17 research outputs found
Probability Predicting Tool for Identifying Incidence and Severity of Pancytopenia as a Result of Megaloblastic Anemia
Background: One of the most common etiology in the diagnosis of pancytopenia in physician practice is megaloblastic anemia. However there is significant confusion associated with marrow megaloblastic features, which need not always because of pancytopenia. They may be just co-incidental findings. Its often difficult to establish that the peripheral pancytopenia is related to marrow megaloblastic features, as Vitamin B12 and folate are often normal in these cases [because of prior treatment]
Aim: This study was conducted to develop a probability predicting system for possible incidence and severity of pancytopenia as a result of megaloblastic anemia.
Materials and Methods: This is a retrospective analysis conducted at a tertiary care center with approximately 2,000 new cases of megaloblastic anemia. We Hypothesized age, duration of symptoms, Mean Corpuscular Volume [MCV], nutritional status, B12 and folate levels, underlying illness and response to therapy as possible factors associated with pancytopenia of megaloblastic anemia. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data.
Results: A total of 458 patients with pancytopenia and marrow findings of megaloblastic anemia were analyzed. Based on ROC analysis, following cutoff values were selected: age > 40 years or <20, Folate <30% lower limit, B12 any value close to lower limit of reference laboratory value, Mean Corpuscular Volume>110 fl, duration of symptoms more than 18 weeks, Serum Albumin <2.5 gm/dl [taken as marker for nutrition]. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above factors if they were present. For patients, the final score of 2 or less there is 22% probability of having pancytopenia while patients having score of 6 or more have 89% probability. Similarly when the Mean Corpuscular Volume recovered/reduced by 8 fl at week 3, patients have positive predictable recovery pattern. Those who does not have such recovery by week 3, the etiology of pancytopenia is unlikely to be megaloblastic anemia. And they need further evaluation
Conclusion: The current tool is fairly accurate in predicting development of pancytopenia in patients with low B12 and folate/megaloblastic anemia. This will further help clinicians to look for other reasons of pancytopenia in case, where MCV does not recover beyond week 3 of therapy, so that valuable time of patient is not lost in resource constraints nations like India
Approach to Aplastic Anemia- An Overview and Practical Approach
Despite the fact that cytopenia has been a common hematological entity seen in clinical practice for decades, the understanding of its etiopathogenesis has been changing, which in turn impacts on the management strategies. The current review focuses on the understanding of the current concepts and a brief overview of the management of aplastic anemia. As the spectrum of stem cell biology, etiology, and treatment from transplantation to graft-versus-host disease cannot be covered in few paragraphs, the most concise form is presented here
Retrospective Evaluation of Anemia in Relation to Body Mass Index [BMI] in Women Presenting to Tertiary Care Hospital from Telangana
Objective: This is a retrospective analysis to investigate the prevalence, nature [Like megaloblastic vs Iron deficiency vs blood loss vs hemolytic etc.] and determinants of anemia among women in a tertiary care hospital during the period 2011-2014. We examined differences in anemia related to, urban/rural location, nutrition status as reflected by body mass index (BMI) and serum albumin levels and hemogram values
Methods: The Hb values of all women presenting to the OPD was captured along with the details of the Haemogram, Iron profile, as well as other clinical examination findings. Wherever the complete work up was performed, the details were also captured. The standard definitions were used for entering the data and MEDCALC version 7.0 was used for the statistical analysis.
Results: A total of 463 women aged 15–59 were analyzed. (Elderly were not included as the etiologic of the anemia will be different in them as well as multiple co-morbidities confounding the analysis) Prevalence of anemia was high among all women, however as compared to national statistics; this is slightly less in the current study. In all 28.4% of women had mild, 12.6% had moderate, and 5.2% had severe anemia. Both high and low BMI were associated with anemia, though very low BMI had mixed picture, Low BMI had Iron deficiency and high BMI had Megaloblstic variants of anemia.
Conclusion: Anemia still is an important health burden in women of both urban and rural origin, even-though the prevalence compared to a decade ago appears to be slightly less. New differential and tailored program strategies are needed for improving the hemoglobin for those with very low BMI [Iron supplements alone may not be enough and they need both Iron and B12 with folic acid]. Similarly in urban women, its essential to sensitize regarding the balanced diet, [especially if the BMI is high] with focus on the B12 and folate supplements [besides other dietary modifications]
Retroperitoneal inflammatory myofibroblastic tumor
BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is a neoplasm of unknown etiology occurring at various sites. By definition, it is composed of spindle cells (myofibroblasts) with variable inflammatory component, hence the name is IMT. CASE PRESENTATION: The present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor. CONCLUSION: IMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment
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Glycaemic control in people with type 2 diabetes mellitus during and after cancer treatment: A systematic review and meta-analysis
Background
Cancer and Diabetes Mellitus (DM) are leading causes of death worldwide and the prevalence of both is escalating. People with co-morbid cancer and DM have increased morbidity and premature mortality compared with cancer patients with no DM. The reasons for this are likely to be multifaceted but will include the impact of hypo/hyperglycaemia and diabetes therapies on cancer treatment and disease progression. A useful step toward addressing this disparity in treatment outcomes is to establish the impact of cancer treatment on diabetes control.
Aim
The aim of this review is to identify and analyse current evidence reporting glycaemic control (HbA1c) during and after cancer treatment.
Methods
Systematic searches of published quantitative research relating to comorbid cancer and type 2 diabetes mellitus were conducted using databases, including Medline, Embase, PsychINFO, CINAHL and Web of Science (February 2017). Full text publications were eligible for inclusion if they: were quantitative, published in English language, investigated the effects of cancer treatment on glycaemic control, reported HbA1c (%/mmols/mol) and included adult populations with diabetes. Means, standard deviations and sample sizes were extracted from each paper; missing standard deviations were imputed. The completed datasets were analysed using a random effects model. A mixed-effects analysis was undertaken to calculate mean HbA1c (%/mmols/mol) change over three time periods compared to baseline.
Results
The available literature exploring glycaemic control post-diagnosis was mixed. There was increased risk of poor glycaemic control during this time if studies of surgical treatment for gastric cancer are excluded, with significant differences between baseline and 12 months (p < 0.001) and baseline and 24 months (p = 0.002).
Conclusion
We found some evidence to support the contention that glycaemic control during and/or after non-surgical cancer treatment is worsened, and the reasons are not well defined in individual studies. Future studies should consider the reasons why this is the case
Zoledronic acid in the treatment of bone metastases by hepatocellular carcinoma: a case series
Case Report-Malignant adenomyoepithelioma of the breast
Malignant adenomyoepithelioma of the breast is a rare tumor
characterized by biphasic proliferation of both epithelial and
myothelial cells. Here we report a 20-year-old female presented to us
with recurrence of a breast lump shortly following lumpectomy.
Histopathological examination suggested malignant adenomyoepithelioma.
She had undergone modified radical mastectomy, received local radiation
to the chest wall and six courses of adriamycin and cyclophosphamide.
She remains in complete remission at 18 months follow-up. The present
case is rare in several respects. The age of presentation was 20 years,
much less than what has been reported. Mammography showed
micro-calcifications, thus far not described. In addition, our patient
had an exceptionally aggressive tumor that recurred within two months
of lumpectomy. This tumor also showed good chemo sensitivity