A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening

Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a cluster-randomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide health-education, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n = 75360) and control arms (n = 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast

A case series of metastases to the breast from extramammary malignancies

Metastases to the breast from extra-mammary malignancies are extremely uncommon. The discovery of a breast mass in a patient with a known primary tumor elsewhere poses a diagnostic challenge to the clinician. An awareness of the various malignancies that can metastasize to the breast and accurate diagnosis of the same is essential to avoid an unnecessary mastectomy and to guide further therapy. In this case series, we describe such clinical scenarios with an emphasis on the imaging features of metastases to the breast, which will enable radiologists to recognize this entity with greater ease

Gestational Trophoblastic Disease: A Multimodality Imaging Approach with Impact on Diagnosis and Management

Gestational trophoblastic disease is a condition of uncertain etiology, comprised of hydatiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. It arises from abnormal proliferation of trophoblastic tissue. Early diagnosis of gestational trophoblastic disease and its potential complications is important for timely and successful management of the condition with preservation of fertility. Initial diagnosis is based on a multimodality approach: encompassing clinical features, serial quantitative β-hCG titers, and pelvic ultrasonography. Pelvic magnetic resonance imaging (MRI) is sometimes used as a problem-solving tool to assess the depth of myometrial invasion and extrauterine disease spread in equivocal and complicated cases. Chest radiography, body computed tomography (CT), and brain MRI have been recommended as investigative tools for overall disease staging. Angiography has a role in management of disease complications and metastases. Efficacy of PET (positron emission tomography) and PET/CT in the evaluation of recurrent or metastatic disease has not been adequately investigated yet. This paper discusses the imaging features of gestational trophoblastic disease on various imaging modalities and the role of different imaging techniques in the diagnosis and management of this entity

Imaging of retained surgical items: A pictorial review including new innovations

With the advent of newer imaging modalities retained surgical items are now easily diagnosed by their characteristic imaging appearances. A combination of complementary imaging modalities helps to arrive at the diagnosis of this relatively rare complication. Factors contributing to their imaging features include the timing of diagnosis and imaging, presence of secondary infection, communication of the retained item with hollow viscus or external skin wound, and type of imaging modality used. A high index of suspicion is necessary for diagnosis before labeling it as a retained surgical item. In parallel with recent advances in surgery, it is essential that there is increasing awareness among radiologists regarding the newer types of retained surgical items

A preliminary analysis of repetitive sequence organisation in <i>Bubalus bubalis</i> genome

62-66The most prevalent feature of eukaryotic genomes is their repetitive DNA sequences, which plays a critical role in genome evolution. Hence, identification and analysis of repetitive DNA regions are vital to understand genome structure and function completely. The investigation of repeats in preliminary draft sample of buffalo genome with 60,999 contigs was carried out through comparison of sequences with those in curated repeat libraries using WU-Blast. It was found that around 80% of the genome can be currently recognized as repetitive elements including simple repeats, satellite, long terminal repeats (LTR) retrotransposons, long interspersed nuclear elements (LINE) and short interspersed nuclear elements (SINE), which together cover the total repetitive fraction. Repeat analysis revealed the presence of ribosomal RNA (rRNA) and transfer RNA (tRNA) repeats along with other repeats like DNA/hAT, DNA/TCMAR and a small amount of unknown repeats. A comparative analysis of repeats of the buffalo, cow, mouse and human genomes was also discussed

Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries

When undertaking quality improvement (QI) initiatives, one of the greatest burdens is repeated data collection. Intensive care registries, such as those commonly used in high-income countries (HICs), have enabled systematic capture of routine information needed to measure intensive care unit (ICU) performance. Once considered unfeasible in resource-limited settings, newer cloud-based platforms are gaining increasing traction. Collaborative surveillance platforms, such as NICS-MORU and PRICE, which have mobile and desktop applications, have established methods for daily capture of individual patient-level information and have shown that—even in resource-limited settings—the systematic evaluation of patient care throughout the hospital journey is feasible at scale using coalesced minimal data sets

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used