Survival of patients with cervical cancer in India - findings from 11 population based cancer registries under National Cancer Registry Programme.

Background: Cancer survival data from Population Based Cancer Registries (PBCR) reflect the average outcome of patients in the population, which is critical for cancer control efforts. Despite decreasing incidence rates, cervical cancer is the second most common female cancer in India, accounting for 10% of all female cancers. The objective of the study is to estimate the five-year survival of patients with cervical cancer diagnosed between 2012 and 2015 from the PBCRs in India. Methods: A single primary incidence of cervical cancer cases of 11 PBCRs (2012-2015) was followed till June 30, 2021 (n = 5591). Active follow-ups were conducted through hospital visits, telephone calls, home or field visits, and public databases. Five-year Observed Survival (OS) and Age Standardised Relative Survival (ASRS) was calculated. OS was measured by age and clinical extent of disease for cervical cancers. Findings: The five-year ASRS (95% CI) of cervical cancer was 51.7% (50.2%-53.3%). Ahmedabad urban (61.5%; 57.4%-65.4%) had a higher survival followed by Thiruvananthapuram (58.8%; 53.1%-64.3%) and Kollam (56.1%; 50.7%-61.3%). Tripura had the lowest overall survival rate (31.6%; 27.2%-36.1%). The five-year OS% for pooled PBCRs was 65.9%, 53.5%, and 18.0% for localised, regional, and distant metastasis, respectively. Interpretation: We observed a wide variation in cervical cancer survival within India. The findings of this study would help the policymakers to identify and address inequities in the health system. We re-emphasise the importance of awareness, early detection, and increase the improvement of the health care system. Funding: The National Cancer Registry Programme is funded through intra-mural funding by Indian Council of Medical Research, Department of Health Research, India, Ministry of Health & Family Welfare.

Breast cancer survival in India across 11 geographic areas under the National Cancer Registry Programme.

BACKGROUND: Population-based cancer survival is a key indicator for assessing the effectiveness of cancer control by a health care system in a specific geographic area. Breast cancer is the most common cancer among women in India, accounting for over one quarter of all female cancers. The objective of this study was to estimate the 5-year survival of female patients who were diagnosed with breast cancer between 2012 and 2015 from the existing Population-Based Cancer Registries (PBCRs) in India. METHODS: In total, 17,331 patients who had breast cancer diagnosed between 2012 and 2015 from 11 PBCRs were followed until June 30, 2021. Active methods were used to track the vital status of registered breast cancer cases. The study conducted survival analysis by calculating the difference between the date of first diagnosis and the date of death or censoring to estimate observed survival and relative survival using the actuarial survival approach and the Ederer-II approach, respectively. RESULTS: The 5-year age-standardized relative survival (95% confidence interval [CI]) of patients with breast cancer was 66.4% (95% CI, 65.5%-67.3%). Mizoram (74.9%; 95% CI, 68.1%-80.8%), Ahmedabad urban (72.7%; 95% CI, 70.3%-74.9%), Kollam (71.5%; 95% CI, 69.2%-73.6%), and Thiruvananthapuram (69.1%; 95% CI, 67.0%-71.2%) had higher survival rates than the national average. Conversely, Pasighat had the lowest survival rate (41.9%; 95% CI, 14.7%-68.6%). The 5-year observed survival rates for localized, regional, and distant metastasis in the pooled PBCRs were 81.0%, 65.5%, and 18.3%, respectively. CONCLUSIONS: The overall disparity in survival rates was observed across 11 PBCRs, with lower survival rates reported in Manipur, Tripura, and Pasighat. Therefore, it is imperative to implement comprehensive cancer control strategies widely throughout the country.

An assessment of childhood cancer care services in India - gaps, challenges and the way forward.

Background: Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design. Methods: The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean. Findings: A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals. Interpretation: The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally. Funding: World Health Organization, India provided funding and technical support.

Amalgamation of MnWO4 nanorods with amorphous carbon nanotubes for highly stabilized energy efficient supercapacitor electrodes.

Enhanced electrochemical performance of supercapacitors can be achieved through optimal hybridization of electroactive nanomaterials, as it effectively increases the overall surface area and ensures greater electrolyte-electrode interaction. This work reports the realization of a manganese tungstate and amorphous carbon nanotube (MnWO4-aCNT) hybrid and its utilization as the electrodes for a solid-state asymmetric supercapacitor. Large-scale synthesis of aCNTs was carried out via an economical solid-state reaction at low temperature and the walls of these nanotubes were decorated with MnWO4 nanorods via a surfactant-free in situ hydrothermal process. The as-fabricated electrode based on this hybrid over nickel foam delivered a high specific capacitance of 542.18 F g-1 at a scan rate of 2 mV s-1, which is much superior to the values of the structural units separately. This MnWO4-aCNT based electrode showed a high-rate capacity with ∼100% capacitance retention and a coulombic efficiency of ∼100% even after operation for 15 000 cycles. A solid-state asymmetric supercapacitor based on this hybrid attained an energy density of 5.6 W h kg-1 and a power density as high as 893.6 W kg-1. Significantly enhanced electrochemical behaviour registered from the hybrid sample is accounted for by its enhanced surface area and thereby greater number of redox reaction sites along with the positive synergetic effect of the building blocks. This study unlocks further exploration possibilities with other types of aCNT-based hybrid materials for the development of highly stable, non-toxic and cost-effective sustainable energy storage systems.

Incorporation of V2O5 nanorods into perovskite photodetectors as an alternative approach to enhance device performance: a step towards stability against ambient water species.

Numerous reports have been made in the literature on the usability of a halide perovskite, namely methyl ammonium lead iodide (CH3NH3PbI3), as a light harvesting material. Suitable optimization in material composition and synthesis has led to an improvement in device performance. However, the susceptibility of CH3NH3PbI3 towards atmospheric water is an alarming issue which hinders its long-term application in day-to-day life. Herein, low temperature synthesized V2O5 nanorods are incorporated into the CH3NH3PbI3 matrix to facilitate carrier dynamics by interface engineering. The optimized hybrid sample exhibits a much improved and stable photo-response behaviour than the pristine building blocks. Additionally, the modified perovskite shows improved hydrophobicity in the form of small-scale surface undulations due to the incorporation of V2O5 nanorods into it. This way, we have solved two problems with one single action, firstly by improving the device performance and secondly by stabilizing the sample against ambient water species.

Patterns of Cancer Incidence and Mortality in North- Eastern India: The First Report from the Population Based Cancer Registry of Tripura.

BACKGROUND: There is, till date no population-based data regarding cancer patterns in North- Eastern India, dictating the need to understand the epidemiology of cancer in this population for its effective management. METHODS: This is the first report of the Population Based Cancer Registry (PBCR) in Tripura (2010-2014). The protocol involves active collection of data on all cancer cases from Tripura through staff visit in more than 150 sources of incident and mortality registration, government and private hospitals, municipal corporation, etc. and scrutiny, corroboration with existing records. Data was analyzed statistically to understand cancer trends in terms of incidence and mortality across different sites, age groups affected and gender. RESULTS: A total of 10,251 cases were registered during the period, with overall age-adjusted incidence rates of 75.7 and 54.9 per 100,000 males and females respectively. Crude Incidence Rate (CR) and Age- Adjusted Rate (AAR) was among the lowest reported in India, probably due to associated socio-economic factors. The most prevalent cancers were lung (18.1%), esophageal (8.3%) for men and cervix uteri (17.6%), breast (13.8%) for females. Gall bladder cancer in females was one of the highest in the country. Rate of cancer mortality in the population was quite high and significantly increased with time, probably accounting for dearth in early detection and feasible treatment alternatives. CONCLUSION: The data suggests that high cancer incidence and mortality are prevalent in the population of Tripura, dictating the need of active tobacco control measures, early detection and awareness drives for effective cancer control.

Suspicious-Region Segmentation From Breast Thermogram Using DLPE-Based Level Set Method.

Segmentation of suspicious regions (SRs) of a thermal breast image (TBI) is a very significant and challenging problem for the identification of breast cancer. Therefore, in this work, we have proposed an active contour model for the segmentation of the SRs in TBI. The proposed segmentation method combines three significant steps. First, a novel method, called smaller-peaks corresponding to the high-intensity-pixels and the centroid-knowledge of SRs (SCH-CS), is proposed to approximately locate the SRs, whose contours are later used as the initial evolving curves of the level set method (LSM). Second, a new energy functional, called different local priorities embedded (DLPE), is proposed regarding the level set function. DLPE is then minimized using the interleaved level set evolution to segment the potential SRs in TBI more accurately. Finally, a new stopping criterion is incorporated into the proposed LSM. The proposed LSM not only increases the segmentation speed but also ameliorates the segmentation accuracy. The performance of our SR segmentation method was evaluated on two TBI databases, namely, DMR-IR and DBT-TU-JU, and the average segmentation accuracies obtained on these databases are 72.18% and 71.26% respectively, which are better than the other state-of-the-art methods. Beside this, a novel framework to analyze TBIs is proposed for differentiating abnormal and normal breasts on the basis of the segmented SRs. We have also shown experimentally that investigating only the SRs instead of the whole breast is more effective in differentiating abnormal and normal breasts.

Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India.

The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation.

Designing of Ground-Truth-Annotated DBT-TU-JU Breast Thermogram Database Toward Early Abnormality Prediction.

The advancement of research in a specific area of clinical diagnosis crucially depends on the availability and quality of the radiology and other test related databases accompanied by ground truth and additional necessary medical findings. This paper describes the creation of the Department of Biotechnology-Tripura University-Jadavpur University (DBT-TU-JU) breast thermogram database. The objective of creating the DBT-TU-JU database is to provide a breast thermogram database that is annotated with the ground-truth images of the suspicious regions. Along with the result of breast thermography, the database comprises of the results of other breast imaging methodologies. A standard breast thermogram acquisition protocol suite comprising of several critical factors has been designed for the collection of breast thermograms. Currently, the DBT-TU-JU database contains 1100 breast thermograms of 100 subjects. Due to the necessity of evaluating any breast abnormality detection system, this study emphasizes the generation of the ground-truth images of the hotspot areas, whose presence in a breast thermogram signifies the presence of breast abnormality. With the generated ground-truth images, we compared the results of six state-of-the-art image segmentation methods using five supervised evaluation metrics to identify the proficient segmentation methods for hotspot extraction. Based on the evaluation results, the fractional-order Darwinian particle swarm optimization, region growing, mean shift, and fuzzy c-means clustering are found to be more efficient in comparison to k-means clustering and threshold-based segmentation methods.

Analytical Study of Short- and Long-term Results of Home-based Palliative Care Services to Cancer Patients.

AIMS AND OBJECT: Identification and selection of patients suffering from terminal stage in bed ridden condition upto village level and to determine the type of palliative care need. Also to asses the effectiveness of the palliative care provided at the bed side. MATERIALS: All registered patients under palliative care of Regional Cancer Centre, Agartala from 2014 April to 2016 March. METHODS: A retrospective study. Ten teams comprising of doctors, nurses, pharmacists & Social Workers were trained and engaged in this study for symptom assessment and pain relief of palliative patients. RESULTS: It is highly beneficial for the bed ridden & home bound cancer patients with improved quality of life due to regular home visits and medicine distribution by trained medical personnel. Short term benefits in symptom like pain, nausea & vomiting, retention of urine, constipation, bloating, fever etc. was dramatic after medication by palliative team. Patients also get relief as a result of repeated visit of palliative care team. CONCLUSION: Home based palliative care is beneficial for the bed ridden and home bound chronically ill patients including cancer patients. Bed ridden patients should be cared by palliative care team at least in every week.

DNA Repair Mechanism Gene, XRCC1A ( Arg194Trp) but not XRCC3 ( Thr241Met) Polymorphism Increased the Risk of Breast Cancer in Premenopausal Females: A Case-Control Study in Northeastern Region of India.

X-ray repair cross complementary group gene is one of the most studied candidate gene involved in different types of cancers. Studies have shown that X-ray repair cross complementary genes are significantly associated with increased risk of breast cancer in females. Moreover, studies have revealed that X-ray repair cross complementary gene polymorphism significantly varies between and within different ethnic groups globally. The present case-control study was aimed to investigate the association of X-ray repair cross complementary 1A (Arg194Trp) and X-ray repair cross complementary 3 (Thr241Met) polymorphism with the risk of breast cancer in females from northeastern region of India. The present case-control study includes histopathologically confirmed and newly diagnosed 464 cases with breast cancer and 534 apparently healthy neighborhood community controls. Information on sociodemographic factors and putative risk factors were collected from each study participant by conducting face-to-face interviews. Genotyping of X-ray repair cross complementary 1A (Arg194Trp) and X-ray repair cross complementary 3 (Thr241Met) was carried out by polymerase chain reaction-restriction fragment length polymorphism. For statistical analysis, both univariate and multivariate logistic regression analyses were performed. We also performed stratified analysis to find out the association of X-ray repair cross complementary genes with the risk of breast cancer stratified based on menstrual status. This study revealed that tryptophan allele (R/W-W/W genotype) in X-ray repair cross complementary 1A (Arg194Trp) gene significantly increased the risk of breast cancer (adjusted odds ratio = 1.44, 95% confidence interval = 1.06-1.97, P < .05 for R/W-W/W genotype). Moreover, it was found that tryptophan allele (W/W genotype) at codon 194 of X-ray repair cross complementary 1A (Arg194Trp) gene significantly increased the risk of breast cancer in premenopausal females (crude odds ratio = 1.66, 95% confidence interval = 1.11-2.46, P < .05 for R/W-W/W genotype). The present study did not reveal any significant association of X-ray repair cross complementary 3 (Thr241Met) polymorphism with the risk of breast cancer. The present study has explored that X-ray repair cross complementary 1A (Arg194Trp) gene polymorphism is significantly associated with the increased risk of breast cancer in premenopausal females from northeastern region of India which may be beneficial for prognostic purposes.

TLR2∆22 (-196-174) significantly increases the risk of breast cancer in females carrying proline allele at codon 72 of TP53 gene: a case-control study from four ethnic groups of North Eastern region of India.

Breast cancer (BC) is the second most common cancer in women. In the North Eastern Region (NER) of India, BC is emerging as an important concern as evidenced by the data available from population and hospital-based cancer registries. Studies on genetic susceptibility to BC are important to understand the increase in the incidence of BC in NER. The present case control study was conducted to investigate the association between tumour suppressor gene TP53 codon 72 polymorphism and innate immune pathway gene TLR2∆22 (-196-174) polymorphism with BC in females of NER of India for the identification of novel biomarker of BC. Four hundred sixty-two histopathologically confirmed BC cases from four states of NER of India, and 770 healthy controls were included by organizing community surveys from the neighbourhood of cases. In our study, no significant association between TP53 codon 72 polymorphisms and the risk of BC was found. However, our study has shown that TP53 codon 72 polymorphism is an important effect modifier. In the present study it was found that females carrying 22 base-pair deletion in the promoter region of their TLR2 gene had two times (AOR= 2.18, 95 % CI 1.13-4.21, p=0.019 in dominant model; AOR= 2.17, 95 % CI 1.09-4.34, p=0.027 in co-dominant model) increased risk of BC whwn they also carry proline allele at codon 72 of their TP53 gene.

Effect of operating parameters on mechanical expression of solvent-soaked soybean-grits.

Oil from soybean is obtained mostly by solvent extraction of soybean flakes. Legislation banning the use of hexane as solvent for extracting edible vegetable oil has forced a search for an alternative solvent and for developing a suitable oil recovery process. Expellers are being used for obtaining vegetable oil by mechanical means (expression) from oil seeds having oil content higher than 20 %. It was felt, in view of the stiffness of the soybean matrix, a combination of solvent treatment and expression could be a cheaper alternative; thus an attempt has been made here to develop a two stage process constituting soaking of soybean grits in solvent followed by mechanical compression (hydraulic press) of solvent-soaked grits to recover oil. The present work aimed at studying the effect of various process parameters on oil yield from solvent soaked soybean-grits during soaking as well as pressing stages using the solvents: hexane, ethanol (alternative solvent). The process parameters were identified through holistic approach. The dependant variable was oil recovery (expressed as fraction of initial oil content of soybean) whereas the independent parameters were particle size, solvent-bean mass ratio, soaking time, soaking temperature, applied pressure and pressing time. The effect of each of the above parameters on fractional oil recovery (FOR) was studied. The results of the present study indicate that the above parameters have a significant effect on the fractional oil recovery with particle size, soaking temperature, soaking time and pressing time being the most significant factors. The present study also indicates that ethanol can be used as an alternate solvent to hexane by optimizing the factors as discussed in this paper.

Growth Characteristics Modeling of Mixed Culture of Bifidobacterium bifidum and Lactobacillus acidophilus using Response Surface Methodology and Artificial Neural Network

Different culture conditions viz. additional carbon and nitrogen content, inoculum size and age, temperature and pH of the mixed culture of Bifidobacterium bifidum and Lactobacillus acidophilus were optimized using response surface methodology (RSM) and artificial neural network (ANN). Kinetic growth models were fitted for the cultivations using a Fractional Factorial (FF) design experiments for different variables. This novel concept of combining the optimization and modeling presented different optimal conditions for the mixture of B. bifidum and L. acidophilus growth from their one variable at-a-time (OVAT) optimization study. Through these statistical tools, the product yield (cell mass) of the mixture of B. bifidum and L. acidophilus was increased. Regression coefficients (R2) of both the statistical tools predicted that ANN was better than RSM and the regression equation was solved with the help of genetic algorithms (GA). The normalized percentage mean squared error obtained from the ANN and RSM models were 0.08 and 0.3%, respectively. The optimum conditions for the maximum biomass yield were at temperature 38°C, pH 6.5, inoculum volume 1.60 mL, inoculum age 30 h, carbon content 42.31% (w/v), and nitrogen content 14.20% (w/v). The results demonstrated a higher prediction accuracy of ANN compared to RSM.

Growth characteristics modeling of Lactobacillus acidophilus using RSM and ANN

The culture conditions viz. additional carbon and nitrogen content, inoculum size, age, temperature and pH of Lactobacillus acidophilus were optimized using response surface methodology (RSM) and artificial neural network (ANN). Kinetic growth models were fitted to cultivations from a Box-Behnken Design (BBD) design experiments for different variables. This concept of combining the optimization and modeling presented different optimal conditions for L. acidophilus growth from their original optimization study. Through these statistical tools, the product yield (cell mass) of L. acidophilus was increased. Regression coefficients (R²) of both the statistical tools predicted that ANN was better than RSM and the regression equation was solved with the help of genetic algorithms (GA). The normalized percentage mean squared error obtained from the ANN and RSM models were 0.06 and 0.2%, respectively. The results demonstrated a higher prediction accuracy of ANN compared to RSM.

Growth characteristics modeling of Bifidobacterium bifidum using RSM and ANN

The aim of this work was to optimize the biomass production by Bifidobacterium bifidum 255 using the response surface methodology (RSM) and artificial neural network (ANN) both coupled with GA. To develop the empirical model for the yield of probiotic bacteria, additional carbon and nitrogen content, inoculum size, age, temperature and pH were selected as the parameters. Models were developed using » fractional factorial design (FFD) of the experiments with the selected parameters. The normalized percentage mean squared error obtained from the ANN and RSM models were 0.05 and 0.1 percent, respectively. Regression coefficient (R²) of the ANN model showed higher prediction accuracy compared to that of the RSM model. The empirical yield model (for both ANN and RSM) obtained were utilized as the objective functions to be maximized with the help of genetic algorithm. The optimal conditions for the maximal biomass yield were 37.4 °C, pH 7.09, inoculum volume 1.97 ml, inoculum age 58.58 h, carbon content 41.74 percent (w/v), and nitrogen content 46.23 percent (w/v). The work reported is a novel concept of combining the statistical modeling and evolutionary optimization for an improved yield of cell mass of B. bifidum 255.

Multipod znO nanoforms: low temperature synthesis and characterization.

ZnO nanotetrapods were synthesized by a simple thermal evaporation of Zn powder at a relatively low temperature approximately 600 degrees C. The tetrapods have four legs with hexagonal cross-section. Interpenetrating growth was observed in some of these nanotetrapods. Multipod ZnO nanoforms were produced at higher temperature. The optical characterizations such as optical absorbance, photoluminescence and Raman spectroscopy reveal excellent crystal qualities of these nanoforms. The field emission studies indicated that these nanoforms could be utilized in field emission based devices.

Sol-gel synthesized SnO2 nanoparticles and their properties.

Sol-gel synthesized SnO2 nanoparticles with an average size of 2.0 nm obtained at 373 K were gradually annealed to 673 K in air for 25 minutes. Sequentially taken transmission electron microscopy (TEM) images showed that particle agglomeration of these non-matrix SnO2 nanocrystals was a very slow process. The blue shifts of the band gap (approximately 2.3 eV) obtained from the optical absorbance spectra were matched with the theoretical results of the size related excitonic binding energies. These calculations also supported the observed slow grain growth. The depth sensitive hardness measurements of the thin films indicated hardness in the range of 5.03 GPa to 6.79 GPa. These undoped and non-matrix SnO2 nanoparticles were also investigated with the X-ray photoelectrons spectroscopy (XPS), atomic force microscope (AFM), X-ray diffraction spectroscopy (XRD), and ac impedance analyzer.

No association between seropositivity for hepatitis C virus and lichen planus: a case control study.

BACKGROUND: The epidemiological association of lichen planus (LP) with hepatitis C virus (HCV) infection has been recorded from some countries and HCV RNA3 has been isolated from lesional skin in patients with LP and chronic HCV infection. The observed geographical differences regarding HCV infection and LP could be immuno-genetically related. AIM: To determine whether HCV has a causal relationship with LP. METHODS: Histopathologically proved cases of LP were subjected to antibody to HCV test by the Third Generation Enzyme Immunoassay Kit for the detection of antibody to HCV (Anti-HCV) in human serum or plasma. They were routinely screened in the virology department by the reagent kit, HIVASE 1 + 2, adopting the "direct sandwich principle" for the assay to detect antibodies to HIV-1 and/or HIV-2. There were 150 age and sex matched controls (not suffering from LP) and HIV-I and II negative, and negative for HCV. RESULTS: Of the 104 patients studied only 2 patients (1.92%) of generalized LP with disease duration of more than 3 months were found to be positive for antibodies to HCV. This was not a significant finding and no statistical methods, e.g. Chi square test etc. could be applied. CONCLUSION: Hepatitis C virus is not significant to the causation of LP in India.

Acute tumour lysis syndrome after oral fludarabine in a patient with chronic lymphocytic leukaemia.

Acute tumour lysis syndrome (TLS) is a very rare complication of cytotoxic therapy in patients with chronic lymphocytic leukaemia (CLL). We report a patient with CLL who developed tumour lysis syndrome twice after oral fludarabine therapy. Both times TLS developed more than 2 weeks after the initiation of therapy. To our knowledge this is the first reported case of TLS in CLL precipitated by oral fludarabine.