Micronucleus frequencies in lymphocytes and buccal epithelial cells from patients having head and neck cancer and their first-degree relatives

Head and neck squamous cell carcinoma is the fifth most common cancer type worldwide. Even though it is known that the most important environmental aetiological factors for head and neck cancer (HNC) development are tobacco and alcohol, genetic susceptibility is also thought to be important. The use of biomarkers of chromosomal damage due to genetic instability in order to predict risk of cancer as well as to identify high-risk individuals is imperative. We have investigated genetic damage in patients having HNC (n = 59) and their first-degree relatives (FDRs) (n = 34) with a biomarker in two different tissues; the micronucleus (MN) test in peripheral blood lymphocytes and in exfoliated buccal cells. The mean (standard deviation) levels of MN frequencies (‰) in lymphocytes of patients, relatives and controls were 27.10 (9.52), 14.09 (5.13) and 9.00 (6.87), respectively. The mean (standard deviation) levels of MN frequencies (‰) in exfoliated buccal cells of patients, relatives and controls were 2.87 (1.16), 1.38 (0.85) and 1.23 (0.93), respectively. Our results indicated that spontaneous genetic damage in lymphocytes of patients having HNC was significantly higher than that of controls (P < 0.01) and thus genetic instability appeared to exist in lymphocytes of cancer patients. Similar findings were obtained for exfoliated buccal cell MN frequencies of cancer patients (P < 0.01). We observed that the FDRs of patients having HNC showed significantly higher chromosomal damage in terms of MN frequencies in lymphocytes when compared with those of controls (P < 0.05), thus reflecting an increased susceptibility to HNC in FDRs. However, for buccal cell MN frequencies, we could not demonstrate enhanced genetic instability in the FDRs of patients having HNC.     

Antipyretic effect of ketoprofen

Objective  The aim of this study was to investigate the efficacy and side effect profile of ketoprofen as well as compliance with respect to the taste of the drug and compare these parameters with those of acetaminophen and ibuprofen. Methods  A total of 301 patients between 1–14 years of age who applied to emergency rooms of three medical centers with the complaint of fever that required antipyretic therapy were included in the study. Fever was measured with the aid of a tympanic thermometer (Braun Kronberg 6014) and followed for 4–6 hours. The measurement was repeated at 30, 60, 120 minutes, and again 4–6 hours after the initial assessment. Results  The mean age of the patients was 47.8±41.1 months. The patients randomly received 15 mg/kg/dose of acetaminophen (n=112 group 1), 0.5 mg/kg/dose of ketoprofen (n=105, group 2), or 10 mg/kg/dose of ibuprofen (n=84, group 3). Fever was 38.4±0.7°C, 38.4±0.7°C, and 38.5±0.5°C at 30 minutes; 38.0±0.7°C, 37.9±0.7°C, and 38.0±0.6°C at 60 minutes (p>0.05), 37.7±0.6°C, 37.6±0.7°C, and 37.7±0.5°C at 120 minutes (p>0.05); 37.5±0.7°C, 37.3±0.6°C, and 37.4±0.6°C at 4–6 hours after admission (p>0.05). The fever was significantly lower at 30, 60, and 120 minutes in all group s (p<0.05). Early vomiting after medication (<6 hours) was observed in 3.8%, 13.5%, and 9.6% whereas late vomiting (6–48 hours) occurred in 1.3%, 2.7%, and 5.8% respectively (p>0.05). Bad taste was expressed by 5.1%, 12.2%, and 5.8% early (<6 hours), and 3.9%, 8.1%, and 3.8% late (6–48 hours) (p>0.05). There were no differences between age groups for antipyretic effect, taste and adverse effect in three drugs (p>0.05). Conclusion  All three drugs were similar in terms of efficacy, adverse effects, and compliance within 48 hours of therapy. These results suggest that ketoprofen may be used for antipyresis as an alternative to acetaminophen and ibuprofen.     

Giant cell reparative granuloma of the sphenoid bone

We present 2 patients with giant cell reparative granuloma (GCRG) of the sphenoid bone. The first patient is an 8-year-old boy with involvement of the greater wing, and the second is a 53- year-old man with a lateral pterygoid plate mass. Both patients presented with rapid expansion of lytic bone lesions, which had solid and cystic components and lacked matrix calcification. Biopsies were indeterminate for definitive diagnoses. The radiologic appearance, location, and incidence of the lesions, and the patient's age and medical history are helpful aids in narrowing the differential diagnosis of sphenoid bone lesions. However, the imaging and, occasionally, even the histologic findings may not suggest the specific diagnosis of GCRG, which must be added into the differential diagnosis of rapidly enlarging cystic bone lesions of the sphenoid bone.     

A Closer Look at the Recurrent Laryngeal Nerve Focusing on Branches & Diameters: A Prospective Cohort Study

Aim: We aimed to investigate the anatomical characteristics of the recurrent laryngeal nerve (RLN) highlighting on its diameter and branching pattern. Materials and Methods: We prospectively collected 215 patients (178 female, 37 male) who underwent thyroid/parathyroid surgery during over a 2-year period. Apart from demographic features and surgical data, diameter of RLNs, and their branches and as well as branching distance (distance between the point of bifurcation and the laryngeal entry of RLN) were recorded. Results: In 215 patients, 378 RLNs were assessed and 42% (n = 159) bifurcated RLNs were observed. The bifurcation rate was similar on the right and left side(s) of the neck (40% and 44%, respectively; p = 0.47). In those, who underwent bilateral exploration, in the case of bifurcation on the first side of the neck, the possibility of contralateral bifurcation was approximately 50%, whereas this rate was found to be only 30% in those with nonbranching RLNs. Mean branching distance was 18 ± 9 mm, and it was similar on the right and left sides (17 and 19 mm, respectively). Approximately 80% of bifurcations were observed within 5–24 mm of the RLN. Mean diameter of the anterior branches was found to be significantly larger compared to posterior branches (1.09 ± 0.35 and 0.82 ± 0.36 mm, respectively; p < 0.01).Conclusions: There is great variability in RLN branching. We observed that approximately two out of three bifurcations were unilateral and anterior branches were thicker compared to posterior branches. These findings should be taken into consideration to avoid any damage to the RLN during thyroid and parathyroid surgery.     

Short-term effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain

Background In this study the effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain in the postoperative period was evaluated. Methods Between April 2004 and February 2006 we planned to perform 179 laparoscopic cholecystectomies. One hundred of these patients were included in this study. Patients were divided into two groups: group 1 with gallbladder perforation during the operation and group 2 without perforation. Two groups were compared regarding age, gender, comorbidities, mean hospital stay, respiratory function tests, and postoperative pain scores. Results Gallbladder perforation occurred in 33 patients (33%). The male-to-female ratio of group I was 5/28. In group 2 the male-to-female ratio was 12/55. Age and perforation had a significant correlation according to Spearman’s correlation test (p < 0.05, r = 0.211). Regarding respiratory function tests and arterial blood gases analysis, there was a significant decrease in both groups postoperatively but perforation had no effect on them. No statistically significant difference occurred regarding mean hospital stay and postoperative visual pain scores (p > 0.05). Conclusion Gallbladder perforation during laparoscopic cholecystectomy had no effect on postoperative respiratory mechanics and depth of pain. This paper was presented in the 10th World Congress of Endoscopic Surgery, 13–16 September 2006, Berlin, Germany.     

Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries

Design.?Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP). Setting.?Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey. Patients.?NICU inpatients. Methods.?VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology. Results.?During phase 1, we recorded 3,153 mechanical ventilation (MV)-days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50-0.91]; [Formula: see text]), indicating a 33% reduction in VAP rate. Conclusions.?Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.     

TMEM231 Gene Conversion Associated with Joubert and Meckel–Gruber Syndromes in the Same Family

Joubert and Meckel–Gruber syndromes (JS and MGS) are ciliopathies with overlapping features. JS patients manifest the “molar tooth sign” on brain imaging and variable eye, kidney, and liver disease. MGS presents with polycystic kidneys, occipital encephalocele, and polydactyly; it is typically perinatally fatal. Both syndromes are genetically heterogeneous; some genes cause either syndrome. Here, we report two brothers married to unrelated women. The first brother had three daughters with JS and a son with polycystic kidneys who died at birth. The second brother's wife had a fetal demise due to MGS. Whole exome sequencing identified TMEM231 NM_001077416.2: c.784G>A; p.(Asp262Asn) in all children and the wife of the first brother; the second brother's wife had a c.406T>G;p.(Trp136Gly) change. In‐depth analysis uncovered a rare gene conversion event in TMEM231, leading to loss of exon 4, in all the affected children of first brother. We believe that the combination of this gene conversion with different missense mutations led to a spectrum of phenotypes that span JS and MGS.     

Hydroxyurea Therapy for Children With Sickle Cell Anemia in Sub‐Saharan Africa: Rationale and Design of the REACH Trial

Background

Sickle cell anemia (SCA) is an inherited hematological disorder that causes a large but neglected global health burden, particularly in Africa. Hydroxyurea represents the only available disease‐modifying therapy for SCA, and has proven safety and efficacy in high‐resource countries. In sub‐Saharan Africa, there is minimal use of hydroxyurea, due to lack of data, absence of evidence‐based guidelines, and inexperience among healthcare providers.

Procedure

A partnership was established between investigators in North America and sub‐Saharan Africa, to develop a prospective multicenter research protocol designed to provide data on the safety, feasibility, and benefits of hydroxyurea for children with SCA.

Results

The Realizing Effectiveness Across Continents with Hydroxyurea (REACH, ClinicalTrials.gov NCT01966731) trial is a prospective, phase I/II open‐label dose escalation study of hydroxyurea that will treat a total of 600 children age 1–10 years with SCA: 150 at each of four different clinical sites within sub‐Saharan Africa (Angola, Democratic Republic of Congo, Kenya, and Uganda). The primary study endpoint will be severe hematological toxicities that occur during the fixed‐dose treatment phase. REACH has an adaptive statistical design that allows for careful assessment of toxicities to accurately identify a safe hydroxyurea dose.

Conclusions

REACH will provide data that address critical gaps in knowledge for the treatment of SCA in sub‐Saharan Africa. By developing local expertise with the use of hydroxyurea and helping to establish treatment guidelines, the REACH trial results will have the potential to transform care for children with SCA in Africa. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.