Efficacy and Safety of Transdermal Buprenorphine Patch for Cancer Pain Relief in Elderly Patients : A Retrospective Study from a Tertiary Care Centre of Eastern India

Cancer is one of the leading causes of morbidity and mortality worldwide & cancer pain is experienced by patients with advanced, metastatic and terminal disease. Buprenorphine, a partial µ-receptor agonist and antagonist at the kopioid receptor, shows no clinically relevant accumulation of active metabolites, and pharmacokinetics remain unchanged in renal insufficiency. In elderly cancer patients, the use of opioids for control of cancer pain is a therapeutic challenge, as these group of patients often associated with renal and hepatic comorbidity that limited the use of strong opioids like morphine. Methods : A retrospective observational study was conducted in elderly patients to estimate the efficacy of transdermal buprenorphine patch for controlling of cancer pain as well as to assess the safety of the patch. For pain control Numerical Rating Score (NRS) was used & for safety assessment Grade 3 or 4 toxicity were recorded.Hepatic & renal toxicity were measured at baseline, at 1st month & at 3rd month of treatment & lastly at 6th month of treatment. Results : Majority of the patients showing good to excellent global satisfaction with Buprenorphine patch and 57% of patients suffered from constipation along with 38% nausea & vomiting. It was found that there was a significant reduction in pain intensity from baseline with a p value of <0.05. There was no significant hepatic or renal toxicity found in the study. Conclusion : Transdermal buprenorphine patch is effective and safe in elderly cancer patients for pain control. Further studies should be performed in order to find safe and effective opioid methods necessary to give greater insight into the difficult balance between analgesia and toxicity

Role of vitamin D3 supplementation in allergic rhinitis: an outpatient department based prospective analytical observational study

Background: Allergic rhinitis is a common disorder characterized by sneezing, rhinorrhoea, nasal congestion, itching and lacrimation which adversely affect quality of life to a substantial degree. Evidence suggests that low serum vitamin D3 has correlation with severity of allergic rhinitis. The objective of the study was to evaluate whether vitamin D3 supplementation has any role to reduce the severity of disease spectrum among allergic rhinitis patients.Methods: This prospective analytical observational study was carried out in 6 months in ENT OPD of Midnapore medical college and Hospital. Only the persistent moderate to severe allergic rhinitis patients as per ARIA-WHO guideline, aged >12 years were included in this study. 64 subjects were randomised into two groups. The test group received oral vitamin D (60000 IU/week for 2 months) along with levocetirizine, fluticasone spray and montelukast while the control group received three drug therapies without vitamin D3. Allergy symptom score (ASS) was assessed at the start and end of the study period.Results: The study population (n=64) was predominantly female (37) and had a mean age of 39.79 years. The ASS score was 14.06�01 in Test group and 13.93�01 in Control group and the Post treatment ASS score was 2.65�12 and 6.06�87 respectively. This difference between groups was significant (p<0.001).Conclusions: There was significant reduction in the Allergy symptom score after vitamin D3 supplementation which alters the course of disease towards clinical improvement.

Micro-albuminuria: a predictor of short-term mortality in acute ischaemic stroke.

We studied 89 non-diabetic patients of acute ischaemic stroke, confirmed by imaging, admitted within 24 hours of onset, to investigate the prevalence and significance of micro-albuminuria (MA) as a predictor of in-hospital mortality. Two control groups consisted of 70 patients with non-stroke chronic neurological diseases and 60 age- and sex- matched healthy individuals. Spot urinary albumin-to-creatinine ratio was measured in first morning sample on days 1, 4 and/or 7. Functional status was assessed daily for 7 days by National Institute of Health Stroke Scale (NIHSS). Outcome data were recorded for 14 days. MA was found in 61.79% of acute ischaemic stroke patients on day 1 compared to 13% in non-stroke neurological patients and 7% of healthy controls. Patients with MA were older and had a higher systolic blood pressure. The 14-day disease-specific mortality was higher in patients with MA (25.45%) compared to patients without it (5.88%). High day 1 MA (>100 microg/mg) and rising or static value from day 1 to day 4 or day 7 correlated with statistically more chance of death. Increasing MA had a positive correlation with higher NIHSS score. Thus, MA was found to be a reliable predictor of shortterm in-hospital mortality in acute ischaemic stroke.

An unusual presentation of tuberculous lymphadenitis.

A 43 years male presented with recurrent epistaxis and had generalised lymphadenopathy on examination. No haematological disorder could be established even after bone marrow aspiration and biopsy but the patient was found to have tuberculosis of the lymph node on histopathology, with severe thrombocytopenia in the peripheral blood and increased platelet precursor in the marrow suggesting peripheral platelet destruction. Anti-tuberculous therapy was started but the patient died due to subarachnoid haemorrhage.