BASHH Scotland/Scottish HIV and AIDS group national audit 2009-2010: sexual health care for people living with HIV

A national Scottish audit of 282 patients with HIV infection attending 11 clinics showed the following levels of performance against quality improvement Scotland Sexual Health Services Standards: syphilis serology was offered in the previous six months to 55% of patients (range: 12-97% of patients in individual clinics), sexual history documented within four weeks of initial HIV diagnosis in 67% (12-100%) and offer of tests for sexually transmitted infections (STIs) documented within four weeks of HIV diagnosis in 45% (4-96%). Considerable variation in performance exists between clinics. The audit prompted interventions to further improve the sexual health care of people living with HIV infection.

Endovascular Aneurysm Repair (EVAR) for Infra-renal Abdominal Aortic Aneurysm (AAA) under Local Anaesthesia - Initial Experience in Hospital Kuala Lumpur

This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysm undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All four patients were males with a mean age of 66.7 years. Only one required ICU stay of two days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).

Molecular and Morphological Characterization of a Taxol-Producing Endophytic Fungus, Gliocladium sp., from Taxus baccata

The endophytic fungal populations of different tissues of Taxus baccata grown at high altitudes in West Bengal, India were explored. These isolated fungal populations represented different genera, which were screened for taxol production using immunoassay technique. The culture AAT-TS-4(1) that produced taxol was identified as Gliocladium sp. based on its cultural, morphological characteristics, internal transcribed spacer, and 18S rRNA sequence analysis. Kinetics of taxol production as a function of culture growth were investigated.

Aggressive and devastating neuropathy: the consequence of untreated slow-onset type 1 diabetes

Though type 1 diabetes (T1D) is described to be a disease of acute onset, there is strong evidence for a period of subclinical hyperglycaemia leading up to diagnosis. We describe two clinical cases with a prolonged and insidious onset of T1D, where neurological complications were present at the time of diagnosis. In both, there was an initial rapid and debilitating progression in neurological as well as other microvascular complications, but with a subsequent stabilization in complications over the next few years. These rare and unusual cases illustrate the variable nature of the natural history of T1D as well as its microvascular complications.

A Rare case of Intestinal Malrotation presenting as Appendicitis in Late Adulthood

Appendicitis is a common surgical condition with various clinical presentations. The diagnosis could be obscured by underlying undiagnosed anatomical anomalies like intestinal malrotation. Intestinal malrotation is a rare foetal anomaly resulting from an incomplete, or failure of midgut rotation and fixation. 85% of cases have been estimated to present in the first two weeks of life. Presentation at adulthood is rare. In cases where peritonism is elicited elsewhere other than the right iliac fossa, clinicians should bear in mind the possibility of underlying intestinal malrotation, as this could be the first presentation of this rare congenital condition.

Post Operative Analgesia for Breast Surgery: Intercostal Nerve Block Versus Subcutaneous Infiltration

BackgroundPost operative analgesia is often underestimated in breast surgery resulting in long term sequelae. Opiates and epidural analgesia may produce complications and limits early rehabilitation. We compare the effects of intercostal nerve block with subcutaneous infiltration as post operative analgesia in breast surgery.MethodsAll patients who undergo breast surgery were assigned to two groups. They either receive intercostal nerve block or subcutaneous infiltration of 0.5% bupivacaine at the end of surgery. Pain score using visual analogue scale and the total amount of morphine consumption were recorded. Personnel taking measurements were kept blind.ResultsThere were 70 patients included in the study. Of these, three patients (two from Group A and one from Group B) were excluded because of post operative haematoma and drain related complications. 33 patients had intercostal nerve block and 34 patients received subcutaneous infiltration. The groups were comparable with respect to age and type of breast surgery. There were significant differences in the visual analogue pain scores at the early post operative period in the study group (P value of < 0.05).Table 1Pain ScoreGroup A Median (range)Group B Median (range)No. of patientsP valueWith in 4 hr of surgery2 (1-8)2 (1-9)330.7521st post op 8am2 (1-6)3 (1-8)330.0091st post op 6pm2 (1-6)2 (1-10)330.0112nd post op 8am1 (1-5)2 (1-8)120.2442nd post op 6pm1 (1-4)1.5 (1-5)110.2213rd post op 8am1 (1-4)1 (1-6)90.1373rd post op 6pm1 (1-7)2 (1-4)90.347 ConclusionsWe have demonstrated in our study that intercostal nerve block provides effective post operative analgesia in breast surgery patients. The accessibility of intercostal nerves in the operative field makes blockade feasible. Contrary to the misconception, incidence of pneumothorax is very rare. It should therefore be used more widely in view of its simplicity.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5052.

A Wnt kinase network alters nuclear localization of TCF-1 in colon cancer

Constitutive activation of the Wnt/beta-catenin pathway has been implicated as the primary cause of colon cancer. However, the major transducers of Wnt signaling in the intestine, T-cell factor 1 (TCF-1) and TCF-4, have opposing functions. Knockout of TCF-4 suppresses growth and maintenance of crypt stem cells, whereas knockout of TCF-1 leads to adenomas. These phenotypes suggest that TCF-4 is Wnt-promoting, whereas TCF-1 acts like a tumor suppressor. Our study of TCF expression in human colon crypts reveals a mechanistic basis for this paradox. In normal colon cells, a dominant-negative isoform of TCF-1 (dnTCF-1) is expressed that is equally distributed between nuclear and cytoplasmic compartments. In colon cancer cells, TCF-1 is predominantly cytoplasmic. Localization is because of active nuclear export and is directed by an autocrine-acting Wnt ligand that requires Ca2+/calmodulin-dependent kinase II (CaMKII) activity for secretion and a downstream step in the export pathway. TCF-4 remains nuclear; its unopposed activity is accompanied by downregulation of dnTCF-1 and increased expression of full-length isoforms. Thus, the dnTCF-1 and TCF-4 balance is corrupted in cancer by two mechanisms, a Wnt/CaMKII kinase signal for nuclear export and decreased dnTCF-1 expression. We propose that dnTCF-1 provides homeostatic regulation of Wnt signaling and growth in normal colon, and the alterations in nuclear export and promoter usage contribute to aberrant Wnt activity in colon cancer.

The views of obstetricians in the south-west of England on the use of prostaglandins and syntocinon in VBAC

The aim of our study was to explore the views of consultant obstetricians in the south-west of England on the use of prostaglandin and oxytocin in women undergoing vaginal birth after caesarean delivery (VBAC), and assess how the perceived risk of uterine rupture in such a cohort of women affected their practice. A postal questionnaire was sent to randomly selected consultant obstetricians in the south-west of England. The response rate from the survey was 59.2%. The study showed that the willingness of consultants to use prostaglandin in VBAC was related to their length of practice. Some 89.7% of all respondents claim they would use syntocinon for augmentation in VBAC; 75% of all the responding consultants who have been in the post for longer than 10 years claim they would not use either of the agents in VBAC. We conclude that, despite concerns about the risks of increased uterine rupture in both induction and augmentation in labour of women undergoing VBAC, our study did not seem to support the fact that obstetricians' practices are influenced by this perceived risk.

The use of statins may prolong survival of non-small cell lung cancer patients: Final update from 1,205 cases

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Background: Hypercholesterolemia is one of the most common morbidities in United States. Statins have been proven as effective cholesterol-lowering agents and have been widely used in this country. They have been reported reducing the incidence and risk of various cancer types. However, the impact of using statins on the survival of 407 patients with diagnosed non-small cell lung cancer (NSCLC) was initially reported (Wang, et al. Abstract #7149, ASCO Meeting 2006). Methods: 1,233 patients with diagnosed non-small cell lung cancer were identified from the Tumor Registry at Henry Ford Health System between January 1999 and December 2004. The data from 1,206 patients were extracted from their available electronic medical records. Statistical analyses were performed and stratified for statin users versus non statin users. Results: Data from 1,205 eligible patients were included in this updated report. There were 391 patients with hypercholesterolemia, 250 of them were statin users at the time of their non-small cell lung cancer diagnosis. Average age was 68 (range 46–90) years for statin users and 65.9 (range 29–94) years for non statin users. Overall median survival of 1,205 subjects was 9.85 months. After stratifying for statin use, the median survival of statin users was 13.9 (95% C.I. 9.9 - 17.4) months while the median survival of non statin users was 9.6 (95% C.I. 8.1 - 10.4) months, with a P value of 0.0001. After having several prognostic variables (age, stage, co-morbids, other cancers, performance status, anti-cancer therapies, and serum albumin, etc.) adjusted, statin use still demonstrated protection from death with a hazard ratio of 0.74 (95% C.I. 0.59 - 0.95, P=0.017). Conclusion: The trend of survival benefit from NSCLC among statin users was shown in our previous report and it has maintained with further enhanced statistical significance in this update. Though statin use will unlikely become an independent anti-cancer regimen by itself, the choice of continuation of statin among NSCLC patients may still provide survival benefit to this population. The favorable impact of statin use on NSCLC patients is intriguing; a prospective study of co-morbidity management with statins in patients with non-small cell lung cancer is warranted.

No significant financial relationships to disclose.

Organizing and updating whole genome BLAST searches with ReHAB

In the current genomics era, protein and DNA sequence databases are continuously growing at an exponential rate. It has become increasingly important and useful to repeat similarity searches at frequent intervals, which then retrieve larger and larger sets of results. In addition, sequence similarity searches are now often performed with many sequences or even whole genomes. ReHAB (Recent Hits Acquired from Basic Local Alignment Search Tool [BLAST]) is a tool for tracking new protein hits in repeated PSI-BLAST searches. It is designed to simplify the analysis of large numbers of database matches and is therefore especially suited to comparative genomics. Results are presented in a user-friendly graphical interface with simple-to-navigate tables and new hits are indicated by highlighted text. In this paper, we describe the use of this software for organizing results from whole virus genome PSI-BLAST searches using a ReHAB database maintained at the Virus Bioinformatics Resource Centre.