Dr Shahram Agah:

• Gastroenterology and liver specialist from Tehran University of Medical Sciences
• Fellowship in endosonography and endoscopy therapeutics from the German Elliptical University

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New discovery of scientists about lung cancer

Together, the McGill University Health Centre (MUHC), the Centre hospitalier de l’Université de Montréal (CHUM) and St. Mary’s Hospital Center (SMHC) have contributed to an international clinical trial that will change the way we treat non-small cell lung cancer (NSCLC)—the most common form of lung cancer. In this trial, an immunotherapy drug called pembrolizumab (KEYTRUDA®), used in conjunction with neoadjuvant chemotherapy (i.e., given before surgery) and then again after surgery, has been shown to slow cancer progression and recurrence and to reduce the presence of residual tumours in patients with early-stage operable NSCLC. In the experimental group, three out of five patients remained stable for two years (without cancer progression or recurrence), compared with two out of five in the control group, an improvement of around 50 per cent.

The interim analysis of this randomized, double-blind, Phase III clinical trial was recently presented at the American Society of Clinical Oncology (ASCO) 2023 Annual Meeting in Chicago and published in The New England Journal of Medicine.

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Cervical cancer is the growth of abnormal cells in the lining of the cervix. The most common cervical cancer is squamous cell carcinoma, accounting for 70% of cases. Adenocarcinoma is less common (about 25% of cases) and more difficult to diagnose because it starts higher in the cervix.

It is estimated that more than 900 people were diagnosed with cervical cancer in 2022. The average age at diagnosis is 49 years old.

Precancerous changes in cervical cells rarely cause symptoms. The only way to know if there are abnormal cells that may develop into cancer is to have a cervical screening test. If early cell changes develop into cervical cancer, the most common signs include:

• vaginal bleeding between periods

• menstrual bleeding that is longer or heavier than usual

• pain during intercourse

• bleeding after intercourse

• pelvic pain

• a change in your vaginal discharge such as more discharge or it may have a strong or unusual color or smell

• vaginal bleeding after menopause.

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The most common causes of end-stage renal disease (ESRD) in children are congenital, cystic, and hereditary diseases, which combined account for 38% of incident cases. The most common disorders in this category are congenital obstructive uropathies (9.5%) and renal hypoplasia/dysplasia (10%). Primary glomerular disease is the second-most common etiology accounting for 25% of new cases, predominantly due to focal segmental glomerulosclerosis (FSGS). Secondary glomerulonephritis and vasculitis account for 12% of new cases, of which lupus nephritis is the most common. The underlying etiology of ESRD also varies by age of presentation. As expected, congenital/hereditary/cystic disorders are the most common underlying cause of ESRD amongst the youngest age groups, while primary and secondary glomerular diseases are the leading cause among adolescents.

Kidney transplantation is the preferred treatment for ESRD in children and confers improved survival, skeletal growth, heath-related quality of life, and neuropsychological development compared to dialysis.

Transplantation is initially considered when renal replacement therapy is imminent. Due to increased risk of graft loss and mortality in very young children, most pediatric centers perform kidney transplantation once children achieve a weight above 10–15 kg, which is typically around the age of 2 years. The underlying etiology for kidney failure, the rapidity of decline in kidney function, and the age and size of the patient determine whether an individual can receive a pre-emptive kidney transplant without preceding dialysis, which may provide a graft survival advantage. On average, 30% of pediatric kidney transplant recipients in the U.S. receive pre-emptive transplant, and an additional 24% receive dialysis treatment for less than 1 year prior to transplant.

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According to the official announcement of the World Health Organization, one to two out of every 1,000 newborns have hearing loss in one or both ears.
According to experts, the maximum time to diagnose hearing problems in babies is up to the age of one month, and finally, the baby should be ready to start hearing rehabilitation training by the age of three months, which shows the importance of timely follow-up and parents’ attention to their child’s hearing problems.

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The use of Implantable Corneas from Pig Skin to Restore Vision

Scientists in Sweden from Linköping University have successfully developed implantable corneas from pig skin for 14 previously blind patients. From sites in Iran and India, a study was performed on 20 patients who got an implant for restoring their corneal thickness and curvature to a normal level. The visual outcome was perfect as a human-donated cornea was used.

An implant rejection was prevented due to an eight-week course of immunosuppressive eye drops used instead of the normal regimen typically used following a human corneal transplant. An eight-week course of immunosuppressive eye drops was enough to prevent implant rejection, much shorter than the regimens typically used following a human corneal transplant.

According to the analytics firm Vision Research Reports, the corneal implants market is around $420 million this year but it is expected to increase to $700 million by 2030. This growth is due to the rising prevalence of corneal diseases and the interest of industries in bioengineered, 3D-printed, and stem cell-derived corneas.

Source: Pharmiweb

 corneal / pig / Sweden / Linköping University  / Iran / Transplant

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THE INCIDENCE of chronic renal failure (CRF) in children is unknown, but current data suggest that 1.5
to 3 children per million develop end-stage renal disease (ESRD) each year.

The prevalence of CRF in the pediatric population worldwide is approximately 18 per million.

It has been reported that approximately 8% of adults on dialysis and 20% to 30% of children on dialysis have
abnormal urinary tracts.1 The registry of the North America Pediatric Renal Transplantation society confirms that different forms of obstructive uropathy (including reflux and dysplasia)

were not significantly different with regard to mean donor and recipient ages, and sex distribution. We also divided our patients
into two groups (before versus after 1996,) seeking to match patients by immunosuppressive drugs and year of transplantation.

Rejection was clinically diagnosed when a patient exhibitedtenderness over the graft site, swelling of the graft on ultrasonography, persistent fever, oliguria, hypertension, and progressive elevation of serum creati nine.

Biopsy was performed in cases of suspected rejection; the diagnosis was confirmed by increased
mesengial matrix, increased lobularity, decreased glomerular size and hyalinization, and vascular and tubular lesions. Children
returned to chronic dialysis, those who required retransplantation, and those who died of renal complications were all considered to have lost their grafts.

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The renal transplant program in Iran is one of the successful programs in the region. In 1988, a controlled live unrelated renal transplant program was started in Iran because of a low numbers of live related donors and because cadaveric renal transplant program was not established completely at that time.

Finally, therenal transplant waiting list of the country was eliminated by the end of 1999.

Recently, in the annual report of NAPRTCS, 48.6% of all transplants were from deceased donor, 41.2% were from a parent, with the remaining 10.2% from other living donors.

In developing countries, the donor sources vary depending on cultural and ethical status.

In some countries, most transplants are from living related donors, such as Egypt and some Asian countries.

In contrast, in some other countries, the majority of transplants are from deceased donors such as South Africa, Thailand…

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n

Abstract: NGAL is a member of the lipocalin protein family that has diverse function but similar structure. The functions of NGAL are not clear, but it appears to be expressed in stress conditions and in tissues undergoing involution.

Varied studies have shown increased levels of plasma or urinary NGAL in diverse renal damages. The aim of this study was the serial measurement of serum and urinary NGAL within the first week after renal transplantation in children to predict imme- diate and short-term graft function. A total of 27 patients were assessed.

These patients were classified into those with rapid reduction in serum creatinine (more than 50% reduction in serum creatinine in the first day after transplantation) and patients with slow reduction in serum cre- atinine (<50% reduction in serum creatinine). We also assessed the absolute reduction in serum creatinine before and after transplantation. Serum and urinary NGAL on the first day post-transplantation were higher in recipients with slow reduction in serum creatinine (urinary NGAL at the first day: 197 ± 153 [s.e.m.] vs. 22.54 ± 8.5 [s.e.m.],

p = 0.04; serum NGAL at the first day: 199 vs. 69.8, p = 0.003). The cutoff point of serum NGAL at the first day after transplantation for prediction of slow creatinine reduction was 174 ng/mL with a sensitivity of 100% and specificity of 95.5%. However, we did not find association between the absolute reduction in serum creatinine before and after transplantation with the amount of serum and urinary NGAL post- transplant. Additionally, we did not find any effect of high serum and urine NGAL concentration on the graft function at the first year post- transplant. Although it is supposed that high serum and urine NGAL may predict ischemia of graft in early phases; however, it appears that this mild ischemic injury to graft without DGF or SGF cannot affect the graft function in short-term period. Further studies are needed using larger transplant recipients in pediatric age group. It is also needed to determine the effects of mild ischemic injuries on the graft function in long-term period in future studies.

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