IntroductionBreast cancer is the second leading cause of cancer death in women worldwide and the third most common cancer in India. Various studies have reported that chemotherapy reduces the antioxidant status in patients with cancer. A diet rich in omega-3 fatty acids has been shown to offer protection against breast cancer through various mechanisms. However, there are no reports suggesting a relationship between consumption of omega-3 fatty acids during chemotherapy and antioxidant status in patients with breast cancer. Thus, the objective of this study was to evaluate whether fish oil supplementation could improve the antioxidant status of five women with breast cancer undergoing chemotherapy.Case presentationWe report on the cases of five Indian women with breast cancer, in the age group of 34 to 60 years, who had poorly differentiated breast carcinoma and underwent modified radical mastectomy. Postsurgery, the patients were given fish oil capsules containing eicosapentaenoic acid (180mg) and docosahexaenoic acid (120mg)/capsule during their chemotherapy. Informed consent was obtained from each participant and they were followed-up to the completion of six chemotherapy cycles at 21-day intervals.ConclusionsThe supplementation of fish oil significantly (p < 0.01) increased superoxide dismutases, glutathione reductase and catalase activity in red blood cells as well as the total plasma antioxidant status in the patients. This approach of using omega-3 fatty acids as an adjuvant treatment for breast cancer may help oncologists to manage the side effects of ongoing chemotherapy by improving the antioxidant status in patients.

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Background: Accidental or suicidal poisoning with yellow phosphorus or metal phosphides (YPMP) such as aluminum (AlP) zinc phosphide (Zn 3 P 2) commonly causes acute liver failure (ALF) and cardiotoxicity. These are used as household, agricultural, and industrial rodenticides and in production of ammunitions, firecrackers, and fertilizers. In absence of a clinically available laboratory test for diagnosis or toxin measurement or an antidote, managing their poisoning is challenging even at a tertiary-care center with a dedicated liver intensive care unit (LICU) and liver transplant facility. Methods: Patients with YPMP-related ALF were monitored using standardized clinical, hemodynamic, biochemical, metabolic, neurological, electrocardiography (ECG), and sequential organ failure assessment (SOFA) score and managed using uniform intensive care, treatment, and transplant protocols in LICU. Sociodemographic characteristics, clinical and biochemical parameters, and scores were summarized and compared between 3 groups i.e. spontaneous survivors, transplanted patients, and non-survivors. Predictors of spontaneous survival and the need for liver transplant are also evaluated. Results: Nineteen patients with YPMP-related ALF were about 32 years old (63.2% females) and presented to us at a median of 3 (0-10) days after poisoning. YPMP-related cardiotoxicity was rapidly progressive and fatal, whereas liver transplant was therapeutic for ALF. Spontaneous survivors had lower-dose ingestion (<17.5 g), absence of cardiotoxicity, < grade 3 hepatic encephalopathy (HE), lactate < 5.8, SOFA score < 14.5, and increase in SOFA score by < 5.5. Patients with renal failure need for continuous veno-venous hemodiafiltration (CVVHDF) and King College criteria positivity on account of prothrombin time and international normalized ratio (PT-INR) > 6.5 had higher mortality risk. Patients undergoing liver transplant and with spontaneous recovery required longer intensive care unit and hospital stay. At median follow-up of 3.4 (2.6-5.5) years, all spontaneous survivors and transplanted patients are well with normal liver function. Conclusions: Early transfer to a specialized center, preemptive close monitoring, and intensive care and organ support with ventilation, CVVHDF, plasmapheresis, and others may maximize their chances of spontaneous recovery, allowing accurate prognostication and a timely liver transplant. (J CLIN EXP HEPATOL xxxx;xxx:xxx)

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