Batra Hospital and Medical Research Centre

Dear Editor, In recent years, India has seen a significant rise in the prescription of itraconazole for the management of dermatophytosis [1]. However, its pharmacokinetic variability has often led to inconsistent clinical outcomes. To address these challenges, a newer formulation-Super-Bioavailable Itraconazole (SB-ITZ) has been commercialized in India [2]. Although SB-ITZ has supportive pharmacokinetic and clinical data, large scale real world evidence remains limited. We therefore undertook a retrospective, record based evaluation of SB ITZ in Indian patients with dermatophytosis.

A 75-year-old man presented with extreme weakness and fatigability. On physical examination, there was no hepatomegaly or splenomegaly. He was found to be anemic with thrombocytosis. His blood count showed a white cell count of 3.46 × 109/L, hemoglobin concentration 94 g/L, mean corpuscular volume 91.6 fL, mean corpuscular hemoglobin 28.1 pg., and platelet count 881 × 109/L. Blood smear examination showed marked thrombocytosis and occasional hypochromic erythrocytes, but no other abnormalities. A bone marrow aspirate showed a mildly hypercellular marrow for the age of the patient with a myeloid: erythroid ratio of 3:1. Megakaryocytes were increased and of normal size with reduced lobulation (top left image ×40, top right ×100, May–Grünwald–Giemsa). Storage iron was increased (Grade 5/10) but, although siderotic granules were increased, a careful search disclosed no ring sideroblasts. Trephine biopsy sections showed hypercellularity with increased megakaryocytes, mostly with hypolobated or nonlobated nuclei (lower image, hematoxylin and eosin ×100) and Grade 2/4 reticulin fibrosis. His platelet count remained persistently elevated, between 850 and 1100 × 109/L. Ultrasonography and computed tomography showed the spleen to be of normal size. Next-generation sequencing (NGS) demonstrated a missense mutation in SF3B1, p.(Lys666Med) and frameshift insertions in ASXL1, p.(Gly646TrpfsTer12), and STAG2, p. (Glu750AsnfsTer2). Variant allele frequencies were 43%, 24%, and 30%, respectively. No mutation was detected in BCR, ABL1, JAK2, CALR, or MPL. The disease features demonstrated did not meet the World Health Organization (WHO) criteria for myelodysplastic/myeloproliferative neoplasm (MDS/MPN) with SF3B1 mutation and thrombocytosis as the presence of at least 15% ring sideroblasts is regarded as an essential diagnostic criterion [1]. Nor were the criteria for essential thrombocythemia met. Assignment is necessarily to the category MDS/MPN NOS (unclassifiable) [2]. In the International Consensus Classification (ICC), however, assignment to the category MDS/MPN with thrombocytosis and SF3B1 mutation can be made as the presence of ring sideroblasts is regarded as “common but no longer required” for diagnosis [3]. With the move towards increasingly molecular criteria for classification of hematologic neoplasms the ICC criteria might be favored. The authors declare no conflicts of interest. No further data are available.

ABSTRACT Breast cancer is a common malignancy in older women, and the incidence of breast cancer increases with age. Management of breast cancer in the elderly is challenging given the presence of comorbidities and declining functional status. Geriatric assessment (GA) is a multidimensional evaluation tool that assesses the functional, cognitive, social, and psychological aspects of older adults. The aim of this literature review is to explore the use of GAs in guiding breast cancer treatment decisions for older patients. The review focuses on the evidence supporting the use of GA in identifying older adults at risk of adverse outcomes from cancer treatment and guiding treatment decision-making. The review also discusses the challenges and limitations of these novel metrics and provides recommendations for future research. The aim of this review is to iterate the importance of GA tools in guiding the practices of geriatric breast cancer in India.

Abstract Leprosy is a chronic granulomatous disease which can affect the musculoskeletal system in one-third of the patients. Leprosy may manifest with symptoms that usually mimic classic autoimmune disease. A 71-year-old male presented to us with inflammatory arthritis with rheumatoid factor positivity and was being treated as rheumatoid arthritis. Skin and neuropathic symptoms with anticyclic citrullinated antibody negativity helped us keep leprosy as a differential. Therefore, a skin biopsy was performed which confirmed lepromatous leprosy. Initial presentation with musculoskeletal symptoms in leprosy can delay its diagnosis and treatment leading to increased morbidity.

The aim of this study was to assess the effect of ticagrelor monotherapy among high-risk patients with anaemia undergoing percutaneous coronary intervention (PCI). In the TWILIGHT (Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomized to aspirin or placebo for 1 year. Anaemia was defined as haemoglobin <13g/dL for men and <12g/dL for women. The primary endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. The key secondary endpoint was a composite of all-cause death, myocardial infarction, or stroke.Out of 6828 patients, 1329 (19.5%) had anaemia and were more likely to have comorbidities, multivessel disease, and to experience bleeding or ischaemic complications than non-anaemic patients. Among anaemic patients, BARC 2, 3, or 5 bleeding occurred less frequently with ticagrelor monotherapy than with ticagrelor plus aspirin [6.4%vs. 10.7%; hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.41-0.88; P=0.009]; the rate of the key secondary endpoint was similar in the two arms (5.2%vs. 4.8%; HR 1.07; 95% CI 0.66-1.74; P=0.779). These effects were consistent in patients without anaemia (interaction P values 0.671 and 0.835, respectively). In high-risk patients undergoing PCI, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a reduced risk of clinically relevant bleeding without any increase in ischaemic events irrespective of anaemia status (TWILIGHT: NCT02270242).

Introduction: Blur vision for near objects that are gradually visible is an age-related, irreversible reduction in amplitude of accommodation leading to the condition of presbyopia.Presbyopia gets noticed at the age of 40-45 years.The mode of treatment is a convex lens of desired power as per working distance and accommodation left is prescribed to the symptomatic patients.Aim & Objective: To lessen the trouble shootings of non-adaptation to the near addition in presbyopia patients/customers caused due to lack of occupation and working distance questioning.Case Report: A 62-year-old Female patient visited Optical for a new prescription of distance as well as near power.The customer was a progressive lens wearer with a correction of RE: +0.50/-0.50*900and LE: +0.75/-0.50*900for distance and near addition of +2.25D with PGP VA of 6/6, N8 in both eyes.The customer was advised to continue the same distance correction and was prescribed +2.75D near addition in both eyes (N6) at a standard reading distance (40 cm). Conclusion:This study focuses on the equal importance of proper questioning of working distance as well as the occupation to the customers/patients while prescribing near addition and not solely on age and amplitude of accommodation.