Considerations in setting up and conducting epidemiologic studies of cancer in middle‐ and low‐income countries: the experience of a case–control study of inflammatory breast cancer in N orth A frica in the past 10 years

This article illustrates some issues we faced during our experience in conducting an epidemiologic case–control study of inflammatory breast cancer in N orth A frica. We expect that some of the questions we had to ask in order to address these issues might be helpful to others in setting up epidemiologic studies in developing regions. We describe our experience from different angles including the use of multiple sites to achieve adequate sample size, standardizing diagnosis of disease, identifying cancer cases at the time of diagnosis, control selection procedures, logistics of study implementation, questionnaire development and interviewing, biologic specimens, and procedures for protection of human subjects. We have developed a brief checklist to summarize important issues for conducting future epidemiologic studies in these or similar low‐ or middle‐income countries. This article illustrates crucial issues in setting up and conducting epidemiologic studies on cancer in North Africa. The questions we had to ask in order to address these issues might be helpful to others in setting up epidemiologic studies in developing regions. Our experience could improve time and cost efficiency of future epidemiologic studies in this or other regions in low‐ and middle‐income countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94458/1/cam436.pd

Bilateral Luxatio Erecta – Etiology, Diagnosis and Management

Luxation erecta is a rare form of shoulder dislocation, bilateral inferior shoulder dislocation is very rare and few cases have been published in the literature. We present a case of a male, fell down the ladder, presented with bilateral luxation erecta treated with close reduction, immobilisation and rehabilitation

Dosimetric Comparison Between High Dose Rate Brachytherapy Boost and Volumetric Arc Therapy Boost in Locally Advanced Cancer cervix

Concurrent chemoradiotherapy is considered the standard treatment for the locally advanced cancer cervix (LACC).Radiotherapy is usually administered by a three-dimensional conformal external beam(3DCRT EBRT) approach to whole pelvis to a minimum dose of 45Gy, followed by a brachytherapy ( BT)boost to give additional dose to the gross tumor within the cervix and parametria. High dose rate (HDR) brachytherapy is commonly administered with intracavitory applicator. HDR BT allows delivery of a high radiation dose to the tumor site with rapid fall off so protect normal tissue. Besides, less target motion compared to EBRT. However, several drawbacks exist including invasive technique, pain, requiring spinal or general anesthesia and operative risks such as uterine perforation, infection, and bleeding. Due to the above risks, we tried to assess the possibility of using high technique  EBRT to replace the BT boost  in patients who are either medically unfit for or refuse a brachytherapy boost. we tried to achieve a similar dose distribution with comparable or improved normal tissue sparing to that seen in previously treated HDR BT plans at our institution. Dosimetric comparison between high technique of external beam radiotherapy volumetric arc therapy (VMAT) and high technique Computer topography (CT) guided HDR BT.Ten patients were selected with LACC, representing typical clinical situations according to initial tumor extension and response after EBRT. A boost was given by intracavitary CT guided HDR BT. High risk clinical target volume (HR CTV), bladder, rectum, sigmoid and small bowel were delineated. Planning was done using Sagi planning system and was manually optimized with respect to organ dose limits. A VMAT planning was created using the variance planning system and a margin of 5mm were added to the CTV to create the target planning target volume (PTV).The inversely planned VMAT was challenged to deliver the highest possible doses to PTVs while respecting D2cc limits from BT, assuming the same fractionation (7 Gy in 3 fractions). When VMAT was limited to D2cc from BT, the D90 for the PTV in VMAT boost was lower than received by the HR CTV in the BT boost (6.3Gy vs. 6.9Gy, p value 0.037). Mean volume of the PTV in VMAT was higher than that of HR CTV in the BT (89 cm3vs 41.7cm3).The dose to the organ at risks (OARs) was comparable.D2cc was higher in VMAT for bladder, sigmoid and rectum (5.6Gy, 0.51, 5.5Gy vs. 4.3Gy, 0.33, 3.9Gy) while D2cc for the small bowel in BT was higher compared to the VMAT (4.1Gy vs. 1.94Gy    ).The VMAT had comparable target coverage and potential for improved sparing of most normal tissues compared to brachytherapy boost. It is an option that exists for patients who refuse BT or can’t tolerate it or in case of non availability of BT or non working machine. However, this is a dosimetric comparison that needs larger number of patients and further application to study the drawbacks that might exist for the VMAT use

A Study Comparing the Effectiveness of Hamstring Tendon Graft Versus Quadriceps Tendon Graft in Press Fit Anterior Cruciate Ligament Reconstruction

Background: Press fit ACL reconstruction is a surgical procedure used to repair a torn anterior cruciate ligament (ACL) in the knee. During press fit ACL reconstruction, a graft is used to replace the torn ACL. The graft can be harvested from various sources, such as the patient's own hamstring tendons or patellar tendon, or from a donor. The graft is then inserted into tunnels created in the femur and tibia bone. The term "press fit" refers to the technique used to secure the graft within these bone tunnels. Instead of using screws or other fixation devices, press fit ACL reconstruction relies on tight fitting of the graft within the tunnels. Objective: This study aimed to compare the subjective, objective, and radiological results of press fit anterior cruciate ligament (ACL) reconstruction using hamstring tendon graft versus quadriceps tendon graft. Methods: A total of 50 patients with complete ACL tears underwent press fit ACL reconstruction between March 2016 and June 2019. Among them, 25 patients received a hamstring tendon graft, and another 25 patients received a quadriceps tendon graft. Results: The study demonstrated favorable outcomes of press fit ACL reconstruction, with improvements observed in all 50 patients when comparing postoperative to preoperative parameters. The results also showed comparable outcomes between the quadriceps and hamstring groups in terms of subjective, objective, and radiological measures. Conclusion: The press fit technique for ACL reconstruction is a successful method of graft fixation that offers advantages such as fewer complications, lower cost, and easier revision compared to other commonly used techniques

Limited genetic variability and spatial population structure in grasshoppers between natural and metal-contaminated areas in Egypt

Pollutants in an environment can have long-term implications for the species living there, resulting in local adaptations with implications for their genetic structure. Heavy metal pollutants infiltrate soils and groundwater, bioaccumulate in food webs, and negatively impact biota. In this study, we investigated the degree to which the genetic structure and variability of the slender green-winged grasshopper (Aiolopus thalassinus (Fabricius) (Orthoptera: Acrididae)) were impacted by heavy metal pollution and distance. We used the random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) method to examine the genetic variability of populations in 3 heavy metal-polluted and 3 unpolluted locations across varying geographical distances in Egypt. The heavy metal concentrations of cadmium, copper, lead, and zinc were measured from the grasshopper tissue and soils. Sixty-nine unique and polymorphic bands were produced by 4 primers. Cluster and principal component analyses separated the populations inside and outside Cairo into 2 main branches, which were further divided into smaller branches corresponding to their geographical regions. We found no differences in the Shannon genetic diversity index between populations or with increasing heavy metal concentrations in either the soil or the grasshopper tissue. Our results showed a greater genetic variation among populations than between populations within the same location, indicating populations within locations were less differentiated than those between locations. The moderate correlation between genetic similarity and spatial distance suggests geographical isolation influenced grasshopper population differentiation. Based on the RAPD analysis, environmental pollutants and geographical distances impact the A. thalassinus population structure, potentially restricting gene flow between sites even at small spatial scales

Geographic Trends of Tobacco-Related Cancers in Cyprus

BACKGROUND: Causal relationships have been previously established between smoking and various cancers. In Cyprus, 39 % of men and 14 % of women reported daily smoking in 2008. The objective of this study was to compare the incidence of tobacco-related cancers to all other cancers by district and rural-urban classification to understand the impact of tobacco in Cyprus. METHODS: Data on lung, urinary bladder, oral, pharyngeal, head/neck, and laryngeal cancers were obtained from the Cyprus Cancer Registry (1998-2008). There were 3,635 patients with tobacco-related cancers and 18,780 with non-tobacco cancers. Univariate analysis comparing tobacco-related cancers and all other cancers were conducted with regards to age at diagnosis, age groups, sex, smoking status, disease stage, and rural/urban status, with a p-value of 0.05 considered significant. Smoking prevalence, lung cancer, and bladder cancer rates of Cyprus were also compared to a number of other European countries. RESULTS: Patients with tobacco-related cancers were older than those with non-tobacco cancers (mean age 67.2 ± 12.4 vs. 62.4 ± 17.1, p \u3c 0.0001). Among those with tobacco-related cancers, 80.1 % were male compared to 45.4 % males with other cancer types. The proportion of ever smokers was higher among males compared to females in urban and rural districts. Sub-districts 41 (Age Adjusted Rate (AAR) 41.9, 95 % CI: 35.7-48.1), 60 (AAR 40.3, 95 % CI: 35.2-45.3), and 50 (AAR 36.3, 95 % CI: 33.8-38.7) had the highest rates of tobacco-related cancers. The overall tobacco-related cancer rate was the highest among males in urban districts (AAR 60.8, 95 % CI: 58.2-63.5). Among tobacco-related cancers, lung cancer had the highest overall AAR (17.9 per 100,000) while head and neck cancer had the lowest overall AAR (5.3 per 100,000). Additionally, even though Cypriot males aged 65-69 years old exhibited higher smoking prevalence than other European countries, the overall lung and bladder cancer rates were lower in Cyprus. CONCLUSION: Despite the high proportion of smokers in Cyprus, cancer rates are low compared to other countries. Future in-depth measurements of relevant risk factors and smoking exposure can help understand this phenomenon and provide insights for cancer prevention

Regional variation in histopathology‐specific incidence of invasive cervical cancer among Peruvian women

ObjectiveTo evaluate patterns of cervical cancer incidence in Peru by examining variation in 2 common histopathologic types, squamous cell carcinoma (SCC) and adenocarcinoma (ADC), and analyzing trends over time.MethodsData on the incidence of invasive cervical cancer between 1984 and 2006 were obtained from 3 population‐based cancer registries in Peru: Lima, Trujillo, and Arequipa. For each registry, data quality assessment was performed, crude and age‐specific incidence was calculated, and time trends were analyzed.ResultsOverall and SCC incidence varied across registries but incidence of ADC did not. Overall and SCC incidence showed significant declines in Trujillo (P 0.05) over time. ADC incidence showed marginally significant increases among women aged 15–29 years in Trujillo (P = 0.10) and modest increases among young women in Lima (P > 0.05).ConclusionPopulation‐based cancer registries were an efficient source of data for evaluating the incidence of cervical cancer once data quality had been established. Geographic and temporal variations in cervical cancer burden were documented in Peru. The trends suggest that cervical ADC is increasing among young women in urban Peru, particularly in Trujillo. We recommend supplementing current Papanicolaou test screening with complementary methods of cervical cancer control, including human papillomavirus (HPV) vaccination and HPV DNA testing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135622/1/ijgo47.pd

The changing pattern of ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin’s lymphoma as non-AIDS-defining cancers, by HIV status, in Tanzania over 11 years (2002-2012): a retrospective case-report study

Abstract Background In Tanzania, 5.1% of adults aged 15-49 are infected with HIV. While rates of HIV-related malignancies have declined globally with antiretroviral therapy (ART), including Tanzania, rates of non-AIDS-defining cancers (NADCs) are believed to have increased. Therefore, we determined trends of three NADCs in Tanzania: ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin’s lymphoma. Methods This study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam. All medical records of patients diagnosed with ano-rectal cancer, squamous cell carcinoma of the eye, and Hodgkin’s lymphoma between 2002 and 2012 were reviewed regarding HIV status, cancer clinical characteristics and management. Analysis was conducted to determine trends and proportions in these three NADCs and patient characteristics. Results We identified 980 NADCs. The relative proportion of these three NADCs at ORCI out of all cancers treated increased from 2.37% in 2002 to a peak of 4.34% in 2009. The prevalence of HIV in patients diagnosed with these NADCs also increased—from 6.67% in 2002 to 20.87% in 2010—and 85% of squamous cell carcinoma of the eye cancer patients with a reported HIV status were HIV-positive. Conclusions The frequency and proportions of these three NADCs in Tanzania have increased over the past 11 years, as has the prevalence of HIV positivity amongst these NADC patients. The current and possibly increasing burden of NADCs in Tanzania and other low- and middle-income countries with high HIV rates should be a focus for future cancer prevention and control and HIV therapy programs.http://deepblue.lib.umich.edu/bitstream/2027.42/111050/1/13027_2014_Article_524.pd

Changing Patterns of lung, liver, and head and neck non-AIDS-defining cancers relative to HIV status in Tanzania between 2002-2014

Abstract Background Tanzania, like other low-income countries, has an increasing cancer burden that remains underestimated. Infection-associated malignancies, particularly HIV-infection, represent a great proportion of cancer burden in Tanzania and throughout Africa. Availability of HIV treatment and improved survival of HIV patients are suggested factors related to increasing prevalence of non-AIDS-defining cancers (NADCs). This study examined patterns of NADCs and proportions of HIV-positivity at the Ocean Road Cancer Institute (ORCI). Methods We reviewed logbooks of all ORCI patients diagnosed and/or treated for lung, liver, and head and neck cancers during 2002–2014. The number of total cancers diagnosed at ORCI during this period was used to calculate proportions of NADCs. We abstracted medical records to obtain demographic and clinical profiles and HIV status information for 1127 patients diagnosed or treated during 2010–2014. Trends in numbers and proportions of NADCs were analyzed using Joinpoint regression. Characteristics of NADC patients were analyzed using multinomial logistic regression. Results NADCs diagnosed at ORCI increased by 33.8% from 2002 to 2014 while the proportion of NADCs relative to all cancers significantly decreased from 6.8% in 2002 to 5.6% in 2014 (APC = -2.74%). Numbers and proportions of lung and liver cancers increased compared to all cancer diagnoses from 2002 to 2014. The number of head and neck cancers increased while decreasing proportionally compared to all cancer diagnoses from 2002 to 2014. Among patients with pathologically confirmed NADCs between 2010 and 2014, HIV prevalence showed a non-statistically significant decrease from 8.1 to 7.1% (APC = -3.77%). Conclusions Absolute numbers of lung, liver, and head and neck cancers increased at ORCI by 1/3 since 2002. Improving survivorship of HIV patients and varying immunodeficiency status may have contributed to the increasing number of NADCs. Total cancer diagnoses nearly doubled during this period, leading to a smaller relative proportion of NADCs diagnosed in 2014 compared to 2002. Late- stage diagnosis and short survival of NADCs included this study may explain possible underestimation and smaller increase in proportion of these particular NADCs compared to other NADCs studied in Tanzania. The slight decrease in proportion of HIV-positive NADC patients during 2010–2014 may suggest increasing patient longevity and more effective HIV management in Tanzania.http://deepblue.lib.umich.edu/bitstream/2027.42/134744/1/13027_2016_Article_106.pd

Healthcare access and mammography screening in Michigan: a multilevel cross-sectional study

Abstract Background Breast cancer screening rates have increased over time in the United States. However actual screening rates appear to be lower among black women compared with white women. Purpose To assess determinants of breast cancer screening among women in Michigan USA, focusing on individual and neighborhood socio-economic status and healthcare access. Methods Data from 1163 women ages 50-74 years who participated in the 2008 Michigan Special Cancer Behavioral Risk Factor Survey were analyzed. County-level SES and healthcare access were obtained from the Area Resource File. Multilevel logistic regression models were fit using SAS Proc Glimmix to account for clustering of individual observations by county. Separate models were fit for each of the two outcomes of interest; mammography screening and clinical breast examination. For each outcome, two sequential models were fit; a model including individual level covariates and a model including county level covariates. Results After adjusting for misclassification bias, overall cancer screening rates were lower than reported by survey respondents; black women had lower mammography screening rates but higher clinical breast examination rates than white women. However, after adjusting for other individual level variables, race was not a significant predictor of screening. Having health insurance or a usual healthcare provider were the most important predictors of cancer screening. Discussion Access to healthcare is important to ensuring appropriate cancer screening among women in Michigan