A Retrospective Audit of Demography and Different Surgical Modalities Adopted for Giant Cell Tumor of Bone in Eastern India.

Background and objective There is scarce data on demography and different surgical treatment modalities for giant cell tumor of bone (GCTB) from eastern India. In light of this, the present study aimed to examine the demographic characteristics, different surgical treatment modalities, and recurrence rate of GCTB at a tertiary care institute in Bihar. Materials and methods A retrospective audit of 52 GCTB patients who were treated at the center from January 2016 to December 2020 was conducted. The minimum follow-up period was one year. GCTB patients underwent surgical procedures ranging from extended intralesional curettage with bone graft or bone cement with or without fixation to wide local excision to resection with or without reconstruction or amputation depending on the stage and site of the tumors. Results The mean age of patients was 31.86 years (range: 13-67 years). The distal femur (20 patients, 38.46%) and proximal tibia (11 patients, 21.15%) were the most common sites of the tumor. Sixty-eight confirmed cases (male: 32, female: 36) of GCTB were operated on, with a male-to-female ratio of 1:1.125. Sixteen patients (four males and 12 females) were lost to follow-up. So, the final study consisted of 52 patients with a median age of 28 years (first quartile: 24 years, third quartile: 38 years). The majority of patients (32 patients, 61.53%) were in the third and fourth decades of life. Conclusion Based on this retrospective audit, it is concluded that the knee region is the most common site of GCTB. Surgery is the mainstay of management. Most of the patients came under Campanacci Grade 3 with low compliance with follow-up and adherence to the treatment. Hence, educational programs, the establishment of early detection centers, and timely referral to expert treatment are necessary.

Hepatitis B in hepatocellular carcinoma patients and its correlation with alpha-fetoprotein and liver enzymes.

Background: Hepatocellular carcinoma (HCC) in India ranges from 0.7 to 7.5 for men and 0.2 to 2.2 for women, per 100,000 population per year. The major risk factors for the development of HCC are infection with hepatitis B virus (HBV), hepatitis C virus, and cirrhosis of liver. Alpha-fetoprotein (AFP) and liver enzymes are widely used by clinicians for diagnostic purpose in HCC. Aims and Objective: This study was conducted in HCC patients related to HBV infection and to assess the significance of AFP and liver enzymes in it. Materials and Methods: Blood samples of 68 patients were taken. The samples were analyzed for AFP and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]). Liver enzymes were estimated by auto analyzer OLYMPUS AU400. AFP was analyzed by chemiluminescence immunoassay. Results: The mean values of AFP in serum hepatitis B surface antigen (HBsAg) negative and positive patients ranges from 22745.4 to 23269.3 ng/ml with P = 0.921. The mean value of ALP in HbsAg-negative patients was 418 U/ml, whereas in positive patients, it was 310 U/ml. Both the groups did not show any significant changes in AFP levels. The ALP showed slight rise in negative group. The other parameters did not show significant rise in all patients. Conclusion: These values suggest that there was no significant influence of viral etiology on AFP and liver enzymes level in HCC patients.

Genomic Pattern of GSTM1 and T1 Gene Null polymorphism of Head and Neck Cancer Patients in Eastern India.

OBJECTIVE: Homozygous deletion i.e., null polymorphism of the Glutathione S transferases genes hinders detoxification reactions by altering the sensitization of glutathione s transferases enzymes. Hence, we analysed the association between the GSTM1 and GSTT1 gene polymorphisms and head and neck cancer (HNC). METHODS: The study consists of 238 healthy controls and 160 diagnosed cases of HNC, who attended the Regional Cancer Centre, Indira Gandhi Institute of Medical Sciences (a tertiary care hospital). DNA was extracted from whole blood of patients and control using Qiagen DNA extraction kit. GSTM1 and GSTT1 gene polymorphisms were examined using PCR and agarose gel electrophoresis. RESULTS: GSTM0 null polymorphism was 26.25% and 15.13% in cases and control respectively. GSTT0 null polymorphism was observed in 18.13% cases and 8.82% in control groups. The GSTM0 null polymorphism was present significantly in case group as compared to control group (OR = 1.997, p = 0.006). There was also significant association of GSTT0 null polymorphism with case group as compared to control group (OR = 2.288, p = 0.006). The combined genotypes were also analysed. GSTM0T1 genotype (n = 27) was found to be most common among HNC group followed next by GSTM0T0 double deletion (n =15). CONCLUSION: The result indicated that there was strong association of GSTM0 and GSTT0 null polymorphism in those patients. The combined genotypes i.e., GSTM0T1 and GSTM0T0 null polymorphism also showed significant association in HNC patients.

Lifestyle factors influencing medical and nursing student's health status at the rural health-care institute.

BACKGROUND: Noncommunicable diseases (NCDs) may be influenced by lifestyle behavior, acquired during transition in student life at university. Health is a major concern globally. The developing counties are facing a double burden of disease, both communicable and NCD. This study is aimed to assess the lifestyle and its associated factors that can affect the health status of medical and nursing students. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among medical and nursing students of Sasaram, Bihar, by universal sampling. The study population consisted of 303 medical and 233 nursing students. The 536 students in the study, included 195 from rural areas and 341 from urban areas. Simple Lifestyle Indicator Questionnaire was used and Chi-square statistics was computed to determine the association of demographic variables with lifestyle behavior using Epi InfoTM 7 analysis software. RESULTS: Mean age and body mass index were 21 ± 2.59 years and 22.12 ± 3.77, respectively. After statistical analysis utilizing the Chi-square test, it was shown that the difference was found to be nonsignificant (P > 0.05) in all the following variables, such as gender, age, marital status except in designation, and alcohol and tobacco intake which showed the difference to be highly significant. CONCLUSIONS: The maximum number of students in the study population showed intermediate healthy lifestyle (57.1%), despite being the upcoming health-care providers of future. Fruits were rarely present in diet in 82%, no physical activity in 21.2%, and tobacco and alcohol were consumed by 11.7% and 13%, respectively. Targeted intervention for healthy diet, physical activity, stress, tobacco, and alcohol reduction can lead to healthy lifestyle. Independence and autonomy gained in the transition phase in student life needs guided supervision to raise responsible adults. It may help to assist or to plan accordingly in future to improve lifestyle of the students.

Giant Cervicodorsal Schwannoma.

OBJECTIVE: Schwannomas are benign slow growing tumors that arise from myelin producing Schwann cells. Schwannomas developing in cervical-dorsal region are rare benign neoplasms which are emerges leisurely remains asymptomatic some times and functionally inactive tumours. Giant Schwannomas extending over two or more vertebral levels have been documented and attempts have been made to classify these in available literature, however inadequate. Advancement in imaging modalities and microsurgery has bettered management of these tumors. A rare case of intradural extramedullary cervicodorsal schwannoma extending along seven vertebral levels to thoracic levels is reported in a 55 year old male patient with progressive weakness and numbness of over one and a half years. MRI of cervical spine showed a heterogeneously lesion with cord oedema till D7 level on T1contrast saggital view. Histological examination revealed encapsulated spindle cell lesion with hypocellular and hypercellular areas with verucay bodies, occasional bizzare nuclei, hyalinized blood vessels, with no evidence of necrosis/atypical mitosis, suggestive of schwannoma. In the prone position, C4 to D7 enbloc laminotomy was done and total excision of intradural extramedullary lesion was done. Post-operative CT scans revealed normal spinal canal dimensions with implants in situ. At quarterly follow up upto one year post-operative, the patient had near normal power in all four limbs and normal bladder function.

First case report of spontaneous posterior fossa subdural hemorrhage - A rare cause of neonatal encephalopathy.

Posterior fossa subdural hemorrhage (PFSDH) in term neonates is rare and unknown in the absence of obvious trauma. Its management is challenging and decided case to case basis. Here we report two cases of posterior fossa subdural hemorrhage in term babies with normal transition at birth and presenting later with neonatal encephalopathy. First baby was born by elective caesarean section and the second baby by assisted vaginal delivery. They presented at 60 h and 48 h respectively. Both babies had similar clinical presentation in the form of poor feeding, shrill cry and posturing. But they had contrasting clinical course with features of brainstem compression in the first baby requiring ventilation. Coagulation workup was normal in the first baby but fibrinogen level was low in the second baby. Magnetic resonance imaging of the first baby showed PFSDH with tonsillar herniation while in the second baby, there was no midline shift or herniation associated with the PFSDH. Management was tailor made to suit the clinical course and imaging findings. Craniotomy and clot evacuation was done in the first case and in the second baby, management was conservative. Neurological examination was normal at discharge. Both are developmentally normal on follow up. There is no evidence of hydrocephalus in both. Management of PFSDH depends on clinical course and MRI findings. Timely intervention leads to good outcome.