Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience.

BACKGROUND: Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis. METHODS: This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death. RESULTS: Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001). CONCLUSIONS: Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.

Detection of Trichomonas vaginalis by different methods in women from Dohok province, Iraq.

This study compared 4 different diagnostic methods for the detection of Trichomonas vaginatis in vaginal swab specimens from women attending a hospital in Dohuk in Iraq. A total of 425 vaginal swabs were obtained from women complaining of vaginal discharge associated with vaginitis, cervicitis and pelvic inflammatory disease. The results showed that 10 (2.4%) swabs were positive for T. vaginalis by wet smear preparation, 15 (3.5%) by haematoxylin-eosin stained smear, 17 (4.0%) by Papanicolaou stain and 23 (5.4%) using Diamond modified culture. The rate varied significantly by age and was highest in young women aged 20-25 years (7.6%) and lowest in the age group 36-40 years (2.2%). The highest rate of infection with T vaginalis was detected by Diamond modified culture.

Detection of Trichomonas vaginalis by different methods in women from Dohok province, Iraq

This study compared 4 different diagnostic methods for the detection of Trichomonas vaginalis in vaginal swab specimens from women attending a hospital in Dohuk in Iraq. A total of 425 vaginal swabs were obtained from women complaining of vaginal discharge associated with vaginitis, cervicitis and pelvic inflammatory disease. The results showed that 10 [2.4%] swabs were positive for T. vaginalis by wet smear preparation, 15 [3.5%] by haematoxylin-eosin stained smear, 17 [4.0%] by Papanicolaou stain and 23 [5.4%] using Diamond modified culture. The rate varied significantly by age and was highest in young women aged 20-25 years [7.6%] and lowest in the age group 36-40 years [2.2%]. The highest rate of infection with T. vaginalis was detected by Diamond modified culture

Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients.

To aim of this study is to analyse the survival rate and prognostic indicators of systemic lupus erythematosus (SLE) in Pakistani population. A total of 198 patients with SLE diagnosed between 1992 and 2005 were reviewed retrospectively. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and mortality data were obtained. Prognostic factors for survival were studied by statistical analysis. Of 198 SLE patients studied, 174 were women and 24 were men. The women to men ratio was 7.2:1. Mean age at presentation was 31 years (range 14-76). Mean duration of symptoms before diagnosis was 2.8 years. Mean duration of follow-up was 34.21 months (+/-33.69). Mean disease duration was 15.6 years. At diagnosis, arthritis, malar rash, oral ulcers and alopecia were the commonest features. During the follow-up, the prevalence of nephritis, arthritis, neurological and hematological disease increased significantly. About 76% (n = 151) of the patients had organ damage at the time of data analysis, and renal disease was the commonest cause. Univariate analysis revealed that renal disease (P = 0.000), seizures (P = 0.048), pleural involvement (P = 0.019), alopecia (P = 0.000) and discoid lesions (P = 0.005) were predictors for damage. Multivariate model, however, revealed that only renal disease was independent risk factor for damage (P = 0.002). During the study period, 47 patients (24%) died (five due to disease-related complications and rest as a result of infections). The 3-, 5-, 10-, 15- and 20-year survival rates of our cohort were 99, 80, 77, 75 and 75%, respectively. Cox regression analysis revealed that renal involvement (P = 0.002) and infections (P = 0.004) were independent risk factors for mortality. The survival of our Pakistani SLE patients was significantly lower compared to that of the Caucasian series reported in last decade. Nephritis not only contributes to organ damage but also acts a major determinant for survival. Infection remains the commonest cause of death. Renal involvement and infections are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term survival of lupus patients.

Prevalence and socioeconomic risk factors of obesity among urban female students in Al-Khobar city, Eastern Saudi Arabia, 2003.

The aim of this study was to determine the prevalence and the socioeconomic risk factors associated with obesity among female school-aged children and adolescents in primary and intermediate schools in Al-Khobar city, Kingdom of Saudi Arabia. This is a cross-sectional study conducted in Al-Khobar city, which is located in the eastern part of Saudi Arabia, during the period of January to March 2003. It involved 2239 female schoolchildren randomly selected from 30 regular government and private primary and preparatory schools. The students' ages ranged from 6 to 17 years, with a mean of 10.49 +/- 2.64 years. A multistage stratified random sampling technique with proportional allocation was used. Data were collected using questionnaires and anthropometric measurements. Body mass index interpretation was based on using a table of standard definitions for overweight and obesity in children (Cole's). The spss version 10 (SPSS Inc., Chicago, IL, USA) was used for data entry and analysis. A chi-squared test was used in cross-tabulation analysis to test the significance of association between body mass index and socioeconomic variables. The prevalence of overweight and obesity were 20% and 11%, respectively. The prevalence of overweight was higher among schoolchildren with father in private work (P<0.01) and the prevalence of overweight and obesity was higher among schoolchildren with highly educated mothers (P=0.008). The prevalence of overweight and obesity among female school-aged children and adolescents in the Al-Khobar city was very high. Accordingly, it is recommended that health education programmes regarding obesity should be provided to all schoolchildren, their families and teachers.

Recurrent carpal tunnel syndrome in a child due to fibrolipomatous hamartoma of the median nerve successfully treated by limited excision and decompression.

We present a case of recurrent carpal tunnel syndrome in a child caused by fibrolipomatous hamartoma of the median nerve which was successfully treated by limited excision of the fibrolipomatous tissue and decompression.

Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours.

OBJECTIVE: To evaluate bronchial wash cytology with histology in our set up. METHODS: Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains. RESULTS: A total of 73 patients were studied. The age range was 21 to 80 years. Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 (77.4%) cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 (32.9%) as malignant and 29 (39.8%) as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity (80.5%), specificity (96.6%) and accuracy (87.3%). Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma. CONCLUSION: It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage.

Violence and homicidal behaviors in psychiatric disorders.

Our review evaluating the relationship between violent/homicidal behaviors and mental illness/psychiatric disorders used many different data including that assessing the prevalence of violent/homicidal behaviors in former psychiatric inpatients (just before hospitalization, during hospitalization, and after discharge) as outpatients and in community samples as well as evaluating the prevalence rate of psychiatric disorders in people who actually engaged in violent/homicidal disorders (jail detainees, prison inmates, and community samples). Irrespective of which line of investigation, there was convincing evidence that violent/ homicidal behavior was associated significantly with mental illness. Although earlier investigations failed to control for important variables, such as age and sociodemographics, most studies reviewed in this article did control for these items, further underlining the association of violence and mental illness. The question of whether specific psychiatric diagnostic categories are associated with violent/homicidal behavior is less definite across the various studies reviewed. The presence of substance abuse and dependence and alcohol abuse and dependence as well as antisocial personality disorder are particularly associated with an increased risk of violent/homicidal behaviors. The risk for these latter behaviors in schizophrenia, mood disorders, and anxiety disorders may appear somewhat greater than that for a general population but are not of the same magnitude of that for substance abuse or antisocial personality disorder. Interestingly, our outpatient study found that homicidal behaviors were not associated with any specific psychiatric diagnosis. Although understanding whether specific psychiatric diagnostic categories are more prone to violent behaviors may be of importance, most studies have been shortsighted regarding this evaluation. All the studies presented in this article except the ECA project, presented diagnostic data where either the presence of one psychiatric disorder did not preclude the diagnosis of another or assigned subjects/patients into the severest disorder of a predetermined hierarchy of diagnoses or only selected their principal/primary diagnosis. Thus, the effect of having a solitary psychiatric disorder (only one disorder present) as well as the effect of comorbidity per se on the relationship of psychiatric disorders and violent/homicidal behaviors were unexplored. Only the ECA study by Swanson and colleagues reported on the effect of comorbidity. As reviewed earlier in the article, Swanson et al found that comorbidity of psychiatric diagnostic categories further increased the risk of violent/ homicidal behaviors. In most cases, it was many more times than simply adding the rates of either diagnosis alone. Because more than 54% of respondents of the National Comorbidity Survey study who had one DSM-III-R diagnosis also had at least a second Axis I diagnosis, the association of violent/homicidal behaviors to mental illness may even be stronger than originally believed. Within the relationship of violent/homicidal behaviors and mental illness, this article suggests a number of particular risk factors. As just reviewed, substance/alcohol abuse and antisocial personality disorder as well as the presence of comorbid psychiatric disorders are significant risk factors. Which particular comorbid illness increases the risk still needs further elaboration. Studies must continue to try to define and understand the relationship of violent/homicidal behaviors in mental illness. Although mental disorders per se are significantly associated with violent/homicidal behaviors, it is reasonable to believe that targeting certain subgroups of patients should be helpful. Probably the presence of psychotic symptoms is a significant risk factor in violent/ homicidal behaviors in the mentally ill. Only one of the studies reviewed in this article evaluated this issue. (ABSTRACT TRUNCATED)

The 'turkey wattle' sign revisited: diagnosing parotid vascular malformations in the adult.

The turkey wattle sign describes enlargement of a facial mass on dependency of the head and when the sign is present it is pathognomonic of a vascular malformation or haemangioma. We present a case of vascular malformation of the parotid gland in which this sign was demonstrated. The clinical and radiological features of this rare parotid mass are discussed with reference to the literature.

Skin injuries afflicting three oil workers following contact with calcium bromide and/or calcium chloride.

Calcium bromide brine is a highly concentrated aqueous solution of calcium bromide and calcium chloride. It is used extensively in the oil industry. This solution and its components are recognized as causes of skin injury and information is available from the manufacturers on their safe use and handling. Two patients who were injured following unprotected skin exposure to this solution and one patient who was injured following exposure to calcium chloride powder are reported. All sustained skin injuries characterised by an absence of pain and a delayed clinical appearance of the full extent of the injury. Furthermore healing was complicated by graft loss or was slow. Although organic bromine compounds are recognized as a cause of skin injuries, no previous reports of such injuries to humans secondary to calcium chloride or bromide exposure were found in the medical literature. Our experience with these patients is described.

Sensory innervation of the little finger by an anomalous branch of the median nerve associated with recurrent, atypical carpal tunnel syndrome.

Superficial sensory communication between the ulnar and median nerves is well recognized. In the vast majority of cases this communication is from the ulnar nerve to the median nerve. We report a case in which a communicating branch passed from the median nerve to the ulnar nerve immediately proximal to the wrist to supply sensation to the little finger. The presence of this branch correlated with the presence of symptoms which had persisted in spite of conventional open carpal release 7 years earlier. Surgical decompression of this branch led to complete resolution of those symptoms.

Harvest of palmaris longus tendon: technique.

We present a modification of Bunnell's technique for harvest of the palmaris longus tendon. Using a 0.5 cm distal incision and a proximal stab incision the tendon is harvested with minimal scarring and, in our experience of over 30 cases, no morbidity.

Modulation of the prolactin response to thyrotropin releasing hormone by ovarian steroids in ovariectomized turkeys (Meleagris gallopavo).

The effect of thyrotropin releasing hormone (TRH) administered intramuscularly (im) on serum levels of prolactin (Prl) in ovariectomized (ovx) adult turkeys before and following the onset of photostimulation, before and during daily administration (im) of progesterone (P; 0.1, 0.4, or 1.0 mg/kg), estradiol benzoate (EB; 0.01, 0.1, or 0.2 mg/kg), or their combination (1.0 mg/kg EB + 0.1 mg/kg P) were studied. Ovariectomy reduced Prl levels in the serum of photostimulated turkeys, and blunted the Prl response to TRH administration. Progesterone treatment had no effect on basal serum Prl levels but the Prl response to TRH was higher in P-treated turkeys than in non-treated ovx turkeys. Basal serum Prl levels were higher (P less than 0.05) in the EB-treated ovx turkeys than in the untreated birds. The Prl response to TRH in ovx EB-treated turkeys was greatly increased (P less than 0.05). Progesterone treatment of EB-primed ovx turkey did not alter the basal levels of serum Prl or the Prl response to TRH administration. These results suggest that ovarian steroids may be responsible for the increased Prl secretion in the female turkey associated with laying.