Pattern of referral and management of oro-dental problems in patients with cancer: a retrospective study

Background: General dentistry care is of paramount importance in maintaining oral hygiene of cancer patients. Methods: The data of patients registered at the dental wing in a tertiary care cancer center for one year period (2013) was used for the present analysis. All the cases were retrospectively analyzed for the pattern of referral, diagnosis of different oro-dental conditions, and different interventions done for the various oro-dental conditions.Results: A total of 798 patients were referred from various oncology wings for management of oro-dental problems, 50.1% patients were referred from head and neck oncology, 31% were from radiation department, 6.2% patients were from medical oncology and palliative care department each, 4% patients were from gynecologic oncology, and 2.5% patients were from screening wing. Acute gingivitis (62%) in pre treatment and mucositis (28%) in post treatment were major symptoms and signs for referral. 47% patients were managed with tooth extraction, grinding was done on 23%, scaling were done on 12.5%, desensitization was done on 8.7% patients, filling was done on 2.5% patients, prosthesis fitting in 2.5% patients, root canal treatment in 2.2% patients, and post surgical obturator fittings in 0.75% patients. Conclusion: Majority of cancer patients were referred for oro-dental care from head and neck oncology department with head and neck cancers and extraction of tooth pre radiotherapy and chemotherapy remains an important part of oro-dental care in cancer patients.

Oral premedication for pediatric anaesthesia: a comparison between midazolam and clonidine

Background:In children any anticipated surgery is associated with profound psychological stress to the patients. To allay this stress and anxiety, wide variety of pharmacological interventions are used.Methods: A prospective observational study was carried out between July’2005 and June’2006 in a tertiary care hospital in Assam. The study included children undergoing surgery under general anaesthesia in age group 2-10 years. Sixty children were divided into two groups, in one group patients received oral midazolam and other group received oral clonidine as pre-medicant.Results: In the midazolam group 23 (76.67%) children had no apprehension after parental separation and at induction (P˂0.001), sedation score at induction was significant higher in midazolam group versus clonidine group (93.33% versus 66.6%, P<0.01), clonidine resulted in a more stable pulse and blood pressure peri-operatively (P<0.05).Conclusion: Oral midazolam has better efficacy in terms of preoperative sedation and oral clonidine had stable hemodynamic profile and better analgesia in the clonidine group

A retrospective study of post-operative gall bladder pathology with special reference to incidental carcinoma of the gall bladder

Background:Surgical removal of gall bladder for its diseases is common. However, not much is known about the incidence of incidental carcinoma in such patients in our population. Objective of current study was to analyze the different pathological entities of post-operative gall bladder specimen with particular emphasis on incidental carcinoma.Methods:This retrospective study was carried out at a multi-specialty hospital in eastern India from the pathology records for the period from August 2005 to July 2008. The records were analyzed for gender, age group distribution, and pathological types with different histology.Results:Out of 863 records, chronic cholecystitis 51.2% was the most common histology and malignancy was seen in 2.7% (23/863) both pre-operative and post-operative diagnosis. In the neoplastic group incidental carcinoma was diagnosed in 1.9% (17/23) of casesConclusion:Histopathological examination of gallbladder specimen helps to identify non-neoplastic conditions with its complications and also, for the detection of incidental carcinoma. Thorough sampling of all gallbladder specimens is a must to detect focal neoplastic changes

Profiles of gall bladder cancer reported in the hospital cancer registry of a Regional Cancer Center in the North-East India

Background: The incidence of gall bladder cancer (GBC) is very high in this part of the world and there is little information on the descriptive epidemiology of GBC from our population.Methods: A retrospective study on the data set of hospital cancer registry was analyzed. The data set consisted of patient information registered during the period of January 2011 to December 2012. The cases included for the present study were histologically confirmed and radiologically diagnosed cases of GBC. All the cases were retrospectively analyzed for gender, age, urban-rural residences, religion of patients and their educational levels. Descriptive statistics was calculated and Chi square test was done to see the significance differences among categories.Results: A total of 837 cases of GBC were registered, F:M was 2.33, median age in females and males was 54 and 50 years respectively, majority of cases in both the genders were seen in 50-59 years of age, 81.1% patients were from rural areas and 18.8% from urban areas, Chi square on comparison with other cancers showed p<0.05, and there was no major religious and educational pattern of GBC seen in our population.Conclusion: In our population females are at high risk especially past 40 years of age and rural population with its varied environmental, lifestyles and infective agents should be investigated for possible risk factor in the causation of GBC.

Value of urinary microalbumin test in cancer patients with borderline serum creatinine level

Background: Micralbuminuria (MA) is an early sign of incipient renal damage and cancer patients are at the risk of developing kidney diseases due to the use of nephrtoxic chemotherapeutic agents.Methods: A pilot study of urinary microalbumin on 41 patients with borderline serum creatinine was carried out at regional cancer centre of North-East India during the period from June to August 2014. The patients whose serum creatinine levels were between 1.2 mg/dl to 1.3 mg/dl were considered as borderline for the present study. The assays were performed with a dimension Rxl max random access biochemistry analyzer.Results: Out of 41 cases, 22 (53.6%) had MA, M:F = 1.75, 65 years 2 (9.0%) patients were detected with urinary microalbumin. Chi square test showed P = 0.695 (Fisher’s exact P value).  Conclusion: Testing of urinary microalbumin can be done in cancer patients with borderline serum creatinine level in order to identify patients at risk of developing kidney disease.

Correlation between ABO blood groups and various cancers in the north eastern region of India: a retrospective observational study

Background: Numerous studies have documented the association of the ABO blood groups with the occurrence of cancers. Aim was to find out an association of ABO blood groups and various cancers in the North Eastern region of India.Methods: The study was a retrospective observational study that included 1000 cases and 1000 controls. The data included the ABO blood typing of the selected cancer sites which were head and neck, esophagus, stomach, breast, cervix, and ovary. Patients who attended blood bank of regional cancer center with requisition for blood transfusion from 2014 to 2016 were included. The control group was healthy blood donors. Chi square test was used to assess the difference among the compared groups. Risk was calculated by regression analysis. P value <0.05 was considered as statistically significant at 95% confidence interval.Results: Out of 1000 cases and 1000 controls, O blood group were seen in 377 (37.7%) and 395 (39.5%) cases and control, respectively. Significant reduced odds ratio (OR) in non O blood groups for head and neck, esophagus, stomach, and breast was observed. In case of carcinoma cervix, OR for B group was 1.5 (P=0.05), and for blood group A OR=2.2 (P=0.02) was seen in carcinoma ovary.Conclusions: In the studied population, patients with O blood group are at an increased risk of developing head and neck, esophagus, stomach, and breast cancers

Rosai-Dorfman disease in a child with involvement of extra-nodal wrist joint

Rosai-Dorfman Disease (RDD) is a benign condition primarily affecting the lymph nodes. The term sinus histiocytosis with massive lymphadenopathy was first used. There may be extra-nodal presentation of RDD with or without constitutional symptoms. A 10-year-old boy presented with massive bilateral cervical lymphadenopathy which mimicked the diagnosis of lymphoma. We describe here a case of RDD in a child with extra-nodal bone involvement of the wrist joint, its diagnosis by histopathological examination supported by immunohistochemistry and consequent initial management

Hypofractionated radiotherapy in post mastectomy locally advanced breast cancer: a study from a regional cancer center in North East India

Background: Adjuvant radiotherapy has increased local-regional and overall survival rates in breast cancer. Conventional fractionation delivering 50-60 Gray (Gy) over 5-6weeks is a standard approach. A shorter duration of hypofractionated treatment will be more convenient for patients and treatment providers if found safe and equally effective.Methods: Around 50 high risk breast cancer patients who underwent mastectomy were enrolled and randomized into the study arms- CF (Conventional Fractionation) Arm (50Gy/25 Fr @ 2 Gy/fraction/day 5 days a week over 5weeks) and HF (Hypo-Fractionation) arm (40.05 Gy/15 Fr @ 2.67 Gy/fraction/day 5 days a week over 3weeks). Treatment related acute and late toxicities, loco-regional recurrence; distant metastasis and survival rates were recorded for comparison.Results: Twenty-five patients were enrolled in each arm with baseline characters well matched. At median follow up of 44 months, OS was 80% in HF arm against 64% in CF arm (p-value: 0.292). HF arm also showed better DFS at 4 years of 76% compared to 64% in CF arm (p-value: 0.411). Although the difference was not significant statistically, the Hazard Ratio of 1.543 (95% CI: 0.549-4.339) for DFS and 1.801 (95% CI: 0.603-5.377) for OS indicated trends towards better outcomes in HF arm in terms of disease control and survival. Acute and late toxicities were also lesser in HF arm, though not statistically significant (all p-values >0.05).Conclusions: In post mastectomy setting, HFRT is comparable to CFRT in terms of safety and efficacy, will be more convenient for patients and care givers and hence can be a routine standard practice