Level of oral cancer awareness among Indian rural population: A possible research model using knowledge, attitude and practice (KAP) intervention and its utilisation in low resource settings of LMICs

A study was conducted to establish levels of awareness of oral cancer and its causes among an Indian population.A pre-tested structured questionnaire on Knowledge, Attitude and Practice [KAP] (open and closed ended questionnaire) was used to estimate the KAP score, followed by clinical examination of the oral mucosal lesions. The subjects were counselled immediately after completion of KAP scoring using a structured protocol of regarding tobacco cession, and given advice about intake of natural sources of anti-oxidants in the diet, of tomato, carrot and green leafy vegetables (GLV).Subjects who had a KAP score 50% or less were counselled using a structured protocol. Subjects who had a KAP score greater than 50% were also counselled and given the correct information to their incorrect answers.In the group of people with a KAP score 50% or less, continual behavioural therapy was given to remain tobacco free for life. The subjects were monitored weekly for between 30 and 40 days. Clinically suspect lesions of hyperplasic candidiasis, lichen planus, and all varieties of Leucoplakia were confirmed histopathologically and routine treatment (conservative or surgical) was started without delay for the group. Those cases with dysplastic changes (of all different grades) were also counselled. Regular follow-up was maintained over several months and re-assessment carried out at intervals and any improvement noted.

CONCLUSION

This is a cost-effective and simple method for estimation of the score on knowledge, attitude, and practice (KAP), and determinants of the ill-effect of tobacco habit(s) and engaging the popolation-in-need for their appropriate understanding about oral cancer screening and education for prevention and control.

Understanding neonatal jaundice: UK practice and international profile

Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants.

Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.

Herbal medicine induced Stevens-Johnson syndrome: a case report

A severe form of Erythema multiforme (EM), diagnosed as Stevens-Johnson syndrome (SJS) was detected in a 10-year-old Indian male child who took herbal medication of plant origin prescribed by a traditional healer for remission of his fever. The child developed a severe and florid form of mucocutaneous oral ulceration, severe ocular manifestations, along with marked constitutional disturbances and dehydration. An extensive literature search revealed few previous reports of herbal drug induced EM and SJS. In India, traditional therapy with herbal preparation (Ayurvedic medicine) is not uncommon.

Dexamethasone for the prophylaxis of radiation-induced emesis: a National Cancer Institute of Canada Clinical Trials Group phase III study

PURPOSE

To investigate the efficacy of dexamethasone as a prophylactic antiemetic for patients receiving fractionated radiotherapy to the upper abdomen in a randomized controlled trial.

PATIENTS AND METHODS

One hundred fifty-four patients planned to receive fractionated radiotherapy to fields involving the upper abdomen (minimum total dose, 20 Gy; minimum number of fractions, five) were randomized to receive prophylactic dexamethasone (2 mg orally three times a day [tid], starting in the morning of first treatment and continuing until after their fifth treatment) or placebo. The primary end point of the study was the proportion of patients free from emesis during the study period. Secondary end points included a quality-of-life assessment using the core questionnaire of the European Organization for Research and Treatment of Cancer and side effects of dexamethasone therapy in this population of patients.

RESULTS

Fifty-four (70%) out of 75 patients receiving dexamethasone had complete protection versus 37 (49%) out of 75 patients on placebo (P = .025). Most emetic episodes occurred during the initial phase of treatment. Although there was no difference in global quality of life between the two sets of patients, patients receiving dexamethasone had less nausea and vomiting and less loss of appetite but more insomnia.

CONCLUSION

Dexamethasone 2 mg tid seems to be an effective prophylactic antiemetic in this situation. Side effects were acceptable, but there seemed to be no overall effect on global quality of life.

High-energy electron and photon therapy to the parotid bed: radiation dose perturbations with a titanium mandibular implant

Adjuvant radiation therapy to the parotid bed is commonly administered following surgical resection using either a pair of angled wedged photon beams or an ipsilateral mixed-beam portal of electrons and photons. The present study seeks to determine the optimal parotid bed treatment technique in the presence of a titanium mandibular implant by investigating perturbations in the dose distribution deep to this implant for a 15-MeV electron beam and a 6-MV photon beam. A titanium mandibular plate was embedded in a tissue-equivalent phantom, and irradiated with 15-MeV electrons, and 6 MV photons. Radiation doses behind the plate were measured with both thermoluminescent dosimeters and radiographic film. With 15-MeV electrons, there is a clinically significant decrease in the dose beyond the titanium plate, which is most important at 5-mm and 10-mm depths (18-27%). With 6-MV photons the dose at the deep interface of titanium and tissue is reduced by between 15 and 18%, but rapidly drops to < 5% at a depth of 5 mm. In adjuvant treatment to the parotid bed, when the clinical target volume includes tissue positioned deep to a titanium implant, significant underdosage occurs with ipsilateral beam arrangements, especially when electrons are used.

Frontal sinus carcinoma: a case report and review of the literature

A rare case of frontal sinus carcinoma is reported. The patient developed early recurrence following surgery, and was managed by accelerated hyperfractionated radiation therapy and concurrent cisplatinum-based systemic chemotherapy. The patient has remained disease-free for 30 months following the end of treatment.

The role of radiation therapy in Graves' ophthalmopathy

Graves' ophthalmopathy can occur in 25-30% of patients with hyperthyroidism. This condition can result in serious visual disturbance and disfigurement. The treatment options for symptomatic disease are oral corticosteroids or orbital irradiation. Ten patients with Graves' ophthalmopathy were treated with external beam radiotherapy at Saint Lukes Hospital from March 1991 to February 1994. Eight of these patients had excellent response with minimal morbidity. We believe that orbital radiotherapy is effective and well tolerated, and should replace corticosteroid therapy as the initial treatment modality in these patients.

Bone involvement in Hodgkin's disease

Bone involvement in Hodgkin's disease is uncommon and seldom encountered at initial diagnosis. Seven cases with osseous involvement were identified from a series of 147 patients with Hodgkin's disease treated at Auckland Hospital from 1980 to 1988. Only one patient was found to have bone lesions at the time of initial presentation. Two patients had multiple lesions and 5 had a solitary lesion. Sites of involvement included the spine, pelvis, femur, humerus, ribs, sternum, scapula and base of skull. Six patients had nodular sclerosing histology and one had mixed cellularity disease. All 7 patients were treated with systemic chemotherapy for their advanced disease, and 5 patients needed local radiotherapy to sites of bone involvement. The radiation dosage schedules were individualized, ranging from 30 Gy to 40 Gy, using either a 6 MeV linear accelerator or cobalt machine. At the time of analysis of this study, 4 patients were in complete remission, 2 patients completed chemotherapy with good response and only 1 patient died of disseminated disease. The current review has demonstrated an encouraging response to treatment and good long term control. We believe that combined-modality therapy is effective in the treatment of osseous involvement in Hodgkin's disease.

Kaposi's sarcoma in AIDS: the role of radiation therapy

Radiotherapy can provide good palliation for AIDS patients with symptomatic Kaposi's sarcoma. We have retrospectively reviewed the treatment of 13 lesions in 5 patients. All treated tumours demonstrated significant regression with moderate doses of radiation. Side effects were acceptable and treatment provided good pain relief, functional improvement, and restoration of cosmesis. Our experience confirms that radiotherapy has a meaningful role in the management of AIDS-related Kaposi's sarcoma.

Eosinophilic granuloma of mandible in an adult (a case report)

A case of mono-ostotic eosinophilic granuloma localised to the mandible of an adult patient is described. The role of low dose radiation therapy as a curative modality is discussed.