INTRODUCTION: In breast cancer, the regimen used for the neoadjuvant and adjuvant nonmetastatic setting is the 4 cycles of Adriamycin and cyclophosphamide(AC) followed by Docetaxel(T), Docetaxel and Carboplatin regimens(T+Ca) and Docetaxel + Trastuzumab(T+Tr) (1,2). METHODS: A prospective open-label observational comparative study to evaluate the incidence of anemia and thrombocytopenia among the three regimens of chemotherapy regimen I AC-T, Regime II AC-T+Ca, Regimen III AC-T+Tr. All enrolled patients received pegfilgrastim/filgrastim. The total number of enrolment of patients in the study was 124 and distributed as 38,40,46 in three regimens respectively. RESULTS: The mean incidence of anemia in the regimen I , regimen II and regimen III in overall 8 cycles, it was 7.1± 1.5, 7.4+1.1, 7.1+1.5 respectively. There was no statistically significant difference in the mean incidence of anemia among the 3 study groups. A total of 109 episodes of thrombocytopenia out of 992 cycles of chemotherapy (10.9%) were observed.The mean incidence of thrombocytopenia in regimen I in the initial 4 cycles was 0.1+ 0.5; in the final 4 cycles, 0.2+ 0.6; and in the overall 8 cycles, 0.3+ 1. There was no statistically significant difference in the mean incidence of thrombocytopenia among the 3 study regimens. CONCLUSION: There was no significant difference in the incidence of anemia among the 3 regimens in the initial 4 chemotherapy cycles, final 4 chemotherapy cycles, or overall 8 cycles of chemotherapy.Among the overall 8 cycles of chemotherapy, there was no statistically significant difference in the mean incidence of thrombocytopenia among the three regimens.

Background: Ipratropium, an anticholinergic medication, holds a significant position in the management of various respiratory disorders. Primarily utilized in the pharmacotherapy of chronic obstructive lung disease and to relieve the symptoms of bronchospasm by acting on the muscarinic receptors of the bronchial smooth muscle by inhibiting the same receptors. This case report aims to highlight the ipratropium-induced bronchospasm in a patient of Chronic Obstructive Pulmonary Disease (COPD). Case Presentation: We present a compelling case of severe bronchospasm occurring in a 65-year-old Indian man following the inhalation of a combination of ipratropium bromide and budesonide. This distressing event was accompanied by a precipitous decline in oxygen saturation, plummeting to as low as 40%. Urgent resuscitation measures were imperative, leading to intubation and ventilatory support to restore the patient to a stable state. Following the initial resuscitation, the patient was transferred to the intensive care unit for further management. Disturbingly, another exacerbation of symptoms ensued during ventilator support subsequent to nebulization with combination of ipratropium and levosalbutamol. Encouragingly, the patient’s condition ameliorated upon discontinuation of the nebulization. Conclusion: This case report illuminates the concerning potential for ipratropium-induced bronchospasm in COPD patients. As we navigate these complexities, the pursuit of safer alternatives like tiotropium takes center stage, reminding us of the continuous evolution in optimizing respiratory therapies. These findings emphasize the significance of vigilant monitoring and tailored interventions in clinical practice.