People with TB: DOTS cured me, it will cure you too

Directly Observed Treatment - Short course (DOTS) has been declared as the global strategy for tuberculosis (TB) control by the World Health Organization (WHO) since 1991. This strategy has shown to reverse the TB epidemic in many countries. Principles of the DOTS strategy have had many contributions from research carried out in Indi

Supervising Christian education of Hindu children

https://place.asburyseminary.edu/ecommonsatsdissertations/2168/thumbnail.jp

Cancer in Women

Cancer is emerging as a public health problem among an array of non-communicable diseases. The common cancers in women are breast, cervix uteri, colo-rectum, ovary, corpus uteri, lung and oral cavity. Breast cancer (BC) is the common cancer (20-30% of all cancers in women) and the leading cause of cancer death in women worldwide. About half of the BCs and 60% of the deaths are estimated to occur in economically developing countries. In most of the registries in India, BC is the commonest cancer with the highest incidence of nearly 50 per 100,000 women in Trivandrum. Half of this cancer is reported in <50 years of age and it exercises adverse influence on the productive role of women in the society. The factors that contribute to the international variation in BC incidence rates are largely due to the differences in reproductive and hormonal factors and the availability of early detection services.Gynecological cancers account 15-30% of all cancers in women. Cervix uteri cancer (CC) is the 3rd most common cancer affecting women worldwide, the most common cancer among women in several less developed countries and 2nd common cancer in India. During last few decades, this cancer incidence has been decreased in India. Significant declines in CC are likely due to changes in marriage and family planning, supported by underlying improvements in education and socioeconomic status. In spite of decreasing incidence of this cancer, gynecologic cancers have increased in India. Among these, ovary and corpus uteri cancers are the major contributors. Ovarian cancer (OC) has emerged as one of the common malignancies affecting women in India and is the 5th common cancer in India (4th common in Trivandrum). A steady increase has been observed in OC incidence in several registries including Trivandrum. More than 50% of women with OCareunder the age of 50 years. The risk of it increases in women who have ovulated more over their lifetime. This includes those who begin ovulation at a younger age or reach menopause at an older age. Other risk factors include hormone therapy after menopause, fertility medication and obesity. Factors that decrease risk include hormonal birth control, tubal ligation, and breast feeding. Efforts are to be made to detect ovarian cancer at an early stage by educating population about the risk factors. Corpus uteri cancers (CUC) are most common in western countries but are becoming more common in Asia. In India, the highest CUC incidence rates are observed in Trivandrum and its incidence has been increasing. Presently, it is the 5th common cancer among women in Trivandrum, 75% of women are over the age of 50 years. The risk factors of CUC include obesity, diabetes mellitus, BC, use of tamoxifen, never having had a child, late menopause and high levels of estrogen.Colo-rectal cancer (CRC) is the 2nd most common cancer in women world-wide. The burden of CRC has risen rapidly in some economically developed Asian countries like Japan, South Korea and Singapore. In India, the highest CRC incidence rates are observed in Trivandrum and its incidence has been increasing. Presently, it is the 5th common cancer among women in Trivandrum. The major factors include certain dietary practices and family history of cancer. Individuals with a family history of colon cancer, especially if more than one relative has had the disease, are at increased risk of CRC. Other common cancers in women are tobacco-related cancers such as oral cavity (lip, tongue and mouth) and lung. Declining trends in mouth cancer has been reported in India.Results on the burden, trends in incidence & mortality, risk factors of breast, cervix uteri, ovary and corpus uteri colo-rectal, lung and oral cavity cancers will be presented.Keywords : Cancer in women, breast cancer, cervix uteri cancer, corpus uteri cancer, ovarian cancer, colo-rectal cancer, gynecological cancer, hormone therapy, menopause, oral cavity cancer

Dietary fat and risk of breast cancer

BACKGROUND: Breast cancer is one of the major public health problems among women worldwide. A number of epidemiological studies have been carried out to find the role of dietary fat and the risk of breast cancer. The main objective of the present communication is to summarize the evidence from various case-control and cohort studies on the consumption of fat and its subtypes and their effect on the development of breast cancer. METHODS: A Pubmed search for literature on the consumption of dietary fat and risk of breast cancer published from January 1990 through December 2003 was carried out. RESULTS: Increased consumption of total fat and saturated fat were found to be positively associated with the development of breast cancer. Even though an equivocal association was observed for the consumption of total monounsaturated fatty acids (MUFA) and the risk of breast cancer, there exists an inverse association in the case of oleic acid, the most abundant MUFA. A moderate inverse association between consumption of n-3 fatty acids and breast cancer risk and a moderate positive association between n-6 fatty acids and breast cancer risk were observed. CONCLUSION: Even though all epidemiological studies do not provide a strong positive association between the consumption of certain types of dietary fat and breast cancer risk, at least a moderate association does seem to exist and this has a number of implications in view of the fact that breast cancer is an increasing public health concern

Do younger women with non-metastatic and non-inflammatory breast carcinoma have poor prognosis?

BACKGROUND: Controversy abounds over whether breast cancer in younger women is more aggressive than those in older. The aim of the study was to assess the influence of age on long-term survival of women with breast carcinoma. MATERIALS AND METHODS: Patients with non-metastatic and non-inflammatory invasive breast carcinoma treated at the Regional Cancer Centre, Trivandrum, Kerala, India during 1990–93 were divided into 4 age groups as < 40 years, 40–49, 50–59, and > 60 years. The overall survival (OS) for each age group was estimated using the Kaplan-Meier method in relation to the primary tumor (T) and the axillary node status (N). The OS of the various age groups were compared using the log-rank test. Hazard ratio and 95% confidence interval for each age group was estimated using Cox-regression model after adjusting for T and N. RESULTS: Between 1990–1993, 1701 women (26%, <40 years) reported with non-metastatic and non-inflammatory invasive breast carcinoma. Overall survival (OS) of all the women was 52.6 % (standard error 1%) at 10 years. The OS for women with age < 40 years and with T3 and T4 disease status was 36.6% and 10.4% respectively and for those in 40–49 age group was 41.9% and 33.5%. The 10-year OS for women with node positive (N1) disease was 24.6% in < 40 years and 45.2% in the 40–49 age group (p = 0.0006). After adjusting for tumor and node stage the relative risk for death was 24% lower for women in 40–49 age group as compared to women <40 years of age. CONCLUSION: Women under 40 years with T3/ T4 breast lesions and/or positive axillary nodes were found to have a significantly poorer survival

Course of action taken by smear negative chest symptomatics: A report from a rural area in South India

Objective: To evaluate adherence to diagnostic algorithm of Revised National Tuberculosis Control Programme (RNTCP) and course of action taken by smear-negative chest symptomatics (CSs). Method: Interviewing smear-negative chest symptomatics. Results: Of the 423 smear-negative CSs interviewed, 85 (20%) were not prescribed antibiotics and only 133 (39%) received it for more than seven days. Of the 148 patients with persistence of symptoms, 83 (56%) returned for further investigations and only 39% were X-rayed. Main reasons for not returning were: ‘not aware’ or ‘consulted another health provider.’ Conclusion: Strict adherence to diagnostic algorithm and proper counselling of patients are important for diagnosing smear-negative pulmonary tuberculosis (PTB) cases

Role of QuantiFERON-TB Gold, Interferon Gamma Inducible Protein-10 and Tuberculin Skin Test in Active Tuberculosis Diagnosis

The measurement of Interferon gamma or Interferon gamma inducible protein (IP)-10 in antigen stimulated blood samples is suggested as an alternative method for latent tuberculosis (TB) diagnosis. Nonetheless, their role in active TB diagnosis, particularly in TB endemic settings is yet to be defined. In this study, the sensitivities and specificities of Interferon gamma release assay (IGRA), IP-10 assay and tuberculin skin test (TST) in detecting active TB cases were assessed in human immunodeficiency virus (HIV) sero-negative TB patients and healthy controls respectively.A total of 177 adult TB patients and 100 healthy controls were included for this study. QuantiFERON-TB Gold In-tube (QFT-IT) method was used to analyze the sensitivity and specificity of IGRA. QFT-IT, IP-10 and TST yielded the diagnostic sensitivities of 90.6% (95%CI: 86.3%-94.9%), 92.5% (95%CI: 88.6%-96.4%) and 68.9% (95%CI: 60.6%-77.2%) and specificities of 55% (95% CI: 35.2%-54.8%), 48% (95% CI: 38.2%-57.8%) and 75.5% (95% CI: 66.8%-84.2%), respectively. The extent of pulmonary involvement or presence of diabetes mellitus did not appear to influence the sensitivities of any of these tests. The combination of any of the two tests among QFT-IT, IP-10 and TST showed >98% sensitivity among smear negative cases and particularly the combination of IP-10, TST and smear microscopy showed 100% sensitivity, however, the specificity was decreased to 44.8%.QFT-IT and IP-10 were highly sensitive in detecting active TB cases. The combination with TST improved the sensitivity of QFT-IT and IP-10 significantly. Although the higher sensitivity of combination of QFT-IT/IP-10 and TST may be useful in active TB diagnosis, they are limited by their poor specificity due to the high prevalence of latent TB in our settings

Knowledge, anxiety levels and attitudes of infertile couples towards COVID-19 and its impact on self-funded fertility treatment : a cross-sectional questionnaire survey

Acknowledgement We thank the couples who were willing to participate in the study. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Peer reviewedPublisher PD

Feasibility of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients Under the TB Control Programme in Two Districts of South India

BACKGROUND:Provider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million). METHODOLOGY/PRINCIPAL FINDINGS:Starting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre (ICTC)--often in the same facility--for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment (ART). Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 (72%) were referred to an ICTC, and 3111 (66%) were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709/5299 (70%) of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 (8.8%) of all registered TB patients were HIV-infected; 177 (37%) were documented to have also received any ART. CONCLUSIONS:With implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation