Perspective of Recent Advances in Medical Research Vol. 10

Although amlodipine (AML) and hydrochlorothiazide (HCZ) have been recommended by various Hypertension Writing Groups to initiate antihypertensive therapy, it has not yet been properly investigated whether AML or HCZ would demonstrate a safer adverse events profile.  This chapter aims to evaluate whether AML or HCZ would be preferable for treating hypertensive type 2 diabetic Nigerians by comparing the adverse events profiles of the 2 drugs. Forty male (M) and female (F) newly diagnosed hypertensive subjects with controlled type 2 diabetic mellitus (T2DM) aged 43-68 years were randomized to AML and HCZ treatment groups of 20 patients each (10 Ms, 10 Fs), and they were treated respectively, with AML 10mg and HCZ 25mg, both drugs being given once daily for 48 weeks. Each subject had their body mass index (BMI) calculated. The following measurements were made: baseline, weeks 1, 3, 6, 12, 24, 36, and 48. Blood pressure (BP), heart rate (HR), and 24-hour urine volume. Additionally, from week 1 to week 48, adverse event profiles were recorded. The findings showed that The drugs significantly reduced BP, though the effect of AML was significantly greater compared to that of HCZ (P<0.01). Diuresis was significant in HCZ group (P<0.01). There were 48 adverse events (48.5%) in the AML group including weight loss and mild tachycardia. No patient had peripheral pedal edema. The majority of the 51 occurrences (51.5%) in the HCZ group were weight loss, moderate tachycardia, polyuria, myalgia/cramps, impotence, and visual impairment. Despite the fact that both medications seemed to be well tolerated, AML showed a higher ability to decrease blood pressure and had a lower incidence of side effects. In diabetic Nigerian patients with essential hypertension, it is preferable to utilise medications that provide effective blood pressure management and carry the lowest possible risk of side effects, such as AML.

Extracorporeal membrane oxygenation (ECMO) is a type of circulatory support used in patients experiencing refractory cardiac and/or respiratory failure. The primary role of such support is to provide adequate oxygenation to vital organs while managing the underlying pulmonary/cardiac pathologies. During extracorporeal support, the venous blood removed is decarboxylated, oxygenated, warmed, and infused back into the circulation. ECMO support has a variety of indications and contraindications, and its management requires expertise. Intensive care unit staff should be familiar with ECMO in order to provide the best care for critically ill patients.

The overexpression of the CD163 antigen by tumor-associated macrophages (TAMs) in the Hodgkin's lymphoma (HL) is considered to be a significant predictive biomarker for risk stratification. This is most likely due to a single nucleotide polymorphism (SNP) at the gene promoter. The goal of this retrospective case control study was to create a gene expression profile of a specific biomarker to predict the outcome and survival of patients with classical HL (CHL) in Saudi Arabia. The protein expression of CD163 was investigated using immunohistochemistry (IHC). To assess risk stratification, a prognosis index was calculated for the CD163 protein. This antigen's selected SNPs were genotyped in 100 CHL cases and controls. The analysis revealed that the CD163 protein expression level was significantly correlated with disease relapse (DR) and overall survival (OS), (P <0.001). In addition, the CD163 index threshold (15.0) was found to be significantly correlated with the relapse rate (P= 0.022). CD163 promotor SNP (rs75608120) exhibited a significant correlation with the DR (P=0.032) but not with OS. We concluded that CD163 is a specific biomarker and its overexpression by TAMs is significantly associated with DR and reduced OS.

Uterine fibroid is the most prevalent benign tumour of the reproductive age population and constitutes a major public health cost to the community in terms of out patient attendances and hospital costs for surgery of the disease.

It causes significant morbidity and is the single most common indication for hysterectomy, representing a major personal and public health concern worldwide. This tumour is also a significant cause of pelvic pain, menorrhagia, abnormal uterine bleeding, infertility and pregnancy complications.

The current definitive treatment for Uterine fibroid is hysterectomy which is not desirable in all cases of child bearing age women especially in those who want to retain their fertility or want to delay childbirth.

Some system of priority must therefore be established taking into account the social as well as the medical needs of the patients. The development of a safe, effective, and non-surgical method of treatment for Uterine fibroid would greatly benefit many women, especially those who want to retain their fertility. Women are seeking alternatives to conventional medications and surgery for the treatment of Uterine fibroid.

The impact of symptoms on health-related quality of life in the study population was assessed by using the Uterine Fibroid Symptoms and Quality of Life (UFS-QOL) questionnaire. The questionnaire consists of 8 questions addressing both the frequency and severity of symptoms, and 29 questions on health related QOL. Two distinct scores were calculated for symptom severity and quality of life. Higher symptom scores are indicative of greater symptom severity while higher QOL scores mean a better health- related QOL. Women were asked to complete the UFS-QOL questionnaire at baseline and after complete treatment.

The subjects in the Test Group resulted in decrease in UFS score and an increase in the QOL score.

Many studies have reported the application and benefits of scaling and root planning (SRP) therapy in improving clinical and biochemical oxidative stress (OS) markers in patients with chronic periodontitis. This chapter aims to determine and quantify relative percentage change in chronic periodontitis patients and propose this as a new metric in assessing SRP therapy outcomes. Individuals with generalized chronic periodontitis (CAL \(\ge\) 3mm American Academy of Periodontology 1999 criteria) were clinically (Gingival index, plaque index, probing depth, clinical attachment level) evaluated. Their systemic biochemical OS markers (TAOC, MDA) were determined. The SRP therapy was performed on them and a follow-up was done after 3 months. The results of this study demonstrated that the SRP therapy was beneficial in significantly improving (p < 0.05) both clinical and biochemical parameters from their corresponding pre-treatment values. The relative percentage change in clinical parameters ranged between 14.5% to 38.7%, and those of TAOC and MDA were -10.3% and 34.71% respectively. Further, the relative % change in TAOC and MDA showed a significant correlation (p < 0.05) to those of PI, PD, and CAL.  Also, the relative percentage change may be used as a possible quantifiable tool for the assessment of SRP therapy outcomes.

Hyperuricaemia is an independent risk factor for kidney functional decline, and its prevalence rises as estimated glomerular filtration rate (eGFR) staging progresses. The study investigated hyperuricaemia and other markers of kidney impairment in patients with chronic noncommunicable diseases in a developing economy. We retrospectively reviewed the data collected from a study conducted between January 2014 and December 2014 in which a total of 968 patients with diabetes, hypertension, cardiovascular diseases and chronic kidney disease (CKD) participated. Each subject provided blood sample, which was then tested for glucose, serum uric acid, blood urea nitrogen, serum creatinine, lipid profiles, liver enzymes, and albumin. Anthropometric measurements of each subject, including height, weight, waist circumference, age, gender, education level, occupation, and medical history with medication use, were also taken. The result of the study shows that, patients with raised serum uric acid (SUA) levels have higher mean age, systolic blood pressure (SBP), SUA, blood urea nitrogen (BUN), triglycerides, albumin, and very low-density lipoprotein cholesterol (VLDL) and lower mean value of estimated glomerular filtration rate (e-GFR) compared to patients with normal SUA levels, (P = 0.05). In addition, correlation studies between SUA, e-GFR, BUN, serum creatinine, body mass index, (BMI), waist circumference (WC) and albumin shows strong association between SUA and these parameters (p<.0001). About 223 (23.34%) of the CKD patients have raised uric acid levels and 745 (76.96%) have normal uric acid levels. Therefore, this study further documented the well-established association between hyperuricaemia and CKD. However, the measures already in place in lifestyle clinics must be maintained in order to prevent any increase in SUA levels in these patients.

Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease) is a devastating incurable disease that involves motor neuron degeneration, stimulation of immune cells and increased inflammatory mediators in the nervous system. Alpha-1-antitrypsin (AAT) and IL-23 are immuno-modulatory/anti-inflammatory proteins involved in controlling inflammation-related pathologies. The present study determines AAT and IL-23 levels in the cerebrospinal fluid (CSF) of newly diagnosed ALS patients and age-matched controls. AAT levels in CSF of ALS patients were significantly reduced by 45% (21.4µg/ml) as compared to the control group (mean 38.8µg/ml, p=0.013). The pro-inflammatory cytokine IL-23 was significantly increased by 30.8% in CSF of ALS patients (1647pg/ml) in comparison to the controls (1259pg/ml, p=0.012). Linear regression analysis revealed a negative correlation coefficient (r=-0.543) of the two measured parameters (p=0.036). The notion of neuroinflammatory process occurring in ALS patients is further supported by the present findings showing reduction in the anti-inflammatory protein AAT and elevation in the pro-inflammatory cytokine IL-23 in CSF of ALS patients. Increasing AAT levels in the patients' nervous system, particularly via intranasal administration, should be considered as a potential therapeutic approach for ALS treatment.

The present study investigated the knowledge of diabetic patients and seek the factors associated with good knowledge while providing podiatry advice.

This is a prospective cross-sectional descriptive study, involving 100 diabetic patients, followed up in the C Department of the National Nutrition Institute of Tunis (INNTA), recruited from 02 to 30 September 2019.

 We enroled 100 diabetic patients with diabetes (44 men, 56 women; age range 29-87 years). We evaluated  their knowledge on the diabetic foot, using a medical chart, as well as  their metabolic parameters.

We found that the mean age was 54±12.9 years, The sex ratio was 0.78. 56% had a high school or higher education level. 35% of the population was smokers. Diabetes was type 2 in the majority of cases (78%). The average duration of diabetes was 13.62±6.29 years. 78% of the population has been unbalanced. 34% of the population had good knowledge of preventive measures for diabetic foot. Having good knowledge of preventive measures was significantly associated with secondary or higher education (p=0.005), female gender (p=0.026) and glycemic control (p=0.043).

In concusion, the proportion of patients who were knowledgeable about diabetic foot prevention strategies was low and it didn't exceed one-third of the population. Then, Larger studies are necessary to determine the factors linked to inadequate podiatric knowledge and practises, as well as the factors that hinder adherence to advised preventive measures.

The present study evaluate and assess the visual acuity, refractive error, ocular alignment and movement, anterior and posterior segment of the eye, and other eye manifestations in cerebral palsy patients. Cerebral palsy is a term used to describe a variety of neurological disorders caused by abnormal brain development or permanent injury to brain tissue, which affects muscle tone and limb movement and results in abnormal motor function. It makes it harder for the body to move purposefully and in unison.

This is a hospital based, descriptive, cross-sectional, non-interventional study done in Navodaya Medical College Hospital and Research Centre. Duration of this study was from august 2019 to August 2020.

The result shows that spastic type of cerebral palsy was the most common. 84% of children were found to have refractive error. Hypermetropia (36%) followed by hypermetropic astigmatism (30%) was most commonly seen refractive error among these children. Alternating convergent squint (20%) was the most common form of strabismus. Ptosis (2%), nystagmus (8%) and optic nerve head hypoplasia (6%) were also found. Cortical visual impairment was found in 12% of children with cerebral palsy. Healthcare professionals need to be aware of these manifestations and the parents/guardians need to be counselled regarding the upbringing of such children so as to influence overall development of children with cerebral palsy.

Most cerebral palsy patients are found to have some ocular abnormalities. Therefore, it is necessary to conduct routine ophthalmic examinations at regular intervals to prevent complications in these kids. This will help to cater to the needs of these children ensuring their overall development.

Interleukin-6 (IL-6) has a central role in the orchestration of immune response. It is proven to have a key role in the transition from innate to adaptive immune reaction. It has both pro and anti-inflammatory properties. Normal values in serum are below 7 pg/ml. Its effects are largely dependent on the presence of its receptor (IL-6R) which is bound either on the cell surface or exists in free soluble form (sIL-6R). The binding of a small molecular weight molecule (i.e a drug) to its receptor and to HLA molecules on T-memory cells does not involve necessarily hapten presentation but can proceed very rapidly by pharmacologic interaction (p-i) activating immune mechanisms (Pichler). This in turn can activate pro-inflammatory mechanisms and start through the IL-6 release a response sequence both in vitro and in vivo. Our aim was to measure secreted IL-6 from the mononuclear cells’ supernatants after 20 minutes incubation in a large cohort of patients after both of early and late skin hypersensitivity (HS) reactions to various common drugs (43) arising from the history and compare the results with those of an appropriate control group and validate them by in vivo tests. Together 213 patients with the history of adverse effects to drugs and 48 control subjects were involved. The majority of patients (159) and all the controls’ mononuclear cells were separated and after incubation with a standard series of 0.15-0.5 µmol solutions of various drugs for 20’ together with negative and positive controls, IL-6 released into the cell free supernatants was measured by ELISA assay. The tests were correlated to the earlier diagnostic method elaborated to measure nuclear rearrangements after similarly short incubation with drugs named chromatin activation test. The exact conditions necessary for reproducible and clinically relevant results were established by comparing two groups of similar clinical phenotype composition. The method offering high sensitivity was selected out.   Sensitivity of 85.4% and specificity of 82.4% of the IL-6 release assay was found against the in vivo tests. In the molecular mass range of 76-4000 Da, IL-6 release was dependent on the clinical phenotype but not on the evoking drug(s). Reactivity of mononuclear cells at the lowest or at multiple drug test concentrations reflected clinical severity per diagnoses, or in HS cases with varying skin involvement the area, involved. The largest pharmacological subgroup causing positive test results was of nonsteroidal anti-inflammatory drugs (NSAID). Consisting of 51 patients and 9 controls, respectively was tested by 9 different non-steroidal anti-inflammatory drugs and compared with another group of patients (56 with immediate or early HS reaction in their history) using determination of specific IgE against NSAID from their sera within one year after the event. In vivo tests (patch, intradermal and oral provocations) were performed in parallel to in vitro testing. The positivity ratio of validated test results was nearly double within the IL-6 release-tested group after adverse reactions due to NSAID compounds as compared to specific IgE tested patients’ positivity in their sera (65.4% vs. 36.5%). The mechanism of IL-6 transsignaling which is behind the life threatening “Cytokine Release Syndrome” is believed to account for this novel diagnostic test.