Inadequate lymph node sampling as a risk factor in stage II colon cancer.

UNLABELLED: The aim of this study is to clarify the magnitude of the risk-to-benefit ratio with adjuvant therapy in high risk stage II colon cancer. PATIENTS AND METHODS: 162 patients with pathologically documented stage II colon cancer were randomly distributed into two groups. The first group (80 patients) received Capecitabine for 6 cycles and the second group (82 patients) received FOLFOX4 for 6 cycles . All patients in both groups were assessed for disease-free survival (DFS) and overall survival (OS) as regards to chemotherapy regimen and high risk factors. Tolerability and safety were assessed for all study population in both groups. RESULTS: Three-year DFS rates were 73% and 87% (Hazard ratio (HR)=2.051, 95%Cl(1.13-3.721) , P-value= 0.018), 3-year OS rates were 87% and 93% (P-value=0.26); corresponding 5-year OS rates for patients with stage II disease were 34% and 93% (HR=2.555, 95%Cl(1.276-5.119), P-value=0.008) in the Capecitabine and Folfox4 groups, respectively. Statistical significant differences in 5-year DFS and OS with lymph node sampling > 12 lymph nodes in favor Folfox4 group (HR=0.172, 95%Cl(0.0080- 0.370), P-value=<0.001) and (HR=0.087, 95%Cl(0.028-0.268), P-value=0.001) respectively. Multivariate analysis for all study population stated that the only significant risk factor was the inadequate lymph node sampling as regards to relapse (HR= 0.244, 95%CI (0.094-0.631), P-value=0.004) in stage II colon cancer. Diarrhea and peripheral sensory neuropathy (PSN) were the most pronounced side effects in FOLFOX4 treatment arm. CONCLUSION: This study has demonstrated that patients with microscopic disease do behave more like stage III colon cancer patients; our data suggest that we must analyze tumors at this level if at all possible and those patients with more than 12 lymph nodes resection should received adjuvant chemotherapy in favor of FOLFOX4 regimen with significant improvement in DFS which can be translated into an OS benefit.

Antimicrobial effect of bee honey in comparison to antibiotics on organisms isolated from infected burns.

Despite recent advances in antimicrobial chemotherapy and burn wound management, infection continues to be an important problem in burns. Honey is the most famous rediscovered remedy that is used to treat infected wounds and promote healing. The present study aims to evaluate the antimicrobial effect of bee honey on organisms isolated from infected burns in comparison to the antibiotics used in treatment of burn infection, and to evaluate the effects produced when bee honey is added to antibiotic discs. Thirty patients with burn infection were selected for this study. The collected specimens were cultured on blood agar plates. The isolated colonies were identified by different methods. The isolated organisms were inoculated onto Müller-Hinton agar. Each agar plate was divided by a marker pen into two halves - in one half the antibiotic discs were plated while on the opposite side each antibiotic disc, immersed in honey, was plated opposite to the same antibiotic disc. At the centre of the agar, a sterile filter paper disc immersed in honey was applied. The most frequently isolated organism was Pseudomonas aeruginosa, representing 53.3% of the isolates. The mean inhibition zones (in mm) produced by honey (18.2 ± 2.5 mm) when applied to isolated gram-negative bacteria were significantly higher than amoxicillin/clavulinic acid, sulbactam/ampicillin, and ceftriaxone (p1 = 0.005 for each). When honey was added to the antibiotic discs there was highly significant increased sensitivity of isolated gram-negative bacteria compared with each of the antibiotic discs alone and with honey alone. The susceptibility of isolated staphylococci revealed the synergistic effect of added honey to the antibiotic discs tested. The antimicrobial effect of honey (18.7 ± 2.2 mm) was significantly higher than antibiotics - ciprofloxacin, sulbactam/ampicillin, ceftriaxone, and vancomycin (p1 ≤ 0.05 for each). After the addition of honey to the tested antibiotic discs there were highly significant increased inhibition zones of antibiotic mixed with honey compared with antibiotic alone - ciprofloxacin, vancomycin, and methicillin (p3 ≤ 0.001 for each). Also, the increase was significant compared with antibiotics alone - imipenem, amoxicillin/clavulinic acid, and ceftriaxone (p3 ≤ 0.05). In conclusion, honey had more inhibitory effect (85.7%) on isolated gram-negative bacteria (Pseudomonas aeruginosa, Enterobacter spp., Klebsiella) than commonly used antibiotics, while it had an inhibitory effect on all methicillin-resistant Staphylococcus aureus (100%) compared with antibiotics used. A synergistic effect of honey was observed when it was added to antibiotics for gram-negative bacteria and also for coagulase-positive staphylococci.