Safety Profile and Toxicity Amelioration Strategies of Common Adverse Effects Associated with Anticancer Medications

More than half the cancer patients undergoing cancer chemotherapy develop adverse drug reactions (ADRs). Cancer chemotherapeutic agents have a lower risk-benefit ratio than other drug therapy and kill cancerous as well as the normal rapidly dividing cells including bone marrow cells, gastrointestinal epithelium, hair follicles, etc. Their main ADRs are nausea and vomiting, mucositis, constipation, diarrhea, hematological toxicities, cardiac toxicity, alopecia, gonadal toxicity pulmonary toxicity, neurotoxicity, nephrotoxicity, etc. The severity of the adverse effects may range from mild nausea to life-threatening neutropenia. Administering premedication and antidotes are very vital in these patients. Upon the occurrence of adverse effects, immediate steps should be taken to manage them. Though the ADRs due to anticancer medications are not avoidable, careful monitoring of the patients and modulating the drug schedules/dosages can help in minimizing them. Healthcare professionals should also develop strategies to minimize the occupational hazards associated with these drugs

Review of laparoscopic cholecystectomy in Nepal Medical College Teaching Hospital.

Laparoscopic cholecystectomy (LC) is a commonly performed procedure in general surgical practice. The present study aims to highlight the results of LC in our institute. All LC carried out at our institution was prospectively audited. Data were collected regarding indications for surgery, rate of conversion to open operation, co morbid medical conditions and complication rate. One hundred and forty patients underwent LC from March 2005 to December 2006. There were 104 (74.2%) females and 36 (25.7%) males; age range was 18-75 years with a mean of 41 years. Indications for surgery were repeated attacks of biliary colic in 87 (62.0%), symptomatic dyspepsia in 48 (34.0%) and asymptomatic gall stone in 5 (4.0%) patients. Operating time was 25-120 minutes with a mean of 71.9 minutes. Conversion was performed in 13 (9.2%) patients because of unclear anatomy due to the dense inflammatory adhesions and chronic cholecystitis. Our results of LC are favorable and comparable with those of published series. We conclude that LC has been successfully introduced in our institution.

Blunt aortic injury.

Blunt aortic injury (BAI) is a lethal complication of blunt chest trauma. It accounts for up to 18.0% of deaths related to motor vehicle accident. Specific signs and symptoms are frequently absent. The majority of patients who sustain BAI die at the scene. Those who reach the hospital will survive if diagnosis and treatment is provided in timely manner. Several different techniques of repairing the BAI have been reported. Although endovascular grafts have gained much ground as an acceptable alternative to traditional surgical repair of aortic aneurysms, its application in the acute setting has been reported. We reported two cases of BAI successfully treated with endovascular graft in acute setting.

Analysis of mastalgia cases presented at Manipal Teaching Hospital, Pokhara, Nepal.

Breast pain (Mastalgia) is a common cause of anxiety among women and frequently leads to a primary care clinic for consultation. This study has been designed to study about mastalgia cases presented at Manipal Teaching Hospital, Pokhara. A total of 221 female patients with breast pain presented at outpatient department of surgery from Jan 2000 to Dec 2001 were enrolled in this study. Overall 36.8% presented with cyclical mastalgia and 43.1% with noncyclical mastalgia. Nonhormonal therapy like reassurance, breast support, reduction in dietary fat intake, VitE, Vit B6 was preferred for initial therapy of mastalgia as it was found to be associated with improvements of cyclical mastalgia and good compliance. Non cyclical mastalgia mostly presented with breast lump and ended with excision of lump.

The clinical study of chronic pancreatitis.

Chronic pancreatitis is a relentlessly progressive fibro inflammatory process which may eventually lead to pancreatic insufficiency. This study is done to review the various treatments for chronic pancreatitis and to analyze the clinical features, different etiological factors, comparing different clinical trials in India as well as western countries. One hundred and eight patients with the diagnosis of chronic pancreatitis were included in this study from January 1996 to June 1999. In this present series, most of the patients presented in the 3rd and 4th decades of life. The most common presentation was recurrent episodes of pain in the epigastrium radiating to the back. Most patients are non-alcoholic and the etiological factor in this group may be attributed to the nutritional, idiopathic, hereditary etc, though the single most common etiological factor seemed to be alcohol. The most specific investigation to detect the presence of pancreatic calculi, pseudo cysts, and duct dilatation was ultrasonography. Among the drugs, antioxidant therapy found to have effective role in the conservative management. Puestow's lateral pancreaticojejunostomy is most commonly performed surgery which has good results.