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Importance: Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown. Objective: To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts. Design, Setting, and Participants: This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024. Main Outcomes and Measures: The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated. Results: Included in the analysis were 2019 estimates for 7â¯091â¯897 adults (2.8% of US adult population; 76.7% males and 23.3% females) who were released from incarceration at least once, typically after brief pretrial stays. The RR of suicide was 8.95 (95% CI, 7.21-10.69) within 1 year after jail release and 6.98 (95% CI, 4.21-9.76) across 2 years after release. A total of 27.2% (95% CI, 18.0%-41.7%) of all adult suicide deaths occurred in formerly incarcerated individuals within 2 years of jail release, and 19.9% (95% CI, 16.2%-24.1%) of all adult suicides occurred within 1 year of release (males: 23.3% [95% CI, 20.8%-25.6%]; females: 24.0% [95% CI, 19.7%-36.8%]). The alternate method yielded slightly larger estimates. Another 0.8% of adult suicide deaths occurred during jail stays. Conclusions and Relevance: This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.
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Prisioneros , Suicidio , Humanos , Adulto , Femenino , Masculino , Suicidio/estadística & datos numéricos , Suicidio/psicología , Prisioneros/estadística & datos numéricos , Prisioneros/psicología , Persona de Mediana Edad , Estados Unidos/epidemiología , Estudios de Cohortes , Cárceles Locales/estadística & datos numéricos , Adulto Joven , Factores de RiesgoRESUMEN
Stem rust is one of the major diseases threatening wheat production globally. To identify novel resistance quantitative trait loci (QTLs), we performed 35K Axiom Array SNP genotyping assays on an association mapping panel of 400 germplasm accessions, including Indian landraces, in conjunction with phenotyping for stem rust at seedling and adult plant stages. Association analyses using three genome wide association study (GWAS) models (CMLM, MLMM, and FarmCPU) revealed 20 reliable QTLs for seedling and adult plant resistance. Among these 20 QTLs, five QTLs were found consistent with three models, i.e., four QTLs on chromosome 2AL, 2BL, 2DL, and 3BL for seedling resistance and one QTL on chromosome 7DS for adult plant resistance. Further, we identified a total of 21 potential candidate genes underlying QTLs using gene ontology analysis, including a leucine rich repeat receptor (LRR) and P-loop nucleoside triphosphate hydrolase, which have a role in pathogen recognition and disease resistance. Furthermore, four QTLs (Qsr.nbpgr-3B_11, QSr.nbpgr-6AS_11, QSr.nbpgr-2AL_117-6, and QSr.nbpgr-7BS_APR) were validated through KASP located on chromosomes 3B, 6A, 2A, and 7B. Out of these QTLs, QSr.nbpgr-7BS_APR was identified as a novel QTL for stem rust resistance which has been found effective in both seedling as well as the adult plant stages. Identified novel genomic regions and validated QTLs have the potential to be deployed in wheat improvement programs to develop disease resistant varieties for stem rust and can diversify the genetic basis of resistance.
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Basidiomycota , Plantones , Mapeo Cromosómico , Plantones/genética , Triticum/genética , Estudio de Asociación del Genoma Completo , Sitios de Carácter Cuantitativo/genética , Basidiomycota/genética , Resistencia a la Enfermedad/genética , Enfermedades de las Plantas/genéticaRESUMEN
Background: Autonomic dysfunction is one of the major complications in noncommunicable diseases, and there are studies to prove yoga practice improves cardiac autonomic function. So, this present study was done to compare the autonomic functions among yoga practitioners and nonyoga practitioners. Methods: This cross-sectional comparative study was initiated among 68 healthy volunteers of both sexes, after recruiting them based on inclusion and exclusion criteria in the age group of 17-30 yrs. The autonomic reactivity tests like resting heart rate, response of heart rate to standing, Valsalva maneuver, and response of heart rate to deep breathing, response of BP to standing, and sustained hand-grip were done. Results: In the autonomic reactivity test, resting heart rate (80.92 ± 11.76 vs 69.24 ± 10.64) and sustained handgrip (16.30 ± 4.53 vs 10.20 ± 3.67) significantly decreased (P < 0.05) in the participants of the yoga group compared to control group. Deep breathing test, Valsalva maneuver, 30:15 ratio in lying to standing, and BP response to standing test did not show any significant difference between the groups (P > 0.05). Conclusion: The present study revealed diminished sympathetic activity and improved parasympathetic activity among the regular yoga practicing participants. It can be practiced regularly to reduce stress and prevent lifestyle-associated disorders in the future.
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Leaf rust is one of the important diseases limiting global wheat production and productivity. To identify quantitative trait nucleotides (QTNs) or genomic regions associated with seedling and adult plant leaf rust resistance, multilocus genome-wide association studies (ML-GWAS) were performed on a panel of 400 diverse wheat genotypes using 35 K single-nucleotide polymorphism (SNP) genotyping assays and trait data of leaf rust resistance. Association analyses using six multi-locus GWAS models revealed a set of 201 significantly associated QTNs for seedling and 65 QTNs for adult plant resistance (APR), explaining 1.98-31.72% of the phenotypic variation for leaf rust. Among these QTNs, 51 reliable QTNs for seedling and 15 QTNs for APR were consistently detected in at least two GWAS models and were considered reliable QTNs. Three genomic regions were pleiotropic, each controlling two to three pathotype-specific seedling resistances to leaf rust. We also identified candidate genes, such as leucine-rich repeat receptor-like (LRR) protein kinases, P-loop containing nucleoside triphosphate hydrolase and serine-threonine/tyrosine-protein kinases (STPK), which have a role in pathogen recognition and disease resistance linked to the significantly associated genomic regions. The QTNs identified in this study can prove useful in wheat molecular breeding programs aimed at enhancing resistance to leaf rust and developing next-generation leaf rust-resistant varieties.
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Basidiomycota , Triticum , Basidiomycota/genética , Pan , Mapeo Cromosómico , Resistencia a la Enfermedad/genética , Estudio de Asociación del Genoma Completo , Genómica , Enfermedades de las Plantas/genética , Proteínas Quinasas , Plantones/genética , Triticum/genéticaRESUMEN
In this work, we characterize the micellization and morphology transition induced in aqueous cetyltrimethylammonium bromide (CTAB) solution by the addition of the antioxidant propyl gallate (PG) using tensiometry, rheology, and small-angle neutron scattering (SANS) techniques combined with the molecular dynamics (MD) simulation approach. The adsorption of CTAB at the air-water interface in the presence of varying [PG] revealed a progressive decrease in the critical micelle concentration (CMC), while the changes in different interfacial parameters indicated enhancement of the hydrophobicity induced by PG in the CTAB micellar system. The dynamic rheology behavior indicated an increase in the flow viscosity (η) as a function of [PG]. Moreover, the rheological components (storage modulus, G', and loss modulus, Gâ³) depicted the viscoelastic features. SANS measurements depicted the existence of ellipsoidal micelles with varying sizes and aggregation number (Nagg) as a function of [PG] and temperature. Computational simulation performed using density functional theory (DFT) calculations and molecular dynamics (MD) provided an insight into the atomic composition of the examined system. The molecular electrostatic potential (MEP) analysis depicted a close proximity of CTAB, i.e., emphasized favorable interactions between the quaternary nitrogen of CTAB and the hydroxyl group of the PG monomer, further validated by the two-dimensional nuclear Overhauser enhancement spectroscopy (2D-NOESY), which showed the penetration of PG inside the CTAB micelles. In addition, various dynamic properties, viz., the radial distribution function (RDF), the radius of gyration (Rg), and solvent-accessible surface area (SASA), showed a significant microstructural evolution of the ellipsoidal micelles in the examined CTAB-PG system, where the changes in the micellar morphology with a more elongated hydrophobic chain and the increased Rg and SASA values indicated the notable intercalation of PG in the CTAB micelles.
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Compuestos de Cetrimonio , Micelas , Antioxidantes , Cationes , Cetrimonio , TensoactivosRESUMEN
Diet plays an important role in management of diabetes and foods having low glycemic index are gaining more importance as they delay the release of glucose in the blood. It is essential to develop low glycemic food mix from regionally available ingredients for use in daily dietaries. Hence, the present study was undertaken to assess the glycemic index of the traditional recipes prepared from developed millet based food mix and their effect on pre diabetic subjects. The developed millet based food mix had appreciable amount of protein (19.41 g/100 g) and dietary fibre (21.11 g/100 g). The traditional recipes viz., roti, dosa and dumpling (mudde) prepared from developed mix exhibited higher acceptance with good sensory parameters and are comparable to regional preparations. The glycemic index was found to be 37, 48 and 53 for dosa, mudde and roti respectively with a glycemic load of 11.05, 18.43 and 18.09. However, all the three developed products showed the relatively lower glycemic index (< 55) and moderate glycemic load of < 20. Further, dietary intervention on pre diabetic subjects revealed that there was a significant reduction in FBS (120.50 ± 18.73 to 97.81 ± 20.00) and HbA1c (6.14 ± 0.30 to 5.67 ± 0.40) indicating their preferable option in the management of diabetes mellitus.
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The leading causes of death in the world are cardiovascular disease (CVD) and stroke according to the World Health Organization, as is also the case in India. There is also a high prevalence of major conventional risk factors in India, where 18.3%, 9.0% and 14.1% of adults are diagnosed with hypertension, diabetes and smoking, respectively. The aim of the present study was to look at the risk of CVD among doctors in our country using a validated tool developed by the National Health Service (NHS) in the UK, the QRISK3 calculator.
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Enfermedades Cardiovasculares/epidemiología , Médicos/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiologíaRESUMEN
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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OBJECTIVE: To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity. METHODS: We use data from the Behavioral Risk Factor Surveillance System for 14 states. Logistic regressions yield estimates of the direct associations of ACEs exposure with health outcomes net of health risk factors, and indirect ACEs-health associations via health risk factors. Models were estimated for California (N = 22,475) and pooled data from 13 states (N = 110,076), and also separately by state. RESULTS: Exposure to ACEs is associated with significantly higher odds of smoking, heavy drinking, and obesity. Net of these health risk factors, there was a significant and graded relationship in California and the pooled 13-state data between greater ACEs exposure and odds of depression, asthma, COPD, arthritis, and cardiovascular disease. Four or more ACEs were less consistently associated across states with cancer and diabetes and a dose-response relationship was also not present. There was a wide range across individual states in the percentage change in health outcomes predicted for exposure to 4+ ACEs. ACEs-related smoking, heavy drinking, and obesity explain a large and significant proportion of 4+ ACEs associations with COPD and cardiovascular disease, however some effect, absent of risk behavior, remained. CONCLUSIONS: ACE's associations with most of the health conditions persist independent of behavioral pathways but only asthma, arthritis, COPD, cardiovascular disease, and depression consistently exhibit a dose-response relationship. Our results suggest that attention to child maltreatment and household dysfunction, mental health treatment, substance abuse prevention and promotion of physical activity and healthy weight outcomes might mitigate some adverse health consequences of ACEs. Differences across states in the pattern of ACEs-health associations may also indicate fruitful areas for prevention.
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Experiencias Adversas de la Infancia/estadística & datos numéricos , Enfermedad/psicología , Epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Prevalencia , Probabilidad , Factores de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
OBJECTIVES: To estimate the adult health burden and costs in California during 2013 associated with adults' prior Adverse Childhood Experiences (ACEs). METHODS: We analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008-2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY. RESULTS: Among adults in California, 61% reported ACEs. Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars. During 2013, the estimated health burden per exposed adult included $589 in personal healthcare expenses and 0.0224 DALYs valued at $5,769. CONCLUSIONS: Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts.
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Experiencias Adversas de la Infancia/economía , Artritis/epidemiología , Asma/epidemiología , Enfermedades Cardiovasculares/epidemiología , Depresión/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Adolescente , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/economía , Consumo de Bebidas Alcohólicas/epidemiología , Artritis/economía , Asma/economía , California/epidemiología , Enfermedades Cardiovasculares/economía , Niño , Depresión/economía , Personas con Discapacidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/economía , Obesidad/epidemiología , Vigilancia en Salud Pública/métodos , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Fumar/economía , Fumar/epidemiologíaRESUMEN
HIV-associated nephropathy (HIVAN) is a rapidly progressive kidney disease that is caused by HIV infection of renal epithelial cells with subsequent expression of viral genes, including vpr. Antiretroviral therapy ameliorates HIVAN without eradicating HIV from the kidneys and the mechanism by which it protects kidneys is poorly understood. Since HIV protease inhibitors have "off target" cellular effects, we studied whether darunavir, the most commonly prescribed protease inhibitor, protects kidneys from HIV-induced injury via mechanisms independent of HIV protease and viral replication. Renal epithelial cells were transduced with lentiviruses encoding HIV (lacking protease and reverse transcriptase), Vpr, or vector control. Darunavir attenuated HIV and Vpr-induced activation of Stat3, Src, Erk, and cytokines, which are critical for HIVAN pathogenesis. We then studied HIV-transgenic mice, which develop HIVAN in the absence of HIV protease or reverse transcriptase. Mice were treated with darunavir, zidovudine, darunavir + zidovudine, or control. Darunavir and darunavir + zidovudine reduced albuminuria and histologic kidney injury and normalized expression of dysregulated proteins. RNA-seq analyses demonstrated that darunavir suppressed HIV-induced upregulation of immune response genes in human kidney cells. These data demonstrate that darunavir protects against HIV-induced renal injury via mechanisms that are independent of inhibition of HIV protease.
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Nefropatía Asociada a SIDA/prevención & control , Darunavir/farmacología , Inhibidores de la Proteasa del VIH/farmacología , VIH-1/metabolismo , Riñón/metabolismo , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Nefropatía Asociada a SIDA/metabolismo , Nefropatía Asociada a SIDA/patología , Animales , Línea Celular , Humanos , Riñón/patología , Riñón/virología , Ratones , Ratones Transgénicos , Zidovudina/farmacologíaRESUMEN
INTRODUCTION: Many low- and middle-income countries are implementing strategies to increase dialysis availability as growing numbers of people reach end-stage renal disease. Despite efforts to subsidize care, the economic sustainability of chronic dialysis in these settings remains uncertain. We evaluated the association of medical subsidy with household financial hardship related to hemodialysis in Kerala, India, a state with high penetrance of procedure-based subsidies for patients on dialysis. METHODS: Patients on maintenance hemodialysis at 15 facilities in Kerala were administered a questionnaire that ascertained demographics, dialysis details, and household finances. We estimated direct and indirect costs of hemodialysis, and described the use of medical subsidy. We evaluated whether presence of subsidy (private, charity, or government-sponsored) was associated with lower catastrophic health expenditure (defined as ≥40% of nonsubsistence expenditure spent on dialysis) or distress financing. RESULTS: Of the 835 patients surveyed, 759 (91%) reported their households experienced catastrophic health expenditure, and 644 (77%) engaged in distress financing. Median dialysis-related expenditure was 80% (25th-75th percentile: 60%-90%) of household nonsubsistence expenditure. Government subsidies were used by 238 (29%) of households, 139 (58%) of which were in the lowest income category. Catastrophic health expenditure was present in 215 (90%) of households receiving government subsidy and 332 (93%) without subsidy. CONCLUSIONS: Provision of medical subsidy in Kerala, India was not associated with lower rates of household financial hardship related to long-term hemodialysis therapy. Transparent counseling on impending costs and innovative strategies to mitigate household financial distress are necessary for persons with end-stage renal disease in resource-limited settings.
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Background:Swallowing is affected following stroke. Many studies focus on various aspects of swallowing difficulties (dysphagia) following stroke. However, there are not many studies on the determinants of dysphagia following stroke. The aim of the present study is to establish the association between various factors with the severity of dysphagia. Methods: After screening for Mann Assessment of Swallowing Ability (MASA),110 patients, post-stroke were selected using consecutive sampling to assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage and smoking habits. Additionally, other variables such as age, gender, type of lesion, side of lesion, tobacco chewing, speech disorders, arterial dysfunction, lobe involvement and Brunnstrom's stages, were also evaluated using a structured interview method. ï£2 (chi-squared) analysis was carried outto find out the association between the selected determinants and severity of dysphagia following stroke.Results: It was found that age and Brunnstrom's stages are the determinants of dysphagia, as analysis showed a strong association with a p value < 0.001. A marginal association between post-stroke dysphagia and type of lesion with a p value of 0.056 was also observed.Conclusions: Among15 factors evaluated, age, type of lesion and Brunnstrom's stages showed a significant association with the severity of dysphagia following stroke. This study advocates early dysphagia management for elderly patients with high Brunnstrom's grading, for those who are not expected to spontaneously recover following stroke, and for earlier and better community rehabilitation
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Trastornos de Deglución , Etiopía , Factores de Riesgo , Accidente CerebrovascularRESUMEN
OBJECTIVE: Frontal executive dysfunction (FED) and abnormalities in volumetric magnetic resonance imaging (MRI) have been described in juvenile myoclonic epilepsy (JME). We aimed to compare JME patients with and without FED by group analysis of voxel-based morphometric (VBM) estimates of brain volume in MRI. SUBJECTS AND METHODS: We studied frontal executive functions in patients with JME and analyzed the possible association of FED with their demographic, clinical, and electrographic characteristics. We aimed to do group analysis of the VBM MRI brain data to compare the gray matter (GM) volumes of JME patients with and without FED. RESULTS: We recruited 34 patients (20 women) with JME (mean age 23.7 ± 4.58 years) from the epilepsy outpatient services. FED was detected in twenty patients (58.8%). Group analysis of VBM MRI brain showed significant (P < 0.001) reduction in GM volume in dorsolateral prefrontal cortex (left Brodmann area [BA] 10, 46, 9, Z-score 3.36, 2.91, 2.03, respectively, and right BA 10 and BA 45, Z-score 2.98 and 3.36, respectively), left insula (BA 13, Z-score 2.14), temporal lobe (BA 38, Z-score 2.76), in the subgroup of JME with FED. INFERENCE: JME with FED has an anatomical correlate in the form of reduced GM volume in dorsolateral prefrontal cortex.
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Pancreatic disease in children has a wide clinical spectrum and may present as Acute pancreatitis (AP), Acute recurrent pancreatitis (ARP), Chronic pancreatitis (CP) and Pancreatic disease without pancreatitis. This article highlights the etiopathogenesis and management of pancreatitis in children along with clinical data from five tertiary care hospitals in south India [Chennai (3), Cochin and Pune].
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Pancreatitis , Enfermedad Aguda , Niño , Enfermedad Crónica , Humanos , India , Pancreatitis/diagnóstico , Pancreatitis/etiología , Pancreatitis/terapia , RecurrenciaRESUMEN
INTRODUCTION: Little is known about the effects of employee assistance programs (EAPs) on occupational injuries. MATERIALS AND METHODS: Multivariate regressions probed a unique data set that linked establishment information about workplace anti-drug programs in 1988 with occupational injury rates for 1405 establishments. RESULTS: EAPs were associated with a significant reduction in both no-lost-work and lost-work injuries, especially in the manufacturing and transportation, communication and public utilities industries (TCPU). Lost-work injuries were more responsive to specific EAP characteristics, with lower rates associated with EAPs staffed by company employees (most likely onsite). Telephone hotline services were associated with reduced rates of lost-work injuries in manufacturing and TCPU. Drug testing was associated with reductions in the rate of minor injuries with no lost work, but had no significant relationship with lost-work injuries. PRACTICAL APPLICATIONS: This associational study suggests that EAPs, especially ones that are company-staffed and ones that include telephone hotlines, may prevent workplace injuries.
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Servicios de Salud del Trabajador/estadística & datos numéricos , Traumatismos Ocupacionales/epidemiología , Detección de Abuso de Sustancias/estadística & datos numéricos , Humanos , Traumatismos Ocupacionales/etiología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The objective was to design and validate the questionnaire for capturing palliative chemotherapy-related preferences and expectations. DESIGN: Single arm, unicentric, prospective observational study. METHODS: EXPECT questionnaire was designed to capture preferences and expectations of patients undergoing palliative chemotherapy. This questionnaire underwent a linguistic validation and then was tested in patients. Ten patients are undergoing chemotherapy for solid tumors who fulfilled the inclusion and exclusion criteria self-administered the EXPECT questionnaire in regional language. After filling this questionnaire, they self-administered quick questionnaire-10 (QQ-10). SPSS version 16 (IBM New York) was used for analysis. Completion rate of EXPECT questionnaire was calculated. The feasibility, face validity, utility and time taken for completion of EXPECT questionnaire was also assessed. RESULTS: The completion rate of this questionnaire was 100%. All patients completed questionnaire within 5 min. The QQ-10 tool confirmed the feasibility, face validity and utility of the questionnaire. CONCLUSION: EXPECT questionnaire was validated in the regional language, and it's an effective tool for capturing patient's preferences and expectation from chemotherapy.
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Cuidados Paliativos/métodos , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: An audit was planned to study the demographics, staging, treatment details, and outcomes of operable endometrial cancers. METHODOLOGY: All operable endometrial cancers treated between January 2009 and October 2014 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. Descriptive statistics was performed. The time-to-event analysis was done by Kaplan-Meier method. Univariate and multivariate analyses were done for disease-free survival (DFS) and overall survival (OS). RESULTS: There were 55 patients with a median age of 59 years (35-73 years). The Eastern Cooperative Oncology Group performance status was 1 in 52 patients (94.5%) and 2 in 3 patients (5.5%). Forty-nine patients (89.1%) had disease restricted to endometrium while 6 patients (10.9%) had cervical involvement. The surgery done was Type I hysterectomy in 49 patients (89.1%), Type II in 5 patients (9.1%), and Type III in 1 patient (1.8%). Pelvic lymph node dissection was done in all patients while para-aortic (infrahilar) dissection was done in 48 patients (87.3%). The pathological stages were Stage IA in 19 patients, Stage IB in 15 patients, Stage II in 4 patients, Stage IIIA in 3 patients, Stage IIIB in 2 patients, Stage IIIC1 in 5 patients, Stage IIIC2 in 4 patients, and Stage IV in 3 patients. Grade 1 tumors were seen in 23 patients, Grade 2 in 13 patients, and Grade 3 in 19 patients. The histology was endometrioid in 44 patients, serous in 6 patients, clear cell in 3 patients, and others in 2 patients. Adjuvant treatment was received by 40 patients. With a median follow-up of 2.5 years, the 3-year DFS and OS were 78% and 82%, respectively. Age >59 years, Stage III or greater, and Grade 3 tumors were independent prognostic factors adversely affecting both DFS and OS. CONCLUSION: The outcomes in our study are comparable to that seen in Western literature. Elderly status, higher stage, and a poorly differentiated tumor are associated with poor outcomes.
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Neoplasias Endometriales/cirugía , Adulto , Anciano , Quimioterapia Adyuvante , Neoplasias Endometriales/patología , Femenino , Humanos , India , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Servicios de Salud Rural , Centros de Atención TerciariaRESUMEN
BACKGROUND: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming. AIM: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India. MATERIALS AND METHODS: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided. RESULTS: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70-95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco-regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0-1, primary site and clinical extent of disease. CONCLUSION: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.