Adjuvant versus early Salvage radiation therapy for prostate cancer with adverse pathological features on radical prostatectomy—Do we finally have an answer?

Background: The presence of adverse pathological features like extraprostatic extension, seminal vesicle involvement, or positive margins at radical prostatectomy incurs a high risk of postoperative recurrence. Currently, adjuvant radiotherapy (ART) is the standard of care in these patients, while early salvage radiotherapy (eSRT) is a potential alternative strategy. Aims: The purpose of this paper is to review the latest evidence comparing outcomes of adjuvant versus early SRT in this clinical scenario. Materials and Methods: A systematic review of Google Scholar, PubMed/Medline, and EMBASE was done to identify relevant studies published in the English language, regarding outcomes of adjuvant radiotherapy and early SRT in post radical prostatectomy patients. Twelve studies, including six randomized trials, four retrospective studies, one systematic review, and one metanalysis were included in the final analysis. Results: We found that initial randomized trials demonstrated better event?free survival with adjuvant radiotherapy when compared to observation alone. However, ART was associated with increased risk of overtreatment and thus increased radiation?related toxicity rates. Conclusion: Preliminary evidence from recently reported RCTs suggests that eSRT may provide equivalent oncological outcomes to ART in prostate cancer patients with adverse pathology on radical prostatectomy while decreasing unnecessary treatment and radiation?related toxicity in a significant proportion of patients. However, the final verdict would be delivered after the long?term metastasis?free survival and overall survival outcomes are available.

recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Efectos del tratamiento homeopático individualizado en la hipertensión esencial de estadio I: ensayo aleatorizado, simple ciego, controlado con placebo / Effects of Homeopathic Treatment Individualized in Hypertension Stage I Essential: Randomized Trial, Single Blind, Placebo controlled

Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)

Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)

The Study of Mortality in Hospitalized Patients with Impaired Fasting Glucose in Acute Myocardial Infarction

Introduction: Hypertension is one of most commoncardiovascular disorder in clinical practice. It is also calledhigh blood pressure. Hypertension is well known risk factorfor cardiovascular, renal and cerebrovascular disease. Evenslightly rise elevated blood pressure lead to increase risk incardiovascular disease and strokes (CVD). Hypertensiveemergency is define as recent increase in blood pressure toa very high level (> 180 mmHg systolic and > 110 mmHgdiastolic) with target organ damage. Study aimed to evaluatethe modes of presentations, clinical profile and spectrum oftarget organ damage in patients with hypertensive emergency.Material and methods: This study was hospital basedprospective study. The present study was carried out in 100patients admitted in various medical wards in R.N.T. MedicalCollege Udaipur, Rajasthan over a period of eight months.Patients fulfilling the eligible criteria were included.Result: Among the 100 patients studied, 70 were males andthe male female ratio was 2.33:1. In the age distribution, 72%patients were found age more than 50 years and rest 28% wasless than 50 years. The commonest clinical presentation foundwas neurological deficits in 50% followed by dyspnoea in34% and chest pain in 10% patients.Conclusion: The present study done over hypertensiveemergencies patients conclude that majority of patientsbelonged to the fifth and sixth decades of age and of malesex. It was commonly observed in the patients knownhypertensive. Diabetes and dyslipidemias was commonassociation observed. Commonest mode of presentation wasneuro deficit and higher level of mean blood pressure at thetime of presentation may associated with worst out come

Grahani (IRRITABLE Bowel Syndrome) : A Case Report

Grahani is a disease of great clinical relevance in modern era because of its direct link with improper food habits and stressful lifestyle of the present era. Grahani is the main functional part of Mahasrotas and also known as a Pittadhara Kala. Ayurveda characterize the disease by passage of stool with constipation or diarrhoea and with undigested or digested food particles. This disease also associated with thirst, pedal oedema, abdominal cramping & pain, fever and vomiting. The symptoms of Grahani resembles most of IBS symptoms. So we can co–relate the Grahani Roga with IBS. Whole world is looking towards Ayurveda for safe treatment modalities, so it is essential to find out the effective therapeutic procedure from our science. A diagnosed case of Grahani (IBS) discussed here. In this case study patient was administered combination of Avipattikar Churna, Bilva Churna, Kutaj Churna & Panchaamruta Parpti, syp. Kutaj Bilvapaak, Kutajaghan Vati and Vinamibo pouch. This Ayurvedic formulation showed highly significant result.

Can higher end tonometers be used interchangeably in routine clinical practice.

Context: Precise intraocular pressure (IOP) measurement is important in glaucoma practise. Various instruments are available today to accurately measure IOP. Thus, the question arises about which instrument to use and whether all of them can be used interchangeably. Aims: To assess the agreement between noncontact tonometer (NCT), rebound tonometer (RBT), Goldmann applanation tonometer (GAT), and dynamic contour tonometer (DCT) in measuring IOP. Subjects and Methods: 499 eyes of 250 patients were evaluated during a period of 24 months from September 2010 to August 2012 and measurement of IOP by NCT, RBT, GAT, and DCT was done in the given sequence. The agreement was assessed by use of the Bland–Altman plot keeping GAT as a gold standard technique. Results: The mean IOP value of NCT, RBT, GAT, and DCT was 15.9 ± 5.5, 15.9 ± 5.8, 15.9 ± 4.9, and 16.0 ± 4.7 mm of Hg, respectively. The limits of agreement of GAT with DCT, NCT, and RBT were found to be +5.4 to −5.2, −4.7 to +4.6, and −5.2 to +5.1 mm of Hg, respectively. Conclusions: A positive and strong correlation was found between newer tonometers and GAT, but the limit of agreement was clinically unacceptable. The use of a single tonometer should be practised at a glaucoma clinic for a patient at each follow‑up.

A Study of Antimicrobial Resistance in Clinical Isolates of Enterococci.

Introduction: Recent years have witnessed a resurgence of interest in enterococci due to increasing resistance to antibiotics in term of both multiplicity of resistance and level of resistance to particular drugs. Methodology: This is a hospital based study, conducted in R.D. Gardi Medical College and C.R.G.Hospital Ujjain (M.P.). All clinical samples such as urine, blood, pus, sputum, ascitic fluid, stool etc. were collected from patients visiting OPD and admitted in CRGH in the study period of 1 and 1/2 year (January 2011-June 2012). Bacterial colonies suggestive of enterococci were further identified and antibiotic susceptibility testing done for each enterococcal isolates by DDT of Kirby Bauer on Muller Hinton Agar according to CLSI guideline.3,5,6 MIC was also determine for ampicillin, gentamicin, streptomycin and vancomycin by Agar dilution.6 Result and Observation: Only 2 enterococcal species isolated they were E.faecalis (86.62%) and E.faecium (15.18%). In pathogenic E.faecalis, 90.28% isolates showed resistance to penicillin, 65.28% to ampicillin, 62.5% to high level gentamicin (HLG) and 51.39% to high level streptomycin (HLS). One E.faecalis was resistant to vancomycin (VRE). All E.faecalis were sensitive to linezolid. In pathogenic E.faecium 84.61% isolates showed resistance to penicillin, 23.08 % to ampicillin, 53.85% to HLG and 69.23% to HLS. All E.faecium were sensitive to vancomycin and linezolid. In colonizing enterococci resistance is very low as compared with pathogenic. Multiple drug resistance (penicillinG, ampicillin, HLG, HLS) was more common (32.94%) in isolates of enterococci. Discussion: Study from Sevagram and Nagpur also isolated two species of Enterococci. Very high penicillin-G resistance was also observed in study from Nagpur.15 In this study resistance to ampicillin in E.faecalis was 65.28% and in E.faecium 23.08%. A study done in Mumbai also find similar finding.16 A study done by Rahangdale et al, which showed 49.59% high level resistance to gentamicin.15 In this study HLSR in E.faecalis was 51.39% and in E.faecium 69.23%. Observation close to our study was reported from Nagpur.15 Vancomycin resistance was not detected in E.faecium. Resistance to vancomycin is widely variable. Agrarwal et al, Titze-de-Almeida et al, Rahangdale et al, did not get any VRE in their study. 14,15,17 Conclusion: Multidrug resistances are the common problem. Although, at present, VRE is not a problem in our set up, its routine monitoring is essential, since it appears to be an emerging pathogen in India.

Prevalence of uropathogens in various age groups & their resistance pattern in a Tertiary Care Hospital in Central India.

Background: The prevalence of multidrug resistance among uropathogens in rapidly increasing. Analysis of the prevalence in various age groups and the common antimicrobial co-resistance pattern of uropathogens isolated from patients in a tertiary care hospital would have important implication for patient care. Methods: A total of 1383 urine samples received during year 2010 were processed. Urine microscopy & culture was done using standard microbiological techniques. Organisms were identified by standard microbiological techniques. Antimicrobial susceptibility testing was done as per CLSI guidelines.Results: A total of 426 uropathogens were isolated. E coli were seen in 65.96 % (most common) followed by Klebsiella spp. 12.44%. Enterococcus was the commonest Gram positive isolate (5.86%). Urinary tract infection (UTI) was seen in 59.86% females as compared to 40.14% males. Average antimicrobial resistance for E.coli 75.74%, Klebsiella spp. 47.45%, Proteus 65.54%, Pseudomonas 75.89%, Enterococci 66.54%, Staphylococcus aureus 39.28%, Staphylococcus saprophyticus 47.79%.