Unmet Needs of Asian American and Pacific Islander Cancer Survivors

In the USA, cancer is the leading cause of death for Asian Americans and Pacific Islanders (AAPIs), but little is known about the unmet needs of AAPI cancer survivors, especially from a national perspective. Using a community-based participatory research approach, we partnered with the Asian and Pacific Islander National Cancer Survivors Network and the Asian American Cancer Support Network to design and conduct a cross-sectional survey to understand the unmet needs of a national sample of AAPI cancer survivors. We assessed unmet needs in 10 domains: day-to-day activities, financial expenses, emotional concerns, medical treatment, cancer information, home care, nutrition, physical concerns, family relationships, and spirituality. We also assessed self-reported measures related to quality of life. This national sample of AAPI cancer survivors included people from 14 states and two territories who had been diagnosed with a broad range of cancers, including cancer of the breast, ovary/uterus/cervix, prostate, blood, and other sites. Over 80 % reported at least one unmet need. Participants reported an average of 8.4 unmet needs, spanning an average of 3.9 domains. Most commonly reported were unmet needs pertaining to physical concerns (66 %), day-to-day activities (52 %), and emotional concerns (52 %). This is the first report of unmet needs in a national sample of AAPI cancer survivors with a range of different cancer types. It describes the areas of greatest need and points to the importance of devoting more resources to identifying and addressing unmet needs for the underserved population of AAPI cancer survivors.

Early expression profile of inflammatory markers and kidney allograft status

Cellular rejection after renal transplantation, in general, occurs as a result of an interaction between immunologic processes that maintain graft tolerance versus allograft rejection. A potential mechanism that triggers such processes might be through the activation of the innate immune response initiated during organ procurement and ischemia/reperfusion injury, contributing to delayed graft function or graft dysfunction. Our goal was to test the impact of molecular markers that have key roles in innate immunity such as cytokines, Toll-like receptors (TLRs), and allograft inflammatory factor-1 (AIF- 1) at early times after transplantation. Blood samples from a total of 90 patients who received kidney transplants were included in this study. Three samples from each patient at different time intervals (pretransplantation, day 3, and day 6 after transplantation) were tested using a quantitative reverse transcriptase polymerase chain reaction. The mRNA transcripts were tested in association with glomerular filtration rates (GFR) as a measure of allograft function. Surgical samples obtained from transplant nephrectomy were used in a tissue array for immunohistochemistry testing. In peripheral blood mononuclear cells, the mean ± standard error of mean (SEM) for interleukin 18 (IL-18), and IL-10 mRNA expression were increased and interferon-γ was decreased in association with high GFR post-transplantation as compared with the pretransplantation expression levels. The mean ± SEM for expression level of AIF-1 was increased 1.5-fold and for TLR-2 and TLR-4 were increased 1.2 to 1.4-fold in samples obtained on day 6 post-transplantation in association with low GFR (P < .05). In neutrophils, the mean ± SEM levels of TLR-2 mRNA was increased 2-fold on day 6 in association with high GFR (P < .005), but was reduced 2.8-fold in association with low GFR (P < .002). In conclusion, the mRNA profiles of biomarkers presented here appeared to be informative for prediction of allograft status and outcome.

Awareness and experience of needle stick injuries among dental students at the University of Nairobi, Dental Hospital

BACKGROUND

Needle stick injuries (NSI) are the commonest route by which blood borne viruses and/or infections such as HIV, Hepatitis B and C are transmitted from patients to health care workers (HCW). Dental students are also at risk of such infections and injuries due to accidental contamination during their practical occupational exposure. There is hardly any information regarding the knowledge and experiences of NSI among dental students in Kenya.

OBJECTIVE

To determine the knowledge and experiences of NSI among dental students at the University of Nairobi Dental Hospital (UONDH).

DESIGN

Descriptive cross-sectional study.

SETTING

University of Nairobi Dental Hospital premises. The population included undergraduate and postgraduate dental students pursuing their degrees at the university.

RESULTS

Seventy two questionnaires were issued and a response rate of 62 (81%) was achieved. The age of the respondents ranged from 21-35 years with a mean age of 24 years (SD +/- 4.7) years. There were 33 (53%) males and 29 (47%) females. Most of the students were undergraduates (87%) while the rest were postgraduate students (13%). The majority (97%) of the respondents reported that NSI was a means of cross-infection. Only 29% of the respondents had suffered NSI. Of those who had suffered NSI, 36% of the incidents occurred when administering local anaesthesia, while 23% were during scaling, 18% when recapping needles, 18% while clearing up and 5% when suturing. Only seven of those who had suffered NSI (39%) had reported of NSI. The reasons for not reporting were: fear of stigmatisation (25%) or the fear of consequences of cross-infection (38%). All the respondents who had experienced NSI were undergraduates with no statistical significant difference between the undergraduate and postgraduate students (chi2=3.758, p=0.052). Among the respondents who had experienced NSI, nine were males and nine were females with no statistical significance between the two genders (chi2=0.106, p=0.481). All the respondents recorded inadequate knowledge on the modes of prevention of NSI. Less than half (27%) of the respondents had accurate knowledge on the procedure followed in case of NSI. Only 27% of the respondents had taken post-exposure prophylaxis (PEP) after suffering NSI with no statistically significant difference between males and females (chi2=44, p=0.108).

CONCLUSION

Although the level of knowledge on the risk of cross-infection from NSI was high, there was decreased awareness on the means of prevention and protocol.

Optimisation of circulating biomarkers of cell death for routine clinical use

BACKGROUND

M30 and M65 enzyme-linked immunosorbent assays detect circulating cytokeratin 18 fragments released during caspase-dependent or total cell death, respectively, and have potential as biomarkers in epithelial cancers. While these assays have been validated, their robustness for routine clinical use is unknown.

PATIENTS AND METHODS

M30 and M65 were measured in matched serum and plasma samples from 31 lung cancer patients and 18 controls.

RESULTS

Time allowable between sample acquisition and processing is critical for assays in clinical use. A 4-h delay in processing at room temperature increased M30 (P < 0.0001), an effect minimised by incubation on ice. M30 and M65 in serum were resistant to processing variations including delays. Serum and plasma measurements correlated well although M30 but not M65 was lower in serum (P < 0.0005). Less variation between duplicate assays was observed in serum. Prolonged storage (-80 degrees C) led to increased M30 (12%, 6 months; 34%, 1 year). Sample dilution in the supplied assay diluent proved non-linear, whereas dilution in donor serum or porcine plasma restored linearity up to a ratio of 1 : 6.

CONCLUSION

We present recommendations that improve the reliability of these assays for clinical use and recommend serum as the preferred matrix with data more resistant to variations in collection.

Qualification of M30 and M65 ELISAs as surrogate biomarkers of cell death: long term antigen stability in cancer patient plasma

PURPOSE

M30 and M65 ELISAs are proposed as surrogate biomarkers of tumour cell death in patients and are being applied increasingly in the pharmacodynamic (PD) evaluation of anticancer drugs during clinical trials. In the absence of such data, we have studied the long-term stability of the antigens of both assays in plasma of cancer patients stored at -80 degrees C over 2 years.

RESULTS

No evidence was detected of degradation in the M65 antigen. However, in a proportion of patients significant increases in levels of M30 antigen were detected

CONCLUSION

Plasma samples for M65 analysis can be stored at -80 degrees C for 2 years; however, caution is recommended when considering long-term storage of samples for the M30 assay.

Refractory ascites after liver transplantation: an analysis of 1058 liver transplant patients at a single center

A retrospective study of 1058 liver transplant recipients was performed to determine: (i) the incidence, etiology, timing, clinical features and treatment of refractory ascites (RA), (ii) risk factors for RA development, (iii) predictors of RA disappearance, (iv) predictors of survival following RA and (v) the impact of RA on patient survival. Sixty-two patients (5.9%) developed RA and its disappearance occurred in 27/62 cases. Patients having hepatitis C virus (HCV) had a significantly higher hazard rate of developing RA (p < 0.00001). No other baseline characteristic was associated with RA. Cox stepwise regression analysis of the hazard rate of RA disappearance found two significant factors: HCV recurrence as the reason for developing RA implied a poorer outcome (p = 0.006), whereas an unknown reason implied a favorable outcome (p = 0.02). In addition, survival following RA was significantly poorer among patients having bacterial peritonitis or HCV recurrence. Finally, the mortality rate was significantly (nearly 8.6 times) higher in patients following RA development while it was ongoing (p < 0.00001); however, if the RA disappeared, then the additional risk of death also disappeared. This study illustrates the importance of developing an optimal treatment strategy to (i) effectively treat RA if it develops and (ii) prevent hepatitis C recurrence.

Sideroblastic anemia. A diagnosis to consider in alcoholic patients

Alcoholic patients who present with anemia can pose a diagnostic challenge. Although deficiencies of iron, vitamin B12, and folate commonly result in anemia, bone marrow suppression of red blood cell production related to the direct toxic effects of alcohol can cause a form called sideroblastic anemia. This case report describes a patient presenting with acute alcohol intoxication and anemia in whom extensive evaluation revealed a hematologic picture compatible with acquired sideroblastic anemia.

Progressive disseminated histoplasmosis in patients with acquired immunodeficiency syndrome

PURPOSE

Progressive disseminated histoplasmosis is now diagnosed frequently in patients with the acquired immunodeficiency syndrome (AIDS) living in the central United States. Previous review articles of AIDS have failed to mention this infection. Herein, we describe 48 AIDS patients with progressive disseminated histoplasmosis in an effort to better understand the clinical presentation and diagnosis of the condition in this setting and to assess the efficacy of antifungal chemotherapy.

PATIENTS AND METHODS

In the Houston metropolitan area, there were 66 cases of progressive disseminated histoplasmosis among 1,300 confirmed cases of AIDS from January 1983 to July 1987. Of AIDS patients in East Texas with histoplasmosis, 16 patients were available for follow-up by one of us, and the histories of 32 were obtained by examination of hospital charts and physician records.

RESULTS

Fever, weight loss, and splenomegaly were the most common presenting signs and symptoms, occurring in 81, 52, and 31 percent, respectively. One-third of the patients had hematologic abnormalities. Infiltrates on chest roentgenograms were observed in 52 percent. Progressive disseminated histoplasmosis was the initial manifestation of AIDS in almost three-fourths of our patients. Biopsy and culture of the bone marrow established the diagnosis of progressive disseminated histoplasmosis in 69 percent. Clinical or autopsy proof of relapse occurred in three patients despite an initial course of more than 2 g of amphotericin B chemotherapy followed by ketoconazole suppression.

CONCLUSION

Progressive disseminated histoplasmosis is often the first sign of immunodeficiency in patients with AIDS, and the diagnosis of this condition is most often established by bone marrow biopsy and culture. Because of the permanence of the immunodeficient state in these patients, progressive disseminated histoplasmosis is resistant to treatment.