To Study the Barriers in Palliative Care to Nonmalignant Cases in COVID-19 Crisis in a Tertiary Health-Care Center.

INTRODUCTION: COVID-19, the new pandemic faced by the world, is a novel betacoronavirus causing severe respiratory coronavirus syndrome. Elderly patients, people with underlying chronic illnesses, cancer patients, and those who are immunocompromised are at higher risk and account for higher mortality rate. Unfortunately, there is no approved medication for treatment, till date, thereby supporting triage management and difficult decision-making. Thus, there should be a substantial increase in the palliative care in times of pandemic. There should be an increase in the availability of palliative care services in different care settings. Due to a surge in the number of cases of COVID-19, it has been reported on how palliative care is being delayed, discontinued, or deprioritized. AIM: The aim of this study is to evaluate the barriers occurring in providing the palliative care to the patients with nonmalignant illness. METHODOLOGY: A questionnaire was designed after studying previous work over palliative care and pandemic crisis and was distributed among the physicians, surgeons, and the residents; a total of 95 health-care workers were involved. The survey was done through mails. The response then was evaluated and analyzed. RESULTS: As seen by the responses we got from the health-care workers, the main issue is the nonavailability of the personal protective equipment during this pandemic. Keeping the current scenario in mind, regarding COVID-19, the patients are at fear of coming to the hospital at first place, and even if they come then the fear of being alone haunts them. One of the biggest fears of the patient is dying alone, without being in contact with their loved ones. CONCLUSION: Palliative care should be an essential part of any health-care service in any humanitarian crisis, including the COVID-19 pandemic. Thus, effort should be made to remove the barriers and provide palliative care to the patient.

Biosynthesis of planet friendly bioplastics using renewable carbon source.

Plastics are uniquely flexible materials that offer considerable benefits as a simple packing to complex engineering material. Traditional synthetic polymers (often called plastics), such as polypropylene and polyethylene have been derived from non-renewable petrochemicals and known to cause environmental concerns due to their non-biodegradable nature. The enormous use of petroleum-based plastic compounds emphasized a need for sustainable alternatives derived from renewable resources. Bioplastics have attracted widespread attention, as eco-friendly and eco-tolerable alternative. But they have got certain limitations as well, such as high cost of production and unsatisfactory mechanical properties. In this study we have found agriculture waste (AW) as low-cost and renewable substrate for the production of bioplastics in bacterial fermentation. Improvement in tensile properties of produced bioplastic film has also been documented upon blending with Cellulose Acetate Butyrate (CAB).

Anti-infective Potential of Hot-spring Bacteria.

AIM AND BACKGROUND: Antibiotic resistance currently spans most of the known classes of natural and synthetic antibiotics; limiting our options for treatment of infections and demanding discovery of new classes of antibiotics. Much effort is being directed towards developing new antibiotics to overcome this problem. Success in getting novel chemical entities from microbial sources depends essentially on novelty of its habitat. The diversity of geographical location decides the type of micro-flora. In the past various terrestrial and aqueous microorganisms have provided several novel bioactive secondary metabolites of pharmaceutical importance. Hot-springs have not been as extensively exploited as other terrestrial resources. However, perseverance with such microbes augment the probability of getting novel bioactive compounds. MATERIALS AND METHODS: Hot-springs soil samples were collected from Hot-springs in Maharashtra. Actinomycetes and other eubacteria were isolated from these soil samples by selective methods and purified. They were classified based on gram's nature and morphology. Six representative morphological strains were screened for their anti-infective potential by agar well diffusion method as reported by Nathan P. et al (1974). The bioactivity of the active microbes was confirmed. RESULTS: Seventy three strains of bacteria encompassing eight actinomycetes, and 65 eubacteria were isolated and purified. Among the actives eubacteria PPVWK106001 showed broad spectrum antibacterial activity encompassing both gram positive and gram negative bacterial test models. The extract was active against resistant bacteria such as MRSA and VREs. Activity was very specific as there was no activity against fungi even at 100 fold concentration. The active principle was extractable in butanol. CONCLUSIONS: The study showed that Hot-springs exhibit diverse bacteria and it serves as potential reservoirs for bacteria of antimicrobial importance with diverse facet of activities. Thus Hot-springs microbes have ability to address issue of resistant bugs.

Peripheral nerve field stimulation for intractable post-thoracotomy scar pain not relieved by conventional treatment.

Peripheral nerve field stimulation (PNFS) is being applied in individual cases where conventional treatments have failed to control pain localized to limited dermatomal distribution. We applied PNFS for unrelieved post-thoracotomy scar pain. Although spinal cord stimulation may have resulted in good coverage in the same dermatomal distribution, we chose the more peripheral approach to minimize the risk of complications, avoiding the potential neurologic sequelae associated with stimulation of the spinal cord. In summary, PNFS was effective in relieving post-thoractomy pain refractory to conventional pain management suggesting great potential of PNFS as a treatment option for chronic surgical-scar pain.

Pediatric cancer pain management at a regional cancer center: implementation of WHO Analgesic Ladder.

PURPOSE: To collect data on the prevalence of various types of cancer pain in a sample of children with cancer, and to implement the WHO Analgesic Ladder in the management of pain in pediatric cancer. METHODS: Eighty four pediatric patients suffering of cancer pain were studied during the period 2001-2006. Patients were requested to rate their global intensity of pain on 0-100 mm visual analogue scale (VAS 0 = no pain, 100 = maximum pain). Pain management was performed in accordance with the WHO Analgesic Ladder for cancer pain. Patients were followed up weekly for three weeks. RESULTS: Of the 84 pediatric children with cancer, pain was nociceptive in 26 (31%), neuropathic in 12 (14.3%) and mixed in 46 (54.8%). Almost 7 (8.3%) of patients were on WHO step 3 at baseline. Thereafter the WHO step 3 increased; first week visit 36 (43%) patients; second week visit 58 (69%), and third week 69 (82.1%). At baseline, 40 (47.6%) patients took NSAID only, 2 (2.4%) patients took adjuvant, while 38 (45.2 %) patients took combination of NSAID and adjuvant treatment. There was statistically significant (p = 0.000) reduction in VAS as time progressed. CONCLUSION: Cancer pain in pediatric age group can be well managed in accordance with the WHO Analgesic Ladder. Aggressive symptoms and control of treatment of related side effect are also needed to ensure successful implementation and the WHO Analgesic Ladder.

Management of postoperative chylothorax in a patient with carcinoma of thyroid and lymphadenopathy--a case report.

Chylothorax is a rare but serious complication following neck dissection with an incidence of 0.5%-2%. Because of the rarity of chylothorax, surgeons are unfamiliar with its early signs which allow a prompt diagnosis and effective management. Most cases reported in the literature are associated with a concurrent external chyle leakage, occurring either during or after surgery. We report a case of chylothorax without concurrent external chyle leakage, which occurred following neck dissection and mediastinal lymphadenopathy, for thyroid cancer.

Respiratory support in oncology ward setting: a prospective descriptive study.

BACKGROUND: Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes. METHODS: Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation. RESULTS: Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively. CONCLUSION: Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

Management of neuropathic cancer pain following WHO analgesic ladder: a prospective study.

Cancer pain treatment according to the guidelines of World Health Organization (WHO) is effective and safe in majority of patients. 818 neuropathic cancer pain patients were enrolled in the study and pain was managed according to WHO analgesic ladder and followed up to six months. Main adjuvant drugs used were amitryptaline (29.9%), gabapentin (29.9%) and gabapentine with dexamethasone in (19.9%) and dexamethasone alone in (20.2%) patients. Opioids prescribed were mainly tramadol, codeine sulphate and morphine. 52% patients received morphine as rescue analgesic. At the end of six months 53.2% patients had no pain and 41.9% of patients had mild pain as compared to 0% and 10.2% patients respectively at the first visit. 4.9% of patients had moderate pain even after the treatment. Neuropathic cancer pain can be relieved by multimodal treatment following WHO guidelines as majority of cancer patients suffered multiple types of pain.

Ultrasonography reinvents the originally described technique for ganglion impar neurolysis in perianal cancer pain.

Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the ganglion impar. Since the first description of the technique of accessing the ganglion impar through anococcygeal ligament, many techniques for ganglion impar block have been described. We present a patient diagnosed with carcinoma of the anal canal who was successfully given ultrasound-guided ganglion impar block using a Chiba needle inserted through the anococcygeal ligament. In summary, ultrasound-guided ganglion impar neurolysis is a fast, safe, and cost-effective method, which can be used as a first-line pain relief intervention for good quality of life in patients with perianal cancers.

Oral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.

An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. During the titration of the analgesic dose, he developed severe symptoms of morphine overdose. He was immediately treated with intravenous naloxone. After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.

Management of pericatheter cerebrospinal fluid leak after intrathecal implantation of a drug delivery system.

Persistent cerebrospinal fluid leak is a known complication of intrathecal pump system insertion for drug delivery. Various treatment modalities, such as an epidural blood patch, use of glue, removal of catheter, and surgical closure of dura and subdural blood patch, have been reported previously. This report presents a 35-year-old woman in whom an intrathecal pump system was inserted for cancer pain management with intrathecal morphine. This was complicated by a persistent cerebrospinal fluid leak that was successfully managed by purse-string sutures over the dura around the catheter, without removing the intrathecal implant. The cause of the cerebrospinal fluid leak and different treatment approaches are discussed.

Marine molecular biology: an emerging field of biological sciences.

An appreciation of the potential applications of molecular biology is of growing importance in many areas of life sciences, including marine biology. During the past two decades, the development of sophisticated molecular technologies and instruments for biomedical research has resulted in significant advances in the biological sciences. However, the value of molecular techniques for addressing problems in marine biology has only recently begun to be cherished. It has been proven that the exploitation of molecular biological techniques will allow difficult research questions about marine organisms and ocean processes to be addressed. Marine molecular biology is a discipline, which strives to define and solve the problems regarding the sustainable exploration of marine life for human health and welfare, through the cooperation between scientists working in marine biology, molecular biology, microbiology and chemistry disciplines. Several success stories of the applications of molecular techniques in the field of marine biology are guiding further research in this area. In this review different molecular techniques are discussed, which have application in marine microbiology, marine invertebrate biology, marine ecology, marine natural products, material sciences, fisheries, conservation and bio-invasion etc. In summary, if marine biologists and molecular biologists continue to work towards strong partnership during the next decade and recognize intellectual and technological advantages and benefits of such partnership, an exciting new frontier of marine molecular biology will emerge in the future.