TitleInterventions for the treatment of metastatic extradural spinal cord compression in adults AuthorsGeorge R, Jeba J, Ramkumar G, et al. JournalCochrane Database of Systematic Reviews Date of Publication2015 (Issue 9; CD006716) Clinical Background – MESCC is an oncological emergency. Early preservation of ambulation is the strongest predictor of functional outcome and independence. Management is primarily… — read more

TitlePalliative biliary stents for obstructing pancreatic carcinoma AuthorsMoss AC, Morris E, Leyden J, MacMathuna P. Date of publicationCochrane Database of Systematic Reviews, 2006. Endoscopic stenting is the preferred first-line palliative intervention over surgical bypass in most patients with unresectable malignant obstruction. Major limitation: Choice of stent is primarily determined by expected survival. Metal stents: This… — read more

Always replace cortisol before starting thyroid hormones in a case of suspected hypopituitarism or combined thyroid and adrenal insufficiency, as increased metabolism related to the catabolic effects of Thyroid hormones might precipitate adrenal insufficiency and cardiovascular collapse. Thyroxine increases basal metabolic rate, oxygen consumption, and hepatic clearance of cortisol. Steroid equivalence Hydrocortisone 20 mg =… — read more

Important pointers Routine pre-operative stenting is not advised in those fit for surgery. Metallic stenting may be attempted when surgery is being planned in the future for temporarily unfit patients. Endoscopic stenting is preferred over surgical bypass for palliation of symptoms. Indications References National Institute for Health and Care Excellence. (2018).Pancreatic cancer in adults: Diagnosis… — read more

Favorable pointers for stenting Dilated ducts (>3 mm)Significance: Indicates a decompressed upstream biliary tree that provides an accessible target for guidewire passage and stent placement.Clinical implication: Higher technical success with more effective biliary drainage and earlier relief of jaundice and pruritus. Clear level of obstruction.Significance: Allows accurate planning of the stent length and position, reducing… — read more

Indicators of significantly poor prognosis:a. Intramedullary T1 hypointensityRepresents irreversible cord injury due to myelomalacia, necrosis, or chronic ischemia. b. Long-segment T2 hyperintensityIndicates extensive cord edema or ischemic injury across multiple segments from sustained compression. c. Complete CSF effacement with cord flatteningSignifies critical mechanical compression with loss of the protective CSF buffer around the cord. d.… — read more

The addition of clonidine to a multimodal regimen containing amitryptiline might potentially offset its anti-hypertensive effect and prove to be of some utility in advanced disease. References Wilcock, A., Howard, P., Stark Toller, C., Droney, J., & Charlesworth, S. (Eds.). (2025). Palliative care formulary (9th ed.). Pharmaceutical Press. — read more

Sequential withdrawal – The following order may be followed, while attempting rationalization of treatment, in advanced ILD Non-essential or duplicate therapies – multivitamins, anti-oxidants, duplicate bronchodilators and proton pump inhibitors. Long term preventive medications – statins, low-dose aspirin, bisphosphonates, those intended for tight glycemic and strict glycemic control. Disease-modifying therapies with limited benefit – Immunosuppressants… — read more

The following pointers might be used as potential identifiers: Chronic opioid exposure shifts pain processing from:Inhibitory to facilitatory,Localized to diffuse and Tissue-linked pain generators to centrally maintained nociception. References Mao, J. (2002). Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain, 100(3), 213–217. https://doi.org/10.1016/S0304-3959(02)00352-0Chu, L. F., Angst, M. S., & Clark, D. (2008). Opioid-induced… — read more

In addition to assessing caregiver needs, the CSNAT (Caregiver Support Needs Assessment Tool), envisages the following as part of a five-stage approach: a)Framing the assessment- Introduction of CSNAT – addresses role captivity and moral inhibition. b)Needs identification – CSNAT Completion – assessment of needs across 14 domains – conversion of diffuse burden into structured needs.… — read more