Prevalence of Delirium in Advance Cancer Patients Admitted in Hospice Centre and Outcome after Palliative Intervention.

Objectives: The assessment of prevalence of delirium in advanced cancer patients admitted in hospice centre and outcome after palliative intervention. The possible related risk factors for development of delirium. Material and Methods: This was prospective analytic study done at hospice centre attached with tertiary cancer hospital in Ahmedabad during August 2019 - July 2021. This study was approved by the Institutional Review Committee. We selected patients according to following inclusion criteria (all patient admitted to hospice centre above 18 years, with advance cancer disease and on best supportive care) and exclusion criteria (Lack of informed consent, Inability to participate in study due to mentally retard or coma). The following information were collected: age, gender, address, type of cancer, comorbidities, history of substance abuse, history of (h/o) palliative chemotherapy or radiotherapy within last 3month, general condition, ESAS (Edmonton symptom assessment scale), ECOG (Eastern cooperative oncology group), PaP score (palliative prognostic score), medication including opioids, NSAIDs (Non-steroidal anti-inflammatory drugs), steroids, antibiotic, adjuvant analgesic, PPI (Proton pump inhibitor), anti-emetic etc. Delirium diagnosis was based on diagnostic criterion of DSM-IV text revised and MDAS. Results: In our study we found prevalence of delirium was 31.29% in advanced cancer patients admitted to hospice centre. We found most common type of delirium is hypoactive (34.7%) and mixed subtype (34.7%) followed by hyperactive (30.4%) delirium. Resolution of delirium was higher among hyperactive delirium (78.57%) followed by mixed subtype (50%) and hypoactive (12.5%). Mortality was higher among patient with hypoactive subtype (81.25%) followed by mixed (43.75%) and hyperactive delirium (14.28%). Conclusion: An identification and assessment of delirium is vital for acceptable end of life care within the palliative care in light of the fact that the presence of delirium is related with morbidity, mortality, prolonged ICU hospitalization, expanded time on a ventilator, and by and large more prominent medical services costs. Clinicians should utilize one of a few approved delirium assessment tools to help evaluate and archive cognitive function. Prevention and recognizing the clinical reason for delirium are generally the best method for diminishing the morbidity from delirium. The study results demonstrate that multi component delirium management or projects are generally proficient to lessen the prevalence and negative outcomes of delirium. It was found that palliative care intervention has quite a positive outcome as it not only focus on the mental health of the patients but also of family members who go through the same amount of distress and also help them to communicate properly and manage to settle the mental state and end the life without pain and distress.

Examining Vaccine Sentiment on Twitter and Local Vaccine Deployment during the COVID-19 Pandemic.

Understanding local public attitudes toward receiving vaccines is vital to successful vaccine campaigns. Social media platforms may help uncover vaccine sentiments during infectious disease outbreaks at the local level, and whether offline local events support vaccine-promotion efforts. Communication Infrastructure Theory (CIT) served as a guiding framework for this case study of the San Diego region examining local public sentiment toward vaccines expressed on Twitter during the COVID-19 pandemic. We performed a sentiment analysis (including positivity and subjectivity) of 187,349 tweets gathered from May 2020 to March 2021, and examined how sentiment corresponded with local vaccine deployment. The months of November and December (52.9%) 2020 saw a majority of tweets expressing positive sentiment and coincided with announcements of offline local events signaling San Diego's imminent deployment of COVID-19 vaccines. Across all months, tweets remained mostly objective (never falling below 63%). In terms of CIT, considering multiple levels of the Story Telling Network in online spaces, and examining sentiment about vaccines on Twitter may help scholars to explore the Communication Action Context, as well as cultivate positive community attitudes to improve the Field of Health Action regarding vaccines. Real-time analysis of local tweets during development and deployment of new vaccines may help monitor local public responses and guide promotion of immunizations in communities.

Rare occurrence of dural arteriovenous fistula in a child: Multi-modality imaging and literature review.

A dural arteriovenous fistula (AVF) is a rare condition in a child and is not evident clinically. It is a type of an acquired cerebral vascular malformation that usually occurs after a thrombotic event of the cerebral venous sinuses. Dural AVF is not suspected clinically and is revealed through imaging done for evaluation of cranial symptoms. Therefore, it is essential to revisit the pathophysiology and the clinical situations leading to intracranial dural AVF. Equally crucial is identifying the imaging findings on computed tomography, or magnetic resonance imaging brain scans done as a preliminary work-up in these patients. However, for optimal management decision and prognostication of dural AVF, a digital subtraction angiography is essential. As the entire burden of establishing the diagnosis rests on the radiologists, we would like to present this rare case report highlighting both the clinical and imaging aspects and the management options available for dural AVFs.

Bronchial carcinoid with bronchocele masquerading as Scimitar syndrome on chest radiograph.

Bronchial carcinoid tumors occur predominantly in the perihilar location and can be asymptomatic. They may present in early stages with only obstructive features such as mucus plugging of airways resulting in bronchocele formation. We report the case of a 44-year lady with no chest complaints, who underwent chest radiograph for a routine preanesthetic checkup. A vertically oriented, tubular, soft tissue density lesion was observed in the right lower lung, which mimicked a Scimitar vein. Scimitar syndrome is a congenital disorder in which an anomalous vein drains the middle and lower lobes of right lung and enters into the IVC most commonly. It may present asymptomatically in adults and on chest radiograph appears as a vertical tubular opacity paralleling the right cardiac border. However, CT angiography revealed the lung lesion to be a bronchocele, distal to a central intensely enhancing spherical mass, completely occluding the right lower lobe bronchus. This perihilar mass had been missed on the chest radiograph. Bronchoscopic biopsy revealed a carcinoid tumor. As the patient was asymptomatic, she refused surgery in the ongoing COVID-19 pandemic.

Design and development of a compact thermal ionization mass spectrometer for isotope ratio measurement of uranium.

RATIONALE: A new compact thermal ionization (TI) mass spectrometer, for the isotope ratio analysis of the elements relevant to nuclear applications, has been designed and developed. The new development offers superior performance in terms of sensitivity, precision and a compact footprint in comparison with the conventional one. The main feature of the TI mass spectrometer is the magnetic sector analyser with a sector radius of 20 cm (instead of 30/27 cm in conventional/commercial geometry). An apparent reduction in dispersion has been adequately compensated by employing variable dispersion zoom optics (VDZO). METHODS: The theoretical calculations were validated by computer simulations using SIMION 7.0, leading to the finalization of the mechanical design. Experimental evaluation was carried out using standard TI mass spectrometric methodology to determine the parameters, namely peak flatness, mass range, sensitivity, abundance sensitivity, resolution and precision. RESULTS: The multi-collector resolution was 496, and the maximum mass was m/z 382. The sensitivity for uranium was found to be better than 1 ion for 500 atoms, and an abundance sensitivity of 50 ppm at m/z 237 was obtained. The peak flatness for the uranium peak was 3200 ppm of mass. The precision for the isotopic ratio 235 U/238 U was found to be 0.05% for the U200 standard. CONCLUSIONS: A new compact TI mass spectrometer with a 20 cm sector radius has been designed and developed. The advantage of larger dispersion produced by the VDZO (developed in-house) was exploited when deciding the 20 cm sector radius. The comparison study with the conventional TI mass spectrometer shows an enhanced (1.5×) sensitivity and an improved precision (0.05%) for the 235 U/238 U ratio of U200.

Ileal Trichobezoar Presenting as Intestinal Obstruction and Peritonitis.

Trichobezoar is less common in boys. We are reporting a case of isolated ileal trichobezoars in a 4-year old boy causing intestinal obstruction and gut ischemia with perforation and peritonitis. The case was managed surgically with ileal resection and anastomosis. Postoperative period was uneventful.