Clinical evaluation of a mobile, low-cost system for fluorescence guided photodynamic therapy of early oral cancer in India.

BACKGROUND: Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery. METHODS: 30 patients with T1N0M0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed. FINDINGS: There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers. INTERPRETATION: This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.

HIV/AIDS in Bangladesh: the role of government in health and human services administration.

Explore the susceptibility of the People of Bangladesh to HIV/AIDS. The prevalence of HIV/AIDS in the neighboring countries may have reasonable proportions of impact in our country. According to the data provided by a Bangladesh University, the number of detected People living with HIV/AIDS reached 567 as of Dec 2005. Importance of appropriate education on safe sex, violence, HIV/AIDS at all levels of our society, including counseling and advocacy, is emphasized and recommends governmental policy and research for prevention of HIV/AIDS.

Defining and implementing arsenic policies in Bangladesh: possible roles for public and private sector actors.

A UN report warned up to 50% of Bangladesh's population (57 million) are at risk of arsenic poisoning from naturally occurring arsenic in well water. This article explores how this problem occurred, assesses what factors impede progress eliminating this problem and recommends governmental measures for prevention of arsenic poisoning.