Conflict of interest disclosure and interpretation – rest assured the medical professional in the audience is perceptive, alert and smart

INTRODUCTION:We present data from a systematic survey on conflict of interest (COI) disclosure and its interpretation by the doctors participating in continuing medical education (CME).METHODS:A brief 12 question online Google survey with multiple choice options (read, select, and click) was done among Indian practicing doctors using links shared through WhatsApp through the internet over a 72 h period.RESULTS:Of the 386 replies, 373 unique replies were eligible for evaluation. The majority found CME activities beneficial. About 73% of participants would watch out for bias, even if the speaker shows COI disclosure slide. The use of brand/trade names was considered as a flag for bias by the majority. About 99% wanted the speaker to show a final take home message slide. Cross verification of the data presented by comparing to published data was done in more than 75% of instances by only 25% of the participating doctors. A significantly higher number of doctors found bias when CME activities were being organized by the health-care industry as compared to programs of medical bodies/societies/organizations.DISCUSSION:COI considerations are given due to the importance of medical professionals. However, doctors are smart enough to understand the limitations of such disclosures and remain alert to ensure they are not influenced by any bias. Take home message slide gives the presenters opportunity to share their insights and allows the audience to make their own judgment on the impartiality of the data presented. The doctors are aware that bias could be more when CME activities are organized by healthcare industry and take appropriate precautions.CONCLUSION:COI is is given due importance by the medical professionals. COI disclosures are often incomplete. Doctors remain alert to ensure they are not influenced by biased presentations. Concluding take home message slide is unanimously recommended. Presentation bias is more when healthcare industry is directly organizing educational and promotional activities.

Sunitinib in metastatic renal cell carcinoma: Experience from single center study, efficacy and safety.

BACKGROUND: The 5‑year survival rate for metastatic renal cell carcinoma (RCC) is estimated to be <10%. RCC is highly resistant to chemotherapy. Targeted agents are now first choice of therapy for metastatic RCC such as sunitinib and sorafenib. METHODS: This study is a retrospective analysis of 15 patients having metastatic RCC treated with sunitinib. Apart from three patients, all had clear cell histology. Thirteen patients received dosage of 50 mg/d (4 weeks on/2 weeks off cycles). In 14 patients sunitinib was used as 1st line. The primary end point was objective response rate. Secondary end points were progression free survival (PFS) and safety. RESULTS: Until date of reporting, 3 out of 15 patients are currently on sunitinib. The most common Memorial Sloan = Kettering Cancer Centre poor prognostic factor was an interval of <1 year between diagnosis and starting of treatment (80%). The objective response rate was 13.66% (complete response [CR] + partial response [PR] = 0 + 2). Clinical benefit rate (CR + PR + stable disease) was 60% (n = 9). Median PFS in this study was 7.5 months, with a range of 2‑22 month. Median overall survival (OS) of patients in this study was 12 months with a range of 3‑24 month. An impact of the dose or/and number of cycles on response was seen in this study, with patients having average cycles >3 showing better response rates, PFS and OS. Major toxicities seen were fatigue ( n = 7), diarrhea (n = 3) and skin rash (n = 4) with majority patients experienced Grade 1‑2 toxicities. While Grade 3‑4 toxicities include fatigue (n = 1), mucositis (n = 1) and nausea (n = 1). CONCLUSIONS: These results confirm efficacy and safety profile of sunitinib in metastatic RCC, particularly as a first line. Sunitinib produced a 60% disease control rate for metastatic RCC in Indian patients, with acceptable rates of toxicity at a dose of 50 mg daily. Response rates were well matched to other studies confirming the efficacy of sunitinib.

Detection of antibodies to HIV in saliva.

BACKGROUND: Saliva has been recommended as an alternative non-invasive specimen for detection of antibodies to human immunodeficiency virus (HIV) because of the inherent disadvantages of using serum for such testing. METHODS: In a double-blind study, paired serum and saliva specimens were collected from 100 known HIV antibody seropositive and 100 seronegative individuals. The serum was tested in the conventional way while saliva was tested after modifying the routinely used serum enzyme-linked immunosorbent assay so as to detect antibodies to HIV from saliva. RESULTS: The sensitivity of saliva for HIV antibody detection using the modified test protocol was found to be 95% by GENELAVIA MIXT ELISA and 97% by DETECT-HIV ELISA, while the specificity for both was 100%. Identical results were obtained even after 7 months of storage of the saliva at 4 degrees C without any preservatives. CONCLUSION: Saliva is a safe and cost-effective alternative to serum for HIV antibody detection for most surveillance purposes but not for diagnostic purposes.