Risk of hepatitis B virus reactivation in cancer patients undergoing treatment with tyrosine kinase-inhibitors

This editorial commented on an article in the World Journal of Gastroenterology titled“Risks of Reactivation of Hepatitis B Virus in Oncological Patients Using Tyrosine Kinase-Inhibitors:Case Report and Literature Analysis”by Colapietro et al.In this editorial,we focused on providing a more comprehensive exploration of hepatitis B virus reactivation(HBVr)associated with the usage of tyrosine kinase inhibitors(TKIs).It includes insights into the mechanisms underlying HBV reactivation,the temporal relationship between TKIs and HBV reactivation,and preventive measures.The aim is to understand the need for nucleos(t)ide analogs(NAT)and serial blood tests for early recognition of reactivation and acute liver injury,along with management strategies.TKIs are considered to be an intermediate(1%-10%)of HBVr.Current guidelines stipulate that patients receiving therapy with high or moderate risks of reactivation or recent cancer diagnosis must have at least tested hepatitis B surface antigen,anti-hepatitis B core antigen(HBc),and anti-hepatitis B surface antibody.Anti-HBc screening in highly endemic areas means people with negative tests should be vaccinated against HBV.Nucleoside or nucleotide analogs(NAs)like entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide(TAF)form the basis of HBV reactivation prophylaxis and treatment during immunosuppression.Conversely,lamivudine,telbivudine,and adefovir are generally discouraged due to their reduced antiviral efficacy and higher risk of fostering drug-resistant viral strains.However,these less effective NAs may still be utilized in cases where ETV,TDF,and TAF are not feasible treatment options.

A study on p53 gene alterations in esophageal squamous cell carcinoma and their correlation to common dietary risk factors among population of the Kashmir valley

AIM： To systematically examine the extent of correlation of risk factors, such as age, consumed dietary habit and familial predisposition with somatic Tp53 molecular lesion causal to elevate carcinogenesis severity of esophageal squamous cell carcinoma （ESCC） among the Kashmiri population of Northern India. METHODS： All cases （n = 51） and controls （n = 150） were permanent residents of the Kashmir valley. Genetic alterations were determined in exons 5-8 of Tp53 tumor suppressor gene among 45 ESCC cases histologically confirmed by PCR-SSCP analysis. Data for individual cancer cases （n = 45） and inpatient controls （n = 150） with non-cancer disease included information on family history of cancer, thirty prevailing common dietary risk factors along with patient＇s age group. Correlation of genetic lesion in p53 exons to animistic data from these parameters was generated by Chi-square test to all 45 histologically confirmed ESCC cases along with healthy controls.RESULTS： Thirty-five of 45 （77.8%） histologically characterized tumor samples had analogous somatic mutation as opposed to 1 of 45 normal sample obtained from adjacent region from the same patient showed gerrnline mutation. The SSCP analysis demonstrated that most common p53 gene alterations were found in exon 6 （77.7%）, that did not correlate with the age of the individual and clinicopathological parameters but showed significant concordance （P 〈 0.05） with familial history of cancer （CD = 58）, suggesting germline predisposition at an unknown locus, and dietary habit of consuming locally grown Brassica vegetable ＂Hakh＂ （CD = 19.5）, red chillies （CD = 20.2）, hot salty soda tea （CD = 2.37） and local baked bread （CD = 1.1）. CONCLUSION： Our study suggests that somatic chromosomal mutations, especially in exon 6 of Tp53 gene, among esophageal cancer patients of an ethnically homogenous population of Kashmir valley are closely related to continued exposure to various common dietary risk factors, especially hot salty tea, meat, baked bread and ＂Hakh＂, that are rich in nitrosoamines and familial cancer history.

A Point-Specific Site for Placement of Epigastric Port in Iaparoscopic Management of Gallbladder Disease: An Observational Study

Backgound: Laparoscopic cholecystectomy has revolutionized the world in the surgical management of benign gallbladder disease. However, for any procedure to learn properly, anatomy becomes a major concern. Aims and Objectives: We present a point, a convenient site, speedily accessible by our maneuver of placing epigastric port on the patient. Materials and Methods: This is an outcome of an observation with the prospective study of 100 patients irrespective of age, sex, body habitus and severity of gallstone disease. Our point for epigastric port satisfies all the criteria for an ideal port. Results: Our general observation with majority of patients with this point specific epigastric port placement was that it is easy to locate, needs less thrust on trocar for creation, stays on the linea alba, is easily maneuverable facilitates safe, easy and speedy dissection, causes less portal bleeds and is easy to angulate towards the right of falciform ligament. Conclusion: The point specific epigastric port conveys many benefits to the operating surgeon in terms of easy location, adds safety and speed to the procedure, causes less portal bleeds, needs less thrust and is easy to angulate to the right of the falciform ligament adding technical ease to the surgeon. It is easy to be learnt, taught and practiced by the young surgeons.

Isolated Blunt Traumatic Diaphragmatic Rupture in a Case of Situs Inversus

Situs inversus, a very rare congenital anomaly of reversal site of thoracic and abdominal organs, can be very problematic to surgeon while dealing with a case of trauma in emergency. Surgical procedures are considered difficult, complex and more challenging in patients with this condition due to the anatomical difference and position of organs. We came across an interesting and very rare case of isolated blunt traumatic diaphragmatic injury in a case of situs inversus. Traumatic injuries of the diaphragm are uncommon and isolated blunt traumatic injuries of diaphragm are very rare. Our case is very unique of its kind of situs inversus with isolated right sided diaphragmatic rupture in a 60-year-old male patient presenting 4 hours after blunt trauma to chest and abdomen.

A Prospective Study of Cholilithiasis in Children

Background: Gallstones are generally uncommon in infants and children. Formation of gallstone is a very poorly understood phenomenon. In general, the risk factors for cholithiasis in infants include patients who are ill, are receiving hyperalimentation, are premature, have congenital anomalies and have necrotizing enterocolitis. Children aged 1 - 5 years most frequently have hemolysis as the underlying condition [1]. Materials and Methods: From Jan 2012 to Feb 2014, a study entitled “A Prospective Study of Cholelithiasis in Children” was conducted in Postgraduate Department of General Surgery Govt. Medical College Srinagar. The patients selected for the study were in the age group of 1 to 14 years of either sex. There were a total of 141 cases, out of which only 38 had ultrasound documented gallstones. All the patients included in the study were evaluated for prevalence, clinical presentation, and pathological features of gallstones, and were analysed for metabolic causes of gallstones. Results: The prevalence of chliothiasis in symptomatic patients was found to be 26.95% higher than the prevalence of gallstones in children in other parts of world, also the mean age of presentation was 9.3 years ranging from 6 - 14 years. Male to female ratio was 3:2 and male predominance was found in all age groups contrary to female predominance in adults. Most common presenting symptom was right upper quadrant pain followed by vomiting and nausea similar to presentation of symptomatic gallstones in adults. 4 patients had a positive family history of cholithiasis in the first degree relatives;25 (65.7%) patients had no underlying risk factor for gallstones contrary to presumption that gallstones in children are mostly secondary to some hematological disorder or other predisposing factors. Chronic cholecystities was found in 81% of patients with gallstones and composition of gallstones retrieved was different from those of adult gallstones with calcium carbonate gallstones relatively common in children but composition of black and brown stones was almost similar to adult stones. Conclusion: Gallstone disease was increasingly gaining recognition in peadiatic practice due to significant documented increase in non-heamolytic cases over the last two decades. The observed gallstones prevalence, clinical presentation, pathological features of gallstones, and analysed metabolic causes of gallstones in children are different from those stones found in adults. The results of our study demonstrated that gallstones and gallstone related complications in peadiatic populations were different from the adult gallstone disease and there was an increase in prevalence of gallstones in children with no under lying risk factor for gallstones, and surgery remained the corne stone of treatment for peadiatric cholithiasis as in adults.

Free tubercular perforation of the ileum

BACKGROUND： Peritonitis secondary to small bowel perforation is a common surgica emergency seen across the globe. METHODS： A young male patient presented with ileal perforation that was repaired primarily He recovered uneventfully after the operation. RESULTS： Histopathology of the margins of the perforation revealed tuberculosis. A search for evidence of a primary focus of tuberculosis was unsuccessful. The patient was started on anti- tubercular therapy and he was followed up with good results. CONCLUSION： This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

Abdominal cocoon in a young man

BACKGROUND:Intestinal obstruction remains a common problem encountered in the surgical emergency,and usually occurs secondary to adhesions,obstructed herniae or tubercular strictures. However,at times,rare causes of obstruction can also be encountered.METHODS:A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy.RESULTS:The patient underwent adhesiolysis of the cocoon,and remains well on a follow-up. Histopathological report of the cocoon wall revealed f ibrocollagenic tissues with a mixed inf lammatory inf iltrate,without any evidence of tuberculosis.CONCLUSIONS:Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

Recurrent Intestinal Obstruction Caused by Abdominal Cocoon

Abdominal cocoon is a rare disease of the peritoneum and the rare cause of intestinal obstruction. The etiology of this disease is largely unknown. It primarily affects young adolescent females. We report a case of abdominal cocoon in a 16-year-old girl patient who presented with recurrent episodes of subacute intestinal obstruction.

Traumatic lumbar hernia

BACKGROUND:Trauma has various presentations ranging from common injuries that are easily managed to uncommon presentations such as traumatic hernia that may be missed.METHODS:Despite being operated for fracture of the femur after a road traffic accident,a50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months after the accident.In this period,the patient underwent incision and drainage thrice for swelling in the right flank which was diagnosed as an infected hematoma by a doctor.RESULTS:The patient underwent surgery for repair of traumatic lumbar hernia by combined fascia lata graft and mesh hernioplasty.She remains well on follow-up.CONCLUSION:This case underscores the need for awareness of this entity for correct diagnosis and appropriate management that are the key to avoiding complications.

Is Cancer Still the Villain, Even during COVID 19 Outbreak?

Background :Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients needs to be addressed for planning strategies. Methods: This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS), a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A & D were calculated separately & categorized as normal, borderline and abnormal with a score of 0 - 7, 8 - 10 & 11 - 21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient & treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. Findings: 208 patients were included in this study. The overall prevalence rate of anxiety was 7.2%, with borderline cases 4.3% and abnormal cases 2.9%. The overall prevalence of the rate of depression was 5.3% (3.4% borderline & 1.9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance. Interpretation: The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.