Seroprevalence with epidemiological determinants of hepatitis C virus and Treponema pallidum infection in blood donors of a teaching hospital in southwest Punjab, India: A 5-year study.

Background: A high seroprevalence of various transfusion-transmitted infections (TTIs) in donated blood is the main safety concern, especially in low- and middle-income countries. As per the World Health Organization (WHO) recommendation, all blood donations must be tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum infection, and malaria, which mainly comprises the major bulk of TTIs. Aims: The purpose of this study is to observe the seroprevalence of hepatitis C virus and Treponema pallidum infection over the period of 5 years in blood donors of our blood center along with their epidemiological determinants with respect to age, sex, residence, occupation, and type of donors. Materials and Methods: Retrospective study was conducted for the period of 5 years, from 1st January 2017 to December 2021, estimating the seroprevalence of hepatitis C and Treponema pallidum infection in the blood donors along with their epidemiological determinants. Results: Out of 19,689 donations in 5 years, 690 (3.50%) units were positive for transfusion-transmissible infections with 1.67% donors seropositive for HCV, 1.23% for Treponema pallidum infection, 0.42% for HBV, and 0.18% for HIV. The prevalence of TTIs was found to be highest in 2020 (4.52%) and least in 2017 (2.57%). Out of a total of 330 HCV cases detected in 5 years, 84.85% of cases were seen in voluntary donors. Rural donors constituted 71.21% of cases. The majority of cases were seen in the age group of 18-30 years, i.e., 61.82%, and a maximum number of cases were seen in the farmers (31.21%), followed by laborers and construction workers (21.21%). Out of a total of 242 cases of Treponema pallidum infection, 84.29% were seen in voluntary blood donors. Demographic data showed 70.24% of cases in rural donors. Occupational data revealed a maximum number of cases in farmers (34.29%), followed by laborers (21.90%). Conclusion: Higher seroprevalence of HCV and Treponema pallidum infection in our region as compared with other areas is a matter of great concern about the growing infection rate of these in our area. Stringent use of donor selection criteria and more vigorous donor screening is utmost need of the hour for reducing the burden of TTIs in blood transfusion services.

A Case Series on Acute Mesenteric Ischemia (AMI) Leading to Intestinal Gangrene Following Blunt Trauma to the Abdomen.

The term "acute mesenteric ischemia" (AMI) refers to a set of conditions where the blood supply to various segments of the small intestine is cut off, causing ischemia and subsequent inflammatory changes that might result in bowel gangrene. Estimates place the incidence between 0.09% and 0.2% of all acute surgical hospitalizations. Early diagnosis is essential, despite the entity being a rare cause of abdominal discomfort, because if left untreated, mortality is 50%. Herein, we present a case series of three patients with bowel ischemia following blunt abdominal trauma.

Programmed cell death ligand 1 (PD-L1) expression in non-small cell lung cancer: Findings from a tertiary care institute in western part of India.

BACKGROUND: Immune checkpoint inhibitors targeting either programmed cell death protein 1 (PD-1) or programmed cell death ligand 1 (PD-L1) have been established as a novel target for immunotherapy in non-small cell lung cancer (NSCLC). Prevalence of PD-L1 expression in NSCLC varies from 13% to 70%, with sparse data from the Indian subcontinent. In this study, we looked at PD-L1 expression and its association with demographic, clinical, radiologic and pathologic parameters in NSCLC patients. METHODS: This was an observational study carried over a period of 18 months in which 65 patients of NSCLC were included. Immunohistochemistry (IHC) for PD-L1 was done using an automated IHC stainer and testing was performed using PD-L1 IHC CAL10. For statistical analysis, unpaired t test, Chi square test, Fisher's exact test and binomial logistic regression were used. P < 0.05 was taken to be statistically significant. RESULTS: Mean age of the patients was 62.9 ± 9.2 years, and majority (87.3%) of them were males. Seventeen (26.2%) patients expressed PD-L1, among whom 10 had high PD-L1 expression (≥50%) and 7 had low PD-L1 expression (1-49%). PD-L1 expression was seen in 13 out of 43 cases of squamous cell carcinoma (SCC) and 4 out of 15 cases of adenocarcinoma. On applying binomial logistic regression analysis, association between smoking and PD-L1 expression was found to be insignificant. CONCLUSION: Almost a quarter of NSCLC cases were PD-L1 positive without any difference in expression between SCC and adenocarcinoma. PD-L1 status was not associated with any specific demographic, clinical or radiologic parameter including the histologic subtype.

An Unexpected Finding of Isolated Hydatidosis of the Spleen With Concomitant Visceromegaly in an Elderly Female.

Hydatidosis of the spleen is a rare zoonotic clinical entity. The occurrence of isolated splenic hydatid cysts in the absence of these cysts in any other portion of the body is referred to as primary splenic hydatidosis. It is a rare disorder that accounts for only 2% of the burden of hydatid disease worldwide. After the liver and the lungs, the spleen is the organ that is most frequently affected by this condition.

Giant Lipoma of the Arm Masquerading as an Accessory Breast: A Report of a Rare Case.

Accessory breast is an extremely rare condition that develops in 0.4%-6% of females. It is primarily found in the axilla and is frequently misdiagnosed. It is usually bilateral and manifests during pregnancy or lactation as an asymptomatic tumor. The diagnosis of ectopic breast tissue is crucial because it is capable of undergoing the same pathological changes as normal breast tissue, including mastitis, fibrocystic changes of the breast tissue, and, in extreme cases, even malignancy. We present the case of a 40-year-old female who presented with swelling in the left upper arm for the past eight years, which was associated with pain. Initially, accessory breast was kept as the clinical diagnosis. However, further imaging and histological analysis revealed it to be a giant lipoma of the upper arm.

An Incidental Finding of Morgagni Hernia in an Elderly Female and Its Successful Management: A Rare Case Report and Review of Literature.

Morgagni hernia is one of the congenital diaphragmatic hernias, but it can also occur in adults. It usually manifests in childhood, but in rare cases, it may also present in adults. It is linked to a congenital defect during the embryological development of the diaphragm. Uncommon diaphragmatic hernias, also called the foramen of Morgagni hernias, often affect the right side and are found in the anterior mediastinum. Typically asymptomatic in adult patients, the foramen of Morgagni hernia is linked to obesity, trauma, or other causes of elevated intraabdominal pressure. Diagnostic aids include plain pulmonary roentgenograms, contrast-enhanced radiographic investigations of the gastrointestinal tract, computerised tomography, and magnetic resonance imaging tests. We report a rare case of an 85-year-old female with a Morgagni hernia that was incidentally detected on a chest X-ray and was managed successfully.

Contrasting Presentations of Spigelian Hernia in a Single Surgical Unit of a Tertiary Healthcare Center: A Case Series.

A Spigelian hernia is a very rare type of anterior abdominal wall hernia. The etiology revolves around the dehiscence of the transverse abdominis and internal oblique aponeurosis. The majority of Spigelian hernias develop in the lower abdomen where the posterior sheath is absent. This condition is also known as a spontaneous lateral ventral hernia or hernia of the semilunar line. It is mostly asymptomatic and is generally proven by radiological diagnosis. In the worst-case scenario, strangulation of the Spigelian hernia can occur. Here, we report a case series of contrasting presentations of Spigelian hernia in a single surgical unit of a tertiary healthcare center, considering the rarity and associated complications of Spigelian hernia.

Adolescent Health Academy Statement on the Care of Transgender Children, Adolescents, and Youth.

JUSTIFICATION: The transgender community has been long stigmatized, and discriminated against, and faces numerous mental and physical problems. Certain indicators of transgender personality appear during childhood and more often before puberty begins. This puts the onus on Pediatricians to identify and offer evidence-based care for their benefit. There is an urgent and deep-felt need to understand the medical, legal, and social aspects of the care of transgender children. Hence, Adolescent Health Academy decided to release a statement on the care of transgender children, adolescents, and youth. OBJECTIVES: To review the existing international and national guidelines and recommendations to formulate a statement for the Pediatricians on (a) terminologies and definitions; (b) legal status in India; and (c) implications for pediatric practice. PROCESS: A task force was convened by the Adolescent Health Academy as the writing committee to draft the guidelines. These were approved by all the members of the task force and the Executive Board of Adolescent Health Academy (2022). RECOMMENDATIONS: Gender identity develops in childhood and adolescence as a feeling of self, and it should be respected to mitigate gender dysphoria. The law permits transgenders the right of self-affirmation and it upholds their dignity in society. The transgender community is prone to victimization, and prejudice leading to a high risk of substance abuse, suicidal ideation, and mental health issues. Pediatricians are the primary care providers of children and adolescents including those with gender incongruence, so they should be abridged with gender-affirmative practices. Gender-affirmative care involves pubertal suppression, hormonal therapy, and surgery which should be done in conjugation with the social transition, by a gender-affirmative care team.

Effect of Structural Variation on Spectral, NLO Properties, and Biological Activity of Pyrrole Hydrazones.

This paper describes spectral, non-linear optical (NLO), and biological activity variation of pyrrole hydrazones as a result of structural variation. In order to study structure-property variation, pyrrole hydrazones (3A, 3B, and 3C) were synthesized in both solid and solution phases. The grinding solvent-free method becomes rapid, easy, convenient, useful, sustainable, and eco-friendly green synthesis as compared to the classical solution phase reactions. The structure of pyrrole hydrazones has been elucidated by microanalysis and quantum chemical calculations. The intense emission at λem 521 nm (3A and 3B) and 617 nm (3C) in the visible (green and orange) region with Stokes shifts at 195, 160, and 282 nm reveals that the studied compounds work as good photoluminescent materials. All compounds show strong n-π* and charge transfer (π-π*) transitions in the UV-vis region with high extinction coefficients. In the studied systems (3A, 3B, and 3C), the orbital overlap between σ(NH-O) → σ*(NH-O) is found due to intra-molecular charge transfer. The first hyperpolarizabilities were found to be 48.83 × 10-30 esu for 3B and 63.89 × 10-30 esu for 3C, showing variation with structure. Their high values indicate more suitability for NLO application. Incorporation and/or change in position of electron-withdrawing groups increase the ß0 values of 3B and 3C compared to 3A. The ß value also increases monotonically as the polarity of the solvents increases. The red shift in N-H and C=O stretching Fourier-transform infrared bonds is due to the formation of dimers. The synthesized 3A, 3B, and 3C show good antimicrobial activity and are predicted to be potential antibacterial and antifungal drugs. The 3B has more molar refractivity (122.16 esu) than 3A and 3C and correlates well with the calculated binding affinity and experimental antimicrobial data.

Relationship between vascular endothelial growth factor expression and thyroid stimulating hormone level in benign and malignant thyroid lesions.

Background: Vascular endothelial growth factor (VEGF) stimulates angiogenesis, increases vascular permeability and seems to correlate to aggressiveness of tumors. Thyroid cancer has been found to have higher levels of VEGF expression. Thyroid stimulating hormone (TSH) is the most important thyroid hormone, yet few researches have been done on its relationship with VEGF. Aim: To study the clinical and demographic profile of thyroid lesions (benign and malignant) and to explored the relationship between VEGF expression (using immunochemistry) and serum TSH level. Methods: This prospective, observational study includes 61 patients of thyroid lesions who underwent partial, hemi, subtotal or total thyroidectomy as the primary treatment from June 2014 and July 2016. Tissue specimens of thyroid lesions for immunohistochemistry study of VEGF expression were done. Serum TSH was done using Chemiluminiscence technique and correlated to VEGF expression. Results: The mean age of patient was 36.26 ± 11.53 years (range 20-50 years) with female preponderance. Swelling was the most common presenting symptom. Of 61 patients, 37 (60.65%) patients were benign and 24 (39.35%) were malignant thyroid lesions. The mean TSH level in benign group was 1.92 ± 0.94 mIU/liter and malignant group was 2.73 ± 1.74 mIU/liter which was statistically significant (P = 0.023). VEGF expression was strongly positive (3+) in 26 (42.62%) patients and negative/equivocal (1+ & 2+) in 35 (57.38%) patients. In benign group, 10 (27.0%) patients were strongly positive for VEGF whereas in malignant group, 16 (66.7%) patients were strongly positive for VEGF showed significant association (P = 0.002). On comparing TSH level of benign, malignant and total patients separately with VEGF expression, significant association were also observed (P < 0.001, P = 0.004 and P < 0.001, respectively). Conclusion: VEGF was strongly expressed in malignant thyroid lesions which are having high serum concentration of serum TSH level. Serum TSH levels reveal a significant correlation with VEGF expression.

Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study.

INTRODUCTION: Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic. MATERIAL AND METHODS: This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale - 21 (DASS 21) which was used to quantify emotional distress experienced by them. RESULTS: A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician. CONCLUSIONS: Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system.

Diagnostic accuracy and adequacy of rapid on-site evaluation performed by a pulmonologist on transbronchial needle aspiration specimens (DREPA): a prospective study.

INTRODUCTION: Rapid on-site evaluation (ROSE) during transbronchial needle aspiration (TBNA) is conventionally performed by pathologists. However, availability of a pathologist in the bronchoscopy suite is often an issue. We aimed to study if a pulmonologist, after receiving a short period of training in cytopathology, is able to assess the adequacy of onsite samples during TBNA. MATERIAL AND METHODS: A pulmonologist was initially trained by a pathologist in examining cytology slides and assessing sample adequacy on TBNA smears. During TBNA, one slide from each needle pass was stained on-site using rapid Giemsa stain and was labelled as ROSE slide. The remaining slides were sent to the pathology laboratory for definitive cytological analysis. The ROSE slides were examined by a pulmonologist and a pathologist blinded to each other's interpretation. Level of agreement between the pulmonologist and pathologist was assessed by estimating Cohen's kappa. RESULTS: A total of 172 slides from 35 patients were prepared for ROSE and evaluated independently by pulmonologist and pathologist. For adequacy, the pulmonologist and pathologist agreed in 143 out of the 172 slides (83% agreement), κ 0.649 (p < 0.001). For diagnostic categories, the pulmonologist and the pathologist agreed in 143 out of the 172 slides (83% agreement); κ 0.696 (p < 0.001). The sensitivity, specificity and accuracy of ROSE performed by the pulmonologist with respect to that performed by the pathologist was 66.2%, 96.8% and 83.1% respectively. CONCLUSION: After a short period of training in cytopathology, a pulmonologist can assess for adequacy of TBNA ROSE slides in the bronchoscopy suite.

Expression of Poly(Adenosine Diphosphate-Ribose) Polymerase Protein in Breast Cancer.

Background: The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC. Methods: The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method. Results: The mean age for BC patients was 51.30 ± 10.694 years (range: 25-75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001). Conclusion: We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC.

Effect of negative pressure wound therapy on wound thermometry in diabetic foot ulcers.

Background: Negative pressure wound therapy (NPWT) is the treatment of choice for diabetic foot ulcers (DFUs), and the role of NPWT in the management of DFU is limited. The aim of the study was to compare the effects of NPWT versus conventional dressing (CD) on wound healing in DFU. Materials and Methods: A total of 55 patients were included and divided into two groups: 23 patients were treated with NPWT and 32 patients with CD. The NPWT dressings were changed every 7 days, while the CDs were changed daily. Wound culture sensitivity, wound size, granulation tissue, and pain evaluation (assessed by Visual Analog Scale) were all measured at the start and 3 weeks or until the ulcer was healed. The wound margin temperature was measured at four random sites for thermometric evaluation, and normal limb temperature was also measured for comparison. Patients' satisfaction and treatment costs were also compared. Results: On days 14 and 21, the wound size was reduced significantly in the NPWT group (P < 0.001 and P < 0.001, respectively). The percentage reduction in wound size from baseline to days 7, 14, and 21 was significantly higher in the NPWT group (P = 0.013, P = 0.001, and P = 0.029, respectively). On days 7, 14, and 21, the granulation tissue score was significantly higher in the NPWT group (P = 0.001, P = 0.001, and P < 0.001, respectively). On days 14 and 21, the mean VAS score was significantly low in the NPWT group (P < 0.001 and P < 0.001, respectively). The majority of wounds in the NPWT group were sterile on day 21 compared to those in the CD group (P = 0.008). The majority of patients in the NPWT group had excellent patient satisfaction (P < 0.001). The average material cost was significantly higher in the NPWT group (P = 0.001). The mean wound temperature of the affected limb was significantly higher compared to that of the unaffected limb (P < 0.001). Conclusion: In terms of early formation of granulation tissue, faster wound size reduction, less discomfort, and patient satisfaction, the study indicated that NPWT appeared to be superior. An initial rise in temperature in a DFU may indicate the presence of a pre-ulcerative lesion.

Safe Practice of Flexible Bronchoscopy for Non-COVID-19 Indications during the SARS-CoV-2 Pandemic.

Background: Flexible bronchoscopy is an aerosol-generating procedure (AGP), which increases the risk of transmission of SARS-CoV-2 infection. We aimed to find COVID-19 symptoms among healthcare workers (HCWs) involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic. Materials and Methods: The participants of this hospital-based single-center descriptive study were HCWs of our hospital involved in flexible bronchoscopies of patients with non-COVID-19 indications. These patients had no clinical features of COVID-19 and were tested negative for SARS-CoV-2 by the real-time polymerase chain reaction of nasopharyngeal and throat swabs before the procedure. The study outcome was the occurrence of COVID-19 in study participants after exposure to bronchoscopies. Results: Thirteen HCWs performed 81 bronchoscopies on 62 patients. Indications for bronchoscopies included malignancy (61.30%), suspected infections (19.35%), non-resolving pneumonia (6.45%), mucus plug removal (6.45%), central airway obstruction (4.84%), and hemoptysis (1.61%). The mean age of patients was 50.44 ± 15.00 years, and the majority was males (72.58%). Bronchoscopic procedures included 51 bronchoalveolar lavages, 32 endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA), 26 endobronchial biopsies, 10 transbronchial lung biopsy (TBLB), 3 mucus plug removals, 2 conventional TBNA, and 2 radial EBUS-TBLB. Except for two HCWs who complained of transient throat irritation of non-infectious cause, none of the cases developed any clinical features suggestive of COVID-19. Conclusion: A dedicated bronchoscopy protocol helps in minimizing the risk of transmission of SARS-CoV-2 infection among HCWs involved in flexible bronchoscopies for non-COVID-19 indications during the SARS-CoV-2 pandemic.

TMT-Based Plasma Proteomics Reveals Dyslipidemia Among Lowlanders During Prolonged Stay at High Altitudes.

Acute exposure to high altitude perturbs physiological parameters and induces an array of molecular changes in healthy lowlanders. However, activation of compensatory mechanisms and biological processes facilitates high altitude acclimatization. A large number of lowlanders stay at high altitude regions from weeks to months for work and professional commitments, and thus are vulnerable to altitude-associated disorders. Despite this, there is a scarcity of information for molecular changes associated with long-term stay at high altitudes. In the present study, we evaluated oxygen saturation (SpO2), heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP) of lowlanders after short- (7 days, HA-D7) and long-term (3 months, HA-D150) stay at high altitudes, and used TMT-based proteomics studies to decipher plasma proteome alterations. We observed improvements in SpO2 levels after prolonged stay, while HR, SBP, and DBP remained elevated as compared with short-term stay. Plasma proteomics studies revealed higher levels of apolipoproteins APOB, APOCI, APOCIII, APOE, and APOL, and carbonic anhydrases (CA1 and CA2) during hypoxia exposure. Biological network analysis also identified profound alterations in lipoprotein-associated pathways like plasma lipoprotein assembly, VLDL clearance, chylomicron assembly, chylomicron remodeling, plasma lipoprotein clearance, and chylomicron clearance. In corroboration, lipid profiling revealed higher levels of total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL) for HA-D150 whereas high density lipoproteins (HDL) levels were lower as compared with HA-D7 and sea-level indicating dyslipidemia. We also observed higher levels of proinflammatory cytokines IL-6, TNFα, and CRP for HA-D150 along with oxidized LDL (oxLDL), suggesting vascular inflammation and proartherogenic propensity. These results demonstrate that long-term stay at high altitudes exacerbates dyslipidemia and associated disorders.

Predictors of Clinical Outcomes in Adult COVID-19 Patients Admitted to a Tertiary Care Hospital in India: an analytical cross-sectional study.

BACKGROUND: The outbreak ofsevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted inexponential rise in the number of patients getting hospitalised with corona virus disease 2019 (COVID-19). There is a paucity of data from South East Asian Region related to the predictors of clinical outcomes in these patients. This formed the basis of conducting our study. METHODS: This was an analytical cross-sectional study. Demographic, clinical, radiological and laboratory data of 125 patients was collected on admission. The study outcome was death or discharge after recovery. For univariate analysis, unpaired t-test, Chi-square and Fisher's Exact test were used. Receiver operating characteristic (ROC) curves were plotted for Sequential Organ Failure Assessment (SOFA) score and few laboratory parameters. Logistic regression was applied for multivariate analysis. RESULTS: Elderly age, ischemic heart disease and smoking were significantly associated with mortality. Elevated levels of D-dimer and lactate dehydrogenase (LDH) and reduced lymphocyte counts were the predictors of mortality. The ROCs for SOFA score curve showed a cut-off value ≥ 3.5 (sensitivity- 91.7% and specificity- 87.5%), for IL-6 the cut-off value was ≥ 37.9 (sensitivity- 96% and specificity- 78%) and for lymphocyte counts, a cut off was calculated to be less than and equal to 1.46 x 109per litre (sensitivity-75.2%and specificity- 83.3%). CONCLUSION: Old age, smoking history, ischemic heart disease and laboratory parameters including elevated D-dimer, raised LDH and low lymphocyte counts at baseline are associated with COVID-19 mortality. A higher SOFA score at admission is a poor prognosticator in COVID-19 patients.

Effect of neoadjuvant chemotherapy (NAC) on programmed cell death ligand (PD-L1) in patients of carcinoma breast: A prospective study in Indian tertiary care setting.

CONTEXT: Several studies have reported that PD-L1 has shown therapeutic activity in various tumor types. However, its expression changes in a person on administration of NAC which is reported by very few studies. AIMS: To find out the difference in the expression of PD-L1 by tumor cells after the administration of NAC. SETTINGS AND DESIGN: This prospective study was conducted on 30 patients who were diagnosed with locally advanced breast carcinoma (LABC) between 2017 and 2019 and those who received NAC followed by surgery. METHODS AND MATERIAL: Breast cancer specimens were collected using core needle biopsy prior to administration of NAC and IHC was performed. Frequency and staining intensity of PD-L1 by tumor cells were analyzed. PD-L1 expression was dichotomized into two groups according to the frequency distributions of the H-scores. STATISTICAL ANALYSIS USED: The differences in expression of PD-L1 along with various parameters were analyzed using Chi-square test and Student's t test. RESULTS: The mean age of the patients in our study was 51.37 ± 11.37 years. The response of NAC according to the RECIST criteria showed that most of patients (83.3%) showed complete response. Of the 30 cases, 11 (36.7%) patients were PD-L1 positive before the administration of NAC. We found a significant change in expression from positive to negative status, i.e., seven patients changed from positive to negative (p = 0.036). Upon comparing the PD-L1 expression before NAC, significant association was observed between the primary tumor (T) and tumor stage with high PD-L1 expression (p = 0.020 and P = 0.034). After NAC, 18 (69.2%) patients who were ER positive and 18 (69.2%) patients who were PR positive showed negative PD-L1 expression while none of them were positive in PD-L1 positive patients (p = 0.018 and P = 0.018). CONCLUSION: PD-L1 expression in a same person changes upon administration of NAC which may indirectly be used as a predictor of response to NAC.

Convalescent plasma in the management of moderate COVID-19 in India: An open-label parallel-arm phase II multicentre randomized controlled trial (PLACID Trial)

ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19. DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial. SettingThirty-nine public and private hospitals across India. ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 [≤] 93% on room air). InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm. Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment. ResultsBetween 22nd April to 14th July 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: -0.61 to 1.83]. InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19. Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.