Cancer deaths in India: is the model-based approach valid?

The model-based cancer mortality estimates for India (775,800) are nearly double the data-based estimates (433,000), and are higher than even the incidence estimates (612,300). The model-based approach is therefore, at least in the case of India, incorrect. Established practice is to use real data to validate theoretical models, not to reject the data if apparently the model does not fit.

An approach to consumer feedback in an out-patient specialty service

Details an approach to consumer feedback in an out-patient specialty service. Outlines the approach to undertaking a consumer survey and how feedback from people using the Genito-Urinary Medicine services can be obtained. The aim of the survey was to assess the level of individual/personal care. Gives the objectives and methodology, main findings and recommendations, together with a cost benefit analysis of the work.

Primary prevention trial of oral cancer in india: a 10-year follow-up study

Oral cancer is caused by chewing and smoking of tobacco. To assess the feasibility of primary prevention of oral cancer, two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state. The intervention cohort consisted of 12212 tobacco users aged 15 yr and over, who were exposed to a concentrated program of education against tobacco use. The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use. The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort. The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related. This study demonstrated feasibility of primary prevention of oral cancer.

Icterometer: a useful screening tool for neonatal jaundice

One hundred and sixty one jaundiced newborns were investigated for the usefulness of perspex icterometer as a screening tool for neonatal jaundice. Along with serum bilirubin estimation, icterometer score was simultaneously obtained in all the cases. The correlation between serum bilirubin and icterometer score was high (r = 0.99). The icterometer was useful in various subgroups. A high sensitivity, specificity, positive and negative predictive value was seen in all the groups. A possible role of icterometer in India for screening newborns with jaundice at peripheral level is highlighted.

Plain radiograph skull: is it really needed in epilepsy?

One hundred and three children with seizure disorder were studied. Plain radiograph skull was normal in all the cases. CT scan skull done in 34 patients, showed abnormalities in 24 cases. More than 80% children in partial seizures group had treatable lesions on CT scans, mainly CNS tuberculoma. The need for omitting plain radiograph skull as a routine investigation for epilepsy cases is emphasized.

Alopecia with rickets: an end organ unresponsiveness to 1,25-dihydroxyvitamin D--a case report

Two siblings of a rare syndrome of vitamin D dependent type II rickets are reported for the first time from India. The clinical and biochemical picture was characterised by florid rickets, alopecia, hypocalcemia and resistance to therapy with high dosages of vitamin D3. Due to lack of facilities for estimation of 1,25(OH)2D, alopecia remains the only clue to the diagnosis of this rare syndrome in association with resistant rickets.

Effect on the incidence of oral submucous fibrosis of intervention in the areca nut chewing habit

Incidence of oral submucous fibrosis was calculated from a 10-yr prospective intervention study of 12,212 individuals with a strong component of health education on tobacco and area nut chewing. Based on 11 new cases among 6341 chewers, the annual incidence was 8.0 per 100,000 among men and 29.0 for women. An earlier 10-yr follow-up study, with no intervention component, served as control. Based on 11 new cases among 3,809 chewers, the annual incidence was 21.3 per 100,000 for men and 45.7 for women controls. Although the decrease in the incidence in the intervention cohort was not statistically significant due to small number of cases, the results underscored the causal role of areca nut chewing and indicated the potential for primary prevention of oral submucous fibrosis.

A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut

A case-control study to elucidate the etiology of oral submucous fibrosis was conducted in Bhavnagar, Gujarat. Sixty consecutively arriving oral submucous fibrosis patients at a dental clinic were selected as cases. An equal number of controls matched for age, sex, religion and socioeconomic status were selected from individuals who did not exhibit any oral mucosal lesion or condition. Among cases, 98% chewed areca nut regularly in one form or the other whereas among controls 35% chewed areca nut, giving an overall relative risk of 109.6. Areca nut chewing was practiced most commonly in the form of mawa: a mixture containing mainly areca nut (over 90% by weight), some tobacco, and a few drops of lime. Mawa chewers and those who chewed mawa along with other chewing habits showed very high relative risks. The relative risks increased with increase in the frequency as well as the duration of chewing habits. In a bivariate analysis the effect of frequency and duration of chewing appeared to be multiplicative. The present findings confirm areca nut as the most important etiologic factor in oral submucous fibrosis.

Spinal muscular atrophy: some easy clues to diagnosis

Seven cases of benign form of spinal muscular atrophy were studied to evaluate the importance of detecting hand tremors, muscle fasciculation, evertion of foot and ECG tremors to distinguish these cases from muscular dystrophy. Taken in combination, diagnosis of all the seven cases was possible without the need for application of more sophisticated and invasive investigations, e.g., EMG, nerve conduction study, CPK levels and muscle biopsy.

Central papillary atrophy of the tongue among bidi smokers in India: a 10-year study of 182 lesions

The occurrence of central papillary atrophy of the tongue among tobacco users, its clinical characteristics and the long term behavior in relation to changes in tobacco use was studied in 182 individuals in Ernakulam district, Kerala, India. Almost all (98%) lesions occurred among bidi smokers. Clinically, about 31% occurred in combination with bidi smoking associated lesions such as palatal erythema (14%), leukoplakia (8%) or both (3%). Histologic evaluation in 12 biopsies using single PAS stained sections showed candidal hyphae in 67%. A 10-yr follow-up (mean: 6.7 yr) of the 182 lesions showed that the regression was highest (87%) among those who stopped their smoking habit and persistence among those who did not reduce or stop their smoking habits. The findings from this study confirm a strong link between bidi smoking and central papillary atrophy of the tongue in rural Indian populations.

Immunoglobulins profile of measles

Immunoglobulins profile was carried out in 60 cases of measles (30 each with and without complications) and 30 age and sex matched controls. Antibody titres and immunoglobulins levels (IgG, IgM and IgA) were determined by hemagglutination inhibition and single radial immunodiffusion techniques, respectively. Though higher IgG and IgM levels were found in complicated cases compared to controls, more importantly lower IgA levels were seen in these cases. As most of the measles complications are secondary bacterial infections of mucosal surfaces, it is postulated that these patients might have been selected for a relatively severe form of the disease due to either a pre-existing or induced IgA deficiency.

An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia

A cohort of 12,212 tobacco users was followed up annually to assess malignant potential of oral precancerous lesions in the Ernakulam district in Kerala, India. A total of 19 new oral cancers were diagnosed over a period of 8 years, and 15 (79%) of these arose from some preexisting precancerous lesion or condition. Nodular leukoplakia showed highest rate of malignant transformation (16% per year) as six of 13 nodular leukoplakia underwent malignant transformation over a mean follow-up period of 2.8 years. The relative risk (3243.2) compared with individuals with tobacco habits but without any precancerous oral lesion was also the highest for nodular leukoplakia. In addition, nodular leukoplakia was associated with submucous fibrosis in two patients, which progressed to oral cancer and was the clinical diagnosis for four lesions that turned out to be malignant on histopathologic examination. Nodular appearance was noted in two other precursor lesions as well. Thus, 14 of 19 oral cancers (74%) were either preceded by nodular leukoplakia and with lesions showing a distinct nodular appearance, or had the clinical appearance of nodular leukoplakia.

Leukoplakia and incidence of oral cancer

Reports from India showing comparatively lower prevalence rates of oral leukoplakia and lower malignant transformation rates than in western countries appear paradoxical because of high incidence rates of oral cancer in India. On a closer examination of available data however, it becomes clear that there is no inconsistency.

Regional variations in oral submucous fibrosis in India

Regional variations in the characteristics of submucous fibrosis were studied in two districts in India. In Pune district this condition involved soft palate, uvula and retromolar areas significantly more often than in Ernakulam district. The tongue, floor of the mouth and the hard palate were not involved in Pune. The age of the patients in Pune district was lower than in Ernakulam district. Associated oral cancer, leukoplakia and petechiae were observed solely among patients in Ernakulam. The most important etiologic factor for submucous fibrosis is the chewing of areca nut, and in both areas studied all patients chewed areca nut. In Pune, cured areca nut without other ingredients was chewed by 66% and in Ernakulam, raw areca nut was chewed as an ingredient of pan with tobacco by 100%. Thus in Ernakulam, the juice and the quid were mostly spat out, whereas in Pune they were swallowed. The regional variations in the characteristics of submucous fibrosis could be related to the differences in the areca nut chewing habit between the two areas.

Structure of a water-soluble polysaccharide from the seeds of Cassia angustifolia

A water-soluble galactomannan consisting of D-galactose and D-mannose in the molar ratio 3:2 has been isolated from the seeds of Cassia angustifolia. Hydrolytic fission of the methylated polysaccharide resulted in three methylated sugars: (a) 2, 3-di- O-methyl- D-mannose, (b) 2, 3, 4-tri- O-methyl- D-galactose, and (c) 2, 3, 4, 6-tetra- O-methyl- D-galactose in the molar ratio 2:1:2. Partial acid hydrolysis of the polysaceharide afforded five oligosaccharides: (a) epimelibiose, (b) galactobiosylmannose, (c) mannobiose, (d) mannotriose, and (e) galactobiose. Periodate oxidation of the polysaceharide indicated 59.7% end group while methylation gave 60%. Sodium borohydride reduction of the periodate oxidised polysaceharide and subsequent hydrolysis revealed the presence of (1-->4) and (1-->6)-glycosidic bonds. Thus, the main chain of the galactomannan was found to consist of (1-->4)-linked mannoypyranosyl units having beta-glycosidic bonds while (1-->6)-linked alpha-glycosidically bonded galactopyranosyl units form the branching points.