Nazir A Khan

Cancer trends in Kashmir; common types, site incidence and demographic profiles: National Cancer Registry 2000-2012

BACKGROUND An assessment of cancer incidence in population is required for prevention, early diagnosis, treatment and resource allocation. This will also guide in the formation of facilities for diagnosis, treatment, rehabilitation and follow-up for these patients. The demographic trend of cancer will help to identify common types and etiological factors. Efforts at clinical, research and administrative levels are needed to overcome this problem. SETTINGS AND DESIGN Present retro prospective study was conducted in regional cancer center of a tertiary care hospital. MATERIALS AND METHODS After permission from ethics committee, a retro prospective study of 1 year duration was undertaken to study the profile of cancer patients and to compare it with other cancer registries in India. STATISTICAL ANALYSIS Pearsons Chi-square test and simple linear regression were used. Statistical Package for the Social Sciences version-16 (University of Bristol information services (www.bristol.ac.uk/is/learning/resources) was used. RESULTS The overall incidence of cancer in Kashmir is on the increase and common sites of cancer are esophagus and gastroesophageal (GE) junction, lung, stomach, colorectal, lymphomas, skin, laryngopharynx, acute leukemias, prostate and brain in males.In females common sites are breast, esophagus and GE junction, ovary, colorectal, stomach, lung, gallbladder, lymphomas, acute leukemias and brain. CONCLUSION Cancers of esophagus, stomach and lungs have a high incidence both in men and women in Kashmir. Future studies on sources and types of environmental pollution and exposures in relation to these cancers may improve our understanding of risk factors held responsible for causation of these malignancies in this region. This will help in the allocation of available resources for prevention and treatment strategies.

Quality of life assessment in survivors of breast cancer

AIM The aim was to assess the health-related quality of life (HRQOL) and its temporal variation at first visit and subsequent visits among breast cancer patients. DESIGN AND SETTING The prospective study was carried out in Outpatient Department of Radiation Oncology, University Teaching and Tertiary Referral Hospital. MATERIAL AND METHODS After clearance from the ethical committee and EORTC group, 81 surgically treated female breast cancer patients referred to the Outpatient Department of Radiation Oncology for chemoradiation and hormonal therapy were included in the study after informed written consent, irrespective of the age and stage of disease. The patients were interviewed as per the EORTC QLQ-C30 Questionnaire module at four levels at the first visit and at subsequent follow-up visits at 6, 12, and 24 months, respectively, and are still on follow-up. STATISTICAL ANALYSIS The data collected were expressed as mean/raw score (RS), standard deviation (SD), and percent mean/scale score expressed on the linear transformation scale, derived as per the calculations and equations of the EORTC QLQ-C30 Scoring Manual. Intragroup comparison (IGC) was done at four levels/visits, a, b, c and d. A P-value of <0.05 was considered significant. RESULTS The mean age at presentation was 46.6 ± 10.2 years. The study showed that the physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, global health status, and symptomatology showed statistically significant improvement over time (P < 0.001). CONCLUSION The survivors of female breast cancer over the long-term follow-up showed significant improvement and coping mechanisms involved in a majority of HRQOL parameters.

Gorham's disease of femur

Gorhams disease is a rare condition of bones characterized by spontaneous massive and progressive osteolysis. Less than 200 cases have been reported so far. Femur is an uncommon site of Gorham disease. We report a young female, presenting as pathological fracture of the femur, wherein rapid osteolysis of femur occurred. The clinical, pathological, and radiological picture suggested a diagnosis of Gorhams disease. The patient was subjected to radiotherapy (40 Gys) and put on bisphosphonates. At a follow-up of 2 years, the disease process had stopped and partial recalcification of the bone had occurred.

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital

AIM Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. DESIGN AND SETTING The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. MATERIALS AND METHODS After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. RESULTS The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 (

Uses of Various Grafting Techniques in External Approach Rhinoplasty: An Overview

125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). CONCLUSION The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Profile of malignant spinal cord compression: One year study at regional cancer center

The surgeons performing rhinoplasty found Graft selection the greatest challenge. To avoid an immune response the preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of rejection. We have evaluated 30 patients who underwent open rhinoplasty and We used conchal and septal cartilaginous grafts in various forms by the open approach to correct various nasal deformities compared our experience regarding the operative technique, graft availability, indications, and limitations. No bony graft material or synthetic materials were used. Preoperative extensive evaluation of the patient was done in order to determine the type of deformity and the type of graft to be used in order to correct the deformity. Preoperative and postoperative photographs were taken in four basic views: frontal, lateral, lateral-oblique and basal in order to assess the results of the surgery. The study was done on 30 patients (20 male and 10 females) using the external rhinoplasty approach using the septal and conchal cartilages in different forms. Autologous septal cartilage was used in most of the patients (25 out of 30) and conchal cartilage was used in 5 patients. Multiple grafting techniques were used in some patients. Three patients had traumatic etiology. Columellar strut graft along with TIG technique was used in 16 patients, spreader graft was used in 8 patients, and septal extension graft was used in 5 patient and shield graft in 1 patient. Septorhinoplasty continues to evolve through various new techniques and modifications with the main goal to improve functional nasal airway and to restore cosmetic harmony to the face. Optimum result is very much dependent on the surgeon’s attention to functional, aesthetic, and reconstructive principles and graft selection.

Renal cell carcinoma presenting as recurrence in vastus intermedius after 22 years of long-term disease free survival: A rare metastatic presentation

Background and Objectives: Malignant spinal cord compression is an oncologic emergency, unless diagnosed early and treated appropriately, can lead to permanent neurological impairment and compromised quality of life of patients. We analyzed the epidemiology and the effect of common interventions on the outcome in these patients. Patients and Methods: We conducted a prospective study of 77 patients in the year 2014 and recorded relevant patient and disease characteristics. All patients received corticosteroids. Eight patients were operated upon, and radiotherapy was delivered in 62 patients. Results: Most of the patients were in the age group of 41–60 years and there was no gender preponderance in patients. Female breast cancer was the most common incident (15.5%) malignancy followed by multiple myeloma, lung, and prostatic carcinoma. Lower dorsal spine was the most common site of compression (35%) followed by lumbar (31%) and mid-dorsal (26%) spine. 70 (91%) patients had cord compression subsequent to bone metastasis while as other patients had leptomeningeal metastasis. In 31 (40%) patients, spinal cord compression was the presenting symptom. Overall, only 26 patients had motor improvement after treatment. Conclusion: Grade of power before treatment was predictive of response to treatment and overall outcome of motor or sensory functions. Neurodeficit of more than 10 days duration was associated with poor outcome in neurological function.

Determining the contralateral breast dose during radiotherapy of breast cancer using rainbow dosimeter

Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential, even when the curative nephrectomy is performed. RCC can metastasize via venous and lymphatic routes virtually to any site but commonly metastasizes to lungs, lymph nodes, bones, liver, and brain. Muscular metastases are rare from RCC. After 22 years of curative radical nephrectomy and disease-free follow-up, the patient presented with discomfort on walking and climbing upstairs and also complained of thigh swelling confirmed on clinical examination. Noncontrast computed tomography showed mass lesion in quadriceps muscle (vastus intermedius), fine needle aspiration cytology revealed metastatic deposits of RCC. Rest of the metastatic evaluation was normal. In long-term survivors of RCC, skeletal muscle survey (SMS) should be included in addition to metastatic evaluation for other sites, as the current case is an eye opener for the inclusion of SMS in the metastatic evaluation of such patients.

Pediatric Deep Neck Space Abscesses: A Prospective Observational Study

Abstract External beam radiotherapy is being used regularly to treat the breast malignancy postoperatively. The contribution of the collimator leakage and scatter radiation dose to contralateral breast is of concern because of high radio sensitivity of breast tissue for carcinogenesis. This becomes more important when the age of breast cancer breast patient is younger than 45 years and therefore the contralateral breast must be treated as organ at risk. Quantification of contralateral dose during primary breast irradiation is helpful to estimate the risk of radiation induced secondary breast malignancy. In present study contralateral breast dose was measured in forty cancer breast patients undergoing external beam therapy by cobalt-60 teletherapy machine. Post-operative radiotherapy was delivered by medial and lateral tangential fields daily, in addition to supraclavicular field with 200cGy per fraction to a total dose of 5000cGy in 25 fractions. The detectors of rainbow dosimeter were employed for these measurements. The dose at the contralateral breast measured by a rainbow dosimeter for tangential fields was between 5.34–6.40% whereas for supraclavicular field it is 1.2–1.75% of the dose. The contribution due to the medial tangential field is almost twice as that due to lateral tangential field so that maximum dose which contributes contralateral breast dose is due to medial tangential field. The goal of this investigation was to quantify the radiation dose to the contralateral breast after radiotherapy for primary breast cancer. Rainbow dosimetry is easy, accurate and convenient method to measure the contralateral breast dose.

Isolated multiple angiokeratoma of tongue—A case report and review of literature

Pediatric patients with deep neck space abscesses were prospectively followed from 2009 to 2011 in SKIMS MC and Peoples care polyclinic. Observational data were collected regarding age, location and size of abscess, source of infection, organism, antibiotic susceptibility, treatment plan, and rate of complications. A brief review of the literature is included to compare our patient population to what has previously been reported in the literature.