Centre In Mumbai Research Articles

Prevalence of pre-extensively drug-resistant tuberculosis (Pre XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) among extra pulmonary (EP) multidrug resistant tuberculosis (MDR-TB) at a tertiary care center in Mumbai in pre Bedaquiline (BDQ) era.

Drug-resistant tuberculosis (DR-TB) is the most exigent and calamitous challenge encountered in treatment of TB. Extra pulmonary (EP) DR-TB poses a complex diagnostic and therapeutic challenge owing to myriad of presentations and paucibacillary nature. Data available on this subset is limited. We studied the prevalence of EPDR-TB cases among the total DR-TB cases visiting our Programmatic management of Drug-Resistant TB (PMDT) site. We also studied the demographic and microbiological profile of these cases and analyzed the prevalence of pre-extensively drug-resistant TB (pre XDR-TB) and extensively drug-resistant TB (XDR-TB) among patients of EPDR-TB in pre Bdq era. Of the 1086 DR-TB patients, 64 (5.89%) were cases of EPDR-TB. Seven out of 64 (10.93%) were primary EPDR-TB. The site wise distribution of cases was 34 (53.125%) lymph node DR-TB, 18 (28.125%) pleural DR-TB, 9 (14.0625%) spinal DR-TB/paraspinal abscess/psoas abscess, 1 case (1.5625%) each of abdominal DR-TB, sternal and gluteal abscess. On the basis of the second-line drug susceptibility testing (DST), patients were grouped into: (1) multidrug-resistant TB (MDR-TB), (2) MDR-TB with fluoroquinolone (FQ) resistance {pre XDR XDR-TB (FQ)}, (3) MDR-TB with second-line injectable (SLI) resistance {pre XDR XDR-TB (SLI)}, (4) XDR-TB. Of the 64 patients, 43 (67.185%) had MDR-TB, 19 (29.687%) had preXDR-TB (FQ), none had preXDR-TB (SLI) and 2 (3.125%) had XDR-TB. Gastro esophageal reflux disease (GERD) was the most common comorbidity seen in 26 (40.6%) patients, followed by anemia in 5 (7.8%), psychiatry problems 5 (7.8%), hypertension in 3 (4.6%), renal disorders in 2 (3.1%) while thyroid disorder, HIV and thalassemia in 1 each (1.5%). EPDR-TB forms a small but significant proportion of total DR-TB. Lymph node DR-TB is its most common subclass. Our study emphasises the momentousness and essentiality of baseline DST to FQ and SLI in patients of DR-TB. This enables an appropriate modification of therapy at baseline itself to better the treatment outcomes. We observed a strikingly high proportion of preXDR-TB (FQ) in our study group.

Different presentation of autoimmune hepatitis in children: Case series.

Autoimmune hepatitis (AIH) is a disorder causing chronic hepatic inflammation. Its clinical presentation is highly variable from the affected child might have only biochemical evidence of liver dysfunction or present in hepatic failure. It is important to distinguish AIH from other forms of chronic hepatitis because a high percentage of cases respond to immunosuppressive therapy. In this article, we describe the clinical presentation, biochemical and histological findings, treatment, and clinical outcome of the four children with AIH in a tertiary care center in Mumbai. Most patients with AIH have high levels of immunoglobulin. All four cases showed high serum Ig G levels and responded to oral prednisolone only. AIH should be excluded for all patients with symptoms or signs of prolonged, relapsing, or severe liver disease so that treatment can be promptly initiated and morbidity can be reduced.

Drug resistance patterns and treatment outcomes in DR-TB patients at a tertiary care centre in Mumbai

BackgroundDrug-resistant tuberculosis (DR-TB) is a major health problem and threatens Tuberculosis (TB) control and outcomes globally. India holds one-fourth of global DR-TB burden.1 Aims1- To study drug resistance patterns and outcomes in DR-TB patients under National Tuberculosis Elimination Programme (NTEP) at a tertiary care-centre. 2- To correlate outcome of DR-TB with drug resistance patterns. MethodsIt is a retrospective study of 302 Drug Resistant Tuberculosis patients from Jan 2020 to May 2022. Common mutations of drug resistance, pyrazinamide resistance in DR-TB patients, correlation of High dose Moxifloxacin sensitivity by Line Probe Assay (LPA) and drug sensitivity test (DST), outcome of DR-TB patients with drug resistance patterns and correlation of outcome of DR-TB patients with their initial body-weight were studied. ResultsKat G was the most common mutation in Isoniazid (96%) resistance for MDR TB as well as Isoniazid Mono-resistance TB (p = 0.001). 91% cases with MDR-TB were resistant to pyrazinamide. 51.2% cases had low dose Fluroquinolone resistance. 18.8% cases had low and high dose Fluroquinolone resistance. 8.5% cases had resistance to injectables. 21.7% of cases who were resistant to High dose Moxifloxacin on second line LPA were found to be sensitive on DST. Outcomes were not dependent on the LPA resistance patterns. Body-weight greater than 45 Kg at the time of initiation of treatment was associated with better outcomes (p = 0.007). ConclusionDR-TB patients are resistant to pyrazinamide in nearly all cases; hence pyrazinamide is not suitable for initial replacement sequence. Second line resistance doesn't impact outcome in DR-TB patients.

Nail Changes in Immuno-Bullous Disorders: A Cross-Sectional Study.

Autoimmune blistering (AIBD) disorders affect mucosae, skin, and appendages. Appendageal involvement has not been studied extensively to date. However, they are important as nail changes are commonly encountered during a flare-up of the disease. To determine the prevalence and patterns of nail changes in various Immunobullous disorders and to study the relationship between the nail changes and the disease duration and severity. A cross-sectional study was conducted at the Department of Dermatology, venerology, and leprosy at a tertiary care center in Mumbai. A cross-sectional study including a total of 74 cases of Immunobullous diseases was conducted and the prevalence of nail changes was determined. The association between the mean number of nail changes and the disease duration and severity was analyzed using ANOVA (Analysis of variance) and unpaired t-test. The Statistical Package for Social Studies (SPSS) software was used for statistical evaluation. We found that the prevalence of nail changes was 91%. There was a significant difference in the mean number of nail changes with respect to the severity grades of mucosal involvement in AIBD (P value < 0.05). There was no significant difference in the mean number of nail changes with respect to the severity grades of Pemphigus vulgaris (PV), Pemphigus foliaceous (PF), subepidermal blistering diseases, and the duration of AIBD. Nails are frequently affected in AIBD. The number of nail changes is related to the severity of mucosal disease but not to duration.

Role of education and income on disparities of time-to-treatment initiation and its impact on cervical cancer survival.

In India, cervical cancer is the second-leading cause of cancer incidence among women. Socioeconomic factors play a vital role in cervical cancer survival. This study assessed the role of education and income on disparities in time-to-treatment initiation (TTI) and its impact on cervical cancer survival. This was a retrospective facility-based record study conducted among newly treated cervical cancer patients registered in a tertiary medical care center in Mumbai between 2014 and 2016. Adjusted hazard ratio with a 95% confidence interval was reported. In total, 1947 cervical cancer patients with a mean age of 52.89 (±10.55) years were included. The average number of days for TTI among highly educated patients was 27 versus 35 days for patients with no formal education. An increasing trend in survival was observed as education levels shift from no formal to higher education category (75.54%, 77.30%, and 85.10%, P = 0.01). All cause mortality was lower in cervical cancer patients with secondary education and above than illiterates (hazard ratio [HR] = 0.63, P < 0.01), among those with higher income (HR = 0.78, P = 0.04) than lower income and among who started on treatment within 30 days (HR = 0.90, P = 0.29) than patients who started treated after 30 days. Inferior survival is found for cervical cancer patients with lower education and income and who initiated treatment after 30 days. Hence, it is important to improve awareness and screening activities, especially among the lower socioeconomic groups, for early diagnosis and better treatment outcomes.

Palliative care needs assessment in patients with metastatic and locally advanced oesophageal cancer

Background Palliative care plays an important role in improving symptom burden and quality of life for patients with incurable oesophageal cancers. There is a dearth of studies regarding palliative care needs in advanced oesophageal cancer patients. Aim To understand the unmet palliative care needs and the associated factors in advanced oesophageal cancer patients. Design We conducted a cross-sectional observational study. Study/Participants We recruited 50 patients in the Thoracic Oncology OPD in a tertiary cancer centre in Mumbai, India, who were newly diagnosed with locally advanced, unresectable, or metastatic Oesophageal Cancer. The recruited patients’ concerns were assessed using Needs Assessment Tool-Progressive Disease Cancer (NAT-PDC) and symptom burden was assessed using Edmonton Symptom Assessment Score (ESAS). A Chi-square test was performed for correlating different factors with some or significant concerns, considering p ≤ 0.05 as statistically significant. Results Oesophageal cancer patients had concerns in physical (94%), financial (94%), psychological (82%), sociocultural (76%), activities of daily living (70%) and spiritual (58%) domains. They had a high symptom burden, most common symptoms being dysphagia, pain and tiredness. Anxiety and depression were associated with higher psychological and spiritual concerns. Older age, female gender and low financial income were associated with higher levels of concerns. Caregivers were most concerned about their patients’ physical symptoms (94%) and financial issues (92%). Conclusion Patients with advanced oesophageal cancer have significant burden of unmet palliative care needs. This should trigger referrals to specialist palliative care for comprehensive care of patients and their caregivers.

Epidemiological Trend of Esophageal Cancer at a Tertiary Cancer Center in Mumbai, India, Over the Past 15 Years.

In developed countries, there has been a definite change in the histopathological spectrum of esophageal cancer towards adenocarcinoma. There are limited data from India regarding the histopathological profile of patients with esophageal cancer. We retrospectively evaluated patients with histologically proven esophageal cancer who were registered at the Tata Memorial Hospital (Mumbai, India) between 2003 and 2018. The primary aim of the study was to analyze the time-trend of the histological pattern of esophageal cancer. Our secondary objectives included evaluating whether there was any correlation between the histology of the esophageal cancer and the age, sex, socioeconomic status (the paying ability of the patient, which was reflected in the treatment category of the patient, i.e., private [full payment], general [subsidized payment], or no charge), comorbidities, and a history of substance abuse. Among 7874 patients with esophageal cancer, 5092 (64.7%) were men, with a male-to-female ratio of 1.8:1. The median age was 57years (IQR, 50-65). Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, 1360 (27.7%) had no history of substance abuse. A majority of the tumors (2942, 37.4%) originated in the middle-third of the esophagus. Squamous cell carcinoma was the predominant histological type, noted in 6413 (81.4%) patients and remained the most common histologic type consistently through the study with no evidence of a time-trend in the histological pattern. On the multivariate analysis, female sex and a history of substance abuse were associated with higher odds of squamous cell carcinoma, while the presence of comorbidities and lower esophageal/gastroesophageal junction primaries were associated with higher odds of adenocarcinoma. There is no evidence of an epidemiological shift in the histopathologic spectrum of esophageal cancer in India over the last two decades. Four out of five Indian patients with esophageal cancer have squamous cell histology, with the commonest site of origin being the middle third. This is important to recognize, given the varying molecular spectrum and efficacy of therapeutic modalities based on histopathology.

Study of fetomaternal outcomes in eclampsia in correlation to coagulation profile in a tertiary care center in Mumbai

Background: Eclampsia is the leading cause of maternal and perinatal mortality as well as morbidity. The present study was conducted to assess the severity of eclampsia and coagulopathy by a method that is rapid, cheaper, and easily available and to assess the clinical evaluation and comparison of the fetomaternal outcomes in eclampsia with normal and deranged coagulation profiles. Aims and Objectives: This study aims to assess the severity of eclampsia and coagulopathy by a method that is rapid, cheaper, and easily available and to assess the clinical evaluation and comparison of the fetomaternal outcomes in eclampsia with normal and deranged coagulation profiles. Materials and Methods: A hospital-based prospective case–control study was done at tertiary care institute in the department of obstetrics and gynecology over a period of 1½ years from February 2018 to August 2019. Template was generated in MS Excel sheet and analysis was done on SPSS software. Results: Overall incidence of eclampsia was found to be 2.4%. Majority of the eclampsia patients in both normal coagulation profile group and deranged coagulation profile group were in the age group of 21–25 years (42.8% and 46.6%, respectively). The most common maternal outcome in the eclampsia patients with both normal (50%) and deranged (36.6%) coagulation profile was operative intervention, that is, lower segment cesarean section, followed by the requirement of maternal intensive care in critical care unit or medical intensive care unit. The least common fetal outcome among those with normal coagulation profile being neonatal death and still birth accounting for 2.85% of cases each whereas among those with deranged coagulation profile, the least common outcome being very low birth weight accounting for 3.33% of cases. Of the 46 eclampsia mothers who underwent operative intervention, 93.47% had normal platelet counts and 6.52% had thrombocytopenia. Of the eight neonatal deaths, 50% were among those of eclampsia mothers with normal platelet count and 50% among those with thrombocytopenia. Conclusion: In the present study, eclampsia accounted for 2.3% of all deliveries. Hence, relevant investigations need to be promptly done to identify the derangement of the coagulation profile in cases of eclampsia and pre-eclampsia which can alert the obstetrician of the severity of the disease so that appropriate and timely management can be initiated to prevent adverse outcomes.

Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India.

BackgroundPeople with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai.MethodsThe cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity.ResultsAmong 2,390 patients, the majority (74.5%) had CD4 between 101–200 cells/mm3. The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm3, the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm3, the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests.ConclusionThe study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

IMPACT OF COVID-19 PANDEMIC RESPONSE ON THE UPTAKE OF ROUTINE CHILDHOOD IMMUNISATION AT A TERTIARY CARE CENTRE IN MUMBAI.

Background The COVID-19 pandemic response has impacted the delivery of healthcare, including routine childhood immunisation. This manuscript studies the extent of this impact. To assess the decline in daily average routine childhood immunisation uptake compared toObjectives the baseline level and to assess the problems faced by the beneciaries in accessing the immunisation services during the pandemic period at a tertiary care centre in Mumbai. Data of daily routine childhood immunisations in the year 2019 and 2020 was collected from theMethods immunisation records register of Child Welfare Centre (CWC) of the tertiary care centre. The baseline (2019) and the COVID-19 lockdown period data were compared to analyse the impact on daily routine childhood immunisation uptake. Guardians of beneciaries visiting the CWC from 24 December 2020 to 23 January 2021 were interviewed using a questionnaire to study the causes of delayed/missed immunisations. ThereResults was 24.62% decline (p&lt;0.05) in the number of immunisations administered in 2020 compared to 2019. Fear of COVID-19 infection (45.9%), migration to hometown due to lockdown (13.11%), travelling restrictions during lockdown (9.84%) and miscellaneous reasons (31.15%) were the reasons given by the 93 guardians interviewed for delayed/missed immunisations (63.16%). COVID-19 pandemic response has led toConclusion a disruption in immunisation services, leading to a drop in uptake. Childhood immunisation and implementation of strategies to achieve signicant immunisation coverage should be prioritised during pandemics.

Hematological and hepatic profile of dengue patients presenting to a tertiary care hospital in Mumbai

Objective: To assess the pattern of hematological and hepatic involvement in patients of dengue fever. Methods: This study was performed in a tertiary care center in Mumbai, India. 142 patients diagnosed with dengue who were admitted between January 2016 to December 2017 enrolled for the study. Patients Demographic data, clinical history, examination findings, and investigations including complete blood count and liver profile were done. Results: Highest incidence of dengue was seen in the age group of 21-30. More males were affected than females. Highest incidence was seen in monsoon months in Mumbai (August-September). Commonest symptom was fever followed by rigor, chills, bodyache and headache. Altered sensorium was the rarest. In investigations thrombocytopenia was the commonest followed by raised AST and ALT. Conclusion: As Dengue causes significant mortality and morbidity,there is excess burden on healthcare infrastructure of metro cities in India, knowing about the disease behavior is of paramount importance. Doing simple and easily available investigations can be vital in predicting disease severity and need of inpatient and intensive care in Dengue patients.

Real-world evidence of the effectiveness and safety of generic tofacitinib in rheumatoid arthritis patients: a retrospective, single-centre analysis from Western India.

Generic tofacitinib has been available in India for more than a year and is widely used in rheumatoid arthritis (RA) therapy. There is scarce real-world data on its effectiveness and safety from India, especially given infection endemicity. We retrospectively analysed records (demographic and clinical information, haematology and biochemistry, adverse events) of patients prescribed generic tofacitinib from a single centre in Mumbai, India. Disease activity was calculated using the disease activity score-28 and erythrocyte sedimentation rate (DAS28-ESR) and other tools, and we used paired T-tests for significant response. We defined clinical tofacitinib failure as a composite outcome, including clinician’s decision to change to an alternative disease-modifying anti-rheumatic drug (DMARD) or flare after self-withdrawal. We performed logistic regression and survival analysis for determinants of clinical failure. We reviewed records of 102 patients (92 female; median age: 53 years) with mean RA duration of 146 months. Thirteen had prior treatment with innovator tofacitinib. There was significant improvement in disease activity parameters at a mean duration of 186 days. No serious adverse events were reported; 4 patients had tuberculosis and 19 patients had mild COVID-19 while on treatment. Clinical failure was seen in 25 patients, and mean time to failure on survival analysis was 357 days. No baseline characteristic predicted clinical failure. Generic tofacitinib showed good effectiveness and a tolerable adverse effect profile, despite tuberculosis endemicity and COVID-19. Setting up registries would be valuable in gaining more data on generic tofacitinib.Key Points• There is scarce data from India regarding the use of tofacitinib in rheumatoid arthritis, despite widespread use.• In this retrospective analysis of 102 patients at a single centre, we found tofacitinib monotherapy was efficacious and tolerable.• Tuberculosis was detected in four and nineteen patients had mild covid.

Age, growth and mortality parameters of Indian oilsardine Sardinella longiceps Valenciennes, 1847 from Mumbai waters, off Maharashtra, India

Age, growth and mortality parameters of Sardinella longiceps Valenciennes, 1847 were studied based on the lengthfrequency data of 785 individuals collected on weekly basis from New Ferry Wharf, Sassoon Docks and Versova landing centres in Mumbai from September 2013 to May 2014. The data were analysed through ELEFAN employing the FiSAT program. Asymptotic length (L∞), growth coefficient (K) and age at zero-length (to ) were estimated at 233 mm, 1.51 y-1 and -0.000022, respectively. The von Bertalanffy growth formula indicated that the fish reaches 182, 221 and 230 mm at the end of 1, 2 and 3 years of life, respectively. Total (Z), natural (M) and fishing (F) mortalities were estimated at 4.82, 2.46 and 2.36 y-1, respectively. The estimated M/K ratio falls within the range for the accurate estimation of natural mortality coefficient, indicating that the M and K estimates are reasonable and reliable. With exploitation rate of 0.48 and the fishing mortality being only slightly lower than the natural mortality, it can be concluded that the stock is exploited to near optimum levels in the region.Keywords: Asymptotic length, ELEFAN, Growth coefficient, Modal progression analysis, Mortality parameters

Trends of a syndromic approached based respiratory PCR during the second wave of the COVID 19 pandemic in a tertiary care center in Mumbai

PurposeThe clinical presentation of COVID 19 disease caused by Severe Acute Respiratory Syndrome Related Coronavirus – 2 (SARS-CoV2) is similar to other causes of upper respiratory viral infections caused by influenza, epidemic corona viruses, Parainfluenza virus etc. This study was undertaken to study the presence of different pathogens in the nasopharyngeal samples of symptomatic patients visiting the COVID OPD or the Emergency services over six month duration.Methods & MaterialsThis was a prospective study from Dec 2020 to May 2021 conducted in a 220 bed tertiary care hospital in Mumbai. We are a designated COVID care hospital with 55 isolation beds including 16 beds in the COVID ICU, a dedicated OPD for symptomatic patients and Emergency services (EMS). The test was performed on a syndromic approach based respiratory PCR with 22 targets inclusive of SARS-CoV2. Nasal and a pharyngeal swab samples (NPS) were collected and the results of the test were available in 1.5 hours from sample receipt to the lab.ResultsA total of 335 patient samples were received during the study period for the syndromic approach based PCR. 133 (39.7%) of the symptomatic patients had a positive test result. 87(26%) SARS-CoV2 and 27(8.05%) Rhinovirus/Enterovirus (RhV/EV) were the two common viruses that were identified during the study duration. Other viruses, like Parainfluenza 3 (PIV3), Coronavirus 229E (229E), Coronavirus HKU1 (HKU1), Influenza AH3 (AH3), H1N1, Coronavirus OC43 (OC43) and Adenovirus were also identified. We observed co-infections 1 each of RhV/EV+AH3, RhV/EV + OC43, SARS-CoV2 +PIV3 and 2 cases of SARS-CoV2+HKU1. The trend indicated the appearance of the 2nd wave of SARS-CoV2 infection that Mumbai experienced between 1st March to 15th May 2021. Other pathogens were mostly seen in the symptomatic population especially before and after the 2nd wave.ConclusionOur study documented the appearance of the second wave in Mumbai between 1st March to 15th May 2021. Approximately,34.5% of patients has other respiratory pathogens detected in the syndromic PCR. This is the 1st study from Mumbai documenting the types of respiratory pathogens and co infections seen during the 2nd wave of the COVID 19 pandemic in Mumbai.

Genomic Analysis of AZD1222 (ChAdOx1) Vaccine Breakthrough Infections in the City of Mumbai.

Background This manuscript describes the genetic features of SARS-CoV-2 mutations, prevalent phylogenetic lineages, and the disease severity amongst COVID-19-vaccinated individuals in a tertiary cancer hospital during the second wave of the pandemic in Mumbai, India. Methods This observational study included 159 COVID-19 patients during the second wave of the pandemic from 17th March to 1st June 2021 at a tertiary cancer care centre in Mumbai. The cohort comprised of healthcare workers, staff relatives, cancer patients, and patient relatives. For comparison, 700 SARS-CoV-2 genomes sequenced during the first wave (23rd April to 25th September 2020) at the same centre were also analysed. Patients were assigned to nonvaccinated (no vaccination or <14 days from the 1st dose, n = 92), dose 1(≥14 days from the 1st dose to <14 days from the 2nd dose, n = 29), and dose 2 (≥14 days from the 2nd dose, n = 38) groups. Primary measure was the prevalence of SARS-CoV-2 genomic lineages among different groups. In addition, severity of COVID-19 was assessed according to clinical and genomic variables. Results Kappa B.1.1671.1 and delta B.1.617.2 variants contributed to an overwhelming majority of sequenced genomes (unvaccinated: 40/92, 43.5% kappa, 46/92, 50% delta; dose 1: 14/29, 48.3% kappa, 15/29, 51.7% delta; and dose 2: 23/38, 60.5% kappa, 14/38 36.8% delta). The proportion of the kappa and delta variants did not differ significantly across the unvaccinated, dose 1, and dose 2 groups (p = 0.27). There was no occurrence of severe COVID-19 in the dose 2 group (0/38, 0% vs. 14/121, 11.6%; p = 0.02). SARS-CoV-2 genomes from all three severe COVID-19 patients in the vaccinated group belonged to the delta lineage (3/28, 10.7% vs. 0/39, 0.0%, p = 0.04). Conclusions Sequencing analysis of SARS-COV-2 genomes from Mumbai during the second wave of COVID-19 suggests the prevalence of the kappa B.1.617.1 and the delta B.1.627.2 variants among both vaccinated and unvaccinated individuals. Continued evaluation of genomic sequencing data from breakthrough COVID-19 is necessary for monitoring the properties of evolving variants of concern and formulating appropriate immune response boosting and therapeutic strategies.

Impact of evolution of molecular technologies on evaluation of Neuromuscular Disorders in India at a Centre in Mumbai.

Abstract:&#x0D; Advances in molecular methods has made genetic testing as an imperative parameter, to be used in research studies and clinical practice. The present article includes the evolution of Molecular Diagnostic techniques over a period of two decades leading to the corresponding expansion in identification &amp; classification of various Neuromuscular disorders in the population of mainly Western India.&#x0D; Initially conventional testing was done by mPCR, RFLP-PCR for single gene disorders like DMD/BMD &amp; SMA respectively; followed by MLPA technique, for deletion duplication analysis. Under a research study, immuno-specific Western Blot was used for protein analysis as an initial screening tool for LGMD2B. Sangers sequencing was done for single gene (for a few LGMD2B cases) &amp; known familial variants of LGMD2B &amp; LGMD2A and GNE myopathy. Availability of Next generation sequencing technique involving massive parallel sequencing of multiple genes, improved the possibility of identifying the disease causing/ pathogenic mutations in phenotypically overlapping NMDs like LGMDs and Hereditary Neuropathies.&#x0D; Since last 12 years, over 2,600 patients from mainly western India have been analysed for various neuromuscular disorders. Carrier status of relatives of the probands was also determined in many of the cases. These molecular technologies have enabled to attained definitive diagnosis of different neuromuscular disorders in India. The diagnostic and predictive data generated helps in better management of the disease. It also has immense relevance in carrier and prenatal testing for the families at risk, thereby limiting the occurrence of the diseases in the population.&#x0D;

Screening for Early Detection of Cervical Cancer in Women Living with HIV in Mumbai, India - Retrospective Cohort Study from a Tertiary Cancer Center

Abstract Introduction Women living with human immunodeficiency virus (HIV) have an increased risk of persistent human papillomavirus infection (HPV) of developing cervical cancer precursors and are, therefore, considered at higher risk for cervical cancer. Despite the higher risk, screening for cervical cancer is extremely low among HIV-positive women in India. Objectives Given the limited usefulness of cytology-based screening programs, the current study retrospectively evaluated the comparative performance of visual inspection with 5% acetic acid (VIA), conventional cytology, and human papillomavirus (HPV) testing among HIV-positive women attending the cancer screening clinic at the tertiary cancer center. Materials and Methods Retrospective analysis of 291 HIV-positive women attending cervical cancer screening services in a tertiary cancer center in Mumbai was undertaken. All underwent simultaneous screening with VIA, Pap cytology, and HPV DNA testing, followed by diagnostic colposcopy and histopathology. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to detect cervical intraepithelial neoplasia (CIN) 2/3 on histology were estimated. Results The screen positivity rate for cervical cancer screening by VIA, high-risk HPV DNA, and Pap cytology was 35.7, 34.4, and 6.2% respectively. At the CIN2+ disease threshold, the sensitivity, specificity, PPV, and NPV estimates were 80.00% (59.30–93.17), 68.42% (62.46–73.96), 19.23% (15.46–23.67), 97.33% (94.30–98.77) for VIA; 80.00% (68.78–97.45), 70.68% (64.81–76.08), 22.00% (18.22–26.32), 98.43% (95.58–99.45) for HPV DNA; and 64.00% (42.52–82.03), 98.12% (95.67–99.39), 76.19% (56.13–88.89), 96.67% (94.50–98.00) for cytology (HSIL cutoff). Conclusion The diagnostic performance of VIA and HPV DNA was comparable and better than cytology indicating that VIA as a cost-effective cervical cancer screening test can be incorporated within the services under sexually transmitted diseases /HIV testing and counseling centers within the country.

Physician Voices on ECHO Autism India-Evaluation of a Telementoring Model for Autism in a Low-Middle Income Country.

Training pediatricians in low- and middle-income countries (LMICs) in early diagnosis and comprehensive management of autism spectrum disorder (ASD) is crucial to ensure optimal developmental outcomes for a substantial number of children with ASD in this region. This study evaluates the relevance and effectiveness of an evidence-based telementoring model Extension for Community Healthcare Outcomes (ECHO) Autism in increasing pediatricians' access to best-practice care for children with ASD in LMIC contexts. ECHO Autism was launched by a ‟hub" team of multidisciplinary ASD experts at a child development center in Mumbai, India. The culturally modified model included 13 biweekly sessions conducted annually using video-conferencing technology. Sessions combined expert-delivered didactics and facilitated case-based discussions on best-practice methods in screening, diagnosing, and managing autism and its comorbidities. Sixty-two physicians, including 59 pediatricians across 2 cohorts (2019-2020), participated in the mixed-methods study to evaluate participants' reactions, knowledge, behaviors, and impact on children and families. Participants represented a broad geographic reach across India (n = 47) and other LMICs (n = 15). Both quantitative and qualitative data revealed high levels of participant satisfaction and improved knowledge and self-efficacy in ASD diagnosis and management. Qualitative themes highlighted the adult-learning processes of ECHO Autism that participants considered novel and beneficial, such as reflective discussions, respectful mentoring, having a parent as ‟expert," and cultural relevance, alongside changes in practice behaviors. ECHO Autism clinics facilitated by local experts in LMICs can improve access to early diagnosis and evidence-based, comprehensive management for children with ASD and their families by positively influencing pediatricians' knowledge, attitudes, and practice behaviors.

Assessment of Palliative Care Needs among People Living with HIV/ AIDS Attending Antiretroviral Therapy Outpatient Department in an Urban Slum of Mumbai: A Mixed Method Study.

Objectives:According to WHO, Palliative care is an essential component of a comprehensive package of care for people living with HIV/AIDS. Lack of palliative care results in untreated symptoms that hamper an individual’s ability to perform daily activities. The study aimed to explore the perceived Palliative care needs of People Living With HIV/AIDS and the association between socio- demographic profile with Palliative care needs.Materials and Methods:It was a mixed method study conducted over 2 months in November and December 2020 at Link ART OPD of Urban Health Training Centre in Mumbai. Out of 120 registered patients,15 patients were selected for in-depth interview by purposive sampling. The remaining 105 patients were selected for quantitative part of the study by complete enumeration method. For Qualitative part, Thematic analysis of the transcripts was done. Data were coded using Microsoft word comment feature. Themes and categories were drawn from it. For Quantitative part, Data analysis was done using SPSS version 22. Chi- square test was applied to find out the association between socio- demographic profile & palliative care needs. P value < 0.05 was considered statistically significant.Results:The major themes identified were poor attitude towards the disease, lack of support and role of counselling. The common palliative care needs identified were need for financial assistance, family support and psychological support.Conclusions:Palliative care should be introduced early in the care process by a team of providers who is aware of the patient’s history and requirements.