Research Trends and Challenges in Medical Science Vol. 4

Hepatitis B Positivity can Impair Some Haematological Parameters

2021-08-28T10:11:14+00:00

Hepatitis B virus is a deadly viral infection that kills slowly if not treated and could be the underlying cause of liver cirrhosis and liver cancer. Some Hepatitis B positive patients may present with symptoms while some others maybe asymptomatic hence, the need to assess their haematological indices. Twenty-five Hepatitis B positive patients (male and female) attending Madonna University Teaching Hospital (MUTH) Elele Nigeria were used as subjects while another twenty five Hepatitis B negative apparently healthy individuals (males and females) served as controls. The positive patients were further divided into symptomatic and non-symptomatic groups. Verbal consent was obtained prior to sample collection. The samples were analyzed using standard manual methods. The research was approved by Madonna University Ethical Committee (MUEC). There was significant (p<0.05) decrease in PCV and Hb and while ESR had significant increase. Most of the Hepatitis B positive patients (17) were asymptomatic while others (8) showed symptoms. When the asymptomatic and symptomatic groups were compared, there was no significant (p>0.05) difference in all the parameters. Hepatitis B positive patients could be at risk of developing anaemia. Management and treatment could be better handled before the onset of symptoms associated with Hepatitis B infection. Early diagnosis and inclusion of Hepatitis B screening in routine test is recommended.

Critical Observation on Pancreatic Lymphoepithelial Cyst: An Atypical Benign Pancreatic Tumour

2021-08-28T10:15:19+00:00

Introduction: Pancreatic lymphoepithelial cyst is a rare benign lesion that usually presents itself as an incidental radiological finding. Symptoms mayinclude abdominal pain, weight loss, nausea or compression of adjacent structures. The differential diagnosis includes most of the pancreatic cystic lesions, even benign or malignant tumours. In most cases, for the final diagnosis, fine needle aspiration or surgery can be required.

Case Report: We report a case of a giant pancreatic lymphoepithelial cyst in a 43-year-old man with abdominal pain and weight loss. In this case, radical surgery wasconsidered a too difficult procedure and due to benignity of the tumour, conservative resection was elected.

Conclusion: Surgery can be the final diagnosis test in case of pancreatic lymphoepithelial cyst due to diagnostic uncertainty. Conservative resection can be a good option in case of complex resection, with a low rate of postoperative complications and without risk of tumoural degeneration.

Left Ventricular Outflow Tract Obstruction after Mechanical Mitral Valve Replacement

2021-08-28T10:20:51+00:00

Background: Left ventricular outflow tract (LVOT) obstruction is a serious complication that can occur after various mitral-valves, surgical or percutaneous, interventions.

It was rarely described in mechanical mitral valve replacements.

Aim: To analyze a case of late LVOT obstruction after a mitral valve replacement by a low-profile mechanical prosthesis in the light of a review of the literature.

Case Presentation: A 48-year old woman, with a history of rheumatic mitral valve disease and mechanical mitral replacement by a hemi-disc valve 18 years ago, presented for a recent dyspnea. Echocardiography showed a narrowing of the LVOT, with anterior position of the mitral prosthesis, aorto-mitral annular angulation, septal thickening and remnant native sub-valvular tissue attached to the septum in the LVOT region. This resulted in LVOT obstruction with a peak gradient of 75 mmHg. The heart team opted for a redo surgery, but the surgical decision was refused by the patient.

Discussion: LVOT obstruction after mitral valve replacement was mainly related to preserved native mitral valve tissue, but we highlighted that other causes can contribute to it like septal thickening and anterior prosthetic position. Aorto-mitral annular angulation that was identified as a risk factor of LVOT obstruction after trans-catheter mitral valve replacements, should be, probably, also took into account and assessed pre-operatively in patients undergoing surgical mitral replacements.

Conclusion: LVOT obstruction can occur after mechanical mitral replacements event with low profile prosthesis. In patients with identified risk factors preservation mitral anterior leaflet should be avoided, and preservation of other native mitral tissue should be discussed.

The Relationship between Urinary Tract Infection and Vesicourethral Reflux in Children

2021-08-28T10:23:20+00:00

Background: The incidence of vesicoureteral (VUR) in the general population is less than 1%. Reflux carries an increased risk of pyelonephritis and renal failure. The purpose of the current study was to check whether the voiding cystourethrography (VCUG) test is necessary in most cases of upper urinary tract infection (UTI) in children, and to investigate if there is a correlation between the presence of VUR and urinary tract infection, or the reflux is a random finding that does not require monitoring. In the same time we studied the correlation with various markers of inflammation, renal ultrasound findings (US), 99m technetium (Tc)-dimercapto-succinic acid (DMSA) nuclear renal scans findings, and the clinical presentation.

Methods: The current study is retrospective, based on tests taken at the Poriya medical center in Tiberius (Eastern Galilee population), between 2009-2013. The study includes 88 children up to 2 years that were asked for VCUG. All the children had symptoms of UTI. Prior to performing the imaging tests, the children had laboratory tests (blood, urine, culture), then renal US. VCU was performed within two weeks to one month from the beginning of the complaints, for children up to six-month-old. Older children did the voiding test after doing DMSA. DMSA was done 3-5 months after the acute UTI.

Results: Approximately 40% (37.5%) of patients suffered from reflux: 66.7% with incorrect DMSA (filling defect / scar) had reflux. Only 18.2% of children with normal DMSA results had reflux. Renal US test was not correlated with VCU results. High inflammation factors levels (CRP, ESR) were found in all subjects with reflux, and only 52.6% of cases with positive reflux had low lymphocytes levels compared with only 14.3% in patients without reflux.

Conclusions: VCUG is not required in most cases of upper UTI. Suitable replacement test can be done by renal DMSA, which has also an added value of detecting a potential renal damage (scars). High levels of inflammation factors, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) strongly suggest a possible existence of reflux. In contrast, lower levels deny the existence of reflux in children with upper UTI.

A Comparative Study on Oral Busulfan and Cyclophosphamide (BU/CY) versus Cyclophosphamide, Melphalan and Vepsid (Etoposide) (CMV) with Autologous Stem Cell Transplant in Patients with Relapsed Non-Hodgkin Lymphomas (NHL)

2021-08-28T10:28:08+00:00

Background: High dose chemotherapy with autologous stem cell transplantation (ASCT) is the standard of care and commonly used procedure for patients with relapsed non Hodgkin lymphomas (NHL). There is no clear evidence of superior conditioning regimen and studies that comparing different high dose regimens regarding the efficacy and toxicity profiles were little.

Objectives: To compare efficacy and toxicity profiles of BU/CY and CMV conditioning regimens in patients with relapsed NHL scheduled for ASCT.

Patients and Methods: Between June 2013 and January 2017, a total of 50 patients were enrolled in the study, 25 patients received CMV and 25 patients received BU/CY followed by ASCT in Bone Marrow Transplantation Center, Nasser Institute and El Sheikh Zayed Hospitals, Egypt.

Results: The median time for both neutrophil and platelet engraftment showed no significant difference between the two groups (p= .4) and (p=.3) respectively. Transplant related mortality (TRM) was less in CMV arm, but p value didn't reach the statistical difference (p= .1). The 3- year DFS and OS were slightly higher in CMV arm. However, they didn't show any significant statistical difference 72.8% and 66.5%, (p =.81) and (p= .07). The toxicities, Grade III / IV mucositis, nausea/vomiting and diarrhea occurred slightly higher in BU/CY than in the CMV (16%, 24%, 8% vs. 12%, 16%, 4% respectively).Pulmonary toxicity was higher in BU/CY (3 patients (12%) in BU/CY arm and 1 patient (4%) in CMV arm). However, the toxicities didn't reach the statistical difference.

Conclusion: We found that both BU/CY and CMV regimens are not significantly different in terms of efficacy and toxicity. Although, the small number of patients that were enrolled in our study, we recommend further trial with larger number of patients to confirm the results.

Effectiveness of Nano Bio Fusion Gel in Treatment of Periodontal Diseases: A Clinical Study

2021-08-28T10:39:50+00:00

Background: The most common oral diseases - tooth decay (dental caries) and gum disease (periodontal disease) show various clinical symptoms and seriousness among individuals. The oral cavity have moist environment that may reduces its potency and effectiveness and the application of the nano particles in the Nano-Bio Fusion (NBF) gel are found efficient in reducing the problem. The purpose of the study aimed to evaluate clinically the effectiveness of locally delivered NBF technology gel as an adjunctive therapy to scaling and root planning (SRP) in the treatment of periodontal disease.

Materials and Methods: Ten chronic periodontitis patients with 120 sites and probing pocket depth (PD) between 5 and 7 mm were selected in a randomized controlled clinical trial. SRP was performed in both control and test group followed by NBF gel application in 60 sites. The plaque index, gingival index, papillary bleeding index, probing PD, and clinical attachment level (CAL) were recorded at baseline, 6 weeks, and 3 months. Supragingival microbial plaque analysis was done at baseline and 6 weeks interval. The statistical analysis with paired t‑test was used to compare the test and control sites.

Results: From baseline to a period of 3 months, a statistically significant difference was seen between both groups for PD, CAL, P value being PD (P = 0.001) and CAL (P = 0.01) along with the significant reduction of colony forming units of aerobic periodontal pathogens.

Conclusions: Locally delivered NBF gel exhibited a significant improvement compared with SRP alone in periodontal diseases.

Clinical Significance: Nano Bio Fusion gel contains Vitamin C, Vitamin E and Propolis. It has antibacterial, antifungal, antiviral, antioxidant and anti-inflammatory properties. It has natural contains that promotes the healing, reduces the gingival inflammation, reduces the colony forming periodontal pathogens and significant reduces the periodontal pocket.

An Overview on Plasma Cell Leukemia – Behind a Disguise

2021-08-28T10:43:14+00:00

Plasma cell leukemia is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells greater than 2x109/l in the peripheral blood. It is classified as primary if present at diagnosis, or secondary, if evolved from relapsed or refractory multiple myeloma. It has an aggressive clinical course with limited durations of remission and survival.

It may at times, present as a lymphoproliferative disorder, leading to misdiagnosis if proper diagnostic tools are not used. This in turn, will lead to adoption of a completely different line of treatment.

Our patient presented with a disturbed dietary regimen and significant weight loss. He was a known case of hypothyroidism since 2009 for which he was on medications. Before landing at our centre, complete blood counts were done at another centre, which showed bicytopenia with hyperleucocytosis. Bone marrow biopsy made a diagnosis of lymphoproliferative disorder while morphologically a provisional diagnosis of Hairy cell leukemia was made.

At our center, complete blood count was repeated, which again showed similar counts with bicytopenia and leucocytosis, but the morphological examination of his peripheral smear showed the presence of 80% plasma cells. Immunophenotyping showed CD23(+) and CD56(+) while the immunohistochemistry showed CD23(+), CD56(+) and CD138(+). Cytogenetics showed the presence of t(4;14) in 5% of the cells examined. Based on the above mentioned investigations, a diagnosis of Plasma cell leukemia was reached and the patient was placed on a treatment regimen including Lenalidomide, Bortezumib and Dexamethasone. His blood counts reached the normal range within a week of starting the treatment. This regimen was given for a full months and there was an overall better response. His last follow up was a month ago and he is doing well till date.

To conclude, in the wake of constantly advancing diagnostic approaches and availability of more precise investigative tools, one should not hesitate in employing these to reach a more accurate diagnosis as is clinically and economically possible; so that the patient may receive the most appropriate treatment.

Highlights on the Inflammatory Bowel Disease, a Rare or under Diagnosed Disease in Nigeria

2021-08-28T10:46:50+00:00

Six Nigerians, consisting of 5 females and 1 male with confirmed inflammatory bowel disease (IBD) were recruited from a tertiary institution and two private hospitals in Lagos into this study from January 2001 to January 2014. Their ages at the time of first visit ranged from 27 to 65 years. They all had repeated bouts of bloody mucoid stools and abdominal pain plus or minus tenesmus requiring admission and fluid replacement. One of the cases even showed a total reversal of barium enema findings after the follow up treatment of oral sulphasalazine and prednisolone given. The four females and the male have remained relatively symptom free up to the time of their last visit in the follow up clinic, while one of the females was lost to follow up.

This is a prospective case series that highlights the need for a high index of suspicion to make a diagnosis of inflammatory bowel disease in an environment where the reported incidence is low. Its diagnosis requires a team approach between the gastroenterological surgeon, radiologist, gastroenterologist Physician and a sub-specialized pathologist.

Detailed Research on the Functional Outcomes of Primary Partial Arthrodesis with Dorsal Multiple Plating in Tarsometatarsal Fractures-dislocations

2021-08-28T10:52:05+00:00

Lisfranc fractures-dislocations are uncommon injuries while the gold standard of therapy is anatomical reduction and stabilization with a type of implants. The aim of this study is to analyze the outcome of these injuries in long term applying primary partial arthrodesis with dorsal plates.

Materials and Methods: Twenty three patients with an average age of 34 years old (mean range 17-52 yrs old) were treated for tarsometarsal dislocations in our department. The main cause of injuries was a traffic accident. In three cases the injuries were open (2 cases type II and one case type IIIa). Myerson classification system was used to categorize the type of injury. Three cases were type A injuries, eleven cases type B2, five cases C1 and four cases type C2. Under regional anesthesia all patients underwent open reduction and primary partial arthrodesis with dorsal multiple plates (1^stTMT, 2^ndTMT, 3^rdMTM joints) and Kirschner wire for 4^th-5^th metatarsal. Postoperatively, a splint was applied for 3 weeks and a functional knee brace for other 5 weeks until radiographic consolidation.

Results: The median follow-up was 16 months (range from 12-20 months). The results revealed by the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society midfoot score (AOFAS) and satisfaction of the patients at six and 12 months. The majority of patients (83%) returned to previews activities in ratio time of 12 months postoperatively. At one year the final mean VAS Score was 1,15(range 0,9-1,7) and AOFAS 82,7 (range 79-87) while satisfaction level was 78,2% (range 1-6).

Conclusions: Lisfranc fractures-dislocations untreated or improperly treated lead to disorganization of the foot chronic pain and largely disability. Great suspicion of diagnosing these great varieties of lesions should exist in emergency department. The most crucial factor for therapy of these injuries is anatomical reduction regardless the type of implant. Primary partial arthrodesis with dorsal plates offers high patients’ satisfaction rate with less complications and low possibility of re-operation.

Lateral Cephalometric Norms: An Overview

2021-08-28T10:55:42+00:00

Background: Lateral cephalometric is used in diagnosis, treatment planning and stability of orthodontic treatment. This research aimed to search the literature and formulate cephalometric norms for lateral cephalometric measurements of Emirates adults and to study gender differences.

Methods: Lateral cephalometric radiographs of 176 Emirates adults, 91 males and 85 females, were selected according to the following criteria; an age range between 19 to 25 years, esthetically pleasing and harmonious faces with balanced and acceptable profiles and occlusions, normal skeletal and dental relationship, all permanent teeth present and no history of orthodontic treatment or facial trauma. The mean values and standard deviations of 91 angular and 21 linear cephalometric variables were calculated using the Dolphin version 10.5 software package. The resulting norms for Emirates male and female groups were compared using a student t-test.

Results: Several statistically significant gender differences were noticeable. Skeletally, Emirates males showed significantly greater (p < 0.001) total, anterior, and posterior cranial base lengths as well as longer facial heights, greater SGn-FH (°), ANS Xi PM (°), and FH/MP (°) angles than females. In addition, Emirates males had significantly greater (p < 0.001) Co-A (mm), Co-Gn (mm), and significantly greater (p < 0.05) Pog-N vert (mm) than females. Dentally, Emirates males had significantly greater (p < 0.05) UI-SN (°) and U1-NA (°), U1-NA (mm), and L1-NB (mm) (p < 0.001) than females. For soft tissue measurements there were significant gender differences (p < 0.001) for all angular and linear measurements except for lower lip to E-plane and nose prominence measurements which have no significant gender difference. Emirates males revealed greater measurements than females except for soft tissue convexity, Z-angle, and both upper and lower lips protrusion which were significantly greater in Emirates females.

Conclusions: The use of specific ce- phalometric standards for Emirates adults, separate for gender, seems to be justified. It is appropriate to put these cephalometric norms into daily orthodontic practice when Emirates adults are being treated.

Role of Procalcitonin as Diagnostic Marker in Neonatal Sepsis and Its Correlation with Clinical, Biochemical and Haematological Profile: Scientific Study

2021-08-28T10:59:10+00:00

Neonatal sepsis is the most common cause of morbidity and mortality in neonatal period particularly in the developing countries. Early diagnosis and treatment of sepsis is essential since a delay in treatment can lead to neonatal death. Different investigative techniques are assessed for usefulness, either singly or in combination, for the early detection of neonatal sepsis. The results of blood culture may be negative despite presence of bacterial infection. Therefore, early diagnosis is difficult, despite advanced bacteriological techniques. Inflammatory markers can also be used for early diagnosis such as C-reactive protein but it does not reliably differentiate between systemic inflammatory response and sepsis. Therefore, there is a need to identify a biomarker by which an infected neonate can be identified rapidly before the onset of life threatening symptoms and for the promt institution of anti-microbial therapy, which improves outcomes. Assessment of Procalcitonin (PCT) in the serum may help in the rapid and accurate diagnosis of sepsis as it is a reliable and specific biomarker.

A Case Report of Concurrent Occurrence of Both Intracranial and Intramedullary Tuberculomas

2021-08-28T11:00:57+00:00

Tuberculosis involving spinal cord in the form of intramedullary tuberculoma is uncommon, and the concurrent occurrence of cranial and intramedullary tuberculomas is extremely rare. We report a case of disseminated tuberculoma involving brain and spinal cord with miliary tuberculosis in a 32-year-old male presenting with fever, cerebellar signs and motor weakness of both upper and lower extremities. Based on magnetic resonance imaging and polymerase chain reaction, we diagnosed as tuberculoma. He completely recovered with conventional antituberculous treatment and steroids. The follow-up of the patient showed disappearance of signs and symptoms.

Effect on Acid Reflux Symptoms Occurring during Sleep of Oral Adhering Melts Containing Only Food Ingredients and Flavor

2021-08-28T11:07:13+00:00

This chapter describes a study assessing the efficacy of a slowly dissolving adhering oral melt currently in use for reducing dry mouth during the day and the night in the management of gastro-esophageal reflux (GERD) while sleeping. To provide context, it is worthwhile reviewing the historical background that led to the idea that this dry-mouth product, XyliMelts, might alter the symptoms of GERD.

In 2006, Jeff Haley, CEO of OraCoat, Bellevue, Washington, USA, developed a fully dissolving intraoral adhering melt that could be applied beside an oral ulcer to reduce its pain and duration, now marketed as Renewing Melts. Subsequently, another formulation incorporating 550 mg of xylitol, 8.5 mg calcium carbonate to neutralize acidity of the adhesive, and a mild mint flavor was studied to see if it could alter the sensation of dry mouth occurring during sleep; with results indicating that it could improve perceived dry mouth. XyliMelts was then put on the market and feedback from users indicated that when used as directed, there seemed to be a reduction in GERD symptoms. Given this, a randomized controlled and blinded trial was pursued to see whether the reported anecdotes actually represented a true clinical effect. This study confirmed that it did. Based on this research, one of the ingredients, calcium carbonate, was increased to 300 mg in a new product to be released under the brand name AlkaMelts.

Pattern of Ultrasonographic Breast Findings in a Tertiary Hospital in North-Central Nigeria

2021-08-28T11:48:46+00:00

Introduction: Radiological examination of the breast is established as an essential part of the modern multidisciplinary approach to effective investigation and management of breast disease. Ultrasonography of the breast plays a prominent role in radiological management of breast lesions.

Methods: The study was a retrospective analysis of all the breast ultrasound scan at the Jos university Teaching Hospital (JUTH), Jos, Plateau State. Over a one year period of January 2^nd 2013-January 2^nd 2014. All the breast ultrasound scan results were retrieved from the archive of the department after necessary approval. Information soughts for included patient age, sex, indications for the scanning and outcome of the scanning.

Results: Women constituted 88.56% of the 201 patients scanned. There was an increase in the age of the patients to the age group of 20-29 after which, there was a steady decline? Fibroadenoma was the highest indication and the second highest finding. There was a good relationship between indications and findings, with a p value of 0.001.

Conclusion: It was noted that younger age groups had more breast US, in which benign lesions constituted the major abnormal findings. Most of the males US scans were abnormal compared to females. The clinico-radiological correlation was significant.

Histopathological Effects of Gordon Dry Gin (Moringa Citrus Blend) Induce Adenomatous Hyperplasia in Female Sprague Dawley Rats

2021-08-28T11:51:38+00:00

Objectives: This study aim to investigate the histopathological effects of binge consumed Gordon’s dry gin moringa citrus blend on the uterus of adult female dawley Sprague rats.

Materials: Fifty female rats (weighing range; 120±2.6 g - 250±3.5 g) were divided into four groups (A, B and C & D). Group A, B, C (15 animals each) were orally administered with Gordon’s dry gin moringa citrus blend, 43% ethanol, and 200 mg/kg moringa extract, respectively, while Group D (5 animals) did not receive any treatment and was used as negative control. In groups A, B, and C, five animals were sacrificed on the 7^th, 14^th and 21^st day of administration, whereas animals of group D were sacrificed on day 21. The uterus of each rat was harvested, processed and stained with haematoxylin and eosin solution for histological analysis.

Results: Results of the study revealed histological alterations in the uterus of treated animals. Such alterations include adenomatous hyperplasia and cystic hyperplasia.

Conclusion: The oral administration of gordon’s dry gin moringa citrus and moringa extract at 200 mg/kg induced cystic and adenomatous hyperplasia in rat uterus, inferring that both gordon dry gin and moringa might yield antifertility activity.

Biochemical and Molecular Pathogenetic Mechanisms behind Causation of Parkinson’s Disease

2021-08-28T11:54:33+00:00

Parkinson’s disease (PD) is an age-related neurodegenerative disorder that affects approximately 1 million persons in the United States. It is characterized by resting tremor, rigidity, bradykinesia, gait disturbance and postural instability. Its pathological features include degeneration of dopaminergic neurons in the substantia nigra pars compacta coupled with intracytoplasmic inclusions known as Lewy bodies. Neurodegeneration and Lewy bodies can also be found in locus ceruleus, nucleus basalis, hypothalamus, cerebral cortex, cranial nerve motor nuclei, and central & peripheral components of autonomic nervous system. The appearance of Lewy-body-like inclusions in nigro-striatal terminals might be followed by retrograde degeneration, further accumulation of aggregated proteins in nigral cell bodies and, finally, reactive gliosis and cell death. In familial forms of Parkinson’s disease, linked to mutations in α-synuclein, it is proposed that a loss of normal function of this protein, as well as a toxic effect of altered forms of the mutant protein, promote the accumulation of dopamine in cytoplasm. This would result in oxidative stress, leading to the onset of neurodegenerative changes mentioned above. Finally, we review evidence for a role of α-synuclein in synaptic vesicle recycling& suggest that impaired function of this protein might lead to accumulation of dopamine in cytoplasm. This could be the final deleterious event that triggers the death of nigral dopaminergic neurons in PD. In addition to prevailing pharmacologic therapies and surgical procedures,Yoga can be one of the most beneficial complementary therapies for PD patients, which canact at molecular level to reduce oxidative stress, improve neuro-cognition, boost their mood, enhance sensory-motor performance, increase dopamine & serotonin secretion and reduce cortisol secretion, thereby collectively enhancing quality of life of PD patients & their care-takers.