BACKGROUND Carcinoembryonic antigen (CEA) is an important serum tumour marker with a substantial role in diagnosis and monitoring of various solid tumours. About 36%-70% of breast cancers have elevated serum CEA. And the available studies show discrepancy in addressing the prognostic significance of CEA in advanced breast cancer. AIM To estimate the serum CEA level in our metastatic breast cancer patients and correlate it with response to treatment and clinical outcome. METHODS This was a prospective clinical study conducted on 50 metastatic breast cancer patients treated at breast clinic, with newly diagnosed metastatic breast cancer planned for palliative chemotherapy, targeted therapy, and hormonal treatment. We estimated the proportion of patients with elevated serum CEA level at baseline and after palliative treatment and also studied the association of serum CEA levels with known prognostic factors. The response to treatment was correlated with the serum CEA levels in the context of responders and non-responders. RESULTS The median pre-treatment and post-treatment CEA levels were 7.9 (1.8-40.7) ng/mL and 4.39 (1.4-12.15) ng/mL, respectively, in the whole study population ( P = 0.032). No statistically significant difference was seen in baseline serum CEA between responders and non-responders. Even in the luminal group, pre-treatment serum CEA was not a predictor of response, but post-treatment CEA was a significant predictor of tumour progression. In patients with liver and lung metastases, post-treatment CEA level difference was not statistically significant in both responders and non-responders though the values were higher in non-responders. Among those with bone metastases, 69.5% had elevated post-treatment serum CEA, and only 37.5% had elevated serum CEA in those with no bone metastases. CONCLUSION Elevated post-treatment serum CEA levels are associated with disease progression and poor response to therapy. Persistently elevated post-treatment serum CEA levels are significantly associated with bone metastases. Elevated serum CEA and hormonal status are significant predictors of treatment response.

Emerging infectious diseases have vigorously devastated the global economy and health sector; cost-effective plant-based vaccines (PBV) can be the potential solution to withstand the current health economic crisis. The prominent role of tobacco as an efficient expression system for PBV has been well-established for decades, through this review we highlight the importance of tobacco-based vaccines (TBV) against evolving infectious diseases in humans. Studies focusing on the use of TBV for human infectious diseases were searched in PubMed, Google Scholar, and science direct from 1995 to 2021 using the keywords Tobacco-based vaccines OR transgenic tobacco OR Nicotiana benthamiana vaccines AND Infectious diseases or communicable diseases. We carried out a critical review of the articles and studies that fulfilled the eligibility criteria and were included in this review. Of 976 studies identified, only 63 studies fulfilling the eligibility criteria were included, which focused on either the in vitro, in vivo, or clinical studies on TBV for human infectious diseases. Around 43 in vitro studies of 23 different infectious pathogens expressed in tobacco-based systems were identified and 23 in vivo analysis studies were recognized to check the immunogenicity of vaccine candidates while only 10 of these were subjected to clinical trials. Viral infectious pathogens were studied more than bacterial pathogens. From our review, it was evident that TBV can be an effective health strategy to combat the emerging viral infectious diseases which are very difficult to manage with the current health facilities. The timely administration of cost-effective TBV can prevent the outburst of viral infections, thereby can protect the global healthcare system to a greater extent.

Background: Persons of tribal origin account for over a quarter of India’s poorest people and also have a higher burden of disease attributable to adverse effects of tobacco use. Therefore, this study was planned in a health facility in Wayanad District to assess prevalence, pattern and determinants of tobacco use.Methods: A cross-sectional study was conducted among the persons of tribal origin by interview method using a pretested semi-structured questionnaire in a primary care facility in Wayanad, Kerala. Minimum sample size was calculated to be 140; 524 persons of tribal origin were enrolled. The chi-square test, logistic regression was used to determine association between qualitative variables.Results: Mean age of respondents was 42.52±16.95 years. The proportion of current tobacco users was found to be 39.1% (95% CI 34.9-43.4). Majority of respondents (90.2%) chewed tobacco, only 5.2% were smokers and 0.2% used other forms such as snuff. Of the tobacco users 81.95% had considered quitting. One in five persons, 19.9% used tobacco within 30 minutes of waking up. By logistic regression, men were found to be 2.59 times (95% CI 1.69, 3.97; p<0.001), illiterates 2.25 times (95% CI 1.51, .35; <0.001) and Paniya group 2.36 times (95% CI 1.6, 3.48) more likely to use tobacco.Conclusions: A high prevalence of tobacco use, early initiation and dependency, are a challenge to tobacco control among the socially and economically vulnerable indigenous people. However, the desire and attempts made to quit tobacco can be leveraged for harm reduction and tobacco cessation among males, Paniyas and illiterate people.

Awareness about the Hepatitis B is less addressed in the Indian settings even though hepatitis seems to be a serious public health problem. Objective to assess the Hepatitis B adult vaccination status among the patients of a medical college teaching hospital and to check the proportion of patientsaffected with Hepatitis B. A cross-sectional observational study was carried out over a period of six months at inpatients general medicine department. Patients of adult age group (18 -59years) of both genders were included.Patient interview was done using Twelve structured questions for assessing the awareness about hepatitis B and vaccination status. Out of 82 patients interviewed demographic details shows equal number males and females [50%] with an average age group of40yrs. The proportion of hepatitis B was found to be 3.68% with male predominance. Majority of patients were found to be not vaccinated (n=70, 85.36%) and even awareness about hepatitis B infection as also very minimal among them. Poor educational status (p-value=0.0425) shows statistically significant association withlower vaccination status scores. Implementation of proper public awareness program and foster proper screening campaigns can resolve the current scenario of deprived vaccination status in India toa greater extent.

Purpose: to compare intensity‐modulated radiotherapy (IMRT) plans generated by segmental multileaf collimator (SMLC, 1‐cm leaf width) and helical Tomotherapy (HT) techniques for patients with cancers of paranasal sinuses and nasal cavity. Method and Materials: Five patients with locally advanced cancers of the paranasal sinuses and nasal cavity previously treated using HT technique were selected for this study. Treatment goals included a prescribed dose of 70 Gy to at least 95% of the PTV over 35 treatments while respecting dose‐volume constraints to OARs. Each patient was planned using Tomotherapy HI‐ART system with 2.5 cm jaw, 0.3 pitch, and 2.5 initial modulation parameters. All five patients were subsequently planned on Pinnacle TPS using the same goals for PTV and OARs for a 9‐field SMLC technique on an Elekta Synergy™ LINAC equipped with 1 cm MLC. Dose volume histograms were generated and compared from both planning systems. Results: HT planning results (average ± one standard deviation (SD)) for PTV70 are: V77 (percentage of PTV70 receiving 77 Gy): 8.0% ± 17.7%; V70: 94.9% ± 0.2%; V65.1: 98.3% ± 1.2%. In comparison, SMLC planning results are: V77: 37.4% ± 43.8%; V70: 95.3% ± 0.7%; V65.1: 98.5% ± 1.3%. Maximum point doses for HT technique are: to optic chiasm (40.0 ± 21.9 Gy), ipsi optic nerve (ON) (39.0 ± 26.7 Gy) and contralateral ON (37.1 ± 22.9 Gy). For SMLC technique: to optic chiasm (41.8 ± 30.4 Gy), ipsi ON (45.2 ± 30.2 Gy) and contralateral ON (39.9 ± 30.1 Gy). Summary: Results are consistent with those of others evaluating HT‐IMRT for cancers of the head and neck, i.e. HT technique achieved a more homogeneous PTV dose coverage while delivering less dose to OARs compared to 9‐field SMLC technique used. Investigations using Synergy‐S™ SMLC, 4‐mm leaf width are underway and will also be presented.