Efficacy of Muscle Relaxants in Routine Treatment Protocol of OSMF and Regional Epidemiological

Oral submucous fibrosisis a chronic disorder presenting with the plaguing symptoms of burning sensation in mouth, intolerance to spicy food and progressive trismus. OSMF is insidious in onset characterized by fibrosis of the lining mucosa of the upper digestive tract involving the oral cavity, oropharynx and hypopharynx and the upper third of oesophagus.

The fibrosisinvolves the lamina propria and the submucosa and may extend into the underlying musculature resulting in the deposition of dense fibrous bands, resulting in limited mouth opening. It is widely prevalent in all age groups and across all socioeconomic strata in India. OSMF is etiologically related to chewing of areca nut [betel nut] and its commercial products, a habit prevalent in India and South-East Asia.

This increaing prevalence is not only our concern but its treatment challenges is also our concern. Though a benign disease, the frequency of malignant change in patients with OSMF ranges from 3% to 6%. We have various established treatment modalities available, medical and surgical both. But the results vary.

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Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

Medicinal tablets are sometimes difficult to swallow, even for healthy individuals. Accordingly, it is likely more difficult for patients to swallow tablets after oral surgery for tongue tumors. In this study, we aimed to investigate the dynamics of swallowing tablets in the recovery period following surgery for tongue tumors.

Two experiments were conducted (Experiment 1 and Experiment 2). In Experiment 1, 20 tongue cancer patients swallowed simulated tablets and underwent videofluoroscopic (VF) examination of swallowing before and after surgery. The ability or inability to pass the tablet to the esophagus and the number of swallowing attempts required to ingest the tablet were evaluated. In Experiment 2, 48 similar subjects swallowed thickened barium and simulated tablets and underwent VF examination of swallowing after surgery.

The ability or inability to pass the tablet to the esophagus, the number of swallows required to ingest the tablet, the tablet position after the initial and the final swallowing reflexes, and the oral transit time and pharyngeal transit time for swallowing the thickened barium solution and simulated tablets were evaluated.

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Gentimacin Injection Induced Digital Necrosis in a 32 -Year Old Apprentice

Gentamicin is a type of aminoglycoside produced by the fermentation of bacteria widely present in the environment. Because of its widespread use and abuse, their toxic effects have become more obvious and sometimes bizarre.

Toxic effects involve the kidneys, ears and rarely neuromuscular junction as well as neurovascular bundles leading to ischemia and tissue necrosis. I present a 32-year old apprentice who developed bluish to black discoloration of the terminal phalanx of the index, middle, ring and little fingers of both hands following several injections of gentamicin.

Digital necrosis arising from injection of gentamicin is rare in the scientific literature. Adverse effects of aminoglycosides can be prevented through proper regulation of its use.

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Experiences, Strengths and Challenges of Integration of Mental Health into Primary Care in Ethiopia

The burden of mental disorders is increaasing in low and middle income countries including Ethiopia but the number of psychiatry professionals is scarce. Integrating mental health in primary health care is vital to address the problem. This survey aimed in assessing the experiences, strengths and challenges of integrating mental health in primary health care in Ethiopia.

Facility based supervisions was done in primary health care centers where the scale up program was implemented and giving mental health services. Semi structured and standardized WHO mental health Global Action Programme support and supervision questionnaires was used to collect information's.

Findings: A total of 1576 mental, neurological and substance use (MNS) disorders were identified and treated in selected four regions. Majority of identified cases were epilepsy (46.64%) followed by psychosis (28.49%). Essential drugs for treating psychosis, depression and epilepsy were available in almost all health institutions.

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The Benefit and Tolerability of Adjuvant Chemotherapy in Elderly Stage III Colon Cancer Patients

The benefit of adding oxaliplatin to adjuvant fluoropyrimidine chemotherapy in patients >70 years is controversial. This retrospective audit investigated usage, benefit and tolerability of adjuvant chemotherapy for colon cancer in older adults.

Materials and methods: Patients aged >60 years with stage III colon cancer referred for adjuvant chemotherapy between 2010–2012 were identified from a tertiary hospital oncology database. Data were collected on demographics, chemotherapy received, completion rates, toxicities, relapse and survival.

Comparison was made between the older group (age >70 years) and the younger group (age 60-70 years). 95 eligible patients were identified; 50 in the older group (median age 76), 45 in the younger group (median age 66), 56% male, 82% NZ European and 5% Maori.

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Clinical Emergencies Presented by Anemia

Anaemia affects 24.8% of the population worldwide. It has wide variety in terms of clinical manifestation of the disease severity. It can also ranges from almost asymptomatic to severe haemolytic anaemia. In contrast to all other nucleated cells, RBCs show very interesting biology.

An alteration in any of the major factors in RBCs (eg. shape, size, and structural or functional or quantitional abnormalities in haemoglobin) usually results in compensatory changes in the other compensatory factors. Sometimes, the compensatory responses may fail because of severity of disease or due to underlying pathologic conditions.

The result of failed compensatory responses is cellular dysfunction, tissue hypoxia and eventual cell death, which ultimately leads to severity in anaemia and emergency situations due to it. In this paper, we have concentrated to focus on how the extrinsic and intrinsic defects on RBCs cause severe haemolytic anaemia, leading to emergencies.

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THE COST-EFFECTIVENESS OF IBRUTINIB IN TREATMENT OF RELAPSED OR REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment options for patients with previously-treated Chronic Lymphocytic Leukemia are limited; no standard of care exists. In the Phase III RESONATE trial, oral, once-a-day, first-in-class covalent Bruton’s tyrosine kinase inhibitor ibrutinib was associated with improved Progression-Free Survival (PFS) (Hazard Ratio 0.106, 95% Confidence Interval and Overall Survival compared with ofatumumab. The current study evaluated the cost-effectiveness of ibrutinib compared to commonly-used therapies for Relapsed or Refractory (R/R) CLL.

A health state model simulated a cohort of R/R CLL patients receiving ibrutinib, ofatumumab, Idelalisib+Ofatumumab (IO), or Physician’s Choice (PC) (a mixed bag of treatments) until death or disease progression, at which point they received subsequent treatment or best supportive care. PFS and OS were extrapolated based on data from RESONATE (ibrutinib and ofatumumab) and from indirect treatment comparisons.

The analysis was conducted over a 30-year time horizon from a Swedish healthcare payer perspective. Health outcomes and costs were discounted per Swedish guidelines. Costs, Life Years (LYs), Quality-Adjusted LYs (QALYs), and incremental costs per QALYs were evaluated.

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