PROPORTION OF TYPE 2 DIABETES AMONG PATIENTS WITH UPPER TRACT UROLITHIASIS

Introduction: All industrialized nations are currently witnessing a steep rise in the incidence of urinary stone diseases, which closely follow the trends of obesity, metabolic syndrome, and type 2 diabetes. Aims: To nd the proportion of Type 2 Diabetes among patients with upper tract urolithiasis. Material & methods: The present study was a Cross-Sectional study. This Study was conducted from July 2021 to June 2022 at Department of Urology, Government Medical College, Thiruvananthapuram. Total 285 patients were included in this study. Result: In the serum prole of 285 patients, statistically signicant differences were found in the values of S. Creatinine (p<0.001), S. Calcium (p=0.029) and Fasting Blood Sugar (p<0.001). Urea (p=0.025) and uric acid (0.012) also showed statistically signicant differences in the two groups. Conclusion:In the current global scenario, obesity and type 2 diabetes are considered as epidemic. Both of them are considered as independent risk factors for nephrolithiasis

Arterial hypertension, cognitive decline and cerebrovascular damage

Introduction

Arterial hypertension has been associated with increased risk of cognitive dysfunction (CD) and dementia explained by the onset of cerebral microvascular disease. However, it is not well known which are true markers of cognitive decline and how to demonstrate them.

Purpose

We aimed to evaluate cognitive functions and study microvascular disease with cerebral localization in hypertensive patients.

Methods

Patients over 50 years with arterial hypertension were included. Cognitive status was assessed by using the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) tests. We selected 50 patients in two groups: 25 patients with mild CD (MoCA &lt;26 points, MMSE &gt;24 points), respectively 25 patients without CD (MoCA ≥26 points, MMSE ≥24 points). In these groups, magnetic resonance imaging (MRI) using GE Optima MR450w 1.5 Tesla of the brain was performed. MRI images with the RadiAnt program were studied and ImageJ was used to measure the area of the thalamus with a method developed by our team, by calculating the total area and hyperintense areas (microvascular damage) in number of pixels. For statistical analysis IBM-SPSS v.26 program was used.

Results

585 consecutive hypertensive patients were enrolled, mean age 67.9±9.5 years, 52.1% women, mean blood pressure 135/80±20/11 mmHg (with antihypertensive treatment). The MoCA test identified cognitive impairment in 66.1% of participants (mean scores 20.66±3.9) while the MMSE in 17.1% (mean scores 20.64±3.0). In the subgroup of 50 patients, the mean age was 70.9±5.5 years for the CD group and 69.9±3.9 years for the group without CD (p=0.4, between 59–79 years). No significant difference was detected between groups in mean blood pressure, ambulatory blood pressure, and hypertension duration (18.0±12 years vs. 17.7, p=0.9). Cerebrovascular disease was detected in 48 patients by brain MRI. There was no statistically significant difference between the two groups. The most frequent changes were white matter hyperintensities in 89.6%, enlarged perivascular spaces in 77.1%, and lacunar infarcts in 52.1%. In three cases silent brain infarct was unmasked. In 45 patients, we applied the modified measurement of the thalamic area and a statistically significant difference was detected in the right thalamus area in patients with CD (p=0.009) compared to patients without CD (on the left side p=0.058).

Conclusions

CD and cerebral microvascular changes were frequently present in hypertensive patients with associated cardiovascular disease in the studied group. At the level of the thalamus with the method developed by our team, we demonstrated that microvascular alterations on the right side are associated with cognitive decline. The methodology developed for the quantitative measurement of the injured thalamic area proved to be objective and repeatable. The innovative method, the analysis of imaging data with pixels is a promising way to continue the research.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Academy of Science

Geometrical changes of the left ventricle and cognitive impairment in hypertensive patients

Funding Acknowledgements

Type of funding sources: None.

Introduction

 From the view of the heart-brain axis, several biomarkers have been suggested for the assessment, eventually for the prevention of cognitive impairment. Remodeling of the left ventricular (LV) structure could be such a marker. Purpose: This study aimed to investigate the relationship between cognitive functions and left ventricular geometrical structure. Methods: We enrolled 512 consecutive hypertensive patients (mean age 68 ±9.5 years, females: 51%, males 49%), the mean blood pressure was 135/81 mmHg (±19/11 mmHg). Cognitive abilities were measured with two questionnaires the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), considering cognitive impairment under 24 and 26 points respectively. Measures of the left ventricular structure were performed with transthoracic echocardiography using left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT). Cut off value for LV geometrical changes were: LVMI 115 g/m2 in males and 95 g/m2 in females and RWT 0.42 mm. IBM SPSS v20. was used for statistical analyses. Results: Normal geometry of LV was present in 7.4% and remodeling of LV in the studied group was: concentric remodeling in 16.8%, concentric hypertrophy in 61.9% and eccentric hypertrophy in 13.9%. Lower MoCA scores were observed in LV hypertrophy (22.6 vs. 23.4, p = 0.08). Patients with LV concentric hypertrophy had significantly lower cognitive scores compared to eccentric hypertrophy (mean MoCA 22.4 vs. 23.8 p = 0.02; mean MMSE 26.1 vs. 27.0 p = 0.02). Increased RWT alone were associated with poorer cognition (mean MoCA 22.58 vs. 23.89 p = 0.009; mean MMSE 26.17 vs. 26.99 p = 0.02).  Higher LVMI negatively correlated with MoCA scores (p = 0.018, r=-0.105), but not with MMSE scores (p = 0.216, r=-0.006). Conclusions: Left ventricular hypertrophy and even changes in relative wall thickness may cause cognitive impairment. Preventing LV geometrical changes may prevent the deterioration of cognitive abilities.

P5659Atrial fibrillation causes cognitive impairment-which cognitive domains are affected?

Introduction

Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains.

Purpose

We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains.

Methods

In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program.

Results

Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains.

Conclusions

The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction.

Acknowledgement/Funding

Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.

Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer

Concerns about the potential for genomic advances to increase health disparities have been raised. Thus, it is important to assess referral and uptake of genetic counseling (GC) and testing in minority populations at high risk for hereditary breast and ovarian cancer (HBOC). Black women diagnosed with invasive breast cancer ≤age 50 in 2009-2012 were recruited through the Florida State Cancer Registry 6-18 months following diagnosis and completed a baseline questionnaire. Summary statistics, Chi-square tests, and path modeling were conducted to examine which demographic and clinical variables were associated with referral and access to genetic services. Of the 440 participants, all met national criteria for GC, yet only 224 (51 %) were referred for or received GC and/or HBOC testing. Variables most strongly associated with healthcare provider referral for GC included having a college education (OR 2.1), diagnosis at or below age 45 (OR 2.0), and triple negative tumor receptor status (OR 1.7). The strongest association with receipt of GC and/or HBOC testing was healthcare provider referral (OR 7.9), followed by private health insurance at diagnosis (OR 2.8), and household income greater than $35,000 in the year prior to diagnosis (OR 2.0). Study findings suggest efforts are needed to improve genetic services access among a population-based sample of high-risk Black women. These results indicate that socioeconomic factors and physician referral patterns contribute to disparities in access to genetic services within this underserved minority population.

Survival in women with ovarian cancer with and without microsatellite instability

PURPOSE OF INVESTIGATION

Microsatellite instability (MSI) is a hallmark of defective mismatch repair and is present in approximately 20% of ovarian cancers. It is not known if the presence of MSI predicts survival in women with epithelial ovarian cancer.

MATERIALS AND METHODS

Cases of epithelial ovarian cancer were ascertained from a population-based study in Ontario and tumour samples were tested for MSI, using five MSI markers. Patients were divided into MSI-high and MSI-low/normal, according to National Cancer Institute criteria. The authors compared the prevalence of specific prognostic factors in the two subgroups, including age, grade, stage, and histology. They estimated the hazard ratio for death from ovarian cancer associated with MSI-high and with other prognostic factors using a multi-variate analysis.

RESULTS

A total of 418 ovarian cancer patients were included. One hundred and twenty-seven (19.7%) cancers were MSI- high. Subgroup analyses did not reveal any statistically significant differences for pathologic features associated with MSI status. No survival difference was seen according to MSI status.

CONCLUSIONS

The presence of MSI in ovarian cancer is not associated with survival.

Pre-test genetic counseling services for hereditary breast and ovarian cancer delivered by non-genetics professionals in the state of Florida

Genetic counseling and testing for hereditary breast and ovarian cancer now includes practitioners from multiple healthcare professions, specialties, and settings. This study examined whether non-genetics professionals (NGPs) perform guideline-based patient intake and informed consent before genetic testing. NGPs offering BRCA testing services in Florida (n = 386) were surveyed about clinical practices. Among 81 respondents (response rate = 22%), approximately half reported: sometimes scheduling a separate session for pre-test counseling lasting 11-30 min prior to testing, discussing familial implications of testing, benefits and limitations of risk management options, and discussing the potential psychological impact and insurance-related issues. Few constructed a three-generation pedigree, discussed alternative hereditary cancer syndromes, or the meaning of a variant result. This lack of adherence to guideline-based practice may result in direct harm to patients and their family members. NGPs who are unable to deliver guideline adherent cancer genetics services should focus on identification and referral of at-risk patients to in person or telephone services provided by genetics professionals.

Panel-based testing for inherited colorectal cancer: a descriptive study of clinical testing performed by a US laboratory

Next-generation sequencing enables testing for multiple genes simultaneously (‘panel-based testing’) as opposed to sequential testing for one inherited condition at a time (‘syndrome-based testing’). This study presents results from patients who underwent hereditary colorectal cancer (CRC) panel-based testing (‘ColoNext™’). De-identified data from a clinical testing laboratory were used to calculate (1) frequencies for patient demographic, clinical, and family history variables and (2) rates of pathogenic mutations and variants of uncertain significance (VUS). The proportion of individuals with a pathogenic mutation who met national syndrome-based testing criteria was also determined. Of 586 patients, a pathogenic mutation was identified in 10.4%, while 20.1% had at least one VUS. After removing eight patients with CHEK2 mutations and 11 MUTYH heterozygotes, the percentage of patients with ‘actionable’ mutations that would clearly alter cancer screening recommendations per national guidelines decreased to 7.2%. Of 42 patients with an ‘actionable’ result, 30 (71%) clearly met established syndrome-based testing guidelines. This descriptive study is among the first to report on a large clinical series of patients undergoing panel-based testing for inherited CRC. Results are discussed in the context of benefits and concerns that have been raised about panel-based testing implementation.

Conflict of interest

Cristi Radford and Jill Dolinsky are full-time employees for the commercial laboratory Ambry Genetics, which performs ColoNext™ testing. Elizabeth Chao is a paid consultant for Ambry. Deborah Cragun, Meghan Caldwell, and Tuya Pal report no potential conflicts of interest. Specifically, they are not employed by Ambry, and they did not receive any financial or other incentives from Ambry.

Modes of delivery of genetic testing services and the uptake of cancer risk management strategies in BRCA1 and BRCA2 carriers

BRCA testing services are now offered by various healthcare providers, thus it is important to evaluate whether the implementation of cancer risk management (CRM) strategies varies by service provider. Using a registry-based sample of 795 female BRCA mutation carriers, we explored the association between uptake of CRM strategies with duration of genetic counseling (GC) sessions, provider type, and other demographic and clinical variables. All participants completed a baseline questionnaire. Information about uptake of CRM strategies was collected for a subset of 438 participants who completed additional questions. Summary statistics and Pearson chi-squared analysis were used to examine the associations between demographic and clinical variables with service delivery factors and with the uptake of various CRM strategies. Overall uptake of CRM strategies was high across all provider types. However, GC sessions were longer when provided by a genetics professional than by another provider (p < 0.001). Furthermore, higher frequencies of uptake of most CRM strategies were associated with longer GC sessions and when testing was performed by a genetics professional. Identification of factors to optimize delivery of these specialized GC services is important to maximize implementation of CRM strategies in BRCA carriers.

Evaluation of phone-based genetic counselling in African American women using culturally tailored visual aids

Genetic counselling (GC) services for inherited breast and ovarian cancer (HBOC) are underutilized by African American (AA) women. We sought to evaluate factors associated with knowledge gain in a sample of AA women diagnosed with early-onset breast cancer, in whom GC for HBOC was provided, using a culturally targeted genetic counselling aid (GCA). Through a cancer registry-based study, phone-based GC for HBOC was offered to AA women with breast cancer < or =50. A questionnaire to assess knowledge about HBOC was completed prior to GC. All women were provided a GCA about HBOC developed by the investigative team for use during the GC session. Following GC, a personalized summary letter was mailed to all study participants and the same knowledge questionnaire was completed. A total of 37 study participants completed the pre- and post-GC knowledge questionnaires with significant gains in knowledge following the GC process (p < 0.0001). Statistically significant factors associated with knowledge gain included earlier stage of diagnosis of breast cancer and education level. Our results indicate that phone-based GC supplemented by a culturally targeted visual aid is an effective means of improving knowledge about HBOC in young AA women with invasive breast cancer.

Development of educational materials about inherited breast cancer in black women

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Background: Current educational materials about inherited breast and ovarian cancer (HBOC) have not been culturally tailored for the Black community, which may contribute to lower levels of awareness about this topic. Through an academic and community partnership, realized through a Community Advisory Panel (CAP) comprised of breast cancer survivors, advocates, community leaders, and health care providers, this need was identified. Methods: Utilizing a phased approach implemented through this academic and community partnership, a culturally tailored brochure and booklet about HBOC for the Black community were developed and reviewed. To evaluate the brochure, three focus groups were conducted by race-concordant moderators. HBOC was discussed with Black women from diverse backgrounds, including those with and without breast cancer (n = 46). Summaries were created from audiotapes and handwritten notes and content was analyzed based on Grounded Theory, after which the brochure was revised. Similarly, revisions to the booklet were made based on feedback obtained about the brochure. Materials were then presented to the CAP for re-review. Results: From this iterative process, the key content identified as areas for improvement were: (1) Inclusion of breast cancer information specific to Black women; (2) Use of the term “Black”; (3) Inclusion of African American flag colors; (4) Clarification of the concept of genetic counseling; and (5) Enhancing relevance of information for young women. Conclusions: The CAP and study participants recognized the need for culturally relevant educational materials addressing HBOC in the Black community. Their feedback identified important areas for improvement which have been implemented in the design of a culturally tailored brochure that is available for widespread dissemination. Further evaluation of the booklet is currently in progress.

No significant financial relationships to disclose.

Interobserver and interlaboratory variability of mismatch repair protein expression in ovarian tumors

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Background: Immunohistochemistry (IHC) for mismatch repair (MMR) protein (MLH1, MSH2, MSH6) expression has been a useful strategy for identifying tumors with MMR deficiency. However, despite its wide use, interpretation of results suffers from poor reproducibility. Methods: To assess inter-observer (IO) and inter-laboratory (IL) variability of MMR protein expression, 41 epithelial ovarian cancer (EOC) samples were arrayed in triplicate for construction of a tissue microarray (TMA). Six slides were made from this donor TMA block, of which 3 were stained at the Moffitt Cancer Center (MCC) and 3 were stained at the University of South Florida (USF), using different lab procedures. IHC for MMR protein expression was performed using the avidin-biotin-complex (ABC) method with appropriate controls. Subsequently, all slides were independently scored for protein expression by two pathologists. The Concordance Correlation Coefficient (CCC) value was computed to evaluate IO and IL concordance, with a value >0.75 indicating excellent concordance. Results: The CCC value for the IO analysis was 0.95 (for MCC-stained slides; 95% C.I.: 0.89–0.98) and 0.85 (for USF-stained slides; 95% C.I.: 0.66, 0.93), indicating excellent concordance. The CCC value for IL analysis was 0.53 (95% C.I.: 0.37–0.66). Conclusions: Our findings demonstrate that variability in IHC protocols may contribute to the interpretation of IHC results. Our data suggest that when pathologists are given the same slide, there is excellent agreement between two observers; however, when the same slides are stained in a separate laboratory using the same method (ABC) but different protocol, there may be considerable disagreement. These findings are of great clinical significance due to the widespread use of IHC as diagnostic, prognostic and therapeutic tools in cancer care.

No significant financial relationships to disclose.

The presence of germ line mosaicism in cleidocranial dysplasia

Cleidocranial dysplasia (CCD) is typically an autosomal dominant condition. The possibility of alternative causes, such as an autosomal recessive form or germ line mosaicism, have been suggested in some families with CCD, but not proven. We present a family consisting of a mother having three sons affected with CCD. One of the affected boys is a half brother to the other two affected children. The diagnosis of CCD was confirmed by DNA analysis of the RUNX2 gene in all three of the boys in blood; however, initial DNA testing in the mother's blood did not detect the presence of a RUNX2 mutation in the mother. Further testing through heteroduplex analysis applying high-resolution melting analysis followed by subcloning detected low-level mosaicism in DNA isolated from maternal blood and buccal swab, confirming low-level mosaicism in somatic cells. We present the first case of confirmed germ line mosaicism in CCD.

Germline truncating mutations in both MSH2 and BRCA2 in a single kindred

There has been interest in the literature in the possible existence of a gene that predisposes to both breast cancer (BC) and colorectal cancer (CRC). We describe the detailed characterisation of one kindred, MON1080, with 10 cases of BC or CRC invasive cancer among 26 first-, second- or third-degree relatives. Linkage analysis suggested that a mutation was present in BRCA2. DNA sequencing from III: 22 (diagnosed with lobular BC) identified a BRCA2 exon 3 542G>T (L105X) mutation. Her sister (III: 25) had BC and endometrial cancer and carries the same mutation. Following immunohistochemical and microsatellite instability studies, mutation analysis by protein truncation test, cDNA sequencing and quantitative real-time PCR revealed a deletion of MSH2 exon 8 in III: 25, confirming her as a double heterozygote for truncating mutations in both BRCA2 and MSH2. The exon 8 deletion was identified as a 14.9 kb deletion occurring between two Alu sequences. The breakpoint lies within a sequence of 45 bp that is identical in both Alu sequences. In this large BC/CRC kindred, MON1080, disease-causing truncating mutations are present in both MSH2 and BRCA2. There appeared to be no increased susceptibility to the development of colorectal tumours in BRCA2 mutation carriers or to the development of breast tumours in MSH2 mutation carriers. Additionally, two double heterozygotes did not appear to have a different phenotype than would be expected from the presence of a mutation in each gene alone.

Removal of arsenic from water using hardened paste of Portland cement

Portland cement has been used as a new low-cost adsorbent for the removal of arsenic from the water environment. In the batch experiments conducted at an initial concentration of 0.2 mg l(-1) of arsenate, it was found that up to 95% of arsenate could be removed. Kinetic profiles were developed for various conditions. The effect of adsorbent dose, effects of common ions such as Ca2+, Mg2+, Fe3+/Fe2+, Cl-, SO4(2-), NO3(-), PO4(3-) and the effect of pH was studied. Adsorption isotherm studies were performed and it was observed that the Freundlich isotherm was followed with a better correlation than the Langmuir isotherm. Arsenite could also be removed up to approximately 88% using the same material. A new detection method for arsenate/arsenite was developed for routine analysis of arsenic and used during the entire study.

Double primary cancers of the breast and thyroid in women: molecular analysis and genetic implications

Multiple primary cancers are characteristic of hereditary cancer syndromes. A familial association between breast and thyroid cancer has been suggested, but a genetic basis for this association has not yet been established. To determine the extent to which double primary cancers of the breast and thyroid are due to common hereditary factors, we conducted a registry- and hospital-based study in Ontario and Quebec. We obtained family histories of 74 women diagnosed with both cancer of the breast and thyroid before 70 years of age. Cancer histories were obtained for the 533 first- degree relatives of these women. The observed cancer rate in the relatives was compared with the expected number, based on age- standardized Canadian cancer incidence rates, and relative risks were estimated. A total of 87 cancers were observed in the relatives, compared to 93.7 expected cancers, giving a relative risk of 0.9 (95% confidence interval (CI): 0.7-1.1). The risk for breast cancer was 1.1 (95% CI: 0.6-1.7) and the risk for thyroid cancer was 0.7 (95% CI: 0-3.8). Blood samples were collected on 53 patients for mutational analysis of the BRCA1, BRCA2, and PTEN genes. One woman was found to be a carrier of a BRCA1 mutation (exon 11 3227delT). Our findings do not support the hypothesis that a significant proportion of double primary cancers of the breast and thyroid are due to hereditary factors.

Familial and hormonal risk factors for papillary serous uterine cancer

OBJECTIVES

To identify genetic and non-genetic risk factors for papillary serous uterine cancer.

METHODS

A case-control study was conducted. Case women with papillary serous uterine cancer were compared with two control groups: 1) women with endometrioid uterine cancer and 2) healthy women with no past history of cancer. Cases and controls were matched for age (within two years) and ethnic group. All study subjects completed a questionnaire addressing family history. The cases and healthy controls were assessed for factors associated with estrogen exposure.

RESULTS

The risks of breast cancer (RR 1.84, CI 1.03-3.31) and of prostate cancer (RR 2.21, CI 0.77-6.37) were higher among the relatives of patients with papillary serous uterine cancer, than among relatives of those with endometrioid uterine cancer. Other significant risk factors included weight at 18 years (p = 0.04) and the use of estrogen replacement therapy (p = 0.04).

CONCLUSION

Relatives of women with papillary serous cancer of the uterus had an increased risk of breast and prostate cancer. Hormonal exposure also increases the risk for this cancer. These findings suggest that predisposing genetic factors, possibly related to hormone metabolism, may be common to the three forms of cancer.

Increased risk for nonmedullary thyroid cancer in the first degree relatives of prevalent cases of nonmedullary thyroid cancer: a hospital-based study

The genetic basis for nonmedullary forms of thyroid cancer (NMTC) is less well established than that of medullary thyroid cancer. However, epidemiological and family studies suggest that a proportion of NMTC may be due to inherited predisposition. To estimate the familial risk of thyroid cancer, we conducted a hospital-based case-control study at the Princess Margaret Hospital in Toronto, Ontario, Canada, and at 2 university hospitals in Montréal, Québec, Canada. We obtained pedigrees from 339 unselected patients diagnosed with NMTC and from 319 unaffected ethnically matched controls. Family histories of cancer were obtained from the cases and controls for 3292 first degree relatives of cases and controls. Seventeen cases (5.0%) and 2 controls (0.6%) reported at least one first degree relative with thyroid cancer. In relatives of patients with thyroid cancer, the incidence of any type of cancer (including NMTC) was 38% higher than in relatives of controls (incidence rate ratio, 1.4; 95% confidence interval, 1.1-1.7). The relative risk for thyroid cancer was 10-fold higher in relatives of cancer patients than in controls (incidence rate ratio, 10.3; 95% confidence interval, 2.2-47.6). Our findings suggest that hereditary or other familial factors are important in a small proportion of NMTC. Molecular studies are needed to determine the genetic basis of cancer susceptibility in these families.

A comprehensive analysis of MNG1, TCO1, fPTC, PTEN, TSHR, and TRKA in familial nonmedullary thyroid cancer: confirmation of linkage to TCO1

About 5% of nonmedullary thyroid cancer is familial. These familial nonmedullary thyroid cancer cases are characterized by an earlier age of onset, more aggressive phenotype, and in some families a high propensity to benign thyroid disease. Little is known about the genes conferring predisposition to nonmedullary thyroid cancer. Three loci have been identified through genetic linkage: MNG1 on 14q32, TCO1 on 19p13.2, and fPTC on 1p21. In addition to these putative genes, a number of loci represent candidate familial nonmedullary thyroid cancer predisposition genes by virtue of their involvement in sporadic disease (TRKA), their role in benign disease (TSHR), and because they underlie syndromes with a risk of nonmedullary thyroid cancer (PTEN). To evaluate the roles of MNG1, TCO1, fPTC, PTEN, TSHR, and TRKA in familial nonmedullary thyroid cancer, we have carried out a comprehensive mutation and linkage analysis of these genes in 22 families. One family was linked to chromosome 19q13.2, confirming that TCO1 underlies a subset of familial nonmedullary thyroid cancer. None of the families was linked to MNG1 or fPTC, and there was no evidence to support the roles of PTEN, TSHR, or TRKA. Familial nonmedullary thyroid cancer is an emerging clinical phenotype that is genetically heterogeneous, and none of the currently identified genes accounts for the majority of families.

Intestinal carcinoid tumours in a father and daughter

Familial cases of carcinoid tumours that are not associated with any known syndrome or disease are extremely rare. All cases reported in the world literature have involved carcinoid tumours of the gastrointestinal tract. Two cases of carcinoid tumours of the small intestine in a father and daughter are presented. Laboratory analyses did not support the hypothesis that the occurrence of carcinoid tumours in this family is a variant of the multiple endocrine neoplasia type 1 syndrome. A review of the literature on familial occurrence of intestinal carcinoid tumours in the absence of any other known carcinoid tumour-predisposing genetic syndrome is provided.

Is uterine papillary serous adenocarcinoma a manifestation of the hereditary breast-ovarian cancer syndrome?

BACKGROUND

Uterine papillary serous carcinoma (UPSC) shares common pathologic, genetic, and clinical features with other serous cancers of müllerian origin. The most common histologic type of ovarian tumor associated with BRCA mutations is papillary serous. Because of these histologic similarities, we postulated that, in some cases, UPSC may be a manifestation of a field defect in BRCA1 carriers, which also includes ovarian carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma.

METHODS

Fifty-six living patients with UPSC were contacted through their treating physicians and agreed to a family history interview and to provide a blood specimen for BRCA testing. The protein truncation test was used to detect mutations in exons 10 and 11 of BRCA1 and in exon 11 of BRCA2. The presence of four common mutations was assessed by PCR-based specific assays.

RESULTS

A high proportion of patients had a past history of breast cancer (11%) or a first-degree relative with breast cancer (29%). Four patients were from families with site-specific hereditary breast cancer. However, there was no clear example of the hereditary breast-ovarian cancer syndrome, and none of the 56 patients was found to carry a BRCA1 or BRCA2 mutation.

CONCLUSIONS

BRCA mutations do not appear to predispose to UPSC and this type of cancer does not appear to be a manifestation of the classical hereditary breast-ovarian cancer syndrome. The observed association between UPSC and breast cancer may be due to the presence of mutations in other cancer predisposing genes.

Do MSH6 mutations contribute to double primary cancers of the colorectum and endometrium?

Mismatch repair (MMR) gene mutations cause hereditary nonpolyposis colorectal cancer (HNPCC), a common form of familial colorectal cancer. Among MMR genes, germline MSH6 mutations are often observed in HNPCC-like families with an increased frequency of endometrial cancer. We have previously shown that a proportion of women affected with double primary cancers of the colorectum and endometrium carry germline MSH2 or MLH1 mutations and, thus, belong to HNPCC families. In this study, we have investigated the specific contribution of MSH6 defects to such double primary patients. By sequence analysis of the entire coding region of MSH6, three putative missense mutations were identified in patients with atypical family histories that do not meet HNPCC criteria. Moreover, one of these mutations, a novel substitution Arg901 His, was found in a patient previously shown to carry a truncating germline MLH1 mutation. Thus, MSH6 mutations are likely to contribute to the etiology of double primary cancers of the colorectum and endometrium.

Mismatch repair gene defects contribute to the genetic basis of double primary cancers of the colorectum and endometrium

Hereditary non-polyposis colorectal cancer (HNPCC) is a dominantly inherited cancer syndrome caused by germline defects of mismatch repair (MMR) genes. Endometrial cancer is the most common extracolonic neoplasm in HNPCC and is the primary clinical manifestation of the syndrome in some families. The cumulative incidence of endometrial cancer among HNPCC mutation carriers is high, estimated to be from 22 to 43%. We hypothesized that women with double primary cancers of the colorectum and endometrium are likely to be members of HNPCC families. In order to determine how frequently HNPCC manifests in the context of double primary cancers, we examined alterations of two MMR genes, hMSH2 and hMLH1, in 40 unrelated women affected with double primary cancers. These cases were identified using hospital-based and population-based cancer registries in Ontario, Canada. MMR gene mutations were screened by single-strand conformation polymorphism analysis and confirmed by direct sequencing. Eighteen percent (seven of 40) were found to harbor mutations of one of the two MMR genes. Analysis of colorectal and/or endometrial tumors of mutation-negative probands found microsatellite instability in seven of 20 cases. Six of seven mutation-positive probands had strong family histories suggestive of HNPCC. First degree relatives of mutation-positive probands had a very high relative risk (RR) of colorectal cancer (RR = 8.1, CI 3. 5-15.9) and endometrial cancer (RR = 23.8, CI 6.4-61.0). The relative risk of mutation-negative cases was 2.8 (CI 1.7-4.5) for colorectal cancer and 5.4 (CI 2.0-11.7) for endometrial cancer. We recommend that all double primary patients with cancers at these sites should have a genetic evaluation, including molecular analysis for HNPCC where appropriate.

Genetic implications of double primary cancers of the colorectum and endometrium

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant condition predisposing to cancers of the colorectum and endometrium. Endometrial cancer is the most commonly occurring extracolonic cancer in HNPCC. Estimates of the cumulative incidence of endometrial cancer in women with mutations in the HNPCC genes range from 22-43%. In order to determine how frequently double primary cancers of the colorectum and endometrium are the result of a hereditary factor, we conducted a registry based study in Ontario and Quebec, Canada. We obtained pedigrees on 80 women diagnosed with double primary cancers of the colorectum and endometrium at less than 70 years of age. Family histories of cancer were obtained for all first degree relatives of these women and cancer rates were compared with age standardised provincial incidence rates in order to estimate the relative risks. There was a total of 82 cancers observed in relatives below the age of 55, compared with 31.2 expected, giving a relative risk of 2.6 (95% confidence interval (CI) 2.1-3.3). The relative risk for colorectal cancer below 55 was 16.1 (95% CI 11.6-21.8). This risk decreased with increasing age of onset of cancers in probands. For probands with both colorectal and endometrial cancer diagnosed under the age of 55, the relative risk of colorectal cancer in relatives below the age of 55 was 30.5 (95% CI 18.8-46.6). Similar patterns were observed for endometrial and pancreatic cancer. There were non-significant increases in rates of cancer of the oesophagus, stomach, small intestine, and bladder. There was no increased risk of breast cancer. The risk of lung cancer was decreased, especially in older relatives. Our findings indicate the presence of a significant genetic component of cancer in women with double primary cancers of the colorectum and endometrium.

Serogroups and antimicrobial susceptibility of clinical isolates of Salmonella species from a teaching hospital in Kuwait

Salmonella strains isolated in a teaching-cum-general hospital in Kuwait during 1990-1993 and 1996 were analysed to determine the trend in the prevalence of the serogroups and their changing pattern of susceptibility. The records were reviewed for all the 661 isolates encountered during these periods. The most prevalent serogroup in both children and adults was serogroup B, followed by serogroup C and D. A sizeable proportion of the strains were resistant to first-line drugs. About 39% of the isolates were resistant to ampicillin, 17% to co-trimoxazole, 13% to chloramphenicol, and 15% to cephalothin. The majority were, however, susceptible to the other drugs with low to very low resistance rates: 7% to amoxicillin/clavulanic acid, and 0.3% to cefotaxime. All the strains were susceptible to ciprofloxacin. In all, resistant strains were more prevalent among children than adults.

Prevalence and susceptibility of Shigella species to 11 antibiotics in a Kuwait teaching hospital

During the 5-year period 1990-1993 and 1996, 202 Shigella spp. were isolated from stool specimens of symptomatic patients of all age groups seen in our hospital. Over these periods the trend of the incidence of shigellosis showed that 18% of the total strains were isolated during the invasion year (1990) followed by an upsurge (24%) during the Gulf War period (1991) and a steady decline in the post-war period, 17% in 1992 and 14% in 1993. There was another wave of increased isolation rate (27%) during a period of relative calm in the country (1996) studied for comparison. The predominant Shigella species was S. flexneri which accounted for 46% of the 202 isolates, followed by S. sonnei (42%), S. dysenteriae (7%) and S. boydii (5%). Fifty-four percent of the 202 Shigella isolates were resistant to ampicillin, 56% to trimethoprim/sulfamethoxazole, 35% to chloramphenicol, 13% and 9% to cephalothin and amoxicillin/clavulanic acid respectively. All the isolates were fully susceptible to ciprofloxacin, the aminoglycosides and the second- and third-generation cephalosporins. Eighty-seven (43%) of the 202 isolates were resistant to two or more antibiotics. Of the 87 multiply resistant Shigella spp., 58 (67%) were S. flexneri while 19 (22%) were S. sonnei. Shigella resistance to the first-line antibiotics is a major problem that frequently limits the therapeutic options with orally available active antibiotic therapy.

Identification of enteroinvasive Escherichia coli and Shigella strains in pediatric patients by an IpaC-specific enzyme-linked immunosorbent assay

A new method, a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) recognizing a secreted, invasion plasmid-coded protein antigen (IpaC), was used to identify enteroinvasive Escherichia coli and Shigella strains among colonies from 859 cultures of fecal samples from children in Kuwait. A total of 33.8% of the samples were diarrheal. By the immunoassay, enteroinvasive E. coli strains were identified from two diarrheal samples but from none of the samples from children without diarrhea. These strains were fully virulent and belonged to serogroup O28ac. In addition, 26 Shigella strains were also recognized by the ELISA, while only 23 were isolated by routine biotyping and serotyping. For two diarrheal patients, Shigella was identified by culture only. The study showed that the IpaC-specific immunoassay is a simple and useful tool for identifying enteroinvasive strains. Furthermore, by reporting the first enteroinvasive E. coli isolates from Kuwait, the study indicates the presence of this group of pathogens as a potential source of diarrhea in the region.

Cyclic changes in salivary lactate dehydrogenase, peroxidase and leucine aminopeptidase during menstrual cycle

Salivary lactate dehydrogenase (LDH), peroxidase (Px) and leucine aminopeptidase (LAP) activities were scanned in both normally ovulating and anovulating women during entire menstrual cycle. In ovulating women, all the three enzymes exhibited significant increase in the activity on or before the onset of ovulation which was monitored by the shift of the basal body temperature (BBT) as well as the ferning pattern of the cervical mucus. The peak maximum at the midcycle was several times higher than the previous day value in all the six normal women. In anovulatory women, no such remarkable change in the enzyme activities was found throughout the cycle. Salivary LDH and LAP showed peak at the midcycle and at the same time required short time for assay, so the present results are strongly suggestive that the determination of salivary enzyme content may be a convenient method for detecting the day of ovulation.

Structural changes in human cervical mucus

The crystallization phenomenon of human cervical mucus was investigated with the help of scanning electron microscope. Changes in the conformation of crystals and ferning patterns were studied on different days of the menstrual cycle in both normally ovulating women and those using oral contraceptives. No crystalline structure was found on day 5 in both categories of women, whereas square crystals were observed on day 21 in normal woman. Nature and type of ferning pattern changes seen from days 11 to 14 in normal women were not seen during this period in women who were on oral contraception, instead a thick, viscous mucus was found during the entire period of the cycle.