The aim of the study was to assess and compare the clinical and pathological response and the toxicity profile between neoadjuvant chemotherapy FEC followed by docetaxel versus AC followed by docetaxel in locally advanced breast cancer patients. Between June 2013 and June 2014, 148 patients diagnosed with LABC were randomized into two groups with 74 in each group. Group 1 received AC (adriamycin 60 mg/m(2), cyclophosphamide 600 mg/m(2)) followed by docetaxel 100 mg/m(2) with primary GCSF prophylaxis and group 2 received FEC (5-fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2), cyclophosphamide 500 mg/m(2)) followed by docetaxel 75 mg/m(2). MRM/BCS was performed for all patients after NACT and assessed for pathological response. Toxicity profile was assessed according to CTCAE version 4. All baseline parameters were equally matched between the two regimens. 90 % of patients completed NACT and underwent surgery. pCR rates were 31 % in group 1 and 34 % in group 2 without any difference. Any grade of hand-foot syndrome was significantly high in group 1 as compared to group 2. Grade 3 and grade 4 neutropenia and febrile neutropenia were significantly high in group 1 as compared to group 2. Median follow-up was 13.7 months (range, 2.9-25 months). There was no difference in the 2-year PFS between group 1 and group 2 (70.9 vs. 73.8 %, respectively) and OS (87.8 vs. 91.8 %, respectively) in our study population. Chemotherapy with FEC followed by docetaxel can be considered as an optimal neoadjuvant regimen in LABC as compared to AC followed by docetaxel.
Mortality rate associated with invasive fungal infections is very high. Early suspicion for fungal infections is important during intensive chemotherapy for acute leukemia. Empirical treatment with antifungals amphotericin B or caspofungin should be started if patient is not responding to broad spectrum antibiotics and if expected duration of neutropenia is prolonged. We are reporting a 3 years old girl child with diagnosis of pre-B acute lymphoblastic leukemia who developed invasive candidiasis with typical clinical and radiological findings during induction chemotherapy. Candida non-albicans was isolated and she was treated with amphotericin B followed by caspofungin. Patient deteriorated after initial response and succumbed to death. Species identification and sensitivity pattern of fungus can help in selecting appropriate antifungal drug.Keywords Invasive candidiasis Á Acute lymphoblastic leukemia Á Candida non-albicans This 3-year old girl presented in June 2012 at JIPMER with fever off and on and progressive abdominal distension for 2 months. Fever was high grade intermittent associated with significant lethargy. There was no history of headache, vomiting, cough, expectoration, chest pain, diarrhea, abdominal pain or any urinary symptoms. Patient developed progressive paleness of body over 2 months. There was no history of bleeding, join pain or arthralgia. At presentation blood pressure was 100/70 mm of Hg and pulse rate was 126/minute regular. Patient had marked pallor, facial puffiness and multiple cervical and axillary lymph nodes, maximum 2.0 9 1.5 cm in size. Systemic examination showed moderate hepatosplenomegaly.Hemogram showed Hb = 11.3 gm/dl, TLC-5400/cmm and platelets-5000/cmm differential count showed 60 % blasts with morphololgy suggestive of lymphoblast. Bone marrow aspiration differential showed 90 % blasts. Bone marrow flocytometry showed positivity of CD19, CD34, HLA-DR, CD10 and cCD79 suggestive of pre-B acute lymphoblastic leukemia. CSF examination was normal. Baseline chest X-ray was normal and USG abdomen showed hepatosplenomegaly.Patient was started on tumor lysis measures followed by MCP-841 acute lymphoblastic leukemia (ALL) induction protocol. Initially patient tolerated chemotherapy well and became afebrile from day-3 onwards. Day-20 of induction therapy patient developed high grade fever in background of severe neutropenia (ANC \ 100/mm 3 ). Bacterial and fungal blood cultures were sent. Patient was started on empirical IV antibiotics (ceftazidime and amikacin). After two days patient developed papulonodular skin rashes all over the body predominantly on extremities ( Fig. 1) with progressive splenomegaly. Peripheral smear did not show any blasts. There was no evidence of oral candida and fundus examination was normal. She was started empirically on amphotericin B. Blood culture showed candida non-albicans. FNAC from skin lesions showed budding yeast. Candida sub-species identification and drug sensitivity pattern could not be done due to unavailability of test. Abdomina...
A 65 year old male diagnosed as multiple myeloma was started on bortezomib developed tumor lysis syndrome. Bortezomib induced tumor lysis is rare and suitable precautions should be considered in these patients.
Medicinal plants have been on the forefront where research on the anticancer agent is planned. This review mainly focuses on several such as medicinal plants Rosmarinus officinalis, Solanum nigrum, Kaffir lime, and Garcinia nujiangensis used in the treatment of cervical cancer and the secondary metabolites derived from different plant sources. Plant molecules such as cisplatin, curcumin (-)- epigallocatechin (EGC)-3-gallate, EGC, epicatechin- 3-gallate, and other catechins that have a wide range of biological properties and the molecular mechanism with different cells were reviewed. This review will promote the research on the development of a plant-derived anticancer drug with lesser or no side effects and aid in understanding the mechanism of action of several plant-derived molecules.
Paramphistomosis is one of the major pathogenic diseases in domestic animals and responsible for heavy economic loss in terms of reduced milk, meat and wool production. Cotylophoron cotylophorum is more prevalent in Tamilnadu. In the present investigation, the effect of Syzygium aromaticum ethanol extract on the enzymes of carbohydrate metabolism viz. pyruvate kinase, phosphoenolpyruvate carboxykinase, lactate dehydrogenase, malate dehydrogenase, fumarate reductase and succinate dehydrogenase of Cotylophoron cotylophorum was studied in vitro. The parasites were incubated in five different sub-lethal concentrations of ethanol extract of Syzygium aromaticum viz. 0.005, 0.01, 0.05, 0.1 and 0.5mg/ml for 2, 4 and 8 h. The activity of the enzymes was assayed using standard procedures. The enzyme activity was expressed in terms of protein. The data obtained were analyzed statistically. Ethanol extract of Syzygium aromaticum significantly inhibited the enzymes of carbohydrate metabolism and the percentage of inhibition was dose and time dependent. Inhibition of these enzymes leads to decreased ATP production which may be fatal to the parasites. The present study validates the anthelmintic property of ethanol extract of Syzygium aromaticum against C. cotylophorum.
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