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Musculoskeletal diseases are a group of clinical conditions affecting the body's movement and remain a common source of pain affecting the quality of life. The aetio-pathological reasons for pain associated with musculoskeletal diseases can be varied and complex. Conventional medicine can treat or modify pain due to musculoskeletal diseases; however, these may be associated with some side effects and at times may not be able to relieve pain completely. These treatment modalities also have ceiling effects like doses of analgesics, the number of nerve blocks, etc. Complementary and Alternative Medicine (CAM) provides a supplementary, unconventional modality to alleviate discomfort and disability associated with these mostly chronic conditions to manage activities of daily living. These modalities have been variedly combined with conventional management for symptom control and thus improve day-to-day activities. We assess the role of commonly used CAM modalities in the management of pain arising from Musculoskeletal diseases.

The whole world is affected due to pandemic caused by SARS Cov 2. Imposition of nationwide lockdown to curb viral transmission has impacted various healthcare services including cancer care services. Most important concern is the risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2) and its effect on patients with cancer. Alteration in lung cancer care services including number of chemotherapy sessions, dosages of chemotherapy, number of radiotherapy fractions and duration, about maintenance therapy and immunotherapy etc., could maintain the continuity of care without affecting quality of cancer care. In this review, we have discussed challenges and counter measures for lung cancer management amidst COVID-19 pandemic.

Cancer care is adversely affected by the corona virus disease 2019 (COVID-19). Due to increasing number of COVID-19 cases, all healthcare resources are diverted to take care of COIVD-19 patients. This is the most difficult time for cancer patients because cancer treatment is getting delayed or interrupted due to COVID-19. In this tough time, the supportive care can be continued with basic minimum resources and can provide a big relief to cancer patients.

Background: Malignant ascites is an accumulation of fluid in the peritoneal cavity due to the manifestation of terminal metastatic malignancies. Accumulation of ascitic fluid could cause abdominal distention, early satiety, and shortness of breath. The onset and progression of these symptoms are not only distressing but also cause deterioration of the quality of life. Malignant ascites is associated with poor prognosis with anticipated life expectancy ranging from 1 to 4 months. Therapeutic paracentesis is the mainstay of palliation for malignant ascites. It only provides a temporary relief of symptoms, ascites re-accumulates, and paracentesis has to be repeated. Objectives: The aim of this case series was to evaluate our experiences when treating malignant ascites with placement of central venous catheter in the peritoneal cavity, with special emphasis on patient satisfaction, comfort of caregiver, technical success, and adverse events. Methods: Five patients with advanced disease and recurrent malignant ascites who required multiple paracentesis were selected for placement of 7-FG triple-port Central venous catheter in the peritoneal cavity. Maximum fluids that can be tapped were removed in ward. Patients and their relatives were assessed for satisfaction with the procedure. Results: Out of 5 patients, 3 were female and 2 male (age between 46 and 62 years). Two patients had carcinoma gallbladder and one each of carcinoma ovary, breast, and prostate. All patients were followed up till 1 month from catheter placement. Patients and their relatives were well satisfied in terms of frequent hospital visit for paracentesis. Conclusion: In summary, we suggest that central venous catheter may be used as indwelling peritoneal catheter for the symptom management of recurrent malignant ascites. It provides a relatively safe and cost-effective alternative to serial large-volume paracentesis that requires multiple hospital admissions.

The solid tumors of the central nervous system (CNS) are the most common cancers in the pediatric population. It accounts for about 25% of tumors seen in children. Due to advancements in treatment modalities, the prognosis and 5-year survival rate have improved steadily. Along with surgery and chemotherapy, radiation oncology forms the cornerstone in the treatment and outcome of CNS tumors. Radiation therapy (RT) is used for both curative as well as palliative intent. It is one of the primary management modalities for primary CNS lymphoma, glioma, and brain metastasis.

Vasovagal syncope is defined as a sudden and transient loss of consciousness. We report a case of vasovagal attack during insertion of thoracic paravertebral cathether. A 28 year old male ASA I, case of bronchus Schwannomas was posted for left sided Pneumonectomy. Past history of 2 episodes of dizziness and fainting on visualization of blood. During insertion of the catheter through the needle, patient felt paraesthesia and complained of giddiness and became unconscious. The monitor showed sudden bradycardia and hypotension. The blood glucose was found to be 55 mg/dl. 25% dextrose 100 ml was given to correct hypoglycemia. Patient was resuscitated and surgery completed. Therefore, Vasovagal episodes along with regional anesthesia can be a significant hazard. Attention must be given to patients with history of vasovagal episodes. Adequate comfortable positioning, reassurance, adequate sedatives to relieve anxiety and preprocedure optimization of blood glucose may be useful in such patients.

Bronchial thermoplasty (BT) is an upcoming treatment for patients with asthma refractory to traditional pharmacotherapy. BT is an invasive procedure which carries a risk of coughing, wheezing, bronchospasm, and laryngospasm during and after the procedure. Some of these complications can be minimized using better anesthetic techniques during BT. We hereby report a case of a 63-year-old female with poorly controlled asthma posted for BT done under general anesthesia (GA) with supraglottic device. GA provides better working conditions for pulmonologists when compared with sedation. But still there is no consensus on what would be the ideal anesthetic technique for BT procedure. Till the time, considering anesthesiologist and pulmonologist's prospective, GA (total intravenous anesthesia) using supraglottic device would be a preferred choice for a safe and effective anesthetic strategy in BT.

Background: Bupivacaine being the drug of choice for spinal anaesthesia is associated with serious cardiac toxicity. Levobupivacaine and ropivacaine, both being the two S enantiomers of bupivacaine can be a safer alternatives with better cardiovascular safety. Hence, the clinical efficacy of both were assessed and compared in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double blind study was done in 68 adult posted for elective lower abdominal and lower limb surgeries under spinal anesthesia. They were randomized into 2 groups. About 3ml isobaric levobupivacaine 0.5% (15mg) was given in group A and 3ml isobaric ropivacaine 0.5% (15mg) was given in group B. Onset, duration of sensory and motor blocks, time for maximum sensory and motor block, time for 2 segment sensory regression and haemodynamic parameters were recorded and analyzed.Results: All patients achieved a sensory block of T10 dermatome. Onset of sensory blockade at T10 was similar in both groups, group A (5.71±1.31min) and group B (5.94±1.72min). Time from injection to two dermatomal regression was 129.68±15.54min in group A and 111.38±22.35min in group B. Onset of Bromage score of 1 in group A was 4.68±1.27min and in group B was 6.44±1.64min. The mean duration of motor and complete motor block was prolonged in group A patients (197.74±18.51min, 168.82±17.90 min) as compared to group B (131.88±20.41min, 106.71±10.85min).Conclusions: Isobaric levobupivacaine was found to be a better and safer substitute for spinal anesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries.