Liver cancer: contributory factors, diagnosis and treatment

Liver cancer have high mortality secondary to hepatitis B,hepatitis C and secondary to alcohol.Hepatocellular carcinoma (HCC),most common form of liver cancer with highest rates in China and in Sub-Saharan Africa. Approximately 75% of all primary liver cancer is HCC (also named hepatoma). Cholangiocarcinoma can form within liver as the bile duct.Liver fluke infection increases the risk of cholangiocarcinoma in Thailand.Tumor of blood vessels-angiosarcoma.Cancers produced from muscles in the liver are leiomyosarcoma.Many cancers in the liver are due to metastasis. Contributory factors of liver cancer includes: viral infection either with hepatitis C (HCV) or hepatitis B (HBV). Viruses cause HCC because massive inflammation, fibrosis and eventual cirrhosis within the liver. Aflatoxin exposure can lead to the development of HCC. High grade dysplastic nodules are precancerous lesions of the liver. Beckwith-Weidemann syndrome is associated with hepatoblastoma in children. Liver cancer is associated with abdominal mass, abdominal pain, emesis, anemia, back pain, jaundice, itching, weight loss and fever. Diagnosis mainly by ultrasound, CT, MRI, and magnetic resonance cholangiopancreatography (MRCP). Tests for tumor markers are helpful. Treatment by surgery, antiviral drugs and liver transplant. Prevention by reducing exposure to risk factor for liver cancer, vaccination against hepatitis B virus, reducing alcohol abuse,prevention of carcinogenesis and treatment to prevent recurrence of liver cancer, by the chemotherapy drugs and antiviral drugs.With the advances in diagnosis and treatment the prognosis in liver cancer remains poor

Prevalence of obesity in patients suffering from migraine

Background: Migraine is one of the most common primary headaches, accounting for significant morbidity in patients suffering from it. An association between obesity and migraine has been documented in the past, despite some studies pointing to the contrary. Author’s purpose is to calculate the prevalence of obesity in migraine patients in order to contribute to the existing concepts. A positive correlation could lead to the employment of weight loss interventions in the management of obese patients with migraine.Methods: In this cross-sectional study, 400 patients, recently diagnosed with migraine, attending the Neurology Outpatient Department at the Dr. Ruth KM Pfau Civil Hospital Karachi were enrolled after taking informed consent.  Migraine was diagnosed using International Classification of Headache Disorders III (ICHD III) criteria. Height (meters) and weight (kilograms) were measured and body mass index calculated. This data was kept confidential. The results were tabulated and analyzed using SPSS version 19.  Continuous quantitative data were analyzed using chi square test. A p Value of less than or equal to 0.05 was considered significant.Results: The mean age of enrolled participants was 30.69±6.96 years, 204(51%) were >30 years of age, 159(39.8%) were male and 241(60.3%) were female, mean height was 1.55±0.1 meters, mean weight was 56.26±12.98 kg, and mean duration of migraine was 5.04±2.02 weeks. The prevalence of obesity in patients with migraine was 108 (27%).Conclusions: It was concluded that the prevalence of obesity in patients with migraine was 27%

Invasiveness of endometrial cancer cell lines is potentiated by estradiol and blocked by a traditional medicine Guizhi Fuling at clinically relevant doses

The Traditional Chinese medicine, Guizhi Fuling (here called Fuling), has been confirmed in meta-analysis studies to reduce recurrence of endometriosis and improve pregnancy outcomes; however, the possible use of Fuling as a fertility-preserving treatment in endometrial cancer has not previously been tested. Results here are the first to demonstrate dose-dependent inhibition of cell motility by Fuling in two endometrial cancer cell lines, classified as Grade I which is responsive to progesterone treatment, and Grade III (MFE-280) which is resistant. The major outcome of this study was the novel demonstration that Fuling (30-80 µg/ml) significantly inhibits invasiveness in both high and low grades of EC cells, achieving 70-80% block of trans-barrier migration without cytotoxicity. This effective dose range is estimated to be comparable to that used in human clinical trials and traditional practice. Results here further show that clinically relevant doses of Fuling override the motility-promoting effects of estradiol in endometrial cancer cell lines. Medroxyprogesterone acetate has to date been the standard therapy to treat metastatic or inoperable endometrial cancers; however, success rates are low with high rates of recurrence, due in part to acquired resistance to medroxyprogesterone acetate therapy. The discovery here that Fuling appears to control the spread of treatment-resistant advanced cancers is an exciting prospect

Exposure of Ophthalmology Residents to Cornea and Keratorefractive Surgeries in the United States

Purpose: To describe the cornea and keratorefractive surgeries experience of U.S. ophthalmology residents. Methods: Deidentified case logs of residents graduating in 2018 were collected from ophthalmology residency program directors in the United States. Using Current Procedure Terminology codes, case logs were reviewed in the categories of cornea and keratorefractive surgeries. Accreditation Council for Graduate Medical Education national graduating resident surgical case logs on cornea procedures published from 2010 to 2020 were also analyzed. Results: Case logs were received for 152/488 (31.1%) residents from 36/115 (31.3%) ophthalmology residency programs. The most common procedures logged by residents as primary surgeons were pterygium removal (4.3 ± 4.2) and keratorefractive surgeries (3.6 ± 6.2). Residents logged an average of 2.4 keratoplasties as primary surgeon, performing an average of 1.4 penetrating keratoplasties (PKs) and 0.8 endothelial keratoplasties (EKs). As assistants, the most common procedures logged were keratorefractive surgeries (6.1 ± 4.9), EKs (3.8 ± 3.3), and PKs (3.5 ± 2.3). Medium or large residency class size was associated with higher cornea procedural volumes (odds ratio: 8.9; 95% confidence interval: 1.1–75.6; p  Conclusion: The most common cornea surgeries performed by residents include keratoplasty, keratorefractive, and pterygium procedures. Larger program size was associated with greater relative cornea surgery volume. More specific guidelines for logging of procedures could provide a more accurate assessment of resident exposure to critical techniques such as suturing as well as reflect trends in current practice such as the overall increase in EKs.</p

Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery

BACKGROUND: Although bariatric surgery is the most effective treatment for obesity and weight-related comorbid diseases, utilization rates are disproportionately low among non-white patients. We sought to understand if variation in baseline characteristics or access to care exists between white and non-white patients. METHODS: Using a statewide bariatric-specific data registry, we evaluated all patients who underwent bariatric surgery between 2006 and 2020 and completed a preoperative baseline questionnaire, which included a question about self-identification of race. Patient characteristics, co-morbidities, and time from initial preoperative clinic evaluation to date of surgery were compared among racial groups. RESULTS: A total of 73,141 patients met inclusion criteria with 18,741 (25.5%) self-identified as non-white. These included Black/African American (n = 11,904), Hispanic (n = 3448), Asian (n = 121), Native Hawaiian/Pacific Islander (n = 41), Middle Eastern (n = 164), Multiple (n = 2047) and other (n = 608). Non-white males were the least represented group, accounting for only 4% of all bariatric cases performed. Non-white patients were more likely to be younger (43.0 years vs. 46.6 years, p \u3c 0.0001), disabled (16% vs. 11.4%, p \u3c 0.0001) and have Medicaid (8.4% vs. 3.8%, p \u3c 0.0001) when compared to white patients, despite having higher rates of college education (78.0% vs. 76.6, p \u3c 0.0001). In addition, median time from initial evaluation to surgery was also longer among non-white patients (157 days vs. 127 days, p \u3c 0.0001), despite having higher rates of patients with a body mass index above 50 kg/m(2) (39.0% vs. 33.2%, p \u3c 0.0001). CONCLUSIONS: Non-white patients undergoing bariatric surgery represent an extremely diverse group of patients with more socioeconomic disadvantages and longer wait times when compared to white patients despite presenting with higher rates of severe obesity. Current guidelines and referral patterns for bariatric surgery may not be equitable and need further examination when considering the management of obesity within diverse populations to reduce disparities in care-of which non-white males are particularly at risk

Pesticides contaminated dust exposure, risk diagnosis and exposure markers in occupational and residential settings of Lahore, Pakistan

There are few studies documenting the dust loaded with pesticides as a potential non-dietary exposure source for occupational worker and populations living near agricultural farms and pesticides formulation plants. In present study we have evaluated the pesticide concentration in dust from potential sites and relevant health risk from dust ingestion. Furthermore, the effect of currently used pesticides was investigated on blood and urine parameters of subjects: farmer, factory worker, urban resident and rural resident and controlled subjects with presumably different levels of exposure. The urinary metabolites (TCPY and IMPY) were quantified as biomarkers of exposure to chlorpyrifos and diazinon in relation with biomarkers of effect including BuChE, LH, FSH, testosterone and oxidative stress. Results showed that chlorpyrifos and diazinon were present in higher concentration in dust and posed a high health risk to exposed subjects. The mean SOD value was high among the farmer (3048 U/g Hb) followed by factory worker (1677.6U/g Hb). The urinary biomarkers – TCPY and IMPY- were found higher in exposed subjects as compared to control. Furthermore, testosterone was found in higher concentration in factory worker than control (12.63 ng/ml vs 4.61 ng/ml respectively). A decreased BuChE activity was noticed in occupational group and significant differences were observed in control verses exposed subjects. The PCA analysis evidenced the impact of pesticides on exposure biomarkers and male reproductive hormones. The study suggests that dust contaminated with pesticides engenders significant health risk particularly related to the nervous and endocrine system, not only for occupational workers exposed to direct ingestion but also for nearby residential community. Succinctly putting: Pesticides loaded dust in the city of Lahore, being a high priority concern for the government of Pakistan, demands to be addressed

Mental Health Antecedents of Early Midlife Insomnia: Evidence from a Four-Decade Longitudinal Study

Insomnia is a highly prevalent condition that constitutes a major public health and economic burden. However, little is known about the developmental etiology of adulthood insomnia

Pilot Study to Assess the Effectiveness of the Sustainable Culturally adaptive Nutrition Program (Scan) to Improve adherence to the National Diabetes Prevention Program

PURPOSE: The Sustainable Culturally Adapted Nutrition Program (SCAN) is a novel adaptation to the National Diabetes Prevention Program (NDPP) that aims to improve attendance and effectiveness. This paper presents its feasibility and impact through the initial 6-month outcomes. DESIGN: A pragmatic quasi-experimental pilot study with intervention (DPP plus SCAN) and control (DPP only) groups. SAMPLES AND INCLUSION CRITERIA: Sustainable Culturally Adapted Nutrition Program participants were recruited from federally qualified health center (FQHC) clinic patients enrolled in a NDPP in Houston, Texas. Participants needed to be (1) ≥18 years old, (2) body mass index \u3e25, (3) no prior diagnosis of diabetes, and (4) not pregnant. INTERVENTION: Sustainable Culturally Adapted Nutrition Program cooking classes were designed to teach skills to prepare fresh produce, and utilized Motivational Interviewing (MI) techniques to encourage participants to adapt these skills for foods that were culturally important to them. OUTCOME MEASURES: (1) National Diabetes Prevention Program attendance, (2) BMI and (3) percent weight loss. ANALYSIS: We used linear mixed models to test the association between weights and NDPP attendance. RESULTS: 22 intervention and 15 control participants completed the program to the 6-month point. Intervention participants had increased DPP attendance over controls (7.14 vs 6.87 session). Intervention participants also demonstrated on average, 1.5% weight loss for each additional SCAN class attended ( CONCLUSIONS: The SCAN adaptation shows promising results for effectively increasing both NDPP attendance and weight loss