| From the Literature |
When to Consider the Use of Antibiotics in the Treatment of 2009 H1N1 Influenza-Associated PneumoniaWright PF, Kirkland KB, Modlin JF. Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in CaliforniaLouie, J. K., Acosta, M., Winter, K., Jean, C., Gavali, S., Schechter, R., et al.
for the California Pandemic (H1N1) Working Group Context: Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease. Objective: To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death. Design, Setting, and Participants: Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009. Main Outcome Measure: Characteristics of hospitalized and fatal cases. Results: During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome. Conclusions: In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza. [Full Text] The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 InfluenzaBirnkrant D, Cox E. Evidence-Based Practice: Step By Step: Igniting a Spirit of Inquiry: An Essential Foundation for Evidence-Based PracticeMelnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. "This is the first article in a new series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved." [Full Text] Lost in Transmission—FDA Drug Information That Never Reaches CliniciansSchwartz LM, Woloshin S. "The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated—and relatively little would be needed—to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles." [Full Text] Primary Plasma Cell Leukemia: A Surveillance, Epidemiology, and End Results Database Analysis Between 1973 And 2004Ramsingh G, Mehan P, Luo J, Vij R, Morgensztern D. Background: Primary plasma cell leukemia (PCL) is a rare plasma cell disorder, and current knowledge regarding survival in this disease is limited to small series of patients. Although there has been significant improvement in the survival of patients with multiple myeloma (MM) over the past few decades, it is not known whether there has been a similar trend for PCL. Methods: The authors analyzed the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the characteristics and survival of patients who had PCL compared with those of patients who had MM. Results: Among 291 patients with PCL, the median age was 67 years (range, 19-98 years), the distribution of men and women was nearly equal, and the majority of patients were white (79.4%). The median overall survival (OS) was 4 months and the median disease-specific survival (DSS) was 6 months for patients with PCL; the 1-year, 2-year, and 5-year OS rates were 27.8%, 14.1%, and 6.4%, respectively. There were no survival differences noted according to sex or race. Patients aged <60 years were found to have a better median OS compared with patients aged >/=60 years (median OS, 7 months vs 3 months; P = .007), although the 5-year OS was equally poor in both groups (6.3% vs 6.4%, respectively). During the same period, 49,106 patients with MM were identified. Unlike MM, in which there has been a modest but statistically significant improvement in OS and DSS noted over time, no significant improvement was evident for PCL. Conclusions: The poor long-term outcome and the lack of survival improvement in PCL suggest the need for better therapeutic options for these patients. Cancer 2009. © 2009 American Cancer Society. [Full Text] Acute Pulmonary Failure During Remission Induction Chemotherapy in Adults With Acute Myeloid Leukemia or High-Risk Myelodysplastic SyndromeAl Ameri A, Koller C, Kantarjian H, Ravandi F, Verstovsek S, Borthakur G, Pierce S, Mattiuzzi G. Background: Acute pulmonary failure during remission induction therapy is a serious complication in patients with acute myeloid leukemia (AML). To the authors' knowledge, the course and prognosis of such patients is not well known. Methods: A total of 1541 patients referred for remission induction chemotherapy of AML or high-risk myelodysplastic syndrome were retrospectively reviewed. Results: A total of 120 (8%) patients developed acute pulmonary failure within 2 weeks of the initiation of chemotherapy; 87 of these patients (73%) died during remission induction, whereas 17 (14%) achieved a complete response. The median survival among the 120 patients with early acute pulmonary failure was 3 weeks. Predictive factors for the development of early acute pulmonary failure by multivariate analysis were: male sex (P = .00038), acute promyelocytic leukemia (P = .00003), poor performance status (P = .001), lung infiltrates at diagnosis (P = .000001), and increased creatinine (P = .000005). Patients who had 0 to 1, 2, 3, or 4 to 5 adverse factors were found to have estimated predictive incidences of acute pulmonary failure of 3%, 13%, 23%, and 34%, respectively. Conclusions: Preventive approaches at the start of induction therapy in patients at high risk of pulmonary failure may improve the outcome of these patients. Cancer 2009. © 2009 American Cancer Society. [Full Text] The TRAIL to Targeted Therapy of Breast CancerRahman M, Pumphrey JG, Lipkowitz S. "Breast cancers can be classified into those which express the estrogen (ER) and progesterone (PR) receptors, those with HER-2 amplification, and those without expression of ER, PR, or amplified HER-2 (referred to as triple-negative or basal-like breast cancer). Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) activates apoptosis upon binding to its receptors in many tumor types and the ligand and agonist antibodies are currently being studied in patients in clinical phases I and II trials. Cell line studies suggest that many breast cancer cell lines are very resistant to TRAIL-induced apoptosis. However, recent data suggest that a subset of triple-negative/basal-like breast cancer cells is sensitive to TRAIL as a single agent. In addition, many studies have demonstrated that resistance to TRAIL-mediated apoptosis in breast cancer cells can be overcome by combinations of TRAIL with chemotherapy, radiation, and various targeted agents. This chapter will discuss the current understanding of the mechanisms, which control TRAIL-mediated apoptosis in breast cancer cells. The preclinical data supporting the use of TRAIL ligands and agonistic antibodies alone and in combination in breast cancer will also be discussed." [Request a copy of this article.] |