Innovations in Medicine and Medical Research Vol. 3

Investigating the Effectiveness of Traditional Healers in Program to Control Leprosy in Nagan Raya District in Aceh

Said Usman — 2020-06-06

Aceh Province had the highest rate of leprosy in Indonesia; in 2014, 436 new Multibacillary cases were reported. Nagan Raya was the District in Aceh with the highest number of cases; new cases in 2015 comprised 26 with Paucibacillary (PB) and 21 with Multibacillary (MB) with a total of 4.26% with Grade II disability. The phenomena of handling and treatment by the people in Nagan Raya involve treatment by traditional healers, “Tabib”, to treat the leprosy, with treatments known as Peundang locally. The purpose of this study was to find out and to take steps to improve the effectiveness of the Tabib in controlling leprosy in Nagan Raya. The main object of this study, which used a quasi-experimental design, was to find out and to improve the treatment of leprosy patients by the Tabib who treat them there. Data was gathered using a questionnaire with an interview and the intervention was to provide training and a pocket book about leprosy and how to detect, control, and manage it there and the role that the Tabib can play in controlling leprosy in the future. The results of the study showed that there was a significant difference in knowledge about leprosy between the EG (Experimental Group) Tabib after they got the training including the pocket book and the Tabib in the Control Group (CG); i.e., that did not get any training nor the pocket book. Furthermore, after the training, there was also a significant difference in the attitude towards leprosy between the EG and the CG of Tabib. There was also a significant difference in the future role of the Tabibs to control the spread of leprosy between the EG and the CG. Based on these results, it is hoped that the District Health Department can implement a partnership model with the Tabib in Nagan Raya (and elsewhere) to use the pocket book with training to implement a program to control the spread of leprosy and also to always support the Tabib to improve their role in controlling and eliminating leprosy amongst the village people.

Vitiligo and Thyroid Autoimmunity

Emina Kasumagic-Halilovic — 2020-06-06

Vitiligo is an acquired skin disorder characterized by depigmented maculae resulting from a reduction or the number and function of melanocytes. It is characterized by macular depigmentation of varying sizes or shapes with a tendency to progress. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine dysfunction may be involved. Vitiligo has been reported in association with numerous endocrine disorders. One of the main association is with thyroid abnormalities. Thyroid autoimmunity is the most prevalent autoimmune condition in the general population, and is also associated with various skin diseases. The mechanisms by which these diseases develop are unknown, although it is likely that diseases occur in genetically susceptible individuals exposed to a permissive environment.

This chapter is an attempt to update the current knowledge about the relationship between vitiligo and thyroid autoimmunity. Although cutaneous manifestation of autoimmune thyroid diseases are well described, a better understanding of these processes is needed. It is a multidisciplinary problem requiring cooperation of specialist in different fields of medicine. Both dermatologist and endocrinologists have to inquire their patients about the family history of autoimmune diseases and to look for associated disorders.

Intravitreal Injections and Secondary Sterile Endophthalmitis

Joaquín Marticorena — 2020-06-06

Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that have not been conceived for intravitreous administration. The aetiology of sterile endophthalmitis, independently of the administered drug, remains uncertain and a multi-factorial origin cannot be discarded. Sterile inflammation secondary both to intravitreal triamcinolone acetonide and to intravitreal bevacizumab share many characteristics such as the acute and painless vision loss present in the big majority of the cases. Dense vitreous opacity is a common factor, while anterior segment inflammation appears to be mild to moderate. In eyes with sterile endophthalmitis, visual acuity improves progressively as the intraocular inflammation reduces without any specific treatment. If by any chance the ophthalmologist is not convinced of the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the devastating visual prognosis of this intraocular infection in the absence of therapy.

A Case of Late-Onset Neurofibromatosis Speculated as Type 7: Brief Overview

Shunji Yasaki — 2020-06-06

Neurofibromatosis (NF) is one of the commonest hamartoneoplastic syndromes and is an autosomal dominant neurocutaneous syndromes. NF type 1 and NF type 2 are the main forms of NF. NF type 3 to type 8 are very rare but accurate their incidences are not known. NF type 7 occurs rarely in late adulthood (from age 30 onward) and is characterized by schwannoma or neurofibroma, skin freckling, but no café-au-lait spot.

Recently, a first Japanese case of late onset NF speculated as type 7 was reported. A 65-year-old woman developed freckling on her skin from axillary to inguinal regions at age 40. At age 55 and 63, she had respectively, a subcutaneous tumor from her right buttock and a left acoustic tumor removed, in both cases, histopathological analyses diagnosed a schwannoma. At age 65, she was admitted to the hospital for a detailed examination of an abdominal mass previously detected by MRI. The patient had no family history of schwannoma, nor presented café-au-lait skin spots. The abdominal mass was diagnosed as a retroperitoneal tumor by enhanced-CT-scan, MRI and FDG-PET/CT. Needle biopsy examinations confirmed a schwannoma diagnosis. Thus, it is considered she is a very rare case of late-onset neurofibromatosis speculated as type 7.

Study on Administration of Non-phachologic Intervention in the Control of Hypertension among Selected Volunteer Retirees in Awka Metropolis Anambra State Nigeria

Alagbu Chukwubuikem Eugene — 2020-06-06

High blood pressure under medical palance is associated with a variety of circulatory diseases, and it has been estimated that over 12% of all deaths in the world is directly or remotely connected with hypertension. It is said that one out of every five persons, can expect to have high blood pressure at one time or the other, during one’s life time. Based on hemodynamic equation, the mean arterial pressure is equal to cardiac out-put, times resistance (p means = Q x R). Hence hypertension is usually as a result of either an increased cardiac output and/or an increased resistance. The most common form of high blood pressure in humans is called “essential hypertension”, while is said to have no known cause. However this research aims at showing how a 12-week moderate exercise with bicycle egometer (i.e use of non-pharmacologic approach to reduce the resting heart rate and blood pressure of 6 volunteer retired civil servants from Anambra state civil service and 6 retired academic staff of Nnamdi Azikiwe university in Awka. The paired T-test analysis of data obtained revealed a statistical significant effect of the moderate 12-week exercise on bicycle egometer, on the resting heart rate and blood pressure of the experimental group of the respondents. Hence it could be concluded that the administration of moderate exercise on bicycle egometer could be an effective use of non-pharmacologic intervention in the control and prevention of high blood pressure or hypertension among the elderly.

Application of Motivational Techniques to Improve Sports Participation and Performance among Adolescents: Implications to Sports Administration in Secondary Schools

Alagbu Chukwubuikem Eugene — 2020-06-06

This research is on the application of motivational techniques to improve sports performance and participation among adolescents: Implications to sports Administration in secondary schools in Nigeria. The researchers investigated sufficient use of motivational techniques as a tool, feedbacks, reinforcement and punishment, goal-setting as factors influencing the application of motivation on adolescents. In the research, ten schools from ten local governments out of 21 (twenty one) local government areas of Anambra State were used. The schools were purposively chosen to ensure that both Federal, state and mission owned schools were all represented in the sample. To guide the study’s data collection, four research questions were formulated and data were gathered using questionnaire patterned after that of Likert. A total number of 200 adolescents (students in the secondary schools) were used. The data collected were analyzed using frequency and mean (x) to determine level of agreement and disagreement to the research questions. The findings of this study revealed that it is through motivation that the human resources in the adolescents could be utilized and channeled to improved sports performance and participation in secondary schools in Nigeria. Recommendations were appropriately made.

Female Undergraduate Sports Participation and Adequate Education, Perceived Implications of Reproductive Health Problems/Male Dominance: University Sports Administration Experience a Critical Study

Alagbu Chukwubuikem Eugene — 2020-06-06

This study sought to examine female undergraduates sports participation and adequate education, perceived implications of reproductive health problems/male dominance: University Sports administration experience. Sports have grown from its earlier humble beginnings of being a mere entertainment and recreational pass-time, to becoming a prominent, business both in the social, political and economic circles of all nations of the world. Hence the researcher tried to verify perceived implications of the reproductive health problems of the girl-child and persistent male dominance in University sports vis a vis female undergraduates participation in sports and their education. Consequently the specific objective of this study was to verify if the reproductive health problems of the girl-child, poorly funded and maintained sports facilities of the universities and perceived male dominance over the girls in virtually all sports determine female undergraduates participation in university sports and their education generally. To guide this study 3 research questions were formulated, with 3 corresponding hypotheses that were tested at 0.05 level of significance. The descriptive survey research design was considered appropriate, while the instrument for data collection was a self structured questionnaire designed after the Likert type by the researcher. Total of 380 female undergraduates of three universities in Anambra State of Nigeria. Nnamdi Azikiwe University, Awka, Odumegwu Ojukwu University Uli, and Madonna University Elele Port Harcourt (Federal, State and Privately owned universities) constituted the population of the study, out of which a total of 263 respondents were sampled. The descriptive statistics of mean, frequency counts and standard deviation (SD) were used to describe the data, while inferential statistics of Chi-square (X²) was used to test the 3 null hypotheses at 0.05 level of significance. Based on the data collected and analyzed, revealed that reproductive health problems (X² = 84.18, df =3, P>0.05), poor funding/maintenance of sports for faculties (X²= 75.412, df = 3, P>0.05) male undergraduates dominance in all sports (X² = 128.68 df. 3, P>0.05) were seen to be determinants of female undergraduates participation and education generally in universities. It was therefore recommended that stiffer measures must be taken and applied to preserve the few sports facilities built around the female hostels, to be strictly used by the female undergraduates, at their convenience. Universities need to further improve on their reproductive health service delivery, to adequately cater for the needs of the female undergraduates who presently seem to be on their own, in terms of solutions to their numerous reproductive health problems that tend to interfere with their sports participation and academic pursuits in the university. Highly qualified Nurses should be employed to serve as Matrons attached to all female hostels in the universities to assist the female undergraduates cope with their reproductive health problems at beck and call.

Nutrition and Exercise as a Tool in Controlling Cardiovascular Diseases among the Elderly in Anambra State: New Perspective

Alagbu Chukwubuikem Eugene — 2020-06-06

The research investigated the perception of nutrition and exercise as a tool in controlling Cardiovascular Diseases (CVDs) among elderly civil servants in Anambra State of Nigeria. A total of respondents comprising 150 elderly academic staff of Nnamdi Azikiwe University Awka and 100 senior civil servants in the Anambra state civil service, all in Awka, who willingly, volunteered to participate in the study. Their ages ranged between 55 – 65 years and were purposively selected. The instrument for data collection was a self structured questionnaire with a reliability value of 0.73 using the test retest method. All data collected were subjected to descriptive statistics of frequency, percentages and chi square inferential statistics tested at 0.05 level of significance. Findings from the study showed that nutrition (diet) and exercise having significant effect in the prevention/control of (CVDs) among the elderly and equally reduce the chances of its on-set among young adults too. It is therefore recommended that at the civil service secretariats, universities and other establishments and parastatals should establish high standard eateries (restaurant) where well qualified caterers would regularly provide quality nutritious diet, at highly subsidized rate for workers in this category. In order to enable these class of workers have at least one good meal per day, in addition to a mandatory one work-free (2.00p – 4.00) afternoon for routine/regular physical exercises.

Statistical Measures Performance for Pre-processing and Locate ROI Using Segmentation in Mammograms

Neha N. Ganvir — 2020-06-06

Breast cancer is a cancer that develops from breast tissue and it is considered one of the deadly diseases for women. X-ray mammography is the most successful method for the early phase detection of breast diseases. Micro-calcifications in mammogram have been targeted as earliest symptom of breast cancer and their detection is very important to improve its prediction. For micro calcifications, the interpretation of their presence is very tricky because they are very small, typically in the range of 0.1 mm- 1.0 mm and average is about 0.3 mm. Micro-calcification is a tiny bit, which may not be clearly visible because of low contrast in the mammogram image. To and locate the region of interest using segmentation technique. This paper presents statistical measures of different preprocessing to lighten the low contrast images and selecting filter for accurate detection of microcalicifications with proper segmentation technique.

How to Reduce Cardiovascular Mortality and Morbidity in Population

Štefan Farský — 2020-06-06

Ischaemic heart disease and stroke are the world’s biggest killers. The good news is that 80% of cardiovascular diseases can be prevented with healthy lifestyle habits. The most effective approach to improve this situation is the reduction of risk factors levels. Small positive shifts of risk factors, across a whole population consistently leads to greater reductions in disease burden than the huge investment to the new drugs and devices including invasive procedures. Motivation is a key element of cardiovascular prevention. It means in practice non-smoking, support for nutrition changes, regular and effective physical activities and obesity management mainly.

As for nutrition how much people with high risk profile for Ischaemic heart disease and stroke know the role of saturated fatty acids and their recommended maximal daily intake (cca 30 g) ? How much from them monitor their content on food labels? But the decrease of their intake about to 10% of daily energetic intake leads to decline cardiovascular risk about 20-30%!. How much people know that adding 30 g unsalted nuts daily decreases cardiovascular risk about 30%?. The same accounts for increasing the fiber content. We present some concrete examples of daily menu and adequate proposals how to change to reach recommended values.

Regular and effective physical activities mean 150 to 300 min. of moderate-intensity exercise or 75 to 150 minutes of vigorous-intensity exercise each week for health benefits. This translates into an energy expenditure of 7.5 to 15 MET hours per week. That leads to a 31% reduction in all-cause mortality. The benefit concerns not cardiovascular diseases only but the metabolic and oncological protection too. Clinical evaluation, including exercise testing, should be considered for sedentary people with risk factors who intend to engage in vigorous physical activity. Specialized prevention programmes such as complex cardiovascular rehabilitation (including cardiotraining, education and cognitive-behavioural methods), home-based cardiac rehabilitation and yoga are very effective.

The nutrition and physical activity changes are two milestones of obesity management. The increase of BMI about 5kg/m2 leads to increase of mortality risk about 30% and about 40% risk of ischemic heart disease, stroke and other vascular diseases. Weight decrease in obese patients leads not only to reduction of these parameters, but moreover, to reduction of drug intake, hospitalisations and diagnostic and therapeutic procedures rate. It means significant economical benefit.

Real Data on the Hypertension Treatment in Patients with Metabolic Syndrome and/or Type 2 Diabetes Mellitus: Analysis of the Therapy Effectivity and the Therapeutic Inertia in Outpatient Study

Štefan Farský — 2020-06-06

We have analysed the database of 1,595 consecutive patients visiting our department of cardiology and internal medicine clinic in 2005-2014. The analysis included 13,990 visit records and the average number of visits per patient was 8.5 ± 7.0. Our goals were to evaluate the effectivity of hypertension treatment as for drug choice, decrease of sBP and dBP associated with certain drug, drug combination and therapeutic inertia in patients with metabolic syndrome and/or diabetes mellitus. The final number of patients for analysis who fulfilled the inclusion criteria for interpenetration of both diagnostic circles was 570.

Results: 15% of patients were treated using hypertension monotherapy, 70% of patients were treated using 2- to 4-drug combination therapy, and 15% of patients were treated using 5- to 6-drug combination. The drugs usedmost frequently were perindopril (perin), nitrendipine (nitre), amlodipine (amlo), telmisartan (telmi), hydrochlorothiazide (hydro), rilmenidine and nebivolol (used >100 patients). The most significant decrease of sBP was associated with treatment by nitre, hydro, telmi and urapidil (>19 mmHg).The most significant decrease of dBP was associated with treatment by nitre, hydro, telmi and verapamil (>10 mmHg). The most significant decrease of both sBP and dBP was associated with treatment using 3-drug combination of telmi+hydro+spironolactone (41 and 16mmHg, respectively), telmi+hydro+nitre (34 and 15 mmHg, respectively) and telmi+hydro+urapidil (34 and15 mmHg, respectively). At the last visit, 281 out of 413 patients at the first visit had sBP >140 mmHg (68%) i.e. sBP control was 32%. At the last visit 76 patients out of 217 at the first visit had dBP >90 mmHg (35%) i.e. dBP control was 65%.

Therapeutic inertia was calculated by evaluating the proportion of visits at which sBP was above the target for eligible visits minus the proportion of visits where the change was made in antihypertensive treatment (AHT), either medication type or dose, over the number of eligible visits, with the resultant value multiplied by the mean of difference between actual sBP and target value at clinic visits:

TIQ= ((%>TARGET - %Δ AHT/visits)/visits)* mean sBP- target sBP.

TIQ was counted at first 200 consecutive patients and the average value was 57.30 ± 147.20.

Conclusion: The study presents the real-life data concerning the difficulties in hypertension treatment in patients with concomitant metabolic syndrome and/or 2 type diabetes mellitus. SBP was controlled at 32% patients only. The study results allow evaluating effectivity of hypertension treatment as for drug choice, decrease of sBP and dBP associated with a certain drug, a drug combination, and therapeutic inertia in patients with metabolic syndrome and/or diabetes mellitus. The score of therapeutic inertia evaluation should contribute to the improvement of hypertension control and should be a part of the quality assessment in hypertension management.

Detailed Research on Disseminated Tumor Cells in Bone Marrow of Gastric Cancer Patients: Correlation with Tumor Hypoxia and Clinical Relevance

Larissa Bubnovskaya — 2020-06-06

Aim: The evaluation of the clinical relevance of disseminated tumor cells (DTCs) in bone marrow (BM) of patients with gastric cancer (GC) and their association with primary tumor hypoxia.

Methods: It was used immunocytochemistry (detection of DTCs, VEGFR-1 expression in BM); immunohistochemistry (CD68, CD34, VEGF, and VEGFR-1 (Flt-1) expression); NMR spectroscopy (level of tumor hypoxia), zymography (MMP-2 and MMP-9 activity, both in tumor and BM).

Results: DTCs were detected in 51.4% of GC patients with M₀. There was significant correlation between frequency of DTCs in BM and level of tumor hypoxia (P<0.024). DTCs presence was accompanied with Flt-1 positivity of BM. The correlation between DTCs and tumor VEGF expression in patients with M₀ was shown (P<0.0248). Activity of MMP-2 and MMP-9 in BM was linked with DTCs in BM in patients with M₀ (P<0.05). Overall survival (OS) of patients with category M₀ and DTCs in BM was shorter than that of patients without DTCs (P=0.0497). OS of patients with DTCs and Flt-1-positive BM was shorter than that of patients without DTCs but with Flt-1-positive BM (P=0.0437). Conclusion: Appearance of DTCs in BM correlates with hypoxia level in primary tumors. Detection of DTCs in GC patients may be relevant indicator for adjuvant chemotherapy using.

Critical Study on Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature

Saptarshi Biswas — 2020-06-06

Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula.

Blood Flow and Arterial Infusion by Implanted Port in In-111 Octreotide Therapy: Critical Overview

Maria Lyra Georgosopoulou — 2020-06-06

In-111-Octreotide infusion, via intrahepatic catheterization is well established technique in our Institution in hepatocellular carcinoma and neuroendocrine tumors treatment. In order to facilitate repetitive infusions of our patients, a method of implanted ports use, gave a simpler therapeutic way but also improved therapy results. Our aim is to show that radiopharmaceutical fluid flow through implanted port is rich; the absorbed dose in the tumor increased for best therapy results.

Surgically implanted ports have been used in repetitive intra-arterial In-111 radiolabeled Octreotide infusions for 22 patients with hepatocellular carcinoma and similarly 18 patients with neuroendocrine tumors in a continuous base. A percutaneous implantation procedure facilitates safe and less invasive radiopharmaceutical infusions for the treatment. We have focused on the interventional techniques for percutaneous implantation of a vascular access device, consisting of an implantable port, to perform In-111 Octreotide infusions. Hepatic arterial infusion radiotherapy employs a hepatic artery catheter as a conduit to achieve a high concentration of radiolabeled agent to liver tumors. It is performed using less-invasive percutaneous image guided procedures. Various techniques were used to ensure high concentration of radiopharmaceutical in liver tumors, as there are many anatomical hepatic arterial variations and complicated blood flow patterns. These techniques are composed of arterial redistribution by embolization, percutaneous catheter placement, evaluation and management of flow patterns that reflect In-111 Octreotide distribution.

Using fluid flow theory, we describe blood flow alterations that could be performed to obtain selective radiopharmaceutical distribution to the target area and avoid side effects caused by the accumulation of the radiolabeled agent into non tumor areas. By steady, laminar and disturbed flow equations, the rich distribution of our agent in the scintigraphy imaging of the tumor, by the implanted ports technique, can be explained.

The factors affecting hepatic arterial flow in tumor feeding artery were analyzed. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed port method than those undergo fully interventional catheterization. A ratio of 5: 1 to 3: 1 flow increase was calculated through poiseuille flow and Reynolds number for circular pipe.

We consider that in continuous therapy, it is important to use the simplest fixed port method for percutaneous catheter placement instead of interventional catheterization, in order to increase absorbed dose into tumor for best response of radionuclide therapy.

Analysis of Different Filtering Methods for Pre-processing and GLCM Feature Extraction Using Wavelet in Mammogram Images

Neha N. Ganvir — 2020-06-06

Breast cancer is a stand-out surrounded by the most widely perceived diseases and has a high rate of mortality around the world, significantly risking the health of the females. Among existing all modalities of medical scans, mammography is the most preferred modality for preliminary examination of breast cancer. To assist radiologists, a computer-aided diagnosis (CAD) is enhancing and important medical systems for mammographic lesion analysis. In mammogram images, micro-calcifications are one of the imperative signs for breast cancer detection. Mammographic medical scan may present unwanted noise and CAD systems are very sensitive to noise. Early stage detection for any medical image analysis application like brain tumor detection, breast cancer detection is considered as an important step. Micro calcification is small calcium deposits in the breast region and mammogram images are of low contrast. Thus, in this work, different types of filtering techniques used for noise reduction and image enhancement for medical image processing are analyzed on mini-MIAS mammogram image databases. Anisotropic diffusion with wavelet filtering method shows best results for enhancement and noise removal of the image. This filtered image is segmented; region of interest (ROI) is extracted through global Thresholding technique with discrete wavelet transform (DWT). Gray level co-occurrence matrix is used to extract the important features. Here, seven features are extracted for different categories of micro calcified images like normal, benign, malignant. Results show that from extracted features the values of malignant and micro calcified images are same whereas normal and benign are same. This proposed methodology can help to categorize different classes of images.

Research on Disseminated Tumor Cells in Bone Marrow in Gastric Cancer Patients with Obesity

Larissa Bubnovskaya — 2020-06-06

Background: Obesity is a risk factor for cancer development and is associated with poor prognosis in multiple tumor types. There is emerging evidence of a strong association between obesity and gastrointestinal cancer. The molecular mechanism underlying gastric cancer invasion and metastasis is still poorly understood. Problem of disseminated tumor cells (DTCs) in gastric cancer remains to be relevant for clinics and less is known concerning this problem for patients with obesity.

Aim: This study was aimed to evaluate how incidence of DTCs in bone marrow is conditioned by excess of adipocites in tumor microenvironment of patients with gastric cancer and obesity.

Results: There was not found the associations between availability of DTCs in BM as well CXCR4-positive cells in tumor and body mass index (BMI) but incidence of DTC in BM was associated with high density of cancer-associated adipocytes (CAAs) as well with high number of CXCR4-positive cells in tumor of patients with BMI<25 and BMI>25<30 but it was not true for patients with BMI>30 where frequency of DTCs finding in BM was significantly decreased and that was statistically significant. Overall survival of patients with obesity was significantly longer (P=0.0270) than that of the patients with BMI<30.

Conclusion: In patients with BMI>30 high density of CAAs and high number of CXCR4-positive cells in tumor may create specific tumor microenvironment that prevent tumor cells to leave primary lesion. OS of patients with gastric cancer is mainly influenced by CAAs density in tumors and such influence depends essentially on the BMI.