Role of broad-range polymerase chain reaction in diagnosis of infective endocarditis

Positive blood culture is one of the modified Duke's major criteria for diagnosis of infective endocarditis [IE]. Nevertheless, negative blood culture may occur in IE due to prior antimicrobial utilization or infection with fastidious microorganisms. Direct amplification of bacterial DNA by using broad-range PCR primers provides an alternative approach to the detection of pathogens from clinical specimens. Amplification of the 16S and 18S ribosomal RNA gene in DNA extracted from excised heart valve tissue [HV] has been used to provide etiological diagnosis in patients with culture-negative IE. In this study we aimed to assess the usefulness and the practicality of broad-range PCR [brPCR] in diagnosis of infective endocarditis for the first time in Endocarditis Service, Cairo University and for the first time in Egypt. HV surgically removed from 32 patients with definite IE were included in the study. H V were subjected to brPCR and culture. By brPCR, 20 [62.5%] valves were positive for bacteria, of these seven [35%] valves from blood culture positive patients and 13 [65%] of culture-negative patients. Eleven [34.4%] of all patients were positive for fungus by broad-range PCR, all from patients with negative blood culture for fungus. DNA amplification with universal primers is a promising diagnostic tool in infective endocarditis patients where routine laboratory culture failed to identify the pathogen and diagnosis in the coming decade will likely rely more on PCR-based methods

Comparative study between two-dimensional and three dimensional planning for external irradiation after breast conservation surgery

The aim of this work is to compare between 2-dimensional [2-D] and 3-dimentional [3-D] treatment planning in female patients who are undergoing radical irradiation after breast conservation surgery [BCS]. The treatment plans of 10 consecutive patients receiving radical breast irradiation after BCS were studied for various dosimetric parameters. In 2-D planning the chest and breast contours were taken using rigid tape at midplane of the two tangential fields. The Planned Target Volume [PTV] included the whole breast and one centimetre of the underlying lung tissue. The contour and the PTV were fed to the computer via a scanner and 95% isodose line was made to cover the PTV and as a Mean Tumour Dose [MTD]. In 3-D planning, the patient was put on Computed Tomography [CT] flat table in the same position of simulation and the chest was scanned from supra-sternal notch to 5cm below the inferior margin of the intact breast PTV and organs at risk [i.e. heart and both lungs] were contoured at each 5mm CT cut as well as the PTV which included the whole breast with 2cm margin below. Isodose distribution, dose volume histograms [DVH] of various tangential fields were studied in coronal and sagital sections aiming to obtain maximum dose at Organs at Risk [OAR]. Results of 2-D and 3-D plans were compared regarding dose homogeneity within the PTV. The plans of ten patients were compared, the PTV received 95%, however analysis of dose distribution showed the mean dose homogeneity in the PTV was +/- 9.0% [range 6.4-11.4%] for the 2-D plans and 5.6% [range 4.5-10.3%] for the 3-D technique. The dose to the heart and lungs was minimal in the 3-D planning and could not be assessed in the 2-D plans. Three-dimensional treatment planning for the intact breast results in better dose homogeneity in the PTV and ensures minimal dose to OAR

prospective randomized clinical trial of ceftazidime versus ceftazidime plus gentamicin versus meropenem versus piperacillin/ tazobactam plus gentamicin in the treatment of febrile neutropenia [FN] in Oman

A prospective randomised clinical trial was designed to evaluate the efficacy and safety of 4 frontline intravenous [IV] antibiotic regimens in treatment of FN in adults receiving chemotherapy. During a 3 year enrolment period 120 episodes of FN in 96 patients were randomly allocated to receive one of die 4 IV antibiotic arms: [ceftazidime [F] Vs [F] plus gentamicin [FG] Vs meropenum [M] Vs piperacilin/tazobactam plus gentamicin [TG]]. Main end points were: clinical outcome, number of days to become afebrile and cost of treatment. 117 episodes in 96 patients [52 males and 44 females - median age of 44.9 years, 42% lymphomas and 58% solid tumours] were evaluable for response. F= 30, FG=29, M=28 and TG= 30 episodes. Bacteraemia was reported in 19% [12% gram-negative and 7% gram-positive], clinically confirmed infection in 36%, and fever of unknown reason in 45% of studied cases. No statistical significance was found between the 4 arms in terms of response rate [RR] [80%, 83%, 85% and 87% respectively]. The mean time to fever defervescence was significantly shorter in the TG arm [F=3.3, FG=3.1, M=2.8 and TG=2.1 days P=0.014]. Overall episode treatment cost was significantly lower for TG arm [p=0.005]. The 4 arms showed equal RR. However, time to clinical response, and total cost was in favour of TG combination

Pattern of relapse and experience with first line treatment of metastatic and relapsed breast cancer in Oman

The objective of this study was to evaluate the pattern of relapse and the management experience of metastatic and relapsed breast cancer in Oman. Patients who presented to the Royal Hospital, Muscat, between January 1999 and September 2001 either with metastatic breast cancer at first presentation or who relapsed after initial adjuvant treatment were included. Treatment for relapsed patient was tailored according to the previous adjuvant treatment, disease free period, and pattern of metastatic disease. Patients who presented with metastatic disease at first presentation were treated with anthracycline based chemotherapy and/or hormonal therapy. Fortynine patients were studied. 48 [98%] females [of which 29 were pre-menopausal] and only one male patient [2%]. The mean age was 52.7 years [range 30-80 years]. Thirtyone patients [63%] had relapsed disease, and 18 patients [37%] presented with metastatic disease at first presentation. The most common sites- of metastatic disease were bone [45%], lung [31%], liver [18%], soft tissue [26%], and brain [4%]. Out of the 18 patients who presented with metastases, 13 [72%] had only one site involved and the others [28%] had between 2-4 involved sites. The mean disease-free period for patients who developed relapse was 32.2 months. The mean progression free survival [PFS] for treated relapsed patients [31 patients] was 10.4 months. Nineteen patients of 31 [61%] received chemotherapy, 12 had anthracyclines, and 7 received taxanes: the mean PFS for both groups was 8.3 months and 11.2 months respectively [p = 0.022] Twenty patients out of 31 received hormonal therapy, and 11 patients did not receive any hormonal therapy: the mean PFS were 14 months and 4 months respectively [p = 0.002]. The mean PFS for patients who presented with metastatic disease [18 patients] was 14.4 months, 12/18 [67%] patients received chemotherapy. The mean PFS for patients who presented with only one metastatic site was 15.5 months versus 11.5 months for patients who presented with more man one metastatic site. This study demonstrated that the majority of out patients still presented with advanced stage. Among the studied patients, the most common metastatic site was bones. Relapsed patients treated with taxanes had significantly longer PFS than those who were treated with anthracyclines. Patients who presented with only one metastatic site had longer PFS than patients who presented with more than one site. Better health education and increasing the awareness of breast cancer is needed

Racial differences in left ventricular mass among hypertensive Egyptians: results from the Egyptian national hypertension project [NHP]

In this study, LV measurements were obtained from the records of 103 black [B] and 1108 non-black [NB] hypertensive [SBP >/140 and/or DBP >/90 mmHg] Egyptians who received no treatment and were age and gender matched. In B cases, the mean age was 56 years, 39% of them were males. In NB cases, age was 54 years, 43.4% were males. Left ventricular mass [LVM] was corrected for body surface area [BSA] and LVM index [LVMI]. The results of echocardiographic survey study of hypertensive Egyptians revealed that black hypertensive Egyptians have similar or even less LVMI as compared with NB in spite of the higher levels of SBP and urinary NA excretion. Data did not support the notion that black race is at especially higher risk of developing LVH

Early results of pre-irradiation cisplatin and etoposide in the treatment of childhood medulloblastoma

Fifteen children with a pathologically confirmed diagnosis of medulloblastoma were treated with three cycles of cisplatin 100 mg/m2 i.v. Dl and VP16 100 mg/m2 i.v. Dl-3 before standard craniospinal irradiation, then followed by another three cycles chemotherapy after irradiation. After the initial three cycles of cisplatin-VP16, there were three complete responders [CR], nine partial responders [PR], two patients with stationary disease [SD] and one patient had a progressive disease [PD]. After completing the craniospinal irradiation, there were eleven complete responses and four partial responses. At the end of six cycles, there were twelve CRs and three PRs. The progression free survival ranged between 4 and 22 months [mean 14.1 months]. The toxicity of treatment was minimal ranging from mild to moderate nausea for 2-4 days post chemotherapy. Grade 1 neutropenia was encountered in five patients [5 in 90 cycles]. No renal or ototoxicity were encountered during the study

Clinical study evaluating salvage chemotherapy platinum and etoposide in refractory wilm's tumour

A total of 17 patients with refractory Wilm's tumor was included in this study who had received previous surgery, chemotherapy and/or radiotherapy to their primary disease. Site of recurrent disease was abdominal [local] in two patients, lung in four patients, liver in one patient and multiple in ten patients [local, lung, liver]. Cisplatin was given in a dose of 100 mg/m2 day 1 after proper hydration and etoposide in a dose of 100 mg/m2 days one-three. Cycles were repeated every 21 days and initial response was assessed after the 2nd cycle. The efficacy and/or toxicity of the drugs were evaluated during and after treatment. After initial assessment, only two patients attained complete response [CR], four patients had a partial response [PR], six patients had a stationary disease [SD] and five patients had progressive disease [PD]. At the end of the study, a total of 76 cycles was administered to 17 patients, the overall response rate [CR + PR] was 41.2% and the median follow up period was 8.9 months [range 4-20 months]. The combination was tolerable and chemotherapy had to be delayed for one week due to neutropenia on eight occasions of courses and no toxicity related deaths were recorded