Hypofractionated radiotherapy and adjuvant chemotherapy do not increase radiation-induced dermatitis in breast cancer patients.

PURPOSE: Radiation-induced dermatitis is a common side effect of breast irradiation, with hypofractionation being a well-known risk factor. In the context of the widespread adoption of hypofractionated breast radiotherapy, we evaluated the effect of hypofractionated radiotherapy on the incidence of skin toxicity in patients receiving adjuvant chemotherapy. PATIENTS AND METHODS: We retrospectively reviewed the records of patients with breast cancer treated from 2004 to 2006 at a single institution. Patients undergoing lumpectomy with or without adjuvant chemotherapy followed by hypofractionated radiotherapy consisting of 42.4 Gy in 16 fractions were included in the study. Using cosmetic and skin toxicity scales, all patients were evaluated weekly during treatment and at scheduled follow-up visits with the radiation oncologist. RESULTS: During the study period, 162 patients underwent radiotherapy, and 30% of those (n = 48) received chemotherapy. Radiotherapy boost to the tumour bed was more common in the chemotherapy group [n = 20 (42%)] than in the radiotherapy-alone group [n = 30 (26%)]. We observed no statistically significant difference between the groups with regard to acute skin toxicity of grade 3 or higher (2.1% in the chemotherapy group vs. 4.4% in the radiation-alone group, p = 0.67) or of grades 1-2 toxicity (62.5% vs. 51.7% respectively, p = 0.23). There was also no significant difference in late grade 3 or higher skin toxicity between the groups (2.1% vs. 0% respectively, p = 0.30) or in grades 1-2 toxicity (20.8% vs. 25.5% respectively, p = 0.69). Similarly, excellent or good cosmetic result scores were similar in both groups (p = 0.80) CONCLUSIONS: In our single-institution review, we observed no adverse effects of chemotherapy in combination with hypofractionated whole-breast irradiation. Further investigations are necessary to better elucidate the effects of chemotherapy on skin toxicity in the context of hypofractionated irradiation.

Pure isolated unilateral internuclear ophthalmoplegia from ischemic origin: report of a case and literature review.

PURPOSE: To report a case of pure isolated unilateral internuclear ophthalmoplegia from ischemic stroke, and to review its literature. METHODS: A 55-year old man, with a history of long-standing diabetes mellitus, developed acute-onset left internuclear ophthalmoplegia. MRI revealed a small paramedian dorsal pontine infarct ventral and lateral to the aquaductus cerebri. Intracranial MR angiography was normal. A systematic search was performed of the literature from January 1980 to December 2004 by using MEDLINE and EMBASE. Case reports with or series including patients with negative MRI findings were excluded. RESULTS: Nine cases of pure isolated MRI-proven unilateral INO resulting from ischemic stroke including this one, have been reported. In over 75% recovery was reported. CONCLUSION: Isolated unilateral internuclear ophthalmoplegia can be the sole manifestation of ischemic stroke and generally carries a good prognosis.

Heavy metals in urban soils of central Jordan: should we worry about their environmental risks?

Forty soil samples collected from central Jordan were analyzed by atomic absorption spectrophotometry for Pb, Cd, Zn, Cr, and Hg. The samples were also investigated for mineralogy using X-ray, electron, and optical microscopes. Sequential extraction procedures were used to predict the percentages of the Pb, Zn, Cd, and Cr present in each of the soil geochemical phases. The clay mineral assemblage encountered in the analyzed samples is composed of kaolinite, smectite, illite, and illite/smectite mixed-layer. The nonclay minerals of the sand-sized fraction are composed mainly of quartz and calcite as major minerals with pyroxene, biotite, and feldspars as minor minerals. The enrichment factors of the measured heavy metals Pb, Cd, Zn, Cr, and Hg in the clay fraction (<2 microm) of the collected samples are 3.1, 16.6, 1.5, 0.9, and 4.5, respectively. According to the index of geoaccumulation, the soils of the study area are considered to be moderately contaminated with respect to Cd, uncontaminated to moderately contaminated with respect to Pb, Hg, and Zn, and uncontaminated with respect to Cr. The measured metals correlated positively with the determined physicochemical factors such as pH, clay content, organic matter content, and carbonate content. The relatively high concentrations of Cd, Pb, and Hg in the soils of the study area are related to anthropogenic sources such as cement industry, fertilizers, and vehicle exhausts. It was found that Pb, Zn, and Cr are associated mainly with the residual phases and are relatively immobile. On the other hand Cd is enriched in the carbonate phase of the analyzed soil samples. It is possible to suggest the sequence of mobility for Pb, Zn, Cd, and Cr in the analyzed soil samples as the following: Cd>>Pb>Cr>Zn.

Eleven years of malaria surveillance in a Sudanese village highlights unexpected variation in individual disease susceptibility and outbreak severity.

An analysis is presented of continuous data collected over 11 years based on 1,902,600 person/days of observation on the malaria experience of the people of Daraweesh, a village in eastern Sudan. Malaria transmission is hypo-endemic: the acquisition of clinical immunity with age is not as obvious as in more holo-endemic areas and malaria remained a problem in all age groups throughout the study. However, this population, who are of Fulani origin, showed a distinctly variable level of disease susceptibility. Thirty-two percent of the village never reported malaria symptoms or required malaria treatment while others experienced up to 8 clinical episodes over the 11 years of observation. Malaria incidence was clearly influenced by drought but much less obviously by rainfall. To what extent outbreak patterns are explicable in terms of anopheline factors, and to human immune factors, remains an interesting question for malaria modelling in this, and in other low transmission zones, such as the burgeoning urban areas of modern Africa.

Chronic Plasmodium falciparum infections in an area of low intensity malaria transmission in the Sudan.

Chronic Plasmodium falciparum malaria infections in a Sudanese village, in an area of seasonal and unstable malaria transmission, were monitored and genetically characterized to study the influence of persistent infection on the immunology and epidemiology of low endemicity malaria. During the October-December malaria season of 1996, 51 individuals out of a population of 420 had confirmed and treated P. falciparum malaria in the village of Daraweesh in eastern Sudan. In a cross-sectional survey carried out in December 1996, an additional 6 individuals were found to harbour a microscopically negative but polymerase chain reaction (PCR)-positive P. falciparum infection. On 1 January 1997, a cohort of 43 individuals aged from 9 to 53, recruited from this group of recently malaria-infected individuals agreed to donate fortnightly blood samples for the next 9 months, the first 6 of which constitute the long Sudanese dry season when transmission falls to undetectable levels. Each blood sample was tested for the presence of persistent malaria infection by microscopy and PCR. Parasite-positive samples were genotyped using PCR assays that detect allelic polymorphism at the MSP-1, MSP-2 and GLURP marker gene loci. Of 43 individuals 16 were found to maintain chronic P. falciparum infections which were continuously genetically characterized.

First report of infectious necrotic hepatitis (black disease) among Nubian goats in Sudan.

In a flock of 425 female and male Nubian goats in the Khartoum Province, an outbreak of a disease causing sudden death of 18 apparently healthy goats occurred (11 females and 7 males, 3-6 years old). Adult Fasciola gigantica were found in the livers of all goats and in seven of them Cysticercus tenuicollis cysts. These organs showed necrotic and severe histopathological changes. Clostridium novyi type B was isolated from necrotic areas of all livers and found to be highly pathogenic and toxigenic to laboratory animals. The disease was diagnosed as infectious necrotic hepatitis (black disease). Faecal examination revealed the presence of F. gigantica eggs. Lymnaea natalensis snails were found to be prevalent in the water canals. As the Khartoum Province is regarded as an endemic area for black disease, routine vaccination is highly recommended for its control in goats and sheep.

Abscess disease in goats in the Sudan.

The "abscess disease" was described in naturally infected goats for the first time in Sudan. An anaerobic respiratory deficient staphylococcus was isolated in pure form. The biochemical properties were studied. The disease was successfully reproduced in experimental goats.