Breast cancer: Clinical stage at the time of presentation, its correlates and quality of life after treatment

Objective: Research worldwide indicates that early presentation of breast cancer leads to early intervention and better prognosis with improved quality of life. Our objectives were to determine the clinical stage of breast cancer in Sri Lankan women at the time of presentation, its correlates and its association with their quality of life after interventions. Methods: A descriptive cross sectional study was conducted on 200 breast cancer patients attending two selected tertiary care centers in Colombo district, who have undergone treatment. A pre-piloted interviewer-administered questionnaire was used to assess stage of breast cancer at the time of presentation and its correlates. Interviewer-administered SF-36 health survey was used to assess their quality of life. Results: Early clinical staging (UICC 0, I, II) was seen in 64.6%.  Duration between noticing the first symptom and seeking medical care  is significantly (p< 0.01) associated with age, educational level, self breast examination, breast cancer screening, spouse’s influence and stigma. This duration showed a stronger association (p< 0.001) with presenting symptom, family history, monthly income, availability of transport, initial ayurveda treatment, fear of detection, fear of surgery, embarrassment, and unawareness. Mean SF 36 score was 46. Fifty nine percent of both early and late clinical staged patients had a score  above mean. Conclusion: Promotion of self breast examination and screening for breast cancer is of value in early detection and presentation. Improved awareness about breast cancer and a facilitatory health care process would improve outcome of disease.

Experimental treatment of Ebola virus disease with brincidofovir

Background The nucleotide analogue brincidofovir was developed to prevent and treat infections caused by double-stranded DNA viruses. Based on in vitro data suggesting an antiviral effect against Ebola virus, brincidofovir was included in the World Health Organisation list of agents that should be prioritised for clinical evaluation in patients with Ebola virus disease (EVD) during the West African epidemic. Methods and Findings In this single-arm phase 2 trial conducted in Liberia, patients with laboratory-confirmed EVD (two months of age or older, enrolment bodyweight ≥50 kg) received oral brincidofovir 200 mg as a loading dose on day 0, followed by 100 mg brincidofovir on days 3, 7, 10, and 14. Bodyweight-adjusted dosing was used for patients weighing <50 kg at enrolment. The primary outcome was survival at Day 14 after the first dose of brincidofovir. Four patients were enrolled between 01 January 2015 and 31 January 2015. The trial was stopped following the decision by the manufacturer to terminate their program of development of brincidofovir for EVD. No Serious Adverse Reactions or Suspected Unexpected Serious Adverse Reactions were identified. All enrolled subjects died of an illness consistent with EVD. Conclusions Due to the small sample size it was not possible to determine the efficacy of brincidofovir for the treatment of EVD. The premature termination of the trial highlights the need to establish better practices for preclinical in-vitro and animal screening of therapeutics for potentially emerging epidemic infectious diseases prior to their use in patients

A Delphi study and ranking exercise to support commissioning services:Future delivery of Thrombectomy services in England

Background: Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed to using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. Methods: A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Results: Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n=43) and BSNR members (86%, n=21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. Conclusions: The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is conveying suspected stroke patients for CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience centre

Informal rental housing in Colombia: an essential option for low-income households

Around the world, rental housing is frequently seen as secondary to home ownership; yet it plays a crucial role in many countries. In particular, rental housing in urban informal neighbourhoods has a critical but consistently overlooked role in housing the most vulnerable households in the Global South. If better policy and practice are to be pursued, there is a need for improved data on rental housing in urban informal settlements, and in particular, better understanding of ‘the lived experiences of the poor’. This paper responds to these empirical gaps in debates on informality and rental housing with qualitative research on residents’ experiences of informal rented housing in two Colombian cities, Bogotá and Cali. The paper frames informal rental housing as an essential option for diverse low-income households for whom ownership is not accessible or attractive. In this way, it also contributes to policy and theoretical debates calling for a better understanding of the dynamics, possibilities and potential of informal housing