Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis

ABSTRACT OBJECTIVE To present the overall survival rate for lung cancer and identify the factors associated with early diagnosis of stage I and II lung cancer. METHODS This is a retrospective cohort study including individuals diagnosed with lung cancer, from January 2009 to December 2017, according to the cancer registry at UMass Memorial Medical Center. Five-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. Factors associated with diagnosing clinical stage I and II lung cancer were identified by bivariate and multivariate backward stepwise logistic regression (Log-likelihood ratio (LR)) at 95% confidence interval (CI). RESULTS The study was conducted with data on 2730 individuals aged 67.9 years on average, 51.5% of whom female, 92.3% white, and 6.6% never smoked. Five-year overall survival was 21%. Individuals diagnosed with early-stage disease had a 43% five-year survival rate compared to 8% for those diagnosed at late stages. Stage at diagnosis was the main factor associated with overall survival [HR = 4.08 (95%CI: 3.62-4.59)]. Factors associated with early diagnosis included patients older than 68 years [OR = 1.23 (95%CI: 1.04-1.45)], of the female gender [OR = 1.47 (95%CI: 1.24-1.73)], white [OR = 1.63 (95%CI: 1.16-2.30)], and never-smokers [OR = 1.37 (95%CI: 1.01-1.86)]; as well as tumors affecting the upper lobe [OR = 1.46 (95%CI: 1.24-1.73)]; adenocarcinoma [OR = 1.43 (95%CI: 1.21-1.69)]; and diagnosis after 2014 [OR = 1.61 (95%CI: 1.37-1.90)]. CONCLUSIONS Stage at diagnosis was the most decisive predictor for survival. Non-white and male individuals were more likely to be diagnosed at a late stage. Thus, promoting lung cancer early diagnosis by improving access to health care is vital to enhance overall survival for individuals with lung cancer.

Clinical and Microbiological Profile of Chronic Osteomyelitis Cases with Reference to Virulence Markers in Staphylococcus aureus.

Due to increase in road traffic accidents resulting in compound fractures and also increase in the number of orthopaedic surgeons using implants, iatrogenic and chronic osteomyelitis is being encountered more frequently. The objective of this study was to describe clinical and microbiological characteristics of acute and chronic osteomyelitis with regard to virulence markers and antibiogram of isolates to prevent unnecessary morbidity and mortality.METHODSA total of 148 samples like pus or exudates or pieces of necrotic tissues were collected during surgery, if possible, otherwise aspirated. All samples were subjected to Gram staining and culture. Various organisms were identified by standard methods. Various virulence determinants were detected by phenotypic tests. Kirby-Bauer method was employed to perform the antimicrobial susceptibility on Mueller-Hinton agar [MHA]. For detection of methicillin-resistant Staphylococcus aureus (MRSA), MHA supplemented with 4% NaCl was used.RESULTSOut of the 148 cases studied, 110 (74.3%) were male and 38 (25.6%) were female. The predominant number of osteomyelitis cases was found in the age group of 26-30 years, of these 48.5% (16/33) occurred following orthopaedic implants and 24.2% (8/33) due to post-operative wound infections. Staphylococcus aureus was the main isolate [43.9% (58/132)]. Escherichia coli [44.4% (4/9)] was the predominant isolate in the age group 36-40 years. The only isolate in the age group 46-50 years was Pseudomonas aeruginosa [100% (2/2)]. Almost all the bones were involved in all age groups, but spine was mainly infected in the 46-50 years age group. Differences in the presence of clumping factor, DNase, phosphatase, lipase, gelatinase, and presence of haemolysis on blood agar in MRSA were statistically insignificant (p= 0.13, 0.27, 0.95, 0.22, 0.40, 0.92 respectively) as compared to MSSA strains.CONCLUSIONSMRSA strains expressing some virulence factors with multi drug resistance might play a role in pathogenesis of osteomyelitis. Therefore, novel therapeutics targeting these virulence markers, instead of conventional antibiotic therapy, as well as following new guidelines, should take place in the fu­ture that might aid in the prevention and control of MRSA infections in our hospitals

Perceptions And Attitude Towards The Use Of Generic Drugs By Oncologists From Emerging Markets: A Multinational Cross Sectional Survey

Introduction Generic drugs provide same therapeutic effect as an originator, at more affordable price. Still, they are not best adopted. We conducted a survey to understand oncologist’s perceptions and attitudes towards generic drugs and understand factors that influence their prescribing behavior. Methods Oncologists from 15 countries were invited for this cross-sectional survey. Assessment was completed using a series of structured, closed qualitative questions to which participants could select from predefined answers. Results Fifty three oncologists participated in the. About 70% oncologists acknowledged high-cost of originator drugs often limits providing guidelines based therapy to patients. Most of the participants (86%) opined that quality of generic drugs depends on the manufacturing company. More than 90% respondents agreed that good generic companies often match the quality of originator drugs. Amajority (67.5%) of the oncologists believed that side effects caused by generics were similar to those caused by originator drugs. Conclusions Our finding suggest that educational programs highlighting the benefits of generic drugs should be imparted to the key stakeholder including patients.

Strychnos nux-vomica seeds: Pharmacognostical standardization, extraction, and antidiabetic activity.

Background: Strychnos nux-vomica, commonly known as kuchla, contains strychnine and brucine as main constituents. Minor alkaloids present in the seeds are protostrychnine, vomicine, n-oxystrychnine, pseudostrychnine, isostrychnine, chlorogenic acid, and a glycoside. Seeds are used traditionally to treat diabetes, asthma, aphrodisiac and to improve appetite. Objective: The present study was aimed to evaluate the various pharmacognostical characters and antidiabetic activity of S. nux-vomica seed. Materials and Methods: Pharmacognostical characters were performed as per the WHO guideline. Extraction was carried out in petroleum ether, chloroform, alcohol, hydroalcoholic, aqueous, and phytochemical constituents present in extracts were detected by different chemical tests. Among these extracts hydroalcoholic, aqueous extracts were evaluated for antidiabetic activity on the basis of extractive yield and phytoconstituents, in alloxan-induced diabetic rats using gliclazide as standard. Results: Various analytical values of S. nux-vomica extract were established. Phytoconstituents present in S. nux-vomica extracts were detected. Conclusion: S. nux-vomica extracts show antihyperglycemic activity in experimental animals.

Myasthenia gravis and acute respiratory muscle paralysis following wasp sting.

A 34-year-old lady presented with generalised weakness of body, indistinguishable from myasthenia gravis within 24 hours of a wasp sting. Respiratory muscle paralysis leading to respiratory failure developed and mechanical ventilatory support was required. The patient made an uneventful recovery.