Patient reported outcomes after risk-reducing surgery in patients at increased risk of ovarian cancer.

OBJECTIVE: To describe the quality of life of women at an increased risk of ovarian cancer undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). METHODS: Patients evaluated in our gynecologic oncology ambulatory practice between January 2018-December 2019 for an increased risk of ovarian cancer were included. Patients received the EORTC QLQ-C30 and PROMIS emotional and instrumental support questionnaires along with a disease-specific measure (PROM). First and last and pre- and post-surgical PROM responses in each group were compared as were PROMs between at-risk patients and patients with other ovarian diseases. RESULTS: 195 patients with an increased risk of ovarian cancer were identified, 155 completed PROMs (79.5%). BRCA1 or BRCA2 mutations were noted in 52.8%. Also included were 469 patients with benign ovarian disease and 455 with ovarian neoplasms. Seventy-two at-risk patients (46.5%) had surgery and 36 had both pre- and post-operative PROMs. Post-operatively, these patients reported significantly less tension (p = 0.011) and health-related worry (p = 0.021) but also decreased levels of health (p = 0.018) and quality of life <7d (0.001), less interest in sex (p = 0.014) and feeling less physically attractive (p = 0.046). No differences in body image or physical/sexual health were noted in at-risk patients who did not have surgery. When compared to patients with ovarian neoplasms, at-risk patients reported lower levels of disease-related life interference and treatment burden, less worry, and better overall health. CONCLUSIONS: In patients with an increased risk of ovarian cancer, RRBSO is associated with decreased health-related worry and tension, increased sexual dysfunction and poorer short-term quality of life. Patients with ovarian neoplasms suffer to a greater extent than at-risk patients and report higher levels of treatment burden and disease-related anxiety.

Outcomes of minimally invasive versus open abdominal hysterectomy in patients with gestational trophoblastic disease.

OBJECTIVE: The aim of this study is to compare surgical and oncologic outcomes for women undergoing MIH or open abdominal hysterectomy (OAH) for management of gestational trophoblastic disease (GTD). METHODS: Patients who underwent hysterectomy for GTD between January 1, 2009 and December 31, 2018 were identified using an institutional database and tumor registry. Patients were stratified based on indication for and mode of hysterectomy. RESULTS: 39 patients underwent hysterectomy for GTD - 22 MIH and 17 OAH. 26 hysterectomies (66.7%) were performed for primary treatment of GTD, 7 (17.9%) for chemoresistance, 2 (5.1%) for uterine hemorrhage, and 4 (10.3%) for other indications. Mean tumor size (4.2 vs 4.6 cm; p = .81) and operative time (136 vs 163 mins; p = .42) were similar in both groups. MIH was associated with significantly less blood loss (71.5 vs 427.3 ml; p = .03) and shorter hospital stay (1.5 vs 3.9 days, p = .02) than OAH. Postoperative histology comprised 12 complete moles (6 invasive), 8 choriocarcinomas, 9 placental site trophoblastic tumors and 9 epithelioid trophoblastic tumors. Median follow-up was 67.2 months (50.2 MIH, 79.3 OAH; range 11.1-131.2) and there was no difference in remission (81.8% MIH vs 76.5% OAH; p = .68). There were 7 recurrences (4 MIH, 3 OAH) and 3 deaths (2 MIH, 1 OAH). Overall survival was 97.3% at 2 years and 88.5% at 5 years. There was no significant difference in 5-year survival by mode of surgery (MIH 90.9%, OAH 83.3%; p = .40). CONCLUSIONS: Patients undergoing MIH at our centers have similar oncologic outcomes, lower surgical blood loss and shorter hospital stay compared to those undergoing OAH. Overall survival is similar regardless of mode of surgery.

Gynecologic oncology care in the world of accountable care organizations.

Accountable Care Organizations (ACOs) are an example of alternative payment models that are becoming increasingly common in our healthcare system. ACOs focus on increasing value through cost reduction and improved outcomes, and historically focus on Medicare patients within primary care practices. As ACOs grow, attention will likely turn to costly subspecialty care as an area for improvement and standardization. This brief communication addresses the potential benefits and consequences of ACOs on Gynecologic Oncologists and for patients with gynecologic malignancies.

Bacterial penetration along different root canal fillings in the presence or absence of smear layer in primary teeth.

AIMS: To study the effect of the smear layer on the penetration of bacteria along different root canal fillings and to compare the sealing ability of new endodontic material Apexit plus as compared to Zinc Oxide Eugenol (ZOE) in primary teeth. STUDY DESIGN: A total of 60 human root segments were instrumented for endodontic treatment. Half of the sample size was irrigated with normal saline and in other half 3% NaOCl, 3% H2O2 and 17% EDTA was used alternatively as irrigant during instrumentation. The roots were rinsed thoroughly with distilled water and sterilized by autoclaving for 20 min at 121 +/- 2 degrees C. Roots with and without smear layer were obturated with Apexit plus, Zinc oxide eugenol. Following storage in humid conditions at 37 degrees C for 2 days, the specimens were mounted into a bacterial leakage test model for 180 days. RESULTS: At 180 days, there is statistically significant difference with a P value of < 0.05 among all groups except ZOE-smear and -nonsmear. In the presence of smear layer Apexit plus demonstrated more leakage. No leakage was observed in ZOE groups. ZOE demonstrated better sealing ability than Apexit plus. CONCLUSIONS: Removal of smear layer helps in better resistance to bacterial penetration along Apexit plus root canal fillings but no effect is seen along ZOE root canal fillings.

Antibacterial and antioxidant activity of lichen species Ramalina roesleri.

Solvent extracts of Ramalina roesleri Nyl were assayed for antimicrobial and antioxidant activity. Hexane extract was highly active against Staphylococcus aureus and Streptococcus mutans. The 1,1-diphenyl-2-picryl-hydrazil (DPPH) radical scavenging activity of extracts ranged from 29.42% to 87.90%. Atranorin, protolichesterinic acid, usnic acid, 2-hydroxy-4-methoxy-6-propyl benzoic acid, homosekikaic acid, sekikaic acid, benzoic acid, 2,4-dihydroxy-6-propyl and 2,4-dihydroxy-3,6-dimethyl benzoate were isolated from the hexane extract. Maximum DPPH radical scavenging activity was exhibited by sekikaic acid followed by homosekikaic acid.

TB control in India--efforts, challenges and priorities.

TB control is a long battle. Since after the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, endeavours have been made at different levels in the form of control measures like establishment of open-air sanatorium in Tilonia (Ajmer) in 1906, Tuberculosis Dispensary in Mumbai (1917), Tuberculosis Association of India (1939), Mass BCG campaign (1951), Establishment of Chemotherapy centre (TRC Chennai), National Sample Survey (1955-58), National Tuberculosis Institute Bangalore (1961), Developments of National Tuberculosis Programme (1962), Review of NTP by GOI, SIDA & WHO (1992), pilot testing of RNTCP (1993), implementation/expansion of RNTCP across the country (1997-2006). Shopping for health, marketing for TB diagnosis and treatment, MDR-TB, XDR-TB, TB-HIV combination and partnership related challenges are crucial and needs to be addressed .Universal access to DOTS for cutting the chain of transmission of bacilli, reducing the morbidity and mortality and reversing the TB epidemic in line with Millennium Development Goals, surveillance of notification, drug resistance, TB/HIV coinfection, operation researches, development of vaccines, immune therapeutic agents against tuberculosis and expansion of package of care to MDR-TB and XDR-TB would be the priorities for eradicating TB as a public health problem.

Can IMA-RNTCP stop TB by 2050?

Tuberculosis has been with mankind since time immemorial. No other disease has so much sociological, economic and health significance as tuberculosis. In the poorly functioning tuberculosis control programme, the ratio of incidence to prevalence may be as high as 1: 3.5. Experience and observations from both developed and developing countries have demonstrated that if case detection and cure rates in smear positive cases are consistently achieved to 70 % and 85 % respectively, the incidence would decline to 5% annually while prevalence decline very rapidly, being reduced to less than half of its previous level within three years. Since RNTCP India is based on scientific principles of DOTS strategy, its effective clinical and public health management, committed and co-ordinated efforts of public and private partners (IMA) would certainly lead to decline the prevalence (already declined from 586/1,00,000 in 1990 to 185/1,00,000 population in 2008 - 68 % reduction), mortality rate from 42/ 1,00,000 in 1990 to 21/1,00,000 in 2015 (already reduced to 24/1,00,000 in 2008 - 43 % reduction) as target set under indicator 23 of TB-related Millennium Development Goal. This kind of impact would result in halting and reversing TB Incidence to pave way for future effective control of TB, which may not remain a public health problem by 2050. Thus, TB control is a winnable battle.

Source of retreatment cases under the revised national TB control programme in Rajasthan, India, 2003.

BACKGROUND: Three years after state-wide DOTS coverage and achievement of global targets for detection and cure, the proportion of sputum-positive retreatment cases remained high in the north Indian state of Rajasthan. AIM: To determine source, accuracy of categorisation and treatment outcomes in Category II sputum-positive retreatment cases registered from January to March 2003 in five districts of Rajasthan. MATERIAL AND METHODS: Two hundred consecutive Category II sputum-positive retreatment cases were identified from the tuberculosis register and interviewed using a semi-structured questionnaire. RESULTS: Categorisation was correct in 195 (97.5%) of retreatment cases interviewed. Treatment after default (TAD) comprised 84.6% (165/195) of interviewees, with 13.3% (n = 26) relapses and 2.1% (n = 4) failure cases. Of the TAD cases, 84.8% (n = 140) had defaulted from previous treatment in the private sector. Only 6.1% (n = 10) had defaulted from Category II DOTS treatment. The most unfavourable treatment outcome seen amongst interviewees was default, as also described in the national data. CONCLUSION: TADs constituted the majority of interviewed retreatment cases (84.6%), and were overwhelmingly being generated by irregular treatment in the private sector. Further involvement of the private sector in the DOTS programme in Rajasthan is needed to stop the creation of further retreatment cases.

Diversity of avifauna of Jamwa Ramgarh wetland of Rajasthan in India.

The present paper deals with the rich avifauna available at Jamwa Ramgarh Lake of Rajasthan in India. More than 100 species of birds belonging to 38 families were recorded at lake during the year 2002, maximum species were sighted during the winter season. Due to scanty rainfall in 2002, this lake was also affected and had only one-fourth of water of its total capacity, which affected the numbers of migratory waterfowl also. In the wetland most water birds were found to be migratory and few being resident. Some rare, endangered, uncommon, vulnerable, threatened and near threatened species of birds those already listed in Red Data Book were sighted.

Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.

SETTING: Governmental health facilities in six districts of India. OBJECTIVE: To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks. DESIGN: Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy. RESULTS: Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks. CONCLUSION: The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.

Radioprotective role of Amaranthus gangeticus Linn.: a biochemical study on mouse brain.

Brain tissue is highly susceptible to oxidative damage due to its high utilization of oxygen and its poorly developed antioxidative defense mechanisms. Radiation or pro-oxidants interact with cells and tissues through secondary ionization mechanisms such as lipid peroxidation (LPO). LPO can be inhibited by antioxidants such as vitamins A, C, and E and the carotenoid beta-carotene. beta-Carotene, the provitamin A, plays an important radioprotective role due to its properties as a potent free radical scavenger, singlet oxygen quencher, and lipid antioxidant. Amaranthus gangeticus Linn., widely considered as a weed, has a high content of carotene, ascorbic acid, and folate and may prove an efficient antioxidant. To evaluate the antioxidative efficacy of Amaranthus, healthy Swiss albino mice from an inbred colony were treated with alcoholic extract of A. gangeticus leaves (AE) for 2 weeks, at 800 mg/kg body weight, before radiation exposure. Irradiated mice were examined and autopsied at intervals of 1, 3, 7, 15, and 30 days after exposure. Brain was removed by skull dissection, and various biochemical changes were sought. Radiation caused a maximum increase of 27% in LPO and a maximum decrease of 27.96% in protein content at day 7 in controls. However, in the experimental group the increase in LPO was 9.98% and the increase in protein content was 18.78% at day 7. By day 30 after irradiation, AE brought these values to near-normal levels. AE protected brain biochemical activity in this murine study and may prove beneficial for clinical use as a radioprotector.