Outcome of young age at diagnosis of breast cancer in South Egypt

BACKGROUND

Incidence of breast cancer in patients <40 years old accounts for 20% of the total breast cancer patients in Egypt which is quite higher than the incidence reported worldwide. This study was conducted to evaluate the differences in survival between age groups below and above the age of 40.

METHOD

170 patients <40 years and 500 patients ≥40 years were evaluated retrospectively to assess the differences in disease free survival (DFS) and overall survival (OS) between age groups after adjustment of other risk factors like stage, lymph node status, tumor size, and hormonal positivity.

RESULTS

After median follow up of 49 months, there was no significant difference between the 2 age groups with regards to DFS p= 0.6 and OS P=0.7 and there was no significant difference between the 2 groups when we stratified the patients according to stages, hormonal status and number of metastatic lymph nodes. However, we found significant increase in local recurrence after breast conserving surgery in patients <40 years compared to patients ≥40 years.

CONCLUSION

Patients <40 years exhibited more often at advanced stage and large tumors size compared to patients ≥ 40 years; However, there was no significant difference in DFS and OS when we adjusted other risk factors. Furthermore, our analysis revealed that age <40 years can be considered as an adverse prognostic factor for the locoregional failure after breast conserving surgery.

KEYWORDS

breast cancer, young age, <40 years old, locoregional failure, DFS.

The need for repeat evacuation of retained products of conception: how common is it?

Evacuation of retained products of conception with suction curettage is a widely used method for the management of missed miscarriage, incomplete miscarriage and termination of pregnancy. This procedure carries a risk of incomplete evacuation, which may lead to a further repeat evacuation. There are limited data on the incidence of repeat evacuation for suspected retained products. We undertook a retrospective audit on patients who underwent suction curettage for retained products of conception between January 2006 and February 2008, in order to evaluate the rate of repeat evacuation. Our study showed 3.1% (17 of 541) of patients underwent a repeat evacuation for suspected retained products. Suction curettage remains a safe and common procedure, however, it is important to minimise the recurrence of repeat evacuations through the use of medical management, improved training and local guidelines. This in turn should lower the risk of further complications associated with a surgical procedure.

Effect of health education on knowledge, attitude and practices of personal hygiene among secondary school students in rural Sokoto, North West, Nigeria

BACKGROUND

Personal hygiene related diseases are serious public health problems in developing countries.

OBJECTIVE

To assess the effect of health education on knowledge, attitude, and practices of personal hygiene among rural secondary school students in Sokoto state, north western Nigeria.

METHODS

A quasi-experimental controlled study with pretest and post-test design was carried out. A total 120 subjects per group were selected by multistage sampling technique. Two pre-tested instruments, structured interviewer-administered questionnaire and observer's checklist for personal hygiene practices were used for data collection. Health education intervention was carried out one week after baseline data collection and repeated after four weeks for the intervention group only. Postintervention data collection was carried out in both intervention and control groups three months after the 2nd intervention. However, for ethical consideration, the control group was also provided with the health education intervention similar to that provided to the intervention group.

RESULTS

A total of 120 and 116 subjects in the intervention and control groups respectively participated in all phases of the study. The mean knowledge score (%) of the study subjects was high and similar (73.18 +/- 25.82; 77.06 +/- 21.79; p = 0.21) in both the intervention and control groups at baseline, but differed very significantly (91.16 +/- 11.03; 81.74 +/- 21.78; p < 0.0001) at post-intervention. The mean attitude score (%) was high but differ significantly (82.6 +/- 12.73; 86.38 +/- 10.74; p = 0.01) between the intervention and control groups at baseline, and further differed very significantly (95.5 +/- 3.66; 86.90 +/- 10.44; p < 0.0001) at post intervention. The mean reported practice score (%) was high but differ significantly (94.86 +/- 3.00; 93.25 +/- 6.31; p = 0.01) between the intervention and control groups at baseline, and further differed very significantly (96.68 +/- 4.08; 93.7 +/- 6.28; p < 0.0001) at post-intervention. The mean observed practice score (%) was high and similar (57.50 +/- 29.65; 61.35 +/- 28.49; p = 0.31) in both the intervention and control groups at baseline, but differed very significantly (88.20 +/- 9.99; 62.10 +/- 26.94; p < 0.0001) at post-intervention.

CONCLUSION

Health education intervention had impact on knowledge base, attitude and practice of study subjects in intervention group compared to control group. Personal hygiene health education is therefore recommended to be taught in secondary schools.

Facial dimensions of Malay children with repaired unilateral cleft lip and palate: a three dimensional analysis

This comparative cross-sectional study assessed the facial surface dimensions of a group of Malay children with unilateral cleft lip and palate (UCLP) and compared them with a control group. 30 Malay children with UCLP aged 8-10 years and 30 unaffected age-matched children were voluntarily recruited from the Orthodontic Specialist Clinic in Hospital Universiti Sains Malaysia (HUSM). For the cleft group, lip and palate were repaired and assessment was performed prior to alveolar bone grafting and orthodontic treatment. The investigation was carried out using 3D digital stereophotogrammetry. 23 variables and two ratios were compared three-dimensionally between both groups. Statistically significant dimensional differences (P<0.05) were found between the UCLP Malay group and the control group mainly in the nasolabial region. These include increased alar base and alar base root width, shorter upper lip length, and increased nose base/mouth width ratio in the UCLP group. There were significant differences between the facial surface morphology of UCLP Malay children and control subjects. Particular surgical procedures performed during primary surgeries may contribute to these differences and negatively affect the surgical outcome.

Novel polymorphic microsatellite DNA markers from Malaysian giant freshwater prawn, Macrobrachium rosenbergii

Seven single locus microsatellite markers were characterized in Malaysian giant freshwater prawn, Macrobrachium rosenbergii from an enriched genomic library Primer pairs were designed to flank the repeat sequences and the loci characterized for this species. The bands resulting from the PCR amplifications of these eight microsatellite loci were polymorphic with the number of alleles ranging from 8 to 26 alleles per locus, whereas the observed heterozygosity ranged from 0.0641 to 0.6564. These newly developed microsatellite markers should prove to be useful for population studies and in the management of genetic variations in broodstocks of freshwater prawn, M. rosenbergii.

Fentanyl Transdermal Therapy System (TTS-Patch) for Post-Traumatic Blunt Chest Injury

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid (Remifentanil) infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System (Fentanyl TTS Patch). The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects.

Acute Myeloid Leukemia Following Treatment with Cladribine for Hairy Cell Leukemia: A Case Report and Review of the Literature

The overall survival of patients with hairy cell leukemia (HCL) has significantly increased in recent years because of the development of effective treatments such as interferon alpha and purine analogs. Several reports have described an increased risk of secondary cancers, particularly solid tumors, in patients with HCL. We describe a case of a patient with HCL, who had prolonged pancytopenia after a single course of cladribine. Fifteen months after the diagnosis of HCL the patient developed acute myeloid leukemia (AML) and died shortly afterwards. Review of the literature shows few reports of acute leukemia in HCL patients. All of the 11 reported cases of leukemia in patients with HCL have been in patients who have been treated with either interferon alpha or purine analogs, and developed several years (mean 4.3 years; range 1.6-6.4 years) after the diagnosis of HCL. Our case is unusual in that the patient developed AML shortly (1.2 years) after the diagnosis and treatment of HCL. Further studies are needed to clarify whether leukemias seen in patients following the treatment of their HCL are incidental findings or related to HCL and its treatments.

Role of fibrinolytic markers in acute stroke

INTRODUCTION

The fibrinolytic system plays an important role in normal haemostasis and endothelial function. This study was conducted to compare three fibrinolytic markers, i.e. plasminogen, tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1) between acute stroke and stable non-stroke patients and to investigate the clinical significance of these markers.

METHODS

A prospective study was done for a one-year period upon obtaining ethical approval from the local institution. 106 non-stroke individuals from general outpatient clinics (control group) and 51 acute stroke patients were selected. All subjects were tested for t-PA and PAI-1 levels using the enzyme immunoassay technique (Biopool TintElize) and for plasminogen level by colorimetric assay (HemosIL). They were followed up over a period of three months for survival and neurological recovery.

RESULTS

Only the mean t-PA level was significantly higher in acute stroke patients compared to the control group, including after adjusting for confounders (using ANCOVA). There was no statistical association between the three fibrinolytic markers and the age, gender, stroke subtypes, number of risk factors, functional impairment, survival and neurological recovery. We observed that all the eight patients who died within one month of stroke onset had high levels of t-PA. An association between high t-PA antigen and acute stroke was found during a cerebrovascular event with a 4.6-fold odds ratio compared to non-stroke controls.

CONCLUSION

High t-PA antigen in acute stroke patients probably indicates a poor prognosis. Its value as a marker for monitoring and prognostication needs to be evaluated as a routine clinical practice.