Impact of COVID-19 on cancer care in India: a cohort study.

BACKGROUND: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. METHODS: We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FINDINGS: Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities). INTERPRETATION: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. FUNDING: None. TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.

Traditional healing practice and folk medicines used by Mishing community of North East India.

Assam and Arunachal Pradesh have very rich tradition of herbal medicines used in the treatment of various ailments. Tribal communities practice different types of traditional healing practices. Enough documentation is available on the healing practices in other tribal communities except Mishing community of Assam and foot hill of East Siang district of Arunachal Pradesh hence the attempt was made for the same. A survey on folk medicinal plants and folk healers of Mishing tribe was conducted in few places of Lakhimpur and Dhemaji district of Assam and East Siang district of Arunachal Pradesh, where this ethnic group is living since time immemorial. All information was collected based on interview and field studies with local healers within the community. The identification of medicinal plants collected with help of indigenous healers was done. Such medicines have been shown to have significant healing power, either in their natural state or as the source of new products processed by them. This study is mainly concentrated with plants used to cure diseases and to enquire about different healing systems. Detail note on the method of preparation of precise dose, the part/parts of plants used and method of application is given.

Antimalarial plants of northeast India: An overview.

The need for an alternative drug for malaria initiated intensive efforts for developing new antimalarials from indigenous plants. The information from different tribal communities of northeast India along with research papers, including books, journals and documents of different universities and institutes of northeast India was collected for information on botanical therapies and plant species used for malaria. Sixty-eight plant species belonging to 33 families are used by the people of northeast India for the treatment of malaria. Six plant species, namely, Alstonia scholaris, Coptis teeta, Crotolaria occulta, Ocimum sanctum, Polygala persicariaefolia, Vitex peduncularis, have been reported by more than one worker from different parts of northeast India. The species reported to be used for the treatment of malaria were either found around the vicinity of their habitation or in the forest area of northeast India. The most frequently used plant parts were leaves (33%), roots (31%), and bark and whole plant (12%). The present study has compiled and enlisted the antimalarial plants of northeast India, which would help future workers to find out the suitable antimalarial plants by thorough study.

Effect of ether- and water-soluble fractions of Carica papaya ethanol extract in experimentally induced hyperlipidemia in rats.

CONTEXT: The papaya is the fruit of the plant Carica papaya L. (Caricaceae) used in India. Fruit and latex are both rich in an enzyme called papain. It is used as a folk remedy for contraception and abortion. OBJECTIVE: The present study explored the anti-hyperlipidemic effect of the ether- and water-soluble fractions of C. papaya ethanol extract in olive oil-induced hyperlipidemic rats. The study also involved chromatographic studies of extract and fractions. MATERIALS AND METHODS: Flash chromatography was done for the most active fraction. The extract and fractions were administered orally at doses of 200 and 400 mg/kg body weight in rats. Olive oil (5 mL/kg oral dose) was administered 30 min after treatment. Blood was collected and centrifuged at 3000 rpm for 15-20 min and subjected to biochemical analysis. RESULT: The study dose-dependently inhibited the total cholesterol (TC), triglycerides (TG), low-density lipoproteins (LDL) level, and significantly increased high-density lipoprotein (HDL) level. Phytochemical screening revealed the presence of fats in the ether fraction, whereas the water fraction revealed the presence of tannins, alkaloids, glycosides. UV λ(max) was found to be 217 nm with a melting point of 41°C for the isolated component. DISCUSSION AND CONCLUSION: The anti-hyperlipidemic effect was evaluated in olive oil-loaded rats. Acute treatment caused stimulatory effect on HDL level and inhibition in TC and TG elevation induced by olive oil. The extract and water fraction showed protective action by increasing the HDL cholesterol level.

Effects of altering dietary cation-anion difference on calcium and energy metabolism in peripartum cows.

Our objective was to determine the effects of varying dietary cation-anion differences (DCAD: meq[(Na + K) - (Cl + S)]/100 g of dry matter) in prepartum diets on Ca, energy, and endocrine status prepartum and postpartum. Holstein cows (n = 21) and heifers (n = 34) were fed diets with varying amounts of CaCl2, CaSO4, and MgSO4 to achieve a DCAD of +15 (control), 0, or -15 meq/100 g of dry matter for the last 24 d before expected calving. Dietary Ca concentration was increased (by CaCO3 supplementation) with decreasing DCAD. Plasma ionized Ca concentrations prepartum and at calving in both cows and heifers increased with reduced DCAD in the diet. At calving, plasma ionized Ca concentration was 3.67, 3.85, and 4.35 for cows and 4.44, 4.57, and 4.62 mg/dl for heifers fed diets containing +15, 0, and -15 DCAD, respectively. All heifers had normal concentrations of plasma ionized Ca (>4 mg/dl) at calving. Also at calving, plasma concentrations ofparathyroid hormone and calcitriol were less in cows and heifers fed diets containing reduced DCAD, but the plasma concentration of hydroxyproline was not affected by diet. Prepartum dry matter intake, energy balance, and body weight gains were lower and concentration of liver triglyceride was higher for heifers but not cows fed the -15 DCAD diet. Also, nonesterified fatty acids the last week prepartum were positively correlated with liver triglyceride for heifers but not cows. Feeding of anionic salts plus CaCO3 to reduce DCAD to -15 and increase Ca in prepartum diets prevents hypocalcemia at calving in cows, but decreases prepartum dry matter intake and increases the concentration of liver triglyceride in heifers. That heifers maintained calcium homeostasis at calving regardless of diet but ate less when fed the -15 DCAD diet suggests that they should not be fed anionic salts before calving.

In vitro degradation of choline from selected feedstuffs and choline supplements.

The objective of this experiment was to determine the extent of in vitro degradation of choline from barley, corn, corn gluten meal, cottonseed meal, fish meal, soybean meal, alfalfa hay, timothy hay, choline chloride, and choline stearate. During four individual fermentation runs, samples were incubated in vitro for .25, 1, 3, 6, 12, 18, 24, 36, and 48 h with an inoculum mixture containing rumen fluid obtained from a rumen-fistulated dairy cow fed 17.5% corn silage and 28.7% grass silage and 53.8% concentrate diet. Because of their low choline content (less than .68 mg/g) corn, corn gluten meal, alfalfa hay, and timothy hay gave erratic values for choline disappearance for different fermentation runs and times of incubation although disappearance tended to increase with time. Data for the rest of the feeds and choline supplements were analyzed using nonlinear regression procedure to obtain estimates of potentially degradable choline, rapidly degradable choline, and the rate of choline degradation in vitro. The mean estimates of rumen degradable choline (%) were 79.4, 84.7, 82.9, 83.8, 98.0, and 98.6 for barley, cottonseed meal, fish meal, soybean meal, choline stearate, and choline chloride, respectively. The results suggest that incorporating choline-rich feedstuffs in diets can only marginally increase the postruminal flow of choline in dairy cows.

Effects of dietary and abomasally infused choline on milk production responses of lactating dairy cows.

Three experiments investigated the effects of exogenous choline on milk production responses of dairy cows. Ruminally fistulated Holstein cows were fed total mixed diets containing 30% corn silage and 70% corn/soybean meal-based concentrate in experiment 1, or 40% corn silage and 60% concentrate in experiments 2 and 3. In experiment 1, the effects of unsupplemented (control), dietary supplemented choline (50 g/d) and abomasally infused choline (50 g/d) were examined using three first-lactation cows in a 3 X 3 Latin square design. While dietary added choline had no effect, abomasally infused choline increased daily milk and 4% fat-corrected milk yield 3.2 and 3.8 kg/d respectively. In experiment 2, effect of daily abomasal infusion of 0, 30, 60 and 90 g choline were studied using four mature cows in a 4 X 4 Latin square design. Fat-corrected milk and milk fat percent were 2.6 kg/d and 0.59 percentage units higher for cows infused with 30 g/d choline than for unsupplemented controls, with 60 and 90 g/d choline infusions showing smaller effects. In experiment 3, daily abomasal infusion of 0 or 40 g choline were studied using four mature cows in a switchback design. Choline infusion (40 g/d) increased daily milk 1.6 kg/d over control while having no effect on milk composition or feed intake. Results of these experiments suggest a possible requirement for supplementing choline in lactating dairy cows.

Effect of antihypertensive therapy on plasma lipids and lipoproteins in mild hypertension.

Antihypertensive drugs have been incriminated for altering the lipid profile of hypertensives, obscuring the beneficial effect of blood pressure reduction on coronary artery disease. The effects of Propranolol, Nifedipine and Hydrochlorothiazide on plasma lipid fractions in recently diagnosed mild hypertensives, randomly allocated to PROP, NIF, HCT groups were studied at 0, 12 and 24 weeks of treatment. Target DBP of less than or equal to 90 mmHg was achieved in all the groups of patients. At 24 weeks, skewed distribution of lipid components was observed in PROP and NIF groups without significant alteration in various lipid fractions. In HCT group, TG increased and HDL-C and HDL-C/CH decreased significantly. Long-term significance of these changes, which make the lipid profile more atherogenic, needs to be considered while treating hypertensives.

Septilin and geriforte in allergic and vasomotor rhinitis.

Our study comprised 50 patients of allergic and vasomotor rhinitis. Seventeen patients gave history of stress and strain hence they were given Geriforte in addition to Septilin. The results of therapy were judged on following criteria: i) Symptomatic improvement. ii) Appearance of nasal mucosa before and after the therapy. Thirty-nine patients (78%) were cured 100% as they had total relief from symptoms along with change of nasal mucosa from bluish to pink. Eight patients (16%) had about 75% improvement and 3 patients (6%) had only 50% improvement. These patients were advised to continue the therapy for a longer time (6-8 weeks). Of these, 4 patients showed further improvement. In our opinion, Septilin has proved very useful in cases of allergic and vasomotor rhinitis. The patients who have history of stress and strain may also need Geriforte in addition to Septilin.