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Introduction: The world is in the midst of a COVID-19 pandemic. As WHO and partners work together on the response -- tracking the pandemic, advising on critical interventions, distributing vital medical supplies to those in need--- they are racing to develop and deploy safe and effective vaccines. COVID-19 can have serious, life-threatening complications. Current evidence suggests that re infection with the virus that causes COVID-19 is uncommon in the 90 days after initial infection. However, experts don’t know for sure how long this protection lasts, and the risk of severe illness and death from COVID-19 far outweighs any benefits of natural immunity. COVID-19 vaccination will help protect you by creating an antibody (immune system) response without having to experience sickness. Vaccines will work with your immune system so it will be ready to fight the virus if you are exposed. The combination of getting vaccinated and following CDC’s recommendations to protect yourself and others will offer the best protection from COVID-19. Statement Of The Problem: “A descriptive study to assess the knowledge, attitude and belief regarding covid vaccine among non teaching staff working in SGT University, Gurugram.” Method: Research approach used was the quantitative, a descriptive design was used.

Urinary bladder cancer (UBC) is among the top ten cancers worldwide. Incidence is rising mainly attributed to environmental contamination due to chemical carcinogens and smoking habits. Recently, we have seen a higher number of UBC patients and thus aim to study the associated epidemiological parameters. This was a single-center retrospective analysis that involved histology-proven UBC patients presented from the inception of medical oncology services. Clinical, demographic data and history of exposure to potential risk factors were noted. A telephonic interview with the patient or family members was conducted for the missing data. Mean age of patients was 60.36 ± 10.33 years. More than half of the patients were of the geriatric age group. Males were affected 7.5 times more as compared to females. Sixty-four percent of the patients were smokers. Seventy-three percent of the patients had a residence in the plains or Terai region. Thirty percent of the patients reported farming as their occupation. Anthranilic diamide, chlorpyriphos cypermethrin, lesenta (imidacloprid + fipronil), and tricyclazole were the commonly used insecticides/pesticides. Untreated groundwater, river, or pond was the source of drinking water for 68% of the patients. The insecticides/pesticides used in agriculture and the subsequent contamination of food and water serving as the vehicle for the potential carcinogens need a critical review and are hypothesis-generating.

Cancer-associated deep venous thrombosis (DVT) and venous thromboembolism (VTE) are exceedingly common in patients with cancer. One-fifth of DVT events occur in patients with cancer and it is the second leading cause of death in patients with cancer after cancer itself. Data on DVT in cancer patients on medical therapy, especially from Indian experiences, are sparse. Here, we present our experience in ambulatory patients with solid organ cancer. The purpose of the study was to study the incidence of DVT in cancer patients on medical therapy and to analyze probable DVT risk factors. This study was a hospital-based single-arm retrospective collection and analysis of hospital records from patients receiving medical therapy on an outpatient and short-stay basis. From January 2016 to February 2017, adult solid organ cancer patients attending the medical oncology outpatient department (OPD), receiving active anticancer treatment, either oral or injectable, were included. The data was retrieved from the medical records department and the department of radiology. Descriptive statistics were used to analyze the data. Twenty-nine out of 1190 patients were documented to have developed DVT during the study period. The incidence of DVT in the outpatient settings was 2.4%, and DVT associated with venous access device in situ was seen in 4.05% (20/493) of the patients. Gynecological, breast, and hepatobiliary malignancies comprised most of the cases. Cancer patients are clearly at increased risk for DVT, but this risk is highly variable. It differs between subgroups of cancer patients. Five points Khorana risk model can predict risk for DVT in the ambulatory cancer patients receiving chemotherapy; however, the routine use of thromboprophylaxis in all cancer patients is not recommended. High-risk patients especially those with venous access devices need careful evaluation and counseling for prompt reporting and recognition of venous thrombosis.

Background: Patients with cancer are more susceptible to acquire SARS-Cov-2 infection due to their immunocompromised state related to the disease and anticancer treatment. There is a lack of literature assessing the patient’s perspective of the present crisis and its impact on their treatment. Aims and Objective: The present study aimed to address the challenges and sufferings faced by patients with cancer during their treatment in the current COVID-19 pandemic era. Materials and Methods: A single-institute, cross-sectional questionnaire-based observational study was conducted in a tertiary care teaching hospital. Patients attending the Oncology outpatient department were enrolled in the study. Results: One hundred patients (64 males, 36 females) with a mean age of 47.17 years (range-24-71) participated in the study. The majority of patients (89%) were aware of the COVID 19 symptoms and did not confuse them with cancer symptoms. Most of them were aware of preventive measures like frequent hand washing, sanitizer usage, and face masks to reduce the risk of infection. Almost half of them encountered difficulties in commuting to the Hospital. Most (83%) of them were worried about treatment delay and disease progression due to the COVID-19 pandemic. Almost half of the patients (54%) were fearful of acquiring the infection from the radiotherapy machine and immobilizing devices. Two-third of the patients (64%) were afraid to carry the virus back to their homes. Awareness regarding our Hospital’s teleconsultation facility was limited among patients. Conclusion: The present study underscores the success of ongoing COVID-19 awareness programs run by the government. However, there is an urgent need to address the various challenges encountered by patients with cancer. The strengthening of telemedicine facilities may reduce the in-person visits made by the patients.

Cancer as a malady is perspicacious and molds itself just before we reach to stab it, on the other hand, COVID-19, an entity with limited genetic material is affecting entire humanity in such a florid way is overwhelming and the mechanism is so simple yet so authoritative.COVID-19 pandemic is affecting all dimensions of mankind with maximum impact on the healthcare system and economy. We the oncologists are so constrained and helpless due to a blooming pandemic, which we have never seen in recent history. We wish to highlight certain issues pertaining to cancer care, which became relevant in such vacillating anticipation. Another dimension needs consideration for limited resources countries; they will always be in the state of prolonged waitlists, limited availability of quality care centers, and hence inferior cancer outcome. Closing the machinery of radiotherapy, surgical and medical oncologists sitting idle is a big loss for sure. We here discuss and suggest a few need of the hour interventions.

BACKGROUND: Skeletal muscle is relatively uncommon site for metastasis in head and neck primary. This study was conducted to report our experience of three such cases and analyze the previously reported cases to assess the overall outcomes and formulate a treatment plan for these patients. METHODS: We pooled the data extracted on extensive literature review and analyzed. RESULTS: A total of 17 patients were analyzed for this study. All the patients had locally advanced primary and 14/17 developed metachronous metastasis. Median duration to development of metastasis was 8.5 months, and 13/17 patients had skeletal muscle as the only site of metastasis. Only 6/13 were treated with aggressive intent, 4 of which who underwent surgical resection had the best survival outcomes. CONCLUSIONS: Isolated skeletal muscle metastasis in a head and neck primary is relatively rare, and in future, the research work needs to be taken up afresh, on prospective model, with adequate patient sample, to draw a scientifically valid conclusion.

IntroductionChildhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.MethodsProspective cohort study in 109 institutions in 41 countries. Inclusion criteria: children ResultsAll-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3–11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); pConclusionsChildren with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.

Half-antiperovskites (HAPs) are a class of materials consisting of stacked kagome lattices and thus host exotic magnetic and electronic states. We perform high-throughput calculations based on density functional theory (DFT) and atomistic spin dynamics (ASD) simulations to predict stable magnetic HAPs M$_3$X$_2$Z$_2$ (M = Cr, Mn, Fe, Co, and Ni; X is one of the elements from Li to Bi except noble gases and 4$f$ rare-earth metals; Z = S, Se, and Te), with both thermodynamical and mechanical stabilities evaluated. Additionally, the magnetic ground states are obtained by utilizing DFT calculations combined with the ASD simulations. The existing spin frustration in an AFM kagome lattice manifests as competing behavior of the in-plane FM and AFM couplings. For a total number of 930 HAP compositions considered, we have found 23 compounds that are stabilized at non-collinear antiferromagnetic (AFM) state and 11 compounds that possess ferromagnetic (FM) order.

The majority of patients with advanced metastatic gynecological malignancies are difficult to treat, yet few patients respond exceptionally well to standard anticancer treatment as compared to others. These patients are termed as exceptional responders. Exceptional or super-responders to cancer drugs have been described in the literature. However, there is paucity of the literature regarding the exact mechanism behind such responses. Further research is needed to determine whether these responses are secondary to anticancer treatment or reflect underlying biology of the patient. The present article describes two such patients of advanced malignancies who showed extra ordinary response to standard treatment as compared to outcome data reported regarding similar cases in the literature. We describe two rare malignancies of advanced stage in terms of clinical characteristics, tumor type, extent of disease and stage of tumor, histopathological and immunohistochemical type, multimodality treatment received, depth of response and duration of response to the present treatment. The immunophenotypic and clinicopathologic features exhibited in this small series of cases are described to call attention to early diagnosis and prompt treatment of such cases for better outcome. Further research in this regard would unravel the mechanisms behind such responses and enable better management of advanced malignancies. It would also lead to new understandings of the basic tumor biology and help us to move closer to the goal of precision oncology

Solid organ cancers infrequently metastasize to bone marrow (BM). BM involvement by cancer in adults leads to poor prognosis and it becomes difficult to provide appropriate treatment. We aimed to study the clinical, pathological and radiological characteristics of adult patients with BM involvement at our institute. Eleven adult patients diagnosed with BM involvement associated with solid organ cancer were included in the study. Clinical, laboratory, radiological and treatment details were analysed. Carcinoma of the breast accounted for majority of the cases. Most of the patients had poor performance status (PS) at diagnosis. Serum lactate dehydrogenase (LDH) was found to be elevated in all cases. Serum alkaline phosphatase (ALP) was elevated in all except 1 case. Median overall survival (OS) was 91 days. BM involvement from solid organ cancer in adults predicts a poor outcome. Serum LDH and serum ALP can serve as a marker of BM involvement.

Metastatic carcinoma breast involving hepatobiliary system and peritoneum is a common and well-described entity. However, colonic luminal involvement by breast metastases is rare and its early recognition is important for accurate management planning. We report a case of an elderly woman with luminal A type invasive ductal carcinoma (IDC) breast, initially controlled/stabilized on hormonal treatment and later progressed to involve colon presenting with intestinal obstructive symptoms. Lobular carcinoma breast which constitutes around 10% of breast cancers is more likely to have gastrointestinal tract (GIT) involvement. On the other hand, GIT metastasis from IDC breast is quite rare. Given the progressively increasing survival with current and forthcoming novel treatment modalities, it is very important to recognize and understand unusual presentation of metastatic breast cancer, such as colonic metastasis, for timely treatment planning and implementation.

Background and Objectives: L-asparaginase has become the backbone of acute lymphoblastic leukemia induction. In Berlin–Frankfurt–Munster (BFM) 95/2000 protocols, L-asparaginase was given twice weekly for initial 4 weeks. While sufficient L-asparaginase levels are important, there is no apparent correlation between high L-asparaginase levels and minimal residual disease (MRD). In view of toxicities of L-asparaginase, we planned to study the effect of dose and schedule of Escherichia coli-derived L-asparaginase on early MRD by phasing the same total dose, once a week over 8 weeks. Methods: This prospective, observational study enrolled 45 children and young adults ≤40 years. Modified BFM 95 protocol was followed. Weekly 5000 IU/m2 L-asparaginase was given intravenously, and MRD was analyzed at the end of 4 weeks (MRD1) and at 8 weeks (MRD2), using multicolor flow cytometry. MRD positive was defined as residual blasts ≥0.01%. Results: Thirty-one patients were eligible for final analysis. Nine could receive scheduled eight doses of L-asparaginase and 22 patients received less than eight doses. We analyzed age, gender, diagnosis, prednisone response, cytogenetics, central nervous system status, BFM risk group, MRD2, and relapse. L-asparaginase dose association was not statistically significant with respect to MRD2 (P = 0.237). There were no cases of pancreatitis, hypersensitivity, bleeding, or thrombosis. Reasons for patients receiving less than the scheduled eight doses were low serum fibrinogen levels and liver dysfunction. This study revealed 8 MRD1-negative and 13 MRD2-negative patients. Conclusion: L-asparaginase dose intensity does not affect early MRD. Phasing L-asparaginase over 8 weeks could lead to the achievement of more MRD2-negative status and thereby improve long-term outcome. This strategy may also reduce the incidence of adverse drug events.

Background: Carcinoma gallbladder is mostly diagnosed in locally advanced, inoperable, or metastatic stage. Best supportive care with or without palliative chemotherapy is the only feasible treatment option. Gemcitabine and platinum agents' combination is the most effective first option with no well-established second-line regimen. Objectives: We planned to study the response rate, safety, the progression-free survival (PFS), and overall survival (OS) on the second-line FOLFOX-4 chemotherapy. Methods: This is a prospective single-arm observational study of 29 eligible patients. Patients were studies for response to the second-line FOLFOX-4 chemotherapy. Positron emission tomography/computed tomography scans were done for response assessment; chemotherapy toxicity was graded using National Cancer Institute clinical toxicity criteria; and survival rates (PFS and OS) were studied. Results: Among the 39 patients with gemcitabine-based chemotherapy (CT-1), the median PFS-1 was 6.5 months. Twenty-nine patients received second-line chemotherapy (CT-2). Responses observed complete response in 2/29, partial response in 7/29, stable disease in 1/29 patients, and progressive disease in 19/29. The overall response rate was 9/29 (31.0%). Grades 2–4 toxicities were anemia (17.95%), thrombocytopenia (12.82%), neutropenia (12.82%), and peripheral neuropathy (7.69%). The median OS was 9.13 months. Late PFS-1 (>median PFS-1) patients had significantly lower mortality as compared to early PFS-1, odds ratio of 0.251 (P = 0.002), and median PFS-2 was 2.53 months. Conclusion: After the failure of gemcitabine and platinum-based chemotherapy, FOLFOX-4 is modestly effective, fairly well tolerated and this needs to be proven in a larger randomized phase 3 study. Further research into the pathogenesis of biliary tract cancer with the aim to identify new targets for treatments is required.

While lymphopenia has been a common finding in COVID-19 infection, particularly in severe cases, febrile neutropenia has been very rarely reported in immunocompetent patients with COVID-19. Herein, we report the case of a 76-year-old hypertensive and diabetic man who was hospitalised with severe COVID-19 infection and developed delayed-onset severe neutropenia with neutropenic fever, which responded to treatment with antibiotics and granulocyte colony-stimulating factor. This case highlights the importance of identifying a rare complication (febrile neutropenia on the fifth week) of COVID-19 infection in hospitalised patients by intensive monitoring and aggressive management for favourable outcomes.

Background Isolated leptomeningeal relapse in a case of cutaneous lymphoma is an uncommon event more so in a case of primary cutaneous diffuse large B‐cell lymphoma (PCDLBCL). This phenomenon is of great significance as the subsequent prognosis becomes poor and the prophylactic central nervous system (CNS) therapy if administered, can reduce the chances of relapse, however, the survival benefit remains uncertain. The role of prophylactic CNS therapy is not well defined in the case of PCDLBCL. Case We report a case of PCDLBCL leg type with a low CNS International Prognostic Index (CNS‐IPI) risk, who developed isolated leptomeningeal relapse in the form of bilateral facial nerve palsy. He was managed by 2nd line chemotherapy and CNS directed therapy and achieved complete remission. Conclusion PCDLBCL leg type is an aggressive malignancy. Molecular/genomic mechanism likely responsible for CNS dissemination should be identified by prospective multi‐centric studies that can better define the subsets of patients eligible for prophylactic therapy in the absence of a high CNS‐IPI risk.

Background Tripe palms (TP) is one of the rare cutaneous paraneoplastic manifestations of various intra‐abdominal malignancies. TP and malignant acanthosis nigricans (MAN) occur together and may precede even years before the index cancer. Though rare, the clinical significance of TP and MAN holds significance as an indicator of internal malignancy. Case Here, we describe 71‐year, postmenopausal female with ovarian cancer who presented to us with a history of dyspepsia, abdominal distension, and weight loss. On detailed history and evaluation, it was found that she had TP and MAN 4 years before diagnosis. Conclusion The unique presentation preceding the primary illness necessitates extensive early work‐up to look for malignancy and the initial consideration for surgery due to the tumor biology in such patients.

The COVID-19 pandemic has posed a grave challenge to mankind as it doesn't appear to get controlled in the near future. Worldwide, health care centers are working more than their capacity with the scarcity of medical resources. Cancer patients are considered to be at higher risk of developing life-threatening complications from COVID-19 and at the same time treatment delays can lead to poorer oncological outcomes. Appropriate planning is therefore important to continue with cancer treatment services and simultaneously avoiding the risk of infection to the patients and healthcare staff and not allowing community transmission of viral infection.We modified our practice measures in cancer patients receiving systemic therapy. Tele-consultations and use of electronic means, providing the best supportive care at or near home, and involvement of local/ family physicians were widely practiced. We minimised in-patient admissions, however, day-care chemotherapies were continued to provide optimum oncology services.Modified oncological practice measures need to be implemented as the pandemic seems to stay for a longer time.

Palmar fasciitis and polyarthritis syndrome (PFAPS) is a rare paraneoplastic event that has been reported mainly in ovarian cancers. Clinical diagnosis of PFAPS is characterized by the diagnosis of neoplasm with accompanying flexion contractures, inflammatory fasciitis, fibrosis, and generalized arthritis of the hands. Since first published report, only rare few additional cases of PFPAS have been reported. In this case report, we describe a patient with metastatic breast cancer who subsequently developed PFPAS in association with advanced breast cancer. She had clinical rheumatological symptoms course parallel to her primary breast cancer disease status.

Background: COVID-19 is one of the most unfortunate events seen in the 21st century due to its outrageous spread and ordeal effect on people. Cancer care providers (CCPs) are under immense mental burden due to the unpredictable pandemic and compromised cancer care amongst patients. Pandemic has taken a toll on the caregivers, be it physically, mentally, or psychosocially. Methods: A prospective longitudinal study was conducted from May 2020 to September 2020 to assess the pandemic's impact on mental health amongst the CCP. DASS 21 & PCL5 instruments were used to identify the temporal change with pandemic evolution on mental health. An online survey was administered at three different periods with 6-week intervals through email. Collected data is analyzed using the SPSS 26. Independent variables are presented as categorical data and analyzed using chi-square. Temporal change in the mean scores analyzed using independent t-tests. Various demographic factors were correlated with the DASS 21 scores and PCL 5 scores using logistic regression. Results: The questionnaire was emailed to 240 CCP's;115 responses were valid. Mean age is 29.9 +/- 5.86, 62.6% were male and 27.4% were female respondents. 41.7% were nursing staff, and 58.3% were doctors;67% had less than five years of medical experience. Respondents who stayed with family had significant depression levels in the first and third surveys (OR: 0.37, CI- 0.15-0.91, P=0.03), (OR: 0.17, CI-0.026-1.1, P=0.04). Stress levels were significantly high in the caregivers staying with family in the first survey (OR: 4.38, CI: 1.2-15.7, P=0.02). On analyzing three surveys, 55 respondents in both the first and second survey 21,8,17 respondents persisted in having depression, stress, and anxiety. There was an increase in the stress levels in the third survey when compared to the second survey. Conclusions: In any disaster or an unnatural event, time helps the human mind to adapt to the new conditions;it is similar to our initial results that show improvement in the depression, stress, and anxiety levels with the second survey. It is essential to assess and address the mental health status-related problems to ensure HCW's personal well-being and deliver quality health care to the patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Cutaneous metastasis (CM) from internal malignancies is commonly seen. Sometimes, skin metastases can be the first sign of advanced cancer or an indicator of cancer recurrence. Cases of breast cancer with cutaneous progression after or during trastuzumab therapy have been described in the past, frequently associated with systemic disease progression. However, CM during adjuvant trastuzumab therapy is very rare. It has been hypothesized that cancer cells located in the skin survive and take proliferative advantage by virtue of an immune-tolerance mechanism that hampers trastuzumab-mediated antibody-dependent cell-mediated cytotoxicity. We describe a case of human epidermal growth factor receptor-2-overexpressing breast cancer presenting with diffuse CM during adjuvant trastuzumab therapy.

INTRODUCTION: Gall bladder cancer (GBC) accounts for 80%-95% of biliary tract malignancies in the world. There is however striking variability in the global incidence of gallbladder cancer, reaching epidemic levels for some regions and ethnicities. The aim of this study was to evaluate the demographic and clinicopathological profile of the gallbladder cancer patients. MATERIALS AND METHODS: All patients of carcinoma gall bladder presenting to department of surgery in hepatopancreaticobiliary unit from July 2017 to November 2020 were included in this study. A proforma containing all the relevant details including history, examination, blood, radiology, and pathological investigations was filled. RESULTS: A total of 326 patients of GBC were analyzed. The majority (75%) were found to be females with a mean age of 55 years. Pain abdomen was the most common presenting symptom in 81% of patients. The most common stage of presentation was stage IV and only 6 were in stage I. Two hundred and thirty three (71.4%) patients had metastatic disease at presentation. Liver infiltration at the time of diagnosis was present in 89% of patients. The most common site of metastasis was found in the liver (23.3%). GBC was more common in patients with A blood group. Baseline serum albumin levels were found to be significantly associated with the staging of GBC. CONCLUSIONS: Due to the non specific symptoms patients of GBC present at very advanced stages, high index of suspicion and health education seems to play an important role in early detection and improvement of survival.

The outcome of hyperacute grade 3-4 steroid-refractory graft-versus-host-disease (SR-GVHD) remains dismal despite a plethora of agents being tried alone or in combination. Following T replete haploidentical transplantation with post-transplantation cyclophosphamide on 75 patients, 10 patients (13%) aged 2-20years, developed hyperacute SR-GVHD. We report on the outcome of two different regimens for treatment of SR-GVHD on the outcome of these patients. Five patients were treated in Regimen A consisting of anti-thymocyte globulin, Etanercept and Basiliximab. The next 5 patients were treated combining T cell costimulation blockade with Abatacept along with Etanercept and Basiliximab. The overall response at days 29 and 56 were 40% and 0% with Regimen A and100% and 40% with Regimen B. The major cause of treatment failure was progression of GVHD and opportunistic infections. Two of the patients achieving a complete remission on Regimen B are long term disease free survivors off immunosuppression. Our study demonstrates the dismal outcome of early onset SR-GVHD in children following T replete haploidentical transplantation. However, the combination of Abatacept with anticytokine agents seems to produce encouraging early response and might warrant further investigation.

Tryptase, a serine protease released during mast cell degranulation has been associated with anaphylactic reactions and inflammations. In recent studies on solid tumor proliferation, it has been seen that tryptase has a role in tumor angiogenesis and tumor cell proliferation. This also makes tryptase a potential therapeutic target. Many anti-tryptase agents have shown to decrease tumor angiogenesis and proliferation. Authors have thus reviewed various articles which have done extensive studies on the role of tryptase as an important factor in tumor proliferation and angiogenesis.

Background: Delayed presentation of patients of cancer is associated with poorer survival. Early presentation, timely diagnosis and treatment are critical factors in improving long-term survival for patients with cancer. Thus, reducing delays in diagnosis of cancer should be a priority. Against this backdrop this study was conducted to identify factors leading to delayed presentation of patients in advanced stages of cancer at our institute. Methods: Newly diagnosed patients of cancer coming to radiation oncology, surgery and medical oncology outpatient departments were included in this study. Data was collected in a pre-validated questionnaire format.Results: 360 patients were included. Majority of patients 212 (58.9%) were male. 66.7% patients were from rural areas. Most of the patient’s educational level was upto primary schooling 178 (49.4%) and caregiver educational level was upto primary schooling 153 (42.5%). Reason for alternative treatment correlated significantly with patient awareness about the disease (p