Case Report of Cutaneous Squamous Cell Carcinoma at the Wrist Joint and the Public Health Crisis of Arsenicosis

Context. Arsenicosis is caused by long term (6 months plus) ingestion of arsenic above a safe dose, characterized by skin lesions and possible involvement of internal organs. Arsenicosis is common in India and Bangladesh where naturally occurring high concentrations of arsenic in the earth's crust contaminate ground water, causing adverse health effects. Case Presentation. We report a case of a 55-year-old Indian male, resident of a known arsenic endemic region of Uttar Pradesh who suffered from characteristic pulmonary and cutaneous features of chronic arsenic toxicity which included radiological findings of interstitial lung disease, hyperkeratotic lesions over the palms and soles, rain drop like pigmentation over the trunk, and carcinomatous changes at the wrist joint. The patient was started on chelating agents (d-penicillamine) and oral retinoids (isotretinoin) followed by the surgical excision of the carcinoma. Discussion. Environmental contamination with arsenic is a well-known health hazard in South Asian countries. The main source is consumption of contaminated ground water for domestic purposes. Cutaneous lesions, internal organ involvement including interstitial lung disease and carcinomas as observed in our patient have been reported in the literature. Various mechanisms like epigenetic changes and arsenic-induced immune suppression have been proposed for the development of cutaneous carcinomas with prolonged exposure to arsenic. Relevance to Clinical Practice. Among the various causes of palmo-plantar hyperkeratosis, arsenicosis should be kept in mind when presenting in combination with pigmentary changes and carcinomatous growth from an arsenic-endemic region. Conclusions. People residing in arsenic-endemic regions should be made aware of arsenic-related health hazards. Rainwater harvesting and good nutrition are the simplest measures which could be adopted by the exposed population in affected areas. Several methods have also been employed by governmental and non-government organizations to separate arsenic from contaminated water to combat arsenic-related diseases and carcinomas. Competing Interests. The authors declare no competing financial interests.

The epidemiology and direct medical costs of diseases associated with human papillomavirus infection among men in Manitoba, Canada

BackgroundThere is little information on the economic burden of human papillomavirus-related diseases (HPV-RDs) among men. We used province-wide clinical, administrative and accounting databases to measure the direct medical costs of HPV infections in men in Manitoba (Canada).MethodsWe included all males aged 9 years and older with health insurance coverage in Manitoba between January 1997 and December 2016. We identified HPV-RD patient cohorts and matched each patient to HPV-RD-free men. We estimated the net direct medical cost (excess cost of hospitalizations, outpatient visits, and prescription drugs) of patients compared to their matches for anogenital warts (AGWs) and HPV-caused cancers. We adjusted costs to 2017 Canadian dollars. For each condition, we attributed costs to HPV based on the etiological fraction caused by HPV infection.ResultsWe found that the median net direct medical cost was about $250 for AGW patients and $16,000 for invasive cancer patients. The total cost was about $49 million or $2.6 million per year. Overall, 54%-67% ($26-$33 million) was attributable to HPV infection according different estimates of the attributable fraction. The net annual attributable cost was $2.37-$2.95 per male resident and $161-$200 per male newborn. The estimated potential savings was 30% for the bivalent vaccine and 56%-60% for the quadrivalent and nonavalent vaccines.ConclusionsOverall, HPV’s economic burden on males remains significant, the average cost of treating all conditions attributable to HPV was about $180 per male newborn. Invasive cancer accounted for the majority of these costs.

Demographic and Psychosocial Determinants of Life Satisfaction Among Youths in Nigeria: Evidence from the Multiple Indicators Cluster Survey

Subjective Wellbeing, implying an evaluation of one’s life has recently received intellectual attention, especially in developed countries. Measuring this concept entails both an effective and cognitive evaluation of life. Life satisfaction plays a vital role in positive life outcomes as a key part of the cognitive component of subjective wellbeing. Various factors could determine the current state of wellbeing on an individual. Leveraging on one of the surveys that collect data on subjective wellbeing in Nigeria, we examined the determinants of life satisfaction among youths in Nigeria, with a concentration on the demographic and psychosocial factors. Multiple Indicator Cluster Survey (MICS) data for Nigeria (n = 18,454) was analyzed using chi-square tests and binomial logistic regression in Stata 14. The result showed that gender, residence, and region significantly determined life satisfaction. For psychosocial factors influencing life satisfaction; health, family life satisfaction, friendship, treatment by others, and perceived improvement in comparison to last year, significantly determine life satisfaction. Specifically, male resident in rural areas of Nigeria were more likely to report satisfaction with life. Further, youths that reported satisfaction with family life were more likely to be satisfied with life in general, while satisfaction with health, friendships, treatment by others, and improved condition from last year influenced satisfaction with life. In conclusion, it has been shown that beyond the socio-demographic factors, psychosocial determinants play vital roles in determining life satisfaction among youths. It is therefore imperative that government agencies consider policies and interventions that address psychosocial support for youths in Nigeria.

The Role of Gender in Ophthalmology Resident Evaluations

Background Gender affects various aspects of medical training. Prior research in surgical specialties has shown that female residents are given less positive feedback, granted less autonomy in the operating room, perform fewer procedures, and achieve competency milestones at a slower rate as compared with their male counterparts. Purpose The purpose of this research is to evaluate whether gender affects ophthalmology resident evaluations at a single institution. Methods Ophthalmology resident evaluations at a single residency program from 2010 to 2018 were reviewed. Data were collected on faculty gender, resident gender, and year of resident training. A linear mixed-effects model was utilized to analyze the degree to which differences in evaluation scores could be predicted from demographic data, while accounting for multiple sources of nonindependence of data. Results A total of 490 evaluations for 43 residents by 34 faculty were analyzed. Evaluations consisted of up to 23 questions graded on a scale from 0 (poor) to 9 (excellent). Female residents received marginally higher scores than male residents on average (coefficient of male residents = −0.2). Both male and female residents received marginally lower scores from male faculty than from female faculty on average (coefficient of male faculty = −0.21). Male faculty also appeared to have scored male residents lower to a greater degree than did female faculty (coefficient of male faculty by male resident interaction = −0.14), though this result was sensitive to model specifications. There was no significant interaction between year of resident training and gender. Conclusion In contrast to other procedural specialties, female residents appear to have been graded at a similar level or higher than male residents on average. Male faculty gave slightly lower scores to both male and female residents than female faculty did. Male faculty also may have graded male residents marginally lower than female residents to a greater degree than female faculty did.

Filariasis Diagnosed by Real Time Sonographic Imaging as Filarial Dance Sign: A Case Report

Lymphatic filariasis is a major public health problem. World Health Organization (WHO) has graded filariasis, as the second leading cause for permanent and long-term disability after leprosy. It is a chronic disabling parasitic disease prevalent in South Asia and Africa. A case of 26-year-old male resident of district Palpa presented with swelling of left inguinal region since 3-4 days and pain in inguinal region since a month. He had no history of trauma, fever or any other systemic symptoms. High frequency, high-resolution scrotal ultrasonography is a valuable technique for diagnosing scrotal filarial infection. This method revealed “Filarial Dance Sign” which is a distinctive and continuous pattern of movement of live microfilaria indicating active infection. It is a simple, rapid, sensitive and noninvasive technique. Noninvasive ultrasonography is preferable to the invasive FNAC.

Primary Renal Squamous Cell Carcinoma: An Unusual Malignancy

Malignancies of the upper urinary tract are rare, accounting for about 8% of all malignancies of the renal system, presenting mostly as urothelial carcinoma. Squamous cell carcinoma (SCC) arising from the upper urinary tract is even more rare, accounting for about 0.5% of all malignancies of the renal system and 10% of all renal pelvic tumors. There are very few case reports in the indexed literature regarding renal squamous cell carcinoma. Here we present a case of SCC arising from the lower pole of left kidney, in a 35-year-old male resident of Muzaffarabad, Azad Kashmir.

Complete Genome Sequence of a Novel Human Papillomavirus Isolated from Oral Rinse

ABSTRACT A novel human papillomavirus (HPV TG550) isolated from the oral rinse of a Chinese male resident was fully characterized. The L1 open reading frame of HPV TG550 shares 82.5% nucleotide sequence similarity with its closest relative, HPV166, and clusters within the species group Gammapapillomavirus 19.