Trends in gynecological cancer incidence, mortality, and survival among elderly women: A SEER study.

Objectives: This paper aims to comprehensively analyze trends in gynecological cancers among elderly women in the United States from 1975 to 2020. Methods: Surveillance, Epidemiology, and End Results (SEER) population data were utilized for the analysis. Annual Percentage Change (APC) and Average APC were estimated using join-point regression to assess trends in mortality rates. Results: The study reveals an increasing pattern of incidence and mortality in all gynaecological cancer sites except cervical cancer among elderly. The incidence of cervical cancer decreased from 1975 to 2007 and then increased, whereas cancer-specific mortality decreased from 1977 to 2020, indicating positive advancements in detection and treatment. Conclusions: Despite progress in managing certain gynecological cancers, challenges persist, particularly evidenced by increasing mortality rates for cancers in other female genital organs. This underscores the necessity for sustained research efforts and targeted interventions to address these ongoing challenges effectively.

SARS-CoV-2 seroprevalence in patients with autoimmune rheumatic diseases versus family controls: a multi-city cross-sectional survey.

There is uncertainty regarding the effect of the SARS-CoV-2 infection on patients with autoimmune rheumatic diseases (AIRD) who are on immunosuppressive drugs. We did a multicity cross-sectional seroprevalence study conducted in five different cities in India before COVID-19 immunization. Patients with a diagnosis of AIRD and DMARDs were included. Relatives of the patients, preferably staying in the same household with no known rheumatic diseases served as controls. Serum IgG antibodies to SARS-CoV-2 Receptor Binding Domain (RBD) of the spike protein and nucleoprotein (NP) were assayed in eight hundred and eighty nine sera (subjects with disease = 379 and in subjects without disease = 510). IgG antibodies to either RBD and/or NP were positive in 135 (36%) subjects with AIRD as compared to 196 (38%) controls. The seroprevalence of anti-RBD and anti-NP varied between different cities but was not significantly different between subjects with and without disease in Mumbai, Ahmedabad, Bengaluru and Bhubaneswar. However, the occurrence of IgG antibodies to RBD was significantly (p < 0.05) lower in subjects with disease (28/65;43%) as compared to subjects without disease (42/65;65%) in Kolkata, where the positivity rate was lower in connective tissue disease group than in inflammatory arthritis group. Overall, patients with rheumatic diseases on DMARDs have IgG antibodies to RBD and NP of SARSCoV-2 at a comparable level with that of subjects without disease, but the level of antibodies to RBD is lower in patients with connective tissue disease on immunosuppressive drugs in one centre.

Nintedanib vs pirfenidone in the management of COVID-19 lung fibrosis: A single-centre study.

BACKGROUND: COVID-19 pneumonia is complicated with residual lung fibrosis, as evidenced by imaging and postmortem pathological findings. In addition to steroids, we compared the efficacy of nintedanib and pirfenidone in the management of COVID-19 lung fibrosis measured by CT severity score (CTSS). METHODS: All cases of COVID-19 pneumonia diagnosed as COVID-19 positive by RT-PCR having SpO2 ⩽ 96% and CTSS ⩾ 10 even after 15 days were included in the study. The patients were divided into three groups. All three groups received steroids at a dose of 1 mg/kg body weight of prednisolone or equivalent. The first group received steroids alone, the second group received pirfenidone with steroids and the third group received nintedanib with steroids. All patients were followed up at 6 and 12 weeks. The primary endpoint of our study was to find out any improvement in CTSS. RESULTS: Out of 90 patients, 56 patients completed the study. Among three groups, 19 (33.9%) patients received steroids (control) only, 16 (28.6%) patients received steroids with pirfenidone and 21 (37.5%) patients received steroids with nintedanib. The study population had a mean (±SD) age of 52.5 ± 10.1 years, mean (±SD) C-reactive protein of 97.1 ± 102.2 mg/L (normal <6 mg/L), mean (±SD) serum ferritin 459.4 ± 305.5 ng/mL (normal <250 ng/mL), mean (±SD) serum d-dimer level 2.1 ± 2.6 µg/mL (normal <0.5 µg/mL) and mean (±SD) CTSS of 16.9 ± 4.3. There was significant improvement in CTSS in group receiving nintedanib compared to pirfenidone at 12 weeks (3.67 ± 1.21 vs 9.07 ± 1.12) with a p-value <0.01. CONCLUSION: Along with steroids in the treatment of COVID-19 lung fibrosis, there was a significant improvement in lung CTSS with nintedanib compared to pirfenidone.

Poorer Obstetrics Outcomes During the Second Wave of COVID-19 in India.

Introduction: Outcomes of pregnancy in COVID 19-infected mothers are worse than in the general population. Due to immunological changes, antenatal women are more vulnerable to severe complications. The India has experienced two waves of the disease. We analysed whether the second wave of the disease had affected pregnancy outcomes differently by comparing pregnancy outcomes with those of the first wave. Materials and Method: The study population included all the women delivered in the same tertiary centre during both the waves. Maternal outcome parameters include maternal oxygen requirement, maternal ICU admission and maternal death. Foetal outcome parameters include APGAR scores, preterm deliveries and NICU admissions, maternal and foetal outcome parameters between the first and the second waves were compared. Results: Demographic parameters were similar in both the waves of COVID 19. No significant differences were found in pre-pregnancy comorbidities, high-risk pregnancies and mode of deliveries between the two waves. Maternal oxygen requirement increased in the second wave [first wave 6(4.7%) vs second wave 25(40.3%) (p-value < 0.001)]. There was also a significant increase in ICU admission [4(3.1%) vs 8(12.9%)], which was in positive correlation with maternal oxygen requirement during the second wave (r = 0.81, p < 0.001). However, there was no significant difference in maternal death [2(1.6%) vs 2(3.2%)]. No significant change noted in neonatal outcomes except for an increase in neonatal sepsis [0 vs 5(8.1%)]. Conclusion: Mothers had more severe diseases during the second wave. But this did not translate into significant increase in maternal mortality and poor neonatal outcomes, possibly due to better preparedness.

Water, Sanitation, and Hygiene (WaSH) practices and morbidity status in a rural community: findings from a cross-sectional study in Odisha, India.

INTRODUCTION: Global evidence indicates an association between poor WaSH practice and inferior health outcomes. In rural areas, this practice is predominantly compromised with limited access to safe drinking water, knowledge gaps, and unhealthy socio-behavioural practices. Suboptimal WaSH practice leads to increased vulnerability of various infections, thereby posing a challenge to the primary health care system. METHODS: A community based cross-sectional study was conducted among 879 participants of two villages in Tigiria block, Cuttack district, Odisha, India. Information pertaining to socio-demography, WaSH practices and self-reported morbidities were captured and analysed. Bi-variate analysis was done to assess the association between WaSH practices and any acute illnesses. Differences were considered statistically significant if p-value was less than 0.05. RESULTS: Tube well was the main source of drinking water (49.3%) followed by dug well (46.6%). Only 7.1% of participants reported to purify drinking water and around 40% were still practicing open defecation. The prevalence of acute and chronic illnesses was 9.2% and 19.1% respectively. Major acute illnesses were respiratory diseases, diarrhoeal disorders, and musculoskeletal problems, while major chronic illnesses were gastrointestinal problems, musculoskeletal problems, and hypertension. After adjusting for age, gender, and education, a significant odds ratio of 3.79 [CI = (1.23-11.70)] was observed between drinking water source (surface water Vs tube well water) for acute illnesses. CONCLUSIONS: Poor WaSH practices among rural people make them vulnerable to acute and chronic morbidities. Health awareness and socio behavioural changes pertaining to WaSH practices need utmost priority to ensure better health for rural people of Odisha.

Forecasting suicide rates in India: An empirical exposition.

INTRODUCTION: Suicide is a major social and health issue in India. Yearly statistics show a concerning increasing pattern of suicidal deaths in India which is higher in comparison to the global trend. There is limited evidence regarding historical analysis of suicide or any forecasting for suicide in India towards predicting the possible risks of death due to suicide. METHODS: This paper examines the trend of suicide rate and characteristics of suicide victims in India, based on the longitudinal time series data over the last 50 years-collected from the National Crime Record Bureau Reports (1969 to 2018) of the Government of India. In our analysis, we have used the time series model to forecast the suicide rates in India for the next decade. ARIMA (4,1,0) model is found to be the best fit model for forecasting the data. FINDINGS: There has been an observable and rising trend of suicide rates in India over the last five decades. The forecast indicates a continuance of rising suicide cases for an upcoming couple of years in India with a limited decline in the following years. The prediction model indicates a future relatively consistent pattern of suicide in India which does not seem to be a very encouraging trend. As we have not included the period staring the year 2020 onwards affected by Covid-19 and which has several disruptions in personal and family spaces, the projected suicide trend during the period of next two to three years (2020-22) may rise far high and then it may show a declining path. Along with this, there is a shift in means of suicide in the last couple of decades. Constituting the second-highest number of cases, Illness associated suicide was visibly a serious concern. CONCLUSION: The present analysis finds that there is no visible substantial relief for suicide deaths during the coming years in India. On the other hand, more extensive exploration of sample cases may provide important information for suicide prevention. Availability of detailed and more inclusive data will be highly useful for analysis and suicide preventive policies. Investment in public health care and other welfare activities like education and employment generation will yield visible positive results in suicide control.

Determinants of home deliveries - Findings from India DLHS 4 analysis.

BACKGROUND: Place of delivery has major implication on decreasing maternal morbidity and mortality. India has adopted various policies to encourage institutional births, still there are large numbers of deliveries which occur at home. Thus, it is imperative to understand the risk factors associated with home deliveries among women in India. METHODS: The national representative district level household data-4 (2012-13) have been used for this analysis. A multiple logistic regression model has been used to determine the significant factors associated with home deliveries. RESULTS: A total of 22,363 live births were selected for analysis for the year 2012. Out of which 3,602 (15.4%) are found to be home delivery births, remaining are either private or government institutional births. North-east states are found to be high prevalence of home deliveries. The potential factors viz., age of women, educational level of both husband and wife, age at first birth, higher order parity and not registered for ANC check-up, etc., are significantly associated with home delivery birth preferences among women in India. CONCLUSION: Our analysis demonstrates that targeting the significant predictors particularly education of family members and compulsory registration for ANC check-up will significantly reduce the preference for home delivery.

Intrapartum monitoring using partograph at secondary level public health facilities-A cross-sectional study in Odisha, India.

CONTEXT: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. AIM: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities. SETTINGS AND DESIGN: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. STATISTICAL ANALYSIS USED: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. RESULTS: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. CONCLUSIONS: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting.

Epidemiology of obesity and its related morbidities among rural population attending a primary health centre of Odisha, India.

CONTEXT: Overweight and obesity has become a major contributor to global burden of chronic diseases and disability. Obesity among rural India is emerging as a major health problem because of change in lifestyle and food habits, thereby increases the risk of multiple morbid conditions among rural population. AIMS: This study aims to find out the association of overweight/obesity with different socio-demographic factors and explore the co-morbidities among overweight and obese in a rural setting. SETTINGS AND DESIGN: A cross-sectional study was done in a randomly selected primary health centre of Khurda district, Odisha for 4 months. MATERIALS AND METHODS: This study was done among 183 patients aged >20 years with BMI >25 kg/m2 after taking their consent. Anthropometric measurements were done and data were collected using a semi-structured questionnaire. STATISTICAL ANALYSIS USED: Descriptive statistics such as proportion, mean and standard deviation were calculated and inferential statistics such as Chi-square test, univariate and multivariate regression was done using the SPSS version 20.0. RESULTS: Mean age of participants was 45.7 (±13.8) years. About 93.4% were Grade II obese while 51.9% were at risk according to their waist-hip ratio. Around 53.6% of participants had multi-morbidity. Age, occupation and number of children were significantly associated with obesity. Morbidity was significantly associated with age, occupation, marital status and number of children. Increased grade in obesity the more is the probability of having morbidity. CONCLUSIONS: There is an urgent need to screen for obesity at rural health facility and early management for prevention from co-morbidities.

Suppression of prostate tumor cell growth in vivo by WT1, the Wilms' tumor suppressor gene.

The primary form of therapy for prostate cancer is androgen ablation resulting in apoptosis and expression of apoptotic genes (i.e. par-4). Prostate cancer cells that survive androgen ablation therapy express pro-survival genes (i.e. bcl-2) permitting these androgen independent (AI) cells to overcome apoptotic signals and proliferate in the absence of normal growth signals. To disrupt tumor growth and progression to AI, we expressed the tumor suppressor gene, WT1 in LNCaP prostate tumor cells. The WT1 transcription factor modulates expression and activity of several prostate growth control genes (i.e. par-4, bcl-2 and AR) in vitro. To provide insight into potential mechanisms of prostate cancer growth suppression both the transcriptionally active form of wild-type WT1 (D) and an inactive WT1 (D) R394W mutant form were stably transfected in LNCaP cells. Surprisingly both transfected lines underwent apoptosis and were growth suppressed in nude mice. A 3-fold reduction in overall tumor incidence and volume was associated with increased apoptosis, as evidenced by DNA fragmentation and par-4 expression, and was reduced or absent in early forming LNCaP tumors. After several months the indolent WT1-LNCaP cells became proliferative forming small tumors lacking par-4 protein. Although bcl-2 protein was present in all LNCaP tumors at this late-stage, it was detected in only a minority of WT1-LNCaP tumors, suggesting that pro-survival signals continued to be reduced in WT1-suppressed tumor cells. While the mechanisms of WT1-mediated growth suppression and apoptosis in LNCaP tumor cells are unknown, our results argue against simple transcriptional regulation since the mutant WT1 (D) R394W suppressed tumor formation similarly to wild-type WT1. This suggests that the mechanism of WT1-mediated growth suppression does not rely upon DNA binding at known WT1 recognition sites.

Purification, characterization, antibacterial activity and N-terminal sequencing of buffalo-milk lysozyme.

Lysozyme from buffalo milk was purified to homogeneity and its N-terminal amino acid sequence, biochemical properties and antibacterial spectrum were determined. The purification procedure, comprising ion-exchange chromatography using CM-cellulose and size-exclusion chromatography using Sephadex G-50, conferred 8622-fold purification and 39.3% recovery of lysozyme. The purified enzyme migrated as a single band on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and native PAGE. Immunological purity of lysozyme preparation was confirmed by immuno-electrophoresis. Molecular weight of buffalo-milk lysozyme as determined by SDS-PAGE was 16 kDa and its amino acid composition was determined by reverse phase high performance liquid chromatography (HPLC). The sequence of 23 amino acid residues at the N-terminal end showed 56.5% homology with bovine milk lysozyme and 30.4% with equine milk lysozyme. The specific activity of buffalo milk lysozyme was ten-times that of bovine milk lysozyme. Buffalo-milk lysozyme was active over a wide range of pH and its activity was strongly influenced by molarity of the medium. Antibacterial activity of buffalo-milk lysozyme was determined against 11 species of bacteria; out of seven Gram-positive bacteria tested, four were inhibited, while Gram-negative bacteria were resistant.