Shame and Stigma Over Long-Term Survival in Postoperative Cases of Head and Neck Cancer.

Background: Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life. Objective: The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients. Methodology: Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale. Results: The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration. Conclusion: We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.

Serum Concentration of MMP-9 as a Predictive Biomarker for the Progression of Oral Cancer.

Background: Oral cancer is the most prominent cancer subtype among all head and neck cancers, the incidence and prevalence of which has been consistently increasing in past years around the globe. At advanced stages, oral cancer imparts significant mortality, morbidity, and mutilation among the patients, and therefore, diagnosis and treatment of the disease at early stages are considered the optimum strategy for the management of the disease. Since molecular changes appear earlier than physical symptoms, several molecular biomarkers are currently being investigated for their role in diagnosing and treating disease. MMP-9 belongs to the family of proteinases that are involved in cytoskeletal degradation, which is a crucial phase of cancer progression. Objective: In the present study, we analyzed the serum concentration of MMP-9 in oral cancer patients and tried to establish MMP-9 as a predictive biomarker for the progression of oral cancer. We also correlated the clinical, sociodemographic and biochemical parameters with the serum concentration of MMP-9 in oral cancer patients. Methods: Serum was extracted from the blood sample of 38 oral cancer patients and was analyzed for the concentration of MMP-9 using sandwiched ELISA. Predesigned proforma was used to capture the clinical, sociodemographic and biochemical parameters. Unpaired t-test was used to compare two means, one way ANOVA was used to compare more than two means and Pearson's correlation was used to correlate the variables. Results: The mean concentration of MMP-9 in patients of oral cancer was 816.9 ± 236.1 ng/mL. The MMP-9 expression level was higher at advanced oral cancer stages than in the early stages. No significant difference in the MMP expression was found in terms of sociodemographic risk factor and tumor site. MMP-9 exhibit significant negative correlation with the HDL and significantly positive correlation with the PTI. Rest of the biochemical parameters does not exhibit significant correlation. Conclusion: The present study suggests that serum concentration of MMP-9 can be a predictive biomarker for the progression of oral cancer, which needs to be validated by performing further longitudinal cross-sectional studies by taking ample sample size.

Assessment of Shame and Stigma in Head and Neck Cancer: A Meta-Analysis.

Background: Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life. Objectives: Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer. Methods: In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed. Results: Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched. Conclusion: Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.

Accuracy of a self-reported Measure in Psychological Assessment when the Instrument is self-administered by the Patient or when Administrated by the Clinician.

Background: Self-reported measures are the questionnaire-based instrument that are routinely used in the clinical scenario to assess psychological health. Technically, the self-reported measure should be administrated by the patients themselves but due to the complexity of tools and illiteracy among patients, clinicians often tend to interview the patients. Objective: Present article aims to compare the accuracy of a self-reported measure in the assessment of the psychological health of a patient when the instrument is self-administrated by the patient and when administrated by the clinician or researcher. Methods: We have recruited 43 patients of oral cancer in the study who have a tumor in the buccal mucosa region. The Hindi version of the shame and stigma scale was used to analyse the shame and stigma in patients. The questionnaire was first provided to the patient for the self-administration and after that clinician administrated the questionnaire to the patient by keeping the clinician blinded to the patient self-administrated responses. Results: There was no significant difference in the global mean score and mean score of various subdomains of shame and stigma scale in the self-administered and clinician-administered mode of interview. However, the clinician-administered mode could provide more accurate measures as it helps the patient towards a better understanding of questions. Conclusion: It is recommended that the newly developed or translated self-reported measure should be tested for both patient administrated and clinician administrated compatibility. Questionnaires could be administrated by the clinician in the case when the patient is illiterate or in the case when the patient does not understand the language of the instrument.

Quality of Life in Oral Cancer Patients Following Surgical Excision and Flap Reconstruction.

Background: Incidence of oral cancer have been increased aggressively in recent years, and many advanced surgical techniques have developed to facilitate the treatment of disease while preserving the patient's quality of life (QoL). Subjects and Methods: The present study aims toward the evaluation of patient's satisfaction toward the current treatment procedure for oral cancer by assessing the QoL preoperatively and postoperatively. In the study period of four years, we had operated 150 patients with oral cancer (Stage III and IVa) by surgical excision and flap reconstruction, and QoL was assessed using the WHO-QoL BREF questionnaire. Results: We found significant improvement after surgery in various aspects of QoL including the physical health, social health, psychological health and environmental health. Conclusions: The present study is evidence of patient satisfaction toward the current treatment protocols  of oral cancer. However, advanced surgical techniques that can enhance the rate of functional rehabilitation can have paramount importance in improving the patient's QoL.

Media Commercials Conveying Awareness Regarding Prevention of Head and Neck Cancer by Focusing on Stigmatized Perspective of Disease: Right or Wrong?

Cancer in the head and neck region is among the most common cancer around the world, the incidence of which keep increasing in past years. Treatment of disease is usually done by the surgical excision which often leads to some degree of facial disfigurements which cause mutilation in patients. Mutilation imparts the feeling of stigma in patients, and patients usually tend to hide facial disfigurements using additional clothing. As a prevention strategy, awareness regarding the disease conveys to the mass population via media commercials. Media commercials which highlight the adverse outcomes of cancer are found to target the stigmatized perspective of disease. On the brighter side, more stigmatized is the patient image in the commercials, more motivation it will create in masses to avoid risk factors like tobacco, smoking and alcohol. But on the darker side, stigmatized commercials create a social environment in which people tend to maintain social distance to cancer patients, and patients have to bear social disapproval by society for their whole life. It reduces the self-esteem and quality of life of patients which affects their overall survival. In the present article, we review the status of stigma in head and neck cancer patients, tools that are available for assessment of stigma, and effects of the stigmatized media commercials on the patient's self-esteem. The present article represents the accurate picture of the problem and highlights the policies which could be employed to balance the paradox of stigmatized media commercials and a healthy social environment for cancer patients.

Stigmatic Impact of COVID-19 Pandemic on Head & Neck Cancers Survivors.

Social stigma is the spoilation of the social image of an individual, which leads to the social disapproval of the individual by the community. Patients of many diseases like HIV, deafness, and reproductive disorders often face social disproval. Head & neck cancer survivors perceived stigma due to the mutilation that occurred after surgical treatment procedures. The novel coronavirus is a recently emerged zoonotic viral agent that affects the respiratory system of humans. Following its outbreak from the Wuhan city of China, the COVID-19 spreaded fiercely around the globe, forming a pandemic. Since COVID-19 is a contagious disease with no available treatment, social distancing is considered as the best strategy to prevent the geometric spread of infection. With the social distancing model, the head & neck cancer survivors along with the various other stakeholders perceived stigma being a high-risk group for COVID-19 infection. As the pool of caregivers is diminished due to pandemic, head & neck cancer survivors face increased social isolation and perceived stigma in asking for help from relatives. At the time of the pandemic, social support is critical to fighting against the disease. Social distancing should be maintained along with communication with the patients through calls, text, and online social platforms. It is not wise to stigmatize disease as, in that case, patients who are infected with the disease will try to hide it and avoid seeking medical care. With the promotion of social distancing, it is crucial to convey awareness regarding not to stigmatize the disease.

Yoga as a Preventive Intervention for Cardiovascular Diseases and Associated Comorbidities: Open-Label Single Arm Study.

Aim: Common Yoga Protocol (CYP) is a standardized yoga protocol authored by experts from all over the world under the aegis of the Ministry of AYUSH, Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa and Homeopathy (AYUSH). The potential of CYP can be determined as a cost-effective lifestyle modification to prevent the risk of developing cardiovascular diseases (CVD). Methods: In this prospective trial, we compared the effect of CYP at baseline and after 1 month. A total of 374 yoga-naïve participants performed CYP under the supervision of experienced trainers. Physiological [body mass index (BMI), blood pressure, percent oxygen saturation], biochemical (fasting blood glucose and lipid profile), and neurocognitive parameters were measured before and after the intervention. Results: At day 30 of yoga practice, serum levels of low-density lipoprotein (LDL), total cholesterol (TC), and high-density lipoprotein (HDL) were found significantly improved as compared to the baseline levels observed at the time of enrollment. Similarly, the lipid profile was also obtained from experienced trainers and found to be significantly different from those of yoga-naïve volunteers. When the intervention was compared between the healthy yoga-naïve participants with yoga-naïve participants suffering from medical issues, it was found that cholesterol profile improved significantly in the healthy-naive group as compared to the diseased group (hypertension, diabetes, underwent surgery, and CVD). Conclusion: These results highlight the need for further research to better understand the effects of yoga on the primary prevention of CVD.

Stage-specific expression analysis ofMMP-2 & MMP-9 in laryngeal carcinoma.

AIM OF THE STUDY: Both matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) is involved in degradation of extracellular matrix and found to stimulate invasion and metastasis in cancer patients. However, studies on the stage-specific expression of MMPs at different stages of larynx carcinoma are still lacking. In the present study, we compare the expression level of MMP-2 and MMP-9 at different stages of laryngeal carcinoma. MATERIAL AND METHODS: Tumor tissues samples were taken from larynx cancer patients by deep biopsy during direct laryngoscopy. Gene expression for MMP-2 and MMP-9 was analyzed using RT-PCR. RESULTS: Significantly high expression of MMP-2 was observed compared to the MMP-9 at stage IV compared to the less advanced stages of the disease. CONCLUSION: Present study concluded that the MMP-2 expressed with a greater magnitude as compared to the MMP-9 in advance stages of laryngeal carcinoma.

Guinness world record attempt as a method to pivot the role of Yoga in Diabetes management.

BACKGROUND: Attempts for Guinness world record have continued worldwide but these attempts were rarely aimed to promote public health. Diabetes is one of the rapidly growing lifestyle disorders in India which requires awareness reinforcements among the local population. In recent studies, Yoga has proved to be useful in lifestyle modification and Diabetes management. However, most individuals from rural and urban localities in the country are unaware of this fact. PURPOSE: The purpose was to organizing a nationwide attempt under the Niyantrit Madhumeh Bharat (NMB) programme to break the world record to be the largest Diabetes lesson, to spread awareness among general population. METHODS: Present article represents the perspective of the Chandigarh chapter of NMB programme and its experience in Guinness world record attempt. Diabetes awareness lesson was organized in the city as per the standards defined by the Guinness Book and outcomes of the entire campaign were assessed at the end of the campaign. RESULT: Total 498 individuals participated in the campaign. Among them, 268 participants were questioned at the end of the campaign about the role of Yoga in Diabetes. 247 participants (92%) were agreed that Diabetes can be modified by Yoga and 9 participants (3%) disagreed. The remaining 12 participants (5%) did not give any response. CONCLUSION: We noticed that most of the participants became aware of the role of Yoga in Diabetes.

Creating a role model for "Academicians" Social Responsibility (ASR) synergizing with Swachh Bharat Abhiyaan: A campus hygiene initiative by PGIMER, Chandigarh.

BACKGROUND: The state of disarray from unhygienic conditions and excessive litter throughout urban highways, alleyways, and byways across rural and urban localities of India is abysmal. Such unsanitary conditions impinge upon the future health and welfare of its citizens, tourists and economic development. PURPOSE: The NRL volunteered PGIMER's campus hygiene initiative" is a pioneering effort spearheaded in compliance with Indian Prime Minister's call that citizens of India work together to establish a cleaner and healthier environment. METHODS: A group of 15 highly motivated students in the Neuroscience Division of the PGIMER, worked together vigorously 2 hours a week to affect a cleaner urban environment in the city. RESULT: The results were national Kayakalp and Skoch award to PGIMER as the cleanest hospital in the country, the vendors or patients no longer litter around the campus, the pot holes have been converted into greener patches, signs board adorn the campus. CONCLUSION: To inspire citizens through faculty- student led sanitation programs.

Steroidogenesis and VEGF Production Doesn't Alter in Leydig Cells within the Homeostatic Range of Testicular Temperature.

CONTEXT: Physiologically defined homeostatic temperature range for human testis falls within 32°C-37°C and any deviation outside that range can result in impaired steroidogenesis. However, whether temperature deviation within the homeostatic range can affect the steroidogenesis, is still a question of the investigation. AIM: In the present study, we investigated the production of progesterone, testosterone, and vascular endothelial growth factor (VEGF) within the homeostatic temperature range of testis, i.e., 32°C-37°C. SETTING AND DESIGN: We used mouse Leydig tumor cells-1 (MLTC-1) cell line as a model in the present study. MATERIALS AND METHODS: Progesterone and testosterone production by MLTC-1 cells was measured by radioimmunoassay and VEGF production was measured using ELISA. STATISTICAL ANALYSIS USED: Data were analyzed using GraphPad Prism software version 7.04. Student's t-test and ANOVA were used to calculate the P value. P < 0.05 was considered statistically significant. RESULTS AND CONCLUSIONS: Results of our study indicate that there is no significant difference in production of progesterone, testosterone, and VEGF within the homeostatic range of the testicular temperature. Thus, we concluded that testicular cells are able to regulate the steroidogenesis and VEGF production under the homeostatic range of the testicular temperature.

Is Rajyoga helpful in maintaining patient's biochemical and hematological profile during breast cancer treatment?

The present study is the case of a breast cancer patient who visited the local unit of the Brahma Kumaris (BK). Conversations with the patient revealed that the patient was being treated in the Post Graduate Institute of Medical Education and Research, Chandigarh, India. The treatment of the patient included the surgery, radiotherapy, and chemotherapy. The patient narrated her ability to manage the psychological stress associated with the cancer treatment. She ascribed it to the positive attitude developed by her practice of the Rajyoga meditation from last 15 years. Rajyoga involved the daily meditation and regular listening to the specified commentary recommended by BK. Patient's health remains stable during the whole treatment process as analyzed by the mammography, histopathology and PET scan. The patient was also able to maintain the total body weight, biochemical and hematological profile within normal physiological range. The present case study is an attempt to provide Rajyoga as supportive means to the maintenance of patient's biochemical and hematological profile, and overall general health during breast cancer treatment.

Yoga as an Integrative Approach for Prevention and Treatment of Oral Cancer.

Despite tremendous advancements in medicine, the number of oral cancer cases continues to increase, and the need for integrating alternate medicine or adopting an integrative approach has become a compelling cost-effective requirement for the management and treatment of diseases. Conventional treatment of oral cancer involves surgery followed by radiotherapy with or without chemotherapy which causes several complications including poor quality of life and high chances of recurrence of cancer. Oral cancer is often linked with obesity which is major risk factors in other cancers. Apart from obesity, oral cancer is thought to have an inverse relation with neurodegenerative disorders presumably because cell death decreases in the former case and increases in the latter. Ancient mind-body techniques such as yoga have not been adequately tested as a tool to synergize the cellular equilibrium pertaining to the treatment of oral cancer. Nerve growth factor (NGF), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) are among the early experimental cellular biomarkers that may be used to probe the modulation of oral cancer, obesity, and neurodegenerative disorders. Yoga has been reported to influence these molecules in healthy individuals but whether their expression can be altered in patients of oral cancer by yoga intervention is the subject of this research being discussed in this review article. Therefore, the present article not only reviews the current status of research studies in oral cancer, obesity, and neurodegenerative disorders but also how these are linked to each other and why the investigations of the putative NGF pathway, involving TNF-α and IL-6, could provide useful clues to understand the molecular effects brought about by yoga intervention in such patients.