Galectins in Esophageal Cancer: Current Knowledge and Future Perspectives.

Esophageal cancer is a disease with poor overall survival. Despite advancements in therapeutic options, the treatment outcome of esophageal cancer patients remains dismal with an overall 5-year survival rate of approximately 20 percent. To improve treatment efficacy and patient survival, efforts are being made to identify the factors that underlie disease progression and that contribute to poor therapeutic responses. It has become clear that some of these factors reside in the tumor micro-environment. In particular, the tumor vasculature and the tumor immune micro-environment have been implicated in esophageal cancer progression and treatment response. Interestingly, galectins represent a family of glycan-binding proteins that has been linked to both tumor angiogenesis and tumor immunosuppression. Indeed, in several cancer types, galectins have been identified as diagnostic and/or prognostic markers. However, the role of galectins in esophageal cancer is still poorly understood. Here, we summarize the current literature with regard to the expression and potential functions of galectins in esophageal cancer. In addition, we highlight the gaps in the current knowledge and we propose directions for future research in order to reveal whether galectins contribute to esophageal cancer progression and provide opportunities to improve the treatment and survival of esophageal cancer patients.

Knowledge of Anticoagulation Among Saudi Patients With Atrial Fibrillation: A Cross-Sectional Study.

Background Knowledge about oral anticoagulant treatment can impact treatment outcomes in patients with atrial fibrillation. However, evidence is scarce regarding the knowledge of oral anticoagulants among Saudi patients with atrial fibrillation. Hence, this study aimed to assess the level of anticoagulation knowledge among patients with atrial fibrillation taking oral anticoagulants. Methodology A survey using a cross-sectional study design was conducted among patients with a confirmed diagnosis of atrial fibrillation in a tertiary care setting. The Oral Anticoagulation Knowledge Tool (AKT), a 33-item, self-administered questionnaire, was used to assess the knowledge of anticoagulation. Results A total of 290 patients with a median age of 67 years participated in the survey. More than half of those surveyed (56.2%) were females. Overall, 195 (67.2%) patients had an overall adequate anticoagulation knowledge. The median knowledge score of participants on warfarin was significantly higher than those on direct-acting oral anticoagulants (p < 0.001). Only age was found to be a predictor of AKT. Increasing age was associated with fewer odds of adequate AKT. For every one-year increase in age, the knowledge score decreased by 0.08 (95% confidence interval: -0.13 to -0.04). Conclusions This study found significant knowledge gaps among Saudi patients with atrial fibrillation taking oral anticoagulants. Advancing age was inversely associated with oral anticoagulation knowledge.

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

BACKGROUND: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).

Adherence to anti-tuberculosis treatment in Tigray, Northern Ethiopia.

SETTING: Tuberculosis (TB) patients in Mekelle Zone, Tigray Region, in Ethiopia. OBJECTIVE: To investigate adherence to anti-tuberculosis treatment. DESIGN: A cross-sectional study in health facilities providing anti-tuberculosis treatment was conducted. Adherence was measured in three ways: through self-reported missed doses, by visual analogue scale whereby patients rate their own adherence and by record review. A patient was considered to be adherent if 90% or more of the prescribed medication was taken. RESULT: Of 278 TB patients included, 101 were in the intensive and 177 in the continuation phase. Respectively 67 (24.1%), 130 (46.8%) and 80 (28.8%) patients had smear-positive, smear-negative and extra-pulmonary TB. Self-report of missed doses and record review indicated adherence of respectively 273 (97.3%) and 271 (97.5%) patients. By visual analogue scale, 250 (91.6%) patients rated themselves as adherent. History of drug side effects (aOR 0.25, 95%CI 0.08-0.77) and knowledge about TB prevention (aOR 0.19, 95%CI 0.05-0.8) were independently associated with being adherent in this setting. CONCLUSION: Adherence to anti-tuberculosis treatment was high in our study. Adherence support should be given to the poor, the elderly, patients co-infected with the human immunodeficiency virus, alcohol abusers and smokers. Health education on TB prevention should be given to all TB patients regularly.

Contexte : Patients tuberculeux dans la zone de Mekelle, région du Tigray en Ethiopie.Objectif : Examiner l'adhésion au traitement antituberculeux.Schéma : Une étude transversale a été réalisée dans des centres de santé offrant un traitement antituberculeux. L'adhésion a été mesurée de trois manières : par la déclaration des doses manquées par les patients eux-mêmes, par une échelle visuelle analogue grâce à laquelle les patients notent leur propre adhésion et en étudiant les dossiers. Un patient était considéré comme adhérent s'il avait pris au moins 90% des doses prescrites.Résultats : Un total de 278 patients tuberculeux ont été inclus, 101 dans la phase intensive et 177 dans la phase de continuation. Respectivement 67 (24,1%), 130 (46,8%) et 80 (28,8%) patients avaient une tuberculose à frottis positif, à frottis négatif et extra-pulmonaire. La déclaration par les patients sur les doses manquées et la consultation des dossiers ont indiqué une adhésion de 273 patients (97,3%) et 271 patients (97,5%), respectivement. Avec l'échelle visuelle analogue, 250 (91,6%) patients se considéraient comme adhérents. Des antécédents d'effets secondaires (aOR ajusté [aOR] 0,25 ; IC95% 0,08­0,77) et des connaissances en matière de prévention de la TB (aOR 0,19 ; IC95% 0,05­0,8) étaient indépendamment associés à l'adhésion dans ce contexte.Conclusion : L'adhésion au traitement antituberculeux était élevée dans notre étude. Un soutien à l'adhésion devrait être offert aux patients pauvres, âgés, co-infectés par le virus de l'immunodéficience humaine, consommateurs excessifs d'alcool et fumeurs. Tous les patients devraient bénéficier régulièrement d'une éducation sanitaire à la prévention de la TB.

Marco de referencia: Los pacientes con diagnóstico de tuberculosis (TB) de la zona de Mekelle en la región Tigray en Etiopía.Objetivo: Evaluar el cumplimiento del tratamiento antituberculoso.Método: Se practicó un estudio transversal en los centros de atención sanitaria que suministran tratamiento antituberculoso. La medición de la observancia terapéutica se obtuvo mediante tres mecanismos, a saber la referencia de los propios pacientes sobre las dosis omitidas, una escala visual analógica en la cual los pacientes calificaban su propio cumplimiento y el examen de las historias clínicas. Se consideró que un paciente cumplía con el tratamiento cuando tomaba como mínimo 90% de los medicamentos recetados.Resultados: Se incluyeron en el estudio 278 pacientes con diagnóstico de TB, de los cuales 101 se encontraban en la fase intensiva del tratamiento y 177 en la fase de continuación. Sesenta y siete pacientes presentaron una baciloscopia positiva (24,1%) y 130 una baciloscopia negativa (46,8%); en 80 pacientes la TB fue de localización extrapulmonar (28,8%). Con base en la autorreferencia sobre las dosis omitidas se observó cumplimiento terapéutico en 273 pacientes (97,3%) y en 271 (97,5%) cuando se examinaron los registros clínicos. En la prueba de la escala visual analógica, 250 pacientes consideraron que eran cumplidos (91,6%). Los factores que se asociaron de manera independiente con la observancia del tratamiento en este entorno fueron los antecedentes de reacciones adversas a los medicamentos (OR ajustada [aOR] 0,25; IC95% 0,08­0,77) y los conocimientos en materia de prevención de la TB (aOR 0,19; IC95% 0,05­0,8).Conclusión: Se observó una alta tasa de cumplimiento del tratamiento antituberculoso. Es importante respaldar la observancia terapéutica de las personas con escasos recursos, los ancianos, los pacientes aquejados de coinfección por el virus de la inmunodeficiencia humana o abuso de alcohol y los fumadores. Se recomienda impartir educación en materia de prevención de la enfermedad de manera sistemática a todos los pacientes que reciben tratamiento antituberculoso.

The Rhizobium etli gene iscN is highly expressed in bacteroids and required for nitrogen fixation.

Sequence analysis of the rpoN (2)- fixA intergenic region in the genome of Rhizobium etli CNPAF512 has uncovered three genes involved in nitrogen fixation, namely nifU, nifS and nifW. These genes are preceded by an ORF that is highly conserved among nitrogen-fixing bacteria. It encodes a putative gene product of 105 amino acids, belonging to the HesB-like protein family. A phylogenetic analysis of members of the HesB-like protein family showed that the R. etli HesB-like protein clusters with polypeptides encoded by ORFs situated upstream of the nifUS nitrogen fixation regions in the genomes of other diazotrophs. The R. etli ORF that encodes the HesB-like protein was designated iscN. iscN is co-transcribed with nifU and nifS, and is preferentially expressed under free-living microaerobic conditions and in bacteroids. Expression is regulated by the alternative sigma factor RpoN and the enchancer-binding protein NifA. A R. etli iscN mutant displays a reduction in nitrogen fixation capacity of 90% compared to the wild-type strain. This Nif(-) phenotype could be complemented by the introduction of intact copies of R. etli iscN.