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2015| January-March | Volume 52 | Issue 1
Online since February 3, 2016
SYMPOSIUM - BREAST CANCER: REVIEW ARTICLES
Palliative care in India: Situation assessment and future scope
SS Kar, L Subitha, S Iswarya
January-March 2015, 52(1):99-101
DOI:10.4103/0019-509X.175578 PMID:26837989
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.
SYMPOSIUM - BREAST CANCER: ORIGINAL ARTICLES
Family caregivers' burden: A hospital based study in 2010 among cancer patients from Delhi
S Lukhmana, SK Bhasin, P Chhabra, MS Bhatia
January-March 2015, 52(1):146-151
Background: A large number of patients with chronic diseases like, cancer are cared for in homes by the family members in India. The vital role that these family members play as "caregivers" is well recognized, however, the burden on them is poorly understood. Aims: To assess burden and to determine the predictors of burden on family caregivers of cancer patients. Setting And Design: A cross-sectional, hospital based study conducted in National Capital Territory of Delhi. Materials And Methods: 200 family caregivers of cancer patients were selected by systematic random sampling and interviewed using standard, validated Hindi version of Zarit Burden Interview. Statistical Analysis: Univariate analysis and multivariable logistic regression were carried out using Statistical Package for the Social Sciences software (version 17.0). Results: The study population consisted of 90 (45%) males and 110 (55%) female caregivers aged 18-65 years. 113 (56.5%) caregivers reported no or minimal burden while 75 (37.5%) caregivers reported mild to moderate burden. Using logistic regression marital status, education and type of family of caregivers, occupation of cancer patients and type of treatment facility were found to be the predictors of burden on caregivers. Conclusion: In view of the substantial burden on family caregivers coupled with lack of adequate number of cancer hospitals, there is a public-health imperative to recognize this important group. All levels of health-staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.
SYMPOSIUM - MOLECULAR ONCOLOGY: REVIEW ARTICLES
Applicability of RNA interference in cancer therapy: Current status
S Maduri
January-March 2015, 52(1):11-21
Cancer is a manifestation of dysregulated gene function arising from a complex interplay of oncogenes and tumor suppressor genes present in our body. Cancer has been constantly chased using various therapies but all in vain as most of them are highly effective only in the early stages of cancer. Recently, RNA interference (RNAi) therapy, a comparatively new entrant is evolving as a promising player in the battle against cancer due to its post-transcriptional gene silencing ability. The most alluring feature of this non-invasive technology lies in its utility in the cancer detection and the cancer treatment at any stage. Once this technology is fully exploited it can bring a whole new era of therapeutics capable of curing cancer at any stage mainly due to its ability to target the vital processes required for cell proliferation such as response to growth factors, nutrient uptake/synthesis, and energy generation. This therapy can also be used to treat stage IV cancer, the most difficult to treat till date, by virtue of its metastasis inhibiting capability. Recent research has also proved that cancer can even be prevented by proper modulation of physiological RNAi pathways and researchers have found that many nutrients, which are a part of routine diet, can effectively modulate these pathways and prevent cancer. Even after having all these advantages the potential of RNAi therapy could not be fully tapped earlier, due to many limitations associated with the administration of RNAi based therapeutics. However, recent advancements in this direction, such as the development of small interfering RNA (siRNA) tolerant to nucleases and the development of non-viral vectors such as cationic liposomes and nanoparticles, can overcome this obstacle and facilitate the clinical use of RNAi based therapeutics in the treatment of cancer. The present review focuses on the current status of RNAi therapeutics and explores their potential as future diagnostics and therapeutics against cancer.
Unique roles of nanotechnology in medicine and cancer-II
F Alam, M Naim, M Aziz, N Yadav
January-March 2015, 52(1):1-9
Applications of nanotechnology in medicine and cancer are becoming increasingly popular. Common nanomaterials and devices applicable in cancer medicine are classifiable as liposomes, polymeric-micelles, dendrimers, nano-cantilevers, carbon nanotubes, quantum dots, magnetic-nanoparticles, gold nanoparticles (AuNPs) and certain miscellaneous nanoparticles. Here, we present review of the structure, function and utilities of the various approved, under trial and pretrial nanodevices applicable in the cancer care and medicine. The liposomes are phospholipid-vesicles made use in carrying drugs to the target site minimizing the bio-distribution toxicity and a number of such theranostics have been approved for clinical practice. Newly worked out liposomes and polymeric micelles are under the trail phases for nano-therapeutic utility. A multifunctional dendrimer conjugate with imaging, targeting and drug molecules of paclitaxel has been recently synthesized for cancer theranostic applications. Nano-cantilever based assays are likely going to replace the conventions methods of chemical pathological investigations. Carbon nanotubes are emerging for utility in regenerative and cancer medicine. Quantum dots hold great promise for the micro-metastasis and intra-operative tumor imaging. Important applications of magnetic nanoparticles are in the cardiac stents, photodynamic therapy and liver metastasis imaging. The AuNPs have been employed for cell imaging, computed tomography and cancer therapy. Besides these categories, miscellaneous other nanoparticles are being discovered for utility in the cancer diagnosis and disease management. However, the use of nanoparticles should be cautious since the toxic effects of nanoparticles are not well-known. The use of nanoparticles in the clinical practice and their toxicity profile require further extensive research.
The cancer awareness assessment project: A small-scale survey across people with different levels of education in Mysore, India
A Sheshachalam, AR Chakravarthy
Aim: To assess the cancer awareness in respondents, their knowledge about the nature of cancer as a disease, its diagnosis and treatment, warning signs, environmental risk factors and conceptions of how risk factors work, as well as willingness to participate in screening programs if available. Methodology: Cancer awareness is an increasingly important issue in light of increasing incidence and associated healthcare costs, as well as the presence of risk management strategies. In this study, 453 people, drawn from several educational institutes/workplaces, were surveyed with respect to cancer awareness. The test sample included pre university students, undergraduates, and postgraduate students/workers. We checked for variations in cancer awareness across multiple educational levels to determine whether there was variation in levels of cancer awareness across educational classes. Results: We found that confidence in perception of cancer awareness, and awareness itself, was not very high, and only postgraduates had a nuanced appreciation of some of the complexities of cancer epidemiology, and even then only moderately. Conclusion: The conclusions of the study point towards the need for optimal policymaking in the development of cancer awareness in the population.
Increasing cancer incidence in a tertiary care hospital in a developing country, India
T Cherian, P Mahadevan, S Chandramathi, J Govindan, IL Mathew
Objective: Cancer is a major health problem in many countries including India. Since Cancer Registries are incomplete in India, only a few epidemiological studies have been done so far. The objective was to determine the leading causes of cancer in a tertiary care hospital and compare the incidences of different types of cancer with the incidences in India and developed countries.Materials And Methods: An epidemiological study was done to collect data from pathology records of 1003 cancer cases during 6-month period in the year 2010. The data was collected in a computer and the data was utilized to make tables and histograms.Results: Of the 1003 cases, the leading cancer site was breast, followed by colon and rectum, lymph node and stomach. The leading cancer site for men was colon and rectum and for women was breast. Conclusion: Cancer incidence is now low in India, a developing country, compared to developed Western countries. However, some cancers, like breast and colon and rectum cancers are increasing every year.IMPACT: The findings of this study support that cancer incidence is increasing in India and more epidemiological studies are needed.
A population-based screening program for early detection of common cancers among women in India – methodology and interim results
GA Mishra, HD Dhivar, SD Gupta, SV Kulkarni, SS Shastri
Background: Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008. Aim: The major objectives were to create awareness regarding common cancers among women, to detect pre-cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low-cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow-up among the diagnosed cases. Settings And Methods: This is a community-based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set-up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years. Results: Twenty-one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty-seven oral pre-cancers, 25 cervix pre-cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment. Conclusions: The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre-cancers and cancers among asymptomatic women and is assisting them in receiving treatment.
Trace elements; copper, zinc and selenium, in breast cancer afflicted female patients in LAUTECH Osogbo, Nigeria
ML Adeoti, AS Oguntola, EO Akanni, OS Agodirin, GM Oyeyemi
Background: There is an indication of the possibility of the direct or indirect influence of trace element in the development and prevention of malignant diseases, the contribution of the trace elements in the etiology of breast cancer has been under scrutiny. Aims: The aim of this study was to determine the serum concentration of trace element in serum of female patients with breast cancer in comparison with healthy controls. Settings: Breast Clinic of the Department of Surgery LAUTECH University teaching hospital Osogbo, in south-western Nigeria. Materials And Methods: A cross-sectional age matched controlled prospective study wherein the venous blood sample of 30 patients with breast cancer and 30 healthy volunteers as controls were analyzed using atomic absorption spectrophotometry. The collected data were analyzed using statistical package for the social sciences (SPSS Inc) 16. Result: The mean serum concentration of the copper, zinc and selenium were 95.3 ± 4.9 ug/dl and 65.2 ± 15 ug/dl, 62.7 ± 15.7 ug/dl and 93.5 ± 7.2 ug/dl, 45.0 ± 4.6 ug/l and 76.4 ± 8.9 ug/l in the two groups respectively. The concentrations of copper and copper-zinc ratio (C/Z) were significantly higher in the cancer bearing group compared to the controls (C/Z 1.6 ± 0.5 against 0.70 ± 0.14 the P < 0.01). The concentration of zinc and selenium in the venous blood of the breast cancer patients showed inverse relationship while that of the control showed a direct relationship (−0.03 against 0.09). In the breast cancer patients the correlation of copper and zinc, copper and selenium and zinc and selenium showed inverse relationships, none of the relationships was statistically significant. Conclusion: We found a significant association between the serum concentration of trace elements and breast cancer.
A study on biochemical facet of anemia in cancers: A strong link between erythropoietin and tumor necrosis factor alpha in anemic cancer patients
P Kalyani, K Jamil
Background: The three direct factors that could lead cancer patients to anemia, apart from therapy are iron deficiency, inflammatory cytokines surge and decreased erythropoietin (Epo). Our aim was to quantify biochemical and hematologic markers serum Epo, ferritin (Fe) and tumor necrosis factor-alpha (TNF-α) along with hemoglobin (Hb) to understand the associations between these factors, patient characteristics and anemia. Materials And Methods: The study group consisted of 100 anemic cancer patients and 80 controls. Biochemical marker levels were determined by the enzyme linked immunosorbent assay on an autoanalyser. Univarient analysis, t-test, ANOVA, Bonferroni test, linear regression was performed to find correlations and associations among various factors. Results: The baseline serum Epo (153.07 ± 173.88 vs. 23.607 ± 36.462) and Fe levels (233.53 ± 257.12 vs. 23.06 ± 20.04) were adequately high in cases compared with that controls (P ≤ 0.001). Considerable raise in TNF-α levels was also observed (16.26 ± 13.44 vs. 11.2375 ± 4.84) (P = 0.001). TNF-α correlated positively (P = 0.022) with Epo and Fe (P = 0.000), which was also evident from large effect size of Epo (r2 = 0.414), TNF-α (r2 = 0.369), Hb (r2 = 0.226). Epo and Hb were negatively correlated (β = −0.375, P = 0.001) and Epo production was found to be appropriate for the degree of anemia (O/P ratio of 3.51 ± 1.26 vs. 1.43 ± 0.47). A strong association was seen between Hb, Epo and TNF-α in hematological and gynecological malignancies for different grades of anemia. Men were more prone to life-threatening anemia (13%) than women (9%). Conclusion: Anemia in cancers was not because of inadequate Epo or Fe levels, but because of improper Epo response. Further studies on molecular analysis of Epo, biochemical and molecular interplay between Epo and TNF-α could explain a rationale for anemia in cancers.
SYMPOSIUM - HEAD AND NECK CANCER: ORIGINAL ARTICLES
Stromal myofibroblasts in oral squamous cell carcinoma and potentially malignant disorders
G Jayaraj, HJ Sherlin, P Ramani, P Premkumar, A Natesan
Introduction: Concurrent with the progression of a non- diseased epithelium to the pre-cancerous epithelium to carcinoma, the stroma also undergoes modifications. Myofibroblasts are important stromal cells that play a crucial role in carcinogenesis. The current study investigated the presence of myofibroblasts in healthy oral mucosa, potentially malignant disorders (PMDs) and squamous cell carcinoma (SCC). Materials And Methods: The study material consisted of a total of 106 samples categorized into three groups, namely, Group I - Oral SCC (OSCC) (n = 42), Group II – PMDs (n = 32) and Group III – Oral healthy mucosa (n = 32) subjected to immunohistochemical analysis using alpha Smooth Muscle Actin. Results: Among the 42 cases of OSCC, the staining index was negative in 23 cases (54.7%), low in 9 cases(21.4%) and moderate in 10 cases (23.8%). The stroma of cases of verrucous carcinoma, cases of Hyperkeratosis with epithelial dysplasia, 77.5% of the cases of oral Submucous Fibrosis (OSMF) and healthy oral mucosa were devoid of myofibroblasts resulting in a grade of "0" in all cases.Two of the cases of OSMF (12.5%) showed low staining index for myofibroblast. There was a significant difference in the myofibroblasts expression between the Groups (Kruskal-Wallis test P<0.001). Conclusion: The findings of the current study justify "myofibroblast" as one among the key stromal element in tumor progression. Future studies involving a larger sample size along with follow up of patients with PMDs are essential to identify the exact stage in which they emerge in the stroma of these lesions.
Phenytoin mouthwash to treat cancer therapy-induced oral mucositis: A pilot study
M Baharvand, M Hamian, MA Moosavizadeh, A Mortazavi, A Ameri
Background: Oral mucositis is one of the most common side effects of cancer therapy with no definite treatment. Phenytoin has positive effects on healing of mucosal and dermal wounds. In this study efficacy of 1% phenytoin mouthwash on severity of mucositis (on the basis of WHO scale), pain relief (based on Visual Analogue Scale), and improvement of patients' quality of life (on the basis of EORTC-QLQ-H and N35 questionnaire) was evaluated. Materials And Methods: In a pilot -double-blind randomized clinical trial, eight patients in study group were given 1% phenytoin mouthwash while eight patients in control group used normal saline. Data analysis was performed by Mann-Whitney and Repeated Measured ANOVA tests. Results: Reduction of mucositis severity was observed, but the difference was not significant. On the other hand, patients on phenytoin therapy had better pain relief (VAS# 6.75 ± 1.58 at the beginning of the study reached to # 3.75 ± 1.16 after 3 weeks in phenytoin group) and improvement in quality of life (score of QOL was 70.63 ± 5.5 that reached to 63.61 ± 6.39 in phenytoin group) than normal saline group significantly (P < 0.05). Conclusion: One percent phenytoin mouthwash caused pain relief and improvement of life quality significantly in patients with mucositis due to cancer therapy, but it did not reduce the severity of mucositis in a statistically significant scale.
Developing a comprehensive cancer specific geriatric assessment tool
S Rao, N Salins, J Deodhar, M Muckaden
Background: Population aging is one of the most distinctive demographic events of this century. United Nations projections suggest that the number of older persons is expected to increase by more than double from 841 million in 2013 to >2 billion by 2050. It is estimated that 60% of the elderly patients may be affected by cancer and may present in the advanced stage. The aim of this paper was to develop a brief cancer-specific comprehensive geriatric assessment tool for use in a geriatric population with advanced cancer that would identify the various medical, psychosocial, and functional issues in the older person.Methods: Literature on assessment of geriatric needs in an oncology setting was reviewed such that validated tools on specific domains were identified and utilized. The domains addressed were socioeconomic, physical symptoms, comorbidity, functional status, psychological status, social support, cognition, nutritional status and spiritual issues. Validated tools identified were Kuppuswamy scale (socioeconomic), Edmonton Symptom Assessment Scale (Physical symptoms) and SAKK cancer-specific geriatric assessment tool, which included six standard geriatric measures covering five geriatric domains (comorbidity, functional status, psychological status, social support, cognition, nutritional status). The individual measures were brief, reliable, and valid and could be administered by the interviewer.Conclusion: The tool was developed for use under the geriatric palliative care project of the department of palliative medicine at Tata Memorial Hospital, Mumbai. We plan to test the feasibility of the tool in our palliative care set-up, conduct a needs assessment study and based on the needs assessment outcome institute a comprehensive geriatric palliative care project and reassess outcomes.
SYMPOSIUM - MOLECULAR ONCOLOGY: ORIGINAL ARTICLES
miR-17-92 host gene, uderexpressed in gastric cancer and its expression was negatively correlated with the metastasis
F Bahari, M Emadi-Baygi, P Nikpour
Background: This study aimed to evaluate the expression of miR-17-92 host gene (MIR17HG), in gastric cancer and paired normal adjacent tissues for the 1st time. Methods: Using quantitative real-time-polymerase chain reaction, the MIR17HG expression was assessed in 30 paired tumoral and nontumoral gastric tissue samples. Results: Our results showed that this transcript was significantly underexpressed in gastric tumors compared with normal ones. Furthermore, there was an association between the expression levels of MIR17HG and gastric cancer grades and stages. Moreover, the expression level of MIR17HG was conversely associated with the size of tumoral specimens in early stages (stages I and II). We also observed an association between the presence of metastasis and lower expression of MIR17HG. Conclusion: Our results suggest that MIR17HG gene expression is dysregulated in gastric cancer in which it may indicate a tumor suppressive function of this miRNA cluster host gene in gastric cancer.
Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India
NA Thakur, AY Humne, LB Godale
Introduction: Despite lower incidence of breast cancer in India, the total number of cases and the net mortality is high. To reduce this increasing load of mortality due to breast cancer we need to lay emphasis on early detection and increased use of systemic therapy. Early detection itself depends on early presentation to a health facility; thus, it is important to identify factors affecting delay in a presentation to hospital.Aim And Objectives: To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them. Materials And Methods: A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was done according to planned proforma. Observations: Maximum study subjects were in the age group of 41-50 years. Right and left breasts were equally affected. The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma (NOS) in 105 (87.50%) cases. Majority of the cases were in stage III or stage II. The median time lag self-detection of lump in the breast by women and presentation to the hospital was 6 months. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late. Conclusions: Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. Hence, proper awareness and screening programmers are needed to identify, inform and educate these categories of women.
Patterns of care in geriatric cancer patients – An audit from a rural based hospital cancer registry in Kerala
VM Patil, S Chakraborty, S Dessai, SS Kumar, K Ratheesan, T Bindu, M Geetha, K Sujith, S Babu, V Raghavan, CK Nair, V Syam, S Surij, B Sathessan
Background: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming. Aim: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India. Materials And Methods: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided. Results: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70-95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco-regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0-1, primary site and clinical extent of disease. Conclusion: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.
SYMPOSIUM - GASTROINTESTINAL CANCER: REVIEW ARTICLE
Bursectomy for gastric cancer: What does the evidence indicate?
SG Barreto, A Perwaiz, A Singh, T Singh, A Chaudhary
Radical resection of the bursa omentalis (radical bursectomy) as part of a curative resection for gastric cancer has been advised for close to a century. However, the postulated associated morbidity and lack of a clear benefit in terms of survival preclude its routine use. To objectively review the available evidence on the role of bursectomy as part of a curative resection for gastric cancer. A systematic search of the scientific literature was carried out using Embase, PubMed, MedLine and the Cochrane central register of controlled trials for the years 1965-2013 to obtain access to all publications, especially randomized controlled trials (RCTs), systematic reviews and meta-analyses involving bursectomy in gastric cancer with the appropriate specific search terms, namely, "bursectomy," "stomach cancer," "gastric cancer," "survival," "morbidity," "outcomes" and "RCTs". Using the above search strategy, a total of 29 publications was retrieved of which five publications were identified describing bursectomy and its outcomes in gastric cancer. These included three retrospective cohort studies and two publications from a single RCT. Bursectomy do not appear to add the morbidity or mortality of the overall surgery. However, it did not appear to significantly improve overall survival neither in the retrospective cohort studies nor in the only RCT. The evidence to date is insufficient to suggest any additional benefit of routine bursectomy to a radical gastrectomy with D2 lymphadenectomy for gastric cancer. Results of an on-going RCT are awaited to determine if bursectomy may further improve overall survival in patients with advanced T-stage of disease.
Correlation of various histopathologic prognostic factors with Nottingham prognostic index and microvessel density in invasive breast carcinoma: A study of 100 cases
A Kwatra, D Aggarwal, R Gupta, AK Chaturvedi, M Kudesia, S Singh
Background: Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. Methods: This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. Results: Of the 100 cases, 54% of the tumors were in T2 tumor size category (2-5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41-5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). Conclusion: NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.
Duodenal adenocarcinoma: A rare cause of chyloperitoneum (chylous ascites)
B Civelek, S Aksoy, T Kos, Z Arık, MB Akıncı, D Uncu, N Özdemir, S Cihan, N Zengin
Clinical outcome of primary non-metastatic breast cancer: A single institution experience
A Jamshed, MA Shah, AA Syed, G Murtaza, T Mehmood, SJ Chaudry, A Loya, S Hameed
Background: We report on prognostic factors and long-term survival of non-metastatic breast cancer patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC) in Pakistan. Materials And Methods: This retrospective cohort study is based on a review of 2829 pathologically confirmed non-metastatic breast cancer patients managed from January 1995 to May 2009. Median age was 45 years. Stage at presentation: Stage I (9%), stage II (59%), and stage III (32%). Infiltrating ductal carcinoma (92%) constituted the most prevalent histological subtype. Estrogen (ER), progesterone (PR) and Her2-neu were positive in 49%, 50%, and 26%, respectively. A mastectomy was performed in 67% and conservative surgery in 33% of the patients. Post-operative radiotherapy was delivered in 85% of the cases. Ninety percent of the patients received chemotherapy and mainly consisted of anthracycline-based regimens + taxanes. Hormonal manipulation was done in ER/PR positive patients. Results: The 5- and 10-year overall survival (OS) was 70% (95% confidence interval [CI]: 68.2-71.8%) and 54% (95%CI: 51.2-56.8%), while disease free survival (DFS) was 65% (95% CI: 63-67%) and 52% (95% CI: 49.2-54.8%), respectively. Recurrence following primary treatment was seen in 35% of the patients. On multivariate analysis T stage, number of axillary nodal involvement, tumor grade, ER status and family history, were found to be independent predictors for OS and DFS. Conclusions: Over 90% of non-metastatic breast cancer patients present with stagesII and III disease and a significant proportion develop distant metastasis accounting for overall long-term outcome inferior to developed countries. Efforts should be directed to raise the level of health awareness and screening programs to improve early detection in Pakistan.
Evaluating of suppressor of zeste 12 and chromobox homolog 8 genes expression showed two possible origins for gastric cancer development
M Ghalandary, M Behmanesh, M Sadeghizadeh
Context: Changes in genome, made by multiple genetic and epigenetic alterations result to the cancer initiation and progression. Suppressor of zeste 12 (SUZ12) and chromobox homolog 8 (CBX8) proteins are two components of epigenetic regulators that their function in the initiation and progression of cancers are not well-understood. Aims: The role of SUZ12 and its target CBX8 is examined. Settings And Design: Comparing the expression levels of SUZ12 and CBX8 between 30 gastric tumor and their marginal tissues. Materials And Methods: Quantitative reverse transcription polymerase chain reaction technique was performed. Statistical Analysis: Statistical comparison was carried out using Statistical Program for Social Sciences software 16.0 (Released 2007, SPSS for Windows. SPSS Inc., Chicago, IL, USA) and (GraphPad Prism version 5 for Windows, GraphPad Software, La Jolla, California USA, ww.graphpad.com).Results: Despite the obvious differences in the expression of these genes in each sample for tumor and its marginal tissue, statistical analysis did not show significant differences in the mean of expression for SUZ12 and CBX8 genes in total. Due to the variation in expression levels, the samples could be divided into two groups for each gene; group 1, in which the genes were overexpressed in tumor and group 2, in which the genes were down regulated in tumor samples. Conclusion: We found that in each group, the difference in the SUZ12 and CBX8 genes expression were significantly divergent between tumors and their marginal tissues. It means that the regulatory mechanisms involved in developing and controlling the process of gastric cancer pathogenesis is more complex than it thought. These results also bring new evidence on the possible double origin for gastric cancer development, bone-marrow-derived cells and tissue stem cells.
Response to taxane-based chemotherapy in metastatic eccrine porocarcinoma with extensive cutaneous involvement
D Joseph, B Dubashi, D Basu, Sathish Srinivasan, A Jain
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Visfatin effects on telomerase gene expression in AGS gastric cancer cell line
M Mohammadi, N Zarghami, M Hedayati, S Ghaemmaghami, RM Yamchi, M Mohaddes
Aim: The aim of this study was to assess visfatin expression and its effect on human telomerase gene expression in AGS gastric cancer cell line. Materials And Methods: In this study, human gastric cancer (AGS) cell line was established as an in vitro model. Reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay was performed to show that visfatin expression in messenger ribonucleic acid (mRNA) and protein level respectively. After stimulating with increasing concentrations of visfatin for times of 24 h and 48 h, cell proliferation was assessed by 2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide (XTT) assay. In order to investigate telomerase gene expression affected by visfatin in AGS cell line, total RNA was extracted and complementary deoxyribonucleic acid was synthesized buy using commercially available kits. Expression of human telomerase reverse transcriptase (hTERT) mRNA was carried out by real-time RT-PCR. Results: After visfatin treatment gastric cell line proliferation was enhanced and was increased the expression of hTERT. Conclusions: The obtained data showed that visfatin induces endogenously gastric cancer cell proliferation and increases telomerase (hTERT) gene expression, as a cancer gene. Based on this study, it is suggested that expression of this adipocytokine protein in real samples could be biomarker for gastric cancer.
Efficacy of argyrophilic nucleolar organizing region analysis using computer-assisted and manual in oral leukoplakia: A comparative study
Kavita Nitish Garg, Vineet Raj, Shaleen Chandra
Objective: Nucleolar organizer regions are loops of DNA containing ribosomal RNA genes and presumably are associated with ribosomal RNA activity, protein synthesis, and cell proliferation. Argyrophilic nucleolar organizer region (AgNOR) count has been suggested as an objective method in differentiating dysplastic lesions from non-dysplastic lesions. Materials And Methods: This descriptive study was done on archival paraffin blocks (n = 60), consisting of 10 normal human oral epithelium, 22 cases of non-dysplastic leukoplakia (NDLK), and 28 cases of dysplastic leukoplakia (DLK). The AgNORs were counted with the aid of a manual using conventional light microscopy and photographs of the same were taken and analyzed using Image Pro Express 6.0 (Media Cybernetic Inc., USA) for windows. Results: The mean AgNOR count per nucleus was found to be higher in patients with DLK as compared to NDLK and controls using both manual counting and image analysis method and on comparing both the techniques, image analysis provide a more accurate reflection of AgNOR counts than manual counting. Conclusion: To conclude, reliability of computerized image technique of AgNOR count is the most appropriate marker to differentiate between dysplastic and NDLK. Computer-assisted image analysis system was found to be an effective tool in achieving high reproducibility as compare to manual.
A prospective study to assess the efficacy and toxicity of 5-flurouracil and cisplatin versus taxane and cisplatin as induction chemotherapy in locally advanced head and neck squamous cell cancer in a regional cancer center in India
KC Lakshmaiah, AH Rudresha, TM Suresh, D Lokanatha, GK Babu, LA Jacob
Aim: The aim of this study is to assess the efficacy and toxicity of 5-flurouracil (5-FU) and cisplatin (PF) versus taxane and cisplatin (TP) as induction chemotherapy in locally advanced head and neck squamous cell cancer. Materials And Methods: There were 50 patients in each arm, matched for age, performance state, site and stage of disease. PF arm (cisplatin - 100 mg/m2 D1, 5-FU - 1000 mg/m2 D1-D5) TP arm (docetaxel - 75 mg/m2 or paclitaxel - 175 mg/m2 on D1, cisplatin 75 mg/m2 on D2), received once in 3 weeks for 3 cycles. Patients without progressive disease underwent either surgery or chemoradiation. The primary end point was overall response rate (ORR) and secondary endpoint was toxicity. Results: In a total of 100 patients in our study, 44 in PF and 47 in TP arm were evaluable. ORR was 86.6% in PF arm and 82.9% in TP arm (P = 0.71).There were more Grade 3 or 4 events of neutropenia, mucositis (P ≤ 0.05) and myelosuppression diarrhea, febrile neutropenia (P ≥ 0.05) in PF arm compared with TP arm. Post-chemotherapy hospital admissions due to toxicity were more frequent in PF arm (38.6% vs. 19%), dropout rate due to toxicity (9% vs. 0%) and deaths (6.8% vs. 2.1%) were more common in PF arm compared with TP arm. Conclusion: TP induction chemotherapy better tolerated than PF, which has similar efficacy, further multicenter randomized controlled studies; involving a large sample size is needed to confirm our data.
Clinicopathological characteristics of ameloblastomas in Western Uttar Pradesh population: An institutional study
S Gupta, S Sexana, S Bhagwat, P Aggarwal, PK Gupta
Objective: The aim of this study was to compare the clinical, radiologic, and histopathological features of 28 intraosseous ameloblastomas. In addition, we compared the data obtained in this study with that of previous studies. Materials And Methods: Data with regard to age, gender, clinical manifestation, radiographic aspect, anatomical distribution, and histopathological subtypes were analyzed in 28 subjects. Results: The patients' age ranged from 7 years to 65 years (mean, 30.4 years). Sixteen (57.14%) of the 28 subjects were males, and 12 (42.85%) were females. A total of 22 cases (78.5%) were located in the mandible, posterior region was more often affected with 17 cases (77.27%) than only 5 cases (22.72%) in the anterior segment. Swelling was the most common symptom and was experienced by 12 (42.85%) patients. Radiographically, 14 cases (50%) were multilocular with a well-demarcated border. Of the remaining 14 cases, 10 were unilocular and 4 were unknown in appearance. The most common histopathological pattern was follicular followed by plexiform or acanthomatous. Conclusions: The clinical epidemiological profile to patients in the present study is similar to that in other populations, with follicular ameloblastoma being the most common histological subtypes seen.
Impact of post-operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India
S Roy, D Mondal, W Melgandi, M Jana, KK Chowdhury, S Das, KP Haresh, S Gupta, D Sharma, PK Julka, GK Rath
Background: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast-conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx). Materials And Methods: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student's t-test was used for comparative analysis of the means. Results: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007;). The mean Dmean of LAD for L-EBC and R-EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029;). The mean-Dmax of LCx for patients with L-EBC (2.9 Gy; range: 1.2–4.35 Gy) was statistically higher than that for R-EBC (1.3 Gy; range: 0.7–3.2 Gy) (P = 0.045). The mean-Dmean of LCx for L-EBC (2.1 Gy; range: 0.6–3.6 Gy) was also significantly higher than that of L-EBC (0.9 Gy; range: 0.7–2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m-Dmax and m-Dmean of LCx). Conclusion: This pilot dosimetric study confirms the assumption that patients with left-sided EBC are at higher risk of developing long-term cardiac morbidity when treated with PORT due to increased dose to LAD.
Is taxane/platinum/5 fluorouracil superior to taxane/platinum alone and does docetaxel trump paclitaxel in induction therapy for locally advanced oral cavity cancers?
V Noronha, V Patil, A Joshi, V Muddu, A Bhattacharjee, S Juvekar, S Arya, P Chaturvedi, D Chaukar, PS Pai, AK Dcruz, K Prabhash
Background: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. Methods: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow-up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi-square analysis was done to compare response rates (RRs) between regimens. Results: Two hundred and forty-five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). Conclusions: TPF has better RR than a 2 drugs taxane-containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.
SYMPOSIUM - GASTROINTESTINAL CANCER: ORIGINAL ARTICLES
Synchronous primary cancers in the head and neck region and upper aero digestive tract: Role of triple endoscopy
M Krishnatreya, T Rahman, AC Kataki, K Lahkar
Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. AIM: The aim of this study is to see the role of endoscopy in the pre-therapeutic works-up of patients with the cancers in the head and neck region. Materials And Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of mode for average age have been employed for analyzing results. Results: Incidence of synchronous primaries has been found to be 1.43% and mostly males were affected. The common index sites for synchronous primaries are oropharynx 22 (36.6%), oral cavity 14 (23.3%), hypopharyx 12 (20%) and larynx eight (13.3%) cases in decreasing order, 58.3% synchronous occurred at esophagus and 0.83% of all head and neck cancers developed synchronous primary at esophagus. Association of UADT synchronous cancers with smoking (odds ratio = 13.42, Chi-square 7.12 at 95% confidence interval, P = 0.0076) is highly significant and the average age is 62.6 years in males and 62 years in females. Conclusion: Endoscopy can be rationally used during the pre-therapeutic work-up of patients with a history of smoking and/or in patients over the age of 62 years. Instead of complete upper gastro intestinal endoscopy up to the second part of duodenum, only esophagoscopy is needed for the detection of synchronous primary of upper aero-digestive tract in cancers of the head and neck region.
Fungating extramedullary plasmocytoma of breast; a unique case presentation
S Naqash, AH Sarmast, HI Showkat, M Wani, S Besina, M Banday, M Shah
A case of tuberous sclerosis complex with bilateral advanced renal cell carcinoma
CR Choudhury, S Biswas
Inguinal lymphnode metastatic testicular seminoma: A case report and review of literature
Shishir Shah
Giant testicular tumor with pulmonary metastases: Stroke as the initial manifestation
A Agrawal, A Bhake
Evaluating the relation between patients-related factors and dissected lymph node ratio in gastric cancer
HS Saedi, A Fanipakdel, A Shafaghi, S Ghorbani
Background: Gastric cancer is a forth common malignancy world-wide and the second most common cause of cancer-related deaths. According to the current International Union Against Cancer staging system, nodal status is categorized based on the number of metastatic lymph nodes (LNs). Some groups have recently proposed the metastatic lymph node ratio (MLR) (the ratio between metastatic LNs and total dissected LNs; MLR) as an alternative prognostic factor. The aim of the present study is to evaluate the relationship between MLR and different clinico pathologic factors including patients' age, tumor grade, stage, sites of involvement and disease prognosis. Methods: Atotal of 70 patients with gastric adenocarcinoma who underwent gastrectomy with negative margin and LN resection during 2004-2009 and were referred to Radiotherapy-Oncology Department of Name of Hospital, Name of City, were included in the study. MLR status was divided to five groups. Collected data were analyzed with SPSS 16 (SPSS Inc., Chicago, IL, USA). Results: The difference between MLR groups in age was significant; older patients had lower MLR (P = 0.01). The ratio of male to female was 5.3, which indicated higher prevalence of gastric cancer in males. The difference between MLR groups for tumor location, tumor stage, disease free periods and tumor T stages were not significant. A significant relation existed between different stages of LN involvement and MLR; and also between cancer stages and MLR. Conclusion: We found a significant relation between MLR and cancer stage and metastatic LN. Due to small sample size and short period of follow-up, we could not find significant relation between MLR and other factors such as depth of tumor invasion, disease free period and tumor grading. In conclusion with regards to our results and other similar studies' results, we acknowledge the importance of MLR in determining patients' prognosis in gastric cancer.
Results of combination chemotherapy and radiation therapy in non-metastatic gastric cancer in Yazd – Iran
A Akhavan, F Binesh, A Seifaddiny
Background: Gastric cancer is the first cause of cancer death in Iran. Most of the patients are diagnosed in advanced stages and survival rate is low. The aim of this study was to evaluate the survival rate of patients with gastric and gastroesophageal junction adenocarcinoma receiving combination chemotherapy and radiation therapy in Iran. Materials And Methods: This study was conducted on 53 patients with gastric or gastroesophageal junction adenocarcinoma referring to Shahid Ramezanzadeh Radiation Oncology Center between 2004 and 2010. All patients underwent surgical operation, chemotherapy, and radiotherapy. Data contained in patients' records were extracted and follow-up was conducted through telephone contacts. To analyze the data, Kaplan Meier curves, and SPSS software were employed. Results: Seventeen (32.1%) patients were female and 36 (67.9%) were male. Mean age was 58.32 years. In 14 patients (26.9%) no lymph node was resected or reported by the pathologist. In 29 patients (54.7%) one to six lymph nodes were found, and in10 patients (18.9%) seven lymph nodes or more were detected. In two patients, (3.77%) more than 15 lymph nodes were resected. Surgical staging was impossible for 16 patients (30.2%). Mean survival was 50.9 months and median survival was 51 months. 3,5 and 7 year survival rates were 73%, 36%, and 18% respectively. None of the variables had a significant relation to survival. Conclusions: Despite inadequate surgery, the survival rate in our study is one of the best one reported in our country. We think this advantage may be due to poly drug chemotherapy and sequential radiation therapy.
Primary neuroendocrine carcinoma of breast: A rare tumor
V Rana, S Kakkar, S Anand, Y Singh
A rare and unusual occurrence of rhabdomyosarcoma arising from the larynx
GK Chiramel, BR Chacko, R Thomas, D Jebakumar
Superior vena cava syndrome: Initial presentation of acute myeloid leukemia in a child
A Gogia, A Sharma, V Raina, A Chopra
Indirect evidences of functionality of insulinoma on FDG-PET: The 'whole body-metabolism' advantage and its clinical implications
S Basu
Hyperpigmented mycosis fungoides with ecthyma gangrenosum
VV Pai, NN Kikkeri, SC Athanikar, V Rai, US Dinesh
Renal impairment in prostate cancer: A close look is important
Vanita Naronha, Rakesh Pinninti, Amit Joshi, Kumar Prabhash
Is histologic differentiation a prognostic indicator for gastric carcinoma patients with curative resection?
SY Ryu, HG Kim, JK Joo, H Kang, JH Lee, DY Kim
Background: The prognostic relevance of histologic differentiation in gastric carcinoma patients with curative resection is unclear. We analyzed the clinicopathologic features of gastric carcinoma patients with curative resection according to the histologic differentiation and evaluated surgical outcome. Materials And Methods: Of 1198 gastric carcinoma patients with curative resection (American joint committee on cancer, Stages I-III), 274 (22.9%) had well-differentiated, 331 (27.6%) had moderately differentiated and 593 (49.5%) had poorly differentiated gastric carcinomas. Results: Patients with the poorly differentiated type had more prominent serosal invasion, much more lymph node involvement and more advanced stage than patients with the well-differentiated type. The overall survival rate was higher for patients with a well-differentiated gastric carcinoma than for patients with a poorly differentiated type. Using Cox's proportional hazard regression model, histologic differentiation was found to be a statistically significant prognostic parameter (risk ratio, 1.41; 95% confidence interval, 1.028-1.922; P < 0.05). Conclusion: Our results suggest that patients with a well-differentiated gastric carcinoma have a good prognosis compared with those with a poorly differentiated type. Therefore, histologic differentiation can be used as a prognostic indicator in gastric carcinoma patients with curative resection.
Display of health-risk warning on "arecanut sachets"
VK Gupta, S Malhotra
Proximal type of epithelioid sarcoma of back with metastasis to humerus at presentation: Indicating aggressive behavior
SP Gayatri, VA Amrut, DD Sanjay, SP Shirish, K Pankaj
A rare case of recurrent intravenous leiomyomatosis: Role of GnRH analogues?
S Kaur, HB Tongaonkar, A Maheshwari, S Menon
Primary pure squamous cell carcinoma of the stomach treated with neoadjuvant chemotherapy and surgical resection
Y Modi, H Shaaban, N Parikh, G Guron, M Maroules
Extranodal non: Hodgkin's lymphomain HIV
MM Rizwan, P Gaba, M Zulfiqar, AH Gaba
Nasopharynx carcinoma: A rare primary for bilateral breast metastasis
KU Vaishnav, S Pandhi, TS Shah, A Chaudhary, S Sethi
January-March 2015, 52(1):9-10
F-18 FDG PET/CT in restaging of a rare case of malignant cystosarcoma phylloides
K Manohar, BR Mittal, R Kashyap, A Bhattacharya, SC Sharma
Leukemic transformation in Fanconi's anemia
R Bhagat, J Ahluwalia, N Varma
No evidence of association of xenotropic murine leukemia virus-related virus with oral cancers: Experience from a tertiary care center in South India
M Sinha, M Shafiulla, K Trupti, NR Namrata, H Nadimul, KS Sabitha, RV Kumar, RS Jayshree
Background: Development of oral cancer, a widely prevalent cancer in India, is multifactorial with increased risk in those habituated to smoking, consuming alcohol and chewing paan and tobacco. This does not preclude other etiological factors in the causation of this cancer. Exploratory studies on several oncogenic viruses have found varied associations with oral cancers.Aim: The aim of this study was to explore the association of xenotropic murine leukemia virus-related virus, (XMRV) a retrovirus recently implicated in oncogenesis in humans, with oral cancers.Settings And Design: The presence of XMRV proviral deoxyribonucleic acid (DNA) was evaluated by standard nucleic acid amplification from DNA extracted from representative bits of tumor tissues and adjacent normal tissues from surgically resected specimens sent post-operatively for routine histopathological testing.Materials And Methods: This prospective study comprised 109 patients with a provisional diagnosis of oral cancer who were operated at the Oral Oncology Department of Kidwai Memorial Institute of Oncology, over a period of 10 months.Results: XMRV was not found in any of the tumor tissues (squamous cell carcinomas - 98; verrucous carcinomas - 4) nor in any of the normal tissues. It is thus important that the absence of this oncogenic virus in all the cases makes the association of XMRV with oral cancers very unlikely.Conclusions: There is a need to investigate potentially oncogenic viruses in other solid tumors and in larger sample sizes. Any such association could have implications in detecting, preventing and treating these cancers.
Recurrent urinary tract infection masquerading as skeletal metastasis of hepatocellular carcinoma
A Gulia, V Pai, A Puri, S Menon
Feasibility and efficacy of salvage radiotherapy with concurrent weekly topotecan in recurrent primitive neuroectodermal tumor
I Ghosh, I Mallick, S Ray
Tackling the delay: A unified approach
Vidya Viswanath, Samapika Routray
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text:
Deputy Principal/Learning Diversity Leader
St Mary's School - Mansfield
MANSFIELD, VIC
Deputy / Assistant Head of School
St Mary's Primary School is a vibrant and dynamic Catholic School that invites faith filled people to work as part of a collaborative, high performing team. We are looking for suitably qualified and experienced applicants within a primary school environment for a Deputy Principal/RE Leader role that will support the School Principal in the strategic leadership of St Mary's to ensure the vision and ethos of the School are achieved. This position will commence on the 27th of January 2023 and conclude on the 28th of January 2024.

Applicants should be able to demonstrate:

Capacity to think and act strategically;

Ability to work at both a strategic and operational level;

An active, positive participant as a senior leader and on the school leadership team.

Excellent interpersonal skills and the ability to relate well to staff and community members;

 Excellent verbal and written communication skills, together with a creative approach;

Experience in Learning Diversity and a thorough knowledge of the NCCD process.

Strong organizational and time management skills, with an ability to prioritise tasks, meet deadlines and manage competing tasks with a high level of attention to detail;

Enthusiasm for working in a team environment;

Ability to manage operations in a timely manner within budgetary constraints.

As a school, we value staff that work as part of a high performing team, and who are comfortable in an environment of ongoing improvement, self-reflection, coaching/mentoring and peer interaction.

St Mary's is a school committed to the safety, well-being and protection of all children in our care. A sound and demonstrated knowledge and understanding of current 'Child Safe' standards is required.

 Applicants are asked to demonstrate:

• Current VIT registration;

• Confidence in using ICT;

• Knowledge of Victorian Curriculum;

• Accreditation to teach and lead RE in a Catholic School;

• A commitment to faith formation, both personally and professionally;

• An ability to lead staff and be a Catholic Faith Leader to the community.

Note: You must reside, and have the right to work in Australia – overseas applicants will not be considered for this role.

https://www.stmarysmansfield.com.au/
Principal: Trish Etcell
Single School
The intention of the first Parish Priest Rev. Kavanagh was to establish a school within the Parish of St. Francis Xavier's School was opened in 1869, The school reopened as St. Mary's in 1876. In 1891 the Sisters of Mercy came to Mansfield. The core purpose of our school is to provide an inclusive, rigorous learning environment, providing a comprehensive curriculum with a strong focus on the Catholic religion, Literacy and Numeracy.

Please email your application and resume to the School Principal at principal@smmansfield.catholic.edu.au

redpajama_set_name: RedPajamaCommonCrawl


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SCHOTT Smart Containers: Entering a new era in digitized pharma manufacturing
In light of the growing need for pharmaceutical packaging innovations and digitalization, international technology group SCHOTT is introducing Smart Containers. The concept enables industry 4.0 for pharma manufacturers to unlock the power of machine vision and big data analytics on pharmaceutical filling lines. Each SCHOTT Smart Container is laser-marked with a unique identifier to create unprecedented traceability throughout the manufacturing process. The technology can be used to improve reject management and line clearance. Other applications include reducing the risk of mix-up, optimizing lyophilization processes, and supporting container-based targeted recalls.
The unique identifier is positioned at the bottom of the vial to eliminate the need to turn the container or install multiple cameras. Image: SCHOTT
"SCHOTT Smart Containers enable control over pharmaceutical packaging at the most granular level available – the individual unit," said Diana Löber, Global Product Manager Vials at SCHOTT. "We're unlocking a new era in digitized pharmaceutical manufacturing toward real-time release and taking advantage of the latest developments in machine vision and data science."
Each Smart Container is marked with a data matrix code that can be as small as 1 x 1 mm, which equals 14 x 14 dots. Developed according to ISO/IEC 16022, the numeric or alphanumeric machine readable code contains 16 or 24 digits, leading to sextilions of possible individual unique numbers. For vials, the unique identifier is positioned at the bottom, hence eliminating the need to turn the container or install multiple cameras, as it would be the case if the code were placed on the body of the vial.
The code remains stable during the whole fill & finish process including washing, autoclaving, and depyrogenation up to a temperature of 600°C. It resists abrasion, and avoids the risk of particle contamination, a key advantage over solutions which need additional substances for the application of the code. Moreover, in contrast to engraving laser technologies, the data matrix code of Smart Container is applied via melting in order to maintain glass strength. By inextricably linking the code to the container at the earliest possible stage within the entire value chain, the concept offers an advantage over systems wherein the code is attached or adhered at a later stage.
To discuss possible applications of SCHOTT Smart Containers, or to learn how SCHOTT is helping to fuel the pharmaceutical manufacturing industry's evolution towards industry 4.0, visit schott.com/smart-container.
The data matrix code on each Smart Container can be as small as 1 x 1 mm, which equals 14 x 14 dots. Image: SCHOTT
PR & Communication Manager
Pharma | Medical | Diagnostics
Hattenbergstraße 10
Phone: +49 6131/66-4073
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Beer Revolution, Rosamunde and Bernal Cutlery call it quits in Oakland
Plus, kosher wines to sip on Rosh Hashanah; Berkeley Restaurant Week To-Go; Blake's Grillery and more East Bay food news.
By Sarah Han Sept. 16, 2020, 12 p.m. Sept. 17, 10:16 a.m.
Beer Revolution has been a favorite spot for East Bay beer lovers for the past 10 years; its owner says it's going on pause when "bars can be bars again." Photo: Quinn Dombrowski/Flickr
Beer Revolution taps out for now
We heard word that Beer Revolution, the 10-year-old craft beer taproom at 464 Third St. in Jack London Square has possibly closed for good. A beer lovers' wonderland, Beer Rev offered nearly 50 taps and many more bottles and cans of specialty brews, along with a low-key place to enjoy said suds over some punk rock tunes. The bar closed when the pandemic arrived, and although the bar's voicemail still has a hopeful message of it reopening, visitors to Beer Rev's website will find it mostly non-operational, with a short but sweet note from owner Rebecca Boyles, aka Rebecca Revolution: "thank you for all the amazing years in beer."
Nosh has attempted to contact Boyles for more details. In the meantime, on Facebook, she shared that she has "decided to put a pause on Beer Revolution," adding "I created this place to be filled with people, building community, a place for best friends to meet, brewers to show off their amazing suds, all while drinking the best brews in California. The current landscape is not conducive to this environment… I am not gone for good, though, I'll wait to come back when bars can be bars again." She aims to bring Beer Rev back in 2022. We wish Beer Revolution a happy return in the future.
Bernal Cutlery closes on 40th Street
Bernal Cutlery's Oakland knife shop on 40th Street, seen here in 2018, has closed for good. Photo: Sarah Han
Bernal Cutlery has closed its Oakland knife shop at 308 40th St. As with Beer Rev, the store has been temporarily closed since March with intentions to return. But on Sept. 7, the business announced on Instagram that it will be leaving the space for good: "We have struggled to find a way to open the Oakland store during Covid in a way that would be safe for our employees and customers and not drain us financially but with all the pieces that would need to come together, we have not been able to."
The Oakland store opened in 2018, and was the second location for Josh Donald's San Francisco knife shop, which sold an amazing collection of new and vintage, mostly Japanese and European, cooking knives along with other covetable kitchen tools, and which offered Japanese whetstone and wet grinding sharpening services for both home cooks and restaurant professionals.
There is some good news — before the pandemic, Donald and crew had already been talking about opening a bigger store in Oakland, and they hope to actualize that plan once it is safe to do so. In the meantime, Bernal Cutlery's online shop is still selling wares, and its San Francisco shop is taking drop-offs for sharpening services. During this time of transition, Bernal Cutlery is giving free return shipping to East Bay customers on all sharpening orders through the end of 2020.
Farewell to Rosamunde's last remaining East Bay location
Another San Francisco-based business has called it quits in Oakland. Rosamunde Sausage Grill announced Tuesday that it has closed its outpost at Swan's Market, its last remaining East Bay location. In 2017, Rosamunde closed its Temescal restaurant, and perhaps even sadder, two years later, the sausage-and-beer eatery shuttered its original 20-year-old Lower Haight restaurant. At this time, the Mission Street Rosamunde and its sister restaurant Willkommen, both in San Francisco, are still open.
According to a message Rosamunde staff posted on Facebook, sustaining the business in Oakland was too difficult while its regular customer base has been sheltering in place. "Unfortunately, this location has fallen victim to the dramatic decrease in business that followed the onset of the COVID-19 pandemic, with widespread office closures downtown as people sheltered in place and worked from home. While too many restaurants and bars have already closed, we are fortunate that our Mission Street location and our sister restaurant have not been as adversely affected."
Kosher wines for Rosh Hashanah
Covenant Wines offers a wide variety of kosher wines at a range of prices that can be picked up at its Berkeley tasting room. Photo: Covenant Wines
With Rosh Hashanah starting Friday night, we wanted to remind you that Covenant Wines, Berkeley's kosher winery is open and offering bottles via curbside pickup at its tasting room.
Covenant offers a number of varietals at a range of price points, including a bubbly Blanc de Blancs ($38) — perfect for toasting the new year — and its lush, full-bodied and splurge-worthy Solomon Lot 70 ($150), featuring Cabernet Sauvignon grapes grown on Leslie Rudd's estate in Napa Valley. There are also affordable selections amongst its Red C, Mensch, The Tribe, Landsman, and Winemaker Blends collections. Locals can order online and select "pickup and alternate options" to arrange in-person pickup.
For those interested in learning more about the role wine plays in Jewish culture, RSVP for tonight's free Zoom conversation at 7 p.m., presented by the Jewish Community Center of San Francisco and co-sponsored by Covenant and Chochmat HaLev. Maggid Jhos Singer will discuss the history of liquor and wine throughout history, especially its place in Jewish rituals. RSVP to get the Zoom log-in information (and find a 15% off discount code for Covenant wines for the month of September on Chocomat HaLev's website).
And just for the record, while Covenant's wines are a perfect fit for a Rosh Hashanah celebration, they can be enjoyed at any time, by anyone. Covenant Wines, 1102 Sixth St. (between Red Oak and Harrison streets), Berkeley
Berkeley Restaurant Week To-Go is on
Berkeley Restaurant Week To-Go launched yesterday, featuring more than 60 participating restaurants, cafes, dessert spots and wineries offering special menus of takeout and outdoor dining eats priced between $15-$25 per person. The line-up includes longtime venues like Musical Offering Cafe, Julia's Restaurant, Jupiter and Homemade Cafe; newer spots like Cali Alley, Southside Station, Garden Variety and Blue Ox Wine; and tried and true favorites like Ippuku, Riva Cucina, Doc's Refresher, Lemat and Royal Rangoon (I linked to each restaurant's BRWToGo special; but there are many, many others to check out on the website). You have until Sept. 30 to eat your way through the choices.
Blake's Grillery is back in action
Cheese fried tacos from Blake's Grillery, a taco pop-up that helps three East Bay bars stay open for outdoor seating. Photo: Blake's Grillery
Chris Parks tells Nosh that Blake's Grillery is a "COVID-19 success story." Had it not been for the pandemic, Parks and his business partner Mario Camargo might not have joined forces again to start the taco pop-up. As reported by SFGate, Parks left Oakland in 2019, after his marriage ended and his North Oakland neighborhood wine bar, Bar 41, closed. He was hunkering down in Southern California when Camargo, the former head chef at Bar 41, convinced him to come back to the Bay Area. But when the pandemic started and Camargo lost his restaurant gig, it was Parks who came up with a plan for the two friends to thrive.
In June, outdoor dining was greenlit for businesses that served meals, which put bars without kitchens in a bind. Parks realized he and Camargo could help those bars reopen by providing the bonafide meals required by the guidelines. Resurrecting Blake's Grillery, Camargo's Southern-style taco concept that had been on the back burner for several years, the friends approached East Bay bars about teaming up so they could be COVID-compliant. Now, Blake's Grillery splits its time at The Avenue in Temescal (on Wednesday and Saturday), Heart and Dagger Saloon in Lakeshore (Monday and Thursday) and Runway Spirits in Alameda (Friday), where it serves up street tacos with chicken tinga, BBQ carnitas and vegan spicy potatoes, along with specialty tacos, like beef cheeks quesabirria and cheese fried tacos.
The unhealthy air quality from lingering wildfire smoke did put a brief pause on Blake's Grillery. "We have been operating during this fire season except for the last couple days," Parks told Nosh in an email on Tuesday, "We finally needed to give our lungs a break." But now that the air seems to be improving, Parks expects to be back at The Avenue tonight. "We fully plan to operate as normal, smoke be damned!" Follow Blake's Grillery on Instagram for latest updates on their appearances at The Avenue, 4822 Telegraph Ave., Oakland; Heart and Dagger Saloon, 504 Lake Park Ave., Oakland; Runway Spirits, 2505 Monarch St., Alameda
Sobre Mesa reopens for takeout and delivery
Chef Nelson German's Afro-Latino cocktail lounge announced it will reopen today for takeout and delivery. You may recall that Sobre Mesa celebrated its grand opening in early March, about two weeks before COVID-19 shut it down. Up until now, Sobre Mesa was offering some of its menu items, including cocktails and small bites, at Nelson's Uptown restaurant, alaMar Kitchen and Bar. Something worth noting about Sobre Mesa's return — it's open for breakfast (starting at 8:30 a.m., Wednesday through Friday; 10 a.m., Saturday and Sunday), serving coffee, brunch cocktails and pastries like the Sobre Doissant with coconut lime cream ($5) and a croissant stuffed with Jamon serrano, Oaxaca cheese and basil ($4.50). Sobre Mesa, 1618 Franklin St. (at 17th Street), Oakland
Chef Joseph Paire is now at Limewood
Joseph Paire is the new executive chef at Limewood Bar and Restaurant at the Claremont Hotel. Photo: Claremont Club and Spa
The Claremont Hotel's Limewood Bar and Restaurant reopened in August with a new executive chef at the helm. Chef Joseph Paire had joined the kitchen just as the coronavirus crisis hit, but with Limewood closed since March, local diners haven't had a chance to try his food until last month.
Paire's name may sound familiar if you've spent time in the South or back East. He has more than 20 years of fine-dining experience, most recently as the executive chef at The Southern Gentlemen in Atlanta, but also at Barcelona Wine Bar & Restaurant and Mulebone in D.C. In 2016, Paire appeared on an episode of Guy Fieri's Food Network cooking competition show, "Guy's Grocery Games," and that same year, Washington Post food critic Tom Sietsema credited Paire with "cooking notches better than his resume suggests."
At Limewood, Paire has reset and refreshed the menu with a California-D.C.-southern spin, sending out dishes like a bay scallop succotash and avocado toast with Dungeness crab and fermented chili. Diners can give Paire's brunch and dinner menus a try on Limewood's outdoor deck (that view!) or under a canopy in the "Limewood Bungalow." Note that reservations are required. Limewood Bar and Restaurant, Claremont Club and Spa, 41 Tunnel Rd., Berkeley
Sarah Han is Nosh editor at Berkeleyside. Email: sarah@berkeleyside.com.
Oakland's vegan Singaporean-Chinese cafe opens Saturday; another pandemic pop-up gets shut down by health officials
Restaurant Week's return; East Brother's Black Is Beautiful beer; a Mexi-terranean pop-up
La Santa Torta feeds farmworkers affected by wildfires; Mama Oakland to close indefinitely
Oakland food and drinks


PLAB 1 course and the mock tests can be done live at our centre in Manchester UK or you can attend as Live online ( you can attend the classes and the mock tests from your home through Skype).
There will be 2 types of courses.
1) Long course – 3 weeks ( 21 days ) including weekends. There will be two off days during the course.
There will be lecture (theory class) about a particular topic ( example – Respiratory system, Psychiatry etc) in the morning and there will be discussion of past exam questions of the same topic in the afternoon. Usually we teach one topic per day. We will give printed lecture notes and past exam questions during the class.
There will only discussions of the past exam questions of a particular topic. Usually we teach two topics per day. We will not be teaching the theory in the short course. We will give printed past exam questions during the class.
We advise everyone to attend the long course as we teach everything in detail. Chances of passing the exam is very high when you attend the long course. However if you cannot attend the long course for any reason then it is advisable to attend the short course.
We conduct mock tests which almost similar to the PLAB 1 exam.
Mock test will be held in the morning from 9am to 12 noon for 3 hours and there will be discussion of questions in the afternoon from 1.30pm to 7.30pm.
9am till 7pm. There will be 3 breaks. Coffee breaks for 15 minutes in the morning and evening and one hour lunch break.
Off days – 12th and 19th April.
Off days – 6th and 13th May.
Off days – 31st May and 7th June.
There will be 6 mock tests for this exam.
Off days – 12th and 19th July.
Off days – 12th and 19th August.
PLAB 1 Course and Mock test fee from 2018 .
There is refund for the course fee or the mock test fee once paid.
in our course. If you cannot come for the course on the day you have booked, for any unforeseen reasons, you can just call or email us to postpone the course date.
You can pay for the course by cash or bank transfer either on the first day of the course or before. We do not accept cards or cheque at the moment.
If you wish to pay by bank transfer, please email us, we will give you our bank details.
There is no refund for the course fee or the mock test fee once paid.


There was some important bite-sized breakfast news this week, especially if you grew up during the 1990s.
Trix is bringing back its fruit-shaped cereal pieces.
"Classic Trix Fruit Shapes" will hit store shelves this fall, General Mills confirmed in a recent news release.
"Trix cereal is beloved by our fans, and we heard loud and clear that they wanted to see the iconic shapes back in their bowls," said Scott Baldwin, director of marketing for General Mills Cereal, in a written statement.
Apparently, the company received more than 20,000 requests for the change over the last 18 months.
Trix launched in 1954, but it was not until 1991 that the sphere-shaped cereal pieces were swapped out for fruit-shaped ones. The company went back to its spherical roots in 2006.
The classic cereal should be on store shelves at major retailers in the fall.


My flight to Denver is 1 week from today and my life long friend Kirsten and I hike the Gray and Torrey's peak the next day, Saturday, September 3rd.
I have been shopping all week for supplies and have just about everything I need for the hike, but I wanted to make something homemade to take with me to keep my energy up.
We are starting the hike very early in the morning, so it's up to me to pack the food and water I will need for the day. I have Cliff Bars and Jelly Beans that have electrolytes, but I also wanted to make my own energy balls.
Today I am going to share a recipe for a condensed form of energy. They are all natural, gluten-free and delicious. In my opinion, it tastes like chocolate chip cookie dough. They are great for kids before or after practices and activities too.
You will need a food processor or a good blender. I use my food processor all the time to make salsa, hummus, pesto, and these energy balls. The other day I used it to chop my vegetables for my soup. It is one of my favorite kitchen tools.
Add the cashews in your food processor until they are ground fine. Transfer to a bowl and add the flax, chia, protein powder, maple syrup and Better'n Peanut Butter.
It will look something like this at this stage.
Add 1 Tbsp of water and if that is not enough and 1 more until it looks like cookie dough.
Fold in your mini chocolate chips. Make small balls about half the size of a golf ball.
Store in the refrigerator and use anytime.
My kids love these and they are much healthier than cookie dough…and in my opinion, taste just as good.
I will be taking many of these in my camelback to keep my energy up throughout the hike.


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The Origins and Practices of Juneteenth
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The Origins and Practices of Holidays: Father's Day & Shaheedi Guru Arjan Devji
by Dhruti Bhagat June 14, 2019
June 16, 2019 - Father's Day
Sunday, June 16, 2019 is Father's Day in the United States. The annual holiday falls on the third Sunday of June. Father's Day is meant to honor fathers, fatherhood, and paternal bonds. The origins of Father's Day is unclear. Some believe it was created in response to Mother's Day. Other's believe that it stemmed from a memorial service held in 1908 for a group of men who died in a mining accident in Monongah, West Virginia in 1907.
What is clear, is that Sonora Smart Dodd founded the holiday in Spokane, Washington at the YMCA in 1910. The first Father's Day celebration was held at that YMCA on June 19, 1910. Dodd was inspired by the work of Anna Jarvis, who had pushed for Mother's Day celebrations. Her father, Civil War veteran William Jackson Smart, raised six children as a single parent after the death of their mother. Dodd believed her father deserved to be honored and so she established the first Father's Day celebration.
Father's Day did not have much initial success. In the 1920s, Dodd stopped promoting the celebration because she was studying in the Art Institute of Chicago, and it faded. In the 1930s, she returned to Spokane and started promoting the celebration again, raising awareness at a national level. A bill to in favor of recognizing Father's Day nationally was submitted in 1913. In 1916, President Woodrow Wilson wanted to make it official, but Congress resisted, fearing that the holiday would become commercialized. Later, President Calvin Coolidge recommended in 1924 that the day be observed by the nation, but stopped short of issuing a national proclamation. In 1966, President Lyndon B. Johnson issued the first presidential proclamation honoring fathers, designating the third Sunday in June as Father's Day. The holiday was then made a permanent national holiday when President Richard Nixon signed it into law in 1972.
People typically celebrate Father's Day by spending it with the fathers and father figures in their lives. It is also popular to give gifts and share in activities that the fathers/father figures enjoy.
Lear more with the books below.
It's Father's Day!
Father's Day Blessings
June 16, 2019 - Shaheedi Guru Arjan Devji
Sikhs observe the Shaheedi (martyrdom) of the Skih Guru Arjan on June 16. Guru Arjan was the fifth leader of the Sikh religion. On June 16, 1606, Guru Arjan died after being tortured for five days by the Mughal government. The government was led by Emperor Jahangir (you may remember him from our post on Bandi Chhorh Divas).
During the Guruship of Guru Arjan, many people began to follow Sikhism. The Guru also laid the foundation for the Harmandir Sahib. The Harmindir Sahib is the most important pilgrimage site for Sikhs. It eventually became the Golden Temple, when it was rebuilt in the 19th century. The Guru also compiled the hymns and writings of past Gurus to create the Guru Granth Sahib, which is the holy text for Sikhs.
Image of Baba Budda Ji bestowing the GurGaddi upon Guru Arjan Dev Ji. Photo courtesy of Flickr user Navroop Sehmi.
The increased followers of Sikhism, and other actions of the Guru, angered the Emperor, who wanted India to become a Muslim empire. This made the Emperor wary of the Guru. Not too long before, the Emperor Jahangir had prevented his son, Khusrau, from taking his place as Emperor, which the previous Emperor had wanted. After the Emperor cut Khusrau off, Khusrau started to plan a rebellion against him. Then, one day Khusrau went to visit the Guru. The Guru invited him inside, and offered him food and blessings, as he did for all who came to see him. When the Emperor found out, he was upset, and had the Guru arrested for aiding and abetting a fugitive. When the Guru came for the trial, he nominated his son to be his successor, Guru Hargobind. This suggests that he knew that he was unlikely to survive what was going to happen next.
At the trial, the Guru was asked to either pay a fine and admit wrongdoing, or to convert to Islam. The Guru refused to do both, and was sentenced to death by torture. According to historical texts, the Guru was subjected to extreme torture for five days. On the sixth day, the Guru, who was severely burned, was taken for a bath in the river, and he never emerged.
This holiday remembers the sacrifice Guru Arjan made for the Sikh people. The holiday is often celebrated with a cover-to-cover reading of the Sri Guru Granth Sahib. The celebration finishes with hymns and lectures on Sikhism. Sweets are typically offered outside of the gurdwaras for anyone who wants them. Sometimes there is also a procession outside with the Sri Guru Granth Sahib.
Learn more about Sikhism with these items:
The Sikhs
If there's a particular celebration you or someone you know participates in that we missed, let us know by leaving a comment on this post. Or, if you think we got something wrong, please also comment and let us know. We try to be as accurate as possible, but if there's a mistake, we want to correct it.
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text:
Q: Mongoose, MATCH operator doesn't return results The company parameter has a valid value to obtain the result, but I get an empty array.
company = company.replace('.', '');
company = company.replace('.', '');
company = company.replace('-', '');
company = company.replace('/', '');

try {
    const result = await cteModel.aggregate([
    {
        $addFields': {
            date': {
                $dateFromString': { 'dateString': '$dataEmissao' }
            }
        }
    },
    {
        $match: { 'empresa': company }
    },
    {
        $sort: { date: -1, _id: 1 }
    }]);
    res.status(200).send(result);
} catch (error) {
    console.log(error);
    return res.status(500).json(error);
}

A: The query return the deisered result if I substitute the variable by string, like this : { $match: { 'empresa': '1111' } },

redpajama_set_name: RedPajamaStackExchange


Thunder Bay Has a New Photo Booth In Town!
The Beauty Mirror Interactive Selfy Photobooth!
Rent the best photo booth in town!
It is a fully enclosed beautiful Selfy Mirror. The enclosed camera and computer are behind the Glass hidden from spectators. The voice guides users through steps to take awesome photos.
BB image added this awesome new piece to our list of services. Rent it on its own or as part of a Package with one of Our Weddings or Other Photography Services.


text:
2021 Iowa legislative session sees passage of many conservative priorities before adjournment
Stephen Gruber-Miller Ian Richardson
The Iowa Legislature adjourned its 2021 session just before midnight Wednesday, closing out a consequential year that saw the passage of Republican priorities on voting, guns, police, education, abortion and tax cuts.
The legislative session blew past its target end date of April 30 as lawmakers worked to reach a deal on a tax cut package that will shift mental health funding from property taxes to the state, speed up income tax cuts and end the state's inheritance tax.
Republican leaders reached that elusive deal on taxes over the weekend, paving the way for a packed sprint that featured late night debates on enhancing legal protections for police and increasing criminal penalties for protest-related crimes, passing an anti-abortion constitutional amendment, banning local mask mandates and approving the state budget — typically the final item to be passed each year before adjournment.
"I think this legislative session will be seen as one of the most active and influential sessions we've ever had," Senate Majority Leader Jack Whitver, R-Ankeny, told reporters Thursday. "In a lot of ways, I think it will be looked at as a historic session with a number of major policy pieces that we were able to accomplish."
More:The Iowa Legislature just passed a massive tax bill, impacting mental health care and the income tax. Here's what's in it.
Even before the tax discussion dominated the final weeks of the session, Republicans saw many of their priorities become law. Those included requiring schools to offer 100% in-person learning, expanding the options for creating charter schools, reducing the time for early and Election Day voting and allowing adults to purchase and carry handguns without a permit.
"This legislative session, I charged the House and Senate to work together to further advance Iowa's strong recovery from COVID-19 and promote policies that strengthen our families, communities, schools, workforce and economy," Gov. Kim Reynolds, a Republican, said in a statement following the session's conclusion. "I'm proud that we delivered on the promises made to the people of Iowa."
Democrats accused Republicans of focusing on divisive topics and shunting aside their ideas to help the state recover from the COVID-19 pandemic.
"They've largely ignored the challenges that our state is facing, that our small businesses are still struggling with, and it was politics as usual from Iowa Republicans. Division over unity and partisanship over common sense," said Senate Minority Leader Zach Wahls, D-Coralville.
Tensions over COVID-19, masks run through session
The polarization in Iowa over the coronavirus pandemic was apparent in the Legislature from the opening gavel to the final flurry.
On the first day of session in January, several hundred protesters in the Capitol rotunda argued against a statewide mask requirement that was in place at the time. Reynolds lifted the limited requirement in early February.
The pandemic affected how legislators ran the session. For the first time, committee and subcommittee meetings were livestreamed, allowing the public to view the legislative process from afar.
Attendance at the Capitol dwindled as lobbyists and members of the public chose to participate virtually. Those who were present were not required to wear masks, although they were encouraged to do so.
While the legislative session never shut down due to COVID-19, unlike last year, there were 10 publicly reported COVID-19 cases at the Capitol throughout the session. However, reporting a positive test was not mandatory.
From January:Republicans' COVID-19 guidelines for Iowa Legislature have no mask mandate, optional disclosure of positive test
More than four months later, the session ended with lawmakers banning cities, counties and school districts from implementing mask mandates of their own. Reynolds signed the law less than an hour after the session adjourned, to applause as Republican lawmakers and others gathered in her office. A woman in a video of the moment, which House Speaker Pat Grassley tweeted, held a sign that read "Unmask Our Children."
On Thursday, school districts across the metro quickly dropped mask mandates for the final weeks of the year.
"Our students and staff have been doing an amazing job of protecting one another's health, and so it's disappointing that we don't have the support to continue masking through the end of the year," Des Moines Superintendent Tom Ahart told the Register Thursday.
At the Capitol, Democrats argued Republicans didn't do enough to address the health and economic damage caused by the pandemic, which has killed more than 6,000 Iowans since it began last spring.
"We've had over 1,800 Iowans die since we started session," said House Minority Leader Todd Prichard, D-Charles City. "And where had been the urgency for those people?"
More:Iowa records 6,000 COVID-19 deaths. That pain is 'just the tip of the iceberg.'
Republicans have said their approach has been borne out by falling COVID-19 cases and an improving economic outlook.
Grassley, R-New Hartford, pointed to the tax cut package, which includes exemptions on taxation for COVID-19 related grants, as an important piece of pandemic recovery response.
"When the question is asked, 'What have we done for COVID recovery?' I feel very confident in saying anytime we can leave those dollars in the pocket of hardworking Iowans," he said. "I feel pretty good about that as (a) piece of our recovery."
Democrats also criticized Republicans and Reynolds in particular for focusing on issues that divide Iowans, like Reynolds' unsuccessful push for a bill to ban transgender women and girls from participating in girls' sports.
"Instead of working with Iowans to recover from the pandemic she found time to make it on Fox News and throw out some really divisive policies that hurt kids, hurt Iowans and hurt Iowa's reputation instead of being here to help shepherd this session along," said Rep. Jennifer Konfrst, D-Windsor Heights.
'Boring' standings bill gets applause: Lighthearted moments in final hours
When Rep. Gary Mohr, R-Bettendorf, introduced the end-of-session "standings" bill — the final budget bill to receive a vote in the House — late Wednesday he got applause for what he said next.
"It's one of the most boring standing bills in recent memory," he said.
Past standings bills have contained last-minute controversial policy proposals, and there had been murmurings that the measure would contain a ban on transgender women and girls from competing on women's and girls' sports teams.
More:Gov. Kim Reynolds asked lawmakers for a trans athlete ban. The Iowa Legislature adjourned without one.
The applause for Mohr was among the lighthearted moments as lawmakers drew close to the finish late Wednesday.
A few hours earlier, as Democrats and Republicans prepared to leave the floor for their final caucus meeting ahead of the standings bill vote, House Majority Leader Matt Windschitl, R-Missouri Valley, asked Prichard to make a "gentleman's agreement" that Democrats would take a break and return to the floor if the House needed to vote to suspend a rule allowing them to debate past midnight.
Prichard responded by asking what could be in the bill that would require Democrats to lengthen their meeting.
"That is a subjective question. Your caucus thinks differently than my caucus," Windschitl answered.
"I will give you a gentleman's agreement, Army to Marine, to let you know if we're going to need to suspend the rules to go past midnight," Prichard said.
Windschitl asked if that meant he would personally come out to the floor.
"You have me in person," Prichard said. "I realize how much your caucus enjoys my presence."
In the end, the agreement was not necessary. The House adjourned at 11:45 p.m.
Stephen Gruber-Miller covers the Iowa Statehouse and politics for the Register. He can be reached by email at sgrubermil@registermedia.com or by phone at 515-284-8169. Follow him on Twitter at @sgrubermiller.
Ian Richardson covers the Iowa Statehouse for the Des Moines Register. Reach him at irichardson@registermedia.com, at 515-284-8254, or on Twitter at @DMRIanR.


Evan Falcon has spent his whole life in Elbow Creek, a tiny rural town. When his father gets a new job, he's forced to move to Lincoln Heights in the middle of eleventh grade and adjust to life in the big city.
Moving as a teen is tough, especially when his best friend in Elbow Creek is no longer talking to him. Evan finds a new friend, and life starts to feel more normal, especially when he meets Maya. But trouble with his parents leads to being grounded and having to come up with creative ways to date and hang out with his classmates.
And lurking in the background is the sneaking suspicion that his mother is having an affair. How can Evan let his parents know that he knows, and does he even want to tell them? Would this revelation disrupt his life even more than it already is?
Jennifer Caloyeras has created a convincing world for Evan Falcon as he adjusts to his big move. The reader sympathizes with his struggles and wants the best for this likable young man. Urban Falcon is a great read, and I look forward to seeing more from this talented new author.
Warning: Rated mature for sexual situations and language.