Search

Background: Patients with head and neck cancers (HNCs) are at an increased risk of developing functional symptoms associated with eating, speaking, and breathing along with symptoms caused by a fungating tumour (e.g., cosmetic change, malodor, and bleeding). These may substantially reduce their physical functioning and quality of life (QoL). This observational study aimed to find out the QoL in patients with HNC in a tertiary care oncology centre. Methods: A prospective observational study was conducted in adult patients diagnosed with HNC. The patients were divided depending upon their disease extent into early, advanced, and very advanced local disease. The physical, cognitive, emotional, financial and social domains were assessed using a validated Hindi version of the European Organisation for Research and Treatment of cancer (EORTC)- QoL 30 and EORTC HN 35 at baseline and 3 months. Results: A total of 100 patients were assessed with a mean age of 49.3 ± 12.4 years. Most of the patients had carcinoma buccal mucosa (42) followed by carcinoma tongue (17). The patients experienced difficulties with physical functioning and deterioration in emotional functioning. Pain and fatigue were the major problematic symptoms especially in advanced disease patients resulting in poor QoL. There was a significant improvement in various domains of QoL at 3 months follow-up in those with advanced disease. The fatigue scores at baseline and follow-up showed a positive correlation with other symptoms. Conclusion: Patients with HNC have a high symptom burden that leads to poor QoL. Appropriate palliative care interventions help to decrease symptom burden and prevent deterioration of their QoL in patients with HNC. Keywords: Fatigue, head and neck cancers, pain, QoL, Author(s): Abhity Gulia [1]; Nishkarsh Gupta (corresponding author) [1]; Prateek Sharma [2]; Vinod Kumar [1]; Rajeev Kumar [3]; Seema Mishra [1]; Sushma Bhatnagar [1] Introduction Head and neck carcinoma (HNC) [...]

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with increased morbidity and mortality. We retrospectively analysed the perioperative anesthetic management in patients undergoing HIPEC surgery.

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol‐based total intravenous anesthesia and sevoflurane‐based general anesthesia—on antitumor immunity, including tumor growth factor‐β (TGF‐β), T‐helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I‐III fulfilling the inclusion criteria were randomized to either group S (sevoflurane‐based general anesthesia) or group T (propofol‐based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF‐β (higher in group T). There was a statistically significant difference in postoperative interleukin‐17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol‐based TIVA increases serum TGF‐β levels. At the same time, Sevoflurane modulates T‐helper cells‐based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations. [ABSTRACT FROM AUTHOR]

In this article, Gallagher and Mishra state that "innovation" is in vogue in the increasingly competitive and globalized higher education landscape, particularly in the world of serving working professionals in continuing higher education. Too often, however, colleges and universities do not consider the voice of the consuming public--in particular, that of prospective students--in creating a roadmap for innovation and growth. Listening to customers' voices can help sort through the noise of interesting and nascent ideas in order to prioritize and focus on initiatives that will meet the needs of students and the public. In the spirit of continuous innovation and maintaining alignment with evolving market needs, Northeastern University places considerable emphasis on regularly surveying prospective professional students and other parties. Gallagher and Mishra use this article to build on the results of a number of Northeastern's marketplace surveys and opinion polls over the last year and make a case for fundamental innovations that professional students and others are demanding. The authors' conclude that, in order to keep pace with market trends, and indeed, to stay ahead of them, higher education institutions and their professional and continuing education units must continually evaluate the needs and interests of their customers. In addition, innovation and new investments should be grounded in evidence and reflect customer demands rather than reacting to the direction of peer institutions.

Background: Psychological factors have a key role in affecting the clinical outcome of a disease. Studies have found an alteration in the immune system and endocrine function in patients with psychological stress. Cancer patients often display these symptoms. This study aims to find out the prevalence and factors affecting the presence of preoperative depression, anxiety, and stress in cancer patients by using the Depression Anxiety Stress Scale-42 (DASS 42). Methods: Three hundred and sixty patients were included in the study who were posted for cancer surgery. They were required to answer a questionnaire where details were collected about the sociodemographic and economic background, type of cancer and treatment received, details about the presence of pain, and if the patient is on any analgesics. Data were analyzed using Stata version 16, and multivariate analysis was done using logistic regression. Results: The prevalence of depression, anxiety, and stress was found to be 16.11%, 32.5%, and 12.78%, respectively. Logistic regression analysis revealed that marital status and type of surgery proposed predicted depression; anxiety was significantly contributed by the type of surgery proposed and analgesic the patient is taking; whereas marital status, type of surgery proposed, and analgesic the patient is taking predicted stress. Conclusion: Married patients are more likely to suffer from depression and stress. Patients undergoing palliative surgery will be prone to all kinds of negative emotions including depression, anxiety, and stress. The type of analgesics, which the patent is taking as prescribed based on the World Health Organization (WHO) ladder for cancer pain also significantly influences anxiety and stress. [ABSTRACT FROM AUTHOR]

Chronic pain emanating from the abdominal wall is frequently unrecognized or confused with visceral pain, often leading to extensive diagnostic testing before an accurate diagnosis is established. Anterior cutaneous nerve entrapment syndrome (ACNES) is one of the most frequent causes of chronic abdominal wall pain. [ABSTRACT FROM AUTHOR]

Acute intermitttent porphyria belongs to a rare group of diseases hallmarked by deficient biosynthesis of heme. It carries a significant symptom burden, both physical and emotional,and therefore palliative care has emerged as an essential tool in the armamentarium of porphyria management. It takes care of the patient as a whole and caters to all aspects that the disease process demands. There are many lacunae in the literature regarding the palliative management of porphyria. We are reporting a case of a 16-year-old female who presented with severe abdominal pain, lower backache and symmetrical bilateral lower limb pain to the palliative ward referred by the neurology department for supportive care. This case describes the palliative care aspects of porphyria management which was successfully provided in the palliative care unit right from referral till the last. A multidisciplinary palliative care team managed the patient, and the necessary interventions were provided to the patient and family. Palliative acre in AIP needs to be emphasized, and palliative care services need to be utilized in these cases. The unavailability of specific treatment measure, heme, in countries like India further emphasizes the need for long-term supportive care for the patient and family. The case shows the importance of palliative care throughout the disease course as it is a chronic disease with significant morbidity and carries a heavy symptom burden. This case provides the insight that rather than conventional management alone for such chronic diseases, palliative care should be incorportated. Early integration with palliative care helps in exploring all the domains of disease. This is one of the first cases reported highlighting palliative care in porphyria , bridging the gap in the literature. [ABSTRACT FROM AUTHOR]

Byline: Nitish. Thakur, Mahima. Gupta, Raghav. Gupta, Seema. Mishra Major head and neck surgery is a known factor for postoperative delirium; however, Cotard's syndrome (CS) has been rarely reported following [...]