Background:In the first half of 20th century; mortality from colorectal surgery often exceeded 20%, mainly due to sepsis. Modern surgical techniques and improved perioperative care have significantly lowered the mortality rate. Mechanical bowel preparation (MBP) is aimed at cleansing the large bowel of fecal content thus reducing morbidity and mortality related to colorectal surgery. We carried out a study aimed to investigate the outcomes of colorectal surgery with and without MBPs, to avoid unpleasant side-effects of MBP and also to design a protocol for preparation of a patient for colorectal surgery.Materials and Methods:This was a prospective study over a period of March 2008-May 2010 carried out at Department of General Surgery of our institution. A total of 63 patients were included in this study; among those 32 patients were operated with MBPs and 31 without it; admitted in in-patient department undergoing resection of left colon and rectum for benign and malignant conditions in both emergency and elective conditions.Results:Anastomotic leakage, intra-abdominal collections was detected clinically and radiologically in 2 and 4 patients in each group respectively. P > 0.5 in both situations, indicating statistically no difference between results of two groups. Wound infections were detected in 12 (37.5%) patients with MBP group and 11 (35.48%) patients without MBP.Conclusion:The present results suggest that the omission of MBP does not impair healing of colonic anastomosis; neither increases the risk of leakage.
The purpose of this study was to evaluate the efficacy and toxicity of radiotherapy concurrently with weekly cisplatin, followed by adjuvant chemotherapy, for the treatment of N2–3 nasopharyngeal cancer (NPC) in Asian countries, especially regions of South and Southeast Asian countries where NPC is endemic. Between 2005 and 2009, 121 patients with NPC (T1–4 N2–3 M0) were registered from Vietnam, Malaysia, Indonesia, Thailand, The Philippines, China and Bangladesh. Patients were treated with 2D radiotherapy concurrently with weekly cisplatin (30 mg/m 2), followed by adjuvant chemotherapy, consisting of cisplatin (80 mg/m2 on Day 1) and fluorouracil (800 mg/m2 on Days 1–5) for 3 cycles. Of the 121 patients, 56 patients (46%) required interruption of RT. The reasons for interruption of RT were acute non-hematological toxicities such as mucositis, pain and dermatitis in 35 patients, hematological toxicities in 11 patients, machine break-down in 3 patients, poor general condition in 2 patients, and others in 8 patients. Of the patients, 93% completed at least 4 cycles of weekly cisplatin during radiotherapy, and 82% completed at least 2 cycles of adjuvant chemotherapy. With a median follow-up time of 46 months for the surviving 77 patients, the 3-year locoregional control, distant metastasis-free survival and overall survival rates were 89%, 74% and 66%, respectively. No treatment-related deaths occurred. Grade 3–4 toxicities of mucositis, nausea/vomiting and leukopenia were observed in 34%, 4% and 4% of the patients, respectively. In conclusion, further improvement in survival and locoregional control is necessary, although our regimen showed acceptable toxicities.
Uterine cervical cancer is among the most common cancers in East and Southeast Asia, and it is necessary to develop new treatment methods suitable for developing countries. This multiinstitutional observational study conducted among 11 East and Southeast Asian countries aimed to evaluate the clinical outcomes of prophylactic extended-field concurrent chemoradiation therapy with locally advanced cervical cancer. The results indicated that extended-field concurrent chemoradiation therapy is feasible and effective for locally advanced cervical cancer in developing countries.Purpose: This multi-institutional observational study conducted among 11 countries in East and Southeast Asia aimed to assess the clinical outcomes of prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin for patients with locally advanced cervical cancer. Methods and Materials: Between October 2007 and May 2016, 106 patients with untreated squamous cell carcinoma of the cervix were enrolled in the present study. Radiation therapy consisted of pelvic irradiation (total dose, 50 Gy in 25 fractions including central shielding), prophylactic paraortic regional irradiation (36-40 Gy in 20 fractions), and either high-or low-dose-rate intracavitary brachytherapy (ICBT) according to institutional practice. The planned point A dose was 21 to 28 Gy in 3 to 4 fractions for high-dose-rate ICBT and 40 to 41 Gy in 1 to 2 fractions for low-dose-rate ICBT. Five cycles of weekly cisplatin (40 mg/m 2 ) were administered during the radiation therapy course. Results: A total of 106 patients were enrolled. Of these, 9 had major protocol violations and 2 did not receive treatment because of worsened general condition. Thus, 95 patients were evaluable. The median follow-up was 56 months. Of the 95 patients, 76 (80%) received 4 or 5 cycles of chemotherapy. Acute grade 3 leukopenia was observed in 20 of the patients (21%), and late grade 3 gastrointestinal toxicity was observed in 3%. The 2-year local control, progression-free survival, and overall survival rate for all patients were 96%, 78%, and 90%, respectively. Conclusions: The results indicated that prophylactic extended-field concurrent chemoradiation therapy using weekly cisplatin is feasible and effective for patients with locally advanced cervical cancer in East and Southeast Asia.
Background: Neuropathy, being a common complication of diabetes mellitus is frequently encountered in patients related to duration and severity of hyperglycaemia and had a multi-modality treatment approach by the treating physicians.Aims and Objective: To understand and analyze the current drug prescribing trends in the management of diabetic neuropathy in hospitalized and OPD patients in a tertiary care hospital.Materials and Methods: A cross sectional, observational study on (n=100) patients of either sex aged between 18 to 70 years admitted in the Department of Neuromedicine as well as visiting the OPD was conducted for a period of 3 months. Prescriptions were collected and the relevant information i.e. drugs prescribed for diabetic neuropathy only excluding other drugs mentioned in the prescription were documented in a predesigned, pretested proforma and were analyzed. Results: All the prescribed drugs i.e. (100%) were oral formulations. The average number of drugs prescribed per prescription for the treatment of diabetic neuropathy including indoor and OPD patients was 3.60 ± 0.66. Prescription of single drug for the treatment of diabetic neuropathy was found to be the commonest trend among the prescribers i.e. 78% of all the prescriptions and they were all in their generic form.Conclusion: Gabapentin and pregablin (antiepileptics), amitryptylline (anti-depressants) and methylcobalamine were most commonly prescribed drugs. Side effects profiles of these drugs were also well evident among the patients. Much larger multicentric studies of similar type including private and public hospitals might reflect the true scenario of current drug prescribing trend among physicians in treating diabetic neuropathy.Asian Journal of Medical Sciences Vol.9(5) 2018 8-11
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