Incidence of advanced cutaneous malignant melanoma in the UK: a systematic review

Objectives: Cutaneous melanoma (CM) is one of the most aggressive forms of skin cancer. In 2008, CM was found to be the sixth most common cancer in the UK. The aim of this review was to systematically identify patients with advanced CM, limited to stage IIIc and stage IV disease. Methods: Literature searches were undertaken in the Cochrane Library, MEDLINE, CINAHL and EMBASE between December 2010 and March 2011. Webpages of the Office of National Statistics, Cancer Research UK and the Welsh Cancer Intelligence and Surveillance Unit were also scanned. A narrative synthesis was undertaken due to the heterogeneity of included studies. Results: Three observational studies were identified. One study was in East Anglia, England while the remaining two were in Scotland. Both studies in Scotland estimated that 2% of all melanoma patients had advanced CM at the time of diagnosis. It was also noted that, in East Anglia, the incidence of stage IV CM decreased from 0.42 to 0.13 per 100,000 population per year between 1991 and 2004. The review highlighted the challenges in identifying patients with advanced CM from available data. Conclusions: This review highlighted the lack of, and the need for primary studies to estimate the incidence of advanced CM in the UK. Defining this subgroup of patients is important for identifying patients for targeted treatment. We suggest that researchers must clearly define this population of patients in future studies

Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai

Background: Aggregate urban health statistics mask inequalities. We described maternity care in vulnerable slum communities in Mumbai, and examined differences in care and outcomes between more and less deprived groups. Methods: We collected information through a birth surveillance system covering a population of over 280 000 in 48 vulnerable slum localities. Resident women identified births in their own localities and mothers and families were interviewed at 6 weeks after delivery. We analysed data on 5687 births over one year to September 2006. Socioeconomic status was classified using quartiles of standardized asset scores. Results: Women in higher socioeconomic quartile groups were less likely to have married and conceived in their teens (Odds ratio 0.74, 95% confidence interval 0.69–0.79, and 0.82, 0.78–0.87, respectively). There was a socioeconomic gradient away from public sector maternity care with increasing socioeconomic status (0.75, 0.70–0.79 for antenatal care and 0.66, 0.61–0.71 for institutional delivery). Women in the least poor group were five times less likely to deliver at home (0.17, 0.10–0.27) as women in the poorest group and about four times less likely to deliver in the public sector (0.27, 0.21–0.35). Rising socioeconomic status was associated with a lower prevalence of low birth weight (0.91, 0.85–0.97). Stillbirth rates did not vary, but neonatal mortality rates fell non-significantly as socioeconomic status increased (0.88, 0.71–1.08). Conclusion: Analyses of this type have usually been applied across the population spectrum from richest to poorest, and we were struck by the regularly stepped picture of inequalities within the urban poor, a group that might inadvertently be considered relatively homogeneous. The poorest slum residents are more dependent upon public sector health care, but the regular progression towards the private sector raises questions about its quality and regulation. It also underlines the need for healthcare provision strategies to take account of both sectors

Prevalence of hyperventilation syndrome in an allergy clinic, compared with a routine ENT clinic

Objectives: A high prevalence of chronic hyperventilation syndrome in patients with asthma has been reported. We examined whether this phenomenon extended to allergy clinic patients in general and whether the prevalence was higher in patients attending a general allergy clinic compared with those attending a routine ENT clinic in our hospital.Methods: We examined the prevalence of hyperventilation syndrome in unselected, consecutive patients (n = 100) seen in an allergy clinic. The validated Nijmegen questionnaire was completed by patients in the waiting room. We also administered the questionnaire to unselected, consecutive patients (n = 100) in a routine ENT clinic.Results: There was no significant difference in prevalence of hyperventilation between allergy clinic and routine ENT clinic patients (25/100 vs 23/100).Conclusion: The result indicates a high prevalence of hyperventilation amongst hospital attendees in general. Consideration should perhaps be given to the possible role of hyperventilation in symptomatology

Community resource centres to improve the health of women and children in Mumbai slums: study protocol for a cluster randomized controlled trial

Background: The trial addresses the general question of whether community resource centers run by a non-government organization improve the health of women and children in slums. The resource centers will be run by the Society for Nutrition, Education and Health Action, and the trial will evaluate their effects on a series of public health indicators. Each resource center will be located in a vulnerable Mumbai slum area and will serve as a base for salaried community workers, supervised by officers and coordinators, to organize the collection and dissemination of health information, provision of services, home visits to identify and counsel families at risk, referral of individuals and families to appropriate services and support for their access, meetings of community members and providers, and events and campaigns on health issues. Methods/design: A cluster randomized controlled trial in which 20 urban slum areas with resource centers are compared with 20 control areas. Each cluster will contain approximately 600 households and randomized allocation will be in three blocked phases, of 12, 12 and 16 clusters. Any resident of an intervention cluster will be able to participate in the intervention, but the resource centers will target women and children, particularly women of reproductive age and children under 5. The outcomes will be assessed through a household census after 2 years of resource center operations. The primary outcomes are unmet need for family planning in women aged 15 to 49 years, proportion of children under 5 years of age not fully immunized for their ages, and proportion of children under 5 years of age with weight for height less than 2 standard deviations below the median for age and sex. Secondary outcomes describe adolescent pregnancies, home deliveries, receipt of conditional cash transfers for institutional delivery, other childhood anthropometric indices, use of public sector health and nutrition services, indices of infant and young child feeding, and consultation for violence against women and children

Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial.

Improving maternal and newborn health in low-income settings requires both health service and community action. Previous community initiatives have been predominantly rural, but India is urbanizing. While working to improve health service quality, we tested an intervention in which urban slum-dweller women's groups worked to improve local perinatal health

Prospective study of determinants and costs of home births in Mumbai slums

Background: Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth.Methods: As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models.Results: We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location.Conclusions: We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by community-based health workers, who could play a greater part in helping women plan their deliveries and making sure that they get help in time

Emblica Officinalis: A Novel Therapy for Acute Pancreatitis — An Experimental Study

Acute necrotising pancreatitis is associated with an unacceptably high mortality for which no satisfactory remedy exists. Emblica officinalis (E.o.) is a plant prescribed in Ayurveda, the Indian traditional system of medicine, for pancreas-related disorders. This study was carried out to evaluate the protective effect of E.o. against acute necrotising pancreatitis in dogs. Pancreatitis was induced by injecting a mixture of trypsin, bile and blood into the duodenal opening of the pancreatic duct. Twenty eight dogs were divided into 4 groups (n = 6-8 each): GpI–control, GpII–acute pancreatitis, GpIII–sham-operated, GpIV–pretreatment with 28 mg E.o./kg/day for 15 days before inducing pancreatitis. Serum amylase increased from 541.99 ± 129.13 IU/ml to 1592.63 ± 327.83 IU (p<0.02) 2 hrs after the induction of pancreatitis in GpII. The rise in serum amylase in both GpIII and GpIV was not significant. On light microscopic examination, acinar cell damage was less and the total inflammatory score was significantly lower in the E.o. treated group as compared to GpII. Electron microscopy confirmed this and showed an increased amount of smooth, endoplasmic reticulum and small, condensed granules embedded in a vacuole. More studies are needed to explore the clinical potential of E.o. and its mechanism of action

Характеристики и методы лечения основных нежелательных явлений у пациентов с распространенным почечно-клеточным раком, получающих терапию комбинацией ленватиниба с пембролизумабом на основании результатов исследования CLEAR

.Введение. Комбинация ленватиниба с пембролизумабом продемонстрировала значительное улучшение показателей выживаемости без прогрессирования и общей выживаемости у пациентов с распространенным почечно-клеточным раком по сравнению с сунитинибом в исследовании CLEAR (Clinicaltrials.gov: NCT02811861).Цель исследования – на основании данных исследования CLEAR охарактеризовать основные нежелательные явления (НЯ) (предпочтительные термины сгруппированы в соответствии с обзором регулирующего органа), ассоциированные с использованием комбинации ленватиниба с пембролизумабом, и привести стратегии их преодоления.Материалы и методы. Проанализирована безопасность комбинации ленватиниба с пембролизумабом у 352 пациентов, включенных в исследование CLEAR. Наиболее важные НЯ были выбраны на основании частоты их встречаемости (≥30 %). Оценено время до появления НЯ и описаны подходы к их лечению.Результаты. Наиболее частыми НЯ были повышенная утомляемость (63,1 %), диарея (61,9 %), скелетно-мышечные боли (58,0 %), гипотиреоз (56,8 %) и гипертония (56,3 %). НЯ ≥III степени тяжести, зафиксированные у ≥5 % пациентов, включали гипертонию (28,7 %), диарею (9,9 %), повышенную утомляемость (9,4 %), снижение массы тела (8,0 %) и протеинурию (7,7 %). Медиана времени до появления первых симптомов основных НЯ составила приблизительно 5 мес (около 20 нед) с момента начала лечения. Стратегии эффективного преодоления НЯ включали мониторинг исходных показателей, изменение дозы препарата и/или назначение сопутствующих медикаментозных препаратов.Заключение. Профиль безопасности комбинации ленватиниба с пембролизумабом соответствовал известному профилю каждого из 2 препаратов, применяемых в монорежиме. НЯ рассматривались как преодолимые с помощью таких подходов, как мониторинг, изменение доз и поддерживающая терапия. Активное и своевременное выявление НЯ и их лечение важны для безопасности пациента и продолжения лечения.Идентификатор исследования на Clinicaltrials.gov: NCT0281186

A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy

<p>Abstract</p> <p>Objectives</p> <p>Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.</p> <p>Methods</p> <p>Sixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.</p> <p>Results</p> <p>After 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm²when no protective disc was used, and 1.15 ± 0.19 cm²when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.</p> <p>Conclusion</p> <p>Inserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.</p

The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis – a single center experience with 54 patients

Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007