Hormone replacement therapy in gynecologic cancer survivors: why not?

Purpose

As a result of treatment, many women with gynecologic malignancies will go through menopause and display climacteric symptoms at an earlier age than occurs naturally. Iatrogenic menopause may adversely affect quality of life and health outcomes in young female cancer survivors. Hormone replacement therapy (HRT) has often been withheld from women with gynecologic cancer because of concern that it might increase the risk of relapse or the development of new primary cancers. The purpose of this review was to examine the published literature on menopause management in gynecologic cancer survivors and highlight the risks and benefits of conventional and alternative HRT in this population.

Methods

A comprehensive literature search of English language studies on menopause management in gynecologic cancer survivors and women with a hereditary predisposition to a gynecologic malignancy was performed in MEDLINE databases through December 2010.

Results

Both our review and a 2008 Cochrane review of randomized trials on the effects of long-term HRT demonstrate that for menopausal women in their 40s or 50s with and without gynecologic cancer, the absolute risks of estrogen-only HRT are low. Several prospective observational studies and randomized trials on HRT use in women with a genetic predisposition for or development of a gynecologic malignancy suggest benefits in quality of life with no proven adverse oncologic effects as a result of short-term HRT use.

Conclusion

In select women, it is reasonable to discuss and offer conventional HRT for the amelioration of menopausal symptoms and to improve quality of life. HRT does not appear to increase the risk of gynecologic cancer recurrences; however, this conclusion was largely based on observational data and smaller prospective studies.     

Saphenous varix – A pitfall in ultrasound imaging of femoral hernia: A case report

Saphenous varix is a rare vascular malformation occurring in the groin and its recognition may pose a diagnostic challenge.This paper highlights the importance of differentiating saphenous varix from femoral hernia amongst a wide range of possible groin masses, using ultrasound as a front-line imaging modality which clinical examination could not diagnose.We present a case report of a 39 year old male patient with saphenous varix, a sacculated varix of the greater saphenous vein closely simulating femoral hernia.Our report highlights the key points to note in correctly diagnosing this rare condition and the role of ultrasound as a cheap, non-invasive and readily available modality.     

A systematic review and appraisal of methods of developing and validating lifestyle cardiovascular disease risk factors questionnaires

BackgroundWell developed and validated lifestyle cardiovascular disease (CVD) risk factors questionnaires is the key to obtaining accurate information to enable planning of CVD prevention program which is a necessity in developing countries. We conducted this review to assess methods and processes used for development and content validation of lifestyle CVD risk factors questionnaires and possibly develop an evidence based guideline for development and content validation of lifestyle CVD risk factors questionnaires.Materials/methodsRelevant databases at the Stellenbosch University library were searched for studies conducted between 2008 and 2012, in English language and among humans. Using the following databases; pubmed, cinahl, psyc info and proquest. Search terms used were CVD risk factors, questionnaires, smoking, alcohol, physical activity and diet.ResultsMethods identified for development of lifestyle CVD risk factors were; review of literature either systematic or traditional, involvement of expert and /or target population using focus group discussion/interview, clinical experience of authors and deductive reasoning of authors. For validation, methods used were; the involvement of expert panel, the use of target population and factor analysis.ConclusionCombination of methods produces questionnaires with good content validity and other psychometric properties which we consider good.     

Differences in microbial signatures between rectal mucosal biopsies and rectal swabs

There is growing evidence the microbiota of the large bowel may influence the risk of developing colorectal cancer as well as other diseases including type-1 diabetes, inflammatory bowel diseases and irritable bowel syndrome. Current sampling methods to obtain microbial specimens, such as feces and mucosal biopsies, are inconvenient and unappealing to patients. Obtaining samples through rectal swabs could prove to be a quicker and relatively easier method, but it is unclear if swabs are an adequate substitute. We compared bacterial diversity and composition from rectal swabs and rectal mucosal biopsies in order to examine the viability of rectal swabs as an alternative to biopsies. Paired rectal swabs and mucosal biopsy samples were collected in un-prepped participants (n = 11) and microbial diversity was characterized by Terminal Restriction Fragment Length polymorphism (T-RFLP) analysis and quantitative polymerase chain reaction (qPCR) of the 16S rRNA gene. Microbial community composition from swab samples was different from rectal mucosal biopsies (p = 0.001). Overall the bacterial diversity was higher in swab samples than in biopsies as assessed by diversity indexes such as: richness (p = 0.01), evenness (p = 0.06) and Shannon’s diversity (p = 0.04). Analysis of specific bacterial groups by qPCR showed higher copy number of Lactobacillus (p < 0.0001) and Eubacteria (p = 0.0003) in swab samples compared with biopsies. Our findings suggest that rectal swabs and rectal mucosal samples provide different views of the microbiota in the large intestine.     

Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

Background:

Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre.

Patients and Methods:

This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed.

Results:

A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8^th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively.

Conclusion:

Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents.Key words: Complications, infants, neonates, Nigeria, plastibell circumcisions, preferences     

Incarceration and Current Tobacco Smoking Among Black and Caribbean Black Americans in the National Survey of American Life

Objectives. We examined the relationship between having a history of incarceration and being a current smoker using a national sample of noninstitutionalized Black adults living in the United States.Methods. With data from the National Survey of American Life collected between February 2001 and March 2003, we calculated individual propensity scores for having a history of incarceration. To examine the relationship between prior incarceration and current smoking status, we ran gender-specific propensity-matched fitted logistic regression models.Results. A history of incarceration was consistently and independently associated with a higher risk of current tobacco smoking in men and women. Formerly incarcerated Black men had 1.77 times the risk of being a current tobacco smoker than did their counterparts without a history of incarceration (95% confidence interval [CI] = 1.20, 2.61) in the propensity score-matched sample. The results were similar among Black women (prevalence ratio = 1.61; 95% CI = 1.00, 2.57).Conclusions. Mass incarceration likely contributes to the prevalence of smoking among US Blacks. Future research should explore whether the exclusion of institutionalized populations in national statistics obscures Black–White disparities in tobacco smoking.In the United States, local, state, and national measures first enacted in the 1970s and 1980s under the “war on drugs” and “tough on crime” policies radically changed the criminal justice system as well as the social, economic, and political landscapes.1 As a result, the US incarceration rate soared higher than that of Russia by 2001.2 The overall incarceration rate has increased by more than 400% since 1980, and the incarceration rate associated with felony drug offenses has increased by 1100%.3,4 Black Americans have borne the brunt of these criminal justice policy changes. One in 21 Black men and 1 in 279 Black women are currently incarcerated, and almost one third of Black men will be incarcerated at least once in their lifetime.4 Mass incarceration is thus potentially an important driver of the distribution of disease and ill-being in Black Americans.Tobacco is an integral part of prison culture, serving as a stress reliever, currency, and means of social interaction. Furthermore, the sensory and social deprivation of the prison environment may encourage tobacco use. Until the 1980s, cigarettes were freely distributed to incarcerated individuals as part of their rations and were (and still remain) the currency of choice for underground prison economies.5–7 However, tobacco policy in US prisons has changed radically in the past 25 years, culminating in the Federal Bureau of Prisons’ indoor smoking ban in federal prisons in 2004.8,9 Meanwhile, state and local prison and jail systems also modified their policies. By 2007, 87% of state prisons reported having either a total or indoor smoking ban in place, with none offering free tobacco.5As a population, people who have been incarcerated have a greater likelihood of having problems with substance abuse, psychiatric illness, and stressful or traumatic life events, potentially increasing susceptibility to nicotine addiction, with smoking prevalence in prison estimated at 40% to 80%.10–13 A systematic review of smoke-free policies in US prisons and jails that included 27 studies cited noncompliance with smoke-free policies ranging from 20% to 76% and demonstrated inconsistent implementation and control of contraband as well as the rise of tobacco black markets.14 In essence, if the available data are representative, the influence of underlying smoking norms seems to outweigh institutional policy changes, although the institutional setting may limit access and therefore consumption.In a systematic review, only 6 studies examining smoking postrelease from smoke-free prisons and jails were identified, and it indicated that individuals released went back to their previous smoking behavior almost immediately.14 With fewer constraints on consumption, individuals released from prison and jail may increase their cigarette consumption to achieve previous nicotine levels, especially those undergoing drug treatment or suffering from mental illness (and perhaps taking antipsychotics).15Even less is known about differences in incarceration-related tobacco smoking by race/ethnicity. Research shows that Blacks are less likely to participate and are not sampled in sufficient numbers to allow subgroup analyses.16,17 Controlling for socioeconomic status, Blacks have lower risk trajectories of cigarette smoking from childhood into adulthood than do Whites; they are also less likely to be heavy or regular smokers and more likely to be nonsmokers, initiating smoking later and reaching lower daily cigarette consumption.18–21 Although this lower tobacco consumption is one of the few health behavior advantages for Blacks compared with Whites, Blacks are more vulnerable to the health consequences of smoking (e.g., lung cancer).22 However, the role of incarceration in tobacco smoking prevalence among Blacks in the United States has not been examined.We therefore sought to evaluate the relationship between adult history of incarceration and tobacco smoking using a national sample of noninstitutionalized Black adults living in the United States, while taking account of differential propensity for having a history of incarceration.     

Liver safety evaluation of endothelin receptor antagonists using HepatoPac®: A single model impact assessment on hepatocellular health,function and bile acid disposition

Marketed (bosentan, ambrisentan) and discontinued (sitaxsentan, CI‐1034) endothelin receptor antagonists were examined in the human micropatterned hepatocyte co‐culture (MPCC) model HepatoPac^®. Differences across hepatocellular health (cellular adenosine triphosphate/glutathione content), function (urea production/albumin secretion) and taurocholic acid transport (biliary clearance/excretion index) were compared using amiodarone and ciclosporin A as positive controls. Ambrisentan had the weakest potency in all six endpoints, while sitaxsentan, bosentan and CI‐1034 had more potent effects on hepatobiliary transport than health/function endpoints. Normalization to clinical C_max gave the following relative rank order of safety based on margins for each endpoint: ambrisentan ≥ CI‐1034 ~ bosentan > sitaxsentan. These data suggested impaired hepatobiliary disposition might contribute to a more prominent role in liver injury associated within sensitive human populations exposed to these compounds than direct hepatocellular toxicity. Rat, dog and monkey MPCCs also showed greater sensitivity potential to disrupted hepatobiliary disposition compared with hepatocellular health/functional endpoints. Drug metabolism competency was exhibited across all species. In vivo, rats and dogs appear more resistant to transaminase elevations and/or histological evidence of liver injury caused by these mechanisms even at exceedingly high systemic exposures relative to sensitive humans. Rats and dogs are resistant to hepatobiliary toxicants due to physiological differences in bile composition/handling. Although traditional animal testing provides adequate safety coverage for advancement of novel pharmaceuticals into clinical trials, supplemental assays employing human MPCCs may strengthen weight‐of‐evidence predictions for sensitive human populations. Proving the predictive value of this single impact assessment model in advance of clinical trial information for human liver injury risk is needed across more pharmaceuticals.     

Irrational career beliefs in agricultural education students,demographics, impacts,and rational career education intervention

Background:Studies have shown that a good number of students admitted into Agricultural Science Education program in Nigerian universities exhibit irrational career interest which affects their perceptions, feelings, and academic behaviors. This study, therefore, explored the effect of rational emotive career education on irrational career beliefs among students enrolled in agricultural education program in federal universities in Enugu state. Three null hypotheses guided the study.Method:Of the population (N = 79 students) targeted for the study and who underwent a screening exercise, 61 students were recruited as participants/sample size for the study. Sequence allocation software was used to assign 31 students into experimental groups and 30 into waitlisted control group. Participants in the intervention group received a rational emotive career education program that lasted for 12 sessions while those in waitlisted group did not receive the intervention. The participants in both groups were assessed at three points (Time 1, Time 2, and Time 3) using rational and irrational belief scale. A repeated measure (ANOVA) and partial eta square statistical tools were used to analyze the data collected.Result:This study result showed that rational emotive career education significantly reduced irrational career beliefs among students enrolled in Agricultural Science Education program exposed to intervention group compared to those in waitlisted control group. It also showed that there was time × group interaction for irrational career beliefs. The follow-up assessment indicated that the efficacy of rational emotive career education was sustained overtime.Conclusion:This study concluded that rational emotive career education is beneficial in reducing irrational career beliefs of university students enrolled in Agricultural Science Education program. Recommendations were also made in line with the results.