Risk-reducing mastectomy in BRCA1/2 mutation carriers: Factors influencing uptake and timing

Introduction

Strategies in case of high risk of breast cancer in BRCA1/2 mutation carriers are either intensive breast cancer screening or risk-reducing mastectomy (RRM). Both options have a high physical and psychosexual impact. The aim of this study is to investigate who chooses when to undergo RRM.

Methods

BRCA1/2 mutation carriers have been prospectively registered at the family cancer clinic between 1994 and 2011. Analyses were performed to assess the relation between characteristics of the BRCA1/2 mutation carriers and an earlier decision for RRM.

Results

A cumulative percentage of 35.6% of all women chose to undergo RRM within the first five years after disclosure of DNA test results. Women needed less time to choose for RRM measured from the first visit, if they were younger than 50 years of age (hazard ratio (HR) = 2.67, 95% confidence interval (CI) = 1.30–5.48) or had a mother who had had breast cancer (HR = 1.51 95% CI = 1.04–2.18). Also, women needed less time to choose for RRM in case of a previous breast cancer (HR = 2.25, 95% CI = 1.55–3.27). After a previous unilateral therapeutic mastectomy as a treatment for breast cancer, women needed less time to choose for RRM of the contralateral breast (HR = 2.69, 95% CI = 1.29–5.62) compared to women who had had breast-conserving therapy.

Conclusion

BRCA1/2 mutation carriers aged under 50, having a mother with breast cancer, who had previous unilateral breast cancer and previous unilateral therapeutic mastectomy chose more often and earlier for RRM.     

10th Survey of antimicrobial resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2007–2008

Objectives

The aim of the study was to evaluate the antibiotic resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2008–2007.

Method

Four hundred and forty eight unduplicated isolates collected by 15 laboratories were tested by microdilution following CLSI.

Results

Insusceptibility rates (I + R) were as follows: penicillin G (PEN) 11.6% (4.0% R), ampicillin 11.4% (4.0% R), amoxicillin + /–clavulanic acid 0, cefaclor 10.3% (9.6% R), cefuroxime 9.2% (8.7% R), cefuroxime-axetil 8.7% (7.8% R), cefotaxime, ceftazidime and cefepime 2.0% (0% R), imipenem 2.5% (0% R), ciprofloxacin and ofloxacin 5.1% (0.4% R), levofloxacin 0.7% (0.4% R), moxifloxacin 0.4% (0.2% R), erythromycin (ERY) 29.7% (29.2% R), azithromycin 29.7% (28.8% R), telithromycin 0%, clindamycin 26.3% (25.4% R) and tetracycline (TET) 21.9% (16.5% R). From 2001 to 2008, a significant decrease in penicillin-insusceptibility (21.0% to 11.6%), penicillin-resistance (9.7% to 4.0%) and ciprofloxacin-insusceptibility (11.2% to 5.1%) was found. Cross-resistance between penicillin and other betalactams in penicillin-insusceptible isolates was incomplete: all these isolates remained fully susceptible to amoxicillin. Erythromycin-insusceptibility was significantly higher in children than in adults (43.9%/27.4%), while penicillin-insusceptibility significantly higher in Brussels than in the Flanders (22.9%/8.1%). The commonest resistance phenotype was ERY-TET (12.7%) followed by ERY (7.4%) and PEN-ERY-TET (5.8%). Capsular types 19 (25%), 14 (19.3%), 23 (15.4%) and 15 (13.5%) were the most important in penicillin-insusceptible.

Conclusion

We noted a decrease in resistance to the majority of the compounds. Insusceptibility rates were higher in children than in adults and the difference between the north and the south of Belgium became less marked.     

Prevalence and role of efflux pump activity in ciprofloxacin resistance in clinical isolates of <Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis>

We investigated the prevalence and role of efflux pump activity and possible drug influx resistance in ciprofloxacin susceptibility amongst 26 distinct clinical isolates of Klebsiella pneumoniae of varying ciprofloxacin susceptibilities and known quinolone resistance-determining region (QRDR) genotypes. Cellular [¹⁴C]ciprofloxacin accumulation patterns and the amount of cell-associated [¹⁴C]ciprofloxacin of mid-logarithmic phase cells were determined before and after challenging with the efflux pump inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Most isolates (24/26), and all with ciprofloxacin minimum inhibitory concentrations (MICs) >1 μg/ml, had efflux activity that could extrude up to 90% of cell-associated [¹⁴C]ciprofloxacin; none had significant influx resistance. In isolates with no QRDR mutations, efflux alone reduced ciprofloxacin susceptibility. In isolates with QRDR mutations, the efflux activity varied: in one isolate with no efflux activity, the most common fluoroquinolone resistance-causing QRDR mutation did not bring about clinically significant ciprofloxacin resistance; isolates with multiple mutations had high MICs and, usually, high levels of efflux activity. Fluoroquinolone efflux activity is much more common in clinical isolates of K. pneumoniae than previously reported and it can contribute to decreased ciprofloxacin susceptibility.     

The use of spa and phage typing for characterization of a MRSA population in a Belgian hospital: Comparison between 2002 and 2007

Target of the study

Strain typing of pathogens is essential to pinpoint the sources and routes of transmission and to forecast future trends. In a general hospital, we studied possible changes in the MRSA population.

Patients and methods

MRSA isolates received from a Belgian general hospital, during 2002 (n = 150) and the second half of 2007 (n = 105), were compared by phage and spa typing.

Results

In 2002, [J]* phage types characterized 45% of the MRSA isolates, 13% belonged to the [O]* phage types, 12% to a local phage type 29/42E/54/D11* and 28% were not assigned to a defined group. Thirteen different spa types were found among the isolates: 39% belonged to t038, 27% to t121, 14% to t041, 5% to t740, and 4% to t002 and t024 each. Two spa types were found respectively in two and three isolates, five were unique.In 2007, 35% belonged to [J]*, 23% to [O]* and 39% could not be put in a defined group. Eighteen different spa types were found: 30% belonged to t740, 29% to t121, 13% to t038 and 10% to t002. Three spa types were represented in two isolates, eleven were unique.The t041 spa type was specific for the 29/42E/54/D11* and the majority of the t121 isolates were related to [J]*.

Conclusion

[J]* remained the dominant phage types group but decreased whereas [O]*, the second phage types group, increased. As to the spa types, t740 became dominant while t121 remained second. Phage and spa typing point to some quantitative changes among the Belgian MRSA population.     

Évolution de la résistance aux antibiotiques de Pseudomonas aeruginosa dans un centre hospitalier universitaire entre 2002 et 2006

Aim of study

Monitor evolution of antibiotic resistance of Pseudomonas aeruginosa from 2002 to 2006 in our hospital to optimize antibiotherapy.

Patients and method

The infections/colonizations with P. aeruginosa have been identified by the hospital's informatic database. Bacteriological samples realized 48 hours after patient's admission was considered as nosocomial. A Cochran-Armitage test was conducted to assess the evolution of resistance.

Results

During this period, 2098 infections/colonizations with P. aeruginosa have been identified. Bacteriological samples (68.5%) were nosocomial. Among the β-lactam antibiotics, ceftazidime and imipenem were the most active (R = 16.8% and 15.2%, respectively), followed by piperacillin and piperacillin–tazobactam (R = 24.8%, 18.4%, respectively). Amikacin and tobramycin were more active than gentamicin (R = 19.9%; 22.2% and 40.6%, respectively). 28.9% of strains were resistant to ciprofloxacin. Nosocomial strains were significantly more resistant than non-hospital strains: ceftazidime: 17.9% versus 14.2%, p = 0.0346; ticarcillin–clavulanic acid: 47.5% versus 39.6%, p = 0.0009; piperacillin–tazobactam: 20.0% versus 14.8%, p = 0.0046; ciprofloxacin: 30.7% versus 25.2%, p = 0.0112. A significant increase in the resistance of nosocomial strains to ceftazidime, ticarcillin–clavulanic acid and piperacillin–tazobactam was noted. Resistance from non-hospital strains to fluoroquinolones, aminoglycosides, ceftazidime, piperacillin and ticarcillin–clavulanic acid decreased significantly.

Conclusion

P. aeruginosa is a predominantly nosocomial microorganism. There is a decrease of resistance for non-hospital strains. But the resistance of nosocomial strains to antibiotics widely prescribed in hospital is worrying.     

Short-term surgical outcome and safety of risk reducing salpingo-oophorectomy in BRCA1/2 mutation carriers

Objective

Women with a BRCA1/2 mutation or members of a hereditary breast ovarian cancer family (HBOC) have an increased risk of developing ovarian cancer. The only effective strategy to reduce this risk is a risk reducing salpingo-oophorectomy (RRSO). The aim of this study was to evaluate the short-term surgical outcome and safety of a RRSO.

Patient and methods

Included were all consecutive women with a BRCA1/2 mutation or members of a HBOC family who visited our Family Cancer Clinic between September 1995 and March 2006, and choose for RRSO.

Results

159 women were included, of which 97 (61.0%) BRCA1 and 32 (20.1%) BRCA2 mutation carriers, and 30 women of a HBOC family (18.9%). The median age at RRSO was 42.9 years (30.3–61.1) in the BRCA1 group, 48.4 years (33.5–66.9) in the BRCA 2 group and 46.4 (32.8–68.7) years in the HBOC group (p = 0.02). The median body mass index (BMI) was 24.9 kg/m², 30.1% were overweighed (BMI 25–30) and 18.7% were obese (BMI > 30). The RRSO was performed by primary laparoscopy (n = 154) or laparotomy (n = 5). Intraoperatively, one (0.6%) major complication occurred and laparoscopy was converted to laparotomy. In one patient (0.6%) a minor complication occurred. Post-operatively five minor complications (3.1%) were observed. Median hospital stay was 1 day (0–13 days).

Conclusion

Laparoscopic RRSO in BRCA1/2 mutation carriers seems to be a safe procedure with a low intraoperative and post-operative complication rate (1.3% and 3.1% respectively), a low conversion rate (0.6%) and a short median hospital stay (1.0 day).     

Mise au point d’une technique de PCR en temps réel pour la détection rapide des gènes qnr chez des entérobactéries productrices de bêta-lactamases à spectre étendu

Aim of the study

To develop a fast and reliable real time PCR technique for detecting plasmid-mediated quinolone resistance genes qnrA, qnrB and qnrS.

Methods

A real-time PCR assay using SYBR Green I and Roche LightCycler^® was developed to detect qnr genes. Detection of qnr genes was based on comparison of melting temperature differences with a positive control of each qnr genes. This assay was performed to study 138 isolates collected from diagnostic and screening samples in the Champagne-Ardenne region in 2004 (France).

Results

In optimized conditions, the three positive controls tested alone and with isolates confirmed the specificity of the PCR primers. Each PCR assay was able to test 30 strains in 60 min for 1 qnr gene. Out of 138 isolates screened, 3.6 % isolates were positive for a qnrA1, 1.5 % for qnrS1 and no qnrB-like gene. Prevalence of qnr determinants was 5 % and reached 9.5 % in clinical isolates.

Conclusion

Real-time PCR is a fast and reliable technique for screening of qnr-positive strains. This study shows a relatively high prevalence of qnr determinants (5 %) among ESBL-producing Enterobacteriaceae.     

Central European BRCA2 mutation carriers: Birth cohort status correlates with onset of breast cancer

Background

Mutations in brca1 and 2 genes lead to a significant increase in the lifetime risk of developing breast (BC) and ovarian cancer (OC). There are indications that birth cohort can influence the cancer risk in brca1 mutation carriers. Therefore, we investigated the risks for BC and OC associated with brca2 mutations in a cohort of female mutation carriers of a genetically heterogeneous Central European population.

Patients and methods

This study included 246 women in whom a functional mutation in the brca2 gene had been identified at our institution. At the time of analysis, 153 women had developed cancer (142 BC, 9 OC, 2 BC and OC). Risks were estimated using the product limit method. The log rank test was used to compare different strata.

Results

After correction for risk-reducing surgeries, the cumulative risk of developing cancer to age 70 was found to be 88% for BC (95% CI 81–95%) and 31% for OC (95% CI 17–45%). Female brca2 mutation carriers born in 1958 or later were at a significantly higher risk of developing BC at a younger age (p < 0.001), while no such age cohort-dependent correlation was found for OC.

Conclusion

The age cohort-dependent early onset in BC in women born after 1958 strongly suggests the importance of exogenous factors such as lifestyle modification while this does not seem to be the case for OC. Female brca2 mutation carriers should be counseled about their age cohort-dependent breast cancer risk.     

Labisia pumila extract regulates body weight and adipokines in ovariectomized rats

Objective

We investigated the effects of a standardized water extract of Labisia pumila var. alata (LPva), and compared to estrogen replacement (ERT), on body weight gain, uterus weight, adipose tissue mRNA and protein levels of adipokines in ovariectomized (OVX) rats.

Methods

Eight-week-old OVX Sprague-Dawley rats were administered orally with either 10 mg/kg/day (LPva10), 20 mg/kg/day (LPva20) or 50 mg/kg/day (LPva50) of LPva for 30 days. Sham-operated (Sham) and estrogen-treated OVX rats (ERT, 0.625 mg/kg/day) served as controls. Plasma adipokines were measured, and mRNA expressions of the adipokines were determined in the adipose tissues.

Results

ERT- and LPva50-treated OVX rats showed significantly less (p < 0.05) weight gain compared to untreated OVX rats. Ovariectomy caused plasma leptin levels to decrease significantly (p < 0.05), but when treated with LPva or ERT, plasma leptin increased significantly to levels higher or comparable to that seen in the Sham group. The mRNA expression of leptin was higher in the LPva-treated animals than in all other groups. In contrast, the elevated plasma resistin concentrations in OVX rats were significantly reduced in rats given ERT (p < 0.05) and LPva extracts (p < 0.05). There was no difference in adiponectin levels in all groups. The uterus to body weight ratio of untreated OVX rats was significantly low compared to Sham (p < 0.05), but showed dose-dependent increase upon treatment with LPva.

Conclusion

The present study provides first evidence that LPva exerts uterotrophic effect and regulates body weight gain by modulating secretion of leptin and resistin, and expression of the adipokines in adipose tissues.     

C-kit overexpression is not associated with KIT gene mutations in chromophobe renal cell carcinoma or renal oncocytoma

Introduction

C-kit overexpression has previously been described in chromophobe renal cell carcinoma (cpRCC) and renal oncocytoma (RO). However, so far no KIT mutations have been found. The objective of our study was to analyse c-kit in a large cohort of renal tumors and to perform KIT mutation analysis in a subset cpRCC and RO cases with overexpression of c-kit.

Materials and methods

We studied the immunohistochemical expression of c-kit on tissue microarrays containing formalin-fixed, paraffin-embedded samples of 948 patients with renal tumors. CpRCC and RO cases with c-kit overexpression (n = 23) were analyzed for KIT mutations in exons 9, 11, 13, 14, 15, and 17.

Results

Expression of c-kit was found in 6/642 (0.9%) clear cell RCC, 3/154 (1.9%) papillary RCC, 54/69 (78.3%) cpRCC, 37/45 (82.2%) RO and 2/30 (6.7%) of other unclassified tumor types. In none of the RO and cpRCC cases analyzed, a KIT gene mutation was found.

Conclusion

C-kit expression is found in the majority of cpRCC and RO, but these tumors do not harbor the usual c-kit activating mutations. This may have implications for the use of tyrosine kinase inhibitors in patients with advanced cpRCC and c-kit expression.     

Enterococcus faecium isolated from bone marrow transplant patients in Tunisia: high prevalence of antimicrobial resistance and low pathogenic power

Objectives

Investigation of the occurrence and antibiotic susceptibility of Enterococcus faecium isolates, collected during four years from neutropenic patients at the Tunisian bone marrow transplantation centre.

Materials and methods

E. faecium strains were identified by conventional methods and by the Api20 Strep (Bio-Mérieux, France). Antibiotic susceptibility was determined by the disk diffusion method on Mueller-Hinton agar and interpreted as recommended by CA-SFM. MICs of ampicillin, vancomycin, and teicoplanin were determined by E-test method.

Results

Two hundred and thirty five E. faecium isolates were recovered from stool cultures or rectal swabs (229), throat (three), urine (two), and pus of wound (one). None was responsible for bacteraemia. Ampicillin resistance, without production of β-lactamase, was observed in 43.8% of isolates. All the isolates were susceptible to glycopeptides. High rates of resistance were observed: high-level resistance (HLR) to gentamicin (33.6%), HLR to kanamycin (55.7%), HLR to streptomycin (47.6%), erythromycin (86.4%), ciprofloxacin (78.7%), rifampicin (85%), and tetracycline (43%). Strains with HLR to gentamicin were significantly more resistant to ampicillin and streptomycin. Multiple drug resistance was observed in most isolates.

Conclusion

These findings demonstrated the low pathogenic power of E. faecium in our patients, and the high frequencies of resistance to ampicillin and aminoglycosides. In the absence of glycopeptide-resistance, vancomycin remains an alternative treatment against multidrug resistant strains.     

Phenotypic and genotypic characterization of food animal isolates of Salmonella with reduced sensitivity to ciprofloxacin

Reports of nontyphoidal Salmonella enterica subsp. enterica showing reduced sensitivity to ciprofloxacin (RSC) have increased rapidly during the past decade. Infection in humans with Salmonella possessing RSC may compromise the effectiveness of ciprofloxacin therapy. Nineteen among 4,357 Salmonella strains isolated from food animals in Canada from 1998 to 1999 showed RSC; 17 were from turkeys and 2 from chickens. All were resistant to nalidixic acid and sulfisoxazole and possessed RSC at a level of 0.125-0.5 microg/ml. PCR-RFLP of the gyrA quinolone resistance-determining region (QRDR) with Hinfl revealed that S. Bredeney and S. Heidelberg isolates possessed a mutation in this region. Single-strand conformational polymorphism (SSCP) analysis showed that S. Schwarzengrund and S. Senftenberg isolates also possessed a point mutation in the QRDR. DNA sequencing confirmed the findings and showed that all isolates possessed a base substitution in the gyrA QRDR. Sequencing revealed no mutations in the gyrB and silent wobble mutations in the parC QRDR. Reserpine, a known efflux pump inhibitor, did not effect the MICs for ciprofloxacin, nalidixic acid, and tetracycline. The mar operon could be induced in all isolates at 37 degrees C and in 18 of 19 at 30 degrees C; induction resulted in a two- to four-fold increase in the MIC of ciprofloxacin. In 14 of the 19 isolates, the mutation rate was two-fold or higher than in a ciprofloxacin sensitive S. Bredeney and S. Typhimurium LT2 control strain. Examination of clonal relatedness using pulsed-field gel electrophoresis (PFGE) and plasmid profiles indicated that some degree of clonal dispersion may have occurred, but the majority of isolates may have arisen from de novo mutations.     

Prevalence and correlates of mothers and fathers attending pretest cancer genetic counseling together

Objective

To determine the prevalence of fathers’ attendance at pretest cancer genetic counseling sessions with mothers undergoing BRCA1/2 genetic testing for hereditary breast/ovarian cancer (HBOC) risk, and to identify psychosocial and other correlates of fathers’ attendance.

Methods

One hundred and twenty-one fathers of minor-age children who were spouses/partners of women (mothers) undergoing such counseling and testing were recruited, completed a behavioral self-report survey, and provided data about their sociodemographic backgrounds, father–child cancer communication histories, parenting relationship quality, and information-seeking and perceived knowledge.

Results

A total of 27.3% of fathers attended pretest cancer genetic counseling with mothers. Compared to fathers who did not attend pretest cancer genetic counseling, those who did had stronger parenting alliances with mothers, were more likely to have sought out information about BRCA1/2 testing, and felt more informed about testing. In an adjusted logistic regression model of session attendance, the strength of the parenting alliance was associated with a 6% increase in the likelihood of attending genetic counseling (odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.01, 1.12, p < .05) and greater perceived knowledge about BRCA1/2 testing was associated with a four-fold increase in the likelihood of session attendance (OR = 4.03, CI = 1.77, 9.37, p < .001).

Conclusion

One in three fathers attend pretest cancer genetic counseling with mothers undergoing BRCA1/2 testing; those who do have closer parenting relationships and are more informed about BRCA1/2 testing.

Practice implications

When possible, providers should discuss mothers including fathers in cancer genetic counseling sessions as this may affect outcomes of HBOC genetic counseling and testing.     

Optimization of the use of ciprofloxacin

Aims

To compare mutant prevention concentration (MPC) of ciprofloxacin and time-killing curve with regards to 11 genotyped Escherichia coli.

Method

MICs were determined using the E-test method. Time-killing studies were performed in accordance with the NCCLS guidelines. The genes gyrA, gyrB, parC, parE and marR were amplified by PCR and sequenced. The MPC was defined as the lowest antibiotic concentration preventing the growth of resistant colonies when 10¹⁰ CFU/mL were spread on a solid medium.

Results

Strains with no genes gyrA, gyrB, parC, parE and marR mutation presented MIC less or equal to 0.023 mg/L and MPC less or equal to 0.25 mg/L. Strains with two mutations (gyrA and parC) presented MIC equal to 1.5 mg/L and MPC equal to 4 mg/L. Strains with one mutation (gyrA) presented MIC less or equal to 0.75 mg/L, but MPC ranged from 0.5 to 6 mg/L depending of the MIC of ciprofloxacin. The time-killing curves for ciprofloxacin showed a bactericidal activity of 0.25 mg/L in 1 h for strains without mutation, compared with a bactericidal activity of 2 and 4 mg/L in 4 h for strains with one and two mutations, respectively.

Conclusion

For strains of E. coli resistant to nalidixic acid, it was necessary to evaluate the MIC of ciprofloxacin in order to asses the optimal dosage of ciprofloxacin.     

Caractérisation phénotypique et génotypique (randomly amplified polymorphic DNA analysis et multiple-locus variable-number tandem-repeat analysis) de 96 isolats cliniques de Pseudomonas aeruginosa à l’hôpital F. Bourguiba (Monastir,Tunisie)

Aim of the study

Phenotypic and genotypic characterization of 96 clinical isolates of Pseudomonas aeruginosa recovered in a Tunisian teaching hospital during a 16-month period.

Materials and methods

All the isolates were characterized by serotyping, antimicrobial susceptibility typing and genotyping with randomly amplified polymorphic DNA (RAPD) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA).

Results

Forty-one isolates out of 96 (43%) were recovered from two intensive care units (medical and chirurgical). Most of the isolates (48%) belonged to serotype O:11. Among the 13 antibiotypes, three multidrug resistant ones were mostly observed within the two intensive care units. Genotyping showed 83 RAPD types and 52 MLVA types. Isolates showing the same serotype could show different genotypes. A limited number of clusters was highlighted with MLVA typing, of which an outbreak of nine cases within the surgical intensive care unit.

Conclusion

Except this outbreak of nine cases, the heterogeneity observed for most of the P. aeruginosa isolates showed that outbreak situations were rare in the F. Bourguiba hospital during the study period. MLVA genotyping is a good tool for genotyping P. aeruginosa clinical isolates.     

Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: A randomized,double-blind,placebo-controlled study

Background

Vaginal atrophy, the thinning and drying of vaginal mucosa, is associated with menopause. The standard estrogen treatment is not suitable for all women.

Objective

To investigate the effects of oral sea buckthorn (SB) oil supplementation on vaginal atrophy.

Method

A total of 116 postmenopausal women experiencing symptoms of vaginal dryness, itching or burning were randomized to this placebo-controlled, double-blind study. Ninety-eight participants completed the intervention of three months, during which they consumed 3 g of SB or placebo oil daily. At the beginning and end, factors of vaginal health were scored by a gynecologist, vaginal pH and moisture were measured and vaginal health index was calculated. Symptoms of atrophy and menopause were evaluated at study visits and by daily logbooks. Serum samples were collected for the analysis of circulating lipids, liver enzymes and C-reactive protein.

Results

Compared to placebo, there was a significantly better rate of improvement in the integrity of vaginal epithelium in the SB group when both compliant and noncompliant participants were included (odds ratio (OR) = 3.1, 95% CI 1.11–8.95). A beneficial trend was observed when only the compliant participants were included (OR = 2.9; 95% CI 0.99–8.35). There was a tendency (P = 0.08) toward better improvement of vaginal health index from baseline to the end in the SB group [(0.8 (SD 2.8)] compared to placebo [−0.1 (SD 2.0)].

Conclusions

SB oil showed beneficial effects on vaginal health, indicating it is a potential alternative for mucosal integrity for those women not able to use estrogen treatment for vaginal atrophy.     

MBL serum concentration in women with HPV presenting CIN III lesions

Purpose

This study proposes to assess MBL serum concentrations in HPV positive women that developed high risk preinvasive lesions, CIN III.

Materials and methods

A total of 90 consecutive women (mean age 32.2 years, range 18–45 years) with CIN III lesions confirmed by cone biopsy were enrolled as cases at the gynecology cancer department of the Erasto Gaertner Hospital, a center of reference for cancer treatment in Southern Brazil. All the patients were HPV positive. In addition, 81 healthy women, voluntary blood donors, were enrolled as healthy control subjects (mean age 33.3 years, range 14–71 years) with no evidence of HPV infection, tested by hybrid capture, or CIN lesions, from the same geographic area.

Results

The median concentration of MBL in the cases was 912 ng/ml (IQR: 100–5820 ng/ml) and in the controls was 1207.3 ng/ml (IQR 100–4320.6 ng/ml). No statistically significant difference was observed between cases and controls.

Conclusion

This study reports data on MBL serum concentrations in HPV infected women for the first time. The analysis of our findings did not show a statistically significant difference between MBL serum concentrations in HPV women that developed CIN III lesions and healthy controls.     

Comparing BRAF mutation status in matched primary and metastatic cutaneous melanomas: Implications on optimized targeted therapy

Background

Selective BRAF inhibitors have shown dramatic results with regard to improving outcome in patients with melanoma. Testing the BRAF status in matched primary and metastatic melanomas to optimize individual targeted therapy is not well investigated.

Methods

Extended BRAF testing using PCR for 9 mutations and VE1 immunohistochemistry for BRAF V600E detection on 95 lesions including 40 primary melanomas with their matched metastases (n = 42), recurrences (n = 9) and second primaries (n = 4) was performed. Nine patients had multiple metastases.

Results

V600E was the only identified mutation type; 35.4% of primary vs. 18.9% of metastatic melanomas. The overall primary-metastatic BRAF status discordance rate was 32.3% using PCR and 27.5% with immunohistochemistry, and was significantly more frequent in primary lesions with mutant BRAF (67%). Males and patients with metastasis to lymph nodes were less likely to be discordant compared to females and those with metastasis to other sites (p = 0.023). Discordant BRAF mutation status was predicted by multivariate binary logistic regression: the presence of a mutant BRAF in the primary melanoma [OR (95% C.I.) = 23.4 (2.4–229.7)] and female gender [OR = 10.6 (1.08–95)]. Inter-metastases BRAF concordance was 100% (6 comparisons).

Conclusion

A high discordant rate implies the need for clinical trials addressing the response to targeted therapy in patients with discordant BRAF statuses between their primary and metastatic lesions.     

A health literacy pilot intervention to improve medication adherence using Meducation technology

Objective

To determine whether antihypertensive medication adherence could improve using a Meducation^® technology health literacy intervention.

Methods

We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation^® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months.

Results

There was a 42% enrollment rate (n = 23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients’ average systolic blood pressure (0.5 mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p > 0.05).

Conclusions

A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes.

Practice implications

Health literacy interventions may improve adherence while requiring relatively few resources to implement.     

Providing support to relatives and friends managing both chronic physical illness and depression: The views of a national sample of U.S. adults

Objective

To describe how comorbid depression in chronically ill adults affects the willingness of their family and friends to provide them with illness management support.

Methods

We identified a national sample of U.S. adults (n = 1027), all of whom had a close relative or friend with a chronic physical illness. We examined whether respondents were less willing to help their relatives/friends with disease management when they reported that these relatives/friends were also diagnosed with depression.

Results

In multivariate models, the odds of respondents being willing to provide disease-management support doubled when the relative/friend was depressed (adjusted odds ratio (AOR) = 1.99; 95% C.I. = 1.31, 3.02). Respondents were willing to perform an equal number of illness support tasks for relatives/friends with and without depression. However, respondents reported 30% more difficulties discussing health issues (incidence rate ratio (IRR) = 1.30; 95% C.I. = 1.11, 1.53), and 44% more barriers to providing support (IRR = 1.44; 95% C.I. = 1.18, 1.75) to depressed relatives/friends.

Conclusion

U.S. adults are more willing to provide disease-management support for chronically ill relatives/friends with depression. However, helping depressed relatives/friends is also more challenging.

Practice implications

By providing resources for potential supporters, health providers could mobilize an important source of disease-management support for patients with chronic illness and depression.