To Access Knowledge Regarding Organ Donation among Healthcare Workers and Their Willingness toward Organ Donation.

BACKGROUND: In India, critical shortage of organ donations, particularly deceased donations, has led to a dire situation in India, with thousands of patients waiting for transplants and a significant number of them succumbing. One of the reasons for the shortage of organs for transplantation is unawareness and prejudiced information about organ donation. Being direct or indirect stakeholders, the knowledge regarding organ donation among healthcare workers may play an important role in the donation process. AIM: To assess the knowledge regarding cadaver organ donation among healthcare workers and their willingness toward organ donation. MATERIALS AND METHODS: It is a cross-sectional offline self-administered questionnaire-based survey conducted among healthcare professionals at tertiary care teaching institutes. Survey was carried out between the months of August to December 2019. A structured questionnaire was used to assess knowledge and willingness toward organ donation. Statistical analyzed was done by using statistical package for social sciences (SPSS) 20.0. All p-values were considered significant at <0.05. RESULTS: A total of 1,039 healthcare professionals participated in the survey. Out of them, 362 (34.8%) were males and 675 (65%) were females. Average age of the healthcare workers participating in survey was 30.81 years, and age ranged from 18 to 60 years. Awareness regarding corneal donation after brain death was found to be maximum (89.7%) and was comparable to that of kidney (86.6%) and heart (83.7%). Participants were unlearned of donation of lungs, pancreas, hands and unaware of heart valve donation. About 45% respondents considered that age affected the donors. About 40% respondents considered younger patients as ideal recipients, while 18.7% respondents considered waiting list patients as ideal recipients. Doctors had highest willingness (78. 3%) for organ donation, followed by nurses (69.9%) and support staff (59.3%) (p < 0.001). Only 119 (11.5%) participants received organ donation cards as against 68.7% willingness toward organ donation (p < 0.01). CONCLUSION: We have observed fair awareness regarding overall cadaver organ donation concept among healthcare workers. There is a need to improve knowledge of extended age criteria and which organs can be retrieved from deceased donor. Authorities have to work hard on delivery of organ donation pledging card to promote donation program.

Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand?

Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.

Subsequent Breast Cancer in Female Childhood Cancer Survivors in the St Jude Lifetime Cohort Study (SJLIFE).

PURPOSE: Anthracycline-associated risk for subsequent breast cancer in childhood cancer survivors is hypothesized to be mediated by TP53 mutation-related gene-environment interactions. We characterized treatment/genetic risks and the impact of screening for breast cancer in the St Jude Lifetime Cohort. PATIENTS AND METHODS: Female participants underwent risk-based assessments, prior health event validation, chest radiation dosimetry, and whole genome sequencing. Breast biopsy reports were reviewed. A subgroup (n = 139) underwent both breast magnetic resonance imaging and mammography. Multivariable regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS: Among 1,467 women, 56 developed 68 breast cancers at a median age 38.6 (range, 24.5 to 53.0) years. Cumulative incidences at age 35 years were 1% (no chest radiation) and 8% (≥ 10 Gy of chest radiation). In adjusted models, breast cancer was associated with 20 Gy or more of chest radiation versus none (HR, 7.6; 95% CI, 2.9 to 20.4), anthracycline exposure versus none (1 to 249 mg/m2: HR, 2.6; 95% CI, 1.1 to 6.2; ≥ 250 mg/m2: HR, 13.4, 95% CI, 5.5 to 32.5), and having a breast cancer predisposition gene mutation (HR, 23.0; 95% CI, 7.3 to 72.2). Anthracyclines 250 mg/m2 or greater remained significantly associated with increased risk of breast cancer in models excluding survivors with cancer predisposition gene mutations, chest radiation 10 Gy or greater, or both. Sensitivity/specificity were 53.8%/96.3% for mammography, 69.2%/91.4% for magnetic resonance imaging, and 85.8%/99.7% for dual imaging. Breast cancers detected by imaging and/or prophylactic mastectomy compared with physical findings were more likely to be in situ carcinomas, smaller, without lymph node involvement, and treated without chemotherapy. CONCLUSION: Higher doses of anthracyclines are associated with increased risk of breast cancer independent of mutations in known cancer predisposition genes. Surveillance imaging identifies breast cancers less likely to require chemotherapy than those detected by physical findings.

Breast disease in the pregnant and lactating patient: radiological-pathological correlation.

OBJECTIVE: Substantial physiological changes occur during pregnancy and lactation, making breast evaluation challenging in these patients. This article reviews the imaging challenges of the breast during pregnancy and lactation. The normal imaging appearance, imaging protocols and the imaging features of each commonly encountered benign and malignant entity with pathological correlation and supporting examples is described. An awareness of the imaging features of the breast during these physiological states and of various benign and malignant diseases that occur permits optimal management. CONCLUSIONS: Evaluation of the pregnant and lactating patients who present with a breast problem is challenging. Although ultrasound may characterise the finding in many cases, mammography and even MRI may have a role in the management of these patients. TEACHING POINTS: • To review physiological changes of the breast during pregnancy and lactation • To review imaging protocols of the breast during pregnancy and lactation • Discuss imaging findings with pathological correlation of benign and malignant diseases in pregnancy and lactation • Discuss pathological correlation of imaging findings in pregnancy and lactation.

Safety and immunogenicity of an indigenously developed Haemophilus influenzae type b conjugate vaccine through various phases of clinical trials.

In view of the need for a cost effective Haemophilus influenzae type b (Hib) conjugate vaccine, a lyophilized vaccine as capsular polysaccharide (PRP) conjugated to tetanus toxoid (Sii HibPRO) was indigenously developed by Serum Institute of India Ltd., Pune (SIIL). From 2004-07, this new vaccine underwent a series of clinical studies before its licensure by National Regulatory Authority (NRA). This paper discusses the results obtained during the clinical development of this vaccine. On finding the vaccine to be safe in animal toxicity studies, a Phase I single dose study was carried out to assess the safety profile of Sii HibPRO in healthy adult male volunteers. Subsequently, in Phase III pre-licensure study, immunogenicity and safety of Sii HibPRO was assessed and compared with Hib tetanus conjugate vaccine (Act-HIB) of Aventis, France. Immunogenicity was evaluated based upon serum anti-PRP IgG antibody concentrations by ELISA at prevaccination and one month each after the second and third dose. Safety was evaluated by recording details of adverse events after each dose of the vaccine. Postvaccination after the third dose, there was 100% seroprotection (anti PRP IgG titre >or= 0.15 microg/ml) in both the groups. Long term protection (>or=1 microg/ml) was achieved in 95.2% and 98.06% infants in Sii HibPRO and Act-HIB groups, respectively. At 15 months, prior to booster dose, 30 children in each group were evaluated and all were found to be seroprotected. Post booster, all of them responded with a strong boost response. Safety of Sii HibPRO was re-established in the post marketing surveillance in which 2,739 doses were administered to 1,029 infants, in 23 cities across India.

Safety and immunogenicity of diphtheria-tetanus-pertussis vaccine and hepatitis B vaccine as a new tetravalent combination (DTwP/HB) administered alone and at separate sites (DTwP and HB) including comparison with standard commercially available combination vaccine in Indian infants 6-14 weeks of age.

An open, comparative study was conducted at two tertiary care hospitals in India to assess immunogenicity and reactogenicity following administration of the DTwP/HB combination vaccine (Q-Vac) alone and DTwP and HB (Genevac B) vaccines at separate sites. These vaccines manufactured by Serum Institute of India, Ltd. (SIIL), Pune were compared with DTwP/HB vaccine (Tritanrix HB) manufactured by GlaxoSmithKline (GSK) in infants aged 6-14 weeks. The sample size comprised 447 infants who received DTwP/HB vaccine (Group A-150, SIIL) or DTwP and HB (Group B-147, SIIL) vaccines at separate sites or DTPw/HB vaccine (Group C-150, GSK), in a dose of 0.5 ml intra-muscularly. Pre and postvaccination IgG antibodies were determined by ELISA. Postvaccination, in Group A seroprotection was 99.3%, 100%, 96% and 100% to Diphtheria, Tetanus, Pertussis and HBs components respectively. In Group B (n = 147) it was 98.6%, 100%, 95.9% and 99.3% and in Group C (n = 150), it was 96%, 99.3%, 93.3% and 98.6% to D, T, P and HBs component of the vaccine. Postvaccination, geometric mean titres for each component were comparable across three groups by analysis of variance (ANOVA). Adverse events observed were within the range quoted in literature and no Serious Adverse Event (SAE) was observed. Reactogenicity profile in all three groups was comparable. Q-Vac vaccine manufactured by SIIL was found to be safe and immunogenic. Hepatitis B (HB) component did not interfere with the immune response to DTwP components of the vaccine.

Cystic bone tuberculosis in children--a case series.

Cystic tuberculosis of the bone is a rare form of tuberculosis (TB) osteomyelitis associated with disseminated lesions. In children, the lesions involve the peripheral skeleton, are symmetric and less sclerotic while in adults, the lesions are axial and predominantly sclerotic. TB dactylitis and spina ventosa are the other common variants of TB osteomyelitis seen in children below five years. Here we report seven cases of cystic TB bone disease. There were three males and four females with age of diagnosis between 2-11 years. Most patients presented with localized swelling and pain. X-rays revealed classical cystic lesions and spina ventosa. Four children had multiple cystic lesions and three had isolated lesions. Diagnosis was confirmed by FNAC of the bone or histopathological/radiological evidence of TB. The patients responded well to anti-tubercular therapy. The entity of cystic TB bone disease should be borne in mind as, lack of awareness may delay diagnosis and treatment. Biopsy is mandatory to confirm diagnosis and antitubercular drugs are the mainstay of therapy. Curettage of affected bone in selected cases may promote early healing. Response to therapy is excellent and the overall prognosis is good.

Familial type IV hypertriglyceridemia presenting as hemiparesis with cerebellar signs.

Stroke in pediatric patients is distinctive as compare to adults. The authors report a rare case of familial hypertriglyceridemia type IV who had left hemiparesis with cerebellar signs. There was no history of oral trauma, head injury, convulsions, acute gastroenteritis, meningitis or otitis media.

Essential hypertension: antecedents in children.

A prospective study was conducted to determine the incidence of essential hypertension (EH) and identify markers, if any, in children of essential hypertension families. The study group included 90 children (2-18 years) with a parent or grandparent with EH while the control group had 25 age matched children from non-hypertensive families. Around 30% children (n=27) from these families had a diastolic blood pressure of >95th centile and an additional 27% (n=24) had borderline hypertension. The serum cholesterol, serum triglycerides and 24 hour urinary sodium excretion were significantly higher in the study group (p < 0.05) as compared to controls. The children from the study group also had a significant high salt (p < 0.001) and fat intake (P < 0.05).