Inhibitory effect of garlic extract on multi-drug resistant organisms

Multi-drug resistant bacteria have become a major global healthcare problem in the twenty-first century thus an urgent need for products that act on novel molecular targets that circumvent resistance mechanisms, garlic is one of hundreds of plants that are used in traditional medicine as treatment for bacterial infections, In this study, we tried to uncover the effect of different concentrations of local Aqueous Garlic Extract [AGE] on Multi-drug organisms including Escheichia coli [ESBL],Klebsiella pneumonia [ESBL],Pseudomona aeruginosa,Acinitobacter spp, MRSA, by disk diffusion and agar well diffusion assay. All tested organisms were inhibited by AGE up to 25% concentration and the activity was a linear function of concentration. At 100%, the maximum zone of inhibition was observed against MRSA, a Gram positive organism and the minimum was against Klebsiella pneumonia [ESBL], a Gram-negative organism. This indicates that AGE has the potential of a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. In conclusion, the results of this study have provided scientific Justification for the use of local garlic extract in health products and herbal remedies against multidrug-resistant bacterial infections in Kingdom of Saudi Arabia

Assessment of response of locally advanced breast carcinoma to docetaxel and epirubicin neoadjuvant combination regimen: a prospective phase II study

This study aimed to evaluate the efficacy and toxicity of neoadjuvant chemotherapy [NCT] with docetaxel/epirubicin combination in patients with locally advanced breast carcinoma. In addition, to stratify the pathological response to chemotherapy according to a proposed grading system of response. Between July 2000 till December 2002, 24 patients with locally advanced breast carcinoma were recruited and completed their treatment with neoadjuvant chemotherapy, followed by surgery, adjuvant chemotherapy and radiotherapy +/- tamoxifen; following a proposed regimen. Clinical and pathological results of neoadjuvant chemotherapy were evaluated. The patients' median age was 50 years, 54.2% were postmenopausal and all patients had stage III disease with minimum T3 tumour. Clinically positive axilla was detected in 70.8% of patients and 91.7% had infiltrating duct carcinoma. Patients were treated with 4 cycles of NCT formed of epirubicin 90 mg/m2/i.v plus docetaxel 75 mg/m2, one-hour infusion on day one, repeated every 3 weeks upon full marrow recovery. The post treatment clinical assessment revealed that 6 patients [25%] showed clinical complete response, 70.8% achieved clinical partial response [overall response rate 95.8%] with significant reduction of the tumour and axillary nodes dimension. Twenty-two patients underwent surgical interference [10 conservative resection and 12 modified radical mastectomy]. Pathological assessment of the specimen showed that the objective pathological response of breast lesion was 59.1% with 18.2% pathological complete response [Grade 5]. Similarly pathological complete response of axillary involved lymph nodes [Grade D] was achieved in 50% of patients. The clinical and pathological responses were significantly higher for patients with negative hormone receptors. Grade 3 and 4 neutropenia were the major side effect encountered in 79.2% of patients during NCT phase. Patients were followed up for a median of 15 months, the median disease free survival [DFS] was 15 months and the median overall survival [OAS] was not reached. The estimated 2-year DFS was 70% and 2-year OAS was 84%. It was concluded that this regimen of NCT proved to be efficient for treatment of locally advanced breast cancer in terms of clinical, pathological responses as well as the rate of conservative surgery that could be achieved. The pathologic grading of response may be useful for selection criteria of the subset of patients that could benefit from maximizing adjuvant chemotherapy. Future trials should incorporate growth factor support in the treatment regimen to avoid undue toxicity

Concomitant chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma

In this study, 31 patients with stages III and IV non-metastatic nasopharyngeal carcinoma were treated with concomitant chemoradiotherapy in the form of 70 Gy to the primary tumor and the involved neck nodes and 50 Gy to non-involved neck nodes with cisplatinum 100 mg/m2/day 1, 22 and 43 of irradiation. This treatment was followed by 3 cycles of adjuvant chemotherapy in the form of cisplatinum 80 mg/m2/day 1-4/by 24 hours continuous infusion and the cycle to be repeated every 3-4 weeks. All patients were evaluated at the end of concomitant phase and adjuvant phase clinically and radiologically. Follow up was maintained for a median of 32 months. The response to treatment, toxicity profile, pattern of failure, 3-year disease free and overall survival rates were estimated. The current regimen resulted in an improved 3-year disease free survival [DFS] and overall survival [OAS] similar to other studies concerned with the same topic. However, there were high incidences of grade III and IV mucositis, neutropenia and weight loss in this group. Full nutritional support, proper oral hygiene and dental care with the possible use of radio and chemo-protectors as well as growth factor support might be indicated to increase the treatment compliance which ultimately lead to an improved long-term disease free and overall survival

Factors delaying the diagnosis of cancer in children

In this study, an interview questionnaire including the patient's age, the number of siblings as well as the order of the patient among them, the level of education of the parents and the primary complaint was administered to 150 patients and their families. 59% of the patients were younger than 5 years and 66% were males. 73% of the parents were illiterate and only 17% of them were colleague graduate. The primary complaint was fever and/or fatigue in 42% of the patients, mass in abdomen in 21% and lump in the neck in 18.5%, respectively. The patients included in the current study had leukemias and lymphomas [45%] as well as solid tumor [45%]. The delayed diagnosis was represented in an interval of more than three weeks between the first appearance of symptoms or signs and the diagnosis. Only 41 patients were diagnosed within the first 3 weeks of onset of symptoms

Parental factors in childhood malignancies

The current study included 125 children with cancer, in addition to 125 age and sex matched healthy children as a control group. 49% of the cancer patients were coming from rural places versus 35.2% of the controls, this difference was statistically significant. As regards the degree of consanguinity, there was a statistically significant high prevalence of first degree of consanguinity among children of cancer group than the controls; this was the same for children with solid tumors, but not for those with lymphoma and leukemia. The present study showed an increased percentage of parental exposures to pesticides, paints and dyes as well as maternal exposures to irradiation among children in the cancer group. However, this difference was mot statistically significant, may be due to the small number of the study group. However, there was a significant increase of the parental exposure to motor exhaust products in the cancer group

Survival and prognostic factors in differentiated thyroid carcinoma-ongoing controversial Issue

Eighty-one patients with thyroid carcinoma have been treated at King Abdul Aziz Hospital and Oncology Center, Jeddah, KSA between 1992 and January 2000. They were referred postoperatively to Oncology Center for radioiodine ablation, hormone suppression +/- external irradiation. Their mean age was 39 years, with a peak in the 4th decade and follicular carcinoma patients were older than those with papillary carcinoma [median 42 Vs 35]. Females represented 76.6%, with female to male ratio 3.2:1. Diagnostic work up revealed that only 22.2% performed fine needle aspiration [FNA], 37% performed preoperative thyroid scan and 92.5% performed thyroid ultrasonography. Papillary carcinoma represented 84% Vs 12% for follicular carcinoma and the rest were medullary and anaplastic carcinoma. Survival analysis was performed for differentiated thyroid carcinoma patients only [78 patients]. Over a mean follow up of 42.6 months, the mean values for locoregional free survival was 35.4 months, distant metastases free survival was 38.1 months and overall survival was 38.5 months. Correlation of survival parameters with the different prognostic factors showed statistically insignificant difference for age variable [above and below 40 years], gender, tumour size [less or more than 4 cm diameter], presence or absence of cervical adenopathy, type of pathology and extent of surgical resection [lobectomy Vs. thyroidectomy in papillary carcinoma patients]. But there was a borderline statistical significance difference [p=0.07] for locoregional disease free survival for patients with or without capsular invasion. Also, there was a statistical significant difference [p=0.02] for distant metastases free survival and overall survival [p=0.02] for patients with or without vascular invasion. The estimated overall 5-year survival was 96.8% and it was 80% for patients with vascular invasion and 97.6% for paints without vascular invasion. The rate of local recurrence and distant metastases in correlation with the different risk factors showed only significance for capsular and vascular invasion. The prognostic impact of age, gender, cervical adenopathy, size of the nodule, pathological subtypes and extent of surgical resection needs a longer follow-up to clarify the exact significance of those factors; However, capsular and vascular invasion carried a worse prognosis on loco-regional, distant metastases and overall survival on short term follow-up, hence those patients should be treated aggressively. FNA should be one of the main diagnostic methods of malignancy, by which unnecessary surgery for benign conditions could be avoided. We have to expand our efforts to identify high-risk patients more accurately, thereby facilitating a more rational approach to treatment and till this time lobectomy for papillary carcinoma should be extremely restricted even for low risk patients to those in whom surgical morbidity is highly expected