CA 15-3, Ceruloplasmin and tissue polypeptide specific antigen as a tumour marker panel in breast cancer

Background: Tumour markers along with other tests, may be useful in the assessment of the prognosis, monitoring response to treatment and early detection of metastases in breast cancer. The most commonly used breast cancer antigen is CA 15-3.Objective: To examine the value of CA 15-3, ceruloplasmin and tissue polypeptide specific antigen (TPS) panel in the monitoring of breast cancer.Subjects: Serum concentrations of CA 15-3, ceruloplasmin and TPS were measured in 90 women: Fifteen controls, sixteen patients with benign breast disease (BBD), thirty one patients in remission and twenty eight patients with active breast cancer.Results: The results of CA 15-3, ceruloplasmin and TPS estimates were separated into four groups. The patients not in remission were found to have significantly higher levels of CA 15-3 (p0.05). The sensitivities of CA 15-3, ceruloplasmin, and TPS for detecting active breast cancer were 75.0%, 75.0%, and 78.0%, respectively.Conclusion: The highest sensitivity for active breast cancer detection was obtained by the combined use of three tumour markers. We concluded that there may be an advantage in using panels in the follow up of breast cancer patients, although so far such tests have too lowa specificity to be of practical value in screening

Evaluación de las prácticas tradicionales de lactancia materna, alimentación complementaria y aumento de la leche materna en madres con lactantes de 0 a 24 meses: Un estudio transversal

Introduction: To evaluate the traditional practices of breastfeeding, complementary feeding, and increasing breast milk in mothers with 0-24 month-old infants. Material and methods: The study sample includes 215 mothers with 0-24 month-old infants. The mothers’ socio-demographic characteristics, knowledge and behaviors regarding breast milk, complementary feeding, and traditional practices for increasing breast milk were questioned. Results: 60.0% of the infants were exclusively breastfed in the first six months. There was a significant difference between the mothers’ educational levels and the frequency of breastfeeding (p<0.001). A significant difference was observed between the educational level of the mothers and the first complementary food given to the infants (p=0.046). The rate of mothers who breastfed less frequently after introducing to complementary feeding was significantly lower in the group with a low level of education compared to the group with a high level of education (p=0.040). The rate of receiving training from a healthcare professional specialized in breastfeeding before and after birth was significantly higher in the group with a high level of education (41.1% and 52.8%, respectively) than the group with a low level of education (17.3% and 15.4%) (p=0.002 and p<0.001, respectively). The rate of those who knew that breast milk alone was sufficient for feeding the infant in the first six months was significantly higher in the group with a high level of education (96.3%) than the group with a low level of education (86.5%) (p=0.017). Percentage of mothers with a high educational level who consume herbal tea (17.8%) is higher than those with low educational level (4.0%). There is a statistically significant difference between the educational status of mothers and traditional practices to increase breast milk (p<0.001). Conclusions: Mothers had imperfect knowledge regarding breastfeeding and complementary feeding. They should be educated by healthcare professionals to eliminate deficiencies and correct their current practices.Introducción: Evaluar las prácticas tradicionales de lactancia materna, alimentación complementaria y aumento de la leche materna en madres con bebés de 0-24 meses. Material y métodos: La muestra del estudio incluye 215 madres con bebés de 0-24 meses. Se utilizó un cuestionario sobre las características sociodemográficas, los conocimientos y comportamientos de las madres con respecto a la leche materna, la alimentación complementaria y las prácticas tradicionales para aumentar la leche materna. Resultados: el 60,0% de los lactantes fueron amamantados exclusivamente en los primeros seis meses. Hubo una diferencia significativa entre los niveles educativos de las madres y la frecuencia de la lactancia materna (p<0,001). Se observó una diferencia significativa entre el nivel educativo de las madres y el primer alimento complementario dado a los lactantes (p=0,046). La tasa de madres que amamantaron con menor frecuencia después de la introducción a la alimentación complementaria fue significativamente menor en el grupo con bajo nivel educativo en comparación con el grupo con alto nivel educativo (p=0,040). La tasa de formación de un profesional sanitario especializado en lactancia materna antes y después del parto fue significativamente mayor en el grupo con alto nivel educativo (41,1% y 52,8%, respectivamente) que en el grupo con bajo nivel educativo (17,3% y 15,4%) (p=0,002 y p<0,001, respectivamente). La tasa de quienes sabían que la leche materna sola era suficiente para alimentar al lactante en los primeros seis meses fue significativamente mayor en el grupo con un alto nivel de educación (96,3%) que en el grupo con un bajo nivel de educación (86,5%) (p=0,017). El porcentaje de madres con alto nivel educativo que consumen té de hierbas (17,8%) es superior al de madres con bajo nivel educativo (4,0%). Existe una diferencia estadísticamente significativa entre el nivel educativo de las madres y las prácticas tradicionales para aumentar la leche materna (p<0,001). Conclusiones: las madres tenían conocimientos imperfectos sobre la lactancia materna y la alimentación complementaria. Deben ser educados por profesionales de la salud para eliminar las deficiencias y corregir sus prácticas actuales

Cisplatin plus oral etoposide (EoP) combination is more effective than paclitaxel in patients with advanced breast cancer pretreated with anthracyclines: a randomised phase III trial of Turkish Oncology Group

Our objective was to determine whether oral etoposide and cisplatin combination (EoP) is superior to paclitaxel in the treatment of advanced breast cancer (ABC) patients pretreated with anthracyclines. From December 1997 to August 2003, 201 patients were randomised, 100 to EoP and 101 to paclitaxel arms. Four patients in each arm were ineligible. The doses of etoposide and cisplatin were 50 mg p.o. twice a day for 7 days and 70 mg m−2 intravenously (i.v.) on day 1, respectively, and it was 175 mg m−2 on day 1 for paclitaxel. Both treatments were repeated every 3 weeks. A median of four cycles of study treatment was given in both arms. The response rate obtained in the EoP arm was significantly higher (36.3 vs 22.2%; P=0.038). Median response duration was longer for the EoP arm (7 vs 4 months) (P=0.132). Also, time to progression was significantly in favour of the EoP arm (5.5 vs 3.9 months; P=0.003). Median overall survival was again significantly longer in the EoP arm (14 vs 9.5 months; P=0.039). Toxicity profile of both groups was similar. Two patients in each arm were lost due to febrile neutropenia. The observed activity and acceptable toxicity of EoP endorses the employment of this combination in the treatment of ABC following anthracyclines

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Basel III: dehybridisation of capital

One of the core problems in the credit crisis of 2007-08, which continued in an attenuated form through 2011, is the risk of national banking failure stemming from inadequate banking capital. Basel II, whose main purpose was to set out standards for the regulation of capital of internationally active banks, had encouraged a hybridization of capital which was dramatically reversed by the announcement of Basel III in December 2009. This paper explores the rationale for the new capital standard under Basel III. We focus on the link between excessive hybridization of tier 1 capital as a result of implementing Basel II, and the subsequent need for government sponsored bailouts during periods of high liquidity risk. This linkage indicates that Basel II had failed to mitigate liquidity risk, and perversely, amplified it by allowing hybrid financial instruments to be treated with equity-like certainty. Basel III in effect represents a failure of the financial economic models of Basel II. To allay these failures, we propose that substantive legal distinctions replace financial risk metrics in drawing distinctions between equity, hybrid capital and debt with regards to core capital. These distinctions will provide a sense of certainty and financial stability to banking capital

The impact of COVID-19 pandemic on the indications of non-COVID-19 obstetric and gynecological admissions to the intensive care unit (ICU) and its overall consequences

Abstract Since COVID-19 outbreak caused a substantial reduction in intensive care unit (ICU) bed capacity, a significant change in triaging ICU admissions has become necessary for obstetric and gynecologic (OG) patients, as well. In the present study, we aimed to analyze the patients admitted to ICU for non-COVID-19 OG pathologies to understand the probable effects of the pandemic on demographics, admission rates and indications, complications, and the overall outcome. Medical records of patients who were admitted to ICU for OG diseases between 2018 and 2022 were reviewed. This four-year time was divided into two equal periods; Group I (March 2018 to March 2020, before the pandemic starts) and Group II (March 2020 to March 2022, during pandemic). Demographics, indications for admissions to ICU, length of stay, acute physiology and chronic health evaluation II (APACHE-II) scores and the factors contributing to their morbidity and mortality were recorded. Chi-square Kolmogorov-Smirno and Shapiro–Wilk tests were used to compare the variables. p < 0.05 was considered statistically significant. 511 patients were in Group I (61.94%) and 314 in Group II (38.06%). Between 2020 and 2022, our ICU admitted 38.56% fewer OG inpatients, compared with the pre-pandemic period (p < 0.05). While number of patients with gynecological pathologies increased (50 vs 57%), obstetric patients’ admission to ICU decreased (49 vs 42%). In gynecologic patients, postoperative complications and sepsis showed a significant rise (57 vs 69% and 7 vs 12%, p < 0.05), and most were after oncological operations (81%). There was a significant rise in numbers of pregnancy-induced hypertension and placental pathologies (29 vs 36% and 41 vs 58%, p < 0.05). Outcome of obstetric patients in ICU was good (99% survival rate). Mortality was higher in gynecologic patients (4 vs 9%, p < 0.05), correlated with the increased APACHE-II score (8 vs 10, p < 0.05). Older age and oncologic operations were the primary factors increasing mortality. Length of stay in ICU prolonged in these patients, as well (1 vs 3 days, p < 0.05). Selection of priority patients by gynecologists and intensive care specialists in cooperation, and meticulous implementation of the rule of only accepting patients with strict indications may explain the change in OG admissions during the outbreak. These findings will question the accuracy of wider indications for ICU admissions in pre-pandemic period, and help in planning the policy for future post-pandemic days