DELAYED ORAL FEEDING IN PATIENTS OF SALVAGE LARYNGECTOMY AND ITS EFFECT ON DEVELOPMENT OF PHARYNGOCUTANEOUS FISTULA

Objective: Pharyngocutaneous fistula (PCF) is a complication of post radiotherapy total laryngectomy. Early post operative feeding is a risk factor for development of PCF. Delayed oral feeding (DOF) and inserting a nasogastric tube has been considered a safe practice among head and neck surgeons, and there is no general agreement on the timing of initiation of the oral intake. This study compared the effect of EOF and DOF on PCF formation. Study Design: Prospective case-controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Apr 2019 to Jul 2020. Methodology: Non-probability convenience sampling was done for both groups. The patients were not matched and were assigned to either EOF or DOF alternately. EOF was defined as feeding at seventh post operative day and DOF criterion was feeding on fourteenth post operative day. The primary outcome was development of PCF within the 30th post operative day. A total of 20 patients with prior radiotherapy for laryngeal cancer who presented with recurrence of carcinoma were included in the study. Same technique closure of neopharynx was done in all cases of laryngectomy. Results: Overall PCF frequency was 20% (4/20). In EOF group, 30% (3/10) of patients developed PCF whereas 10% (1/10) of patients in DOF developed PCF. However, the difference in outcome of two groups was not statistically significant. Conclusion: DOF in cases of Salvage total laryngectomy is a safe practice and it might help to reduce the frequency of pharyngocutaneous fistula.

Knowledge, Attitude and Preventive Practice towards Breast Cancer among Women Visiting Public Health Facility, Saudi Arabia

Background: Breast cancer is the highest burden of disease in high and low income countries and it is the leading cause of disability and death. Knowledge is important predictor of breast cancer. The objective of this study is to determine the knowledge, attitude and practice regarding breast cancer among women visiting public health facilities in Hail, Saudi Arabia. Method: It’s was a cross-sectional study in the leading public sector hospital and 127 study participants were selected through stratified random sampling technique. Validated and structured questionnaire used. Study participants who scored greater than or equal to mean valued were considered good knowledge, positive attitude and safe practice. Chi square test was used to cross tabulation between socio-demographic characteristics and knowledge, attitude and practice score. Results: Over all 18.1%, 47.2% and 52% of study participants had good knowledge, positive attitude and safe practice for prevention of breast cancer respectively. More than two third (89%) of participants were stated that breast cancer was not curable disease, more than half (67.7%) of were heard about mammogram. Only 10.2% were belief that screening was essential to breast cancer for early diagnosis. More than two third (69,9%) were not practice self breast examination and 69% were stated that fear of disease was major barrier to mammogram test. Conclusion: The knowledge level among communities member of female regarding breast cancer was in-appropriate. Majority of them were not practicing self breast examination. Health education programme through workshops and seminars will be needed to increase the awareness toward breast cancer among females.

Regional anaesthesia

This chapter discusses the techniques of regional anaesthesia and analgesia. It begins with an overview of regional anaesthesia and goes on to describe safe practice, and local anaesthetic agents. Techniques of locating nerves are then discussed, including ultrasound, and needle design is explored. Nerve blocks of the neck; upper limb; trunk; lower limb, and the neuraxis (spine) are described. Coagulation disorders, nerve injury and the management of local anaesthetic toxicity are discussed. The chapter concludes with a dermatome map and tables of recommended nerve blocks for particular operations.

Off-Label Medication: From a Simple Concept to Complex Practical Aspects

Off-label use of drugs is widely known as unapproved use of approved drugs, and it can be perceived as a relatively simple concept. Even though it has been in existence for many years, prescribing and dispensing of drugs in an off-label regimen is still a current issue, triggered especially by unmet clinical needs. Several therapeutic areas require off-label approaches; therefore, this practice is challenging for prescribing physicians. Meanwhile, the regulatory agencies are making efforts in order to ensure a safe practice. The present paper defines the off-label concept, and it describes its regulation, together with several complex aspects associated with clinical practices regarding rare diseases, oncology, pediatrics, psychiatry therapeutic areas, and the safety issues that arise. A systematic research of the literature was performed, using terms, such as “off-label”, ”prevalence”, ”rare diseases”, ”oncology”, ”psychiatry”, ”pediatrics”, and ”drug repurposing”. There are several reasons for which off-label practice remains indispensable in the present; therefore, efforts are made worldwide, by the regulatory agencies and governmental bodies, to raise awareness and to ensure safe practice, while also encouraging further research.

A dual-modality quantification of scattered radiation from head to female breasts during radiological investigations in a tertiary hospital in Nigeria

Background To quantify the amount of scattered radiation reaching the breasts during x-ray and CT investigations of the head in order to find appropriate justification for an intended change in practice involving torso shielding. Results Scattered radiation from the head reached the breasts in both procedures. The range and mean dose were (CR 1.02–3.61/1.94 ± 0.63 mGy) and (CT 2.20–8.50/3.74 ± 2.28 mGy). Both breasts had enormous dose difference in CR (72.3%) and CT (51.4%) which were statistically significant (p < 0.05). Correlation of dose with anthropometric parameters gave weak results. Conclusion Despite dose mitigation strategies such as software and hardware modifications in radiological modalities, use of anti-scatter grid, appropriate collimation and dose optimization by radiographers, scattered radiation still traveled from the head to the breasts. These were, however, significantly reduced when shielding was applied. For a dose-safe practice, radiographers are urged, in addition to current strategies at mitigating scatters, to adopt torso shielding during examinations involving contiguous anatomies to the breast.