Highlights on Medicine and Medical Science Vol. 4

Decoding the Cardio-vascular Pathophysiology in COVID-19

Smita R. Sorte, Sachin B. Rathod, Ashwini Patil, Ashok Ahirwar — Wed, 09 Jun 2021 00:00:00 +0000

The global pandemic caused by Coronavirus 19 (SARS-CoV-19) has spread rapidly and affected the entire world with the maximum number of cases reported from the United States, India and Brazil. Coronavirus 19 (SARS-CoV-19) has infected a total of 31,664,104 people and caused 972,221 deaths according to the WHO data as on 24 September 2020 [1].

Globally, the age- normalized death rate due to cardio-vascular disease (CVD) is 272 per one lakh population and in India, it is 235 per one lakh population on an average [2]. People with heart diseases are twelve times more prone to die and six times more prone to be hospitalized due to severe coronavirus disease (Covid-19) than healthy people [3]. Covid 19 disease mainly affects the respiratory system, and other extra-pulmonary complications are acute renal injury, gastrointestinal consequences, hepatocellular damage, hyperglycemia, ketosis, ocular complications, dermatologic manifestations, thrombotic sequelae, acute coronary syndromes, myocardial dysfunction and arrhythmia, neurological illnesses, etc. [4]. Acute cardiac injury is the commonest covid related cardiac abnormality affecting 8-12% of all patients [5]. Elevated level of cardiac troponin is described as acute cardiac injury [6].

Coronavirus leads to increased pro-inflammatory markers, T-lymphocyte-mediated cytotoxicity, increased sympathetic activity, rupture of plaque, myocardial cell invasion and direct myocardial damage augmented by the cytokine storm syndrome. COVID-19 related cardiovascular complications includes acute cardiac injury, acute coronary event, left ventricular systolic dysfunction, acute left ventricular failure, diastolic dysfunction [7], brain medullary cardiorespiratory dysfunction and congestive heart failure (CHF) [8-12], ST-segment elevated myocardial infarction, cardiogenic shock, diffuse myocardial edema, pericarditis, pericardial effusion, cardiac tamponade, venous thromboembolism, and cardiomyopathies mimicking STEMI presentations, sinus bradycardia [13], arrhythmia, cardiac conduction abnormalities [14] and sudden death [15]. Sufficient understanding of the COVID-19 effect on cardiovascular system is important for optimum treatment of covid affected patients and to prevent morbidity and mortality in the patients. The pathophysiology of myocardial complications is still speculative and hence, we have tried to decode the cardiovascular pathophysiology in Covid 19 infection.

Operational Oncology

Teodor Horvath — Wed, 09 Jun 2021 00:00:00 +0000

The decision making process in the surgery of premalignancy including overdiagnosis and underdiagnosis, key principles in the treatment of surgical stage of oncological disease, locally advanced, and metastatic disease from the view of the surgeon involved into precision personalized medicine.

Charming Surgery: A Reflection on the Surgical Specialty

T. Horváth, V. Švec, P. Moravcík, M. Španková, Z. Kala — Wed, 09 Jun 2021 00:00:00 +0000

The perfect examination, a clinical working diagnosis and its paraclinical confirmation, decision making processes, the suitability of the procedure, the cooperation of colleagues both our own and from different specialisations. Surgery is a profession of the heart and soul, serving the widest common community and, at the same time, the most inward expression of the individuality of every person involved in its range – professional, personal, family, physical, psychological, spiritual, civil, academic and social.

Malaria in Children in Guediawaye, Senegal: A Retrospective Study

A. Noubadoum, J. B. Diouf, N. M. Sougou, P. Adomson — Wed, 09 Jun 2021 00:00:00 +0000

Introduction: Malaria is one of the leading causes of infant and child mortality, despite the efforts made in Senegal. The epidemiological profile of malaria in Senegal is linked to climatic conditions that can influence the abundance and survival of mosquitoes. The objective of this study is to describe the epidemiological, clinical, Para clinical, therapeutic and evolutionary aspects of malaria in children in a pediatric ward of a Dakar hospital.

Patients and Methods: This is a retrospective descriptive study, with an analytical focus over a 5-year period from January 1st, 2013 to December 31st, 2017, in the pediatrics department of Roi Baudouin Hospital Center, involving 259 children hospitalized for malaria.

Results: The frequency of hospitalization during the period was estimated at 7.7%.The mean age was 82.9 months, with a median of 84 months, and the age range from 1 month to 5 years was the most representative (35.9%) with extremes from 1 to 180 months.

The majority of cases occurred in the last quarter of the year, with a peak in October (19.7%). Clinical manifestations on admission were dominated by fever, which was found in 93.1% of cases. More than 30.9% of the children showed clinical signs of severity on entry, with jaundice (37.5%) in the foreground, followed respectively by disturbances of consciousness (29.0%) and respiratory distress (19.0%). The majority of patients were treated with quinine (80.3%) and overall progress was satisfactory with a cure rate of 97.7%. Factors associated with death were represented by a time to management more than 7 days and the presence of co-infections, with a p value equal to 0.002 and 0.04 respectively.

A Case Report on Hypomethylating Agent-Induced Cardiomyopathy

Mehmet Can Ugur, Cansu Atmaca Mutlu, Oktay Bilgir — Wed, 09 Jun 2021 00:00:00 +0000

Hypomethylating agents, 5-azacytidine and 5-aza-2'-deoxycytidine (decitabine) , which have an effect by inhibiting DNA methyltransferase have been approved in Myelodysplastic syndrome (MDS). The most common side effects of hypomethylating agents are cytopenias, nausea, pain, and local reactions in injection zones. The toxicity associated with other organ functions is very rare. Our paper reported a case which a decrease was observed in left ventricular ejection fraction (EF) due to Decitabine treatment because of no response to Azacitidine as the fourth case in the literature.

Three cases with cardiac toxicity and function loss have been reported in the literature. our case did not undergo ECHO check before starting Decitabine treatment after Azacitidine, it cannot be clearly understood whether cardiac toxicity occurred with 10 cycles of Azacitidine or 1 cycle of Decitabine treatment. Randomized controlled trials with large patient series are needed to clarify the etiology and pathophysiology of this side effect.

Personality Disorder and Substance Use Disorder Outside Treatment Settings: The Prison Community

Enyidah Nonyenim Solomon, Nonye-Enyidah Esther Ijeoma — Wed, 09 Jun 2021 00:00:00 +0000

Background: Studies on comorbidity of personality disorder (PD) and substance use disorders (SUDs) have largely been done on normal and unrestricted environments and on free and unrestricted patients. Illicit drugs are used in prisons despite their highly structured controlled environment. The few studies on the health of prison inmates have indicated high levels of mental disorder, yet no studies have been done on comorbidity of SUDs and PD in the prison community.

Objectives: To determine the prevalence of SUDs and PD in the prison community and the degree of comorbidity between both disorders in this community.

Methods: Prison inmates who met the inclusion criteria were interviewed using (IPDE) International Personality Disorder Examination and Sections 10 and 11of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Both instruments are semi structured questionnaires modified to conform to DSM-111-R (Diagnostic and Statistical Manual) and ICD-10 (International Classification of Diseases) classifications. ICD-10 classification was used for the diagnoses. The data was fed into the Statistical Package for Social Sciences (SPSS/PC+) and cross- tabulation of the variables obtained using chi-square and t- test.

Results: The study showed that out of the 213 inmates that consented to the study, (77) 36% had SUDs, and (111) 52% had PD with Borderline/ Impulsive PD Dissocial PD and Anankastic PD having the highest prevalence of comorbidity.

Conclusion: The prison communities harbour inmates with SUD and PD. A strong association has been established between both disorders with a comorbid prevalence rate of 70%. An urgent need for a close medical and psychiatric care is advocated.

Breast Cancer Stage at the Time of Presentation: Clinicopathological Correlations

Nada A. S. Alwan, Furat N. Tawfeeq, Mina H. Maallah, Safana A. Sattar — Wed, 09 Jun 2021 00:00:00 +0000

Background: Breast cancer is the most frequently diagnosed malignancy and the second leading cause of mortality among women in Iraq forming 23% of cancer related deaths. The low survival from the disease is a direct consequence to the advanced stages at diagnoses.

Aim: To document the composite stage of breast cancer among Iraqi patients at the time of diagnosis; correlating the observed findings with other clinical and pathological parameters at presentation.

Patients and Methods: A retrospective study enrolling the clinical and pathological characteristics of 448 Iraqi female patients diagnosed with breast cancer. The composite stage of breast cancer was determined according to UICC TNM Classification System of Breast Cancer and the American Joint Committee on Cancer Staging. The studied parameters comprised age of the patient, stage of the disease, marital and educational status, history of lactation and hormonal intake (for a minimum period of 6 months), family history of breast or any other cancer, the effected breast side, hormone (Estrogen and Progesterone) receptor (ER, PR) and Her2 contents of the primary cancer. Statistical analysis was performed to correlate the recorded composite stages at diagnosis with the corresponding clinical and pathological data utilizing SPSS version 16.0 statistical program.

Results: Out of 448 patients, four (0.9%) had ductal carcinoma in situ (Stage 0). Stages I, II and III were documented in 7.6%, 46.9% and 39.3% respectively; while only 5.4% presented in Stage IV. No correlation was elicited between the stage of breast cancer and the age of the patients or the history of lactation. A significant association was demonstrated with the marital and educational status, history of hormonal intake, contralateral breast involvement and familial cancer. The ER+PR+Her2+ (Triple Positive/Luminal B), ER-PR-Her2- (Triple Negative), ER+PR+Her2- (Luminal A) and ER-PR-Her2+ (Her2) subtypes were detected in 13.4%, 11.8%, 48.2% and 9.8% respectively. When correlating the composite stage with the corresponding breast cancer subtypes, categorized according to the immunohistochemical staining, the relationship was highly significant at p < 0.01.

Conclusions and Recommendations: The regression in Stage IV breast cancer at the time of presentation among Iraqi patients represents one of the fruitful outputs of initiating the National Program for Early Detection of Breast Cancer. Further professional efforts, endorsed by practical policy decisions, are recommended to down stage breast cancer through promoting evidence based protocol guidelines and adopting comprehensive well designed diagnostic, screening and cancer control strategies.

Reduced Effective T Helper Responses against Plasmodium falciparum and Schistosoma mansoni Co-Infection in ex vivo: Th1, Th2 & Th17 Immune Responses

Wed, 09 Jun 2021 00:00:00 +0000

Background: Parasitic worms evade immune responses, and interactions between diseases can cause altered immunologic outcomes compared to what usually occurs with single infections. These interactions may influence vaccine and chemotherapeutic efficacy. Schistosoma mansoni and Plasmodium falciparum are co-endemic in Uganda and are the leading parasitic causes of public health problems across sub-Saharan Africa. Plasmodium falciparum is the major causative agent of malaria and Schistosoma mansoni is one of the causative agents of intestinal schistosomiasis.

Objectives: The overall aim was therefore, to elucidate the impact of the comorbidity on protective T helper immune responses on P. falciparum and S. mansoni co-infection.

Methodology: This study evaluated the T helper immune responses in individuals with independent S. mansoni infection, independent P. falciparum infection, co-infection and non-infection in school attending children in a co-endemic area along Lake Victoria shores, Uganda. Immune responses were categorized into Th1, Th2, and Th17 based on unique cytokine(s) produced by the T helper subpopulation in ex vivo. Kato Katz thick smears and circulating cathodic antigen tests were performed for S. mansoni screening, whereas thick and thin blood smear techniques were performed for P. falciparum screening.

Results: We observed an up regulated Th1 T helper subpopulation in independent P. falciparum infections compared to the uninfected group. Suboptimal T helper immune responses were detected in independent S. mansoni infection characterized by significantly down regulated Th1 (Z = -1.425, p = 0.0313) response in comparison to the non-infected group. Suboptimal T helper immune responses were also recorded in the co-infected individuals characterized by significantly down regulated Th1 (Z = -3.260, p = 0.0273) and Th2 (Z = -1.180, p = 0.0078) responses compared to independent P. falciparum.

Conclusions: S. mansoni infection is a major contributor of a reduced effective T helper immune response against P. falciparum in P. falciparum and S. mansoni co-infection.

A Brief Study Related to Treatment of Sigmund Freud’S Maxillary Jawbone Cancer by Hans Pichler and Varaztad Kazanjian

Xavier Riaud — Wed, 09 Jun 2021 00:00:00 +0000

Ackerman’s tumour is a rare histological form of carcinoma, currently recognised as a clinical and independent histopathological entity. It can grow at all membrane levels located in the upper aerodigestive tract but occurs most frequently in oral cavities. From 1919 to his death, Sigmund Freud was treated for a maxillary jawbone cancer by two exceptional surgeons, the Austrian, Hans Pichler, and the American, Varaztad Kazanjian. Fleeing the Nazi regime, he went into exile in England where he died after numerous recurrences of the disease.

Do the Fluctuating Estrogen Levels during the Menstrual Cycle Influence Muscle Performance in Females?

Ayesha Juhi — Wed, 09 Jun 2021 00:00:00 +0000

This a review article to know whether fluctuating estrogen levels across the menstrual cycle influence the muscle performance in females. Hormonal fluctuations during the course of a women’s menstrual cycle, apart from reproductive system also affects the physiological and psychological component of the body, which has an influence on her day to day performance. The presence of estrogen receptors (ER) has been noted on skeletal muscle, ligaments, tendons and smooth muscle. Estrogen has been shown to have a significant influence on muscle membrane stability and there by possibly, minimizing the post exercise muscle damage and soreness.

Serrated Polyps of the Colon and Rectum: Clinicopathological Features

Wed, 09 Jun 2021 00:00:00 +0000

The serrated neoplasia pathway, in which serrated polyps develop as colorectal cancer, has received a lot of interest in recent years as a new carcinogenic process. Hyperplastic polyps (HPs), sessile serrated lesions, and traditional serrated adenomas are histopathologically characterized colorectal serrated polyps; the latter two are considered premalignant in the serrated neoplasia pathway. Apart from diminutive rectosigmoid HPs, all colorectal polyps, including serrated polyps, are removed in Western countries. The treatment strategy for colorectal serrated polyps in Asian countries, on the other hand, has remained unestablished. Therefore, we detailed the clinicopathological aspects of colorectal serrated polyps in this review and recommended eliminating HPs and sessile serrated lesions \(\geq\) 6 mm in size, as well as traditional serrated adenomas of any size.

In vitro Generation of Human Adipose Derived Mesenchymal Stromal Cells Using \(\alpha\) –MEM and DMEM

Aruna V. Vanikar, Chetan N. Patel, Kunal S. Gupte, Umang G. Thakkar — Wed, 09 Jun 2021 00:00:00 +0000

The basic media for cell culture are \(\alpha\)-MEM and DMEM. \(\alpha\)-MEM has lesser and rather optimal glucose and amino acid concentration as compared to DMEM. In our current study we compared the individual effect of these two media on quantity, viability and immunophenotyping of AD-MSC. Adipose tissue was procured from anterior abdominal wall of healthy willing donors. It was divided equally into two tissue culture flasks with culture medium, one containing \(\alpha\)-MEM and the other containing DMEM. It was incubated in collagenase-I. Pellet was re-suspended in centrifuge tubes with phosphate buffered saline and divided into 6 equal parts. Each set was incubated separately for in-vitro generation in 6-well plates. Media were replenished on alternate days and no passaging was done. One well from each set was harvested by trypsinization, every 3^rd day. Sterility, quantity, viability and immunophenotyping (CD45^-/90⁺/73⁺) by flow cytometry were checked. We analyzed the data to determine maximum total cell count, viability, CD45^-CD90⁺ and CD45^-CD73⁺ population in \(\alpha\)-MEM and compared it with that in DMEM.

Implementing a SARS CoV2 Antigen Testing Program (COVID-ATP) in Healthcare Organisations

P. Kechagioglou — Wed, 09 Jun 2021 00:00:00 +0000

Objectives: The COVID-19 pandemic has had a profound impact on population health, with the prevalence and severity of the illness being higher in cancer patients and others who suffer from a weakened immune system. All cancer and other clinics where patients with immunosuppressive state are treated, such as transplant and rheumatology clinics, should consider routine staff and patient testing. This is because people infected with COVID-19 may have very mild or no symptoms while they can still transmit the virus to others, acting as super spreaders. The goal of the study is to determine the prevalence of SARS-CoV-2 in asymptomatic healthcare workers and patients, as well as the impact of preventative measures, at a private oncology provider in the United Kingdom. The learnings from this study are applicable to other healthcare organisations who are looking to implement a preventative testing program for SARS-CoV-2.

Study Design: In this study, Asymptomatic staff and patients entered a prospective screening program, the SARS-CoV-2 Antigen Testing Program (COVID-ATP), consisting of the nationally approved real time Polymerase-Chain-Reaction (RT-PCR) nasopharyngeal swab test looking for SARS-CoV-2 viral RNA. The program run April to December 2020, during the peak of the pandemic and covered the period of the 1st lockdown, the summer period of viral remission and the second wave in autumn/winter 2020. Here we present our results between April and October 2020.

Methods: Cancer patients were checked at specific intervals based on their treatment plan, and asymptomatic personnel working across 14 centres were tested weekly. Staff and patient adherence to infection prevention control (IPC) procedures, social distancing, clinic spacing, virtual clinics, intensive cleaning routines, and appropriate Personal Protective Equipment (PPE) use complimented the COVID-ATP testing programme.

Results: Each week, an average of 204 healthcare workers and 21 patients were tested. The prevalence of asymptomatic staff infection was 0.8% shortly after the first lockdown in April/May 2020, reduced to 0% between June/July 2020, increased to 1% in August/September and was 0.8% in September/ October 2020. Two asymptomatic patients tested positive on routine testing, towards the end of the 1st lockdown, but they carried on with treatment and they did well. Staff who tested positive on routine testing entered a period of self-isolation according to Public Health England guidelines.

Conclusions: This is the first longitudinal study in which a systematic testing programme was used to determine the prevalence of asymptomatic COVID-19 in healthcare staff and patients in a UK private healthcare group.

The asymptomatic COVID-19 prevalence in staff was comparable to the community prevalence in England at the time of testing, and the temporal prevalence reflected community prevalence trends. The protective measures taken within centres and the self-isolation of staff testing positive, resulted in lack of viral spread. The program continued until December 2020 with no increase in the prevalence of asymptomatic infections, as we entered the second wave. The introduction of mass vaccinations in England from December 2020 offered an extra protection from the virus to those vulnerable cancer patients.

Research Article: Formulation and Evaluation of Buccoadhesive Tablets of Buspirone Hidrochloride

Jignyasa Raval, Ankita Yagnik — Wed, 09 Jun 2021 00:00:00 +0000

Objective: The aim of the study was to prepare and evaluate buccal-adhesive tablets of Buspirone HCl that avoid gastric degradation and first pass metabolism, thereby increasing the drug bioavailability and onset of action. Buspirone HCl belongs to a class anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds.

Methods: In the present work, different ratios of Gantrez MS 955 along with Carbopol 934 were studied to give bioadhesive strength. A 3² full factorial design was applied to investigate the combined effect of concentration Carbopol 934 (X1) i.e. 5,7.5,10 mg and Gantrez MS 955 concentration (X2) i.e. 10,12.5,15 mg.

Results: Results of the multiple regression analysis revealed that the independent variables significantly affected the dependent variables (bioadhesive strength (Y1), Q2 (Y2), Q3 (Y3), Q4 (Y4)). On the basis of multiple linear regression analysis and contour plot evaluation, it was found that combination of two polymers possessed excellent mucoadhesive properties allowing ease of application and removal of the tablets from the buccal mucosa.

Conclusion: The formulation batch A9 fulfilled all the criteria set from the desirability search. From the in vitro diffusion study flux was calculated for the optimized batch. Study of the effect of tablet diameter and the environmental factors on the bioadhesion of the tablet was done. To study the environmental factor on bioadhesion, prehydration time and contact time were considered. Result found that increase in prehydration time decrease in bioadhesive strength and increase in contact time increased bioadhesive strength. Thus a stable Buccoadhesive formulation optimized for formulation ingredients and process parameters was prepared successfully.

Breast Cancer and Features of Molecular Genetic Subtypes in Diabetes Mellitus

V. G. Cherenkov, B. B. Frumkin, K. G. Pasevich, A. A. Ivanov — Wed, 09 Jun 2021 00:00:00 +0000

Breast cancer (BC) and diabetes mellitus are the most relevant risk and development factors in modern oncology. The paper presents the analysis of the molecular breast cancer subtypes in patients with diabetes mellitus (DM) and without diabetes. In our material it was found that patients with diabetes there is a predominance in the frequency of luminal subtypes, and less receptioni. As a result, these factors, combined with early and timely diagnosis, can increase the observed 5-year survival rate in patients with DM .But in the presence of DM with metabolic disorders, the survival rate is significantly lower. As a result, these factors, combined with early and timely diagnosis, can increase the observed 5-year survival rate in this category of patients. But in the presence of DM with metabolic disorders, the survival rate is significantly lower. There is a question of conducting opportunistic screening.

A Case Report on Meningitis-malaria Co-infection

Savadogo Mamoudou, Zoungrana Jacques, Boushab Mohamed Boushab — Wed, 09 Jun 2021 00:00:00 +0000

Introduction: Meningitis-malaria co-infection is a medical emergency.

Objective: the aim of this report is to remind clinicians of the seriousness of this co-infection Observations: Through three clinical cases, the authors draw the attention of clinicians to cases of severe bacterial meningitis and malaria co-infection. They underline the interest of the concomitant research of these two pathologies in front of a febrile meningoencephalitis picture with an alteration of the consciousness. Cerebrospinal fluid analysis and thick blood drop are essential to confirm the diagnosis. Despite management with antibiotics and antimalarials, one death was recorded.

Conclusion: Bacterial meningitis with severe malaria co-infection is not rare in our context. It constitutes an emergency of diagnosis and treatment. Its prevention requires vaccination and the use of insecticide-treated mosquito nets.