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.

Spectrum of Posterior Cerebral Artery Dissection: A Retrospective Observational Study and a Critical Review.

Background and Aims: Intracranial arterial dissections commonly involve the vertebrobasilar system leading to subarachnoid hemorrhage (SAH) or cerebral infarction attributable to a dissecting aneurysm of the vessel or occlusion of the lumen depending on the depth of dissection. However, isolated posterior cerebral artery dissections (PCADs) are rare and sparsely reported in the literature. Methodology: A retrospective multicentric observational study was carried out after collecting data from 14 patients admitted with PCAD in three hospitals of Kolkata, Jaipur, and Patna within the period of July 2021 to June 2022. Results: The median age of the population was 48.5 years, and 64.28% were females. SAH was the most common presentation with dissecting aneurysms in all patients barring one, who presented with a left occipital infarct consequent to ipsilateral PCAD. Among the 14 patients, three patients denied endovascular intervention and were lost to follow-up; one patient with an occipital infarct and another patient with a dissecting left P3 aneurysm, which underwent spontaneous thrombosis, were managed conservatively. Among the nine patients scheduled for endovascular coiling, one patient succumbed before intervention and one patient succumbed to sepsis in the postoperative period. A complete recovery was noted in six patients, whereas residual neurodeficits were present in three patients. Among the six patients who had an uneventful recovery at the end of 3 months, five patients had an endovascular intervention. Conclusion: PCAD may present with large-scale neurodeficits and is associated with high morbidity and mortality, hence necessitating prompt management. Conservative management is preferable for consequent infarcts, whereas endovascular management is desirable in cases of dissecting aneurysms, which usually tend to have a favorable outcome if intervened early.

Phytochemical Constituents, Antimicrobial Properties and Bioactivity of Marine Red Seaweed (Kappaphycus alvarezii) and Seagrass (Cymodocea serrulata).

The present work was performed to evaluate the levels of phytochemical constituents and the antioxidant and antibacterial properties of marine red seaweed (Kappaphycus alvarezii) and seagrass (Cymodocea serrulata). Quantitative phytochemical analysis, antioxidant activity and antimicrobial activity against five potential pathogenic bacteria was investigated. In each case, we found the presence of flavonoids, tannins, phenolic compounds, glycosides, steroids, carbohydrates and ashes. Alkaloids were only found in K. alvarezii, though they were not found in C. serrulata. The antimicrobial properties of both K. alvarezii and C. serrulata chloroform extracts were found to be antagonistically effective against the Gram-positive bacteria Bacillus subtilis and the Gram-negative bacteria Vibrio parahaemolyticus, Vibrio alginolyticus, Vibrio harveyi and Klebsiella pneumoniae. GC-MS analysis revealed the presence of 94 bioactive compounds in K. alvarezii and 104 bioactive compounds in C. serrulata, including phenol, decane, dodecane, hexadecane, vanillin, heptadecane, diphenylamine, benzophenone, octadecanoic acid, dotriaconate, benzene, phytol, butanoic acid and 2-hydroxyl-ethyl ether, which all played important roles in antioxidant and antibacterial activities. Thus, in view of the results, both K. alvarezii and C. serrulata could be considered to be sources of ingredients with appreciable nutritional and medicinal value.

Strong Dopant-Dopant Electronic Coupling in Emissive Codoped Two Dimensional Metal Halide Hybrid.

Multimetallic halide hybrids are attractive for the fundamental understanding of interacting excitons. However, realizing halide hybrids that incorporate multiple heterometal centers has been synthetically challenging. This further limits access to gaining physical insight into the electronic coupling mechanism between the constituent metal halide units. Reported herein is an emissive heterometallic halide hybrid, synthesized by codoping (with Mn2+, Sb3+) a 2D host (C6H22N4CdCl6) hybrid, that shows strong dopant-dopant interaction. Here, C6H22N4Sb0.003Mn0.128Cd0.868Cl6 codoped hybrid shows weak green emission (Sb3+ dopant based) and strong orange emission (Mn2+ dopant based). The observed dominance of the Mn2+ dopant emission, arising due to efficient energy transfer between the distant dopants (Sb3+ → Mn2+), highlights strong dopant-dopant electronic coupling. DFT calculations, supporting the observed dopant-dopant interaction, suggest that the electronic coupling between the dopant units (Mn-Cl; Sb-Cl) is mediated by the 2D networked host structure. This work reports physical insight into the coupling mechanism of interacting excitons in multimetallic halide hybrids synthesized through a codoping strategy.

Controlled Modulation of the Structure and Luminescence Properties of Zero-Dimensional Manganese Halide Hybrids through Structure-Directing Metal-Ion (Cd2+ and Zn2+) Centers.

Zero-dimensional (0D) metal halide hybrids with high exciton binding energy are excellent materials for lighting applications. Controlling/modulating the structure of the constituent metal halide units allows tunability of their photoluminescence properties. 0D manganese halide hybrids are currently attracting research efforts in lighting applications due to their eco-friendly and strong emission. However, structural transformation-induced tunability of their photophysical properties has rarely been reported. Herein, we demonstrate a rational synthetic strategy to modulate the structure and luminescence properties of 0D Mn(II) halide hybrids utilizing the structure-directing d10 metal ions (Cd2+/Zn2+). 0D metal halide hybrids of Cd2+/Zn2+, which act as hosts with tunable structures, accept Mn2+ ions as substitutional dopants. This structural flexibility of the host d10 metal ions is realized by optimizing the metal-to-ligand ratio (Cd/AEPip). This reaction parameter allows structural transformation from an octahedral (AEPipCdMnBrOh) to a tetrahedral (AEPipCdMnBrTd) 0D Mn halide hybrid with tunable luminescence (orange → green) with high photoluminescence quantum yield. Interestingly, when Zn2+ is utilized, a tetrahedral AEPipZnMnBr structure forms exclusively with strong green emission. Optical and single-crystal X-ray diffraction structural analysis of the host and the doped system supports our experimental data and confirms the structure-directing role played by Cd2+/Zn2+ centers. This work demonstrates a rational strategy to modulate the structure/luminescence properties of 0D Mn(II) halide hybrids, which can further be implemented for other 0D metal halide hybrids.

Successful closure of trigemino-cavernous fistula with minimally invasive approach.

A male in his early teens presented with redness of the right eye following a fall. This redness was progressive and increased suddenly over the week prior to presentation. Fundus evaluation revealed an exudative retinal detachment, and a bruit was audible over the right eye. A digital subtraction angiogram revealed the cause to be a ruptured persistent trigeminal artery aneurysm causing a carotid-cavernous fistula like haemodynamic situation with a massively dilated superior ophthalmic vein. Curative embolisation was done using both vertebrobasilar and carotid approach, and the aneurysm as well as the fistula was occluded using detachable coils and n-butyl cyanoacrylate glue. Patient made a complete recovery in his proptosis and chemosis over 8 weeks, with significant improvement of his visual acuity. The key to successful outcome in this case was a complete occlusion with thrombosis of the fistula bed that can only be achieved using a combination of coils and liquid embolic agents.

A Versatile Pd-Catalyzed Alkyne Annulation Process for Benzo[a]carbazoles and their Anticancer Analogues.

A Pd-catalyzed, simple, and divergent approach for the direct synthesis of benzo[a]carbazoles from internal alkynes and N-tosyl-iodoindoles has been demonstrated. This methodology highlights the influences of reaction media and temperature for the synthesis of either N-protected or N-deprotected benzo[a]carbazoles. This cascade strategy provides a series of electronically different benzo[a]carbazoles with good yields. The synthesized benzo[a]carbazoles were evaluated for in vitro anticancer activity against human lung cancer A549 cells and human breast cancer MDA-MB-231 cells. Notably, two of the representative analogues displayed potent anticancer activity against both cancer cell lines.

Simulation of complex strabismus surgical procedures on goat eyes.

PURPOSE: To describe the possibility of complex strabismus surgical simulation on goat eyes. METHODS: The goat eyes were procured from local slaughterhouse with retained extra ocular muscle tissues. The obtained eyes were inspected for globe integrity, muscle quality, muscle length, and the surrounding teno-conjunctival layers. The included eyes were then segregated for surgical simulation based on their insertion and orientation (as oblique or recti), and they were mounted on a mannequin head, with a fixation suture at free end to simulate the resting tension. Additionally, as per necessary, extra muscles were also transplanted along desired sites to simulate human extra ocular muscle anatomy. RESULTS: The inferior oblique, superior oblique, and all other four recti were successfully simulated in varying proportions in more than 50 eyes. Primarily, by simulating the lateral rectus, inferior rectus, and the inferior oblique muscle, staged weakening procedures of inferior oblique were successfully practiced (Fink's recession, Park's recession, Elliot and Nankin procedure, total anterior positioning, and antero-nasal trans-position or Stager's procedure). Similarly, by simulating superior rectus, inferior rectus, lateral rectus, and the medial rectus muscles, half width transposition, full width transposition, and other complex procedures were practiced (Knapp's procedure, augmented Knapp's, Nishida's procedure, Faden operation, and Y splitting procedure). Furthermore, by simulating superior oblique and the superior rectus muscles, superior oblique tuck, posterior tenectomy, loop tenotomy, and Harada Ito procedures were successfully practiced. CONCLUSIONS: On goat eyes, the complex strabismus surgical procedures can be successfully simulated and practiced after re-organizing the existing muscles in different patterns.

A 1H NMR spectroscopic method for the quantification of propenylbenzenes in the essential oils: Evaluation of key odorants, antioxidants and post-harvest drying techniques for Piper betle L.

1H quantitative Nuclear Magnetic Resonance (qNMR) spectroscopy technique has certain advantages such as low-temperature operation, authentic structural prediction and short data acquisition time. In this study, a 1H qNMR method was developed for the analysis of propenylbenzenes (eugenol and seven analogues) in the essential oils, a broadly distributed class of natural flavours. It was validated in terms of specificity (methoxy/acetate signal), linearity (range 0.05-5.00 mg per assay), sensitivity (limit of detection and quantification 4.4 and 14.9 µg/mL respectively), accuracy and precision. The qNMR technique was utilized during the sensory or activity-guided identification of chavibetol as the key odorant and antioxidant in the betel (Piper betle L., Bangla cultivar) oil, a widely consumed chewing stimulant and valuable flavouring agent. The method was also applied for the evaluation of six different post-harvest drying techniques for betel leaves through the quantitative analysis of unambiguously identified propenylbenzene markers (chavibetol, chavibetol acetate and 4-allyl-1,2-phenylene diacetate).

Successful embolisation of an intracranial meningioma via a right-sided aortic arch.

Right aortic arch is an unusual arch variation. Supra-aortic neurointervention in such cases has been sparingly reported. This case highlights the unusual association of a left hemispheric convexity meningioma with a right aortic arch which was successfully navigated. Particle embolisation of the meningioma produced good results followed by complete surgical excision and gratifying overall final outcome in this challenging scenario.

Hemispheric venous dysgenesis in a woman presenting with seizures, weakness and parkinsonism.

This report describes an unusual case of a woman who developed progressive hemiparesis, seizures and hemiparkinsonism associated with MRI and angiographic evidence of chronic venous hypertension in the contralateral cerebrum and cerebellum. In the absence of inflammatory or veno-occlusive disorders, the patient's clinical and neuroradiological findings point to a developmental disorder, such as a hemispheric venous dysgenesis, as the underlying lesion.

A sphenoid wing meningioma presenting with intraparenchymal and intraventricular hemorrhage treated with endovascular embolization alone: case report and radiologic follow-up.

Haemorrhagic presentation of intracranial meningioma is rare, and meningiomas with both intraparenchymal hemorrhage and intraventricular extension have not been reported. An unusual case of a sphenoid wing meningioma that was treated with endovascular embolization alone is presented.