Information and rehabilitation needs of Indian breast cancer patients: Report of a cross-sectional study.

Background: Breast cancer causes significant disruption to the quality of life (QOL) of its patients, which is compounded further by lack of information and adequate facilities for rehabilitation. Materials and Methods: This descriptive cross-sectional study was conducted in women who had completed their Primary treatment of breast cancer. The QOL was assessed by Functional assessment of cancer therapy-breast (FACT-B) version 4, and information and rehabilitation needs were enquired about in a semi-structured interview. Results: A total of 154 patients were enrolled and divided into three groups according to the time elapsed after initial treatment; Group I: 1-2 years, Group II: 2-5 years, Group III: >5 years The FACT-B mean scores were; Group I (n = 64): 79.06 ± 14.60; Group II (n = 48): 85.75 ± 20.15; and Group III (n = 42): 89.83 ± 12.80. Patients in Group I scored lowest on physical well-being subscale, Group II on breast specific subscale and Group III on Social well-being subscale. Pain, lack of energy, inability to meet the needs of the family, fear that the condition will get worse and loss of body image were significant factors contributing to poor QOL. Analysis of interviewshowed many unmet information needs. Main rehabilitation needs were effective treatment of physical symptoms and counselling about body image issues and sexual dysfunctions. Easy availability of clinical and social support services were major felt needs in the long-term follow-up. Conclusions: Targeted Interventions are needed to address issues relating to QOL and rehabilitation needs of breast cancer patients.

Role of anti cyclic citrullinated peptide antibodies in erosive disease in patients with rheumatoid arthritis.

BACKGROUND & OBJECTIVES: Antibodies to cyclic citrullinated peptide (CCP) are a recently described marker in rheumatoid arthritis (RA), which are said to connote aggressive disease. No data on these antibodies are available from India. We undertook this study to evaluate the role of second generation anti CCP antibodies (anti CCP-2) in predicting erosive disease in Indian patients with rheumatoid arthritis and to define their role in seronegative RA. METHODS: A total of 211 patients with established RA were evaluated in this cross-sectional study for radiographic erosions. A high percentage of seronegative RA patients (40%) were included to assess the role of anti CCP-2 antibodies in this subgroup. Radiographic damage was quantified using modified Sharp score. Apart from anti CCP-2 antibodies, other factors evaluated for their ability to predict erosions included rheumatoid factor (RF) positivity, disease duration, and disease modifying anti rheumatic drugs (DMARD) naïve period. RESULTS: Anti CCP-2 antibodies were seen in 80 per cent patients with RA. Predictors of erosive disease included anti CCP-2 antibody positivity and DMARD naïve period. Patients positive for both RF and anti CCP-2 antibodies had a higher prevalence of erosions as compared to patients positive for only one antibody or negative for both. In seronegative RA (RF absent), anti CCP-2 antibodies were seen in over 50 per cent patients and were associated with a higher incidence of erosive disease. INTERPRETATION & CONCLUSION: Our finding showed that anti CCP-2 antibodies were present in 80 per cent patients with established RA. These have an independent role in predicting erosive disease, especially in the seronegative subgroup.

Transfusion associated infections: a threat to life.

Blood transfusion is indispensable in the management of many haematological diseases and has become the mainstay in major surgical procedures. Transfusion-transmitted infections have been a major threat to life since the dawn of transfusion therapy. The authors have highlighted the different viral, parasitic and bacterial infections associated with transfusion and have focussed on the precautionary measures that can be implemented for prevention of the infections along with a brief review of the literature.

Bacteriological study of Indian cheese (paneer) sold in Chandigarh.

A study was conducted to isolate and identify bacterial pathogens/contaminants in paneer samples sold in Chandigarh. Fifty eight samples of paneer bought at random were cultured on several media. Bacterial colony counts were also done. The predominant organisms isolated were Staphylococcus species, aerobic spore bearers, Klebsiella pneumoniae, Campylobacter jejuni, Acinetobacter species and Streptococcus species. The viable bacterial counts obtained ranged from 3 x 102 to 9.7 x 1010 CFU/mL. Contamination of paneer by pathogenic bacteria could be an important factor of gastrointestinal illnesses in the consumers.

Oncoprotein c-erbB-2 in squamous cell carcinoma of the uterine cervix and evaluation of its significance in response of disease to treatment.

Tissues from 50 cases of squamous cell carcinoma of the uterine cervix were analysed for immunohistochemical expression of c-erbB-2 oncoprotein and the patients were followed-up for 2 years. Immunopositivity of c-erbB-2 was studied with reference to clinical stage, histopathological differentiation and response to the cancer therapy. Expression of c-erbB-2 protein was found to be higher (37.5%) in cases with stage II disease, whereas more expressions were noticed in poorly differentiated squamous cell carcinoma (33.3%). Among cases who showed complete response to the treatment, 20.8% were positive for c-erbB-2 oncoprotein. On the contrary, 36.8% of prognostically unfavourable cases revealed positivity for c-erbB-2 immunostaining. However, the difference between c-erbB-2 expressions of these two said groups of patients, which were divided in accordance with the response to treatment, did not attain to statistical significance. Study on c-erbB-2 among larger number of patients with cervical carcinoma may prove to be an important factor in response to cancer therapy.

Prevalence of hepatitis B virus infection in Chandigarh over a six year period.

A total of 6418 samples were received between January 1993 to December 1998 from patients with hepatitis. Blood samples were also collected from 946 apparently healthy subjects. All these samples were tested for Hepatitis B surface antigen (HBsAg) by third generation micro ELISA. The overall HBsAg prevalence rate was 12.8%. The highest prevalence was noted in renal transplant patients (21.7%) followed by patients with acute hepatic disease (15.3%), pregnancy with jaundice (9.4%), chronic renal failure (8.8%), nephrotic syndrome (3.1%), whereas the prevalence rate in control group was 2.4%. The prevalence rate of HBsAg was higher in subjects between 21 to 30 years of age with a male preponderance (Male:Female = 2.8:1).

Experience of human rabies in north India.

Rabies is one of the most common causes of human encephalitis in developing countries. This study shows the diagnosis of rabies among suspected human rabies encephalitis cases by Seller stain, Flourescent stain as well as mouse inoculation test. Out of 71 postmortem brain specimens, 26 were diagnosed as rabies positive. Negri bodies were demonstrated in 18 (25.4%) brain saples by Seller stain. Flourescent antibody technique could detect rabies antigen in 21 (29.6%) samples. Rabies virus could be isolated in 15 (42.9%) of the 35 samples by intracerebral inoculation in 15 (42.9%) of the 35 samples of intracerebral inoculation in newborn Swiss albino mice. Of the 26 confirmed cases, 61.5% occurred during the months of June to August and history of dog bite was present in 9 (34.6%) cases.

Changing scenario of cryptococcosis in a tertiary care hospital in north India.

BACKGROUND & OBJECTIVES: With the increase in the number of patients of AIDS, the incidence of cryptococcosis is on the rise in India. It was therefore considered important to evaluate the predisposing factors, laboratory investigations and outcome of patients with cryptococcosis in this changed scenario. METHODS: We assessed 58 patients with cryptococcosis retrospectively over a five year period (January 1995-December 1999) at the Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. RESULTS: The annual incidence of cryptococcosis in PGIMER, Chandigarh has increased about 15 fold from 1970-1982 (pre AIDS era) to 1995-1999 (present series). Of the 47 patients studied for predisposing factors, 36 patients were identified with predisposing factors, HIV infection (57.4%) was the commonest followed by haematologic malignancies (6.3%) and renal transplant (4.2%). Forty one patients were diagnosed by isolation of the organism as well as antigen detection in cerebrospinal fluid/serum, 9 by isolation alone and 8 by antigen detection alone. Quantitative antigen titres were done in 38 patients and a significantly higher (P < 0.01) antigen titre (> 512) was observed in HIV positive patients as compared to HIV negative patients. All isolates tested were of Cryptococcous neoformans var neoformans biotype and no resistance to antifungal agents was noted. Twenty of 41 patients receiving treatment improved. The results were compared with other studies available from India. INTERPRETATION & CONCLUSION: The incidence of cryptococcosis is on the rise in this part of north India and this can be attributed to an increase in AIDS cases.

Evaluation of transperineal template implant technique in Indian cervical carcinoma patients.

The prognosis in advanced cervical cancer patients is poor specially in presence of distorted anatomy, gross residual growth etc. In these cases template implant offers good option for treatment. We have carried out the procedure in 19 patients with acceptable level of complication. Preliminary results have been described.