Prince Aly Khan Hospital

Absract Background: Older women living away from family form a unique group. Multiple studies evaluate different aspects of psychological or musculoskeletal health. Given the mortality from chronic obstructive pulmonary disease, we included the respiratory component in the comprehensive health assessment. The main goal was to conduct a thorough health evaluation of older women residing in an elderly home. Materials and Methods: This cross-sectional descriptive study was conducted from December 2021 to January 2022. A multidisciplinary team, including a qualified respiratory technician, psychologist, cardiopulmonary physiotherapist, and nutritionist, supervised by a professor from the Department of Respiratory Medicine, visited the nursing home once or twice weekly. The study used various assessments, including a portable spirometer; the Depression, Anxiety, and Stress Scale-21 tool; the Malnutrition Universal Screening Tool; the Chronic Obstructive Pulmonary Disease Assessment Test; and the 6-Minute Walk Test. Results: The study assessed the health of 61 women. The mean age was 73.5 years (standard deviation = 6.82). The most common comorbidity was hypertension (44.26%). About one-third had a moderate impact on quality of life. Most women (63.3%) had a normal body mass index. Depression, anxiety, and stress affected approximately one-third to two-thirds of the women. The overall risk of undernutrition was 60.86% and was higher among those aged 75 years and older ( χ 2 = 11; P < 0.001). Underweight women had significantly lower baseline oxygen saturation levels ( P = 0.020) and a greater increase in the pulse rate after the 6-Minute Walk Test ( P = 0.003) compared with other women. Seven women had obstructive airway disease. Conclusion: Women above 75 years and underweight women are more vulnerable.

To evaluate the feasibility, tolerance, and efficacy of OMCT (oral metronomic chemotherapy) after CRS + HIPEC for peritoneal mesothelioma in patients with poor prognostic factors: PCI > 20, incomplete CRS, poor performance status, or progression on systemic chemotherapy. A retrospective analysis of patients undergoing CRS + HIPEC for peritoneal mesothelioma and receiving OMCT for poor risk factors. Sixteen patients underwent CRS + HIPEC between 2013 and 2017. The median PCI was 31.5. Complete cytoreduction (CC-0/1) was obtained in 8 patients (50%). All 16 received HIPEC except one patient with baseline renal dysfunction.Thirteen patients had PCI > 20 where only 5 had CC-0/1. Of 8 suboptimal cytoreduction (CC-2/3), 7 received OMCT (6 for progression on chemotherapy and one for mixed histology). Three patients had PCI < 20 and all had CC-0/1 clearance. Only one received OMCT for progression on adjuvant chemotherapy. Patients receiving OMCT for progression on adjuvant chemotherapy (ACT) were in poor PS.The median follow-up was 13.4months. Five are alive with the disease (three are on OMCT). Six are alive without disease (2 are on OMCT). The mean OS was 24.3months and the mean DFS was 18months. Outcomes were similar between CC-0/1 and CC-2/3 groups, OMCT vs no OMCT groups.All patients receiving OMCT for progression on neoadjuvant chemotherapy had better survival (alive at 12, 20, 32, 36months) compared to those receiving OMCT for progression on the ACT (p = 0.012). OMCT is a good alternative in high-volume peritoneal mesothelioma with incomplete cytoreduction and progression on chemotherapy. OMCT may improve outcomes in these scenarios when started early.

(1) To study layer of invasion as predictor of cervical lymph node metastasis. (2) To decide a cut off depth according to layer of invasion for neck dissection. It is a prospective study with sample size of 220 patients at tertiary care hospital with previously untreated operable buccal mucosa carcinoma over period of 21months. The factors considered under the study were Tumor layer of invasion, lymph node metastasis, Ultrasonography doppler neck, CT scan and gender. Wide excision of the lesion and reconstruction was done. Histopathologicalanalysis ofresected specimen were recorded as part of data collection for all thecases. Quantitative data represented using Mean ± SD (Standard Deviation) and median and interquartile range compared using Chi square test. Standard principles of univariate analysis was used according to statistical methods. Depth when measured according to layer of invasion, was significantly associated with lymph node metastasis with 89% of the muscle as layer of invasion being Lymph node positive (p = 0.009). There is 1.39 times chances of lymph nodal metastasis in patients with muscle invasion as compared to submucosal invasion. Tumour layer of invasion plays important role in predicting chances of nodal metastasis in clinically N0 neck in buccal mucosa cancer. According to the study, we should electively proceed with ipsilateral lymph node dissection once the layer of tumour invasion is muscle. This study is limited by sample size and short duration of one year and nine months.

Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions.

Respiratory distress is one of the leading causes of neonatal morbidity and mortality. Factors such as gestational age at birth, pulmonary maturity, and congenital factors are peculiar to this demographic. Clinical evaluation accompanied by chest radiography is the standard protocol for evaluating the underlying causative factors. Knowledge of the radiographic appearances of various pathologies and associations with certain congenital factors is quintessential for radiologists and primary neonatal care providers to steer the management in the right direction.

Operable stage IV gingivobuccal complex cancer is classified as Stage IVA and IVB. Among patients with Stage IVA disease, different subgroups with likely different prognoses are combined. Patients with advanced nodal status tend to have a poorer prognosis. We divided these patients into four groups: group I (T4aN0), group II (T4aN1-2), group III (T1-3N2) constituting stage IVA category, and group IV (TanyN3) representing stage IVB. This study assesses if these patients can be prognostically subgrouped based on nodal status. It is a prospective observational study done at a tertiary care center from July 2017 to June 2020. This study aims to analyze survival outcomes in these subgroups using Kaplan Meir, univariate and multivariate analysis. The study enrolled 113 patients of operable gingivobuccal complex stage IVA cancer with a median follow up of26months, disease-free survival (DFS) was 74% for group 1, while it was 55%, 26% and 32.2% for group 2, group 3 and group 4 respectively. Patients with T4N3 disease had DFS of just 15%. Patients in group 3 and 4 had the worst outcomes in terms of DFS and Overall Survival(OS) with HR-3.7 and 3.3 and 3.3 and 3.8 respectively (p value-0.001). The nodal status is the most important prognostic factor affecting DFS and OS. Patients with small primary but advanced nodal stage do poorly than patients with advanced primary and node-negative disease. There is a need for subgrouping patients with Stage IVA tumors based on nodal status for better prognostication.

Choosing Wisely India (CWI) is an initiative to identify low-value and/or potentially harmful practices in cancer care in India. Modeled after Choosing Wisely in the US and Canada,[1],[2],[3] the CWI project was intended to facilitate a conversation between patients, clinicians, hospitals, and policymakers on delivering high-quality, affordable cancer care. By identifying common low-value and/or harmful practices, this process aims to reduce unnecessary interventions to improve the overall quality of care, reduce patient toxicity, and reduce the financial burden on both the patient and system. The formal CWI report has been recently published in Lancet Oncology;[4] in this commentary, we provide a summary of the process, describe the Top 10 CWI list, and offer suggestions for future actions to improve the delivery of high-quality cancer in India's cancer system.