Use of fMRI to predict psychiatric adverse effects of interferon treatment for Hepatitis C – preliminary report

Interferon alfa2 (IFN-α2) is a parenterally administered cytokine used to treat patients with Hepatitis C and B, and malignancy. Interferon (INF) has a relatively high rate of central nervous system (CNS) adverse effects, including agitation, depression, fatigue, cognitive dysfunction, suicidal thought and drug craving. Using functional magnetic resonance imaging (fMRI) we studied patients with Hepatitis C virus (HCV) infection who were not more than mildly clinically depressed at baseline for their CNS reaction to IFN-α2. During fMRI, patients underwent visual stimulation with pictures designed to induce feelings of depression. In the two patients who became clinically depressed or markedly anxious while on treatment with interferon, but not in patients who did not experience these effects, there was a significant activation in specific areas of the brain known to be involved with depression, along with an increase above baseline in the Beck Depression Scale for the patient who developed INF-induced depression. The activation pattern differed from that previously observed for endogenous depression, indicating that INF-induced depression may differ in its underlying neuropathology. Functional magnetic resonance imaging can be an important tool in understanding and monitoring for (INF and other) medication-induced CNS effects, and response to treatment.     

Functional imaging of a large demyelinating lesion.

PURPOSE: To determine the metabolic characterization of a large solitary demyelinating lesion. METHODS: Magnetic Resonance Spectroscopy (MRS) and Positron Emission Tomography (PET) studies with 2-deoxy-2-[F-18]fluoro-d-glucose (FDG), carbon-11-methionine (methionine) and carbon-11-choline (choline) were done on the demyelinating lesion. RESULTS: The demyelinating lesion exhibited a low glucose uptake, prominent methionine uptake and a minimal choline uptake on the PET studies. MRS data revealed an increased choline to creatine (cho/cr) ratio and a decreased N-acetyl-aspartate to creatine (NAA/cr) ratio, which demonstrated a return to near normal ratios on follow-up study. CONCLUSION: The report summarizes the metabolic characteristics of a demyelinating plaque.     

Pancreatic Adenocarcinoma in Young Adults in a Moroccan Population

Introduction

Pancreatic adenocarcinoma (PAC) is diagnosed generally in patients older than 60 years old of age. It is rarely diagnosed in young adults. There is a dearth of data in younger population of patients with pancreatic ductal adenocarcinoma regarding epidemiology, prognosis, and outcome. The aim of our study of young PAC patients was to characterize the clinical features of this distinct young population who were treated in the National Institute of Oncology of Rabat. We selected the age of 45 years and under as the cutoff point in defining our patient population of interest.

Materials and Methods

A retrospective analysis of patients referred to the national institute of oncology of Rabat with PAC, who were ≤45 years at the date of histological diagnosis, between January 2005 and February 2010, was performed. Epidemiological, clinical, and pathological staging and therapeutic and follow-up data were extracted.

Results

The study included 32 cases of PAC. Male:female ratio was 2:1. It represents 17 % of the entire population (N?=?176) of PAC referred to the National Institute of Oncology over the time of study period. Mean age was 44 years old (range: 28–45). Age range distribution was 1, 5, and 26 patients in age subgroups 20–29, 30–39, 40–45 years, respectively. Four patients (12.5 %) had a smoking history and two patients (6 %) had diabetes. None of the patients had a positive familial history of PAC or chronic pancreatitis. Tumor was located in head of pancreas in 75 %, body in 12.5 %, and tail in 12,5 %. Six patients (18.7 %) had localized resectable disease and underwent resection with curative intent. Seven (21.8 %) presented with locally advanced, inoperable disease. Two of them received only concurrent chemoradiation. Nineteen patients (59.3 %) presented as AJCC Stage IV. Four (12.5 %) of the six patients with resected tumors underwent adjuvant chemoradiation. Median overall survival was 50 % at median follow-up of 6.8 months.

Conclusion

This is the first reported study in our patient population of young patients with PAC. The data suggested that patients with younger age seem to have the same poor prognosis as the typical (older) patient population with PAC. No risk factors have been identified. However, this study is retrospective and more larger studies are needed in this young population.     

Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date

Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis.We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%.On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children—including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.     

A survey of gastrointestinal helminthes in stray cats in northern Iran

The aim of this study was to determine the prevalence of the feline intestinal helminthes in Sari, northern Iran. From April to October 2004, post-mortem examinations were carried out on 100 stray cats. The gastrointestinal tract was removed, opened up and the mucosa examined microscopically for mature and immature worms. Overall, 90% of cats were infected with a high prevalence of Ancylostoma tubaeforme (64%). In relation to sex, the differences were not significant. Infection with multiple parasite species (53%) was more common than infection with only one species of parasite (37%). There was significant difference in the prevalence of infection between adult and juvenile cats (p < 0.05). From the veterinary and medical points of view, stray cats represent potential reservoirs of disease. Children especially may be at great risk, since they are more likely to come in closer contact with cats and with contaminated soil when playing with the cats and in the garden. Both animal and human health education are recommended in these communities.     

Functional imaging in Lhermitte-Duclose disease.

PURPOSE: A comprehensive metabolic characterization of a patient with dysplastic gangliocytoma of the cerebellum or Lhermitte-Duclos Disease (LDD) is presented. PROCEDURES: Assessment using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), carbon-11-labeled methionine (11C-MET), carbon-11-labeled choline (11C-Choline) positron emission tomography (PET), and 1H-proton magnetic resonance spectroscopy (MRS) was carried out in a 30-year-old Caucasian woman. RESULTS: FDG-PET revealed hypermetabolism of the tumor. 11C-MET-PET revealed moderate uptake and 11C-Choline showed no uptake. 1H-MRS demonstrated an elevated level of lactate and decreased levels of choline (Cho) and myoinositol. CONCLUSION: Functional imaging in LDD reflects the dual pathological features of neoplasm and hamartoma.     

Evaluation of the Finnish Diabetes Risk Score (FINDRISC) as a Screening Tool for the Metabolic Syndrome

OBJECTIVES: Traditionally, the Finnish Diabetes Risk Score (FINDRISC) questionnaire is a screening tool to estimate risk of type 2 diabetes. In this study, we evaluated the ability of FINDRISC to predict the development of the metabolic syndrome (MetS) in an Iranian population without diabetes and MetS. METHODS: A total of 1,010 first-degree relatives of consecutive patients with type 2 diabetes, 30-70 years old (274 men and 736 women), without diabetes and MetS, were examined and followed up over 8.0 ± 1.6 years (mean ± SD) for MetS incidence. The incidence of MetS was examined across quartiles of FINDRISC, and a receiver operating characteristic (ROC) curve was plotted to assess the discrimination. At baseline and through follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). Data for determining FINDRISC were available from each participant. RESULTS: During 8,089 person-years of follow-up, 69 men and 209 women without MetS and diabetes at baseline subsequently developed MetS. The incidence of MetS was 31.4 per 1000 person-years in men and 35.5 in women. The FINDRSC at baseline was significantly associated with MetS evolution. Participants in the top quartile of FINDRISC were 4.4 times more likely to develop MetS than those in the bottom quartile (rate ratio 4.4; 95% CI 2.7-7.0). The area under the ROC curve was 65.0% (95% CI 61.3-68.7). CONCLUSION: The results of this study suggest that FINDRISC can be applied to detect MetS in a high-risk population.     

KDR gene polymorphisms and idiopathic recurrent spontaneous abortion

Objective: Process of angiogenesis is essential for successful gestation. Disruption in this pathway leads to various undesirable consequences in pregnancy such as recurrent spontaneous abortion (RSA). One of the most important genes involved in angiogenesis is kinase-insert domain-containing receptor (KDR). This study aimed to investigate the associations between two single-nucleotide polymorphisms (SNPs) of KDR gene, 1719A?>?T and 1192G?>?A, with idiopathic RSA in south-east Iran.

Methods: A total of 230 women, including 110 women with a history of at least two consecutive spontaneous miscarriages and 120 healthy women were recruited in this study. Genomic DNA was extracted from peripheral blood samples of participants using the Salting out method. The KDR 1719A?>?T and 1192G?>?A polymorphisms were genotyped by the standard amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) technique.

Results: For the case group, frequencies of 2.73%, 30% and 67.27% were observed for AA, AT and TT genotypes in1719A?>?T SNP, respectively, and the genotype frequencies for controls were equal to AA?=?3.33%, AT?=?32.5% and TT?=?64.17%. Distribution of genotypes in 1192G?>?A SNP in the case group was 79.1%, 19.1% and 1.8% for GG, AG and AA, respectively, whereas the corresponding values for the controls were GG = 80%, AG = 20% and AA = 0. No significant difference was found between the case and control groups based on the frequency of KDR gene polymorphisms with the susceptibility to RSA.

Conclusions: There is no association between these two SNPs of KDR gene and the susceptibility to RSA in women from south-east Iran.     

Use of “Kangaroo Care” to Alleviate the Intensity of Vaccination Pain in Newborns

Objective

It has been demonstrated that newborns feel pain completely. Thus, they should be treated with this in mind. Recent research showed that non-pharmacological interventions such as “Kangaroo Care” may be useful for decreasing pain in newborns. We tried to determine the effect of kangaroo care on the pain intensity of vaccination in healthy newborns.

Methods

This study was a randomized case-control clinical trial. Subjects were 60 healthy full-term newborns delivered in a general Hospital, in Iran, from March to July 2006. They were randomly assigned to case and control groups. The case group received 30 minutes skin to skin contact, whereas infants in the control group were put, wrapped in a blanket, aside the mothers. Behavioral changes of newborns were evaluated and observed 2 minutes before, during, and 3 minutes after the intervention. All procedures were filmed. An assistant who was blinded to the study, scored behavior changes using Neonatal/Infant Pain Scale. Heart rate and oxygen saturation levels as displayed on the pulse monitor and duration of crying were recorded using a stopwatch.

Findings

Mean pain intensity during the intervention v was significantly lower in the case group (P<0.006). Mean pain intensity 3 minutes after intervention was also significantly lower in the case group (P<0.021). Mean duration of crying was significantly lower in case group as well (P<0.001).

Conclusion

Kangaroo care may be used to decrease pain intensity in newborns undergoing painful procedures.