Community Health Worker Training Curricula and Intervention Outcomes in African American and Latinx Communities: A Systematic Review.

In recent years, community health workers (CHWs) have emerged as key stakeholders in implementing community-based public health interventions in racially diverse contexts. Yet little is known about the extent to which CHW training curriculums influence intervention effectiveness in marginalized racial and ethnic minority communities. This review summarizes evidence on the relationship between CHW training curricula and intervention outcomes conducted among African American and Latinx populations. We conducted a literature search of intervention studies that focused on CHW public health interventions in African American and Latinx populations using PubMed, PsycINFO, ERIC, CINAHL, EMBASE, and Web of Science databases. Included studies were quantitative, qualitative, and mixed methods studies employed to conduct outcome (e.g., blood pressure and HbA1c) and process evaluations (e.g., knowledge and self-efficacy) of CHW-led interventions. Out of 3,295 articles from the database search, 36 articles met our inclusion criteria. Overall, the strength of evidence linking specific CHW training curricula components to primary intervention health outcomes was weak, and no studies directly linked outcomes to specific characteristics of CHW training. Studies that described training related to didactic sessions or classified as high intensity reported higher percentages of positive outcomes compared to other CHW training features. These findings suggest that CHW training may positively influence intervention effectiveness but additional research using more robust methodological approaches is needed to clarify these relationships.

Initial experience with first-line pazopanib in the treatment of metastatic renal cell carcinoma: A single institution data.

INTRODUCTION: Pazopanib is one of the recently introduced first-line therapeutic options in the treatment of metastatic renal cell carcinoma (mRCC). There is no published literature from India on the use of pazopanib in mRCC. MATERIALS AND METHODS: We report the efficacy and toxicity analysis of first-line pazopanib therapy administered for patients with mRCC at our institute. It is a retrospective analysis of a prospectively maintained continuous data. RESULTS: Between March 2013 and December 2015, 28 patients have been treated with pazopanib. The median age was 56.5 years with 23 males and five females. Sixty-eight percent patients had clear-cell histology. The most common site of metastasis was lung (75%), followed by bone (36%), liver (25%), and brain (14%) with 43% having more than one metastatic site. Partial response, stable disease, and progression were observed in 3 (11%), 10 (36%), and 4 (14%) cases, respectively, and the response was not evaluable in 11 patients. The median follow-up duration was 11.8 months, and progression-free survival was 5.9 months. Most of the toxicities were Grade I-II except in three patients who experienced Grade III hand-foot syndrome (HFS) and one patient who had Grade III anemia. Common side effects were hypertension, HFS, fatigue, transaminitis, hyperglycemia, dyslipidemia, and proteinuria which were quite manageable. No patient required treatment discontinuation due to toxicity. CONCLUSION: Based on this initial experience at our center, pazopanib seems a feasible first-line treatment for mRCC due to its well-tolerable toxicity profile. However, larger data are required to confirm its efficacy in Indian patients.

Patterns of care and outcomes for second-line targeted therapy in metastatic renal cell carcinomas: A registry based analysis.

AIM: Patterns of care for metastatic renal cell carcinomas (mRCC) have seen tremendous reform in the last decade. Here, we present our pattern of care in second-line targeted therapy for mRCC. METHODS: Patients with mRCC treated with second-line therapy were included from a prospective database. Demographics, risk stratification, and treatment details were noted. Event-free survival (EFS) and overall survival (OS) was calculated using Kaplan-Meier method. Log-rank test was used to identify factors affecting EFS and OS. Multivariate analysis was performed using cox regression. RESULTS: Nearly 21.7% (46/212) of patients received second-line targeted treatment. Heng score for risk stratification showed 21.7% of patients in low risk, 36.9% in intermediate, and 34.8% in high risk group. Everolimus followed by pazopanib were the most common second-line therapies used in 65.2% and 13% of patients, respectively. The estimated median EFS was 3.5 months (95% confidence interval [CI] 2.7-4.26 months) and estimated median OS from the start of second-line therapy was 6.2 months (95% CI 3.4-9.0 months) with a median follow-up of 4.3 months. On univariate log-rank analysis, EFS of more than 6 months with first-line therapy was associated with improvement in EFS with second-line therapy (9.5 vs. 2.0 months; hazard ratio (HR) 0.364; P = 0.002). There was no factor independently associated with EFS or OS on multivariate analysis. CONCLUSION: Patterns of care for second line targeted therapy tend to vary with setting. A longer EFS with first-line therapy predicts improved outcomes with second-line treatment.

Efficacy and safety of sorafenib in advanced renal cell cancer and validation of Heng criteria.

INTRODUCTION: Sorafenib is an established upfront treatment option for metastatic RCC (mRCC). There is no published literature regarding its performance in Indian Patients. We present an analysis of Sorafenib use in our institute and attempt to validate the Heng criteria as a prognostic score in these patients. MATERIALS AND METHODS: Patients who received Sorafenib as first line treatment for advanced RCC from June 2012 to December 2015 were prognosticated by Heng criteria and retrospectively analysed for baseline demographics, toxicity, response and outcomes. RESULTS: 82 patients (65 males, 17 females) with a median age of 57 years were included for final analysis. Median ECOG PS was 1, 95.2 % of the patients had Stage IV disease and clear cell was the predominant histology (79.4%). 23.2%, 42.7% and 34.1% of patients were classified as low, intermediate and high risk by Heng's criteria, respectively. Dose reduction was required in 24.4% of patients, while 14.6% required permanent cessation of Sorafenib due to intolerable or recurrent side effects. Common adverse events included HFS (68.2%), mucositis (35.3%), fatigue (35.3%), rash (32.9%) and hypertension (25.6%). Response rate observed was 18.2%, while clinical benefit rate was 57.2% in the 57 patients where response was evaluable. Median progression free survival was 7.75 months (5.45-10.05) and median overall survival (OS) was 12.18 months (9.61 - 14.76). Median OS was 19.6, 16.1 and 10.3 months respectively for low, intermediate and high risk patients by Heng criteria and the criteria was statistically discriminatory for the 3 groups for OS (p=0.045, chi-square test). CONCLUSION: Sorafenib is a viable upfront treatment option for metastatic RCC in Indian patients with acceptable PFS, although a high incidence of HFS, mucositis and rash is observed. The Heng score has discriminatory value in mRCC with Sorafenib and can be considered for routine use in the clinic.

Retromolar trigone squamous cell cancers: a reappraisal of 16 section MDCT for assessing mandibular invasion.

AIM: To reinvestigate the accuracy of 16 section multidetector computed tomography (MDCT) in assessing mandibular invasion in retromolar trigone (RMT) squamous cell cancers (SCC). MATERIALS AND METHODS: A search for diagnosed cases of early RMT SCC that were both imaged and treated at Tata Memorial Centre, Mumbai, India, between 2007 and 2010, was undertaken and yielded 37 patients. The average tumour size was 2.6 cm. All patients had undergone segmental, marginal, or hemimandibulectomy within 2 weeks of imaging. Imaging records archived on the picture archiving and communication system (PACS) were analysed. Contrast-enhanced CT had been performed using a 16 section MDCT system using the puffed-cheek technique. Image acquisition was at 2.5 mm section thickness, but axial images and isotropic coronal and sagittal multiplanar reformations were generated ad hoc from 0.625 mm retro-reconstructed images. Optimal oblique reformations were generated at will by the radiologist to depict the RMT in its entirety. The soft-tissue algorithm and bone window or bone algorithm reformations and axial images were analysed on a volume viewer integrated within the PACS using triangulation. Two investigators independently studied the images and these were compared with the findings at histopathology. RESULTS: The sensitivity, specificity, and accuracy of 16 section MDCT for mandibular cortical and marrow invasion was 94, 90, and 91.8% and 83, 92, and 89%, respectively. Use of ad hoc generated oblique reformation contributed to the enhanced sensitivity and specificity. The accuracy for inferior alveolar canal invasion was 100%. There was excellent agreement between the two observers. CONCLUSION: Sixteen-section MDCT used to its full potential has high accuracy for the detection of mandibular invasion in RMT SCC.

Early treatment of a quetiapine and sertraline overdose with Intralipid.

We describe the initial management and subsequent recovery of a 61 year-old male patient following attempted suicide by oral ingestion of a potentially fatal overdose of quetiapine and sertraline. Intravenous Intralipid was given soon after initiation of basic resuscitation. There was a rapid improvement in the patient's level of consciousness. No other clinical signs of drug toxicity were observed. Intralipid may have reversed the deep coma associated with ingestion and prevented other manifestations of drug toxicity occurring, thus expediting this patient's recovery.

Variable adherence of fimbriated Haemophilus influenzae type b to human cells.

The attachment of isogenic fimbriated and nonfimbriated Haemophilus influenzae type b variants to human cells was studied by using a radioactive assay and an indirect immunofluorescent assay. As described previously, fimbriated H. influenzae variants adhered to a greater extent than nonfimbriated variants to human buccal epithelial cells (2.1 and 0.29 bacteria per cell, respectively, as determined by the radioactive assay [P less than 0.05]; 7.6 and 1.6 bacteria per cell, respectively, as determined by the immunofluorescent assay [P less than 0.01]). As the concentration of fimbriated bacteria was increased, so were the numbers of adherent bacteria; in contrast, increasing the bacterial concentration had a much smaller effect on adherence of nonfimbriated H. influenzae type b. The distribution of bacteria on the buccal cells also differed. Whereas 37% of the buccal cells failed to bind nonfimbriated H. influenzae type b, failure to bind was observed for only 4% of the buccal cells exposed to fimbriated H. influenzae. In contrast, adherence to human foreskin fibroblasts was low regardless of the presence of fimbriae. On the other hand, fimbriated H. influenzae type b adhered less well than nonfimbriated variants to HEp-2 cells (1.6 and 3.8 bacteria per cell, respectively, as determined by the radioactive assay [P less than 0.05]; 1.3 and 4.8 bacteria per cell, respectively, as determined by the immunofluorescent assay [P less than 0.02]). Whereas adherence to HEp-2 cells increased considerably as the concentration of nonfimbriated bacteria was increased, there was only a small enhancement of adherence with an increase in the concentration of fimbriated H. influenzae type b. Furthermore, only 16% of the HEp-2 cells failed to bind nonfimbriated H. influenzae type b, whereas 50% failed to bind fimbriated H. influenzae type b. These data indicate that H. influenzae type b may contain two adhesins. One is associated with fimbriae and enables adherence to buccal cells, whereas the other is nonfimbrial and is associated with adherence to HEp-2 cells. It is not known whether either of these adhesins plays a role in pathogenesis.