Outcome of Adjuvant Concurrent Chemo-Radiation in Operated Locally Advanced Rectal Cancer.

Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.

Aerobic bacteriology of chronic suppurative otitis media: a hospital based study.

Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra- and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley. Methods: A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin. Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

Prevalence of bilateral cataract blindness in persons ≥50 years of age in Pulwama district, Jammu & Kashmir, India.

Rapid assessment of cataract blindness has been accepted as a robust tool to help planners in developing countries. Prevalence of cataract blindness can give important information about the impact of a cataract intervention programme. A study in this direction was carried out in Pulwama district of Jammu & Kashmir. Our results clearly showed that with the increase in age, the prevalence of bilateral cataract blindness increases manifold. However, gender did influence the prevalence of cataract in the present survey. The prevalence of bilateral cataract decreases considerably, with the increase in education of both the genders. Among both male and female respondents examined, 89 percent were having both eyes phakia. Similarly 79 percent of study population were not having lenticular opacity either in R/E or L/E in both males and females. Results show that the prevalence of bilateral cataract blindness in district Pulwama is 4.16 percent.

Twin load of hypertension and diabetes amongst adults: community based study from Jammu and Kashmir, India.

Background: Data regarding the occurrence of hypertension and diabetes in the community are crucial for optimum allocation and utilization of health resources. Objective was to assess the efficacy of such field based exercise in detection of new undiagnosed cases and calculation of the consequent prevalence. Methods: A cross sectional community based study was carried out to find out prevalence of hypertension and diabetes amongst adults (35-64 years) in Chatergam, Budgam (Jammu and Kashmir) during Oct 2011 to Feb 2012 on a pre-tested structured questionnaire. Blood pressure was measured in 2077 adults and random blood sugar (RBS) was measured in 1732 subjects to detect diabetes. Data was analyzed to find out the distribution of systolic (SBP) and diastolic (DBP) and the prevalence of hypertension and diabetes along with 95 percent confidence intervals. Results: Mean SBP and DBP of 2077 subjects were 130.7 ± 40.3 and 83.1 ± 11.4 mm of mercury respectively. Values were the highest for both SBP and DBP amongst women of urban areas and in the 55 – 64 years of age. Quarter of studied persons (24.4%) had the family history of hypertension or diabetes or both. Based on the criteria of JNC 7, 41.1% subjects (95 % CI 38.9 – 43.2) were found hypertensive including 593 known cases (496 alone & 97 in combinations with diabetes). Prevalence of new cases of hypertension was 17.5 percent; it significantly increased with increasing age and was high amongst males and those residing in urban areas. 4.6% subjects (95% CI 3.6-5.7) were positive for diabetes based on RBS. Conclusions: Considering high load of twin diseases and their impact on coronary vascular diseases (CVD), study emphasizes the need to implement an integrated population-based cost-effective control program with a focus on primordial and primary prevention.

An overview of hospital acquired infections and the role of the microbiology laboratory.

Every year, many lives are lost because of the spread of infections in hospitals. These nosocomial infections, also called hospital acquired infections (HAI) are infections that patients acquire during the course of receiving healthcare treatment for other conditions. HAIs are a cause of significant morbidity and mortality in patients receiving healthcare, and the costs direct and indirect of these infections deplete the already limited financial resources allocated to healthcare delivery.

Seroprevalence of brucellosis in Kashmir (India) among patients with pyrexia of unknown origin.

Over a period of 5 years from 1992 to 1997 a total of 3,532 patients of pyrexia of unknown origin (PUO) were subjected to Wright's tube agglutination test for brucellosis. Of the 3,532 patients tested, 28 (0.8%) were found seropositive for brucellosis. Males outnumbered females by a ratio of 3:1. Whereas the seroprevalence among males clearly was age-related, the seroprevalence among women was not. The highest number (43%) of positive males belonged to the age group 21-30 years. The majority of patients had titres of 1:160 or 1:256, high titres of 1:512 and 1:1024 were found in 21.4% patients.