A comprehensive and multi-layered strategy addressing both population-wide and individual biological risk factors is required to combat the growing cardiovascular disease (CVD) epidemic affecting the Indian population.
A possible treatment choice for oral cancer that is resistant to platinum or experiencing early treatment failure is triple metronomic chemotherapy. However, the long-term outcomes resulting from the application of this method are presently unknown.
The research subjects were adult patients whose oral cancer was platinum-resistant or had failed to respond adequately in the initial phases of treatment. Patients undergoing phase 1 trials received metronomic chemotherapy regimens, featuring erlotinib 150 mg daily, celecoxib 200 mg twice daily, and methotrexate weekly in variable doses ranging from 15-6 mg/m².
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Oral administration of all medications continues throughout phase two until disease progression or the onset of unacceptable adverse events. The central purpose of the study was to estimate long-term overall survival and to identify the associated contributing factors. The Kaplan-Meier procedure was instrumental in time-to-event analysis. The Cox proportional hazards model served to pinpoint factors that impacted overall survival (OS) and progression-free survival (PFS). The model utilized the following baseline factors: age, sex, Eastern Cooperative Oncology Group performance status (ECOG PS), tobacco exposure, and the level of endothelial cells from both primary and circulating subsite locations. Statistical importance was assigned to p-values of 0.05 or lower. paediatrics (drugs and medicines) The clinical trial, CTRI/2016/04/006834, holds critical information.
Recruiting a total of ninety-one patients (fifteen in phase one and seventy-six in phase two), the study observed a median follow-up duration of forty-one months and eighty-four events of death. The median observed survival time is 67 months; this estimate is associated with a 95% confidence interval from 54 to 74 months. molecular pathobiology Respectively, the one-year, two-year, and three-year operating systems experienced performance increases of 141% (95% confidence interval 78-222), 59% (95% confidence interval 22-122), and 59% (95% confidence interval 22-122). Circulating endothelial cell detection at baseline was the singular factor beneficially impacting overall survival. The hazard ratio was 0.46, 95% confidence interval 0.28-0.75, and p-value was 0.00020. Regarding progression-free survival, the median duration was 43 months (confidence interval 41-51), while the rate at one year was 130% (95% confidence interval 68-212%). Progression-free survival was significantly impacted by two factors: the detection of circulating endothelial cells at baseline (HR=0.48; 95% CI 0.30-0.78, P=0.00020) and not using tobacco at baseline (HR=0.51; 95% CI 0.27-0.94, P=0.0030).
Triple oral metronomic chemotherapy, comprising erlotinib, methotrexate, and celecoxib, has unfortunately yielded unsatisfactory long-term outcomes. Circulating endothelial cells, when detected at baseline, act as a biomarker for the effectiveness of this treatment.
A grant from the Tata Memorial Center Research Administration Council (TRAC), an intramural grant, and the Terry Fox foundation's contribution financed the study.
An intramural grant from the Tata Memorial Center Research Administration Council (TRAC) and the Terry Fox Foundation facilitated the study.
Unfortunately, locally advanced head and neck cancers treated with radical chemoradiation frequently produce suboptimal outcomes. In palliative situations, oral metronomic chemotherapy exhibits a more positive impact on outcomes compared to the maximum tolerated dose of chemotherapy. The limited evidence available suggests the possibility of an adjuvant benefit. Therefore, a randomized study was carried out.
Patients with head and neck (HN) cancer, primarily in the oropharynx, larynx, or hypopharynx, who exhibited a post-radical chemoradiation complete response (PS 0-2), were randomly assigned to either observation or 18 months of oral metronomic adjuvant chemotherapy (MAC). Each week, the MAC treatment called for a 15mg/m^2 oral methotrexate dose.
Patients were instructed to take celecoxib (200mg orally, twice daily) and any additional medication as directed. The primary outcome measure was OS, and the total sample size was 1038 individuals. The study's design included three planned interim analyses to monitor efficacy and futility. Trial registration in the Clinical Trials Registry-India (CTRI) for the trial, identified as CTRI/2016/09/007315, occurred on 28th September, 2016, and was conducted prospectively.
Following the recruitment of 137 patients, an interim analysis was carried out. A 3-year progression-free survival rate of 687% (confidence interval 551-790) was observed in the observation arm, compared to 608% (confidence interval 479-714) in the metronomic arm; this difference was statistically significant (P = 0.0230). The hazard ratio calculation yielded 142, within a 95% confidence interval between 0.80 and 251, and a p-value of 0.231. Significant differences were observed in the 3-year OS, with the observation arm showing a rate of 794% (95% CI 663-879), compared to the metronomic arm's 624% (95% CI 495-728) (P = 0.0047). Selleck V-9302 The hazard ratio demonstrated a value of 183, with a corresponding 95% confidence interval of 10 to 336, and a p-value of 0.0051.
Oral metronomic treatments combining weekly methotrexate and daily celecoxib, assessed in a randomized phase three study, did not result in improvements in progression-free survival or overall survival. A post-treatment observation period, following radical chemoradiation, continues to serve as the established standard of care.
This study received funding from ICON.
The ICON organization supported the undertaking of this study.
Rural India, where roughly 65% of the population is concentrated, suffers from a prevalent lack of sufficient fruit and vegetable intake. Though financial incentives have successfully increased the demand for fruits and vegetables in urban supermarkets, their practical application and effectiveness amongst the unorganized retail systems in rural India is currently uncertain.
A cluster-randomized controlled trial, focusing on a financial incentive scheme, providing a 20% cashback on purchases of fresh produce from neighborhood stores, was carried out in six villages with 3535 households. The three-month (February-April 2021) program extended an invitation to participate to all households in the three intervention villages, in contrast to no intervention offered in the control villages. Households in both the control and intervention villages, a random selection, provided self-reported details on their fruit and vegetable purchases both before and after the intervention.
Of those invited, 1109 households (88%) contributed data. Self-reported fruit and vegetable purchases, following the intervention, showed a difference between intervention and control groups: 186kg (intervention) against 142kg (control) from any retailer (primary outcome), with a baseline-adjusted mean difference of 4kg (95% CI -64 to 144), and 131kg (intervention) against 71kg (control) from participating local retailers (secondary outcome), showing a baseline-adjusted mean difference of 74kg (95% CI 38-109). The intervention, regardless of household food security or socioeconomic status, exhibited no discernible differential effects, nor were any unintended negative consequences observed.
Schemes offering financial incentives are applicable to unorganized food retail settings. The prospect of bettering household dietary habits heavily relies on the proportion of retailers who are supportive of this initiative.
With funding provided by the Drivers of Food Choice (DFC) Competitive Grants Program—a program overseen by the University of South Carolina, Arnold School of Public Health, which is supported by the UK Government's Department for International Development and the Bill & Melinda Gates Foundation—this research was conducted; however, these findings do not necessarily mirror the official policies of the UK Government.
The UK Government's Department for International Development and the Bill & Melinda Gates Foundation, through their funding of the Drivers of Food Choice (DFC) Competitive Grants Program, administered by the University of South Carolina, Arnold School of Public Health, have enabled this research; however, the views presented do not inherently reflect official UK Government policy.
Within the context of low- and middle-income countries (LMICs), cardiovascular diseases (CVDs) sadly represent the most prevalent cause of death. Historically, CVDs and their metabolic risk factors have tended to concentrate among higher socioeconomic status urban residents of lower-middle-income countries, including India. Still, with the advancement of India, the continuation or transformation of these socioeconomic and geographical differences remains unclear. For effective CVD burden reduction and targeted support for those most in need, a deep understanding of these social determinants of cardiovascular risk is critical.
We examined the patterns of four cardiovascular risk factors – smoking (self-reported), unhealthy weight (BMI ≥ 25), elevated blood pressure, and high cholesterol – within the Indian population using representative data from the 2015-16 and 2019-21 national family and health surveys, encompassing biomarker information.
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For the study population, comprising adults aged 15-49 years, inclusion was contingent upon the presence of diabetes (a random plasma glucose concentration of 200 mg/dL or self-reported diagnosis) and hypertension (average systolic blood pressure of 140 mmHg, average diastolic blood pressure of 90 mmHg, self-reported prior diagnosis, or self-reported current use of antihypertensive medication). Starting with a description of national-level changes, we then investigated trends stratified by place of residence (urban/rural), geographic region (north, northeast, central, east, west, south), level of regional development (Empowered Action Group status), and two measures of socioeconomic status: educational attainment (no education, incomplete primary, complete primary, incomplete secondary, complete secondary, higher) and wealth (quintiles).