Bacille Calmette–Guerin (BCG) vaccine containing live-attenuated Mycobacterium bovis was first used in humans to prevent tuberculosis (TB) in 1921. Intradermal BCG vaccine gives rise to classic primary complex that consists of a cutaneous nodule at the site of injection and subclinical involvement of the regional lymph nodes, which is self-limiting and requires no treatment. BCG lymphadenitis is the most common complication of BCG vaccination. Fine-needle aspiration is the rapid, safe, and cost-effective method for diagnosis as well as the management of BCG lymphadenitis. Awareness of this lesser known entity is important to prevent misdiagnosis. We report two cases of 2½ month and 6-month healthy male infants with left axillary lymphadenopathy following BCG vaccination. Fine-needle aspiration from both the cases revealed features of necrotizing granulomatous lymphadenitis with Ziehl-Neelsen stain for acid-fast bacilli being positive in 2^nd case. Ipsilateral regional lymph node enlargement following BCG vaccination is considered as the most common complication, some progress to suppuration. Very rarely disseminated BCG infection may develop in immune-compromised individuals, resulting in a devastating outcome. Variable strategies have been applied in treating lymphadenitis related to BCG vaccine in the past decade, ranging from observation, antimycobacterial therapy, aspiration, incision, and drainage to lymph node surgical excision.

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Last few decades have seen changes in the approach toward the management of gallbladder cancer (GBCA). Availability of high-definition imaging modalities and accurate interpretations of their findings have helped in early and accurate diagnosis. A structured approach toward the disease with the aid of clinical, noninterventional/interventional radiology and laparoscopic findings has helped surgeons to choose between an aggressive approach of radical cholecystectomy for those with a resectable growth and suitable palliation for those who are unlikely to benefit from therapeutic laparotomy, thereby helping in proper and judicious utilization of health-care resources. Better understanding of the tumor biology is encouraging oncologists for trials with different targeted therapies in advanced disease. This review addresses some of the key issues related to the management of GBCA based on extensive search of available literatures and current international guidelines.

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Introduction: Hepatitis C is caused by hepatitis C virus (HCV), which is classified into 6 genotypes. It leads to chronic liver disease in majority of cases resulting in morbidity and mortality. Awareness of cause of a disease prevents its progression in the community so knowledge regarding the cause of infection (HCV) is necessary to devise a strategy to prevent its spread. The present study was undertaken to assess the incidence, prevalence, and cause of Hepatitis C among the Malwa region of Punjab, India. Materials and Methods: Seven hundred and forty hepatitis C-positive patients were included in the study. Prevalidated questionnaire was designed to collect their demographic information including age, gender, demographic area, occupation, and clinical information including the history of dental treatment (extraction, root canal treatment, and scaling), blood donation, blood transfusion, surgical intervention, drug abuse (oral or intravenous), and tattooing. Collected data were analyzed by statistical tests. Results: Among the study population, a large number of patients, that is, 84.8% presented with a history of dental treatment indicating that a number of 190 (25.6%) patients had received dental treatment from family dentist and 175 (23.6%) from referral dentist, that is, from the government hospital. A large number of patients 270 (36.5%) had received dental treatment from Quacks in the past. Blood transfusion was received by 8.1% and 17.6% had donated blood in the past. Conclusion: The etiology of HCV is multifactorial with inadequate awareness about the routes of transmission of infection among patients, therefore, knowledge regarding this issue is important. The use of disposable syringes, sterilization protocol, disposal, strictly following biomedical waste management guidelines, and organizing continued medical and dental education programs, and workshops will help in preventing the spread of HCV infection.

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Background and Objectives: Breast carcinoma, the most common malignant tumor and the leading cause of cancer death in women, affects Iranian women at least one decade earlier. Lymphatic vessel invasion (LVI) is one of the most important prognostic factors in breast carcinoma. The aim of this study was to compare the results of detecting lymphatic invasion in immunohistochemistry (IHC) method with routine histologic evaluation. Materials and Methods: A total of 116 breast cancer specimens were evaluated. IHC staining for D2–40 marker was performed on paraffin-embedded blocks of tumor samples to detect LVI. Results: Sensitivity, specificity, positive, and negative predictive values of H and E staining for detection of the lymphatic invasion were 41%, 66%, 54.8%, and 53.5%, respectively. Kappa coefficient between H and E and D2–40 stainings was 0.078. The most common sites of lymphatic invasions were intratumoral area and tumor periphery. Conclusions: It seems that D2–40 staining is necessary for accurate diagnosis of LVI in breast cancer. Furthermore, evaluation of intratumoral area and tumor periphery can probably increase the chance of finding lymphatic invasion.

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The aim of this study was to investigate the three heart chambers' cardiac chloroma in a patient with non-M3 acute myeloid leukemia. In this report, we presented a 38-year-old man in good health with no relevant history of any specific diseases before. There was swelling of the right lower extremity with the first impression of acute deep vein thrombosis. Anticoagulant treatment was initiated after duplex sonography of lower limbs confirmed this diagnosis. Our case had a complete response to chemotherapy regimen, and radiotherapy was not needed and then bone marrow transplant was performed successfully.

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Aims: The aims of this study were to identify the risk factors and describe molecular epidemiology carbapenem-resistant Acinetobacter calcoaceticus-baumannii complex (ACB complex) at a district hospital in Taiwan. Materials and Methods: This is a case–control study at a district hospital in the Penghu Islands, Taiwan, from May 2014 to June 2016. Patients with carbapenem-resistant ACB complex and controls with carbapenem-nonresistant ACB complex were identified, and relevant clinical data obtained from them were compared. Risk factors for carbapenem-resistant ACB complex isolation were searched using bivariable and multivariable analysis. The available isolates from patients were genotyped using a pulsed-field gel electrophoresis (PFGE) method. Results: A total of 70 patients were included in this study (36 cases and 34 controls). A bivariable analysis showed that patients who had a hospital admission within the past 3 months and had a recent nasogastric tube insertion had a tendency for subsequent carbapenem-resistant ACB complex isolation (P = 0.066 and 0.051, respectively). Previous exposure to fluoroquinolones was significantly associated with the occurrence of carbapenem-resistant ACB complex (P = 0.028). Further multivariable analysis showed that previous exposure to fluoroquinolones (odds ratio, 10.477; 95% confidence interval, 1.117–98.270; P = 0.040) was an independent risk factor associated with the occurrence of carbapenem-resistant ACB complex. According to PFGE for available carbapenem-resistant ACB complex isolates, one major clone was disseminated in the hospital. Conclusions: The antibiotic selective pressure of fluoroquinolone and interpatient dissemination contributed to the occurrence of carbapenem-resistant ACB complex.

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Background: The aim of this study is to evaluate the outcomes and prognostic factors in patients with hepatocellular carcinoma (HCC) and Child–Turcotte–Pugh (CTP) class B liver function after stereotactic ablative radiotherapy (SABR). Materials and Methods: This retrospective study evaluated patients with HCC and impaired liver function who underwent SABR between December 2007 and August 2016. All patients had CTP class B liver function before treatment. Local control (LC) rate, overall survival (OS) rate, prognostic factors, and radiation-related toxicity were evaluated. Results: This study included 34 patients. The majority had a CTP score of B7 (52.9%) and advanced HCC (91.2%). The median survival time was 4.8 months, and the 1-year OS rate was 21.4%. Only the tumor number (multiple vs. single) was identified as an independent predictor of survival. The 1-year LC rate was 95.8%. Eight patients (23.5%) developed the radiation-induced liver disease, and 15 (44.1%) had a CTP score decline of ≥2 within 3 months. Other toxicities were generally tolerable. Conclusion: SABR may be considered as an alternative option for patients with HCC and CTP class B liver function, particularly for those with a single lesion.

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We report a case of huge carcinosarcoma of lung initially presenting as an intra-abdominal mass: treatment with enucleation of the firm sarcomatous component followed by pulmonary resection. A 65-year-old man with mild mental retardation who smoked one pack of cigarettes per day until 1-month before he was admitted to our hospital complaining of a progressively poorer appetite, vomiting and an abdominal mass at the left upper quadrant region. Physical examination revealed a palpable mass over the left upper abdomen with percussion dullness of the lower hemithorax. Chest radiograph revealed a homogeneous mass lesion in the left lower lung field with obliteration of the costophrenic angle. Computed tomography scans of the chest disclosed a huge mass over the left lower thorax and upper abdomen with compression of the heart and shift of the esophagus and descending aorta to the midline. Sono-guided aspiration biopsy cytology revealed squamous cell carcinoma. Surgical intervention with enucleation of the very firm sarcomatous component with fragmentation followed by radical lobectomy. Chemotherapy was planned as adjuvant therapy in the postoperative period, but the patient's family declined it. The patient is currently survived without tumor recurrence 14 months after surgery. Our case revealed a huge tumor not only mediastinal compression but also initial presenting abdominal symptoms. Initially, from the symptoms and nonbiopsy study, we were unable to determine exactly if it was an intrathoracic tumor or an intra-abdominal tumor. This case highlights the importance of remaining clinically vigilant to differentiate an unusual tumor mass, and preoperative tissue proof is warranted.

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Objectives: Heroin dependence (HD) is a chronic brain disease with genetic contribution. NeuroD1/D6 are neurogenic differentiation factors that play a role in development and differentiation of the brain. In this study, we intended to investigate the association of NeuroD1/D6 gene polymorphism and the occurrence of HD, and the role of this genetic variability in specific personality traits of HD patients. Materials and Methods: A total of 694 individuals were recruited in this study (313 HD patients and 381 normal controls). Patients with HD were further classified into four clinical subgroups to reduce heterogeneity. Genetic variants of selected single-nucleotide polymorphisms in NeuroD1 (rs1801262, rs16867467, and rs2583016) and NeuroD6 (rs2233404) were genotyped. We used the Chinese version of tridimensional personality questionnaire to assess specific personality traits in subjects. Results: For allele and genotype frequency analysis, we found a weak association between NeuroD1 rs16867467 and patients with HD (P < 0.05). Nonetheless, the association findings could not remain significant after Bonferroni's correction. For specific personality traits, NS score was negatively correlated with age in both study groups (P < 0.05); however, the NeuroD SNPs were not associated with the novelty-seeking/harm avoidance scores in patients with HD. Conclusions: Our study suggests that NeuroD1/D6 gene polymorphism may neither be associated with the occurrence of HD nor did these polymorphisms influence the personality traits in patients with HD.

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