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   Table of Contents - Current issue
Coverpage
September-October 2019
Volume 8 | Issue 5
Page Nos. 177-214

Online since Tuesday, October 15, 2019

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ORIGINAL ARTICLES  

The diagnostic value of kappa/lambda ratios determined by immunohistochemistry in the differentiation of plasma cell myeloma from reactive plasmacytosis p. 177
Yunes Shafeno, Babak Izadi, Sedigheh Khazaei, Maryam Foroughikia, Sara Hookari, Sima Nazemi, Mitra Tarlan
DOI:10.4103/ccij.ccij_65_19  
Context: Plasma cell myeloma (PCM) is the second-most common B-cell malignancy in western countries. In this disease, the bone marrow is infiltrated by monoclonal plasma cells, which may secrete immunoglobulin light chains. In this line, reactive plasma cells may infiltrate into the bone marrow that can lead to misdiagnosis of the disease. Aims: The purpose of this study was to determine monoclonality using immunohistochemistry (IHC) for kappa and lambda light chains in bone marrow biopsy (BMB) specimens. These findings may be useful in the differentiation of PCM from reactive plasmacytosis. Materials and Methods: In this study, BMB paraffin blocks from 90 patients including 45 cases of PCM and 45 patients with reactive plasmacytosis were collected at the pathology center of Imam Reza Hospital from 2006 to 2014. IHC staining for CD138 and Kappa-Lambda light chains were performed. Relative frequencies of Kappa to Lambda light chain positive cells were calculated. Statistical Analysis Used: The results were analyzed with spss16 and Rx64 3.1.2 software. Results: Strong Kappa staining was found in 37 of 45 PCM cases (82.2%), with the ratio of Kappa/Lambda>3 and eight other cases (17.8%) expressed Kappa/Lambda<0.48. In cases with reactive plasmacytosis, K/L ratio was 0.48≤ × ≤3. Sensitivity and specificity for the diagnosis of PCM versus reactive plasmacytosis were 100% and 97.8%, respectively. Conclusions: Results indicated that immunohistochemical staining of CD138, kappa, and lambda light chains could be considered as an assured and reliable assay for the diagnosis of monoclonal plasma cells and differentiating it from other hematological malignancies.
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Bacteriological profile of patients with periampullary cancer and effect of preoperative biliary drainage on bacterial flora p. 182
Abhijit Talukdar, Rashmisnata Barman, Joydeep Purkayastha, Anupam Sarma, Sawmik Das, Jagannath Dev Sharma, Manigreeva Krishnatreya, Amal Chandra Kataki
DOI:10.4103/ccij.ccij_61_19  
Aim: This study aims to identify the frequency of bacteriobilia, commonly isolated bacteria and their antibiotic susceptibility pattern from cancer patients with periampullary carcinoma attending a regional cancer center in the North-East India. Materials and Methods: This was a retrospective 1-year study of patients with obstructive jaundice due to periampullary carcinoma treated between January 2018 and December 2018. Intraoperative bile samples were obtained for microbiological analysis after transection of the common bile duct. Bile specimens were transported to the microbiology laboratory, and processing was done according to the standard protocol used in our clinical microbiology laboratory. Results: Intraoperative bile samples were obtained from 27 patients, and in 21 (77.77%) patients, it was culture positive. Stenting was done in 10 (37.07%) patients, and in those who underwent stenting, microbial contamination of bile was increased significantly (80%) compared to 61.90% in those without stenting. Organisms isolated were Escherichia coli 9 (42.85%), Klebsiella pneumonia 7 (33.33%), Pseudomonas 3 (14.28%), and Enterococcus cloacae 2 (9.52%). Carbapenamase producing E. coli(n = 1) and K. pneumonia (n = 1) was isolated from the two stented patient and one was vancomycin-resistant enterococcus (n = 1). Conclusion: Patients who underwent stenting for periampullary carcinoma had a significant risk for acquiring infection with multidrug-resistant bacteria.
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Evaluation the effect of auriculotherapy on the clinical signs of single girls with polycystic ovary syndrome: A single-blinded clinical trial p. 186
Imaneh Khaki, Mahboubeh Valiani, Abolfazl Mohammadbeigi
DOI:10.4103/ccij.ccij_63_19  
Context: Polycystic ovary syndrome (PCOS) is one of the most common endocrine abnormalities in women. This study aimed to evaluate the effect of auriculotherapy on the clinical manifestations of PCOS in single girls aged 18–35 years. Setting and Design: A single blinded parallel clinical trial. Materials and Methods: This study was performed on 60 single girls aged 18-35 years that randomly assigned into two groups including auriculotherapy and medication. The clinical symptoms, hirsutism score, laboratory tests and ultrasound were measured and both groups were treated for two months. Statistical Analysis Used: The results were analyzed in three stages and analyzed by t-test, Chi square and repeated measurement tests. Results: A significant reduction was observed in hirsutism score in auriculotherapy group (P = 0.04). There was a significant difference before and immediately after the intervention in auriculotherapy group (P = 0.01). Hair loss immediately after the end of intervention was significantly lower in auriculotherapy group (P = 0.04). There was a significant change in relative frequency of acne immediately after the intervention between two auriculotherapy and medication groups (P = 0.01). Acne recovery in auriculotherapy group was higher, and the relative frequency of acne was significantly different between the two groups after 3 months of intervention (P = 0.005). The irregularity of menstruation in auriculotherapy group was reduced more compared with medication group (P = 0.02). The mean weight 3 months after the intervention was significantly different between two groups (P = 0.04). Conclusion: Auriculotherapy can play a role in reducing the symptoms of hirsutism, hair loss, and acne in single girls with PCOS, and even can control weight gain.
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Study of metronomic chemotherapy in cancer patients at a tertiary care center in South India p. 192
Paraashar R Rai, Nishitha Shetty, Dinesh Shet, Pareekshith R Rai, Arpitha Shetty
DOI:10.4103/ccij.ccij_41_19  
Background and Objectives: Metronomic chemotherapy is a treatment regimen which involves the administration of low-dose chemotherapy frequently with shorter drug-free intervals. In India, a majority of the patients diagnosed with cancer present to the health-care providers at an advanced stage. Moreover, they are often from the lower socioeconomic strata with limited access to health care. Metronomic chemotherapy is a convenient, minimally toxic, and economically viable treatment option whose potential should be explored. Materials and Methods: We retrospectively reviewed the data of 100 patients diagnosed with cancer who received metronomic chemotherapy in a tertiary cancer care center. The records of all the patients who visited the cancer care center between September 2015 and February 2017 were reviewed. Data on age, sex, address, diagnosis with staging, sequence of prior treatment received, and duration of metronomic chemotherapy, reasons for discontinuing metronomic chemotherapy, response, toxicity profile, and outcome were collected and analyzed. The statistical analysis was performed using SPSS statistics software, version 23.0. The survival analysis was done using the Kaplan–Meier survival analysis. Results: The mean age of patients was 53.75 years (32–92 years). About 60% were in Stage 4. With therapy, 79% improved, 16% deteriorated, and 5% were stable in their symptom profile. The mean disease progression-free survival was 232 days, while the overall survival was 310 days. Interpretation and Conclusion: Metronomic therapy is a feasible option in the palliative care setting. It does not require stringent monitoring, as it has a well-tolerated side effect profile when compared to conventional chemotherapy. Its utility in patients being treated with curative intent and the criteria for response assessment with low-cost imaging has to be explored.
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A comparative study of nab-paclitaxel versus cisplatin concurrent chemoradiotherapy in locally advanced cervical cancer p. 198
Varsha Mandloi, Veenita Yogi, Om Prakash Singh, Manish Kumar Ahirwar, Suresh Yadav, HU Ghori
DOI:10.4103/ccij.ccij_59_19  
Background: Approximately, 80%–90% patients presented with locally advanced stage with bulky central disease in our center, thus induction followed by concurrent chemoradiotherapy (CCRT) plays a predominant role in the treatment of cervical cancer. Aim: The purpose of this study was to compare the effects, toxicities, treatment response, and progression-free survival (PFS) of nab-paclitaxel and cisplatin in the management of cervical cancer as CCRT. Materials and Methods: This was a prospective, observational study performed at a tertiary care hospital. A total of 120 patients of squamous cell carcinoma of cervical cancer had received three cycles of induction chemotherapy (CT), paclitaxel 175 mg/m2, and cisplatin 75 mg/m2, three weekly regimen. All patients were divided into two CCRT arm, A and B. In arm A, patients received external beam radiation therapy (EBRT) with weekly cisplatin 40 mg/m2 plus intracavitary brachytherapy (ICBT). In arm B, patients received EBRT with weekly nab-paclitaxel 70 mg/m2 plus ICBT. Results: In this study, International Federation of Gynecology and Obstetrics Stage III B, 53.33% in arm A and 46.66% in arm B. After EBRT, complete response was 48.33% in arm A and 73.33% patients in arm B, and 51.66% in arm A and 26.66% patients in arm B had partial response. Median duration of follow-up was 33 months (range 24–48). The PFS, P = 0.0093 was significant. Conclusion: With this study, we can consider the justification for future approach for locally advanced cervical cancer which incorporates induction CT followed by concurrent nab-paclitaxel with EBRT followed by ICBT.
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Value of ascitic fluid lipids in the differentiation between cirrhotic and malignant ascites p. 205
Ahmad Abdelbaset, Amal A Jouda, Heba Pasha, Ahmad Sallam Soliman, Mostafa Toam, Mohammad N Elkhashab
DOI:10.4103/ccij.ccij_53_19  
Background: The diagnosis of malignant ascites can be difficult. The overall sensitivity of cytology smears for the detection of malignant ascites is 58%–75%. There is a debate about the role of ascitic fluid lipids and their gradients in the differential diagnosis of ascites. This study aims to evaluate the role of ascitic fluid lipids and their gradients in the differentiation of malignant ascites from cirrhotic ascites. Patients and Methods: Ninety-six patients were enrolled in this study divided into two groups according to the cause of ascites; Group I: included 48 patients with malignant ascites and Group II: included 48 patients with cirrhotic ascites. Results: Ascitic fluid cholesterol, triglycerides, and phospholipids were significantly higher among patients of Group I (77.5 ± 11.5, 82.4 ± 17.04 mg/dl, and 0.92 ± 0.14 mmol/L vs. 27.7 ± 7.5, 56.2 ± 16.2 mg/dl, and 0.33 ± 0.09 mmol/L in succession P < 0.001). The cutoff values of cholesterol, triglycerides, and phospholipids were (41.5, 62.5 mg/dl and 0.45 mmol/L successively); they can predict the presence of malignant ascites with sensitivity of (100, 87, and 100% successively) and with specificity of (97.9, 60.4, and 87.5% successively). Conclusion: Ascitic fluid lipids are valuable markers in the differentiation of malignant ascites from cirrhotic ascites.
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CASE REPORT Top

Mesenchymal hamartoma of the chest wall in a newborn: A case report study p. 212
Abdolhamid Amouei, Mohammad Zare, Farzin Banei, Shokouh Taghipour-Zahir, Mojtaba Babaei Zarch
DOI:10.4103/ccij.ccij_48_19  
Mesenchymal hamartoma of the chest wall is an extremely rare benign lesion arising from one or more ribs in neonates. Its incidence is estimated to be <1 case in a million in general population. It usually presents in the form of chest wall mass. Respiratory distress may be existed resulting from compression of the airways and lungs. Herein, we reported a 1-day-old neonate with respiratory distress and mild chest wall deformity. Imaging studies revealed an extrapleural solid cystic lesion in the middle zone of the left hemithorax. When her respiratory distress was managed, she underwent left thoracotomy, resection of chest wall tumor, and thoracoplasty with titanium mesh. Six months of follow-up revealed no evidence of recurrence. The findings of this case report yielded that mesenchymal hamartoma is a benign lesion presenting with aggressive clinical, radiological, and histopathological characteristics that can be mistaken for malignancy.
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