Study protocol to investigate the effect of a lifestyle intervention on body weight, psychological health status and risk factors associated with disease recurrence in women recovering from breast cancer treatment

Background Breast cancer survivors often encounter physiological and psychological problems related to their diagnosis and treatment that can influence long-term prognosis. The aim of this research is to investigate the effects of a lifestyle intervention on body weight and psychological well-being in women recovering from breast cancer treatment, and to determine the relationship between changes in these variables and biomarkers associated with disease recurrence and survival. Methods/design Following ethical approval, a total of 100 patients will be randomly assigned to a lifestyle intervention (incorporating dietary energy restriction in conjunction with aerobic exercise training) or normal care control group. Patients randomised to the dietary and exercise intervention will be given individualised healthy eating dietary advice and written information and attend moderate intensity aerobic exercise sessions on three to five days per week for a period of 24 weeks. The aim of this strategy is to induce a steady weight loss of up to 0.5 Kg each week. In addition, the overall quality of the diet will be examined with a view to (i) reducing the dietary intake of fat to ~25% of the total calories, (ii) eating at least 5 portions of fruit and vegetables a day, (iii) increasing the intake of fibre and reducing refined carbohydrates, and (iv) taking moderate amounts of alcohol. Outcome measures will include body weight and body composition, psychological health status (stress and depression), cardiorespiratory fitness and quality of life. In addition, biomarkers associated with disease recurrence, including stress hormones, estrogen status, inflammatory markers and indices of innate and adaptive immune function will be monitored. Discussion This research will provide valuable information on the effectiveness of a practical, easily implemented lifestyle intervention for evoking positive effects on body weight and psychological well-being, two important factors that can influence long-term prognosis in breast cancer survivors. However, the added value of the study is that it will also evaluate the effects of the lifestyle intervention on a range of biomarkers associated with disease recurrence and survival. Considered together, the results should improve our understanding of the potential role that lifestyle-modifiable factors could play in saving or prolonging lives

Packages of Care for Epilepsy in Low- and Middle-Income Countries

In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

ICAR: endoscopic skull‐base surgery

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Post-traumatic endophthalmitis due to Brevibacterium casei : A case report

Endophthalmitis is a serious post-traumatic ocular complication that can lead to loss of vision. We report a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an unusual organism, Brevibacterium casei . The patient was successfully treated with intravitreal antibiotics like ceftazidime and vancomycin, along with topical cefazolin and tobramycin. Brevibacterium casei can be added to the list of rare bacteria causing endophthalmitis and should be kept in mind by clinicians as a potential source of pathology

DEVELOPMENT, EVALUATION AND TARGETING OF STAVUDINE LOADED SERUM ALBUMIN POLYMER BASED NANOCARRIERS TO HIV RESERVOIRS

Objective: Stavudine is an antiretroviral drug that is part of the nucleoside reverse transcriptase inhibitor (NRTIs) family, which is used to delay the progression of HIV infection. The present investigation involves the development and evaluates stavudine loaded nanocarriers using natural polymer bovine serum albumin (BSA). Methods: The desolvation technique was used to prepare nanoparticles and coated with 1% v/v polysorbate 80 to improve the targeting of drugs to the organs (HIV reservoirs). Biodistribution studies were also investigated for the best formulation to determine the targeting efficiency of nanocarriers loaded stavudine and compared with pure compound. Results: The formulated nanocarriers have shown mean particle size below 300 nm, zeta potential in the range of -16.5 Mv, encapsulation efficiency in the range of 50.10 to 73.7%, drug loading in the range of 14.73 to73.84%. Cumulative % drug release was in the range of 24.72 to 71.20% and release kinetics studies showed that the mechanism of drug release was controlled simultaneously by diffusion and erosion of the matrix type formulations. The stability studies over a period of three months confirmed the stability of BSA nanoparticles. Biodistribution studies demonstrated that nanoparticles coated with 1% v/v polysorbate 80 were able to reach the HIV reservoirs in an amount higher than that of uncoated stavudine nanoparticles or pure drug itself. Conclusion: The method adopted is simple and the biodistribution studies demonstrated that nanoparticles coated with 1% polysorbate 80 were able to reach the selected organs in an amount higher than that of uncoated stavudine nanoparticles or pure drug itself