Evaluation of physical and mental health status of orphan children living in orphanages in Sonitpur district of Assam: a cross-sectional study

BACKGROUND

Orphan children living in orphanages are often neglected. These children's physical and mental health status is essential as they are highly prone to malnourishment and psychosocial distress. We aim to evaluate the orphan children's physical and psychosocial status living in orphanages.

METHODS

This study adopted a cross-sectional research design conducted with the children living in the orphanages using a pretested, predesigned schedule. A total of 83 children (aged 5 to 19 years) living in three different orphanages in the Sonitpur District of Assam were randomly selected for the study. Body Mass Index (BMI) for age and height were then determined using WHO standards. Thinness was defined as BMI for age below -2 SD (Standard Deviation) and thinness as height for age below -2 SD. The behavioural and mental status of children aged 10-19 years were evaluated using the Strengths and Difficulties Questionnaire (SDQ-21) with a cut-off value of SDQ score > 15 as the presence of emotional and behavioural distress.

RESULTS

Almost 50% of orphans were in the age group of 10-14 years, 62.7% were females, and 42.2% had a primary level of education. 52.5% of orphans exhibited severe thinness for < -3 SD. Observed severe thinness more among the 5-9 years and 10-14 years (p-value < 0.05) group and among the male orphans (p-value < 0.05). Of 65 children aged 10-19, 18.5% had behavioural and mental distress. Emotional (32.3%) and poor conduct problems (23%) were observed significantly among male adolescents.

CONCLUSIONS

Orphaned children, particularly those living in orphanages, are at risk of malnutrition and experience behavioural and psychosocial problems. Frequent assessments of their physical and mental health are advocated for early detection, prevention, and timely intervention.

Knowledge, Attitude, Practice and Preparedness toward COVID-19 Pandemic among Healthcare Workers in Designated COVID Hospitals of a North-Eastern State of India

The knowledge, attitude, and practice (KAP) of healthcare workers (HCW) toward the COVID-19 pandemic influence their preparedness to accept the preventative measures. This study investigates KAP toward COVID-19 among the HCWs working in two designated COVID hospitals. It was a cross-sectional study. The overall KAP scores were calculated, and the difference in mean scores among various demographic and other variables was tested using t-test and one-way ANOVA. The participants were knowledgeable about transmission modes and disease symptoms and were aware of the preventive measures like hand sanitisations for 96% and 91% for wearing masks. Among the knowledgeable group, 87% were aware of the control measures of COVID-19 infection like isolation and treatment of the infected; quarantine of their close contacts; and 92% had the acquaintance about the avoidance of public transport and crowded places as a safety measure. The HCWs also showed a positive attitude toward keeping distance and staying at home (81.13% strongly agreed) and regularly washing hands (agreed 91%). The mean knowledge, attitude, and practice scores of the study participants were 19.67(±1.85), 27.95(1.81) and 4.61(0.51), respectively. Nurses were found to have significantly better knowledge, attitude, and practice toward COVID-19 than laboratory technicians and pharmacists. HCWs having higher education levels were also found to have better knowledge about COVID-19. The majority of the HCWs who participated in the study also strongly agreed that the referred hospitals are well prepared for infection prevention and control (IPC). Better knowledge, attitude and practices toward COVID-19 may considerably decrease the risk of getting the disease.

One-step fabrication of thermally stable TiO2/SiO2 nanocomposite microspheres by evaporation-induced self-assembly

The evaporation-induced self-assembly of mixed colloids has been employed to synthesize microspheres of TiO(2)/SiO(2) nanocomposites. Small-angle neutron/X-ray scattering and scanning electron microscopy experiments reveal the hierarchical morphology of the microspheres. Although the internal structure of the microspheres, consisting of solely silica nanoparticles, gets significantly modified with time because of the reduction in the high specific surface area by internal coalescence, the same for the composite microspheres remains stable over an aging time of 1 year. Such temporal stability of the composite microspheres is attributed to the inhibition of coalescence of the silica nanoparticles in the presence of titania nanoparticles. X-ray diffraction and thermogravimetric results show the improved thermal stability of the composite grains against the anatase-to-rutile phase transition. Such thermal stability is attributed to the suppression of the growth of titania nanoparticles in the presence of silica nanoparticles. The UV-vis results indicate the confinement effect of the TiO(2) nanoparticles in the silica matrix. A plausible mechanism has been elucidated for the formation of microspheres with different morphology during self-assembly.

Control of buckling in colloidal droplets during evaporation-induced assembly of nanoparticles

Micrometric grains of anisotropic morphology have been achieved by evaporation-induced self-assembly of silica nanoparticles. The roles of polymer concentration and its molecular weight in controlling the buckling behavior of drying droplets during assembly have been investigated. Buckled doughnut grains have been observed in the case of only silica colloid. Such buckling of the drying droplet could be arrested by attaching poly(ethylene glycol) on the silica surface. The nature of buckling in the case of only silica as well as modified silica colloids has been explained in terms of theory of homogeneous elastic shell under capillary pressure. However, it has been observed that colloids, modified by polymer with relatively large molecular weight, gives rise to buckyball-type grains at higher concentration and could not be explained by the above theory. It has been demonstrated that the shell formed during drying of colloidal droplet in the presence of polymer becomes inhomogeneous due to the presence of soft polymer rich zones on the shell that act as buckling centers, resulting in buckyball-type grains.

Distinctive patterns of Her-2/neu, c-myc, and cyclin D1 gene amplification by fluorescence in situ hybridization in primary human breast cancers

BACKGROUND

Human solid tumors undergo clonal evolution as they progress, but evidence for specific sequences of genetic changes that occur in individual tumors and are recapitulated in other tumors is difficult to obtain.

METHODS

Patterns of amplification of Her-2/neu, c-myc, and cyclin D1 were determined by fluorescence in situ hybridization (FISH) in relation to the presence of p53 dysfunction and ploidy in 60 primary human breast cancers.

RESULTS

We show that there are clusters of genophenotypic abnormalities that distinguish lobular breast cancers from nonlobular tumors; that cyclin D1 amplification occurs prior to the divergence of lobular breast cancers from nonlobular cancers; that p53 dysfunction, Her-2/neu amplification, and c-myc amplification are characteristic features of nonlobular breast cancers, but not of lobular breast cancers; and that the frequencies of amplification of all three oncogenes examined increase progressively with increasing aneuploidy, but that each gene exhibits a different profile of increasing amplification in relation to tumor progression. Early amplification of c-myc appears to be an especially prominent feature of hypertetraploid/hypertetrasomic tumors.

CONCLUSIONS

The data suggest that in tumors containing multiple abnormalities, these abnormalities often accumulate in the same cells within each tumor. Furthermore, the same patterns of accumulation of multiple genophenotypic abnormalities are recapitulated in different tumors.

Correlations among p53, Her-2/neu, and ras overexpression and aneuploidy by multiparameter flow cytometry in human breast cancer: evidence for a common phenotypic evolutionary pattern in infiltrating ductal carcinomas

Human solid tumors develop multiple genetic abnormalities that accumulate progressively in individual cells during the course of tumor evolution. We sought to determine whether there are specific sequences of occurrence of these progressive evolutionary changes in human breast cancers by performing correlated cell-by-cell measurements of cell DNA content, p53 protein, Her-2/neu protein, and ras protein by multiparameter flow cytometry in 56 primary tumor samples obtained at surgery. In addition, p53 allelic loss and Her-2/neu gene amplification were determined by fluorescence in situ hybridization in cells from the same samples. We reasoned that if there is a specific order in which genetic changes occur, the same early changes would be found consistently in the cells with the fewest abnormalities. We reasoned further that late-developing abnormalities would not occur alone in individual cells but would almost always be found together with the early changes inherited by the same cells. By these criteria, abnormalities involving p53 generally occurred early in the course of development of invasive breast cancers, whereas ras protein overexpression was found to be a late-occurring phenomenon. Within individual tumors, cellular p53 overexpression was often observed alone in individual cells, whereas ras protein overexpression was rarely observed in the absence of p53 overexpression and/or Her-2/neu overexpression in the same cells. Furthermore, the intracellular level of each abnormally expressed protein was found to increase progressively as new abnormalities were acquired. Infiltrating ductal carcinomas exhibited characteristic phenotypic patterns in which p53 allelic loss and/or p53 protein overexpression, Her-2/neu amplification and/or overexpression, aneuploidy, and ras overexpression accumulated within individual cells. However, this pattern was not a prominent feature of lobular breast cancers. All six lobular breast cancers studied were diploid. p53 allelic loss and/or early p53 overexpression, and late ras cooverexpression in the same cells were less common in lobular breast cancers than in infiltrating ductal carcinomas. Although Her-21neu overexpression was a common finding in lobular breast cancers, Her-2/neu amplification was not observed in these tumors.

Intracellular coexpression of epidermal growth factor receptor, Her-2/neu, and p21ras in human breast cancers: evidence for the existence of distinctive patterns of genetic evolution that are common to tumors from different patients

Multiparameter flow cytometry studies were performed on cells from the primary tumors of 94 patients with breast cancer. Correlated cellular measurements of cell DNA content, Her-2/neu, epidermal growth factor receptor (EGFR), and p21ras levels were performed on each of 5,000 to 100,000 cells from each tumor. When criteria for positivity were matched with those in common use for immunohistochemical studies, 28 of 94 (30%) breast cancers were classified as positive for Her-2/neu overexpression. When similar criteria were applied to the EGFR measurements, 23 of 94 (24%) cases were classified as positive for EGFR overexpression. Similarly, 23 of 94 (24%) cases were classified as positive for p21ras overexpression. By conventional flow cytometric criteria for DNA ploidy, 24 cases were diploid, 28 were tetraploid, and 42 were aneuploid. When the measurements were treated as separate sets of data, the only statistically significant correlations noted were the high frequency of diploid tumors, which did not overexpress any of the three oncogenes studied (P < 0.05), and an association between Her-2/neu overexpression and aneuploidy (P < 0.03). When the data were treated as correlated intracellular measurements, 90 of the 94 tumors studied contained a population of cells in which the intracellular levels of Her-2/neu expression were directly correlated with the levels of EGFR expression in the same cells. The ratio of Her-2/neu molecules to EGFR molecules in the same cells exceeded 1 in the majority of tetraploid and aneuploid cases and was close to or less than 1 in the majority of diploid cases. In nearly all tumors, p21ras overexpression was observed only in cells that overexpressed Her-2/neu, EGFR, or both, and p21ras levels per cell were more closely correlated with levels of EGFR per cell in the same cells than with Her-2/neu levels per cell. The data are consistent with a model in which heterodimerization of Her-2/neu and EGFR in individual cells is achieved by one of several genetic evolutionary pathways, all of which commonly lead to p21ras overexpression. The two major genetic evolutionary pathways identified in this study are an aneuploid, Her-2/neu overexpression-driven pathway seen in 59 of 94 tumors, and a diploid, EGFR overexpression-driven pathway seen in 19 of 94 tumors. All tumors with Her-2/neu:EGFR ratios greater than 2 contained an infiltrating ductal carcinoma component, whereas all infiltrating pure lobular carcinomas had Her-2/ neu:EGFR ratios that were less than 2. All of the genetic evolutionary pathways identified in this study were represented among the 11 tumors from patients who experienced early tumor recurrences.

The accumulation of multiple genetic abnormalities in individual tumor cells in human breast cancers: clinical prognostic implications

PURPOSE

Human solid tumors undergo multiple genetic evolutionary changes as they evolve from the normal state to advanced stages of malignancy. This study characterizes the degree of advancement of primary human breast cancers in their genetic evolutionary pathways, and determines if this is of clinical significance.

MATERIALS AND METHODS

Correlated cell-by-cell measurements of cell DNA content, HER-2/neu protein content per cell, and H-ras protein content per cell were obtained by means of multiparameter flow cytometry on primary tumors from 95 patients with clinically localized breast cancer. Laboratory findings were correlated with subsequent clinical course in 91 of these patients.

RESULTS

Multiple genetic abnormalities were found to accumulate in individual cells in primary human breast cancers. Almost all tumors contained subsets of cells with one, two, or three abnormalities per cell in various combinations. After a median follow-up time of 32 months, 11 of 13 patients with early recurrence had primary tumors in which more than 5% of cells were hypertetraploid, overexpressed HER-2/neu protein, and overexpressed H-ras protein (triple-positive cells). The duration of disease-free survival among patients with primary tumors that contained triple-positive cells was significantly shorter than for patients whose tumors did not contain triple-positive cells. The presence of subpopulations of cells with maximums of only one abnormality per cell or only two abnormalities per cell, in any combination, was of no prognostic significance. Among patients whose nodal status was known, 12 had recurrent disease, and all had positive axillary nodes. Among 36 patients known to have negative axillary nodes, no recurrence has been reported to date.

CONCLUSIONS

The number of genetic abnormalities that accumulate in individual cells in primary breast cancers reflects the degree of advancement of a tumor in its genetic evolutionary sequence, and provides useful clinical prognostic information. Because follow-up duration is still relatively short, and because disease in node-negative patients tends to recur later than in node-positive patients, it is still too early to know if three measurements per cell will be sufficient to improve prognosis in node-negative disease.

Aneuploidy in breast cancer: a fluorescence in situ hybridization study

Although ploidy is associated with the development and progression of most breast cancers, the value of flow cytometric ploidy as a clinical prognostic factor remains controversial. The technique of fluorescence in situ hybridization (FISH) can be used not only to determine overall ploidy, but also to assess the over-representation or under-representation of specific chromosomes in interphase cells. This information may be of prognostic value. We studied 84 primary breast cancers and 20 metastatic tumors by FISH, using chromosome-specific fluorescent centromeric probes. Of these, 100 cases were also studied by DNA flow cytometry. The FISH studies were concordant with DNA flow cytometry with regard to distinguishing aneuploid from diploid tumors in 78% of cases. The FISH data suggested that aneuploidy arises by a process of chromosome complement doubling with subsequent chromosome loss. In tumors that exhibited evidence of more than one round of chromosome complement doubling, the selective accumulation of multiple copies of specific chromosomes or chromosome segments was common. Multiple copies of chromosomes centromeres 1, 3, and 17 were accumulated selectively in the cells of individual tumors more frequently than chromosomes centromeres 7, 11, and 16. Multiple copies of chromosomes centromeres 10 and 20 were selectively accumulated only rarely, if at all. Aneuploidy in breast cancer can be divided into distinct stages using fluorescence in situ hybridization techniques. The stages of aneuploidy provide potential landmarks in the genetic evolution of this disease with possible links to chromosome-specific evolutionary changes.

Preferred genetic evolutionary sequences in human breast cancer: a case study

Multiparameter flow cytometry studies were performed on the cells of an aggressive human breast cancer at the time of diagnosis and at relapse. The aneuploid cells that overexpressed large amounts of both HER-2/neu and ras survived intensive chemotherapy and were responsible for tumor relapse. At relapse, these cells were shown to overexpress simultaneously at least five oncogenes: HER-2/neu, ras, EGF receptor, p53 and c-myc. A partial reconstruction of the genetic evolutionary sequence in this tumor indicated that HER-2/neu overexpression was an early step in the sequence. Subsequent HER-2/neu overexpression, EGF receptor overexpression and p53 protein overexpression were each associated with ras overexpression. The data suggest that ploidy and oncogene overexpression cannot be used as independent clinical prognostic factors. The ability to characterize tumors according to the degree of advancement in the genetic evolutionary might serve as a basis for genetic staging for adjuvant therapy.

Assessing sequential oncogene amplification in human breast cancer

Studies of amplification and/or overexpression of c-myc, HER-2/neu, and H-ras in breast cancer have shown that each is associated with a poor prognosis. The purpose of this study was to explore the possibility that there is a preferred sequence of amplification of these oncogenes in breast cancer. The frequencies of amplification and patterns of co-amplification of c-myc, HER-2/neu, and H-ras were studied in a group of 84 breast cancers. The data suggested a preferred sequence of amplification that consisted of c-myc amplification-HER-2/neu amplification-H-ras amplification. This model was supported by loglinear analysis. In addition, the levels of amplification of JC-A, a DNA fragment newly isolated from a patient with advanced breast cancer, were studied in 61 of these cases. The data suggested that JC-A amplification occurred early. Loglinear analysis supported a model in which JC-A amplification occurred either before or after c-myc amplification but was unrelated to Her-2/neu or ras amplification.

Sequential paraformaldehyde and methanol fixation for simultaneous flow cytometric analysis of DNA, cell surface proteins, and intracellular proteins

A cell fixation and permeabilization procedure consisting of sequential paraformaldehyde and methanol was evaluated and found suitable for concomitant flow cytometric quantification of total cellular DNA, immunofluorescence measurements of cell surface proteins, and immunofluorescence measurements of intracellular proteins. Paraformaldehyde/methanol-fixed cells exhibited significantly greater intracellular antitubulin immunofluorescence than cells fixed with paraformaldehyde or methanol alone (p less than 0.002) and significantly greater intracellular antitubulin immunofluorescence than cells fixed with methanol followed by paraformaldehyde (p less than 0.006). With paraformaldehyde/methanol fixation, cell morphology was well preserved and forward and right angle light scatter properties were sufficiently well maintained to permit gating on these parameters. Cell surface marker staining with fluorescent anti-leukocyte antibodies was unaffected by fixation with paraformaldehyde/methanol. Paraformaldehyde effects on the intensity of DNA staining with propidium iodide were dependent on paraformaldehyde concentration and fixation temperature; these effects were least pronounced at low paraformaldehyde concentrations (0.25% or less), and at temperatures lower than 37 degrees C. Paraformaldehyde fixation may result in differences in propidium iodide staining of DNA in some diploid cells, which may produce small spurious aneuploid peaks in normal peripheral blood leukocytes. Paraformaldehyde fixation also produces an apparent increase in the DNA index of aneuploid cell populations in comparison with methanol fixation, particularly when the DNA index exceeds 1.5. Occasionally, this paraformaldehyde fixation-induced effect is useful in identifying biologically distinct near-diploid subpopulations in tumors.