Radiation proctitis with recurrent gastrointestinal bleeding complicated by cytomegalovirus

Cytomegalovirus (CMV) usually causes infections with mild symptoms in immunocompetent individuals. However, in immunocompromised patients, these infections can be serious or life-threatening. Following initial infection, CMV typically becomes dormant but remains lifelong in the host. Reactivation of the latent virus can occur in many organ systems, including the gastrointestinal (GI) tract. Radiation proctitis is a known risk factor associated with prostate radiation, with complicating ulceration and GI bleeding. We present the first case report of an immunocompetent 81-year-old male with multiple episodes of life-threatening GI bleeding, secondary to a non-healing CMV-positive rectal ulcer and CMV colitis following radiation for prostate cancer. Multiple insults including prostate radiation, repeated blood transfusions and CMV infection likely contributed to the recurrent bleeding episodes.

Superior vena cava syndrome presenting as chylothorax

Chylothorax caused by superior vena cava (SVC) syndrome is a rare but potentially life-threatening complication requiring a multidisciplinary diagnosis and management approach. We present a case of a 27-year-old female with end-stage renal disease who developed chylothorax secondary to SVC syndrome caused by venous stenosis from a tunneled hemodialysis (HD) catheter. The patient had a history of ongoing hemodialysis through a tunneled catheter placed in the right internal jugular vein approximately seven months before presentation. She presented with dyspnea, chest pain, and a large left-sided pleural effusion. A multidisciplinary diagnostic workup and management included 2 thoracentesis, pleural fluid studies, serial radiological tests, right and left heart catheterizations, and blood serum studies with flow cytometry. They revealed that SVC stenosis around the hemodialysis catheter was causing the patient's pathology. The patient underwent veno-plasty of the right SVC and brachiocephalic veins and replacement of HD catheter leading to the resolution of the chylothorax and significant improvement in respiratory symptoms. This report will highlight the approach to diagnosing and managing chylothorax and a review of existing medical literature.

Cytotoxicity of Metal-Based Photoactivated Chemotherapy (PACT) Compounds

Metal-based compounds have been used to treat cancer for decades, with cisplatin being the most common and widely used. Photodynamic therapy (PDT) is another clinical modality used to fight cancer, which uses a photosensitizer (PS) that localizes in cancer tissues. This PS is activated by the illumination of the tumor with visible light. Photoactivated chemotherapy (PACT) is a new concept that brings these two ideas together. Like PDT , PACT aims at sparing healthy tissues while maintaining toxicity against cancerous cells. Unlike PDT , which often stops working when the concentration of dioxygen in illuminated tissues is too low, light activation of PACT compounds remains efficient in hypoxic cancer cells. This chapter addresses the methodology to experimentally measure the phototoxicity of PACT compounds in cancer cell lines, under both normoxic and hypoxic conditions.

Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings

Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.

A Systematic Review Protocol of the Barriers to Both Physical Activity and Obesity Counselling in the Secondary Care Setting as Reported by Healthcare Providers

Physical activity and obesity counselling have both been gaining increasing interest in preventive health and treatment. However, most healthcare professionals do not provide advice on these topics nearly as often as they should. There are many reasons for this. Common barriers for the provision of brief advice on physical activity and obesity in both primary and secondary care are lack of time, motivation and knowledge. Systematic reviews have been published on the barriers of physical activity and obesity counselling in the primary care setting, but there is no published work on the barriers present in secondary care. This systematic review aims to assess all published data that discuss the barriers of physical activity and obesity counselling as noted by healthcare providers in secondary care. Four databases will be searched using the same search strategy, and the findings will be compiled using the COM-B model to explore the frequency of a reported barrier. This systematic review will be beneficial not only to practicing healthcare providers, but also the educational and managerial staff of secondary care facilities, as it may highlight the need for further training to fill gaps in the provision of preventive healthcare.

Photo-Uncaging of a Microtubule-Targeted Rigidin Analogue in Hypoxic Cancer Cells and in a Xenograft Mouse Model

Marine alkaloid rigidins are cytotoxic compounds known to kill cancer cells at nanomolar concentrations by targeting the microtubule network. Here, a rigidin analogue containing a thioether group was "caged" by coordination of its thioether group to a photosensitive ruthenium complex. In the dark, the coordinated ruthenium fragment prevented the rigidin analogue from inhibiting tubulin polymerization and reduced its toxicity in 2D cancer cell line monolayers, 3D lung cancer tumor spheroids (A549), and a lung cancer tumor xenograft (A549) in nude mice. Photochemical activation of the prodrug upon green light irradiation led to the photosubstitution of the thioether ligand by water, thereby releasing the free rigidin analogue capable of inhibiting the polymerization of tubulin. In cancer cells, such photorelease was accompanied by a drastic reduction of cell growth, not only when the cells were grown in normoxia (21% O₂) but also remarkably in hypoxic conditions (1% O₂). In vivo, low toxicity was observed at a dose of 1 mg·kg^-1 when the compound was injected intraperitoneally, and light activation of the compound in the tumor led to 30% tumor volume reduction, which represents the first demonstration of the safety and efficacy of ruthenium-based photoactivated chemotherapy compounds in a tumor xenograft.