Impact of Clinical Examination and Gamma Knife Surgery in Stage IV Breast Cancer With Brain Metastasis.

Metastatic breast cancer often presents with significant diagnostic and treatment challenges. This case report highlights the crucial role of thorough clinical examination and history-taking in diagnosing and managing a patient with metastatic breast cancer, mainly focusing on the successful integration of Gamma Knife radiosurgery (GKRS). We present a case of a 68-year-old postmenopausal woman with metastatic breast cancer, initially presenting with a primary tumour in the left breast and later developing a solitary brain metastasis (BM) in the left temporal lobe. Following neoadjuvant chemotherapy and left mastectomy, the patient experienced involuntary movements in the right arm, leading to the discovery of the brain lesion. Critical to this diagnosis was a detailed clinical examination emphasising the importance of vigilant monitoring in cancer management. The patient underwent GKRS, offering a focused and less invasive treatment approach with favourable outcomes. This case underscores the value of clinical vigilance in managing complex breast cancer cases. The integration of GKRS as a targeted treatment modality for BM represents a pivotal aspect of modern oncological care, especially for patients with multiple treatment modalities. This report emphasizes the importance of clinical examination in the early detection of complications such as BM in breast cancer patients. Furthermore, it demonstrates the effectiveness of GKRS in managing such metastases, reinforcing its role as a valuable tool in the multidisciplinary treatment approach for advanced breast cancer.

Analysis and risk assessment of pharmaceutical residues in fish from three water bodies in Ghana.

Illegal mining has overshadowed pharmaceutical pollution even though exposure to pharmaceutical waste is high. Consumption of fish potentially polluted with pharmaceuticals from the rivers continues with little concern or potential threat it poses. In the present study, the residues of one antibiotic (Chloramphenicol), five hormones (progesterone, 17-beta Estradiol, Estrone, 17a-Ethynylestradiol, and one), three environmental contaminants (4-para-nonylphenol, 4-tert-octylphenol, and Bisphenol A), one barbiturate (Primidone) and one analgesic (Diclofenac sodium salt), were investigated from fish samples from the rivers Pra, Narkwa, and the Volta. The results show a high concentration of drugs in River Pra in comparison to those in Rivers Narkwa and Volta. The hazard quotients (HQs) for the environmental contaminants were all above 1, except Bisphenol A. Furthermore, the HQs from this study suggest that consumers of fish from any of the three rivers stand a hazard risk of Chloramphenicol (19), 17a-Ethynylestradiol (4), Estrone (1.366), Diclofenac sodium salt (3.29), Progesterone (4.598), 4-tert-octylphenol (87.2), and 4-para-nonylphenol (7.252), but negligible risk against E2 (0.687), Primidone (0.014), Testosterone (0.16), and Bisphenol A (0.642). Of the fish species studied, the highest concentration of all pharmaceuticals put together is found in Clarias gariepinus, Labeo senegalensis, and Chrysichthys nigrodigitatus in that order.

Potentially Toxic Elements (PTEs) contamination and ecological risk of sediment in the upper course of the Ankobra River, Ghana.

Metals, when introduced into a high pH aquatic environment, generally sink into bottom sediments and can pose a direct and indirect threat to aquatic organisms as well as humans. The concentrations of ten heavy metals (Mn, Fe, Cd, Cu, Cr, Pb, Hg, As, Zn, and Al) in the surface sediment samples from the upper part of the Ankobra, which is an illegal mining (Galamsey) prone area, were assessed in both the dry and wet seasons. To ascertain the quality of sediments, sediment quality indices, including enrichment factor (EF), index of geo-accumulation (I-geo), and modified pollution index (MPI), were employed. A comprehensive potential ecological risk assessment was also carried out using the consensus-based sediment quality guideline (CBSQG) as well as the modified potential ecological risk index (MPERI). In general, the sediment is considered to be "slightly" to "moderately" polluted in the dry season as well as "moderately" to "heavily'' polluted in the wet season. The potential ecological risk of the metals in the sediments was within the considerable to high-risk grade for Hg, moderate to considerable risk for Cd, low to moderate risk for As, and low risk for Cu, Cr, Pb, and Zn. The order of decreasing potential ecological risk for the metals is Hg > Cd > As > Cu > Pb > Cr > Zn and the risk in the wet season was higher than that in the dry season.

Mechanism and multi-step kinetic modelling of Cr(VI) adsorption, reduction and complexation by humic acid, humin and kerogen from different sources.

Humin (HM) and kerogen (KG) are widespread in soils and sediments, which have strong retention effects on the migration and transformation of Cr(VI) in subsurface environment. Previous studies mainly focused on the interaction between Cr(VI) and soluble organic matter, such as humic acid (HA); however, the adsorption and reduction mechanism for Cr(VI) by insoluble HM and KG are still unclear, the processes of which might be quite different from HA due to their different sources and humification degrees. Consequently, in this study, HA, HM and KG extracted from different sources were used to explore the adsorption, reduction and complexation mechanisms of Cr(VI) in soils and sediments, based on which a multi-step kinetic model of Cr(VI) was carried out. According to the results, the retention of Cr(VI) by humus was found to obey a coupling mechanism of "adsorption-reduction-complexation", where Cr(VI) adsorption was by complexation with carboxylic groups by ligand exchange. The phenolic and hydroxylic groups were determined to be the main electron donor for Cr(VI) reduction. Notably, the Cr(III) produced was found to be adsorbed on the surface of humus by complexation on phenolic and hydroxylic groups, and the excesses were released into the liquid phase after the saturation of complexation sites. Based on the revealed mechanism, a multi-step kinetic model for simultaneously describing Cr(VI) adsorption and reduction and behaviour of Cr(III) was proposed producing a better fitting performance (R2 ≥ 0.984) than the first-order and second-order kinetic models (R2 ≤ 0.84 and 0.87, respectively) and hence could provide more factual understanding of Cr(VI) transformation in soils and sediments enriched in various types of humus.

Managing cancer care during the COVID-19 pandemic-experience at a cancer department in a tertiary hospital in Antigua and Barbuda.

The emergence of corona virus disease 2019 (COVID-19) has caused a global public health emergency and the pandemic has forced the healthcare givers to organise their work differently to provide the same level of care to their patients. Meticulous planning and implementation of robust infection control, proper triage of patients, patient education and awareness and establishment of good command structure has become the norm. In this article we illustrate how the COVID-19 pandemic has affected the oncology department in a tertiary centre in the Caribbean country of Antigua & Barbuda. We describe the changes in treatment decisions for outpatient and inpatient services along with a look at the ethical considerations and the well-being of the oncology team.

Assessment of Heavy Metal Pollution in the Sediments of the River Pra and Its Tributaries.

An investigative study was conducted to determine the heavy metal pollution in the sediment in the Pra Basin of Ghana from 27 sampling points during the dry and wet seasons using the geo-accumulation index (Igeo), enrichment factor (EF), and pollution load index (PLI). Sediments were acid digested and analyzed for the following selected metals: arsenic (As), lead (Pb), cadmium (Cd), zinc (Zn), manganese (Mn), total chromium (Cr), nickel (Ni), and iron (Fe) using the dual atomizer and hydride generator atomic absorption spectrophotometer (model ASC-7000 No A309654, Shimadzu, Japan). The metal concentrations (mg kg-1) in the sediments were as follows: As (0.175) < Cd (3.206) < Ni (79.927) < Zn (118.323) < Cr (216.708) < Mn (234.742) < Pb (335.381) < Fe (1354.513) in the dry season and As (0.002) < Cd (7.279) < Ni (72.663) < Zn (35.622) < Pb (135.863) < Cr (167.604) < Mn (183.904) < Fe (1138.551) for the wet season. The EF which is an indication of whether metal concentrations are due to anthropogenic activities shows enrichment at all site for the metals Cr, Pb, and Cd in the wet seasons. However, only 4 out of the 27 sites showed Ni enrichment in the wet season. Contrary to the wet season, only Pb and Cr recorded enrichment at all sites during the dry season. Fifteen out of the 27 sites recorded Cd enrichment and 24 out of the 27 sites recorded Ni enriched during the dry season. None of the sites were enriched with Fe, As, Zn, and Mn in either the dry or wet seasons. For both dry and wet seasons, the pollution load index for all the sites except one was at the background levels which is a sign of non-deterioration of the sites studied. In the wet season, the calculated Igeo reveals that the study area is not contaminated with respect to As, Zn, Fe, and Mn; uncontaminated to moderately contaminated with Cd; moderately contaminated with Cr; uncontaminated to moderately to heavily contaminated with Ni; and moderately to heavily contaminated with Pb. The dry season Igeo results reveal non-contamination of the study area with respect to As, Fe, and Mn; uncontaminated to moderately contaminated with Zn; moderately contaminated with Cr; uncontaminated to heavily contaminated with Cd; uncontaminated to extremely contaminated with Ni; and moderately to extremely contaminated with Pb. The high levels of Cd, Pb, and Cr in all the sites are due to unregulated illegal mining activities occurring in and around the study area. It is hoped that this study will prompt the basin management board to improve their management strategies in controlling unregulated illegal mining in the basin sediments.

Management of ampullary carcinoid tumors with pancreaticoduodenectomy.

A 66 year old female was found to have an ampullary mass on endoscopic examination. A pancreaticoduodenectomy was performed and the pathology was consistent with carcinoid tumor. Carcinoid tumors of the ampulla of Vater are rare tumors of the gastrointestinal tract, accounting for 0.3-1% of gastrointestinal carcinoids. Management of ampullary carcinoid tumor with pancreaticoduodenectomy is in accordance with current recommendations.