RESUMEN
It is estimated that around 2.5 lac patients are identified as having an acute venous thrombo-embolic event in India annually. This includes patients with deep vein thrombosis and pulmonary embolism, and is estimated to result in more than 3.7 lacs deaths each year in European countries. The 'Consensus on Management of Deep Vein Thrombosis with Emphasis on NOACs (Non-Vitamin K Antagonist Oral Anticoagulants): Recommendations from Inter-Disciplinary Group of Indian Experts' position paper was developed to assist clinicians and institutions with an evidence-based approach to the diagnosis and treatment of acute deep vein thrombosis patients. Key to the evaluation of patients with suspected deep vein thrombosis is the use of the clinician's clinical evaluation with the help of pre-test probability tools as well as judicious use of objective diagnostic tests. Our hope is that we have supplemented clinicians' clinical acumen, and assisted them and their health systems in developing best practice approaches to this ever-interesting population of patients. The Deep Vein Thrombosis Consensus Working Group welcomes your inputs on how improvements might be made on this paper in the future.
Asunto(s)
Anticoagulantes/uso terapéutico , Trombosis de la Vena/prevención & control , Administración Oral , Antídotos/uso terapéutico , Monitoreo de Drogas , Hemorragia/inducido químicamente , Hemorragia/tratamiento farmacológico , Humanos , India , Aparatos de Compresión Neumática Intermitente , Embolia Pulmonar/prevención & control , Medición de Riesgo , Factores de Riesgo , Medias de Compresión , Trombectomía , Terapia Trombolítica , Trombosis de la Vena/diagnósticoRESUMEN
This article provides an overview of the recruitment strategies utilized in the Mumbai Worksites Tobacco Control Study, a cluster randomized trial testing the effectiveness of an integrated tobacco control and occupational safety and health program in Indian manufacturing worksites. From June 2012 to June 2013, 20 companies were recruited. Companies were identified using association lists, referrals, internet searches and visits to industrial areas. Four hundred eighty companies were contacted to validate information, introduce the study and seek an in-person meeting with a company representative. Eighty-three company representatives agreed to meet. Of those 83 companies, 55 agreed to a formal 'pitch meeting' with key decision makers at the company. Seventy-seven recruitment 'pitches' were given, including multiple meetings in the same companies. If the company was interested, we obtained a letter of participation and employee roster. Based on this experience, recommendations are made that can help inform future researchers and practitioners wishing to recruit Indian worksites. When compared with recruitment of US manufacturing worksites, recruitment of Indian worksites lacked current industrial lists of companies to serve as a sampling frame, and required more in-person visits, incentives for control companies and more assurances around confidentiality to allow occupational safety and health experts into their worksite.
Asunto(s)
Promoción de la Salud/organización & administración , Salud Laboral , Selección de Paciente , Lugar de Trabajo , Humanos , India , Prevención del Hábito de FumarRESUMEN
Chitosan-tripolyphosphate (CTPP) beads were prepared using in-liquid curing method and used for the adsorption of uranium from aqueous solution. Beads were prepared at two different cross-linking densities by adjusting the pH of the tripolyphosphate solution. The synthesized beads were characterized using FTIR spectroscopy before and after adsorption of uranium. Beads having higher cross-linking are found to have better adsorption capacity for uranium. Factors that influence the uranium adsorption onto CTPP beads such as solution pH, contact time and initial uranium concentration were studied in detail. The experimental results were fitted into Langmuir and Freundlich adsorption isotherms. From Langmuir adsorption model the adsorption capacity of CTPP beads for uranium is estimated as 236.9 mg/g. Pseudo-first order, pseudo-second order and intraparticle diffusion model were applied to the observed kinetics data and the results shows that the pseudo-second order model is more suitable to explain the kinetics of adsorption of uranium on CTPP beads. FTIR spectroscopic characterization of the beads showed that the phosphate groups may be more responsible for the adsorption of uranium on CTPP beads.
Asunto(s)
Quitosano/química , Uranio/química , Agua/química , Adsorción , Concentración de Iones de Hidrógeno , Soluciones , Espectroscopía Infrarroja por Transformada de Fourier , TermodinámicaRESUMEN
A variety of betel/areca nut/tobacco habits have been reviewed and categorized because of their possible causal association with oral cancer and various oral precancerous lesions and conditions, and on account of their widespread occurrence in different parts of the world. At a recent workshop in Kuala Lumpur it was recommended that "quid" be defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured or processed form." Clear delineations on contents of the quid (areca nut quid, tobacco quid, and tobacco and areca nut quid) are recommended as absolute criteria with finer subdivisions to be added if necessary. The betel quid refers to any quid wrapped in betel leaf and is therefore a specific variety of quid. The workshop proposed that quid-related lesions should be categorized conceptually into two categories: first, those that are diffusely outlined and second, those localized at the site where a quid is regularly placed. Additional or expanded criteria and guidelines were proposed to define, describe or identify lesions such as chewer's mucosa, areca nut chewer's lesion, oral submucous fibrosis and other quid-related lesions. A new clinical entity, betel-quid lichenoid lesion, was also proposed to describe an oral lichen planus-like lesion associated with the betel quid habit.
Asunto(s)
Areca/efectos adversos , Enfermedades de la Boca/etiología , Mucosa Bucal/patología , Plantas Medicinales , Plantas Tóxicas , Tabaco sin Humo/efectos adversos , Humanos , Liquen Plano Oral/clasificación , Liquen Plano Oral/etiología , Liquen Plano Oral/patología , Erupciones Liquenoides/clasificación , Erupciones Liquenoides/etiología , Erupciones Liquenoides/patología , Malasia , Enfermedades de la Boca/clasificación , Enfermedades de la Boca/patología , Neoplasias de la Boca/clasificación , Neoplasias de la Boca/etiología , Neoplasias de la Boca/patología , Fibrosis de la Submucosa Bucal/clasificación , Fibrosis de la Submucosa Bucal/etiología , Fibrosis de la Submucosa Bucal/patología , Lesiones Precancerosas/clasificación , Lesiones Precancerosas/etiología , Lesiones Precancerosas/patología , Terminología como AsuntoRESUMEN
BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition caused by use of the areca nut. The reported prevalence of OSF in Bhavnagar district during 1967 was 0.16%. We investigated whether the impression of an increase in the incidence of the disease was real. METHODS: A house-to-house survey was conducted in Bhavnagar district, Gujarat state. The use of areca nut-containing products and tobacco was assessed through an interviewer administered questionnaire. The oral examination was done by dentists. The diagnostic criteria for OSF was the presence of palpable fibrous bands. RESULTS: A total of 11,262 men and 10,590 women aged 15 years and older were interviewed for their tobacco habits. Among 5018 men who reported the use of tobacco or areca nut, 164 were diagnosed as suffering from OSF. All but four cases were diagnosed among 1786 current areca nut users (age-adjusted relative risk: 60.6). Areca nut was used mostly in mawa, a mixture of tobacco, lime and areca nut, and 10.9% of mawa users had OSF (age-adjusted relative risk: 75.6). The disease as well as areca nut use was concentrated (about 85%) in the lower (< 35 years) age group. CONCLUSIONS: An increase in the prevalence of OSF, especially in the lower age groups, directly attributable to the use of areca nut products was observed. This could lead to an increase in the incidence of oral cancer in the future.
Asunto(s)
Areca , Fibrosis de la Submucosa Bucal/epidemiología , Plantas Medicinales , Adolescente , Adulto , Anciano , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Fibrosis de la Submucosa Bucal/etiología , Plantas Tóxicas , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/etiología , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Encuestas y Cuestionarios , Tabaco sin Humo/efectos adversosRESUMEN
The potential of p53 protein expression as a marker for determining which oral precancerous lesions may transform to malignancy with time was assessed. We compared the p53 expression in archival formalin-fixed, paraffin-embedded tissues from 22 baseline biopsies of precancerous lesions that transformed to cancer in 4-25 years against that in 68 similar lesions that did not transform over the same time period. Twenty-nine percent of precancers that transformed were p53-positive at baseline, compared to 31% of the biopsies that did not transform to malignancy. When examined by immunohistochemical methods p53 expression failed to detect potential malignant status of oral precancer. Non-specificity of the assay may account for this result but overexpression of p53 due to DNA damage by tobacco/betel-quid in non-progressive lesions needs further study. Nine precancerous lesions became p53-immunoreactive from precancer to cancer. This may suggest p53 overexpression peaks close to the time of transition from precancer to cancer rather than early in the natural history of oral precancer.
Asunto(s)
Biomarcadores de Tumor/genética , Transformación Celular Neoplásica/genética , Regulación Neoplásica de la Expresión Génica , Neoplasias de la Boca/genética , Lesiones Precancerosas/genética , Proteína p53 Supresora de Tumor/genética , Areca , Biopsia , Transformación Celular Neoplásica/patología , Daño del ADN , Fijadores , Estudios de Seguimiento , Formaldehído , Humanos , Inmunohistoquímica , Leucoplasia Bucal/genética , Leucoplasia Bucal/patología , Neoplasias de la Boca/patología , Adhesión en Parafina , Plantas Medicinales , Plantas Tóxicas , Lesiones Precancerosas/patología , Tabaco sin Humo , Proteína p53 Supresora de Tumor/análisisAsunto(s)
Areca/efectos adversos , Neoplasias de la Boca/etiología , Fibrosis de la Submucosa Bucal/etiología , Plantas Medicinales , Plantas Tóxicas , Lesiones Precancerosas/etiología , Tabaco sin Humo/efectos adversos , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11,707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication, was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92%. The age in the sample ranged from 25 to 115 years with a mean of 44.5+/-14.0. The sample comprised 40.2% males and 59.8% females; 55.8% were Malays, 29.4% Chinese, 10.0% Indians and 1.2% other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7%) subjects, 5 (0.04%) had oral cancer, 165 (1.4%) had lesions or conditions that may be precancerous (leukoplakia, erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6%) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0%) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5%) while the lowest prevalence was amongst the Chinese (0.5%).
Asunto(s)
Enfermedades de la Boca/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Areca , China/epidemiología , China/etnología , Demografía , Eritroplasia/epidemiología , Etnicidad , Femenino , Humanos , India/epidemiología , India/etnología , Liquen Plano Oral/epidemiología , Malasia/epidemiología , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Neoplasias de la Boca/epidemiología , Fibrosis de la Submucosa Bucal/epidemiología , Plantas Medicinales , Lesiones Precancerosas/epidemiología , Prevalencia , Factores Sexuales , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Oral submucous fibrosis (OSF) is a high risk precancerous condition, predominantly affecting Indians. Consumption of chilli was hypothesized as an etiologic factor on the basis of ecological observations and a solitary animal experimental study. Subsequent epidemiologic studies that included case-series reports, large cross-sectional surveys, case-control studies, cohort and intervention studies have identified areca nut as the major etiologic agent. Tissue-culture studies involving human fibroblasts, areca nut extracts and areca nut alkaloids supported this etiologic hypothesis by showing fibroblastic proliferation and increased collagen formation. Currently, the role of genetic susceptibility and that of autoimmunity are receiving attention. The influence of nutritional factors, if any, remains unclear.
Asunto(s)
Areca , Fibrosis de la Submucosa Bucal/etiología , Plantas Medicinales , Trastornos Relacionados con Sustancias/complicaciones , Animales , Arecolina/farmacología , Colágeno/biosíntesis , Reacciones Cruzadas , Susceptibilidad a Enfermedades , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Humanos , India/epidemiología , Fibrosis de la Submucosa Bucal/epidemiología , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
Betel-quid chewing is an ancient and socially accepted practice. The introduction of tobacco reinforced this practice, and now almost all habitual chewers of betel quids include tobacco. It is well established that chewing of betel quid with tobacco causes oral cancer and is largely responsible for the high incidence of oral cancer in several South Asian countries. The feasibility of primary prevention of oral cancer was studied in a population-based prospective intervention study. A cohort of 12,212 betel-quid chewers and smokers was exposed to a programme of health education for stopping chewing and smoking and subjected to annual examinations for detection of oral precancerous lesions. Evaluations after one, five and eight years showed that primary prevention of oral cancer is feasible and practicable. Early detection of oral cancer is an important control measure. In a secondary prevention study, 53 basic health workers were trained in the detection and referral of lesions suspected of being oral cancer. Over one year, they examined more than 39,000 high-risk individuals, resulting in the detection of 20 cases of oral cancer. The sensitivity and specificity of their diagnoses was assessed through a re-examination of a 5% sample: we concluded that it was possible to incorporate a secondary prevention programme into the existing health care system.
Asunto(s)
Areca , Neoplasias de la Boca/etiología , Plantas Medicinales , Educación en Salud , Humanos , Neoplasias de la Boca/prevención & control , Lesiones Precancerosas/etiologíaRESUMEN
Two siblings of a rare syndrome of vitamin D dependent type II rickets are reported for the first time from India. The clinical and biochemical picture was characterised by florid rickets, alopecia, hypocalcemia and resistance to therapy with high dosages of vitamin D3. Due to lack of facilities for estimation of 1,25(OH)2D, alopecia remains the only clue to the diagnosis of this rare syndrome in association with resistant rickets.
Asunto(s)
Calcitriol/uso terapéutico , Raquitismo/tratamiento farmacológico , Alopecia , Preescolar , Dihidroxicolecalciferoles/sangre , Femenino , Humanos , Masculino , Raquitismo/sangre , Raquitismo/complicacionesRESUMEN
A case-control study to elucidate the etiology of oral submucous fibrosis was conducted in Bhavnagar, Gujarat. Sixty consecutively arriving oral submucous fibrosis patients at a dental clinic were selected as cases. An equal number of controls matched for age, sex, religion and socioeconomic status were selected from individuals who did not exhibit any oral mucosal lesion or condition. Among cases, 98% chewed areca nut regularly in one form or the other whereas among controls 35% chewed areca nut, giving an overall relative risk of 109.6. Areca nut chewing was practiced most commonly in the form of mawa: a mixture containing mainly areca nut (over 90% by weight), some tobacco, and a few drops of lime. Mawa chewers and those who chewed mawa along with other chewing habits showed very high relative risks. The relative risks increased with increase in the frequency as well as the duration of chewing habits. In a bivariate analysis the effect of frequency and duration of chewing appeared to be multiplicative. The present findings confirm areca nut as the most important etiologic factor in oral submucous fibrosis.
Asunto(s)
Areca , Enfermedades de la Boca/etiología , Fibrosis de la Submucosa Bucal/etiología , Plantas Medicinales , Adolescente , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Niño , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Fibrosis de la Submucosa Bucal/epidemiología , Fibrosis de la Submucosa Bucal/patología , Plantas Tóxicas , Riesgo , Tabaco sin HumoRESUMEN
Incidence of oral submucous fibrosis was calculated from a 10-yr prospective intervention study of 12,212 individuals with a strong component of health education on tobacco and area nut chewing. Based on 11 new cases among 6341 chewers, the annual incidence was 8.0 per 100,000 among men and 29.0 for women. An earlier 10-yr follow-up study, with no intervention component, served as control. Based on 11 new cases among 3,809 chewers, the annual incidence was 21.3 per 100,000 for men and 45.7 for women controls. Although the decrease in the incidence in the intervention cohort was not statistically significant due to small number of cases, the results underscored the causal role of areca nut chewing and indicated the potential for primary prevention of oral submucous fibrosis.
Asunto(s)
Areca , Enfermedades de la Boca/epidemiología , Fibrosis de la Submucosa Bucal/epidemiología , Plantas Medicinales , Adolescente , Adulto , Anciano , Femenino , Educación en Salud , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Fibrosis de la Submucosa Bucal/etiología , Fibrosis de la Submucosa Bucal/prevención & control , Estudios ProspectivosRESUMEN
Regional variations in the characteristics of submucous fibrosis were studied in two districts in India. In Pune district this condition involved soft palate, uvula and retromolar areas significantly more often than in Ernakulam district. The tongue, floor of the mouth and the hard palate were not involved in Pune. The age of the patients in Pune district was lower than in Ernakulam district. Associated oral cancer, leukoplakia and petechiae were observed solely among patients in Ernakulam. The most important etiologic factor for submucous fibrosis is the chewing of areca nut, and in both areas studied all patients chewed areca nut. In Pune, cured areca nut without other ingredients was chewed by 66% and in Ernakulam, raw areca nut was chewed as an ingredient of pan with tobacco by 100%. Thus in Ernakulam, the juice and the quid were mostly spat out, whereas in Pune they were swallowed. The regional variations in the characteristics of submucous fibrosis could be related to the differences in the areca nut chewing habit between the two areas.
Asunto(s)
Enfermedades de la Boca/patología , Fibrosis de la Submucosa Bucal/patología , Adolescente , Adulto , Anciano , Areca , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Fibrosis de la Submucosa Bucal/etnología , Plantas Medicinales , Plantas Tóxicas , NicotianaRESUMEN
A water-soluble galactomannan consisting of D-galactose and D-mannose in the molar ratio 3:2 has been isolated from the seeds of Cassia angustifolia. Hydrolytic fission of the methylated polysaccharide resulted in three methylated sugars: (a) 2, 3-di- O-methyl- D-mannose, (b) 2, 3, 4-tri- O-methyl- D-galactose, and (c) 2, 3, 4, 6-tetra- O-methyl- D-galactose in the molar ratio 2:1:2. Partial acid hydrolysis of the polysaceharide afforded five oligosaccharides: (a) epimelibiose, (b) galactobiosylmannose, (c) mannobiose, (d) mannotriose, and (e) galactobiose. Periodate oxidation of the polysaceharide indicated 59.7% end group while methylation gave 60%. Sodium borohydride reduction of the periodate oxidised polysaceharide and subsequent hydrolysis revealed the presence of (1-->4) and (1-->6)-glycosidic bonds. Thus, the main chain of the galactomannan was found to consist of (1-->4)-linked mannoypyranosyl units having beta-glycosidic bonds while (1-->6)-linked alpha-glycosidically bonded galactopyranosyl units form the branching points.
RESUMEN
In a house-to-house survey in Ernakulam district, Kerala State, 10914 individuals were interviewed for their tobacco and alcohol habits and examined for the presence of oral leukoplakia. Very few females (1.6%) were found to be alcohol users and they were excluded from further analysis. Among 7604 males, 30.4% used alcohol regularly, 25.4% occasionally and 44.2% were non-users. The prevalence of leukoplakia was significantly higher among regular (5.7%) and occasional (3.9%) users than among non-users (2.9%) of alcohol. Alcohol usage was found to be related to age as well as tobacco habits. The prevalence of leukoplakia was higher among alcohol users in each age-group as well as in each tobacco habit category. After age-adjustment the difference between alcohol users and non-users, although reduced, remained significant. For most tobacco habit categories the trend remained similar after age-adjustment except for the mixed habits group, for which there was a reversal of the trend. The alcohol habit may, perhaps, produce discernible effects only in association with other 'weak' etiological risk factors, such as a single tobacco habit of smoking or chewing rather than a 'strong' etiologic factor such as the mixed habits of chewing and smoking.
Asunto(s)
Consumo de Bebidas Alcohólicas , Leucoplasia Bucal/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Areca , Humanos , India , Leucoplasia Bucal/etiología , Persona de Mediana Edad , Plantas Medicinales , Plantas Tóxicas , Fumar , NicotianaRESUMEN
A comparison of carcinogenicity of the habit of chewing betel quid with and without tobacco has been attempted through a reassessment of the available epidemiological evidence on aetiology of oral cancer and pre-cancer. Primary evidence comes from the reports which emphasize a low incidence of oral cancer among population groups who practise the habit of chewing betel quid without tobacco compared with those which practise the habit of chewing betel quid with tobacco. A more specific comparison is sought here through the quantitative estimation of the relative risks of the two types of betel habits. Out of three studies selected, two studies showed that the relative risk for the habit of betel quid without tobacco was not significant whereas the relative risk for the habit of betel quid with tobacco was highly significant. In the third study, although both relative risks were significant, the relative risk for the habit of betel quid with tobacco was significantly higher than the risk for the habit of betel quid without tobacco. The evidence from studies of oral pre-cancer was also in the same direction. It is suggested that in intervention and primary prevention programmes for oral cancer, the emphasis in the first instance might be upon the exclusion of tobacco from the betel quid rather than the complete discontinuation of the habit of chewing betel quid.
Asunto(s)
Areca , Neoplasias de la Boca/inducido químicamente , Nicotiana , Plantas Medicinales , Plantas Tóxicas , Asia Sudoriental , Humanos , India , Leucoedema Bucal/inducido químicamente , Leucoedema Bucal/epidemiología , Leucoedema Bucal/prevención & control , Leucoplasia Bucal/inducido químicamente , Leucoplasia Bucal/epidemiología , Leucoplasia Bucal/prevención & control , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/prevención & control , PakistánRESUMEN
A new flavonol glycoside, kaempferol-3-O-beta-D-mannopyranosyl (1-->4)-O-beta-D-glucopyranoside has been isolated from the seeds of Cassia grandis L. (N. O. Leguminoseae).