Variation in prognostic factors in hormone receptor-positive breast cancer patients who responded to hormonal therapy and those who did not: A retrospective analysis

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Background: Hormone receptor positive patents historically had a better prognosis than their receptor negative counterparts when other parameters are balanced. However not all the patients expressing Estrogen and progesterone respond well to the hormonal manipulation. Therefore we thought of doing a retrospective analysis of our hospital data to find out the differences in the prognostic factors in therapy responders and non responders. Methods: The study was conducted at tertiary care cancer center from India. Between 2002–2003 a total of 120 breast cancer patients who expressed either Estrogen receptor (ER) or progesterone receptor (PR) were analyzed. Only patients with metastatic breast cancer were analyzed. The patients were treated with our standard institutional protocol at the beginning according to the stage of the disease. The details and baseline characters were shown in table . Results: The responders tend to be post menopausal, having low grade, node negative tumors, expressed both ER and PR, and had long interval from the date of initial diagnosis. However tumor size and the site of metastasis (visceral vs. non visceral) did not alter the outcome to hormone therapy. Conclusion: patients who are having higher age, lower tumor grade, lower number of nodes, longer disease free interval after adjuvant therapy and expressing both receptors tend to respond to hormone therapy better than those who had the opposite characters. However as thought earlier, presence of visceral metastasis or larger tumors at the time of initial diagnosis dose not preclude response to hormonal manipulation.

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No significant financial relationships to disclose.

Chronic myeloid leukemia with variant translocations: A cytogenetic profile

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Background: Chronic Myeloid Leukemia (CML) is characterized by the translocation between chromosomes 9 and 22. The resulting Philadelphia chromosome is the cytogenetic hallmark of this disease. Occasionally, other variant translocations may be present. Methods: We performed a retrospective analysis of case records between 1999 and 2006 of patients diagnosed with CML at the Kidwai Memorial Institute of Oncology, a tertiary care cancer centre in South India. The cytogenetic profile of CML patients was determined. Results: The total number of CML patients (proven by bone marrow aspiration) diagnosed at our centre during the study period was 1268. Of these, 79 cases (48 M, 31 F) had variant translocations ( Table 1 ). The mean age at diagnosis was 35.9 yrs (SD 11.4). The involved chromosomes were 22 (91.1%), 9 (69.9%), 1 (13.9%), 19 (11.4%), 12 (8.8%), 7 (7.6%), and 6 (7.6%). Other involved chromosomes were 11, 2, 3 13, 15, 17, 16, 20, 21, and 8 in decreasing order of frequency. Table 1 : Cytogenetic Profile of CML Conclusions: Other than chromosomes 22 and 9, the variant translocations commonly involved chromosomes no 1, 19, 12, 7, and 6. The identification of these variant translocations and their co-relation with the clinical behavior may identify new prognostic markers.

[Table: see text]

No significant financial relationships to disclose.

A case of successful management of recurrent bacterial vaginosis of neovagina after male to female gender reassignment surgery

As sex reassignment surgeries become common and advanced, doctors are more likely to encounter cases with 'different' anatomy. Due to variations in examination and management as compared with non-transsexual patients, these cases generally prove challenging to the physicians. We present a case of recurrent bacterial vaginosis (BV) of neovagina in a transsexual patient successfully managed by using metronidazole gel and occasional douching. This case illustrates the difference in the microscopy of vaginal flora and management of BV in transsexual as compared with non-transsexual women.

Outcome of alveolar hemorrhage in hematopoietic stem cell transplant recipients

Alveolar hemorrhage (AH) is a frequent, serious complication of hematopoietic stem cell transplantation (HSCT). To study the incidence of AH, its clinical course and outcomes in HSCT patients, a retrospective review of the records of all adult patients who underwent bronchoscopy between January 1, 2002 and December 31, 2004 was carried out and those who underwent bronchoscopy after HSCT identified. A total of 223 patients underwent bronchoscopy after HSCT for diffuse pulmonary infiltrates with respiratory compromise. Eighty-seven (39%) patients had AH. Of these, 53 had AH without any identified organism while 34 had an organism along with hemorrhage on bronchoalveolar lavage (BAL). Six-month survival rate of patients with AH was 38% (95% confidence interval: 27-48%). In 95 of the 223 patients, an organism was isolated from BAL. These patients had poor outcomes compared to patients in whom no organism was identified. Patients with both AH and an organism had the worst prognosis. Mortality of patients with AH is improving and long-term survival of patients with AH is feasible. Isolation of a microbial organism in BAL is a strong predictor of poor outcome.

Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district

High prevalence of dental diseases has been recorded in Rajasthan, however, not much work has been done to ascertain the prevalence of dental diseases in Udaipur district. This study was conducted among 1,587 government school children of Udaipur district in the age group of 5-14 years for recording the prevalence of gingival diseases, fluorosis and malocclusion. Gingivitis was found in 84.37% of children, malocclusion in 36.42% and fluorosis in 36.36%.

Chlamydia sp. in hospitalised children with community acquired pneumonia

Our aim was to document the prevalence of chlamydial infection in children less than five years of age with Community Acquired Pneumonia (CAP). Seventy three children, 1 month to 5 years of age, hospitalized with CAP were enrolled over a period of one year. Microimmunofluorescence (MIF) was done to detect IgM antibodies against Chlamydia sp. in sera of all patients; PCR was performed to detect C. pneumoniae DNA in nasopharyngeal aspirates. The prevalence of Chlamydia species infection in CAP in children < 5 years of age was 5.5% (4/73). Two cases were positive for C. trachomatis antibodies; one case was positive for C. pneumoniae antibodies and one case was positive for C. pneumoniae DNA. Chlamydia sp. have an important role in CAP in children < 5 years and for early diagnosis of infection, use of more than one method i.e. PCR and serology both is advisable.

Active stabilization of a rapidly chirped laser by an optoelectronic digital servo-loop control

We propose and demonstrate a novel active stabilization scheme for wide and fast frequency chirps. The system measures the laser instantaneous frequency deviation from a perfectly linear chirp, thanks to a digital phase detection process, and provides an error signal that is used to servo-loop control the chirped laser. This way, the frequency errors affecting a laser scan over 10 GHz on the millisecond timescale are drastically reduced below 100 kHz. This active optoelectronic digital servo-loop control opens new and interesting perspectives in fields where rapidly chirped lasers are crucial.

Diagnosis of biological tissue morphology and function with endoscopic optical coherence tomography

We present some of the recent technological advances in our MEMS-based endoscopic optical coherence tomography (OCT) system for the enhancement of image fidelity and diagnosis. The endoscopic OCT system permits simultaneous cross-sectional OCT imaging and en face white-light visual guidance as well as fluorescence imaging guidance. The transverse and axial resolutions of the OCT scope are roughly 12&#956;m and 10&#956;m, respectively, and the axial resolution can be enhanced to 3um if connecting it to our recent custom sub-8fs Ti:Al²O³laser. To test the endoscopic OCT system for imaging diagnosis of early epithelial cancers, rat bladder cancer models were used and the results show over 90% sensitivity and specificity. Applications in imaging of bladder functions and engineering tissue growth are demonstrated.

Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C

Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled post-transplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95% CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score > 20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA > 30000000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-alpha/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.

Occurrence of overlooked zoonotic tuberculosis: detection of Mycobacterium bovis in human cerebrospinal fluid

The paucibacillary nature of the cerebrospinal fluid (CSF) has been a major obstacle in the diagnosis of human tuberculous meningitis (TBM). This study shows that with molecular techniques direct precise determination to the species level of mycobacterial pathogens can be made. The present report describes the utility of a nested PCR (N-PCR) assay (A. Mishra, A. Singhal, D. S. Chauhan, V. M. Katoch, K. Srivastava, S. S. Thakral, S. S. Bharadwaj, V. Sreenivas, and H. K. Prasad, J. Clin. Microbiol. 43:5670-5678, 2005) in detecting M. tuberculosis and M. bovis in human CSF. In 2.8% (6/212) of the samples, M. tuberculosis was detected, and in 17% (36/212), M. bovis was detected. Mixed infection was observed in 22 samples. Comparative analysis of clinical diagnosis, smear microscopy, and N-PCR in 69 patients (TBM, 25; non-TBM, 44) showed that the sensitivity of N-PCR (61.5%) was greater than that of smear microscopy (38.4%). Determination to the species level is important from the viewpoint of determining the prevalence of these mycobacteria in a community and would influence strategies currently adopted for the prevention of tuberculosis.

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal delivery

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice.

Levels of lipid peroxides and antioxidants in smokers and nonsmokers

BACKGROUND AND OBJECTIVE

The aim of the study was to evaluate the relationship between cigarette smoking and periodontal damage in terms of the levels of free radicals and antioxidants.

MATERIAL AND METHODS

Thirty-five healthy subjects in the age group 25-56 yr and with chronic moderate inflammatory periodontal disease (attachment loss of 3-4 mm) were selected. All subjects were matched with respect to the clinical parameters plaque index, gingival index and attachment loss. Of the 35 subjects, 25 were smokers (smoking a minimum of 15 cigarettes/day) and 10 were nonsmokers. Smokers were subdivided into three subgroups: group I (10 subjects smoking 15-20 cigarettes/day); group II (10 subjects smoking 21-30 cigarettes/day) and group III (five subjects smoking > 50 cigarettes/day). Gingival tissue (obtained during Modified Widman surgery) and blood samples were collected from each of the subjects and analyzed for the following parameters: lipid peroxide, superoxide dismutase, catalase, glutathione and total thiol.

RESULTS

The level of lipid peroxide was lowest in nonsmokers (2.242 +/- 0.775 in tissue and 1.352 +/- 0.414 in blood) and highest in smokers smoking > 50 cigarettes/day (6.81 +/- 1.971 in tissue and 4.96 +/- 0.890 in blood), both in tissue and in blood. The increase was statistically significant in all groups, except in tissue of group I smokers. Catalase showed a similar trend, where the levels increased from 0.245 +/- 0.043 in controls to 0.610 +/- 0.076 in group III smokers for tissue, and from 0.231 +/- 0.040 in controls to 0.568 +/- 0.104 in group III smokers for blood. The increase was statistically significant for all groups. Total thiol levels were also higher in smokers than in controls (0.222 +/- 0.050 in controls vs. 0.480 +/- 0.072 in group III smokers in tissue; 0.297 +/- 0.078 in controls vs. 0.617 +/- 0.042 in group III smokers in blood). Except for group I in both tissue and blood, the increase was statistically significant. The superoxide dismutase (SOD) level was higher in nonsmokers (2.406 +/- 0.477 in tissue and 2.611 +/- 0.508 in blood) than in group III smokers (1.072 +/- 0.367 in tissue and 0.938 +/- 0.367 in blood), both in tissue and in blood, but this was significant only in the case of blood and for group III smokers in tissue. The glutathione level in tissue was consistently lower in smokers than in controls, showing a decrease from 121.208 +/- 37.367 in controls to 46.426 +/- 14.750 in group III smokers, but the decrease was not significant in group I smokers. In the case of blood, the glutathione level dropped from 262.074 +/- 68.751 in controls to 154.242 +/- 51.721 in group III smokers, but was statistically significant only for group III smokers.

CONCLUSION

The study results show that smoking increases the level of free radicals in periodontal tissues, which in turn may be responsible for the destruction seen in periodontal diseases.