ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA).

In advanced Renal Cell Carcinoma (aRCC), systemic therapy is the mainstay of treatment, with no or little role for surgery in these patients. Tyrosine kinase inhibitors (TKIs) and immune-oncological (IOs) therapies, either alone or in combination, are recommended in these patients depending on patient and tumour factors. The sequencing of therapies is critical in RCC because the choice of subsequent line therapy is heavily dependent on the response and duration of the previous treatment. There are additional barriers to RCC treatment in India. Immunotherapy is the cornerstone of treatment in ccRCC, but it is prohibitively expensive and not always reimbursed, effectively putting it out of reach for the vast majority of eligible patients in India. Furthermore, in advanced RCC (particularly the clear cell variety), Indian oncologists consider the disease burden of the patients, which is particularly dependent on the quantum of the disease load, clinical symptoms, and performance status of the patient, before deciding on treatment. There are no India-specific guidelines for clear cell RCC (ccRCC) treatment or the positioning and sequencing of molecules in the management of advanced ccRCC that take these country-specific issues into account. The current consensus article provides expert recommendations and treatment algorithms based on existing clinical evidence, which will be useful to specialists managing advanced ccRCC.

Rapid Colorimetric and Fluorometric Discrimination of Maleic Acid vs. Fumaric Acid and Detection of Maleic Acid in Food Additives.

An anthracene thiazole based Schiff base L was synthesized and employed for fluorescence switch-on detection of maleic acid in aqueous DMSO. The non-fluorescent L (10-5 M) showed an instantaneous and selective fluorescence enhancement at 506 nm upon interaction with maleic acid (10-5 M). Other potential carboxylic acids (10-5 M), such as malic acid, citric acid, acetic acid, cinnamic acid, tartaric acid, succinic acid, fumaric acid, oxalic acid and malonic acid failed to alter the chromo-fluorogenic properties of L. Probe L can be employed to detect maleic acid down to 2.74 × 10-6 M. The probe L showed good linearity from 2.97 to 6.87 µM. Analytical utility of L was examined by detecting maleic acid in various food additives and drosophila larvae.

Search for 70 µeV Dark Photon Dark Matter with a Dielectrically Loaded Multiwavelength Microwave Cavity.

Microwave cavities have been deployed to search for bosonic dark matter candidates with masses of a few µeV. However, the sensitivity of these cavity detectors is limited by their volume, and the traditionally employed half-wavelength cavities suffer from a significant volume reduction at higher masses. Axion dark matter experiment (ADMX)-Orpheus mitigates this issue by operating a tunable, dielectrically loaded cavity at a higher-order mode, which allows the detection volume to remain large. The ADMX-Orpheus inaugural run excludes dark photon dark matter with kinetic mixing angle χ>10^{-13} between 65.5 µeV (15.8 GHz) and 69.3 µeV (16.8 GHz), marking the highest-frequency tunable microwave cavity dark matter search to date.

Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India.

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India.

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions. Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.

Search for Invisible Axion Dark Matter in the 3.3-4.2 µeV Mass Range.

We report the results from a haloscope search for axion dark matter in the 3.3-4.2 µeV mass range. This search excludes the axion-photon coupling predicted by one of the benchmark models of "invisible" axion dark matter, the Kim-Shifman-Vainshtein-Zakharov model. This sensitivity is achieved using a large-volume cavity, a superconducting magnet, an ultra low noise Josephson parametric amplifier, and sub-Kelvin temperatures. The validity of our detection procedure is ensured by injecting and detecting blind synthetic axion signals.

Complexation thermodynamics of diglycolamide with f-elements: solvent extraction and density functional theory analysis.

Comparative extraction of trivalent lanthanide and actinide ions (La(3+), Eu(3+), Lu(3+), Am(3+) and Cm(3+)) with tetra-n-octyl diglycolamide (TODGA) was studied and showed the trend: Lu(3+) > Eu(3+) > Cm(3+) > Am(3+) > La(3+). The structure, bonding, energetic and thermodynamic parameters of the trivalent lanthanide and actinide ions (La(3+), Eu(3+), Lu(3+), Am(3+) and Cm(3+)) with a tridentate ligand, tetra-methyl diglycolamide (TMDGA), are reported in the gas and solvent phases in order to understand their complexation and extraction behaviour. The calculations were performed using the generalized gradient approximated BP86 density functional and the hybrid B3LYP functional using SVP and TZVPP basis sets. The calculated structure obtained at the BP86/SVP level of optimization was found to be in close agreement with the X-ray data and also with the structure obtained at the B3LYP/TZVP level of theory. The free energy of extraction was found to be exergonic for the explicit monomer water model. From the solvent extraction experiment the order of extraction was observed as Lu(3+) > Eu(3+) > Cm(3+) > Am(3+) > La(3+), which was in line with the trends predicted based on the free energy changes in the gas phase calculations (ΔGgp). The Born-Haber thermodynamic cycle and the COSMO (conductor like screening model) solvation model were applied to calculate the free energy of extraction, ΔGext, of lanthanide and actinide ions in the aqueous-dodecane biphasic system and ΔGext, however, predicted different extraction trends. After dispersion correction (B3LYP-D3), the free energy of extraction for the metal ions was found to follow the order: Lu(3+) > Eu(3+) > La(3+), which was also observed in the solvent extraction experiments. Both COSMO and DCOSMO-RS models predict the same metal ion selectivity trend. Different bonding analyses indicate the electrostatic and less covalent nature of interactions between the ligands and the metal ions.

Spectrum of Clinical Presentation of Pulmonary Alveolar Microlithiasis: Case Series from North India.

We describe five cases of pulmonary alveolar microlithiasis (PAM) from North India with characteristic radiological and histopathological features. All patients were symptomatic with variable severity and duration of the symptoms and one patient developed cor-pulmonale during the course of follow-up. Diagnosis of PAM was suspected on the basis of classical sand-storm appearance on radiological examination and confirmed by transbronchial lung biopsy in four of the five cases. Apart from other features, presence of pleural and pericardial calcification in one case makes this discussion valuable. Awareness of this specific entity among the clinicians is essential to avoid unnecessary investigations.

Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or ≥ 15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Investigations on preferential Pu(IV) extraction over U(VI) by N,N-dihexyloctanamide versus tri-n-butyl phosphate: evidence through small angle neutron scattering and DFT studies.

Straight chain amide N,N-dihexyloctanamide (DHOA) has been found to be a promising alternative extractant to tri-n-butyl phosphate (TBP) for the reprocessing of irradiated uranium- and thorium-based fuels. Unlike TBP, DHOA displays preferential extraction of Pu(IV) over U(VI) at higher acidities (≥3 M HNO3) and poor extraction at lower acidities. Density functional theory (DFT) based calculations have been carried out on the structures and relative binding energies of U(VI) and Pu(IV) with the extractant molecules. These calculations suggest that the differential hardness of the two extractants is responsible for the preferential binding/complexation of TBP to uranyl, whereas the softer DHOA and the bulky nature of the extractant lead to stronger binding/complexation of DHOA to Pu(IV). In conjunction with quantum chemical calculations, small angle neutron scattering (SANS) measurements have also been performed for understanding the stoichiometry of the complex formed that leads to relatively lower extraction of Th(IV) (a model for Pu(IV)) as compared to U(VI) using DHOA and TBP as the extractants. The combined experimental and theoretical studies helped us to understand the superior complexation/extraction behavior of Pu(IV) over U(VI) with DHOA.

Consensus & evidence-based INOSA Guidelines 2014 (first edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Probiotics in fish and shellfish culture: immunomodulatory and ecophysiological responses.

Aquaculture is emerging as one of the most viable and promising enterprises for keeping pace with the surging need for animal protein, providing nutritional and food security to humans, particularly those residing in regions where livestock is relatively scarce. With every step toward intensification of aquaculture practices, there is an increase in the stress level in the animal as well as the environment. Hence, disease outbreak is being increasingly recognized as one of the most important constraints to aquaculture production in many countries, including India. Conventionally, the disease control in aquaculture has relied on the use of chemical compounds and antibiotics. The development of non-antibiotic and environmentally friendly agents is one of the key factors for health management in aquaculture. Consequently, with the emerging need for environmentally friendly aquaculture, the use of alternatives to antibiotic growth promoters in fish nutrition is now widely accepted. In recent years, probiotics have taken center stage and are being used as an unconventional approach that has numerous beneficial effects in fish and shellfish culture: improved activity of gastrointestinal microbiota and enhanced immune status, disease resistance, survival, feed utilization and growth performance. As natural products, probiotics have much potential to increase the efficiency and sustainability of aquaculture production. Therefore, comprehensive research to fully characterize the intestinal microbiota of prominent fish species, mechanisms of action of probiotics and their effects on the intestinal ecosystem, immunity, fish health and performance is reasonable. This review highlights the classifications and applications of probiotics in aquaculture. The review also summarizes the advancement and research highlights of the probiotic status and mode of action, which are of great significance from an ecofriendly, sustainable, intensive aquaculture point of view.

Sequential Serum Cytokine Levels of TNF-Alpha, IL-4 and IL-12 are Associated with Prognosis in Plasmodium falciparum Malaria.

We investigated the prognostic role of TNF-alpha, IL-4 and IL-12 in a clinically well defined group of Plasmodium falciparum infected patients (n = 32) sequentially from Day 0 to Day 10 with a 2 day interval along with a control group of 16 healthy volunteers of same range of age and sex. Infection with malaria is often fatal because mitochondria are unable to generate enough ATP to maintain normal cellular function. ATP deficiency arises in malaria due to an inability of mitochondria through the effects of inflammatory cytokines on their function, to utilize available oxygen. In our study TNF-alpha and IL-12 levels were significantly elevated but IL-4 level showed persistent decline in Day 0, but subsequent measurement in Day 2, 4, 6, 8 and 10 showed persistent decline in levels of TNF-alpha and IL-12, an elevation in IL-4 levels which were associated with disease prognosis of the infected patients. These results again provide evidence that cytokines are very much a dominant partner in malaria pathogenesis with a specific prognostic role.

Ligand structure and diluent nature in defining improved Am3+ and Cm3+ separation using diglycolamides: a combined solvent extraction and DFT study.

Separation of Am3+ and Cm3+ is one of the most challenging yet unavoidable steps in the back end of the nuclear cycle. Various ligands evaluated for Am/Cm separation have their own merits and demerits, and not a single ligand has been uniquely proposed for this purpose. In the present work, we evaluated N,N,N',N'-tetra-n-octyldiglycolamide (TODGA) vis-à-vis N,N,N',N'-tetra-2-ethylhexyldiglycolamide (T2EHDGA) in combination with a hydrophilic 2,6-bis(1,2,4-triazinyl)pyridine (SO3PhBTP) derivative in the aqueous phase for the separation of Am3+ and Cm3+ from nitric acid medium. The results showed that marginal selectivity for Am3+ over Cm3+ was observed with T2EHDGA in the presence of SO3PhBTP, which was attributed to the difference in the entropy change for their extraction from both the temperature-dependent liquid-liquid extraction and computational studies.

Remarkable enhancement in radio-cesium uptake from acidic feeds into an extraction chromatography resin containing a calix[4]arene-mono-crown-6 ligand.

An extraction chromatography resin, prepared by the impregnation of bis-octyloxy-calix[4]arene-mono-crown-6 (BOCMC)onto an acrylic ester based polymeric support material, gave excellent uptake data for the removal of radio-cesium (Cs-137) from nitric acid feed solutions. The weight distribution coefficient (Kd) value of >300 obtained during the present study at 3 M HNO3 was the highest reported so far while using a calix-crown-6 based extraction chromatographic resin material. Analogous resin reported previously has yielded a Kd value <100 at comparable feed conditions. The sorbed metal ions could be efficiently desorbed with de-ionized water. Kinetic modeling of the uptake data indicated that both the film and the intra-particle diffusion mechanism are simultaneously operating in the sorption of Cs+ion onto the BOCMC resin. The metal ion sorption data were fitted to the sorption isotherm models and did not conform to the chemisorptions of physisorption models and indicated a pi-pi interaction between the benzene rings of the calix-crown-6 ligand and the Cs+ ion. The reusability of the resins was quite satisfactory after 5 cycles and the radiation stability of the resin material was very good upto an absorbed dose of 500 kGy. The results of column studies were quite encouraging with 15 mL (9 bed volumes) as the breakthrough volume while the elution was complete in about 12 bed volumes of de-ionized water.

Unusual redox stability of pentavalent uranium with hetero-bifunctional phosphonocarboxylate: insight into aqueous speciation.

The +5 state is an unusual oxidation state of uranium due to its instability in the aqueous phase. As a result, gaining information about its aqueous speciation is extremely difficult. The present work is an attempt in that direction and it provides insight into the existence of a new pentavalent species in the presence of hetero-bifunctional phosphonocarboxylate (PC) chelators, other than the carbonate ion, in the aqueous medium. The aqueous chemistry of pentavalent uranium species with three environmentally relevant PCs was probed using electrochemical and DFT methods to understand the redox energy and kinetics of conversion of the U(VI)/U(V) couple, stability, structure, stoichiometry, binding modes, etc. Interestingly, pentavalent uranium complexes with PCs are quite persistent over a wide range of pH starting from acidic to alkaline conditions. The PC chelators block the cation-cation interaction (CCI) of U(V) through strong hetero-bidentate chelation and intermolecular hydrogen bonding (IMHB) interactions which stabilize the pentavalent metal ion against disproportionation. For uranyl species in the presence of PCs, acting as chelators, CV plots were obtained at varying pH values from 2 to 8. The obtained results indicate an irreversible single redox peak involving U(VI) to U(V) conversion and association of a coupled chemical reaction with the electron transfer step. ESI-MS studies were performed to understand the speciation effect on the U(VI)/U(V) redox couple with varying pH. Speciation modelling of U(V) with the PC ligands was carried out, which indicated that the U(V) is redox stable in nearly 47% of the pH region in the presence of the PCs as compared to the carboxylate-based chelators. The free energy and reduction potential of the U(V) complexes and the reduction free energy and disproportionation free energy for the U(VI)/U(V) couple were determined by DFT computations in the presence of the PCs. In situ spectroelectrochemical spectra were recorded to provide evidence for the existence of U(V) species with PCs in the aqueous medium and to acquire its absorption spectra. The present study is highly significant for understanding the coordination chemistry of pentavalent uranium species, accurate modelling of uranium, and isolation of U(V).

Characterization of the species formed during the extraction of thorium employing tri-n-butyl phosphate and N,N-dihexyl octanamide as extractants by laser desorption/ionization time-of-flight mass spectrometry.

Laser desorption/ionization-time-of-flight mass spectrometry (LDI-ToF-MS) has been applied to identify and characterize the organic phase species formed during the extraction of thorium nitrate by 1.1 M tri-n-butyl phosphate (TBP) and N,N-dihexyl octanamide (DHOA) solutions in n-dodecane. The aqueous phase thorium concentrations (at 4M HNO3) have been suitably chosen to get Loaded organic phases with/without third-phase. The extracted species have been characterized for the first time using LDI-ToF-MS. The results show feasibility of the use of this technique for understanding the extraction mechanisms and third-phase formation behavior of different extractants. The different chemical species observed using this technique are consistent with those observed by small-angle neutron scattering (SANS).

In vitro and in vivo antiplasmodial activity of the root extracts of Brucea mollis Wall. ex Kurz.

Malaria control is compromised worldwide by continuously evolving drug-resistant strains of the parasite demanding exploration of natural resources for developing newer antimalarials. The northeastern region of India is endemic for malaria characterized by high prevalence of drug-resistant Plasmodium falciparum strains. Many plants are used by the indigenous communities living in the northeast India in their traditional system of medicine for the treatment of malarial fever. Folklore claim of antimalarial property of one such plant Brucea mollis was evaluated in vitro and in vivo for antiplasmodial activity. Crude extracts from dried B. mollis root powder were prepared through soxhlet extraction using petroleum ether, methanol, and water sequentially. Methanol extract was further partitioned between chloroform and water. These extracts were tested in vitro against laboratory-adapted chloroquine-sensitive and chloroquine-resistant strains of P. falciparum. In in vitro evaluation, extracts were found more active on the chloroquine-sensitive strain. Methanolic-chloroform (IC(50) 5.1 µg ml(-1)) and methanolic-aqueous (IC(50) 13.9 µg ml(-1)) extracts recorded significant in vitro antiplasmodial activity which was also supported by their promising in vivo activity (ED(50) 72 and 30 mg kg(-1) bw day(-1), respectively) against chloroquine-resistant Plasmodium yoelli N-67 strain in Swiss albino mice. Methanolic-aqueous extract-treated mice survived on average for 14 days that was comparable to the reference drug chloroquine. This is the first report of antiplasmodial activity of B. mollis validating the traditional use of this plant as antimalarial in the northeast India and calls for further detailed investigations.

Tuberculosis lymphadenitis in a well managed case of sarcoidosis.

Differentiation between tuberculosis (TB) and sarcoidoisis is sometimes extremely difficult. Sequential occurrence of sarcoidosis and TB in the same patient is uncommon. We present the case of a young man, with a proven diagnosis of sarcoidosis who later developed TB after completion of treatment for sarcoidosis. A 32-year-old male patient presented with low-grade fever since two months. Physical examination revealed cervical lymphadenopathy. Initial fine needle aspiration cytology (FNAC) of the cervical lymph node was suggestive of granulomatous inflammation; the chest radiograph was normal. Repeat FNAC from the same lymph node was suggestive of reactive lymphoid hyperplasia. The patient was treated with antibiotics and followed-up. He again presented with persistence of fever and lymphadenopathy and blurring of vision. Ophthalmological examination revealed uveitis, possibly due to a granulomatous cause. His repeat Mantoux test again was non-reactive; serum angiotensin converting enzyme (ACE) levels were raised. This time an excision biopsy of the lymph node was done which revealed discrete, non-caseating, reticulin rich granulomatous inflammation suggestive of sarcoidosis. The patient was treated with oral prednisolone and imporved symptomatically. Subsequently, nearly nine months after completion of corticosteroid treatment, he presented with low-grade, intermittent fever and a lymph node enlargement in the right parotid region. FNAC from this lymph node showed caseating granulomatous inflammation and the stain for acid-fast bacilli was positive. He was treated with Category I DOTS under the Revised National Tuberculosis Control Programme and improved significantly. The present case highlights the need for further research into the aetiology of TB and sarcoidosis.

Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries.

Purvish M. ParikhCancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.