Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis

BACKGROUND

The use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano.

METHODS

MEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates.

RESULTS

After screening 661 citations, 29 studies were included. Overall, 1513 patients undergoing CS (18.8% female, mean age: 43.1 years) were included. Patients with CS had a 6% (95% CI: 3-12%) risk of recurrence and a 16% (95% CI: 5-38%) risk of incontinence at 6 months. CS patients had an average healing time of 14.6 weeks (95% CI: 10-19 weeks) with 73% (95% CI: 48-89%) of patients achieving complete healing at 6 months postoperatively. There was no difference in recurrence between CS and fistulotomy, advancement flap, two-stage seton fistulotomy, or draining seton.

CONCLUSIONS

Overall, this analysis shows that CS has comparable recurrence and incontinence rates to other modalities. However, this may be at the expense of more postoperative pain and extended healing time. Further comparative studies between CS and other modalities are warranted.

Tolerability of Metastasis-Directed Stereotactic Body Radiotherapy with Short-Course Triple-Agent Androgen Annihilation Therapy in Recurrent Oligometastatic Prostate Cancer: Secondary Analysis of a Phase II Study

PURPOSE/OBJECTIVE(S)

A majority of patients with oligometastatic prostate cancer experience relapse within 12 months of metastasis-directed therapy. Intense, triple-agent androgen annihilation therapy (AAT) with leuprolide, abiraterone acetate plus prednisone (AAP), and apalutamide may improve efficacy, but long courses of AAT have been shown to be associated with increased rates of grade≥3 toxicity. The purpose of this secondary analysis of this study is to characterize the tolerability of a short, six-month course of AAT added to metastasis-directed therapy.

MATERIALS/METHODS

All 28 patients enrolled on this phase II study were included in this analysis. All patients had oligometastatic prostate cancer after initial radical prostatectomy, defined by the presence of 1-5 extrapelvic metastases on prostate-specific membrane antigen (PSMA) PET/CT. Patients were started on six months of AAT. After the first month, patients received stereotactic body radiotherapy (SBRT) in 1, 3, or 5 fractions to metastases with or without radiotherapy to the prostate bed and pelvic lymph nodes. Physician-scored toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0.

RESULTS

Median follow-up time was 11.4 months. Twenty patients (71.4%) completed AAT with all three agents. Six patients (21.4%) completed six months of therapy but discontinued at least one agent [4 patients (14.3%) discontinued apalutamide, 1 patient (3.6%) discontinued AAP, and 1 patient (3.6%) discontinued both apalutamide and AAP]. Two patients (7.1%) withdrew from the trial due to adverse events and did not complete therapy. Grade 2 and grade 3 toxicity rates from AAT were each 21.4%. Of the 6 cases of grade 3 toxicity, 3 were skin rashes, 2 were hypertension, and 1 was hepatic toxicity. At the time of SBRT, 1 patient had withdrawn from the study and 1 patient declined radiation therapy. All 26 remaining patients completed SBRT. Grade 2 and grade 3 toxicity rates from SBRT were 7.7% and 0%, respectively.

CONCLUSION

A majority of patients were able to tolerate and complete AAT in combination with metastasis-directed SBRT. Some patients experienced acute grade 3 toxicities, the most common being drug-related skin rashes and hypertension. While efficacy data are needed to evaluate the oncologic benefit, these data suggest a short course of AAT is considerably better tolerated than longer courses of AAT, with grade 3 toxicity rates similar to long courses of single-agent androgen deprivation therapy alone.

Prevalence of diabetes distress and cross-cultural reliability of DDS-17 scale in rural Haryana

Background

Diabetes distress associated with diabetes is an important under-appreciated domain of diabetes management. The aim of the study is to assess the prevalence of diabetes distress among T2DM patients in Jhajjar district of Haryana, using widely accepted DDS-17 scale along with testing the scale's reliability through Cronbach's α.

Material and Methods

This observational study with cross-sectional design was carried out among 503 T2DM patients in district, Jhajjar, Haryana. DDS-17 scale was used for diabetes distress assessment. Data entry and analysis were performed using appropriate software.

Results

37.97% subjects had diabetes distress either in moderate (DDS-17 Score ≥2) or severe (DDS-17 Score ≥3) form. English version of DDS-17 scale showed good internal consistency reliability (α = 0.79).

Conclusions

This study conclusively showed that diabetes distress is very common among T2DM patients as more than one third of the T2DM patients had diabetes distress and diabetes distress scale (DDS-17) is an easy, well-accepted questionnaire with good reliability.

Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation

Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology  This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study group in the first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.

Epidemiological Profile and Spatio-Temporal Pattern of Infant Deaths in a District of North India during 2016-2019

Background

Infant mortality is an important health indicator of a population given its strong link to socioeconomic status, health service access, and quality and maternal health. The declining trend of Infant Mortality Rate has been observed in India where it reduced from 89 deaths per 1000 live births in 1990 to 28 deaths per 1000d live births in 2019. Most of the studies regarding the trend of infant mortality are state-based, however, state-level infant mortality has masked the intradistrict clustering of individual infant deaths. Hence, this study was planned with an objective to study the trend of infant mortality at the district level.

Material and Methods

A retrospective study was conducted in the district Rohtak of Haryana using the data collected regarding infant deaths. The collected data regarding addresses were geocoded. The resulting layer was then analyzed using QGIS v3.10. The descriptive data was analyzed using SPSS v20.0.

Result

In total, 1336 infant deaths during the study period were included. A declining trend of infant mortality was observed over the study period. The number of grids (25 km2) reduced from 18 in 2016 to 10 in 2019 depicting a reduction in the areas with more than expected count.

Conclusion

This study emphasizes on the importance of using the geographic information science technique in identifying local hotspots within the district so as to find areas that need more support and observation.

Pretreament neutrophil-lymphocyte ratio (NLR): A felicitous prognostic marker in carcinoma lung

BACKGROUND

Mechanics of inflammation and oncogenesis are intertwined with each other. Thus, the role of inflammatory markers like neutrophil-lymphocyte ratio (NLR) as a foreteller of lung carcinoma is retrospectively appraised in this study.

MATERIAL AND METHODS

Retrospective assessment of hospital records of carcinoma lung patients was done between January 2018 and January 2020 and pretreatment NLR was calculated. Median NLR was taken as cut off and thereafter correlation was studied between pretreatment NLR and overall survival, using Kaplan-Meier survival analysis. Cox regression analysis was applied to identify factors affecting survival.

RESULTS

Study population included 135 eligible patients with median age of 60 years and male to female ratio of 8.6:1. 47.41% patients were of stage III and 52.59% patients belonged to stage IV. The duration of follow-up ranged between 0.5 and 22 months. Median NLR was 3.1 (range, 0.90-11.25) and median overall survival in patients with NLR <3.1 and ≥3.1 was 6 months versus 3 months, respectively (P-value = 0.001). NLR value in nonsmall cell and small cell lung cancer was analyzed separately and showed significant variation in median survival in nonsmall cell lung cancer patients only (P-value = 0.001).

CONCLUSIONS

Study results summarized that pretreatment NLR can be taken as a cheap and easily available predictor of prognosis in carcinoma lung cases and more so in nonsmall cell lung carcinoma cases. Large prospective trials are warranted to further potentiate this fact.

Epidemiological profile and management practices of animal bite cases in a tertiary care hospital of Haryana: A cross-sectional study

Introduction

Rabies is one of the oldest and deadliest diseases known to man. After the clinical occurrence of rabies, there is no comprehensive treatment possible. However, the development of rabies can be prevented to a large extent if animal bites are managed appropriately and in time. The post-exposure treatment of animal bite cases is of prime importance in this regard. India has the highest burden of animal bite and rabies cases in the world. This imposes a substantial burden on the healthcare delivery services of the country.

Materials and Methods

This was a cross-sectional study conducted in the immunization clinic of a tertiary care hospital in Haryana from January 2018 to December 2018. A total of 614 cases were interviewed using a pre-designed, pre-tested, and semi-structured interview schedule.

Results

Around 80.5% of the bites were inflicted by stray animals, among which 70% of cases were by stray dogs. Precisely, 97.7% of cases took anti-rabies vaccine and 96.6% of cases took Tetanus Toxoid. 204 (33.2%) of victims were category III cases, who needed local infiltration of immunoglobulin but only 46% of them got it. The association of time lag between bite and reporting to the first health facility with socio-economic status, residence, and education was found to be statistically significant.

Conclusion

To conclude it was observed that proper wound management practices were lacking in the people of the study area and there is a need to strengthen the availability of provision of free-of-cost life-saving immunoglobulin at the health facility, under the rabies control program.

Socio demographic determinants of violence among school-going adolescent girls in a rural area of North India: A cross-sectional study

Background:

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”.[1] Violence can take many forms, including physical, sexual or emotional and varies in its severity. Gender discrimination, norms and practices mean that adolescent girls are likely to experience certain forms of violence, such as sexual violence, at much higher rates than boys.

Methods:

This cross-sectional study was conducted in a rural block of North India. A total of 500 adolescent girls in the age group of 13–19 years studying in class VIII to class XII in 10 government and private senior secondary schools of the Lakhanmajra block were included in the study. A pre-designed pre-tested semi-structured interview schedule was used.

Results:

In this study, we found the prevalence of physical, sexual and emotional violence among adolescent girls as 6.6, 5.4 and 5.2%, respectively. The most frequent perpetrator of physical violence was the parent and of sexual violence was the neighbour followed by friends or relatives. Higher emotional violence was experienced by adolescent girls from middle-class families (P < 0.05). The prevalence of physical violence among adolescent girls was maximum in the younger age group 13–14 years (10.2%), followed by 15–17 years (4.0%). This association was found statistically significant (P < 0.05).

Conclusions:

There are several restrictions on free communication about violence-related topics in our highly conservative society. Blaming the victim is the rule rather than the exception and sexual abuse is usually linked to a loss of virginity and family honour in our patriarchal society. Hence, girls may be more reluctant to disclose their experience of violence.

Association of psychosocial factors with aggression among school going rural adolescents in Haryana

Background:

Adolescents are being involved in aggressive activities nowadays. Sometimes, involvement in aggressive activities may be fatal for the victim as well as for the doer. It is a matter of great concern for all including parents, teachers, psychologists, social reformers, and others. A momentary expression of anger sometimes may spoil the future life of the adolescents.

Aim and Objectives:

To determine the prevalence of aggression and to identify the psychosocial risk factors associated with aggression among school-going adolescents.

Methodology:

The study recruited 480 school-going rural adolescents from eight government senior secondary schools in the rural block of Beri, district Jhajjar (Haryana).

Observations:

The mean age of the adolescents was 14.11 ± 1.12 years; 49.4% of the adolescents were found to be aggressive. After applying binary logistic regression, there was a statistically significant relation between aggression and determinants like class, gender, occupation of the father.

Conclusion and Recommendations:

The study concluded that determinants like age, class of students, gender of the subject, occupation of father found a significant association with aggression. To solve this current situation, parents must give love, attention to their children and must act in an appropriate way in front of them and be role models.

Burden of Silicosis among stone crushing workers in India

BACKGROUND

In North India, the mining industry is disorganized and profit-driven. It predisposes its workers towards the development of silicosis. Haryana, a major North Indian state, has developed a compensation-rehabilitation policy for mining workers.

AIMS

This study is the review of the policy's functioning and limitation from the first 4 years of implementation.

METHOD

The labour department does surveillance of workers in the mining industry. All suspected cases of silicosis are evaluated by a multidisciplinary team. Based on the final diagnosis, the compensation is decided.

RESULT

Nearly 5000 workers were screened, and 729 appeared before the medical board. Of these 729, 465 were having silicosis, and their data are presented here (data of 7 patients were missing). All workers were males. The mean age was 44.54 ± 9.6 years, and the mean exposure (work experience) was 17.25 ± 6.7 years. Most of the workers were between the age of 40 and 50 years and had exposure for 10-20 years. Chest radiography examination showed that progressive massive fibrosis (large size type C opacities) was the most common type of presentation (23%). Smaller opacities (p, q, r and s, t, u) were combined for further analysis, given their similar prognostic significance. It was found that age and experience both had a linear and significant correlation with the severity of lung involvement.

CONCLUSIONS

Nearly a quarter of subjects were suffering from the worst type of lung involvement at screening itself. The policy has laid a foundation for the welfare of workers, but there is still a long way to go.

SDH-deficient renal cell carcinoma: a clinicopathological analysis highlighting the role of genetic counselling

Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) accounts for 0.05-2% of all RCCs. The majority of patients have germline mutations, most frequently in the SDHB gene. People with these mutations are predisposed to developing paragangliomas, phaeochromocytomas and gastrointestinal stromal tumours. Patients should be referred to genetic services for further workup and close surveillance imaging due to the risk of development of further tumours. We present a woman with SDH-deficient RCC and review the literature associated with this uncommon entity.

Association between the socioeconomic determinants and soil-transmitted helminthiasis among school-going children in a rural area of Haryana

Background:

WHO indicates that India has the highest burden of soil-transmitted helminthiasis (STH) in the world, contributing to 25% of the total global cases, with 220 million children aged 1–14 estimated to be at risk.

Aim and Objective:

To study the association between the socioeconomic factors and STHs among primary school children in a rural area of Haryana.

Methodology:

The study was conducted among children aged 6–10 years studying in the rural government primary schools in the rural areas of Haryana. A total of 300 children were enrolled from government school.

Results:

The study found that the prevalence of helminthiasis was 28.7% (86/300) and of these 14.0% children were infected with Ascaris lumbricoides and sex wise association with Helminthic infection was observed as statistically nonsignificant. One third of the (31.39%; 27/86) children were pallor and 5.81% subjects were having Bitot's spot while 13.95% children were having constitutional symptoms such as weakness, 6.97% subjects have fatigue, and 5.81% children have body ache.

Discussion:

The morbidity can be reduced with appropriate inputs to improve the environmental factors. This may need investment for sanitary latrines, food hygiene, and safe drinking water, anti-helminthic drugs, and health education.

Conclusion and Recommendations:

The results of the study concluded and recommended that proper implementation of national deworming day and other long-term strategies like sanitation, clean drinking water, adequate sanitation, and also improvement in nutritional status through various nutritional health programmes.

Electrical and structural properties of multi-walled carbon nanotube–doped polymer electrolyte for photo electrochemical device

The present investigation deals with the preparation of multi-walled carbon nanotube (MWCNT)-doped plasticized polymer electrolyte. The nanocomposite has been prepared using solution casting method. Complex impedance spectroscopy study revealed the utmost room temperature conductivity of 5.6 × 10−4 S/cm when optimized plasticized polymer electrolyte (poly(ethyl methacrylate)+30% sodium iodide+60% ethylene carbonate) was doped with 7% MWCNT. Temperature dependence of conductivity showed Arrhenius behavior. The surface morphology and crystalline–amorphous deviation of the composite was observed using scanning electron microscope. Perfect complexation of various components of the composite was confirmed from Fourier-transform infrared spectroscopy and X-ray diffraction (XRD) data. The transference number measurement was done to calculate the proportionate amount of ionic and electronic conductivity. A dye sensitized solar cell has been fabricated using maximum ionic conductivity of solid polymer electrolyte and its electrical parameters measured at 1 sun condition.

A novel thermal detection method based on molecularly imprinted nanoparticles as recognition elements

Molecularly Imprinted Polymers (MIPs) are synthetic receptors that are able to selectively bind their target molecule and, for this reason, they are currently employed as recognition elements in sensors. In this work, MIP nanoparticles (nanoMIPs) are produced by solid-phase synthesis for a range of templates with different sizes, including a small molecule (biotin), two peptides (one derived from the epithelial growth factor receptor and vancomycin) and a protein (trypsin). NanoMIPs are then dipcoated on the surface of thermocouples that measure the temperature inside a liquid flow cell. Binding of the template to the MIP layer on the sensitive area of the thermocouple tip blocks the heat-flow from the sensor to the liquid, thereby lowering the overall temperature measured by the thermocouple. This is subsequently correlated to the concentration of the template, enabling measurement of target molecules in the low nanomolar regime. The significant improvement in the limit of detection (a magnitude of three orders compared to previously used MIP microparticles) can be attributed to their high affinity, enhanced conductivity and increased surface-to-volume ratio. It is the first time that these nanosized recognition elements are used in combination with thermal detection, and it is the first report on MIP-based thermal sensors for determining protein levels. The developed thermal sensors have a high selectivity, fast measurement time (<5 min), and data analysis is straightforward, which makes it possible to monitor biomolecules in real-time. The set of biomolecules discussed in this manuscript show that it is possible to cover a range of template molecules regardless of their size, demonstrating the general applicability of the biosensor platform. In addition, with its high commercial potential and biocompatibility of the MIP receptor layer, this is an important step towards sensing assays for diagnostic applications that can be used in vivo.

Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey

OBJECTIVE

To assess the quality of maternity care in an Indian metropolitan city.

STUDY DESIGN

Three-stage cluster randomised cross-sectional survey.

SETTING

Sixty selected colonies of Delhi.

POPULATION

One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses. Women who had delivered a live viable birth in the past 6 months were selected for the study.

METHODS

In stage 1, 20 wards (of 150) were selected using a probability-proportionate-to-size systematic method. In stage 2, one colony from each income stratum (high, middle and low) was selected from each ward by simple random sampling. In stage 3, a house-to-house survey was conducted to recruit 30 women for administering a peer-reviewed and pilot-trialled questionnaire.

MAIN OUTCOME MEASURES

Caesarean section rate, induction rate and episiotomy rate.

RESULTS

National health targets such as iron supplementation advice (>96%), tetanus vaccination (>81%), and ≥3 antenatal visits (>90%) were largely achieved across health care facilities but not in home deliveries. Interventions were lower in public than private hospitals: caesarean section [23.7% (20.2-27.7) versus 53.8% (49.3-58.3)], induction [20.6% (17.5-24.25) versus 30.8% (26.8-33.2)] and episiotomy [57.8% (52.3-63.1) versus 79.4% (71.0-85.9)]. Private hospitals achieved better labour support rates [1.1% (0.5-2.2) versus 14.6% (8.5-24.1)] and pain relief [0.9% (0.4-2.0) versus 9.9 (6.5-14.8)]. Pubic hair shaving [16.2% (11.5-22.5) versus 36.4% (29.9-43.4)], enema [20.2% (15.5-26.0) versus 57.3% (49.5-64.8)], and IV fluids during labour [44.0% (36.2-52.2) versus 38.7% (29.3-49.1)] were widely prevalent in public and private hospitals.

CONCLUSION

Present practices fall short of evidence-based guidelines, with relative overuse of interventions in private hospitals and deficiency of patient-centred practices such as labour support in public hospitals.

Meta-analysis: efficacy of bovine lactoferrin in Helicobacter pylori eradication

BACKGROUND

Several randomized-controlled trials (RCTs) have sought to determine the efficacy of bovine lactoferrin in Helicobacter pylori eradication with equivocal results.

AIM

To evaluate the effect of bovine lactoferrin supplementation in H. pylori eradication.

METHODS

Electronic databases, reviews, bibliographies, abstracts and conference proceedings were searched. Included trials had to be randomized or quasi-randomized and controlled, using bovine lactoferrin in the intervention group, treating Helicobacter-infected subjects and evaluating eradication of H. pylori as an outcome.

RESULTS

The search identified five eligible RCTs (of 169). Data were available for 682 subjects (bovine lactoferrin group-n = 316; control group-n = 366). The pooled odds ratio (five studies) for eradication by intention-to-treat analysis was 2.22 (95% CI 1.44-3.44; P = 0.0003) using the fixed effects model (FEM) and 2.24 (95% CI 1.15-4.35; P = 0.0003) using the random effects model (REM) (Cochran's Q = 6.83; P = 0.145). The pooled risk difference was 0.11 (95% CI 0.05-0.16; P = 0.0001) by FEM (Cochran's Q = 6.67; P = 0.154) and 0.10 (95% CI 0.04-0.17; P = 0.0023) by REM. There was no significant difference in incidence of adverse effects.

CONCLUSION

Bovine lactoferrin potentially improves H. pylori eradication rates without any impact on adverse effects, but available evidence is limited and further research is necessary to confirm the findings.

Elevation of carbohydrate antigen 19.9 in benign hepatobiliary conditions and its correlation with serum bilirubin concentration

BACKGROUND

Carbohydrate antigen 19.9 (CA19.9), a tumor marker for malignancies of the hepatobiliary tract and pancreas, has frequently been shown to be deranged in a number of non-malignant conditions that are associated with jaundice. This study aims to demonstrate the correlation between CA19.9 and serum bilirubin concentration in patients with benign conditions and to determine the frequency of a false-positive increase in CA19.9 in patients being investigated for potential HPB malignancies.

METHODS

This is a retrospective review of 83 consecutive patients presenting with an abnormal CA19.9 and radiological or clinical features suggestive of HPB malignancy subsequently shown to have benign disease. All patients were thoroughly investigated and followed up until the diagnosis of malignancy could be safely excluded.

RESULTS

Serum bilirubin, sodium, lymphocyte count, neutrophil:lymphocyte ratio (NLR), beta-human chorionic gonadotrophin (HCG), and age were found to correlate with CA19.9 by Pearson's correlation (P = 0.001, P = 0.006, P = 0.006, P < 0.001, P = 0.012, and P = 0.049, respectively). In multivariate regression analysis, bilirubin was identified as an independent variable that may predict CA19.9 level (P = 0.028).

CONCLUSION

CA19.9 level is significantly influenced by serum bilirubin and elevated levels have been observed in patients with non-malignant HPB conditions. Adjusting CA19.9 according to bilirubin levels is likely to improve the specificity of this antigen in the differential diagnosis of benign and malignant HPB diseases and its reliability in the monitoring of disease response to chemotherapy.

Linking diet, religion and cancer

21172

Background: Consumption of onion and garlic has been shown to give protection against various cancers. Motivated by this observation we intended to look at the cancer incidence in a population belonging to Jain religion that does not consume garlic and onion due to religious belief. This study was done to see cancer incidence in children of Jain religion as compared to other religions at a single centre. Methods: It was a retrospective analysis of consecutive children less than 16 years of age diagnosed with cancer at Sir Ganga Ram Hospital from January 2005 to January 2007. We excluded adult patients with cancer as tobacco and alcohol consumption in this age group would have been confounding factors.Age, sex and religion were noted. Data from Census of India for year 2001 was used to know distribution of various religions in general population alongwith literacy rates and proportion in 0–6 years age. Results: As per 2001 Census of India , distribution of population in India as per various religions is Hindu 80.5%, Muslim 13.4%, Christian 2.3%, Sikh 1.9%, Buddhist 0.8% , Jain 0.4% and others 0.6%. Proportion of population in 0–6 year of age in India is 15.9% and as per religions Hindu 15.6%, Muslim 18.7% ,Christian 13.5%, Sikh 12.8%, Buddhist 14.4% and Jain 10.6%. Literacy rates of India is 64.5% and by religion is Hindu 65%, Muslim 59.1% Christian 80.3%, Sikh 69.4%, Buddhist 72.7% and Jain 94%. Distribution of population in Delhi as per various religions is Hindu 82%, Muslim 11.7%, Christian 0.9%, Sikh 4%, Buddhist 0.2% and Jain 1%. Total of 201 patients were diagnosed with cancer and distribution as per religions was Hindu 162 (81%), Muslim 15 (7.5%), Christian 3 (1.5%), Sikh 8 (4%), Buddhist 1 (0.05%) and Jain 12 (6%). Conclusions: Incidence of cancer in children of different religions is similar to that of proportions of population of different religions in Delhi except for Jain religion where incidence of cancer is 6 times higher despite lesser number children in 0–6 year in this population as compared to other religions . Major difference is the diet lacking in onion and garlic . Other reason could be increased literacy levels in Jain community . This link between diet ,religion and cancer in Jain population needs to be studied in a larger muticenteric setting as it has implications for the whole world.

No significant financial relationships to disclose.

Formation of Silver Nanoparticles in Poly(perfluorosulfonic) Acid Membrane

The formation of silver nanoparticles by chemical reduction of Ag+-loaded Nafion-117 membrane with NaBH4 was studied using radioactivity tagged ions. The counterion-exchange method (Ag(m)+ <--> Na(s)+) was used to obtain a membrane sample with a varying proportion of Ag+ ions. The X-ray elemental mapping across the thickness of the membrane by energy-dispersive X-ray spectrometer attached to the environmental scanning electron microscope (ESEM/EDAX) indicated that Na+ and Ag+ were uniformly distributed in the membrane samples before reduction. The average size of nanoparticles formed after reduction was found to be 15 +/- 3 nm, irrespective of the concentration of silver ions present in the membrane before reduction. Energy-dispersive X-ray fluorescence (EDXRF) analyses of the membrane samples, carried out before and after reduction, indicated that the Ag concentration on the membrane surface was considerably increased after reduction. EDXRF measurements of the membrane samples, obtained from reduction carried out in a dead end cell, indicated that Ag nanoparticles were formed only on the membrane surface exposed to NaBH4 solution. Reduction carried out with NaBH4 tagged with 22Na showed that the formation of Ag nanoparticles involved exchange of Ag+ ions from ion-exchange sites in the interior of the membrane with Na+ ions, followed by reduction of Ag+ ions with BH4- ions at the surface of membrane. The study of self-diffusion of water, Na+, and Cs+ ions in the membrane loaded with Ag nanoparticles indicated that formation of Ag nanoparticles did not affect the diffusional transport properties of the membrane. The ion-exchange capacity and water uptake capacity were also not affected by the formation of Ag nanoparticles in the membrane. The spatial distribution of Ag nanoparticles across the thickness of the membrane obtained by ESEM/EDAX showed that Ag nanoparticles were confined to a few-micrometer surface layer of the membrane. Based on these observations, an attempt has been made to explain the mechanism of the formation of Ag nanoparticles in the membrane.