To evaluate the role of human papillomavirus (HPV) and other risk factors in the aetiology of invasive cervical carcinoma (ICC), we conducted a hospital-based case-control study in Chennai, Southern India. A total of 205 ICC cases (including 12 adenocarcinomas) and 213 frequency agematched control women were included. HPV DNA in cervical cells was evaluated by means of a polymerase chainreaction assay. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed by means of unconditional multiple logistic regression models. HPV infection was detected in all but one ICC cases and in 27.7% of control women (OR ‫؍‬ 498). Twenty-three different HPV types were found. HPV 16 was the most common type in either cases or controls, followed by HPV 18 and 33. Approximately 125,000 new cervical cancer cases have been estimated to have occurred in India in 2000 (i.e., nearly one-third of all new cervical cancer cases worldwide). 1 Incidence rates in the country, however, varied between 11 per 100,000 in Trivandrum and 30 per 100,000 in Chennai (former Madras), all in Southern India. 2 In Chennai, a woman's estimated probability of developing cervical cancer up to age 74 was more than 3%. As in other developing countries, squamous cell carcinoma predominates, whereas adenocarcinoma of the cervix accounts for a small percent of all cervical cancer, even in the urban areas (e.g., Mumbai, 7%). 3 A high prevalence of human papillomavirus (HPV) 16 and 18 in cervical cancer specimens has been shown in India 2 as elsewhere, 4 but limited information is available on the distribution of HPV types in the country.Case-control studies on invasive cervical carcinoma (ICC) in India have been relatively few. 6 -11 Low educational and socioeconomic level, young age at marriage or first sexual intercourse, high parity and male partner's sexual behaviour were the most consistently reported risk factors. No case-control study from India has provided thus far an estimate of the association between cervical cancer and infection with HPV, the necessary cause of the disease worldwide. 12 To further elucidate the role of different HPV types and its co-factors in ICC aetiology, we carried out a case-control study in Chennai, Southern India. MATERIAL AND METHODSOur study is part of an international multicenter case-control study of ICC and HPV coordinated by the International Agency for Research on Cancer (IARC). 13 From June 1998 to May 1999, 222 women with a diagnosis of ICC were recruited into the Cancer Institute in Chennai, Southern India. 14 On account of the high burden of ICC cases at the Cancer Institute, the first woman to be newly diagnosed with ICC each working day was asked to participate in our study and was administered an informed consent. Inclusion criteria for case subjects were: (i) histologic confirmation of ICC diagnosis; (ii) no previous cancer treatment; and (iii) lack of physical or mental impairments that would have made the interview impossible. Seventeen women were excluded based on the revision of histol...

Non-viral factors contribute to human papillomavirus (HPV)-related cervical carcinogenesis. We investigated the role of paan chewing and dietary habits among 205 women with invasive cervical cancer (ICC) and 213 age-matched control women in Chennai, India. Odds ratios (OR) and 95% confidence intervals (CI) were computed by means of unconditional multiple regression, taking into account major correlates of ICC risk. Paan chewing showed a dose-dependent direct association with ICC (OR for X5 paan day À1 ¼ 4.0; 95% CI 1.2 -13.3). Among dietary habits, the highest vs lowest intake tertile for vegetables and fruit was associated with an OR of 0.5 (95% CI 0.2 -1.0). Low education level and low body weight were also risk factors for ICC, but they did not account for the associations of paan chewing and low vegetable and fruit intake. In the analyses restricted to HPV-positive cases and controls, the inverse association with vegetable and fruit intake was confirmed. Conversely, the adverse influence of paan chewing on ICC risk seemed to be attributable to a higher prevalence of cervical HPV infection in women who chewed.

AimsUp to 3% of hospitalised paediatric patients are at risk of sudden deterioration. Paediatric early warning systems (PEWS) aim to identify at-risk patients to assist clinical decision-making. Although many UK hospitals use PEWS, there is no national standard. Our hospital introduced a new PEWS in August 2015, based on the Australian ‘Between the Flags’ system. Each physiological parameter is graphed in colour coded bands (red – severely deranged; amber – very deranged; blue – moderately deranged; white – normal), with no numerical scoring. In Australia, ‘Between the Flags’ decreased the proportion of deteriorating patients who were not appropriately escalated and admitted to paediatric intensive care (PICU)1 – an improvement we have also seen in our hospital, after applying a PEWS within inpatient areas. We undertook a study to assess the suitability of this PEWS to recognising deterioration in children who were referred from regional hospitals to our PICU.MethodWe retrospectively analysed referral records from our intensive care transport service to assess the sensitivity of PEWS. We hypothesised that PEWS would be sensitive enough to detect deterioration in regional hospitals, as defined by the need for PICU admission, using a threshold of one red event or three or more amber events. Clinical observations at the time of transfer request were recorded according to age-specific charts. Transfer requests from other PICUs, step-down units, and emergency departments were excluded.Results100 patient records fulfilling inclusion criteria were randomly selected from January and July 2016. 146 red triggers were identified. Our PEWS would have been activated in 97 out of 100 patients who were subsequently admitted to PICU – 97% sensitivity, based on a threshold of one red event or three or more amber events. With threshold of only one red event, our PEWS is 91% sensitive.ConclusionOur PEWS is sensitive as a trigger tool for regional referring hospitals. Further study on specificity is required to identify its wider utility.ReferenceAkre, M. et al. ‘Sensitivity Of The Paediatric Early Warning Score To Identify Patient Deterioration’. PAEDIATRICSPEDIATRICS 125.4 (2010): e763–e769.

AimsSub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. We aimed to undertake a systematic review of studies assessing CFP in SA children aged 0– 2 years in Bangladesh, India and Pakistan.MethodsSearches undertaken between January 1990 to June 2016; MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity and Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CFP in SA children aged 0–2 years and/or their families. Search terms were: ‘children’, ‘feeding’ and ‘Asians’ with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).ResultsFrom 45,712 studies identified, 126 descriptive studies (105 cross-sectional, 11 cohort, 8 qualitative, 1 case-control and 1 mixed studies) were included. 73 from India, 17 Pakistan and 36 Bangladesh. Despite each adopting WHO Infant and Young Children Feeding (IYCF) Guidelines, CFP were sub-optimal in all three countries.In Pakistan, of 15 studies reporting CFP timings, 8 recorded timely initiation (between 6–9 months). Of those reporting dietary diversity, 3 of 9 studies met minimum dietary diversity requirements across 4 of 7 WHO IYCF food groups. 2 of 3 studies observed minimum meal frequency in over 50% of participants.In India 35 of 59 studies reported timely initiation of CFP. 7 of 9 studies noted minimum dietary diversity achieved between 10%–23% of the study population. 5 of 15 studies noted minimum meal frequency achieved between 25%–96% of the study population.In Bangladesh, in 13 of 36 studies timely initiation of CFP ranged from 42%–64%. 3 of 17 studies noted minimum dietary diversity achieved between 19.8%–57.7% of the study population. 1 of 7 studies noted minimum meal frequency achieved between 33%–81% of the study population.Influencing factors included poor education about CFP, cultural beliefs and socioeconomic variables.ConclusionThis is the first SR to evaluate CFP in infants in India, Pakistan and Bangladesh. There is a great need for revision of nationwide child health programmes and campaigns to change health and nutrition behaviour.