PubMed Health⌕ Search

Biomedical subjects

A Mathew

Publications and source records attributed to A Mathew.

98 records · Page 6Linked to original sources
PubMedDate not supplied

A step towards quality medical research.

Only well planned and conducted research can answer questions that arise in day-to-day clinical practice. Unfortunately, most studies in India are deficient in design or execution. The results thus obtained are biased and cannot be extrapolated to the population studied. Some important questions which arise during the statistical design of investigations are selection of subjects on which observations are to be made, number of observations falling into different groups, allocation of subjects among different groups, etc. Besides planning and execution, appropriate methods need to be chosen for data analysis beforehand. If the study has been well designed and correctly analysed, the interpretation of results can be fairly simple. The present communication focuses on some issues relating to the planning of investigations in medical research with emphasis on statistical design.

Research Design↗
PubMedDate not supplied

A profile of tumor markers in the population of Kuwait.

The tumour markers CEA, AFP, CA 125 and CA 199 were analyzed in a group of apparently healthy subjects in Kuwait. The sample (n = 394) included both genders in the population with a mean age of 38 (S.d. 12.0) years. The distribution of CEA levels values was significant different (Mann-Whitney U test) between Kuwaiti and non-Kuwaiti. The distribution of AFP levels was found to be the same in all groups. The distribution of CA 125 levels was significantly higher in females than in males, both in Kuwaiti and non-Kuwaiti. The distribution of CA 19-9 values was found to be significantly higher in the Kuwaiti female group when compared to the males. The upper reference level was defined as the 95 percentile of the normal values in each group. In the total population the reference level of AFP was 5.6 micrograms/l and of CA 19.9 43 kU/l. The reference level of CA 125 was 16 U/l in males and 24 kU/l in females, respectively. The CEA reference level in Kuwaitis was 6.9 micrograms/l and in non-Kuwaitis 4.4 micrograms/l. The results indicated the importance of determining the reference levels of tumour markers for each individual laboratory. It was also emphasized that care should be taken on the impact of 95 percentiles of normal and benign disease groups.

Adult↗
PubMedDate not supplied

Estimating cancer survival in developing countries. Use of reply-paid post cards to augment follow-up information.

Survival from cancer is one of the indices to evaluate cancer control activities. Reliability of survival estimates depends to a large extent on the completeness of follow-up information available for patients in the study group. Loss to follow-up (LFU) is one of the potential problems introduced in follow-up of cancer patients. An attempt is made to improve the follow-up system for reducing the LFU of cancer patients by repeatedly sending reply-paid post cards for the LFU patients. A total of 353 ovarian cancer patients registered at the Regional Cancer Centre, Trivandrum during a three year period and followed-up to a total of five years showed 67 percent loss to follow-up. The five-year survival rate of this group calculated using Kaplan-Meier method under the assumption that the LFU's occurred at random was 75 percent. Efforts to improve the follow-up rate for the study population were made through the simple and cost effective method of postal enquiry which resulted in a reduction of 63 percent of losses to follow-up. Incorporation of this information in the data brought about a revised five-year survival estimate of 55 percent. The reply paid post card system was found to be effective in obtaining useful follow-up data. The result shows that LFU can be reduced by better design of survival study.

Cohort Studies↗
PubMedDate not supplied

Screening for cancer of uterine cervix and approaches adopted in India.

Cervical cancer is the leading malignancy among Indian women. It has been estimated that in the absence of any control programme, the incident number of cervical cancer cases in the country would rise to 140 thousand by the turn of this century. Cytology screening remains the main stay for the control of cervix cancer. In the present communication the evidence available for screening for cancer of cervix has been presented. Difficulties in organising cervical cancer screening programmes in India and the alternative approach have been discussed.

Cervix Uteri↗
PubMedDate not supplied

Oral cancer among patients under the age of 35 years.

BACKGROUND: Cancer of the oral cavity is one of the commonest cancers among males. AIMS: To assess the aetiological factors, patient characteristics, treatment and the outcome in young patients with oral cancer. SETTINGS AND DESIGN: A retrospective descriptive study of patients under the age of 35 years with cancer of the oral cavity treated between 1982-1996, with the last follow-up till 2001, using the tumour registry data of Regional Cancer Centre (RCC), Trivandrum, Kerala, India. SUBJECT AND METHOD: The detailed clinical, treatment and follow-up data were obtained from the computerised records of RCC and recorded on a preset proforma. This was analysed with emphasis on age, sex, risk factors, site, histology, clinical extent and treatment methods and survival in the study group. STATISTICAL ANALYSIS: The survival analysis was carried by Kaplan-Meier method and the difference in survival was analysed using log-rank test. RESULTS: Out of 264 patients analysed, tongue was the commonest site identified in 136 (52%) patients followed by buccal mucosa in 69 (26%) patients. A male female ratio of 2.3:1 was observed with a significantly higher male preponderance in buccal mucosa (4.3:1). Prior exposure to tobacco or alcohol was noted in 59.4% patients, with more habitués in buccal mucosa cancer. Histological confirmation was present only in 83.7% patients and among them most were squamous cell carcinoma (85.9%). Radiotherapy, surgery or combined modalities of treatment were employed for majority of patients. The 5-year survival was 57.3%. T stage of the tumour was found to be significant in predicting disease free survival (P=0.03). CONCLUSIONS: The importance of early detection for clinical down staging is stressed. There is a need to investigate the aetiology of intra oral cancers in younger patients since a significant proportion (almost 40%) of these patients do not have associated risk factors for cancer.

Adult↗
PubMedDate not supplied

Attributing death to cancer: cause-specific survival estimation.

Cancer survival estimation is an important part of assessing the overall strength of cancer care in a region. Generally, the death of a patient is taken as the end point in estimation of overall survival. When calculating the overall survival, the cause of death is not taken into account. With increasing demand for better survival of cancer patients it is important for clinicians and researchers to know about survival statistics due to disease of interest, i.e. net survival. It is also important to choose the best method for estimating net survival. Increase in the use of computer programmes has made it possible to carry out statistical analysis without guidance from a bio-statistician. This is of prime importance in third- world countries as there are a few trained bio-statisticians to guide clinicians and researchers. The present communication describes current methods used to estimate net survival such as cause-specific survival and relative survival. The limitation of estimation of cause-specific survival particularly in India and the usefulness of relative survival are discussed. The various sources for estimating cancer survival are also discussed. As survival-estimates are to be projected on to the population at large, it becomes important to measure the variation of the estimates, and thus confidence intervals are used. Rothman's confidence interval gives the most satisfactory result for survival estimate.

Cause of Death↗
PubMedDate not supplied

Acute abdomen in patients receiving chemotherapy.

OBJECTIVE: To assess the incidence of acute abdomen in patients receiving chemotherapy and to evaluate the factors affecting the clinical decision-making. MATERIAL AND METHODS: Retrospective analysis of surgical oncology references for the patients developing acute abdomen while receiving chemotherapy was carried out. A surgical oncologist reviewed each referral and a full work-up was carried out. Surgical interventions were carried out as and when deemed necessary. Response to treatment, whether surgical or conservative, was used as main outcome variable. RESULTS: Mean age of the patients was 37 years (7-58 years). Half of the patients were receiving chemotherapy for lymphoproliferative disorders, 13 for haematological malignancies and 3 for ovarian cancer. Clinical diagnosis was of acute appendicitis in 13, paralytic ileus in 9, typhilitis in 3 and intestinal perforation in 2, acute intestinal obstruction in 3, and obstructed hernia and intussception in one each. Six patients underwent surgery. Two patients expired postoperatively of progressive septicaemia and multi-system organ failure. CONCLUSION: Evaluation of cancer patients on chemotherapy is difficult. Tenderness, presence of peritoneal signs and absence of exaggerated bowel sounds are most important clinical signs, however they may be blunted by progressive neutropenia or corticosteroid administration. Decision to operate, should be made with extreme caution as mortality and morbidity after surgery is high.

Abdomen, Acute↗