Dr. Rajendra Prasad Government Medical College (DRPGMC) is a government medical college and hospital located in district Kangra of Himachal Pradesh.
Current tuberculosis (TB) control programs, including India's National TB Elimination Programme (NTEP), heavily rely on risk-based screening that prioritizes high-risk individuals. Evidence suggests that a significant portion of TB cases are not from these defined high-risk categories, questioning the adequacy of this approach as the primary strategy for elimination. The study aimed to describe the clinico-demographic profile of notified TB cases under the NTEP in district Kangra and to assess whether risk-based screening strategies identify the disease burden. This cross-sectional study included data of 2,664 patients notified under the NTEP from January 1 to December 31, 2024 and available on the Nikshay portal. After extraction, the data was transferred into excel sheets and analysed using SPSS version 22. Key variables included age, sex, site of disease, diagnostic basis, body-mass index, smoking status, diabetes, and HIV infection. The mean age of patients was 47.7 years, with a male predominance (67.2
Background: Given the national imperative to eliminate tuberculosis (TB) in India and the need to foster an adaptable healthcare system, an implementation research study is proposed. The study is planned with the objective to assess the feasibility of improving access to point-of-care TB screening in underserved populations through the strategic deployment of hand-held X-ray technology. Materials and Methods: Implementation research with a Community Health Center (CHC)-based three-stepped wedge design will be used. After conducting formative research as part of phase 1 of study, a staggered intervention (hand-held X-ray) will be introduced across CHCs using a stepped wedge design during phase 2 of the study. Phase 3 will include evaluation and end-line assessment. Results: Metrics and processes like the proportion of TB patients screened, improved TB detection rates, and treatment outcomes will be evaluated. Conclusion: The research will evaluate the effectiveness of integrating hand-held X-ray units in routine TB screening programs, thereby providing valuable insights into its feasibility and adaptability in our healthcare system to combat TB in India and other resource-limited settings.
Background: Post-mastectomy radiotherapy (PMRT) pain encompassing somatic shoulder and chest wall pain (SCWP) and neuropathic pain (NP) is a clinically significant late toxicity following hypofractionated radiotherapy (HFRT) for breast cancer. Limited data exist regarding its incidence, temporal evolution, and determinants across different HFRT regimens. Objectives: To evaluate the incidence and predictors of SCWP and NP in patients receiving chest wall and regional nodal HFRT, across three HFRT schedules. Materials and methods: Breast cancer patients were treated with one of three HFRT regimens: 26 Gy in 5 fractions, 34 Gy in 10 fractions, or 40 Gy in 15 fractions. PMRT pain was evaluated using the Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE v5.0) for SCWP, and NP using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. The temporal patterns of both pains were analyzed. Dosimetric parameters of the chest wall (CW), brachial plexus (BP), axillary levels I-III, and supraclavicular fossa (SCF), anatomical parameter (CW thickness), and clinical parameters (age, BMI) were correlated with pain outcomes. Results: The mean duration of SCWP was 6 months (range, 3-36 months), which was most frequently observed with HFRT-C (40%), followed by HFRT-B (22.9%) and HFRT-A (23.3%) (p=0.09). Patients with Grade≥2 SCWP had significantly thinner CW (p=0.04) and higher CW Dmax EQD2 values (p=0.04). NP occurred with a mean onset of 12 months (range, 3-24 months) and was most common in HFRT-C (60%), versus 40% in HFRT-A and 28.6% in HFRT-B (p=0.001). On multivariate analysis, Level III axillary dissection (0.049) and higher BP Dmax EQD2(p=0.001), axillary level III Dmean EQD2 (p=0.049) were found to be significant predictors of NP.
INTRODUCTION:Urinary bladder stones cause significant morbidity and are increasingly treated by transurethral holmium laser cystolithotripsy (TULC), a minimally invasive procedure. While spinal anesthesia is commonly used, local anesthesia is gaining interest, especially for high-risk or elderly patients. This study compares the safety, efficacy, and outcomes of TULC under local versus spinal anesthesia. METHODS:A retrospective observational study at AIIMS, Jodhpur, India (March 2023-March 2025) included 81 bladder stone patients undergoing TULC. 43 received local anesthesia and 38 spinal anesthesia. Data on demographics, stone size and number, operative time, pain scores (Visual Analogue Scale), complications, and stone clearance were analyzed. RESULTS:Both groups were comparable in age and sex. Mean stone size was smaller in the local anesthesia group (22 mm) compared to spinal anesthesia (30 mm); multiple stones were more common with spinal (26.3% vs 9.3%). Complete stone clearance was achieved in all patients. Operative time was shorter under local anesthesia (45.3 vs 55 min). Pain scores were similar (VAS 3.69 vs 3.70). Minor complications, such as hematuria and fever, occurred but resolved conservatively. No major complications or mortality were reported. Patient satisfaction was slightly lower with local anesthesia (Likert 4.05 vs 4.13). CONCLUSIONS:Holmium laser cystolithotripsy is safe and effective under both local and spinal anesthesia. Local anesthesia is a well-tolerated alternative for smaller stones, offering a quicker procedure with similar pain outcomes. Spinal anesthesia remains preferred for larger or multiple stones. Further randomized studies are needed to optimize anesthesia selection criteria.
Background Tumour sphericity (TS) and its inverse, tumour asphericity (ASP) = 1 - TS, derived from baseline 18 F-FDG PET/CT may capture morphologic heterogeneity linked to tumour aggressiveness. Aim To determine whether baseline primary tumour asphericity on 18 F-FDG PET/CT provides incremental prognostic value beyond clinical stage, molecular subtype, histologic grade, and PET metabolic burden (SUVmax, MTV, TLG) for synchronous distant metastasis and survival outcomes in breast carcinoma. Methods This retrospective study included 202 women (median age 52 years) with biopsy-confirmed breast cancer staged by 18 F-FDG PET/CT (January 2017 to December 2021) and followed for a median of 48 months. Primary endpoints were synchronous distant metastasis at presentation and overall survival (OS); early metabolic non response and progression-free survival (PFS) were secondary endpoints. Primary tumours were semi automatically segmented (Python; Trimesh) and TS/ASP were computed from 3D surface geometry. Optimal cut offs were identified by ROC analysis. Early metabolic non response was defined as failure to achieve ≥ 30% reduction in primary tumour SUVmax on interim PET/CT (where available). Multivariable logistic and Cox models were adjusted for age, TNM stage, molecular subtype, tumour grade, and PET metabolic metrics (SUVmax, MTV, TLG). Results Median TS was 0.78 (IQR 0.72–0.84); an ASP threshold of 0.25 optimally separated metastatic from non-metastatic cases (AUC 0.78, 95% CI 0.71–0.84). High ASP (> 0.25) independently predicted synchronous distant metastasis (OR 3.1, 95% CI 1.6-6.0; p = 0.001) and was associated with inferior 5 year OS after adjustment (HR 2.4, 95% CI 1.2–4.7; p = 0.010). High ASP (> 0.25; TS < 0.75) increased the likelihood of early metabolic non response (OR 2.5, 95% CI 1.4–4.5; p = 0.002). Associations with PFS were also observed (HR 1.9, 95% CI 1.2–2.9; p = 0.004). In decision curve analysis for 5 year PFS, models including ASP showed higher net benefit than clinical only models across clinically relevant thresholds. Conclusions Baseline tumour asphericity is a reproducible, interpretable biomarker of metastatic dissemination and adverse survival in breast cancer, complementing stage, tumour biology, and metabolic burden. Its association with early metabolic non response supports a role for PET/CT based risk stratification and treatment tailoring, pending multicentre validation.
