ABSTRACT
Under the current practice in organizing surgical services, proportionate representation of disciplines is provided in the curricular planning and in corresponding clinical functions. This is based on the level of competence expected by the end of training period. The disciplines as a “whole” are placed in general surgery or super specialty. The system of vertical arrangement has some serious concerns. Paradoxically, patients with diseases of simple and routine nature of discipline categorized as super specialty are neglected. Super specialist is unable to attend on account of preoccupation with serious challenging problems. The general surgeon hesitates because of privileging issues, fear of allegations of negligence and litigation. The system of vertical division is based on premise that some disciplines deal with complex procedures and others with only simple and routine nature. This premise is incorrect. Each discipline is a mix of simple and complex cases requiring specialized treatment. Alternate modified organization of surgical service is proposed. Activities of all disciplines are scrutinized according to the level of expected competence by the end of training. Categorization is shifted from the “discipline' to “activities.” Criteria applied for classification of activities are as follows: on completion, the trainee is capable to assume full responsibility-category 1; has gained sufficient experience-category 2; and is conversant with broad understanding of management-category 3. Activities of category 1 from all disciplines are assigned to general surgery and those of category 3 from all disciplines are assigned to respective super specialty. Those in the middle, comprising difficult cases but not requiring specialized training or heavy inputs in equipment, are in category 2. They are assigned to general surgery as additional/optional items, or super specialty, guided by local factors. The scope and practice of general surgery are broadened with a shift from “residual” to “comprehensive” discipline. Advantages, concerns, collateral issues of horizontal distribution of activities, its positive impact on research and education are discussed. It is concluded that the proposed organization of surgical services is a rational, logical, and practical strategy for good-quality surgical care in the society. The super specialists need to be convinced that “taking load off” is good for the specialty.
ABSTRACT
Euthanasia is mercy killing to alleviate the pain and misery of moribund persons. The thought in this regard is “Right to Life” includes “Right to Die.” This paper examines the issue of euthanasia in advanced stage of terminal cases with no possibility of reversal and it has been argued that there is a case for lifting euthanasia from the domain of human rights “Right to Die,” bringing the issue as a matter for professional opinion, a kind of medical advice/prescription. Guidelines need to be framed and criteria are laid down and notified under which euthanasia can be recommended. The decision is taken whether or not the criteria laid down are fulfilled in an objective manner. Like for other medical interventions “informed consent” is essential. In consideration of safeguards the decision is entrusted to a medical board and is subject to a legal prescrutiny. Professionally prescribed decision will to a great extent reduce emotive response surrounding euthanasia. The family may not have to face a difficult dilemma in deciding about euthanasia. There may not be a necessity of “living will,” although it may still be useful. The change to treat euthanasia as a professional decision/medical advice will require making legal and administrative provisions to empower medical establishment to discharge responsibility of euthanasia. It is essential to legalize euthanasia with corresponding modifications of medical ethics and code of conduct prescribed by Medical Council of India, State Medical Councils, and other regulatory bodies. It is essential to identify the procedure for carrying out euthanasia and the personnel assigned to actually carry out. Injection of lethal substance in lethal dose may be a favored choice. Once final decision after legal prescrutiny is arrived for euthanasia, differentiating passive and active euthanasia is unnecessary. In one perspective, active euthanasia is less disturbing for the patient, family, and friends as withdrawal of supporting tubes leading to dehydration, wasting, and struggling for breath associated with passive euthanasia, which nullifies the basic tenet of euthanasia, can be avoided. There is a possibility of spill over benefit of “active euthanasia” in the form of opportunity to promote cadaveric organ transplantation. Caution has to be exercised for effective safeguards to prevent misuse. There is a case for consideration for brining decision-making process regarding euthanasia within medical professional assessment and implementation
ABSTRACT
Trace elements are extremely important for normal metabolism. Copper is one of the trace metals which has important physiological function in maintaining thyroid activity. Copper is known to effect lipid metabolism. Increase in serum copper level is associated with decrease in concentration of total cholesterol (TC). Thyroid hormone binding transcription factors, which are essential for modulation of gene expression, contain zinc bound to cysteine residues and also thyroid hormones influence zinc metabolism by affecting zinc absorption and excretion. Zinc is required for enzymes involved in lipid synthesis and lipoprotein excretion. The purpose of this study was to determine the effect of various levels of serum copper and zinc on total cholesterol, plasma triglyceride and low density lipoprotein cholesterol in subjects with thyroid dysfunction. 61 subjects were divided into three groups of 13 hypothyroid, 23 hyperthyroid and 25 euthyroid based on thyroid stimulating hormone levels. The correlation between serum copper and low density lipoprotein (p <0.01) (r = -0.842), serum zinc correlated strongly negative and significantly with total cholesterol (r= -0.564) , low density lipoprotein cholesterol (r= -0.666) in hyperthyroid group. But the correlation in hypothyroid and euthyroid group differed and was not significant. Elevated levels of total cholesterol and low density lipoprotein cholesterol may be proatherogenic and increase the risk of cardio vascular diseases hence measures must be taken in correcting and maintaining levels of micronutrients in thyroid dysfunction.
ABSTRACT
Background: The most common cancer affecting women in developing countries is cervical cancer. The most effective tools of cancer detection is cervical smears. The present study is done to see whether the combination two devices can increase the adequacy of smears, The Ayer’s spatula is good sampling device but for sampling endocervical cells it is not that useful, therefore Cytobrush is used in combination to improve the adequacy as it is most efficient in sampling the endocevical cells. Material and methods: The collection of cervical smears was done by combination of Ayer’s spatula and Cytobrush. They were fixed in 95% ethanol and stained by Papanicolaou’s stain. Results: In this study 387 (96.75%) smears were satisfactory and 13(3.25%) were unsatisfactory smears. Conclusion: The combination is better than the devices used alone. The cost is limiting factor in developing countries, but it can be brought down by others ways.
ABSTRACT
Dyslipidemia, a very common complication of diabetes mellitus (DM), is associated with life threatening complication like coronary artery disease (CAD). Apolipoprotein A-I and apo B100 are the protein components of high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) respectively. Apo B100/apo A-I ratio represents the balance between pro-atherogenic and antiatherogenic factors. Apolipoproteins have recently gained importance as they are said to be a better indicator of coronary artery disease as compared to other lipid and lipoproteins. This study was done to study the apo B100/apo A-I ratio in type 2 diabetes mellitus. Methods: Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), extended lipid profile (total cholesterol (TC), triglyceride (TG), HDL, apoA-I and apoB100) were estimated in 34 non diabetic controls and 37 diabetic cases.The cases were further subdivided into 2 groups based on their glycemic control. LDL levels were calculated by Friedewald’s formula. Statistical analysis was done using SPSS software version 11.5. P value less than 0.05 was considered significant. Results: Poorly controlled diabetic cases had significantly lower levels of HDL and apoA-I and significantly higher levels of TG. Total cholesterol, LDL and apoB-100 were comparable in both the groups. ApoB100/apoA-I ratio was significantly elevated in poorly controlled diabetic. Apo B100/apo A-I ratio showed a strong positive correlation with glycated HbA1c Conclusion: Diabetes mellitus is associated with dyslipidemia. Strict glycemic control is capable of partially improving dyslipidmia. Apo B100/apo A-I ratio can be used as an additional parameter for assessment of risk of CAD in diabetes mellitus.
ABSTRACT
It is a well known fact that iodine is a very important trace element for normal growth and metabolism. Iodination of biomolecules has many important functions in the field of research, assay procedures, investigation and diagnosis of diseases. The present study is done to compare the iodine uptake by the serum of diabetes mellitus cases and healthy controls. Methods: The study was carried out on 50 cases of known diabetes mellitus with mean fasting blood glucose level of 324 mg/dl and 25 healthy controls with mean fasting blood glucose level of 78 mg/dl. The modified version of the colorimetric method was employed for the assay of iodine uptake. The data’s were analyzed using SPSS version 10. Results: Serum total iodine uptake was decreased significantly in cases as compared to healthy controls (p <0.01). Conclusion: The results of our study indicate that there is decreased iodine uptake by diabetic serum. The cause for decreased iodine uptake may be related to high blood sugar level which possibly may be causing some alteration in the structure of biomolecules by glycation leading to decrease in the binding sites of iodine.
ABSTRACT
PURPOSE: To investigate the feasibility of combining concomitant boost-accelerated radiation regimen (ACB) with full-dose mono-chemotherapy using cisplatin and to assess its local response and acute toxicity patterns in patients with advanced loco-regional head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: Between July 2004 and August 2005, a pilot study involving 27 patients with stage III to IVB (AJCC-6th) HNSCC of the oropharynx, hypopharynx and larynx who met the eligibility criteria was undertaken. Twenty-four of these patients (median age--53 years) were analyzable. The radiation dose was 72 Gy in 42 fractions over 6 weeks, delivered in one daily fraction of 1.8 Gy during the first 3.5 weeks and two fractions per day, 1.8 Gy and 1.5 Gy boost-separated by > 6 h interval, during the last 2.5 weeks. cisplatin, 100 mg/m2, was given in intravenous (i.v.) infusion on day 1 and day 22. Tumor and clinical status were assessed and acute toxicities were graded. RESULTS: Out of 27 patients, 24 patients received both radiation and chemotherapy as per protocol and were available for analysis. The loco-regional response rates were as follows: an overall response of 95.8% (23 patients), a complete response of 79.1% (19 patients), a partial response of 16.7% (4 patients) and progressive disease in 4.2% (1 patient). Dysphagia, nausea, vomiting and bone marrow suppression were the most common side effects and were associated with cisplatin administration. One patient (3.7%) died of complications (pneumonia and sepsis), 3 patients (12.5%) had acute grade 4 toxicity and 21 patients (87.5%) had acute grade 3 (17 patients) or grade 2 (4 patients) toxicity. CONCLUSION: This data shows that it is feasible to combine ACB and full-dose mono-chemotherapy using cisplatin with manageable, although substantial, toxicity. The compliance to therapy was high and the loco-regional response achieved compared favorably with ACB alone or other concurrent chemoradiation regimens using standard or altered fractionation regimens tested by the Institute. It also compares well with the available literature. An extended phase II trial; and a new phase III trial, comparing ACB plus cisplatin against standard radiation plus cisplatin, are being planned at the Institute to determine whether the use of ACB in the concurrent chemoradiation setting further improves outcome.