Radiotherapy-induced depigmentation in a patient with breast cancer

Vitiligo is a common dermatological disorder. A middle-aged woman with preexisting vitiligo was diagnosed with breast carcinoma. After surgery and chemotherapy she received regional radiotherapy. Six months after the completion of radiotherapy she developed depigmentation in the irradiated area. This article discusses the etiology for this phenomenon and the literature in this regard.     

Spinal Cord Injury Induced by a Cervical Spinal Cord Stimulator

Objective: The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators. Methods: Analysis of a patient with a cervical spinal cord stimulator presenting with a spinal cord injury. Patient was followed from presentation in the emergency room until 1‐year follow‐up in the office. Results: The patient in this case presented after a fall and sustained a cervical spinal cord injury induced by the electrodes of her spinal cord stimulator working as a space occupying mass. Conclusion: As more patients are undergoing implantation of spinal cord stimulators we must be aware of the long‐term risks that can be encountered.     

The sign of the cross

Acute, painful, transient, right-sided, monocular visual loss lasting 4 hours developed in a 46-year-old man. This was followed by headache and left-sided transient hemiparesis. The association of ipsilateral transient vision loss with transient contralateral hemiparesis implicates involvement of the ipsilateral internal carotid artery (i.e., a crossed symptom).     

Nodular fasciitis of the thumb: a case report.

Nodular fasciitis is an uncommon, benign, reactive fibroblastic soft tissue tumour. It is infrequently seen in the hand. A case of nodular fasciitis involving the thumb of a 34-year-old male is reviewed, and its clinicopathologic features are presented. Main significance lies in clinical and pathological recognition of the lesion to avoid over-treatment.     

Subjective Global Assessment in chronic kidney disease: a review.

Nutritional assessment of patients with chronic kidney disease is a vital function of health care providers. Subjective Global Assessment (SGA) is a tool that uses 5 components of a medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (signs of fat and muscle wasting, nutrition-associated alternations in fluid balance) to assess nutritional status. SGA was originally used to predict outcomes in surgical patients; however, its use has gone beyond this function and population. In chronic kidney disease patients, SGA is incorporated into the complete nutritional assessment. Validation of SGA as a screening tool for surgical patients was done by Detsky et al in 1984. Since that time, SGA has been altered by different researchers and clinicians to better meet the needs of the patients they served. Validation of the altered SGA formats has not been thoroughly done. Further work in establishing validity and reliability of each version of SGA in different patient populations should be done to enable clinicians and researchers to properly use this nutritional assessment tool.     

Informing resource-poor populations and the delivery of entitled health and social services in rural India: a cluster randomized controlled trial

Context  A lack of awareness about entitled health and social services may contribute to poor delivery of such services in developing countries, especially among individuals of low socioeconomic status. Objective  To determine the impact of informing resource-poor rural populations about entitled services. Design, Setting, and Participants  Community-based, cluster randomized controlled trial conducted from May 2004 to May 2005 in 105 randomly selected village clusters in Uttar Pradesh state in India. Households (548 intervention and 497 control) were selected by a systematic sampling design, including both low-caste and mid- to high-caste households. Intervention  Four to 6 public meetings were held in each intervention village cluster to disseminate information on entitled health services, entitled education services, and village governance requirements. No intervention took place in control village clusters. Main Outcome Measures  Visits by nurse midwife; prenatal examinations, tetanus vaccinations, and prenatal supplements received by pregnant women; vaccinations received by infants; excess school fees charged; occurrence of village council meetings; and development work in villages. Results  At baseline, there were no significant differences in self-reported delivery of health and social services. After 1 year, intervention villagers reported better delivery of several services compared with control villagers: in a multivariate analysis, 30% more prenatal examinations (95% confidence interval [CI], 17%-43%; P < .001), 27% more tetanus vaccinations (95% CI, 12%-41%; P < .001), 24% more prenatal supplements (95% CI, 8%-39%; P = .003), 25% more infant vaccinations (95% CI, 8%-42%; P = .004), and decreased excess school fees of 8 rupees (95% CI, 4-13 rupees; P < .001). In a difference-in-differences analysis, 21% more village council meetings were reported (95% CI, 5%-36%; P = .01). There were no improvements in visits by a nurse midwife or in development work in the villages. Both low-caste and mid- to high-caste intervention households reported significant improvements in service delivery. Conclusions  Informing resource-poor rural populations in India about entitled services enhanced the delivery of health and social services among both low- and mid- to high-caste households. Interventions that emphasize educating resource-poor populations about entitled services may improve the delivery of such services. Trial Registration  clinicaltrials.gov Identifier: NCT00421291      

Pediatric cardiac catheterization procedure with dexmedetomidine sedation: Radiographic airway patency assessment

Aims:

The aim of the study was to measure airway patency objectively during dexmedetomidine sedation under radiographic guidance in spontaneously breathing pediatric patients scheduled for cardiac catheterization procedures.

Subjects and Methods:

Thirty-five patients in the age group 5–10 years scheduled for cardiac catheterization procedures were enrolled. All study patients were given loading dose of dexmedetomidine at 1 μg/kg/min for 10 min and then maintenance dose of 1.5 μg/kg/h. Radiographic airway patency was assessed at the start of infusion (0 min) and after 30 min. Antero-posterior (AP) diameters were measured manually at the nasopharyngeal and retroglossal levels. Dynamic change in airway between inspiration and expiration was considered a measure of airway collapsibility. Patients were monitored for hemodynamics, recovery time and complications.

Statistical Analysis:

Student paired t-test was used for data analysis. P < 0.05 was considered significant.

Results:

Minimum and maximum AP diameters were compared at 0 and 30 min. Nasopharyngeal level showed significant reduction in the minimum (6.27 ± 1.09 vs. 4.26 ± 1.03, P < 0.0001) and maximum (6.51 ± 1.14 vs. 5.99 ± 1.03, P < 0.0001) diameters. Similarly retroglossal level showed significant reduction in the minimum (6.98 ± 1.09 vs. 5.27 ± 1.15, P < 0.0001) and maximum (7.49 ± 1.22 vs. 6.92 ± 1.12, P < 0.0003) diameters. The degree of collapsibility was greater at 30 min than baseline (P < 0.0001). There was a significant decrease in heart rate (P < 0.0001), and the average recovery time was 39.86 ± 12.22 min.

Conclusion:

Even though airway patency was maintained in all children sedated with dexmedetomidine, there were significant reductions in the upper airway dimensions measured, so all precautions to manage the airway failure should be taken.     

Trigemino-Cardiac Reflex: A Phenomenon Neglected in Maxillofacial Surgery?

Background

Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management.

Patients and Methods

A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015–March 2016 were considered for the study.

Results

A male preponderance is observed with the most susceptible age group being 21–30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine.

Conclusion

Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.