Social determinants of Health and Alcohol consumption in the UK

  Addressing the social determinants of health (SDH) and health inequities are essential for successfully combating alcohol-related harm. In U.K, excessive consumption of alcohol is a huge public health concern. An estimated 9 million adults drink at level that increase the risk of harm to their health; 1.6 million adults in England have some degree of alcohol dependence; and of these some 250,000 are believed to be moderately or severely dependent and may benefit from intensive specialist treatment. To be able to devise effective action, it is essential to comprehend these inequities in the healthcare system. Health inequities are not solely related to access to health care services; there are many other determinants related to living and working conditions, as well as the overall macro-policies prevailing in a country. The key intention of this review was to critically analyse the degree to which social determinants have impacted on excess alcohol consumption. A comprehensive approach to reduce inequities in alcohol-related harm requires action that includes mix of long- and short-term impacts, addressing the consequences and the root causes of inequities, and acting on both individuals and environments. Whereas, consequences of harmful alcohol use are more severe for those already experiencing social exclusion. We suggest that (1) the effective legislation, (2) modifying marketing strategies, (3) enhancing cooperation with regional organizations, (4) more effectively implementing existing regulation and (5) consulting expert will enhance SDH for this vulnerable population

Organ preservation for advanced laryngeal cancer: Experience with concurrent chemoradiation therapy

Introduction: The larynx is a part of the upper respiratory tract that performs many essential functions including breathing, speaking, and swallowing. For this reason, the quality of life is significantly affected by laryngeal cancer and its treatment. Therefore, the focus of management for the last few decades has been on preserving the function of a larynx without compromising survival. This study was done with the purpose of reviewing our experience of organ preservation approach with concurrent chemoradiation therapy (CCRT) for locally advanced cancers of larynx.Methods: A retrospective chart review was carried out for the data of pathology reports and clinical notes of the patients who were diagnosed with laryngeal squamous cell carcinoma and primarily treated with CCRT at our tertiary care institute from November 2010 to June 2015.Results: Of 25 patients included in the study, there were 19 males and six females. The mean age was 56 years. On comparison of post-treatment CT scan following eight weeks of completion of therapy, 21 patients showed complete resolution of the disease and four patients had persistent disease who were later treated with salvage laryngectomy. The speech was understandable in 18 patients and poor or not understandable in seven patients. Three patients had chronic aspiration and breathing difficulties necessitating permanent tracheostomy. Three patients required permanent gastrostomy due to chronic dysphagia, one of them belonged to those who were also tracheostomized.Conclusions: Our experience with CCRT as an organ preservation approach for advanced laryngeal cancers was promising. When considering the functional organ preservation, the proportion of success is remarkably less; however, the overall impression is worthy enough to uphold the sentiment in favor of non-surgical organ preservation. The debate is ongoing in the quest of finding a balanced approach with acceptable toxicity and decent functional outcome with adequate speech, breathing, and swallowing

Preservation of hearing and facial nerve function with the microsurgical excision of large vestibular schwannomas: Experience with the retrosigmoid approach

Introduction: Vestibular schwannomas (VS) are the most common benign neoplasms of a cerebellopontine angle (CPA), which arise from the Schwann cells of the vestibulocochlear nerve. Eighty percent of CPA tumors are VS followed by meningioma as the second common mass lesion in this critical potential space. Treatment options range from watchful waiting with serial imaging studies to radiosurgery or a microsurgical excision or a combination of surgery and radiation therapy. The primary objective of the study was to assess hearing and facial nerve status before and after the surgery via the retrosigmoid approach.Methods: The database of Aga Khan University Hospital was searched for diagnoses of vestibular schwannomas between 2000 and 2007. A total of 35 patients were identified; among them, 27 were selected for the study who met the inclusion criteria. The variables of the study were age, gender, presenting symptoms, size of the tumor, surgical approach, hearing levels, and facial nerve function. Hearing loss was categorized according to the Gardener-Robertson hearing classification and the House-Brackmann Scale was used for facial nerve assessment.Results: Out of the 27 patients, 18 were male and nine were female. The mean age was 43 years. The most common presenting complaint was hearing loss and tinnitus, seen in 21 patients. Headache was present in six patients, ataxia in five, and vertigo in three. Facial nerve weakness was noticed in six patients. Two patients had Grade-III paralysis, three had Grade-IV paralysis, and one had Grade-V paralysis. The audiogram confirmed the presence of sensorineural hearing loss (SNHL) in all patients. Twelve patients out of 27 had Class II hearing with the threshold between 31 and 50 decibels and a Speech Discrimination Score (SDS) of 50% to 69%. Ten patients had non-serviceable hearing and the remaining five had poor hearing. The audiogram was repeated after surgery for those 12 patients who had Class II hearing and showed that seven out of 12 patients maintained a hearing threshold within the range of Class II at the one-year follow-up (hearing preservation 58%). The facial nerve preservation rate was 56% considering House-Brackmann Grade III or less as acceptable facial nerve function.Conclusion: The optimal treatment for small vestibular schwannomas is a matter of controversy; however, the choice of treatment for large vestibular schwannomas in patients without significant comorbidity is generally microsurgical excision. The surgical excision of a large VS with the retrosigmoid approach is found to be safe consistently. The hearing and facial nerve preservation in our study were found comparable with the literature

Vegetation conditions in various plant communities and their performance in district Tharparkar, Sindh, Pakistan

Six villages were registered for the experimental purpose/plantation where more than 25,000 plants were planted to develop range forest. These plants were developed at Marvi nursery PARC-Arid Zone Research Institute, Umerkot and some were purchased from private nursery situated at Mirpurkhas. Results revealed that maximum plants mortality rate was found at village Ratnore and lowest mortality of plants was observed at Mithrio Charan. Plants damaged due to unknown reason (natural), termite attack and diseases. In various locations most of plants were affected by termites than others biotic and abiotic factors. The most influenced plant was Prosopis cinerera. Maximum plants survived numbers of grafted ber was found at village Ratnore, the biomass production of green and dry grasses was taken after harvesting. A highest green grass weight 21812.58 kg and dry 3439.83 kg were observed from elephant grass stock and lowest green weight 5001.92 kg from Gatten grass and dry weight 477.57 kg per acre were recorded from Rhode grass 1 (Sabri). Gatten grass and Rhode grass 1 (Sabri) were found lower weight. All these seven grasses showed excellent performance except Elephant grass and Gatten grass. These two grasses needed more water as compared to remaining five species. These grasses when fed by goats their milk production was increased and goats like to feed these grasses. The pictures of these grasses showed their appearance and health irrigated by underground brackish water with more than 2200 ppm

Occult nodal metastasis in oral cavity cancers

Introduction: In squamous cell carcinoma (SCC) of the oral cavity, there is always a risk of occult metastasis to neck nodes in the clinically and radiologically negative neck (N0). Therefore, elective neck dissection (END) has ever been under discussion since the beginning of their routine use for the management of neck for oral carcinomas. The purpose of the current study is to identify the percentage of occult nodal metastasis to neck levels I-V in the cases of oral carcinoma who were treated for the N0 with END.Methods: Patients who were treated between June 2005 and May 2010 with END from neck levels I to V for the management of N0 with oral SCC had been identified from the database of Aga Khan University Hospital. Those who met the inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS 16 software. Using descriptive statistics, the mean was computed for the quantitative variable (age). Frequencies and percentages were calculated for gender, site, tumor grade, and lymph node involvement for each neck level.Results: A total of 50 patients were included in the study. There were 38 males and 12 females. The mean age was 47 (range 25-72). The most common site of the tumor was buccal mucosa in 50% of the cases followed by tongue 20%, then floor of mouth 14%, dentoalveolar ridge 8%, retromolar area 4%, lip 2%, and hard palate 2%. Histopathological grading of tumors showed well-differentiated 28%, moderately differentiated 33%, and poorly differentiated 6%. Twenty-seven out of 50 patients were found positive for nodal metastasis on final postoperative histopathology. Neck node metastasis at level I was found in 22 patients, at level II in 16 patients, at level III in seven patients, and at level IV in two patients. The level V was found free of metastasis in all of the cases.Conclusion: The rate of occult metastatic disease to the neck nodes was similar to that found in the literature. Both early and advanced local disease is associated with a risk of occult metastasis. END for neck levels I-V is, therefore, recommended for the management of the N0 in all cases of oral SCCs. Spread to levels IV and V is rare and these levels should not be a part of routine END

Hemichorea Associated with type 2 Diabetes: A Rare Neurological Complication

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a good prognosis. Screening for hyperglycemia even in those patients without a prior history of diabetes is very important, once they present with an involuntary movement disorder. Recognition and early treatment is beneficial to prevent adverse outcomes. Today, in the medical literature it is often referred to as C-H-BG (chorea, hyperglycemia, basal ganglia) syndrome

Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy

AbstractObjectiveThe objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients.Materials and methodsCharts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and positive surgical margins.ResultsUnivariate analysis showed diabetes, pre-operative radiotherapy, pre-operative chemotherapy and pre-operative tracheostomy to be significantly associated with the formation of PCF. However, multivariate regression revealed that the only pre-operative radiotherapy was highly associated with the formation of PCF (OR=132.923, P=0.001).ConclusionsWe found 28.6% incidence of pharyngocutaneous fistula mainly because of the number of patients undergoing radiotherapy and chemotherapy as primary treatment for laryngeal cancers is increasing with current approach of organ preservation protocol

Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy

Objective The objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients. Materials and methods Charts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and positive surgical margins. Results Univariate analysis showed diabetes, pre-operative radiotherapy, pre-operative chemotherapy and pre-operative tracheostomy to be significantly associated with the formation of PCF. However, multivariate regression revealed that the only pre-operative radiotherapy was highly associated with the formation of PCF (OR = 132.923, P = 0.001). Conclusions We found 28.6% incidence of pharyngocutaneous fistula mainly because of the number of patients undergoing radiotherapy and chemotherapy as primary treatment for laryngeal cancers is increasing with current approach of organ preservation protocol