An alternative approach for daily perineal care of patients with indwelling urinary catheterization: Photodynamic inactivation with cationic porphyrin derivatives

Background: Catheter-associated urinary tract infections (CAUTI) constitute a significant portion of healthcare-associated infections. Using antiseptic for routine daily perineal care of patients with IUC may reduce CAUTIs. Aim: This study aimed to examine antimicrobial photodynamic inactivation (aPDI) against clinical isolates for use in the daily perineal care of patients with IUC. In addition, it was also aimed to compare the antimicrobial activities of aPDI and 0.1% chlorhexidine gluconate. Methods:  In this in-vitro study, cationic porphyrin derivatives (CPDs) were used as photosensitizers in the experiments. CPDs, named PM, PE, PN, and PL were synthesized by the researchers. A diode laser device emitting light with a wavelength of 450 nm (blue light) was used as the light source. Methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Klebsiella pneumoniae with multidrug-resistant (MDR) properties and Candida albicans were used.  Photosensitizer (PS), aPDI, light (L), and control (C) groups in aPDI experiments; control (C) and chlorhexidine gluconate 0.1% groups were used in the chlorhexidine gluconate experiments. Survival was calculated based on CFU/mL in the control group. Results: In experiments, combinations of 25 J/cm² with 6.25 and 3.125 µM PM, PE reduced E. coli, K. pneumoniae, MRSA, and C. albicans survival in the range of 8.70 to 11.53 log₁₀. In aPDI experiments performed with 6.25 and 3.125 µM PN and PL concentrations at the same energy density, reductions in the range of 4.41 to 0.17 log₁₀ were observed in all four clinical isolates. In experiments where 1.5625 µM concentration was used, survival decreased in the range of 8.29 to 10.87 log₁₀ in PM and PE, while antimicrobial activity was limited in PN and PL. In the 0.1% chlorhexidine gluconate experiments, the survival reduction in all four clinical isolates ranged from 8.87 to 10.24 log₁₀. Conclusion: For PM and PE, a very strong aPDI was obtained in C. albicans, E.coli, K. pneumoniae, and MRSA at low concentrations and energy density. The same antimicrobial activity was found in experiments using 0.1% chlorhexidine gluconate. In this context, we would like to inform you that aPDI to be performed with a combination of 25 J/cm² at 6.25 and 3.125 µM concentrations of PM and PE has the potential to be an antiseptic in the daily perineal care of patients with IUC

Granüloza hücreli over tümörlerinin yönetimi: Tersiyer bir merkeze ait 10 yıllık deneyim

Objective: Granulosa cell tumors (GCT) arise from the mesenchymal cells and sex cords of the ovaries and can be observed in women of all age groups. This study presented our 10 year-long gynecology oncology experience on the clinical course and outcome of GCT cases. Methods: Thirty-one patients who were operated due to suspicious adnexal masses in our hospital between January 2011 and January 2018 and whose final pathology report confirmed the diagnosis of GCT was included in the study. The data of the patients were evaluated. Preoperative ultrasound findings and serum tumor marker results are noted. Results: Twenty-nine (94%) patients were diagnosed with AGCS and only two (6%) patients were diagnosed with JGCS. The mean age of the study population was 47.74 14.47 years and the mean body mass index was 32.51 7.1. Most patients presented with heavy menstrual bleeding (29%). 48.4% of the patients underwent hysterectomy with bilateral salpingo-oophorectomy, and complete lymph-node dissection, whereas 22.6% of them had hysterectomy with bilateral salpingo-oophorectomy, and 29% of them had oophorectomy only. Three patients (9.3%) had a disease recurrence. The overall survival was 54.4 29.3 months and disease free survival was 49.6 24.2 months. Conclusion: The most important predictor of survival among patients with GCT is a disease stage at the time of initial diagnosis. Long-term surveillance, including routine clinical follow-up and evaluation of tumor markers is mandatory.Amaç: Granüloza hücreli tümörler (GCT) yumurtalıkların mezenkimal hücrelerinden ve cinsiyet kordonlarından ortaya çıkar ve her yaş grubundaki kadınlarda görülebilir. Bu çalışma, GCT olgularının klinik seyri ve sonuçları hakkında 10 yıllık jinekoloji onkoloji deneyimimizi sunmayı amaçladı. Yöntem: Ocak 2011-Ocak 2018 tarihleri arasında hastanemizde şüpheli adneksiyal kitle nedeniyle ameliyat edilen ve son patoloji raporu GHT tanısı ile doğrulanan 31 hasta çalışmaya dahil edildi. Hastaların verileri değerlendirildi. Preoperatif ultrason bulguları ve serum tümör belirteç sonuçları not edildi. Bulgular: Yirmi dokuz (%94) hastaya AGCS tanısı kondu ve sadece iki (%6) hastaya JGCS tanısı kondu. Çalışma popülasyonunun ortalama yaşı 47,74 14,47 yıl ve ortalama vücut kitle indeksi: 32,51 7,1 idi. Hastaların çoğu ağır adet kanaması (%29) ile başvurdu. Hastaların %48,4’üne bilateral salpingo-ooferektomi ve tam lenf nodu diseksiyonu ile histerektomi, %22,6’sına bilateral salpingo-ooferektomi ile histerektomi, %29’una sadece ooferektomi yapıldı. Üç hastada (%9,3) hastalık nüksü vardı. Genel sağkalım 54,4 29,3 aydı ve hastalıksız sağkalım 49,6 24,2 aydı. Sonuç: GCT’li hastalar arasında sağkalımın en önemli prediktörü, ilk tanı anındaki hastalık evresidir. Tümör belirteçlerinin rutin klinik takibi ve değerlendirmesini içeren uzun vadeli sürveyans zorunludur

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy

Background: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.Breast Cancer Consortiu