Maternal and Child Health Training of Traditional Birth Attendants and Pregnancy Outcomes: A Systematic Review and Meta-analysis.

INTRODUCTION: In remote communities, maternal and child health is often compromised due to limited access to healthcare. Simultaneously, these communities historically rely greatly on traditional birth attendants (TBAs). However, optimal integration of these traditional methods with modern healthcare practices remains a topic of debate. We assessed the effect of maternal and child health training of traditional birth attendants on adverse pregnancy outcomes. METHODS: We conducted a systematic review and meta-analysis to answer the above research question. We independently screened studies using databases like PubMed, Scopus, and CENTRAL, extracted data, and assessed the study quality. Due to fewer original studies in this field, we considered both pre-post and between-group differences to assess the effect of differences. These were synthesised separately, assessed against a p-value function, and subjected to sensitivity analyses. RESULTS: We included six interventional studies. Training TBAs reduced the risk of perinatal mortality [0.69, 0.61-0.78] and 7-day neonatal mortality [0.65, 0.53-0.80] but not stillbirth [0.70, 0.39-1.26]. In randomized controlled trials, there is a lower risk of perinatal mortality [0.73, 0.67-0.79] and neonatal mortality [0.70, 0.62-0.80] but not stillbirth [0.81, 0.56-1.18] with trained traditional birth attendants. There are methodological concerns with most existing studies, including domains like allocation concealment. DISCUSSION: There is some evidence of the benefit of training TBAs, though of a low to very low certainty. Due to fewer studies, inconsistent estimates for different critical outcomes, and concerns with the existing studies, further well-designed studies can give more insights. They can also help optimize the contents of TBA training interventions. PROTOCOL: CRD42023412935 (PROSPERO).

Willingness to pay for a tobacco-free life: a contingent valuation assessment.

Tobacco, being an established risk factor for significant mortality and morbidity, causes over 7 million annual deaths globally. India is a country with over 270 million active tobacco users. On the one hand, although the willingness to quit amongst tobacco users is as high as 55.4%, the actual quit rates translate to less than 20%. Taking a cue from the economic principle of commitment and consistency, paying a nominal fee can serve as a form of public commitment and motivation to decrease the dropout rate amongst those committed to quitting. This study uses contingent valuation assessment to determine the willingness to pay (WTP) values for an effective tobacco cessation service across individuals with different socio-demographic characteristics. A cross-sectional observational study with multistage cluster sampling in Rajasthan was conducted to recruit 360 active tobacco users from 8 districts. Q-Q plots were used to determine the non-parametric distribution, and statistical differences between median WTP values were compared using Mann-Whitney U and Kruskal-Wallis H tests, considering a p-value less than 0.05 to be statistically significant. The majority of participants were males (57.78%) between the ages of 26 and 35 (40.28%), married (82.50%), and with children (65.83%), with an annual income between USD 7500-10,000 (23.61%) and graduate-level education (40.56%). Exclusive smokers formed the majority of the cohort (48.06%), and 50.83% were willing to quit as well as willing to pay for cessation. Median WTP values were maximum for males (USD 54.05; p<0.05), age group 26-35 years (USD 54.05; p<0.05), post-graduates (USD 81.08; p<0.05), and annual income above USD 20,000 (USD 121.62; p<0.05). Weak positive and significant correlations were observed between WTP and annual spending on tobacco, annual spending on health, and annual income. The study emphasizes the critical importance of early-age interventions for effective tobacco cessation prior to transitioning into dependency, resulting in reduced financial parity for availing health services. These are the first such WTP values from the Southeast Asian region, tailored for different population subsets, specifically for tobacco cessation. Our findings contribute to the growing body of evidence to support innovative approaches to enhance tobacco cessation efforts through financial commitments.

Ultrasound-guided short-axis out-of-plane versus long-axis in-plane technique of Posterior Tibial Artery Cannulation in adult patients: The POTACUT (POsterior Tibial Artery Access with Ultrasound Trial) Randomized Trial.

BACKGROUND: No research has been conducted to compare long-axis in-plane and short-axis out-of-plane techniques for ultrasound-guided posterior tibial artery cannulation in adults. This study compared these two procedures for cannulating the posterior tibial artery. METHODS: This prospective randomized trial included 236 adult patients undergoing general anesthesia who required arterial cannulation. The posterior tibial artery was cannulated using either the long-axis in-plane technique (group LAIP) or the short-axis out-of-plane method (group SAOP) with an ultrasound machine. First-attempt cannulation success, the number of cannulation attempts required to achieve successful cannulation, ultrasound localization time, cannulation time, and perioperative complications in these two groups were analyzed. RESULTS: The LAIP group demonstrated a significantly higher first-attempt success rate (40.7% vs 18.6%, p < 0.001), shorter ultrasound localization time (36.5 [30, 60] s vs 50 [35, 80] s, p < 0.001), and faster cannulation time (80 [55, 100] s vs 110 [70, 180] s, p < 0.001). LAIP group showed a significantly higher overall success rate (92.4% vs 81.4%, p = 0.012). The median number of cannulation attempts in the LAIP and SAOP groups were 2 [1, 2] and 2 [2, 3], respectively (p < 0.001). Complications were comparable between groups (p = 0.248). CONCLUSIONS: The LAIP group demonstrated higher first-attempt and overall success rates compared to the SAOP group for ultrasound-guided posterior tibial artery (PTA) cannulation in adult patients.

Expression of Programmed Death Ligand 1 [PD-L1] and Mismatch Repair Status in Squamous Cell Carcinomas of Cervix.

Background and Objectives: To assess mismatch repair (MMR) status and programmed death-ligand 1 (PD-L1) expression in squamous cell carcinomas of the cervix and their association with clinicopathologic parameters. Material and Methods: Expression of PD-L1 and MMR status (MSH2, MSH6, MLH1, and PMS2) was assessed on 50 cases of SCCs of the cervix by immunohistochemistry. Results: 80% of tumor cells and 84% of tumor-infiltrating lymphocytes showed PD-L1 expression. 80% of cases had a combined positive score (CPS) of > 1, whereas 20% had a CPS of < 1. 94% of cases showed pMMR proteins, while 6% showed dMMR. 94% of the SCCs were HPV associated, and 6% were HPV-independent. All HPV-independent SCCs of the cervix showed PD-L1 expression, and all HPV-associated SCCs showed MMR deficiency. Between PD-L1 expression in the tumor and the grade of the tumor, a statistically significant association was noted (p = 0.022). All MMR-deficient SCCs were HPV-independent. Conclusion: This research highlighted the HPV association in cervical SCCs in the Indian population. Most of the cervical SCCs were HPV-associated. Furthermore, most of the HPV-associated SCCs were MMR stable. This study found no significant association between MMR status and PD-L1 expression in cervical SCCs.

Health care needs and barriers to care among the transgender population: a study from western Rajasthan.

BACKGROUND: Transgender people comprise an estimated 0.3-0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. METHODOLOGY: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. RESULTS: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual's health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. CONCLUSION: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Challenges and Barriers Faced by People with TB and Healthcare Workers Providing TB Care and Management - A Qualitative Study.

BACKGROUND: In tuberculosis (TB) care and management, there are practical challenges existing at the patient-provider level leading to implementation barriers at the primary care level. OBJECTIVES: The objective of the study is to explore the challenges and barriers faced by people with TB and health-care workers in TB care and management. MATERIALS AND METHODS: This study was done as a part of a community intervention study between November 2021 and December 2022. Twenty interviews were taken with treatment for TB (n = 7) and health-care personnel (n = 13). Health-care personnel include nursing staff, medical officers, laboratory technicians, community health workers, and medical personnel from tertiary care hospital. Participants were recruited across all levels of health-care systems. Interviews were carried out in the Hindi language, audio recorded, and translated to English. Participants were asked about their experiences of challenges and barriers faced during TB care and management. Qualitative data were coded, and thematic analysis was done manually. RESULTS: The challenges and barriers at the level of people with TB were issues with communication between providers and people with TB, out-of-pocket expenditure, poor adherence to medicines, lack of proper diet, gender issues, and stigma. The challenges and barriers at the level of health-care providers were a lack of infrastructure and logistics, lack of awareness, COVID-19-related issues, lack of workforce, and technical issues. CONCLUSION: Communication between providers and people with TB must be improved to improve the drug adherence and satisfaction of the end user. Proper funding must be provided for the TB programs. People with TB must be counseled properly regarding the free health care services available near their homes to prevent out-of-pocket expenditure. These will help in fast-tracking the elimination of TB.

Quality Assessment of Interactive Mobile Application - Maternal and Infant Care for Tribal Birth Attendants.

Digital health interventions can overcome geographical barriers and prepare health-care providers for better health outcomes in rural and remote tribal areas, however, it has not been explored among traditional birth attendants (TBAs). A mobile application, "maternal and infant care" (MAI) for capacity building of tribal birth attendants was developed and its quality was evaluated using the Mobile Application Rating Scale for user's interest in and satisfaction with the esthetics, information, and functionality. Thirteen Android user TBAs with the MAI application were piloted with the MARS checklist. Engagement, functionality, esthetics, and information quality; and one subjective quality scale having 29 items were used. The application was found to be entertaining excellent rating (mean score ± standard deviation) (4.00 ± 0.58), and scored high on performance (3.77 ± 0.93); layout design (3.85 ± 0.90); subjective quality (4.23 ± 0.93), however, scored minimum on interest; gestural design; visual appeal, etc. MAI is a user-friendly, culturally acceptable Android app that can be used for the capacity building of frontline workers.

Provider's satisfaction with telemedicine services for tribals of Western Rajasthan: A qualitative analysis.

Background: There are significant barriers to healthcare access in tribal areas, even though for every 834 people, there is one public physician (registered allopathic and AYUSH doctors). More than 86% of hospital visits occur in rural areas. Furthermore, the bulk of them travel long distances to reach hospitals. A telemedicine center was established in the aspirational tribal district of Sirohi, Rajasthan, to provide accessible quality health care. Objective: To understand providers' attitudes and satisfaction with telemedicine services for tribal populations. Materials and Methods: This cross-sectional, mixed-method study enrolled consultants from various clinical departments of AIIMS Jodhpur (n = 23) who provide teleconsultations to the tribal population. Result: The mean score of the satisfactory index was 54.7 ± 22.04. The higher score is 87.4 regarding the ability to use the technology platform during teleconsultation. The lower score was 34.7 for video quality during teleconsultation at STHR. 91.3% found this a beneficial model for the tribal population. Consultants providing teleconsultations expressed that this model is a boon for tribal patients as a screening tool and will save time and money for improved accessibility. Conclusion: Positive indications of teleconsultation with a provider's utility, acceptability, and satisfaction. Most marginalized people can efficiently access all levels of (primary, secondary, or tertiary) health care from experts through telemedicine, which will broaden outreach in hard-to-reach or inaccessible tribal or rural areas.

Is anxiety a public health problem among older adults in India: Results from a systematic review and meta-analysis.

For medical fraternity, health system and policymakers to undertake effective countermeasures, a comprehensive assessment of the prevalence of anxiety among older adults is required; hence, we conducted a systematic review and meta-analysis using data pooled from surveys across the country. The search strategy was developed using medical subject headings (MeSH) terms and free-text keywords. We searched PubMed and Scopus for articles to report the prevalence of anxiety among older adults. The appraisal tool for cross-sectional studies was used for quality assessment. Prevalence from different studies was pooled together using the inverse variance heterogeneity method. Sensitivity analyses were performed to assess the impact of included studies' methodological quality on pooled results and to investigate potential causes of heterogeneity. Twenty-three studies were included in this systematic review. The overall pooled estimate of the prevalence of anxiety in older adults was 18.7% (95% CI: 2.4, 38.8). The studies had a high degree of heterogeneity. Publication bias was assessed using a Doi plot which showed an luis furuya-kanamori (LFK) index of 1.21 indicating minor asymmetry. Like other parts of the world, India has witnessed a rise in the number of elderly due to lower fertility rates, higher life expectancies and a shift in illness patterns from communicable to non-communicable. The number of elderly people suffering from diseases of mental health is expected to rise dramatically. This review consolidates the existing evidence to showcase anxiety as an upcoming public health problem requiring due focus from policymakers and health systems.

Increased taxes and regulation of Indian cigarillos (bidi) industry: Effects on revenue and years of life lost.

INTRODUCTION: Indian cigarillos (bidi) are low-cost alternatives to cigarettes with only 22% imposed taxes, and turnover of upto INR 4 million per annum exempted from taxation. This paper estimates revenue implications and potential loss of life years (YLLs) averted, if bidi industry is subjected to increased regulations and taxation. METHODS: Revenue estimated at 10% increased regulation and 100% regulation were calculated, followed by estimates at taxes equivalent to cigarettes and World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC) recommendation. Price elasticity was considered to assess demand. Price change in separate fractions (previously regulated and unregulated) were calculated to obtain potential YLLs averted. RESULTS: Current revenue of USD 59.25 million is projected to increase to USD 179.25 million with 695,159 averted YLLs at cigarette equivalent taxes and 10% increased regulation; USD 639.38 million with 4,527,597 averted YLLs with 100% regulation; USD 54.75 million, at WHO recommended taxes with 2,233,740 YLLs averted at 10% increased regulation, and 10,486,192 YLLs at 100% regulation. CONCLUSION: Proposed estimates are inline with WHO recommendations as they consider price elasticity and suggest substantial increase in revenue, while averting YLLs. A national action is needed to drive the policy decisions towards increased regulation and taxation and revision of India's tobacco control legislation. IMPLICATIONS: Our study presented empirical evidence of how the currently underutilized tool of taxation, as proposed in the WHO-FCTC, can be utilized to decrease bidi smoking prevalence and save measurable life years while generating government revenue simultaneously. While the revenue statistics counter the misleading tobacco industry narratives, the projected reduction in mortality will be seen as an irrefutable driving force for policy reforms, targeted at strategic increase in regulation and taxation of the traditional Indian cigarillos industry.

Diagnostic performance of F-18 FDG PET/CT in differentiating autoimmune pancreatitis from pancreatic cancer: a systemic review and meta-analysis.

OBJECTIVES: This study aims to evaluate the utility of F-18 FDG PET/CT in the non-invasive diagnosis of autoimmune pancreatitis (AIP) and differentiating it from pancreatic cancer (CaP) based on the amount and pattern of FDG uptake, as well as involvement of extra-pancreatic sites. METHODS: A systematic search was conducted using PubMed, Scopus, Cochrane Library and Google Scholar. Only those studies that compared the findings of F-18 FDG PET/CT in terms of SUVmax, pattern of FDG uptake and presence of FDG-avid extra-pancreatic sites in both AIP and CaP were included. Studies were qualitatively assessed for risk of bias and publication bias. The diagnostic performance of parameters on PET/CT was examined through pooled sensitivity, specificity, diagnostic odd's ratio (DOR) and summary receiver operator characteristic (SROC) curve analysis. RESULTS: Six studies were included with a total of 580 patients. 178 patients had AIP (Age 18-90 years, male, M: female, F ratio-8.4:1) and 402 patients had CaP (Age 22-88 years, M:F ratio-1.5:1). Type of AIP was reported in only 3 studies, with the included cases predominantly being type 1 AIP. All studies were retrospective with heterogeneity and a risk on patient selection and index test. The FDG uptake, expressed as SUVmax, was lower in AIP with a weighted mean difference of -3.11 (95% confidence interval, CI: -5.28 to -0.94). To diagnose AIP, the pooled sensitivity, specificity and DOR of diffuse pattern of FDG uptake were 0.59 (95% CI: 0.51-0.66), 0.89 (95% CI: 0.86-0.92) and 21.07 (95% CI: 5.07-88.32), respectively, with an area under curve (AUC) of 0.717 on SROC analysis. The pooled sensitivity, specificity and DOR of FDG-avid extra pancreatic sites were 0.55 (95% CI: 0.45-0.65), 0.58 (95% CI: 0.52-0.64) and 2.33 (95% CI: 1.40-3.89), respectively, with an AUC of 0.632. CONCLUSION: On F-18 FDG PET/CT, a pancreatic lesion of AIP has a lower SUVmax value than CaP. A diffuse pattern of FDG uptake and presence of an extra-pancreatic FDG-avid site are nearly 21 times and twice more likely in AIP than CaP, respectively.

Assessment of self-esteem and quality of life in patients with transtibial amputations using an exoskeletal prosthesis.

BACKGROUND: Lower limb amputation can have profound physical, psychological, and social effects on individuals. Assistive aids like prosthetic lower limbs can help an individual regain mobility and thereby affect their self-esteem and quality of life. OBJECTIVE: To assess self-esteem and quality of life in patients with transtibial amputations who are using a transtibial prosthesis and explore the association between sociodemographic and amputation-related factors with self-esteem and prosthesis-related quality of life measures. DESIGN: A cross-sectional study. SETTING: An orthotics and prosthetics center (Bhagwan Mahaveer Viklang Sahayata Samiti) in Jaipur, Rajasthan. PARTICIPANTS: Patients with transtibial amputations using exoskeletal prostheses between July and September 2022, in Jaipur, Rajasthan. MAIN OUTCOME MEASURES: The study used Rosenberg self-esteem questionnaire and Prosthesis Evaluation Questionnaire (PEQ) for self-esteem and quality of life assessment, respectively. Descriptive analysis was used to present the demographic details, and nonparametric tests examined the relationship between PEQ dimensions and sociodemographic variables. RESULTS: The study included 138 participants, primarily <40 years old (45.7%) and mostly engaged in high-activity occupations. Self-esteem mean score (SD) was 19.9 (3.9), with 89.1% exhibiting normal self-esteem. Prosthesis-related quality of life, showed high satisfaction across various domains, including ambulation, appearance, frustration, perceived response, residual limb health, social burden, sounds, utility, and well-being. No significant associations were found between sociodemographic factors, amputation-related variables, and self-esteem. However, PEQ scales showed associations with gender, age, occupation, type of amputation, and years of prosthesis use. CONCLUSION: These results highlight the potential advantages of exoskeletal prostheses in improving the standard of living for people with transtibial amputations. Further research is essential to develop targeted interventions for improving their overall quality of life.

Utility of metabolic ratios in the diagnosis of tumor Thrombus on F-18 FDG PET/CT.

BACKGROUND: This study aims to predict quantitative parameter in form of metabolic ratios to diagnose tumor thrombus on F-18 FDG PET/CT. METHODS: This is a retrospective study from Nuclear Medicine department at All India Institute of Medical Sciences, Jodhpur, India. Patients with malignancies who underwent F-18 FDG PET/CT in our department or images sent for review from February 2020 till September 2022 were screened for tumor thrombus that comprised study group. Control group had patients with malignancy and no imaging evidence of tumor thrombus. Metabolic activities (SUVmax) of tumor thrombus, liver and descending aorta in study group, and that of IVC, liver and descending aorta in control group were recorded. Metabolic ratios of tumor thrombus to liver (SUR L) and to aorta (SUR A) in study group, and IVC to liver (SUR* L) and to aorta (SUR*A) in control group were compared using receiver operator curves. RESULTS: Of 2277 studies screened, 12 had tumor thrombus. The most common primary malignant site and vessel involved were lung and IVC respectively. The median (IQR) SUR L, SUR A, SUR* L and SUR* A were 2.5 (3.25), 2.6  (6), 0.67 (0.18) and 1 (0.17) respectively. Area under ROC for SUR L and SUR A were 0.983 [95% CI: 0.955-1.0] and 0.958 [95% CI: 0.90-1.0] respectively. The ideal cut-off for SUR L was 0.953 (sensitivity 92.3%, specificity 98.0%) and for SUR A was 1.42 (sensitivity 84.6%, specificity 98.0%). CONCLUSION: Metabolic ratios of tumor thrombus to liver (SUR L) and aorta (SUR A) have good diagnostic performance and can be useful in studies with non-iodinated contrast CT.

COVID-19 Vaccination in a Patient With Gluten Enteropathy: A Case Report.

In India, the COVID-19 vaccination for adolescents aged 15-17 years has been started since January 2022. Gluten enteropathy, also known as celiac or nontropical sprue, can arise as an autoimmune disease of the small intestines. We report a 15-year-old female with a history of allergy to gluten-containing products who came for the first dose of the COVID-19 vaccination to adult vaccination OPD at All India Institute of Medical Sciences, Jodhpur. After taking a detailed history, she had an allergy to gluten-containing products for five years. She had no previous history of allergic reactions to injections or medicines. The first dose of Covaxin was given to this female under proper supervision, and she was followed up for any adverse events. We did not find any evidence of adverse events following the COVID-19 vaccination in people with gluten enteropathy. The patient was discharged after one hour of observation. To date, no cases of Covaxin vaccination have been reported among gluten enteropathy patients. We discuss the current evidence relating to Covaxin vaccinations, highlighting that administering the vaccine to gluten-sensitive individuals did not cause any adverse reactions. However, proper history taking and other standard procedures should be followed while administering Covaxin to any known allergies.

National and regional prevalence of gestational diabetes mellitus in India: a systematic review and Meta-analysis.

BACKGROUND: Gestational diabetes mellitus (GDM) is frequently misdiagnosed during pregnancy. There is an abundance of evidence, but little is known regarding the regional prevalence estimates of GDM in India. This systematic review and meta-analysis aims to provide valuable insights into the national and regional prevalence of GDM among pregnant women in India. METHODS: We conducted an initial article search on PubMed, Scopus, Google Scholar, and ShodhGanga searches to identify quantitative research papers (database inception till 15th June,2022). This review included prevalence studies that estimated the occurrence of GDM across different states in India. RESULTS: Two independent reviewers completed the screening of 2393 articles, resulting in the identification of 110 articles that met the inclusion criteria, which collectively provided 117 prevalence estimates. Using a pooled estimate calculation (with an Inverse square heterogeneity model), the pooled prevalence of GDM in pregnant women was estimated to be 13%, with a 95% confidence interval (CI) ranging from 9 to 16%.. In India, Diabetes in Pregnancy Study of India (DIPSI) was the most common diagnostic criteria used, followed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) 1999. It was observed that the rural population has slightly less prevalence of GDM at 10.0% [6.0-13.0%, I2=96%] when compared to the urban population where the prevalence of GDM was 12.0% [9.0-16.0%, I2 = 99%]. CONCLUSIONS: This review emphasizes the lack of consensus in screening and diagnosing gestational diabetes mellitus (GDM), leading to varied prevalence rates across Indian states. It thoroughly examines the controversies regarding GDM screening by analyzing population characteristics, geographic variations, diagnostic criteria agreement, screening timing, fasting vs. non-fasting approaches, cost-effectiveness, and feasibility, offering valuable recommendations for policy makers. By fostering the implementation of state-wise screening programs, it can contribute to improving maternal and neonatal outcomes and promoting healthier pregnancies across the country.

Human epidermal growth factor receptor 2/neu expression in urothelial carcinomas.

Introduction: Urothelial carcinomas of the bladder are more common in males, making them the sixth-most common cancer in men and the tenth-most common cancer overall, worldwide. Current guidelines do not recommend routine testing for human epidermal growth factor receptor (HER2/neu) expression on the biopsy specimens of patients with urothelial carcinoma. This study was aimed at determining the expression pattern of HER2/neu and its usefulness in muscle-invasive and nonmuscle-invasive urothelial carcinoma. Methods: HER2/neu expression was assessed in 89 specimens of urothelial cancer by immunohistochemistry (IHC), and equivocal cases were subjected to fluorescent in situ hybridization (FISH). Results: On IHC for HER2/neu, 17.9% (7/39) of the muscle-invasive bladder cancers (MIBCs) showed a 3+ expression, whereas 22% (11/50) of the non-muscle invasive cancers were positive with a score of 3+. A significant correlation between HER2/neu status and muscle invasion could not be established in the current study (P = 0.74, Fisher's exact test). Three cases of muscle-invasive (7.7%) and 2 cases (4%) among nonmuscle invasive cancers showed equivocal expression. All the cases with equivocal (2+) expression on IHC were subjected to FISH and none showed gene amplification on hybridization and were considered as negative. Conclusion: Overexpression of HER-2/neu was seen in 17.9% of MIBCs and 22% of non-MIBCs. There are no norms for routine testing of HER2/neu expression in the biopsy specimens of urothelial carcinoma. There is an unmet need to establish guidelines for HER2/neu scoring, similar to that for breast and gastric cancers, to determine the proportion of positive cases and help in identification of those who may benefit from targeted therapies.

Electronic-PRO Measures for adverse events Of Treatment In ONcology (E-PROMOTION).

PURPOSE: Cancer patients struggle with the trauma of the disease and its treatment. PRO-CTCAE was developed to improve the recording of underreported symptomatic toxicities. We evaluated the improvement and ease in reporting symptomatic adverse events through add-on PRO-CTCAE (via a mobile application) compared to standard clinician-reported outcomes in routine clinical practice. We also evaluated changes in the health-related quality of life (HRQoL). METHODS: 110 cancer patients were studied for three weeks between their first and second chemotherapy session. HRQoL was assessed using EORTC QLQ-c30. RESULTS: Fifty-three patients self-reported their symptomatic adverse events on the day 7th & day 14th after the first cycle of chemotherapy. For the other fifty-seven patients, recording of adverse events was done by standard clinician-reported outcomes. All the patients in the study group reported adverse events compared to only 21 % in the standard reporting group. All 15 domains of adverse events were reported in the self-reporting group compared to only 5 in the standard reporting group. The self-reporting group had a significantly better overall quality of life. CONCLUSIONS: Self-reporting of adverse events using mobile app-based PRO-CTCAE helps patients and clinicians with better documentation of symptomatic toxicities of chemotherapy, reducing the burden on physicians and improving patient satisfaction. Mobile app-based self-reporting empowers cancer patients undergoing treatment, improves their quality of life, and should be implemented in routine clinical practice. Wider implementation can lead to further optimised solutions.

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19.

INTRODUCTION: The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS: Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS: Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION: Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Can Neonatal Pull-through Replace Staged Pull-through for the Management of Anorectal Malformation? A Systematic Review and Meta-analysis.

Anorectal malformations (ARMs) are managed classically in three stages - colostomy at birth, anorectal pull-through after 2-3 months, and stoma closure. Single-stage pull-through has been contemplated in neonatal age aimed to reduce the number of procedures, better long-term continence, the better psycho-social status of the child, and reduced cost of treatment, especially in resource-strained countries. We conducted a systematic review comparing neonatal single-stage pull-through with stage pull-through and did a meta-analysis for the outcome and complications. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and Scopus databases were searched and RevMan 5.4.1 was used for the meta-analysis. Fourteen comparative studies including one randomized controlled trial were included in the systematic review for meta-analysis. The meta-analysis included 1845 patients including 866 neonates undergoing single-stage pull-through. There was no statistically significant difference for the occurrence of surgical site infection (odds ratio [OR] 0.82, 95% confidence interval [CI]: 0.24-2.83), urinary tract injury (OR 1.82, 95% CI: 0.85-3.89), rectal prolapse (OR 0.98, 95% CI: 0.21-5.04), anal stenosis/stricture, voluntary bowel movements (OR 0.97, 95% CI: 0.25-3.73), constipation (OR 1.01, 95% CI: 0.61-1.67), soiling (OR 0.89, 95% CI: 0.52-1.51), mortality (OR 1.19, 95% CI: 0.04-39.74), or other complications. However, continence was seen to be better among patients undergoing neonatal pull-through (OR 1.63, 95% CI: 1.12-2.38). Thus, we can recommend single-stage pull-through for managing patients with ARMs in the neonatal age.