ABSTRACT
We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies. Observational cross-sectional study in a tertiary care center. Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline [CLSI] guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients. Of 150 patients recruited, the majority [n = 27] were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients [10%] were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia [ALL] than in non-ALL patients [p = 0.03]. There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease [p = 0.032] and duration of hospitalization [p = 0.003] were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate [46.67%], with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies [2.75:1]. All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine. This observational study identifies ALL and chronic lymphocytic leukemia [CLL] as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics
ABSTRACT
To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival [OS], Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates [MVA] and analyzed on SPSS software [version 19.0; SPSS, Inc., Chicago, IL]. Thirteen patients [72%] had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 [28%] progressed to SVCO after initiating treatment with chemotherapy. Twelve [68%] patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 [62%], while the median biologically equivalent dose delivered was 28 Gy. Six [33%] patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3 +/- 1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score [p=0.02], and partial response to chemotherapy [p= 0.001] have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients [p = 0.05] have a better OS. RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients