Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India, between January 2018 and April 2018.

Methodology: After institutional ethical clearance and written informed consent 393 patients were enrolled in the study. We prospectively evaluated patients admitted with diagnosis of cancer for presence, severity and pattern of pain, using clinical assessment and numerical pain scale at admission and at discharge. Chi-square test was used for categorical data and multivariate analysis was performed with multinominal regression and ANNOVA tests.

Results: In 393 patients prevalence of pain, moderate-severe pain, neuropathic pain (NPP), mixed pain was 67%, 47.8%, 10.2% and 31.9% respectively. More than one pain site was present in 43% of patients. The median numerical pain score was 2 overall, 4 in patients with pain and 7 in patients with NPP or mixed pain. Prevalence of severe pain and NPP or mixed pain was highest in hepatobilliary, lung, head and neck and genitourinary cancers. As many as 42.97% (113/263) patients had more than one pain site. On multivariate analysis severity of pain was significantly associated with primary tumor site (P=0.002), NPP (P=0.000), number of metastatic sites (P=0.02) and number of pain sites (P=0.009); NPP with primary tumor site (P=0.000), number of pain sites (P=0.000) and severity of pain (P=0.014). The proportion of patients with moderate-severe pain reduced from 47.8% before admission to 10.7% at discharge with adequate analgesic management.

Conclusion: The prevalence of cancer pain and moderate-severe pain is high in admitted patients. Various patient, disease and pain variables need to be considered for an adequate cancer pain assessment and management. Team approach with active participation of primary medical team, adjunct support from palliative care specialist is desirable for cancer pain management.

Research on Containment of Ebola – Steps to Prevent Spread of Emerging Infectious Diseases: The Nigeria Example

Y. J. Peter — 2020-04-03

Emerging infectious diseases are diseases whose incidence in humans have increased in the past decades or threaten to increase in the near future. The epidemiological and Laboratory techniques needed to detect, investigate and contain a deliberate outbreak are the same as those used for natural outbreaks. The threat to Nigeria posed by the arrival in Lagos of a patient acutely ill with Ebola was potentially enormous. Six response teams were deployed within the Emergency Operations Centre; 1) Epidemiology/ Surveillance, 2) Case Management/ Infection Control, 3) Social mobilization, 4) Laboratory Services, 5) Point of Entry and 6) Management / Coordination. The strategy group reviewed and approved all of the teams work and needed resources. Eleven patients with laboratory confirmed Ebola were admitted and discharged, an additional patient was diagnosed at convalescent stage while eight patients died.

Comparative Study between Anthracycline Based Regimen and Taxane Based Regimen in Metastatic Gastric Cancer: General Perspectives

Abeer Ibrahim — 2020-04-03

Introduction: Taxanes and anthracyclin containing regimes are the most successful regimens in advanced gastric cancer with comparable results but with different toxicity profiles.

Objective: To compare efficacy and toxicity of 2 regimens one containing anthrathycline (ECSF regimen) and other contain taxane (PCF regimen) as a first line therapy in advanced gastric cancer.

Methods: Between May 2011 and Dec 2015, a total of 120 patients with locally advanced and metastatic gastric adenocarcinoma were included in the study, 60 patients received ECSF (Epirubicin 50 mg/m²iv d1, Cisplatin 60 mg/m² iv d1, 5-FU 1750 mg/m²/d “1 and 8” CIVI over 24 h, Folinic acid 200 mg /m² day 1, 8 repeated every 3 weeks), while, another 60 patients received PCF (Paclitaxel 150 mg/m² IV on day 1; Cisplatin 15 mg/m² IV on days 1-5 and 5-FU 600mg/m²/day CIVI d1-5 every 3 weeks) until disease progression or unacceptable toxicities.

Results: ORR of ECSF was superior to PCF arm, 47% vs. 34% respectively p = 0.001. The toxicity profiles were less in ECSF arm than PCF arm especially in neutropenia and mucositis. Median PFS and OS were significantly higher in ECSF arm than PCF (6.9 vs. 4.9 months p= 0.022) and (11.1 vs.8.9 months p = 0.028) respectively.

Conclusion: The use of anthracycline based regimen as first line therapy in advanced gastric cancer showed better outcome and acceptable toxicity when it compared with paclitaxel containing regimen.

Origin of the Viruses and Their Evolutionary History: Recent Advancement

Giulio Tarro — 2020-04-03

The human immunodeficiency virus (HIV) originated via a process of natural evolution, probably emerging from the primate SIV reservoir into the human population via hunting or other behavior involving contact with the blood of these animals. A particular subspecies of chimpanzee, the Pantroglodytes troglodytes, has been recognized as the most probable original source of human infection. Analysis of viral genetic sequences has allowed researchers to estimate that the native strain of HIV originated in 1931. In the West, sexual behavior patterns and injecting drug use subsequently began the epidemic.

Polymerase Chain reaction (PCR), is a technique in molecular biology that amplifies a specific region of deoxyribonucleic acid (DNA), and has been useful in the molecular characterization of viruses.

The Variola major, the virus that causes the smallpox, lethal virus in the 30% of the cases, was eradicated in 1979 in the human species, thanks to a capillary vaccination on global scale. It has now become a “historical footprint” in two known laboratories, one in the USA and another in Russia, leaving no obvious source for its often-theorized use as a bioterrorist weapon. Nevertheless, mass vaccination against smallpox continues to be a leading initiative in Western countries to guard against bioterrorist attack.

Evaluation of In vitro Antioxidant and Diuretic Potential of Ethanol Extract of Gongronema latifolium Leaves on Wistar Albino Rats

O. D. Omodamiro — 2020-04-03

Medicinal herbs are the significant source Diuretics, phytochemicals and antioxidants. Gongronema latifolium had been widely used for its reported biological activities in indigenous system of medicine. The diuretics, phytochemicals and antioxidant properties were evaluated considering their possible contribution to improve the use of herbal products in treatment of diseases. The phytochemical properties such as Tannins, Alkaloids, saponin, steroids, flavonoids, glycosides and terpenoid were observed to be present after the qualitative analysis on the plant extract. The antioxidant activity was determined using nitric oxide, lipid peroxidation and 2,2-diphenyl-1-picrylhydrazyl free radical scavenging activities. The plant extract showed 93.18% inhibition in nitric oxide at highest (200 µg/ml) used. This is higher when compared to DPPH and lipid peroxidation extract which are 90.652 and 90.99 mg respectively. The percentage inhibition of the plant extract showed low inhibition concentration as against 50% (IC₅₀). Seven groups of two rats each was used for diuretic study. Ethanol leaf extract was administered intra-peritoneally to the rats at doses of 25, 50, 100, 200 and 400 mg/kg body weight respectively. Furosemide (40 mg/kg) was used as positive control. This was evaluated by measuring the urine volume and urinary electrolyte excretion. The extracts produced a significant increase in urine volume at 200 and 400 mg/kg (1.50 and 1.90) respectively and enhanced urinary excretion of sodium, chloride, potassium and bicarbonate (p<0.05). The result obtained showed that Gongronema latifolium has potential and significant phytochemical, antioxidant and diuretic properties.

From Sequence of Tumor Liberated Protein (TLP) to Potential Targets for Diagnosis and Therapy: Advanced Study

Giulio Tarro — 2020-04-03

A preliminary analysis of immunoprecipitation followed by Western Blotting (WB) shows corin and TLP precipitate at the same level (approximately 50 KDa) and are recognized by the same antibodies. In parallel the tests of immunoprecipitation were improved by the use of cell extracts derived from lung cancer cells A549 and NCI-H23 with the aim of obtaining a precipitate containing only the TLP. In fact the partial amino acid sequence of TLP shows a high homology with the sequence of human corin (only one amino acid is different) and is present in lung cancer under different isoforms. It is known that human corin is expressed mostly outside the cells and the protein extract derived from the extracellular medium and from the cells transfected with the plasmid, which over expresses corin, shows several bands analysed on SDS-PAGE that are equivalent to the bands (about 50-100 KDa) observed in the WB analysed by anti-TLP.

Study on Human Vaccines for Oncogenic Viruses and Perspectives for Tumor Antigens Induced by Virus

Giulio Tarro — 2020-04-03

The Variola major, the virus that causes the smallpox, lethal virus in the 30% of the cases, was eraticated in 1979 in the human species, thanks to a capillary vaccination on global scale.

Recently the Word Health Organization (WHO) declared that India and Southeast Asia are polio-free, really a great achivement since the vaccine for polio, an infectious desease that can cause paralysis, was certificated safe and useful only 60 years ago.

The vaccine for the virus, responsible for hepatitis B infection HBV, is able to prevent 50% of all liver cancers. Human Papilloma Virus (HPV) have been correlated with the cervical cancer (genotypes 16 and 18 particularly oncogenic in humans): the USA Food and Drug Administration (FDA) in 2006 released the first vaccine against HPV.

Finally, the ability of the immune system to recognize a tumor-associated antigen enables the development of a vaccine approach for therapeutic application and represents a main target of this field of research.

Long years of research were required for busting new systems to fight cancer. Research is going to obtain the complete sequence by proteomics approaches, in order to achieve adequate antigen preparations that might be used to generate assays for a specific anticancer vaccine.

Investigation of Concealed Homicide and Establishment of Positive Identification: A Critical Study

Mohammed Iliyas Sheikh — 2020-04-03

To conceal a crime to be detected by the investigating agencies like police and doctor is the prime moto for the criminals. These concealed homicides are very difficult to investigate by the investigating officers starting from confirmation of alleged accused to the collection of positive evidences in favour of the case to prove beyond doubt in the court of law. More difficulties arise when they try to destroy the evidences by concealing dead body of offence, by throwing the body in the unapproachable area or making difficult to identify by relatives or investigation officers by burning or mutilating the deceased by the accused. A case is discussed here, having similar observations that the accused tried to concealed the crime by burning the dead body on the outskirt of the city. Various aspects in this case like cause of death, establishment of positive identification etc. are discussed in this paper.

Fluoroquinolone Resistance in Relation to Phylogenetic Background and Iron Uptake Associated Virulence Profile among Urinary Escherichia coli Isolates from HIV and Non-HIV Patients

Kesavaram Padmavathy — 2020-04-03

Introduction: Urinary tract infection is a major cause of morbidity among HIV patients and is more often underestimated in developing countries. Urinary Escherichia coli isolated from HIV and non-HIV patients in South India were analyzed to determine the virulence profile and phylogenetic distribution and their correlation with fluoroquinolone (FQ) resistance.

Methods: This study aimed to assess the difference in the incidence of iron uptake associated virulence genes among urinary E. coli isolated from HIV (n= 76) and non-HIV antenatal patients (n=42). We compared the incidence of virulence associated genes (VAGs) among the E. coli isolates in relation to FQ resistance, phylogeny and host immunocompromise.

Results: fyuA was higher among the isolates from HIV than from non-HIV patients (P=0.00024). E. coli isolates from HIV, non-HIV patients primarily belonged to the phylogroups D and B2 respectively. Q and FQ resistance were higher among isolates from HIV patients compared to non-HIV patients (P=0.000414, P<0.0001 respectively). PhylogroupB2 strains were predominant among the FQ susceptible than FQ-resistant strains (P=0.000652). fyuA and iutA was higher among the Q-resistant isolates than their susceptible counterparts (P<0.0001; P=0.000132). FQ resistant isolates harboured fyuA, iutA than the susceptible isolates (P=0.0063; P=0.000478). Hly⁺ phenotype was significantly associated with FQ-susceptible isolates (P=0.003253).

Discussion: Our results establish the relative predominance of non-hemolytic, fyuA⁺, Q, FQ resistant E. coli isolates primarily of phylogroup-D among the HIV patients and there by suggests that non-B2 strains with lower virulence but with increased antibiotic resistance establish infection in HIV patients.

Dental Treatment of a Child with Pallister-Killian Syndrome: Critical Research

Serhan Didinen — 2020-04-03

The Pallister-Killian syndrome (PKS) is an extremely rare genetic disorder with an incidence estimated around 1/25000 and a multiple congenital anomaly deficit syndrome caused by mosaic tissue limited tetrasomy for chromosome 12p. The presented report is the first confirmed case with PKS in Turkey. This report focuses on the orofacial clinical manifestations of an 6-year-old boy with PKS who was referred to the Department of Paediatric Dentistry clinic, Gazi University. It has been learned that the PKS was diagnosed 1 year after birth. Due to intellectual disability, it was decided to make the dental treatments under moderate sedation. Although significant tongue thrust and anterior open bite were determined, any oral appliances could not be applied because of the 2 epilepsy seizures in the last 2 years. The aim was to treat decayed teeth and set good oral hygiene in the patient’s mouth. Still, there is a probability for epilepsy seizures. If epileptic seizures stop permanently, we can apply an oral appliance to block tongue thrust. The patient is now under control. In cases of systemic and oral findings such as PKS, conducting medical and dental approaches together will increase the life quality of patients.

Immunotherapy Using Mycobacterium w Vaccine in Locally Advanced Head and Neck Cancer: Illustrative Research

Rakesh Dhankhar — 2020-04-03

The oncological treatment has been advanced promisingly over the past decades. The patients may be treated with surgery, chemotherapy (CT), radiotherapy (RT) or combination of these treatment modalities. Immunotherapy for prevention and treatment of malignant disease is also in initial stage and has raised a hope that improving immune mechanism can be of use. Most suitable treatment modality for the patient is selected after the final diagnosis. The use of Mycobacterium w (Mw) vaccine in Head and neck cancer (HNC) is an effort to reduce treatment induced toxicity with resultant improvement in the response rate. Immunotherapy in the form of Mw vaccine may be useful as concurrent therapy with radical intent concomitant chemo radiation treatment to improve response rate with less side effects in patients suffering from locally advanced head and neck squamous cell carcinoma.

Hybrid Appliance for the Correction of Parafunctional Habits

Reji Abraham — 2020-04-03

Tongue thrusting and thumb sucking are the most commonly seen oral habits which act as the major etiological factors in the development of dental malocclusion. This case report describes a fixed habit correcting appliance, Hybrid Habit Correcting Appliance (HHCA), designed to eliminate these habits. This hybrid appliance is effective in less compliant patients and if desired can be used along with the fixed orthodontic appliance. Its components can act as mechanical restrainers and muscle retraining devices. It is also effective in cases with mild posterior crossbites.

An Approach of Acute Encephalitis Syndrome in Muzaffarpur, Bihar; A Different Perspective

Anil Kumar — 2020-04-03

Acute encephalitis syndrome (AES) is a disease characterized by fever and mental confusion, disorientation, delirium, or coma. It could be due to various causes such as viruses, bacteria, fungus, parasites, spirochetes, chemical, and toxins. This chapter is an outcome of an Epidemiological investigation of AES occurred in Muzaffarpur, Bihar in 2011 which was done by a team consisting of experts from various disciplines. The team visited Muzaffarpur, from 14^thto 20^thJuly 2011 and reviewed the situation of deaths among children due to AES, as directed by the Authorities. A total of 147 cases of fever with altered sensorium were admitted between 11^thJune to 18^thJuly 2011 in a private hospital and a Medical College Hospital of Muzaffarpur. Out of these, 54 patients died indicating case fatality rate of 36.73%. Clinico-epidemiological and environmental evidence supports the diagnosis of Acute Encephalitis Syndrome which has significant mortality, affecting predominantly rural population with poor sanitation and presence of wild rats. No significant association of litchi consumption and poor nutritional status of children with AES disease were found. Evidences suggest that there were increased chances of contacts between cases and wild rats during the period of occurrence of outbreak. Key observation was the sudden drop in incidence of cases with rainfall as during and just after the rain children abandons the outdoor games in farmlands/ litchi gardens due to accumulation of water in these areas and exposure from the rodents prevented Etiological agent could not be identified by laboratory tests. Time, place and person distribution of cases is suggestive of infectious disease of short incubation period (<1 day) having wider spectrum of sub clinical and clinical phases & lifelong immunity after first infection.

Paul Ehlrich’s Mastzellon- The Legend Lives

Uzma Iqbal Belgaumi — 2020-04-03

Background: Mast cells (MC) secrete a variety of molecules that are implicated in either promoting tumour growth or may act in an opposite manner in other tumour types.

Aim: To evaluate the association of mast cells in the different grades of Oral Squamous Cell Carcinoma (OSCC).

Material and Methods: 45 diagnosed cases each of well, moderate and poorly differentiated OSCC were identified from the institutional archival material. Slides were made of 5 µm thickness and stained with Hematoxylin and eosin and 1% Toluidine blue stain. Each section was evaluated for mast cells in peritumoural, intratumoural locations and at the invasive front of the tumour. The results obtained were subjected to statistical evaluation by an SPSS version 19 using Chi square test, Anova and Post hoc Tuckey tests.

Results: An inverse relation was observed between MC count with grade of the tumour with maximum MC located in the peritumoural area followed by the invasive front and the least in the intra tumoural areas.

Conclusion: The results of the present study suggest that a decrease in MC count is associated with an advanced histologic grade of OSCC and hence a poorer prognosis, thus favouring the protective role of mast cells in OSCC.

Current Research on Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality

Apostolos Sovatzidis — 2020-04-03

Introduction: Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is a rare anatomical deformity characterized by the partial or complete encasement of the small intestine with fibrotic peritoneum. 193 incidents have been described worldwide. The aim of this study was to present two ACS cases successfully treated at the Surgical Clinic of the Agios Dimitrios General Hospital in Thessaloniki, Greece.

Presentation of Cases: Two men (55 and 54 years old) presented to the emergency department complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these patients had surgical histories. The computed tomography of the first patient showed considerable distension of the small bowel, suggestive of an internal hernia. The second case showed distention of the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, we found that a fibrous membrane had completely covered the small intestine of the first patient, and the jejunum and part of the large intestine of the second patient. Adhesiolysis and a partial excision of the membrane were performed in both cases.

Discussion: ACS is a rare cause of small bowel ileus. Although pharmaceutical treatments with immunosuppressants and steroids have been described, surgical treatment is the gold standard.

Conclusion: Preoperative clinical suspicion of this disease can help determine the diagnosis and protect surgeons from intraoperative “surprises.”

TLP Sequenced and Studied for Its Functions with Targets Diagnostic and Therapeutic: Recent Perspective

Giulio Tarro — 2020-04-03

From the first analysis of immuneprecipitation followed by Western Blotting (WB) Corin and TLP seem to precipitate at the same height (approximately 50 KDa) and are recognized by the same antibodies. In parallel the tests of immunoprecipitation by the use of cell extracts derived from lung cancer cells A549 and NCI-H23 are improved with the aim to be able of obtaining a precipitate containing only the TLP. In fact the partial aminoacid sequence of TLP showes a high homology with the sequence of human Corin (only one aminoacid is different) and is present in lung cancer under different isoforms. It is known that human Corin is expressed mostly outside the cells and the protein extract derived from the extracellular medium and from the cells transfected with the plasmid, which overexpresses Corin, showes many more bands analyzed on SDS-PAGE that are equivalent to the bands (about 50-100 KDa) observed in the WB analyzed with anti-TLP.

Review ofa Case of Coexisting KRAS and BRAF Mutations in a Patient with Metastatic Colon Adenocarcinoma

Anusha Vittal — 2020-04-03

KRAS and BRAF mutations are found in 30-50% and 10% of metastatic colorectal cancer (mCRC) patients respectively. Here we report a unique case of mCRC with coexistent KRAS and BRAF mutations. Patients harboring concomitant KRAS and BRAF mutations do not usually respond to standard chemotherapeutic regimens, usually have aggressive course of illness with poor prognosis and we are in dire need of developing new treatment strategies.

Evaluation of Novel Cost-effective Technique for Speedy Resolution of Infantile Umbilical Hernia: Ammannaya’s Technique

Ganesh Kumar K. Ammannaya — 2020-04-03

Umbilical hernia in the infant is common and resolves in majority of the cases by 6 years of age. Observation till this age and surgery in the event of persistence are the widely followed management strategies. Trusses, taping and adhesive strapping have been tried to achieve speedy resolution with variable success and a significant incidence of skin complications. We present a novel, simple, easily reproducible, and highly cost-effective technique to achieve complete resolution of infantile umbilical hernia in a span of 8 weeks, with no skin complications.

Development on Tumor Associated Antigen with Specific Target toward Lung Cancer: Recent Developments

Giulio Tarro — 2020-04-03

Tumor liberated protein (TLP) has been previously described as a TAA (complex) present in the sera from lung cancer patients with early stage disease. Since early detection improves overall survival in lung cancer, identification of screening biomarkers for patients at risk for the development of this disease represents an important target. Starting from the peptide epitope RTNKEASI previously isolated from TLP complexes, we generated a rabbit anti-RTNKEASI serum. This antiserum detected and immunoprecipitated a 55 kDa protein band in the lysate of the lung cancer cell line A549. This protein band was identified as aldehyde dehydrogenase is form 1A1 through mass spectrometry, revealing the molecular nature of at least one component of the previously described TLP complex.