Middle Asia Research Articles

A link between severe hepatitis in children and adenovirus 41 and adeno-associated virus 2 infections.

Over the past few months there have been reports of severe acute hepatitis in several hundred, otherwise healthy, immunocompetent young children. Several deaths have been recorded and a relatively large proportion of the patients have needed liver transplants. Most of the cases, so far, have been seen in the UK and in North America, but it has also been reported in many other European countries, the Middle East and Asia. Most common viruses have been ruled out as a causative agent; hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) were not detected, nor were Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV) in many cases. A small proportion of the children had been infected with SARS-CoV-2 but these seem to be in a minority; similarly, almost none of the children had been vaccinated against COVID-19. Significantly, many of the patients were infected with adenovirus 41 (HAdV-F41). Previously, HAdV-41 had not been linked to hepatitis and is usually considered to cause gastroenteritis in both immunocompetent and immunocompromised patients. In two most recent studies, adeno-associated virus 2 (AAV2) was detected in almost all patients, together with species C and F HAdVs and human herpesvirus 6B (HHV6B). Here, I discuss the possibility that a change in tropism of HAdV-41 and changes in AAV2 may be responsible for their links to acute hepatitis.

Comparative Study of AutoML Approach, Conventional Ensemble Learning Method, and KNearest Oracle-AutoML Model for Predicting Student Dropouts in Sub-Saharan African Countries

ABSTRACT Student dropout in secondary schools is a major issue in developing countries, particularly in Sub-Saharan Africa. Sub-Saharan African countries had the highest dropout rate (37.5%), followed by South Asia (15.5%), the Middle East (11%), East Asia (9.5%), Latin America (7%), and Central Asia (3.5%). Various initiatives such as the big results now initiatives, no child left behind, and secondary education development programme as well as machine learning prediction models have been used to reduce the severity of the problem in Sub-Saharan countries. The ongoing dropout problem, particularly in secondary schools is ascribed to improper root cause identification and the absence of formal procedures that can be used to estimate the severity of the issue. This study has compared the AutoML model, ensemble learning approach, and KNORA-AutoML to predict student dropout problems. The KNORA-AutoML model scored 97% of accuracy, precision = 71%, and AUC = 87% when compared to the conventional ensemble of optimized ML models with accuracy = 96%, precision = 70%, and AUC = 78%. KNORA-AutoML model performance increased by 0.6% accuracy, 0.8% precision, and 8.7% AUC. An optimized model draws a lot of attention to the findings related to student dropout rates in developing countries.

The Rise of the Party in Arms

This article discusses the origin and nature of a novel type of revolutionary organization that emerged in the years between 1890 and 1914: the “party in arms.” A party in arms can be defined as a political party that possesses its own military branch. During this time parties in arms sprang up in eastern Europe, the Middle East, East Asia, and Latin America. This article shows how the emergence of the party in arms was part of a wider process of modernization that played out over the course of the last two centuries. Revolutionary organizations developed from relatively simple to more complex and differentiated “bureaucratic” organisms, manifesting deepening and more sophisticated, functional divisions of labor. This was a global process. This article explores some of the sociological implications of these findings, touching on classical sociology, postcolonialism, and new global history writing.

A Low-Carbon Future for the Middle East and Central Asia: What are the Options?

A Low-Carbon Future for the Middle East and Central Asia: What are the Options?

A clinical pathway for the diagnosis of sesame allergy in children

BackgroundSesame allergy (SA) is a common cause of life-threatening, persistent food allergy, not only in the Middle East and Asia, but increasingly worldwide. Commercially available tests such as extracts for skin testing or specific IgE for sesame or its components in serum, have very limited predictive values. Therefore the diagnosis is dependent on the performance of oral food challenges (OFC), frequently avoided in children, due to time and resource constraints, as well as the risk of anaphylaxis. In the current study we aimed to develop a simple, readily available, clinical tool, able to predict sesame OFC outcomes in children. MethodsChildren with a history of SA were evaluated in the outpatient allergy clinic. All children underwent natural sesame OFC, with an additional baked-sesame challenge offered to children with SA. Clinical data were compared between the sesame tolerant (ST) and SA groups. Machine-learning tools were applied, to create a simple, clinically driven, decision tree analysis (DTA), predicting the outcome of sesame OFCs and the diagnosis of SA. ResultsOne hundred four children, mean age 47.2 months, 58% boys were included, with a high prevalence of additional food allergies, atopic dermatitis, asthma, and rhinitis. Following OFC, 56 (54%) were diagnosed as ST and 48 (46%) SA. Among SA children, 85% were able to consume baked-sesame in equal or higher protein amounts compared to natural sesame paste. Compared to ST, SA children had a tendency towards a higher incidence of allergic rhinitis (5% Vs 17%, p = 0.062), multiple food allergies (3.6% vs 12.5%, p = 0.09) and requiring medical treatment after the initial SA reaction (27% vs 41%, p = 0.022). As a group, skin tests with both commercial and natural tahini paste differed significantly between ST and SA (mean wheal in mm, for extract 4.2 vs 13.4, p < 0.001 and for natural sesame paste 6.7 vs 24.4, p < 0.001), However, the PPV of any individual test was only between 60%–85%. Our exploratory, clinical DTA, predicted OFC outcomes and the presence or absence of Sesame Allergy, with ≥96% positive (PPV) and negative (NPV) predictive values. ConclusionOFCs remain the gold standard for the diagnosis of Sesame Allergy and are indicated to define ST/SA status even in highly atopic patients with previous immediate allergic reactions to sesame. A decision-tree analysis based on clinical parameters easily available in every allergy clinic, can predict the outcome of sesame OFC in the vast majority of children, increasing the safety and availability of such diagnostic procedures.

Editorial introductions.

Editorial introductions.

Isolation and identification of 6-methoxy parillin and coniferin from the bulbs of Allium affine L.

Phytochemically, Allium species are a rich source of important secondary metabolites especially steroidal saponin and sapogenins, flavonoids, and sulfur compounds. As a member of this genus, Allium affine, which is locally known as "tareh kouhi", is an endemic plant of middle Asian countries. Bulbs of A. affine were collected and air-dried in the shade. The chloroform-methanol (9:1) extract of the sample was subjected to purification by MPLC and HPLC. Structure elucidation of isolated compounds was done using comprehensive spectroscopic methods including 1D-NMR, 2D-NMR, and MS. A steroidal saponin structurally related to parillin and a phenylpropanoid glycoside (coniferin) were isolated and identified from the plant chloroform-methanol extract. To the best of our knowledge isolation of these potentially medicinal compounds from A. affine was reported for the first time in this study.

The Dynamic Volatility Connectedness of Major Environmental, Social, and Governance (ESG) Stock Indices: Evidence Based on DCC-GARCH Model

This study investigates the dynamic volatility connectivity of important environmental, social, and governance (ESG) stock indexes from May 2010 to March 2021. The empirical research is focused on five major S&P ESG stock indexes from the US, Latin America, Europe, the Middle East and Africa, and Asia Pacific regions. The study reveals that ESG stock indexes in the Middle East Africa, and Latin America are net shock transmitters, whereas the United States and Asia Pacific are net volatility receivers. Furthermore, the study finds that bilateral intercorrelations are higher among US, Latin America, and Europe region group pairs and weaker in relation to Middle East Africa and Asia Pacific region group pairs, indicating the presence of contagion within developed and/or emerging regions, which has relevance for portfolio and risk management.

Pastoral Khans: from Mongolian Steppe to African Savannah

The developing field of Mongolian International Studies offers a diverse range of research topics. A review of recent articles reflects an emphasis on geo-politics, particularly evolving relations with its superpower neighbours. Whilst state-to-state engagement with China and Russia predominates, regional countries (Japan, Korea) and the US and Europe are examined within the ‘Third Neighbour’ policy. Trade and economics are also studied, from Oyu Tolgoi and mining to the role of the IMF and international agencies. Currently lacking is a focus on human-driven engagement that reflects Mongolian livelihoods, spirituality and community environments. Such social and cultural dynamics are essential to both pastoral and rural livelihoods and to understanding the nation. In 2020-2022 international academic endeavours enabled Mongolian herder representatives to participate in a global drylands exchange network with dryland residents in thirteen countries. The process provided an exceptional opportunity to present Mongolian perspectives to pastoralists and academics from Africa, the Middle East and Central Asia. This grounded Mongolian livelihoods and situated rural dynamics in a global context. Here we report key engagements and findings as Mongolian herders shared lives and practices in the context of this international pastoral/drylands project. Moving beyond the political/economic rubric, as this project did, delivers a more representative and complete comprehension of Mongolia to the global international studies community.

Crowding-Out Effect of Natural Resources on Domestic Investment: The Importance of Information Communication and Technology (ICT) and Control of Corruption in the Middle East and Central Asia

Countries of the Middle East and Central Asia depend heavily on natural resources for their exports, income, and employment. This study is a preliminary investigation that explores the effect of natural resources on domestic investment in a sample of 12 highly resource-dependent countries in the Middle East and Central Asia from 2000 to 2019. The recently advanced cross-sectional dependent auto-regressive distributed lag (CS-ARDL) model and panel quantile regression are employed. The results validate the accelerator theory that an increase of the non-oil GDP growth rate has a robust positive impact on domestic investment, while natural resources crowd-out domestic investment. The long-run estimate of ICT reveals a significant positive impact, while corruption shows a significant negative effect. These findings urge sample resource-dependent countries to focus on developing ICT-based enterprises and control prevailing corruption levels. Moreover, adopting liberal trade policies can also enhance domestic investment opportunities.

Empirical Analysis Of Covid-19 On Brics Nations And Their Impact Positive/Negative On Stock Market Indices

The coronavirus is a novel disease affected across the world. The symptoms are cold and fever. It was invented in December 2019 byChina and is denoted as Covid-19 by World Health Organization (WHO). This disease affected not only humans but also influencedthe stock market and an economic crisis across the world. About 3% effect on the global economy, it was comparatively higher than2008-09. 1.2% and 2.8% were affected by middle Asia and the middle east during 2019-20. The oil export and import countries wereaffected by about 4.2% and 0.7% (IMF, 2020).The stock market is one of the barometers for Post Covid-19 status measurement. The study aims to analyze the infected cases,investigate the stock market indices in BRICS Nations, and find the relations between infected situations and the stock market ofBRICS Nations. This study uses secondary data from the official websites of the World Health Organization, Dashboard fromJanuary 2021-June 2022. Using Multi Regression analysis in the five nations were infected and death cases and stock market indices.This study will be helpful in the present situation, and investors will decide to diversify funds in the profitable sector to acceleratetheir wealth.

Aegilops crassa Boiss. repeatome characterized using low-coverage NGS as a source of new FISH markers: Application in phylogenetic studies of the Triticeae.

Aegilops crassa Boiss. is polyploid grass species that grows in the eastern part of the Fertile Crescent, Afghanistan, and Middle Asia. It consists of tetraploid (4x) and hexaploid (6x) cytotypes (2n = 4x = 28, D1D (Abdolmalaki et al., 2019) XcrXcr and 2n = 6x = 42, D1D (Abdolmalaki et al., 2019) XcrXcrD2D (Adams and Wendel, 2005), respectively) that are similar morphologically. Although many Aegilops species were used in wheat breeding, the genetic potential of Ae. crassa has not yet been exploited due to its uncertain origin and significant genome modifications. Tetraploid Ae. crassa is thought to be the oldest polyploid Aegilops species, the subgenomes of which still retain some features of its ancient diploid progenitors. The D1 and D2 subgenomes of Ae. crassa were contributed by Aegilops tauschii (2n = 2x = 14, DD), while the Xcr subgenome donor is still unknown. Owing to its ancient origin, Ae. crassa can serve as model for studying genome evolution. Despite this, Ae. crassa is poorly studied genetically and no genome sequences were available for this species. We performed low-coverage genome sequencing of 4x and 6x cytotypes of Ae. crassa, and four Ae. tauschii accessions belonging to different subspecies; diploid wheatgrass Thinopyrum bessarabicum (Jb genome), which is phylogenetically close to D (sub)genome species, was taken as an outgroup. Subsequent data analysis using the pipeline RepeatExplorer2 allowed us to characterize the repeatomes of these species and identify several satellite sequences. Some of these sequences are novel, while others are found to be homologous to already known satellite sequences of Triticeae species. The copy number of satellite repeats in genomes of different species and their subgenome (D1 or Xcr) affinity in Ae. crassa were assessed by means of comparative bioinformatic analysis combined with quantitative PCR (qPCR). Fluorescence in situ hybridization (FISH) was performed to map newly identified satellite repeats on chromosomes of common wheat, Triticum aestivum, 4x and 6x Ae. crassa, Ae. tauschii, and Th. bessarabicum. The new FISH markers can be used in phylogenetic analyses of the Triticeae for chromosome identification and the assessment of their subgenome affinities and for evaluation of genome/chromosome constitution of wide hybrids or polyploid species.

S3101 When a Cyst Isn't Just a Cyst: A Rare Case of a Hydatid Liver Cyst Caused by Echinococcus in the United States

Introduction: Echinococcus Granulosus is a parasite that causes hydatid disease. It is endemic to many countries but is rarely seen in the US, particularly in the Northeast. We present a case of a 22-year-old American male with a hydatid liver cyst due to an Echinococcus infection. Case Description/Methods: 22-year-old obese male presented to a local hospital for RUQ abdominal pain that radiated throughout his abdomen. He denied recent diet changes, travel or sick contacts.On presentation the patient had leukocytosis, transaminitis, hyperbilirubinemia and an elevated alkaline phosphatase. CT abdomen showed mild splenomegaly and a new 8.6cm diameter heterogeneous low density poorly enhancing mass in the right hepatic lobe. RUQ US revealed a heterogeneous irregularly marginated hypoechoic 9.6 × 9.5 × 5.7 cm soft tissue liver mass. Abdominal MRI showed a 9.3 × 7.3 cm complex, cystic and multilobulated lesion with thick walls and internal septations in the right hepatic lobe. He was transferred to our hospital for GI evaluation, where an US guided aspiration of the collection was recommended. 5 ccs of purulent aspirate were drained, sent for culture and a hepatic drain was placed. There was no evidence of malignancy in the aspirate. He then shared that over a year before his presentation, he served 9 months in Afghanistan with the US military. An infectious workup then showed serum positive for echinococcus antibody. Treatment was started with daily oral albendazole for Cystic Echinococcus (CE). Eight and half weeks later his pain had resolved and interval improvement with decreased abscess size was seen on CT (Figure 1). Discussion: CE is common in South America, the Middle East, Africa and Asia. Most cases of CE in the US are found in immigrants from endemic countries. Local transmission has been reported in California, Alaska and the southwest US. Our case of an American male with CE highlights the importance of understanding the lifecycle of CE as there is often many years between ingestion of eggs and symptom onset. It also demonstrates the importance of obtaining enzyme-linked immunosorbent assay test for Echinococcus, which is 90% sensitive, prior to considering surgery for a cystic liver lesion. Rupture of hydatid cysts occurs spontaneously or during surgery and can cause multifocal dissemination leading to fever, urticaria, eosinophilia or anaphylaxis. If physicians are familiar with pathology endemic to different countries, patients will be more likely to receive timely, appropriate care.Figure 1.: A. CT abdomen completed at time of presentation demonstrating heterogenous low density and poorly enhancing mass. B. MRI abdomen completed at time of presentation showing complex cystic and multilobulated lesion with thick walls and thick internal septations. C. CT abdomen eight and half weeks after initiation of Albendazole.

Type specimens of Potentilla (Rosaceae) stored in the Herbarium of the Komarov Botanical Institute (LE). Part 2. Taxa described from Kazakhstan and Middle Asia

An information about 410 type and original specimens of taxa (65 published names) described as part of the genus Potentilla L. based on collections from Central Asia and Kazakhstan and stored in the Herbarium of the Komarov Botanical Institute RAS (LE) is provided. Considering data from other collections (DR, PR, MW, TK, JE, KFTA, KW, L, M, MO and P), the total amount of type material presented in the article is 509 samples. They include 33 lectotypes (27 in LE), 19 isolectotypes (8 in LE), 24 holotypes (23 in LE), 23 isotypes (20 in LE), 76 paratypes (75 in LE), 133 syntypes (91 in LE), and 203 specimens (168 in LE) which belong to original material (“original specimens”). The lectotypes of the names of 25 taxa (P. algida, P. approximata, P. biflora var. stenopetala, P. bifurca var. canescens, P. desertorum, P. desertorum var. arnavatensis, P. fedtschenkoana, P. fedtschenkoana var. digitata, P. flabellata, P. fruticosa var. angustifolia, P. hololeuca var. calvescens and var. subtrijuga, P. komaroviana, P. lipskyana, P. malacotricha, P. multifida var. nubigena, P. nivea var. cano-tomentosa, P. schrenkiana, P. sibirica, P. soongorica, P. soongorica var. viridescens, P. tephroleuca, P. transcaspia, P. turczaninowiana, P. turgaica) are designated in this work. The images of type specimens of P. ferganensis and P. × jakovlevii, local endemics of Asia, known only from locus classicus, which were not collected after the original description, are presented.

Woolly whitefly in agrocenoses of citrus crops of Abkhazia and the eff ectiveness of chemical plant protection products

The woolly whitefly (Aleurothrixus floccosus Maskell), a species of neotropical origin, is a new pest of mandarin orange in Abkhazia. The invasive range of the species has been developing since 1959 and now covers Europe, North America, Africa, the Middle East and East Asia. It was recorded in Abkhazia in spring, 2017. The studies were conducted in 2016-2021 in all regions of Abkhazia by means of standard methods. According to the six-year study of the distribution and development of the phytophage population in the territory of Abkhazia, the species has dramatically increased in number and spread throughout all regions of the country. The identification of the pest was carried out in 2020, but the vector of its penetration into Abkhazia is yet to be clarified. Most likely, A. floccosus was introduced in Abkhazia with planting material of citrus crops. The first colonies of woolly whitefly are recorded in late May-June, followed by a rapid growth of the pest population. The development of the colony reaches its maximum by September, with a density of imago and nymphs of 102.2-152.3 units/leaf. The bioefficacy of different chemical insecticides was evaluated: organophosphorus compounds (Bi-58 Top, KE, with dimethoate as an active ingredient, consumption rate of 2 l/ha), neonicotinoids (Confidor Extra, VDG, active ingredient: imidacloprid, consumption rate of 0.4 kg/ha and Gazelle, RP, active ingredient: acetamipride, consumption rate of 0.15 and 0.5 kg/ha), chitin synthesis inhibitors (Applaud, SP, active ingredient: buprofezin, consumption rate of 0.5 and 1.0 kg/ha). Trials were set in August-September. Treatment of plants was carried out in triplicate against the background of treatment with Product 30 Plus, MME (petroleum jelly oil), the consumption rate of 30 l/ha in the third part of February. At the beginning of the trial, one leaf of mandarin, on average, had 80.2-89.4 whiteflies. From mid-August till the end of September, the number of whitefly colonies increased 1.52 times in control. The use of the insecticide Confidor Extra, WDG, 0.4 kg/ha and variants with increased rates of consumption of insecticides Apploud, SP, 1.0 kg/ha and Gazelle, RP, 0.5 kg/ha (triple treatment) appeared to be the most effective with the biological efficiency of 80.0, 86.7 and 85.8 %, respectively. Dimethoate-based organophosphorus insecticide, traditionally used in agrocenoses of citrus crops, showed insufficient effectiveness (70.0 %).

Contribution of French explorers to the study of Middle Asian flora: the herbarium collections by Guillaume Capus (1857-1931)

Contribution des explorateurs français à l'étude de la flore de l'Asie Centrale: les collections d'herbier de Guillaume Capus (1857-1931). Les explorations de Guillaume Capus en Asie Centrale entre 1880 et 1887 ont notamment abouti à une collection remarquable de 3000 spécimens d'herbiers, toujours conservés dans l'Herbier de Paris (France). Les récoltes de sa première exploration ont été rapidement déterminées par un autre botaniste français, Adrien Franchet, dans ‘Plantes du Turkestan' publié en 1883-1884. Dans le cadre du projet de ‘Flore d'Ouzbékistan’ en cours, nous avons étudié exhaustivement la liste des plantes déterminées par Franchet, en dénombrant 1387 récoltes. D'abord, nous avons mis à jour la taxonomie pour toutes ces récoltes, et trouvé que les plantes récoltées par Capus représntent une diversité importante consistant en 87 familles, 375 genres, et 851 espèces (incluant 74 espèces nouvelles et 21 variétés décrites par Franchet). Ensuite, notre étude approfondie des herbiers d'Asie Centrale conduit à identifier sept nouveaux signalement d’espèces d’angiospermes pour trois pays d’Asie Centrale: Phlomoides agraria (Bunge) Adylov, Kamelin & Makhm. (Lamiaceae) pour le Kyrgyzstan, Picris strigosa M.Bieb. (Asteraceae) et Gentianella umbellata (M.Bieb.) Holub (Gentianaceae) pour l’Ouzbékistan, ainsi que Oxytropis tatarica Hook.f. & Thomson ex Bunge, Onobrychis arnacantha Bunge (Fabaceae), Pedicularis pycnantha Boiss. (Orobanchaceae) et Matthiola flavida Boiss. (Brassicaceae) pour le Tajikistan. Enfin, nous avons élucidé toutes les localités originales de récoltes visitées par Capus, nous les avons géoréférencées, et avons compilé une carte de densité des récoltes et de la richesse spécifique rassemblées par Capus, créant ainsi un gazetter du voyage botanqiue de Capus, prélude d’un gazetter d’Asie Centrale.

Short-term effects of particulate matter and desert dust on mortality in Southern Europe, the Middle East and Eastern Asia

Background: Desert dust represents a threat to health, but the evidence is limited, as past studies were localised and adopted different exposure metrics and/or statistical approaches. We aim to evaluate the short-term effects of desert dust episodes and particulate matter (PM) on natural mortality in multiple cities from different geo-climatic zones. Methods: Daily death counts were collected for 21 cities in southern Europe (France, Greece, Italy, Portugal, Spain), the Middle East (Iran, Kuwait) and Eastern Asia (China, Japan, South Korea, Taiwan) from 2003-2018. Dust advection days were identified using satellite data, operational models and back-trajectories. Daily mean concentrations of PM10 (PM&amp;#x3c;10µm) and PM2.5 (&amp;#x3c;2.5µm) were available for 21 and 16 cities, respectively. City-specific quasi-Poisson regression models were fitted, adjusted for time trends and meteorology, and city-specific estimates were combined using random-effects meta-analysis. Results: The frequency of dust days ranged from 5% in Northern Italy to 61% in Northern China, with highest levels of PM10 and PM2.5 raised in Kuwait (191 µg/m3) and Xian (182 µg/m3). Overall, dust (yes/no), PM10 and PM25 (10 µg/m3) increased mortality at the same day by 0.52% (95% confidence interval: 0.04, 1.01), 0.14% (0.07,0.21) and 0.16% (0.02, 0.31), respectively. We found differential effects of PM on non-dust versus dust days: on non-dust days 10 µg/m3 increases in PM10 and PM25 increased mortality by 0.20% (0.11, 0.29) and 0.26% (0.05, 0.46) in non-dust days, while in dust days they increased mortality by 0.06% (95% confidence interval: 0.01, 0.10) and 0.05% (-0.04, 0.15), respectively. Conclusions: Desert dust may have independent adverse health effects. Further investigation is needed to disentangle the complex role of dust on air quality and health. On-going analyses on a broader set of cities within the MCC network provide a promising opportunity for this purpose. Key words: Desert dust; particulate matter; short-term effects; mortality

A comparison of invasive lobular carcinoma with other invasive breast cancers at Tygerberg Academic Hospital.

The second most common histological subtype of invasive breast carcinoma is invasive lobular carcinoma (ILC) occuring with a frequency 10-15% in Western countries and approximately 5%, in Africa, the Middle East and Asia (AMA). Combined hormone replacement therapy (CHRT) is a risk factor for the development of ILC which is infrequently diagnosed at our centre.This study aimed to investigate the incidence and clinicopathological characteristics of ILC as compared to invasive breast carcinoma of no special type (IBC-NST). Clinical and pathological data on breast carcinoma patients attending the breast and endocrine unit at Tygerberg Academic Hospital since 2017 have been recorded on a Stellenbosch University REDCap® database. IBC-NST was the most frequent subtype diagnosed (83.9%) and ILC the second most common subtype (5.2%). Most ILCs were of luminal B intrinsic subtype, and the median size was slightly smaller than IBC-NST. There were significantly more grade 2 ILCs than IBC-NSTs (81.5% vs 50.9%). There was no statistical difference between stage and histological subtype. ILC has clinicopathological differences when compared to IBC-NST, although these were less pronounced in this study. The prevalence of ILC was similar to numbers reported in AMA. We hypothesise that there may be a discrepancy in the prevalence of ILC between public and private healthcare systems in South Africa, and that it may be due to differing trends in prescribing CHRT.

A comparison of invasive lobular carcinoma with other invasive breast cancers at Tygerberg Academic Hospital

BACKGROUND: The second most common histological subtype of invasive breast carcinoma is invasive lobular carcinoma (ILC) occuring with a frequency 10-15% in Western countries and approximately 5%, in Africa, the Middle East and Asia (AMA). Combined hormone replacement therapy (CHRT) is a risk factor for the development of ILC which is infrequently diagnosed at our centre.This study aimed to investigate the incidence and clinicopathological characteristics of ILC as compared to invasive breast carcinoma of no special type (IBC-NST METHODS: Clinical and pathological data on breast carcinoma patients attending the breast and endocrine unit at Tygerberg Academic Hospital since 2017 have been recorded on a Stellenbosch University REDCap® database RESULTS: IBC-NST was the most frequent subtype diagnosed (83.9%) and ILC the second most common subtype (5.2%). Most ILCs were of luminal B intrinsic subtype, and the median size was slightly smaller than IBC-NST. There were significantly more grade 2 ILCs than IBC-NSTs (81.5% vs 50.9%). There was no statistical difference between stage and histological subtype CONCLUSION: ILC has clinicopathological differences when compared to IBC-NST, although these were less pronounced in this study. The prevalence of ILC was similar to numbers reported in AMA. We hypothesise that there may be a discrepancy in the prevalence of ILC between public and private healthcare systems in South Africa, and that it may be due to differing trends in prescribing CHRT

Debate: Are We Limiting the Potential of Oocytes by Not Using ICSI for All? - ICSI for Some

Intracytoplasmic sperm injection (ICSI) was invented nearly thirty years ago and the first pregnancies in Australia were obtained at the Queen Elizabeth Hospital in the University of Adelaide’s Reproductive Medicine Program. Since then, ICSI has become the predominant method of fertilisation for IVF in cycles in Australia and in many parts of the world used for 100% of all cycles. While its value for male factor infertility, IVM egg fertilisation and injection into previously frozen eggs have been validated, the use of ICSI for non-male-factor infertility remains controversial and unproven. Given the significant concerns about the potential effects of ICSI on the health of children conceived by this method, a debate about its use in an excessive number of IVF cycles is warranted. The first randomised control trial of ICSI versus standard IVF fertilisation for unexplained infertility occurred more than twenty years ago and showed a lower ongoing pregnancy rate for those who received the ICSI form of fertilisation. Despite this evidence, ICSI continued to grow in prevalence across Europe, North America, the Middle East, Asia, and Australia for non-male factor infertility. Significant cohort studies started to emerge from the US and from Europe that showed either no benefit from ICSI for unexplained infertility, or indeed harm, in terms of ongoing pregnancy rates. This year we published in The Lancet, a randomised control trial where couples with unexplained infertility and a normal total sperm count and motility were randomised to receive either ICSI or standard IVF as a fertilisation method. No significant benefit of using ICSI was found with respect to ongoing pregnancy or live birth. The potential health benefits to the child and the cost effectiveness of the treatment weigh against the routine use of ICSI in the presence of normal sperm. Other cohort studies show that there is no benefit of ICSI for low egg numbers, advanced maternal age, or preimplantation genetic diagnosis. Examination of the use of ICSI across Australia, shows enormous variations between states and within the same state. It is clear, that members of the Society have very heterogeneous view of the use of ICSI and my intention in this talk is to encourage everyone to be more critical of its use when there is no sperm abnormality. I would encourage clinicians to use the normal natural processes of sperm selection which occur in routine IVF without sperm injection.