Highlights on Medicine and Medical Research Vol. 1

The medical diagnostic label is the most important process in patient management. Diagnostic decisions are not easy but very crucial. The diagnosis is a vital part in patient care as it not only affects the patient but the society at large. The decision process involves the thinking process of the caregiver which operates differently in emergencies and outpatient clinic. The heuristics aspect of the mind is more efficient in dealing with emergencies and the slower analyzing mind in outpatient setting. The heuristic approach is useful in rapid decisions and management of emergencies whereas the slower stepwise approach in outpatient treatment will help in reducing investigations, medical errors and cost of care. A properly equipped and trained system1 needs to play a dominant role in the emergency setting. The activated and time consuming system2 needs to be more involved in the outpatient setting .The combination of system1 and system can probably give the most likely diagnosis in both outpatient and emergency setting. The article also gives an evidence based template for predicting the disease process based on positive and negative likelihood ratios.

The aim of this chapter was to evaluate amount of calcium elution from bovine enamel due to single and short immersion into carbonated soft drink, to calculate depth of the eroded lesion, and to determine when to brush teeth after carbonated soft drink intake from the view point of preventing enamel abrasion.

Four enamel specimens (4 mm width × 4 mm height × 5 mm thickness) were cut out of each bovine crown (a total of 8 bovine crowns were used), followed by making enamel samples by embedding them in quick cure resin. The enamel samples in each crown were randomly divided into 3 minutes of immersion (IM3), 6 minutes of immersion (IM6), 9 minutes of immersion (IM9), and 12 minutes of immersion (IM12) groups, and then, immersed in 5 mL of carbonated soft drink for respective immersion time.

The amount of eluted calcium per unit area of the enamel surface was measured using atomic absorption spectrophotometry, and then, the depth of the demineralized lesion was  calculated.

Both the amount of eluted calcium and the lesion depth in the IM6, IM9, and IM12 groups was significantly higher than that in the IM3 group.

Even in the IM12 group, the lesion depth ranged 0.05-0.35 µm. A white spot lesion that is remineralized by oral fluid was reported to range 50 - 600 µm, so the eroded lesion depth in this study was considered to be remineralized by saliva quickly, hence it was concluded that brushing just after single short time intake of carbonated soft drink hardly induce enamel abrasion.

The incidence of hypertension, diabetes and overweight-obese are emerging health problems, which are increasingly prevalent globally. The objective of the study was to evaluate the prevalence and the relationship between blood pressure, blood glucose and body mass index, and the tendency of developing prehypertension and pre-diabetes in rural adults in the Niger Delta region. A cross-sectional, population-based descriptive design was used. A total sample of 250 subjects aged 20 years and older, that had resided continually in the order of 10 years and above, in the oil and gas extraction environments, were recruited. While body mass index was calculated using internationally accepted standard methods, blood pressure and fasting blood glucose level were recorded also by standard methods, classified and correlated. One-way ANOVA and Pearson’s correlation analyses were used for comparisons between groups. Result showed that although blood pressure and blood glucose measurements increase with age, males had higher prevalence of high blood pressure and raised blood glucose compared with females (p<0.05). Both sexes had almost similar distribution of high body mass index which was not statistically significantly different (p>0.05). In total, overweight coexisted among 14% of participants with normal blood glucose, 19.6% pre-diabetes, 7.6% diabetes, 24% normotensive, 15.4% pre-hypertensive and 1.8% hypertensive. Pre-diabetes coexisted among 9.8% normotensive and pre-hypertensive respectively, while 0.2% normotensive, 5.6% pre-hypertensive, and 18.2% hypertensive had combined diabetes. About 16.4% had both combined diabetes and obesity, and hypertension and obesity. Overall, 19.5% had combined hypertension, obesity and diabetes. In total, the prevalence of obesity was 16.4%, hypertension 18.2% and diabetes 24.0%. The prevalence of coexisting prehypertension and pre-diabetes, pre-non-communicable and main non-communicable diseases was 17.5%, 21.3% and 23.7% respectively. Data analysis revealed positive and linear correlation and statistically significantly different (p<0.001) in the varying degree of complex association of blood pressure and blood glucose as well as body mass index. In conclusion, notwithstanding, this study provides baseline population based data establishing that the populations in the oil bearing communities are at high risk of developing hypertension, diabetes, and overweight-obese together with high prevalence of combination of pre-hypertension and pre-diabetes. The coexisting of significantly high prevalence of prehypertension and pre-diabetes with raised body mass index, in particular, have a more adverse effect by progression to full hypertension and diabetes. There is the need for national programme for prevention, control or delay the burden of the risk factors for non-communicable diseases for oil and gas bearing communities.

Colorectal cancer is the fourth leading cause of cancer death in the world. It is the third most commonly diagnosed malignancy in the world and is responsible for 1.4 million new cases and approximately 700,000 deaths in the year 2012. This paper is a review of work done on colorectal adenocarcinoma in East Africa showing geographic spread, age and sex ratios, clinical presentation, management and predominant histopathology. A steady increased incidence of CRC in East African countries is currently being documented however this is associated with a higher CRC-associated morbidity and mortality. Whilst the male: Female ratio varies between 1.2:1 to 1.88:1, up to 38% of CRC diagnosis are in patients younger than 40 years, in contrast to only 1.9% of CRC patients in Western developed countries such as the USA. Generally rectal carcinoma is more common than colon carcinoma and abdomino-perineal resections are commonly performed in up to between 54% - 71% due to the advanced stage of presentation of rectal tumours in East Africa. The late stage presentation and delayed effective treatment in East Africa may result in a higher morbidity in CRC patients. Interestingly there is a significant incidence of mucinous adenocarcinoma sub-groups compared to Western developed countries which carry a poor prognosis. A significant proportion of CRC patients have been found to have histological and demographic features which suggest that MSI-tumours and these tumours are more common in younger patients. However only a few authors have looked at the possibility of mismatch repair mutations in the genetic aetiopathogenesis of colorectal adenocarcinoma in East Africa. Colorectal cancer in East Africa requires more unravelling especially in the aetiopathogenesis and therefore immunohisto-chemical staining and MSI testing is being recommended to establish the molecular subtypes and hence the prevalence of Hereditary Non-Polyposis colorectal carcinoma (HNPCC). This will clarify the genetic aetiopathogenesis of colorectal adenocarcinoma in the East African region.

Decreased nitric oxide (NO) availability due to obesity and endothelial dysfunction might be causally related to the development of lifestyle-related diseases such as insulin resistance, ischemic heart disease, and hypertension. In such situations, instead of impaired NO synthase (NOS)-dependent NO generation, the entero-salivary nitrate-nitrite-NO pathway might serve as a backup system for NO generation by transmitting NO activities in the various molecular forms including NO and protein S-nitrosothiols. Recently accumulated evidence has demonstrated that dietary intake of fruits and vegetables rich in nitrate/nitrite is an inexpensive and easily-practicable way to prevent insulin resistance and vascular endothelial dysfunction by increasing the NO availability; a NO-rich diet may also prevent other lifestyle-related diseases, including osteoporosis, chronic obstructive pulmonary disease (COPD), and cancer. This review provides an overview of our current knowledge of NO generation through the entero-salivary pathway and discusses its safety and preventive effects on lifestyle-related diseases. Although the role of diet-derived NO activity in lifestyle-related diseases is complex and remains to be fully elucidated, the intake of nitrate as a nutrient in vegetables might be beneficial to human health as a result of synergistic effects with other nutrients present in vegetables, and would be recommended as a nutritional approach to the prevention and treatment of the lifestyle related diseases.

Aims: Primary congenital glaucoma (PCG) is a leading cause of childhood blindness. Primary congenital glaucoma manifests in early infancy and is characterized by an elevated IOP, large cornea, and Haab’s striae. Variable degrees of corneal haze, photophobia, epiphora, and blepharospasm are also seen. The cytochrome P450 family 1, subfamily B, polypeptide 1 (CYP1B1) is the most mutated gene that is associated with PCG. Very few studies have examined the promoter region and exon1 of the CYP1B1 gene. This work was planned to contribute to the description of the possible causative mutations of CYP1B1 gene that are related to PCG affected Egyptian patients.

Patients and Methods: Patients diagnosed as glaucomatous based on their symptoms and detailed ophthalmological examinations at the time of presentation, underwent an intraocular pressure lowering surgical procedure. Investigations were further proceeded on the molecular level. Sequencing-based mutation screen for the promoter region, exon1 and the coding region of exon3 of CYP1B1 gene have been performed in two related consanguineous PCG affected families and four other sporadic Egyptian patients using the polymerase chain reaction (PCR) assay; where PCR products were sequenced, and further analyzed.

Results: Sequencing analysis revealed three novel mutations in PCG affected patients one in the promoter region (g.G2872A) and two in exon1 (g.C3268T and g.C3332T). Two additional mutations in exon3 (p.L432V and p.N453S) are reported for the first time in PCG affected Egyptian patients. Clinical and genetic data of the two consanguineous families revealed that although the four parents have the same variations as their sons, they are ophthalmologically free. Regular ophthalmic examinations of siblings and parents of these affected patients should take place for early detection of any form of glaucoma to allow prompt diagnosis and early treatment when needed.

Conclusion: The present investigation revealed the presence of six different mutations distributed on the promoter-exon1 region and the coding region of exon3 of CYP1B1 gene. To the best of our knowledge, three of these mutations are novel mutations reported for the first time in the present study.

Clinical examination and molecular genetic data could contribute to early diagnosis and prevention of the visual impairment caused by PCG. This study provides groundwork for expanded genetic investigations in Egypt paving the way for genetic counseling to help affected families make informed medical and personal decisions.

• There is a definite need for representations of, and tools for, conditional probability that enhance understanding, simplify calculations, foster insight, and facilitate reasoning. Such representations and tools are desirable and useful in a wide variety of scientific disciplines, but their utility in medical contexts and applications are stressed herein, so as to address a clinical rather than a mathematical audience. We employ a plethora of time-tested pedagogical representations or tools of conditional probability including: (a) Visualization on Venn diagrams or Karnaugh maps, (b) Reformulation as natural frequencies, (c) Entity interrelations via Signal Flow Graphs, (d) Specification of certain problem formats such as the format of Trinomial Graphs, and (e) Use of a pair of complementary Karnaugh-map-like or eikosogram-like diagrams. Most of the new representations or tools have well known histories of pedagogical advantages, but are still to be tested in the specific realm of conditional probability. Further assessment of the novel representations or tools proposed herein is needed. Each of these is to be taught to a group of students, and a control group of students is to be instructed via the conventional representation. Detailed statistical analysis of the outcomes is warranted. Similar investigations were performed earlier, but they were on a limited scale. Therefore, the need arises for an explorative study that exhausts all proposed representations or tools.

Background: Personality disorders have since the 19th century been known and established as psychiatric diagnosis, yet very few epidemiological studies have been done. Absence of information about this disorder in the prisons led to the assessment of its prevalence in Agodi prisons in Nigeria.

Objective: To determine the prevalence of personality disorder in a prison community in Nigeria.

Methods: A total of 213 inmates who met the study criteria were interviewed, using (IPDE) International Personality Disorder Examination, a semi structured questionnaire modified to conform to DSM 111-R and ICD-10 classifications. Using the Statistical Package for Social Sciences (SPSS/PC+), cross tabulation of the variables was obtained using chi-square and t- test.

Results: The results showed that at least 31% of prison inmates have personality disorders with antisocial personality disorder being most prevalent. A strong association between criminality and personality disorder was established, and the need for psychiatric services in the prison was recommended. As part of the correctional programs, educational packages should be introduced into Nigerian prisons with focus on vocational and technical education.

Antibody–drug conjugates (ADCs), constructed with monoclonal antibodies, linkers, and natural cytotoxins, are innovative drugs developed for oncotherapy. Owing to the distinctive advantages of both chemotherapy drugs and antibody drugs, ADCs have got enormous success during the past several years. The development of highly specific antibodies, novel marine toxins’ applications, and innovative linker technologies all accelerate the rapid R&D of ADCs. Meanwhile, some challenges remain to be solved for future ADCs. For instance, varieties of site-specific conjugation have been proposed for solving the inhomogeneity of DARs (Drug Antibody Ratios). In this review, the usages of various natural toxins, especially marine cytotoxins, and the development strategies for ADCs in the past decade are summarized. Representative ADCs with marine cytotoxins in the pipeline are introduced and characterized with their new features, while perspective comments for future ADCs are proposed. Site-specific conjugation technology has caught numerous pharmaceuticals companies’ eyes for solving the inhomogeneity problem to some extent, pointing out the way to further development of ADCs. With the advancement of conjugation technology, a variety of conjugated groups have been designed and connect with many different drugs by the diversified modification of linkers.

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor with a dismal prognosis, largely due to its late presentation. PDAC was ranked fourth in terms of tumor-related mortality in the Western world in 2015. This is at least in part due to its rapid spread in the asymptomatic phase of the disease. Methods for early detection, the development of reliable screening tools, and the identification of sensitive and specific biomarkers have remained essential research priorities to improve early patient management and outcomes. The pancreas and salivary glands share histological and functional similarities, and the salivary glands have demonstrated a role in oral and systemic health. This review focuses on the similarities and differences between the pancreas and salivary glands and how these can inform our understanding of PDAC genesis and early diagnosis. In particular, chemical exposure, which alters salivary gland gene transcription and morphogenesis, may not only directly impact salivary gland regulation but alter pancreatic function via the systemic secretion of growth hormones. Diabetes and obesity are associated with an increased risk of pancreatic cancer, and a link between chemical exposure and the development of diabetes, obesity, and consequently PDAC genesis is proposed. Possible mechanisms include altering salivary or pancreatic morphology and organ function, disrupting endocrine signaling, or altering pro-inflammatory homeostasis. Finally, saliva contains putative specific biomarkers that show promise as non-invasive diagnostic tools for PDAC. Finally, this review highlights the important role of the salivary glands and environmental factors on pancreatic homeostatic mechanisms and normal regulation through salivary gland dysfunction.