Multi-Omics and Management of Follicular Carcinoma of the Thyroid

Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid gland, accounting for up to 20% of all primary malignant tumors in iodine-replete areas. The diagnostic work-up, staging, risk stratification, management, and follow-up strategies in patients who have FTC are modeled after those of papillary thyroid carcinoma (PTC), even though FTC is more aggressive. FTC has a greater propensity for haematogenous metastasis than PTC. Furthermore, FTC is a phenotypically and genotypically heterogeneous disease. The diagnosis and identification of markers of an aggressive FTC depend on the expertise and thoroughness of pathologists during histopathological analysis. An untreated or metastatic FTC is likely to de-differentiate and become poorly differentiated or undifferentiated and resistant to standard treatment. While thyroid lobectomy is adequate for the treatment of selected patients who have low-risk FTC, it is not advisable for patients whose tumor is larger than 4 cm in diameter or has extensive extra-thyroidal extension. Lobectomy is also not adequate for tumors that have aggressive mutations. Although the prognosis for over 80% of PTC and FTC is good, nearly 20% of the tumors behave aggressively. The introduction of radiomics, pathomics, genomics, transcriptomics, metabolomics, and liquid biopsy have led to improvements in the understanding of tumorigenesis, progression, treatment response, and prognostication of thyroid cancer. The article reviews the challenges that are encountered during the diagnostic work-up, staging, risk stratification, management, and follow-up of patients who have FTC. How the application of multi-omics can strengthen decision-making during the management of follicular carcinoma is also discussed.

Prediction of acute myocardial infarction or death in acute chest pain patients with machine learning models or first troponin T alone

Background

Machine learning approaches are increasingly being explored for use in healthcare systems, but there is a trade-off between increased accuracy and decreased explainability with more complex models. We aimed to evaluate the diagnostic performance for acute myocardial infarction (AMI) or death within 30 days of index visit. Machine learning models were trained using demographic factors, ECG and blood markers, and to compare them to a single high sensitivity TnT (hs-cTnT) value.

Methods

Using records from 9519 ED patients from two hospitals in Skåne, Sweden, we created machine learning models based on both logistic regression and artificial neural networks. Inputs in the models varied and included sex and age, first hs-cTnT value at the ED, glucose, creatinine, hemoglobin, and ECG signal data. The models were adapted to meet the following criteria for safe rule-out of 30-day myocardial infarction or death: Negative predictive value (NPV) >99.5% and sensitivity >99%. For rule-in of myocardial infarction or death, a positive predictive value (PPV) of >70% was set. The models were then compared to the performance of a first hs-cTnT <5 ng/L for rule-out, and >51 ng/L for rule-in. The patient population was split by arrival date and models were trained on the initial 50% of patients. Thresholds were selected from the subsequent 25%, and tests were performed on the final 25% (2379 patients).

Results

The best model, a convolutional neural network, identified 1309 (55%) patients for rule-out and 125 (5.3%) for rule-in, with the required NPV, sensitivity and PPV. In comparison, a single hs-cTnT value identified 1123 (47.2%) patients for rule-out and 158 (6.6%) for rule-in, but failed to reach the required sensitivity and PPV levels.

Conclusions

These results indicate that more complex models are able to safely identify a large proportion of patients for early rule-out or rule-in without the need for serial troponin tests. In future studies attempts should be made to improve the explainability of these models.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): VR; grant no. 2019-00198

Molecular detection of Chlamydia psittaci and Chlamydia felis in human keratoconjunctivitis cases

Given the high incidence of keratoconjunctivitis in Iran (approximately 3.6–53.9%) and low efficiency of clinical diagnostic measures, application of laboratory tests for detection of different keratoconjunctivitis/conjunctivitis causes and determination of their accurate prevalence is essential. In this research, conjunctival samples were collected from 100 patients with keratoconjunctivitis signs referred to an eye hospital of Iran. After DNA extraction, PCR was carried out for detection of Chlamydia psittaci and Chlamydia felis. PCR positive products were further subjected for DNA sequencing. In this study, one sample was Chlamydia psittaci positive and none was positive for Chlamydia felis. There wasn’t a statistically significant relationship between working in the field of veterinary medicine or keeping a pet and Chlamydia psittaci prevalence (P>0.05). This study showed a low rate of chlamydial keratoconjunctivitis and therefore further studies for detection of other causes are necessary.

Developing an Antiviral Drug Screening System for Anti-Bovine Viral Diarrhea Virus (BVDV) Therapies

Bovine viral diarrhea virus (BVDV) is an economically important animal pathogen affecting cattle. Despite the use of vaccination, test and slaughter practices, BVD remains a serious problem of cattle breeding. This study was conducted in order to develop a cell line that expresses some of BVDV sub-replicons. BVDV-NADL NS3 and 5’UTR were cloned in pWPI-linker B lentiviral plasmid at the upstream of EGFP gene. Consequently, lentiviral vectors containing BVDV-NS3 and BVDV-5’UTR were produced by using the second-generation lentiviral packaging system. By these lentivectors, MDBK cells expressing BVDV-5’UTR and BVDV-NS3 partial fragments were prepared. The efficiency of the infection was evaluated by fluorescence microscopy, western blotting, and RT-PCR. The results indicated that the development of MDBK cell line expressing these transgenes provides a very sensitive antiviral drug screening system for anti-bovine viral diarrhea virus (BVDV) therapies.

Ovarian Cancer in Morocco: Diagnosis and Outcome

Background: Ovarian cancer is the fifth most common cancer and the fourth leading cause of cancer death among women in northern Africa, with an estimated 5050 new cancer cases and 3509 deaths from cancer in 2012 ( GLOBOCAN 2012 ). Aim: This study was conducted to determine the epidemiologic characteristics of ovarian cancer in Morocco. Methods: This is a descriptive retrospective study of ovarian cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: There were 164 new cases of ovarian cancer diagnosed at Al Azhar Oncology Center, accounting for 3.5% of all cancers affecting women reported during 2005-2015. During this period, ovarian cancer was the third most common cancer and the third leading cause of cancer death after breast and cervical cancer among women. The average age at diagnosis of ovarian cancer was 52.5 ± 13.3 years (range 18-81 years). The risk of developing the disease is associated with age, 91.1% of cases were diagnosed in women aged 35 years and older, with 70.2% of new ovarian cancer cases occurring among those aged 35-64 years. A 43-year-old woman was diagnosed with metastatic disease. Among all detected cases, 18 (11%) died during the study period, accounting for 6.6% of all female cancer deaths. Conclusion: Ovarian cancer is a preventable disease, and a significant decrease in incidence and mortality can be expected as a result of population-based screening programs, which rely on regular preventive examinations to search for precancerous changes and to prevent the development of malignant tumors.

Ovarian Cancer in Niger: Results of a Nationwide Study

Background: Ovarian cancer is the fourth most common cancer and the fourth most common cause of cancer death among women in western Africa, with about 3820 new cases and 2912 cancer deaths in 2012 ( GLOBOCAN 2012 ). Aim: The current study aims to estimate the incidence and determine the epidemiologic characteristics of ovarian cancer in Niger. Methods: This is a descriptive retrospective analysis of ovarian cancer cases, reported between 1992 and 2009 to the Niger Cancer Registry, established in 1992, in the Faculty of Health Sciences at the Abdou Moumouni University in Niamey. Results: There were 363 cases diagnosed with ovarian cancer in Niger, accounting for 8.8% of all cancer cases in women reported during 1992-2009. During this period, ovarian cancer was the third most common cancer after breast and cervical cancer and the third leading cause of cancer death after breast and liver cancer in women. In 2009, the incidence of ovarian cancer was 4.9 new cases per 100,000 women and the number of deaths was 5.6 per 1,000,000 women. The average age at diagnosis of ovarian cancer was 42 ± 16 years (range 6-85 years). The risk of developing ovarian cancer is strongly related to age, with 13.2% of new ovarian cancer cases diagnosed in women younger than 25 years, 77.7% in those aged 25-64 years and 9.1% in those aged 65 years and over. Most ovarian cancers were cystadenocarcinomas. Among the cases for whom the outcome was known, 11.3% died during the study period, accounting for 9.3% of all female cancer deaths in Niger. Conclusion: The most recent estimates of ovarian cancer incidence and mortality in the world reveal sharp differences between developed and developing countries possibly related to missed opportunities for early diagnosis and incomplete reporting of ovarian cancer in Western Africa.

Prostate Cancer in Morocco: The Epidemiological Evidence

Background: Prostate cancer is one of the most common types of cancer in men. It is the fourth most common cancer and the fourth leading cause of cancer death among men after liver, lung and bladder cancer in northern Africa, with an estimated 7548 new cancer cases and 5000 deaths from cancer in 2012, the most recent year for which international estimates are available ( GLOBOCAN 2012 ). Aim: The aim of this study is to determine the prevalence and the epidemiologic characteristics of prostate cancer in Morocco. Methods: This is a descriptive retrospective analysis of prostate cancer cases, diagnosed and treated at Al Azhar Oncology Center in Rabat between 2005 and 2015. Results: During the period of study, there were 644 new cases diagnosed with prostate cancer at Al Azhar Oncology Center, accounting for 20% of all new cases of cancer in men reported during this period. The average age of the patients at diagnosis was 68.1 ± 9.6 years (range 8-97 years). The risk of developing prostate cancer is associated with advancing age, 97.7% of cases were diagnosed in men aged 50 years and older, with 85.1% of new cancer cases occurring among those aged 55-79 years. Among all detected cases, 6.5% were diagnosed with metastatic disease and 4.8% died during the study period. Conclusion: Prostate cancer is the second leading cause of death from cancer in elderly men. Early detection to improve prostate cancer outcome and survival remains the cornerstone of prostate cancer control.

Parathyroid adenoma with concurrent toxic thyroid adenoma: a rare combination

BACKGROUND

Hypercalcemia in association with hyperthyroidism is a well-recognized phenomenon. Primary hyperparathyroidism due to parathyroid adenoma in association with thyroid adenoma is extremely rare. These cases can present a diagnostic and therapeutic challenge to the treating physician as the patient may present with symptoms of either disease.

CASE SUMMARY

A 47-year-old female patient presented with non-specific complaints including fatigue and muscle cramps. Diagnostic workup revealed significantly elevated plasma calcium levels in association with hyperthyroidism. There was a considerable delay in measuring the parathyroid hormone levels which were significantly elevated. Nuclear medicine studies revealed features consistent with a parathyroid adenoma and a concurrent thyroid adenoma. The patient was rendered euthyroid and subsequently taken to theatre for a thyroid lobectomy and removal of the associated parathyroid adenoma. One year later the patient remains normocalcemic, euthyroid and clinically well.

CONCLUSION

Toxic thyroid adenoma with concurrent parathyroid adenoma and primary hyperparathyroidism is rare. The possibility of primary hyperparathyroidism should be considered where hypercalcemia persists on correcting the hyperthyroidism. Removal of both adenomas will result in cure of the patient.

Fabrication and characterization of Cu(OH)2/CuO nanowires as a novel sensitivity enhancer of the luminol–H2O2chemiluminescence system: determination of cysteine in human plasma

Cu(OH)₂/CuO nanowires as a sensitivity enhancer in luminol–H₂O₂chemiluminescence system and its application for the determination of cysteine.

Effect of Montanide™ IMS 1312 VG adjuvant on efficacy of Yersinia ruckeri vaccine in rainbow trout (Oncorhynchus mykiss)

The efficacy of immersion vaccination Yersinia ruckeri bacterin containing Montanide™ IMS 1312 VG was evaluated in 100-120 g rainbow trout against yersiniosis. Healthy fish were vaccinated by immersion vaccination with inactivated whole cells (1 × 10(8) cells/ml) of a virulent strain of Y. ruckeri biotype I with and without Montanide (1:1; Montanide/antigen) for 2 min at 12-14 °C. Control group was immersed in sterile PBS. Leukocyte counts, serum lysozyme assay, alternative hemolytic complement (ACH50) assay, antibody titration and relative percent survival (RPS) were measured on 2-10 weeks post-immunization. No significant difference was seen in leucocyte population of trout immunized either with Y. ruckeri antigen or Y. ruckeri antigen containing Montanide (P > 0.05), while leucocyte and heterophil populations in control group were significantly lower and higher, respectively, than both immunized groups (P < 0.05). In addition, there was no significant difference in lymphocyte population of trout immunized either with Y. ruckeri antigen or Y. ruckeri antigen containing Montanide (P > 0.05), while lymphocyte population in control group was significantly lower than both immunized groups (P < 0.05). Lysozyme activity in immunized fish with Y. ruckeri containing Montanide was higher than the immunized fish with Y. ruckeri antigen alone during 8 weeks post-immunization ((P < 0.05). Also, level of lysozyme in control fish was generally lower than both immunized groups (P < 0.05). The level of ACH50 between both immunized groups was insignificant (P > 0.05) but these were significantly higher than control group through the experiment (P < 0.05). The lowest anti-Y. ruckeri antibody titers in both immersion vaccination groups were significantly higher through 2-8 weeks post-vaccination compared to the control group (P < 0.05). In the group immersion vaccinated with Y. ruckeri bacterin plus Montanide the titers 2-8 weeks post-vaccination were significantly higher the titer in the immersion vaccinated with Y. ruckeri bacterin (P < 0.05). Fish vaccinated with antigen without Montanide resulted in RPS of 80-82% on 2-10 weeks post-vaccination, while those for antigen containing montanide gave RPSs of 93.8-100% 2-10 weeks post-immunization (P < 0.05).

Prognostic factors of Atractylis gummifera L. poisoning, Morocco

In Morocco, acute Atractylis gummifera L. poisoning represents the leading cause of death by plant poisoning especially for children. All cases received in the Moroccan poison control centre from January 1981 to December 2009 (n = 467) were included in a retrospective study of the characteristics and risk factors of A. gummifera L. poisoning. The most vulnerable age group was children (63.4% of cases). Most cases were due to accidental exposure (75.5%), but some were from therapeutic use (18.1%) or attempted abortion (7.4%). Patients presented with moderate poison severity signs (grade 2) in 22.3% of cases or severe signs (grade 3) in 21.0%. The mortality rate was 39.2%. The majority of deaths (81.1%) occurred in children aged < 15 years following accidental exposure. Multivariate logistic regression analysis revealed that risk factors for mortality were coma (OR = 20.5); hepatitis (OR = 52.7) and rural residence (OR = 7.26), while gastric decontamination was a protector factor (OR = 0.26).

Hepatitis B in Moroccan blood donors: a decade trend of the HBsAg prevalence in a resources limited country

OBJECTIVES

To calculate the hepatitis B surface antigen (HBsAg) reactive rate for 2011 blood donors (BD) across Morocco. In addition, to monitor the profile of donors bearing the HBsAg during 2000 and 2011, we calculated the percentage of the prevalence in both sexes, in different age groups and in first-time replacement and regular BD from the Rabat Regional Blood Transfusion Centre.

BACKGROUND

Hepatitis B is a viral infection that spreads through blood and other biological fluids. The hepatitis B virus remains one of the most common serious complications of transfusion. No information exists on the real prevalence of hepatitis B in Moroccan BD.

METHODS

For the 2011 national HBsAg reactive rate, the percentage was calculated based on enzyme-linked immunosorbent assay (ELISA) results of the 232 190 blood donations collected around the country. For the Rabat blood Centre, we calculated the hepatitis B sero-prevalence from donations made at the donors' suite during 2000 and 2011.

RESULTS

The national prevalence of HBsAg was 1·34%. The HBsAg variations among different regions was between 0·43 and 2·86%. The Rabat donors' suite hepatitis B prevalence decreased from 2·47% in 2000 to 0·91% in 2011 (P < 0·001). In both years, family/replacement donors were found as safe as first-time BD and female donors were the safest.

CONCLUSIONS

These results, presented for the first time in the country, mapped the hepatitis B distribution across Morocco in a healthy population. The findings of this study could be of great importance in setting up strategies for the recruitment of the BD and keeping blood safety at the highest level.