ABSTRACT
BACKGROUND: Gemcitabine plus cisplatin has been established as a standard chemotherapy regimen for advanced biliary tract cancers (BTCs) based on the phase III UK ABC-02 study, which included all types of biliary cancers. There is very limited data regarding the effectiveness of known chemotherapeutic regimens especially in IHCC. METHODS: Records of 63 patients diagnosis of IHCC who received Gemcitabine and Carboplatin (G-C Regimen) chemotherapy as a first line were retrospectively reviewed. The primary aim of this study was to assess the response rate of gemcitabine carboplatin-based chemotherapy as a first line therapy in advanced intrahepatic cholangiocarcinoma (IHCC). The secondary objectives were to assess toxicity, progression free survival and overall survival. RESULTS: There were 38 men and 25 women in our study with a median age of 56.75 years (range 31–78 years). Of the 38+25= 63 patients, 21 patients (33.8%) progressed, 5 patients (8.06%) had complete response, 25 patients (40.3%) had partial response, 12 patients (19.3%) had stable disease. Overall response rate was 48.36% and tumor control rate was 67.6%. Progression free survival was 5.3 months and overall survival of 10.3 months was seen. The most common grade 3–4 toxicities were anemia, neutropenia, and thrombocytopenia. Most common nonhematological toxicity was fatigue. CONCLUSION: Gemcitabine in combination with carboplatin has activity against advanced IHCC. Our results are comparable with other gemcitabine carboplatin studies as well as gemcitabine cisplatin-based studies.
ABSTRACT
Background & objectives: Bisphosphonates (BPs) are the most widely prescribed medicines for the treatment of osteoporosis because of their efficacy and favourable safety profile. There have been, several reports on an increased incidence of atypical femoral fractures after long term treatment with BPs. The objective of this study was to evaluate the clinical presentation including prodromal symptoms, skeletal radiograph findings, type and duration of BPs received and treatment outcome of patients who developed atypical femoral fractures during bisphosphonate therapy. Methods: In this retrospective study, eight patients with atypical femoral fractures were analysed based on clinical features, biochemical and radiological investigations. Results: Of the eight patients, who sustained atypical femoral fractures, six were on alendronate and two were on zoledronate therapy before the fractures. In addition to BPs, two patients were on long term corticosteroid therapy for rheumatoid arthritis and Addison’s disease. Three patients had bilateral atypical femoral fractures. Except one, all of them had prodromal symptoms prior to fracture. Skeletal radiograph showed cortical thickening, pointed (beaking of) cortical margin and transverse fracture in meta-diaphyseal location. Serum calcium, phosphate, alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) concentrations were within the reference range in all patients. Interpretation & conclusions: Long term bisphosphonate therapy may increase the risk of atypical femoral fractures. Presence of prodromal pain, thickened cortex with cortical beaking may be an early clue for predicting the atypical fractures. High risk patients need periodical skeletal survey and a close follow up for early detection of cases.
Subject(s)
Health Policy/trends , Humans , India , National Health Programs , Preventive Health Services , Public Health/trendsABSTRACT
Clonazepam is a benzodiazepine with prominent anticonvulsant action than other members of the group at equisedating doses. It especially blocks pentylenetetrazole-induced seizures. Other important actions include anxiolysis. Common adverse effects to Clonazepam include drowsiness and lethargy. In this submission we report a case of Clonazepam induced maculopapular rash in a 30 year old female treated for panic disorder.
ABSTRACT
Background: There is an enormous health burden caused by the co-prevalence of tuberculosis (TB) and tobacco use in India. This intervention study was undertaken in district Vadodara, Gujarat, India to promote tobacco cessation by integrating 'brief advice' for tobacco cessation in TB patients who were tobacco users and registered for treatment under TB control programme, based on the tested strategies advocated by World Health Organization (WHO) and the International Union against Tuberculosis and Lung Diseases (The Union). Materials and Methods: Brief advice for tobacco cessation based on five A's, advocated by the WHO and the UNION was incorporated into the on-going TB Control programme in India in the year 2010. The tools were developed for education, training and capturing data. All the registered TB patients receiving directly observed treatment short-course (DOTS) who used tobacco in any form were offered brief advice during routine interaction for treatment. Results: A total of 46.3% of TB patients, predominantly males (89.6% males and 10.3% females) were current users of tobacco; 39.1% used smokeless tobacco, 35.9% were smokers and 25% were dual users, that is, smoked as well as used smokeless tobacco. At the end of treatment, of the 67.3% patients who were offered brief advice, quit tobacco use, 18.2% re-lapsed while 14.5% were lost to follow-up. Conclusion: A significant numbers of TB patients use tobacco with adverse impact on TB control programmes. Our study shows that it is feasible to introduce 'brief advice' strategy as a cost effective intervention for tobacco cessation among TB patients with careful monitoring.
ABSTRACT
The fungal infections have become a persistent health problem, still always remain under reported. A change in species distribution has been observed now a days with the emergence of many non-albicans candida species. Our study aimed at evaluating the incidence of invasive Candidiasis [Candida albicans and non-albicans] and to assess the risk factors and predictors of mortality in seriously ill patients. This prospective, observational study was conducted at Division of Intensive Care Unit, Institute of Medical Science, BHU, Varanasi [India], during the period of 2009 to 2011. Patients with >8 out of 16 risk factors, e.g. prolonged antibiotic use, IV cannulation, steroid use etc, Candida scores [CS] > 2, Age >12 years and ICU stay >2 days were included in the study. Those with Candida scores > 3 were prophylactically given fluconazole. A case report performa was completed for each patient, including demographic characteristics, dates of hospital and ICU admission and of discharge, vital sign status at discharge, previous treatment with antibiotics or immunosuppressive agents, presence of risk factors. Patients were followed till discharge from the ICU or death. Candida was isolated from blood in 53/206 patients. The P-value calculated in five risk groups, e.g. diabetics, patients receiving TPN, neutropenic patients, HIV and malignancy was significant [P<0.05]. For all other risk factors P-value was >0.05. Over half of the Candida isolates recovered from blood were non-albicans species. The overall mortality in candidaemia patients was 37/53 [69.81%]. Mortality was low with Candida tropicalis [57.7%] but number of patient was high among candida species. Multiple risk factors were found to be associated with invasive fungal infection in critically ill patients. In the ICU population studied, candidemia was due to non-albicans spp. The importance of Candida scores on predicting mortality was also observed