Tata Memorial Hospital

Population-based cancer registry (PBCR) of Bhutan was established in Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in 2014 with the support of the Ministry of Health (Bhutan) and IARC Regional Hub, Tata Memorial Centre (TMC), Mumbai, India. This PBCR provides nationwide coverage (0.7 million population). We aim to present the cancer patterns in Bhutan for the years 2014-2022 using PBCR data. Trained registry staff collect cancer patient information by visiting various sources such as hospitals and diagnostic facilities. Data is entered into CanReg5 software. Data quality and consistency are checked by the IARC Regional Hub-TMC, Mumbai. The age-specific rate and age-adjusted rate were calculated using CanReg5 software. In the 9-year period (2014-2022), the PBCR registered 5906 incidence cancer cases, of which 2659 (45%) were males and 3247 (55%) were females. The age-adjusted incidence rate for males and females was 88.3 and 113.2 per 100,000 population, respectively. Age-adjusted mortality rates for males and females were 42.7 and 44.6 per 100,000 population, respectively. The leading cancer sites among males are stomach, esophagus, liver, lung, and rectum, and for females, cervix uteri, stomach, breast, lung, and thyroid. Cancer registry will play a pivotal role in boosting and monitoring screening program initiatives in Bhutan. Through effective linkages, it will build a robust database providing a cancer profile of the Bhutanese population which can be employed to devise effective cancer control activities in Bhutan.

Myocardial perfusion imaging (MPI) aids in evaluating the left ventricular function and therefore helps in risk stratification and prognosis. The purpose of this study was to evaluate the clinical impact of three cardiac software packages (Emory Cardiac Toolbox, Cardiogam, and Myovation Evolution) at 1-year follow-up. This prospective investigation involved 370 patients who underwent myocardial perfusion scintigraphy. Participants were stratified into three groups based on left ventricular ejection fraction determined by two-dimensional echocardiography. Among these, 294 patients were available for follow-up at 1 year. Semiquantitative parameters (summed rest score [SRS], summed stress score [SSS], summed difference score [SDS]) and quantitative parameters (defect extent [DE], transient ischemic dilatation [TID], ejection fraction [EF], end-diastolic volume [EDV], end-systolic volume [ESV], and stroke volume [SV]) derived from each software platform (ECTb, Cgam, and ME) were used to evaluate their diagnostic performance in predicting major adverse cardiac events (MACE) using receiver operating characteristic curve analysis in patients during 1-year follow-up. Among the 294 participants available for follow-up, 6% ( n = 17) developed MACE at 1 year and 88% ( n = 15) belonged to the high-risk group. Follow-up analysis indicated that all three software packages could predict 1-year cardiac events with varying cut-off values, sensitivities, and specificities. Cut-off values for SRS (ECTb) was ≥4 (area under the curve [AUC], 0.82), while for Cgam it was ≥11 (AUC 0.8), DE (REST) (ECTb) was ≥6% (AUC 0.82), and Cgam value ≥4.18% (AUC 0.81), EF (REST) was ≤44% (AUC 0.82), ≤68% (AUC 0.84) and ≤35% (AUC 0.83) for ECTb, Cgam, and ME, respectively, EDV (REST) was ≥137 mL for both ECTb (AUC 0.83) and Cgam (AUC 0.85) while for ME it was ≥116 mL (AUC 0.8), ESV (REST) was ≥91 mL (AUC 0.83), ≥55 mL (AUC 0.86) and ≥78 mL (AUC 0.82) for ECTb, Cgam, and ME, respectively. Majority of the MACE occurred in the group with high-risk characteristics. All three software packages demonstrated the ability to predict 1-year cardiac events, albeit with varying parameter cut-off values, sensitivities, and specificities.

Background: Carbapenem-resistant Gram-negative bacilli (CR-GNB) significantly compromise therapeutic options in clinical practice. Plazomicin, a next-generation Aminoglycoside, has been structurally optimized to evade most AMEs and retain activity against MDR Enterobacterales, may offer improved activity over conventional aminoglycosides, yet data from the Indian context are limited. Methods: In this cross-sectional study conducted at a tertiary care cancer hospital in western India from December 2024-January 2025, 100 non-duplicate CR-GNB clinical isolates were evaluated. Antimicrobial susceptibility testing was performed using VITEK-2. Carbapenem isolates were further evaluated for expression of Carbapenemase genes and in vitro susceptibility to Plazomicin and its comparison to other Aminoglycoside. Results: Plazomicin susceptibility (42%) was significantly higher than amikacin (18%), gentamicin (33%), and tobramycin (13.3%) (p<0.001). Isolates co-producing NDM with OXA-48 demonstrated elevated plazomicin MICs and resistance while those producing KPC or OXA-48 demonstrated a relatively higher proportion of susceptibility. Klebsiella pneumoniae showed MIC₅₀=>256, MIC₉₀=>256; Escherichia coli MIC₅₀=1, MIC₉₀=>256; Pseudomonas aeruginosa MIC₅₀=12, MIC₉₀=>256; and Enterobacter cloacae MIC₅₀=0.75, MIC₉₀=1. Plazomicin retains potent activity against isolates harboring single carbapenemase genes, while coproduction of multiple resistance determinants- especially NDM with OXA-48 markedly diminishes susceptibility and results in elevated MIC values. Conclusions: Plazomicin shows superior in vitro activity compared to conventional aminoglycosides against selected CR-GNB isolates. Resistance genotypes markedly influence plazomicin susceptibility, highlighting the role of molecular characterisation in guiding antimicrobial therapy.

Abstract In carbon dioxide capture and storage (CCS), CO2 containing various impurities emitted from multiple sources is captured and injected underground through pipes at high pressure in a dense or supercritical phase. Experimental data on material corrosion resistance under such conditions have been extremely limited. Therefore, corrosion tests were conducted to evaluate the corrosion resistance of CRA materials in supercritical CO2 with O2, SO2, NO2 and H2S and practical mixtures of gases. These tests were performed under the assumption of flow back of the formation water. Based on our investigation of 13Cr (S42000), Super 13Cr (S41426), Duplex stainless steels (S82551), Super duplex stainless steels (S39274), all test data were compiled into material selection charts with two versions corresponding to different chloride concentrations as continuing work form AMPP publication C2024-20598, C2025-00004 and C2025-00068. Furthermore, accidental depressurization of high-pressure CO2 may lead to blowout, causing a temperature drop due to the Joule-Thomson effect. To address this concern, Charpy impact test results for each alloy are presented, providing a comprehensive assessment of material integrity under low-temperature conditions. Overall, super duplex stainless steel UNS S39274 exhibits excellent suitability even under high-salinity formation water flowback. When low-temperature toughness is a critical requirement, solution-annealed UNS S39275 (80 ksi grade) demonstrates superior performance. Considering economic feasibility, UNS S82551 is identified as the next most effective option.

Anthracyclines significantly improve overall survival and play a vital role in the treatment of breast cancer. However, they are associated with cardiac dysfunction, which is often irreversible. Although anthracycline-induced cardiotoxicity (AIC) is dose-dependent, the difference in susceptibility patterns suggests the role of pharmacogenomics. Several studies explored the role of genetic variants in AIC. Integrating pharmacogenomic testing with routine anthracycline surveillance will help to predict the individuals who are at risk of developing AIC. Therefore, this current systematic review aims to evaluate and synthesize the evidence on the pharmacogenomics association of cardiotoxicity in individuals receiving anthracyclines for breast cancer treatment. PubMed, Embase, and Scopus databases are systematically searched for the literature. After the initial search, 842 records have been identified. Following screening, 18 studies investigating genetic associations with AIC in breast cancer patients were found to be eligible for inclusion in the study. The quality of studies is assessed with the Q-Genie tool. The data is extracted and summarized with odds ratios and corresponding confidence intervals were reported. A total of 18 candidate gene association studies involving 4,703 breast cancer patients were included in the qualitative synthesis. Out of 57 genetic variants reported, 18 genetic variants (31.5%) are associated with an increased risk, while 3 genetic variants (5.3%) have demonstrated a risk-reducing tendency. Characterizing genetic variants in biological pathways of anthracyclines could inform precision therapy and the development of targeted interventions. The limitations of the synthesized evidence include the inadequate sample size, methodological bias within the included studies, inconsistent findings from different studies, and imprecise effect estimates. The genetic variants influence susceptibility to AIC in breast cancer patients. Further large-scale studies with longer follow-up are warranted to validate these associations and facilitate their translation into clinical practice.

Carica papaya leaf extract (CPLE) is known to increase platelet counts (PCs) in certain infections. Patients were randomly assigned in a 2:1 ratio to the CPLE or placebo arm and continued treatment until the PC improved to 75,000 × 109/L or above, a platelet transfusion was required, or upto D+10. The primary outcome was to evaluate whether CPLE improves PC faster compared with placebo in a significant proportion of patients with a modified intention-to-treat protocol. Between March 2020 and October 2024, 219 patients were randomly assigned, of whom 198 patients (CPLE arm: 129; placebo arm: 69) were analyzed for outcomes. The primary end point with modified intention-to-treat analysis showed a statistically significant increase in PC to ≥75,000 × 109/L in a greater proportion of patients by D+4 compared with placebo (59% v 44%; P = .042). The primary outcome of increasing PC >75,000 × 109/L at D+4 was significantly improved by CPLE (83/129, 64% v 33/69, 48%; P = .034) compared with placebo as per protocol analysis. There was no grade 3 or grade 4 treatment-related adverse events associated with CPLE. About 43% of patients in the placebo arm versus 25% of patients in the CPLE arm needed dose reductions or delays in their subsequent chemotherapy treatment for patients with grade 2 chemotherapy-induced thrombocytopenia (CIT) at the baseline (P 0.033) and not significant in grade 3 CIT. CPLE is a potential therapeutic intervention to improve CIT faster and to a greater extent than placebo in this phase III randomized trial without any safety concerns. It could be potentially used as a secondary prophylaxis to maintain the chemotherapy intensity.