Dry eye disease in head and neck cancer patients undergoing radiotherapy

Purpose: To study the incidence of dry eye disease (DED) in head and neck cancer (HNC) patients undergoing external beam radiotherapy (EBRT), to find a correlation between tumor location and total radiation dose with DED, and to report various radiotherapy (RT) induced acute toxic effects on ocular and adnexal structures. Methods: A prospective cohort study was conducted at a tertiary eye?care center on 90 patients of HNC undergoing EBRT from March 2021 to May 2022. All underwent a thorough clinical history and complete ophthalmological examination including an ocular surface disease index (OSDI) questionnaire, visual acuity, anterior segment, angle and posterior segment examination, dry eye workup including the Schirmer test, tear meniscus height, tear break?up time, corneal fluorescein staining and grading, and meibography by auto?refractometer and its scoring at each visit. Patients were evaluated before the start of RT and then at 1 week, 4 weeks, and 12 weeks post?RT. Radiation records of all patients were noted. Data were analyzed using percentage and Microsoft Excel. Results: Of the 90 patients, 66 were male and 24 female (M: F ratio of 2.75) with a median age of 52.5 years (range 24 to 80 years). The most common HNC was the carcinoma oral cavity and lip. Most patients received a total radiation dose between 46 to 55 Gy. DED developed in 48 (53.3%) patients. The incidence of DED increased with the increase in total radiation dose (r = 0.987). DED was also found to be correlated with tumor location (r = 0.983). Conclusion: The incidence of DED positively correlated with the total radiation dose and tumor location.

Maxillary reservoir denture to overcome radiation-induced xerostomia – Light at the end of the tunnel

Xerostomia is a subjective symptom of dry mouth. It can occur as a part of the systemic disease, drug-induced side effect, or following therapeutic radiation therapy to the head-and-neck region. The primary complication faced by these xerostomic patients is the difficulty in retention of removable dentures. It is important to recognize that the prosthodontic management of these patients requires special attention and care. In an attempt to overcome the presence of xerostomia, several techniques of introducing reservoirs into the dentures containing salivary substitutes have been proposed. This case report presents a simplified approach for the construction of a reservoir in the maxillary denture, specifically in patients where other treatment modalities have failed. This technique provided excellent lubrication to oral tissues, hygienic for the patient, and utilized routine denture base material

A pharmacoepidemiology study of local fungal infections in skin and venereal diseases outpatient department of a rural tertiary care hospital

Background: Fungal infections of the skin were the 4th most common skin disease in 2010 affecting 984 million people. An estimated 20-25% of the world抯 population has some form of fungal infection. Dermatophytes are fungi that cause superficial infections of the skin, commonly referred to as tinea infections.Methods: This was a prospective and an observational study conducted from February 2018 to January 2019 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended dermatology OPD. Factors considered were sociodemographic parameters, the disease encountered and number of patients in each group and number of patients who received antifungal therapy (oral and topical) etc.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. There were a greater number of males (57.4%) than females (42.6%). The average number of antifungal drugs prescribed per prescription was 2.33. Majority of the patients were prescribed itraconazole (82.30%) followed by terbinafine (9.70%) and fluconazole (8.0%).Conclusions: The most common oral antifungal drug used was itraconazole. Ketoconazole and Terbinafine were the most commonly used topical agents respectively.

Mifepristone In The Management Of Uterine Myoma

Hysterectomy for fibroids is one of the commonest gynaecological surgeries in India. To reduce the morbidity and mortality associated with the surgery a number of medical treatments have been tried. Mifepristone is one of them and is being used in the recent decade as a more or less effective option in the treatment of myoma. This study was undertaken to evaluate the efficacy and safety of low dose mifepristone in medical management of uterine myomas. Women with symptomatic myomas or myoma of more than 5cm were included in this study. They were given oral mifepristone 25mg per day for 3 months. Patients were followed at 1, 3 and 6 months. The prospective clinical trial was conducted from august 2006 to august 2018 at my clinic. It was found that blood loss reduced significantly in 3 months therapy and the effect started from the first cycle onwards. Amenorrhoea developed in 90% - 95% patients which reverted later

Reporting ethical processes in the Nursing Journal of India

Nursing research is a developing field to which individuals within the profession can contribute substantially based on their skills and practical experience of nursing care. Both reporting of informed consent and ethical approval are key aspects of published papers which indicate the researchers’ knowledge of and sensitivity to ethical aspects of research.

Cytohistological Correlation of Breast Tumors – A case study

Generally patients with breast tumors complain of lump in the breast which may be painful or painless and may be associated with nipple discharge or not. Benign tumors of the breast are common among younger age group <30 years. But the chances of malignancy increases with increasing age. Most of the cases of breast cancer are found in age group >50 years. FNAC forms the initial diagnostic method in patients with breast lump. A total of 250 patients with different breast lesions attended cytology section of our Pathology department for FNAC. Out of which 197 cases came for histopathological correlation in the study period of 2 years from January 2016 to December2017. Among these majority were benign tumors (114 cases) but an alarming number of 51cases were malignant. Next in number were benign breast diseases (24 cases). There was one case each of ductal papilloma, gynaecomastia. The commonest benign breast tumors were fibroadenoma whereas the commonest malignant tumors were infiltrating ductal carcinoma. There was one case each of lobular carcinoma in situ, infiltrating lobular carcinoma, medullary carcinoma, ductal carcinoma in male breast, inflammatory carcinoma, sarcoma breast. Hereby, we have analyzed different types of breast lesions in different age groups based on cytological evaluation followed by its histopathological confirmation.

Cerebral Hydatid Cyst: A Case Report.

Objective: Cerebral Hydatid disease (CHD) is very rare manifestation of echinococcosis, representing only 2% of all celebral space occupying lesion even in the countries where the disease in is endemic. The aim of this paper is to describe the characteristic features of cerebral hydatid disease in computed tomography, magnetic resonance Imaging (MRI) and to report a multiloculated cyst (more than 100 loculi) along with its management. Case Presentation: In this paper we have reported a young boy of 20yrs with primary CHD without associated extracranial lesions with focal neurological deficits and intracranial hypertension. The extracranial investigations were found to be negative. CT and MRI of the patient suggested it to be a multiloculated Hydatid cyst. The patient was managed surgically and more than 100 daughter cysts were recovered, antihelminthic medications were given to the patient was discharged successfully. Conclusion: Multilocular Hydatid cyst is a rare SOL of Brain. When present the patient remains asymptomatic for long followed mostly by symptoms of headache and vomiting. Patients may also present with focal deficit or seizures‑Surgery remains the mainstay of treatment with careful evacuation of the cysts alongwith the medications for the causative agent (Echinococcus granulosus or multilocularies). Prevention of the disease should be given utmost emphasis.

Extra Gastrointestinal Stromal Tumor of Uterus: A Rare Presentation.

Gastrointestinal stromal tumors (GISTs) occurring outside the gastrointestinal tract, also termed as extra GISTs (EGISTs) are rare tumors believed to arise from the peritoneum. Here, we present the case of highly aggressive EGISTs mimicking as a leiomyosarcoma of the uterus which is a very rare entity which to our knowledge has been reported once before. The diagnostic dilemma thus created was solved with the help of immunohistochemistry. These tumors are resistant to chemotherapy and radiotherapy but sensitive to targeted therapy with the tyrosine kinase inhibitor, imatinib mesylate and have a better prognosis unlike their closest differential diagnosis namely leiomyosarcoma of the uterus.

Persistent Post-radiotherapy Pain and Locoregional Recurrence in Head and Neck Cancer-Is There a Hidden Link?

BACKGROUND: To explore the relationship between persistent post-radiotherapy pain and locoregional recurrence in head and neck cancer patients. METHODS: Five year retrospective data was reviewed of 86 patients of head and neck cancer treated with radiotherapy who continued to have pain at 6 weeks after completion of treatment. At follow-up after 3 months, these patients were stratified into: Group A (n = 39) constituted of patients whose pain subsided and Group B (n = 47) were patients who continued to have persistent pain. RESULTS: At median follow-up time of 25 months (range: 8-47), one patient (2.6%) and 18 (38.3%) patients in group A and group B had locoregional recurrence respectively (P < 0.0001). Furthermore, group B patients had higher mean pain score levels as compared to group A (P = 0.03). Patients in whom pain subsided within 3 months had statistically much greater disease-free survival in comparison to those with persistent pain (P < 0.0001). CONCLUSIONS: Pain in head and neck cancer is an important symptom and should be considered a poor prognostic factor. In the current study, the majority of the patients with persistent pain had recurrent disease as compared to those in whom pain subsided within 3 months of post-treatment. It is suggested that patients with persistent pain need more intense follow-up and should be investigated thoroughly to detect recurrence at an early stage to provide a better quality of life.

Bilateral Parotid MALToma: a sure shot for radiation

No abstract available.

Evaluation of bupivacaine-clonidine combination for unilateral spinal anesthesia in lower limb below-knee orthopedic surgery

The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any. Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A [control group] was given Inj. bupivacaine [hyperbaric] 0.5% - 12.5 mg [2.5 ml] 0.5 ml of normal saline intrathecally. Group B [clonidine group] was given Inj. bupivacaine [hyperbaric] 0.5% - 12.5 mg [2.5 ml] 50 mcg clonidine in 0.5 ml volume intrathecally. The mean peak sensory block was earlier in Group B [4.7 +/- 1.23 min] as compared with Group A [6.27 +/- 1.51 min]. The mean peak motor block was earlier in Group B [6.17 +/- 1.20 min] as compared with Group A [8.63 +/- 1.71 min]. The two-segment regression of sensory block was longer in Group B [106.23 +/- 9.17 min] as compared with Group A [104.43 +/- 17.75 min], which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B [450.33 +/- 95.10 min] as compared with Group A [220 +/- 36.36 min], which was also clinically highly significant. Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in unilateral spinal anesthesia for lower limb below knee surgery

Dietry Factors in Alzheimer's Disease: A Compilation of Helping Evidences.

The increasing life expectancy of Indians is likely to result in an increase in age-related disorders like Alzheimer’s disease. Alzheimer’s disease is a chronic, progressive, untreatable neurodegenerative disorder characterized by apraxia, aphasia, agnosia and severe cognitive deficits. Several behavioural changes like anxiety, hallucinations, depression and delusions are also experienced. AD have a serious impact on families, caregivers, and the healthcare system in general. Although lot of theories and treatments have been proposed targeting pathophysiology of AD yet, current treatments are merely palliative and do little to slow the progression of the disease. Yet, a great deal of progress has been made in the understanding of AD and many promising therapies have entered clinical trials. Several of key areas have been recognized and out of them life style modifications and role of food stuff has been regarded as inseparable and crucial factor involved. Present review is an effort to investigate the status and role of different common food stuffs and supplements in pathogenesis of AD.

Evaluation of toxic potential of acephate and chlorpyrifos by dominant lethal test on Culex quinquefasciatus.

The present paper deals with the toxicity evaluation of pesticides acephate and chlorpyrifos by applying dominant lethal test (DLT) on mosquito Culex quinquefasciatus taken as an experimental model. For this, the adult male mosquitoes emerging from LC20 treated larval stock were allowed to crossmate with normal virgin females under controlled conditions of mosquito rearing laboratory along with the parallel controls, separately for each pesticide. The eggs obtained from such females were allowed to hatch after which they were examined under suitable magnification. The number of unhatched eggs was taken as the measure for calculating the dominant lethality caused by the pesticides and the data was analyzed statistically by applying Student's t-test. The statistical analysis of the results for acephate treated groups was 9.49±1.50 as against 3.92±0.41 in the control groups and chlorpyrifos treated groups gave the value 9.94±1.92 as against 4.26±0.35 in the control groups. The results indicated that these pesticides induced significant (p<0.05) dominant lethality.

randomized, double blind, control study of the effects of adding nalbuphine to spinal bupivacaine for lower abdominal surgeries in elderly patients

The purpose of this study was to evaluate the onset, quality and duration of sensory and motor blockade achieved with hyperbaric bupivacaine and nalbuphine combination when administered intrathecally for spinal anesthesia in lower abdominal surgery as well as efficacy of nalbuphine for postoperative analgesia and its side effects if any. 40 ASA I and II patients of age group 50-70 years, scheduled for below umbilicus surgeries were chosen for this study. Patients were randomised in two equal groups of 20 each by lottery method. Group I [Study Group] received 3 ml of hyperbaric bupivacaine 0.5% + 0.5 ml inj. nalbuphine [0.5 mg] intrathecally. Group II [Control Group] received 3 ml of hyperbaric bupivacaine 0.5% + 0.5 ml of inj. normal saline intrathecally. Assessment of motor and sensory blockade was done by Bromage scale and pin prick method. Pulse rate, BP, respiratory rate and SpO[2] were monitored. There is no significant difference between 2 groups for onset of motor and sensory blockade but mean time of postoperative analgesia in Study Group was highly significant than Control Group. No patient in our study developed any side effects. Nalbuphine provides better quality of block as compared to bupivacaine alone. It also prolongs postoperative analgesia when used as adjuvant to spinal bupivacaine in elderly patients

Anesthetic management of a case of a large atrial septal defect with mild pulmonary hypertension for emergency cesarean section

Atrial septal defect [ASD] is the most common congenital acyanotic heart disease in adults and accounts for 10% of congenital cardiac defects in adults. It is the most commonly seen congenital cardiac lesion in women of child-bearing age and the pregnancy is usually well tolerated. Pulmonary hypertension is defined as a mean pulmonary arterial pressure greater than 25mm Hg at rest or greater than 30mm Hg during exercise. We report a case of a large ASD with mild pulmonary hypertension in a patient who underwent emergency caesarean section under general anesthesia for failure to progress. During the general anesthesia for the procedure our objectives were to avoid hypotension, hypoxemia, hypercarbia, hypothermia, reversal of shunt [Eisenmenger's syndrome] and fluid overload. The patient had an eventful perioperative course and discharged from the hospital on the 8[th] postoperative day in good physical condition

Comparison between intrathecal isobaric ropivacaine 0.75% with hyperbaric bupivacaine 0.5%: a double blind randomized controlled study

To compare the sensory and motor loss and duration of analgesia in patients undergoing lower abdominal and lower limb surgeries when isobaric ropivacaine or bupivacaine were used in spinal anesthesia. One hundred ASA grades I and II patients of either sex in the age range of 20-60 years undergoing lower abdominal and lower limb surgery were randomly divided into two equal groups: in Ropivacaine Group, patients received 22.5 mg of inj. ropivacaine for spinal analgesia and in Bupivacaine Group; 15 mg of inj. bupivacaine was used for spinal analgesia. Parameters observed were onset of sensory and motor block, two segments regression and duration of motor blockade. The sensory onset was significantly delayed in the Ropivacaine Group [42.6 +/- 11.39 min] compared to the Bupivacaine Group [18.4 +/- 6.53 min], P<0.001. The motor onset was also significantly delayed in Ropivacaine Group [55.54 +/- 13.01 min] compared to Bupivacaine Group [27.5 i 8.03 min], P<0.001. The peak sensory time was significantly delayed in the Ropivacaine Group [10.92+ 2.60 min] compared to Bupivacaine Group [7.38 + 1.69 min], P<0.001. The peak motor time was also significantly delayed in the Ropivacaine Group [8.92 +/- 2.41 min] compared to the Bupivacaine Group [4.82 +/- 1.22 min], P<0.001.The two dermatomal sensory segment regression was significantly prolonged in Ropivacaine Group [117.2 +/- 12.5 min] compared to Bupivacaine Group [108.5 +/- 10.61 min], P<0.001. The duration of motor blockade was significantly prolonged in the Bupivacaine Group [190.2 + 28.37 min] compared to the Ropivacaine Group [149.7+8.60 min], P<0.001.The duration of post-operative analgesia was similar in both the groups and was statistically insignificant. There was no significant difference in the comparison of heart rate, blood pressure nor significant respiratory side effects between the groups. The quality of sedation was better in Ropivacaine Group [1.161:0.37] as compared to Bupivacaine Group [0.96+0.49] but statistically insignificant. Intrathecal plain ropivacaine might be superior to bupivacaine in terms of a longer sensory block, and a shorter motor block duration. Therefore 0.75% isobaric ropivacaine can be safely used in lower limb and lower abdominal surgeries, especially in cases where early ambulation is desired