Predictive value of changes in the serum CA-125 levels in patients undergoing interval debulking surgery after neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

Background: The objective of this study is to evaluate the predictive value of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian carcinoma (EOC).Methods: A retrospective hospital-based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Department of Obstetrics and Gynecology in Gujarat Cancer and Research Institute, Ahmedabad, for two years. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed.CA 125 levels before (baseline) and after NACT were analyzed.Results: Out of 50, there were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. Maximum 37(74%) patients had CA 125 levels >500 on presentation while none of the patients had baseline CA125 levels in the normal range (<35). Range of baseline CA 125 was 164-5394.All patients were given NACT and after NACT, out of 50 patients, 22(44%) patients had CA 125 values within the normal range (<35) while 23(46%) had values between 35 and 100. Thus, statistically significant difference (Z = 6.154, P<0.0001) was found between CA 125 level before and after NACT. Out of 45 patients with CA 125 <100, 35(77.8%) underwent optimal cytoreduction.Conclusions: Baseline (prechemotherapy) serum CA-125 levels are powerful indicators of the presence and extent of spread of disease while CA-125 level particularly <100U/ml after NACT strongly predicts optimal cytoreduction in advanced epithelial ovarian cancers

Home-Based Work and Home-Based Workers (1800-2021)

Home-Based Work and Home-Based Workers (1800-2021) is about the past and present of home-based work and homebased workers between 1800 and 2021 from a global perspective.; Readership: All interested in social and economic history, and especially in the past and present of home-based work and homebased workers

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

Risk of Malignancy Index (RMI) in the Pre-Operative Evaluation of Patients with Adnexal Masses

The aim of this study is to evaluate use of RISK of MALIGNANCY INDEX (RMI) in primary evaluation of adnexal masses without clear evidence of malignancy, by combining serum CA 125 levels, USG score and menopausal status. It is a cross sectional study conducted at Department of gynaec- oncology, Gujarat Cancer and Research Institute, Ahmedabad. A total of 40 women aged 20 to 65 years with ultrasound diagnosed adnexal masses, and serum measurement of cancer-associated antigen CA-125 levels, were studied. They all had surgical exploration (laparotomy) between May 2005 to July 2007 .The RMI was based on menopausal status, ultrasound morphology of adnexal masses and absolute level of serum CA-125. RMI cut-off of 200 was chosen. The various testing methods were evaluated for sensitivity, specificity, positive and negative predictive values. The best performance was with a RMI at a cut-off of 200 with a sensitivity of 66.66%, specificity of 63.15%, positive predictive value of 66.66% and negative predictive value of 65.15% to diagnose malignancy. When RMI was used, it is better in detecting benign tumour and malignant tumour rather than individual component. RMI to be a valuable, reliable and applicable method in primary evaluation of patients with adnexal masses, and a usable method for referral of advanced neoplasia to a more complex healthcare unit. [Med-Science 2016; 5(1.000): 1-11

Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters

Aim: To assess the nutritional status of gynecological cancer patients using scored Patient Generated Subjective Global Assessment (PG-SGA) then compare it with the body mass index (BMI), hemoglobin, serum albumin, and approximate percentage weight lost in last 1 month so as to find any one parameter that can be used in place of the comprehensive assessment tool. Materials and Methods: Sixty gynecological cancer patients were assessed for their nutritional status using BMI, serum albumin, hemoglobin, percentage weight lost in last 1 month, and scored PG-SGA. Correlation, sensitivity, specificity, and predictive values of the former four parameters compared to scored PG-SGA were calculated. Results: 88.33% of cases were at risk of or had some degree of malnutrition according to scored PG-SGA. Serum albumin level ≤ 2 g/dl had highest specificity and positive predictive value at 1, whereas percentage weight lost in last month had better overall sensitivity, specificity, and positive and negative predictive values of 0.5833, 0.9444, 0.875, and 0.7727, respectively. The Pearson′s correlation coefficient between scored PG-SGA and percentage weight lost in last 1 month was 0.784, highest among all the parameters. Conclusion: 88.33% of gynecologic cancer cases had some degree of malnutrition or were at risk of malnutrition. Approximate percentage weight lost in last 1 month, that is, ≥ 5% may be used in place of the comprehensive scored PG-SGA to triage the patients in case the latter is not used for some reason. Severe hypoalbuminemia ≤ 2 g/dl is an indicator of severe malnutrition in gynecologic cancer cases

Role of Percutaneous Nephrostomy in Advanced Cervical Carcinoma with Obstructive Uropathy: A Case Series

Aims and Objective: Over 70% of the cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. In many of them, it is difficult to offer definitive treatment as they present in uremia due to associated obstructive uropathy. There are no clear-cut guidelines for performing percutaneous nephrostomy (PCN) in patients of advanced cervical cancer. The results are unpredictable in terms of benefits achieved in these cases. Thus, we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy. Material and Methods: 15 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their management Results: PCN was done in 15 patients of advanced cervical cancer. The mean age of patients was 44.5 years. Twelve (80%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. Three (20%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.5 mg% to 0.9 mg% over a period of 1-3 weeks was noted post PCN. Out of 12 patient with primary untreated advanced disease, curative treatment was possible in 3, palliative radiotherapy/chemo-therapy in 7 and only symptomatic treatment in 2 cases, after obstructive uropathy was managed with PCN insertion. Out of 3 already treated patients, 2 were disease free after curative radiotherapy/surgery. PCN was done to prevent permanent kidney damage in them. One patient was defaulter of curative radiotherapy. She had progressive residual disease. Complications like hemorrhage (20%), infection (26%), reinsertion for dislodgment/misplacement (53%), percutaneous leak or perinephric leak (20%), blockage of PCN (33%) were noticed. Conclusion: In spite of inherent, albeit manageable complications, PCN is a simple and safe technique. One of the major benefits observed was ability to administer either curative/palliative radiotherapy or chemotherapy in 85% of patients (11 out of 13 with disease). There was no active disease in remaining 2 patients. Therefore, the decision to attempt PCN in carefully selected cervical cancer patients is justified

Diphenylhydantoin (phenytoin)-induced chronic pulmonary disease

Drug-induced respiratory diseases are difficult to diagnose and therefore usually not identified, probably underestimated and under-reported. We report a case of diphenylhydantoin/phenytoin-induced chronic pulmonary disease in a 62-year-old male patient presenting with progressive dyspnea, eosinophilia, and pulmonary abnormalities. The importance of drug history in clinical history-taking and early diagnosis of drug-induced respiratory diseases is emphasized so as to prevent permanent pulmonary damage

Diphenylhydantoin (phenytoin)-induced chronic pulmonary disease

Drug-induced respiratory diseases are difficult to diagnose and therefore usually not identified, probably underestimated and under-reported. We report a case of diphenylhydantoin/phenytoin-induced chronic pulmonary disease in a 62-year-old male patient presenting with progressive dyspnea, eosinophilia, and pulmonary abnormalities. The importance of drug history in clinical history-taking and early diagnosis of drug-induced respiratory diseases is emphasized so as to prevent permanent pulmonary damage

Occurrence and distribution of selected heavy metals and boron in groundwater of the Gulf of Khambhat region, Gujarat, India

The concentration of selected heavy metals, like As, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn as well as B, was measured by inductively coupled plasma–optical emission spectrometry (ICP–OES) in groundwater samples from various locations in the Gulf of Khambhat (GoK), an inlet of the Arabian Sea in the state of Gujarat, India, during postmonsoon, winter, and pre-monsoon seasons in a year. Most heavy elements are characterized by low mobility under slightly alkaline and reducing conditions; concentrations in confined aquifers are smaller than the maximum permissible values for drinking water. The temporal changes indicate that a majority of metals is entering the aquifer during monsoon. Principle component analysis of the heavy metal data suggests that Co, Cu, Cd, and Zn are interrelated with each other and derived significantly from anthropogenic route, while input of Pb and Cr may be due to atmospheric deposition in the study area. Both weathering of rocks and anthropogenic input were found to be main sources of elements in the groundwater. The heavy metal levels in groundwaters of the GoK region in comparison with some of the European and Asian sites were higher; however, these metal levels were found to be comparable with few urban sites in the world