Awareness about cervical cancers among health workers in Shimla district, Himachal Pradesh, India

Background: Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in low-resource countries. Aim of this study was to assess knowledge and awareness of cervical cancer prevention among health workers in Shimla district, Himachal Pradesh.Methods: A cross sectional study was conducted among multipurpose health care workers (both males and females) in Shimla district, Himachal Pradesh. A self-administered close ended questionnaire was used. The questionnaire, consisted of two parts. The first part comprised of questions relating to demographic data and the second part had questions on knowledge about cervical cancers. The data was analyzed using the statistical analysis program SPSS version 16.0.  Tests used were Chi square, t test and ANOVA. A p-values <0.05 were considered  statistically significant.Results: Out of 122 subjects, there were 45 (36.9%) males and 77 (63.1%) females. The mean knowledge percent of the population was 55.9+16.4. Among the age groups it was highest for the age group of 21-30 years (62.5+23.6) and lowest for the age group of 51-60 years (53.6+16.4). Knowledge about risk factors was correctly reported by 44.3% of population. Who should be screened for cervical cancers was reported correctly by 29.5% and at what interval screening should be done was reported by 14.8%.Conclusions: Half of the population had moderate overall knowledge about cervical cancers, but the knowledge about risk factors and screening eligibility and screening interval was inadequate. So, education programs should be arranged for the health workers in order to prevent cervical cancers

DCE-MRI and parametric imaging in monitoring response to neoadjuvant chemotherapy in breast carcinoma : a preliminary report

Purpose: Neoadjuvant chemotherapy is recommended in patients with locally advanced breast cancer. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables evaluation of the tumour neovasculature that occurs prior to any volume change, which helps identify early treatment failures and allows prompt implementation of second-line therapy. Material and methods: We conducted a prospective study in 14 patients with histopathologically proven breast cancer. DCE-MRI data were acquired using multisection, T1-weighted, 3D vibe sequences with fat suppression before, during, and after IV bolus injection (0.1 mmol/kg body weight, Gadoversetamide, Optimark). Post-processing of dynamic contrast perfusion data was done with the vendor's Tissue 4D software to generate various dynamic contrast parameters, i.e. Ktrans, Kep, Ve, initial area under the time signal curve (IAUC), apparent diffusion coefficient (ADC), and enhancement curve. Patients underwent MRI examinations at baseline, and then after two cycles, and finally at completion of chemotherapy. Results: Based on Sataloff criteria for pathological responses, four patients out of 14 were responders, and 10 were non-responders. At the 2nd MRI examination, IAUC was significantly smaller in responders than in non-responders (p = 0.023). When the results of the first and second MRI examinations were compared, Kep decreased from baseline to the second MRI (p = 0.03) in non-responders and in responders (p = 0.04). This change was statistically significant in both groups. The ADC values increased significantly in responders from baseline to the third MRI (p = 0.012). Conclusions: In our study, IAUC and ADC were the only parameters that reliably differentiated responders from non-responders after two and three cycles of chemotherapy

Clinicopathological profile of patients with brain secondaries from Ca cervix: a case series of five patients from tertiary cancer centre in North India

Ca cervix is a common gynaecological cancer in daily practice but secondaries in brain after ca cervix as primary is a rare occurrence. As the survival of ca cervix patients has improved, we are able to encounter secondaries in unusual sites like brain. Prognosis is usually dismal due to presence of extra cranial mets along with brain secondaries which limits the use of new radiotherapy techniques like Stereotactic radiosurgery. We present a case series of five patients who presented to us post radical treatment of cancer cervix and treated with whole brain radiation therapy and best supportive care

Assessment of clinical epidemiology, treatment patterns, and survival outcomes in epithelial ovarian cancer: a retrospective analysis from a tertiary cancer centre in North India

Background: Ovarian cancer stands as the daunting third most prevalent cancer among females. The aim of this study is to assess the clinical epidemiology, treatment patterns (including end-of-life care), and survival outcomes among patients diagnosed with epithelial ovarian cancer. Methods: This retrospective analysis encompassed all patients diagnosed with epithelial ovarian cancer and enrolled at the tertiary cancer center, IGMC Shimla in Himachal Pradesh. The study included patients registered between January 2014 and December 2018, spanning all age groups. Results: During the aforementioned period, ovarian cancer accounted for 18.7% of gynaecological cancers among females out of which epithelial ovarian cancer accounted for 14.8% of the cases. The median age of patients diagnosed with epithelial ovarian cancer (EOC) was 54.5 years. Most patients hailed from Shimla, followed by Mandi and Kullu districts, among the twelve districts in the state of Himachal Pradesh. The majority of patients were diagnosed at advanced stages FIGO III and IV, comprising a total of 77.1%. Chief complaints included abdominal pain, followed by abdominal distention, heaviness, or bloating. The median duration of follow-up was 27 months (with a standard deviation of ±9.175). The median overall survival (OS) for stage I, II, III, and IV was 92.59 months, 87 months, 82.17 months, and 52.5 months, respectively, and these differences were statistically significant. Conclusions: Ovarian cancer patients are often diagnosed in advanced stages III and IV, primarily due to late diagnosis and the presence of vague symptoms. Achieving optimal cytoreduction significantly improves overall survival. Therefore, it's crucial to raise awareness among general physicians in rural healthcare settings and the public about the symptoms of ovarian cancer to facilitate early detection. Additionally, there's a notable deficiency in end-of-life discussions and palliative care management, which should be accessible to every patient

Concurrent chemoradiation in head and neck cancers with weekly cisplatin: analysing toxicities

Background: Head and neck cancers constitute 6% of cancers worldwide. The management requires a multidisciplinary approach. Concomitant chemoradiotherapy with cisplatin is the standard approach for locally advanced head and neck cancers. The most commonly used regime uses three weekly cisplatin which is more toxic. Low-dose once-a-week cisplatin is substituted because of perceived lower toxicity and convenience.  Methods: Squamous cell carcinoma of stage III, IVA and IVB of oropharynx, hypopharynx and larynx were studied for one year. 82 patients were studied. Total dose of radiation was 66Gy/33#/6 ½ weeks from Monday to Friday with inj. Cisplatin 40mg/m2 i.v. infusion weekly.Results: 88% of patients were able to complete five or more weekly chemotherapy cycles with cumulative dose of 200mg/m2. Grade 2 and 3 acute toxicities were seen in weekly cisplatin arm but were conservatively managed.Conclusions: Weekly cisplatin can be used with concurrent radiotherapy as the acute toxicities are manageable and is well tolerated

Addition of temozolamide as radiosensitizer in brain metastasis: experience from a resource limited centre in sub-Himalayan region

Background: Brain metastasis is a common, debilitating and undesirable neurological complication of systemic cancer and a significant cause of morbidity and mortality. Methods: 39 patients of brain metastasis with Ca breast/Ca lung as primaries were randomized into a study arm and control arm in between 1st August 2018 to 31st July 2019 at IGMC Shimla. Control arm consisted of WBRT (30 GY/10 fractions/5 days a week). Study arm consisted of WBRT with same dose and temozolamide administered 75mg /m2/day during RT days. Results: Out of 39 patients 34 patients completed treatment out of which 17 in study and 17 in control arm. Response to brain lesions could not be assessed in 20 out of 39 patients. In remaining 19 patients 36.8% patients in study arm and 20% patients in control arm had partial response (PR). 5.3% patient in study arm and none in control arm has complete response (CR). 25% patients in control arm and 15.8% patients in study arm had stable disease. Improvement in QOL (FACT- G) seen in both study and control arm post Rx, however improvement sustained in study arm at 1st F/u. Conclusions: Leveraging the additional radio-sensitizing effect of TMZ may hold promise as an attractive strategy to enhance the quality of life in patients with a favourable performance status. Moreover, RPA could serve as a decisive factor in tailoring the treatment approach, guiding the choice between palliative radiotherapy and best supportive care for these individuals

Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India

The prison population is a challenging one with many health problems including oral health. In a country such as India, the information regarding the oral health status in prisoners is scant. So, a cross-sectional study was carried out among a 311 prison inmate population of Kanda model jail, Shimla, Himachal Pradesh, India, to assess the dental caries levels, periodontal health status, and oral health-related quality of life (OHRQoL). Dental caries was present among 71.8% of the population and the mean decayed missing and filled teeth index (DMFT) of the population was 5.1 ± 2.1. Calculus was seen among 54.9% of the population. The mean severity score, summed for the 14 items in the scale was 14.57. Dental caries, periodontal disease, the number of missing teeth were significantly associated with OHRQoL. The population had a higher level of oral diseases and one half of the population reported that their oral condition had negatively impacted them in some way, thereby affecting their quality of life

Knowledge, attitude and practices about oral cancers among dental students in H.P Government Dental College, Shimla-Himachal Pradesh

Aim: The aim was to assess the knowledge, attitude and practices among undergraduate dental students about oral cancer. Materials and Methods: A cross-sectional questionnaire study was conducted among undergraduate dental students between the 3rd and 5th years in H.P Government Dental College, Shimla. The questionnaire consisted of 15 questions, five each on knowledge, attitudes and practices. The data were analyzed by Statistical Package for the Social Sciences (SPSS Inc., version 16 for Windows, Chicago, IL, USA). Results: The response rate of the study was 90.6%. There were 23 (21.5%) males and 84 (78.5%) females in the study. There was a predominance of females (78.5%). The average knowledge percentage for the entire population is 81.9% (excellent knowledge). Tobacco and alcohol were correctly identified by 63.5% of the subjects. Squamous cell carcinoma was described as the most common type of oral cancer by 105 (98.3%) of the students. 60.7% of the subjects strongly disagreed that their knowledge regarding the prevention and detection of oral cancer is current and adequate, and 99% agreed that there is a need for additional training/information regarding oral cancer. About 92.5% of the subjects used to educate their subjects about the harmful effects of tobacco and alcohol. Conclusion: The study implies that the knowledge, especially about the etiological factors of oral cancer needs to be reinforced throughout the undergraduate dental courses so that they can use the same in educating and motivating the masses to adapt healthy lifestyles

Oral health knowledge and practices among primary healthcare workers in Shimla District, Himachal Pradesh, India

Context: Primary healthcare workers being grassroot workers in rural areas can be effective in oral health promotion in these areas. Aim: To assess oral health knowledge and practices among primary healthcare workers in Shimla district in Himachal Pradesh. Setting and Design: A cross-sectional study. Subjects and Methods: A cross-sectional study was conducted to assess oral health knowledge and practices of primary healthcare workers in Shimla using a self-administered questionnaire. Statistical Analysis Used: Data were analyzed using SPSS package version 16. The tests used were t-test and Fisher's exact test. A P value < 0.05 was considered statistically significant. Results: Of 130 subjects, there were 60 (46.2%) males and 70 (53.8%) females. The mean age of the population was 48.4 ± 5.9 with a range of 25–57. The mean knowledge score percent of the population was 51.9 ± 18.2. It was higher for males (52.3 ± 15.0) when compared with females (51.5 ± 20.7). The mean knowledge score percent was positively associated with education and negatively associated with age. Tooth brush was used by 97.7% and tooth paste by 121 (93.1%). The frequency of brushing twice was reported by 79 (60.8%). Conclusion: Though the overall knowledge about oral health is good among primary healthcare workers, the understanding about various aspects is lacking. Therefore, it is recommended that health workers should be given education to enhance knowledge and practices toward oral healthcare and to increase their screening capacity for common dental problem which will serve the community in long way