Journal of Current Oncology and Medical Sciences

A promising therapeutic approach of dendritic cell vaccines for ovarian cancer

2024-08-11T05:14:52-04:00

Ovarian cancer (OC) remains one of the most lethal gynecological malignancies, primarily due to its often late-stage diagnosis and the development of resistance to conventional therapies. In recent years, significant advancements in immunotherapy have highlighted the potential of dendritic cell (DC) vaccines as a novel therapeutic approach. This review aims to thoroughly evaluate the current landscape and the future potential of DC vaccinations for OC therapy. Recent Studies have provided evidence that DC vaccines can generate specific T-cell responses, thereby enhancing the immunogenicity of ovarian tumors. Furthermore, combining DC vaccines with other therapeutic modalities, such as checkpoint inhibitors and chemotherapy, has shown considerable promise in overcoming the immune evasion mechanisms employed by tumors. However, several challenges remain, including optimizing antigen selection, improving DC maturation and migration, and countering tumor-induced immunosuppression. Continued research is essential for fully unlocking the potential of DC vaccines in improving outcomes for ovarian cancer patients.

Prevalence and clinical significance of saprophytic bacteria in bloodstream infections among cancer patients

2024-08-11T02:35:29-04:00

Introduction: Bloodstream infections (BSIs) in cancer patients are associated with high morbidity and mortality. While common pathogens are well-studied, the role of saprophytic bacteria in BSIs among this population is less understood. To investigate the prevalence and clinical significance of saprophytic pathogens causing BSIs in cancer patients at a tertiary care center.

Materials and Methods: This retrospective study included all 200 consecutive adult cancer patients with suspected sepsis over four months. Blood cultures were processed on an automated BACTEC system. Subculture and identification were performed using standard microbiological techniques and the Vitek 2 system. Antimicrobial sensitivity was performed as per CLSI guidelines.

Results: The blood culture positivity in these patients was 79% (158/200). Of the 158 positive blood cultures, 10.1% (16/158) were saprophytic pathogens. These included Enterococcus avium, Sphingomonas paucimobilis, Actinomyces meyeri, Kodamaea ohmeri, Elizabethkingia meningoseptica, Aeromonas hydrophila, Achromobacter xylosoxidans, Stenotrophomonas maltophilia, Pantoea dispersa, and Burkholderia pseudomallei. The overall 30-day mortality rate for patients with saprophytic pathogen BSIs was 20%.

Conclusion: Saprophytic bacteria have gained recognition as possible human pathogens, especially in immunocompromised patients including cancer patients. Such high-risk patients should be put on empiric antibiotics to improve patient outcomes till the time clinical significance is established.

Platelet count/spleen diameter ratio for the non-invasive diagnosis of esophageal varices in Iranian patients with cirrhosis

2024-09-02T05:04:54-04:00

Introduction: Esophageal varices (EVs) carry a significant risk of rupture and subsequent life-threatening bleeding. While previous research has investigated the effectiveness of the platelet count to spleen diameter ratio (PC/SD) as a non-invasive predictor of EVs in various populations, this study specifically focuses on the Iranian population to assess the applicability and effectiveness of this parameter in this region.

Materials and Methods: Upper gastrointestinal endoscopy was performed on 147 cirrhotic patients to screen for EVs. Biochemical tests and ultrasonography were done to measure spleen diameter (SD) and calculate the PC/SD ratio. ROC analysis was done to determine the predictive performance of the parameters.

Results: Among the patients, 73% had EVs. The analysis showed the following: platelet count (PC) had an AUC of 0.695 with 78.7% sensitivity and 56.4% specificity; SD had an AUC of 0.750 with 49.1% sensitivity and 89.7% specificity; and the PC/SD ratio had an AUC of 0.734 with 60.2% sensitivity and 79.5% specificity. The PC/SD ratio exhibited a high positive predictive value of 93% but a low negative predictive value of 41.9%. Optimal cutoff values were determined as follows: PC≤ 100,000, SD< 163, and PC/SD ratio≤ 523.

Conclusion: By identifying high-risk patients who may benefit from targeted endoscopic screening, this non-invasive method could contribute to improving overall patient care and reducing the need for invasive procedures. However, due to suboptimal performance results, it is crucial to use this approach with caution, as endoscopic screening remains the standard practice for the diagnosis and management of esophageal varices.

Malignant transformation of multiple exostosis: a case report

2024-07-28T04:19:28-04:00

Introduction: Osteochondroma is a benign tumor of bone. Malignant transformation of Osteochondroma is the most devastating complication one can encounter. Osteochondroma can transform into any malignancy like Osteosarcoma, Chondrosarcoma and Ewing sarcoma. Malignant transformation is more common in patients with multiple exostosis. Recognition of this malignant transformation is needed to predict the patient's outcome.

Case presentation: A 26-year-old male patient came with complaints of a mass in the left knee region for the past 7 years. X-ray of the knee showed multiple pedunculated exostosis on either side of the distal end of the femur, tibia and fibula. Histopathological examination revealed a bony lesion with a cartilaginous cap of increased thickness and cellularity. The cartilaginous cap possesses plump chondrocytes showing binucleation-forming nodules with mild atypia. The cartilaginous cap undergoes endochondral ossification, suggesting the possibility of a secondary peripheral atypical cartilaginous tumor from osteochondroma of the tibia.

Discussion: Chondrosarcoma is a heterogeneous type of primary bone cartilaginous malignancy with variable clinical outcomes. Malignant transformation of osteochondroma in the appendicular skeleton was named atypical cartilaginous tumor; in the axial skeleton, it is named Grade 1 Chondrosarcoma.

Conclusion: Differentiation between osteochondroma and its malignant transformation can be possible if made in a multidisciplinary setting such as clinical history, radiological findings along with histology to confirm the diagnosis.

Alpha-fetoprotein as a predictor of liver disease progression in HBV patients with HIV and HCV co-infections

2024-08-11T02:25:37-04:00

Introduction: Hepatitis B virus (HBV) infection is a significant health challenge globally, especially in sub-Saharan Africa. Co-infections with HIV and HCV worsen HBV-related liver diseases, complicating clinical management. Alpha-fetoprotein (AFP) is a key biomarker for monitoring liver disease progression and detecting hepatocellular carcinoma (HCC). This study evaluates AFP levels in HBsAg and HBeAg seropositive patients with and without HIV and HCV co-infections over one year in Warri, Delta State, Nigeria. This study aimed to understand the impact of HIV and HCV co-infections on liver disease prognosis in HBV patients by evaluating AFP levels and liver function over one year.

Materials and Methods: This longitudinal cohort study included 200 HBsAg and HBeAg seropositive patients aged 18-65 years, divided into three groups: HBV monoinfection (n=80), HBV/HIV co-infection (n=60), and HBV/HCV co-infection (n=60). Participants were followed for one year with quarterly blood sample collections for AFP measurement using ELISA, liver function tests (ALT, AST, ALP, bilirubin), and viral load assessments. Sociodemographic data were also collected. Results: AFP levels were significantly higher in the HBV/HCV co-infection group (36.2 ± 12.4 ng/mL) compared to the HBV monoinfection (12.5 ± 4.3 ng/mL) and HBV/HIV co-infection groups (18.7 ± 6.8 ng/mL) (p<0.001). Elevated liver function tests, particularly ALT and AST, were more prevalent in the HBV/HCV co-infection group. AFP levels positively correlated with ALT (r=0.52, p<0.01) and AST (r=0.47, p<0.01) in the HBV/HCV co-infection group.

Conclusion: The higher AFP levels in HBV/HCV co-infected patients indicate an increased risk of liver disease progression and HCC. The positive correlations between AFP and liver enzymes suggest ongoing liver damage and regeneration in this group. These findings underscore the importance of routine AFP and liver function tests in the early detection and treatment of liver disease among HBV patients, particularly those with HCV co-infection, to enhance clinical outcomes.

Ecthyma gangrenosum with a coinfection of methicillin-sensitive staphylococcus aureus and streptococcus pyogenes: a case report

2024-08-11T05:17:13-04:00

Introduction: Ecthyma gangrenosum (EG) is a cutaneous infection characterized by gangrenous ulcers with erythematous borders seen in immunocompromised as well as immunocompetent individuals. Although Pseudomonas aeruginosa is the commonest pathogen isolated, several other bacteria and fungi contribute to the pathogenesis of EG. Identification of the microorganism is very essential to initiate early empirical antimicrobial therapy.

Case presentation: We present a case report of a 13-year-old boy with multiple recurrent ulcerative lesions in both lower extremities for the past 1 year. His blood parameters showed signs of inflammation but was negative for aerobic blood culture, suggesting absence of underlying bacteraemia. There were no features of immunosuppression. On examination of pus sample, Methicillin Sensitive Staphylococcus aureus and Streptococcus pyogenes were isolated from the ulcerative lesions. Amoxicillin- Clavulanate and Doxycycline was advised for 2 weeks along with surgical debridement of the lesion followed by aseptic dressing. Patient showed complete resolution after 2 weeks.

Discussion: Staphylococcus aureus and Streptococcus pyogenes were the causative agents in this case, suggesting a polymicrobial association of EG besides Pseudomonas aeruginosa. Underlying bacteraemia or any other immunodeficiency is usually seen in a case of EG, however there are cases reported where cutaneous manifestations show predominance.

Conclusion: A prompt diagnosis of EG is essential because there are instances when it has proven to be fatal. Ruling out any immunodeficiency disorders and underlying bacteraemia is of vital importance. Administration of proper antibiotic coverage (gram positive or gram negative) along with debridement and regular dressing can help in limiting the spread of infections and thus improving patient outcome.