Improving participation of detained men in organised screening of colorectal cancer in Toulon

In France, organised screening for colorectal cancer was set up in 2008. Participation rate was assessed in March 2014 at the prison of Toulon / La Farlède. On the 100 detained men aged 50-74 years old concerned by screening, only 3.9 % were screened. A project aiming at improving participation in screening while addressing specific difficulties related to prison settings (lack of privacy in cells, low socioeconomic and education status of the population, stronger exposition to risk factors for colorectal cancer) was launched in 2015 and has been yearly conducted since then. How to improve colorectal cancer screening in a prison setting? How to organise a sustainable screening program? What proximity guidance should be provided to foster participation? The program that was developed mainly consisted in awareness sessions and proximity guidance to testing. Among the 330 detained men targeted between 2015 and 2018, 165 men performed an immunologic test (57.9%) and 45 were excluded for medical reasons. Colonoscopy was performed for 10 of the 13 men with a positive result and lesions were detected for 9 men. Among them, one cancer, 6 high-risk polyps and 2 low-risk polyps were found. Those findings exceeded expected numbers. Despite a small population sample, data revealed the benefit of the project in comparison with other participation rates: only 33.5% in France and 29.3% in the Var department (estimates for 2016-17 by Santé Publique France). Furthermore, we achieved a participation rate compliant with European recommendations establishing 45% as a minimum target. The success of our program relied on the synergy between health prevention professionals screening organisers and prison medical staff. Strong involvement of each team constituted a real leverage for project to ensure effective proximity guidance for detained persons leading them to get screened. Key messages Awareness program adapted to prison improved participation in colorectal cancer organised screening. Proximity guidance helped to detect cancer and to improve medical care of detained persons.

A man with history of heavy alcoholic drinking

A 33-year-old Thai man presented with fever and jaundice for 10 days. He had history of significant alcohol intake. Physical examination revealed tender hepatomegaly and signs of chronic liver stigmata. Laboratory results showed: TB 17.5 mg/dL; DB 13.1 mg/dL; AST 230 IU/L; ALT 77 IU/L; ALP 332 IU/L; albumin 2.5 g/dL; globulin 3.9 g/dL; PT 13.4 sec. Serum immunologic test were negative for HAV, HBV, HCV and HEV. The histological result from liver biopsy was compatible with alcoholic steatohepatitis. Maddrey’s discriminant function was 79. Prednisolone 40 mg/day was prescribed. The clinical and liver function tests gradually improved after treatment. Figure 1 พยาธิสภาพของชิ้นเนื้อตับ (A) ย้อม H&E (20x) พบ Macrovesicular steatosis, Ballooning hepatocyte & Mallory-Denk bodies (วงกลมสีแดง), Lobular inflammation with neutrophilic infiltrate (วงกลมสีดำ), Canalicular cholestasis (ลูกศร) (B) ย้อม H&E (40x) พบ Ballooning hepatocytes และ Mallory-Denk bodies (ลูกศร) (C) ย้อม Masson’s trichrome พบ Fibrosis stage 4

Association of HLA-B*5701 Genotypes and Abacavir-Induced Hypersensitivity Reaction: A Systematic Review and Meta-Analysis

OBJECTIVES: This study aimed to systematically review and quantitatively synthesize the association between HLA-B*5701 and abacavir-induced hypersensitivity reaction (ABC-HSR). METHODS: We searched for studies that investigated the association between HLA-B genotype and ABC-HSR and provided information about the frequency of carriers of HLA-B genotypes among cases and controls. We then performed a meta-analysis with a random-effects model to pool the data and to investigate the sources of heterogeneity. RESULTS: From 1,026 articles identified, ten studies were included. Five using clinical manifestation as their diagnostic criteria, 409 and 1,883 subjects were included as cases and controls. Overall OR was 23.6 (95% CI = 15.4 – 36.3). Whereas, the another five studies using confirmed immunologic test as their diagnostic criteria, 110 and 1,968 subjects were included as cases and controls, respectively. The association of ABC-HSR was strong in this populations with HLA-B*5701. Overall OR was 1,056.2 (95% CI = 345.0 – 3,233.3). CONCLUSIONS: Using meta-analysis technique, the association between HLA-B*5701 and ABC-HSR is strong in the studies using immunologic confirmation to identify ABC-HSR. These results support the US FDA recommendations for screening HLA-B*5701 allele before initiating abacavir therapy.This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Hypomorphic mutations in PRF1, MUNC13-4, and STXBP2 are associated with adult-onset familial HLH

Familial hemophagocytic lymphohistiocytosis (HLH) is a rare primary immunodeficiency disorder characterized by defects in cell-mediated cytotoxicity that results in fever, hepatosplenomegaly, and cytopenias. Familial HLH is well recognized in children but rarely diagnosed in adults. We conducted a retrospective review of genetic and immunologic test results in patients who developed HLH in adulthood. Included in our study were 1531 patients with a clinical diagnosis of HLH; 175 patients were 18 years or older. Missense and splice-site sequence variants in PRF1, MUNC13-4, and STXBP2 were found in 25 (14%) of the adult patients. The A91V-PRF1 genotype was found in 12 of these patients (48%). The preponderance of hypomorphic mutations in familial HLH–causing genes correlates with the later-onset clinical symptoms and the more indolent course in adult patients. We conclude that late-onset familial HLH occurs more commonly than was suspected previously.

Correlation between rapid urease test and pathohistological gastrobiopsy finding with positive immunological test in detecting Helicobacter pylori infection

Introduction. Helicobacter pylori is a bacterium that has been in the limelight of gastroenterologists and oncologists worldwide since its immediate effect on the development of gastritis, ulcer disease, mucosa-associated lymphoid tissue lymphoma and gastric cancer was proved. The aim of this study was to determine the correlation between the positive immunological test, rapid urease test and pathohistological finding in detecting Helicobacter pylori infection of the gastric mucosa. Material and Methods. This retrospective study included 250 endoscopic findings of subjects having undergone endoscopy in the first half of 2010 at the Ward of Gastroenterology, Department of Internal Diseases, Hospital in Senta. The endoscopy procedure was performed by Fujinon endoscopes and the fast urease test was done by the Cambridge Life Science set from England. The immunological test was carried out by the Vidas apparatus applying the Enzyme-Linked Fluorescent Assay (ELFA) technique and the staining for the pathohistological analysis was done by the modified Giemsa method. Results. The paper presents the results obtained by endoscopic examination of a group of 250 patients performed at the Ward of Gastroenterology, Department of Internal Diseases, Hospital in Senta. The endoscopic findings were the first to be analyzed then the rapid urease test findings, which showed that 95 (38%) patients were positive and 155 (62%) patients were negative; whereas the immunologic test for Helicobacter pylori was positive in all 250 patients (100%). The histological test for Helicobacter-Like Organism was positive in 105 subjects (42%), whereas it was negative in 145 patients, that being 58% of all the cases. Sensitivity, specificity and predictability of the serological test and the rapid urease test were calculated according to the pathohistological finding as the ?gold standard? and they were found to be: sensitivity 100% and specificity 0% for the serological test and sensitivity 90% and specificity 100% for the rapid urease test. The immunologic test was not correlated with other findings, and there was a high level of correlation between the rapid urease test and histological test (r=0.927589261). The t-test was calculated to be 36.16513; p=0.0001; that indicating that the correlation coefficient was statistically significant (p>0.01). Discussion. The obtained results were compared with the data found in the available literature sources. Conclusion. It can be concluded that the most competent technique for the optimal diagnosis of Helicobacter pylori infection is the invasive one with the pathohistological examination of bioptates together with the rapid urease test.

Primary echinococcal cyst in the thyroid gland: a case report from Iran

Hydatid disease is prevalent in most sheep-raising countries in Asia , Australia , East, and Southern Europe. Hydatid disease caused by Echinococcus granulosus is often manifested by a slow growing cyst mass. Hydatid cysts may be found in almost every parts of the body. However the lungs and liver are the most involved locations. Due to the vital cycle of the parasite the thyroid gland is an uncommon site of infection even in the countries where the disease is endemic. However, hydatic origin was suspected in only 50% of patients preoperatively and immunologic test had 33% false positive rate. Although hydatid cyst was considered intra-operatively and confirmed by a frozen section histology. This study is to report a case of primary hydatid disease of the thyroid.