A spontaneous unveiling of bilateral DCIS in an elderly male.

The rarity of male breast cancer continues to limit its study despite increasing incidence rates, particularly within the past decade [Speirs V, Shaaban AM. The rising incidence of male breast cancer. Breast Cancer Res Treat 2009;115:429-30]. Although this trend appears to be substantially documented, male patients with breast cancer have been and continue to be excluded from landmark breast cancer trials. Currently, there are no standardized breast cancer screening protocols in place for men, including those with pathogenic BRCA mutations. As a result, men with breast cancer typically present at a later stage, and on average, 8-10 years later than females [Ruddy KJ, Winer EP. Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship. Ann Oncol 2013;24:1434-43]. As the incidence of disease continues to rise, the need for algorithmic standardization with regards to screening, diagnosing, treating and managing male breast cancer has become imperative. We report the case of a 71-year-old male who presented with spontaneous bloody nipple discharge and was found to have bilateral ductal carcinoma in situ.

Modulations of microbehaviour by associative memory strength in Drosophila larvae.

Finding food is a vital skill and a constant task for any animal, and associative learning of food-predicting cues gives an advantage in this daily struggle. The strength of the associations between cues and food depends on a number of parameters, such as the salience of the cue, the strength of the food reward and the number of joint cue-food experiences. We investigate what impact the strength of an associative odour-sugar memory has on the microbehaviour of Drosophila melanogaster larvae. We find that larvae form stronger memories with increasing concentrations of sugar or odour, and that these stronger memories manifest themselves in stronger modulations of two aspects of larval microbehaviour, the rate and the direction of lateral reorientation manoeuvres (so-called head casts). These two modulations of larval behaviour are found to be correlated to each other in every experiment performed, which is in line with a model that assumes that both modulations are controlled by a common motor output. Given that the Drosophila larva is a genetically tractable model organism that is well suited to the study of simple circuits at the single-cell level, these analyses can guide future research into the neuronal circuits underlying the translation of associative memories of different strength into behaviour, and may help to understand how these processes are organised in more complex systems.

Feasibility of community-based HIV self-screening in South Africa: a demonstration project.

BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.

Are women more likely to self-test? A short report from an acceptability study of the HIV self-testing kit in South Africa.

This study assessed the acceptability of, as well as the facilitators of and barriers to the HIV self-testing kit in the Gauteng province, South Africa. An exploratory qualitative cross-sectional study was conducted using focus group discussions (FGDs) among a sample of 118 respondents selected from the Braamfontein and Soweto areas of Johannesburg. Sixteen FGDs were conducted in order to assess the acceptability of the HIV self-testing kit. Respondent groups were segmented according to area (Soweto or Braamfontein), gender (male or female), age (20-34 and 35-49 years of age) and HIV testing status (have previously tested for HIV or have never tested for HIV) in order to achieve maximum variability. The main advantage identified was that the self-testing kit allows for privacy and confidentiality with regard to HIV status, and does not require a visit to a health facility - two of the main barriers to current HIV counselling and testing uptake. However, respondents, predominantly males, were concerned about the lack of counselling involved, which they thought could lead to suicide ideation among testers. The HIV self-testing kit was found to be acceptable among the majority of respondents. However, there is still a need for follow-up services for self-testers. The idea of a hotline for telephonic counselling within the self-testing model seemed to be favourable among many respondents and is an alternative to traditional face-to-face counselling, although some respondents felt that this was not sufficient.

Does take-home analgesia improve postoperative pain after elective day case surgery? A comparison of hospital vs parent-supplied analgesia.

BACKGROUND: More children are undergoing same-day surgery. While advances have been made in pediatric pain management, there have been few studies addressing pain management in the home (Br J Anaesth, 82, 1999 and 319). We wished to investigate whether issuing parents with take-home analgesia would improve postoperative pain scores and/or parental satisfaction following hospital discharge. METHODS: Two hundred children, and their parents, attending for day case surgery at our institution were randomized into two groups. One group received advice regarding the management of postoperative pain and were given a pack containing discharge medications: group 'dispensed'. The other group received the same advice, but did not receive any medication: group 'advised'. Telephone interviews were conducted to assess pain scores, PONV, functional activity, analgesia requirements, and satisfaction rates. RESULTS: Data were available for 181 patients (median age, 4 years; range, 0-12 years): 89 children in group 'dispensed' and 92 children in group 'advised'. Postoperative instructions were followed by 86% in group 'advised' and 89% in group 'dispensed' (P = 0.68). Although all parents received analgesia advice, only 85/181 (48%) recalled the information. Rates for no/mild pain and moderate/severe pain were similar between the two groups: 59% (group 'advised') vs 62% (group 'dispensed') and 41% (group 'advised') vs 38% (group 'dispensed') (P = 0.78). DISCUSSION: Our study did not show any differences in the incidence of pain/parental satisfaction between the two groups. Analgesia advice given to parents was poorly retained, suggesting that other methods for disseminating information should be considered.

Cultivar evaluation and effect of fermentation on antioxidant capacity and in vitro inhibition of α-amylase and α-glucosidase by highbush blueberry (Vaccinium corombosum).

The berry fruits of highbush blueberry (Vaccinium corymbosum) contain bioactive compounds with potential health benefits. The objective was to evaluate blueberries grown in southern Illinois as well as the effect of fermentation, at two different temperatures, on chemical and physical parameters. Fruits from fifteen blueberry cultivars were analyzed. Fruit diameter ranged from 12.8 mm to 18.7 mm, pH from 2.6 to 3.7, reducing sugars from 6.4% to 15.2%, total sugars from 13.9% to 21.6%, total polyphenols from 0.39 to 1.00 mg gallic acid equivalents (GAE)/g blueberry and antioxidant capacity from 5.8 to 10.9 µM Trolox equivalents (TE)/g. In vitro α-amylase and α-glucosidase inhibitory capacity relative to the positive control acarbose, a known anti-diabetic drug, showed a range from 91.8 to 103.3% for α-amylase and from 103.2% to 190.8% for α-glucosidase. Wines prepared from several of these blueberry cultivars were analyzed throughout fermentation and compared at room temperature and cold temperature fermentation for pH (3.5 to 6.3), °Brix (13.6 to 29.7), total polyphenols (375.4 to 657.1 µg GAE/mL wine), and antioxidant capacity (4.5 to 25.1 mM TE). The wines were also tested for their in vitro capacity to inhibit α-amylase and α-glucosidase and maintained similar inhibitory action as the berries. Highbush blueberry cultivars and their fermented beverages are good natural sources of antioxidants and starch-degrading enzyme inhibitors important for type 2 diabetes management.