Donald Fernandes

Abstract

Introduction and objective: The present study was undertaken to assess the Dysphagia and pain intensity among patients undergoing chemoradiotherapy. Materials and Methods: This was a prospective comparative study conducted from March 2009 to August 2010. A total of 109 patients with oral and oropharyngeal cancer were included in the study. The placebo group received sham treatment wh ereas Laser group patients were treated with Low Level Helium-Neon Laser at 6 anatomical sites in the oral cavity prior to Radiotherapy for 45 days. Severity of Dysphagia was assessed daily using Functional Impairment Scale (FIS). Patients were asked for the type of food they were able to take and related difficulty in swallowing that food. Severity of Oral Pain was assessed each day of treatment using The Visual Analogue Scale (VAS) 0 to 10 and Verbal scale were used to describe their pain in terms of various levels and these values were coded for statistical analysis. SPSS 18.0 version was used for statistical analysis. Results: All the patients were above 40 years of age in laser and placebo group respectively. Nearly 3/4th of the patients developed a mild degree of dysphagia by the end of first week. At the completion of treatment, 44% of the patients in the study arm had grade 4 dysphagia, compared to 60% in the placebo arm. As per the pain, there was a steady increase in the VAS scores from 2nd week onwards. At the completion of treatment, 50% of the patients in the control arm had pain scores more than or equal to 7, while only 16% in the study arm had severe pain. Both the tools revealed statistically significant results, with the patients in the laser arm experiencing much lower pain during the course of treatment when compared to the placebo arm. Conclusion: The Laser group experienced less pain and dysphagia while on treatment, compared to the placebo arm. The difference was statistically significant. Keywords: Dysphagia, Pain Intensity, Visual Analogue Scale, Functional Impairment Scale, Laser therapy.

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Introduction: Tuberculosis and HIV epidemic is the most prevalent problem in both developed and developing countries. Tuberculosis is the most prevalent airborne opportunistic infection among people living with HIV. Aim: The present study aims to assess the impact of 6 months ART treatment on CD4 counts among HIV-TB co infected patients. Materials and Methods: This was a prospective longitudinal study to assess the impact of 6 months ART treatment among HIV-TB infected patients. The study duration was between August 2012-March 2013. 189 HIV with TB diagnosed patients were taken from CG Hospital, treated under NACO guidelines. Follow up of cases done after six months of duration with CD4 count. CD4 Count was done by Flow Cytometry Method and expressed as cells/ml. Results: 189 HIV-TB infected cases enrolled for the study who attended ART Centre, Among them 75(40%) were fresh diagnosed cases of HIV and TB and were started on ART therapy. 114(60%) cases were in age group 14 to 50 years with co-infection already on ART. A large number were diagnosed as having pulmonary tuberculosis (120cases). Extrapulmonary TB cases were 69 (lymphnode TB - 39, ascities-15, pleural effusion-10, CSF-5) and total 169 patients were having CD4 count of < 200> ART, CD4 count increased to more than 300. Conclusion: The clinical manifestation of TB-HIV is quite distinct exhibiting different CD4 counts. The co morbidities of HIV -TB has shown a challenge in diagnosis and treatment. HIV-TB cases have shown a decline in CD4 count without ART treatment leading to increased morbidity and mortality. Keywords: Tuberculosis, Co-morbidity, HIV, ART and CD4 count.

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Introduction and Objectives: The present study was undertaken with the objective to study the functional outcome with Oswestry Disability Index and VAS in patients with degenerative lumbar canal stenosis who underwent unilateral laminotomy and bilateral decompression of the canal. Materials and Methods: The cases were the patients who underwent microsurgical treatment for degenerative lumbar canal stenosis, between the age group of 40 to 60 during 2008 – 2010 were taken for the study. Patients with a history of low back pain, neurogenic claudication, radicular pain with single level canal stenosis and without spinal instability were included in the study. The patients underwent a thorough preoperative clinical and radiological examination at the department. VAS- Visual Analog Scale and Oswestry Disability Index and Neck Disability Index (0-10 scale) were used to assess the functional outcome. Results: 45 patients were included in our study. 42.2% were between 60-70 yrs. Males were more compared to females, 82 % people presented with neurogenic claudication pain and the pain was bilateral in 70 %. The duration was ranging from 6 months to 1 year. The functional outcome analyzed with VAS and ODI which showed progressive improvement in the values at the end of 1 year follow up the difference showed a p- value of < 0> had recurrence of the symptoms and did not develop any spinal instability. Conclusion: The functional outcome measured with VAS and ODI showed strongly significant as well as analysis showed immediate improvement with bilateral symptoms, canal stenosis at the L4-5 level. However good results noted in follow -up with a female who was having bilateral symptoms and stenosis at L5 S1 level. Keywords: Lumbar Canal Stenosis, ODI Scores, VAS scale, Neurogenic Claudication, Laminotomy

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Introduction: Cervical radiculopathy is a neurological disfunction wherein a nerve root in the cervical spine becomes inflamed with disc herniation and uncovertebral osteophytes accounting for the majority of cases. The standard surgical treatment for this cervical radiculopathy till now is posterior lamino foraminotomy and anterior discectomy with or without fusion. This study describe the outcome of a minimally invasive anterior cervical disc preserving technique of upper vertebral transcorporeal anterior microforaminotomy to treat cervical radiculopathy Cervical. Objective: To Evaluate the clinical and radiological outcome of disk preserving functional cervical disk surgery. Material and Methods: This is a prospective non randomised hospital based study. The study population included 11 patients operated for cervical radiculopathy with the new technique at the department of Neurosurgery, Manipal Hospital, Bangalore during July 2007 to June 2010. The patients were followed up from 8 to 30 months with a mean follow up of 17 months for clinical and radiological outcome. Results: The mean age of the patient was 40.099.71 years. The majority of the patients (five) were in 31-40 age groups. Male patients (63.6%) were more as compared to females. All patients in this study had neck pain, radicular pain and weakness. Clinical symptoms were between 1 to 3months. The mean preoperative visual analogue scale score was 8.55 and postoperative score was 1.18. The VAS score reduced significantly postoperatively and it was statistically significant. There was no significant reduction in the disc height postoperatively. Conclusion: The Disk preserving functional cervical disk surgery is a minimal invasive procedure with the least complications and adequate motion at the operated site. Keywords: Cervical Disk Surgery, Cervical radiculopathy, Disk preserving, Disk Herniation

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