Medical students and interns' knowledge about and attitude towards homosexuality

Background and Rationale:

Medical professionals’ attitude towards homosexuals affects health care offered to such patients with a different sexual orientation. There is absence of literature that explores the attitudes of Indian medical students or physicians towards homosexuality.

Aim:

This study aimed to evaluate Indian medical students and interns’ knowledge about homosexuality and attitude towards homosexuals.

Materials and Methods:

After IEC approval and written informed consent, a cross-sectional study was conducted on a purposive sample of undergraduate medical students and interns studying in one Indian medical college. The response rate was 80.5%. Only completely and validly filled responses (N = 244) were analyzed. The participants filled the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) and the Attitudes towards Homosexuals Questionnaire (AHQ). SEKHQ consisted of 32 statements with response chosen from ‘true’, ‘false’, or ‘don’t know’. AHQ consisted of 20 statements scorable on a 5-point Likert scale. Multiple linear regression was used to find the predictors of knowledge and attitude.

Results:

Medical students and interns had inadequate knowledge about homosexuality, although they endorsed a neutral stance insofar as their attitude towards homosexuals is concerned. Females had more positive attitudes towards homosexuals. Knowledge emerged as the most significant predictor of attitude; those having higher knowledge had more positive attitudes.

Conclusion:

Enhancing knowledge of medical students by incorporation of homosexuality related health issues in the curriculum could help reduce prejudice towards the sexual minority and thus impact their future clinical practice.

The increased cost of ventral hernia recurrence: a cost analysis

PURPOSE

Over 300,000 ventral hernia repairs (VHRs) are performed each year in the US. We sought to assess the economic burden related to ventral hernia recurrences with a focused comparison of those with the initial open versus laparoscopic surgery.

METHODS

The Premier Alliance database from 2009 to 2014 was utilized to obtain patient demographics and comorbid indices, including the Charlson comorbidity index (CCI). Total hospital cost and resource expenses during index laparoscopic and open VHRs and subsequent recurrent repairs were also obtained. The sample was separated into laparoscopic and open repair groups from the initial operation. Adjusted and propensity score matched cost outcome data were then compared amongst groups.

RESULTS

One thousand and seventy-seven patients were used for the analysis with a recurrence rate of 3.78 %. For the combined sample, costs were significantly higher during recurrent hernia repair hospitalization ($21,726 versus $19,484, p < 0.0001). However, for index laparoscopic repairs, both the adjusted total hospital cost and department level costs were similar during the index and the recurrent visit. The costs and resource utilization did not go up due to recurrence, even though these patients had greater severity during the recurrent visit (CCI score 0.92 versus 1.06; p = 0.0092). Using a matched sample, the total hospital recurrence cost was higher for the initial open group compared to laparoscopic group ($14,520 versus $12,649; p = 0.0454).

CONCLUSIONS

Based on our analysis, need for recurrent VHR adds substantially to total hospital costs and resource utilization. Following initial laparoscopic repair, however, the total cost of recurrent repair is not significantly increased, as it is following initial open repair. When comparing the initial laparoscopic repair versus open, the cost of recurrence was higher for the prior open repair group.

Phase II study of saracatinib (AZD0530) in patients with previously treated metastatic colorectal cancer

BACKGROUND

Src has a critical role in tumor cell migration and invasion. Increased Src activity has been shown to correlate with disease progression and poor prognosis, suggesting Src could serve as a therapeutic target for kinase inhibition. Saracatinib (AZD0530) is a novel selective oral Src kinase inhibitor.

METHODS

Metastatic colorectal cancer patients who had received one prior treatment and had measurable disease were enrolled in this phase 2 study. Saracatinib was administered at 175 mg by mouth daily for 28 day cycles until dose-limiting toxicity or progression as determined by staging every 2 cycles. The primary endpoint was improvement in 4 month progression-free survival. Design of Thall, Simon, and Estey was used to monitor proportion of patients that were progression free at 4 months. The trial was opened with plan to enroll maximum of 35 patients, with futility assessment every 10 patients.

RESULTS

A total of 10 patients were enrolled between January and November 2007. Further enrollment was stopped due to futility. Median progression-free survival was 7.9 weeks, with all 10 patients showing disease progression following radiographic imaging. Median overall survival was 13.5 months. All patients were deceased by time of analysis. Observed adverse events were notable for a higher than expected number of patients with grade 3 hypophosphatemia (n = 5).

CONCLUSION

Saracatinib is a novel oral Src kinase inhibitor that was well tolerated but failed to meet its primary endpoint of improvement in 4 month progression-free survival as a single agent in previously treated metastatic colorectal cancer patients.

Growth, Doping and Characterization of AlxGa1−xN Thin Film Alloys on 6H-SiC(0001) Substrates

Thin films of AlxGa1−xN (0.05 ≤ x ≤ 0.96) having smooth surfaces were deposited directly on both vicinal and on-axis 6H-SiC(0001) substrates. Cross-sectional TEM of Al0.13Ga0.87N revealed stacking faults near the SiC/Nitride alloy interface and numerous threading dislocations. EDX, AES and RBS were used to determine the compositions, which were paired with their respective CL near band-edge emission energies. A negative bowing parameter was determined. The CL emission energies were similar to the bandgap energies obtained by SE. FE-AES of the initial growth of Al0.2Ga0.8N revealed an aluminum rich layer near the interface. N-type (silicon) doping was achieved for AlxGa1−xN for 0.12 ≤ x ≤ 0.42. Al0.2Ga0.8N/GaN superlattices were fabricated with coherent interfaces. Additionally, HEMT structures using an AlN/GaN/AlN buffer structure were fabricated.

Effect of gender and geographic location on the expression of primary hyperparathyroidism

BACKGROUND

The effect of gender on the expression of primary hyperparathyroidism (PHPT) is not well characterized.

AIM

We therefore evaluated two Caucasian populations (US and Italian) of men and women with PHPT, matched for age and body mass index (BMI), in a cross-sectional retrospective observational study.

METHODS

We studied 74 US (23 men) and 126 Italian (42 men) patients evaluating main biochemical indices of the disease and bone mineral density (BMD) at the spine and proximal femur.

RESULTS

Mean serum calcium levels were higher both in Italian men compared to women (11.7 ± 1.22 mg/dl and 11.1 ± 0.83, p<0.01) and in Italian compared to US patients (11.3 ± 1.01 and 10.8 ± 0.58, p<0.001), with similar results for the serum ionized calcium. Mean serum PTH levels were not different either between the genders or between the countries. After controlling for BMI, the mean BMD at both the femoral neck and total hip in females US patients was significantly higher compared with Italian female patients.

CONCLUSION

Despite similar levels of circulating PTH, Italian patients have more pronounced effects of the disease as assessed by serum calcium and a more significant cortical involvement in women as assessed by BMD.

Effect of dual inhibition of the Src and insulin-like growth factor-1 receptor (IGF-1R) pathways on antitumor effects in prostate cancer (PCa)

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Background: The Src and IGF-1R axes are aberrantly activated in both PCa and the microenvironment of bone metastases. Dasatinib and BMS-754807 are clinically promising small molecule inhibitors with high potency against Src family kinases and IGF-1R, respectively. The aim of this study was to establish antitumor co-operativity by combining IGF-1R and Src blockade in a preclinical PCa model.

Methods: LNCaP and PC3 cells were used as models for androgen-dependent and independent PCa, respectively. Inhibition of Src and IGF-1R pathways was accomplished by pharmacologic agents (dasatinib against Src and BMS-754807 against IGF-1R) as well as by shRNA. Serum IGF-1 levels were measured in patients (pts) with castration-resistant PCa (CRPC) treated with dasatinib and docetaxel in a phase II trial.

Results: Src inhibition decreased proliferation of PCa cells, and migration in modified Boyden Chamber and wound assays. In contrast, IGF-1R blockade induced apoptosis (increased Sub-G1 fraction cells, Annexin-V(+) cells and PARP cleavage). Phosphorylation of Akt was partially inhibited by either drug alone and almost completely abrogated by the combination. Intraprostatic injection of shIGF-1R or shSrc PC3 cells in nude mice led to an 83% and 60% decrease in tumor size compared to control shRNA, respectively. In both cell lines, all observed antitumor effects were enhanced when dual blockade was used, relative to blocking the Src or IGF-1R pathway alone. In 9/19 (47%) pts with CRPC, treatment with dasatinib resulted in a compensatory increase of serum IGF-1 levels.

Conclusions: Dual inhibition of Src and IGF-1R is effective and complementary in PCa, mediated, in part, through inhibition of the downstream target Akt. In about half of pts treated with dasatinib, an increase in soluble IGF-1 levels was observed, indicating there is a compensatory upregulation of survival pathways that might be abrogated by dual inhibition of Src and IGF-1R. The combination of dasatinib and BMS-754807 may be a rational therapeutic approach in PCa by blocking complementary processes of tumor growth and progression.

[Table: see text]

Doping of GaN by Ion Implantation: Does it Work?

Epitaxially grown GaN by metal organic chemical vapor deposition (MOCVD) on SiC were implanted with 100 keV Si+ (for n-type) and 80 keV Mg+ (for p-type) with various fluences from 1×1012 to 7×1015 ions/cm2 at liquid nitrogen temperature (LT), room temperature (RT), and 700 °C (HT). High temperature (1200 °C and 1500 °C) annealing was carried out after capping the GaN with epitaxial AIN by MOCVD to study damage recovery. Samples were capped by a layer of AIN in order to protect the GaN surface during annealing. Effects of implant temperature, damage and dopant activation are critically studied to evaluate a role of ion implantation in doping of GaN. The damage was studied by Rutherford Backscattering/Channeling, spectroscopic ellipsometry and photoluminescence. Results show dependence of radiation damage level on temperature of the substrate during implantation: implantations at elevated temperatures up to 550 °C decrease the lattice disorder; “hot implants” above 550 °C can not be useful in doping of GaN due to nitrogen loss from the surface. SE measurements have indicated very high sensitivity to the implantation damage. PL measurements at LT of 80 keV Mg+ (5×1014 cm-2) implanted and annealed GaN showed two peaks : one ∼100 meV and another ∼140 meV away from the band edge.

Revealing the 3D internal structure of natural polymer microcomposites using X-ray ultra microtomography

Properties of composite materials are directly affected by the spatial arrangement of reinforcement and matrix. In this research, partially hydrolysed cellulose microcrystals were used to fabricate polycaprolactone microcomposites. The spatial distribution of cellulose microcrystals was characterized by a newly developed technique of X-ray ultra microscopy and microtomography. The phase and absorption contrast imaging of X-ray ultra microscopy revealed two-dimensional and three-dimensional information on CMC distribution in polymer matrices. The highest contrast and flux (signal-to-noise ratio) were obtained using vanadium foil targets with the accelerating voltage of 30 keV and beam current of >200 nA. The spatial distribution of cellulose microcrystals was correlated to the mechanical properties of the microcomposites. It was observed that heterogeneous distribution and clustering of cellulose microcrystals resulted in degradation of tensile strength and elastic modulus of composites. The utilization of X-ray ultra microscopy can open up new opportunities for composite researchers to explore the internal structure of microcomposites. X-ray ultra microscopy sample preparation is relatively simple in comparison to transmission electron microscopy and the spatial information is gathered at much larger scale.

Long-term prospective follow-up of intracranial aneurysms treated with endovascular coiling using contrast-enhanced MR angiography

BACKGROUND AND PURPOSE

Catheter angiography has been the criterion standard for follow-up evaluation of coiled intracranial aneurysms. In our center, CE-MRA has been used to evaluate aneurysm recanalization. Our aim was to investigate the feasibility and usefulness of a CE-MRA protocol for following patients with intracranial aneurysms treated with endovascular coiling.

MATERIALS AND METHODS

From September 2003 to December 2006, 134 aneurysms were treated by endovascular coiling in 124 patients by using detachable coils. These patients were followed with CE-MRA at 3 months, 15 months, and 3 and 5 years. MRAs were analyzed by 2 interventional neuroradiologists. Findings were assigned to 3 categories: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3).

RESULTS

Initially, CE-MRA demonstrated 67 (50%) complete obliterations (class 1), 57 (41.79%) residual necks (class 2), and 8 (5.97%) residual aneurysms (class 3). No patient experienced rebleed during the follow-up period. A total of 214 patient-years of follow-up were obtained (range, 0-53 months). Two (1.49%) patients died after the follow-up, and 11 (8.21%) patients were lost to follow-up. On follow-up, 76 (56.72%) patients showed stable results. Fifty-six (41.79%) aneurysms showed change in their obliteration pattern. Of these 56, 47 demonstrated recanalization and 9 (6.72%) showed further obliteration. Most of the aneurysms that showed change in their obliteration remained stable on follow-up. Only 11 (8.21% of the total and 23.4% of those who showed recanalization) patients underwent recoiling or clipping.

CONCLUSIONS

CE-MRA can be used in routine practice to follow-up aneurysm recanalization noninvasively. CE-MRA permits close-interval follow-up and may show more filling of the aneurysm neck or sac than DSA.

Squamous cell carcinoma arising in a recent plaque of discoid lupus erythematous, in a sun-protected area

Squamous cell carcinoma is a known complication reported to occur in chronic discoid lupus erythematosus in sun-exposed areas. We report a patient with systemic lupus erythematosus who developed a squamous cell carcinoma in a recent plaque of discoid lupus erythematosus in a sun-protected area. This article emphasizes the need for a very high index of suspicion for squamous cell carcinoma and repeated biopsies when discoid lupus erythematosus fails to respond to conventional therapy or there is unexplained exacerbation. Lupus (2010) 19, 210—212.

Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five-year cross-sectional study with public health implications

We assessed vitamin D nutritional status in unselected consecutive patients seeking advice on osteoporosis. The prevalence of vitamin D depletion ranged from 15-72% depending upon the cut-off levels used for serum 25-hydroxyvitamin D, and the prevalence did not change over the 5 years of the study.

INTRODUCTION

Vitamin D depletion is a significant public health problem and has been studied in different populations using different cut-off levels, but the optimal level is yet to be established.

METHODS

In a cross-sectional study of 2,924 patients seen for osteoporosis advice we determined the prevalence of vitamin D depletion, as assessed by 25-hydroxyvitamin D (25-OHD), using three different cut-off levels stratified by gender, race and the year of the study over 5 years.

RESULTS

Mean age was 68.3 +/- 10.0 years; 90% women and 88% white. Mean 25-OHD level was 24.6 +/- 10 ng/ml and mean PTH was 48.4 +/- 32 pg/ml. The prevalence of vitamin D depletion was 15% with a cut-off level of <15 ng/ml, and rose to 32% and 72% with cut-off levels <20 ng/ml and <30 ng/ml, respectively. The prevalence was higher in men and blacks and remained constant over 5 years, regardless of the cut-off level. The expected inverse relationship between 25-OHD and PTH was observed irrespective of gender or ethnicity.

CONCLUSIONS

The prevalence of vitamin D depletion in patients seeking advice for osteoporosis is high and did not change over the 5 years of the study.

Inhibition of colon tumor metastasis in an orthotopic nude mouse model with the dual selective Src/Abl kinase inhibitor, AZD0530

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Background: Colorectal cancer is the leading cause of cancer deaths in the USA, largely due to metastatic disease in the liver. The specific activity of the non-receptor protein tyrosine kinase, Src, is increased during colon tumor progression and contributes to metastasis; thus, Src inhibitors may have efficacy in the treatment of advanced-stage colon cancer. AZD0530 is a potent, orally available Src/Abl kinase inhibitor currently in clinical trials. Methods: We examined the effects of AZD0530 alone and in combination with oxaliplatin on two colon tumor cell lines, KM12L4 and LS174T in vitro and in orthotopic nude mouse models. AZD0530 inhibits in vitro proliferation and cellular migration of KM12L4 and LS174T, and decreases phosphorylation of the Src substrates FAK and paxillin in a dose- dependent manner. To examine the ability of AZD0530 to affect colon cancer growth and metastasis in a nude mouse model, we inoculated 1x106 cells into the cecum of nude mice. After 2 weeks, mice were treated with vehicle (n=12), AZD0530 alone (n=13; 25mg/kg/day by oral gavage), oxaliplatin alone (n=13; 5mg/kg/day twice weekly), or AZD0530 and oxaliplatin (n=13). Mice were sacrificed after 4 weeks of treatment. Results: Tumor incidence in all groups of mice was greater than 80%. Mice treated with AZD0530 had an average cecal tumor weight of 0.26 g compared with 0.32 g for control (P=0.24). In contrast, the incidence of liver metastases was reduced by 50% in mice treated with AZD0530 alone or oxaliplatin alone, and no mice developed pathologically evident liver metastases when the combination of inhibitors was used. Furthermore, in mice that developed liver metastases, AZD0530 decreased the size of these metastases 9-fold compared with control. Immunohistochemical analysis of primary cecal tumors demonstrated a decrease in phosphorylated Src (Y418) and FAK (Y861) in AZD0530-treated mice compared with control. Conclusions: These results support further investigation of AZD0530, both alone and in combination, as a new therapeutic strategy for the treatment of advanced colon cancer.

No significant financial relationships to disclose.