Patient Perception of Health Care Services: A Comparative Study

Assessment of patient satisfaction is a measurement that obtains information or ratings from patients about their perception of the services being provided from an organization, hospital, physician, or healthcare provider and plays an increasingly important role toward accountability among health care providers. The present study aimed at comparing the patient’s perception of services being provided in the government and private sectors. 120 patients (60 from each sector) natively from Karnataka, India with knowledge of English participated in this study. Subjects were asked to rate their experiences before, during and after consultation. A checklist to rate the patient satisfaction was developed. The checklist comprised of 11 questions covering the most important domains pertaining to patient satisfaction about the health care services provided. Obtained responses were statistically compared using independent t test. Significant differences in the satisfaction levels of the subjects in the government and the private set ups were seen at p< 0.05 (t=2.921, 118). In government sector patients were better satisfied with certain aspects like the cost factor, information provided about the problem and guidance regarding intervention whereas the patients in the private sector were better satisfied with the orientation to the department, information furnished about the problem, comfort and privacy during the testing procedure

Unusual paraneoplastic syndrome of inappropriate antidiuretic hormone secretion with gastric cancer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) results in impaired water excretion and consequent water intoxication and hyponatremia. In patients with cancer, SIADH is most commonly driven by ectopic ADH production, a paraneoplastic syndrome frequently seen in small cell lung cancer. A 63 year old male presented with loss of appetite, vomiting and hiccups. No abnormalities were detected on physical examination. Upper gastrointestinal endoscopy showed a proliferative growth in the stomach and histopathology report confirmed gastric adenocarcinoma. His laboratory investigations revealed low serum sodium and further work up for SIADH confirmed the diagnosis. The patient was treated with hypertonic saline and he improved symptomatically. He was subsequently treated with two cycles of capecitabine and oxaliplatin. The patient was asymptomatic and maintained a serum sodium in the range of 120 to 130 mEq/L, with a serum sodium of 127 mEq/L on follow up

Integration of Liquid Biopsy and Pharmacogenomics for Precision Therapy of EGFR Mutant and Resistant Lung Cancers

The advent of molecular profiling has revolutionized the treatment of lung cancer by comprehensively delineating the genomic landscape of the epidermal growth factor receptor (EGFR) gene. Drug resistance caused by EGFR mutations and genetic polymorphisms of drug metabolizing enzymes and transporters impedes effective treatment of EGFR mutant and resistant lung cancer. This review appraises current literature, opportunities, and challenges associated with liquid biopsy and pharmacogenomic (PGx) testing as precision therapy tools in the management of EGFR mutant and resistant lung cancers. Liquid biopsy could play a potential role in selection of precise tyrosine kinase inhibitor (TKI) therapies during different phases of lung cancer treatment. This selection will be based on the driver EGFR mutational status, as well as monitoring the development of potential EGFR mutations arising during or after TKIs treatment, since some of these new mutations may be druggable targets for alternative TKIs. Several studies have identified the utility of liquid biopsy in the identification of EGFR driver and acquired resistance with good sensitivities for various blood-based biomarkers. With a plethora of sequencing technologies and platforms available currently, further evaluations using randomized controlled trials (RCTs) in multicentric, multiethnic and larger patient cohorts could enable optimization of liquid-based assays for the detection of EGFR mutations, and support testing of CYP450 enzymes and drug transporter polymorphisms to guide precise dosing of EGFR TKIs

Cervico-Facial Soft Tissue Emphysema with Pneumo-Mediastinum Following Endoscopic Sinus Surgery: A Dilemma of Related or Unrelated Complication

ABSTRACT We present a rare and unusual complication of cervico-facial soft tissue emphysema with pneumo-mediastinum which occurred in a 30-year-old female Jordanian patient in our hospital in October 2010 in Abu Dhabi following FESS. CT scan evaluation of aero-digestive tract in the immediate post-operative period was done to ascertain the cause pertaining to any surgical trauma or anaesthesia related complications. Such a case previously unreported has been included in this study. A simple close monitoring after establishing the cause is usually sufficient in management of such related or unrelated complications during FESS which in our case was likely to be anaesthesia related. Published data of such a complication assists in building up a good and effective medical audit based on ethical practice. This paper stresses the importance of immediate CT scan of aero-digestive tract in evaluating the cause

A case of synchronous isolated thyroid metastasis from a primary lung cancer presenting as thyroid primary: Diagnostic challenge!

The thyroid metastasis from any primary is rare, and usually is a late event and presents as a thyroid swelling. Further, the diagnosis of a metastatic lesion in a patient with no antecedent history of any malignancy can be very challenging. Recently, a patient presented to us with a history of diagnostic evaluation suggesting a primary thyroid malignancy with a synchronous lung primary. After surgery for the thyroid swelling, final histopathology revealed a metastatic lesion from a lung primary. Here, we discuss this rare case of isolated synchronous thyroid metastasis from a lung primary and review the relevant literature

Unprecedented behaviour of chronic myeloid leukaemia

We report the occurrence of leukaemic infiltration of cervical spinal cord secondary to chronic myeloid leukaemia (CML) in a 31-year-old male patient. He presented with left upper limb monoplegia. On examination he had asymmetric quadriparesis, graded sensory loss and urinary retention. Diagnosis was suggested by magnetic resonance imaging. He responded dramatically to radiotherapy and corticosteroids treatment. Infiltration of the cervical spinal cord in a patient with CML has seldom been reported in literature till date, and hence we are reporting this case

Recommendations for the adjuvant use of the poly-antibiotic–resistant probiotic Bacillus clausii (O/C, SIN, N/R, T) in acute, chronic, and antibiotic-associated diarrhea in children: consensus from Asian experts

© 2020, The Author(s). This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Evidence-based recommendations and randomized controlled trials in the region are included. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by utilizing a modified Delphi process and applying the Likert scale in an electronic voting process. Bacillus clausii was recommended as an adjunct treatment with oral rehydration solution for acute viral diarrhea. B. clausii may also be considered for prevention of antibiotic-associated diarrhea, Clostridium difficile-induced diarrhea, and as adjunct treatment of Helicobacter pylori. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations currently apply to most Asia-Pacific countries. Ideally, these need to be validated with local randomized-controlled trials