Geetha R. Menon

Burkitt's lymphoma

Burkitts lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma and is the fastest growing human tumour. The disease is associated with Epstein-Barr virus and was one of the first tumours shown to have a chromosomal translocation that activates an oncogene (c-MYC). Burkitts lymphoma is the most common childhood cancer in areas where malaria is holoendemic. The incidence is very high in immunosuppressed patients in non-endemic areas, especially when associated with HIV infection. Outcome with intensive chemotherapy has improved and is now excellent in children, but the prognosis is poor in elderly adults. The success of intensive treatment relies on good supportive care. The therapy offered in oncology units in low-income countries is not as aggressive as in centres in high-income countries and outcomes are less successful. Adjuvant monoclonal antibody therapy with rituximab shows promise for improved outcomes and reduced toxic effects in the future.

Urban rural differences in prevalence of self-reported diabetes in India—The WHO-ICMR Indian NCD risk factor surveillance

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.

Meta-analysis of Randomized Controlled Trials on Hydrocolloid Occlusive Dressing Versus Conventional Gauze Dressing in the Healing of Chronic Wounds

Chronic wound management is a difficult area in surgical practice. A wide range of dressings have been recommended for the management of chronic wounds. The present meta-analysis was undertaken to determine the effectiveness of hydrocolloid dressing (HCD) in the healing of chronic wounds compared with conventional gauze dressing. All available controlled clinical trials published before December 2001 that compared HCD to conventional gauze dressing in the healing of chronic wounds were systematically reviewed. We identified and analysed 12 randomized trials (11 published; 1 unpublished) comprising 693 patients with 819 ulcers. The overall odds ratio under the fixed effect model was 1.72, that is, 72% more ulcers healed completely with HCD than with conventional gauze dressing. This result was both clinically and statistically significant.

Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis.

A systematic review was carried out to analyse continence at 2 years or more after lateral internal sphincterotomy (LIS) for chronic anal fissure (CAF).

Comparison of Interrupted Versus Continuous Closure in Abdominal Wound Repair: A Meta-analysis of 23 Trials

OBJECTIVE There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. METHODS All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. RESULTS Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p = 0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. CONCLUSION Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure.

Laying open (deroofing) and curettage of sinus as treatment of pilonidal disease: a systematic review and meta-analysis.

Laying open (deroofing, not excision) and curettage of the sinus is a minimally invasive procedure to treat pilonidal disease. A consensus on its efficacy and outcomes has not been reached. We reviewed and meta‐analysed the efficacy of this procedure.

Epstein-Barr virus-driven lymphoproliferative disorder post-CAMPATH-1H (alemtuzumab) in refractory polymyositis

1 Geborek P, Bladström A, Turesson C et al. Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas. Ann Rheum Dis 2005;64:699 703. 2 Wolfe F, Michaud K. The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person-years of observation. Arthritis Rheum 2007;56:1433 9. 3 Thonhofer R, Gaugg M, Kriessmayr M, Neumann HJ, Erlacher L. Spontaneous remission of marginal zone B cell lymphoma in a patient with seropositive rheumatoid arthritis after discontinuation of infliximab-methotrexate treatment. Ann Rheum Dis 2005;64:1098 9. 4 Park SH, Kim CG, Kim JY, Choe JY. Spontaneous regression of EBV-associated diffuse lymphoproliferative disease in a patient with rheumatoid arthritis after discontinuation of etanercept treatment. Rheumatol Int 2008;28:475 7. 5 Moseley AC, Lindsley HB, Skikne BS, Tawfik O. Reversible methotrexate associated lymphoproliferative disease evolving into Hodgkin’s disease. J Rheumatol 2000;27: 810 3. 6 Kamel OW, van de Rijn M, Weiss LM et al. Brief report: reversible lymphomas associated with Epstein-Barr virus occurring during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med 1993;328: 1317 21. 7 Komatsuda A, Wakui H, Nimura T, Sawada K. Reversible infliximab-related lymphoproliferative disorder associated with Epstein-Barr virus in a patient with rheumatoid arthritis. Mod Rheumatol 2008;18:315 8. 8 Balandraud N, Guis S, Meynard JB et al. Long-term treatment with methotrexate or tumor necrosis factor alpha inhibitors does not increase Epstein-Barr virus load in patients with rheumatoid arthritis. Arthritis Rheum 2007; 57:762 7. 9 Beaugerie L, Brousse N, Bouvier AM et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. CESAME Study Group. Lancet 2009;374:1617 25. 10 Askling J, Baecklund E, Granath F et al. Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register. Ann Rheum Dis 2009;68: 648 53. Rheumatology 2011;50:810 812 doi:10.1093/rheumatology/keq429 Advance Access publication 5 January 2011

A multi-sectoral approach to capture information on road traffic injuries

Background: Regularly available data is shown to be inadequate for developing, implementing, and evaluating injury prevention and control programs in India. The present study was undertaken in the hospitals of Bangalore and Pune, to examine the feasibility of gathering information on injuries using multiple sources. Materials and Methods: Stakeholders meeting and training programs were held for the hospital staff, police personnel, and traffic and transport staff, to identify their roles and responsibilities. Prospective data on morbidity and mortality due to injuries were collected by trained staff from Emergency Departments on a pre-tested questionnaire. The information gathered was cross-checked with the hospital and police records. Results: The stakeholders meeting and training programs were able to motivate the departments to provide the correct data. Data on 32188 patients could be extracted from hospital and police records during the study period. Injuries accounted for 16% of the emergency cases. Unintentional injuries were 64%, and 32% were intentional. Road traffic injuries accounted for 44% of all the injuries. One-third of the injured were children and young adults below 25 years. Among the injured, two wheeler riders were 29% and pedestrians were 23%. Conclusion: It was possible to improve the data on injuries by adequate training and a data linking mechanism between the Police, Hospital, and Transport Departments. The problem of road traffic injuries could be highlighted and addressed by a good data capture mechanism.

Regulatory and road engineering interventions for preventing road traffic injuries and fatalities among vulnerable (non-motorised and motorised two-wheel) road users in low- and middle-income countries

This is the protocol for a review and there is no abstract. The objectives are as follows: The purpose of this review will be to establish what is known about the effects and effectiveness of enforcement of traffic laws and regulations and road engineering interventions for prevention of injury (fatal and non-fatal) to non-motorised road users and motorised two-wheel road users in low-income and middle-income countries. Language: en

Pattern of reporting and practices for the management of traumatic brain injury: An overview of published literature from India

Background: Published literature regarding the demographics and mechanism of injury for traumatic brain injury (TBI) in India has not been analyzed in an organized sample. Objectives: The objective of this systematic review was to organize the published literature from India related to TBI and analyze it in a very specific sample to identify the specific patterns of injury and associated mortality. Materials and Methods: A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the World Health Organisation (WHO) Global Health Library. The process included an additional search within the indexed literature and the website-based population survey reports. Results: Our review identified 72 studies from 300 potentially relevant articles based on the broad criteria that defined the demographics of the patients suffering from TBI and the details of trauma sustained, including the mechanism of injury as well as its diagnosis, management, and outcome. Changes in demographic patterns, the patterns of the body regions involved, the associated injuries, the clinical presentation, the follow-up status of patients suffering from TBI, who may or may not have shown clinical improvement, the overall outcome, as well as the mortality and disability status reported in the literature were analyzed. A high incidence of TBI in the productive population is of serious concern. Extremes of ages are more vulnerable to severe injury and a poor outcome. Conclusion: Quantitative analysis of injuries and outcomes of TBI victims shows a bigger health impact in the economically active population and in patients in the extremes of age groups.