Cancer in Punjab: evidence from cancer atlas

Cancer in Punjab has been a news item in the recent past. It was thought that cases in Punjab exceeded the national average and felt that “Punjab the country’s food bowl was in throes of cancer” (1). This presumption was perhaps incorrect. In order to have clarity on the issue, we aimed to review the report of Cancer Atlas in Punjab state for the year 2012-13, recently released by Indian Council of Medical Research (ICMR). The main idea of generating data through Cancer Atlas approach is to assess patterns of cancer in various parts of Punjab state and to estimate cancer incidence at various districts in Punjab. The sources of data collection in the state are all medical colleges, pathology labs, civil hospitals and individual oncologist throughout the state. These data collection sources are considered important as over 80-85% of registered cases of cancer are generally with a microscopic diagnosis (2). Patient data details in the Atlas approach included are Cancer site and morphology of the cancer as per guidelines for collecting information on all malignant cases. The similar approach that adopted in Cancer Atlas in India such as internet approach is used in entering core patient data for Punjab Atlas by standardized procedures.&nbsp

Effect on nosocomial sepsis of topical oil application, skin condition, and care practice device usage in preterm neonates: A randomized controlled trial

Introduction: Compromised skin barrier increases the susceptibility of high-risk preterm neonates to nosocomial sepsis. Thus, topical oil application may be a promising strategy for improving neonatal outcomes. Objectives: The objectives of the study were to study the effect of topical oil application on the incidence of nosocomial sepsis and skin condition. Materials and Methods: This randomized controlled trial was conducted in a referral neonatal unit. The study included consecutive preterm neonates admitted before 4 days of age with admission weight of 1000–2000 g. Computer-generated random number sequence was used for grouping neonates in sunflower oil (n=39) and control (n=39) groups. Results: 70 neonates (89.7%) completed the trial. At enrollment, baseline characteristics, clinical features, and lab abnormalities for sepsis evaluation were comparable in two groups. The incidence of nosocomial sepsis was 15.4% and 17.9% in oil and control group (p=0.7613). On day 10 of enrolment, in oil group, all 23 babies, and in control group, only 1 of 21 babies had normal skin (p<0.001). On multiple regression analysis, the odds ratio (95% confidence interval) for care practice device usage (v/s. randomized group and skin condition) in the causation of nosocomial sepsis was 1.189 (1.08−1.298, p=0.002). Conclusions: No difference in the incidence of nosocomial sepsis was observed between the oil and control groups. However, each additional day of care practice devices usage increased the risk of nosocomial sepsis by 1.19 times, despite oil application and/or improvement in the skin condition

Efficacy of Virtual Reality in Upper Limb Rehabilitation in Patients with Spinal Cord Injury: A Pilot Randomized Controlled Trial

Study Design Pilot randomized controlled trial. Purpose To compare the efficacy between virtual reality intervention (using Nintendo Wii) along with conventional occupational therapy and conventional occupational therapy alone in improving upper limb function in patients with spinal cord injury (SCI). Overview of Literature The use of virtual reality has gained importance in the rehabilitation sector over the last few years. Nintendo Wii has the potential to encourage upper limb function while engaging in an interesting activity, which is important in long-term interventions, such as the treatment of SCI. Methods Overall, 22 patients with SCI participated in the study. They were randomly assigned to two groups. Group I received 30 minutes of virtual reality intervention (using Nintendo Wii) and 30 minutes of conventional therapy, whereas group II received conventional therapy only for 30 minutes. Both groups received therapy 3 days a week for 4 weeks. One hand of each patient was identified as the target hand based on the inclusion criteria. All patients were assessed at baseline, 2 weeks and 4 weeks (post-intervention), and 6 weeks (follow-up). The functional ability of the target hand was assessed using the Capabilities of Upper Extremity (CUE) questionnaire. Gross motor dexterity was assessed using the Box and Block Test (BBT). The level of independence in activities of daily living was assessed by the Spinal Cord Independence Measure-Self Report and quality of life by the World Health Organization Quality of Life-BREF. Results After 4 weeks of intervention, there was no significant difference in improved hand function between the groups. Mean scores were higher for group I than for group II, with a higher percent change (31.5% in CUE questionnaire and 51.7% in BBT) in group I. Conclusions Virtual reality along with conventional therapy produces similar results in upper limb function as does conventional therapy alone

A multicountry evaluation of careHPV testing, visual inspection with acetic acid, and papanicolaou testing for the detection of cervical cancer.

OBJECTIVE: This study evaluates the feasibility and performance of careHPV, a novel human papillomavirus (HPV) DNA test, when used for screening women for cervical cancer in low-resource settings. METHODS AND MATERIALS: Clinician-collected (cervical) and self-collected (vaginal) careHPV specimens, visual inspection with acetic acid (VIA), and Papanicolaou test were evaluated among 16,951 eligible women in India, Nicaragua, and Uganda. Women with positive screening results received colposcopy and histologic follow-up as indicated. The positivity of each screening method was calculated overall, by site, and age. In addition, the clinical performance of each screening test was determined for detection of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2+) and CIN grade 3. RESULTS: Moderate or severe dysplasia or cancer (taken together as CIN2+) was diagnosed in 286 women. The positivity rate ranged between 2.4% to 19.6% for vaginal careHPV, 2.9% to 20.2% for cervical careHPV, 5.5% to 34.4% for VIA, and 2.8% to 51.8% for Papanicolaou test. Cervical careHPV was the most sensitive for CIN2+ (81.5%; 95% confidence interval [CI], 76.5-85.8) and CIN grade 3 (85.3%; 95% CI, 78.6-90.6) at all sites, followed by vaginal careHPV (69.6% and 71.3%, respectively). The sensitivity of VIA ranged from 21.9% to 73.6% and Papanicolaou test from 40.7% to 73.7%. The pooled specificities of cervical careHPV, vaginal careHPV, VIA, and Papanicolaou test were 91.6%, 90.6%, 84.2%, and 87.7%, respectively. CONCLUSIONS: careHPV performed well in large multicountry demonstration studies conducted in resource-limited settings that have not previously been conducted this type of testing; its sensitivity using cervical samples or vaginal self-collected samples was better than VIA or Papanicolaou test. The feasibility of using careHPV in self-collected vaginal samples opens the possibility of increasing coverage and early detection in resource-constrained areas

Medical Biostatistics

Medical Biostatistics, Fourth Edition By Abhaya Indrayan and Rajeev Kumar Malhotra Chapman & Hall/CRC Press, 2018 Medical Biostatistics (IV edition) looks like the most comprehensive book on biostatistics. All the topics of medical statistics are widely covered by the authors and the explanations are provided in non-mathematical easy language conducive to medical professionals. The book is a treasure tower for practicing medical statisticians, epidemiologists, clinicians and medical researchers of all disciplines. The first author of the book, Dr Indrayan, is just about the best known biostatistician of the country.   The book consists of 21 chapters, which are well demarcated and segregated from each other.Each section deals with a specific biostatistical topic. Each topic is again divided to various subheadings which intern divided into specific topic. Each chapter has provided a list of references which could be useful for further reading.The exercises at the end of each chapter arethought-provokingand comprise questions that could also be useful for PG entrance exams as well as for UG/PG exams. Initial few chapters are very useful for biomedical researchers as they deal with various types of study designs with many examples, and how to choose appropriate study designs is also discussed. The advance topics are a good reference guide for biostatisticians. A check list on prerequisite of various study designs are also incorporated for giving concise overview of the study designs. Separate chapters are given for various study designs such as for observational study, experimental study, and clinical trials. The details are elaboration of basic design concept, enrolment of subjects, analysis of data, its merits and demerits, and potential bias in that particular design. The chapteron clinical trials discusses therapeutic trials and non-therapeutic trials separately considering the aspect of how to do allocation of the subjects in clinical trial, designs with interim appraisal and reporting of trials. Elaborate methods of qualitative assessment of clinical trials are also a unique feature of this book. Probability concept is given with practical orientation of medical problems. Diagnostic tests and validation techniques are also described in details along with utilization of combination of tests.Survivals analysis and other multivariate analysis methods, which are generallynot covered by most other biostatistics books, are also explained in this volumein a simple language along with modelling approaches. Statistical quality control method in medical care and risk of bias, quality of data issues aredealt appropriately.   A unique feature of the book is a full chapter on statistical fallacies which deals with underuse, overuse and misuse of statistical methods in medical literature and related misconceptions.This chapter nicely explains about interpretation of data and also what test to apply in a particular situation.Brief notes about statistical software are given in appendix with illustration of avariety of problems with the popular package called R.   This book is invaluable to every medical college library and other departments that are active in research and its reporting. Dr.Smita Asthana MD (PSM) Scientist – E Dr.Satyanarayana Labani Ph D, FSMS Scientist – G (Director Grade) ICMR – National Institute of Cancer Prevention and Research, Dept of Health Research, MOHFW, Noid

A review on cancer incidence in India from 25 population-based cancer registries

Background and Objective: An overview of the update of cancer incidence summary findings will be of help to researchers and clinicians for quick reference of facts in cancer control. To present an overview of cancer incidence available from the recent population-based cancer registries (PBCRs) in India from 2009 to 2011. Materials and Methods: Data on age-adjusted incidence rates and cumulative risks of cancer at various sites were collected for both sexes for six major cancer sites from the first report of the National Cancer Registry Programme (NCRP) on 25 PBCRs in India for the years 2009-2011. Site-specific risks in terms of one out of the total number of persons who develop cancer were computed. The summaries, in the form of ranges, are presented in six regions of the country in which the 20 PBCRs are located. The range of age-adjusted rates (AARs) and one out of the number of persons who develop cancer as a lifetime risk in the age of 0-64 years is presented. Results: In different regions, the highest risks for males for developing cancer in the various major sites studied were as follows: One out of 67 for cancer in the lungs in the Northeast, one out of 27 for cancer in the esophagus in the Northeast, one out of 71 for cancer in the mouth in the western region, one out of 100 cancer in the tongue in the rural western region, one out of 333 for cancer in the prostate in the northern region, and one out of 33 for cancer in the stomach in the northeastern region. The highest risks for the various sites studied were as follows: one out of 36 for cancer in the breast in the south, one out of 59 for cancer in the cervix in the western region, one out of 125 for cancer in the ovary in the northern region, one out of 63 for cancer in the esophagus in the northeastern region, one out of 250 for cancer in the mouth in three regions, and one out of 125 for cancer in the gall bladder in the western and central regions. Overall, for all cancers there is a risk of one out of 8-27 persons and one out of 10-25 persons among males and females, respectively, in the Indian population who are likely to develop cancer of any site in their lifetime during the age of 0-64 years. Conclusion: Female breast cancer in the southern region and esophagus and stomach cancers among males in the northeast region were of the highest magnitudes

Cervical cancer screening trials in India and ethical issues

Cervical cancer is a preventable disease with an annual global load of 528000 new cases and 266000 deaths, majority occurring in low resource countries (LRCs). The magnitude of the disease in India is with 123000 new cases and 67000 deaths every year [1]. Developing countries successfully implemented Pap smear based cervical cancer screening into public health services and achieved reduction in incidence and mortality. With lack of the infrastructural resource requirements and trained technical manpower, LRCs including India do not have current capacity to implement cytology based Pap screening. Several alternatives to Pap testing were extensively studied in observational study settings. Visual inspection with acetic acid (VIA) is considered to be effective alternative method to reduce the disease burden in LRCs. Studies are conducted in randomized trial settings to confirm whether a significant reduction in incidence and mortality can be achieved in a real programme settings

Compliance of a Government Act on Cigarettes and Other Tobacco Products around Educational Institutions of Noida

Objectives: The aim of study was to evaluate the Compliance to the Government Act on Cigarettes and Other Tobacco Products (COTPA Act 2003) Section 6 that protects the exposure of under 18 children to tobacco products and to identify areas of violations, near Educational Institutions (EIs) in Noida.Study Design: Cross-sectional field study.Methods: Observational cross sectional survey was done on compliance of COTPA Act 2003 section 6 by tobacco Vendors situated within 100 yards of EIs of Noida using a questionnaire. The questionnaire consisted of 21 questions which included the criteria related to tobacco-free provisions of Section 6 of COTPA Act 2003.Results: The display of sign boards of “NO Tobacco” compliance was 7% in private schools and zero percent in government schools. In thirty fi ve percent of schools at least one vendor was situated at within 100 yards of school. The violation was seen at points of sale (POS) of tobacco products as well as around the EIs such as sale of tobacco products by minors (6.7%) and to the minors (37.1%).Conclusions: Implementation of tobacco control policy COTPA Act 2003 section 6 needs further emphasis. The schools and the local district health authorities should be made aware of the extent of non-compliance of COTPA Act 2003 and be made stakeholders to reduce tobacco use by Minors.</p

Cancer in Punjab: evidence from cancer atlas

Cancer in Punjab has been a news item in the recent past. It was thought that cases in Punjab exceeded the national average and felt that “Punjab the country’s food bowl was in throes of cancer” (1). This presumption was perhaps incorrect. In order to have clarity on the issue, we aimed to review the report of Cancer Atlas in Punjab state for the year 2012-13, recently released by Indian Council of Medical Research (ICMR). The main idea of generating data through Cancer Atlas approach is to assess patterns of cancer in various parts of Punjab state and to estimate cancer incidence at various districts in Punjab. The sources of data collection in the state are all medical colleges, pathology labs, civil hospitals and individual oncologist throughout the state. These data collection sources are considered important as over 80-85% of registered cases of cancer are generally with a microscopic diagnosis (2). Patient data details in the Atlas approach included are Cancer site and morphology of the cancer as per guidelines for collecting information on all malignant cases. The similar approach that adopted in Cancer Atlas in India such as internet approach is used in entering core patient data for Punjab Atlas by standardized procedures.