Efficacy of maternal B-12 supplementation in vegetarian women for improving infant neurodevelopment: protocol for the MATCOBIND multicentre, double-blind, randomised controlled trial

INTRODUCTION: Vitamin B12 deficiency is widely prevalent across many low- and middle-income countries, especially where the diet is low in animal sources. While many observational studies show associations between B12 deficiency in pregnancy and infant cognitive function (including memory, language and motor skills), evidence from clinical trials is sparse and inconclusive. METHODS AND ANALYSIS: This double-blind, multicentre, randomised controlled trial will enrol 720 vegetarian pregnant women in their first trimester from antenatal clinics at two hospitals (one in India and one in Nepal). Eligible mothers who give written consent will be randomised to receive either 250 mcg methylcobalamin or 50 mcg (quasi control), from enrolment to 6 months post-partum, given as an oral daily capsule. All mothers and their infants will continue to receive standard clinical care. The primary trial outcome is the offspring's neurodevelopment status at 9 months of age, assessed using the Development Assessment Scale of Indian Infants. Secondary outcomes include the infant's biochemical B12 status at age 9 months and maternal biochemical B12 status in the first and third trimesters. Maternal biochemical B12 status will also be assessed in the first trimester. Modification of association by a priori identified factors will also be explored. ETHICAL CONSIDERATIONS AND DISSEMINATION: The study protocol has been approved by ethical committees at each study site (India and Nepal) and at University College London, UK. The study results will be disseminated to healthcare professionals and academics globally via conferences, presentations and publications. Researchers at each study site will share results with participants during their follow-up visits.Trial registration numberCTRI/2018/07/015048 (Clinical Trial Registry of India); NCT04083560 (ClinicalTrials.gov)

Therapeutic mammoplasty: a “wise” oncoplastic choice—lessons from the largest single-center cohort from Asia

IntroductionThe majority of breast cancer patients from India usually present with advanced disease, limiting the scope of breast conservation surgery. Therapeutic mammoplasty (TM), an oncoplastic technique that permits larger excisions, is quite promising in such a scenario and well suited to breast cancer in medium-to-large-sized breasts with ptosis and in some cases of large or multifocal/multicentric tumors. Here, we describe our TM cohort of 205 (194 malignant and 11 benign) patients from 2012 to 2019 treated at a single surgeon center in India, the largest Asian dataset for TM.MethodsAll patients underwent treatment after careful discussions by a multidisciplinary tumor board and patient counseling. We report the clinicopathological profiles and surgical, oncological, cosmetic, and patient-related outcomes with different TM procedures.ResultsThe median age of breast cancer patients was 49 years; that of benign disease patients was 41 years. The breast cancer cohort underwent simple (n = 84), complex (n = 71), or extreme (n = 44) TM surgeries. All resection margins were analyzed through intra-operative frozen-section assessment with stringent rad-path analysis protocols. The margin positivity rate was found to be 1.4%. A majority of the cohort was observed to have pT1–pT2 tumors, and the median resection volume was 180 cc. Low post-operative complication rates and good-to-excellent cosmetic scores were observed. The median follow-up was 39 months. We observed 2.07% local and 5.7% distal recurrences, and disease-specific mortality was 3.1%. At median follow-up, the overall survival was observed to be 95.9%, and disease-free survival was found to be 92.2%. The patient-reported outcome measures (PROMs) showed good-to-excellent scores for all types of TMs across BREAST-Q domains.ConclusionWe conclude that in India, a country where women present with large and locally advanced tumors, TM safely expands the indications for breast conservation surgery. Our results show oncological and cosmetic outcomes at acceptable levels. Most importantly, PROM scores suggest improved overall wellbeing and better satisfaction with the quality of life. For patients with macromastia, this technique not only focuses on cancer but also improves self-image and reduces associated physical discomfort often overlooked by women in the Indian setting. The popularization of this procedure will enable Indian patients with breast cancer to receive the benefits of breast conservation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Water management in alpha methyl styrene-butyl acrylate grafted and sulfonated PEEK membranes

176-181Radiation grafted and sulphonated PEEK (poly ether ether ketone) membranes have been analyzed for water management within the matrix. Grafting is done using alpha methyl styrene-butyl acrylate (AMS/BA) mixture. Membranes exhibit enhanced water content with the increasing ionic content due to higher hydrophilicity. However, the water/ionic site ratio increases significantly with the increasing graft levels. The ionic mobility also increases with increasing graft levels. It is stated that the water management within the hydrophilic membrane matrix plays a key role and is responsible for the high proton mobility at higher graft levels in the membrane. This, in turn, is governed by the physiochemical changes taking place in membranes due to the grafting and sulfonation process. A correlation of the higher water/ionic site ratio arising out of the structural changes in the proton exchange membranes may be developed by radiation grafting of AMS/BA followed by sulfonation

A Validation of Emotional Contagion Scale on the Indian Youth

The Emotional Contagion Scale (ECS) developed by Dr. Elaine Hatfield, is a self-report measure used to investigate the individual’s susceptibility to catch another person’s emotions and experience the same. The catching of emotions could be conscious or unconscious. The study aims to validate the Emotional Contagion scale on the Indian subcontinent population for future use and application. The original American scale consisted of 15 items to be responded to by selecting the suitable option from given five, was given to an Indian sample of 498 individuals. To check the validity, Confirmatory Factor Analysis (CFA) was performed. Gender differences were assessed and it was observed that men were high on catching and experiencing the emotions of others as compared to women. The Indian sample on ECS shows moderate to high reliability and high content validity. It thus concludes that the Emotional Contagion scale is valid for future use on the Indian Population

Dhoti cancer revisited

Dhoti is traditional Indian dresses worn by males in the Indian subcontinent to cover the lower parts of the body. The term Dhoti cancer was first used by Khanolkar and Suryabhai in 1945. It is a type of waistline SCC reported in Indian males wearing dhoti. Only a handful of cases are reported in English literature. This case is remarkable due to its rare site of presentation, simultaneous presence of carcinoma and suspicious acanthosis on both side of waist in the same patient. Any hypo pigmented patch and acanthosis on the waist area in a dhoti clad man should be viewed with suspicion and continuous surveillance is needed thereof

Aptamer: A theranostic approach towards breast cancer

Breast cancer has a heavy toll on the world's health, both in terms of morbidity and death. For women aged 35 to 54, it is the primary cause of mortality. In addition, over the preceding 2 decades, the mortality rate has not decreased noticeably. Early diagnosis and detection are still essential for enhancing patient outcomes despite substantial advancements in treatment. Also, possible to use monoclonal antibodies, but they come with a host of drawbacks, including unspecified binding, toxicity, expense, and debated clinical efficacy. Aptamers, which are small nucleic acid molecules that can bind to specific target molecules with high specificity, have instead emerged as potential theranostic treatments for breast cancer. Both for diagnosis and treatment, aptamers can be made to precisely target breast cancer cells or molecules linked to tumor progression. High binding affinity and specificity, low immunogenicity, and ease of modification are just a few of the characteristics that set aptamers apart from other delivery systems and make them desirable options for the delivery of drugs, imaging agents, or both, to breast cancer cells. In this study, we provide a comprehensive overview of the aptamer-based theranostic strategies for treating breast cancer, including aptamer selection, modifications, and imaging and drug delivery applications.We also discussed the SELEX method for picking aptamers and why they are good breast cancer treatments. The toxicity and weak immunogenicity of some antigens do not affect aptamer selection, unlike antibodies. Compared to antibodies, they are more selective and have higher affinities. Therefore, in the future, these therapies may be used as both main therapies and adjuvants to traditional anti-HER2 therapies. We also discussed the difficulties and potential futures of theranostic approaches based on aptamers for treating breast cancer

Assessment of asymptomatic ischemic heart disease using stress myocardial perfusion imaging in patients with type 2 diabetes mellitus

Background: Coronary artery disease (CAD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM) and may be asymptomatic. Objective: The objective of this study was to assess the prevalence of asymptomatic myocardial ischemia in patients with T2DM using stress myocardial perfusion imaging. Methods: We evaluated 97 consecutive patients with T2DM without clinical evidence of CAD presenting to Cardiology and Endocrinology clinics using Tc-99m MIBI gated single-photon emission–computed tomography (SPECT) myocardial perfusion imaging for the presence of asymptomatic CAD. Results: Abnormal myocardial perfusion was observed in 10 patients (10.3%). Of these, one half of patients had reversible myocardial perfusion defects suggestive of inducible myocardial ischemia. The other half had fixed perfusion defects suggestive of previous silent myocardial infarctions. Small and moderate reversible perfusion defects were observed in 3 and 2 patients, respectively. The fixed perfusion defects observed in 5 patients were medium sized. The presence of asymptomatic ischemia was significantly associated with age and smoking but not with other traditional cardiac risk factors. Conclusion: Ten percent of patients with T2DM with no clinical evidence of CAD were found to have evidence of asymptomatic ischemia or infarction. Keywords: Diabetes mellitus, Asymptomatic myocardial ischemia, Myocardial perfusion imagin