Transcript and protein signatures derived from shared molecular interactions across cancers are associated with mortality.

BACKGROUND: Characterization of shared cancer mechanisms have been proposed to improve therapy strategies and prognosis. Here, we aimed to identify shared cell-cell interactions (CCIs) within the tumor microenvironment across multiple solid cancers and assess their association with cancer mortality. METHODS: CCIs of each cancer were identified by NicheNet analysis of single-cell RNA sequencing data from breast, colon, liver, lung, and ovarian cancers. These CCIs were used to construct a shared multi-cellular tumor model (shared-MCTM) representing common CCIs across cancers. A gene signature was identified from the shared-MCTM and tested on the mRNA and protein level in two large independent cohorts: The Cancer Genome Atlas (TCGA, 9185 tumor samples and 727 controls across 22 cancers) and UK biobank (UKBB, 10,384 cancer patients and 5063 controls with proteomics data across 17 cancers). Cox proportional hazards models were used to evaluate the association of the signature with 10-year all-cause mortality, including sex-specific analysis. RESULTS: A shared-MCTM was derived from five individual cancers. A shared gene signature was extracted from this shared-MCTM and the most prominent regulatory cell type, matrix cancer-associated fibroblast (mCAF). The signature exhibited significant expression changes in multiple cancers compared to controls at both mRNA and protein levels in two independent cohorts. Importantly, it was significantly associated with mortality in cancer patients in both cohorts. The highest hazard ratios were observed for brain cancer in TCGA (HR [95%CI] = 6.90[4.64-10.25]) and ovarian cancer in UKBB (5.53[2.08-8.80]). Sex-specific analysis revealed distinct risks, with a higher mortality risk associated with the protein signature score in males (2.41[1.97-2.96]) compared to females (1.84[1.44-2.37]). CONCLUSION: We identified a gene signature from a comprehensive shared-MCTM representing common CCIs across different cancers and revealed the regulatory role of mCAF in the tumor microenvironment. The pathogenic relevance of the gene signature was supported by differential expression and association with mortality on both mRNA and protein levels in two independent cohorts.

The role of Nigerian medical students in the HIV response: lessons from the COVID-19 pandemic.

Background: With the advent of the COVID-19 pandemic, this study seeks to understand how medical students' involvement in the HIV response during the COVID-19 pandemic - as well as before and after it - has influenced their decision to specialise in HIV care and their participation in HIV-related activities in the future.Method: Quantitative and qualitative approaches were utilised among medical students from Ambrose Alli University in their fourth, fifth and sixth years of study respectively. Data from this study was analysed using the SPSS version 21 module for descriptive statistics.Results: Medical students were more involved in community-based HIV awareness campaigns (48.6%) during the pre-COVID era, but then became more involved in online awareness campaigns (55%). Only 8.6% were involved in HIV research and evaluation activities. Over 31.2% of respondents were interested in specialising in HIV-related fields, with 23.6% attributing their decision to the COVID-19 pandemic. 92.3% of the respondents were of the opinion that medical students need to become more involved in HIV-related activities. There was statistical significance between the year of study of respondents and awareness of HIV-related activities (p < 0.007). Focused discussions revealed that all students felt that medical students should be more involved in HIV-related activities.Conclusion: Our results suggest that the COVID-19 pandemic marginally boosted the number of medical students involved in online awareness campaigns for HIV and AIDs, but there was decreased involvement in community campaigns and participation in community HIV testing. The impact of these findings on the lives of people living with HIV needs further investigation.

Effectiveness of health education module on work safety culture in improving knowledge, attitudes and practices: a cluster randomized controlled trial among public sector administrative workers in Nigeria.

INTRODUCTION: Studies have shown that a workplace safety culture (WSC) is lacking among the general workforce in Nigeria. Poor WSC can adversely impact workers' health and high remedial costs for employers. To improve WSC, workers need to improve related knowledge, attitude, and practices (KAP) towards WSC through effective health interventional programs at the workplace. The main objective of this study is to develop, implement and evaluate the effectiveness of the Work Safety Culture Health Education Module (WSCHEM). The specific goals are to improve KAP related to office ergonomics towards WSC among public sector administrative workers in Abeokuta, Nigeria MATERIALS AND METHODS: The study was a two-armed, singleblinded cluster randomised controlled trial (CRCT) involving 247 public sector administrative workers from clusters of 20 ministries in Abeokuta, Southwestern Nigeria. The intervention group was given WSCHEM, whereas the waitlist group received a seminar on team building and leadership skills and received the WSCHEM after the intervention program ended. The evaluation was done three times using the first formal validated, self-administered Work Safety Culture Questionnaire (WSCQ) among the administrative workers: first at baseline, second at 1 month, and third at 3 months post-intervention. RESULT: The results showed no statistically significant differences between groups regarding the respondents' characteristics (socio-demographic and occupational/officerelated ergonomic factors) and the outcome variables KAP towards WSC at baseline. For practices towards WSC, both intervention (ß 6.8, 95%CI 4.85, 8.72) and time (ß 6.2, 95%CI 4.49, 7.94) significantly improved the respondents' practices towards WSC in the per-protocol analysis. In the secondary outcomes, both knowledge of WSC, intervention (ß 3.5, 95%CI 2.8, 4.2) and time (ß 3.4, 95%CI 2.7, 5.9); and attitudes towards WSC, intervention (ß1.7, 95%CI 1.25, 2.23) and time (ß 2.3, 95%CI 1.92, 2.76) significantly improved the respondents' level of knowledge and attitudes respectively towards WSC. CONCLUSION: The intervention, WSCHEM, was effective in improving the administrative workers' KAP towards WSC, as demonstrated by the significance between and within-group differences.

ProkSeq for complete analysis of RNA-Seq data from prokaryotes.

SUMMARY: Since its introduction, RNA-Seq technology has been used extensively in studies of pathogenic bacteria to identify and quantify differences in gene expression across multiple samples from bacteria exposed to different conditions. With some exceptions, tools for studying gene expression, determination of differential gene expression, downstream pathway analysis and normalization of data collected in extreme biological conditions is still lacking. Here, we describe ProkSeq, a user-friendly, fully automated RNA-Seq data analysis pipeline designed for prokaryotes. ProkSeq provides a wide variety of options for analysing differential expression, normalizing expression data and visualizing data and results. AVAILABILITY AND IMPLEMENTATION: ProkSeq is implemented in Python and is published under the MIT source license. The pipeline is available as a Docker container https://hub.docker.com/repository/docker/snandids/prokseq-v2.0, or can be used through Anaconda: https://anaconda.org/snandiDS/prokseq. The code is available on Github: https://github.com/snandiDS/prokseq and a detailed user documentation, including a manual and tutorial can be found at https://prokseqV20.readthedocs.io. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Incidence and determinants of catastrophic health expenditure among low-income Malaysian households.

INTRODUCTION: Catastrophic health expenditure (CHE) incurs when out-of-pocket health expenditure (OOPHE) exceeds a certain threshold, therefore exposing households to financial hardship, with the low-income population being most vulnerable. Data related to the incidence and determinants of CHE among the low-income population in Malaysia are lacking. This study aims to determine the incidence and determinants of CHE among Malaysian lowincome households. METHODOLOGY: This is a cross-sectional study using data from 6,720 low-income households from the national Household Expenditure Survey (HES) 2016 conducted from May 2016 till February 2017. The data were analysed using IBM SPSS software 25.0. OOPHE in this study included all spending on healthcare products and services by the household. CHE was identified in households with OOPHE of at least 10% of total monthly income. RESULTS: The incidence of CHE at the threshold of 10% household income was 1.7% (n=112). The determinants of CHE were households with any accident or medical insurance (p<0.001), having less than five members in a household (p<0.001), presence of elderly (p=0.024), and hospitalisation (p=0.021). In contrast, employment of the head of household (p=0.003) and having a child aged ≤5 years old (p=0.033) protect households from CHE. CONCLUSION: In the context of this study, the incidence of CHE among the low-income Malaysian population was low, indicating that a majority of the low-income population is protected from financial catastrophe. Regardless, the determinants of CHE among low-income population should be considered in future health policies.

Allergic rhinitis: An indicator of otitis media with effusion in children seen at aminu kano teaching hospital, Kano.

Background: Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction involving nasal mucosa characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness, and eyes itching. Tympanometry is a simple, rapid, and objective test that can be easily carried out. The use of tympanometry in clinical setting can improve detection of middle ear effusion and other middle ear abnormalities. AR has been found to be one of the predisposing factors to developing Otitis Media with Effusion (OME) in children. Patients and Methods: A case-control study was used to determine the prevalence of OME among children with AR as cases and those without allergy as controls. The study participants were children aged 4-12 years with clinical diagnosis of AR attending ENT clinics of Aminu Kano Teaching Hospital, whereas controls were children age 4-12 years without history of AR, ear diseases, or other respiratory system related ailments attending general outpatient clinics in Aminu Kano Teaching Hospital. An interviewer-administered score for AR (SFAR) questionnaire was filled out for all the participants, those with score of 6 and above were selected as cases. The two groups had complete ENT examination and tympanometry done, findings were recorded, and analyzed using SPSS version 21. Results: The mean age of the cases was 6.8 ± 2.1 years, whereas it was 7.5 ± 2.6 years for the controls. The mean difference was 0.7 and was not statistically significant (t = 2.35, df = 258, P value = 0.20). Type B tympanogram suggesting OME was found in 7.3% of subjects and in 2.8% of controls. Type C tympanogram suggesting negative middle ear pressure was found in 15.5% of subjects and in 4.6% of controls. Type A tympanogram suggesting normal middle ear pressure was found in 75% of subjects and in 90% of controls. Acoustic reflex was found to be absent in 29.6% of subjects and in 15.4% of controls and this found to be statistically significant (χ2 = 7.77, df = 1, P value = 0.001). The difference between type A, B, and C tympanograms of subjects and that of controls was found to be statistically significant (Type A χ2 = 14.62, df = 4, P value = 0.01, Type B χ2 = 14.06, df = 4, P value = 0.01, Type C χ2 = 17.01, df = 6, P value = 0.01). Type B tympanogram was used as an indicator to suggest OME for the purpose of this study. Conclusion: Participants with AR were found to have more abnormalities of tympanometric parameters and higher prevalence of type B tympanogram suggesting OME than controls.

Lockdown and sustainability: An effective model of information and communication technology.

Covid-19, a corona virus, has maintained its momentum in spreading among communities. In this context of social crisis, this study seeks to identify the reasons for the partial failure to fulfill the intended goal of lockdown, and to formulate an inclusive behavioral model reflecting comprehensive human behavior and social psychology. In order to answer the research questions, this study has conducted extensive interviews among individuals who were targets of the lockdown system. From this exploratory and qualitative investigation, researchers have recognized four paradigms as the key to understanding human behavior and social psychology in violating lockdown as a social isolation system during this period of crisis. The identified parameters depicting social behavior are: Derogation and Argument (SDA), Tangible Need and Deficiency (TND), Intangible Desire and Expectancy (IDE), and Evaluation of Benefit and Loss (UBL). Finally, as a comprehensive guideline, a grounded theory of the social behavior 'paradigm for lockdown violation (PLV)' is explored as the reason for the violation of the social system.

Genome-wide association mapping in a diverse spring barley collection reveals the presence of QTL hotspots and candidate genes for root and shoot architecture traits at seedling stage.

BACKGROUND: Adaptation to drought-prone environments requires robust root architecture. Genotypes with a more vigorous root system have the potential to better adapt to soils with limited moisture content. However, root architecture is complex at both, phenotypic and genetic level. Customized mapping panels in combination with efficient screenings methods can resolve the underlying genetic factors of root traits. RESULTS: A mapping panel of 233 spring barley genotypes was evaluated for root and shoot architecture traits under non-stress and osmotic stress. A genome-wide association study elucidated 65 involved genomic regions. Among them were 34 root-specific loci, eleven hotspots with associations to up to eight traits and twelve stress-specific loci. A list of candidate genes was established based on educated guess. Selected genes were tested for associated polymorphisms. By this, 14 genes were identified as promising candidates, ten remained suggestive and 15 were rejected. The data support the important role of flowering time genes, including HvPpd-H1, HvCry2, HvCO4 and HvPRR73. Moreover, seven root-related genes, HERK2, HvARF04, HvEXPB1, PIN5, PIN7, PME5 and WOX5 are confirmed as promising candidates. For the QTL with the highest allelic effect for root thickness and plant biomass a homologue of the Arabidopsis Trx-m3 was revealed as the most promising candidate. CONCLUSIONS: This study provides a catalogue of hotspots for seedling growth, root and stress-specific genomic regions along with candidate genes for future potential incorporation in breeding attempts for enhanced yield potential, particularly in drought-prone environments. Root architecture is under polygenic control. The co-localization of well-known major genes for barley development and flowering time with QTL hotspots highlights their importance for seedling growth. Association analysis revealed the involvement of HvPpd-H1 in the development of the root system. The co-localization of root QTL with HERK2, HvARF04, HvEXPB1, PIN5, PIN7, PME5 and WOX5 represents a starting point to explore the roles of these genes in barley. Accordingly, the genes HvHOX2, HsfA2b, HvHAK2, and Dhn9, known to be involved in abiotic stress response, were located within stress-specific QTL regions and await future validation.

On the role of different age groups during pertussis epidemics in California, 2010 and 2014.

There is limited information on the roles of different age groups in propagating pertussis outbreaks, and the temporal changes in those roles since the introduction of acellular pertussis vaccines. The relative roles of different age groups in propagating the 2010 and the 2014 pertussis epidemics in California were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases before vs. after the epidemic peak. For the 2010-11 epidemic, evidence for a predominant transmission age group was weak, with the largest RR estimates being 1.26 (95% CI 1.08-1.46) (aged 11-13 years); 1.19 (1.01-1.4) (aged 9-10 years); 1.17 (0.86-1.59) (aged 14-15 years); 1.12 (0.86-1.46) (aged 16-19 years) and 1.1 (0.89-1.36) (aged 7-8 years). The 2014 epidemic showed a strong signal of the role of older adolescents, with the highest RR estimate being in those aged 14-15 years (RR = 1.83, 1.61-2.07), followed by adolescents aged 16-19 years (RR = 1.41, 1.24-1.61) and 11-13 years (RR = 1.26, 1.12-1.41), with lower RR estimates in other age groups. As the time following introduction of acellular pertussis vaccines in California progressed, older adolescents played an increasing role in transmission during the major pertussis outbreaks. Booster pertussis vaccination for older adolescents with vaccines effective against pertussis transmission should be considered with the aim of mitigating future pertussis epidemics in the community.

Evaluating the Reasons for Partial and Non-immunization of Children in Wushishi Local Government Area, Niger State, Nigeria: Methodological Comparison.

Immunization of children against childhood preventable diseases has remained one of the most important cost effective and public health strategies to reduce childhood preventable morbidity and mortalities arising from infectious diseases. A recent report released by World Health Organization (WHO) stated that 1 in 10 infants did not receive vaccination in 2016. Also, a survey conducted in Bida Emirate Area of Niger State Nigeria in 2015 found that full routine immunization coverage in this area was less than 30%. The aim of this study was to establish the full routine immunization status and the reasons for its partial and non-immunization of children in Wushishi Local Government Area using WHO recommended cluster survey method and contrast with Factor Analysis (FA) method to see if the same results were achieved. The findings showed that the full immunization status for this area was very low (36%) and the results of analysis of reasons for failure from both methods seem contradictory. However, it reflected that lack of proper information was strongest for both methods. The disparity obtained in the two methods might be a result of methodological issues. The health implication is that much is expected to be done in the area of enlightenment campaign of the need for immunization and the need to complete the required basic dose especially in the rural areas.

Endoplasmic Reticulum Lipid Flux Influences Enterocyte Nuclear Morphology and Lipid-dependent Transcriptional Responses.

Responding to a high-fat meal requires an interplay between multiple digestive tissues, sympathetic response pathways, and the gut microbiome. The epithelial enterocytes of the intestine are responsible for absorbing dietary nutrients and preparing them for circulation to distal tissues, which requires significant changes in cellular activity, including both morphological and transcriptional responses. Following a high-fat meal, we observe morphological changes in the enterocytes of larval zebrafish, including elongation of mitochondria, formation and expansion of lipid droplets, and the rapid and transient ruffling of the nuclear periphery. Dietary and pharmacological manipulation of zebrafish larvae demonstrated that these subcellular changes are specific to triglyceride absorption. The transcriptional changes that occur simultaneously with these morphological changes were determined using RNA sequencing, revealing a cohort of up-regulated genes associated with lipid droplet formation and lipid transport via lipoprotein particles. Using a microsomal triglyceride transfer protein (MTP) inhibitor to block ß-lipoprotein particle formation, we demonstrate that the transcriptional response to a high-fat meal is associated with the transfer of ER triglyceride to nascent ß-lipoproteins, possibly through the activation of Creb3l3/cyclic AMP-responsive element-binding protein. These data suggest that a transient increase in ER lipids is the likely mediator of the initial physiological response of intestinal enterocytes to dietary lipid.

Loss of the proprioception and touch sensation channel PIEZO2 in siblings with a progressive form of contractures.

Dominant mutations in PIEZO2, which codes for the principal mechanotransduction channel for proprioception and touch sensation, have been found to cause different forms of distal arthrogryposis. Some observations suggest that these dominant mutations induce a gain-of-function effect on the channel. Here, we report a consanguineous family with three siblings who showed short stature, scoliosis, gross motor impairment, and a progressive form of contractures involving the distal joints that is distinct from that found in patients with dominant mutations in PIEZO2. These siblings also displayed deficits in proprioception and touch sensation. Whole-exome sequencing performed in the three affected siblings revealed the presence of a rare homozygous variant (c.2708C>G; p.S903*) in PIEZO2. This variant is predicted to disrupt PIEZO2 function by abolishing the pore domain. Sanger sequencing confirmed that all three siblings are homozygous whereas their parents and an unaffected sibling are heterozygous for this variant. Recessive mutations in PIEZO2 thus appear to cause a progressive phenotype that overlaps with, while being mostly distinct from that associated with dominant mutations in the same gene.

Drivers of measles mortality: the historic fatality burden of famine in Bangladesh.

Measles is a major cause of childhood morbidity and mortality in many parts of the world. Estimates of the case-fatality rate (CFR) of measles have varied widely from place to place, as well as in the same location over time. Amongst populations that have experienced famine or armed conflict, measles CFR can be especially high, although past work has mostly focused on refugee populations. Here, we estimate measles CFR between 1970 and 1991 in a rural region of Bangladesh, which experienced civil war and famine in the 1970s. We use historical measles mortality data and a mechanistic model of measles transmission to estimate the CFR of measles. We first demonstrate the ability of this model to recover the CFR in the absence of incidence data, using simulated mortality data. Our method produces CFR estimates that correspond closely to independent estimates from surveillance data and we can capture both the magnitude and the change in CFR suggested by these previous estimates. We use this method to quantify the sharp increase in CFR that resulted in a large number of deaths during a measles outbreak in the region in 1976. Most of the children who died during this outbreak were born during a famine in 1974, or in the 2 years preceding the famine. Our results suggest that the period of turmoil during and after the 1971 war and the sustained effects of the famine, is likely to have contributed to the high fatality burden of the 1976 measles outbreak in Matlab.

Comparative dynamics, seasonality in transmission, and predictability of childhood infections in Mexico.

The seasonality and periodicity of infections, and the mechanisms underlying observed dynamics, can have implications for control efforts. This is particularly true for acute childhood infections. Among these, the dynamics of measles is the best understood and has been extensively studied, most notably in the UK prior to the start of vaccination. Less is known about the dynamics of other childhood diseases, particularly outside Europe and the United States. In this paper, we leverage a unique dataset to examine the epidemiology of six childhood infections - measles, mumps, rubella, varicella, scarlet fever and pertussis - across 32 states in Mexico from 1985 to 2007. This dataset provides us with a spatio-temporal probe into the dynamics of six common childhood infections, and allows us to compare them in the same setting over the same time period. We examine three key epidemiological characteristics of these infections - the age profile of infections, spatio-temporal dynamics, and seasonality in transmission - and compare them with predictions from existing theory and past findings. Our analysis reveals interesting epidemiological differences between the six pathogens, and variations across space. We find signatures of term-time forcing (reduced transmission during the summer) for measles, mumps, rubella, varicella, and scarlet fever; for pertussis, a lack of term-time forcing could not be rejected.

Training on Kielland's forceps: A survey of trainees' opinions.

We conducted a cross-sectional survey including specialist trainees in obstetrics and gynaecology in the Health Education West Midlands region, UK, to capture their views and assess training opportunities on the use of Kielland's forceps. Half of the trainees in the region completed the survey (87/172, 50%). Only 31% of our trainees worked in units that supported the training on these forceps (27/87, 31%). The majority reported that they did not get enough exposure to using Kielland's forceps (53/87, 60.9%). Only a minority (5.7%, 5/87) felt confident to perform a Kielland's rotational delivery independently. The majority (64.3%, 56/87) were keen to continue using Kielland's forceps in the future if competent. More than two-thirds (86.2%, 75/87) felt that simulation could aid their training. There was large enthusiasm for training on the safe use of Kielland's forceps among trainees in obstetrics and gynaecology in the West Midlands region. A national assessment of training resources is needed to better plan training recourses on this complex skill.

Colistin-associated nephrotoxicity among patients in intensive care units (ICU) of hospitals in Selangor.

INTRODUCTION: The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population. METHODS: The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria. RESULTS: A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant. CONCLUSION: Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.

Shifting practice in definitive chemoradiation for localized esophageal cancer.

BACKGROUND: The efficacy of carboplatin-paclitaxel in the trimodality setting was demonstrated in the cross trial. Because of better tolerance, that regimen has been adopted as an alternative for patients receiving definitive chemoradiation (dcrt). The purpose of our study was to compare outcomes in patients with localized esophageal and gastroesophageal junction (gej) cancer who received dcrt using either platinum-5-fluorouracil (5fu) or carboplatin-paclitaxel. METHODS: Medical records and outcomes for all patients diagnosed with localized carcinoma of the esophagus and gej at our centre between 2008 and 2015 were reviewed. All patients who underwent dcrt using cisplatin-5fu, carboplatin-5fu, or carboplatin-paclitaxel were included. RESULTS: The 73 identified patients (34 cisplatin-5fu, 13 carboplatin-5fu, 26 carboplatin-paclitaxel) were all prescribed concomitant radiotherapy of 50 Gy in 25 daily fractions. The diagnosis was adenocarcinoma in 64% and squamous cell carcinoma in 36%. Median overall survival (os) duration for the cisplatin-5fu group was 28 months [95% confidence interval (ci): 19 to 41 months], with a 3-year os rate of 44%, in contrast to the 15 months (95% ci: 11 to 17 months) and 15% in the carboplatin-paclitaxel group (log-rank p = 0.0047). Median os duration for the carboplatin-5fu group was 17 months (95% ci: 11 to 68 months) with a 3-year os rate of 31%. Adjusting for patient and disease factors, better os durations and rates were associated with cisplatin-5fu (hazard ratio: 0.34; p = 0.0016) and carboplatin-5fu (hazard ratio: 0.55; p = 0.20) than with carboplatin-paclitaxel. CONCLUSIONS: In a dcrt regimen, a better os is associated with cisplatin-5fu than with carboplatin-paclitaxel. Clinical trials to determine optimal chemotherapy regimens are warranted for patients who are not suitable for surgery.

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016.

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics: ■ Follow-up and survivorship of patients with resected colorectal cancer■ Indications for liver metastasectomy■ Treatment of oligometastases by stereotactic body radiation therapy■ Treatment of borderline resectable and unresectable pancreatic cancer■ Transarterial chemoembolization in hepatocellular carcinoma■ Infectious complications of antineoplastic agents.

Presentation and In-Hospital Outcome in First Attack of Acute Coronary Syndrome among Diabetic and Non-Diabetic People.

This was a prospective and observational study. One hundred and sixty five consecutive patients (75 diabetic and 90 were non-diabetic) admitted to coronary care unit in Rangpur Medical College and Hospital, Rangpur from December 2011 to June 2012 with the diagnosis of first attack of acute coronary syndrome were included in this study. Patients were selected considering the inclusion and exclusion criteria, Symptom time, typical or atypical chest pain, Dysponea, palpitation, cardiogenic shock, cardiac arrest, vital signs and Killip classes were regarded as presentation at admission. Outcome parameters observed during the hospital stay were in-hospital mortality, cardiogenic shock, congestive cardiac failure, symptomatic arrhythmias, cardiac arrest, recurrent ischemia and hospital stay. The results were obtained by calculating 'p' value by 'z' test, 't' test, chi-square test, as appropriate to see the difference between two groups. The results thus obtained were plotted on table, pie-chart, line chart, bar-diagram etc. as appropriate p value <0.05 was considered significant. In the study, diabetic patients presented with acute coronary syndrome at earlier age (p=053). Body Mass Index was significantly more in diabetic group (25.053 ± 2.1428 vs. 24.0822 kg/m² ± 2.233 kg/m², p=0.0045). Atypical chest pain (40% vs. 24.4%, p=0.0323), Dysponea (53.3 vs. 36.7%, p=0.0315), cardiac shock (17.33 vs. 6.7%, p=0.03236) and symptom duration before presentation (31.067 ± 42.5 hours vs. 19.44 ± 30.3 hours, p=0.0471) were significantly more observed in diabetic group. In respect of outcome, diabetic patients experienced more recurrent ischemia (24% vs. 16.67%, p=0.0524) and heart failure (36% vs. 22.2%, p=0.05). Hospital stay was also found significantly higher in diabetic group (5.097 ± 1.023 vs. 4.097 ± 1.009, p=0.0078). Atypically presented group suffered significantly more from congestive heart failure p=0.0392. Triglyceride level (230.7 ± 61.7 vs. 180.1 ± 39.1, p<0.001) were significantly more in diabetic group. The mean value of Hba1C in diabetic patients was 8.0278 ± 10.44965%. This study suggested that atypical chest pain, dysponea and cardiac shock were more in diabetic group at presentation. Recurrent ischemia, heart failure and hospital stay were more in diabetic group as outcome.

Attitude and Practices of Mothers on Breastfeeding Attended at a Tertiary Hospital in Bangladesh.

This descriptive cross sectional study was conducted in Pediatric Out Patient Department (OPD) of Mymensingh Medical College Hospital (MMCH) from November 2013 to April 2014 to assess the knowledge and practices of the mothers about breastfeeding. Four hundred mothers having children 6 months to 2 years of age attended at OPD of MMCH for any cause were included in the study by systematic random sampling. A structured, pre-tested, interview schedule was used to collect data from mothers. All mothers were continuing to breastfeed their children. Two hundred and seventy-two (68.00%) infants received breast feeding within 1 hour after birth, while 128(32.00%) infants received breast feeding after 1 hour of birth. Of 128, in 48(37.50%) cases, mother's illness was the reason for delay in initiation of breast feeding, whereas in 70(54.69%) cases, it was due to reduced milk production on mother's statement. Pre-lacteal feeding was given in 96(24.00%) children. Among them honey was given in 24(25.00%) cases, cow's milk was given in 14(14.58%) cases, sugar water was given in 18(18.75%) cases and formula milk was given in 40(41.67%) cases. One hundred and twenty-eight (32.00%) mothers started to give their child food other than breast milk before 3 months of age and 148(37.00) mothers started to give their child food other than breast milk before 6 months of age. The reason for starting to give their child food other than breast milk before 6 months of age was mother's assumption of milk insufficiency in 166(60.14%) cases and baby's cry for hunger in 110(39.86%) cases. Formula milk was given in 120(30.00%) infants before 6 months of age. Among them 96(80.00%) mothers prepared it with larger amount of water. Plain water was given in 240(60.00%) children before the age of 6 months. One hundred and twenty-four (31.00%) children were exclusively breastfeed for first 6 months of age. Breastfeeding is almost universal in Bangladesh but the exclusive breastfeeding rate is alarmingly very low. Great emphasis is needed to educate mothers about benefits of colostrum, exclusive breastfeeding, and the harmful effects of pre-lacteal feeding.