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2014| October-December | Volume 51 | Issue 4
Online since
February 1, 2016
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SYMPOSIUM - BREAST CANCER: REVIEW ARTICLES
Garlic: Review of literature
Shridevi Adaki, Raghavendra Adaki, Kaushal Shah, Amol Karagir
October-December 2014, 51(4):577-581
DOI
:10.4103/0019-509X.175383
PMID
:26842201
Garlic is one of the components, which have effects on reducing the risk of cancer. Including garlic in the diet helps for the betterment of the health. Medicinal effects of the garlic were known since 5,000 years. Recently, studies were carried out to known its effect on the cancer cell lines. Many studies have shown its effects not only on carcinomas, but also on the cardiovascular system and immune system. Functions of the each component of the garlic were studied to know exactly, which component has got beneficial effect. So this review has been carried out to know about the component, functions of each component, mode of action, and beneficial effects of the garlic.
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25
Reproductive factors and risk of breast cancer: A Review
U Kapil, AS Bhadoria, N Sareen, P Singh, SN Dwivedi
October-December 2014, 51(4):571-576
DOI
:10.4103/0019-509X.175345
PMID
:26842199
Breast cancer is one of the most common incident cancer and cause of death from cancer in women. It is known that several factors that influence hormonal status (e.g., age at first child birth) or are markers of change in hormonal status (e.g., age at menarche and age at menopause) are associated with the risk of breast cancer. Reproductive factors are known risk factors for breast cancer that probably act early in life. They point toward endogenous estrogens as likely player in the initiation, progression, and promotion of breast cancer. An attempt has been made in this article to review the scientific data published in Indexed journals on the role of reproductive factors in breast cancer.
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SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
The impact of hereditary colorectal cancer on the Indian population
R Maharaj, PJ Shukla, SV Sakpal, V Naraynsingh, D Dan, S Hariharan
October-December 2014, 51(4):538-541
DOI
:10.4103/0019-509X.175307
PMID
:26842188
Introdution:
The incidence of colorectal cancer in India is lower compared to the Western world. In Western countries, most cases of colorectal cancer are sporadic and the hereditary variety accounts for only 10-15% of all cases. The aim of the present review is to determine the clinical and epidemiological characteristics of hereditary colorectal cancer in India.
Materials And Methods:
A Medline search was conducted to review the literature published from India regarding colorectal cancer. The keywords used included India, colorectal cancer, hereditary nonpolyposis, and familial adenomatous polyposis. All relevant articles were reviewed and the characteristic features of this disease in Indian population were collated and presented.
Results:
Literature search revealed eighty two articles pertinent to India, of which only ten articles had relevant information on hereditary cancers. Although the overall incidence of colorectal cancer was low in both genders, there were a high proportion of patients developing colorectal cancer before the age of 45 years. Additionally, there was a higher proportion (10-15%) of hereditary nonpolyposis colorectal cancer cases, as confirmed by microsatellite instability.
Conclusion:
The overall incidence of colorectal cancer is low in India. There is a tendency to affect a relatively younger age group, and we infer that the incidence of hereditary colorectal cancer is high and is similar to the Western countries.
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2
SYMPOSIUM - MOLECULAR ONCOLOGY: REVIEW ARTICLES
Unique roles of nanotechnology in medicine and cancer
F Alam, M Naim, M Aziz, N Yadav
October-December 2014, 51(4):506-510
DOI
:10.4103/0019-509X.175320
PMID
:26842179
Here we review the scope of nanotechnology in Medicine and human cancer. The imaging and therapy agents can be co-delivered by same nanoparticle for integrated molecular diagnosis, therapy, and follow-up of cancer or 'cancer theranostics' is implying multimodal use of nanoparticles in cancer care. Nanoparticles are used for passive targeting and in conjugation with ligands for active targeting, to have optimum concentrations of imaging and therapeutic agents in the tumor cells specifically, sparing normal tissue from unwanted side effects. Potential utility of nanoparticles in the nano biosensors, nano fluorescent tag imaging, nano tumor mapping, nano gene profiling, nano molecular delivery, nano chemo-radio therapy, nano thermotherapy, nano photodynamic therapy, etc., is tending to revolutionize medicine particularly personalized cancer care and laboratory. Nanoparticle induced oxidative stress based inflammation reported by few studies; in lung, liver and brain required further investigations.
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Clinical and microbiological profile of febrile neutropenia in solid tumors and hematological malignancies at a tertiary cancer care center in South India
LA Jacob, KC Lakshmaiah, K Govindbabu, TM Suresh, D Lokanatha, M Sinha, BR Vijaykumar, BG Sumathi, RS Jayashree
October-December 2014, 51(4):464-468
DOI
:10.4103/0019-509X.175330
PMID
:26842163
Background:
Febrile neutropenia (FN) is a common but serious complication of chemotherapy in patients with solid tumors (ST) and hematological malignancies (HM). The epidemiology of FN keeps changing.
Objective:
The objective was to study the epidemiology of FN in adult patients with ST and HM at Kidwai Memorial Institute of Oncology, Bangalore – A tertiary cancer care center.
Materials and Methods:
Data of all episodes of FN that occurred during the period July 2011 to December 2011 were collected prospectively and analyzed.
Results:
A total of 75 episodes of FN was observed during study period involving 55 patients. Febrile neutropenic episodes were more frequent in HM than in ST (57% vs. 43%). The rate of bloodstream infection was 14.7%. Gram-negative organisms were the predominant isolates (56.25%). Overall mortality rate was 13.3%. Presence of medical co-morbidity and positive culture predicted high mortality. Mortality rate did not differ significantly between HM and ST (14% vs. 12.5%;
P
= 1.0). Gram-positive bacteremia was associated with greater mortality than Gram-negative bacteremia (
P
= 0.02).
Conclusion:
Empiric antibiotic treatment for FN should be tailored to the locally prevalent pathogens and their susceptibility patterns.
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Epidemiology of blood stream infections in pediatric patients at a Tertiary Care Cancer Centre
N Thacker, N Pereira, SD Banavali, G Narula, T Vora, G Chinnaswamy, M Prasad, R Kelkar, S Biswas, B Arora
October-December 2014, 51(4):438-441
DOI
:10.4103/0019-509X.175311
PMID
:26842152
Background:
Blood stream infections (BSI) are among the most common causes of preventable deaths in children with cancer in a developing country. Knowledge of its etiology as well as antibiotic sensitivity is essential not only for planning antimicrobial policy, but also the larger infection prevention and control measures.
Aims:
To describe the etiology and sensitivity of BSI in the pediatric oncology unit at a tertiary cancer center.
Materials and Methods:
All the samples representative of BSI sent from pediatric oncology unit during the period of January to December, 2013 were included in the study, and analyzed for microbiological spectrum with their antibiotic sensitivity.
Results:
A total of 4198 samples were representative of BSI. The overall cultures positivity rate was 6.97% with higher positivity rate (10.28%) from central lines. Of the positive cultures, 208 (70.9%) were Gram-negative
bacilli
(GNB), 71 (24.2%) were Gram-positive organisms, and 14 (4.7%) were
Candida
species. Lactose fermenting
Enterobacteriaceae
i.e.,
Escherichia coli
(28.4%),
Klebsiella pneumoniae
(22.1%), and
Enterobacter
(4.8%) accounted for 55.3% of all GNB.
Pseudomonas
accounted for 53 (25.5%) and
Acinetobacter
19 (9.1%) of GNB. Among Gram-positive isolates, staphylococci were the most frequent (47.8%), followed by
Streptococcus pneumoniae
17 (23.9%),
beta-hemolytic streptococci
11 (15.5%), and
enterococci
9 (12.68%). Of GNB, 45.7% were pan-sensitive, 24% extended spectrum beta–lactamase (ESBL) producers, 27% were resistant to carbapenems, and 3.4% resistant to colistin.
Pseudomonas
was most sensitive, and
Klebsiella
was least sensitive of GNB. Of the staphylococcal isolates, 41.67% were methicillin-resistant Staphylococcus aureus (MRSA) and 10% of Coagulase Negative Stapylococci (CONS) were methicillin.
Conclusion:
A high degree of ESBL producers and carbapenem-resistant
Enterobacteriaceae
is concerning; with emerging resistance to colistin, raising the fear of a return to the preantibiotic era. An urgent intervention including creating awareness and establishment of robust infection control and antibiotic stewardship program is the most important need of the hour.
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Alarming prevalence of community-acquired multidrug-resistant organisms colonization in children with cancer and implications for therapy: A prospective study
N Thacker, N Pereira, SD Banavali, G Narula, T Vora, G Chinnaswamy, M Prasad, R Kelkar, S Biswas, B Arora
October-December 2014, 51(4):442-446
DOI
:10.4103/0019-509X.175310
PMID
:26842153
Background:
Infection or colonization with multidrug-resistant organisms (MDRO) is associated with high mortality and morbidity. Knowledge of MDRO colonization may help in planning empirical antibiotic approach in neutropenic patients, which is known to improve patient outcomes. While routine cultures are positive and may help direct antibiotic therapy in only up to 15% neutropenic patients, surveillance cultures are positive in more than 90% of cancer patients.
Aims:
To assess the rate of MDRO carrier status at presentation and rate of conversion to MDRO during the treatment.
Materials And Methods:
Rectal swabs of all the outpatients presenting to pediatric oncology unit were sent within 7 days from date of registration from January 2014 to December 2014. Furthermore, stool cultures/rectal swabs of all patients who got directly admitted to the pediatric ward at presentation were sent within 24 h. Repeat rectal swabs were sent again for patients from this cohort when they got readmitted to the ward at least 15 days after last discharge or when clinically indicated.
Results:
Baseline surveillance rectal swabs were sent for 618 patients, which included 528 children with hematological malignancies and 90 children with solid tumors. Forty-five (7.3%) showed no growth. Of the remaining 573, 197 (34.4%) patients were colonized by two organisms and 30 (5.2%) by three organisms. Three hundred and thirty-four (58.4%) showed extended spectrum beta-lactamase (ESBL)
Enterobacteriaceae
, of which 165 (49.5%) were ESBL sensitive to beta-lactam with beta-lactamase inhibitors combinations and 169 (50.5%) were resistant to combinations. One hundred and sixteen (20.2%) were carbapenem-resistant
Enterobacteriaceae
(CRE) and 65 (11.4%) had vancomycin-resistant enterococci in baseline cultures. Only 63 (21%) patients were colonized by a sensitive organism in their baseline surveillance cultures. Morbidity (Intensive Care Unit stay) and mortality was higher in patients colonized by MDR organisms. There was a significant correlation between the place of residence and CRE colonization status with the highest rate (60%) of CRE colonization observed in children from East India. The repeat cultures showed the further conversion of sensitive isolates to MDRO in 80% of these children, of which 40% each converted from non-ESBL and non-CRE to ESBL and CRE, respectively.
Conclusion:
This is the first study illustrating the alarming high prevalence of community-acquired MDRO colonization, especially CRE, which has grave implications for therapy for children with cancer potentially compromising delivery of aggressive chemotherapy and affecting outcomes. This incidence further increases during the course of treatment. Knowing the baseline colonization also guides us for the planning of chemotherapy as well as antibiotic approach and infection control strategies. Local antibiotics stewardship including education of the healthcare workers as well as national level interventions to prevent antibiotic misuse in the community is critical to minimize this problem.
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SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Young breast cancer: A single center experience
A Gogia, V Raina, SVS Deo, NK Shukla, BK Mohanti
October-December 2014, 51(4):604-608
DOI
:10.4103/0019-509X.175332
PMID
:26842210
Background:
Breast cancer in women aged less than 35 years is uncommon and accounts for 1-2% of all breast cancer in the West. There is a paucity of data on young breast cancer from India. The aim of this study was to analyze the clinical, pathological, prognostic factors and outcome in young breast cancer patients.
Materials And Methods:
This analysis was performed in 251 patients aged <35 years or less (defined as breast cancer in the young), who were registered at our institute over an 11 year period between 2001 and 2011.
Results:
The median age was 31 years (range 18-35). Positive family history (siblings and parents) was elicited in only 10 patients. The TNM stage distribution was: Stage I was 2.5%, stage II - 20.5%, stage III - 55% and stage IV - 22%. The median clinical tumor size was 5.1 cm. Modified radical mastectomy was the most common surgical procedure and this was done in 79% of cases. 40% of tumors were high grade and 60% had pathological node positive disease. Estrogen and Progesterone and human epidermal growth factor receptor 2/neu positivity were 33% and 29% respectively. Triple negative breast cancer constituted 31% of patients. With a median follow-up of 30 months, 3 years relapse free survival and overall survival was 51% and 66%.
Conclusion:
Young women constituted 8% of breast cancer cases. Advanced disease at presentation and triple negativity (nearly one third of patients) results poor outcome.
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Risk predictors for adverse outcome in pediatric febrile neutropenia: Single center experience from a low and middle-income country
M Prasad, G Chinnaswamy, B Arora, T Vora, R Hawaldar, S Banavali
October-December 2014, 51(4):432-437
DOI
:10.4103/0019-509X.175321
PMID
:26842150
Background:
Risk stratification of patients with febrile neutropenia (FN) into those at "High Risk" and "Low Risk" of developing complications helps in making decisions regarding optimal treatment, such as whether to treat with oral or intravenous antibiotics, whether to treat as inpatient or outpatient and how long to treat. Risk predictors obtained from Western studies on pediatric FN are unlikely to be relevant to low middle-income country (LMICs). Our study aimed to identify clinical and laboratory parameters predictive of poor outcomes in children with chemotherapy-induced FN in a LMIC.
Procedure:
Two hundred and fifty consecutive episodes of chemotherapy-induced FN in pediatric (<15 years) patients were analyzed prospectively. Adverse outcomes were defined as per SPOG 2003 FN study as serious medical complications (SMC) due to infection, microbiologically defined infection, and radiologically defined pneumonia (RDP). Variables found to be significant for adverse outcome (
P
< 0.05) on univariate analysis were selected for multivariate analysis.
Results:
Five factors that were found to independently predict adverse outcome were (a) previously documented infection in the past 6 months, (b) presence of significant focus of infection, (c) absolute phagocyte count <100/mm
3
, (d) peak temperature more than 39°C in this episode of FN, and (e) fever lasting more than 5 days during this episode of FN.
Conclusions:
Identifying the risk factors for adverse outcome in pediatric FN, which are objective and applicable across LMICs would contribute in developing guidelines for the management of FN in a resource-limited setting.
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Management of febrile neutropenia in malignancy using the MASCC score and other factors: Feasibility and safety in routine clinical practice
P Kumar, J Bajpai, N Shetty, A Medekar, PA Kurkure, N Ghadyalpatil, S Gupta, V Noronha, A Kanujia, P Parikh, SD Banavali
October-December 2014, 51(4):491-495
DOI
:10.4103/0019-509X.175340
PMID
:26842174
Background:
The current standards for empirical broad-spectrum intravenous antibiotic (AB) treatment, combined with hospitalization, are cautious and safe, but lead to over-treatment of a substantial group of patients. We need to validate parameters to identify these low-risk febrile-neutropenia (FN) patients, who could then be safely treated in an outpatient setting with minimal/no AB treatment.
Materials And Methods:
A retrospective analysis for validation of a risk-assessment model in FN patients was done on a patient population from January 2007 to December 2008. Inclusion criteria were a histological diagnosis of malignancy, FN secondary to chemotherapy, absolute-neutrophil-count of ≤500/μl, axillary temperature of ≥38°C, and age ≥14 years. Other clinical and laboratory parameters were explored for risk stratification during the FN episodes. Receiver-operating characteristic curves were used to find the threshold value, an Chi-square analysis was done to find the association between the outcome and the parameters.
Results:
A total of 178 FN episodes were documented; 22 in solid tumors and 156 in hematolymphoid malignancies. Culture positivity was documented in 59 episodes; peripheral blood was the most common source, with
Escherichia coli
being the most common organism identified. Risk stratification was done using the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The association between the MASCC score and risk stratification could not be established (
P
= not significant) at a score of ≤21; however, it was found to be significant at a score of ≤18. The total number of complications was 23 (sepsis 22, mortality 23). Other factors found to be significantly associated with a high risk of complications in the univariate analysis were, mucositis (
P
= 0.03), maximum temperature ≥103°F (
P
= 0.01), tachycardia (
P
< 0.001), tachypnea (
P
= <0.001), age (
P
= 0.006), high dose of steroid (
P
< 0.001), total duration of fever (≥2.5 days (for which sensitivity (S) and specificity (Sp) were 87 and 81%, respectively), serum-creatinine (≥0.45 mg%, S = 100%, Sp = 97%), serum-bilirubin (≥0.5 mg/dl, S = 100%. Sp = 90%), requirement of second-line antibiotics (
P
= 0.02), intensive-care (
P
≤ 0.001), ventilatory support (
P
< 0.001), and requirement of packed cell (PC) transfusion (
P
= 0.02). In the multivariate analysis, mucositis (
P
= 0.02), HD steroid use (
P
= 0.026), and PC requirement (0.026) were identified as independent variables.
Conclusions:
The MASCC risk-index score was found to be meaningful at a score of ≤18. Other clinical and laboratory parameters were found to have a strong association with risk stratification in cancer patients during FN episodes.
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SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
Prevalence of KRAS mutations in metastatic colorectal cancer: A retrospective observational study from India
VH Veldore, MR Rao, SA Prabhudesai, R Tejaswi, S Kakara, S Pattanayak, N Krishnamoorthy, BN Tejaswini, D Hazarika, A Gangoli, SM Rahman, J Dixit, R Naik, RB Diwakar, CT Satheesh, HP Shashidhara, S Patil, KS Gopinath, BS Kumar
October-December 2014, 51(4):531-537
DOI
:10.4103/0019-509X.175371
PMID
:26842186
Background:
One of the genetic alterations implicated in tumor progression in colorectal cancers (CRCs) are abnormalities in Kristen Rat Sarcoma (KRAS) gene. Evaluation of KRAS mutation status is an important prognostic factor and has predictive value in deciding first line therapy based on monoclonal antibodies such as Cetuximab and Panitumumab in metastatic CRCs.
Materials And Methods:
In this retrospective study, we analyzed 7 different somatic mutations in Exon 2 of KRAS gene in 299 unselected incidental CRC patients who visited the hospital for clinical management during the period 2009–2013. Most of the tumors were primarily originating from colon and rectum; nevertheless, there were a few from rectosigmoid, sigmoid, ceacum and anal canal in the study group. Genomic DNA extracted from paraffin embedded tumor tissues was screened for 7 point mutations located in Codons 12 and 13 of KRAS gene, using Scorpions amplified refractory mutation system real time polymerase chain reaction technology. Statistical analysis was performed to assess bivariate relationship between different variables that includes: mutation status, mutation type, tumor location, tumor morphology, age and sex.
Results:
Prevalence of mutation in Codons 12 and 13 was 42.8% in the study group. Well-differentiated tumors had significantly more mutation positivity than moderately and poorly differentiated tumors (
P
= 0.001). 92% of the mutations were from Codon 12 and 8% in Codon 13. Glycine to Arginine was relatively more common in rectosigmoid followed by ceacum, while Glycine to Alanine mutation was relatively more prevalent in sigmoid, followed by rectum and rectosigmoid.
CONCLUSION:
The results suggest a prevalence of KRAS mutation at 42.8% in Indian population indicating that this testing is very crucial for targeted therapy management in metastatic CRC in India. Further analysis on mutation status of other homologues such as NRAS and downstream partner, v-raf murine sarcoma viral oncogene homolog B1, would add value to understanding the role of anti-epidermal growth factor receptor therapy in CRC management.
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Colonic J pouch neo-rectum versus straight anastomosis for low rectal cancers
FQ Parray, U Farouqi, ML Wani, NA Chowdri, F Shaheen
October-December 2014, 51(4):560-564
DOI
:10.4103/0019-509X.175341
PMID
:26842195
Aim:
The development of sphincter saving procedures for low carcinoma rectum has been the consequence of oncological and technological factors. The major disadvantage associated with these procedures is the development of anterior resection syndrome because of the resection of rectal reservoir. Colonic J pouch (CJP) neorectum has been practiced as an antidote to overcome this problem. We are working at a tertiary care center, which is a high volume center for rectal cancers. We thought it worthwhile to assess the efficacy of J Pouch neorectum viz.-a-viz. a straight coloanal anastomosis for low rectal cancers.
Materials And Methods:
Hospital based prospective randomized study (June 2007-December 2009) low rectal cancers (4-12 cm from the anal verge). One group (20 patients) subjected to low/ultralow anterior resection with straight anastomosis (SA) and other group (22 patients) to CJP. The two groups were compared on the basis of functional outcome.
Results:
Anastomotic leak, strictures, frequency of bowel movements, nocturnal bowel movements, use of retarding medication and incontinence to solids, liquids and gases were seen more in SA group. All these findings were statistically significant.
Conclusions:
We conclude that CJP has a significant functional advantage over SA and improves the overall quality-of-life in patients of low rectal cancers and the advantage persisted over a period of more than 30 months.
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SYMPOSIUM - INFECTIONS IN CANCER: REVIEW ARTICLES
Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center
Sirisharani Siddaiahgari, A Manikyam, K Anand Kumar, A Rauthan, R Ayyar
October-December 2014, 51(4):403-405
DOI
:10.4103/0019-509X.175367
PMID
:26842136
Background:
Outcome of pediatric cancers has significantly improved with modern chemotherapy and good supportive care. However, febrile neutropenia remains one of the important limiting factors in these patients especially with the emergence of resistant organisms. Choosing appropriate antimicrobials is possible only if we understand the local microbial spectrum and their sensitivity pattern.
Aims:
To study the likely etiologic agents and their antibiotic sensitivity pattern among systemic infections in children with cancer.
Settings and Design:
This is a prospective study.
Materials and Methods:
The study was conducted at a tertiary care center for pediatrics, in which culture samples representing blood stream infections and others like urinary tract infections sent from the Oncology services of the Hospital during the year of 2013 were analyzed. The microbiological profile and antibiotic sensitivity pattern of these isolates were studied.
Results:
There were 89 isolates that represented blood and urinary tract infections in neutropenic patients with cancer.Out of 89 positive cultures 76 were gram negative isolates. The most common gram negative bacterial isolates were
Escherichia coli
33 (37%), followed by
Pseudomonas
21 (23.5%).
Acinetobacter
grew in 2 patients (2.2%). Extended spectrum beta-lactamases (ESBL's), carbepenem resistant and pan-resistant organisms seen in 28 (31.4%), 5 (5.6%) and 2 cases (2.3%) respectively. Over all Gram-positive organisms were 13/89 (12.3%).
Staphylococcus
was the most common Gram-positive organism and methicillin resistant
Staphylococcus aureus
seen in 5each.
Conclusion:
Gram-negative organism is a common isolate in cancer children with febrile neutropenia, which is resistant to first-line antibiotic cefepime. Meropenem is most sensitive antibiotic and ESBL's are sensitive to piperacillin–tazobactam.
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3,013
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Factors predicting outcome in high risk febrile neutropenia in patients receiving intensive chemotherapy for acute sleukemia: A prospective, observational study from South India
R Rajendranath, VKK Balasubramaniyum, V Vijayakumar, P Ganesan, GS Tenali
October-December 2014, 51(4):481-486
DOI
:10.4103/0019-509X.175303
PMID
:26842171
Background:
Outcome of febrile neutropenia (FN) in acute leukemia patients undergoing intensive chemotherapy from India is scanty.
Materials and Methods:
A prospective, observational, single institutional study was conducted to evaluate the clinical features, microbiological aspects, risk factors influencing the outcome of high risk FN during intensive therapy in acute leukemia.
Results:
Among 115 febrile episodes, though 94 (81.7%) had indwelling central venous catheter (CVC) at the time of diagnosis of FN, infective foci clinically were identified in 70.4% of episodes, with lung as the major site (25.2%) followed by CVC (17.4%). Microbiological documentation was possible in 33% (
n
= 40) episodes. Gram-negative bacteria isolates were 58.3% and Gram-positive isolates were 41.7% of which
Pseudomonas
was the predominant Gram-negative and
Staphylococcus aureus
was the most common Gram-positive isolate. Piperacillin-tazobactam + amikacin were used as first line antibiotic in 93% episodes and second line antibiotics were necessary in 73% episodes. Granulocyte colony stimulating factor was used in 60.9% episodes of high risk FN mostly in acute myeloid leukemia consolidation patients. Eighteen episodes (15.7%) were assigned to have invasive fungal disease. Eleven (9.6%) out of 115 high risk FN had a fatal outcome. Presence of pulmonary infection predicted for fatal outcome (
P
= 0.02).
Conclusion:
This study reports the outcome of high risk FN in patients with acute leukemia undergoing intensive chemotherapy. Gram-negative isolates are highly sensitive to piperacillin-tazobactum and hence in a cost restraint scenario, carbapenems needs to be judiciously used. Focus of Infection in lungs during FN predicted higher fatal outcomes.
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Epidemiology of bacterial isolates among pediatric cancer patients from a tertiary care oncology center in North India
G Kapoor, N Sachdeva, S Jain
October-December 2014, 51(4):420-424
DOI
:10.4103/0019-509X.175364
PMID
:26842145
Background:
Infections are a major cause of morbidity and mortality in pediatric oncology. Resistance pattern of bacterial isolates determine empiric antibiotic therapy and influence outcome.
AIMS:
This study was planned to determine profile of bacterial isolates and their antibiotic resistance pattern among pediatric cancer patients. DESIGN: It was a retrospective, single institutional study.
Materials and Methods:
The study was carried out in the department of pediatric hematology-oncology of a tertiary care cancer centre in north India over a period of 24 months (2012-2014). Microbiological data pertaining to pediatric cancer patients, less than 18yrs of age was analysed.
Results:
Hence, 238 bacterial isolates were cultured from among 1757 blood, urine and other specimens. Gram negative bacteria were the most common (74%) pathogens identified and E. coli and Klebsiella comprised 80% of them. A high incidence of extended spectrum beta lactamase producing organisms (84%), beta-lactam beta-lactamase inhibitor (78%) and carbapenem resistance was observed (29%). Blood stream infection with multi-drug resistant Klebsiella was associated with high mortality. The gram positive bacteria isolated were predominantly staphylococcus aureus and were antibiotic sensitive. Reduction in the number of culture positive isolates in the second year of our study was probably due to rigorous implementation of infection control measures.
Conclusion:
These results on microbiologic profile and antibiotic sensitivity pattern of the isolates will be extremely helpful in revision of antibiotic guidelines for our patients and in developing strategies for coping with high prevalence of multi-drug resistance. Antibiotic stewardship and strict implementation of infection control practices will be important components of this effort.
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5
Clinical study of carbapenem sensitive and resistant Gram-negative bacteremia in neutropenic and nonneutropenic patients: The first series from India
AK Ghafur, PR Vidyalakshmi, P Kannaian, R Balasubramaniam
October-December 2014, 51(4):453-455
DOI
:10.4103/0019-509X.175362
PMID
:26842159
Objective:
Carbapenem resistance is a growing global concern. There is a lack of published clinical studies on the topic from Indian subcontinent. Aim of this study was to analyze clinical profile of patients with carbapenem sensitive and resistant bacteremia among neutropenic and nonneutropenic patients.
Materials And Methods:
Retrospective analysis of 141 patients who had carbapenem resistant or sensitive Gram-negative bacteremia, identified over a period of 1-year was done by medical records review, in Apollo Specialty Hospital, a 300-bedded tertiary care Oncology, neurosurgical and orthopedic center in South India.
Results:
Of the total 141 patients with Gram-negative bacteremia, 44 had carbapenem resistant ones. Of these 44 patients, 17 were neutropenics (resistant neutropenic group) and 27 nonneutropenic patients (resistant nonneutropenic group). Of the 97 patients with carbapenem sensitive bacteremia, 43 were neutropenic (sensitive neutropenic group) and 54 nonneutropenics (sensitive nonneutropenic group). The 28 days mortality was significantly higher in carbapenem resistant bacteremic group compared to the sensitive one (
P
= 0.008).
Conclusion:
This is the first study from India comparing clinical features of patients with carbapenem sensitive and resistant blood stream infections. Patients with carbapenem resistant bacteremia had higher mortality compared to patients with sensitive bacteremia.
[ABSTRACT]
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[CITATIONS]
[PubMed]
2,907
244
6
SYMPOSIUM - INFECTIONS IN CANCER: REVIEW ARTICLES
Leptomeningeal metastasis in solid tumors with a special focus on lung cancer
A Joshi, J Ghosh, V Noronha, PM Parikh, K Prabhash
October-December 2014, 51(4):410-413
DOI
:10.4103/0019-509X.175351
PMID
:26842139
Leptomeningeal metastasis is a common problem in advanced solid tumor malignancies. A significant number of patients have underlying lung cancer. With the advent of better therapies, the management of leptomeningeal metastasis is gained more importance to improve survival and quality of live. This review article focuses on the epidemiology, clinical features, diagnostics and the recent management strategies directed towards leotomeningela metastasis from solid tumor, esp lung cancer.
[ABSTRACT]
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[CITATIONS]
[PubMed]
2,852
280
5
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Pattern of infection, therapy, outcome and risk stratification of patients with febrile neutropenia in a tertiary care oncology hospital in India
V Noronha, A Joshi, VM Patil, B Bhosale, VK Muddu, S Banavali, R Kelkar, K Prabhash
October-December 2014, 51(4):470-474
DOI
:10.4103/0019-509X.175306
PMID
:26842166
Context:
Indian febrile neutropenia (FN) data are limited, especially in adult solid tumor patients.
AIMS:
The aim was to study patterns of presentation, source of infection, management and outcome and to evaluate the factors which may correlate with outcome.
Materials And Methods:
A retrospective analysis of prospective data of FN patients at a tertiary care oncology teaching hospital in India between 2007 and 2012. A standardized form was filled for each patient. Patient management was at the discretion of the treating physician. Multinational Association for Supportive Care in Cancer (MASCC) score was retrospectively calculated. Failure of therapy was defined as death, organ failure, shifting from outpatient to inpatient or requirement of intensive care support. SPSS version 16 was used for analysis.
Results:
A total of 388 FN episodes were included: 256 in hematolymphoid and 132 in solid tumor patients. 156 episodes were high-risk by MASCC score. Focus of infection was clinical in 45% and radiologic in 16%. Blood cultures were positive in 18% cases, most commonly Gram-negative organisms (72%). 93% patients were treated with an antibiotic combination of third-generation cephalosporin/beta-lactamase inhibitor, with aminoglycoside or fluoroquinolone. Antibiotic sensitivity to ceftriaxone was low at 38% while sensitivity to cefoperazone/sulbactam and piperacillin/tazobactam ranged between 50% and 55% and for carbapenems 75%. Failure of therapy occurred in 156 episodes, most commonly due to the need for second line antibiotics. Mortality was 5.5%. On univariate analysis, MASCC score, age, type of malignancy, prophylactic growth factors, presence of focus of infection, hemoglobin and nadir platelet count correlated with FN complications.
Conclusion:
Gram-negative bacteremia continues to be the predominant cause of FN in our setup.
[ABSTRACT]
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2,810
293
3
LETTERS TO THE EDITOR
Penile cornu cutaneum with squamous cell carcinoma
Tejinder Kaur, Sumitoj Singh, Rajwinder Singh, Varun Aggarwal
October-December 2014, 51(4):449-449
DOI
:10.4103/0019-509X.175336
PMID
:26842156
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
2,932
114
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SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
An analysis of response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response
H Narendra, J Thomas, S Ray, DJ Fernandes
October-December 2014, 51(4):587-592
DOI
:10.4103/0019-509X.175316
PMID
:26842205
Context:
In India, most breast cancer women present at a locally advanced stage. Routine practice in majority of the cancer centers is to administer neo-adjuvant chemotherapy (NACT) followed by loco-regional treatment. Surgery is scheduled after 3 or 4 cycles. The patients who achieve pathological complete response (pCR) are expected do well.
Aims:
The present study was conducted to analyze our results with NACT, to know pCR rate, to compare pCR rates among various subgroups and to determine the factors which predict pCR.
Settings And Design:
The study was conducted in a tertiary care university affiliated cancer hospital in South India.
Subjects And Methods:
All patients with non-metastatic locally advanced breast cancer and agreed by the hospital tumor board to receive NACT were included. At each visit, response was assessed according to RECIST criteria. Re-staging work up and mammography was done prior to surgery.
Statistical Analysis Used:
Chi square test was used to analyze categorical variables and uni and multivariate analysis were performed to determine the factors predicting pCR rates.
Results:
A total of 84 patients received NACT. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal. Totally 72 patients completed the full course before surgery. Clinical response was complete in 26, partial in 52 and 3 had local progression, one stable and two patient developed distant metastasis. Forty-eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients, pCR rate was 36%.
Conclusions:
Compared with historical controls particularly from India, we could achieve higher pCR rates.
[ABSTRACT]
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[CITATIONS]
[PubMed]
2,740
294
2
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Microbiology, infection control and infection related outcome in pediatric patients in an oncology center in Eastern India: Experience from Tata Medical Center, Kolkata
Arpita Bhattacharyya, Shekhar Krishnan, Vaskar Saha, Gaurav Goel, Sanjay Bhattacharya, Lalawmpuia Hmar
October-December 2014, 51(4):415-417
DOI
:10.4103/0019-509X.175365
PMID
:26842142
Context:
Infection is a major determinant in the outcome of patients with cancer.
Aims:
The aim was to know the epidemiology and outcome of patients with cancer in a cancer care center in Eastern India.
Settings And Design:
Retrospective study of pediatric patients in Tata Medical Center, Kolkata, India. Methods: Patients (
n
= 262) between the age group of 0 and 18 years were reviewed for infections and infection-related outcome (January to December 2013).
Statistical Analysis:
Modified Wald method was used to determine confidence interval of proportions.
RESULTS:
Gram-negative bacteria were found to be the most common cause of bloodstream infections (BSIs) (56.4%), followed by Gram-positive cocci (34.5%), and
Candida
species (9.1%). Carbapenem-resistance was noted among 24% of Gram-negative
bacilli
(GNB), and extended-spectrum beta-lactamase among 64% of GNBs. A single case of
Vibrio cholerae
septicemia was also noted. No case of vancomycin-resistant
Enterococcus
was observed, whereas only two cases of methicillin-resistant
Staphylococcus aureus
bacteremia (1/3 of all
Staphylococcus aureus
bacteremia) were detected.
Escherichia coli,
followed by
Klebsiella, Pseudomonas, and Acinetobacter
were the predominant organisms detected in BSIs. Among
Candida spp.
BSIs no resistance to caspofungin, amphotericin B, Voriconazole was noted.
Candida tropicalis
was the most common isolate, and 1 isolate of
Candida glabrata
showed dose-dependent sensitivity to fluconazole. Three out of 25 patients died of multi-drug resistant Gram-negative bacteria (12%) in 2013. Seventeen patients had radiological evidence of invasive fungal infections (no mortality was noted).
Conclusions:
Periodic review of infection-related data, as well as infection control practices, is essential to optimize clinical outcome in patients with pediatric malignancies.
[ABSTRACT]
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2,712
305
5
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Retrospective analysis of clinicopathological factors and outcome in breast cancer in young women in a tertiary care hospital in India
SP Deshmukh, AD Mane, BP Zade, SP Sane
October-December 2014, 51(4):594-598
DOI
:10.4103/0019-509X.175352
PMID
:26842207
Background:
The proportion of breast cancer is rising in India. It presents at a younger age in India as compared to the western countries.
Aims:
This is a retrospective study of 86 breast cancer patients less than 40 years treated in a single center from June 2006 to June 2011. The aim was to assess the factors that may influence clinical outcome.
Materials and Methods:
Data were collected from medical records. Variables such as age, stage, surgery, chemotherapy, tumor size, grade, nodal status, perinodal extension, lymphovascular emboli, estrogen receptor, progesterone receptor, and HER-2 neu were analyzed in relation to outcome.
Results:
Out of total 613 breast cancer patients, 91 (14.8%) were younger than 40 years. Five were excluded due to incomplete data; hence, 86 patients were included in this study. Median tumor size was 3 cm and lymph node positivity was 56.9%. Lymphovascular emboli were positive in 48.8% and perinodal extension was positive in 41.8%. Estrogen receptor positivity was 34.8%, progesterone receptor positivity was 45.3%, and triple negativity was 45.3%. The median follow-up period was 27 months with disease free survival being 73.2% and overall survival being 87.2%. In univariate analysis, the factors significantly associated with survival were stage at presentation, presence of lymphovascular emboli, perinodal extension and grade of the tumor. In multivariate analysis grade of tumor was the only significant factor.
Conclusions:
In young women with breast cancer, the factors significantly associated with survival were clinical stage at presentation, the presence of lymphovascular emboli and perinodal extension and grade of tumor.
[ABSTRACT]
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[PubMed]
2,739
263
2
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Invasive bacterial infections in a pediatric oncology unit in a tertiary care center
A Trehan, S Totadri, V Gautam, D Bansal, P Ray
October-December 2014, 51(4):428-431
DOI
:10.4103/0019-509X.175368
PMID
:26842149
Background:
Multidrug resistant (MDR) pathogens are becoming a major problem worldwide, more so in the immunocompromised hosts resulting in the urgent need of antibiotic stewardship.
Purpose:
To analyze the organisms isolated and the drug resistance pattern in a pediatric oncology unit.
Results:
Data pertaining to infections with 128 positive cultures in patients with febrile neutropenia over a period of 1-year are presented. The unit antibiotic policy is decided depending on the sensitivity of the prevailing common organisms. We isolated Gram-negative organisms in 56% cases.
Escherichia coli
and
Klebseilla
were the most frequent lactose fermenting Gram-negative
Bacilli
and
Pseudomonas
and
Acinetobacter
the nonfermenting Gram-negative
Bacilli
. Only 20–30% of the Gram-negative organisms cultured were sensitive to a 3
rd
/4
th
generation cephalosporin. The combination of a beta-lactam/inhibitor covered 2/3
rd
of Gram-negative organisms. About 80% of the organisms were sensitive to carbapenems. There was no colistin resistance. About 44% of our cultures grew a Gram-positive bacterial organism and included coagulase negative
Staphylococcus
. We had an incidence of methicillin resistant
Staphylococcus aureus
to be 30%. About 30% of the enterococci isolated in our unit were vancomycin-resistant enterococci. About 23% of patients with a positive bacterial culture died.
Conclusions:
Infections in pediatric cancer patient's account for about 15–20% of the deaths in developing countries as these patients are at a high risk for developing MDR infections. Resistance rates among Gram-positive and Gram-negative organisms have increased worldwide. Every unit needs a rational antibiotic policy. Antibiotic de-escalation and judicious decrease in the duration of antibiotics needs to be practiced.
[ABSTRACT]
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[CITATIONS]
[PubMed]
2,689
270
3
SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
Young onset colorectal cancer: How does it differ from its older counterpart?
SS Saluja, JM Manipadam, PK Mishra, S Sachdeva, N Solanki, H Shah
October-December 2014, 51(4):565-569
DOI
:10.4103/0019-509X.175350
PMID
:26842197
Background:
Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group.
Materials And Methods:
Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young-onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years).
Results:
Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (
P
= 0.02) and obstruction at time of presentation (
P
= 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (
P
= 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (
P
= 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65
P
= 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39
P
= 0.02). The survival was similar among the two groups.
Conclusions:
Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.
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2,703
225
4
Predictors of quality of life in patients with colorectal cancer in Iran
Maryam Momeni, Atefeh Ghanbari, Farahnaz Jokar, Abbas Rahimi, Ehsan Kazemnezhad Leyli
October-December 2014, 51(4):550-556
DOI
:10.4103/0019-509X.175331
PMID
:26842192
Background:
Colorectal cancer (CRC) is one of the most common invasive cancers and is responsible for physical and psychosocial morbidity. Quality of life (QOL) is an important outcome for these patients. The aim of this study was to determine the predictive factors of QOL in patients with CRC.
Materials And Methods:
A cross-sectional design was used to assess 110 patients with CRC who referred to Oncology Department of Razi Hospital, Guilan. Data were collected by structured interview with patients and review of medical records. Generic and specific QOL were evaluated by short form-36 and functional assessment of cancer therapy-colorectal, respectively. Generalized linear models identified variables significantly associated with QOL.
Results:
Out of 110 patients with CRC, 58.2% were men. Mean age of patients was 58.33 ± 12.39 years. Mean of Generic and specific QOL were 70.92 ± 15.56 and 95.72 ± 19.18, respectively. In regression analysis, age, sex, living condition, health insurance, hospitalization frequency, Karnofsky performance status, and co-morbidity were predictors of generic QOL and age, sex, living condition, health insurance, monthly income, family history of CRC, Karnofsky performance status, and co-morbidity were predictors of specific QOL in patients.
Conclusion:
There are nine socio-demographic and clinical factors that are significant predictors of QOL in patients with CRC which should be considered in treatment and care of patients. The findings of this study should be the target of future research, emphasizing the need for interventional studies that minimize the adverse impact of the disease symptoms on the QOL in patients with CRC.
[ABSTRACT]
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[EPub]
[CITATIONS]
[PubMed]
2,668
233
2
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Effect of aged garlic extract on immune responses to experimental fibrosarcoma tumor in BALB/c mice
M Abouhosseini Tabari, S Ebrahimpour
October-December 2014, 51(4):609-613
DOI
:10.4103/0019-509X.175359
PMID
:26842212
Background:
Aged garlic extract (AGE) has many biological activities including radical scavenging, antioxidative and immunomodulative effects.
Aim:
In this research work, the antitumor and immunomodulatory effects of AGE against fibrosarcoma implanted tumor were studied.
Materials And Methods:
WEHI-164 fibrosarcoma cells were implanted subcutaneously on day 0 into the right flank of 40 BALB/c mice at age of 8 weeks. Mice were randomly categorized in two separate groups: First received AGE (100 mg/kg, IP), second group as the control group received phosphate buffered saline. Treatments were carried out 3 times/week. Tumor growth was measured and morbidity was recorded. Subpopulations of CD4+/CD8+ T cells were determined using flow cytometry. WEHI-164 cell specific cytotoxicity of splenocytes and in vitro production of interferon gamma (IFN-γ) and interleukin-4 cytokines were measured.
Results:
The mice received AGE had significantly longer survival time compared with the control mice. The inhibitory effect on tumor growth was seen in AGE treated mice. The CD4+/CD8+ ratio and in vitro IFN-γ production of splenocytes were significantly increased in AGE group. WEHI-164 specific cytotoxicity of splenocytes from AGE mice was also significantly increased at 25:1 E: T ratio.
Conclusion:
Administration of AGE resulted in improved immune responses against experimentally implanted fibrosarcoma tumors in BALB/c mice. AGE showed significant effects on inhibition of tumor growth and longevity of survival times.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
2,674
226
3
SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
Comparison of different scoring systems in patients undergoing colorectal cancer surgery for predicting mortality and morbidity
F Cengiz, E Kamer, B Zengel, B Uyar, C Tavusbay, HR Unalp
October-December 2014, 51(4):543-548
DOI
:10.4103/0019-509X.175318
PMID
:26842190
Background:
Preoperative risk estimation evaluating mortality and morbidity might help surgical decision.
Aims:
The aim of this study was to compare the sensitivities of physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), portsmouth-POSSUM (P-POSSUM), colorectal-POSSUM (CR-POSSUM), the Association of Coloproctology of Great Britain and Ireland colorectal cancer model (ACPGBI CRC) and revised ACPGBI CRC scoring systems that are used for evaluating mortality and morbidity in colorectal surgery performed in third-level healthcare centers.
Settings And Design:
A retrospective analysis has been performed on 335 consecutive patients undergoing colorectal cancer surgery between 2002 and 2012.
Materials And Methods:
Mortality and morbidity risks of 335 patients who underwent colorectal cancer were evaluated using these scoring systems and the results were compared with actual mortality and morbidity within postoperative 30-day that extend the duration of hospital stay.
Statistical Analysis Used:
The receiver operating characteristic (ROC) curves were designed to identify the score values.
Results:
Results of POSSUM and P-POSSUM systems showed statistical differences compared with those of CR-POSSUM, ACPGBI CRC and revised ACPGBI CRC systems (
P
< 0.05). P-POSSUM was found to be the best scoring system for predicting mortality risk, although all scoring systems seem to be appropriate for this parameter. On the other hand POSSUM, which can predict morbidity, was found to have moderate differentiation ability due to the magnitude of the area under the ROC curve.
Conclusions:
Despite altering patient demographics and surgical conditions, POSSUM seems to lead as the best scoring system for predicting mortality and morbidity among others including those most-recently proposed.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
2,637
250
2
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Pattern of bloodstream infections in patients with hematological malignancies in a tertiary care centre
S Bansal, SH Advani
October-December 2014, 51(4):447-449
DOI
:10.4103/0019-509X.175308
PMID
:26842155
Background:
The purpose of our study was to evaluate the clinical characteristics, to understand the pattern of bloodstream infections (BSIs), and to determine the risk factors contributing to high-risk febrile neutropenia in patients with hematological malignancy.
Materials And Methods:
A comprehensive review of retrospective data was done from 2004 till 2012 from a single center.
Results:
There were total 171 consecutive febrile episodes with 103 acute lymphoblastic leukemia (ALL) patients and 63 acute myeloid leukemia (AML) patients. The highest number of febrile neutropenia episodes occurred during ALL and AML induction followed by consolidation treatment with high-dose cytarabine. In our study population, the most common organisms isolated were Gram-positive (20%) followed by Gram-negative (6.4%) organisms. The incidence of fungal sepsis was only 3%. In our study, it was seen that the recovery from febrile neutropenia depends upon the disease, ALL recovered rapidly compared to AML (
P
< 0.001) and also the on the phase of treatment, i.e consolidation recovered earlier than induction (
P
< 0.001). There was no death recorded in this study population during febrile neutropenia.
Conclusions:
The incidence of febrile neutropenia depends upon the type of haematological malignancy and the aggressiveness of therapy required treating the disease especially during induction. The improvement in antimicrobial coverage and its prompt use leads to the selective growth of Gram-positive organisms.
[ABSTRACT]
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
2,518
328
2
Bloodstream infections in pediatric patients at cancer institute, Chennai
V Radhakrishnan, V Vijaykumar, P Ganesan, R Rajendranath, G Trivadi, S Tenali
October-December 2014, 51(4):418-419
DOI
:10.4103/0019-509X.175360
PMID
:26842144
Background:
There is paucity of data on the epidemiology of bloodstream infections in pediatric cancer patients from India. Rationale use of antibiotics in febrile neutropenia is important for reducing morbidity and preventing the emergence of drug resistant bacteria.
AIMS:
The study was conducted to look at the prevalence of bloodstream bacterial infection and the antibiotic resistance profile at Cancer Institute, Chennai.
Settings And Design:
This was a retrospective study.
Materials and Methods:
Data on all blood cultures taken from pediatric cancer patients treated at Cancer Institute, Chennai, during the year 2013 were analyzed. The microbiological profile and sensitivity pattern were analyzed.
Results:
A total of 1045 blood culture samples were taken, and there were 82/1045 (7.5%) positive blood cultures. Gram-negative organisms accounted for 50/82 (61%) of all positive cultures.
Klebsiella pneumoniae
(32%) was the most common Gram-negative isolate, and
Staphylococcus aureus
(93.5%) was the most common Gram-positive. There was high resistance to aminoglycosides and beta-lactam/beta-lactamase inhibitor antibodies.
Conclusion:
Gram-negative organisms are the predominant bacteria isolated. There is high resistance to first-line combination antibiotics used as empiric therapy for treatment of febrile neutropenia.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
2,566
273
6
SYMPOSIUM - MOLECULAR ONCOLOGY: ORIGINAL ARTICLES
Xanthohumol inhibits cellular proliferation in a breast cancer cell line (MDA-MB231) through an intrinsic mitochondrial-dependent pathway
YB Yoo, KS Park, JB Kim, HJ Kang, JH Yang, EK Lee, HY Kim
October-December 2014, 51(4):518-523
DOI
:10.4103/0019-509X.175328
PMID
:26842182
Aims:
Xanthohumol isolated from hops has been reported to exhibit anticancer effects in diverse human cancers. However, its effect on breast cancer has not yet been clearly defined. The purpose of this study was to investigate the effects of xanthohumol on breast cancer cell proliferation.
Materials And Methods:
After treatment with 5 μM, 10 μM, and 20 μM xanthohumol for 48 h, cells from the human breast cancer cell line MDA-MB-231 were studied using colony assay, flow cytometry, and western blotting.
Results:
The survival rate of the MDA-MB231 cells treated with 10 μM and 20 μM xanthohumol for 48 h decreased significantly by 64.7 ± 1.8% and 40.1 ± 1.8%, respectively. The numbers of SubG0/G1 cells in the group treated with 10 μM and 20 μM xanthohumol increased significantly to 11.3 ± 0.2 and 18.4 ± 0.1, respectively. A ladder pattern of DNA fragmentation was also observed. Xanthohumol increased the expression of Bax in the mitochondria, which correspondingly decreased in the cytoplasm. The activity of caspase-3 and caspase-9 was shown to increase significantly in the treated groups but not in the control group.
Conclusions:
Xanthohumol inhibited the proliferation of MDA-MB-231 cells through a mitochondria- and caspase-dependent apoptotic pathway. This result suggests that xanthohumol might serve as a novel therapeutic drug for breast cancer.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
2,499
217
12
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Frequency of bacterial isolates and pattern of antimicrobial resistance in patients with hematological malignancies: A snapshot from tertiary cancer center
M Sengar, R Kelkar, H Jain, S Biswas, P Pawaskar, A Karpe
October-December 2014, 51(4):456-458
DOI
:10.4103/0019-509X.175387
PMID
:26842160
Background:
Infections are the most important cause of mortality in patients with high-risk febrile neutropenia. Emergence of multi-drug resistant organisms (MDROs) has become a major challenge for hemato-oncologists. Knowledge of the prevalent organisms and their antimicrobial sensitivity can help deciding the empirical therapy at individual centers and allows timely measures to reduce the risk of antimicrobial resistance.
Aims:
To evaluate the frequency of bacterial isolates from all the samples and the pattern of bacterial bloodstream infections and incidence of MDROs.
Settings And Design:
This is a retrospective analysis from a tertiary care cancer center.
Materials And Methods:
From January to June 2014 information on all the samples received in Department of Microbiology was collected retrospectively. The data from samples collected from patients with hematological cancers were analyzed for types of bacterial isolates and antimicrobial sensitivity.
Results:
A total of 739 isolates were identified with 67.9% of isolates being Gram-negative. The predominant Gram-negative organisms were
Escherichia coli
,
Psuedomonas
spp. and
Klebsiella
spp. Among the bacterial bloodstream infections, 66% were Gram-negative isolates. MDROs constituted 22% of all isolates in blood cultures. Incidence of resistant Gram-positive organisms was low in the present dataset (methicillin resistant
Staphylococcus aureus
and vancomycin-resistant enterococci-1.3%).
Conclusions:
The analysis reconfirms the Gram-negative organisms as the predominant pathogens in bacteremia seen in patients with hematological cancers. The high frequency of multi-drug resistance in the dataset calls for the need of emergency measures to curtail further development and propagation of resistant organisms.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
2,380
296
2
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
The outcome effect of double-hormonal therapy in premenopausal breast cancer patients with high nodal-status: Result of a prospective randomized trial
A Uslu, B Zengel, G Akpinar, H Postaci, H Yetis, B Corumlu, E Kebapci, A Aykas
October-December 2014, 51(4):582-586
DOI
:10.4103/0019-509X.175301
PMID
:26842203
Purpose:
The combination of taxanes and anthracyclines has proven efficacy in node-positive (N
+
) premenopausal primary breast cancer patients. Ovarian ablation is also associated with better survival outcomes in premenopausal hormone-receptor positive (HR
+
) patients. Therefore, this trial aims to determine the superiority of combined hormonal treatment of ovarian ablation with tamoxifen (TMX) versus TMX alone, in premenopausal N
+
, HR
+
patients receiving adjuvant chemotherapy (AC) with taxane and anthracycline.
Materials And Methods:
Premenopausal women who had surgically removed breast cancer with histologically confirmed N
+
and HR
+
were included in the trial. The AC consisted of six cycles of taxotere, adriamycin, cytoxan or taxotere, epirubicin and cytoxan with the completion of radiation therapy. Patients were randomly assigned to receive TMX 20 mg/day for 5 years or up to menopause or TMX 20 mg/day for 5 years plus goserelin (GOS) 3.6 mg injection per month for 2 years. The primary end point was disease-free survival (DFS).
Results:
Between 2003 and 2011, 101 consecutive patients were allocated to TMX (51 patients) and TMX/GOS (50 patients) groups. The mean follow-up period was 52.4 ± 2.8 months. DFS was 43.0 ± 3.6 months versus 49.9 ± 4.22 months (
P
= 0.13) and overall survival was 51.1 ± 3.8 months versus 53.1 ± 4.2 months (
P
= 0.50) in the TMX and TMX/GOS groups, respectively. The results showed 9% absolute risk reduction with respect to DFS in favor of the TMX/GOS group.
Conclusion:
This study group was comprised of stage II and III disease patients with high nodal status. The TMX/GOS combination reduced absolute risk of developing first locoregional or distant relapse by almost 9%. Longer follow-up is required to justify this protocol for routine use.
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1
SYMPOSIUM - MOLECULAR ONCOLOGY: ORIGINAL ARTICLES
Role of Sphk1 in the malignant transformation of breast epithelial cells and breast cancer progression
XD Zheng, Y Zhang, XW Qi, MH Wang, P Sun, Y Zhang, J Jiang
October-December 2014, 51(4):524-529
DOI
:10.4103/0019-509X.175343
PMID
:26842184
Background:
The ojective of the following study is to investigate the role of sphingosine kinase 1 (Sphk1) in the malignant transformation of breast epithelial cells and breast cancer progression and its mechanism.
Materials And Methods:
Immunohistochemistry was performed to detect Sphk1 and E-cadherin (E-cad) in resected breast samples. Sphk1 was transfected in normal human breast epithelial cell line (MCF-10A) by
Lentivirus
and silenced in breast cancer cell line (MCF-7) using small interfering ribonucleic acid. The effect of tumor necrosis factor alpha (TNF-α) and/or N, N-dimethylsphingosine (DMS) on the Sphk1 and E-cad expression, MCF-10A cell proliferation and invasion was investigated. Real time-polymerase chain reaction and western-blot was used to detect messenger ribonucleic acid and protein. Cell counting kit-8 and transwell were used to measure cell proliferation and invasion.
Results:
Sphk1 was positive expression in 114 breast tumors (75.50%) but negative in fibroadenomas. The expression of E-cad and Sphk1 were negatively correlated and E-cad (−)/Sphk1 (+) carriers showed higher ratio of axillary lymph node metastasis than E-cad (+)/Sphk1 (−) carriers. Overexpression of Sphk1 in MCF-10A reduced E-cad expression and improved cell proliferation and invasion, but knockdown of Sphk1 in MCF-7 decreased cell proliferation and invasion. TNF-α increased Sphk1 expression, enhanced the ability of Sphk1 in decreasing E-cad expression, which could be blocked by DMS. TNF-α promoted MCF-10A cell proliferation and invasion.
Conclusion:
Sphk1 plays an important role in the malignant transformation of breast epithelial cells and modulates breast cancer metastasis through the regulation of E-cad expression. TNF-α can up-regulate Sphk1 expression and reduce E-cad expression through Sphk1, which can be blocked by DMS. TNF-α/Sphk1/E-cad pathway may be a newly discovered pathway and plays an important role in tumorigenesis and metastasis.
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5
LETTERS TO THE EDITOR
Primary yolk sac tumor of the endometrium: A rare entity
N Abhilasha, UD Bafna, VR Pallavi, PS Rathod, S Krishnappa
October-December 2014, 51(4):446-446
DOI
:10.4103/0019-509X.175315
PMID
:26842154
[FULL TEXT]
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2,348
172
11
SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Review of spectrum and sensitivity of bacterial bloodstream isolates in children with malignancy: A retrospective analysis from a single center
R Reddy, S Pathania, A Kapil, S Bakhshi
October-December 2014, 51(4):425-427
DOI
:10.4103/0019-509X.175363
PMID
:26842147
Background:
Febrile neutropenia is a life-threatening emergency in pediatric cancer patients. Its management is based on established guidelines that emphasize on prompt action. Consideration of local microbiologic spectrum and its susceptibility is pivotal in devising a rational protocol.
AIMS:
To study the spectrum of bacterial isolates and its antibiotic sensitivity profile in bloodstream infections (BSIs) of pediatric cancer patients.
Settings And Design:
Retrospective study.
Materials And Methods:
This study was conducted at a tertiary cancer center for pediatric cancer patients. Blood culture samples sent during the evaluation of patients with clinical diagnosis of febrile neutropenia during the year of 2013 were analyzed. The microbiological and antibiotic sensitivity patterns were studied.
Results:
A total of 27 isolates represented BSIs out of 412 blood cultures sent (6.5%). These were predominantly Gram-negative (92%) with
Klebsiella
contributing to the majority of them. Extended spectrum beta-lactamase production was seen in 59% of all isolates. Multidrug resistance phenotype was seen in 48%, extreme drug resistance in 32% and pan drug resistance in 16% of Gram-negative isolates.
Klebsiella
predominated in all of these isolates. Mortality resulted in 15% isolates, majorly contributed by
Klebsiella
. Colistin was the most sensitive antibiotic (75% sensitivity) and in significant number of cases the only salvage option.
Conclusion:
Gram-negative bacteria are the most common etiologic agents. The emergence of drug resistant strains of
Klebsiella
and the poor sensitivity of most of these strains to common first choice empiric agents is alarming. Low prevalence of Gram-positive organisms questions the routine use of empiric vancomycin.
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8
Spectrum of malignancies in human immunodeficiency virus – positive patients at a Tertiary Care Centre in South India
TR Paul, MS Uppin, SG Uppin, K Radhika, AK Prayaga, C Sundaram, VS Reddy, DR Rao, S Rajappa, VR Sreenivasan
October-December 2014, 51(4):459-463
DOI
:10.4103/0019-509X.175295
PMID
:26842162
Context:
India has a very large number of patients living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Opportunistic infections in these patients are commonly encountered. However, malignancies in such patients also do occur.
Aim:
The aim was to study the spectrum of malignancies in HIV-positive patients at a tertiary health care center.
SETTINGS AND DESIGN:
Retrospective study.
Materials And Methods:
The cases were retrieved from pathology record files at our Institute from January 2003 to December 2008. The follow-up was obtained from Medical oncology records. The morphology of each case was reviewed along with immunohistochemistry wherever done.
Results:
There were 61 such cases (51 males, 10 females). The age range was 7–78 years with a median of 35 years. The clinical presentation varied according to the malignancy. The largest group was non-Hodgkin lymphoma (18 nodal, 23 extra-nodal). The others included carcinoma breast (4), chronic myeloid leukemia (3), Burkitt Leukemia (2), squamous cell carcinoma anal region (2), multiple myeloma (2) and one each of miscellaneous malignancies (7).
Conclusion:
Malignancies in HIV positive individual occurred in younger individuals. Non-Hodgkin lymphomas, especially extra-nodal lymphomas, were the most common malignancy. There were no cases of proven Kaposi's sarcoma or invasive cervical carcinomas. There were two cases of multiple myeloma which are infrequently reported.
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2,272
185
3
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Pedigree studies and evaluation of risk factors of breast cancer in Goa
NV Fernandes, S Pinto, P Dias, D Kolwalkar, T Chipkar
October-December 2014, 51(4):600-603
DOI
:10.4103/0019-509X.175300
PMID
:26842209
Background:
Incidence of breast cancer (BC) is increasing in most of the countries, including the areas which have had previously low rates.
AIM:
The aim of this prospective study was to analyze the pedigrees of the patients for detecting hereditary factor prevalence and to investigate the possible risk factors associated with BC in a sample population from Goa.
Materials And Methods:
A prospective analysis was performed for 95 BC patients between 2011 and 2012. For assessing the risk factors, a proforma was designed and the necessary data was collected by interview. The process of collecting family history for drawing the pedigree included interviewing the informant.
Statistical Analysis Used:
Online calculators of statistics were used for standard deviation at
www.easycalculation.com
and fishers test at
www.graphpad.com
.
Results:
High frequency of BC was revealed in the sample population from Goa. This could be attributed to the changes in reproductive patterns, physical inactivity and obesity, or general increase in BC awareness. Factors which did not influence the frequency of BC in the sample population include parity, oral contraceptives, alcohol consumption, occupation, exercise, and nutritional supplement. High incidence of family history of 168/1000 individuals was observed in the present study.
Conclusions:
Proper management of BC is possible after assessment of cumulative risk of BC in females by a thorough study of both environmental and genetic factors. Cumulative risk can be greatly reduced by controlling the environmental risk.
[ABSTRACT]
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2,270
172
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Characterization and anti-microbial susceptibility of bacterial isolates: Experience from a tertiary care cancer center in Delhi
R Singh, S Jain, R Chabbra, R Naithani, A Upadhyay, M Walia
October-December 2014, 51(4):477-480
DOI
:10.4103/0019-509X.175305
PMID
:26842169
Background:
Hospitalization for fever in cancer patients is associated with considerable morbidity, mortality, and cost.
AIM:
The aim of this study was to study the bacterial spectrum and susceptibility patterns of pathogens in culture positive patients from the oncology unit of our hospital.
Methods:
We retrospectively reviewed the medical records of patients admitted in our cancer center (medical, radiation, and surgical oncology) from January to December 2013. Blood and respiratory secretions from the indoor patients were evaluated.
Results:
Of the total 693 samples, 76.4% were Gram-negative and 23.6% were Gram-positive. The most common bacterial isolates among Gram-negative organisms in blood were
Escherichia coli
,
Salmonella
and among the Gram-positive organism were
Staphylococcus aureus
and
Enterococcus
. Among the blood isolates extended spectrum of beta-lactamase, multidrug-resistant (carbapenem-resistant) and pan resistant bugs were seen in 47%, 15%, and 5% of the blood isolates. Among the Gram-positive organisms, 25% respiratory isolates were vancomycin-resistant Enterococci.
Conclusion:
We observed a high incidence of Gram-negative isolates with clinically significant resistance to first-line antibiotics such as cephalosporin's, piperacillin tazobactum, and fluoroquinolones.
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6
Comparison of isolates and antibiotic sensitivity pattern in pediatric and adult cancer patients; is it different?
K Prabhash, J Bajpai, A Gokarn, B Arora, PA Kurkure, A Medhekar, R Kelkar, S Biswas, S Gupta, V Naronha, N Shetty, G Goyel, SD Banavali
October-December 2014, 51(4):496-501
DOI
:10.4103/0019-509X.175356
PMID
:26842176
Background:
Infection is a common cause of mortality and morbidity in cancer patients. Organisms are becoming resistant to antibiotics; age appears to be one of the factors responsible. We analyzed common organisms and their antibiotic sensitivity pattern in the correlation with age.
Methods:
This is a single institutional, retrospective analysis of all culture positive adult and pediatric cancer patients from January 2007 to December 2007. For statistical analysis, Chi-square test for trend was used and
P
values were obtained. Of 1251 isolates, 262 were from children <12 years of age and 989 were from adolescents and adults (>12 years of age). Gram-negative organisms were predominant (64.95) while Gram-positive constituted 35.09% of isolates.
Results:
The most common source in all age groups was peripheral-blood, accounting to 47.8% of all samples. The most common organisms in adults were
Pseudomonas aeruginosa
(15.3%) while in children it was coagulase negative
Staphylococcus aureus
(19.8%). Antibiotic sensitivity was different in both groups. In pediatric group higher sensitivity was seen for Cefoparazone-sulbactum, Cefipime, Amikacin, and Tobramycin. No resistance was found for Linezolid.
Conclusions:
The isolates in both children and adults were predominantly Gram-negative though children had proportionately higher Gram-positive organisms. High-dose cytarabine use, cotrimoxazole prophylaxis, and frequent use of central lines in children especially in hematological malignancies could explain this observation. Children harbor less antibiotic resistance than adults; Uncontrolled, cumulative exposure to antibiotics in our community with increasing age, age-related immune factors and variable bacterial flora in different wards might explain the higher antibiotic resistance in adults. Thus age is an important factor to be considered while deciding empirical antibiotic therapy.
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2,255
185
2
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Ferula gummosa Boiss
flower and leaf extracts inhibit angiogenesis
in vitro
S Mirzaaghaei, H Akrami, MH Asadi, H Mahdiuni
October-December 2014, 51(4):615-620
DOI
:10.4103/0019-509X.175323
PMID
:26842214
Background:
Angiogenesis is a vital process in development as well as in tumor metastasis. Therefore, inhibition of tumor angiogenesis may be an approach for cancer therapy. In this study, we evaluated the effect of
Ferula gummosa Boiss
flower and leaf extracts on angiogenesis.
Materials And Methods:
Cell growth and cytotoxic effects of different concentrations (0-70 μg/mL) of
F. gummosa Boiss
flower and leaf extracts were evaluated on the growth of human umbilical vein endothelial cells (HUVECs) using Neutral Red assay. Then, wound healing,
in vitro
angiogenesis assay and quantitative
VEGF
gene expression analysis were conducted with the noncytotoxic concentrations of the ethanol extract.
Results:
Our results indicated that observed HUVECs viability was higher than 60% for both extracts after 24 hours treatment at concentration of 30 μg/mL or lower, whereas cytotoxic effects were observed at higher concentrations or after 48 hours treatment.
F. gummosa Boiss
flower and leaf extracts inhibited migration and angiogenesis capacity in a concentration-dependent manner (10-30 μg/mL), and down regulated
VEGF
transcription (20 μg/mL for flower extract and 30 μg/mL for leaf extract).
Conclusions:
Our findings revealed that
F. gummosa Boiss
flower and leaf extracts may contain antiangiogenic compounds, which could be used in preparation of new therapeutic agents for inhibition of tumor angiogenesis. To the best of our knowledge, this is the first report of antiangiogenic effects of
F. gummosa Boiss
flower and leaf extracts and more studies are needed to identify the effective components of the extracts.
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2,221
209
1
SYMPOSIUM - INFECTIONS IN CANCER: REVIEW ARTICLES
Competing risk: An illustration with aspiration pneumonia in head and neck cancer patients undergoing radical radiotherapy: A biostatistician's perspective
T Bhattacharyya, A Bhattacharjee
October-December 2014, 51(4):406-409
DOI
:10.4103/0019-509X.175322
PMID
:26842137
Interest in survival analysis is to look and capture the information about the occurrence of events, i.e., death. In human life different types of events may happen at the same time. Sometimes, few events completely interrupt or make subtle changes on the occurrence of an event of interest. The method to capture information about the specific event of interest along with other events is known as competing risk modeling. This paper is dedicated to explore the application of competing risk model in oncology practice. It is aimed in near future that more and more survival analysis will be performed through application of competing risk modeling instead of traditional survival analysis to generate robust statistical inference.
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2,156
201
5
LETTERS TO THE EDITOR
Extra nodal diffuse large B cell lymphoma at a rare site: A case report
D Shanmugam, NRV Prasad, K Srinivasan, D Basu
October-December 2014, 51(4):475-476
DOI
:10.4103/0019-509X.175370
PMID
:26842168
[FULL TEXT]
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2,122
140
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Basaloid squamous cell carcinoma of conjunctiva: A rare entity
SK Mathur, P Jain, A Batra, R Sen
October-December 2014, 51(4):469-469
DOI
:10.4103/0019-509X.175329
PMID
:26842165
[FULL TEXT]
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2,148
110
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
Susceptibility profile of Gram-negative bacteremic isolates to beta lactam-beta lactamase inhibitor agents in comparison to other antibiotics
K Ghafur Abdul, PR Vidyalakshmi, VA Jayalakshmi, I Poojary
October-December 2014, 51(4):450-452
DOI
:10.4103/0019-509X.175361
PMID
:26842157
Background:
Comprehensive understanding about the local antibiogram is an essential requirement for preparation of hospital or unit based antibiotic policy. Bacteremic isolates are the most useful ones for this purpose, representing invasive disease.
Objective:
To analyze susceptibility pattern of bacteremic Gram-negative isolates in our center, to various antibiotics, including beta lactam-beta lactamase inhibitor (BL-BLI) agents and carbapenem.
Materials
And
Methods:
This is a retrospective study done in Apollo Specialty Hospital, a tertiary care oncology center in South India. The susceptibility of
Escherichia coli
,
Klebsiella,
Acinetobacter
and
Pseudomonas
blood culture isolates, identified between January 2013 and June 2014 to various antibiotics were analyzed.
Results:
A total of 231-Gram-negative bacteremic isolates were analyzed. ESBL rate among
E. coli isolates
was 82.7% (67 out of 81) and 74.3% (58 out of 78) in
Klebsiella
. Carbapenem (imipenem) susceptibility rate in
E. coli
was 76.5%,
Klebsiella
58.9%,
Acinetobacter
32% and
Pseudomonas
77.2%. Colistin susceptibility in
E. coli
was 96.2%,
Klebsiella
93.5%,
Acinetobacter
92.8% and
Pseudomonas
97.7%. Difference in the susceptibility of
Enterobacteriaceae
to BL-BLI agents (especially cefepime-tazobactam) and carbapenem were minimal. In nonfermenters, BL-BLI susceptibility was better than that of carbapenem.
Conclusion:
Findings of the study make a strong argument for using BL-BLI agents and sparing carbapenem to curtail the spiraling scenario of carbapenem resistance.
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2,025
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3
SYMPOSIUM - MOLECULAR ONCOLOGY: ORIGINAL ARTICLES
Association of vascular endothelial growth factor single nucleotide polymorphisms on the prognosis of breast cancer patients
J Rani, B Rahul, G Ramesh, L Krishnamoorthy, C Shilpa, G Ramaswamy, V Deshmane
October-December 2014, 51(4):512-517
DOI
:10.4103/0019-509X.175334
PMID
:26842181
Background:
Vascular endothelial growth factor (VEGF), a major mediator of vascular permeability and angiogenesis, may play a pivotal role in mediating the development and progression of breast cancer. In the present study, we examined the genetic variations of the VEGF gene to assess its possible relation to breast cancer.
Materials And Methods:
A total of 200 patients with histologically confirmed cases of breast cancer and 200 healthy women were genotyped for VEGF single nucleotide polymorphisms (405G > C and −1154G > A) by polymerase chain reaction-restriction fragment length polymorphism analysis. Pre-operative plasma VEGF levels were determined by enzyme-linked immunosorbent assay in 200 women with breast cancer and in 200 normal female controls.
Results:
The genotype frequencies of the +405G > C, −1154G > A polymorphisms did not show a significant deviation from the Hardy-Weinberg expectation. The minor allele frequencies of the +405G > C and −1154G > A polymorphisms among cases and controls were 33.5% (C allele), 31.5% (A allele) and 35% (C allele), 34.5% (A allele) respectively. +405GG and −1154GG genotypes were associated with higher levels of VEGF among breast cancer cases and controls. Increased plasma VEGF levels were significantly associated with, clinical stage of the disease (
P
= 0.035).
Conclusion:
Although none of the polymorphisms were significantly associated with breast cancer, some of the VEGF genotypes may influence tumor growth through an altered expression of VEGF and tumor angiogenesis.
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2,059
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1
LETTERS TO THE EDITOR
Pilomatrix carcinoma of the eyelid
B Mukherjee, P Roy, N Adulkar, S Krishnakumar, J Biswas
October-December 2014, 51(4):569-570
DOI
:10.4103/0019-509X.175357
PMID
:26842198
[FULL TEXT]
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2,089
137
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Reply to 'comprehensive decongestive therapy in post-mastectomy lymphedema: An Indian perspective'
H Sreekar, AK Gupta, S Lamba, MK Sharma
October-December 2014, 51(4):608-608
DOI
:10.4103/0019-509X.175381
PMID
:26842211
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
2,059
153
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SYMPOSIUM - INFECTIONS IN CANCER: ORIGINAL ARTICLES
An audit of febrile neutropenia cases from a rural cancer center in India
VM Patil, S Chakarborty, MS Kumar, M Geetha, S Dev, S Samuel, G Ahmed, SK Nayanar, R Vineetha, CK Nair
October-December 2014, 51(4):487-490
DOI
:10.4103/0019-509X.175338
PMID
:26842173
Background:
Data of febrile neutropenia (FN) from rural cancer centers is sparse. We did a audit of outcome of patients with FN in the period of March 2013-August 2013. The aim was to help us to develop rational antibiotic usage policies.
Materials and Methods:
Retrospective analysis of all consecutive patients presenting with FN. Data regarding demographic profile, tumor type, intent of treatment, chemotherapy regimen, blood culture susceptibility details, use of antibiotics, response to antibiotics and complications of FN were noted. SPSS (Statistical Product and Service Solutions) 16 was used for analysis.
Results:
67 patients had FN and there were 91 episodes. The median day of presentation with FN after start of chemotherapy was 10 days. The nadir absolute neutrophil count was 161.5 and nadir platelet count 1,00,000. The median multinational association for supportive care in cancer (MASCC) Score was 24. In accordance with MASCC there were 27 high risk FN and 64 low risk FN episodes. On multivariate analysis using logistic regression MASCC score strata was the only significant variable that predicted failure to 1
st
line antibiotics (
P
= 0.03) and mortality (
P
= 0.01). Nine patients (9.9%) had positive isolates on blood cultures. The blood culture isolates were predominantly Gram negative (66.7%).
Conclusion:
The importance of developing local guidelines for rational antibiotic usage is highlighted.
[ABSTRACT]
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2,017
186
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LETTERS TO THE EDITOR
Acute leukemia presenting as primary ecthyma gangrenosum
S Koley, G Das, RK Mandal, DC Barman, S Mallick, P Kumar
October-December 2014, 51(4):598-599
DOI
:10.4103/0019-509X.175355
PMID
:26842208
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
2,070
127
4
SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
Colorectal carcinoma up to the second decade of life: An 8-year experience in a tertiary care center
RK Gupta, S Ali, P Sakhuja, D Mukherjee, AK Agarwal, AS Puri
October-December 2014, 51(4):557-559
DOI
:10.4103/0019-509X.175313
PMID
:26842194
Aims And Objectives:
To evaluate the demographic pattern, incidence, and histological characteristics of colorectal carcinomas (CRCs) in very young adults diagnosed in the center.
Materials And Methods:
We retrieved and reviewed slides and data pertaining to all the cases of CRCs and "segregated into decade wise age-groups" from the archives of Department of Pathology. Patients with age ≤20 years diagnosed during the last 8 years (2006–2013) were further evaluated.
Results:
Totally, 590 cases of CRCs diagnosed over last 8-year period, of which 4.2% (25 cases) presented in the study group (age ≤20 years) with a mean age of 17 years. About 50% of the tumors were either signet ring cell, mucin-secreting or poorly differentiated carcinomas. Four cases occurred in a background of familial adenomatous polyposis (FAP), three of which showed high-grade dysplasia, while in one case, carcinoma-
in-situ
was diagnosed. In all but two cases, rectum was the site of involvement except FAP cases in which colorectal location was noted. CRCs show a sharp rise in earlier age onset (≤40 years) and an increasing trend was followed in patients between age groups third, fourth, and fifth decades of life over the last 8 years.
Conclusion:
Colorectal carcinomas show an increasing trend in young age (≤40 years). This change may be attributed to dietary, lifestyle changes, and newer genetic alterations in developing countries. In very young age group (≤20 years), a higher grade and stage at the time of diagnosis and predominantly rectal involvements are the distinct features.
[ABSTRACT]
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[CITATIONS]
[PubMed]
2,003
193
1
SYMPOSIUM - MOLECULAR ONCOLOGY: REVIEW ARTICLES
Overexpression of cyclin A in oral dysplasia: An international comparison and literature review
R Tandon, LL Cunningham, DK White, AS Herford, M Cicciu
October-December 2014, 51(4):502-505
DOI
:10.4103/0019-509X.175324
PMID
:26842177
Oral squamous cell carcinoma (OSCC) is one of the most debilitating cancers in the world and while its causes have been heavily researched, the outcome remains grim. Most of these cancers are identified in the late stage and as a result treatment options are limited. Therefore, researchers have focused their efforts on recognizing and identifying dysplastic tissue that has an increased chance of progressing to cancer. Research has begun to look at cell cycle dysfunctions and in particular, aberrant protein functions as a way of identifying the cellular mechanism at fault. The overexpression of a group of regulatory proteins called cyclins has been demonstrated in many types of dysplasia and carcinomas. Although researchers have identified several different types of cyclins as potential culprits, we chose to focus our study primarily on the overexpression of cyclin A. While most research on oral dysplasia and OSCC has been focused on cyclin D, studies have been done on cyclin A. While the etiology of oral dysplasia/SCC appears to be multifactorial, we chose to compare our results with those of similar studies performed across the globe. The social factors, such as the increased use of tobacco that may have contributed to our results, were compared with similar studies performed in Europe and Asia. While our results were remarkably similar and demonstrated a link between the overexpression of cyclin A in oral dysplasia, there exists some differences and thus may require a multicenter, longitudinal study.
[ABSTRACT]
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1,966
182
2
LETTERS TO THE EDITOR
Unexplained splenic cyst in a patient with breast cancer after receiving Tian Xian Liquid
Kamon Chaiyasit, Viroj Wiwanitkit
October-December 2014, 51(4):417-417
DOI
:10.4103/0019-509X.175353
PMID
:26842143
[FULL TEXT]
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2,029
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Isolated central nervous system relapse in a patient with systemic diffuse large B-cell lymphoma: Diagnostic and treatment challenges
P Das, B Dubashi, D Joseph, A Jain
October-December 2014, 51(4):468-469
DOI
:10.4103/0019-509X.175319
PMID
:26842164
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1,915
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Giant ameloblastoma: A rarity
K Choudhary, H Shah, S Panda, S Gandhi
October-December 2014, 51(4):592-593
DOI
:10.4103/0019-509X.175298
PMID
:26842206
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1,926
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SYMPOSIUM - INFECTIONS IN CANCER: REVIEW ARTICLES
H7N9 influenza: The concern in oncology
B Joob, V Wiwanitkit
October-December 2014, 51(4):414-414
DOI
:10.4103/0019-509X.175312
PMID
:26842141
Emerging influenza is at great concern at present. Since early 2013, the new emerging H7N9 influenza has been detected in China. As a new disease, it is lack for knowledge on this emerging disease. Here, the author will discuss on this new emerging influenza and concern in oncology.
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1,765
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LETTERS TO THE EDITOR
Fibromatosis of the ovary
S Asotra, N Gupta
October-December 2014, 51(4):505-505
DOI
:10.4103/0019-509X.175335
PMID
:26842178
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1,818
117
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Nimotuzumab as a palliative treatment for liver metastasis: The first world report
K Chaiyasit, V Wiwanitkit
October-December 2014, 51(4):581-581
DOI
:10.4103/0019-509X.175369
PMID
:26842202
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1,800
123
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Pure micropapillary carcinoma of breast: A quite rare subtype
A Oguz, F Aykas, FC Kaya, D Unal, A Tasdemir
October-December 2014, 51(4):576-576
DOI
:10.4103/0019-509X.175325
PMID
:26842200
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1,795
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Primary ovarian carcinoid tumor simulating virilizing tumor of the ovary: A rare entity
B Gupta, A Suneja, NB Vaid, A Bhatia
October-December 2014, 51(4):529-530
DOI
:10.4103/0019-509X.175302
PMID
:26842185
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1,774
128
2
L-asparaginase induced acute parotitis during intensification therapy of acute lymphoblastic leukemia
J Kathwate, S Mundada, P Patil
October-December 2014, 51(4):537-537
DOI
:10.4103/0019-509X.175358
PMID
:26842187
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1,742
127
3
Ewing's sarcoma of the mandibular condyle
TT Kourosh, KM Hosein, A Neda
October-December 2014, 51(4):564-564
DOI
:10.4103/0019-509X.175326
PMID
:26842196
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1,739
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Liposarcoma of thyroid gland: A review of the gained experience
Virad Kumar, Anoop Raj, Praveen Kumar Rathore
October-December 2014, 51(4):548-549
DOI
:10.4103/0019-509X.175296
PMID
:26842191
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1,743
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Multicentric synchronous ductal and mucinous carcinoma in ipsilateral breast: An unusual presentation
A Riti, C Prem, A Rajeev
October-December 2014, 51(4):424-424
DOI
:10.4103/0019-509X.175339
PMID
:26842146
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1,736
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A case of biphasic pulmonary blastoma showing good response to preoperative chemotherapy
P Muthu, A Unnikrishnan, WM Jose, P Keechilat
October-December 2014, 51(4):510-511
DOI
:10.4103/0019-509X.175297
PMID
:26842180
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1,668
138
2
Clinico-radiological profile with suspicion of lung cancer and its correlation with flexible TBNA (transbronchial needle aspiration) and cytological analysis-initial results from a tertiary rural setup of Ambala District, Haryana
N Tangri, S Singhal, D Mehta, S Bansal, VK Maini, P Misra, S Wadhwa, S Singla
October-December 2014, 51(4):474-475
DOI
:10.4103/0019-509X.175294
PMID
:26842167
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1,646
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Patient with multiple metachronous primary cancers
JR Robbins, X Wang, R Tousignant, I Aref, F Siddiqui
October-December 2014, 51(4):480-480
DOI
:10.4103/0019-509X.175346
PMID
:26842170
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1,595
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The utility of molecular testing in the futility of definite therapy
A Joshi, V Noronha, J Ghosh, K Prabhash
October-December 2014, 51(4):409-409
DOI
:10.4103/0019-509X.175366
PMID
:26842138
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1,562
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Multidisciplinary team meetings for optimal management of cancer patients: A must?
G Aggarwal, MK Roy
October-December 2014, 51(4):495-495
DOI
:10.4103/0019-509X.175337
PMID
:26842175
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1,516
142
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Carcinoembryonic antigen levels in colorectal cancer: Are we too preoccupied?
G Aggarwal, MK Roy, S Banerjee
October-December 2014, 51(4):452-452
DOI
:10.4103/0019-509X.175344
PMID
:26842158
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1,539
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Discordant and aggressive tumor biology of solitary scalp metastasis amidst widespread skeletal metastases in differentiated thyroid carcinoma: Functional radionuclide and MR imaging features and clinical correlates
S Basu, A Mahajan
October-December 2014, 51(4):613-614
DOI
:10.4103/0019-509X.175309
PMID
:26842213
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1,531
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An interesting case of metastatic thyroid nodules
CR Choudhury, S Biswas, D Das, S Mukherjee
October-December 2014, 51(4):620-621
DOI
:10.4103/0019-509X.175382
PMID
:26842215
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1,443
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Giant inflammatory fibroid polyp of the terminal ileum presenting with lower urinary tract symptoms: Case report
RB Nerli, SM Jali, AK Guntaka, PR Malur, B Anita, MB Hiremath
October-December 2014, 51(4):541-542
DOI
:10.4103/0019-509X.175304
PMID
:26842189
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1,434
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Response to article - Mohanty NK, Kumar A, Vasudeva P, Jain M, Prakash S, Arora RP. Analysis of the perioperative and five-year oncological outcome of two hundred cases of open radical cystectomy: A single center experience. Indian J Cancer 2012;49 (1):96-101
M Kumar, S Chakraborty, B Satheeshan
October-December 2014, 51(4):556-556
DOI
:10.4103/0019-509X.175327
PMID
:26842193
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1,387
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Esophageal cancer surgery: Concerns
N Barbetakis, C Asteriou, A Kleontas
October-December 2014, 51(4):458-458
DOI
:10.4103/0019-509X.175299
PMID
:26842161
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1,371
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Concurrent malaria infection on anticancer therapy
E Hai, V Wiwanitkit
October-December 2014, 51(4):413-413
DOI
:10.4103/0019-509X.175354
PMID
:26842140
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1,333
110
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Direct oral microscopy to enhance diagnostic accuracy
A Dave
October-December 2014, 51(4):523-523
DOI
:10.4103/0019-509X.175333
PMID
:26842183
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1,328
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Rule-flouting by the Indian tobacco industry: A definite cause for concern
AG Nayak
October-December 2014, 51(4):427-427
DOI
:10.4103/0019-509X.175347
PMID
:26842148
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1,328
99
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Prevalence of abnormal mammogram among working Thai women
Viroj Wiwanitkit
October-December 2014, 51(4):486-486
DOI
:10.4103/0019-509X.175349
PMID
:26842172
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1,180
95
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Isolated splenic vein thrombosis and splenic infarct due to external compression of enlarged lymph nodes in a patient with lymphoma
AS Köksal, IH Kalkan, S Torun, M Yüksel, RS Ökten, E Kayacetin
October-December 2014, 51(4):586-586
DOI
:10.4103/0019-509X.175293
PMID
:26842204
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508
33
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Reply to: Initial experience with hyperthermic intraperitoneal chemotherapy and cytoreductive surgery
A Macrì, F Fleres, E Cucinotta, E Saladino
October-December 2014, 51(4):437-437
DOI
:10.4103/0019-509X.175348
PMID
:26842151
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392
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