The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

Background: Because of its prompt onset of action and clearance, the use of etomidate as an anaesthetic induction agent is increasing in clinical practice. However, etomidate-induced myoclonus (EIM) remains a prevalent issue. Such myoclonic activity can be prevented by the administration of drugs that inhibit subcortical neuronal activity. Aims: This study was designed to compare the effects of pre-treatment with dexmedetomidine and fentanyl–midazolam combination on EIM as well as on attenuation of pharyngolaryngeal reflex. Materials and Methods: One hundred adult patients with the American Society of Anesthesiologists Grades 1 or 2 posted for elective surgery were enrolled and were randomly divided into two groups of 50 patients each. Group D received dexmedetomidine (1 μg/kg) in over 10 min and Group F received midazolam (0.02 mg/kg) + fentanyl (2 μg/kg) intravenously. Haemodynamic variables, incidence and severity of myoclonus were recorded. Results: The incidence of EIM was lower in Group F (26%) when compared to Group D (40%), but the difference was not statistically significant (P = 0.28). Eighteen per cent of the subjects in Group F had Grade 1 myoclonus as compared to 32% of Group D, whereas 8% of the subjects in Group F had Grade 2 myoclonus as compared to 6% of Group D. None of the patients in Group F experienced myoclonus of Grade 3, whereas 2% of the subjects had Grade 3 myoclonus. Conclusion: Administration of a combination of fentanyl and midazolam, along with dexmedetomidine as a pre-treatment, has been found to be an effective strategy for mitigating the incidence of myoclonus

Association of social anxiety disorder with depression and quality of life among medical undergraduate students

Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001). Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa