Rising incidence of oral cancer in Ahmedabad city.

CONTEXT: In 1999, an increase in mouth cancer incidence among young men (<50 years) in urban Ahmedabad was reported to be occurring along with decreasing mouth cancer incidence in older age groups and increasing oral submucous fibrosis incidence associated with areca nut consumption among young men in Gujarat. The aim was to investigate whether the increase in the incidence mouth cancer that had started among young men in the 1990s was continuing. SETTINGS AND DESIGN: Ahmedabad urban population, comparison of reported mouth cancer cases in the population across four time period. METHODS: Age‑specific incidence rates of mouth cancer (International Classification of Diseases [ICD]‑9:143–5; ICD‑10:C03–06) in five year age groups among men aged ≥15 years for the city of Ahmedabad for years 1985, 1995, 2007 and 2010 were extracted from published reports. For comparison, lung cancer (ICD‑9:169; ICD‑10:C33–C34) rates were also abstracted. STATISTICAL ANALYSIS USED: A cohort approach was used for further analysis of mouth cancer incidence. Age adjusted incidence rates of mouth and lung cancer for men aged ≥15 years were calculated and compared. RESULTS: The age specific incidence rates of mouth cancer among men increased over the 25‑year period while lung cancer rates showed a net decrease. Using a cohort approach for mouth cancer, a rapid increase in younger age cohorts was found. CONCLUSIONS: Mouth cancer incidence increased markedly among men in urban Ahmedabad between 1985 and 2010, apparently due to increasing consumption of areca nut products, mawa and gutka. Gutka has now been banned all over India, but a more vigorous implementation is necessary.

Accidental implantation of a bur tip in the elbow of a dentist. A possible pathway for inoculation with deadly infectious agent

The most common source of occupational injury to dentists is percutaneous puncture of the hands from "sharps". We report a percutaneous injury involving a dentist where the tip of a dental bur became implanted in his elbow. The dentist had been vaccinated against Hepatitis B and both the patient and dentist were Hiv and Hepatitis B seronegative immediately after the incident. Surgical exploration of the dentist's elbow the following day was unsuccessful in locating the bur tip. The dentist remains healthy and is not incapacitated as a result of the injury, despite retention of the bur tip. This accident has implications for modifying the design of present and future dental units. We are not aware of a previous report of this type of injury.

Case reports of chromomycosis.

Two cases of chromomycosis were diagnosed in B.Y.L. Nair Charitable Hospital during the years 1980-1989. Isolates were identified as Fonsecea compactum.

Serological characterisation of Neisseria gonorrhoeae by co-agglutination technique.

Antibiotic susceptibility pattern in cases of acute gonococcal urethritis, was studied by single disc diffusion technique and minimum inhibitory concentration (MIC) by agar dilution technique were determined for 5 antibiotics, viz penicillin, ampicillin, tetracycline, gentamicin and norfloxacin. All the penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG strains were sensitive to norfloxacin. 72% of the isolates belonged to serogroup WII/WIII by co-agglutination technique.

Hepatitis C virus infection in chronic liver disease in Bombay.

To find out the prevalence of antibody of hepatitis C virus (anti-HCV) in patients with chronic liver disease in Bombay, sera from 126 patients (93 men, 33 women; aged 9-70 years, mean 39.7) with chronic liver disease (cirrhosis 103, cirrhosis with hepatocellular carcinoma 3, chronic active hepatitis 20) were tested for HBsAg and anti-HCV antibody. HBsAg positive sera were tested for anti-delta antibody and IgM anti-HBc. All the tests were carried out by ELISA. Of 126 patients, 51 (40.5%) were HBsAg positive, 49 (38.8%) alcoholic and 21 (16.6%) anti-HCV positive. The prevalence of anti-HCV in HBsAg positive, alcoholic and cryptogenic (HBV negative and no alcohol) liver disease patients was 13.7%, 14.7% and 20.5% respectively. Of 21 anti-HCV antibody positive patients, 8 (38%) had received blood transfusions previously. HCV is present in 15-20% of patients with chronic liver disease in Bombay.

HIV infection in patients of liver cirrhosis.

A total of 130 patients of liver cirrhosis (97 males, 33 females; aged 9-70 yr) of various etiologies were subjected to anti HIV antibodies testing by ELISA and supplementary Western Blot (WB) tests. Eleven patients were positive by ELISA. Of these 11 patients, 5 were WB positive, 4 were WB negative and 2 were indeterminate. Of the 5 WB positive patients none had received blood transfusions and one was a homosexual. These results indicate that HIV infection was present in 3.8 per cent patients of liver cirrhosis. Further studies are required on a large number of patients to recommend HIV testing routinely in cirrhotic patients.

Frequency of hepatitis B, C and D and human immunodeficiency virus infections in multi-transfused thalassemics.

Of forty multi-transfused thalassemia patients (26 males, 14 females; mean age 8.1 +/- 5.3 years, range 1-35) with no clinical or biochemical evidence of liver disease, HBsAg, anti-hepatitis C virus and anti-human immunodeficiency virus antibodies were present in 18 (45%), 7 (17.5%) and 1 (2.5%) cases respectively. Three of the 18 (16.7%) HBsAg positive patients were anti-delta antibody positive. Our results indicate that more than 50% of multi-transfused thalassemia patients show serological evidence of one or more of hepatitis B, C and D and human immunodeficiency virus infection.

Prevalence of delta virus infection in high risk population and hepatitis B virus related liver diseases.

Two hundred and fifty four high risk persons or patients with hepatitis B virus related liver disease (209 men, 45 women; age range 1-78 years) were tested for anti-delta antibody and IgM anti-HBc to determine the prevalence of delta agent coinfection and superinfection. The prevalence of delta infection was as follows: acute viral hepatitis 23/148 (16%) and chronic liver disease 17/92 (19%), and asymptomatic HBsAg carriers 1/6 (17%). In the high risk population, the delta antibody prevalence was as follows: multiple transfusion recipients 3/8 (38%), patients with chronic renal failure 1/5 (20%) and medical professionals 2/7 (29%). Of 44 patients (34 men, 10 women; age 3-63 years) with delta infection, 26 (59%) had coinfection and 18 (41%) had superinfection. Six patients with anti-delta antibody had received blood transfusion(s) and six others gave history of parenteral exposure.

Mono and dual therapy for Helicobacter pylori associated gastritis.

Sixty patients with Helicobacter Pylori positive non ulcer dyspepsia were randomly allocated to one of the following treatment groups: Group I--norfloxacin 400 mg bid for 10 days, Group II--amoxycillin 500 mg bid plus tinidazole 500 mg bid for 15 days, Group III--colloidal bismuth subcitrate (CBS) 240 mg bid for 4 weeks. H pylori elimination was achieved in 14%, 81%, and 62% in Groups I, II and III respectively. Eradication of H pylori was not observed in Groups I and II, but was achieved in 25% of patients in Group III. Antral gastritis improved in 69% in Group II and 50% in Group III. We conclude that norfloxacin is not effective in H pylori infection. A combination of amoxycillin and tinidazole is highly effective in H pylori elimination with improvement in associated gastritis, but H pylori eradication is not observed with this therapy. CBS is also effective in H pylori elimination though H pylori eradication is achieved in only 25%.

Salmonella phage types in Bombay from 1983 to 1987.

A total of 156 strains of Salmonella isolated at T.N. Medical College and B.Y.L. Nair Ch. Hospital, Bombay over a period of 5 years from 1983 to 1987 were subjected to Phage Typing. Out of the 111 Salmonella typhi strains, phage type A was found in highest proportion (45.95%), followed by phage type E1 (15.32%), 0(9.91%), Deg. Vi. (9.91%) and C5(5.41%). Salmonella paratyphi A had phage type pattern of 1(60.0%), 2(22.86%) and Untypable (14.29%). Majority of the Salmonella typhimurium isolates (90.0%) were untypable.

A bacteriological study of purulent meningitis in children.

There was an increase in incidence of meningitis in children within the last three years at the Bai Yamunabai Laxman Rao Nair Charitable Hospital in Bombay. Out of 270 purulent samples, 60 (22.22 percent) were culture positive. Neisseria meningitidis showed an increase from one case in 1985 to 11 cases by the end of 1987. Staphylococcus aureus was isolated from 6 percent cases, Streptococcus pneumoniae 15 percent, and Gram negative bacilli were predominant, isolation rate being 57 percent. Salmonella species were isolated from 6 (10 percent) cases. They were multidrug resistant type, some belonging to the rare zoonotic species.