Recognizing true H5N1 infections in humans during confirmed outbreaks.

INTRODUCTION: The goal of this study was to evaluate whether any characteristics that are evident at presentation for urgent medical attention could be used to differentiate cases of H5N1 in the absence of viral testing. METHODOLOGY: Information about exposure to poultry, clinical signs and symptoms, treatments, and outcomes was abstracted from existing data in the global avian influenza registry (www.avianfluregistry.org) using standardized data collection tools for documented and possible cases of H5N1 infection who presented for medical attention between 2005-2011 during known H5N1 outbreaks in Azerbaijan, Indonesia, Pakistan and Turkey. RESULTS: Demography, exposure to poultry, and presenting symptoms were compared, with only the common symptoms of fever and headache presenting significantly more frequently in confirmed H5N1 cases than in possible cases. Reported exposure to  infected humans was also more common in confirmed cases. In contrast, unexplained respiratory illness, sore throat, excess sputum production, and rhinorrhea were more frequent in possible cases. Overall, oseltamivir treatment showed a survival benefit, with the greatest benefit shown in H5N1 cases who were treated within two days of symptom onset (51% reduction in case fatality). CONCLUSION: Since prompt treatment with antivirals conferred a strong survival benefit for H5N1 cases, presumptive antiviral treatment should be considered for all possible cases presenting during an outbreak of H5N1 as a potentially life-saving measure

Prevention of microbial colonization of feeding tubes in the intensive care unit

Background Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir. Aim To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization. Methods A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications. Results The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017). Conclusions An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization. Relevance to Clinical Practice Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care

Tendency of cancer patients and their relatives to use Internet for health-related searches: Turkish Oncology Group (TOG) Study

Conclusion: Cancer patients and their relatives showed a higher tendency to use health-related internet information which may mislead them, and can result in treatment incompliance. Health professionals should offer evidence-based information to the patients and their relatives through internet

Regorafenib or rechallenge chemotherapy: which is more effective in the third-line treatment of metastatic colorectal cancer?

PurposeTo assess the efficacy and safety of regorafenib versus rechallenge chemotherapy in previously treated mCRC patients in third-line setting.Materials and methodsThe data of 104 patients diagnosed with mCRC enrolledfrom2010to2017 in six oncology centers were analyzed. Tumor treatment options were obtained from follow-up and treatment files. Rechallenge chemotherapy was identified as the re-use of the regimen which was previously administered to patients in one of the therapy lines and obtained disease control, these were the patients whose disease did not progress within 3months.ResultsA total of 104 patients had received previously two lines of chemotherapy regimens for mCRC. Of these, 73 patients with mCRC who received regorafenib and 31 those who received rechallenge chemotherapy in third-line therapy were analyzed. Overall survival was better with rechallenge than it was with regorafenib (HR 0.29 95% CI 0.16-0.54, p<0.001). Median OS was 12.0months (95% CI 8.1-15.9) in rechallenge versus 6.6months (95% CI 6.0-7.3) in regorafenib group (p<0.001). Progression-free survival in the rechallenge group showed a higher median value of 9.16months (95% CI 7.15-11.18) versus with that recorded in the regorafenib group of 3.41months (95% CI 3.01-3.82), in favor of rechallenge chemotherapy. The most common adverse events of regorafenib was liver function test abnormality and hand-foot syndrome. Although grade 3 or 4 adverse events were similar, non-hematologic toxicities were more common than those of rechallenge.ConclusionsRechallenge is still a valuable option against regorafenib in patients who achieved disease control in one of the first two lines of therapy. Even though mCRC patients treated with regorafenib benefited clinically from this treatment, we revealed that chemotherapy rechallenge compared to regorafenib was more effective in the third-line treatment for mCRC patients

Effectiveness of antiviral treatment in human influenza A(H5N1) infections: analysis of a Global Patient Registry.

BACKGROUND: Influenza A(H5N1) continues to cause infections and possesses pandemic potential. METHODS: Data sources were primarily clinical records, published case series, and governmental agency reports. Cox proportional hazards regression was used to estimate the effect of treatment on survival, with adjustment using propensity scores (a composite measure of baseline variables predicting use of treatment). RESULTS: In total, 308 cases were identified from 12 countries: 41 from Azerbaijan, Hong Kong SAR, Nigeria, Pakistan, and Turkey (from clinical records); 175 from Egypt and Indonesia (from various sources); and 92 from Bangladesh, Cambodia, China, Thailand, and Vietnam (from various publications). Overall crude survival was 43.5%; 60% of patients who received ≥1 dose of oseltamivir alone (OS(+)) survived versus 24% of patients who had no evidence of anti-influenza antiviral treatment (OS(-)) (P <.001). Survival rates of OS(+) groups were significantly higher than those of OS(-) groups; benefit persisted with oseltamivir treatment initiation <or=6-8 days after symptom onset. Multivariate modeling showed 49% mortality reduction from oseltamivir treatment. CONCLUSIONS: H5N1 causes high mortality, especially when untreated. Oseltamivir significantly reduces mortality when started up to 6-8 days after symptom onset and appears to benefit all age groups. Prompt diagnosis and early therapeutic intervention should be considered for H5N1 disease

Prognostic factors for survival in metastatic renal cell carcinoma patients with brain metastases receiving targeted therapy

Background: The primary objective of our study was to examine the clinical outcomes and prognosis of patients with metastatic renal cell carcinoma (mRCC) with brain metastases (BMs) receiving targeted therapy. Patients and methods: Fifty-eight patients from 16 oncology centers for whom complete clinical data were available were retrospectively reviewed. Results: The median age was 57 years (range 30-80). Most patients underwent a nephrectomy (n = 41; 70.7%), were male (n = 42; 72.4%) and had clear-cell (CC) RCC (n = 51; 87.9%). Patients were treated with first-line suni-tinib (n = 45; 77.6%) or pazopanib (n = 13; 22.4%). The median time from the initial RCC diagnosis to the diagnosis of BMs was 9 months. The median time from the first occurrence of metastasis to the development of BMs was 7 months. The median overall survival (OS) of mRCC patients with BMs was 13 months. Time from the initial diagnosis of systemic metastasis to the development of BMs (2; p2) were independent risk factors for a poor prognosis

Magnetic Nanoparticle-Based Electrochemical Sensing Platform Using Ferrocene-Labelled Peptide Nucleic Acid for the Early Diagnosis of Colorectal Cancer

Diagnostic biomarkers based on epigenetic changes such as DNA methylation are promising tools for early cancer diagnosis. However, there are significant difficulties in directly and specifically detecting methylated DNA regions. Here, we report an electrochemical sensing system based on magnetic nanoparticles that enable a quantitative and selective analysis of the methylated septin9 (mSEPT9) gene, which is considered a diagnostic marker in early stage colorectal cancer (CRC). Methylation levels of SEPT9 in CRC samples were successfully followed by the selective recognition ability of a related peptide nucleic acid (PNA) after hybridization with DNA fragments in human patients&rsquo; serums and plasma (n = 10). Moreover, this system was also adapted into a point-of-care (POC) device for a one-step detection platform. The detection of mSEPT9 demonstrated a limit of detection (LOD) value of 0.37% and interference-free measurement in the presence of branched-chain amino acid transaminase 1 (BCAT1) and SRY box transcription factor 21 antisense divergent transcript 1 (SOX21-AS1). The currently proposed functional platform has substantial prospects in translational applications of early CRC detection

Results of Adjuvant FOLFOX Regimens in Stage III Colorectal Cancer Patients: Retrospective Analysis of 667 Patients

Objective: The aim of this study was to assess the use of 5-fluorouracil (5-FU), leucovorin and oxaliplatin (FOLFOX) regimens in clinical practice according to their efficacy and toxicity. Methods: Patients who received oxaliplatin-containing regimens after curative resection for colorectal carcinoma from 10 different oncology centers between May 2004 and December 2009 were included in the study. All patients were treated with FOLFOX regimens. Patients with rectal carcinoma were also treated with chemoradiotherapy with 5-FU after 2 cycles of a FOLFOX regimen. Results: The median age of the patients was 56 years (range 17-78). Of the total 667 patients, 326 were given FOLFOX-4, 232 were given modified FOLFOX-4 and 109 were given FOLFOX-6. The distribution according to disease stage was 33 patients with stage IIIA colorectal cancer, 382 patients with stage IIIB and 252 patients with stage IIIC. The most common adverse events were neutropenia (54%), nausea (36.9%), neuropathy (38.2%) and anemia (33.1%) for all grades. The median follow-up time was 23 months (range 1-79). Three-year disease-free survival and overall survival were 65 and 85.7%, respectively. Conclusion: The different oxaliplatin-containing 5-FU-based adjuvant chemotherapy regimens in patients with stage III colorectal cancer seemed to be at least equal in terms of efficacy regardless of the method of 5-FU administration or oxaliplatin dose. Copyright (C) 2012 S. Karger AG, Base