Pediatric Cancer Burden in Different Regions of India: Analysis of Published Data From 33 Population-Based Cancer Registries

Objective:To provide the regional pediatric cancer (age-group 0-14 years) burden and pattern in India utilizing published data of population-based cancer registries established under the National Cancer Registry Programme and Tata Memorial Centre, Mumbai. Methods:Based on the geographic locations, the population-based cancer registries were categorized into six regions. The age-specific incidence rate was calculated using the number of pediatric cancer cases and population in the respective age-group. Age-standardized incidence rate per million and 95% CI were calculated.Results: In India, 2% of all cases were pediatric cancer. The agestandardized incidence rate (95% CI) for boys and girls is 95.1 (94.3-95.9) and 65.5 (64.8-66.2) per million population, respectively. Registries from northern India reported the highest rate; while the lowest rate was in northeastern India. Conclusion:There is a need to establish pediatric cancer registries in different regions of India to know the accurate pediatric cancer burden.

Trends of humoral immune responses to heterologous antigenic exposure due to vaccination & omicron SARS-CoV-2 infection: Implications for boosting

Background & objectives: Vaccination and natural infection can both augment the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but how omicron infection has affected the vaccine-induced and hybrid immunity is not well studied in Indian population. The present study was aimed to assess the durability and change in responses of humoral immunity with age, prior natural infection, vaccine type and duration with a minimum gap of six months post-two doses with either ChAdOx1 nCov-19 or BBV152 prior- and post-emergence of the omicron variant. Methods: A total of 1300 participants were included in this observational study between November 2021 and May 2022. Participants had completed at least six months after vaccination (2 doses) with either ChAdOx1 nCoV-19 or an inactivated whole virus vaccine BBV152. They were grouped according to their age (? or ?60 yr) and prior exposure of SARS-CoV-2 infection. Five hundred and sixteen of these participants were followed up after emergence of the Omicron variant. The main outcome was durability and augmentation of the humoral immune response as determined by anti-receptor-binding domain (RBD) immunoglobulin G (IgG) concentrations, anti-nucleocapsid antibodies and anti-omicron RBD antibodies. Live virus neutralization assay was conducted for neutralizing antibodies against four variants – ancestral, delta and omicron and omicron sublineage BA.5. Results: Before the omicron surge, serum anti-RBD IgG antibodies were detected in 87 per cent participants after a median gap of eight months from the second vaccine dose, with a median titre of 114 [interquartile range (IQR) 32, 302] BAU/ml. The levels increased to 594 (252, 1230) BAU/ml post- omicron surge (P<0.001) with 97 per cent participants having detectable antibodies, although only 40 had symptomatic infection during the omicron surge irrespective of vaccine type and previous history of infection. Those with prior natural infection and vaccination had higher anti-RBD IgG titre at baseline, which increased further [352 (IQR 131, 869) to 816 (IQR 383, 2001) BAU/ml] (P<0.001). The antibody levels remained elevated after a mean time gap of 10 months, although there was a decline of 41 per cent. The geometric mean titre was 452.54, 172.80, 83.1 and 76.99 against the ancestral, delta, omicron and omicron BA.5 variants in the live virus neutralization assay. Interpretation & conclusions: Anti-RBD IgG antibodies were detected in 85 per cent of participants after a median gap of eight months following the second vaccine dose. Omicron infection probably resulted in a substantial proportion of asymptomatic infection in the first four months in our study population and boosted the vaccine-induced humoral immune response, which declined but still remained durable over 10 months

Transcatheter Mitral Valve Implantation: Implications of Interventional Technique and 3D Echocardiography for Complex Valve?in?Valve Paravalvular Leak

Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiography

Study of cytomorphological features of thyroid lesions and its correlation with thyroid function tests.

Background: Fine needle aspiration cytology along with ultrasound and assessment of thyroid function status remains the mainstay of evaluation of thyroid swellings. According to the guidelines put forth by American Thyroid Association, serum estimation of TSH should be part of initial assessment of thyroid swellings. Present study aims to assess the cytomorphological features of various thyroid lesions, classify them in different categories based on The Bethesda System of Reporting Thyroid Cytology and correlate them with thyroid hormone status of patients. Methods: 165 cases of thyroid lesions were subjected to FNAC, smears were categorised according to The Bethesda System of Reporting Thyroid Cytopathology and cases were also assessed for T3, T4, TSH hormone levels. Results: On interpretation of FNAC non-neoplastic lesions outnumbered the neoplastic lesions and Colloid goitre accounted for the majority of the cases (40.6%). Among the neoplastic lesions, follicular neoplasms were most common. Cytologically majority of the lesions belonged to category II (benign) as per the Bethesda System. On evaluation of thyroid function majority of the cases (69.1%) were euthyroid and were interpreted as either colloid goitre or adenomatoid nodule, whereas most patients of lymphocytic thyroiditis presented with either hypo or hyperthyroidism. Majority of malignant cases also turned out to be hypothyroid (9/12 Cases). None of the malignant case presented with hyperthyroidism. Conclusions: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure. FNAC together with thyroid function test can be used for early and accurate diagnosis of various thyroid lesions, and reduces unnecessary intervention.

Psychiatric Morbidity in Cancer Patients

Introduction: Psychiatric disorders are most prevalent (adjustment disorder- 13-42%, depression- 41-47% and generalized anxiety disorders upto 15%) in cancer patients. Some of initial responses like shock and denial, fear of disease and anxiousness about familial responsibilities are also common. Study aimed to investigate psychiatric morbidity in cancer patients. Material and Methods: The study was conducted at the cancer research centre of a large tertiary care hospital. Hamilton Rating Scale for Depression and Beck Anxiety Inventory were administered to the 200 cancer patients and 200 normal healthy relatives of patients. It was followed by a formal psychiatric interview based on the International Classification of Diseases-10 (ICD-10). The patients were studied before commencement of treatment to know the effect of cancer on psychological status of cancer patients. Results: The study revealed that a significant number of cancer patients (74%) suffered from psychiatric diagnostic entity (Adjustment disorder in 32%, Depression in 32% and Anxiety disorder in (10%) and other morbidities (suicidal ideations in 32%, Fear of disease and anxious about their familial responsibilities in 12% and Denial defense mechanism in 6%). Gastro-intestinal cancer patients suffered more from depression and other psychiatric disorders. Evaluation by Hamilton Rating Scale for Depression and Beck Anxiety Inventory also revealed more and statistically significant (P value= 0.000 and 0.011, respectively) psychiatric disorders and morbidities among cancer patients. Conclusions: The patients who were old, male, married, less educated and from lower socioeconomic status (SES) suffered more. However, female patients suffered more from adjustment disorder and more middle aged men had fear of disease and were anxious

Effect of Heat Stress on Physiological and Hemato-biochemical Profile of Cross Bred Dairy Cattle

The present study was done to see the effect of heat stress on blood parameters in dairy cattle. Dairy cows of similar physiological status were selected. Blood samples were collected and analyzed based on the temperature-humidity index (THI). Blood samples were collected and analyzed for packed cell volume PCV(%), red blood cell count RBC count, white blood cell count (WBC) and hemoglobin (Hb). Significant rise in physiological parameters such as respiration rate (RR), pulse rate, was observed. Hematobiochemical parameters such as red blood cell count (RBC), (WBC), (PCV%), (Hb), Cholesterol, creatinine, ALT, AST, Cortisol and BUN were increased. From the present study it can be concluded that THI is a sensitive indicator of heat stress.

High-Dose-Rate Intracavitary Brachytherapy Boost Post-External Beam Radiotherapy Using Rotterdam’s Applicator In A Case Of Recurrent Carcinoma Nasopharynx

Long-term local control is possible in a highly radio-responsive tumor-like carcinoma of the nasopharynx, even in the recurrent setting. High-dose-rate brachytherapy boost with its steep dose fall-off helps achieve salvage by providing optimal dose coverage to the tumor volume which is in close anatomic proximity to critical structures at the base of the skull. Here, we report the case of a 58-year-old lady, an old case of carcinoma nasopharynx presented with recurrence of symptoms in the form of nasal blockade along with a right pre-auricular swelling. Further evaluation showed an fluorodeoxyglucose-avid nasopharyngeal mass, a biopsy from which was positive for nasopharyngeal carcinoma (NPC). She first received re-radiation with external beam radiotherapy using 6 MV photons to the face and neck along with concurrent chemotherapy withcisplatinfollowed by brachytherapy boost with Rotterdam’s Brachytherapy Applicator @5 Gray×2# 1 week apart. Brachytherapy is a feasible tool that allows dose escalation to achieve long-term tumor control in locally advanced NPCs.

Role of redox iron towards an increase in mortality among patients: a systemic review and meta-analysis

An increase in biochemical concentrations of non-transferrin bound iron (NTBI) within the patients with an increase in serum iron concentration was evaluated with the following objectives: (a) Iron overloading diseases/conditions with free radicle form of ‘iron containing’ reactive oxygen species (ROS) and its imbalance mediated mortality, and (b) Intervention with iron containing drugs in context to increased redox iron concentration and treatment induced mortality. Literature search was done within Pubmed and cochrane review articles. The Redox iron levels are increased during dys-erythropoiesis and among transfusion recipient population and are responsive to iron-chelation therapy. Near expiry ‘stored blood units’ show a significant rise in the ROS level. Iron mediated ROS damage may be estimated by the serum antioxidant level, and show reduction in toxicity with high antioxidant, low pro-oxidant levels. Iron drug therapy causes a significant increase in NTBI and labile iron levels. Hospitalized patients on iron therapy however show a lower mortality rate. Serum ferritin is a mortality indicator among the high-dose iron therapy and transfusion dependent population. The cumulative difference of pre-chelation to post chelation ROS iron level was 0.97 (0.62; 1.32; N=261) among the transfusion dependent subjects and 2.89 (1.81–3.98; N=130) in the post iron therapy ‘iron ROS’ group. In conclusion, iron mediated mortality may not be mediated by redox iron among multi-transfused and iron overloaded patients.

Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

Objective: To improve the rates of first hour initiation ofbreastfeeding in neonates born through cesarean section from 0to 80% over 3 months through a quality improvement (QI)process.Design: Quality improvement study.Setting: Labor Room-Operation Theatre of a tertiary carehospital.Participants: Stable newborns ?35 weeks of gestation born bycesarean section under spinal anesthesia.Procedure: A team of nurses, pediatricians, obstetricians andanesthetists analyzed possible reasons for delayed initiation ofbreastfeeding by Process flow mapping and Fish bone analysis.Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.Outcome measure: Proportion of eligible babies breast fedwithin 1 hour of delivery.Results: The rate of first-hour initiation of breastfeeding increasedfrom 0% to 93% over the study period. The result was sustainedeven after the last PDSA cycle, without any additional resources.Conclusions: A QI approach was able to accomplish sustainedimprovement in first-hour breastfeeding rates in cesareandeliveries.

Apical surgery as cystic lesion treatment for barodontalgia prevention: a case report / Cirugía apical como tratamiento de lesión quística para prevenir la barodontalgia: informe de caso

ABSTRACT Barodontalgia is not a pathology but a symptom of a subclinical oral problem that, although rare, may affect patients subjected to atmospheric pressure changes and have an influence on flights. This paper aims to discuss the clinical characteristics of pathologies related to the etiology of barodontalgia, as well as differential diagnoses, treatments, and prevention. This paper reports a case of a Brazilian air force officer who went to the Santos Dumont Air Force Dental Clinic reporting pain in the anterior maxillary during a flight. An endodontic treatment followed by periradicular surgery was performed, in order to quickly seal the bone lesion and to avoid new cases of barodontalgia. This work demonstrated a successful approach of a periradicular lesion solved by surgical treatment in order to avoid new cases of barodontalgia during flights. In addition, this paper highlights the importance of deepening knowledge on this event and the need for periodic oral and dental assessment, as well as conclusive treatment in aircrew members in order to prevent aircraft accidents.

ABSTRACT La barodontalgia no es una patología en sí misma, sino un síntoma de un problema oral subclínico que, si bien es poco frecuente, puede afectar a pacientes sometidos a cambios en la presión atmosférica y afectar la seguridad de los vuelos. Este artículo pretende analizar las características clínicas de las patologías relacionadas con la etiología de la barodontalgia, así como los diagnósticos diferenciales, los tratamientos y la prevención. Se presenta el caso de un agente de la fuerza aérea brasileña que acudió a la Clínica Dental de la Fuerza Aérea Santos-Dumont reportando dolor en el maxilar anterior durante un vuelo. Se realizó un tratamiento de endodoncia seguido de cirugía perirradicular, con el fin de sellar rápidamente la lesión del hueso y evitar nuevos casos de barodontalgia. Este trabajo describe un procedimiento acertado para una lesión perirradicular resuelta por tratamiento quirúrgico para evitar nuevos casos de barodontalgia durante los vuelos. Además, destaca la importancia de profundizar en el conocimiento sobre este evento y la necesidad de llevar a cabo no solo una evaluación bucodental periódica de los miembros de las tripulaciones, además de ofrecerles tratamientos definitivos, con el fin de prevenir los accidentes aéreos.

Childhood Morbidity and Mortality in India – Analysis of National Family Health Survey 4 (NFHS-4) Findings

National Family Health Survey (NFHS)-4 report was recently released for health-related data. This review compares the child healthindicators across NFHS-3 and NFHS-4 with a background of existing health programs catering to child health. Reports of NFHS-4 andNFHS-3, along with ministry reports and existing literature were reviewed to understand the current status of child health. Child healthindicators were compared between the two rounds of NFHS and among Empowered Action Group states of India. National Health Policy2017 and National Health Programs related to child health were also analyzed. There has been an improvement in almost all child healthindicators from NFHS-3 to NFHS-4. The infant mortality rate has reduced to 41 per 1000 live births. The immunization rate is 62%, andhas almost doubled in the states of Uttar Pradesh, Rajasthan and Madhya Pradesh. Despite existence of many health programs, there isstill a substantial lack of achievement in most of the indicators.a

Medication errors in anesthesia: unacceptable or unavoidable? / Erros de medicação em anestesia: inaceitável ou inevitável?

Abstract Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to ‘treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and ‘just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.

Resumo Os erros de medicação são as causas mais comuns de morbidade e mortalidade dos pacientes. Além disso, esses erros aumentam os encargos financeiros da instituição. Embora o impacto varie de nenhum dano a efeitos adversos graves, inclusive o óbito, é preciso estar atento à ordem de prioridades porque os erros de medicação são evitáveis. Na atualidade, com as pessoas cientes e os processos médicos em evidência, frear esse problema é de extrema prioridade. O esforço individual para diminuir os erros de medicação pode não obter sucesso até que uma mudança nos protocolos e sistemas existentes seja incorporada. Muitas vezes, os erros de medicação ocorridos não podem ser revertidos. A melhor maneira de "tratar" esses erros é impedi-los. Os erros de medicação (devido à troca de seringa), de overdose (devido a mal-entendido ou preconcepção da dose, mal uso de bomba e erro de diluição), de via de administração incorreta, de subdosagem e de omissão são causas comuns de erro de medicação que ocorrem no período perioperatório. A omissão e erros no cálculo de medicamentos ocorrem comumente em UTI. Os erros de medicação podem ocorrer no período perioperatório, tanto durante a preparação e administração quanto na manutenção de registros. Um grande número de erros humanos e do sistema pode ser responsabilizado pela ocorrência de erros de medicação. A necessidade do momento é parar o jogo da culpa, aceitar os erros e desenvolver uma cultura segura e "justa" para evitar os erros de medicação. Os sistemas recém-criados, como o Veinrom, um sistema de administração de líquidos, é uma nova abordagem na prevenção de erros de medicação devido aos medicamentos mais comumente usados em anestesia. Desenvolvimentos semelhantes, juntamente com médicos vigilantes, uma cultura de local de trabalho seguro e apoio organizacional, todos em conjunto podem ajudar a evitar esses erros.

A Study of Cutaneous Manifestations Associated with Diabetes Mellitus at a Tertiary Care Teaching Hospital

Background: Diabetes mellitus has emerged as a major public health problem in our country, and our country has a distinction of having the largest number of diabetics in the world. Only a few epidemiologic studies have been done on the prevalence of skin disorders in patients with diabetes mellitus. Present study was conducted to study of cutaneous manifestations associated with diabetes mellitus at a tertiary care teaching hospital. Methods: 200 patients with Diabetes Mellitus, visiting the Department of Medicine and Department of Dermatology (outpatient and inpatient) of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, UP (India) during the period of 1 yr. from April 2015 to March 2016 were included in the study. Detailed history was taken as per proforma and patient investigated. Results: Maximum incidence was seen between 41-70 yrs. of age and in middle class. Infections and infestations were the commonest associations detected in 49.5% of cases out of which fungal infections were observed in majority of the cases (24.5%) followed by bacterial infection (15.5%) and viral infections (7.0%). Psoriasis and xerosis were detected in 6.0 % of cases each. Skin disease strongly associated with diabetes mellitus like vitiligo were observed in 3.5 % of cases. Conclusion: Skin lesions in Diabetes mellitus are sometimes mirror to an underlying disease process and they may be the first expression of the disease. Most of the diabetic patients who developed cutaneous manifestations were in the 41-70 year age group, and infections were the single largest type of involvement seen. Cutaneous lesions can serve as cutaneous markers for DM. These can be detected by a simple cutaneous examination. The commonly seen nonspecific skin manifestations can also be used as skin markers for DM. This can be especially useful in the rural areas where advanced facilities are often unavailable.

Adenomatoid Odontogenic Tumor: An Unusual Presentation.

Adenomatoid odontogenic tumor (AOT) is a not so common neoplasm of the odontogenic origin, accounting for around 3-7% of all odontogenic tumors. It is usually present in young females in the anterior maxillary region and thus commonly referred to as a two-third tumor. It is a benign (hamartomatous), usually non-invasive tumor which shows slow and progressive growth. Due to its rarity and varied clinical presentation it is often misdiagnosed. To add to confusion further, there are various lesions which mimic AOT closely. Herein this article, we present a case report of a young female patient with an unusual presentation of AOT tumor in the mandibular region focusing on the versatility of this rare entity.

Clear cell renal cell carcinoma with hemangioblastomalike features: A recently described pattern with unusual immunohistochemical profile.

The diagnosis of clear cell renal cell carcinoma may sometimes pose challenges because of the presence of uncharacteristic morphology, varied immunophenotypic patterns and due to lack of molecular or genetic determinants. More often, the morphological variations can be easily overlooked in routine practice and a more common diagnosis is usually put forward. Solid, acinar and alveolar are the common patterns described in the literature. We report a recently described pattern of clear cell renal cell carcinoma which has hemangioblastoma-like morphology and an unusual immunoprofi le. In our case, the tumor showed a diffuse hemangioblastoma-like pattern and diffuse positivity for Alpha-inhibin on immunohistochemistry. A thorough literature search, extensive sampling and an expanded immunohistochemistry panel revealed a clear cell renal cell carcinoma component. Presence of renal vein thrombosis and focal necrosis were other helpful features in discerning the malignant nature of tumor.

Unilateral segmental odontomaxillary dysplasia: A rare entity of 3 cases and review.

Segmental odontomaxillary dysplasia (SOD) is an uncommon, nonhereditary, rare developmental disorder primarily involving the posterior part of the maxilla and related dental components. It is a rare condition of uncertain etiology that results in painless unilateral expansion of the posterior dentoalveolar complex, gingival hyperplasia, lack of one or both premolars in the affected area, delayed eruption of adjacent teeth and malformations of the primary molars. Radiographically, the affected bone is thickened and irregular in outline, with a coarse trabecular pattern that is vertically oriented resulting in a relatively radioopaque granular appearance. The treatment is focused on extraction of the involved teeth, while in some milder cases the teeth may be retained for a long period. The treatment plan should be based on the degree of involvement as well as the functional and esthetic needs in each case. Considering the rarity of the condition, we report three cases of SOD with variable presentations in a 45-year-old, 24-year-old and 23-year-old individual.