Links between socio-demographic characteristics and body mass index to colorectal cancer in North Borneo, Malaysia: A case-control study

INTRODUCTION

The fourth leading cause of cancer-related mortality and morbidity worldwide is colorectal cancer (CRC). Numerous reasons have contributed to the massive rise in CRC cases, for which Asian nations differ significantly in terms of risk incidence rates. The objectives of this study were to, first, identify the socio-demographic characteristics of those of North Borneo ethnicity and body mass index (BMI) and, second, determine the association of these factors with CRC. This research will contribute to preventing this form of cancer.

MATERIALS AND METHODS

This study is an analysis of a matched case-control study with a ratio of 1:2. The case group contained 206 respondents, and the control group contained 412. All CRC cases were confirmed with the histological results. The control group was matched for links between age, sex and ethnicity with CRC. The Statistical Package for Social Sciences Statistics (SPSS) IBM version 28.0 was used to conduct descriptive analysis using chi-squared testing and simple logistic regression. The statistical significance was P < 0.05.

RESULT

Overall, 618 respondents took part in this survey, of which 256 (41.4%) were female and 362 (58.6%) were male. The maximum age was 76, with a mean age ± SD of 53.17 ± 11.4. Those of Bajau ethnicity comprised 24.6% (152) of the population, followed by Dusun with 22.8% (141), Kadazan with 17.6% (109%), other North Borneo ethnic groups with 15.5% (96), Bugis with 9.7% (60), Brunei with 4.4% (27) and other predominant races with 5.3% (33). Regression analyses revealed that the incidence of CRC in North Borneo, Malaysia, was substantially correlated with income, occupation, other linked diseases and BMI.

CONCLUSION

Various risk factors are linked to CRC, based on the findings related to socio-demographic characteristics and BMI. Therefore, to lower the nationwide prevalence of CRC, national public health campaigns should include collaboration with the regional authorities to highlight the incidence and risk factors of CRC based on ethnicity.

Education as a protective factor for mental health risks among youth living in highly dangerous regions in Afghanistan

BACKGROUND

Children in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education.

OBJECTIVES

The objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys.

METHOD

The study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location.

RESULTS

A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health.

CONCLUSION

Attending school is essential for children's mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.

A Rare Case of Metastatic Extragonadal Yolk Sac Tumor – A Challenging Diagnosis on Cytomorphology

Introduction/Objective

Yolk sac tumors are characterized by variable histologic patterns and broad cytologic spectrum; thereby making the distinction from a poorly differentiated adenocarcinoma in a metastatic site extremely challenging. We present cytology and histology of a metastatic extragonadal germ cell tumor with predominant solid yolk sac component.

Methods/Case Report

36-year-old male presented with bilateral supraclavicular masses (right: 6 x 7 cm, left: 3 x 4 cm). CT chest and abdomen revealed large mediastinal and hilar nodal mass (11.6 cm), right hilar mass (8.5 cm), bilateral heterogeneous adrenal masses (right: 11.4 cm, left: 3.1 cm), and an enhancing retroperitoneal implant. Differential diagnoses of lymphoma, adrenocortical carcinoma, small cell lung carcinoma, and metastatic germ cell tumor were considered. Testicular ultrasound revealed no masses. Fine needle aspiration of supraclavicular lymph nodes showed highly cellular smears comprised of tumor cells, dispersed singly and in clusters, with irregular nuclear contours, increased nuclear to cytoplasmic ratio, coarse chromatin, occasional prominent nucleoli, and vacuolated cytoplasm. Tumor cells were positive for KRT7 and TTF-1, and negative for p40 and PAX8. A diagnosis of metastatic poorly differentiated carcinoma was rendered. Subsequent excisional biopsy of the lymph node showed a metastatic tumor with tumor cells similar to those seen in cytology, appearing in solid sheets with focal papillary architecture, replacing the entire lymph node. Additional immunohistochemistry showed expression of SALL4, Glypican 3, with lack of expression for OCT3/4, AFP, hCG, and CD30, supporting the diagnosis of metastatic yolk sac tumor, solid pattern.

Results (if a Case Study enter NA)

NA.

Conclusion

Aggressive clinical presentation, broad clinical differential diagnoses, rarity of a primary mediastinal yolk sac tumor, non-diagnostic cytomorphology along with expression of divergent differentiation markers (TTF-1 in our case) makes a definitive diagnosis of metastatic extragonadal yolk sac tumor extremely challenging. High index of clinical suspicion is required for a definitive diagnosis on cytomorphology.

Metastatic Common Bile Duct Melanoma Presenting as Obstructive Jaundice: A Case Report and Review

Introduction/Objective

Malignant melanomas (MM) account for 4-7% of all new cancer cases. The most common primary site is the skin, however, in 1.3% of cases, these tumors originate from the mucous membranes of the respiratory, genitourinary, and gastrointestinal tracts. The metastatic spread to the biliary system is extremely infrequent, with rare reports in the literature. Herein, we report a case of history of cutaneous MM with metastasis to the biliary tract.

Methods/Case Report

A 35-year-old Caucasian female presented with pruritis, dark urine, and jaundice. Laboratory results favored the cholestatic process (total bilirubin – 10 mg/dL, alkaline phosphatase – 500 U/L, AST- 400 U/L, ALT – 1000 U/L). She had a remote diagnosis of MM of the left chest with metastases to bilateral axillary and periclavicular lymph nodes 8 years ago. She underwent wide local excision of the skin lesion and lymph node dissection then. ERCP with direct cholangioscopy revealed a 3 x 2 cm obstructive mass in the common bile duct which was biopsied to reveal cohesive, pleomorphic, epithelioid cells containing black-brown pigment with enlarged, irregular, and hyperchromatic nuclei. These atypical cells stained strongly with SOX10 and Mart-1 immunohistochemical stains, confirming the diagnosis of metastatic malignant melanoma.

Results (if a Case Study enter NA)

NA.

Conclusion

MM is cancer that originates from melanocytes, derived from the neural crest during embryogenesis. The pathogenesis of metastatic spread to the biliary system is still unknown due to the paucity of literature describing this. Diagnosis is often difficult, with many patients completely asymptomatic or occasionally presenting with biliary symptoms. There should be a detailed history, and extensive clinical workup along with extensive histological and immunoprofile, esp. in cases with a history of cutaneous melanoma for early detection of a potential metastasis leading to adequate management.

Malignant Dural Solitary Fibrous Tumor; An Exceedingly Rare Entity

Introduction/Objective

A solitary fibrous tumor (SFT) is an extremely rare mesenchymal neoplasm, accounting for &lt;1% of all primary CNS tumors. Most SFT is dural-based and occurs predominantly in the fourth to sixth decade of life. Here, we present a case of a dural solitary fibrous tumor.

Methods/Case Report

A 28-year-old male presented with intermittent throbbing headache, nausea, and vomiting. Imaging revealed a large, well-circumscribed left parafalcine, dural-based multilobulated, solid, and cystic mass. The patient underwent craniotomy with mass resection. Preliminary intraoperative findings were of a spindle cell neoplasm. Histopathologic examination showed hypercellular neoplasm composed of the spindle to ovoid cells with a high nuclear to cytoplasmic ratio and limited intervening stroma arranged in a haphazard pattern with prominent branching staghorn vasculature. Focal areas of necrosis and mitotic counts of 8/10 high power field were also seen. The lesional cells showed focal cytoplasmic CD34 expression and strong STAT6 nuclear expression. Finally, a diagnosis of SFT, haemangiopericytoma phenotype classified as grade 3, was made.

Results (if a Case Study enter NA)

NA

Conclusion

Most SFTs are considered clinically benign (grade 1 tumors) with favorable outcomes after complete resection. However, haemangiopericytoma phenotype with hypercellularity, necrosis, and elevated mitotic count (&gt; 4/10 HPF) is known to have an increased risk of local recurrence and rare metastasis, requiring patients to receive adjuvant radiotherapy after resection for longer progression-free survival. Therefore, it is vital to be aware of this entity for optimal management and more active systemic surveillance in patients with high-grade SFT tumors. Our patient is currently doing well post-adjuvant radiotherapy and is under active annual surveillance.

over-activated p21 protein activated kinase-3 (pak3) leads to myocardial lipotoxicity and cardiac dysfunction in diet-induced metabolic stress

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

In clinics, metabolic stress-induced cardiomyopathy is featured as diastolic/systolic dysfunction, at least partially resulting from impairment of metabolic flexibility in the myocardium, which leads to lipotoxicity and oxidative stress accompanied with cardiomyocytes death. P21-activated kinases (Paks) are a family of serine/threonine kinases, involved in cell survival, proliferation and cytoskeleton remodelling. In spite of the cardioprotective functions of Pak1 and Pak2 in the myocardium, the role of cardiac Pak3 is unexplored.

Purpose

The study is to investigate the function of cardiac Pak3 on myocardial steatosis in response to diet-induced metabolic stress, which will provide proof-of-concept evidence for the therapeutic potential for alleviating cardiac dysfunction by targeting lipotoxicity in the myocardium.

Methods

Pak3 overexpression in the myocardium was achieved by tail vein injection of adeno associated virus (AAV9) delivery of troponin T promoter-driven Pak3 on C57BL/6J mice. The mice were fed with high fat high sucrose diet, the metabolic profiles and cardiac function were measured at 4-week intervals. In addition, cardiac morphological and cellular changes were assessed, including cell size, fibrosis formation, cell death, lipid accumulation and lipid peroxidation. In addition, the transcript levels of the genes either participating lipid metabolism or regulating oxidative stress were also assessed by qPCR.

Results

First, we detected that Pak3 expression and activation was increased in the myocardium from human with obese or diabetes. Consistently, the augmented Pak3 was also detected in the failing heart from C57BL/6J mice, ob/ob and db/db mice. Next, in a time-course study, the mice with AAV9-delivery cardiac Pak3 overexpression were vulnerable to cardiac dysfunction upon diet-induced metabolic stress. Pak3 overexpression did not alter cardiomyocyte size; however, more fibrosis and cell death in the myocardium were detected due to Pak3 enhancement. More importantly, myocardial lipid accumulation and profound lipid peroxidation were determined by immunefluorescent staining of Perilipin 5 (PLIN5) and 4-Hydroxynonenal (4-NHE), respectively. Finally, the abnormal expression of the genes involved in lipid synthesis and fatty acid oxidation was detected in Pak3-overexpressed myocardium under metabolic stress, whereas the levels of anti-oxidative stress genes were decreased.

Conclusion

Altogether, the study has demonstrated that Pak3 over-activation makes the heart more susceptible to myocardial lipotoxicity, which accelerates cardiac steatosis and dysfunction in the fact of metabolic stress.

Paracrine signal emanating from stressed cardiomyocytes aggravates inflammatory microenvironment in diabetic cardiomyopathy

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Cardiovascular issues associated with diabetes, such as diabetic cardiomyopathy (DCM), can lead to heart failure. DCM is etiologically related to myocardial inflammation and can stem from a complex interplay of different cell types. Cardiomyocyte as an active mediator of the inflammatory response is an emerging concept with limited mechanistic understanding.

Purpose

We aimed to address the knowledge gap of cardiomyocyte endoplasmic reticulum (ER) dysfunction-mediated macrophage response and provide functional evidence for the therapeutic feasibility of managing inflammatory paracrine signals in response to diet-induced metabolic stress.

Methods

In vivo mouse model of high fat high sucrose diet-induced diabetes, cardiomyocyte-specific p21-activated kinase 2 (PAK2) knockout model, echocardiography, histology, 3D imaging, qPCR, co-culture of H9c2 culturing medium and bone-marrow derived macrophages, immunoblotting, macrophage isolation from myocardium, flow cytometry and AAV9-gene therapy.

Results

In a time-course study, diet-induced diabetic mice demonstrated an association between cardiac ER stress and sustained myocardial inflammation, with a maladaptive shift in myocardial ER stress response over time. Furthermore, as a cardiac ER dysfunction model, mice with cardiac-specific PAK2 deletion exhibited heightened myocardial inflammatory response in diabetes. Using human and mice diabetic heart samples, we show that ER stress-induced CCAAT/enhancer-binding protein homologous protein (CHOP) is a novel transcriptional regulator of high mobility group box-1 (HMGB1). Cardiac stress-induced active release of HMGB1 facilitated M1 macrophage polarization, and aggravated myocardial inflammatory signatures. Therapeutically, sequestering the extracellular HMGB1 using Glycyrrhizin conferred cardioprotection through its anti-inflammatory action. Also, as functional evidence, we showed that un-mitigated cardiac ER response due to PAK2 loss under diabetes may account as a barrier for leveraging the anti-inflammatory potential of Vildagliptin.

Conclusion

Collectively, we introduce an ER stress-mediated cardiomyocyte-macrophage link, altering the macrophage response in the myocardium, thereby providing insight into therapeutic prospects for diabetes-associated cardiac dysfunction.

Fracture toughness and fractal analysis of ceramic benchmark materials

Previous studies have reported various methods of measuring the fracture toughness of brittle ceramics. The purpose of the present research was to use a new method of fractal dimension measurement on benchmark materials (silica glass, Viosil SX, Shin-Etsu, n = 13, and silicon nitride standard reference material, SRM2100, NIST, n = 10), to compare the fracture toughness calculated using different methods, and to study the effect of noise filtering on the fractal dimension and fracture surface roughness. Fracture toughness was determined using surface crack in flexure method according to ASTM C1421 and fractal analysis method. Fractal dimension was determined using the Minkowski Cover algorithm on atomic force microscope scans of epoxy replicas of fracture surfaces. The mean ± standard deviation of fracture toughness using surface crack in flexure method and fractals method were 0.97 ± 0.18 MPa·m1/2 and 1.03 ± 0.07 MPa·m1/2 for silica glass and 4.62 ± 0.14 MPa·m1/2 and 2.54 ± 0.07 MPa·m1/2 for silicon nitride, respectively. The mean ± standard deviation of fractal dimension was 2.17 ± 0.03 for silica glass and 2.13 ± 0.01 for silicon nitride. The mean ten-point roughness (Rz) before and after noise filtering was 89 ± 102 nm and 87 ± 101 nm for silica glass and 355 ± 132 nm and 357 ± 134 nm for silicon nitride, respectively. Noise filtering had no significance on the fracture surface roughness of the two materials. The newly developed fractal analysis method can be used to predict the baseline fracture toughness of specimens with unknown failure stress.

AB1421 IMPACT OF HOSPITALIZATION ON CLINICAL OUTCOMES IN PATIENTS WITH CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE (CTD-ILD) - A SINGLE CENTER OBSERVATIONAL STUDY

Background

Interstitial lung disease(ILD) is major cause of morbidity and mortality in patients with connective tissue disease (CTD). Hospitalization is being increasingly recognized as poor prognostic indicator in these patients.

Objectives

The objective of our study was to assess the impact of hospitalization on clinical outcomes in patients with CTD-ILD.

Methods

We conducted a retrospective chart review of patients with radiologically or biopsy proven ILD associated with rheumatologist diagnosed CTD who were seen at Montefiore Medical Center between January 2007 and December 2018. Patients with age>18 years who had either 2 CT scans of the chest and/or 2 sets of pulmonary function tests (PFT) atleast 6 months apart were included in the study. Clinical demographics, cause of hospitalization, length of stay, use of immunosuppression and mortality were identified. Patients were stratified into 2 cohorts; non-hospitalized and hospitalized patients. The latter cohort was further sub-stratified into patients with cardiopulmonary vs. non-cardiopulmonary hospitalization (Figure 1). Two-sample t-tests and Wilcoxon’s rank sum tests were used for comparing the continuous variables. Chi-square tests and Fisher’s exact tests were used for comparing the categorical variables as appropriate. Kaplan-Meier method was used for calculating the survival probabilities, and log-rank tests were used to compare differences between the groups.

Results

During the study period, we identified 213 patients with CTD-ILD using ICD 9/10 code. Of the 213 patients, 96 met our inclusion criteria and 73 (76%) had at least 1 hospitalization (Figure 1). Both groups were similar in baseline clinical characteristics but we identified significantly higher transplant referrals in the hospitalized group(23.9%) vs. non-hospitalized group(0%) (Table 1). Overall rheumatoid arthritis (29.2%) was the most common CTD associated ILD followed by inflammatory myositis (21.9%) and scleroderma (14.6%). Median time from diagnosis of ILD to first hospitalization was 1.42 years.

Table 1.

Baseline Characteristics of patients with CTD-ILD

CharacteristicEntire Cohort (n = 96)Patients with CTD-ILD and hospitalization (n = 73)Patients with CTD-ILD and no hospitalization (n = 23)p-valueAge(mean ± SD)54.15 ± 13.9754.82 ± 13.7752.00 ± 14.710.40Female, n (%)76 (79.2)56 (76.7)20 (87.0)0.39Race, % (n)0.10 Black38 (39.6)31 (42.5)7 (30.4) White4 (4.2)3 (4.1)1 (4.4) Others54 (56.2)39(53.4)15(65.3)Ethnicity, % (n) (Hispanic)44 (53.7)35 (53.0)9 (56.3)0.82Former or active smoker, % (n)41 (42.7)34 (46.6)7 (30.4)0.17Pulmonary hypertension, % (n)28 (31.1)24 (33.3)4 (22.2)0.36FVC, n (%)0.37Moderately severe(47.1-64.2)37 (44.6)26 (40.6)11 (57.9)Severe(24.3-47.0)7 (8.4)6 (9.4)1 (5.3)DLCO, n(%)0.30Moderate26(31.7)23(37.1)3(15.0)Severe25(30.5)17(27.4)8(40.0)Immunosuppression, n(%)78 (81.3)59 (80.8)19 (82.6)1.00Transplant referral, n(%)17 (18.3)17 (23.9)0 (0)0.01

The patients hospitalized for cardiopulmonary cause were significantly older(57.2 ±13.1 years) than those admitted with non-cardiopulmonary cause(49.2±14.8 years)(Mean±SD). Older age (HR 1.95, p=0.02) and length of stay greater than 7 days for cardiopulmonary cause(HR 4.82,p=0.01) was associated with higher risk of mortality.

Kaplan Meier curve analysis showed that hospitalization (p-value=0.02) was associated with statistically significant increased risk of death.

Conclusion

-Hospitalization in CTD-ILD patients especially length of stay more than 7 days due to cardiopulmonary causes was associated with statistically significant increased risk of death.

Male gender and older age was associated with a worse prognosis in patients who were hospitalized.

References

[1]Ratwani AP, Ahmad KI, Barnett SD, Nathan SD, Brown AW. Connective tissue disease-associated interstitial lung disease and outcomes after hospitalization: A cohort study. Respiratory Medicine. 2019;154:1-5. doi:10.1016/j.rmed.2019.05.020

Disclosure of Interests

None declared

Reducing mortality in mucormycosis of the head and neck in diabetic patients: A CARE case series

INTRODUCTION

Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality.

CASE SUMMARY

We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control.

DISCUSSION

Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

Mechanical and release behaviour of theophylline from matrix tablets containing psyllium powder in combination with grewia polysaccharides

This study was aimed at investigating the effect of grewia polysaccharides on the mechanical and release properties of tablet matrices containing binary mixtures of the polysaccharide with psyllium. Two grades of grewia polysaccharides (GG and GDS) were extracted and binary mixtures of the polysaccharides with psyllium were formulated into tablet matrices containing theophylline as the model drug. The true, bulk and tapped densities, Carr's compressibility index of the powders and binary composites were determined before tablet compression. Tablet properties (hardness, porosity, and drug release from the matrices) were investigated. The dissolution test was carried out in 0.1 M HCl (pH 1.2) and phosphate buffer (pH 6.8). The results show that GG and GDS produced tablets with good mechanical strength (108.33 N and 95.70 N, respectively) while psyllium produced softer tablets (7.13 N). The combination of psyllium and grewia polysaccharides in the matrices resulted in a significant increase in the mechanical strength of the matrices when compared to matrices containing psyllium alone as the matrix former. The results also showed that GG and GDS reduced the dissolution rate and effectively eliminated the burst release of theophylline from the psyllium matrices at both pHs. The matrices of GG or GDS and the binary mixtures conform to non-Fickian anomalous diffusion with n > 0.45. When overcoming the burst release of drug from matrices such as psyllium, grewia polysaccharides may provide an effective reduction and a more sustained drug release from such matrices.

Socioecological differences in factors associated with inconsistent condom use with female sex workers and casual partners: an observational study of heterosexual men attending an anonymous HIV testing clinic in Singapore

Sexual practices among heterosexual men may differ between female sex workers (FSWs) and casual partners. We surveyed 203 heterosexual men and investigated the attributes associated with inconsistent condom use among them. Lower educational attainment was positively associated with inconsistent condom use with FSWs (adjusted prevalence ratio (aPR) 2.63; P = 0.018) and casual partners (aPR 1.55; P = 0.022), whereas early age of sexual debut (aPR 3.00; P = 0.012) and alcohol use during sex (aPR 7.95; P < 0.001) were positively associated with inconsistent condom use with FSWs. Socioecological factors may explain such differences.

Survivourship Issues As Determinants of Quality of Life After Breast Cancer Treatment: Report From a Limited Resource Setting

Background: Cancer survivorship is an unremitting struggle for breast cancer patients, as the consequence of complex treatment processes and its multitude of residual and late emerging side effects, have a significant impact on their quality of life (QOL). Unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being of women. Amid a growing population of breast cancer survivors (BCs) worldwide, supportive care research is assuming greater importance in breast cancer care. Focus of survivorship research is to identify issues impacting QOL of the cancer survivors so that supportive care services can be tailored to their specific needs. Role of individual survivor's issues have been widely reported but a comprehensive picture is lacking. Aim: This study was conducted with the aim to identify important survivorship issues adversely affecting QOL of women after breast cancer treatment. Main objectives were to (1) estimate prevalence of various survivorship issues (2) assess QOL of survivors by using FACT-B and SF-36 questionnaires (3) study impact of time elapsed since treatment on survivorship issues and QOL scores (4) identify most important issues from the perspective of impact on QOL. Methods: This descriptive, hospital based, cross sectional study was conducted in 230 breast cancer survivors and a group of 112 healthy age-matched-controls, in an academic healthcare setting in northern India. A checklist of 14 commonly reported survivorship issues, and questionnaires for QOL assessment were administered to participants. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment (< 2 year follow-up, 2-5 year follow-up and > 5 year follow-up) (2) association of survivorship issues with QOL scores (3) stepwise regression analysis to identify issues with most significant impact on QOL of survivors. Results: Breast cancer survivors showed an improvement in their QOL over time which was sustained in long term survivors. However their quality of life remains poorer, compared with healthy women, irrespective of the duration of follow-up. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). However the issues which had maximum adverse effect on QOL scores were emotional distress, fatigue, postmastectomy chronic pain, cessation of menstruation, body and joint pain, vaginal dryness and sleep disturbances. Conclusion: Thus in this study, emotional distress and cancer related fatigue were found to be the chief determinants of poor QOL. Further premature menopause, with its attendant systemic symptoms, vulvo-vaginal atrophy and sexual dysfunction emerged as a key contributor to poor QOL in BCs.

Organochlorine Pesticides Exposure as a Risk Factor for Breast Cancer in Young Women: A Case Control Study

Background: Young women (< 40 years) constitutes about 10%–25% of total breast cancer cases in south-Asian women and an increase in incidence rates have been noted in the recent past. It is higher compared with their western counterparts, where rates of 5%–10% are reported. Younger women usually present with more aggressive tumor and poorer prognosis, suggesting that breast cancer in young women represents a distinct entity. Exposure to environmental estrogens such as organochlorine compounds in pesticides and industrial chemical has been proposed to be a risk factor for breast cancer. There is rampant use of pesticides in farming in south-Asian countries. However the associations between organochlorine compounds and breast cancer risk, reported in different studies has been inconsistent. Hence this study was planned with the objectives to assess the serum levels of organochlorine compound and the presence of other risk factors in north Indian population of young women diagnosed with breast cancer. Aim: To assess the serum level of organochlorine compounds and the other risk factors in north-Indian population of young women diagnosed with breast cancer. Methods: This case control study was conducted at UCMS & GTB Hospital, Delhi, India in 42 patients of breast cancer ≤ 40 years age and 42 age-matched-controls. The study subjects were evaluated for various known risk factors such as family history of breast or ovarian cancer, age of menarche, number of pregnancies and abortions, duration of breast feeding, oral contraceptive intake, obesity, benign breast disease & biopsy, etc. Study subjects were also evaluated for exposure to environmental pollutants by performing of assays of twelve different organochloride pesticides in their blood samples. Genetic analysis also done to look for polymorphisms of genes: BRCA1 at Q365R, BRCA2 at 6174delT and p53 at 216 location. Results: Significant association was seen between serum level of β- HCH, heptachlor, dieldrin, p,p'-DDE and risk of breast cancer in young women in our patient population. Significant association was also found between early age of menarche, obesity, BRCA 2 and p53 gene polymorphism as risk factors for breast cancer. Conclusion: Exposure to organochlorine pesticides could be an important modifiable risk factor, responsible for an increase in the rates of breast cancer in younger women. Polymorphism of p53 at 216 location & BRCA2 at 6174delT could be independent susceptibility marker in younger women with breast cancer. Larger studies are required to validate these results.

Examples of dynamic chirality in nuclei

In many cases the chirality was almost observed but the transition probabilities are different. This fact is clearly seen in the cases of 134Pr and 102Rh. In the case of chirality, the yrast and the side bands should be nearly degenerate. In the angular momentum region where chirality sets, the B(E2) values of the electromagnetic transitions deexciting analog states of the chiral twin bands should be almost equal. Correspondingly the B(M1) values should exhibit staggering. Our lifetime measurements in the cases of 134Pr and 102Rh and the theoretical analysis do not support static chirality. Chirality has mainly a dynamical character in both nuclei. In the present paper, we compare our results with the results for other chiral candidate nuclei, which fulfill static chirality conditions.

Chikungunya outbreak in Delhi, India, 2016: report on coinfection status and comorbid conditions in patients

Chikungunya fever is a major public health issue in India affecting billions. After 2010, the infection was in a decline until in 2016, when a massive outbreak affected the country. In this report, we present serologic and molecular investigations of 600 patient samples for chikungunya and dengue viruses along with clinical and comorbidity features. We recruited 600 patients during this outbreak and evaluated them for chikungunya and dengue virus antibodies and virus RNA through IgM, NS1 antigen and quantitative real-time PCR (qPCR). We further evaluated Zika virus RNA by qPCR. Additionally, we documented all clinical and comorbid features that were observed during the outbreak in the hospital. We report a total incidence rate of 58% of chikungunya during the outbreak in our hospital. Within the recruited patients, 70% of the patients were positive for chikungunya virus IgM whereas 24.17% were positive by qPCR. None of the samples was positive for Zika virus RNA. Additionally, coinfection of dengue and chikungunya was seen in 25.33% of patients. Analysis of clinical features revealed that 97% of patients had restricted movements of the joints with other features like swelling, itching and rashes of varying severity observed. Twelve patients presented with comorbid conditions, and two fatalities occurred among these comorbid patients. The high incidence of coinfection in the current outbreak warrants implementation of routine testing of both chikungunya and dengue virus in suspected patients for better patient management. The post-acute phase complications reported in the hospitals require in-depth studies to understand the actual impact of the current outbreak.

Deranged regulatory T-cells and transforming growth factor-β1 levels in type 1 diabetes patients with associated autoimmune diseases

Aim:

This study was designed to enumerate regulatory T-cells (Tregs) and estimate transforming growth factor-β1 (TGF-β1) levels in type 1 diabetic (T1D) patients with respect to disease duration and associated autoimmune diseases.

Methods:

One hundred and fifty patients and twenty healthy controls were recruited in the study. The patients were subcategorized into eight categories on the basis of disease duration (new onset [NO] and long standing [LS]) and associated diseases, i.e., celiac disease (CD) and autoimmune thyroid disease (AiTD). Treg cells were assessed as CD4⁺ CD25^hi+, FOXP3⁺ cells and serum TGF-β1 levels were assessed by ELISA.

Results:

The frequency of Tregs and levels of TGF-β1 were significantly increased in the patients compared to the healthy controls. Among the different categories of the patients, no significant differences were seen for TGF- β1 levels, but for Tregs in patients with T1D and AiTD (P = 0.035). A significant correlation was also found between percentage count of Tregs and TGF-β1 levels in NO cases in all disease subcategories, but not in LS patients.

Conclusion:

Thus, there was an increased percentage of Tregs and serum levels of TGF-β1 in T1D patients, irrespective of the disease duration and associated autoimmune diseases. The significant correlation in these two parameters at the onset of the disease, but not in LS disease, indicates that the immunological milieu in LS autoimmune diseases is more complicated with disease-associated conditions such as prolonged hyperglycemia, insulin therapy, and/or continued gluten in diet. Treatment and modulation of these long-term complications for improving immunological parameters require further research.

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

In certain regions of the United States in which organ donor shortages are persistent and competition is high, recipients wait longer and are critically ill with Model for End-Stage Liver Disease (MELD) scores ≥40 when they undergo liver transplantation. Recent implementation of Share 35 has increased the percentage of recipients transplanted at these higher MELD scores. The purpose of our study was to examine national data of liver transplant recipients with MELD scores ≥40 and to identify risk factors that affect graft and recipient survival. During the 12-year study period, 5002 adult recipients underwent deceased donor whole-liver transplantation. The 1-, 3-, 5- and 10-year graft survival rates were 77%, 69%, 64% and 50%, respectively. The 1-, 3-, 5- and 10-year patient survival rates were 80%, 72%, 67% and 53%, respectively. Multivariable analysis identified previous transplant, ventilator dependence, diabetes, hepatitis C virus, age >60 years and prolonged hospitalization prior to transplant as recipient factors increasing the risk of graft failure and death. Donor age >30 years was associated with an incrementally increased risk of graft failure and death. Recipients after implementation of Share 35 had shorter waiting times and higher graft and patient survival compared with pre-Share 35 recipients, demonstrating that some risk factors can be mitigated by policy changes that increase organ accessibility.

Nickel oxide nanowires: vapor liquid solid synthesis and integration into a gas sensing device

In the field of advanced sensor technology, metal oxide nanostructures are promising materials due to their high charge carrier mobility, easy fabrication and excellent stability. Among all the metal oxide semiconductors, nickel oxide (NiO) is a p-type semiconductor with a wide band gap and excellent optical, electrical and magnetic properties, which has not been much investigated. Herein, we report the growth of NiO nanowires by using the vapor liquid solid (VLS) technique for gas sensing applications. Platinum, palladium and gold have been used as a catalyst for the growth of NiO nanowires. The surface morphology of the nanowires was investigated through scanning electron microscopy to find out which catalyst and growth conditions are best for the growth of nanowires. GI-XRD and Raman spectroscopies were used to confirm the crystalline structure of the material. Different batches of sensors have been prepared, and their sensing performances towards different gas species such as carbon monoxide, ethanol, acetone and hydrogen have been explored. NiO nanowire sensors show interesting and promising performances towards hydrogen.

Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents

The direct-acting antivirals (DAAs) constitute an emerging group of small molecule inhibitors that effectively treat hepatitis C virus (HCV) infection, a common comorbidity in end-stage renal disease patients. To date, there are no data to guide use of these agents in kidney transplant patients. The authors collected data from 20 consecutive kidney recipients treated with interferon-free treatment regimens for HCV at their center: 88% were infected with genotype 1; 50% had biopsy-proved advanced hepatic fibrosis on their most recent liver biopsy preceding treatment (Metavir stage 3 fibrosis [F3] or F4); and 60% had failed treatment pretransplantation with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation. All patients cleared the virus while on therapy, and 100% have achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were used, with comparable results. The DAAs were well tolerated, and less than half of patients required calcineurin inhibitor dose adjustment during treatment. Eradication of HCV infection with DAAs is feasible after kidney transplantation with few treatment-related side effects.