Pneumocystis carinii pneumonia in HIV infected patients from Mumbai.

OBJECTIVE: Pneumocystis carinii pneumonia (PCP) is believed to be rare in the developing world and no large prospective Indian series have been reported to date. The present study was conducted to study the clinical profile and outcome of PCP in patients with HIV infection. METHODS: All HIV positive patients with PCP admitted over 4 years (2000-2003) to a tertiary referral centre in Mumbai were prospectively studied. RESULTS: There were 38 patients with proven PCP from 300 HIV admissions. The patients with PCP were predominantly male (M: F = 5.4:1), with a mean age of 40.1 years. The median CD4 count of the PCP group was 96 cells/microL. Bronchoscopy was needed to make a definitive diagnosis in 17 of the 38 patients. PCP co-existed with tuberculosis in 4 of the 38 patients. The mortality of the group was high at 15.8% with all patients needing ventilatory support dying. CONCLUSIONS: PCP is not an uncommon infection in Indians with advanced HIV. Lack of recognition has probably been responsible for the absence of any large series from this country. In our series of hospitalised HIV positive patients, PCP was the second commonest pulmonary disease after tuberculosis accounting for 32% of pulmonary admissions and 13 % of all HIV positive admissions.

High incidence of oestrogen receptor negative progesterone receptor positive phenotype in Indian breast cancer: fact or fiction?

The incidence of oestrogen receptor negative and progesterone receptor positive (ER-/PR+) invasive breast carcinoma is reported to be as high as 21% in India, as compared to 3-5% in the western literature. We used automated immunohistochemistry with Biogenex antibodies to re-evaluate the ER status in 37 Indian patients with invasive breast carcinomas previously reported as ER-/PR+ by a different manual staining protocol in two city hospitals. The automated technique utilized different reagents (all US FDA approved for in vitro diagnostic use) and staining protocols from those used in the manual assays. Of the 37 previously ER-tumours, only 9 (24.3%) tumours remained ER-. Twenty-eight (75.6%) tumours were found to be ER+. Our results indicate that the high incidence of ER-/PR+ breast cancer reported from India is most likely due to the use of suboptimal manual assays, rather than true genetic differences. ER expression in breast cancer among Indian women may be much higher than previously believed. These results have important implications for the use of oestrogen modulators such as tamoxifen in developing countries such as India.

Cystic variant of embryonal sarcoma of liver.

Embryonal sarcoma of the liver is an unusual tumor. The cystic form is rare and can mimic hydatid disease. We present a case that was mistakenly treated as a hydatid cyst for 3 months. Surgery was successful in removing the mass.