Histological markers that predict clinical recurrence in ductal carcinoma in situ of the breast: an Australian population-based study

AIMS: The incidence of ductal carcinoma in situ (DCIS) has increased substantially since the advent of widespread screening mammography. Identification of histological markers that predict recurrent disease is essential for optimal treatment management. To assist the clinico-pathological stratification of DCIS, we sought to determine histological markers of recurrence in DCIS in an Australian population-based series. METHODS: In a study of all DCIS reported in Victoria between 1988 and 1992, managed by breast conserving therapy (wide local excision or subtotal mastectomy) with or without adjuvant radiotherapy and/or hormonal therapy, the histological features of DCIS lesions with subsequent ipsilateral recurrence as in situ or invasive breast cancer were compared with a similarly managed control group of DCIS without recurrence. RESULTS: Large lesion size, presence of nuclear pleomorphism, absence of cellular polarisation and extensive necrosis were all significant predictors of recurrence (P<0.05). Primary and recurrent DCIS lesions had similar morphological features, and invasive recurrence was characterised by ductal type with high nuclear grade. CONCLUSION: This study identifies histological markers in DCIS associated with recurrence in an Australian population, and demonstrates similar histological appearances between primary and secondary lesions. These histological characteristics may be used to stratify DCIS subtypes and facilitate the future optimisation of disease management.     

Effect of leaf extracts of Vernonia amygdalina on glucose utilization in chang-liver,C2C12 muscle and 3T3-L1 cells

Diabetes mellitus is a chronic disease which affects millions of people worldwide. The prevalence of this disease is increasing annually and the number of diabetics is projected to rise above 300 million before 2025. The growing number of diabetics, coupled with the harsh side effects of some synthetic drugs has led to the increasing search for more natural products of plant origin. Vernonia amygdalina Del. (Asteraceae) is one of the plants commonly used for the treatment of diabetes in Africa. This study evaluated the effect of leaf extracts of this plant on glucose utilization in 3T3-L1, C₂C₁₂ muscle, and Chang-liver cells. Treatment of the cells with the acetone, methanol, water, and n-hexane/isopropanol extracts of V. amygdalina leaves significantly increased glucose utilization in the C₂C₁₂ muscle and Chang-liver cells but showed no effect on the 3T3-L1 cells. The water and n-hexane/isopropanol extracts were the most active in the C₂C₁₂ cells with a response of 78.3 and 95.6% above the control, respectively, while in the Chang-liver cells, water and acetone extracts had a response of 65.8 and 59.6% above the control, respectively. The results, especially of the water extract, strongly corroborate the ethnomedical uses of V. amygdalina as an antidiabetic plant.     

Plant species used in the treatment of diabetes by South African traditional healers: An inventory

The indigenous people of southern Africa have a long history of traditional plant usage for medicinal purposes, with about 4,000 taxa being so employed. Traditional medicines continue to play a significant role in the treatment of life-threatening diseases such as malaria, tuberculosis, diabetes and AIDS in the developing world, although no adequate scientific evidence has been documented in support of their healing properties. The primary goal of this paper is to summarize information on some of the plant species used by traditional healers for the treatment of diabetes in South Africa. The information obtained is from published literature as well as personal communication with various traditional healers and herbalists from different areas. In total, the information of 32 plant species, representing 20 families, traditionally used by healers in the treatment of diabetes, has been discussed, of which 14 are currently being investigated for their hypoglycemic activity by various scientists at the University of Pretoria.     

Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in johannesburg, South Africa

BACKGROUND: A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood. METHODS: A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow-up for at least 6 weeks were identified and further studied, and causes for treatment default were tabulated. RESULTS: Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Death accounted for 48% (n = 83) of those traced. Characteristics associated with death were older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of whom 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up. CONCLUSIONS: Nearly 1 in 6 patients receiving ART in a resource-constrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes.