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Vitamin D Levels and Its Correlation with Severity of Breast Cancer Anagha V. Sahasrabuddhe; Sanika Deshmukh; Shailesh U. Pitale; Chandrasekhar Mahakalkar; Ajonish Kamble
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 2 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i2.15052

Introduction: Vitamin D has wide range of actions in the body which include immunogenic actions,differentiation of immune cells and keratinocytes, expression of growth factors etc. Genes encoding forproteins that regulate cellular differentiation, cell proliferation, apoptosis and angiogenesis contain vitaminD response element.Materials and Methods: A total of 135 newly diagnosed cases of breast cancer and equal number ofcontrols were recruited in the study. The histo-pathological grading of cancer, Hormone-receptor status(estrogen receptor-ER, progesterone receptor PR and HER-2 receptor) was done by immunohistochemistry,stage of tumor (based on TNM Classification), details of metastasis were noted. Vitamin D levels were doneby HPLC method.Results: The mean age, age at menarche, BMI, calcium intake, sun exposure, Ser PTH levels, Ser Calciumlevels were insignificantly different in both the groups. Ser Vitamin D levels were 30.95±17.65 ng/Ml incases and 27.21±7.97 ng/Ml in controls, with a p value of 0.198 which is not significant. The levels ofVitamin D in ng/Ml in Stage I, Stage II, Stage III and Stage IV were as follows: 26.06±11.45, 29.61±17.23,47.33±21.13, 42.67±28.92 and a p value of 0.190(NS). Thus there was no significant difference in VitaminD levels of cases and controls. The association between the biomarker status and stages showed significantresults as indicated by p-value of 0.043.Conclusion: This study fails to find any inverse association of vitamin D with severity of breast cancer andreceptor status.

Management Modalities and their Outcome in Patients of Acute Pancreatitis: A Cross Sectional Study Anil Akulwar; Ajonish Kamble; Chandrasekhar Mahakalkar; Dhruba Hari Chandi
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15422

Background: Acute pancreatitis is a potentially serious condition with wide variation in severity rangingfrom mild and self-limiting to a rapidly progressive illness leading to multi-organ failure.Aim and Objective: To study early enteral feeding and their outcome in patients of acute pancreatitis.Methodology: Present study was a prospective study carried out in 60 patients out of 50 were male (83.3%) and 10 female (16.6 %) admitted as acute pancreatitis in the department of surgery, Shalinitai Meghehospital and Research centre, Datta Meghe Medical College, Nagpur. A thorough history was taken anddetailed clinical examination was conducted of all the patients on admission. All the patients were subjectedto biochemical and Radiological investigations. Radiological investigations like X-Ray chest abdomen andUltrasonography were carried out initially in all the patients. CT Abdomen performed as per requirement.Severity of disease was accessed on admission on the basis of BISAP scoring system. Conservativemanagement was instituted with early enteral feeding for all patients. All patients who recovered weredischarged and followed up on outpatient basis. Data was analyzed with appropriate statistical tests.Results: All the patients were initially managed conservatively with early enteral feeding. Type of feedingwas according to the severity of the illness. Oral in mild / moderate pancreatitis and nasogastric feedingin severe pancreatitis. Mild and moderate variety tolerated enteral feeding well thus need for intravenousinfusion was obviated. Out of these, 1 patient (1.7 %) required interventional management due to acutenecrotizing pancreatitis. This patient later required intravenous infusion and TPN in view of progressiveclinical deterioration due to necrotizing pancreatitis. The management of complications was essentiallyconservative. Acute necrotizing pancreatitis has a mortality of 100 % even with aggressive management.The overall mortality rate in our study was 1.7% .Conclusion: Conservative management is the mainstay of treatment in acute pancreatitis. Early enteralfeeding obviates the need for intravenous infusion in mild and moderate pancreatitis and in selected casesof severe acute pancreatitis. Early enteral feeding has advantages over Parenteral nutrition and reducesmortality, infectious complications, preventing malnutrition, reduction in length of hospital stay. Earlydetection and aggressive management of in acute severe pancreatitis can prevent its progression to acutenecrotizing pancreatitis and its complications.

A Prospective Study of Use of Modified Triple Test (MTT) in Diagnosing Breast Mass Anil Akulwar; Avinash Rinait; chandrasekhar Mahakalkar; Dhruba Hari Chandi
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15423

Breast cancer is one of the most common cause of cancer related mortality and morbidity worldwide. A palpable breast mass in young women is a common cause of anxiety. It is indeed a frightful experience for the patient to directly undergo an invasive procedure like biopsy of breast mass. Hence the need for such diagnostic tool which is noninvasive or minimally invasive, quick, reliable, and also cost effective. Hence this study was undertaken to study the use of modified triple test (MTT) in the diagnosis of palpable breast mass. Methodology- The study was a prospective study done in the department of General Surgery in a tertiary care teaching hospital in Central India from January 2020 to December 2020. A total of 150 patients who presented with palpable breast mass were included. All the patients were investigated at first by sonomammography then FNAC. Either core biopsy or excisional biopsy of breast mass was done in all the cases. Findings were recorded and data analysis was done. Breast mass histopathology (HPE) report was considered to be gold standard and all the results were compared with HPE of the same breast mass. Observation and results: Out of total 150 patients studied, 148 were females and 2 were males. The sensitivity, specificity and accuracy of MTT is comparable with histopathology of the same breast mass. Conclusion: MTT is alone a reliable investigation for diagnosing palpable breast mass and biopsy of breast mass should be reserved only for doubtful cases.

A Comparative Analysis between Laparoscopic and Open Cholecystectomy at a Tertiary Care Hospital in Patients with Acute Cholecystitis A V Akulwar; Ajonish Kamble; Neha Bhatt; chandrasekhar Mahakalkar
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 3 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i3.15426

Background: Acute cholecystitis is clinically characterized as an episode of acute biliary pain; fever and right hypochondrial tenderness with symptoms persistence exceeding 24 hours. Aims & Objectives: We compared and analyzed open and laparoscopic cholecystectomy in the current study on the basis of the duration of the operation, intra and postoperative complications and the length of hospital stay & return to work.Material and Methods: This was a prospective comparative, randomized hospital-based study performed in patients of 20 - 80 years of age with acute cholecystitis in the Department of General Surgery from July 2019 to January 2021 at SMH&RC, Datta Meghe Medical College Nagpur. Patients were divided randomly into two classes as Open cholecystectomy (60 patients) and laparoscopic cholecystectomy (60 patients). The key assessed outcome was death, peri-operative & post-operative complications; length of hospital stay and wound infection, return to work. The gathered data was statistically analyzed. Results: In both categories, the most common age group was 40-59 years old. The female population (78%) was greater than the male population (22 percent). 1: 3.6 was the male to female ratio. The mean time needed for open cholecystectomy was 53.18 ± 12.74 minutes, while 38.37 ± 6.21 minutes for laparoscopic cholecystectomy, and the difference was statistically important. 2 (3.3 percent) laparoscopic procedures involved conversion to open surgery due to difficult dissection, bleeding & blurred vision. In terms of postoperative pain (VAS > 4), hospital stay period and return to work, laparoscopic cholecystectomy had better outcomes than open cholecystectomy and the difference was statistically important. In Open Cholecystectomy patients, wound infection, post-operative paralytic ileus was substantially greater. There were 2 patients with wound dehiscence from open cholecystectomy. No significant morbidity or any mortality during the study period was reported.Conclusion: Laparoscopic cholecystectomy provides decisive advantages over open cholecystectomy in acute cholecystitis (e.g. shorter time of surgery, fewer post-operative complications, less paralytic ileus, less analgesic use, early discharge and mobilization).

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