Genotoxic and genoprotective effects of some antipsychotic drugs, methylphenidate and atomoxetine on human lymphocytes and HepG2 cells

OBJECTIVE

Aripiprazole, risperidone, atomoxetine, and methylphenidate are drugs commonly prescribed for many psychiatric conditions and can be used alone or in combination in children and adolescents. This study aimed to investigate comparatively the possible genotoxic effects or genoprotective potentials of these drugs on human lymphocytes and HepG2 cells.

MATERIALS AND METHODS

Cytotoxicity analysis was performed with the cell viability test on human lymphocytes and HepG2 cells, and half-maximal inhibitory concentration (IC50) values of the drugs were determined, and three different doses (¼ IC50, ½ IC50, and IC50) were applied for genetic analysis. For the determined doses, cells with and without DNA damage were examined by comet analysis.

RESULTS

In lymphocytes, aripiprazole and risperidone increased DNA damage at moderate and maximum doses, whereas atomoxetine increased DNA damage only at the maximum dose. In HepG2 cells, risperidone reduced DNA damage at all doses, while atomoxetine increased DNA damage at all doses. On the other hand, in the DNA-damaged cells induced by hydrogen peroxide (H2O2), DNA damage decreased at all concentrations of all drugs in both lymphocytes and HepG2 cells.

CONCLUSIONS

As a result, the genotoxicity of the drugs was found to be dose-dependent, and all drugs showed a genoprotective effect on DNA-damaged cells.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

AB1525-HPR EXAMINATION OF PHYSICAL FITNESS IN CHILDREN AND ADOLESCENTS WITH JUVENILE IDIOPATHIC ARTHRITIS: A COMPARATIVE STUDY

Background

Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease of childhood. Although its etiology is not known exactly; Immunological susceptibility and environmental factors (infections, stress, trauma) are emphasized (1). These children have low activity levels since a young age, and significant problems are observed in the realization of daily living activities (2).

Objectives

This study aims to compare the physical fitness of children/adolescents with Juvenile Idiopathic Arthritis (JIA) and their healthy peers.

Methods

Seventy children/adolescents (mean age: 13.40±2.31 years 35 JIA; mean age: 12.94±2.31 years 35 healthy) were included in the study. After recording demographic data, the functionality levels of the children/adolescents with JIA were evaluated by CHAQ (Childhood Health Assessment Questionnaire), all lower extremity muscle strengths were evaluated by the manual muscle test device, and the physical fitness levels were evaluated by the Brockport physical fitness test battery which is grip strength, push-up test, curl-up test, trunk lift test, shoulder stretch, back saver sit-reach test, calf, triceps, subscapular skinfold thickness and PACER 20 meter test. While the disease activities of children/adolescents with JIA were evaluated with JADAS-27 (Juvenile Arthritis Disease Activity Score); quality of life were evaluated with the PedsQL 3.0 Arthritis Module (Pediatric Quality of Life Inventory).

Results

As a result of the comparative analysis; In terms of functionality which is CHAQ dressing (p=0.008), eating (p=0.011), reaching (p=0.001), rising (p=0.001), walking (p=0.001), holding (p=0.016), hygiene (p=0.011), activity (p=0.00), total score (p=0.00), pain (p=0.00), general well-being (p=0.00) in terms of all sub-parameters, there was found to be significant in favor of healthy children/adolescents (p<0,05). In terms of physical fitness which is grip strength (p=0,041), PACER 20 meter test (p=0,00), trunk lift test (p=0.018) and curl-up (p=0.00) tests, there was a significant difference in favor of the healthy group (p<0,05). There was no significant difference between the groups in terms of other physical fitness tests (p>0.05). When all lower extremity muscle strengths were compared, only right hip external rotation (p=0.023) showed a difference in muscle strength. There was no correlation between JADAS-27 score and physical fitness scores (p>0.05) of children/adolescents with JIA, except for the push-up test (p=0.01). In terms of JADAS-27 score and some PedsQL child form which is pain, total score and activities of daily living of children/adolescents with JIA; there was a significant relationship. In terms of JADAS-27 score and some PedsQL parent form which is pain and total score of children/adolescents with JIA; there was a significant relationship. However there was no relationship in terms of the other parameters (p>0.05).

Conclusion

According to the results of our study, it was observed that the functionality and physical fitness levels of children/adolescents with JIA were lower than their healthy peers, and physical fitness was not affected by disease activity. However, it has been observed that the disease ability of children/adolescents with JIA affects the quality of life of both themselves and their families. For all these reasons, it is very important to encourage children/adolescents with JIA in terms of participation in physical activity and exercise, with informative training aimed at improving their physical fitness.

References

[1]Fink CW. Proposal for the development of classification criteria for idiopatic arthritides of childhood. J Rheumatol 1995; 22: 1566-69.

[2]Bohr, A.H.; Nielsen, S.; Muller, K.; Karup Pedersen, F.; Andersen, L.B. Reduced physical activity in children and adolescents with Juvenile Idiopathic Arthritis despite satisfactory control of inflammation. Pediatr Rheumatol Online J 2015, 13, 57.

Disclosure of Interests

None declared

Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database

PURPOSE

To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters.

METHODS

Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined.

RESULTS

Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters.

CONCLUSIONS

78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.

The therapeutic effect of Cilastatin on drug-induced nephrotoxicity: a new perspective

OBJECTIVE

By creating nephrotoxicity models with cisplatin, vancomycin, and gentamicin in HK-2 (human renal proximal tubule cell) and HEK293T (human embryonic kidney epithelial cells) cell lines, we aimed to evaluate the effect of cilastatin on recovery of cell damage after toxicity had occurred.

MATERIALS AND METHODS

In the first phase of the study, the doses of cisplatin, vancomycin, and gentamicin (50% inhibitive concentration; IC50) were determined. In the second phase, the effective dose of cilastatin against these drugs was determined, and IC50 doses of nephrotoxic agents were administered simultaneously. In the third phase of our study, to evaluate the possible therapeutic effect of cilastatin after toxicity had occurred, the analyses of cell viability, apoptosis, oxidative stress, expression of kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) were performed.

RESULTS

In the second phase of the study, it was observed that cilastatin increased cell viability when treated simultaneously with a nephrotoxic agent. In the third phase, cilastatin provided a significant increase in cell viability. After treatment with each agent for 24 hours, we determined that adding cilastatin to the medium had an effect on the recovery of cell damage by increasing cell viability and reducing apoptosis and oxidative stress. The expression of KIM-1 and NGAL increased when nephrotoxicity occurred and decreased with the addition of cilastatin to the medium.

CONCLUSIONS

The findings of the study suggest that cilastatin may have a healing effect after the development of nephrotoxicity.

SAT0626-HPR EXPLORING THE RELATION BETWEEN PAIN AND ACTIVITY AND PARTICIPATION BASED ON ICF IN CHILDREN AND ADOLESCENTS WITH JUVENIL IDIOPATIK ARTRIT: A PILOT STUDY

Background:

Functional limitation and inactivation are the most important problems in children with Juvenil Idiopatik Artrit (JIA).

Objectives:

The aim of this study was to link and allocate items of Childhood Health Assessment Questionnaire (CHAQ) with activity and participation based on International Classification of Functioning, Disability and Health (ICF). The other aim was to examine the relationship between the pain and activity and participation determined on the basis of CHAQ with Juvenil Idiopatik Artrit (JIA).

Methods:

Thirty-seven children and adolescents (26 girls, 11 boys, mean age=11.75±4.04 years) were included. The mean BMI of the participants was 19.61±4.52 kg / cm2. Inclusion criteria: To be diagnosed with JIA according to ILAR classification. Being in the 6-18 age range. To be stable in drug use for at least 3 months or longer. Exclusion criteria:The presence of another disease. Intraarticularsteroid injection or surgery in any joint in last 3 months. Evaluations were made by the same pediatric rheumatologist and physiotherapist (PT) by face to face interview method. Pain was evaluated by use of Numeric Rating Scale (NRS) (0=no, 10=worst) and disability by CHAQ. As CHAQ score increases, disability increases. CHAQ has 8 categories. The highest score for any question determines the score for that category. The items of CHAQ were linked with ICF codes and allocated with the ICF components by three PT. Original scoring of CHAQ allocated to ICF components was used in order to calculate scores of activity and participation in accordance with clinical data for 37 JIA. The 20th item in the “Reach” category is not included in the calculation as it contains the body function component of ICF. The data was analyzed using Pearson’s correlation coefficient.

Results:

Mean score of NRS was 3.52±2.34. Mean activity and participation score of CHAQ was 0.51±0.58, 0.70±1.10, respectively. Based on expert distinction, activity and participation categories of ICF were covered 24 and 5 items of CHAQ, respectively. Pain had moderate correlation with activity (r=0.595; p=0.002) and participation (r=0.604; p=0.001) for CHAQ. Activity had high correlation with participation (r=0.702; p=0.000).

Conclusion:

Pain in children and adolescents with JIA is an important parameter affecting activity and participation. Pain should be evaluated in all aspects due to the limitation of both activity and participation. CHAQ largely contains the activity component of ICF. The development of new questionnaire is needed to assess the participation of JIA children and adolescents in more detail.

References:

[1]Schanberg LE. Widespread pain in children: when is it pathologic? Arthritis Rheum 2003;48:2402-2405.

Table 1.

Linking and allocating items of CHAQ

ItemsICF CodeICF ComponentDRESSING & GROOMINGDress, including tying shoelaces and doing buttons?d5402AShampoo his/her hair?d5100ARemove socks?d5403ACut fingernails?d520AARISINGStand up from a low chair or floor?d4103AGet in and out of bed or stand up in crib?d4100AEATINGCut his /her own meat?d550ALift a cup or glass to mouth?d4402AOpen a new cereal box?d440AWALKINGWalk outdoors on flat ground?d450AClimb up five steps?d4551AHYGIENEWash and dry entire body?d510ATake a tub bath?dd410AGet on and off the toilet or potty chair?d4103ABrush teeth?d5201AComb/brush hair?d5202AREACHReach and get down a heavy object from just above his/her head?d4452ABend down to pick up clothing or a piece of paper from the floor?d4105APull on a sweater over his/her head?d5400ATurn neck to look back over shoulder?b7101Body FunctionGRIPWrite or scribble with pen or pencil?d170AOpen car doors?d4450AOpen jars which have been previously opened?d4453ATurn faucets on and off?d4402APush open a door when he/she to turn a door knob?d4453AACTIVITIESRun errands and shop?d6200PGet in and out of car or toy car or school?d4702PRide bike or tricycle?d4750PDo household choresd6402PRun and play?d9201P

A:Activity, P:Participation

Disclosure of Interests:

None declared

AB0985 THE EFFECT OF GENDER ON CHILDREN AND ADOLESCENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

In the literature, it was reported that children with with Familial Mediterranean fever (FMF) have lower functional capacity and muscle strength than healthy children. With reduced functional capacity, daily activities are negatively affected. The individual starts to adopt an inactive lifestyle and decreases in muscle strength are observed. A vicious circle occurs and results in exacerbation of symptoms and worse quality of life.

Objectives:

The aim of this study is to investigate the effect of gender on dynamic muscular endurance, physical activity and quality of life with FMF.

Methods:

Forty-eight children and adolescents (26 girls, 22 boys, mean age=12.43±3.04 years, age range=7-18 years) were included. Exclusion criteria:The presence of another disease. Intraarticularsteroid injection or surgery in any joint in the last 3 months. Evaluations were made by the same pediatric rheumatologist and physiotherapist by face to face interview method. Dynamic muscle endurance was evaluated by use of curl up test (30 sec), push up test (30 sec) and one-legged stationary hop test (15 sec); physical activity level by Physical Activity Questionnaire and quality of life by Pediatric Quality of Life Inventory (PedsQL) 3.0 Arthritis Module. Physical Activity Questionnaire contains nine items and evaluates physical activities in last seven days and frequency of these activities. As score increases, level of physical activity increases. In this study, child and parent forms of PedsQL were used to evaluate the quality of life. High scores mean high quality of life. Independent Samples Test was used in the analysis because the data fit the normal distribution.

Results:

Difference was significant in Physical Activity Questionnaire (p=0.028) in favor of girl gender whereas in child form (p=0.017) and parent form (p=0.040) of PedsQL (p=0.003) in favor of boy gender.

Conclusion:

We see that the physical activity are lower in children and adolescents with FMF who have a gender of girls and, accordingly, lower quality of life. Therefore, we believe that these individuals should increase their physical activities.

References:

[1]Gualano B, S´a Pinto AL, Perondi B, Leite Prado DM, Omori C, Almeida RT, Sallum AM, Silva CA. Evidence for prescribing exercise as treatment in pediatric rheumatic diseases. Autoimmun Rev 2010;9(8):569-573.

[2]Alayli G, Durmus D, Ozkaya O, Sen HE, Nalcacioglu H, Bilgici A, Kuru O. Functional Capacity, Strength, and Quality of Life in Children and Youth With Familial Mediterranean Fever. Pediatric Physical Therapy 2014;26(3):347-352.

Table 1.

Demographic characteristics

VariablesGirls (n=26)Boys (n=22)M±SDM±SDAge (years)12.96±2.9111.86±3.24Body weight (kg)42.76±12.5540.17±11.89Height (m)1.50±0.131.48±0.15BMI (kg/m2)18.25±2.9017.85±3.39Age of onset (years)7.57±4.077.22±3.99Dose of colchicine (per day)1.18±0.601.63±0.68Duration of treatment (years)5.30±2.904.61±3.34C-reactive protein (mg/dl)0.88±2.281.25±2.91Pras et al severity score6.35±2.685.31±2.60n (%)n (%)FMF in the family (Yes/No)4(15.4)/16(61.5)12(54.5)/10(45.5)Arthritis (Yes/No)9(34.6)/17(65.4)6(27.3)/16 (72.7)Arthralgia (Yes/No)20(76.9)/6(23.1)14(63.6)/ 8(36.4)Knee (Yes/No)6(23.1)/20(76.9)7(31.8)/15 (68.2)Elbow (Yes/No)1(3.8)/25(96.2)0(0)/22(100)Ankle (Yes/No)6(23.1)/20(76.9)7(31.8)/15(68.2)Hand (Yes/No)1(3.8)/25(96.2)1(4.5)/21(95.5)Table 2.

Comparison of data in terms of gender

VariablesGirls (n=26)Boys (n=22)p*M±SDM±SDCurl Up Test (repeat)10.70±3.5812.80±3.660.075Push Up Test (repeat)10.55±5.0611.75±6.290.511One-legged Stationary Hop Test (repeat)37.60±12.7435.35±6.020.480Physical Activity Questionnaire16.93±5.7020.70±5.770.028PedsQL- child form19.15±13.4810.68±9.380.017PedsQL- parent form22.30±17.8513.04±11.060.040

Disclosure of Interests:

None declared

Using PVA and TPGS as combined emulsifier in nanoprecipitation method improves characteristics and anticancer activity of ibuprofen loaded PLGA nanoparticles

In the preparation of nanoparticles (NPs) by the nanoprecipitation method, emulsifiers play a key role for NPs' characteristics. The present study aimed to investigate the combined emulsifier effect on ibuprofen loaded poly(lactic-co-glycolic acid) (PLGA) NPs' characteristics and anticancer activity. Ibuprofen loaded PLGA NPs were prepared by nanoprecipitation using different concentrations of PVA (poly(vinyl alcohol)) or PVA-TPGS (d-α-tocopherol polyethylene glycol 1000 succinate) combination as emulsifier. It was found that encapsulation efficiencies of NPs varied between 17.9 and 41.9 % and the highest encapsulation efficiency was obtained with 0.5% PVA + 0.1% TPGS (coded as PLGA PVA/TPGS NPs). PLGA PVA/TPGS NPs were characterized and compared with PLGA PVA NPs, which was obtained by 0.5% PVA alone. Polydispersity index of PLGA PVA/TPGS and PLGA PVA NPs were found to be 0.08 and 0.15, respectively. Incorporation of TPGS with PVA slightly decreased the initial ibuprofen release. Transmission electron microscopy analyses demonstrated a nearly uniform particle size distribution and spherical particle shape of the PLGA PVA/TPGS NPs. Additionally, PLGA PVA/TPGS NPs were significantly more cytotoxic than PLGA PVA NPs on the MCF-7 (human breast adenocarcinoma cells) and Caco-2 (human epithelial colorectal adenocarcinoma) cells (p<0.05). Also PLGA PVA/TPGS NPs were not cytotoxic on normal cells (L929, mouse healthy fibroblast cells) (p>0.05). In conclusion, these results indicated that using a combination of TPGS and PVA as an emulsifier in nanoprecipitation could be a promising approach for preparing ibuprofen loaded PLGA NPs because of their improved characteristics and anticancer activity.

Protective effect of thymoquinone against cyclophosphamide-induced genotoxic damage in human lymphocytes

OBJECTIVE

Protective effect of thymoquinone (TQ) against the cytotoxic and genotoxic effects of cyclophosphamide (CP) was assessed in human peripheral blood lymphocyte culture.

METHODS

Mitotic indices were determined as endpoints of cytotoxicity, while sister chromatid exchanges (SCE) served as endpoints of genotoxicity. Firstly, the genotoxic effect of 0.16 µg/ml of CP was tested and CP was detected as genotoxic. In the second set, CP group was treated with 20 µM and 40 µM TQ.

RESULTS

TQ reduced the SCE frequencies, suggesting its protective action on human lymphocytes in vitro against the CP induced genotoxic damage.

CONCLUSIONS

Our results suggest that TQ produces a protective mechanism against CP-induced genetic damage, and suggest a role of DNA strand breaks in the genotoxicity (Tab. 1, Fig. 1, Ref. 19).

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Primary mucinous carcinoma of the vulva with signet ring cells deriving from the cloaca

Vulvar neoplasias are rarely encountered lesions at female genital tract, regardless if they are primary or metastatic. Presence of signet ring cells in a tumour at female genito-urinary tract is highly suggestive of a metastatic lesion particularly from a gastrointestinal tumour. Here the authors present a case of vulvar carcinoma with signet ring cells with an undetermined primary site possibly originating from embryonic cloaca.

A CASE OF CONFINED PLACENTAL MOSAICISM WITH TRISOMY 15 ASSOCIATED WITH TURNER SYNDROME

We here present a rare case of a Turner syndrome with mosaic trisomy 15 identified on chorionic villous sampling (CVS). Although there are several reports in the literature indicating confined placental mosaicism (CPM), counseling parents of a fetus with trisomy 15 mosaicism at CVS remains difficult because of the phenotypic variability. To illuminate that condition an amniocentesis or cord blood study should be offered in conjunction with genetic counseling.

The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients

AIM

The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens.

MATERIALS AND METHODS

Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule.

RESULTS

Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded.

CONCLUSIONS

Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.

Neutrophil-to-lymphocyte ratio in inflammatory bowel disease - as a new predictor of disease severity

BACKGROUND

The aims of this study were to investigate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available predictor for clinical disease activity in inflammatory bowel disease (IBD).

METHODS

Sixty-six patients (22 CD, 44 UC) and 41 healthy controls were enrolled in the study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and complete blood count (CBC) were measured. The neutrophil and lymphocyte counts were recorded and NLR was calculated. The patients with active or inactive UC and CD were classified according to the severity of the disease.

RESULT

The serum NLR values of active CD patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively). NLR values of active UC patients were significantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively. The optimum NLR cut-off point for active CD and UC was 3.2 and 3.1.

CONCLUSION

This study demonstrates that NLR in subjects with IBD is strongly associated with active disease and correlated with clinical and laboratory indices (Tab. 5, Fig. 2, Ref. 31).

Management of a Benign Phyllodes Tumor in a 13-Year-Old Girl with Trans-position of the Nipple Areola Complex and Breast Reconstruction

Phyllodes tumor is a rare primary tumor of the breast. In children and adolescents, it is even rarer with only 20 cases, treatment of which vary in the literature. Herein we report the case of a 13-year-old female patient with a giant benign phyllodes tumor eroding the bottom of the breast skin and causing nipple retraction. We performed breast conservative surgery by mobilizing the areola, using skin flaps and inserting an implant. Breast malignancy, including phyllodes tumor (PT), is very rare in adolescents. PT, previously called cystosarcoma phylloides, consists of leaf-like fronds, from which the tumor gets its name (1, 2). Although PT is most often seen in the fourth decade of life, almost 20 cases have been reported in the adolescent period, most of which are benign. The histologic types are benign, borderline, and malignant, depending on the mitotic rate of the tumor (3, 4).

Genotoxic effects of tacrolimus on human lymphocyte cells

We designed in vitro study to determine possible genotoxic effects oftacrolimus (FK-506), which is used as a potent immunosuppressive drug, by using sister chromatid exchange (SCEs), chromosome aberration (CAs), micronuclei tests (MN) and cell growth kinetics such as mitotic index (MI) and replication index (RI) in human lymphocytes. The cells were treated with 5, 25, 50, and 100 ng/mL concentrations of tacrolimus, for 24 h and 48 h treatment periods. Tacrolimus induced CA and MN frequency at all concentrations for 24 and 48 h In additon, it induced the SCE at the highest concantration for 24 h and at 25 and 100 ng/mL for 48 h. Tacrolimus decreased MI at all concentrations (except 5 ng/mL) for all treatment periods. It also inhibited the RI at 50 and 100 ng/mL concentrations for 24 h and at all concentrations for 48 h. Treatments given with tacrolimus result in the enhance of the different endpoints ofgenotoxicity, suggesting its mutagenic action on lymphocytes in vitro.

To study the correlation between carrier status of nasal Staphylococcus aureus in patients on haemodialysis with hepatitis C, hepatitis B and their sociodemographic features

AIM

To study the correlation of nasal Staphylococcus aureus carrier status in patients on haemodialysis, infected by hepatitis C virus (HCV), hepatitis B virus (HBV), and their sociodemographic features.

SUBJECTS AND METHODS

A survey, including patients' sociodemographic features, was applied to patients by physicians in face to face interviews. Medical records regarding their serologic data were recorded from haemodialysis centres. Nasal swab samples of 2 cm depth from both nostrils of patients were obtained for nasal culture. Samples were inoculated in 5% sheep blood agar and incubated in an incubator at a temperature of 37 degrees C for 24 hours. The results were studied by the same microbiologist.

RESULTS

A total of 185 patients were enrolled in the study. According to culture results, 14.1% of patients (n = 26) had methicillin sensitive Staphylococcus aureus (MSSA) and 1.1% (n = 2) had methicillin resistant Staphylococcus aureus (MRSA). Status of viral hepatitis was 3.8% (n = 8), 10.8% (n = 20) for HBV and HCV respectively. Forty per cent (n = 8) of patients with HBV (+) had MSSA carrier status. Statistically significant positive correlation between MSSA and HCV carrier was detected (r = 0.325, p = 0.001) but not between HBV carrier and MSSA (p = 0.255).

CONCLUSION

In the present study, significant positivity was detected between MSSA carrier status and HCV in patients on haemodialysis and who have lived together with < or = 2 family members at home. Particularly, statistically significant correlation between HCV(+) and MSSA carrier was observed.

How does the presence of urologic problems change the outcome of kidney transplantation in the pediatric age group

PURPOSE

We retrospectively reviewed the impact of functional and anatomic urologic disorders on kidney transplantation outcomes in terms of the surgical and long-term results of pediatric renal transplantation.

MATERIALS AND METHODS

Of the 55 kidney transplantations in the pediatric age group, end-stage renal disease (ESRD) was secondary to genitourinary disorders in 23 patients (42%). The urologic abnormalities were vesicoureteral reflux in 13 patients (59%), neurogenic bladder in 4 patients (18%), posterior urethral valves in 3 patients (14%), renal stone disease in 4 patients (18%), bilateral ureterovesical junction obstruction in 3 patients (14%), and unilateral renal agenesis with concomitant contralateral ureteropelvic junction obstruction in 1 patient (4%).

RESULTS

Of the 23 patients with urologic problems, 19 (83%) had functioning grafts with a mean follow-up of 49 months (range, 7-120 months). In the other 32 patients, 26 (81%) had functioning grafts with a mean follow-up of 43 months (range, 1-144 months). The graft survival, mean serum creatinine, and urinary tract infection rates of the patients did not differ between the two groups.

CONCLUSIONS

The presence of functional urologic disorders as the cause of ESRD did not seem to change the outcome of renal transplantation in terms of graft survival when compared with patients without any urologic disorders. Urinary tract infections seem to be a little more common and yet clinically not significant in those patients. Reflux does not always need to be corrected before transplantation, unless it is causing symptoms or infection.

Treatment of facial asymmetry with a functional appliance: a case report

A five-year-old girl, who had a facial asymmetry from trauma to the condyle, was treated by a hybrid functional appliance. At the end of 1 year 5 months of treatment, symmetry was gained and condylar process showed a significant development.

Anxiety management training for anxiety states: positive compared with negative self-statements

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.