Identification & correlation of bacterial diversity in oral cancer and long-term tobacco chewers- A case-control pilot study

Introduction. Squamous cell carcinoma is a highly aggressive type of oral cancer (OC). It is the most common cancer among men, and accounts for almost 90 % of all oral cancers in India. Consumption of tobacco is a leading factor contributing to maximum oral cancer incidences as per the WHO. Hypothesis/Gap statement. Researchers reported a direct association of microorganisms with dysbiosis in various oral lesions including oral cancer. However, there is a dearth of information related to compositional changes in the oral microbiome in long-term tobacco chewers and the Indian oral cancer population. Aim. The aim of this study was to identify and correlate the bacterial diversity in the oral cavity of tobacco chewers, patients with oral cancer and healthy subjects in the Indian population. Methods. Oral rinse samples were collected for ten subjects in each group followed by DNA extraction. The variable regions of the bacterial 16S rRNA gene (V6-V8) were amplified, sequenced, processed, and analysed using QIIME2 platform to assess alpha and beta diversity between the study groups. Results. This pilot study showed genus Streptococcus dominated the control group (18.54 %), and the abundance decreased in tobacco and OC group (9.63 and 5.45% respectively); whereas genus Prevotella dominated the tobacco and OC group (21.01 and 26.03% respectively). A shift in abundance of microbiome was observed from control population to oral cancer via the tobacco chewing population. Maximum alpha diversity of oral microbiome was found in Indian tobacco chewers. Beta diversity of tobacco chewers was similar to both the healthy population as well as oral cancer patients suggesting transitioning of the oral microbiome from healthy to oral cancer microbiome via the tobacco chewers microbiome. Conclusion. The data provides evidence of oral bacterial dysbiosis due to tobacco chewing habits that can further lead to progression towards cancer.

An observational study on clinical profile of acute coronary syndrome among young adults attending a tertiary care institute in Maharashtra

Background: ACS is most common cause of hospital admissions even in middle income countries like India. ACS in an early age is one of the important causes of sudden death. Incidence of ACS is positively correlated with age. But in the recent years, there is increased incidence of ACS among younger adults. In depth studies have been conducted in older adults but profile among younger patients is rarely reported.Methods: An observational study was conducted among young adults with ACS admitted under department of medicine of Punjabrao Deshmukh memorial medical college. This study was conducted for one and half years (August 2019 to March 2021). All young patients of both sexes less than 35 years of age admitted with diagnosis of ACS were included in the present study. The questionnaire had demographic details like age, gender, address, occupation, etc. It also had detailed clinical history, physical examination findings, systemic examination findings and investigations in it.Results: The most common chief compliant was chest pain (73.05%) followed by epigastric pain (53.30%) and sweating (53.90%). The most common risk factors were overweight/obesity (58.66%), tobacco chewing (38.32%) and smoking (34.73%). About 48.5% of the cases were STEMI, 32.9% were NSTEMI and 18.6% were UA in the present study. Among 167 cases studied, 1.19% cases had ventricular septal rupture, 3% had arrhythmia, 7.78% were in cardiogenic shock and 3.60% was the mortality rate.Conclusions: Chest pain was present in more than 75% of the cases. The most common risk factors were overweight/obesity, tobacco chewing and smoking. Complications like cardiogenic shock, arrhythmia and ventricular septal rupture were noted. Minor patients suffered cardiac arrest. It is important to screen for ACS even in young adults. The time with a saying that ACS is a disease of older adults is gone

The study of cases of hoarseness of voice of north India region

In Medical Science, Hoarseness is the term used to describe a change in normal quality of voice of a patient which is rough or harsh, lower in pitch and more or less discordant Depends on duration of illness, hoarseness can be divided into acute or chronic condition. The acute onset is more common and mainly caused by inflammation (acute laryngitis) chronic sinusitis acid reflux disease, excessive alcohol use, smoking and over use or misuse of voice whereas other cause may be, laryngeal trauma or thyroid surgery and systemic disease The aim of our study is to analyse clinical profile, assess different etiological factors and to find out common precipitating factors leading to hoarseness of voice.A total of 34500 patients visited OPD of Otolaryngology department from June 2017 to May2019. Out of these,253 cases presented with complaint of change in voice (Hoarseness). The incidence of hoarseness among total OPD patient was 0.73%. Among 253 cases ,165 (65.21%) were male and 88 (34.78%) were female. Male predominance was observed with Male: female ratio of 1.87:1 in this study. Majority of patients (22.13%) were reported in 51-60 years age group followed by 31-40 years age group (21.73%). Largest group of patients were housewives (19.76%), then farmer (19.36%%) and labour (18.57%). Rest was teacher (13.43%), singer (5.92%) politician (5.13%), policeman (1.97%) and sportsman (0.79%).Many predisposing factors were noted like tobacco chewing, smoking, alcohol drinking. Tobacco chewing (38.33%), smoking (33.99%) and alcohol consumption (15.81%) were most common predisposing factors in descending order. Functional disorder was reported in (5.13%) cases and vocal abuse in 2.37% cases. In present study most of the patients were referred for speech therapy and psychotherapy along with vocal conservation and maintenance of vocal hygiene.

Esophageal Cancer in North West India: A Tertiary Care Center Experience of 5 Year

Background: Incidence of Esophageal cancer (EC) is increasing now a days and it has became a sixth leading cause of cancer related death in world. EC is associated with multiple risk factors. Despite various advances in the treatment of EC, it remains one of the least responsive tumors to cancer therapy, thereby overall prognosis remains poor. The current status of EC in North West India in relation to the demographics, diagnosis, staging, multimodality treatment, and the future perspectives are discussed. Methods and Materials: This is a retrospective analysis of medical records of the EC patients registered in the Department of Radiation Oncology SMS Medical and Attached Hospitals Jaipur from January 2015 to December 2019. Results: Out of 10,464 patients with various malignancies registered in SMS hospital for radiotherapy via Co-60 technique in the previous 5 years from 2015-2019; 449 were having EC. 40.25% patients were in 6th decade and male to female ratio was 1.49:1. EC was most common in farmers (51.79%) and 76.16% patients were the resident of rural areas addicted with smoking (41.4%) and tobacco chewing (24.7%) habit. Dysphagia was the presenting feature in almost all the patients. Most common type and site of involvement were squamous type (75.72%) and middle third (45.43%) part of the esophagus respectively. 39.19% patients presented in stage III and 24.70% patients in stage IVA. The patients were planned with treatment according to their age, performance status, extent of disease and other co-morbidities. Conclusions: At our centre most of the patients landed up in advanced stage poverty, illiteracy, ignorance, late diagnosis. Majority of the EC patient were addicted with smoking and tobacco chewing habit, hence screening of high risk population and lifestyle modifications limiting the use of tobacco, may help in the early detection and can decrease the mortality related to EC. Careful selection of patients for radical treatment is very important for providing relatively longer disease free interval.

Relative deprivation in income, tobacco chewing and bidi smoking among Indian adults: Findings from a cross-sectional national study

The robust relationship of income with health outcomes is widely documented and there is a rich body of work examining the direct impact of income on health. However, researchers have also extensively studied the relationship of an individuals relative socioeconomic position with their wellbeing, frequently explained by the relative deprivation (RD) hypothesis. Despite the high socioeconomic inequality, research on RD in the Indian context is scarce. Therefore, the primary objective of this study was to assess the relationship of RD in income with the risk of tobacco chewing and bidi smoking in a sample of Indian adults. We drew data from the second round of the nationally representative India Human Development Survey for our analysis. Using data on annual household equivalized income from 26,529 adults, we created the Yitzhaki index to operationalize RD in income. We then fitted survey adjusted logistic regression models accounting for age, gender, absolute household equivalized income, education, place of residence, caste, and religion. Odds ratios from fully adjusted models for the third tertile (greatest relative deprivation) versus the first tertile (lowest relative deprivation) ranged between 1.32 (95% CI=1.15, 1.50) and 1.63 (95% CI=1.40, 1.89) for tobacco chewing and varied between 0.99 (95% CI=0.86, 1.14) and 1.32 (95% CI=1.15, 1.51) for bidi smoking, depending on the reference group used to compute the RD measure. Our findings suggested that with higher RD, the risk of consumption of smokeless tobacco and bidi smoking was higher. These results point to the health hazard of relative deprivation in a society that has enjoyed rapid economic growth coupled with rising income inequality in the last few decades. Our findings call for a comprehensive assessment of the socioeconomic inequality in income and health observed in India and the implementation of efficient programs to narrow the gap.

Interim Prosthesis for Repositioning of Mandible in a Hemimandibulectomy Patient: A Case Report

Background: Squamous cell carcinoma is prevalent in middle asia due to prevalence of tobacco chewing. Management includes removal of mandibular bone along with adjacent muscles and nerves. Mandible is attached to cranium with the support of muscles. Removal of muscles results in deviation of mandible and loss of occlusion, which is necessary for functions such as chewing, swallowing and to some extent in speech. Prosthetic appliances help in restoration of position of mandible and thus restoring the function. Case Report: This is a case of 58 year old male with hemimandibulectomy due to moderately differentiated squamous cell carcinoma. Treatment Plan: Interim guiding prosthesis was planned for mandibular repositioning as the patient did not report before the surgical excision. Conclusion: a definitive management would be undertaken by using cast partial dentures after mandibular repositioning with interim prosthesis is done.

Risk factors for chronic liver disease in population of Central India: a case-control study from rural India

Background Chronic liver disease (CLD) is one of the leading causes of morbidity and mortality in today’s world. Common risk factors for CLD are alcohol, chronic hepatitis B, chronic hepatitis C, non-alcoholic steatohepatitis (NASH), malnutrition, toxins, and some tropical infections. This case-control study was carried out to determine the risk factors of domestic CLD in a resource-constrained setting in central rural India. A hospital-based matched case-control study was carried out among eligible CLD cases from November 2015 to October 2017. A total of 200 cases and 200 age- and gender-matched community controls were selected using consecutive sampling from tertiary care hospitals from central rural India. Information on socio-demographic, etiological was collected through using a pretested structured questionnaire after obtaining informed written consent. Univariate and multivariate analyses were carried out to find the risk factors associated with CLD. Results The median age of study participant was 58.5 years among the cases. There were 75% male and remaining 25% were female in each case and control group. On multivariate analysis, we found less education, poor socioeconomic status, diabetes mellitus, increased body mass index (BMI), alcohol consumption, and tobacco chewing were significant risk factors for CLD in comparison to controls. However, amount of alcohol, smoking, and occupation were not found to be statistically significant association with CLD. Conclusions The findings showed that in patients with CLD when compared to controls, high alcohol intake, diabetes mellitus, tobacco chewing, central obesity, low education, and low-income group are significant risk factors in our rural population. An initiative needs to be taken to reduce alcohol, and tobacco chewing habits at various levels through awareness campaigns, strict control, and legislation to limit further abuse. Control of blood glucose and reduction of obesity may be important in preventing CLD in our rural community.

Overexpression of Stathmin in Oral Squamous Cell Carcinoma, its Association with Histomorphological Features and Pathological Staging

Introduction: Stathmin, one of the most important intracellular phosphoprotein that plays the vital role in the regulation of cell cycle and cell proliferation. It acts by disassembly of Microtubules (MT) that helps in the formation of mitotic spindle. It is overexpressed in various human cancers. Aim: To investigate the expression status of stathmin and its relation with clinicopathologic significance in Oral Squamous Cell Carcinoma (OSCC) and its association with age, sex, tobacco chewing, histomorphological features and pathological staging. Materials and Methods: A descriptive and observational study in cross-sectional design was conducted in a tertiary care centre of Kolkata, West Bengal, India, from January 2020 to March 2020 in the Department of Pathology of RG Kar Medical College and Hospital in collaboration with Department of Oto-Rhino-Laryngology of the same institute. Stathmin expression was assessed by immunohistochemistry (IHC) in 28 OSCC cases. The association between stathmin expression and clinicopathological parameters like age, sex, tobacco chewing, tumour site, histomorphological type, Tumor Nodes Metastases (TNM) stage and Worst Pattern Of Invasion (WPOI) were evaluated on the basis of Chi-square test and Fisher’s-exact test (software Statistical Package for the Social Sciences (SPSS) V 25.0). Results: Stathmin was overexpressed in 18 cases out of 28 cases of OSCC. In this study a positive association was observed between stathmin expression and age group, history of tobacco chewing, advanced T stage, advanced pTNM staging and WPOI of OSCC. Conclusion: The study suggests that overexpression of stathmin could contribute to cancer progression. There is a higher likelihood that stathmin may be used as a potential biomarker as well as therapeutic target for OSCC.