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Fulltext Changing epidemiology of SARS-CoV in the context of COVID-19 pandemic

Bhattacharya S, Basu P, Poddar S

J Prev Med Hyg, 2020 Jun;61(2):E130-E136.
PMID: 32802995 DOI: 10.15167/2421-4248/jpmh2020.61.2.1541

SARS-CoV-2 is a new form of β-coronavirus that has been recently discovered and is responsible for COVID 19 pandemic. The earliest infection can be traced back to Wuhan, China. From there it has spread all over the world. Keeping in view the above perspective, an attempt is made in order to find out the epidemiological pattern of COVID 19 pandemic, if any, in different geo-climatological regions of the world in terms of case incidence and mortality. This study is also an endeavor to review and analyze the gradual changes of the genetic makeup of SARS-CoV from evolutionary and epidemiological perspectives. The raw data of COVID-19 cases and death incidences were collected from the World Health Organization (WHO) website from the time period: 1st April to 6th April, 2020. The data that are utilized here for general and Case fatality rate (CFR) based analysis. Western pacific region, European region and Americas have the greatest number of infected cases (P < 0.001); whereas deaths have been found to be significantly higher in Europe (P < 0.001). Total number of confirmed cases and deaths in south-east Asia are comparatively lower (P < 0.001). Case fatality rate (CFR) has also found significant for European region. SARS-CoV-2 is considered to be a strain of SARS-CoV that has a high rate of pathogenicity and transmissibility. Result indicated that the European region has been affected mostly for both cases and death incidences. The novel mutations in SARS-CoV-2 possibly increase the virus infectivity. Genetic heterogeneity of this virus within the human population might originate as the representatives of naturally selected virus quasispecies. In this context, the presence of the asymptomatic individuals could be a significant concern for SARS-CoV-2 epidemiology. Further studies are required to understand its genetic evolution and epidemiological significance.
Recycling of Malaysia's electric arc furnace (EAF) slag waste into heavy-duty green ceramic tile

Teo PT, Anasyida AS, Basu P, Nurulakmal MS

Waste Manag, 2014 Dec;34(12):2697-708.
PMID: 25242607 DOI: 10.1016/j.wasman.2014.08.015

Recently, various solid wastes from industry such as glass waste, fly ash, sewage sludge and slag have been recycled into various value-added products such as ceramic tile. The conventional solutions of dumping the wastes in landfills or incineration, including in Malaysia are getting obsolete as the annual huge amount of the solid wastes would boost-up disposal cost and may cause permanent damage to the flora and fauna. This recent waste recycling approach is much better and greener as it can resolve problems associated with over-limit storage of industrial wastes and reduce exploration of natural resources for ceramic tile to continuously sustain the nature. Therefore, in this project, an attempt was made to recycle electric arc furnace (EAF) slag waste, obtained from Malaysia's steel making industry, into ceramic tile via conventional powder compaction method. The research work was divided into two stages. The first stage was to evaluate the suitability of EAF slag in ceramic tile by varying weight percentage of EAF slag (40 wt.%, 50 wt.% and 60 wt.%) and ball clay (40 wt.%, 50 wt.% and 60 wt.%), with no addition of silica and potash feldspar. In the second stage, the weight percentage of EAF slag was fixed at 40 wt.% and the percentage of ball clay (30 wt.% and 40 wt.%), feldspar (10 wt.% and 20 wt.%) and silica (10 wt.% and 20 wt.%) added was varied accordingly. Results obtained show that as weight percentage of EAF slag increased up to 60 wt.%, the percentage of apparent porosity and water absorption also rose, with a reduction in tile flexural strength and increased porosity. On the other hand, limiting the weight percentage of EAF slag to 40 wt.% while increasing the weight percentage of ball clay led to a higher total percentage of anorthite and wollastonite minerals, resulting in higher flexural strength. It was found that introduction of silica and feldspar further improved the flexural strength due to optimization of densification process. The highest flexural strength, lowest apparent porosity and water absorption of EAF slag based tile was attained at the composition of 40 wt.% EAF slag--30 wt.% ball clay--10 wt.% feldspar--20 wt.% silica. The properties of ceramic tile made with EAF slag waste (up to 40 wt.%), especially flexural strength are comparable to those of commercial ceramic tile and are, therefore, suitable as high flexural strength and heavy-duty green ceramic floor tile. Continuous development is currently underway to improve the properties of tile so that this recycling approach could be one of the potential effective, efficient and sustainable solutions in sustaining our nature.
Knowledge, attitudes, and communication around human papillomavirus (HPV) vaccination amongst urban Asian mothers and physicians

Chow SN, Soon R, Park JS, Pancharoen C, Qiao YL, Basu P, et al.

Vaccine, 2010 May 14;28(22):3809-17.
PMID: 20347631 DOI: 10.1016/j.vaccine.2010.03.027

To determine why HPV vaccination uptake is low in Asia, we surveyed attitudes, knowledge and communication about cervical cancer and HPV vaccination amongst 480 physicians and 1617 randomly selected urban mothers who could afford HPV vaccines in Korea, Malaysia, Taiwan and Thailand. HPV vaccine rejection by mothers was linked with poor knowledge and low perceptions of self-relevance. Physicians' likelihood of raising the subject and/or recommending vaccination was linked to how proactively they advocate preventive health, their attitude to the subject's sensitivity and their knowledge levels. Because most Asian mothers seek doctors' advice and prefer them to take the initiative, physicians should be more proactive in discussing and recommending HPV vaccination.
Cervical cancer burden, status of implementation and challenges of cervical cancer screening in Association of Southeast Asian Nations (ASEAN) countries

Zhao S, Huang L, Basu P, Domingo EJ, Supakarapongkul W, Ling WY, et al.

Cancer Lett, 2022 Jan 28;525:22-32.
PMID: 34728309 DOI: 10.1016/j.canlet.2021.10.036

Multiple barriers impede the transformation of evidence-based research into implementation of cervical cancer screening in ASEAN countries. This review is the first of its kind to show the disease burden of cervical cancer, progress till date to implement screening and corresponding challenges, and propose tailored solutions to promote cervical cancer prevention in ASEAN. In 2020, approximately 69 000 cervical cancer cases and 38 000 deaths happened in ASEAN, and more than 44% and 63% increases on new cases and deaths are expected in 2040. Only four countries have initiated population-based cervical cancer screening programs, but the participation rate is less than 50% in some countries and even lower than 10% in Myanmar and Indonesia. Inequity and unavailability in service delivery, lack of knowledge and awareness, limited follow-up and treatment capacity, and funding sustainability affect successful scale-up of cervical cancer screening most in ASEAN. Implementing HPV detection-based primary screening, appropriate management of screen-positives, enhancing health education, integrating health services can accelerate reduction of cervical cancer burden in ASEAN. Achieving high screening coverage and high treatment compliance will help ASEAN countries remain aligned to cervical cancer elimination strategies.
Managing menopause after cancer

Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, et al.

Lancet, 2024 Mar 09;403(10430):984-996.
PMID: 38458217 DOI: 10.1016/S0140-6736(23)02802-7

Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
Fulltext Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update

Shastri SS, Temin S, Almonte M, Basu P, Campos NG, Gravitt PE, et al.

JCO Glob Oncol, 2022 Sep;8:e2200217.
PMID: 36162041 DOI: 10.1200/GO.22.00217

PURPOSE: To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally.
METHODS: American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus.
RESULTS: This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement.
RECOMMENDATIONS: Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.
Fulltext Towards elimination of cervical cancer - human papillomavirus (HPV) vaccination and cervical cancer screening in Asian National Cancer Centers Alliance (ANCCA) member countries

Ong SK, Abe SK, Thilagaratnam S, Haruyama R, Pathak R, Jayasekara H, et al.

Lancet Reg Health West Pac, 2023 Oct;39:100860.
PMID: 37576906 DOI: 10.1016/j.lanwpc.2023.100860

About 95% of cervical cancers worldwide are caused by human papillomavirus (HPV). Cervical cancer is preventable and curable if it is detected and treated early. We reviewed the latest national cervical cancer indicators, and barriers to HPV vaccination and cervical cancer screening in 21 Asian National Cancer Centers Alliance (ANCCA) member countries. Half (n = 11, 52%) of the countries have introduced HPV vaccination for girls as part of their national vaccination programme, three countries reported coverage of over 90%. Most ANCCA member countries have cervical cancer screening programmes, only five countries reported screening uptake of over 50%. The barriers to HPV vaccination coverage and cervical cancer screening participation have been identified. Ensuring health service accessibility and affordability for women, addressing sociocultural barriers, and strengthening the healthcare system and continuum of care are essential to increase HPV vaccination and cervical cancer screening coverage.