Zydus Lifesciences Limited, formerly known as Cadila Healthcare Limited, is an Indian multinational pharmaceutical company headquartered in Ahmedabad, which is primarily engaged in the manufacture of generic drugs. It ranked 100th in the Fortune India 500 list in 2020.
INTRODUCTION: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a nuclear imaging modality employed for evaluation of distant metastasis, response to chemotherapy or recurrence of disease in early breast cancer (EBC), but its role in diagnosing locoregional axillary nodal disease is still unclear. Current guidelines dictate sentinel lymph node biopsy (SLNB) for evaluation of axillary involvement followed by axillary lymph node dissection (ALND). We conducted a study to test the sensitivity of FDG PET/CT in detecting lymph node metastasis in EBC, compared with post-ALND histopathological examination. MATERIALS AND METHODS: In a prospective single-center study at a rural tertiary hospital, 33 women with newly diagnosed EBC underwent FDG PET/CT for primary disease status and abnormally increased axillary nodal FDG uptake. These results were then compared with postoperative ALND histopathology report and the data collected were subjected to appropriate statistical analysis. RESULTS: Out of 33 patients who underwent FDG PET/CT followed by modified radical mastectomy and ALND, 24 patients had T2 lesions and 9 had T1 lesions. The sensitivity, specificity, and positive and negative predictive values for nodal metastasis on PET/CT were 50%, 100%, 100%, and 62.5%, respectively. CONCLUSIONS: FDG PET/CT exhibits moderate sensitivity and high specificity for axillary nodal metastasis in EBC. It is not advisable to use FDG PET/CT as a standalone investigation for axillary nodal staging in EBC as it cannot replace SLNB. SLNB remains the investigation of choice for nodal staging and requires capacity building, infrastructure, and training, especially in resource-poor institutions.
Endoscopic Retrograde Cholangiopancreatography (ERCP) is the gold standard for managing biliary drainage in patients with Common Bile Duct (CBD) obstruction, boasting a success rate exceeding 95%. However, its efficacy is limited in cases involving tumor invasion of the duodenum or major papilla, as well as post-surgical conditions. This study evaluates the outcomes of Endoscopic Ultrasound (EUS)-guided choledochoduodenostomy as an alternative for patients with unsuccessful ERCP due to malignant mid and lower-end biliary obstruction at our center. A single-center prospective observational study was conducted from September 2018 to March 2020, compiling data from patients with confirmed malignancy and mid to lower-end CBD block undergoing choledochoduodenostomy. Exclusion criteria included pregnancy, heart, renal, and hepatic failure, and bleeding disorders. The study assessed technical success (successful stent placement) and clinical success (≥50% reduction in serum total bilirubin at day 14). Procedure and follow-up complications were also documented. EUS-guided choledochoduodenostomy was performed on 12 patients with varying causes of biliary obstruction: seven with pancreatic cancer, one with periampullary carcinoma and lower CBD strictures, two with gallbladder carcinoma and mid-CBD block due to metastatic lymph nodes, and two with ampullary carcinoma. The mean bilirubin was 21.8 mg/dL (±3.4 mg/dL). The study showed a 100% technical success rate and a 91.67% clinical success rate. Minor procedure-related complications were observed, including one case of local bleeding and one case of stent blockage. Additionally, two patients experienced stent migration during follow-up. The 12- month follow-up revealed a 65% survival rate, with four patients succumbing to their underlying malignancy or other causes. EUS-guided choledochoduodenostomy is a safe and effective alternative for biliary drainage in patients with mid and lower-end malignant CBD block after failed ERCP.
Nuclear protein of the testis (NUT) carcinoma is an extremely rare and aggressive malignancy characterized by NUTM1 gene rearrangements, often presenting as poorly differentiated tumors in midline structures. This case describes a 27-year-old male with a rapidly progressive nasal mass extending into adjacent structures, ultimately diagnosed as NUT carcinoma of salivary gland origin through molecular confirmation of the BRD4-NUT fusion. Despite surgery, radiotherapy, and systemic chemotherapy, the disease exhibited poor response and aggressive progression, consistent with its known high mortality and resistance to conventional treatment. This case underscores the importance of molecular diagnostics in diagnosing rare cancers and highlights the urgent need for targeted therapies such as bromodomain and extraterminal inhibitors to improve outcomes.
Introduction: The fixed-dose combination (FDC) of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors offers an effective, non-metformin based option for patients with type-2 diabetes mellitus (T2DM) who cannot tolerate metformin. The objective of the study was to address the existing gaps in knowledge about FDC of SGLT-2 inhibitors and DPP-4 inhibitors particularly, the combination of dapagliflozin and sitagliptin FDC and to provide evidence to address these issues. Methods: This cross-sectional, observational, questionnaire-based study was conducted at five round table meetings, which included clinicians from India. A validated questionnaire (of 9 questions) was used to assess clinical views on dapagliflozin and sitagliptin FDC therapy for T2DM management. The opinions and suggestions from all the meetings were compiled and analyzed, to derive the consensus statement. Results: A strong consensus (89.47%) identified efficacy as the key factor for the early initiation of combination therapies for glycemic control. Experts (90.91%) agreed that combining SGLT-2 inhibitors and DPP-4 inhibitors enhances insulin sensitivity. A consensus (55.56%) supported early initiation of dapagliflozin and sitagliptin FDC to reduce hypoglycemia risk. Experts also noted the regimen’s simplicity (59.26%) and, with a majority (78.57%), agreed that it reduces major cardiovascular (CV) events, weight, blood pressure, and heart failure risk while improving the lipid profile. Most experts (80.56%) supported the early use of dapagliflozin and sitagliptin FDC in T2DM patients with CV risk. Conclusion: The consensus strongly indicates that early initiation of dapagliflozin and sitagliptin FDC therapy improves glycemic control, reduces CV events, and enhances patient outcomes.
