Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup

The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.

The determinants of compliance with an early intervention programme for high-risk babies in India

BACKGROUND

Early intervention is known to improve outcomes for babies at risk for growth and developmental problems. Such programmes usually have a prolonged course and require frequent contacts with the service providers. As a consequence of poverty, illiteracy and lack of communication facilities in developing countries, treatment adherence can suffer.

METHODS

The present study is an analysis of a clinic-based early intervention programme for high-risk babies in a developing society in Goa, India. A sample of 152 neonates and their parents were offered an early intervention programme and followed up until their first birthday. The primary outcome under study was the uptake of the programme. Various socio-demographic, programmatic and infant-related variables that could affect compliance were examined.

RESULTS

Compliance with the intervention programme was only moderate, with 59.2% of infants brought for three or more sessions. Higher maternal educational levels and proximity of the place of residence of the family to the early intervention clinic were significantly associated with better compliance.

CONCLUSIONS

Early intervention programmes that go into homes have a greater chance of reaching high-risk infants, compared with those provided at a distant centre. Better-educated mothers are more likely to be convinced about the benefits of such inputs. The authors conclude with recommendations for future practice and research.

Drugs that inhibit mycolic acid biosynthesis in Mycobacterium tuberculosis

Tuberculosis resurged in the late 1980s and now kills more than 2 million people a year. The reemergence of tuberculosis as a potential public health threat, the high susceptibility of human immunodeficiency virus-infected persons to the disease, and the proliferation of multi-drug-resistant (MDR) strains have created much scientific interest in developing new antimycobacterial agents to both treat Mycobacterium tuberculosis strains resistant to existing drugs, and shorten the duration of short-course treatment to improve patient compliance. Bacterial cell-wall biosynthesis is a proven target for new antibacterial drugs. Mycolic acids, which are key components of the mycobacterial cell wall, are alpha-alkyl, beta-hydroxy fatty acids, with a species-dependent saturated "short" arm of 20-26 carbon atoms and a "long" meromycolic acid arm of 50-60 carbon atoms. The latter arm is functionalized at regular intervals by cyclopropyl, alpha-methyl ketone, or alpha-methyl methylethers groups. The mycolic acid biosynthetic pathway has been proposed to involve five distinct stages: (i) synthesis of C20 to C26 straight-chain saturated fatty acids to provide the alpha-alkyl branch; (ii) synthesis of the meromycolic acid chain to provide the main carbon backbone, (iii) modification of this backbone to introduce other functional groups; (iv) the final Claisen-type condensation step followed by reduction; and (v) various mycolyltransferase processes to cellular lipids. The drugs shown to inhibit mycolic acid biosynthesis are isoniazid, ethionamide, isoxyl, thiolactomycin, and triclosan. In addition, pyrazinamide was shown to inhibit fatty acid synthase type I which, in turn, provides precursors for fatty acid elongation to long-chain mycolic acids by fatty acid synthase II. Here we review the biosynthesis of mycolic acids and the mechanism of action of antimicrobial agents that act upon this pathway. In addition, we describe molecular modeling studies on InhA, the bona-fide target for isoniazid, which should improve our understanding of the amino acid residues involved in the enzyme's mechanism of action and, accordingly, provide a rational approach to the design of new drugs.

[Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics]

PURPOSE

To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU) in fentanyl use and midazolam.

METHODS

Evaluation of 36 children interned in PICU of the Hospital São Paulo--Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem) who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam.

RESULTS

Certain abstinence syndrome in 18 (50%) of the 36 children. Applied Mann Whitney's statistical test to compare the groups with and without abstinence syndrome. Dose accumulated of fentanyl total (5732.7 +/- 5114.91 vs 624.2 +/- 591.2 mcg, p < 0.005), dose daily of fentanyl (98.54 +/- 6.12 vs 36.23 +/- 23.42 mcg/Kg/dia, p < 0.005), velocity of infusion of the fentayl (4.09 +/- 2.75 vs 1.5 +/- 0.95 mcg/Kg/hora, p < 0.005), time of use of the fentanyl (10.2 +/- 5.1 vs 3.16 +/- 1.09 days, p < 0.005), dose accumulated of midazolam total (118.8 +/- 86.97 vs 20.03 +/- 14.79 mg, p < 0.005), dose daily of midazolam (2.32 +/- 0.86 vs 1.21 +/- 0.68 mg/Kg/dia, p < 0.005), velocity of midazolam infusion (0.13 +/- 0.16 vs 0.05 +/- 0.02 mg/Kg/hora, p < 0.005) and time of use of the midazolam (9.20 +/- 4.67 vs 2.55 +/- 1.54 days, p < 0.005) they were considered significant.

CONCLUSION

The abstinence syndrome presents an elevated incidence in children interned in PICU owing to the interruption of the fentanyl infusion and midazolam and in these patients it was related with the dose and the time of use.

Methionine supplementation of soya products: effects on nitrogen balance parameters

Soybean protein is one of the best quality foods available. Contribution of soy to human nutrition increases because of its overall positive nutritional profile, low cost, high protein and excellent functional properties. Addition of methionine to rat soybean diets improve biological value of soy protein. Few studies on methionine fortification of soya protein were carried in infants, but fortification of baby formulas with this amino acid is usually found. This study was carried out to demonstrate in malnourished children that the effect of methionine supplementation of soya milk and soy isolated protein, as well as to compare with their results to cows' milk. A total of 30 malnourished children, 1 to 3 years old, admitted to our metabolic unit and distributed in groups of 6 children were studied. They were fed experimental formulas with cows' milk, soya milk, soya milk plus methionine, soya isolated and soya isolated plus methionine. Nutrient compositions of formulas were calculated to be similar to mothers' milk. DL-methionine, 1.5 g per 100 g protein content was added to soya milk and soya isolated formulas. Two nitrogen balances, 3 days each, were carried out. Fecal and urinary nitrogen, serum proteins, creatinine and urea in serum and urine were followed during the study. Results showed differences of intake and retention of nitrogen between some of the groups, but there were no statistically significant differences on protein absorption in the groups. No differences were demonstrated in serum proteins, total nitrogen and other serum and urine parameters analyzed. Cows' milk fed children presented the highest nitrogen retention in both balance studies. The addition of methionine to the soya milk formula increased the nitrogen retention, not reaching the cows' milk levels and did not have the same effect when added to the isolate soy protein.

[Adenocarcinoma of the appendix. A propos of a case complicated by double local and parietal recurrence]

Adenocarcinoma of the appendix is rarely encountered and is usually discovered fortuitously at pathology examination of the surgical specimen. Six years after surgery for degenerative villous tumor of the appendix, local and parietal recurrence led to surgery in our patient. We present here the indications for complementary hemicolectomy and management of parietal scars resulting from the initial appendectomy.

The malarial impact on the nutritional status of Amazonian adult subjects

The anthropometric (body weight, height, upper arm circumference, triceps and subescapular skinfolds; Quetelet index and arm muscle circumference) and blood biochemistry (proteins and lipids) parameters were evaluated in 93 males and 27 females, 17-72 years old voluntaries living in the malarial endemic area of Humaita city (southwest Amazon). According to their malarial history they were assembled in four different groups: G1--controls without malarial history (n:30); G2--controls with malarial history but without actual manifestation of the disease (n:40); G3--patients with Plasmodium vivax (n:19) and G4--patients with Plasmodium falciparum (n:31). The malarial status was stablished by clinical and laboratory findings. The overall data of anthropometry and blood biochemistry discriminated the groups differently. The anthropometric data were low sensitive and contrasted only the two extremes (G1 > G4) whereas the biochemistry differentiated two big groups, the healthy (G1 + G2) and the patients (G3 + G4). The nutritional status of the P. falciparum patients was highly depressed for most of the studied indices but none was sensitive enough to differentiate this group from the P. vivax group (G3). On the other hand the two healthy groups could be differentiated through the levels of ceruloplasmin (G1 < G2) and alpha nitrogen (G1 > G2). Thus it seems that the malaria-malnourishment state exists and the results could be framed either as a consequence of nutrient sink and/or the infection stress both motivated by the parasite.

Experimental infection of Lutzomyia longipalpis fed on a patient with cutaneous leishmaniasis due to Leishmania mexicana amazonensis

The authors were able to infect phlebotomine sandflies on a human case of American Cutaneous Leishmaniasis by feeding females of Lutzomyia longipalpis on a patient with a lesion due to Leishmania mexicana amazonensis.

[Analysis of the socioeconomic and health data of families residing in the district of Botucatu (São Paulo, Brazil) in 1969]

Foi realizado, em 1969, um levantamento de dados sócio-econômicos e sanitários da zona urbana de Botucatu. Trezentas e cinco famílias amostradas foram entrevistadas sobre: constituição familiar, idade, ocupação, renda, grau de instrução, condições sanitárias dos domicílios, conhecimento e uso de vacinas, demanda e opiniões relativas aos serviços de saúde. Algumas respostas foram associadas ao "status" sócio-econômico das famílias. As condições de saneamento básico estavam dentro de padrões quantitativos razoáveis e era alto o desconhecimento sobre o valor e número de doses das vacinas. Constatou-se acentuada dispersão de recursos para saúde, indicando falta de coordenação dos órgãos assistenciais; a demanda ao Centro de Saúde era baixa, quase restrita às crianças, indicando distorsão da percepção da comunidade com relação aos serviços médico-sanitários e necessidade de desenvolvimento adequado desses serviços, além de educação sanitária sistemática.