Efficacy and safety of capecitabine and oxaliplatin (CAPOX) treatment in colorectal cancer: An observational study from a tertiary cancer center in South India

Background: 5-fluorouracil (5-FU) was the standard treatment care for colorectal cancer (CRC), however, its efficacy was limited due to safety concerns. Capecitabine and oxaliplatin (CAPOX) treatment was found equivalent to 5-FU in efficacy and preferred now due to easy management and convenience in administration. Hence, the present study aims to determine the efficacy and safety associated with CAPOX treatment in a real world non clinical setting. Methods: 145 treatment-naive and newly diagnosed CRC patients were recruited in the study. Each patient received oxaliplatin 130 mg/m2 infusion over 2 hours on day 1 and oral capecitabine 1000 mg/m2 in divided doses twice daily for the next 14 days of a 21-day cycle. Results: In the adjuvant setting, the observed disease-free survival rate was 62% (n=34) in the colon and 67% (n=15) in the rectum cancer patients at 2 years. The observed overall survival rate in the colon and rectal cancer was 80% (n=44) and 83% (n=18) respectively at 2 years. In the palliative setting the observed progression-free survival rate was 28% (n=13) in the colon and 33% (n=7) in rectal cancer patients at 2 years. The observed OSR at 2 years was 64% (n=30) in the colon and 67% (n=14) in the rectal cancer patients. Thrombocytopenia (17, 11.7%) and diarrhea (8, 5.5%) were the most commonly observed grade 3/4 hematological and gastrointestinal toxicities. Hand-foot syndrome and peripheral neuropathy were the major contributors for dose reduction (14, 9.6%), treatment delay (8, 5.4%), and drug discontinuation (9, 6.1%) in the study cohort. Conclusion: CAPOX treatment was found to be effective but associated with several dose-limiting toxicities.

Factors affecting breastfeeding techniques among postnatal mothers: an experience in a tertiary care centre

Background: Large number of factors related to mother and neonates can affects breastfeeding technique. Therefore, the main objective of this study was to know the association of maternal and neonatal characteristics that can affect correct breastfeeding techniques after intervention among post natal mothers admitted in a tertiary care centre.Methods: An institutional-based pre and post interventional study design was used. 414 lactating mothers were contacted during study period.Results: It was found that parity, time of delivery, mode of delivery, birth weight were statistically significantly associated with correct breast feeding technique.Conclusions:This study highlights that correct breastfeeding technique depends on various factors related to mother and neonate.

Prevalence of complications of diabetes among patients with diabetes mellitus attending a tertiary care centre in Tamil Nadu

Background: Diabetes will be the 7th leading cause of death by the year 2030 as per the World Health Organization. In adults the prevalence of diabetes globally has risen from 4.7% in 1980 to 8.5% in 2014. Level of awareness depends on socioeconomic class, literacy of the patients, training received by them, source of information on diabetes. Knowledge, attitude, and practices about diabetes mellitus and its complications are important to reduce the prevalence and morbidity associated with diabetes mellitus and its complications.Methods: The cross sectional study was conducted among 201 patients with diabetes visiting. Outpatient department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu during a period from January 2017 to June 2018 using a pre-tested, semi structured questionnaire.Results: Among 201 patients with diabetes included in the study, 69.0% had one or more of the complications of diabetes. Factors significantly associated with high rate of complications were the female gender (p<0.001), obesity, rural residential area, high blood pressure (p<0.001), familial history of diabetes (p<0.001), duration of the disease above 5 years (p< 0.001) and high HbA1c level (p<0.001).Conclusions: This study revealed that type 2 diabetic patients followed up in the OPD of SMIMS showed a high rate of chronic complications which often occurred in age more than 50 years. Socio-demographic and biological factors were significantly associated with the high rate of complications of diabetes.

Study of cervical cytology in papanicolaou smears in a tertiary care center

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions. Materials and methods: This was a prospective study aimed to evaluate all pap smears examined at KGH over a period of 6 months i.e. from December 2016 to May 2017. Detailed clinical data and pap smear cytology reports were obtained and data noted in a structured proforma. All PAP smears reported as per THE BETHESDA System 2014. Women with abnormal smears were followed up by repeat pap smears or acetic acid guided cervical biopsy. Results: Total of 770 pap smears were examined in 6 months duration. Max no. of patients (around 40%) were of 31-40 years age group. Most of the patients (90.77%) were categorized into NILM (negative for intraepithelial lesion or malignancy). Among the five organisms, we found trichomonas were 38 (4.9%), and candida 38 (4.9%) cases of total NILM cases. Epithelial cell abnormalities in cytological examination were found in total 61 cases constituting 7.92%. Among epithelial cell abnormalities, LSIL was the commonest (27 cases, 3.57%). Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.

Performance of the BacT Alert 3D System Versus Solid Media for Recovery and Drug Susceptibility Testing of Mycobacterium tuberculosis in a Tertiary Hospital in Korea / 결핵및호흡기질환

BACKGROUND: Tuberculosis (TB) is a major health problem, and accurate and rapid diagnosis of multidrug-resistant (MDR) and extended drug-resistant (XDR) TB is important for appropriate treatment. In this study, performances of solid and liquid culture methods were compared with respect to MDR- and XDR-TB isolate recovery and drug susceptibility testing. METHODS: Sputum specimens from 304 patients were stained with Ziehl-Neelsen method. Mycobacterium tuberculosis (Mtb) isolates were tested for recovery on Löwenstein-Jensen (LJ) medium and the BacT Alert 3D system. For drug susceptibility testing of Mtb, isolates were evaluated on M-KIT plates and the BacT Alert 3D system. RESULTS: The recovery rates were 94.9% (206/217) and 98.2% (213/217) for LJ medium and the BacT Alert 3D system, respectively (kappa coefficient, 0.884). The rate of drug resistance was 13.4% for at least one or more drugs, 6.0% for MDR-TB and 2.3% for XDR-TB. M-KIT plate and BacT 3D Alert 3D system were comparable in drug susceptibility testing for isoniazid (97.7%; kappa coefficient, 0.905) and rifampin (98.6%; kappa coefficient, 0.907). Antibiotic resistance was observed using M-KIT plates for 24 of the total 29 Mtb isolates (82.8%). CONCLUSION: The liquid culture system showed greater reduction in the culture period, as compared with LJ medium; however, drug susceptibility testing using M-KIT plates was advantageous for simultaneous testing against multiple drug targets.

Assessment of knowledge, attitude and perception of Pharmacovigilance among nurses in a rural tertiary care center.

Background: Pharmacovigilance (PV) is an integral and essential part of patient care. PV deals with the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The aims of PV are to improve patient care, public health and safety in relation to the use of medicines, to contribute to the assessment of benefit, harm, effectiveness and risk of medicines, encouraging their safe, rational and more effective use, to promote understanding, education and clinical training in PV and its effective communication to health professionals and the public. The objective of present study was to assess the knowledge, attitude and perception of PV among nurses in a rural tertiary care center, Adichunchanagiri Institute of Medical Sciences (AIMS), B G Nagar. Methods: A cross-sectional questionnaire-based study was conducted among nurses of AIMS, B G Nagar, Mandya, Karnataka. Results: A total of 94 respondents were analyzed. 75.53% of participants knew the definition of PV, 77.65% participants knew the international PV reporting centers, 81.91% have knowledge about regulatory body responsible for monitoring adverse drug reactions (ADRs), 80.85% have good orientation of specific ADR format, 98.93% of nurses thought ADR reporting is necessary, 86.13% have attitude of encouraging non-medical persons to report ADR and 95.74% of nurses want PV to be taught in detail and 87.23% nurses reported that they came across ADRs. 31.91% participants are not aware about how to report ADR. Lack of knowledge about the reporting procedure is the major reason for under-reporting. Conclusions: The majority of nurses has good knowledge and attitude toward PV and understand the need for reporting in our study, but unfortunately the actual practice of ADR reporting is still deficient among them. Training programs and continued medical education type of interventions periodically can improve the knowledge toward PV.

Profile of patients with intellectual disability visiting a tertiary care center in western India.

Background: Intellectual disability is commonly associated with variety of etio-pathological and co-morbid conditions influencing outcome of rehabilitative measures. Understanding of these factors helps in better management of disabled condition. Methods: A qualitative retrospective case record review, of patients with intellectual disability, visiting psychiatry department of a tertiary care hospital, within a period of one year, was conducted to assess their epidemiological and clinical profile. Results: Patients with Intellectual disability are brought to the hospital at all ages and commonly by their parents. Etiologically related various peri-natal factors (delayed birth cry and seizures being most common) as well as childhood medical conditions (epilepsy and recurrent respiratory/GI infections being most common) were commonly found in these patients. Milestones are delayed in almost 60-70% of cases whereas various physical and psychiatric conditions commonly co-existed with disability. Conclusion: Clinical profile of these patients demands a comprehensive evaluation and management apart from routine IQ assessment.

Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais / Frequency of types of headache in the tertiary care center of the Hospital das Clínicas of the Universidade Federal de Minas Gerais, MG, Brazil

OBJETIVO: Avaliar a frequência dos diferentes diagnósticos de cefaleias do Ambulatório de Cefaleias do Hospital das Clínicas da Universidade Federal de Minas Gerais (AmbCef-UFMG). MÉTODOS: Estudo transversal e descritivo com 289 pacientes atendidos consecutivamente no AmbCef-UFMG. O diagnóstico da cefaleia baseou-se nos critérios da Classificação Internacional das Cefaleias (ICDH-2004). RESULTADOS: A idade média dos pacientes foi 42,6 anos, sendo a maioria do sexo feminino (86,9%) e com menos de nove anos de escolaridade. As cefaleias primárias foram as mais comuns, sendo a migrânea encontrada em 79,8% dos casos e a cefaleia do tipo tensional (CTT), em 20,4%. Entre as secundárias, o tipo mais comum foi a cefaleia por uso excessivo de analgésicos (16,6%), seguido de casos menos comuns como a hipertensão intracraniana idiopática. A cefaleia crônica diária (CCD) esteve presente em 31,8% dos casos. CONCLUSÃO: Este estudo confirma dados da literatura que mostram a migrânea como a cefaleia mais comum em centros terciários. O número expressivo de casos de CCD e de uso excessivo de analgésicos indica que, desde o nível primário de atenção, os pacientes deveriam ser orientados a evitar o uso abusivo de medicação sintomática.

OBJECTIVE: To assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG). METHODS: Cross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004). RESULTS: The average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases. CONCLUSION: This study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs.