The role of p53 and ki67 in predicting clinical outcome in breast cancer patients.

Background: ">ki67 may be used as a proliferative index in addition to estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) negative status. p53 gene expression is a well-known biomarker in breast cancer and its role in predicting clinical outcome remains unclear. The current study aimed to determine the relationship between p53 gene mutation and ki67 expression, their clinical characteristics, and overall survival (OS), and to differentiate the significance of p53 and ki67 as the prognostic value in breast cancer patients. Methods: ">In this study, 135 patients were enrolled in the study from December 2015 to May 2017. Medical records for all patients were reviewed prospectively. The inclusion criteria included age more than 18 years with histologically proven breast cancer and willingness to be enrolled in p53 genetic study. Exclusion criteria included dual malignancy, male breast cancer, with a loss to follow-up during the study. Results: ">The mean survival of patients with ki67 ≤20 index was 42.7 months (95% confidence interval [CI] 38.7-46.7) and 129 months (95% CI 101.3-157.2) in patients with ki67 >20. The mean OS was 145 months (95% CI 105.6-185.5) in the p53 wild-type group and 106 months (95% CI 78.0-133.0) in the p53 mutated group, as illustrated. Conclusion: ">Our results indicated that p53 mutational status and high ki67 might have an essential impact on overall survival, with p53 mutated patients having a poorer outcome than p53 wild type patients.

Plasmablastic Lymphoma Involving Kidney in an HIV Positive Patient: A Case Report with Review of the Literature.

Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. It most commonly presents in the oral cavity and rarely involves the kidney. Herein, we report a case of HIV positive male with renal involvement of PBL. The patient presented with unilateral severe hydronephrosis with unaltered renal functions. Despite aggressive management, there was an early relapse and the patient died within 2 years of the diagnosis. Despite the recent advances in the therapy of HIV-associated aggressive lymphomas, patients with PBL have a poor prognosis. Multimodal treatment with chemotherapy, newer targeted and biological agents, along with hematopoietic stem cell transplantation is essential for the treatment of PBL.

An Update on Advances in COVID-19 Laboratory Diagnosis and Testing Guidelines in India.

The declaration of COVID-19 as a global pandemic has warranted the urgent need for technologies and tools to be deployed for confirming diagnosis of suspected cases. Diagnostic testing for COVID-19 is critical for understanding epidemiology, contract-tracing, case management, and to repress the transmission of the SARS-CoV-2. Currently, the Nucleic Acid Amplification Test (NAAT)-based RT-PCR technique is a gold standard test used for routine diagnosis of COVID-19 infection. While there are many commercially available RT-PCR assay kits available in the market, selection of highly sensitive, specific, and validated assays is most crucial for the accurate diagnosis of COVID-19 infection. Laboratory diagnosis of SARS-CoV-2 is extremely important in the disease and outbreak management. Development of rapid point of care tests with better sensitivity and specificity is the critical need of the hour as this will help accurate diagnosis and aid in containing the spread of SARS-CoV-2 infection. Early detection of viral infection greatly enhances implementation of specific public health intervention, such as infection control, environmental decontamination, and the closure of specific high-risk zones. Large-scale sequencing of SARS-CoV-2 genome isolated from affected populations across the world needs to be carried to monitor mutations that might affect performance of molecular tests. Creation of genome repositories and open-source genetic databases for use by global researchers is clearly the way forward to manage COVID-19 outbreak and accelerate vaccine development. This review summarizes various molecular diagnostics methods, technical guidelines, and advanced testing strategies adopted in India for laboratory diagnosis of COVID-19.

Floral Pattern of Keratic Precipitates in Vitreoretinal Lymphoma on In Vivo Confocal Microscopy.

PURPOSE: To describe the morphological patterns of keratic precipitates (KPs) in vitreoretinal lymphoma (VRL) using in vivo confocal microscopy (IVCM). METHODS: Six eyes of three biopsy-proven VRL patients were included. KPs were identified and analyzed on IVCM. RESULTS: On examination, pigmented KPs in four eyes, white central KPs in two eyes and anterior chamber cells with flare in six eyes and pseudo hypopyon in one eye were identified. A typical floral pattern of KPs on IVCM was noted in all eyes. Three eyes each showed the complete and incomplete floral patterns, respectively. Resolution of KPs on IVCM was noted after chemotherapy. CONCLUSION: In addition to the routinely used clinical and imaging markers like the visual acuity, presence of lymphomatous cells in the vitreous and optical coherence tomography findings, the presence and appearance of KPs on IVCM can also be considered as a useful, diagnostic and treatment monitoring marker in VRL.

Prospective Analysis of Patients with Metastatic Breast Cancer receiving Eribulin Mesylate as Second or More Lines of Chemotherapy: An Indian Experience.

BACKGROUND: Eribulin mesylate is a non-taxane microtubule inhibitor which can be used after anthracycline and taxane treatment in patients with metastatic breast cancer (MBC). The purpose of this study was to investigate the efficacy and safety of eribulin monotherapy in heavily pretreated patients with MBC. METHODS: In this study, a total of 45 eligible patients with MBC who received eribulin in HCG Cancer Speciality Center from November 2014 to March 2016 were prospectively analyzed. Breslow (generalized Wilcoxon) survival analysis was carried out for progression-free survival and for overall survival. Patients were excluded if they had not taken treatment for 3 cycles and defaulted/expired during the treatment. RESULTS: In this study, median age of patients was 52 years. A total of 27 (60%) patients had estrogen receptor and progesterone receptor (PR) positive primary tumors, whereas HER2 was overexpressed or amplified in 7 (15.6%); a triple negative subtype was recorded in 13 patients (28.9%). Regarding toxicity, 30 patients (66.67%) tolerated treatment well and 3 patients (6.67%) got anemia, 6 patients (13.3%) experienced neutropenia, and 7 (15.62%) patients had neurological toxicity. About 14 (31.1%) patients showed PR, 12 (26.7%) patients had stable disease (SD), whereas 19 (42.25%) patients showed progression disease (PD). Response evaluation at 6 cycles was possible in 18 patients and revealed that 4 (22.5%) patients showed PR, 10 (55.5%) patients had SD, whereas 4 (22.2%) patients had PD. Progression-free survival of the overall study population was 3.95 months. CONCLUSIONS: Eribulin mesylate is efficacious and tolerable chemotherapy as second- and third-line treatment options for MBC.

Medico-religiousplantsusedbytheHajongcommunityofAssam,India.

ETHNOPHARMACOLOGICAL RELEVANCE: The Hajong people use many medicinal plants in their different rituals. The information generated from the present study regarding the medico-religious plants used by the Hajong tribes need a thorough phytochemical investigation. This could help in creating awareness regarding the need for conservation of such plants and also in the promotion of ethno-medico-botany knowledge within the region besides contributing to the preservation and enrich- ment of the gene bank of such economically important species before they are lost forever. Medico-religious plants so found out in this study should be screened for their efficacy by which new drugs or products could be brought out. There is also need to document this information and compare with that of other tribes in the state and region. MATERIALS AND METHODS: The diseases found during the research work among the Hajong community were grouped in 11 categories. The category of diseases includes plants used for both human and animal diseases. The informants having good knowledge on medico-religious plants were chosen for the interview. Kabiraj or Vaidyas were also included among the informants though they were not available in all villages. The informants were asked about the ritual and religious importance and the medicinal properties of the plants used in different cultural practices. RESULTS: Some 36 plant species including herbs, shrubs and trees are used for curing 51 different diseases with 63 formulations which are recorded during the study. Most of the medicinal plants were collected from their own homestead and rest from the forest. Hajongs make sustainable use of available natural resources that include both medicinal and religious plants. They lead a much disciplined life. They are very much religious and knowledgeable. The survey revealed that not only the Kabiraj but also the elder community member have good knowledge of the medicinal value of some plant usually those species used to treat common diseases like cough, cold, fever, viral fever, headache, stomachache, joint pain, diarrhea, dysentery, minor wounds and cuts etc. Thus 36 plants are found to be used by Hajong in different medico-religious practices. These are regarded as holy plants. These plants are strictly protected by the community. Traditional conservation and management on cultural grounds, therefore, represents a historic contribution to the present day rich biodiversity in the region. CONCLUSION: The whole life system and socio-economic as well as religious and cultural activities of Hajongs were totally dependent upon forests. It reflected their high possession of knowledge on medico religious plants which allowed them to apply their indigenous knowledge regarding various aspects of exploitation of such resources. Different types of important species have been disappeared from the study area, which ultimately creates social, economical and religious problem in Hajong community. The information generated from the present study regarding the medico-religious plants used by the Hajong tribes need a thorough phytochemical investigation. This could help in creating awareness regarding the need for conservation of such plants and also in the promotion of ethno-medico-botany knowledge within the region besides contributing to the preservation and enrichment of the gene bank of such economically important species before they are lost forever. Traditional culture in different Hajong populated areas is very fast declining with lot of traditional knowledge under the influence of dominant culture. Cultural diversity conservation is needed urgently.

Hepatocellular carcinoma presenting as an isolated sphenoid sinus lesion: a case report.

We report a rare case of a metastatic sphenoid sinus lesion originating from an undiagnosed hepatocellular carcinoma (HCC) in a 53-year-old man who presented with gradually progressive external ophthalmoplegia. Imaging showed a right sphenoid sinus lesion infiltrating the parasellar region. Although a primary sphenoid biopsy was inconclusive, positive hepatitis B surface antigen and CT-guided fine-needle aspiration cytology suggested an HCC. A repeat endoscopic biopsy from the sphenoid with immunohistochemistry confirmed the lesion to be metastatic HCC. Metastasis to the paranasal sinuses is extremely rare, and metastasis from a liver primary even more rare. Because of clinical and radiologic similarity between the primary and metastatic lesions, metastasis to the sphenoid sinus is often undiagnosed. Patients with features suggestive of sphenoid sinus malignancy should also be evaluated for the possibility of a metastatic tumor. In this article, we emphasize the rarity of the tumor, the unusual presenting symptoms, and problems with early diagnosis.

Neuroendocrine carcinoma of gallbladder: report of 2 cases.

BACKGROUND: Neuroendocrine carcinoma of the gallbladder is rare. Its best treatment is not known. METHODS: Two patients underwent surgery earlier: one for suspected cholecystitis and the other for cholelithiasis. Magnetic resonance cholangiopancreatography (MRCP) showed residual lesions in the livers. The two patients underwent revision surgery followed by chemotherapy. RESULTS: Both patients tolerated the second stage surgery well, which was followed by chemotherapy with paclitaxel, ifosphamide and cisplatin for 6 cycles. They were treated this way for 8 months and 12 months post treatment, respectively. CONCLUSIONS: A proper diagnosis of neuroendocrine carcinoma is made often after surgery. As it is a slow growing tumor and not very chemotherapeutically, sensitive surgery offers the best local control.