According to a new study by University of Illinois Chicago researchers, environmental quality is associated with advanced-stage prostate cancer at diagnosis.

Prostate cancer is up to 57 per cent heritable, with the remainder attributed to environmental exposures. However, studies on those environmental factors and prostate cancer aggressiveness have previously been limited. For their study, “Association between environmental quality and prostate cancer at diagnosis,” published in the journal Prostate Cancer and Prostatic Disease, researchers paired data from the environmental quality index, or EQI, and the Surveillance, Epidemiology and End Results Program, or SEER.

Study co-author Dr Michael Abern, associate professor and director of urologic oncology at the University of Illinois College of Medicine, said by combining the data from SEER and EQI, researchers found that lower environmental quality was associated with an advanced-stage prostate cancer diagnosis.

The EQI combines data from multiple sources and reports an overall quality index, as well as five subdomains: air, water, land, built and sociodemographic. The data is collected from sources such as Environmental Protection Agency air quality monitoring.

“When we drilled down further into the subdomains of the EQI, we found that some of the associations were stronger than others. Specifically, the land, water and sociodemographic domains seem to be driving the association more than air or built domains,” Abern said.

Additionally, areas with low-quality land, water and sociodemographic variables showed the strongest association with prostate cancer being diagnosed at a later stage, which can mean poorer treatment outcomes.

The study also found that race was an independent predictor of metastatic prostate cancer — cancer that has spread — at diagnosis, with Black men at higher risk. That risk is elevated more when coupled with living in an area with low environmental quality.

According to the study, there were more than 174,000 newly diagnosed prostate cancer cases and more than 31,000 prostate cancer deaths in the United States in 2019, making it the most common non-cutaneous (skin) malignancy in men. When diagnosed early, prostate cancer has a nearly 100 per cent five-year survival rate.

Though there have been other studies that explore environmental exposures, they often compare a single agent and individual exposure. Using the EQI and SEER offers a more comprehensive ecologic analysis to better represent environmental exposures and the relationship to advanced prostate cancer, the study states. Because the EQI also looks at sociodemographic variables, it takes health equity into account.

“They are actually measuring infrastructure and barriers to getting healthcare,” Abern said.

Abern said the study provides the ability to make hypotheses as to why late-state prostate cancer diagnoses are higher in certain areas, and then drill down into the components of the environmental variables to try to find solutions such as environmental policy changes.

It is well established that age and Black race are risk factors to develop prostate cancer in addition to genetic risk factors including family history. An important distinction can be drawn between incidence and aggressiveness, Abern said, and this study focuses on the aggressiveness of prostate cancer.

“When I see a patient with prostate cancer, they assume maybe they got it because of something they did. It is probably not. Not a lot is known about personal lifestyle choices that lead to prostate cancer. Diet, exercise and smoking have never had a very strong association with prostate cancer,” Abern said. “Seeing a doctor and getting screened is still the most important thing about getting diagnosed.”

Nearly half a billion people on the planet have diabetes, but most of them aren’t getting the kind of care that could make their lives healthier, longer and more productive, according to a new global study of data from people with the condition. Only 1 in 10 people with diabetes in the 55 low- and middle-income countries studied to receive the type of comprehensive care that’s been proven to reduce diabetes-related problems, according to the new findings published in Lancet Healthy Longevity. That comprehensive package of care – low-cost medicines to reduce blood sugar, blood pressure and cholesterol levels; and counselling on diet, exercise and weight – can help lower the health risks of under-treated diabetes. Those risks include future heart attacks, strokes, nerve damage, blindness, amputations and other disabling or fatal conditions. The new study, led by physicians at the University of Michigan and Brigham and Women’s Hospital with a global team of partners, draws on data from standardized household studies, to allow for apples-to-apples comparisons between countries and regions. The authors analyzed data from surveys, examinations and tests of more than 680,000 people between the ages of 25 and 64 worldwide conducted in recent years. More than 37,000 of them had diabetes; more than half of them hadn’t been formally diagnosed yet but had a key biomarker of elevated blood sugar.

The researchers have provided their findings to the WHO, which is developing efforts to scale up the delivery of evidence-based diabetes care globally as part of an initiative known as the Global Diabetes Compact. The forms of diabetes-related care used in the study are all included in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. “Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries,” says David Flood, M.D., M.Sc., lead author and a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation. “It confers a high risk of complications such as including heart attacks, blindness, and strokes. We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.” To lead the analysis of detailed global data, Dr Flood worked with senior author Jennifer Manne-Goehler, M.D., Sc.D., of Brigham and Women’s Hospital and the Medical Practice Evaluation Center at Massachusetts General Hospital. Key findings In addition to the main finding that 90% of the people with diabetes studied weren’t getting access to all six components of effective diabetes care, the study also finds major gaps in specific care.

For instance, while about half of all people with diabetes were taking a drug to lower their blood sugar, and 41% were taking a drug to lower their blood pressure, only 6.3% were receiving cholesterol-lowering medications. These findings show the need to scale up proven treatment to lower glucose and address cardiovascular disease risk factors, such as hypertension and high cholesterol, in people with diabetes. Less than a third had access to counselling on diet and exercise, which can help guide people with diabetes to adopt habits that can control their health risks further. Even when the authors focused on the people who had already received a formal diagnosis of diabetes, they found that 85% were taking a medicine to lower blood sugar, 57% were taking a blood pressure medication, but only 9% were taking something to control their cholesterol. Nearly 74% had received diet-related counselling, and just under 66% had received exercise and weight counselling. Taken together, less than one in five people with previously diagnosed diabetes were getting the full package of evidence-based care. Relationship to national income and personal characteristics In general, the study finds that people were less likely to get evidence-based diabetes care the lower the average income of the country and region they lived in. That’s based on a model that the authors created using economic and demographic data about the countries that were included in the study.

The nations in Oceania region of the Pacific had highest prevalence of diabetes-both diagnosed and undiagnosed — but the lowest rates of diabetes-related care. But there were exceptions where low-income countries had higher-than-expected rates of good diabetes care, says Flood, citing the example of Costa Rica. And in general, the Latin America and Caribbean region was second only to Oceania in diabetes prevalence but had much higher levels of care. Focusing on what countries with outsize achievements in diabetes care are doing well could provide valuable insights for improving care elsewhere, the authors say. That even includes informing care in high-income countries like the US, which does not consistently deliver evidence-based care to people with diabetes. The study also shines a light on the variation between countries in the percentage of cases of diabetes that have been diagnosed. Improve reliable access to diabetes diagnostic technologies is important in leading more people to obtain preventive care and counselling. Women, people with higher levels of education and higher personal wealth, and people who are older or had high body mass index were more likely to be receiving evidence-based diabetes care. Diabetes in people with “normal” BMI is not uncommon in low- and middle-income countries, suggesting more need to focus on these individuals, the authors say.

As per a new report, studies show that maintaining good oral hygiene can help you overcome Covid-19, implying that there is a direct connection between oral hygiene and the deadly infection. This report was published in the US’s leading organisation of periodontists, the American Academy of Periodontology (AAP). Dr James G. Wilson, President of the AAP, mentioned in the report, “It is well-established that systemic inflammation is not only linked with periodontal disease but to several other respiratory diseases as well.

Therefore, maintaining healthy teeth and gums in an effort to avoid developing or worsening periodontal disease is absolutely crucial in the midst of a global pandemic like Covid-19, which is also known to trigger an inflammatory response.” Furthermore, a report by McGill University in Montreal, Canada, found a direct link between gums with inflammation and infection and even connected how oral hygiene can play a role in aggravating Covid-19 complications and even lead to deaths. According to this study, people that have gum issues or periodontitis are 8.8 times more likely to die of Covid-19. Not just this, such people are 3.5 times more likely to require hospitalisation for Covid-19 and 4.5 times more likely to require a ventilator. It has also come to light that oral health plays a pivotal role even in the Covid post-recovery period. Shedding more light on this, Dr Mohendar Narula, Founder and Chairman of MyDentalPlan Healthcare Pvt. Ltd. said, “Taking care of your gums and oral hygiene was always vital but it has become even more significant during this pandemic.

In this second wave of Covid-19, oral symptoms are on the rise.” Talking about maintaining gum health, he continued, “However, maintaining optimum gum health with simple steps such as brushing twice a day, tongue cleaning, flossing and gargles can help people combat these life-threatening diseases even better. Furthermore, professional dental cleanings twice a year and regular dental check-ups are known to minimize the severity of Covid-19 and the associated complications.” Adding to it Dr Narula said, “The second wave of Covid-19 is also witnessing Mucormycosis, a deadly fungal infection affecting the gums, teeth and the peri-oral area, developing as a post-Covid complication among immunocompromised individuals with poor gum and oral health status. It has now come to light that taking care of oral hygiene can also help people safeguard themselves even from this post-Covid-19 complication.” Oral care should be a part of health recommendations for every individual and its importance has increased significantly during this pandemic.

Can cancer patients take Covid-19 vaccines?    

A. The Covid-19 pandemic, caused by the SARS-CoV-2 virus, continues to have a serious impact on many people, including cancer patients, their families, and caregivers. Due to frequent hospital visits and increased exposure, vaccination for cancer patients has become imperative now. Individuals with cancer sadly have a higher risk of severe Covid infection because of their age, the disease, cancer treatment and medical comorbidities.

Currently, vaccination for cancer patients has been recommended for all people with cancer and blood malignancies. These vaccines can be taken as long as the components of the vaccine suit the patient even while their immunity is down. However, the following points to be noted –

· These vaccines should not be taken if they do not suit one’s body (like known allergic reaction, which is a contraindication) 

· There could be an unknown safety situation which can rarely cause a problem

· Effectiveness may not be as much as in the general population due to a less immune reaction. Here the vaccine is given to give whatever benefit possible and with the intent to reduce the severity of Covid-19 infection if it happens.

Q. When to start and which are the most preferred vaccines for cancer patients? Can the vaccination lead to a change of plans in the cancer treatment of the patients? 

A. While starting your programme of vaccination, It is important to discuss with your oncologists and plan strategies for taking vaccines between the cycles of chemotherapy, targeted therapy and immunotherapy. It is recommended to take any of the available vaccines as long as the blood counts are acceptable.

Cancer patients who are undergoing major surgery should ideally wait for a few days before going for vaccination. The best time for such patients to get vaccinated is before treatment, optimally 2 weeks before the start of chemotherapy. Furthermore, patients who have opted for radiotherapy can start their vaccination program anytime. Patients undergoing immunotherapy should opt. for vaccination at the earliest as toxicities and reaction can be severe if the Covid infection happens along with chemotherapy/immunotherapy.

Other than the appropriateness and timing of the vaccination, there are no changes that the vaccination causes in the plan for cancer therapy. Vaccination can be recommended one week from the start of the chemotherapy cycle.

Q. How long does immunity last?

A. The expected immunity usually develops in 2-3 weeks after the second dose of the vaccine and is effective beyond six months. As the vaccines and vaccination programmes are relatively new. We are still awaiting further data on whether or not the immunity lasts beyond six months. However, considering the current scenario, where comorbid patients are at an increased risk of contracting the Covid virus, vaccination is strongly recommended for all such patients. Cancer patients who have also recovered from Covid-19 can also undergo vaccination without the fear of any complications.

Q. What are the concerns of vaccination with regards to cancer patients?

A. A major concern is an uncertainty in the level of effectiveness of vaccination when immunity comes down during treatment. However, any level of effectiveness is better than status without Covid-19 vaccination. Lymphoma patients can have lower vaccine responses as we do not know precisely the efficacy of the Covid vaccine for lymphoma when on active treatment. For cancer patients, despite the vaccination, it is essential to continue the practice of wearing a mask, social distancing, and maintaining hand hygiene as they are already immune-compromised and chances of re-infection are also high among them.

Q. Is the Covid-19 vaccine safe in bone marrow transplants?

A. Covid-19 vaccination is recommended at least two to four weeks before the planned transplant. We recommend most of the transplant patients to delay all vaccines for at least three months following a stem cell or bone marrow transplant.

Q. What are the vaccine’s side effects?

A. Currently, serious side effects are rare and compared to the benefit of protection, it would be negligible. However, common side effects of vaccines are pain at the injection site, tiredness, headache, muscle pain, and fever. Chills, joint pain, nausea, injection site redness and swelling, swollen lymph nodes.

Q. Can one get ill with Covid-19 after vaccination?

A. It is possible that one can get sick post receiving a vaccine, but the good news is that it is likely to be less severe and people may not require hospitalisation in such cases.

The writer is Lead & Sr Consultant—Medical Oncology & Haematology, Aster CMI Hospital.

In a conversation with NewsX on Friday, Maharashtra Health Minister Rajesh Tope said that thehealthcare experts are actively studying real medication for black fungus and they will hopefully be able to cope with it. There are close to 1,500 cases of black fungus in Maharashtra and thus the state task force is actively monitoring the situation.

Q. Positivity rates in Maharashtra are declining but not the death rates. What do you think is the reason behind it? 

Our recovery rate has improved and so has the positivity rate. Some people are still not taking any precautions, I would urge them not to repeat such mistakes. Everyone must take all the required precautions.  

Q. How is the state is ensuring the stop of spread in rural areas?  

We are vaccinating people in full strength. If the Government of India will provide us with a sufficient amount we will do it better. We didn’t get vaccines as per our population due to which we are lacking behind. I would urge the Centre to provide us with the required amount of vaccines.  

Q. Has Maharashtra issued global tenders for vaccines? 

We have done that but didn’t get any response. It has happened maybe because of the complexity of norms implemented and if it’s eased in future then only foreign companies will approach us to sell their vaccines. There should be one uniform tender at a national level for smooth coordination and to lure foreign companies.  

Q. How is the state dealing with the cases of Black Fungus?  

People who fail in controlling their blood sugar and take steroids are prone to this disease. Our healthcare experts are actively studying real medication for this fungus and we will hopefully be able to cope with it. We have close to 1500 cases of Black Fungus due to which our state task force is actively monitoring the situation. Hospitals are being specifically designated for the same and I would urge the public to follow the guidelines to avoid the spread of Black Fungus.   

Q. How are you preparing for the third wave which is more dangerous for kids?  

We are discussing with doctors, analysts and researchers in different ways so that we can easily handle the third wave. Various experiments are being done to ensure immunity for kids and children. We are also educating parents to stay positive if their kids face symptoms and immediately approach the doctors.

Punjab Health and Family Welfare Minister Balbir Singh Sidhu joined NewsX on Friday for a conversation and informed that the state does not have many cases of black fungus but they have already started preparations on a war-footing manner to stop the spread before things go beyond control.  

Excerpts:

Q. Why do you think that in every state the positive rate is declining but not the death rates? People are alleging that states are hiding real facts. How Punjab is doing on this front?  

There is no such discrepancy happening in Punjab, we have ensured fair testing and recoveries. The second wave has been tough for us all due to which a lot of people are having a hard time. We have ensured testing on the ground level and followed up well to make sure that people don’t have side effects. Even in rural areas, people are asked to get involved in the process of vaccination and testing.  

Q. How is the state dealing with Black Fungus?  

Punjab does not have many cases of Black Fungus. We have already started preparations on a war footing manner to stop the spread before things go beyond control.  

Q. Are you considering announcing Balck Fungus as an epidemic? 

Yes, we have done that.  

Q. What do you think is the reason behind the shortage of vaccines? Do you think the coordination between the Centre and states is the real issue?  

We had to shut down so many vaccine centres because of the same reason. And to tackle the issue we have released global tenders so that private and international players can directly approach us.  

Q. How is the state ensuring to decrease the spread of the virus in villages? 

We are doing door-to-door vaccination in rural areas and educating them about the same. We have asked communities to come forward and cooperate with the state government. 

Q. How are you preparing for the third wave of Covid-19 which is expected to be more harmful to children? 

We have already informed our healthcare experts to prepare and convey the guidelines for the same. Our teams are working on the ground so that we can cope up with the third wave.