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Androgen deprivation therapy (ADT) using gonadotropin‑releasing hormone agonist (s) (GnRH‑A) remains the backbone of advanced prostate cancer treatment. In this review, we assessed the efficacy, safety, and convenience of administration of various GnRH‑A. All GnRH‑A (goserelin, triptorelin, buserelin, histrelin, and leuprorelin) have comparable potential to suppress testosterone (T) levels (≤50 ng/dL in a month and ≤20 ng/dL in 3 months). However, goserelin has shown better efficacy in maintaining T levels ≤50 ng/dL compared with leuprolide. The incidences of T escape are lower with goserelin and leuprolide than buserelin. Goserelin also has maximum benefit in prostate‑specific antigen suppression. In neoadjuvant setting, when only goserelin was used, the 10‑year overall survival (OS) rate was 42.6% to 86%. When either goserelin or leuprolide was used, the 10‑year OS rate was 62%. As an adjuvant to radical prostatectomy, goserelin had a 10‑year survival rate of 87%, and triptorelin had an 8‑year survival rate of 84.6%. Goserelin further showed an absolute survival rate of 49% when used as an adjuvant to radiotherapy. The survival rates further improved when GnRH‑A are used as combined androgen blockade compared with monotherapy. The frequency and severity of adverse events (hot flushes, fatigue, sexual dysfunction) are comparable among the GnRH‑A. Goserelin appears to be the most convenient of all the GnRH‑A for administration. Lack of conclusive comparative evidence makes it imperative to have a holistic approach of considering the patient profile and the disease characteristics to select the appropriate GnRH‑A for ADT in prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Mental disorders have got high prevalence and low priority among the elderly in most of the countries worldwide, of which depression being the most common treatable condition. The causes for elderly depression are multifactorial and preventable. Objective: The aim of this study is to estimate the prevalence of depression and to assess the factors associated with depression among the elderly age. Materials and Methods: A cross-sectional study was conducted among participants more than 60 years of age residing in tenements under resettlement scheme in Semmenchery, Kancheepuram district, Tamil Nadu with a sample size of 184. Systematic sampling method was adopted to collect data at participants door step. A predesigned, pretested questionnaire was used to assess the factors associated with depression, and the Geriatric depression scale-30 was used to assess depression. The data were analyzed using SPSS and Chi-square <0.05 was considered significant. Results: The overall prevalence of depression was 35.3%. The factors such as female gender, educational status, occupation, type of family, financial dependency, history of depression, smoking and medical factors such as hypertension, cardiac disease, and chronic kidney disease and life events like conflict in family, unemployment, and financial problem were statistically significant (P < 0.05). Conclusion: Loss of spouse, financial dependency, neglected care, lack of awareness about the disease were found to be barriers in reaching basic mental health care for the elderly. Depression remains one of the main causes of DALY, especially among elders. National Program for Health care of elderly provides doorstep services, so incorporation of depression screening into that can impart the effects of depression on quality of life and DALY. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe the agreement of three methods of Near Point of Convergence (NPC) measurement among patients with different refractive errors. METHODS: 60 asymptomatic subjects, 18 -- 25 yrs old, were included in 3 groups: emmetropes, myopes and hypermetropes. All subjects underwent NPC break point and recovery point measurement by Royal Air Force (RAF) rule, Pencil Rule (PR) and penlight with red green glasses (RG) using standard techniques. The values obtained were compared within each group by Friedman test. Bland Altman plots were constructed and Limits of Agreement calculated. RESULTS: Hypermetropes performed poorly in RG test with significantly receded break point and recovery point values (10.30 ± 1.45cm, 13.13± 1.20cm) compared to RAF test (7.18 ± 1.86 cm, 10.15 ± 2.11cm ) and PR test (7.78 ± 1.75 cm, 10.75 ± 1.44cm). The recovery point values of the emmetropes with RG test (10.15 ± 2.32cm) was significantly receded compared to PR (9.30 ± 1.72 cm) and RAF test (Emm: 9.08 ± 2.30cm). The myopes performed better with PR test with significantly better recovery point values with PR test (8.70 ± 1.97 cm) compared to RAF (9.68 ± 2.08) and RG (9.45 ± 1.73) tests. The limits of agreement were wide suggesting disagreement between the tests. CONCLUSION: The RG test yields more receded results in hypermetropes compared to the RAF and PR tests, and the PR test yields better results than the RAF test in myopes. Thus, the results obtained by these different methods show a lack of agreement. The variability is not uniform in patients with different refractive errors. [ABSTRACT FROM AUTHOR]

Introduction: The double burden of malnutrition is the co-existence of undernutrition along with overweight/obesity. The underweight can cause cognitive impairment, increase mortality, and over nutrition increases the chance of noncommunicable diseases like type 2 diabetes and hypertension. Women are vulnerable for early marriages, early conception, and so forth, which have an impact on their nutritional status. Objective: To estimate the prevalence of double burden of malnutrition among women residing in tenements in a resettlement area, Kancheepuram district. Materials and Methods: This is a cross-sectional study conducted among women aged above 18 years residing in a tenement in a resettlement area, Kancheepuram district using a semi-structured questionnaire. The sample size was 211. Results: The median age of the participants was 44. 78; 2% were married; 30.8% belong to class III. Based on BMI 1.4% were underweight, 17.1% had normal BMI, 48.8% were pre-obese, and 19.9% were under obese stage 1. Based on the waist circumference, 23.7% were under high risk and according to the waist–hip ratio, 69.7% were under high risk. The prevalence of diabetes among the high-risk category for waist–hip ratio was higher (80.3%) with statistical significance. Conclusion: The national programs are concentrating more on the undernutrition. The importance of obesity as a risk factor for many noncommunicable diseases should be stressed in the nutritional programs thereby providing proper interventions to prevent them, which could be done by interlinking with NPCDCS. [ABSTRACT FROM AUTHOR]

Patients with non-small cell lung cancer (NSCLC) commonly harbor epidermal growth factor receptor (EGFR) mutation. Due to the complex disease pathology, early-stage diagnosis of patients with EGFR mutation is essential to make appropriate treatment decision. Tyrosine kinase inhibitors (TKIs) are commonly used for their treatment, but almost half of the patients with EGFR mutation do not respond to the available TKIs and develop acquired resistance owing to T790M mutation. The presence of T790M mutation also warrants a robust diagnostic method so as to allow clinicians to modify cancer treatment. Numerous diagnostic techniques for the detection of EGFR mutation, however, their performance and working profile variation necessitate a comparative evaluation for the selection of a better diagnostic method or an advanced combination of theirs. The present review compares various EGFR-mutation detection techniques such as Sanger sequencing, next-generation sequencing, and different polymerase chain reaction (PCR)-based methods. It also highlights the role of advanced PCR-based techniques, i.e., real-time or quantitative PCR and digital droplet PCR (ddPCR) for detecting EGFR mutations in NSCLC patients. ddPCR, when compared to other methods, shows enhanced sensitivity, superior reliability, and improved time and cost-effectiveness. Moreover, its ability to detect EGFR mutations including T790M, in both conventional (solid tissue biopsy samples) and nonconventional sample sources (blood, plasma, and urine samples), gives it an edge over other diagnostic techniques and support its integration in clinical practice setting. [ABSTRACT FROM AUTHOR]

Background: Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB.Materials and Methods: We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center.Results: Over a 3-year study period (2011-2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups.Conclusion: Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue including the molecular aspects of cancer, use of gefitinib in lung cancer treatment, and the molecular genetics of colorectal cancer.

Treatment of chronic myeloid leukemia has evolved from symptom control to long-term disease-free survival with cure potentially round the corner. This required faster, deeper, and longer response. Optimizing treatment decisions therefore requires clear understanding of and strict implementation of guidelines for shift from imatinib. In patients who are resistant to or intolerant of imatinib, second-line TKIs have to be selected carefully. Currently available data show comparable efficacy between nilotinib and dasatinib. With a better safety profile (especially with respect to grade 3 or 4 hematologic toxicity and clinically relevant non-hematologic toxicities), nilotinib becomes the preferred choice in most instances. [ABSTRACT FROM AUTHOR]

Radiotherapy, being an inherent treatment modality for many solid tumors, including the brain, has seen technical advancements leading to more advanced conformal techniques of radiation delivery in recent times. Reversal of cerebral radiation necrosis with bevacizumab treatment in 17 Chinese patients. 11 Furuse M, Kawabata S, Kuroiwa T, Miyatake S. Repeated treatments with bevacizumab for recurrent radiation necrosis in patients with malignant brain tumors: A report of 2 cases. [Extracted from the article]

Primary signet ring cell adenocarcinoma (PSRCC) of the bladder is a relatively rare variant of adenocarcinoma of the bladder with poor prognosis. Also PSRCC of the bladder presenting with spontaneous urinary extravasation is very rare. We present the case of a 48-year male who presented with spontaneous urinary extravasation and was diagnosed to have PSRCC of the urinary bladder on evaluation. He was treated with radical cystectomy and adjuvant chemotherapy. This report emphasizes the need to rule out other primary sites of adenocarcinoma in the body, which may metastasize to the urinary bladder. [ABSTRACT FROM AUTHOR]

Osteosarcoma is the most common type of bone malignancy. The primary mode of metastasis is hematogenous. Lung metastasis is common. Isolated hemorrhagic intra-cerebral metastasis has not been reported earlier. This case report is of an 11-year-old boy with proximal tibial osteosarcoma who presented with right focal seizures secondary to a hemorrhagic solitary deposit in the left posterior frontal region. Histopathology confirmed this to be a metastasis from an osteosarcoma. [ABSTRACT FROM AUTHOR]

Background: Despite the relatively low prevalence of Gram-positive bacteremic infections in Indian oncology patients, glycopeptides are extensively used for empirical management of febrile neutropenia. Our aim was to analyze the spectrum of bacteremia in posthematopoietic stem cell transplant (HSCT) recipients in our center and make a recommendation on glycopeptide use in this patient population.Materials and Methods: Retrospective analysis of bacteremic data from HSCT recipients in a tertiary care oncology and transplant center from South India, between 2011 and 2013.Results: In 217 patients, 52 bacteremic episodes were identified. The majority of the isolates were Gram-negatives (88.4%) with very few Gram-positives (7.69%).Conclusion: Glycopeptides need not be included in the empirical antibiotic regimen in post-HSCT settings with very low Gram-positive infection rates. [ABSTRACT FROM AUTHOR]

Hematological malignancies comprise a diverse group of neoplasms, and may directly or indirectly (treatment related) lead to neurological complications. We report one of the first case reports of severe intracranial haemorrhage, a causal association with rituximab in an elderly patient with follicular lymphoma Stage II (below diaphragm) after excluding all other causes of ICH. Introduction: In adult patients with haematological malignancies, Intracranial haemorrhage (ICH) is the second most common complication after infection and is associated with high morbidity and mortality. Several comprehensive reviews have highlighted the various risk factors for ICH in cancer patients like hypertension, vessel wall abnormality, invasion or compression of vessels from a tumour in or adjacent to the brain, low platelet count or platelet dysfunction, coagulation factor deficiency, disseminated intravascular coagulation (DIC), sepsis, and hyperleukocytosis. Rituximab, is a medication used to treat certain autoimmune diseases and types of cancer. It is used for non- Hodgkin's lymphoma, chronic lymphocytic leukaemia, rheumatoid arthritis, idiopathic thrombocytopenic purpura, and pemphigus vulgaris. Common side effects, which often occur within few hours of the medication being given, include rash, itchiness, low blood pressure, and shortness of breath. Other severe side effects include reactivation of hepatitis B in those previously infected, progressive multifocal leukoencephalopathy, and toxic epidermal necrolysis, but nothing like haemorrhage. Case report: The Present case report describes 58 year female patient with permanent pacemaker (PPI) in situ since last 4 years but not on any antiplatelet, now presented with abdominal pain. CECT abdomen showed pre and para and retro aortic mass (likely conglomerate node mass), encasing the mesenteric vessels and mesenteric nodes, suggestive of lymphoma. On further evaluation, 2D Echo showed S/P PPI with normal LV size and function, no RWMA. Core needle biopsy from Para aortic node which confirmed Follicular lymphoma, grade II with CD20 +ve by HPE and IHC. PET-CT whole body showed hypermetabolic retroperitoneal, mesenteric and retrocrural nodal masses, with no other metabolically active disease elsewhere in the whole body survey. Imaging suggestive of lymphomatous involvement of nodes below the diaphragm (stage II). All routine blood test including coagulation profile were normal, viral markers were negative and bone marrow aspiration and biopsy showed no evidence of lymphoma involvement. After Cardiologist fitness, patient was started on Chemotherapy with CHOP-R regimen. Post 18 hours after completion of Rituximab, patient started complaining of headache, vomiting and suddenly patient developed right sided hemiplegia. CT Brain was done (MRI not done as patient was having PPI in situ) which showed acute intracerebral haemorrhage with subarachnoid haemorrhage. 3D CT Angio was done to rule out vascular abnormalities but imaging showed no vascular abnormalities. Coagulation profile and platelets were normal. Patient was managed with IV fluids, anti-hypertensives, antiepileptics and antiedema measures. Patient's general condition improved later and power in right upper and lower limb also improved. Discussion: Follicular lymphoma is the most common of the indolent (slow-growing) non-Hodgkin's lymphomas, and the second-most-common form of non-Hodgkin's lymphomas overall. Rituximab is a monoclonal antibody against the protein CD20, which is primarily found on the surface of immune system B cells. When it binds to this protein it triggers cell death. In 2010, rituximab was approved by the European Commission for first-line for maintenance treatment of follicular lymphoma who are CD 20 +ve. Rituximab is used to treat cancers of the white blood system such as leukemias and lymphomas, including non-Hodgkin's lymphoma and lymphocyte predominant subtypes of Hodgkin's Lymphoma. Serious adverse events related to rituximab, which can cause death and disability, includes severe infusion reaction, cardiac arrest, cytokine release syndrome, tumour lysis syndrome, causing acute renal failure, Infections, Hepatitis B reactivation, other viral infections, Progressive multifocal leukoencephalopathy (PML) Immune toxicity, with depletion of B cells in 70% to 80% of lymphoma patients, pulmonary toxicity, bowel obstruction and perforation but nothing related to intracranial hemorrhage mentioned as a side effect in literature. After literature search, we found only one case report by Ganguly S showing acute intracerebral hemorrhage in intravascular lymphoma: a serious infusion related adverse event of rituximab and that to in a case of CNS lymphoma. We discussed with patient and relatives about the rare causal association of Rituximab with Intracranial haemorrhage and advised to continue chemotherapy without adding Rituximab. Conclusion : Rituximab is a chimeric monoclonal antibody against the protein CD20. Infusion related adverse effect and some serious adverse effects does occur with Rituximab. We report one of the first case report documenting intracranial hemorrhage, a causal association with rituximab. Caution should be used in selective patient populations, such as elder's and patients with other co-morbidities. [ABSTRACT FROM AUTHOR]