Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.

A clinical study to evaluate the efficacy of Herbal Formulation for Obesity (HFO-02) in overweight individuals

Ayurveda, the Indian system of medicine offers many herbs and formulations for management of obesity. Baidyanath Bhawan Pvt. Ltd has designed a formulation, HFO-02, based on Ayurvedic literature.ObjectiveTo evaluate the efficacy of Herbal Formulation for Obesity (HFO-02) in overweight individuals.Materials & methodsWith approval from the Institutional Ethics Committee, a proof of concept study was carried out in overweight individuals (Body Mass Index, BMI ≥25.0 and ≤ 30.0 kg/m2), devoid of any endocrinological disorders. Tablet HFO-02 (500 mg) was administered to these individuals twice daily for 90 days, during which they were called at study site fortnightly. After stopping the treatment, they were further followed up for 30 days off-medication and the last follow up was scheduled on day 120. Anthropometric parameters were assessed at every visit, while biochemical parameters viz. lipid profile, blood sugar & insulin levels (both fasting and post prandial), C- reactive protein and adipocytokines (leptin & adiponectin) were estimated monthly.ResultsOf the 18 participants recruited in the study; 14 completed the study. HFO-02 did not show reduction in weight, however a significant decrease in the body circumference and skin fold was demonstrated. This decrease was maintained till day 120. The levels of all biochemical parameters were maintained and no adverse events were reported throughout the study.ConclusionTablet HFO-02 reduced body circumferences and skinfold thickness indicating its potential for obesity management.

Study To Assess The Knowledge & Awareness Regarding Eye Donation Among Students Of Cims Bilaspur (C.G.)

Background-Eye donation is an act of donating ones eye after his/her death. it is an act of charity,purely for the benefit of the society and is totally voluntary. age or systemic illness such as diabetes or hypertension, heart disease \,kidney disease is not barrier for eye donation.. eye disease are a significant cause of visual impairment and blindness in the developing world.approximately 18.7 million people are blind in india and 1,90,000 are blind from bilateral corneal disease.For such people corneal transplantation helps in restoring their sight. According to the eye bank association of india the current cornea procurement rate in india is 22,000 per year.Programme and activities conducted across the country to impart the significance of eye donation and its useful to visual impaired people. Objectives- 1.To assess sociodemographic profile of the students.2.To assess the knowledge & awareness regarding eye donation among study subject. Methodology-Study Subject;-Medical student CIMS college Bilaspur. Type Of Study :-Observational Cross sectional study. Study Area :- CIMS medical college Study Duration:-July 2017 to December 2017. Sample Size :- 100medical students in CIMS medical college Bilaspur(C.G) Study Tools :- Pre designed questionnaires Results:- In the present study, there was nearly 46% male and 54% female. 100% of the participants had heard about eye donation.The commonest source of knowledge on eye donation, Dr (32%) followed by TV(25%), Friends (20%). Majority (63%) of participants had correct knowledge that eye should be removed from dead donor within 6 hours.80% of the participants replied eye donation is done by all age group people. Conclusion:- Majority (63%) of participant had correct knowledge regarding eye donation. Majority (79%) of the students have willingness regarding eye donation

Analysis of surgical outcome and review of literature of schwannomas arising from the extremities

Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018.  There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.

Evaluation of Modified Mallampati Score with Neck Circumference and Thyromental Distance to Predict Difficult Intubation in Non-obese Patients

Introduction: Preoperative diagnostic validity of airwayassessment help for prediction of difficult airway. Severalmodels were established for prediction of difficult intubation.In this study, we aim to predict difficult intubation in nonobese patients from various airway predictive indices suchas modified mallampati grade, neck movement (NM), neckcircumference (NC), thyrometal distance (TM), NC/TMD.Material and Methods: Total 121 patients with 18-72 yearsof age, ASA grade I or II, scheduled for elective surgerythat required general anaesthesia. Difficulty of intubationwas assessed using the IDS for each non-obese patient. Thestudy population was divided into two groups Easy (IDS <5)and Difficult intubation (IDS ≥5). Preoperative assessmentsincluded Mouth Opening (MO), modified mallampati grade,neck movement (NM), neck circumference (NC), thyrometaldistance (TM), NC/TMD. Multivariate analysis was usedto predict independent risk factors. Receiver OperatingCharacteristic Curve analysis (ROC analysis) was performedfor the airway assessment tests. The area under curve (AUC)was calculated.Results: The weight (59.74±7.76 kg and 65.00±5.92 kg)and BMI (21.51±1.79 and 23.8157±1.09) were significantlydifferent in between easy and difficult intubation. TheMouth Opening, NC, TMD, and NC/TMD were significantlyindependent risk factor for difficult intubation. NC/TMDwas showed higher sensitivity, specificity, positive predictivevalue (PPV) and a negative predictive value (NPV) with thirdlarge area under the curve (AUC) on the ROC curve.Conclusions: This study shows that the NC/TMD ratio canbe considered as a better predictor of difficult intubation innon-obese patients.

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

Xanthogranulomatous Cystitis Presenting As Hematuria: A Case Report And Review Of Literature

Xanthogranulomatous cystitis (XC) is a rare benign chronic granulomatous inflammation of the urinary bladder of unknown etiology. Here, we report a rare case of XC in a 54-year-old man who presented with painless hematuria and frequent urination for the past 3 years. His urine culture and sensitivity were positive for Escherichia coli with significant colony count. Contrast-enhanced computed tomography showed diffusely thickened urinary bladder with no definitive mass. The patient was subjected to other investigations including cystoscopy and biopsy. All the above investigations confirmed the entity to be XC. An endoscopic resection was performed and he was started on a sulfamethoxazole-trimethoprim combination. The patient was asymptomatic at 3-month follow-up.

Anesthetic Management of Sacrococcygeal Teratoma- A Case Report

Sacrococcygeal teratoma is a tumour of new born which is derived from germ cells. It is mostly found in female child and has good prognosis if complete resection of the tumour along with coccyx done early. Recurrence or turning into malignant form is uncommon if careful resection is done early. Here we describe anesthetic management of a suspected case of sacrococcygeal teratoma in a new born baby.

Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.

Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.

Mature Ethmoid Sinus Osteoma - Incidental finding in CT.

Paranasal osteomas are not uncommon to be found as an incidental finding in routine radiological examinations. Many a times, this entity is found while undergoing computerized tomography (CT) for some other reason. Sometimes, patient comes with vague complaints not related to this finding but indirectly is responsible for few of these symptoms. We present a case of 18-years old male who presented with the complaint of vague headache of about one year duration. He underwent CT examination and was found to be having slightly uncommon mature type of ethmoid osteomas in addition to pan sinusitis.

Psychosocial impact of acne on quality of life in north India: a hospital-based cross-sectional study

Objective: To evaluate the level of impact among acne patients on their quality of lifestyle and emotional well-being and to highlight the wider spectrum of problems that the patients face with acne

Methods: A total of 125 patients were enrolled for the study. Acne severity was graded using Global Acne Grading System [GAGS] after the clinical diagnosis. All the patients went through self administered questionnaire of Cardiff Acne Disability Index [CADI] to fill out, to assess the reflection of patients' experiences and perceptions

Results: Out of 125 patients, 72 [57.6%] were females and 53 [42.4%] were males. The age ranged from 14 to 38 years. The maximum number of patients was in the age group of 14-20 years [90/125, 72%]. Out of total 53 males, 33 [62.3%] had moderate to severe acne, whereas 58.3% females had such a severe acne. 47.2% [34/72] of females had high CADI scores in comparison to only 30.2% [16/53] of males. The impact on quality of life was more in the age-group of 21-30 years even though in this age group clinical severity of acne was mild to moderate only. According to duration of acne, patients having longer history of acne [>1 year] had highest CADI scores. There was significant correlation between severity of acne and CADI

Conclusion: We found compelling evidence that individuals with acne had profound emotional, as well as, social impact on their quality of life. Greater efforts are needed to improve physicianpatient communication while consultation, and provide more information to the patients. Patients should be managed rather than treated

Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation.

Background: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. Methods: Our study had 45 patients, all patients belonged to ASA Grade-I or II, between 20 and 55 years of age with an average height of 150 and 170 cm and have ideal body weight requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups Group-I: Epidural bupivacaine 0.5% (16 ml) + clonidine 75 μgm (1 ml) Group-II: Epidural bupivacaine 0.5 % (16 ml) + Dexmedetomidine 50 μgm (1 ml) Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia, sedation and adverse effects in perioperative period. Results: The time of onset of sensory block at T10 and time to reach maximum sensory block (T6) in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3) was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia.

Mucoadhesive microemulsion of ibuprofen: design and evaluation for brain targeting efficiency through intranasal route

This study aimed at designing mucoadhesive microemulsion gel to enhance the brain uptake of Ibuprofen through intranasal route. Ibuprofen loaded mucoadhesive microemulsion (MMEI) was developed by incorporating polycarbophil as mucoadhesive polymer into Capmul MCM based optimal microemulsion (MEI) and was subjected to characterization, stability, mucoadhesion and naso-ciliotoxicity study. Brain uptake of ibuprofen via nasal route was studied by performing biodistribution study in Swiss albino rats. MEI was found to be transparent, stable and non ciliotoxic with 66.29 ± 4.15 nm, -20.9 ± 3.98 mV and 98.66 ± 1.01% as average globule size, zeta potential and drug content respectively. Transmission Electron Microscopy (TEM) study revealed the narrow globule size distribution of MEI. Following single intranasal administration of MMEI and MEI at a dose of 2.86 mg/kg, uptake of ibuprofen in the olfactory bulb was around 3.0 and 1.7 folds compared with intravenous injection of ibuprofen solution (IDS). The ratios of AUC in brain tissues to that in plasma obtained after nasal administration of MMEI were significantly higher than those after intravenous administration of IDS. Findings of the present investigation revealed that the developed mucoadhesive microemulsion gel could be a promising approach for brain targeting of ibuprofen through intranasal route.

O objetivo deste trabalho foi planejar microemulsão/mucoaesiva em gel a fim de melhorar a captação cerebral de ibuprofeno por via intranasal. A microemulsão para mucoadesão com ibuprofeno (MMEI) foi desenvolvida pela incorporação de policarbofil como polímero mucoadesivo em microemulsão otimizada (MEI) com base em Capmul (MCM) e foi submetida à caracterização, estabilidade, mucoadesão e naso-ciliotoxicidade. A captação cerebral de ibuprofeno pela via nasal foi estudada por meio de estudo de biodistribuição em ratos albinos suíços. MEI se mostrou transparente, estável e não ciliotóxica, com 66,29 ± 4,15 nm, -20,9 ± 3,98 mV e 98,66 ± 1,01%, respectivamente, de tamanho médio dos glóbulos, potencial zeta e conteúdo do fármaco. O estudo revelou o estreita distribuição do tamanho dos glóbulos de MEI. Após administração intranasal única de MMEI e MEI, em dose de 2,86 mg/kg, a captação de ibuprofeno no bulbo olfativo foi em torno de 3,0 e 1,7 vezes maior, comparativamente, à injeção endovenosa de ibuprofeno (IDS). As taxas de ASC em tecido cerebral em relação ao plasma, obtidas após administração da MMEI nasal, foram, significativamente, mais elevadas do que aquelas observadas após a administração intravenosa de IDS. Os resultados do presente estudo mostraram que a microemulsão/mucoadesiva em gel poderia ser uma abordagem promissora para o direcionamento cerebral de ibuprofeno por via intranasal.

Tinea pseudomibricata due to Trichophyton mentagrophytes: a rare case report

Tinea pseudoimbricata is characterized by concentric scaly rings simulating tinea imbricata but caused by dermatophytes other than Trichophyton concentricum. We report a unique case of tinea pseudomibricata, its pathogenesis and review of previously reported cases. A 1.5-year-old baby developed concentric rings of scaly lesions over groins and buttocks following use of topical corticosteroids for 1 month. Mycological studies were performed to establish the diagnosis. Diagnosis of tinea pseudoimbricata was made on the basis of morphology of lesions and was confirmed by isolation of T. mentagrophytes on culture. Complete clinical and mycological cure was obtained with topical 1% sertaconazole given for 4weeks

Cross-species amplification of microsatellite markers in Mycteria leucocephala Pennant 1769: Molted feathers as successful DNA source.

DNA from molted feathers is being increasingly used for genetic studies on birds. However, the DNA obtained from such non-invasive sources is often not of enough quantity and quality for isolation of new microsatellite markers. The present study examined the potential of shed feathers of near threatened Painted Stork as a source of its DNA for cross-species amplification of microsatellites. Thirty-one shed feathers of varying conditions (‘good’ and ‘deteriorated’) and sizes (‘large’, ‘intermediate’ and ‘small’) collected in a north Indian population were used to isolate DNA by a standard isopropanol method and 11 microsatellite markers already developed in the Wood Stork were screened for amplification. Nine plucked feathers from two dead Painted Storks were also used to compare the DNA yield and amplification success. The DNA yield of feathers varied significantly in relation to the calamus size and condition. Among molted feathers, ‘good’ and ‘large’ samples provided more DNA than ‘deteriorated’ and ‘small’ ones, respectively. ‘Large’ plucked feathers yielded more DNA than ‘large’ molted feathers. DNA was almost degraded in all the samples and ratio of absorbance at 260/280 nm varied from 1.0 to 1.8, indicating impurity in many samples. Independent of DNA yields, all microsatellites were cross-amplified in all kinds of feathers, with >80% success in different feather categories. It is concluded that the shed feathers can be successfully used to isolate DNA in the Painted Stork and for cross-species amplification of microsatellites.

Clinical profile of pneumonia and its association with rain wetting in patients admitted at a tertiary care institute during pandemic of influenza A (H1N1) pdm09 virus infection.

Background. Influenza pneumonia often occurs as epidemics in the Asian countries and have significant impact on the health of world population. Methods. We studied the association of rain-wetting with occurrence of pneumonia during the outbreak of the influenza A (H1N1) pdm09 virus infection. All patients admitted with community-acquired pneumonia during the period 13th September to 10th October 2010 were recruited in the present study. The diagnosis of influenza was established by realtime polymerase chain reaction (RT-PCR). The demographic data and clinical profile of the patients were recorded with a special consideration to record of possible risk factors. Results. Of the 123 patients studied, 39 (32%) patients had tested positive for influenza A (H1N1) pdm09; 12 (10%) tested positive for influenza A and remaining 72 (58%) patients were negative for influenza virus. Pattern of illness was almost identical in H1N1-positive and-negative groups. History of rain-wetting was present in 48 patients (39%) preceding the onset of illness. Getting wet in the rain was significantly higher in patients with pneumonia than control subjects [odds ratio 2.53, 95% confidence intervals (CI) 1.301 - 4.91; p=0.009)]. The number of pneumonia patients was also higher on rainy days and the numbers started declining a week later. Conclusion. More pneumonia patients are admitted during the periods of greater rainfall and rain-wetting may be an important risk factor for the occurrence of pneumonia.