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   2015| April-June  | Volume 4 | Issue 2  
    Online since April 22, 2015

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Histopathological differentiation of oral squamous cell carcinoma and salivary lactate dehydrogenase: A biochemical study
Audrey M D'Cruz, Varsha Pathiyil
April-June 2015, 4(2):58-60
DOI:10.4103/2278-330X.155629  PMID:25992341
Context: Early diagnosis of oral cancer is a priority health objective, in which oral health professionals may play a pivotal role. Detection should lead to less damage from cancer therapy and to a better prognosis. Aims: The aim was to estimate and compare the salivary lactate dehydrogenase (LDH) levels in various histological differentiation of oral squamous cell carcinoma (OSCC) patients and normal subjects. Settings and Design: Hospital-based setting, case-control study. Subjects and Methods: A case-control study was undertaken comprising 30 OSCC patients and 30 healthy controls. The OSCC patients were grouped into well-differentiated, moderately differentiated and poorly differentiated OSCC based on their histological tumor differentiation. Unstimulated whole saliva was collected, assayed for LDH levels using a standard kit and measured spectrophotometrically at 340 nm. Statistical Analysis Used: The results obtained were subjected to statistical analysis using Kruskal-Wallis and Mann-Whitney U-tests. Spearman's correlation was used to correlate the histological tumor differentiation with the salivary LDH levels. Results: The mean salivary LDH levels in the control group, well-differentiated OSCC group, moderately differentiated OSCC group, and poorly differentiated OSCC group were 117.33 ± 19.37 IU/L, 355.83 ± 16.73 IU/L, 484.18 ± 25.84 IU/L, and 620.35 ± 18.69 IU/L, respectively. The difference in the mean salivary LDH levels was statistically significant among the various groups (Kruskal-Wallis χ2 = 50.820, P < 0.001). Spearman's correlation showed significant difference between salivary LDH levels and histological differentiation of OSCC (r = -0.689, P < 0.01). Conclusions: The salivary LDH levels were higher in OSCC patients when compared to the healthy controls. The salivary LDH levels were found to be the highest among the poorly differentiated OSCC.
  2,210 229 6
Knowledge, attitude and practices about oral cancers among dental students in H.P Government Dental College, Shimla-Himachal Pradesh
Shailee Fotedar, Vinay Bhardwaj, Kavita Manchanda, Vikas Fotedar, Avishek De Sarkar, Naintara Sood
April-June 2015, 4(2):65-67
DOI:10.4103/2278-330X.155643  PMID:25992343
Aim: The aim was to assess the knowledge, attitude and practices among undergraduate dental students about oral cancer. Materials and Methods: A cross-sectional questionnaire study was conducted among undergraduate dental students between the 3rd and 5th years in H.P Government Dental College, Shimla. The questionnaire consisted of 15 questions, five each on knowledge, attitudes and practices. The data were analyzed by Statistical Package for the Social Sciences (SPSS Inc., version 16 for Windows, Chicago, IL, USA). Results: The response rate of the study was 90.6%. There were 23 (21.5%) males and 84 (78.5%) females in the study. There was a predominance of females (78.5%). The average knowledge percentage for the entire population is 81.9% (excellent knowledge). Tobacco and alcohol were correctly identified by 63.5% of the subjects. Squamous cell carcinoma was described as the most common type of oral cancer by 105 (98.3%) of the students. 60.7% of the subjects strongly disagreed that their knowledge regarding the prevention and detection of oral cancer is current and adequate, and 99% agreed that there is a need for additional training/information regarding oral cancer. About 92.5% of the subjects used to educate their subjects about the harmful effects of tobacco and alcohol. Conclusion: The study implies that the knowledge, especially about the etiological factors of oral cancer needs to be reinforced throughout the undergraduate dental courses so that they can use the same in educating and motivating the masses to adapt healthy lifestyles.
  2,047 356 3
Pancytopenia - (?) An obstacle in the diagnosis and outcome of pediatric acute lymphoblastic leukemia
Shruti Raja, Febe Renjitha Suman, Julius Xavier Scott, MS Latha, Aruna Rajenderan, Abhirami Ethican
April-June 2015, 4(2):68-71
DOI:10.4103/2278-330X.155648  PMID:25992344
Context: Acute lymphoblastic leukemia (ALL) ranks first among pediatric malignancies. 8-12% of ALL present with pancytopenia and 2% with hypocellular marrow a. Diagnosis of ALL in the background of pancytopenia and aplastic bone marrow is difficult. Aims: This study was aimed to compare the clinicopathologic, genetic, and outcome of paediatric ALL patients with and without pancytopenia. Settings and Design: This is a retrospective cross-sectional study. Subjects and Methods: The study included all ALL patients presenting with pancytopenia. The control group included equal number of randomly selected patients with ALL without pancytopenia treated during the same period. Ethics committee approved this study. The demographic, laboratory, and treatment-related details were retrieved from the records and entered in an Excel sheet. Statistical Analysis Used: Data was analyzed with Chi-square test with IBM SPSS statistics 16 software. Results: Diagnosis by peripheral smear is significantly lower (P = 0.015) in comparison with the control group. There is no significant difference in diagnosis between the groups by bone marrow aspirate (P = 0.731) and biopsy (P = 0.849). The diagnosis of leukemia is misdiagnosed as hypo cellular/aplastic marrow in 10% of the pancytopenic patients. Flow cytometry yielded the diagnosis in all the pancytopenic patients. Though cytogenetic abnormalities are more common in pancytopenic group, it is not statistically significant (P = 0.106). There is no significant difference in treatment outcome between the groups (P = 0.0827%). Conclusions: Clinical expertise is highly essential to evaluate a case of pancytopenia to diagnose leukemia. Pancytopenia is an obstacle in the diagnosis of ALL without immunophenotyping. There is no significant difference in the outcome between the two groups.
  2,006 353 1
Locally advanced oral cavity squamous cell carcinoma: Barriers related to effective treatment
KC Lakshmaiah, TM Suresh, K Govind Babu, Nagesh T Sirsath, Lokanatha Dasappa, Linu Jacob Abraham
April-June 2015, 4(2):61-64
DOI:10.4103/2278-330X.155637  PMID:25992342
Background: Oral cavity cancer is a significant health problem in India. Majority of patients present with locally advanced disease requiring multimodality treatment. Compliance to recommended treatment is an important factor affecting outcome. Aims: The aim was to evaluate the outcome of locally advanced oral cavity cancer patients with regards to treatment adherence and to assess reasons of noncompliance. Materials and Methods: This was a prospective observational study. We included patients referred to Department of Medical Oncology for induction chemotherapy in view of locally advanced oral cavity cancer. Results: Only 15 (26%) patients completed planned treatment schedule. Their 1 year overall survival was 93%. The remaining 43 patients who received inadequate treatment had a dismal 21% 1 year overall survival. Illiteracy, poverty, long waiting list for surgery, prolonged delay for health scheme treatment plan approval and dissatisfaction with attitude of hospital staffs are major barriers related to effective treatment of these patients. Conclusions: A detailed discussion with patient and their relatives regarding recommended treatment, proper implementation of health schemes, increasing trained manpower to avoid long waiting list for surgery, provision of additional financial support for family member accompanying the patient and a sympathetic approach toward patients are needed to help these patients overcome the battle.
  1,885 364 1
Anticancer activity of Cynodon dactylon L. root extract against diethyl nitrosamine induced hepatic carcinoma
R Kowsalya, Jagatheesh Kaliaperumal, M Vaishnavi, Elangovan Namasivayam
April-June 2015, 4(2):83-87
DOI:10.4103/2278-330X.155691  PMID:25992348
Background: Hepatocellular carcinoma is one of the most common cancers and a lethal disease. In view of the limited treatment and a grave prognosis of liver cancer, preventive control has been emphasized. Materials and Methods: The methanolic extract of roots of Cynodon dactylon was screened for its hepato-protective activity in diethyl nitrosamine (DEN) induced liver cancer in Swiss albino mice. The plant extract at a dose of 50 mg/kg was administered orally once a week, up to 30 days after DEN administration. The animals were sacrificed; blood sample and liver tissue were collected and used for enzyme assay such as, asparatate amino transferase (AST), alanine aminotransferase (ALT), catalase (CAT), glutathione peroxidase (GPx) and glutathione-S-transferase (GST). The liver marker enzymes AST and ALT produced signifi cant results in the protective action. Results: The antioxidant enzyme assay results concerning the improved activity of GPx, GST and CAT. These results concluded that enhanced levels of antioxidant enzyme and reduced amount of serum amino transaminase, which are suggested to be the major mechanisms of C. dactylon root extract in protecting the mice from hepatocarcinoma induced by DEN. These biochemical observations were supplemented by histopathological examination of liver sections. Conclusion: The methanolic extract of C. dactylon possesses signifi cant anticancer properties
  1,891 307 7
Perception and attitudes versus medical writing skills
PM Parikh
April-June 2015, 4(2):55-57
DOI:10.4103/2278-330X.155627  PMID:25992340
  1,740 319 -
Emerging potential of parenteral estrogen as androgen deprivation therapy for prostate cancer
Syed Imran Ali Shah
April-June 2015, 4(2):95-97
DOI:10.4103/2278-330X.155699  PMID:25992351
Androgen deprivation therapy (ADT) is a key management strategy for prostate cancer (PC), achieved commonly by administration of luteinizing hormone-releasing hormone agonist (LHRHa), ADT markedly suppresses both male and female sex hormones which results in "castration syndrome", a constellation of adverse events such as muscle weakness, impairment of glucose and lipid metabolism, impotence, osteoporosis, and fractures. Recent evidence suggests that estrogen, in the parenteral form, may emerge as an alternative to LHRHa as it offers potential benefits of arresting PC growth as well as avoiding some of the estrogen deficiency related toxicities of LHRHa by maintaining endogenous levels of estrogen.
  1,600 248 2
Prognostic significance of cell surface phenotype in acute lymphoblastic leukemia
Shiek Aejaz Aziz, Susheel Kumar Sharma, Iram Sabah, M Aleem Jan
April-June 2015, 4(2):91-94
DOI:10.4103/2278-330X.155696  PMID:25992350
Context: To find out the phenotypic character of lymphoblasts of acute lymphoblastic leukemia (ALL) patients in our study cohort and their possible effect on the prognosis. Aims: To investigate the phenotype in ALL in our demographic population and to prognosticate various upfront current protocols employed in our hospital. Settings and Design: The study spanned over a period of 4 years with retrospective and prospective data of January 2008 through December 2011. Materials and Methods: 159 patients of all age groups were enrolled for the study, of which flow cytometry was done in 144 patients. Statistical Analysis Used: Analysis was done using the variables on SPSS (statistical package for social sciences) software on computer. Survival curves were estimated by method of Kaplan-Meir. Results: Majority of the patients were of B-cell (68.1%) and 30.6% patients were of T-cell lineage. Of these, 80.6% patients were having cALLa positivity. Complete remission (CR) was achieved in 59.1%, 16.4% relapsed, and 20.1% patients died. Conclusions: Phenotyping has become an important and integral part of diagnosis, classification, management and prognosticating in ALL. B-cell has been found to have a better survival over T-cell lymphoblastic leukemia. cALLa antigen positivity has good impact in achieving CR in only B-cell lineage, myeloid coexpression has no significant effect on the outcome. BFM (Berlin-Frankfurt-Münster) based protocols though showed a higher CR and survival vis-a-vis UKALL-XII. However, patients enrolled in former group being of low risk category and lesser in numbers cannot be compared statistically with a fair degree of confidence.
  1,492 234 1
Knowledge, attitude, and awareness of childhood cancer among undergraduate medical students in South India
M Sneha Latha, Kumaravel Chitralakshmi, Manipriya Ravindran, P Ravichandran Angeline, Lakshminarayanan Kannan, Julius Xavier Scott
April-June 2015, 4(2):75-77
DOI:10.4103/2278-330X.155680  PMID:25992346
Background :In India roughly 60000 childhood cancer cases are diagnosed annually with only nearly 100 pediatric oncologists. So it's pertinent that the physicians and pediatricians are adequately equipped to recognize and refer them appropriately. Hence this study was conducted to assess the knowledge, attitude and awareness of childhood cancer among undergraduate medical students in South India. Materials and Methods: The study was conducted among 240 undergraduate students from all over South India in a undergraduate pediatric clinical training. A 24 point questionnaire was given to assess their understanding of pediatric malignancies and their interest towards pediatric oncology. Statistical analysis was done with SPSS 18.V software. Results: 50% were interested in pursuing pediatrics as their career but 80% of them were not interested in pursuing pediatric oncology as their career. 55% of the students have not encountered any pediatric oncology patients in the ward. 40% did not have any lecture classes on pediatric oncology. 65.5% felt that their knowledge of childhood cancer did not make them competent to suspect and refer appropriately during their practice. 84% supported that there is a need to improve pediatric oncology teaching in their medical curriculum. Conclusions : The study unambiguously states that the future physicians lack confidence in identifying and managing childhood malignancies and pediatric oncology is far down in their career options. There is a need to reform the undergraduate medical students by increasing their exposure to pediatric oncology to improve their competence levels and interest in pursuing it as a career also.
  1,524 194 -
Correlation of p53 immunoexpression with DNA ploidy and apoptotic index in subsets of prostate cancer: A marker reiterated in progression and recurrence of prostate cancer
Anju Bansal, Anup Gupta, Sunita Saxena
April-June 2015, 4(2):88-90
DOI:10.4103/2278-330X.155693  PMID:25992349
Background: Prediction of biological behavior in patients of prostate cancer (CaP) is a major challenge as current parameters only partially meet the need for prognostication. p53 as a prognostic indicator has been studied in several human cancers, including breast, lung, and colorectal carcinoma. However, its significance as a predictive biomarker for CaP is less well-studied. Materials and Methods: This study included 125 cases of CaP, 27 cases of prostatic intraepithelial neoplasia and 25 cases of benign prostatic hyperplasia. Immunohistochemical assessment for p53 nuclear protein was performed. Assessment for apoptotic index and DNA ploidy status by flow cytometry were also done. Results: p53 immunoreactivity was low in organ confined CaP cases having Gleason score ≤3 (P < 0.003). More hormone resistant cases 37 (83%) were aneuploid when compared with hormone sensitive cases 26 (33%) (P < 0.005). 93% of p53 positive cases and none of the p53 negative patient were aneuploid suggesting a significant relation between p53 immunoreactivity and aneuploidy. p53 positivity and DNA aneuploidy, independently, were also predictors of progression and relapse. Conclusion: DNA ploidy and p53 positivity go hand in hand and together yield additional prognostic information in CaP. p53 positivity is possibly a late event in carcinogenesis in CaP and a marker of change in biological behavior of CaP.
  1,498 202 3
Expression of inducible nitric oxide synthase in carcinomas and sarcomas affecting the oral cavity
Dominic Augustine, B Sekar, S Murali, Maya Ramesh, R Nirmal Madhavan, Shankar Gouda Patil, Roopa S Rao
April-June 2015, 4(2):78-82
DOI:10.4103/2278-330X.155686  PMID:25992347
Context: Inducible nitric oxide synthase (iNOS) is a cytoplasmic enzyme which plays a crucial role in the pathogenesis of oral carcinomas and sarcomas. Aims: The objective of this study was to analyze the immunohistochemical expression of iNOS in carcinomas and sarcomas affecting the oral cavity in order to understand the possible role of iNOS in their biologic behavior and to correlate iNOS expression with lymph node metastasis in carcinomas and sarcomas. Settings and Design: Patients, who attended the oral diagnosis department of Vinayaka Missions Sankarachariyar Dental College, were screened, for the purpose of the study. Besides these, paraffin-embedded tissue blocks were also retrieved from archives of the Oral and Maxillofacial Pathology Department. A total of 40 cases (20 carcinomas and 20 sarcomas) were selected for the study. Subjects and Methods: A total of 40 cases (20 carcinomas and 20 sarcomas) were selected for the study. Five apparently normal tissues were obtained from the tumor adjacent normal tissue to be used as a control. These were subjected to immunohistochemical staining using antibody to iNOS and evaluated. Statistical Analysis Used: The results were analyzed using the Chi-square test. Results: Among the 20 carcinomas 19 showed a positive immunoreactivity for iNOS and 1 case was negative. Among the 19 immunopositive iNOS cases of carcinomas, 15 cases showed positive lymph node metastasis. Among the sarcomas, positive immunoreactivity for iNOS was seen in 10 hard tissue sarcomas, while the remaining 10 soft tissue sarcomas were negative for iNOS expression. The results were analyzed using the Chi-square test. Conclusions: iNOS is a reliable marker for lymph node metastasis in carcinomas irrespective of the histologic grade. The high expression in carcinomas shows that the carcinomas elaborate more angiogenesis for growth compared with the sarcomas with the exception of hard tissue sarcomas.
  1,453 204 3
Clinical significance of thymidine kinase in Egyptian children with acute lymphoblastic leukemia
Adel A Hagag, Mohamed A Saad, Sohair A Mohamed
April-June 2015, 4(2):72-74
DOI:10.4103/2278-330X.155675  PMID:25992345
Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, representing one-third of pediatric cancers. Thymidine kinase-1 (TK-1) is expressed in proliferating cells so elevated TK-1 indicates active tumor growth. Objective: To study the clinical significance of TK-1 in children with ALL. Patients and Methods: This study was carried out on 40 children with newly diagnosed ALL who were admitted to Oncology Unit, Pediatric department, Tanta University (26 males and 14 females) with their ages ranged from 4 to 10 years and 30 healthy children of matched age and sex as a control group. For all patients the following were done: Complete blood picture, bone marrow examination, immunophenotyping and TK-1 serum levels. Results: Mean TK-1 level was significantly higher in patients at diagnosis than controls and significantly higher in patients with unfavorable outcome than patients with favorable outcome. Mean TK-1 level was significantly higher in patients in relapse than patients in remission and controls. No significant differences in mean TK-1 level between patients in remission and controls. There were statistically significant differences in disease free survival and overall survival between patients with favorable and unfavorable outcome. Conclusion: From this study we concluded that TK is a helpful marker in diagnosis and follow-up of patients with ALL. Recommendations: Thymidine kinase-1 should be routinely assessed at diagnosis and during follow-up in ALL patients for better diagnostic and prognostic assessment and should be taken in consideration in designing future therapeutic strategies based on patients-specific risk factors.
  1,431 210 -
Mediastinal schwannoma: A clinical, pathologic, and imaging review
Akhil Kapoor, Mukesh Kumar Singhal, Satya Narayan, Surender Beniwal, Harvindra Singh Kumar
April-June 2015, 4(2):104-105
DOI:10.4103/2278-330X.155708  PMID:25992358
  1,400 200 -
Iatrogenic implantation of soft tissue sarcoma at skin graft donor site: Delayed manifestation of an avoidable complication
Vishwas D Pai, Ajay Puri, Shridhar Epari, Ashish Gulia
April-June 2015, 4(2):100-101
DOI:10.4103/2278-330X.155704  PMID:25992354
  1,314 128 1
Is female smoking rising or declining in India?
Pritam Roy, Sonu Goel
April-June 2015, 4(2):99-100
DOI:10.4103/2278-330X.155702  PMID:25992353
  1,254 181 1
Breast cancer in ethnically different populations
Vani Parmar, Akshita Singh
April-June 2015, 4(2):105-106
DOI:10.4103/2278-330X.155709  PMID:25992359
  1,200 163 -
Asynchronous cutaneous metastases of medullary thyroid carcinoma
Alireza Ghanadan
April-June 2015, 4(2):103-104
DOI:10.4103/2278-330X.155707  PMID:25992357
  1,134 164 1
Midline or near-midline radioiodine uptake in the oropharyngeal region in patients of differentiated thyroid carcinoma: Differential diagnosis between lingual thyroid and retropharyngeal nodal metastasis, the subtle clues in the scan and their implications for patient management
Pradeep Thapa, S Joshi, Sandip Basu
April-June 2015, 4(2):98-99
DOI:10.4103/2278-330X.155700  PMID:25992352
  1,054 136 -
Intracranial hemorrhagic metastases as the first manifestation of an occult melanoma
V Umamaheswara Reddy, P Suneetha, Vissa Shanthi, KV Murali Mohan, Amit Agrawal
April-June 2015, 4(2):101-102
DOI:10.4103/2278-330X.155705  PMID:25992355
  955 149 -
Ablatio mammae like Angelina: Fad or a wise decision?
Himanshi Aggarwal, Pradeep Kumar
April-June 2015, 4(2):102-103
DOI:10.4103/2278-330X.155706  PMID:25992356
  963 127 -