Clinicopathological profile of hepatoblastoma: An experience from a tertiary care center in India.

BACKGROUND: Hepatoblastoma is the most common primary hepatic malignancy in the pediatric population. Advances in pathological evaluation, imaging, risk stratification, neo-adjuvant chemotherapy, and surgery including transplantation have improved survival of these children in the western countries. However, a successful outcome in developing countries such as India with limited resources poses great challenges to the clinician and the family. Histology plays a major role in determining the prognosis of these patients. METHODS: A retrospective study was done on 10 children diagnosed with hepatoblastoma between January 2010 and December 2015 in our institution. Clinical, laboratory, radiological, histopathological diagnoses, treatment, and outcome data were collected and analyzed. RESULTS: The median age of these children at diagnosis was 11 months, and only 1 child was premature at birth. Most children were presented with abdominal distension. One child had lung metastasis at presentation. Elevated alpha fetoprotein levels were present in 90% of the children. The histological types were fetal, embryonal, macrotrabecular, and mixed epithelial-mesenchymal types. SIOPEL risk stratification was done, which showed 40% of the children to be of high risk. Three children had PRETEXT 1, 2, and 4, respectively. CONCLUSION: Our study is significant with respect to the information on PRETEXT staging, risk status, and histological favorability. In developing countries with limited resources and low-socioeconomic status, it is important to have a multidisciplinary team approach and tailor treatment to manage these patients effectively and improve the overall survival.

Smartphone geospatial apps for dengue control, prevention, prediction, and education: MOSapp, DISapp, and the mosquito perception index (MPI).

India has the largest number of dengue cases in the world, contributing approximately 34% of the global burden. The framework for a geospatially enabled early warning and adaptive response system (EWARS) was first proposed in 2008. It was meant to be a decision support system for enhancing traditional surveillance methods for preventing mosquito-borne diseases in India by utilizing remote sensing data and fuzzy logic-based mathematical predictive modeling. This conceptual paper presents a significant evolution of EWARS such that it synthesizes inputs from not only traditional surveillance and reporting systems for dengue but also from the public via participatory disease surveillance. Two smartphone-based applications have been developed to support EWARS. The first-MOSapp-allows field health workers to upload surveillance data and collect key data on environmental parameters by both direct observation and via portable microclimate stations. The second-DISapp-collects relevant information directly from the community to support participatory disease surveillance. It also gives the user a real-time estimate of the risk of exposure to dengue in proximity to their home and has an educational component that provides information on relevant preventive measures. Both applications utilize a new mosquito abundance measure-the mosquito perception index (MPI)-as reported by the user. These data streams will feed into the EWARS model to generate dynamic risk maps that can guide resource optimization and strengthen disease surveillance, prevention, and response. It is anticipated that such an approach can assist in addressing gaps in the current system of dengue surveillance and control in India.

The Prognostic Role of Maximum Standardized Uptake Value of 18 F-FlouroDeoxy Glucose Positron Emission Tomography-Computed Tomography in Head and Neck Cancer Patients Undergoing Chemoradiotherapy.

AIMS AND OBJECTIVES: This retrospective study aims at correlating the pre- and post-therapy maximal standardized uptake values (SUVmax) of the whole-body 18-flourodeoxy glucose positron emission tomography (FDG-PET) scan with tumor response in patients with head and neck squamous cell cancer undergoing chemoradiotherapy. MATERIALS AND METHODS: Data for this retrospective study were taken from the clinical records of 20 evaluable head and neck cancer patients who had availed treatment and evaluation at our institute during the previous year (March 2017-April 2018). All these above-mentioned patients had undergone chemoradiation at our center for locally advanced squamous cell carcinoma of the head and neck and had undergone pre- and post-therapy whole-body FDG PET scan. The posttherapy PET-computed tomography (CT) was advised after 8 weeks' postcompletion of therapy. During the PET CT scan, images were acquired 1 h after injection of FDG. Pre- and post-therapy SUVmax were recorded and correlated with immediate treatment response. RESULTS: The mean pretherapy SUVMax of the primary tumor was 10.27 ranging from 4.5 to 26.17. The mean pretherapy SUVMax of the node was 5.34 ranging from 0 to 17.9. The mean time of recording the posttherapy SUVMax was 3 months (range 2-5 months). The mean posttherapy SUVMax of the primary tumor was 1.05 ranging from complete metabolic response to 6.4. The mean posttherapy SUVMax of the node was 0.7 ranging from complete metabolic response to 5.43. The statistical analysis based on Wilcoxon-Signed Rank test revealed a statistically significant difference in the pre- and post-therapy SUVmax values for both primary tumor (P < 0.001) and regional node (P = 0.001). Majority of patients (n = 15) showed clinical remission; however, five patients had progressive disease at the time of evaluation. CONCLUSION: Although the retrospective study revealed that complete responders had a statistically significant reduction in the posttherapy SUVmax in comparison to the pretherapy SUVmax it failed to identify a cutoff value for pretherapy SUVmax which could predict the probable outcome of therapy. In view of the same further prospective studies need to be conducted with larger patient numbers including various other tumor metabolic markers for greater clarity.

18F-FDG PET/CT scanning: Biological effects on patients: Entrance surface dose, DNA damage, and chromosome aberrations in lymphocytes.

Positron Emission Tomography/Computed Tomography (PET/CT), a combination of PET and CT, is used in tumor staging, therapy planning, and treatment response monitoring. During PET imaging, patients receive low doses of radiation, which can induce an adaptive response and necessitate higher doses for therapeutic efficacy. Higher doses may augment toxicity to normal cells. We are examining the effects of short-term, low-dose exposures to ionizing radiation. Entrance Surface Dose (ESD) to head, shoulders, and pelvis regions were measured using Li2B4O7: Mn thermoluminescent dosimeters. Induced DNA damage in lymphocytes was measured using γ-H2AX, p53Ser-15, chromosome aberrations, and micronucleus formation in subjects (n = 25) who underwent 18F-FDG PET/CT. The mean ESD ± SD value obtained were 32.40 ± 16.86, 32.58 ± 14.22, 32.02 ± 15.42, 43.55 ± 18.25 and 42.80 ± 24.67 mGy for the head, right shoulder, left shoulder, right pelvic, and left pelvic regions, respectively. The effective doses of PET and CT ranged from 4.01 to 6.61 and 16.40-72.18 mSv, respectively, and the obtained Dose Length Product (DLP) varied from 1093 to 4812 mGy*cm. There was no correlation between DLP and ESD (r2 = 0.1). The chromosome aberration assay showed a significant increase (p < 0.05), post-scanning vs. pre-scanning; the γ-H2AX, p53Ser-15, and micronucleus assays did not show significant increases. Induced DNA damage showed inter-individual variation among the study subjects. Our results imply that the patients received a biologically significant dose during 18F-PET/CT scanning and precautions may be needed to reduce any long-term risk of exposure.