Rashmi Bagga

Background: Malignant ascites is a common presentation in advanced high-grade serous ovarian carcinoma (HGSOC), yet its immune composition and genetic correlates remain poorly defined. This study explored the immune microenvironment of ascitic fluid in ovarian carcinoma and its association with BRCA mutation status, chemotherapy response, and survival. Methods: Ascitic fluid from 133 patients (33 non-malignant controls, 31 non-ovarian carcinoma, and 69 HGSOC cases) was analyzed using multiparameter flow cytometry to quantify lymphocyte and macrophage subsets, and programmed cell death 1/programmed cell death ligand 1 immune-checkpoint marker expression. Targeted sequencing of TP53 and BRCA1/2 was performed in HGSOC, and findings were correlated to immune parameters, chemotherapy response, progression-free and overall survival. Results: Ovarian carcinoma ascites, compared with non-malignant effusions, showed increased CD3+ and CD8+ T-cell frequencies, higher regulatory T cell (Treg)–associated populations, and reduced CD19+CD20+ B-cell levels. Targeted sequencing identified TP53 mutations in 97.4% and BRCA1/2 mutations in 35.9% of sequenced HGSOC cases. BRCA-wild-type cases showed significantly lower CD4+ T-cell and B-cell levels, higher Treg levels, and shorter progression-free and overall survival than BRCA1/2-mutated cases. Higher CD3+ and CD8+ T-cell levels were associated with poor chemotherapy response. In exploratory multivariable Cox models, BRCA-wild-type status remained significantly associated with poorer overall survival, whereas immune-cell groups were not independently significant. Conclusions: HGSOC ascites showed a Treg-enriched immune profile, with relatively higher Treg levels in BRCA-wild-type cases. BRCA-wild-type status was associated with poorer outcomes, while the evaluated immune-cell subsets were not independently prognostic in exploratory analysis. Ascitic fluid-based immune and molecular profiling may provide prognostic information worthy of validation in larger independent cohorts.

Advanced cervical cancer remains a major cause of mortality in women worldwide as it has limited treatment options and recurrence is very common. This highlights the necessity to develop patient-derived organoids (PDOs) as preclinical models that can recapitulate the clinical heterogeneity of the cancer in terms of molecular features and genetic background. The PDOs have potential for guiding personalized treatment in clinical practice. In this study, we have established patient-derived cervical cancer organoids from biopsy samples of five patients with two different histological subtypes (squamous cell carcinoma and adenocarcinoma) using a modified protocol. The organoids were characterized to assess their genetic and phenotypic similarity to the parental tumor tissue. The organoids developed in vitro preserved several characteristics of the parental tumors, including histological features, HPV status and a subset of genomic alterations. The expression of cervical cancer-related genes, including PIK3CA, MET, and LRP1B, was found to be comparable between the organoids and the parental tumor tissue. Moreover, characterization of the PDOs after cryopreservation showed the histopathological features of the parental tumor tissue. This study demonstrates that the CERvical Cancer OrganoidS (CERCOS) established using the current protocol hold potential to serve as a platform for personalized medicine.

Cervical cancer remains the leading gynaecological malignancy in India, with a disproportionate burden among underserved populations. Although HPV vaccines have been available since 2008, national coverage has been hindered by safety concerns, misinformation, sociocultural resistance, and logistical barriers. The introduction of Cervavac, an indigenously developed quadrivalent HPV vaccine, marks a pivotal shift in India's immunisation landscape. By improving affordability and supply stability, Cervavac offers a sustainable path forward. State-led initiatives in Sikkim, Punjab, and Delhi highlight the effectiveness of school-based delivery and community mobilisation. Implementing HPV vaccination into the National Immunisation Schedule is a critical step. Leveraging infrastructure and strategies from the COVID-19 vaccination campaign, such as digital tracking, inter-sectoral coordination, and public trust-building, can enhance implementation at scale. To achieve the WHO's cervical cancer elimination targets, India must pursue a dual approach: gender-neutral HPV vaccination alongside accessible, structured cervical screening programmes. A coordinated, evidence-based strategy is essential for equitable and sustained public health impact.

Background: Perinatal social support and maternal education throughout the antenatal, childbirth, and postpartum phases contribute to the optimization of health and well-being of mothers and infants. Understanding deficits among support and educational resources can contribute to improved public health decision-making and maternal and child healthcare and wellbeing. This study aimed to explore health and social experiences and resources to characterize and unmet needs across the perinatal period. Methods: We conducted a qualitative study among 20 primiparous postpartum women from Punjab state, North India. Potential participants were identified from antenatal care registers maintained at healthcare sub-centers and were interviewed at their homes. Data were analyzed thematically, examining social support resources and needs across perinatal phases by social support domain: emotional, tangible, and informational. Results: Study participants received the most social and educational support antenatally. We identified considerably low knowledge surrounding childbirth and low maternal knowledge and social support around postpartum care and practices. Notable issues reported involved lack of consent, and satisfaction and comfort with childbirth care. Participant narratives highlighted the crucial role of both formal and informal support structures, with a heavy reliance on advice from community health workers (ASHAs), midwives, and doctors. Unmet needs were identified in areas such as post-cesarean section diet and care, institutional childbirth, and ASHA support, along with discrepancies between the advice given and evidence-based practices. While many participants' support needs were met by their networks, these gaps highlight critical areas for systems improvement. Conclusion: This study-identified gaps in maternal knowledge and support, particularly in the post-cesarean and institutional childbirth contexts, are underexplored in existing research. Findings suggest critical areas for improvement in maternal healthcare support, particularly regarding the alignment of advice with evidence-based practices. Programs should focus on educating women about the institutional childbirth process and providing better postpartum care education, especially regarding post-cesarean care and infant care. Strengthening the role of community health workers (ASHAs) with evidence-based training can improve support. Additionally, programs should enhance the integration of both formal (doctors, midwives) and informal support networks to create a more comprehensive care system. Trial registration: This research is part of the formative phase of a larger intervention trial. Trial was prospectively registered with Clinical trial registry of India. (CTRI/2020/12/029800 [Registered on: 15/12/2020].

Background: We evaluated a pilot mobile health (mHealth) intervention aimed at improving postnatal maternal and infant health. The intervention featured provider-led group sessions for education, health care communication, in-person care referrals, and virtual mHealth support for postpartum mothers through weekly calls, texts, interactive voice response (IVR), and a phone app. Objective: We aimed to assess the preliminary effectiveness of the pilot mHealth intervention, MeSSSSage (Maa Shishu Swasthya Sahayak Samooh, which means maternal and child health support group), on infant health knowledge, behaviors, and outcomes at 6 months post partum. We focus on maternal knowledge of infant danger signs and optimal young child feeding practices at 6 months post partum and also evaluate maternal care-seeking behaviors for infants, adherence to age-appropriate immunization, and infant and young child feeding practices such as early initiation of breastfeeding and complementary feeding. Methods: We evaluated the preliminary effectiveness of an intervention on maternal health knowledge among 135 participants in Punjab, India, who completed pre- and postintervention surveys. The intervention, led by research personnel with backgrounds similar to community health officers, aimed to empower society and support universal health coverage if successful. We assessed changes in knowledge of maternal danger signs and the appropriate age for introducing different food groups over 6 months post partum. Additionally, we examined postintervention differences in health-seeking behavior for infants, adherence to age-appropriate immunizations, and adoption of breastfeeding and complementary feeding practices among women in the synchronous (group call), asynchronous (IVR and app), and control arms. Results: Of 12 infant risk factors, maternal knowledge of infant danger signs remained low (mean range: 1.85-2.31 preintervention and 1.81-2.22 postintervention). Participants in the synchronous arm had a statistically significant higher mean increase (mean difference: 0.87, 95% CI 0.06‐1.69) compared to the control arm. Participants in synchronous arms had nearly 3-fold increased odds of infant health checkup by a clinical provider than asynchronous arm participants (odds ratio [OR] 2.72, 95% CI 1.02-7.23). No significant differences were noted in age-appropriate vaccine coverage among infants between arms, though vaccination coverage was more than 80% across all arms. Early initiation of breastfeeding remained low across all arms (~47%). Conclusions: Our pilot study on group-based mHealth education and virtual social support during the postnatal phase showed modest yet promising results. Rigorous testing is crucial to strengthening the limited evidence base for group-oriented mHealth approaches.