Background. The efficacy, safety, and cost benefit of olanzapine (OLN) when compared to aprepitant (APR) in the prevention of chemotherapy induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC) were evaluated. Methods. A prospective pilot study was done in chemotherapy-naive patients receiving HEC to compare OLN versus APR along with palonosetron and dexamethasone. 100 patients consented to the protocol and were randomized and evaluated for Complete Response (CR) (no emesis, no rescue). Results. CR was 86% for the acute period, 86% for the delayed period, and 80% for the overall period in 50 patients receiving the APD regimen. CR was 84% for the acute period, 88% for the delayed period, and 78% for the overall period for 50 patients receiving the OPD regimen. Patients without nausea were APD: 88% acute, 84% delayed, and 84% overall, and OPD: 84% acute, 88% delayed, and 84% overall. There were no significant grade 3 or 4 toxicities. OPD was comparable to APD in the control of CINV. Conclusion. In this study, there was no significant difference between olanzapine and aprepitant in preventing CINV with highly emetogenic chemotherapy. Olanzapine may thus be used as a potential, safe, and cost beneficial alternative to prevent nausea and vomiting in HEC.

Purpose of study This study was conducted to study the clinical and laboratory parameters in patients with macrocytic anemia and to determine the etiology of macrocytic anemia with special reference to megaloblastic anemia. Materials and methodsThis study was a cross-sectional descriptive study carried over a period of 18 months on 60 adult patients (age ≥13 years) of macrocytic anemia. Macrocytic anemia was identifi ed when peripheral blood examination showed anemia with a mean red blood corpuscular volume of >95 fl .Result The most common cause of macrocytic anemia was megaloblastic anemia (38.4%). The major causes of nonmegaloblastic macrocytic anemia were primary bone marrow disorders (35%), liver diseases (15%) and hemolytic anemia (8.3%). There was a signifi cant male preponderance in the study (65%). The megaloblastic anemias observed were due to either vitamin B 12 defi ciency (78.3%) or combined B 12 and folate defi ciency (21.7%). A signifi cant proportion of non-vegetarians (73.9%) had megaloblastic anemia.Patients with an MCV of >110fl were more likely to have megaloblastic anemia (p value 0.0007). Three patients (mean age 55 years) with a megaloblastic marrow did not respond to vitamin replacement and were found to have myelodysplastic syndrome.Conclusion Megaloblastic anemia due to Vitamin B 12 or folate defi ciency remains the most important cause of macrocytic anemia. In settings with limited laboratory facilities, a therapeutic trial of vitamins B 12 or folic acid is useful in determining the specifi c vitamin defi ciency.

Background: Thyroid hormone metabolism disrupts after cardiopulmonary bypass both in adults and pediatric patients. This is known as Euthyroid sick syndrome, and it is more evident in pediatric patients who were undergoing complex cardiac surgeries compared to adults. This decrease in serum T3 levels increases the incidence of low cardiac output, requirement of inotropes, prolonged mechanical ventilation, and prolonged intensive care unit (ICU) stay. Aims and Objectives: The primary objective was to compare the mean Vasoactive-inotropic score (VIS) at 72 hours postoperatively between T3 and Placebo groups. Materials and Methods: One hundred patients were screened, and 88 patients were included in the study. Triidothyronine 1 mic/kg 10 doses 8 th hourly was given orally postoperatively to cases and sugar sachets to controls. The blood samples for analysis of FT3, FT4, and TSH were taken every 24 hours postoperatively, and baseline values were taken after induction. Mean VIS scores, ejection Fraction (EF), Left ventricular outflow tract velocity time integral (LVOT VTi), hemodynamics and partial pressure of oxygen/ fraction of inspired oxygen(PaO2/FiO2) were recorded daily. Results: The Mean VIS scores at 72 Hours postoperatively were significantly less in the T3 group (5.49 ± 6.2) compared to the Placebo group (13.6 ± 11.7). The PaO2/FiO2 ratios were comparatively more in the T3 group than the Placebo group. The serum levels of FT3 FT4 were significantly higher in the T3-supplemented group than the Placebo group. The VIS scores were significantly lower from 48 hours postoperatively in children < 6 months of age. Conclusion: In this study, we observed that supplementing T3 postoperatively decreases the ionotropic requirement from 72 hours postoperatively. This is more useful in children <6 months of age undergoing complex cardiac surgeries.

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The science of life Ayurveda, not only deals with the prevention of diseases by maintaining health but also with the alleviation of diseases. In this ultra modern era due to change in lifestyles, sedentary works and food habits, people are unable to follow the Dinacharya and Ritucharya as explained in the classics, which may lead to different diseases. Due to improper postural habits, weight bearing and other unwholesome diets and habits there are higher the chances of discomfort and disease pertaining to spinal cord. Manyasthambha is one such condition that disturbs a big population due to today’s alterations in lifestyle. Here an effort is made to study and understand the role of Nasya Karma, Nasaapana and Shamanaushadhi like Vyoshadi Guggulu in the treatment aspect of this disease. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Manyasthambha. As per the clinical data, ‘Nasaapana is found to be more effective than Nasya Karma’. So it can be concluded that better results can be obtained with Shaddharana Yoga as Amapachana, Nasaapana with Mashabaladi Kwatha followed by Vyoshadi Guggulu as Shamanoushadhi.

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4491 Background- Imatinib has revolutionized the treatment of CML. Still there are hurdles with the drug, as, with the passage of time patients are either not responding or showing loss of response. The nonresponsiveness has been proved to be due to genetic mutations which may be primary or acquired. Still less is known about the pattern of mutations especially in asian countries. So there is a need to identify the pattern of mutations, so that second line tyrosine kinase inhibitors’ response may be studied with respect to these mutations and new drugs can be designed concentrating on the most common mutations. In an attempt to identify a pattern of mutation in asian population we carried out an analysis at our centre. Methods- The patients who were on imatinib at Kidwai memorial institute of oncology, underwent testing for hematological response(HR) every month, cytogenetic response (CyR) every 6 month and molecular response(MR) every year. Patients who did not achieve either hematologic or cytogenetic or molecular milestones or had loss of response underwent imatinib resistance mutation analysis(IRMA). We analyzed a total of 102 patients. The IRMA was done at Oncquest Laboratories Ltd.,New Delhi, India. The method used at the laboratory is a combination of RTPCR and double pass sequencing. The sequence results were analyzed using BLAST software from NCBI and GRAPH ANALYSIS software from applied biosystems. Results- Between Jan. 2007 to May 2010, a total of 102 patients were analysed for imatinib resistance. Out of these 102 patients, 5(4.9 %) patients presented in blast crisis, 7(6.86%) in accelerated phase and 90(88.23%) in chronic phase. Male to female ratio was 1.7:1. 95 patients had achieved complete hematological response(CHR) at the end of 3 mths but 7 patients did not achieve CHR at 3 mths. So these were the candidates of IRMA. 2 patient had loss of HR. 42 patients did not achieve cytogenetic milestones. 28 patients had loss of cytogenetic response. 15 patients did not achieve major molecular response. and 8 had loss of molecular response. So these 102 patients were candidates for IRMA. Analysis revealed: No mutation - 74 patients. F 359 I – 3 patients, T 315 I(Thr to Ile) – 4 patients, M 351 T (Met to Thr) – 5 patients, M 244 V (Met to Val) – 2patients, H 395 R – 1 patients, Y 253 H – 2 patients, 355 G(GLU to GLY) – 1 patient, 250 E (GLY to GLU)- 1 patient, G250 E (GLY to GLY) - 1patient, F 359 C (Phe to Cys) – 1 patient, F 311 L(Phe to Leu) – 1 patient, Y 253 F(Tyr to Phe) – 1 patient, E 275 K (Glu to Lys) – 2 patients, V 253 F – 2 patients and F317L- 1 patient. Conclusions- Most of the patients (74/102 patients) did not show any mutations. Most common mutation seen was M 351 T in 5 patients. T 315 I mutation was seen in 4 patients and all these patients had a loss of response. All these mutations should be studied with respect to response to second line tyrosine kinase inhibitors particularly in asian Indian population. Disclosures: No relevant conflicts of interest to declare.

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