Impact of Covid-19 pandemic on upper gastrointestinal cancer services: Experience from an oncosurgical unit

BACKGROUND The Covid-19 pandemic continues to affect the delivery of cancer care across the world. We evaluated the impact of the pandemic on the delivery of cancer care, to patients diagnosed with upper gastrointestinal (UGI) tract malignancies, during the first 4 months of the pandemic in India. METHODS We retrospectively analysed a database of patients with UGI malignancies discussed in the Multidisciplinary Tumour Board (MDTB) between 24 March and 24 July 2020. The results in the study group were compared to that of a similar group of patients from the corresponding period in 2019. RESULTS A total of 117 and 61 patients were discussed in the MDTB in 2019 and 2020, respectively, thereby showing a 48% reduction in the number of new cases seen in 2020. The reduction in the number of new cases was huge for oesophageal cancer (53–13; 75.5% reduction), compared to gastric cancer (53–43; 18.9%). The proportion of patients with metastatic disease at presentation was significantly higher in 2020, compared to 2019 (39.3% v. 23.1%; p=0.023). In 8 (13.1%) patients, the pre-existing treatment protocol had to be modified to suit the prevailing pandemic situation. Two patients with gastric cancer acquired asymptomatic Covid-19 infection during the treatment, which delayed the delivery of further therapy. Oncosurgeries were less in 2020 compared to 2019 (25 v. 63). The rate of 30-day major postoperative complications in 2020 was comparable with that in 2019 (12% v. 6.3%; p=0.4). CONCLUSIONS The number of new patients with UGI cancer, seeking elective cancer care and the number of oncosurgical procedures reduced during the Covid-19 pandemic. Continuous delivery of UGI cancer services was ensured during the pandemic through clinical prioritization, the adaptation of specific care pathways and selective modification of protocols, to suit the prevailing local conditions.

Flunarizine: a review of its role in migraine prophylaxis

Flunarizine, a potent calcium channel blocker has been used for more than three decades for the prophylactic management of migraine. Theories suggest that flunarizine may act through multiple mechanisms such as inhibition of cortical spreading depression, neurogenic inflammation and channelopathy. Flunarizine is efficacious in the management of various types of migraines such as common, classical, vestibular, abdominal, hemiplegic and pediatric migraine. It has a manageable safety profile with weight gain and drowsiness being commonly reported.

Diabetes mellitus as a risk factor for ischemic stroke: a case control study

Background: In developed countries, stroke is the third most common cause of mortality, following cancer and coronary heart disease. The increase risk is often seen in individuals with diabetes and is associated with poorer clinical outcomes (including higher mortality). That’s why assessment of risk factors for stroke are important.Methods: This age and sex matched hospital based case control study assessed the risk factors of ischemic stroke in tertiary care hospital for a period of one year. Sample size was calculated for matched case control (1:1 ratio) by n-master software and came out to be 189 pairs. All patients under WHO case definition were enrolled as cases for study purpose, controls were selected from the same hospital with disease other than stroke. Analysis was conducted through calculation of odd ratio (OR) and confidence internal (CI) by using SPSS 22.0 program. Odds ratio (OR) of risk factor was calculated using bivariate analysis.Results: Results revealed that male: female ratio among the case and control was 2.1:1, mean age of case and control were 58.86±13.03 and 58.21±12.67. Out of 189 Case, 59 (31.2%) were suffering from diabetes, while only 39 (20.6%) controls were having diabetes mellitus. P value was 0.02, which is significant.Conclusions: In the present hospital based case control study, it was found that diabetes mellitus was a significant risk factor among the ischemic stroke patients.

Effect Of Constraint Induced Movement Therpy In Storke Rehbilitation

INTRODUCTION: Stroke is most common in hypertensive patients in old age. This definition of stroke is the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24–hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. Various physiotherapy techniques used for the rehabilitation after stroke. Constraint induced movement therapy is from one of the technique used for stoke rehabilitation. Constraint Induced Movement Therapy is a new treatment technique that claims to improve the arm motor ability and the functional use of a paretic arm – hand. Constraint Induced Movement Therapy focus the use of the affected side by restraining the unaffected side. It is observed that patients with hemiparesis did not use their affected extremity (hemi –neglecting). The application of the method is the patients wear a mitt on the unaffected arm 90% of their waking hours and perform repetitive exercises with the more affected arm six to seven hours per day during two to three weeks OBEJECTIVE: The objective of this project is to determine the effects of constraint induced movement therapy in stoke rehabilitation. CONCLUSION: It can be concluded from the present study that Constraint Induced Movement Therapy might be beneficial than traditional rehabilitation therapy in stroke. These findings from the articles which are included in the study have clinical significance for the rehabilitation of patient within stroke. These articles shows significant effects of constraint induced movement therapy in Stroke Rehabilitation.

Evaluation of changes in retinal nerve fiber layer thickness and visual functions in cases of optic neuritis and multiple sclerosis.

Context: Retinal nerve fiber layer (RNFL) thinning has been demonstrated in cases of optic neuritis (ON) and multiple sclerosis (MS) in Caucasian eyes, but no definite RNFL loss pattern or association with visual functions is known in Indian eyes. Aim: To evaluate RNFL thickness in cases of ON and MS, and to correlate it with visual function changes in Indian patients. Settings and Design: Cross‑sectional case‑control study at a tertiary level institution. Materials and Methods: Cases consisted of patients of (i) typical ON without a recent episode (n = 30:39 ON eyes and 21 fellow eyes), (ii) MS without ON (n = 15;30 eyes) while the controls were age‑matched (n = 15; 30 eyes). RNFL thickness was measured using the Stratus 3°CT. The visual functions tested included the best‑corrected visual acuity (BCVA), contrast sensitivity, stereopsis, visual evoked responses, and visual fields. Statistical analysis used: Intergroup analysis was done using ANOVA and Pearson’s correlation coefficient used for associations. Results: RNFL thickness was reduced significantly in the ON and MS patients compared to the controls (P‑0.001). Maximum loss is in the temporal quadrant. Lower visual function scores are associated with reduced average overall RNFL thickness. In ON group, RNFL thinning is associated with severe visual field defects while contrast sensitivity has strongest correlation with RNFL in the MS group. Conclusions: RNFL thickness is reduced in ON and MS cases in a pattern similar to Caucasians and is associated with the magnitude of impairment of other visual parameters. Contrast sensitivity and stereoacuity are useful tests to identify subclinical optic nerve involvement in multiple sclerosis.

Congenital myopathies: a clinicopathological study of 25 cases.

OBJECTIVE: Congenital myopathies are rare. Through this article, the authors want to present a clinicopathological analysis of 25 new cases. MATERIALS AND METHODS: The clinical data of patients who were diagnosed with congenital myopathy between 2001 and 2006 was retrieved. Muscle biopsies were processed for H&E staining, enzyme histochemistry, and immunohistochemistry. Biopsies were also processed for ultrastructural analysis. RESULTS: During a period of 6 years, 1.12% of the muscle biopsies were diagnosed as congenital myopathies. The most common congenital myopathy was central core disease followed by nemaline rod myopathy and multi-mini core disease. Clinically, they have variable features. The final diagnosis was made with the help of enzyme histochemistry and ultrastructural features. CONCLUSION: This study emphasizes the importance of enzyme histochemistry and electron microscopic examination in the diagnosis of congenital myopathies especially in the absence of genetic studies.

IgM anti-GM1 antibody titers in patients with monomelic amyotrophy.

BACKGROUND: Monomelic amyotrophy (MMA) is a benign motor neuron disorder, which particularly affects young people and the etiology is still unknown. Gangliosides are located on the outer surface of motor neurons. Anti-GM1 antibodies have been found to be elevated in multi-focal motor neuropathy with conduction block and other neurological diseases, which may have therapeutic implication. AIM: To evaluate IgM anti-GM1 antibody titers in patients of monomelic amyotrophy. SETTING AND DESIGN: prospective controlled study. MATERIALS AND METHODS: Forty-six clinically and electrophysiologically diagnosed cases of MMA were assessed for IgM anti-GM1 antibody titers by enzyme-linked immunosorbent assay (ELISA) method and compared with titers in healthy controls, cases of amyotrophic lateral sclerosis (ALS) and acute inflammatory demyelinating polyneuropathy (AIDP). Titer of 800 units was taken as upper limit of normal (Buhlmann Laboratories AG, Switzerland). STATISTICAL ANALYSIS USED: one-way ANOVA. RESULTS: The mean age of 46 patients with MMA was 24.5 (+/- 7.3) years, with male female ratio of 44:2. The mean age of 19 healthy controls was 24.1 (+/- 3) years with male: female ratio of 18:1. Five (26%) individuals in the healthy control group, 22 (48%) patients of MMA, four (30%) of ALS and five (50%) of AIDP had high titers of IgM anti-GM1 antibody (P> 0.05). CONCLUSIONS: Although larger number of patients with MMA had higher IgM anti-GM1 antibody titers, the difference was not statistically significant from titers of healthy individuals and of patients in the ALS and AIDP group.

Verbal and visual memory in patients with early Parkinson's disease: effect of levodopa.

BACKGROUND: The effect of initiation of levodopa therapy on the memory functions in patients with Parkinson's disease remains poorly understood. AIMS: To evaluate the effect of initiation of levodopa therapy on memory, in patients with early Parkinson's disease. SETTINGS AND DESIGN: Prospective case control study. MATERIALS AND METHODS: Seventeen patients with early Parkinson's disease were evaluated for verbal memory using Rey's auditory verbal learning test, and visual memory using the Benton's visual retention test and Form sequence learning test. UPDRS scores, Hoehn and Yahr's Staging and Schwab and England scores of Activities of daily living. Hamilton's depression rating scale and MMSE were also evaluated. Six controls were also evaluated according to similar study protocol. Levodopa was then prescribed to the cases. Same tests were repeated on all the subjects after 12 weeks. RESULTS: The mean age of the patients was 59.8 (+ 12.9 yrs); mean disease duration of 3.26 (+ 2.06 yrs). The mean UPDRS scores of patients were 36.52 (+ 15.84). Controls were of a similar age and sex distribution. A statistically significant improvement in the scores on the UPDRS, Hamilton's depression scale, Schwab and England scale, and a statistically significant deterioration in the scores of visual memory was observed in patients with PD after starting levodopa, as compared to their baseline scores. There was no correlation between degree of deterioration and the dose of levodopa. CONCLUSION: Initiation of levodopa therapy in patients with early and stable Parkinson's disease is associated with deterioration in visual memory functions, with relative preservation of the verbal memory.

Isolated "one and a half syndrome" with brainstem tuberculoma.

A seldom reported causal association of two rare entities, an isolated brainstem tuberculoma and an isolated One and a half syndrome in a 12 year old girl is presented. MRI showed an isolated inflammatory granuloma in the brainstem which on empirical treatment with anti tubercular drugs resulted in complete restoration of ocular motility, along with resolution of the lesion on follow up MRI at 6 months. The diagnosis and management are discussed.

Thoracoscopic thymectomy for juvenile myasthenia gravis.

Thoracoscopic thymectomy is feasible in adolescents with myasthenia gravis. It allows complete resection of the gland with less morbidity, shorter ICU and hospital stay and far superior cosmetic result as compared to trans-sternal thymectomy. Our experience with this procedure in 9 adolescents with myasthenia gravis is presented along with review of the relevant literature.