Boys should be given HPV jab, says vaccine committee. Here’s what happens next.

It’s nearly a decade since the human papillomavirus (HPV) vaccine was first introduced in the UK to help protect against the virus that causes most cases of cervical cancer. But until now, it has only been routinely offered to girls.Today, the Joint Committee for Vaccination and Immunisation (JCVI) recommended that adolescent boys should now also receive the vaccine.When and how this will happen is now down to the Government. But the recommendation comes from years of mounting evidence around likely health benefits and overall cost effectiveness.

HPV and cancer

HPV is a big family of viruses. There are more than 100 different types and some are more dangerous than others. While some low-risk types cause growths like warts or verrucas, there are thirteen high-risk types that are linked to cancer.HPV is very common, with 8 in 10 people infected at some point in their life. Usually our bodies clear the infection without it causing any problems. But in some cases a lasting infection can lead to cancer.This is because the virus damages the infected cells’ DNA and causes them to start dividing out of control, setting them on the road to cancer.Thanks to the vaccination programme, many people know that HPV causes cervical cancer – in fact it’s linked to all cases of the disease in the UK. But HPV is linked to other cancers too – including anal, penis and some types of mouth and throat cancer.

Why wasn’t the HPV vaccine always available for boys?

The HPV vaccine protects against 4 types of HPV. Two are linked to cancer: HPV 16 and 18, which together cause around 7 in 10 cervical cancer cases in the UK. The vaccine also protects against HPV 6 and 11, which cause most genital warts.The vaccine has been available to girls in the UK since 2008. It was initially only recommended for girls as the strongest evidence of health benefits and cost effectiveness was for cervical cancer and genital warts.Since the vaccine was introduced, we’re starting to see HPV infections in people who have been vaccinated falling. This suggests the vaccine is preventing HPV infection and, in the future, this should prevent cervical cancers.But HPV is linked to cancers in men as well as women.Men who have sex with women will get some protection from the current vaccination programme if their partner is vaccinated. The same can’t be said for adult men who have sex with men .In 2015, the JCVI, which advises UK health departments on vaccines, recommended extending vaccination to adult men who have sex with men. This group of men are at a higher risk of anal cancer. Up to the age of 45, these men can request HPV vaccination at sexual health clinics.But up until today, the programme hadn’t been recommended for boys, as the JCVI weren’t convinced it would be cost-effective.Today’s decision brings the UK in line with other countries including the US and Australia, which already offer the vaccination to boys.

Who will be offered the vaccine?

The JCVI has recommended the vaccine for boys aged 11-13, similar to the vaccination programme for girls. HPV vaccination is most effective in people who haven’t ever had an HPV infection. And as HPV is mostly transmitted through close sexual contact, vaccination is offered at a young age when people are unlikely to have had any sexual experiences.Men above the vaccination age who don’t have sex with men won’t be offered the vaccine. But it’s important to remember that most people clear HPV infections without them causing any symptoms or problems. And for most cancers linked to HPV there are also other ways to reduce your risk through things like not smoking or drinking less alcohol.

What happens now?

The recommendation for a gender neutral vaccination programme for adolescents has been years in the making. The next step is for the Government to formally accept the recommendation and extend the programme to boys.Until it does, we won’t know the details of when and how the programme will be rolled out. Once they have accepted the recommendation, the Government must publish a plan and timetable for the roll-out.This will need to be accompanied by more details on the programme itself. When the vaccine was first offered to girls in the UK, a ‘catch-up’ programme was introduced for girls up to the age of 18, and we want the Government to do the same for boys.Finally, the programme will do nothing if people aren’t aware it’s happening. We want to see a national awareness campaign to clearly communicate about the vaccine and its potential benefits, as well as new information for parents and boys.By offering the vaccine to everyone aged 11-13, the number of cases of HPV, along with the cancers they cause, could be dramatically reduced in the future.

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Targeted microbubbles in the experimental and clinical setting

TARGETED MICROBUBBLES IN THE EXPERIMENTAL AND CLINICAL SETTING

Ahmed Alzaraa, M.R.C.S.a,*, Gianpiero Gravante, M.R.C.S., Ph.D.a,
Wen Yuan Chung, Ph.D.a, Dhya Al-Leswas, M.R.C.S.a, Morgan Bruno, M.D.b,
Ashley R. Dennison, M.R.C.S., M.D.a, David M. Lloyd, M.R.C.S., M.D.a

Abstract
BACKGROUND: Microbubbles have improved ultrasonography imaging techniques over the past 2 decades. Their safety, versatility, and easiness of use have rendered them equal or even superior in some instances to other imaging modalities such as computed tomography and magnetic resonance imaging.Herein, we conducted a literature review to present their types, general behavior in tissues, and current and potential use in clinical practice.
METHODS: A literature search was conducted for all preclinical and clinical studies involving
microbubbles and ultrasonography.
RESULTS: Different types of microbubbles are available. These generally improve the enhancement of tissues during ultrasonography imaging. They also can be attached to ligands for the target of several conditions such as inflammation, angiogenesis, thrombosis, apoptosis, and might have the potential of carrying toxic drugs to diseased sites, thereby limiting the systemic adverse effects.
CONCLUSIONS: The use of microbubbles is evolving rapidly and can have a significant impact on the management of various conditions. The potential for their use as targeting agents and gene and drug delivery vehicles looks promising.

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Combined endocrine and exocrine tumours of the pancreas

Ahmed Alzaraa*1, Valeri Udom2, Husam Mousa1, Abdulhalem Alzein1,
Abduljalil Benhamida1 and Neha Dalal3
Address: 1Department of General Surgery, Tameside General Hospital, Manchester, UK, 2Department of Radiology, Tameside General Hospital,Manchester, UK and 3Department of Histopathology, Tameside General Hospital, Manchester, UK
Email: Ahmed Alzaraa* – ahmedwahabf@gmail.com; Valeri Udom – vudom52@aol.com; Husam Mousa – hmousa2006@hotmail.co.uk;Abdulhalem Alzein – aelzein73@yahoo.com; Abduljalil Benhamida – abduljalil.benhameda@tgh.nhs.uk; Neha Dalal – neha.dalal@tgh.nhs.uk
* Corresponding author

ABSTRACT

Background: Cystic neoplasms of the pancreas comprise 10%–15% of pancreatic cystic lesions,with the serous cystadenoms being the commonest. The association of exocrine and endocrine tumours of the pancreas unrelated to Von Hipple Lindau disease is very rare. Very few cases have been reported in the literature. We present another case of both these tumours in one patient.

Case presentation: A female patient was seen in the surgical clinic for a pain in the right groin.Clinical examination and investigations confirmed a diagnosis of combined endocrine and exocrine tumours of the pancreas. She underwent surgery and is under regular follow-up in the surgical clinic.

Conclusion: Biphasic differentiation of pancreatic stem cell during embryological development could happen and may result in combined endocrine and exocrine tumours of the pancreas. Imaging studies are excellent in diagnosing theses lesions. Surgery has a central role and could be curative.

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Coexistence of carcinoma and tuberculosis in one breast

Case report
Coexistence of carcinoma and tuberculosis in one breast

Ahmed Alzaraa*1 and Neha Dalal2

Abstract
Background: The coexistence of breast cancer and tuberculosis is very rare. This can create a dilemma in the diagnosis and treatment as there are no pathognomonic symptoms or signs to
distinguish both diseases.
Case presentation: A female patient was seen in the breast clinic for a right breast lump. Clinical examination and investigation confirmed cancer and tuberculosis of the right breast. She underwent right mastectomy and axillary clearance and received chemo and radiotherapy.
Unfortunately, she died of wide spread metastases.
Conclusion: The simultaneous occurrence of these two major illnesses in the breast can lead to many problems regarding diagnosis and treatment. Though rare, surgeons, pathologists and
radiologists should be aware of such condition.

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Sebaceous carcinoma of the skin of the breast: a case report

Ahmed Alzaraa*1, Imran Ghafoor1, Andrew Yates2 and Alhad Dhebri1

Abstract

Introduction: Sebaceous gland tumours are rare and their presence should be considered as a
marker for Muir-Torre Syndrome, alerting to search for an occult malignancy.
Case presentation: A 43-year-old Caucasian female patient underwent excision of a sebaceous cyst. Histopathology confirmed a sebaceous carcinoma. Further investigations revealed multiple intra-abdominal malignancies. She has been under regular follow-up in the relevant clinics.
Conclusion: Sebaceous carcinoma should be excised completely and followed-up for the
detection of possible metastases. Surgical removal of primary or metastatic cancers may be curative and should be attempted wherever possible. It is very important for clinicians not to miss such skin lesions as they may precede the presentation of internal malignancies.

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Ahmed Alzaraa, Aleksandar Vodovnik3, Hugh Montgomery,Mohammed Saeed and Narinder Sharma

Abstract
Background: Metastases to the breast from extramammary tumours are uncommon, and
metastatic renal cell carcinoma to the breast is extremely rare. We report a metastasis to the
breast from a renal primary with the radiological and histopathological features.
Case presentation: An 81-year-old lady was seen in the breast clinic for a right breast mass after sustaining a fall. Clinical examination and investigations revealed a metastatic cancer from a renal primary. She received surgical treatment only and is under regular follow-up in the oncology clinic.
Conclusion: The treatment strategy for metastatic breast diseases is based on a proper
assessment of such cases by surgeons, radiologists and histopathologists

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richilemmoma in continuity with pigmented basal cell carcinoma; with dermatoscopy and dermatopathology

Moayad Al Kaptan, Joseph Kattampallil, Cliff Rosendahl

A case of trichilemmoma in continuity with a pigmented basal cell carcinoma is presented with dermatoscopy and dermatopathology. The distinction between the two lesions was evident dermatoscopically and was confirmed dermatopathologically. While trichilemmoma has been reported in association with basal cell carcinoma and dermatoscopy images of four previous cases of trichilemmoma have been published, no previous dermatoscopy image has been published of trichilemmoma associated with basal cell carcinoma.

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Ahmed Alzaraa, MRCS,* George D.H. Thomas, MD,† Alexander Vodovnik,MD,† Vijay K Modgill,FRCS

Abstract: Merkel cell carcinoma is a rare skin neoplasm and has not been reported yet in a male breast. We present a case of 74-year-old patient who was referred to the breast clinic with a lump in his right breast, which led first to the core biopsy followed by radical mastectomy and axillary clearance. The clinical characteristics, gross, microscopic and immunohistochemical
findings and management of this lesion are discussed. Surgical excision remains the main option for treating this lesion including prophylactic lymphadenectomy and local radiotherapy

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Training needs of clinical research associates

ABSTRACT

Clinical research is a relatively new field in our country that has seen very rapid growth in the last few years. Availability of personnel appropriately trained to the specific requirements of the role they will perform in clinical research is critical for capacity expansion. Our study attempts to understand the specific areas of knowledge and skills that are important for the role of a clinical research associate. The survey was conducted among clinical research professionals from industry and academia who had more than five years of clinical research experience and held important decision making positions in clinical research (stakeholders). The survey questionnaire was designed as a matrix of various clinical research roles on the y-axis and six knowledge modules and eight skills on the x-axis. Respondents were asked to rate the importance of the knowledge /skills to the role of clinical research associates on a three point scale. In discussing results, a significant response was considered to be 50% or greater positive response from the total group. The significant findings were that general, ethics and clinical trial execution modules were rated as critical for the role of clinical research associate. Regulatory module was rated as important for the role. The other significant responses were that three of the sub-topics in the methodology module – framing a research proposal/protocol and experimental design, designing case report forms and EDCs and conducting PK studies – were rated as important and one sub topic in the data management and statistics module was rated as not important. All the skills except leadership skills were rated as critical for the role. The findings of our survey were in general on the lines of expectations of performance of the role. The general, ethics and clinical trial execution modules are critical knowledge areas for the role of a clinical research associate. No clear trends emerged for some of the other modules. Leadership skills were not rated as critical to the role. This kind of a survey gives a good direction when training curriculum has to be designed for specific roles in clinical research. However, there is a need to expand the sample size to fine-tune the knowledge and skills areas.

Keywords: Clinical research associates, clinical research training, modules, performance, roles, topics

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