Dermatological adverse reactions to cancer chemotherapy.

The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail fi nding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effl uvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of signifi cant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.

Granulomatous cheilitis with granulomatous vulvitis: A rare association.

Granulomatous cheilitis and granulomatous vulvitis are rare disorders characterized by painless swelling of lips and vulva, respectively. Histopathology of both conditions show non-caseating epithelioid cell granulomas in the dermis. Both disorders have been associated with Crohn’s disease rarely. Occurrence of the two conditions in the same patient is extremely infrequent. We hereby report, the association of granulomatous cheilitis with granulomatous vulvitis in a 30-year-old female.

A Study of Correlation of Anthropometric Parameters and Heart Rate Variability Among Medical Students in South India.

Background: Obesity is known to cause a number of life style diseases. In spite of this, the developed and developing world is faced with increasing number of people with high Body fat. In the present study we evaluated the correlation of Heart rate variability with the anthropometric parameters depicting body fat among young students recruited from our Medical school. Materials and methods: Two hundred and forty medical students (120 males & 120 females) were selected on the basis of their BMI into four groups: viz. Normal (N), Underweight (UW), Overweight (OW) & Obese (OB), [n=30 each]. Their Lean Body Mass (LBM), W/H ratio were calculated and tabulated, their HRV was recorded for 5 minutes and both time domain and frequency domain analysis was done. Results: The body fat was significantly higher in OW and OB groups as reflected in increased W/H ratio and lower LBM. (p<0.001) and significantly lesser in the UW group. But women showed significantly more W/H ratio and lesser LBM compared to men in the same group (p<0.01). Cardiac autonomic control represented by HRV showed significant reduction in the OW and Obese groups (p<0.01). HRV parameters were significantly lower in Underweight subjects when compared to Normal subjects. Conclusions: The HRV parameters showed a sympathetic predominance as the body fat increases. Females showed higher Body fat content compared to men. Therefore the treatment strategy should involve in weight reduction and diet control in vulnerable subjects and sustained physical exercise regimen may be prescribed to prevent the possible cardiovascular and endocrine disorders which they are prone. Key words: BMI, LMB, Waist hip ratio, Heart rate variability.

A study of prevalence of obesity and an assessment of nutritional status in elderly South Indian Population.

Obesity and abnormal nourishment are the biggest concerns of developed and developing societies. We analysed the nutritional status using Mini Nutrition Assessment (MNA) and correlated the findings with BMI, Waist – to – Hip (W/H) ratio in elderly population of Dakshina Kannada District of Karnataka. Total of 221 elderly subjects above the age of 50 years (105 were males and 116 were females) were recruited, who did not have any morbid diseases. Their Anthropometric parameters namely BMI and W/H were recorded and tabulated. They were grouped into Underweight, Normal, Over weight and Obese and the respective numbers were segregated and shown in table. MNA scores of each group were found out and the correlation was done. Results were analysed by using ANOVA and Tukey – Kramer test using SPSS version 16. The results suggested that there is a correlation between the BMI, W/H ratio with the MNA scores. Underweight elderly had low scores while overweight and obese subjects had higher scores. Women showed a higher tendency to become over weight and obese compared to men. This study reiterates that there is a correlation between anthropometric parameters and the nutritional status. A wider study with more number of subjects could yield more insight into the findings and be useful guide for suggesting any lifestyle modification.

Management of internal hemorrhoids by Kshara karma: An educational case report.

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as “Raktarsha” - 11 & 7 ‘o’ clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.

Maternal Healthcare Financing: Gujarat’s Chiranjeevi Scheme and Its Beneficiaries.

Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government’s inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3,000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.

Commitment among state health officials & its implications for health sector reform: lessons from Gujarat.

BACKGROUND & OBJECTIVE: Commitment, competencies and skills of people working in the health sector can significantly impact the performance and its reform process. In this study we attempted to analyse the commitment of state health officials and its implications for human resource practices in Gujarat. METHODS: A self-administered questionnaire was used to measure commitment and its relationship with human resource (HR) variables. Employee's organizational commitment (OC) and professional commitment (PC) were measured using OC and PC scale. Fifty five medical officers from Gujarat participated in the study. RESULTS: Professional commitment of doctors (3.21 to 4.01) was found to be higher than their commitment to the organization (3.01 to 3.61). Doctors did not perceive greater fairness in the system on promotion (on the scale of 5, score: 2.55) and were of the view that the system still followed seniority based promotion (score: 3.42). Medical officers were upset about low autonomy in the department with regard to reward and recognition, accounting procedure, prioritization and synchronization of health programme and other administrative activities. INTERPRETATION & CONCLUSION: Our study provided some support for positive effects of progressive HR practices on OC, specifically on affective and normative OC. Following initiatives were identified to foster a development climate among the health officials: providing opportunities for training, professional competency development, developing healthy relationship between superiors and subordinates, providing useful performance feedback, and recognising and rewarding performance. For reform process in the health sector to succeed, there is a need to promote high involvement of medical officers. There is a need to invest in developing leadership quality, supervision skills and developing autonomy in its public health institutions.

Alcohol expectancy responses from first year medical students: Are they prone to alcoholism?

CONTEXT: Modern life style and affluence lead to changes in people's outlook on various habits, including alcohol intake. Some of them will fall prey to the addictive nature of the drink. AIMS: Present study was done to evaluate the responses to comprehensive alcohol expectancy questionnaire (comprehensive effects of alcohol - CEOA) in order to test the tendency towards alcohol intake among the First Year Medical (MBBS) students of our college - that is, to assess the positive or negative reinforcement they would expect if they consumed alcohol. SETTINGS AND DESIGN: The study was done by giving a set of questionnaires to be answered by the students. MATERIALS AND METHODS: Questionnaires of CEOA had 38 responses, in which both negative and positive feelings were represented. All questions were again grouped into four groups of positive and three groups of negative responses. Each question was rated to what degree they agreed, by 4-point Likert-type scale (1 = disagree, 2 = slightly disagree, 3 = slightly agree, 4 = agree). The positive and negative responses were analyzed to group them into agreeing or disagreeing type. STATISTICAL ANALYSIS USED: Analysis of responses by Student 't' test and 2-way ANOVA was done to analyze the results. 'P' RESULTS: Results showed that negative expectancies outweighed positives significantly (2.8017 +/- 0.58554 vs. 2.3055 +/- 0.67604, t = 7.526; P< 0.001.). Females rated the negatives more firmly (P< 0.001). However, there was no statistically significant difference with respect to different religious beliefs, places of origin or incomes of the respondents. An experience of alcohol had a significant effect on the responses where they had stronger positive expectancy, which is an important point revealed in this study. CONCLUSIONS: In this study, we have observed a general acceptance that alcohol could provide positive reinforcement, especially among those who have had a prior experience of intake of alcohol. Thus, this study throws light on whether there is likelihood of youngsters falling into addiction in the later part of their life; hence it can act as a useful predictor for parents, health professionals, social counselors and the society as a whole so that they can take preventive measures against alcohol addiction.

Management of pyoderma gangrenosum--an update.

Pyoderma gangrenosum is a neutrophilic dermatosis with distinctive clinical manifestations. It is frequently associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis and myeloproliferative diseases. The etiopathogenesis of pyoderma gangrenosum is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. The diagnosis mainly depends on the recognition of evolving clinical features as there are no specific investigations for the diagnosis. It is essential to exclude other infectious diseases before therapy is initiated as corticosteroids and immunosuppressant therapy are the mainstays in the treatment of this disease. Recently, drugs like tacrolimus, mycophenolate mofetil and infliximab have shown promising results in this condition. Recent concepts regarding the various types of pyoderma gangrenosum and its management are reviewed.

A clinical study of vitiligo.

A clinical study of one hundred patients having vitiligo revealed the incidence among new patients to be 1.84%. The male/female ratio was 1:1.22. Family history of vitiligo was available in 8% of our patients. The different morphological pattern consisted of vitiligo vulgaris (39 cases), focal vitiligo (27 cases), acrofacial vitiligo (18 cases), lip-tip vitiligo (7 cases), lip vitiligo (5 cases), segmental vitiligo (3 cases) and universal vitiligo (1 case). Associated diseases include atopic dermatitis (2 cases), Hansen's disease (2 cases), alopecia areata (1 case), halo naevus (1 case), chronic urticaria (1 case), lichen planus (1 case), diabetes mellitus (9 cases), hypertension (4 cases), hypothyroidism (2 cases), epilepsy (1 case) and IHD (1 case).