RESUMEN

The medical sub-specialty of Oncology presents diverse ethical dilemmas, often challenging cancer healthcare workers with difficult-to-handle clinical scenarios that are tough from a personal and professional perspective. Making decisions on patient care in various circumstances is a defining obligation of an oncologist and those duty-based judgments entail more than just selecting the best treatment or solution. Ethics is an essential and inseparable aspect of clinical medicine and the oncologists as well as the allied health care workers are ethically committed to helping the patient, avoiding or minimizing harm, and respecting the patient's values and choices. This review provides an overview of ethics and clinical ethics and the four main ethical principles of autonomy, beneficence, non-maleficence, and justice are stated and explained. At times there are frequently contradictions between ethical principles in patient care scenarios, especially between beneficence and autonomy. In addition, truth-telling, professionalism, empathy, and cultural competence; which are recently considered important in cancer care, are also addressed from an Indian perspective.

RESUMEN

Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.

RESUMEN

AIMS AND OBJECTIVES: The aim of the study was to estimate and compare aspartate aminotransferases (AST) and alanine aminotransferases (ALT) levels in saliva and serum of insulin-dependent diabetes mellitus (IDDM) and normal children, and the objective was to evaluate the significance of these enzymes in assessing the salivary gland injury in IDDM children. MATERIALS AND METHODS: The study group comprised of thirty children clinically and biochemically diagnosed for IDDM and thirty healthy children of similar age in the control group. Saliva and serum samples were collected and enzyme assay was performed by optimized ultraviolet test method (according to International Federation of Clinical Chemistry). The values obtained were subjected to statistical analysis using Mann-Whitney U-test for comparison of the variables and Karl-Pearson's coefficient test for correlation. The SPSS 16.0, (SPSS Inc., Chicago, USA) was used for statistical analysis. RESULTS: Higher values of AST (mean = saliva 91.60 IU/L) and ALT (mean = saliva 94.93 IU/L) were found in the saliva than in serum (AST serum = 15.83 IU/L) (ALT serum = 20.80 IU/L) among the patients and the differences were statistically highly significant (P = 0.001). A similar comparison in the control group did not show statistical significant difference (saliva - AST mean = 23.50 IU/L, ALT mean = 21.95 IU/L and serum - AST mean = 12.60 IU/L, ALT mean = 13.25 IU/L). On correlation between patient and normal group, greater values of AST and ALT were observed in saliva of patients and the difference was statistically highly significant ([AST-mean = patients 91.166 IU/L and controls = 23.500 IU/L] [ALT-mean = patients 94.933 IU/L and controls 21.950 IU/L]). The serum values of patients and controls did not show statistical difference. Although higher values of salivary ALT and AST were observed in patients with the disease for 0-5-year clinical duration (ALT mean = 100.21 IU/L and AST mean = 95.39 IU/L) than those with the disease for 6-10-year duration (ALT mean = 77.57 IU/L and AST mean = 77.28 IU/L), values were statistically nonsignificant. CONCLUSION: Elevated salivary AST and ALT levels in IDDM patients suggest the injury to salivary glands and could aid as a salivary marker for the involvement of salivary glands in IDDM.

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BACKGROUND: Many pathogenic fungi fluoresce in hematoxylin and eosin stained sections, and Papanicolaou (PAP)-stained smears under ultraviolet illumination. In theory, this phenomenon could aid in the diagnosis of common fungal infections without the delay which is usually associated with special stains. OBJECTIVE: To evaluate the role of fluorescence as a rapid screening technique for oral infections caused by Candida organisms in exfoliative smears of oral candidiasis. MATERIALS AND METHODS: Two smears and one swab were collected from each of 62 clinically diagnosed cases of oral candidiasis. Smears were stained with (PAP) and periodic acid-Schiff stain (PAS). Both smears were evaluated under light microscopy (LM). Later, PAP smears were observed under fluorescent microscopy (PAP-FM). The swab was inoculated on Sabouraud's agar plate. Each technique was evaluated for sensitivity and specificity. RESULTS: It was found that the PAS-stained smears were more reliable for detection of Candida species than other methods (sensitivity = 100%; specificity = 66.7%). The PAP-LM and PAP-FM showed less sensitivity (67.9% and 85.7%) and specificity (66.7% and 33.3%), respectively. Combined results of both light and fluorescent microscopy of PAP (LM + FM) showed increased sensitivity (89.3%) but reduced specificity (16.7%). CONCLUSION: PAP autofluorescence is less sensitive than PAS, still it accentuates the distinct morphological features of Candida.

Asunto(s)

Candida/aislamiento & purificación , Candidiasis Bucal/diagnóstico , Microscopía Fluorescente/métodos , Coloración y Etiquetado/métodos , Candida/patogenicidad , Humanos , Hifa , Microscopía/métodos , Prueba de Papanicolaou/métodos , Reacción del Ácido Peryódico de Schiff/métodos , Sensibilidad y Especificidad

RESUMEN

AIM: Oral mucositis induced by radiation is an inevitable but transient side-effect of radiotherapy. Acute phase proteins are a class of proteins whose phase concentrations fluctuate in response to inflammation. The best known of the acute phase proteins is C-reactive protein, a protein that rises in the blood with inflammation. MATERIALS AND METHODS: 30 patients undergoing chemo - radiotherapy for head and neck cancer were clinically evaluated for mucositis on day 0, 7, 14, 28 and 42. Blood investigations like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were also conducted. RESULTS: There was a significant increase in the severity of mucositis during the course of treatment followed by a gradual decrease in severity towards the end of radiotherapy. Comparison of C-reactive protein levels from day 0 to day 42 in the study group showed a significant increase towards the end of radiotherapy. There was a significant increase in erythrocyte sedimentation rate levels till day 14 followed by a decrease towards the end of radiotherapy whereas total leukocyte count showed a significant decrease from day 0 to day 7 followed by an increase towards the end of radiotherapy. CONCLUSION: The oral mucosa bears only a small clinical spectrum of the side-effect conveyed by chemo-radiation. Both widespread and late effects do occur, and tissues may never return to normal completely. Inflammatory serum markers like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count can thus be used as an objective measure to study the complexities of radiation mucositis which is documented as one of the worst side effects of head and neck cancer therapy.