Risk factors for Epstein Barr virus-associated cancers: a systematic review, critical appraisal, and mapping of the epidemiological evidence

Background Epstein Barr Virus (EBV) infects 90%-95% of all adults globally and causes~1% of all cancers. Differing proportions of Burkitt’s lymphoma (BL), gastric carcinoma (GC), Hodgkin’s lymphoma (HL) and nasopharyngeal carcinoma (NPC) are associated with EBV. We sought to systematically review the global epidemiological evidence for risk factors that (in addition to EBV) contribute to the development of the EBV-associated forms of these cancers, assess the quality of the evidence, and compare and contrast the cancers. Methods MEDLINE, Embase and Web of Science were searched for studies of risk factors for EBV-associated BL, GC, HL and NPC without language or temporal restrictions. Studies were excluded if there was no cancer-free comparator group or where analyses of risk factors were inadequately documented. After screening and reference list searching, data were extracted into standardised spreadsheets and quality assessed. Due to heterogeneity, a narrative synthesis was undertaken. Results 9916 hits were retrieved. 271 papers were retained: two BL, 24 HL, one GC and 244 NPC. The majority of studies were from China, North America and Western Europe. Risk factors were categorised as dietary, environmental/non-dietary, human genetic, and infection and clinical. Anti-EBV antibody load was associated with EBV-associated GC and BL. Although the evidence could be inconsistent, HLA-A alleles, smoking, infectious mononucleosis and potentially other infections were risk factors for EBV-associated HL. Rancid dairy products; anti-EBV antibody and EBV DNA load; history of chronic ear, nose and/or throat conditions; herbal medicine use; family history; and human genetics were risk factors for NPC. Fresh fruit and vegetable and tea consumption may be protective against NPC. Conclusions Many epidemiological studies of risk factors in addition to EBV for the EBV-associated forms of BL, GC, HL and NPC have been undertaken, but there is a dearth of evidence for GC and BL. Available evidence is of variable quality. The aetiology of EBV-associated cancers likely results from a complex intersection of genetic, clinical, environmental and dietary factors, which is difficult to assess with observational studies. Large, carefully designed, studies need to be strategically undertaken to harmonise and clarify the evidence. Registration PROSPERO CRD4201705980

Problem drug use the public health imperative: what some of the literature says

<p>Abstract</p> <p>Background</p> <p>With more than 200,000 problem drug users is contact with structured treatment services in England the public health imperative behind drug treatment is great. Problem drug use for many is a chronic and relapsing condition, where "cure" is often neither a reasonable or appropriate expectation and it can further be argued that in these circumstances problem drug use is no different from any number of chronic and enduring health conditions that are managed in the health care system and therefore should be conceptualised as such.</p> <p>Discussion</p> <p>A public health approach to drug treatment emphasises the need for drug users in or accessing treatment, to reduce their harmful drug use, reduce drug use related risks such as sepsis and overdose and stay alive for longer. However a public health perspective in relation to problem drug use isn't always either apparent or readily understood and to that end there is still a significant need to continue the arguments and debate that treatment and interventions for problem and dependent drug users need to extend beyond an individualistic approach. For the purposes of discussion in this article public and population health will be used interchangeably.</p> <p>Summary</p> <p>A recognition and acceptance that a public and population health approach to the management of problem drug users is sound public health policy also then requires a long term commitment in terms of staffing and resources where service delivery mirrors that of chronic condition management.</p

A STUDY OF ALTERATION IN COAGULATION PROFILE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction: Laparoscopic cholecystectomy has become the gold standard for the treatment of cholelithiasis. It has many advantages such as better cosmetic, shorter hospitalization time, minimal postoperative pain, early return to normal life. However carbon dioxide pneumoperitoneum may cause alteration in the coagulation system and moreover the reverse Trendelenburg position adopted diring surgery can induce blood stagnation in the lower limbs leading to a hypercoagulable state. The aim Objective: of the study was to record the effect of carbon dioxide pneumoperitoneum on coagulation factors and brinolysis response during laparoscopic cholecystectomy and to assess if there is any risk of postoperative thromboembolic complications following laparoscopic cholecystectomy. Methods: The hospital based descriptive study of 50 patients undergoing elective laparoscopic cholecystectomy was designed to study alteration in Clotting time, Prothrombin time(PT), Activated partial thrombin time(aPTT), Fibrinogen and D-dimer, which were measured preoperatively and 6 hour postoperatively. Out of 50 Results: patients operated 38 were female and 12 were male. Signicant decrease in PT and aPTT suggested activation of coagulation pathways while signicant increase in d-dimer and brinogen suggested activation of brinolytic systems. None of the patients had any postoperative thromboembolic complications. From the study we found that there was activati Discussions: on of coagulation and brinolysis after laparoscopic cholecystectomy leading to a hypercoagulable state which may be either due to carbon dioxide pneumoperitoneum or due to increased intraabdominal pressure. Although none of the patients had any thromboembolic complications postoperatively, however there may be the need to use prophylactic measures for thrombosis in high risk patients.</jats:p

Effect of Solvent on Antioxidant Activity of Zanthoxylum oxyphyllum Edgew and its DFT Study

Background: Free radicals can easily damage DNA, proteins and lipids within the tissue. Anti-oxidants from natural sources can diminish the actions of free radicals. The current study deals with the chemical composition and antioxidant activity of the leaves of Zanthoxylum oxyphyllum Edgew. Methods: The antioxidant activities for DPPH, FRAP, ABTS radicals, phosphomolybdate assay, reducing power, and chelating power assay were evaluated of ethanol (ET), methanol (ME), chloroform (CH), ethyl acetate (EA), and petroleum ether (PE) extracts of the leaves. The Density Functional Theory (DFT) study was carried out on major identified phytochemicals to evaluate bioactive molecules responsible for the antioxidant activity. Results: It was observed that the ME extract showed the most potent scavenging activity in DPPH, FRAP, ABTS radicals, phosphomolybdate assay, reducing power, and chelating power assay. The phenolic acids and flavonoids like quercetin, gallic acid, sinapic acid, etc. were identified. The DFT study was done for major phytochemicals of ME extract to evaluate the most responsible bioactive molecule for antioxidant activity. The Gallic acid exhibited the lowest bond dissociation energy (BDE) of 314.9 kcal/mol in gas, 309.2 kcal/mol in methanol, respectively, along with the highest value of radical stabilization energy (RSE), 29.5 kcal/mol. Conclusion: Gallic acid was found to be the most responsible antioxidant among the other compounds, and ME the best solvent system for extraction, followed by CH. </jats:sec