CT imaging and staging of carcinoma oesophagus

Background: Over the past decades, computerized tomography (CT) technology has led to an early detection of cancers and thereby decreasing mortality rate. The objective was to demonstrate usefulness of Toshiba Activion 16 slice multi detector computerized tomography (MDCT) scan in staging of oesophageal cancer.Methods: The study was carried out in the Department of Radio diagnosis, Bapuji Hospital and Chigateri Government Hospital attached to Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India over a period of 24 months. After taking a properly informed written consent, complete history and thorough clinical examination was done and these patients were subjected to CT scan.Results: The total numbers of patients studied in present study were 25. Out of which 10 were males and 15 were females. There were 6 patients upto the age of 54 years and 8 patients equal to or greater than 65 years of age, there were 11 patients between 55-64 years of age. Dysphagia was the most common symptom in patients and was present in all the 25 patients of present study. Other common symptoms were weight loss followed by pain in throat. Two different types of wall thickenings of the involved portion have been reported. The most common asymmetrical wall thickening was observed in maximum number of patients 18 (72%) and circumferential wall thickening was observed only in 7 number (28%) of patients out of 25 total patients showing heterogeneous/homogeneous enhancement. Lower third (40%) and middle third (40%) of the esophagus was the most common site of involvement with regards to location of oesophageal cancer followed by upper third (20%) of the esophagus. Homogeneous wall attenuation was observed in most of the cases accounting for (64%). The other type of wall attenuation noted were heterogeneous (36%).Conclusions: By performing endoscopy uncertainty lies in discrimination of muscular layer from serosal layer in most parts of esophagus. However, by employing MDCT technique separation of 2 layers of esophagus can be better judged.  Therefore, MDCT has been found to be the most valuable and preferential technique for planning operational strategy

Radiographic imaging of metabolic bone disorders and their relative management

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging to keep proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: Serum alkaline phosphatase is a good marker in rickets and osteomalacia, ICTP in osteoporosis, pyridinoline, deoxypyridinoline in primary hyperparathyroidism, serum PICP in renal osteodystrophy.Conclusions: In cases of rickets and osteomalacia either decreased or normal values of serum calcium and serum phosphorus were obtained. But the cases pertaining to renal failure with rickets values of serum phosphorous were found to be raised. However, in all cases of rickets and osteomalacia values of serum alkaline phosphatase were also found to be raised

Radiographic imaging of metabolic bone disorders in consonance with biochemical parameters

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging keeping proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: With regards to fracture relating to different skeletal structures frequency was more in vertebra (38%), the maximum to be reported in 38 cases followed by hip fractures (17%) in 17 cases. Pelvis fractures were reported as (11%) in 11 cases and tibia fractures were reported to be only (7%) in meagre population of 7 cases, while remaining skeletal organs had (27%) fractures with subject to realisation in other 27 cases.Conclusions: In all the osteoporotic cases irrespective to age of patients, values of serum calcium, serum alkaline phosphatase, serum phosphorus, serum potassium, serum sodium, serum calcidiol were within normal limits

Diminishing Effectiveness of Long-Term Maintenance Topical Steroid Therapy in PPI Non-Responsive Eosinophilic Esophagitis

While topical corticosteroids are first-line therapy for eosinophilic esophagitis (EoE), the data regarding long-term effectiveness are lacking. We aimed to determine long-term histologic and endoscopic outcomes of maintenance therapy in EoE steroid responders

Regular breakfast consumption and type 2 diabetes risk markers in 9- to 10-year-old children in the child heart and health study in England (CHASE): a cross-sectional analysis.

BACKGROUND: Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children. METHODS AND FINDINGS: We conducted a cross-sectional study of 4,116 UK primary school children aged 9-10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%-37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%-37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%-2.0%), glucose (percent difference 1.0%, 95% CI 0.0%-2.0%), and urate (percent difference 6%, 95% CI 3%-10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity <0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers. CONCLUSIONS: Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk. Please see later in the article for the Editors' Summary

Population dynamics of a pathogen: the conundrum of vivax malaria

Building a mathematical model of population dynamics of pathogens within their host involves considerations of factors similar to those in ecology, as pathogens can prey on cells in the host. But within the multicellular host, attacked cell types are integrated with other cellular systems, which in turn intervene in the infection. For example, immune responses attempt to sense and then eliminate or contain pathogens, and homeostatic mechanisms try to compensate for cell loss. This review focuses on modeling applied to malarias, diseases caused by single-cell eukaryote parasites that infect red blood cells, with special concern given to vivax malaria, a disease often thought to be benign (if sometimes incapacitating) because the parasite only attacks a small proportion of red blood cells, the very youngest ones. However, I will use mathematical modeling to argue that depletion of this pool of red blood cells can be disastrous to the host if growth of the parasite is not vigorously check by host immune responses. Also, modeling can elucidate aspects of new field observations that indicate that vivax malaria is more dangerous than previously thought

Plasmodium vivax lineages: geographical distribution, tandem repeat polymorphism, and phylogenetic relationship

<p>Abstract</p> <p>Background</p> <p>Multi-drug resistance and severe/complicated cases are the emerging phenotypes of vivax malaria, which may deteriorate current anti-malarial control measures. The emergence of these phenotypes could be associated with either of the two <it>Plasmodium vivax </it>lineages. The two lineages had been categorized as Old World and New World, based on geographical sub-division and genetic and phenotypical markers. This study revisited the lineage hypothesis of <it>P. vivax </it>by typing the distribution of lineages among global isolates and evaluated their genetic relatedness using a panel of new mini-satellite markers.</p> <p>Methods</p> <p><it>18S SSU rRNA S-type </it>gene was amplified from 420 <it>Plasmodium vivax </it>field isolates collected from different geographical regions of India, Thailand and Colombia as well as four strains each of <it>P. vivax </it>originating from Nicaragua, Panama, Thailand (Pak Chang), and Vietnam (ONG). A mini-satellite marker panel was then developed to understand the population genetic parameters and tested on a sample subset of both lineages.</p> <p>Results</p> <p><it>18S SSU rRNA S-type </it>gene typing revealed the distribution of both lineages (Old World and New World) in all geographical regions. However, distribution of <it>Plasmodium vivax </it>lineages was highly variable in every geographical region. The lack of geographical sub-division between lineages suggests that both lineages are globally distributed. Ten mini-satellites were scanned from the <it>P. vivax </it>genome sequence; these tandem repeats were located in eight of the chromosomes. Mini-satellites revealed substantial allelic diversity (7-21, <it>AE </it>= 14.6 ± 2.0) and heterozygosity (<it>He </it>= 0.697-0.924, <it>AE </it>= 0.857 ± 0.033) per locus. Mini-satellite comparison between the two lineages revealed high but similar pattern of genetic diversity, allele frequency, and high degree of allele sharing. A Neighbour-Joining phylogenetic tree derived from genetic distance data obtained from ten mini-satellites also placed both lineages together in every cluster.</p> <p>Conclusions</p> <p>The global lineage distribution, lack of genetic distance, similar pattern of genetic diversity, and allele sharing strongly suggested that both lineages are a single species and thus new emerging phenotypes associated with vivax malaria could not be clearly classified as belonging to a particular lineage on basis of their geographical origin.</p

A Descriptive Study of Colorectal Cancer in Hiwa Cancer Hospital, Sulaymaniyah, Iraq

Colorectal cancer is the third most common cancer and the fourth leading cause of death from cancer worldwide. This study provides an overview of changes in sociod-demographic parameters in patients with colorectal cancer (henceforth CRC) disease in a local cancer hospital in Sulaymaniyah province of Kurdistan region of Iraq. The study included 113 patients admitted to Hiwa Cancer Hospital, Sulaymaniyah from January 2014 to December 2015. The data collection lasted for 3 weeks (from 19/12/2015 to 11/01/2016) and was obtained from the management department of Hiwa Cancer Hospital. Several socio-demographic parameters including age, gender, and smoking, as well as biochemical parameters such as liver function, renal function and blood glucose level were studied and statistically analyzed. Results have shown that the majority of CRC patients were neither current smoker nor x-smoker (P-value < 0.05). Males suffered from CRC at an earlier age compared to females (P-value < 0.05). Regarding the biochemical tests, there was no significant correlation between CRC and impaired liver function during the diagnosis process and most of the study patients had a normal liver function test on presentation. In contrast, the correlation between CRC and impaired renal function on presentation was statistically siginificant (P-value < 0.05). No significant difference was noted in the means of hematological and biochemical parameters between males and females, except for white blood cells and serum Aspartate Aminotransferase. White blood cells and total serum bilirubin showed significant differences (P-value < 0.05) between smoker and nonsmoker sub-populations. It was concluded that CRC is one of the common cancers in Sulaymaniyah province. Males develop it at an earlier age compared to females, and the impaired renal function is a significant finding on presentation

Transmural Inflammation, Ileitis, and Granulomas at the Time of Proctocolectomy in Patients with Ulcerative Colitis Do Not Predict Future Development of Pouchitis

Background: The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis. Our study aimed to investigate the relationship between histopathologic findings of ileitis, granuloma, or transmural inflammation on the colectomy specimen of patients with clinically and endoscopically diagnosed UC and the development of pouchitis within the first 2 years after IPAA. Methods: We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. Bivariate analyses were conducted to evaluate the relationship between clinical factors and the development of pouchitis. We performed multivariate logistic regression to evaluate the relationship between histologic, clinical, and demographic factors at the time of colectomy and subsequent development of pouchitis. Results: Among 626 patients, pouchitis occurred in 246 (39%). Patients with primary sclerosing cholangitis were more likely to develop pouchitis (adjusted odds ratio [aOR] 2.81, 95% confidence interval [CI] 1.02-7.72), as were patients with a family history of inflammatory bowel disease (aOR 1.75, 95% CI 1.11-2.77). Histologic findings of ileitis, granuloma, or transmural inflammation were not associated with an increased odds of developing pouchitis (aOR 0.70, 95% CI 0.45-1.08). Discussion/Conclusion: Patients with ileitis, granulomas, or transmural inflammation at the time of colectomy were not at greater risk for development of pouchitis in the 2 years after IPAA. These pathological findings should not preclude IPAA for UC