Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women.

BACKGROUND: Women with breast cancer in sub-Saharan Africa are commonly diagnosed at advanced stages. In Tanzania, more than 80% of women are diagnosed with stage III or IV disease, and mortality rates are high. This study explored factors contributing to delayed diagnostic evaluation among women with breast cancer in Tanzania. METHODS: A qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Twelve women with symptomatic pathologically proven breast cancer were recruited. In-depth, semi-structured interviews were conducted in Swahili. Interviews explored the women's journey from symptom recognition to diagnosis, including the influence of breast cancer knowledge and pre-conceptions, health seeking behaviors, psychosocial factors, preference for alternative treatments, and the contribution of culture and norms. Audio-recorded interviews were transcribed and translated into English. Thematic analysis was facilitated by a cloud-based qualitative analysis software. RESULTS: All women reported that their first breast symptom was a self-identified lump or swelling. Major themes for factors contributing to delayed diagnostic presentation of breast cancer included lack of basic knowledge and awareness of breast cancer and misconceptions about the disease. Participants faced barriers with their local primary healthcare providers, including symptom mismanagement and delayed referrals for diagnostic evaluation. Other barriers included financial hardships, fear and stigma of cancer, and use of traditional medicine. The advice and influence of family members and friends played key roles in healthcare-seeking behaviors, serving as both facilitators and barriers. CONCLUSION: Lack of basic knowledge and awareness of breast cancer, stigma, financial barriers, and local healthcare system barriers were common factors contributing to delayed diagnostic presentation of breast cancer. The influence of friends and family also played key roles as both facilitators and barriers. This information will inform the development of educational intervention strategies to address these barriers and improve earlier diagnosis of symptomatic breast cancer in Tanzania.

Evaluation of the anti-inflammatory potential of Solidago microglossa (Arnica-brasileira) in vivo and its effects on PPARγ activity.

Solidago microglossa is used as an anti-inflammatory agent in traditional Brazilian medicine, and this work evaluated the anti-inflammatory potential of the crude ethanolic extract of the flowers of S. microglossa in vivo, as assayed by paw edema models induced by carrageenan, prostaglandin E2, bradykinin and compound 48/80. In the chemical profile, we identified compounds by electrospray ionization mass spectrometry and quantified them by HPLC-DAD. Additionally, this study analyzed the potential to activate the in vitro transcriptional activity of PPARγ, which is a nuclear receptor linked to the anti-inflammatory response. It was possible to identify five compounds: quinic acid, quercetin, chlorogenic acid, hyperoside, and rutin. In the paw edema evaluation, it was possible to show the potential of reducing edema during the inflammatory process. The crude ethanolic extract of the flowers of S. microglossa activated PPARγ compared to the full agonist rosiglitazone and in a dose-response manner. It is possible to conclude that the extract of the flowers of S. microglossa showed anti-inflammatory activity, and the phenolic compounds present in this species might be responsible for this activity.

Oral butyrate does not affect innate immunity and islet autoimmunity in individuals with longstanding type 1 diabetes: a randomised controlled trial.

AIMS/HYPOTHESIS: The pathophysiology of type 1 diabetes has been linked to altered gut microbiota and more specifically to a shortage of intestinal production of the short-chain fatty acid (SCFA) butyrate, which may play key roles in maintaining intestinal epithelial integrity and in human and gut microbial metabolism. Butyrate supplementation can protect against autoimmune diabetes in mouse models. We thus set out to study the effect of oral butyrate vs placebo on glucose regulation and immune variables in human participants with longstanding type 1 diabetes. METHODS: We administered a daily oral dose of 4 g sodium butyrate or placebo for 1 month to 30 individuals with longstanding type 1 diabetes, without comorbidity or medication use, in a randomised (1:1), controlled, double-blind crossover trial, with a washout period of 1 month in between. Participants were randomly allocated to the 'oral sodium butyrate capsules first' or 'oral placebo capsules first' study arm in blocks of five. The clinical investigator received blinded medication from the clinical trial pharmacy. All participants, people doing measurements or examinations, or people assessing the outcomes were blinded to group assignment. The primary outcome was a change in the innate immune phenotype (monocyte subsets and in vitro cytokine production). Secondary outcomes were changes in blood markers of islet autoimmunity (cell counts, lymphocyte stimulation indices and CD8 quantum dot assays), glucose and lipid metabolism, beta cell function (by mixed-meal test), gut microbiota and faecal SCFA. The data was collected at the Amsterdam University Medical Centers. RESULTS: All 30 participants were analysed. Faecal butyrate and propionate levels were significantly affected by oral butyrate supplementation and butyrate treatment was safe. However, this modulation of intestinal SCFAs did not result in any significant changes in adaptive or innate immunity, or in any of the other outcome variables. In our discussion, we elaborate on this important discrepancy with previous animal work. CONCLUSIONS/INTERPRETATION: Oral butyrate supplementation does not significantly affect innate or adaptive immunity in humans with longstanding type 1 diabetes. TRIAL REGISTRATION: Netherlands Trial Register: NL4832 (www.trialregister.nl). DATA AVAILABILITY: Raw sequencing data are available in the European Nucleotide Archive repository (https://www.ebi.ac.uk/ena/browse) under study PRJEB30292. FUNDING: The study was funded by a Le Ducq consortium grant, a CVON grant, a personal ZONMW-VIDI grant and a Dutch Heart Foundation grant.

The association of plasma fatty acids with prostate cancer risk in African Americans and Africans.

Higher risk for prostate cancer (PCa) among African Americans is partly associated with exposure to dietary fatty-acids, the carcinogenic effects of which remain controversial. Odds ratio of PCa risk was determined by unconditional logistic regression comparing highest with lowest quartiles of plasma fatty-acids in a case-control design. Mean age for 173 African Americans and 340 Nigerians was 56.9 +/- 9.8 and 60.1 +/- 14.0, p<.006, median (25th, 75th percentile) plasma fatty-acid was 2598 (2306, 3035) microg/ml and 2420 (2064, 2795) microg/ml, p<.001, with 48 (27.7%) and 66 (19.4%) PCa cases, respectively. African Americans recorded higher total, omega-6, and trans, but lower saturated and omega-3 fatty-acids, with non-significant PCa risk association for total, omega-6 and trans fatty acids. Positive PCa risk trend was observed in both populations with nervonic, erucic, and arachidonic acids, with docosahexaenoic acid (DHA) among African Americans, and with behenic and stearic acids in Nigerians. Non-significant negative PCa risk trend was observed with ecosapentaenoic acid (EPA) in Nigerians only. These preliminary findings need to be further explored in a larger study that will include risk analysis of fatty-acid ratios to clarify their combined impact on PCa risk.

Neuronal and extraneuronal expression and regulation of the human alpha5 nicotinic receptor subunit gene.

The mRNA encoding the human alpha5 nicotinic subunit was detected in several structures of the nervous system but appeared to be mainly expressed in cerebellum, thalamus, and the autonomic ganglia. For the first time, the alpha5 transcript was also detected in several non-neuronal tissues, with maximal expressions being found throughout the gastrointestinal tract, thymus, and testis. Many other extraneuronal sites expressed alpha5, but there were also nonexpressing organs, such as the liver, spleen, and kidney. To understand the transcriptional mechanisms controlling such a diversified expression of alpha5 in neuronal and nonneuronal cells, we isolated the 5'-regulatory region of the human gene and characterized its properties. Here we identify the alpha5 core promoter and demonstrate that the DNA regions surrounding it contain elements (with positive or negative activities) that work in a tissue-specific fashion. In particular, the segment specifying the 5'-untranslated region in neuronal cells has most of the properties of an enhancer because it activates a heterologous promoter in a position- and orientation-independent fashion. We therefore conclude that the expression of alpha5 relies on a highly complex promoter that uses distinct regulatory elements to comply with the different functional and developmental requirements of the various tissues and organs.

Phytochemical analysis and hemodynamic actions of Artemisia vulgaris L.

Artemisia vulgaris L. is widely used in the Philippines for its anti-inflammatory properties. The plant was cultivated and mature leaves were collected and washed. The dried leaves were extracted with both distilled water and chloroform. NMR data were obtained using a Varian Unity 500 MHz spectrophotometer. High and low-resolution mass spectra were obtained on a Finnigan MAT 96 high resolution gas chromatograph/mass spectrophotometer with a MAT ICIS operating system. The leaves yielded 2 sesquiterpene lactones and a novel aromatic compound. Two partition fractions from the aqueous extracts and four partition fractions from the chloroform extracts were tested on male Sprague-Dawley rats using both the in situ mesenteric circulation and the isolated perfused mesentery. In the isolated perfused rat mesentery, administration of 10% w/v solutions of water extract fractions FGN 63-1 and FGN 63-2 of A. vulgaris were highly effective in reversing the hypertensive action induced by norepinephrine, but they did not change the regional mesenteric pressures when given at baseline. In the intact rat, injection of 10 mg/ml of FGN 63-1 and chloroform extract FGN 64-2 did not significantly alter baseline blood pressures, but were able to reverse the increase in mean systolic and diastolic pressures induced by norepinephrine. The same fractions did not exert any significant effect on heart rate in either the normotensive or hypertensive states. The present data suggest that aqueous and chloroform extracts from leaves of A. vulgaris have anti-hypertensive actions but have no significant effects on cardiovascular hemodynamics under basal conditions.