A retrospective cohort study to evaluate disease burden, health care resource utilization, and costs in patients with breast cancer in Dubai, UAE.

BACKGROUND: The current study evaluated the disease burden, health care resource utilization and analyzed the cost burden due to events of special interest among patients with breast cancer (BC) diagnosed and treated in Dubai, United Arab Emirates (UAE), in general and in the subset of patients treated with cyclin-dependent kinase (CDK) 4/6 inhibitors. METHODS: This retrospective cohort study, using insurance e-claims data from Dubai Real-World Database, was conducted from 01 January 2014 to 30 September 2021. Female patients aged ≥ 18 years with at least 1 diagnosis claim for BC and with continuous enrollment during the index period were included. RESULTS: Overall, 8,031 patients were diagnosed with BC (median age: 49.0 years), with the majority (68.1%) being in 41-60-year age group. During the post-index period, BC-specific costs contributed to 84% of the overall disease burden among patients with BC. Inpatient costs (USD 16,956.2) and medication costs (USD 10,251.3) contributed significantly to BC-specific costs. In the subgroup of patients in whom CDK4/6 inhibitors were part of the treatment regimen (n = 174), CDK4/6 inhibitors were commonly prescribed in combination with aromatase inhibitors (41.4%) and estrogen receptor antagonists (17.9%). In patients with BC, health care costs due to events of special interest (n = 1,843) contributed to 17% of the overall disease cost burden. CONCLUSION: The study highlights the significant cost burden among patients with BC, with BC-specific costs contributing to 84% of the overall disease cost burden. Despite few limitations such as study population predominantly comprising of privately insured expatriate patients and only direct healthcare costs being assessed in the current study, most indicative costs have been captured in the study, by careful patient selection and cost comparisons, as applicable. The findings can guide key health care stakeholders (payers and providers) on future policy measures aiming to reduce the cost burden among patients with BC.

Assessment of oral hygiene trends among dental patients in relation to chronic medical conditions by dental students. A cross-sectional study.

INTRODUCTION: There is a lack of information about knowledge, attitude and behavior regarding oral hygiene and dietary habits of adult patients attending dental clinical settings. Hypertension, diabetes, obesity and caries are increasing among different populations, resulting in the deterioration of the quality of life related to oral and general health. OBJECTIVES: To involve second year dental students in assessing oral health knowledge, attitude, behavior, dietary habits and general health of dental patients, and screening for blood pressure, blood glucose level and obesity. PARTICIPANTS AND METHODS: A convenient sample of 652 adult subjects participated in the study. They were screened, and involved in an interviewer - led questionnaire, led by the students over the period of two successive academic years (2013-2014 and 2014-2015). RESULTS: Subjects with high blood pressure and /or blood glucose levels were more likely to disagree regarding the presence of a relation between general health and dental health [(correlation coefficient (r) = - 0.159, probability value P < 0.001) (correlation coefficient (r) = - 0.257, probability value P < 0.001) respectively]. Subjects with high BMI were less aware of the importance of using the tooth brush in prevention of gingival inflammation. The overall students' satisfaction score was 71.5%. The practical part of the research had the highest satisfaction score (83.7%). CONCLUSIONS: There is scarcity of data regarding dental healthcare knowledge and attitudes in dental clinical settings. Additional clinical training for dental students would increase their willingness to play a preventive and educational role in the oral care of patients.

Effect of feeding Acacia nilotica pods to sheep on nutrient digestibility, nitrogen balance, ruminal protozoa and rumen enzymes activity.

This study was conducted to evaluate the effect of supplying two levels of Acacia nilotica (A. nilotica) pods to rations of sheep on nutrient digestibility, nitrogen balance and rumen liquor parameters (pH, total protozoa count, protein concentration and enzymes activity). Twelve mature rams (50 ± 1.25 kg B.W.) were distributed into three groups, each with four rams. Animals in group one were considered as a control which fed a basal diet, consisting of concentrate mixture and Egyptian clover. The second group and the third one received the same basal diet with supplying the concentrate mixture by 1.5% and 3.0% of A. nilotica pods meal respectively. The experiment lasted for 3 weeks. It was found that supplementation of A. nilotica pods to the concentrate mixture at a rate of 1.5% and 3.0% significantly improved the total feed intake compared to the control. The digestibility of dry matter and crude fibre was significantly reduced with A. nilotica supplements, whereas the digestibility of crude protein was significantly improved. All of nitrogen intake and N-retained were significantly increased in rams fed on concentrates with 1.5% and 3.0% A.  nilotica pods when compared to the control. The pH of ruminal fluid was not affected by the dietary treatments. Nevertheless, the total rumen protozoa count was significantly decreased in A. nilotica pods supplemented groups. Also, the rumen protein concentration and the ruminal enzymes activity, especially α-amylase, cellulase and protease, were lower in A. nilotica pods supplemented treatments. In conclusions, inclusion of low levels of A. nilotica pods (1.5% and 3.0%) in the concentrates can be used as a natural protein protectant in ruminants by forming tannin protein complexes in the rumen to maximize the amino acids available in the lower digestive tract. Also, these levels can increase the protein digestibility as well as the N-retained in the body .

Vitamin D receptor gene FokI polymorphism in Egyptian children and adolescents with SLE: A case-control study.

Background Childhood-onset systemic lupus erythematosus (cSLE) is a lifelong autoimmune disorder. The vitamin D receptor (VDR) gene is a potential candidate gene for cSLE susceptibility. In this study, we aimed to investigate the FokI polymorphism in the VDR gene in Egyptian children and adolescents with SLE, to determine whether this polymorphism could be a genetic marker for cSLE susceptibility or disease activity and we also measured the serum level of 25-hydroxyvitamin D [25(OH) D] to assess its relation to such polymorphism. Methods This was a case-control study, which included 300 patients with cSLE and 300 age, sex, and ethnicity-matched healthy controls. All participants were genotyped for the VDR gene FokI (rs2228570) polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), while the serum [25(OH) D] levels were measured by enzyme-linked immunosorbent assay (ELISA). Results The VDR FokI FF genotype and F allele were overrepresented among cSLE patients compared with the controls, [odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.6-4.4 for the FF genotype; p = 0.000; and OR = 1.6; 95% CI: 1.27-2.05 for the F allele; p = 0.000, respectively]. We found a significant association between VDR FokI FF genotype with lupus nephritis (OR: 4.8; 95% CI: 2.2-10.6; p = 0.002); and high disease activity index score ( p = 0.01). Conclusions The FokI polymorphism in the VDR gene may contribute to susceptibility to SLE in Egyptian children and adolescents. Moreover, the FF genotype constituted a risk factor for the development of lupus nephritis and was associated with low serum [25(OH) D] levels as well as higher disease activity index score among studied patients with cSLE.

Occupational exposure to aluminum and its amyloidogenic link with cognitive functions.

As many other metals, aluminum is a widely recognized neurotoxicant and its link with neurodegenerative disorders has been the subject of scientific debate. One proposal focuses on amyloid ß deposition (amyloidogenesis) as the key player in triggering neuronal dysfunction the so-called amyloid cascade hypothesis. We undertook this study first to investigate the cognition status of workers exposed to Al dust in an Al factory in Southern Cairo, second, to evaluate serum amyloid precursor protein (APP) and cathepsin D (CD) enzyme activity to study the possible role of Al in amyloidogenesis, and finally to explore the relation between these potential biomarkers and cognitive functions. The study was conducted on 54 exposed workers and 51 matched controls. They were subjected to questionnaire, neurological examination and a cognitive test battery, Addenbrooke's Cognitive Examination - Revised (ACE-R). Serum Al, APP and CD enzyme activity were measured. A significant increase of serum Al was found in the exposed workers with an associated increase in serum APP and decrement in CD activity. The exposed workers displayed poor performance on the ACE-R test. No significant correlation was detected between ACE-R test total score and either APP or CD activity. We concluded that occupational exposure to Al is associated with cognitive impairment. The effect of occupational Al exposure on the serum levels of APP and CD activity may be regarded as a possible mechanism of Al in amyloidogenesis. However, our findings do not support the utility of serum APP and CD activity as screening markers for early or preclinical cognitive impairment.

Investigation of chronic toxicity of (14)C-fenitrothion and its degradation products on stored soybeans.

Grains of soybeans were treated with the recommended dose of fenitrothion insecticide, 5mg/kg, and double that dose, before storage for 30 weeks under ambient local conditions. During the storage period, the penetration and distribution of insecticide residues were studied. The amount of surface residues on stored soybeans, internal extractable and bound residues were determined. Surface residues were found to decrease with the increase in time of storage, whereas internal residues showed a gradual increase with time to reach 56%, 54% of applied doses after 30 weeks. The amount of bound residues inside the matrix showed a slow increase with time. Toxicity of the total internal residues of fenitrothion in stored soybeans was studied in mice through a sub-chronic feeding experiment for 3 months. The maximum inhibition in plasma and erythrocyte cholinesterase activity was 37% and 13% after the first month, respectively. Treated mice suffered from deterioration of hepatic and renal functions as indicated by the increase level of blood serum esterase's and blood urea nitrogen. Percentage increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was reached to about 62% and 55%, respectively as compared with control animals with the end of feeding period.

Impact of repeated pesticide applications on the binding and release of methyl 14C-monocrotophos and U-ring labelled 14C-carbaryl to soil matrices under field conditions.

The dissipation of (O-methyl-14C) monocrotophos and U-ring labelled 14C-carbaryl was monitored for over two years in absence and presence of other insecticides using in situ soil columns. The dissipation of 14C-monocrotophos from soil treated with methomyl and carbaryl showed a faster rate of downward movement than in a control column tagged with the labelled insecticide alone. The same trend was observed in experiments with 14C-carbaryl that dissipated more readily in soil treated with non-labelled monocrotophos and methomyl. In the presence of other insecticides the percentage of bound residues was generally lower than in control experiments. The bound residues at the top of the column are released at a low rate under conditions prevailing in the field. The overall time required for dissipation of 50% of monocrotophos and carbaryl (t50) as estimated from control experiment was approximately 20 and 24 weeks, respectively. The data indicate that repeated applications of pesticides might enhance the release of 14C-bound residues.

Toxicological evaluation and bioavailability of (14)C-fenitrothion bound residues on soybeans towards experimental animals.

Under local practice of Egyptian conditions, the application of (14)C-fenitrothion on soybeans at a dose of 10mg insecticide/kg grains, led to the formation of 21% of (14)C-bound residues (non-extractable) after 24 weeks of storage. The external residues were 20% and the internal extracts were 55% of the applied dose. Feeding studies on rats revealed that bound residues were bioavailable. After feeding rats for three days with bound (14)C-fenitrothion residues, the main portion of radioactivity was eliminated via expired air (42%), urine (20%) and feces (11.5%). About 15% of the administered radioactivity was distributed among various organs as, liver, kidney, lung, fat, intestine, blood, heart, and brain. Toxicity of bound residues of (14)C-fenitrothion in stored soybeans was studied in mice through feeding experiments for three months at a concentration of 1.9 mg/kg. The maximum inhibition in plasma and erythrocyte cholinesterase activity was observed 22.5%, 18.9% and 8.6%, 9% after one and seven days, respectively. The obtained results showed a slight significant elevation after three months in the activity of liver enzymes alanine amino transferase, aspartate amino transferase and alkaline phosphatase. A moderate increase in blood urea nitrogen and creatinine concentration was observed in the treated groups at the end of the experimental period. The detected levels of albumin and total protein showed no significant compared to the control values, of controlled animals, after three months.

Central obesity among adults in Egypt: prevalence and associated morbidity.

Through a home-based survey, all people aged 18 years and over (n = 1800) in the catchment areas of 12 primary health care centres in 4 Egyptian governorates were subjected to standardized waist and hip measurements. Central obesity was determined based on the waist circumference (WC) and waist-to-hip ratio (WHR) indicators. The age-adjusted prevalence of central obesity among adults was 24.1% and 28.7% based on the WC and WHR indicators respectively. After adjustment for sex and other confounding factors, WC was significantly associated with the risk of diabetes and hypertension, while WHR was not significantly associated with either diabetes or hypertension. No significant association was seen between body mass index and diabetes or hypertension.

Behavior of the organophosphorus insecticide fenitrothion in stored faba beans and its biological effects towards experimental animals.

Sound whole-seed faba beans were treated with (methyl-(14)C) fenitrothion [O, O-dimethyl-O-(3-methyl-4-nitrophenyl) phosphorothioate] at 5 and 10 mg insecticide/kg seeds, a dose normally used in practice. During the 30 weeks of storage period, the penetration and distribution of insecticide residues were studied. The amount of surface residues, internal residues and bound insecticide residues was estimated. Surface residues were found to decrease with the increase in time of storage, whereas internal residues showed a gradual increase with time apparently not dose dependent. Grain-bound residues increased with time and reached to its maximum (14-18%) after 24 weeks of storage. Chromatographic analysis of the internal extracts revealed the presence of the parent compound together with three main metabolites which were found in both free and conjugated form. Feeding mice for 90 days with a diet mixed with total internal fenitrothion residues in stored faba beans led to a reduction in body weight gain, and an appreciable decrease in cholinesterase activity of 32% for plasma and 15% for red blood cells (RBC(S)) after two months of experiment. Also, a significant decrease was showed in both total protein and albumin concentration at the end of feeding period (90 days). Liver and kidney function, as well as lipid profile of treated mice significantly increased at the end of feeding period. After a one-month recovery period, all the examined blood parameters returned to about the control values except blood urea and serum triglyceride.

Quality improvement programme for diabetes care in family practice settings in Dubai.

A continuous quality improvement programme for the care of registered diabetes patients was introduced in 16 government-affiliated primary health care centres in Dubai. Quality improvement teams were formed, clinical guidelines and information systems were developed, diabetes nurse practitioners were introduced and a team approach was mobilized. Audits before and after the introduction of the scheme showed significant improvements in rates of recording key clinical indicators and in their outcomes. For example, the proportion of patients with glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.

Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city.

OBJECTIVES: To assess the knowledge, attitude and behaviour in relation to periodontal health status among Saudi intermediate and high school students living in Jeddah, Kingdom of Saudi Arabia. METHODS: A dental health questionnaire was distributed to a random sample of a total of 2586 Saudi students from intermediate and high school, aged 12-18 years residing in Jeddah. RESULTS: While about 87.1% knew that tooth brush helps prevent periodontal disease, only 33.1% knew that using dental floss helps in preventing periodontal disease. Females used brushing and flossing more than males, while males used miswak more than females. Tooth brushing (P<0.001) and dental floss (P<0.015) were used more frequently among private subjects, while miswak was utilized more frequently among governmental school students (P<0.005). Dental pain was found to be the main reason for visiting the dentist among the target group. CONCLUSIONS: It appears that knowledge, attitude, and behaviour concerning periodontal health among young Saudi school students living in Jeddah city are in need of improvement.

Fate of 14C-chlorpyrifos in stored soybeans and its toxicological potential to mice.

Grains of soybeans were treated with [ethyl-1-4C]chlorpyrifos at a dose of 15 ppm and its triplet. During the 30-week storage period, the penetration and distribution of insecticide residues were studied. The amount of surface residues on stored soybeans, internal extractables and bound residues were determined. Surface residues were found to decrease with the increase in time of storage, whereas internal residues showed a gradual increase with time to reach 40-52% of applied dose after 30 weeks. Non-extractable residues showed a relatively slow but definite increase with time. The degradation products include, in addition to the parent insecticide which constitutes 50% of the total residues, the oxygen-analogue of chlorpyrifos, desethyl chlorpyrifos and 3,5,6-trichloropyridinol. Feeding mice for 90 days with a diet mixed with total internal chlorpyrifos residues in stored soybeans led to considerably inhibited plasma and red blood cells-cholinesterase activity by 78 and 46%, respectively, during the experimental period. Blood picture, liver and kidney function of treated mice were significantly affected during the feeding period.

Reference levels of the tumor markers carcinoembryonic antigen, the carbohydrate antigens 19-9 and 72-4, and cytokeratin fragment 19 using the Elecsys Relecsys 1010 analyzer in a normal population in Kuwait. The importance of the determination of local reference levels.

The tumor markers CEA, CA 19-9, CA 72-4 and CYFRA 21-1 were analyzed in a group of apparently healthy subjects (n=232) in Kuwait using the Elecsys Relecsys 1010 analyzer. The distribution of the tumour marker levels was analyzed separately in Kuwaitis (n=103), non-Kuwaitis (n=129), smokers (n=68), non-smokers (n=164), males (n=138) and females (n=94). The distribution of CEA was significantly different in Kuwaitis vs. non-Kuwaitis in the total population (p=0.033) and in non-smokers (p=0.049); in males vs. females in the total population (p<0.0001) and in non-smokers (p=0.0002); and in smokers vs. non-smokers in the total population (p<0.0001) using the non-parametric Mann-Whitney U test. None of the other tumour markers showed significant differences in the subgroups. The upper reference level was defined as the 95th percentile of the normal values in each group. A higher reference level of CEA was observed in smokers (vs. non-smokers) in the total population. Also higher reference levels of CEA were observed in males (vs. females) both in the total population and in non-smokers. In the total population the respective reference levels were: CEA: 4.4 microg/L, CA 19-9: 35 kU/L, CA 72.4: 2.4 kU/L, and CYFRA 21.1: 2.1 microg/L. These results were compared with data in the kit inserts and literature data. The impact of 95th percentiles in a local heterogeneous population is discussed.

Mineralization of 14C-ring labelled 2,4-D in Egyptian soils under aerobic and anaerobic conditions.

OBJECTIVES: To study the mineralization of 2,4-D in clay and clay loam Egyptian soils under subtropical conditions over a period of 90 d. METHODS: Using 14C-ring labelled pesticide, laboratory studies under aerobic and anaerobic conditions were conducted. 14C-activity in solutions was directly determined by liquid scintillation counting. Unextractable soil residues were determined by combustion. The nature of methanolic 14C-residues was determined by thin layer and high performance liquid chromatographic analysis. RESULTS: Under aerobic conditions 10%-14% of applied dose was mineralized during 90 d irrespective of soil type. The soil extractable pesticide residues decreased with time and the bound residues gradually increased. The highest binding capacity of about 26%-29% was observed in clay soil under aerobic conditions after 90 d. A good balance sheet was obtained and the percentage recovery was generally between 91% and 100%. CONCLUSION: The mineralization of 2,4-D in clay soil was higher than that in clay loam soil under anaerobic conditions. Under aerobic conditions, the soil type had no influence on mineralization capacity of 2,4-D during 90 d. The soil binding increased with time whereby the extractable 14C-residues simultaneously decreased. Chromatographic analysis of the methanol extractable 14C-residues of soils revealed the presence of 2,4-D as a main product together with 2,4-dichlorophenol.

Plasma concentrations of alpha-tocopherol and urate in patients with different types of cancer.

OBJECTIVE: To measure plasma concentrations of alpha-tocopherol and urate to determine whether there is any relationship with different types of cancer before treatment. METHOD: Plasma concentrations of those two antioxidants were measured in cancer patients and sex- and age-matched controls. Plasma total cholesterol concentration was measured to derive an alpha-tocopherol/cholesterol ratio. RESULTS: Alpha-tocopherol and urate concentrations as well as alpha-tocopherol/cholesterol ratios were significantly lower in the cancer patients as whole, in gastrointestinal cancer and in breast cancer compared to the controls. There was no significant relationship between alpha-tocopherol and urate levels in either the plasma of patients (r=0.048; P=0.653) or controls (r=0.073; P=0.406). Alpha-tocopherol was more positively correlated with cholesterol in the plasma of controls (r=0.539; P < 0.0001) in comparison with the patients (r=0.456; P < 0.0001). There was no significant correlation between urate and cholesterol levels in both patient and control plasma samples. CONCLUSION: The data suggest that although alpha-tocopherol and urate provide important antioxidant defence in cancer, the association between their levels is weak.

Plasma micronutrient antioxidant in cancer patients.

The distribution of breast, colon, gastric, thyroid, oral, rectal, pancreatic and renal cancers were determined in 71 Kuwaitis, 45 other Arabs, and 26 Indians. Plasma levels of micronutrient antioxidants, retinol, alpha-tocopherol, lycopene, and beta-carotene were measured in the groups and in 90 matched controls for comparison. Cholesterol was measured to determine its association with the micronutrient antioxidants. Pancreatic cancer occurred exclusively in Kuwaitis, while breast and colon cancers were disproportionately higher in Kuwaitis than in the other groups. Micronutrient antioxidant levels were similar in the groups, except for higher lycopene levels in Kuwaitis. In most instances, the micronutrient antioxidants, except beta-carotene, decreased significantly in levels in patients than in controls. Low levels of retinol, lycopene, and beta-carotene were strongly associated with pancreatic cancer. Compared to controls, significantly increased levels of beta-carotene occurred in breast, colon, thyroid, and renal cancers; increased lycopene occurred in oral cancer, and increased alpha-tocopherol occurred in pancreatic cancer. Alpha-tocopherol strongly correlated with cholesterol. Generally, changes in alpha-tocopherol/ cholesterol ratios mimicked those of alpha-tocopherol levels. Micronutrient antioxidant levels were significantly lower in male patients than female patients. Age showed a negative but statistically insignificant relationship with micronutrient antioxidants. Lycopene strongly correlated with alpha-carotene and alpha-tocopherol with retinol. Among the patients, all micronutrient antioxidants except retinol decreased significantly in levels in smokers than nonsmokers, suggesting susceptibility to cigarette smoke oxidative stress. We conclude that micronutrient antioxidant depletions and altered associations may imply tumor utilization or antioxidant burden in oxidative stress or both. Furthermore, the incidence of pancreatic, colon and breast cancers among Kuwaitis warrants further study.

Infection after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall.

OBJECTIVE: To assess the incidence of infected bile and gallbladder wall infection at the time of laparoscopic cholecystectomy, and find out if they influenced the rate of postoperative infective complications. DESIGN: Prospective study. SETTING: District hospital, Kuwait. SUBJECTS: All 279 patients who had their gallbladders removed laparoscopically for gallbladder disease between September 1995 and August 1998. INTERVENTIONS: Samples of bile and gallbladder wall were taken from all patients and cultured separately for aerobic and anaerobic bacteria. Patients with complicated gallbladder disease (n = 80) were given preoperative therapeutic antibiotics for five days (cephalosporin plus metronidazole), and other high-risk patients (n = 138) were given prophylactic ceftriaxone either 1 g x 3 starting at induction of anaesthesia (n = 42), or a single dose at induction (n = 96). MAIN OUTCOME MEASURES: Incidence of infected cultures, and infective morbidity. RESULTS: 26 specimens of bile (9%) and 56 specimens of gallbladder wall (20%) were infected. Two patients in whom neither specimen had shown any growth developed minor infections at the umbilical port. No patient in whom either specimen was infected developed an infective complication. CONCLUSIONS: The overall rate of infective complications was negligible, and did not correlate with the presence of bacteria in the bile or gallbladder wall. This is probably a reflection of our aggressive antibiotic regimen in the management of high-risk patients.

Dietary cancer risk from conditional cancerogens (tumor promoters) in produce of livestock fed on species of spurge (Euphorbiaceae). V. Skin irriitant and tumor-promoting diterpene ester toxins of the tigliane and ingenane type in the herbs Euphorbia nubica and Euphorbia helioscopia contaminating fodder of livestock.

Irritant diterpene ester toxins were isolated from Euphorbia nubica and E. helioscopia, which are contaminants of the green fodder of livestock in Egypt. Fractionations of methanol extracts of aerial parts of both plants were monitored by the irritation unit on the mouse ear. Plant extracts were subjected to multiplicative distribution methods, yielding irritant hydrophilic fractions that were further purified by column chromatography. Final purification of the materials was achieved by TLC (silica gel) followed by HPLC, or by TLC alone. In this way, from E. nubica, five Euphorbia factors (Nu1-Nu5) were isolated and characterized as short-chain polyfunctional diterpene esters of tigliane-type parent alcohols. The two weak irritants Nul and Nu3 were triesters of 4-deoxy(4alpha)phorbol. Nu2 was shown to be a triester of the stereoisomeric tigliane-type parent alcohol 4-deoxyphorbol. Weak irritant Nu4 probably is a positional isomer of Nu2. Nu5 was characterized as a short-chain triester of 4,20-dideoxy-5xi-hydroxyphorbol. From E. helioscopia, six short- to medium-chain polyfunctional diterpene esters of the ingenane type, generally containing unsaturated acids were obtained, i.e., four irritant esters of ingenol (Euphorbia factors H1, H2, H5, and H6) and two esters of 20-deoxyingenol (non-irritant Euphorbia substance HS4, and irritant Euphorbia factor H8). All irritant Euphorbia factors of the tigliane and ingenane diterpene ester type described in this investigation are considered to be more or less active tumor promoters, i.e., conditional (non-genotoxic) cancerogens. The Euphorbia factors assayed exhibited moderate (H1) to low (H8) relative tumor-promoting potency in comparison to the ingenane prototype DTE tumor promoter 3-TI.