Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future.

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a "female neurosurgery" and a "male neurosurgery" is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

Modulation of intrinsic defects in vertically grown ZnO nanorods by ion implantation.

Intrinsic defects created by chemically inert gas (Xe) ion implantation in vertically grown ZnO nanorods are studied by optical and X-ray absorption spectroscopy (XAS). The surface defects produced due to dynamic sputtering by ion beams control the fraction of O and Zn with ion fluence, which helps in tuning the optoelectronic properties. The forbidden Raman modes related to Zn interstitials and oxygen vacancies are observed because of the weak Fröhlich interaction, which arises due to disruption of the long-range lattice order. The evolution of the lattice disorder is identified by O K-edge and Zn K-edge scans of XAS. The hybridization strength between the O 2p and Zn 4p states increases with ion fluence and modulates the impact of intrinsic defects. The ion irradiation induced defects also construct intermediate defects bands which reduce the optical bandgap. Density functional theory (DFT) calculations are used to correlate the experimentally observed trend of bandgap narrowing with the origin of electronic states related to Zn interstitial and O vacancy defects within the forbidden energy gap in ZnO. Our finding can be beneficial to achieve enhanced conductivity in ZnO by accurately varying the intrinsic defects through ion irradiation, which may work as a tuning knob to control the optoelectronic properties of the system.

Anthropogenic arsenic menace in contaminated water near thermal power plants and coal mining areas of India.

Coal mining and coal combustion in thermal power plants (TPPs) are the major anthropogenic sources of arsenic (As) contamination in many different industrial regions. In this study of industrial regions of West Bengal and Singrauli, it is observed that there is an anthropogenic contribution to the contamination from As-bearing coal. Up to 14.53 mg/kg of As is obtained in coal of West Bengal which also has very high average Fe concentration (16,095 mg/kg) along with high concentration of Cu, Mn and Hg. Similar observations are also found in Singrauli Industrial Region where 3.14 mg/kg of As with very high concentration of Fe 43,867 mg/kg along with high Cu, Mn and Hg concentration is found in coal samples. This low-grade bituminous coal contains arsenopyrite as observed by SEM-EDX. Arsenopyrite is converted to arsenolite upon combustion in these TPPs as observed in XRD. The fly ash has average As concentration of 1.53 mg/kg for West Bengal and 2.38 mg/kg for Singrauli Industrial Region and high concentration of toxic elements. The soil near these TPPs and mining areas is enriched in As, Fe, Hg, Cu and Mn. Not only As but high concentrations of Fe, Hg, Mn are also observed from analysis of water which relates to the anthropogenic inputs. The dissolution of arsenolite in reducing environments caused by periodic flooding releases As into water. Hence, the As contamination in the study area also has anthropogenic origin from coal consumption in TPPs.

Long-term variability of trace gases over the Indian Western Himalayan Region.

The four-year continuous measurements of CO, NOx, NH3, SO2, and O3 were carried at a high altitude site (32.12°N, 76.56°E at 1347 m AMSL) of the Indian Western Himalayan area to study the mixing ratios of these gases for understanding the changing trends of these trace gases over the region. Each of these trace gases showed significant daily and monthly variabilities. The highest variability was recorded in the monthly mean values of O3 as it varied from 10 to 63 ppb during the study period. All the trace gases except CO showed maximum variability in the pre-monsoon seasons due to the strong advection and vertical circulation of air masses at the site. The seasonal mean maxima of CO were recorded during the monsoon season, while the mean maxima of NH3 were recorded during the post-monsoon seasons. The meteorological parameters have been found to influence the mixing ratios of trace gases. The least variability in the mean seasonal mixing ratios of SO2 during the study period indicated the constant point source of SO2 near the site. The trajectories analysis revealed that the area receives maximum air masses from the southeast to the west directions where a number of the coal-based thermal power plants, industries, cement plants, and agricultural fields are also located. The influence of valley-to-mountain circulations was also observed at the site, resulting in the transport of pollutant-rich air masses from local and distant sources to the site. A comparison of the mixing ratios of different trace gases obtained in the present study is also made with the values reported for other high altitude stations in the world.

Deciphering the role of meteorological parameters controlling the sediment load and water discharge in the Sutlej basin, Western Himalaya.

The Sutlej River basin of the western Himalaya (study area), owing to its unique geographical disposition, receives precipitation from both the Indian summer monsoon (ISM) and the Westerlies. The characteristic timing and intensity of the ISM and Westerlies, leaves a distinct footprint on the sediment load of the River. Analysis with the last forty years data, shows an increasing trend for temperature. While for precipitation during the same period, the Spiti watershed on the west has highest monthly accumulated precipitation with long term declining trend, in contrast to the other areas where an increasing trend has been observed. Thus, to probe the hydrological variability and the seasonal attributes, governed by the Westerlies and ISM in the study area, we analyzed precipitation, temperature, snow cover area (in %), discharge, suspended sediment concentration (SSC) and suspended sediment load (SSL) for the period 2004 - 2008. To accomplish the task, we used the available data of five hydrological stations located in the study area. Inter-annual shift in peak discharge during the monsoon period is controlled by the variation in precipitation, snow melt, glacier melt and temperature. Besides seasonal variability has been observed in generation of the sediments and its delivery to the river. Our analysis indicates, dominance of the Westerlies footprints in the hydrological parameters of the Spiti region, towards western part of the study area. While, it is observed that the hydrology of the Khab towards eastern part of the study area shows dominance of ISM. Further downstream, the hydrology of Nathpa station also shows dominance of ISM. It also emerged out that the snowmelt contribution to the River flow is mostly during the initial part, at the onset of the monsoon, while for rest and major part of the summer monsoon season, the River flow is augmented by the precipitation, glacial melt and some snow melt. We observed, that the SSC increases exponentially in response to increase in temperature and correlates positively with River discharge. The average daily SSL in the summer monsoon is many times more than that in the winter monsoon. The downstream decrease in steepness of the sediment rating curve is attributed to either a change in the River-sediment dynamics or on account of the anthropogenic forcing. The top 1% of the extreme summer monsoon events (only 4 events) in our study area contribute up to 45% of SSL to the total sediment load budget. It has also been observed that the River-sediment dynamics in the upstream catchments are more vulnerable and sensitive to the extreme events in comparison to the downstream catchments. The present study for the first time gives a holistic insight in to the complex dynamics of the hydrological processes operational in the study area. The research findings would be crucial for managing the water resources of the region and the linked water and food security.

Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India.

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

A setup for Seebeck coefficient measurement through controlled heat pulses.

A setup is designed for measuring the Seebeck coefficient (S) of materials in the form of thin films, bars, and wires. The main feature of this setup is its control in heating and cooling cycles. In this setup, a heat pulse is used to generate the temperature gradient. To demonstrate the capabilities of this setup, S versus T of standard wire samples such as Au-Fe (0.07%), chromel, Pt, and thin films of Pt and F doped SnO2 are presented. The standard uncertainty of the repeatability in the S measurement is found to be ∼±0.056 µV/K while the temperature stability is ∼±10 mK (at 320 K), estimated for a chromel wire sample. We have tested the setup in the temperature range 100 K-320 K, while it does not have any intrinsic limitations in going down to liquid He temperatures. For temperatures above 320 K, the limitation is due to gluing materials such as varnish.

High temperature-mediated rocksalt to wurtzite phase transformation in cadmium oxide nanosheets and its theoretical evidence.

Herein, a high temperature-induced phase transformation (PT) in chemically grown CdO thin films is demonstrated, and its corresponding electronic origin further investigated by density functional theory. In particular, the cubic rocksalt to hexagonal wurtzite PT in the CdO thin film annealed at 900 °C was confirmed by X-ray diffraction (XRD), which was consistent with the high-resolution transmission electron microscopy (TEM) results. Moreover, atomic force microscopy and scanning electron microscopy clearly evidenced the morphological evolution via the formation of a nanosheet network in the wurtzite-phase CdO film. The high temperature treatment also led to a significant enhancement in the optical band gap from 2.2 to 3.2 eV, as manifested by UV-visible spectroscopy. The enhanced surface roughness of the nanosheet caused a deviation in the net dipole moment, which may break the polarizable bonds and help in reducing the average dielectric constant, resulting in a band gap opening for the transformed phase. Furthermore, X-ray absorption spectroscopy at the oxygen k-edge revealed a notable shift in the inflection point of the absorption edge, while the X-ray photoelectron spectroscopy (XPS) Cd 3d and O 1s spectra suggested a gradual reduction in the CdO2 phase with an increase in annealing temperature. In addition, different complementary techniques including Rutherford backscattering and Raman spectroscopy were exploited to understand the aforementioned PT and its structural correlation. Finally, molecular dynamics simulation together with density functional theory calculation suggested that the symmetry modification at the Brillouin zone boundary provides a succinct signature for the PT in the CdO thin film.

Efficient multicolor tunability of ultrasmall ternary-doped LaF3 nanoparticles: energy conversion and magnetic behavior.

Luminescence-tunable multicolored LaF3:xCe3+,xGd3+,yEu3+ (x = 5; y = 1, 5, 10, and 15 mol%) nanoparticles have been synthesized via a low cost polyol method. Powder X-ray diffraction and high-resolution transmission electron microscopy studies confirm the hexagonal phase of the LaF3:xCe3+,xGd3+,yEu3+ nanophosphors with average sizes (oval shape) ranging from 5 to 7 nm. Energy-dispersive X-ray spectroscopy analyses show the uniform distribution of Ce3+, Gd3+, and Eu3+ dopants in the LaF3 host matrix. The photoluminescence spectra and electron paramagnetic resonance measurements guarantee the presence of Eu2+, corroborated through DC susceptibility measurements of the samples displaying paramagnetic behavior at 300 K, whereas weak ferromagnetic ordering is shown at 2 K. The non-radiative energy transfer processes from the 4f(2F5/2) → 5d state (Ce3+) to the intraconfigurational 4f excited levels of rare earth ions and simultaneous emissions in the visible region from the 4f65d1 (Eu2+) and 5D0 (Eu3+) emitting levels, leading to overlapped broad and narrow emission bands, have been proclaimed. The energy transfer mechanism proposes involvement of the Gd3+ ion sub-lattice as the bridge and finally trapping by Eu2+/3+, upon excitation of the Ce3+ ion. The calculation of experimental intensity parameters (Ω2,4) has been discussed and the highest emission quantum efficiency (η = 85%) of the Eu3+ ion for the y = 10 mol% sample is reported. The advantageous existence of the Eu2+/Eu3+ ratio along with variously doped nanomaterials described in this work, results in tunable emission color in the blue-white-red regions, highlighting the potential application of the samples in solid-state lighting devices, scintillation devices, and multiplex detection.

Redundant and regulatory roles for Toll-like receptors in Leishmania infection.

Toll-like receptors (TLRs) are germline-encoded, non-clonal innate immune receptors, which are often the first receptors to recognize the molecular patterns on pathogens. Therefore, the immune response initiated by TLRs has far-reaching consequences on the outcome of an infection. As soon as the cell surface TLRs and other receptors recognize a pathogen, the pathogen is phagocytosed. Inclusion of TLRs in the phagosome results in quicker phagosomal maturation and stronger adaptive immune response, as TLRs influence co-stimulatory molecule expression and determinant selection by major histocompatibility complex (MHC) class II and MHC class I for cross-presentation. The signals delivered by the TCR-peptide-MHC complex and co-stimulatory molecules are indispensable for optimal T cell activation. In addition, the cytokines induced by TLRs can skew the differentiation of activated T cells to different effector T cell subsets. However, the potential of TLRs to influence adaptive immune response into different patterns is severely restricted by multiple factors: gross specificity for the molecular patterns, lack of receptor rearrangements, sharing of limited number of adaptors that assemble signalling complexes and redundancy in ligand recognition. These features of apparent redundancy and regulation in the functioning of TLRs characterize them as important and probable contributory factors in the resistance or susceptibility to an infection.

The influence of carbon concentration on the electronic structure and magnetic properties of carbon implanted ZnO thin films.

The influence of carbon concentration on the electronic and magnetic properties of C-implanted ZnO thin films has been studied using synchrotron radiation based X-ray absorption spectroscopic techniques and vibrating sample magnetometer measurements. 20 keV carbon ions were implanted in ZnO films with different fluences (2 × 1016, 4 × 1016 and 6 × 1016 ions per cm2). The pristine ZnO film shows diamagnetic behaviour while the C-implanted films exhibit room temperature ferromagnetism. Our first-principles calculations based on density functional theory show an appreciable magnetic moment only when the implanted C atom sits either in the O-site (2 µB) or in the interstitial position (1.88 µB), whereas the C atom in the Zn substitutional position does not possess any magnetic moment. X-ray absorption near edge structure analysis at the O K-edge reveals that the charge transfer from O-2p to the C-defect site causes the ferromagnetism in the C-implanted ZnO film at low fluence. However at high fluence, the implanted C replaces the lattice and produces more Zn vacancies, as evidenced by extended X-ray absorption fine structure studies at the Zn K-edge, which favors the ferromagnetism. The persistence of the implanted carbon and ferromagnetism of the C-implanted ZnO film has also been studied by isothermal annealing at 500 °C and discussed in detail.

Potassium channel gene associations with joint processing speed and white matter impairments in schizophrenia.

Patients with schizophrenia show decreased processing speed on neuropsychological testing and decreased white matter integrity as measured by diffusion tensor imaging, two traits shown to be both heritable and genetically associated indicating that there may be genes that influence both traits as well as schizophrenia disease risk. The potassium channel gene family is a reasonable candidate to harbor such a gene given the prominent role potassium channels play in the central nervous system in signal transduction, particularly in myelinated axons. We genotyped members of the large potassium channel gene family focusing on putatively functional single nucleotide polymorphisms (SNPs) in a population of 363 controls, 194 patients with schizophrenia spectrum disorder (SSD) and 28 patients with affective disorders with psychotic features who completed imaging and neuropsychological testing. We then performed three association analyses using three phenotypes - processing speed, whole-brain white matter fractional anisotropy (FA) and schizophrenia spectrum diagnosis. We extracted SNPs showing an association at a nominal P value of <0.05 with all three phenotypes in the expected direction: decreased processing speed, decreased FA and increased risk of SSD. A single SNP, rs8234, in the 3' untranslated region of voltage-gated potassium channel subfamily Q member 1 (KCNQ1) was identified. Rs8234 has been shown to affect KCNQ1 expression levels, and KCNQ1 levels have been shown to affect neuronal action potentials. This exploratory analysis provides preliminary data suggesting that KCNQ1 may contribute to the shared risk for diminished processing speed, diminished white mater integrity and increased risk of schizophrenia.

Correlations of charge neutrality level with electronic structure and p-d hybridization.

The formation of charge neutrality level (CNL) in highly conducting Cadmium oxide (CdO) thin films is demonstarted by the observed variation in the band gap upon annealing and doping. It may be explained by the observation that Tin (Sn) doping breaks the perfect periodicity of CdO cubic crystal structure and creates virtual gap states (ViGS). The level of local CNL resides at the branch point of ViGS, making the energy at which native defect's character changes from predominantly donor-like below CNL to predominantly acceptor-like above the CNL and a schematic band diagram is developed to substantiate the same. Further investigations using soft x-ray absorption spectroscopy (SXAS) at Oxygen and Cadmium edges show the reduction of Sn4+ to Sn2+. The analysis of the spectral features has revealed an evidence of p-d interaction between O 2p and Cd 4d orbitals that pushes the valence band minima at higher energies which is symmetry forbidden at г point and causing a positive valance band dispersion away from the zone centre in the г ~ L, K direction. Thus, origin of the CNL is attributed to the high density of the Oxygen vacancies as confirmed by the change in the local electronic structure and p-d hybridization of orbitals.

Synthesis, phase composition, Mössbauer and magnetic characterization of iron oxide nanoparticles.

The present work describes the synthesis of iron oxide nanoparticles by thermal decomposition of Fe-precursors in argon and vacuum environments with control over particle size distribution, phase composition and the resulting magnetic properties. The Rietveld refinement analysis of X-ray diffraction data revealed the crystallinity as well the single-phase of γ-Fe2O3 nanoparticles prepared under vacuum, whereas the argon environment leads to the formation of multi-phase composition of γ-Fe2O3/Fe3O4 (90%) and wustite (10%). Synchrotron X-ray absorption near edge structure (XANES) indicates that the predominant phase in both samples is γ-Fe2O3, which is subsequently verified from the Mössbauer spectra. DC magnetic measurements indicate behavior typical of a superparamagnetic system validated by Mössbauer analysis. However, further investigation of ac susceptibility by typical Néel-Arrhenius and Vogel Fulcher magnetic models suggests an influence of interparticle interactions on the overall magnetic behavior of the system.

Post-traumatic cervical spondyloptosis: A rare entity with multiple management options.

Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient.

Electronic structure modification and Fermi level shifting in niobium-doped anatase titanium dioxide thin films: a comparative study of NEXAFS, work function and stiffening of phonons.

The electronic structure and tuning of work function (WF) by electronic excitations (EEs) induced by swift heavy ions (SHIs) in anatase niobium-doped titanium dioxide (NTO) thin films is reported. The densities of EEs were varied using 80 MeV O, 130 MeV Ni and 120 MeV Ag ions for irradiation. The EE-induced modifications in electronic structure were studied by O K-edge and Ti L3,2 edge absorption spectra using near edge X-ray absorption fine structure (NEXAFS) spectroscopy. The reduction of hybridized O 2p and Ti 3d unoccupied states in the conduction band with a decrease in energy of the crystal field strength of ∼ 480 meV and the correlated effect on the decrease in the WF value of ∼ 520 meV upon increasing the total energy deposition in the lattice are evident from the study of NEXAFS and scanning Kelvin probe microscopy (SKPM), respectively. The observed stiffening in the low frequency Raman mode (LFRM) of ∼ 9 cm(-1) further validates the electronic structure modification under the influence of EE-induced strain in TiO6 octahedra. The reduction of hybridized valence states, stiffening behavior of LFRM and decrease in WF by nano-crystallization followed by amorphization and defects in NTO lattice are explained in terms of continuous, discontinuous amorphous ion tracks containing intestinally created defects and non-stoichiometry in the lattice. These studies are very appropriate for better insights of electronic structure modification during phase transformation and controlled Fermi level shifting, which plays a crucial role in controlling the charge carrier injection efficiency in opto-electronic applications and also provides a deeper understanding of the involved physical processes.

Establishing integrated rural-urban cohorts to assess air pollution-related health effects in pregnant women, children and adults in Southern India: an overview of objectives, design and methods in the Tamil Nadu Air Pollution and Health Effects (TAPHE) study.

INTRODUCTION: In rapidly developing countries such as India, the ubiquity of air pollution sources in urban and rural communities often results in ambient and household exposures significantly in excess of health-based air quality guidelines. Few efforts, however, have been directed at establishing quantitative exposure-response relationships in such settings. We describe study protocols for The Tamil Nadu Air Pollution and Health Effects (TAPHE) study, which aims to examine the association between fine particulate matter (PM2.5) exposures and select maternal, child and adult health outcomes in integrated rural-urban cohorts. METHODS AND ANALYSES: The TAPHE study is organised into five component studies with participants drawn from a pregnant mother-child cohort and an adult cohort (n=1200 participants in each cohort). Exposures are assessed through serial measurements of 24-48 h PM2.5 area concentrations in household microenvironments together with ambient measurements and time-activity recalls, allowing exposure reconstructions. Generalised additive models will be developed to examine the association between PM2.5 exposures, maternal (birth weight), child (acute respiratory infections) and adult (chronic respiratory symptoms and lung function) health outcomes while adjusting for multiple covariates. In addition, exposure models are being developed to predict PM2.5 exposures in relation to household and community level variables as well as to explore inter-relationships between household concentrations of PM2.5 and air toxics. Finally, a bio-repository of peripheral and cord blood samples is being created to explore the role of gene-environment interactions in follow-up studies. ETHICS AND DISSEMINATION: The study protocols have been approved by the Institutional Ethics Committee of Sri Ramachandra University, the host institution for the investigators in this study. Study results will be widely disseminated through peer-reviewed publications and scientific presentations. In addition, policy-relevant recommendations are also being planned to inform ongoing national air quality action plans concerning ambient and household air pollution.

Indian Council of Medical Research consensus document for the management of tongue cancer.

The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.Early diagnosis is imperative in improving outcomes and preserving quality of life. High index of suspicion is to be maintained for leukoplakia (high risk site).Evaluation of a patient with newly diagnosed tongue cancer should include essential tests: Magnetic resonance imaging (MRI) is investigative modality of choice when indicated. Computed tomography (CT) scan is an option when MRI is unavailable. In early lesions when imaging is not warranted ultrasound may help guide management of the neck.Early stage cancers (stage I & II) require single modality treatment - either surgery or radiotherapy. Surgery is preferred. Adjuvant radiotherapy is indicated for T3/T4 cancers, presence of high risk features [lymphovascular emboli (LVE), perineural invasion (PNI), poorly differentiated, node +, close margins). Adjuvant chemoradiation (CTRT) is indicated for positive margins and extranodal disease.Locally advanced operable cancers (stage III & IVA) require combined multimodality treatment - surgery + adjuvant treatment. Adjuvant treatment is indicated in all and in the presence of high risk features as described above.Locally advanced inoperable cancers (stage IVB) are treated with palliative chemo-radiotherapy, chemotherapy, radiotherapy, or symptomatic treatment depending upon the performance status. Select cases may be considered for neoadjuvant chemotherapy followed by surgical salvage.Metastatic disease (stage IVC) should be treated with a goal for palliation. Chemotherapy may be offered to patients with good performance status. Local treatment in the form of radiotherapy may be added for palliation of symptoms.Intense follow-up every 3 months is required for initial 2 years as most recurrences occur in the first 24 months. After 2(nd) year follow up is done at 4-6 months interval. At each follow up screening for local/regional recurrence and second primary is done. Imaging is done only when indicated.

Prevalence of and risk factors for hypertension in urban and rural India: the ICMR-INDIAB study.

The aim of the study is to determine the prevalence of hypertension (HTN) and its risk factors in urban and rural India. In Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, individuals aged ⩾20 years were surveyed using a stratified multistage sampling design, in three states (Tamil Nadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India. Blood pressure was measured in all study subjects (n=14 059). HTN was defined as systolic blood pressure ⩾140 mm Hg, and/or DBP ⩾90 mm Hg and/or use of antihypertensive drugs. Overall age-standardized prevalence of HTN was 26.3% (self-reported: 5.5%; newly detected: 20.8%). Urban residents of Tamil Nadu, Jharkhand, Chandigarh and Maharashtra (31.5, 28.9, 30.7 and 28.1%) had significantly higher prevalence of HTN compared with rural residents (26.2, 21.7, 19.8 and 24.0%, respectively). Multivariate regression analysis showed that age, male gender, urban residence, generalized obesity, diabetes, physical inactivity and alcohol consumption were significantly associated with HTN. Salt intake ⩾6.5 g per day, showed significantly higher risk for HTN (odds ratio: 1.4, 95% confidence interval: 1.0-1.9, P=0.042) even after adjusting for confounding variables. In conclusion, prevalence of undiagnosed HTN is high in India and this calls for regular screening.