Neo-adjuvant chemotherapy in locally advanced breast cancer: a retrospective analysis from tertiary care centre

Introduction: Breast cancer is the most common cancer in women in India. The incidence of LABC is 30%-40% in developing countries as compared to developed countries, lack of awareness and screening programmes in developing countries are supposed to be main contributor of this increase incidence. The use of neoadjuvant chemotherapy in locally advanced breast cancer has shown benefits in down staging of tumors, and increases the rate of breast conserving surgeries

Aim: The aim was to compare response rate [clinical and pathological], the disease free survival, and overall survival in two chemotherapy regime

Methods: Medical records of 415 patients diagnosed with invasive breast cancer were analysed. One hundred and seventy five patients received neo-adjuvant chemotherapy. They were divided in two groups, sequential therapy with 4 cycles of anthracycline followed by 4 cycles of docetaxal were in group 1 as compared to those who received anthracycline based chemotherapy were allocated in group 2

Results: Sequential NACT with AC-D showed better disease free survival and overall survival in comparison to anthracycline based NACT

Conclusion: Locally advanced breast cancers have shown good response with taxane based sequential chemotherapy

Development of OMP based indirect ELISA to gauge the antibody titers in bovines against Pasteurella multocida

Pasteurella multocida [P. multocida] is an important pathogen of various domestic animals. The outer membrane proteins [OMPs] play a major role in pathogenesis and immunogenicity of P. multocida. The aim of the study was to develop indirect enzyme linked immuno sorbant assay [ELISA] based on OMPs to ascertain the antibody titers in animals post-infection or to gauge the potency of vaccine. The OMPs were extracted and purified from P. multocida P: 52 [vaccine strain] and P. multocida B: 2 isolated from natural outbreak of Haemorrhagic septicaemia [HS] and analyzed on SDS PAGE and through western blot. The OMPs profile of the vaccine strain and the isolate from the natural outbreak of HS were found to be similar. Optimization of various components viz. coating antigens, anti-species conjugate, etc. were carried out against both anti-P. multocida hyper immune and pre immune serum. Validation of OMP based indirect ELISA assay to measure immune response against P. multocida in bovine revealed 91% diagnostic sensitivity [DSN] and about 100% diagnostic specificity [DSP] at 25% cut off. OMP based indirect ELISA was found to be more specific, but less sensitive as compared to WCL based assay

Robot assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

The treatment options in clinical stage 1 nonseminomatous germ cell tumor [NSGCT] of testis are either surveillance, chemotherapy or retroperitoneal lymph node dissection [RPLND]. While open RPLND still serves as the gold standard, laparoscopic and robot assisted laparoscopic approaches are gaining popularity. In this report, we share our experience and technique of robot assisted laparoscopic RPLND in a patient with clinical stage 1b NSGCT of testis

Sciatic nerve division: a cadaver study in the Indian population and review of the literature

<p><b>INTRODUCTION</b>The sciatic nerve is the largest nerve, with a long course in the inferior extremity. Its division into the tibial and common peroneal nerves can occur at any level from the sacral plexus to the inferior part of the popliteal space. These anatomical variations may contribute to clinical conditions such as piriformis syndrome, sciatica and coccygodynia.</p><p><b>METHODS</b>This study was performed on cadavers in order to study the level of sciatic nerve division. The inferior extremities of 43 cadavers were classified into six groups depending on the level of sciatic nerve division in the gluteal region, the upper, middle and lower parts of the back of the thigh, and the popliteal fossa.</p><p><b>RESULTS</b>The highest incidence of sciatic nerve division (40.7 percent) was observed in the lower part of the posterior compartment of the thigh. In 34.9 percent of the specimens, the sciatic nerve was divided into tibial and common peroneal nerves in the popliteal fossa. 16.3 percent of extremities showed sciatic nerve division proximal to its entrance in the gluteal region.</p><p><b>CONCLUSION</b>In sciatic nerve neuropathies, the extent of neurological deficits depends on the level of sciatic nerve division. Sciatic nerve division into tibial and common peroneal components at a higher level can result in the involvement of only one out of the two divisions from sciatic neuropathy. It can also result in a failure of the sciatic nerve block while performing popliteal block anaesthesia.</p>

Heavy metal contamination and its indexing approach for river water

The objective of the study is to reveal the seasonal variations in the river water quality with respect to heavy metals contamination. To get the extend of trace metals contamination, water samples were collected from twelve different locations along the course of the river and its tributaries on summer and the winter seasons. The concentrations of trace metals such as cadmium, cromium, copper, cobalt, iron, manganese, nickel, lead, mercury and zinc were determined using atomic absorption spectrophotometer. Most of the samples were found within limit of Indian drinking water standard [IS: 10500]. The data generated were used to calculate the heavy metal pollution index of river water. The mean values of HPI were 36.19 in summer and 32.37 for winter seasons and these values are well below the critical index limit of 100 because of the sufficient flow in river system. Mercury and chromium could not be traced in any of the samples in the study area

Lymphoepithelioma-like carcinoma of the urinary bladder: report of a rare case

Lymphoepithelioma-like carcinoma [LELC] is a rare malignant neoplasm in the urinary bladder, which can histologically mimic lymphoma, poorly differentiated invasive transitional cell carcinoma or poorly differentiated squamous cell carcinoma with a lymphoplasmacytic background. A urinary bladder tumor was identified in a 65-year-old man suffering from hematuria for several weeks. Transurethral biopsy revealed an undifferentiated tumor with prominent lymphocytes and plasma cell infiltration. Immunohistochemical evaluation showed positive staining for cytokeratin and epithelial membrane antigen. Subsequent radical cystectomy showed pure LELC. We present the case to highlight the significance of recognizing this unusual bladder tumor and discuss the important differential diagnosis, treatment options and prognosis

Teratogenic effects of the anticonvulsant gabapentin in mice

<p><b>INTRODUCTION</b>We aim to study and elucidate the safety profile of the antiepileptic doses of gabapentin during pregnancy, and to evaluate gabapentin-induced murine fetotoxicity at different dose levels.</p><p><b>METHODS</b>A total of 60 pregnant mice, divided into 12 groups of five mice each, were exposed to gabapentin in four different doses of 0 (control), 113, 226, or 452 mg/kg body weight per day, at three different gestational stages including early gestation (1-6 days), mid-gestation (7-12 days), and late gestation (13-17 days). The pregnant mice were euthanized on day 18 of gestation, and foetuses were examined for teratogenic manifestations. Their brains were dissected and examined for gross changes, malformations, histological changes, and quantitative protein estimation.</p><p><b>RESULTS</b>Foetal resorptions were observed in all treated groups with gabapentin administration at early gestation (1-6 days), and mid-gestation (7-12 days). On the other hand, growth retardation along with stunting in size of live foetuses were observed in all the mid-gestation (7-12 days), and late gestation (13-17 days) treated groups. Various gross malformations were observed with all the three doses (113, 226, and 452 mg/kg body weight per day) when gabapentin was administered at mid-gestation (7-12 days). The same trends were confirmed by gross and microscopic examination of brains along with quantitative protein estimation.</p><p><b>CONCLUSION</b>Gabapentin should not be prescribed during pregnancy, as no therapeutic dose of gabapentin is safe during this period as far as the foetal well-being is concerned.</p>

Cadavers as teachers in medical education: knowledge is the ultimate gift of body donors

In most of the medical colleges in India, unclaimed bodies from various mortuaries reach the dissection hall; and here, the body donors club has yet to gain the desired dimensions. In spite of all the adverse circumstances, the cadaver and the dissection both have survived the most rigorous test of pedagological fitness--the test of time. Today, many of the Western countries have long donor waiting lists where cadavers are acquired as anatomical gifts or through body donor programmes. Thailand's approach to body donors offers a role model for resolving the present situation. The spirit of volunteerism reflects the drastic shift in public perception and a global change in approach is needed in the present time.

Lamotrigine in pregnancy: safety profile and the risk of malformations

The use of antiepileptic drugs in pregnancy always presents challenges to doctors and their patients as it may have deleterious effects on the developing embryo. Lamotrigine is most commonly-prescribed drug among the newer antiepileptic drugs; hence, it has been selected for the present review. A number of studies pertaining to the safety of lamotrigine use during pregnancy have been reported, with differing results. Contradictory results have been reported in animals regarding lamotrigine teratogenicity, and human studies have also proven inconclusive. In many countries, human pregnancy registries are maintained to establish the safety of antiepileptic drugs during pregnancy, as all the different suggestions favour some over others, with specific antiepileptic combinations still being questioned. It is our hope that the present work may integrate the available disparate relevant facts into a directed effort towards minimising the risk of foetal compromise.

A variation of the phrenic nerve: case report and review

During routine dissection in the department of anatomy, the following anatomical variations of the phrenic nerve were observed on the right side of the neck of a 30-year-old male cadaver. The phrenic nerve, in its early course close to its origin, gave a communicating branch to the C5 root of the brachial plexus. At the level of the root of neck just before entering the thorax, the phrenic nerve was located anterior to the subclavian vein. This unique case of phrenic nerve variation gains tremendous importance in the context of subclavian vein cannulation, implanted venous access portals, and supraclavicular nerve block for regional anaesthesia.

Psoriasis and atopy

In an attempt to correlate psoriasis and atopy, personal and family history of atopy together with serum total immunoglobulin E [IgE] levels and peripheral blood absolute eosinophilic counts [AEC] were investigated in 50 Libyan patients with psoriasis [Sex: 21 males, 29 females; age: 12-60 years]. A random group of 100 subjects and their first degree relatives was included as 'control subjects' for comparing the prevalence of atopy. The serum total IgE levels and AEC in psoriatic patients were compared with a control group of 70 healthy subjects [Sex: 35 males, 35 females; age: 19-44 years]. Further comparison was mode with a group of 30 non-psoriatic patients with one or more atopic manifestations [Sex: 7 males, 23 females; age: 13-40 years]. Although 17 [34%] and 9 [18%] psoriatic patients gave personal history and only family history of atopy respectively, these were found to be similar to these of control subjects [P > 0.01]. No difference was also observed regarding the prevalence of atopy in first degree relatives of psoriatic and controls [P > 0.25]. Both serum IgE levels and AEC in psoriatic as well as atopic patients were significantly higher than in controls [Controls vs psoriatics - IgE: P < 0.005, AEC: P < 0.001; Controls vs atopics - IgE P < 0.05, AEC: P < 0.001], but no differences were noted between psoriatics and atopics [P > 0.5]. These changes in IgE levels and AEC in psoriatics were found to be independent of history of atopy as well as severity of the disease suggesting that there is no relation between psoriasis and atopy

Dandruff in Benghazi

In a dermatology clinic in Benghazi, 10.9% out of 1000 consecutive cases were labeled as dandruff. It was suspected that this high rate may have been due to misdiagnosis of other causes of excessive scaling, such as seborrheic dermatitis and psoriasis. This paper attempts to define what really constitutes dandruff to help the general practitioner in reaching the right diagnosis in such cases

Warts - a review of literature

Several types warts in man have been recognized and classified, primarily according to the shape or the location of the lesion. A discussion of the viral agent responsible, the natural history of the ailment, and possible therapeutic measures, is presented