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Background Sikkim Himalaya is under consistent distress due to landslides. Abrupt thrust on infrastructure development in the valley regions of Sikkim Himalaya has led to a need for a prior planning to face landslide hazard. A comprehensive study for the identification of landslide hazard zones using landslide frequency ratio and fuzzy logic in GIS environment has been presented for the Lachung valley, Sikkim, India, where a number of hydroelectric projects are proposed. Temporal remote sensing data was used to generate significant landslide causative factors in addition to landslide inventory. Primary topographic attributes namely slope, aspect and relative relief were derived from digital elevation model. Landslide frequency ratio approach was adopted to correlate landslide causal factors with landslide incidences. Further, fuzzy logic method was used for the integration of landslide causative factors in order to delineate the landslide hazard zones. Fuzzy memberships were derived from the landslide frequency ratio values. Different gamma values were used in fuzzy gamma integration process, which resulted different landslide hazard index maps. Receiver operating characteristic curves were prepared to analyze consistency of the resulting landslide hazard index maps. Results Landslide frequency ratio values have emphasised the importance of factors/classes in landsliding. High slope angle (35°-45°), very high slope category (>45°), High and very high relative relief categories; south, southeast and southwest aspects; drainage and lineaments buffer range of 0-50m, 50-100m and 100 to 150m; quartzite/garnet schist and migmatite type of lithology; Sandy loam and Rock/loam classes of soils; fallow land and sparse vegetation classes of land use/land cover were found to be associated with landsliding. Five landslide hazard zonation maps with each comprising five relative landslide hazard zones namely; very low, low, moderate, high and very high hazard zones were prepared by using five fuzzy gamma operators. Maps indicated that steep talus slopes, close proximity to drainages, ridges and spars fall under high hazard zones. Settlement areas were observed in low to moderate hazard zones. Very high hazard zones were observed in steep slopes, cliffs and cut slopes excavated for the roads. Low hazard zones were observed in agricultural terraces and permafrost areas. Conclusions Hence it can be concluded that landslide causative factor’s integration using fuzzy logic has yielded good results for Lachung valley. Frequency ratio method for determination of fuzzy membership value has reduced subjectivity in the model. The final LHZ map (γ = 0.92) can be used for the planning of future infrastructure, settlement and ecological development in Lachung region.

Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.

Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.

Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.

Introduction/BackgroundThe updated 2014 WHO Classification of Tumors of Female Reproductive Organs recognizes low and high grade endometrial stromal sarcoma (HGESS). HGESS is rare and it is unclear whether specific subtypes differ in prognosis.MethodologyHGESS patients treated from 2015 till 2022 were analysed for demographics, disease characteristics, treatment details and outcome.ResultsHGESS was reported in 18 patients. Median age was 57(IQR 48–67); postmenopausal= 12; most common presenting symptom- vaginal bleeding= 15; mean tumor size in stage IA= 3.9cm(2.5–5), stage IB= 9.2cm(7–10.2), stage III-IV= 10cm(3.7–25). Hysterectomy with salpingo-oophorectomy: robotic= 3, laparoscopic= 1, open= 13 and no surgery= 1. Stage IA= 3, Stage IB= 7, Stage IIIC= 1, Stage IVA= 1, Stage IVB= 6. In addition to Cyclin D1 positivity, focal CD10 positivity was seen in 10 cases along with SMA(n=3),desmin(n=2) and caldesmon(n=1). Adjuvant therapy included observation (Stage IA=2, IB=4), radiotherapy and systemic therapy with ifosfamide plus adriamycin (Stage IA= 1, IB= 3). Systemic therapy was given in IIIC= 1, IVA= 1, IVB= 6 (Vemurafenib in 1, 2nd line Rucaparib in 1). Adjuvant therapy in Stage I High ESS was given before 2019, after which observation was adopted. Median OS of 20 months(95% CI 6–34). At last follow-up stage IA patients are disease free and alive, 3 out of 7 stage IB expired with relapse in lungs (pazopanib for 5 months), abdominal wall (palliative care for 1 month) and unknown site confirmed on telephonic follow-up. In Stage III & IV, 1 out of 8 patients is alive. 2-year PFS of Stage IA= 100%, Stage IB= 57.1%, Stage III & IV= 0%. Median follow-up for alive patients was 38 months(IQR 29–48).ConclusionTo our knowledge this is the largest series of HGESS reported from India. Stage IB and higher tumors have a poor prognosis and require newer therapeutic strategies to improve outcome.DisclosuresNone.