Impact of Reducing Irritative Symptoms in Non-Muscle Invasive Bladder Cancer During BCG Instillation: A Pilot Study

INTRODUCTION: We evaluated use of anticholinergics, mirabegron, and combination of anticholinergics with mirabegron during Bacillus Calmette-Guérin (BCG) instillation for reducing irritative symptoms in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Prospectively recorded data of NMIBC patients receiving BCG were retrospectively evaluated between August 2015 and April 2019. Patients with low-grade T1 solitary papillary lesions <4 cm were included in the study. Validated questionnaires (OAB-V8) for irritative symptoms adapted to Turkish language, and QoL index forms were filled out by the study participants. OAB-V8 scores of ≥8 were considered as an indication to start medical treatment for irritative symptoms. Groups were formed according to daily used anticholinergic drugs and combinations as follows: Group 1, tolterodine; Group 2, solifenacin 5mg; Group 3, mirabegron, and Group 4, mirabegron with solifenacin 5 mg. RESULTS: Mean follow- up period was 20.4+-6.8 months. There were 132 patients [110 men (83%) and 22 (17%) women] with irritative symptoms and NMIBC. Mean age of the study population was 59.7+-12.4 years. The OAB-V8 scores and QoL indexes significantly improved with all drugs. However, in subgroup analyses, Group 4 provided the most dramatic improvement in OAB-V8 and QoL index scores (P=0.02 for both). The longest in time to micturition was recorded in Group 4 (P=0.04). Tumour recurrence was similar for groups 12 months after BCG instillation (P=0.9), however the least recurrence was observed in Group 4. DISCUSSION AND CONCLUSION: Combination of solifecacin and mirabegron can reduce irritative symptoms, improve QoL, and prolong time to micturition, during BCG instillation in selected NMIBC patients. This combination may also decrease recurrence rates in this patient population

Case Report: Hepatic Mass Caused By Fasciola Hepatica: A Tricky Differential Diagnosis

Fascioliasis is a zoonotic infestation caused by the trematode fasciola hepatica. It presents a wide spectrum of clinical pictures ranging from fever and eosinophilia to ambiguous gastrointestinal symptoms in the acute phase. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to the presentation of malignancy. Here, we report a case of a hepatic mass caused by fasciola hepatica

Serum Beta 2-Microglobulin As A Biomarker in Inflammatory Bowel Disease

AIM: To investigate the diagnostic utility of beta 2 microglobulin (B2-M) levels and analyze this correlation with the activity of inflammatory bowel disease (IBD). METHODS: Overall, 78 IBD patients and 30 healthy controls were enrolled in the study. We examined B2-M serum levels in 43 ulcerative colitis (UC) patients, 35 with Crohn's disease (CD) and 30 control subjects, using an enzymatic method. Patients were divided into two groups according to two disease types: active and in remission. Subjects were also divided into two subgroups according to extent of the disease: left-side and pancolitis for UC and ileitis and ileocolitis for CD. All groups were compared for mean serum B2-M levels and also examined to see whether there was a correlation between serum B2-M levels and other inflammatory markers. RESULTS: The mean serum B2-M levels in the control group, UC and CD were 1.71, 2.41 and 2.24 respectively. B2-M values >= 1.96 mg/L had a 62% sensitivity, 76% specificity, a 79% positive predictive value, and a 58% negative predictive value for UC patients. B2-M values >= 1.70 mg/L had 80% sensitivity, 53% specificity, 66% positive predictive value, and 69% negative predictive value for CD patients. Mean B2-M values were significantly higher in ulcerative colitis and Crohn's disease patients than in healthy controls (UC 2.41 +/- 0.87 vs 1.71 +/- 0.44, P = 0.002; CD 2.24 +/- 1.01 vs 1.71 +/- 0.44, P = 0.033). Also, mean B2-M values were significantly higher in active disease when compared to patients in remission (UC 2.66 +/- 0.92 vs 1.88 +/- 0.41, P = 0.004; CD 2.50 +/- 1.15 vs 1.73 +/- 0.31, P = 0.033). The difference between groups (UC and CD) in terms of serum B2-M levels was statistically insignificant (2.41 +/- 0.87 vs 2.24 +/- 1.01, P > 0.05 respectively). CONCLUSION: Serum B2-M levels may be used as an activity parameter in IBD. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.WoSScopu

Strategic level three-stage production distribution planning with capacity expansion

In this paper, we address a strategic planning problem for a three-stage productiondistribution network. The problem under consideration is a single-item, multi-supplier, multi-producer, and multi-distributor productiondistribution network with deterministic demand. The objective is to minimize the costs associated with production, transportation, and inventory as well as capacity expansion costs over a given time horizon. The limitations are the production capacities of the suppliers and producers, and transportation capacities of the corresponding transportation network. On the other hand, all capacities may be increased at a fixed cost. The problem is formulated as a 0-1 mixed integer programming model. Since the problem is intractable for real life cases efficient relaxation-based heuristics are considered to obtain a good feasible solution