Prioritizing tobacco control & its cessation under sustainable development goals with a focus on India

Sustainable development goals (SDGs) were meant to put each and everywhere ‘at par’. The tobacco epidemic globally is one major deterrent to their achievement. While it gets addressed under SDG 3 through the Framework Convention on Tobacco Control (FCTC) - the World Health Organization (WHO) global treaty (the target 3.a of SDG 3), the progress made globally and by India is slow. As a result, many countries may fall short of achieving the target of reducing tobacco usage (taking 2016 as base year) by 30 per cent by the year 2030. India with its high burden of tobacco use and abysmally low quitting along with soaring economic costs of tobacco related diseases and deaths can do better with the engagement of multisectoral stakeholders to strengthen tobacco control under SDGs. Moreover, there is a need to emphasize that the goal of O - Offer to Quit of WHO MPOWER can be achieved through increasing ‘onus’ on policy makers, and strategists, and opportunities for masses, tobacco users, healthcare professionals (HCPs) and enforcers to have tobacco cessation delivered optimally. By doing so, the United Nations can significantly facilitate a reduction in tobacco use and the resultant economic costs. Furthermore, it will assist the WHO to fulfil the targets set for 2030 under SDG 3.a by the FCTC member countries. In addition, it will fulfil the vision and mission defined in the Chandigarh declaration of the 5th National Conference on Tobacco or Health for India to be tobacco free by 2030.

Effect of Artificial Ageing Using Different Wood Chips on Physico-chemical, Sensory and Antimicrobial Properties of Apple Tea Wine

Abstract: Freshly prepared apple tea wine (a combination of tea extract and apple juice) is having yeasty and dull flavour, which needs to be improved to increase the acceptability of this product. Therefore, an attempt has been made for artificial ageing of apple tea wine using different wood chips to improve its physico-chemical, sensory and antimicrobial attributes. Different types of wood chips (Quercus spp., Bombax spp. and Acacia spp.) were added respectively (2.5 g/L to the freshly prepared apple tea wine) and allowed for ageing in carboys for the six months at the room temperature. The influence of each wood species on physico-chemical, sensory and antimicrobial attributes was tested upto 6 months of storage. Storage intervals significantly affected all the physico-chemical attributes (except total sugars, volatile acidity, and antioxidant activity), whereas, the addition of wood chips affected titratable acidity, ethanol, higher alcohols, total phenols, and amino acid. Cluster analysis of the physico-chemical attributes data revealed the same and showed that storage intervals exerted more effect on the physico-chemical and antimicrobial properties of the apple tea wine rather than the wood chips. The antimicrobial activity of 6 months aged wine was low as compared to the fresh wine. Among all the wood chips, apple tea wine aged with Quercus spp. possesses a significantly higher score (according to desirability) than the wine aged with other wood chips and control. In nutshell, apple tea wine matured with Quercus spp. wood chips for 6 months were the best with improved physico-chemical and sensory attributes.

Importance of Synovial Biopsy of Knee Joint in the Diagnosis of Various Joint Disorders

Background: Rheumatoid arthritis hardly causes diagnostic problems when presented typically. Generally, difficulties arise when atypical clinical presentation is related with non-contributory preliminary investigations. Arthritis is an important cause of morbidity. Methods: In this study 60 total numbers of cases were included. This study was conducted in the Department of Orthopedics in K M Medical College & Hospital, Mathura. The duration of study was over a period of one year. Result: This result revealed that 40% cases were suffering from Chronic non -specific synovitis, 31.6% Rheumatoid arthritis, 6.7% Septic Arthritis & Osteoarthritis, 5% Gout & Synovial (osteo) chondro mitosis,3.3% Synovial sarcoma, 1.6% Giant cell tumor of tendon sheath Conclusion: This study concludes that Diagnostic method like immune-histological methods can be used to eliminate the “non-specificity”. It is also useful in achieving a better specific diagnosis.

Analysis of clinicopathological and immunohistochemical parameters and correlation of outcomes in gastrointestinal stromal tumors

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We analyzed the clinicopathological features, resectability, immunohistochemical markers, and various factors predictive of disease recurrence and survival. MATERIALS AND METHODS: Retrospective analysis of prospectively maintained database of GIST patients managed from 2005 to 2016 was done. Size, site, malignant potential, nuclear pleomorphism, histopathological variety, immunohistochemical markers, type of surgery, and adjuvant imatinib therapy were analyzed. RESULTS: Ninety-two patients with GIST were analyzed. Immunohistochemistry showed positivity for c-kit (82.4%), DOG1 (75%), and PDGFR-α (79%). Among 16 patients with c-kit-negative tumors, 10 patients were positive for DOG1, PDGFR-α, or both. The most common primary site was stomach (44, 47.8%) followed by small bowel (17, 18.5%) and duodenum (14, 15.2%). Of 92 patients, 80 (87%) underwent R0 resection with organ sparing resection in 56 (70%) patients. Seventeen (21.3%) patients showed recurrence at a median follow-up of 6 years. Median and 5-year overall survival (OS) was 36 months (12–120) and 75%, respectively, and 5-year RFS was 81.8%. On univariate analysis, size, mitotic activity, malignant potential, and nuclear pleomorphism were predictors of recurrence. However, on multivariate analysis, only nuclear pleomorphism was significant. CONCLUSIONS: GISTs had a wide spectrum of presentation, and immunohistopathological features with organ sparing resection were conceivable in maximum. Nuclear pleomorphism may be considered as an important variable to predict recurrence in addition to malignant potential of tumors.

A Morphometric Study Of Body And Vertebral Canal Of Thoracic Vertebrae & Its Clinical Significance

Introduction: Accurate anatomical descriptions of the size, shape and orientation of the main structures of thehuman vertebrae and intervertebral discs are necessary for a variety of approaches and objectives such as theidentification of clinical situations that are related to the morphometry of the spine structures, such as theincidence of low-back pain related to the spinal canal size. So the present study was done to measure the variousmorphometric parameters of thoracic vertebral body and neural canal.Materials and Methods: Total 100 sets of dry human thoracic vertebra were obtained. These are of unknown ageand sex. All Morphometric parameters were measured by digital Vernier caliper of accuracy of 0.01mm. Anteriorheight of the body (VBAH), Posterior height of the body (VBPH), Antero-posterior Diameter of Vertebral body(VBAPD), Transverse Diameter of Vertebral body (VBTD), Anteroposterior diameter of Vertebral Canal (VCAPD) andTransverse diameter of Vertebral Canal (VCTD). All parameters were entered into excel sheet and analysis wasdone by SPSS.Results: Mean VBAH ranged from 13.17+1.35mm (T1) to 17.92+2.25mm (T12), mean VBPH from 15.01+1.27mm(T1) to 20.92+4.58mm (T12), mean VBAPD ranged from 11.62+1.96mm (T1) to 18.12+5.71mm (T12), mean VBTDfrom 24.28+5.68mm (T1) to 28.59+5.97mm (T12), mean VCAPD ranged from 12.46+1.30mm (T1) to 16.05+2.41mm(T12) and VCTD from 17.15+2.19mm (T1) to 20.11+3.74mm (T12).Conclusion: The results of the present study may help in designing implants and instrumentations; understandingspine pathologies; and management of spinal disorder

Utility of Placental Umbilical Cord Blood in Autoimmune and Degenerative Disorders

Background: Umbilical cord blood is whole human blood (60 to 80 ml) that remains in the placenta and umbilical cord after childbirth; generally considered as a medical waste. It is a rich source of stem cells, growth factor, cytokines, etc., and, can be collected, stored and utilized in the treatment of incurable diseases. Aims and Objects: The aim of the present study is to establish the fact that placental umbilical cord whole blood is a safe alternative to adult blood and to assess its utility in degenerative and autoimmune disease along with its hematological parameters. Materials and Methods: It is a prospective two year study (From September 2016 to August 2018) of 250 umbilical cord whole blood transfusions in autoimmune and degenerative disorders at Gajra Raja Medical College, Gwalior, India. Follow up of patients was done up to 3 months and data was collected and analyzed statistically by frequency distribution and percentage proportion. Results: A total of 250 units meeting the inclusion and exclusion criteria were transfused to 99 preregistered patients; Vitiligo 61 (159 transfusions), Thalassemia 15 (30), Retinitis Pigmentosa 9 (23), Geriatric Disorders 9 (24), Aplastic anemia 4 (9) and High Myopia 1 (5). Out of 250 transfusions, in one case (0.4%) adverse event was reported. Outcome of transfusion reveals; In Vitiligo –regimentation in affected area, Thalassemia-reduction in frequency of transfusions, Retinitis Pigmentosa- improvement in vision area, Geriatric patients- sense of well being, Aplastic anemia- prolonged survival and High Myopia-improvement in vision area. Conclusion: Umbilical cord blood is safe and genuine alternative of adult blood. It is effective in degenerative and autoimmune diseases. It should not be discarded as medical waste and utilized judiciously in the human well being.

Do phosphatase of regenerating liver‑3, matrix metalloproteinases‑2, matrix metalloproteinases‑9, and epidermal growth factor receptor‑1 predict response to therapy and survival in glioblastoma multiforme.

Context: Poor survival of the glioblastoma multiforme (GBM) has been attributed in part to the invasive nature of the lesion making complete surgical removal near impossible. Phosphatase of regenerating liver‑3 (PRL‑3), matrix metalloproteinases‑2 and ‑9 (MMP‑2 and MMP‑9), and epidermal growth factor receptor (EGFR‑1) play a role in invasive nature of tumor cells. Aims: This study was conducted to evaluate PRL‑3, MMP‑2, MMP‑9, and EGFR‑1 (markers) expression in cases to GBM and to correlate their expression with therapy response and survival. Settings and Design: GBM cases (n = 62) underwent surgery followed by radiation (n = 34) and chemoradiation (n = 28). Using WHO Response Evaluation Criteria in Solid Tumors criteria response to therapy was assessed at 3 months and cases followed up for survival. Subjects and Methods: Expression of markers was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots. Statistical Analysis Used: Kaplan–Meier, ANOVA, Chi‑square test, univariate, and multivariate Cox‑regression analysis was done. Results: Response to therapy was evident in 54.8% cases of responders with the mean survival of 494.03 ± 201.13 days and 45.2% cases of non responders (278.32 ± 121.66 days) with P = 0.001. Mean survival for the patient’s opted chemoradiation was 457.43 ± 222.48 days which was approximately 3 months greater than those who opted radiation alone (P = 0.029). We found PRL‑3 overexpression was an independent, significant, poor prognostic factor for survival by multivariate analysis (P = 0.044). Cases negative for MMP’s and EGFR showed increased survival, but the difference was insignificant. Conclusion: PRL‑3 expression appears to be related to an adverse disease outcome.

A clinicopathological study of primary central nervous system lymphomas & their association with Epstein-Barr virus.

Background & objectives: Primary central nervous system lymphomas (PCNSLs) are relatively uncommon, accounting for 2-3 per cent of primary brain tumours. Majority of these are diffuse large B cell lymphomas (DLBCL) occurring both in immunocompromised and immunocompetent patients. We undertook this study to classify PCNSL into germinal centre (GC) and non-germinal centre (NGC) type based on Hans classification and to find the role of Epstein-Barr virus (EBV) in pathogenesis both by conventional immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH). Methods: The consecutive cases of PCNSL during a 10 years period were analysed by IHC for CD45, CD20, CD3, B-cell lymphoma 2 and 6 (Bcl-2 and Bcl-6), B-cell specific octamer binding protein-1 (BOB-1), multiple myeloma oncogene-1 (MUM-1), EBV latent-membrane protein 1 (LMP-1), cyclin-D1, CD10, CD5 and CD23, as well as by CISH for EBV. Results: During a period of 10 years, 65 PCNSL were diagnosed which comprised 0.69 per cent (65/9476) of all intracranial tumours. The mean age of presentation was 49 yr with sex ratio (M:F) of 1.4:1. Most common location was supratentorial region with predominant involvement of frontal lobe. Single lesions were seen in 38 (58.4%) and multifocal lesions in 27 (41.5%) patients. None of the patients were immunocompromised. All cases were B cell immunophenotype and were DLBCL except one case of follicular lymphoma. According to Hans classification, majority of them were NGC (n=51, 79.6%) and 13 (20.3%) were GC type. Bcl-2 expression was noted in 34 (52.3%) tumours. EBV was positive in three (4.6%) cases; two were detected both by IHC and CISH and one case by CISH only. Interpretation & conclusions: In Indian population, PCNSL occurs mainly in immunocompetent patients, and a decade earlier than in western population. Immunophenotyping revealed that all cases were DLBCL with predominance of NGC type. No prognostic difference was seen between GC and NGC DLBCL. Association of EBV was rare and this virus was possibly not involved in the pathogenesis of PCNSL in immunocompetent individuals. CISH was an easy, economical and less cumbersome method for detection of EBV in PCNSL.

Textiloma: Uncommon Cause of Failed Back Syndrome after Lumbar Spine Surgery.

Textiloma is the term used to describe retained foreign objects in the body which are left intentionally or accidentally during the operation. Textiloma is rare in neurosurgery. They are more frequent in thoracic and abdominal surgeries. Depending on their location, they can present with complications and symptoms or they may remain asymptomatic for many years. Textiloma and their complications are rarely reported due to medico-legal implications. In this article, we are presenting a case of spinal asymptomatic textiloma in a patient, who was operated 16 years ago, for a lumbar discectomy. On reviewing the literature, we found less than 60 cases reported until 2015.

A Study Of Patent Posterior Condylar Canal In North Indian Crania.

Abstracts: Background Studies of non-metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance. Methodology: Total of 28 north Indian human crania of U.P. was studied for the incidence of patent posterior condylar canal. Results: Patent posterior condylar canal was found in 9 (32.1%) of total human crania. Conclusion: The presence of patent posterior condylar canal found to be of considerable regional and racial significance.

Revisiting epidermal growth factor receptor in glioblastoma multiforme: Does it play a role in response to therapy.

Background and Aim: Glioblastoma multiforme (GBM) are the most aggressive class of cancer of central nervous system with hallmark characteristics that include rampant proliferation, necrosis, and endothelial proliferation. Epidermal growth factor receptor (EGFR) has been implicated as the primary contributor to glioblastoma initiation and succession. The present study was designed to evaluate EGFR protein expression in GBM as predictor of response to therapy and survival. Materials and Methods: Epidermal growth factor receptor was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots (10 high-power fields). The study group comprised of 35 cases of GBM. All cases underwent surgical resection and subsequently underwent radiotherapy (n = 17) or radiotherapy with adjuvant temozolomide chemotherapy (n = 18). Immediate response to therapy was assessed at 3 months using World Health Organization response evaluation criteria in solid tumors criteria and cases followed up for survival. Results: Twenty-four cases (68.6%) expressed EGFR while 11/35 (31.4%) cases were negative. Response to therapy was evident in 21/35 cases (60.0%) and 14/35 were (40.0%) nonresponders. Mean EGFR protein expression in responders was 37.23 ± 33.70 and in nonresponders was 59.5 ± 39.46 (P = 0.542). The percentage of responders which were EGFR negative was 72.7% and while response in EGFR positive cases was observed in 54.2%. Mean survival in EGFR positive and negative GBM was 394.37 ± 189.11 and 420.54 ± 191.23 days, respectively. Conclusion: The EGFR negative cases appear to respond better to therapy, however, the difference is not statistically significant (P = 0.298). Further, EGFR protein expression does not play a definitive role in predicting survival. This is an original study evaluating EGFR in terms of therapeutic response.

A study on human leukocyte antigen class I molecules in paediatric bronchial asthma.

Childhood asthma, often associated with atopy, is more common in boys and may persist throughout life in 50% of cases. This case-control study was carried out to examine if any association of paediatric bronchial asthma with human leukocyte antigen (HLA) class I antigens. Thirty-six children with bronchial asthma diagnosed on basis of Global Initiative for Asthma (GINA) criteria and an equal number of healthy controls without history of bronchial asthma were studied. Low resolution HLA- ABC typing was performed by sequence specific primers (SSP) and the frequency of HLA–ABC antigens in the two groups was compared. Total serum immunoglobulin E (IgE) estimation was done as a marker of atopy by ELISA. The study included 24 boys and 12 girls aged 13 months to 11 yrs, of which 16 (44%) had positive family history. Serum IgE levels were elevated in 20 (55%) of the cases and 33% of controls with peak values of 4877 and 627 IU/ml, respectively. No statistically significant correlation was observed between childhood asthma and HLA class I antigens, however, a statistically significant correlation was observed between serum IgE levels and asthma, which was elevated in cases, as compared to normal population. Serum IgE levels did not show a linear trend, in that a direct correlation with the severity of disease was not observed.

Newborn care practices and home-based postnatal newborn care programme – Mewat, Haryana, India, 2013

Background:In India, the Home Based Postnatal Newborn Care programme by Accredited Social Health Activists (ASHAs) under the National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rates (NMRs). ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana, having a high NMR and determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits.Methods:A cross-sectional survey was conducted among mothers who had delivered a child during the previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on the six safe newborn care practices, namely safe breastfeeding, keeping cord and eyes clean, wrapping baby, kangaroo care, delayed bathing and hand washing.Results:We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% of mothers adopted less than three safe practices. Wrapping newborns (96%) and delayed bathing (64%) were better adopted than cord care (49%), safe breastfeeding (48%), hand washing (30%), kangaroo care (20%) and eye care (9%). Cultural beliefs and traditional birth attendants influenced the mother’s practices. The lack of supervision by auxiliary nurse midwives (ANM), delayed referral and transportation were the other challenges.Conclusion:Knowledge–practice gaps existed among mothers counselled by ASHAs. Poor utilization of reproductive and child health services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBAs as ASHAs, innovative communication strategies for ASHAs and improved referral system.

Incidence of bregmatic bone in north Indian skulls.

Background and objective: Studies of non-meteric cranial variants have been a field of considerable interest to research workers specially because of their racial and regional importance. Supernumerary ossicles (or Wormian bones) of the cranial vault are formations associated with insufficient rate of suture closure. It was reported that there exists racial variability among the incidence of these bones. Material and methods: Studies of fifty north Indian skulls of Rohilkhand Medical College Bareilly and Shri Ram MurtiSmarak Institute of Medical Sciences, Bareilly, U.P. were studied for the incidence of Bregmatic bone cranial variant. Results: In our study the incidence of bregmatic bone was 4%, which was higher than reported elsewhere. Conclusion: The findings are discussed in the light of available literature and are of considerable racial and regional significance. We believe that the knowledge of bregmatic bone is of importance to the neuroanatomists, neurosurgeons, radiologists, anthropologists, paediatricians and morphologists.

A study of mastoid foramen in adult north Indian crania.

Background: Non metric cranial variants have always been a topic of considerable interest for research workers, as they possess racial, regional and sex dimorphic differences. These variants are also of anthropometric, genetic, morphological and forensic importance. Material and methods: 71 skulls from north indian region were studied for one of such variant, absence of mastoid foramen and presence of multiple mastoid foramen. Results: Incidence of absent mastoid foramen is 7.04 %, while bilateral incidence of absent mastoid foramen is only 1.4 %, however unilaterally mastoid foramen is absent in 5.63 %. (2.8 % on right side and 2.8 % on left side). Incidence of multiple mastoid foramina is 12.67 %, out of this it is bilateral in 8.45 %, however unilaterally it is present in 4.22 %. ( 1.40 % on right side and 2.81 % on left side).Conclusions: Findings are discussed and compared with other global studies and are found to be of considerable racial and regional significance. Knowledge of this variant is valuable in some neurosurgical and otolaryngeal procedures.

A biodegradation study of forest biomass by Aspergillus niger F7: correlation between enzymatic activity, hydrolytic percentage and biodegradation index

Aspergillus niger F7 isolated from soil was found to be the potent producer of cellulase and xylanase. The residue of forest species Toona ciliata, Celtris australis, Cedrus deodara and Pinus roxburghii was selected as substrate for biodegradation study due to its easy availability and wide use in industry. It was subjected to alkali (sodium hydroxide) treatment for enhancing its degradation. Biodegradation of forest waste by hydrolytic enzymes (cellulase and xylanase) secreted by A. niger under solid state fermentation (SSF) was explored. SSF of pretreated forest biomass was found to be superior over untreated forest biomass. Highest extracellular enzyme activity of 2201±23.91 U/g by A. niger was shown in pretreated C. australis wood resulting in 6.72±0.20 percent hydrolysis and 6.99±0.23 biodegradation index (BI). The lowest BI of 1.40±0.08 was observed in untreated saw dust of C. deodara having the least enzyme activity of 238±1.36 U/g of dry matter. Biodegradation of forest biomass under SSF was increased many folds when moistening agent i.e. tap water had been replaced with modified basal salt media (BSM). In BSM mediated degradation of forest waste with A. niger, extracellular enzyme activity was increased up to 4089±67.11 U/g of dry matter in turn resulting in higher BI of 15.4±0.41 and percent hydrolysis of 19.38±0.81 in pretreated C. australis wood. A. niger exhibited higher enzyme activity on pretreated biomass when moistened with modified BSM in this study. Statistically a positive correlation has been drawn between these three factors i.e. enzyme activity, BI and percent hydrolysis of forest biomass thus proving their direct relationship with each other.

Ultrasonographic study of correlation between development of gallstones with morphology of gallbladder and common bile duct in North Indian Population.

Background & objectives- Gallbladder diseases are very common in Indian population. Ultrasonography (USG) is the commonest mode of investigation in such conditions .In view of above mentioned points we have conducted the present study on ultrasonographic findings of gallstone (GS) patients . Present study aims at determining the comparative prevalence of single and multiple gallstones and size of gallbladder(GB) and common bile duct (CBD) in patients . In present study we have also tried to find relationship of development of gallstones with age and sex of the patient . Methods- For the purpose of study we have divided patients into seven groups(groups A-G) according to age . In each group we have calculated mean gallbladder size and mean common bile duct diameter with the help of ultrasonographs . Then we will calculate percentage of patients ,patients with multiple stones, patients with single stones , mean gallbladder size and mean gallbladder diameter in each age group. Results- Gallstones patients are more of 25-50 years of age and females are more susceptible according to present study . There were more cases of multiple stones . Mean gallbladder length in all age groups is found to be less than normal. Interpretation & conclusion- Present study suggests increased incidence of gallstones in young population and it underlines the importance of ultrasound in screening gallbladder diseases.

A study of metopic suture in adult north Indian skulls.

Background:- Studies of non metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance. Material and Methods:- Total of 40 north Indian skulls of U.P. were studied for the incidence of metopism, a cranial variant in the present study. Results:- Metopism was found in 2(5%) of total of human skulls. Conclusion:-The presence of Metopic suture found to be of considerable regional and racial significance and it simulates fracture of frontal bone, therefore its presence should be properly ruled out in X-rays.