ecancermedicalscience最新文献

Sexually transmitted infections (STIs) and human papillomavirus (HPV) infections are common among women of reproductive age and can lead to infertility, adverse pregnancy outcomes, neonatal infections and cervical cancer. In countries with limited medical coverage, untreated infections contribute to high morbidity. This study aimed to expand the current knowledge on the prevalence of bacterial vaginosis (BV) and STIs in pregnant Ethiopian women and assess the association of these conditions with HPV infections. Socio-demographic data and vaginal lavage samples were collected from 779 asymptomatic women aged 18 to 45 years (median age, 25.9 years) attending antenatal care in seven centres across Ethiopia. Multiplex polymerase chain reaction was used to test for BV, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, herpes simplex virus types 1 and 2 (HSV-1/2), Mycoplasma, Ureaplasma, Candida species and HPV. Overall, 26.8% (95% confidence interval (CI): 23.7-29.9) of women tested positive for BV or one of the following STIs: C. trachomatis, T. vaginalis, N. gonorrhoeae, Mycoplasma genitalium, HSV-1/2 or Ureaplasma urealyticum. Additionally, 22.1% tested positive for at least one high-risk HPV type. Chlamydia trachomatis and HSV-2 were significantly more common among women who were positive for HPV and high-risk HPV. This study reveals a high prevalence of asymptomatic pregnant women who are positive for BV, STIs or HPV, putting them at risk of adverse pregnancy outcomes, secondary infertility or cervical cancer in a country with limited medical coverage. Screening and treating these women could be crucial in reducing morbidity.

Background: Mastectomy and breast reconstruction with latissimus dorsi myocutaneous flap (LDF) is a major surgery that covers eight or more dermatomes causing severe pain in the postoperative period.

Objectives: We evaluated the analgesic effect of a hybrid technique of ultrasound-guided combined thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in a single needle pass in ten consecutive patients scheduled for mastectomy with LDF reconstruction as a part of a multimodal analgesia regimen.

Design: Prospective observational study.

Setting: A tertiary-level cancer hospital in Eastern India. The study was conducted between 01/09/2023 and 20/12/2023.

Patients: 10 consecutive consenting female patients of age between 18 and 75 years suffering from breast cancer, scheduled for a mastectomy with LDF reconstruction were recruited in this study, excluding patients with body mass index more than 40, coagulopathy or thrombocytopenia, skin conditions such as dermatitis, infection and so on, and known allergy to local anaesthetics (LAs).

Interventions: The recruited patients received an ultrasound-guided combined thoracic paravertebral and erector spinae (COMPARES) block at the third thoracic (T3) level in a single needle pass, with 10 mL in the TPVB and 30 mL in the ESPB compartment, respectively, in a cephalad to caudad approach before induction of general anaesthesia.

Main outcome measures: The primary endpoint was pain score at 9:00 am on postoperative day one. Other outcome measures were pain scores at postoperative hours 0 (immediately after awakening from general anaesthesia), 4, 8 and 12, postoperative nausea vomiting, requirement of rescue analgesics and pain score on shoulder movements on postoperative day one.

Results: Median (range) resting pain scores at 0, 4, 8 and 24 hours were 1.5 (0-5), 2.5 (0-4), 2.5 (2-5) and 3 (2-4), and dynamic pain score on shoulder mobilization on postoperative day one morning was 3 (2-6). Only one patient required rescue analgesia.

Conclusions: We found the technique inexpensive and potentially useful, but difficult in obese and short-statured patients due to increased depth and narrowing of the intertransverse space. This technique should be further evaluated in a randomised controlled trial.

Trial registration: This trial was registered with the Clinical Trials Registry of India with the registration number CTRI/2023/08/057119.

Background: CD44 is a cell-surface transmembrane glycoprotein that participates in the regulation of many cellular processes, including cell division, adhesion, migration and stem-like characteristics. CD63 is involved in the exocytosis process.

Objective: To evaluate the relationship between CD44 and CD63 expression and clinicopathological features, including tumor-infiltrating lymphocytes (TILs), phosphoinositide 3-kinase (PIK3CA) mutation and survival.

Methodology: CD44 and CD63 were stained in samples from 101 breast cancer cases from Peruvian women.

Results: Median age was 52 years, most were most were grade-3 (68%), estrogen receptor (ER)+ (64%) and stage II-III (92%). Median ki67 was 30%, median stromal TIL was 30% and PIK3CA mutation was found in 49%. Longer survival was associated with earlier stages (p = 0.016), lower ki67 (p = 0.023), ER+ (p = 0.034), luminal phenotype (p = 0.029) and recurrence (p < 0.001). CD44 was classified as high cell density staining in 57% and high intensity in 55%. High CD44 density was associated with younger age (p = 0.043), triple-negative phenotype (p = 0.035) and shorter survival (p = 0.005). High CD44 expression was associated with short survival (p = 0.005). High CD63 cell density was found in 56% of cases and was associated with ER-positive (p = 0.045), low TIL levels (p = 0.007), Luminal-A (p = 0.015) and low CD44 intensity (p = 0.032).

Conclusion: CD44 expression was associated with aggressive features and low CD63 density staining.

Introduction: The burden of colorectal cancer (CRC) is on a rapid increase on the African continent, yet grossly under reported. Herein, we provide and updated estimates of CRC burden (incidence and mortality) across Africa as of 2022, and make crucial predictions to 2050.

Methods: We gathered information on CRC incidence and mortality from the GLOBOCAN 2022 database, which covers 185 countries. The age-standardised incidence and mortality rates (ASRs) per 100,000 person-years were determined. Cases and deaths up to 2050 were estimated using 2022 incidence and mortality rates.

Results: In 2022, an estimated 70,428 cases and 46,087 mortalities due to CRC were recorded across the African continent. Africa's ASRs for CRC incidence and mortality were 8.2 and 5.6 per 100,000 population, respectively, and were highest in North Africa followed by East Africa. At national levels, CRC ranked in the top four of the most commonly diagnosed cancers in more than half (56%) of African countries. ASRs of both incidence and mortality were higher among males than females. New cases are predicted to increase by 139.7% (from 70,428 in 2022 to 168,683 in 2050) at the current incidence rate. Similarly, mortalities will increase by 155.2% (from 46,061 in 2022 to 117,568 in 2050).

Conclusion: CRC remains a major cause of morbidity and mortality in many African countries, and the number of new cases and deaths is predicted to rise significantly by 2050. Efforts to reduce the incidence of preventable CRC cases should be prioritised.

The Government of India established National Tobacco Quitline Services (NTQLS) to provide free and effective telephonic counselling to help people quit tobacco. The objective of the paper is to present the data of tobacco quitters who quit tobacco through NTQLS, Mumbai, in the years 2021-2022 and the factors that influenced tobacco quitting. This is a prospective study where individuals willing to quit tobacco utilised NTQLS. Effective counselling was provided and was followed up. Multiple logistic regression analysis was conducted. Tobacco quitting is the dependent variable while sociodemographic characteristics, tobacco consumption habits, previous quit attempts, alcohol consumption, other substance use and co-morbidity were independent variables. In the years 2021-2022, a total of 448,893 calls hit the system. Of these, 127,163 (28.3%) calls were attended. Of the attended calls, a quit date was set for 21,504 calls (16.9%); of these, 8,276 (38.5%) callers quit tobacco. Individuals with no previous quit attempts [OR: 1.48, 95% confidence interval (CI): 1.25-1.75], never consumed alcohol (OR: 1.37, 95%CI: 1.2-1.56), consumed tobacco within 6-30 minutes (OR: 1.29, 95% CI: 1.12-1.49) and 30-60 minutes after waking up (OR: 1.26, 95% CI: 1.05-1.51) had higher quitting rates. While, female callers (OR: 0.59, 95% CI: 0.35-0.99), private sector workers (OR: 0.70, 95% CI: 0.61-0.81), individuals consuming more than ten tobacco units/packets (OR: 0.70, 95% CI: 0.61-0.79), tobacco use more than 10 years (OR: 0.85, 95% CI: 0.73-0.97), expenditure of more than 5,000 rupees on tobacco (OR: 0.58, 95% CI: 0.44-0.77) and those with no known co-morbid conditions (OR: 0.8, 95% CI: 0.71-0.91) were less likely to quit tobacco. Reduced tobacco consumption will inadvertently reduce the non-communicable disease (NCD) burden and help in achieving the sustainable development goals related to tobacco control and NCD. Quitline plays an important role in tobacco control.

Introduction: The delivery of positive Human papillomavirus (HPV) test results can have a psychosocial impact and act as a barrier for women to continue the cervical cancer (CC) prevention process. A previous formative research based on a woman's perspective indicated that a mobile app could be an acceptable and appropriate tool to help women obtain information and reduce fears related to a positive result. Based on these findings, we developed an app-based intervention that would function as a support for professionals who offer the HPV test and communicate their results. We report data on the perceptions of healthcare providers regarding the barriers and facilitators to the incorporation, in a low and middle-income context.

Methods: Qualitative study based on individual semi-structured interviews with health professionals. All the professionals (n =13) took HPV and Pap test samples and provided information on HPV testing, in the public health system of Ituzaingó, Greater Buenos Aires, Argentina. The themes explored were selected and analysed using domains and constructs of Consolidated Framework for Implementation Research (CFIR).

Results: Practitioners had a positive assessment of the intervention through most included constructs: adaptability, compatibility, complexity, relative advantage, belief in the validity and robustness of the intervention, innovation source and knowledge and beliefs about the intervention. However, some potential barriers were also identified including: adaptability, tensions for change, relative priority and leadership engagement. Practitioners conditioned the intervention's success to specific adjustments of the app (weight and interface usability), legitimmated institutions' support, and clear and sustained health authorities' commitment and directions.

Conclusion: Health professionals had a positive assessment of implementing an app to support the HPV test communication and information provision process, although they conditioned its effectiveness to specific adjustments. The results allow us to identify and develop recommendations for the app to be implemented effectively and sustained over time. The findings of this study have important implications not only for Argentina, but also for other low and middle-income countries, given that the implementation could be adapted, with the aim of improving communication between patients and health institutions in the CC prevention process.

Background: Non-clear-cell renal cell carcinoma (nccRCC) refers to a rare diverse heterogeneous group of tumours; usually treated with immune check point inhibitors and or tyrosine kinase inhibitors (TKIs). Prospective large-scale data from Asian countries is limited.

Methods: This is a retrospective study of patients with metastatic nccRCC treated at Tata Medical Centre, Kolkata, India, from 2012 to 2022. Demographic profiles, histologic subtypes, treatment details, response to therapy (by response evaluation criteria in solid tumours (RECIST v1.1)) and survival status were captured from electronic medical records (EMRs) of hospitals up till May 2023. Kaplan Meier methods were estimated to assess progression-free survival (PFS) and overall survival (OS).

Results: A total of 89 consecutive patients were screened for this study, 24 were excluded due to inadequate data in EMR. 65 patients were included in the final analysis, with a median age at diagnosis of 59 years (range 20-84) of which 81% were male. Histologic subtypes comprised of 43% papillary, 31% clear cell with mixed histology, 3% sarcomatoid and 23% others including chromophobe, mucinous-tubular, spindle cell, oncocytic, medullary, poorly differentiated and rhabdoid). The most common site of metastasis was the lung 62% (n = 40) followed by non-regional nodes 32%, bone 26% and liver 14%. 15% patients presented with haematuria and 62% underwent nephrectomy prior to systemic therapy. The majority received pazopanib 46% (n = 30), chemotherapy 20% (n = 13) including bevacizumab plus erlotinib, sunitinib 15% (n = 10) or cabozantinib 14% (n = 9). Only 3(5%) patients received nivolumab plus cabozantinib combination. Response to treatment showed complete response in 1.5%, partial response in 20%, stable disease in 51% and progressive disease in 23% as per RECIST v1.1. 17 patients required dose reduction and interruption due to adverse effects and 33% (n = 22) received second-line therapy with nivolumab 18% (n = 4), axitinib and everolimus among others. After a median follow up of 44 months, the median PFS was 13 months (95%CI 7.2-18.9) and the median OS was 17 months (95%CI 12.1-22.1) for the entire cohort.

Conclusion: The overall response and survival for metastatic nccRCC was relatively better in comparison with published data, despite the limited number of patients treated with ICIs due to cost and access barriers.

This case report presents the diagnosis and management of a pleomorphic adenoma in a 55-year-old male smoker with a habit of smoking tobacco for 6 years. The patient presented with a chief complaint of swelling in the posterior palatal region. Clinical examination revealed a well-circumscribed, non-tender, firm swelling in the palatal region. An incisional biopsy followed by surgical excision was performed, and histopathological evaluation confirmed the diagnosis of pleomorphic adenoma. Tyrosine crystals were observed within the tumour stroma, providing additional diagnostic insight. A 10-year post-operative follow-up revealed no recurrence of the lesion.