Tobacco Chewing Research Articles

Impact of a structured teaching on the ill effects of tobacco chewing among Indian adults.

Tobacco chewing remains a prevalent health issue globally, particularly in India, where it is deeply ingrained in cultural practices. This study evaluates the impact of a structured teaching program on knowledge regarding the ill effects of tobacco chewing among adults enrolled in arts and commerce colleges in Patan, India. A quasi-experimental design was employed, with 100 participants recruited from arts and commerce colleges. The structured teaching program included educational sessions covering the harmful effects of tobacco chewing and cessation strategies. Pre and post-test knowledge assessments were conducted using a self-structured questionnaire. The majority of participants were aged 15-17 years (75%), male (75%), and from urban areas (58.33%). Significant improvements in knowledge scores were observed following the intervention (pretest mean score = 11.5, posttest mean score = 44.38), with a significant difference between pre and post-test scores (t = 11.38, p < 0.001). Associations between pre-test knowledge scores and demographic variables such as gender, education, type of family, area of residence, father's education and occupation, monthly income, history of illness, and previous knowledge were identified (p < 0.05). Conclusion: The study underscores the significance of targeted health education programs in addressing tobacco-related health risks and promoting public health. By enhancing awareness and knowledge among adults, such interventions contribute to fostering behavior change and reducing the burden of tobacco-related diseases.

Comparative proteomic analysis of saliva from chewing tobacco users and oral cancer patients reveals shared biomarkers: A case control observational study

ObjectiveThe aim of this study was to compare the salivary proteomic profile of smokeless tobacco users with that of non-users and oral cancer patients using Liquid Chromatography-Mass Spectrometry/ Mass Spectrometry (LC-MS/MS). MethodsSaliva samples from 65 participants were collected in three groups: control (25 participants), smokeless tobacco users (25 participants), and oral cancer (15 participants). ResultsThe analysis revealed 343 protein groups with significantly altered abundance in the saliva samples (P < 0.05). Among these, 43 out of 51 dysregulated proteins in the smokeless tobacco group were also dysregulated in the oral cancer group. Notably, Apolipoprotein A1 (ApoA1) and Pon1 were found to be significantly increased in both smokeless tobacco users and oral cancer patients (p < 0.05). Furthermore, six out of the 20 most significantly altered proteins were mitochondrial proteins, and all of these were decreased relative to controls in both smokeless tobacco users and cancer samples. ConclusionThe proteomic profile of users of chewing (smokeless) tobacco (SLT) shows substantial overlap in the altered pathways and dysregulated proteins with those altered in oral cancer samples, suggesting that SLT use induces a shift toward an oncogenic state. Specifically indicated pathways included blood microparticles, platelet α-granules and protease inhibitors as well as indicators of oxidative stress and exogenous compound processing. What differentiates oral cancer samples from SLT users is enrichment of alterations related to cytoskeletal organisation and tissue remodelling. Clinical SignificanceThe findings emphasize the importance of salivary proteomic profiles because changes in certain proteins may be indicators for early oral cancer identification and risk assessment in smokeless tobacco users.

Demographic profile of head and neck cancer patients: a single tertiary institution-based study in Telangana

Background: Head and neck cancer (HNC) is a broad category of cancerous entity that arise from different types of tissues and organ sites located in the topographical areas of the head and neck (Hand N). H and N squamous cell carcinomas (HNSCC) comprises 30% of all cancer cases in India. The risk factors for HNSCC include tobacco and alcohol consumption. Methods: This study aimed to determine the demographics of HNC patients and classify the incidence of H&amp;N cancers according to the primary histological type and organ of origin along with any recent change in pattern compared with previous study. Results: Highest incidence seen in 41-50 years of age group with majority of cases belonging to urban area. Tobacco chewing was observed as most common habit. Buccal mucosa cancer was seen as most common cancer particularly at gingivo-buccal sulcus. Squamous cell carcinoma was the most common type identified on histopathology. Majority of the cancers presented in locally advanced stage. Conclusions: Male plurality of carcinoma noted indicating male being more likely to be engaged in behaviours increasing risk of carcinoma head and neck. Buccal muscosa carcinoma particularly at gingivo-buccal sulcus noted to be most common site correlating to tobacco chewing habit and keeping tobacco quid at gingivo-buccal sulcus leading to prolonged exposure.

Transforming Hospital Housekeeping: The Kayakalp Journey.

The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the "Do" phase. The "Check" phase included monitoring of the activities followed by the "Act" phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category "B" (Institute of National Importance) Hospitals in 2019. The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

High Risk Human Papillomavirus Prevalence in Patients with Hypopharynx Cancer of Northeast India: A Pilot Study

Oncogenic viruses such as, Human papillomavirus (HPV) associated head and neck cancers have been considered to represent different etiological and pathological behaviour. This pilot study was conceived to investigate high risk HPV (hr-HPV) infection and its association with life style habits such as tobacco, alcohol consumption in patients with hypopharynx cancer from North –East India. A total of thirty four primary hypopharynx cancer biopsy specimens were collected. These samples were analysed for hr-HPV DNA using nested multiplex PCR (NMPCR). The lifestyle and dietary associated factors were collected through a self- designed questionnaire. The presence of hr-HPV was confirmed in 50% (n = 17) patients with hypopharynx cancer by nested multiplex PCR (NMPCR). Among hr-HPV positive cases, only HPV- 16 genotype was found. Significant association was observed between hr-HPV infections with alcohol consumption (p-0.025), alcohol with tobacco habit (p-0.01). Our study demonstrated that alcohol consumption, tobacco chewing may act as risk factors for hr-HPV infection in a subset of patients with hypopharynx cancer from the North-East region of India.

MiRNA genetic variations associated with the predisposition of oral squamous cell carcinoma in central Indian population

The disease burden of Oral Squamous Cell Carcinoma (OSCC) is rising day-by-day and is expected to rise 62 % through 2035. The chewing of tobacco, areca nut, and betel leaf, poor oral hygiene, and chronic infection are common risk factors of OSCC, but genetic and epigenetic factors also contribute equally. MicroRNAs (miRNAs) are comprised of small, non-coding endogenous RNA that regulate a plethora of biological activities by targeting messenger RNA through degradation or inhibition. Single Nucleotide Polymorphisms (SNPs) in miRNA genes can regulate the development and progression of OSCC. The present study aimed to determine the association between SNPs in miRNA genes (miRSNPs) with the risk of OSCC. A case-control study involving 225 histo-pathologically confirmed OSCC cases and 225 healthy controls was conducted, where 25 miRSNPs were analyzed by iPLEX MassArray analysis. A SNP rs12220909 in MIR4293 showed a highly protective effect (CC vs GG, OR = 0.0431, 95%CI = 0.005–0.323, p = 3e-6). Whereas three SNPs, namely, rs4705342 in MIR143 (CC vs TT, OR = 2.25, 95%CI = 2.00–2.53, p = 0.0008), rs531564 in MIR124 (CC vs GG, OR = 24.18, 95%CI = 3.22–181.37, p = 3e-6), and rs3746444 in MIR499 (AA vs GG, OR = 2.01, 95%CI = 1.32–3.05, p = 0.001) were significantly associated with a higher risk of OSCC. Additionally, NanoString-based nCounter miRNA expression profiling revealed that miR-499a (Log2FC = −1.07), and miR-143 (Log2FC = −1.56) were aberrantly expressed in OSCC tissue. Taken together, the above miSNPs may contribute to the high incidence of OSCC in central India. However, further studies with large cohorts and ethnic stratification are required to validate our findings.

TUSC3, p53 and p21 genetic association with development of oral submucous fibrosis and oral squamous cell carcinoma among addictive tobacco chewers of Pakistan

BackgroundThis study delves into the intricate landscape of oral cancer, a global concern with a high incidence in Asian countries. We focus on oral squamous cell carcinoma (OSCC), primarily driven by the consumption of betel nut and its derivatives. OSCC often arises from premalignant lesions like oral submucous fibrosis (OSF). In Pakistan, OSCC is prevalent among men due to various addictive substances, including smokeless tobacco and chewing materials. Mutations in tumor suppressor genes, such as TP53 and p21, play crucial roles in this malignancy’s development. We also explore the involvement of TUSC3 gene deletion in OSCC and OSF.MethodsIn this study we investigated demographics, TUSC3 gene expression, deletion analysis, and TP53 and p21 genetic alterations in OSCC and OSF patients (blood and tissue of 50 samples in each condition) who had tobacco derivates usage history. The association analysis was carried out mainly through PCR based genotyping.ResultsThe study’s patient cohort (OSCC and OSF) displayed a wide age range from 13 to 65 years (Mean = 32.96 years). Both conditions were more prevalent in males, with a male-female ratio of approximately 2.5:1. Chewing habits analysis revealed high frequencies of gutka use in both OSF and OSCC patients. TUSC3 expression analysis in OSCC cell lines indicated significant downregulation. Genotyping showed no TUSC3 deletion in OSF cases, but a deletion rate of over 22% in OSCC tissue samples. Analysis supported a significant association of TUSC3 deletion with OSCC development but not with OSF. Polymorphism in p53 exon 4 and p21 (rs1801270) were significantly associated with both OSCC and OSF, adding to their pathogenesis. Our findings further revealed a strong correlation between TUSC3 deletion and the excessive use of tobacco and related products, shedding light on the genetic underpinnings of OSCC development.ConclusionsNotably, our study provides a crucial insight into genetic aspects underlying OSCC and OSF in response of addictive consumption of areca nut, betel quid, and tobacco derivatives. A significant association between TUSC3 deletion and OSCC development, along with polymorphisms in TP53 and p21, underscores the importance of further research into the molecular mechanisms driving oral cancer progression for improved diagnosis and treatment outcomes.

Diabetes Mellitus as a Risk Factor for Tuberculosis: A Community Based Case Control Study.

Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor. To study if diabetes is associated with tuberculosis compared to controls. A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer. Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB. Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis.

The patterns and correlates of tobacco use in patients with schizophrenia: A cross-sectional study from North India

Abstract: BACKGROUND: Schizophrenia is a severe mental illness that is attributed to significant morbidity. Tobacco use is widespread among patients with schizophrenia. The purpose of this research was to evaluate the patterns and correlates of tobacco use in patients with schizophrenia. METHODS: This was a cross-sectional study conducted on patients with schizophrenia visiting a tertiary care center in North India. Adult patients of schizophrenia who were adherent to antipsychotic treatment were evaluated for the pattern and severity of tobacco use with reference to sociodemographic and clinical characteristics. RESULTS: A total of 93 patients were enrolled in the study. The current prevalence of tobacco use was found to be 61.54% among the patients with schizophrenia, and the majority (65.6%) of them was tobacco chewers with initiation of tobacco use during the second to third decades of life. More than half the tobacco users had at least a moderate level of dependence and had a positive family history of tobacco use. Patients with moderate-to-severe tobacco dependence had more severe psychopathology of schizophrenia than those with mild-to-moderate levels of tobacco dependence. CONCLUSION: The prevalence of tobacco use is high among patients with schizophrenia, and the psychopathology of schizophrenia may have a bearing on tobacco use behavior.

Association of oral cancer site with addiction and sociodemographic characteristics: A cross-sectional study conducted at a tertiary health centre

Abstract Introduction: In contemporary epidemic scenarios, oral cancer ranks the top 3 cancer types afflicting the Indian population. The primary risk factors include alcohol consumption, tobacco usage in various forms, such as cigarettes and smokeless tobacco, betelnut chewing, and infection with the human papillomavirus. This article submitted in preprint in medRxiv on 20 February 2024. Materials and Methods: This study, conducted at a tertiary healthcare center, adopted a hospital-based cross-sectional approach involving 233 oral cancer patients who sought medical care from January 1 to December 31, 2017. Results: The findings indicate that males above the age of 60 (40.11%) and females aged between 41 and 50 years (45.45%) were the most affected groups. A statistically significant association (P &lt; 0.05) was found. The primary sites for oral cancer were the cheek (40.36%) and tongue (31.78%). Remarkably, the majority of male patients exhibited a combination of addictions, including tobacco chewing, smoking, and alcohol use, whereas most female patients were exclusively involved in tobacco chewing. Conclusion: To curb the increasing prevalence of oral cancer in India, it is imperative to implement comprehensive public education initiatives and health promotion strategies aimed at reducing both smoking and alcohol consumption.

Self-Compassion is Associated with Improved Well-Being and Healthier Cortisol Profiles in Undergraduate Students

ObjectivesStress is highly prevalent in college students. Self-compassion, the tendency to respond in a caring manner to one’s own suffering or failures, reduces psychological distress and promotes mental health. Self-compassion may also influence physiological manifestations of stress; however, research is limited. Among undergraduate students over the course of an academic semester, we explored the associations of self-compassion with stress-related psychological variables including measures of affect, anxiety, and depressive symptoms. We also examined daily patterns of salivary cortisol over four days: diurnal slope, mean, and day-to-day cortisol rhythm stability.MethodThis sample of undergraduate students from introductory psychology courses in a large United States Midwestern university was predominantly non-Hispanic White (71.2%) and female (86.4%). All data were collected prior to final exams. After providing baseline psychosocial data, participants engaged in a 2-week mindfulness intervention: They were provided an iPod loaded with audio tracks based on the well-known Mindfulness-Based Stress Reduction intervention, but received no face-to-face instruction. Fifty-nine participants provided self-report demographic and medical data and completed the saliva sampling regimen over the first 4 days of the intervention. Diurnal salivary cortisol was assessed immediately after waking and again at bedtime over four consecutive days.ResultsHierarchical multiple regressions replicated previous findings showing that self-compassion is associated with higher positive and lower negative affect, lower perceived stress, and fewer symptoms of anxiety and depression. Regression models controlling for oral contraception and tobacco use revealed a positive association of self-compassion with healthy cortisol profiles marked by steeper diurnal cortisol slopes and increased regularity of the inter-daily cortisol slope.ConclusionsThese results confirm that self-compassion may be protective against the psychological and physiological manifestations of stress in college. Kind and compassionate responses to one’s own struggles may shield students from the adverse effects of stress. The potential mechanisms underlying these associations are worthy of future research.PreregistrationThis study is not preregistered.

Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

ObjectivesTo investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms.DesignCross-sectional analysis of a population-based cohort.SettingStudy centres in Norway, Sweden, Iceland, Denmark and...

Effect of Lead Exposure and Lifestyle Factors on Methylation Index Markers Among Pb-Exposed Workers.

S-Adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) and the ratio of SAM and SAH in Pb-exposed workers need to be assessed. In this study, we investigated the effects of Pb exposure on SAM, SAH, and methylation index (MI) in Pb-exposed workers with contemplation of lifestyle factors. Blood lead levels (BLLs), SAM, SAH, MI, and lifestyle factors were assessed in 338 male Pb-exposed workers. BLLs are estimated by ICP-OES method. SAM and SAH levels in serum were determined by ELISA method. The MI was calculated using SAM and SAH individual values. The lifestyle factors were collected using standard questionnaire. Levels of SAM and MI were significantly decreased with increased age, experience > 5 years, habits of tobacco chewing, smoking, alcohol consumption, and BLLs 10-30, 30-50, and > 50 µg/dL. Levels of SAH were significantly increased with increased age, habits of tobacco chewing and smoking, and BLLs 10-30, 30-50, and > 50 µg/dL. The association between BLLs and methylation index markers (SAM and MI) was reported as negative and significant. The association between BLLs and SAH was noted positive and significant. The influence of BLLs and lifestyle factors on SAM was noted at 12%, SAH at 35%, and MI at 27%, respectively. The highest percentage of influence was noted in SAH, followed by MI and SAM. In the workers exposed to Pb, lifestyle factors resulted in decreased SAM and MI and increased SAH levels. Adaptation of healthy lifestyle factors, personal hygiene practices, and use of PPE were suggested to minimize the reduction of methylation index markers.

Cigarette Smoking and its Association with Dyslipidemia among Middle-aged Population in Rajshahi District

Background &amp; objective: Dyslipidemia is one of the major risk factors for ischemic heart disease. Many factors contribute to the development of dyslipidemia. Smoking is one of them. Smoking and dyslipidemia are claimed to interact with each other and synergistically increase the risk of heart disease. The present study is, therefore, intended to find the association between smoking and dyslipidemia in the context of the Bangladeshi population. Methods:The present cross-sectional study was conducted in the Department of Biochemistry, Rajshahi Medical College (RMC), Rajshahi in collaboration with the Institute of Biological Science, Rajshahi University, Rajshahi over a period of five years between 2017 and 2022. A total of 230 adult (ranging from 30 to 60 years) male subjects who attended at Biochemistry Lab of RMC to have their blood tested for lipid profile were consecutively included in the study. However, individuals with the habit of chewing tobacco, ex-smokers, or those having any diseases influencing lipid profile, taking drugs (like β-blockers, thiazide, statins, fibric acid derivatives, and nicotinic acid) that may influence lipid profile, or obese persons under dietary restrictions were excluded from the study. The subjects who exhibited either serum TC: HDL ratio &gt; 4.5 or serum Tg: HDL ratio &gt; 3.5 or both conditions were considered as cases and the subjects who did not have either of the conditions were considered as controls in the present study. Result: In the present study, over one-third (34.8%) of subjects had a smoking habit with the mean duration of smoking being 13.6 ± 5.0 years. Dyslipidaemia (as defined by serum TC: HDL &gt; 4.5) was found in 33% of subjects, while the same condition, defined by serum Tg: HDL &gt; 3.5, was found in 42.6% of the subjects. While either of the two conditions was present in 13% of subjects, both conditions were concurrently observed in 31.3% of subjects. Of the total 230 subjects, 102(44.3%) were dyslipidaemic. Smoking habit was observed to be significantly higher in the case group (54.9%) than that in the control group (18.8%). The risk of having dyslipidaemia in smokers was &gt; 5-fold (95% CI = 2.9 – 9.5) higher than that in non-smokers (p &lt; 0.001). However, as the duration of smoking was correlated with different lipid profiles, it was not found to be significantly correlated with any of the lipid profiles. Conclusion: The study concluded that smokers are more likely to have dyslipidaemia than non-smokers. The risk of having dyslipidaemia in smokers is much higher than that in non-smokers. While serum total cholesterol, low-density lipoprotein (LDL) and serum triglycerides are increased, serum high-density lipoprotein (HDL) is reduced. Ibrahim Card Med J 2023; 13 (1&amp;2): 26-31

Complication Of Intralesional Hyaluronidase Injection DuringTreatment Of Oral Submucous Fibrosis: A Case Report

Aims and background: Oral submucous fibrosis (OSMF) is a potentially malignant condition of oral cavity. Optimal dosage of local injection of corticosteroids with hyaluronidase is an effective treatment. Case description: A 34 years’ old male, diabetic patient reported with reduced mouth opening. He had a tobacco chewing habit. He was thoroughly examined and diagnosed with OSMF. Due to diabetes, he was advised only hyaluronidase injection. After 4 sessions of intralesional injection, he started developing facial edema after every session that subsided within 48-72 hours. Conclusion: The present report is to discuss a complication of intralesional hyaluronidase therapy. Clinical significance: Hyaluronidase can be administered without corticosteroid in OSMF patients with diabetes keeping in mind the adverse reactions that could happen and how to manage them when encountered.

Various risk factors associated with peri implantitis: A review

There are so many factors which contributes to the development of the peri implantitis or may work as etiological factors which can lead to formation of peri implantitis. Peri implantitis can occur due to systemic conditions, due to local conditions, due to some personal habits like smoking, drinking, stress, tobacco chewing, not maintaining oral health properly. These all conditions, joined together and lead to formation of peri implantitis.

Verrucous carcinoma on lateral tongue in association with oral submucous fibrosis: A rare case report

Oral verrucous carcinoma (VC) is a rare tumor, which a clinical variant of well differentiated oral squamous cell carcinoma characterized by exophytic growth or cauliflower like growth in appearance. It establishes in older individuals, who has habit of chronic tobacco chewing and predominance in males. Oral submucous fibrosis (OSMF) is a chronic, insidious, potentially malignant disorder associated with betel nut chewing habit. The development of oral squamous cell carcinoma (OSCC) is seen in one-third of the OSMF patients, but the development of VC is rarely seen in such patients. In the literature a very few cases of OSMF with VC are reported. Here, we present such a rare case in a 25 years old female patient with VC in conjunction with OSMF.

HER2/neu in head and neck cancers: A worthy target or not?

e18022 Background: Head and neck cancers (HNC) account for a major public health problem across the globe, more so in India where it ranks as the second most common cancer. Most cases involve oral cavity due to use of chewable tobacco products and more than 65% present in locally advanced stage. It thus becomes imperative to continuously look for newer, more advanced targets and treatment modalities. One such target we sought to evaluate was HER2/neu, which has been successfully used for treatment in different tumors showing HER2/neu amplification from breast cancers to Gastric cancers and others, significantly improving survival outcomes. Further, with the development of Trastuzumab Deruxtecan now being evaluated as a tumor agnostic antibody for cancers showing even low levels of HER2/neu expression, we attempted to assess the incidence of HER2/neu expression (including HER2 low) in 50 cases of HNC using Immunohistochemistry (IHC) and Fluorescence In Situ Hybridization (FISH) with an aim to evaluate the utility vs futility, of treatment with Anti-HER2 antibody. Methods: Retrospective analysis was done in 50 recent cases of HNC diagnosed at Global Reference Laboratory, Agilus Diagnostics and they were evaluated for HER2/neu expression by IHC using the FDA approved Ventana clone. The study design was akin in most aspects to HER2/neu analysis in breast cancer, in which, on IHC, Score 3+ was considered positive and Score 0 was considered negative, both of which not warranting subsequent FISH analysis. Score 2+ on IHC was considered equivocal and thus subjected to FISH for confirmation. Positive cases in this category would be considered positive while negative cases would be considered negative but analyzed for appropriate group and kept in a separate category of HER2/neu low for analysis and future reference. Score 1+ though considered negative was also subjected to FISH to analyze copy numbers and HER2/CEP17 ratio and these cases were also clubbed separately in HER2/neu low group for analysis and future reference. Results: In 50 cases analyzed, none tested positive (Score 3+) for HER2/neu on IHC. Two cases showed equivocal staining while six cases showed Score 1+. Both equivocal cases tested negative on FISH and fell in Group 5 as per the latest 2023 guideline update. Of the six cases which showed Score 1+ on IHC, four cases fell in Group 5 while two showed Group 4 pattern. Thus, none of the cases were positive for HER2/neu as per the recent guidelines, while 8 cases fell under the category of HER2/neu low expression by definition. Conclusions: This study is in concordance with extremely low HER2 expression documented in HNC implying the futility of treatment with current Anti- HER2 antibodies. However, 16% cases showing HER2/neu low expression definitely make it prudent to do clinical studies assessing the utility of Trastuzumab Deruxtecan and similar antibody drug conjugates in this setting just like other tumor types where numerous studies are already undergoing at the moment.

A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL

Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.

Systematic Review on Oral Health Knowledge, Practice and Attitude In Pakistan

Background: The term "oral health" describes the state of the mouth's defence against ailments that affect the oral cavity, such as tooth decay, periodontal disease, cancer of the mouth and throat, facial discomfort, and ulcers. Oral cleanliness, tobacco usage, alcohol consumption, and general diet are the main contributors to oral health issues and illnesses. The most significant advantage of maintaining proper dental hygiene is the prevention of diseases. In Pakistan, dental health is not given much priority. The aim of this systematic review is to thoroughly examine and summaries the body of research on Pakistani people's attitudes, practices, and knowledge on oral health. The study aims to identify knowledge gaps, offer a thorough review of the existing situation regarding oral health awareness, habits, and attitudes, and indicate possible areas for development. Methods: This thorough systematic review, which adheres closely to PRISMA principles, examines all cross-sectional studies examining the gaps in oral health knowledge, practice, and attitude in Pakistan. Several databases such as Medline, ProQuest Central, Web of Science, and Scopus were used and past and current reviews on the same subject were looked in the Cochrane Database of Systematic Reviews. Selected papers were meta-synthesized to produce results that were both statistically sound and strong. Results: The findings reveal that there are differences in the population's knowledge about oral health, certain groups with low socio-economic status showing less understanding of preventive and good oral hygiene habits. Conclusion: This review highlights the need for all-encompassing strategies that account for differences in geography, culture, and socioeconomic disparities by placing the findings in a broader literary context. To improve oral health outcomes across the country, specific public health campaigns, educational programmes, and policy measures are crucial given the knowledge gaps and practice discrepancies that have been discovered. By addressing these problems, we can improve people's general health and lessen the prevalence of oral disorders in Pakistan.