Radiotherapy and geriatric cancer patients: A single institute experience

OBJECTIVES:The aim of this study was to study patient, disease, and treatment related characteristics in geriatric patients 65 years and older treated by Radiotherapy (RT).MATERIAL AND METHODS:A retrospective observational and descriptive study was conducted in a tertiary care gov- ernment institute with academic and research potential. The electronic medical records, medical documents, and Radiotherapy treatment charts were retrieved and studied.RESULTS:247 patients aged 65 years and older were included over 2-year study period. Mean age was 70.3 years and the oldest patient treated was of 94 years. 66% patients were males. 82 patients (33%) had metastatic disease. The common sites of origin were head and neck (28%), lung (23%), genitourinary (20%), and gastrointestinal malig- nancies (15%). 125 patients (51%) were having one or more co-morbidities. 135 patients (55%) were treated with radical intent. 66 patients (27%) received chemotherapy in concurrent setting. 89 patients (36%) were hospitalized for some duration of their RT course. In 58 patients (23%), RT was interrupted briefly. 46 patients (19%) could not complete the prescribed RT. 8 patients (3%) developed Grade 3 and 4 hematological toxicities. 57% patients developed Grade 2,3 mucocutaneous toxicities. 53% patients developed Grade 2,3 GI toxicities. Mortality rate while on treatment was 4%.CONCLUSION:Geriatric patients, though more prone to develop systemic and site-specific toxicities warranting supportive care in indoor or outdoor setting, can be offered Radiotherapy either alone or concurrently with che- motherapy. Such patients present with heterogeneous spectrum of entities often posing a therapeutic challenge to clinicians; but proper selection of cases and diligent supervision may allow these patients to be treated with Radiotherapy with radical or palliative intent as indicated.

Prevalence of multidrug-resistant tuberculosis among Category II pulmonary tuberculosis patients.

Background & objectives: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant global health concern. The most important risk factor for the development of MDR-TB is previous anti-tuberculosis therapy. Category II pulmonary TB includes those patients who had failed previous TB treatment, relapsed after treatment, or defaulted during previous treatment. We carried out this study to ascertain the prevalence of MDR-TB among category II pulmonary TB patients. Methods: This was a cross-sectional, descriptive study involving category II pulmonary TB patients diagnosed between 2005 and 2008. All sputum-positive category II TB cases were subjected to mycobacterial culture and drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 196 cases of sputum-positive category II pulmonary tuberculosis patients were included. Of these, 40 patients (20.4%) had MDR-TB. The mean age of MDR-TB patients was 33.25 ± 12.04 yr; 9 patients (22.5%) were female. Thirty six patients showed resistance to rifampicin and isoniazid; while 4 patients showed resistance to rifampicin, isoniazid and streptomycin. The prevalence of MDR-TB among category-II pulmonary tuberculosis patients was 20.4 per cent. Interpretation & conclusions : The prevalence of MDR-TB in category II TB patients was significant. However, nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. We stress the importance of continuous monitoring of drug resistance trends, in order to assess the efficacy of current interventions and their impact on the TB epidemic.

Prevalence of multidrug-resistant tuberculosis among newly diagnosed cases of sputum-positive pulmonary tuberculosis.

Background & objectives: The prevalence of multidrug-resistant tuberculosis (MDR-TB) is increasing throughout the world. Although previous treatment for TB is the most important risk factor for development of MDR-TB, treatment-naïve patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains. We sought to ascertain the prevalence of MDR-TB among new cases of sputum-positive pulmonary TB. Methods: This was a prospective, observational study involving newly diagnosed cases of sputum-positive pulmonary tuberculosis diagnosed between 2008 and 2009 carried out in New Delhi, India. All sputum-positive TB cases were subjected to mycobacterial culture and first-line drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 218 cases of sputum-positive pulmonary tuberculosis were enrolled between 2008 and 2009. Of these, 41 cases had negative mycobacterial cultures and DST was carried out in 177 cases. The mean age of the patients was 27.8 ± 10.2 yr; 59 patients (27%) were female. All patients tested negative for HIV infection. Out of 177 cases, two cases of MDR-TB were detected. Thus, the prevalence of MDR-TB among newly diagnosed pulmonary tuberculosis patients was 1.1 per cent. Interpretation & conclusions: MDR-TB prevalence is low among new cases of sputum-positive pulmonary TB treated at primary care level in Delhi. Nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. Efforts should be directed towards continued surveillance for MDR-TB among newly diagnosed TB cases.

Physical growth and nutritional status of Garhwali girls.

OBJECTIVE: The present study was conducted to evaluate physical growth and nutritional status of 214 school-going girls ranging in age from 5 to 12 years of rural area in Pauri Garhwal district of Uttaranchal. METHODS: Physical growth was evaluated using eleven standard anthropometric measurements viz., height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold. To assess the nutritional status, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated using NCHS standards. RESULTS: It has been observed that the well nourished Indian girls and American girls show better performance in physical growth parameters as compared to the Garhwali girls at all ages. The Garhwali girls were found to be comparable with rural Indian girls in their growth status. Grade-I and Grade-II malnutrition was prevalent among the Garhwali girls, however, Grade-III malnutrition was found to be present in only a few girls. CONCLUSION: This average to poor nutritional status of the present Garhwali girls may be attributed to low dietary intake, low-middle socio-economic background, uneducated or partially educated parents, large family size, gender discrimination etc.