Nandagudi Srinivasa Murthy

Flow Cytometric analysis of Th1 and Th2 cytokines in PBMCs as a parameter of immunological dysfunction in patients of Superficial Transitional cell carcinoma of bladder

Transitional cell carcinoma (TCC) is the commonest cancer of the bladder. Although majority of TCC can be diagnosed at an early stage and removed easily by transurethral resection of tumor (TURT), the management of this carcinoma is complicated due to frequent recurrences usually within 6xa0months to one-year period. An imbalance between the Th1 and Th2 immune responses has been attributed to immune dysregulation in various malignancies. The present study aims to evaluate the Th1 and Th2 balance in Peripheral Blood Mononuclear Cells of 41 TCC patients (20 recurrent and 21 non-recurrent) using flow cytometry. It also further assesses immunological and cellular factors influencing the anti-neoplastic activity of the TCC patients and in 21 normal healthy subjects in terms of their cytokine expression and various cell surface markers. The findings of the study revealed that the cell surface markers CD3+, CD4+ and CD8+ along with NK cells were found to be significantly lower in patients than healthy controls (p<0.01). The mean percent expression of CD4+ was significantly lower in patients showing recurrence (23.9±9.84) as compared to patients with non-recurrence (31.1±12.27). The percentage of CD4+T-cells (mean±SD) producing IFN-γ, IL-2 and TNF-α were statistically significantly reduced in patients (19.1±4.94, 52.3±20.86 and 12.8±4.49) as compared to healthy controls (23.3±3.67, 67.5±12.0 and 17.6±5.96 respectively), (p<0.01, 0.018, 0.001). On the contrary, the mean levels of IL-4, IL-6 and IL-10 in patients (63.8±17.01, 60.4±14.79 and 65.7±14.84 respectively) were significantly higher as compared to healthy controls (24.4±8.77, 26.5±5.28 and 20.6±3.81 respectively), (p<0.001). No statistically significant difference was observed in the cytokine expression between patients showing recurrence and non-recurrence. Patients with bladder cancer seem to develop a Th2 dominant status with a deficient type1 immune response. The lymphocyte evaluation along with cytokine measurement can provide a sensitive and valuable tool for evaluating the function of cell-mediated immunity in these patients and can also find application in therapeutic monitoring of bladder cancer patients as new targets for immunotherapy.

Trends in cervical cancer incidence--Indian scenario.

Cancer of the uterine cervix is the second most common cancer among women in the world after breast cancer. It is the most common cancer among Indian women. The present communication reports the trends in the incidence rate of cervical cancer for the Indian population. The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registry served as the source material. During the years 1990–1997, the age-adjusted incidence rates (AAR) for cervical cancer varied from 10.9 to 65.4 amongst various registries. The highest incidence was noted in the Ambillikai registry. The age-specific incidence rates (ASIR) for cervical cancer revealed that the disease increases from 35 years and reaches a peak between the ages 55 to 64 years. The trend analysis by period showed a decreasing trend in the incidence rate of cervical cancer in all the registries. However, the decrease was very small. The mean annual percentage decrease in the AAR ranged from 0.9 to 2.6% amongst various registries. Analysis of the data by ASIR revealed that the mean annual percentage decrease was higher for women in earlier age groups in most of the registries. For women beyond 64 years, the disease incidence showed an increasing trend or minimal decrease. It was also noted that most of the cervical cancer cases were detected with regional spread of the disease and a very small proportion were diagnosed at a localized stage. In India, an organized mass-screening programme with Pap smear for early detection of cervical cancer is not in practice. The data suggest an urgent need for initiation of community screening and educational programmes for the control and prevention of cervical cancer.

Estimation of Time Trends of Incidence of Prostate Cancer - an Indian Scenario

BACKGROUNDnWith increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on rise. Globally prostate cancer is the second most frequently diagnosed cancer and sixth leading cause of cancer death in men. The present communication makes an attempt to analyze the time trends in incidence for different age groups of the Indian population reported in different Indian registries using relative difference and regression approaches.nnnMATERIALS AND METHODnThe data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publications by the individual registries served as the source materials. Trends were estimated by computing the mean annual percentage change (MAPC) in the incidence rates using the relative difference between two time periods (latest and oldest) and also by estimation of annual percentage change (EAPC) by the Poisson regression model.nnnRESULTSnAge adjusted incidence rates (AAR) of prostate cancer for the period 2005-2008 ranged from 0.8 (Manipur state excluding Imphal west) to 10.9 (Delhi) per 105 person-years. Age specific incidence rates (ASIR) increased in all PBCRs especially after 55 years showing a peak incidence at +65 years clearly indicating that prostate cancer is a cancer of the elderly. MAPC in crude incidence rate(CR) ranged from 0.14 (Ahmedabad) to 8.6 (Chennai) . Chennai also recorded the highest MAPC of 5.66 in ASIR in the age group of 65+. Estimated annual percentage change (EAPC) in the AAR ranged from 0.8 to 5.8 among the three registries. Increase in trend was seen in the 5-64 year age group cohort in many registries and in the 35-44 age group in Metropolitan cities such as Delhi and Mumbai.nnnCONCLUSIONSnSeveral Indian registries have revealed an increasing trend in the incidence of prostate cancer and the mean annual percentage change has ranged from 0.14-8.6.

Trends in incidence of gallbladder cancer – Indian scenario

Correspondence: Aleyamma Mathew Division of statistics and epidemiology, regional Cancer Centre, Thiruvananthapuram 695 011, Kerala, india email amathew@rcctvm.org Background: Reports of increasing incidence rates of gallbladder cancer in several areas in India prompted the analysis of time trends. The present communication reports its geographic and gender distribution and trends in occurrence of this disease over time. Materials and methods: The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registries served as the source material. Mean annual percentage change (MAPC) in incidence rates was computed using relative difference between two time periods (earliest and latest), and estimation of annual percent change (EAPC) was computed by log-linear regression model. Results: In 1998–2006, incidence rates of gallbladder cancer (age-standardized rate, ASR) were high in Delhi and Kamrup ((3.6 and 7.4) and (5.3 and 14.3) per 10 person years in males and females, respectively) and lowest in Aurangabad, 0.0 in both genders. The incidence rate revealed an increase in all registries. MAPC in ASR ranged from 1.0% to 8.10%. EAPC for Mumbai, Chennai, and Bangalore for the period 1983–2002 revealed statistically significant increase in crude, age-standardized, and truncated rate (TR) (35–64 years) incidence rates. The largest EAPC in ASR was in Chennai (almost 6.0% in both genders) and smallest in Mumbai (3.5% and 2.1% in males and females, respectively). Conclusions: Statistically significant increase in gallbladder cancer incidence rates has been reported for Mumbai, Chennai, and Bangalore. Further studies are required in identifying factors that may be operative in etiology of cancer of gallbladder.

Combination of music with lifestyle modification versus lifestyle modification alone on blood pressure reduction - A randomized controlled trial.

OBJECTIVEnTo evaluate the change in blood pressure (BP) after 3 months of music intervention combined with lifestyle modifications, in comparison with conventional lifestyle modifications.nnnMETHODSnA Prospective randomized control trial was conducted on hundred prehypertensives or stage I hypertensives who were randomly divided into two groups (nxa0=xa050 each). Both the groups were given lifestyle modifications while one had added music intervention (raga bhimpalas) for 3 months. Main outcome measures were 24xa0h ambulatory BP monitoring, stress levels, and biomarkers of hypertension.nnnRESULTSnMean (SD) of diastolic BP (DBP) pre and post intervention were overallxa0=xa085.1(6.8) and 83(8.7){Pxa0=xa00.004}, awakexa0=xa087.7(7.6) and 85.9(9.2){Pxa0=xa00.021}. Regression analysis showed association between diastolic BP change and post-intervention stress score in the music intervention group. Significant change in BP was seen among those who were prehypertensives prior to intervention.nnnCONCLUSIONnMusic decreased DBP and when used as an adjunct benefitted subjects with initial BP in prehypertension range.

Prevalence and severity of dental fluorosis and genu valgum among school children in rural field practice area of a medical college

Abstract Objective To assess the prevalence of dental fluorosis and genu valgum among school children in the above mentioned area. Methods A Cross sectional study was conducted on school children of 1st to 7th standard in the rural field practice area of a medical college. Children were examined for dental fluorosis and genu valgum. Drinking water samples were also tested for fluoride levels. Proportion of children with dental fluorosis and genu valgum were calculated by severity, age and sex. Statistical significance was analyzed by using Chisquare test or Mc Nemar test. Results Of the 1 544 children examined 42.1% and 8.4% had dental fluorosis and genu valgum respectively. Prevalence of very mild dental fluorosis and moderate grade genu valgum were high compared to other categories. Prevalence rates increased with the age (P Conclusions Findings of the present study reveal a high prevalence of dental fluorosis and genu valgum amongst school children and high fluoride level in the water. Further studies are needed to evaluate the other risk factors and reasons for gender differences.

Perception and Practices on Screening and Vaccination for Carcinoma Cervix among Female Healthcare Professional in Tertiary Care Hospitals in Bangalore, India

BACKGROUNDnCervical cancer is potentially the most preventable and treatable cancer. Despite the known efficacy of cervical screening, a significant number of women do not avail themselves of the procedure due to lack of awareness.nnnOBJECTIVESnThis study was conducted to elicit information on the knowledge, attitude and practice (KAP) regarding screening (Pap test) and vaccination for carcinoma cervix among female doctors and nurses in a tertiary care hospital in Bangalore and to assess barriers to acceptance of the Pap test.nnnMATERIALS AND METHODSnA cross-sectional, descriptive study was conducted with semi-structured, self-administered questionnaire among female health professionals. The study subjects were interviewed for KAP regarding risk factors for cancer cervix, Pap test and HPV vaccination for protection against carcinoma cervix.nnnRESULTSnHigher proportion of doctors 45 (78.9%) had very good knowledge as compared to only 13 (13.3%) of the nurses, about risk factors for cancer cervix and Pap test (p=0.001). As many as 138(89.6%) of the study subjects had favorable attitude towards Pap test and vaccination, but 114 (73.6%) of the study subjects never had a Pap test and the most common reason 35 (31%) for not practicing was absence of disease symptoms.nnnCONCLUSIONSnIn spite of good knowledge and attitudes towards cancer cervix and Pap test being good, practice remained low among the study subjects and most common reasons for not undergoing Pap test was absence of disease symptoms. The independent predictors of ever having a Pap test done was found to be the occupation and duration of married life above 9 yrs. Hence there is a strong need to improve uptake of Pap test by health professionals by demystifying the barriers.

Increase in incidence of cancer of corpus uteri: estimation of time trends - an Indian scenario.

Reports of increasing rates of cancer of the corpus uteri in several countries prompted this analysis of time trends. This study reports the trends in the incidence rate of cancer of the corpus uteri in Indian women. The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registries served as the source material. The mean annual percentage change in the incidence rates was computed using the relative difference between two time periods (latest and furthermost) and estimation of annual percentage change (EAPC) was also computed by the Poisson regression model. In 1998–2005, the incidence rate of cancer of the corpus uteri [age standardized rate (ASR)], was highest in Delhi and lowest in Pune and Imphal West (4.4 and 0.0 per 100 000 woman-years, respectively). The incidence rate in most of the registries between the two time periods showed an increase with few exceptions. Estimation of EAPC carried out in Mumbai, Chennai, and Bangalore PBCRs for the period 1983–2002 showed statistically significant increases in crude rate, ASR, and age-specific incidence rates (ASIR). The largest EAPC in ASR was in Bangalore (6.4%) and the smallest in Chennai (1.8%). Incidence trends for cancer of the corpus uteri appeared to result from an increase in the prevalence of risk factors and in improvement in diagnostic procedures. Most cancer of the corpus uteri is environmental in origin. Limiting fat consumption and avoiding excess energy intake may result in some reduction in the incidence of cancer of the corpus uteri.

Adjuvant intravesical therapy based on an in vitro cytotoxicity assay in the management of superficial transitional cell cancer of the urinary bladder.

To investigate the utility of an individualized chemo/immunotherapy regimen of intravesical therapy based on the results of an assessment of in vitro cytotoxicity.

Prevalence and Factors Associated with Goitre among 6–12-year-old Children in a Rural Area of Karnataka in South India

In India, endemic goitre is present in sub-Himalayan region and in pockets in states of Andhra Pradesh, Karnataka and Gujarat. Being a public health problem amenable for prevention, the assessment of prevalence of endemic goitre in an area helps in understanding whether the preventive strategies under National Iodine Deficiency Disorder Control Program (NIDDCP) have any impact on the control of endemic goitre. Hence, the current study was carried out to determine the prevalence, distribution and factors associated with iodine deficiency goitre among 6–12-year-old children in a rural area in south Karnataka. A cross-sectional study was conducted among 838 children, using a questionnaire adopted from Iodized Salt Program Assessment Tool and the tools prescribed by WHO for goitre survey. The prevalence of goitre in the study area was 21.9xa0% (95xa0% CI 19.2–24.8). There was higher prevalence of goitre among those having salt iodine <15xa0ppm than those with >15xa0ppm (Pu2009=u20090.01; OR 1.59; 95xa0% CI 1.10–2.29). In 10xa0% of the children, urinary iodine excretion (UIE) was assessed and prevalence was higher among those with <100xa0μg/l of UIE than those with normal UIE, which was not statistically significant (Pu2009=u20090.8, OR 1.36; 95xa0% CI 0.62–2.96). Multiple logistic regression revealed that gender (Pu2009=u20090.002; OR 1.7; 95xa0% CI 1.21–2.35) was an independent variable associated with goitre. The study area was found to be moderately endemic for goitre based on the WHO criteria. Higher prevalence of goitre was found to be still associated with consumption of low iodized salt (<15xa0ppm) necessitating emphasis on monitoring of salt iodine levels in the study area. Though NIDDCP is being implemented since five decades in India, the burden of iodine deficiency disorders (IDDs) is still high demanding further impetus to the monitoring systems of the programme.