Tamoxifen treatment and its outcome in breast cancer patients at a hospital-based cancer registry in Kerala

Background: Endocrine therapy for breast cancer is directed at reducing oestrogen synthesis or alternatively blocking oestrogen receptors (ER) in tumour-sensitive tumors. Despite side effects, the use of systemic adjuvant therapy after local management of breast cancer substantially improves survival and reduces the risk of relapse. The study objective was to assess the recurrence of breast cancer and the complications seen in breast cancer patients on tamoxifen therapy at a hospital-based cancer registry, Thrissur, Kerala.Methods: After obtaining institutional ethical clearance, included 75 patients of histologically diagnosed breast carcinoma currently on tamoxifen, diagnosed in the year of 2016. Data was obtained from the patient files and by personal intimation.Results: Of the 75 patients on tamoxifen, four (5.33%) patients had history of recurrence. 22.6% of patients on tamoxifen were noted to have increased endometrial thickness. Other side effects noted were weight gain, TIA, bone pain and vaginal discharge.Conclusions: It was found that the recurrence rate at three years for the study population was 5.33%. More studies from developing countries, with larger sample size and clinical trials will give us more accurate information regarding the efficacy of the drug

The Gendered Experiences of Local Volunteers in Conflicts and Emergencies

This article explores the gendered experiences of local volunteers operating in conflicts and emergencies. Despite decades of progress to integrate gender issues into development and humanitarian research, policy and practice, the gendered dynamics of volunteering are still little understood. To redress this, this article draws on data collected as part of the Volunteers in Conflicts and Emergencies (ViCE) Initiative, a collaboration between the Red Cross Red Crescent Movement led by the Swedish Red Cross, and the Centre for International Development at Northumbria University. Contributing original empirical findings on the intersection of gender, volunteering and emergencies, this article offers new ways of thinking about how gender equality and women’s empowerment can be advanced in humanitarian crises, as seen through the experiences of local volunteers

Effectiveness of selected maternal positions upon non stress test parameters among antenatal women

A Pre Experimental Study to Assess the Effect of Selected Maternal Positions upon Non Stress Test Parameters among Antenatal Women at Selected Hospital, Chennai. OBJECTIVES: 1. To determine the effectiveness of positions upon the non stress test parameters among antenatal women. 2. To compare the effectiveness of various positions upon the non stress test parameters among antenatal women. 3. To find out the association between the selected demographic variables and non stress test parameters in various positions among antenatal women. 4. To find out the association between the selected obstetrical variables and non stress test parameters in various positions among antenatal women. 5. To assess the level of satisfaction of the nurses regarding effect of positions upon the non stress test parameters among antenatal women. The conceptual framework for the study was developed on the basis of “King’s Goal Attainment Model” (1981) which was modified for the present study. The variables of the study were non stress test parameters and selected maternal positions. Null hypothesis were formulated. The level of significance selected was P<0.05. An extensive review of literature was made based on the opinion of experts. A pre experimental study of time series design was used. The study included 60 antenatal women who were selected by non probability purposive sampling technique. The study was conducted at St. Antony’s Hospital, Chennai. Demographic variable proforma, Obstetric variable proforma, Observational checklist and Rating scale on level of satisfaction of nurses regarding positions on non stress test parameters were the various tools used by the researcher. After making the antenatal women comfortable the experiment started with the antenatal women in supine position for 20 minutes followed by left lateral position for 20 minutes followed by semi fowlers position for 20 minutes. During each position non stress test parameters (fetal heart rate, fetal movement and fetal reactivity) was recorded at 5 and 15 minutes interval when the antenatal women came to outpatient department. Finally the effectiveness of each positions upon non stress test parameters was computed. Then the level of satisfaction of nurses regarding positions on non stress test parameters was assessed among the experimental group of antenatal women. The data obtained were analyzed using Descriptive and inferential statistics. MAJOR FINDINGS OF THE STUDY: All of them (100%) were housewives, vegetarian, worked in indoor area as moderate workers with no any bad personal habits. Majority of them were Hindus (81.7%), most of them resided in semiurban area (63.3%) and had nuclear family (60%). Significant percentages of the antenatal women were between the age group of 21 - 25 years (45%), were graduates and above (41.7%) with a family income per month between 5001-10,001 rupees (41.6%). • All of them (100%) had regular antenatal check up, majority of them were primipara (73.3%), anemic (85%), with no any previous obstetrical history (75%), most of them had weight between 61-80 kg (66.6%) were primigravida (68.3%) and significant percentage of the antenatal women were in a height of 141 – 160 cm (56.7%) with a gestational age above 37 weeks (41.7%). • The mean and standard deviation of antenatal women assessed at 5 minutes the mean fetal heart rate was (M = 134.5 , SD = 12.5) and at 15 minutes (M = 133.9, SD = 11.8), the mean fetal heart rate of them was between 134.5 to 133.9 beats/minute in supine position, similarly in left lateral position mean fetal heart rate at 5 minutes was (M = 143.06 ,SD = 8.53) and at 15 minutes was (M = 143.2 , SD = 8.37), so the mean fetal heart rate in left lateral position was between 143.06 to 143.2 beats /minute. In semi fowlers position the mean fetal heart rate at 5 minutes was (M = 143.2 , SD = 9.12) and at 15 minutes was (M = 142.6 ,SD = 8.96), so the mean fetal heart rate was between 143.2 to 142.6 beats / minute in semi fowlers position. It shows that antenatal women in left lateral position had highest mean fetal heart rate than in other positions respectively. Hence the null hypothesis H01 was rejected. • Mean and standard deviation of antenatal women assessed at 5 and 15 minutes was (M = 1.08, SD = 1.09) and (M = 1.91, SD = 1.95) in supine position, (M = 2.11, SD = 2.29) and (M = 3.11 ,SD = 3.62) in left lateral position and (M = 2.13, SD = 2.12), (M = 2.96, SD = 3.07) in semi fowlers position respectively. It reveals that antenatal women in left lateral position had highest mean fetal movement than in other positions. Hence the null hypothesis H01 was rejected. • Mean and standard deviation fetal reactivity among antenatal women assessed at 5 and 15 minutes was (M = 1.23, SD = 0.74) and (M = 1.73, SD = 1.05) in supine position, (M = 1.6, SD = 1.05) and (M = 2.51, SD = 1.30) in left lateral position and (M = 1.35, SD = 0.81), (M = 2.55, SD = 1.41) in semi fowlers position respectively. It proves that antenatal women in left lateral position had highest mean fetal reactivity. Hence the null hypothesis H01 was rejected. • There was a significant association between family income per month in rupees of antenatal women (χ2 = 5.24, df = 1) and fetal heart rate in supine position and no significant association between other demographic and obstetrical variables at the level of confidence P < 0.05, hence hypothesis H02 and H03 was rejected with regard to family income. • There was a significant association between complication during antenatal period of antenatal women (χ2 = 4.56, df = 2) and fetal heart rate in left lateral position and no significant association between other demographic and obstetrical variables at the level of confidence P < 0.05, hence hypothesis H02 and H03 was rejected with regard to complication during antenatal period. • There was a significant association between complication during antenatal period of antenatal women (χ2 = 4.64, df = 2) and fetal heart rate in semi fowlers position and no significant association between other demographic and obstetrical variables at the level of confidence P < 0.05, hence hypothesis H02 and H03 was rejected with regard to complication during antenatal period. • There was no significant association between selected demographic and obstetrical variables and fetal movement in supine position at the level of confidence P < 0.05, hence hypothesis H02 and H03 was retained. • There was no significant association between selected demographic and obstetrical variables and fetal movement in left lateral position at the level of confidence P < 0.05, hence hypothesis H02 and H03 was retained. • There was no significant association between selected demographic and obstetrical variables and fetal movement in semi fowlers position at the level of confidence P < 0.05, hence hypothesis H02 and H03 was retained. • There was a significant association between complication during antenatal period of antenatal women (χ2 = 6.41, df = 2) and fetal reactivity in supine position and no association between other demographic and obstetrical variables at the level of confidence P < 0.05, hence hypothesis H02 was retained and H03 was rejected with regard to complication during antenatal period. • There was no significant association between selected demographic and obstetrical variable and fetal reactivity in left lateral position at the level of confidence P < 0.05, hence hypothesis H02 and H03 was retained. • There was a significant association between type of family (χ2 = 5, df = 1) and fetal reactivity in semi fowlers position and no association between other demographic and obstetrical variable at the level of confidence P < 0.05, hence hypothesis H02 was rejected with regard to type of family and H03 was retained. • Repeated measure of analysis of variance of mean fetal heart rate assessed at 5 and 15 minutes was (-53.1, -53.1), mean fetal movement was (-62.8, -62.9) and mean fetal reactivity was (-54.9, -54.7). This revealed that the result of analysis of variance of non stress test parameters among antenatal women between three positions varied significantly. This finding was not consistent with H01, hence the null hypothesis H01 was rejected. • The study findings revealed that all the nurses were highly satisfied (100 %) with left lateral position and none of them reported dissatisfaction towards the position. RECOMMENDATIONS: 1. The same study can be conducted on a large sample to generalize the results. 2. A comparison can be made between primipara and multipara. 3. A similar study can be conducted by using true experimental design. 4. The same study can be conducted in different settings with similar facilities. 5. A similar study can be conducted by using cross – over design

The Social Contract and India's Right to Education

India's 2009 Right of Children to Free and Compulsory Education (RTE) Act presents an idealized social contract which assigns roles to multiple actors to uphold a mutual duty, or collective responsibility, to secure children's access to a quality school education. This article explores how the social contract assumed by the RTE Act misrepresents the conditions required to enact mutual responsibilities as well as actors’ agreement to do so. Qualitative data from Bihar and Rajasthan show how state actors, parents, community groups and teachers negotiate and contest the RTE Act norms. The analysis illuminates the unequal conditions and ever-present politics of accountability relations in education. It problematizes the idealization of the social contract in education reform: it proposes that if the relations of power and domination through which ‘contracts’ are entered into remain unaddressed, then expressions of ‘mutual’ responsibility are unlikely to do other than reproduce injustice. It argues that policy discourses need to recognize and attend to the socially situated contingencies of accountability relations, and that doing so would offer an alternative pathway towards addressing structural inequalities and their manifestations in education

Comparison of V10 and V20 of bone marrow in carcinoma cervix patients receiving radiation with Bone Marrow Sparing (BMS)–IMRT, IMRT , 3DCRT, and 4 field box technique.

OBJECTIVE: To assess the feasibility of modelling Bone Marrow Sparing IMRT without compromising the dose to the planning target volume and without increasing the dose to other organs at risk. METHODS:CT Data set from 16 women with Carcinoma cervix treated in our institution from July 2013 to January 2014 using 3D CRT or IMRT were selected for the study. For all the 16 patients ,4 plans ;four field box,3DCRT, IMRT and Bone Marrow Sparing IMRT were modeled.Bone marrow was contoured using free hand technique in each CT cut including entire L5 vertebral body, sacrum, coccyx, ileum, ischium, pubis and femoral head extending down till the level of ischial tuberosity. Constraints to the organs at risk and the target volume were prescribed as per the standard RTOG guidelines.Bone Marrow constrain was V10< 95% and V 20< 76%.Dose volume histogram,isodose curves, dose colour wash and presence of hot spot were used for plan evaluation. Chi-square test was used for statistical analysis. RESULTS Out of the 16 plans with BMS IMRT, 15 plans achieved the desired goals while respecting the bone marrow constrains. This gave a 93.8% chance of achieving this constrain with a p value of .001.The The mean V10 and V20 to bone marrowin our study was 89.58% and 69.99%. In case of femoral head, it was observed that the constrain was attained for 12/16 patients with 4 FIELD BOX, 12/16 patients for 3DCRT, 16/16 patients with IMRT and 16/16 patients with BMS – IMRT.The bowel bag constrain could be achieved for 13/16 patients with 4 FIELD BOX plan, 12/16 patients with 3DCRT plan, 16/16 patients with IMRT plan an 16/16 patients with BMS – IMRT plan .Bladder and rectum constrains could not be achieved in any of the plans. Bone Marrow Sparing IMRT is a feasible option for the management of locally advanced carcinoma cervix as it helps in reducing the dose received by the bone marrow without compromising the planning target volume coverage and without increasing the dose to other normal organs at risk

Cytotoxic clinical isolates of Pseudomonas aeruginosa identified during the Steroids for Corneal Ulcers Trial show elevated resistance to fluoroquinolones.

BackgroundTo determine the relationship between type three secretion genotype and fluoroquinolone resistance for P. aeruginosa strains isolated from microbial keratitis during the Steroids for Corneal Ulcers Trial (SCUT) and for two laboratory strains, PA103 and PAO1.MethodsConfirmed P. aeruginosa isolates from the SCUT were divided into exoU(+) or exoU(-). The exoU(+) strains contained the gene encoding ExoU, a powerful phospholipase toxin delivered into host cells by the type three secretion system. Isolates were then assessed for susceptibility to fluoroquinolone, cephalosporin, and aminoglycoside antibiotics using disk diffusion assays. Etest was used to determine the MIC of moxifloxacin and other fluoroquinolones. Laboratory isolates in which the exoU gene was added or deleted were also tested.ResultsA significantly higher proportion of exoU(+) strains were resistant to ciprofloxacin (p = 0.001), gatifloxacin (p = 0.003), and ofloxacin (p = 0.002) compared to exoU(-) isolates. There was no significant difference between exoU(+) or exoU(-) negative isolates with respect to susceptibility to other antibiotics except gentamicin. Infections involving resistant exoU(+) strains trended towards worse clinical outcome. Deletion or acquisition of exoU in laboratory isolates did not affect fluoroquinolone susceptibility.ConclusionsFluoroquinolone susceptibility of P. aeruginosa isolated from the SCUT is consistent with previous studies showing elevated resistance involving exoU encoding (cytotoxic) strains, and suggest worse clinical outcome from infections involving resistant isolates. Determination of exoU expression in clinical isolates of P. aeruginosa may be helpful in directing clinical management of patients with microbial keratitis

Validation of the olfactory disorders questionnaire for English‐speaking patients with olfactory disorders

Objectives 1. To adapt the existing German language olfactory disorders questionnaire for use with English-speaking patients 2. To validate the adapted version for routine clinical use Design The translated version of the original German questionnaire was revised with a patient and a clinician to reflect British language and culture. Patients attending an olfactory dysfunction clinic were recruited to perform the adapted questionnaire on two occasions at least one month apart. Additional online participants completed the questionnaire via the charity Fifth Sense. Main outcome measures • Re-test reliability of the English olfactory disorders questionnaire (eODQ) in affected patients including potential for redundancy in any of the included questions • Correlation of eODQ scores with Sniffin’ Sticks scores Results Eighty-seven patients reporting olfactory dysfunction were recruited and had a mean age of 48 with 35% of them being male; 50 datasets were available for analysis. A total of 957 members of the charity entered responses into the online questionnaire; 699 responses could be scored with participants’ mean age of 55 years and with 69% reporting as female. The eODQ score and Sniffin’ Sticks TDI score at timepoint 1 were correlated to assess for concurrent validity, (r=-0.15, p=0.17) and showed no significant correlation. Female participants had a significantly higher mean total eODQ score than men, 55.75 compared to 52.28 (p=0.001). The average score was 54.7 (SD 13.5) with a range from 26 to 87. The internal consistency of the questionnaire was good with a Cronbach’s alpha of 0.90 (Confidence intervals 0.89, 0.91). Conclusions The results of this study support the use of the eODQ in a native English-speaking population and highlight the different distinctions between “objective” testing of olfaction with the Sniffin’ Sticks test and the patient reported impact of olfactory dysfunction on daily life. These two types of assessment can be easily administered in an outpatient setting and used in the assessment and management of olfactory dysfunction

Rethinking Volunteering and Cosmopolitanism: Beyond Individual Mobilities and Personal Transformations

In this paper we use assemblage thinking to offer a new interrogation of the relationalities of volunteering and development and to revisit volunteering’s relationship to cosmopolitanism. Recent debates about the rise of new actors in development cooperation have seen a growing interest in the geopolitical significance of volunteers and their contribution to development. Research has addressed the ways international volunteering can shape cosmopolitan subjectivities, whilst claims for volunteering’s universality are a key feature of global development policy. However, we argue that existing approaches to volunteering, cosmopolitanism and development remain contained by established development imaginaries and their ascription of agency, authority and expertise to actors from the global North. We use the idea of the assemblage, and data from two research projects, the International Federation of Red Cross and Red Crescent’s (IFRC) Global Review on Volunteering, and a doctoral research project on diaspora volunteering, to explore the constitution of what volunteering is within and between places. Through this, we identify alternative sites for interrogating the capacity of volunteering to challenge established ideas of agency, care and responsibility in development

Age-related macular degeneration and the aging eye

Age-related macular degeneration (AMD) is an ocular disease that causes damage to the retinal macula, mostly in the elderly. Normal aging processes can lead to structural and blood flow changes that can predispose patients to AMD, although advanced age does not inevitably cause AMD. In this review, we describe changes that occur in the macular structure, such as the retinal pigment epithelium and Bruch’s membrane, with advancing age and in AMD. The role of genetics in AMD and age-related changes in ocular blood flow that may play a role in the pathogenesis of AMD are also discussed. Understanding the pathophysiology of AMD development can help guide future research to further comprehend this disease and to develop better treatments to prevent its irreversible central vision loss in the elderly

Unusually Divergent Ubiquitin Genes and Proteins in Plasmodium Species

Ubiquitin is an extraordinarily highly conserved 76 amino acid protein encoded by three different types of gene, where the primary translation products are fusions either of ubiquitin with one of two ribosomal proteins (RPs) or of multiple ubiquitin monomers from head to tail. Here, we investigate the evolution of ubiquitin genes in mammalian malaria parasites (Plasmodium species). The ubiquitin encoded by the RPS27a fusion gene is highly divergent, as previously found in a variety of protists. However, we also find that two other forms of divergent ubiquitin sequence, each previously thought to be extremely rare, have arisen recently during the divergence of Plasmodium subgenera. On two occasions, in two distinct lineages, the ubiquitin encoded by the RPL40 fusion gene has rapidly diverged. In addition, in one of these lineages, the polyubiquitin genes have undergone a single codon insertion, previously considered a unique feature of Rhizaria. There has been disagreement whether the multiple ubiquitin coding repeats within a genome exhibit concerted evolution or undergo a birth-and-death process; the Plasmodium ubiquitin genes show clear signs of concerted evolution, including the spread of this codon insertion to multiple repeats within the polyubiquitin gene.</p