Introduction
Medullary carcinoma (MTC) is a rare neuroendocrine thyroid neoplasm. The international medullary thyroid carcinoma grading scheme (IMTCGS), which has prognostic significance, has been ...introduced recently. The present study graded MTC cases using the IMTCGS and evaluated it in our study cohort.
Methods
All MTC thyroidectomy cases over 6 years were evaluated. Low-grade (LG) and high-grade (HG) were compared. Survival analysis included overall survival (OS), loco-regional free survival and distant metastasis free survival (DMFS).
Results
Of 32 cases, 31.25% were HG and 68.75% LG. The mean age was 44.0 years and M:F ratio 1:1.146. HG patients were older and had tumour cells with high-grade nuclear features and prominent nucleoli and showed distant metastasis. Necrosis was found more in patients with high grade nuclear features. There was discordance between the high Ki67 (60%) and increased mitotic activity (20%). Univariate survival analysis revealed poor DMFRS and OS in the cohorts with high grade, Ki67 > 5% and coagulative necrosis. The multivariate cox regression analysis showed IMTCGS significantly associated with overall survival (HR 28.30,
p
= 0.009) and DMFS (HR 15.70,
p
= 0.02).
Discussion and conclusion
This is the first Indian study evaluating IMTCGS, a very simple and convenient grading system that can be readily used in any tertiary health care centre. IHC for Ki 67 should mandatorily be done irrespective of the low mitotic activity on the HPE and necrosis should be diligently searched in cases with high-grade nuclear morphology. HG MTC cohorts were associated with poor OS as well as DMFRS.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
BACKGROUND: According to the WHO, about 830 women die from pregnancy or childbirth-related complications globally and can be attributed to the three delays that influence the outcome of any ...pregnancy. Birth preparedness and complication readiness (BPCR) is one of the most conceptual and logical means of addressing these delays.
OBJECTIVE: The objective was to study BPCR among pregnant women visiting ANC clinic at a tertiary care government hospital in Delhi.
MATERIALS AND METHODS: It was a cross-sectional study conducted among 200 pregnant women, irrespective of gestational age visiting the hospital. Information was gathered using a pre-designed, pre-tested, semi-structured questionnaire by an interview about BPCR. Descriptive analysis was done and tests of significance were applied to determine association.
RESULTS: Awareness about dangers signs during pregnancy and childbirth and symptoms indicating onset of labor were all found to be poor, none of subjects were aware of all the signs. About 76% believed they should identify an institution for delivery ahead of time, while 68.5% had identified one and 64 (32%) had arranged a mode of transport. One hundred sixteen women (58%) believed that they should save money for the incurring costs of pregnancy, while 105 (52.5%) were saving money for the same. Sixty-three women (31.5%) agreed that it is necessary to identify a blood donor; however, only 7.5% had identified one. The BPCR index for the current study was 37.12.
CONCLUSION: Efforts should be targeted to increase the awareness about various components of BPCR along with increased involvement of community health workers and health-care providers.
Herb-based extracellular vesicles (EV), inherently replete with bioactive proteins, RNA, lipids, and other medicinal compounds, are noncytotoxic and uniquely capable of cellular delivery to meet the ...ever-stringent challenges of ongoing clinical applications. EVs are abundant in nature, affordable, and scalable, but they are also incredibly fragile and stuffed with many biomolecules. To address the low drug binding abilities and poor stability of EVs, we demonstrated herb-based EVs (isolated from neem, mint, and curry leaves) conjugated with chitosan (CS) and PEGylated graphene oxide (GP) that led to their transformation into robust and efficient vectors. The designed conjugates successfully delivered estrogen receptor α (ERα1)-targeting siRNA to breast cancer MCF7 cells. Our data revealed that neem-based EV-CS-GP conjugates were most efficient in cellular siRNA delivery, which could be attributed to hyaluronic acid-mediated recognition of neem EVs by MCF7 cells via CD44 receptors. Our approach shows a futuristic direction in designing clinically viable, sustainable, nontoxic EV-based vehicles that can deliver a variety of functional siRNA cargos.
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IJS, KILJ, NUK, PNG, UL, UM
Background: In May 2006, there was a large Chikungunya virus infection
(CHIKV) outbreak in the Nagpur district of Maharashtra, a province in
western India. Usually, CHIKV is a self-limiting febrile ...illness.
However, neurological complications have been described infrequently.
Aim: To study the clinical characteristics of various neurological
complications associated with CHIKV infections. Materials and Methods:
Patients with neurological complications following CHIKV infection
during the outbreak were the subjects of the study. On the basis of
clinical features and investigative findings, patients were grouped
into various neurological syndromes: Encephalitis, myelopathy,
peripheral neuropathy, myeloneuropathy, and myopathy. Cerebrospinal
fluid (CSF) samples were also collected for biochemical and serological
studies. Results: Of the 300 patients with CHIKV infection seen during
the study period, June-December 2006, 49 (16.3%) M : F: 42:7 had
neurological complications. The neurological complications included:
Encephalitis (27, 55%), myelopathy (7, 14% ), peripheral neuropathy (7,
14%), myeloneuropathy (7, 14%), and myopathy (1, 2%). Reverse
Transcriptase polymerase chain reaction (RT-PCR) and real-time PCR was
positive in the CSF in 16% and 18%, respectively. Conclusion: Recent
CHIKV infection was associated with various neurological complications,
suggesting neurotropic nature of the virus. The outcome of the
neurological complications is likely to be good.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background. With rapid urbanization and hectic lifestyle, there is a growing demand of pre-packaged food items. 'Food label', present on most packaged food items provides information about the ...contents, their nutritive value and other information that can help the consumer to make an informed choice. Few studies in India have assessed the consumer's knowledge and practices related to information on a food label.
Methods. We assessed the awareness, perceptions and practices related to the use of information on food labels among residents of an urbanized village of south Delhi. House-to-house visits were made and information gathered using a pre-designed, pre-tested, semi-structured questionnaire. Descriptive analysis was done and logistic regression performed to document the determinants of 'reading food label' by the study participants.
Results. A total of 368 individuals were interviewed. The mean (SD) age of the participants was 29.1 (9.7) years. Around one-fourth (97/368; 26.4%) of all participants reported buying pre-packaged foods daily. A majority (222/ 368; 60%) of participants bought pre-packaged foods because they liked the taste, and also because they were easily available (153/368; 41.7%). A total of 64.1% (236/368) reported that they read food labels, but a majority checked only for the manufacture and expiry dates (203/236; 86%). Educational status, socioeconomic status and body mass index of the study participants were found to be significantly associated with reading of labels.
Conclusions. The intention of promoting healthy food choices through the use of food labels is met inadequately at present. Awareness generation activities would be required to improve this behaviour.
The increasing burden of cancer is a cause of concern worldwide including in India. Cervical cancer is amongst the most common cancers among women associated with high morbidity and mortality. ...Younger women are at risk of acquiring human papilloma virus (HPV) infection that can lead to cervical cancer later in life. The present study is an attempt to assess awareness about cervical cancer, its prevention and HPV among young women so that future policies can be designed accordingly.
This was a cross-sectional study conducted among college-going women students of Delhi. Data was collected using a pre-designed, pretested semi-structured tool followed by descriptive statistical analysis.
Although 83% women students had heard of cervical cancer, the signs and symptoms were known to less than half (41.9%) of the students. HPV vaccine availability was known to 56.0% of the students, but very few students were vaccinated (15.0%). Similar disparity was also found in screening knowledge and practices.
With poor knowledge about risk factors, and preventive strategies among young women, this study highlights the need for health education programmes related to cervical cancer targeting young women. As most of the risk factors of cervical cancer are modifiable, awareness generation at a young age could bring about a paradigm shift in incidence and the mortality associated with it.
There are limited global data on head-to-head comparisons of vaccine platforms assessing both humoral and cellular immune responses, stratified by pre-vaccination serostatus. The COVID-19 vaccination ...drive for the Indian population in the age group 18–45 years began in April 2021 when seropositivity rates in the general population were rising due to the delta wave of COVID-19 pandemic during April–May 2021.
Between June 30, 2021, and Jan 28, 2022, we enrolled 691 participants in the age group 18–45 years across four clinical sites in India. In this non-randomised and laboratory blinded study, participants received either two doses of Covaxin® (4 weeks apart) or two doses of Covishield™ (12 weeks apart) as per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titre (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins post two doses. The secondary outcome was the frequency of cellular immune responses pre- and post-vaccination.
When compared to pre-vaccination baseline, both vaccines elicited statistically significant seroconversion and binding antibody levels in both seronegative and seropositive individuals. In the per-protocol cohort, Covishield™ elicited higher antibody responses than Covaxin® as measured by seroconversion rate (98.3% vs 74.4%, p < 0.0001 in seronegative individuals; 91.7% vs 66.9%, p < 0.0001 in seropositive individuals) as well as by anti-spike antibody levels against the ancestral strain (GMT 1272.1 vs 75.4 binding antibody units/ml BAU/ml, p < 0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p < 0.0001 in seropositive individuals). As participants at all clinical sites were not recruited at the same time, site-specific immunogenicity was impacted by the timing of vaccination relative to the delta and omicron waves. Surrogate neutralising antibody responses against variants-of-concern including delta and omicron was higher in Covishield™ recipients than in Covaxin® recipients; and in seropositive than in seronegative individuals after both vaccination and asymptomatic infection (omicron variant). T cell responses are reported from only one of the four site cohorts where the vaccination schedule preceded the omicron wave. In seronegative individuals, Covishield™ elicited both CD4+ and CD8+ spike-specific cytokine-producing T cells whereas Covaxin® elicited mainly CD4+ spike-specific T cells. Neither vaccine showed significant post-vaccination expansion of spike-specific T cells in seropositive individuals.
Covishield™ elicited immune responses of higher magnitude and breadth than Covaxin® in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of most of the vaccinated Indian population.
Corporate social responsibility (CSR) funding from Hindustan Unilever Limited (HUL) and Unilever India Pvt. Ltd. (UIPL).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: There are limited global data on head-to-head comparisons of vaccine platforms assessing both humoral and cellular immune responses, stratified by pre-vaccination serostatus. The COVID-19 ...vaccination drive for the Indian population in the age group 18–45 years began in April 2021 when seropositivity rates in the general population were rising due to the delta wave of COVID-19 pandemic during April–May 2021. Methods: Between June 30, 2021, and Jan 28, 2022, we enrolled 691 participants in the age group 18–45 years across four clinical sites in India. In this non-randomised and laboratory blinded study, participants received either two doses of Covaxin® (4 weeks apart) or two doses of Covishield™ (12 weeks apart) as per the national vaccination policy. The primary outcome was the seroconversion rate and the geometric mean titre (GMT) of antibodies against the SARS-CoV-2 spike and nucleocapsid proteins post two doses. The secondary outcome was the frequency of cellular immune responses pre- and post-vaccination. Findings: When compared to pre-vaccination baseline, both vaccines elicited statistically significant seroconversion and binding antibody levels in both seronegative and seropositive individuals. In the per-protocol cohort, Covishield™ elicited higher antibody responses than Covaxin® as measured by seroconversion rate (98.3% vs 74.4%, p < 0.0001 in seronegative individuals; 91.7% vs 66.9%, p < 0.0001 in seropositive individuals) as well as by anti-spike antibody levels against the ancestral strain (GMT 1272.1 vs 75.4 binding antibody units/ml BAU/ml, p < 0.0001 in seronegative individuals; 2089.07 vs 585.7 BAU/ml, p < 0.0001 in seropositive individuals). As participants at all clinical sites were not recruited at the same time, site-specific immunogenicity was impacted by the timing of vaccination relative to the delta and omicron waves. Surrogate neutralising antibody responses against variants-of-concern including delta and omicron was higher in Covishield™ recipients than in Covaxin® recipients; and in seropositive than in seronegative individuals after both vaccination and asymptomatic infection (omicron variant). T cell responses are reported from only one of the four site cohorts where the vaccination schedule preceded the omicron wave. In seronegative individuals, Covishield™ elicited both CD4+ and CD8+ spike-specific cytokine-producing T cells whereas Covaxin® elicited mainly CD4+ spike-specific T cells. Neither vaccine showed significant post-vaccination expansion of spike-specific T cells in seropositive individuals. Interpretation: Covishield™ elicited immune responses of higher magnitude and breadth than Covaxin® in both seronegative individuals and seropositive individuals, across cohorts representing the pre-vaccination immune history of most of the vaccinated Indian population. Funding: Corporate social responsibility (CSR) funding from Hindustan Unilever Limited (HUL) and Unilever India Pvt. Ltd. (UIPL).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Hairy Cell Leukemia (HCL) is an uncommon, indolent lymphoproliferative disorder of mature B lymphoid cells, accounting for 2% of all lymphoid tumors. The present study evaluated the ...clinical-hematological profile of HCL patients diagnosed at a single tertiary care center over a 11-year period.
The retrospective observational study was done between October 2010 and September 2021. The relevant clinical and laboratory information were retrieved from hospital medical records and electronic databases. The statistical analysis was performed using version 23.0 of SPSS.
66 (5.9%) of 1125 cases of chronic lymphoproliferative disorder were HCL. Splenomegaly was found in 47 (71.2%), hepatomegaly in 26 (39.5%), and lymphadenopathy in 17 (25.7%) of the cases. The mean hemoglobin, total leukocytes count, and platelets count were 8.04 g/dl, 6.76 X 109/L, and 77 X 109/L, respectively. Pancytopenia was detected in 40 cases (60.61 %). Bone marrow biopsies were majorly hypercellular and showed predominantly diffuse infiltration by atypical lymphoid cells. In two patients, initially thought of having refractory/hypoplastic anemia, the bone marrow biopsy and flow cytometry revealed HCL involvement. 42 cases of HCL underwent flow cytometry. CD20, CD 11c, CD 25 and CD 103 were positive in all the cases. The aberrant expression of CD5, CD10, and CD23 was found in frequencies of 5.71 %, 31.42 %, and 19.35%, respectively. In 40 cases for which follow-up information was available, there was full remission in 26 patients (65%), and later three showed relapse (7.5%) of which one died, and persistent leukemic activity in five (10%). Eight patients (20%) died even before the initiation of treatment. One patient died within one month of therapy. No patient was examined for BRAF V600E mutation analysis.
CD 10+ HCL was the most prevalent atypical immunophenotypic subgroup. Bone marrow biopsy and flow cytometry are crucial diagnostic tools to rule out hairy cell leukemia. However, BRAF V600E mutation analysis should be performed in cases with unusual presentation or resistance to treatment.
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