Smoking prevention and cessation in the Africa and Middle East region: a consensus draft guideline for healthcare providers--executive summary

Despite the abundance of scientific evidence confirming the health consequences of smoking and other forms of tobacco use, the tobacco epidemic remains an important public health problem and by 2030 it is predicted that more than 80% of tobacco deaths will be in developing countries. In Africa and the Middle East, many local factors contribute to the initiation and maintenance of tobacco use. Although efforts to reduce the mortality and morbidity associated with smoking and tobacco dependence are underway, there is a need for guidance on how to utilize appropriate tobacco control policies and psychology- and pharmacology-based therapies to counter tobacco dependence as recommended by the Framework Convention on Tobacco Control (FCTC). A group of tobacco cessation experts from public health services and/or academic institutions in Africa and the Middle East participated in a series of four meetings held in Cairo, Cape Town, and Dubai between May 2008 and February 2011 to develop a draft guideline tailored to their region. This article provides the background to the development of this draft smoking cessation guideline and discusses how the recommendations can be implemented and progress monitored to promote both primary prevention and cessation of tobacco use within our countries. The draft guideline for Africa and the Middle East provides an important resource in combating the devastating effects of tobacco use in these regions which can be further localized through engagement with local stakeholders in the countries of the region.     

Evaluation of motion sickness susceptibility by motion sickness susceptibility questionnaire in adolescents with idiopathic scoliosis: a case–control study

Purpose

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine, with unknown origin. Some studies have noted impaired postural balance in AIS, in particular, difficulty to manage situations with sensory conflict. The motion sickness susceptibility can be secondary to a sensory conflict, for example, between visual and vestibular information. Our hypothesis is: patients with AIS have difficulty in managing situations with sensory conflict and therefore have increased motion sickness susceptibility. The purpose of this study was to evaluate in AIS subjects by evaluating their susceptibility to motion sickness, as compared to a control group.

Methods

We conducted an analysis of data on motion sickness susceptibility collected prospectively from 2012, with the B score of motion sickness susceptibility questionnaire. This evaluation was completed for 65 adolescents (age 14.5 ± 1.6 year) with major right thoracic AIS (Cobb = 40.7° ± 13.1°) and 71 matched controls (14.6 ± 1.6 year).

Results

Adolescents with major right thoracic AIS were more susceptible to motion sickness (B score = 5.3 ± 5.8) than controls (B score = 3.4 ± 3.7) with significant difference (p = 0.025).

Conclusions

We interpret our results suggesting there is difficulty for patients with AIS to manage situations with sensory conflict. Previous studies focusing on situations with sensory conflict in AIS have required sophisticated technology. They are not accessible for routine patient management. Our research shows the same result with simple, non invasive, low-cost and quick method: B score of motion sickness susceptibility questionnaire.

     

The effect of delivering the chemokine SDF-1α in a matrix-bound manner on myogenesis

Several chemokines are important in muscle myogenesis and in the recruitment of muscle precursors during muscle regeneration. Among these, the SDF-1α chemokine (CXCL12) is a potent chemoattractant known to be involved in muscle repair. SDF-1α was loaded in polyelectrolyte multilayer films made of poly(l-lysine) and hyaluronan to be delivered locally to myoblast cells in a matrix-bound manner. The adsorbed amounts of SDF-1α were tuned over a large range from 100 ng/cm² to 5 μg/cm², depending on the initial concentration of SDF-1α in solution, its pH, and on the film crosslinking extent. Matrix-bound SDF-1α induced a striking increase in myoblast spreading, which was revealed when it was delivered from weakly crosslinked films. It also significantly enhanced cell migration in a dose-dependent manner, which again depended on its presentation by the biopolymeric film. The low-crosslinked film was the most efficient in boosting cell migration. Furthermore, matrix-bound SDF-1α also increased the expression of myogenic markers but the fusion index decreased in a dose-dependent manner with the adsorbed amount of SDF-1α. At high adsorbed amounts of SDF-1α, a large number of Troponin T-positive cells had only one nucleus. Overall, this work reveals the importance of the presentation mode of SDF-1α to emphasize its effect on myogenic processes. These films may be further used to provide insight into the role of SDF-1α presented by a biomaterial in physiological or pathological processes.     

Total mercury and selenium concentrations in Sarpa salpa and Balistes capriscus and in their respective Digenean endoparasites Robphildollfusium fractum and Neoapocreadium chabaudi from Tunisia

The present study reports the levels of mercury and selenium in Sarpa salpa and Balistes capriscus collected along the coast of Mahdia and Sfax (Tunisia). The systems constituted by S. salpa and Robphildollfusium fractum and by B. capriscus and Neoapocreadium chabaudi were tested as potential bioindicators to monitor environmental Hg pollution in marine ecosystems. Mercury and selenium concentrations were assessed in kidney, liver and muscle of 51 S. salpa and of 45 B. capriscus as well as in their respective endoparasites R. fractum and N. chabaudi. The Se:Hg molar ratios were evaluated for both species across the study areas. Surprisingly, the Se:Hg molar ratio in B. capriscus muscle from Mahdia is significantly lower than in Sfax. Our results indicate that some parasites may also be implicated in the amount of Se and Hg available in tissues and therefore contribute to oscillations of the Se:Hg molar ratios. In the model involving the carnivorous species (B. capriscus), the 5.1-times higher levels of mercury in N. chabaudi than in B. capriscus muscle in Sfax enable this fluke to be a sensitive biomonitoring tool for Hg pollution. The present results confirm that the habitual consumption of S. salpa should not suppose any potential health risk for Tunisian people. On the other hand, the consumption of B. capriscus may be of concern and further monitoring is advisable, since the Hg average concentration in Mahdia was above the maximum allowed Hg concentration in the edible portion of fish fixed by the European Union.     

Radiomics in radiation oncology for gynecological malignancies: a review of literature

Radiomics is the extraction of a significant number of quantitative imaging features with the aim of detecting information in correlation with useful clinical outcomes. Features are extracted, after delineation of an area of interest, from a single or a combined set of imaging modalities (including X-ray, US, CT, PET/CT and MRI). Given the high dimensionality, the analytical process requires the use of artificial intelligence algorithms. Firstly developed for diagnostic performance in radiology, it has now been translated to radiation oncology mainly to predict tumor response and patient outcome but other applications have been developed such as dose painting, prediction of side-effects, and quality assurance. In gynecological cancers, most studies have focused on outcomes of cervical cancers after chemoradiation. This review highlights the role of this new tool for the radiation oncologists with particular focus on female GU oncology.     

Pathomimia in upper limb

Pathomimia, or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considerd as a psychatric disorder, pathomimuia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms, A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements.     

Gastrointestinal manifestations in severe scorpion envenomation

OBJECTIVES: To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance. PATIENTS AND METHODS: All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002). RESULTS: During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission. CONCLUSION: In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.