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Background: Androgen deprivation therapy (ADT) is indispensable part of treatment for metastatic prostate cancer (MPC) patients. There is documented association between ADT and adverse cardiovascular (CV) events, with variability between the different modes. However, there is dearth of evidence on the background CV risk factors of these group of patients at diagnosis. Aims and Objectives: We envisaged this retrospective observational study in the department of oncology to document the background CV risk factors of MPC patients at diagnosis, to help us better select the available ADTs based on their CV risks. Materials and Methods: Over a period of 2 years, all patients registered for treatment with a diagnosis of MPC, indicated for ADT, and available detailed history and background cardiological evaluation at presentation, were included in the study. As indirect indicators of CV risks, history of smoking, presence and treatment of dyslipidemia, and type 2 diabetes mellitus (T2DM), were documented. As direct indicators of CV risks, presence and treatment of hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF), ECG, and echocardiography changes suggesting cardiac morbidity were documented and the data were analyzed using descriptive statistical methods. Results: Indirect indicators: dyslipidemia, habit of smoking, and T2DM were found in 74%, 29.3%, and 13.3% patients, respectively. Direct indicators: Presence of hypertension, IHD, CCF, abnormalities in ECG, and echocardiography were found in 38.7%, 10.6%, 4%, 28%, and 34.6% patients, respectively. ST-T changes on ECG, low EF, and IHD on echocardiography were seen in 28.5%, 23%, and 26.9%, respectively. Conclusions: MPC patients have a substantial pre-existing CV risk at diagnosis. Our findings warrant a meticulous screening of all MPC patients for CV risk factors, to help in judicious selection of their ADT.
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Background: The re-emerging Monkeypox disease is spreading worldwide, thus if prevention measures are not followed or awareness is not raised, chaos could result. Aims and Objectives: The present study aimed to assess the awareness and preventive measures of Monkeypox among medical students in a tertiary care hospital of Kolkata. Materials and Methods: A hospital-based, descriptive, observational, and cross-sectional study was conducted over 6 weeks, among final year MBBS students of Medical College Kolkata. Convenience sampling was done. Minimum sample size calculated was 110. A pre-designed, pre-tested, semi-structured, and self-administered questionnaire which was face and content validated by experts used as the study tool in this study. Questionnaire was answered while keeping their identities confidential. Data were collected and entered in a coded manner in MS Excel. Using SPSS version 25, tabulation, the necessary tables, and diagrams were created. The Institutional Ethics Committee of the Medical College in Kolkata was consulted for ethical approval. Results: The students lacked sufficient information. Majority of them responded well when asked about the disease’s cause, incubation period, natural host signs and symptoms, mode of transmission, preventive measures, and treatment, but it was clear that they were unsure about identification of a suspected, probable, or confirmed case and definitive diagnosis. Conclusion: The present study reported that the students had limited knowledge about Monkeypox disease.
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Background: Appropriate use of drugs is essential in dermatophytosis to reduce morbidity and associated financial burden to the sufferers. Aims and Objectives: To explore the demographic characteristics along with the prescription pattern, self-medication practice, and price variability of the prescribed brands in the treatment of the dermatophytosis patients. Materials and Methods: Newly diagnosed consented dermatophytosis patients were enrolled in this cross-sectional observational study. Their baseline demographic characteristics were documented in the case report form along with the prescription details with self-medication history and Maximum Retail Price of each prescribed brand of drug. Results: Among total of 114 subjects (68 males, 46 females), majority were young (56.14%, <33 y). Most common diagnosis was tinea cruris followed by combination of tinea cruris and corporis. Average monthly family income was 11469.29 ± 10027.5 INR. Brand prescription was (74.15%), higher than generic (25.84%). Oral formulations were more prescribed (54.83%) than topical (45.16%) whereas individually luliconazole (cream) topped (23.18%) in the list. No topical or systemic steroid was prescribed. The commonest drug regimen was capsule itraconazole, luliconazole cream, and cetirizine or levocetirizine tablet with or without ketoconazole soap or tea tree body wash (71/114, 62.28%). About 39.47% subjects practiced self-medication, topical steroids (37.20%) mostly used. Price variability (percentage) among brands of the same drug was highest in ketoconazole soap (138.66%), followed by terbinafine tablet 250 mg (89.50%) followed by itraconazole capsule (83.33%). Conclusion: Luliconazole cream, itraconazole (capsule/tablet), terbinafine (tablet) and ketoconazole soap were the highly prescribed antifungal agents whereas topical steroid was mostly preferred as self-medication. Prescription of generic drugs should be promoted as well as inappropriate use of self-medication should be discouraged among the prescribers and the patients respectively.
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Background: Rechallenge of a platinum-based chemotherapy is the most common approach for a recurrent platinumsensitive epithelial carcinoma ovary. However, this carries a substantial risk of cumulative neurotoxicity. Objectives: In the present study, we tried to compare the efficacy and toxicities of gemcitabine pegylated liposomal doxorubicin combination regimen to rechallenge of paclitaxel-carboplatin in this setting. Materials and Methods: A total of 30 patients were included in the study. The patients were randomized into two groups each containing 15 patients. The study group received injection gemcitabine at the dose of 1 g/m2 injection intravenously on day 1 and day 8 and liposomal doxorubicin 30 mg/m2 on day 1 in a 3 weekly cycle up to a total of six cycles in absence of disease progression or unacceptable toxicities. The control group patients were treated with injection paclitaxel at a dose of 175 mg/m2 I/V infusion and injection carboplatin at a dose considering area under the curve 6 in a 3 weekly for six cycles. Results: In the study arm, out of 14 patients, 4 (28.57%) patients had complete response, 6 (42.85%) had partial response, 3 (21.42%) had stable disease, and 1 (7.14%) showed disease progression. In the control arm, 6 (40%) patients out of 15 showed complete response, and 4 (26.66%) partial response. Disease progression was noted in 1 (6.66%) patient. There was less incidence of neurotoxicity compared to the control arm. Conclusion: Chemotherapy with a combination of gemcitabine and pegylated liposomal doxorubicin shows equivalent efficacy in platinum-sensitive recurrent ovarian cancer when compared to rechallenge of platinum-based chemotherapy. The regimen has an acceptable toxicity profile with lesser incidence of neuropathy than rechallenge of paclitaxel-carboplatin combination.
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Background: External beam radiotherapy with concurrent chemotherapy has become the mainstay of treatment for locally advanced head and neck cancers. Objective: The objective of this study was to compare paclitaxel to cisplatin as an agent for concurrent chemoradiation in locally advanced squamous cell carcinoma of head neck region in terms of toxicities and response to treatment. Materials and Methods: Biopsy-proven Stage III and Stage IVA head and neck squamous cell cancer patients were included in the study. The study arm patients received concurrent dose of paclitaxel 20 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients in the control arm received concurrent dose of cisplatin 30 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients of both arms received a total dose of 66 Gy external beam radiation, 200 cGy/day, 5 fractions in a week in 6.5 weeks treated on a Theratron 780E Cobalt-60 teletherapy unit. Results: Acute Grades III and IV renal toxicity and nausea were reported significantly more number of cases in cisplatin arm in comparison to paclitaxel arm. There was no statistically significant difference observed in the groups in terms of treatment response and failure pattern (χ2 = 3.63, df = 1, level of significance 0.05). On follow-up, up to 6 months, 51.85% of cases are disease free in the control arm and 50.66% of cases in the study arm. Conclusion: Low-dose weekly paclitaxel concurrent with external beam radiation therapy given in conventional fractionation is comparable to concurrent cisplatin in locally advanced head and neck squamous cell carcinoma in terms of efficacy. There is lower incidence of severe renal toxicity and vomiting with concurrent paclitaxel than with cisplatin.
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Background & objectives: The well-being of donors undergoing frequent plateletpheresis has been a matter of concern. The aim of this study was to analyze the effect of frequent plateletpheresis on the haematological parameters (HP) of repeat donors. Methods: The study was conducted during February 2016 to March 2017 on all the repeat plateletpheresis donors undergoing the 2nd plateletpheresis within a month of the first in a tertiary care centre. Donors repeating plateletpheresis 3rd and 4th times were also studied. The values of the HP observed on follow up after plateletpheresis done on three different separators were compared. Results: HPs of the 98 donors were similar at follow up except mean platelet volume (P <0.05). Of the 98 donors, 35 were followed up within a week and 63 were followed up within 8-30 days. No significant alteration was found in the HPs except a significant difference in the variation of platelet counts of the two groups (P=0.025). In 34 donors who presented 3rd time for plateletpheresis (mean gap between 1st and 3rd plateletpheresis=31 days), no significant differences in the HPs were found except the platelet distribution width (P <0.05). Minimal difference in the HP was found in the baseline and the follow up of 3rd plateletpheresis i.e., at 4th plateletpheresis donation. Plateletpheresis through all the three cell separators used had similar effects on the follow up HPs. Interpretation & conclusions: Repeated plateletpheresis can be done without any detrimental effects on the cell counts of the plateletpheresis donors. The three cell separators yielded similar post-donation follow up haematological parameters.
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A term neonate developed respiratory distress, paradoxical cyanosis (relieved by crying) soon after birth. Inability to insert No.5 French infant feeding tube through the nose into the pharynx led to the diagnosis of Bilateral Choanal Atresia , which was confirmed by HRCT Scan of the nose. Insertion of an oropharyngeal tube reduced the respiratory distress. Extensive investigations did not reveal any other congenital anomaly. The baby was treated with Transnasal Surgery.
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Background. In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. Methods. We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). Results. Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. Conclusion. In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.
Subject(s)
Adolescent , Adult , Blood Banks/standards , Blood Donors , Blood Specimen Collection , DNA, Viral/blood , HIV-1/genetics , HIV-1/isolation & purification , Hepacivirus/genetics , Hepacivirus/isolation & purification , Hepatitis B virus/genetics , Hepatitis B virus/isolation & purification , Humans , Middle Aged , RNA, Viral/blood , Tertiary Care Centers/standards , Young AdultABSTRACT
The effect of trichloroethylene (Trielene) anaesthesia was studied in 10 young male patients undergoing short surgical procedures. Equal number of males operated upon for the same indication under epidural anaesthesia, served as a control group. Paracetamol concentrations in saliva were measured at hourly intervals on the day before and after surgery. Paracetamol half life (t1/2) significantly decreased (from 2.5 to 0.84 h) and clearance rate (CL) significantly increased (from 8.0 to 14.0 ml/min/kg) as compared to preoperative values. The control also showed significant but smaller alterations in these parameters. Our result suggests that trielene exposure may accelerate the hepatic metabolism of paracetamol.