Assessing the quality of life of head and neck healthcare workers during the COVID-19 pandemic-A self-reported global cross-sectional questionnaire study by the International Federation of Head and Neck Oncologic Societies.

BACKGROUND: Considering the pandemic's mode of transmission, the impact on quality of life (QOL) is likely to be exaggerated among healthcare workers (HCWs) who treat head and neck diseases (hHCWs). METHODS: A cross-sectional self-reported QOL assessment was undertaken between July and September 2020 using the World Health Organization Quality of Life instrument sent out to hHCWs. Factors that predicted a poorer QOL were identified using regression models and mediation analysis. RESULTS: Responses from 979 individuals across 53 countries were analyzed with 62.4% participation from low- and middle-income countries. The physical domain had the highest mean scores of 15 ± 2.51, while the environmental domain was the lowest (14.17 ± 2.42). Participants from low- and middle-income countries had a significantly worse physical (p < 0.001) and environmental (p < 0.001) domains, while a low coronavirus disease 2019-related mortality significantly impacted the environmental domain (p-0.034). CONCLUSION: QOL-related issues among hHCWs are a vexing problem and need intervention at an individual and systems level in all parts of the world.

Oral sex and human papilloma virus-related head and neck squamous cell cancer: a review of the literature.

Head neck squamous cell carcinomas (HNSCCs) are a significant cause of morbidity and mortality all around the world. Just like tobacco and alcohol, Human papilloma virus (HPV) infection is now recognized to play a role in the pathogenesis of a subset of HNSCCs. Unprotected sexual behaviours with the HPV carrier plays an important role in transmission of this virus. The global incidence of head and neck cancers is declining, but the incidence of HPV related head and neck cancers is rapidly increasing over the last few decades. However, most institutions do not mandate documentation of sexual history or counselling of patients regarding sexual practices like they do for tobacco and alcohol addictions in HNSCC patients. The aim of this review of literature is to analyse if there is a strong evidence to correlate oral sex with HPV related HNSCC and counsel the patient's regarding sexual behaviours.

Adequacy of surgical margins in oral cancer patients with respect to various types of reconstruction.

BACKGROUND: Surgical margin is an important prognostic factor for oral cancers (oral squamous cell carcinoma [OSCC]). The correlation of margin with the type of reconstruction has never been studied. AIM: This study aimed to correlate surgical margins with the type of reconstruction. METHODS: This was a retrospective study of 410 treatment-naïve OSCC patients. As per the methods of reconstruction, three groups were made when reconstruction was performed using pedicled flap (PF) or local flap, free flap, and primary closure (PC). STATISTICAL ANALYSIS: Chi-square test was used for comparison of margin status as per the method of reconstruction. Mann-Whitney test was used to find the difference between the mean margin width with respect to the type of reconstruction. RESULTS: The overall incidence of close/positive margins was 7.8%. The incidence of close/positive margins was not significantly different in free flap group compared to PF (P = 0.06) or PC (P = 0.835) group. However, there was a significant difference in the incidence of close/positive margins between PC and PF groups (P = 0.021). Whether the reconstruction is performed by the primary surgeon or by a another surgeon, it did not have an impact on adequacy of margins (P = 0.334). Margins were wider when the reconstruction is performed by a different team (P = 0.015) or when reconstruction is performed as compared to PC. CONCLUSION: Margins are not affected by the type of reconstruction (pedicled vs. free flap) and the team doing reconstruction (same vs. another team). Margins are significantly compromised when a surgeon performs PC himself/herself compared to PF.

Oral squamous cell carcinoma associated with oral submucous fibrosis have better oncologic outcome than those without.

OBJECTIVE: Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut, and is mainly seen in the parts of Southeast Asia and the Indian subcontinent. We hypothesized that oral cancers occurring in presence of OSMF are clinicopathologically a distinct entity. STUDY DESIGN: We analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using the χ2 test. Kaplan-Meier analysis was used for survival analysis. RESULTS: Oral squamous cell carcinoma along with OSMF was seen more often in younger patients (P < .001) and males (P < .007), and had a lower T-stage (P < .002) and N-stage (P < .000). These were thinner (P < .002), less infiltrative (P < .04) tumors and required adjuvant therapy less frequently (P < .017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (P < .002), and specifically for stages III and IV was 49.4 and 38.5 months, respectively (P < .053). CONCLUSIONS: Oral squamous cell carcinomas associated with OSMF are associated with good clinicopathologic profile and have better prognosis and oncological outcomes.

Analysis of Alkaloids in Areca Nut-Containing Products by Liquid Chromatography-Tandem Mass Spectrometry.

Chewing of areca nut in different forms such as betel quid or commercially produced pan masala and gutkha is common practice in the Indian subcontinent and many parts of Asia and is associated with a variety of negative health outcomes, particularly oral and esophageal cancers. Areca nut-specific alkaloids arecoline, arecaidine, guvacoline, and guvacine have been implicated in both the abuse liability and the carcinogenicity of the areca nut. Therefore, variations in the levels of areca alkaloids could potentially contribute to variations in addictive and carcinogenic potential across areca nut-containing products. Here, we developed an accurate and robust liquid chromatography-tandem mass-spectrometry (LC-MS/MS) method for simultaneous quantitation of all four areca alkaloids and applied this method to the analysis of a range of products obtained from India, China, and the United States. The results of the analyses revealed substantial variations in the levels of alkaloids across the tested products, with guvacine being the most abundant (1.39-8.16 mg/g), followed by arecoline (0.64-2.22 mg/g), arecaidine (0.14-1.70 mg/g), and guvacoline (0.17-0.99 mg/g). Substantial differences in the relative contribution of individual alkaloids to the total alkaloid content were also observed among the different products. Our results highlight the need for systematic surveillance of constituent levels in areca nut-containing products and a better understanding of the relationship between the chemical profile and the harmful potential of these products.

Acute toxicities of adjuvant treatment in patients of oral squamous cell carcinoma with and without submucous fibrosis: A retrospective audit.

OBJECTIVE: To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cell carcinoma (OSCC) patients with and without submucous fibrosis (SMF). MATERIALS AND METHODS: The study population comprised treatment naïve OSCC patients who underwent curative intent surgical resection from June 2010 to April 2011 followed by adjuvant treatment. Patients whose treatment details including toxicity profile were available were included in the study. One-hundred nine patients met the inclusion criteria of whom 36 had associated SMF and 73 no SMF. Overall, 35 patients received chemotherapy (CT) with radiotherapy (RT) and the rest only RT. Forty-two patients had centralized and 67 lateralized lesions. All patients with centralized lesions and 3 with lateralized lesion received radiation to bilateral face and neck. All others received ipsilateral radiation. The severity of mucositis, xerostomia, and skin toxicity (as per radiation therapy oncology group scale of acute toxicity) was compared between the SMF and non-SMF groups and patients with centralized and lateralized lesions. RESULTS: CT in addition to RT did not add significant to the assessed toxicities. Severe mucositis as well as treatment breaks were more in SMF group as compared to non-SMF group (P = 0.001 and <0.001 respectively). Severe mucositis and xerostomia were more in centralized than in lateralized lesions (P = 0.002 and 0.00 respectively). In subgroups of lateralized as well as centralized lesions, severe mucositis was more common in SMF patients than those without SMF (P = 0.01 and 0.02 respectively). CONCLUSION: OSCC patients with SMF have worse toxicity with adjuvant therapy and require good supportive care.

Point-of-Sale Tobacco Advertising Remains Prominent in Mumbai, India.

OBJECTIVES: In India, a 2003 law ("COPTA") banned tobacco advertising with the exception of "point of sale" and "on-pack" advertising. Given substantial evidence regarding the impact of point of sale advertising (PoS), we analyzed the prevalence of encountering such advertising in Mumbai, India. METHODS: A survey was conducted of 199 current and recent former tobacco users recruited at the Tata Memorial Hospital (Mumbai). Enrollees were queried regarding their exposure to tobacco advertising in the last 30 days through multiple media sources. Descriptive epidemiologic techniques were used to characterize the data. RESULTS: Overall, 95% of participants were men and 5% were women (mean age=49 years). All were current tobacco users or quit using all forms of tobacco in the last 60 days. Participants' responses revealed that PoS tobacco advertising had been encountered in the last 30 days for cigarettes (61%), bidis (54%), and smokeless tobacco (59%). Other forms of tobacco advertising were virtually non-existent. CONCLUSIONS: PoS tobacco advertising remains prominent and highly visible to consumers in Mumbai, India, indicating corporate exploitation of a loophole in the COPTA legislation. Given the observed compliance with the currently imposed bans, revisions of COPTA to include all forms of tobacco promotion and advertising would be impactful.

Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity.

BACKGROUND: The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity. METHODS: This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted. RESULT: The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue. CONCLUSION: Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

A review on harmful effects of pan masala.

Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. It is widely available and used by all the sections of the Indian society. It is genotoxic as it increases sister chromatin exchange and chromatin aberrations. Among humans, it is a leading cause of oral submucous fibrosis that often progresses to oral cancer. Among experimental animals, it leads to neoplastic lesions in lung, liver and stomach. It is hepatotoxic leading to increased level of enzymes, deranged carbohydrate and lipid metabolism. It is harmful to kidneys and testes leading to increased creatinine and sperm deformities respectively. PM is a very harmful substance affecting almost all organ systems, and there is immediate need for a national policy on complete ban on the production, storage, sale and marketing of PM.

Harmful effects of nicotine.

With the advent of nicotine replacement therapy, the consumption of the nicotine is on the rise. Nicotine is considered to be a safer alternative of tobacco. The IARC monograph has not included nicotine as a carcinogen. However there are various studies which show otherwise. We undertook this review to specifically evaluate the effects of nicotine on the various organ systems. A computer aided search of the Medline and PubMed database was done using a combination of the keywords. All the animal and human studies investigating only the role of nicotine were included. Nicotine poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is decreased immune response and it also poses ill impacts on the reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents. The use of nicotine needs regulation. The sale of nicotine should be under supervision of trained medical personnel.

A review of the systemic adverse effects of areca nut or betel nut.

Areca nut is widely consumed by all ages groups in many parts of the world, especially south-east Asia. The objective of this review is to systematically review and collate all the published data that are related to the systemic effects of areca nut. The literature search was performed by an electronic search of the Pubmed and Cochrane databases using keywords and included articles published till October 2012. We selected studies that covered the effect of areca nut on metabolism, and a total of 62 studies met the criteria. There is substantial evidence for carcinogenicity of areca nut in cancers of the mouth and esophagus. Areca nut affects almost all organs of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It causes or aggravates pre-existing conditions such as neuronal injury, myocardial infarction, cardiac arrhythmias, hepatotoxicity, asthma, central obesity, type II diabetes, hyperlipidemia, metabolic syndrome, etc. Areca nut affects the endocrine system, leading to hypothyroidism, prostate hyperplasia and infertility. It affects the immune system leading to suppression of T-cell activity and decreased release of cytokines. It has harmful effects on the fetus when used during pregnancy. Thus, areca nut is not a harmless substance as often perceived and proclaimed by the manufacturers of areca nut products such as Pan Masala, Supari Mix, Betel quid, etc. There is an urgent need to recognize areca nut as a harmful food substance by the policy makers and prohibit its glamorization as a mouth freshener. Strict laws are necessary to regulate the production of commercial preparations of areca nut.