Analysis of caesarean sections according to Robson’s criteria at a tertiary care teaching hospital in central India

Background: The rate of caesarean section (CS) has been skyrocketed globally over the past three decades which makes it utmost essential to be reanalyzed. Hence, the Robson’s classification of international standards has become a need of an hour. This study aimed to analyze the trend of caesarean sections at a tertiary care teaching hospital, by using Robson’s criteria.Methods: This cross-sectional observational study was conducted at Government Medical College in Akola. The data was collected for the women delivered by CS during November 2017 to April 2019 and proportions in various groups as per Robson’s criteria were calculated.Results: The overall CS rate for the study period at our hospital was 63.89%. Robson Group 1 (24.5%) had the greatest representation in the study population followed by Group 5 (21.27%) and 3 (14.18%). While Groups 6 (10.13%) and 9 (0.63%) had the least representation. Group 5 was found to be the highest absolute contributor (20.5%) to overall CS rates followed by Group 1 (16.08%). Group 9 had a least possible share in the study population, but it had 100% CS rate.Conclusions: Robson’s classification must be implemented in all delivery units to avoid unnecessary caesarean sections. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate and Robson’s criteria is a step forward in the same direction

Re-establishing Responsiveness in a Case of Refractory Metastatic Rectal Cancer with a Personalized de novo Combination Regimen

Introduction: Encyclopedic Tumor Analysis (ETA) is multi-analyte, molecular and functional interrogation to identify latent vulnerabilities in solid tumors which can then be targeted in organ- and label-agnostic combination treatment regimens.Case Presentation: We describe here a case of metastatic rectal cancer in a 61-year-old male who was progressed on all prior Standard of Care (SoC) treatment modalities including surgery, chemotherapy and radiotherapy. We addressed disease recurrence via personalized therapy guided by ETA which revealed characteristic molecular heterogeneity in primary and metastatic lesions in terms of single nucleotide variations (SNVs) and gene copy number variations (CNVs).  Notably, a novel TBL1XR1 (Exon1) – PIK3CA (Exon 2) gene fusion was identified in the tumor along with gene copy number gains in TERT, IGF-1R, MYC, FGFR1 and EGFR genes.Conclusion: ETA based molecular analysis with synchronous in vitro chemo-sensitivity profiling strategy helped to define de novo combinatorial therapy regimen of targeted and cytotoxic drugs which countered disease progression at each instance and led to the durable regression of primary as well as metastatic lesions