Objective: The aim of the study was to see the effect of intravenous steroids in patients with blunt chest trauma-lung contusion and to compare the effect of steroid use based on improvement in oxygen saturation, ABG, and hospital stay, in the study group and control group. Methods: A prospective and observational study was carried out on patients with blunt chest trauma having lung contusion who were admitted to the multispecialty hospital for 2 years. Data were collected in a predesigned proforma. All patients with radiologically proven lung contusion were observed based on the steroid treatment given or not. Group A was steroid (study) group and Group B was non-steroid (control) group with 25 sample size in each group. Group A patients were treated with steroid (hydrocortisone) 20 mg/kg/day 6 hourly which was tapered over time. Control group patients were treated identically except for steroid use. Results: Most of the injuries affected the middle age group (25 to 65 years) which accounted for a total of 84%. The percentage of males and females in the study were 76% and 24%, respectively. The most common mode of injury was road traffic accidents which account for 76% as compared to non-road traffic accidents (24%). Statistical analysis showed there was an improvement in both groups in parameters such as Spo2, ABG-Pco2, and ABG-Sao2 and were statistically significant. While other improvements like ABG-Po2, radiological CT, and hospital stays were statistically insignificant. Conclusions: As both groups were showing improvements and there was no statistically much difference seen in both groups, we concluded that there is no role of intra-venous steroid use in lung contusion. However, every patient must undergo CT for a better assessment of the injury. Objective scoring systems are required in CT assessment of lung injury and studies with increased sample size and carried out at multiple centers are required for better conclusions.
Objectives: The aim of the study was to assess patients belonging to four main molecular subtypes (Luminal A, Luminal B, HER2 neu positive and Triple negative) and their treatment plans with a view to compare their early surgical complications and the final outcomes specific to the surgical procedure adopted and molecular subtype. Methods: A Cross-sectional observational study at a Tertiary care center in central UP in a two-year period with Inclusion Criteria and Exclusion Criteria. Data Collection was carried out from the patients, diagnostic confirmation to rule out any exclusion criteria was performed. Clinical staging was done using the standard TNM criteria. All the specimens were subjected to immune-histochemical evaluation for surrogate molecular subtyping to see later the early surgical outcomes. Results: Mean age ranged from 47.57±9.57 (Group III) to 50.67±8.08 (Group II) years and BMI ranged from 23.71 (Group IV) to 26.38 kg/m2 (Group II). Neoadjuvant chemotherapy use was reported in 15.6% of Luminal A group, 33.3% of Luminal B group, 40% of Her2 negative and 52.2% of Triple negative group cases. Statistically, there was a significant difference among groups with respect to use of neoadjuvant chemotherapy. Breast conservation therapy was the preferred surgical intervention in majority of cases with Luminal A (60%) and Luminal B subtype (66.7%) whereas MRM was preferred in 54.3% of Her2 negative and 65.2% of Triple negative cases. MRM was performed in 36% of Luminal A cases. Primary surgical intervention failure (BCS) was seen in 1 (4%) case with Luminal A subtype. In this patient, mastectomy was performed as the corrective measure. Surgical site infection was noted in 1 (4%) case in Luminal A group only. Seroma formation was noted in 4 (16%) of Luminal A, 8 (22.9%) of Her2 negative and 2 (8.7%) of Triple negative patients. No case of flap necrosis was noted. Follow-up duration ranged from 15 days to 36 months. Median duration of follow-up was 6 months. No mortality was noticed in any group. Conclusion: Different surgical management strategies suggested that breast conservative surgery was more feasible in Luminal A cases whereas MRM was the preferred mode of surgery in other molecular subtypes. Within the limitations of short duration of follow-up, there was no significant difference among different molecular subtypes with respect to late complications and survival. Further studies with longer duration of follow-up and larger sample size are recommended.
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