Paratesticular metastasis from Wilms tumor: the possible routs of metastasis and literature review

Testicular or paratesticular metastasis from Wilms tumor (WT) is extremely rare. We report a 5-year-old boy with WT of right kidney presented with metastasis to the ipsilateral spermatic cord. The patient underwent a high inguinal right orchiectomy. Histopathological examination revealed infiltration of WT to spermatic cord but the testis and epididymis were not involved. The patient received the standard chemotherapy regimen but the response to treatment was poor with 2 tumor recurrences within the follow-up period. Among the mechanisms of metastasis to scrotal region, retrograde venous and the patent processus vaginalis seem to be more common and also preventable.     

Treatment of localized non-segmental vitiligo with intradermal 5-flurouracil injection combined with narrow-band ultraviolet B: A preliminary study

Abstract Background: Several treatment modalities had been used for the treatment of vitiligo but the optimal treatment has not yet been identified. Aim: To evaluate the efficacy and safety of intradermal injection of 5-flurouracil (5-FU) combined with narrow-band ultraviolet B (NB-UVB) as a treatment option for vitiligo. Patients and methods: The study included 60 vitiligo patients with overall symmetrical lesions affecting less than 30% of body surface area. For each patient, one side of the body was treated with NB-UVB alone (control side) while the other side was treated with NB-UVB therapy in addition to intradermal injection of 5-FU (50 mg/ml), 0.01-0.02 ml per injection with 1 cm apart in skin of vitiligo, every 2 weeks for 4 months. Results: The overall repigmentation was significantly higher in the 5-FU side compared with control side in all body parts (p < 0.001) except for the acral lesions where the difference was not significant (p = 0.561). No systemic side effects of 5-FU were detected, and the majority of the patients reported pain during injections. Conclusions: Intradermal 5-FU injection in combination with NB-UVB could be considered as a simple, safe, tolerable and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and improves the outcome, repigmentation. Longer follow-up is needed.     

Detection of plasma and urinary monoamines and their metabolites in nonsegmental vitiligo

Vitiligo is one of the most troubling diseases to both patient and physician. Monoamines are chemical compounds derived from the hydroxyderivative of amino acids. They have been implicated in many dermatoses, but their role in the etiopathogenesis of vitiligo remains obscure. The aim of the study was to evaluate the role of the neural factor in the pathogenesis of nonsegmental vitiligo (NSV) by measuring catecholamines and their metabolites in plasma and urine of patients suffering from NSV, and to correlate these factors with the onset and activity of the disease. The study included 20 patients with NSV and 20 healthy individuals. All subjects were subjected to plasma and urine detection of catecholamines and 5-hydroxyindoleacetic acid (5-HIAA) using high-performance liquid chromatography and electrochemical detection. Comparison of plasma and urinary catecholamines and 5-HIAA between the patient and control groups revealed a statistically significant increase in the group of NSV patients (P<0.05). There was no statistically significant difference (P>0.05) between the patients with recent and old onset of NSV. In conclusion, the increase in the level of monoamines may be the initiating event in the pathogenesis of NSV.     

Prevalence of CagA and antimicrobial sensitivity of <Emphasis Type="Italic">H. pylori</Emphasis> isolates of patients with gastric cancer in Egypt

Background

Helicobacter pylori (H. pylori) infection has been recognized as a significant threat for gastric cancer. However, studies that investigated the oncogenic factors and antimicrobial resistance of H. pylori in Egyptian isolates with gastric cancer are rare. The current study aimed to examine: (1) The pattern of antimicrobial resistance of H. pylori isolates of Egyptian gastric cancer patients, and (2) the prevalence of Cytotoxin-associated gene A (CagA).

Methods

Samples were collected from patients with gastric cancer. Isolation of H. pylori was performed using Columbia blood agar supplemented with 10% horse blood, and selective supplement of H. pylori for 3 to 5 days at 37 °C under microaerophilic condition. Isolates were identified by biochemical traits of H. pylori: oxidase, urease and catalase tests. Antimicrobial susceptibility of H. pylori isolates was examined against five antimicrobial agents using disc diffusion method. After that, extraction of DNA and Polymerase Chain Reaction (PCR) were performed to amplify the target genes.

Results

Twelve samples were collected from six males and six females Egyptian patients with cancer with an age range from 22 to 65 years. These cases are scarce and samples were collected over a period of almost eleven months. All isolates were confirmed as positive H. pylori through colony morphology and biochemical tests. The most effective antibiotic found was ciprofloxacin whereas all isolates showed resistance to metronidazole and erythromycin. The target CagA oncogene gene with expected product size was reported and seven (out of twelve) isolates (58%) were identified as CagA positive.

Conclusion

The current study is unique in two main aspects. First, it reported the pattern of antimicrobial susceptibility and prevalence of CagA gene in H. pylori from Egyptian patients. Second, it exclusively recruited isolates from gastric cancer patients which were confirmed by clinical and laparoscopic examination. The moderately high prevalence of CagA gene in Egyptian cancer patients calls for more vigilance against that oncogene.

     

Clinical and histological significance of atypical glandular cell on Pap smear

BACKGROUND: Atypical glandular cell (AGC) on Pap smear is uncommon but may represent a variety of benign and malignant lesions. AIM: The aim of this study was to evaluate the association between AGC on Pap smear and significant pathological finding to tailor management protocols. METHODS: Between 2002 and 2005, 60 women with AGC on Pap smears were referred to our colposcopy clinic. Forty-one women underwent colposcopy-directed biopsy, endocervical curettage, endometrial sampling and cervical conisation to determine the cytological and histological correlations of AGC on Pap smears. RESULTS: The mean age of the patients was 46.9 +/- 11.5 years (range, 23-80 years). Of these patients 13 patients (31.7%) were postmenopause and 28 patients (68.2%) were in reproductive age. We found eight (19.5%) significant pathological findings including four (9.7%) high-grade squamous intraepithelial lesion, one (2.4%) adenocarcinoma of uterus, one (2.4%) adenocarcinoma of cervix, one (2.4%) squamous cell carcinoma of cervix and one (2.4%) papillary serous tumour of ovary. CONCLUSION: AGC on Pap smear was associated with a clinically significant diagnosis in approximately 20% of our cases. The women with a diagnosis of AGC on cervicovaginal smear are needed to be evaluated at least with colposcopy, endocervical and endometrial curettage. Clinicians should be careful about the significance of AGC on Pap smears.     

The anti-inflammatory effect of milk and dairy products on periodontal cells: an in vitro approach

Clinical Oral Investigations - Milk can reduce intestinal tissue damage in colitis models, and protects infants against necrotizing enterocolitis. However, whether milk can decrease inflammation...     

Efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women: a meta-analysis

ABSTRACT

The aim of our study was to investigate the therapeutic efficacy of pharmacological and non-pharmacological interventions on low sexual interest/arousal of peri- and post-menopausal women. In this systematic review and meta-analysis, randomized clinical trials (RCTs) that published up to 22 June 2016 were retrieved from several online electronic databases, including Cochrane Library, PubMed, Ovid, Scopus, Medline, CINHAL, and EBSCO. Fifty-seven studies were included in the meta-analysis. The results showed that both pharmacological interventions (mean difference (MD) = –0.86, 95% confidence interval (CI) = –1.49 to –0.90, p = 0.0001) and non-pharmacological interventions (MD = –0.92, 95% CI = –1.35 to –0.49, p = 0.0001) had statistically significant effects on improving sexual interest/arousal. Among pharmacological interventions, hormone therapy with dehydroepiandrosterone, testosterone, tibolone and estrogen in combination with progesterone, estrogen in combination with testosterone as well as estrogen in combination with progesterone and testosterone were found to be effective. Non-hormonal medications including flibanserin and sildenafil as well as herbal medicines were also shown to be effective. However, due to high heterogeneity of the findings and scarcity of the studies in certain domains, there is uncertainty of their true effect. So, further well-designed RCTs with larger samples are required to ascertain the long-term effects of studies.     

Topical Corticosteroids and Hospital Length of Stay in Children with Eczema Herpeticum

Abstract: There is concern that the use of topical corticosteroids in patients with eczema herpeticum may facilitate dissemination of herpes simplex virus and worsen disease. Our primary aim therefore was to determine whether topical corticosteroid use in children hospitalized with eczema herpeticum is associated with longer hospital length of stay (LOS). We performed a multicenter retrospective cohort study of 1,331 children ages 2 months to 17 years admitted with a diagnosis of eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System database. Multivariable linear regression models determined the association between receipt of topical corticosteroid therapy on the first day of hospitalization and the main outcome measure: LOS. Receipt of topical corticosteroid therapy on day 1 of hospitalization was not associated with a longer LOS on unadjusted or multivariable analysis (p = 0.75). Receipt of topical calcineurin inhibitors during the hospitalization was also not associated with a longer LOS (p = 0.12). Receipt of systemic corticosteroids was associated with an 18% adjusted longer LOS (95% confidence interval 2%–36%; p = 0.03). Further study is needed to identify which children with eczema herpeticum may benefit from topical corticosteroids, but their use during active infection is not associated with poorer outcomes, although the use of systemic corticosteroids was associated with a longer LOS and should be avoided in patients with eczema herpeticum pending future prospective study.     

Relationship between using cell phone and the risk of accident with motor vehicles: An analytical cross-sectional study

Purpose: Traffic accidents are one of the major health problems in the world, being the first cause of burden of illness and the second leading cause of death in Iran. The Sistan-Baluchestan province is one of the most accidental provinces of Iran with the highest rate of accidents-caused deaths. This study was conducted to determine the risk factors associated with traffic accidents in Zahedan through 2013 to 2016.Methods: This analytical cross-sectional study was carried out on 223 drivers from Zahedan who were traumatized by traffic accident and sent to Zahedan hospitals. The data were obtained through interviews taken by the trained interviewers via refereeing to the medical records and collected in the researcher-made checklist. Census was obtained from the study subjects. For data analysis, independent t-test, one-way ANOVA, Chi-square and logistic regression were used with the Stata software version 11.0.Results: In this study, 223 male subjects with the mean age of (32.54 ± 12.95) years, 39.8% single and 60.2% married, entered for investigation. Most accidents (38.8%) occurred between 12:00 to 17:59. While driving, 47.1% of the study subjects were using cell phones, 89.1% had manual use of mobile phones, 21.9% had a habit of sending short message service (SMS) and 23.4% had sent SMS within 10 min before the accident. The one way analysis of variance showed that the mean age of individuals with marital status, driving experience, education and accident with motorcycle were significantly different (p < 0.05). Also, the multivariate logistic regression test indicated a significant relationship of smoking, ethnicity, insurance and SMS typing while driving with motorcycle accident (p < 0.05).Conclusion: In this study, SMS and smoking while driving had the highest risk among the variables studied in the motorcycle accidents. Therefore, effective education attempting to enhance people''s awareness about the consequences of using cell phone and smoking during driving to reduce traffic accidents seems necessary.     

Tumor suppressor protein p53 and anti-p53 autoantibodies in pediatric rheumatological diseases

The tumor suppressor protein p53 plays an important role in cell cycle regulation. One of the major features in rheumatic diseases is the abnormal proliferation of lymphocytes. p53 expression in peripheral blood mononuclear cells (by flowcytometry) and serum anti-p53 antibodies (by ELISA) were therefore measured in 18 children and adolescents with juvenile rheumatoid arthritis (JRA) and 17 with systemic lupus erythematosus (SLE) in comparison to 20 healthy controls, to determine their role. p53 expression in patients was insignificantly higher than that of controls (2.28 ± 2.71% vs. 1.08 ± 1.02%, respectively, p > 0.05) with 29.4% of the patients showing values above a cut-off level of 2.55% (95th percentile of controls). SLE patients with active disease had significantly higher p53 expression compared to controls and to patients with quiescent disease although no significant correlation with ESR or complement 3 was detected. Seropositivity to anti-p53 antibodies was observed in none of controls but in 22.8% of patients, all of whom, except one, had active disease. Seropositivity to anti-p53 antibodies was more prominent in lupus nephritis than in other presentations of SLE (p < 0.05). The mean p53 expression in seropositive patients was insignificantly higher than in seronegatives. p53 expression and seropositivity to anti-p53 were slightly higher in SLE than in JRA and were not significantly affected by the mode of therapy. Thus, the overexpression of p53 in some patients with active SLE and JRA might explain the abnormal proliferation of autoreactive lymphocytes that perpetuates the inflammatory response. The presence of anti-p53 antibodies might cause malfunctioning of p53 protein interfering with its regulatory functions.