Technical Considerations and Outcome Analysis of Using Extended Bipaddle Pectoralis Major Myocutaneous Flaps for Reconstructions of Large and Complex Oral Cavity Defects: Expanding the Horizons

Reconstruction of large and complex defects arising from resection of advanced oral cancers requires free flaps or multi-staged reconstructions using a combination of pedicled flaps. Bipaddle (pectoralis major myocutaneous (PMMC) flap is a good alternative for reconstruction of such defects, especially in low-middle-income countries (LMIC). However, care should be taken while expanding its limits to avoid unnecessary morbidity. We discuss technical considerations while extending the PMMC flap design beyond the usual boundaries and analyse surgical and quality of life (QOL) outcomes in our patients with large (≥ 10 cm) oral cavity defects while using extended bipaddle PMMC flaps. We retrospectively analysed the results of 72 oral cancer patients with large buccoalveolar defects with at least one dimension ≥ 10 cm who underwent single-stage reconstruction using extended bipaddle PMMC flaps between January 2018 and December 2019. Total flap loss was seen in one patient and partial loss in 10 (13.8%) patients, while 18 (25.1%) patients had major complications (Clavien-Dindo grade III). Discharge from hospital was delayed beyond a mean of 6 days in 15 (20.8%) patients and the start of adjuvant treatment was delayed in 5 patients (6.9%). On univariate analysis, age > 50 years, female gender, the largest dimension and flap area were significant factors increasing morbidity. The QOL outcomes were acceptable. The satisfactory results from our series reaffirm that extended bipaddle PMMC flaps are a viable alternate option for such reconstructive challenges in resource-limited centres. However, age, gender, the defect dimensions and flap area should be taken into consideration while using this flap.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13193-021-01345-1.

Effect of Postsurgical Nurse-led Follow-ups on Quality of Life in Head-and-Neck Cancer Patients: A Pilot Randomized Controlled Trial

Objective:

Burden of head-and-neck cancer is disproportionately bigger in India and can be regarded as “tip of iceberg” situation. Postoperatively, head-and-neck cancer patients report tremendous challenges conversely, affects quality of their life. Oncology nurses contribute significantly in supportive care issues encountered by patients in the postoperative period. However, there is a paucity of the literature on effect of nurse-led postsurgical education program on quality of life (QOL) of head-and-neck cancer patients.

Methods:

In this pilot randomized controlled, parallel group trial, 64 head-and-neck cancer patients; who were electively planned for surgery were randomized in experimental (n₁ = 32) and control group (n₂ = 32). In the experimental group, participants received structured nurse-led postsurgical education program through virtual mode and control group participants received standard of care. The QOL as an outcome variable was assessed through face-to-face interview at baseline on first postoperative day and postoperative day-4, 15, and 30 follow-ups by using standardized instruments, i.e., EORTC QLQ-C30 and H and N35 questionnaire.

Results:

The experimental group had a significant improvement in global health (P = 0.02), role functioning (P = 0.02), emotional functioning (P = 0.01), swallowing (P = 0.01), and opening mouth (P = 0.02). Postoperative pain and speech problems were most distressing symptoms in participants of both groups.

Conclusions:

The nurse-led postsurgical virtual education programme was found effective to improve the selected domains of QOL and may be used as an adjuvant intervention for head-and-neck cancer patients.

Robust expression of LINE-1 retrotransposon encoded proteins in oral squamous cell carcinoma

BACKGROUND

Oral Squamous Cell Carcinoma (OSCC) results from a series of genetic alteration in squamous cells. This particular type of cancer considers one of the most aggressive malignancies to control because of its frequent local invasions to the regional lymph node. Although several biomarkers have been reported, the key marker used to predict the behavior of the disease is largely unknown. Here we report Long INterpersed Element-1 (LINE1 or L1) retrotransposon activity in post-operative oral cancer samples. L1 is the only active retrotransposon occupying around 17% of the human genome with an estimated 500,000 copies. An active L1 encodes two proteins (L1ORF1p and L1ORF2p); both of which are critical in the process of retrotransposition. Several studies report that the L1 retrotransposon is highly active in many cancers. L1 activity is generally determined by assaying L1ORF1p because of its high expression and availability of the antibody. However, due to its lower expression and unavailability of a robust antibody, detection of L1ORF2p has been limited. L1ORF2p is the crucial protein in the process of retrotransposition as it provides endonuclease and reverse transcriptase (RT) activity.

METHODS

Immunohistochemistry and Western blotting were performed on the post-operative oral cancer samples and murine tissues.

RESULTS

Using in house novel antibodies against both the L1 proteins (L1ORF1p and L1ORF2p), we found L1 retrotransposon is extremely active in post-operative oral cancer tissues. Here, we report a novel human L1ORF2p antibody generated using an 80-amino-acid stretch from the RT domain, which is highly conserved among different species. The antibody detects significant L1ORF2p expression in human oral squamous cell carcinoma (OSCC) samples and murine germ tissues.

CONCLUSIONS

We report exceptionally high L1ORF1p and L1ORF2p expression in post-operative oral cancer samples. The novel L1ORF2p antibody reported in this study will serve as a useful tool to understand why L1 activity is deregulated in OSCC and how it contributes to the progression of this particular cancer. Cross-species reactivity of L1ORF2p antibody due to the conserved epitope will be useful to study the retrotransposon biology in mice and rat germ tissues.

Differentially expressed full-length, fusion and novel isoforms transcripts-based signature of well-differentiated keratinized oral squamous cell carcinoma

Highly keratinized oral squamous cell carcinoma (OSCC) exhibits an improved response to treatment and prognosis compared with weakly keratinized OSCC. Therefore, we aimed to develop gene transcript signature and to identify novel full-length isoforms, fusion transcript and non-coding RNA to differentiate well-differentiated (WD) with Moderately Differentiated (MD)/Poorly Differentiated (PD)/WD-lymphadenopathy OSCC through, HTA, Isoform sequencing, and NanoString. Additionally, specific copy number gain and loss were also identify in WD keratinized OSCC through Oncoscan array and validated through Real-time PCR in histopathologically characterized FFPE-WD keratinized OSCC. Three-hundred-thirty-eight (338) differentially expressed full-length (FL) transcript isoforms (317 upregulated and 21 down-regulated in OSCC) were identified through Isoform Sequencing using the PacBio platform. Thirty-four (34) highly upregulated differentially expressed transcripts from IsoSeq data were also correlated with HTA2.0 and validated in 42 OSCC samples. We were able to identify 18 differentially expressed transcripts, 12 fusion transcripts, and two long noncoding RNAs. These transcripts were involved in increased cell proliferation, dysregulated metabolic reprogramming, oxidative stress, and immune system markers with enhanced immune rearrangements, suggesting a cancerous nature. However, an increase in proteasomal activity and hemidesmosome proteins suggested an improved prognosis and tumor cell stability in keratinized OSCC and helped to characterize WD with MD/PD/WD with lymphadenopathy OSCC. Additionally, novel isoforms of IL37, NAA10, UCHL3, SPAG7, and RAB24 were identified while in silico functionally validated SPAG7 represented the premalignant phenotype of keratinized (K4) OSCC. Most importantly we found copy number gain and overexpression of EGFR suggest that TKIs may also be used as therapeutics in WD-OSCCs.

Oral Submucous Fibrosis- Correlation between Clinical Findings and Histopathological Grading

Introduction Oral Submucous fibrosis (OSMF) occurs in young adults, who are in the habit of chewing tobacco mixed with areca nut and its various commercially available preparations. The disease results in progressive inability to open the mouth due to the submucosal fibrosis initiated by chronic inflammation affecting mainly oral mucosa. Authors undertook the present study to correlate the clinical features of OSMF to histopathological features and to find out aetiopathological factors of this condition. Materials and Methods A total of 123 clinically diagnosed OSMF patients, in the age range of 17 to 70 years were studied. Mouth opening was measured using a scale and was recorded in millimeters. Incisional biopsy was taken from the representative areas in the oral cavity. The patients were graded clinically and histopathologically and results were analyzed and discussed. Result Most of the patients were in the age group of 20-30 years (37.4%) with male predominance. The duration of either tobacco or areca nut chewing ranged from 1 to 35 yrs. Most patients had these habits for 6-19 yrs. Majority (55.3% & 54.5%) of the patients belonged to grade-2 (clinical grading) and intermediate grade (HPE grading) respectively. The HPE grading showed significant and direct association with duration of ill habits. The HPE grading showed significant and direct association with clinical grading (χ2=204.08, p<0.001). Discussion The HPE grading showed significant and direct association with duration of ill habits and also with clinical findings of restriction of mouth opening and inter incisal distance. The HPE findings showed significant and direct association with clinical grading i.e. when the clinical grading increases, the histopathological grading also increases. Conclusion OSMF is a disease with a high incidence. It also carries a significant risk of transformation to oral cancer. As no effective medical and surgical treatment is available for this condition; it is desirable to diagnose OSMF at early stages.

Abstract 3396: Characterization of oral squamous cell carcinoma transcriptome through long read sequencing technology

Large and increasing public-databases of oral squamous cell carcinoma (OSCC) transcriptome sequencing data has been generated through next-generation which has limitation for novel full-length transcript isoforms. Hence, our objective was to identify differential specific OSCC-related novel full length transcript isoforms, long noncoding RNA and fusion genes compared to non-matched oral-cavity control samples through PacBio-RSII platform. The OSCC, patients from different anatomical sites (gingivobuccal region, retro-molar trigone and lower gum) were processed through human transcriptome array 2.0 (HTA2.0). Heatmap generated expression patterns showed two distinct subgroups against control. Both tumor and control samples were individually run on Oncoscan array. On aggregate analysis significant copy number gain of Ch 7p11.2 EGFR gene; and Ch11q13.3-13.4 (FGF19, FGF4, FGF3, LOC101928443, ANO1-AS2, ANO1, FADD, MIR548K, PPFIA1, CTTN, SHANK2) were identified. Based on HTA2.0 and Oncoscan array we pooled six oral cancer and three oral control samples for Isoseq analysis. Differentially expressed full length transcripts between OC and OT were generated through GFOLD and were processed through Reactome Pathway. On considering more than 20 transcript-entities, Metabolism of RNA (22), Developmental Biology (25), Cytokine Signaling (25), Innate Immune System (25), Metabolism of proteins (31), Immune System (35), Metabolism (29), and Signal Transduction (21) pathways were identified. Differential regulation was also validated through HTA2.0. The identified high quality full length transcripts were annotated and classified through Blast2Go in different sub-group under Biological-Process, Cellular-Process and Molecular-function in Level 2. Out of these most highly up-regulated were Type I-Keratins (KRT)-KRT17, -KRT16, -KRT14 and Type-II keratins-KRT6A and -KRT6B showing involvement of formation of cornified envelope, Keratinization, Cell-cell communication, Type I hemi-desmosome assembly and developmental biology pathways. Long non-coding RNA-NMD candidates ARL2-SNX15, RAB4B-EGLN2, SENP3-EIF4A1 and fusion genes-ACTA2–ACTB, ACTB–ACTC1, ACTB–ACTG2, CALML3–CALM3, CKM–CKB, ENO1–ENO3, IGKV1-27–IGKV3-15, IGKV4-1–IGKJ1, IGKV4-1–IGKJ2, IGKV4-1–IGKJ3, IGKV4-1–IGKJ4, KRT6B–KRT6A were also differentially expressed. Additionally, 457 novel full length transcript isoforms including 289 from OC and 168 from OT datasets were identified. Hence, differentially regulated-KRT17, KRT16, KRT14, KRT6A, KRT 6B; long non-coding RNA and identified fusion genes and full length novel transcript isofoms may be the characteristic of these tumors after validation in histo-pathologically characterized FFPE-Keratinized OSCC and may also prove as early detection marker for Keratinized OSCC if identified in pre-neoplastic conditions.

Citation Format: Neetu Singh, Dinesh Kumar Sahu, Ratnesh Kumar Tripathi, Archana Mishra, Satyendra Kumar Singh, Rebecca Chowdhry, Sameer Gupta, Divya Mehrotra, Preeti Agarwal, Madhu Mati Goel, Sudhir Singh, Arun Chaturvedi, Akshay Mishra, Satya Prakash Agarwal, Manish Bajpai, Ravi Kant, Madan Lal Bhatt. Characterization of oral squamous cell carcinoma transcriptome through long read sequencing technology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3396.

Fungal Rhinosinusitis: Microbiological and Histopathological Perspective

INTRODUCTION

On the basis of histopathology Fungal Rhinosinusitis (FRS) is categorized into non-invasive (allergic fungal rhinosinusitis, fungal ball) and invasive (acute invasive, chronic invasive and granulomatous invasive fungal sinusitis). This differentiation helps to decide the treatment. Role of latest molecular methods such as PCR and conventional methods such as KOH microscopy and culture also needs to be evaluated. Therefore, in this study we planned to categorise fungal rhinosinusitis on the basis of histopathology and compare it with other methods such as PCR, culture and KOH microscopy.

AIM

To analyse fungal rhinosinusitis cases by both histopathologically and microbiologically.

MATERIALS AND METHODS

A total of 76 clinically suspected fungal rhinosinusitis cases were included in the study. The tissue of suspected cases were processed and examined by KOH microscopy, histopathologically, culture and PCR. Histopathological examination was done by PAS, GMS and H&E stain.

RESULTS

FRS was diagnosed in 37 (48.68%) cases out of 76 clinically suspected cases of FRS. In which 17 (22.3%) cases were positive by direct microscopy, 21 (27.6%) by culture, 27 (35.5%) by PCR and 14 (18.42%) by histopathology. Approximately 14 cases of FRS were classified according to histopathology; 10 (71.3%) as non-invasive FRS. Out of these 10, 9 (64.2%) were classified as AFRS and 1 (7.14%) as fungal ball. Only 4 cases (28.5%) were diagnosed with invasive FRS. Out of these 4 cases, 2 (14.2%) were of chronic invasive fungal rhinosinusitis, 1 (7.14%) was of granulomatous invasive fungal rhinosinusitis and 1 (7.14%) was of acute fulminant invasive fungal rhinosinusitis. Allergic Fungal Rhinosinusitis (AFRS) is the most common type of FRS. Aspergillus flavus was found to be the most common fungi causing FRS.

CONCLUSION

Diagnosis should not be based on the single method. It should be done by both histopathological and microbiological methods, especially for those cases which are difficult to diagnose.

Juvenile Nasopharyngeal Angiofibroma: Combined Approach for Excision, Transpalatal and Endoscopic; A New Perspective

Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumour, affecting predominantly male adolescents. To describe our experience in diagnosis of angiofibroma and treatment by combined endoscopic and transpalatal route. We analysed a case series of 50 patients of nasopharyngeal angiofibroma in Fisch stages I and II who presented at our institute during a period of four years 2011-2014, their clinical presentation, their treatment by combined transpalatal and endoscopic approach, intraoperative and post operative course, complications and tumour recurrence. Patients were aged 8-26 years. All patients were treated surgically by combined approach endoscopic and transpalatal. The mean operation time was 90 min, and the mean bleeding volume was 300 ml. Only 8 % patients came with recurrence and only 10 % came with palatal perforation (fistula formation). With gratifying results we advocate this novel technique for the treatment of early to intermediate JNA.

Huge ossifying fibroma maxilla

Maxillofacial fibro-osseous lesions comprise a group of face and jaw disorders characterized by the replacement of bone by a benign connective-tissue matrix with varying amount of mineralized substances. Fibro-osseous lesions of the maxilla are not an uncommon tumor. Majority of the lesions with fibrous and osseous components include ossifying fibroma, fibrous dysplasia, cemento-ossifying fibroma, and cementifying fibroma. We present a case of 15-year-old female with huge fibroosseous lesion which was treated with total maxillectomy via a Weber-Ferguson approach. Histopathology established that fibroosseous lesion as an ossifying fibroma.

Abstract A27: DNA methylation and transcriptional dysregulation of miRNA-137 and -193a in premalignant oral lesions and oral squamous cell carcinoma

Background: Oral squamous cell carcinoma (OSCC) is a multistep process arising through the progressive accumulation of multiple genetic and epigenetic events. Tobacco, bidi (tobacco flakes wrapped in a tendu leaf) smoking and alcohol consumption are established risk factors associated with OSCC and premalignant oral lesions (PMOLs) in Indian population. The microRNAs (miRNAs) are non-coding RNAs that leads to gene silencing at the post- transcriptional level by degradation or repression of target mRNA. The miRNA expression may be oncogenic or tumor suppressor and can be regulated epigenetically, either through DNA methylation or histone modification. Tumor suppressor miRNA-137 and -193a are epigenetically silenced in many cancers. In this study, we attempted to elucidate the miRNA methylation and expression in the patient of PMOLs [leukoplakia with (LKP) or without dysplasia (LKPD) and oral submucous fibrosis (OSMF)] and OSCC to determine the potential role of both miRNA as early predictive biomarkers. Both miRNAs methylation was finally correlated with the clinicopathological variables in Indian population.

Material and Methods: Methylation-specific PCR for miR-137 and -193a methylation was performed in biopsy proven tissues; controls (n=34), PMOLs (n=84) and OSCC (n=84) and in corresponding blood samples. Mature miRNA expression was examined using quantitative reverse transcriptase PCR in tissue samples (10 controls, 30 PMOLs and 10 OSCC) using TaqMan chemistry based primers and probes. RNU44 was selected for normalization as an endogenous control for expression analysis. All experiments were performed in triplicate in a clinical setting of a tertiary care hospital.

Results: We observed miR-137 methylation frequency of 48% in tissue and 35% in blood samples of OSCC, and 27% in tissue and 10% in blood samples of PMOL group, as compared to the control samples which showed methylation frequency of 17.6% in tissue and 2.9% in blood samples. Further, we found methylation of miR-193a in patients with OSCC, i.e., 49% in tissue and 39% in blood samples of OSCC group. In PMOL group, methylation frequency of miR-193a was observed in 27% of tissue samples and 10% of blood samples, respectively as compared to the controls which showed miR-193a methylation frequency of 14.7% in tissue and 2.9% in blood samples. The promoter methylation frequency was found higher in histologically well-differentiated OSCC as compared to moderately and poorly differentiated OSCC. Multinomial logistic regression showed tobacco and bidi smoking were significantly associated with methylation of both miRNAs in PMOLs and OSCC group. As compared to controls, significant downregulation of miRNA-137 was observed only in OSCC group (2.23 fold, p=0.049) whereas miRNA-193a was significantly downregulated in both PMOL (LKP: 3.45 fold, p=0.000; LKPD: 3.80 fold, p=0.034) and OSCC group (4.34 fold, p=0.002).

Conclusion: Our results suggest that promoter DNA methylation of both miRNA-137 and -193a in tissue and corresponding blood samples of PMOLs and OSCC group may be predictive biomarkers for early detection and malignant risk in premalignant lesions. Taken together DNA methylation and miRNA downregulation, we concluded that both miRNAs are epigenetically silenced during oral carcinogenesis.

Note: This abstract was not presented at the conference.

Citation Format: Vikram Bhatia, Madhu Mati Goel, Annu Makker, S P Agarwal, Sandeep Kumar, Sudhir K Goel. DNA methylation and transcriptional dysregulation of miRNA-137 and -193a in premalignant oral lesions and oral squamous cell carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Chromatin and Epigenetics in Cancer; Sep 24-27, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2016;76(2 Suppl):Abstract nr A27.

Huge Osteoclastoma of Hyoid Bone: A Case Report

Giant cell tumors (GCT) of hyoid bone are very rare, and only few individual cases were reported in literature. We present such a case of GCT arising from left cornu of hyoid bone. The patient underwent trans-cervical complete excision of the tumour. Postoperatively, patient did well without recurrence or metastasis for 2 years follow up.

Molecular detection of Schizophyllum commune in a case of allergic fungal rhinosinusitis

We present a rare case of Schizophyllum commune causing allergic fungal rhinosinusitis (AFRS) in a 56-year-old immunocompetent woman. In our case, diagnosis of AFRS was based on the history of illness, CT scan findings, culture and PCR. The PCR product was further analysed by sequencing to confirm S. commune. The patient was treated by functional endoscopic sinus surgery (FESS) and antiallergic drugs.

Stridor: an unusual presentation of juvenile nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma is a rare and benign disease, which is mainly found in adolescent male subjects. It is usually diagnosed on clinical grounds on the basis of its presenting symptoms of nasal obstruction, nasal mass and most importantly unprovoked recurrent moderate to severe epistaxis. Imaging studies are only needed to confirm the diagnosis and formulate the management plan. A case of juvenile nasopharyngeal angiofibroma is presented here, which presented to us with severe respiratory distress and stridor. Urgent tracheostomy had to be performed before definitive management could be started. Definitive treatment was excision through modified transpalatal with sublabial route, which resulted in successful outcome.

Cephalometric evaluation of mandibular advancement at different horizontal jaw positions in obstructive sleep apnoea patients: a pilot study

BACKGROUND

The aim of this study was to comparatively evaluate the efficacy of the mandibular advancement device (MAD) at 50% (P2) and 75% (P3) of maximum mandibular advancement, relative to maximum intercuspation (P1) subjectively and objectively.

METHODS

Eighteen subjects previously diagnosed with obstructive sleep apnoea (OSA) were selected for the study. ESS score, VAS score, soft palate angle, MP-H distance, S-H distance, a C4 -H distance, a Pu -p Pu distance and total pharyngeal area were calculated at P1, P2 and P3 positions with the help of an adjustable MAD. The results were statistically analysed.

RESULTS

ESS score, VAS score, soft palate angle, MP-H distance, S-H distance and radius of curvature of airway at P2 and P3 were significantly lower compared to P1, but there was no significant difference between P2 and P3.

CONCLUSIONS

The MAD produced significant improvement in objective signs and subjective symptoms at both 50% and 75% of the maximum mandibular protrusion positions at comparable comfort levels. Therefore, MAD may be given at 50% of maximum advancement in order to reduce dental or temporomandibular joint disturbances.

Seasonal variations in serum levels of thyroid hormones and their relation with seminal quality and libido in buffalo bulls

Blood samples from 15 Murrah buffalo bulls, (10- to 15- years-old) were collected during the summer, monsoon and winter seasons. The serum samples were analysed for thyroxine (T4) and triiodothyronine (T3) by RIA. Semen samples from these bulls were evaluated for various attributes. Sexual behaviour of these bulls was also recorded during the different seasons and was expressed as reaction time and refusal response. T4, T3, (T4 + T3) level and T4:T3 ratio did not reveal significant difference between seasons. Similarly, seminal characteristics did not exhibit any seasonal variation except for the percentage of live spermatozoa. However, the refusal response (no interest in mounting and ejaculating) was highest during summer months. T4 was significantly correlated to T(3) (r=0.53). Overall, T4 showed a positive correlation with seminal volume and initial motility while T3 exhibited a positive correlation with total sperm concentration and percentage of live spermatozoa. T3 was negatively correlated with refusal response only during the monsoon season. Correlation with other seminal and behavioural characteristics were not significant. The results indicated that although the sexual interest of buffalo bulls is reduced during the summer, the bulls can produce semen throughout the year under appropriate feeding and management conditions.

Serum thyroid hormone levels in male buffalo calves as related to age and sexual development

A total of 155 male buffalo calves were classified into 17 groups according to chronological age. The body weight was recorded on a balance or computed. Sera samples were analysed for thyroxine (T(4)) and triiodothyronine (T(3)) by radioimmunoassay. Highest concentration of thyroid hormones (T(4), 87.6+/-17.6; T(3), 3.1+/-0.07 ng/ml) were seen during the first week after birth followed by a gradual decline until two months of age. Later, the mean T(4) and T(3) levels fluctuated between 30 and 40 ng/ml and at around 1.0 ng/ml, respectively, except for a mild peak at 12 to 15 months of age. T4:T3 ratio did not vary significantly among various age groups. Both T4 and T3 were negatively correlated with age.

Circulating concentrations of thyroid hormones in pregnant camels (Camelus dromedarius )

Blood samples from 16 female camels were collected at monthly intervals commencing from 60 d post. breeding until the last month of gestation. Two camels failed to conceive and two had unnoticed abortions. The average gestation period was 398+/-13 and 372+/-11 in camels bearing male and female fetus, respectively, with an overall mean of 383+/-9 d. Sera were analyzed for thyroxine (T(4)) and triiodothyronine (T(3)) by radioimmunoassay. Mean T(4) and T(3) concentrations varied from 76 to 116 ng/ml and 0.73 to 1.32 ng/ml, respectively, during various stages of gestation. In general, the T(4) and T(3) levels were higher during early pregnancy, with lowest values in the tenth month. T(4):T(3) ratio showed minor, nonsignificant fluctuations. Age of dam of sex of fetus had no effect on hormone levels. Similarly, hormone levels were not affected by failure of conception or by abortion.

The effect of mouth breathing on dentofacial morphology of growing child

BACKGROUND

The oral mode of respiration cause postural adaptations of structures in the head and neck region producing the effect on the positional relationship of the jaws.

AIM

The aim of this study is to verify the skeletal relationship of mouth and nose breathing child.

STUDY DESIGN

A cross sectional study was performed to assess the association of changed mode of respiration with dentofacial growth.

MATERIALS AND METHODS

One hundred children among which 54 were mouth breathers and 46 were nasal breathers of 6-12 years of age were submitted to clinical examination and cephalometric radiographical analysis. Statistical analysis : Chi-square test for proportions and independent sample's "t" test for parametric data is used.

RESULT

The mean values of N-Me (P<0.001) ANS-Me (P<0.001) and SN-GoGn (P<0.001) for mouth breathers is significantly higher. ArGo-GoMe (P=0.003) and (P<0.011) for 6-9 and 9-12 years age group, respectively, were significantly low in nasal breathers group.

CONCLUSIONS

Changed mode of respiration was associated with increased facial height, mandibular plane angle and gonial angle.

Preparation, characterization, and in vitro antimicrobial assessment of nanocarrier based formulation of nadifloxacin for acne treatment

The objective of the present study was to develop a nanocarrier based formulation of nadifloxacin and to investigate its in vitro antimicrobial effect against Propionibacterium acnes. Nanocarrier based microemulsion formulations were prepared by aqueous titration method, using oleic acid as oil phase, Tween-80 as surfactant and ethanol as co-surfactant in different ratios. This procedure yielded monodisperse microemulsions exhibiting a mean droplet size in the range of 95-560 nm. This range of particle size is good to treat follicle related disorders like acne vulgaris because the size of follicles is in the range of 50-100 microm. Furthermore the optimized formulations were characterized for surface morphology by transmission electron microscopy and refractive index. The permeation studies were carried out using rat skin mounted in Franz diffusion cells. Flux of the optimised formulation was 2.24 times that of control. The diameter of inhibition zone of the microemulsion was found good but smaller than that of a clindamycin disc because of the higher therapeutic efficacy of clindamycin against P. acnes. The results indicated that the developed microemulsion shows promising results against P. acnes bacteria and may be a good approach for acne treatment.

Determination of Artemisinin in Bulk and Pharmaceutical Dosage Forms using HPTLC

A new, simple, rapid, accurate and precise HPTLC method was developed. The detector response was linear for concentrations between 100-600 ng/spot (r =0.9931). The limits of detection and quantitation were 25 ng/spot and 75 ng/spot, respectively. The recovery study was carried out by standard addition method and was found to be 99.60+/-0.27. Statistical analysis proved that the method was precise, accurate and reproducible, and hence was suitable for the routine analysis of artemisinin.

Compliance of Bhabhatron-II telecobalt unit with IEC standard - Radiation safety

Bhabha Atomic Research Centre, Mumbai, India designed and developed a telecobalt unit, which was named as Bhabhatron-II. In this paper, the results pertaining to radiation safety of indigenously developed Bhabhatron-II telecobalt unit are reported. The various tests were carried out as per requirements of International Electrotechnical Commission standard and acceptance criteria developed nationally. Various devices such as CaSO4:Dy based thermoluminescent dosimeters, farmer type ionization chamber, water phantom and radiographic films were used. All the parameters pertaining to radiation leakage/transmission were within the tolerance limits as per IEC-60601-2-11 standard except the collimator transmission through X collimators (upper jaw), which marginally exceeds the tolerance limit.

Prompt laboratory diagnosis in timely containment of a plague outbreak in India

A focal outbreak of pneumonic plague occurred in a hamlet of village Hatkoti, district Shimla, Himachal Pradesh in the first fortnight of February, 2002. A total of 16 cases with 4 deaths were reported. Diagnosis of plague was confirmed by the laboratory in 10 (63%) cases. Y. pestis was isolated from clinical samples of 3 cases and confirmed by bacteriophage lysis. Molecular tests confirmed the presence of Y. pestis specific pla and F1 genes in 4 cases; DNA fingerprinting had identity with the known sequence of plague bacilli. Paired samples from 5 cases showed more than 4 fold rise and 1 case showed more than 4 fold fall in antibodies against F1 antigen of Y. pestis. The present communication emphasises that timely and systematic laboratory investigations give confirmatory diagnosis in shortest possible time which forms the backbone of the outbreak control in a timely fashion and prevents confusion and controversy.

Oxidant, vitamin A and angiogenic markers in laryngeal cancer patients

In this study the status of oxidant stress, vitamin A and angiotensin-converting enzyme (ACE) levels were evaluated in cases of laryngeal carcinoma patients from Northern India. In control subjects the levels of malondialdehyde (MDA), vitamin A and ACE were 0.23 ± 0.07 nmole/ml, 2515 ± 84 IU, and 1.4 ± 0.8 U/ml respectively. Thirty laryngeal cancer patients were divided into three groups according to the TNM classification (American Joint Committee on Cancers). In laryngeal cancer patients according to tumour size, MDA and ACE levels increased to 0.32 ± 0.04 nmole/ml and 4.7 ± 0.5 U/ml respectively and the effect was statistically significant (p<0.01). The correlation coefficient between different subgroups was also highly significant (r =0.96, p<0.01). However, serum vitamin A levels decreased to 621 ± 20 IU and the effect was statistically significant (p<0.01). In another two groups of laryngeal cancer patients, a similar pattern of various markers was obtained. Thirty patients with laryngeal carcinoma were divided into four different groups according to nodal involvement and it was observed that in laryngeal cancer patients with no nodal involvement, ACE levels were low 3.6 ± 1.4 U/ml while patients with maximum nodal involvement had the highest levels of ACE 7.1 ± 0.18 U/ml. The correlation coefficient between different groups is highly statistically significant (r = 0.95, p<0.01). In patients with laryngeal cancer the serum MDA and vitamin A levels correlation coefficient between different groups was not significant. It is thus concluded that serum ACE might be a specific test marker for laryngeal cancer disease burden. The use of this marker enzyme for therapeutics is being planned.

Nipah/Hendra virus outbreak in Siliguri, West Bengal, India in 2001

BACKGROUND & OBJECTIVE

The viral encephalitides caused by animal or human viruses are characterized by sudden outbreaks of neurological disease in both tropical and temperate regions. An outbreak of acute encephalitis occurred in Siliguri (West Bengal) town of India between January 31 and February 23, 2001. This outbreak was investigated by a team of scientists from four major institutions, and the findings are presented here.

METHODS

Detailed information about the outbreak was collected with the help of local health authorities. Limited entomological investigations were also done. Samples collected from cases and contacts were sent for analysis.

RESULTS

A total of 66 probable cases and 45 deaths were reported. Epidemiological linkages between cases point towards person-to-person transmission and incubation period of around 10 days. There was neither any concurrent illness in animals nor was there any exposure of cases to animals. Centres for Disease Control and Prevention, Atlanta, USA concluded on the basis of tests carried out on serum specimen from four cases and two contacts that the causative pathogen appears to be Nipah/ Hendra or closely related virus.

INTERPRETATION & CONCLUSION

This outbreak highlights the importance and urgency of establishing a strong surveillance system supported by a network of state-of-the-art laboratories equipped to handle and diagnose new pathogens and including patient isolation techniques, use of personal protective equipment, barrier nursing and safe disposal of potentially infected material in the prevention and control measures for Nipah/Hendra virus infection.

Health sector in India--progress, challenges and the way forward

Health is a priority goal in its own right and a central input into economic development and poverty reduction. Significant achievements have been made in a number of areas which include health parameters, legislation, research and technology and disease control. The life expectancy has gone up by 17% since 1981. In disease control significant achievements are in sight. Some new programmes have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a fundamental one. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like propulation stabilisation, to reduce infant and maternal matality, mobilisationof funds on health, to increase manpower, to increase female literacy and so on. Control of some diseases like HIV/AIDS, vector borne ones, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery. To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research and social factors like sanitation, drainking water availability, female literacy, etc.

Annual risk of tuberculous infection in four defined zones of India: a comparative picture

SETTING

Twenty-six selected districts in India.

OBJECTIVES

To estimate the average annual risk of tuberculous infection (ARTI) in four defined zones in the country.

STUDY DESIGN

A tuberculin survey was conducted in selected clusters of 26 districts in four defined zones of India. Children 1-9 years of age were subjected to tuberculin testing with ITU PPD RT23 with Tween 80, and the maximum transverse diameter of induration was measured 72 h later. Prevalence of infection was estimated using the cut-off point method (Method I) and the mirror-image technique (Method II) among children without bacille Calmette-Guérin scar. Results from individual zones have been reported earlier, and the results from all four zones are presented here as a consolidated summary.

RESULTS

The ARTI computed from estimated prevalence was found to be lowest in the southern zone (Method I: 1.1%, Method II: 1.0%). It was higher in the eastern zone (1.3% by both methods) and highest in the western (Method I: 1.8%, Method II: 1.6%) and northern zones (1.9% by both methods). The proportion of infected children was found to be significantly higher in urban than in rural areas in all zones.

CONCLUSION

The intensified tuberculosis control efforts need to be sustained for many years.

Quick control of bubonic plague outbreak in Uttar Kashi, India

A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the disease can be diagnosed early and mounting of supervised comprehensive response can prevent the disease to proceed to pneumonic stage where man to man transmission gets established and outbreak assumes larger dimensions.

Modified release bi-layered tablet of melatonin using beta-cyclodextrin

A modified release bi-layered tablet of melatonin incorporating a fast release fraction consisting of melatonin-beta-cyclodextrin inclusion complex and a slow release fraction containing melatonin in HPMC K15M and Carbopol 971 P matrices was prepared. The formulation developed showed an initial burst followed by a near zero order release pattern for a period of 8 h. The drug content, physical characteristics and the release profile were unaffected after 3 months of an accelerated stability study at 40 degrees C and 75% relative humidity.

Development of an ophthalmic formulation containing ciprofloxacin-hydroxypropyl-b-cyclodextrin complex

Ophthalmic formulations of ciprofloxacin were formulated using inclusion complexes of ciprofloxacin HCl (CFLX HCl) and hydroxypropyl-beta-cyclodextrin (HP-beta-CD). The complexes were prepared by the method of freeze drying and evaluated by phase solubility studies, differential scanning calorimetry, powder X-ray diffractiometry, fourier transform infrared spectroscopy and scanning electron microscopy. The ophthalmic solutions formulated using the complexed drug exhibited better stability, biological activity and ocular tolerance in comparison to another ophthalmic solution formulated using uncomplexed drug and also in comparison to a marketed preparation.

Evaluation of guar gum in the preparation of sustained-release matrix tablets

Polymeric hydrophilic matrices are widely used for controlled-release preparations. The process of drug release is controlled by matrix swelling or polymer dissolution. It has been shown that the swelling of guar gum is affected by concentration of drug and viscosity grade of the polymer. This study examines the mechanism of behavior of guar gum in a polymer-drug matrix. The swelling action of guar gum, in turn, is controlled by the rate of water uptake into the matrices. An inverse relationship exists between the drug concentration in the gel and matrix swelling. This implies that guar gum swelling is one of the factors affecting drug release. The swelling behavior of guar gum is therefore useful in predicting drug release.