The classification of breast cancer has undergone a paradigm shift with the identification of HER2-low and HER2-ultra-low subtypes, representing a continuum of HER2 protein expression. These categories challenge the traditional binary system of HER2-positive and HER2-negative cancers, offering new insights into tumor biology and therapeutic opportunities. This review was done to look into the emerging concepts of HER2-low and ultra-low breast cancers, their molecular characteristics, diagnostic challenges, and evolving therapeutic landscape. A comprehensive review of recent literature was conducted, focusing on definitions, diagnostic criteria, and clinical implications of HER2-low (immunohistochemistry (IHC) 1 + or 2+, FISH-negative) and HER2-ultra-low (IHC 0 with faint staining) breast cancers. Emphasis was placed on assay standardisation, emerging diagnostic modalities, and ongoing clinical trials evaluating targeted therapies. HER2-low and ultra-low tumors demonstrate distinct molecular signatures and clinical behaviours compared with both HER2-positive and completely HER2-negative counterparts. Conventional immunohistochemistry often fails to accurately distinguish these subgroups due to limited sensitivity. Novel, standardised, and more sensitive assays are essential to reliably identify these categories. Several ongoing trials are exploring the efficacy of novel anti-HER2 agents and antibody-drug conjugates in these subtypes, indicating promising therapeutic potential. Recognition of HER2-low and HER2-ultra-low breast cancers marks a critical evolution in breast cancer pathology and precision oncology. Improved diagnostic tools and targeted therapies may enable more personalised treatment approaches, refining prognostic assessment and improving patient outcomes.
Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45
Elevated intracranial pressure (ICP) can complicate various neurological conditions in children and may result in fatal brainstem herniation. Early detection and management can prevent this fatal complication. This prospective observational study conducted over 18 months aimed to evaluate point-of-care ultrasound (POCUS) as a noninvasive, efficient method to detect elevated ICP in children aged less than 14 years. The primary objective of this study is to determine optic nerve sheath diameter (ONSD) values in children, measured by POCUS, and correlate them with the clinical severity of ICP. Secondary objectives include establishing age-specific ONSD values for diagnosing and predicting ICP severity, determining normal ONSD values from age-matched control groups, and estimating ONSD changes in response to hyperosmolar therapy. This study found a significant increase in ONSD in children with raised ICP compared to controls (5.63 mm vs. 4.35 mm), with consistent measurements across different locations. However, ONSD did not correlate with the clinical severity of ICP. While age moderately influenced ONSD in healthy children, it had no significant impact in those with raised ICP. The age-specific cut-off values for POCUS-measured ONSD (e.g., 4.91 mm for 1.5–10 years and 5.27 mm for 10–14 years) exhibited high sensitivity and specificity for detecting raised ICP. Furthermore, both hypertonic saline and mannitol effectively reduced ONSD, with no significant difference in their efficacy, suggesting both are viable options for managing raised ICP. Conclusion: This study establishes POCUS-measured ONSD as a reliable tool for detecting raised ICP in children. While more research is needed for age-specific norms and severity prediction, ONSD shows promise as a valuable adjunct in pediatric ICP management.
Guided by Donabedian’s framework and WHO’s person-centred quality model, this study conceptualises patient satisfaction as a patient-reported outcome reflecting the interpersonal and organizational processes of care within public and private health service contexts in rural India. This paper aimed to measure satisfaction and its domains from health service use in rural Aligarh, and to compare satisfaction between private and public health service use in rural Aligarh. A cross-sectional study was conducted among rural households in the Jawan Block of Aligarh from January 2023 to December 2023 using the patient satisfaction questionnaire short form (PSQ-18). A sample of 565 participants from four villages was included in the study. The overall satisfaction from health service use in rural Aligarh was 66.70
OBJECTIVE:This survey was conducted to explore the current status of empyema thoracis management practices of pediatricians in India, as a prelude to developing evidence-based guidelines for managing empyema. METHODS:A questionnaire examining various aspects of empyema management (diagnosis, investigations, treatment, monitoring and follow-up) was prepared, refined, and pilot-tested. It was disseminated to pediatricians across the country, through a Google form link, using email and a social media platform. Responses were collated, analyzed, and presented with descriptive statistics. RESULTS:Ninety-four complete responses were received, mostly from pediatricians in teaching/ tertiary-care hospitals. There were significant variations in all aspects of empyema management. There was overuse of computed tomography (CT) scan (27%) and pleural fluid Cartridge Based Nucleic Acid Amplification Test (CBNAAT) (61%) in children with pleural effusion. Whilst > 80% pediatricians used ceftriaxone empirically for pneumonia and empyema, co-amoxiclav (18%), vancomycin (56%), and teicoplanin or linezolid (16%) were also used for empyema. Less than three quarters of respondents used intercostal drainage appropriately. 25% pediatricians routinely used intrapleural fibrinolytic therapy (most often streptokinase); 37% did not use it at all. The common indications were septations/loculations on ultrasonography (57%), thick pus (38%), and persisting clinical features (33%). The duration of antibiotics ranged from < 4 weeks (18%), 4-6 weeks (59%), and > 6 weeks (15%). The indications for surgical referral also varied widely, as did monitoring during therapy, and post-treatment follow-up protocols. CONCLUSION:There are significant variations in all facets of empyema management amongst pediatricians working in diverse Indian healthcare settings, underscoring the need for evidence-based guideline recommendations.
