Thyroid dysfunctions and autoimmunity in breast cancer patients: a prospective case-control study

ABSTRACT Objective: The relationship of thyroid dysfunction and autoimmunity with breast cancer (BC) continues to be contentious. The primary aim of this study was to estimate the prevalence of thyroid dysfunctions and autoimmunity in BC patients, and the secondary aims were to investigate the relationship of thyroid dysfunction with the clinicopathological profile of and therapy received by BC patients. Materials and methods: This was a single-center prospective case-control study (March 2015-May 2017). Women with BC (n = 191), age-matched healthy controls (n = 166) and malignant controls (patients with cervical cancer, n = 87) were enrolled. Basal serum free thyroxin (fT4), thyrotropin (TSH) and anti-thyroid peroxidase (TPO) antibody levels were measured in all three groups; fT4, TSH and TPO measures were repeated after chemotherapy and at the 1-year follow-up (one year after diagnosis) in the BC patients. Results: The prevalence of overall hypothyroidism and autoimmunity (p = 0.106) did not differ significantly between the three groups, but the rate of clinical hypothyroidism was significantly higher in the BC group than in the healthy control group and the malignant control group (12.2% vs. 3.0% vs. 4.6%, respectively; p = 0.001). BC patients had significantly lower mean basal TSH concentrations than the healthy controls (p = 0.017). The postchemotherapy TSH concentrations were significantly lower (p = 0.001), and the fT4 concentrations were higher, albeit not significantly (p = 1.00), than the respective basal concentrations. The reverse was true for the follow-up values, in which the TSH (p = 1.00) values were higher and the fT4 (p = 0.03) concentrations were lower than the respective basal concentrations. An additional 6% of the BC patients developed clinical hypothyroidism during follow-up. Hypothyroid (p = 0.02) and TPO-positive (p = 0.004) patients had significantly smaller tumors, but their other clinicopathological features were comparable to those without thyroid dysfunction. Conclusions: The prevalence of clinical hypothyroidism requiring thyroxine replacement was significantly high in BC patients and increased further during follow-up. Hence, BC patients should be considered a high-risk group that should receive routine screening for hypothyroidism.

Sale and Consumption on Smokeless Tobacco in Jammu and Kashmir, India: Attitude and Views of Jammu Adult Population

Background: Concerned over increasing cases of mouth cancer in the state, the Jammu and Kashmir Government hasbanned the smokeless tobacco (ST) products like gutkha and also increased the taxes in other tobacco-related products.Despite legislation, the effectiveness of this step is a matter of concern. The gutka users are able to get their regular supplyand shopkeepers are still seen selling gutka pouches.Objective: The objective of this study was to assess the attitude and views of Jammu adult population toward the sale andconsumption on ST by Jammu and Kashmir Government.Materials and Methods: A cross-sectional survey was carried out among the general adult population of Jammu city. 400respondents completed a questionnaire on tobacco use, knowledge of existence of law, health warning, cost increase, andhazards related to ST.Results: Half of the current users (51.6%) surveyed compared to the past users (61.4%) and non-users (69.7%) had knowledgeabout laws on gutka products. Significantly higher percentage of the current users (52.1%) and past users (57.9%) indicatedthat the actions against tobacco products would be slightly effective (P < 0.05). 52.5–68.4% of respondents were aware ofhealth warning signs printed on the tobacco packet. 59.1% of the current users reported easy availability of gutka. The pastusers (54.4%) reported an increase in black marketing of ST gutka.Conclusion: The sale and consumption ban and increased taxes by the government are an effective measure for the improvementof health and reduce consumption. They demonstrate that there is a need for greater public education and the policy has beenlagging behind to curb the black market sale.

Chryseobacterium Indoloegenes Meningitis in a Patient with Ventriculo-peritoneal Shunt.

Chryseobacterium indologenes organism is mostly confined to water and soil and has been isolated from patients in hospitals with severe underlying disease with indwelling devices and implants. Despite its low virulence, it has been found to be inherently resistant to many antibiotics. A rare case of meningitis was reported by C. indologenes in an 18-year-old patient treated for hydrocephalous with meningitis with an indwelling ventriculoperitoneal shunt, who was successfully managed with levofloxacin and gentamicin and discharged. This case report describes identification and isolation of C. indologenes on the basis of biochemical and microbiological analysis along with clinical signs and symptoms of meningitis with an indwelling ventriculoperitoneal shunt.

Pediatric and Adolescent Pheochromocytoma: Clinical Presentation and Outcome of Surgery.

Objectives: To describe the clinical presentation and outcome of surgery in children with pheochromocytoma in a tertiary care hospital in India. Methods: Clinical records of 24 children who were operated between January 1990 and January 2011 were reviewed. The diagnosis of familial disease was established based on clinical examination and follow-up events. Results: Familial, bilateral, extra-adrenal and malignant pheochromocytoma were observed in 20.8%, 20.8%, 12.5% and 4.2% children, respectively. Median follow-up duration was 36 months. Persistent hypertension was noted in 12.5% patients and similar proportion died in follow-up. Conclusions: In the absence of routine genetic screening, good history and long- term follow up are essential to rule out familial pheochromocytoma.

Rathke's cleft cyst--an uncommon cause of headache in a young boy.

Developmental disorders of the pituitary can present like a mass lesion in the region of the pituitary and produce pressure effects. Rathke's cleft cyst is one such developmental disorder of the pituitary which presents in early life producing pressure effects namely visual disturbances due to its proximity to optic chiasma, headache, and hormonal imbalance due to pituitary malfunction. In this case report a 19 years boy presented with symptoms of headache and gradual loss of vision over one year period. Neuro-imaging study demonstrated a cystic lesion in the region of the pituitary. Trans-sphenoidal hypophysectomy was performed. Histopathology of the biopsied material was suggestive of Rathke's cleft cyst. Following surgery the boy had a good visual recovery. So early diagnosis and removal of a Rathke's cleft cyst has a good prognosis as compared to a craniopharyngioma which is a very close differential diagnosis.

Isolated Primary Tubercular Prostatic Abscess presenting as Pyrexia of unknown origin.

The genito-urinary tract is a common site of involvement in extra-pulmonary tuberculosis. However, an isolated tubercular abscess in the prostate with no evidence of disease elsewhere in the urinary tract is extremely uncommon unless the patient is immuno-compromised. We report an extremely rare instance of an isolated prostatic abscess presenting solely as pyrexia of unknown origin in a young male with no evidence of immuno-suppression.

Oxyphilic cell adenoma of parathyroid resulting in primary hyperparathyroidism and osteitis fibrosa cystica--a case report.

Adenomas of the parathyroid gland, the majority of which are of the solitary chief cell type, are the most frequent cause of primary hyperparathyroidism (pHPT). Parathyroid adenomas composed predominantly or exclusively of oxyphil cells are rare and most oxyphil cell adenomas of this organ remain clinically silent. We present here a case of hyperfunctioning oxyphil cell adenoma of the parathyroid gland resulting in pHPT, osteitis fibrosa cystica and simultaneous bilateral fractures upper shafts of femora.

Water-clear cell adenoma of the parathyroid gland: a rare entity.

Water-clear cell hyperplasia is a rare but well-documented cause of primary hyperparathyroidism. Parathyroid adenomas of water-clear cell type are exceptionally rare, and only five case reports are available at present in the medical literature. We report an additional case of water-clear cell adenoma of the parathyroid gland, and the differential diagnoses are discussed.