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Introduction: Ovarian cancer is a disease that presents in advanced stage, due to the absence of any specific or overtly dramatic symptoms. The standard of care is primary debulking surgery, followed by chemotherapy. Ovarian cancer recurrence treatment is very challenging and there is always a debate between cytoreduction vs chemotherapy. Methods: The electronic medical records of all patients who underwent secondary cytoreductive surgery for recurrent ovarian cancer between January 2011 and December 2019 were retrieved the patients with platinum sensitive recurrent ovarian cancer who underwent secondary cytoreductive surgery in our department during this time period were included. Results: A total of 52 patients underwent secondary cytoreductive surgery for recurrent ovarian cancer during the study period. Median treatment free interval after primary treatment was 20 months (range 6-132). The secondary cytoreductive surgery was highly complex in 4(8 %) patients,19 (37 %) had intermediate surgical complexity score, 29 (55 %) had low surgical complexity score according to the Aletti complexity score. Secondary cytoreductive surgery was complete (no macroscopic residual disease) in 31(60 %); Optimal (R1) in 17 (33 %) and suboptimal in only 4 (7 %) of the patients. Out of the 52 patients,8 expired, 16 had a second recurrence, and 10 were lost to follow up over time. Conclusion: Successful surgery is possible in well selected patients, which in turn can lead to a meaningful progression free and overall survival benefit. Meticulous individualisation of cases should be done keeping in mind the patient's performance status, prior treatment history & toxicity; distribution & extent of disease, and the patient's overall life goals.
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Background: COVID-19 is caused by the Severe Acute Respiratory Distress Syndrome Coronavirus 2. Since the antioxidant mechanisms such as glutathione peroxidase or superoxide dismutase are downregulated during infection by the virus, there is an imbalance in the oxidant-antioxidant system. In this study we aimed to identify the effect of COVID-19 on the antioxidant defense mechanism by comparing the concentrations of antioxidants and microminerals in COVID-19 patients and healthy controls. Methods: This cross-sectional analytical study involved 200 patients at Kasturba Hospital, Manipal University. The serum concentrations of antioxidants and minerals were determined to establish the impact of COVID-19 on antioxidants mechanism and nutrient status in COVID-19 patients. Results: The serum concentrations of GPX (10.36 ± 2.70 ≥ 5.82 ± 1.64 mKAT/L, p < 0.0001) and copper (2192.5 ± 449.8 ≥ 782.15 ± 106.5 µg/dL, p < 0.0001) were significantly greater, and zinc (34.78 ± 4.5 ≤ 81.07 ± 10.13 µg/dL, p < 0.0001) was significantly less, in the study group than in controls. The Pearson correlation between serum SOD and zinc was significant (r = 0.491, p < 0.0001) indicating the importance of zinc in maintaining and improving SOD activity. No significant correlations were observed between copper and SOD (r = -0.089) or iron and CAT (r = -0.027). Conclusion: Our study demonstrated the expected increase in oxidant-radical production during COVID-19 by estimating the altered concentrations of antioxidants and the minerals required to neutralize the elevated ROS. This finding is not novel but adds to the existing literature, which recommends nutritional supplementation of microminerals and antioxidants.
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BackgroundSince the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors. MethodsA national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis. FindingsThe survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would somewhat affect their health if infected and 19% perceived their level of risk as high or very high. 84{middle dot}9% had performed [≥]1 of the three recommended hygiene-related behaviors and 93{middle dot}4% performed [≥]1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 5{middle dot}5, 95% CI 3-9{middle dot}0), higher perceived rating of effectiveness of behaviors (aOR: 4{middle dot}3, 95% CI: 2{middle dot}8-6{middle dot}9) and higher levels of perceived ability to adopt social distancing strategies (aOR: 1{middle dot}8, 95% CI 1{middle dot}1-3{middle dot}0). InterpretationIn the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed. FundingNone
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OBJECTIVE: Black women have a higher rate of BRCA1 and BRCA2 (BRCA) mutations, compared with other populations, that increases their risk for hereditary breast and ovarian cancer (HBOC). However, Black women are less likely to know about HBOC and genetic testing. Based on a request from a community advisory panel of breast cancer survivors, community leaders and healthcare providers in the Black community, our team developed a culturally targeted educational brochure to promote awareness of HBOC among Black women. METHODS: To reach the target population we utilized a passive dissemination strategy. Using Diffusion of Innovations (DOI) as a framework, we traced dissemination of the brochure over a five year period using self-addressed postcards contained inside the brochure that included several open-ended questions about the utility of the brochure, and a field for written comments. Closed-ended responses were analyzed using descriptive statistics and thematic analysis was conducted on the open-ended responses. RESULTS: DOI captured the proliferation of the brochure among Black women across the US. PRACTICE IMPLICATIONS: The use of passive dissemination strategies among pre-existing social networks proved to be a useful and sustainable method for increasing knowledge of HBOC among Black women.
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Población Negra/educación , Neoplasias de la Mama/genética , Conocimientos, Actitudes y Práctica en Salud , Neoplasias Ováricas/genética , Folletos , Adulto , Concienciación , Población Negra/genética , Neoplasias de la Mama/etnología , Difusión de Innovaciones , Retroalimentación , Femenino , Asesoramiento Genético , Predisposición Genética a la Enfermedad , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/etnología , Evaluación de Programas y Proyectos de SaludRESUMEN
Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause bacterial skin infections that are common problems for Aboriginal children in New South Wales (NSW). MRSA is not notifiable in NSW and surveillance data describing incidence and prevalence are not routinely collected. The study aims to describe the epidemiology of CA-MRSA in Aboriginal children in the Hunter New England Local Health District (HNELHD). Methods: We linked data from Pathology North Laboratory Management System (AUSLAB) and the HNELHD patient administration system from 33 hospital emergency departments. Data from 2008–2014 for CA-MRSA isolates were extracted. Demographic characteristics included age, gender, Aboriginality, rurality and seasonality. Results: Of the 1222 individuals in this study, 408 (33.4%) were Aboriginal people. Aboriginal people were younger with 45.8% aged less than 10 years compared to 25.9% of non-Aboriginal people. Most isolates came from Aboriginal people who attended the regional Tamworth Hospital (193/511 isolates from 149 people). A larger proportion of Aboriginal people, compared to non-Aboriginal people, resided in outer regional (64.9% vs 37.2%) or remote/very remote areas (2.5% vs 0.5%). Most infections occurred in summer and early autumn. For Aboriginal patients, there was a downward trend through autumn, continuing through winter and spring. Discussion: Aboriginal people at HNELHD emergency departments appear to represent a greater proportion of people with skin infections with CA-MRSA than non-Aboriginal people. CA-MRSA is not notifiable in NSW; however, pathology and hospital data are available and can provide valuable indicative data to health districts for planning and policy development.
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Natural products are an important source of antioxidant molecules like tannins, phenolic compounds, flavonoids, etc., Helicanthus elastica (Desr.) Danser (Loranthaceae) is one such plant belonging to the category of mistletoe, and grows commonly on the mango trees in India. In the present study, an attempt has been made to assess the antioxidant properties of the plant. Ethanol extract of H. elastica growing on mango tree was studied using different in vitro models. Shade-dried whole plant material was extracted with ethanol by cold percolation. Fifty milligrams of the alcohol extract of H. elastica was weighed and dissolved in 10 ml of methanol. The resultant 5 mg/ml solution was suitably diluted to obtain different concentrations. Total phenol content, reducing power assay, and scavenging of free radicals like nitric oxide, hydroxyl, hydrogen peroxide, and 1,1-diphenyl-2-picrylhydrazyl were studied by standardized in vitro chemical methods using ascorbic acid as the standard. The total phenol content of the plant was found to be 1.89% w/w. The extract showed good reducing power as well as scavenging of free radicals (nitric oxide, hydroxyl, superoxide anion, and hydrogen peroxide) at concentrations ranging from 5 to 100 µg/ml. The study revealed the antioxidant potential of H. elastica.
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BACKGROUND: Genetic testing for several cancer susceptibility syndromes is clinically available; however, existing data suggest limited population awareness of such tests. PURPOSE: To examine awareness regarding cancer genetic testing in the U.S. population aged ≥25 years in the 2000, 2005, and 2010 National Health Interview Surveys. METHODS: The weighted percentages of respondents aware of cancer genetic tests, and percent changes from 2000-2005 and 2005-2010, overall and by demographic, family history, and healthcare factors were calculated. Interactions were used to evaluate the patterns of change in awareness between 2005 and 2010 among subgroups within each factor. To evaluate associations with awareness in 2005 and 2010, percentages were adjusted for covariates using multiple logistic regression. The analysis was performed in 2012. RESULTS: Awareness decreased from 44.4% to 41.5% (p<0.001) between 2000 and 2005, and increased to 47.0% (p<0.001) in 2010. Awareness increased between 2005 and 2010 in most subgroups, particularly among individuals in the South (pinteraction=0.03) or with a usual place of care (pinteraction=0.01). In 2005 and 2010, awareness was positively associated with personal or family cancer history and high perceived cancer risk, and inversely associated with racial/ethnic minorities, age 25-39 or ≥60 years, male gender, lower education and income levels, public or no health insurance, and no provider contact in 12 months. CONCLUSIONS: Despite improvement from 2005 to 2010, ≤50% of the U.S. adult population was aware of cancer genetic testing in 2010. Notably, disparities persist for racial/ethnic minorities and individuals with limited health care access or income.
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Concienciación , Pruebas Genéticas/estadística & datos numéricos , Neoplasias/epidemiología , Adulto , Factores de Edad , Anciano , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupos Raciales , Medición de Riesgo , Factores Sexuales , Factores Socioeconómicos , Estados UnidosRESUMEN
Over a decade has passed since the clinical availability of BRCA1/2 mutation testing for Hereditary Breast and Ovarian Cancer (HBOC). The purpose of this article is to review key areas of psychosocial and behavioral research related to genetic counseling and testing for BRCA1/2 mutations. Special attention will be given to understudied issues within each of these key areas. Where appropriate, the article will also highlight the clinical and research experiences of the authors. The first area that will be reviewed is the impact of genetic testing on psychological well-being. This will be followed by a brief discussion of a practical assessment strategy for psychosocial distress in clinical settings. Next, published data on the uptake of risk management options based on genetic testing results as well as the psychosocial impact of these behaviors will be reviewed. Thirdly, research focused on understanding the decision making at various points in the genetic counseling and testing process will also be examined. Finally, the available research on genetic counseling and testing in minority communities will be presented. By recognizing and addressing the psychosocial and behavioral issues faced by patients undergoing BRCA1/2 genetic counseling and testing, researchers and providers have the potential to maximize opportunities for prevention, early detection, and healthy coping.
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Neoplasias de la Mama/genética , Genes BRCA1 , Genes BRCA2 , Asesoramiento Genético/psicología , Pruebas Genéticas/psicología , Neoplasias Ováricas/genética , Estrés Psicológico/etiología , Toma de Decisiones , Femenino , Humanos , Gestión de RiesgosRESUMEN
AIM: To examine medical and lifestyle preventive behaviors among women with varying levels of familial breast cancer risk. METHODS: Using cross-sectional data from the Minnesota Breast Cancer Family Study, a historical cohort of 426 families, we compared medical (mammography adherence, antiestrogen use, and prophylactic surgery) and lifestyle (physical activity, smoking, alcohol, and diet) behaviors across three groups of cancer-free women ages 18 to 95 defined by their family history of breast cancer. Family history was classified as high-risk, moderate-risk, or average to low-risk depending on the number and degree of relationship of family members with breast cancer. RESULTS: After adjusting for age and education, high-risk women were twice as likely to have ever used an antiestrogenic agent (9.0% versus 4.6% among moderate-risk and 4.1% among average to low-risk; P = 0.002). Among women ages <40, the high-risk group were more likely to have ever had a mammogram (82% versus 47% among moderate-risk and 35% among average to low-risk; P < 0.001). Average to low-risk women were the least likely to be current smokers and high-risk women may consume slightly fewer fruits and vegetables compared with the other groups, but there were no other differences in lifestyle behaviors, including physical activity and alcohol use. CONCLUSIONS: Women with strong family histories of breast cancer are more likely to undertake medical but not lifestyle preventive behaviors.
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Neoplasias de la Mama/prevención & control , Familia , Conductas Relacionadas con la Salud , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Minnesota , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
Commercial marketing materials may serve as a source of information for physicians about genetic testing for inherited cancer susceptibility (GTICS) in addition to medical guidelines, continuing education, and journal articles. The primary purposes of this study were to: (1) determine the percentage of physicians who received advertisements for GTICS early in the diffusion of commercial GTICS (1999-2000); (2) assess associated characteristics; and (3) measure the perceived importance of commercial advertisements and promotions in physicians' decisions to recommend testing to patients. A nationally representative, stratified random sample of 1,251 physicians from the American Medical Association (AMA) Physician Masterfile completed a 15-20 min mixed mode questionnaire that assessed specialty, previous use of genetic tests, practice characteristics, age, and receipt of advertising materials (response rate = 71%). Overall, 27.4% (n = 426) had received advertisements. In multivariate analysis, factors associated with receipt of advertisements included: specialties in obstetrics/gynecology, oncology, or gastroenterology; past GTICS use, and age 50+. One of four felt that advertisements would be important in their decision to recommend GTICS. Study results indicate that physicians, particularly in oncology, obstetrics/gynecology, and gastroenterology, began receiving GTICS advertisements commensurate with the early diffusion of commercially available tests into clinical practice. At that time, one-quarter of the physicians considered advertisements to play an important role in their clinical decision making, suggesting attention to other sources of information and additional factors.
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Publicidad , Actitud , Predisposición Genética a la Enfermedad/genética , Pruebas Genéticas/psicología , Neoplasias/diagnóstico , Médicos/estadística & datos numéricos , American Medical Association , Humanos , Modelos Logísticos , Medicina/estadística & datos numéricos , Persona de Mediana Edad , Análisis Multivariante , Neoplasias/genética , Médicos/psicología , Pautas de la Práctica en Medicina , Especialización , Encuestas y Cuestionarios , Estados UnidosRESUMEN
OBJECTIVES: To highlight areas where persons who undergo BRCA1/2 mutation testing may benefit from psychosocial or behavioral support and intervention. DATA SOURCES: Published scientific literature, cal, and research experiences. CONCLUSION: Key psychosocial areas that deserve attention by clinicians and researchers include: indeterminate or inconclusive test results, selection of risk management strategies in unaffected BRCA1/2 mutation carriers, and genetic testing in minority communities. IMPLICATIONS FOR NURSING PRACTICE: By addressing the psychosocial issues faced by patients undergoing genetic testing for cancer, nurses have the potential to maximize opportunities for prevention, early detection, and healthy coping.
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Neoplasias de la Mama , Asesoramiento Genético , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Enfermería Oncológica , Neoplasias Ováricas , Neoplasias de la Mama/genética , Neoplasias de la Mama/enfermería , Neoplasias de la Mama/psicología , Femenino , Genes BRCA1 , Genes BRCA2 , Asesoramiento Genético/métodos , Asesoramiento Genético/psicología , Predisposición Genética a la Enfermedad/psicología , Pruebas Genéticas/métodos , Pruebas Genéticas/psicología , Humanos , Relaciones Enfermero-Paciente , Evaluación en Enfermería , Investigación Metodológica en Enfermería , Enfermería Oncológica/normas , Neoplasias Ováricas/genética , Neoplasias Ováricas/enfermería , Neoplasias Ováricas/psicología , Educación del Paciente como Asunto/métodos , Calidad de Vida , Factores de RiesgoRESUMEN
First-degree relatives (FDRs) of prostate cancer patients are known to be at increased risk for the disease, yet relatively little is known about their screening behaviors. The current lack of consensus about the value of prostate cancer screening underscores the importance of examining why some men at increased risk participate in screening and others do not. In this study, variables from Protection Motivation Theory were used to identify predictors of prostate specific antigen (PSA) testing in this at-risk population. Toward this end, scales assessing perceived vulnerability, perceived severity, response efficacy, and self-efficacy for prostate cancer screening were administered to 82 unaffected male FDRs aged 40 and older. When recontacted approximately 14 months later, 50% of FDRs were found to have undergone PSA testing in the interim. Older age, prior prostate cancer screening, and a greater sense of personal efficacy about being able to undergo prostate cancer screening were found to be significant (P < 0.05) predictors of subsequently undergoing PSA testing. These findings provide partial support for the predictive validity of Protection Motivation Theory variables and suggest the importance of considering efficacy beliefs in attempting to understand decision-making about PSA testing in at-risk individuals.
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Actitud Frente a la Salud , Predisposición Genética a la Enfermedad , Antígeno Prostático Específico/análisis , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/genética , Distribución por Edad , Anciano , Biomarcadores de Tumor/sangre , Estudios de Cohortes , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Cooperación del Paciente , Linaje , Valor Predictivo de las Pruebas , Probabilidad , Antígeno Prostático Específico/genética , Neoplasias de la Próstata/sangre , Medición de RiesgoRESUMEN
OBJECTIVES: This study explores factors associated with differential awareness of genetic tests for increased cancer risk in the US. METHODS: 27,405 respondents from the 2000 National Health Interview Survey, ages 25+, were asked if they had heard of these tests. RESULTS: 44.4% said 'yes', including 49.9% of whites, 32.9% of African-Americans, 32.3% of American Indians/Alaskan Natives, 28.0% of Asian/Pacific Islanders, and 20.6% of Hispanics. In multivariate analysis, test awareness was significantly associated with higher education, white race, age <60 years, female gender, private health insurance, personal or parent's history of certain cancers, physical activity, and vitamin/supplement use, among other factors. CONCLUSIONS: The survey showed which population subgroups may lack access to cancer genetics information and may therefore benefit from targeted strategies to ensure risk-appropriate utilization of genetic counseling and testing.