Search

Background: Breast cancer, the most common malignancy among women globally, recorded over 2.26 million new cases and almost 685,000 deaths in the same year. Evidence indicates breast cancer risk links to both modifiable and non-modifiable lifestyle factors. Promoting education and access to screening programs is crucial for early detection and intervention in breast cancer. This approach ultimately enhances the effectiveness of prevention efforts and reduces complications and mortality of breast cancer. Objective: To estimate the prevalence of risk factors of breast cancer and to assess the awareness of breast cancer screening in women of age group 30-70 years in Karamadai Block of Coimbatore Health Unit District. Methodology: A cross sectional study was conducted among 150 women in Coimbatore using a semi-structured questionnaire and statistical analysis was done using SPSS 21 version. Results: Out of 150 participants, the mean age of subjects was 50 ± 11 years, with 98% being married women. The prevalence of modifiable and non- modifiable risk factors of breast cancer were found to be 61% and 9% respectively. 54% were aware of government facility-based breast cancer screening. But only 25% had undergone screening for breast cancer. Individuals who underwent breast cancer screening in the last one year found to be aware of breast cancer screening compared to those who did not. (OR 2.5, 95% CI 2.02-3.18). Conclusion: Awareness and screening for breast cancer are low among the study participants. Women =30 years of age attending all outpatient departments in any health facility should be educated regarding the importance of screening of breast cancer.

Background and Objective The study aimed to explore the antioxidant and antifungal properties of the invasive and prolific weed species Lantana camara. The weed distributed globally belonging to the Verbenaceae family is not confined to a specific region making the studys findings relevant and applicable worldwide.Methods The methodology involved assessing the free radical scavenging activity of the methanolic extract from L. camara leaves through in vitro tests against specific fungi utilizing the well diffusion method. The crude extract was isolated characterized and evaluated for its antioxidantfree radical scavenging activity by the DPPH 11-diphenyl-2-picrylhydrazyl radical method and further assessed for antifungal properties. Phytochemical screening and detection of phenolic and flavonoid content were conducted.Results Phytochemical constituents present in the L. camara leaf demonstrated antimycotic and anti-oxidant properties. The crude extract demonstrated free radical scavenging activity RSA ranging from 26.11 ww to 47.5 ww at concentrations varying from 30 microgmL to 150 microgmL. It showed high antioxidant activity at 150 microgmL concentration with an IC50 value of 1.8 to 24.1. Additionally it exhibited antifungal activity against certain Candida albicans species with a zone of inhibition of 9 mm comparable to the standard ketoconazole. Conclusion The findings suggest that L. camara may serve as a potential source of antioxidant and antifungal agents. However further research is needed to explore their complete potential and to ensure safety for medicinal purposes.

Abstract Background Methaemoglobinemia (MetHb) is a rare entity in clinical practice which often goes undiagnosed and keeps both the anaesthesiologist and attending surgeon under tension during surgery on seeing dark or chocolate-coloured blood in the surgical field. A low oxygen saturation (SpO2) will further panic us to search for a cause but may end futile. To add further, SpO2 may not rise significantly with adequate oxygenation and may not reach 100 with a fraction of inspired oxygen (FiO2) of 1 which keeps us searching further for a cause. An arterial blood gas (ABG) finally clinches our diagnosis. It is often missed in the pre-anaesthetic evaluation due to its rarity and the patient being asymptomatic most of the time. Case presentation We present a case of a 61-year-old man, a reformed smoker and hypertensive on regular medication was evaluated for laparoscopic partial nephrectomy for right renal cell carcinoma. MetHb was diagnosed preoperatively in the midst of the COVID pandemic when we had all our patients’ room air SpO2 recorded and thus helped us in the smooth and hassle-free management with vitamin C preoperatively for 5 days and an uneventful perioperative period. Conclusions MetHb is an uncommon and potentially reversible cause of hypoxia. A simple bedside SpO2 evaluation may give a hint to the diagnosis along with a high haematocrit which urges us to order for an ABG when no other cause is attributable. A preoperative diagnosis can lead to an effective and simple management with vitamin C which often reduces methaemoglobin to significantly low levels and to have a favourable outcome. According to the literature, any level of less than 20% does not have much clinical significance in asymptomatic patients and surgery need not be deferred.

Abstract Background Dexmedetomidine is a widely used alpha-2 adrenoreceptor agonist in perioperative patient care. Its postsynaptic activation of the receptors in the central nervous system is responsible for reduced neuronal firing with resultant sedation, anxiolysis, analgesia, hypotension and bradycardia leading to effective stress response attenuation seen during laryngoscopy and orotracheal intubation. Major head and neck surgeries demand nasotracheal intubation which is more stressful than orotracheal as it traverses through the nasopharynx which is very pain-sensitive. This is to protect the airway in the immediate postoperative period from oedema or haematoma in the oral cavity or neck. Though its stress response attenuation, haemodynamic stability during the intraoperative period following orotracheal intubation has been well studied, its role in the prevention of emergence delirium and tube tolerance following nasotracheal intubation in major head and neck surgery is not found in the literature. Our aim was to evaluate whether dexmedetomidine effectively attenuates the stress response following nasotracheal intubation, perioperative haemodynamic fluctuations and quality of emergence in patients undergoing head and neck oncosurgeries. Methods A total of 150 patients were randomly assigned to one of the two groups; group D (dexmedetomidine group) and group S (control group with saline). Group D patients received a bolus dose of dexmedetomidine 1 μg/kg in 10 ml saline over 10 mts before induction of GA followed by an infusion at 0.4 μ/kg/h during surgery. Statistical analysis was done using SPSS version 11.0 (SPSS Ltd., Chicago, IL). Categorical data were represented using frequencies and percentages. Continuous variables were represented using mean and standard deviation. The association between categorical variables was assessed using the chi-square or Fisher’s exact test, and continuous variables following normality assumption with respect to the two groups were assessed using an independent sample t-test. P value < 0.05 was considered to be statistically significant. Results Patients in the D group showed statistically significant attenuation of heart rate (P < 0.05) and blood pressure (P < 0.05) throughout the surgical period compared to saline. Also, there was a significant reduction in blood loss (P = 0.042), cough score (P = 0.001) and sedation score (P = 0.001) in the D group. Conclusions We conclude that a bolus dose of dexmedetomidine 1 μg/kg given 10 min before induction of anaesthesia followed by an infusion at 0.4 μg/kg/h during surgery effectively attenuates the haemodynamic responses during nasotracheal intubation and provides smooth emergence as evidenced by reduced coughing, agitation and arousable sedation without respiratory depression which facilitates tube tolerance following major head and neck oncosurgeries. Blood loss was also found to be significantly reduced.

Introduction: World Health Organization (WHO) 6 steps for effective Hand Hygiene (HH) practice to prevent cross infections emphasises on coverage of all aspects of the hand with the Alcohol Based Hand Rub (ABHR). The quality of hand rubbing usually remains un-monitored among healthcare workers. Hence, interventions to ensure both compliance and quality combined with periodic training would fill the deficiency in these practices in the healthcare setting. Aim: To analyse the quality of HH using an Ultraviolet (UV) sensitive ABHR among healthcare workers in the Operation Theatre (OT) and post-surgical Intensive Care Unit (ICU). Materials and Methods: This cross-sectional study was conducted in Regional Cancer Centre, Trivandrum, Kerala, India. Study population included 104 healthcare providers in the OT and post-surgical ICU, over a period of two months, from June 2017 to July 2017. Participants were asked to disinfect their hands according to WHO 6 steps using an ABHR to which an UV light sensitive pigment was added, and then place them in an UV light sensitive cabinet. Digital images of both sides of their hands were recorded. Every area of the hand not covered by the hand rub appeared as a dark spot and was considered an error. Pass criteria allowed a maximum of two small uncovered areas (dark spots

Abstract Background Castleman’s disease is a rare lymphoproliferative disease which can mimic other malignant tumours and can be associated with paraneoplastic pemphigus especially in the paediatric age group. This presentation can be challenging even to the seasoned anaesthesiologist when it comes to managing such a case presenting for laparotomy. Case presentation Here such a case in a 12-year-old who was initially diagnosed as retroperitoneal sarcoma complicated with paraneoplastic pemphigus and inferior venacaval thrombus is presented and its anaesthetic management and challenges are discussed. Special care needs to be taken while anaesthetizing such a patient keeping in mind the difficult airway, adrenocortical suppression, and exacerbation of skin lesions due to various anaesthetic procedures. For this case, the histopathology turned out to be Castleman’s disease. Conclusion The anaesthetic challenges associated with paraneoplastic pemphigus in paediatric age group receiving perioperative thromboprophylaxis need special mention. Here we are discussing the challenges and anaesthetic management of such a case as literature on this aspect is few.

Introduction: The use of clonidine, as additives to bupivacaine provides pain relief for longer duration than bupivacaine alone. This study was planned to evaluate the safety and efficacy of clonidine as an adjunct to bupivacaine in caudal block in paediatric patients. Methodology: This was randomized controlled trial where study was done in three groups. In Group : A: was Inj. Bupivacaine 0.25% {0.75ml/kg}, Group : B: Inj. Bupivacaine 0.25% {0.75ml/kg}+ inj. clonidine 1µg/kg and Group : C: Inj. Bupivacaine 0.25% {0.75ml/kg}+inj. clonidine 2µg/kg was given. Results: There was a statistically significant prolongation in the duration of analgesia in Group B (p < 0.05) and Group C (p

Kylie Thaler1, Divya V Chandiramani2, Richard A Hansen2, Gerald Gartlehner11Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria; 2UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAObjective: To systematically review the general and comparative efficacy and safety of anakinra for rheumatoid arthritis.Methods: We searched MEDLINE®, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts from 1980 to April 2009. We manually searched reference lists of pertinent review articles and explored the Center for Drug Evaluation and Research database. For efficacy we included randomized controlled trials (RCTs) comparing anakinra with placebo or other biologics. For safety both experimental and observational studies were eligible. Two persons independently reviewed abstracts and full text articles and extracted relevant data.Results: We included data from 3 RCTs comparing anakinra with placebo for rheumatoid arthritis (RA). The pooled relative risk (RR) of an ACR50 (American College of Rheumatology) response for anakinra compared with placebo is 2.28 (95% CI 1.41 to 3.67). Adjusted indirect comparisons of ACR50 response rates of anakinra and anti-TNF agents showed a RR of 0.67 (95% CI 0.38 to 1.17) favoring the anti-TNF drugs. This result did not reach statistical significance. For safety, we included 9 experimental and observational studies of 24 weeks to 3 years duration. Up to 30% of patients withdrew from the studies due to adverse events. 67.2% (95% CI 38.7 to 95.7) of patients experienced an injection site reaction.Conclusions: Anakinra is an effective drug for treating RA. Indirect comparisons with adalimumab, etanercept and infliximab, however, showed a trend towards greater efficacy for the anti-TNF drugs. Anakinra also seems to be associated with comparably high rates of injection site reactions. These results should be taken into account when considering biologic therapy for patients with RA.Keywords: anakinra, rheumatoid arthritis, infection

Synthetic biology has established powerful tools to precisely control cell function. Engineering these systems to meet clinical requirements has enormous medical implications. Here, we adopted a clinically driven design process to build receptors for the autonomous control of therapeutic cells. We examined the function of key domains involved in regulated intramembrane proteolysis and showed that systematic modular engineering can generate a class of receptors that we call synthetic intramembrane proteolysis receptors (SNIPRs) that have tunable sensing and transcriptional response abilities. We demonstrate the therapeutic potential of the receptor platform by engineering human primary T cells for multi-antigen recognition and production of dosed, bioactive payloads relevant to the treatment of disease. Our design framework enables the development of fully humanized and customizable transcriptional receptors for the programming of therapeutic cells suitable for clinical translation.