Pregabalin in the treatment of postmastectomy chronic pain: Results of an open label, single-arm clinical study.

Postmastectomy chronic pain (PMCP) is one of the important survivorship issues faced by breast cancer patients. It is a chronic pain which persists for more than 3 months after mastectomy or quadrantectomy and is considered to be neuropathic in nature. An open label, single-arm, prospective study was conducted to evaluate the efficacy of Pregabalin in relieving clinically significant PMCP (pain score ≥3 on visual analogue scale). Pregabalin brought about significant reductions in pain (visual analogue scale [VAS] Scores; baseline 5.50 ± 1.197, end of 1 month 2.40 ± 1.430, end of 2 months 2.10 ± 1.370) and significant improvement in quality of life.

The Impact of Peritumoral Retraction Clefting & Intratumoral Eosinophils on Overall Survival in Oral Squamous Carcinoma Patients.

This retrospective study aimed to investigate the impact of peritumoral retraction clefts (RC) and tumor-associated tissue eosinophilia (TATE) as predictors of overall survival (OS) in oral squamous cell carcinoma (OSCC) patients. Their relationships with tumor-factors were also examined. Eighty-seven OSCC cases (pTNM: I + II/III + IV; 32/55), post-curative surgery, comprised the study cohort. Three observers independently estimated the percent RC semi-quantitatively in the selected tumor sections. Additionally, stromal eosinophils were counted in ten consecutive high-power fields of intratumoral and peritumoral regions to evaluate the corresponding TATE. The percent RC ranged between 0% -90% (Mean ± SD: 16 ± 24%; Median: 5%). The stromal eosinophils were greater in peritumoral as compared to intratumoral region. The events of death and tumor recurrence were reached in 16 (18.4%) and 36 (41%) cases respectively. The 3-years OS was 69% [Median OS: 1880 days; Mean follow up: 471(Range; 36-1880) days]. Increased percent RC exhibited relationship with pathologic stage (pTNM III&IV), primary tumor (pT III&IV), tumor depth > 4 mm and categorical tumor recurrence. Additionally, peritumoral eosinophilic infiltrates increased with increasing tumor depths and muscle invasion. Kaplan-Meier curves revealed significantly reduced OS in OSCC cases exhibiting: increased percent RC (>2.5%), mild -moderate/absent intratumoral TATE (versus intense TATE) or categorical tumor recurrence. In subsequent multivariate tests, all the three variables retained significance. Additionally, intraclass correlation coefficient demonstrated acceptable internal consistency for the observers who estimated percent RC. In conclusion, RC and intratumoral TATE proved to be independent predictors of OS in our OSCC cohort. Additionally, increased percent RC pointed towards aggressive tumor behaviour.

Comparison of the Seventh and Eighth Editions of the American Joint Committee on Cancer pT and pN Classifications as Predictors of Survival in Patients With Oral Squamous Cell Carcinoma.

Objectives: We retrospectively compared the seventh and eighth editions of American Joint Committee on Cancer (AJCC) TNM frameworks as disease-free survival (DFS) and overall survival (OS) predictors in oral squamous carcinomas (OSCCs). Methods: We restaged the 342 patients with the revised pT and pN criteria and performed survival analyses. Results: The 3-year DFS (mean follow-up, 364 days; recurrences, 99) was 50%, and the 5-year OS (mean follow-up, 615 days; deaths, 69) was 42%. The eight edition pN classification was an independent multivariate survival predictor. The revised TNM criteria upstaged pT, pN, and stage groupings in 99 (38.8%), 58 (37.3%), and 101 (29.5%) patients. The latter two groups revealed significantly worse DFS and OS compared with those whose categorizations had remained unaltered. In addition, their classification/staging criteria demonstrated superior discrimination, monotonicity, and accuracy for survival estimations. Conclusions: Of the competing AJCC staging criteria, the revised pN classification was the most powerful system to predict OSCC survivals.

Useful information provided by graphic displays of automated cell counter in hematological malignancies.

BACKGROUND: Automated cell counters have become more and more sophisticated with passing years. The numerical and graphic data both provide useful clues for suspecting a diagnosis especially when the workload is very high. AIM: We present our experience of useful information provided by graphic displays of an automated cell counter in hematological malignancies in a cancer hospital where a large number of complete blood count (CBC) requests are received either before or during chemotherapy. This study was conducted to assess the usefulness of hematology cell counter, viz. WBC-Diff (WBC differential), WBC/BASO (WBC basophil) and IMI (immature myeloid information) channel scatter plots, and the flaggings generated in various hematological malignancies. MATERIAL & METHODS: The graphic displays have been compiled over a period of 1 year (October 2015-September 2016) from blood samples of various solid and hematological malignancies (approximately 400 per day) received for routine CBC in the laboratory. Approximately 50 000 scattergrams have been analyzed during the study period. The findings were confirmed by peripheral blood smear examination. RESULTS: The scattergram analysis on XE-2100 is very sensitive as well as specific for diagnosing acute leukemia, viz. acute myeloid leukemia, acute lymphoblastic leukemia; chronic myeloproliferative disorders, viz. chronic myeloid leukemia; and chronic lymphoproliferative disorder especially chronic lymphocytic leukemia. CONCLUSION: It is suggested that the laboratories using the hematology analyzers be aware of graphic display patterns in addition to flaggings generated which provide additional information and give clue toward the diagnosis even before peripheral smear examination.

A semi-quantitative World Health Organization grading scheme evaluating worst tumor differentiation predicts disease-free survival in oral squamous carcinoma patients.

We investigated World Health Organization (WHO) grading and pattern of invasion based histological schemes as independent predictors of disease-free survival, in oral squamous carcinoma patients. Tumor resection slides of eighty-seven oral squamous carcinoma patients [pTNM: I&II/III&IV-32/55] were evaluated. Besides examining various patterns of invasion, invasive front grade, predominant and worst (highest) WHO grade were recorded. For worst WHO grading, poor-undifferentiated component was estimated semi-quantitatively at advancing tumor edge (invasive growth front) in histology sections. Tumor recurrence was observed in 31 (35.6%) cases. The 2-year disease-free survival was 47% [Median: 656; follow-up: 14-1450] days. Using receiver operating characteristic curves, we defined poor-undifferentiated component exceeding 5% of tumor as the cutoff to assign an oral squamous carcinoma as grade-3, when following worst WHO grading. Kaplan-Meier curves for disease-free survival revealed prognostic association with nodal involvement, tumor size, worst WHO grading; most common pattern of invasion and invasive pattern grading score (sum of two most predominant patterns of invasion). In further multivariate analysis, tumor size (>2.5cm) and worst WHO grading (grade-3 tumors) independently predicted reduced disease-free survival [HR, 2.85; P=0.028 and HR, 3.37; P=0.031 respectively]. The inter-observer agreement was moderate for observers who semi-quantitatively estimated percentage of poor-undifferentiated morphology in oral squamous carcinomas. Our results support the value of semi-quantitative method to assign tumors as grade-3 with worst WHO grading for predicting reduced disease-free survival. Despite limitations, of the various histological tumor stratification schemes, WHO grading holds adjunctive value for its prognostic role, ease and universal familiarity.

Surgical Site Infection Caused by Aeromonas hydrophila in a Patient with Underlying Malignancy.

Aeromonas skin and soft tissue infections in cancer patients can lead to serious life threatening conditions such as cellulitis, necrotizing fasciitis and myonecrosis. We report here a case of surgical site infection, post radical mastectomy, in a 58-year-old female with carcinoma breast. Cultures of exudates from the wound grew Aeromonas hydrophila on repeated occasions. Recovery was uneventful following targeted antimicrobial therapy and regular dressing of the wound. Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging pathogen.

Case report and literature review of carbapenem resistant shewanella putrefaciens isolated from ascitic fluid.

Shewanella species are Gram-negative, non-fermentative, oxidase positive, motile bacilli with the major phenotypic characteristic of production of large amounts of hydrogen sulfide. Shewanella putrefaciens, primarily considered to be an environmental bacterium, is infrequently recovered from clinical specimens. Herein, we report a case of ascitic fluid infection with carbapenem resistant Shewanella putrefaciens in a patient with underlying liver disorder requiring repeated ascitic fluid tapping. Proper antibiotic therapy helped in complete recovery of the patient.

Multidrug-resistant Staphylococcus hominis subsp. novobiosepticus causing septicemia in patients with malignancy.

A new subspecies of Staphylococcus hominis described by Kloos et al. in 1998 and named S. hominis subsp. novobiosepticus (SHN) has been implicated in nosocomial outbreaks. Multidrug resistance, including resistance to novobiocin and oxacillin, is a particularly important feature of SHN. In our institute, we encountered 13 cases of S. hominis subsp. hominis in cancer patients with septicemia, of which seven were methicillin resistant. The isolates were identified by VITEK ® 2 compact automated system, using GP REF 21342 identification card and antimicrobial susceptibility testing card P-628. The biochemical reactions and antibiotic susceptibility pattern of the seven methicillin-resistant isolates were re-analyzed and patient details were re-checked to finally identify them as SHN. The increasing number of cases reporting isolation of SHN from biological specimens point to potential virulence and clinical importance of this bacterium.

Usefulness of automated cell counter in detection of malaria in a cancer set up--our experience.

BACKGROUND: Malaria diagnosis presents a challenge to all laboratories. In malaria-endemic areas, there is a need for rapid, sensitive and cost-effective method to effectively screen all samples, especially when the workload is very high. Various hematology analyzers have been investigated for detection of malaria in the past. Here, we present our experience of malaria detection in a cancer hospital where a large number of complete blood count requests are received either before or during chemotherapy. Fever, being a very common symptom in cancer patients, causes a suspicion of malaria. AIM: This study was conducted to assess the usefulness of hematology cell counter, viz. WBC-DIFF and WBC/BASO scatter plots and the flaggings generated in malaria-positive cases. The occurrence of pseudoeosinophilia as reported by previous studies was also assessed. The parasitic index was determined and its correlation with the abnormalities found on the Hematology analyzer was also studied. MATERIALS AND METHODS: Blood samples were collected from 80 out-patient department and inpatients with various solid as well as hematological malignancies, who presented with acute febrile illness during September 2010 and January 2012, and for whom complete blood cell analysis and peripheral smear for malaria parasite had been requested. RESULTS: Of the 80 patients who presented with fever and suspicion of malaria, 29 patients were positive for malaria and 10 cases were diagnosed incidentally by the findings on the cell counter and were confirmed by Giemsa-stained blood smears. The sensitivity and specificity of the abnormalities detected in the WBC-Diff channel in detecting malaria is 82% and 100% respectively. Using WBC-BASO channel abnormality for initial diagnosis the sensitivity and specificity is 50% and 92.5% respectively. The sensitivity and specificity with respect to pseudoeosinophilia is 18% and 100% respectively. The most common WBC and PLT flags were leukopenia, atypical lymphocytes, lymphopenia, WBC abnormal scattergram, platelet clumps, thrombocytopenia, platelet abnormal distribution flag. CONCLUSION: The instrument provides significantly valuable diagnostic parameters in detecting acute Plasmodium vivax malaria; however, it is not very useful for acute falciparum malaria infection. It is suggested that the laboratories using the hematology analyzers should be aware of such specific parameters, even in the absence of a clinical request.

Association of GSTM1 and GSTT1 polymorphism with lipid peroxidation in benign prostate hyperplasia and prostate cancer: a pilot study.

Association of glutathione S-transferase (GST) M1 and T1 deletions with benign prostate hyperplasia (BPH) and prostate cancer is well reported. These enzymes metabolize numerous toxins thus protecting from oxidative injury. Oxidative stress has been associated with development of BPH and prostate cancer. The present study was designed to analyze role of GST deletions in development of oxidative stress in these subjects. GSTs are responsible for metabolism of toxins present in tobacco therefore effect of tobacco usage in study groups was also studied. Three groups of subjects: BPH (53 patients), prostate cancer (57 patients) and controls (46 subjects) were recruited [corrected]. Genotyping was done using a multiplex polymerase chain reaction (PCR) method. Malondialdehyde (MDA) levels as marker of oxidative stress were estimated by measuring thiobarbituric acid reactive substance (TBARS) in plasma. Based on genotyping, subjects were categorized into: GSTM1+/GSTT1+, GSTM1-/GSTT1+, GSTM1+/GSTT1- and GSTM1-/GSTT1-. Significantly higher plasma MDA levels were noticed in GSTM1-/GSTT1- as compared to GSTM1+/GSTT1+ in all study groups. Double deletion (GSTM1-/GSTT1-) is associated with higher oxidative stress which might play a role in the pathogenesis of BPH and prostate cancer. However, other markers of oxidative stress should be analyzed before any firm conclusion.

CYP 1A1 polymorphism and organochlorine pesticides levels in the etiology of prostate cancer.

Organochlorine pesticides (OCPs) and polymorphisms of xenobiotic metabolizing enzymes are reported to be associated with the possible risk of prostate cancer. OCPs are endocrine disruptors (EDs) which may act by disrupting the physiologic function of endogenous hormones and therefore possibly increase prostate cancer risk. CYP1A1 metabolizes several carcinogens and estrogens, etc. and hence polymorphism of this gene has been reported to be associated with prostate cancer risk. We studied 70 newly diagnosed prostate cancer patients and 61 age-matched healthy male controls. OCP levels in blood were determined by using gas chromatography-mass spectrometry (GC-MS) and CYP1A1 polymorphisms were analyzed by allele-specific PCR and RFLP-PCR methods. Significantly higher levels of ß-HCH, γ-HCH and p,p'-DDE were found in cases as compared to controls (p-values=0.04, 0.008, and 0.01, respectively). Higher levels of γ-HCH were observed in advanced stages of prostate cancer cases (or=T(3)), (p-value=0.04). Dieldrin was found significantly higher in cases with initial stages (p-value=0.03). We did not observe any correlation between prostate cancer and CYP1A1 polymorphisms. Hence, higher level of OCPs, especially ß-HCH, γ-HCH and p,p'-DDE might be associated with prostate cancer risk.

Novel intramolecular rearrangement leading to the synthesis of biheterocyclic indole-benzoimidazole derivatives on solid phase.

[reaction: see text] A novel intramolecular SNAr rearrangement observed during the S-alkylation of benzoimidazole-2-thione with alpha-haloacetophenone is reported. The rearrangement led to the formation of a new benzoimidazole-based intermediate, which is further utilized for the generation of a new biheterocyclic indole-benzimidazole derivatives with a two-point diversity.