Consequence of neo-adjuvant chemotherapy on morphology of breast carcinoma: A systematic evaluation.

BACKGROUND: Neo‑adjuvant chemotherapy (NAC) in locally advanced breast cancer is the present trend. Following NAC, a considerable alteration of morphology occurs in the tumor. AIMS: To study effects of NAC on morphology of breast carcinoma and to evaluate the pathologic response (PR). MATERIALS AND METHODS: A total of 39 surgically resected mastectomy specimens of patients of invasive locally advanced breast carcinoma who received NAC were evaluated for macroscopic and microscopic (by routine stains and immunohistochemistry) alteration of morphology. RESULTS: Macroscopically well‑defined tumor noted in 25 cases (64.1%) and in the rest (14 cases, 35.9%), only fibrotic areas identified. Microscopic examination identified malignant cells in 29 (74.4%), significant chronic inflammation in 24 (61.5%), hyalinized fibrosed stroma in 25 (64.1%) and necrosis in 11 (28.2%) cases. Immunohistochemistry assisted in differentiating malignant cells from histiocytes. In 15 cases (38.5%), axillary lymph nodes isolated where fibrosis seen in 12 (30.8%) and malignant cell in 8 (20.5%) cases. In 34 cases where the pre‑treatment biopsy were available, complete pathologic response (pCR) and partial pathologic response (pPR) were achieved in 7 (20.6%) and 23 (67.4%) cases respectively. DISCUSSION: Protocol of systematic evaluation of morphological changes is different in cases of a patient treated by NAC. Nature of malignancy was difficult to categorize as morphology of typical breast carcinomas were altered. Sometimes, immunohistochemistry is advantageous as routine H and E stains are not sufficient to isolate malignant cells in fibrotic and necrotic areas. Appropriate morphological evaluation of the mastectomy specimen is absolutely crucial for assessment of PR and subsequent management.

Changing profile of Vibrio cholerae O1, O139 in Delhi & its periphery (2003-2005).

BACKGROUND & OBJECTIVE: Cholera caused by either Vibrio cholerae O1 or O139 is endemic in Delhi and its peripheral areas. The present study was carried out to understand the changing epidemiology of V. cholerae in terms of prevalence of serotypes, antibiogram pattern and phage types. METHODS: A total of 9858 stool samples from the admitted diarrhoea patients were used for the isolation of V. cholerae O1 and O139. Subsets of isolates were tested against thirteen antimicrobials and phage typed. RESULTS: Among 4251 (43.1%) confirmed cases, 41.6 per cent were V. cholerae O1 and rest (1.5 %) V. cholerae O139. Detection of V. cholerae O1 serotype Inaba was 87.7 per cent during 2005 and rest were serotype Ogawa. Majority of cases (93.1%) were from Delhi. Male:Female ratio remained 1.5:1.0. Children below 5 yr age group constituted 32.7 per cent cases. Shift in the age groups and seasonal incidence were recorded. All 226 strains of V. cholerae O1 and O139 were resistant to nalidixic acid; 96 per cent V. cholerae O1 isolates were multidrug resistant (FX NA SXT). Phage type 27 (98.7%) was the most prevalent and the new phage types were 4, 16 and 25 in this area. INTERPRETATION & CONCLUSION: Enhanced surveillance helped in bringing down cases from 47.7 per cent in 2003 to 36.8 per cent in 2005. Additionally, the changing epidemiology of V. cholerae O1 and O139 infections and drug resistance need regular monitoring.

Pathology of benzalkonium chloride toxicity and its effect on body weight gain in broiler birds.

Four groups comprising 16 broiler birds each were given benzalkonium chloride (BC) at 100, 300, 500 and 700 ppm in drinking water for 40 days and one group of 16 birds (control) was kept on plain water. Clinical signs in higher dose groups were respiratory distress, drooling of saliva, difficulty in deglutition, inappetence, apathy, lethargy and loss of body weight. Better body weight gain was recorded in 100 ppm dose rate. At 300 ppm, no significant body weight variation was recorded, whereas, at 500 and 700 ppm dose rates, significantly poor body weight gain was recorded. Major pathological changes were seen in 500 and 700 ppm groups, which exhibited formation of yellow diphtheritic plaques in the buccal cavity, swollen and pale commissures of beak and shortening of tongue. Minute necrotic and ulcerative foci were seen in oesophagus and crop. Hyperplastic and hypertrophic alterations were seen in mucosa of the upper digestive tract. Crop of 300 ppm group revealed formation of well developed epithelial nest with pseudoepitheliomatous hyperplasia at the margin of the lesion. Serum alanine transaminase, urea and uric acid in 500 and 700 ppm groups were elevated whereas no significant variations were observed in the 100 and 300 ppm groups. BC could enhance performance of broiler birds at 100 ppm dose rate. It should not be used beyond 300 ppm.

Utilisation pattern of blood in a teaching hospital of Kolkata.

An annual utilisation of blood transfusion services at several depts. of R.G. Kar Medical College and Hospital, Kolkata were assessed among a sample of 3122 patients selected by Systematic Random Sampling Technique from the register made available in the blood bank there. Record analysis revealed that overall 79.4% of supplied blood units were actually transfused, wastage of 21.6%. Wastage was maximum in the Department of Gynae & Obstetrics (33.11%) and Surgery (32.87%). Only single unit of blood was requisitioned and transfused for 5.44% & 30.90% of the patients respectively. Most common indications of blood transfusion were for surgical cases (37.92%), followed by anaemia (34.80%) and haemorrhage (26.92%). The use of blood and blood products merit attention, appraisal and instructional guiding accordingly.

Efficacy of arteether in chloroquine resistant falciparum malaria in eastern India.

BACKGROUND & OBJECTIVES: Morbidity and mortality due to falciparum malaria are increasing in many tropical areas. The situation is further complicated by drug resistant malaria. The present study was undertaken to evaluate the efficacy of arteether on acute chloroquine resistant Plasmodium falciparum malaria in eastern coalfield area of Asansol. METHODS: A total of 30 patients with chloroquine resistant falciparum malaria smear and histidine-rich protein II (HRPII) antigen positive were given arteether intramuscularly in a single daily dose of 150 mg (3 mg/kg body weight in case of children) for three consecutive days. They were followed up to 28 days of arteether therapy. Each patient was assessed in terms of fever clearance time, parasite clearance time and parasite reappearance rate. RESULTS: The cure rate was found to be 100% with fever clearance time between 1-3 days (mean +/- SD 48.2 +/- 10.6 h) and mean parasite clearance time of 1.2 +/- 0.3 days. Parasite reappearance rate was found to be 0%. No adverse effect due to arteether therapy was observed following the treatment. INTERPRETATION & CONCLUSION: The results indicated that arteether was effective in patients with acute chloroquine resistant, complicated as well as uncomplicated, falciparum malaria and might be considered as a suitable alternative to quinine.