Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head

Abstract Objective Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. Methods We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. Results We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. Conclucion Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidence How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series)

Constipação oculta e semi-oculta em crianças com enurese monossintomática ou não monossintomática / Occult and semi-occult constipation in children with monosymptomatic or non monosymptomatic enuresis

ABSTRACT Background: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. Objective: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). Methods: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). Results: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. Conclusion: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.

RESUMO Contexto: Constipação funcional e enurese frequentemente coexistem. Tratamento da constipação geralmente resulta em cura ou melhora da enurese. Entretanto, além da apresentação clássica, pode ocorrer constipação oculta (CO), diagnosticada por exame subsidiário; ademais, ao aplicar questionário detalhado, pode-se detectar constipação semioculta (CSO). Objetivo: Obter as frequências de CO e CSO em crianças com enurese mono- ou não monossintomática (EMN ou ENMN). Métodos: Crianças/adolescentes saudáveis, exceto por enurese refratária à terapia comportamental, e que negavam constipação após perguntas simples, respondiam a questionário estruturado sobre hábito intestinal, e realizavam radiografia simples de abdômen. A constipação foi classificada considerando os critérios diagnósticos de Boston (que permitem diagnóstico em fases iniciais) e retenção fecal na radiografia quantificada ≥10 pelo escore de Barr. As crianças com constipação receberam tratamento padronizado (exceto 26 crianças "piloto"). Resultados: Das 81 crianças, 80 com idade 9,34±2,07 anos, 52,5% masculinas, foram diagnosticadas com constipação: 30 CO, 50 CSO; 63.75% tinham EMN, 36.25% ENMN (6 ENMN sem terapia comportamental). Os dados demográficos e o escore de Barr foram semelhantes para CO e CSO, mas as crianças com CSO apresentaram significativamente mais complicações de constipação (incontinência fecal retentiva e/ou dor abdominal recorrente). A não apresentação da Escala Fecal de Bristol (EFB) para 24 crianças "piloto", ou ausência de sintomas de constipação acompanhando EFB predominantemente do tipo 3, em 13 crianças, não teve impacto significativo na detecção de constipação pelo escore de Barr. Crianças que identificaram EFB 3 ou ≤2 tiveram resultados semelhantes. Vinte e oito crianças, com acompanhamento adequado após o tratamento, melhoraram ou se recuperaram da constipação em 44 de seus 52 retornos. Conclusão: Em pacientes com EMN ou ENMN refratária à terapia comportamental, e que inicialmente negavam constipação após perguntas simples, questionário baseado nos critérios diagnósticos de Boston detectou CSO em 61.7%, e o escore radiológico de Barr revelou retenção fecal (CO) em 37% deles.

Manejo conservador del neumotórax oculto en trauma

Introducción: El neumotórax oculto (NTXO) se encuentra hasta en el 15% de los traumatismos torácicos. Existen antecedentes del manejo conservador de esta patología (sólo observación), aunque su práctica continúa siendo discutida, especialmente, en traumatismos penetrantes. El objetivo de este trabajo es describir nuestra experiencia en el manejo conservador del NTXO. Materiales y Método: Estudio de cohorte retrospectivo realizado durante un período de 3 años en un Hospital de Trauma nivel I. Se incluyeron pacientes con traumatismo torácico (cerrado o penetrante) con NTXO. Se dividieron en dos grupos (conservados o drenados), realizándose una comparación de su evolución. Resultados: En 3 años fueron admitidos con traumatismo torácico 679 pacientes. De 93 pacientes con NTXO, 74 (80%) fueron conservados inicialmente y 19 (20%) tratados con drenaje pleural. Dos (3%) presentaron progresión del neumotórax en el seguimiento radiológico (conservación fallida). No se registraron complicaciones relacionadas con la ausencia de drenaje pleural. Las complicaciones y estancia hospitalaria fueron menores en el grupo de manejo conservador. Conclusión: Pacientes con NTXO por traumatismo de tórax (cerrado o penetrante), sin requerimiento de ventilación asistida y hemodinámicamente estables, pueden manejarse de manera conservadora con un monitoreo cercano durante 24 horas en forma segura, con menor tasa de complicaciones y de estancia hospitalaria.

Background: Occult pneumothorax (OPTX) is found in up to 15% of chest injuries. There is a history of conservative management of this pathology (only observation), although its practice continues to be discussed, especially in penetrating trauma. The objective of this paper is to describe our experience in the conservative management of OPTX. Materials and Method: Retrospective cohort study conducted over a 3-year period at a level I Trauma Center. Patients with thoracic trauma (blunt or penetrating) with OPTX were included. They were divided into two groups (preserved or drained) comparing their evolution. Results: Over a 3-year period 679 patients were admitted with chest trauma. From 93 patients with OPTX, 74 (80%) were initially preserved and 19 (20%) drained. Two patients (3%) presented pneumothorax progression in the follow-up imaging. There were no complications related to the absence of pleural drainage. Complications and hospital stay were lower in the conservative management group. Conclusion: Patients with OPTX due to chest trauma (blunt or penetrating), without requiring assisted ventilation and hemodynamically stable, can be safely conservative managed with close monitoring for 24 hours, with a lower rate of complications and hospital stay.

Sentinel lymph node biopsy after nipple?sparing mastectomy in early postoperative period: Is it feasible?

Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple?sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow?up of 42.82 (19�) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM

Radiolucência intracoronal pré-eruptiva (PECR) de um segundo molar permanente. relato de caso / Pre-eruptive intracoronal radiolucency (PECR) of a permanent second molar. case report

Introdução: A Radiolucência intracoronal pré eruptiva (PECR) é um achado radiográfico, com aspecto de lesão radiolúcida na dentina coronária, adjacente a junção amelodentinária, em dentes não irrompidos. Objetivo: Relatar um caso de possível reabsorção intracoronal pré-eruptiva com destruição extensa de dentina e envolvimento pulpar de um segundo molar permanente recém-erupcionado. Método: Após definição do diagnóstico, optou-se por um tratamento conservador, com a realização de capeamento pulpar direto com a finalidade de manutenção da vitalidade pulpar e término de formação das raízes. Resultado: Após o tratamento, paciente permaneceu assintomática no controle de quinze dias, com teste de vitalidade normal e sem sinais de inflamação. Conclusão: A interpretação cuidadosa do exame radiográfico é crucial para a detecção precoce e manejo adequado dessas lesões.

Pre-eruptive intracoronal radiolucency (PECR) is a radiographic finding, with the appearance of a radiolucent lesion in the coronary dentin, adjacent to the dentinal-enamel junction, in unerupted teeth. Objective: To report a case of possible pre-eruptive intracoronal resorption with extensive dentin destruction and pulpal involvement of a newly erupted second permanent molar. Method: After defining the diagnosis, a conservative treatment was chosen, with direct pulp capping in order to maintain pulp vitality and end root formation. Result: After treatment, the patient remained asymptomatic in the fifteen-day control, with normal vitality test and no signs of inflammation. Conclusion: Careful interpretation of the radiographic examination is crucial for early detection and proper management of these lesions.

Clinical significance of LncRNA-MIAT as a non-invasive diagnostic marker of nonHodgkin's lymphoma associated with occult hepatitis C virus infection

Aims: the current research aimed to investigate LncRNA-MIAT in patients with nonHodgkin lymphoma (NHL) and to assess its correlation with clinicopathological features and treatment protocols of NHLs among Egyptian patients with Occult hepatitis C virus (HCV) infection (OCI). Patients & Methods: This study was conducted on 20 patients with NHL and 30 healthy subjects as the control group. All subjects were screened for HCV-RNA in both plasma and PBMCs. RT-PCR determined lncRNA-MIAT. Results: lncRNA-MIAT relative expression level was upregulated in NHL groups (2.73±0.86) compared to controls (1.06±0.07), P ˂0.001*. Among NHL, patients with OCI (3.2±0.63) had significantly higher levels of lncRNA-MIAT compared to HCV (2.6±1.08) and non-HCV (2.4±0.4), P ˂0.001*. Additionally, the relative expression levels of lncRNA-MIAT were significantly positively correlated with laboratory and clinicopathological features of NHL. Interestingly, concerning the treatment of DLBCLNHL, there were significantly higher levels of lncRNA-MIAT in no treatment subgroup (n=10, 3.31±0.95) compared to successfully treated subgroups [CHOP (n=7, 1.58±0.34) and R-CHOP (n=3, 11.16±0.21), P ˂0.001* Conclusions: lncRNA-MIAT level was upregulated in NHL patients, particularly patients with OCI. Thus, circulatory lncRNA-MIAT may serve as a promising non-invasive diagnostic marker for NHL associated with OCI

The utility of ultrasound-guided tru-cut biopsy in the diagnosis of occult breast carcinoma presenting as ovarian malignancy with multiple metastases: A case of unknown primary

@#This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.

Mantle Cell Lymphona Masquerading as Obstructive Sleep Apnoea

@#Tonsillar malignancy typically presents with asymmetrical tonsillar enlargement, lesion on the tonsils, sore throat or a neck mass. We report a case of unsuspected tonsillar malignancy in a 56-year-old gentleman who presented with symptoms of obstructive sleep apnoea. His tonsils were grade III bilaterally with normal mucosa. Tonsillectomy was performed to improve patient’s compliance with Continuous Positive Airway Pressure (CPAP) therapy. These tonsillar specimens were reported to be Mantle Cell Lymphoma (MCL) based on the histology and ancillary studies. This case highlights that benign-looking symmetrical tonsillar enlargement can harbour occult malignancy. It is important to note that OSA symptoms may be the presentation for haematological malignancies. Tonsillar specimens should be sent for histopathological examination regardless of the indication to avoid misdiagnosis and delay in treatment.

Superficial retinal blood flow density analysis and related factors in adolescents with different classification of high myopia / 中华眼底病杂志

Objective:To observe and analyze the superficial retinal blood flow density and its related influencing factors in the macular area of adolescents with different types of non-pathological high myopia (HM).Methods:A retrospective clinical study. From March to August 2022, 117 eyes of 117 adolescents who were admitted to Liaocheng Aier Eye Hospital due to myopia were included in the study. According to equivalent spherical degree (SE) and corneal curvature, subjects were divided into mild myopia or emmetropia group (control group), HM group, occult HM (OHM) group, and super HM (SHM) group, with 30 eyes, 28 eyes, 35 eyes, and 24 eyes, respectively. All subjects underwent medical optometry, intraocular pressure, optical coherence tomography (OCT), OCT angiography (OCTA), axial length (AL) and corneal curvature measurements. The diopter was SE. OCTA instrument was used to scan the macular region in the range of 6 mm×6 mm, and the software automatically divided it into three concentric circles centered on the fovea of the macular, namely, the central area with a diameter of 1 mm, the inner ring area with a diameter of 1-3 mm, and the outer ring area with a diameter of 3-6 mm. The superficial retinal vascular density (SRVD), vascular perfusion density (SBPD), the area, perimeter (PERIM), avascular index (AI) of foveal avascular area (FAZ) and retinal thickness were measured in the macular region as a whole and in different regions. One-way analysis of variance was used to compare the data among groups, and the least significant difference t-test was used to compare the data among groups. The correlation of AL, corneal curvature and intraocular pressure with SRVD and SBPD in macula was analyzed by Pearson correlation analysis. Results:There were significant differences in SRVD and SBPD in the central, inner and outer regions of macula in control group, HM group, OHM group and SHM group ( P<0.05). There were statistically significant differences in the thickness of the retina above, below and on the temporal side of the central and outer ring regions ( P<0.05). However, no statistically significant difference was in the thickness of the retina on the nasal side ( P>0.05). There was no significant difference in PERIM ( P>0.05). There were significant differences in FAZ area and AI ( P<0.05). Correlation analysis showed that AL was negatively correlated with SRVD and SBPD in macular whole and central, inner and outer ring regions ( P <0.05). Corneal curvature and SE were positively correlated with the SRVD and SBPD of macular whole, central area and outer ring area ( P<0.05). AL was negatively correlated with retinal thickness in the outer ring region ( P<0.05). SE was positively correlated with the thickness of the retina above, below and temporally in the outer ring region ( P<0.05). AL was negatively correlated with FAZ area and AI ( P<0.05). SE was positively correlated with FAZ area and PERIM ( P<0.05). Retinal thickness was positively correlated with SRVD and SBPD ( P<0.05). Conclusions:The SRVD and SBPD of different types of HM in adolescents decreases to different degrees. The thickness of the retina in the central region is thicker, and the retina in the outer ring region is thinner. With the decrease of SRVD, the retinal thickness gradually is thinner.

Post-COVID-19 cryptosporidiosis: A serious risk or mere association?

@#Post-COVID-19 conditions encompass a wide range of health problems, including enteritis, but their association with parasitic infections has not yet been investigated. This study analyzed gastrointestinal symptoms, medical histories, fecal Cryptosporidium oocysts, and the history of COVID-19 infection in patients who attended the Faculty of Medicine, Cairo University, from January to July 2021. Fecal biomarkers, including H. pylori, occult blood, fecal calprotectin (FCAL), and TNF-a, were measured, and Cryptosporidium spp. genotypes were molecularly characterized among post-COVID-19 patients using RFLP. Preliminary results from 210 post-COVID-19 patients revealed that group 1 (Cryptosporidiumpositive) (n = 49) and group 2 (Cryptosporidium-negative) (n = 161) showed no significant difference in the prevalence rate of diabetes mellitus (DM). While group 2 was linked to diarrhea, only infections with Cryptosporidium post-COVID-19 were related to chronic diarrhea, vomiting, and weight loss. A total of 220 healthy subjects served as negative controls. Administering azithromycin, hydroxychloroquine, and ivermectin was significantly related to an increased risk of Cryptosporidium infection in group 1, whereas only azithromycin was more frequently recorded in group 2. Antioxidant supplementation insignificantly affected the incidence of cryptosporidiosis. Cryptosporidiosis with a history of COVID-19 was linked to H. pylori infections, increased inflammatory biomarkers (FCAL and TNF-a), and occult blood when compared with group 2. Cryptosporidium genotype 1 was the most commonly occurring subset in individuals with post-COVID-19. The findings demonstrated that aggravating gastrointestinal manifestations, increased fecal biomarkers and anti-COVID-19 therapeutic interventions are significantly related to the existence of Cryptosporidium oocysts in patients with post-COVID-19, indicating the predominance of.

Blood donors with HBV core anti-body: a follow-up study / 中国输血杂志

【Objective】 To evaluate the role of anti-HBc detection in current blood screening strategy by the follow-up of repeated donors with antibody to hepatitis B virus core antigen. 【Methods】 Plasma samples were collected randomly from Dalian Blood Center. to test anti-HBc(dual reagents) and anti-HBs via ELISA. The re-donation of eligible donors who were anti-HBc+ and donors reactive to HBV detection were followed up. 【Results】 A total of 1 291 plasma samples were collected randomly from May 2017 to March 2018, among which 405 samples(31.4%)were anti-HBc+. The median age of anti-HBc+ group was observed much higher than that of anti-HBc-group (39 vs 31 years old) (P0.05). Among the 405 anti-HBc+ donors, 3 donors were OBI (0.7%), of which one was screened out in second donation. No HBV DNA was detected out in 3 OBI cases. 【Conclusion】 Although anti-HBc detection is not suitable in blood screening currently, it is of great value in the assessment of blood donor re-entry for HBV reactive donors in blood screening due to the high anti-HBc prevalence among blood donors.

Connotation of distal bleeding based on modern pathophysiological mechanism and application of Huangtu Decoction for acute coronary syndrome complicated with acute upper gastrointestinal hemorrhage in critical care medicine / 中国中药杂志

Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.

Occult hepatitis B virus infection in patients with chronic liver disease of different etiology in a Brazilian referral center: comparison of two different hepatitis B virus deoxyribonucleic acid amplification protocols: a cross-sectional study

ABSTRACT BACKGROUND: Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) in the liver of individuals with undetectable hepatitis B virus surface antigen (HBsAg) in the serum. The actual prevalence of OBI and its clinical relevance are not yet fully understood. OBJECTIVE: To evaluate the prevalence of HBV DNA in liver biopsies of HBsAg-negative patients with chronic liver disease of different etiologies in a referral center in Brazil and compare two different HBV DNA amplification protocols to detect HBV. DESIGN AND SETTING: This cross-sectional observational study was conducted at the Liver Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil, between January 2016 and December 2019. METHODS: HBV DNA was investigated in 104 liver biopsy samples from individuals with chronic liver disease of different etiologies, in whom HBsAg was undetectable in serum by nested-polymerase chain reaction (nested-PCR), using two different protocols. RESULTS: OBI, diagnosed by detecting HBV DNA using both protocols, was detected in 6.7% of the 104 individuals investigated. Both protocols showed a good reliability. CONCLUSION: In addition to the differences in the prevalence of HBV infection in different regions, variations in the polymerase chain reaction technique used for HBV DNA amplification may be responsible for the large variations in the prevalence of OBI identified in different studies. There is a need for better standardization of the diagnostic methods used to diagnose this entity.

Serological Pattern of Hepatitis B Virus Infection and Risk Factors among Infected Individuals in Port Harcourt, Rivers State, Nigeria

Hepatitis B virus infection is a serious global public health challenge that affects more than two billion people worldwide. This study aimed to evaluate the serological pattern of HBV infection in HBV infected patients in Port Harcourt, Nigeria. The main aim of this study was to evaluate the serological pattern of hepatitis B infection in Port Harcourt, Nigeria. This was a comparative cross sectional study carried out on 260 hepatitis B patients and blood donors attending hepatitis B clinics, and blood banks in Rivers State University Teaching Hospital, Port Harcourt, Military Hospital, Port Harcourt, and University of Port Harcourt Teaching Hospital, Choba. The study involved the use of hepatitis B panel assay, measurement of prevalence of hepatitis B virus infection in Port Harcourt, assessment of hepatitis B serological markers in all subjects, determination of the presence and prevalence of occult HBV among participants. HBV 5-parameter (panel) Rapid Test kit was used to assess HBV serological markers. Standard operation procedure, good laboratory practice, External/Internal Quality Control were used accordingly and Quality Assurance ensued. 84.2%

Utility of video capsule endoscopy in clinical practice, experience at King Faisal Specialist Hospital and Research Center, Riyadh

Background: Video capsule endoscopy (VCE) is a valuable diagnostic tool for the evaluation of the small intestine. Evidence shows that it is effective in the diagnosis of occult bleeding and superficial lesions that are not radiographicallyobserved. We evaluated the efficacy and safety of the capsule endoscopy in the diagnosis and management of the common gastrointestinal disorders.Methods: A retrospective chart review of a total of 326 candidates who have met the inclusion criteria and who underwent VCE from the period from January 2006 till December 2018.Results: The main indication for Video Capsule Endoscopy was small bowel overt gastrointestinal bleeding with 106 cases (32.6%) followed by iron deficiency anemia with 104 cases (32%). Capsule retention rate was observed in 11 cases (3.4%) 4 of which were crohn抯 disease patients (22.2%). Overall diagnostic yield was 36%, 64% for overt gastrointestinal bleeding and 41% for occult gastrointestinal bleeding. The most common reported positive finding was Angiodysplasia in 19.9% of cases, followed by ulcers in 13.8% of cases, followed by polyps in 8.3% of cases and erosions in 8% of cases.Conclusions: Video capsule endoscopy proved to be an essential diagnostic tool in gastrointestinal bleeding. Advantages of VCE include; less labor, higher resolution examination of mucosa, relative safety, and noninvasiveness. On the other hand, it does not offer intervention capabilities when compared with enteroscopy and its interpretation was sometimes difficult and time consuming. Risk of capsule retention remains significant especially in patients suffering from crohn抯 disease.

Indicadores de desempeño de un programa de rastreo de cáncer colorrectal en la provincia del Neuquén, Argentina, 2015-2019 / Performance indicators of a colorectal cancer screening program in the province of Neuquén, Argentina, 2015-2019

INTRODUCCIÓN: El cáncer colorrectal (CCR) es una causa frecuente de mortalidad en adultos. El objetivo de este estudio fue mostrar resultados de la implementación del Programa de Rastreo de Cáncer Colorrectal (PRCCR) en la provincia del Neuquén, Argentina. MÉTODOS: Se realizó un estudio retrospectivo con análisis de resultados de sangre oculta en materia fecal (SOMF) y videocolonoscopía (VCC) en personas de 50-75 años, en efectores del sistema de salud pública en 2015-2019. Se determinó porcentaje de participación, resultados de SOMF, realización de colonoscopía en pacientes con SOMF positiva y sus hallazgos, y valor predictivo positivo (VPP) para detección de lesiones y de CCR. RESULTADOS: Se analizaron 11 189 SOMF. La participación promedio fue 6,52% de la población objetivo. Tuvieron SOMF positiva el 24,6% de los participantes; de ellos, realizaron la VCC un 24%. Se encontró lesión significativa en el 24,8% (pólipos adenomatosos 21,9%, cáncer 2,9%), con un VPP para la detección de lesiones del 34,3%. Tuvieron adenomas avanzados el 7,4%. Repitieron la SOMF tras un resultado negativo (segunda o tercera ronda) el 17,6% de los pacientes, y realizaron una VCC de control tras el hallazgo de un pólipo adenomatoso el 13,7%. DISCUSIÓN: El PRCCR en Neuquén muestra algunos indicadores que deben mejorarse (cobertura, realización de VCC) y otros adecuados (frecuencia de lesiones). Ante las dificultades se pueden plantear medidas más focalizadas, como la aplicación de escalas de riesgo de CCR, rastreo bianual, etc.

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of mortality among adults. The objective of this study was to show results of the implementation of the colorectal cancer screening program (CRCSP) in the province of Neuquén, Argentina. METHODS: A retrospective study was conducted, with analysis of fecal occult blood test (FOBT) results in people aged 50 to 75 years, in public hospitals between 2015- 2019. Participation rate, FOBT results, colonoscopy (CC) performance in patients with positive FOBT and their findings, and positive predictive value (PPV) for detection of lesions and CRC were determined. RESULTS: A total of 11,189 FOBT were requested. The average participation was 6.52% of the target population, 24.6% of the participants had positive FOBT, and 24% of them had a CC performed. A significant lesion was found in 24.8% (adenomatous polyps 21.9%, cancer 2.9%), with a PPV for the detection of lesions of 34.3%. Furthermore, 7.4% had advanced adenomas, 17.6% of the patients repeated the FOBT after a negative result (second or third round), and 13.7% had a control CC performed after the finding of an adenomatous polyp. DISCUSSION: The CRCSP in Neuquén shows some indicators that need to be improved (coverage, conduction of CC) and others that are adequate (frequency of findings). In view of these difficulties, some more focused screening measures can be considered, such as use of CRC risk scales, bi-annual screening, etc.

S gene mutation of blood donors with occult hepatitis B virus infection in Huzhou area / 中国输血杂志

【Objective】 To analyze the characteristics of gene mutation in S region of blood donors with occult hepatitis B virus infection (OBI) in Huzhou area. 【Methods】 A total of 60 107 blood samples in Huzhou between October 2018 and June 2020 were collected by our blood station. Among them, 52 samples were NAT, yield and their epidemiological characteristics were analyzed. Twenty-seven OBI out of the 52 NAT yield samples were included in experimental group. Other eight HBV-infected individuals with positive HBsAg, core antibody (anti-HBc) and HBV-DNA were selected as positive control. Liver function and 5 serological markers of HBV were compared between the two groups, and HBV genotypes and amino acid mutation in S region in the two groups were analyzed. 【Results】 The number of NAT-yield samples were different by gender, age, and educational background (P0.05). Surface antigen (HBsAg) in the experimental group was significantly lower than that in the control group, while surface antibody (anti-HBs) and e antibody (anti-HBe) were significantly higher than those in the control group (P<0.05). Twenty sequences in S region were obtained from the experimental group, including 4 in S region and 16 in preSS region; 16 cases with type C and 4 cases with type B. 【Conclusion】 The follow-up of NAT-yield blood donors in Huzhou area should be conducted. Compared with HBV infected individuals with positive HBsAg, anti-HBc and HBV-DNA, those with OBI have a higher gene mutation rate in S region.

Study on methylation level of replication related genes of occult hepatitis B virus / 中国输血杂志

【Objective】 To study the level of occult hepatitis B virus methylation and replication related genes, and to explore the effect of the former on the latter. 【Methods】 The cases in control group (healthy control, n=3), occult hepatitis B group (occult HBV group, n=3) and hepatitis B group (HBV group, n=3) were detected by Illumina methylation 850k chip. The difference analysis, GO analysis and KEGG analysis were carried out. The methylation and virus replication related genes DNMT1, DNMT2, Dnmt3a and ZHX2 were screened for RT-PCR. 【Results】 The methylation level of occult HBV group and HBV group was significantly higher than that of the control group. Difference analysis showed that there were 1 050 differential methylation sites in occult HBV group with the methylation level greater than non-methylation level, and 1 340 differential methylation sites as the opposite compared with the control group. In HBV group, there were 1 008 differential methylation sites with methylation level greater than non-methylation level, and 1 242 differential methylation sites as the opposite. Go analysis showed that compared with the control group, the differential gene expression in occult HBV group and HBV group was significantly related to many anabolic processes in biological process (BP), cell composition (CC) and molecular function (MF). The enrichment analysis of KEGG pathway between the control group and the occult HBV group showed that the differential genes were mainly involved in adhesion junction, basal cell carcinoma, endometrial carcinoma, EB virus infection, hepatocellular carcinoma and other signal pathways. The enrichment analysis of KEGG pathway in occult HBV group and HBV group showed that the differential genes were mainly involved in AMPK signal pathway, cell cycle, endometrial cancer, hepatitis C, hepatocellular carcinoma and other signal pathways. DNMT1 and DNMT3a in occult HBV group and HBV group were significantly higher while ZHX2 was significantly lower than those in control group. 【Conclusion】 The methylation level of occult HBV group and HBV group increased significantly while ZHX2 decreased significantly. Hypermethylation inhibited the expression of ZHX2 and changed the replication of hepatitis B virus. Hepatitis B virus DNA methylation provides a theoretical basis for the replication mechanism of hepatitis B virus and a new method for the treatment of hepatitis B virus.

Long-term immunization and prognosis outcome of patients with occult hepatitis B virus infection / 中国输血杂志

【Objective】 To investigate the prognosis of blood donors with occult hepatitis B virus infection (OBI) by long-term follow-up and repeated testing of HBsAg and HBV DNA. 【Methods】 From January 1, 2010 to December 31, 2020, voluntary blood donors were screened by both serological and viral nucleic acid(NAT) testing, then samples were further confirmed as HBV DNA positive by manual nested-PCR amplification.A total of 306 cases were detected as HBsAg negative /HBV DNA positive, then followed-up for a long time and re-examined of HBsAg and HBV DNA to confirm whether they had infected with OBI.The prognosis of patients with OBI who experienced long-term immunization was determined by repeated testing. 【Results】 A total of 306 HBsAg negative/ HBV DNA positive blood donors had been followed up, and 40(13.07%, 40/306) were recalled frequently for re-examination.Among them, 90%(36/40), 57.5%(23/40), 40% (16/40)were anti-HBc + , anti-HBs + and anti-HBe + , respectively, and 50%(20/40), 40%(16/40), 7.5%(3/40) and 2.5% (1/40)were anti-HBs+ / anti-HBc + , anti-HBc + / anti-HBs -, anti-HBc -/ anti-HBs + and anti-HBc -/ anti-HBs -, respectively.Those 40 blood donors were followed-up for 1-13 times, with the duration of 8-108 months (0.6~9 years).1 donor (2.5%) was followed-up less than 1 year, 11 (27.5%)>1 year and ≤3 years, 23 (57.5%) 23(57.5%)>3 years and ≤5 years, and 5 (12.5%) for more than 5 years.After long-term following up and repeated testing, 50%(20/40)of OBI blood donors turned negative for HBV DNA (HBsAg negative / HBV DNA negative), 42.5% (17/40)were confirmed as OBI infection (HBsAg negative / HBV DNA positive), and 7.5%(3/40) were hard to determine (after repeated testing, the results were either positive or negative). 【Conclusion】 After long-term following up and repeated screening, we found that none of the OBI patients turned into acute or chronic HBV infection, and most of them maintained OBI.However, OBI blood donors carry very low load of HBV DNA for a long time, which could lead to false negative results of NAT and bring a great challenge to the safety of blood transfusion.

HBV serologic and virus characteristics of HBsAg negative and NAT non-discriminated samples from blood donors / 中国输血杂志

【Objective】 To investigate the HBV infection of TMA initially reactive but discriminatory test non-reactive samples(NDR) after the individual donation nucleic acid detection(ID-NAT)of TMA, and analyze its serological and molecular biological characteristics, so as to improve the safety of blood transfusion. 【Methods】 121 970 samples of blood donors in the center from January 1, 2021 to December 31, 2021 were routinely tested by serology and nucleic acid of ID NAT, and 21 HBsAg(-)/ NDR samples were random collected. After the plasma samples were concentrated by ultra-high speed centrifugation, the gene sequences of BCP/PC, pre-S/S and S region were amplified by Nested PCR. The S region sequence was also sequenced to analyze the viral genotype and amino acid variation. At the same time, the original TMA retest discriminatory test was adopted, and Roche MPX 2.0 was used for ID-NAT, and the samples was not virus-concentrated.NDR samples were supplemented with electrochemiluminescence for anti-HBc and anti-HBs quantitative detection. 【Results】 Of the 121 970 samples screened, 117(0.096%) were found to be HBsAg(-)/NDR samples, of which 21 samples underwent a confirmation test. Sixteen(76.2%) cases were positive for HBV DNA by TMA retest, 7(33.3%) positive for HBV DNA by Roche MPX 2.0 ID-NAT, 9(42.9%) confirmed by Nested PCR, and 8(38.1%) positive by any two methods. Test results of serological markers were as follows: 17(80.9%) positive anti-HBc and 8(38.1%) positive anti-HBs. Eight infected cases were confirmed to have occult hepatitis B infection(OBI). The gene sequence of S region was successfully amplified and sequenced in 3 cases, all of which belonged to C type. Two mutations occurred in specimen S-2, all of which were outside MHR. There were 13 mutations in sample S-6, 6 mutations outside MHR and 7 mutations inside MHR. 【Conclusion】 Nearly 40% of NDR samples can still be detected as HBV DNA positive after virus concentration. Anti-HBc has a high detection rate, and there may be a potential risk of HBV transmission. The current NAT detection sensitivity should be improved. The amino acid mutation of S gene sequence may be related to OBI formation.