Genomic analysis of clonal eosinophils by CGH arrays reveals new genetic regions involved in chronic eosinophilia

To assess the presence of genetic imbalances in patients with myeloproliferative neoplasms (MPNs), 38 patients with chronic eosinophilia were studied by array comparative genomic hybridization (aCGH): seven had chronic myelogenous leukaemia (CML), BCR‐ABL1 positive, nine patients had myeloproliferative neoplasia Ph? (MPN‐Ph?), three had a myeloid neoplasm associated with a PDGFRA rearrangement, and the remaining two cases were Lymphoproliferative T neoplasms associated with eosinophilia. In addition, 17 patients had a secondary eosinophilia and were used as controls. Eosinophilic enrichment was carried out in all cases. Genomic imbalances were found in 76% of all MPN patients. Losses on 20q were the most frequent genetic abnormality in MPNs (32%), affected the three types of MPN studied. This study also found losses at 11q13.3 in 26% of patients with MPN‐Ph? and in 19p13.11 in two of the three patients with an MPN associated with a PDGFRA rearrangement. In addition, 29% of patients with CML had losses on 8q24. In summary, aCGH revealed clonality in eosinophils in most MPNs, suggesting that it could be a useful technique for defining clonality in these diseases. The presence of genetic losses in new regions could provide new insights into the knowledge of these MPN associated with eosinophilia.     

Zinc Sulfate for Relief of Pruritus in Patients on Maintenance Hemodialysis

Pruritus is a common complaint in patients undergoing maintenance hemodialysis. The pathophysiology of pruritus in these patients is not well known, but the role of histamine release from mast cells has been reported. According to the inhibitory effects of zinc on histamine release and reported low levels of serum zinc in hemodialysis patients, we aimed to evaluate the effects of zinc sulfate for the relief of pruritus in these patients. This double‐blind, randomized, placebo‐controlled trial was conducted on 40 adults with end stage renal disease (ESRD) who were on maintenance hemodialysis in two university hospitals in Isfahan, Iran. Patients were randomized to receive either zinc sulfate (440 mg/day) or placebo for two consecutive months. Pruritus was assessed at baseline and then every two weeks using a numerical rating scale from 0 to 10 until one month after treatment. Drug side effects were also assessed along with pruritus. There were 40 patients with a mean age of 55.5 ± 15.2 (72.5% male) who completed the study. The two groups were similar in baseline characteristics. Pruritus was decreased in both groups after treatment but there was a significantly greater decrease in the zinc sulfate group compared with placebo (P = 0.018). Patient compliance was good and no severe side effects were observed. Zinc sulfate (440 mg/day) is more effective than placebo for the relief of pruritus in patients under maintenance hemodialysis. Further studies with larger sample size, longer treatment duration and follow‐up and with various dosages of zinc sulfate are recommended.     

Developing an Interactive Web-Based Learning Program on Skin Cancer: the Learning Experiences of Clinical Educators

Web-based learning in medical education is rapidly growing. However, there are few firsthand accounts on the rationale for and development of web-based learning programs. We present the experience of clinical educators who developed an interactive online skin cancer detection and management course in a time-efficient and cost-efficient manner without any prior skills in computer programming or technical construction of web-based learning programs. We review the current state of web-based learning including its general advantages and disadvantages as well as its specific utility in dermatology. We then detail our experience in developing an interactive online skin cancer curriculum for primary care clinicians. Finally, we describe the main challenges faced and lessons learned during the process. This report may serve medical educators who possess minimal computer programming and web design skills but want to employ the many strengths of web-based learning without the huge costs associated with hiring a professional development team.     

Synthesis, calcium-channel blocking activity, and conformational analysis of some novel 1,4-dihydropyridines: application of PM3 and DFT computational methods

Novel 1,4-dihydropyridines were synthesized and subjected to calcium-channel blocking evaluation and conformational analysis using semi-empirical (PM3) and density functional theory (DFT) as computational methods. All molecules had a boat-like 1,4-dihydropyridine ring in both the methods. In PM3 method almost 54% of the molecules were deviated from planarity, but in DFT method all the molecules had perfect flattened-boat conformation. Using both the methods, the C-4 substituent was pseudoaxial with its phenylamino substitution in sp orientation in 82.14% of the molecules. Trans–trans and cis–cis conformation had the greatest and lowest proportion in the molecules, respectively. Trans–trans conformers which possessed sp conformation for the substituted group on the imidazole ring were active calcium-channel blocking agents.     

Adenocarcinoma in an ano-vaginal fistula in Crohn's disease

INTRODUCTIONFistulas are a relatively common occurrence in Crohn's disease (CD), and often present early in the disease process. Additionally, patients suffering from either CD or ulcerative colitis are shown to have an increased risk of colorectal malignancies compared with the general population.PRESENTATION OF CASEWe present a case of adenocarcinoma in an ano-vaginal fistula in a patient with longstanding CD.DISCUSSIONVarious pathogenic mechanisms for the development of carcinoma in fistulas have been suggested, but there is no consensus and indeed this risk may be cumulative. In this case report, we also discuss the pathogenesis of mucinous adenocarcinoma in fistulas secondary to CD.CONCLUSIONBetter detection of adenocarcinoma in patients presenting with persistent non-resolving fistulas in the presence of CD should be undertaken with regular biopsies following examinations under anaesthetic of the anorectum.     

Diagnostic du cancer du sein après 74 ans : information donnée par les structures de gestion du dépistage organisé à la sortie de la tranche d’âge concernée

BackgroundBreast cancer among older women is a major and increasing public health issue. No clear recommendation has been established in France after 74 years, the age limit for state-organised screening program. A survey was performed among all regional agencies in charge of the breast screening to analyse which information is delivered to women reaching the age of 75 years.MethodsA postal survey sent to 91 French organised cancer screening agencies.ResultsAmong the 89 agencies that answered, only 22 deliver a systematic written information. Twelve suggest that mammographic screening should be continued, and five mention clinical examination. Twenty agencies dispatch the screening to general practitionners or gynaecologists. Two information letters insist on the ongoing risk of breast cancer. Most of the written information is given with the last mammography report. No impact study has ever been performed.ConclusionIn our study, only 25% of the screening agencies give systematic information to women. The modalities and the substance of this information are heterogeneous. A better information seems to be a key-point for earlier clinical breast cancer diagnosis among older women, for whom there is little direct evidence of the benefit of systematic mammographic screening.