Cervical cancer screening in Tamilnadu, India: a feasibility study of training the village health nurse

Uterine cervical cancer is the most common malignancy among females in developing countries, including India. The success of cervical cancer screening programs in North America and Western Europe has been the result of centralized cervical-cytology screening. This is not possible in the villages (n=17,000) of Tamilnadu where 58 percent of females in rural areas are illiterate, health infrastructure is mediocre, and cervical cytology is unknow. The present study was undertaken to examine if the village health nurse (VHN) could be trained quickly to identify a cervical abnormality by visual inspection so that we could down stage the cancer to earlier stages, more amenable to treatment. VHNs also would be trained to take an adequate Pap smear. A total of 101 VHNs were trained in batches and returned to their villages. Within two years, 6,459 engible women in the study area were screened. The agreement between the gynecologists and the VHNs in identifying cancer among those with abnormal cervix was 95 percent, and 80 percent of the Pap smears taken by VHNs were adequate by WHO criteria, making the feasibility study highly successful.Authors are with The Cancer Institute (WIA), Adyar, Madras, Tamil Nadu,India. Address correspondence to Dr Gajalakshmi, Epidemiology Division and Cancer Registry, 18, Sardar Patel Road, Cancer Institute (WIA), Madras-600 036, Tamilnadu, India. This project was funded by the Indian Council of Medical Research, Government of India, New Delhi, India.520 Cancer Causes and Control. Vol 7. 1996     

Myeloperoxidase and oxidative stress in rheumatoid arthritis

Objective. To determine whether MPO contributes to oxidative stress and disease activity in RA and whether it produces hypochlorous acid in SF. Methods. Plasma and where possible SF were collected from 77 RA patients while 120 healthy controls supplied plasma only. MPO and protein carbonyls were measured by ELISAs. 3-Chlorotyrosine in proteins and allantoin in plasma were measured by mass spectrometry. Results. Plasma MPO concentrations were significantly higher in patients with RA compared with healthy controls [10.8?ng/ml, inter-quartile range (IQR): 7.2-14.2; P?3.2) and those with low disease activity (LDA; DAS-28 ≤3.2) (HDA 27.9?ng/ml, 20.2-34.1 vs LDA 22.1?ng/ml, 16.9-34.9; P?>?0.05). There was a significant relationship between plasma MPO and DAS-28 (r?=?0.35; P?=?0.005). Plasma protein carbonyls and allantoin were significantly higher in patients with RA compared with the healthy controls. MPO protein was significantly higher in SF compared with plasma (median 624.0?ng/ml, IQR 258.4-2433.0 vs 30.2?ng/ml, IQR 25.1-50.9; P?相似文献   

Pharmacotherapeutic strategies for treating hypertension in patients with obesity

Introduction: Hypertension and obesity are important health challenges that independently increase cardiovascular morbidity and mortality. There is a lack of randomized controlled trials to clearly inform on preferred drug choices to be adopted in clinical practice for the treatment of obesity-related hypertension (OHT). Adequate differentiation of drug classes for preferential use in obesity or the metabolic syndrome aimed at avoiding adverse effects on body weight and the metabolic profile is neglected in this population, at least in part due to the lack of specific pharmacologic recommendations in hypertension guidelines.

Areas covered: The authors summarize and suggest pharmacotherapeutic strategies based on pathophysiologic rationale to achieve blood pressure (BP) control and avoid adverse metabolic consequences in OHT.

Expert opinion: Combinations of various pharmacologic antihypertensive approaches are required in the management of OHT. It is recommended that targeting sympathetic overactivity with a centrally acting sympatholytic agent such as moxonidine should be considered as a preferred second line treatment choice in combination with renin angiotensin system (RAS) blockade, the current first line choice. Though not all obese subjects have sympathetic overdrive, this approach is likely to provide effective control of blood pressure and improve the metabolic profile of patients with OHT along with positive implications for cardiovascular risk reduction.     

Validation of the human activity profile in stroke: a comparison of observed, proxy and self-reported scores

PURPOSE: To assess the concurrent validity of the Human Activity Profile (HAP) with stroke and healthy control individuals, when reported by the subject or a proxy and compared to observed performance, used as gold standard; factors related to discrepancies; as well as to determine variables that could best predict physical activity levels. METHODS: A total of 24 stroke and 23 healthy control subjects took part in the study. Functional outcome measures included personal/demographic factors, HAP, the 10-meter walk, and cognition. RESULTS: Strong relationships were found between self-reported and observed scores for both groups (r=0.89-0.99). The relationships between proxy and observed scores were acceptable for stroke (r=0.80-0.87) but lower for control subjects (r=0.65-0.75), with intraclass correlation coefficients (ICCs) ranging from 0.69-0.89. Significant differences were found between proxy and observed scores for stroke, but not for control subjects. Discrepancies between scores showed little predictability from selected variables. For stroke subjects, the strongest variable explaining physical activity levels was walking speed (r2=43%) and the best combination of variables was walking speed plus cognition (r2=55%). CONCLUSIONS: Self-reported HAP was an excellent measure both for stroke and control subjects and related well to observed performance. Proxy reports appear to be valid for stroke subjects. HAP was significantly related to measures of walking speed.     

Potential applications of lactic acid bacteria and bacteriocins in antimycobacterial therapy

Tuberculosis(TB) is a communicable disease caused by Mycobacterium tuberculosis(M. tuberculosis). WHO estimated that 10.4 million new(incident) TB cases worldwide in year 2016. The increased prevalence of drug resistant strains and side effects associated with the current anti-tubercular drugs make the treatment options more complicated. Hence, there are necessities to identify new drug candidates to fight against various sub-populations of M. tuberculosis with less or no toxicity/side effects and shorter treatment duration. Bacteriocins produced by lactic acid bacteria(LAB) attract attention of researchers because of its "Generally recognized as safe" status. LAB and its bacteriocins possess an effective antimicrobial activity against various bacteria and fungi. Interestingly bacteriocins such as nisin and lacticin 3147 have shown antimycobacterial activity in vitro. As probiotics, LAB plays a vital role in promoting various health benefits including ability to modulate immune response against various infectious diseases. LAB and its metabolic products activate immune system and thereby limiting the M. tuberculosis pathogenesis. The protein and peptide engineering techniques paved the ways to obtain hybrid bacteriocin derivatives from the known peptide sequence of existing bacteriocin. In this review, we focus on the antimycobacterial property and immunomodulatory role of LAB and its metabolic products. Techniques for large scale synthesis of potential bacteriocin with multifunctional activity and enhanced stability are also discussed.     

Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study

BACKGROUNDCarpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions. AIMTo correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.METHODSThis was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe. RESULTSThere were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSIONWe feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.