Effectiveness of low-dose oral etoposide treatment in patients with recurrent and platinum-resistant epithelial ovarian cancer.

The aim of this study was to evaluate the efficacy and toxicity profile of oral etoposide (50 mg/day, days 1-14, every 3 weeks) in recurrent platinum-resistant epithelial ovarian cancer (EOC). 52 recurrent platinum-resistant EOC patients followed up in four centres between April 2000 and December 2013 were analysed retrospectively. There was response in a total of 21 patients [partial response (PR) and stable disease (SD)], 12 of them used etoposide in second and third, and 9 of them used it in fourth- to fifth-lines of treatment. The overall response rate was 19.2% and clinical benefit rate was 40.4% [PR (19.2%), SD (21.2%)]. Median overall survival (OS) and progression-free survival (PFS) was 9.95 months (95%CI, 0.2-19.7 months) and 3.2 months (95%CI 2.6-3.8 months), respectively. Grade III-IV haematologic and non-haematologic adverse events were observed in 7 (13.4%) patients. We consider that oral etoposide (50 mg/day, days 1-14, every 3 weeks) is an effective treatment with a manageable adverse effect profile in recurrent platinum-resistant EOC patients. Impact statement What is already known on this subject: Oral etoposide is an effective option for recurrent EOC patients at a dose of 50-100 mg/m2/day (1-21 days, every 28 days) regimen. However, it has a high toxicity rate. What the results of this study add: Oral etoposide at a dose of 50 mg/kg (1-14 days, every 21 days) is an effective treatment with a manageable toxicity profile in platinum- resistant ovarian cancer patients when it is used as ≤4th-line palliative setting. What the implications are of these findings for clinical practice and/or further research: We need trials evaluating the effect of low-dose oral etoposide combination with bevacizumab or other chemotherapy agents (irinotecan and gemcitabine) in platinum-resistant EOC patients.

Evaluation of the effects of red blood cell distribution width on survival in lung cancer patients.

AIM OF THE STUDY: Data are available indicating that red blood cell distribution width (RDW) is higher in cancer patients compared to healthy individuals or benign events. In our study, we aimed to investigate the influence of different RDW levels on survival in lung cancer patients. MATERIAL AND METHODS: Clinical and laboratory data from 146 patients with lung cancer and 40 healthy subjects were retrospectively studied. RDW was recorded before the application of any treatment. Patients were categorised according to four different RDW cut-off values (median RDW, RDW determined by ROC curve analysis, the upper limit at the automatic blood count device, and RDW cut of value which used in previous studies). Kaplan-Meier survival analysis was used to examine the effect of RDW on survival for each cut-off level. RESULTS: The median age of patients was 56.5 years (range: 26-83 years). The difference in median RDW between patients and the control group was statistically significant (14.0 and 13.8, respectively, p = 0.04). There was no difference with regard to overall survival when patients with RDW ≥ 14.0 were compared to those with RDW < 14.0 (p = 0.70); however, overall survival was 3.0 months shorter in low values of its own group in each of the following cut-off values: ≥ 14.2 (p = 0.34), ≥ 14.5 (p = 0.25), ≥ 15 (p = 0.59), although no results were statistically significant. DISCUSSION: We consider that the difference between low and high RDW values according to certain cut-off values may reflect the statistics of larger studies although there is a statistically negative correlation between RDW level and survival.

[Activity of tigecycline on planktonic and sessile cells of Acinetobacter baumannii]. / Tigesiklinin Acinetobacter baumannii planktonik ve biyofilm hücrelerine etkisi.

Acinetobacter baumannii is an important pathogen, capable of survival for very long periods on various surfaces in the hospital environment. Tigecycline is a commonly used antimicrobial agent especially for the treatment of resistant infections. The aim of this study was to investigate the activity of tigecycline on both planktonic and sessile biofilm cells of A. baumannii strains isolated from blood cultures and to compare the efficiency in terms of biofilm synthesis. Tigecycline activity on 59 A. baumannii strains was examined by agar dilution technique. The ability of strains to form biofilm was evaluated by adherence on polystyrene surfaces in brain heart infusion broth supplemented with 0.25% glucose. Time-kill technique was used for determination of the time and concentration dependent activity of tigecycline on biofilm positive and negative strains. The planktonic cells in logarithmic growth phase were exposed to tigecycline at 0.5, 1, 2, 4, ve 8 x minimum inhibitory concentration (MIC) concentrations and colony counts were evaluated after 0, 2, 4, 6, 24 and 48 hours. The effect of tigecycline on sessile cells was studied on biofilm matrix composed around plastic beads. Tigecycline susceptibility rate of planktonic cells was 89.8% and MIC50 and MIC90 values were 1 and 2 microg/ml, respectively. Biofilm formation was detected in 52.5% of isolates and no significant correlation was found between MIC values and biofilm production of the strains (p > 0.05). Tigecycline showed a potent antibacterial activity against planktonic cells regardless of biofilm forming capability of strains. Biofilm inhibitory concentrations of sessile cells were elevated significantly. As a result, tigecycline showed a potent activity on planktonic A. baumannii cells however, the effect was decreased significantly on sessile cells in biofilm environment. The results suggest that, the possibility of decreased sensitivity of cells in biofilm environment should be considered as well as antibiotic sensitivity test results during the treatment of infections caused by A. baumannii.

Pimecrolimus 1% cream for pruritus in postmenopausal diabetic women with vulvar lichen simplex chronicus: a prospective non-controlled case series.

BACKGROUND: Pruritus vulvae may have a variety of causes, such as infections, dermatologic disorders or non-neoplastic/neoplastic vulvar diseases. OBJECTIVES: To investigate the efficacy and side effects of topical pimecrolimus 1% cream for pruritus vulvae. METHODS: Twelve postmenopausal diabetic women with vulvar lichen simplex chronicus were enrolled in this trial. Each patient was treated with pimecrolimus 1% cream which was applied twice daily in a thin layer to the vulvae for 3 months. Clinical examination and recording of patients' symptoms using a scoring system was performed by the same physician before, after 4 weeks and after 3 months of therapy. RESULTS: All of the patients completed the study. A substantial decrease in pruritus after treatment was reported by the patients at the 4th week (2.17+/-0.72, p<0.01) and 3rd month of treatment (0.42+/-0.92, p<0.001) when compared with the baseline score (3.75+/-0.45). Follow-up of the patients after 3 months of treatment showed that complete cure occurred in 10 patients (83.3%) and the pruritus was improved in two (16.7%) patients. CONCLUSIONS: Pimecrolimus 1% cream seems to be an effective and safe treatment modality for pruritus in postmenopausal women with vulvar lichen simplex chronicus.

[In vitro resistance rates of Streptococcus pneumoniae and Haemophilus influenzae clinical isolates to the antibiotics used in therapy]. / Streptococcus pneumoniae ve Haemophilus influenzae klinik izolatlarinin tedavide kullanilan antibiyotiklere karsi in vitro direnç oranlari.

Streptococcus pneumoniae and Haemophilus influenzae which cause infections with high morbidity and mortality all over the world, are also the most important bacterial pathogens of community-acquired pneumoniae. In recent years S. pneumoniae is becoming increasingly resistant to a variety of antibiotics. The aim of this study was to detect the in vitro resistance rates of S. pneumoniae and H. influenzae strains isolated from different clinical samples to the antibiotics which are used in the therapy of infections due to these pathogens. Between the period of January 2005 to May 2006, 77 S. pneumoniae (44 sputum, 20 blood, 8 bronchoalveolar lavage, 4 pleural fluids and 1 tracheal aspirate isolate) and 31 H. influenzae (30 sputum and 1 bronchoalveolar lavage isolate) strains isolated from patients who were admitted to Baskent University Hospital, Research and Practice Center of Adana (located in southern Turkey), were included to the study. The antibiotic susceptibility tests were performed by disc diffusion method according to CLSI (Clinical and Laboratory Standards Institute; M100-S13) guidelines. The MIC values of S. pneumoniae which gave an inhibition zone diameter of > or =19 mm in with disc diffusion test, were detected by E-test (AB Biodisk, Sweden). Intermediate and high resistance rates of pneumococci to penicilin were found as 38.9% (30/77) and 10.4% (8/77), respectively, with a total resistance rate of 49.4%. Trimethoprim-sulphamethoxazole (TMP/SMX), erithromycin, tetracyclin, clindamycin and chloramphenicol were the other antibiotics which followed penicillin with the resistance rates of 42.8%, 37.6%, 31.1%, 23.3% and 10.3%, respectively. Amongst H. influenzae strains, one (3.2%) was found to be a beta-lactamase producer and it was resistant to both ampicillin and azitromycin. Eight (25.8%) of H. influenzae isolates were resistant to TMP/SMX, and two (6.4%) were resistant to chloramphenicol. As a result, the high penicilin and erithromycin resistance rates of S. pneumoniae clinical isolates in our hospital emphasize that the empirical use of these antibiotics should be limited and well-controlled in our region.

[A case of brucellosis presenting with urinary tract infection]. / Idrar yolu enfeksiyonu yakinmasi ile basvuran bir bruselloz olgusu.

In this report an acute brucellosis case presenting with the symptoms of urinary tract infection (UTI) has been discussed. A 29 years old male patient was admitted to the emergency service of our hospital with the complaints of acute UTI. His complaints were persisting for five days before admission. His physical examination was normal but there were fever (39 degrees C) and costovertebral angle tenderness. His medical history revealed that multiple stones in the lower pole of the right kidney and paranchyme loss were detected by IVP two years ago. The bacteria that were isolated from blood and urine cultures were identified as Brucella melitensis by conventional methods. Rose Bengal test was found positive, and standard tube agglutination test was positive at a titer of 1/640. The patient was treated with oral ciprofloxacin (1000 mg/day) and rifampicin (600 mg/day) combination for six weeks. The aim of this presentation was to draw attention to this uncommon condition, as UTI symptoms are not the first symptoms of acute brucellosis. UTI symptoms should be carefully considered as a presentation of brucellosis especially in regions where brucellosis is endemic.

Prognostic role of pretreatment platelet/lymphocyte ratio in patients with non-small cell lung cancer.

BACKGROUND: It was reported that hematological markers of systemic inflammatory response might be prognostic in various cancer types. We aimed to evaluate the platelet/lymphocyte ratio (PLR) as a prognostic factor and its effect on overall survival in non-small cell lung cancer (NSCLC). METHODS: Clinicopathological characteristics and basal (pretreatment) PLR of 145 patients with NSCLC were evaluated retrospectively. The preoperative or pretreatment blood count data were obtained from the recorded computerized database. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. RESULTS: A total of 145 patients were enrolled. Median age was 57 years(range 26-83). Receiver operating characteristic curves for overall survival prediction were plotted to verify the optimum cut-off point for PLR. The recommended cut-off values for PLR was 198.2 with a sensitivity of 65.0 % and a specificity of 71.4 %. Median overall survival was 34.0 (95 % confidence interval (CI) 14.7-53.3) months in the group with low PLR (< 198.2), while it was 11.0 (95 % CI 5.6-16.3) months in the group with high PLR (≥ 198.2). The difference between the groups was statistically significant (p < 0.0001). CONCLUSIONS: Our study supports the view that a high basal PLR is a poor prognostic factor in NSCLC. However, the validity of the cut-off values for PLR identified in our study needs further prospective trials.

Successful medical treatment of intracranial abscess caused by Brucella spp.

An unusual presentation of unilateral cerebellar abscesses due to neurobrucellosis observed in a patient is reported. He gave a history of fever, headache, vomiting and had unilateral cerebellar signs. The abscess was detected on magnetic resonance imaging (MRI) and analysis of cerebrospinal fluid revealed neurobrucellosis. Patient treated by only antibiotics therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We are presenting a case of cerebellar abscess due to neurobrucellosis diagnosed by MRI, treated medically, and had both radiologic and clinical follow-up. We also made a review of the literature concerning the cerebellar abscess due to neurobrucellosis.

Assessment of Prognostic Value of "Neutrophil to Lymphocyte Ratio" and "Prognostic Nutritional Index" as a Sytemic Inflammatory Marker in Non-small Cell Lung Cancer.

BACKGROUND: Systemic inflammatory response was shown to play an important role in development and progression of many cancer types and different inflammation-based indices were used for determining prognosis. We aimed to investigate the prognostic effects of neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: NSCLC patients diagnosed in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristics were recorded. NLR and PNI was calculated before the application of any treatment. RESULTS: A total of 138 patients were included in the study. Patients were divided into two groups according to NLR (<3.24 or ≥3.24) and PNI (<49.5 or ≥49.5). While median overall survival was 37.0 (95% CI 17.5-56.5) months in the group with low NLR, it was calculated as 10.0 (95%CI 5.0-15.0) months in the group with high NLR (p<0.0001). While median overall survival was 7.0 (95%CI 3.5-10.5) months in the group with low PNI, it was calculated as 33.0 (95% CI 15.5-50.4) months in the group with high PNI (p<0.0001). Stage, NLR and PNI levels were evaluated as independent risk factors for overall survival for all patients in multivariate analysis (p<0.0001, p=0.04 and p<0.001, respectively). CONCLUSIONS: NLR (≥3.24) and PNI (<49.5) at diagnosis is an independent marker of poor outcome in patients with NSCLC. NLR and PNI is an easily measured, reproducible prognostic tests that could be considered in NSCLC patients.

A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients.

OBJECTIVE: This study aimed to compare clinical, laboratory, and radiological features of spontaneous spondylodiscitis secondary to tuberculosis and brucellosis, both of which are endemic in Turkey, and spondylodiscitis due to other bacterial causes (pyogenic spondylodiscitis) and to provide guidance for clinicians in determining causative agents of spondylodiscitis. MATERIAL AND METHODS: This prospective study involved 75 patients diagnosed as spondylodiscitis. All the patients were divided into three groups: tuberculous spondylodiscitis (Group TS), brucellar spondylodiscitis (Group BS), and pyogenic spondylodiscitis (Group PS). RESULTS: Forty patients (53.3%) were male and 35 (46.7%), female. The mean age of the patients was 57.8+/-14.8 years (17-82 years). Group TS included 13 patients (17.3%), Group BS 32 patients (42.7%), and Group PS 30 patients (40%). A significantly higher rate of microorganisms was isolated and a significantly higher rate of high fever was determined in Group BS. Group TS had a significantly higher rate of accompanying chronic renal failure, constitutional symptoms, psoas abscess, history of tuberculosis, high sedimentation rate, involvement of posterior elements, and/or surgical treatment. CONCLUSION: The presence of back pain, fever, elevated inflammatory markers and a documented history of tuberculosis in association with radiological involvement of the posterior spinous elements is pathognomonic of tuberculous spinal infection, even in the absence of positive culture.