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To compare the efficacy of intravenous acetaminophen and intravenous diclofenac sodium in the management of skeletal vaso-occlusive crisis among children with sickle cell disease. Single blind randomized controlled trial. Tertiary care hospital. 104 children with sickle cell disease and skeletal vaso-occlusive crisis. Intravenous acetaminophen at 10mg/kg/dose 8 hourly and intravenous diclofenac sodium at 1mg/kg/dose 8 hourly in 1:1 ratio. Reduction in pain score (50%), number of doses needed to relieve pain after 24 hours of drug administration and decrease in pain score at 1 hour. A 50% reduction in pain score was seen in 35 (77.3%) and 10 (21.7%) children among acetaminophen and diclofenac sodium groups respectively (RR, 95% CI 3.6; 2.02–6.33, P< 0.001). The mean (SD) fall in pain score at 1 hour was significantly higher among intervention arm as compared to control arm [1.51 (0.5) and 1.06 (0.5); P

Breast Self-Examination (BSE) is a screening method used in an attempt to detect early breast cancer. The method involves the women herself looking at and feeling each breast for possible lumps, distortions or swelling. Breast Self-Examination (BSE) was once promoted heavily as a means of finding cancer at a more curable stage. So this study was aimed at assessing knowledge regarding Breast Self-Examination among Medical students in IGIMS, Patna, Bihar.

Background:The global alliance for genomics and healthcare facilities provides innovative solutions to expedite research and clinical practices for complex and incurable health conditions. Precision oncology is an emerging field explicitly tailored to facilitate cancer diagnosis, prevention, and treatment based on patients’ genetic profiles. Advancements in “omics” techniques, next-generation sequencing, artificial intelligence, and clinical trial designs provide a platform for assessing the efficacy and safety of combination therapies and diagnostic procedures.Method:Data were collected from PubMed and Google Scholar using keywords “Precision medicine,” “precision medicine and cancer,” “anticancer agents in precision medicine,” and reviewed comprehensively.Results:Personalized therapeutics, including immunotherapy and cancer vaccines, serve as a groundbreaking solution for cancer treatment. Herein, we take a measurable view of precision therapies and novel diagnostic approaches targeting cancer treatment. The contemporary applications of precision medicine have also been described, along with various hurdles identified in the successful establishment of precision therapeutics.Conclusion:This review highlights the key breakthroughs related to immunotherapies, targeted anticancer agents, and target interventions related to cancer signaling mechanisms. The success story of this field in context to drug resistance, safety, patient survival, and improving quality of life is yet to be elucidated. We conclude that, in the near future, the field of individualized treatments may truly revolutionize the nature of cancer patient care.

Objectives We retrospectively compared the seventh and eighth editions of American Joint Committee on Cancer (AJCC) TNM frameworks as disease-free survival (DFS) and overall survival (OS) predictors in oral squamous carcinomas (OSCCs). Methods We restaged the 342 patients with the revised pT and pN criteria and performed survival analyses. Results The 3-year DFS (mean follow-up, 364 days; recurrences, 99) was 50%, and the 5-year OS (mean follow-up, 615 days; deaths, 69) was 42%. The eight edition pN classification was an independent multivariate survival predictor. The revised TNM criteria upstaged pT, pN, and stage groupings in 99 (38.8%), 58 (37.3%), and 101 (29.5%) patients. The latter two groups revealed significantly worse DFS and OS compared with those whose categorizations had remained unaltered. In addition, their classification/staging criteria demonstrated superior discrimination, monotonicity, and accuracy for survival estimations. Conclusions Of the competing AJCC staging criteria, the revised pN classification was the most powerful system to predict OSCC survivals.

Background: Natural Killer (NK) cell plays an important role in the innate immune system and is known to produce IFN-γ at an early stage of infection that is essential to eliminate intracellular infection like Leishmania spp. It is already established that Leishmania parasite inhibits the activity of NK cells, avoiding the encounter with the early innate immune response. This, in turn, favors establishment and further dissemination of the infection. Methods: In the present study, we have tried to measure the frequency of different phenotypic subsets of NK cells among visceral leishmaniasis (VL) patients. Results: We have phenotyped three distinct three distinct subsets (CD56–CD161+, CD56+CD161–, and CD56+CD161+) of NK (CD3–) cell using their specific markers CD161 and CD56. Conclusion: Interestingly, we observed selective loss of CD56+CD161+ subset of circulating NK (CD3–) cells. Importantly, the other subsets (i.e., CD56−CD161+ and CD56+CD161–) of circulating NK cells remain unaffected as compare...

One of the problems among Women of Reproductive Age (WRA) group has been lack of effective programs whose benefits are not reaching WRA group. Another problem is the prevalence of monotonous diet based on starchy staple food, which lacks essential micronutrients and contribute to the burden of malnutrition and micronutrient deficiency. The objectives of the study was to assess household dietary diversity and nutritional status of non-pregnant non-lactating women of reproductive age in urban field practice area in Burla as a way of comparing food security situation. It was a cross sectional study. Data were collected from urban field practice area in Burla and were analysed to assess the dietary diversity among “women of reproductive age (WRA)” group. One third (about 29%) of them was malnourished. On application of logistic regression, those aged ≥25years had better odds of having Minimum Dietary Diversity (MDD) score of 5 and above (OR=1.777). Subjects with BMI range ≥21.5 Kg/mt2 also had better odds of having MDD score of 5 and above (OR=3.371). Women of reproductive age are nutritionally more vulnerable because of pregnancy, lactation and menstruation requiring nutrient dense quality food. Monotonous diet based on starchy staple lacks essential micronutrients and contribute to the burden of malnutrition and micronutrient deficiency. Intake of diverse diet is a cost effective strategy to overcome this problem. From our survey we conclude that more than half of WRA failed to achieve MDD. Based on findings, Information Education and Communication (IEC) activities are recommended with an emphasis on locally available, low-cost nutrition diet. Keywords: Minimum Dietary Diversity, Women of Reproductive Age, Micronutrients

Infection with L. donovani affects mainly visceral organs. Importantly, the parasitic load differs in different visceral organs; therefore there is a need to understand the organ specific immune regulation, particularly in the spleen and liver. Comparative studies between these organs in Leishmania infected hamster (Mesocricetus auratus) are lacking. Our study highlights the importance of eicosanoids in the organ specific pathology of visceral leishmaniasis. Among other immune cells, macrophages (mφ) which harbor Leishmania parasite are major producers of eicosanoids. In this study, we intend to explore linkage between organ specific immune response and eicosanoids. We suggest that eicosanoids (early immune modulators) and their organ specific expressions, possibly tune the outcome of mφ differently at different sites. We have observed that liver showed better containment of parasitic load than spleen, where we have found higher expression of 5-lipoxygenase (5-LO) enzyme along with IL-12 and iNOS. However, in spleen, enzymes of the PGE2 pathway i.e. PGE2 synthases (cytosolic and microsomal) along with IL-10 were predominantly higher. To further corroborate our findings, in vitro assays were carried out using purified eicosanoids (LTB4 and PGE2) and the inhibitors of these pathways. Findings establish that the 5-lipoxygenase pathway (i.e. LTB4) is anti-parasitic and its inhibition increases the parasitic load (qPCR based kDNA detection). On the contrary, PGES pathway (i.e. PGE2) supports establishment of infection in mφ. Taken together, 5-LO pathway plays a protective role in liver during L. donovani infection. However, the PGES pathway favors the parasite growth, particularly in the spleen at a later stage.

Globally, around 34 million people are living with HIV in 2010, and 35% of the pregnant women are tested for HIV in the low and middle income countries. HIV infection in pregnancy has become a complication of pregnancy in some developing countries. This has major implications for the management of pregnancy and birth. A cross sectional study was conducted from December 2018 – February 2019 in tertiary care hospital, VIMSAR Burla . The present study was conducted to assess the knowledge about HIV/AIDS and mother to child transmission issues among women seeking antenatal care and visiting ICTC. A sample of 150 pregnant females was used to accomplish the study. A pre- tested semi-structured questionnaire was used to gather information on the study variables. The questionnaire included variables related socio-demographics e.g., age, education status, occupation, residence, awareness about HIV/AIDS. The study reflected that 83.4% of the women had heard of the term HIV/AIDS which reflects a relatively high level of awareness about the term but subsequently dropping levels of awareness about the routes of transmission, laboratory diagnosis and the availability of drugs. Only 45.3% of the respondents were aware of ICTC. 42.7% were aware about mother to child transmission of HIV and only 32% were aware of anti-retro viral therapy for newborn. Keywords: HIV, ICTC, Antenatal

Colorectal cancer is the third major cause of cancer-related mortality worldwide. The upward trend in incidence and mortality rates, poor sensitivity to conventional therapies and a dearth of early diagnostic parameters pose a huge challenge in the management of colorectal cancer in India. Due to the high level of genetic diversity present in the Indian population, unraveling the genetic contributions towards pathogenesis is key towards understanding the etiology of colorectal cancer and in reversing this trend. We have established a novel cell line, MBC02, from an Indian colorectal cancer patient and have carried out extensive molecular characterization to understand the pathological alterations in this cell line. In-depth molecular analysis of MBC02 revealed suppression of E-cadherin expression, concomitant with overexpression of EMT related molecules, which manifested in the form of highly migratory and invasive cells. Loss of membrane-tethered E-cadherin released β-catenin from the adherens junction resulting in its cytoplasmic and nuclear accumulation and consequently, upregulation of c-Myc. MBC02 showed dramatic transcriptional upregulation of β-catenin. Remarkably, we observed significantly elevated proteasome activity that perhaps co-evolved to compensate the unnaturally high mRNA transcript of β-catenin to regulate the increased protein load. In addition, there was substantial misregulation of other clinically relevant signaling pathways that have clinical relevance in the pathogenesis of colorectal cancer. Our findings pave the way towards understanding the molecular differences that could define pathogenesis in cancers originating in the Indian population.

People suffering from malnutrition become susceptible to the infection like Leishmania sp., as it results in a compromised immune response. Retinoic acid (RA), an important constituent of nutrition, shows an immune-modulatory activity. However, its role in the containment of infection is not yet ascertained, particularly in case of visceral leishmaniasis (VL). VL patients (n = 10) and healthy endemic controls (n = 9) were recruited to measure the serum levels of RA. An in vitro model of Leishmania infection using the murine mφ cell line J774.1 was used to investigate the RA-synthesizing enzymes (RALDH-1 and RALDH-2). Parasite loads among infected mφ were measured by quantitative expression of kDNA in the presence of an inhibitor of the RALDH-2 enzyme. We found a significant decrease in the serum levels of RA in VL cases. Importantly, we observed decreased levels of RALDH-1 and RALDH-2 among L. donovani-infected mφ along with simultaneous decrease as well as increase in the Th-1 and Th-2-associated factors, respectively. Furthermore, the pretreatment of mφ with an RALDH-2 inhibitor improved parasite in vitro infection. Our findings show impaired RA pathway among infected mφ and indicate that an intact RA pathway is critical for anti-Leishmania immune response. Graphical abstract ᅟ.

Introduction: In INDIA almost 20000 people die (40% of world death) each year from rabies. Most of these deaths could be prevented by post exposure prophylaxis with wound washing, rabies immunoglobulin & vaccination. Local wound management alone can reduce viral load by up to 80%. Objective: To study self-wound management practices in animal exposure patients before attending a tertiary level ARV clinic. Methodology: Data regarding wound management was collected by individual interview of patients attending the ARV clinic during OCT 2011 to MAR 2012. The data collected in the form of a questionnaire. Analysis of data was done in the Department Of Community Medicine, V.S.S. Medical College, Burla. Results: Total 493 cases of animal exposure were attended during the study period. Most common biting animal was dog (94.5%). 31% of cases were under the age of 10 years & 23% belongs to the age of 10-19 years. Male to female ratio was 3:1. Most of the cases (91%) were of category III exposure. Immediate management of wound was practiced by 63-77% of cases before visiting ARV clinic; only 2% wash the wound with running water & soap for 15 minutes. 39% of cases applied Dettol/savlon at the wound side & other 38% applied turmeric, red chilli, kerosene, Band-Aid & ghee locally. Most cases (61%) reported to ARV clinic within 24hours.

Background: Oligohydramnios presents a threat to the fetus and has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. It is associated with perinatal morbidity and mortality and maternal morbidity in a significant number of cases. Therefore, early detection of oligohydramnios and its management is important. Aim of this study was to know the fetal and maternal outcome in oligohydramnios.Methods: 90 patients in third trimester of pregnancy with Oligohydramnios were selected after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring Amniotic fluid index (AFI).Results: Mean maternal age-26.1 years. Incidence of oligohydramnios was more in primipara (64.4%) in our study. And operative morbidity was also more in primipara (51.7%). Most common cause of Oligohydramnios was idiopathic (44.44%). Operative morbidity was significantly higher in Non-reassuring FHR (80%) than reassuring FHR (32%). 7 patients (7.78%) were found with fetoplacental insufficiency on Doppler study.Conclusions: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care so that perinatal morbidity and mortality and maternal morbidity can be reduced.

Non-communicable disease (NCD), is a medical condition or disease which by definition is noninfectious and non-transmissible between persons. It may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke. They include autoimmune diseases, heart disease, stroke, many cancers, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts and more. Out of these, India is facing an "epidemic" of diet-related non-communicable disease namely diabetes along with widely prevalent under-nutrition resulting in substantial socio-economic burden over the country. According to data released by International Diabetes Federations, in India the number of persons suffering from diabetes have increased from 19 million in 1995 to 51 million in 2010 and it is projected to be increased to 87 million by 2030 (Ramachandran, 2010). Diabetes mellitus is a chronic metabolic disorders characterized by high blood glucose levels resulting from defects in insulin secretion, insulin action or both, which prevents the body to utilize glucose completely or partially (zimmet, 1983). The prevalence of diabetes in developing countries is due to adoption of western life-style, sedentary life, smoking, high fat diet and lack of physical exercise. Indians are at special risk because of fat accumulating phenotype/ genotype, high percentage of body fat at lower level of BMI as well as central and truncal distribution of fat. All these factors have led to substantial increase in the prevalence of obesity. People who eat too much food and lead a sedentary life become overweight and obese. Obesity reduces the sensitivity of tissues to the action of insulin in the utilization of glucose. Lack of physical activity and obesity increases the risk for development of diabetes in the later stage of a person’s life (Raghuram et al, 1998). Extensive research published over the past two decades has demonstrated a positive association between increased levels of body fatness, obesity and type-2 diabetes (Pi-Sunyer, 1991). In particular abdominal obesity has been identified as a significant risk factor for the development of insulin resistance, glucose intolerance and type-2 diabetes (Despres, 1993). Although not all Individuals with increased body fatness and abdominal obesity manifest the metabolic complications of diabetes, approximately 85% of patients with type-2 diabetes display increased levels of body fatness (Tsui Eyl et al, 1998). In order to make the most valid assessment of body composition, it is necessary to understand the underlying theoretical models and reference methods used to develop body composition prediction equations. The two-component model of body composition divides the body into a fat component and fat free body (FFB) component (Brozek et al, 1963; siri, 1961). The FFB consists of all residual chemicals and tissues including water, muscles (protein) and bone (minerals). This model assumes that (a) the density of the FFB is 1.1 g/cc and (b) the densities of the fat and the FFB components are same for all individuals (c) the individual being measured differs from the reference body only in the amount of fat, and (4) the FFB of the reference body is 73.8% water, 19.4% protein and 6.8% mineral. So, the present study was planned to know the relationship between body composition and diabetes.

Background: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. The objective of the study was to assess the efficacy, acceptability and side effects of LUS IUS in women with heavy menstrual bleeding.Methods: 42 women with heavy menstrual bleeding with or without associated dysmenorrhoea or chronic pelvic pain and had no contraindication to IUS insertion were included in the study. Patients having active genital tract infection, suspicion of pregnancy, uterine fibroids >2.5 cm in size or sub mucosal distorting the uterine cavity, uterine size >12 weeks, atypical endometrial hyperplasia or malignancy, abnormal cervical cytology, coagulopathy or liver disease were excluded from the study. Preliminary endometrial biopsy was done to rule out malignancy and LNG IUS was inserted under anaesthesia. Women were followed for 3,6,12 and 24 months post insertion.Results: In first 3 months, 20% patients achieved normal menstrual cycle, and at 6 months 44.44% had scanty menstrual flow and after 1 year of use 81.5% achieved amenorrhoea. In initial 3 months 37.5% patients had irregular heavy bleeding, which reduced to 13.89% at 6 months and 0% at 1 year follow up. Irregular spotting was second most complaint in 32.5% patients in initial 3 months that persisted in 7.4% patients at 1year follow up. In 5.0% patients, there was spontaneous expulsion of the device in first 3 menstrual cycles. After 3 months of use 57.5% patients were satisfied with the device and at the end of 1 year 92.5% were satisfied.Conclusions: LNG IUS is highly effective in controlling blood loss, well tolerated and better alternative for hysterectomy with higher user satisfaction in all age group of women.

153 Background: Triple-negative breast cancer (TNBC) accounts for 15-20% of breast cancer patients, with a median survival of 13 months and limited treatment options. Recent studies have indicated clinical benefits in TNBC with platinum agents. We designed a novel platinum chemotherapeutic (IO-125), with platinum (II) tethered to cholesterol-based leaving group via a novel coordination environment, conferring properties unique from current platinum-based chemotherapies. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC. Methods: Cellular viability of IO-125 was assessed in TNBC cell lines using MTT assay, while Pt levels in cells, plasma and tumors were quantified using atomic absorption spectroscopy. Antitumor activity was assessed in MDA-MB-231 xenograft model. Results: We reportthat IO-125 shows enhanced cellular cytotoxicity and higher intracellular uptake as compared to oxaliplatin in TNBC lines. In addition to uptake by organic cation transporters known for transporting current platinum chemotherapies, IO-125 is also internalized via caveolin-mediated endocytic pathway, resulting in 10-20 fold greater uptake into cells as compared to oxaliplatin. Studies have implicated caveolin in TNBC progression and drug resistance, and harnessing this mechanism could confer enhanced activity. In animals bearing MDA-MB-231 xenografts, three cycles of IO-125 at well-tolerated doses (35 mg Pt/kg) resulted in significant tumor growth inhibition as compared to reported tumor inhibitions seen with existing platinum chemotherapies. Pharmacokinetic studies conducted in mice and rabbits indicate markedly improved profile of IO-125 as compared to oxaliplatin, showing a significantly higher area-under-the-curve (AUC), a substantial reduction in clearance and volume of distribution, with an enhanced half-life. Conclusions: Collectively, our findings demonstrate that IO-125 exhibits superior pharmacokinetics profile and biodistribution to tumors, resulting in enhanced anti-tumor activity in a TNBC xenograft model. Based on these observations, we propose that IO-125 may emerge as a potentially effective platinum-based drug for TNBC patients.