Pediatric desmoid fibromatosis – Experience from a tertiary care cancer hospital

BackgroundCancer patients are vulnerable to infections due to immunosuppression caused by cancer itself and its treatment. The emergence of antimicrobial-resistant bacteria further complicates the treatment of infections and increases the mortality and hospital stays. This study aimed to investigate the microbial spectrum, antimicrobial resistance patterns, risk factors, and their impact on clinical outcomes in these patients.MethodsA prospective study was conducted at a tertiary care cancer hospital in Patna, Bihar, India, which included cancer patients aged 18 years and older with positive microbial cultures.ResultsThis study analysed 440 patients, 53% (234) of whom were females, with an average age of 49.27 (± 14.73) years. A total of 541 isolates were identified, among which 48.01% (242) were multidrug resistant (MDR), 29.76% (150) were extensively drug resistant (XDR), and 19.84% (112) were sensitive. This study revealed that patients who underwent surgery, chemotherapy, were hospitalized, had a history of antibiotic exposure, and had severe neutropenia were more susceptible to MDR and XDR infections. The average hospital stays were 16.90 (± 10.23), 18.30 (± 11.14), and 22.83 (± 13.22) days for patients with sensitive, MDR, and XDR infections, respectively. The study also revealed overall 30-day mortality rate of 31.81% (140), whereas the MDR and XDR group exhibited 38.92% and 50.29% rates of 30-day mortality respectively (P < 0.001). Possible risk factors identified that could lead to mortality, were cancer recurrence, sepsis, chemotherapy, indwelling invasive devices such as foley catheter, Central venous catheter and ryles tube, MASCC score (< 21) and pneumonia.ConclusionsThis study emphasizes the necessity for personalized interventions among cancer patients, such as identifying patients at risk of infection, judicious antibiotic use, infection control measures, and the implementation of antimicrobial stewardship programs to reduce the rate of antimicrobial-resistant infection and associated mortality and hospital length of stay.

Background: Cancer is a leading cause of mortality and morbidity in the world. Cancer incidence varies widely throughout India from east to west and from north to south making the prevention and control programs difficult the alarming increase of cancer cases in low and middle-income countries like India warrants us to have a better knowledge about the transition in the epidemiology in various parts of the country. Aims and Objectives: The aim of this study was to assess the incidence of different cancers among patients visiting a tertiary care cancer hospital in central India. Materials and Methods: The data were collected retrospectively from the medical record database of a tertiary care cancer hospital in Central India from the time period between January 2017 and December 2021. A total of 13011 patients were registered at our hospital between this time period. Data were analyzed for the site of disease and tabulated, and then, the percentage distribution was calculated. Results: Head-and-neck cancer was the most commonly reported one followed by cervical cancer and breast cancer. Among gynecological malignancies, cervical cancer dominated the spectrum followed by ovarian cancer and endometrial cancer. Tobacco-related cancers were seen in high number each year. Less commonly reported cancers were that of urethral, adrenal, germ cell tumors, and choriocarcinoma followed by that of eye and ear. Conclusion: There is an urgent need to set up stringent hospital-based and population-based cancer registration system to understand the profile of cancer in each geographical region for a better understanding and implementation of cancer control programs.

Background and AimsA study was done to create and run a discrete event simulation in the outpatient department (OPD) of a tertiary care cancer hospital in North India to project and optimize resource deployment.MethodsThe OPD process & workflow as per the expected load at tertiary care cancer hospital were finalized with various stakeholders in a focused group discussion. The finalized OPD process & workflow along with the OPD Building plans were utilized to develop a discrete event simulation model for the OPD at a tertiary care cancer hospital using a discrete event simulator. The simulation model thus developed was tested with incremental patient loads in 5 different scenarios/“What if” situations (Scenario 1–5). The data regarding initial patient load and resources deployed was taken from on‐ground observations at the tertiary care cancer hospital.ResultsIt was found that rooms and doctors were over‐utilized and support staff utilization remained low. This was implemented with a lesser waiting time for patients. No additional support staff was provided thus improving utilization of existing staff and saving on resources. The simulations enabled us to deploy resources just when it was required, which ensured optimal utilization and better efficiency. The peak census helped us to determine the capacity of the waiting area in different scenarios with incremental patient load and resource deployment.ConclusionThe simulation software was very helpful, as “what if scenarios” could be created and the system tested, without disturbing the normal functioning of OPD. This enabled decision‐making before making on‐ground changes which saved a lot of time and money. Also, the processes of the old system were reengineered to fit the needs of changing times.

Background: Differentiated thyroid cancers (DTC), including papillary thyroid carcinoma (PTC), are on the rise. This study provides a detailed examination of PTC cases in a tertiary care cancer hospital in Nepal, aiming to understand its clinical characteristics and treatment patterns. We conducted a retrospective analysis of PTC, including demographics, features of tumor, and treatment modalities. Methods: A retrospective cross-sectional study assessed cases of PTC from January 2022 to December 2022. Patient data were collected and analyzed, focusing on demographics, tumor attributes, and treatment approaches. Results: Among 105 patients, females were predominant (female-to-male ratio 5.2:1), and ethnic diversity was observed. Most patients were from Lumbini Pradesh. The mean age was 40.78 years. Fine-needle aspiration cytology (FNAC) showed Bethesda VI as the most common classification. Primary treatment involved total thyroidectomy (76.25%). Classical PTC was the major histopathological variant (78.1%). Tumors were frequently located in the right lobe (55.25%). Unifocal tumors were prevalent (74.28%), with an average size of 2.74 cm. Lymph node metastasis occurred in 49.5% of patients. Intermediate-risk patients constituted the majority (53.5%). Conclusion: This study offers crucial insights into PTC's clinical spectrum in Nepal, aiding in tailored patient care strategies. The findings contribute to informed decision-making for enhanced treatment outcomes.

Background: Surgical site infections (SSIs) are significant complications following abdominal cancer surgery, resulting in patient discomfort, prolonged hospitalization, and increased healthcare costs. Despite efforts to mitigate their occurrence, SSIs remain a challenge in healthcare settings, particularly in low- and middle-income countries. Materials and Methods: This retrospective cross-sectional study aimed to determine the incidence, risk factors, microbiological patterns, and impact of SSIs in patients undergoing open abdominal cancer surgery at a tertiary cancer hospital in Nepal. Results: A total of 206 patients were included in the study, with an SSI incidence of 35.4%. Superficial SSIs accounted for 87.7% of cases, while 12.2% were deep or organ/space infections. The study explored various risk factors, including patient demographics, wound classification, surgical type, and preoperative conditions, and although certain factors showed associations, none reached statistical significance. Notably, longer surgical duration was linked to a higher risk of SSIs. Patients with SSIs experienced significantly longer hospital stays compared to those without SSIs. The predominant pathogens isolated were Escherichia coli, Staphylococcus aureus, and Citrobacter freundii, many of which displayed multidrug resistance. Conclusions: These findings highlight the need for tailored prevention strategies, prudent antibiotic use, and enhanced infection control measures in this high-risk population undergoing abdominal cancer surgery.

Background: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. The aim of the current study was to evaluate the effect of neoadjuvant chemotherapy on downstaging and resectability rate in locally advanced gastric cancer. Material &amp; Methods: This was a single-center quasi-experimental study conducted in the Department of Surgical Oncology in collaboration with the Departments of Medical Oncology, Radiation oncology, and Pathology at the National Institute of Cancer Research and hospital, Dhaka, which is a tertiary care cancer hospital in Bangladesh, between January 2021 and June 2022.Patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) were randomly included in this study by purposive sampling. Patients in Group I underwent upfront surgery Patients in Group II were started on neoadjuvant chemotherapy, either XELOX or FLOT regimen. Surgery was done following the response assessment CECT. We assessed R0 resection rate, age, sex, comorbidities, tumour size, TNM stage and complications were compared between the two groups. Response to NACT was assessed in Group II. Results: The mean age of patients in groups 1 &amp; 2 was 56 ± 11.06 and 55.70 ± 10.46 years of age respectively (p &gt; 0.05). Majority of the respondents (55/74) were male and 19 patients (26%) were female. Male to female ratio was (24/37 &amp;31/37) in group 1 and (31/37 &amp; 6/37) groups respectively (p &gt; 0.05). Out of 37 patients who received NACT, in 9 patients (24.32%) complete response was noted. Partial response was found in 20 cases (54.05%), p-value (&lt;.0001) while a stable disease was reported in three (8.1%) cases. 5 patients (13.51%) had progressive disease. In the upfront surgery group, R0 resection was feasible in 16 (43.2%) cases, and in the NACT plus surgery group, R0 resection was done in 29 (78.4%) cases. In group 1, R1 resection was done in considerable numbers (19/37) compared to group 2 (5/37), P=0.001. Three patients (8.1%) in group 2 and one (2.7) in group 1 had irresectable lesions. Conclusion: In this study it can be concluded that neoadjuvant chemotherapy could downstage tumour and increase tumor resectability rate in patients with locally-advanced gastric adenocarcinoma. However, further studies are necessary to confirm the effect of this modality on patients’ overall survival. We await survival analysis to further validate the role of NACT.

Background: Renal cell carcinoma (RCC) is associated with highest mortality rates of all the genitourinary tumors with increased incidence in the past few decades. It is heterogenous tumor with several histological types. Main diagnostic approach is radiological imaging followed by histopathology.Methods: It is a retrospective study conducted at a tertiary care cancer hospital in Pakistan. We reviewed the record of all the RCC patients in terms of age, gender, radiological manifestation of tumor size, polarity, laterality, stage including nodal status, metastasis and histological type.Results: Our study included 149 patients of RCC. Mean age of presentation was 57 years with a male predominance. The most common stage of presentation was stage 3 seen in 41% patients followed by stage 1 in 37% patients. nodal metastasis was observed in around 13% patients and distant metastasis in 8% patients. Also, majority of the patient had histological subtype of clear cell CA (63%) followed by papillary CA (33%).Conclusions: Epidemiological features of renal cell CA are observed over a period of 5 years representing our population. The current trends show variation from those observed in developed countries depicting the struggle of healthcare awareness in developing countries.

BackgroundAdnexal tumors of the skin are a large and diverse group of benign and malignant neoplasms, which exhibit morphological differentiation toward one of the different types of adnexal epithelium present in normal skin and they pose a diagnostic challenge. The purpose of this study is to share our experience with these rare but aggressive tumors at a tertiary care cancer hospital in a developing country. A retrospective review of 11 patients diagnosed with rare adnexal tumors and their variants from January 2005 to December 2014, treated either surgically or non-surgically, was performed to describe the clinicopathological characteristics and outcome of the disease.Case presentationA total of 11 patients were diagnosed with adnexal carcinoma and its variants: a 34-year-old Sindhi man, a 59-year-old Punjabi woman, a 32-year-old woman from Khyber Pakhtunkhwa, a 43-year-old Punjabi woman, a 64-year-old Punjabi man, a 51-year-old man from Khyber Pakhtunkhwa, a 51-year-old Punjabi woman, a 74-year-old Punjabi woman, a 75-year-old Punjabi man, a 61-year-old man from Khyber Pakhtunkhwa, and a 53-year-old man from Khyber Pakhtunkhwa. The male to female ratio was 1.2:1. The histological variations were sebaceous differentiation (n = 4), microcystic adnexal carcinoma (n = 4), trichilemmal carcinoma (n = 1), pilomatrix carcinoma (n = 1), and hidradenocarcinoma (n = 1). The mean age at presentation was 54 years (range 32 to 75). The primary subsite of involvement was the scalp in nine patients followed by eyelids in two patients. Surgery was the primary treatment modality in almost all patients; postoperative radiotherapy (PORT) was offered to eight patients. The median dose of radiation was 45 Gy to the primary site. Indications for radiotherapy included close margins (n = 2), positive margins (n = 1), high grade histology (n = 4), and multifocal disease (n = 1). On follow-up, two patients presented with local, one regional and two patients developed distant metastasis.ConclusionsAdnexal carcinomas are rare tumors with diverse histological patterns and a tendency for locoregional and distant metastasis. Surgery should be the mainstay of treatment reserving radiotherapy for adjuvant, palliative, and re-treatment scenarios.

BackgroundVentilator-associated pneumonia (VAP) is an important cause of healthcare-associated infections, resulting in prolonged hospitalization with increased morbidity and mortality. Knowledge of predominant local pathogens and their antimicrobial susceptibility patterns helps in selection of appropriate initial antibiotic therapy in these critical cases.Aim and objectiveThe aim and objective of this study is to characterize the microbiology and antimicrobial susceptibility patterns of VAP isolates in a tertiary cancer center.Materials and methodsThis is a 4-year qualitative observational study carried out at a tertiary care cancer hospital in Mumbai. All nondirect bronchoalveolar lavage specimens from patients with a clinical suspicion of VAP sent from the critical care unit to the department of microbiology were processed as per standard laboratory procedures. All isolates were identified to species level and an antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method and/or the VITEK 2 automated identification and susceptibility system, according to Clinical and Laboratory Standards Institute guidelines.ResultsThe study comprised 1,074 patients: 710 (66.10%) men and 364 (33.90%) women. A total of 827 bacterial isolates were obtained with 780 (94.32%) gram-negative organisms and 47 (5.68%) gram-positive organisms; of which Acinetobacter baumannii (38.7%), Pseudomonas aeruginosa (17.5%), and Klebsiella pneumoniae (16.6%) were the commonest. Of gram-negative bacilli, multidrug-resistant organisms constituted 87.50% and were susceptible to colistin.ConclusionsVAP is associated with pathogens, such as A. baumannii, P. aeruginosa, and K. pneumoniae in our setting. High rates of resistance to aminoglycosides, β-lactam-β-lactamase inhibitor combinations, and carbapenems were noted.How to cite this articleSangale A, Bhat V, Kelkar R, Biswas S. Microbiology of Ventilator-associated Pneumonia in a Tertiary Care Cancer Hospital. Indian J Crit Care Med 2021;25(4):421–428.

Tumors of the ear can be benign or malignant. They can occur on the external ear or in the ear canal, the middle ear, and inner ear. Tumors in different areas of the ear behave differently. They are rare which causes several problems in diagnosis and appropriate treatment. The purpose of this study was to analyze retrospectively the patients with malignant neoplasm of the ear. The main objectives of this study were to study the clinicopathological presentation of ear and temporal bone malignancy and to study the management of different types of malignancy of ear and temporal bone. This study is conducted at our tertiary care cancer hospital from Feb 2015 to Jan 2020. This study includes 15 patients treated for malignancy of the external and middle ear. The entire patient was thoroughly examined for malignancy. Details ENT examination was done. History of smoking and tobacco chewing asked. The patient factors considered in this study were age, sex, diagnosis, treatment (surgery, radiotherapy, and chemotherapy), complications, follow-up, and recurrence. This study includes [n = 15] patients. Due to a variety of malignant lesions of the ear and temporal bone they were classified into two groups, Superficial location lesions [n = 5] 3 of disease limited to pinna and 2 cases of primary of parotid origin involving pinna. Deep location involving external auditory meatus and middle ear [n = 12]. In this study of [n = 15] cases lowest age was 18years. male and highest age was 75years. male and most common age group was 56-65years in which [n = 7] patients present. In this study we studied [n = 11] male patients and [n = 4] female patients. The most common symptom present was ear discharge [n = 8], the next common symptom was hard of hearing [n = 7]. A less common symptom was facial weakness [n = 3]. In sign, mastoid tenderness was commonest in [n = 5], and less common was facial palsy in [n = 3]. In our study of [n = 15] patients we did lateral temporal bone resection in [n = 5] patients, wide local excision of lesion in [n = 4] patients, lateral temporal bone resection with postero-lateral neck dissection with PMMC flap done in [n = 2] patients. In our study of [n = 15] cases of ear malignancy most common histopathology is squamous cell carcinoma [n = 12] cases, least were basal cell carcinoma [n = 1], melanoma [n = 1], and Rhabdomyosarcoma [n = 1]. Malignant tumors of the ear and temporal bone are rare. Neoplasm's of the external and middle ear constitutes a group of various histopathological and clinical tumors that differ in diagnostic difficulties, treatment, and prognosis. Surgery is the mainstay of treatment followed by reconstruction. Radiotherapy and chemotherapy play an adjuvant role in post-operative management in the high-risk category. Prognosis is worst as the tumor stage advances. And most of the cases diagnosis was often made in the advanced stage especially for middle ear tumors that diminished the possibility of effective treatment.

Background and AimsIncidence of acute post-operative pain varies widely in different studies and is largely undertreated. Role of a protocolised acute pain service in alleviating postoperative pain is well recognised....

Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis, cancer type and stage, treatment effects, recurrence, fear of end-of-life, survivorship, and financial burden. Depression and anxiety are both psychological and physiological disturbances among cancer patients. To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital. A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years. Ethical approval was taken from the Institutional Review Committee of CiST College. Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire (PHQ-9) for Depression and Hospital Anxiety and Depression sub-scale (HADS-A) for anxiety. Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis. The study revealed that of 220 patients, most of the respondents belonged to the age group 51-60 years. More than half 131 (59.6%) of the respondents were female, most of them had depression, and one-third had anxiety. Among the respondents, 124 (56.4%) had mild depression, 70 (31.8%) had moderate depression, and 3 (1.3%) had severe depression; 79 (35.9%) had mild anxiety, 64 (29.1%) had moderate anxiety, and 4 (1.8%) had severe anxiety. Most respondents were depressed and one-third had anxiety. More than half and nearly one-third had mild and moderate depression, respectively, and nearly one-third had mild and moderate anxiety, which is higher than other studies.

Introduction: Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/ AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus. The purpose of this study is to obtain data on the prevalence of HIV in the cancer population and vice versa at a major tertiary cancer in Bathinda and as the HIV population is also growing, the proportion, epidemiology and demographic profile of HIV in cancer patients need to be evaluated. Aims & Objectives:- To estimate the proportion of HIV infection among cancer patients visiting tertiary care hospital in District Bathinda and to study the demographic profile of patients suffering from HIV and cancer as primary outcome and to study the epidemiology of cancer among HIV-infected people as secondary outcome. Materials and Method:- Descriptive cross sectional study in cancer patients coming to tertiary care cancer hospital in Bathinda. Results & Conclusion:- In our hospital based study, we observed low proportion of HIV (0.28%) as well as HIV+ Cancer patients(0.23%). In cancer patients burden of HIV-infection will have implications for current and future cancer risk.

Context:Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities.Aims:The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors.Settings and Design:This is a record-based retrospective study from a single institution.Subjects and Methods:The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed.Statistical Analysis:Data were analyzed using descriptive statistics. Kruskal–Wallis and Chi-square test were used to assess relationship between variables.Results:The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status.Conclusion:This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.

Background:Preventing cancer is better than treating or curing it. Cancer prevention ensures reduced physical, emotional, financial burden to the individual.Methods:The focus of the preventive oncology unit at Healthcare Global (HCG) Enterprise Limited, Bangalore, India, is to increase the understanding of how lifestyle and risk of cancer are related. It also focusses on screening of normal individuals for estimating their risk of developing cancer, which in-turn can lead to earlier detection, improved treatment and outcomes. This unique endeavor started one year back, provides counseling and vaccination services for HPV (Human Papilloma Virus) and HBV (Hepatitis B Virus). Our outreach initiatives in collaboration with the State and City health Departments include screening camps, and awareness sessions focusing on HPV and HBV vaccination.Results:The focus of research is in the areas of cancer epidemiology, prevention, screening, and control. Such research involves a multidisciplinary approach involving the fields of epidemiology, biostatistics, behavioral science, nutrition, and basic science.Conclusion:This novel endeavor at a tertiary cancer hospital in a Developing Country is aimed at preventing the development or progression of the malignant cancer process.