RESUMEN
BACKGROUND: There is a dearth of research examining the association between differential expression (DE) of genetic transcritome associated with cognition alteration (CA) and emotional frailty (EF) in treatment naïve head and neck squamous cell carcinoma (HNSCC) patients. The present study was undertaken to identify the DE of mRNA of CA-EF in HNSCC tumor and correlate with clinical and other known genetic factors that promote oncogenesis as well as CA-EF. MATERIAL AND METHODS: Using Genome-Wide Association Studies, putative genes associated with CA-EF(Prixie Fixie score ≥0.10) were identified. The DE of the mRNA of the thus selected genes were obtained from The CANCER GENOME ATLAS - HNSCC patients along with clinical details. The DE of mRNA pertaining to known factors such as inflammation, serotonergic and dopaminergic functions as well as clinical parameters were studied for association with the risk of DE of CA-EF. Appropriate statistics were performed and Pâ¯≤â¯0.05 was taken as significant. RESULTS: A total of 520 HNSCC patients formed study group. There were 77 (14.81%) patients at risk for CD, 41 (7.9%) for CI and 113 (21.73%) for EF risk. In all, 103 (19.81%) HNSCC patients of this cohort had DE of mRNA of genes associated with CA. Inflammation, circadian genes, mTOR pathway, invasion and metastasis set of genes had a significant association with the risk of DE of CA-EF. DISCUSSION: Transcriptome's have been postulated to mediate CA-EF by targeted action on human brain. Differential Expression of putative genes associated with CA-EF have been demonstrated in HNSCC tumor. These DE could predispose the patients to CA-EF by the action of gene-environmental as well as psycho-social constructs. As CA-EF could adversely influence the treatment and alter the quality of life among survivors, screening for CA-EF at HNSCC presentation becomes imperative.
RESUMEN
BACKGROUND: -Mentally Disabled (MD) subjects often have multiple co-morbidities and also experience injuries, acute and chronic illness like the general population. Details of such episodes and the impact of health insurance have not been described for Tamil Nadu, an Indian state population. This manuscript intends to report on this experience. MATERIALS AND METHOD: -Secondary Data Analysis of District Level Household and Facility survey-4 (2012-13) were employed for this study. Comparison of MD with the normal population was performed. Demographic characteristics along with injury (in preceding year), acute illness (within past 15 days) and the experience of chronic illness (requiring treatment for 1 month), treatment seeking behavior and health insurance coverage formed the variables. Descriptive statistics, chi-square and odds ratio are presented. P≤0.005 was considered as statistical significance. RESULT: -Of the 179381 surveyed, 565(0.3%) had some form of MD and 169938 (94.7%) had no disabilities. The two groups varied in age, gender, and marital status. MD population had nearly 4 times the incidence of injury (P = 0.000) in the past 1 year, more commonly requiring in-patient treatment. Epilepsy was more common among individuals with MD with odds ratio of 7.159 [P = 0.015]. Health insurance cover and its influence on treatment seeking behavior are presented. DISCUSSION: -The experience of injuries, acute and chronic illness by individuals with MD, to the best of our knowledge has been described for the first time in Tamil Nadu. Individuals with MD and without health insurance often do not take treatment. The absence of health insurance with the resulting increased cost of out-of-pocket expense for chronic illness may force them to neglect their health. These factors are discussed along with recommendations for policy makers.
