An assessment of childhood cancer care services in India - gaps, challenges and the way forward

Background

Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design.

Methods

The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean.

Findings

A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals.

Interpretation

The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally.

Funding

World Health Organization, India provided funding and technical support.

Aortic Thrombus Extending to Left Subclavian in a Patient With Diffuse Venous Thromboembolism on Aromatase Inhibitor Therapy

Concomitant arterial and venous thrombosis is an infrequent event often associated with malignancy, hyperhomocysteinemia, and thrombophilic conditions. Some overlapping pathophysiology mechanisms suggest an association between arterial and venous thrombosis. It is reported that thrombosis in the arterial and venous systems develops through distinct mechanisms affecting inflammatory and oxidative pathways. Recently, the aromatase inhibitors have moved to the forefront of adjuvant hormonal therapy, however, the adverse effects of these agents are not yet fully understood. It is generally accepted that tamoxifen, but not aromatase inhibitors, is associated with an increased risk of thrombosis in women with breast cancer. Here, we report an unusual case of an 87-year-old female on anastrozole therapy with aortic thrombus extending into the left subclavian artery with associated diffuse venous thromboembolism (VTE). An 87-year-old-female with a history of breast cancer in remission, obesity, hypertension, and dyslipidemia presented to the emergency department with new onset of left arm weakness and tingling sensation. Vital signs showed respiratory rate of 20 per minute, oxygen saturation of 95% on 3 L of oxygen via nasal cannula, blood pressure of 150/79 mmHg, and pulse 81 beats per minute. Computed tomography angiography (CTA) neck showed an aortic thrombus extending into the left subclavian artery and bilateral pulmonary emboli (PE). Doppler ultrasound of the lower extremities showed a deep venous thrombosis (DVT) in the left lower extremity. Echocardiography showed no patent foramen ovale. She was started on continuous heparin infusion and subsequently transitioned to an oral anticoagulation medication upon discharge. Symptomatic ischemic lesions of the upper extremity due to thrombosis of the subclavian artery are extremely rare, occurring in less than one percent of the population. While this patient had a history of early-stage breast cancer, she was on adjuvant anastrozole therapy with no evidence of recurrence or further tumor burden as per her outpatient oncologist, who also followed her during her hospital stay. She also had no prior history of thromboembolic disease or clotting disorders. Her only risk factors appear to be her age and her obesity (with a BMI over 30). Nevertheless, the extent of thromboembolism seen in this patient is greater than that might be expected with these factors. This case highlights a concomitant rarity of arterial and venous thrombosis. Also, there are not enough studies on anastrozole effect on thromboembolism. Given these risk factors, we recommend a high degree of suspicion for VTE in patients who are on anastrozole therapy.

Functional group characterization of lactic bacterial biosurfactants and evaluation of antagonistic actions against clinical isolates of methicillin-resistant Staphylococcus aureus

The present study investigated the antimicrobial and antibiofilm potential of biosurfactants derived from Lactobacillus fermentum Lf1, L. fermentum LbS4 and Lactobacillus plantarum A5 against clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA). The cell wall-bound and intracellular biosurfactants were extracted by solvent extraction method. Fourier-transform infrared spectroscopy-based characterization of biosurfactants revealed the heterogeneous chemical composition involving proteins, fatty acids and carbohydrate moieties in LbS4 and A5, while only the sugar and lipid fractions in Lf1. Fatty acid profiling using Gas chromatography-mass spectrometry indicated hexadecanoic acid and stearic acid as the predominant fatty acids in the biosurfactants of all these strains. Biosurfactants demonstrated dose-dependent antibacterial action against MRSA isolates with the highest inhibition zone diameter (30·0 ± 0·0 to 35·0 ± 0·0 mm) recorded at 400 mg ml^-1 . Biosurfactants showed an excellent staphylococcal antibiofilm activity by preventing the biofilm formation and disrupting the preformed biofilms. Visual inspection through scanning electron microscopy witnessed the biosurfactants-induced alteration in the cell membrane integrity and subsequent membrane pore formation on staphylococcal cells. Taken together, our findings emphasize the prospects of biomedical applications of biosurfactants as bactericidal and biofilm controlling agents to confront staphylococcal nosocomial infections.

Efficacy of transcutaneous electrical nerve stimulation on salivary flow rates in normal healthy adults according to gender and age groups

Introduction:

Salivary gland hypofunction might be associated with various local and systemic conditions and is managed with a plethora of therapeutic options with associated side effects. Transcutaneous electrical nerve stimulation (TENS) is one such option with no known systemic side effects for dealing with this crippling condition. The present study was planned with a similar intent of assessing impact of TENS on salivary flow rates in normal healthy adults according to gender and age groups.

Materials and Methods:

The present study was designed as a cross-sectional study on 130 healthy adults wherein unstimulated and stimulated saliva was collected for 5 min in graduated test tubes fitted with a funnel while mean salivary flow rates were calculated. The data were analyzed using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA).

Results:

In the present study, differences between mean unstimulated and stimulated salivary flow rates with TENS were found to be statistically significant for both genders (P < 0.001). Furthermore, in relation to age groups included, maximum increase in salivary flow rate was seen in 20–29 years of age group, though significant results were seen in all three age groups included namely 20–29 years, 30–39 years, and 40–49 years (P < 0.001).

Conclusions:

Based on results from the present study, it could be concluded that TENS comes out to be a safer, nonpharmacological therapeutic option for treating patients with xerostomia.

Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy - A dosimetric comparison: Do we need intensity-modulated radiotherapy?

Background and Purpose:

To examine the feasibility of improving breast-conserving radiotherapy with simultaneous integrated boost (SIB) and analyzing the efficiency of forward versus inverse intensity-modulated radiotherapy (IMRT) techniques in providing the same.

Materials and Methods:

Three-dimensional conformal radiotherapy (3DCRT) field-in-field (FIF) plans with simultaneous and sequential boost and IMRT SIB plans were generated for the datasets of 20 patients who had undergone breast-conserving surgery. The 3 plans were compared dosimetrically for efficiency in terms of planning target volume (PTV) coverage (PTV 95%), homogeneity and conformity, dose delivered to ipsilateral/contralateral lungs (I/L: V10, V20, C/L: Vmean, V5), heart and contralateral breast (Vmean, V30 for heart and Vmean, V1, V5 for C/L breast).

Results:

The FIF 3DCRT plan with SIB (PLAN B) was more homogeneous than the classical technique with sequential boost (PLAN A). There were less hot spots in terms of Dmax (63.7 ± 1.3) versus Dmax (68.9 ± 1), P < 0.001 and boost V107%, B (0.3 ± 0.7) versus A (3.5 ± 5.99), P = 0.001. The IMRT SIB (PLAN C) did not provide any significant dosimetric advantage over the 3DCRT SIB technique. IMRT SIB plan C was associated with increased dose to contralateral lung in-terms of V5 (10.35 +/- 18.23) vs. (1.13 +/- 4.24), P = 0.04 and Vmean (2.12 ± 2.18) versus Vmean (0.595 ± 0.89), P = 0.008. There was 3-fold greater exposure in terms of Monitor Unit (MU) (1024.9 ± 298.32 versus 281.05 ± 20.23, P < 0.001) and treatment delivery time.

Conclusions:

FIF 3DCRT SIB provides a dosimetrically acceptable and technically feasible alternative to the classical 3DCRT plan with sequential boost for breast-conserving radiotherapy. It reduces treatment time by 2 weeks. IMRT SIB does not appear to have any dosimetric advantage; it is associated with significantly higher doses to contralateral lung and heart and radiation exposure in terms of MU.

Structural and Optical Properties of GaN Film on Copper and Graphene/Copper Metal Foils Grown by Laser Molecular Beam Epitaxy

We report the direct growth of crystalline GaN on bare copper (Cu) and monolayer-graphene/Cu metal foils using laser molecular beam epitaxy technique at growth temperature of 700 °C. The surface morphology investigated with field emission scanning electron microscopy revealed that the size of GaN grains for film grown on bare Cu falls in range of 90 to 160 nm whereas large grains with size of ˜200 to 600 nm was obtained for GaN grown on graphene/Cu foil under similar growth condition. The transverse optical mode of cubic GaN and E₂ (high) phonon mode for wurtzite GaN phases were obtained on the GaN film grown on Cu and graphene/Cu metal foils as deduced by Raman spectroscopy. The photoluminescence (PL) spectroscopy studies showed that the near band edge emission peaks for GaN on Cu and graphene/Cu consist two major peaks at 3.26 and 3.4 eV, corresponding to cubic and wurtzite GaN, respectively. The Raman and PL studies disclosed that the mixed phase growth of GaN occurs on these foils and better structural and optical quality for GaN on graphene/Cu foil. The direct growth of GaN on two dimensional graphene on polycrystalline metal foils is beneficial various transferrable and flexible opto-electronics device applications.

Biological tailoring of adjuvant radiotherapy in head and neck and oral malignancies - The potential role of p53 and eIF4E as predictive parameters

BACKGROUND

Recent advances in radiation technology has allowed to significantly reduce toxicity and improve the efficacy of radical radiotherapy in head and neck and oral squamous cell cancers. Insights into molecular biology of carcinogenesis has opened a window for identifying aggressive clinical situations that may benefit with larger clinical target volume (CTV ) margin, broader levels of nodal coverage, or alternative radiation sensitizers.

AIM

To evaluate the potential role of eukaryotic translation initiation factor 4E (elF4E) and p53 as predictive biomarkers in resected margins of head and neck and oral cancers.

MATERIAL AND METHODS

Forty patients with oral cancers and 26 patients with head and neck cancers were evaluated for p53 and eIF4E in their negative surgical margins, for pattern of distribution and outcome.

RESULTS

In oral cancers, 27 patients (67.5%) were positive for p53 and 10 (25%) for eIF4E in surgically negative margins. For head and neck cancer, the values were 13 (50%) for p53 and 9 (34.6%) for eIF4E. Twelve patients with oral cancers and 8 patients with head and neck cancers had local failure or death. The association with these biomarkers did not achieve statistical significance. However, adjuvant radiotherapy had a significant protective value. It improved median survival from 15 to 21 months in patients positive for p53 (P = 0.018) and from 12 to 20 months (P = 0.03) in those with eIF4E. There was no predictive association of subsite, tumor size, or nodal status.

CONCLUSION

The overexpression of p53 and eIF4E in pathologically negative margins may represent a subset of patients who would benefit from early initiation of adjuvant radiation and tailored intensity-modulated radiotherapy (IMRT).

Soft Tissue Changes Following Combined Anterior Segmental Bimaxillary Orthognathic Procedures

AIMS & OBJECTIVES

To analyze the soft tissue response in patients treated by combined anterior segmental bimaxillary procedures.

METHODS

A  Prospective, observational and analytical study was carried out for a period of 2 years involving 37 patients with predefined inclusion and exclusion criteria; lateral cephalograms were taken by the same operator on the standardized unit immediately before and 6 months after surgery; hard and soft tissue landmarks were measured in millimeters to both horizontal and vertical reference lines; any differences in distances were recorded as a surgical change; appropriate statistical test was carried; level of significance was p < 0.05.

RESULTS

All patients underwent anterior maxillary osteotomy with 34 anterior mandibular osteotomies, 2 advancement genioplasties and 1 reduction genioplasty. Analysis showed significant angular, horizontal and vertical change. The significant differences in skeletal variables were observed in N-Pg distance, overjet, overbite, U1-NF angle, L1-Mp angle and soft tissue variables like labiomental angle, upper-lower lip protrusion, upper-lower lip length and lower incisor to labrale inferius distance. Nasolabial angle, interlabial gap and upper incisor exposure were extremely significant.

CONCLUSION

Soft tissue response to surgery is perhaps more predictable after 6 months, so this may be a treatment modality of choice in adult bimaxillary/dentoalveolar protrusion patients who need instant esthetic facial results.

Electrophilic Substitution Reactions of Indoles with Carbonyl Compounds Using Ceric Ammonium Nitrate: A Novel and Efficient Method for the Synthesis of Di- and Tri-Indolylmethanes1

Ceric ammonium nitrate (CAN) is used to catalyse the electrophilic substitution reactions of indoles with carbonyl compounds at room temperature to produce di- and tri-indolylmethanes in high yields.

Clerodendrone, a Novel Hydroquinone Diterpenoid from Clerodendrum Indicum

Chemical investigation of Clerodendrum indicum has resulted in the isolation of clerodendrone, a new member of hydroquinone diterpenoids (which are rare in the investigated family, Verbenaceae). The compound was characterised from its spectral (1D and 2D NMR) data and chemical reactions and was found to contain an uncommon structural pattern with beta-methyl dihydrofuran moiety.

Investigating the photocatalytic degradation property of Pt, Pd and Ni nanoparticles-loaded TiO2 nanotubes powder prepared via rapid breakdown anodization

The present study was performed to investigate the photocatalytic efficiency of the titania (TiO₂) nanotubes (NTs) powder prepared via rapid breakdown anodization sensitized individually with Ni, Pd and Pt metal nanoparticles (NPs). The TiO₂ NTs powder had the length of 5-6 μm, with the outer diameter between 20 and 25 nm and the wall thickness of 3-4 nm as observed in the scanning and transmission electron microscopes. The crystal structure analysis employing X-ray diffraction indicated the presence of Pt, Pd and Ni NPs in face-centered cubic phase over the anatase TiO₂ NTs powder. The photocatalytic degradation of methylene blue (MB) was carried out with these photocatalysts. As a result, the performance of the 2 at.% Pt-loaded Pt-TiO₂ NTs nanocomposite was determined to be superior on comparison to other photocatalysts under the current investigation. Fourier-transform infrared spectra confirmed the absence of any adsorption of MB or degraded products onto the surface of all the photocatalysts. The electron paramagnetic resonance analysis substantiated the e^- transfer interaction from the conduction band of TiO₂ NTs to Fermi level of Pt NPs has resulted in the better photodegradation process. The possible degradation mechanism using Pt-TiO₂ NTs nanocomposites is discussed.

Trends in incidence of Ewing sarcoma of bone in India - Evidence from the National Cancer Registry Programme (1982-2011)

Background

Ewing sarcoma is a malignant tumour found mainly in childhood and adolescence. The present study aims at analyzing the data on Ewing sarcoma cases of bone from the National Cancer Registry Programme, India to provide incidence, patterns, and trends in the Indian population.

Materials and Methods

The data of five Population Based Cancer Registries (PBCR) of Bangalore, Mumbai, Chennai, Bhopal and Delhi over 30 years period (1982- 2011) were used to calculate the Age Specific and Age Standardized Incidence Rates (ASpR and ASIR), and trends in incidence was analyzed by linear and Joinpoint Regression.

Results

Ewing sarcoma comprised around 15 % of all bone malignancies. Sixty-eight percent were 0-19 years, with 1.6 times risk of tumour in bones of limbs as compared to other bones. The highest incidence rate (per million) was in the 10-14 years age group (male -4.4, female -2.9) with significantly increasing trend in ASpR observed in both sexes. Pooled ASIR per million for all ages was higher in male (1.6) than female (1.0) with an increasing rate ratio of ASIR with increase in age. Trend of pooled ASIR for all ages was significantly increased in both sexes. Twelve percent cases were reported in ≥30 years of age.

Conclusion

This paper has described population based measurements on burden and trends in incidence of skeletal Ewing in India. These may steer further research questions on the clinical and molecular epidemiology to explain factors associated with the increasing incidence of Ewing sarcoma bone observed in India.

Hypofractionation in postmastectomy breast irradiation. How safe are we in using standard tangentials?

Aim: Hypofractionation in breast radiotherapy is gaining increasing relevance in routine clinical practice; however, gray areas remain on its safety. Majority of data regarding the same pertains to the treatment of the conserved breast. This study aimed to compare the use of standard wedge-based tangentials (two-dimensional [2D] TW) versus 3D conformal radiotherapy field in the field (3DCRT FIF) with the intent of evaluating if the latter would provide a dosimetric advantage.

Materials and Methods: Twenty-six postmastectomy patients were enrolled in this study. Comparative plans using 2D TW and 3DCRT FIF were generated to deliver 50 Gy in 25 fractions. Dosimetric parameters pertaining target dose, Homogeneity Index (HI), Conformity Index, and dose to normal structures were compared and analyzed. The parameters that achieved significance were evaluated using the hypofractionated plan.

Results: The 3DCRT FIF plan showed better planning target volume coverage, V95% (P < 0.001) and less cardiac dose (V30 and MD) as well as lung V20, V30, MD, and V5 for both lungs (P < 0.001). The dose to the left descending coronary artery (LAD) was also less with a trend toward significance (P = 0.07). The 3DCRT FIF plan also improved HI (P = 0.02). However, the high-dose volume V107% and radiation exposure were not higher. The significant parameters were evaluated in the hypofractionated schedule of 40 Gy/15 Fr. The MD to the heart was 8.96 Gy in FIF plan versus 20.16 Gy in TW plan. The average V20 to the ipsilateral lung was 37.8% versus 65.2%. The average dose to the contralateral breast was 50% less, i.e., 3.92 Gy versus 8.96 Gy.

Conclusion: The results of this study suggest that there would be a significant benefit of using 3DCRT FIF plans for patients being considered for hypofractionated radiotherapy in the postmastectomy setup.

Posterior urethra: Anterior urethra ratio in the evaluation of success following PUV ablation

INTRODUCTION

There are conflicting reports on the criteria with which to determine success following posterior urethral valve (PUV) ablation. The aims of this study were to assess the value of the posterior urethra: anterior urethra ratio (PAR) in predicting successful PUV ablation.

MATERIALS AND METHODS

All neonates and infants with confirmed PUV on voiding cystourethrogram (VCUG) were included. Initial PAR was computed by dividing maximum posterior urethral diameter by anterior urethral diameter. Distances were measured by an on-screen distance measurement tool in the Radiology department, to avoid error. Only oblique images with good voiding phases were used for assessment. All patients underwent cystoscopy and PUV ablation using cold knife. Postoperative VCUG and cystoscopy were performed at 3 months follow-up. Success was defined as cystoscopic resolution of obstruction, in addition to biochemical and radiological improvement, and this was compared with PAR findings. An equal number of age-matched control patients who had a normal VCUG (as a part of evaluation of antenatal hydronephrosis) were also analyzed.

RESULTS

A total of 56 patients (median age 15 days, range 3-250 days) were analyzed between 2013 and 2016. The mean PAR was 1.5 (0.42) in controls and 3.42 (0.75) in those with PUV at diagnosis (P = 0.001). In those with successful PUV ablation (n = 51) the mean PAR was 1.8 (0.21), and in those with residual PUV/stricture (n = 5) the mean PAR was 3.16 (0.54). The difference between these two groups was statistically significant (P = 0.0001). Applying the value of mean + 2 SD of successful PUV ablation, an upper limit of PAR >2.2 was proposed to predict failure. Using this cut-off, 4/7 with PAR >2.2 had confirmed failure, while 48/49 with PAR <2.2 had successful resolution (P = 0.001) CONCLUSION: Whenever the posterior urethra is more than 2.2 times the diameter of the anterior urethra (PAR >2.2) on repeat VCUG following a PUV ablation, a cystoscopy check is essential to rule out residual PUV/stricture.

Paediatric retinoblastoma in India: evidence from the National Cancer Registry Programme

BACKGROUND

Globally, retinoblastoma is the most common primary intraocular malignancy occurring in children. This paper documents the recent incidence rates of retinoblastoma by age and sex groups from the Population Based Cancer Registries (PBCRs) of Bangalore, Mumbai, Chennai, Delhi and Kolkata using the data from the National Cancer Registry Programme.

MATERIALS AND METHODS

Relative proportions, sex ratio, method of diagnosis, and incidence rates (crude and age standardized) for each PBCR and pooled rates of the five PBCRs were calculated for the years 2005/06 to 2009/10. Standard errors and 95% confidence limits of ASIRs by sex group in each PBCR were calculated using the Poisson distribution. Standardised rate ratios of ASIR by sex group and rate ratios at risk were also calculated.

RESULTS

The maximum retinoblastoma cases were in the 0-4 age group, accounting for 78% (females) and 81% (males) of pooled cases from five PBCRs. The pooled crude incidence rate in the 0-14 age group was 3.5 and the pooled ASIR was 4.4 per million. The pooled ASIR in the 0-4, 5-9 and 10-14 age group were 9.6, 2.0 and 0.1 respectively. The M/F ratio in Chennai (1.9) and Bangalore PBCRs (2.0) was much higher than the other PBCRs. Among the PBCRs, the highest incidence rate in 0-4 age group was found in males in Chennai (21.7 per million), and females in Kolkata (18.9 per million). There was a distinct variation in incidence rates in the PBCRs in different geographic regions of India.

Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases

Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism.

Trends in oesophagus and Stomach cancer incidence in Bangalore, India

BACKGROUND

During recent decades, an increase in the incidence of certain oesophago-gastric cancer has been reported in some countries and in India. This study sought to analyze oesophageal and gastric cancer incidence trends in Bangalore by sex and morphology for the period 1982-2007.

PATIENTS AND METHODS

Oesophageal and gastric cancer cases were drawn from Bangalore population-based cancer registry locating in Kidwai memorial Institute of Oncology started in 1982 under national cancer Registry Programme funded by Indian Council of Medical Research. Time trends in sex- and age-standardized cancer incidence rates were analyzed by site and histology over the study period, using relative change.

RESULTS

Age-standardised oesophageal cancer incidence rates increased in males, in females failed to register a significant trend over the study period. Overall, gastric cancer decreased from 9.81 and 5.48 rates per 100 000 person-years in 1982-86 to 9.45 and 5.25 in 2002-07, among men and women, respectively. Where as oesophageal adenocarcinomas increased sharply in both sex, among men, oesophageal squamous cell cancer rates increased steadily from the mid-1982s onwards a bit decline was observed from 1997, the same trend observed in females. The gastric cancer decreased over the study period. There was a marked decrease in the incidence of oesophago-gastric cancer presenting with unknown and unspecified morphology reported.

KEYWORDS

adenocarcinoma, Oesophageal and stomach, incidence, age specific rate, age adjusted rate, population-based registry, trends.

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.

High risk of essential hypertension in males with intron 4 VNTR polymorphism of eNOS gene

In this study 250 patients with essential hypertension were investigated in comparison to 218 normotensives for association with epidemiological parameters. Of these DNA samples from 176 patients and 168 controls were analyzed for intron 4 27bp repeat polymorphism of eNOS gene. The study revealed significantly high risk of essential hypertension for individuals who were obese, with a positive family history and with non-vegetarian food habits. Though the intron 4b/a polymorphism of eNOS gene did not reveal any association with essential hypertension in general, males with a/a genotype of the polymorphism did show significantly high risk for developing hypertension.

Acute toxoplasmosis in nonstem cell transplant patients with haematological malignancies: a study from a regional cancer institute in South India

The frequency of Toxoplasma gondii (Tgondii) infections was investigated during febrile episodes in nonstem cell transplant patients with haematological malignancies (HM). One hundred and sixty-two febrile episodes in 125 HIV-negative patients with HM undergoing treatment at Kidwai Memorial Institute of Oncology, Bangalore, India comprised the study group. Plasma from anticoagulated whole blood was used for amplifying the B1 gene of T. gondii by nPCR. Specific antibodies to T. gondii (IgM and IgG) were tested using commercial kits. Corticosteroid and cotrimoxazole usage during these episodes was 50 and 41%, respectively. Twenty-two of the febrile episodes (14%) were positive for T. gondii; nine of which did not have any other concomitant infecting pathogen and were seen in symptomatic patients. While majority of these (13%) were 'Toxoplasma infection', there was a single case of 'probable Toxoplasma disease' (0.6%). In four of the fatal febrile episodes, T. gondii was the causative agent; two of which did not have any other concomitant infection. None of the patients had undergone stem cell transplantation.

Lymphoscintigraphic evidence of lymph vessel dilation in the limbs of children with Brugia malayi infection

Lymphatic filariasis (LF) is targeted for global elimination by the year 2020. It was earlier believed that LF is mostly a disease of adults. Recent studies indicate that in endemic countries filarial infection starts mostly in childhood even though the disease manifestations occur much later in life. The initial damage to the lymph vessels where the adult worms are lodged is dilation, thought to be irreversible even with treatment. Most of these studies relate to bancroftian filariasis. Studies that address this early pathology in brugian filariasis in humans are scarce. We report here for the first time, the lymphatic abnormalities seen on lymphoscintigraphy (LSG) in children with Brugia malayi filariasis. LSG was performed in 100 children aged between 3-15 years, who were enrolled in the study either because they were microfilaremic; had present or past filarial disease or were positive for antifilarial IgG4 antibodies. Inguinal and axillary lymph nodes were imaged in most children. Dilated lymph vessels were visualized in 80 children and this pathology was evenly distributed in all the three study groups. Lymph vessels dilation was seen even in three year old children. The implications of these findings for management of LF and control programmes are discussed.

Doppler ultrasonography reveals adult-worm nests in the lymph vessels of children with brugian filariasis

Although ultrasonography has allowed 'nests' of live adult worms and dilated lymphatics to be detected in the early stages of infection with Wuchereria bancrofti, previous attempts to locate such adult-worm nests in brugian filariasis have been unsuccessful. In this study, the successful location of live adult Brugia malayi parasites, in the lymphatics of the axilla, thigh, epitrochlear region and/or popliteal fossa of children aged 3-15 years, is described for the first time. The 'filarial dance sign' (FDS), which indicates the presence of live adult worms, was observed in six children with microfilaraemia and in eight children who, though amicrofilaraemic, either had experienced an episode of lymphoedema (one) or were only positive for antifilarial IgG4 antibodies (seven). In bancroftian infection, the adult-worm nests have mostly been seen in asymptomatic but microfilaraemic subjects. The suspected worm nests, 18 in the 14 children, were all confirmed using colour-power and pulse-wave Doppler examinations. The worm nests were distinctly smaller and the wriggling movements were less rapid and less conspicuous than those seen in bancroftian filariasis. The importance of these findings in the management and control of lymphatic filariasis is discussed.

Preliminary findings from a cross-sectional study on lymphatic filariasis in children, in an area of India endemic for Brugia malayi infection

As the more obvious clinical manifestations of the disease are very uncommon in children, lymphatic filariasis has been considered to be primarily a disease of adults. In many recent reports, however, there is evidence indicating not only that filarial infection is commonly acquired in childhood but also that many infected children already have irreversible damage to their lymphatics. The preliminary results of a cross-sectional study on the patterns of Brugia-attributable pathology in 7934 children (aged 3-15 years) who live in an area of India with endemic B. malayi infection confirm these trends. The children were screened for microfilaraemia, evidence of filarial disease, and the presence of antifilarial IgG(4) antibodies. One hundred children who were microfilaraemic but asymptomatic (32), with filarial disease or an history of such disease or microfilaraemia (29) or amicrofilaraemic and asymptomatic but seropositive for antifilarial IgG(4) (39) were investigated further. They were given detailed clinical examinations, their levels of microfilaraemia were evaluated (by counting microfilariae filtered out of blood samples), their lymphatics were explored by Doppler sonography, and their limbs were checked by lymphoscintigraphy. The 'filarial dance sign', which indicates the presence of live adult worms, was detected by sonography in 14 children (apparently the first time this sign has been observed in brugian filariasis). Lymphoscintigraphy revealed dilated lymphatic channels in the limbs of 80 of the children. At the end of the study, each of the 100 hospitalized children was treated with a single combined dose of diethylcarbamazine and albendazole; the aim is to follow-up the treated children every 6 months for 3 years. Even these preliminary results have important implications for filariasis-control programmes and emphasise the need for disability-alleviation efforts among children as well as adults.

Taurine-diabetes interaction: from involvement to protection

Taurine is a sulfur amino acid (2-amino ethane sulfonic acid) and has been claimed for a number of beneficial actions ranging from anti-epilepsy to anti-hypertension. Taurine in diabetes has an age old story; taurine is involved in the development and protection of insulin apparatus. Taurine and insulin both have mutual stimulating actions with hypoglycemic properties. On the clinical front, taurine supplementation has an acceptable beneficial effect in platelet aggregation and, to name few more, in neuropathy, cardiomyopathy, and nephropathy to retinopathy. Recent studies have provided a role for taurine in fetal development and in blocking the transfer of diabetes from diabetic mother to offspring. A number of mechanisms for the actions of taurine have been advocated, from osmoregulation to anti-oxidation. Though sulfonylurea and recently introduced thiazolidinediones are effective, however they are not free from complications, thus there is a need to design new therapeutics. As taurine is also a sulfonyl derivative, it will be of great interest to develop taurine analogues as an alternative therapy. Considering the great involvement of taurine in diabetes, this review may provide a holistic view of taurine in diabetes and in its prevention in this century.

Therapeutic management strategies for type 2 diabetes

Diabetes mellitus type 1 and 2 affects people worldwide and is associated with further complications like macrovascular, microvascular and its effect is observed as retinopathy, cardiovascular diseases, nephropathy and many more diseases. There are numerous suggestions, treatments for presentation and controlling diabetes but no curative agents. Therefore the aim is to prevent or delay onset or control the complications. This work outlines the principle strategies for management of type 2 diabetes.

Evaluation of genetic potential of the polyvoltine silkworm (Bombyx mori L.) germplasm and identification of parents for breeding programme

In the present study, polyvoltine germplasm stock of Andhra Pradesh State Sericulture Research and Development, Institute (APSSRDI) was evaluated for its performance based on quantitative and qualitative traits. Twenty-one oval and 10 peanut cocoon shaped lines were reared in different seasons of the year. Since the polyvoltines are non-diapausing, six generations were reared and evaluated for various economically important traits based on evaluation index and sub-ordinate function statistical methods. Ten top ranked lines obtained by using both the methods were identified as potential parental strains. Among oval lines, APM14, APM11, APM18, APMW9, and APM19, and among peanut lines APMD5, APMD1, APMD3, APMD9 and APMD8 were selected as base material. The identified high yielding lines will be used in various breeding programmes as initial parents for the synthesis of superior polyvoltine breeds/hybrids.