Biomedical subjects

Beela S Mathew

Publications and source records attributed to Beela S Mathew.

4 recordsLinked to original sources

PubMed2006

Initial response to glucocorticoids.

BACKGROUND: Known prognostic variables in patients with primary central nervous system lymphomas (PCNSL) include age, Karnofsky performance status, involvement of deep regions of the brain, intensity of blood-brain barrier disruption, and treatment with radiation and chemotherapy. PCNSL often responds transiently to glucocorticoids administered to control neurologic symptoms before radiation or chemotherapy. This retrospective chart review was designed to estimate the prognostic significance of a clinical or radiologic response to initial glucocorticoid therapy. METHODS: By using data from The Johns Hopkins Cancer Registry from January 1980 to June 2001, a total of 76 human immunodeficiency virus (HIV)-negative adults with newly diagnosed PCNSL were identified. Nineteen patients with uninformative medical records were excluded from the study. RESULTS: The median survival of the remaining 57 patients was 11.8 months. The median survival for the 48 patients who had clinical response to initial steroid therapy was 17.9 months, and for nonresponders, it was 5.5 months (P = 0.05). The 16 patients with documented radiologic response had a median survival of 117.0 months compared with 5.5 months for nonresponders (P = 0.001). After adjusting for known prognostic factors (age and treatment), significant reduction in risk of death was noted in patients who had either clinical (hazard ratio [HR] = 0.40; 95% confidence interval [CI], 0.16-0.99}) or radiologic response (HR = 0.14; 95% CI, 0.04-0.46) to glucocorticoids given before radiation or chemotherapy. CONCLUSION: This analysis suggests that initial response to treatment with glucocorticoids may be an important prognostic factor in patients with PCNSL.

Adult↗

PubMed2005

Quality of life determinants in women with breast cancer undergoing treatment with curative intent.

BACKGROUND: The diagnosis of breast cancer and its subsequent treatment has significant impact on the woman's physical functioning, mental health and her well-being, and thereby causes substantial disruption to quality of life (QOL). Factors like patient education, spousal support and employment status, financial stability etc., have been found to influence QOL in the breast cancer patient. The present study attempts to identify the determinants of QOL in a cohort of Indian breast cancer patients. PATIENTS AND METHODS: Functional Assessment of Cancer Therapy-Breast (FACT-B) Version 4 Malayalam was used to assess quality of life in 502 breast cancer patients undergoing treatment with curative intent. The data on social, demographic, disease, treatment, and follow-up were collected from case records. Data was analysed using Analysis of Variance (ANOVA) and multinomial logistic regression. RESULTS: The mean age of the patients was 47.7 years with 44.6% of the women being pre-menopausal. The FACT-B mean score was 90.6 (Standard Deviation [SD] = 18.4). The mean scores of the subscales were - Physical well-being 19.6 (SD = 4.7), Social well-being 19.9 (SD = 5.3), Emotional well-being 14 (SD = 4.9), Functional well-being 13.0 (SD = 5.7), and the Breast subscale 23.8 (SD = 4.4). Younger women (< 45 years), women having unmarried children, nodal and/or metastatic disease, and those currently undergoing active treatment showed significantly poorer QOL scores in the univariate analysis. However multivariate analysis indicated that the religion, stage, pain, spouse education, nodal status, and distance travelled to reach the treatment centre as indicative of patient QOL. CONCLUSION: QOL derangements are common in breast cancer patients necessitating the provisions for patient access to psychosocial services. However, because of the huge patient load, a screening process to identify those meriting intervention over the general population would be a viable solution.

Journal Article↗

PubMed2003

Clinicopathological significance of tissue homeostasis in Indian breast cancer.

BACKGROUND: Tissue homeostasis and the maintenance of cell populations depend on a delicate balance between the rates of cell proliferation and cell death. Disruption of this balance is an important factor in development and progression of tumors. In the present study we evaluated the growth index in a large group of breast cancer patients and correlated it with various clinical and histopathological features of the tumor. METHODS: Estimation of apoptosis was determined by TUNEL assay while immunocytochemistry for proliferating nuclear cell antigen (PCNA) was used as a measure of proliferation. Necrosis was identified morphologically by haematoxylin and eosin staining. RESULTS: A positive correlation was observed between the percentage of PCNA positive cells and the frequency of mitosis (r=0.6117, p<0.0001). A highly statistical significant correlation was observed between type of tissue analyzed and growth index (r=0.46869, p<0.0001). No significant association was observed between hormone receptor status and growth index. CONCLUSIONS: The growth index was found to be higher in carcinoma cells that metastasised into lymph nodes compared with primary lesions with no nodal metastasis. Growth index was particularly prominent in high-grade tumors in which increased proliferative activity was evident. Apoptotic cells were detected more frequently in tumor cells with higher rather than lower proliferative activity. This suggests that not only proliferative activity but also capacity for apoptosis is altered in breast tumors.

Apoptosis↗

PubMed2003

Pneumocystis carinii pneumonia prophylaxis in HIV negative patients with primary CNS lymphoma.

Primary central nervous system lymphoma (PCNSL) is an uncommon malignant brain tumor, which is increasing in incidence in immunocompetent individuals. In the recent past, the survival at 5 years was less than 5% when this cancer was treated with radiation therapy and standard chemotherapy. Current high dose methotrexate-based regimens have resulted in median survival of 3-4 years and the 5-year survival approaches 40%. However, these potentially curable patients appear to be at significant risk for developing Pneumocystis carinii pneumonia (PCP), which has a mortality of nearly 50%. The major risk factors in this patient population appear to be glucocorticoids, high dose methotrexate, and radiation therapy all of which reduce CD4+ counts. Prophylaxis must be considered carefully because of the significant risk of drug interactions between the methotrexate and the antibiotics used to prevent Pneumocystis infections. This manuscript reviews the changing therapy for primary CNS lymphomas, the pathogenesis, diagnosis and treatment of P. carinii pneumonia, the potential interactions between methotrexate and prophylactic antibiotics, and the risk of Pneumocystis infection in these patients. It also provides recommendations for Pneumocystis prophylaxis for this patient population.

Antibiotic Prophylaxis↗