Annular pancreas in adults: single unit experience from a tertiary care centre of Northern India

Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy.

Fallopian tube as a cause of intestinal obstruction: a rare case report with review of literature

Adhesive Intestinal obstruction is the most common cause of intestinal obstruction in post-operative period. Diagnosis is based on history, clinical examination, plain X-ray abdomen. Authors here report an interesting case of intestinal obstruction after surgery for chronic calcific pancreatitis with pancreatic duct stone with intractable pain. In post-operative period patient developed features of intestinal obstruction, patient was planned for re- exploration and it was found that band was formed by left fallopian tube with transition point at terminal ileum and treated successfully with left Salpingectomy. Very few cases of fallopian tube as cause of intestinal obstruction have been reported in literature and it should be considered as one of the cause of intestinal obstruction in females presenting with acute abdomen.

Psychosocial and quality of life assessment in cancer patients: a pilot study in Indian set up

Background: Routine screening for distress is internationally recommended as a standard of care among cancer patients. This study was conducted to assess the level of stress and determine the association between quality of life (QOL) with demographic, socio-economic status, treatment phase, cancer stage, etc.Methods: An observational study, performed in the department of Clinical Oncology, Nayati Multi Super Speciality Hospital, Mathura, India. Data of 62 histopathologically proven cancer patients between Nov 2016 and July 2018, were analyzed. This pilot study was conducted to assess the QOL and stress levels of cancer patients by using scales of WHOQOL-BREF, QSC-R23 and Hamilton scale. Results: Among 62 cancer patients, high distress along with poor QOL was seen maximum in males, 40-60 year age group and educated. In majority of domains, high distress was found in middle class, whereas poor QOL was found in Lower class in Environmental domain (p<0.01). We found higher distress in nuclear families (p<0.05). High distress was seen in cancer patients who were aware of illness and was found to statistically significant. Poor QOL in stage 4 was found to be statistically significant in Psychological domain of WHOQOL-BREF. High distress was found in patients undergoing treatment in all patients as compared to Pre-treatment phase and Post-treatment phase (p<0.05).Conclusion: To assess psychological stress in cancer patients using all three scales we could not obtain a conclusive result covering all dimensions of QOL. So, in our next study authors plan to develop one indigenous new scale.

Retrospective analysis of random and systematic errors in radiation therapy of head and neck cancer patients and its clinical predictive implications with VMAT treatment

Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment.

Antimalarial drug policy in India: Past, present & future.

The use of antimalarial drugs in India has evolved since the introduction of quinine in the 17th century. Since the formal establishment of a malaria control programme in 1953, shortly after independence, treatments provided by the public sector ranged from chloroquine, the mainstay drug for many decades, to the newer, recently introduced artemisinin based combination therapy. The complexity of considerations in antimalarial treatment led to the formulation of a National Antimalarial Drug Policy to guide procurement as well as communicate best practices to both public and private healthcare providers. Challenges addressed in the policy include the use of presumptive treatment, the introduction of alternate treatments for drug-resistant malaria, the duration of primaquine therapy to prevent relapses of vivax malaria, the treatment of malaria in pregnancy, and the choice of drugs for chemoprophylaxis. While data on antimalarial drug resistance and both public and private sector treatment practices have been recently reviewed, the policy process of setting national standards has not. In this perspective on antimalarial drug policy, this review highlights its relevant history, analyzes the current policy, and examines future directions.

Analysis of bite mark evidence.

Bite mark analysis casework strives to connect a biter to the teeth pattern present on an object linked in some way to a crime or event. The general public and some law enforcement may consider any “bite mark” case they develop to be a certainty in the quest to identify the biter. The ability of skin to register sufficient detail of a biter’s teeth is highly variable. Bite mark casework indicates that many bite marks are not well defined in detail and posses distortion due to the physical nature of skin itself. The current opinion is that bite mark can be useful in including or excluding possible suspects and ability to identify only one person as the biter. In mortal combat situations, such as the violence associated with life and death struggles between assailants and victims, the teeth are often used as a weapon. It is well known that assailants in sexual attacks, including sexual homicide, rape and child sexual abuse, often bite their victims as an expression of dominance, rage and animalistic behaviour. The teeth are a significant component of our natural arsenal.