Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India

<p>Abstract</p> <p>Background</p> <p>Breast cancer incidence in India is on rise. We report epidemiological, clinical and survival patterns of breast cancer patients from community perspective.</p> <p>Methods</p> <p>All breast cancer patients treated at this hospital from July 2000 to July 2005 were included. All had cytological or histological confirmation of breast cancer. TNM guidelines for staging and Immunohistochemistry to assess the receptor status were used. Either lumpectomy with axillary lymph node dissection or Modified radical mastectomy (MRM) was done for operable breast cancer, followed by 6 cycles of adjuvant chemotherapy with FAC or CMF regimens to patients with pT >1 cm or lymph node positive or estrogen receptor negative and radiotherapy to patients after breast conservation surgery, pT size > 5 cm, 4 or more positive nodes and stage IIIB disease. Patients with positive Estrogen receptor or Progesterone receptor were advised Tamoxifene 20 mg per day for 3 years. Descriptive analysis was performed. Independent T test and Chi-square test were used. Overall survival time was computed by Kaplan – Meier method.</p> <p>Results</p> <p>Of 1488 cancer patients, 122 (8.2%) had breast cancer. Of 122 patients, 96.7% had invasive breast carcinoma and 3.3% had sarcoma. 94% came from the rural and semi urban areas. Premenopausal women were 27%. The median age was 50 years. Stage I-6.8%, II-45.8%, III-22%, IV-6.8%, Bilateral breast cancer – 2.5%. The mean pT size was 3.9 cm. ER and PR were positive in 31.6% and 28.1% respectively. MRM was done in 93.8%, while 6.3% patients underwent breast conservation surgery. The mean of the lymph nodes dissected were 3. CMF and FAC regimens were used in 48.8% and 51.2% of patients respectively. FAC group were younger than the CMF group (43.6 yr vs. 54 yrs, P = 0.000). Toxicities were more in FAC than CMF group, alopecia (100% vs. 26.2%), grade2 or more emesis (31.8% vs. 9.2%), grade2 or more fatigue (40.9% vs.19%), anemia (43.1% vs. 16.6%). Median Survival for the cohort was 50.8 months. ER positive patients had better median survival (P = 0.05).</p> <p>Conclusion</p> <p>MRM was the most frequent surgical option. CMF and FAC showed equivalent survival. FAC chemotherapy was more toxic than CMF. ER positive tumors have superior survival. Overall 3 year survival was 70 percent</p

Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial

Background: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). Objectives: This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. Methods: The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life–5 Dimensions–5 Level visual analogue scale at 12 weeks. Results: MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). Conclusions: Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Assessment of seawater mixing in a coastal aquifer by high resolution electrical resistivity tomography

Seawater intrusion is a major problem in urbanized coastal regions of India which is due to over exploitation of groundwater for various purposes. This study was carried out with the objective of assessing the zone of mixing between seawater and groundwater in the coastal aquifer in south of Chennai, Tamil Nadu, India using high resolution electrical resistivity tomography. High resolution electrical resistivity tomography was carried out in five profiles perpendicular to the sea using IRIS make SYSCAL Pro-96 system with 2.5 m or 5 m inter-electrode separation. The maximum length of the profile was 170 m which resulted in a depth of investigation of 28.7 m. The apparent resistivity measured in this area varies from 0.3 ohm-m to 30,000 ohm-m. The apparent resistivity of saturated zone decreases towards the sea, indicating the influence of seawater. This was also confirmed by measuring the electrical conductivity of groundwater, which gradually increases from 156 μS/cm to 3430 μS/cm towards the sea. Further, the concentration profiles of electrical conductivity, sodium, chloride and chloride / bicarbonate ratio are compared with the high resolution electrical resistivity tomography profile. The distance of influence of seawater is comparatively high in northern part than in southern part of the area. The high resolution electrical resistivity tomography was effectively used to determine the effect of seawater mixing with groundwater. © IRSEN, CEERS, IAU

Pancreatic tuberculosis mimicking malignancy in an immunocompetent Individual

Tuberculosis of pancreas in an immunocompetent individual is rare even in endemic regions. We report here one such case where in a 53-year-old man presented with jaundice, weight loss and cervical lymphadenopathy. Base line liver functions were deranged. Imaging studies of abdomen and chest revealed a pancreatic mass and miliary filtrates. Fine needle aspiration cytology of cervical lymph nodes was suggestive of tuberculosis. In view of deranged baseline liver functions the patient was started on a modified daily self-supervised antituberculosis treatment and oral corticosteroid treatment made an uneventful recovery with complete resolution of mass lesion

ELECTRICAL IMAGING TECHNIQUES FOR GROUNDWATER POLLUTION STUDIES: A CASE STUDY FROM TAMIL NADU STATE, SOUTH INDIA

An attempt was made to identify the extent of pollution in the aquifer matrix of Tirupur, a highly industrialized zone of Tamilnadu state, South India. Electrical imaging techniques were adopted with a Syscal Pro-96 system, for measuring apparent resistivity values using different electrodes separation. The first profile conducted atValipalayam recorded a resistivity range of &lt;10 Ùmat a depth of 8m, which indicates contamination of top soil due to discharge of effluents. An increase in resistivity &gt;45.5 Ùmwas observed at a depth of 27 to 47 mindicating the possibility of contamination. The second profile conducted at Pethichettipuram indicates source of contaminationat left end corner with a drop in resistivity &lt;46.5 Ù m at a depth of 7.91 m. A drop in resistivity &lt;21.6 Ù m was also observed at a depth of 11.5 m indicating a contaminated zone in deeper regolith. The thirdsurvey conducted in Palayakadu indicates contamination of regolith at a depth of 0 to 20 mwith a resistivity less than 40 Ùm. The fourth survey at Chellapuram indicates contamination of overburden with resistivity &gt;11.5 Ùm, to a depth of about 10 m. Five imaging surveys conducted across the contaminated sites reveals that shallower regoliths are highly contaminated and deeper aquifers are free from contamination except a few locations