Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India.

PURPOSE: Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India. METHODS: We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed. RESULTS: We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores. CONCLUSION: QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Cancer epidemiology literature from India: Does it reflect the reality?

BACKGROUND: The alarming escalation of cancers over infectious diseases in the lower and middle-income countries warrants a better understanding of this epidemiological transition. The epidemiology of cancers in India is sparsely addressed in the literature. Hence, in this manuscript, we present the review done, on research manuscripts, addressing cancer incidence, trends and risk factors from India over the last 12 years. Studies addressing screening, treatment and clinical trials were excluded. METHODS: We evaluated the studies for the theme addressed, study design, sample size, the region of origin and whether it was population or hospital-based study. RESULTS: The studies highlighted a significant shortage of multicenter population-based data in the incidence and risk factors associated with various malignancies in India. Further, we also observed that there was a relative lack of information from the northern and northeastern parts of India. The reviewed articles also indicated the need for a robust design for the studies, large sample size and uniformity in reporting incidence for appropriately drawing conclusions from a study. Reporting of country-specific risk factors with their geographical variations was also sparse. CONCLUSION: Overall, the cancer epidemiology literature from India is sparse. More studies with robust designs representing all parts of the country are currently needed.

A proteomic approach of biomarker candidate discovery for alcoholic liver cirrhosis.

Alcoholic liver disease (ALD) progresses from steatosis to alcoholic hepatitis to fibrosis and cirrhosis. Liver biopsy is considered as the gold standard method for diagnosis of liver cirrhosis and provides useful information about damaging process which is an invasive procedure with complications. Existing biomarkers in clinical practice have narrow applicability due to lack of specificity and lack of sensitivity. The objective of this article is to identify proteomic biomarker candidates for alcoholic liver cirrhosis by differential expression analysis between alcoholic liver cirrhotic and healthy subjects. Blood samples were collected from 20 subjects (10 alcoholic liver cirrhosis and 10 healthy) from R. L. Jalapa Hospital and Research Centre, Kolar, Karnataka, India. Differential protein analysis was carried out by two-dimensional electrophoresis after albumin depletion, followed by liquid chromatography-mass spectrometry. The image analysis found 46 spots in cirrhotic gel and 69 spots in healthy gel, of which 14 spots were identified with significant altered expression levels. Based on the protein score and clinical significance, among 14 spots, a total of 28 protein biomarker candidates were identified: 13 with increased expression and 15 with decreased expression were categorized in alcoholic liver cirrhosis compared to healthy subjects. Protein biomarker candidates identified by "-omics" approach based on differential expression between alcoholic liver cirrhotic subjects and healthy subjects may give better insights for diagnosis of ALD. Prioritization of candidates identified is a prerequisite for validation regimen. Biomarker candidates require verification that demonstrates the differential expression will remain detectable by assay to be used for validation.

Stellate Ganglion Block as Rescue Therapy in Refractory Ventricular Tachycardia.

Pain physicians and anesthesiologists routinely perform stellate ganglion block for the treatment of painful upper extremity sympathetic dystrophy. Close proximity of ganglion to vascular structures warrants some expertise and training in the procedure. Off late, successful use of the technique in intractable ventricular tachyarrhythmias has come in literature. We have few cases wherein we could successfully ablate intractable ventricular tachycardia with stellate block which was refractory to repeated shocks. We are reporting one such case with the intention of making an awareness in the anesthesia community about this treatment option.