Mucosal melanoma of the head-and-neck

Mucosal melanoma of the head-and-neck region: A single institutional clinical experience

Mathumitha Ramesh, Siddhartha Nanda, Biplab Misra
Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Date of Web Publication 14-Jan-2019

Correspondence Address:
Dr. Siddhartha Nanda
Department of Radiotherapy, All India Institute of Medical Sciences, Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sajc.sajc_326_18

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How to cite this article:
Ramesh M, Nanda S, Misra B. Mucosal melanoma of the head-and-neck region: A single institutional clinical experience. South Asian J Cancer 2019;8:26-40

How to cite this URL:
Ramesh M, Nanda S, Misra B. Mucosal melanoma of the head-and-neck region: A single institutional clinical experience. South Asian J Cancer [serial online] 2019 [cited 2019 Jan 17];8:26-40. Available from: http://journal.sajc.org/text.asp?2019/8/1/26/250091


Dear Editor,

Due to the rarity of mucosal melanoma, the scientific knowledge is limited compared to its cutaneous counterpart. Weber reported the first case of mucosal melanoma of the head-and-neck region in 1856.[1] The largest case series of mucosal melanoma of the head-and-neck region was reported by Bachar et al.[2] with 61 patients over 41 years and in India, Gupta et al.[3] reported 42 patients over the period of 8 years. This is one such attempt with four cases over 1 year.

A 26-year-old female patient presented with the complaints of epistaxis and nasal obstruction. Computed tomography-scan (CT) revealed a large expansile soft-tissue mass in the right maxillary sinus extending into the nasal cavity, right upper alveolar arch, right orbit, and right buccal space. Biopsy and immunohistochemistry confirmed the diagnosis of malignant melanoma [Figure 1] and [Figure 2].

Figure 1: (a) Stratified squamous epithelium lined tissue with underlying diffuse sheets of epithelioid melanocytes along with brownish-black pigment (H and E). (b) Individual tumour cells showing clear cytoplasm and pleomorphic vesicular nuclei with prominent nucleoli (c) HMB 45 expression. (d) Melan-A positivity

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Figure 2: Computed tomographyscan reconstructed saggital view

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The patient underwent right total maxillectomy with right orbital exenteration and the bony margin was involved by tumor. Adjuvant radiotherapy of 60 Gy in 6 weeks was delivered. Unfortunately, 4 months after the completion of treatment, the patient developed recurrent right submandibular lymphnode, bilateral lung metastasis along with nodular lesions in retroperitoneal and right infrarenal region. The patient was started on palliative chemotherapy (paclitaxel + carboplatin). After three cycles of chemotherapy, contrast-enhanced CT scan (CECT) showed all the retroperitoneal and infrarenal lesions had regressed completely, whereas there was a partial reduction in the right submandibular lymphnode and lung metastasis. In view of the good response, the patient was given three more cycles of the same chemotherapy regimen. After 1 month, the follow-up CECT scan showed residual right submandibular lymph node and persisting bilateral lung metastasis. The patient was put on Tablet Sorafenib. Due to toxicity, she was shifted to an alternative chemotherapy regimen (dacarbazine + cisplatin). After three cycles, positron-emission tomography (PET-CT scan) showed the persistence of the previous disease and an appearance of new metastatic involving right iliac bone for which the patient received palliative radiotherapy. At present, the patient is put on tablet Imatinib and has a stable disease condition until the last follow-up.

A 43-year-old male presented with complaint of blackish mass in the right buccal mucosa. The biopsy from this lesion confirmed melanocarcinoma. He underwent inferior partial maxillectomy, and the postoperative histopathology showed malignant melanoma. All margins were uninvolved by tumor with no perineural invasion or lymphovascular invasion [Figure 3].

Figure 3: Stratified squamous epithelium lined tissue with underlying sheets of epithelioid melanocytes arranged in an organoid pattern and fascicles of spindled melanocytes along with brownish-black pigment. Inset-epithelioid melanocytes showing indistinct cytoplasmic borders and pleomorphic vesicular nuclei with prominent nucleoli

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The patient received immunotherapy as adjuvant treatment. However, after 3 months of disease-free interval, the patient had regional reccurrence in right level II lymphnode confirmed by fine-needle aspiration cytology (FNAC) and PET-CT scan [Figure 4]. The patient underwent bilateral modified radical neck dissection.

Figure 4: Computed tomographyscan and positron emission tomography scan showing right level II lymphnode involvemet

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Following which the patient received radiotherapy of 60 Gy in 6 weeks. The patient had no evidence of disease until last follow-up.

A 62-year-old male presented with complaints of Left nasal blockage, protruding Left nasal mass covering the whole of the Left nasal cavity and swelling in the Left side of the hard palate. The CECT-scan showed a locally advanced lesion in the Left nasal cavity, Left maxillary cavity which was extending to the oral cavity along with liver and lung metastasis. The biopsy and immunohistochemical of nasal mass confirmed the diagnosis of malignant mucosal melanoma [Figure 5] and [Figure 6].

Figure 5: (a) Diffuse positivity for HMB 45. (b) Diffuse positivity for Melan A. (c) Diffuse positivity for S 100. (d) Vimentin expression by tumour cells. (e) Negative staining for CK 20 and (f) negative staining for synaptophysin

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Figure 6 : Computed tomography-scan (axial and reconstructed saggital view) showing a large sino-nasal mass

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The patient was treated with palliative chemotherapy (dacarbazine, cisplatin, and vinblastine X six cycles). Later, he received palliative radiotherapy for epistaxis. At the last follow-up, the patient had no bleeding from the local site and had a stable disease.

The patient was treated with palliative chemotherapy (dacarbazine, cisplatin, and vinblastine X six cycles). Later, he received palliative radiotherapy for epistaxis. At the last follow-up, patient had no bleeding from the local site and had stable disease.

A 68-year-old female presented with complaints of bulging of the left eye with occasional bleeding from the left eye. CT-scan showed an intraorbital mass on the posterolateral wall of the left orbit. She underwent left orbital exenteration, and the postoperative histopathology confirmed the diagnosis of malignant melanoma of the eye. Neck dissection was planned, but the patient was lost to follow-up [Table 1].

Table 1: Summarised Observertaions

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In western studies,[2],[4] the mean age was 65–70 years. In an Indian study,[3] mean age was 53 years which was similar to our series (49.7 years). The majority of mucosal melanoma arises in the sinonasal and oral cavity[2],[3] which correlates with our study. According to Szabo,[5] this is mainly due to the high density of melanocytes in these regions.

According to many studies,[2],[6],[7] the female patients were relatively younger and had a better prognosis. The female patient in our series is the youngest. Nasal obstruction, pain, and epistaxis were the most common symptoms in our sinonasal melanoma patients which is similar to a study by Meleti et al.[6]

According to Bakkal et al.,[8] the local, regional, and systemic recurrences were 20%, 50%, and 80%, respectively, and all patients with metastasis had lung involvement. Two of our patients who had metastatic disease had lung involvement, and one had developed regional recurrence. As surgery is the primary modality of treatment,[9] three of our patients who had localized disease underwent surgery.

Mendenhall et al.[9] stated that the radiation could reduce local recurrence but has no survival benefit. One of our patients who underwent adjuvant radiotherapy had developed distant metastasis after 3 months of disease-free survival (DFS). Another patient who received immunotherapy as adjuvant treatment developed regional recurrence after 3 months of DFS.

As noted by various studies,[6],[10] our experience with these patients showed that the outcome was not affected by treatment modality chosen. With the use of hypofractionation schedules and newer treatment delivery techniques, radiotherapy presently improves loco-regional control[7],[11] in malignant melanoma which was once thought to be radio-resistant.[12] However, larger case series and longer follow-up are required to bring further light to this topic.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to show our gratitude to our departmental staff and collegues, especially Dr. Nighat Hussain, Additional Professor and Dr. Vandita Singh, Assistant Professor from the Department of Pathology, All India Institute of Medical Sciences, Raipur, for their assistance in preparation in the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References Top

1. Weber CO. Surgical Experience and Research, in Addition to Interesting Observations from the Surgical Clinic and the Protestant Hospital Bonn. Berlin, Germany: Reimer G; 1859. p. 304-5. Back to cited text no. 1
2. Bachar G, Loh KS, O’Sullivan B, Goldstein D, Wood S, Brown D, et al. Mucosal melanomas of the head and neck: Experience of the princess Margaret hospital. Head Neck 2008;30:1325-31. Back to cited text no. 2
3. Gupta T, Agarwal J, Singh S, Ghosh-Laskar S, Chaturvedi P, Kane S, et al. Mucosal melanoma of the head and neck: Tata memorial hospital experience. Int J Head Neck Surg 2010;1(3):141-5. Back to cited text no. 3
4. Manolidis S, Donald PJ. Malignant mucosal melanoma of the head and neck: Review of the literature and report of 14 patients. Cancer 1997;80:1373-86. Back to cited text no. 4
5. Szabo G. The number of melanocytes in human epidermis. Br Med J 1954;1:1016-7. Back to cited text no. 5
6. Meleti M, Leemans CR, de Bree R, Vescovi P, Sesenna E, van der Waal I, et al. Head and neck mucosal melanoma: Experience with 42 patients, with emphasis on the role of postoperative radiotherapy. Head Neck 2008;30:1543-51. Back to cited text no. 6
7. Wada H, Nemoto K, Ogawa Y, Hareyama M, Yoshida H, Takamura A, et al. A multi-institutional retrospective analysis of external radiotherapy for mucosal melanoma of the head and neck in Northern Japan. Int J Radiat Oncol Biol Phys 2004;59:495-500. Back to cited text no. 7
8. Bakkal FK, Başman A, Kızıl Y, Ekinci Ö, Gümüşok M, Ekrem Zorlu M, et al. Mucosal melanoma of the head and neck: Recurrence characteristics and survival outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;120:575-80. Back to cited text no. 8
9. Mendenhall WM, Amdur RJ, Hinerman RW, Werning JW, Villaret DB, Mendenhall NP, et al. Head and neck mucosal melanoma. Am J Clin Oncol 2005;28:626-30. Back to cited text no. 9
10. Gaze MN, Kerr GR, Smyth JF. Mucosal melanomas of the head and neck: The Scottish experience. The Scottish melanoma group. Clin Oncol (R Coll Radiol) 1990;2:277-83. Back to cited text no. 10
11. Ballo MT, Ang KK. Radiation therapy for malignant melanoma. Surg Clin North Am 2003;83:323-42. Back to cited text no. 11
12. Paterson R. Classification of tumors in relation to radiosensitivity. Br J Radiol 1933;6:218-33. Back to cited text no. 12
Mucosal melanoma of the head-and-neck

Head-and-neck soft-tissue sarcomas

zoom.png Multimodality treatment of head-and-neck soft-tissue sarcomas and short-term outcomes: Analysis from sarcoma medical oncology clinic p. 69
Ilavarasi Vanidassane, Aparna Sharma, Aditi Aggarwal, Sudhakar Gunasekar, Adarsh Barwad, Ekta Dhamija, Rambha Pandey, Suryanarayana Deo, Rakesh Garg, Sameer Rastogi
DOI:10.4103/sajc.sajc_229_18 Background: Head-and-neck soft-tissue sarcomas (HNSTS) are extremely rare and lack definite guidelines. Methods: We retrospectively analyzed consecutive adult patients with HNSTS who presented to our sarcoma medical oncology clinic from January 2016 to October 2017. Results: There were a total of 30 patients. Unresectable localized disease was seen in 13 (43%) patients, metastatic disease 10 (34%) patients, while resectable disease in 7 (23%) patients only. Among unresectable localized disease, 3 (25%) patients could be converted to resectable disease after neoadjuvant therapy. Median follow period was 11 months. Progression-free survival was 19 months in patients with resectable disease and 6 months in patients with the unresectable/metastatic disease. Median OS was not reached. Conclusion: Unresectable HNSTS has a poor outcome. Neoadjuvant therapy can be tried in selected cases for achieving respectability or for vital organ preservation until robust data are available. A multidisciplinary approach for local control is crucial in managing unresectable HNSTS.
Head-and-neck soft-tissue sarcomas

Locally advanced oral cavity and oropharyngeal cancers

A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation p. 47
Rituparna Biswas, Anirban Halder, Anshuman Ghosh, Sajal Kumar Ghosh
DOI:10.4103/sajc.sajc_7_18
Background: Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers. Aim: The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation. Materials and Methods: Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m2). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome. Results: The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups. Conclusions: Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities.

Locally advanced oral cavity and oropharyngeal cancers

Pressurized intraperitoneal aerosol chemotherapy

zoom.png Pressurized intraperitoneal aerosol chemotherapy procedure for nonresectable peritoneal carcinomatosis: First Indian study p. 27
SP Somashekhar, KR Ashwin, Rohit C Kumar, Amit Rauthan, Sushmita H Rakshit
DOI:10.4103/sajc.sajc_92_18 Background: Peritoneal carcinomatosis (PC) is a common evolution of abdominal cancers and is associated with poor prognosis. A few selected patients have option of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, but majority who are not eligible for curative approach can undergo pressurized intraperitoneal aerosol chemotherapy (PIPAC). It is an emerging field of research with major therapeutic potential. It is a safe and innovative approach, which enhances the effect of chemotherapy without major toxicity. Methods: Between June 2017 and December 2017, 21 PIPAC applications in seven patients with standard chemotherapy regimen every 6 weeks at 37°C and 12 mmHg for 30 min was performed. The patients’ demographics, perioperative findings, adverse events, and outcomes were prospectively recorded. Results: Twenty-one PIPAC administrations were performed in 7 patients with PC from various pathologies. The median hospital stay was 1 day. All the patients had symptomatic relief with complete resolution of ascites. There was no major perioperative complications. CTCAE Grades 1 and 2 were observed in three patients, for abdominal pain and nausea. Renal and hepatic functions were not impaired. Of the seven patients, one patient had complete histological remission; three patients had partial response, one had stable disease and one patient had no response with clinical progression. Conclusion: Our results show the feasibility and safety of PIPAC in Indian patients. The procedure has low morbidity with no mortality with the short learning curve. It can be easily adapted for Indian patients with diffuse PC as a palliative option apart from systemic chemotherapy.
Pressurized intraperitoneal aerosol chemotherapy

Cancer

REVIEW ARTICLE
Treatment of advanced nonsmall cell lung cancer: First line, maintenance and second line – Indian consensus statement update Highly accessed article p. 1
Kumar Prabhash
DOI:10.4103/sajc.sajc_227_18 The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming increasingly complex with the identification of driver mutations/rearrangements and development/availability of appropriate targeted therapies. In 2017, an expert group of medical oncologists with expertise in treating lung cancer used data from published literature and experience to arrive at practical consensus recommendations on treatment of advanced NSCLC for use by the community oncologists. This was published subsequently in the Indian Journal of Cancer with a plan to be updated annually. The present document is an update to the 2017 document.
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ORIGINAL ARTICLES: BREAST CANCER Top

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Stromal expression of CD10 in breast carcinoma and its correlation with clinicopathological parameters p. 18
Ashish Nitin Dhande, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Maithili Mandar Kulkarni, Nidhi Pandya, Neelam Mohanapure, Aakriti Aggarwal, Gargi Patil
DOI:10.4103/sajc.sajc_56_18 Introduction: Breast cancer is the foremost cause of death in women worldwide with more than one million cases occurring annually. Aim: This study was conducted to study the stromal CD10 expression in breast carcinomas (BCa) and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2neu, and Ki67 status. Materials and Methods: Sixty cases of BCa diagnosed between 2013 and 2015 were included in the study. Stromal expression of CD10 was studied on entire section of selected BCa blocks for all cases. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical markers ER, PR, and HER2/Neu and Ki67 in all cases. Results were subjected to statistical analysis. Results: Stromal CD10 positivity was seen in 78.3% cases, out of which 53.3% of cases were strongly positive, and 25.0% cases were weakly positive. Positivity for ER, PR, HER2, and Ki67 was 31.7%, 33.3%, 65%, and 75%, respectively. Stromal expression of CD10 was found to be significantly associated with increasing tumor grade, lymph node status, HER2neu positivity, ER negativity, and Ki67 positivity. CD10 stromal expression was seen mainly in PR negative BCa cases; however, it was statistically insignificant. It was noted that CD10 stromal positivity increased with increasing grade. Conclusion: CD10 can be used as an independent prognostic marker and should be included in routine histopathology report. CD10 could act as a potential target for newer drug development.
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ORIGINAL ARTICLES: GI CANCER Top

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Practice patterns and outcomes with the use of regorafenib in metastatic colorectal cancer: Results from the Regorafenib in Metastatic colorectal cancer – An Indian exploratory analysis study p. 22
Anant Ramaswamy, Vikas Ostwal, Nikhil Pande, Atul Sharma, Shekar Patil, Ravi Thippeswamy, Nikhil Ghadyalpatil, Rakesh Roy, Harish Peshwe, Bhavesh Poladia, Deepan Rajamanickam, Bharat Rangarajan, PR Neelesh Reddy, Vimal Pandita, Ashis Mukherjee, Aniket Thoke, Abhijit Sarkar, CT Satish, H Shashidara, SD Banavali
DOI:10.4103/sajc.sajc_173_18 Background: Regorafenib is considered a standard of care as third-line therapy in metastatic colorectal cancers (mCRCs). Materials and Methods: The study was based on a computerized clinical data form sent to oncologists across the country for entry of anonymized patient data. The data entry form was conceived and generated by the coordinating center’s (Tata Memorial Hospital) gastrointestinal medical oncologists and disseminated through personal contacts at academic conferences as well as through E-mail to various oncologists across India. Results: A total of 19 physicians contributed data resulting in 80 patients receiving regorafenib who were available for the evaluation of practice patterns. The median age was 55 years (range: 24–75). Majority had received oxaliplatin-based (97.5%), irinotecan-based (87.5%), and targeted therapy (65%), previously. Patients were primarily started on reduced doses of regorafenib upfront (160 mg – 28.8%, 120 mg – 58.8%, and 80 mg – 12.5%). The median duration of treatment (treatment duration) with regorafenib was 3.1 months (range: 0.5–18), while the median progression free survival was 3.48 months (range: 2.6–4.3). Forty-five percent of patients required dose modifications due to toxicities, and the most common were (all grades) hand-foot syndrome (68.8%), fatigue (46.3%), mucositis (37.6%), and diarrhea (31.3%). Conclusions: Majority of physicians in this collaborative study from India used a lower dose of regorafenib at the outset in patients with mCRC. Despite a lower dose, there was a significant requirement for dose reduction. Duration of treatment with regorafenib as an efficacy end point in this study is similar to available data from other regions as it is the side effect profile.
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Pressurized intraperitoneal aerosol chemotherapy procedure for nonresectable peritoneal carcinomatosis: First Indian study p. 27
SP Somashekhar, KR Ashwin, Rohit C Kumar, Amit Rauthan, Sushmita H Rakshit
DOI:10.4103/sajc.sajc_92_18 Background: Peritoneal carcinomatosis (PC) is a common evolution of abdominal cancers and is associated with poor prognosis. A few selected patients have option of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, but majority who are not eligible for curative approach can undergo pressurized intraperitoneal aerosol chemotherapy (PIPAC). It is an emerging field of research with major therapeutic potential. It is a safe and innovative approach, which enhances the effect of chemotherapy without major toxicity. Methods: Between June 2017 and December 2017, 21 PIPAC applications in seven patients with standard chemotherapy regimen every 6 weeks at 37°C and 12 mmHg for 30 min was performed. The patients’ demographics, perioperative findings, adverse events, and outcomes were prospectively recorded. Results: Twenty-one PIPAC administrations were performed in 7 patients with PC from various pathologies. The median hospital stay was 1 day. All the patients had symptomatic relief with complete resolution of ascites. There was no major perioperative complications. CTCAE Grades 1 and 2 were observed in three patients, for abdominal pain and nausea. Renal and hepatic functions were not impaired. Of the seven patients, one patient had complete histological remission; three patients had partial response, one had stable disease and one patient had no response with clinical progression. Conclusion: Our results show the feasibility and safety of PIPAC in Indian patients. The procedure has low morbidity with no mortality with the short learning curve. It can be easily adapted for Indian patients with diffuse PC as a palliative option apart from systemic chemotherapy.
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Transarterial radioembolization with Iodine-131-Lipiodol for hepatic metastases from gastrointestinal malignancies – Experience in tertiary care oncology center in India p. 31
Vidya Bhargavi, Indusekhar Subbanna, KG Kallur, Aakash Patel, Shivakumar Swamy, Shekar Patil
DOI:10.4103/sajc.sajc_205_17 Context: Unresectable colorectal hepatic metastases can be treated with radioembolization. Aims: The aim of this study is to analyze the response and survival benefits of transarterial radioembolization (TARE) with Iodine-131 (131I) Lipiodol for hepatic metastases from gastrointestinal malignancies. Settings and Design:Retrospective study of 20 patients with pathologically proven hepatic metastases from primary gastrointestinal malignancies referred for palliative therapy with TARE. Subjects and Methods: At baseline, standard laboratory and imaging data were recorded. All patients fulfilling the inclusion/exclusion criteria underwent TARE with 131I Lipiodol. Post procedure, the patients were reviewed after 1 month with follow-up positron emission tomography–computed tomography and tumor marker levels to evaluate treatment response with continued follow-up till December 2016 and overall survival calculated. Statistical Analysis Used: Data were analyzed using a statistical analysis package (Social sciences, version 15.0 for Windows; SSPS Inc.). Survival data were plotted using Kaplan–Meier survival curves. Results: At the end of follow-up period, 15 of 20 patients were alive. The mean and median survival was 38.88 ± 5.0 months (95% confidence interval [CI], 29.03–48.74 months, P = 0.17) and 49.3 ± 12.4 months (95% CI, 25.0–73.7 months, P = 0.17), respectively. 66 months survival was 75%. Response evaluation in 10 patients showed partial response in 3 (30%), stable disease in 2 (20%) and progressive disease in 5 (50%) patients. All patients with partial response showed a reduction in serum tumor marker levels. Conclusions: TARE with 131I-Lipiodol is highly effective with a significant survival benefit in refractory cases of hepatic metastases from gastrointestinal malignancies.
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ORIGINAL ARTICLE: GENITOURINARY CANCERS Top

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A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors p. 35
Reshu Agarwal, Anupama Rajanbabu, Pavithran Keechilattu, Indu R Nair, DK Vijaykumar, UG Unnikrishnan
DOI:10.4103/sajc.sajc_6_18 Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion:Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.
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ORIGINAL ARTICLE: GYNAECOLOGIC CANCERS Top

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Conventional radiotherapy and intensity-modulated radiotherapy in carcinoma vulva: An experience from a tertiary medical center of India p. 41
Koustav Mazumder, Arun Elangovan, Bhavana Rai, Vanita Suri, Vanita Jain, Jaswinder Kalra, Sushmita Ghoshal
DOI:10.4103/sajc.sajc_66_17 Context: Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease. Aims: The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution. Subjects and Methods: This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated. Statistical Analysis Used: Kaplan–Meier survival analysis and Chi-square test were used for statistical analysis. Results: Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy – 2, radical vulvectomy – 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity (P = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up. Conclusions:Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks.
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ORIGINAL ARTICLES: HEAD AND NECK CANCER Top

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Squamous cell carcinoma of upper alveolus: An experience of a tertiary care center of Northeast India p. 44
Nizara Baishya, Tashnin Rahman, Ashok Kumar Das, Chandi Ram Kalita, Jagannath Dev Sharma, Manigreeva Krishnatreya, Amal Chandra Kataki
DOI:10.4103/sajc.sajc_66_18 Objective: The main objective of this study was to analyze the clinical behavior and the impact of nodal metastasis on the prognosis of upper alveolus squamous cell carcinoma (SCC). Materials and Methods: The medical records of 110 patients with SCC of the upper alveolus (International Classification of Diseases-10-C03.0) diagnosed during 2010–2015 were reviewed. Survival analysis was done using the Kaplan–Meier method and was compared using log rank-test. P < 0.05 was considered statistically significant. Results: Of the 110 patients, 59 were males and 51 were females. Forty-six (41.8%) patients presented with lymph node metastasis. Fifty-three (51.8%) patients presented in Stage IVA, thirty (27.3%) patients in Stage IVB, ten (9.1%) patients in Stage III, 12 (10.9%) patients in Stage II. The 5-year overall survival (OS) was 71.1% in Stage II, in Stage III it was 65.6%, in Stage it was IVA 56.7%, and in Stage IVB it was 19.4% (P = 0.02). The 5-year OS for node negative compared with node positive was 66.3% versus 37.3%, respectively (P = 0.019).Conclusion: Presence of lymph node metastasis is associated with lower survival rates. Adequate surgical resection with adjuvant treatment, where necessary, offers the best chance of disease control.
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A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation p. 47
Rituparna Biswas, Anirban Halder, Anshuman Ghosh, Sajal Kumar Ghosh
DOI:10.4103/sajc.sajc_7_18 Background: Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers. Aim: The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation. Materials and Methods: Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m2). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome. Results: The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups. Conclusions:Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities.
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Safety and efficacy of nimotuzumab with concurrent chemoradiotherapy in unresectable locally advanced squamous cell carcinoma of head and neck: An Indian rural hospital experience p. 52
Shyamji Rawat, Hemu Tandan, Sanandan Patel, Sameer Chaudhari
DOI:10.4103/sajc.sajc_76_18 Context: Nimotuzumab is the only anti-epidermal growth factor receptor monoclonal antibody which can be safely added to concurrent chemoradiotherapy (CRT) to improve efficacy in the management of unresectable, locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). However, the evidence available on this is limited. Aims: We retrospectively investigated efficacy and safety of nimotuzumab when combined with chemoradiation for LA-SCCHN. Settings and Design: Hospital records of 39 patients from January 2012 to December 2016 diagnosed with locally advanced (Stage III-IVb), unresectable SCCHN, and treated with concurrent CRT with weekly nimotuzumab were reviewed retrospectively after fulfilling the inclusion/exclusion criteria. Subjects and Methods: Tumor response was calculated as per response evaluation criteria in solid tumors criteria 1.1. Association of tumor response with independent variables was assessed. Overall survival (OS) and progression-free survival (PFS) were calculated. All patients were assessed for toxicity as per common terminology criteria for adverse events Common Terminology Criteria for Adverse Events v 4.0 (U.S. Department of health and human services, National Institutes of Health, National Cancer Institute). Results:At 6 months after completion of treatment, objective response rate was 97.44% with 26 (66.67%) patients attaining Complete response (CR), 12 (30.77%) patients with Partial response (PR), and one patient (2.56%) had stable disease. Subgroup analysis did not show a significant association of tumor response with independent factors. OS at 1 and 2-year was 100% and 72.9%, while PFS at 1 and 2-year was 87% and 54.40%. The incidence of Grade I, II, III, and IV toxicity was 30%, 18.18%, 41.82%, and 10%, respectively. No grade V toxicity was observed. Common adverse events observed were mucositis (33.64%), skin reaction (24.55%), neutropenia (20.91%), vomiting (18.18%), and diarrhea (2.73%). Conclusions: Nimotuzumab is an efficacious and safe option when added to concurrent CRT in unresectable, LA-SCCHN.
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ORIGINAL ARTICLES: HEMATOLYMPHOID MALIGNANCIES Top

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Primary gastrointestinal diffuse large B-cell lymphoma: A prospective study from South India Highly accessed article p. 57
Babu Suresh, Vikas Asati, KC Lakshmaiah, Govind Babu, D Lokanatha, Linu Abraham Jacob, KN Lokesh, AH Rudresh, LK Rajeev, Saldanha Smitha, Abhishek Anand, Rajesh Patidar, CS Premalata
DOI:10.4103/sajc.sajc_52_18 Background: Gastrointestinal tract (GIT) is the most common extranodal site for non-Hodgkin’s lymphoma (NHL) and constitutes about 10%-15% of all NHL. This was a prospective study to evaluate the epidemiological, clinicopathological characteristics, and treatment outcome of primary GIT diffuse large B-cell lymphoma (PGIL). Materials and Methods: Newly diagnosed patients of PGIL with DLBCL histology were eligible. Lugano staging system was used. All patients were treated with prephase treatment (1 mg vincristine and 100 mg prednisolone) followed by CHOP-based chemotherapy (with or without rituximab) as definitive treatment. Results: A total of 21 patients of PGIL were diagnosed. The median age was 46 years (range: 27–69 years) with male:female ratio of 2:1. Dull aching abdominal pain was the most common presenting complaint. Stomach was the most common site involved (52.4%, n = 11) followed by the colon (23.8%, n = 5). The estimated median survival in patients with Stage IV disease was significantly lower as compared to patients with localized disease (Stage I and II) (6.23 months vs. 23.4 months; P = 0.04). Patients, who did not achieve complete response (CR), had 15.5 times higher risk of death, as compared to those who achieved CR (P = 0.01). Conclusions: Stomach was the most common site for PGIL. Localized disease and CR after first-line chemotherapy were associated with better survival. A higher cost of rituximab was the prohibitive factor for cure in these patients.
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Role of CD138, CD56, and light chain immunohistochemistry in suspected and diagnosed plasma cell myeloma: A prospective study p. 60
Jasmita Dass, Sudheer Arava, Pravas Chandra Mishra, Amit Kumar Dinda, Hara Prasad Pati
DOI:10.4103/sajc.sajc_64_17 Introduction: Plasma cells (PCs) have conventionally been counted on the bone marrow aspirate, and small focal involvement may be missed even on bone marrow biopsy sections. Material and Methods: We aimed to study the role of CD138, CD56, anti-κ, and anti-λ immunohistochemistry (IHC) to separate PC myeloma from reactive plasmacytosis and to study the utility of these in cases suspected as myelomas and lacking >10% PCs on bone marrow aspirate. The study comprised 35 diagnosed myelomas, 20 reactive plasmacytosis, and 19 M-band positive suspected myelomas. CD138 IHC was performed on all cases along with CD56, anti-κ, and anti-λ IHC. PCs were counted on CD138-immunostained sections by manual count and by image analysis. In addition, CD56 expression was correlated with clinical features in diagnosed myeloma group. Results: In all cases, both manual counts and image analysis, PC counts were significantly higher on the CD138 stained sections than bone marrow aspirates. It was seen that the manual PC counts and image analysis counts were equivalent in diagnosed myeloma cases. CD56 expression was seen in ~62.85% diagnosed myeloma cases while it was negative in cases of reactive plasmacytosis. CD56 expression was significantly higher in patients with lytic lesions (78.26% vs. 21.74%). CD138, anti-κ, and anti-λ IHC also helped classify 11/19 (57.8%) cases correctly. Conclusion: The use of CD138 along with the light chain and CD56 IHC adds a high diagnostic value in myeloma patients and suspected myeloma cases. The PCs can be counted manually on the CD138-immunostained sections and correlate well with the counts obtained by image analysis.
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ORIGINAL ARTICLE: IMMUNO ONCOLOGY Top

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Immune checkpoint inhibitors: Real-world experience from india in advanced solid cancers that have progressed on chemotherapy p. 65
Vineet Govinda Gupta, Ranga Rao Rangaraju, Waseem Abbas, Peush Bajpai, Ruchika Khetrapal
DOI:10.4103/sajc.sajc_167_18 Context: The immune checkpoint inhibitors (ICIs) nivolumab and pembrolizumab have shown dramatic efficacy with low toxicity in international studies of advanced solid cancers. No published Indian experience with ICIs exist other than isolated case reports. Aims: The aim of this study is to evaluate real-world data about the efficacy and toxicity of ICIs in advanced solid cancers among Indian patients who have progressed on one or more prior lines of chemotherapy. Materials and Methods: All patients with advanced solid cancers who received ICIs after the failure of chemotherapy at our center were retrospectively assessed. Information about efficacy and toxicity was collected and analyzed. Results: The present study included 24 patients who had received ICIs for indications including non-small cell lung, bladder, head and neck, gastrointestinal, and unknown primary cancer. Patients had received a median of two prior lines of chemotherapy (range 1–5). Grade III or higher toxicity was seen in 8% of patients. Clinical benefit at 3 months was realized in 33% of evaluable patients. Twenty-six percentages of evaluable patients achieved a response, including one patient who achieved a complete response that is ongoing at 18 months. Median progression-free survival was 3 months, and median overall survival was 8 months at a median follow-up of 10 months. Among patients who achieved clinical benefit, the majority (84%) have an ongoing response at the time of data cutoff. Conclusions: Efficacy and toxicity of ICIs in the Indian population are similar to the experience seen in large international cohorts, and Indian oncologists may feel reassured using these agents in similar settings.
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ORIGINAL ARTICLE: SARCOMAS Top

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Multimodality treatment of head-and-neck soft-tissue sarcomas and short-term outcomes: Analysis from sarcoma medical oncology clinic p. 69
Ilavarasi Vanidassane, Aparna Sharma, Aditi Aggarwal, Sudhakar Gunasekar, Adarsh Barwad, Ekta Dhamija, Rambha Pandey, Suryanarayana Deo, Rakesh Garg, Sameer Rastogi
DOI:10.4103/sajc.sajc_229_18 Background: Head-and-neck soft-tissue sarcomas (HNSTS) are extremely rare and lack definite guidelines. Methods: We retrospectively analyzed consecutive adult patients with HNSTS who presented to our sarcoma medical oncology clinic from January 2016 to October 2017. Results: There were a total of 30 patients. Unresectable localized disease was seen in 13 (43%) patients, metastatic disease 10 (34%) patients, while resectable disease in 7 (23%) patients only. Among unresectable localized disease, 3 (25%) patients could be converted to resectable disease after neoadjuvant therapy. Median follow period was 11 months. Progression-free survival was 19 months in patients with resectable disease and 6 months in patients with the unresectable/metastatic disease. Median OS was not reached. Conclusion: Unresectable HNSTS has a poor outcome. Neoadjuvant therapy can be tried in selected cases for achieving respectability or for vital organ preservation until robust data are available. A multidisciplinary approach for local control is crucial in managing unresectable HNSTS.
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LETTERS TO THE EDITOR Top

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Giant solitary fibrous tumor: A rare case report
Sanjay Sharma, Prriya Eshpuniyani, Kirti Bhushan, Kanishka Gautam Siddharth, Sameer Pathan
DOI:10.4103/sajc.sajc_204_18
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Mucosal melanoma of the head-and-neck region: A single institutional clinical experience
Mathumitha Ramesh, Siddhartha Nanda, Biplab Misra
DOI:10.4103/sajc.sajc_326_18
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Chronic lymphocytic leukemia with deletion 17p: An Indian scenario
Ajay Gogia, Ritu Gupta, Lalit Kumar, Atul Sharma, Lata Soni
DOI:10.4103/sajc.sajc_287_18
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Pazopanib use preceding curative surgery in low rectal gastrointestinal stromal tumors after imatinib failure: A case report
Nikhil Pande, Omshree Shetty, Mounika Boppana, Anant Ramaswamy, Avanish Saklani, Nitin Shetty, Vikas Ostwal
DOI:10.4103/sajc.sajc_183_18
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Cancer

Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumo rs for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

The Diagnostic Performance of Ultrasonography and Computed Tomography in Differentiating Superficial from Deep Lobe Parotid Tumors
Ping‐Chia Cheng Chih‐Ming Chang Chun‐Chieh Huang Wu‐Chia Lo Tsung‐Wei Huang Po‐Wen Cheng Li‐Jen Liao
First published: 12 January 2019 https://doi.org/10.1111/coa.13289
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289
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Abstract
Objectives
To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.

Design and Setting
This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.

Participants
We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.

Main outcome measures
We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.

Results
A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn’s arc), but the sensitivities were all below 50%.

Conclusions
MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumo rs for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

Journal of Nursing and Midwifery Sciences, a publication of Mazandaran University of Medical Sciences, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal’s full text is available online at: http://www.jnmsjournal.org. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.

ORIGINAL ARTICLES

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The effect of concurrent endurance and resistance training on cardio-respiratory capacity and cardiovascular risk markers among sedentary overweight or obese post-menopausal women p. 123
Anahita Shabani, Ramin Shabani, Setila Dalili, Afagh Hassanzadeh Rad
DOI:10.4103/JNMS.JNMS_34_18 Context: Exercise training has been inversely associated with cardiovascular risk factors. However, the clinical trials examining the effect of exercise training on reducing cardiovascular risk factors have produced conflicting results. Aims: We aimed to assess the effect of concurrent exercise training on cardiorespiratory capacity and cardio-vascular risk factors among sedentary overweight or obese post-menopausal women. Settings and Design: This randomized controlled trial was done in 2016. Materials and Methods: This study was conducted on 22 healthy post-menopausal overweight and obese females, which randomly divided into concurrent endurance and resistance (ER) exercise (n = 12) and control (n = 10) groups. The participants did not have any history of any serious medical condition or using drugs. Demographic questionnaire was completed, vital signs and biochemical tests were measured, and Rockport one-mile submaximal exercise test for assessing maximal oxygen consumption (VO2max) was performed before and after the study. Statistical Analysis Used: Mean, standard deviation, and paired and independent t-test were used for statistical analysis. Results: The data from the ER groups showed that the body mass index (BMI), heart rate (HR), systolic and diastolic blood pressure, triglyceride, high-sensitivity C-reactive protein (CRP) decreased, high-density lipoprotein, and VO2max increased significantly, during the 8 weeks (P < 0.05). Moreover, no changes were found in the cardiovascular risk factors of women who did not exercise (P > 0.05). Conclusion: Concurrent ER training can be a suitable exercise program for improving plasma lipid profile as well as reducing body composition, high-sensitivity CRP, and increasing VO2max in postmenopausal women.
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The effect of staff training on the amount of sound pollution in the intensive care unit p. 130
Kobra Zamani, Hossein Ali Asgharnia, Jamshid Yazdani, Zohreh Taraghi
DOI:10.4103/JNMS.JNMS_38_18 Context: Sound pollution is a common problem in intensive care units (ICUs) with unfavorable consequences.Aims: The aim of the current study was to determine the effect of staff training on the amount of sound pollution in the ICU. Setting and Design: This quasi-experimental study was conducted in the ICU of Rouhani Hospital in Babol. Materials and Methods: Level of equivalent (leq) sound was measured in three work shifts for 2 weeks, before and after training, in 2 workdays and a holiday, using a systematic network stationing method. The sample size was determined based on the days of measurement, work-shift, and measuring stations (6 × 3 × 10 = 180). Indirect training was performed. A 2-week opportunity was given to study materials. Statistical Analysis Used:Data were analyzed using paired t-test and RMANOVA. Results: Following the training, the mean leq in all stations (ten stations) decreased from 67.21 to 62.11 dB (P = 0.002). Conclusion: Although the amount of sound pollution decreased significantly after training, it was still higher than standard. To achieve the desired level of sound, continuous monitoring of sound at intervals of 6 months, along with structural engineering and equipment, is suggested.
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The effect of relaxation exercises on emotions of primigravida women in famenin p. 134
Farzaneh Soltani, Samerah Ghlichkhani, Arezoo Shayan, Parisa Parsa, Ghodratollah Roshanaei
DOI:10.4103/JNMS.JNMS_32_18 Context: Recognizing effective interventions for improving women’s positive emotion can improve mental health and self-confidence in anxious women, at least during pregnancy. Aim: This study aimed to investigate the effect of relaxation training on positive and negative emotions of primigravida women. Setting and Design: In this randomized quasi-experimental study, 100 primigravida women with gestational age of 28–32 weeks, who were referred to the prenatal care centers in Famenin City (Hamadan, Iran), were randomly assigned into two groups of intervention and control, using randomized blocking. Methods and Material: All the pregnant women completed the positive and negative affect schedule questionnaire. In the intervention group, eight sessions were held twice a week with emphasis on relaxation techniques. The control group received routine prenatal care.Statistical Analysis Used: Descriptive statistics, independent and paired t-tests were used to compare the difference between and within two groups. Results: The mean score of positive emotion increased from 31.92 ± 6.39 to 34.12 ± 5.41 after intervention (P = 0.034). In contrast, the mean score of positive emotion in the control group reduced from 33.62 ± 6.58 to 26.92 ± 6.35 after the intervention (P < 0.001). In addition, there was a significant difference between the mean scores of positive emotion in the two groups after the intervention (P < 0.001). The mean score of negative emotion reduced from 24.12 ± 7.06 to 17.18 ± 5.95 in the intervention group (P < 0.001). On the other hand, the mean score of negative emotion in the control group increased from 22.08 ± 6.85 to 28.42 ± 7.24 after the intervention (P < 0.001). There was a significant difference between the mean scores of negative emotion in the two groups after the intervention (P < 0.001). The mean score of positive emotion of the women increased after the intervention (from 31.92 ± 6.39 to 34.12 ± 5.41) (P = 0.034). In contrast, the mean score of positive emotion of the women in the control group reduced after the intervention (from 33.62 ± 6.58 to 26.92 ± 6.35) (P < 0.001). Also, the mean score of negative emotion reduced in the intervention group (from 24.12 ± 7.06 to 17.18 ± 5.95). On the other hand, the mean score of negative emotion of the women in the control group significantly increased after the intervention (from 22.08 ± 6.85 to 28.42 ± 7.24).Conclusion: Research findings suggest that relaxation training may increase positive emotion and reduced negative emotion in pregnant women. It is recommended that relaxation techniques are used in prenatal care centers as a simple and available health intervention in pregnancy.
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Qualitative needs assessment: Iranian parents’ perspectives in sexuality education of their children p. 140
Jila Ganji, Mohammad Hassan Emamian, Raziyeh Maasoumi, Afsanah Keramat, Effat Merghati-Khoei
DOI:10.4103/JNMS.JNMS_42_18 Context: Parental education in sexuality plays a vital role in children’s lives. Aims: The purpose of this study was to explore Iranian parents’ perspectives about the needs of children sexuality education. Setting and Design: This qualitative study was done in 2016. Materials and Methods: In this qualitative inquiry, seven sessions of community group interview and focus group discussions were conducted with the parents of Ghaemshahr, Iran, using purposive sampling (n = 39, 27 mothers and 12 fathers). Statistical Analysis Used:We employed thematic analysis method to extract our findings. Results: The findings were categorized into three essential needs: (1) parents’ preparedness, (2) efficacious parental management, and (3) supportive environments. The sub-theme describing the theme 1 includes “the need for adequate knowledge to answer the sexual questions and the child’s sexual curiosity” and “the need for awareness about the time of beginning an appropriate sexuality education for children.” Moreover, the sub-theme describing theme 2 includes “the need for sufficient skills to begin proper and intimate communication,” “the need for effective monitoring and care,” and “the need for capability in managing the child sexual behavior.” Moreover, the sub-theme describing theme 3 includes “the need to receive training from sexual health professionals,” “the need for authorized sexuality education programs,” “the need for national-wide policy-making and strategy planning in sexuality education,” and “the need for a comprehensive and complete educational resource.” Conclusion: Our findings suggest that to address the goals in sexuality education for children, parents’ need to be prepared in knowledge, and gaining positive attitude and practical skills. To achieve these goals, supportive environments must be provided by policy-makers and health providers with culturally appropriate strategy planning.
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Strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health: using nominal group technique p. 147
Maryam Hajizadevalokolaee, Zohreh Shahhosseini, Soghra Khani, Fereshteh Yazdani, Zeinab Hamzeghardeshi
DOI:10.4103/JNMS.JNMS_35_18 Context: The spread of HIV is growing, so that its way of transmission has created worries in the field of sexual and reproductive health, because the wave of transmission has changed from injection to sexual activities.Aims: To evaluate the perspectives of sexual and reproductive health experts and providers on strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health using the nominal group technique (NGT). Setting and Design: Mazandaran University of Medical Sciences, Sari, Iran. NGT. Materials and Methods: It was a semiquantitative/qualitative methodology research through NGT, based on the opinions of 30 experts and sexual and reproductive health providers in the field of health in Mazandaran (2016).Statistical Analysis Used: Semiquantitative/qualitative analysis. Results: In total, 15 cases got the scores of 2–62 as strategies to improve the integrated program of HIV/AIDS with sexual and reproductive health. The highest scores were found in society-centered level and stigma management, and the lowest scores were found in individual-centered level and negotiation skill training. Conclusion: One of the strategies to improve the integrated program of HIV/AIDS was the empowerment of women and men in sexual and reproductive health and stigma management. Based on the results, the NGT is a useful tool for doing researches and prioritizing the programs. Based on the expert opinion, it can be concluded that designing strategies based on individual-, community-, and society-centered approach would be an appropriate approach for improving the integrated program of HIV/AIDS with sexual and reproductive health issues in Iranian society.
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Evaluation of occupational hazards for nurses in intensive care units of tertiary care centers p. 153
Kobra Abdi Zarrini, Akram Sanagoo, Leila Jouybari, Mohammad Ali Vakili, Ali Kavosi
DOI:10.4103/JNMS.JNMS_52_18 Context: Nursing is a high-risk occupation, and intensive care units (ICUs) are one of the most sensitive hospital wards. Aim: This study aimed to determine the level of occupational hazards among nurses in the ICUs. Setting and Design: This descriptive-analytical study was conducted on a total of 281 nurses in the ICUs of tertiary care centers in Golestan and Mazandaran Universities of Medical Sciences in 2017. Materials and Methods: Data were collected using a five-dimensional occupational hazard questionnaire. Statistical Analysis Used: Data analysis was performed in SPSS software (version 16) and descriptive and inferential statistics were considered statistically significant (P < 0.05). Results: In this study, 75.1% of the nurses were female and 50.9% of the participants were within the age range of 26–35 years. The total mean and standard deviation of occupational hazards was 3.20 ± 0.66. In addition, the mean values and standard deviations of chemical, ergonomic, biological, psychosocial, and organizational, as well as physical hazards were reported to be 2.43 ± 1.06, 2.6 ± 0.82, 2.63 ± 0.91, 3.38 ± 0.7, and 3.38 ± 0.86, respectively. According to the results, significant differences were observed between occupational hazards and variables of gender, marital status, educational level, and work experience (P = 0.0001). Conclusion: Occupational hazard level was moderate among nurses in the ICUs, and most of the damages were related to the physical dimension. In addition to holding educational workshops in tertiary care centers by the related officials, proper preventive plans must be designed to reduce occupational injuries.
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Incidence and risk factors of pressure ulcers among general surgery patients p. 159
Ensieh Ramezanpour, Amir Emami Zeydi, Mohammad Ali Heidari Gorji, Jamshid Yazdani Charati, Mahmood Moosazadeh, Vida Shafipour
DOI:10.4103/JNMS.JNMS_23_17 Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score <15 (P = 0.017), type of surgery (P = 0.003), and type of anesthesia (P = 0.015).Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.
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The relationship between the quality of nursing care and the satisfaction of pregnant mothers p. 165
Ali Hatami, Zohreh Saeidlandi, Azam Jahanghiri Mehr, Akram Hemmatipour
DOI:10.4103/JNMS.JNMS_44_18 Context: The Health System Development Plan is one of the key steps taken by the eleventh government to promote health services in the country. Aims: The aim of this study was to determine the relationship between the quality of nursing care and the satisfaction of pregnant mothers from the implementation of the health system development plan. Settings and Design: This research was an analytic cross-sectional study. The study population included 163 mothers who were hospitalized before delivery and 18 nurses from maternity sections who were selected by the census method during the 3 months of September 2017–November 2017. Material and Methods: The data collection tool was a demographic data form, quality patient care scale, and a researcher-made questionnaire on the satisfaction of hospitalized mothers in maternity sections of the implementation of the Health System Reform Plan. Statistical Analysis Used: Data were analyzed using descriptive statistics, Mann–Whitney test, and correlation coefficient in SPSS-16 software. Results: The results showed that the quality of care in nurses at the desired level (63%) and the satisfaction of mother maternity sections of the delivery system had a moderate level of implementation of the Health System Development Plan (56.3%). The results of Pearson’s correlation test showed that there is a statistically significant relationship between the quality of nursing care and patient satisfaction (P = 0.001). Conclusions: The satisfaction of the mothers participating in the research was that the quality of nursing care was often modest after implementing the Health System Reform Plan.
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Journal of Nursing and Midwifery Sciences, a publication of Mazandaran University of Medical Sciences, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal’s full text is available online at: http://www.jnmsjournal.org. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.