Research Trends and Challenges in Medical Science Vol. 2

An Overview on Pathogenesis of Cancer: Cancer Reparative Trap

Oleg V. Bukhtoyarov, Denis M. Samarin — Wed, 24 Jun 2020 00:00:00 +0000

Cancer is one of the leading causes of death in the world, and the long-term prognosis is still unfavorable, despite the enormous efforts in the search for effective anti-cancer drugs. We think that the obstacle to creating the effective anti-cancer drugs is the existing idea that the basis of cancer is the damage of the genetic apparatus of the cell. In this paper we present the pathogenesis of cancer which is based on the formation of the special sustainable pathophysiological state of the organism – the state of "cancer reparative trap". The essence of this pathophysiological state of the organism is in the reparative orientation of the immune system of cancer patients, when constant tissue repair is accompanied by systemic suppression of the anti-tumor immunity. Specifically, during the long-term exposure to carcinogens (exogenous and/or endogenous) the continuous tissue damage occurs which induces permanent stimulation of cell proliferation (imbalanced Th1<Th2 lymphocytes, M1<M2 macrophages, inflammation, angiogenesis, etc.) in order to repair the tissues damaged. At the same time, tissue repair is necessarily accompanied by the suppression of anti-tumor immunity (increase in T regulatory cell (Treg), imbalanced Th1<Th2 lymphocytes, M1<M2 macrophages et al.), which creates the necessary conditions for the survival of the malignantly transformed cells, formed by the action of carcinogens. The determining role of the imbalance in the autonomous nervous system (simpathetic/hypersympathetic dominance) in the development, maintenance and generalization of the cancer process has been shown. The explanation of a number of phenomena has been presented: the cell resistance to chemotherapy and the phenomenon of cancer cell dormancy. The promising approaches for the cancer management in clinical practice has been proposed.

The Epidemiology of Human Cysticercosis and Diagnostic Challenges in Sub-Saharan Africa

Beda J. Mwang’onde — Wed, 24 Jun 2020 00:00:00 +0000

The prevalence of human cysticercosis (HCC) in sub-Saharan Africa ranges from 0.3% to 72%. These prevalence estimates are highly dependent on the community and population involved in the study and the diagnostic test used. The disease is an important cause of acquired epilepsy that it contributes to about 29% of all epileptic cases worldwide. It is therefore imperative that the status and epidemiology of HCC is monitored. However, HCC is a neglected disease that it has acquired little attention worldwide. There is no single ideal system in place for diagnosis and hence, the surveillance of the disease in both developed and developing countries. This chapter reports the epidemiological status and the diagnostic challenges of the disease in the sub-Saharan Africa region. The chapter further proposes how surveillance of the disease can be carried out.

Hepatitis C Virus in HIV Co-morbid Pregnancies in Jos, Nigeria: Critical Overview

Bernard Terkimbi Utoo, Musa Jonah, Solomon Atiene Sagay — Wed, 24 Jun 2020 00:00:00 +0000

Background: Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) infections are of medical significance.

Objective: The study was designed to determine the rates and risk factors for HCV infection among HIV positive pregnant women compared with HIV negative controls.

Methods: It was a cross-sectional comparative study at the Department of Obstetrics and Gynecology of the Jos University Teaching Hospital (JUTH), Jos and the Aids Preventive Initiative in Nigeria (APIN) laboratory, Jos. Blood samples of both HIV negative antenatal attendees and HIV positive pregnant women attending Prevention of Mother to Child Transmission (PMTCT) clinic was taken in an EDTA anti-coagulant containing specimen bottle for serological test with second generation ELISA. Specimen containers were coded to ensure confidentiality. Plasma samples were obtained after centrifugation of the whole blood. The sample was stored at -20°C until the time for analysis.

Results: A total of 326 subjects were studied .The mean (SD) for age, parity and gestational age of subjects were 30.1±4.9 years, 1.4±1.3 and 21.9±8.4 weeks respectively. Twelve (7.4%) and 4(2.5%) tested positive for anti-HCV antibodies in the HIV positive group and HIV negative group respectively. There was a statistically significant odd of having HCV among women with HIV compared to HIV negative controls (fishers exact =0.03, p<0.05) {or 0.32 (0.10-1.00) 95% ci}.More proportion of the study participants with co-infections have multiple sexual partners, sexually transmitted diseases, low education, higher parity and advanced age than the comparative group.

Conclusion: Education, public health enlightenment and modification of social lifestyle will halt or reduce this trend in sub-Saharan Africa.

Effect of Inhaled Tiotropium as the Perioperative Management of Patients Undergoing Pulmonary Resection for Primary Lung Cancer: Critical Study

Takanori Ayabe, Masaki Tomita, Eiichi Chosa, Katsuya Kawagoe, Kunihide Nakamura — Wed, 24 Jun 2020 00:00:00 +0000

Background: The purpose of this study was to evaluate the effectiveness of perioperative tiotropium therapy for patients undergoing pulmonary resection for primary lung cancer. The short-term tiotropium effect was investigated by perioperative pulmonary function and “lung age”.

Methods: The fifty-five patients who underwent a lobectomy and had tiotropium treatment available from October 2007 through May 2009 were the subjects. The patients were divided into 3 groups according to their airway limitation such as Chronic Obstructive Pulmonary Disease (COPD) or a history of smoking; those with COPD (%FEV₁ ≤ 70%, C-group, n = 22), smokers (%FEV₁ > 70%, S-group, n = 10) and non-smokers (%FEV₁ > 70%, N-group, n = 23). As the bronchodilator groups, the C- and S-groups received inhaled tiotropium bromide (18 μg once daily) for 1 week before surgery until at least 3 weeks after surgery without interruption, and as a control, the N-group had no treatment. The preoperative baselines, the predicted postoperative values, and the actual postoperative ones were measured by the pulmonary function test. The changed rates were calculated and denoted as ΔVC, ΔFEV₁, ΔVC% and ΔFEV₁/FVC, from the baseline of the predicted postoperative values. The mean “real age” and “lung age” were calculated.

Results: In the S-group, the parameters of ΔVC, ΔFEV₁, ΔVC% and ΔFEV₁/FVC significantly increased compared to those of the N-group. In the C-group, the increased extents of ΔFEV₁ and FEV₁/FVC were lower compared to those in the S-group (not significant). In the N-group, the parameters of ΔVC, ΔFEV₁, and ΔVC% decreased. The postoperative “lung age” and “real age” were increased to 29.5 ± 18.0 year-old in the C-group, 25.8 ± 18.0 in the S -group, and 24.7 ± 17.0 in the N-group. Lung resection affected the “lung age”; the aging was a 28.9 ± 12.7 year-old increase in the N-group. In the C- and S-group, the “lung age” was a 14-year-old increase. The effect of tiotropium treatment affected the “lung age” as a 15-year-old increase.

Conclusion: Perioperative interventional tiotropium contributed to the lobectomy patients with COPD and for smokers with a non-obstructive airway and played a role of preserving the postoperative lung function.

Clinical Features of Rhinosporidiosis in the Endemic Areas of Brazil

Wed, 24 Jun 2020 00:00:00 +0000

Background: Rhinosporidiosis is a rare chronic disease caused by Rhinosporidium seeberi, mainly affecting the nasal and conjunctival mucosa. The diagnosis is made through histopathological examination. The disease is endemic to the Indian subcontinent, with few cases described in Brazil. Thus, this study aimed to describe clinical and histopathological aspects of rhinosporidiosis in an area of northeastern, Brazil.

Methods: To identify the clinical and histopathological characteristics, a retrospective study was carried out on 21 patients diagnosed with rhinosporidiosis at the Presidente Dutra University Hospital during 10 years. The data are obtained from medical records and review of histological slides of each case.

Results: In this study, most of the patients were men (80.00%), aging between the first and second decade of life, and with an infection in the nasal cavity (85.71%). Their main complaints were nonspecific, such as foreign body sensation, nasal obstruction and epistaxis, which decreased clinical suspicion (14.28%). Hemograms showed a high eosinophil count (14.01%, ±13.73). The main morphological alterations found in histopathological analysis were squamous metaplasia, mucosal hyperplasia, vascular ectasia, and inflammatory infiltration.

Conclusions: In our country, little is known about the pathogenesis of rhinosporidiosis, and it is easily confused with other pathologies. However, our cases have shown a series of morphological alterations that can be helpful to histopathological diagnosis and are poorly described in the literature.

Critical Overview on Missed Clavicular Fracture in an Adult without Head Injury or Polytrauma Review of Literature and a Rare Case

A. Raviraj, Ashish Anand — Wed, 24 Jun 2020 00:00:00 +0000

We present a case of missed clavicular fracture in a patient with an associated wrist fracture but without head injury. This is the first case of missed clavicular fracture in an adult, despite adequate imaging, and without head injury presenting two days after the patient was discharged after fixation of the distal radius fracture.

Overview on Osteoid Osteoma of the Sacrum - Case Report and Review of Literature

Vidyasagar Maalepati, A. Raviraj, Ashish Anand — Wed, 24 Jun 2020 00:00:00 +0000

Sacrum is an extremely rare site for osteoid osteoma. We present a 25 year-old male, a computer operator who presented with chronic back pain of 4 years duration. He was initially investigated with routine x-rays and lab investigations and was treated for chronic back pain at another facility. Extensive work up at our clinic revealed a diagnosis of Osteoid Osteoma of Right 2^nd Sacral vertebral arch Interlesional resection of the tumor was done and this was verified on histopathology. The patient had complete relief of pain following surgery. Repeat CT scan done at one year follow up. It showed complete removal of the Nidus. To the best of our knowledge there have not been many case reports in English Literature from the Indian subcontinent. There are many studies in which tumor of lumbar region is one of the causes of radiating pain in lower extremities but to the best of our knowledge this finding is unique and can also be an important cause of radicular pain.

The Details of Os Acromiale-unusual Manifestation as Superior Spur and Bursitis-A Case Report

Wed, 24 Jun 2020 00:00:00 +0000

An Os acromiale is a condition that results from the failure of fusion of the anterior acromial apophysis. It can be asymptomatic. It can also result in subacromial impingement and rotator cuff tear. In this case report of a 39 year-old lady we would like to present the management of the painful bursitis and spur formation on the superior surface of a meso-type of os acromiale. Conservative management in the form of rest, anti-inflammatory drugs and physiotherapy did not provide symptomatic relief. Patient then underwent surgical excision of the superior spur. Open reduction and internal fixation was not carried out. Patient had resolution of pain and no recurrence of symptoms or features of impingement at 6 months follow up. To the best of our knowledge there are limited reports in English literature about this rare subset of patients with symptomatic os acromiale with superior spur formation and with no features of impingement or cuff pathology.

Critical Overview on Early Infection of Bilateral Total Knee Arthroplasty with Salmonella typhi: Case Report and Review of Literature

Wed, 24 Jun 2020 00:00:00 +0000

Acute Salmonella typhi prosthetic joint infection (PJI) is a rare event. In Endemic areas one needs to be cautious if the patient is immunocompromised. We report a case of bilateral simultaneous PJI of the knee in a 60-year-old lady who was not immunocompromised. The patient presented on Post op Day 5 with Fever and local signs suggestive of infection. As this was an Early PJI she was successfully treated with Debridement, Poly exchange and Intravenous and oral antibiotics for 6 weeks. This case highlights the fact that in patients living in these areas and in seasons where incidence of enteric fever is high, patients should be screened preoperatively for Salmonella infection by history and stool cultures. To our knowledge this is the first case report of Early Bilateral Simultaneous infection with Salmonella typhi.

Brief Overview of a Modified Technique for Repair of Triceps Avulsion Using Suture Anchors-A Case Report

A. Raviraj, Vidyasagar Maalepati, Ashish Anand — Wed, 24 Jun 2020 00:00:00 +0000

The bony avulsion of the Triceps is a rare injury. The Triceps tendon injury accounts for <1% of all tendon injuries. Various surgical techniques have been described for the repair. We describe our variation of suture anchor technique for bony avulsion of Triceps injury and report its advantages.

Recent Study on Immunosuppressive Treatment for Lupus Nephritis: Long-term Results in 178 Patients

Wed, 24 Jun 2020 00:00:00 +0000

Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival significantly differ for subgroups that achieved complete or partial renal response and nonresponders: patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58% versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period sustained complete renal response; however, only 9 of them had 0 disease activity according to SELENA SLEDAI scale, while 13 patients had scores 2–4 due to the serological abnormalities only. We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and can be used in agreement with International Guidelines until the evidence for biological treatments benefits becomes available; (2) complete and even partial renal response have positive prognostic value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the validity of complete renal response in SLE is questioned by the absence of conventional definition of SLE remission.

Experience with Oral Contraceptive Pills at the Rivers State University Teaching Hospital, Southern Nigeria

E. I. Nonye-Enyidah, F. C. C. Wekere, R. Donubari — Wed, 24 Jun 2020 00:00:00 +0000

Background: Oral contraceptive pills (OCPs) are one of the most widely prescribed forms of hormonal contraception. They are most popular non-surgical effective method of contraception.

Objective: This study is aimed at reviewing the prevalence rate, the yearly trend of OCP use and socio-demographic features of the acceptors of oral pills at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Rivers State, Nigeria.

Methods: This was a retrospective study in which records of acceptors of oral contraceptive pills in the family planning unit of RSUTH from 1^st January, 2008 to 31^st December, 2017 were reviewed. Data collated were analysed using Statistical Package for Social Sciences (SPSS) IBM version 25.0 (Armonk, NY).

Results: There were 1893 contraceptive acceptors during the study period. Out of which 86 (4.5%) accepted the oral pills. The mean age of the clients was 30.4 SD 6.92. Majority of the clients 66 (76.8%) were between the age range of 20 to 34 years. Over half 48 (55.8%) of the acceptors were multiparous women. Majority of the acceptors of oral pills 82 (95.3%) were Christians and had formal education respectively. The commonest source of information on the use of oral contraceptive pills was from clinical personnel, accounting for 36 (41.8%). There was a downward trend in the use of OCP during the study period.

Conclusion: Oral contraceptive method was mostly used by young, multiparous and educated women. The rate of acceptance of oral contraceptive pills in our centre was 4.5%. As such, concerted efforts should be made to increase the uptake of oral pills in the family planning unit of the hospital.

Effects of Diets Containing Unripe Plantain Diet on Brain Serotonin in Mice: New Perspective

P. Erigbali, K. Kiridi, I. Ogregade — Wed, 24 Jun 2020 00:00:00 +0000

Musa paradisiaca (Plantain) fruit has been shown to be useful for nutritional, medicinal and industrial purposes. It contains serotonin (5-HT) and its immediate precursor, 5-Hydroxytryptophan (5-HTP). Serotonin plays a fundamental role in integration of behaviour and many physiological functions including regulation of mood, anxiety, arousal, aggression, impulse control, and thinking abilities. In this study, the effect of plantain-containing mouse diet on brain serotonin mice was investigated in mice. Thirty adult Swiss mice were divided into three groups of ten each and fed normal rodent chow containing 0%, 50% and 100% unripe plantain. After thirty days, the brain levels of 5-HT and 5-HTP were measured using High Performance Liquid Chromatography (HPLC) technique. Results show that 5-HT level was significantly increased in the plantain-diet fed mice. Conversely, 5-HTP level was reduced in the 100% plantain fed mice when compared with the control.

An Overview of Early Response to Dexamethasone as Prognostic Factor: Result from Indonesian Childhood WK-ALL Protocol in Yogyakarta

Wed, 24 Jun 2020 00:00:00 +0000

Early response to treatment has been shown to be an important prognostic factor of childhood acute lymphoblastic leukemia (ALL) patients in Western studies. We studied this factor in the setting of a low-income province in 165 patients treated on Indonesian WK-ALL-2000 protocol between 1999 and 2006. Poor early response, defined as a peripheral lymphoblasts count of ≥1000/µL after 7 days of oral dexamethasone plus one intrathecal methotrexate (MTX), occurred in 19.4% of the patients. Poor responders showed a higher probability of induction failures compared to good responders (53.1% versus 23.3%, P < 0.01), higher probability of resistant disease (15.6% versus 4.5%, P = 0.02), shorter disease-free survival (P = 0.034; 5-year DFS: 24.9% ± 12.1% versus 48.6% ± 5.7%), and shorter event-free survival (P = 0.002; 5-year EFS: 9.7% ± 5.3% versus 26.3% ± 3.8%). We observed that the percentage of poor responders in our setting was higher than reported for Western countries with prednisone or prednisolone as the steroids. The study did not demonstrate a significant additive prognostic value of early response over other known risk factors (age and white blood cell count) for DFS and only a moderately added value for EFS.

Preformulation Studies for Generic Omeprazole Magnesium Enteric Coated Tablets: Recent Study

C. O. Migoha, M. Ratansi, E. Kaale, G. Kagashe — Wed, 24 Jun 2020 00:00:00 +0000

Preformulation is an important step in the rational formulation of an active pharmaceutical ingredient (API). Micromeritics properties: bulk density (BD) and tapped density (TD), compressibility index (Carr’s index), Hauser’s ratio (H), and sieve analysis were performed in order to determine the best excipients to be used in the formulation development of omeprazole magnesium enteric coated tablets. Results show that omeprazole magnesium has fair flow and compressibility properties (BD 0.4 g/mL, TD 0.485 g/mL, Carr’s index 17.5%, Hauser’s ratio 1.2 and sieve analysis time 5 minutes). There were no significant drug excipient interactions except change in colour in all three conditions in the mixture of omeprazole and aerosil 200. Moisture content loss on drying in all three conditions was not constant and the changes were attributed to surrounding environment during the test time. Changes in the absorption spectra were noted in the mixture of omeprazole and water aerosil only in the visible region of 350–2500 nm. Omeprazole magnesium alone and with all excipients showed no significant changes in omeprazole concentration for a 30-day period. Omeprazole magnesium formulation complies with USP standards with regards to the fineness, flowability, and compressibility of which other excipients can be used in the formulation.

Immuno-inflammatory Aspects of Interleukin-21 in Periodontal Sequelae: Current Development

Archana Mootha, Sankari Malaiappan, Gurumoorthy Karthikeyan — Wed, 24 Jun 2020 00:00:00 +0000

Interleukin-21 (IL-21) has a dual anti-inflammatory and pro-inflammatory role in chronic inflammation. It causes breakdown of other surrounding hard and soft tissues by coupling with other destructive mediators, along with increasing several other proinflammatory cytokines. This chapter describes concepts in relation to effects of IL-21 on critical immune cells of both innate and adaptive immune systems, and how the cytokine evades its deactivation through a positive feedback loop. The chapter also reports results of an original study regarding quantification of IL-21 among types of periodontitis and comparing its levels to healthy subjects. Previous literature and our current study results suggest that IL-21 has a definite role in chronic and acute kind of inflammatory progression. Although, further longitudinal studies will strengthen its evidence to be characterized as a true diagnostic periodontal marker.