Current and forthcoming perspectives in linkage to care of hepatitis C virus infection: Assessment of an Italian focus group

Hepatitis C virus (HCV) remains a significant public health problem and is one of the major causes of chronic liver disease worldwide. In recent years many new tools to facilitate widespread HCV screening and new therapeutic options with excellent efficacy and tolerability profiles and cost lowering policies have become available. To fully utilise these new tools, the link between local and specialist centres for the management of HCV infection must be reinforced. In order to GAIN further insight into these aspects, with a particular focus on the Italian scenario, a group of experts met to discuss relevant aspects and open issues on chronic HCV. As a summary of that meeting, the following aspects are here overviewed: (i) global situation of HCV; (ii) screening, diagnosis and indications for the treatment of HCV; (iii) the Italian situation of HCV referrals; (iv) ‘hard to reach’ patients; (v) treatment of HCV with extrahepatic manifestations; (vi) treatment of patients with advanced cirrhosis. It is the intention of the expert panel to further promote widespread screening and eradication policies that should be accompanied by greater interaction, by attempting to involve all healthcare providers in an organised process to facilitate linkage to care of patients with HCV infections.     

Mitochondria,its DNA and telomeres in ageing and human population

In the last decades, studies about ageing have become more essential as our population grows older. The incidence of age-related diseases increases, which pose challenges both for societies and individuals in terms of life quality and economic impact. Understanding ageing and ageing-related processes will help us to slow down or even prevent these diseases and provide opportunities for healthy ageing; additionally, we all want to live longer. Ageing is a consequence of the interaction between processes that occur over time and genetics interacting with various disease states and an individual’s lifestyle. There are several hallmarks of ageing that are generally accepted, but neither of the theories appears to be fully satisfactory. The focus of this article is on two theories of ageing: telomere shortening and mitochondrial DNA (mtDNA) alterations and dysfunction. We discuss characteristic molecular features such as mitochondrial haplogroups, telomere length, mtDNA copy number and heteroplasmy, and how all these traits come together in the ageing population. The recent evidence shows the existence of a strong linkage between these two theories suggesting common molecular mechanisms and a complicated telomere-mitochondria interplay during the humans’ ageing. However, this relationship is still not completely understood, which is why it needs more attention.     

Venous spread of renal cell carcinoma: MDCT

BACKGROUND: The purpose of our study was to present multidetector computed tomography (MDCT) findings in venous spread of renal cell carcinoma (RCC), to determine the superior extent of tumor thrombus and to compare MDCT findings with surgical report. METHODS: The prospective MDCT study was performed on 31 patients diagnosed with RCC with venous spread (19 males and 12 females; age range 39-80 years; mean age 62.6 years). CT scans were obtained by MDCT scanner, in triphasic scanning protocol. All postprocessing techniques were performed by two independent radiologists, and the findings were reported in their consensus. MDCT diagnosis was compared with surgical and pathohistological findings. RESULTS: Tumor thrombus extension into renal vein only (T3b stage) was found in 13/31 (42%) patients. Involvement of infradiaphragmatic level of inferior vena cava (IVC) (T3c stage) was found in 14/31 (45%) patients and supradiaphragmatic level of IVC (T4b stage) in 4/31 (13%) patients. In 27/31 (87%) patients surgery was performed, while 4/31 (13%) could not undergo surgery. In comparison with surgical report, in 25/27 (93%) operated patients the upper extent of the tumor thrombus was correctly diagnosed by MDCT, and 2/27 (7%) patients were falsely diagnosed. CONCLUSION: MDCT represents a fast, relatively inexpensive, and reliable diagnostic method for evaluating the venous spread of RCC as well as the level of its upper extent. Triphasic MDCT is often the only diagnostic method necessary for planning the surgical procedure. Surgery should be performed as soon as possible for MDCT findings to be valid.     

Y‐Chromosomal Lineages of Latvians in the Context of the Genetic Variation of the Eastern‐Baltic Region

Variations of the nonrecombining Y‐chromosomal region were investigated in 159 unrelated Baltic‐speaking ethnic Latvians from four different geographic regions, using 28 biallelic markers and 12 short tandem repeats. Eleven different haplogroups (hgs) were detected in a regionally homogeneous Latvian population, among which N1c, R1a, and I1 cover more than 85% of its paternal lineages. When compared its closest geographic neighbors, the composition of the Latvian Y‐chromosomal gene pool was found to be very similar to those of Lithuanians and Estonians. Despite the comparable frequency distribution of hg N1c in Latvians and Lithuanians with the Finno‐Ugric‐speaking populations from the Eastern coast of the Baltic Sea, the observed differences in allelic variances of N1c haplotypes between these two groups are in concordance with the previously stated hypothesis of different dispersal ways of this lineage in the region. More than a third of Latvian paternal lineages belong specifically to a recently defined R1a‐M558 hg, indicating an influence from a common source within Eastern Slavic populations on the formation of the present‐day Latvian Y‐chromosome gene pool.     

Kimura’s disease

A 12 year old child developed primary unilateral cervical mass. Routine investigations were inconclusive except cosinophibilia. Excision biopsy revealed the diagonisis as Kimura’s Disease. Retrospective investigations confirmed it. This disease should be suspected when a patient presents with tetrad of painless unilateral cervical lymphodenopathy. Eosinophilia, Hyperimmunoglobulimemia (††/gE) & Positive Candida Specific Antibodies. A flow chart has been drawn to treat this condition after review of literature.     

Observations on the ganglionic and neuromuscular blocking action of calcium in the guinea-pig isolated ileum

Calcium chloride acting from the serosal surface depressed or abolished the peristaltic reflex of the guinea-pig isolated ileum. Acetylcholine, methacholine, eserine, neostigmine or eledoisin acting from the serosal surface antagonized the peristaltic block, but nicotine, dimethylphenylpiperazinium, 5-hydroxytryptamine, histamine, pilocarpine, arecoline, angiotensin or bradykinin applied serosally did not. Graded concentrations of calcium chloride decreased the maximal contraction induced in the longitudinal muscle by acetylcholine, 5-hydroxytryptamine, histamine or nicotine and shifted the dose-response curves to the right. 5-Hydroxytryptamine and nicotine were about twice as sensitive to the blocking action of calcium chloride than acetylcholine or histamine. It is suggested that calcium chloride blocked the peristaltic reflex of the guinea-pig isolated ileum by an action on cholinoceptive sites in the myenteric ganglia and at the nerve-muscle junction in the longitudinal muscle. However, the anti-acetylcholine action of calcium chloride is not specific and is probably due partly to “stabilizaon” of the excitable membranes.     

The effect of nifedipine and verapamil on the pendular movements of the rabbit isolated ileum

The inhibitory effect of calcium antagonists such as nifedipine and verapamil on the pendular movements of the rabbit isolated ileum was investigated. Nifedipine and verapamil depressed or abolished the pendular movements. The inhibitory effects of nifedipine and verapamil were concentration-dependent. Nifedipine is about 1000 times more potent than verapamil. Calcium ions failed to reverse the inhibitory effects of nifedipine and verapamil. Calcium antagonists which influence the motor activity of the digestive tract, therefore, could have therapeutic use independent of their action on the cardiovascular system.     

Which questionnaires should we use to evaluate quality of life in patients with chronic graft-vs-host disease?

AimTo investigate the ability of two standard quality of life (QOL) questionnaires – The Short Form (36-item) Health Survey (SF-36) and The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ C30) to evaluate QOL in patients with chronic graft-vs-host disease (cGVHD) graded according to National Institutes of Health (NIH) consensus criteria.MethodsIn this cross-sectional study, QOL was assessed in patients who underwent allogeneic stem cell transplantation (allo-SCT) at the University Hospital Centre Zagreb and were alive and in complete remission for more than one year after allo-SCT.ResultsThe study included 58 patients, 38 patients with cGVHD and 20 controls, patients without cGVHD. Patients with cGVHD scored according to the NIH criteria had significantly lower scores of global health status and lower QOL on all SF-36 subscales and most of QLQ C30 functional subscales (P < 0.050 for all comparisons). Furthermore, patients with active cGVHD had significantly lower QOL scores than patients with inactive cGVHD, and this difference was most evident in physical functioning subscale of SF-36 (P = 0.0007) and social functioning subscale of QLQ C30 (P = 0.009).ConclusioncGVHD scored according to the NIH criteria is correlated with patient-reported QOL, particularly in the physical domains as detected by SF-36. QLQ C30 questionnaire adds more information on social functioning and should be used as a valuable tool in the evaluation of social domains in cGVHD patients.Although it is potentially lifesaving for a variety of hematological malignant and non-malignant disorders, allogeneic stem cell transplantation (allo-SCT) carries a significant risk of acute and late post-transplant complications. Improvements in transplantation techniques and supportive care have resulted in a reduction of early transplant-related mortality (1,2). However, the burden of late complications remains high, and two thirds of long-term allo-SCT survivors experience at least one chronic health condition (3). These complications occur due to treatment exposures before and during allo-SCT, cause substantial mortality, and severely impair patients’ functional status and quality of life (QOL). This is why today the aim of the treatment is not just to cure the primary hematological disease, but to facilitate the recovery of the physical and emotional functioning and improve QOL and social reintegration in family and work environment.Health-related QOL is now considered to be one of the relevant treatment outcomes because it provides a broader understanding of the patient’s status beyond simple disease-free survival. It is a multi-dimensional construct comprised of several related domains including physical, emotional, social, and role functioning, as well as a person''s overall evaluation of his or her well-being and ability to function (4,5). Better understanding of QOL in long-term survivors is necessary to provide adapted pre-transplant counseling and recommendations for post-transplant follow-up.With a cumulative incidence of 40%-70% and significant mortality, chronic GVHD (cGVHD) represents the most important late complication following allo-SCT (6,7). Moreover, it seems that the incidence of cGVHD in the recent years has been increasing, probably due to the fact that much older patients undergo allo-SCT, as well as due to the increased use of peripheral blood stem cell grafts and matched unrelated donors, all known risk factors for cGVHD (8). In a series of publications originating from 2005 National Institutes of Health (NIH) Consensus Conference, investigators proposed means to standardize diagnosis, scoring, histopathology, biomarkers, response assessment, and research in cGVHD (9-14). These criteria were developed to advance clinical trials and consequently improve the management of cGVHD and long-term survivorship after allo-SCT.As one of the important treatment outcomes, QOL is increasingly being subjected to the same degree of rigorous study as other significant allo-SCT outcomes. Most of the studies so far have reported a negative, significant association between cGVHD and QOL after allo-SCT (15-20). However, some of the studies have found no association (21-25), and this relationship still needs to be elucidated. The awareness of the relationship between QOL and cGVHD is necessary to further facilitate the prevention and treatment of cGVHD.The aim of this study was to examine the effect of cGVHD on QOL in our cohort of long-term allo-SCT survivors with the use of two standard QOL questionnaires; The Short Form (36-item) Health Survey (SF-36) and The EORTC Quality of Life Questionnaire (QLQ C30). Furthermore, we assessed QOL according to cGVHD severity and activity defined by the NIH consensus criteria.     

Eye care habits of dentists registered in the United Kingdom

Objective To determine the current eyecare behaviour of dentists and compare this against published standards concerning frequency of sight test intervals and eye protection.Design Postal questionnaire.Subjects and methods Four hundred dentists were selected at random for inclusion in the study from the UK 2004 Dentists Register. They were invited to complete a questionnaire that ascertained their gender and age, current eyesight status and method of correction, elapsed time interval since their last eyesight test and reason for attendance. In addition, the use and power of magnification was sought along with the adoption of protective eyewear. Responses were coded and placed in a relational database to facilitate interrogation and subsequent statistical analysis.Results The questionnaire return rate was 63% (247 and allowing for the seven questionnaires returned marked unknown at this address). Of these 158 were males and 81 female. The majority worked in general dental practice. Those with known eyesight deficiencies were statistically more likely (p <0.01) to attend for routine eye examination. Sixteen percent of respondents failed to attend for routine eye examination at least every two years. The mean age of those who had detected a change in their eyesight and sought examination was 43.59 (SD = 10.57) for males and 39.07 years (SD = 9.41) for females. This mirrored closely the mean age when the use of magnification was adopted (males = 42.39 (10.30), females = 40.33 (10.55)). The use of magnification was not universally adopted. Eye protection compliance was a low as 57% when using laboratory cutting equipment.Conclusions Although compliance with accepted recommendations for biannual eyesight testing was higher than that for the general population, not all dentists complied. The adoption of protective eyewear was patchy and exposed dentists to unnecessary risk.