Vaginal high-grade sarcoma in pregnancy.

BACKGROUND: Vaginal cancer is a rare malignancy making up 1-2% of all female genital tract cancers. Among vaginal cancers, sarcomas constitute 2% of malignant vaginal lesions, with leiomyosarcomas being the most common type of sarcoma. There is a paucity of data to guide treatment of vaginal sarcomas. This case report details a patient diagnosed with a gynecologic sarcoma during pregnancy who is subsequently treated for residual vaginal disease in the postpartum period with local resection and adjuvant vaginal brachytherapy. CASE: A 31-year-old gravida 4 para 0 who presented at 22-weeks gestation with vaginal bleeding to an outside hospital and expelled a mass 11 cm in diameter from the vagina during her admission. Findings were consistent with a high grade gynecologic sarcoma. She underwent planned cesarean section at 36 weeks gestational age with uterine pathology showing no sarcoma. At her 3 month postpartum visit she was found to have a 1 cm posterior vaginal wall lesion which was resected and consistent with vaginal sarcoma. She underwent adjuvant brachytherapy. CONCLUSION: This case demonstrates the challenges with obtaining a correct pathological diagnosis for pregnant patients with vaginal sarcoma during pregnancy. Surgical resection with negative margins remains an important treatment component. Given the low incidence of disease occurrence in pregnancy and rare number of cases reported in literature, further elucidation of timing of delivery and adjuvant treatment is warranted.

Additional active tuberculosis cases detected and costs incurred by a second household contact investigation.

In routine contact investigation in Myanmar, basic health staff conduct home visits and symptom screening among household contacts before investigation. We supplemented this with follow-up telephone calls by programme nurses inviting all contacts to be screened. The staff identified 376 contacts, 4 with symptoms, 3 of whom presented, including 1 with tuberculosis (TB). Due to the second intervention, 264 of the remaining 373 contacts received screening and 17 additional cases were detected. The additional cost incurred by the second intervention was 4.3 times higher than that of the conventional method, but TB yield was increased by a factor of 17.

Dans la recherche de routine des contacts au Myanmar, le personnel de santé de base fait des visites à domicile et du dépistage de symptômes parmi les contacts familiaux avant l'investigation. Nous avons complété cette méthode avec un suivi par téléphone par les infirmiers du programme invitant tous les contacts à se faire dépister. Le personnel a identifié 376 contacts, dont 4 avaient des symptômes, 3 se sont présentés et 1 avait une tuberculose. Grâce à cet initiative complémentaire, 264 des 373 contacts restants ont été dépistés et 17 cas supplémentaires ont été détectés. Le coût additionnel lié à cette intervention supplémentaire a multiplié par 4,3 celui de la méthode conventionnelle mais le rendement a été multiplié par 17.

En la investigación corriente de los contactos de pacientes con tuberculosis (TB) en Myanmar, los trabajadores de salud básica visitan los hogares y realizan el tamizaje de síntomas en los contactos domiciliarios antes de remitirlos para investigación. Este método se complementó con llamadas telefónicas de seguimiento por parte de personal de enfermería del programa, que invitaban a todos los contactos a participar en la detección sistemática. Con la investigación corriente se encontraron 376 contactos, cuatro presentaban síntomas y en tres de ellos se diagnosticó la TB. Al poner en práctica la iniciativa complementaria, se practicó la detección sistemática a 264 de los 373 contactos restantes y se diagnosticaron otros 17 casos de TB. El costo de la intervención adicional fue 4,3 veces más alto que el costo del método habitual, pero el rendimiento diagnóstico se multiplicó por 17.

Suppression of hepatitis C virus replication by baculovirus vector-mediated short-hairpin RNA expression.

Short-hairpin RNAs (shRNAs) inhibit gene expression by RNA interference. Here, we report on the inhibition, by baculovirus-based vector-derived shRNAs, of core-protein expression in full-length hepatitis C virus (HCV) replicon cells. shRNAs were designed to target the highly conserved core region of the HCV genome. In particular, the core-shRNA452 containing nucleotides 452-472, as the target in the HCV core gene, dramatically inhibited the expression of the HCV core protein in replicon cells. Furthermore, HCV core-protein expression was inhibited more strongly by the vesicular stomatitis virus glycoprotein (VSV-G)-pseudotyped baculovirus vector than by the wild-type baculovirus vector.