Role of systemic inflammatory markers (biomarkers) as important prognostic factors for survival in head and neck cancer

Introduction and Aim: Cancer related inflammation is recognized as a critical multifaceted player in tumour initiation and progression. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are important markers of systemic inflammatory burden in malignancy. The present retrospective study aimed to evaluate the prognostic value of pre-treatment baseline (NLR) and (PLR) for survival in HNC patients. Materials and Methods: Analysis of data of 257 patients with head and neck cancer treated with definitive therapy over 3.5 yrs. Neutrophil, lymphocyte and platelet counts before treatment of all patients were collected and NLR and PLR were calculated. Results: Median value of NLR and PLR were 3.7 and 170.63 respectively. Receiver operator characteristics (ROC) curve analysis showed the predictive cut-off value of NLR and PLR as 3.9 and 158.3. Univariate analysis using Cox-regression model showed NLR (p < 0.001) and PLR (p = 0.001) significantly influenced the locoregional recurrence free survival (LRRFS) and overall survival (OS). The multivariate analysis showed NLR is the independent prognostic factors influencing LRRFS (p = 0.007) and OS (p = 0.002). Kaplan-Meier survival curve (Log rank test; Chi-square (?2) value) showed OS is significantly influenced by NLR group (LRRFS; ?2 = 23.9 and OS; ?2 = 33.7) and PLR group (LRRFS; ?2 = 11.2 and OS; ?2 = 19.3) in contrast to LRRFS. Conclusion: NLR can be strongly used as biomarker for prognostication for outcome and survival in head neck cancer. However, a well-designed, larger studies with longer follow-up is warranted.

Oxygen Saturation (SPO2) in Covid-19 Patients

One of the emergency problems of Covid-19 patients is a decrease in oxygen saturation (SpO2). Factors that affect the decrease in oxygen saturation, age, immune system, and gender. The purpose of this study was to identify Oxygen Saturation (SpO2) in Coronavirus Disease (Covid-19) patients. The research design is descriptive. The population in this study were all Covid-19 patients at the Aminah Blitar Islamic Hospital starting last month December 2020 to March 2021 totaling 346 and the number of samples is 185. This research instrument uses data studies on the medical records of Covid-19 patients. Sampling technique using purposive sampling. Statistic testusefrequency distribution. The results of this study indicate that from 185 respondents there were 77 (41.4) respondents who did not experience hypoxemia and 108 (58.6) respondents experienced hypoxemia. Covid-19 must be watched out for because of its relatively fast transmission, has a mortality rate that cannot be ignored, and there is no definitive therapy yet. A decrease in oxygen saturation (SpO2) is an important thing that needs to be considered in Covid-19 patients.

Hairy Cell Leukemia: Morphological and Immunophenotypic Characteristics of Seven Cases and Cyclin D1 Expression

Aberrant immunophenotypic expression in hairy cell leukemia (HCL), both at medullary and extramedullary sites, is not uncommonly reported in literature. Cyclin D1 positivity in HCL may mimic mantle cell lymphoma (MCL) morphologically, especially in the presence of aberrant CD5 immunopositivity, requiring BRAFV600E mutation and/or CCND1 gene testing for confirmation. Here, we describe seven cases of HCL with clinicomorphological and immunophenotypic characteristics with an emphasis on cyclin D1 expression using immunohistochemistry (IHC) with a brief comprehensive literature review. We suggest that cyclin D1 positive HCL may be a distinct subtype which requires further immunophenotypic and molecular characterization for accurate diagnosis and planning of definitive therapy.

Predictors of transcatheter closure cancellation in children with ventricular septal defect

Background Ventricle septal defect (VSD) is the most common type of congenital heart disease in children. If definitive therapy delayed, failure to thrive and developmental delays can lead to decreased quality of life. The options for VSD closure include surgical and minimally invasive procedures with transcatheterization. Although transcatheterization is considered to be the safest therapy, the risk of complications can lead to cancellation of procedure. Objective To determine whether nutritional status, body height, VSD type and size, and type of device used were predictors of cancellation of transcatheter closure of VSD. Methods A retrospective cohort study using medical records was performed for all children who underwent transcatheter closure of VSD at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2017 to March 2020. Cancellation of closure was defined as complications occurring during the procedure, such as cardiac conduction problems, valve regurgitation, and device embolization. Multivariate logistic regression analysis was done to determine independent predictors of closure cancellation. Results One hundred thirty-four children were enrolled. Independent variables that were significant predictors were doubly committed subarterial (DCSA) VSD type (OR 5.98; 95%CI 1.52 to 23.61; P=0.045), moderate VSD size (OR 15.59; 95%CI 4.67 to 52.06; P=0.001), and types of devices used: symmetric (OR 27.06; 95%CI 2.75 to 266.17; P=0.001), asymmetric (OR 16.46; 95%CI 2.15 to 210.0; P=0.001), and coil (OR 21.26; 95%CI 2.15 to 210.0; P=0.001). Taller body height was a protective factor against cancellation of the procedure (OR 0.98; 95%CI 0.96 to 1.00; P=0.008). Conclusion Significant predictors of cancellation of transcatheter VSD closure are DCSA VSD, moderate VSD size, as well as coil, symmetric, and asymmetric devices, and increased body height.

A case of primary varicella meningoencephalitis in the absence of cutaneous lesions in a 4-month-old infant

Primary varicella infection has typical cutaneous lesions which aid in clinical diagnosis. Infants with transplacental transfer of varicella antibody can have varied cutaneous lesions. We report a 4-month-old infant with primary varicella meningoencephalitis without cutaneous lesions whose mother had no history of varicella during antenatal or post-natal period. Diagnosis was made possible by CSF DNA PCR. Infants with encephalitis pose diagnostic challenge to clinicians in resource limited settings. Varicella encephalitis is one such aetiology for which definitive therapy with Acyclovir is available. CSF PCR is the definitive and cost-effective test for the diagnosis varicella encephalitis. In children with meningoencephalitis it is prudent to add Acyclovir empirically pending CSF viral PCR results.

Efficacy and Safety of Convalescent Plasma Transfusion Administered as Adjunctive Treatment to Standard Treatment in Moderate, Severe, and/or Critically Ill Patients with COVID-19 in Dr. M. Djamil General Hospital

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2. High mortality rate due to COVID-19 has become a serious health problem globally. At present, there is no definitive therapy for COVID-19. AIM: The objective of this study is to evaluate convalescent plasma therapy (CPT) in COVID-19 patients. METHODS: The study was conducted in prospective experimental design with sample population of COVID-19 inpatient in Dr. M. Djamil General Hospital, Padang, isolation ward. This study was involving 20 patients consisted of 10 patients of experimental group who received standard therapy and CPT and 10 patients of control group who received standard therapy only; 10 males and 10 females. Differences in laboratory results in both groups were analyzed by T-test or Mann–Whitney U-test. RESULTS: Twenty subjects included in this study with average of age 56.50 (9.606) years. The mean of C-reactive protein (CRP) serum of the experimental group on day 1 (CRP +1) after CPT was 17.50 (25.343) while the control group was 77.50 (75.177) with p = 0.028 (p < 0.05). However, there were no differences in sequential organ failure assessment, hemoglobin, leukocyte, platelet, partial pressure of oxygen, D-dimer, procalcitonin, interleukin-6, lactate dehydrogenase, ferritin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, glomerular filtration rate, bilirubin, cycle threshold values, and chest X-ray finding between both groups. CONCLUSION: There was a significant difference in CRP +1 between the experimental group and control group, while no significant differences found in other parameters between both groups. As CRP is an inflammatory indicator, CPT showed benefit in reducing inflammation in COVID-19 patient.

Diagnosis of Streptococcus pneumoniae infection using circulating antibody secreting cells

Background Streptococcus pneumoniae infections cause morbidity and mortality worldwide. A rapid, simple diagnostic method could reduce the time needed to introduce definitive therapy potentially improving patient outcomes. Methods We introduce two new methods for diagnosing S. pneumoniae infections by measuring the presence of newly activated, pathogen-specific, circulating Antibody Secreting Cells (ASC). First, ASC were detected by ELISpot assays that measure cells secreting antibodies specific for signature antigens. Second, the antibodies secreted by isolated ASC were collected in vitro in a novel matrix, MENSA (media enriched with newly synthesized antibodies) and antibodies against S. pneumoniae antigens were measured using Luminex immunoassays. Each assay was evaluated using blood from S. pneumoniae and non-S. pneumoniae-infected adult patients. Results We enrolled 23 patients with culture-confirmed S. pneumoniae infections and 24 controls consisting of 12 non-S. pneumoniae infections, 10 healthy donors and two colonized with S. pneumoniae. By ELISpot assays, twenty-one of 23 infected patients were positive, and all 24 controls were negative. Using MENSA samples, four of five S. pneumoniae-infected patients were positive by Luminex immunoassays while all five non-S. pneumoniae-infected patients were negative. Conclusion Specific antibodies produced by activated ASC may provide a simple diagnostic for ongoing S. pneumoniae infections. This method has the potential to diagnose acute bacterial infections.

Proton Radiotherapy for Patients With Oligometastatic Breast Cancer Involving the Sternum

Introduction A subset of metastatic breast cancer patients present with oligometastatic disease involving the sternum. Given the proximity to traditional target structures, a proton radiation field can be expanded to include this region, providing definitive therapy for patients who are otherwise metastatic. We evaluated the feasibility and outcomes of a small series of patients who received comprehensive nodal irradiation inclusive of an isolated sternal metastasis using proton pencil beam scanning. Materials and Methods Four patients with a diagnosis of metastatic breast cancer with an isolated metastasis to the sternum received multimodality therapy with curative intent and then underwent adjuvant pencil beam scanning with definitive treatment to the sternum. Dosimetric parameters and treatment outcomes were evaluated. Results With respect to treatment coverage, proton therapy was able to deliver comprehensive target structure coverage while maintaining modest doses to the organs at risk compared with photon techniques. At a median follow-up of 28 months from diagnosis, none of the patients have experienced relapse within the radiation portal or developed additional sites of metastatic disease. Conclusion Pencil beam scanning for oligometastatic breast cancer with isolated sternal lesions appears feasible without undue normal tissue exposure. Current treatment outcomes appear promising.

NCMP-17. BEWARE: ALL POSTERIOR FOSSA MASSES IN CHILDREN ARE NOT BRAIN TUMORS

INTRODUCTION Isolated Myeloid sarcoma (MS) of the central nervous system (CNS-MS) is a very rare presentation of Acute Myeloid Leukemia (AML). A 10-year-old boy with a two-week history of intermittent headaches was referred to the emergency department (ED) by an optometrist for evaluation of bilateral papilledema. Physical examination in the ED confirmed the presence of papilledema with no other abnormal neurologic findings. Emergent MRI of the brain showed an avidly homogeneously enhancing extra-axial dural based mass in the right posterior fossa measuring 4.8 cm (AP) x 3.2 cm (CC) x 4.6cm (T), with significant mass effect and peri-tumoral vasogenic edema. Neuro-surgery consultation was obtained and complete blood count (CBC) was normal except for the presence of 13% blasts with occasional Auer rods seen on the peripheral blood smear. Bone marrow aspirate demonstrated 56% myeloblasts; A diagnosis of AML with CNS-MS (CNS-3c) was made and the initial lumbar puncture (LP) was deferred due to the risk of CNS herniation. Induction chemotherapy was initiated as per protocol. A CT scan done two weeks later showed complete resolution of the intracranial mass. DISCUSSION The incidental finding of papilledema, with imaging to investigate the intracranial pathology revealed a large posterior fossa mass in our patient. However, the atypical features of the mass (dural based extra-axial location; extensive infiltration into adjacent structures) and the finding of blasts with Auer rods in peripheral blood helped us to diagnose CNS-MS, and avoided an extensive neurosurgical procedure and a delay in definitive therapy. Our patient had a normal CBC and the review of the peripheral blood film by an experienced Hematologist was very crucial in making a clinical diagnosis of MS. CONCLUSION Myeloid sarcomas should be considered in the differential diagnosis of an intracranial mass, particularly when accompanied by abnormal findings in the CBC.