Esophageal Cancer and Treatment Modalities

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients.

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Esophageal Cancer and Treatment Modalities

10.33169/surg.gsoaoj-i-101 ◽

2018 ◽

Vol I (1) ◽

pp. 01-03

Author(s):

Takalkar Unmesh Vidyadhar

Keyword(s):

Esophageal Cancer ◽

Public Health Problem ◽

Diagnostic Techniques ◽

Treatment Modalities ◽

Surgical Approaches ◽

Major Public Health Problem ◽

Key Words Esophageal Cancer ◽

Minimally Invasive Surgical ◽

Predominant Type ◽

Modal Treatment

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Justification and active guideline implementation for spine radiography referrals in primary care

Acta Radiologica ◽

10.1177/0284185116661879 ◽

2016 ◽

Vol 58 (5) ◽

pp. 586-592 ◽

Cited By ~ 11

Author(s):

Pirita Tahvonen ◽

Heljä Oikarinen ◽

Jaakko Niinimäki ◽

Esa Liukkonen ◽

Seija Mattila ◽

...

Keyword(s):

Primary Care ◽

Lumbar Spine ◽

Guideline Implementation ◽

Public Health Problem ◽

Further Education ◽

Major Public Health Problem ◽

Spine Radiography ◽

Cervical Spine Radiography ◽

Active Implementation

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

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Awareness of Oral Cancer in a Community of Tarahara, Sunsari, Nepal

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v9i1.38077 ◽

2021 ◽

Vol 9 (1) ◽

pp. 33-40

Author(s):

Poonam Rai ◽

Punam Kumari Mandal ◽

Namita Yangden ◽

Munawatee Rai ◽

Sabitra Subedi

Keyword(s):

Risk Factors ◽

Oral Cancer ◽

Data Entry ◽

Public Health Problem ◽

Structured Interview ◽

Demographic Variables ◽

Treatment Modalities ◽

Major Public Health Problem ◽

Cross Sectional ◽

South Central

Background and Objectives: Oral cancer is one of the highly prevalent cancers worldwide and a leading cause of mortality in certain regions like South-Central Asia and a major public health problem. According to National Health Policy, oral cancer is the most common form of cancer in men and the third most common cancer in females in Nepal. Several studies have shown that public is not well aware of risk factors associated with oral cancer. The objective of this study was to assess the awareness of oral cancer among people of Tarahara-20. Material and Methods: A cross-sectional descriptive study was conducted among people of age group 18-65 years in 2019. Data were collected from 128 respondents through face to face interview using Semi – structured interview schedule with non-probability purposive sampling method. Data entry and analysis was done in SPSS version 17. Descriptive statistics i.e. frequency, percentage, mean and standard deviation was used to assess the level of knowledge and inferential statistics i.e. chi square was used to find the association between awareness of oral cancer and selected demographic variables. Results: Total findings of the study showed that More than half (52.3%) of respondents were known about treatment modalities of Oral cancer whereas two third, 78.9% of respondents stated out movement is best for physical rehabilitation. Likewise, more than half (65.6%) had moderate level of awareness and 28.1% of the respondents had inadequate level of awareness regarding oral cancer. The result showed there was no association between level of awareness of oral cancer and selected demographic variables. Conclusion: The study concluded that awareness regarding oral cancer is moderate among community people of Tarhara. It reflects that efforts should be made to increase the awareness regarding oral cancer. Health education regarding oral cancer and its risk factors with periodic reinforcement will play an important role in creating awareness.

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Study of association and prognostic correlation of cardiac troponin I estimation in acute decompensated heart failure patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205403 ◽

2020 ◽

Vol 8 (1) ◽

pp. 26

Author(s):

Sunil Kumar Tripathi ◽

Vikas A. Mishra ◽

Amit B. Kinare ◽

Vishwa Deepak Tripathi ◽

Ravi Shankar Sharma

Keyword(s):

Heart Failure ◽

Troponin I ◽

Acute Decompensated Heart Failure ◽

Public Health Problem ◽

Decompensated Heart Failure ◽

Major Public Health Problem ◽

Positive Group ◽

Medical College ◽

Follow Up Study

Background: Heart failure is a major public health problem since last few decades affecting significant number of people worldwide. Acute decompensated heart failure is a major cause of hospitalization in elderly people with a high mortality rate. Heterogeneity and non-specificity of symptoms makes diagnosis of heart failure by clinical presentation alone more challenging. Aim of current study was to investigate troponin biomarkers in diagnosis, prognosis and management of acute decompensated heart failure. Methods: Present study was a prospective observational study conducted on 100 patients at Department of Cardiology, Superspeciality hospital, NSCB medical college Jabalpur and Department of cardiology Superspeciality hospital, SS medical college Rewa from October 2019 to August 2020. Patients were investigated for clinical, echocardiographic parameters and NYHA classification. Cardiac functions were analyzed by color doppler echocardiography. Results: According to study findings, 65.2% of TnI positive patients were males whereas 34.8% were females. Mean age of TnI positive group was observed to be higher. Majority of troponin positive patients were in NYHA class IV. Recurrent hospitalization was observed more in TnI positive group. Logistic regression analysis depicted systolic blood pressure reduced significantly (p<0.001) on follow up study in TnI positive patients, FBS was significantly more in TnI positive patients (131.4+42.9 mg/dl) (p=0.049). LVID was significantly more in TnI positive patients (p=0.022). Reduction in EF was statistically significant (p=0.03) at the three months follow up study. Conclusions: A positive prognostic correlation was established between ADHF and troponin positivity, large prospective randomized trials are necessary to recommend quantitative troponin I determination in all patients of acute decompensated heart failure for prognosis and guiding therapy.

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System Delay in Breast Cancer Diagnosis in Gaza Strip, Palestine

Journal of Oncology ◽

10.1155/2019/5690938 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Samira S. Abo Al-Shiekh ◽

Yasser S. Alajerami ◽

Bothyna B. Etewa ◽

Aymen M. Elsous

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Gaza Strip ◽

Diagnostic Delay ◽

Public Health Problem ◽

Diagnostic Tools ◽

Major Public Health Problem ◽

Related Factors ◽

The Gaza Strip

Background. Breast cancer is a major public health problem and the first leading cause of cancer deaths among females in Palestine. Early diagnosis of breast cancer contributes to reduction of morbidity and mortality rates. This study aimed to explore system-related factors affecting the timely diagnosis of breast cancer in the Gaza Strip. Method and Materials. A mixed method, sequential explanatory design was employed. A quantitative study was conducted first, and it was cross-sectional in nature, followed by a qualitative study. An interviewed questionnaire and an abstraction sheet were used to collect necessary quantitative data among 122 females diagnosed with breast cancer. A purposive sample of five medical specialists were selected for in-depth interview. Descriptive and inferential analyses were used to find differences between variables. Odds ratio and confidence interval at 95% were presented, and P<0.05 was considered statistically significant. Results. Around 12.3% of women experienced diagnostic delay for 3 months and more, and 6.6% reported a delay in referral for more than 2 weeks. Regarding imaging delay, around 8.2% and 2.7% of women had reported a delay in performing mammography and ultrasound, respectively. Moreover, one-fourth reported delay in performing biopsy for more than 14 days, and 46.3% reported delay more than 14 days in getting histopathology report. In addition, 9% missed the follow-up after benign findings of the previous breast imaging and no national protocols are available for the diagnosis of breast cancer in the Gaza strip. Conclusion. There is a long appointment time for diagnostic tools especially in biopsy. The nonmalignant findings from mammography or ultrasound could affect diagnosis time. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health.

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First-episode psychosis

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0015 ◽

2020 ◽

pp. 122-131

Author(s):

Merete Nordentoft ◽

Nikolai Albert

Keyword(s):

Public Health Problem ◽

Convincing Evidence ◽

Community Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

Major Public Health Problem ◽

Clinical Effects ◽

Long Run ◽

Follow Up Studies

Psychosis in the schizophrenia spectrum constitutes a major public health problem. There is convincing evidence for positive effects of 2-year specialized early intervention programs with intensive care, assertive outreach, and family involvement. Follow-up studies indicate a risk of loss of positive clinical effects after termination of specialized programs, but clinical effects can be sustained or even improved with prolonged specialized treatment or transfer to standard treatment, including assertive community treatment (ACT) for the most disabled patients. Long-term studies show substantial heterogeneity in clinical and functional outcomes, resulting in a very diverse picture. Ten-year follow-up studies of the OPUS and the AESOP cohort indicate that more than half of the patients will achieve stable remission of psychotic symptoms and that half of those patients can maintain remission in the long run without antipsychotic medication.

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Evaluation of Malignant Mesothelioma in Central Anatolia: A Study of 67 Cases

Canadian Respiratory Journal ◽

10.1155/2004/204793 ◽

2004 ◽

Vol 11 (4) ◽

pp. 287-290 ◽

Cited By ~ 11

Author(s):

Inci Gulmez ◽

Levent Kart ◽

Hakan Buyukoglan ◽

Ozlem Er ◽

Suleyman Balkanli ◽

...

Keyword(s):

Pleural Effusion ◽

Malignant Mesothelioma ◽

Environmental Control ◽

Public Health Problem ◽

Central Anatolia ◽

Major Public Health Problem ◽

Pleural Thickening ◽

Chest X Ray ◽

Fibrous Mineral

BACKROUND:Malignant mesothelioma (MM) is a fatal neoplasm which frequently results from exposure to asbestos or erionite.METHOD:Sixty-seven patients with MM were seen between 1990 and 2001. Their clinical and radiological features, as well as the therapy, were retrospectively evaluated.RESULTS:In 51 patients (76.1%), the MM was confined to the pleura, in 14 patients it was exclusively peritoneal and in two patients, it involved both areas. Of the 67 cases, 35 (52.2%) were women. The mean (± SD) age for all cases was 57.6±11.5 years. Dyspnea (67.2%), cough (55.2%) and chest pain (50.7%) were the most frequent symptoms of onset. Pleural effusion (92.4%) was the most common chest x-ray finding, whereas pleural effusion (60.8%), pleural nodules (34.7%) and pleural thickening (34.7%) were the most common computed tomography findings in pleural MM patients. The histological subtypes of MM were determined as epithelial in 60 patients (89.5%), sarcomatous in four patients (5.9%) and mixed in three patients (4.4%). Although 50.7% and 25.4% of the cases were exposed to erionite and asbestos, respectively, 23.9% of the cases recalled no exposure to asbestos or erionite. Exposures were environmental as opposed to occupational. Thirty-five patients (52.2%) were administered chemotherapy, and follow-up data were available for 22 patients. For these patients, the two-year survival rate was 22% and the two-year progression-free interval was 15.7%. There were no differences between patients with asbestos and erionite exposure.CONCLUSION:MM should be considered when exudative pleural effusion is detected in a patient who has been exposed to asbestos or erionite. MM is a major public health problem in parts of Turkey and compulsory environmental control of fibrous mineral should be considered.

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Minimally Invasive Surgical Approaches to Esophageal Cancer

Journal of Gastrointestinal Surgery ◽

10.1016/s1091-255x(02)00026-4 ◽

2002 ◽

Vol 6 (4) ◽

pp. 522-526 ◽

Cited By ~ 10

Author(s):

L Swanstrom

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Surgical Approaches ◽

Minimally Invasive Surgical

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A Clinical Audit on Management of Hypertension

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v18i1.42136 ◽

2019 ◽

Vol 18 (1) ◽

pp. 49-51

Author(s):

AK Fazlul Haque ◽

Faruque Uddin ◽

Farzana Hamid

Keyword(s):

Clinical Audit ◽

Combined Treatment ◽

Public Health Problem ◽

Hypertensive Encephalopathy ◽

Smoking History ◽

Daily Routine ◽

Major Public Health Problem ◽

Cvd Risk ◽

Hypertensive Patients

Background : Hypertension is a major public health problem globally in both the developed and developing countries and it leads to cardiovascular diseases, stroke and kidney failure. The aim of this study was to identify the deficiency of management and to know the overall approach both by physician and cardiologist in daily routine OPD setting. Materials and methods : The patients’ mean age was 54.9±9.9years, 53.2% were male and 46.8% were female. In history taking important symptoms, family history and smoking history were poorly recorded (51.2%). Results : Of the hypertensive patients, 78.4% were well controlled (BP<140/90). Out of 80 patients, 44 patients needed combined treatment either at the beginning or during follow up. Hypertension preceded before the onset of many newly detected diabetic subjects in our series. About 70% did have LVH and notably ACS were noted in 7.5% cases. 8.3% were obese. TIA/Hypertensive encephalopathy/CVD were detected in 6.2% cases. CCR or eGFR measurement done in only <1% of subjects routinely when we noted renalinsufficiency in 14% and interestingly some were having erectile dysfunction. Conclusion : A significant number (20%) of patients discontinued their BP check. At OPD setting Framingham 10 year CVD risk evaluated in <1% cases only. Refractory or Secondary HTN is seen in only 2 cases. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 49-51

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Abdominal Viscera Migration Performing Hemodynamic Instability after Esophagectomy: A Case Report

Gastrointestinal Tumors ◽

10.1159/000518937 ◽

2021 ◽

pp. 1-6

Author(s):

Ian Torres de Lima ◽

Edno Tales Bianchi ◽

Gabriel Lunardi Aranha ◽

Beatriz Camargo Azevedo ◽

Guilherme Naccache Namur ◽

...

Keyword(s):

Esophageal Cancer ◽

Case Report ◽

Minimally Invasive ◽

Surgical Techniques ◽

Rare Condition ◽

Hemodynamic Instability ◽

Minimally Invasive Surgical ◽

Late Postoperative Period ◽

Made In

Hiatal hernia is a rare postoperative complication of esophagectomy in the treatment of esophageal cancer. Although rare, its incidence increased after the establishment of minimally invasive surgical techniques. The patient is usually oligosymptomatic, and the diagnosis is made in the late postoperative period, during outpatient follow-up. The initial presentation of hiatus hernia with hemodynamic instability is a rare condition that has never been described in the literature before. In the following report, we address the clinical picture, diagnosis, and treatment for this condition, discussing the main nuances of the literature.

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