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1.
Article | IMSEAR | ID: sea-205590

ABSTRACT

Background: In adults most common intracranial malignant lesion is brain metastasis, far outnumbering primary brain tumor. The most common primary site is lung cancer (18–64%), followed by breast (25–21%), malignant melanoma (4–16%), and colorectal cancer (2–12%). It is hypothesized that the incidence of brain metastasis might be increasing, as a result of increasing survival from recent advance in cancer treatment, more frequent brain screening for specific primary malignancy that known to have a higher prediction for brain metastasis and greater availability and use of magnetic resonance imaging (MRI) of brain. In clinical oncology, understanding brain metastasis is important, because it has profound effect on length of survival, quality of life, and in one-third to one-half of affected patients, they represent the direct cause of death despite current improvement in therapeutic approach. Epidemiological data of brain metastasis are lacking in India. Objectives: Aims of our retrospective analysis are to study epidemiology and pattern of care of brain metastasis over last one decade in Nil Ratan Sircar Medical College and Hospital, Kolkata. Materials and Methods: Between 2006 and December 2017, a total of 710 patients of brain metastasis treated in our department with palliative intent were analyzed retrospectively. New-onset neurological symptoms in a known case of cancer we always presumed that, symptoms were due to brain metastasis until proven otherwise. Hence, all patients presenting with acute neurological signs and symptoms underwent through clinical examination, contrast-enhanced (CE) computed tomography brain, and/or CEMRI of brain. Epidemiology, pattern of care, and outcome in the form of overall survival (OS) and disease-free survival were determined. Results: Fifty-seven percent patients were male. The median age was 62 years at the time of diagnosis. Lung carcinoma was most common primary site seen in 52% patients, followed by carcinoma breast second most common primary site, seen in 32% patients. Headache (73%) and motor weakness were most common presenting symptoms. Supratentorial location most common site, out of which parietal region is most common. The only small number of patients was offered best supportive care alone whereas majority of the patients were considered fit for palliative therapy. Treatment consisted of metastasectomy when possible and palliative whole-brain radiotherapy (WBRT) alone or followed by systemic therapy. Optimal supportive care in addition to chemotherapy or radiotherapy is given to all patients. A total of 254 patients were given blood product, erythropoietin, granulocyte-colony-stimulating factor following chemotherapy. Hospitalization required in 71% patients and tumor-related problem was most common cause (46%). Remaining patients were hospitalized for delivery WBRT or CCT. The median OS is 9 months. Patients with younger age and breast primary associated with better prognosis than lung primary. Conclusions: We can conclude that carcinoma lung in male and carcinoma breast in females was most common cause of brain metastasis. Because advance in palliative therapy, outcome of patients with brain metastasis has improved, and patients with brain metastasis benefit from palliative radiotherapy and chemotherapy and this treatment could be delivered easily on outpatients basis.

2.
Article | IMSEAR | ID: sea-205470

ABSTRACT

Background: Lung cancer is the most common cancer diagnosed worldwide. Tobacco smoking is the most important environmental factor associated with the development of lung cancer. However, a large number of patients with lung cancer have no history of smoking frequently among female patients. There are no enough data in Eastern India regarding epidemiological study of lung cancer. Objectives: The aim of our study was to evaluate the prevalence and pattern of lung cancer in our institution (NRS Medical College and Hospital). Materials and Methods: Our study was a retrospective analysis of prospectively collected data for newly diagnosed adult patients. All patients were registered only after lung cancer diagnosis was confirmed by histopathological and/or cytological examination. The following information was collected from the database such as age, sex, smoking status and histological type, disease location, and stage. Results: A number of male patients were 786 (82%) and a number of female patients were 172 (18%). 692 (72.2%) patients had a history of smoking and 266 (27.8%) patients had no history of smoking in their life. Among the non-smoker patients, female patients were 147 (55.3%) and male patients were 119 (44.7%). 80% of patients came from rural areas and 20% of patients came from urban areas. In our study; histologically, the adenocarcinoma was 398 (41.6%) found most prevalent which is followed by squamous cell carcinoma 365 (38.1%). Conclusion: Adenocarcinoma lung with the right upper lobe involvement was prevalent in our study and non-smoker female patients were predominant. The major etiological factor was smoking. Awareness in the society is needed about cancerous effect of tobacco smoking for reducing the incidence of lung cancer.

3.
Article | IMSEAR | ID: sea-205400

ABSTRACT

Background: Esophageal carcinoma is high prevalence in Asia, including India and most of the patients present in advanced and inoperable stage. Most of the patients have poor nutritional status and low performance status. These patients are unable to tolerate radical treatment. Prognosis of these patients is very poor. There are no enough data of prospective study in palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy in Eastern India. Objectives: The main objective of our study was palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy. Materials and Methods: The study was done with 43 patients with histopathologically proven squamous cell carcinoma and/or adenocarcinoma at thoracic esophagus, intraluminal brachytherapy feasible. Patients were received external beam radiotherapy palliative dose 30 Gy in 10 fractions for 2 weeks followed by intraluminal high-dose rate brachytherapy 6 Gy per fraction per week for 2 weeks. Results: In our study, the mean age of the patients was 58 years (age range 48 years–70 years). 1 month after completion of intraluminal brachytherapy, a number of patients with improvement of dysphagia were 34 (79%). The improvement of dysphagia was maintained 25 (73.5%) patients at 3-month completion of treatment and 14 (56%) patients at 6-month completion of treatment. The median duration of dysphagia relief was 5.2 months. Post-radiotherapy complications as chest pain were seen in 10 (23.2%) patients, esophageal strictures were developed in 7 (16.3%) patients, ulcerations were in 4 (9.3%) patients, and esophageal fistula was developed in 1 (2.3%) patient. Conclusion: The patients with advanced inoperable or metastatic esophageal carcinoma and poor performance status, palliative radiotherapy are effective modality of treatment for the improvement of dysphagia.

4.
Article in English | IMSEAR | ID: sea-172783

ABSTRACT

Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence can be as high as 76% which would cause unexpected delay in hospital discharge. This study was designed to compare the efficacy of the ondansetron alone with combination of ondansetron and dexamethasone the given as prophylaxis for PONV in patients undergoing laparoscopic cholecystectomy. One hundred patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into 2 groups of 50 each. Group I received 4mg of ondansetron intravenously (iv), whereas Group II received ondansetron 4mg and dexamethasone 4mg just before induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic. Complete response defined as no nausea and vomiting during first 24 hours, was noted in 76% of patients in Group I and in 92% of patients in Group II. Rescue anti emetic requirement was less in Group II (4%) than Group I (20%). So it can be concluded that the combination of ondansetron and dexamethasone is more effective in preventing PONV in patients undergoing laparoscopic cholecystectomy than ondansetron alone.

5.
Article in English | IMSEAR | ID: sea-168314

ABSTRACT

Background: Spontaneous echocardiographic contrast (SEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. The present study was conducted to evaluate the association between left atrial spontaneous echocardiographic contrast with inflammatory markers in mitral stenosis patients. Methods: This observational analytical study was undertaken in the department of Cardiology, National Institute of Cardiovascular diseases (NICVD), Dhaka. A total of 70 patients with mitral stenosis were categorized into two groups: group I with left atrial SEC and group II without left atrial SEC. All patients underwent transthoracic as well as transoesophageal echocardiography. Complete blood count with ESR was done and neutrophil lymphocyte ratio was calculated. The high sensitive C-reactive protein (hs-CRP) was assayed. Results: The hs-CRP levels were significantly greater in the SEC-positive group (5.6±2.1vs 1.5±0.7, p=0.001). The mean ESR level was significantly greater in the SEC-positive group (32.6±15.5 mmvs15.8±4.7 mm).The neutrophil levels ((76.1±1.9 vs 63.7±3.3) were significantly greater in the SEC-positive group, and the lymphocyte levels (33.3±3.0 vs 21.5±1.3) were significantly greater in the SEC-negative group (p=0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.4±0.4 vs2.1±0.6, p=0.001).On multivariate analysis hs-CRP, neutrophil/lymphocyte ratio, raised ESR, mitral valve area and left atrial diameter were independent risk factors for SEC in patients with mitral stenosis. Conclusion: From this study it may be concluded that left atrial SEC is associated with raised inflammatory markers in majority of patients with mitral stenosis. So, SEC may be considered as a reflection of ongoing inflammatory process in patients with mitral stenosis.

6.
Article in English | IMSEAR | ID: sea-168313

ABSTRACT

Background: Cardiovascular disease is the leading cause of morbidity and mortality in renal impaired patients. Many of the patients of chronic kidney disease die of cardiovascular disease before requiring dialysis. Cardiovascular disease in renal impaired patient is potentially preventable and treatable. The aim of this study was to evaluate the association between renal impairment and coronary artery disease severity in chronic stable angina patients. Methods: 110 patients with chronic stable angina who got admitted for coronary angiography were included in the study. They were divided into impaired renal function group (with estimated glomerular filtration rate [eGFR] <90 ml/min/1.73m2) and normal renal function group (eGFR e” 90 ml/min/1.73m2) on the basis of eGFR. The severity of the CAD was assessed by angiographic Vessel score and Gensini score. Results: Mean Gensini score was significantly high in impaired renal function group (42.30±24.9 vs 25.65±17.9, p <0.05). There was significant negative correlation between eGFR and vessel score (r=-0.30, p <0.05) and between eGFR and Gensini score (r =-0.65, P <0.05). In multivariate logistic regression analysis, after adjustment of factors eGFR remain independent predictors of severe CAD (P=0.002, OR -5.73). Conclusion: Impaired renal function, assessed by eGFR is associated with angiographic severe coronary artery disease in chronic stable angina patients and this association is independent of conventional cardiovascular risk factors.

7.
Article in English | IMSEAR | ID: sea-172665

ABSTRACT

Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy and postoperative complications are still inevitable in certain cases. Knowledge of the rate and underlying reasons for conversion and postoperative complications could help surgeons during preoperative assessment and improve the informed consent of patients. We decide to review the rate and causes of conversion and postoperative complications of our LC series. This study included 760 consecutive laparoscopic cholecystectomies from July 2006 to June 2011 at Faridpur Central Hospital and Faridpur Medical College Hospital. All patients had surgery performed by same surgeon. Conversion to open cholecystectomy required in 19 (2.5%) patients. The most common reasons for conversion were severe adhesions at calot's triangle (6, 0.83%) and acutely inflamed gallbladder (5, 0.66%). The incidence of postoperative complications was 1.58%. The most common complication was wound infection, which was seen in 5 (0.66%) patients followed by biliary leakage in 3 (0.40%) patients. Delayed complications seen in our series is port site incisional hernia (2, 0.26%). LC is the preferred method even in difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands, the surgeons should keep a low threshold for conversion to open surgery and it should not be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

8.
Article in English | IMSEAR | ID: sea-172572

ABSTRACT

The laparoscopic incisional hernia repair is a safe alternative to open mesh repair. The procedure has the advantages of minimal access surgery and lower recurrence rate. A prospective study of laparoscopic incisional hernia repair of our first 11 patients was performed from July 2008 to December 2009. No serious intraoperative or postoperative morbidity was encountered, only two patients developed seroma. The mean operating time was 90 minutes (60 to 180 minutes). The mean day of discharge after surgery was 3 days (2-7 days). No patient developed a recurrence during mean follow up period of 10 months. Laparoscopic repair of incisional hernia has been shown to be feasible, safe and effective. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

9.
Article in English | IMSEAR | ID: sea-172557

ABSTRACT

In 1991 WHO International Survey of Drug Utilization in Pregnancy is 86% of women took medication during pregnancy, Average of 2.9 prescriptions and despite this high rate of medication intake, most drugs are not labeled for use during pregnancy. Most women use a number of different medications during pregnancy, many of which are self-administered. It is essential to consider the following factors before prescription of drugs during pregnancy. A) Dose and duration of drug exposure is important. The larger the dose is more likely the effects. The longer the duration of drug exposure is greater chance of susceptible periods of organogenesis and developmental problem. B) Timing of exposure is very crucial. Certain organ systems may have only limited period of susceptibility for damage. C) Pathogenetic mechanism, teratogens produce their adverse effect by specific mechanism. D) Host susceptibility, variability in the genetic factors related to mechanism of certain drugs. All drugs can affects the health of the mother and fetus, therefore any drugs should be administer with care during pregnancy.

10.
Article in English | IMSEAR | ID: sea-172534

ABSTRACT

Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallbladder disease. Its role in surgical treatment of acute cholecystitis has also been well defined. Here a prospective study was conducted over a 3 year period of 28 patients with acute cholecystitis at district level hospitals of Bangladesh, where many modern surgical facilities were lacking. Out of 28 patients of acute cholecystitis, 24 were operated by laparoscopic methods and rests 4 were converted to open cholecystectomy. Mean operation time was 87.95 minutes and only 2 patients had postoperative complications. This study showed the appropriate time of laparoscopic cholecystectomy for acute cholecystitis, conversion rate and complications. It may be concluded that laparoscopic cholecystectomy is feasible and beneficial to the patient with acute cholecystitis in its early phase, if necessary support and expertise is available.

12.
Article in English | IMSEAR | ID: sea-85488

ABSTRACT

Splenic metastasis is a rare clinical entity--incidence being 0.6% at autopsy and 1.1% at splenectomy. We report the case of a 30 year old female who presented with purpura and melena and who was later diagnosed to have a mucinous adenocarcinoma of stomach with disseminated intravascular coagulation and splenic metastasis.


Subject(s)
Adenocarcinoma, Mucinous/pathology , Adult , Disseminated Intravascular Coagulation/etiology , Female , Humans , Splenic Neoplasms/secondary , Stomach Neoplasms/pathology
13.
J Indian Med Assoc ; 2006 Aug; 104(8): 428-30
Article in English | IMSEAR | ID: sea-96352

ABSTRACT

Two hundred and thirty cases of diabetes mellitus were selected in a case-control fashion by applying systemic random sampling technique taking 20% of the patients attending the diabetic clinic of Calcutta National Medical College during the period from January to June, 2003 to find out association and risks of some socio-economic and demographic factors with the occurrence of diabetes mellitus. Controls were selected from the patients admitted in the department of surgery in the same period. Factors like physical activity, socio-economic status, residential status, family history and obesity have shown statistically significant association with diabetes. For physical activity the estimated relative risk is maximum in case of sedentary worker where the odd's ratio was 9.4. So far other factors are concerned the estimated relative risk of diabetes was 5.1 in case of urban population, 6.2 in case of positive family history, 2.5 in case of upper and upper middle classes, and 2.4 in case of obesity in comparison to their respective reference category.


Subject(s)
Adult , Case-Control Studies , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , India/epidemiology , Life Style , Male , Middle Aged , Obesity/epidemiology , Risk Factors , Socioeconomic Factors , Urban Population
14.
J Indian Med Assoc ; 2006 Jan; 104(1): 38-9
Article in English | IMSEAR | ID: sea-97167

ABSTRACT

A 9-year-old male child presented with features of recurrent episodes of pneumonia. Following administration of different types of antibiotics, resolution of pneumonia was not complete. Antituberculous drugs were given on two occasions for sufficient period of time without any improvement. Following admission, history of a choking sensation during taking food pointed to perform barium swallow examination of oesophagus which revealed the diagnosis of tracheo-oesophageal fistula.


Subject(s)
Airway Obstruction/etiology , Bronchi/abnormalities , Child , Esophagus/abnormalities , Humans , Male , Medical History Taking , Pneumonia/etiology , Recurrence , Trachea/abnormalities , Tracheoesophageal Fistula/congenital
15.
Indian J Public Health ; 2004 Oct-Dec; 48(4): 171-80
Article in English | IMSEAR | ID: sea-109163

ABSTRACT

331 primary school students studying from Nursery classes to Class IV in 2 randomly selected schools in Naxalbari Village in Darjeeling district of West Bengal were tested for visual acuity (VA), Vitamin A deficiency (VAD) and Bitot's spot. 329 students could be tested for visual acuity whereas all 331 students were tested for VAD and Bitot's spot. The prevalence of abnormal Visual Acuity (VA) (VA < 6/9 in any eye) in this study group was 3.65% and it was highest in 7-8 years age group in both the sexes contributing to 75% of the total students having abnormal VA. All these children fell within 50th percentile of weight and height for their respective age and sex. Hindu & ST children accounted for 91.67% & 50% abnormal VA respectively; however, when presence of abnormal VA was compared with its absence between 2 sexes, Hindu and Muslim students and in different castes, no statistically significant differences were found (p > .05). Students of Class-I and Class-II contributed 25% and 50% respectively and together accounted for 75% of abnormal VA. Prevalence of VAD was 8.16%. Among sufferers of VAD Hindus (81.48%) and ST (51.85%) were the main contributors; the differences between presence and absence of VAD in 2 sexes, among 3 religious groups were not statistically significant (p > .05); however, differences among ST and NonSCST groups, and again SC, ST and Non-SCST groups were statistically significant (p < .05). Prevalence of Bitot's spot was 3.63%. Among the students having Bitot's spot, females (58.33%) outnumber the males (41.67%); but the difference between presence and absence of Bitot's spot in 2 sexes was not statistically significant (p > .05). 83.33% each of Hindus and STs had Bitot's spot. No SC and no Muslim student had this spot; the differences between presence and absence of Bitot's spot between Hindu and Christian students were statistically significant (p < .01); similarly when the findings were considered between ST and NonSCST students the difference was found to be statistically highly significant (p < .001).


Subject(s)
Child , Child, Preschool , Female , Humans , India/epidemiology , Male , Prevalence , Religion , Rural Health Services/organization & administration , Visual Acuity , Vitamin A Deficiency/epidemiology
16.
Indian J Public Health ; 2003 Apr-Jun; 47(2): 66-71
Article in English | IMSEAR | ID: sea-110311

ABSTRACT

A hospital based prospective study was carried out from 1st October 1998 to 30th September 1999 on children with clinical diagnosis of bronchiolitis in OPD and indoor patients of the Department of Paediatric Medicine, Medical College Kolkata. The objective of the study was to find out the proportional case rate and clinico epidemiological features of the disease. The effectiveness of nebulized salbutamol among bronchiolitis children was also looked into. The proportional case rate was found to be 4.65%. Low birth weight (LBW)/premature babies (51.11%) malnutrition (40%), nonimmunization (55.55%) & non breastfeeding practices (48.88%) were significant risk factors for severe bronchiolitis. Response to nebulized salbutamol was remarkably higher (70%) in 6m to 12m age group.


Subject(s)
Administration, Inhalation , Age Distribution , Albuterol/administration & dosage , Bronchiolitis/drug therapy , Comorbidity , Female , Hospitals, Teaching/statistics & numerical data , Humans , Immunization/statistics & numerical data , Incidence , India/epidemiology , Infant , Infant, Low Birth Weight , Infant, Newborn , Male , Malnutrition/epidemiology , Pediatrics/statistics & numerical data , Prospective Studies , Sex Distribution , Treatment Outcome
17.
Indian J Public Health ; 2002 Apr-Jun; 46(2): 57-60
Article in English | IMSEAR | ID: sea-109678

ABSTRACT

Bed management is one of the important activities for efficient hospital management. The present study on evaluation of bed management in a rural hospital revealed that the total bed capacity could not be utilised. The turnover rate, turnover interval, bed occupancy rate and average length of stay were closely corroborating.


Subject(s)
Bed Occupancy/statistics & numerical data , Efficiency, Organizational , Female , Hospital Units/statistics & numerical data , Hospitals, Rural/organization & administration , Humans , India , Length of Stay , Male , Nepal , Utilization Review/organization & administration
18.
Indian J Public Health ; 1997 Apr-Jun; 41(2): 56-60, 67
Article in English | IMSEAR | ID: sea-109531

ABSTRACT

The overall prevalence of dental caries was found to be 57.47 percent in an urban slum irrespective of sex, with a maximum of 75.88 percent in the age group of 5-9 years. Habit of taking hard and sticky food, bad oral hygiene were some of the important epidemiological correlates. Fluoride content of drinking water did not show any significant role.


Subject(s)
Adolescent , Adult , Age Distribution , Child , Child, Preschool , Dental Caries/epidemiology , Dental Health Surveys , Female , Feeding Behavior , Humans , India/epidemiology , Male , Poverty , Prevalence , Risk Factors , Sex Distribution , Urban Health/statistics & numerical data
19.
Indian J Public Health ; 1993 Jan-Mar; 37(1): 16-22
Article in English | IMSEAR | ID: sea-109698

ABSTRACT

117 families, having a total population of 558 were studied regarding drug consumption pattern. It was found that the average no. of episodes per person was 0.99 of which drugs were consumed for 72% of episodes. Significant difference was observed in consumption of drugs between males and females. Allopathic medicines were consumed for 93.3% of the episodes and the major source (53.8%) of medical care was from private practitioners. It was seen that the number of drugs consumed per episode of sickness rose as the per capita income increased. Vitamins and Minerals (22.3%) were the main group of drugs consumed. Drugs acting on the alimentary system (17.5%), Respiratory System (14.7%), Antimicrobials (14.6%) and Analgesics (10.8%) contributed to 80% of drug intake.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Drug Therapy/classification , Drug Utilization , Family Characteristics , Female , Health Services/statistics & numerical data , Homeopathy , Humans , India , Infant , Male , Middle Aged , Poverty , Seasons , Self Medication/statistics & numerical data , Socioeconomic Factors , Urban Population
20.
Indian J Public Health ; 1991 Jul-Sep; 35(3): 71-4
Article in English | IMSEAR | ID: sea-109723

ABSTRACT

Bed utilisation efficiency and hospital resource utilisation are of prime importance to remove the "Hospital Bottlenecks" which in turn reduces length of stay of in-patients. The present study on in-patient system in Gynaecology Ward of a non-teaching hospital revealed that a considerable number of bed days were unnecessarily lost during various activities related to investigation, operation and post-operative stay. Overall length of stay found in this study (14.02 days) is considerably higher than Indian optimum. Average time-lags found between admission to pre-operative investigation and post-operative stay were 3.25 days and 10.22 days respectively.


Subject(s)
Bed Occupancy , Cost Control , Female , Genital Diseases, Female/diagnosis , Humans , India , Length of Stay/economics , Obstetrics and Gynecology Department, Hospital/economics , Postoperative Care/economics , Time Factors
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