Efficacy of Neoadjuvant Chemotherapy on Locally Advanced Gastric Adenocarcinoma in Terms of Downstaging and Resectability in a Tertiary Cancer Hospital

Background: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. The aim of the current study was to evaluate the effect of neoadjuvant chemotherapy on downstaging and resectability rate in locally advanced gastric cancer. Material & Methods: This was a single-center quasi-experimental study conducted in the Department of Surgical Oncology in collaboration with the Departments of Medical Oncology, Radiation oncology, and Pathology at the National Institute of Cancer Research and hospital, Dhaka, which is a tertiary care cancer hospital in Bangladesh, between January 2021 and June 2022.Patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) were randomly included in this study by purposive sampling. Patients in Group I underwent upfront surgery Patients in Group II were started on neoadjuvant chemotherapy, either XELOX or FLOT regimen. Surgery was done following the response assessment CECT. We assessed R0 resection rate, age, sex, comorbidities, tumour size, TNM stage and complications were compared between the two groups. Response to NACT was assessed in Group II. Results: The mean age of patients in groups 1 & 2 was 56 ± 11.06 and 55.70 ± 10.46 years of age respectively (p > 0.05). Majority of the respondents (55/74) were male and 19 patients (26%) were female. Male to female ratio was (24/37 &31/37) in group 1 and (31/37 & 6/37) groups respectively (p > 0.05). Out of 37 patients who received NACT, in 9 patients (24.32%) complete response was noted. Partial response was found in 20 cases (54.05%), p-value (<.0001) while a stable disease was reported in three (8.1%) cases. 5 patients (13.51%) had progressive disease. In the upfront surgery group, R0 resection was feasible in 16 (43.2%) cases, and in the NACT plus surgery group, R0 resection was done in 29 (78.4%) cases. In group 1, R1 resection was done in considerable numbers (19/37) compared to group 2 (5/37), P=0.001. Three patients (8.1%) in group 2 and one (2.7) in group 1 had irresectable lesions. Conclusion: In this study it can be concluded that neoadjuvant chemotherapy could downstage tumour and increase tumor resectability rate in patients with locally-advanced gastric adenocarcinoma. However, further studies are necessary to confirm the effect of this modality on patients’ overall survival. We await survival analysis to further validate the role of NACT.

Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India

Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald’s omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

HR Must Study Personal Economics - A Behavioral Economics Approach

Organizations in both the public and private sectors are increasingly using behavioural economics techniques to address a range of problems, including mechanism design and incentive architecture. Yet, there hasn't been much attention paid to how behavioural economics' experimental techniques might assist businesses in learning more about their (current or potential) workforce, and particularly about the preferences and tendencies of their employees. This has significant ramifications for overall organisational performance because certain designs or incentives may only influence people who share a certain disposition (such as those who are risk-averse or fairness-oriented), but not others, or they may even have the opposite effect on people who have different sets of preferences. In this post, we highlight a variety of intriguing directions for using a behavioural economics lens to comprehend and control employees. Also, a thorough case study is given.

A rare case of primary disseminated multi-drug resistant tuberculosis

Tuberculosis (TB) is the commonest cause of infection-related death globally. Disseminated tuberculosis (TB) is a life-threatening disease which results from the hematogenous spread ofMycobacterium tuberculosis. Genitourinary tuberculosis(GUTB) is usually caused as a result of the hematogenousspread of the mycobacteriaduring the initial infection. The patient's clinical presentation may vary from asymptomatic to non-specific symptoms related to the organ involved and may also overlap with urinary tract infections caused by other pathogens hence delaying the diagnosis. Here we report one such case where the vague symptoms of the patient and absence of respiratorysymptoms delayed the diagnosis of primary disseminated multi-drug resistant(MDR) tuberculosis.

Characteristics of lumbar canal stenosis patient at Koja district hospital year 2011-2021

Background:Since there are too many cases of lumbar canal stenosis in Indonesia. The aim of the study was to discover all the factors that influence the incidence of lumbar canal stenosis.Methods:This study used all cases of lumbar canal stenosis in Koja District Hospital in Jakarta from 2011 to 2021. This was a medical record-based retrospective study in which files of patients with the diagnosis of lumbar canal stenosis were reviewed. A descriptive analytic test was used to analyze results was presented in the form of a table.Results:There were 48 lumbar canal stenosis cases in male patients out of 66 total patients. Incidents of lumbar canal stenosis occurred more frequently in anatomical locations L4-5 than in other locations. There were 48 lumbar canal stenosis cases with anatomical locations L4-5 in 50 patients from 66 patients. Incidents of lumbar canal stenosis occur in people with obesity more frequently than in people without obesity. There were 48 lumbar canal stenosis cases in people with obesity patients out of 66 total patients. The incidence of lumbar canal stenosis with a moderate VAS score was greater than that with a mild or severe VAS score. There were 48 lumbar canal stenosis patients with a moderate vas score out of 66 patients. There were 59 lumbar canal stenosis patients who got surgery out of 66 patients, and 7 of them had no surgery. Lumbar canal stenosis more frequently occurred in men than women, with more frequent anatomical lesions in L4-L5, and more frequently in people with obesity than in people without obesity. Most of them had a moderate VAS score and got surgery.Conclusions:According to this study, males had more lumbar canal stenosis incidents than females.

Delayed diagnosis of disseminated tuberculosis in pregnancy: a case report

Miliary tuberculosis (TB) is a lethal form of TB, if left untreated. Miliary TB accounts for <2% of all cases of TB in immunocompetentindividuals. Intracranial tuberculoma is a rare manifestation ofMycobacterium tuberculosis(MTB), seen in only 1% of TB patients. It can occur as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features mimicthat of any space-occupying lesion in the brain.In pregnant women, diagnosis of TBmay be delayed by the non-specific nature of early symptoms and because they are often attributed to pregnancy.Here we report one such case where the diagnosis of TBwas delayed due to the non-specific nature of her symptoms in ante-natal period.

Oral and dental care before radiotherapy: Guidelines and development of a time?bound protocol

Involvement of multidisciplinary team is the mainstay in the holistic treatment outcome in head and neck cancer patients. Achieving a state of oral health is regarded as an essential treatment goal before radiation therapy but, it may get overlooked due to many competing priorities, lack of multidisciplinary facilities and/or incoordination, and limited overall awareness with regards to means of achieving oral health and in a time?bound manner and its relevance in improving quality of life in cancer survivors. Radiation inflicts an immense amount of damage upon the entire maxillofacial complex and consequently oral treatment after radiotherapy may remain untreated and/or undertreated. It is, therefore, vital to eliminate oral foci of infections well within a time frame before radiation so that tumor prognosis is not compromised.This article describes the current guidelines combined with a time?bound protocol developed in our center to not only prepare a patient for conventional radiotherapy but also to provide a logical perspective towards the feasibility of the oral rehabilitation post?cancer cure. The protocol aims to maximize the quality of life in head and neck cancer survivors by; patient education, minimizing preventable oral complications, and retaining strategic teeth for function, aesthetics, speech, and prosthetic support. The time?bound pre?radiation oral care protocol is rational, achievable, and is aligned towards the sustained oral health care goals in head and neck cancer patients and can be utilized as a useful resource in multidisciplinary head and neck cancer care facilities

Transforming HR practices with Behavioral Economics

Behaviors Economics is presently a thriving field of research for many researchers. It offers a descriptive model of decision making which is entirely different from the traditional decision making models of economics. This research paper is an attempt to bring insights from Behavioral Economics which can help Human Resource personnel to address the issues like Dynamic Inconsistency and incentive design strategies. The author argues that the insight from Behavioral Economics can transform HR practices. HR managers and leaders stand to benefit from the emerging evidence from the lab and field of behavioral economics that calls for s rethinking of traditional decision making model

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study

Objective@#The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. @*Methods@#We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. @*Results@#We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. @*Conclusion@#In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study

Objective@#The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. @*Methods@#We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. @*Results@#We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. @*Conclusion@#In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Role of para-cervical block in reducing immediate postoperative pain after total laparoscopic hysterectomy: a prospective randomized placebo-controlled trial

Objective@#To study the efficacy and safety of 0.5% bupivacaine in paracervical block to reduce immediate postoperative pain after total laparoscopic hysterectomy. @*Methods@#A prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary referral center involving thirty women each in the treatment and placebo groups. Paracervical block with 10 mL of 0.5% bupivacaine (treatment group) or 0.9% saline (placebo group) was administered following general anesthesia and prior to proceeding with total laparoscopic hysterectomy. Visual analogue scale (VAS) scores at 30 and 60 minutes post extubation and mean VAS score (average VAS score at 30 and 60 minutes) were compared. Adequate pain control was defined as mean VAS score ≤5. Additional postoperative opioid requirement, hospital stay, and readmissions were also compared. @*Results@#Baseline variables such as age, previous history of cesarean section, operating time, and weight of the specimen were comparable in both groups. VAS scores at 30 (5.0±2.8 vs. 7.0±1.4) and 60 minutes (5.2±2.8 vs. 7.0±0.8) and the mean VAS score (5.1±2.7 vs. 6.8±0.9) were significantly lower in the treatment group. Adequate pain control (mean VAS score ≤5) was 57% higher and additional opioid consumption was 47% lower in the treatment group. No significant difference was found in the duration of hospital stay and readmission rate. @*Conclusion@#Paracervical block with bupivacaine was useful in reducing immediate postoperative pain with a 25% reduction in mean VAS score and a 47% reduction in opioid consumption in the first hour after total laparoscopic hysterectomy.

Tinea capitis: dermoscopy and calcium fluorescent microscopy as highly efficient and precise diagnostic tools

Abstract Tinea capitis comprising of tinea favosa and kerion is mostly seen in school-aged children. Some tinea capitis often presented with insignificant findings under the naked eyes are easily overlooked. The authors describe an unusual case of tinea capitis caused by Trichophyton violaceum. The patient was an 8-year-old girl, with a history of pruritus on the scalp for more than one year. A diagnosis of tinea capitis was confirmed by clinical examination aided by dermoscopy, calcium fluorescent microscopy and culture. Comma and corkscrew hairs are two specific dermoscopic patterns of tinea capitis. The patient was treated with systemic itraconazole, topical application with 1% naftifine 0.25% ketoconazole cream followed after daily hair wash with 2% ketoconazole shampoo for 8 weeks.

An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

Background:A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital. Methods:A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study.Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms.Results:Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.Conclusions:The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.

Assessment of Prevalence and Pattern of Mandibular 3rd Molar Impaction: A Cross-Sectional Study

Background: Impacted teeth, if left untreated, have a potentialto induce various complications. The mandibular third molar isthe most frequently impacted tooth with incidence varies from9.5% to 68% in different populations. The aim of the presentcross-sectional study was to assess the prevalence andpattern of mandibular 3rd molar impaction.Materials and Methods: A retrospective cross-sectional studywas conducted over the period of 1 year in which 270 cases ofpatients aged between 20 and 50 years were selected for thestudy. Parameters studied into the study were an age group,gender, location of the impacted third molar, angulation,position, and level of the impacted tooth. The data analysiswas done using the Statistical Package SPSS version 22.0.Results: In the present study total patients were 270 in which61.48% were males and 38.51% were females. Impacted teethwere maximum in both males and females in the age group 20-30 years. Mesioangular kind of impaction was maximum inboth males and females. According to Pell and Gregoryclassification at level B impactions were maximum (66.3%) andclass II impactions were maximum (51%).Conclusion: Our study concluded that the prevalence ofmandibular impactions were common in males than females.The study also noted that mesioangular impactions were themost common type of impaction. The least common form ofimpactions was the transverse types.

Locally advanced cervical cancer – neoadjuvant chemotherapy followed by concurrent chemoradiation and targeted therapy as maintenance: A phase II study

Aim: The survival in locally advanced cervical cancer remains low. We evaluated the role of neoadjuvant chemotherapy (NACT), chemoradiotherapy (CRT), followed by gefitinib maintenance in locally advanced cervical cancer. Materials and Methods: Twenty-five patients with locally advanced carcinoma cervix were enrolled between July 2012 and May 2013. Patients received 6 weekly doses of NACT Paclitaxel (60 mg/m2) and carboplatin (AUC 2), followed by CRT and brachytherapy. The analysis of epidermal growth factor receptor (EGFR) expression was carried out by immunohistochemistry. Gefitinib (250 mg daily) was given as maintenance therapy for 1 year after completion of chemoradiation. Comparison of EGFR expression and survival outcomes was done. Results: Twenty-four of 25 patients completed the neoadjuvant chemotherapy and concurrent chemoradiotherapy. Post-CRT, all patients were started on gefitinib maintenance, and twenty patients completed the intended 1 year of gefitinib maintenance. Nineteen (76%) patients had a radiological complete response to NACT. EGFR was moderately or strongly expressed in 86.3% of the patients. The 3-year overall survival was 69.8%, and 3-year progression-free survival was 51.4%. Expression of EGFR was not found to be a significant factor affecting overall survival or progression-free survival. Conclusions: Weekly neoadjuvant chemotherapy is associated with a good response rate in locally advanced cervical cancer. Neoadjuvant chemotherapy, chemoradiation, followed by gefitinib maintenance gives good survival outcome in patients with locally advanced cervical cancer.

A chronic case of Madurella mycetoma involving left foot

Mycetoma is a localized chronic, suppurative, and deforming granulomatous disorder of subcutaneous tissue, skin and bones. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is completely different, a definite diagnosis after microbiological and histopathological examination, though difficult, is important. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Authors report a case of eumycetoma in a 38 year-old male from Bihar, with history of thorn prick 30 yrs back. Madurella mycetomatis was isolated from the granular discharge from sinuses and itraconazole was given followed by surgical debridement of the lesion. The patient recovered well and is still on follow up.

An unusual giant schwannoma over face diagnosed on FNAC: a case report

Schwannoma is a slow growing benign peripheral nerve sheath tumor arising from schwann cells. It is also known as neurilemmoma. Although it is common in the head and neck region, it rarely exceeds 10 cm in size. Usually Schwannomas are notlarger than 5 to 6 cm in diameter.Large tumors are uncommon and are found in posterior mediastinum or retroperitoneum. We are presenting an unusual giant cell schwannoma over face (cheek) measuring 12×10cmsin size which caused facial deformity to the patient. The tumor was diagnosed on FNAC where cell block was prepared and IHC was done which showed S-100 positivity. This size schwannomaover cheek site has not been reported in the literature as far our knowledge. Therefore this case is unique for its size over face.

A study to know the serum total testosterone levels in type II diabetes mellitus male patients from North India

Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively.  There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male  patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001).

A self-medicating scale and questionnaire based drug use survey and the effect of educational intervention among healthcare professional students

Background: Due to an array of reasons like easy accessibility and awareness about the available drugs, self-medication has steeply increased the already existent drug misuse. As the health professional students are exposed to all the information of drugs, it would be worthwhile to survey if this knowledge is misused to self-medicate. The present study was aimed at determining the impact of educational intervention on the prevalent attitudes and pattern of self-medication among medical, dental and nursing students as they constitute a vulnerable group for such practices.Methods: A total of 360 health professional students participated in the study. A validated questionnaire and self-medication scale (SMS) were used for the survey, before and after the educational workshop.Results: Of the 360 students 70% were females. 93.89% reported practicing self-medication, which reduced to 78.63% after the educational workshops. Average number of self-medication encounters before the workshop was 4.03±0.30. Analgesics were most commonly used. The modified SMS scores were significantly reduced (p<0.0001) after interventional workshops indicating that the enhanced knowledge, increased the reluctance to self-medicate and make students think twice before self-medicating so as to reduce such harmful, casual drug use habits. Educational workshops statistically (p<0.0001) enhanced the participants knowledge of ADRs, OTC drugs, expiry date, package inserts etc. 77.78% nursing students were habituated to at least one drug which was significantly higher (?2=20.45, p<0.0001) than that of medical and dental students taken together.Conclusions: Educational intervention reduces the evil of self-medication and enhances safe drug use habits among healthcare professional students.