Current Topics in Medicine and Medical Research Vol. 13

Background: The accurate mechanisms of the neuropsychiatric involvement of celiac disease (CD) are not absolutely known. Different mechanisms have been suggested. Gluten toxicity, and, as a result, hyper-homocysteinemia (hyperHcy), may be the most suspicious triggering risk factors in the pathogenesis of neuropsychiatric manifestations of CD.

Methods: PubMed/Medline, Web of Science, and Google Scholar were searched to find all of the published data on the relationship between hyperHcy, CD, and neuropsychiatric manifestations.

Conclusions: Until know, there has been no conclusive evidence about relationship between hyperHcy and the neuropsychiatric manifestations of CD. Based on these data, more future studies are needed to evaluate and discuss in detail hyperHcy in the pathophysiological pathways of CD with clinical or subtle neuropsychiatric involvement.  

The leukotriene receptor antagonist is indicated with a therapeutic drug of asthma and is one of the antiallergic agents. We found that mast cells and a leukotriene receptor commonly emerged for various malignant and benign tumors and proved that the allergic reaction was strongly associated with development and proliferation of tumors. And we experimented on the effect of treatment of the leukotriene receptor antagonist for spontaneous rat tumor and confirmed the efficacy. Our data show a wide effect of this medicine and the fewer side effects and will cause a discussion for the chemotherapy of the current malignant tumor. This commentary briefly summarizes about current evidence and future prospect in the oncotherapy of the leukotriene receptor antagonist. As a future therapy for tumors, combination therapy with leukotriene receptor antagonists alone or other drugs is expected. We also hope that preventive medicine will be developed that prevents malignant transformation of benign tumors.

Some drugs that regulate estrogen are currently used as therapy for endometriosis. Endometriosis is a disease characterized by the ectopic presence of endometrial tissue. However, these medical treatments have significant side effects and patients who hope to become pregnant cannot overcome infertility. To compare morphological alterations and clinical symptoms, revised American Fertility Society (r-AFS) scores were compared between patients with and without leukotriene receptor antagonist (LTR-A) treatment. LTR-A-treated cases showed significantly de- creased r-AFS score. Furthermore, a significant correlation was seen between r-AFS score and LTR-A treatment period. In treated cases, clinical symptoms decreased and some patients achieved pregnancy. Morphologically, lesions in LTR-A-treated cases showed apoptotic fibroblasts and degeneration of collagen fibers. Our findings revealed that LTR-As had significant therapeutic value for the treatment of human endometriosis. Anti-LT therapy appears efficacious not only in the treatment of clinical symptoms and lesions, but also in improving fertility.  

Introduction: Patient surrounding might work as a source of infection to patient as well as health care workers. Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections. It is therefore very important to disinfect the patient surroundings regularly using proper technique.

Objective: Mostly the disinfection procedure varies from hospital to hospital, but there are few points that need to be taken care of by the hospital policy makers.

Methodology: In hospitals where the disinfection work is many times handed over to the hospital attendants who are not oriented to the infection control practices, there is increased risk of errors . There are some common errors that need to be recognized and taken care of in the hospital settings.  A special attention need to be placed on the infection control perspective by the person doing disinfection.

Result: An effort has been taken to highlight the management role, common errors and mop handling technique during chemical disinfection of hospital surfaces using triple basin method.

Conclusion: The present article is a reality oriented approach to highlight the challenges observed during the hospital surface disinfection, the reasons related to that, and its management. The regular and systematic review of the procedure related challenges will ensure the better disinfection of the hospital surfaces.

Since the mechanisms of the developmental processes of tumors remain unclear, early detection and early treatment of the tumors is necessary to save patients with malignant tumors. Therapies currently available to patients are surgery, chemotherapy, and radiotherapy. However, there are many patients who cannot be saved by such therapies. In many cases of a suspected benign tumor, the approach is to simply observe the progress of the tumor, and the tumor is then removed surgically when considered necessary. In this study, we found the common features of various tumor tissues, and we demonstrated the effect of therapeutics that target them by using experimental rats with spontaneous tumors. 26 kinds of human tumors (epithelial or mesenchymal origin, and malignant or benign) and Sprague-Dawley rats with spontaneous mammary gland tumors were examined by light and electron microscope. To detect of mast cells and leukotriene receptor, toluidine blue stain and immunohistochemical stain were performed. The rats were orally administered one of leukotriene receptor antagonists. We found that the presence of numerous mast cells and expression of leukotriene receptors in various tumor (human tumors and rat spontaneous tumors). And the therapeutic effects, which suppressed not only tumor progress but also angiogenesis and nerve formation, for rat tumors by administration of leukotriene receptor antagonist could obtain. A more effective method of saving patients with malignant tumors would be the early detection and early treatment of such tumors. Our data suggest the possibility that allergic reactions, in which leukotriene and leukotriene receptors in particular appear to play an important role, are involved in the development and progression of tumors and that it may be possible to control tumor progression by regulating such reactions. Our results might be useful for clinical applications of oncotherapy.

Background: Patients with chronic disease, including tuberculosis, can be easily get depressed. Valid and reliable instrument needed to detect depression in Tuberculosis patients. The Indonesian language version of Zung Self-Rating Depression Scale questionnaire is needed to be proved as a valid and reliable instrument because so many Indonesian people are unable to read the English version.

Objective: The purpose of this research is to obtain evidence on the validity and reliability of Indonesian language version of Zung Self-Rating Depression Scale questionnaire.

Methods: The design of this study is cross sectional by giving Zung Self-Rating Depression Scale questionnaire that have been translated into Indonesian language to pulmonary tuberculosis patients. Characteristics of the population were were presented as mean, standard deviation, and percentage. Corrected Item-Total Correlation table was used for validity test and reliability test result was presented as Cronbach’s Alpha value.

Results: Mean age of the population in this research is 47.75 ± 8.44 years old. Most of all have married (93%). Male and female pulmonary tuberculosis patients are 69% and 31% and 43% only graduated from elementary school. All 20 questions are valid because Corrected Item-Total Correlation values for all the questions are more than r table (>0,195). The questionnaire is also reliable with r Alpha value (Cronbach’s Alpha) 0,887, greater than r table value (>0,195).

Conclusion: Indonesian language version of Zung Self-Rating Depression Scale questionnaire is a valid and reliable instrument to be used for detecting depression in adult pulmonary tuberculosis patients.

Introduction: Cryoballoon (CB) ablation has emerged as a novel treatment for pulmonary vein isolation (PVI) for patients with paroxysmal atrial fibrillation (PAF). Cryoballoon (CB) technology would theoretically allow PVI with a single application the second-generation Arctic Front Advance (ADV) was redesigned with technical modifications aiming at procedural and outcome improvements. We aimed to compare the efficacy of the two different technologies over a long-term follow-up.

Methods: A total of 120 patients with PAF were enrolled. Sixty patients underwent PVI using the first- generation CB and 60 patients with the ADV catheter. All patients were evaluated over a follow-up period of 2 years.

Results: There were no significant differences between the two groups of patients. Procedures performed with the first-generation CB showed longer fluoroscopy time (36.3 ± 16.8 versus 14.2 ± 13.5 min, resp.; ???? = 0.00016) and longer procedure times as well (153.1 ± 32 versus 102±24.8 min, resp.; ???? = 0.019). The overall long-term success was significantly different between the two groups (68.3 versus 86.7%, resp.; ???? = 0.017). No differences were found in the lesion areas of left and right PV between the two groups (resp., ???? = 0.61 and 0.57). There were no significant differences in procedural-related complications.

Conclusion: The ADV catheter compared to the first-generation balloon allows obtaining a significantly higher success rate after a single PVI procedure during the long-term follow-up. Fluoroscopy and procedural times were significantly shortened using the ADV catheter. Based on electroanatomical mapping, lesion areas created by the two CB were not statistically different.

Research has shown the negative effects of antisperm antibodies (ASA) on the infertility. However, the precise etiology of the formation of ASA is yet to be established. Many researchers have suggested possible risk factors for ASA formation while others have contradictory findings. This article reviews the recent published literature in English language using MEDLINE, Google Scholar and print journals to identify the risk associations for ASA formation in human. Collated research findings do not strongly prove associations between ASA and possible risk factors. This, to some extent reflects the inadequacy of well-designed and case controlled studies in this regard.

Hyperthyroidism is an endocrine disorder characterized by excessive secretion of triiodothyronine (T3) and thyroxine (T4). Thyroid hormones (THs) exert pleiotropic actions on numerous tissues and induce an overall increase in metabolism, with an increase in energy demand and oxygen consumption. Therefore, the purpose of this study was to investigate the effects of hyperthyroidism on the production of reactive oxygen species (ROS) in lymph node and spleen cells of euthyroid and hyperthyroid mice, analyzing antioxidant mechanisms involved in the restitution of the cellular redox state. For this, thirty female Balb/c mice were randomly divided into two groups: Euthyroid (by treatment with placebo) and Hyperthyroid (by treatment with 12 mg/l of T4 in drinking water for 30 days). We found a significant increase in ROS and an increase in the genomic and protein expression of the antioxidant enzymes Catalase (CAT) and Glutathione peroxidase-1 (GPx-1) in lymph node and spleen cells of hyperthyroid mice. In vitro treatment with H₂O₂ (250 ?M) of the lymphoid cells from euthyroid mice increased the expression of CAT and GPx-1. The hyperthyroidism increased the phosphorylation levels of Nrf-2 (Nuclear Factor Erythroid 2-related factor) and the kinase activity of Protein kinase C (PKC) and Extracellular signal-Regulated Kinase (ERK). Additionally, we found an increase in the expression of the classic isoenzymes of PKC?, ? and ?. The PKC and ERK kinases phosphorylated Nrf-2 and caused its translocation to the cell nucleus. In conclusion, these results indicated that the increase in ROS found in the lymphoid tissue of hyperthyroid mice induced the transcription of antioxidant enzymes through the activation of Nrf-2. We describe the molecular mechanisms involved in the regulation of the enzymatic antioxidant system in lymphoid cells of hyperthyroid mice. The knowledge about the modulation of the cellular redox state could be useful to establish new molecular targets for the treatment of pathologies associated with high levels of oxidative stress.

A decade ago identified as bone-building mineral improving calcium absorption, today new research opens potentials of Vitamin D in spectrum of diseases from diabetes, hypertension to cancer including special population like pregnancy & lactation. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. As calcium demands increase during pregnancy, Vitamin D status becomes crucial for optimal maternal & fetal outcomes. Adverse health outcomes such as preeclampsia, low birth weight, neonatal hypocalcemia, bone fragility & increased incidence of autoimmune diseases have been linked to low Vitamin D levels during pregnancy & infancy. Vitamin D deficiency is common during pregnancy & lactation despite wide-spread use of prenatal vitamins, because these are inadequate to maintain normal Vitamin D levels. The widespread Vitamin D deficiency in pregnant women and lactating mother’s calls for a view to define optimum level of Vitamin D and the adequate amount of Vitamin D intake required to maintain optimum levels in these populations. The current IOM (US) as well as ICMR (India) recommendations for Vitamin D supplementation is not sufficient to maintain the optimal levels of serum 25(OH) D above 30 ng/ml required during pregnancy. It may therefore be judicious to include screening of all pregnant women for Vitamin D levels as a part of routine antenatal care and supplementation should be considered if deficiency persists. Till date interventional trials in special population suggest that administration of Vitamin D during pregnancy & lactation is safe & beneficial for optimal maternal & fetal outcomes. When Vitamin D deficiency is identified during pregnancy, most experts agree that up to 2000 IU/day of Vitamin D is safe. This review elaborates Vitamin D deficiency in Indian scenario and the need for Vitamin D supplementation, expounds and exercises the facts for implementation of Vitamin D supplementation to be advised when planning for pregnancy, current recommendations and implications of Vitamin D deficiency during pregnancy and lactation.

Objective: To describe the growth profile of breastfeeding babies following early introduction of infant formulas to improve the feeding pattern of the young infant. During the first 1000 days of life, uncontrolled feeding of the newborn increases the child’s risk of malnutrition which will later enhance the possibility of metabolic diseases such as obesity, diabetes and high blood pressure in adulthood. Methodology: This is a longitudinal descriptive study conducted in 2 medical clinics in Abidjan from 11-Jun-2013 to 15-Dec-2016 on 100 healthy newborn babies with the introduction of infant formulas before 6 months of life. The anthropometrics parameters were compared to those of WHO.

Results: The exclusive breastfeeding rate was 5%. Ablactation occurred within 12 months in 95% of cases. All Infants have doubled and tripled their birth weight at 3 and 9 months respectively. The height and the head circumference at birth increased by 50% and 37% respectively at 12 months. Compared to WHO growth charts, the weight gain for the girls at 3 months was 12.4% higher and for the boys was 7.3% higher at 6 months. On the other hands, the statural gain at 12 months was 50% lower than the WHO standards while the head circumference was 37.8% and 45.5% higher than the WHO standards in boys and girls respectively. At 3 months, the prevalence of stunting was 26.1% for boys and 13.3% for girls. Lastly, at 12 months, the BMI showed 10% overweight and 19% obesity.

Conclusion: Breastfeeding associated with an early introduction of infant formulas increases the risk of malnutrition of the young infant. We advise to avoid it and recommend an exclusive breastfeeding.

Acute fatty liver of pregnancy (AFLP) is a rare disease in Vietnam. Diagnosis by recorded literature is often difficult to distinguish from viral hepatitis, paraplegia, or bile duct disease, so AFLP diagnosis is often delayed. The prevalence of hepatitis B in Vietnam in pregnant women is estimated at 10% [1], preeclampsia is estimated at 0.2% [2].  AFLP usually occurs in the last three months of pregnancy or early postpartum. A case pregnant woman has 35.5-week gestational age with AFLP, who was safely delivered both mother and infant at Hung Vuong hospital, Vietnam. A careful history and physical examination, in conjunction with compatible laboratory and ultrasound imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. Intensive adjuvant therapy and rapid birth control are essential for maternal and fetal outcomes.

Hypertension is a major complication associated with more than 50% of diabetic patients. Both diseases have a close pathophysiological relationship and are independent risk factors for cardiovascular disease. In patients with diabetes mellitus and hypertension, cardiovascular complications increase more than four times than in non-diabetic patients with normal blood pressure. Therefore, it is very important for diabetics to diagnose the occurrence of high blood pressure early and to treat it according to the blood pressure control goal. However, it is confused about what standards we should approach managing hypertension by looking at the numerous medical guidelines that have been released recently. Since each treatment guideline can vary depending on what evidence data is used and what level of evidence is adopted, interpretation of this is considered to be very important, but these guidelines cannot take precedence over the judgment of doctors who make clinical judgments considering various characteristics of individual patients.

Aim: To strengthen the District Capacity in surveillance for effective detection, Reporting and Response to Public Health threats.

Background: The overall aim of a good surveillance system is to strengthen the capacity of a Health system through training of health personnel who can conduct effective surveillance activities. A good surveillance system is achieved through improved use of complete and timely health information to detect changes in time to institute a rapid response to the suspected outbreak of Public Health events. This assessment followed a 3-month Field Epidemiology Training program undertaken by the investigator who applied the acquired knowledge and skills in completion of the assessment.

Study Design: It was a descriptive cross-sectional, institutional based epidemiological investigation conducted at district level and Health Centre 1V in Kabarole from 15th December 2019-March 2020. eReports were retrieved from DHIS-2 for epidemiological weeks 44 in 2019 to week 3 in 2020.

Data Analysis: Micro soft word excel program was used to determine the reporting rates, epidemic disease trends and construction of malaria channel. SWOT analysis was done to identify poor HMIS reporting as the lead surveillance quality challenge and route cause analysis done to determine underlying causes.

Results: Weekly reports analyzed were from a total of 53 Health facilities and one Health Centre four for malaria channel construction. Of the 53 functional Health facilities assessed in the district, the average reporting Timeliness was 32% and Completeness at 63% from week 44 in 2019 to week 3 in 2020. This finding shows that the district was not achieving the 80% Timeliness and 80% Completeness national target. The poor reporting situation implies that the district may not detect an emerging Public Health Event and respond in time. Poor reporting rate was linked to knowledge gap among reporting staff in completion of the newly revised HMIS tools and lack of support supervision. The analyzed data revealed that the district had increased dysentery, measles and typhoid fever cases. The dysentery and typhoid fever cases had reached and surpassed the Alert and Action thresh hold levels however there was no reported death from these diseases. Further inquiry revealed that Typhoid fever was being diagnosed using WIDAL test as opposed to WHO recommendation of stool or blood culture. Health facilities diagnose typhoid fever by Widal test instead of doing blood or stool culture and this creates theoretical out breaks. The noted typhoid fever outbreak in the district was therefore being based on wrong laboratory tests hence regarded by the researcher as speculative. Findings on malaria channel revealed a normal and expected trend of malaria in Kabarole district in 2020.

Conclusion: Knowledge and skills from FETP-training enabled the investigator to establish the fact that the district’s surveillance system was less sensitive in detecting Public Health events for a quick response. Intensified targeted support supervision and mentorships of all health workers on reporting could help improve the districts surveillance system.

Background: Neonates on long-term parenteral nutrition (PN) may develop parenteral nutrition-associated liver disease (PNALD). Aluminum (Al) is a known contaminant of infant PN, and we hypothesize that it substantially contributes to PNALD.  In this study, we aim to assess the impact of Al on hepatocytes in a piglet model.

Methods: We conducted a randomized control trial using a Yucatan piglet PN model.  Piglets, aged 3-6 days, were placed into two groups.  The high Al group (n=8) received PN with 63 µg/kg/day of Al, while the low Al group (n=7) received PN with 24 µg/kg/day of Al. Serum samples for total bile acids (TBA) were collected over two weeks, and liver tissue was obtained at the end of the experiment.  Bile canaliculus morphometry was studied by transmission electron microscopy (TEM) and Image-J software analysis. In December 2019, the American Academy of Pediatrics issued a key technical report on Al effects in infants and children. This report was revised and commented on in this chapter.

Results: The canalicular space was smaller, and the microvilli were shorter in the high Al group than in the low Al group. There was no difference in the TBA between the groups.

Conclusions: Al causes structural changes in the hepatocytes despite unaltered serum bile acids.  High Al in PN is associated with short microvilli, which could decrease the functional excretion area of the hepatocytes and impair bile flow. Long-term toxicity studies from the Al content in PN components supported the US Food and Drug Administration (FDA) in the decision to implement specific rules. It has been required that large-volume ingredients reduce the Al concentration and all small volume components be specifically labeled with the Al concentration. However, both US FDA and we consider that despite these rules, the total Al concentration from some components remains above the recommended final concentration. US FDA and our concerns about toxicity from the Al present in infant PN formulas are grounded, requiring more research on this topic.

Background: The global HIV/AIDS epidemic has killed an estimated 21.8 million people and another 36.1 million are living with HIV infection. Sexual transmission is by far the most common mode of transmission globally. The HIV virus is often found predominantly within these subpopulations at the beginning of an epidemic when prevalence is extremely low in the general population

Aim: To study the prevalence rate of HIV among the women delegate in the conference and to determine the incidence rate among the age group as well as occupational category of participants.

Materials and Methods: About 2 ml venous blood samples were collected from each subject and inoculated in a micro-container evacuated blood collection System with additive (K2EK2EDTA- Greiner bio-one USA). The serum samples were screened according to the manufacturer instruction using Determine kit HIV 1 & 2 and reactive serum was further confirmed with Uni-Gold.  Data was coded, computed and analyzed using SPSS version 16.0 and p values ?0.05 is considered to be statistically significant.

Results: Out of the 327 women delegates within the age group 16 & 65years in this studied population, our research showed that the prevalence rate of HIV infections was 2.8%, statistically not significant (p=0.837, mean value=4.91, median=5.00, S.D= ±2.03).

A higher percentage of (8.7%) and (4.2%) with HIV positive in relation to age were found within the age brackets 26 – 30 years and 36 – 40 years respectively. The highest number of HIV positive individual were found among the house wives (9.5%) followed by civil servant (3.7%).

Conclusion: Overall HIV infections prevalence rate of 2.8% in this conference population is a serious health challenge. Therefore, we recommend sex education in our religious communities at all level to both teenagers and adults; sex education should not be over spiritualized to reduce the menace in our society. Also, private sectors such as non-governmental organization need to provide support so as to reduce the financial burden on government.

Knee osteoarthritis (OA) causes significant physical disability in many people. While some research indicates that women with this disease suffer more than men, few studies have attempted to describe the severity and effect of this disease specifically among women with moderate knee osteoarthritis, as well as the relationships that exist between their perceived health status and well-known physical, emotional, and perceptual factors found in this disease. This exploratory research aimed to better understand the factors that influence how the condition is viewed, as well as to explain the level of pain and function in women with mild to moderate knee osteoarthritis and how this affects the condition. The records of 20 women with the disease who had undergone several tests using standardised procedures and approved instruments were reviewed.  The primary outcome measure was the perceived impact of the disease using the Arthritis Impact Measurement Scale. Six-minute walking time, fastest walking velocity, self-reported discomfort, pain and functional self-efficacy, body mass index, and depression were all used as secondary outcome indicators. T-tests and correlational studies were conducted on the variables. Results demonstrated pain is the clinical factor most consistently impacting the disease experience, along with deficiencies in walking ability (p <0.05). Important mediating variables of ambulatory capacity were body mass and pain self-efficacy.

Background: Male sexual or coital difficulties are among the factors contributing to infertility in couples seeking fertility as this may result in low coital frequency. Coital or sexual difficulties may be due to poor sexual knowledge or attitudes, poor self-esteem, emotional difficulties or sexual abuse. 

Aims/Objectives: To evaluate the causes of male sexual or coital difficulties among couples attending the infertility clinic at BSUTH, Makurdi over a 2 year period.

Methodology: This was a cross-sectional study involving all males attending the infertility clinic at Benue State University Teaching Hospital (BSUTH) who consent to participate in the study. A pretested structured questionnaire was administered and analyzed with statistical package for social sciences (version 23.0) and the results were presented in simple proportions.

Results: There were several factors responsible for male coital difficulties. The most common was male erectile dysfunction 33 (32.4%), vaginismus 11 (10.8%), penile pain 14 (13.7%), poor response from the female partner 8 (7.8%) and severe dyspareunia 18 (17.1%).

Conclusion: Coital difficulties resulting to low frequency of sexual exposure constitutes a major cause of infertility among males attending the infertility clinic at BSUTH, Makurdi. Therefore efforts should be made to evaluate these factors while assessing infertility couples in order to mitigate the effect.