Endoluminal Ultrasonography versus Computed Tomography for Locoregional Staging of Carcinoma Stomach

Curative surgery remains the mainstay treatment of carcinoma stomach till to date. Preoperative accurate diagnosis of the depth of tumour invasion (T) and nodal involvement (N) in stomach cancer is important in determining the choice of an optimal therapeutic approach. Endoluminal ultrasonography (EUS) is considered as most reliable tools for assessing locoregional staging as it can overcome bones and air barrier on the other hand computed tomography (CT) has increased its' efficacy greatly after introduction of extreme multi-detector and phase-contrast CT. The objective of this study was to compare the accuracy of T and N staging with EUS and CT by comparing with postoperative histopathology in stomach carcinoma. This cross-sectional observational study was conducted in the department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2019 to July 2020. Forty five (45) patients who underwent curative stomach resection surgery due to carcinoma of stomach were enrolled in this study. All patients were investigated by EUS and CT preoperatively to assess locoregional staging. Then patients underwent stomach resection surgery and specimen sent for histopathology. EUS had sensitivity 80.0% to predict T staging but specificity 60.0% and the overall accuracy was 68.89%. CT result showed sensitivity 59.38% to predict T staging but specificity 46.15%, and the overall accuracy was 55.56%. EUS had 65.63% sensitivity to predict nodal involvement but specificity 61.54% and the overall accuracy was 64.44%. CT had 83.33% sensitivity to predict nodal involvement but specificity 55.56% and the overall accuracy was 77.78%. EUS is more accurate than CT in T staging but CT is more accurate than EUS in the N staging of carcinoma stomach. So EUS and CT both should be used as a diagnostic tool for preoperative locoregional staging of carcinoma stomach.

Knowledge of heat waves and practice of protective measures against it in a rural West African

Background

Heat wave has a direct linkage to global climate change and is associated with increased morbidity and mortality. Between March and May 2019, Nigeria experienced severe heat waves. Understanding heat waves provides an opportunity for individuals to proactively take measures to prevent its negative health impacts. However, illiteracy levels in rural Sub-Saharan Africa are higher than in urban areas.This study was therefore conducted to assess knowledge of heat waves and practice of protective measures against it in an affected rural community of Nigeria.

Methods

A cross-sectional, community based descriptive study conducted among household heads in Nasarawan Buhari, a rural agrarian community in Nigeria. An interviewer-administered questionnaire was used to collect data from 104 household heads, selected using systematic random sampling technique. Data was analyzed using SPSS (version 20).

Results

A majority of the respondents were males (79.8%) and most of them (89.4%) had poor knowledge of heat waves. Farming occupation was significantly associated with knowledge of heat waves (P = 0.025). Awareness of measures needed to protect against the negative health impacts of heat waves was also poor. Hence fluid intake and cold showers were the only protective measures used by majority of respondents to reduce effect of the extreme heat.

Conclusions

Both knowledge of heat waves and practice of protective measures against it were poor among respondents. A health education intervention on heat waves and how to prevent its negative health impacts was conducted in the community.

Key messages

Due to poor knowledge of heat waves and its negative health effects, practice of protective measures against it was poor among respondents. There is need for more public health response to address this rural public health challenge.

Illness perceptions and quality of life among tuberculosis patients in Gezira, Sudan

AIMS

This study aimed to answer the following research question: What is the level of illness perceptions and quality of life among TB patients in Gezira state?.

METHODS

A descriptive study design was used. Newly diagnosed smear positive TB patients registered in Gezira state in 2010 (n=425) formed the study population. The illness perceptions were measured by using Brief Illness Perceptions Questionnaire (BIPQ). Health Related Quality of Life (HRQoL) was assessed by means of the 12-item short form Health Survey questionnaire (FS-12).

RESULTS

TB patients saw TB as having minor consequences, TB not being very well controlled by treatment, and TB as lasting long as a disease; they also associated several symptoms with TB. Furthermore, the patients had relatively poor physical and mental quality of life. Identity, consequences, personal control and emotional representations were associated with poor physical quality of life while concern about illness was associated with poor mental quality of life.

CONCLUSION

The illness perceptions of the TB patients might influence their adherence to treatment. The poor quality of life of the TB patients in the different areas of quality of life such as daily activities and work, calls for programmes to strengthen TB information, education and counselling.

Clinicopathologic features and long-term outcomes of NUT midline carcinoma

PURPOSE

NUT midline carcinoma (NMC) is a poorly differentiated squamous cancer characterized by rearrangement of the NUT gene. Research advances have provided opportunities for targeted therapy in NMC, yet the clinical features of this rare disease have not been systematically characterized. We report on a large population of such patients to identify the disease characteristics and treatments, correlate them with outcome, and to consider clinical recommendations.

EXPERIMENTAL DESIGN

A clinical database was established using retrospective demographic and outcomes data available on all known cases of NMC. Questionnaires were completed by treating physicians. Pathologic, demographic, and clinical variables were assessed for 63 patients, the largest cohort of patients with NMC studied to date. Outcome data from 54 patients were available for survival analyses.

RESULTS

The diagnosis of NMC has increased annually since 2007. Since 2009, there has been an observed increase in the age at diagnosis (P < 0.05). Geographic distribution of patients with NMC has been concentrated in the United States (n = 41, 65%). The median overall survival for patients with NMC was 6.7 months. The 2-year progression-free survival (PFS) was 9% with a 95% confidence interval (CI) of 1% to 17% [1-year PFS 15% (5-24%) and 2-year overall survival (OS) was 19% with a 95% CI of 7%-31% (1-year OS: 30% (27-34%)]. Multivariate analysis suggested that extent of surgical resection and initial radiotherapy were independent predictors of PFS and OS. Notably, no chemotherapeutic regimen was associated with improved outcome.

CONCLUSIONS

NMC portends a poor prognosis among all squamous cell neoplasms and seems to be frequently unrecognized. The finding that conventional chemotherapy has been inadequate indicates a pressing need for the development of targeted therapeutics. Intensive local therapies such as gross total resection and radiotherapy might be associated with enhanced survival.

Biosynthetic studies on the collagenous components of basement membranes

The biosynthesis of the collagenous components of the rat lens capsule and glomerular basement membrane (GBM) has been investigated. Intact lenses, isolated lens capsules and isolated renal glomeruli incorporate [3H]proline into 4-hydroxy[3H]proline containing polypeptides of approximate molecular weight 180,000 (analysed under reducing conditions). These polypeptides are deposited in the deoxycholate-insoluble basement membrane matrix and correspond to subunits of the intact, non-radioactive basement membranes. With time a proportion of the newly synthesised collagenous polypeptides become assembled into high molecular weight aggregates which are stabilized by lysine- and/or hydroxylysine-derived cross-links. Despite the similar patterns of collagen biosynthesis in the rat lens capsule and GMB, the latter has a more complex polypeptide composition the origin of which remains uncertain.