International Journal of Medical Research & Review (IJMRR)
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Predictors of long term survival after surgical resection in carcinoma gall bladder
Get PDFBackground-Carcinoma of the gallbladder is known to be associated with a dismal prognosis, with majority of patients presenting at late stages. Controversies still exist regarding the optimal management and the extent of surgery.
Methods-This study was done at a tertiary hospital in an endemic region for cancer gallbladder (north Indian Gangetic belt). All patients operated for cancer gallbladder between January 2006 and January 2011 were included, with details of clinical presentation, survival analysis and identification of prognostic factors.
Results- Of the total 252 patients of carcinoma gall bladder identified during the study period, 71 patients were explored surgically. Curative resection was achieved in 27 patients with 10 long term survivors (disease free interval >3years). Nodal status, TNM stage and bilirubin levels affect survival. Majority of patients presented late in the course of disease (Mean of 44 days from the onset of symptoms).
Conclusion-Majority patients with carcinoma gallbladder in our region have advanced unresectable disease. Bilirubin levels at presentation predict resectability. Nodal involvement implies a worse prognosis; however the extent of lymphadenectomy to be done is still debatable. Community screening programs and sensitization of local physicians for early referral can improve survival in endemic areas
HER-2/neu overexpression correlates with increased expression of VEGF in primary breast carcinoma
Get PDFBackground: Overexpression of HER-2/neu is associated with up-regulation of vascular endothelial growth factor (VEGF) in human breast cancer cells in vitro. Preclinical experiments indicate that increased expression of VEGF may in part mediate the biologically aggressive phenotype of HER-2/neu overexpressing human breast cancer. It was the purpose of this study to: (a) evaluate the association between HER-2/neu and VEGF expression in a cohort of primary breast cancer patients; (b) find out any association of HER-2/neu or VEGF with traditional histologic prognostic parameters.
Materials and Methods: HER-2/neu and VEGF were measured by immunohistochemistry in 70 cases of newly diagnosed primary breast cancers and the relation between these two markers and their relations with traditional prognostic factors were analyzed by statistical methods.
Results: Our findings indicate a significant positive association between HER-2/neu and VEGF expression. VEGF did not show significant association with tumor size, histologic grade or lymph node status. HER-2/neu overexpression was maximum in grade II, followed by grade I and III with a significant p value (<0.001). But HER-2/neu didn’t have any association with tumor size or lymph node status.
Conclusion: The positive association between HER-2/neu and VEGF expression implicates VEGF in the aggressive phenotype exhibited by HER-2/neu overexpression, and supports the use of combination therapies directed against both HER-2/neu and VEGF for treatment of breast cancers that overexpress HER-2/neu. The unusual association found between HER-2/neu and grade of tumor may be due to uneven distribution of cases among different grades of tumor
Common stress factors faced by elderly in Deoli area of Wardha district
Get PDFBackground: Previous studies have shown that elderly people faced numerous socio-psychological problems like stress, declining authority, lack of respect in the family, loneliness, difference of opinion with family members. To study this we further conducted a study in the deoli area of Wardha district from June to August, 2015.
Objective: To find out common stress factors faced by elderly of Deoli area in Wardha district.
Methods: Observational cross-sectional study. Simple random sampling technique was followed to include the study unit in the study sample and the study unit was selected by using lottery method from among the elderly population in the deoli area.
Result: Elderly are more stressed from psychosocial problems than physical problems. They mostly suffer from limitation of physical activity (78%), back pain (66%) and joint pain (54%), sleep disturbance (88%), decrease in social life (88%), poor concentration (76%), and financial dependency(50%).
Conclusion: It is concluded that there is urgent need for efforts on the part of the government and non-government organization to ensure guaranteed income, health care, social services, recreation and other requirements of the aged which will go a long way to reduce the problems of elderly
Study of socio-demographic profile and contraceptive use among married women attending an Urban Health Centre, Berhampur
Get PDFIntroduction: The higher fertility in India is attributed to early marriage, low level of literacy, poor level of living, limited use of contraceptives and traditional ways of life. Family planning plays a key role in deciding the desired family size and effective limitation of fertility.
Objectives: 1) To study the socio-demographic profile of married women of reproductive age group attending anganwadi centres 2) To assess knowledge and practice of contraception among them 3) To find out the unmet need of contraception.
Materials and Methods: A cross sectional study was conducted from May to July 2014 among married females between 15-45 years attending any of the six Anganwadi centres under the Urban Health Centre, Ankuli, Berhampur. 224 participants were interviewed in local language using a predesigned and pretested questionnaire.
Results: 58.58% of the women were between 20-30 years and lived in nuclear families (65.6%). 29% had history of induced abortion. Most common reason of induced abortion were cited as unintended pregnancy (48.45) followed by complete family size (37.8%). Awareness about OCPs and female sterilisation was 96.9% followed by Condom (90.3%). Major source of information on contraception were through friends and relatives (47.5%) followed by husband (41.4%). Contraception was practiced by 48% of the respondents. Majority of them (26.8%) were OCP users followed by condom (8%). Use of contraception was mutually decided by the couples (99%). The unmet need of contraception was found to be 34.3%.
Conclusion: Awareness about contraceptives is not sufficient for its actual use in this community for which new ways of motivating people to adopt and sustain family planning methods should be considered
Sinonasal Teratocarcinosarcoma
Get PDFSinonasal Teratocarcinosarcoma (SNTCS) is an extremely rare and unusual malignant neoplasm of the sinonasal tract with an aggressive behaviour. Till date, there are less than a hundred cases reported in literature. A 52 year old patient presented with a large, reddish brown, right sided nasal mass with epistaxis since 1 month. Histopathology revealed a highly malignant tumor with diverse histomorphological features and was labelled SNTCS. These unique tumors show diverse histomorphological features of a carcinosarcoma with teratoid elements. Immunohistochemistry was positive for cytokeratin, vimentin, GFAP, NSE, S-100. Chemotherapy with cisplatin and etoposide was given followed by a debulking surgery. The patient is well seven months after diagnosis and scheduled for radiotherapy. Diagnosis of SNTCS requires an adequate representative biopsy and extensive sampling on Histopathology. Treatment required included surgery, chemotherapy and radiotherapy
Comparative study of recurrence after pterygium excision with conjunctival autografting and amniotic membrane transplantation
Get PDFIntroduction: Pterygium is ocular surface lesion thought to originate from damage to limbal stem cells by chronic ultra violet light exposure. It has high recurrence rates following resection. Both amniotic membrane and conjunctival autograft are source of stem cells. We compare recurrence after pterygium excision with conjunctival autografting and amniotic membrane grafting.
Methods: Prospective case study of seventy patients after pterygium excision with Amniotic membrane transplantation or Conjunctival autografting. Thirty five patients divided in each group and fibrin glue used for both Amniotic membrane transplantation and Conjunctival autografting.
Results: Six follow up from first postoperative day to one year were done in each group. Group A (Amniotic membrane transplantation) had less Post operative complaints. In group A, all patients have well placed graft while in group B (conjunctival autografting) nine patients have graft displacement on first post operative day. It was statistically significant (p value 0.001). The recurrence occurring four patients in group A (11.42%) while in 7 patients in group B (20%). The recurrence was more in group B although it was statistically insignificant (p value <0.511). Amniotic membrane transplantation with fibrin glue having less postoperative complaints, better graft stability and less recurrence as compare to conjunctival autografting.
Conclusion: Our study shows good outcome with Amniotic membrane transplantation. Probably this is because of anti- inflammatory property of amniotic membrane, minimum surgical trauma and uniform thickness of graft
A study of role of brachytherapy IR192 in treatment of eyelid tumors
Get PDFBackground: In eye lid cancers, there is a significant risk for tissue damage to nearby vital ocular structures and even of blindness. The skin around the eyelid is thin and contains little subcutaneous tissue and anatomic connections to the underlying bone in the region facilitate rapid local tumor spread into the nasal and orbital cavities.
Objective: The aim of this study was to evaluate the response of high dose rate interstitial brachytherapy in carcinoma eye lid.
Methodology: From January 2011 to December 2012, 25 diagnosed cases of carcinoma eye lid were reported in our department. All cases were staged clinically according to the TNM staging system. All patients were treated with high dose rate interstitial implant and analyzed for presence of residual disease, local recurrence, distant metastasis, radiation reaction and disease free survival.
Result: Total 25 cases were examined, 12 were males while 13 were females. Most of the tumors were involving the lower lid. Squamous cell carcinoma out numbered the basal cell carcinoma. Basal cell carcinoma group of 11 cases, 91% showed complete regression at 6 months while Squamous cell carcinoma group of 14 cases, 93% showed total regression.
Conclusion: High dose rate interstitial brachytherapy with Iridium 192 is appropriate for the treatment of early staged squamous cell carcinoma of eye lid
Study on glaucoma awareness among the rural population of central Kerala
Get PDFBackground: Glaucoma is one among the leading causes of irreversible blindness in India. Lack of awareness and lack of knowledge of this disease is the most important cause for the late presentation which leads to blindness.
Aim: To find out the awareness and knowledge about glaucoma in a rural population of a literate state like Kerala.
Study Design: A cross sectional study using a pre tested semi structured questionnaire and the participants were selected by cluster sampling method.
Materials and Methods: The questionnaire contained details of demographic factors in the first part and questions to assess the knowledge of the participants who were aware of this disease in the second part. The responses were entered in MS EXCEL Sheet and data analysis done using the software SPSS version 15. Chi-square test was done to find out the percentage and proportion.
Results: Out of the 4414 participants 2052 were males and 2362 were females. 805(18.23%) people were aware of glaucoma, Awareness was statistically significant in terms of age, age group 40-59 were more aware of the disease. Knowledge of glaucoma was significant statistically in terms of education (p value =0.003) but not in terms of gender (p value -0.847) Major source of information was through mass media. Only 34.4% knew that this is a disease with no symptoms.
Conclusion: Awareness of glaucoma is less when compared to the literacy rate. But knowledge of glaucoma is good among those who are aware of the disease. Mass Media can be utilized to impart knowledge of this disease .Health education classes should be conducted and people should be motivated to undergo screening procedures so that early detection is possible
Uterine artery Doppler as a predictor of pre eclampsia - hospital based study
Get PDFAim: Study of early second trimester (13-16wks) uterine artery Doppler as predictor of pre eclampsia.
Objective: To study whether early changes in uterine artery Doppler have better predictive value for preeclampsia as compared to gestational hypertension. To analyze the maternal and fetal outcome in cases with pre eclampsia vs gestational hypertension.
Material & Methods: From 2009 to 2011, we conducted an institutional based study among 100 pregnant women. Uterine artery Doppler was done in the women in early second trimester during the antenatal visits at Niloufer Hospital. We measured and recorded the BP, urine analysis, complete blood work done in every antenatal visit. These women were followed up to their delivery. Data were analyzed and p<0.05 was considered significant.
Results: Pre eclampsia developed in 31.25% of the pregnant women with bilateral uterine artery notching at 13-16 weeks of gestational age Odds ratio of patients developing hypertension with uterine artery notching is 6.6. Chi-square = 11.8, P value < 0.0005 (significant). This study has a sensitivity of 71.42%, specificity of 74.41%, positive predictive value of 31.25% and negative predictive value of 94.11% in predicting onset of preeclampsia in pregnancy.
Conclusion: Uterine artery Doppler should be done routinely in all pregnant women as risk factors can be identified at an early stage where timely intervention can reduce the maternal and neonatal complications
Single stage substitution urethroplasty using buccal mucosa in the management of stricture urethra in balanitis xerotica obliterans (BXO)
Get PDFIntroduction: Urethral stricture is “narrowing of the caliber of the urethra caused by the presence of a scar consequent to infection, inflammation or injury". Urethral strictures are difficult to manage. BXO is more resistant to all types of treatment and recurrence is the most common complication. Buccal mucosa dorsal onlay graft urethroplasty is one of the surgical treatment modality for treating BXO related strictures.
Objective and Methods: This study is to assess the outcome of stricture urethra in BXO cases treated by single stage buccal mucosa substitution urethroplasty. A Prospective study , total 35 patients underwent surgery for stricture urethra with BXO.
Results: 33 patients underwent single stage dorsal onlay buccal mucosa substitution urethroplasty and 2 patients underwent augmented roof strip buccal mucosa urethroplasty Pre and post operative uroflowmetry done for all patients , a significant increase in post-operative uroflowmetry rates observed (P value is less than 0.0001.). Patients were followed up post-operatively at 3, 6, 9 ,12 and 36 months intervals out of 35 patients 6 patients had the recurrence. Out of 6 patients ,3 patients underwent one single procedure for recurrent stricture. the success rate is 91.42%.(mean followup period 36.2 months).
Conclusion: Buccal mucosa dorsal onlay urethroplasty a good surgical option for BXO patients with less recurrence rate