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.

Survey of Psychosocial Issues of Nasogastric Tube Feeding in Head-and-Neck Cancer Patients.

BACKGROUND: Because of some psychosocial reasons and misbelieves regarding nasogastric(NG) tube feeding, many patients refuse for NG tube insertion. AIM: Primary aim was to do survey of psychological reasons for refusal of NG tube insertion and feeding in head and neck cancer patients. Secondary aim was to assess impact of psychological counseling of patient who did not accept NG tube feeding. METHOD: This cross sectional study was conducted on patients referred to palliative medicine department and needed NG tube feeding but refused for the same. We prepared our own questionnaire which includes the most common cause for enteral feeding refusal which we found during our routine OPD since last five years response to those questions were recorded. Then we did psychological counseling of patients and again we assessed patient's acceptability for NG tube feeding by Likert scale and record their response. RESULTS: Most common psychological reasons for patient's refusal were "it will disrupt my body image"(88.33%), "unable to go outside/mix with people"(80%) and "dependency on others for activities"(66.66%). Post psychological counseling out of 60 patients 47 patients were agreed while 13 patients did not agree with NG tube feeding (P value 0.000062<0.5). CONCLUSION: We conclude that though NG tube feeding is necessary for some head and neck cancer, there are lots of psychosocial problem regarding its acceptance for patients. For that adequate psychological assessment and counseling is necessary for patients' acceptance, compliance and good quality of life.

Experience of Palliative Care Services at Tertiary Comprehensive Cancer Center during COVID-19 Lockdown Phase: An Analytical Original Study.

BACKGROUND: Recent pandemic Coronavirus disease 2019 has brought the whole world to a standstill. In India too, phases of the lockdown of the country were declared. This hampered the availability of essential health-care services to needy patients. With full emphasis on the pandemic, patients suffering from other diseases and palliative oncology patients requiring essential palliative care services were affected due to the shutting down of regular health-care services. AIM: In this study, we emphasize that in the middle of a pandemic, we need to continue serving the needs of palliative care patients, and simultaneously, necessary steps should be taken for the prevention of the spread of virus by following guidelines, training, support, and monitoring. MATERIALS AND METHODS: In this study, we analyzed electronic medical record of 1161 patients who received palliative care from our institute in the first two lockdown periods, regarding their demographics, extent of travel, type of malignancy, and opioid utilization. RESULTS: Of 1161 patients, male outnumbered female and the patient suffering from head-and-neck malignancy were in the maximum number (48.7%). Our essential opioids utilization rate was 34.2%, and patients who traveled from different states were 21.6%. CONCLUSION: During this pandemic, we cannot overlook the need for essential palliative care services. We can continue regular services with proper precautions as advised and by training the staff. Collaboration with different palliative centers across the country should be done to minimize patient movement.

Management of Malignant Wound Myiasis with Ivermectin, Albendazole, and Clindamycin (Triple Therapy) in Advanced Head-and-Neck Cancer Patients: A Prospective Observational Study.

INTRODUCTION: Myiasis, tissue infestation by housefly larvae, is commonly found in malignant fungating wounds of cancer patients from climatic condition and lower socio-economic strata. AIM OF STUDY: It was aimed to study the effectiveness of systemic Ivermectin, Albendazole& Clindamycin (Triple Therapy) in reducing signs & symptoms associated with maggots in malignant head and neck wounds. METHOD: 25 adult, advanced head and neck cancer patients presenting with maggots either from wound, oral cavity or nostril, with ECOG score 3 or less were enrolled in this study. Symptoms were assessed using Edmonton Symptom Assessment Scale (ESAS) and wound by Wound Assessment Tool - Hospice, at baseline and then Days 1, 3, 5, and 7. All patients received 3 days course of oral Ivermectin 12 mg per day, Albendazole 400 mg twice per day and Clindamycin 300 mg three times per day for 5 days along with Terpentine oil dressing. All patients received oral Morphine as per their pain score. RESULTS: Mean age (yrs) and weight (Kg) were 42.15 ± 8.23 and 52.31 ± 5.18 respectively. 84% patients were male. Mean oral morphine dose was 100.38 mg. There was significant decrease in number of maggots from day 0 (77.28 ± 13.465) to day 1 (20.60 ± 7.263; 73.34% reduction) to day 3 (1.52 ± 2.104; 92.62% reduction). We found statistically significant improvement (P = <0.05) in scores of wound and all other related symptoms on days 1, 3, 5 & 7, except bleeding, edema, nausea, anxiety, appetite loss and feeling of wellbeing, which remained same on Day 1, but improved afterward. Side effects were self-limiting. CONCLUSION: Systemic treatment with Ivermectin, Albendazole and Clindamycin (Triple Therapy) enhances the removal of maggots, early recovery and relief from distress and associated symptoms.

Simultaneous Estimation of Quercetine and Betanine by RP-HPLC from Herbal Formulations Used in Nutritional Deficiencies.

BACKGROUND: Medicinal plants have curative properties due to the presence of various complex chemical substances of different compositions, which are found as secondary plant metabolites in one or more parts of the plants. Moringa oleifera from Moringaceae and Beta vulgaris root are, native to India, grows in the tropical and subtropical regions of the world. It is commonly known as 'drumstick tree' or 'horseradish tree' or 'miracle tree'. Incorporation of more herbal powder leads to much complexity. Above plants were chosen for their utmost nutritional values. RESULTS: Herbal tablet and granules were prepared and evaluated further for various Physico-chemical parameters as a nutritional supplement. Promising results indicate that prepared formulations have potential as supplements. CONCLUSIONS: Present communication mainly focused on estimation of marker components by Reverse Phase-High Performance Liquid Chromatography. It showed the presence of enough number of secondary metabolites and minerals which can be easily consumed by all age groups.

Peripheral refraction in high myopia with spherical soft contact lenses.

PURPOSE: Previous studies suggest that the refractive status of the peripheral retina may influence the progression of myopia. Our aim was to investigate peripheral refractions in human eyes with high myopia when corrected with a conventional soft spherical contact lens (CL). METHODS: Ten young adults with high myopia (over -6.00 D) were investigated. An open-field auto-refractor was used to measure on- and off-axis refractions in primary gaze, with and without a CL, every 5° out to 20° horizontally in nasal and temporal retina. Results were analyzed as mean sphere (M) and astigmatic (J(0) and J(45)) vector components. Partial coherence interferometry measures of eye size were also made on- and off-axis at 10 and 20° in nasal and temporal retina. RESULTS: Subjects (mean age, 22 years; range, 20 to 26 years) had an average on-axis spherical refractive error of -8.31 ± 2.10 D and an average on-axis eye length of 27.39 ± 1.18 mm. Mean sphere exhibited a significant shift from hyperopic relative peripheral refraction (RPR) in the uncorrected state to myopic RPR on correction, in both nasal and temporal retina. Mean RPR of all subjects across all eccentricities was hyperopic when uncorrected (M = +0.20 ± 0.49 D: mean ± 1 SEM) becoming myopic when corrected (M = -0.45 ± 0.56 D: p = 0.0003, reaching -1.21 ± 0.82 D at 20° in the temporal retina). Peripheral J(0) astigmatism also became significantly more negative on correction (p = 0.002), whereas J(45) astigmatism remained unchanged. On- and off-axis measures of eye length indicated a relatively prolate retinal contour. Uncorrected off-axis mean sphere refractive error reduced with eccentricity, and this was accurately predicted (R > 0.98) by the measured retinal contour. CONCLUSIONS: Correcting the foveal refractive error in high myopia with standard spherical soft CLs can result in significant absolute myopic defocus in the peripheral retina. If peripheral refraction does indeed influence myopia progression, then our results suggest that in high myopia, standard soft CLs may be beneficial in reducing myopia progression.

Stability indicating HPLC determination of risperidone in bulk drug and pharmaceutical formulations.

The objective of the current study was to develop a validated stability-indicating assay method (SIAM) for risperidone after subjecting it to forced decomposition under hydrolysis, oxidation, photolysis, and thermal stress conditions. The liquid chromatographic separation was achieved isocratically on a symmetry C18 column (5 µm size, 250 mm × 4.6 mm i.d.) using a mobile phase containing methanol: acetonitrile (80 : 20, v/v) at a flow rate of 1 mL/min and UV detection at 280 nm. Retention time of risperidone was found to be 3.35 ± 0.01. The method was linear over the concentration range of 10-60 µg/mL(r(2) = 0.998) with a limit of detection and quantitation of 1.79 and 5.44 µg/mL, respectively. The method has the requisite accuracy, specificity, sensitivity, and precision to assay risperidone in bulk form and pharmaceutical dosage forms. Degradation products resulting from the stress studies did not interfere with the detection of Risperidone, and the assay is thus stability indicating.