The evaluation of effectiveness of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital: a before and after study

Background: Kangaroo mother care (KMC) is a standard of care for preterm and low birth weight babies. To implement KMC in institutional care it was often practiced inside intensive care unit and also in separate ward. In present study authors have tried to evaluate effect of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital.Methods: Uncontrolled study before and after establishment of separate kangaroo mother care ward comparing kangaroo mother care in sick new-born care unit versus kangaroo mother care in separate ward.Results: In separate ward, as compared to kangaroo mother care practice in sick newborn care unit, mean (SD) duration of kangaroo mother care increased from 5.3 (1.6) to 11.4 (7.4) hours/day (95%CI 5.0-7.1, p value <0.0001). Mean (SD) weight gain increased from 10.7 (7.0) g/day to 13.7 (11.1) g/day (95% CI 1.0-4.8, p value <0.0024). Incidence of sepsis diminished from 14.0% to 28.9% (95% CI 6.4-23, p value <0.0006). Exclusive breast-feeding rate at discharge (42.3% vs. 57.3%) (95% CI 4.8- 24.9, p value <0.0041) and follow up (49.4% vs. 65.0%) (95% CI 1-29.4, p value <0.0378) increased. Mortality also decreased in this group of patients (8.6% vs.2.3%) (95% CI-1.6-11.4, p value <0.0082).Conclusions: Kangaroo mother care ward is better place than sick new born care unit for providing kangaroo mother care in tertiary care hospital.

Chemoradiation for organ preservation in the treatment of muscle invasive bladder cancer: our institutional experience

Aim: To assess outcome of chemoradiotherapy for organ preservation in muscle invasive bladder cancer

Material and Methods: 41 patients treated between January 2010 to January 2015 were evaluated in the present study. All patients T staged ranging from cT2-T4a and had undergone maximal transurethral resection of bladder tumour [TURBT]. After maximum bladder tumour resection patients were treated with Radiotherapy with or without concurrent chemotherapy. 8 weeks after completion of treatment response was assessed by check cystoscopy, urine cytology and CECT scan Abdomen. Data regarding the toxicity profile, initial complete response rates at 3 months, occurrence of loco regional or distant failure and survival was recorded

Results: Age ranged between 45- 84 years, [mean age 65.44]. Radiotherapy dose planned ranged from 60 Gy/30fr to 70.3 Gy/37 fractions to primary target and 59.2 Gy/37fractions to the nodal disease. PTV volume ranged from 69-548.9 cc. 23 patients received concurrent chemotherapy weekly. 11 patients have cystitis [5 Gr 1, 4 Gr II and 2 Gr III]. 5 patients have myelosuppression. 10 patients have acute gastrointestinal toxicity [5 Gr-I, 4 Gr-II, 1 Gr-III]. At the time of analysis follow up ranged from 3-42 months [median follow 1 year].The DFS at 42 months was 54%. Out of 39 patients 3 were lost to follow up [2 in partial bladder group and 1 in whole bladder group]. Out of 36 patients 24 [66.6%] are disease free, 4 [11.1%] patients had recurrence for which 2 underwent salvage cystectomy whereas 2 patients received palliative chemotherapy. Five patients developed distant metastases [4 bone and 1 brain metastasis]

Conclusion: Bladder-preservation therapy for muscle-invasive bladder cancer is a valid substitute in selected cases with long-term efficacy similar to radical cystectomy, with the additional advantage of preserving excellent bladder function in the majority of long-term survivors