ஹெபடாலஜி மற்றும் கணைய அறிவியல்

Aim: To present a systematic review on efficacy and toxicity of modern concurrent chemoradiation (CCRT) in unresectable biliary tract cancers (BTC).

Methods: A systematic review of literature published within the last ten years (1 January 2007-31 December 2017), based on PRISMA methodology and using PubMed electronic database was conducted. Only articles reporting patients’ outcome in terms of toxicity and/or overall survival (OS) or progression-free survival (PFS) after CCRT, with or without other treatments, were analyzed. Only studies of patients with diagnosis of unresectable BTC, including intrahepatic, extrahepatic, and gallbladder neoplasm were considered.

Results: Six eligible studies were included reporting data on 195 patients. Median follow-up ranged between 9.4 and 27.7 months (median: 16 months). Four studies were prospective phase II trials and 2 had a retrospective design. Different external beam radiotherapy (EBRT) techniques and chemotherapy (CT) schedules were used while only in one study a brachytherapy boost was delivered. Grade ≥ 3 acute toxicity (hematological or gastrointestinal) ranged between 0.0 and 55.6% (median: 37.0%). One study reported 30.0% gastrointestinal grade ≥ 2 late toxicity. PFS ranged between 6.8 and 10.5 months (median: 7.5 months) in 5 studies. OS ranged between 9.6 and 13.5 months (median: 13 months) in 5 studies.

Conclusion: CCRT remains a reasonable treatment option for locally advanced BTC, providing results comparable with the ones of standard CT, particularly in terms of OS. Considering the progressive advance of modern EBRT techniques, further improvement of these results can be expected. Therefore, clinical trials based on advanced radiotherapy techniques and new integrations of CCRT with systemic treatments are warranted.

Heterotopic or ectopic mucosa is ongenital anomaly elucidated as the inhabitance of tissue outside its habitual locale. This tissue is discerned coincidentally and may be asymptomatic or with nonspecific gastrointestinal symptoms. Two categories of heterotopic tissue predominantly crop up in the gastrointestinal tract, PANCREATIC and GASTRIC. Isolated heterotopic gastric mucosa (HGM) can arise at all position’s, anywhere along the gastrointestinal tract, from the oesophagus to the rectum. The incidence is sporadic but should be deliberated upon in the differential diagnosis of unexplained pain of the abdomen, bleeding from the gastrointestinal tract or weight loss. Once heterotopia is identified, suitable treatment can be instituted thereby diminishing the danger of complications. Heterotopic or Ectopic tissue is a congenital anomaly, attributed to abnormal embryologic development, of the existence of tissue apart from the typical location, with no neural, vascular, anatomic relation with the main body of an organ in which it customarily exists. Heterotopic gastric mucosa (HGM) was initially detailed by Ewell and Jackson in 1939. The congenital anomaly can be emulated by acquired transition (e.g. pyloric epithelial lining) in some organs e.g. lower oesophagus, duodenal bulb and gall bladder. HGM can appear at any location in the gastrointestinal tract, however, it is exceptional in the lower alimentary canal.

Endoscopic retrograde cholangio-pancreatography (ERCP) is an endoscopic technique to diagnose and treat variable pancreatic and biliary disorders. Liver cirrhosis increases the incidence of cholelithiasis, intrahepatic cholangiocarcinoma and pancreatic carcinoma. Post- ERCP bleeding and pancreatitis are the most common complications in those population.

Background: Hepatitis B and C viral infections during pregnancy are associated with high risk of maternal complications and mortality. There is high prevalence of vertical transmission causing fetal and neonatal hepatitis which can have serious effects on the neonate, leading to impaired physical and mental health later in life. This study was aimed at evaluating HBsAg and Anti-HCV prevalence of these viruses among pregnant women accessing antenatal care in Federal Medical Centre, Keffi, Nigeria.
Materials and methods: This prospective cross sectional study took place between May-July 2016. A total of 200 blood samples were collected from pregnant women after informed consent and self-administered questionnaires were completed. Blood samples were analyzed using HBsAg and anti-HCV immunochromatographic screening kits (Fastep Polymed Therapeutics Inc, USA). Chi square test (Smith’s Statistical Package Version 2.80, California, USA) was used for assessing the association of risk factors with the infections.
Results: The overall level of positivity for both viruses in the study population was 14.0%. The prevalence of HBsAg was 8.0% while Anti-HCV was 6.0% and no woman was coinfected with the 2 viruses. The infection rate was highest among those aged 21-30 years old and 31-40 years old for HBV and HCV respectively (p>0.05). There was a statistically significant association between the viral infections and history of blood transfusion (p<0.05). Surgical/ dental procedure was also a predictor for HCV infection (p<0.05) and was not a predictor for HBV infection (p>0.05) in this study. However, educational status, stage of pregnancy, type of marriage, parity and scarification marks did not show any statistically significant association with HBV and HCV infections (p>0.05), although there were arithmetic differences among the studied risk factors (p>0.05).
Conclusion: The study confirms a high prevalence of HBsAg and Anti-HCV among pregnant women in Central Nigeria which is a serious public health problem that cannot be downplayed. Therefore, there is need for establishment of public health measures in order to reduce disease burden and vertical transmission, including routine screening of all pregnant women for these viruses.