Prevalence of thrombocytopenia in HIV-infected and non-HIV infected drug users and homosexual men

We studied the prevalence and risk factors for thrombocytopenia among 299 drug users and 461 homosexual men. The prevalence of thrombocytopenia was 3.3% in HIV-negative homosexual men, 8.7% in HIV-negative drug users, 16.4% in HIV-positive homosexual men, and 36.9% in HIV-positive drug users. With multivariate logistic regression HIV-seropositivity (odds ratio 3.3), a history of injecting drugs (OR 3.9), an increased number of lymphocytes (OR 0.44), an increased number of neutrophils (OR 0.53) and a larger mean platelet volume (OR 2.8) were independently and significantly associated with thrombocytopenia. The results obtained with linear regression analysis were consistent with the results of the logistic regression. The higher prevalence of thrombocytopenia among drug users was related to a history of intravenous drug use but not to recent injecting. The mechanisms causing thrombocytopenia among HIV-positives and HIV-negatives seem to be related, but HIV-infection seems to enhance thrombocytopenia in an independent way.     

The Investigation of Genotype-Phenotype Relationship in Multiple Primary Malignant Neoplasia Patients

Multiple primary malignant neoplasms (MPMN) are rare tumors that have attracted attention with increasing incidence rates in recent years and where cancer susceptibility genes may play a role in their etiology. In this study, it was aimed to determine the genotype-phenotype correlation in patients with MPMN. From January 2018 to January 2020, thirty patients were analyzed for 59 cancer susceptibility genes and diagnosed with MPMN, using a large multigene panel with Next Generation Sequencing technique (NGS) in Turkey. The mean age of first and second cancer diagnosis of cases were calculated as 42.5 and 49.9 (respectively). These primary cancers were frequently detected in the colon and breast, and the interval between diagnosis was 89 months. In 9 of the patients (30%); BRCA2, MSH6, MLH1, MUTYH, and ATM were detected as causal genes. Relatives with cancer of MPMN patients with causative gene carriers were detected in higher numbers than non-carrier. According to the logistic regression model applied, patients with at least 1 relatives with cancer were found to have a 0.38-fold increased risk of being a causal gene variant carrier. Hereditary cancer susceptibility genes may play an important role in the etiology of MPMN. In MPMN cases, detection of the causal gene by genetic analysis; It will enable not only to ensure a complete and accurate diagnosis of the sick individual and to plan the treatment properly, but also to include the carriers’ relatives in the intensive cancer screening, monitoring, and prevention program.     

Résécabilité des cancers localement avancés du col utérin après radiothérapie externe néoadjuvante

Introduction

Cervical carcinomas are common in developing countries. More than 60% of all cases are locally advanced, considered as unresecable oncologically because of the frequent pelvic structures involvement.

Objective

The aim of this article is to evaluate the surgical resection of locally advanced of the cervical carcinoma after neo-adjuvant external beam radiotherapy.

Patients and method

It was a retrospective study and we enrolled 48 cervical carcinomas staging FIGO: IIA: 18.8%, IIB: 58.3%, III: 16.7% and IVA: 6.2% with objective response and operated after neo-adjuvant radiotherapy from 2000 to 2003. The mean age was 48.8 years old and squamous cells carcinomas represented 95.8%. We studied surgical assessment, macroscopic residual tumour, histological evaluation and follow-up.

Results

The mean delay of the surgery was 13.2 weeks. We realized radical hysterectomy Piver??s type 3 in 75.0%, type 2 in 8.3%, and extrafacial hysterectomy in 12.5%. Pelvic lymphadenectomy has been done in 26 cases. We noted 15 haemorrhages, 2 wounds of bladder and ureteri, 2 urinary fistulas and 1 radic cystitis. Two patients died of pulmonary embolism. Macroscopic residual tumour noted in 29.2%. For the 30 cases with histological evaluation, complete sterilization was 60.0% and partial sterilization 40.0%. The mean follow-up was 40 months. The rate of local control was 60.4%. A 36 months survival was 55.0%, without residue 68.0% vs 20.0% and without recurrence 92.0% vs 10.0%.

Conclusion

Very few patients presenting locally advanced cervical carcinoma benefit treatment. Our results may be validated by cases control studies between patient treated by exclusive radiotherapy and patient treated by radiotherapy follow-up of surgery.     

Estrogen replacement therapy and cognitive functions in healthy postmenopausal women: a randomized trial

This study aimed to evaluate the effect of estrogen replacement therapy on verbal cognitive performance of middle-aged postmenopausal women. Middle-aged (40 to 59 years) hysterectomized, oligosymptomatic women receiving 0.625 mg/day of conjugated equine estrogens (N = 27) or placebo (N = 32) in a double-blind parallel group design were compared according to their performance on a verbal memory battery before and after six 28-day cycles of treatment. Both groups had similar age and educational level. The estrogen group performed better on digit span-forward and on the recall of the easy stimuli on the verbal-paired associates test regardless of age, education, physical symptoms, number of years of menopause, or blood estradiol levels. However, the small magnitude of difference in the effect on attentional span suggests that the estrogen-related improvement is unlikely to be of clinical relevance. Estrogen replacement therapy did not improve verbal memory in middle-aged, hysterectomized, postmenopausal, asymptomatic women.