How "Breast Aware" are the Indian Women? A Study among the Women Visiting a Tertiary Care, Referral, and Teaching Hospital.

INTRODUCTION: "Who will educate us" lamented a School Principal after she took part in our study and education session. There is palpable low breast cancer (BC) literacy with rising incidence and disproportionate mortality rates. METHODOLOGY: Breast Cancer Awareness Measure (BCAM) developed by Cancer Research UK was administered to 944 women. BCAM measures knowledge, age-related risk, and reported frequency of breast checking and other components. A woman is BC aware if she identified five or more nonlump symptoms, age-related risk, and reported breast checking once a week/month. At the end, each participant was given "Be Breast Aware" education; what/how to look for demonstrated on a model. RESULTS: 2.8% health professionals. 3.1% BC survivors. 78.8% had lump knowledge and 55.3% had non-lump knowledge of BC, 10% had age-related risk knowledge. 24.3% check breasts once a week/month. 41.9% aware BC is common after 50 years. 14/944 (1.5%) had BC awareness. 59.9% had breast symptoms, but never consulted a doctor, 31.1% were embarrassed, and 29.4% were scared to consult. Nearly 43% heard of breast screening, 28.4% had mammography, 26.3% had ultrasound. About 44.1% knew family history risk. Those practicing breast checking looked for a size change (24.5%), nipple position (17.4%), discharge (22.1%), pain (32.5%), and lump (24.7%) in standing (17.8%), supine (8.5%) using finger pads (15.8%) fingertips (21.6%), using circular movements (16.4%), and pinching breast tissue (19.6%). CONCLUSION: Health-care workers and BC survivors lack breast awareness which is alarming and indicates the need for BC awareness and post-BC treatment follow-up care education in these two groups and the general population. Some practice the wrong method (e.g., pinching tissue) of breast checking, which may lead to anxiety and unnecessary investigative costs. "Be Breast Aware" education based on the National Health Service 5-point plan given to 944 participants.

Résumé Introduction:'Qui nous éduquera ?' s'est lamentée une directrice d'école après avoir participé à notre séance d'étude et d'éducation. Il existe un faible niveau de connaissances sur le cancer du sein, avec une incidence croissante et des taux de mortalité disproportionnés.Méthodologie:La mesure de sensibilisation au cancer du sein (B-CAM) développée par Cancer Research UK a été administrée à 944 femmes. B-CAM mesure les connaissances, le risque lié à l'âge et la fréquence signalée de l'auto-examen des seins, ainsi que d'autres composants. Une femme est consciente du cancer du sein si elle a identifié au moins 5 symptômes non nodulaires, un risque lié à l'âge et si elle a signalé un auto-examen des seins une fois par semaine/mois. À la fin, chaque participante a reçu une éducation 'Be Breast Aware'; comment auto-examiner les seins a été démontré sur un modèle.Résultats:2,8% de professionnels de santé. 3,1 % de survivantes du cancer du sein. 78,8 % avaient une connaissance des symptômes nodulaires et 55,3 % avaient une connaissance non nodulaire du cancer du sein, et 10 % avaient une connaissance des risques liés à l'âge. 24,3 % vérifient leurs seins une fois par semaine/mois. 41,9 % savent que le cancer du sein est courant après 50 ans. 14/944 (1,5 %) étaient sensibilisées au cancer du sein. 59,9% avaient des symptômes mammaires mais n'avaient jamais consulté de médecin, 31,1% étaient gênées, 29,4% avaient peur de consulter. 43 % ont entendu parler du dépistage du cancer du sein, 28,4 % de la mammographie, 26,3 % de l'échographie. 44,1 % connaissaient le risque lié aux antécédents familiaux. Ceux qui pratiquent l'auto-examen des seins ont examiné le changement de taille des seins (24,5 %), la position du mamelon (17,4 %), l'écoulement (22,1 %), la douleur (32,5 %) et la grosseur (24,7 %) en position debout (17,8 %) en décubitus dorsal (8,5 %) en utilisant le bout des doigts (15,8 %) le bout des doigts (21,6 %), en utilisant des mouvements circulaires (16,4 %) et en pinçant le tissu mammaire (19,6 %)Conclusion:les travailleurs de la santé et les survivantes du cancer du sein manquent de sensibilisation aux seins, ce qui est alarmant et indique la nécessité pour la sensibilisation au cancer du sein et l'éducation aux soins de suivi post-traitement dans ces deux groupes et la population générale. Certaines pratiquent une mauvaise méthode d'auto-examen des seins, ce qui peut entraîner de l'anxiété et des coûts d'investigation inutiles. Éducation 'Be Breast Aware' basée sur le plan en 5 points du NHS dispensé à 944 participantes.

D-dimer as a Marker of Severity and Prognosis in Acute Pancreatitis.

Background and Objectives: Acute pancreatitis (AP) scores need a battery of tests that are not helpful at an early stage. Can a single test predict Complicated Acute Pancreatitis (CAP) which includes moderate and severe AP, local complications, and need for intensive care unit (ICU). Methodology: 30 patients of AP. D-dimer, C-reactive protein levels done within 3 days of AP onset. APACHE II, Ranson's score, CT severity index were done. Inhospital disease course for development of organ failure and need for ICU care was followed daily. Results: D-dimer in CAP was 2732 ng/L (MAP 567 ng/L), in abnormal computed tomography (CT) was 1916 ng/L (normal CT 363 ng/L), and in organ failure was 4776 ng/L (776.5 ng/L absent organ failure). D-dimer increases as the severity of organ failure increases (P = 0.04). D-dimer in ICU patients was significantly elevated (P = 0.021). D-dimer correlates with APACHE II score well, with an increase in predictive mortality rate (P = 0.01). On receiver operator characteristics, D-dimer >933.5 ng/L predicts CAP, >827.5 ng/L predicts positive CT findings (local complications), and >1060.5 ng/L predicts the development of organ failure. Conclusion: Coagulopathy and microthrombi play a significant role in early pathogenesis. D-dimer test acts at the level of this core pathogenesis, even before the complications set in. D-dimer within 72 h of AP correlates well with the CT findings after 72 h. This is the first study that correlates D-dimer levels with CT scores, ICU requirement. D-dimer can guide primary care physicians in selecting AP patients for referral to a higher center in a resource-limited setting.

Predicting and grading liver injury in the absence of computed tomographic imaging.

Background: Even developed countries lack computed tomography (CT) scan in rural areas. Availability, affordability and accessibility of CT scan play an important role in the management of blunt hepatic trauma. Materials and Methods: A descriptive observational study among 56 hepatic blunt trauma patients as Group 1 and 56 non-hepatic blunt trauma patients as Group 2 enrolled retrospectively. Observational analysis of presence of liver trauma, grades of liver injury (I-VI) and clinical course with the liver function tests are done. Results: Aspartate transaminase (AST) (P = 0.02) and alanine transaminase (ALT) (P = 0.003) levels were significantly elevated among Group 1. Significantly elevated levels in Group 1 than Group 2 of AST [467.5 (22-5097) vs. 95 (23-1780); P < 0.001] and of ALT [422 (28-1548) vs. 69 (20-727); P < 0.001] noted. Significant elevation of AST and ALT levels, as the AAST (American Association for the Surgery of Trauma) CT grade of liver injury increases, noted (P = 0.001). Using the ROC curve analysis, the optimal cut-off values of AST and ALT were set at ≥467.5 U/L and ≥111.5 U/L, respectively. At this cut-off, AST had sensitivity 50%, specificity 91.7%, PPV 85%, NPV 66%, ALT had sensitivity 85.3%, specificity 86.1%, PPV 85.3% and NPV 86.1% for liver injury. Conclusion: ALT is more sensitive for liver injury. AST peak is seen in the immediate period. Combining clinical assessment, transaminase levels and Focused Assessment with Sonography in Trauma improves the sensitivity and specificity. Transaminase levels can vary with ethnicity and local epidemiological diseases; therefore, optimal cut-off levels should be established for local population. This would predict and grade the liver injury, helping in early decision-making and avoid wasting the golden hour in trauma.

Histological Surprises in Benign Cytologies after Lymph Node Biopsy-Surgeon's Knife Improving Patient Care.

Lymphadenopathy can be due to multitude of causes. Owing to the high prevalence of infectious diseases in India, and malignancy being a life threatening cause for lymphadenopathy; accurate diagnosis is important in preventing delay or misdiagnosis and in improving patient care, thereby increasing longevity with quality. Fine needle aspiration cytology (FNAC) is the first line investigation commonly done. Should the doctor be contented with the benign FNAC or is a lymph node biopsy needed in this age? The aims of this study are the following: (1) to study the spectral pattern of lymph node biopsies done in a surgical oncology unit of tertiary care centre, (2) to assess the yield of malignant cases from lymph node biopsy and (3) to compare the reliability of benign FNAC with lymph node biopsy. Cross-sectional study of 114 cases that underwent lymph node biopsy during the year 2014, at the Surgical Oncology Department of St. John's Medical College Hospital, Bangalore. Lymph node biopsies were done in the outpatient department (OPD) under local anaesthesia or in the operation theatre under local anaesthesia/monitored anaesthesia care based on the clinical condition of the patient. Regional lymph node dissections, central node biopsy, patients with known case of malignancy were excluded. Specimen sent for histopathological study and immunohistochemistry (IHC) done when needed. 58.8% were males among study population, age ranging from 15 to 80 years, 57% cervical and 29.8% axillary lymph node biopsies done. Sixty-seven percent (67%) of biopsies done in OPD. Thirty-three percent (33%) of biopsies in the operation theatre among which 60.5% under local anaesthesia only. 35.1% cases were reactive hyperplasia, 24.6% lymphomas with non-Hodgkin's lymphoma being the commonest, 13.2% metastatic disease with adenocarcinoma being the commonest. 72.7% of the supraclavicular nodes were malignant. 47.4% of subjects had prior FNAC of the lymph node. Twenty-five percent (25%) of the reactive hyperplasia's on FNAC (p < 0.0001), 33.3% of inadequate FNAC (p = 0.003) and 75% of atypical cells in FNAC turned to be malignant on lymph node biopsy with a discordance rate of 20.3%. Lymph node size didn't correlate with neoplasm. In our study, benign cytologies were malignant on biopsy and statistically significant. Lymph node biopsies are reliable in detecting malignancy and subtyping of the disease. In the presence of strong clinical suspicion, lymph node biopsy is essential even when the FNAC is promisingly benign in a country with limited resources. Lymph node biopsy can be safely done in OPD under local anaesthesia at a lower cost, resulting in a reliable diagnosis thereby improving patient care.