Outcomes of 3-year follow up with induction vs first line chemotherapy in oral cancer patients: An observational hospital-based study.

OBJECTIVE: Our study aims to analyse and compare the efficacy, adverse effect profile and survival among the Paclitaxel/Cisplatin/5-Flurouracil (TPF) induction chemotherapy and Paclitaxel/carboplatin (PC) first line or cisplatin chemotherapy in a high-volume tertiary care cancer centre. MATERIALS AND METHODS: 215 patients with oral cavity cancer were recruited in this study. Patients with stages I-IIc underwent surgical resection or radiation therapy 66-74 GY/fraction. Patients of Stages III-IV were administered with either induction chemotherapy TPF or PC or cisplatin regimen. Treatment responses were assessed by CT and MRI. Response rates, survival and adverse effects data were tabulated and analysed. RESULTS: The mean age was 49.2 ± 11.68 years. Symptoms were ulceration (33.5%), growth (20.5%), pain (13%), ulcer-proliferative growth (8.4%) and swelling (13, 6%). The tumour site was found at the base of the tongue, C01 (42.2%) followed by C06 (35.8%), C08 (6.5%), C07 (5.2%) and C05 (4.6%). There were no significant differences (P > 0.05) in efficacy and survival outcomes between the different groups of treatment. Median survival was achieved within 36 months. The major side effect observed were anaemia (15.81%), diarrhoea (36.2%), dyspepsia (28.8%), fever (33.95%), mucositis (28.85%), myalgia (33.95%) and nausea (7.9%). Survival among the responder categories (CR, PR and NR) was significantly different as per Log-rank analysis (P = 0.015). CONCLUSIONS: TPF induction therapy and PC first line chemotherapy showed similar efficacy, safety profile and survival whereas cisplatin shows poor efficacy and safety and survival in Indian oral cancer patients.

Matrix Metalloproteinase-2 (MMP-2): As an Essential Factor in Cancer Progression.

The development of cancer has been a multistep process involving mutation, proliferation, survival, invasion, and metastasis. Of all the characteristics of cancer, metastasis is believed to be the hallmark as it is responsible for the highest number of cancer-related deaths. In connection with this, Matrix metalloproteinases (MMPs), that has a role in metastasis, are one of the novel therapeutic targets. MMPs belong to the family of zinc-dependent endopeptidases and are capable of degrading the components of the extracellular matrix (ECM). The role of MMPs in ECM remodeling includes tissue morphogenesis, uterine cycling, growth, tissue repair, and angiogenesis. During pathological conditions, MMPs play a critical role in the excessive degradation of ECM which includes arthritis, tumour invasion, tumour metastasis, and several other autoimmune disorders. Moreover, they are believed to be involved in many physiological aspects of the cell, such as proliferation, migration, differentiation, angiogenesis, and apoptosis. It is reported that dysregulation of MMP in a variety of cancer subtypes have a dual role in tumour growth and metastasis processes. Further, multiple studies suggest the therapeutic potential of targeting MMP in invading cancer. The expression of MMP-2 correlates with the clinical characteristics of cancer patients, and its expression profile is a new diagnostic and prognostic biomarker for a variety of human diseases. Hence, manipulating the expression or function of MMP-2 may be a potential treatment strategy for different diseases, including cancers. Hence, the present review discusses the therapeutic potential of targeting MMP in various types of cancers and their recent patents.

Genome sequencing of SARS-CoV-2 omicron variants in Delhi reveals alterations in immunogenic regions in spike glycoprotein.

The SARS-CoV-2 omicron variants keep accumulating a large number of mutations in the spike (S) protein, which contributes to greater transmissibility and a rapid rise to dominance within populations. The identification of mutations and their affinity to the cellular angiotensin-converting enzyme-2 (ACE-2) receptor and immune evasion in the Delhi NCR region was under-acknowledged. The study identifies some mutations (Y505 reversion, G339H, and R346T/N) in genomes from Delhi, India, and their probable implications for altering the immune response and binding affinity for ACE-2. The spike mutations have influenced the neutralizing activity of antibodies against the omicron variant, which shows partial immune escape. However, researchers are currently exploring various mitigation strategies to tackle the potential decline in efficacy or effectiveness against existing and future variants of SARS-CoV-2. These strategies include modifying vaccines to target specific variants, such as the omicron variant, developing multivalent vaccine formulations, and exploring alternative delivery methods. To address this, it is also necessary to understand the impact of these mutations from a different perspective, especially in terms of alterations in antigenic determinants. In this study, we have done whole genome sequencing (WGS) of SARS-CoV-2 in COVID-19 samples from Delhi, NCR, and analyzed the spike's mutation with an emphasis on antigenic alterations. The impact of mutation in terms of epitope formation, loss/gain of efficiency, and interaction of epitopes with antibodies has been studied. Some of the mutations or variant genomes seem to be the progenitors of the upcoming variants in India. Our analyses suggested that weakening interactions with antibodies may lead to immune resistance in the circulating genomes.

Insights from establishing a high throughput viral diagnostic laboratory for SARS-CoV-2 RT-PCR testing facility: challenges and experiences.

Background: The World Health Organization declared the coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. Identifying the infected people and isolating them was the only measure that was available to control the viral spread, as there were no standardized treatment interventions available. Various public health measures, including vaccination, have been implemented to control the spread of the virus worldwide. India, being a densely populated country, required laboratories in different zones of the country with the capacity to test a large number of samples and report test results at the earliest. The Indian Council of Medical Research (ICMR) took the lead role in developing policies, generating advisories, formulating guidelines, and establishing and approving testing centers for COVID-19 testing. With advisories of ICMR, the National Institute of Cancer Prevention and Research (NICPR) established a high-throughput viral diagnostic laboratory (HTVDL) for RT-PCR-based diagnosis of SARS-CoV-2 in April 2020. HTVDL was established during the first lockdown to serve the nation in developing and adopting rapid testing procedures and to expand the testing capacity using "Real-Time PCR." The HTVDL provided its testing support to the national capital territory of Delhi and western Uttar Pradesh, with a testing capacity of 6000 tests per day. The experience of establishing a high-throughput laboratory with all standard operating procedures against varied challenges in a developing country such as India is explained in the current manuscript which will be useful globally to enhance the knowledge on establishing an HTVDL in pandemic or non-pandemic times.

Animal movement ecology in India: insights from 2011-2021 and prospective for the future.

The field of animal movement ecology has advanced by leaps and bounds in the past few decades with the advent of sophisticated technology, advanced analytical tools, and multiple frameworks and paradigms to address key ecological problems. Unlike the longer history and faster growth of the field in North America, Europe, and Africa, movement ecology in Asia has only recently been gaining momentum. Here, we provide a review of the field from studies based in India over the last 11 years (2011-2021) curated from the database, Scopus, and search engine, Google Scholar. We identify current directions in the research objectives, taxa studied, tracking technology and the biogeographic regions in which animals were tracked, considering the years since the last systematic review of movement ecology research in the country. As an indication of the growing interest in this field, there has been a rapid increase in the number of publications over the last decade. Class Mammalia continues to dominate the taxa tracked, with tiger and leopard being the most common species studied across publications. Invertebrates and other small and medium-sized animals, as well as aquatic animals, in comparison, are understudied and remain among the important target taxa for tracking in future studies. As in the previous three decades, researchers have focussed on characterising home ranges and habitat use of animals. There is, however, a notable shift to examine the movement decision of animals in human-modified landscapes, although efforts to use movement ecology to understand impacts of climate change remain missing. Given the biogeographic and taxonomic diversity of India, and the fact that the interface between anthropogenic activity and wildlife interactions is increasing, we suggest ways in which the field of movement ecology can be expanded to facilitate ecological insights and conservation efforts. With the advancement of affordable technologies and the availability of analytical tools, the potential to expand the field of movement ecology, shift research foci, and gain new insights is now prime.

GABB: A global dataset of alpine breeding birds and their ecological traits.

Alpine ecosystems represent varied climates and vegetation structures globally, with the potential to support rich and functionally diverse avian communities. High mountain habitats and species are under significant threat from climate change and other anthropogenic factors. Yet, no global database of alpine birds exists, with most mountain systems lacking basic information on species breeding in alpine habitats, their status and trends, or potential cryptic diversity (i.e., sub-species distributions). To address these critical knowledge gaps, we combined published literature, regional monitoring schemes, and expert knowledge from often inaccessible, data-deficient mountain ranges to develop a global list of alpine breeding bird species with their associated distributions and select ecological traits. This dataset compiles alpine breeding records for 1,310 birds, representing 12.0% of extant species and covering all major mountain regions across each continent, excluding Antarctica. The Global Alpine Breeding Bird dataset (GABB) is an essential resource for research on the ecological and evolutionary factors shaping alpine communities, as well as documenting the value of these high elevation, climate-sensitive habitats for conserving biodiversity.

miRNA therapeutics in precision oncology: a natural premium to nurture.

The dynamic spectrum of microRNA (miRNA) has grown significantly over the years with its identification and exploration in cancer therapeutics and is currently identified as an important resource for innovative strategies due to its functional behavior for gene regulation and modulation of complex biological networks. The progression of cancer is the consequence of uncontrolled, nonsynchronous procedural faults in the biological system. Diversified and variable cellular response of cancerous cells has always raised challenges in effective cancer therapy. miRNAs, a class of non-coding RNAs (ncRNAs), are the natural genetic gift, responsible to preserve the homeostasis of cell to nurture. The unprecedented significance of endogenous miRNAs has exhibited promising therapeutic potential in cancer therapeutics. Currently, miRNA mimic miR-34, and an antimiR aimed against miR-122 has entered the clinical trials for cancer treatments. This review, highlights the recent breakthroughs, challenges, clinical trials, and advanced delivery vehicles in the administration of miRNA therapies for precision oncology.

Classification of Electrocardiography Hybrid Convolutional Neural Network-Long Short Term Memory with Fully Connected Layer.

Electrocardiography (ECG) is a technique for observing and recording the electrical activity of the human heart. The usage of an ECG signal is common among clinical professionals in the collection of time data for the examination of any rhythmic conditions associated with a subject. The investigation was carried out in order to computerize the assignment by exhibiting the issue using encoder-decoder techniques, creating the information that was simply typical of it, and utilising misfortune appropriation to anticipate standard or anomalous information. On a broad variety of applications such as voice recognition and prediction, the long short-term memory (LSTM) fully connected layer (FCL) and the two convolutional neural networks (CNNs) have shown superior performance over deep learning networks (DLNs). DNNs are suitable for making high points for a more divisible region and CNNs are suitable for reducing recurrence types, LSTMs are appropriate for temporary displays, in the same way as CNNs are appropriate for reducing recurrence types. The CNN, LSTM, and DNN algorithms are acceptable for viewing. The complementarity of DNNs, CNNs, and LSTMs was investigated in this research by bringing them all together under the single architectural company. The researchers got the ECG data from the MIT-BIH arrhythmia database as a result of the investigation. Our results demonstrate that the approach proposed may expressively describe ECG series and identify abnormalities via scores that outperform existing supervised and unsupervised methods in both the short term and long term. The LSTM network and FCL additionally demonstrated that the unbalanced datasets associated with the ECG beat detection problem could be consistently resolved and that they were not susceptible to the accuracy of ECG signals. It is recommended that cardiologists employ the unique technique to aid them in performing reliable and impartial interpretation of ECG data in telemedicine settings.

Green synthesis of curcumin-silver nanoparticle and its modified electrode assisted amperometric sensor for the determination of paracetamol.

Contamination of paracetamol, a primary analgesic was wide spread in the water system that affects the eco-system. High-dosage of paracetamol to humans cause organ damages and showed adverse effect. It is important to monitor the paracetamol concentration in environmental and human samples periodically. Conventional methods associated with chromatography is found to be high-cost, time consuming and requires high-end instrumentation, Herein, we investigated the role of curcumin during bio-synthesis of silver nanoparticles. The curcumin functionalized silver nanoparticles were further chemically modifying on the electrode surface and the resulting modified electrode was applied for electrocatalytic oxidation of paracetamol. The experimental finding proved that the modified electrode is capable of sensing paracetamol by applying oxidation potential 0.4 V. Both the synthesised material and modified electrode surface were characterized for its physic-chemical properties using spectroscopy and microscopy techniques. The HR-TEM, FESEM and AFM results showed that the distribution of nanoparticle with the size range from 25 to 70 nm and the UV-Vis and Raman spectrophotometer characterization confirms the coordination between SNP and curcumin. Under optimized condition, in 0.1 M NH4Cl (pH 7) at the scan rate of 50 mVs-1. The modified electrode enhanced the sensitivity towards the detection of paracetamol in trace level. The modified electrode is capable of sensing paracetamol in a linear range between 0.59 × 10-6 and 342.1 × 10-6 M, with LOD of 0.29 µM, and linear regression equation of y = 0.092x+502.6 with a correlation coefficient of R2 = 0.996.

Characterization of Tobacco Microbiome by Metagenomics Approach.

Chronic consumption of tobacco in all forms, either smoked/smokeless forms, causes major health hazards to humans that include cancer, cardiovascular, lung diseases, diabetes, fertility issues, etc. Among tobacco-mediated cancers, the prominent one being the oral cancers are caused due to chronic tobacco chewing. The biochemicals present in tobacco are involved in carcinogenesis, and their presence is partly mediated by the existence of microbes in tobacco products. The microbial characterization has been evolved from classical microscopical observation to the recent development of 16S rRNA sequencing by next-generation sequencing methods. The metagenomics approach using 16S rRNA-based next-generation sequencing methods enables the detection and characterization of the complete microbial community of tobacco, including both cultivable and non-cultivable microorganisms. Identification of microbes will help in devising strategies to limit the carcinogenic compounds present in tobacco.

Bio-prospective potential of Pleurotus djamor and Pleurotus florida mycelial extracts towards Gram positive and Gram negative microbial pathogens causing infectious disease.

BACKGROUND: The emergence of resistance to commonly used antibiotics by human infections occurred mostly due to their overuse, that prompted individuals to pursue novel and innovative treatments. The phytochemical characteristics, antibacterial activity, and cytotoxicity of MCF7 cells were evaluated in two Pleurotus spp. mycelial extracts in this work. METHODS: Pleurotus djamor and Pleurotus florida mycelial extracts from pure cultures were tested for antibacterial activity by a well-diffusion assay and antimicrobial activity against mold fungi was evaluated for biomass inhibition. Mycelial extracts were obtained from dichloromethane extracts and their biophysical characteristics are analyzed by UV-vis spectrum and FTIR analysis. By spraying detection reagents onto TLC plates, the chemicals in dichloromethane extraction of chosen mushroom fungus mycelia were identified. Using the MTT test, the cytotoxic effect of dichloromethane extracts of selected mushroom fungi was evaluated on MCF7 Cell lines. RESULTS: Mycelial extracts of P. djamor and P. florida exhibited significant antimicrobial effect on the bacterial and fungal pathogens tested. Dichloromethane mycelial extracts were obtained using soxhlet extraction which response positive for various phytochemical analysis. Detection of metabolites in thin layer chromatography using spray reagents documented one of few first accounts on flavonoids, anthroquinone and terpenoid compounds in P. djamor and P. florida. P. djamor and P. florida had dose-dependent antiproliferative activity against MCF7 cells, with an inhibitory impact of 55.72% and 64.47% percent at 125 µg/mL, respectively. CONCLUSION: The study has reported the identification with the potent biological activity of some of the key bioactive components present in DCM extracts from the mycelia of P. djamor and P. florida.

Specific ultralow level chemo-recognition using Graphene-fluorophore supramolecular assembly: Fine-tuning the fluorophore framework.

The non-covalent interactions between graphene and aromatic fluorophores have generated highly sensitive fluorimetric turn-on sensors for various significant analytes. Herein, the supramolecular interaction between reduced graphene oxide and 7-Hydroxy-4-Methyl-8-Amino Coumarin is made use of for tracing Cu2+ at sub-zeptomole level with excellent selectivity among a collection of nineteen metal ions. The system enables quantification of the analyte in a commendably wide range, from micromolar to zeptomolar, a feature that almost all-optical sensors lack. Handy solid-state sensor strip fabricated using the above-mentioned supramolecular combination enabled visual recognition of Cu2+ions at the molecular level. Based on the chemo recognition ability of the fluorophore, multiple Boolean logic devices operating at the molecular level are proposed. By screening pertinent coumarin derivatives, it is demonstrated that the selectivity and sensitivity of the sensors of this sort are decided by the number of π- interaction centers of the fluorophores and the strength by which they interact with graphene, respectively, which will enable identification and modification of proper fluorophores for ultra-trace detection of contaminants of environmental relevance from aqueous solutions.

Sex interacts with age-dependent change in the abundance of lice-infesting Amur Falcons (Falco amurensis).

Sex-biassed and age-biassed parasite infections are common in nature, including ectoparasites-vertebrate host systems. We investigated the effect of Amur Falcons' sex, age and body size on the abundance of their lice at a migratory stopover site, where the falcons' habitat use and behaviour are more homogeneous across sex and age categories than during the breeding season. We sampled Amur Falcons in Nagaland, India at major roosting sites in 2016. We applied generalized linear models (with negative binomial distribution and log-link) to model the abundance of their two most numerous lice (Colpocephalum subzerafae and Degeeriella rufa) using the host age category (juvenile or adult) and wing length, both in interaction with sex, as explanatory variables. The abundance of C. subzerafae was only affected by host age, being nearly four times higher on juveniles than on adults. Juveniles were also more infested with D. rufa than the adults. Additionally, the abundance of the latter species was lower on adult male Falcons as compared to adult females. A juvenile bias in ectoparasite infestations is common in nature, probably due to juveniles being immunologically naïve, more resource-limited and may be inexperienced in body maintenance behaviours like preening and grooming. On the other hand, female-biassed infestations are much rarer than male-biassed infestations. We briefly discuss the possible causes of female-biassed infestations on Amur Falcons reported here, and in the closely related Red-footed Falcon and Lesser Kestrel as reported in the literature.

Air quality forecasting using artificial neural networks with real time dynamic error correction in highly polluted regions.

Air pollution is an important issue, especially in megacities across the world. There are emission sources within and also in the regions around these cities, which cause fluctuations in air quality based on prevailing meteorological conditions. Short term air quality forecasting is used not to just possibly mitigate forthcoming high air pollution episodes, but also to plan for reduced exposures of residents. In this study, a model using Artificial Neural Networks (ANN) has been developed to forecast pollutant concentration of PM10, PM2.5, NO2, and O3 for the current day and subsequent 4 days in a highly polluted region (32 different locations in Delhi). The model has been trained using meteorological parameters and hourly pollution concentration data for the year 2018 and then used for generating air quality forecasts in real-time. It has also been equipped with Real Time Correction (RTC), to improve the quality of the forecasts by dynamically adjusting the forecasts based on the model performance during the past few days. The model without RTC performs decently, but with RTC the errors are further reduced in forecasted values. The utility of the model has been demonstrated in real-time and model validations were performed for the whole year of 2018 and also independently for 2019. The model shows very good performance for all the pollutants on several evaluation metrics. Coefficient of correlations for various pollutants varies from 0.79-0.88 to 0.49-0.68 between the Day0 to Day4 forecasts. Lowest deterioration of performance was observed for ozone over the four days of forecasts. Use of RTC further improves the model performance for all pollutants.

Photoelectric performance evaluation of DSSCs using the dye extracted from different color petals of Leucanthemum vulgare flowers as novel sensitizers.

In this work, the natural flower extracted dyes containing luteolin were prepared using three different specimens from daisy flowers family (Leucanthemum vulgare), namely yellow daisy, purple daisy and wine daisy, according to the color of its petals. Moreover, DSSCs were fabricated using nanosized titanium dioxide (TiO2) as an anode; for the photocathodes, two different specimens were used: i) graphite electrode and ii) platinum electrode. To recognize the light absorption behavior, the existence of anchoring groups and coloring components of the extracted dyes were determined using absorption spectroscopy. The surface roughness of the photoanodes and cathodes were examined using atomic force microscope (AFM). The photovoltaic performance and efficiency of assembled DSSCs were evaluated to realize the influence of TiO2 photoanodes on interaction of the Leucanthemum vulgare extracted dye molecules with graphite or platinum photocathodes. DSSCs fabricated with platinum cathode show higher conversion efficiency (η) of 0.6%, 0.4% and 0.8% for the yellow daisy, wine daisy and purple daisy, respectively. DSSCs sensitized with daisy wine dye showed highest open-circuit voltage (Voc) of 520 mV and efficiency of 0.79% and 0.88%, for the graphite and platinum cathodes, respectively. These results showed that the DSSCs, using daisy flowers extracts as efficient photosensitizers, are suitable for the fabrication of environmentally safe, inexpensive, clean and renewable energy.

Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication.

JUSTIFICATION: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS: Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases.

A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.

Development of a Simple, Highly Selective RP-LC Method for the Quantification of Diastereomers and Other Related Substances of Ezetimibe Using Multivariate Analysis.

A simple reverse phase method for the selective quantification of ezetimibe (EZM), its diastereomers and other related substances was developed. The method demonstrated an excellent separation between each of the 14 impurities (including diastereomers, specified impurities and degradation products) and EZM within a runtime of 45 min. The developed method was evaluated against the reported USP method, other literature methods found that none of them was able to separate/show the absence of all the diastereomers and degradation products. The critical method parameters were optimized using central composite design. Forced degradation studies proved the method to be highly specific and the structure of all the major degradation products were confirmed by LC-MS study. The results of validation proved the method to be precise (% RSD < 4), accurate (recoveries in range of 100 ± 6%), linear (R2 > 0.999) and sensitive (LOQ ≤ 0.04% and LOD ≤ 0.01%) for all the impurities and drug. The method is suitable for both drug substance and oral solid dosage form.

A study to explore the factors related to treatment seeking delay among adults diagnosed with acute myocardial infarction at KMCH, Coimbatore.

OBJECTIVE: The main aim of the study was to explore the factors causing delay in seeking treatment among adult patients diagnosed with CAAs acute myocardial infarction (AMI) and compare the factors between timely and late treatment seeking groups. METHOD: A total of 93 subjects were included in the study diagnosed with AMI interviewed within 48h of hospitalization. Data were collected from onset of symptoms to arrival at hospital on demography, clinical profile, clinical factors, cognitive factors and social support factors. Subjects were categorized in two study groups i.e. timely treatment seeking group (<120min from onset of symptoms) and delayed treatment seeking group (>120min from onset of symptoms). RESULTS: The minimum and maximum time took by subjects to seek treatment was 10 and 5450min, respectively. The mean pain score of subjects who sought delayed treatment (2.2619) is less than those who sought timely treatment (3.3725). The mean knowledge score (12.2754), mean symptom perception (3.6667), mean perceived seriousness (4.7647) is more in subjects who sought timely treatment than those who sought delayed treatment (5.7381), (1.3095), (1.8333) respectively. The mean family support score (57.4492), mean non-family support score (24.902), mean social support score (48.3002) is more in timely treatment group than in delayed treatment seeking group (42.6829), (4.7619), (29.2138) respectively. CONCLUSION: Decreased pain, knowledge about AMI, symptom perception, perceived seriousness respectively and inadequate family & non-family support i.e. social support were the factors related to treatment seeking delay among adults diagnosed with AMI.

Aggressive Brainstem Glioblastoma in a 9-Year-Old Child with Neck Node Metastases: A Case Report and Review of Literature.

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and diffusely infiltrates the surrounding brain tissue. Despite their malignant nature, extraneural metastases from glioblastomas are rare with an estimated incidence of <2%. We present a case of a 9-year-old boy with exophytic brainstem GBM who developed cervical node metastases. He had undergone gross total excision of GBM in January 2017. Histopathological examination confirmed the diagnosis of glioblastoma multiforme. The patient underwent chemotherapy and radiotherapy as per hospital protocol. He developed hydrocephalus after 3 months, which required ventriculoperitoneal shunt. Two more months later, he developed drowsiness and was found to have shunt dysfunction causing hydrocephalus and multiple enlarged cervical lymph nodes. Cerebrospinal fluid diversion and neck node biopsy were performed for the patient but he died. The histopathological examination of the neck node biopsy revealed metastases from glioblastoma. We report this case to create awareness regarding possibility of extraneural metastases even in pediatric brainstem glioblastoma.