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   2020| November-December  | Volume 9 | Issue 6  
    Online since November 28, 2020

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Does day 14 bone marrow status predict response to chemotherapy in acute myeloid leukemia? Experience of a hemato-oncology care center from Eastern India
KS Nataraj, Prakas Kumar Mandal, Malay Kumar Ghosh, Maitreyee Bhattacharyya
November-December 2020, 9(6):221-226
Background: Acute myeloid leukemia (AML), the most common type of acute leukemia in adults, yet continues to have the lowest survival rate of all leukemias. The present study aimed to study ability of Day 14 marrow status to predict the remission status in AML. Materials and Methods: This prospective, observational study conducted in 30 AML patients who received “induction remission” as per standard guidelines and undergone bone marrow (BM) aspiration and biopsy on day 14 and day 28. Complete remission (CR) defined as per standard criteria. SPSS 15.3 was used to perform statistical analysis. Results: Median BM blast count on day14 was 10.6% (range, 1–50). Patients achieving remission in day 28 + BM had mean day 14 BM blast count of 8.52% compared to 21.00% in those who did not achieve remission. Majority (90.9%) of the patients with ≤15% BM blast on D14 was in remission. Comparing D14 BM blast% with CR, blast >15% cut off (across all the cut offs, i.e., 5%, 10%, 15%, or 20%) was the best to find those who entered remission; but the negative predictive value (NPV) was poor across all groups. Conclusions: There is a trend toward early relapse in patients with higher blast on D14. However, D14 BM marrow blast >15% has a poor NPV for predicting relapse.
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Evaluation of Jak2 exon 12 mutation in patients with polycythemia vera
Fatemeh Zadeh Asad, Najmaldin Saki, Javad Mohammadi Asl, Tina Vosoughi, Zari Tahannejad Asadi
November-December 2020, 9(6):244-248
Background: Polycythemia vera (PV) increases the red blood cells' production. Jak2 Exon 12 mutation as a new molecular test can be helpful for diagnosing of PV patients. In this study, the evaluation of the Jak2 Exon 12 mutation in patients with PV was done. Materials and Methods: A total of 120 patients with PV were screened for JAK2 V617F gene mutation using amplification refractory mutation system-polymerase chain reaction and Exon12 JAK2 gene mutation by DNA sequencing. Results: There was a significant relationship between the JAK2V617F mutation and hemoglobin, white blood cell, and platelet counts (P < 0.05). Two (7.7%) patients (one male and one female) were positive for JAK2 Exon12 mutation (JAK2R541-E543delinsK, JAK2H531Q, and JAK2V 511G). Conclusions: The high diversity in the JAK2 Exon12 mutation in studies can be due to using different molecular methods. Further studies are needed to investigate the relationship between JAK2 Exon12 mutation and laboratory parameters.
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Sinonasal mucosal melanoma: A 9-year experience from a tertiary-cancer centre in South India
KR Anila, Elizabeth Mathew Iype, Malu Rafi, Thara Somanathan, K Jayasree
November-December 2020, 9(6):233-237
Sinonasal tract malignancies are uncommon, representing not more than 5% of all head and neck neoplasm. Primary sinonasal mucosal melanomas (SNMM) are rare and constitute 1% of all melanomas and about 4% of all sinonasal tumors. Mucosal melanomas are biologically distinct from cutaneous melanomas. Etiology of mucosal melanomas is still under speculation. We retrieved nine cases of SNMM from our archives over a period of 9 years from 2010 to 2018. The aim was to identify the clinical characteristics, histopathological features, disease progression, and treatment of this disease. The most common symptom was epistaxis. The mean duration of symptoms was 3 months. Nasal cavity along with maxillary sinus was the most common site. The male to female ratio was 4:5 and the mean age was 63 years. The tumors showed varying histomorphology including epithelioid, spindle cell, and undifferentiated types. Immunohistochemical studies confirmed the diagnosis with positive reactions for S100 and melanocytic markers HMB45, Melan A. Surgery was the first line of management with postoperative radiotherapy (RT) for margin positive cases. Three inoperable cases were given palliative RT. Four cases developed recurrence. Recurrences were managed with RT in most cases. Three patients died due to disease. The 1 year recurrence-free survival (RFS) rate was 44% and 2 years' RFS rate was 22%. The 5-year overall survival rate was 28%. More studies are required to understand the utility of chemotherapy and immunotherapy in treatment of this rare entity. Multi-institutional studies are needed for better understanding this rare malignancy.
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Heterogeneity: A stumbling block in the expression of human papillomaviruses 16 in oral squamous cell carcinoma
Diana Daniel, R Dhanusha Chandran, Supriya Bhandage, Deepa Pande, Jerin Jose
November-December 2020, 9(6):227-232
Background: Tobacco and smoking are the established risk factors for oral cancer, but studies have reported the occurrence of oral cancer, even in the absence of these established factors. This indicates the need to identify other possible risk factors. In recent years, viral carcinogens have gained interest in which human papillomaviruses (HPVs) are the most researched risk factor in oral carcinogenesis. Therefore, we conducted this study to evaluate the presence of HPV-16 in potentially malignant and malignant lesions of the oral cavity. Methods: The current study comprised 40 patients, and they were divided into two groups: Group A: 20 patients with histopathologically diagnosed oral potentially malignant disorders (leukoplakia/erythroplakia) and Group B: 20 patients with histopathologically diagnosed oral squamous cell carcinoma (OSCC). Tissue samples were collected from all patients and made into formalin-fixed paraffin-embedded (FFPE) blocks. Polymerase chain reaction (PCR) test was carried out to detect the presence of HPV-16. Results: In our study, we found that none of the FFPE tissue samples was positive for the HPV-16 genome using the conventional PCR technique. The level of significance (P value) was set at P < 0.05. Conclusion: The absence of HPV-16 in OSCC could possibly due to variation in the geographical location and anatomical subsites, ethnicity, and host serological response.
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The effect of spiritual intervention on the concentration of interleukin-1β, interleukin-6, interleukin-8 and tumor necrosis factor alpha cytokines in patients with breast cancer: A pretest–posttest experimental study
Saeedeh Sarafraz Mehr, Majid Pornour, Abolfazl Movafagh, Mohammad Esmail Akbari, Shahram Vaziri, Hossein Pourtoloei, Hajar Vaseghi, Farah Lotfi Kashani, Maliheh Entezari
November-December 2020, 9(6):249-257
Background and Aim: Breast cancer (BC) has considerable effects on the immune system by modulating various psychological and biological aspects, especially hormonal function. Given the effectiveness of various psychological interventions on the overall health status of patients, we aimed to show the effect of the spiritual intervention on the immunological structure of patients with BC. Subjects and Methods: This was a pretest-posttest experimental study conducted from October 2017 to March 2018. There were three groups of patients with BC who referred to Shohada-e-Tajrish Hospital, Cancer Research Center, and Azar Clinic. The sample size based on Cohen's table for each group was at least 11 and taking into account the disadvantages of the subjects was 15. The selection of samples in the first stage was purposeful and based on the inclusion and exclusion criteria, but they were assigned to the groups randomly. They were assigned to the experiment group and two control groups. The first group received 12 sessions of spiritual intervention, the second group received 12 sessions of nonpsychological training focused on physical care related to their illness, and the third group received no intervention. The levels of interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α) were measured in all three groups by Enzyme-linked Immunosorbent Assay before, after, and 3 months after the intervention. The data were analyzed with SPSS software version 21 and the P < 0.05 was considered significant. Results: The level of cytokines was significantly changed at the time of follow-up. These changes were significant between the groups who received the spiritual intervention and nonpsychological training in comparison to the group that did not receive the intervention. Moreover, there was no significant difference between the intervention group and the training group. Discussion/Conclusion: Our findings showed that spiritual intervention can increase the success of the treatment process and the improvement of the patients. Spiritual intervention may significantly affect the physical health of patients with special needs, especially cancer patients in both treatment and recovery states.
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Preoperative analysis of risk of malignancy indices in the distinction of malignant ovarian tumors
B Moshina, Seetesh Ghose
November-December 2020, 9(6):238-243
Background: Ovarian cancers are three times more lethal than breast cancer, despite its lower prevalence rate. Thus, it is imperative to determine if an ovarian mass is benign or malignant to structure a pertinent management protocol. Aim and Objective: The study proposed to preoperatively compare the predictive values of the four risk of malignancy indices (RMIs) and categorized benign and malignant ovarian masses. Methodology: The study included 60 women undergoing surgery for ovarian masses. Parameters such as age, menopausal status, ultrasound findings, tumor size, and cancer antigen (CA)-125 levels were recorded. They were assessed through 4 RMI scores and compared with postsurgical histopathological examination (HPE) report. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated. The level of significance was set atP ≤ 0.05. Results: As per the HPE report, 54 (90%) patients were diagnosed with benign and 6 (10%) with malignant ovarian masses. The median levels of CA-125 were significant (P = 0.014). For the universally recommended RMI cutoff values, sensitivity was 66.7%, specificity ranged from 83.3% to 88.9%, PPV from 36.3% to 40.0%, and NPV from 95.7% to 96%. With the suggested cutoff values obtained by plotting the receiver operating characteristic from the study, sensitivity was 66.6%, specificity ranged from 87.03% to 100.0%, PPV was 100.0%, and NPV was 93.1%. The area under the curve ranged from 0.836 to 0.854. Conclusion: The results of the present study endorse the potency of the RMIs. This certifies that the RMIs are valuable diagnostic tools in discriminating ovarian masses, which could ensure appurtenant management.
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Survival of kurdish patients with lung cancer and some related factors
Nahid Bahari, Mehrdad Payandeh, Mitra Tarlan, Neda Izadi
November-December 2020, 9(6):258-263
Context: Lung cancer is the most leading cause of cancer mortality worldwide. Despite being the leading cause of cancer death, there are a few studies that have characterized survival in the geographical area in Kermanshah, Iran. Aims: The current investigation was conducted to identify factors associated with survival after lung cancer in Iranian patients with lung cancer. Settings and Design: The study has designed a retrospective study of 73 patients with lung cancer in the clinic of oncology and hematology. Subjects and Methods: The data were analyzed using SPSS package software version 16. The log-rank test was performed to determine the relationship between different variables and the survival of patients. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall mortality. Kaplan–Meier method and Cox proportional hazards model were used to analyze the survival rate at different times after diagnoses and HRs, respectively. Results: The average age of patients was 59.49 ± 11.12. Patients with non-small cell adenocarcinoma had more prevalence (65.8%), and 68.5% of them were in Stage IV. 1-, 2-, and more than 2-year survival rates for patients with non-small cell lung carcinoma are 28%, 23%, and 17%, respectively. There was a significant relationship between survival and maintenance treatment (P = 0.003). Conclusion: The most obvious finding to emerge from this study is that the survival time in patients received maintenance therapy is higher than other patients. Further studies with large sample size are required with a focus on factors such as the risk of lung cancer and lung cancer incidence patterns.
  809 25 -
Aneurysmal bone cyst: With uncommon location and presentation – A case series with review of literature
Mani Krishna, Seema Dayal
November-December 2020, 9(6):267-270
Aneurysmal bone cyst (ABC) is a expansile osteolytic bone lesion of unknown aetiology. These lesions are usually present in the long bones, particularly the humerus, femur, tibia, and fibula and are composed of blood-filled cavities with the female predominance. ABC is differentiated into two variants such as primary and secondary. Primary ABC arises de novo, whereas secondary arises in association with some pathology. Here, we are presenting three unusual cases of ABC; two cases were reported here because of their rare locations such as talus and ulna, whereas the last case was of giant cell tumor with secondary ABC.
  644 29 -
Spermatocytic tumor in a young patient-not so rare
Beauty Sarkar, Nadeem Tanveer, Ankita Verma
November-December 2020, 9(6):271-272
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Primary amelanotic melanoma of the cervix: A case report with review of literature
Lalita Negi, Kavita Mardi, Liza Negi
November-December 2020, 9(6):264-266
Primary malignant melanoma arising from the uterine cervix is extremely rare. It may be misdiagnosed, especially when amelanotic, in which case immunohistochemistry is useful in reaching the diagnosis. We present a case of 67-year-old postmenopausal patient presenting with bleeding per vaginum. Per speculum examination revealed an ulceroproliferative growth involving the cervix. Microscopic examination showed sheets of pleomorphic cells with prominent eosinophilic nucleoli and intranuclear inclusion. On histopathological examination, possibilities of poorly differentiated carcinoma and amelanotic melanoma were kept. On immunohistochemical analysis, tumor cells were strongly positive for HMB-45, S-100, and vimentin. Keeping in view the histopathological and immunohistochemical findings, diagnosis of amelanotic melanoma of cervix was given. Pertinent literature is also reviewed.
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