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   Table of Contents - Current issue
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July-September 2021
Volume 8 | Issue 3
Page Nos. 87-125

Online since Wednesday, September 1, 2021

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ORIGINAL ARTICLES  

Study of expression of p53 and Ki-67 in Benign, premalignant, and malignant lesions of the gallbladder p. 87
Ranjeet Kumar, Shakti Kumar Yadav, Garima Singh, Ruchika Gupta, Sompal Singh
DOI:10.4103/JCRP.JCRP_7_21  
Background: Gallbladder cancer (GBC) has a distinctly higher incidence in certain demographic groups and areas. Chronic cholecystitis and epithelial changes such as metaplasia/dysplasia are associated with a higher incidence of gallbladder carcinoma. Progression from chronic cholecystitis to metaplasia/dysplasia to carcinoma is multifactorial. Ki-67 and p53 are involved at various stages of the cell cycle, and altered expressions of Ki-67 and p53 have been implicated in the carcinogenesis of various malignant tumors. Materials and Methods: Eighty gallbladder specimens were included in the study. Cases were grouped as chronic cholecystitis (Group 1), metaplasia-dysplasia (Group 2), and GBC (Group 3). P53 and Ki-67 immunoexpressions were determined and results were compared between groups. Results: The p53 expression score was highest in Group 3 (4.35 ± 1.72) and lowest in Group 1 (0.73 ± 0.98). The difference in the mean level of p53 expression was significantly (P = 0.0001) different among the groups. Ki-67 index was highest in Group 3 (47.85 ± 17.46) and lowest in Group 1 (6.50 ± 3.88). The mean Ki-67 index was significantly higher in Group 3 compared to Groups 1 and 2. P53 overexpression and Ki-67 expression were significantly associated with the presence of GBC (P = 0.0001). There was a positive correlation (r2 = 0.37, P = 0.001) between the expressions of p53 and Ki-67. Conclusion: P53 overexpression and Ki-67 index were significantly higher in the patients with GBC compared to those with chronic cholecystitis. This supports the theory of progression from chronic cholecystitis to metaplasia/dysplasia to carcinoma in the gallbladder. The expressions of p53 and Ki-67 in the metaplasia and dysplasia group were between the GBC and chronic cholecystitis groups.
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Impact of an intrahospital awareness strategy on attendance to the cervical cancer screening unit of the Yaoundé university teaching hospital cameroon p. 93
Jesse Saint Saba Antaon, Leuwe Donse Frank Eli, Robertine Mamche, Yvette Nkene Mawamba, Pierre Marie Tebeu
DOI:10.4103/JCRP.JCRP_8_21  
Background: Approximately 1500 women in Cameroon die annually from cervical cancer, but only 8% of women at risk have undergone cervical cancer screening. The objective of this study was to analyze the impact of an intrahospital awareness strategy on the frequency of cervical cancer screening at Yaoundé University Teaching Hospital(YUTH). Materials and Methods: This quasi-experimental study (before/after) was conducted at the Yaoundé UTH. It involved women who received an awareness of cervical cancer intervention at the Yaoundé CHU (intervention group) and those who did not (without intervention group) for 4 months (March to June) of 2 consecutive years (2016 and 2017). Proportions, central tendency parameters (mean or median), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Results: A total of 1,313 women participated in screening for cervical cancer, of whom 40.60% were in the without intervention group and 59.40% were in the intervention group. The level of education and marital status were heterogeneously distributed in the two groups (P < 0.05). Women with a higher education level and who were married were more likely to participate in cervical cancer screening after intrahospital sensitization (OR [95% CI] = 5.64 [4.41–7.20] and OR [95% CI] = 1.48 [1.19–1.85], respectively). Conclusion: An intrahospital awareness intervention increased the number of participants in screening for cervical cancer. There is a need to implement this strategy in other hospitals and place particular emphasis on sensitizing less educated and single women.
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Ureteroscopy for the diagnosis of upper tract urothelial cancer: The outcome in a series with 275 patients in correlation with the final histopathology p. 98
Yasser Osman, Mohamed Mohamed Elawdy, Diaa Eldin Taha, Mohamed Abd El-Hamid, Rasha Taha Abouelkheir
DOI:10.4103/JCRP.JCRP_13_21  
Background: There is still an unresolved debate about whether ureteroscopy (URS) and biopsy are required as a routine for the diagnosis of upper tract urothelial cancer (UTUC) or if these procedures can be omitted in appropriately selected patients. We aimed to report the overall diagnostic accuracy of URS biopsy for ureteral tumors in concordance with the final histopathology. Materials and Methods: We conducted this retrospective study from 2000 to 2019. Data on URS biopsies for ureteral tumors which included pathological diagnosis, staging, and grading were collected. These data were then compared to the results of contrast-enhanced computed tomography (CT) and the final histopathological reports. Results: The data of 275 patients with a mean age of 59 ± 11 years were collected. Complete data regarding URS biopsies for ureteral tumors were available in 94 cases with an overall diagnostic accuracy in detecting malignancy of 93%. When matched to the final histopathology, the accuracy of URS biopsies increased as the tumor grade increased. Upgrading was noticed in 36% of the biopsies. Biopsy grade was an accurate predictor of stage. CT was performed in 270 cases with an overall accuracy of 96%. URS did not affect post-UTUC intravesical recurrence (P = 0.9) or overall survival (log rank = 0.08). Conclusion: URS biopsy for ureteral tumors was highly specific with fair predictive ability for tumor grade, and it could predict tumor stage. URS may not increase intravesical recurrence or affect overall survival. However, false-negative results were noted, which did not change the surgical plan when radical surgeries were decided based on CT.
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SHORT COMMUNICATION Top

Caution “When Rabbit Runs Turtles' Pace”: 5-fluorouracil-induced slowdown of the heart – The bradyarrhythmias p. 104
Shaqul Qamar Wani, Khan Talib, Ishtiyaq Ahmad Dar, Mohammad Maqbool Lone, Fir Afroz
DOI:10.4103/JCRP.JCRP_32_20  
Background: 5-fluorouracil (5-FU) is a widely used antimetabolite drug for the treatment of a variety of cancers. It is associated with side effects and toxicities, most of which have been extensively studied. However, data related to potentially life-threatening cardiotoxicity, and especially bradyarrhythmias, are lacking in the literature. The aim is to assess potentially life-threatening bradyarrhythmias (or bradycardia) in patients on continuous 5-FU infusion. Materials and Methods: Fifty-four patients with esophageal carcinomas were included in this prospective non-randomized observational single-institution study. All of the patients underwent concurrent chemoradiation in curative settings over a period of 30 months (January 2015–June 2017). Results: Fourteen of the 54 patients developed bradycardia during continuous 5-FU infusion. Chemotherapy (CT) was stopped transiently in one of these patients and then continued uneventfully after the return of normal heart rate. The other 13 patients developed severe bradycardia, and CT was stopped completely and switched to other cardiac-safe CT protocols due to persistent bradycardia despite optimal management as per the institutional protocol. One patient died of sudden cardiac arrest during continuous 5-FU infusion. Conclusion: The persistence of life-threatening bradycardia during 5-FU infusion should prompt physicians to switch to other cardiac-safe CT protocols. Patients should be vigilantly monitored for any electrocardiography changes during continuous 5-FU infusion.
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CASE REPORTS Top

Indocyanine green fluorescence imaging-guided resection of colorectal liver metastasis p. 109
Chi-Hsiang Kang, I-Shu Chen
DOI:10.4103/JCRP.JCRP_30_20  
Most people with colorectal cancer eventually develop liver metastasis. Small liver metastasis can be hard to identify and sometimes missed during liver resection. We present our experience and suggest intraoperative navigation using indocyanine green near-infrared fluorescence imaging to ensure complete surgical eradication of liver metastases from colorectal cancer.
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Severe colitis induced by pembrolizumab in a patient with advanced hypopharyngeal squamous cell carcinoma: A case report of an immune-related adverse event p. 113
Sing-Ting Wang, Ming-Yu Lien
DOI:10.4103/JCRP.JCRP_5_21  
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target downregulators of anticancer immune responses: cytotoxic T-lymphocyte antigen-4 (CTLA-4), programmed death protein-1 (PD-1) and programmed death-ligand 1 (PD-L1). Immune-related adverse events (irAEs) can affect multiple organs of the body. Distinct toxicity induced by different ICIs had been observed. Immune-mediated colitis (IMC) is a common irAE and more frequently encountered in anti-CTLA-4 than anti-PD-1 or anti-PD-L1. Owing to a wide range and inconclusive endoscopic and histological findings, the diagnosis of IMC can be made after excluding other possible causes and relies primarily on clinical suspicion. Optimal management of IMC requires early recognition and timely treatment. Corticosteroids are recommended for Grade 2 or more severe colitis while holding the immunotherapy. A better response to corticosteroids has been observed in anti-PD-1-related IMC than in anti-CTLA-4. Herein, we report a case of severe colitis induced by pembrolizumab.
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Disseminated nocardiosis coinfection with extrapulmonary tuberculosis in a patient with metastatic thymoma: A case report and literature review p. 117
Cho-Hao Lee, Ching-Liang Ho, Ren-Hua Ye
DOI:10.4103/JCRP.JCRP_10_21  
Patients with metastatic thymoma postintensive chemotherapy and radiotherapy are prone to opportunistic infectious diseases. Disseminated nocardiosis is a rare disease; however, its incidence has increased in recent years due to the growing population of immunocompromised hosts. We present the first report of Nocardia beijingensis infection with extrapulmonary tuberculosis coinfection causing muscular and brain abscesses in a patient with metastatic thymoma postintensive chemotherapy and radiotherapy. This case illustrates the possibility of coinfection with two pathogens and the difficulty in establishing a rapid diagnosis. Awareness of opportunistic infections and the early initiation of appropriate antibiotic therapy are important for the treatment of immunocompromised patients with infectious diseases.
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Decreased visual acuity after chemotherapy in a case with diffuse large B cell lymphoma p. 123
Cheng-Chih Tsai, Chai-Chun Chen, Tsu-Yi Chao, Yao-Yu Hsieh
DOI:10.4103/JCRP.JCRP_16_21  
A 53-year-old male with no past medical history presented with abdominal pain for 2 days, accompanied with fever and poor appetite. Leukoerythroblastosis along with elevated lactate dehydrogenase and a bone marrow exam led to the diagnosis of diffuse large B-cell lymphoma, germinal center B-cell (GCB) type. After the 5th cycle of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, progressively decreased visual acuity along with left ptosis occurred. Drug-related optic neuropathy was suspected, and initial magnetic resonance imaging (MRI) and cerebral spinal fluid (CSF) studies revealed negative results. However, meningeal lymphomatosis with bilateral optic nerve infiltration was finally diagnosed by subsequent MRI and CSF studies after 1 month. This rare case highlights the pitfalls of CSF studies. Based on previous studies, an adequate sample (>10.5 ml), rapid processing within 1 h, and serial testing at least twice can improve the rate of positive results while reducing the false-negative rate. We hope that this case can remind clinicians of the possible diagnosis of lymphomatous optic nerve infiltration from systemic lymphoma, and that properly conducted CSF studies can help to avoid missing this diagnosis.
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