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.

The Comparative Study To Evaluate The Effectiveness Of Dexmedetomidine Versus Propofol Intravenous Infusion To Facilitate Awake Fibreoptic Nasotracheal Intubation.

Awake fiberoptic intubation (AFOI) is the most valuable technique in the management of difficult airway. This study aimed to compare the effectiveness of dexmedetomidine vs propofol infusion in providing conscious sedation during AFOI Method- Sixty eight patients with anticipated difficult intubation posted for elective surgery were enrolled and randomly allocated into the dexmedetomidine (groupA) (0.4mcg/kg bolus infusion over 10 min, followed by0.12mcg/kg/min) (n = 34) or the propofol (groupB)(0.8mg/kg bolus infusion over 10 min, followed by 0.08 mg/kg/min) (n = 34). Endoscopy and intubation conditions, level of sedation amnesia and patient satisfaction as graded by a scoring system were evaluated as the outcomes. Results-Intubation was successful in all patients.There was statistically significant difference in mean endoscopy score (1.71 vs 2.15 ), mean intubation scores for vocal cord movement (1.29 vs 1.68 ) and the mean postintubation scores (1.68 vs 2.21 ) whereas no statistically significant difference was found in mean endoscopy scores for coughing (1.79 vs 2.15 ) and limb movement (1.53 vs1.82 ) The time taken for endoscopy (116.94 seconds vs 124.32 seconds ) and for the intubation (27.21seconds vs27.06 seconds)were similar in two groups .Patients in the propofol group had a significantly higher level of sedation (OAA/S score 2.76vs4.65). Recall of endoscopy and intubation was(gp A vs gpB;82.4% vs 23.5%). There was no statistically significant difference regarding patient satisfaction between the two groups Conclusion. Dexmedetomidine and propofol both were effective for providing conscious sedation during awake fibreoptic nasotracheal intubation.Dexmedetomidine provided better endoscopy and intubation conditions,similar haemodynamic stability without causing any respiratory distress

Non-compliance to Antiretroviral Therapy:Road Blocks and Possible Solutions.

A hospital based interventional study was done at Anti Retroviral Therapy centre (ART) of SMS Medical College during August 2010 to January 2011 with the objectives of finding out the proportion of patients who did not adhere to ART, its associated factors, reasons for non-compliance and determine the effect of reinforced counselling through interpersonal communication addressing patient specific reasons and solution for increasing compliance. There were 2841 HIV patients on ART during study period and on an average 381 (13%) of them did not adhere to ART. Age, literacy, unemployment, presence of co-infections were significantly associated with non-compliance while marital status, sex of patient, area of living, family size, distance from ART centre and type of ART regime were not associated with non-compliance. Reasons stated for not coming to collect drugs or not consuming them were mainly patients were travelling, forget to take the pills, no one was there to accompany them, no money for fare, busy in agriculture or other day to day activities. 100 randomly selected non-compliant patients were offered reinforced counselling with focus on patient specific reasons for non compliance and with an intention to encourage the patients to come up with solutions in prevailing circumstances. 74 patients started taking drugs regularly at the end of study. One patient out of these hundred died during study period.

In vitro regeneration in olive (Olea europaea L.) cv, ‘Frontio’ from nodal segments.

An efficient and reproducible protocol for plantlet regeneration from nodal segments of Olive cv ‘Frontio’ has been developed. Media and explants browning due to exudation of phenolics from the explants were controlled by fortification of the medium with 100 mg/L ascorbic acid. Best establishment of olive explants was observed on half-strength MS salts fortified with 2.0 mg/L 6-benzylaminopurine (BAP), which resulted in 56.2% of bud break and 93.7% survival whereas, a combination of full strength MS medium with 1.0 mg/L each of 3-indole-butyric-acid (IBA) and kinetin was found to be the best for shoot multiplication, in terms of number of shoots (3.6 shoots/explant) and shoot length (2.2 cm). The in vitro shoots were rooted on half-strength MS medium fortified with 0.2 mg/L IBA and 0.2 mg/L α-naphthalene acetic acid (NAA) with 1.5 g/L activated charcoal, which supported optimum rooting (60 %), with an average of 2-3 roots/shoot, about 2.4 cm length were produced on four weeks of culture.

Multiple transfused thalassemia major: Ocular manifestations in a hospital-based population.

Purpose: To study the ocular manifestations in multiple transfused beta-thalassemia major patients and assess the ocular side-effects of iron chelating agents. Materials and Methods: In this prospective observational study, 45 multiple transfused beta-thalassemia major children between six months and 21 years of age were enrolled and assigned groups according to the treatment regimens suggested. Group A received only blood transfusions, Group B blood transfusions with subcutaneous desferrioxamine, Group C blood transfusions with desferrioxamine and oral deferriprone and Group D blood transfusions with deferriprone. Ocular status at the time of enrolment was documented. Subjects were observed quarterly for one year for changes in ocular status arising due to the disease process and due to iron chelation therapy. Children with hemoglobinopathies other than beta-thalassemia major, congenital ocular anomalies and anemia due to other causes were excluded. Results: Ocular involvement was observed in 58% of patients. Lenticular opacities were the most common ocular finding (44%), followed by decreased visual acuity (33%). An increased occurrence of ocular changes was observed with increase of serum ferritin and serum iron levels as well as with higher number of blood transfusions received. Desferrioxamine seemed to have a protective influence on retinal pigment epithelium (RPE) mottling. Occurrence of lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively. Follow-up of patients for one year did not reveal any change in ocular status. Conclusion: Regular ocular examinations can aid in preventing, delaying or ameliorating the ocular complications of thalassemia.

Osteogenesis imperfecta with bleeding diathesis.

Osteogenesis imperfecta (OI) is a disorder of type 1 collagen synthesis with varied complications in form of brittle bones, hearing loss, dental, skin, and ocular changes. Osteogenesis imperfecta may have bleeding diathesis rarely due to defective vascular integrity for the same reason. Here we come across a rare case of Sillence type IB Osteogenesis imperfecta with bleeding in the form of repeated epistaxis and petechial rash, which seem to have a collagenous link.

Cyanotic child--can it be methaemoglobinemia?

Methaemoglobinemia is a rare condition and can give surprise in emergency setup. We have encountered one such case in emergency recently that presented with both peripheral and central cyanosis without cardio-respiratory compromise. The patient was confirmed to be suffering from methaemoglobinemia due to antimalarials that he had received before coming to the hospital. Cyanosis due to methaemoglobinemia in our patient was precipitated by concomitant glucose 6-phosphate dehydrogenase (G6PD) deficiency. The patient was managed with conservative management and vitamin C administration.