Contralateral Nodal Metastasis from Tongue Malignancy

Oral cavity is the most common site of cancer in India, tongue forms the most common single subsite. Neck node involvement plays an important prognostic role in disease-free survival and overall survival. Most of the nodal metastasis are occult and only an elective neck dissection can disclose the nodal metastasis, which is accepted only when the risk of metastasis exceeds 15-20%. Contralateral nodal metastasis(CLNM) are rarely analyzed due to sparse event.Retrospective analysis of data of patients who underwent surgery for carcinoma tougue with a curative intend between April 2017 and March 2019 were collected. Factors influencing CLNM in carcinoma tongue were studied.The study included 149 patients, with 102 men and 47 women. The mean age of study subjects was 51.5 ± 11.8 years. Thirteen (8.7%) patients had CLNM. With respect to tumor, advanced stage(p < 0.001), floor of mouth involvement(p = 0.001) and lesion crossing midline(p < 0.001) had an increased risk of CLNM. Extranodal extension(ENE)(p < 0.001) and lymphnode ratio(p = 0.002) in ipsilateral node ratio influenced CLNM. Multivariant analysis showed that in addition to lesion crossing midline(p = 0.03), ENE played significant role in CLNM (p < 0.001), with a risk of 12.8 times compared to no ENE. Suspicion of CLNM either clinically/radiologically was a good predictor of metastasis(p < 0.001).CLNM in tongue cancer was significantly influenced by lesion crossing midline and ENE. Contralateral neck dissection should be performed in any case with clinical/radiological suspicion of nodal involvement and above mentioned risk factors.

Effectiveness of Peer-Led Education on Knowledge and Attitude among Adolescents regarding Road Safety

BACKGROUND AND OBJECTIVE

Children and adolescents are the most vulnerable groups for road traffic injuries in India (39%). Hourly, forty youngsters die in road traffic crashes. Road safety education aims at reducing this burden. Peer-led education (PLE) is a credible approach influencing students to modify their behavior positively. This study aimed to evaluate the effectiveness of PLE in terms of knowledge and attitude toward road safety among adolescents.

METHODOLOGY

A single-group pretest-posttest design among 113 adolescents was conducted using a two-stage sampling technique. Ten selected and trained student peers provided PLE on road safety to 103 fellow students using a teaching aid. Effectiveness of PLE on knowledge and attitude was assessed pre- and postintervention.

RESULTS

Post PLE, the mean knowledge score of subjects increased from 10.5 to 17.5 with a significant mean difference of -6.9 (P < 0.001). The mean attitude score of subjects had increased from 46.7 to 48.1. A positive statistically significant correlation (P = 0.04) between knowledge and attitude and associations between certain sociodemographic variables were noted.

CONCLUSION

Knowledge and attitude of subjects regarding road safety improved after PLE. Innovative teaching methods can be used to promote healthy behaviors among adolescents.

'Sufficient Pain relief ' as a Practical Benchmark in Cancer Pain Management: A Prospective Study of Serial Pain Scores, Patient-rated Pain Relief and Perceived Sufficiency of Analgesics

Objectives

Serial pain scores are used to guide pain management but there can be variability in what constitutes 'adequate' pain relief for an individual patient. We aimed to evaluate how patient-rated sufficiency of pain relief corresponded to pain scores, pain relief scores, and the felt need for increasing analgesics.

Material and Methods

Baseline and follow-up scores on the 11-point numerical rating scale (11-NRS) and verbal rating scale were obtained for116 patients with cancer pain. Patients used the pain relief sufficiency rating (PRSR) to rate pain relief as 'no reduction,' 'some reduction, but not enough,' 'sufficient reduction,' and 'very good reduction.' They also rated analgesics as 'sufficient' or 'insufficient.' Receiver-operating characteristic (ROC) curve analysis was used to compare PRSR responses with follow-up pain scores, patient rated percentage pain relief, and the perceived need for an increase in analgesics.

Results

The 11-NRS had an area under the ROC curve of 94.2% against the PRSR. A pain score of three provided the best cutoff to identify adequate pain relief (88.2% sensitivity and 85.7% specificity). Follow-up verbal pain scores corresponded to PRSR categories (severe pain: no reduction; moderate pain: some reduction; mild pain: sufficient reduction and no pain: very good reduction). The PRSR identified 97.3% of patients who wanted analgesics increased and 85% of those who said pain medications were sufficient.

Conclusion

The PRSR is a brief, simple and intuitive measure to elicit patient perceptions on the sufficiency of pain relief. Our findings suggest that it might be a useful tool in pain and symptom management.

Timeliness of care and adverse event profile in children undergoing general anesthesia or sedation for MRI: An observational prospective cohort study

Background and Aims

Anaesthesia for children undergoing magnetic resonance imaging (MRI) ranges from moderate to deep sedation in order to facilitate uninterrupted completion of the scan. While various intravenous and inhalational techniques of anaesthesia have their own merits and demerits, there is a paucity of comparative literature between the two in children undergoing diagnostic MRI.

Materials and Methods

This prospective observational cohort study was conducted at the Radiology suite of a 2800-bedded tertiary care hospital, wherein 107 unpremedicated children between the ages of 6 months to 15 years received either sedation with propofol infusion (Group GSP, n = 57) or inhalational anaesthesia with a laryngeal mask airway (Group GAL, n = 50). Primary outcome measures included time to induction and time to recovery. Secondary outcomes comprised the incidence of respiratory and non-respiratory adverse events in the two groups.

Results

The median time to induction was significantly shorter in GSP than GAL [7.00 (IQR 5.0, 10.0) versus 10.00 minutes (IQR 8.8, 13.0), P < 0.001]; the incidence of desaturation [8 (16.0%) in GAL, 1 (1.8%) in GSP, P = 0.012], laryngospasm [11 (22.4%) in GAL, 1 (1.8%) in GSP, P = 0.001] and emergence delirium (5 (10%) in GAL, 0 in GSP, P = 0.047) were significantly greater in the GAL group. There was no difference in the time to emergence, nausea and vomiting or bradycardia between the two groups.

Conclusion

Sedation with propofol infusion during paediatric MRI scan offers a short turnover time and favourable adverse event profile when compared to inhalational anaesthesia with an LMA.