Puneet Pareek

Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta‐analysis

Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same.

Recent scenario of microRNA as diagnostic and prognostic biomarkers of prostate cancer.

Prostate cancer (CaP) is a leading cause of cancer death and displays a broad range of clinical behavior from relatively indolent to aggressive metastatic disease. Due to the alteration and incomplete characterization of the CaP genomic markers, the quest for novel cellular metabolic regulatory molecules like micro RNA (miRNA) as a biomarker could be considered for the prognosis and treatment of CaP in future. In this article, we review the existing literature pertaining to CaP. Study provides a comprehensive miRNA profile expressed in CaP. Beside the miRNA expressed in the tumor tissue, circulating miRNAs have been found highly stable and are both detectable and quantifiable in a range of accessible bio fluids; therefore, miRNA has the potential to be useful diagnostic, prognostic and predictive biomarker. Along with being an important molecule in modulation of CaP progression, the miRNA have certain limitations such as lack of stable expression of multiple target genes and often disrupt entire signaling networks of cellular metabolic pathways. We conclude that: The alteration of miRNA and their role played in cellular regulatory networks would be the next target of basic research in CaP. The miRNAs identified may be validated and modeled to understand their role in CaP, using bioinformatics. There is an immediate unmet need in the translational approach of identified miRNAs. The characterization of miRNAs involved in CaP is still incomplete: adequate validation studies are required to corroborate current results.

Diseases and Molecular Diagnostics: A Step Closer to Precision Medicine

The current advent of molecular technologies together with a multidisciplinary interplay of several fields led to the development of genomics, which concentrates on the detection of pathogenic events at the genome level. The structural and functional genomics approaches have now pinpointed the technical challenge in the exploration of disease-related genes and the recognition of their structural alterations or elucidation of gene function. Various promising technologies and diagnostic applications of structural genomics are currently preparing a large database of disease-genes, genetic alterations etc., by mutation scanning and DNA chip technology. Further the functional genomics also exploring the expression genetics (hybridization-, PCR- and sequence-based technologies), two-hybrid technology, next generation sequencing with Bioinformatics and computational biology. Advances in microarray “chip” technology as microarrays have allowed the parallel analysis of gene expression patterns of thousands of genes simultaneously. Sequence information collected from the genomes of many individuals is leading to the rapid discovery of single nucleotide polymorphisms or SNPs. Further advances of genetic engineering have also revolutionized immunoassay biotechnology via engineering of antibody-encoding genes and the phage display technology. The Biotechnology plays an important role in the development of diagnostic assays in response to an outbreak or critical disease response need. However, there is also need to pinpoint various obstacles and issues related to the commercialization and widespread dispersal of genetic knowledge derived from the exploitation of the biotechnology industry and the development and marketing of diagnostic services. Implementation of genetic criteria for patient selection and individual assessment of the risks and benefits of treatment emerges as a major challenge to the pharmaceutical industry. Thus this field is revolutionizing current era and further it may open new vistas in the field of disease management.

In Regard to Lee et al

To the Editor: Lee et al (1) has shed light on yet another treatment de-escalation strategy for human papillomavirusepositive (HPVþ) oropharyngeal cancers, by careful and cautious reduction of 10 Gy of dose to only the neck node(s) of patients in whom an F-fluoromisonidazole positron emission tomography scan repeated after the initial 5 fractions of chemoradiation therapy showed reduction of predefined uptake, thereby showing resolution of tumor hypoxia. Thus, the involved neck nodes of patients with no reduction of uptake were treated to 70 Gy of radical dose along with the primary. The substudy published has 33 HPVþ tumors, of which 10 patients met criteria for reduction of uptake to classify as reduction of hypoxia and were de-escalated. It is unclear why the authors chose a period of just 1 week in which hardly 10 Gy of dose could be delivered before reassessing for hypoxia by measuring positron emission tomography uptake. In a study by Okamoto et al (2), the hypoxia measure decreased but was still there in almost 42% of patients at the end of 30 Gy in 15 fractions. Would it not be useful to reassess these patients after 40 to 45 Gy and then make the decision? This may further increase the number of potential patients we can de-escalate. This may further improve the results. I am guessing that a cone-beam computed tomography (CBCT) scan must have been done as a part of the intensity modulated radiation therapy treatment program, either daily or weekly. I was wondering, did a subset of patients show remarkable regression at a time point, say, by the end of 4 or 5 weeks clinically or in their CBCTs? Does the group of 10 patients who were de-escalated overlap with this subset of patients? Patients with N3 or N2c disease do not seem to have any reduction in the measure of hypoxia and could not undergo dose reduction. In a study by Shwatrz et al (3) evaluating adaptive radiation therapy using CBCT guidance, although doses were not altered, the volumetric changes in larger pretreatment volumes were larger. However, in HPVþ patients, it has been seen that nodal regression takes longer (4); it will be interesting to note what the findings were from this study. Puneet Pareek, MBBS, MD, DNB, MAMS Department of Radiation Oncology All India Institute of Medical Sciences Jodhpur, India

Strontium Beta-Irradiation: Can it Prove Strong Enough in Curbing theOphthalmic Hydra Called Pterygium

No other ophthalmic disorder, or may be any medical disorder, has elicited so much interest as pterygium. Even though eons have passed since it was first discovered, its propensity for regrowth like tentacles of hydra, continue to perplex the ophthalmic community. Its propensity for recurrences has attracted all and the sundry and newer modalities are being propounded to prevent recurrences. This article reviews the role of radiation therapy for recurrence prevention in pterygium management.

39P A tertiary care hospital based retrospective study evaluating epidemiology of lung cancers in a western state of India

recently implicated as a causative agent in lung cancer especially in women. We conducted a case control study to find out the role of Domestic Cooking Fuel as a risk factor for Lung Cancer in Indian women. Methods: In the case control study 67 women with proven lung cancer were recruited. Forty-six females having a non-malignant respiratory disease constituted the control group. The patients and controls were asked about the exposure in various cooking fuels using a questionnaire. Results: There were 50(74.6%) non-smokers and 17(25.4%) smokers among the female cancer cases (p = 0.016). Adenocarcinoma was the commonest histological type of malignancy (n = 26, 38.8%) in the whole group and was the predominant form in the non-smoking females. Tobacco smoking was the most important risk factor for lung cancer with OR of 4.87 (95% CI 1.34–17.76). Among non-smokers out of all the cooking fuels the risk of development of lung cancer was highest for biomass fuel exposure with an odds ratio of 5.33 (95% CI 1.7–16.7). Use of mixed fuels was associated with a lesser risk (OR=3.04, 95% CI 1.1–8.38). Conclusions: This study indicated that domestic cooking fuel exposure is an important risk factor in the causation of lung cancer among women in addition of exposure to tobacco smoke. Legal entity responsible for the study: PSM Dental College and Hospital Funding: PSM Dental College and Hospital Disclosure: All authors have declared no conflicts of interest.

Carcinoma Gallbladder- an Indian Problem.

Gallbladder cancer is an uncommon cancer worldwide, but one of the commonest cancer in North India. Apart from India, it is common in South America and Japan. The disease is characterized by late onset of symptoms, advanced stage at presentations and a rapidly progressive disease with a median survival of 6 months in advanced disease [1]. Epidemiological studies have been few and it is difficult to draw much meaningful conclusions from these studies. The etiological factors contributing to the development of this disease still remains to be elucidated. Numerous risk factorsfemale sex, high BMI, multiparity, lifestyle risk factors like smoking have been found to be associated with GBC. However, the strength of these associations remaining variable in different studies and all are not modifiable. The pathogenesis of GBC remains to be understood. The presence of gallstones in majority of patients with GBC raises questions whether the calculi are merely associated or do they have a role in the pathogenesis of GBC. Both, the adenomacarcinoma pathway, as well as the inflammation driven dysplasia-carcinoma pathway, has been proposed. However, there is lack of clarity as to which pathway is involved in the pathogenesis of GBC [2]. Numerous studies have been done to study the molecular alterations which lead to increased susceptibility to GBC. Molecular studies have failed to find clinically relevant biomarkers which would help in the early detection and treatment of GBC [3]. Lack of a recognizable premalignant state precludes screening. Studies for early diagnosis in high risk populations are necessary. The role of prophylactic cholecystectomy in high risk individuals is debatable. Prospective cohorts need to be identified in these high risk populations to determine the natural history of disease and development of cancer. There is, at times, a failure to detect early gallbladder cancer. Number of patients have GBC incidentally detected at the time of cholecystectomy for gallstone disease, or at the time of histopathological examination of the gallbladder specimen [4]. Similarly, despite looking operable on conventional imaging, many patients of GBC have metastatic disease on laparotomy/diagnostic laparoscopy. Improved imaging techniques and use of functional imaging may help in both these circumstances. The extent of surgery varies by centre and surgeon. Data suggests that a large number of patients are still treated with cholecystectomy alone and not by the full procedure. The extent of lymphadenectomy is still debatable as so is the role of extended lymphadenectomy. Only well designed trails can help define the optimal extent of lymphadenectomy. Over the past few decades, the role of neoadjuvant treatment for most gastrointestinal cancers has evolved. Most of these cancers are now treated with preoperative chemotherapy/chemoradiation in order to make surgery less extensive along with increased overall survival. However, there has not been much positive clinical data generated for this strategy for GBC and at present, neoadjuvant treatment protocols are restricted to clinical trials only. Similarly, most of data for adjuvant treatment comes from studies which pool * Sanjeev Misra misralko@gmail.com

Bilateral spontaneous pneumothorax in osteogenic sarcoma due to occult pulmonary metastases

Spontaneous pneumothorax (SPTX) is an uncommon complication of osteogenic sarcoma. Most of these SPTX associated with osteogenic sarcoma are due to detectable pulmonary metastasis. Development of SPTX without any evidence of pulmonary metastasis is extremely rare. Herein, we report a case of a young girl with osteosarcoma of the right femur that developed pneumothorax on both sides following treatment with combination chemotherapy without any obvious pulmonary metastases, bullae, or blebs.

Using social networks in oncology: Is it justifiable??

Clinical Cancer Investigation Journal | July-August-2015 | Vol 4 | Issue 4 593 Sir, In 21st century, Internet and social networking tools such as Facebook, Twitter, and WhatsApp have become the major communication mediums for people, especially the younger generation. This drastic transformation in communication methods can be applied on changing the doctor‐patient relationship,[1] making it difficult to keep their personal and professional lives separate.

Palbociclib: Will the race against endocrine resistance end?

775 Sir, Nearly, 80% of the breast cancers express estrogen receptors (ERs), progesterone receptors, or both. Endocrine therapies remain the backbone of the systemic treatment for hormone receptor positive cancers by substantially reducing the risk of relapse.[1] Many women still relapse during or after completing adjuvant therapy. Further systemic therapy remains considerably challenging for these patients. Fulvestrant, a selective ER modulator has modest activity in these patients[2,3] and the development of effective therapies that can reverse resistance to endocrine therapy, is of clinical importance.