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Background: Snake bite is a major public health issue in India causing significant morbidity and mortality. But, due to lack of awareness and unscientific treatment practices there is under-reporting of cases. In this study we wanted to know about epidemiological profile of snake bite patients and to assess the risk factors of acute kidney injury following poisonous snake bite. Materials and methods: It was a prospective, observational, single institutional study among patients admitted with snake bite in general medicine ward of our institute between January 2020 to September 2021. After selection, proper history, detailed clinical examination and some laboratory examination like-Renal function test, coagulation profile was done. We assessed different clinical/laboratory parameters that were significantly associated with Acute kidney injury(AKI). Results: Among total 100 patients, 56% of patients developed AKI. There was significantly higher incidences of swelling (98% vs 65%, p-value-0.001), bleeding (62.5% vs 6.8%, p-value-0.002) and cellulitis (75% vs 9%, p-value-0.004) in patients with AKI than patients without AKI. Significantly deranged coagulation profile in terms of raised bleeding time of >10 minutes (67% vs 0%, p-value-0.003), abnormal Prothrombin Time (PT), Activated partial Thromboplastin Time (APTT), Whole blood clotting time (WBCT) of >20 minutes, deranged INR (International normalized Ratio) >1.5 (3% vs 0%, p-value-0.003) was seen in AKI patients. Conclusion: So, from our study multiple clinical parameters - Local signs like-swelling, bleeding from wound, cellulitis, coagulative parameters like-BT, PT, APTT, INR>1.5, clotting time, D-DIMER and low BP have emerged out to have significant association with AKI after snake bite. [ABSTRACT FROM AUTHOR]

Background: Accelerated fractionation radiotherapy has radiobiological advantage of preventing accelerated tumor repopulation and logistic advantage of treating more patients than conventionally fractionated radiotherapy because of its relatively shorter treatment duration. Aims and Objectives: In this study, we compared accelerated fractionation with conventionally fractionated radiotherapy in terms of tumor response and acute toxicities for the treatment of locally advanced head-and-neck carcinomas. Materials and Methods: Patients with Stage III and IVA carcinoma of head-and-neck region were randomized into two groups. The study group patients received accelerated radiotherapy to a total dose of 66Gy in 33 fractions, 2Gy/fraction, 6 fractions/week over a time period of 5.5 weeks. Control group received conventionally fractionated radiotherapy to same total dose and fraction size but 5 fractions/week, over a time period of 6.5 weeks. Both groups received concurrent weekly Cisplatin. All patients were followed up weekly for treatment related acute toxicity during the treatment and then at every month for 6 months after completion of treatment. Results: About 26.6% patients of study arm achieved complete response in comparison to 25.6% of control arm, but the difference was not statistically significant (P=0.957). Although statistically not significant, higher grade of skin toxicity (60%vs.35%, P=0.179) and xerostomia (46% vs. 29%, P=0.155) was also numerically higher in accelerated fractionation. Conclusion: For locally advanced head-and-neck carcinoma, accelerated fractionation radiotherapy with concurrent chemotherapy can be considered as an acceptable and effective alternative of conventionally fractionated concurrent chemoradiotherapy in terms of treatment response and acute toxicity profile. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia detected during acute illness-like ischemic stroke is associated with adverse outcomes more than in normoglycemic patients. However, very limited data regarding stress hyperglycemia and its prognostic value are available for our Indian population. Aims and Objectives: This study was aimed at comparing the stress hyperglycemic and normoglycemic patients in terms of mortality and functional recovery during 28 days follow-up assessed by the Barthel index for Activities of Daily Living. Materials and Methods: Adult non-diabetic patients with ischemic stroke were assessed for random venous blood glucose and HbA1c levels and divided into two groups: Patients with hyperglycemia and normoglycemia. The Barthel Index for Activities of Daily Living was used to compare mortality and functional recovery on the day of admission, day 3, and day 28 after stroke. Results: Mortality over the 28 days follow-up was significantly higher in hyperglycemic patients (45% vs. 20%, P=0.02). The Barthel Index score on admission (day 0) was 8.75±7.41 among stress hyperglycemic patient whereas it was13.54±11.12 among normoglycemic patient, which was significantly different (P=0.028). Similarly, day 3 (18.89±6.08 vs. 23.26±13.05, P<0.05) and day 28 scores (83.24±7.49 vs. 84.55±12.84, P=0.039) were significantly better in normoglycemic patients. Conclusion: The mortality rate was much higher and functional recovery was much poorer in stress hyperglycemic patients. Further studies should be directed toward determining complications in long-term follow-up related to stress hyperglycemia and the effects of management on patient outcome. [ABSTRACT FROM AUTHOR]

Background: Framingham risk score (FRS) is a widely recognized tool used by clinicians worldwide to determine and estimate the 10-year risk of manifesting clinical cardiovascular disease (CVD) of an individual and classify them into different risk categories on the basis of which necessary intervention can be taken. However, there is certain evidence questioning its predictive ability for risk stratification among ethnic Indian and Asian population. Aims and Objectives: In this study, we wanted to determine the predictive ability of FRS in the Indian population and to assess how the risk score is associated with certain variables which are not included in original FRS. Materials and Methods: It was a single institutional, retrospective, and observational study in patients with evidence (by ECG or Cardiac biomarker test -Preferably Troponin T) of diagnosis of acute myocardial infarction for first time. Eligible patients were assessed for their previous clinical records to calculate risk score as per FSRcoronary heart disease 2002. Predictive ability of FRS and association with different risk factors was tested for statistical significance. Results: The most of the study participants (63.8%) had low risk and only 4.8% of study population had high risk for developing CVD. Patients in the low risk group had significantly better high-density lipoprotein profile than other risk groups (P=0.001). Mean systolic blood pressure was significantly higher in highrisk population (155 vs. 131 vs. 138 mm of Hg; P=0.005). The left ventricular ejection fraction was significantly lower in high-risk group (39.2% vs. 53% vs. 52%, P=0.008). Serum creatinine level was also significantly higher in high-risk group (P=0.03). Conclusion: This clearly showed underestimation of FRS in prediction of CVDs in our study. Perhaps FRS needs a calibration and modified form with inclusion of other risk factors and parameters to determine and predict the future risk of development of CVD more accurately in Indian population. [ABSTRACT FROM AUTHOR]

Background: Cisplatin based Concurrent chemo-radiation (CTRT) is the corner stone for treatment of locally advanced head and neck carcinoma. Epidermal growth factor receptor(EGFR) expression by squamous cell carcinoma which is associated with cancer development and progression, leads to emergence of anti-EGFR agents as a therapeutic option. In this study we compare cisplatin based CTRT against gefitinib based CTRT in terms of disease control and acute toxicity profile. Material and Methods: Stage III and IV squamous cell carcinoma of Head and neck region (excluding nasopharynx) were randomised into two groups. Control group received conventionally fractionated radiotherapy of 66Gy in 33fractions, over six and half weeks with concurrent weekly cisplatin. Study group received same dose of radiation with concurrent daily oral Gefitinib. All patients were followed up weekly during the treatment and then 6-8 weeks after completion of treatment and thereafter 3 monthly. Results: Overall response rate (complete response + partial response) was comparable for both arms (75% vs 76.2%, p value-0.881). Radiation with cisplatin was associated with significantly higher skin (28.6% vs 15%, p value-0.037) and mucosal (23.8% vs 5%, p-value-0.047) toxicities. Gefitinib containing arm showed significantly higher grade 3 diarrhoea (10% vs 0%, p-value-0.01) and skin rash (6% vs 0%, p -value-<0.001). With a median follow-up of 12.5 months Disease free survival (DFS) was not significantly different between the arms(12 vs 13 months). Conclusion: Gefitinib based CTRT is non-inferior to cisplatin based CTRT for the treatment of locally advanced head and neck carcinoma with acceptable toxicity profile. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiotherapy with cisplatin is the standard treatment for locally advanced carcinoma cervix. Cisplatin can be given either as weekly or a tri-weekly regimen with radiotherapy. However, there were few studies comparing both, so our study aimed at comparing weekly versus tri-weekly cisplatin-based chemoradiation in terms of loco-regional control and acute toxicity profile. Aims and Objectives: To compare the treatment response and acute toxicity profile of these two concurrent chemotherapy schedule. Materials and Methods: Patients with non-metastatic, squamous cell carcinoma of uterine cervix International Federation of Gynecology and Obstetrics stage IB2-IVA were randomized into two arms-control arm patients received external beam radiotherapy (50Gy in 25 fractions over 5 weeks) with concurrent weekly cisplatin (40mg/m²), and study arm patients received radiotherapy with same dose, along with tri-weekly concurrent cisplatin (75 mg/m²) for two cycles. After that, all patients received brachytherapy 21 Gee/3 fractions, one fraction/week. All patients were followed up weekly during treatment and then monthly for at least a period of 6 months for evaluation of toxicity and treatment response. Results: Six weeks after treatment completion, complete treatment response was comparable in both the arms(43.33% vs. 46.67%, P=0.35). Incidences of leucopenia were significantly high in weekly cisplatin arm (P=0.002).Nephrotoxicity of higher grade was also numerically more in control arm (P=0.654). However, treatment compliance was better in tri-weekly cisplatin arm, reflected by reduced treatment interruptions (46.67% vs. 53%). Conclusion: Tri-weekly cisplatin-based concurrent chemoradiation is equally effective as weekly cisplatin-based approach with comparable acute toxicity in treatment of carcinoma cervix. [ABSTRACT FROM AUTHOR]