Gonadotropin-releasing hormone agonists in prostate cancer: A comparative review of efficacy and safety.

Androgen deprivation therapy (ADT) using gonadotropin-releasing hormone agonist (s) (GnRH-A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH-A. All GnRH-A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (≤50 ng/dL in a month and ≤20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ≤50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate-specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10-year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10-year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10-year survival rate of 87%, and triptorelin had an 8-year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH-A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH-A. Goserelin appears to be the most convenient of all the GnRH-A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH-A for ADT in prostate cancer.

Unusual presentation of female bladder outlet obstruction- female hypospadias with urethral stenosis.

Hypospadias is a rare birth deformity characterised by shortening of urethra with dorsal ectopia of the urethral meatus. The occurrence of hypospadias in female patients is extremely rare. We present a young female complaining of recurrent urinary tract infection and voiding difficulty caused by hypospadias.

Ischiopagus tetrapus conjoined twins: 22 years after separation.

There is no record of both separated ischiopagus tetrapus conjoined twins leading normal lives 22 years after separation. We separated a pair of such twins in 1986 and have followed them up till date. Details regarding the technique of separation and the procedures required to ensure normal defecation and micturition and normal musculoskeletal function have been described by us in earlier communications. In this paper we describe their present status and ability to face the world as independent adult females. The outcome reflects the responsibilities and dedication of pediatric surgeons for infant patients with congenital problems after they have become adults, taking a pivotal role to involve surgeons of other disciplines as and when necessary.

Production and purification of a bioactive substance inhibiting multiple drug resistant bacteria and human leukemia cells from a salt-tolerant marine Actinobacterium sp. isolated from the Bay of Bengal.

Four marine actinobacteria tolerant to 200 g NaCl l(-1) were screened for antibacterial activity against eight patient-derived multiple drug resistant (MDR) bacteria. The active compound (MW 300.2, predicted molecular formula C(20)H(28)O(2)) from an actinobacterium, was inhibitory to three Gram-positive and three Gram-negative MDR bacteria, seven non-clinical Gram-positive, four Gram-negative bacteria and five fungi (MIC: 3.5-4.0 microg ml(-1)). Also, 54% of human leukemia (HL-60) cells were killed by the compound at 0.05 microg ml(-1). Bioreactor production demonstrated unusual primary metabolite kinetics. Molecular phylogenetic analysis showed this typical intertidal inhabitant to be a member of the Streptomyces genus and distinct from other salt-tolerant actinobacteria. As no compound was found to match the properties in several electronic databases, our screening strategy should increase the possibility of discovering bioactive molecules from rare actinobacteria.