bluuebunny/crossref_metadata_2025 huggingface dataset:
An Autopsy Study of Cerebrovascular Atherosclerosis in the Elderly
Authors: Shenoy Asha S. , Bhosale Mayur N. , Amonkar Gayathri P.
Published: December 2022

Background:

Stroke is an important cause of mortality with intracranial atherosclerosis as an important risk factor. Geographical variation in the pattern of atherosclerosis is well documented with various studies in stroke patients showing that African Americans and Japanese people tend to have intracranial vascular occlusion, whereas Caucasians more often have extracranial atherosclerotic lesions.

Methods:

This is a prospective study of 50 cases of Indian elderly patients over 60 years of age where we have studied the CNS vasculature in detail including intracranial atherosclerosis with regards to its incidence, severity, distribution, plaque composition and associated risk factors. We compared the atherosclerotic pathology in the intracranial vessels and the extracranial vessels including the carotids.

Results:

Out of 50 cases 31 showed intracranial atherosclerosis. Anterior circulation was more commonly affected. A total of 87 of the intracranial arteries showed atherosclerotic plaques, most common nature of the plaques being fibrofatty. Majority of the intracranial vessels showed mild stenosis and multiple vessels were involved in 15 cases while single vessel involvement was seen in 16 cases with the middle cerebral artery being the most common single vessel involvement. Infarcts were seen in 7 cases and all these cases had history of hypertension. Cerebral atrophy was seen in 28 cases. All cases showing frontoparietal and generalized atrophy had carotid artery stenosis. Of the 100 carotid arteries studied (2 per case) 59 showed atherosclerosis. Majority of the carotid arteries showed mild degree of atherosclerosis and the content was predominantly fatty.

Conclusion:

This study concludes that the pattern of atherosclerosis is different in the Indian population as compared to the western literature. Intracranial atherosclerosis is more common in Indian population with the anterior portion of circle of Willis being more commonly affected.
Analysis of Neuromyelitis Optica Spectrum Disorder in an Indian Cohort using International Consensus Diagnostic Criteria
Authors: Gnanashanmugam G , Somasundaram S P , Parimalam N , Rajmohan V , Pranesh M B
Published: December 2022

Context:

Updates on clinical, investigatory, and therapeutic aspects of neuromyelitis optica (NMO) spectrum disorders are rapidly evolving. Recently published international consensus diagnostic criteria (ICDC) allowed clinicians to rapidly diagnose the expanding spectrum of NMO spectrum disorders more accurately.

Aims:

The aim of the study was to retrospectively analyze 36 consecutive cases of comprehensively evaluated NMO spectrum disorders using the ICDC.

Patients and Methods:

We retrospectively collected 36 cases of NMO spectrum disorders who attended our unit between August 2012 andOctober 2016 and fulfilled the ICDC. All patients underwent magnetic resonance imaging (MRI) of the brain and whole spine with contrast, anti-aquaporin 4 antibody, and detailed blood investigations to rule out systemic vasculitis and other alternate diagnoses.

Results:

Female-to-male ratio was 6.2:1; 50% of the cases were in the 20–40-year age group. Six patients (16.67%) had combined optic neuritis and myelitis. Nine patients (25%) had pure longitudinally extending transverse myelitis LETM with positive anti aquaporin 4 antibody AQ4Ab. Fourteen patients (38.9%) had myelitis and optic neuritis separately. Nine patients (25%) had area postrema syndrome. Two patients (5.6%) had acute brainstem syndrome and one (2.8%) had hypothalamic syndrome. LETM was commonly found in the cervical level (69.4%). Four patients (11.1%) had no spinal cord involvement. Anti-aquaporin 4 antibody was positive only in 23 cases (63.9%).

Conclusions:

Initial presentation of NMO spectrum disorder is often due to brain lesions. The ICDC criteria have enhanced clinician's ability to diagnose NMO spectrum disorder in the early stages. In our study, ICDC criteria helped us to diagnose 33% additional cases that would have been missed if the old 2006 revised criteria was applied.
Van Der Knaap Disease
Authors: Kaushal H , Khutan H , Sood H , Shourya K , Mahendru Z
Published: December 2022

Van der Knaap leukoencephalopathy (Megalencephalic leukoencephalopathy with subcortical cysts) is an autosomal recessive disorder of macrocephaly and neurological deficit. Magnetic resonance imaging (MRI) and clinical features are certainly helpful for determining the characteristic findings and distinguishing it from other diseases of similar presentation.
Fluoxetine or Venlafaxine for Early Post Stroke Depression
Authors: Nambiar Vivek K. , Parvathy J , Philip Tania M. , Abhijith K , Sreeni S , Panicker Naveen K. , Ajai Amrutha V. , Dhanya T. S.
Published: December 2022

Context:

Post stroke depression (PSD) is an under diagnosed morbidity of stroke and can negatively affect the prognosis of the patient.

Aims:

We intended to study the prevalence of PSD and the commonly used anti-depressants and their outcome in patients with PSD.

Settings and Design:

A prospective observational study was conducted in the patients admitted to the stroke unit of a tertiary care centre.

Methods and Materials:

Diagnosis of post stroke depression was made by the Hamilton Depression Rating Scale (HDRS) during the two-week period after stroke or in the clinic follow up. A comparison of clinical outcome and adverse events of the two anti-depressants used, i.e. venlafaxine and fluoxetine were done by a follow up of up to 6 months.

Statistical Analysis Used:

Independent sample test was used for statistical purposes in the study

Results:

Out of the 326 stroke patients admitted in the department, 73 had PSD and 60 patients out of this were assigned into the study. Forty patients were males, and the mean age of the sample population was found to be 62.13 ± 11.14. Major risk factors identified were hypertension, diabetes mellitus, and dyslipidemia. Venlafaxine showed better outcome and less adverse events compared to fluoxetine. Major adverse events observed were hyponatremia, headache, insomnia, and anxiety.

Conclusions:

PSD in the early phase affects a substantial number of the stroke patients. Venlafaxine has got a better outcome and adverse event profile compared to fluoxetine in this group of patients. However, larger multicenter studies will provide more helpful data in this area.
Cerebral Venous Sinus Thrombosis with Bilateral Inverse Duane's Retraction Syndrome—A Case Report
Authors: Nene Devavrat H , Yadav Ravi
Published: December 2022

Background:

Cerebral venous sinus thrombosis (CVST) is a life-threatening condition with a predilection for a younger age group. Patients with CVST can have features of raised intracranial pressure that can be suspected clinically based on ophthalmological findings such as bilateral abduction restriction, papilledema.

Case Description:

A 27-year-old gentleman presented with 15 days history of headache and seizures with complete abduction restriction of both eyes along with retraction of globe and narrowing of palpebral fissure on abduction. His MRI brain showed superior sagittal sinus thrombosis without any parenchymal lesion.

Conclusion:

The final diagnosis in our case was bilateral inverse Duane's retraction syndrome with CVST, a co-occurrence that has not been reported in the past and can be missed if the eye movements are attributed to raised intracranial pressure alone.
Role of Multivoxel MR Spectroscopy Progressive Supranuclear Palsy – A Preliminary Study
Authors: Mangalore Sandhya , Kumar Manoj , Pal Pramod , Saini Jitender , Pasha Shaik , Yadav Ravi
Published: December 2022

Background:

Progressive supranuclear palsy [PSP] is a neurodegenerative condition with characteristic clinical and imaging features.

Aim:

This is an exploratory MRS study to look at metabolic changes that occur due to the disease by using MR spectroscopic methods in subtypes of the PSP, that is, classic [PSP-c] and Parkinsonian [PSP-p].

Materials and Methods:

A total of 12 PSPs subjects were included in this study, of which 8 subjects were clinically diagnosed as PSP-C and 4 subjects with PSP-P. We also included 6 healthy controls to compare metabolites between PSP groups. A multi-voxel MRS was performed using the Philips 3T MRI system, and postprocessing and metabolic peak fitting and quantification were performed using the Tarquin spectroscopic data-processing software. Individual patient MRS ratios of various metabolites were tabulated and analyzed to look for metabolic differences between these groups.

Results:

Significant differences were noted in various neurometabolites including GABA, Glutamate, Glutamine, Tau and NAA / creatinine ratio.

Conclusion:

Our preliminary findings indicate that MRS may act as an in vivo metabolic biomarker in various pathological conditions. Alteration and distribution of these metabolites may act as a marker for symptomatology and clinical presentation. MRS also has the potential for use in prognostic or in assessing the treatment response.
Exposure to Toxocara Canis is not Associated with New-Onset Epilepsy
Authors: Rishi Vivek , Singh Rajveer , Goyal Manoj Kumar , Modi Manish , Garg Vivek , Thakur J. S. , Sehgal R. K. , Khandelwal N. , Jain Gourav , Kumar Amith S. , Choudhary Aditya , Prabhakar Sudesh , Lal Vivek
Published: December 2022

Purpose:

The association between exposure to Toxocara canis and epilepsy is at the best contentious. Most of previous studies were retrospective, community-based, and contradictory to one another. As the impact of a positive association on the magnitude of epilepsy will be huge especially in developing countries where toxocariasis is common owing to poor hygienic practices, this study was carried out to determine whether exposure to T. canis predisposes to development of epilepsy.

Patients and Methods:

This case-controlled observational study was carried out a tertiary healthcare center in North India on 120 patients with newly diagnosed epilepsy who presented within 3 months of diagnosis. A total of 120 age- and sex-matched individuals from the same community were chosen as controls. Epilepsy was defined according to ILAE 1993 definition. Serological testing for T. canis was carried out using commercially available ELISA kits. All the positive samples were subjected to Western blot testing for confirmation.

Results:

The prevalence of antibodies to T. canis was similar in cases (16/120; 13.3%) and controls (16/120; 13.3%). Among the various risk factors, history of pica was significantly associated with T. canis seropositivity, while lack of hand washing was significantly associated with higher risk of epilepsy.

Conclusion:

Our study could not find any association between exposure to T. canis and epilepsy.
Insights and future directions on the combined effects of mind-body therapies with transcranial direct current stimulation: An evidence-based review
Authors: Rebello-Sanchez Ingrid , Vasquez-Avila Karen , Parente Joao , Pacheco-Barrios Kevin , De Melo Paulo S. , Teixeira Paulo E.P. , Jong Kian , Caumo Wolnei , Fregni Felipe
Published: December 2022

Mind-body therapies (MBTs) use mental abilities to modify electrical neural activity across brain networks. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that modulates neuronal membrane potentials to enhance neuroplasticity. A combination of these treatment strategies may generate synergistic or additive effects and thus has been more commonly tested in clinical trials, fostering a novel yet promising field of research. We conducted a literature search in four different databases including only randomized clinical trials (RCTs) that tested the combination of MBTs with tDCS. Ten studies (n = 461) were included. Combined protocols included meditation/mindfulness (8/10), biofeedback (1/10), and hypnosis (1/10). The RCTs were heterogeneous with regard to population, design, and types of outcomes. Based on the findings of this search, we provide here a content description, methodological and practical insights, and future directions for the field. We hope this review will provide future authors with information to facilitate the development of trials with improved protocols.
Amputate or not Amputate? A Fibular Hemimelia Case Report
Authors: Raposo Ana Rita , Lobarinhas Armanda
Published: December 2022

Fibular hemimelia is the most frequent congenital defect of the long bones. It has a wide spectrum of clinical and radiological presentations ranging from minor hypoplasia to complete absence of the fibula. Treatment options range between orthotic support, limb reconstruction, and amputation. In the current article, we present a complex clinical case of a young patient with fibular hemimelia. The patient presented a dysmetria of the lower limbs of 21 cm, also an equinovalgus foot position, and several malformations of the foot and toes. She walked with adapted orthosis and crutches, which was proved difficult for her, and esthetically undesirable. Due to the impairment on her quality of life, she was referred initially to bone-lengthening surgery. However, this surgery did not obtain satisfactory results, in both esthetic and functional levels. Hence, the patient was referred to amputation, with a better outcome after. In this clinical case, and reviewing the current literature, we aim to reflect on the implications of the different surgical options in the treatment of fibular hemimelia, and the role of physical medicine and rehabilitation in the functional recovery of these patients. We invite readers to reflect on some questions: Is amputation the best treatment in cases of serious fibular hemimelia? Should a bone-lengthening procedure be attempted before amputation? Should the amputation be delayed? To amputate or not to amputate?
Predictors of pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer
Authors: Mehraj Asif , Baba Arshad A , Khan Bushra , Khan Mudassir Ahmad , Wani Rauf A , Parray Fazl Q , Chowdri Nisar A
Published: December 2022

Background:

Neoadjuvant chemoradiotherapy (NACRT) is an established treatment option for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following NACRT have better oncological outcomes and may be subjected to wait and watch policy as well. The aim of this study was to identify predictors of pCR in LARC following NACRT.

Materials and Methods:

A retrospective analysis of a prospectively maintained colorectal cancer database from January 2018 to December 2019 was undertaken. A total of 129 patients of LARC who were subjected to conventional long course NACRT, followed by surgery were included in the study. Pathological response to NACRT was assessed using Mandard grading system and response was categorized as pCR or not-pCR. Correlation between various clinico pathological parameters and pCR was determined using univariate and multivariate logistic regression analysis.

Results:

Mean age of patients was 53.79 ± 1.303 years. Complete pathological response (Mandard Gr 1) was achieved in 24/129 (18.6%) patients. Age of patients more than 60 years (P = 0.011; odds ratio [OR] 3.194, 95% confidence interval [CI] 1.274-8.011), interval between last dose of NACRT and surgery >8 weeks (P = 0.004; OR 4.833, 95% CI 1.874-12.467), well-differentiated tumors (P < 0.0001; OR 32.00, 95% CI 10.14–100.97) and node-negative disease (P = 0.003; OR 111.0, 95% CI 2.51–48.03) proved to be strong predictors of pCR.

Conclusion:

Older age, longer interval between NACRT and surgery, node-negative disease and favorable tumor grade help in achieving better pCR rates. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.
Ki-67, CD105, and α-smooth muscle actin expression in oral squamous cell carcinoma corresponds with different forms of tobacco consumption habits
Authors: Gadbail Amol Ramchandra , Sarode Sachin C. , Chaudhary Minal S. , Gondivkar Shailesh M. , Tekade Satyajit Ashok , Yuwanati Monal , Sarode Gargi S. , Hande Alka , Patil Shankargouda
Published: December 2022

Background:

Association with variety of etiological agents is one of the characteristic features of oral squamous cell carcinoma (OSCC). We hypothesized the existence of tobacco consumption habit-based heterogeneity in the immunohistochemical expression of carcinogenesis relevant molecular markers in OSCC. Hence, the present study was conducted to investigate the carcinogenesis relevant three commonly expressed markers (Ki-67, CD105, and α-smooth muscle acting [SMA]) in various forms of tobacco consumption habits in OSCC patients.

Materials and Methods:

A total of 217 patients of OSCC were included in the study, and based on the habit, they were broadly categorized into tobacco lime (TL), TL and areca nut (TLAN), and areca nut (AN). Further, categorization was done on the basis of absence or presence of additional habit of smoking. Immunohistochemistry (IHC) was performed using Ki-67, CD105, and α-SMA markers on formalin-fixed paraffin-embedded tissues.

Results:

TLAN (62.21%) was the most common habit noted in OSCC patient followed by TL (20.73%) and AN (15.20%). The additional habit of smoking was observed in 31.11% and 25.92% of TL and TLAN habits of OSCC patients, respectively. All the three markers (Ki-67, CD105, and α-SMA) showed statistically significant differences in the habit group such as TL, TLAN, and AN (P < 0.001). Although the expression of all the three markers was increased in TL as compared with TLAN, differences were not statistically significant. When these markers were compared in with and without smoking category, only TLAN with smoking and TLAN without smoking showed statistically significant differences in the expression of all three markers.

Conclusions:

Ki-67 CD105 and α-SMA immunohistochemical expression in OSCC corresponds with different forms of tobacco consumption habits. Habit-related unique carcinogenesis events are reflected at IHC level thus providing proof of concept for future studies.
Regorafenib and trifluridine/tipiracil in real clinical practice
Authors: García-Beloso Nerea , Romero-Ventosa Elena Yaiza , Gayoso-Rey Mónica , López-López Aida , Robles-Torres David , de Castro Noemí Martínez-López , Piñeiro-Corrales Guadalupe
Published: December 2022

Background:

Colorectal cancer is the ninth leading cause of death in Spain. The latest therapeutic developments in the advanced stages of this disease are the oral drugs trifluridine/tipiracil and regorafenib.

Objective:

Results of clinical trials (CTs) are not in real conditions and therefore, we want to study the effectiveness and the safety profile in the usual clinical practice and compare it with the bibliography.

Materials and Methods:

A retrospective and unicentric study was carried out in a health area of 500,000 inhabitants. Patients who started treatment with regorafenib and/or trifluridine/tipiracil were included from the date of marketing until June 2019. Patient-related variables, pathology, effectiveness, and treatment toxicity were collected. The statistical analysis was carried out with the PSPP program.

Results:

Fifty-four patients were analyzed. Men accounted for 59.3% of patients. Regorafenib was the treatment for 22.2% of patients and 77.8% received trifluridine/tipiracil. The reason for the drug's suspension was the disease progression in 85.2% of patients. No patient had a full response and 3.2% achieved partial response. The median progression-free survival time in treatments with regorafenib was 2.5 months (95% confidence interval [CI]: 0.0–5.4) and the overall survival time was 3.1 months (95% CI: 0.0–6.7), while in treatments with trifluridine/tipiracil, these data were, respectively, 2.8 (95% CI: 2.5–3.2) and 5.7 months (95% CI: 3.8–7.6). Side effects occurred in 91.7% of patients treated with regorafenib and in 100% of treated with trifluridine/tipiracil. Hematological adverse reactions were, on average, 0.4 ± 0.5/patient with regorafenib and 1.5 ± 0.9 with trifluridine/tipiracil. General (77.8%) and gastrointestinal disorders (50%) were common with both drugs.

Conclusions:

The effectiveness results of standard clinical practice are lower than those described in CTs and in the literature. The toxicity profile does reproduce what is described in the bibliography.
A prospective randomized comparison of simultaneous integrated boost with sequential boost intensity-modulated radiotherapy in locally advanced head and neck cancer
Authors: Mani Nilesh , Aggarwal Sushil K. , Kumar Ishan , Mandal Abhijit , Jaiswal Garima , Ranjan Rakesh , Jaiswal Anil K. , Gupta Neha , Singh Ankita , Mourya Ankur , Aggarwal Lalit M. , Choudhary Sunil
Published: December 2022

Purpose:

A comparison of simultaneous integrated boost (SIB) with sequential boost (SEQ) using intensity-modulated radiotherapy along with concurrent cisplatin in locally advanced head and neck cancer (HNC) was made with regard to their survival outcomes and toxicity profile.

Materials and Methods:

A total of 34 patients were enrolled between October 2016 and March 2019. They were randomized into two arms, SIB and SEQB. All patients were treated with 6 MV photon beam on Linear Accelerator with weekly concurrent cisplatin at 35 mg/m2. Overall survival (OS) and disease-free survival (DFS) were the primary end points and acute and late toxicities were the secondary end points.

Results:

The median follow-up period was 40.6 and 37.3 months for SIB and SEQB, respectively. At the end of 5 years, the median OS was 40.6 and 37.3 months (P = 0.947) and the median DFS was 35.1 and 37.3 months in the SIB and SEQB arms, respectively (P = 0.991). Complete response at 3 months was 64.7% and 76.5% and partial response was 23.5% and 17.6%, whereas progressive disease was 11.8% and 5.9% in SIB and SEQB arms, respectively. Acute dermatitis, mucositis, dysphagia, and salivary gland toxicities were higher in the SIB arm compared to the SEQB arm.

Conclusion:

SIB and SEQ arms were comparable in terms of OS and DFS. However, the acute toxicities were higher in the SIB arm, although the difference was not significant, compared to the SEQB arm.
Comparison of normal tissue doses in deep inspiration breath-hold and free breathing methods for radiotherapy of left-sided breast cancer using 4D-XCAT digital phantom
Authors: Shahzadeh Sara , Barough Mehdi Salehi , Ganjoorian Hamed , Gholami Somayeh
Published: December 2022

Purpose:

To evaluate normal lung and heart tissue doses for treatment of left-sided breast cancer in deep inspiration breath-hold (DIBH) and free breathing (FB) as a function of breast size and diaphragm displacement using 4D-XCAT digital phantom in a simulation study.

Materials and Methods:

4D-XCAT digital phantom was used to create 36 left-sided breast cancer digital phantom datasets with different breast height (BH) of 40, 50, and 60 mm, breast length (BL) of 16, 17, and 18 mm, and diaphragm excursion of 20, 25, 30, and 35 mm. For each dataset, DIBH and FB treatment plans were prepared using planning computerized radiotherapy-three dimensional (PCRT-3D) treatment planning system (TPS) with superposition computational algorithm. Dose differences in DIBH and FB plans were assessed in terms of mean lung dose (MLD), the lung volume receiving ≤20 Gy (V20), normal tissue complication probability (NTCP) of the lung, mean heart dose (MHD), and the heart volume receiving ≤30 (V30).

Results:

DIBH reduced mean dose and V20 and NTCP of the lung in all cases, by up to 4.37 Gy, 7.62%, and 18.95%. Mean dose and V30 of the heart were also significantly reduced by 5.02 Gy and 8.23%.

Conclusions:

The use of DIBH for left-sided breast cancer radiotherapy offers excellent possibilities for sparing critical normal tissue without compromising radiation dose to the target.
Promoter methylation status of key genes and its implications in the pathogenesis of endometriosis, endometrioid carcinoma of ovary and endometrioid endometrial cancer
Authors: Kumari Priti , Sharma Indu , Saha Subhas Chandra , Srinivasan Radhika , Sharma Anuradha
Published: December 2022

Background:

Epigenetic processes play an important role in various physiological processes as well as in the pathogenesis of many diseases. The role of altered DNA methylation in the pathogenesis of endometriosis and associated ovarian and endometrial cancers has not been explored in detail. Therefore, this study aimed to determine the promoter methylation status of genes involved in key biological processes in the pathogenesis of these three gynecological diseases.

Methods:

Tissue samples of endometriosis, endometrioid carcinoma of the ovary, endometrioid endometrial cancer, and control endometrium (n = 10 each) were obtained. DNA was extracted and subjected to bisulfite conversion using commercially available kits. The methylation status of COX2, VEGF, HIF1A, TNF, MYC, and TP53 genes was checked by methylation-specific PCR. The mRNA levels of MYC and TP53 were determined using qRT-PCR in all tissue samples.

Results:

The promoter methylation status of COX2, VEGF, HIF1A, and TNF genes was significantly reduced in all three diseased study subjects (P < 0.05), whereas no significant difference was observed in the promoter methylation frequency of MYC and TP53 genes. Transcriptional expression of the MYC gene was significantly increased in all diseased groups (P < 0.001) whereas, transcriptional expression of the TP53 gene was significantly reduced in endometriosis and endometrioid carcinoma of the ovary and significantly increased in endometrioid endometrial cancer subjects compared to control subjects (P < 0.001).

Conclusion:

The findings suggest that the promoter regions of pro-inflammatory and pro-angiogenic genes involved in the common molecular pathophysiology of these three disorders were significantly hypomethylated and could be the reason for their over-expression associated with them. This indicates the role of epigenetics in the pathogenesis of these three diseases.
Pattern of expression of CDX2 in colorectal cancer and its role in prognosis
Authors: Singh Jagdeep , Rajesh NG , Dubashi Biswajit , Maroju Nanda Kishore , Ganesan Prasanth , Matta Kiran Kumar , Charles I , Kayal Smita
Published: December 2022

Background:

CDX2, a nuclear protein, is essential for the proliferation and development of intestinal epithelial cells and is frequently down-regulated during tumorigenesis. We have evaluated the pattern of CDX2 expression in all stages of colorectal cancer (CRC) and its association with prognosis.

Methods:

We performed CDX2 staining by immunohistochemistry (IHC) on the available biopsy blocks of patients of CRC registered in our institute from January 2014 to January 2018. CDX2 scoring was done using the semi-quantitative method.

Results:

A total of 286 patients were registered during the study period, of which only 110 biopsy blocks were available for staining. Of 110 patients, 77 (70%) had colon cancer and 33 (30%) had rectal cancer. The median age was 54.2 years, with 62 (56.4%) being male and 48 (43.6%) female with a male to female ratio of 1.3:1. In the study cohort, 33 (30%) patients had stage II disease, 30 (27.3%) had stage III, and 47 (42.7%) had stage IV. Seventy-three (66.4%) were positive for CDX2 and 37 (33.4%) were negative. Loss of CDX2 expression was significantly associated with advanced stage, rectal site, poor grade of differentiation, and presence of lymphovascular invasion. With a median follow-up of 16 months, progression-free survival (PFS) at 2 years was 30% for CDX2-negative patients compared to 67% for CDX2-positive patients (P = 0.009), whereas the overall survival (OS) at 2 years was 46% for CDX2-negative versus 77% for CDX2-positive patients (P = 0.01).

Conclusion:

Loss of CDX2 expression is associated with advanced stage, higher tumor grade, presence of LVSI, worse PFS, and OS and thereby functions as a poor prognostic factor in CRC.
Spermatocytic tumor of testis
Authors: Rabade Katha , Panjwani Poonam K. , Menon Santosh , Prakash Gagan , Pal Mahendra , Bakshi Ganesh , Desai Sangeeta
Published: December 2022

Background:

Spermatocytic tumours are a rare subset of testicular tumours seen in elderly patients with distinct clinicopathological features and a favourable outcome. The typical presentation and characteristic histological features usually suffice for the diagnosis. Most of the cases are amenable to surgical excision. However, occasional cases which have a sarcomatous transformation may behave more aggressively and warrant adjuvant therapy.

Methods:

We present the clinicopathological features of a series of 26 cases diagnosed as Spermatocytic tumour at our tertiary cancer institute from 2002-2019.

Results:

Twenty-four of these cases had the typical cytological features of a spermatocytic tumour while two cases showed sarcomatous change, one with rhabdomyosarcomatous differentiation and the other being an undifferentiated spindle cell sarcoma. Although the tumor can show varied patterns, the tripartite cytomorphology is typical in all cases.

Conclusions:

Careful note of these patterns and variations in histology is essential to prevent an erroneous diagnosis of other testicular neoplasms and guide the therapy.
Validity and reliability of the Hindi version of the Summated Xerostomia Inventory-5 among head and neck cancer irradiated patients in Delhi, India
Authors: Gupta Sakshi , Dhawan Pankaj , Tandan Piyush , Jain Meena
Published: December 2022

Objectives:

To cross-culturally adapt and determine reliability and validity of the Hindi version of the Summated Xerostomia Inventory (SXI-H).

Background:

Xerostomia is common among older individuals and patients with head and neck radiation or autoimmune diseases, and it can affect their oral as well as systemic quality of life. To assess the perception of this condition, SXI-H can be used.

Materials and Methods:

This was a multi-centric cross-sectional observational study of volunteers suffering from hypo-salivation in three tertiary care cancer hospitals in Delhi, India. The English version of Summated Xerostomia Inventory (SXI-5) was translated into Hindi according to standard guidelines and field tested. The Hindi version of SXI-5 (SXI-H) was tested on 120 patients with xerostomia. All the participants signed the informed consent form before being interviewed with SXI-H. Thirty participants were interviewed again after 15 days. A global question was asked for criteria validity. Data were analyzed through IBM SPSSTM Statistics for windows version 24. Significance was set at P ≤ 0.05.

Results:

Overall SXI-H score of sample was 11.48 ± 2.29. Cronbach's α value was 0.81. The correlation between the SXI-H summary score and the standard question was 0.79 (95% CI 0.65–0.74). It was found that the intra-class correlation coefficient value for the test–retest reliability was 0.90 and scores for individual question ranged from 0.41 to 0.76.

Conclusion:

The SXI-H demonstrated excellent psychometric properties and can be considered a valid tool for assessing xerostomia in a dry mouth patient.
Oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia
Authors: Yadiki Josna Vinutha , Alruwaili Faris Alturqi K.
Published: December 2022

Aim of the Study:

Oral disease has an inverse relationship with good oral health practices. The present study was aimed at assessing the level of oral health knowledge and practices among healthcare students of Al-Jouf province, Saudi Arabia.

Methodology:

All male and female students from the first to the fifth year of studying in different colleges (medical, dental, and college of allied health sciences) in Jouf University were included as the study sample. The study included 20 structured questions. Among the 20 questions, 12 related to oral health practices and 8 related to oral health knowledge.

Results:

Chi-squared test was used to determine the association among variables, and Pearson correlation analysis was used to determine the correlation between the scores of oral health knowledge and oral health practices. One-way analysis of variance (ANOVA) was done to see if there was any statistically significant association (P > 0.05) of knowledge and practice scores with level, gender, and college of study. The overall mean oral health knowledge score was 4.9 ± 2.3. The range for oral health practice score was from 0 to 12, and the overall mean score was 6.8 ± 2.9.

Conclusion:

Our observations concluded that the overall knowledge level of the students toward oral health was low, and visiting a dentist for regular dental checkup were not given importance by the students. Health practices of students and their knowledge towards oral health determines what and how they educate their patients in the future to create better oral health in society.
Impact of radical dose escalation by endoluminal brachytherapy and induction chemotherapy in the definitive treatment of locally advanced esophageal cancer - A retrospective study
Authors: Raghunath Suresh , Tiwari Richa , Rashmi S. , Geetha S N , Sulthana Raahin , Madabhavi Irappa
Published: December 2022

Background:

The loco-regional recurrence rate remains the main concern in the treatment of esophageal cancer. However, there are controversial data regarding the benefit of dose escalation in the treatment of esophageal cancer. The study examines the implications of dose escalation with endoluminal brachytherapy after induction chemotherapy and definitive chemoradiation in cases of carcinoma esophagus.

Material and Methods:

Total 31 biopsy-proven patients with inoperable, locally advanced esophageal cancer of stage IIA-IIIB were enrolled from January 2006 till December 2018. All patients underwent two cycles of three weekly induction chemotherapy followed by definitive external beam radiotherapy of 45-50.4 Gray (Gy) at 1.8 Gy per fraction along with chemotherapy, followed by intraluminal brachytherapy boost of two fractions with 5 Gy each. Overall survival (OS) was censored at death or the last follow-up.

Results:

Of 31 patients, 26 (83.97%) received concurrent chemotherapy and 30 (96.77%) completed radiation therapy. At the end of 3 months, 10 (32.2%), 13 (41.9%), 5 (16.1%), and 3 (9.6%) had complete response, partial response, stable disease, and progression of the disease, respectively. Distal failure was seen in five (16.1%) cases. The median OS was 28 months. OS at 2 years and 5 years was 20 (64.5%) and 9 (28.3%), respectively. At the end of 3 months, 17 (54.8%) of patients had no dysphagia, four (12.9%) of patients had improvement of more than 2 points in dysphagia score, five (16.1%) of patients had no change in the score and five (16.1%) of the patients had worsening of the dysphagia score by 1 point. Median dysphagia-free survival was 10.7 months, eight (25.8%) developed dysphagia after the dysphagia-free interval and two (6.4%) had worsening of dysphagia after treatment. There were no reported grade III or grade IV acute toxicities.

Conclusion:

The protocol has shown an acceptable survival and dysphagia-free interval. The study suggests intraluminal brachytherapy with induction chemotherapy and definitive chemoradiation is a feasible option in locally advanced esophageal cancer.
Comparative analysis of cytomorphology of thyroid lesion on conventional cytology versus liquid-based cytology and categorize the lesions according to The Bethesda System for Reporting Thyroid Cytopathology
Authors: Alam M Qamar , Pandey Pinki , Ralli Megha , Singh Chauhan Jitendra Pratap , Aggarwal Roopak , Chaturvedi Vineet , Kapoor Asttha , Trivedi Kapil , Agarwal Savita
Published: December 2022

Introduction:

Thyroid nodules are a common disorder of the thyroid. Most of these are benign and only 5%–30% are malignant. Fine-needle aspiration cytology (FNAC) plays a vital role in differentiating benign from malignant and hence directing toward timely intervention. Liquid-based cytology (LBC) has been recently started in sampling thyroid lesions and has shown good results. The aim of our study was to compare the cytomorphology of thyroid lesions by conventional smear (CS) and LBC method and categorize the lesions according to TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology).

Materials and Methods:

A prospective study was conducted from January 2018 to June 2019 on 131 patients. Thyroid FNAC samples were taken to prepare 2–5 slides for conventional reporting and one sample for LBC preparation by SurePath method. Staining with hematoxylin and eosin, May–Grünwald–Giemsa, and Papanicolaou stain was done. Cases were reported by TBSRTC and compared.

Results:

The nonneoplastic lesions constituted the major proportion on both CS (83.2%) and LBC (73.2%). The neoplastic lesions constituted only 9.9% of all the diagnosis both on CS and LBC smear. The kappa agreement between CS and LBC cytology as per The Bethesda System for Reporting Thyroid Cytopathology came out to be 0.715, which was statistically significant.

Discussion:

Colloid appearance was statistically significant on comparison by both methods. The comparison of ill formed epithelioid granulomas was statistically significant in autoimmune thyroiditis cases. In malignancy cases, nuclear and cytoplasmic details were crisper on CS. Cytoplasm appeared fragile and fragmented on LBC smears.
Chemoradiotherapy for elderly patients with rectal cancer
Authors: Uslu Gonca H. , Rakici Sema Y.
Published: December 2022

Introduction:

The incidence of cancer, particularly rectal cancer (RC), in older adults is gradually increasing. The aim of the present study was to evaluate radiotherapy (RT) and chemoradiotherapy (CRT) results, clinicopathological features, and survival factors in older patients with RC.

Methods:

We evaluated patients aged ≥65 years with RC treated at a radiation oncology clinic. The demographic, clinical, and histopathological data of the patients were obtained by reviewing their medical records. The toxicity criteria of the Radiation Therapy Oncology Group were applied.

Results:

Among 401 patients with RC, 183 (45.6%) were older adults (65–92 years). Furthermore, 122 (66.7%) patients had clinically stage 3 and above RC, and 183 and 91 patients received RT and neoadjuvant CRT, respectively. Surgical treatment was performed for 116 (63.4%) patients, 41 (34.4%) and 76 (65.6%) of whom underwent postoperative CRT and preoperative RT, respectively. Grade 3 or higher toxicity was observed in 22 (18.9%) patients during CRT. RT was performed in 64 patients (35%) at a 1–15-day interval. The mean follow-up duration was 34.7 (range, 1.4–149.0) months. The 2- and 5-year overall survival (OS) rates were 71.4 and 37.4%, respectively, and the 2- and 5-year disease-free survival (DFS) rates were 65.7 and 35.3%, respectively. OS was 49.4 and 34.9 months for patients aged 65–74 and ≥75 years, respectively. Survival was shorter in patients with the advanced geriatric disease (p = 0.013). In the multivariate analysis, factors affecting overall and DFS were age, distance from the tumor to the anal canal, and metastasis (p < 0.05).

Conclusion:

The results of this study suggested that the selection of treatment modalities for older patients with RC should be based on performance status and not age. RT and CRT were safe treatment modalities for older patients with RC, particularly for those who could not undergo surgery.
Axillary management in patients with breast cancer and positive axilla at diagnosis. Experience in a Spanish university hospital with a 5-year follow-up
Authors: Jiménez-Gómez Marta , Loro-Pérez Jorge , Vega-Benítez Victor , Hernández- Hernández Juan Ramon , Aguirre Nuria Argudo
Published: December 2022

Background:

Axillary lymph node dissection (ALND) was the standard in breast cancer with axillary involvement until recently. Along with the number of metastatic nodes, axillary positivity was considered a main prognostic factor and scientific evidence shows that the administration of radiotherapy on ganglion areas decreases the risk of recurrence even in positive axilla. The objective of this study was to evaluate the axillary treatment in patients with positive axilla at diagnosis, the evolution of them over time, and to assess patient’s follow-up with the aim of avoiding the morbidity associated with axillary dissection.

Methods:

A retrospective observational study of breast cancer patients diagnosed between 2010 and 2017 was performed. In total, 1,100 patients were studied, out of which 168 were women with clinically and histologically positive axilla at diagnosis. Seventy-six percent received primary chemotherapy and subsequent treatment with sentinel node biopsy, axillary dissection, or both. Patients with positive sentinel lymph node biopsy received either radiotherapy or lymphadenectomy depending on the year time they were diagnosed.

Results:

For 60 patients out of 168, neoadjuvant chemotherapy resulted in a complete pathological axillary response. Axillary recurrence was registered for six patients. No recurrence was detected in the biopsy group associated with radiotherapy. These results support the benefit of lymph node radiotherapy for patients with positive sentinel node biopsy after receiving primary chemotherapy.

Conclusion:

Sentinel node biopsy provides useful and reliable information about cancer staging and might prevent lymphadenectomy, leading to a decrease in morbidity. Pathological response to systemic treatment came out as the most important predictive factor of disease-free survival of breast cancer.
Definitive radiation therapy with dose escalation is beneficial for patients with squamous cell cancer of the esophagus
Authors: Ghosh-Laskar Sarbani , Mummudi Naveen , Kumar Saurabha , Chandre Mukesh , Mishra Shagun , Tibdewal Anil , Agarwal Jai Praklash , Patil Vijay , Noronha Vanita , Prabash Kumar , Patil Prachi , Jiwnani Sabita , Karimundackal George , Pramesh C. S.
Published: December 2022

Objective:

We report the long term follow-up, toxicity, and outcomes of patients with localized squamous cell carcinoma of the esophagus(ESCC) who underwent definitive chemo-radiotherapy(dCRT) at our institute.

Materials and Methods:

Patients diagnosed with carcinoma post cricoid, upper cervical and thoracic oesophagus and treated with dCRT between January 2000 and March 2012 were retrospectively analyzed. Radiotherapy was delivered in two phases to a maximum dose of 63Gy in daily fractions of 1.8Gy using conventional or conformal techniques. OS and PFS were defined from date of registration and were calculated by Kaplan-Meier method with comparisons between different subgroups performed using log-rank test. All data were analysed using SPSS Version 22.

Results:

Three hundred and fourteen patients with ESCC treated with dCRT were included in this analysis. Median age at presentation was 56 years and median KPS at presentation was 70. Two-third of patients were treated with conformal technique. Median dose of radiation delivered was 60Gy(range 30.6Gy–70Gy). Neoadjuvant chemotherapy was administered in about 35% patients and 57% patients received concurrent chemotherapy. About 10% patients required hospitalization during treatment due to complications and 7 patients did not complete treatment. Grade 1/2 dermatitis and mucositis was seen in 77% and 71% patients respectively. Complete response at first follow up was observed in 56% of patients. At a median follow up of 56 months, 77 patients were alive with controlled disease. The 1- and 3-yr OS were 80% and 62% respectively. Median PFS was 28 months; 1- and 3-yr PFS were 66% and 46% respectively. A higher RT dose was found to be a significant predictor for OS and PFS on both uni- and multivariate analysis.

Conclusion:

Our study highlights that the delivery of higher RT doses (≥63Gy) is feasible in this patient group and that a higher RT dose was associated with significantly better PFS and OS.
Correlation of B-cell lymphoma 2 immunoexpression in invasive carcinoma of breast, no special type with hormone receptor status, proliferation index, and molecular subtypes
Authors: Azmat Henna , Faridi Javeria , Habib Hafiz Muhammad , Bugti Umair Jan , Sheikh Ahmareen Khalid , Riaz Syeda Kiran
Published: December 2022

Background:

B-cell lymphoma 2 is involved in various cancers including breast carcinoma. Its expression in breast cancer has been associated with good prognostic factors such as hormone receptor expression, low Ki-67, low grade, and earlier stage. It is also considered to be an independent prognostic factor for luminal and triple-negative tumors.

Objective:

We aimed to determine the expression of B-cell lymphoma 2 (BCL2) in different molecular subtypes of invasive ductal carcinoma of breast and its association with prognostic indicators.

Materials and Methods:

Fifty samples of invasive carcinoma of breast, no special type (NST), were categorized into molecular subtypes according to immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and Ki-67 and then evaluated for BCL2 expression. The expression of BCL2 was correlated with ER, PR, HER2, and Ki-67 and compared between luminal and nonluminal subtypes.

Results:

The BCL2 expression was seen in 68% of the cases with a significant association with ER, PR, and luminal subtypes. No significant association of BCL2 expression was seen with grade, HER2 and Ki-67 status of the tumor, or age group of the patients. BCL2 expression is significantly associated with ER, PR, and luminal subtypes in breast cancer.

Conclusion:

BCL2 is a marker of good prognosis in invasive carcinoma of breast, NST.
Role of sonic hedgehog ligand in gastric cancer therapeutics
Authors: Akhtar Kulsum , Maqbool Irfan , Bhat Gulzar Ahmad , Bhat Ishrat Parveiz , Syed Douhath Yousuf , Niyaz Madiha , Bashir Naheena , Parray Fazl Q. , Syed Besina , Syed Mudassar
Published: December 2022

Purpose:

The abnormal activation of the sonic hedgehog (SHH) signaling pathway is responsible for the progression of several types of cancers including Gastric Cancer (GC). SHH has been associated with the activation of different signaling pathways. Therefore, in this study, we investigated messenger RNA (mRNA) and protein expression of SHH in gastric malignancies and possible correlation with various clinicopathological parameters.

Materials and Methods:

A total of 53 surgically resected tumors and adjacent histologically normal tissues from GC patients were investigated in study subjects. A quantitative real-time polymerase chain reaction and immunohistochemistry methods were used for expression analysis of SHH.

Results:

At mRNA level, SHH was overexpressed in 60% (27/45) of GC cases as compared to their adjacent normal tissues. SHH immunohistochemical analysis revealed abundant cytoplasmic localization and overexpression in 43.39% (23/53) of GC tissues. SHH overexpression was not associated with any of the clinicopathological parameters.

Conclusion:

Our results showed that SHH is dysregulated in GC and might be considered as a biomarker for GC progression and can be used as a target in cancer therapeutics.