Cutaneous actinomycosis presenting as chronic mastitis

Actinomycosis is a chronic granulomatous suppurative infection caused by anaerobic actinomyces. Primary cutaneous involvement is uncommon because of the exclusively endogenous habitat of the organism. We describe a very unusual presentation mimicking chronic mastitis. A 35‐year‐old woman presented 7 months post‐partum with tenderness and induration in the right breast. She was pyrexial and felt systemically unwell. An initial diagnosis of mastitis was made. Treatment with penicillin, imipenem, co‐amoxiclav and metronidazole had no effect. Skin biopsy revealed the characteristic ‘sulphur granules’ of actinomycoses in the deep dermis. Long term oral clindamycin (> 12 months) has produced a very good response clinically, with a concomitant decrease in inflammatory markers. Cutaneous actinomycosis has been described by haematogenous spread from visceral organs or after trauma. The organism is difficult to culture and is often diagnosed histologically by the presence of ‘sulphur granules’. It is very sensitive to penicillin but prolonged treatment is needed.     

Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study.

PURPOSE: To determine whether cisplatin plus paclitaxel (C+P) improved response rate, progression-free survival (PFS), or survival compared with cisplatin alone in patients with stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix. PATIENTS AND METHODS Eligible: patients with measurable disease, performance status (PS) 0 to 2, and adequate hematologic, hepatic, and renal function received either cisplatin 50 mg/m2 or C+P (cisplatin 50 mg/m2 plus paclitaxel 135 mg/m2) every 3 weeks for six cycles. Tumor measurements and quality-of-life (QOL) assessments were obtained before each treatment cycle. RESULTS: Of 280 patients entered, 6% were ineligible. Among 264 eligible patients, 134 received cisplatin and 130 received C+P. Groups were well matched with respect to age, ethnicity, PS, tumor grade, disease site, and number of cycles received. The majority of all patients had prior radiation therapy (cisplatin, 92%; C+P, 91%). Objective responses occurred in 19% (6% complete plus 13% partial) of patients receiving cisplatin versus 36% (15% complete plus 21% partial) receiving C+P (P = .002). The median PFS was 2.8 and 4.8 months, respectively, for cisplatin versus C+P (P < .001). There was no difference in median survival (8.8 months v 9.7 months). Grade 3 to 4 anemia and neutropenia were more common in the combination arm. There was no significant difference in QOL scores, although a disproportionate number of patients (cisplatin, n = 50; C+P, n = 33) dropped out of the QOL component, presumably because of increasing disease, deteriorating health status, or early death. CONCLUSION C+P is superior to cisplatin alone with respect to response rate and PFS with sustained QOL.     

Protracted cognitive effects produced by clonidine in Macaca nemestrina performing a delayed matching task

Introduction

The α₂-adrenergic receptor agonist clonidine was examined for its ability to improve working memory in monkeys.

Materials and methods

Clonidine (0.116–34.8 μg/kg) was administered to six pigtail macaques in their performance of a computer-assisted delayed matching-to-sample (DMTS) task.

Results and discussion

During DMTS sessions initiated 1 hour after dosing, there was a slight improvement in mean task accuracy (long delay trials; 0.116-μg/kg). On the following day, there was continued and added improvement in accuracies associated with the long delay trials. On the day following 1.16-μg/kg, the entire memory retention curve was shifted to the right of vehicle. When the animals were again tested 48 hours after dosing (no pretreatment), these two patterns of task enhancement were continued and enhanced. Mean task accuracy associated with long delay trials was significantly increased by 14.2% trials correct when animals were originally treated with 0.116-μg/kg of clonidine. Mean task accuracy associated with medium delay trials was significantly increased by 11.8% trials correct when animals were treated with 1.16-μg/kg. On the sixth day after clonidine, task accuracies were still significantly improved during medium delay trials after 0.116-μg/kg. Median sample and choice latencies were not significantly influenced by clonidine treatment. These findings are consistent with the ability of clonidine to induce a protracted improvement in aspects of working memory.

Conclusion

Early (attentional) and late (retention) components of memory appeared to be differentially sensitive to the dose of clonidine. Central α₂-adrenergic receptors should be considered legitimate drug targets for future compound development for cognition enhancement.     

A Phase II Trial of Pyrazoloacridine (PZA) in Squamous Carcinoma of the Cervix – A Gynecologic Oncology Group Study

Purpose: The Gynecologic Oncology Groupperformed a Phase II study to determine the response rate ofPyrazoloacridine (PZA) in patients with advanced, persistentor recurrent squamous carcinoma of the cervix.Methods: PZA was administered at a dose of 750mg/m² intravenously over three hours every threeweeks. Results: Among 21 evaluable patients, therewere no complete and one (4.2%) partial response. Themajor toxicities were hematologic. Conclusion: PZA atthe dose and schedule employed has insignificant activity inthis population.     

Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme

The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants’ lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants’ lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45 %) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status.Key words: Antiretroviral therapy, Breastfeeding, Counselling, HIV, Infant-feeding practices, Infant food, PMTCT, Nigeria