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Objectives: This paper aims to comprehensively analyze trends in gynecological cancers among elderly women in the United States from 1975 to 2020. Methods: Surveillance, Epidemiology, and End Results (SEER) population data were utilized for the analysis. Annual Percentage Change (APC) and Average APC were estimated using join‐point regression to assess trends in mortality rates. Results: The study reveals an increasing pattern of incidence and mortality in all gynaecological cancer sites except cervical cancer among elderly. The incidence of cervical cancer decreased from 1975 to 2007 and then increased, whereas cancer‐specific mortality decreased from 1977 to 2020, indicating positive advancements in detection and treatment. Conclusions: Despite progress in managing certain gynecological cancers, challenges persist, particularly evidenced by increasing mortality rates for cancers in other female genital organs. This underscores the necessity for sustained research efforts and targeted interventions to address these ongoing challenges effectively. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pneumonia is complicated with residual lung fibrosis, as evidenced by imaging and postmortem pathological findings. In addition to steroids, we compared the efficacy of nintedanib and pirfenidone in the management of COVID-19 lung fibrosis measured by CT severity score (CTSS). Methods: All cases of COVID-19 pneumonia diagnosed as COVID-19 positive by RT-PCR having SpO2 ⩽ 96% and CTSS ⩾ 10 even after 15 days were included in the study. The patients were divided into three groups. All three groups received steroids at a dose of 1 mg/kg body weight of prednisolone or equivalent. The first group received steroids alone, the second group received pirfenidone with steroids and the third group received nintedanib with steroids. All patients were followed up at 6 and 12 weeks. The primary endpoint of our study was to find out any improvement in CTSS. Results: Out of 90 patients, 56 patients completed the study. Among three groups, 19 (33.9%) patients received steroids (control) only, 16 (28.6%) patients received steroids with pirfenidone and 21 (37.5%) patients received steroids with nintedanib. The study population had a mean (±SD) age of 52.5 ± 10.1 years, mean (±SD) C-reactive protein of 97.1 ± 102.2 mg/L (normal <6 mg/L), mean (±SD) serum ferritin 459.4 ± 305.5 ng/mL (normal <250 ng/mL), mean (±SD) serum d-dimer level 2.1 ± 2.6 μg/mL (normal <0.5 μg/mL) and mean (±SD) CTSS of 16.9 ± 4.3. There was significant improvement in CTSS in group receiving nintedanib compared to pirfenidone at 12 weeks (3.67 ± 1.21 vs 9.07 ± 1.12) with a p -value <0.01. Conclusion: Along with steroids in the treatment of COVID-19 lung fibrosis, there was a significant improvement in lung CTSS with nintedanib compared to pirfenidone. [ABSTRACT FROM AUTHOR]

Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. Aim: To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. Materials and Methods: A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients' feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results: Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83±54.74 mg and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of nalbuphine, respectively. No complications were noted in any patients. Conclusion: Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is a major social and health issue in India. Yearly statistics show a concerning increasing pattern of suicidal deaths in India which is higher in comparison to the global trend. There is limited evidence regarding historical analysis of suicide or any forecasting for suicide in India towards predicting the possible risks of death due to suicide. Methods: This paper examines the trend of suicide rate and characteristics of suicide victims in India, based on the longitudinal time series data over the last 50 years—collected from the National Crime Record Bureau Reports (1969 to 2018) of the Government of India. In our analysis, we have used the time series model to forecast the suicide rates in India for the next decade. ARIMA (4,1,0) model is found to be the best fit model for forecasting the data. Findings: There has been an observable and rising trend of suicide rates in India over the last five decades. The forecast indicates a continuance of rising suicide cases for an upcoming couple of years in India with a limited decline in the following years. The prediction model indicates a future relatively consistent pattern of suicide in India which does not seem to be a very encouraging trend. As we have not included the period staring the year 2020 onwards affected by Covid-19 and which has several disruptions in personal and family spaces, the projected suicide trend during the period of next two to three years (2020–22) may rise far high and then it may show a declining path. Along with this, there is a shift in means of suicide in the last couple of decades. Constituting the second-highest number of cases, Illness associated suicide was visibly a serious concern. Conclusion: The present analysis finds that there is no visible substantial relief for suicide deaths during the coming years in India. On the other hand, more extensive exploration of sample cases may provide important information for suicide prevention. Availability of detailed and more inclusive data will be highly useful for analysis and suicide preventive policies. Investment in public health care and other welfare activities like education and employment generation will yield visible positive results in suicide control. [ABSTRACT FROM AUTHOR]

The study aimed at examining the prevalence of pregnancy termination by Abortion, Miscarriage, and Stillbirths (AMS) and its determinants in the state of Odisha, India. The NFHS-IV data have been used for this analysis. GIS mapping has been used for the spatial distribution of outcome variables at the district level. Univariate analysis (chi-square) and a multivariable logistic model have been used to identify the potential factors associated with AMS. Out of 8,484 pregnancy cases registered, 969 (11.4%) cases had met with pregnancy termination by AMS. Jagatsinghpur, Jajapur, Subarnapur, Kendrapara, Nayagarh, and Puri have been identified as high prevalent districts. The age group of 30-34 years is more likely of pregnancy termination than the age group 15-19 years (OR=1.254). Women who have completed secondary education have 1.568 times higher odds of pregnancy termination by AMS than those who are illiterate. Pregnancy complications show significantly higher odds (OR=1.091) of pregnancy termination. Among the trio of reasons for pregnancy termination, miscarriage cases are the most prevalent, followed by abortion and stillbirths. Potential factors like age, education, wealth index, place of delivery, and anemia are significant for AMS (p value<0.05). Hence, a robust program must be developed to reduce adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Place of delivery has major implication on decreasing maternal morbidity and mortality. India has adopted various policies to encourage institutional births, still there are large numbers of deliveries which occur at home. Thus, it is imperative to understand the risk factors associated with home deliveries among women in India. Methods: The national representative district level household data-4 (2012-13) have been used for this analysis. A multiple logistic regression model has been used to determine the significant factors associated with home deliveries. Results: A total of 22,363 live births were selected for analysis for the year 2012. Out of which 3,602 (15.4%) are found to be home delivery births, remaining are either private or government institutional births. North-east states are found to be high prevalence of home deliveries. The potential factors viz., age of women, educational level of both husband and wife, age at first birth, higher order parity and not registered for ANC check-up, etc., are significantly associated with home delivery birth preferences among women in India. Conclusion: Our analysis demonstrates that targeting the significant predictors particularly education of family members and compulsory registration for ANC check-up will significantly reduce the preference for home delivery. [ABSTRACT FROM AUTHOR]

Decline trend of fertility is a global phenomenon of recent time and Indian is no exception to this. Fertility declined by almost a child in the last 23 years between NFHS-1 and NFHS-4 in India, however; many reasons for fertility decline are yet to be explored at present time. National Family Health Survey-4 (henceforth NFHS-4) 2015-16 data were used to study the reproductive span of ever-married women aged 15-49 years. The Cox Proportional Hazard Model has been used to identify the potential determinants associated with the reproductive span. During NFHS-3 and NFHS-4, the median age at marriage swift from 17.9 to 19.9 years. Sterilization is the primary contraceptive method among women and the age at which they adopted it decreased to 25 years. Reproductive spans of successive cohorts of women decreased from 23 years among those who married during the 1970s to 20 years among the 1980s, followed by 16 years among the 1990s, 10 years among the 2000s and 4 years among those who married in 2010-2016. Our finding demonstrates that current women are taking quick decision to end childbearing than older generations. Some critical factors such as age at marriage, number of children ever born, last birth a caesarean section (P-value < 0.05) is significantly associated with shorter reproductive span. [ABSTRACT FROM AUTHOR]

Context: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. Aim: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities Settings and Design: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. Statistical Analysis Used: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. Results: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. Conclusions: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting. [ABSTRACT FROM AUTHOR]

Introduction: Extrauterine growth restriction (EUGR) is a universal problem but its prevalence using recent reference growth charts and morbidities associated with it are lacking. The study aims at estimating EUGR prevalence in very low birth weight (VLBW) neonates and its associated morbidities. Methods: All VLBW neonates admitted to NICU between Jan 2018 to June 2019 were analysed. Neonatal anthropometries were recorded on Intergrowth 21st gender based postnatal growth chart. EUGR was defined by weight below 10th percentile at discharge. Demographic profile and neonatal morbidities were compared between EUGR and non-EUGR by using unpaired t test and Chi-square test. Regression was used for identification of the risk factors. Results: Out of 148 VLBW neonates, 92 (62.1%) were male, 26 (17.56%) were below 1000 gm, 102 (68%) were EUGR at discharge. Mean (SD) birth weight and gestational age were 1202 (221) gms and 30.89 (2.77) wks respectively. Caesarean delivery, higher gestational age, lower birth weight, SGA at birth and prolonged duration to achieve full enteral feeding were significantly associated with EUGR (P < 0.05). Sepsis was significantly associated with EUGR (36.28% vs. 17.4%; P 0.022). EUGR babies needed longer hospital duration (24.56% vs. 16.78%; P 0.005) with a higher mean PMA at discharge (38.07 wks vs. 35.11 wks; P < 0.001). In regression model SGA at birth and delay in achieving full feeding were independent predictor of EUGR. Conclusions: In VLBW neonate, prevalence of EUGR at discharge was 68%. Sepsis was significantly associated with EUGR. SGA and delay in achieving full feeding were independent predictors of EUGR. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) is an important cause of visual morbidity among preterm infants. The objective of the study was to assess the relationship between the initial hematological parameters of the complete blood count (CBC) and ROP development in preterm neonates., Method: This retrospective cohort study was conducted in a neonatal intensive care unit in Odisha. The hematological parameters of the CBC conducted within the first 48 hours of age, demographic characteristics, neonatal morbidities, and ROP screening findings of preterm neonates (gestational age <34 weeks) were analyzed. Independent risk factors associated with ROP development were identified in a multivariate logistic regression model., Result: A total of 43 (29.1%) out of 148 neonates had any of the ROP stages (stage 1-26, 2-08, and 3-09). Birth weight (aOR 0.003; 95% CI 0.00, 0.11);hemoglobin (Hb) level (aOR 0.70; 95% CI 0.54, 0.90); presence of respiratory distress syndrome (RDS) (aOR 7.61; 95% CI 1.5, 36.39); and need for packed red blood cell (PRBC) transfusion (aOR 4.26; 95% CI 1.1, 16.44) were independently associated with ROP development. The odds of ROP were higher among the neonates with initial Hb 10.5-15.4 g/dL (OR (95% CI) 3.7(1.5, 8.9), p=0.003) and for neonates with Hb 15.4-17.3 g/dL (OR (95% CI) 2.5(1.01, 6.16), p=0.047) in comparison to neonates with initial Hb >17.3 g/dL., Conclusion: Preterm neonates with a lower level of Hb during the early postnatal days are at higher risk for ROP development and need to be prioritized for screening., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Kalinga Institute of Medical Sciences, KIIT issued approval KIIT/KIIMS/IEC/524/2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gudu et al.)

Gynaecological cancers are the most prevalent cancers in women, making them a major public health concern for decades. Health disparities and inequalities in access to care among different racial groups have been a major concern in the US healthcare system. This study was aimed at investigating cause-specific survival rates among non-white women with gynaecological cancer and to identify risk factors associated with gynaecological cancer mortality by race. The Kaplan-Meier method was used to calculate 5-year survival estimates and various risk factors for gynaecological cancer among non-white women were analysed using Cox proportional hazard model. The findings of this study highlight the need for targeted interventions to improve access to care and reduce health disparities for non-white women with gynaecological cancer., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Global evidence indicates an association between poor WaSH practice and inferior health outcomes. In rural areas, this practice is predominantly compromised with limited access to safe drinking water, knowledge gaps, and unhealthy socio-behavioural practices. Suboptimal WaSH practice leads to increased vulnerability of various infections, thereby posing a challenge to the primary health care system., Methods: A community based cross-sectional study was conducted among 879 participants of two villages in Tigiria block, Cuttack district, Odisha, India. Information pertaining to socio-demography, WaSH practices and self-reported morbidities were captured and analysed. Bi-variate analysis was done to assess the association between WaSH practices and any acute illnesses. Differences were considered statistically significant if p-value was less than 0.05., Results: Tube well was the main source of drinking water (49.3%) followed by dug well (46.6%). Only 7.1% of participants reported to purify drinking water and around 40% were still practicing open defecation. The prevalence of acute and chronic illnesses was 9.2% and 19.1% respectively. Major acute illnesses were respiratory diseases, diarrhoeal disorders, and musculoskeletal problems, while major chronic illnesses were gastrointestinal problems, musculoskeletal problems, and hypertension. After adjusting for age, gender, and education, a significant odds ratio of 3.79 [CI = (1.23-11.70)] was observed between drinking water source (surface water Vs tube well water) for acute illnesses., Conclusions: Poor WaSH practices among rural people make them vulnerable to acute and chronic morbidities. Health awareness and socio behavioural changes pertaining to WaSH practices need utmost priority to ensure better health for rural people of Odisha., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Context: Overweight and obesity has become a major contributor to global burden of chronic diseases and disability. Obesity among rural India is emerging as a major health problem because of change in lifestyle and food habits, thereby increases the risk of multiple morbid conditions among rural population., Aims: This study aims to find out the association of overweight/obesity with different socio-demographic factors and explore the co-morbidities among overweight and obese in a rural setting., Settings and Design: A cross-sectional study was done in a randomly selected primary health centre of Khurda district, Odisha for 4 months., Materials and Methods: This study was done among 183 patients aged >20 years with BMI >25 kg/m 2 after taking their consent. Anthropometric measurements were done and data were collected using a semi-structured questionnaire., Statistical Analysis Used: Descriptive statistics such as proportion, mean and standard deviation were calculated and inferential statistics such as Chi-square test, univariate and multivariate regression was done using the SPSS version 20.0., Results: Mean age of participants was 45.7 (±13.8) years. About 93.4% were Grade II obese while 51.9% were at risk according to their waist-hip ratio. Around 53.6% of participants had multi-morbidity. Age, occupation and number of children were significantly associated with obesity. Morbidity was significantly associated with age, occupation, marital status and number of children. Increased grade in obesity the more is the probability of having morbidity., Conclusions: There is an urgent need to screen for obesity at rural health facility and early management for prevention from co-morbidities., Competing Interests: There are no conflicts of interest.

The primary form of therapy for prostate cancer is androgen ablation resulting in apoptosis and expression of apoptotic genes (i.e. par-4). Prostate cancer cells that survive androgen ablation therapy express pro-survival genes (i.e. bcl-2) permitting these androgen independent (AI) cells to overcome apoptotic signals and proliferate in the absence of normal growth signals. To disrupt tumor growth and progression to AI, we expressed the tumor suppressor gene, WT1 in LNCaP prostate tumor cells. The WT1 transcription factor modulates expression and activity of several prostate growth control genes (i.e. par-4, bcl-2 and AR) in vitro. To provide insight into potential mechanisms of prostate cancer growth suppression both the transcriptionally active form of wild-type WT1 (D) and an inactive WT1 (D) R394W mutant form were stably transfected in LNCaP cells. Surprisingly both transfected lines underwent apoptosis and were growth suppressed in nude mice. A 3-fold reduction in overall tumor incidence and volume was associated with increased apoptosis, as evidenced by DNA fragmentation and par-4 expression, and was reduced or absent in early forming LNCaP tumors. After several months the indolent WT1-LNCaP cells became proliferative forming small tumors lacking par-4 protein. Although bcl-2 protein was present in all LNCaP tumors at this late-stage, it was detected in only a minority of WT1-LNCaP tumors, suggesting that pro-survival signals continued to be reduced in WT1-suppressed tumor cells. While the mechanisms of WT1-mediated growth suppression and apoptosis in LNCaP tumor cells are unknown, our results argue against simple transcriptional regulation since the mutant WT1 (D) R394W suppressed tumor formation similarly to wild-type WT1. This suggests that the mechanism of WT1-mediated growth suppression does not rely upon DNA binding at known WT1 recognition sites.