Informal Providers-Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review.

PURPOSE: South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS: A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS: IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION: Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.

An approach of selecting appropriate markers from the primary tumor to enable detection of circulating tumor cells in patients with non-small cell lung cancer.

PURPOSE: Circulating tumor cells (CTCs) are rare and difficult to isolate, and require selecting minimal but appropriate markers. The aim of this study was to identify markers in the primary non small cell lung cancer (NSCLC) tissue to guide isolation of CTCs from the peripheral blood of patients with lung cancer. METHODS: The expression of CK-19, EGFR and MUC-1 was evaluated by RT-PCR in the NSCLC tumor and paired adjacent normal tissues from 27 patients. The normal cytology, and the neoplastic and fibrotic pathology of the tissue were analyzed by histochemistry. The expression of the markers was analyzed in relation to the stage and grade of disease. RESULTS: Expression analysis showed that 42% of the tumors were positive for CK-19, whereas 85% for both EGFR and MUC-1. Ninety two percent of the tumors expressed any one marker. All (100%) adjacent normal tissues were CK-19 negative, 52% EGFR negative and 44% MUC-1 negative. CK-19 expression was specific to the tumor tissue but it was expressed by only 42% of them, manifesting a need for at least three markers to guide the detection of CTCs isolated from the peripheral blood of NSCLC patients. Histopathology demonstrated that 58% were adenocarcinomas, 35% squamous cell carcinomas and 7% had mixed pathology. CONCLUSIONS: This data serves as a prelude and emphasizes the importance of selecting markers expressed in the primary tumor tissue to facilitate and enable enumeration of CTCs.

Isolated asymptomatic skeletal muscle metastasis in a potentially resectable non-small cell lung cancer: detection with FDG PET-CT scanning.

Asymptomatic skeletal muscle metastasis in non-small cell lung cancer is a rare event particularly when it is detected at initial staging. This report describes how whole body imaging with [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) detected a solitary asymptomatic metastasis to the gluteus maximus muscle in a potentially resectable case of non-small cell lung cancer, thereby changing the treatment plan from surgical resection to systemic chemotherapy.

Laryngeal amyloidosis.

Localized amyloidosis is characterized by the deposition of amyloid fibres in a particular site or organ system in the absence of systemic involvement. Patients with localized laryngeal amyloidosis usually present with long-standing hoarseness or dyspnea. The diagnosis is made by a high degree of suspicion on the basis of the history and a characteristic appearance on direct laryngoscopic examination. When such lesions are seen, an adequate deep punch biopsy should be obtained, and an experienced pathologist should be able to identify the lesion on routine staining. However, the slides should be stained with Congo red and examined with polarized light microscopy to establish the diagnosis. Following proper diagnosis and evaluation of the extent of disease, usually by computed tomographic scan, surgery is the treatment of choice. Preservation of the voice and airway should be the aim in all patients. Endoscopic carbon-dioxide laser excision of the mass should be the first line of therapy. Patients may require repeated removal of the amyloid deposits. The results of treatment are excellent.