A multi-ethnic genome-wide association study implicates collagen matrix integrity and cell differentiation pathways in keratoconus

Keratoconus is characterised by reduced rigidity of the cornea with distortion and focal thinning that causes blurred vision, however, the pathogenetic mechanisms are unknown. It can lead to severe visual morbidity in children and young adults and is a common indication for corneal transplantation worldwide. Here we report the first large scale genome-wide association study of keratoconus including 4,669 cases and 116,547 controls. We have identified significant association with 36 genomic loci that, for the first time, implicate both dysregulation of corneal collagen matrix integrity and cell differentiation pathways as primary disease-causing mechanisms. The results also suggest pleiotropy, with some disease mechanisms shared with other corneal diseases, such as Fuchs endothelial corneal dystrophy. The common variants associated with keratoconus explain 12.5% of the genetic variance, which shows potential for the future development of a diagnostic test to detect susceptibility to disease.

The Burden of Comorbidities in Cancer Patients in Southwestern Nigeria

Background: Noncommunicable diseases (NCDs) in sub-Saharan Africa are a major cause of morbidity and mortality. There is especially a paucity of data on the burden of hypertension, diabetes mellitus and other NCDs coexisting with cancer in Nigerian cancer patients. Comorbidities influence the survival of patients with cancer; lead to presentation at advanced disease stages; and result in increased risk of treatment complications, higher rates of postoperative mortality, and a greater consumption of medical resources. Aim: To determine the magnitude and pattern of comorbidities in Nigerian cancer patients. Methods: This is a retrospective study, for which data were extracted from hospital records of patients presenting for oncology care between January 2015 and December 2016 in the Departments of Radiotherapy and Oncology of two tertiary health facilities in Lagos, Nigeria. Comorbidities were identified, ranked and weighted using the Charlson Comorbidity Index (CCI). Results: Eight hundred and forty-eight (848) cancer cases were identified, with breast (50.1%) and cervical (11.1%) cancers being the most prevalent. Comorbidities were present in 228 (26.9%) patients, and the most common comorbidities were hypertension (75.9%), diabetes (25.0%), and peptic ulcer disease (7.9%). Patients with prostate (41.5%), colorectal (34.0%), cervical (25.5%), nasopharyngeal (25.0%), and breast (24.0%) cancers are most likely to have comorbidities. The mean ages of patients with comorbidities and without was 60.1 ± 11.8 years and 52.5 ± 13.7 years respectively ( P < 0.0001). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%), and ≥ 7 (0.6%). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 vs. 2.5 ± 1.9; P < 0.05) and/or surgery (2.1 ± 1.5 vs. 2.4 ± 1.7; P < 0.05). Conclusion: Comorbidities occur in at least one in four Nigerian cancer patients, and significantly influence the treatment outcome and prognosis of these patients. There is a need for a high index of suspicion and routine evaluation of cancer patients for comorbidities, with the aim of instituting appropriate and immediate multidisciplinary management measures where necessary.

Severe recurrent achalasia cardia responding to treatment of severe autoimmune acquired haemophilia

Acquired haemophilia A and severe acquired achalasia are both very rare conditions with unknown aetiology. Haemophilia A is a haemorrhagic disease induced by deficiency or malfunction of coagulation factor VIII. Congenital haemophilia is an inherited disease transmitted by the mother through X-linked inheritance and primarily affects males. However, acquired haemophilia A is a serious, sudden-onset, autoimmune disease that affects either sex. In addition, achalasia is a disease of the oesophagus caused by abnormal function of the nerves and muscles. It causes swallowing difficulties due to the inability of the lower oesophageal sphincter to relax during swallowing, leading to dysphagia, regurgitation and chest pain. In this report, we describe the case of a patient with severe, newly diagnosed, acquired haemophilia A with long-standing, recurrent achalasia; the achalasia had recurred 3 times despite complete and proper surgical fixation. Acquired haemophilia A is treated with immunosuppressive therapy. High-dose steroid therapy was administered for 7 months, during which the patient responded well; moreover, the achalasia did not recur for more than 2 years. The response of the achalasia to immunosuppressive therapy suggests that achalasia may be an autoimmune disorder and that there may be an association between both diseases. The findings of the present case suggest that achalasia may favourably respond to steroid therapy as a first-line treatment prior to surgery.