The severity of coronavirus disease 2019 (COVID-19) symptoms and outcomes vary immensely among patients. Predicting disease progression and managing disease symptoms is even more challenging in cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer therapies, including chemotherapy, radiotherapy, and immunotherapy, often suppress the immune system, rendering cancer patients more susceptible to SARS-CoV-2 infection and the development of severe complications. However, data on the effects of immunosuppression on COVID-19 outcomes in cancer patients remain limited. Further investigations are warranted to better understand the implications of SARS-CoV-2 infection in cancer patients, particularly those that are immunocompromised. In this review, we outline the current knowledge of the effects of SARS-CoV-2 infection in cancer patients.

ImportanceIncreasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location.ObjectiveTo examine the association between neighborhood deprivation and racial disparities in mortality among Black and White patients with breast cancer in the state of Georgia.Design, Setting, and ParticipantsThis population-based cohort study collected demographic and geographic data from patients diagnosed with breast cancer between January 1, 2004, and February 11, 2020, in 3 large health care systems in Georgia. A total of 19 580 patients with breast cancer were included: 12 976 from Piedmont Healthcare, 2285 from Grady Health System, and 4319 from Emory Healthcare. Data were analyzed from October 2, 2020, to August 11, 2022.ExposuresArea deprivation index (ADI) scores were assigned to each patient based on their residential census block group. The ADI was categorized into quartile groups, and associations between ADI and race and ADI × race interaction were examined.Main Outcomes and MeasuresCox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% CIs associating ADI with overall mortality by race. Kaplan-Meier curves were used to visualize mortality stratified across racial and ADI groups.ResultsOf the 19 580 patients included in the analysis (mean [SD] age at diagnosis, 58.8 [13.2] years), 3777 (19.3%) died during the course of the study. Area deprivation index contributed differently to breast cancer outcomes for Black and White women. In multivariable-adjusted models, living in a neighborhood with a greater ADI (more deprivation) was associated with increased mortality for White patients with breast cancer; compared with the ADI quartile of less than 25 (least deprived), increased mortality HRs were found in quartiles of 25 to 49 (1.22 [95% CI, 1.07-1.39]), 50 to 74 (1.32 [95% CI, 1.13-1.53]), and 75 or greater (1.33 [95% CI, 1.07-1.65]). However, an increase in the ADI quartile group was not associated with changes in mortality for Black patients with breast cancer (quartile 25 to 49: HR, 0.81 [95% CI, 0.61-1.07]; quartile 50 to 74: HR, 0.91 [95% CI, 0.70-1.18]; and quartile ≥75: HR, 1.05 [95% CI, 0.70-1.36]). In neighborhoods with an ADI of 75 or greater, no racial disparity was observed in mortality (HR, 1.11 [95% CI, 0.92-1.36]).Conclusions and RelevanceBlack women with breast cancer had higher mortality than White women in Georgia, but this disparity was not explained by ADI: among Black patients, low ADI was not associated with lower mortality. This lack of association warrants further investigation to inform community-level approaches that may mitigate the existing disparities in breast cancer outcomes in Georgia.

Retinopathy in the context of systemic lupus erythematosus (SLE) is associated with severe disease and poorer prognosis. We studied retinopathy in our cohort of Indian lupus patients. Four hundred and thirty-seven patients fulfilling the Systemic Lupus International Collaborating Clinics-American College of Rheumatology-2012 criteria, attending the department of Clinical Immunology were enrolled under this cross-sectional study. A comprehensive clinical (including ophthalmological) examination and immunological profile were performed. Retinopathy was defined if cotton-wool spots, haemorrhages, vasculitis, retinal detachment or optic disc changes as papilledema, optic atrophy were present. Disease activity was assessed using SLE disease activity index (SLEDAI). Mean age of participants was 28.06 ± 9.7 years (93.1% females); median disease duration 12 months (Interquartile range-IQR 6.36). Forty-five (10.3%) had SLE associated retinopathy. Autoimmune haemolytic anaemia [31.1 vs 14.5%, p value 0.004, odd's ratio-OR (95% confidence interval-CI) 2.65 (1.33-5.29)], serositis [33.3 vs 18.9%, p value 0.023, OR (CI) 2.14 (1.11-4.10)], lupus nephritis [62.2 vs 40.8%, p value 0.006, OR (CI) 2.38 (1.26-4.50)], seizures [28.9 vs 12.8%, p value 0.004, OR (CI) 2.77 (1.36-5.65)] and median SLEDAI score (24 vs 12, p < 0.01) were significantly higher in those with retinopathy. On adjusted binary logistic regression, autoimmune hemolytic anemia, lupus nephritis and presence of antibodies to Smith antigen were predictors for retinopathy. Retinopathy is common in SLE, a marker of active disease with frequent renal involvement and should be screened for in all patients with lupus.

Background:The issue of menstrual hygiene is inadequately acknowledged in our nation. The use of sanitary pads and washing the genital area are essential practices for good menstrual hygiene. Poor menstrual hygiene may lead to itching or rashes in the perineal region, bad odor, and sometimes, major complications such as pelvic inflammatory disease and toxic shock syndrome. Therefore, the objective of this study was to assess the knowledge and practice of menstrual hygiene among reproductive age group women.Methods:A Community-based cross-sectional study design was employed. Study was conducted from January 2012 to April 2013. Data were collected using a pretested semi-structured structured questionnaire. The data were entered and analyzed into a computer using SPSS version 20.Results:In this study, 584 (81.7%) respondents had good practice of menstrual hygiene. The findings of the study showed a significant positive association between good practices of menstrual hygiene and years of education of the study subject (adjusted odds ratio [AOR] =9.3, 95% confidence interval [CI]: 4.4–19.5), having a higher socioeconomic status (AOR = 9.27, 95% CI: 4.7–18.03).Conclusions:Awareness of good menstrual practices is of utmost importance. Health education regarding menstrual hygiene should be a part of school curriculum and health institutes. Social marketing of good quality, low-cost sanitary napkins at accessible outlets, provision for adequate water supply, vending machines for low-cost sanitary napkins, privacy and wall-mounted incinerators for disposal in schools, workplaces, and public places would go a long way in improving the menstrual hygiene and help them in securing healthy lifestyle.

Aim The aim of the study was to assess the distribution of human leukocyte antigen (HLA)‐B*27 subtypes and its correlation with disease phenotypes in children with enthesitis‐related arthritis variant of juvenile idiopathic arthritis (JIA‐ERA). Method One hundred and sixty patients (132 males, 28 females) satisfying the International League Against Rheumatism (ILAR) classification criteria for JIA‐ERA were assessed and relevant demographic, clinical and radiographic data were documented. HLA‐B*27 typing was done for all the patients and B*27 positive samples were subjected to high‐resolution gene sequencing. The effect of duration of illness, HLA‐B*27, its subtypes, and gender on the clinical phenotype were analyzed. Results The mean age of disease onset was 12.69 ± 2.4 years with a male:female ratio of 4.7:1.0. HLA‐B*27 was positive in 109/160 patients and HLA‐B*27:04 was detected in 63% followed by B*27:05 (30%). Duration of illness was greater in patients with skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and acute anterior uveitis (AAU) (P < 0.05). HLA‐B*27 positivity was associated with a prolonged course of disease, higher incidence of AAU (14.7% vs 2%, P = 0.015), family history of spondyloarthritis (21.1% vs 5.9%; P = 0.015) and higher erythrocyte sedimentation rate as compared to HLA‐B*27 negative patients (P < 0.01). The HLA‐B*27:04 and *27:05 positive patients had similar clinical phenotypes. Conclusion Presence of HLA‐B*27 and long duration of illness results in skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and AAU. HLA‐B*27:04 followed by B*27:05 are the most common HLA‐B*27 subtypes in our study population and both have a similar clinical phenotype.

Introduction The prevalence of various immunological biomarkers in neuropsychiatric systemic lupus erythematosus (NPSLE) differs among various patients with varied neuropsychiatric manifestations and different populations. We studied the prevalence of these biomarkers; especially the neuron specific autoantibodies in patients with systemic lupus erythematosus (SLE) and compared them among patients with and without neuropsychiatric involvement. Methodology This is a comparative cross-sectional study conducted in a tertiary care hospital in South India. The prevalence of immunological biomarkers including complement levels, systemic and brain specific autoantibodies (anti-myelin antibody, anti–myelin oligodendrocyte glycoprotein and anti–myelin-associated glycoprotein antibody) were assessed and compared among those with and without NPSLE and with different NPSLE manifestations. Results A total of 522 SLE patients were enrolled in the study. The mean age of the study participants was 28.5 ± 8.8 years and 93.5% were women. Neuropsychiatric manifestations were seen in 167 (32%) patients. Seizure was the most common neuropsychiatric manifestation seen in 41.3%, followed by psychosis (18.6%), mood disorder (16.8%), stroke (10.8%), mononeuropathy (10.2%), headache (9.6%), acute confusional state (6.6%) and aseptic meningitis (5.4%). Patients with NPSLE had a higher SLE disease activity index score. Most of the autoantibodies, that is anticardiolipin antibody (aCL), anti–β2 glycoprotein 1 antibody (β2GP1), lupus anticoagulant (LA), anti-nucleosome, anti–ribosomal P, anti-Ro52, anti-Ro60 and anti-La, were seen in higher proportion in the NPSLE group, although the difference failed to reach statistical significance. On subgroup analysis, psychosis was significantly higher in patients with anti-ribosomal P positivity than without (11.8% versus 4.1%, p.0.007; odds ratio (OR) 3.1, confidence interval (CI) 1.4–6.8), while stroke had a higher proportion among those with positive b2GP1 IgG (6.3% versus 1.8%, p.0.03; OR 3.6, CI 1.2–11.0). A higher proportion of demyelination was seen among the LA positive than the negative (10.3% versus 0.2%, p.0.03; OR 5.39, CI 1.15–24.17) and anti–myelin oligodendrocyte glycoprotein in mood disorder (14.3% versus 3.4%, p = 0.03; OR 4.66, CI 1.13–19.13). Conclusion No single biomarker correlated with NPSLE. Among different NPSLE manifestations, the prevalence of IgG β2GP1 in stroke, LA in demyelination, anti–ribosomal P in psychosis and anti–myelin oligodendrocyte glycoprotein in mood disorder were higher. Further studies on the pathogenic mechanisms underlying NPSLE and its different manifestations may help us to identify better biomarkers.

EmporiatricsTravel medicine a b s t r a c t Tourism in India is a large industry. International travel and commerce is here to stay and continue their global expansion. With increase in the travel trend, comes various health risks to the travelers. Children, pregnant women, older age group, people with pre-existing diseases, adventurers and sex travelers are particularly vulnerable. This is where travel medicine or emporiatrics come into light. It encompasses a wide variety of disciplines including epidemiology, infectious disease, public health, tropical medicine, high altitude physiology, travel related obstetrics, psychiatry, occupational medicine, military and migration medicine, and environmental health. In this article an attempt has been made to describe the various health risks to the travelers, their occurrence and how they can be prevented.

Purpose Our research sought to describe barriers to mammography screening among a sample of predominantly Black women in metropolitan Atlanta, Georgia. Methods The Pink Panel project convened community leaders from faith-based institutions to administer an offline survey to women via convenience sampling at fourteen churches in Atlanta in late 2019 and early 2020. With the COVID-19 pandemic, the research team switched to an online survey. The survey included seven questions about breast cancer awareness, barriers to breast cancer screening, and screening status. We used residence information to attain the 9-digit zip code to link to the Area Deprivation Index at the Census Block Group neighborhood level. We report results as descriptive statistics of the barriers to mammography screening. Results The 643 women represented 21 counties in Georgia, predominantly from metropolitan Atlanta, and 86% identified as Black. Among women aged 40 and older, 90% have ever had a mammogram. Among all women, 79% have ever had a mammogram, and 86% indicated that they would get a mammogram if offered in their neighborhood. The top barriers to mammography screening were lack of health insurance and high cost. Barriers to mammography screening did not differ substantially by Area Deprivation Index. Conclusion Among metropolitan Atlanta women aged 40+ , nearly all reported ever having a mammogram. However, addressing the barriers, including lack of health insurance and high cost, that women reported may further improve mammography screening rates.