Supporting Smokers in Difficult Settings: Suggestions for Better Education and Counseling in Cancer Centers in Jordan

Continued smoking in cancer patients is commonly observed in Jordan. In a country that exhibits some of the highest smoking rates globally, enhancing patient education regarding the value of smoking cessation for cancer care is vital. The objectives of our study were to describe sociodemographic and clinical factors associated with continued smoking in Jordanian smokers after a cancer diagnosis; to identify reasons for smoking and knowledge regarding smoking’s impact on care; to examine in a multivariable manner the factors associated with continued smoking, and to accordingly generate patient counseling recommendations. An interviewer-administered survey using the Theoretical Domains Framework was employed. Among 350 subjects (mean age 51.0, median 52.7), approximately 38% of patients had quit or were in the process of quitting; 61.7% remained smokers. Substantial knowledge gaps with regard to the impact of continued smoking on cancer care were observed. Remaining a smoker after diagnosis was associated with being employed, not receiving chemotherapy or surgery, having lower confidence in quitting, and having a lower number of identified reasons for smoking. Interventions to promote cessation in Jordanian cancer patients who smoke should focus on enhancing patient awareness about the impact of smoking in cancer care and raising perceived self-efficacy to quit.     

Mode of delivery and perinatal results of the breech first twin.

To evaluate the safety of vaginal delivery for breech first twin we reviewed retrospectively and compared the perinatal outcome of breech first twin: 42 delivered vaginally and 87 delivered abdominally. Vaginal delivery was allowed under the same criteria for singleton breech presentation. Both groups had similar maternal and neonatal characteristics. Intergroup differences in perinatal outcome, as measured by Apgar score, and mortality cases, were not significant. Our results showed that vaginal delivery is a safe mode of delivery and this route is not associated with higher mortality and morbidity.     

Immunohistochemical analysis of radiation-induced non-healing dermal wounds of the head and neck

Persistent, poorly healing wounds are a significant clinical problem in patients who have had previous irradiation. The pathology of chronic dermal ulcers is characterised by excessive proteolytic activity which degrades the extracellular matrix (required for cell migration) and growth factors and their receptors. Interestingly, the molecular basis of radiation-induced dermal wounds is poorly understood. The aim of this study was to investigate, by immunohistochemistry, the expression of the endothelial marker vWF, of angiogenic bFGF, VEGF and IL-8, of collagenases MMP-2 and MMP-9 and their inhibitors TIMP-1 and TIMP-2, in tissue samples from radiation-induced chronic dermal wounds and healthy control skin. Performing immunohistochemical detection of microvessels, an equivalent density of microvessels was observed within tissue samples from normal healthy skin and from radiation-induced non-healing cutaneous wounds. Investigation of angiogenic bFGF and VEGF demonstrated a decreased expression of both factors in the radiation-induced dermal wounds. The expression of angiogenic IL-8 was weak in both the healthy skin samples and the radiation-induced wounds. In addition, an increased expression of collagenases MMP-2 and MMP-9 protein within the radiation-induced wounds was demonstrated. While the expression of TIMP-1 showed no difference of expression between normal control skin and tissue samples from radiation-induced wounds, TIMP-2 expression was slightly increased compared to healthy controls. Our data suggest that radiation-induced dermal injuries often fail to heal because of decreased angiogenesis and persistently high concentrations of MMPs with an imbalance of their tissue inhibitors. The basic mechanisms of wound healing in radiation-induced dermal wounds at the molecular level need to be understood further for the development of innovative treatment strategies.     

Laparoscopic anterior hemifundoplication and hiatoplasty for the treatment of upside-down stomach: mid- and long-term results after 40 patients

Background  

Treatment of type 4 hiatal hernia using a minimally invasive approach is challenging and requires good familiarity with this technique.     

Does the genotype of HHT patients with mutations of the ENG and ACVRL1 gene correlate to different expression levels of the angiogenic factor VEGF?

The aim of this study was to determine in what way HHT (hereditary hemorrhagic telangiectasia) patients with mutations for the endoglin (ENG) or activin receptor-like kinase 1 (ACVRL1) gene show different expression levels of the angiogenic factor VEGF (vascular endothelial growth factor) by correlating VEGF to the HHT genotype. In 18 HHT patients, who were screened for ENG and ACVRL1 gene mutations and 25 healthy controls the VEGF plasma level as well as the VEGF tissue expression were determined by ELISA technique and cryostat sections of the nasal mucosa. In general, the VEGF plasma levels as well as the VEGF tissue expression were significantly higher in HHT patients compared to healthy controls. However, the correlation of VEGF to the HHT genotype did not show any significant differences, i.e. the VEGF plasma levels as well as the VEGF tissue expression in HHT patients with ENG gene mutations did not differ significantly to those of HHT patients with ACVRL1 gene mutations or mutations for both the genes. In spite of the fact that the angiogenic factor VEGF seems to play an important role in the pathogenesis of HHT, it cannot serve as a specific diagnostic screening marker. These results underline the importance and necessity of molecular analyses in HHT patients.