Pyoderma gangrenosum or leukaemia cutis?

We report a case of atypical bullous pyoderma gangrenosum associated with acute myeloid leukaemia in which we found atypical myeloid cells within the skin lesion. Although there have been many reported cases of leukaemia-associated pyoderma gangrenosum, the finding of myeloblasts in the skin has rarely been described.     

Expected Gain in Body Mass and Onset of the Menarche

Fertility is dependent on sexual maturity, which is associated with a number of factors, including body mass. In this study the Body Mass Index (BMI) was used to estimate body fat in a large sample of 13-year-old New Zealand girls. Nearly half of the subjects (46%) had experienced the menarche. Expected gain in body mass was calculated from growth rates at earlier ages and used to examine whether deviation from the expected gain was associated with the onset of the menarche. In general, the results show an association between the menarche and gain in body mass. However, many girls who failed to achieve their expected gain had experienced the menarche (18%), indicating that the relationship between body weight and the menarche may not be causal or is mediated by other factors.     

Improvement method for cervical cancer detection: A comparative analysis

Cervical cancer is a prevalent and deadly cancer that affects women all over the world. It affects about 0.5 million women anually and results in over 0.3 million fatalities. Diagnosis of this cancer was previously done manually, which could result in false positives or negatives. The researchers are still contemplating how to detect cervical cancer automatically and how to evaluate Pap smear images. Hence, this paper has reviewed several detection methods from the previous researches that has been done before. This paper reviews pre-processing, detection method framework for nucleus detection, and analysis performance of the method selected. There are four methods based on a reviewed technique from previous studies that have been running through the experimental procedure using Matlab, and the dataset used is established Herlev Dataset. The results show that the highest performance assessment metric values obtain from Method 1: Thresholding and Trace region boundaries in a binary image with the values of precision 1.0, sensitivity 98.77%, specificity 98.76%, accuracy 98.77% and PSNR 25.74% for a single type of cell. Meanwhile, the average values of precision were 0.99, sensitivity 90.71%, specificity 96.55%, accuracy 92.91% and PSNR 16.22%. The experimental results are then compared to the existing methods from previous studies. They show that the improvement method is able to detect the nucleus of the cell with higher performance assessment values. On the other hand, the majority of current approaches can be used with either a single or a large number of cervical cancer smear images. This study might persuade other researchers to recognize the value of some of the existing detection techniques and offer a strong approach for developing and implementing new solutions.     

The clinical spectrum of postpartum thyroid disease

The clinical and biochemical features of postpartum thyroid disease were analysed in 152 antithyroid peroxidase antibody-positive (anti TPO+ve) women and compared with 239 anti-TPO-ve age-matched control postpartum women. All were assessed monthly for up to 12 months postpartum. Seventy three anti-TPO+ve women developed post-partum thyroiditis (PPT): 19.2% hyperthyroid alone, 49.3% hypothyroid alone, and 31.5% characterized by hyper- followed by hypothyroidism. None of the antibody-negative women developed any thyroid dysfunction. A significant increase in many of eleven symptoms of hypothyroidism and some of eight symptoms of hyperthyroidism compared to control women was observed in all anti-TPO+ve women, independent of thyroid status. This was particularly seen in women who later developed PPT when they were euthyroid, but was also observed in euthyroid anti-TPO+ve women who showed no decline of thyroid function during the postpartum period. Although PPT is usually transient, this condition, and the euthyroid antibody-positive state, may be associated with significant symptomatology, including an increased incidence of minor to moderate depression. Early recognition of this syndrome by antenatal screening of thyroid antibodies may contribute to improved management of women during the postpartum period.      

Genome-wide association study provides evidence for a breast cancer risk locus at 6q22.33

We performed a three-phase genome-wide association study (GWAS) using cases and controls from a genetically isolated population, Ashkenazi Jews (AJ), to identify loci associated with breast cancer risk. In the first phase, we compared allele frequencies of 150,080 SNPs in 249 high-risk, BRCA1/2 mutation-negative AJ familial cases and 299 cancer-free AJ controls using chi(2) and the Cochran-Armitage trend tests. In the second phase, we genotyped 343 SNPs from 123 regions most significantly associated from stage 1, including 4 SNPs from the FGFR2 region, in 950 consecutive AJ breast cancer cases and 979 age-matched AJ controls. We replicated major associations in a third independent set of 243 AJ cases and 187 controls. We obtained a significant allele P value of association with AJ breast cancer in the FGFR2 region (P = 1.5 x 10(-5), odds ratio (OR) 1.26, 95% confidence interval (CI) 1.13-1.40 at rs1078806 for all phases combined). In addition, we found a risk locus in a region of chromosome 6q22.33 (P = 2.9 x 10(-8), OR 1.41, 95% CI 1.25-1.59 at rs2180341). Using several SNPs at each implicated locus, we were able to verify associations and impute haplotypes. The major haplotype at the 6q22.33 locus conferred protection from disease, whereas the minor haplotype conferred risk. Candidate genes in the 6q22.33 region include ECHDC1, which encodes a protein involved in mitochondrial fatty acid oxidation, and also RNF146, which encodes a ubiquitin protein ligase, both known pathways in breast cancer pathogenesis.     

Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

Background

Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands.

Methods

We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective.

Results

The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values.

Conclusion

Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands.