Clinicopathological Significance of Tumor Budding in Breast Carcinoma.

BACKGROUND: Tumour budding Tuberculosis is a new prognostic marker whose role in breast cancer is still under evaluation. Our aim was to study Tuberculosis in breast carcinoma and correlate it with other prognostic markers. METHODS: A descriptive cross-sectional study was conducted over 2 years on 75 invasive breast carcinoma specimens and biopsies. Hematoxylin and Eosin sections were examined for tumour grade, stage, molecular subtype, necrosis, lymphovascular invasion inflammation and counting of Tuberculosis. Lymph node metastasis was studied only in mastectomies. TB was defined as a cluster of 1-5 tumour cells and counted in 10 consecutive 400X fields. The cut-off for high grade TB was taken as ?10 per 10 HPFs. Immunohistochemical staining was done for molecular subtyping and differentiating Tuberculosis from mimickers. Statistical analysis was done using chi square test and Fischer's exact test. RESULTS: Tuberculosis was present in 66/75 cases; 53% (n=35) were high grade. Among these, majority were of T2 (74%, n= 26), grade 2 (52%, n= 18), luminal A (34%, n= 12), had 3+ inflammation (46%, n= 16) and peripheral tumour buds (54%). Necrosis and lymphovascular invasion were absent in 77% and 71%, respectively. Lymph node metastasis was seen in 63% (n= 25/28) cases. Statistically significant association (p= 0.016) was observed between degree of inflammation and Tuberculosis grade. However, no significant association was observed between TB and other prognostic markers of breast carcinoma. CONCLUSIONS: In our study, association of Tuberculosis with different prognostic markers was appreciated but was not statistically significant. However, it highlights need for standardization of Tuberculosis reporting.

Study of Menstrual Patterns, Abnormalities, and Irregularities in Students.

Introduction One-third to one-half of females with primary dysmenorrhea are missing school or work at least once per cycle, and more frequently 5% to 14% of them. Dysmenorrhea is one of the most common gynecologic disorders among young girls and is the major cause of activity restriction and college absence. A direct link between primary menstrual abnormalities and chronic conditions such as obesity has been established, though the exact pathology behind it is yet unknown. Method A total of 420 female students between 18 and 25 years of age from various professional colleges in a metro city were included in the study. Semi-structured questionnaire was used. Students were examined for height and weight. Results History of dysmenorrhea was given by 82.6% students. Out of these, 30% had severe pain and required medication. Only 20% took professional help for the same. There was a high prevalence of dysmenorrhea in participants who ate food outside frequently. Prevalence of irregular menstruation was more (41.94%) in girls having junk food three to four times a week. Conclusion The prevalence of dysmenorrhea and premenstrual symptoms were much higher as compared to the other menstrual abnormalities. The study revealed a direct association between consumption of junk food and an increase in dysmenorrhea.

Challenges to Cardiac Rehabilitation Post Coronary Artery Bypass Grafting: A Qualitative Study in Pune.

Background Adherence to cardiac rehabilitation (CR) regimen is crucial in the post-coronary artery bypass grafting (CABG) period. Cardiac rehabilitation involves various lifestyle changes, including diet and exercise, regular follow-up in OPD, and implementing secondary prevention recommendations. This study aims to understand the challenges to CR post-CABG. Methodology Seven in-depth interviews using an interview guide were carried out in the outpatient section of the cardiothoracic vascular surgery (CTVS) department of a tertiary health care facility in Pune, India. A purposive sampling technique was followed. Results The qualitative study revealed that dietary restrictions were difficult to follow, that some patients could not quit smoking even after surgery, and that transportation costs were an issue regarding CR follow-up. The majority of the participants appreciated the importance of regular exercise in their post-surgery life. Conclusion Despite the hurdles, the majority of participants stated that the fact that CABG is a major treatment pushed them to attend routine CR follow-ups and adhere to the CR regimen. A solid CR team was one of the study's strengths, and the team established a routine of telephonic reminders for regular follow-up, which resulted in lower rates of loss to follow-up.

People's Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study From Pune, India.

Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people's attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.

Community's perception of lockdown ascribed to the COVID-19 pandemic.

Background: The COVID-19 pandemic caused a mandatory nationwide lockdown from March 24, 2020. In this difficult and unprecedented time, the requirement to adapt to lockdown and a forced stay-at-home had an impact on people's lives. Aim: Community's perception of lockdown ascribed to COVID-19 pandemic. Materials and Methods: A cross-sectional study was done on individuals aged 18 and above across India, to assess their perception regarding lockdown due to the COVID-19 pandemic. The study was carried out using a semi-structured questionnaire, where the data were collected via Google Forms and analyzed via Epi info 7. The questionnaire comprised of how individuals perceived the lockdown, and how COVID-19 news circulating on various social media platforms and news channels affected their mental health. Results: The study included a total of 552 individuals. The study found that the lockdown was supported by 47% of respondents. 69.9% participants acknowledged that during lockdown, a huge amount of COVID-19 news was being disseminated, while 67.2% of individuals were overly preoccupied with thinking about preventative measures. As a result of being confined indoors, 59% of respondents thought their screen time had increased. Conclusion: Respondents perceived that the lockdown had its benefits and drawbacks. They were impacted by the flood of information from various social media platforms as well and there was an increase in screen time.

Dyslexia: An invisible disability or different ability.

Background: With a global dyslexia prevalence of at least 10%, significant numbers of students with dyslexia go undiagnosed and their symptoms unaddressed, but with timely intervention, 90% of dyslexic children can be educated in regular inclusive classrooms. Aim: This study aimed to estimate the prevalence of dyslexia among primary schoolchildren in government and private schools. Material and Methods: A cross-sectional study on 128 primary schoolchildren attending selected government and private schools in Western Maharashtra was conducted and evaluated using the Search tool, which is a standardized study tool for screening dyslexia. Microsoft Excel and MedCalc version 3.1 were used for data entry and analysis. The prevalence of dyslexia was estimated, and differences between groups were evaluated using appropriate tests. Results: Of the total sample size of 128 children, findings showed 10.9% of students as dyslexic, 9.3% as vulnerable, and the remaining 79.8% as non-dyslexic. Of 14 dyslexic children, 10 were found to be from government schools and the remaining four were from private schools. Conclusion: The high prevalence of dyslexia even in a small study sample size is a matter of concern and emphasizes the need for extensive research and initiatives, including awareness campaigns among teachers, parents, and school authorities, and the importance of detection of undiagnosed dyslexic children as early as possible and providing them with appropriate interventions.

Tobacco and alcohol use among adolescents in Northern India.

Background: Alcohol and cigarette usage are major public health issues that particularly affect young people worldwide. Because most users begin using these drugs well before the age of 18, there are significant psychosocial and health consequences. This study seeks to identify the incidence of underage drinking and smoking in northern India and the multiple risk factors associated with this exposure. Materials and Methods: A cross-sectional study was conducted on adolescents (13-18 years) from Northern India, to assess their knowledge, attitude, and practice of usage of alcohol and tobacco. The study was conducted using a semi-structured questionnaire for interview purposes and analyzed via Epi Info version 7. Results: The mean age of the participants was 16.15 (1.34) years, of which 65.74% are males and 34.26% are females. 18.25% of students stay in a hostel. Of 108 participants, about 24.07% of students have tried their first cigarette before 18 years of age. 28.70% of students have people in their homes, and 41.67% have friends who use tobacco. Among the 108 respondents, 26.85% of students have tried or used alcohol before 18 years of age. Conclusion: It is crucial to create preventive techniques to lessen tobacco use in light of the significant negative health effects that come along with tobacco addiction. Spreading awareness among at-risk children and adolescents by limiting advertising and promotional efforts, early user detection and treatment are all examples of preventive techniques.

Tumor budding in breast carcinoma: A systematic review and meta-analysis.

ABSTRACT: Tumor budding is gaining importance as a prognostic factor in various carcinomas due to its association with epithelial-mesenchymal transition (EMT) and hence clinical outcome. Reporting tumor budding in breast cancer lacks homogeneity. We aim to systematically review the existing literature and conduct a meta-analysis to assess the prognostic implication of tumor budding in breast carcinoma. A systematic search was performed to identify studies that compared different prognostic variables between high- and low-grade tumor budding. Quality assessment was performed using a modified Newcastle Ottawa Scale. Dichotomous variables were pooled using the odds ratio using the Der-Simonian-Laird method. Meta-analysis was conducted to study the association between low/high-grade tumor budding and tumor grade, lymph node metastasis, lymphovascular invasion, ER, PR, HER2neu, KI67, and the molecular subtype triple-negative breast carcinoma. Thirteen studies with a total of 1763 patients were included. A moderate risk of bias was noted. The median bias scoring was 7 (6-9). High-grade tumor budding was significantly associated with lymph node metastasis (OR: 2.25, 95% CI: 1.52-3.34, P < 0.01) and lymphovascular invasion (OR: 3.14, 95% CI: 2.10-4.71, P < 0.01), and low-grade budding was significantly associated with triple-negative breast carcinoma (OR: 0.61, 95% CI: 0.39-0.95, P = 0.03)There was significant heterogeneity in the assessment and grading of tumor budding; thus, a checklist of items was identified that lacked standardization. Our meta-analysis concluded that tumor budding can act as an independent prognostic marker for breast cancer.

Psychological aspect of common people during lockdown.

BACKGROUND: Lockdown was implemented to restrict the transmission of COVID-19. This brought upon many unforeseen hurdles, including mental health problems. AIM: The aim of the study is to assess the impact of lockdown on mental health. MATERIALS AND METHODS: A cross-sectional study was conducted using Google Form, which the participants were requested to complete online. The questionnaire included sociodemographic information and general health questionnaire (GHQ)-12, which was used to screen for mental health. RESULTS: A total of 343 participants took part in the study in which 113 participants (32.9%) were having GHQ score of less than or equal to 12. The study showed that people aged less than 41 years were able to concentrate more during lockdown (75.6%) as compared to people aged more than 41 years (65%). Younger participants who were less than 41 years reported sleep disorders associated with late-night entertainment and TV viewing (24.5%). Many experienced stress during lockdown, but it was more in people over 60 years (63.7%). CONCLUSIONS: An appreciable proportion of the participants faced stress during lockdown. Elderly people were more affected. Sleeping disorders were associated with late-night entertainment and TV viewing in younger people.

Severe acute respiratory syndrome-coronavirus-2 seroprevalence study in Pimpri-Chinchwad, Maharashtra, India coinciding with falling trend - Do the results suggest imminent herd immunity?

BACKGROUND: COVID-19 is a public health concern currently demanding continuous efforts to understand its epidemiology. Pimpri-Chinchwad township with a population of over 25 lakhs is located in Maharashtra, one of the worst affected states in India. After the incidence peaked in the township in mid-September 2020, cases started declining even as lockdown restrictions were eased. OBJECTIVES: A seroprevalence study was conducted to understand the transmission dynamics of the pandemic in this region. METHODS: We carried out a population-based seroprevalence study for IgG antibodies for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among 5000 residents 12 years and above selected by the cluster random sampling. We selected 50 clusters in slums, 80 clusters in tenements, and 70 clusters from housing societies. The field work for collection of samples was carried out from October 07 to October 17, 2020. We used kit from Abbott (SARS-CoV-2 IgG), which employs chemiluminescent microparticle immunoassay technology. The prevalence of IgG antibodies was expressed as point estimates with 95% confidence intervals (CIs). These were weighted for areas and cluster effect and further adjusted for test performance. RESULTS: The overall seropositivity for IgG was 34.04% (95% CIl 31.3%-36.8%). Slum dwellers had 40.9% positivity rate (95% CI 37.0%-44.7%), those in tenements 41.2% (95% CI 37.7%-44.8%) and people living in housing societies had 29.8% positivity (95% CI 25.8%-33.8%). CONCLUSION: A considerable proportion of population had encountered the novel coronavirus approaching partial, if not complete, herd immunity, which may partly explain the declining trend in spite of easing of lockdown restrictions.

Access to health services among slum dwellers in an industrial township and surrounding rural areas: a rapid epidemiological assessment.

CONTEXT: The biggest challenge in implementing the primary health care principles is of equitable distribution of health care to all. The rural masses and urban slum dwellers are most vulnerable to lack of access to health care. AIM: To study access to health services among slum dwellers and rural population. SETTING AND DESIGN: A cross-sectional survey in an urban slum and surrounding rural areas in field practice area of a medical college. MATERIALS AND METHODS: Structured instrument along with qualitative techniques such as focus group discussions, were used to collect information on access and utilization of health services from 865 individuals of both sexes and all ages selected from urban slums, villages, and indoor and outdoor patients. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. RESULTS: More than 50% of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases and malnutrition (especially in children), risk of lifestyle diseases as evidenced by high Body mass index in 25% of adults surveyed was found. Private medical practitioners were more accessible than government facilities. More than 60% sought treatment from private medical facilities for their own ailments (for sickness in children this proportion was 74%). People who visited government facilities were more dissatisfied with the services (30.88%) than those who visited private facilities (18.31%). This difference was significant (OR=1.99, 95% confidence interval 1.40 to 2.88; χ(2) =15.95, df=1, P=0.007). The main barriers to health care identified were waiting time long, affordability, poor quality of care, distance, and attitude of health workers. CONCLUSION: The underprivileged in India continue to have poor access to basic determinants of good health as well as to curative services from government sources during illness.