Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score.

Background Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients' (CRASH) score. Materials and Methods Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0-3), intermediate (Int)-low (4-6), Int-high (7-9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity. Results Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days. Conclusion CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.

Grade IV myositis: A rare complication of docetaxel.

An extremely rare case of acute inflammatory myopathy during combination chemotherapy with docetaxel and carboplatin for metastatic breast carcinoma in a 62-year-old diabetic female patient is reported. Despite the early clinical partial response of the underlying malignancy to the chemotherapeutic regimen, the patient developed symmetrical, painful, proximal muscle weakness in the lower limbs with peripheral edema after the administration of the third cycle of treatment. The syndrome regressed after the discontinuation of chemotherapy and the administration of corticosteroids.

Neuroendocrine Carcinoma of Gall Bladder: A Series of 19 Cases with Review of Literature.

BACKGROUND: Neuroendocrine neoplasms of the gall bladder (GB) are rare tumors classified as grade 1 and 2 neuroendocrine tumor (NET), neuroendocrine carcinoma (large cell or small cell type), and mixed adeno-neuroendocrine carcinoma (MANEC). Primary neuroendocrine carcinomas (NEC) of GB are rare with grave prognosis not withstanding radical surgical treatment. Chemotherapy forms the primary management due to the advanced stage at presentation, as complete surgical resection is generally not possible. The overall median survival is 4-6 months despite aggressive management. Only 73 cases of small cell carcinoma (SCC) and 10 cases of large cell neuroendocrine carcinoma (LCNEC) have been reported in English literature till now. We present a series of 19 cases of NEC of GB with their pathological and clinical features and response to treatment. OBJECTIVE: The objective of this study was to evaluate NECs of the GB for their clinical behavior, prognosis, and treatment outcome in terms of survival and to segregate NECs into further subcategories, that is 20-50 % and >50 %, based on MIB-1 index. METHODS: We retrospectively searched the clinical and pathological database over 2.5 years (January 2012 to June 2014) through existing electronic hospital medical records to collect cases of NEC arising in GB. A total of 447 cases of gall bladder pathologies were analyzed, of which 19 cases were diagnosed as NEC. All relevant investigations were documented and response to treatment/therapy was evaluated clinically and radiologically. Tumor specimen was obtained by fine-needle aspiration cytology and/or biopsy and classified using the latest World Health Organisation (WHO) classification (2010) via cytopathologic, histopathologic, and immunohistochemical visage. RESULTS: Nineteen patients diagnosed as NEC of GB were evaluated in the study, with 16 having SCC, 2 having LCNEC, and 1 with MANEC. All patients presented in advanced clinical stage III or IV, along with distant metastasis and showed progressive disease during therapy. Ki67 index was between 20 and 50 % in 5 cases and >50 % in 8 cases. Follow-up was available in 14 cases with a median survival of 3 months, and 2 of these patients capitulated to their illness, before commencement of treatment. The remaining 5 cases were lost to follow-up. Out of these, 2 had deranged liver function test and no chemotherapy could be administered, and the other 3 refused treatment. CONCLUSIONS: NECs are aggressive with generally poor prognosis, characterized by insidious onset and advanced clinical stage of presentation. A radical approach to treatment with chemotherapy is the best form of palliation. Role of radiotherapy remains undefined due to paucity of data.

Attire and appearance of pediatrician: parents'/guardians' opinion.

Professional appearance of a pediatrician is an important element affecting the perception of competence of the doctor among patients and their parents/guardians, thus influencing their compliance. As there is no study on this issue addressing the Indian scene, we requested responses to a questionnaire containing 15 questions from the parents/guardians of the children. The purpose of the study was to assess their opinion regarding attire and appearance of pediatricians. Five each of the questions were related to common aspects of appearance and attire of the pediatrician in general and that of the male and the female pediatrician in particular. A total of 210 parents/guardians responded to see the question listed in the questionnaire. Assertive responses to each question were analysed for any association with the following categories--Urban, Rural, Males, Females, Urban Males, Rural Males, Urban Females, Rural Females, age below 40 years and age 40 years or more. Majority of the total assertive respondents preferred a formal/traditional attire and appearance for the pediatrician. Although most of the above categories concurred with this general opinion, some categories showed statistically significant, but practically unimportant, differences in the extent of agreement. The respondents generally favoured a white coat and nameplate on the pediatrician, shoes and a necktie for the male pediatrician and saree for the female pediatrician. They did not approve clothes with bizarre designs, use of perfumes by the pediatrician, long hair, T-shirts and jeans pant for the male pediatrician, chudidar, lipstick and other make-ups, costly jewelery and short hair for the female pediatrician.

Hemiplegia and motor aphasia following scorpion sting.

Hemiplegia and motor aphasia are rare complications following scorpion sting. This report describes a case of hemiplegia and motor aphasia occurring in a young child, following a scorpion sting.

Trichomegaly of eyelashes after treatment with erlotinib in carcinoma pancreas.

Epidermal growth factor receptor (EGFR) inhibitors have been widely used for the treatment of epithelial malignancies. A wide spectrum of skin toxicities have been described in patients receiving EGFR inhibitors. Trichomegaly, especially of the eyelashes is a rare side effect of this therapy. We report a case of trichomegaly of eyelashes in a 39-year-old male, a case of carcinoma pancreas. This side-effect of these medications gives prospects as a therapy to stimulate the growth of hair.