Clinical features of renal diseases in South-East Asia

Summary: The renal diseases in South-East Asia are similar to other parts of the world (i.e. glomerulonephritis, diabetes mellitus, HT, obstructive uropathy, adult-onset polycystic kidney disease, nephrolithiasis and tubulointerstitial diseases). IgA nephropathy with haematuria is most common in Singapore, while IgM nephropathy with nephrotic syndrome is common in Thailand. Lupus nephritis is the most common cause of secondary glomerulonephritis and a major cause of rapidly progressive glomerulonephritis. Acute renal failure from specific infection (malaria, leptospirosis, melioidosis), from toxin exposure (snake bite, wasp sting), from exertional heat stroke, and from drugs is frequently found. Nephrolithiasis, distal renal tubular acidosis and hypokalaemia are endemic in NE Thailand. In conclusion, the broad clinical features of renal diseases in South-East Asia are similar to other regions, with additional specific causes from infections, toxic, metabolic and environmental derangements associated with these tropical locations.     

Automatic needle insertion diminishes pain during growth hormone injection

Non-compliance in children receiving growth hormone (GH) treatment is often caused by pain on injection and difficulties in administration of GH. It has been suggested that automatic needle insertion diminishes pain perception. We quantitatively measured pain intensity on injection with two prototype pens for GH administration, providing either manual or automatic sc needle insertion, using a combined visual analogue/facial scale and a five-item scale in 18 children. With the automatic pen there was a significantly lower maximum pain score compared with the manual pen (median 28.5 versus 52.0mm) as well as a lower mean pain score (mean 13.7 versus 23.5 mm). The five-item scale revealed that automatic needle insertion was significantly less painful than manual insertion and 13 patients chose to continue treatment with the automatic pen. In conclusion, pain during GH injection can be significantly diminished by automatic needle insertion, which may improve compliance in long-term GH treatment.     

Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study

Abstract. Objectives. To compare cardiovascular risk factor levels between non-westernized Melanesians, apparently free from stroke and ischaemic heart disease [1], and healthy Swedish populations, and to analyse, among adult Melanesians, relations with age, sex and smoking status. Design. Cross-sectional survey. Subjects. (i) Traditional horticulturalists in Kitava, Trobriand Islands, Papua New Guinea, uninfluenced by western diet. This study tested 151 males and 69 females aged 14–87 years with 76% and 80% smokers over 20 years, (ii) Healthy Swedish reference populations. Main outcome measures. Sitting systolic and diastolic blood pressure, weight, height, body mass index, circumferences of waist, pelvis and mid upper arm, triceps skinfold thickness, fasting serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, estimated low-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein Al and apolipo-protein (a). Results. Compared to Sweden, diastolic blood pressure, body mass index and triceps skinfold thickness were substantially lower in Kitava, where all subjects ≥ 40 years were below Swedish medians. Among males ≥ 20 and females ≥ 60 years systolic blood pressure was lower in Kitavans. Fasting serum total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B were 10–30% lower in Kitavan males ≥ 40 and females ≥ 60 years. Triglycerides were higher in Kitavans aged 20–39. High-density lipoprotein cholesterol did not differ while apolipoprotein Al was lower in Kitavans. Apolipoprotein (a) tended to be lower in Kitavans, but the differences were small. Conclusions. Of the analysed variables, leanness and low diastolic blood pressure seem to offer the best explanations for the apparent absence of stroke and ischaemic heart disease in Kitava. The lower serum cholesterol may provide some additional benefit. Differences in dietary habits may explain the findings.     

Public health, conflict and human rights: toward a collaborative research agenda

Although epidemiology is increasingly contributing to policy debates on issues of conflict and human rights, its potential is still underutilized. As a result, this article calls for greater collaboration between public health researchers, conflict analysts and human rights monitors, with special emphasis on retrospective, population-based surveys. The article surveys relevant recent public health research, explains why collaboration is useful, and outlines possible future research scenarios, including those pertaining to the indirect and long-term consequences of conflict; human rights and security in conflict prone areas; and the link between human rights, conflict, and International Humanitarian Law.     

HIF-1A,pimonidazole, and iododeoxyuridine to estimate hypoxia and perfusion in human head-and-neck tumors

PURPOSE: Tumor hypoxia measured by microelectrodes has been shown to indicate poor patient outcome. Here we investigated four potentially more widely applicable immunohistochemical parameters of tumor oxygenation and perfusion in human head-and-neck tumors. METHODS: Twenty patients with squamous cell carcinomas of the head and neck treated with primary surgery were injected with pimonidazole and IdUrd the evening before operation. Consecutive paraffin-embedded sections were stained for blood vessels, pimonidazole, IdUrd, and HIF-1alpha. IdUrd labeling and Ki-67 labeling around individual blood vessels were scored. The spatial relationship between HIF-1alpha and pimonidazole was studied, as well as the distribution of both markers as a function of distance from the nearest blood vessel. RESULTS: Measurement of all four parameters (diffusion-limited fraction, pimonidazole fraction, HIF-1alpha fraction, IdUrd-negative vessels) was feasible, and a significant difference between tumors was found for all parameters. IdUrd-labeled cells were absent around some vessels, indicating lack of perfusion, because these regions were positive for Ki-67. There was a positive correlation between diffusion-limited fraction and pimonidazole area for all images from all tumors, although no correlation for mean values per tumor. Colocalization of pimonidazole and HIF-1alpha was low (0.02%-25%). Most expression profiles showed a more homogenous distribution for HIF-1alpha than pimonidazole. There was no significant correlation between the pimonidazole and HIF-1alpha fractions in the 10 tumors studied. CONCLUSIONS: Simultaneous immunohistochemical measurements related to hypoxia and perfusion are feasible (and easily applicable) in resected human tumors. The different geographic distributions of HIF-1alpha and pimonidazole indicate that HIF-1alpha might not be suitable as a marker for chronic hypoxia. Each parameter will be correlated with outcome in a larger ongoing study on head-and-neck tumors treated with surgery with or without postoperative radiotherapy.     

HIF-1α, pimonidazole, and iododeoxyuridine to estimate hypoxia and perfusion in human head-and-neck tumors

: Tumor hypoxia measured by microelectrodes has been shown to indicate poor patient outcome. Here we investigated four potentially more widely applicable immunohistochemical parameters of tumor oxygenation and perfusion in human head-and-neck tumors. : Twenty patients with squamous cell carcinomas of the head and neck treated with primary surgery were injected with pimonidazole and IdUrd the evening before operation. Consecutive paraffin-embedded sections were stained for blood vessels, pimonidazole, IdUrd, and HIF-1α. IdUrd labeling and Ki-67 labeling around individual blood vessels were scored. The spatial relationship between HIF-1α and pimonidazole was studied, as well as the distribution of both markers as a function of distance from the nearest blood vessel. : Measurement of all four parameters (diffusion-limited fraction, pimonidazole fraction, HIF-1α fraction, IdUrd-negative vessels) was feasible, and a significant difference between tumors was found for all parameters. IdUrd-labeled cells were absent around some vessels, indicating lack of perfusion, because these regions were positive for Ki-67. There was a positive correlation between diffusion-limited fraction and pimonidazole area for all images from all tumors, although no correlation for mean values per tumor. Colocalization of pimonidazole and HIF-1α was low (0.02%–25%). Most expression profiles showed a more homogenous distribution for HIF-1α than pimonidazole. There was no significant correlation between the pimonidazole and HIF-1α fractions in the 10 tumors studied. : Simultaneous immunohistochemical measurements related to hypoxia and perfusion are feasible (and easily applicable) in resected human tumors. The different geographic distributions of HIF-1α and pimonidazole indicate that HIF-1α might not be suitable as a marker for chronic hypoxia. Each parameter will be correlated with outcome in a larger ongoing study on head-and-neck tumors treated with surgery with or without postoperative radiotherapy.     

Concurrent chemoradiation with daily low dose cisplatin for advanced stage head and neck carcinoma.

BACKGROUND AND PURPOSE: To evaluate treatment results of concurrent chemoradiation with daily low dose cisplatin. MATERIALS AND METHODS: 121 patients with advanced stage HNSCC were treated with RT (35 x 2 Gy) and cisplatin (6 mg/m(2) i.v. x20, daily before RT). After 47 patients, the treatment protocol (Standard Group) was changed: Daily i.v. prehydration and accelerated RT were given to the subsequent 74 patients (Hydr-Ac-RT Group). RESULTS: Mean follow-up was 29 months (range 7-62). More chemotherapy could be administered in the Hydr-Ac-RT Group (maximum no. of 20 cisplatin-infusions increased from 59% to 91% of patients, p=0.008), with less renal toxicity (p<0.001) and less hospital admissions (p<0.02). However, mucositis was more pronounced and tubefeeding more frequent in the Hydr-Ac-RT Group. The CR rate of the primary tumor increased from 74% (Standard Group) to 90% (Hydr-Ac-RT Group) (p=0.06), although this did not lead to an improvement in loco-regional control. CONCLUSIONS: Concurrent chemoradiation with daily low dose cisplatin is feasible and effective for selected patients with advanced HNSCC. Although the addition of accelerated RT resulted in more mucositis and tubefeeding, the introduction of prehydration led to better compliance to therapy with more chemotherapy administered and less hospital admissions.