Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB.

BACKGROUND: With the difficulties in choosing colistin sulfate and polymyxin B sulfate (PBS) for carbapenem-resistant gram-negative bacteria (CR-GNB), we compared the efficacy and safety of these two old polymyxins in treatment of critically ill patients infected with CR-GNB infection. METHODS: One hundred four patients infected with CR-GNB in ICU were retrospectively grouped by PBS (68 patients) or colistin sulfate (36 patients). Clinical efficacy including symptoms, inflammatory parameters, defervescence, prognosis and microbial efficacy were analyzed. Hepatotoxicity, nephrotoxicity, and hematotoxicity were evaluated by TBiL, ALT, AST, creatinine, and thrombocytes. RESULTS: Demographic characteristics between colistin sulfate and PBS were not significantly different. Most of the CR-GNB were cultured in respiratory tract (91.7% vs 86.8%), and almost all were polymyxin-sensitive (98.2% vs 100%, MIC ≤ 2 µg/ml). The microbial efficacy in colistin sulfate (57.1%) was significantly higher than PBS (30.8%) (p = 0.022), however, no significant difference in clinical success was seen in both groups (33.8% vs 41.7%), as well as mortality, defervescence, imaging remission, days in the hospital, microbial reinfections, and prognosis, and almost all patients defervesce within 7 days (95.6% vs 89.5%). CONCLUSIONS: Both polymyxins can be administrated in critically ill patients infected with CR-GNB and colistin sulfate is superior to PBS in microbial clearance. These results highlight the necessity of identifying CR-GNB patients who may benefit from polymyxin and who are at higher risk of mortality.

Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease and Its Treatment.

Most patients diagnosed with chronic obstructive pulmonary disease (COPD) present with hallmark features of airway mucus hypersecretion, including cough and expectoration. Airway mucus function as a native immune system of the lung that severs to trap particulate matter and pathogens and allows them to clear from the lung via cough and ciliary transport. Chronic mucus hypersecretion (CMH) is the main factor contributing to the increased risk of morbidity and mortality in specific subsets of COPD patients. It is, therefore, primarily important to develop medications that suppress mucus hypersecretions in these patients. Although there have been some advances in COPD treatment, more work remains to be done to better understand the mechanism underlying airway mucus hypersecretion and seek more effective treatments. This review article discusses the structure and significance of mucus in the lungs focusing on gel-forming mucins and the impacts of CMH in the lungs. Furthermore, we summarize the article with pharmacological and nonpharmacological treatments as well as novel and interventional procedures to control CMH in COPD patients.

Survival trends among patients with advanced renal cell carcinoma in the United States.

INTRODUCTION: Since the approval of sorafenib in December 2005, several targeted therapeutic agents have been approved by the FDA for the treatment of advanced renal cell carcinoma (RCC). This study was conducted to find out whether the improvements in survival of advanced RCC patients with targeted agents have translated into a survival benefit in a population-based cohort. METHODS: We analyzed the SEER 18 (Surveillance, Epidemiology and End RESULTS) registry database to calculate the relative survival rates for advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009. We also evaluated the survival rates by age (<65 and ≥65 years) and sex. RESULTS: The total number of advanced RCC patients during 2001-2009, 2001-2005, 2006-2007 and 2008-2009 were 7,047, 4,059, 1,548 and 1,440, respectively. During 2001-2009, the 1- and 3-year relative survival rates were 26.7±0.6 and 10.0±0.4%, respectively. There was no significant difference in 1-year relative survival rates for patients diagnosed during 2006-2007 and 2008-2009 compared to those diagnosed during 2001-2005. Similarly, the 3-year survival rates for patients diagnosed during 2006-2007 were similar to those diagnosed during 2001-2005. CONCLUSIONS: This population-based study showed that there was no significant improvement in relative survival rates among advanced RCC patients in the era of targeted agents.

Improved survival among older acute myeloid leukemia patients - a population-based study.

BACKGROUND: Survival in acute myeloid leukemia (AML) has improved in younger patients over the last decade. This study was conducted to evaluate the relative survival rates in older AML patients over two decades in the US. MATERIAL AND METHODS: We analyzed Surveillance, Epidemiology, and End Results (SEER) registry database to evaluate relative survival rate in older (≥ 75 years) AML population diagnosed during 1992-2009. We selected AML patients from 13 registries of SEER 18 database to compare RS during 1992-2000 and 2001-2009. RESULTS: The relative survival rates improved significantly during 2001-2009 compared to 1992-2000 for all age groups and sex. For young elderly patients (75-84 years) RS increased from 13.1 ± 0.8% to 17.4 ± 0.9% at one year Z-value = 3.98, p < 0.0001 and from 2.0 ± 0.4 to 2.6 ± 0.5%, Z-value = 3.61, p < 0.0005 at five years. Similarly, for very elderly (≥ 85 years) patients RS increased from 5.3 ± 1.0% to 8.0 ± 1.0%, Z-value = 3.03, p < 0.005 at one year, but no improvement seen at five years. CONCLUSION: The relative survival in elderly AML has increased significantly during 2001-2009 compared to 1992-2000.

Higher diagnostic value of metagenomic next-generation sequencing in acute infection than chronic infection: a multicenter retrospective study.

Background: The aim of this study is to compare the diagnostic value of metagenomic next-generation sequencing (mNGS) vs. conventional culture methods (CM) in chronic infection and acute infection. Methods: We retrospectively analyzed the bronchoalveolar lavage fluid (BALF) of 88 patients with acute infection and 105 patients with chronic infection admitted to three hospitals from 2017 to 2022. Results: The results showed that the sensitivity and specificity of mNGS were higher than those of CM. The number of patients who changed the antibiotic treatment in the mNGS positive group was larger than that of patients in the mNGS negative group in both the acute infection group (60.5 vs. 28.0%, P = 0.0022) and chronic infection group (46.2 vs. 22.6%, P = 0.01112). High levels of temperature (OR: 2.02, 95% CI: 1.18-3.70, P: 0.015), C-reactive protein (CRP) (OR: 15, 95% CI: 2.74-280.69, P: 0.011), neutrophil count (OR: 3.09, 95% CI: 1.19-8.43, P: 0.023), and low levels of lymphocyte count (OR: 3.43, 95% CI:1.26-10.21, P: 0.020) may lead to positive mNGS results in the acute infection group while no significant factor was identified to predict positive results in the chronic infection group. Conclusion: mNGS could provide useful guidance on antibiotic strategies in infectious diseases and may be more valuable for the diagnosis and treatment of acute infection vs. chronic infection.

Iron deficiency thrombocytopenia: a case report.

OBJECTIVE: To describe a rare case of thrombocytopenia secondary to iron deficiency. CLINICAL PRESENTATION AND INTERVENTION: A 34-year-old woman presented with severe microcytic hypochromic anemia and thrombocytopenia. Her ferritin was 1 ng/dl. A diagnosis of iron deficiency anemia and thrombocytopenia was made and the patient was treated with packed red blood cell transfusion and intravenous iron. Thrombocytopenia rapidly improved to normal. CONCLUSION: This case showed that iron deficiency should be considered as a cause of thrombocytopenia in the appropriate setting after ruling out common causes.

Survival Trends in Elderly Patients with Glioblastoma in the United States: a Population-based Study.

BACKGROUND/AIM: Concomitant and adjuvant temozolomide along with radiotherapy following surgery (the Stupp regimen) is the preferred therapy for young patients with glioblastoma as well as for elderly (>70 years) ones with favorable risk factors. This study investigated the survival trend since the introduction of the use of the Stupp regimen in elderly patients in a population-based setting. MATERIALS AND METHODS: Surveillance, Epidemiology, and End Results 18 database was used to identify patients aged ≥70 years with glioblastoma as the first primary cancer diagnosed from 1999 to 2010. Chi-square test, Kaplan-Meier analysis with log-rank test and Cox proportional hazard method were used for analysis. RESULT: A total of 5,575 patients were included in the survival analysis. Survival in Stupp era (year of diagnosis ≥2005) was significantly better compared to the pre-Stupp era with p<0.001 by log-rank test, with 1-, 2- and 3-year overall survival of 18.8% vs. 12.9%, 6.5% vs. 2.1% and 3.1% vs. 0.9% respectively, and hazard ratio for death in 3 years in the Stupp era was 0.87 (95% confidence interval=0.82-0.92; p<0.001) when compared with the pre-Stupp era. Factors such as younger age (<85 years), female sex, married status, Caucasian race and total resection favored better survival compared to their counterparts. CONCLUSION: This study shows that the survival of elderly patients with glioblastoma has improved since the introduction of the Stupp regimen. However, there are significant differences in survival rates among various cohorts.

Second Primary Malignancies in Adults with Gastric Cancer - A US Population-Based Study.

BACKGROUND: Multiple studies have examined the incidence of secondary primary malignancies (SPMs) in gastric cancer patients in Europe and Asia. This retrospective review was conducted to analyze risk of SPM in patients with gastric cancer diagnosed in the United States. METHODS: We included adult patients diagnosed with gastric cancer from the surveillance, epidemiology, and end result (SEER) 13 database. We calculated the risk of SPMs in these patients using the multiple primary standardized incidence ratio session of SEER*stat software and performed subset analyses of SPM with regard to age, sex, radiotherapy used, and latency period. RESULTS: Among 33,720 patients, 1838 (5.45%) developed 2019 SPMs with an observed/expected (O/E) ratio of 1.11 [95% confidence interval (CI) = 1.06-1.16, p < 0.001] and an absolute excess risk of 18.16 per 10,000 population. The median time to first SPM from the time of diagnosis of gastric cancer was 46.9 months (range 6-239 months). Significant excess risk was observed for gastrointestinal malignancies [O/E ratio 1.71 (CI = 1.59-1.84, p < 0.001)], thyroid [O/E ratio 2.00 (CI = 1.37-2.8, p < 0.001)], and pancreatic cancer [O/E ratio 1.60 (CI = 1.29-21.96, p < 0.001)]. Risk of secondary melanoma, breast cancer, and prostate cancer was lower than in the general population. CONCLUSION: The risk for SPMs is significantly increased in adults with gastric cancer compared to the general population.

Disparities in Receipt of Radiotherapy and Survival by Age, Sex, and Ethnicity among Patient with Stage I Follicular Lymphoma.

BACKGROUND: Radiotherapy (RT) is a first-line treatment option for stage I follicular lymphoma (FL). We studied disparities in receipt of RT and survival among patients with stage I FL. METHODS: Adult patients (age ≥18 years) with stage I FL, as the first primary cancer, diagnosed between 1992 and 2007 were identified using Surveillance, Epidemiology, and End Results (SEER) 18 database. Study population was divided into various subgroups based on age, sex, race, and marital status. Factors associated with receipt of RT and survival, among patients receiving RT, was evaluated using regression analysis and Cox PH modeling, respectively. SEER*Stat was used to compute 1- and 5-year RS for various subgroups and compared using Z score. RESULTS: Of the total 7315 patients (median age: 64 years), 2671 (36.5%) received RT. African-Americans, older age group, and single and separated/divorced/widow marital status predicted omission of RT. The 1- and 5-year RS were significantly better in patients receiving RT. In multivariate analysis, male sex, age <60 years, Caucasian race, and married marital status were found to be independent predictor of better RS among patients receiving RT (P < 0.0001). CONCLUSION: This study showed that 36.5% patients with stage I FL received RT. Survival rates were significantly better for patients who received RT.

Association of anemia with parasitic infestation in pregnant Nepalese women: results from a hospital-based study done in eastern Nepal.

BACKGROUND: Anemia is a major contributor to maternal deaths in developing countries. Association of anaemia with helminthic infestations has been seen in the world and by eliminating it, anemia may be reduced with positive effects on maternal outcome. METHODOLOGY: A comparative cross-sectional study was done to assess the association of anemia with parasitic infestation, and other significant risk factors in eastern Nepal. One hundred and twelve pregnant women with and without anemia were enrolled in the study at the antenatal clinic at Dhankuta District Hospital, Nepal from May 2001 to July 2001. The data on social and demographic variables was collected through a structured questionnaire. Hemoglobin estimation and stool examination for parasitic infestation was done for all these women. RESULTS: Anemia was found in 66 (58.91%) women and 52 (46.5%) had helminthic infestation. Anemia was significantly related to hookworm infestation. There was a highly significant relationship between education and the knowledge of women regarding effect of helminthic infestations (P<0.000), transmission and spread of infestations (P < 0.000). The knowledge of women regarding effect of helminthic infestation was significantly (P < 0.001) related to the occurrence of parasitic infestations but its association with anaemia was not significant. CONCLUSION: Hookworm infestation in pregnancy was significantly related with anaemia. Hence all women coming to antenatal clinics should be screened for hookworm infestation. The antenatal care should include de-worming with correction and prevention of anaemia.