DRUGS USED IN THE TREATMENT OF CANCER AND NEPHROTOXICITY

Antineoplastik ilaçlar vücutta patolojik biçimde çoğalmakta olan kanser hücrelerini yok ettikleri gibi, hızlı biçimde çoğalmakta olan normal hücreleri de yok ederler. Bu nedenle çoğu kanser ilacının kemik iliği, kan hücreleri ve diğer hızlı çoğalan hücreleri içiren dokular üzerine de yan etkileri vardır. Böbrek hücrelerinin bölünme hızı yüksek olmamasına rağmen, yüksek kan akımı ile karşılaşması, medüller interstisyumda toksinleri konsantre etme yeteneği ve tübüler epitelde spesifik taşıyıcılara sahip olması nedeniyle toksik zedelenmeye oldukça duyarlıdır. Bu derlemede kanser tedavisinde kullanılan ilaçlara bağlı böbrek bozukluğunu ve nefrotoksisitesi en sık gözlenen kanser ilaçlarının nefrotoksik etki mekanizmalarını değerlendirmeyi amaçladık. Antineoplastic drugs that destroy rapidly dividing tumor cell, but also destroy rapidly dividing normal cells. Thus most of antineoplastic drugs have unwanted efects on bone marrow, blood cells and the other tissue that contain rapidly dividing cells. Renal cells have low dividing rate, however they are highly sensitive to toxic damage, because high renal blood flow, capabilty of consantraiting toxin in medullary interstitium and spesific transporting proteins in tubuler epitelium. In this paper we aim to review renal impairment due to the drugs used in canser treatment and the mechanism of actio

Acanthosis Nigricans in a Patient with Lung Cancer: A Case Report

Some skin lesions may accompany malignancies. Acanthosis nigricans, one such lesion, is a paraneoplastic dermatosis characterized by hyperpigmented and velvety verrucose plaques observed as symetric eruptions. With this report, we aim to present a rare case of concomitant lung cancer and acanthosis nigricans. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. A 65-year-old patient who had hyperpigmented, hypertrophic and symmetric verrucose lesions at the flexor surfaces of the lower and upper extremities, face, palms and the axillary region. Thoracic computed tomography demonstrated a hypodense mass lesion with a dimension of 5 × 5.5 cm at the center of basal segment bronchi of the left pulmonary lobe. Fiberoptic bronchoscopy showed that the access to the lower left lobe was almost completely obstructed by the endobronchial lesion. The result of the histopathologic examination of the endobronchial tissue biopsy was reported as non-small cell (adenocarcinoma) lung cancer. Result of the histopathologic analysis of the punch biopsy of the skin lesions was reported as acanthosis nigricans .There are no pathognomonic dermatological findings for lung cancer. In conclusion, there are skin lesions that accompany lung cancer and we believe that these should be considered for differential diagnosis

A low-cost miniature immunosensor for haemoglobin as a device for the future detection of gastrointestinal bleeding

Gastrointestinal bleeding (GIB) is a serious medical condition, which requires immediate attention to establish the cause of the bleeding. Here, we present the development of a miniaturised electrochemical impedance spectroscopy (EIS) device for the detection of GIB. The device performs EIS measurements up to 100 kHz. Following the development of an immunosensor for haemoglobin (Hb) on screen printed electrodes, the EIS device was used for detecting Hb as an early indication of bleeding. The sensor was able to detect Hb in a redox solution in a linear range between 5 μg mL−1 and 60 μg mL−1, with a limit of detection of 13.3 μg mL−1. It was also possible to detect Hb in simulated intestinal fluid, without the need for a redox solution, within a range of 10 μg mL−1 to 10 mg mL−1 with a limit of detection of 2.31 mg mL−1. The miniature EIS device developed in this work is inexpensive, with an estimated cost per unit of £30, and has shown a comparable performance to existing commercial tools, demonstrating its potential to be used in the future as an ingestible sensor to detect GIB. All these measurements were carried out in a purpose built flow cell with supporting hardware electronics outside the cell. Integration of the hardware and the sensing electrodes was demonstrated in pill form. This pill after integration sampling fluidics has potential to be used in detecting gastrointestinal bleeding

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Detection and elimination of cellular bottlenecks in protein-producing yeasts

Yeasts are efficient cell factories and are commonly used for the production of recombinant proteins for biopharmaceutical and industrial purposes. For such products high levels of correctly folded proteins are needed, which sometimes requires improvement and engineering of the expression system. The article summarizes major breakthroughs that led to the efficient use of yeasts as production platforms and reviews bottlenecks occurring during protein production. Special focus is given to the metabolic impact of protein production. Furthermore, strategies that were shown to enhance secretion of recombinant proteins in different yeast species are presented

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The Socio-Political Dynamics of Corruption: An Analysis on the EU Countries

WOS: 000290501300007The roots of corruption are grounded in a country's economic, political, legal, social and cultural history. The aim of this paper is to empirically test a model that associates non-economic factors such as democracy, law system, education, ethnic fractionalization and Protestant tradition with average corruption rates in a cross-section of 25 Europe countries between the years 2004 and 2007. The empirical results of the study found that democracy, law system, education and Protestant tradition were statistically significant determinants of corruption. In this respect, a country's transition from weak democracy and powerful democracy reduces corruption. An effective law system and education system also decrease corruption. Moreover, it was found that corruption was low in countries with the dominant Protestant tradition. However, in this study, ethnic fractionalization was not found to be statistically significant determinant of corruption

A Basic Approach to Select the Appropriate Method in case of Extended Dominance

WOS: 000487340900019Objective: In cost-effectiveness analysis, treatment methods are ranked by cost and effectiveness, and a method more costly but less effective, is dominated. In models that none of the methods is absolutely dominated but one of them is extendedly dominated, selecting cost-effective method is complicated. Aim of this study was to propose a classification for magnitude of incremental cost-effectiveness ratio of extendedly dominated method, which can use for deciding about cost-effectiveness of this treatment. Methods: Simulated data based on actual data, and simulated hypothetical data in accordance with actual data were used. All possibilities were tried to consider by generating different costs, effectiveness and response rates. Proportional magnitudes of incremental cost-effectiveness ratios of treatments extendedly dominated were investigated. Descriptive statistics for each model, and weighted means by response rates were calculated and change in percentage of extended dominance were compared. Results: Magnitude of incremental cost-effectiveness ratio of the method extendedly dominated is a quite important factor to decide about it, when response rates of alternative methods are similar or same. Slight changes were observed as the response rates differ from each other, but there was not an extreme impact on proportions of extended dominance. Conclusions: A very simple and practical classification which can be used to assess the proportional magnitude of the incremental cost-effectiveness ratio of extendedly dominated treatment method and be valid regardless of whether response rates of treatments in model are same or different was suggested