Delays in reporting of cancer cervix in rural India: sociodemographic and reproductive correlation

Background: Cervical cancer, caused by sexually-acquired infection with human papillomavirus (HPV), continues to be a public health problem worldwide as it claims the lives of more than 270,000 women every year. The majority of cervical cancer deaths (85%) occur in women living in low- and middle-income countries. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings.Methods: This hospital-based cross-sectional study was undertaken at a Regional Cancer Institute at Aurangabad, India. Hundred newly diagnosed women with advanced cervical cancer (stage 2B-4B), who were undertaking radiotherapy and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile. The causes for late presentations were also noted.Results: The mean age of women at the time of detection of cervical cancer was 57.35 years (30-82 years). More than 81% of patients were illiterate and belonged to low socioeconomic status. 47% of the study subjects had their first sexual experience before 15 years of age. Nearly 78% women had 5 or more pregnancies, among them, unusual discharge from vagina (39%) followed by bleeding after menopause (28%) and pain in abdomen (13%) were the most common presenting complaints. The average duration of symptoms was (28 days), time interval between the symptoms and biopsy was (3.6 months). Combination of radiotherapy and chemotherapy was the most common modality of treatment. Most common cause of delay in diagnosis was lack of awareness about the symptom of cancer (11%), feeling ashamed (10%), no one paid attention (19%), not diagnosed and referred at periphery and financial causes (23%) were found.Conclusions: Prevention of cervical cancer include delaying the age at initiation of sexual activity to above 18 years, spreading cancer awareness in women and with well-equipped health workers with diagnosis and knowledge of cancer cervix. This can prevent the medical and patient delay in the diagnosis of cancer cervix

Is thrombocytosis a valid indicator of advanced stage and high mortality of gynecological cancer?

Background: Cytokines that stimulate thrombopoiesis are often elevated in cancer, and as a result, various cancers have been associated with thrombocytosis. In addition thrombocytosis has been found to be an adverse prognostic factor in many types of common cancers.Methods: A cross sectional study was designed to evaluate the factors associated with prognosis of the cases of carcinoma cervix in the Department of Gyne-Oncology, GMCH, Aurangabad from August 2016 to August 2017. Variables analysed were the sociodemographic details, literacy level, symptoms, duration, stage of the disease at diagnosis, pretreatment platelet counts were noted.Results: 85% patients were having squamous cell carcinoma, 6 % patients were having adenocarcinoma and 9% patients had adenosuamous carcinoma. 29% patients have platelet count less than 3 lakhs and 18 patients has tumour less than 4 cm.  71 % patients have platelet count more than 3 lakhs, only 6% patients belonged to early stage and 65% belonged to late stage of cancer cervix.Conclusions: Seventy one percent of the cases had platetlet count >3 lakh, of which only 6% were in early stage of disease, whereas 65% belonged to late stage of the disease. All the patients with tumour size of >4 cm had platelet count more than 3 lakh, this shows strong association of platelet count with tumour size >4 cm and advanced stage of the disease. This can be used as independent prognostic factor for prognosis of cancer cervix

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)