Advancing Tobacco Cessation in LMICs

Tobacco kills more than 8 million people worldwide every year. Over 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries (LMICs), where the future burden is projected to grow. At the same time, progress in tobacco control has not advanced as far as in many LMICs. In particular, the implementation of tobacco-cessation programs and interventions remains limited. The bulk of the evidence for tobacco-cessation interventions comes from high-income countries and may not reflect the context in LMICs, particularly as resources and training for tobacco cessation are limited. This paper summarizes the current evidence for tobacco-cessation interventions in LMICs and highlights some key challenges and research gaps. Overall, there is a need to build capacity for locally relevant research and implementation science to support tailored cessation interventions and strategies for LMICs.     

Hepatic cholesterol transporter ABCG8 polymorphisms in gallstone disease in an Indian population

Background and Aim: Gallstone formation is characterized by the abnormal regulation of cholesterol trafficking and solubilization. The prevalence of gallstone disease (GSD) differs between ethnic groups sharing the common environment. These differences can be explained by a genetic predisposition to gallstone formation. Studies have identified single nucleotide polymorphisms (SNP) D19H and T400K in the cholesterol transporter gene ATP‐binding cassette, subfamily G, member 8 (ABCG8) in patients with cholesterol gallstones. The aim of this study was to analyze the relationship between D19H and T400K polymorphisms in the ABCG8 gene and GSD in an Indian population, and the effects of these polymorphisms on cholesterol levels in sera and bile. Methods: A total of 226 patients with GSD were analyzed for their lipid profile in plasma and bile. A total of 289 controls were recruited, and their plasma lipid profile was analyzed by standard protocols. The genotype of SNP D19H and T400K of ABCG8 was analyzed in 226 patients and 222 control samples. SNP D19H was analyzed by direct sequencing, and SNP T400K genotyping was assayed by the amplification refractory mutation system–polymerase chain reaction. Results: There was no significant difference in the allelic distribution of SNP T400K between the GSD and gallstone‐free groups (P > 0.05), but the distribution of the SNP variant, D19H, was significantly higher (P = 0.017, odds ratio = 2.274) in patients compared to controls. The analysis of serum and bile cholesterol followed a strong association with genotypes. Conclusion: SNP D19H, but not SNP T400K, in the ABCG8 gene is significantly associated with GSD in an Indian population.     

Novel repair of an external iliac vein aneurysm

Aneurysms involving the venous system are a rare entity. We report the case of a 37-year-old woman who presented to us with activity-limiting left gluteal pain and who on consequent workup was found to have a left external iliac vein aneurysm in a setting of iliocavomegaly. She underwent successful treatment of her aneurysm with a novel approach that involved staple plication and resection of the aneurysm over a balloon mandrel. We discuss the presentation, diagnosis, and surgical technique adopted for the treatment of this uncommon condition.     

How does the robot affect outcomes? A retrospective review of open,laparoscopic, and robotic Heller myotomy for achalasia

Background  

Robotic techniques are routinely used in urological and gynecological procedures; however, their role in general surgical procedures is limited. A robotic technique has been successfully adopted for a minimally invasive Heller myotomy procedure for achalasia. This study aims to compare perioperative outcomes following open, laparoscopic, and robotic Heller myotomy.     

Soluble Intercellular Adhesion Molecule-1 and E-selectin in Patients with Asthma Exacerbation

Soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selectin (sE-selectin) are important factors in immunological processes of inflammatory cell buildup in target tissues. Studies have suggested that these molecules could be important markers of inflammatory diseases. This study was undertaken to assess the levels of sICAM-1 and sE-selectin during an acute attack of asthma in adults and children and to establish normal values (95th percentile) in healthy control subjects. We analyzed serum levels of ICAM-1 and E-selectin in 120 children and adults obtained during an acute attack of asthma: 40 with severe and 80 with moderately severe attack, and 50 healthy subjects as controls by ELISA (enzyme linked immunosorbent assay). sICAM-1 from patients with asthma was significantly higher than healthy controls (P < 0.001) but not for sE-selectin (P = 0.778). Significant differences were observed in moderately severe attack versus controls and severe attack of asthma for sICAM-1. With 95th percentile levels as cutoff for normal values (sICAM-1 = 585.08 ng/ml, sE-selectin = 160.87 ng/ml), it was observed that 88.3% of subjects (sICAM-1) and 98.5% of subjects (sE-selectin) with an acute attack of asthma had levels within the normal range. Although mean serum levels of sICAM-1 are higher in asthmatics than normal controls, it may be necessary to establish individual baseline values for serial estimation to evaluate their clinical relevance.     

Bisdemethylcurcumin and structurally related hispolon analogues of curcumin exhibit enhanced prooxidant, anti-proliferative and anti-inflammatory activities in vitro

Curcumin, a component of turmeric (Curcuma longa), exhibits anti-inflammatory and anti-proliferative activities through the generation of reactive oxygen species (ROS). Curcumin (diferuloylmethane) contains two hydroxyl, two methoxy and two phenyl groups but how these groups contribute to its activity is poorly understood. We synthesized analogues that varied in inclusion of these groups and compared their activity. We found that bisdemethylcurcumin (BDC) was more potent than curcumin as an anti-inflammatory agent as indicated by suppression of TNF-induced NF-κB activation, more potent as an anti-proliferative agent, and more potent in inducing ROS. Hispolon, which lacks one aromatic unit in relation to curcumin, also exhibited enhanced anti-inflammatory and anti-proliferative activities. When synthetic curcumin (Cur-S) was compared with bisdemethylcurcumin (BDC), hispolon, hispolon methyl ether (HME), dehydroxy hispolon (DH), hydroxy hispolon (HH), methoxy hispolon methyl ether (MHME), and methoxy hispolon (MH), we found that following order of anti-inflammatory activity: BDC = Hispolon > HME > HH > Cur-S > MHME > MH > DH; for anti-proliferative: Hispolon > BDC > MHME > Cur-S > MH > HME = HH > DH; and for prooxidant: BDC > Cur-S = MHME > HH > MH + HME > DH (254-1414 mean fluorescence intensity). Thus, dehydroxy hispolon was least potent for all three activities. Overall the results indicate that the substitution of a hydroxyl group for a methoxy group at the meta positions of the phenyl rings in curcumin significantly enhanced the anti-inflammatory activity, and the removal of phenyl ring at the 7^th position of the heptadiene back bone and addition of hydroxyl group significantly increased the anti-proliferative activity of curcumin.