Real-World Experience of Patient's Compliance and Clinical Outcomes for Trimodality Treatment for Esophageal Cancer: a Study from a Cancer Center in North-East India.

Preoperative chemoradiotherapy is a standard treatment for patients with locally advanced, resectable esophageal cancer. The treatment completion rates impact the survival outcomes (Eyck et al J Clin Oncol 39(18):1995-2004, 2021). Thus, we aimed to estimate the effect of neoadjuvant chemoradiotherapy (NACRT) in terms of treatment completion rates and survival in this subset of patients and bring out the clinical outcomes in that context. This was a retrospective study done at a tertiary cancer center in North-East India. The study period was from 1 January 2018 to 31 December 2021. We included patients diagnosed with locally advanced and resectable esophageal cancer (cT2-3NanyM0) involving the middle and/or lower thoracic esophagus and who were planned for trimodality treatment in the Joint Tumor Board. Out of the 82 patients who were planned for trimodality treatment, all were squamous cell carcinomas. We found that 54.9% of patients completed the entire trimodality treatment. The median age was 56 years (range 34 to 73 years). The male to female ratio was 59:23. Adverse events, of any grade, were seen in 76% of patients who received NACRT. Fatigue (66%) was the most common toxicity. The common hematologic toxicities were neutropenia and anemia (7.3% each). A total of 45 patients (54.9%) were able to complete all the three modalities of treatment. Transthoracic esophagectomy was the preferred approach (84.4%). The site of anastomosis was in the neck of all the patients. Anastomotic leak was seen in 17.7% of patients. Postoperative pulmonary and cardiac complications occurred in 31.1% and 8.9% of patients respectively. The 30-day mortality was 6.7% (three deaths). A pathological complete response was seen in 35.6% among patients who underwent an esophagectomy. R0 resection was achieved in 93.3% of patients. The median overall survival and disease-free survival were 19 months and 17 months respectively. The completion rate of trimodality treatment in the real-world scenario was found to be low in our study, the reasons for which need to be identified and effectively resolved. Oncological outcomes were similar to the published literature.

Patterns of failure in patients with nasopharyngeal cancer of Northeastern region of India: a retrospective observational study.

PURPOSE: We aimed to analyze patterns of failure and disease volume-treatment outcomes in patients with Nasopharyngeal carcinoma (NPC) treated with definitive radiation with or without concurrent chemotherapy at a tertiary cancer centre in northeast India. METHODS: From February 2018 to February 2022, 99 histopathologically proved non-metastatic NPC patients treated with curative-intent RT with or without chemotherapy were retrospectively analyzed. Locally advanced patients received neoadjuvant or adjuvant chemotherapy. The Cox proportional hazards model was used to investigate the impact of various prognostic factors on locoregional free survival (LRFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). The log-rank test and Kaplan-Meir curves compared outcome variables based on ROC analysis-classified tumor volume. RESULTS: During a median follow up of 25.4 months (17.3-39.2), 35(35.4%) patients developed recurrence. Twenty-three patients developed locoregional failures, of which 11 were in-field; 12 patient showed an out-field failure. The 3-year LRFS, DMFS, PFS and OS was 71.10%, 70.90%, 64.10% and 74.10% respectively. There was statistically significant difference in LRFS according to T staging (p < 0.0001). Gross tumor volume (GTVp) and gross nodal volume (GTVn) were an independent prognostic factor for OS, PFS, LRFS and DMFS. The cut-off volumes for GTVp and GTVn for distant metastases and locoregional failure, respectively, were found to be 13 and 22.7 mL and 3.7 and 39.2 mL, respectively, by ROC curve analysis. Based on this, 99 patients were divided into three subgroups. OS demonstrated significant differences among patients in different volume subgroups for GTVp (p = 0.03) and GTVn (p = 0.00024). CONCLUSIONS: For NPC patients who undergo curative IMRT, primary tumour and nodal volumes are independent prognostic indicators. GTVp and GTVn are highly predictive of local control, distant metastases, disease-free survival, and overall survival. This justifies their use as quantitative prognostic indicator for NPC.

Cost-Effectiveness of Novel Agent Regimens for Transplant-Eligible Newly Diagnosed Multiple Myeloma Patients in India.

BACKGROUND: Survival outcomes for multiple myeloma have improved dramatically since the introduction of novel therapeutic agents. While these drugs are highly effective in improving survival outcomes and quality of life in patients with multiple myeloma, they come at a significant cost. We assessed the cost-effectiveness of bortezomib-based triplet or quadruplet drug regimens in isolation and followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of newly diagnosed multiple myeloma (NDMM) in the Indian context. METHODS: A Markov model was developed to assess the health and economic outcomes of novel drug regimens with and without AHSCT for the treatment of NDMM in India. We estimated the lifetime quality-adjusted life-years (QALYs) and costs in each scenario. The incremental cost-effectiveness ratios (ICERs) were computed and compared against the current willingness-to-pay threshold of a one-time per capita gross domestic product of ₹146,890 (US$1,927.70) for India. Parameter uncertainty was assessed through Monte Carlo probabilistic sensitivity analysis. RESULTS: Among seven treatment sequences, the VCd (bortezomib, cyclophosphamide, dexamethasone) alone arm has the lowest cost and health benefits as compared to four treatment sequences, namely VTd (bortezomib, thalidomide, dexamethasone) alone, VRd (bortezomib, lenalidomide, dexamethasone) alone, VRd plus AHSCT and DVRd (Daratumumab, bortezomib, lenalidomide, dexamethasone) plus AHSCT. It was found that VTd plus AHSCT and VCd plus AHSCT arms were extendedly dominated (ED) by combination of two alternative treatments. Among the five non-dominated strategies, VRd has a lowest incremental cost of ₹ 2,20,093 (US$2,888) per QALY gained compared to VTd alone followed by VRd plus AHSCT [₹3,14,530 (US$4,128) per QALY gained] in comparison to VRd alone. None of the novel treatment sequences were found to be cost-effective at the current WTP threshold of ₹1,46,890 (US$1,927.7). CONCLUSION: At the current WTP threshold of one-time per capita GDP (₹ 146,890) of India, VRd alone and VRd plus AHSCT has 38.1% and 6.9% probability to be cost-effective, respectively. Reduction in current reimbursement rates of novel drugs, namely VRd, lenalidomide, and pomalidomide plus dexamethasone under national insurance program and societal cost of transplant by 50%, would make VRd plus AHSCT and VTd plus AHSCT cost-effective at an incremental cost of ₹40,671 (US$34) and ₹97,639 (US$1,281) per QALY gained, respectively.

Financial toxicity of cancer treatment in India: towards closing the cancer care gap.

Background: The rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities. Methods: A total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression. Results: Mean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment. Conclusion: There is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India.

PURPOSE: Tyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India. METHODS: A Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis. RESULTS: We estimated the total lifetime cost per patient of ₹ 0.27 million ($3,706 US dollars [USD]), ₹ 0.35 million ($4,716 USD), ₹ 9.7 million ($131,858 USD), and ₹ 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of ₹ 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (₹ 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (₹ 168,300) in the Indian context. CONCLUSION: Our findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.

Moderate resolution LAI prediction using Sentinel-2 satellite data and indirect field measurements in Sikkim Himalaya.

The leaf area index (LAI) has been traditionally used as a photosynthetic variable. LAI plays an essential role in forest cover monitoring and has been identified as one of the important climate variables. However, due to challenges in field sampling, complex topography, and availability of cloud-free optical satellite data, LAI assessment on larger scale is still unexplored in the Sikkim Himalayan area. We used two optical instruments, digital hemispherical photography (DHP) and LAI-2200C, to assess the LAI across four different forests following 20 × 20 m2 elementary sampling units (ESUs) in the Himalayan state of Sikkim, India. The use of Sentinel-2 derived vegetation indices (VIs) demonstrated a better correlation with the DHP based LAI estimates than using LAI-2200C. Further, the combination of both reflectance bands and VIs were integrated to predict the LAI maps using random forest model. The temperate evergreen forests demonstrated the highest LAI value, while the predicted maps exhibited LAI maxima of 3.4. The estimated vs predicted LAI for DHP and LAI-2200C based estimation demonstrated reasonably good (R2 = 0.63 and R2 = 0.68, respectively) agreement. Further, improvements on the LAI prediction can be attempted by minimizing errors from the inherent field protocols, optimizing the density of field measurements, and representing heterogeneity. The recent rise of frequent forest fires in Sikkim Himalaya prompts for better understanding of fuel load in terms of surface fuel or canopy fuel that can be linked to LAI. The high-resolution LAI map could serve as input to forest fuel bed characterization, especially in seasonal forests with significant variations in green leaves and litter, thereby offering inputs for forest management in changing climate.

Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women.

BACKGROUND: In this study, we evaluate the cost and outcomes of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) plus fulvestrant, fulvestrant alone, and conventional chemotherapy as the second-line therapy for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in India. METHODS: Using a Markov model, the clinical effectiveness of managing HR+, HER2- MBC in postmenopausal women with either a CDK4/6i (either ribociclib or palbociclib) and fulvestrant, fulvestrant alone, and chemotherapy (single-agent paclitaxel or capecitabine) was measured in terms of quality-adjusted life-years (QALYs). The costs were estimated from two different points of view: scenario I, as per the prevailing market prices of the drugs; and scenario II, as per the reimbursement rates set up by the publicly financed national health insurance scheme. Incremental cost per QALY gained with a given treatment option was compared against the next best alternative and was assessed for cost effectiveness using a threshold of 1-time the per capita gross domestic product (GDP) in India from a societal perspective. RESULTS: In scenario I, an MBC patient was found to incur a lifetime cost of Indian Rupees (₹) 2.54 million ($34,644), ₹2.53 million ($34,496), ₹512,598 ($6,984), ₹326,026 ($4,442) and ₹237,115 ($3,230) for the ribociclib and palbociclib combination arms, fulvestrant monotherapy, single-agent paclitaxel and the single-agent capecitabine treatment arms, respectively. The lifetime cost for CDK4/6i (ribociclib and palbociclib) combination therapy, fulvestrant monotherapy, paclitaxel, and capecitabine arms was estimated to be ₹1.94 million ($26,459), ₹1.92 million ($26,220), ₹315,387 ($4,296), ₹187,392 ($2,553) and ₹153,263 ($2,088), respectively, in scenario II. The mean QALYs lived per MBC patient with CDK4/6i (either ribociclib or palbociclib) combination therapy, fulvestrant, paclitaxel and capecitabine were estimated to be 1.4, 1.0, 0.9 and 0.7, respectively. None of the treatment arms are cost effective at current prices and reimbursement rates at a threshold of 1-time the per capita GDP of India. However, a 78% reduction in the current market price or a 72% reduction in the reimbursement rate of fulvestrant in the government-funded insurance program will make it a cost-effective treatment option for HR+, HER2- MBC patients in India. CONCLUSION: CDK4/6i (ribociclib and palbociclib) therapy is not a cost-effective treatment option for MBC patients. A 72% reduction in the reimbursement rate for fulvestrant monotherapy will make it a cost-effective treatment option in the Indian context.

Rapid assessment of plant diversity using MODIS biophysical proxies.

The spectral information derived from satellite data provides important inputs for assessing plant diversity. If a suitable satellite-derived biophysical proxy is applicable to assess and monitor plant diversity of different biogeographic regions will be of interest to policy makers and conservationists. We selected four biogeographic regions of India, i.e., semi-arid, Eastern Ghats, Western Ghats, and Northeast as the test sites on the basis of variations in moisture availability. The flora data collected for the study sites are the extract of the national biodiversity project 'Biodiversity Characterization at Landscape Level'. The available Moderate Resolution Imaging Spectroradiometer (MODIS)-derived biophysical proxies at high temporal frequencies was considered to compare the biophysical proxies: surface reflectance-red and near-infrared, normalized difference vegetation index-NDVI, enhanced vegetation index-EVI, leaf area index-LAI, and fraction of absorbed photosynthetically active radiation-FAPAR at different temporal scales (monthly, post-monsoon, seasonal, annual) in each selected biogeographic regions of India. Generalized linear model (GLM) and multivariate adaptive regression spline (MARS) were utilized to evaluate the relationship between plant diversity and MODIS-derived biophysical proxies. MARS summarized the suitable biophysical proxies at monthly scale in descending order for the total forest area in semi-arid was red, NDVI, and FAPAR; for Eastern Ghats was EVI, FAPAR, and LAI; for Western Ghats was EVI, LAI, and FAPAR; and for Northeast was NDVI, near-infrared, and red. Furthermore, monthly FAPAR commonly found to be the suitable proxy to large scale monitoring of plant diversity in the moisture-varied biogeographic regions of India, except Northeast. Using artificial neural network, the relationship of plant diversity and monthly FAPAR/NDVI were modeled. The correlation between the predicted and reference plant diversity was found to be r = 0.56 for semi-arid, r = 0.52 for Eastern Ghats, r = 0.52 for Western Ghats and r = 0.61 for Northeast at p-value < 0.001. The study affirms that FAPAR is potentially an essential biodiversity variable (EBV) for carrying out rapid/indicative assessment of plant diversity in different biogeographic regions, and thereby, meeting various international commitments dealing with conservation and management measures for biodiversity.

Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India-A Model-Based Economic Analysis.

PURPOSE: Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India. METHODS: Using a disaggregated societal perspective and lifetime horizon, a Markov model was developed for estimating the costs and health outcomes in a hypothetical cohort of 1,000 patients with advanced and metastatic cervical cancer treated with either standard chemotherapy alone or in combination with bevacizumab. Effectiveness data for each of the treatment regimen were assessed using estimates from Gynecologic Oncology Group 240 trial. Data on disease-specific mortality in metastatic cervical cancer, health system cost, and out-of-pocket expenditure were derived from Indian literature. Multivariable probabilistic sensitivity analysis was undertaken to account for parameter uncertainty. RESULTS: Over the lifetime of one patient with advanced and metastatic cervical cancer, bevacizumab along with standard chemotherapy results in a gain of 0.275 (0.052-0.469) life-years (LY) and 0.129 (0.032-0.218) quality-adjusted life-years (QALY), at an additional cost of $3,816 US dollars (USD; 2,513-5,571) compared with standard chemotherapy alone. This resulted in an incremental cost of $19,080 USD (7,230-52,434) per LY gained and $34,744 USD (15,782-94,914) per QALY gained with the use of bevacizumab plus standard chemotherapy. CONCLUSION: Addition of bevacizumab to the standard chemotherapy is not cost effective for the treatment of advanced and metastatic cervical cancer in India at a threshold of 1-time per-capita gross domestic product.

Clinicoepidemiological Profile and Treatment Outcomes in Children with Retinoblastoma: Experience from a Cancer Care Center in Northeast India.

Gaurav KumarBackground Retinoblastoma (RB) is the most common primary intraocular malignancy in children. We sought to provide a comprehensive assessment of epidemiological profile and treatment outcomes of children with RB. Methods In this retrospective study, we analyzed 189 children diagnosed with RB at our center between 2004 and 2017. Survival was analyzed with the Kaplan-Meier method and log-rank test. Results Median age at presentation was 14 months with male: female ratio 1.2:1. Mean duration between onset of symptoms and presentation was 49 days (standard deviation ± 79). Most common presenting symptom was white pupillary reflex in 60% of children. Family history of RB and other cancers was found in one (0.5%) and seven (4%) children, respectively. Primary mode of diagnosis and staging was ocular ultrasonography (bone scan) in 87% of patients. Computed tomographic scan and magnetic resonance imaging were done in 124 (66%) and 30 (16%) patients, respectively. International staging system grade E disease was found in 144 (76%), extraocular disease in 55 (29%), bilateral disease in 49 (26%), and trilateral disease in 3 (1.5%) children. Out of 189 children with RB, 33 (18%) refused treatment and 156 children received treatment (24 children [15%] abandoned treatment midway and 132 [85%] completed treatment). One hundred children (64%) received systemic therapy as neoadjuvant or adjuvant chemotherapy and 20 (13%) received local therapy. Eyeball and vision salvage rate with chemotherapy were 20 (13%) and 9 (6%), respectively. Cryotherapy was the most common modality of local treatment used in 11 (55%) children. Five-year survival for patients who received treatment was 76% (median survival not reached). In the treatment refusal group, median survival was 9 months. Conclusion In developing countries, RB is mostly detected in advanced stages resulting in poor outcomes. Increased awareness and accessibility to dedicated centers for treating childhood malignancy can lead to early diagnosis, better prognosis, and increased vision salvage.

Clinico-epidemiological profile and treatment outcomes in patients with squamous cell carcinoma of the esophagus following docetaxel-based neoadjuvant chemotherapy: experience from a cancer care center in Northeast India.

BACKGROUND: Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. Surgery alone is associated with poor long-term survival. Neoadjuvant chemoradiation and perioperative chemotherapy without radiation have been tried to improve survival rates. METHODS: We retrospectively evaluated the neoadjuvant chemotherapy in forty-eight patients with non-metastatic, non-cervical squamous cell carcinoma of the esophagus with a docetaxel-based three-drug regimen to improve complete pathological response rates. RESULTS: The median age of presentation was 52 years, with male preponderance. All the patients received three cycles of docetaxel-cisplatin-fluorouracil-based chemotherapy. A complete pathological response to neoadjuvant chemotherapy was seen in 8 patients (17%). Rates of grade 3 hematological toxicities were seen in 12% of patients, with no observed grade 4 toxicity. The most common non-hematological toxicity was grade 3 alopecia (seen in 40%) and grade 2 nausea/vomiting in 8% of patients. At a median follow-up of 26.5 months, 2-year survival for the patients receiving chemotherapy and surgery is 66%. CONCLUSIONS: Preoperative chemotherapy with a taxane-based triple-drug regimen is a reasonable approach in squamous cell carcinoma of the esophagus, associated with improvement in complete pathological response rates, increases complete resection rates, with manageable toxicity.

Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol.

INTRODUCTION: The rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer. METHODS AND ANALYSIS: The present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care. ETHICS AND DISSEMINATION: Approval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.

On the relationships between plant species richness and the environment: a case study in Eastern Ghats, India.

Many places of the earth support high plant species richness, but emphasis is given to biodiversity hotspots with rich endemic species under threats of destruction by anthropogenic interventions. This definitely underplays species conservation at several places significant for optimisation of preserving natural ecosystems. Here we explore influences of climate, physiography and disturbance on plant species richness of the Eastern Ghats. We focus on the implications of water-energy dynamics and climatic heterogeneity on community distribution. Initially, 26-environmental variables were considered for the study, but eight least correlated variables viz., aspect, human appropriation of net primary productivity, global human footprint, mean annual temperature, mean annual precipitation, precipitation of driest quarter, terrain ruggedness index and temperature seasonality were utilised for further analysis. A total of 1670 species from 2274 sampling locations of 22564 records were examined using canonical correspondence analysis (CCA) and decision trees. Water-energy dynamics broadly regulates plant richness, with significant influence of mean annual precipitation and temperature. Precipitation of the driest quarter is the most significant factor in describing plant richness, indicating the availability of water during the dry period is crucial. The rise in temperature is likely to deteriorate further, where temperature seasonality is significant. Temperature seasonality determines thermal variability and assesses the intensity of climate change impacts on plant richness. The study offers ecological insights for successful conservation and management planning for the sustenance of the Eastern Ghats' rich biodiversity.

Angiospermic plant dispersal profile of India-a maiden analysis.

Plant-disperser relationship is a mutual approach that regulates the species composition and habitat diversity. Here, we unfold the dispersal profile of India and provide comprehensive information on plant-disperser relationships, emphasising on plant longevities (annual, biennial, and perennial), plant life forms (tree, shrub, herb, liana), and vegetation types. The floral data were collected from a national database, and the dispersal information of 3301 geo-tagged plant species was gathered. The plant dispersal types were mainly (1) abiotic (hydrochory-water, anemochory-wind) and (2) biotic (endozoochory-internal gut, epizoochory-adherence to external surface, anthropochory-human, ornithochory-bird, myrmecochory-insect, and chirepterochory-bat) that included five dispersal modes, i.e. monochory (single), dichory (double), trichory (triple), quadrichory (four), and quintuchory (five). The generalised linear model was utilised to evaluate plant-disperser relationships. Monochory could explain variances of 56.8%, 51.2%, and 45.1% in perennials, annuals, and biennials, and 45.3%, 46.3%, 39.4%, and 47.7% for trees, shrubs, herbs, and lianas, respectively. Monochory has more significant influence on all major vegetation types, with at least 40% variance explanation. Anemochory, the dispersal by wind factor, was found to exercise by most plants. The life form wise analytics revealed inclination of multiple modes of dispersal for herbs with abiotic factors might be due to lighter weight, followed by trees with biotic dispersers could be owing to large size seeds. The same trend was reported from herb-dominant grassland where abiotic factors mostly contribute to dispersal, whereas the tree-dominant vegetation types exhibit dispersal primarily due to biotic means. This study provides a synoptic diagnosis to understand the dispersal profile of India, which has been an understudied domain.

Clinico-epidemiological features and response in childhood acute lymphoblastic leukemia at regional cancer center of Northeast India.

INTRODUCTION: Acute lymphoblastic leukemia (ALL) comprises 19.3% of all childhood cancers in Northeast India. METHODS: We analyzed clinicoepidemiological features and early response to the treatment of all the cases of childhood ALL (age <15 years) diagnosed and treated at Dr. B Borooah Cancer Institute over 1 year. RESULTS: Of 52 eligible cases, 69% were male (male:female ratio of 2.2:1) and the mean age was 7.1 years. Thirty-three children (63%) had baseline white blood cell count ≥20 × 109/L. Precursor B-cell was most the common subtype seen in 61% of children. Seven cases (14%) had high-risk (HR) cytogenetics, with t (9,22) being the most common one. Male sex and HR cytogenetics were significantly associated with poor early responses. CONCLUSION: ALL is a common childhood malignancy with high cure rates. However, poor socioeconomic status and the presence of higher proportions of disease-related factors lead to poor outcome in this part of the country.

Spatial heterogeneity of climate explains plant richness distribution at the regional scale in India.

INTRODUCTION: Knowledge of species richness patterns and their relation with climate is required to develop various forest management actions including habitat management, biodiversity and risk assessment, restoration and ecosystem modelling. In practice, the pattern of the data might not be spatially constant and cannot be well addressed by ordinary least square (OLS) regression. This study uses GWR to deal with spatial non-stationarity and to identify the spatial correlation between the plant richness distribution and the climate variables (i.e., the temperature and precipitation) in a 1° grid in different biogeographic zones of India. METHODOLOGY: We utilized the species richness data collected using 0.04 ha nested quadrats in an Indian study. The data from this national study, titled 'Biodiversity Characterization at Landscape Level', were aggregated at the 1° grid level and adjudged for sampling sufficiency. The performances of OLS and GWR models were compared in terms of the coefficient of determination (R2) and the corrected Akaike Information Criterion (AICc). RESULTS AND DISCUSSION: A comparative study of the R2 and AICc values of the models showed that all the GWR models performed better compared with the analogous OLS models. The climate variables were found to significantly influence the distribution of plant richness in India. The minimum precipitation (Pmin) consistently dominated individually (R2 = 0.69; AICc = 2608) and in combinations. Among the shared models, the one with a combination of Pmin and Tmin had the best model fits (R2 = 0.72 and AICc = 2619), and variation partitioning revealed that the influence of these parameters on the species richness distribution was dominant in the arid and the semi-arid zones and in the Deccan peninsula zone. CONCLUSION: The shift in climate variables and their power to explain the species richness of biogeographic zones suggests that the climate-diversity relationships of plants species vary spatially. In particular, the dominant influence of Tmin and Pmin could be closely linked to the climate tolerance hypothesis (CTH). We found that the climate variables had a significant influence in defining species richness patterns in India; however, various other environmental and non-environmental (edaphic, topographic and anthropogenic) variables need to be integrated in the models to understand climate-species richness relationships better at a finer scale.

Assessing distributions of two invasive species of contrasting habits in future climate.

Understanding the impact of climate change on species invasion is crucial for sustainable biodiversity conservation. Through this study, we try to answer how species differing in phenological cycles, specifically Cassia tora and Lantana camara, differ in the manner in which they invade new regions in India in the future climate. Since both species occupy identical niches, exploring their invasive potential in different climate change scenarios will offer critical insights into invasion and inform ecosystem management. We use three modelling protocols (i.e., maximum entropy, generalised linear model and generalised additive model) to predict the current distribution. Projections are made for both moderate (A1B) and extreme (A2) IPCC (Intergovernmental Panel on Climate Change) scenarios for the year 2050 and 2100. The study reveals that the distributions of C. tora (annual) and L. camara (perennial) would depend on the precipitation of the warmest quarter and moisture availability. C. tora may demonstrate physiological tolerance to the mean diurnal temperature range and L. camara to the solar radiation. C. tora may invade central India, while L. camara may invade the Western Himalaya, parts of the Eastern Himalaya and the Western Ghats. The distribution ranges of both species could shift in the northern and north-eastern directions in India, owing to changes in moisture availability. The possible alterations in precipitation regimes could lead to water stress, which might have cascading effects on species invasion. L. camara might adapt to climate change better compared with C. tora. This comparative analysis of the future distributions of two invasive plants with contrasting habits demonstrates that temporal complementarity would prevail over the competition.

Optimized grid representation of plant species richness in India-Utility of an existing national database in integrated ecological analysis.

Data on the distribution of plant species at spatial (grid) scales are required as input for integrative analysis along with related climate, environment, topography and soil data. Although the world's scientific community is increasingly generating data on plant species at various spatial grids and statistically interpolating and extrapolating the available information, data on plant diversity from the Asian continent are scant. Such data are unavailable for India, the mainland of which has part of three of the world's 36 biodiversity hotspots. Although sufficient field sampling is always impossible and impractical, it is essential to utilize fully any available database by adjudging the sampling sufficiency at a given scale. In this work, we used an exhaustive database of the plant species of the Indian mainland that was sufficient in terms of sampling vegetation types. We transformed the data, obtained the distribution at the 1° and 2° spatial grid levels and evaluated the sampling sufficiency at acceptable threshold limits (60% to 80%). The greatest species richness values recorded in the 0.04 ha quadrant, 1° grid and 2° grid were 59, 623 and 1244, respectively. Clench model was significantly (p value < 0.001) fitted using the plant species data at both the grid levels with a very high coefficient of determination (>0.95). At an acceptable threshold limit of 70%, almost all the grids at the 2° level and more than 80% of the grids at the 1° level were found to be sufficiently sampled. Sampling sufficiency was observed to be highly scale-dependent as a greater number of 2° grids attained asymptotic behaviour following the species-area curve. Grid-level sampling insufficiency was attributed to lower numbers of sampling quadrats in forests with poor approachability, which coincided with the world biodiversity hotspots', suggesting that additional sampling was required. We prescribe the use of the 1° and 2° spatial grids with sufficient sampling for any ecological analysis in conjunction with other data and thereby offer grid-level plant species richness data for the Indian mainland for the first time.

Mapping forests in monsoon Asia with ALOS PALSAR 50-m mosaic images and MODIS imagery in 2010.

Extensive forest changes have occurred in monsoon Asia, substantially affecting climate, carbon cycle and biodiversity. Accurate forest cover maps at fine spatial resolutions are required to qualify and quantify these effects. In this study, an algorithm was developed to map forests in 2010, with the use of structure and biomass information from the Advanced Land Observation System (ALOS) Phased Array L-band Synthetic Aperture Radar (PALSAR) mosaic dataset and the phenological information from MODerate Resolution Imaging Spectroradiometer (MOD13Q1 and MOD09A1) products. Our forest map (PALSARMOD50 m F/NF) was assessed through randomly selected ground truth samples from high spatial resolution images and had an overall accuracy of 95%. Total area of forests in monsoon Asia in 2010 was estimated to be ~6.3 × 10(6 )km(2). The distribution of evergreen and deciduous forests agreed reasonably well with the median Normalized Difference Vegetation Index (NDVI) in winter. PALSARMOD50 m F/NF map showed good spatial and areal agreements with selected forest maps generated by the Japan Aerospace Exploration Agency (JAXA F/NF), European Space Agency (ESA F/NF), Boston University (MCD12Q1 F/NF), Food and Agricultural Organization (FAO FRA), and University of Maryland (Landsat forests), but relatively large differences and uncertainties in tropical forests and evergreen and deciduous forests.