INTERACTION OF TOBACCO ABUSE WITH OTHER CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR RISK - SYNERGISTIC IMPACT OR AN INDEPENDENT MENACE?

Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.

Substance abuse among the medical students in Central India: an observational study

Background: Substance abuse is a pandemic among adults. We carried out this study to know the prevalence of tobacco and alcohol use among II prof MBBS students. The objective was to know the prevalence of tobacco and alcohol use among II prof MBBS students.Methods: An observational study aimed find out the prevalence of alcohol and tobacco abuse. During the period of January 2015 to October 2015 and 100 student from 2nd professional of a medical college from Central India were interviewed using semi structured interview schedules for students.Results: Total students in our study that ever tried alcohol smoking was 62%, among which 47% continued and 53% discontinued. Among 100 participants 55 were male and 45 were female. Out of 100 student 62 were tried alcohol/smoking once in their life time. 13 students were exposed to substance abuse at during their school life, 7 were started during preparation of medical entrance and 42 were started it after coming to college. 12 participants were who were regular using alcohol were belong to family where either one or both parents were doctors among them. Most of the participants were influenced by their friends, 27% were started it for their own gratitude and 9.6% were have seen their family members. 21% participant were involved in indisciplinary activities.Conclusions: The substance abuse is highly prevalent among youngster and the prevalence of substance abuse among female were also significant which is highly alarming situation.

Hypoxia and Its Influence on Radiotherapy Response of HPV-Positive and HPV-Negative Head and Neck Cancer

Head and neck squamous cancers are a heterogeneous group of cancers that arise from the upper aerodigestive tract. Etiologically, these tumors are linked to alcohol/tobacco abuse and infections with high-risk human papillomavirus (HPV). HPV-positive HNSCCs are characterized by a different biology and also demonstrate better therapy response and survival compared to alcohol/tobacco-related HNSCCs. Despite this advantageous therapy response and the clear biological differences, all locally advanced HNSCCs are treated with the same chemo-radiotherapy schedules. Although we have a better understanding of the biology of both groups of HNSCC, the biological factors associated with the increased radiotherapy response are still unclear. Hypoxia, i.e., low oxygen levels because of an imbalance between oxygen demand and supply, is an important biological factor associated with radiotherapy response and has been linked with HPV infections. In this review, we discuss the effects of hypoxia on radiotherapy response, on the tumor biology, and the tumor microenvironment of HPV-positive and HPV-negative HNSCCs by pointing out the differences between these two tumor types. In addition, we provide an overview of the current strategies to detect and target hypoxia.

Pre-operative direct and inverse clinical characteristic variations by age do not resolve up to 24 months following open roux-en-y gastric bypass

Background: Today open Roux-en-Y gastric bypass (ORYGB) is reserved for abdomens too complex or obesity too severe for laparoscopic surgery. However, outcomes by age in ORYGB are unknown. Objective: Identify variation by age in ORYGB patients. Setting: Independent database. Methods: 5389 ORYGB BOLD patients was analyzed retrospectively by age: <30 (591), 30-40 (1252), 40-50 (1527), 50-60 (1388), 60-70 (592) and >70 (39). Statistics: ANOVA/general linear model. Results: Baseline female/male (p<0.01), weight, BMI, African-American, Hispanic, Medicaid, Private insurance, self-pay (p<0.0001), PCOS, PTC (n=10) varied inversely with age. Medicare, CHF, HTN, angina, LEE, PVD, IHD, dyslipidemia, OHS, diabetes, gout, IFS, and unemployment varied directly. Caucasian, Asian, Other race, DVT/PE, hernia, cholelithiasis, GERD, panniculitis, liver disease, SUI, MSP, fibromyalgia, alcohol and tobacco abuse, depression, PI, MHD (n=17) vary non-linearly. At 12 months, in spite of equal BMI by age, CHF, HTN, angina, PVD, dyslipidemia, cholelithiasis, SUI, diabetes, gout, IFS (n=10) varied directly. PCOS and PTC varied inversely, and LEE, OSA, hernia, MSP, tobacco abuse, depression, MHD varied non-linearly. 24 months CHF, HTN, angina, dyslipidemia, diabetes, IFS, and MSP vary directly. PTC and tobacco abuse varied inversely. LEE, OSA, PHTN, hernia, PCOS, and tobacco abuse varied non-linearly. Conclusions: ORYGB patients vary dramatically by decade of age. Pre-operatively 10 co-morbidities varied inversely, 13 directly, and 17 non-linearly by age. In spite of equal BMI by age at 24 months, important co-morbidities CHF, HTN, angina, dyslipidemia, diabetes varied directly, tobacco inversely, and OSA non-linearly. This advance clinical knowledge of age variation can aid ORYGB management

The first case of BRG (SMARCA4)/INI Deficient Tracheal Carcinoma: A Case Report and Review of the Literature

Introduction/Objective Primary tumors of the trachea are rare, they account for less than 0.1% of tumors in humans. In adults, 90% of primary tracheal tumors are malignant, with squamous cell carcinoma and adenoid cystic carcinoma accounting for two-thirds, with other forms occurring less frequently. The BRG (SMARCA4)/INI deficient tumor is a relatively new defined entity which is recently introduced in the WHO Classification of Tumors, 5th edition, 2021. The gene SMARCA4 is located at 19p13. Loss of SMARCA4 has been reported in several aggressive tumors with high- grade undifferentiated rhabdoid morphology but has not been reported in the trachea. Hence, we report the first case of BRG (SMARCA4)/ INI deficient tracheal carcinoma. Methods/Case Report We present a 60-year-old male with a history of tobacco abuse, shortness of breath, and a tracheal mass on chest imaging. Bronchoscopy was performed and showed a fleshy friable lesion at the anterior trachea with evidence of blood dripping into the distal airways. Results (if a Case Study enter NA) Microscopic examination showed a high grade, poorly differentiated carcinoma with tumor necrosis, high mitotic counts, and marked nuclear pleomorphism. Immunohistochemical stains were performed. The tumor cells were strongly and diffusely positive for CK-7 and weakly positive for synaptophysin, negative for pan-cytokeratin, TTF-1, CK-20, p40, CK5/6, and chromogranin. Then BRG (SMARCA4) and INI 1 (BAR47) were performed and showed negative staining on BRG expression, while INI 1 is intact (nuclear expression). These features are consistent with BRG (SMARCA4)/ INI deficient carcinoma. Conclusion BRG (SMARCA4)/ INI deficient carcinoma is a new entity in the trachea, which is very aggressive with a poor prognosis. Targeted therapy or clinical trials may be available as additional cases are diagnosed in the future.

Obesity years: clinical variation by age pre/post biliopancreatic diversion/duodenal switch (BPD/DS)

Objective: To identify clinical variation by age, pre/post BPD/DS. Methods: 1673 BPD/DS patients from the Surgical Review Corporation’s BOLD database were analyzed retrospectively by age: <30(177), 30-40(456), 40-50(486), 50-60(407), 60-70(138), >70(9). Data: Demographics, BMI and 33 obesity co-morbidities. Statistics: ANOVA and General Linear Models including pre- and post-operative data modified for binomial distribution of dichotomous variables. Results: Pre-op BMI varied inversely by age and continued through to 12 months post operatively. Gout varied directly and tobacco abuse inversely by age at baseline. The incidence of 12 of the 33 obesity-co-morbidities increased directly with age up to 12 months post operatively. In >60 patients, angina, MS pain, LEE and SUI increased from baseline after undergoing BPD/DS. Conclusion: Despite lower pre-operative and 12-month BMI in older BPD/DS patients, baseline co-morbidities varied directly with age, and post-operative resolution of 12 weight-related problems was inversely proportional to age. Only diabetes resolved better among older patients. These findings suggest the concept of “obesity years”, wherein patients carrying obesity the longest accumulate more co-morbidities and resolve them less.

CURRENT SCENARIOS IN MANAGEMENT OF BUERGER'S DISEASE AT TERTIARY HOSPITAL UTTARAKHAND

Introduction / Background: Buerger's disease is a systemic vasculitis of unknown etiology, strongly associated with tobacco abuse worldwide. Buerger described Thromboangiitis obliterans (TAO) in 1908. High prevalence is found in Asian / Middle East countries. The survival rate of TAO is almost 90%. Presently, total abstinence from tobacco is the mainstay of treatment. Aim: To determine the incidence, progression, etiology, impact of seasonal variations on admission, as well as, presentations, and treatment outcomes at our tertiary health care hospital in Uttarakhand region. Materials: Patients of Buerger's disease admitted to our Institute during January 2015 to December 2019, were included in this study. Methods: Retrospective analysis and study of 142 patients of Buerger's disease admitted at our institute. Results: Most patients were males (97%), with mean age 38.6 years. The incidence & total TAO admission were overall decreasing during these years. Trends showed that eighty two (58%) patients were admitted between months of November to February (cold weather), while least in summers (15%). More than 50% were severe smokers (>30 bidi / cigarette per day). Pain in limbs was present in 77.4% cases. Major amputations were done in (12) 8% cases, while digital / finger / forefoot amputations in 31.69% / 3.52% / 10.58.% cases respectively. Lumbar sympathectomy was done in twelve cases. The median requirement of analgesic (opioids) by intravenous & oral route was 10 & 12 doses initially, & mean VAS score on day-1, 5 & 10 was 6.4, 4.1 & 2.9 respectively. Conclusion: We conclude that incidence of TAO overall shows a decreasing trend, with better health practices. Admissions peak in the cold season, along with complaints related to painful / ulcerated limbs, with a strong association with tobacco abuse. Complete stopping of tobacco can halt further progression of TAO.

Efficacy of Lasers in the Treatment of Tobacco Abuse Induced Oral Leukoplakia

Background: Oral leukoplakia is defined as a white patch or plaque, which cannot be characterized clinically or histopathologically as any other disease entity and is recognized as a common precancerous lesion of the oral mucous membrane. Definitive management crucial due to its notoriety for recurrences and malignant transformation depending on the anatomic location, clinical features, degree of epithelial dysplasia and causative factors. High power pulse diode laser has some advantages like less pain, swelling, prevention of metastasis, edema, less bleeding and infection. The prime objective of the study was to evaluate clinically and histopathologically the disease course with six monthly follow up. Methods: Thirty cases who had white lesion in the buccal mucosa with positive history of oral tobacco abuse, clinically diagnosed cases of oral leukoplakia confirmed by histopathology were selected for inclusion in the study and treated by LASER. The outcomes after the clinical and histopathologic determinants were processed with standard statistical tests, the results were derived and findings concluded. Results: Cases were distributed as per the size and histopathologic report and LASER ablation was administered Recurrence was noticed in 4 cases (16.6%) after six months follow up. No case transformed to malignancy during the study follow up period. Conclusion: Management of oral leukoplakia prevents not only recurrence and malignant transformation, but also postoperative dysfunction. Laser ablation of tobacco abuse induced leukoplakia is a simple effective and safe alternative to conventional surgical local excision with predictable outcome which can be undertaken as a routine OPD day care set up.

SCREENING FOR TOBACCO ABUSE IN THE WORKPLACE SETTING: - A CROSS SECTIONAL SURVEY.

Background: - Abuse of drugs is one of the biggest curse that modern society has come across. It is not conned to any one country or region alone, but has widely aficted the globe. Of the various drugs abused, the most widely distributed and commonly used drug in the India is tobacco. Objective: - To assess the patterns of tobacco use among auto rickshaw workers in Rohtak City. Materials and Methods: - This was a cross sectional hospital based study and included 50 auto rickshaw workers. A semi structured questionnaire with questions regarding socio demographic prole, tobacco use pattern, knowledge about harmful effects of tobacco use and Fagerstrom test for nicotine dependence were administered. Results: - The mean age of the participants were 32.68 years with average monthly income of 9400 rupees. Maximum participants were having middle and primary level of education and most of them were married. Most of them were having rural background (38%) and smoking was the major mode of tobacco use among majority of subjects (70%). Majority of the smokers and tobacco chewers reported moderate to high dependence (56%) as per Fagerstrom test. Conclusion: - We observed a high dependence level on nicotine in terms of smoking and smokeless tobacco use in the workplace setting. We needs to adopt a more holistic and coercive approach to ght the problem of tobacco. But the dim part of the management is that people were unable to accept the dependency that become a hurdle for them to seek professional help.