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Abstract Introduction There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia. Methods Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules. Results Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow‐up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow‐up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection. Conclusions Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.

Introduction: Hyperlipidemia and its complications are common health issues in the current era with multifactorial in origin. Foetal malnutrition results in neuroendocrine, pancreatic, and adipose tissue dysfunction, ultimately increasing food intake and decreasing energy utilisation. It leads to an increase in adiposity and insulin resistance and ultimately increase adult diseases in later life. Aim: To compare the lipid profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) babies. Materials and Methods: This was a case-control study was conducted in the Department of Pediatrics, Obstetrics and Gynecology of Karwar Institute of Medical Sciences, Karwar, Karnataka, India over a period from (December 2020 to March 2021). A total of 133 deliveries were recruited randomly and babies were divided into cases including those small for gestational age & controls including those appropriate for gestational age. Data was analysed and described using descriptive (mean, standard deviation, and range) and inferential statistics (students’ t-test). Results: There were 99 appropriate for gestational age (AGA) and 34 small for gestational age(SGA) babies studied. This study found that SGA-babies had statistically significantly lower gestational age(Mean 37.50 ± 2.77 weeks) at birth compared to AGA-babies (Mean 38.55±1.11 weeks) t=-2.584, p=0.012. The mean Total Cholesterol (TC) level (63.62±40.48 mg/dL) was higher in SGAbabies compared to AGA-babies(48.69±2.29 mg/dL) and this difference was statistically significant (p-value=0.007). The mean high density lipoprotein (HDL) levels of SGA and AGA babies were comparable with no statistical significance (21.82±13.26mg/ dL of SGA; 21.4914.64mg/dL of AGA; p-value 0.907). The mean very low density lipoprotein (VLDL) level (17.1125.35 mg/dL) was higher in SGA-babies compared to AGA-babies (9.47±9.35 mg/ dL) and this difference was statistically significant (p-value 0.05). Conclusion: Levels of all lipids were found to be higher in SGAbabies than in AGA-babies.

Objective To describe the process of community engagement (CE) in northern Karnataka, India and its impact on pre-eclampsia knowledge, birth preparedness and complication readiness, pregnancy-related care seeking and maternal morbidity.Design This study was a secondary analysis of a cluster randomised trial of Community Level Interventions for Pre-eclampsia (CLIP). A total of 12 clusters based on primary health centre catchment areas were randomised to intervention or control. CE was conducted in intervention clusters. CE attendance was summarised according to participant group using both quantitative and qualitative assessment. Pre-eclampsia knowledge, birth preparedness, health services engagement and perinatal outcomes was evaluated within trial surveillance. Outcomes were compared between trial arms using a mixed effects logistic regression model on RStudio (RStudio, Boston, USA). Community feedback notes were thematically analysed on NVivo V.12 (QSR International, Melbourne, Australia).Setting Belagavi and Bagalkote districts in rural Karnataka, India.Participants Pregnant women and women of reproductive age, mothers and mothers-in-law, community stakeholders and male household decision-makers and health workers.Results A total of 1379 CE meetings were conducted with 39 362 participants between November 2014 and October 2016. CE activities may have had an effect on modifying community attitudes towards hypertension in pregnancy and its complications. However, rates of pre-eclampsia knowledge, birth preparedness, health services engagement and maternal morbidities among individual pregnant women were not significantly impacted by CE activities in their area.Conclusion Evaluation of our CE programme in India demonstrates the feasibility of reaching pregnant women alongside household decision-makers, community stakeholders and health workers. More research is needed to explore the pathways of impact between broad community mobilisation to strengthen support for maternal care seeking and clinical outcomes of individual pregnant women.Trial registration number NCT01911494.

Aim: Indigenous Australians with lung cancer have poorer survival than non‐Indigenous Australians. The reasons for the disparity are not fully understood and this study hypothesized that there may be a difference in the molecular profiles of tumors. The aim of this study, therefore, was to describe and compare the characteristics of non‐small cell lung cancer (NSCLC) in the Northern Territory's Top End, between Indigenous and non‐Indigenous patients, and describe the molecular profile of tumors in the two groups. Methods: A retrospective review was conducted of all adults with a new diagnosis of NSCLC in the Top End from 2017 to 2019. Patient characteristics assessed were Indigenous status, age, sex, smoking status, disease stage, and performance status. Molecular characteristics assessed were epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), v‐raf murine sarcoma viral oncogene homolog B (BRAF), ROS proto‐oncogene 1 (ROS1), Kirsten rat sarcoma viral oncogene homolog (KRAS), mesenchymal‐epithelial transition (MET), human epidermal growth factor receptor 2 (HER2), and programmed death‐ligand 1 (PD‐L1). Student's t‐test and Fisher's Exact Test were used in the statistical analysis. Results: There were 152 patients diagnosed with NSCLC in the Top End from 2017–2019. Thirty (19.7%) were Indigenous and 122 (80.3%) were non‐Indigenous. Indigenous patients compared to non‐Indigenous patients were younger at diagnosis (median age 60.7 years versus 67.1 years, p = 0.00036) but were otherwise similar in demographics. PD‐L1 expression was similar between Indigenous and non‐Indigenous patients (p = 0.91). The only mutations identified among stage IV non‐squamous NSCLC patients were EGFR and KRAS but testing rates and overall numbers were too small to draw conclusions about differences in prevalence between Indigenous and non‐Indigenous patients. Conclusion: This is the first study to investigate the molecular characteristics of NSCLC in the Top End. [ABSTRACT FROM AUTHOR]

Background: Use of immune checkpoint inhibitors is growing, but clinical trial data may not apply to Indigenous patients or patients living in remote areas. Aims: To provide real‐world incidence of immune‐related adverse events (irAE) in the Top End of the Northern Territory and compare incidence between demographic subgroups. Methods: This retrospective, observational, cohort study collected data from electronic records of patients living in the Top End with solid organ cancer treated with immunotherapy between January 2016 and December 2021. The primary outcome was cumulative incidence of any‐grade and severe irAE. Secondary outcomes were overall survival, treatment duration and reason for treatment discontinuation. Results: Two hundred and twenty‐six patients received immunotherapy. Forty‐eight (21%) lived in a remote or very remote area, and 36 (16%) were Indigenous. Cumulative incidence of any‐grade irAE was 54% (122/226 patients); incidence of severe irAE was 26% (59/226 patients). Rates were similar between Indigenous and non‐Indigenous patients of any‐grade (42% vs 56%, P = 0.11) and severe (11% vs 18%, P = 0.29) irAE. However, Indigenous patients had shorter treatment duration, more frequently discontinued treatment due to patient preference and appeared to have shorter median overall survival than non‐Indigenous patients (17.1 vs 30.4 months; hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 0.92–2.66). There was no difference in mortality between remote and urban patients (median overall survival 27.5 vs 30.2 months; HR = 1.1, 95% CI = 0.7–1.7). Conclusions: Rates of irAE in our cohort are comparable to those in the published literature. There was no significant difference in any‐grade or severe irAE incidence observed between Indigenous and non‐Indigenous patients. [ABSTRACT FROM AUTHOR]

Introduction: There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia. Methods: Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules. Results: Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow‐up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow‐up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection. Conclusions: Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population. [ABSTRACT FROM AUTHOR]

Abstract Background Paraneoplastic neurological syndrome is an immune-mediated phenomenon where antibodies from tumor cells are produced against neuronal proteins. Amphiphysin antibody is an onconeural antibody linked to the diagnosis of breast cancer and small-cell lung cancer. It is uncommon and typically associated with stiff-person syndrome, of which 90% of patients are eventually diagnosed with breast cancer. Case presentation We present a case of a 47-year-old Caucasian woman with metastatic hormone receptor-positive breast cancer who developed bilateral facial nerve palsy while on treatment with nab-paclitaxel. The patient was found to have anti-amphiphysin antibody in the serum and cerebrospinal fluid. She was treated with methylprednisolone and intravenous immunoglobulin, which resulted in partial improvement in her facial nerve palsy. Conclusions This case highlights a rare presentation of bilateral facial nerve palsy that likely related to paraneoplastic syndrome associated with the presence of anti-amphiphysin antibody.

Vivek Narayan, Naomi Balzer Haas Division of Hematology/Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA Background: Axitinib is a next-generation, selective tyrosine kinase inhibitor targeting the vascular endothelial growth factor receptors. It is approved for the treatment of metastatic renal cell carcinoma (mRCC) based on a demonstrated progression-free survival advantage over sorafenib in the second-line treatment setting. However, given the variety of available targeted therapies for mRCC, appropriate patient selection for the available therapies remains a significant clinical challenge. Purpose: This review summarizes the available evidence on the clinical, toxicity, and pharmacologic considerations for determining appropriate patient selection for axitinib therapy. In addition, it describes recent data on the use of predictive biomarkers to guide clinical management. This paper consists of material obtained via PubMed and Medline literature searches through October 2015. Conclusion: Axitinib has a well-established role in the management of mRCC. Consistent clinical efficacy has been demonstrated across prognostic risk groups and prior therapeutic exposures. Although axitinib is generally well tolerated, appropriate toxicity management is critical to maximizing drug delivery and optimizing treatment outcomes. Although incident hypertension has been associated with improved clinical outcomes on axitinib, there are currently no validated clinical or genetic predictive biomarkers to guide patient selection. Keywords: axitinib, vascular endothelial growth factor receptor, renal cell carcinoma, predictive marker

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013-2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women's and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013-2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013-14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

Background: Orofacial anomalies occur due to incomplete fusion of developmental lines in the head and neck region. Dental anomalies regarded as the most common orofacial anomalies either in isolated or syndromic forms arise due to genetic and environmental factors. Among genetic influences, consanguineous marriages are considered as a significant predisposition factor in the transmission of congenital defects and several autosomal recessive diseases from one generation to other with an increased risk of detrimental effects on offspring. Aim: The present study was aimed to evaluate the prevalence and significant association between consanguinity and isolated dental anomalies with that of nonconsanguineous parents among south-Indian population. Methodology: A total of 116 participants with and without dental anomalies in isolated form pertaining to tooth size, shape, altered morphology, number and eruption were selected followed by brief case history. Participants with a positive history of consanguinity were categorized as Group A while others were categorized under Group B. Results: Sixty-four out of 116 participants (55.17%) showed positive consanguinity (Group A) among which 18 females (56%) and 14 males (44%) presented with isolated dental anomalies. 12 females (66.6%) and 9 males (64.2%) in Group A showed significance with first cousin (P = 0.00204) whereas no significance was observed in other consanguinity type (P = 0.7287). Nonetheless, the overall frequency of isolated dental anomalies was slightly higher in Group A than Group B that was statistically significant (P = 0.0213). Conclusion: A positive correlation between dental anomalies among offspring of consanguineous marriages revealed such prevalence may be attributed to increased risk of recessive deleterious gene expression or defective allele carried to offspring. [ABSTRACT FROM AUTHOR]

Impaction of first, second and third molars at once comprise a rare clinical scenario with diverse therapeutic approaches and possess a great challenge for the dentist. Early detection of the eruption disturbances helps to manage and produce optimal outcomes. Here, the author reported a case of 17 years old male patient who reported with the chief complaint of pain in his lower left back tooth region with difficulty in mouth opening and chewing that revealed impacted mandibular left first, second and third molar on radiographic investigation. A proper decision making is required to satisfy the patient and also get an effective result. As the patient had severe pain in the left-side of the jaw near the angle of the mandible, surgical removal of the impacted molars was planned and performed using extra oral submandibular approach. Following the removal of the teeth, implants were placed in the extracted site supported by bone graft material and fixed orthodontic appliance therapy was carried out to correct the supraerupted upper molars on the left-side and arch expansion screw with upper Hawley's appliance was given to expand the maxillary arch to aid in appropriate occlusion. Restoration of the implant was done after one year of orthodontic treatment using ceramic crowns. The combined surgical, orthodontic and periodontal inter-disciplinary approach helped the patient to gain proper occlusion and satisfactory masticatory function. [ABSTRACT FROM AUTHOR]

Aims: Assess the relationship between job satisfaction and feeling of hopelessness among dental academicians.Settings and Design: Cross sectional study was conducted among dental academicians across India through email and social media using a pretested questionnaire.Methods and Materials: An Internet-based cross-sectional survey was conducted among dental academicians via social media and electronic mail (e-mail) throughout India. Demographics, credentials and job satisfaction across five dimensions (working conditions, pay and promotional potential, work relationships, use of skills and abilities and work activities) were rated on a 5-point Likert scale and a sense of hopelessness was assessed using Brief-H-Neg scale. The results were collected using self-reported Google forms. Bivariate and multivariate analysis were performed to identify the risk towards hopelessness, and the relationship between job satisfaction and hopelessness was assessed using student's t-test.Results and Conclusion: The mean hopelessness score among dissatisfied faculty was 8.5 and among satisfied was 5.6 (P < 0.05). Tutors, assistants and associate professors with salary of INR <50000/month were highly dissatisfied (P < 0.05), and those willing to quit reported significantly lesser hopelessness compared to no/maybe. Regarding job satisfaction, greater hopelessness was reported with poor work relationships, poor working conditions and poor pay and promotional opportunities (P < 0.05). Dental academicians in India are highly dissatisfied with their career as a full-time teaching faculty. Willingness to quit has a positive effect on hopelessness, depicting the stress faculties experience in institutions. Job satisfaction among academicians plays a vital role in the student's dental learning experience and dissatisfaction will have huge ramifications on the quality of dental education and future graduates in India. [ABSTRACT FROM AUTHOR]

Background: Paraneoplastic neurological syndrome is an immune-mediated phenomenon where antibodies from tumor cells are produced against neuronal proteins. Amphiphysin antibody is an onconeural antibody linked to the diagnosis of breast cancer and small-cell lung cancer. It is uncommon and typically associated with stiff-person syndrome, of which 90% of patients are eventually diagnosed with breast cancer.Case Presentation: We present a case of a 47-year-old Caucasian woman with metastatic hormone receptor-positive breast cancer who developed bilateral facial nerve palsy while on treatment with nab-paclitaxel. The patient was found to have anti-amphiphysin antibody in the serum and cerebrospinal fluid. She was treated with methylprednisolone and intravenous immunoglobulin, which resulted in partial improvement in her facial nerve palsy.Conclusions: This case highlights a rare presentation of bilateral facial nerve palsy that likely related to paraneoplastic syndrome associated with the presence of anti-amphiphysin antibody. [ABSTRACT FROM AUTHOR]

Background: The aryl hydrocarbon receptor repressor (AHRR), a member of the growing superfamily, is a basic helix-loop-helix/PerAHR nuclear translocator (ARNT)-Sim (bHLH-PAS) protein. AHRR has been proposed to function as a putative new tumor suppressor gene based on studies in multiple types of human cancers. This current study aims to investigate AHHR expression and its prognostic significance in gallbladder cancer. Methods: The study includes 48 gallbladder cancer and 34 chronic cholecystitis cases as controls. The expression level of AHRR was analyzed by using semi-quantitative PCR and immunohistochemical staining. The results were correlated with different clinical parameters. Results: We demonstrate that the expression of AHRR is significantly down-regulated in gallbladder cancer tissue samples as compared to that in chronic cholecystitis tissue samples by reverse transcriptase PCR (RT-PCR) (P = 0.017) and immunohistochemistry analysis (P = 0.002). Interestingly, our RT-PCR data revealed that AHRR mRNA expression is frequently down-regulated (45.8%; 22/48) in cases as compared to 14.7% (5/34) in controls. Similarly, immunohistochemical analysis data show significant down-regulation of AHRR expression in 77.1% (37/48) of gallbladder cancer cases than 44.1% (15/34) in controls (P < 0.017). Reduced mRNA and protein expression is significantly associated with advanced T-stage (P = 0.001), histological differentiation (P = 0.001), and tumors with nodal metastasis (P = 0.001). Decreased expression of AHRR is significantly associated with poor prognosis in gallbladder cancer patients. Conclusion: In conclusion, the present study suggests that low AHRR expression may be critical in gallbladder cancer development. Our data suggests that AHRR may act as a tumor suppressor gene and its expression profile may be useful as a diagnostic marker in gallbladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome. [ABSTRACT FROM AUTHOR]

Oral cancer is of significant public health importance to India owing to its high prevalence. Early detection of oral cancer offers the best chance for long term survival and has the potential to improve treatment outcomes and make healthcare affordable. The objective of this paper is to report a case on similar difficulty faced in public health care scenario and to create awareness among services sector on focusing the incidence of disease in the country highlighting the significance of a community dentist's role in guidance of betterment of life an individual who was ignorant and asymptomatic. Hence an attempt to project this case report with two year follow-up and a quality of life. [ABSTRACT FROM AUTHOR]

Aim: Dentists could play an important role in tobacco cessation counseling. This study is conducted to assess dental professionals' understanding of tobacco prevention and control methods. Material and Method: A descriptive cross sectional study was conducted in which a close-ended, self-administered 30 item-questionnaire was distributed among 130 interns at private dental institutions in Chennai. Demographic data, tobacco use status, attitudes toward cessation programs, perceived barriers and counseling procedure was filled by the surveyed subjects. Results: About 97.7% of the dental interns agreed their role in helping patients to quit smoking. Though 82.3% enquired all their patients regarding their smoking status, 86.9% of them feared improper follow up. Nearly 85.4% of the respondents believed that the counseling done is effective but only 32% anticipated successful intervention and 21% of them were very confident in conducting it. Conclusion: It was concluded that although dentists were aware of their obligations towards smoking cessation counseling for patients but certain factors like lack of time, confidence,,training,absence of reimbursement and fear of losing patients were the common barriers for the same. Expansion of armamentarium to include tobacco cessation counseling strategies in clinical practice must be adopted by all dental professionals. [ABSTRACT FROM AUTHOR]