Abhishek Maiti

Congenital adrenal hyperplasia: an Indian experience.

Aims:  Data regarding the presentation and course of patients with congenital adrenal hyperplasia (CAH) is scarce in South Asia. We aimed to fill that gap by collating our experience with CAH and comparing it with findings from few other centres around the world for pertinent differences.

Peripheral blood blast clearance is an independent prognostic factor for survival and response to acute myeloid leukemia induction chemotherapy

In patients with acute myeloid leukemia (AML), rapid reduction of circulating blasts with induction chemotherapy may serve as an in vivo marker of chemosensitivity. We performed a retrospective analysis of 363 patients with untreated AML who received induction chemotherapy in order to determine the relationship between day of blast disappearance (DOBD) and complete remission (CR) rates, event‐free survival (EFS), and overall survival (OS). DOBD ≤ 5 vs. >5 was identified as the most discriminating cutoff for OS. DOBD > 5 was observed in 35 patients (9.6%). The CR rate for patients with DOBD ≤ 5 vs. >5 was 74.0 and 28.6%, median EFS was 9.4 and 1.8 months, and median OS was 17.1 and 5.8 months, respectively (P < 0.001 for all). DOBD > 5 was independently associated with a lower CR rate and shorter EFS and OS (P < 0.001 for all). DOBD > 5 retained prognostic significance for EFS and OS when patients were stratified by cytogenetic risk group, de novo vs. secondary or therapy‐related AML, European LeukemiaNet‐based risk groups, and whether CR was achieved. We propose DOBD > 5 as a simple and early marker of disease resistance that identifies patients with poor prognosis who otherwise may not be identified with existing risk stratification systems. Am. J. Hematol. 91:1221–1226, 2016.

Thoracic splenosis mimicking pleural mass: the importance of clinical history

A 45-year old man with obesity, type 2 diabetes, hypertension and 30-pack-year smoking history presented with intermittent, severe, sharp, left sided chest pain, associated with dizziness for 5 days. A computed-tomography angiography of the chest ruled out pulmonary embolism, but showed multiple pleural-based nodules along the left diaphragmatic pleura (Figure 1A, arrow). Given his smoking history, malignancy was considered a high probability, and …

Post-Discharge Survival Outcomes of Patients with Advanced Cancer from the University of Texas MD Anderson Cancer Center Investigational Cancer Therapeutics (Phase i Trials) Inpatient Unit

Background: Patients with advanced cancer who progress on standard therapy are potential candidates for phase I clinical trials. Due to their aggressive disease and complex comorbid conditions, these patients often need inpatient admission. This study assessed the outcomes of such patients after they were discharged to hospice care. Patients and Methods: We performed a retrospective analysis of patients with solid tumor malignancies who were discharged to hospice care from the inpatient service. Results: One hundred thirty-three patients were included in the study cohort. All patients had metastatic disease and an Eastern Cooperative Oncology Group performance status ≥3. The median survival after discharge to hospice from an inpatient setting was 16 days, with a survival rate of 5% at 3 months after discharge. The median survival after the last cancer treatment was 46 days, with survival of 17% at 3 months, and 5% at 6 months. Patients with lactate dehydrogenase (LDH) >618 IU/L had a median post-discharge survival of 11 days versus 20 days for patients with LDH ≤618 IU/L. Conclusions: Patients with metastatic cancer participating in phase I trials who have poor performance status and require inpatient admission have a very short survival after discharge to hospice. A high LDH level predicts an even shorter survival.

Acute appendicitis caused by Schistosoma japonicum

74-year-old woman presented with right lower uadrant abdominal pain and diarrhea for 3 days. he was otherwise healthy and had recently reloated from Philippines to the United States. Her hite blood cell count was normal, and testing or human immunodeficiency virus was negative. omputed tomography showed acute appendiciis (Fig. 1a, arrow), cecal wall thickening and at stranding. During laparoscopic appendectomy, he cecum was noted to be adherent to the latral abdominal wall. The appendix was short and dherent to the surrounding fat without signs of erforation or pus. Histopathological examination f the appendix showed oval foreign bodies (Fig. 1b

Phase 2 Trial of Capecitabine, Gemcitabine, and Bevacizumab in Sarcomatoid Renal-Cell Carcinoma

Background Patients with sarcomatoid renal‐cell carcinomas (sRCC) have poor outcomes and limited treatment options. Preclinical and clinical data suggest susceptibility to cytotoxic agents and vascular endothelial growth factor–targeted therapies. We designed a phase 2 trial to evaluate the efficacy and safety of capecitabine, gemcitabine, and bevacizumab in sRCC. Patients and Methods Patients with metastatic or unresectable sRCC were eligible for inclusion. Patients received oral capecitabine 800 mg/m2 twice daily on days 1 to 21 of a 28‐day cycle, intravenous gemcitabine 900 mg/m2 on days 1 and 15, and intravenous bevacizumab 10 mg/kg on days 1 and 15. Primary end points were progression‐free survival and time to treatment failure (TTF). Secondary end points were safety, objective response rate, and overall survival. Results Thirty‐four patients were enrolled onto the trial. One patient was excluded from survival analysis and 4 from response analysis as a result of missing data. Median progression‐free survival was 5.5 months (95% confidence interval [CI], 3.4‐7.7), median TTF was 4.2 months (95% CI, 2.4‐6.0), and median overall survival was 12 months (95% CI, 10.6‐13.4). Objective response rate was 20% (5 partial responses, 1 complete response), and disease control rate was 73%. Thirty‐one (91%) of the 34 patients discontinued treatment. The most common reason for treatment discontinuation was progressive disease, which occurred in 24 patients (71%). The most common grade 3 toxicity was rash (including hand–foot syndrome) in 24% patients. Conclusion The combination of capecitabine, gemcitabine, and bevacizumab is an option for patients with sRCC; however, response rates are low. Novel therapies are needed to improve outcomes in patients with sRCC. Micro‐Abstract Patients with sarcomatoid renal‐cell carcinomas (sRCC) have poor outcomes. We enrolled 34 patients onto a phase 2 trial of capecitabine, gemcitabine, and bevacizumab. Median progression‐free survival was 5.5 months, median overall survival was 12 months, and objective response rate was 20%. This regimen is an option in sRCC; however, response rates are low. Novel therapies are needed.

Peripheral blood blast clearance is an independent prognostic factor for survival and response to AML induction chemotherapy

In patients with acute myeloid leukemia (AML), rapid reduction of circulating blasts with induction chemotherapy may serve as an in vivo marker of chemosensitivity. We performed a retrospective analysis of 363 patients with untreated AML who received induction chemotherapy in order to determine the relationship between day of blast disappearance (DOBD) and complete remission (CR) rates, event‐free survival (EFS), and overall survival (OS). DOBD ≤ 5 vs. >5 was identified as the most discriminating cutoff for OS. DOBD > 5 was observed in 35 patients (9.6%). The CR rate for patients with DOBD ≤ 5 vs. >5 was 74.0 and 28.6%, median EFS was 9.4 and 1.8 months, and median OS was 17.1 and 5.8 months, respectively (P < 0.001 for all). DOBD > 5 was independently associated with a lower CR rate and shorter EFS and OS (P < 0.001 for all). DOBD > 5 retained prognostic significance for EFS and OS when patients were stratified by cytogenetic risk group, de novo vs. secondary or therapy‐related AML, European LeukemiaNet‐based risk groups, and whether CR was achieved. We propose DOBD > 5 as a simple and early marker of disease resistance that identifies patients with poor prognosis who otherwise may not be identified with existing risk stratification systems. Am. J. Hematol. 91:1221–1226, 2016.

Management of gestational diabetes mellitus in a public hospital setting in India: Lessons from a minimalist approach

We designed a safe minimalistic model of GDM management which could be conveniently implemented in resource-constrained settings in developing countries. Pregnancy outcomes in the normal controls and the treated GDM patients were similar. We showed that, with minimal care delivered in a consistent fashion it was possible to obtain excellent pregnancy outcomes.

Vasculitis due to levamisole-adulterated cocaine

A 68-year-old woman presented with skin lesions for 1 week. She reported similar lesions 6 months before, which had resolved within a few weeks. Physical examination showed haemorrhagic lesions over forearms and face with bullae (figure 1A,B). Laboratory tests revealed pancytopaenia with neutropaenia. Antinuclear antibody, perinuclear antineutrophil cytoplasmic antibody (p-ANCA), antiproteinase-3 (anti-PR3) and antimyeloperoxidase (anti-MPO) antibodies were positive with high titres. Complement levels were normal. Cryoglobulin and rheumatoid factor were negative. Urine toxicology screen was positive for cocaine. Skin biopsy showed leukocytoclastic …

Acquired amegakaryocytic thrombocytopenia and red cell aplasia in a patient with thymoma progressing to aplastic anemia successfully treated with allogenic stem cell transplantation

Association of pure red-cell aplasia with thymoma is well documented. However, acquired amegakaryocytic thrombocytopenia (AAMT) has been rarely associated with thymoma with only five reported cases in literature. We report a patient with thymoma complicated by pure red cell aplasia (PRCA) and AAMT who progressed to develop aplastic anemia (AA). The patient was refractory to 10-months of immunosuppressive therapy with cyclosporine, prednisone, and antithymocyte globulin. She was eventually treated with allogeneic stem cell transplantation (allo-SCT). On Day +323 the patient continues to be transfusion-independent. This case illustrates how in patients with thymoma and AAMT may herald development of AA. This is also the first report of a patient with AAMT progressing to thymoma-associated AA being successfully treated with allo-SCT. The successful outcome suggests allo-SCT as a feasible option similar to other AA patients.