Piperacillin/tazobactam plus amikacin versus carbapenem monotherapy as empirical treatment of febrile neutropenia in childhood hematological malignancies

A prospective, randomized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia. Patients aged 2-16 years with hematological malignancies who had febrile neutropenia were randomly assigned to receive piperacillin/tazobactam (80 mg/kg piperacillin/10 mg/kg tazobactam, q6h) combined with amikacin (PTA) (7.5 mg/kg, q12h) or meropenem or imipenem (20 mg/kg, q8h) (C). Response to antimicrobial therapy, evaluated for etiological agents, was measured. Duration of fever, neutropenia, and hospitalization, mortality, and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Out of 87 febrile neutropenic episodes that were evaluable for comparison, 46 patients received PTA and 41 patients were treated with carbapenems (imipenem or meropenem). Overall, the microbiologically documented infection rate was 21.9%, with Staphylococcus epidermidis as the most common cause of bacteremia. The rate of treatment modification was 56.5% in the PTA group and 53.6% in the carbapenem group with no statistical difference (p > .05). There was no infection-related mortality during the study period. There was no difference between the two regimens for durations of fever, neutropenia, and hospitalization (p > .05 for all categories). PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies.

The evaluation of the role of beta-hydroxy fatty acids on chronic inflammation and insulin resistance

β-hydroxy fatty acids are a major component of lipid A moiety of lipopolysaccaride. We aimed to investigate the role of free β-hydroxy fatty acids on inflammation, as well as to evaluate their effects on cytokine release from human blood cells, and whether they exist in plasma of patients with chronic inflammatory diseases with/without insulin resistance. Peripheral venous blood was incubated with β-hydroxy lauric and β-hydroxy myristic acids (each 100 ng, 1 μg, 10 μg/mL) up to 24 hours. Cytokines were measured from culture media and plasma. Free fatty acids and biochemical parameters were also measured from patients' plasma. Only β-hydroxy lauric acid significantly stimulated interleukin-6 production at 10 μg/mL compared to control (533.9 ± 218.1 versus 438.3 ± 219.6 pg/mL, P < .05). However, free β-hydroxy lauric and myristic acids were not found in patients' plasma. Therefore, free β-hydroxy lauric and myristic acids do not seem to have a role on sterile inflammation in chronic inflammatory diseases associated with insulin resistance.

Atypical skin graft-vs.-host disease following bone marrow transplantation in an infant

Herein, we describe an unusual presentation of acute graft versus host disease (GVHD) mimicking contact dermatitis in an infant who underwent 5/6 HLA-matched bone marrow transplantation (BMT) from his mother for malignant infantile osteopetrosis. The initial rash on day +32 simulated diaper rash, which progressed to a belt-shaped rash and then developed hyperkeratotic nodules on the hands. The acute GVHD was atypical and the course was progressive and fatal, with liver and gut involvement. This presentation of atypical initial skin involvement of acute GVHD may be useful for practicing clinicians in the BMT field who need to be aware of the early unusual signs of acute GVHD so that they can initiate prompt treatment.

Familial nodular lymphocyte predominant Hodgkin lymphoma: Successful treatment with CHOP plus rituximab

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare tumor type distinct from classical Hodgkin lymphoma and its familial form is unusual. The two cases (mother at age 48 and son at age 30 years) of NLPHL in advanced clinical stage are described. The patients were successfully treated with an immunochemotherapy schedule consisting CHOP plus rituximab (CHOP-R). This chemotherapy was well tolerated and the patients reached complete remission. These remissions were for 34 and 40 months for mother and son, respectively. In patients with NLPHL, CHOP-R regimen should be used as an alternative treatment regimen to obtain a good long-lasting response without any adverse events.

Effect of propolis in the treatment of experimental Staphylococcus aureus keratitis in rabbits

PURPOSE

The aim of this study was to investigate the antimicrobial and anti-inflammatory properties of an ethanolic extract of propolis, a natural resin produced by honeybees, and to determine synergistic activity between ciprofloxacin and propolis in the treatment of experimental Staphylococcus aureus keratitis.

METHODS

Sixteen young New Zealand white rabbits were given intrastromal injections of S. aureus strains. Twenty-four hours later, the rabbits were randomly divided into 4 groups: group 1 was treated with topical 0.3% ciprofloxacin drops along with the ethanolic extract of propolis drops; group 2 received topical 0.3% ciprofloxacin drops; group 3 was administered the ethanolic extract of propolis drops, and group 4, the control group, was treated with phosphate-buffered saline (PBS) drops. Drugs were instilled 8 times/day for 72 h. Twenty-four and 96 h after inoculation of bacteria, the eyes were examined by slit lamp to assess corneal opacity. Corneas were removed to count bacteria.

RESULTS

Slit lamp examination showed that the corneal opacity scores were significantly lower in eyes that received propolis plus ciprofloxacin than in those treated with ciprofloxacin (p = 0.041) or propolis (p = 0.006) or control eyes treated with PBS (p = 0.0001). There was no significant difference in eyes treated with ciprofloxacin and propolis (p = 1.00). There were significantly fewer bacteria in eyes that received propolis plus ciprofloxacin than in those treated with ciprofloxacin (p = 0.0001) or propolis (p = 0.0001) or control eyes treated with PBS (p = 0.0001). There was no significant difference in eyes treated with ciprofloxacin and propolis (p = 0.38).

CONCLUSIONS

Taking these findings into consideration, we suggest that the ethanolic extract of propolis has antimicrobial and anti-inflammatory properties for S. aureus keratitis. The combination of ciprofloxacin and propolis had better therapeutic effects than either agent alone.

Life-threatening neurological complications after bone marrow transplantation in children

Neurological complications may occur in BMT recipients (11-59%), frequently contributing to morbidity or mortality. They are the main causes of death in 10-15%. Life-threatening neurological complications were seen in 11 out of 113 (9.7%) children who underwent BMT from HLA-matched family (n=7) or mismatched donors (n=4) at our institution. Diagnoses of patients with neurological complications were acute myeloblastic leukemia (AML) (five), thalassemia major (two), Fanconi anemia (two), Omenn syndrome (one) and leukodystrophy (one), and the neurological events were seen between days +13 and +85 after transplantation. Minor symptoms including reversible, nonrepetitive seizures were excluded. Cyclosporine A toxicity was diagnosed in six children. The rest of the complications were brain abscess/meningoencephalitis (two), severe hypomagnesemia (one), busulfan toxicity (one), sustained hypertension (three), and intracranial hemorrhage (three). Six patients with neurological complications suffered from >grade II graft-versus-host disease (GvHD), and all were high risk for transplant-related complications. In this study, risk status of the underlying disease, mismatched transplantation, a diagnosis of AML (advanced stage), older age and >grade II GvHD were important adverse factors for the development of severe life-threatening neurological complications.

Reference serum protein and lipoprotein fractions of ostriches (<i>Struthio camelus<i/>) in Turkey : research communication

The aim of this study was to determine for reference purposes the values of serum albumin, a1-globulin, a2-globulin, b-globulin, g-globulin, and a-lipoprotein (high density lipoprotein), pre-b-lipoprotein (very low density lipoprotein) and b-lipoprotein (low density lipoprotein) fractions of normal ostriches (Struthio camelus) in Turkey. Five male and five female ostriches, 18 months old, were used. All the ostriches were fed on a diet that contained 15.14 % crude protein and 2 950 Kcal/kg of metabolizable energy. The serum protein and lipoprotein fractions were measured using agarose gel electrophoresis. The fractions were found to be 60.96 % albumin, 0.24% a1-globulin, 15.91 % a2-globulin, 13.34 % b-globulin, 9.55 % g-globulin, 53.77 % HDL, 0.60 % VLDL and 48.09 % LDL.

A case of subcutaneous panniculitis-like T-cell lymphoma with haemophagocytosis developing secondary to chemotherapy

A 45-year-old woman presented with fever, generalized skin lesions and multiple lymphadenopathies. In her past history she had had six courses of cyclophosphamide and cisplatin combination chemotherapy 7 years ago because of an ovarian carcinoma. We found pancytopenia in the peripheral blood examination. Skin biopsy showed diffuse subcutaneous infiltration reminiscent of panniculitis but composed of malignant lymphoid cells that were of T lineage. Bone marrow biopsy showed normocellular myeloid tissue with abundant haemophagocytic macrophages. Subcutaneous panniculitis-like T-cell lymphoma with haemophagocytic syndrome was diagnosed. This is the first case reported of subcutaneous panniculitis-like lymphoma occurring secondary to chemotherapy.

A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer

BACKGROUND

Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone.

METHODS

Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths.

CONCLUSIONS

These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.

Meropenem +/- granulocyte colony stimulating factor in the treatment of febrile neutropenic patients with cancer: prospective randomized study

The purpose of this study was to evaluate the impact of granulocyte-colony stimulating factor (G-CSF) on the therapy for febrile neutropenia (FN). Our patient population differed significantly from those of previous studies as no patients received antimicrobial or CSF prophylaxis before randomization and all were solid tumor patients. When the diagnosis of FN was established, patients were started on intravenous meropenem 1 g every 8 hours and randomly assigned to receive G-CSF (5 microg/kg body weight per day subcutaneously) or not. Twenty-eight patients with 30 FN episodes received G-CSF and 25 patients with 30 FN episodes did not receive G-CSF according to randomization. The time to resolution of fever, recovery of neutrophil count over 1000/mm3, duration of hospitalization, need for erythrocyte and platelet transfusion and mortality rate were similar in both study groups. Side effects of therapy were mild. These results provide preliminary evidence that G-CSF administration, in addition to effective antibiotic therapy as treatment of febrile neutropenic patients with solid tumor, does not help improve infection-related morbidity and mortality.

Reference serum protein and lipoprotein fractions of ostriches (Struthio camelus) in Turkey

The aim of this study was to determine for reference purposes the values of serum albumin, alpha 1-globulin, alpha 2-globulin, beta-globulin, gamma-globulin, and alpha-lipoprotein (high density lipoprotein), pre-beta-lipoprotein (very low density lipoprotein) and beta-lipoprotein (low density lipoprotein) fractions of normal ostriches (Struthio camelus) in Turkey. Five male and five female ostriches, 18 months old, were used. All the ostriches were fed on a diet that contained 15.14% crude protein and 2,950 Kcal/kg of metabolizable energy. The serum protein and lipoprotein fractions were measured using agarose gel electrophoresis. The fractions were found to be 60.96% albumin, 0.24% alpha 1-globulin, 15.91% alpha 2-globulin, 13.34% beta-globulin, 9.55% gamma-globulin, 53.77% HDL, 0.60% VLDL and 48.09% LDL.

Characterization of land contaminated by past heavy metal mining using geostatistical methods

Aspects of mining operations, including production, processing, transportation, and, finally, abandoned mine workings, can undoubtedly cause varying degrees of environmental pollution and contamination. Characterization of the spatial distribution of pollutants in contaminated soil is important for risk assessment and soil remediation. This study has been carried out using both conventional statistics and geostatistical methods which are useful for site assessment, characterization, and monitoring situations where data are collected spatially. These methods are particularly suited to cases where spatial dependence structure and contour maps of contaminant concentration or other variables are needed. The aims of this paper were to determine the extent and severity of the pollution levels on land contaminated by past mining activity through using geostatistical techniques, assess sampling strategy, and interpret data for potentially contaminated land. In the study, a total of 329 soil samples was collected at 1-, 5-, and 10-m regular grid intervals of 100 x 1 00-m area of Carsington Pasture in the UK and analyzed using an automatic X-ray fluorescence machine for a large number of elements. Only a few elements (Cu, Pb, Zn, and Ba) were subsequently studied in detail because of their association with the mining operation. Directional and omnidirectional experimental semivariograms of elements Cu, Pb, Zn, and Ba for 10-m grid intervals, pooled data of 10- and 5-m grid intervals (S10+5), and pooled data of 10-, 5-, and 1-m grid interval (S10+5+1) showed that neither geometric nor zonal anisotropy exits in the data. The most evident spatial dependence structure of the continuity for omnidirectional experimental semivariogram, characterized by a spherical model, of each element was obtained for the pooled data set of S10+5. Pooling 1-m grid data to S10+5 shaded the spatial dependence structure. The spherical model adopted for each element embodied no nugget effect, indicating that mineralization did not occur as nuggets in the study area, but it did show different ranges of influence and sill values. Spherical semivariogram model of each element for the pooled data set of S10+5 passed the cross validation tests. Graphs of cross validation test results proved that the isotropic spherical model, with its parameters and kriging search parameters, is representative for the area under study. The values of 10,000 grid nodes established regularly over the study area were estimated by kriging interpolation technique to smooth out the contours. Kriged maps for the Cu, Pb, Zn, and Ba elements were plotted. Anomalies such as bull's-eyes and drift did not observed in the maps generated. Contour maps of estimated element concentrations revealed the extent and severity of contamination. Spatial distribution maps of the elements might be used in the remediation studies and help decision-makers and others involved in the abandoned heavy metal mining site in the UK.