Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- A nd middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Water quality index and human health risk: a case study on Surma river

The study involves extensive laboratory tests to determine the physical and chemical parameters of the Surma river water, the values of which were used to calculate the water quality index and health risk. These parameters were Dissolved Oxygen (DO), Biochemical Oxygen Demand. (BOD), Chemical Oxygen Demand (COD), Total Solids (TS), Ammonium Nitrate (AN) and pH. Water samples were collected at different points along the Surma river for both dry and wet seasons. Samples were analyzed for the above parameters and using the average dry and wet season values of these parameters, an expression of Water Quality Index (WQI) was developed. Moreover, risk has been calculated for the same by Hazard Quotient (HQ). The values of WQI were found to be 73.37 for dry season and 73.51 for wet season. HQ for Cu only was found to be 0.1788. The study concluded that the Surma river water was slightly polluted and no health risk was imminent at that time

Water quality parameters along rivers

Water samples have been collected from a part of Surma River along different points and analyzed for various water quality parameters during dry and monsoon periods. Effects of industrial wastes, municipal sewage, and agricultural runoff on river water quality have been investigated. The study was conducted within the Chattak to Sunamganj portion of Surma River, which is significant due to the presence of two major industries-a paper mill and a cement factory. The other significant feature is the conveyors that travel from India to Chattak. This study involves determination of physical, biological and chemical parameters of surface water at different points. The river was found to be highly turbid in the monsoon season. But BOD and fecal coliform concentration was found higher in the dry season. The water was found slightly acidic. The mean values of parameters were Conductivity 84-805μs; DO: dry 5.52 mg/L, monsoon-5.72 mg/L; BOD: dry-1 mg/L, monsoon-0.878 mg/L; Total Solid: dry-149.4 mg/L, monsoon 145.7 mg/L. A model study was also conducted and values of different model parameters were estimated

Effects of Reclaimed Water and C and N on Breakthrough Curves in Sandy Soil and Loam

International audienceLong-term irrigation with reclaimed water may change soil physical properties and solute transport rate due to C and N in reclaimed water and the particularity of reclaimed water. Ordinary water, reclaimed water and mixed water which added C and N into reclaimed water were used as background water, then potassium bromide was added to background water and mixed them into three kinds of solutions whose bromide concentrations were all 0.5 mol/L, then soil column breakthrough experiments were conducted. The results showed that bacteria quantity increased both in sandy soil and loam after soil column experiments, and bacteria quantity in sandy soil and loam were all in the following descending order: breakthrough solution using mixed water as background water, breakthrough solution using reclaimed water as background water, and breakthrough solution using ordinary water as background water. However, fungi quantity had no significant difference. Cumulative infiltration in sandy soil and loam can be properly described by power function and logarithm function, respectively. The amount of cumulative infiltration in sandy soil and loam in the same infiltration time were all showed a descending order as: breakthrough solution using ordinary water as background water, breakthrough solution using reclaimed water as background water, and breakthrough solution using mixed water as background water. Breakthrough curves can be well described by CXTFIT 2.1 code, it can be seen from the values of V and D that reclaimed water and the addition of C and N made solute transport more difficult in soils and increased diffusion coefficient, and these impacts were greater on loam than sandy soil. Reclaimed water and the added C and N increased soil bacteria, complicated soil pore system, and decreased soil hydraulic conductivity