Response to Tyrosine Kinase Inhibitors in Patients with BCR-ABL1 Positive Chronic Myeloid Leukemia; 13.5 Years’ Experience at Patan Hospital, Nepal

Background:Since the advent of Tyrosine Kinase Inhibitor (TKI), well controlled studies in developed world have shown that the life expectancy of patients with CML is comparable to normal people without the disease. But long-term follow up studies are lacking in resource poor setting. Methods:This is a retrospective follow up study looking at the molecular response and resistance to Tyrosine Kinase Inhibitors (TKI) in patients enrolled in the Max Access Program since February 2003 till March 2017. Patients with twoor more BCR-ABL1 levels by Karyotyping/ fluorescent in situ hybridization (FISH) / reverse transcriptase polymerase chain reaction (RT-PCR) were included. At baseline, complete blood count (CBC), renal function test (RFT), and liver function test (LFT) were evaluated. Bone marrow aspiration and biopsy for morphology, cytogenetic analysis by Karyotyping/FISH and/or molecular analysis by RT-PCR were also done if these tests were not performed earlier. FISH or RT-PCR was done on peripheral blood every 3–12 months as necessary if the patient could afford. Patients with warning response/failure underwent BCR-ABL1 Resistance Mutation Analysis (IRMA).Results:Three hundred and forty six (346) patients had two or more BCR-ABL1 monitoring tests done. Optimal response was seen in 49.42%. Similarly, suboptimal response and failure were seen in 16.5% and 34% respectively. Overall Survival is 89.6% (at 1.8 -165 months, mean 62 months) . If only CML related events is considered survival is 95.9%. Seventy seven (77) patients with a total of 80 BCR-ABL1 domain Imatinib Resistance Mutation Analyses (IRMA) showed 19 different types of mutations with the most common being T315I mutation (8 and 19.5%). About 22.25% of the total patients showed resistance to Glivec out of which 10.98% showed mutations. Nine patients underwent trial for treatment free response (TFR) and 5 of them relapsed between 2-8 months.Conclusions:Despite all the odds of having financial problem, accessibility problem due to distances, transportation, etc. and difficulty monitoring with routine BCR-ABL1 and IRMA, our findings show that the outcome of TKI therapy in our CML patients is comparable to well controlled studies done elsewhere. Overall survival, molecular and cytogenetic responses and mutations in our patients who developed resistance as well as TFR are also similar to other studies. The resistance rate of 22.25% is slightly higher compared to other studies in developed world. This is mainly because of poor monitoring due to unavailability of the test including IRMA in our country and affordability until 2012. It proves that TKI is very effective in CML even in a resource-poor, developing country

Estimation of patient perception on hygiene standards in a tertiary care hospital, West Bengal: A questionnaire-based study

Background: Maintenance of hygiene is very important to lead a healthy, disease-free life. Lack of hygiene increases the chance of communicable and non-communicable diseases. Wastes generated by the hospitals increase the chance of nosocomial infections. Objective: The present study deals with the patient’s perception about hygiene and sanitation rendered by the hospitals. Materials and Methods: The present study was a questionnaire-based cross-sectional survey. The data were collected from the indoor patients admitted in the Department of Surgery, Obstetrics and Gynecology, and General Medicine during December 2016–January 2017 at a Medical College in Kolkata. Results: In the present study, a total of 150 patients were taken as study population, of which majority of them were female. The major age group of the study population was 32–39 years, 33 (22%). In the present study, 93.33% of patients responded that the food was hygienic, 90% of patients opined that all housekeeping staffs used their protective equipment while they were collecting the garbage in this hospital, and 78% of patients agreed that the dustbins were cleaned regularly. Conclusion: In order to improve patients’ compliance and reduce the sufferings, evaluation of to hospital hygiene is of utmost importance. Awareness programs should be implemented in hospitals and health-care centers about the importance and maintenance of hygiene. This would reduce the chances of hospital-borne infections not only for the patients but also for the hospital workers.

A study of marriage and first child bearing pattern on Jirel community of Nepal.

This study was carried out through July 2005 to October 2005 in Jirel community of Eastern Nepal to find out the marriage, first child bearing pattern and educational influences. Total of 121 women were included in the descriptive study applying systematic sampling method. The average median age of marriage in female and male were 18 and 22 years respectively whereas median age at first childbirth was 20 years. 53.72% girls were illiterate and 36.36% had completed 5 years of schooling at their first marriage, but 46.28% male had completed 10 years of schooling before getting married and irrespective of their level of education, 62.81% of girls got married with in 15-19 years of age. 64.46% women gave birth to their first baby within one year of marriage. 80.16% pregnant women underwent Antenatal Check-up (ANC) for three or more times and 29.75% delivered on health institutions whereas 24.79% delivered at home with trained health manpower.

Lack of myocardial damage following Sri Lankan Russell's viper and hump-nosed viper bites.

INTRODUCTION: Cardiac effects following the bite of Burmese Russell's vipers and European vipers are well known. The question whether envenomation caused by Sri Lankan viper bites results in myocardial damage remains largely unanswered. The aim of this prospective study was to investigate whether myocardial damage occurs after Sri Lankan viper bites, using a highly specific and sensitive marker, troponin T. METHODS: 45 patients admitted after a definite viper bite [Russell's viper (RV), n = 13, hump-nosed viper (HNV), n = 32] were studied with regard to cardiac symptoms, ECG changes, and troponin T levels. There were no admissions with bites of other types of Sri Lankan vipers during the study period. RESULTS: Cardiac symptoms were present in a number of patients following the bite. Two patients had transient ECG changes. However, troponin T levels were not elevated in any of them. COMMENT: Myocardial damage does not seem to be an important feature of Sri Lankan Russell's and hump-nosed viper bites. This may be because of venom heterogeneity in vipers, that is based on their geographical distribution.