Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P 0.0001), Non-Hispanic Whites(P 0.0001), and those with a primary care physician(P 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.     

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

Aim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature.

Methods: Retrospective chart review.

Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed.

Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.     

Hybrid PABA-glutamic acid conjugated 1,3,5-triazine derivatives: Design,synthesis, and antimalarial activity screening targeting Plasmodium falciparum dihydro folate reductase enzyme

Despite the successful reduction in the malaria health burden in recent years, it continues to remain a significant global health problem mainly because of the emerging resistance to first-line treatments. Also because of the disruption in malaria prevention services during the COVID-19 pandemic, there was an increase in malaria cases in 2021 compared to 2020. Hence, the present study outlined the in silico study, synthesis, and antimalarial evaluation of 1,3,5-triazine hybrids conjugated with PABA-glutamic acid. Docking study revealed higher binding energy compared to the originally bound ligand WR99210, predominant hydrogen bond interaction, and involvement of key amino acid residues, like Arg122, Ser120, and Arg59. Fourteen compounds were synthesized using traditional and microwave synthesis. The in vitro antimalarial evaluation against chloroquine-sensitive 3D7 and resistant Dd2 strain of Plasmodium falciparum showed a high to moderate activity range. Compounds C1 and B4 showed high efficacy against both strains and a further study revealed that compound C1 is non-cytotoxic against the HEK293 cell line with no acute oral toxicity. In vivo, study was performed for the most potent antimalarial compound C1 to optimize the research work and found to be effectively suppressing parasitemia of Plasmodium berghei strain in the Swiss albino mice model.     

Genetic risk for Huntington Disease and reproductive decision-making: A systematic review

Huntington Disease (HD) is an incurable autosomal dominant single gene neurodegenerative disorder. Typical onset is between 30 and 40 years and characterised by motor difficulties, cognitive impairment, and behavioural and personality changes. The availability of reproductive testing means that affected and at-risk individuals can make reproductive decisions with genetic risk in mind. We aimed to summarise the literature on reproductive decision-making in the context of HD risk in terms of outcomes and the subjective experiences of at-risk individuals. Five databases were searched. Findings were synthesised using Framework analysis to identify common factors across results of quantitative and qualitative studies. Twenty five studies met inclusion criteria. Framework analysis identified the following key areas: ‘The relationship between reproductive intentions and HD genetic risk’, ‘Views on assistive options’, ‘Complexity and challenges in reproductive decision-making’, ‘Actual reproductive outcomes’, and ‘Other factors influencing reproductive decision-making’. Quality of included studies was mixed. Reproductive decision making in the context of HD risk was found to be a complex and emotionally challenging process. Further research is required into reproductive decision-making and outcomes among those not utilising assistive options, and in developing a model of reproductive decision-making in HD.     

Abnormal expression of various molecular forms and distribution of T cell receptor ζ chain in patients with systemic lupus erythematosus

Objective

T cells from the majority of patients with systemic lupus erythematosus (SLE) display antigen receptor‐mediated signaling aberrations associated with defective T cell receptor (TCR) ζ chain expression. The TCR ζ chain, a critical signaling molecule, exists in multiple molecular forms and membrane fractions with distinct functions in antigen‐mediated signaling processes. This study was undertaken to investigate the complete spectrum of expression of the different forms and distribution of the TCR ζ chain in SLE T cells.

Methods

T cells were isolated from 48 SLE patients and 21 healthy subjects. The expression of various forms of the TCR ζ chain was investigated by immunoblotting with specific antibodies. The lipid raft‐associated form of the ζ chain was determined by quantitating the solubilized ζ chain after disruption of the lipid rafts by cholesterol depletion using methyl‐β‐cyclodextrin. The distribution of the ζ chain was investigated by fluorescence microscopy.

Results

The phosphorylated 21‐ and 23‐kd forms and the detergent‐insoluble membrane‐associated form of the TCR ζ chain and alternatively spliced ζ chain were significantly decreased in SLE T cells. In contrast, major ubiquitinated forms of the ζ chain were increased in these cells. We also identified up‐regulation of a novel 14‐kd form of the ζ chain in SLE T cells. Resting SLE T cell membranes had an increased percentage of the residual membrane‐bound ζ chain in the lipid rafts. Fluorescence microscopy findings indicated that the residual ζ chain is more clustered on the cell membranes of SLE T cells.

Conclusion

These results suggest that, in addition to the 16‐kd form, expression of other molecular forms and fractions of the TCR ζ chain as well as its membrane distribution are abnormal in SLE T cells. Increased lipid raft association and surface clustering of the ζ chain may explain the molecular mechanisms underlying the signaling abnormalities in these cells.

     

What is the accuracy of transvaginal ultrasound for endometriosis mapping prior to surgery when performed by a sonographer within an outpatient women's imaging centre?

Introduction

This study aimed to assess the accuracy of transvaginal ultrasound (TVUS) for the mapping of endometriosis before surgery when performed by sonographers in an outpatient women's imaging centre.

Methods

A prospective longitudinal cohort study was performed. The study group comprised of 201 women who underwent a comprehensive TVUS assessment, performed by a sonographer. Laparoscopy was performed as the reference standard. Complete TVUS and surgical data were available for 53 women who were included in the final analysis.

Results

Endometriosis was confirmed at a surgery in 50/53 (94.3%) participants, with 25/53 (47.2%) having deep endometriosis (DE) nodules and/or endometriomas present. TVUS for mapping of DE had an overall sensitivity of 84.0%, specificity of 89.3%, PPV of 87.5%, NPV of 86.2%, LR+ of 7.85, LR− of 0.18, and accuracy of 86.8% (P < 0.001). Ovarian immobility had poor sensitivity for detecting localised superficial endometriosis, DE, adhesions, and/or endometriomas (Left = 61.9% and right = 13.3%) but high specificities (left = 87.5% and right = 94.7%). Site-specific tenderness had low sensitivities and moderate specificities for the same. All soft markers of endometriosis failed to reach statistical significance except for left ovarian immobility (P = <0.001).

Conclusion

Sonographers well experienced in obstetric and gynaecological imaging, working in an outpatient women's imaging setting can accurately map DE; however, the performance of soft markers for detection of SE was poor.