Shalini Thakur

Medicinal plants are frequently used by Gaddi and Gujjar tribes of Kangra and Chamba districts of Himachal Pradesh, India to cure various ailments in humans and livestock. Therefore, extensive field work was conducted to document the traditional use of ethnomedicinal plants by these tribes. Direct interviews of 208 informants were conducted. The data generated through interviews was analysed using quantitative tools such as use-value (UV), factor informant consensus (Fic) and fidelity level (Fl). A total of 73 plant species in 67 genera and 40 families were observed to be medicinal and used to cure 22 ailment categories. The highest number of ethnomedicinal plants was recorded from the family Asteraceae followed by Lamiaceae, Apiaceae, Acanthaceae, Caesalpiniaceae, Polygonaceae, Ranunculaceae, Rosaceae and Rutaceae. Leaves were the most frequently used plant part used to treat various ailments followed by whole plant and roots or rhizomes. Ajuga parviflora, Berberis lycium, Viola canescens, Vitex negundo and Zanthoxylum armatum were the most important medicinal plants used for treating human diseases, whereas Achyranthes bidentata, Aloe sp., Cassia fistula, Podophyllum hexandrum and Pogostemon benghalensis were the most important medicinal plants used for treating animal diseases as per use value. The important ailment categories classified on the basis of factor informant consensus were gastrointestinal and respiratory disorders. The present study revealed that people of the study area are extensively using the ethnomedicinal plants to cure various ailments. Plants with high use value and fidelity level should be subjected to pharmacological investigation for scientific validation.

Artemisia nilagirica is an important medicinal plant found to exhibit several medicinal properties but the use of its leaves for combating E. coli infection has not been scientifically validated in poultry. The present study was conducted to evaluate the protective effects of methanol leaf extract of A. nilagirica (ANE) on E. coli challenged broiler chickens. Three hundred and thirty, day-old broiler chickens, were divided into 6 groups of 55 each, with group EX infected intraperitoneally (I/P) with LD50 dose of 1 × 107 cfu/ml of E. coli; group(s) EA1, EA2 and EA3 infected I/P with 1 × 107 cfu/ml of E. coli and supplemented with ANE @ 0.5, 1.0 and 2.0 g/L of drinking water, respectively; group AX were only given ANE @ 2.0 g/L in the drinking water. ANE treatment was started from day 4 and was continuously given in the drinking water up to day 21. E. coli infection was given to the birds on day 7 of their age. The effect of the plant extract was evaluated on the basis of gross, microscopic and ultrastructural alterations in E. coli challenged broiler chickens. The extract of A. nilagirica was found to show antibacterial, cardioprotective and hepatoprotective properties in a dose-dependent manner on the basis of gross and microscopic examination. The methanol extract of A. nilagirica leaves revealed no toxic effect on the hepatocytes on ultrastructural evaluation. This study demonstrates the antimicrobial, hepatoprotective and cardioprotective activities of ANE in broiler chickens infected with E. coli organism.

Abstract Oral cancer is easily detectable by physical (self) examination. However, many cases of oral cancer are detected late, which causes unnecessary morbidity and mortality. Screening of high‐risk populations seems beneficial, but these populations are commonly located in regions with limited access to health care. The advent of information technology and its modern derivative artificial intelligence (AI) promises to improve oral cancer screening but to date, few efforts have been made to apply these techniques and relatively little research has been conducted to retrieve meaningful information from AI data. In this paper, we discuss the promise of AI to improve the quality and reach of oral cancer screening and its potential effect on improving mortality and unequal access to health care around the world.

Cancer represents an uncontrolled growth of cells that invade and cause damage to the adjacent tissues. Globally oral cancer ranks as the sixth most common type of cancer. As compared to the west, the problem of oral cancer is significantly higher in India. The spectrum of oral diseases is formed with oral cancer at one extreme and potentially malignant disorders (PMDs) at the other extreme. Screening programs for the early detection and prevention of oral cancer indicate that visual examination as a part of a population-based screening program reduces the mortality rate of oral cancer in high-risk individuals. Tobacco and alcohol consumption remains the main factors for oral cancer and education of the population about the ill effects of tobacco and alcohol consumption is necessary at a broader scale.

A pure M-type strontium hexaferrite with nominal composition SrFe12O19 has been prepared via the modified conventional citrate precursor method. The entire work emphasizes on improving the standard of hexagonal ferrite without undergoing high-temperature thermal treatments. By incorporating some adjustments in processing conditions, the prepared sample is sintered at 800 °C and 910 °C, identified through thermal gravimetric analysis (TGA/DTA). The impact of the low-temperature sintering process on structural, spectroscopic, and magnetic properties are investigated via using different characterization techniques like XRD, FESEM, FTIR, Raman spectroscopy (RS), and VSM respectively. The XRD confirmed the formation of the M-phase along with some impurities of Fe2O3 and these results are strongly supported via both FTIR and RS. Similarly, FESEM analysis confirmed the formation of densely packed grains some hexagonal platelets. The magnetic properties of SrM hexaferrites show the increment of saturation magnetization Ms from 81 emu/g to 92 emu/g as the sintering temperature increases from 800 °C to 910 °C. Apart from the higher Ms for SrM hexaferrite, the Hc values 107 Oe and 262 Oe respectively are the vital findings of this research. This rare nature of SrM hexaferrite signifies the erection of soft character in hard SrM hexaferrites. Moreover the abrupt increase in the squarenes ratio (SQR) from 0.26 to 0.54 represents the transformation from multidomains to single domain. Material with such properties can be utilized in switching devices, recording media, high frequency applications.

Majority of patients infected with the COVID 19 virus display a mild to moderate course of disease and spontaneously recover at 14–20 days. However, about 15% of patients progress to severe stages and 2.5% of these patients succumb to this illness. Most patients with severe disease belong to the elderly age group (<65 years of age) and have multiple associated co-morbidities. The immune responses induced by the COVID 19 virus, during the incubation and non-severe stages, requires the early initiation of a specific adaptive immune response to eliminate the virus and prevent the progress to severe stages. In patients with a dysfunctional bridge adaptive immunity, the innate immune response becomes exaggerated due to the lack of feedback from the adaptive immune cells. The resultant cytokine storm is responsible for the severe lung injury leading to acute respiratory distress syndrome seen in COVID 19 patients. Mesenchymal stem cells are known to suppress overactive immune responses as well as bring about tissue regeneration and repair. This immuno-modulatory effect of MSCs could hold potential to manage a patient with severe symptoms of COVID 19 infection due to a dysfunctional adaptive immune system.

Oral squamous cell carcinoma (OSCC) has become a major public health problem in the worldwide for its increasing incidence and mortality, especially in younger trends. Risk factors for OSCC apart from alcohol and tobacco use, include poor oral hygiene, inflammation caused by inadequately fitting dentures and other rough teeth surfaces, poor nutrition and some chronic infections caused by fungi, bacteria or viruses. Several studies have also found that the risk of developing OSCC may increase with periodontal disease (PD). In addition to reduce harm caused by tobacco, alcohol and betel quid it seems prudent to take measures to improve oral hygiene in periodontally compromised patients to minimize OSCC risks. This further intensifies the need for oral health education programs and large cohurt studies to edify individuals about the importance of regular oral health maintenance and routine dental care towards the prevention of oral diseases including OSCC.

Lignin being the second most abundant natural polymer gaining interest as a source for production of biobased chemical, fuel and materials. The presence of phenyl, guaiacyl and syringal derivatives in its structure proves it as a prominent candidate for valorization into various aromatics. Though lignin degradation chemistry is very complicated to understand due to its varying nature from source to source, thermochemical routes like pyrolysis found promising for its valorization. In this study, kinetics of catalytic pyrolysis alkaline lignin was investigated with different catalysts (HZSM-5 and Cu modified HZSM-5) using thermogravimetric technique at three different heating rates (10, 40, and 70 °C/min) from room temperature to 900 °C. Cu modified ZSM-5 catalysts are analyzed using XRD and FESEM-EDS analytical techniques to determine the metallic impregnation in its structure. The average apparent activation energies of alkaline lignin, alkaline lignin + HZSM-5 and alkaline lignin + Cu/HZSM-5 pyrolysis from Friedman (FM), Kissinger-Akahira-Sunose (KAS) and Ozawa-Flynn-Wall (OFW) models are observed to be 116.837, 109.911 and 190.719; 299.346, 191.828 and 218.860; 346.597, 244.754 and 346.339 kJ mol−1 respectively. From Criado's master plots a multistep reaction mechanism was detected for all the pyrolysis processes.

• Examined Lymph node count may vary depending on the patient factors, tumor factors, and surgeon factors. • Improved overall survival is seen in patients with a DOI < 4mm. • Technique of neck dissection may have a significant impact on ELN.

• Skip metastasis is a phenomenon where cancer cells bypass the upper lymph nodal levels and directly metastasize to lower lymph nodal levels. The opinion was written with the intention to underscore the importance of the extent of neck dissection required in these situations and that, the anticipation of complications should not deter the surgeon from providing adequate treatment. • The incidence of perineural invasion is around 28% in oral cancer cases and since it is a poor prognosis indicator, it seems imprudent to base the extent of neck dissection on the presence or absence of it.

The lymph node level ratio appears to be a continuation of nodal yield and nodal density, two prognostic metrics already in use. A retrospective analysis conducted in the current study showed that a value of fewer than 4 lymph nodes/level is linked to a lower overall and disease-specific survival. This letter aims to review the reasoning behind the use of node level ratios and nodal yields as quality and prognostic indicators, and to explore possible factors that could affect these.

• Depth of resection leading to loss of tongue tip sensation seems to be of limited value during the preoperative counselling period. • Post-resection shrinkage is a well-recognized issue and should be considered during the estimation of depth of resection. • Recovery following lingual nerve injury takes several months. Longitudinal assessment of the population should help in the accurate estimation of permanent functional deficits.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

• Platinum-based chemotherapy combined with cetuximab is the first line of treatment for metastatic or recurrent head and neck cancer (HNC), yet its advantages to survival are limited and its toxicity is enhanced. • With certain limits, CPS can be used as a response measure for PD-1 pathway inhibitors, which increase overall survival and safety for HNSCC patients who progress following chemotherapy. • A vital immunosuppressive route in HNSCC, the adenosinergic axis inhibits cytotoxic T-cell activity through extracellular adenosine and its receptors (A2A, A2B). • Patients with HNSCC have an accumulation of regulatory T cells (Tregs), which influence immunological responses and aid in the synthesis of adenosine by means of ectonucleotidases, so promoting immune evasion. • Treg and ectonucleotidase expression quantification in peripheral blood may function as prognostic indicators for immunotherapy response. Treatment efficacy may be increased by focusing on the adenosine pathway, with the use of adenosine receptor inhibitors.

We read with great interest the article titled “Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification” by Bhattacharya et al. 1 Bhattacharya S. Thankappan K. Sukumaran S.V. Mayadevi M. Balasubramanian D. Iyer S. Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification. Int J Oral Maxillofac Surg. 2021; 50: 1533-1539 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The oral tongue is one of the most common sites of oral cavity malignancy and is a critical organ for speech and swallowing. The functions of the oral part of the tongue include speech and articulation, as well as mastication, oral hygiene, and the oral phase of swallowing. 2 Lam L. Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction–a systematic review. Oral Oncol. 2013; 49: 507-524 Crossref PubMed Scopus (100) Google Scholar The oropharyngeal tongue is important for the pharyngeal phase of swallowing and prevention of aspiration, and hence the repair of the defect post glossectomy becomes crucial in restoring the form and function of the tongue.

Brucellosis is one of the neglected zoonotic diseases in humans. The serological methods based on antibody detections are unable to detect the effectiveness of treatment in humans as antibodies persist for long time in humans even after therapy. Therefore, we developed qPCR technique to overcome such discrepancy and device a rapid and efficient test for both diagnosis and follow up of the brucellosis affected individuals.High risk suspected individuals with positive serology (RBPT, STAT and iELISA) and PCR were mainly analyzed for DNA quantification by qPCR assay. The bcsp-31 gene, a shared gene of Brucella species was amplified by genus specific primers and cloned to pGEMT™ easy vector and the cloned plasmid were used to construct a standard curve (R2=0.99, efficiency=1.98) over 7 orders of magnitude with sensitivity of ≈10 copy number. The assay was found 100% specific.Overall 85 individuals were found positive out of 188. Out of them, 23 serological, PCR and qPCR positive individuals were recommended for 45days therapy according to WHO regimen (Doxycycline and Rifampin) and each case was further followed by qPCR. The mean threshold cycle (Cq) before treatment was 26.05±0.347 (3940.5copies/μl), which increased significantly to 32.7±0.66 (259.13copies/μl) on 4th week during treatment, 35.12±3.12 (38.52copies/μl) at 6th week on day of treatment completion, 35.6±0.66 (34.21copies/μl) on 21st day after treatment depicting a significant reduction in DNA load over the course of treatment. Serological follow up showed that only 3 individuals had decreased STAT titre but no change in RBPT results. Out of 17 symptomatic individuals under therapy, 10 improved clinically, 5 improved clinically with persistent weakness and 2 had no effect of therapy.The study suggests that qPCR is more useful and rapid test to follow treated individuals than serology.

Early-stage oral squamous cell carcinoma is treated preferably by wide local tumour excision along with elective neck dissection. The conventional neck dissection leaves an unaesthetic scar, which remains a major challenge that adversely impacts patient satisfaction, their social interactions, and quality of life (QoL). In recent times, retroauricular assisted endoscopic and robotic neck dissection techniques that avoid unaesthetic neck scars have gained popularity. The pitfalls in attaining universal acceptance of these techniques are the need for specialized instrumentation, training, and increased costs. The need for an endoscope or robotic camera when using the retroauricular approach arises mainly while addressing the level I lymph nodes, due to poor access. A combination of transoral and retroauricular approaches that overcomes these factors is presented here, named the transoral retroauricular neck dissection (TREND). The technique successfully avoids a visible neck scar while providing adequate exposure of level I lymph nodes without the need for specialized instrumentation. This approach has been applied, with adequate lymph node clearance achieved in all patients. This novel combination approach of neck dissection is oncologically safe, easy to replicate, and improves patient aesthetics, functional outcomes, and QoL. We recommend that clinicians practice this simple technique and enhance the practice of remote access neck dissection.

Post-radiation primary hypothyroidism is a common late complication in head and neck cancer (HNC) survivors. No radiation dose-volume constraint of the thyroid gland has been externally validated for predicting long-term thyroid function outcomes.This external validation study evaluated the diagnostic properties of 22 radiation dose–volume constraints of the thyroid gland proposed in the literature. Radiation dosimetric data from 488 HNC patients who underwent neck irradiation from January 2013 to December 2015 at two tertiary oncology centers were reviewed. The diagnostic metrics of candidate constraints were computed by inverse probability of censoring weighting and compared using time-dependent receiver operating characteristic (ROC) curves with death designated as a competing event. Multivariable regression analyses were performed using the Fine–Gray sub-distribution hazard model.Over a median follow-up period of 6.8 years, 205 (42.0 %) patients developed post-radiation primary hypothyroidism. The thyroid volume spared from 60 Gy (VS60) had the largest area under ROC curve of 0.698 at 5 years after radiotherapy. Of all evaluated constraints, VS60 at a cutoff value of 10 cc had the highest F-score of 0.53. The 5-year hypothyroidism risks of patients with thyroid VS60 ≥ 10 cc and < 10 cc were 14.7 % and 38.2 %, respectively (p < 0.001). The adjusted sub-hazard ratio for post-radiation primary hypothyroidism for VS60 < 10 cc was 1.87 (95 % confidence interval, 1.22–2.87; p < 0.001).Thyroid VS60 is the best radiation dose–volume parameter to predict the long-term risk of primary hypothyroidism in patients with HNC who underwent neck irradiation. VS60 ≥ 10 cc is a robust constraint that limits the 5-year primary hypothyroidism risk to less than 15 % and should be routinely employed during radiotherapy optimization.

Abstract Tumour metastasis is one of the leading cause of cancer‐related mortality. Circulating tumour cells (CTCs) have been implicated in loco‐regional and distant metastasis and its role is being extensively studied in various malignancies, including those from the head and neck region. The main challenge in understanding their significance lies in the rarity of these cells in the blood. However, newer technologies have attempted to overcome these pitfalls. This review explores the evolution of CTC research and other related areas, including its biological significance, sustainability within the circulating vascular environment and possible clinical implications.

Electronic cigarettes (e-cigarettes) are a popular method to help quit tobacco smoking. However, there is a paucity of data in the literature on their safety and efficacy. Recently, the Indian Government has called for a ban on all e-cigarettes and taken steps to restrict access to vaping products from the market. This major decision was an attempt to safeguard the younger population from using e-cigarette and their possible longer-term addiction together with its promotions by domestic industries. In this article, we evaluate the role of e-cigarettes to help stop smoking tobacco cessation and consider the factors that have facilitated the ban on e-cigarettes in India.

We read with great interest the editorial by Herron JBT et al1 on the Personal protective equipment (PPE) and corona virus disease 2019 (COVID-19). The authors need to be complimented for a well-timed paper that addresses the current issue of exposure of health care workers to COVID-19.

The state of the clinically evident cervical lymph nodes at the time of diagnosis is one of the most important factors impacting long-term survival. While squamous cell carcinomas (SCC) of the hard palate and maxillary alveolus are uncommon in comparison to other primary sites, there is a scarcity of published data on the effective management of the neck nodes for malignancies of these specific subsites. In such circumstances, an intraoperative frozen section or Sentinel node biopsy would aid in the optimal therapy of the neck.

Tonsillar neuroendocrine carcinoma has low incidence and poor prognosis, there is no standard treatment which is mainly by surgery, radiotherapy, or combined with chemotherapy. With announcement of the results of phase III clinical trials of sovantinib in extrapancreatic neuroendocrine carcinoma, sovantinib has shown potential in the treatment of neuroendocrine carcinoma. To our knowledge, there are no reports about the application of sovantinib in tonsillar neuroendocrine carcinoma. We reported a patient with large cell neuroendocrine carcinoma of tonsil, who had developed distant metastasis at the first diagnosis and was not effective after routine chemotherapy; and only temporary remission was achieved with the use of immunotherapy. Then with the subsequent change to sovantinib, long-term disease control without serious adverse reactions was achieved. Therefore, we propose that sovantinib is one of the important alternative treatments for advanced tonsillar neuroendocrine carcinoma.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Head-and-neck cancer represents the 6th-most common malignancy worldwide and the annual incidence of oral cancer exceeds 3,000,000 new cases. Oral cancer is historically linked to well-known behavioral risk factors such as tobacco, smoking, and alcohol consumption.[1] In addition, several dietary factors, nutrition deficiencies, viruses, sexually transmitted infections, chronic irritation, and possibly genetic predisposition have also been associated with oral cancer.[2] Furthermore, several premalignant lesions and conditions such as leukoplakia, erythroplakia, oral submucous fibrosis, and lichen planus carry an increased risk for malignant transformation.[3] Additional risk factors such as chronic oral candidiasis, human papillomavirus, altered oral flora, chronic trauma, and infections also play an important role in disease progression.[4–9] In individuals with significantly lower risk factors and the absence of tobacco exposure, the role of Helicobacter pylori has been explored extensively in the literature. H. pylori is a known causative agent in gastric cancers, however, the exact correlation in oral squamous cell carcinoma (SCC) is still debatable. H. pylori produces a potent cytotoxin vacuolating cytotoxin A that causes progressive vacuolization and gastric injury by disruption of endosomal and lysosomal activity in the host cells. These along with environmental and host genetic factors regulate chronic gastric injury and inflammation leading to gastric carcinogenesis.[10] However, it has been hypothesized that H. pylori causes cell damage and initiates the release of pro-inflammatory mediators that in turn stimulate the host immune system to release cytokines and oxygen radicals, facilitating carcinogenesis. Previous research has found a positive association between premalignant oral diseases and H. pylori infection.[11–14] In one study, 26.4% of observed cases were seropositive for H. pylori, with greater additive risk seen in those exposed to tobacco or alcohol in conjunction with H. pylori.[11] The presence of this bacterium is believed to alter the oral microbiome. The role of H. pylori as a risk factor for oral cancers has been supported by multiple other studies in the literature.[11–13] However, some studies like Meng et al.[14] have demonstrated a negative correlation, requiring further research to conclusively determine the relationship. The diagnosis of inflammatory bowel disease (IBD) including ulcerative colitis and Crohn’s disease is based on a combination of clinical, biochemical, stool examination, endoscopic, cross-sectional imaging, and histological investigations.[15] Besides the gastrointestinal tract, they are also characterized by various extraintestinal manifestations (EIMs), with at least one EIM affecting up to 63.4% of patients, including aphthous stomatitis in 21.6% of patients.[16] Oral lesions are more common in Crohn’s disease as compared to ulcerative colitis.[17] Although the exact pathogenesis of the oral and dental manifestations of IBD is unknown, they are mostly related to the alteration of inflammatory mediators at the cytokine levels.[18] Another common hypothesis that has been put forward is that of immune system dysregulation where a cross-reaction of common antigens occurs in the bowel and oral mucosa.[18] EIMs in patients with active IBD may result from altered cytokine activity in the gastrointestinal tract including the oral cavity.[19] Several studies investigating saliva in patients with IBD found elevated levels of pro-inflammatory cytokines when compared to controls. Said et al.[20] investigated salivary cytokine profiles in patients with ulcerative colitis and Crohn’s disease. They found that saliva levels of interleukin-1β (IL-1β) were elevated in both patient groups compared to controls. However, levels of IL-6, IL-8, and monocyte chemoattractant protein-1 were selectively elevated in ulcerative colitis patients, while tumor necrosis factor-alpha (TNF-α) levels were increased only in Crohn’s disease patients compared to controls. These findings suggest differential salivary cytokine profiles may help distinguish ulcerative colitis from Crohn’s disease. Szczeklik et al.[21] found higher salivary levels of IL-1β, IL-6, and TNF-α in patients with active Crohn’s disease compared to inactive disease and controls.[21] A correlation was observed between elevated levels of pro-inflammatory cytokines IL-6 and TNF-α in saliva and specific oral lesions, such as oral lichen planus.[21] In addition, a strong correlation was seen between lysozyme and IL-1β levels and the relative salivary abundance of different bacteria.[20] The available evidence suggests that oral manifestations of inflammatory bowel disease (IBD), which can be categorized as extraintestinal manifestations (EIMs), may be associated with upregulated pro-inflammatory cytokine levels in the oral cavity of IBD patients. This upregulation appears to be secondary to the systemic immune dysregulation that characterizes IBD. Current evidence confirms that the gut microbiota alterations associated with IBD can lead to dysbiosis of the oral microbiota. This oral dysbiosis subsequently causes localized inflammation that manifests as oral complications of the disease. While oral squamous cell carcinoma remains rare in inflammatory bowel disease patients, the increasing incidence in young individuals with no known risk factors warrants further research into this association. Although oral cancer prevalence in inflammatory bowel disease is low (1.08-1.78%),[22] mandatory oral examinations by experts and a multidisciplinary approach involving gastroenterologists and dermatologists when needed is a rational way to ensure high-quality patient care. Additional studies are warranted to further elucidate the pathogenesis underlying oral manifestations of inflammatory bowel disease, characterize the relationship between gut and oral microbiota and their associations with intestinal disease activity, and optimize management strategies for these manifestations. The true prevalence and incidence of oral cancers in inflammatory bowel disease patients may be obscured by classification with upper digestive tract tumors, along with lack of routine oral screening in this population. These factors highlight the importance of a coordinated multidisciplinary approach involving routine oral assessment and close collaboration between gastroenterology, dermatology, and dental specialties for optimal care of inflammatory bowel disease patients. Further research and clinical vigilance are critical to fully understand and proactively detect the range of oral complications that may arise in the setting of inflammatory bowel disease. Conversely, patients presenting with concerning oral lesions without overt gastrointestinal disease may have undiagnosed inflammatory bowel disease warranting further investigation. In such cases, a comprehensive assessment is necessary to detect subtle IBD and appropriately manage oral lesions, with vigilant follow-up to enable early detection of oral and gastrointestinal malignancies in this population. A high index of suspicion and multidisciplinary coordination between dentistry and gastroenterology is crucial for recognizing occult IBD cases based on oral findings alone and preventing delay in diagnosis and treatment. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

• A more stratified and telescopic analysis is necessary comparing LVI with other histopathological variables. • Inclusion of age and smoking would have revealed the association of LVI with patient characteristics. • Association with distant metastasis and subsequent disease-specific survival could have been explored.

• This study could have contributed to assessing the risk of each T stage as the study reveals that T-stage increases the chances of node positivity and AJCC 8th edition would have upstaged T1 tumours as well. • Reason for higher prevalence for lymph node positivity remains unknown. • Decision to omit Elective Neck Dissection (END) needs to be proved clinically based on the outcomes and the patterns of failure.

• The importance of treatments such as marginal mandibulectomy for lesions next to bone is stressed. • It is said that the lingual septum acts as a barrier to prevent tumours from spreading down the genioglossus. • Requirements for tumour clearance are addressed, including the AJCC's recommendation to maintain a 5mm clearance. • The letter to editor indicates that although tumour growth along the genioglossus muscles usually preserves anatomical integrity, it can approach the septum. • The tumour may invade the opposing genioglossus muscle in more advanced stages. • There are doubts about the significance of narrow medial borders and the median raphe's function as a barrier.

Bedaquiline, a novel drug was approved for the treatment of multi-drug resistance tuberculosis (MDR-TB) by the US FDA in 2012. It is majorly caused because of the transmission of multi-resistant strain from a diseased person to a healthy individual and by genetic factors. Safety, efficacy, and bactericidal activity of Bedaquiline were reported in various studies, but the pharmacokinetic analysis of Bedaquiline in clinical settings was unclear. This study serves as evidence for the physicians regarding the pharmacokinetic data and managing drug therapy and for better patient outcome in routine clinical practice. This study is conducted in a total of 58 patients with newly diagnosed, smear-positive, MDR-TB patients who received Bedaquiline as per RNTCP guidelines. Plasma samples were collected after the Bedaquiline administration. The patient samples were analyzed. The pharmacokinetic data were drawn by using software kinetic-2000, version 5.03.The observed Cmax was 2523.08 ng/mL, Tmax was reached at 4 hrs, AUC(0-24) was 21727.1 ng *hr/mL, AUMC (0-24) was 222953.8 ng *hr2/mL. Whereas the half-life of the drug was found at 7 .02 hrs and mean residence time (MRT) was found to be 10.25 hrs respectively. The data was even on the 14th day of therapy. The Cmax is shown to be 5937.1ng/mL reaching the Cmax at about 5 hours. While the AUC(0-24) was found to be 65780 ng *hr/mL. Conclusively, pharmacokinetic parameters were evaluated and found to be within the desired limits with minimal changes. This method can be further used for the quantification of Bedaquiline in routine clinical practice.

Head and neck malignancies usually lead to locoregional recurrence most often than distant recurrence; however distant metastasis is still challenging. The identification of the risk factors responsible for the incidence of early distant metastasis is crucial and plays an important role in foreseeing the probability of incidence of early distant metastasis. Therefore, we hypothesize that, in advanced oral cavity squamous cell carcinomas (OCSCC), the tumors generate a strong immunogenic response and once the tumor is surgically removed, there exists a withdrawal of this immunogenic response and this could be the genesis for the occurrence of early distant metastasis in these patients. To evaluate the role of immunity, we conducted a retrospective review of 10 patients of OCSCC who achieved local control following definitive therapy and later developed distant metastases within six months after treatment. Out of 10 patients, 60% of the patient’s primary tumor histology is poorly differentiated squamous cell carcinoma, 50% of patients had a pathological N3b disease, and bone invasion is reported in 40% of patients. Lymphovascular invasion was found in 90% of the patients, while the extranodal extension was found in 60% of the patients. Out of 10 patients, 5 patients underwent tumor microenvironment panel and immunohistochemistry study. All five patients exhibited immunogenic “hot” tumors with more than 50% CD3 count expression suggesting that the immunogenic “hot” tumors are a significant risk factor for early distant metastasis. Results provide evidence that early distant metastasis in advanced OCSCC is probably a consequence of loss of immunogenic response after removal of a large tumor. Further systemic studies are recommended to validate this hypothesis.

Electronic cigarettes is an unregulated commercially available nicotine dispensing tool. E-cigarettes contains nicotine which is a highly toxic chemical that can adversely affect any organ and is also potentially carcinogenic. Nicotine is the route to addiction and industry is using this drug to help people not forget tobacco. If not for nicotine these cigarettes will be useless. Thus it is just another way of keeping nicotine in blood to maintain cigarette smoking habits among existing customers and new way to attract young customers using technology to lure young minds, while serving purpose to deliver nicotine.

Speech errors are commonly reported in the literature for postsurgical treatment in lingual carcinomas. The degree of errors relate to the extent of resection and reconstruction. Residual organ compensation is reported in partial glossectomy, while adjacent articulator compensation in total glossectomy. This case report describes an early atypical labial compensation for lingual sounds in a young female postpartial glossectomy and free flap reconstruction. Speech articulation errors were specific to distortion of tongue tip stops, laterals, and liquids. Bilabial flicker like movements were noted during the production of alveolar stops which subsequently developed into a bilabial compensatory articulation. This error indicates that compensation for the affected articulator function may begin at a very early postsurgical stage. The compensation needs to be identified and intervened at an early stage where facilitation must be sought as a modality for speech correction in smaller surgeries to achieve new or near normal speech.

Squamous cell carcinoma of oral cavity is usually treated by surgery followed by adjuvant treatment. In most standard cancer institutions, margin analysis is a key barometer for measuring the quality of surgical resection. Many studies reported that positive margins have at least a 50% reduction in the overall survival. The contributing factors that could improve surgical outcomes have to be explored. Patterns of outcomes in patients with positive margins can be understood better by analyzing the subsites involved. In the past, positive margins have been associated with a poor prognosis. A detailed analysis of the NCDB and other larger databases would aid in revising our practices to optimize oncological outcomes.

SLNB has emerged as a rational proposition in the management of early-stage oral cancer and has mixed responses within the oncological community. It is high time for the clinicians to look into the fact that, when a patient post-surgery has a regional recurrence within 6 months, it could be reasonable to believe that a tumor seed which was earlier an isolated tumor cell (ITC) or in the form of a micro-metastasis (MM) would have led to this. SLNB has the potential to become a standard of care in the future owing to the development and utility of better evaluation tools to pick nodal metastasis. It is not an overemphasizing statement to say that SLNB could become a standard recommendation in the near future, however, it still looks like a distant dream considering its logistical and technological limitations.

Abstract Geophysical studies can be utilized adequately to decide the land, hydro geographical and geotechnical properties of the ground mass in which the designing development is occurring. The investigation must be given to the contractor to ensure the information related to soil or to predict the type of equipment to be used and to estimate productivity and cost. This article examined how integrated geophysical methods were carried out for the determination of the degree of fracturing and rigidity of rock mass. Data were collected from different case studies in which comparison is there between different types of methods suited for different type of evaluations. In this paper, methods involved for the explorations are seismic refraction method, electrical resistivity method, magnetic and gravity method for oil explorations. The authors found that gravity and magnetic are best suited methods for the oil sand exploration and because of the high acceptance of designing a lot latest applications expected in future. The techniques used in these methods are relatively cheap and fast finding in comparison to other methods.

The study was conducted to examine the benefits and constraints of home gardening in three villages out of eight blocks of Lucknow district. On selected home gardeners' fields. Total 25 respondents were interviewed with presented structured interview schedule. Data were analyzed using frequency counts and percentage. Among the benefits derivable form of home gardening in descending order of importance are; easy source of fresh food (85.7%), reduction in family budget (68.5%), health oriented (30.2%) and easing of emotional stress(11.6%) among others, rank order of important constraints to home gardening in the study area in descending order of severity include insect attack, destruction of crop by animals, pest and disease infestation and lack of good quality planting materials. More females (61.8%) than male 38.2% were involved in home gardening.

The study was carried out in rural and urban area of district Aligarh (Uttar Pradesh) during 2008- 2009. About 200 adolescents belonging to rural area was the unit of information for present study, similarly 200 adolescents belonging to urban area was the unit of information for the same. The mean scores of total adjustment in all the category i.e., below normal (27.56), normal (67.62) and above normal (118.09) were found more among the rural adolescents as compared to mean score of below normal (20.04), normal (52.75) and above normal (116.62)among urban adolescents. The mean scores of total adjustment according to caste among the adolescents in rural areas upper caste (68.12), backward caste (69.86) and schedule caste (67.65) as compared to mean score of total adjustment of upper caste (62.75), backward caste (54.45) and schedule caste (51.00) among the urban adolescents. The mean in both the age groups i.e. 11-15 years (64.10) and 16-20 years (77.98) was found to be more among rural as compared to in the age group of 11-15 years (54.23) and 16-20 years (67.30) among the urban adolescents. The mean score in educated up to high school (64.60) and up to intermediate (75.60) in rural area as compared in urban area up to high school (55.43) and up to intermediate (66.96).

The present investigation was undertaken to evaluate three methods (roasting, microwave heating and soak-precook drying) for preparing quick-cooking rice-The raw milled basmati rice was evaluated for the physical, cooking methods, quality and nutritional characteristics. The above three method compared on the basis of physical, cooking quality, organoleptic and nutritional characteristics and most suitable method for preparing quick-cooking rice was determined.

Introduction: Acute appendicitis, the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances and is essentially clinical.However a decision to operate based on clinical suspicion alone can lead to removal of a normal appendix in 15-30% cases.Several diagnostic scoring systems have been devised as an aid to the early diagnosis of acute appendicitis and to reduce the incidence of negative appendicectomy.One such scoring system was described by Alvarado and later modified by Kalan et al.The present study is attempted to evaluate the efficiency of modified Alvarado score in pre-operative diagnosis of acute appendicitis.Material and Method: A 75 consecutive patients suspected of acute appendicitis that were admitted, investigated and treated were taken for the study.After detailed examination and investigations a modified Alvarado score was applied to these patients. Results:The result of the study showed that high score in men (7-9) had a sensitivity of 92% respectively, where as in females it had sensitivity of 76.4%.The score (5-6) in men & females had a sensitivity of 60% and 50% respectively. Conclusion:The high scores in modified Alvarado score is dependable aid in the early diagnosis of acute appendicitis in men and children but it's not true as far as women are concerned.Ultrasonography of abdomen is a useful tool in avoiding negative appendicectomy rates particularly in children.

Asthma is a chronic condition characterized by swelling of walls and contraction of smooth muscles in the airway with the secretion of thick, tenacious mucus resulting in narrowing/obstruction of the airways. It affects people regardless of age, and in some cases can prove to be fatal. Growing incidence of asthma in both developed and developing countries has been a major public health challenge for more than two decades. In this review, we will discuss different instances indicating the detrimental effect of environmental pollution. One of the major issues of interest will be whether the daunting levels of environmental pollution in India has a great impact on lung diseases particularly asthma and allergic diseases.

e17057 Background: Organ-sparing therapy consisting of cisplatin and 5-fluorouracil, combined with radiation for advanced head and neck squamous cell carcinoma (HNSCC) have been advocated in Ca larynx patients. However, failure of some tumors to respond to treatment or tumor recurrence limits the overall success of these therapies. P53 mutations have been linked to cisplatin resistance in other solid tumors. In this study we evaluate the relationships between P53 overexpression/mutations, BCL2 expression and ploidy status on treatment response in retrospective cohort of Ca Larynx patients. Methods: Samples from 18 patients with histopathologically confirmed Ca Larynx were analysed from our biorepository after consent. Clinical, sociodemographic information and response to treatment were abstracted from case records. P53 and BCL2 over expression were checked by IHC and p53 mutation by PCR and direct sequencing. DNA ploidy and S-phase fractions were also analysed. Bivariate relationships were determined between these variables using Spearmans rank correlation. Independent samples t tests were used to determine changes in P53 over expression, BCL2 expression Ploidy status and S phase fractions in both responders and non responders. Results: There was a trend for increase in P53 over expression and BCL2 expression and decrease in S phase fractions in responders vs non responders. Neither p53 over expression (75% of cases) and BCL 2 over expression (17% of cases) correlated significantly with treatment response. However, BCL2 expression correlated negatively with disease stage (r = - 0.57, p = 0.02). Aneuploidy was observed in node positive tumors (p = 0.04). Conclusions: The results suggest poor association of molecular markers with treatment response and should not be relied as a marker for treatment response. Though there is a trend for association a larger sample size is required to demonstrate the findings. No significant financial relationships to disclose.

The substantial work done by the authors in determining level V lymph node metastasis and related clinicopathological indicators in patients with cN+ oral cavity squamous cell carcinoma (SCC) is highly applauded. 1 Jayasuriya N.S. Mannapperuma N.T. Siriwardana S. et al. Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma. Br J Oral Maxillofac Surg. 2021; 59: 771-775 Google Scholar Various clinical, pathological, and genetic studies have reported that level V is rarely involved in oral cavity malignancies, also when other levels are involved. 2 Ferlito A. Silver C.E. Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg. 2009; 47: 5-9 Google Scholar Emerging evidence also suggests that not all patients with a cN+ neck require a modified radical neck dissection.

Head and neck cancer, a disease of the elderly, is now becoming more common in the young due to their lifestyle and habits. With an increasing concern for cosmesis, it has become essential for clinicians to make use of the best technology and surgical skills. With minimal-access surgery reaching new heights, robot-assisted neck dissections (RAND), which allow superior visualisation and fine-motor movements in inaccessible anatomical spaces, are becoming a reality, and surgeons are reworking approaches to achieve the best outcomes.

A pure M-type strontium hexaferrite with nominal composition SrFe12O19 was prepared via modified conventional citrate precursor method. The basic idea of investigation was to improve the quality of hexagonal ferrite without high temperature sintering as these ferrites are generally known for high temperature sintering techniques. Thermogravimetric analysis (TGA/DTA) of powdered sample was carried out to identify the desired crystallization point suitable for the formation of M-phase. After dividing the sample into two equal parts, the prepared sample was sintered at two different temperatures, 800˚C and 910˚C. The properties of the material were investigated via using important characterization techniques, XRD, FESEM, FTIR, Raman spectroscopy (RS) and VSM respectively. The XRD confirmed the formation of M-phase along with some impurities of Fe2O3 and these results were strongly supported via both FTIR and RS. On increasing the sintering temperature, the average crystallite size was found to increase from 25nm to 33nm. The FESEM analysis confirmed the formation of densely packed grains some hexagonal platelets along with agglomerates. The magnetic parameters saturation magnetization (Ms), magnetic coericivity (Hc) and squarenes ratio (SQR) were investigated by using VSM. The value of Ms for ferrite sample sintered at 910˚C was found to be 92emu/g but at the same time the Hc value was found in the range of few hundreds of Oestered. This kind of behavior was due to the smaller grain size and the presence of impurity phase which was totally against the nature strontium hexaferrite. Such properties of M-type hexagonal ferrite was found very rare and procured to be an excellent candidate for switching devices, recording media, high frequency applications and many more.

The treatment and management of patients with T4b oral cavity squamous cell carcinoma (OCSCC) has always been a strong topic of discussion and we commend the efforts made by Kumar et al.1 in their study assessing the role of the structures involved in T4b OCSCC. The authors performed a retrospective analysis of T4 OCSCC treated with surgery and the structures involved, and a comparative survival analysis was done. We are thankful to the authors for sharing their results, which may have therapeutic implications in addressing the surgical resection of T4b OCSCC.

Hemophilia is a hereditary disorder of coagulation that results in deficiency of factor VIII (Hemophilia A) or Factor IX (Hemophilia B) with characteristic X linked mode of inheritance, almost exclusively seen in males while females are asymptomatic carriers.The common clinical manifestation in both is prolonged bleeding on trivial trauma, mainly into larger joints or muscles. Life threatening bleeding episodes can result spontaneously or from trauma to the head or internal organs. Replacement of deficient clotting protein, known as Anti Hemophilic Factor (AHF) is the main stay in the treatment of haemophilia. Any Surgical treatment of these patients is to be planned in Institution hospital where comprehensive care is available. The availability of AHF has enabled surgeons to take up surgeries in patients with haemophilia. We discuss PWH with congenital factor VIII deficiency presented with oral squamous cell carcinoma of left side lower jaw with main aim is to provide insight into surgical management and care protocol of these patients.

Introduction: The incidence of Head-and-Neck Squamous Cell Carcinomas (HNSCC) is on the rise in our country and worldwide, with a worsening prognosis. The abundance of tumor-infiltrating lymphocytes (TILs) is evolving to be a novel prognostic indicator in assessing treatment response of HNSCC. TILs mainly comprise T lymphocytes, which migrate from blood into the tumor as part of the body's immune response. In this context, targeting the tumor microenvironment with the help of immunotherapy may present a potential approach for better cure of head-and-neck cancers. In the present study, we evaluated the potential TILs parameters which can be used in clinical practice to predict treatment outcomes in HNSCC. Materials and Methods: This is a prospective observational study of 41 patients conducted at a tertiary cancer center between September 2019 and September 2020. All patients with biopsy proven, primary/recurrent HNSCC, without distant metastasis, and complete clinicopathological data were included in the study. Patients with a nonsquamous cell carcinoma, patients who underwent upfront chemotherapy or chemoradiotherapy were excluded from the study. Patients who had follow-up of <1 year or lost to follow-up were excluded from the study. Parameters analyzed include mean age; percentage of cluster of differentiation 3 (CD3) cells; CD4, CD8, and FOXP3cell counts; distribution of CD57 and CD3/FOXP3 ratio. Results: A total number of 19 patients were grouped under the nonrecurrence TILs and 22 patients under recurrent TILs category. Majority of the patients (90.2%) had oral cavity squamous cell carcinoma. 68.42% of nonrecurrent cases and 36.36% of recurrent cases were found to be harboring Hot tumors. Using odds ratio, it was noted that the odds of having Hot tumor is 3.79 times (95% confidence interval: [1.03,13.91]) higher in nonrecurrent TILs than in recurrent TILs group. CD3 cell count was higher in nonrecurrent cases (54.74 ± 18.37) than in recurrent cases (42.73 ± 16.09) with P = 0.0157. Using two tailed t-test, it was noted that the mean of CD4, CD8, and FOXP3 is not significantly different between nonrecurrent and recurrent tumor TILs groups. Conclusion: To summarize, we have shown that the CD3/FOXP3 cell ratio, rather than the individual proportion of TILs, is a significant prognostic indicator in HNSCC. It's also been shown that people with Cold tumors have a higher risk of recurrence than those with Hot tumors. Our findings confirm the importance of host immunity in prognosis and suggest that the degree of immune cell infiltration in the tumor microenvironment is a major independent prognostic factor that merits further investigation as a potentially valuable biomarker in HNSCC patients.

Background: Head and neck squamous cell carcinoma (HNSCC) represents approximately 5%–10% of malignancies worldwide. The most appropriate treatment approach for HNSCC varies with the disease stage and disease site in the head and neck (H&N). Radiotherapy (RT) combined with chemotherapy has become the standard of care for patients having locally advanced tumors. However, there is significant morbidity associated with these treatments, and recurrent or metastatic diseases will occur in 50%–60% of patients. Moreover, the detection of residual viable tumor at the end of therapy remains an important issue. It is therefore an unmet need to improve the outcome of therapy by identifying predictive (prognostic) indicators at the molecular level and radioresistance that will enable the clinicians to select the logical treatment modality. Materials and Methods: Fifty H&N cancer patients aged 27 to 85 years diagnosed at HCG between April 2015 and 2017 were screened using Illumina's TSCAP panel and MiSeq technology for hotspot mutations in 48 cancer-related genes. All the cases had histopathological reviews and comprised tumors from the following sites – oral, nasopharynx, throat, hypopharynx, larynx, thyroid, or nasal cavity and paranasal sinuses. The average coverage across 220 hotspots was >1000X. Data were processed using Strand Avadis NGS™. Mutations identified in the tumor were assessed for “actionability,” i.e., response to therapy and impact on prognosis. Results: Somatic variants were detected in 65% of cases with direct impact on therapy and/or prognosis. Genetic aberrations were identified in major RAS/RAF signaling pathways in nearly 15% of H&N cancers, out of which HRAS activating mutations were the most common (n = 5). HRAS was also found to be co-mutated with phosphatidylinositol 3-kinase (n = 3) and PTEN deletions (n = 3). In contrast to the MAPK signaling pathways, mutant HRAS is able to signal exclusively through PI3K-AKT, reducing the response to cetuximab and increasing the response to MEK inhibitors including selutinib and tramatinib. Based on the results, cetuximab was discontinued in two patients who had presented with metastatic HNSCC. Other targetable mutations included PIK3CA (n = 3), EGFR (n = 1), cKIT (n = 1), RB1 (n = 1), and PTEN (n = 3) were reported. Further, disruptive and nondisruptive mutations in TP53 alone were found in 45% of H&N cancers, varying widely among different histologies, indicating a poor response to cisplatin- and 5FU-based chemotherapy. Interestingly, all metastatic/recurrent patients treated with cisplatin presented with very short progression-free survival of 9–12 months were found to have TP53. TP53 was also found to be co-mutated with ATM gene (n = 1), an important prognostic marker indicating poor response to chemotherapy and RT. Conclusion: This study validates the utility of multigene profiling in H&N cancer patients, both early diagnosed and advanced cases, to stratify based on their molecular profile that could potentially benefit/not benefit from targeted therapy and chemoradiation. Few ongoing prospective studies and randomized clinical trials may help us confirm the independent prognostic and therapeutic value of the mutations in a larger cohort of Indian population.

Cutaneous squamous cell carcinoma is a common global cancer with Ultraviolet light recognized as the most significant risk factor. The other definite or plausible risk factors include immunosuppression, infection with oncogenic viruses, exposure to toxins, chemicals, chronic inflammatory skin disease and a high body mass index.This case highlights the rarity of the pathology in terms of size, the subtle transition of verrucous hyperplasia to cutaneous squamous cell carcinoma over a period of time and the fallibility of the frozen section report in deciding the optimum resection margins. The initial innocuous presentation represented a diagnostic challenge as it can be mistaken for other benign entities. A correlation between the history, clinical presentation, tumor biology and the histopathological characteristics helped us to unlock the jigsaw puzzle of approaching a rare condition with a modification in the surgical approach.

Thus far, there is no final conclusion on the treatment of local recurrent nasopharyngeal carcinoma (lrNPC) patients. Herein, we developed a nomogram which combined prognostic biomarkers to predict clinical outcome and guide individual treatment.From 2006 to 2016, 303 patients with lrNPC were retrospectively reviewed. Overall survival (OS) was the primary endpoint. The nomogram was established with the significant prognostic factors (P < 0.05) selected by multivariate analysis using Cox regression model. Harrell Concordance Index (C-index), calibration curves, and decision curve analysis (DCA) were applied to evaluate this model.Four independent prognostic factors (age, hypertension, relapsed T (rT) stage, and Epstein-Barr virus DNA) identified from multivariable analysis were included into the nomogram. The C-index of the nomogram was 0.687. The calibration curves for 1-, 3-, and 5-year OS rate showed satisfactory agreements between the predicted and actual values. The decision curve analysis also exhibited a preferable net benefit of this model. All patients were subdivided into three risk groups based on the nomogram. Local treatment was associated with higher OS than palliative chemotherapy alone in the low (P < 0.001) and intermediate-risk groups (P = 0.001). However, no significant difference was observed between different treatment methods in the high-risk group (P = 0.176).We established the nomogram for patients with lrNPC to predict OS and guide individual treatment, which showed satisfactory performance in accuracy, discrimination capability, and clinical utility.

Despite easy access to clinical examination majority of oral cancer patients ironically present with locally advanced disease, which is a heterogeneous group that includes all stage III/IV tumours in absence of distant metastasis. The AJCC TNM classification has included all tumours with depth of invasion >1 cm into locally advanced group irrespective of their surface dimensions. Surgery followed by adjuvant therapy provides best results and should be offered to all patients when operable. There have been a slew of recent publications popularising the concept of compartmental excision in variance to traditional resection with adequate margins. The role of chemotherapy has been explored in this group of patients for both organ preservation as well as to aid bioselection of suitable patients with borderline operable tumours for surgery.

Operable oral tongue cancers are managed best with surgery followed by adjuvant therapy as and when indicated. The only factor that affects the prognosis, and is under the control of a surgeon, is the tumour margin. Often in cases with trismus, which is prevalent in tobacco and areca nut users, obtaining a clear margin intraorally can be challenging. Approaches described until now to obtain clear margins in these cases have a great impact on the postoperative recovery and morbidity. In our experience, lingual sulcus release is a safe and reproducible technique for these cases. The transcervically elevated lingual sulcus provides an additional layer of safe margin for the management of squamous cell tongue carcinoma with trismus.

e18529 Background: Head and Neck squamous cell carcinoma (HNSCC) represents approximately 5-10% of malignancies worldwide. Despite the advances in treatment modalities there lies a disparity in response, owing to the underlying molecular and genetic make up. In the era of precision medicine, it is important to profile each disease and customise treatment to improve the outcomes by identifying predictive or prognostic indicators at the molecular and genetic level. Methods: 100 patients with HNSCC, diagnosed at our centre from April 2015-17 were profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina’s TSCAP panel and MiSeq technology. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS. Mutations identified in the tumor were assessed for ‘actionability’ i.e. response to therapy and impact on prognosis. The clinical data for these patients was collected retrospectively and analysed for treatment outcomes with standard therapy. The association of mutations with habits, stage at presentation, poor treatment outcomes and prognosis was also analysed. Results: Somatic variants were detected in 63.1% of cases. Genetic aberrations were identified in major RAS/RAF signalling pathway in 10 % of cases out of which HRAS activating mutations were the most common (n=4). HRAS was co-mutated with PI3KCA (n=3) and PTEN deletions (n=2). Based on the result, Cetuximab was discontinued in 2 patients with metastatic HNSCC. Other targetable mutations included ATM (n=1), STK11 (n=1), RB1 (n=1) and BRAF (n=1). Disruptive and non-disruptive mutations in TP53 alone were found in 43.8% of H&amp;N cancers, varying widely among different histology with variable treatment outcome. Interestingly all metastatic/recurrent patients, with very short progression free survival of 9-12 months (PFS) post Cisplatinum based chemotherapy, were found to have mutated TP53. TP53 was also found to be co- mutated with ATM gene (n=1), an important prognostic marker, indicating poor response to chemotherapy and radiotherapy. The patients with recurrence and poorer prognosis (n =5) showed point mutations in codon regions 173 -273. Conclusions: Indian patients with HNSCC display a wide mutational landscape with specific actionable targets. Although traditional treatment modalities remain the standard of care, specific mutations may be utilised to customise treatment, prognosticate and predict outcomes.

Adolescence, a vital stage of growth and development, marks the period of transition from childhood to adulthood. It is also the stage when young people extend their relationships beyond parents and family and are intensely influenced by their peers and the outside world in general. Adolescence is, thus, a turning point in one's life, a period of increased potential but also one of greater vulnerability. As they mature adolescents’ life skills are called upon to form and maintain relationships within home, peer group and community. Acquisition of life skills is not an easy task and especially in today's era it requires focussed interventions to hone life skills of adolescents’ and most importantly that of rural adolescent girls. The present study was done to enhance the life skills of rural adolescent girls by providing intensive interventions to them. A sample of 150 rural adolescent girls from Distt. Udham Singh Nagar and Distt. Nainital was drawn randomly and assessed for its existing life skills. An intervention module on Life Skill Education including a core set of nine life skills namely Decision making, Problem solving, Creative thinking/lateral thinking, Critical thinking/perspicacity. Effective communication, Interpersonal relationships, Self awareness/mindfulness, Empathy and Coping with stress, trauma & loss was developed based on the requirements of selected sample. Intensive interventions were provided to these girls through this intervention module. Impact assessment was done and interventions were proved to be effective in enhancing their life skills and abilities necessary to survive successfully in today's rapid changing era. This will further help them to maximize the use of their existing resources and in effect, will improve the quality of life for all members of society.

Head & NeckVolume 42, Issue 11 p. 3465-3466 LETTER TO THE EDITOR Soft tissue deposits: Surrogate marker for distant metastasis? Abhijith George MDS, Abhijith George MDS orcid.org/0000-0002-7948-5754 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorRitvi K. Bagadia MDS, FIBCSOMS, Ritvi K. Bagadia MDS, FIBCSOMS orcid.org/0000-0001-9870-8530 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorB.M Joshna MS, B.M Joshna MS Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorAnand Subash MS, DNB, FHNO, RCS, IFHNOS, Anand Subash MS, DNB, FHNO, RCS, IFHNOS orcid.org/0000-0003-2645-0694 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorShalini Thakur MDS, Shalini Thakur MDS orcid.org/0000-0002-1621-0868 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorVishal U.S. Rao MS, FRCS, Corresponding Author Vishal U.S. Rao MS, FRCS drvishal.rao@hcgel.com Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India Correspondence Vishal U.S. Rao, Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, #8, P. Kalinga Rao road, Sampangiram Nagar, Bangalore, Karnataka, India. Email: drvishal.rao@hcgel.comSearch for more papers by this author Abhijith George MDS, Abhijith George MDS orcid.org/0000-0002-7948-5754 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorRitvi K. Bagadia MDS, FIBCSOMS, Ritvi K. Bagadia MDS, FIBCSOMS orcid.org/0000-0001-9870-8530 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorB.M Joshna MS, B.M Joshna MS Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorAnand Subash MS, DNB, FHNO, RCS, IFHNOS, Anand Subash MS, DNB, FHNO, RCS, IFHNOS orcid.org/0000-0003-2645-0694 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorShalini Thakur MDS, Shalini Thakur MDS orcid.org/0000-0002-1621-0868 Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, IndiaSearch for more papers by this authorVishal U.S. Rao MS, FRCS, Corresponding Author Vishal U.S. Rao MS, FRCS drvishal.rao@hcgel.com Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka, India Correspondence Vishal U.S. Rao, Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, #8, P. Kalinga Rao road, Sampangiram Nagar, Bangalore, Karnataka, India. Email: drvishal.rao@hcgel.comSearch for more papers by this author First published: 13 August 2020 https://doi.org/10.1002/hed.26410 see page 3467-3468 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume42, Issue11November 2020Pages 3465-3466 RelatedInformation

Summary and Conclusion p., 135 Recommendation and Future Directions p., 136; Reference p., 137-149; Appendixp., 150-154; publication p., 155-156;

INTRODUCTION The current COVID-19 pandemic, accompanied by a wave of medical emergencies across the globe, has caused an unprecedented healthcare crisis, putting both health care providers and their patients at a high risk.1 Aerosol-generating procedures, especially from the aerodigestive tract, carry a serious risk of infection and calls for a better understanding of these procedures to mitigate the associated risks.2,3 Maxillofacial surgical procedures are known to generate significant amounts of aerosols and require specific measures beyond the conventional personal protective equipment to reduce exposure.4 The new norms, guidelines, and safety recommendations from governing/professional bodies of oral and maxillofacial surgery in India are comprehensive in their length and breadth, and they allow elective procedures. However, the concerns regarding the safety of many routine aerosol-generating procedures have not yet been addressed. Evidence suggests that inoculation with a high initial viral load may result in more severe patterns of infection,3 calling for innovative aerosol reduction methods during these procedures. In the maxillofacial practice, osteosynthesis is one of the most commonly undertaken procedures. Considering the high aerosol generation during osteosynthesis, it is recommended that an intermaxillary fixation be performed under local anesthesia. However, in most cases, intermaxillary fixation becomes infeasible due to poor patient compliance, thereby triggering unfavorable outcomes.4 An innovative method of drill activation has recently been proposed. The drill tip, if completely immersed in saline, is known to considerably reduce aerosol generation.4 The method suggests operative fields be fully submerged in saline before drill activation, and the saline be suctioned away before screw placement. However, this method has certain limitations. Firstly, effective submersion of saline is possible only in lower and upper muco-buccal pouch, thereby limiting its utility or mandible fracture fixation and occasionally anterior maxilla. Secondly, the submersion technique risks endanger adjacent vital structures (mental nerve, facial artery, etc) due to poor control and visibility. TECHNICAL NOTE One of the challenges during maxillofacial osteosynthesis is the aerosolization through the use of drills that create aerosols; the splatters that are ejected from the operating site in a ballistic trajectory contaminate the operator and the operating cubicle, thereby increasing the risk of virus exposure.5 Furthermore, in some patients, drilling alongside the nerve and posterior part of the oral cavity becomes a key challenge. We suggest, as an alternative, using the cannula or the trocar sleeve of a transbuccal set as a “drill sleeve” to efficiently reduce the aerosol production and yet protect the vital structures and improve the control over drill (Figs. 1, 2). (See Video [online], which demonstrates aerosol production with and without drill sleeve.) The trocar sleeve is ergonomically designed to be used by the surgeon’s non-operating hand and allows safe drilling even in the non-accessible bony surfaces in the oral cavity. If used, the drill sleeve with saline immersion technique can efficiently reduce aerosolization. Additionally, it can be easily used for fractures in the head and neck regions and also on the bony surfaces with vital structures in its close proximity. The guide helps in decreasing the use of other retractors, and thereby reducing traction on the adjacent soft tissue.5 Further, when used with saline immersion method, safe drilling is ensured even with an obscure view. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"Demonstration of aerosol production with and without drill sleeve","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_38q12sch"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Fig. 1.: Osteosynthesis on fibula flap without cannula showing aerosol production.Fig. 2.: Osteosynthesis on fibula flap with cannula showing less aerosol production.CONCLUSIONS We have found that the use of the drill sleeve (cannula) is a simple, cost-effective, and reliable method to minimize aerosol generation during surgical procedures. The drill sleeve method can be used in conjunction with the saline submerged drilling technique to further reduce the aerosol generation. Although the described method is not being prescribed as a surrogate to proper protective measures, nor does it condone the need for further studies to conclusively prove its efficacy, it can be considered as a potent alternative to reduce the aerosol production, especially given the severity of the Covid-19 crisis, which affects us on a day-to-day basis.

The lives of rural adolescents are characterized by limited resources, minimum exposure lack of education and awareness as well as opportunities affecting their lives. The objective of present study was to assess vocational interest of rural adolescents (both girls and boys) and make them vocationally aligned by providing intensive interventions so as to improve their living standards. Adolescents who scored less than 50% marks in their last exams were considered academically backward. 10–15% of adolescents who scored least in the 7th, 8th and 9th standard were taken as the sample for study. Vocational interest of respondents was assessed using standardized Vocational Interest Record (VIR). Thereafter respondents were provided intensive interventions exposing them to various vocations and assisting them in selecting vocations as per their interest, aptitude and skills. The data were analyzed with the help of frequency, percentage and z-test. Results revealed that intervention had significant impact on their knowledge about the vocations and their choice of vocation according to their skills and interest.

BACKGROUND: Bedaquiline, a novel drug was approved for the treatment of multidrug resistance tuberculosis (MDR-TB) by the US FDA in 2012. It is majorly caused because of the transmission of multi-resistant strain from diseased person to a healthy individual and by genetic factors. Safety, efficacy and bactericidal activity of Bedaquiline were reported in various studies, but the pharmacokinetic analysis of Bedaquiline in clinical settings was unclear. A simple and selective HPLC-UV method was developed to determine the concentration of Bedaquiline and applicable to report pharmacokinetic parameters. This study serves as evidence for the physicians regarding the pharmacokinetic data and managing drug therapy and for better patient outcomes in routine clinical practice. METHODS: This study is conducted in newly diagnosed, smear-positive, MDR-TB patients who received Bedaquiline as per RNTCP guidelines. Plasma samples were collected after the Bedaquiline administration. The patient samples were analyzed by high-performance liquid chromatography equipped with a UV-Visible detector. The pharmacokinetic data were drawn by using software kinetic-2000, version 5.03. RESULTS: From December 2018 to May 2019, a total of 58 patients with newly diagnosed, smear-positive, multidrug-resistant pulmonary tuberculosis administering Bedaquilline were included in this study. The observed Cmax was 2523.08 ng/mL, Tmax was reached at 4 hrs, AUC(0-24) was 21727.1 ng *hr/mL, AUMC (0-24) was 222953.8 ng *hr2/mL. Whereas the half-life of the drug was found at 7 .02 hrs and mean residence time (MRT) was found to be 10.25 hrs respectively. CONCLUSION: Conclusively, pharmacokinetic parameters were evaluated and found to be within the desired limits. This method can be further used for the quantification of Bedaquiline in routine clinical practice.

The primary objective of this study was to determine, using population-based data, whether the addition of postoperative radiotherapy (RT) provides an overall survival benefit in patients with early primary squamous cell carcinoma (SCC) of tongue. The study included the data of tongue cancer patients treated between January 2016 and July 2019 retrieved from our hospital database. Tumours limited to pathologic T1 and T2 category managed with primary surgery with or without postoperative external beam RT were included. Overall survival (OS) and disease-free survival (DFS) were the main outcomes of interest. A total of 211 cases of oral cancer were evaluated and all the patients had clear surgical and pathological margins. Postoperative adjuvant therapy (PORT) was received by 16 patients. Comparison of DFS and OS at 2-year follow-up depicted a similar outcome (p = 0.582 and p = 0.312 respectively). Findings from our study suggest that in the absence of any absolute advantage on quantifiable survival and disease control, it is necessary to define stringent criteria when advocating PORT in early tongue cancer.

Squamous cell carcinoma of oral cavity is usually treated by surgery followed by adjuvant treatment. In most standard cancer institutions, margin analysis is a key barometer for measuring the quality of surgical resection. Many studies reported that positive margins have at least a 50% reduction in the overall survival. The contributing factors that could improve surgical outcomes have to be explored. Patterns of outcomes in patients with positive margins can be understood better by analyzing the subsites involved. In the past, positive margins have been associated with a poor prognosis. A detailed analysis of the NCDB and other larger databases would aid in revising our practices to optimize oncological outcomes.

Extranodal extension (ENE) and more than 4 pathologically involved lymph nodes (pN2) are critical prognostic factors in HPV-associated oropharyngeal cancer (HPV(+) OPSCC). We analyze a patient cohort with HPV(+) OPSCC to determine the sensitivity and specificity of CT and PET/CT in identifying involvement of more than 4 lymph nodes (rN2) compared to pN2 and radiographic ENE (rENE) compared to pathologic ENE (pENE).The dataset consisted of 261 patients enrolled in two prospective clinical trials. All imaging studies were independently reviewed by a blinded neuroradiologist, classifying the presence or absence of rENE and rN2. Secondary analyses included correlations of imaging accuracy and pathologic size of the primary tumor.CT demonstrated sensitivity of 59%, specificity of 92%, positive predictive value (PPV) of 53%, negative predictive value (NPV) of 94%, and accuracy of 88% for pN2. PET/CT showed similar results. Patients with up to 4 involved lymph nodes (rN0-1) had a 93–94% chance of remaining pN0-1. CT and PET/CT identified an equal number of involved nodes in 81% of patients. CT demonstrated sensitivity of 54%, specificity of 71%, PPV of 72%, NPV of 53%, and accuracy of 62% for pENE. PET/CT showed similar outcomes. Notably, when multiple radiographic criteria were used to identify rENE, PPV increased for both CT (84%) and PET/CT (79%).Patients with rN0-1 had a 93–94% chance of remaining pN0-1, suggesting rN0-1 could effectively stratify patients for clinical trials and treatment de-escalation. While CT and PET/CT were highly correlated, both showed low sensitivity for identifying pENE.