Association of HLA class II allele and haplotype frequencies with chronic myelogenous leukemia and age-at-onset of the disease

Chronic myelogenous leukemia (CML) is characterized by the presence of Philadelphia chromosome resulting from bcr/abl translocation. To clarify the association between HLA class II allele and haplotype frequencies in CML, 50 patients referred to Hematology Oncology and Bone Marrow Transplantation (BMT) center, Shariaty Hospital, Tehran, Iran, were randomly selected and compared with a group of 80 unrelated healthy blood donor subjects. HLA class II alleles were determined by PCR-SSP method. The results showed that the frequencies of DQB1*03011 (P=0.01) and DQA1*0505 (P=0.05) were higher, while that of DQB1*03032 (P=0.04) was lower in patients than in the controls. Regarding age-at-onset, the frequency of HLA-DRB1*07 (P=0.03) and -DQA1*0201 (P=0.03) alleles were higher in patients younger than 35 years. The most frequent haplotypes in our CML patients were HLA-DRB1*11/-DQB1*03011/-DQA1*0505 (P=0.01) and HLA-DRB1*04/-DQB1*0302/-DQA1*03011 (P=0.02). In conclusion, it is suggested that positive and negative association in certain HLA alleles and haplotypes exist in Iranian patients with CML.     

Women's knowledge of and attitude toward breast cancer in a developing country: implications for program interventions--results based on interviewing 500 women in Saudi Arabia

We interviewed 500 adult females without personal history of any type of cancer to assess their awareness and attitude toward various aspects of breast cancer. The mean age (SD) of participants was 31.6 (+/- 8.5) years with a range of 18 to 62 years. After control for level of education, age was not found to be a statistically significant factor that influenced participants' performance. Also not statistically significant was the history of having a relative who had cancer. Conversely, education was the only examined factor that correlated with interviewees' awareness and attitude. Individuals with university or higher education (level III) were more knowledgeable (statistically significant) than uneducated or those with only primary schooling (level I), or those participants who only had intermediate or high school education (level II). On the other hand, the responses of those individuals with education level I generally performed in a fashion similar to those at education level II. The general outcome of this exercise was that unacceptably high proportions of females at all education levels were either wrong or uncertain about some fundamental aspects of breast cancer etiology, risk factors, clinical features, detection methods, and management. Also shown was the relatively high percentages of those, particularly in education level I, who held misconceptions about unconventional management or the complications of conventional methods. We conclude that academic education alone is not enough to assure that recommended health behaviors will be adopted. For establishing cancer health education or cancer prevention and early detection programs, primary care physicians and community cancer centers should work jointly. Brief guidelines are proposed.     

Low intensity laser therapy is comparable to bromocriptine-evening primrose oil for the treatment of cyclical mastalgia in Egyptian females

One of the successful treatments for cyclical mastalgia is bromocriptine evening primrose combination. A double blind study was applied on 80 patients with cyclical mastalgia. They were randomly divided into two groups (A and B). In group A, patients were treated by bromocriptine/evening primrose. To group B, LILT with specified dosimetry was applied, using a device that delivers He-Ne laser combined with 4 infra-red diode laser. Evaluation of treatment was both subjective (using VAS) and objective (studying the degree of drop in plasma cortisol level). The drop of plasma cortisol with treatment was studied using the student -t distribution. A good response was observed in the laser group in 82.5%, compared to 63.9% in the bromocriptine/evening primrose group. There was a significant deference before and after treatment in both groups (P<0.05). This difference was more for the drug treated group than for the laser treated group, but in the latter, it acted on a wider sector of patients. In conclusion, LILT is recommended as a new treatment modality for cyclical mastalgia.     

Analysis of mortality rates for pancreatic cancer across the world

Introduction. Pancreas cancer is the fourth commonest cause of cancer-related mortality across the world, with incidence equalling mortality. A recent study has suggested that both the incidence and the mortality of pancreatic cancer are falling in the UK. We investigated whether this trend was being seen all over the world. Methods. Age-standardized mortality (world) rates [ASR(W)] for pancreatic cancer were extracted separately for males and females from a database maintained by the International Agency for Research on Cancer for 51 countries across the world (Europe, 33 countries; Americas, 8 countries; and Asia, 10 countries) for the period 1992–2002; log-linear regression analysis was performed to analyse trends in the past decade. Results. In the period 1992–2002, the ASR(W) remained static across most countries for both sexes. The highest mortality rates (for both sexes) were seen in Central Europe [range: men (8–12), women (4.5–7)] with trends towards increasing mortality in Romania (p<0.001), along with Albania, Spain and Croatia (p<0.01). Korea in the Far East, too, demonstrated increasing mortality trends for both sexes (men p<0.001, women p<0.01). Increasing mortality trends were also observed among women in France (p<0.001). In Canada, there was a decline in mortality [men (7.5–6.4), women (5.9–5); p<0.01], while for men there was a downward trend in Ireland, the UK, Switzerland, Austria, and Poland [p<0.05]. Conclusion. The changes perhaps reflect standardization and consolidation of diagnostic tests for pancreatic cancer in the Western world and further in-depth analysis would be required.     

A survey on causes of amputation in a 9-year period in Iran

Background

Limb loss occurs as a result of different causes and has been increasing in many countries. This study determines the demography of amputees in one of the relatively large cities of Iran.

Methods

This retrospective study was undertaken on all of the amputees between 2003 and 2011. Patients’ demographics including age, sex, the limb that had undergone amputation, etiology of limb loss and side and level of amputation were recorded. Also, the level of amputation was recorded as minor (below wrist or ankle) or major (above wrist or ankle).

Results

In total, 624 patients were enrolled in the study. The number of amputees was from 53 to 118/year. Of the patients, 508 were male (81.4?%) and 118 were female (18.6?%). The men with amputation were younger on average than women; 61.9?% of the amputations (386) were major and 38.1?% were minor (238). Overall, the most common cause of amputation was trauma and the most common level was transmetatarsal. The most common level for major amputations was below knee.

Conclusion

In contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations and in all age groups, which emphasizes the need for preventive measures in the country.     

Methotrexate treatment of pityriasis lichenoides and lymphomatoid papulosis.

Pityriasis lichenoides is a notoriously difficult disease to treat. Three patients with this condition and a fourth with lymphomatoid papulosis have been successfully treated with doses of methotrexate once a week. Toxicity noted during the treatment periods has been minimal.     

Response of hepatitis C genotype-4 naïve patients to 24 weeks of Peg-interferon-alpha2b/ribavirin or induction-dose interferon-alpha2b/ribavirin/amantadine: a non-randomized controlled study

BACKGROUND AND AIM: Currently, pegylated interferon is the most effective therapy for hepatitis C but its cost is out of reach of most patients in the developing countries. The aim of this study was to assess the response rate of genotype-4 patients to 24 wks of peg-interferon-alpha2b (Peg-IFN-alpha2b) and ribavirin (RBV) or interferon-alpha2b (IFN-alpha2b) with RBV and amantadine (AMD) as an alternative option. METHODS: In a controlled study, 180 biopsy-proven na?ve chronic hepatitis C patients were allocated into three groups based on their financial affordability to any of the study regimens. Group I (control) comprised 40 patients who received Peg-IFN-alpha2b in a flat dose of 100 mug/wk (the dose available in Egypt) plus RBV 1,000-1,200 mg per day based on body weight for 48 wks. Group II comprised 70 patients who received the same regimen for 24 wks. Group III comprised 70 patients who received induction-dose triple therapy (IDTT) in the form of IFN-alpha2b 3 MU once daily for the first 4 wks then reduced to TIW for 20 wks plus RBV 1,000-1,200 mg per day based on body weight and AMD 100 mg twice daily for 24 wks. Six patients from group I, eight patients from group II, and four from group III discontinued the study either due to financial limitations and/or intolerable adverse effects of the drugs. RESULTS: Intention-to-treat analysis revealed that sustained virological response (SVR) achieved in 22 (55.0%), 34 (48.6%), and 20 (28.6%) in groups I, II, and III, respectively. Adherence-to-treatment analysis (80/80/80) revealed that SVR achieved in 22 (64.7%), 34 (54.8%), and 20 (30.3%) in groups I, II, and III, respectively. In absence of eradication of hepatitis-C-virus-RNA at week 12, there was virtually no chance of achieving SVR. These data collectively may indicate that genotype 4 is "not difficult to treat" as previously reported. CONCLUSION: Response of genotype-4 patients to 24 wks of Peg-IFN-alpha2b/RBV did not significantly differ from 48 wks, but was significantly higher than IDTT. Although SVR achieved by IDTT is less than Peg-IFN-alpha, yet it might provide a second option when the latter is not affordable. Early virological response should be used as a predictor to SVR to avoid unnecessary expenses in nonresponders patients.