Freshwater resources are a high-priority issue in the Pacific region. Water shortage is a serious problem in many small island states, and many depend heavily on rainwater as the source of their water. Lack of safe water supplies is an important factor in diarrheal illness. There have been no previous studies looking specifically at the relationship between climate variability and diarrhea in the Pacific region. We carried out two related studies to explore the potential relationship between climate variability and the incidence of diarrhea in the Pacific Islands. In the first study, we examined the average annual rates of diarrhea in adults, as well as temperature and water availability from 1986 to 1994 for 18 Pacific Island countries. There was a positive association between annual average temperature and the rate of diarrhea reports, and a negative association between water availability and diarrhea rates. In the second study, we examined diarrhea notifications in Fiji in relation to estimates of temperature and rainfall, using Poisson regression analysis of monthly data for 1978-1998. There were positive associations between diarrhea reports and temperature and between diarrhea reports and extremes of rainfall. These results are consistent with previous research and suggest that global climate change is likely to exacerbate diarrheal illness in many Pacific Island countries.

Understanding of the molecular mechanisms of prostate cancer has led to development of therapeutic strategies targeting androgen receptor (AR). These androgen-receptor signaling inhibitors (ARSI) include androgen synthesis inhibitor-abiraterone and androgen receptor antagonists-enzalutamide, apalutamide, and darolutamide. Although these medications provide significant improvement in survival among men with prostate cancer, drug resistance develops in nearly all patients with time. This could be through androgen-dependent or androgen-independent mechanisms. Even weaker signals and non-canonical steroid ligands can activate AR in the presence of truncated AR-splice variants, AR overexpression, or activating mutations in AR. AR splice variant, AR-V7 is the most studied among these and is not targeted by available ARSIs. Non-androgen receptor dependent resistance mechanisms are mediated by activation of an alternative signaling pathway when AR is inhibited. DNA repair pathway, PI3K/AKT/mTOR pathway, BRAF-MAPK and Wnt signaling pathway and activation by glucocorticoid receptors can restore downstream signaling in prostate cancer by alternative proteins. Multiple clinical trials are underway exploring therapeutic strategies to overcome these resistance mechanisms.

The hormonal response of the anterior pituitary was studied in 10 normal males undergoing treadmill exercise testing, in 5 male patients undergoing diagnostic gastroscopy, and in 8 male patients undergoing elective surgery under general anaesthesia. Serum TSH was depressed below the baseline value at 2 and 3 h post-treadmill exercise, at 1, 2 and 3 h post-gastroscopy and from 10 min through 2 h post-surgery. Serum triiodothyronine was depressed below the baseline value at 10 min through 2 h post-surgery. Serum prolactin, growth hormone and cortisol were elevated by all three stressful procedures. Both gastroscopy and surgery resulted in an elevation of serum luteinizing hormone levels. There was no significant change in serum FSH levels in any of the three procedures. The post-stress depression in TSH levels could result from the suppressive effect at the hypothalamic-pituitary level of high serum levels of cortisol generated by the stress of the procedures.

Daily flow records, rainfall data and tropical cyclone maps during 1970-1998 are used to document the impact of tropical cyclones (TCs) on floods in the Rewa River system, Viti Levu, Fiji. Floods are large, brief, isolated events caused by TCs and non-TC tropical rainstorms. More floods are caused by tropical rainstorms than by TCs, but TC floods are larger. The log Pearson Type III distribution consistently provided the best fit to partial duration flood series and the widelyrecommended generalized Pareto distribution performed very poorly, underscoring the need to test a variety of distributions for a particular geographic location. Tropical cyclones occur more often in Fiji during negative values of the Southern Oscillation Index (SOP) and all TCs that occurred during El Nino conditions caused floods. Peak flood discharges caused by TCs are inversely correlated with the SOI, reflecting possible links with tropical cyclone frequency and precipitation intensity.Résumé Les données de débits journaliers et de précipitations, et les cartes des cyclones tropicaux (CT) des années 1970-1998, ont été utilisées pour étudier l'influence des cyclones tropicaux sur les crues de la rivière Rewa, Viti Levu, Fidji. Les crues sont des événements intenses, brefs et isolés, causés soit par des cyclones tropicaux soit par des orages tropicaux non-cycloniques. La plupart des crues sont causées par des orages tropicaux mais celles qui sont causées par les cyclones tropicaux sont plus intenses. La distribution log Pearson Type III a fourni les meilleurs ajustements, tandis que la distribution de Pareto, largement recommandée, se révèle peu pertinente, ce qui souligne la nécessité de tester plusieurs distributions lors de l'étude d'une station particulière. Les cyclones tropicaux interviennent plus souvent aux Fidji lorsque l'indice de l'oscillation australe prend des valeurs négatives. En outre, tous les cyclones tropicaux intervenus pendant une phase d'El Nino ont généré des crues. Les pics de débit générés par les cyclones tropicaux sont inversement corrélés avec les valeurs de l'indice d'oscillation australe, suggérant ainsi des relations avec la fréquence d'occurrence des cyclones tropicaux et avec l'intensité des précipitations.

An 80-year-old Caucasian male presented with fever of 3-week duration. Outpatient workup for infectious etiologies was negative and due to persistent fever, he was hospitalized for further evaluation of fever of unknown origin (FUO). Physical examination and laboratory studies remained unremarkable; however a follow-up CT scan of chest, abdomen, and pelvis with contrast done to rule out malignancy as an underlying cause of FUO revealed heterogeneous thyroid gland with surrounding hazy changes suggestive of thyroiditis. Thyroid function tests confirmed the diagnosis of subacute thyroiditis. The patient was started on prednisone with good response in his symptoms and was eventually discharged to home. The importance of our case lies in the fact that diagnosing subacute thyroiditis in the absence of classical symptoms of neck pain can be challenging and a physician should have a very high index of suspicion especially in an elderly patient where FUO can be the sole presentation.

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River floods and hydrological droughts (low stream water resources) are a recurrent problem in different parts of Fiji, causing disruption and hardship for many rural communities. These extremes in fluvial behavior are associated with large seasonal variability in rainfall, generated by intense tropical storms in the wet season and prolonged rain failure in the dry season. Such conditions are linked to the influence of El Nino/Southern Oscillation (ENSO) in the Southwest Pacific. The Southern Oscillation Index (SOl) is the climatic measure of the strength of ENSO activities and shows good correspondence with (1) tropical cyclone flood magnitude and (2) critically low stream discharges after a 2-month time lag, in two of Fiji's main river systems. IfENSO conditions become more frequent or sustained in the future as some climate models suggest, then the SOl will be a useful tool for projecting in advance the severity of hydrological hazards, which can assist in disaster mitigation and management.ON THE INTERANNUAL timescale, the El Nino/Southern Oscillation (ENSO) is our planet's most powerful climatic phenomenon (Hilton 1998). At intervals of about 5-7 yr, there is a disturbance in the Walker atmospheric circulation over the Pacific Ocean and a weakening of the southeast trade winds. This causes a large pool of warm ocean water usually centered around New Guinea to surge eastward across the equatorial Pacific (Congbin Fu et al. 1986). This disturbance to the Pacific Ocean and atmospheric system, called El Nino, lasts for more than a year and brings droughts, prolonged wet conditions,

Objective. Fatty liver is a rising global health concern, significantly increasing the burden of health care cost. Nonalcoholic fatty liver disease (NAFLD) has a correlation with metabolic syndrome and its complications. Method. We reviewed the literature regarding the mechanisms of developing NAFLD through AGE-RAGE signaling. Results. NAFLD, metabolic syndrome, and production of advanced glycation end-products (AGEs) share many common risk factors and appear to be connected. AGE induces production of the receptor for AGE (RAGE). AGE-RAGE interaction contributes to fat accumulation in the liver leading to inflammation, fibrosis, insulin resistance, and other complications of the fatty liver disease. The immune system, especially macrophages, has an important defense mechanism against RAGE pathway activities. Conclusion. Soluble form of RAGE (sRAGE) has the capability to reduce inflammation by blocking the interaction of AGE with RAGE. However, sRAGE has some limitations, and the best method of usage is probably autotransplantation of transfected stem cells or monocytes, as a precursor of macrophages and Kupffer cells, with a virus that carries sRAGE to alleviate the harmful effects of AGE-RAGE signaling in the settings of fatty liver disease.