Surveillance for hepatocellular carcinoma: does it work?

BACKGROUND: The surveillance of cirrhotic patients for early detection of hepatocellular carcinoma is recommended but its efficacy is now discussed. The aim of our study was to present the results of a screening program in 110 patients. METHODS: it is a retrospective study that included 110 patients with cirrhosis in a screening program of hepatocellular carcinoma, based on the realization of abdominal ultrasound exam and the determination of alpha-fetoprotein amount every 6 months in 95 patients and every 3 months in 15 patients. RESULTS: the mean duration of the surveillance was 36 months. A hepatocellular carcinoma was diagnosed in 13 patients. Curative treatment was done in only 3 cases and consisted in a hepatic resection in 1 patient and an alcoolisation in 2 cases. Ten patients had new treatment : for 8 patients the discussed was very agressive and 2 patients had a server hepotic failure. The cost of this study was 37.500 Tunisian dinars. CONCLUSIONS: systematic screening for hepatocellular carcinoma offer a limited cost effectiveness ratio.     

Primary Gingival Melanoma: An Important Entity

Primary melanoma of the mandibular gingiva is extremely rare. It is often misinterpreted as a benign pigmented process. The prognosis of this entity is very poor. We report here the first case of primary gingival melanoma described in the Tunisian literature about a 55-year-old smoker having cerebral and pulmonary metastases from gingival melanoma at diagnosis. Our patient underwent brain radiotherapy at a dose of 18 Gy in three sessions but he died with a decline of 3 months before starting systemic therapy. Therefore, each new case should be illustrated to make clinicians aware about the importance of the early diagnosis to improve the poor diagnosis of this entity.     

Characterization of copy number variants for <Emphasis Type="Italic">CCL3L1</Emphasis> gene in rheumatoid arthritis for French trio families and Tunisian cases and controls

Analyses of copy number variants (CNVs) for candidate genes in complex diseases are currently a promising research field. CNVs of C–C chemokine ligand 3-like 1 (CCL3L1) gene are candidate genomic factors in rheumatoid arthritis (RA). We investigated CCL3L1 CNVs association with a case-control study in Tunisians and a transmission analysis in French trio families. Relative copy number (rCN) of CCL3L1 gene was quantified by droplet digital PCR (ddPCR) in 100 French trio families (RA patients and their two parents) and in 166 RA cases and 102 healthy controls from Tunisia. We calculated odds ratio (OR) to investigate association risk for CCL3L1 CNVs in RA. rCN identified varied from 0 to 4 in the French population and from 0 to 7 in the Tunisian population. A significant difference was observed in the distribution of these rCNs between the two populations (p?=?2.34?×?10^?10), as when rCN from French and Tunisian RA patients were compared (p?=?2.83?×?10^?5). CNVs transmission in French RA trios allowed the characterization of genotypes with the presence of tandem duplication and triplication on the same chromosome. RA association tests highlighted a protective effect of rCN?=?5 for CCL3L1 gene in the Tunisian population (OR?=?0.056; CI 95 % [0.01–0.46]). Characterization of CCL3L1 CNVs with ddPCR methodology highlighted specific CN genotypes in a French family sample. A copy number polymorphism of a RA candidate gene was quantified, and its significant association with RA was revealed in a Tunisian sample.     

Is measurement of progesterone level prior to FSH stimulation useful in GnRH-antagonist cycles?

Aim. To reduce patient inconvenience during in vitro fertilization (IVF) cycles, some protocols delay intensive monitoring until mid-follicular stimulation. Others assess hormone levels prior to follicle-stimulating hormone (FSH) administration, not commencing stimulation until baseline progesterone (P4) levels (< 5 nmol/l) are achieved. Higher P4 levels (> 4.8 nmol/L) on the day of FSH trigger have been implicated in poorer pregnancy rates. This study evaluates the association of P4 levels at day 1–2 in gonadotrophin-releasing hormone (GnRH)-antagonist cycles with pre-trigger P4 levels and clinical pregnancy rates (CPRs). Method. All fresh GnRH-antagonist IVF cycles between June 2011 and June 2012, in which pre-FSH P4 levels were not routinely performed (group 1), were retrieved from the IVF Australia database and compared with controls (group 2). Results. There were 163 cycles in each group. P4 levels on the day of trigger were significantly higher in group 1 (3.75 vs. 2.77, p < 0.05). The incidence of pre-trigger P4 levels >4.8 nmol/l was significantly higher in group 1 (30 vs. 16, p < 0.05). The number of oocytes retrieved was higher in group 1 (11.1 vs. 9, p < 0.05), however fertilization rates were significantly lower in that group (53.6% vs. 61.2%, p < 0.05); CPRs were similar between the two groups (27.8% vs. 31.8%, p = ns). Overall, pregnancy rates were lower in cycles with pre-trigger P4 level of > 4.8 nmol/L compared with those with lower levels (15% vs. 32.5%, p < 0.05). Conclusion. We found that measurement of P4 level at early follicular phase was associated with significantly lower pre-trigger levels. However, this did not translate into a difference in CPR between the monitored and unmonitored groups. We have confirmed that elevation in pre-trigger P4 level is associated with halving of the CPR, indicating that the most important P4 measurements are those in the late follicular/pre-trigger phase.     

A novel extended-spectrum TEM-type beta-lactamase, TEM-138, from Salmonella enterica serovar Infantis

A novel natural TEM beta-lactamase with extended-spectrum activity, TEM-138, was identified in a ceftazidime-resistant clinical isolate of Salmonella enterica serovar Infantis. Compared to TEM-1, TEM-138 contains the following mutations: E104K, N175I, and G238S. The bla(TEM-138) gene was located on a 50-kb transferable plasmid. Expression studies with Escherichia coli revealed efficient ceftazidimase and cefotaximase activities for TEM-138.     

−1154G/A and −2578C/A polymorphisms of the vascular endothelial growth factor gene in Tunisian Alzheimer patients in relation to β-amyloid (1–42) and total tau protein

Recent evidences indicate that polymorphisms within the promoter region of the vascular endothelial growth factor (VEGF) gene may elevate the risk for Alzheimer's disease (AD). To further investigate, we have analyzed association between promoter polymorphisms of the VEGF gene in 93 AD patients and age and sex matched 113 controls from Tunisian population. The distribution of genotype and allele frequencies of the VEGF (−2578C/A) and (−1154G/A) polymorphisms did not differ significantly between AD and control groups (p > 0.05). In the subgroup of ApoE ?4 carriers, the −2578A was observed to be significantly higher in the AD patients than in the control individuals. After adjusting the data by gender, age and the ApoE ?4 status using logistic regression, the −2578A allele was found to increase the risk for sporadic AD by 1.7-fold. The present study provides the evidence that the −2578A allele may be associated with the development of AD in the individuals with ApoE ?4 allele. In addition, AD patients carrying the −2578A allele had lower Aβ42 (p = 0.029) levels than those without this allele, particularly in subjects with ApoE ?4 allele.