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Introduction: Iron deficiency is the commonest nutritional disorder in the world. The common prevalent type of anemia is caused by nutritional factors, and it is particularly prevalent in women of childbearing age, pregnant women, and nursing mothers. Anemia is indicative of poor intake of nutrition and leads to ill health. The present study aims to estimate anemia among women of the childbearing age group at the field level using an RDT kit. Methodology: A community-based cross-sectional study was conducted among reproductive age group women to estimate the hemoglobin using an RDT kit at the field level in the coastal area of Dakshina Kannada and Udupi districts. Results: Out of 663 subjects, 17.3% participants were from the age group 35-39 and 40-44 years each. Based on the educational status, graduates and postgraduates accounted for 32.3%. Among the study subjects 63.34% were pregnant and lactating. 77.2% of the subjects were Hindus. Among the study subjects 59.57% had hemoglobin above 12 g/dl. 40.42% had

Background and Objectives The status of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 expression in core needle biopsy and excision specimens has concurrent results, but many show discordance. However, only a few studies on the subject are available in India. Therefore, this study aims to compare the ER and Ki-67 expression status in core needle biopsy and excision specimens of breast carcinoma. Materials and Methods In this cross-sectional analytical study, 50 breast carcinoma cases were histopathologically examined for ER and Ki-67 expression in both core needle biopsy and excision specimen. The interpreter was blinded for the evaluation of ER and Ki-67 expression index and the data obtained were analyzed using SPSS version 27. Results The average age of the participants was 50 years and breast lump was the most common presenting complaint in all the cases. The concordance rate of histological typing between core needle biopsy and excision specimens was 96%, and the majority were invasive ductal carcinoma (60%) and not otherwise specified (48%) having Nottingham histologic grade 3 (46%). The concordance rate between core needle biopsy and excision specimen for ER and Ki-67 expression was 86% (n = 43) and 54% (n = 27), respectively. Most of the cases were found to be luminal A type (38%). Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value of ER between core needle biopsy and excision specimen were 78.79, 100, 100, and 70.83%, respectively; however, these were 44, 64, 55, and 53.33%, respectively, for Ki-67. Conclusion Although the concordance of the ER status between core needle biopsy and excision specimen was substantial, the discordance rate of Ki-67 was found to be high. Hence, relying solely on core needle biopsy for critical decision-making is inadvisable; however, core needle biopsy can be used as an initial procedure to examine histology and receptor status, Therefore, it is better to reconsider performing immunohistochemistry for the excision specimen, more importantly in ER-negative cases, to benefit the patient with targeted therapy.

Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population.To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior.Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved.Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Adolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice.Indian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021.To formulate guidelines to enable pediatricians to establish adolescent friendly health services.Pediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services.

STUDY QUESTION Is there an association between fertility status, method of conception and the risks of birth defects and childhood cancer? SUMMARY ANSWER The risk of childhood cancer had two independent components: (i) method of conception and (ii) presence, type and number of birth defects. WHAT IS KNOWN ALREADY The rarity of the co-occurrence of birth defects, cancer and ART makes studying their association challenging. Prior studies have indicated that infertility and ART are associated with an increased risk of birth defects or cancer but have been limited by small sample size and inadequate statistical power, failure to adjust for or include plurality, differences in definitions and/or methods of ascertainment, lack of information on ART treatment parameters or study periods spanning decades resulting in a substantial historical bias as ART techniques have improved. STUDY DESIGN, SIZE, DURATION This was a population-based cohort study linking ART cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) from 1 January 2004 to 31 December 2017 that resulted in live births in 2004–2018 in Massachusetts and North Carolina and live births in 2004–2017 in Texas and New York. A 10:1 sample of non-ART births were chosen within the same time period as the ART birth. Non-ART siblings were identified through the ART mother’s information. Children from non-ART births were classified as being born to women who conceived with ovulation induction or IUI (OI/IUI) when there was an indication of infertility treatment on the birth certificate, and the woman did not link to the SART CORS; all others were classified as being naturally conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 165 125 ART children, 31 524 non-ART siblings, 12 451 children born to OI/IUI-treated women and 1 353 440 naturally conceived children. All study children were linked to their respective State birth defect registries to identify major defects diagnosed within the first year of life. We classified children with major defects as either chromosomal (i.e. presence of a chromosomal defect with or without any other major defect) or nonchromosomal (i.e. presence of a major defect but having no chromosomal defect), or all major defects (chromosomal and nonchromosomal), and calculated rates per 1000 children. Logistic regression models were used to generate adjusted odds ratios (AORs) and 95% CIs of the risk of birth defects by conception group (OI/IUI, non-ART sibling and ART by oocyte source and embryo state) with naturally conceived children as the reference, adjusted for paternal and maternal ages; maternal race and ethnicity, education, BMI, parity, diabetes, hypertension; and for plurality, infant sex and State and year of birth. All study children were also linked to their respective State cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of cancer by birth defect status (including presence of a defect, type and number of defects), and conception group. MAIN RESULTS AND THE ROLE OF CHANCE A total of 29 571 singleton children (2.0%) and 3753 twin children (3.5%) had a major birth defect (chromosomal or nonchromosomal). Children conceived with ART from autologous oocytes had increased risks for nonchromosomal defects, including blastogenesis, cardiovascular, gastrointestinal and, for males only, genitourinary defects, with AORs ranging from 1.22 to 1.85; children in the autologous-fresh group also had increased risks for musculoskeletal (AOR 1.28, 95% CI 1.13, 1.45) and orofacial defects (AOR 1.40, 95% CI 1.17, 1.68). Within the donor oocyte group, the children conceived from fresh embryos did not have increased risks in any birth defect category, whereas children conceived from thawed embryos had increased risks for nonchromosomal defects (AOR 1.20, 95% CI 1.03, 1.40) and blastogenesis defects (AOR 1.74, 95% CI 1.14, 2.65). The risk of cancer was increased among ART children in the autologous-fresh group (HR 1.31, 95% CI 1.08, 1.59) and non-ART siblings (1.34, 95% CI 1.02, 1.76). The risk of leukemia was increased among children in the OI/IUI group (HR 2.15, 95% CI 1.04, 4.47) and non-ART siblings (HR 1.63, 95% CI 1.02, 2.61). The risk of central nervous system tumors was increased among ART children in the autologous-fresh group (HR 1.68, 95% CI 1.14, 2.48), donor-fresh group (HR 2.57, 95% CI 1.04, 6.32) and non-ART siblings (HR 1.84, 95% CI 1.12, 3.03). ART children in the autologous-fresh group were also at increased risk for solid tumors (HR 1.39, 95% CI 1.09, 1.77). A total of 127 children had both major birth defects and cancer, of which 53 children (42%) had leukemia. The risk of cancer had two independent components: (i) method of conception (described above) and (ii) presence, type and number of birth defects. The presence of nonchromosomal defects increased the cancer risk, greater for two or more defects versus one defect, for all cancers and each type evaluated. The presence of chromosomal defects was strongly associated with cancer risk (HR 8.70 for all cancers and HR 21.90 for leukemia), further elevated in the presence of both chromosomal and nonchromosomal defects (HR 21.29 for all cancers, HR 64.83 for leukemia and HR 4.71 for embryonal tumors). Among the 83 946 children born from ART in the USA in 2019 compared to their naturally conceived counterparts, these risks translate into an estimated excess of 761 children with major birth defects, 31 children with cancer and 11 children with both major birth defects and cancer. LIMITATIONS, REASONS FOR CAUTION In the SART CORS database, it was not possible to differentiate method of embryo freezing (slow freezing versus vitrification), and data on ICSI were only available in the fresh embryo ART group. In the OI/IUI group, it was not possible to differentiate type of non-ART treatment utilized, and in both the ART and OI/IUI groups, data were unavailable on duration of infertility. Since OI/IUI is underreported on the birth certificate, some OI/IUI children were likely included among the naturally conceived children, which will decrease the difference between all the groups and the naturally conceived children. WIDER IMPLICATIONS OF THE FINDINGS The use of ART is associated with increased risks of major nonchromosomal birth defects. The presence of birth defects is associated with greater risks for cancer, which adds to the baseline risk in the ART group. Although this study does not show causality, these findings indicate that children conceived with ART, non-ART siblings, and all children with birth defects should be monitored more closely for the subsequent development of cancer. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data. M.L.E. reports consultancy for Ro, Hannah, Dadi, Sandstone and Underdog; presidency of SSMR; and SMRU board member. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

BACKGROUND Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0-14 years) and adults (aged 15-99 years) diagnosed with a haematological malignancy during 2000-14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0-24 years). METHODS We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0-14 years), adolescents (15-19 years), and young adults (20-24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. FINDINGS 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010-14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010-14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000-14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. INTERPRETATION This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group. FUNDING Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, US National Cancer Institute, and the American Cancer Society.

Human induced pluripotent stem cells (iPSCs) have emerged as an invaluable resource for basic research, disease modeling, and drug discovery over recent years. Given the numerous advantages of iPSCs over alternative models-including their human origin, their ability to be differentiated into almost any cell type, and the therapeutic potential of patient-specific iPSCs in personalized medicine-many labs are now considering iPSC models for their studies. As the quality of the starting population of iPSCs is a key determinant in the success of any one of these applications, it is crucial to adhere to best practices in iPSC culture. In the following protocol, we offer a comprehensive guide to the culture, cryopreservation, and quality control methods required for the establishment and maintenance of high-quality iPSC cultures.

Human induced pluripotent stem cells (iPSCs) have emerged as an invaluable resource for basic research, disease modeling, and drug discovery over recent years. Given the numerous advantages of iPSCs over alternative models-including their human origin, their ability to be differentiated into almost any cell type, and the therapeutic potential of patient-specific iPSCs in personalized medicine-many labs are now considering iPSC models for their studies. As the quality of the starting population of iPSCs is a key determinant in the success of any one of these applications, it is crucial to adhere to best practices in iPSC culture. In the following protocol, we offer a comprehensive guide to the culture, cryopreservation, and quality control methods required for the establishment and maintenance of high-quality iPSC cultures.

Introduction: Integrated teaching helps the students to understand the concepts well and conceptualise the subject well. Clinical cases introduced in the first year are interesting and stimulative for the student but may overwhelm and confuse the student. Aim: To know the perception and acceptance of integrated teaching among the first year Bachelor of Medicine and Medicine of Surgery (MBBS) students which include multiple case scenarios. Materials and Methods: This educational research is a crosssectional observational study involving first year medical students in Ramaiah Medical College, Bangalore. Study was conducted for a period of one year (August 2018 to June 2019). Horizontal integration of a system in the first year MBBS subjects were done. This was followed by an interactive session conducted by a Clinician basically comprising of multiple case scenarios on the particular system. The sessions focussed on integration of basic medical science subjects and their application in the case scenarios. Six organ-systems were similarly covered. The integrated sessions involved in class discussions of the clinical cases and were designed, implemented and moderated by two faculties (clinicians and basic science faculty). Collected data were entered into MS Excel, and analysis was done using Statistical Package for the Social Science (SPSS) software. The students’ feedback regarding the perception of integrated teaching was collected on the Five point likerts scale using a validated questionnaire and analysed. Results: The number of students included in the study was 140. About 135 (96.43%) of the students felt that integrated teaching using multiple case scenarios motivates them to learn in a better way. About 133 (95%) of students felt that integrated teaching helps them to understand concepts well, stimulates the critical thinking. About 136 (97.14%) of students felt that integrated teaching helped them to understand the topic in a holistic way. Conclusion: The students felt that the integrated teaching using multiple case scenarios enhanced their perception and comprehension of the diseases and helped them to understand the relevance of application of pre-clinical knowledge in clinical practise.

Cryptographic operations involved in securing communications are computationally intensive and contribute to energy drain in mobile devices. Thus, varying the level of security according to the user’s location may provide a convenient solution to energy management. Context-adaptive energy-aware security allocation for mobile devices is modeled in this paper as a combinatorial optimization problem. The goal is to allocate security levels effectively so that user utility is maximized while bounding the maximum energy cost to a constant E. Although the offline version of the problem has been previously studied in the literature where both the security levels and the locations to which a user may travel to is known a priori, this is the first work that formulates and solves an online version of the problem where the locations may be known a priori but the security levels are revealed only upon reaching the locations. We provide two different algorithms for the solution of this online problem by mapping it to the online multi-choice knapsack problem. We study competitive ratios of our two algorithms by comparing the solutions they yield to the optimal solution obtained for the corresponding offline problem. We also present simulation experiments on realistic datasets to validate the scalability and efficiency of our approaches (taking in order of milliseconds for up to 100 locations and providing near-optimal competitive ratios).

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in the United States. NHL comprises a heterogeneous group of over 40 histological subtypes, each of which has distinct genetic, morphologic and clinical features. While NHL epidemiology as a single entity has been well-characterized using population-based cancer registry data, the epidemiology of NHL subtypes is not well understood and even less data are available for rarer subtypes. We aimed to determine geodemographic correlates for NHL subtypes in North Carolina to provide rarely reported epidemiologic characterization of each distinct malignancy. Methods: Demographic data were obtained on all NHL subtypes reported in persons >18 years of age from 2009-2019 from the North Carolina Central Cancer Registry (NCCCR). NHL subtypes were determined based on World Health Organization International Classification of Diseases for Oncology,Third Edition (ICD-O-3) Morphology codes provided by NCCCR. Crude incidence and mortality rates were estimated per 100,000 persons for the 10-year period using 2019 population data from the U.S Census Bureau. Urban and rural residence designations were based on zip code using rural-urban commuting codes developed by the Rural Health Research Center. County tier designations were used as markers of economic prosperity, with 3 being most prosperous, and provided by the North Carolina Department of Commerce. Data are being mapped using ESRI ArcMap 10.8.1. Results: A total of 25,627 incident cases of NHL and 9,930 associated deaths were reported between 2009 and 2019 in North Carolina. Therefore, the standard NHL incidence and mortality rates are 24.1 and 9.3 per 100,000 persons. For incident NHL cases, median age at diagnosis was 68 years (range 19-103), 55% were male and 45% female. Most (83%) identified as white, 14% as black, and 3% as other. Median age at death was 70 years (range 19-106). Twenty-eight NHL subtypes were identified with the four most common NHL subtypes being Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL), Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma (FL), and Marginal Zone Lymphoma with 6.54, 6.42, 3.55, and 2.0 cases (per 100,000 persons), respectively. Least common subtypes included Intravascular Large B Cell Lymphoma, Primary Effusion Lymphoma, Primary Cutaneous Gamma Delta T-cell Lymphoma (PCGD-TCL) and Subcutaneous Panniculitis-Like T-cell Lymphoma, all with 0.01 cases per 100,000 persons (or 15, 14, 9 and 6 cases respectively). The distribution of NHL subtypes varied according to demographics with several notable findings. DLBCL had the highest crude mortality rate of 2.98 deaths/100,000 persons, followed by CLL (2.12 deaths/100,000 persons), FL (0.98 deaths/100,000 persons) and Lymphoma NOS (0.51 deaths/100,00 persons). Mediastinal Large B-cell Lymphoma (MLBCL) was diagnosed in the youngest individuals with median age of 36 (range 20-74), whereas PCGD-TCL occurred in the oldest with median age of 74 (range 31-99). Primary Effusion Lymphoma had the highest male predominance (93%) and MLBCL had the highest female predominance (73%). Mantle Cell Lymphoma had the highest predominance of persons who identify as white (90%), Anaplastic Large Cell Lymphoma (ALK+/-) with those who identify as black (66%), and Primary Effusion Lymphoma with those who identify as other (14%). Predominance of rurality and county tier designations varied by NHL subtype. Conclusions: A registry-based assessment of NHL subtypes illustrates the heterogeneous nature of this group of malignancies and highlights significant variation in the geodemographic features of each subtype. Evaluating geodemographic correlates deepens our understanding of NHL subtypes and can inform populations at risk for each unique NHL subtype. Figure 1 Figure 1. Disclosures Dittus: BeiGene: Other: Advisory Board; Seattle Genetics: Research Funding; AstraZeneca: Research Funding; Genentech: Research Funding.

Background: Malaria is most important parasitic disease affecting humans. The literature relating to malaria and the blood groups are sparse and have mixed response. Objectives: The study was undertaken to assess the distribution of ABO blood group and their relationship with malaria species and parasite load. Methods: In 200 malaria positive patients blood group analysis was done. Malaria parasite detection and load estimation was done using quantitative buffy coat (QBC) methodology using a fluorescent microscopy. ABO blood group was determined by agglutination test using antisera. Results: A total of 200 were included in the study of which 121 cases were positive for plasmodium vivax, 32 cases were positive for plasmodium falciparum and 47 patients had mixed infection. The results of blood groups showed, 63 malaria infected patients with A blood group, 50 with B blood group, 80 with O blood group and 7 with AB blood group. Maximum parasite load was noted in blood group O, followed by group A and B. The most common blood group infected with plasmodium vivax is blood group O, similarly with 3+and 4+ parasite load is blood group O. Conclusion: This study suggests significantly higher proportion of O blood group malaria patients infected with plasmodium vivax with higher parasite load.

Background:The pre-donation haemoglobin (Hb) estimation is the only laboratory test done on blood donors to determine an individual's eligibility to donate blood with an intention to prevent bleeding an anaemic donor. With availability of wide range of screening methods, no single technique has emerged as the most appropriate and ideal for screening blood donors. The primary objective of the study was to compare results of copper sulphate method and haemoglobin meter with the gold standard Cyanmeth hemoglobin (CyanHb) method. Materials and methods : Prospective observational study done in 238 blood donors. Sample analyses were done using Copper sulphate solution, haemoglobin meter and Cyanmeth haemoglobin method. Results : Mean values of three methods Cyanmeth haemoglobin, and Haemoglobin meter methods are 12.5±2.2, and 13.08±1.61 respectively. Haemoglobin values obtained by haemoglobin meter and copper sulphate methods were comparable, with sensitivity of 94.25% and 94.47% respectively. Conclusion : CuSo4 method and haemoglobin meter can be used alternatively based on resources available. The higher values obtained by CyanHb method could be due to turbidity factor of the lipids in the blood sample.

Objectives : The objectives of the study were to study the relation of total body adiposity and abdominal adiposity markers with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in adolescents in Bengaluru. Methods : 125 healthy children from a school and 70 asthmatics from Ramaiah hospital between 10 and 15 years were included in the study. Anthropometry including weight, body mass index (BMI), waist and hip circumference, and abdominal height was done in all study adolescents. The subjects were categorized according to BMI. Pulmonary function tests (PFTs) were done by Knudson method and FEV1, FVC, and peak expiratory flow (PEF) were measured. The patients were classified by their asthma severity according to GINA guidelines. Results : BMI, weight, waist and hip circumference correlated with abdominal height in male asthmatics and controls where they revealed significant correlations with FEV1/FVC% ratio. In females, abdominal height correlated with BMI, weight, waist and hip circumference in both the groups. PEF correlated with BMI, weight, waist circumference, and abdominal height in healthy females. FEV1/FVC correlated with BMI, abdominal height in female asthmatics, with weight in healthy females. Independent predictors of FEV1/FVC% ratio were hip circumference in males and abdominal height, and waist circumference in females. Conclusion : Increase in obesity is associated with reduced lung volumes and flows. The abdominal adiposity markers (waist and hip circumference, and abdominal height) are significant and effective predictors of obesity and the variations of PFT’s than total adiposity markers (BMI and weight).

Child abuse is a serious criminal act against children in our country and punishable according to protection of children from sexual offenses act 2012. No one agency has the ability to respond completely to the abuse. Hence a multidisciplinary team approach was developed in India. Aim is to narrate the collaborative effort among the multiple disciplines in a general hospital to deliver child protection services and explore the barriers to integrate psychiatric services. Methodology: Members of the team were recruited from different disciplines and trained by experts. A mission statement, protocol to assess the victims and provide treatment was formulated as an algorithm. The barriers to psychiatric treatment among the stakeholders were analyzed using framework method of qualitative analysis. Results (After 20 months) the unit received 27 referrals in 20 months, 24 females, and 3 males. Age of the victims was between 8 months and 17 years. Two cases found to be physically abused. Penetrative sexual abuse was found in 23 cases, pregnant victims were 4. Most referrals were by police, trafficking found in 6 cases. Discussion: It was possible to provide multidisciplinary care to the victims and families. Recurrent themes of barriers to psychiatric treatment were stigma, victim blaming; focus on termination of pregnancy, minimization of abuse in males by stakeholders. Conclusion is collaboration needs more effort to integrate psychiatric services but can minimize the reduplication of services.

Introduction: In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%. Aim: The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse. Materials and Methods: All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims. Results: Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme. Conclusion: Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit.

Background Population-based cancer registries collect information on first course of treatment that may be utilized in research on cancer care quality, yet few studies have investigated the validity of this information. We examined the accuracy and completeness of registry-based treatment information in a cohort of adolescent and young adult women. Methods Women diagnosed with breast cancer, lymphoma, thyroid cancer, cervical/uterine cancer or ovarian cancer at ages 15–39 during 2003–2014 were identified using data from the North Carolina Central Cancer Registry (CCR) (N = 2342). CCR data were linked to Medicaid and private insurance claims data, and claims were reviewed for the 12 months following diagnosis to identify cancer treatments received. Using claims data as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of CCR data for receipt of chemotherapy, radiation and hormone therapy. We also compared dates of treatment initiation between the two data sources. Results For all cancer types combined, the sensitivity of the CCR data was high for chemotherapy (86%) and moderate for radiation (74%). PPVs were 82% and 83% for chemotherapy and radiation, respectively. Both the sensitivity (67%) and PPV (70%) were lower for hormone therapy for breast cancer. For all three treatment types, dates of initiation in the registry and the claims differed by ≤30 days for most women. Conclusions In this cohort of young women, population-based cancer registry data on chemotherapy receipt was reasonably accurate and complete in comparison with insurance claims. Radiation and hormone therapy appeared to be less complete.

Triple-negative breast cancer (TNBC) is an aggressive subgroup of breast cancer which lacks effective target therapy. Expression of biomarkers is one of the important deciding factors for treatment strategies. The aim of this study was to evaluate expression of E cadherin and Ki 67 in relation to clinicopathological features. This prospective observational study included 141 cases of TNBC. Immunohistochemical staining was employed to analyze two biomarkers: E cadherin and Ki 67 on formalin-fixed paraffin-embedded tumor samples obtained from patients defined as TNBC. The age of the patients ranged from 26 to 84 years. Positive lymph nodes were found in 82 (58.1%). The tumor was grade 3 in 105 (74.4%). The E cadherin receptor was positive in 83 (58.8%). The Ki Index was > 10% in 89 (63.12%). The Ki 67 expression was significantly associated with a high nuclear grade (p = 0.000). The significant association noted between loss of E cadherin expression and positive lymph node (p = 0.0296). According to the results, TNBCs are frequently associated with the younger age groups, and the majority is poorly differentiated. The majorities of these have high expression of the Ki 67 and significantly associated with the higher nuclear grade. Loss of E cadherin was significantly associated with positive lymph nodes. Hence, evaluating the expression of E cadherin and Ki 67 routinely would be helpful for evaluating prognostic implications.

Objective: To assess the role of procalcitonin (PCT) in the diagnosis and prognosis in children with sepsis. Design: Prospective, observational study. Setting: Tertiary care center in South India. Participants: Children, 1 month to 15 years of age, admitted with the diagnosis of sepsis excluding children with chronic systemic/inflammatory disease, degenerative neurologic disease, primary/ acquired immune deficiency, on steroids and children who had trauma/burns. Intervention: None. Main Outcome Measures: Serum PCT levels, grades of sepsis and mortality. Results: Respiratory tract infection was the most common source of sepsis (71%). Of the 53 patients studied, PCT was >2 ng/ml in 42 (79.2%) patients. Mean PCT values were 9.63, 17.72, and 84.68 ng/ml in sepsis, severe sepsis, and septic shock, respectively. PCT was found to be 86.36% sensitive, 55.56% specific with a positive predictive value (PPV) of 90.48, and negative predictive value of 45.45. 79.2% of patients in the study were discharged and 18.9% died. PCT levels were high in children who died subsequently. Conclusions: There is a positive association between PCT levels and the severity of sepsis as reflected by high sensitivity and PPV. High PCT levels also indicate increased chances of mortality. Key words: Procalcitonin, Sepsis, Septic shock, Severe sepsis, Systemic inflammatory response syndrome

Glomangiopericytoma belongs to a spectrum of lesions which include myofibromatosis, myofibroma, and subset of sinonasal hemangiopericytomas. [1, 2] Stout and Murray in 1942 initially reported GPC as hemangiopericytoma, the tumors displaying a characteristic well developed ‘staghorn’ branching vascular pattern [2] Over the years this definition has been questioned and hemangiopericytoma was better considered as a diagnosis of exclusion, as it appeared that this growth pattern was non-specific, shared by numerous, unrelated benign and malignant lesions and that GPC and SFT belongs to category of lesions which are individualised within the heterogeneous group of hemangiopericytoma – like neoplasms. [2] GPC characteristically has a component of cells with glomus type features including cuboidal cells, distinct cell borders, clear to eosinophilic cytoplasm and central round nuclei. Glomus tumors involving, internal organs are very rare and most often situated in GIT. In GIT, tumors usually involve the stomach but tumor developing in the omentum have not been reported. [3] We report a case of GPC of omentum and challenges we faced in immunohistochemistry interpretation based on literature review.

Objectives: To study the clinical characteristics and laboratory profile of systemic lupus erythematosus (SLE) in children in a tertiary care center. Methods: Children presenting to our tertiary care center with suspected SLE, fulfilling at least 4 out of 11 American College of Rheumatology (ACR) criteria for the diagnosis of SLE were reviewed retrospectively. The study period was from June 2012 to May 2015. The clinical presentation and laboratory parameters were analyzed. Results: A total of 14 patients fulfilled the ACR criteria; there were 12 girls and 2 boys with a sex ratio of 1:6 favoring girls. The mean age on presentation was 9.8 years with a range of 3-15 years. At presentation, 70% of the children had features not suggestive of SLE. The most common symptom was fever seen in 100% of the patients, followed by hematological abnormalities in 78%, and renal involvement in 57% patients. Arthritis, skin lesions, and pulmonary involvement were seen in 42% of the patients. The gastrointestinal presentation was seen in 21% of the patients. Conclusion: SLE has a varied clinical presentation depending on the predominant organ involved. A high index of suspicion is required for the early diagnosis of SLE in children. Key words: Anemia, American College of Rheumatology, Antinuclear antibodies, Arthralgia, Lupus nephritis, Systemic lupus erythematosus

Background: Sleep is an integral part of any healthy individual and sleep problems can affect the intellectual abilities including the performance at school. Objectives: We studied the sleep problems among school going children in the age group of 6-16 years and the association of the sleep problems with scholastic performance in them. Materials and Methods: The study was a cross-sectional study carried out in students attending a private school. The children were given a questionnaire based on the “BEARS” screening tool for sleep problems in children to be filled by children and parents. Accordingly, the age and academic grades of students were recorded. The prevalence of sleep problems and their relation to school grades were studied. Results: Out of 229 students, 25.33% (58) students were found to have sleep problems after applying the “BEARS” criteria. Of these 58 children, 31 scored A grade, 25 scored B grade, and 2 scored C grade. 23% (31 out of 135) of A graders were found to have sleeping problems, 28% (25 out of 89) of B graders, and 40% (2 out of 5) of C graders had sleeping problems. Conclusion: Sleep problems were common in school going children. It was observed that as scholastic grades decreased, the prevalence of sleeping problems increased. Sleep problems might be one of the contributors for poor scholastic achievements in children.

Background:Multiple choice questions (MCQ) are used in the assessment of students in various fields. By this method of assessment it is possible to cover a wide range of topics in less amount of time. However the reliability of the test depends on the quality of the MCQ. The MCQ can be evaluated based on the Difficulty Index (DIFI), Discriminatory Index (Dl) and Distracter Efficiency (DE). Objectives:To evaluate the MCQs based on the Difficulty Index (DIFI), Discriminatory Index (Dl) & Distracter Efficiency (DE) and develop a valid pool of questions.Also to assess learner performance and discriminate between students of higher and lower abilities. Materials and Methods:A total of 120 students were assessed based on multiple choice questions in pathology. The number of items were 20 and the number of distracters were 60. Data was entered and analyzed in MS Excel 2007 and simple proportions, mean and standard deviations were calculated. Results:Mean and standard deviations for DIFI, Dl and DE were 57.8 ± 17.4%, 0.27 ± 0.17 and 84.98 ± 20.2 % respectively. Out of the 20 items, 11 items had good level of DIFI (31 - 60%), eight (8) items were considered easy (DIFI >61%) and one (1) item was considered difficult (DIFI < 30). Mean Dl in present study was 0.27 ± 0.17. Analysis of the Dl showed good discrimination power in eighteen (18) of the items. Out of the 60 distracters, nine (9) were non -functional distracters (NFD) and were seen in eight items. Out of these, seven items had one NFD each and one item had two NFD. Conclusions:The study emphasizes on the importance of use of item analysis in construction of good quality MCQs and also in the evaluation of learner performance.

Importance Children with birth defects have a greater risk of developing cancer, but this association has not yet been evaluated in children conceived with in vitro fertilization (IVF). Objective To assess whether the association between birth defects and cancer is greater in children conceived via IVF compared with children conceived naturally. Design, setting, and participants This cohort study of live births, birth defects, and cancer from Massachusetts, New York, North Carolina, and Texas included 1 000 639 children born to fertile women and 52 776 children conceived via IVF (using autologous oocytes and fresh embryos) during 2004-2016 in Massachusetts and North Carolina, 2004-2015 in New York, and 2004-2013 in Texas. Children were followed up for an average of 5.7 years (6 008 985 total person-years of exposure). Data analysis was conducted from April 1 to August 31, 2020. Exposures Conception by IVF for state residents who gave birth to liveborn singletons during the study period. Birth defect diagnoses recorded by statewide registries. Main outcomes and measures Cancer diagnosis as recorded by state cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for birth defect-cancer associations separately in fertile and IVF groups. Results A total of 1 000 639 children (51.3% boys; 69.7% White; and 38.3% born between 2009-2012) were in the fertile group and 52 776 were in the IVF group (51.3% boys; 81.3% White; and 39.6% born between 2009-2012). Compared with children without birth defects, cancer risks were higher among children with a major birth defect in the fertile group (hazard ratio [HR], 3.15; 95% CI, 2.40-4.14) and IVF group (HR, 6.90; 95% CI, 3.73-12.74). The HR of cancer among children with a major nonchromosomal defect was 2.07 (95% CI, 1.47-2.91) among children in the fertile group and 4.04 (95% CI, 1.86-8.77) among children in the IVF group. The HR of cancer among children with a chromosomal defect was 15.45 (95% CI, 10.00-23.86) in the fertile group and 38.91 (95% CI, 15.56-97.33) in the IVF group. Conclusions and relevance This study found that among children with birth defects, those conceived via IVF were at greater risk of developing cancer compared with children conceived naturally.

Background Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. Methods The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. Results For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. Conclusions For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.

Background: ABO and Rh blood groups are most important blood groups in human beings. The frequency of four main blood group systems varies in population throughout the world and even in different parts of country. Objective if this study was to identify distribution of ABO and Rh blood group system. Materials and methods: The study was conducted in rural tertiary care hospital from January 2008 to December 2012. Data were collected from Blood Bank grouping records. All blood samples processed during period of observation were included in study. Results: During the period of observation total 43,103 numbers of blood groups were performed. Patient's samples were 28,305 and donor's samples were 14,798. The frequency of blood group O in our population was 42.0% (40.1% O Rh positive and 1.8% O Rh negative). The frequency of blood group B in our population was 27.3% (25.6% B Rh positive and 1.62% B Rh negative) followed by blood group A was 25.8% (24.3% A Rh positive and 1.4% A Rh negative) and blood group AB was 4.8% (4.4% AB Rh positive and 1.4% AB Rh negative) and a two Bombay blood group donors (0.0046%). Rh positive were 94.64% and Rh negative were 5.35%. Discussion: O positive blood group is significantly high in our population. Every transfusion centre should have a record of frequency of blood group system in their population. It helps in inventory management. Knowledge of blood group distribution is important for clinical studies, for reliable geographical information and for forensic studies in the population.

Subclinical hypothyroidism (SCH) can negatively affect cognitive functioning. This study aimed at correlating serum T3, T4, TSH with adolescent’s performance on a learning disability scale. Methods: A cross-sectional study was conducted on 100 schoolchildren, (10 - 15 years). Thyroid hormones were estimated and classified into two groups: euthyroid and subclinical hypothyroid. NIMHANS index for Specific Learning Disabilities was used to assess the learning ability and cognitive functions. Results: Subclinical hypothyroid group made more mistakes than euthyroid group. In SCH male group, T3 correlated with language and T4 levels correlated in all areas except in language. In the females, there is no significant correlation between T3 and ability parameters except in partial correlation coeffeicient among euthyroid children in arithmetic, visual-motor skills and memory. T4 results did not correlate in language skills. There was a statistical significance between T4 and ability skills in girls except in language. TSH and language skills correlated in females. Conclusion: T3 and T4 levels have correlation with cognitive skills other than TSH. It is necessary to measure both T3 and T4 in addition to TSH in adolescents.

Dirofilariasis is a zoonotic filarial parasitic infestation. Its prevalence has increased in recent times. Hence, it is described as an emerging zoonosis. However, not many cases of subcutaneous manifestation of the disease have been reported in the literature. Here, we are presenting two cases of dirofilariasis manifesting as a breast mass causing a diagnostic dilemma in treating clinician. We present two cases of dirofilariasis in the breast tissue mimicking a tumor initially, and on histopathology, it was diagnosed as a Dirofilaria infestation. The increased incidence of Dirofilaria infestation in the Southern part of the country has created a need for increased awareness among the population living in endemic areas to reduce the load of the parasite. Hence it is an ideal time to initiate the primary preventive measures to reduce the incidence of Dirofilaria infestation.

Autoimmune hemolytic anaemia (AIHA) is rare clinical disorder and requires efficient immunohematological and transfusion support. We report two cases of Immune hemolytic anaemia. A case of AIHA in congestive cardiac failure and second a known case of Giant cell arteritis with cold antibodies. Both the cases we encountered problems during cross matching.

Fibrous dysplasia (FD) is a benign disorder affecting one or more bones seen in all age groups and shows no geographical, racial and sex predilection. Fibrocartilaginous dysplasia (FCD) is a type of fibrous dysplasia where there is extensive cartilaginous differentiation. Our patient was a young girl with a 2 year history of pain in the right forearm and hip. Imaging studies showed multiple lucent lesions in the femur, humerus and radius. Microscopic examination of the curetted fragments from the lesion showed predominant cartilaginous components with focal fibro-osseous areas and areas of enchondral ossification. We present this case due to its rarity and the importance of distinguishing FCD from other benign and malignant cartilaginous tumors as it mimics these in clinical and histological features.

Context: The data on histological and receptor status in breast cancer in an Indian population is limited as receptor status is not routinely carried out for these patients. In the present study, receptor status was analyzed and it was correlated with morphological prognostic parameters. Objective: To analyze the morphological prognostic parameters and its correlation with receptor status in Indian women. Design: The sample consisted of 126 specimens of invasive breast cancer received in department of pathology of our institution with teaching hospital attached to it, situated in South Canara district of, Karnataka, South India between year 2009 and 2011. Result: Sixty-seven percent of patients were 50 years or younger. Histological types were invasive ductal carcinoma, not otherwise specified (58.7%), and overall (15.9%) were grade 3. Estrogen receptor was positive in 36.5%, HER/neu was overexpressed in only three cases; 50.0% were "triple" negative (estrogen receptor, progesterone receptor, HER/neu negative). Estrogen receptor (ER) and progesterone receptor (PR) positivity decreased with increase in tumor grade. There was significant association between tumor size and ER positivity. Conclusions: Breast carcinoma in our population presents at younger age than Western population. Our results showed very high proportion of triple-negative breast cancers. The tumor size and grade is related to expression of only ER. The findings suggest that women in our population more often have histologically aggressive breast carcinoma at young age, likely to be less susceptible to conventional hormonal and targeted antibody treatment. Detecting and treating this increasing important cause of mortality will be an enormous challenge.

Data on initial treatment of 8232 cases of localized prostate cancer diagnosed in 2004 were obtained by medical record abstraction (including hospital and outpatient locations) from seven state cancer registries participating in the Centers for Disease Control and Prevention's Breast and Prostate Cancer Data Quality and Patterns of Care Study. Distinction was made between men receiving no therapy with no monitoring plan (no therapy/no plan [NT/NP]) and those receiving active surveillance (AS). Overall, 8.6% received NT/NP and 4.7% received AS. Older age at diagnosis, lower clinical risk group, and certain registry locations were significant predictors of use of both AS and NT/NP. AS was also related to having more severe comorbidities, whereas nonwhite race was predicted receiving NT/NP. Men receiving AS lived in areas with a higher number of urologists per 100 000 men than those receiving NT/NP. In summary, physician and clinical factors were stronger predictors of AS, whereas demographic and regional factors were related to receiving NT/NP. Physicians appear reluctant to recommend AS for younger patients with no comorbidities.

The thiazolidinediones (TZDs) are a class of oral antidiabetic drugs that improve insulin sensitivity in patients with type 2 diabetes. Although the mechanism by which the TZDs lower insulin resistance is unclear, they are known to target the peroxisome proliferator-activated receptor γ (PPARγ), a nuclear hormone receptor. Ligands for PPARγ regulate adipocyte production and secretion of fatty acids as well as glucose metabolism, resulting in increased insulin sensitivity in adipose tissue, liver, and skeletal muscle. However, TZDs have several adverse effects, including weight gain and liver toxicity. Herein we report identification of non-TZD PPARγ agonists which exhibit beneficial effects similar to that of TZDs in animal models, but without the associated adverse effects.

Introduction Diallyl disulphide is an organo-sulphur compound which is present in garlic and responsible for the characteristic odor of garlic. It is known for its anticancer and invitro membrane stabilizing properties. Aim The main aim was to evaluate the haematopoietic, antioxidant and membrane stabilizing property of diallyl disulfide in irradiated mice. Materials and methods Mice were grouped into 6 groups as control, drug control, radiation control and drug pre-treatment groups (i.e. drug administration + radiation group) The mice were fed orally for 15 consecutive days and on the 15(th) day, one hour after drug administration, the mice were irradiated with 6Gy electron beam radiation. The changes in blood cell count, total antioxidant levels, malondialdehyde and reduced glutathione levels were determined. The immunomodulatory response of DADS to the radiological effects was determined by the estimation of IL-6 levels. Results A significant improvement in pre-drug treatment group when compared to control groups in the haemoglobin, red blood cell count, white blood cell count, haematocrit and platelet counts was observed. There is an increased level of interleukin-6 in the drug treated groups compared to the radiation control. An increase in the malondialdehyde levels and decrease in the glutathione levels in the irradiated group indicate increased lipid peroxidation and oxidative stress, whereas, there is a significant reduction in the malondialdehyde levels and increased glutathione levels in the drug pre-treatment groups showing membrane stabilization. Conclusion Thus DADS proves to be an effective haematopoietic and antioxidative agent to counter radiation induced haematopoietic suppression and oxidative stress.

Aim: Assessment is a very important component of the medical course curriculum. Item analysis is the process of collecting, summarizing, and using information from student's responses to assess the quality of multiple-choice questions (MCQs). Difficulty index (P) and discrimination index (D) are the parameters used to evaluate the standard of MCQs. The aim of the study was to assess quality of MCQs. Materials and Methods: The study was conducted in the Department of Pathology. One hundred and twenty, 2nd year MBBS students took the MCQs test comprising 40 questions. There was no negative marking and evaluation was done out of 40 marks, and 50% score was the passing mark. Postvalidation of the paper was done by item analysis. Each item was analyzed for difficulty index, discrimination index, and distractor effectiveness. The relationship between them for each item was determined by Pearson correlation analysis using SPSS 20.0. Results: Difficulty index of 34 (85%) items was in the acceptable range (P = 30–70%), 2 (5%) item was too easy (P >70%), and 4 (10%) items were too difficult (P 0.4), 4 (10%) items were good (D =0.3–0.39), 6 (15%) items were acceptable (D =0.2–0.29), and 6 (15%) items were poor (D < 0–0.19). A total 40 items had 120 distractors. Amongst these, 6 (5%) were nonfunctional distracters, 114 (95%) were functional distracters. The discrimination index exhibited positive correlation with difficulty index (r = 0.563, P = 0.010, significant at 0.01 level [two-tailed]). The maximum discrimination (D = 0.5–0.6) was observed in acceptable range (P = 30–70%). Conclusion: In this study, the majority of items fulfilled the criteria of acceptable difficulty and good discrimination. Moderately easy/difficult had the maximal discriminative ability. Very difficult item displayed poor discrimination, but the very easy item had high discrimination index, indicating a faulty item, or incorrect keys. The results of this study would initiate a change in the way MCQ test items are selected for any examination, and there should be proper assessment strategy as part of the curriculum development.

Objective Cervical cancer causes over 4000 deaths yearly in the United States, although highly preventable through vaccination, screening, and early treatment. We aimed to determine demographic correlates for cervical cancer in North Carolina to identify target populations for interventions and to create a framework for state-level analyses. Method Data on all reported invasive cervical cancer cases from 1998 to 2007 were obtained from the North Carolina Central Cancer Registry. Age-adjusted incidence and mortality rates were estimated using population data from the National Center for Health Statistics. Results Cervical cancer incidence and mortality rates varied greatly by county and were inversely associated with county prosperity. Hispanic women had the highest incidence rate, black women the highest mortality rate, although white women accounted for most cases. Incidence rates remained fairly steady above age 35 and mortality rates steadily increased with age. A later stage at diagnosis was more common for older women and for women without private insurance. Conclusion Registry-based assessment illustrates the economic, racial, and age disparities associated with cervical cancer. This localized focus on demographic correlates is an important step toward eliminating this preventable disease and offers a template for cervical cancer prevention programs in other states.

Insufficient alveolar gas exchange capacity is a major contributor to lung disease. During lung development, a population of distal epithelial progenitors first produce bronchiolar-fated and subsequently alveolar-fated progeny. The mechanisms controlling this bronchiolar-to-alveolar developmental transition remain largely unknown. We developed a novel grafting assay to test if lung epithelial progenitors are intrinsically programmed or if alveolar cell identity is determined by environmental factors. These experiments revealed that embryonic lung epithelial identity is extrinsically determined. We show that both glucocorticoid and STAT3 signalling can control the timing of alveolar initiation, but that neither pathway is absolutely required for alveolar fate specification; rather, glucocorticoid receptor and STAT3 work in parallel to promote alveolar differentiation. Thus, developmental acquisition of lung alveolar fate is a robust process controlled by at least two independent extrinsic signalling inputs. Further elucidation of these pathways might provide therapeutic opportunities for restoring alveolar capacity., Highlighted Article: Glucocorticoid receptor and STAT3 signalling act in parallel, but cross-regulated, pathways to control epithelial differentiation during lung alveolar development in mice.

Background: To date, no study has reported on the cost of treating breast cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Objective: This study assesses the incremental cost of breast cancer treatment among Medicaid beneficiaries aged below 65 years. Research Design: Administrative data from the North Carolina Medicaid program linked with cancer registry data were analyzed to derive monthly Medicaid costs for cancer patients and the incremental costs of breast cancer treatment at 6, 12, and 24 months from diagnosis. We compared 848 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 1696 comparison cases matched on age. Results: With the exception of in situ cancers, the cost of cancer care continued to increase beyond the initial 6-month period. The incremental costs at 6 months after diagnosis are $ 14,341, $ 24,002, and $ 34,469 for those with local, regional, and distant breast cancers, respectively; and these costs increased to $ 22,343, $ 41,005, and $ 117,033 at 24 months. Conclusions: The extended period of health care utilization, beyond the immediate 6-month period after diagnosis, indicates that Medicaid coverage may be required for many months after diagnosis to complete treatment. Continuous Medicaid coverage should be provided for an adequate time period to ensure that complete and comprehensive treatment is provided.

Background To date, no study has reported on the cost of treating cervical cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the cost effectiveness of screening interventions for low-income women and the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Methods Administrative data from the North Carolina Medicaid program linked with cancer registry data were used to analyze total Medicaid costs for these patients and the incremental costs of cervical cancer care at 6 and 12 months from diagnosis. We compared 207 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 414 controls. Findings Total Medicaid costs at 6 months after diagnosis were $3,807, $23,187, $35,853, and $45,028 for in situ, local, regional, and distant cancers, respectively. The incremental cost of cancer treatment for local and regional cancers was $13,935 and $26,174 and by 12 months increased to $15,868 and $30,917, respectively. Conclusion Medicaid coverage may be required for many months after diagnosis to ensure the provision of comprehensive care, especially for women with late-stage cancers. Given the great differences in cost of early versus late-stage cancers, interventions aimed at increasing screening among low-income women are likely to be cost effective.

Phlebotomy is one of the common invasive procedures carried out all round the globe. The practice of phlebotomy varies widely. In terms of the technique, the procedure may involve the use of a syringe or a vacutainer, and as for the technicians, some are not specifically trained to perform the procedure and others are qualified phlebotomists. Finally, some may receive training on the job, while others undergo formal, focused training. However, the underlying ethical principles of respect for autonomy and informed consent do not change. This commentary, which is supported by data collected during training in phlebotomy, reflects on the ethical issue of obtaining consent for the procedure.

Langerhans cell histiocytosis most commonly occurring in children, demonstrates a broad spectrum of clinical and radiologic features that may mimic those of infection as well as benign and malignant tumors. Osseous involvement is the most common manifestation. Recognition of the skeletal alterations is important so that the disease is considered as differential diagnosis. This disease is of unknown aetiology, non-specific clinical and imaging findings with diagnosis possible only on histopathological examination, will always pose a diagnostic challenge to the orthopaedic surgeon. Here by we are reporting two cases of eosinophilic granuloma that has presented with lytic lesion in the tibia and scapula. The clinico-radiological suspicion was either infection or tumour of the affected bones. Hence, core biopsy was done confirmed as eosinophilic granuloma on histopathology and immunohistochemistry.

Objectives: To describe the epidemiology and clinical profile of cases of HFMD in an outbreak. Design: Descriptive epidemiological study. Setting: Tertiary care center in North Bangalore. Methods: Patients attending to M.S.Ramaiah medical college hospital with features suggestive of HFMD were included in the study. The patient's demographic data, clinical features and examination findings were entered in to a predesigned format. The epidemiol- ogy and clinical features were analyzed using appropriate statistical methods. Results: A total of 71 children were diagnosed as HFMD disease, 47 (66.2%) were boys and 24 (33.8%) were girls, fever was seen in 62 (87.3 %) of the affected children, anorexia and sore throat was seen in 47 (66.2 %) and 35 (49.3%) children respectively. Typical rashes were seen on hands in 67 (94.4%), 64 (90.1%) had rashes on feet, 58 (81.7%) had mouth ulcers, and 37 (52.1%) had rashes on buttocks. There was history of exposure to a HFMD in 46 (64.8%) of the children mostly at home in 19 (26.8%), at day care centers in 14 (19.7%) and in 13 (18.3%) at school. The disease lasted between 2 days to 8 days. There were no complications noted. Conclusion: HFMD affected mainly children in the age group of 1-10 years, affected more boys than girls, complete recovery without any major complications was seen in the present outbreak. The characteristic clinical features will be helpful in early diagnosis of HFMD and will help in looking for any complications occurring in HFMD.