Gemcitabine-induced digital ischaemia in a patient with metastatic breast cancer.

A woman in her 50s with HER2 (human epidermal growth factor receptor 2) positive, estrogen/progesterone receptor negative, metastatic invasive ductal carcinoma of the breast, presented with acral cyanosis and severe throbbing pain after recent administration of gemcitabine. She was treated with aspirin, heparin, amlodipine, topical nitroglycerin and analgesics. Gemcitabine was discontinued permanently. She had a gradual recovery except for a small necrotic area over the right 4th digit. However, surgical intervention was avoided.

Current understanding and future implications of sepsis-induced thrombocytopenia.

Sepsis is a global health burden that needs intensive medical care. Thrombocytopenia in sepsis is well known to increase morbidity as well as mortality. Several studies have been performed both in animal models and in humans to understand the mechanism by which sepsis causes thrombocytopenia. Recent studies have shown that inhibiting thrombocytopenia improves outcomes in sepsis patients. Understanding these mechanisms to identify targets in use of newer treatment modalities besides using resuscitation measures, antibiotics and removal of thrombocytopenia inducing agent could potentially help us improve outcomes in sepsis.

Utilization of Surgery and Its Impact on Survival in Patients With Early Stage Small-cell Lung Cancer in the United States.

INTRODUCTION: For patients with T1 or T2 N0 M0 small-cell lung cancer (SCLC), lobectomy followed by chemotherapy is the standard of care. However, because of its tendency for early dissemination, patients are often treated with concurrent chemo-radiation without surgery. This study was conducted to evaluate the utilization of surgery and its impact on survival in patients with early stage SCLC. MATERIALS AND METHODS: The National Cancer Database was queried to identify patients with T1 or T2 N0 M0 SCLC diagnosed from 2004 to 2013. Multivariate logistic regression modeling was utilized to identify factors associated with receipt of surgery. Patients were stratified into 3 groups: chemo-radiation, surgery followed by chemotherapy, and surgery followed by chemotherapy and prophylactic cranial irradiation (PCI). Kaplan-Meier estimators and Cox proportional-hazards regression were used to compare overall survival. Patients were matched on the propensity score. RESULTS: A total of 3879 SCLC cases were identified. Of those cases, 80.7% received chemo-radiation. Surgery followed by chemotherapy with or without PCI was associated with better median overall survival (93.0 months [lower 95% confidence interval (CI), 72.5] and 61.7 months [95% CI, 51.8-76.5], respectively) compared with chemo-radiation (31.2 months [95% CI, 26.3-37.0]). PCI offered survival benefit in addition to surgery and chemotherapy (hazard ratio, 0.75). CONCLUSIONS: Our study showed a significant survival benefit with surgery (lobectomy or more), adjuvant chemotherapy, and PCI in patients with T1-T2 N0 M0 SCLC.

Survival trends among patients with metastatic melanoma in the pretargeted and the post-targeted era: a US population-based study.

In 2011, ipilimumab was approved by the US Food and Drug Administration (FDA) for metastatic melanoma. Since its approval, numerous targeted therapies have been approved by the FDA. Population-based studies assessing the survival benefit from these agents are lacking. We therefore carried out this study to compare the 1-year, 2-year, and median overall survival (OS) among metastatic melanoma patients in pretargeted and post-targeted eras. This is a retrospective study that utilized the Surveillance, Epidemiology, and End Results (SEER-18) database, version 8.3.4 (22 March 2017). The patient groups were defined as the pretargeted era (2004-2010) and the post-targeted era (2011-2014) as ipilimumab was approved by the FDA in 2011. The database comprised of 5471 patients (3314 in the pretargeted era and 2157 in the post-targeted era). OS in the post-targeted era was found to be significantly better compared with the pretargeted era by Kaplan-Meier curve (1-year OS: 38.9 vs. 36.8%, 2-year OS: 28.3 vs. 23.5%, and median survival: 8 vs. 7 months, P=0.001 by the log-rank test). The survival was significantly better in the post-targeted era compared with the pretargeted era on multivariate analysis using a Cox proportional hazard model after adjusting for age, sex, race, and metasectomy status (adjusted hazard ratio of 0.889, 95% CI: of 0.832-0.951, P=0.001). There is significant survival benefit in metastatic melanoma patients since the introduction of immune checkpoint-blocking agents.

The risk of second primary malignancy in patients with stage Ia non-small cell lung cancer: a U.S. population-based study.

BACKGROUND: Lung cancer is one of the most common cancers worldwide. Patients with early stage lung cancer have improved long-term survival. With the introduction of low-dose CT scan, more patients are going to be diagnosed at an early stage. However, there is limited data on the risk of second primary malignancies (SPMs) in these subsets of patients in the United States. METHODS: We utilized SEER-13 (Surveillance, Epidemiology and End Results) registry to obtain Multiple Primary- Standardized Incidence Ratio and an Absolute Excess Risk between January 2004 and December 2010 for patients with Stage Ia non-small cell lung cancer. RESULTS: The database comprised of 12,246 patients. A total of 1431 (11.68%) patients developed 1563 SPMs with an observed to expected (O/E) ratio of 2.07 (95% CI = 1.92-2.23, p < .001) in patients with adenocarcinoma and 2.05 (95% CI = 1.92-2.19, p < .001) in squamous cell carcinoma group. CONCLUSIONS: This study showed an excess risk of SPMs in patients with early stage non-small cell lung cancer. We recommend a close follow-up, paying attention to concerning symptoms or examination findings and judicious use of age-appropriate cancer screening.

Correlation of genomic alterations assessed by next-generation sequencing (NGS) of tumor tissue DNA and circulating tumor DNA (ctDNA) in metastatic renal cell carcinoma (mRCC): potential clinical implications.

INTRODUCTION: Tumor tissue and circulating tumor DNA (ctDNA) next-generation sequencing (NGS) testing are frequently performed to detect genomic alterations (GAs) to help guide treatment in metastatic renal cell carcinoma (mRCC), especially after progression on standard systemic therapy. Our objective was to assess if GAs detected by ctDNA NGS are different from those detected by tumor tissue NGS, specifically in patients with mRCC, and if these platforms are interchangeable or complimentary. RESULTS: When controlling for genes tested by both platforms, the median mutation rate for ctDNA was similar to tissue (median 3.0 vs. 1.0, p = 0.14). However, the concordance rate between the two platforms was only 8.6%. When comparing GAs by molecular pathway, GAs in tumor tissue were more common for the DNA repair and epigenetic pathways. MATERIALS AND METHODS: Results of NGS testing from tumor tissue and ctDNA from 19 sequential mRCC patients were compared. GAs in each were statistically evaluated using the Wilcoxon signed-rank test. The Fischer's exact test was used to compare the incidence of mutations in selected molecular pathways. CONCLUSIONS: When controlling for genes tested by both platforms, similar number of GAs were detected by both tissue and ctDNA based NGS. However, there was discordance in the type of GAs detected suggesting that ctDNA NGS may be more reflective of dynamic tumor genomic heterogeneity. Hence, these two platforms may be considered complementary to each other, rather than interchangeable, for assessment of tumor GAs to guide selection of targeted clinical trial therapies.

YouTube as a Source of Information on Cervical Cancer.

BACKGROUND: Cervical cancer is the third most common cancer worldwide. Accurate information about cervical cancer to general public can lower the burden of the disease including its mortality. AIMS: We aimed to look at the quality of information available in YouTube for cervical cancer. MATERIALS AND METHODS: We searched YouTube (http://www.youtube.com) for videos using the keyword Cervical cancer on November 12, 2015. Videos were then analyzed for their source and content of information. RESULTS: We studied 172 videos using the keyword Cervical cancer on November 12, 2015. We found that there were videos describing the personal stories, risk factors, and the importance of screening. However, videos discussing all the aspects of cancers were lacking. Likewise, videos from the reputed organization were also lacking. CONCLUSION: Although there were numerous videos available in cervical cancer, videos from reputed organizations including Center for Disease Control and Prevention, American Cancer Society, and World Health Organization were lacking. We strongly believe that quality videos from such organizations via YouTube can help lower the burden of disease.

Clinical profile of diabetic ketoacidosis in tertiary care hospital of Eastern Nepal.

INTRODUCTION: Diabetes ketoacidoisis (DKA) is characterized by hyperketonaemia, metabolic acidosis, and hyperglycemia. AIMS: The aim of this study was to describe the demographic profile, clinical characterstics of patients admitted with diabetic ketoacidosis in BPKIHS, medical ward. SETTINGS AND DESIGN: The hospital based descriptive study. MATERIALS AND METHODS: We took all the patients admitted with a diagnosis of diabetic ketoacidosis (DKA) as defined ADA 2006 consensus statement in medical ward from January 2010 to December 2010. The statistical operations was done through Manufactured by IBM Corp. RESULTS: Only sixteen patients (7 type 1 and 9 type 2DM) were with DKA. When compared to the 16 subjects with type 1 DM, the type 2 were older (56.8 s 25.7 years) and had a significantly higher PH levels (7.11 s 7.28 P = 0.04). The mean body mass index was 20.5±2.44 in both Type 1 and type 2 DM. Four were on diet control and Insulin respectively. Five were on oral hypoglycemic agents (OHA) and three on both (insulin and OHA). Infection was most common precipitating factor (56.25%) followed by poor drug compliance (37.5%) and first presentation (6.25%). CONCLUSIONS: We found majority of patients were type 2 DM. Metabolic acidosis has significant association in both type of diabetic. We found infection was the most common precipitating factor for DKA.