Lung cancer: risk factors, management, and prognosis

Lung cancer or lung tumor the most common cause of cancer death in men and second most common in women after breast cancer. Highest rates in North America, Europe, and East Asia, with one third of new cases in China, lower rates in Africa and South Asia. Worldwide in 2012 lung cancer resulted in 1.6 million deaths. Risk factors include smoking, exposure to radon gas, asbestos, second-hand smoke, air pollution, and geneticfactors. Pathogenesis is similar to other cancers, by activation of oncogenes or inactivation of tumor suppressor genes. Two main types of lung cancer are small-cell lung carcinoma(SCLC),and non-small-cell lung carcinoma(NSCLC) Clinical manifestation include coughing, coughing blood, weight loss, weakness, fever or clubbing of the fingernails, hypercalcemia, myasthenia syndrome (muscle weakness), and metastases. Metastatic disease includes weight loss, bone pain and neurological symptoms. Diagnosis mainly by chest radiographs and computed tomography (CT) scans. Lung cancers are classified according to histological type, staging uses TNM (tumor, lymph node and metastases) system. Management depends on cancer specific type, by surgery, radiotherapy and chemotherapy. In the U.S 16.8% survive for at least five years, in England overall five year survival less than 10%.Prevention, cessation of smoking, screening for lung cancer for those long smoking history and between 55 and 80 years. Long term intake of vitamin A,vitamin vitamin D, or vitamin E does not reduce risk of lung cancer. Higher intake of vegetables and fruit tend to lower risk. There is no clear association between diet and lung cancer

Snake-Bite Gangrene in Children: A Report of Two Cases

Snake-bite can be both life and limb threatening, especially when there is envenomation. Early intervention in a fairly equipped health facility can go a long way in preventing the morbidity and mortality that can result from delay in initiating treatment. In this paper we report two cases of snakebite to the lower limbs in children that were both complicated by gangrene which led to major limb amputation in both. These are avoidable complications that should have been averted by appropriate care immediately after the snake-bite. Key words:Snake-bite, Gangrene, Childre

Meta-analysis of genome-wide association studies from the CHARGE consortium identifies common variants associated with carotid intima media thickness and plaque

Carotid intima media thickness (cIMT) and plaque determined by ultrasonography are established measures of subclinical atherosclerosis that each predicts future cardiovascular disease events. We conducted a meta-analysis of genome-wide association data in 31,211 participants of European ancestry from nine large studies in the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. We then sought additional evidence to support our findings among 11,273 individuals using data from seven additional studies. In the combined meta-analysis, we identified three genomic regions associated with common carotid intima media thickness and two different regions associated with the presence of carotid plaque (P < 5 × 10 -8). The associated SNPs mapped in or near genes related to cellular signaling, lipid metabolism and blood pressure homeostasis, and two of the regions were associated with coronary artery disease (P < 0.006) in the Coronary Artery Disease Genome-Wide Replication and Meta-Analysis (CARDIoGRAM) consortium. Our findings may provide new insight into pathways leading to subclinical atherosclerosis and subsequent cardiovascular events

Ileocaecal TB with multiple hepatic granuloma mimicking malignancy with metastasis to liver

Introduction: Abdominal tuberculosis is a rare manifestation of  tuberculosis1. It can involve any part of the gastrointestinal tract but the most likely sites of infection are the peritoneum and the ileo-caecal region. We present unusual a case of Ileocaecal TB with multiple hepatic  granuloma mimicking malignancy with metastasis to liver.Case presentation: A 38 years old male, Sudanese, had two months history of painful tender mass in the right iliac fossa that was associated with low grade fever, constipation and loss of appetite. He had no symptoms or signs related to other systems and he denied any contact with chronic cough patient. ESR 100mm/hr, normal CXR, ultrasound revealed multiple hypoechoic liver focal lesions, multiple para-aortic Lymph node and a thick wall terminal ilium. CT abdomen showed bowel segment with wall thickening and irregular lumen in the right iliac fossa, enlarge para-aortic lymph nodes and multiple hepatic focal lesions which gave the impression of caecal carcinoma with liver metastasis. OGD was reported as normal. Colonoscopy revealed an abnormal mucosa at the caecum, suspicious of carcinoma caecum. Multiple biopsies were taken.  Histopathology revealed epithelioid granulomas with Langhans giant cells as well as areas of mild cryptitis, could be either tuberculosis or Crohns disease, Ultrasound guided liver biopsy from the focal lesions revealedepithelioid cells and poorly formed granulomas with areas of caseation and fibrosis suggestive of tuberculosis. PCR for aspirate from liver focal lesion biopsy was positive for tuberculosis. The patient was treated with  antituberculous chemotherapy. Complete cure was obtained during followup.Keywords: Abdominal tuberculosis, Ileocaecal tuberculosis hepatic granuloma

Antileishmanial and antitrypanosomal activity of symmetrical dibenzyl-substituted α,β-unsaturated carbonyl-based compounds.

Human African Trypanosomiasis (HAT) and leishmaniasis are two of the most neglected challenging tropical diseases, caused by the kinetoplastid parasites and species, respectively. For both of these complex disease spectra, treatment options are limited and threatened by drug resistance, justifying urgent new drug discovery efforts. In the present study we investigated the antitrypanosomal and antileishmanial activity of a series of 21 symmetrical α,β-unsaturated carbonyl-based compounds, each featuring two 3-methoxybenzene attached to a central cyclohexanone, tetrahydro-4-pyranone scaffold or 4-piperidone ring. Structure-activity relationships were explored with respect to substitution on positions 3, 4 and 6 of the terminal 3-methoxybenzyl groups, and seven types of central ring. Compounds and , showed broad anti-kinetoplastid activity against all species and strains tested. Compound featuring -methyl-4-piperidone was found to be the most potent analog and therefore can serve as a potential lead for the development of new drug candidates for trypanosomiasis and leishmaniasis

HLA-DRB1 as a risk factor in children with autoimmune hepatitis and its relation to hepatitis A infection

<p>Abstract</p> <p>Background</p> <p>The human leukocyte antigens (HLAs) are proteins found in the membranes of nearly all nucleated cells. People with certain HLA antigens are more likely to develop certain autoimmune diseases. The aim of this study was to determine the frequency of HLA-DRB1 in children with autoimmune hepatitis (AIH) as a risk factor for occurrence, its relation to preceding hepatitis A infection and treatment outcome.</p> <p>Subjects and methods</p> <p>25 children with AIH were subjected to HLA-DRB 1 typing performed by sequence specific oligonucleotide probe technique and compared to HLA-DRB1 found in 548 normal populations.</p> <p>Results</p> <p>The most frequent alleles found in our children with AIH were HLA-DRB1*13 (36%), HLA-DRB1*04 (18%) and HLA-DRB1*03 (14%). HLA-DRB1*13 was significantly more frequent in AIH patients compared to controls. In type I AIH patients HLA-DRB1*13 was the most frequent allele (32.4%), followed by HLA-DRB1*04 in (20.6%) and HLA-DRB1*03 in (14.7%), While in type II, the most frequent alleles were HLA-DRB1*13 in (40%), HLA-DRB1*07 (20%) and HLA-DRB1*15 in (20%). HLA-DRB1*12 was significantly more frequent in AIH patients with positive Hepatitis A IgM than in patients with negative hepatitis A IgM. No statistically significant difference between partial responders and complete responders to treatment as regards HLA-DRB1 subtypes.</p> <p>Conclusion</p> <p>It is concluded from the previous study that HLA-DRB1*13 may be a susceptibility allele for the occurrence of autoimmune hepatitis in our population. HLA-DRB1*07 and HLA-DRB1*15 may be susceptibility alleles for occurrence of autoimmune hepatitis type 2. HLA-DRB1*12 association with AIH in patients triggered by hepatitis A needs further studies.</p

Effect of gamma radiation on different stages of Indian meal moth Plodia interpunctella Hübner (Lepidoptera: Pyralidae)

Indian meal moth Plodia interpunctella Hübner is one of the most important stored products pests in the world. In this research, the effect of gamma irradiation was studied on different developmental stages of this pest and the doses required to prevent each of these developmental stages was investigated. From the results, required dose to prevent larval emergence from irradiated 1 to 24 h eggs was 400 Gray (Gy), and 400 Gy was required to prevent pupae from 15 days old larvae. Also, the dose of radiation required to prevent adult emergence from irradiated 5 days old pupa was 650 Gy. According to the results, dose of 650 Gy is adequate to control all immature stages of this pest. In addition, the effect of gamma ray was studied on developmental stage period of each irradiated existence stage till adult eclosion. The results revealed that there was a dose-dependent increase in the developmental periods, and the growth index of the adults was significantly decreased with increasing dose of radiation administered to the eggs, larvae and pupae too. It is concluded that irradiation can be used as a safe method to control stored pests.Key words: Gamma irradiation, prevention dose, developmental period, growth index, Plodia interpunctella

From the animal house to the field : are there consistent individual differences in immunological profile in wild populations of field voles (Microtus agrestis)?

Inbred mouse strains, living in simple laboratory environments far removed from nature, have been shown to vary consistently in their immune response. However, wildlife populations are typically outbreeding and face a multiplicity of challenges, parasitological and otherwise. In this study we seek evidence of consistent difference in immunological profile amongst individuals in the wild. We apply a novel method in this context, using longitudinal (repeated capture) data from natural populations of field voles, Microtus agrestis, on a range of life history and infection metrics, and on gene expression levels. We focus on three immune genes, IFN-γ, Gata3, and IL-10, representing respectively the Th1, Th2 and regulatory elements of the immune response. Our results show that there was clear evidence of consistent differences between individuals in their typical level of expression of at least one immune gene, and at most all three immune genes, after other measured sources of variation had been taken into account. Furthermore, individuals that responded to changing circumstances by increasing expression levels of Gata3 had a correlated increase in expression levels of IFN-γ. Our work stresses the importance of acknowledging immunological variation amongst individuals in studies of parasitological and infectious disease risk in wildlife populations

Predictive values of ultrasound-based scoring system in morbidly adherent placenta for high risk group

Background: The objective of the present study was to find out the predictive values of an ultrasound-based scoring system in diagnosis of morbidly adherent placenta (MAP) for high risk group. Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt.Methods: 63 full term pregnant women (≥37 weeks of gestation) with high risk of morbidly adherent placenta underwent elective cesarean section. Placental assessment by 2 D ultrasound based on ultrasound scoring system in morbidly adherent placenta, these data were recorded for further comparison with intraoperative data for degree of placental adherence.Results: Incidence of MAP was 7.93% (4.76% had a focal form and 3.17% had a complete form of accreta). As regarding to scoring system, 82.5 of cases had a low risk (< 5), 9.5% had a moderate risk (6-7) and 7.93% had a high risk (8-12) of development of morbidly adherent placenta with p value <0.0001. The sensitivity, specificity, positive and negative predictive values of the US scoring system for morbidly adherent placenta were (92.3%, 94.1%, 87.453% and 98.2%) respectively.Conclusions: Ultrasound based scoring system had a high predictive value (sensitivity, specificity, positive and negative predictive values) in diagnosis of morbidly adherent placenta for pregnant women have any risk factors for developing MAP

Impact of Safety-Related Dose Reductions or Discontinuations on Sustained Virologic Response in HCV-Infected Patients: Results from the GUARD-C Cohort.

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced ≥1 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with ≥1 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not ≥5. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin.This study was sponsored by F. Hoffmann-La Roche Ltd, Basel, Switzerland. Support for third-party writing assistance for this manuscript, furnished by Blair Jarvis MSc, ELS, of Health Interactions, was provided by F. Hoffmann-La Roche Ltd, Basel, Switzerland