Hemiplegia in children needs early cardiology evaluations, just as it does for neurological assessments. Early recognition, evaluation, management, and prophylaxis by a multidisciplinary team for infective endocarditis in pediatric groups with rheumatic heart disease are crucial to prevent complications like embolic stroke in resource-limited settings.
e15040 Background: Liquid biopsies analyzing circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) allow minimally invasive monitoring and testing of lung cancer at different stages. It is known that 90% of patients succumb due to metastasis. However, accounting for patients with early metastatic signatures is extremely challenging. In addition, monitoring minimal residual disease (MRD) and identifying patients for recurrence is very prudent. While the role of CTCs in % prediction of survival has been established in several cancers. However, CTC's co-occurrence role with CtDNA and vice versa is not implored in monitoring the aggressiveness of the disease, response to therapies, and therapy decisions. In this study, we investigated ctDNA and CTC's combined roles in monitoring disease aggressiveness and metastasis in lung cancer patients. Methods: A cohort of 265 lung cancer patients with late-stage cancer were retrospectively analyzed for co-occurrence of dual biomarker ctDNA and CTC. The results were correlated as quadrant to assess clinical disease states, obtained from PET scans and HPE findings. Next Generation Sequencing (NGS) test was performed using OncoMonitor dual biomarker assay having CTC enumeration with PD-L1 expression. CTC count was performed using the OncoDiscover Liquid Biopsy Test, approved by CDSCO-India, in 1.5 ml of blood. Results: CTC distribution in this study ranged from 1-8 CTCs with a mean CTC distribution of 1.22. Amongst these patients, 75.47% (n = 200) showed the presence of CTCs and amongst these 200, 91.50% (n = 183) showed PD-L1 expression on their CTCs with a mean value of 0.99. While both biomarkers were positive for ctDNA and CTC (ctDNA+/CTC+) in 135 (50.94%) patients. Interestingly, only 19 (7.17%) patients were negative for both ctDNA and CTC (ctDNA-/CTC-). Similarly, 43 patients (16.23) were positive for ctDNA and negative for CTC (ctDNA+/CTC-), while 68 (25.66%) patients were negative for ctDNA and positive for CTC (ctDNA-/CTC+). The ctDNA+/CTC- cohort had the highest metastatic rate of 62.8%, with ctDNA+/CTC+ at 57.0%. Noteworthy, the ctDNA+ cohort showed the highest % of progressive disease patients with 20.2% and 18.6% along with CTC+ and CTC- status, respectively. The mutations, EGFR, TP53, and KRAS were observed in 62.64% (166/265) of patients. Only stable disease was observed in 29.4% of patients when both biomarkers ctDNA-/CTC- were absent. Conclusions: Overall, the ctDNA+ cohort showed a higher rate of MRD, progression, and metastasis with no stable disease. The quadrant that combined clinical results of the CTC-PD-L1 cells and CtDNA manifest the non-invasive monitoring of disease progression, treatment response, complete remission, and utility of early metastatic detection in lung cancer patients.
Background and aims: One important residual CVD risks is elevated level of lipoprotein a (Lp(a)). High Lp(a) level is atherogenic. It's higher prevalence in South Asian population is important because of a higher prevalence of premature coronary artery disease in younger population of this region. Lp(a) testing is underutilized. Knowing elevated levels in an individual may help address and control traditional risk factors of ASCVD in such patients. Methods: This study was an observational, prospective study carried out in the department of internal medicine, Pokhara Academy of Health Sciences(POAHS), Nepal. The study was started on 17th September 2023 and completed on 16th March 2024. The details of history and the physical examination of cases were recorded in the proforma designated for the study. Baseline data were recorded including age, sex, presence of risk factors like diabetes mellitus(DM), hypertension(HTN), dyslipidemia, smoking, history of CAD (coronary artery disease) and coronary revascularization, family history of premature CAD, lab parameters like blood glucose, lipid profiles, Lp(a), ECG, echocardiography, coronary angiography. Statistical analysis was carried out with the help of the latest version of SPSS. Results: The mean age was 48.52 years (SD=9.06). Majority were (56%) male patients. 42 cases (84%) were dyslipidemics and 26 (52%) were hypertensives, 10 cases (20%) had family history of coronary artery disease in first degree relatives, 10(20%) had coronary artery disease, eight (16%) had DM, two (4%) were smokers. Elevated Lp(a) (>/=50mg/dl) was found in 14(28%) of total cases. Of total cases, Lp(a) was <20mg/dl in 30 (60%), 20-49mg/dl in 6(12%) and thus Lp(a) >/=20 mg/ dl was observed in 40% of cases. Conclusion: The prevalence of elevated Lp(a) in Nepalese patients with traditional risk factors of ASCVD is high. These findings from our study may carry important implications for clinical practice in Nepal. Performing targeted screening in high-risk individuals may help redefine risk category and may help in aggressively managing traditional risk factors
Cancer care in countries in the South Asian Association for Regional Cooperation (SAARC) is hindered by many challenges, including inadequate infrastructure, a shortage of skilled health-care professionals, and economic constraints. These factors contribute to disparities in timely diagnosis and treatment, leading to poorer health outcomes. Health-care systems within the region vary considerably, ranging from free public health care in Sri Lanka to predominantly out-ofpocket expenses in Bangladesh, highlighting inequities in financial access and service delivery for patients within this region. The absence of comprehensive national health insurance systems imposes substantial financial burdens on patients with cancer and their families, often resulting in catastrophic health-care costs. Paediatric oncology services reflect these disparities with greater clarity. Although Bangladesh has developed multiple treatment centres, issues such as delayed diagnoses and financial barriers persist. By contrast, countries such as Afghanistan and the Maldives have few specialised paediatric oncology services, necessitating costly referrals abroad that place large strains on families. Geriatric oncology remains underdeveloped across most SAARC nations, with few dedicated services and guidelines. Despite progress in India and Sri Lanka, gaps in specialised training and holistic care for older patients remain. Addressing these disparities requires coordinated efforts, including improving health-care infrastructure, expanding insurance coverage, and fostering regional collaborations. Implementing comprehensive national cancer control programmes across SAARC nations, leveraging intercountry networks, and ensuring political commitment are essential to achieving equitable cancer care and advancing Sustainable Development Goals in the region.
South Asian Association for Regional Collaboration (SAARC) countries, home to 24% of the world's population, are facing the double burden of disease (ie, where a population experiences both an increasing incidence of cancers typically associated with affluence and a sustained or rising burden of cancers linked to infections and poverty) with non-communicable diseases (NCDs) attributing to 47% of the global burden of disease and to about 60% of all deaths. In 2022, cancer in this region accounted for approximately 9·3% of incidence worldwide and 12% of global mortality. Cancer is one of the major NCDs affecting South Asia, accounting for a large proportion of disability-adjusted life-years lost in this region. The most common cancers are lung, head and neck, and gastrointestinal cancers in both sexes, and cervix and breast cancers in females. The cancer burden is high in SAARC countries, although there are differences among countries and within urban and rural regions of each country, depending on the level of available resources, development, and epidemiological shift. Here we discuss various cancer care issues and challenges throughout the cancer care continuum in the SAARC region. We make an urgent call for regional collaboration to develop, modify, and implement a holistic cancer control plan and formulate a systematic approach directed to address the growing burden of cancer in this region. It is crucial to establish strong political will and commitment to take forward the recommended actions outlined in this Series to overcome and address the cancer crisis in the SAARC region, aligning with Sustainable Development Goal 2030 targets.
