A double-blind, randomized placebo-controlled, phase II study of maintenance enzastaurin (ENZ) with 5-FU/leucovorin (LV) plus bevacizumab (BV) following first-line therapy for metastatic colorectal cancer (mCRC)

501

Background: Maintenance therapy is designed to maximize progression-free survival (PFS) and minimize toxicity in advanced CRC. ENZ is an oral serine/threonine kinase inhibitor that targets PKC-b and the AKT/PI3K pathway. Preclinical studies demonstrated synergistic antitumor effects when ENZ was combined with BV. In phase I studies, the combination was well tolerated. This phase II study assessed ENZ with 5-FU/LV plus BV as maintenance therapy for mCRC.

Methods: Patients had locally advanced or mCRC, and completed 6 cycles of first-line chemotherapy ≤4 wks prior to randomization. Arm A received a loading dose of ENZ 1,125 mg, followed by 500 mg/d subsequent doses. Arm B received placebo. Both groups received 5-FU/LV (LV 400 mg/m2 IV, 5-FU 400 mg/m2 bolus, 5-FU 2,400 mg/m2 IV) plus BV 5 mg/kg IV, every 2 wks. Patients were treated with 5-FU/LV plus BV plus either ENZ or placebo until disease progression or for 1 yr. Primary endpoint was PFS from randomization. Secondary endpoints were overall survival (OS) from randomization, and OS and PFS from start of first-line therapy. Analysis was done after 50 events (objective or clinical progression).

Results: 58 patients were randomized to Arm A (57 treated), 59 to Arm B (58 treated). 82 (70.1%) patients discontinued treatment (Arm A, 42 [72.4%]; Arm B, 40 [67.8%]), the majority due to disease progression. Median cycles were 9 in Arm A, 10 in Arm B. Median PFS in months was 5.8 in Arm A and 8.1 in Arm B (hazard ratio [HR]=1.35, 95% CI: 0.84, 2.16; protocol specified one-sided test, p=0.896). Median OS was not calculable due to high censoring (77.6% in Arm A and 91.5% in Arm B). Median PFS in months from start of first-line therapy was 8.9 in Arm A and 11.3 in Arm B (HR=1.39, 95% CI: 0.86, 2.23; one-sided, p=0.913). More patients developed thrombosis or embolism (TE), including pulmonary embolism, on Arm A (5 [8.8%] patients had grade 3 and 5 [8.8%] grade 4 TE) compared with Arm B (no grade 3 and 1 [1.7%] grade 4 TE).

Conclusions: ENZ did not demonstrate an advantage in PFS compared to BV-based therapy alone. Further development of maintenance therapy with ENZ is not recommended for mCRC.

[Table: see text]

Two brothers with X linked adrenoleukodystrophy

In patients with Addison's disease, diagnosis of Adrenoleukodystrophy (ALD) is suggested by the abrupt development of neuropsychiatric symptoms, associated with Magnetic resonance imaging (MRI) confirmation of extensive, usually symmetric, white matter demyelinating lesion. In these two cases, diagnosis of ALD was strongly supported by symptoms, disease progression, MRI findings. The emergence of neuropsychiatric symptoms in a patient with a prior history of Addison's disease should prompt evaluation for this disorder. Early diagnosis of the disease is required for delaying the progression of the disease. Genetic counseling, carrier detection and antenatal diagnosis can reduce the incidence of this disease, which prognosis is grave in most of the cases.

Pulmonary tuberculosis and drug resistance in Dhaka central jail, the largest prison in Bangladesh

Background

There are limited data on TB among prison inmates in Bangladesh. The aim of the study was to determine the prevalence of pulmonary tuberculosis (TB), its drug resistance and risk factors in Dhaka Central Jail, the largest prison in Bangladesh.

Methods

Cross sectional survey with, active screening of a total number of 11,001 inmates over a period of 2 years. Sputum samples from TB suspects were taken for acid- fast bacilli (AFB) microscopy, culture and drug susceptibility testing.

Results

Among 1,781 TB suspects 245 (13.8%) were positive for AFB on microscopy and/or culture. The prevalence rate of sputum- positive pulmonary TB was 2,227/100,000. Fifty three cases (21.6% of 245 cases) were AFB- negative on microscopy but were found positive on culture. Resistance to isoniazid, rifampicin, streptomycin and ethambutol was 11.4%, 0.8%, 22.4% and 6.5% respectively. No multidrug resistance was observed. The main risk factors of TB in prison were exposure to TB patients (adjusted odds ratio 3.16, 95% CI 2.36–4.21), previous imprisonment (1.86, 1.38–2.50), longer duration of stay in prison (17.5 months for TB cases; 1.004, 1.001–1.006) and low body mass index which is less than 18.5 kg/m² (5.37, 4.02–7.16).

Conclusions

The study results revealed a very high prevalence of TB in the prison population in Dhaka Central Jail. Entry examinations and active symptom screening among inmates are important to control TB transmission inside the prison. Identifying undiagnosed smear-negative TB cases remains a challenge to combat this deadly disease in this difficult setting.

Plasmodium malariae in Bangladesh

We describe a 32-year-old Bangladeshi male presenting with severe malaria caused by a mono-infection with Plasmodium malariae. Rosetting of infected and uninfected erythrocytes, a putative virulence factor in falciparum malaria, was observed in the blood slide. Severe disease caused by P. malariae is extremely rare. The patient made a rapid recovery with intravenous quinine treatment.

Value of FNAC in diagnosis of different types of thyroiditis and its comparison with clinical and biochemical findings

FNAC has developed tremendous improvement in the diagnosis of thyroiditis. The present study was designed to asses the usefulness of FNAC to diagnose various types of thyroiditis and to study their smear patterns. Over a period of one-year, 70 cases of thyroiditis have been evaluated on the basis of cytomorphological criteria and clinical findings of patients. The age ranged from 12-60 years. Majority of the cases were between 21 to 30 years of age with female preponderance in each group of thyroiditis. Among 70 cases, 26(37.14%) cases were Hashimoto's thyroiditis, 21(30%) cases were lymphocytic thyroiditis, seven (10%) cases as granulomatous thyroiditis and 16(22.8%) were non-specific thyroiditis. Further study was carried out in these 70 cases regarding biochemical thyroid status, ultrasonography and radionucleotide scan. Blood was drawn from all patients for estimation of antibody titer to compare with cytological diagnosis. It was found that, clinical examination and history of patients had limited value in the diagnosis of thyroiditis. Ultrasonography and thyroid scan could not reliably differentiate between patients with autoimmune thyroiditis and those with simple and nodular goiter. Biochemically hypothyroidism is more frequently evaluated with Hashimoto's diseases. On the other hand, hyperthyroidism was observed in most other types of thyroiditis. Cytologically diagnosed 78.72% cases of autoimmune thyroiditis had positive antibody titer. From the present study it is concluded that FNAC is a safe, reliable, cost effective and time saving method in the diagnosis of thyroiditis. Being a benign condition also reduce the rate of unnecessary operation, which can be treated conservatively.

Kartagener's Syndrome

Kartagener's Syndrome or Immotile Cilia Syndrome, a variant of Primary Ciliary Dyskinesia (PCD), is a rare autosomal recessive genetic disorder caused by defect in the tiny hair like structure, the cilia lining the respiratory tract (upper and lower), sinuses, eustachian tubes, middle ear and fallopian tubes. Here electron microscopy shows abnormal arrangement of ciliary tubules and patients with Kartagener's syndrome has an absence of dynein arms at the base of the cilia. The inability of cilia to move results in inadequate clearance of bacteria from the air passages, resulting in an increased risk of infection and causing bronchiectasis. Another result of ciliary immobility is infertility. A 60 years old lady was diagnosed as a case of Kartagener's syndrome. She had history of chronic cough for 20 years, irregular fever for 20 years and occasional shortness of breath for 5 years. Relevant investigations revealed dextrocardia, situs inversus, bilateral maxillary sinusitis with non pneumatised frontal sinus and bronchiectasis. She was treated with low concentration oxygen inhalation, antibiotic, bronchodilator, chest physiotherapy including postural drainage, vitamins and other supportive treatment.

Variation between CT scan findings and histological diagnosis of intracranial glioma

A total of 45 cases were studied to elucidate the variation between CT scan findings and histological diagnosis of intracranial glioma. They were operated and histopathological examination of all cases was studied. The mean age of the patients were 35+/-2.37 years and ranged from 01 to 65 years. The highest incidence of glioma was found in age group between 40-50 years. The incidence of glioma was more in male 36(80%) in comparison to female 9(20%). The main presenting complaints were headache in 42(93.3%), vomiting in 34(75%), limb weakness in 28(62.2%) and blurring of vision were in 26(57.8%) patients. Other symptoms were convulsion in 29(64.4%) patients and altered consciousness 24(53.3%) patients. By CT scan, diagnosis was made as informed gliomas in all cases. Histopathological examination showed 41(91.1%) cases were gliomas and 3(6.7%) were meningiomas and 1(2.2%) was brain abscess. So there were little variations between CT scan findings and histopathological diagnosis.

Deterioration of water quality of Surma river

Surma River is polluted day by day by human activities, poor structured sewerage and drainage system, discharging industrial and household wastes. The charas (natural channels) are responsible for surface runoff conveyance from its urban catchments to the receiving Surma River. Water samples have been collected from a part of Surma River along different points and analyzed for various water quality parameters during dry and monsoon periods. Effects of industrial wastes, municipal sewage, and agricultural runoff on river water quality have been investigated. The study was conducted within the Chattak to Sunamganj portion of Surma River, which is significant due to the presence of two major industries--a paper mill and a cement factory. The other significant feature is the conveyors that travel from India to Chattak. The river was found to be highly turbid in the monsoon season. But BOD and fecal coliform concentration was found higher in the dry season. The water was found slightly acidic. The mean values of parameters were Conductivity 84-805 micros; DO: dry-5.52 mg/l, monsoon-5.72 mg/l; BOD: dry-1mg/l, monsoon-0.878 mg/l; Total Solid: dry-149.4 mg/l, monsoon-145.7 mg/l. In this study, an effort has been taken to investigate the status of concentration of phosphate (PO(-4)) and ammonia-nitrogen (NH4-N) at four entrance points of Malnichara to the city, Guali chara, Gaviar khal and Bolramer khal. Data has been collected from March-April and September-October of 2004. Concentrations have been measured using UV Spectrophotometer. Although the phosphate concentration has been found within the limit set by DOE for fishing, irrigation and recreational purposes, however ammonia-nitrogen has been found to exceed the limit.

Morphological study of parathyroid in relation to thyroid gland of Bangladeshi people

The morphological study was done to see the number and location of parathyroid glands in relation to thyroid gland of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty post mortem tissue block containing thyroid and parathyroids along with surrounding structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the topographic relationship and number of parathyroid glands in relation to thyroid gland. In the present study, findings were compared with the findings of Western and Bangladeshi researchers. In the present study, the so-called typical number of parathyroid glands that is 2 pairs per person (in relation to thyroid gland) was externally visible only in fifty percent (50%) of cases. According to this study, middle third of posterior border of thyroid gland lodged most of the glands (60-65%).

Morphological study of recurrent laryngeal nerve in relation to thyroid gland

The study was done to see the relationship of recurrent laryngeal nerves with corresponding inferior thyroid artery with the aim to increase the knowledge regarding variational anatomy in our population. Sixty samples were collected as block dissection of thyroid gland along with the surrounding structures containing the supplying vessels and adjacent nerves from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Fine dissections were carried out to study the toporgaphic relationship of recurrent laryngeal nerves with corresponding inferior thyroid artery. The findings were compared between different age groups and also with the findings of western researchers. In this study, in majority of the cases the recurrent laryngeal nerves were found in their usual location that is posterior to the terminal branches of inferior thyroid artery on the left side and anterior to that artery on the right side. It was important to note that, on both sides recurrent laryngeal nerves were also frequently found to pass in between the terminal branches of inferior thyroid artery.

Epidemiologic characteristics of colon cancer in Asian Indian and Pakistani population living in the USA compared to US White population in SEER database from 1988 to 2002

20112

Background: About 1.5% of the US population is South East Asian in origin and it is one of the rapidly growing groups. Colon cancer is the second most common in male and third most common cancer in females in Asian Indian and Pakistani population living in the USA. This is the first study examining the epidemiologic characteristics of colon cancer in this group. Methods: SEER cancer incidence public use database have reported cancer incidence in 13 SEER registries from 1973 to 2002. Since 1988, Indian/Pakistani populations were reported separately under race and ethnicity. Frequency sessions were performed and descriptive parameters were calculated regarding age, sex, stage, grade, tumor location and diagnostic methods used. Results: A total of 4,229 cases of cancer were reported from 1988 to 2002 in this group and 352 (9%) were colon cancers. The reported incidence of colon cancer in SEER database is increasing (11 in 1988 vs. 53 in 2002). Table shows the comparative studies of different variables of colon cancer between Indian/Pakistani and US White population reported in SEER database. Conclusions: Our study shows that the incidence of colon cancer in Asian Indian and Pakistani population under age 50 is substantially higher than the US White population and the predilection is towards the male sex. Our results suggest that this ethnic group warrants close screening and risk factor stratification for earlier detection of colon cancer as well as awareness and counseling in high-risk families.

[Table: see text]

No significant financial relationships to disclose.

Epidemiologic characteristics of breast cancer (BC) in Asian Indian and Pakistani population living in the US compared to US white population in SEER database from 1988 to 2002

10657

Background: It is estimated that South East Asian population comprises about 1.5% of the total US population and is rapidly growing. BC is the most common cancer in the US-based Indian/Pakistani female population (38%) as reported in the SEER database. This is the first study reporting different epidemiologic characteristics of BC in this population. Methods: From 1988, Indian and Pakistani population with cancer diagnosis was reported separately. Frequency sessions were performed and epidemiologic parameters for BC were calculated regarding age, marital status, stage, grade, laterality, nodal involvement, menopausal status and hormone receptor status. Results: BC comprises about 19% of all cancers reported in US-based Indian and Pakistani population from SEER database. A total of 804 cases of BC were reported in this group in SEER database from 1988 to 2002. BC is the most common cancer (38%) in US-based Indian and Pakistani female population. In comparison, WHO data from 2002 shows that it is the leading cancer in Pakistani females (34%) and second leading cancer in Indian females (19%). BC is more common in this ethnic group than White female (38% vs 32%, p < 0.01) as reported in SEER database. Table shows the comparative studies of different variables of BC between Indian/Pakistani and US White female reported in SEER database. Conclusion: US-based Indian and Pakistani female population is diagnosed with BC at a younger age than US White population. BC tends to express more receptor positivity. A significant number of females are under 50 at the time of diagnosis. More studies in this subset of patients will help in developing screening and educational intervention in this rapidly growing population.

[Table: see text]

No significant financial relationships to disclose.

A study of US-based Indian and Pakistani population with cancer diagnosis reported in the SEER database from 1988 to 2002

20116

Background: Southeast Asian population comprises about 1.5% of the US population and one of the rapidly growing ethnic groups. This is the first study in US-based Indian and Pakistani patients with new diagnosis of cancer analyzing the epidemiologic data. Methods: SEER cancer incidence database have reported cancer incidence from 13 SEER registries from 1973 to 2002. Frequency sessions were performed and descriptive parameters were calculated regarding age, sex, marital status, vital statistics, stage, grade, tumor sites and other diagnostic tests employed. Results: About 11% of the estimated Indian and Pakistani population live in the 13 SEER registry areas. A total of 4,229 cases were reported since 1988 in this subcategory, which is about 0.03% of the total reported cases. 2148 (50.8%) were male and 2081 (49.2%) were female (p = 0.821). Average age at diagnosis was 51 years in male and 53 years in female (p = 0.7295). Table shows the incidence of different cancers compiled from American Cancer Society (ACS) (2005)1, SEER2 and World Health Organization (WHO) (2002)3 databases. Conclusions: Oral cavity cancer in males, and Breast and cervical cancer in females are common malignancies in India and Pakistan. Our study shows that prostate and breast cancer are most common in males and females in US-based Indian and Pakistani population respectively. Immigrants change their demographics regarding cancers and these differences could be attributed to multiple factors. This data may also have implications in terms of earlier screening of cancer in this population and earlier intervention.

[Table: see text]

No significant financial relationships to disclose.