Bharath Hospital & Institute of Oncology

Background: Thyroid dysfunctions are most prevalent in women during their most fertile years (15 - 35) and thyroid dysfunction during pregnancy is associated with higher risk of pregnancy and neonatal complications. Routine screening of thyroid dysfunction during pregnancy can help to identify and treat the disorder early and prevent its complication. Methods: A hospital based observational study on 400 pregnant women was conducted in tertiary level hospital in Nepal. Participants with abnormal thyroid functions were regularly followed up till the pregnancy outcome. Results: Among 400 cases, 45.3% of the respondents were of age group 21-25 years with mean age 23.84 ±3.5 years. This study had 14.7 % (n 59) women with abnormal thyroid functions. Of these 12.7 % were hypothyroid and 2 % were hyperthyroid. Among 51 cases of hypothyroid 10.5 % were subclinical hypothyroid and 2.2 % were overt hypothyroid. Majority of the pregnant women with thyroid dysfunction had one or more adverse events during pregnancy course. Conclusion: Thyroid dysfunction is common during pregnancy. High prevalence of thyroid dysfunction necessitates the standardized screening protocol to pregnant women based on risk categories and early initiation of treatment if significant abnormality is identified and regular follow up for every pregnant woman with abnormal thyroid function.

Triple-negative breast cancer (TNBC) poses a significant challenge in clinical oncology due to its aggressive nature and limited targeted therapeutic options. Neoadjuvant chemotherapy (NACT) has emerged as a promising strategy in the management of early-stage TNBC. This literature review aims to provide an in-depth analysis of the role of NACT in TNBC, focusing on its impact on early-stage disease and associated outcomes. The review synthesizes evidence from recent studies, clinical trials, and meta-analyses to present a comprehensive overview of the current landscape of NACT in early-stage TNBC.

Introduction:Bull injuries are common in India. An injury by a bull is more common in rural and agriculture dependent regions of the country. The incident causing injury by a bull can be sports related or work related. Work related injuries are almost mostly seen in farmers.Case presentation:We would like to present six cases of bull injury over a period of three years who reported to our EM. All six patients were admitted. Five out of six patients survived the hospital stay.Conclusion:Trauma sustained due to being hit by a large animal should be treated akin to a high velocity trauma and such a patient definitely warrants a period of observation even if the injuries are not life threatening. A high index of suspicion is needed for suspecting occult injuries. Fluid resuscitation and age of the patient are important considerations.

A 62-year-old male came to emergency department (ED) with a complaint of “separation of foot” during sleep at night. He noticed he lost his foot while getting up from bed to go to toilet at midnight. Upon arrival in ED, his blood pressure was 218/96 mmHg and random blood sugar 556mg/dl. The patient had large ketone bodies in urine. He was a known case of diabetes and hypertension for many years. He was on homeopathic medications for his diabetes, hypertension and diabetic foot. He refused any form of invasive treatment and hospitalization. The patient was adamant on not getting admitted and wanted to continue his homeopathic medications as before. He only wanted his leg stump covered with a dressing after which he was discharged.

The present study was undertaken to formulate and evaluate the anti-inflammatory, anti-oxidant and anti-angiogenic activities of nanoemulsion of Memecylaene. Memecylaene was isolated from the leaves of Memecylon malabaricum by using various chromatographic methods. An oil-in-water (O/W) nanoemulsion of Memecylaene was formulated by sonication method using sunflower oil (oil phase), Tween 80 (Surfactant) and Ethanol (co-surfactant). The prepared nanoemulsion was characterized for its droplet size, poly dispersity index and zeta potential. Stability studies were performed and the nanoemulsions were subjected to different biological activities. The formulated nanoemulsion had a particle size range of 52.02 nm to 59.47 nm and zeta potential of -1.27 mV. The enhanced activity of Memecylaene, encapsulated in O/W emulsions is evidenced by the inhibition of phospholipase (PLA2) enzyme and H+, K+ -ATPase and thus showing anti-inflammatory and anti-secretagogues effects. The in vitro anti-oxidant activity was evaluated by DPPH radical and Nitric oxide radical scavenging activity. Further, the inhibition of the growth of neo vessels formation in the in-vivo model system of chick chorioallantoic membrane (CAM) assay, which is angiogenesis dependent, was also observed. The above findings would help in understanding the putative potential of Memecylaene-loaded nanoemulsion as a therapeutic agent. Keywords: Anti-angiogenesis, Anti-oxidant, Gastric (H+ K+), Memecylaene, Nanoemulsion, Phospholipase A2 (PLA2).

Context: Thyrotoxicosis is a common clinical problem, and the most common cause of thyrotoxicosis is Graves' disease and is 4 times more common than the other causes combined. Of late, the number of people incidentally detected to have biochemical thyrotoxicosis is increasing, and most patients are detected during health checkups, pregnancy planning, and surgical fitness. There are no data on the etiology and natural course of such cases and no guidelines for evaluation of such patients. Aims: The aim of this study is to evaluate the cause of thyrotoxicosis in patients incidentally detected to have biochemical thyrotoxicosis and to study the natural course of illness of these patients. Subjects and Methods: All patients who were incidentally detected to have biochemical thyrotoxicosis (during health checkups, pregnancy planning, and surgical fitness) were included and studied. Patients who had symptoms of thyrotoxicosis, or patients in whom thyrotoxicosis was suspected by the treating doctor were excluded from the study. All patients underwent an ultrasound thyroid and thyroid scan, and treatment was decided based on the results. All patients were followed up for a minimum period of 3 months. Results: A total of 57 patients were studied. The average age of the study population was 32.8 years, with male:female ratio of 1:3.3. Of 57 patients, 52 (91%) had subacute thyroiditis as the cause of thyrotoxicosis while Graves' disease was seen in 9%. None had toxic adenoma or toxic multinodular goiter. In the patients with subacute thyroiditis, 47 became euthyroid and 5 became subclinically hypothyroid (Stage b). Conclusions: The majority of patients with incidentally detected thyrotoxicosis had thyroiditis as the cause, which reverted to euthyroid state in most of the cases. Based on the study, it seems prudent to wait and follow up this group of patients rather than start antithyroid drugs, especially if facilities for uptake scan are not available or affordable.

Effects of an integrated yoga program in modulating perceived stress levels, anxiety, as well as depression levels and radiation-induced DNA damage were studied in 68 breast cancer patients undergoing radiotherapy. Two psychological questionnaires--Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS)--and DNA damage assay were used in the study. There was a significant decrease in the HADS scores in the yoga intervention group, whereas the control group displayed an increase in these scores. Mean PSS was decreased in the yoga group, whereas the control group did not show any change pre- and postradiotherapy. Radiation-induced DNA damage was significantly elevated in both the yoga and control groups after radiotherapy, but the postradiotherapy DNA damage in the yoga group was slightly less when compared to the control group. An integrated approach of yoga intervention modulates the stress and DNA damage levels in breast cancer patients during radiotherapy.