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   Table of Contents - Current issue
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May-August 2020
Volume 4 | Issue 2
Page Nos. 39-78

Online since Monday, August 17, 2020

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ORIGINAL ARTICLES  

Role of D-dimer in patients of operable breast cancer with lymph node metastases: A matched cross-sectional study p. 39
Samanyoya Gochhait, Soumya Swaroop Sahoo, Gaurav Chhabra, Ashok Kumar Mukhopahay, Subhadra Sharma
DOI:10.4103/oji.oji_16_20  
Introduction: Breast cancer is the most common malignancy amongst women worldwide. Presence of axillary lymph nodes metastases is an important predictor of survival in patients with infiltrative breast cancer. D-dimer levels are elevated in the plasma of various solid tumor patients. There still exists a gap in our knowledge regarding the relationship between quantitative D-dimer levels and extent of disease in primary breast cancer. Aim: To study the fibrinolytic pathway by assaying D-dimer in breast cancer cases and to calculate a suggestive cutoff value for D-dimer for its use a specific marker of lymph node metastasis preoperatively in the cases of breast cancer. Materials and Methods: In this matched cross-sectional hospital-based study, 50 diagnosed cases of operable breast carcinoma not taking any treatment for the cancer and 50 healthy women both in the 25–65 years age group were selected as cases and controls, respectively. Peripheral venous blood was collected and analyzed for prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), D-dimer, platelet count, and mean platelet volume. Results: D-dimer was significantly increased in cases compared to healthy controls. It was markedly increased in patients with lymph node involvement irrespective with the number of nodes involved, while PT, aPTT, and TT did not show significant difference. Receiver operating characteristic curve gave a sensitivity of 56% and specificity of 91%, for cutoff value of 0.765 for D-dimer, in order to predict the chances of lymph node metastases preoperatively. Conclusions: D-dimer is a simple, noninvasive, quick, and nonexpensive laboratory investigation which can be used as a predictor of depicting lymph node metastasis.
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Blood stream infections in hematopoietic stem cell transplant patients: A 2-year study from India p. 43
Purabi Barman, Dharma Choudhary, Shimpi Chopra, Tarun Thukral
DOI:10.4103/oji.oji_7_20  
Background: Hematopoietic stem cell transplant (HSCT) recipients are particularly prone to bloodstream infections (BSIs). This has been attributed to neutropenia and immune-suppression. Regardless of the improvements made in the management perspective, infection still plays a major role in morbidity and mortality in these patients. It has been related to the rise of multidrug-resistant organisms. Aim: The aim of this study was to determine the pattern of BSIs and the burden of antibiotic resistance in HSCT patients. Materials and Methods: We conducted this retrospective study for 2 years in 438 transplant events among 429 HSCT recipients who developed febrile neutropenia. Paired blood culture samples were collected on the onset of fever. Carbapenem-resistant Enterobacteriaceae (CRE) carriage rate was also determined in 127 patients. Results: BSIs were detected in 131 transplant events, which were classified as mucosal barrier injury laboratory-confirmed BSIs in 61, central line-associated, and other primary BSIs among 35 each. A diverse variety of 145 isolated organisms included Gram-negative and Gram-positive bacteria with 4 Candida species. All the Gram-negative isolates were susceptible to colistin, while 68.83% of CRE was detected. CRE carriage rate was observed in 37.80% of 127 individuals. Vancomycin resistance was noticed in 40% Enterococcus species. The overall mortality rate was 20.05%. Conclusions: Screening for CRE carriage in these patients could help in timely initiation of empirical colistin therapy. However, local epidemiology plays an important role in deciding the empirical antibiotic therapy.
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Bloodstream infections in cancer patients: Analysis from a tertiary cancer hospital in Bhubaneswar, Odisha, India p. 49
Sourav Kumar Mishra, Saroj Prasad Panda, Debasish Sahoo, Soumya Surath Panda, Priya Priyadarshini Nayak, Shubhra Debashrita
DOI:10.4103/oji.oji_23_20  
Background: Bloodstream infections (BSIs) account for large-scale morbidity and mortality among cancer patients requiring a rational antibiotic policy. In India, there is a paucity of data regarding incidence and pattern of BSI in such patients. Aim: The study was conducted to evaluate the pattern of BSI in cancer patients and their sensitivity and resistance toward antibiotic. Materials and Methods: All the blood culture-confirmed infections among cancer patients treated at a tertiary care institute in Bhubaneswar, Odisha, India, were retrospectively analyzed during the year 2018. Results: A total of 82 patients/episodes had confirmed BSI. Gram-negative bacteria accounted for 43 (52.4%) cases, followed by Gram positive 38 (46.4%) cases and 1 case of candida species. The most common organisms isolated were Klebsiella pneumoniae and Staphylococcus aureus consisting of 17 cases each. The Gram-negative bacterial isolates (n = 43) were sensitive to cefoperazone plus sulbactam, piperacillin plus tazobactam, carbapenem, and colistin in 18 (41.9%), 19 (44.2%), 29 (67.4%), and 40 (93%) episodes, respectively. The sensitivity of Gram-positive bacteria (n = 38) to vancomycin, linezolid, and teicoplanin was seen in 37 (97.3%), 37 (97.3%), and 35 (92.1%) episodes, respectively. Multidrug-resistant bacteria accounted for 17 (39.5%) cases of Gram-negative isolates and 9 (53%) of which were K. pneumoniae. Extended-spectrum beta-lactamase activity was seen in 11 of 26 episodes of Enterobacteriaceae. Four of 17 S. aureus and 3 of 11 coagulase-negative Staphylococci were methicillin resistant, and 1 of 2 cases of Enterococcus was vancomycin resistant. Conclusion: Gram-negative bacteria are the predominant cause of BSI in cancer patients and development of a high degree of resistance to commonly used antibiotics is challenging.
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Clinical prognostic factors and treatment outcomes in patients with small cell carcinoma of the cervix: A single institution-based retrospective study p. 54
Niketa Thakur, Sonal Patel
DOI:10.4103/oji.oji_18_20  
Introduction: Small cell carcinoma of the cervix (SCCC) is relatively uncommon among cervical malignancies and is more likely to develop lymph node and distant metastasis compared to the common squamous histological variant. There is a lack of knowledge about potential prognostic factors, optimal treatment modalities, and survival outcome of SCCC. Aim: The aim of this study is to correlate clinicopathologic parameters and different treatment schedules with survival outcomes of SCCC as progression-free survival (PFS) and overall survival (OS). Materials and Methods: A retrospective study was conducted on diagnosed SCCC patients taking treatment from January 2005 to December 2014. Results: A total of 21 patients were analyzed. The median age of presentation was 47 years. All the patients presented at an advanced stage (IIB-IVB) with high-grade histological differentiation. The median PFS and OS were 5 and 6 months, respectively. The patient receiving multi-agent platinum- and etoposide-based radical concurrent chemoradiotherapy (CCRT) plus brachytherapy had significantly better PFS (P = 0.028) and a trend toward better OS versus other treatment modalities. The median OS was found to be significantly poor in SCCC patients having an additional neuroendocrine component, not receiving brachytherapy after CCRT, and not receiving prophylactic cranial irradiation after radical radiotherapy (P < 0.05). Cisplatinum- plus etoposide-based CCRT schedule had a trend toward better PFS and OS than that of only cisplatinum-based CCRT (P > 0.05). Furthermore, a trend toward better OS was seen for age >40 years, tumor size ≤4 cm, and lymph node-negative status. Relapse was seen in 42.9% of the cases over a 7-month median follow-up. Conclusions: CCRT using multi-agent platinum- plus etoposide-based chemotherapy followed by brachytherapy remains the mainstay of treatment in locally advanced SCCC. The prognostic factors should be considered for customizing treatment.
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Analysis of nonneoplastic medical renal diseases in tumor nephrectomy specimens predicting future renal function p. 60
Anusmita Tripathy, Maya Menon, Balasubramaniam Ramakrishnan, Arshee Badar
DOI:10.4103/oji.oji_41_19  
Introduction: Nephrectomy for renal tumor leads to decline in global renal function. The pattern of pathological changes in uninvolved renal parenchyma of nephrectomy specimen is useful to predict the future renal function. Aim: The aim of the present study is to analyze the spectrum of medical renal diseases in nonneoplastic renal parenchyma of tumors nephrectomies and preexisting comorbidities to predict future renal function. Materials and Methods: A prospective study was conducted on 100 nephrectomy patients during the period from November 2015 to February 2019. Nonneoplastic renal parenchyma of nephrectomy specimens was analyzed for the presence of any pathological changes. Serum creatinine levels at preoperative and 6 months after nephrectomy were recorded. Results: Medical renal disease in uninvolved renal parenchyma detected in 52% of cases and arterionephrosclerosis (28%) followed by diabetic nephropathy (10%) was most frequently seen. Diabetes mellitus (DM) and/or hypertension (HTN) were significantly associated with increase in arteriolar hyalinosis, glomerulosclerosis, and interstitial fibrosis/tubular atrophy (P < 0.05). The median follow-up for patients attending 6 months after nephrectomy (n = 41) was 20 months with the mean increase in serum creatinine level from the preoperative period of 0.48 mg/dl (P = 0.011). The increase in serum creatinine level from the preoperative period to 6 months after nephrectomy was significant for patients with preexisting DM alone (P = 0.033), DM along with HTN together (P = 0.008), and patients with diabetic nephropathy (P = 0.0001). Three patients developed chronic kidney disease during follow-up (n = 41). Conclusions: Preexisting DM and HTN should be carefully handled in renal tumor patients and routine evaluation of the nonneoplastic renal parenchyma of nephrectomy specimens is necessary to detect the presence of subclinical renal disease for early treatment measures to reduce future morbidity.
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Bacterial vaginosis and its association with human papilloma virus and increased risk of cervical intraepithelial lesions: An experience from Eastern India p. 67
Bhagyalaxmi Nayak, Pallavi Patnaik, Manoranjan Mohapatra, Dhananjaya Soren, Priyadarshini Patra, Kusumbati Besra, Sushil Kumar Giri
DOI:10.4103/oji.oji_9_19  
Background: Bacterial vaginosis (BV) is the most common vaginal disorder affecting women of reproductive age and has an influence in acquisition of certain genital infections. However, it is difficult to determine whether BV is actually a risk factor for human papilloma virus (HPV) acquisition or not and whether it may lead to cervical cancer. Aim of the Study: The aim of the present study is to determine the prevalence of BV and its association with HPV infection and cervical intraepithelial neoplasia (CIN). Materials and Methods: A multiinstitutional prospective study was conducted to analyze the vaginal samples collected from the women aged between 19 and 49 years during the period from December 2014 to January 2018. Results: A total of 333 women with vaginal samples were analyzed for BV. 103 (30.93%) samples were diagnosed with BV as per Amsel's criteria. The prevalence of HPV DNA was higher in BV-positive cases in comparison to that of BV-negative cases (44.7% vs. 9.6%; P = 0.000) showing a significant association between BV and HPV infection. There was a rising trend in the incidence of CIN for women diagnosed with BV when compared to BV negative women (62.1% vs. 43%; P = 0.506), although statistically insignificant. Moreover, the severity/high grading of CIN was not significantly associated with BV (P = 0.765). Conclusion: The result of our study hypothesized that BV was significantly associated with increased risk of HPV infection. There was a rising trend for the association of BV with CIN incidence although statistically insignificant.
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CASE REPORTS Top

Solitary cutaneous metastasis in the palmer aspect of the hand, along with pulmonary metastasis: A rare presentation in an early laryngeal primary and review of literature p. 73
Mrinalini Verma
DOI:10.4103/oji.oji_1_20  
Cutaneous metastasis from head-and-neck cancer is extremely rare, reported in 1%–2% of patients. We report the case of a 67-year-old male with squamous cell carcinoma of epiglottis, who was treated with concurrent chemoradiotherapy. However, the patient developed metastatic nodule on the right palm proven by fine-needle aspiration cytology along with lung metastasis after 8 months of treatment completion despite the complete resolution of carcinoma at the primary site. In view of metastatic disease with poor functional status and controlled primary, he was started on weekly injectable methotrexate, palliative radiotherapy (RT) to palmar nodule with other measures of palliative care. However, he succumbed to disease after 8 months of postpalliative RT. This case report highlights that a seemingly curable disease within the larynx could take an aggressive turn in the form of lung metastasis and solitary palm nodule.
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Malawer limb salvage surgery for large chondrosarcoma of scapula with functional outcome – A case report p. 76
K P Kunhi Mohammed, Prafulla Kumar Das, Supratim Bhattacharyya, Bharat Bhusan Satpathy
DOI:10.4103/oji.oji_5_20  
Chondrosarcoma is a malignant cartilaginous bone tumor. It commonly occurs in the pelvis and femur. However, scapula primary is relatively rare, accounting for 5%–7% of all the chondrosarcomas. Although wide local excision with negative margins is sufficient for chondrosarcoma, amputation is commonly performed for large tumors at the scapula location. Malawer limb salvage surgery can be performed in a large-sized tumor in order to retain the function. Here, we report a case of large scapular chondrosarcoma in a 53-year-old male, and the case was successfully treated with Malawer limb salvage surgery without any residual or positive margin. The patient was on regular follow-up with a well-preserved anatomical function of the shoulder girdle and without any recurrence of the disease after 24 months of surgery.
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