Role of human papillomavirus infection and other factors in patients with head and neck squamous cell carcinoma

OBJECTIVE

To analyse the association between high-risk human papillomavirus (HR-HPV) and other risk factors in the aetiology of head and neck squamous cell carcinoma (HNSCC) in an Asian population.

STUDY DESIGN

This study is a cross-sectional analysis of 80 patients who were diagnosed with HNSCC. Patients' demographics, dietary habit, medical and social history were obtained. Surgical specimens from these patients were then histologically analysed using H&E stain and immunohistochemistry (IHC) for the presence of HR-HPV primary antibody.

RESULTS

High-risk human papillomavirus was detected in 41 patients, representing 51.3% of the 80 paraffin-embedded tissues of HNSCC; 27.5% of these were weak positive, 10.0% medium positive and 13.8% were strongly positive for the HR-HPV on IHC. The tongue lesions had the highest HR-HPV infection of 72.2%. No association existed between HR-HPV and patient's demographics, dietary habit and other predisposing factors.

CONCLUSION

The place of HR-HPV as a possible aetiological factor for HNSCC has further been established from this study.

Antiparasitic efficacy of Artemisia absinthium, toltrazuril and amprolium against intestinal coccidiosis in goats

Various anti-protozoal dugs have been popularly used in the treatment of goat coccidiosis; however, residual effects are well noticed in host animals. The present study was undertaken with the objective to evaluate the anticoccidial efficacy of Artemisia absinthium, as a safe alternative in comparison to two conventional anticoccidial drugs (toltrazuril and amprolium) in goats (Capra hircus) naturally infected with Eimeria spp. (>5,000 oocyst per gram of faeces). Goat kids (1-3 month old, 10 kg body weight) were randomly allocated into five groups (eight kids each). Group A was negative for coccidiosis and was retained as uninfected and untreated (negative control). Group B was infected and was kept untreated (positive control). Group C was given a single oral dose of toltrazuril (Baycox 5 %) at 20 mg kg(-1) BW (IM). Group D received amprolium soluble powder 20 w/w% at 50 mg kg(-1) BW 5 days daily. Group E was given a single dose of ethanolic extract of Artemisia absinthium at 2 g kg(-1) BW. Clinical signs, body-weight gain (BWG) and number of oocysts per gram faeces (OPG) were monitored daily for 30 days post treatment (DPT). The OPG was highly reduced as early as 7 DPT and there was a marked improvement in body weight gain (7 DPT) and faster clinical recovery (3-6 DPT) in the toltrazuril treated kids compared to amprolium and Artemisia absinthium treated groups (P ≤ 0.05). In Artemisia absinthium treated kids, the oocysts continued to be in faeces up to 28th day post treatment indicating that ethanolic extract of herb was less efficacious against caprine coccidiosis as compared to amprolium and toltrazuril. From the observations of the present study it can be concluded that control of goat coccidiosis through single treatment of toltrazuril was highly effective as compared to the other two treatments. However, integrated control involving pasture management, chemical and herbal control will be a more realistic and sustainable means of controlling coccidiosis in goats. Further studies at different doses and concentrations using different solvent preparations of the plant extract are recommended to arrive at a certain conclusion about the anti-coccidial efficacy of Artemisia absinthium, which has been reported to be highly effective against other parasites in ruminants.

A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis

AIM

To measure the change in diagnostic accuracy of conventional film-screen mammography and full-field digital mammography (FFDM) with the addition of digital breast tomosynthesis (DBT) in women recalled for assessment following routine screening.

MATERIALS AND METHODS

Ethics approval for the study was granted. Women recalled for assessment following routine screening with screen-film mammography were invited to participate. Participants underwent bilateral, two-view FFDM and two-view DBT. Readers scored each lesion separately for probability of malignancy on screen-film mammography, FFDM, and then DBT. The scores were compared with the presence or absence of malignancy based on the final histopathology outcome.

RESULTS

Seven hundred and thirty-eight women participated (93.2% recruitment rate). Following assessment 204 (26.8%) were diagnosed as malignant (147 invasive and 57 in-situ tumours), 286 (37.68%) as benign, and 269 (35.4%) as normal. The diagnostic accuracy was evaluated by using receiving operating characteristic (ROC) and measurement of area under the curve (AUC). The AUC values demonstrated a significant (p = 0.0001) improvement in the diagnostic accuracy with the addition of DBT combined with FFDM and film-screen mammography (AUC = 0.9671) when compared to FFDM plus film-screen mammography (AUC = 0.8949) and film-screen mammography alone (AUC = 0.7882). The effect was significantly greater for soft-tissue lesions [AUC was 0.9905 with the addition of DBT and AUC was 0.9201 for FFDM with film-screen mammography combined (p = 0.0001)] compared to microcalcification [with the addition of DBT (AUC = 0.7920) and for FFDM with film-screen mammography combined (AUC = 0.7843; p = 0.3182)].

CONCLUSION

The addition of DBT increases the accuracy of mammography compared to FFDM and film-screen mammography combined and film-screen mammography alone in the assessment of screen-detected soft-tissue mammographic abnormalities.

Corneal confocal microscopy detects improvement in corneal nerve morphology with an improvement in risk factors for diabetic neuropathy

AIM

We have assessed whether corneal confocal microscopy can be used to detect alterations in nerve morphology following an improvement in risk factors associated with diabetic neuropathy.

METHODS

Twenty-five patients with diabetes with mild to moderate neuropathy and 18 control subjects underwent corneal confocal microscopy to quantify corneal nerve fibre (density, branch density, length and tortuosity) at baseline and after 24 months from first visit. This was not planned as an intervention trial and was simply an observational follow-up.

RESULTS

At baseline, nerve fibre density (18.8 ± 2.1 vs. 46.0 ± 3.8 number/mm(2), P = 0.001), nerve branch density (6.9 ± 1.5 vs. 35.6 ± 6.7 number/mm(2), P < 0.0001), nerve fibre length (8.3 ± 0.9 vs. 13.5 ± 0.8 mm/mm(2), P < 0.0001) and nerve fibre tortuosity (19.8 ± 1.6 vs. 22.7 ± 2.2, P < 0.05) were significantly lower in patients with diabetes than in control subjects. At follow-up, glycaemic control (HbA(1c) 64 ± 3 to 58 ± 2 mmol/mol, P = 0.08), total cholesterol (4.9 ± 0.2 to 4.2 ± 0.2 mmol/l, P = 0.01), systolic blood pressure (145.8 ± 4.9 to 135.9 ± 3.7 mmHg, P = 0.09) and diastolic blood pressure (77.8 ± 2.7 to 70.8 ± 2.5, P = 0.03) improved. Nerve fibre density (24.1 ± 2.0, P = 0.05), nerve branch density (11.1 ± 1.3, P < 0.01) and nerve fibre tortuosity (22.6 ± 1.5, P = 0.05) increased significantly, with no change in nerve fibre length (8.4 ± 0.5). Improvement in nerve fibre density correlated significantly with the improvement in HbA(1c) (r = -0.51, P = 0.008). Via four multifactorial regressions, this confirms the negative association between HbA(1c) and nerve fibre density (P = 0.02).

CONCLUSIONS

This study shows that corneal confocal microscopy may be employed in longitudinal studies to assess progression of human diabetic neuropathy and also supports the hypothesis that improvements in risk factors for diabetic neuropathy, in particular HbA(1c) , may lead to morphological repair of nerve fibres.