bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological Characteristics of Patients with Ovarian Carcinoma in a Tertiary Care Center of the Sub-Himalayan Region: An Ambispective Study
Authors: Sunil Hanumanthappa , Chaturvedi Jaya , Singh Sunil K. , Bose Bodhisattva , Solanki Pratik , Mondal Avijit , Sundriyal Deepak , Durgapal Prashant , Bahadur Anupama , Gupta Amit
Published: April 2024

Background and Objective:

The ovary is considered one of the complex organs with respect to histology, embryology, steroidogenesis, as well as tumor incidence. In order to attain a better knowledge of the disease mechanism, the current research highlights a correlation between the pathological and clinical features of epithelial ovarian carcinoma. The aim of this research is to evaluate the oncological and clinicopathological results of patients who were diagnosed with ovarian cancer (OC) in a tertiary care center situated in the Sub-Himalayan region.

Materials and Methods:

Seventy patients with OC registered at the department of surgical oncology, obstetrics and gynecology, and medical oncology between January 2019 and December 2021 had been estimated in this prospective and retrospective observational research. Age, histological type, stage at presentation, and treatment pattern were the characteristics examined in the patients.

Results:

The patients’ average age was 48.18 ± 12.309 years, having a maximum age of 74 years as well as the minimum age of 21 years. The most frequent symptom was abdominal pain (30%). Hypertension was the most commonly seen comorbidity in 7 (10%) patients. Most of the patients had high-grade serous carcinoma in 40 (56.1%) patients. Neoadjuvant chemotherapy and adjuvant type of chemotherapy were given to 30 (42.9%) patients. After 3 months, follow-up imaging showed that there was no residual disease in 51 (72.8%) patients, and the disease progression was seen in 8 (11.4%) patients.

Conclusion:

Because of their clinical correlation, behavioral predictability, as well as proper management of patient care, the right clinicopathological detection of ovarian tumors is extremely important.
Histomorphological Spectrum of Juvenile Salivary Gland Swelling: A Retrospective Case Series Study
Authors: Majumdar Arijit , Biswas Soumali
Published: April 2024

Background:

Salivary gland neoplasms are a rare group of disorders with diverse morphologies and are even rarer in pediatric population.

Aims and Objectives:

This aimed to explore our experience with the histomorphological spectrum of salivary gland tumors in a tertiary care pediatric referral center so that it can add to the cumulative knowledge to these tumors.

Materials and Methods:

The histopathology records from the department of pathology from January 2012 to December 2020 were reviewed in retrospect. Perisalivary gland region lesions were excluded from the study.

Results:

A total of 50 cases were included in the study. The most common location for salivary gland masses was parotid region (70%). Nonneoplastic lesions were seen in 3 (6%) patients and neoplastic lesions were seen in 47 (94%) patients. The most found benign lesion of salivary gland tissue origin was pleomorphic adenoma and 10 out of 15 cases (66.7%) of malignant tumors were found to be mucoepidermoid carcinoma on histology.

Conclusion:

Salivary gland tumors, rare in childhood and adolescence, differ in their incidence and prognosis from those in adult patients. The percentage of malignant salivary gland tumors compared with benign is much more frequent than in adults. The parotid is the most common site, and mucoepidermoid carcinoma is the most common malignant tumor.
Toolkit for delivering the 3Es and 6As tobacco interventions in dental care
Authors: Sujatha S , Iyengar Asha , Pruthvish S , Radhaprashanth  , Nagi Ravleen
Published: April 2024

Tobacco use is one of the major public health problems in India and also the single most important remediable public health problem. Tobacco cessation is the need of the hour. The dentists have a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. However, dentists, in general, have not widely embraced tobacco cessation in practice. In this article, an evidence-based model (an adaptation of the World Health Organization “5As” tobacco cessation model) is presented for the dentist to help patients avoid tobacco initiation, to encourage and assist patients in tobacco cessation.
Consolidation chemoradiation (cCTRT) improves survival in responders to first-line chemotherapy (CT) in locally advanced gallbladder cancer (LA-GBC)
Authors: Alam Mohammed N. , Agrawal Sushma , Rastogi Neeraj , Maria Das Koilpillai Joseph
Published: April 2024

Introduction:

Chemotherapy (CT) is the standard of care in advanced gallbladder cancer (GBC). Should locally advanced GBC (LA-GBC) with response to CT and good performance status (PS) be offered as consolidation chemoradiation (cCTRT) to delay progression and improve survival There is a scarcity of literature on this approach in the English literature. We present our experience with this approach in LA-GBC.

Materials and Methods:

After obtaining ethics approval, we reviewed the records of consecutive GBC patients from 2014 to 2016. Out of 550 patients, 145 were LA-GBC who were initiated on chemotherapy. A contrast-enhanced computed tomography (CECT) abdomen was done to evaluate the response to treatment, according to the RECIST (Response Evaluation Criteria in Solid Tumors) criteria. All responders to CT (PR and SD) with good PS but unresectable were treated with cCTRT. Radiotherapy was given to GB bed, periportal, common hepatic, coeliac, superior mesenteric, and para-aortic lymph nodes up to a dose of 45 to 54 Gy in 25 to 28 fractions along with concurrent capecitabine at the rate of 1,250 mg/m2. Treatment toxicity, overall survival (OS), and factors affecting OS were computed based on Kaplan–Meier and Cox regression analysis.

Results:

The median age of patients was 50 years (interquartile range [IQR] = 43–56 years), and men to women ratio was 1:3. A total of 65% and 35% patients received CT and CT followed by cCTRT, respectively. The incidence of Grade 3 gastritis and diarrhea was 10% and 5%, respectively. Responses were partial response (PR; 65%), stable disease (SD; 12%), progressive disease (PD; 10%), and nonevaluable (NE; 13%) because they did not complete six cycles of CT or were lost to follow-up. Among PR, 10 patients underwent radical surgery (six after CT and four after cCTRT). At a median follow-up of 8 months, the median OS was 7 months with CT and 14 months with cCTRT (P = 0.04). The median OS was 57 months, 12 months, 7 months, and 5 months for complete response (CR) (resected), PR/SD, PD, and NE (P = 0.008), respectively. OS was 10 months and 5 months for Karnofsky performance status (KPS) >80 and <80 (P = 0.008), respectively. PS (hazard ratio [HR] = 0.5), stage (HR = 0.41), and response to treatment (HR = 0.05) were retained as independent prognostic factors.

Conclusions:

CT followed by cCTRT appears to improve survival in responders with good PS.
Can we dream of an integrated pain management app for cancer patients?
Authors: Ahluwalia Pallavi , Gupta Bhavna
Published: April 2024

The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The number of health-related mobile applications (apps) is increasing rapidly. We searched for pain apps specific for cancer patients on App Store for iOS devices and Google Play for Android devices. An integrated pain management app (IPMA) is the need of the hour, which will not only provide a platform to users to assess their pain scores but also assess other associated symptoms and can provide a step-wise assessment to their symptomatology. This can offset the patient burden in the outpatient pain clinic and reduce the number of follow-up visits by addressing common concerns that can be tackled easily at home.
Infratentorial atypical choroid plexus papilloma in an adult: A case report and literature review
Authors: Menon Ritu R. , Arjunan Asha , Mathews Anitha , Valsalamony Jiji , Radhakrishnan Neelima
Published: April 2024

Atypical choroid plexus papilloma is classified as WHO (World Health Organization) Grade II subtype of choroid plexus tumor, and it has intermediate pathological features, prognosis, and clinical outcome rates between choroid plexus papilloma and choroid plexus carcinoma. These tumors are more common in children compared with adults and are usually located in the lateral ventricles. We present a case of an adult with atypical choroid plexus papilloma located in the infratentorial region. A 41-year-old woman underwent evaluation for headache and dull aching neck pain. Magnetic resonance imaging (MRI) of the brain revealed a well-defined intraventricular mass lesion in the fourth ventricle and foramen of Luschka. She underwent craniotomy and gross total excision of the lesion. Histopathological and immunohistochemical findings confirmed the diagnosis of atypical choroid plexus papilloma (WHO Grade II). We discuss the various treatment options for this condition and review the relevant literature.
An interpretive phenomenological analysis of hope in cancer patients: A qualitative study
Authors: Nazam Fauzia , Husain Akbar , Devi Seema , Singh Rajesh Kumar
Published: April 2024

Background:

In positive psychology, increased recognition of the phenomenon of hope among people suffering from cancer, along with alleviating their negative mental states like anxiety, depression, and fear of death is evident and promising. The aim of the study was to explore the lived experience of hope in cancer patients.

Materials:

Qualitative phenomenological research approach was used. A semi-structured in-depth interview with open-ended questions was administered to explore the patient’s hope related experiences during the journey of cancer. A purposive sampling technique was used to select a total of 10 participants for the study. The size of the sample was decided on the basis of literature for the interpretive phenomenological study.

Results:

Results revealed five major common themes related to hope during illness: (1) survival expectation; (2) will to live; (3) prognostic clarification; (4) positivity of health providers; and (5) recovery of other patients: A source of hopefulness.

Conclusion:

The lived experiences of cancer patients shows that hope is the positive expectation of survival, which is a source of motivation during their journey of illness. It also denotes goal setting behaviour. Thus, hope is the “will to live” which is related to social support, positive communication with healthcare providers, and recovery of fellow patients.
The effect of music therapy on chemotherapy-induced nausea and vomiting in women with breast cancer
Authors: Pozhhan Mahboobeh , Sobhani Sahar , Rasouli Aleheh Seyed , Tohidinezhad Fariba
Published: April 2024

Background:

Chemotherapy-induced nausea and vomiting (CINV) is an unavoidable side effect that affects the quality of life (QoL) and treatment compliance in patients with cancer. While the positive effect of music therapy in many clinical settings has been published, little information is available on the relieving effect of music therapy on CINV.

Aim:

To evaluate the effect of music therapy on the frequency and severity of CINV in women with breast cancer.

Methods:

Sixty patients were equally randomized to experimental (music therapy) and control (routine care) groups. One hundred and forty-eight instrumental, relaxation, and religious records were provided to be delivered by a headphone connected to an MP3 player. The intervention consisted of five 25-minute sessions supervised by trained nurses to provide the patient’s favorite music, volume, and timing arrangement. A 0–10 visual analog scale (VAS) and the 4-point Likert scale were used to measure the severity of nausea. Frequencies were also asked and recorded. The study endpoints were before, during, and after (8-hours, 16-hours, and 24-hours) chemotherapy.

Results:

The analysis of variance (ANOVA) showed that the frequency and severity of CINV increased significantly over the first 24 hours after chemotherapy in both groups. The difference between music therapy and control groups was statistically significant with regard to the median of the frequency of nausea (5.92 versus 12.34), frequency of vomiting (4.55 versus 9.95), the severity of nausea (1.26 versus 3.27), and severity of vomiting (1.06 versus 2.53).

Conclusion:

This study supports the idea of incorporating music therapy into the healing process after chemotherapy in women with breast cancer.
Langerhans cell histiocytosis of thyroid
Authors: Yadav Subhash C. , Bal Munita , Patil Asawari
Published: April 2024

Langerhans cell histiocytosis (LCH) is a rare monoclonal disease of antigen presenting cells. Involvement of thyroid gland by LCH is exceedingly rare. Herein, we present a case of LCH involving the thyroid in a 38-year-old woman. Our patient presented clinically as a case of primary thyroid neoplasm. Presence of elongated, epithelioid neoplastic cells with grooved nuclei along with presence of background eosinophils were seen on fine-needle aspiration cytology (FNAC) and histopathology. Positive staining for CD1a and S100 immunohistochemistry confirmed the diagnosis of LCH. Patient was given combination chemotherapy and has responded well to the same without any complaints for last 6 months. With this report, our goal is to expand awareness of this rare tumor in the thyroid. Consideration at the time of FNAC and its correct diagnosis on subsequent excision is imperative for patient management.
Refractory cancer pain in young child at end-of-life
Authors: Agarwal Shilpi , Singh Vikram Pratap , Sangwan Akansha , Mishra Seema
Published: April 2024

Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end-of-life. The prognosis of cancer pain is reported to be worse in those with mixed pain type, high pain severity, daily opioid use, and poor emotional well-being. We describe a case of 13-year-old boy, known case of metastatic Ewing sarcoma right iliac bone, who presented to our palliative care ward with intractable pain and was finally discharged home for terminal care with high doses of morphine, ketamine, and midazolam infusion through elastomeric pump attached to a peripherally inserted central catheter (PICC line). The suffering of imminently dying children should be reduced, and judicious dose escalation of opioids along with adjuvants is appropriate and often necessary.
Quality of life and burden in family caregivers of patients with advanced cancer receiving specialized palliative care
Authors: Koçak Nesteren , Şenel Gülçin , Oğuz Gonca , Karaca Şerife , Gökse Fatih
Published: April 2024

Background:

The caregivers of advanced cancer patients face many physical, psychological, social, and economic problems. In this study, the quality of life and burden in the primary family caregiver of patients with advanced cancer receiving inpatient palliative care were investigated.

Methods:

A total of 200 patients with advanced cancer hospitalized at palliative care center and primary caregivers were included. Functional capacities of patients were evaluated with Karnofsky Performance Scale and need of care with Katz index. The Turkish version of World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF TR) was used to assess the quality of life of caregivers.

Results:

The median Karnofsky Performance score of patients was found to be 30% and Katz Index score to be 2. The mean WHOQOL-BREF TR domain scores of family caregivers were 48.96 (Standard deviation (SD) =12.67) for physical health, 59.21 (SD=14.09) for psychological status, 56.83 (SD=20.91) for social relations, and 55.67 (SD=14.13) for environmental domain. Scores of psychological and environmental subscales were lower in women caregivers. The environmental subscale showed a significant difference in terms of education. The score of social relations subscale of the care giving spouse was lower than caregiving children and siblings. The score of environmental subscale of caregivers with insufficient income was found to be lower than caregivers with sufficient income. Karnofsky Performance and Katz Index scores and subscales of WHOQOL-BREF TR did not reveal any significant relation.

Conclusion:

This study showed that all subscales of quality of life are impaired in caregivers of advanced cancer patients, physical health being the most prominent.
Feasibility and impact of screening for venous thromboembolism in treatment-naive lung cancer patients–Results of a prospective cohort study
Authors: Muthu Valliappan , Narasimhan Ramesh L , Prasad Kuruswamy T , Ahluwalia Jasmina , Garg Mandeep , Behera Digambar , Singh Navneet
Published: April 2024

Background:

Venous thromboembolism (VTE) in cancer remains underdiagnosed. This prospective study aimed to evaluate the feasibility of screening for VTE in lung cancer (LC) patients. We assess the incidence of VTE, its risk factors, and effects on overall survival (OS).

Methods:

Consecutive treatment-naive LC patients were screened for deep venous thrombosis (DVT) with compression ultrasonography and pulmonary thromboembolism (PTE) with computed tomography pulmonary angiography (CTPA) at diagnosis and after 3 months of treatment. The incidence rate of VTE (DVT and/or PTE) was calculated. Risk factors associated with VTE were assessed using logistic regression analysis. All participants were followed-up to 1 year after enrollment. OS was compared in LC subjects with and without VTE, using the Cox proportional hazard analysis.

Results:

Around 301 subjects with LC (stages IIIB-IV accounted for 83.1%) were enrolled, of which 16 had VTE (5.3%). The incidence rate of VTE was 90 per 1000 person-years (PY). PTE was asymptomatic in 27.3% of cases while all DVT episodes were symptomatic. The incidence rate of asymptomatic PTE identified during the screening was 17 per 1000 PY. The median duration from LC diagnosis to the VTE event was 96.5 days. Median OS was significantly less in VTE patients [161 versus 311 days; P = 0.007] and death was attributable to VTE in 50%. After adjusting for covariates, VTE (hazard ratio [HR] = 2.1), smoking (HR = 1.7), and Eastern cooperative oncology group performance status ≥2 (HR = 1.6) were independently associated with poor OS in LC.

Conclusions:

VTE occurs in approximately 1 in 20 newly-diagnosed patients with LC and is associated with decreased OS. Screening for PTE may be considered even in resource-limited settings.
Early response to chemotherapy in children with Langerhans cell histiocytosis predicts long-term disease-free survival
Authors: Krishnan V.P. , Kanvinde Purva , Patel Swati , Golwala Zainab , Swami Archana , Hiwarkar Prashant , Mudaliar Sangeeta
Published: April 2024

Background:

Langerhans cell histiocytosis (LCH) is a rare clonal malignancy of the monocyte-macrophage system. Patients with lesions in “risk organs” have significantly higher risk of mortality than patients with lesions limited to “non-risk” sites. The influence of early response to therapy on long-term survival in this heterogeneous multi-system disease was analyzed.

Methods:

During a 7-year period, we retrospectively analyzed the findings in 24 consecutive patients who required systemic chemotherapy for LCH [single system with multifocal bone involvement and multisystem involvement with or without risk organ (RO) involvement]. All patients were started on vinblastine and prednisolone. Progressive disease was treated with salvage protocols or targeted therapy. Positron emission tomography-computed tomography (PET-CT)/conventional CT based response assessment was performed at week 6 of chemotherapy, and if needed after week 12 of chemotherapy.

Results:

MFO bone, MS ROneg, and MS ROpos LCH was observed in 3, 4, and 17 patients, respectively. Age range of patients varied from 1 month–7 years (median = 18 months). The EFS and OS were 100% and 100% for MFO bone, 50% and 100%, respectively, for MS ROneg and 35% and 52%, respectively, for MS ROpos. OS was 93% and 100% for CR attained at 6 and 12 weeks respectively regardless of the risk status (P < 0.01).

Conclusion:

Rapid early response, that is, complete remission at 6 and 12 weeks was associated with significantly improved overall survival. In slow responders, early salvage with alternative regimens or targeted therapy may result in better outcomes.
Risk factors and prevalence of cervical squamous intraepithelial lesions among women in south India
Authors: Kalavathy MC , Mathew Aleyamma , Jagathnath Krishna KM , Saritha VN , Sujathan K
Published: April 2024

Background:

Cervical cancer in India accounts for one-fifth of the global burden. Well-defined precancerous stages help early detection of the disease. Apart from human papillomavirus, the risk factors include age, education, occupation, early age at marriage and first delivery, abortions, and multiple sexual partners. Prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among women by Pap smear screening in south India were analyzed through a cross-sectional study.

Methods:

Women from rural and urban area were motivated by local accredited social health activists to attend pre-fixed Pap smear clinics in government hospitals. Pap smears collected in these clinics were taken to the Regional Cancer Centre, Thiruvananthapuram, processed, and cytology reports were prepared. Multiple logistic regression analysis was used to identify risk factors for SIL and high-grade SIL (HSIL).

Results:

The number of SIL was 67 out of 10,580 and HSIL was 39. Having higher education (Odds Ratio, OR:0.05(95% Confidence Interval, CI: 0.01-0.2), being married but living single (OR : 5.3, 95%CI:2.4-11.5), Having >2 abortions (OR:21, 95% CI:4.5-24), having younger age at delivery (OR : 0.1, 95% CI:0.01-0.3) and having unhealthy cervix (OR: 16.4, 95% CI:6.2-42.7) were the factors found to be the associated risk factors in multiple regression analysis.

Conclusion:

Pap smear screening can be focused on women with risk factors such as low education, married but living single, having >2 abortions, younger age at delivery, and unhealthy cervix on per speculum examination.
The utility of the Ion Torrent PGM next generation sequencing for analysis of the most commonly mutated genes among patients with colorectal cancer in India
Authors: Mehra Simmi , Tiwari Aseem Kumar , Mehta Swati Pabbi , Sachdev Ritesh , Rajvanshi Chhavi , Chauhan Rajni , Saini Abhishek , Vaid Ashok
Published: April 2024

Background:

The requirement for the mutation analysis for Kirsten rat sarcoma viral oncogene (KRAS) in colorectal cancer (CRC) is rapidly increasing as it is a predictive biomarker and also, its absence signifies response to anti-epidermal growth factor receptor (anti-EGFR) antibody treatment. The aim of our study was to investigate the pathological diagnosis and distribution of KRAS mutations in colorectal cancer with the use of next generation sequencing platform (Ion Torrent).

Methods:

A total of 56 CRC samples were tested to identify the genetic mutations, especially KRAS using the primers which included ~2800 COSMIC mutations of 50 oncogenes. Ion Torrent personal genome machine (semiconductor-based sequencing) was used for the sequencing and analysis. Along with KRAS, other 49 genes were also studied for COSMIC mutations.

Results:

KRAS mutation 25 (44.6%) had the highest frequency, followed by TP53 10 (17.9%) and PIK3CA mutation 4 (7.1%). Of all the KRAS mutations identified, mutations in codon 12 were most frequent followed by mutations in codon 13 and 61. The most frequent substitution was glycine to aspartate mutation in codon 12 (p.Gly12Asp) followed by glycine to valine (p.Gly12Val). Combinations of mutations were also studied. Our study revealed that seven cases (12.5%) had both KRAS and TP53 mutations (highest of all the combinations).

Conclusion:

The analysis of KRAS mutation frequency and its mutational subtype analysis in human CRCs by using semiconductor-based platform in routine clinical practices have been performed in Indian population. The findings were similar to earlier published reports from the Western literature.
Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona-Clinic Liver Cancer- B and portal vein tumor thrombosis
Authors: Anand Santhosh , Pottakkat Biju , Raja Kalayarasan , Chandrasekar Sandip , Satheesh Santhosh
Published: April 2024

Background:

Transarterial chemoembolization (TACE) is the preferred treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT). However, select patients with advanced HCC and with PVTT have shown improved survival with TACE. This study was undertaken to evaluate the outcome of TACE in patients with HCC beyond Barcelona-Clinic Liver Cancer- B (BCLC - B) and those with HCC and PVTT.

Methods:

Patients with unresectable HCC, subjected to TACE were included. HCC patients with PVTT involving main portal vein and, poor performance status were excluded from the study. Patients were stratified according to performance status, alpha feto protein (AFP) values, and up-to-seven criteria. Individually and using various combinations, the influence of these variables on survival was also estimated.

Results:

A total of 50 patients were included in the study. PVTT was present in 12 patients. Clinically, significant liver failure was observed in two patients. The average overall survival of patients beyond BCLC-B following TACE was 13 months. Survival was not influenced by tumor invasion into the portal vein. Patients with higher AFP levels had comparable survival provided their tumor load was satisfying up-to-seven criteria.

Conclusion:

We conclude that TACE could improve survival in selective HCC patients beyond BCLC-B and with PVTT not extending to the main portal vein.
Successful treatment of a patient with recurrent metastatic clear cell carcinoma of the uterine cervix
Authors: Shim Su Jung , Kim Nae Yoo , Lee Ho Jung , Gong Soo Jung
Published: April 2024

Clear cell carcinoma (CCC) of the uterine cervix is a rare gynecologic cancer that accounts for 4–9% of adenocarcinoma of the uterine cervix. Two types of uterine cervical CCCs are known: A type that is associated with in utero exposure to diethylstilbestrol (DES) and idiopathic type that is unrelated to DES exposure. Due to its rare incidence, the clinical behavior and pathological characteristics of CCCs are not fully described and treatment recommendations are not standardized. Moreover, only a few cases are reported on the recurrent metastatic CCCs and the results of various treatment trials are inconsistent. We present a case of successfully treated idiopathic metastatic CCC of the uterine cervix that recurred after concurrent chemoradiotherapy.
Predictors of toxicity after neoadjuvant chemoradiotherapy for locally advanced gall bladder cancer
Authors: Loyal Anushree , Chopra Supriya , Goel Mahesh , Mehta Shaesta , Patil Prachi , Patkar Shraddha , Shrivastava Shyam , Engineer Reena
Published: April 2024

Background:

The present study evaluated the correlation of hepatobiliary toxicity and radiation dose received in patients undergoing neoadjuvant chemoradiotherapy (NACRT) for locally advanced unresectable gall bladder cancers (LAGBC).

Methods:

Twenty-six patients with LAGBC, treated with NACRT (55–57 Gy/25 fractions/5 weeks and weekly gemcitabine 300 mg/m2) within a phase II study, were included. Whenever feasible, surgery was performed after NACRT. Acute and late hepatobiliary toxicity was recorded. Treatment scans were retrieved to delineate central porto-hepatobiliary system (CPHBS), resected liver surface, segment IV B and V, and duodenum. The doses received by these structures were recorded and correlated with toxicity.

Results:

Of 26 patients, 20 (77%) had partial or complete response and 12 (46%) had R0 resection. At the median follow-up of 38 months, overall survival was 38%. Eight (30%) patients had post-treatment toxicity, of which most common was biliary toxicity (30%). A correlation was observed between the biliary leak and V45Gy CPHBS >50 cm3 (P = 0.070). Higher toxicity was observed in those with metallic stents (P = 0.072).

Conclusion:

The incidence of the biliary leak was 46%. CPHBS dose was found to correlate with biliary leaks. Restricting V45Gy CPHBS <50 cm3 and using plastic stent may facilitate a reduction in hepatobiliary toxicity in patients undergoing NACRT and surgery.
Access to HER2-targeted therapy at a tertiary care center in India
Authors: Nair Nita S , Gupta Sudeep , Ghosh Jaya , Desai Sangeeta , Parmar Vani , Shet Tanuja , Chitkara Garvit , Siddique Shabina , Badwe Rajendra A
Published: April 2024

Background:

In a previous retrospective audit from our institution we reported that patients had limited access to HER2-targeted therapy due to financial constraints. Subsequently, the advent of biosimilar versions of trastuzumab and philanthropic support has potentially changed this situation. Herein, we reanalyzed and reported access to HER2-targeted therapy in a more recent cohort of patients.

Methods:

Medical records of new breast cancer patients registered in one calendar year were retrospectively reviewed, supplemented by online pharmacy data to extract information on receptor status, use of HER2-targeted therapy, and other relevant variables. Since not all HER2 immunohistochemistry (IHC) 2+ tumors underwent fluorescent in-situ hybridization (FISH) testing, we estimated the probable HER2 amplified from this group based on a FISH amplified fraction in those HER2 2+ tumors who did undergo FISH.

Results:

Between January 2016 and December 2016, 4717 new BC patients were registered at our institution, of whom 729 (20.04%) had HER2 IHC 3+ tumors while 641 (17.62%) had HER2 IHC 2+ tumors. The final number of HER2 overexpressing/amplified tumors was estimated to be 928 (729 HER2 IHC 3+, 105 known FISH amplified, and 94 estimated FISH amplified), of whom 831 received treatment at our institution. Overall 474 (57.03%, 95% confidence interval [CI] 53.6–60.4) of these 831 patients received trastuzumab for durations ranging from 12 weeks to 12 months in the (neo)adjuvant setting or other durations in metastatic setting compared to 8.61% (95% CI 6.2–11.6) usage of HER2-targeted therapy in the 2008 cohort.

Conclusion:

Access to HER2-targeted therapy has substantially increased among patients treated at a public hospital in the past decade, likely due to the advent of biosimilars, the use of shorter duration adjuvant regimens, and philanthropic support. However, further efforts are required to achieve universal access to this potentially life-saving treatment.
Survival outcomes with 12 weeks of adjuvant or neoadjuvant trastuzumab in breast cancer
Authors: Ghosh Joydeep , Joy Phillip Deepa S , Ghosh Jaya , Bajpai Jyoti , Gulia Seema , Parmar Vani , Nair Nita , Joshi Shalaka , Sarin Rajiv , Budrukkar Ashwini N , Wadasadawala Tabassum , Desai Sangeeta B , Shet Tanuja , Patil Asawari , Sawant Sheela P , Dhir Aruna A , Kembhavi Seema , Popat Palak , Hawaldar Rohini , Kembhavi Yogesh , Perumal Prema , Banavali Shripad D , Badwe Rajendra A , Gupta Sudeep
Published: April 2024

Background:

There is limited access to 1 year of adjuvant trastuzumab in resource-constrained settings. Most randomized studies have failed to prove non-inferiority of shorter durations of adjuvant trastuzumab compared to 1 year However, shorter durations are often used when 1 year is not financially viable. We report the outcomes with 12 weeks of trastuzumab administered as part of curative-intent treatment.

Methods:

This is a retrospective analysis of patients treated at Tata Memorial Centre, Mumbai, a tertiary care cancer center in India. Patients with human epidermal growth factor receptor (HER2)-positive early or locally advanced breast cancer who received 12 weeks of adjuvant or neoadjuvant trastuzumab with paclitaxel and four cycles of an anthracycline-based regimen in either sequence, through a patient assistance program between January 2011 and December 2012, were analyzed for disease-free survival (DFS), overall survival (OS), and toxicity.

Results:

A total of 102 patients were analyzed with a data cutoff in September 2019. The median follow-up was 72 months (range 6–90 months), the median age was 46 (24–65) years, 51 (50%) were postmenopausal, 37 (36%) were hormone receptor-positive, and 61 (60%) had stage-III disease. There were 37 DFS events and 26 had OS events. The 5-year DFS was 66% (95% Confidence Interval [CI] 56–75%) and the OS was 76% (95% CI 67–85%), respectively. Cardiac dysfunction developed in 11 (10.7%) patients.

Conclusion:

The use of neoadjuvant or adjuvant 12-week trastuzumab-paclitaxel in sequence with four anthracycline-based regimens resulted in acceptable long-term outcomes in a group of patients, most of whom had advanced-stage nonmetastatic breast cancer.
Oral and dental care before radiotherapy
Authors: Bhandari Sudhir , Soni Bhavita W , Jamwal Ankush , Ghoshal Sushmita
Published: April 2024

Involvement of multidisciplinary team is the mainstay in the holistic treatment outcome in head and neck cancer patients. Achieving a state of oral health is regarded as an essential treatment goal before radiation therapy but, it may get overlooked due to many competing priorities, lack of multidisciplinary facilities and/or incoordination, and limited overall awareness with regards to means of achieving oral health and in a time-bound manner and its relevance in improving quality of life in cancer survivors. Radiation inflicts an immense amount of damage upon the entire maxillofacial complex and consequently oral treatment after radiotherapy may remain untreated and/or undertreated. It is, therefore, vital to eliminate oral foci of infections well within a time frame before radiation so that tumor prognosis is not compromised. This article describes the current guidelines combined with a time-bound protocol developed in our center to not only prepare a patient for conventional radiotherapy but also to provide a logical perspective towards the feasibility of the oral rehabilitation post-cancer cure. The protocol aims to maximize the quality of life in head and neck cancer survivors by; patient education, minimizing preventable oral complications, and retaining strategic teeth for function, aesthetics, speech, and prosthetic support. The time-bound pre-radiation oral care protocol is rational, achievable, and is aligned towards the sustained oral health care goals in head and neck cancer patients and can be utilized as a useful resource in multidisciplinary head and neck cancer care facilities.
Determining PD-L1 expression in head and neck squamous cell carcinoma using immunohistochemistry
Authors: Mishra Prabha S , Sidhu Avnit , Dwivedi Gunjan , Mulajker Deepak S , Awasthi Shivali
Published: April 2024

Background:

Advanced head and neck squamous cell carcinoma (HNSCC) has limited treatment options. Programmed death-ligand1 (PD-L1) expressed by tumor cells interacts with PD-1 receptor on T lymphocytes leading to immune evasive response and survival advantage. Therapy with immune check-point inhibitors target PD-1/PD-L1 blockade inducing tumor regression. Immunohistochemistry (IHC) for PD-L1 expression enables patient selection for immunotherapy and may be considered a potential predictor of clinical response.

Methods:

A retrospective analysis of IHC for PD-L1 expression using manual laboratory developed technique (LDT) with antibody clone 22C3 (Dako) in 93 cases of HNSCC. PD-L1 expression was correlated with age, gender, tumor site, grade and stage.

Results:

PD-L1 IHC was performed in 93 cases and immunopositivity was noted in 59 (63.4%) cases. High expression with combined proportion score (CPS) ≥50 was seen in 15 (16.1%) cases and low expression with CPS ≥1 expression was seen in 44 (47.3%) cases. An almost-perfect interobserver agreement was noted by two pathologists for PD-L1 IHC expression (Cohen’s kappa coefficient = 0.910). No statistically significant correlation was noted between PD-L1 score and patient demographics, tumor site, grade or stage.

Conclusion:

Detection of PD-L1 status by IHC enables identification of HNSCC patients eligible for future targeted immunotherapy.
Safety profile of G-CSF in chemotherapy-induced neutropenia
Authors: Deb Uttiya , Mukhopadhyay Sandip , Banerjee Sanatan , Biswas Supreeti
Published: April 2024

Background:

Granulocyte-colony stimulating factor (G-CSF) is used in cancer patients to treat chemotherapy-induced neutropenia (CIN). However, G-CSF poses few risks. Despite the regular use of G-CSF in CIN management, there is a paucity of published data on its safety profile in the management of CIN in India. Hence, the present study was designed to demonstrate the safety profile of G-CSF in patients with CIN.

Methods:

A prospective observational study was conducted over a period of 5 months enrolling 100 cancer patients aged from 18 years to 70 years. Patients with a diagnosis of CIN who received G-CSF were included. Patients were followed up for 15 days. Adverse events (AEs) were graded according to US National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The system organ class and preferred term of Medical Dictionary for Regulatory Activities (MedDRA) were used for reporting the AEs. Causality assessment was done by using the WHO-Uppsala Monitoring Centre scale.

Results:

The most frequently reported AEs were musculoskeletal and connective tissue disorders which included bone pain, myalgia, arthralgia, and pain in the extremity. Other AEs reported were general disorders and administration site conditions, and gastrointestinal disorders. The highest grade of toxicity reported was of grade 3 among all AEs. The majority of AEs had a “probable” type of causality relationship with G-CSF.

Conclusion:

G-CSF has a safety profile consistent with previous G-CSF studies.
Cell-free DNA as a Novel Diagnostic Biomarker for Periodontitis
Authors: Kulkarni Pranav , Dodwad Vidya , Bhosale Nishita , Pharne Pooja , Bhatt Niket
Published: April 2024

Periodontitis, a common inflammatory disease affecting the periodontal tissue, poses diagnostic and management challenges. Conventional methods are not capable of assessing disease activity or identifying individuals who are prone to progression. Biomarkers, measurable substances that indicate the presence, severity, or progression of disease, offer a promising approach to diagnosing periodontitis. Recent discoveries in molecular diagnostics have prompted the search for novel biomarkers, including cell-free DNA (cfDNA). This review article gives an insight into current knowledge regarding the use of cfDNA as a diagnostic marker in periodontal disease diagnosis.
A Cone-beam Computed Tomography-guided Endodontic Management of Internal Variations in the Root Canal Anatomy of Maxillary Molar
Authors: Kumar Ankush , Sawhney Mischeal Kaur , Goel Munish , Verma Shweta
Published: April 2024

This case report aims to present and analyze the internal variations in root canal anatomy of a maxillary molar and its successful non-surgical endodontic management using CBCT guidance. This clinical report aims to emphasize the importance of recognizing atypical dental internal anatomy during endodontic treatment and to describe a case where the presence of two palatal roots in the maxillary molar was identified and was managed successfully. This report presents a case where endodontic treatment was performed on a maxillary molar with unusual pulpal and periapical findings. During the treatment, the presence of two palatal roots in the tooth was observed, and relevant treatment modalities were discussed for the treatment’s success. Understanding the internal anatomy of teeth is crucial in clinical and radiographic examinations. This knowledge is essential for detecting unusual roots and canals and ensuring effective cleaning and shaping of calcified canals, which are often overlooked in endodontic treatment.
Comparison of Root Canal Morphology in Intraoral Periapical Radiographs and Cone-Beam Computed Tomography: An In vitro Study
Authors: Sil Shiladitya , Ghosh Subhankar , Saha Nilanjana , Ghosh Suryoday
Published: April 2024

Backgrounds and Objectives:

Intraoral periapical radiographs (IOPAR) are routinely used to fulfill the preoperative, par-operative and postoperative imaging needs in endodontic treatment. IOPAR is not a sensitive tool for identification of complex root canal morphology with failure rates of up to 34%. Cone-beam computed tomography (CBCT) provides three-dimensional imaging and has been recommended when endodontic imaging needs cannot be met by IOPAR. There is a need to understand which anatomic parameters are better viewed in CBCT and which on IOPAR. Hence, this study is planned to compare the root canal morphology on IOPAR and CBCT and correlate with chemically cleared tooth.

Methods:

One hundred recently extracted teeth were collected and subjected to IOPAR and CBCT scanning. A total of six root canal morphologies were compared in both the imaging modalities and with the teeth itself after making it chemically transparent.

Results:

CBCT and IOPAR showed a good agreement in detection of fractured tooth roots with P < 0.005. However, CBCT was better than IOPAR in detection of the number of accessory canals, ramifications, and obliterations in the root canal and fractures with P < 0.005. IOPAR showed reduced artifacts with P < 0.005. During working length measurement, both CBCT and IOPAR showed increased values than the cleared teeth although CBCT was more accurate.

Conclusion:

We can conclude from this study CBCT is more accurate in detection of root canal morphologies in comparison to IOPAR.
The Quality and Reliability of Information in YouTube Videos on Occupational Health and Safety
Authors: Erdoğan Ayşegül , Kaya Erhan , Şahin Musa , Kurt Burk , Gökmen Rasim
Published: April 2024

Background:

Education is very important to prevent occupational injuries and accidents, which are almost all completely preventable. The aim of this study was to evaluate training videos on this subject on the YouTube platform.

Methods:

Six search terms related to occupational health and safety (OHS) were scanned on May 31, 2021. After the application of exclusion criteria, a total of 176 videos were included for final analysis using the parameters of country origin, source of the video, content, number of views, comments, likes, dislikes, and video duration. The Global Quality Scale (GQS) and modified DISCERN tools were used to evaluate the quality and reliability of the videos in this analytical cross-sectional study.

Results:

According to the GQS score, 111 (63.1%) videos were of low quality. Statistically significant differences were found between the low-, moderate-, and high-quality groups with respect to video length, likes, dislikes, comments, likes per day, dislikes per day, comments per day, video category, and the DISCERN scores (P < 0.05). The vast majority of videos contained low-quality information. A large number of videos were uploaded on OHS content from independent users and the USA.

Conclusion:

There is a clear need for professionals to play a more active role in uploading and sharing high-quality information on Internet platforms on the subject of OHS.
Association of Anthropometric Adiposity Indices and Hand Grip Strength among Male Industrial Workers in Chennai, Tamil Nadu, India: A Cross-Sectional Study
Authors: Priyadarshini R. Durga , Beatrice D. Annette
Published: April 2024

Background:

Hand Grip Strength (HGS), a basic, non-invasive measure of musculoskeletal function is found to be a risk marker for cardiovascular diseases, respiratory diseases, diabetes, metabolic syndrome, and cancer. Considering the importance and paucity of studies among industrial workers, we aim to study the association between anthropometric adiposity indices and the HGS of industrial workers.

Materials and Methods:

The study is a descriptive, cross-sectional study. Anthropometric measurements and HGS of 198 male industrial workers between 21 and 60 years of age, employed at metal manufacturing industries in Chennai, Tamil Nadu, India were assessed.

Statistical Analysis:

Descriptive and inferential statistics were done using “R” statistical software.

Results:

The mean age of male industrial workers was 39.51 ± 12.20 years. The majority of the workers were found to be obese (64%) and the mean body fat percentage was 27.69 ± 5.13%. The mean HGS of the worker’s dominant hand was found to be 35.80 ± 8.93 kg and of their non-dominant hand was 35.0 ± 8.67 kg. When compared to the normative values of HGS for Indians, results revealed significantly higher HGS of both dominant and non-dominant hands of workers between the age group of 21–30 years and 51–60 years. Multiple linear regression analysis revealed that body weight [β(s.e) =0.27 (0.05), P < 0.000], body fat [β(s.e) = −0.52 (0.14), P < 0.000) and WHR [β(s.e) = −28.81 (11.9), P = 0.017] independently predicted the HGS of dominant hand. In non-dominant hand, body weight [β(s.e) = 0.26 (0.05), P < 0.000] and body fat [β(s.e) = −0.60 (0.13), P < 0.000] independently predicted HGS.

Conclusions:

Body fat, body weight, and Waist-to-Hip ratio (WHR) were found to have a significant influence on the HGS of industrial workers. Strategies aimed to reduce overall body fat and abdominal obesity may prove beneficial in improving HGS and nutritional status thereby reducing the risk of non-communicable diseases.
Dental Erosion—An Occupational Hazard among Battery Manufacturing Industry Workers in Hyderabad, India
Authors: Kalyani Suma , Reginald B. Ajay , Reddy B. Siva , Samatha Meda
Published: April 2024

Background and Objective:

Dental erosion is a condition that results from exposure of the enamel and dentin to non-bacterial acids of extrinsic and intrinsic origin, causing mineral loss on the surface of the tooth. Occupational exposure to sulfuric acid fumes has been described in association with dental erosion in battery manufacturing industry workers. Hence, this study aimed to assess the dental erosion among battery factory workers in HBL Power Systems Ltd, Hyderabad.

Materials and Methods:

The sample consisted of 90 battery factory workers (62 males and 28 females). Demographic data with regard to age, gender, and length of exposure were recorded. Clinical examination was done to assess dental erosion using the tooth wear index given by Smith and Knight. Data were statistically analyzed by using Fisher exact test. P <0.05 was considered statistically significant.

Results:

Among 90 workers examined, 43.3% showed prevalence of erosion with higher occurrence rate in females (54%) than males (38.7%). 66.6% of affected workers had erosion score of 1, and 33.4% showed erosion score of 2 and 3. We also observed statistically significant highest prevalence and increased severity of dental erosion in workers with prolonged duration of employment (>11 years).

Conclusion:

The present study revealed increased prevalence of dental erosion among battery factory workers. Hence, it highlights the importance of protective measures with efficient surveillance and monitoring in the workplace environment.