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Background: Mycobacterium avium complex (MAC) is connected to human immunosuppressive diseases, including HIV-AIDS, and may pose a zoonotic threat. MAC causes lymphadenopathy in children, respiratory infection in adults, and generalized infection in immunocompromised individuals. Infection with nontuberculous Mycobacteria (NTM) in humans is now primarily brought on by MAC. Recently, MAC members have emerged as pathogenic organisms for animals and humans. While dogs are generally resistant to mycobacterial infections, there have been some cases of infection that result in systemic or disseminated diseases. The organisms can be transmitted to dogs through oral contact, and their faeces can be a possible source of infection for dog owners. It is important to note that this ailment is zoonotic, especially if infected pet dogs are in prolonged contact with their humans. Aims: The study was planned to demonstrate the occurrence of MAC organisms and other Mycobacteria in dogs associated with lymphadenopathy cases with special emphasis on lymphadenitis. Methods: A total of 123 samples (100 lymph node aspirates, 15 lymph node tissues, and 8 blood samples) from 83 dogs suspected of lymphadenitis accompanied by gastroenteritis, chronic skin infections, immunosuppression, chronic pulmonary diseases, and other chronic undiagnosed diseases were studied. The samples were processed for cytological and microscopic examination by Ziehl-Neelsen staining. Following the decontamination procedure, the aspiration and lymph node tissue samples were inoculated into Middlebrook 7H11 media for up to 8 weeks. The aspirated material was also directly used for molecular detection by triplex-nested polymerase chain reaction (nPCR) assay. Results: A cytological study revealed pyogranulomatous inflammation of the lymph node tissue. Impression smears from lymph node tissues displayed the presence of acid-fast organisms. Out of 83 cases of dogs, 8 were found to be positive for Mycobacterium spp. Among those 8 positive cases, 3 were confirmed to belong to MAC, and 5 belonged to the Mycobacterium tuberculosis complex (MTB complex). Conclusion: MAC and MTB are the underestimated bacteria that could be the causative agents of lymphadenitis in animals. [ABSTRACT FROM AUTHOR]

Background: In an open label, Phase 3 randomised study, Pemetrexed maintenance after induction with 4-6 cycles of pemetrexed -Platinum therapy failed to prove its superiority over Erlotinib in patients with EGFR non mutated NSCLC. In this analysis we have assessed the benefit of erlotinib over Pemetrexed using quality adjusted time without symptom or toxicity analysis method. Methods: The overall survival in each arm was partitioned into 3 health states. TOX state (Time spent in grade 3 or above toxicity after randomization and before progression), TWiST state (Time spent after randomization before progression without grade 3 or above toxicity) and REL state (Time spent after progression). The mean QTWiST was calculated for each arm using utility coefficients of 0.65 for TOX, 0.71 for TWiST and 0.67 for REL states respectively. The difference in QTWiST and the 95% CI of difference were calculated using a nonparametric bootstrap. A p value of 0.05 was considered as significant. Results: The mean TOX duration was 2.216 days in Erlotinib arm versus 1.359 days in pemetrexed arm, p = 0.572. The mean TWiST duration was 215.85days in Erlotinib arm versus 217.605 days in pemetrexed arm, p = 0.945. The mean REL state duration was 198.620 days in Erlotinib arm versus 196.254 days in maintenance pemetrexed arm, p = 0.932. There was no statistically significant difference between the two arms in mean TOX duration, mean TWiST duration and mean REL state duration.The mean QTWiST was 287.770 days in Erlotinib arm versus 286.873 days in Pemetrexed arm. The difference was of -0.897 days (95% CI -22.475 - 20.681, p value 0.935). Conclusions: The mean QTWiST of Erlotinib arm was similar to maintenance Pemetrexed arm. Our results failed to prove the benefit of Erlotinib over Pemetrexed maintenance post induction with 4-6 cycles of pemetrexed -Platinum therapy in terms of quality adjusted time without toxicity. [ABSTRACT FROM AUTHOR]

Ten Labrador dogs aged 4-9 months were presented with history of dry cough followed by retching and gagging, respiratory distress for last 4-5 days. Clinical examination revealed normal to slightly elevated body temperature! tachypnea, normal heart rate and normal mucus membrane. Haematological findings were neutrophilic leucocytosis with normal haemoglobin, packed cell volume, total erythrocyte count. Eosinophilia was observed in two animals only. Serum biochemistry revealed normal alanine aminotransaminase, bilirubin, blood urea nitrogen and creatinine and high alkaline phosphatase. Radiographic findings were moderate to severe mixed pattern in cranial and caudal lung lobes. Treatment of animals with antibiotics, antitussive, antihistaminics lead to complete clinical recovery within two weeks of treatment. [ABSTRACT FROM AUTHOR]

A five year old female buffalo ws diagnosed and therapeutically managed for Ddermotophytosis. Animal had a history of mild pruritus along with presence of grayish white, crusty scab like circular lesions located mostly on back, flank, hind limbs and ventral abdominal area. The disease was diagnosed on basis of culturing hair samples on Sabauraud's dextrose agar and Dermatophyte test medium which revealed Trichophyton mentagrophyte. Treatment with topical broad spectrum fungicide once daily for 3 days over lesions followed by its weekly spray along with supportive drugs resulted in complete cure within one month. [ABSTRACT FROM AUTHOR]

Background: Treatment of malignant melanoma has undergone a paradigm shift with the advent of immune checkpoint inhibitors (ICI) and targeted therapies. However, access to ICI is limited in low-middle income countries (LMICs)., Patients and Methods: Histologically confirmed malignant melanoma cases registered from 2013 to 2019 were analysed for pattern of care, safety, and efficacy of systemic therapies (ST)., Results: There were 659 patients with a median age of 53 (range 44-63) years; 58.9% were males; 55.2% were mucosal melanomas. Most common primary sites were extremities (36.6%) and anorectum (31.4%). Nearly 10.8% of the metastatic cohort were BRAF mutated. Among 368 non-metastatic patients (172 prior treated, 185 de novo, and 11 unresectable), with a median follow-up of 26 months (0-83 months), median EFS and OS were 29.5 (95% CI: 22-40) and 33.3 (95% CI: 29.5-41.2) months, respectively. In the metastatic cohort, with a median follow up of 24 (0-85) months, the median EFS for BSC was 3.1 (95% CI 1.9-4.8) months versus 3.98 (95% CI 3.2-4.7) months with any ST (HR: 0.69, 95% CI: 0.52-0.92; P = 0.011). The median OS was 3.9 (95% CI 3.3-6.4) months for BSC alone versus 12.0 (95% CI 10.5-15.1) months in any ST (HR: 0.38, 95% CI: 0.28-0.50; P < 0.001). The disease control rate was 51.55%. Commonest grade 3-4 toxicity was anemia with chemotherapy (9.5%) and ICI (8.8%). In multivariate analysis, any ST received had a better prognostic impact in the metastatic cohort., Conclusions: Large real-world data reflects the treatment patterns adopted in LMIC for melanomas and poor access to expensive, standard of care therapies. Other systemic therapies provide meaningful clinical benefit and are worth exploring especially when the standard therapies are challenging to administer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bajpai, Abraham, Saklani, Agarwal, Das, Chatterjee, Kapoor, Eaga, Mondal, Chandrasekharan, Bhargava, Srinivas, Turkar, Rekhi, Khanna, Janu, Bal, Ostwal, Ramaswamy, Rohila, Desouza, Guha, Kumar, Menon, Rath, Patil, Noronha, Joshi, Laskar, Rangarajan, Prabhash, Gupta and Banavali.)

Background  Various predictive models have been developed which incorporates patient risk factors into the selection of optimal antiemetic therapy, one of which is chemotherapy-induced nausea and vomiting (CINV) risk scoring system developed by Multinational Association of Supportive Care in Cancer (MASCC). Patients and Methods  Consecutive patients with gastrointestinal malignancy who had not received previous chemotherapy were eligible for enrollment in the study if they were scheduled to receive at least one cycle of chemotherapy. The CINV risk assessment tool was used to collect the study data and to assess CINV risk score. Results  Ninety-eight patients fulfilling the eligibility criteria were included in this study, out of which 57% were males, median age was 48 years (range: 28-77). Colorectal cancer (32.7%) was the most common diagnosis followed by gastric cancer (27.6%). Gemcitabine/cisplatin and CAPOX regimen were the most common regimen being administered in 19.4% each. As per MASCC guidelines, 19.4% patients received highly emetogenic chemotherapy, 69.4% moderately emetogenic chemotherapy, while 11.2% received regimen with low emetogenicity. CINV risk module characterized 52% patients to have high risk for CINV, while 48% to have low risk of CINV, thus, 52% had the discrepancy in risk assigned by two methods, and this was statistically significant ( p = 0.025). In subgroup analysis, although patient cohort with acute nausea had no statistically significant discrepancy ( p = 0.123), but statistically significant discrepancy was found in patient cohort with delayed nausea ( p = 0.001), acute ( p = 0.038), and delayed ( p < 0.001) vomiting. Conclusion  A significant percentage of patients who receive chemotherapy continue to experience nausea and vomiting despite receiving antiemetic treatment as per standard guidelines. The study generates a hypothesis for future large randomized studies looking at change in antiemetic prophylaxis based on CINV risk tool, leading to improvement in complete response rates of acute and delayed CINV., Competing Interests: Conflict of InterestSource of Support None declared. None., (MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Because the addition of nimotuzumab to chemoradiation in patients with locally advanced head and neck cancer improved outcomes in a phase 2 study, the authors conducted a phase 3 study to confirm these findings., Methods: This open-label, investigator-initiated, phase 3, randomized trial was conducted from 2012 to 2018. Adult patients with locally advanced head and neck cancer who were fit for radical chemoradiation were randomized 1:1 to receive either radical radiotherapy (66-70 grays) with concurrent weekly cisplatin (30 mg/m 2 ) (CRT) or the same schedule of CRT with weekly nimotuzumab (200 mg) (NCRT).The primary endpoint was progression-free survival (PFS); key secondary endpoints were disease-free survival (DFS), duration of locoregional control (LRC), and overall survival (OS). An intent-to-treat analysis also was performed., Results: In total, 536 patients were allocated equally to both treatment arms. The median follow-up was 39.13 months. The addition of nimotuzumab improved PFS (hazard ratio [HR], 0.69; 95% CI, 0.53-0.89; P = .004), LRC (HR, 0.67; 95% CI, 0.50-0.89; P = .006), and DFS (HR, 0.71; 95% CI, 0.55-0.92; P = .008) and had a trend toward improved OS (HR, 0.84; 95% CI, 0.65-1.08; P = .163). Grade 3 through 5 adverse events were similar between the 2 arms, except for a higher incidence of mucositis in the NCRT arm (66.7% vs 55.8%; P = .01)., Conclusions: The addition of nimotuzumab to concurrent weekly CRT improves PFS, LRC, and DFS. This combination provides a novel alternative therapeutic option to a 3-weekly schedule of 100 mg/m 2 cisplatin in patients with locally advanced head and neck cancer who are treated with radical-intent CRT., (© 2019 American Cancer Society.)

How to cite this article: Kulkarni AP, Sengar M, Chinnaswamy G, Hegde A, Rodrigues C, Soman R, Khilnani GC, Ramasubban S, Desai M, Pandit R, Khasne R, Shetty A, Gilada T, Bhosale S, Kothekar A, Dixit S, Zirpe K, Mehta Y, Pulinilkunnathil JG, Bhagat V, Khan MS, Narkhede AM, Baliga N, Ammapalli S, Bamne S, Turkar S, Bhat KV, Choudhary J, Kumar R, Divatia JV. Indian Journal of Critical Care Medicine 2019;23(Suppl 1): S64-S96.

Background: Quality-adjusted time without toxicity (Q-TWiST) and quality of life (QOL) are indicators of benefit provided by different chemotherapy regimens., Methods: This was a prospective study, in which adult head-and-neck (H and N) cancer patients, treated with metronomic chemotherapy were enrolled. The Functional Assessment of Cancer Therapy-General H and N (FACT-G and H and N) version 4 pro formas were self-administered before the start of chemotherapy and then at 2, 4, and 6 months. FACT QOL and Q-TWiST analysis were then performed., Results: There was an improvement in the social well-being ( P = 0.370), emotional well-being ( P = 0.000), functional well-being ( P = 0.000), H and N cancer subscale ( P = 0.001), FACT H and N trial outcome index ( P = 0.000), FACT G-total score ( P = 0.000), and FACT H and N total score ( P = 0.000) with palliative chemotherapy. The QTWiST value for a utility score of 0.25 for toxicity and relapse state was 145.93 days., Conclusion: Metronomic chemotherapy is associated with improvement in QOL and has a low duration of time spent in toxicity state., Competing Interests: There are no conflicts of interest.

Purpose: This study reports the incidence of distress, the factors associated with distress, and a practical strategy to resolve distress in patients with head and neck cancer who are starting palliative chemotherapy., Methods: Adult patients with head and neck cancer planned for palliative chemotherapy underwent distress screening before the start of treatment as part of this single-arm prospective study. Patients who had a distress score > 3 on the National Comprehensive Cancer Network (NCCN) distress thermometer were counseled initially by the clinician. Those who continued to have high distress after the clinician-led counseling were referred to a clinical psychologist and were started on palliative chemotherapy. After counseling, distress was measured again. The relation between baseline distress and compliance was tested using Fisher's exact test., Results: Two hundred patients were enrolled, and the number of patients with high distress was 89 (44.5% [95% CI, 37.8% to 51.4%]). The number of patients who had a decrease in distress after clinician-led counseling (n = 88) was 52 (59.1% [95% CI, 48.6% to 68.8%]) and after psychologist-led counseling (n = 32) was 24 (75.0% [95% CI, 57.6% to 72.2%]; P = .136). Compliance rates did not differ between the patients with or without a high level of distress at baseline (74.2% v 77.4%, P = .620)., Conclusion: The incidence of baseline distress is high in patients awaiting the start of palliative chemotherapy. It can be resolved in a substantial number of patients using the strategy of clinician-led counseling, with additional referral to a clinical psychologist as required. Patients with a greater number of emotional problems usually require psychologist-led counseling.

Background: Cabazitaxel has shown activity in squamous cancer cell lines and in taxane resistant cell lines. Hence we planned a phase 2 study to evaluate the efficacy of cabazitaxel against Docetaxel in recurrent head and neck cancer, post first line treatment., Methods: This was a phase 2, investigator initiated, randomized controlled trial of Docetaxel (75 mg/m 2 ) versus Cabazitaxel (20 mg/m 2 ), in patients with head and neck cancer with ECOG performance status 0-2 who have been exposed to at least one line of chemotherapy, involving a sample size of 92 (46 per group)(CTRI/2015/06/005848). Disease control rate at 6 weeks was assessed and compared using the chi-square test., Results: The disease control rate at 6 weeks was better in the Docetaxel arm over the cabazitaxel arm (52.3% versus 13.6%, p = 0.017). The median progression free survival was 21 days (95% CI 5.28 to 36.72 days) in the cabazitaxel arm versus 61 days (95% CI 21.39 to 100.60 days) in the Docetaxel arm (HR-1.455, 95% CI 0.919-2.304, p = 0.100). The median overall survival was 115 days (95% CI 74.04 to 155.95 days) in the cabazitaxel arm versus 155 days (95% CI 148.6 to 161.40 days) in the Docetaxel arm (HR-1.464, 95% CI 0.849-2.523, p = 0.170)., Conclusion: Docetaxel had a superior disease control rate at 6 weeks compared to cabazitaxel., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Head and neck cancer patients undergoing palliative chemotherapy have a limited overall survival. Expectations and preferences of such patients towards palliative chemotherapy after explanation of disease prognosis and treatment options are unknown., Methods: This was a single arm, prospective, observational study where newly diagnosed head and neck cancer patients warranting palliative chemotherapy underwent protocol defined counselling. Following counselling, they were administered chemotherapy expectation and preference proforma (CEP). The primary objective of this study was to estimate the percentage of patients opting for an increase in survival as the primary expectation from chemotherapy., Results: We recruited two hundred patients all patients except one answered the CEP. Prolongation of life as the primary expectation from palliative chemotherapy was seen only in 82 patients (41.0%; 95% CI 34.4-47.9%). Symptom relief was the primary expectation or an equally important expectation amongst the remaining 117 patients (58.5%; 95% CI 51.6-65.1%). There was a statistically significant difference between the preferences of patients having a primary expectation of prolongation of life as opposed to symptom relief regarding the minimum expected number of patients need to treat to get prolongation of life (p value -0.00). The minimum expected increment in life expectancy for taking palliative chemotherapy was ">1year" in 190 patients (94.5%; 95% CI 91.5-97.7%)., Conclusion: The primary expectation from palliative chemotherapy in head and neck cancer patients is not necessarily living longer in all patients. The magnitude of benefit preferred by the patients from chemotherapy far exceeded the current standards for drug approval., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Canine demodicosis is a refractory skin disease caused by excessive proliferation of mite Demodex canis. Despite availability of several treatment options, the disease poses a great challenge to clinicians for its long term management as some drugs may be ineffective or toxic. Present report describes successful treatment of two refractory cases of canine demodicosis using homeopathy medicine. After oral administration of Graphitis 200 C two drops once daily for 2 months, complete cure from the disease was observed. No adverse health effects of the medication were recorded during the treatment. Thus, it may be concluded that homeopathy medicine may be used safely for long-term management of canine demodicosis.