Awareness of risk factors amongst first degree relative patients with colorectal cancer

BACKGROUND

The association between family history of colorectal cancer (CRC) in first degree relatives (FDRs) and the risk of developing the disease has been well established. However, little is known about the degree of awareness of CRC risk factors amongst FDRs. This study examined awareness of familial, dietary and lifestyle risk amongst FDRs.

METHOD

Consent to approach relatives was obtained from CRC patients who attended outpatients following surgery for CRC. A study specific questionnaire was sent by post to their FDRs. The dietary and lifestyle risk factors tested in the questionnaire were those promoted in CRC educational material.

RESULTS

One hundred and four questionnaires were returned out of 137 sent (76%). Fifty-nine per cent (n = 61) of FDRs were aware of their increased risk. Fifty-five per cent (n = 57) were aware of the link between CRC and smoking; however, knowledge of association of CRC with excessive alcohol consumption (32%) and lack of exercise (40%) was less well appreciated. Higher awareness scores were obtained by those with a university education (P < 0.001). Ninety four per cent believed that relatives of CRC patients were not provided with enough information as to their being at risk and risk factors.

CONCLUSIONS

This study provides an initial assessment of the awareness of CRC risk factors in a population at increased risk. It demonstrates a poor level of knowledge. Improved education strategies allowing FDRs to make dietary and lifestyle modifications that could reduce their lifetime risk of developing CRC are necessary.

Effect of lidocaine on endothelin-1-mediated airway smooth muscle contraction in the rat trachea

BACKGROUND

Endothelin-1 (ET-1) is a 21-amino acid peptide that induces airway smooth muscle (ASM) constriction by activating G-protein-coupled endothelin receptors A (ETA) and B (ETB), thereby increasing intracellular calcium ([Ca(2+)]i). Lidocaine can cause direct ASM relaxation by decreasing [Ca(2+)]i. This study investigated the direct relaxant effects of lidocaine on ET-1-induced contraction in rat tracheas.

METHODS

Mid-tracheal rings (2-3 mm diameter) were excised and attached to a force transducer suspended in Krebs-Henseliet solution. Carbachol concentration-response curves (10 nM and 100 microM) were generated to determine maximal contractility (C(max)). ET-1 (3 nM to 200 nM) responses to lidocaine (100 nM, 10 microM, and 1 mM) were measured in the presence and absence of extracellular calcium. Contractile responses to ET-1 are presented as percentage of Cmax (% Cmax). Data were analyzed using analysis of variance and unpaired t-tests with Welsh correction.

RESULTS

No significant effect on ET-1-induced constriction was noted in the presence of low concentrations of lidocaine (100 nM and 1 muM), with and without extracellular calcium. At a concentration of 1 mM, lidocaine decreased the response to 100 nM and 200 nM ET-1 by 26% in the presence of extracellular calcium and by 37 and 44%, respectively, in the absence of calcium.

CONCLUSION

The attenuating effect of lidocaine (1 mM) on ET-1-induced ASM contraction is not exclusively dependent on the blockade of intracellular calcium entry.

Polypropylenimine dendrimer-induced gene expression changes: The effect of complexation with DNA, dendrimer generation and cell type

Polypropylenimine (PPI) dendrimers appear attractive non-viral vectors for the delivery of genes, antisense oligonucleotides, and small interfering RNA (siRNA). However, the effects of these synthetic gene delivery vectors on global gene expression are poorly understood. Here we have examined the toxicogenomics of generation 2 (DAB-8) and generation 3 (DAB-16) PPI dendrimers in two human cell lines. At concentrations and treatment protocols routinely used for gene and oligonucleotide transfection, PPI dendrimers alone elicited marked changes in endogenous gene expression in A431 epithelial cells. The extent of PPI-induced gene changes appeared to be dependent on the dendrimer generation as the number of genes affected was greater with G3 compared to G2 PPI dendrimers in A431 cells. The signature of DAB16-induced gene changes in A549 cells was different to those elicited in A431 cells implying a strong dependence on cell type. The DAB-16 polymer complexed with DNA (dendriplexes) also elicited marked gene expression changes in A549 cells but with a signature that was different from the polymer alone implying that dendriplexes are "recognised" by cells as chemical entities that are distinct from the polymer alone. Alterations in expression of a variety of gene ontologies were observed including those involved in defence responses, cell proliferation and apoptosis. Although there was a tendency for increased DNA damage in cells treated with DAB16 alone or its DNA dendriplexes as detected by the COMET assay, these differences were not statistically significant. These data show for the first time that PPI-dendrimers, separate from their capability as transfection reagents, can intrinsically alter the expression of many endogenous genes that could potentially lead to them exerting multiple biological effects in cells. The impact and consequences of polymer-induced gene changes should guide their rational use as delivery systems for gene-based therapeutics.

Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

BACKGROUND

The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.

METHODS

Within a follow-up study of preterm infants<33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.

RESULTS

Low income mothers were more compliant (54%) compared with the defaulters (31%) (P=0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients (P=0.026) and higher maternal age (P=0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association (P=0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.

CONCLUSIONS

Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.

Coding: an audit of its accuracy and implications

As part of ongoing changes undergone by the NHS in recent years, the Department of Health (DH) published new reforms proposing payment by results. This was introduced in April 2004. Under this system, providers are no longer paid by block contracts but by activity adjusted for case mix.

Diabetes and schizophrenia - effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia

OBJECTIVE

There have been innumerable advances in the pharmacotherapy of schizophrenia, but problems have emerged hand-in-glove, such as the presence of treatment-emergent glucose intolerance and frank diabetes mellitus (DM).

METHOD

Medication-naïve patients with schizophrenia (n = 99) underwent baseline fasting and 2 h post-prandial plasma glucose measurements repeated after 6 weeks after randomization to receive olanzapine, risperidone or haloperidol. The results were compared with a matched healthy control group.

RESULTS

A significant difference (P = 0.002) in baseline 2 h post-prandial blood sugar (PPBS) was noted between the control group and the treatment group along with a significant increase in weight (P < 0.001), fasting blood sugar (P = 0.01) and 2 h PPBS (P < 0.001) from baseline to endpoint between the groups. A statistical significance in the incidence of DM at endpoint by the WHO criteria (10.1%) was also noted.

CONCLUSION

Male patients with schizophrenia are liable to develop DM. Antipsychotic treatment leads to the development of DM in a significant 10.1% within 6 weeks.

Study to assess differences in outcome following open carpal tunnel decompressions performed by surgeons of differing grade

INTRODUCTION

Carpal tunnel decompression is the most commonly performed surgical procedure within a hand unit. Although very effective, the complications following the procedure can be significant. In an attempt to identify the causes of such complications, we assessed whether seniority of the surgeon impacts on outcome for open carpal tunnel decompression.

PATIENTS AND METHODS

Data were jointly and prospectively gathered from two units from either side of the Atlantic - the Pulvertaft Hand Center, UK and the Curtis Hand Center, USA. The aim of the study was to assess outcome following carpal tunnel decompression. Completed data were gathered following open carpal tunnel decompression on 352 hands. Surgeons of a consultant grade had performed 123 of these procedures whilst surgical trainees had performed 229 of the procedures. Assessment was by Levine Katz questionnaire results, Semmes-Weinstein testing, grip strength and pinch grip strength testing performed both pre-operatively and 6 months' postoperatively. Complications following the procedure were also recorded.

RESULTS

Mean results were found to be better in those patients where the surgeon was of a consultant grade. However, this was only found to be of statistical significance on Semmes-Weinstein testing. Complications following the procedure were also noted to be higher in the group of patients operated on by trainee grades.

CONCLUSIONS

Our results show the carpal tunnel decompression performed by a surgeon of consultant grade offers slightly better results in objective neurological testing when compared with those performed by a more junior grade.

An MRI derived articular cartilage visualization framework

OBJECTIVE

We present a multi-dimensional framework for the visualization of femoral articular cartilage. The framework comprises methods for visualizing and quantifying changes in cartilage thickness and surface morphology derived from MRI based cartilage segmentation. Adequate visualization of cartilage allows accurate and clinically meaningful assessment of cartilage surface morphology and thickness. In current practice the routine use of conventional 2D MR images provides limited qualitative information and is inconvenient because the imaged volume has to be reviewed slice by slice.

METHOD

A Graphical User Interface (GUI) that encapsulates the framework described above was developed. In the first stage of the analysis MR images of the knee are segmented to delineate cartilage boundaries. Cartilage thicknesses are subsequently measured. The detected points and corresponding thickness data are utilized to produce a visualization framework.

RESULTS

The system was tested using data from six example patients. The spatial distribution of cartilage on the articular surface was visualized using a 3D WearMap. The 2D WearMap allowed the entire cartilage surface to be studied at once. Quantitative interaction with the 2D WearMap was assisted by the ability to ascertain cartilage surface dimensions and TrackBack from a point of interest to the original MR image. As a result, the detection of wear patterns and lesions was efficiently carried out.

CONCLUSION

A means of quantitatively visualizing cartilage defects non-invasively is presented. This stands to reduce clinician reporting times, as well as allowing quantitative follow-up that facilitates osteoarthritis (OA) screening and planning/evaluating interventions.

Primary refractory Hodgkin's lymphoma: outcome after high-dose chemotherapy and autologous SCT and impact of various prognostic factors on overall and event-free survival. A single institution result of 66 patients

We report our experience with high-dose chemotherapy (HDC) and autologous SCT (ASCT) in 66 patients with primary refractory Hodgkin's lymphoma (PR-HL) who received salvage chemotherapy followed by BEAM as HDC. Median age at ASCT was 23 years. Before salvage chemotherapy, stages I:II:III:IV were 2:21:14:29, bulky disease 27%, involvement of mediastinum 79%, spleen 26% and extranodal site 47%, 92% had ESHAP as salvage. Post-ASCT evaluation showed response in 50 patients (76%); complete response (CR) 37 (56%), partial response 14 (21%), no response or stable disease 3 (5%) and progressive disease in 10 (15%). Another five patients achieved CR after radiation therapy and one after surgery, making total CR 43 (65%). From diagnosis and HDC, median follow-up is 38.5 and 22.8 months and median overall survival (OS) 78 and 57 months, respectively. Event-free survival (EFS) and OS are 36 and 64%, respectively. In all, 47% patients are in CR. Twenty-two patients (33%) died due to disease. Multivariate analysis showed elevated lactate dehydrogenase (LDH) for EFS (P=0.041) and mediastinal involvement for OS (P=0.038) as negative prognostic factors. In conclusion, EFS and OS are only 36 and 64%, respectively. Elevated LDH and mediastinal involvement are poor prognostic factors.

Prevalence and predictors of smokeless tobacco use among high-school males in Karachi, Pakistan

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use (gutka, snuff, niswar) was 16.1% (95% CI: 13.5%-18.9%). On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio (OR) 6.3], smoking cigarettes (OR 3.2), not seeing anti-tobacco advertisements (OR 1.5), family history of tobacco use (OR 3.9), use of betel quid (OR 2.9) and use of areca nut (OR 3.2).

Combined treatment with high-dose methotrexate and whole brain radiation improves survival in primary central nervous system lymphoma (PCNSL)

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Background: Primary CNS lymphoma (PCNSL) is an aggressive primary brain tumor, cranial irradiation alone rarely result in long term disease control or prolonged survival. We analyzed our data for the impact of adding high dose methotrexate (HDMTX) prior to whole brain irradiation (WBI). Methods: All patients with PCNSL diagnosed and managed during 1991–2004 were identified from Oncology Data Unit. Patient’s characteristics, prognostic factors, details of treatment and outcome were reviewed. Sixty-two patients were identified, 10 were excluded (4 had WBI < 40 Gy and 6 had no treatment). Radiation alone was considered curative with a dose ≥ 40 Gy. Combined modality therapy included 3–4 cycles of HDMTX (3gm/m2) followed by WBI Results: 52 patients were analyzed for outcome. 36 had WBI, dose ≥40 Gy, 16 received 3–4 cycle of HDMTX followed by WBI (chemo-radiotherapy (CRT)). Median age was 48.2 years; 42 years in CRT group, 51 years in WBI. Patients characteristics were comparable between two groups except for higher multifocal tumor in CRT group (92% vs. x22%, p=0.029). Median follow is 12.83±6.4 months. Results are shown in Table . HR for event is 0.64 (95% CI was 0.52–0.98) and for death 0.58 (95% CI was 0.48–0.92), both in favor of CRT. Univariate regression analysis using one-way analyses of variance (ANOVA) and multivariate Cox regression analysis for prognostic factors including age (< 60 vs. ≥60), ECOG PS (0–2 vs. 3–4), extent of surgery (biopsy vs. debulking), solitary vs mutifocal tumor and dose of radiation therapy (< 50Gy vs. ≥50Gy) failed to identify any prognostic factor. Conclusions: This retrospective comparison supports other phase II trials results that high dose methotrexate followed by WBI in PCNSL improves outcome.

[Table: see text]

No significant financial relationships to disclose.

Drug resistance to tuberculosis in a tertiary care setting in Karachi

OBJECTIVE

To evaluate the resistance pattern of tuberculosis cases.

METHODS

A descriptive study was done in two out patient referral clinics from January 1999 to March 2003. All TB cases that had cultures positive for mycobacterium tuberculosis were evaluated.

RESULTS

Data from 71 proven culture positive patients was available. Resistance to at least one antituberculous drug was found in 44 (60.5%) cases. Primary, Initial and Secondary Resistance to at least one drug was 7.0%, 21.1% and 32.3% respectively. Out of 7.0% primary resistance cases, there were 5.6% of single drug resistance, 1.4% Multiple Drugs and zero percent of Multi drug Resistance (MDR). Initial resistance cases (out of 21.1%) included 12.6% to single drug, 7% to multiple drugs and 1.4% MDR. Acquired Resistance Cases (out of 32.3%) included 5.6% each to single and multiple drugs and 21% MDR. Single drug resistance (for primary, initial and acquired) showed 14% resistance for Isoniazid, 4.2% for Rifampicin, 2.8% each for Ethambutol and Streptomycin and 1.4% to Pyrazinamide.

CONCLUSION

In this cohort of patients, Primary resistance to at least one drug was 7.0% and no MDR. Among individual drugs, resistance to Isoniazid was highest (14%) and lowest for Pyrazinamide (1.4%).

A technique to facilitate symmetrical and atraumatic placement of the core suture during flexor tendon repair

We present a technique aiding symmetrical accurate and atraumatic placement of the core suture during tendon repair. This technique facilitates a neat repair and avoids unnecessary contact with the tendon during the insertion of the core suture.

A chain-binomial model for intra-household spread of Mycobacterium tuberculosis in a low socio-economic setting in Pakistan

A simulation study using Greenwood's chain-binomial model was carried out to elucidate the spread and control of Mycobacterium tuberculosis among the household contacts of infectious pulmonary tuberculosis (TB) patients. Based on the observed data, the maximum-likelihood estimates (+/-S.E.) of chain-binomial probabilities of intra-household M. tuberculosis transmission from an index case in 3-person and 4-person households were 0.313+/-0.008 and 0.325+/-0.009 respectively. The chi2 goodness-of-fit test of observed and simulated mean expected frequencies of cases revealed good fit for 3-person (P=0.979) and 4-person (P=0.546) households. With the assumption of varying risk of M. tuberculosis transmission across the households under beta-distribution, goodness-of-fit tests of observed and mean simulated expected frequencies revealed the inadequacy of Greenwood's chain-binomial model both for 3-person (P=0.0185) and 4-person (P<0.001) households. Simulated M. tuberculosis control strategy comprising efficient diagnosis, segregation and prompt antibiotic therapy of index pulmonary TB patients showed a substantial reduction of new cases among the household contacts in both household sizes. In conclusion, segregation coupled with prompt antibiotic therapy of the index case, chemoprophylaxis of M. tuberculosis-exposed household contacts, and the assessment of household environmental risks to devise and implement an educational programme may help reduce the TB burden in this and similar settings.

Study to outline the efficacy and illustrate techniques for steroid injection for trigger finger and thumb

AIM

To outline the efficacy of a steroid injection in treating trigger finger. Our study defines the anatomy of the A1 pulley, and suggests methods for simple and safe flexor sheath injection for trigger finger and thumb.

METHOD

Systematic review of published literature on trigger finger and thumb and its treatment, particularly steroid injection. The use of the knowledge of the superficial landmarks of the A1 pulley with the techniques described were combined to provide a comprehensive guide to injecting steroids in patients with trigger finger and thumb.

RESULTS

Several studies are outlined, which provided evidence to suggest that a steroid injection into the flexor sheath of the affected digit is successful in treating most of the patients. Methods of identifying the superficial landmarks of the A1 pulley and of approaching the pulley without injury to surrounding structures are also outlined in the literature. Two different techniques used to infiltrate the flexor sheath were described.

CONCLUSION

Steroid injection in the flexor sheath at the level of the A1 pulley is an effective method of treating patients with trigger finger and should be considered as the preferred treatment. Specific anatomical landmarks and methods allow the procedure to be carried out without fear of inadvertent damage to surrounding structures.