Clinico-pathological profile of female breast cancer in Kashmir: an institutional experience

Background: Breast cancer is the most common cancer among women and one of the most important causes of death among them. The present study tries to evaluate the demographic, clinical, and pathological profile of female breast cancer patients in Kashmir Methods: This study was done in government medical college Srinagar, department of radiation oncology. A retrospective review of 84 patients of breast cancer treated between January 2021 and March 2023 was done. Results: A total of 84 patients were taken for this study. Most patients presented in the 4th and 5th decade of life with a mean age of 45.5± 8.58. 50% of the patients were having T2 followed by 19.04% having T4 and 16.66% having T1 while 14.28 % had T3 stage. 32.1% of patients were having N0 nodal status, 25.0% were having N3 followed by 23.80% had N1 and 19.04% had N2 nodal disease.52.38% were having stage II and 36.90% were having stage III and 4.76% were having stage IV. 85.71% were having invasive ductal carcinoma, 9.52% were having invasive lobular carcinoma and 4.76% were having medullary carcinoma. 23.80% of patients were Triple +, 27.38 % of patients were Triple Negative, 25.0% were ER+/ PR+. Conclusions: The incidence of female breast cancer was more in the age group of 41–50 years. Stage II was more followed by Stage III. The most common histopathology type was invasive ductal carcinoma. Triple negativity was seen more in our patients.

Distal tibial interosseous osteochondroma with impending fracture of fibula – a case report and review of literature

Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. We present a 16 year old young boy with an impending fracture, erosion and weakness of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma avoided the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications

Species abundance along the railway of Kashmir Himalaya

1. The significant portion of global terrestrial biodiversity harbored in mountains is under increasing threat from a variety of anthropogenic impacts. Protecting fragile mountain ecosystems requires understanding how these human disturbances affect biodiversity. As roads and railways are extended further into mountain ecosystems, understanding the long-term impacts of this infrastructure on community composition and diversity gains urgency. 2. We used railway corridors constructed across the mountainous landscapes of the Kashmir Himalaya from 1994-2013 to study the effects of anthropogenic disturbance on species' distributions and community dynamics. In 2014 and 2017, we collected vegetation data along 31 T-shaped transects laid perpendicular to the railway line, adopting the MIREN (Mountain Invasion Research Network) road survey methodology. 3. Plant communities shifted significantly from 2014 to 2017, potentially as a result of ongoing species' redistribution after railway construction, mostly driven by declines in both native and non-native species richness, and increasing abundance of a few non-native species, especially in areas away from the railway track. 4. These patterns indicate an advancing succession, where initial – rare – pioneering species are replaced by increasingly dominant and often non-native competitors, and potentially suggest a trend towards delayed local extinctions after the disturbance event. Native and non-native species richness were negatively correlated with elevation, but that relationship diminished over time, with the abundance of non-natives significantly increasing at high elevations. 5. Synthesis and applications: Transport corridors seem to facilitate the spread of non-native species to higher elevations, which has serious implications in light of the warming mountain tops. Our results indicate that plant communities next to railways do not reach equilibrium quickly after disturbance. More than 10 years after railway establishment succession continued, and signs pointed in the direction of a landscape increasingly dominated by non-native species. Our study indicates that the single disturbance event associated with construction of a railway in the Himalayas had large and long-lasting effects on plant communities at and around this transport corridor, and suggests the need for a long-term region-wide coordinated monitoring and management program.The entire stretch of the railway going through the Kashmir region was divided into 31 sites consisting of 16 stations and 15 between-station sites, spanning an elevational gradient from 1591 to 1741 m a.s.l. All these selected sites were first sampled during 2014 and then resampled during 2017

Surface Modification of Mesoporous Silica Nanoparticles with Hexamethyl Disilazane as Smart Carriers for Tocopherol Acetate

Nowadays, nanotechnology is growing very fast, appearing every day in many fields related to this nanotechnology. In the present study silica nanoparticles (Si NPs) were synthesized, their surface was modified using a silazane and mesoporous Si NPs were further used for the loading tocopherol acetate. Si NPs were synthesized from tetraethyl orthosilicate (TEOS) in the presence of NaOH, with an easily handled, well known Stober method. In this, procedure TEOS was used as a source of silica and treated with NaOH and H2O, undergoing condensation and hydrolysis reactions to produce Si NPs. These Si NPs were then modified by the hexamethyl silazane to avoid agglomeration and can be used easily for targeted delivery, as smart carriers. In the end, tocopherol acetate was successfully loaded in the modified Si NPs and different parameters were recorded for optimum loading. All the samples were characterized through SEM XRD, FTIR, BET and UV-VIS spectroscopy. XRD peaks reveled the typical peak of mesoporous Si NPs appeared at 2θ = 22°. The pore size was found to be 2.45 nm. BET surface area was found to be 694.29 m2/g. FTIR presented the main peaks of functional groups at 1600 cm-1, 1000 cm-1 and 2900 cm-1 respectively. Modified Si NPs were synthesized and characterized, and the tocopherol was loaded inside the mesoporous Si NPs successfully. These experiments showed that mesoporous Si NPs can be used as smart carriers to deliver broad types of drugs efficiently

Biomimetic Photocurable Three-Dimensional Printed Nerve Guidance Channels with Aligned Cryomatrix Lumen for Peripheral Nerve Regeneration

Repair and regeneration of critically injured peripheral nerves is one of the most challenging reconstructive surgeries. Currently available and FDA approved nerve guidance channels (NGCs) are suitable for small gap injuries, and their biological performance is inferior to that of autografts. Development of biomimetic NGCs with clinically relevant geometrical and biological characteristics such as topographical, biochemical, and haptotactic cues could offer better regeneration of the long-gap complex nerve injuries. Here, in this study, we present the development and preclinical analysis of three-dimensional (3D) printed aligned cryomatrix-filled NGCs along with nerve growth factor (NGF) (aCG + NGF) for peripheral nerve regeneration. We demonstrated the application of these aCG + NGF NGCs in the enhanced and successful regeneration of a critically injured rat sciatic nerve in comparison to random cryogel-filled NGCs, multichannel and clinically preferred hollow conduits, and the gold standard autografts. Our results indicated similar effect of the aCG + NGF NGCs viz-a-viz that of the autografts, and they not only enhanced the overall regenerated nerve physiology but could also mimic the cellular aspects of regeneration. This study emphasizes the paradigm that these biomimetic 3D printed NGCs will lead to a better functional regenerative outcome under clinical settings.Peer reviewe

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable