Medical Research Institute Research Articles

Effectiveness of Om chanting on perceived stress, negative affectivity, and social inhibition in individuals with pre-hypertension

Background: Akara, Ukara, Makara (OUM) chanting regulates emotions and removes negative emotions by inactivating the processing in the amygdala. At the same time, the prefrontal complex was inhibited followed by chanting OUM. Further, there was an increase in the oxygenation levels followed by chanting OUM. Hence, OUM chanting has multiple benefits and offers improvement in the quality of life. Though there are multiple benefits followed by chanting OUM, the scientific evidence for the same is comparatively less. Hence, there is a need for more studies in this area. Aims and Objectives: The present study aimed to find out the variations in the perceived stress, negative affectivity, and social inhibition in pre-hypertensive individuals and also to observe the effectiveness of Om chanting on perceived stress, negative affectivity, and social inhibition in pre-hypertensive individuals. Materials and Methods: The present study was conducted at the St Peter’s Medical College Hospital and Research Institute, Hosur, Tamil Nadu, India. A total of 50 young adults with pre-hypertension were recruited in the study after obtaining written informed consent. Age- and gender-matched 50 healthy participants were recruited after obtaining the voluntary, informed consent. Diamond digital sphygmomanometer was used to record the blood pressure. All the parameters were recorded at 9 am for the convenience of the participants and also to avoid diurnal variation. The perceived stress scale was used to assess the stress levels. Negative affectivity and social inhibition were recorded using a type D (DS-14) questionnaire. Cases practiced the OUM chanting for 6 weeks after they were trained by an expert yoga therapist. Results: Perceived stress scores were significantly decreased followed by the OUM chanting. There was a significant decrease in the scores of negative affectivity of cases after the intervention when compared with control group participants. There was a significant decrease in the scores of social inhibition of cases after the intervention when compared with control group participants. Conclusion: Perceived stress, negative affectivity, and social inhibition were significantly higher in the pre-hypertensive individuals. The study results provide further evidence that practicing OUM chanting causes stress relief and also decreases the negative emotions that is negative affectivity and social inhibition in pre-hypertensive individuals.

Prehospital Factors Associated with Delayed Hospital Arrival of Stroke Patients: A Regional Single-Center Study from India.

Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as "early arrival" and those who arrived after 4.5 h were considered as "delayed arrival." Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040-8.757], P < 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864-7.522], P < 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018-1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028-1.116], P < 0.001) for prehospital delay. Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay.

Decentralising chronic disease management in sub-Saharan Africa: a protocol for the qualitative process evaluation of community-based integrated management of HIV, diabetes and hypertension in Tanzania and Uganda

IntroductionSub-Saharan Africa continues to experience a syndemic of HIV and non-communicable diseases (NCDs). Vertical (stand-alone) HIV programming has provided high-quality care in the region, with almost 80% of people living...

Blood Donor Selection Profile an Important Tool for Blood Safety: An Institutional Experience

Background and Aim: Blood transfusions can be a crucial, life-saving treatment in modern medical and surgical practice. The primary objective of blood transfusion services worldwide is to guarantee the availability of a sufficient and safe supply of blood and blood products. Meticulous donor screening and use of highly sensitive techniques for the detection of transfusion-transmitted infections (TTIs) may help reduce the risk of TTIs and, hence, are important steps to ensure safety for both donor and recipient. Materials and Methods: This is a retrospective record-based study done at Hamdard Institute of Medical Sciences and Research. The blood donors’ data from January 2012 to December 2022 (10 years) were collected from the blood bank registry at the study site and were analyzed. Results: Males dominated the donor population (98.2%) with females comprising only (1.8%). In total, 10.9% were found unfit for donation for various reasons. Voluntary donors were (6.3%) and replacement donors were (93.7%). Out of the reasons for deferral, majority 497/1223 (40.6%) donors were deferred due to hemoglobin &lt;12.5 g/dl, followed by 156/1223 (12.8%) deferrals due to alcohol intake within the past 72 h. Conclusion: Safe donor selection is the first step toward safe transfusion services. Identification of population groups that can be targeted to enhance the pool of willing blood donors is made easier by studying and analyzing the blood donor profile.

A prospective observational study of predictive factors for conversion of laparoscopic to open cholecystectomy

Background: Cholelithiasis affects about 10 to 15% of general population. LC became the procedure of choice for management of symptomatic gallstone disease for its minimally invasive nature, minimal pain and earlier recovery. Methods: This study was carried out on 300 consecutive patients who underwent LC for gall stone disease (patients falling under inclusion criteria) in the Department of General Surgery, The Calcutta Medical Research Institute, Kolkata. Results: In this study 9% patient were converted to open cholecystectomy while 91% of the patient underwent successfully LC. Increased wall thickness of gall bladder (p=0.01), pericholecystic fluid collection (p=0.04), stone impaction at gall bladder neck (p=0.001), pain abdomen (acute cholecystitis, recurrent acute cholecystitis) (p=0.03), previous abdominal surgery (p=0.001), pre-operative jaundice (p=0.005) were found significant in this study for conversion to open surgery. Increased TLC, total bilirubin, alkaline phosphatase, alanine transaminase and aspartate transaminase (p&lt;0.05) were also risk factors for conversion to open surgery. Conclusions: We conclude that LC is the gold standard treatment for gall stone disease. Identification and safeguarding the bile ducts and arteries is of utmost importance while performing LC.

A Retrospective Study of the Relationship Between Typhoid and Vestibular Disorders- A Case Series

Background: Typhoid fever is caused by Salmonella enterica serovar Typhi (Salmonella Typhi). faecal-oral is the main route of transmission by contaminated water or food. Over the last few years, the classic presentation of typhoid fever has varied, and the cases with atypical presentation are increasing. In this study we are presenting a retrospective evaluation of patients presenting with giddiness post history of typhoid, to correlate a link between vestibular disorders and typhoid. Aims and Objectives: To retrospectively study the relationship between typhoid and vestibular disorders. Materials and Methods: This is a retrospective hospital-based case series conducted in vertigo clinic in The Department of ENT at SGT Medical College Hospital and Research Institute, Budhera, Gurugram. Five patients who gave positive history of typhoid, their case files were retrospectively evaluated. All the patients were made to undergo routine ENT, vertigo, and audiological evaluation. Results: Total of 5 patients presented to vertigo clinic at SGT hospital with complains of giddiness, all of them gave a history of typhoid in the past few weeks. Majority of patients presented with giddiness within four weeks after history of typhoid infection. Patients developed symptoms of giddiness, nausea, and vomiting. Out of 5 patients,4 were females and one male. Two patients were in the age group of 30-40 years. Two patients were in paediatric age group. On examination, Dix Hallpike test was positive in 3 patients. Patients were treated with vestibular sedatives and corrective manoeuvre like Epley’s. Pure tone audiometry, MRI brain and lab parameters were all normal in all the five patients. Conclusion: Endotoxins of the typhoid bacillus are capable of producing cochleovestibular lesions but only a few isolated reports suggest the same. Since very few literatures has been discussed on the possible correlation between vestibular disorders and typhoid, clinicians should be aware of atypical presentations of typhoid is to avoid any delay in diagnosis and prompt treatment. Therefore, there is a strong need to analyse and study the corelation between typhoid fever and vestibular disorders.

Role of Cerebroplacental Ratio in Predicting Perinatal Outcome.

Objective Doppler velocimetry provides a sensitive, non-invasive, and safe method of surveillance of fetal hemodynamics and fetomaternal circulation. Cerebroplacental ratio (CPR) is an indicator of placental function and fetal maladaptation to placental insufficiency. Cerebroplacental ratio (CPR) is becoming a significant indicator of unfavorable pregnancy outcomes, which has implications for the assessment of fetal well-being. This study aimedto determine the cut-off value of the cerebroplacental ratio (CPR) in appropriate for gestational age (AGA) fetuses in high-risk mothers to predict adverse perinatal outcomes. We also compared the efficacy of CPR, umbilical artery pulsatility index (UmA PI), and middle cerebral artery pulsatility index (MCA PI) for predicting adverse perinatal outcomes. Design and setting This was a prospective observational study conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Methods A total of 100 women with singleton high-risk pregnancies were included in this prospective observational study. Obstetric ultrasound was performed at the time of recruitment, and fetal weight and CPR were noted. Based on fetal weight, patients were divided into AGA and fetal growth restriction (FGR) groups; CPR was measured; patients were followed up fortnightly; and outcomes were noted. Main outcome The effectiveness of CPR, UmA PI, and MCA PI for predicting poor perinatal outcomes and identifying the cut-off value of CPR in appropriate for gestational age (AGA) fetuses in high-risk mothers was assessed. Result The values of MCA PI, UmA PI, and CPR were statistically significant between AGA and FGR (p-value =.023, .002 and .0001), respectively. The cut-off value for CPR-detecting adverse outcomes in AGA was 1.49. It has sensitivity, specificity, positive predictive value, and negative predictive value of 67.5%, 68%, 71.69%, and 70.21%, respectively. Conclusion Cerebroplacental ratio (CPR) reflects both circulatory insufficiency of the placenta and adaptive changes of the middle cerebral artery, indicating an important non-invasive surveillance modality.

The impact of Covid-19 pandemic on the research portfolio and approval turnaround time at the Kenya Medical Research Institute.

The Covid-19 pandemic led to an unprecedented impact on many sectors globally including research. We assessed the impact of the Covid-19 pandemic on the research portfolio, and on the approval turnaround time for research protocols submitted to the Scientific and Ethics Review Unit (SERU), at the Kenya Medical Research Institute (KEMRI). We compared research protocols submitted between October 01, 2019 and March 31, 2020 (Period 1), to those submitted between April 1 and September 30, 2020 (Period 2). A document review tool was used to extract data from the 198 research protocols reviewed and approved over the two periods. In the two periods under review, the single largest percentage of protocols (89/198, 45.4%) involved infectious and parasitic diseases, and the single largest percentage of study designs was cross-sectional (75/198, 38%). Before the pandemic, the median time taken to review KEMRI-linked protocols was 87 days and for non-KEMRI linked protocols it was 121 days. During the pandemic, approval turnaround time dropped for both KEMRI and non-KEMRI protocols to 66 days and 92 days, respectively, due to the streamlined processes at the KEMRI SERU. The research portfolio was minimally affected by the pandemic. The adoption of email submission, and faster-than-usual processing and review protocols during the pandemic reduced the approval turnaround time.

Individual approach in the treatment of occupational chronic obstructive pulmonary disease

Introduction. Occupational COPD (PCODD) is characterized by partially irreversible airflow limitation, the phenomenon of "air traps" and the formation of emphysema, has a steadily progressive character. In the work of a practitioner, an individual approach to the patient with targeted pharmacotherapy using new combinations in the treatment of occupational COPD is important, taking into account the evaluation of the effectiveness of previous therapy.&#x0D; The study aims to evaluate the effectiveness of therapy with combined bronchodilators in PCOPD with an analysis of the dynamics of functional parameters, exercise tolerance, using additional criteria for differential diagnosis.&#x0D; Material and methods. The effectiveness of bronchodilator therapy was analyzed in 45 men, diagnosed with occupational COPD (PCODD). Additional differential diagnostics included the following informative indicators: instantaneous volumetric velocity after exhalation 75 FVC (MOS75); cough intensity according to the CAT questionnaire (1 point); ratio of forced vital capacity to forced expiratory volume in 1 minute (FVC/FEV1); 6MWT data, % predicted; 6MWT, m; overall score on the mMRС questionnaire; the severity of shortness of breath according to the CAT questionnaire (point 4); instantaneous volumetric velocity after exhalation 25 FVC (MOS25). The discriminant equation is represented by the formula: F=–9,76+0,75×a1–2,00×a2–0,19×a3+0,27×a4–0,11×a5+1,22×a6+3,62×a7+2,22×a8.&#x0D; Results. Two clinical trials were retrospectively analyzed using combined bronchodilator therapy with long-acting muscarinic receptor antagonists (LAA) and β2-agonists (LAA) in patients with PCOD. A group of patients was identified where a statistically significant improvement in clinical and functional parameters was not achieved against the background of the therapy. When to the group of occupational bronchial asthma (OBA). When conducting an individual analysis of indicators, it was found that for patients with PCOD during bronchodilator therapy, an improvement in spirometric parameters is characteristic, in particular, an increase in FEV1 and FVC; Significant reduction in symptoms of shortness of breath, cough, sputum. Whereas, the PBA group was characterized only by an improvement in the distance traveled in 6MWT.&#x0D; Conclusion. Our earlier clinical studies on the effectiveness of treatment of patients with PCOD with combined bronchodilator therapy showed the effectiveness of this therapy in 70–75% of the patients examined. An individual analysis of the clinical and functional parameters of the examined patients made it possible to identify the features of the course of occupational bronchopulmonary pathology, with the identification of individuals who need the use of a triple combination of LABA, LAAA with the addition of topical glucocorticosteroids. In this regard, all patients, as part of diagnostic measures, in addition to the standard examination, it is necessary to include 6MWT, BPG, questionnaires using mMRС and CAT questionnaires. Calculation of discriminant equations using data from spirometry, questionnaires, 6MWT and BPG will allow at the first stage of differential diagnosis to identify a group of patients for whom "triple" therapy is the means of choice.&#x0D; Ethics. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee East-Siberian Institute of Medical and Ecological Research.

Insulin Ameliorates Neurodegeneration in an Experimental Animal Model of Brain Aging by a Decrease of GFAP Expression and Apoptosis Inhibition

Background: Aging is one of the factors that will cause gradual changes in brain tissue and its destruction. One of the protective factors against aging is insulin. Objectives: Our study investigated insulin's neuroprotective effect by preventing oxidative stress-mediated neuronal damage. Methods: A total of 48 adult male NMRI (the Naval Medical Research Institute) mice were divided into 2 groups: Control and insulin. Insulin was administered intraperitoneally (IP) for 8 weeks to the control group and for 12 weeks to the insulin group. In this study, animals were treated with insulin, and insulin's role in the aging process was evaluated. Then, brain tissue was extracted for evaluation of oxidative stress by assessment of glutathione disulfide (GSH) and reactive oxygen species (ROS) levels, the expression of the glial fibrillary acidic protein (GFAP) as a biomarker for astrogliosis, stereological study, and the real-time polymerase chain reaction (PCR) technique evaluated the level of apoptosis biomarker. Results: The results of stereological parameters show that the volumes of the brain cortex and the number of neurons improved in the insulin group by aging as compared to the control group. The results of real-time PCR showed that the expression level of apoptotic markers decreased in the insulin group compared to the control group. In the insulin group, GSH levels were higher than in the control group, and the control group produced more ROS than the insulin group. As compared with insulin, the control group expressed more GFAP protein and increased the number of glial cells by aging. Conclusions: The results showed that insulin could have neuroprotective effects against aging changes and reduce apoptosis and cell death.

CtDNA transiting into urine is ultrashort and facilitates noninvasive liquid biopsy of HPV+ oropharyngeal cancer.

BACKGROUNDTransrenal cell-free tumor DNA (TR-ctDNA), which transits from the bloodstream into urine, has the potential to enable noninvasive cancer detection for a wide variety of nonurologic cancer types.MethodsUsing whole-genome sequencing, we discovered that urine TR-ctDNA fragments across multiple cancer types are predominantly ultrashort (<50 bp) and, therefore, likely to be missed by conventional ctDNA assays. We developed an ultrashort droplet digital PCR assay to detect TR-ctDNA originating from HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) and confirmed that assaying ultrashort DNA is critical for sensitive cancer detection from urine samples.ResultsTR-ctDNA was concordant with plasma ctDNA for cancer detection in patients with HPV+ OPSCC. As proof of concept for using urine TR-ctDNA for posttreatment surveillance, in a small longitudinal case series, TR-ctDNA showed promise for noninvasive detection of recurrence of HPV+ OPSCC.ConclusionOur data indicate that focusing on ultrashort fragments of TR-ctDNA will be important for realizing the full potential of urine-based cancer diagnostics. This has implications for urine-based detection of a wide variety of cancer types and for facilitating access to care through at-home specimen collections.FundingNIH grants R33 CA229023, R21 CA225493; NIH/National Cancer Institute grants U01 CA183848, R01 CA184153, and P30CA046592; American Cancer Society RSG-18-062-01-TBG; American Cancer Society Mission Boost grant MBGI-22-056-01-MBG; and the A. Alfred Taubman Medical Research Institute.

Self-Supervised Learning for Improved Optical Coherence Tomography Detection of Macular Telangiectasia Type 2

Deep learning image analysis often depends on large, labeled datasets, which are difficult to obtain for rare diseases. To develop a self-supervised approach for automated classification of macular telangiectasia type 2 (MacTel) on optical coherence tomography (OCT) with limited labeled data. This was a retrospective comparative study. OCT images from May 2014 to May 2019 were collected by the Lowy Medical Research Institute, La Jolla, California, and the University of Washington, Seattle, from January 2016 to October 2022. Clinical diagnoses of patients with and without MacTel were confirmed by retina specialists. Data were analyzed from January to September 2023. Two convolutional neural networks were pretrained using the Bootstrap Your Own Latent algorithm on unlabeled training data and fine-tuned with labeled training data to predict MacTel (self-supervised method). ResNet18 and ResNet50 models were also trained using all labeled data (supervised method). The ground truth yes vs no MacTel diagnosis is determined by retinal specialists based on spectral-domain OCT. The models' predictions were compared against human graders using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under precision recall curve (AUPRC), and area under the receiver operating characteristic curve (AUROC). Uniform manifold approximation and projection was performed for dimension reduction and GradCAM visualizations for supervised and self-supervised methods. A total of 2636 OCT scans from 780 patients with MacTel and 131 patients without MacTel were included from the MacTel Project (mean [SD] age, 60.8 [11.7] years; 63.8% female), and another 2564 from 1769 patients without MacTel from the University of Washington (mean [SD] age, 61.2 [18.1] years; 53.4% female). The self-supervised approach fine-tuned on 100% of the labeled training data with ResNet50 as the feature extractor performed the best, achieving an AUPRC of 0.971 (95% CI, 0.969-0.972), an AUROC of 0.970 (95% CI, 0.970-0.973), accuracy of 0.898%, sensitivity of 0.898, specificity of 0.949, PPV of 0.935, and NPV of 0.919. With only 419 OCT volumes (185 MacTel patients in 10% of labeled training dataset), the ResNet18 self-supervised model achieved comparable performance, with an AUPRC of 0.958 (95% CI, 0.957-0.960), an AUROC of 0.966 (95% CI, 0.964-0.967), and accuracy, sensitivity, specificity, PPV, and NPV of 90.2%, 0.884, 0.916, 0.896, and 0.906, respectively. The self-supervised models showed better agreement with the more experienced human expert graders. The findings suggest that self-supervised learning may improve the accuracy of automated MacTel vs non-MacTel binary classification on OCT with limited labeled training data, and these approaches may be applicable to other rare diseases, although further research is warranted.

Vitamin D deficiency during the coronavirus disease 2019 (COVID-19) pandemic among healthcare workers

Vitamin D deficiency is a common nutritional problem worldwide that may have worsened during the coronavirus disease 2019 (COVID-19) pandemic. The present study sought to examine the prevalence and correlates of vitamin D deficiency among healthcare workers three years after the start of the COVID-19 pandemic. Participants comprised 2543 staff members from a medical research institute, who completed a questionnaire and donated blood samples in June 2023. 25-hydroxyvitamin D (25[OH]D) levels were measured using an electrochemiluminescence immunoassay. Logistic regression was used to calculate the odds ratio and its 95% confidence interval while adjusting for covariates. The proportions of participants with vitamin D insufficiency (25[OH]D 20-29ng/mL) and deficiency (25[OH]D<20ng/mL) were 44.9% and 45.9%, respectively. In a multivariable-adjusted model, factors associated with a higher prevalence of vitamin D deficiency included younger age, female sex, fewer hours of daytime outdoor physical activity during leisure time (without regular use of sunscreen), lower intake of fatty fish, no use of vitamin D supplements, smoking, and no alcohol consumption. Occupational factors, including shift work, were not independently associated with vitamin D deficiency. Our results suggest that vitamin D insufficiency and deficiency are highly prevalent among healthcare workers. Health education regarding lifestyle modifications for this occupational group are warranted to improve their vitamin D status in the COVID-19 era.

To study ERG expression in benign, pre-neoplastic, and neoplastic lesions of prostate

Background: Prostate cancer (PCa) is the second most common malignancy in men and the sixth leading cause of death. Clinical course of PCa is highly variable and current clinico pathological parameters are unable to predict accurately the course of the disease because of genetic heterogeneity seen in this tumor. Aims and Objectives: The aim of the study was to study the prevalence of E26 transformation-specific-related gene (ERG) expression in benign and malignant lesions of prostate in Northern Indian patients. Whether ERG expression using immunohistochemical (IHC) methods can also be used for differentiating various lesions of the prostate gland is also evaluated. Materials and Methods: This is an observational study conducted on 50 biopsy specimens encompassing different lesions of prostate. The study was carried out in the Department of Pathology at Integral Institute of Medical Sciences and Research, Lucknow, India, during the period January 2020–September 2022. Results: Amongst 50 cases of prostatic lesions included in the study, there were 20 cases of benign prostatic hyperplasia (BPH), 17 cases of benign mimicker lesions and 13 cases of PCa. ERG expression was absent in all cases of BPH and benign mimicker lesions. ERG expression was seen in 38.5% of cases of PCa. Conclusion: In our study, none of the patients of BPH or benign mimicker lesion expressed ERG on IHC, while 38.5% of patients of PCa showed positive staining. This figure differs from reports from other parts of the world. ERG expressions can be a potential therapeutic target for personalized treatment in a subset of patients of PCa. However, it was not found to be a sensitive marker for the diagnosis of PCa.

Three-PointUltrasonography for Confirmation of Endotracheal Tube Position in Children (TRUCE Study).

To investigate the diagnostic accuracy of three-point ultrasonography for confirmation of endotracheal tube (ETT) position among children undergoing endotracheal intubation (ETI) with chest radiograph as reference standard. This prospective observational study was conducted from January 2021 through December 2021 (12 mo) in the pediatric emergency room (PER) and pediatric intensive care unit (PICU), Division of Pediatric Critical Care, Advanced Pediatrics Centre (APC), Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Children aged 3 mo to 12 y, undergoing ETI in PER or PICU were included. Three-point ultrasonography (suprasternal notch and bilateral anterior chest) was done following ETI for confirmation of correct ETT position. Chest radiograph was used as a reference standard. Interobserver agreement between two investigators (IG and SKA) (kappa statistic) was determined for three-point ultrasonography to confirm the correct ETT position. One hundred fifty-five children with median (IQR) age of 4.5 (1-7) y were enrolled; 60% (n = 94) were males. On neck ultrasound, bilaminar sign was present in 100% of children. On lung ultrasound, bilateral and unilateral pleural sliding were present in 97.4% and 2.6% children, respectively. Three-point ultrasonography identified the correct position of ETT in 97.4% children as compared to 83.2% on chest radiograph. Sensitivity of three-point ultrasonography to identify the correct position of ETT was 98%. The interobserver agreement between two examiners was 96.8% (kappa of 0.53, p = 0.000). Three-point ultrasonography is an effective, sensitive, safe, and reproducible bedside method for identification of correct placement of ETT in children admitted to PER and PICU.

Patient and public involvement in preclinical and medical research: Evaluation of an established programme in a Discovery-Based Medical Research Institute.

Involving people with lived experience of health conditions and the public (consumers) in health research is supported by policy, practice and research funding schemes. However, consumer involvement programmes in discovery-based preclinical research settings are uncommon. Few formal evaluations of these programmes are reported in the literature. This study aimed to evaluate an established patient and public involvement programme operating in a major Australian Discovery-Based Medical Research Institute (DBMRI) to inform programme development and the wider field. A multimethods programme evaluation incorporating demographic, descriptive and qualitative data obtained through consumer/researcher co-developed online surveys and semistructured virtual interviews. Programme participants (n = 111) were invited to complete an online survey seeking feedback on their experience of involvement, programme processes and perceived impacts. A purposive sample of 25 participants was interviewed. Descriptive data were analysed using explanatory statistics and qualitative data from surveys and interviews were thematically analysed. This consumer involvement programme was found to be useful and meaningful for most participants, with specific examples of perceived added value. Consumers most commonly engaged with researchers to inform research development, prepare funding applications or strengthen lay communication of science. Genuine consumer-researcher interactions, relationship development and mutual respect were key elements in a positive experience for participants. Opportunities to 'give back', to learn and to ground research in lived experience were identified programme strengths and benefits. Developing researcher training in how to work with consumers, increasing the diversity of the consumer group membership and expanding the range of consumer activities were identified opportunities for improvement. Organisational support and adequate programme resourcing were identified as key enablers. Discovery-based preclinical research is often viewed as being distant from clinical application; therefore, consumer involvement may be considered less relevant. However this study identified value in bringing a strong consumer voice to the discovery-based research process through a coordinated, organisation-wide approach with the potential for application in similar preclinical research settings. Four consumer partners from the DBMRI Consumer Advisory Panel were actively engaged in developing this programme evaluation. Specifically, these consumer partners co-developed and pilot-tested surveys and interview guides, reviewed and commented on project data analysis and reporting and also contributed as co-authors by editing the manuscript.

Immunohistochemical analysis of cdx2 and its correlation with histopathological parameters of gastric enteric and colorectal epithelial malignancies

:Gastrointestinal tract cancers have become the leading causes of death worldwide. In India, the incidence of gastrointestinal carcinomas is increasing due to urbanization, change in food habits and life style. According to National Cancer Registry, gastro-intestinal carcinomas are more common in men than women and more commonly seen in elderly age group. CDX2 is a caudal type Homeo-box gene, encoding a transcription factor that plays an important role in differentiation, proliferation, cell adhesion and migration. CDX2 is often deregulated in cancer and might have oncogenic and tumour suppressor potential.1) To know the expression of CDX2 in gastric, enteric and colo-rectal epithelial. malignancies. 2) To observe and analyse the staining pattern in various grades and stages of tumour.The resected specimens of gastric, enteric and colo-rectal carcinomas were collected from the Department of Pathology, Mysore Medical College and Research Institute, during the year December 2019 to May 2021. Standard protocol for grossing and histopathological techniques were followed by immunohistochemical staining with CDX2 antibody. Expression of CDX2 marker and its staining pattern in various grades and stages of tumour were recorded and compared with patient’s clinicopathological parameters.A total of 67 cases of Gastrointestinal carcinomas were taken for the study. Positive CDX2 expression was seen in 58 out of 67 cases but the intensity of expression varied. There was significant statistical correlation between the CDX2 expression and histopathological grade (p value &amp;#60;0.05).The present study showed consistent expression of CDX2 in gastrointestinal carcinomas. The CDX2 expression decreased with increase in grade of the carcinoma.Therefore, CDX2 can be used as one of the prognostic indicators in intestinal variants gastrointestinal carcinoma.

A QUASI-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF TOPICAL APPLICATION OF HONEY ON ORAL MUCOSITIS AMONG HEAD AND NECK CANCER PATIENTS UNDERGOING RADIATION THERAPY IN TERTIARY CARE HOSPITAL OF AMRITSAR, PUNJAB.

Cancer is the leading cause of death around the world. Radiation therapy is made to kill growing cancer cells but certain normal cells get effected too, this damage to normal cell cause side effects of radiation therapy. The most debilitating side effect is radiation induced Oral Mucositis. This is major concern for attention, so there is need to provide conventional therapies to head and neck cancer patients to reduce the severity of oral mucositis. A Quasi-experimental study was conducted to assess the effectiveness of topical application of honey among 60 head and neck cancer patients undergoing radiation therapy at Sri Guru Ram Dass Institute of Medical Science and Research, Vallah, Amritsar, Punjab. Purposive sampling technique was used to collect data. The data wa

Profile of poisoning cases in a tertiary care centre in rural South India

BACKGROUND: Poisoning is the fourth most common cause of mortality in rural India. The commonest agents in India appear to be pesticides, sedatives, chemicals, alcohol, animal plant toxins and household toxins. Our hospital receives an average of 20 to 25 poisoning cases every month.&#x0D; AIMS: To profile all cases of poisoning those are reported to casualty department at Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER); to study the types and frequency of poisoning cases admitted to the centre; to study the socio demographic associations of the poisoning cases.&#x0D; MATERIALS AND METHODS: Present study is a hospital record-based retrospective observational study of acute poisoning cases registered in the medicolegal register in the casualty of CDSIMER, which is a tertiary care centre situated in rural area near Harohalli, Ramanagara District, India.&#x0D; RESULTS: Males constituted 58% of the cases and 33.52% of the cases were in the age group of 21–30 years. 81.4% of the cases were able to reach hospital between 1 to 8 hours. 56% of the cases recovered and were discharged within 3 days. In 22 cases the duration of admission was more than 2 weeks as they went into complications. Organo phosphorus group of insecticide was the most common type of poison consumed constituting to 40.8% of the cases followed by Snake bite. Attempt to suicide (60.35%) was more common than accidental poisoning.&#x0D; CONCLUSION: Insecticides mainly Organophosphorus compound are the most common group of poisons which causes morbidity and mortality in rural Indian population especially in young adults between 21 to 40 years. Owing to the presence of forests in the region, Snake bite becomes the second largest type of poisoning. Suicide frequently prevails in the rural areas; financial problem is the leading cause for farmers to commit suicide.

Disitamab vedotin (RC48) plus toripalimab for HER2-expressing advanced gastric or gastroesophageal junction and other solid tumours: a multicentre, open label, dose escalation and expansion phase 1 trial

Although the antibody-drug conjugates (ADCs) have significantly improved the survival outcomes of patients with human epidermal receptor 2 (HER2)-expressing gastric or gastroesophageal junction (G/GEJ) cancer, the efficacy of ADC used as a single agent is limited. Therefore, it is necessary to investigate effective and safe combination regimens. Preclinical data indicated a synergetic antitumour effect of RC48 and programmed cell death protein 1 (PD-1) inhibitors. We aimed to evaluate the safety and efficacy of RC48 plus toripalimab in patients with HER2-expressing G/GEJ cancer and other solid tumours. This was a open-label, multicentre, phase 1 trial performed at three hospitals in China. Eligible patients had advanced G/GEJ cancer or other solid tumours with HER2 IHC≥1 or ISH positivity and were refractory to at least one line of treatment, or standard treatment was intolerable or unavailable for these patients. This study followed a "3+3" design with predefined RC48 dosages of 2.0mg/kg and 2.5mg/kg plus toripalimab 3mg/kg, once every 2 weeks (q2w). The primary objectives were to evaluate the safety and determine the recommended phase II dose (RP2D), and the secondary objectives included assessing the pharmacokinetics (PK) and preliminary efficacy. This study was registered with ClinicalTrials.gov, NCT04280341. Between July 13, 2020 and August 30, 2022, 56 patients, including 30 patients with G/GEJ cancer and 26 patients with other solid tumours, were enrolled and received RC48 plus toripalimab (n=7 for RC48 2.0mg/kg, toripalimab 3mg/kg, q2w; n=49 for RC48 2.5mg/kg, toripalimab 3mg/kg, q2w). No dose-limiting toxic effects occurred. The RP2D was declared as RC48 2.5mg/kg plus toripalimab 3mg/kg, q2w. The most common grade 3 adverse events were a decreased neutrophil count (n=13), and a decreased white blood cell count (n=7). The efficacy assessment was completed for 52 patients. Among patients with G/GEJ cancer (n=30), the confirmed objective response rate (ORR) was 43% (12/28, 95% CI 25, 63), median progression-free survival (PFS) was 6.2 months (95% CI 4.0, 6.9), median overall survival (OS) was 16.8 months (95% CI 7.2, NE). The ORR of patients with G/GEJ cancer receiving RP2D (n=24) reached 50% (11/22, 95% CI 28, 72), with median PFS of 5.1 months (95% CI 1.4, 7.3) and median OS of 14.0 months (95% CI 6.3, NE). Among patients with G/GEJ cancer who received RP2D, a clinical benefit was observed in both HER2-positive and low HER2 expressing populations, with an ORR of 56% (5/9, 95% CI 21, 86) vs. 46% (6/13, 95% CI 19, 75), median PFS of 7.8 months (95% CI 0.9, NE) vs. 5.1 months (95% CI 1.2, 6.9), median OS of NE months (95% CI 4.3, NE) vs. 14.0 months (95% CI 5.1, NE), respectively. Antitumour activity was also observed for other solid tumours, including breast cancer (5/13) and endometrial carcinoma (1/1). Our findings suggested that RC48 plus toripalimab had a manageable safety profile and showed encouraging efficacy in pretreated patients with HER2-positive and low HER2-expressing G/GEJ cancer. The findings of our phase 1 clinical trial support further investigation of HER2-targeted ADC plus immunotherapy in HER2-expressing G/GEJ cancer and pancancer treatment in the future. Beijing Municipal Medical Research Institutes, Beijing Medical Research Institute (Z200015).