Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes.

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.

Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome.

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.

Evaluation of a breast cancer nomogram for prediction of non-sentinel lymph node positivity.

AIMS: This study evaluates the breast cancer nomogram (BCN), an online tool developed by Memorial Sloan-Kettering Cancer Center to determine the rate of non-SLN positivity, in an independent cohort of SLN positive patients. MATERIAL AND METHODS: Available data between 02/2000 and 06/2004 in two prospective databases, 749 cases had successful SLN biopsy including 149 axillary-SLN metastases study cases. These cases had accurately graded tumours up to 9 cm in size and CAD with a minimum total 10 nodes removed. Histopathological assessment of nodes included hematoxylin and eosin staining and/or immunohistochemistry. Computerized BCN was used to estimate probability of non-SLN positivity and compared with actual probability after grouping into deciles. RESULTS: The trend of actual probability in various decile groups was comparable to the predicted probability. An area under the receiver operating characteristic curve was 0.75 as compared to 0.76 in the original study. CONCLUSION: Although this study is small, the results are encouraging and suggest the nomogram is a useful tool to estimate the likelihood of positive axillary non-SLN. However, variations in pathological assessment between centres are the major impediment to widespread application of BCN. If SLN positive patients decline the standard recommendation of CAD or entry into clinical trials evaluating the significance of CAD then the BCN could help in decision making.

Surveillance of bacteriological quality of natural water resources in rural areas around Kasauli Town, Distt. Solan, Himachal Pradesh.

A study was conducted to find out the bacteriological quality of water during the monsoon season in local areas around Kasauli Town, and to evaluate the management of water resources in rural areas. The water samples were collected from bowries and hand pumps. As there is no municipal water supply in majority of these areas, the local residents depends mainly on these natural resources without any treatment of water. All the 14 surface water samples collected from bowries were found bacteriologically polluted with total coliform count ranging from 35-1800+. The main contaminants isolated were atypical thermotolerant E. coli, Pseudomonas fluorescence, Enterobacter cloacae, Aeromonas liquifaciens, Citrobacter freundii and Pseudomonas pseudomaleii. Among seven hand pump samples, two were found to have Coliform count 80 and 250 respectively. These two water samples were found contaminated with Citrobacter freundii and E. coli &Aeromonas liquefaciens respectively. These bacteriological contaminations appear to be both from vegetative & human or animal excreta sources. The study therefore suggested that the water from these natural resources requires treatment either by boiling or chlorination before human consumption to avoid any outbreak.

Leprosy of the eustachian tube (nasopharyngoscopic study).

The technique of nasopharynogoscopy affords an accurate assessment of the lesions at the orifices of the eustachian tube. It was performed in 30 patients suffering from lepromatous leprosy in order to determine the type, nature and site of the lesion. Involvement of the eustachian tube in leprosy may begin with a localized area of erythema progressing to granuloma formation or ulceration. Leprous lesion at the eustachian tube orifices was related with subsequent changes in the tympanogram pattern. Nasopharyngoscopy is also found to be of therapeutic value in removing the crust, discharge and granulations at the eustachian tube orifices.

Verocytopathic activity of Escherichia coli O157 & other 'O' serogroups isolated from patients of diarrhoea.

Twenty diarrhoeal isolates identified as Esch. coli O157 were screened for cytopathic activity on the continuous Vero cell line. Of these, seven strains (35%) showed cytopathic effect which was maximum on the 4th day after inoculation, with a maximum titre of 1 in 128. The total loss of cytopathic activity was observed in the positive filtrates subjected to a temperature of 100 degrees C for 15 min, while heating at 65 degrees C for 15 min, resulted in partial loss of this activity. All the verocytopathic strains were obtained from infants and children and were devoid of heat labile (LT) and heat stable (ST) toxins as well as enteroinvasive property.

Theoretical prediction of surface tension of ternary liquid system (nitrogen + oxygen + argon) at elevated temperature and different pressure.

The surface tension of a ternary liquid mixture of nitrogen, oxygen, and argon has been calculated by a new approach using critical constants Pc, Vc, and Tc at temperatures ranging from 90 to 110 K and pressure up to 865 kPa. New formalism has been made by modifying the Brock-Bird relation. The computed values are compared with the experimental findings. Satisfactory results have been obtained.

Scleroma of the lower respiratory tract: a bronchoscopic study.

Twenty cases suffering from rhinoscleroma were studied. Bronchoscopy was performed for detection of secondary involvement of the subglottic region, trachea and bronchus. The study revealed that the larynx was involved in 40 per cent, the trachea in 20 per cent and the bronchus in 10 per cent of cases. The intranasal lesion, endotracheal and endobroncheal lesions all occur in the form of an atrophic stage, granulomatous (proliferative) stage and finally a fibrotic or scarring stage. The role of bronchoscopy in early diagnosis, initial symptomatic treatment and in follow-up is discussed in the light of the available literature.

Antroscopy in rhinoscleroma.

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity to the mucosa of the upper respiratory tract. Involvement of maxillary antrum is said to be very uncommon. In the present study antroscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion in the maxillary antrum. The maxillary antrum was involved in 60 per cent of cases with rhinoscleroma. The lesions occurred in the form of atrophic changes, granuloma, and the fibrotic thick healed stage. The anterior-inferior part and medial wall of the antrum are found to be more commonly affected. It is suggested that involvement of maxillary antrum in scleroma may act as a reservoir of infection and such patients may therefore take a longer time to respond to antibiotic therapy.

Leprosy of the larynx.

The result of a study conducted on 30 patients of lepromatous leprosy regarding laryngeal involvement is presented. The incidence of leprous laryngitis is 36.6 per cent in this part of India in lepromatous leprosy patients. Leprosy is long standing disease so laryngeal lesions developed gradually and may be asymptomatic in some cases while others have been found to have variety of clinical manifestation in form of congestion, infiltration, nodulation, thickening and fibrosis. Anti-leprosy chemotherapy is equally effective on these lesions. A screening survey of laryngeal pathology in such cases should be done periodically.

Scleroma of the larynx.

Twenty-two cases of rhinoscleroma were studied to determine the involvement of the larynx. The study revealed that scleroma affected the larynx in 40 per cent of cases. In the larynx, scleromatous lesions were found in the subglottic region and the disease was observed in stages i.e., atrophic, granulomatous (proliferative i.e., nodular) and a fibrotic or sclerotic (scarring) stage as found in the nose. The role of laryngological examination is established in the diagnosis of asymptomatic and early laryngeal lesions and in assessing response to initial treatment. Extensive granulomatous lesions were treated by open excision by the laryngofissure approach which was found to be the best method resulting in a quick recovery without any evidence of subglottic stenosis. The disease as a whole is discussed in the light of available literature.

Microscopic rhinoscopy in lepromatous leprosy.

Ten patients with lepromatous leprosy have been studied to detect intranasal pathology by conventional naked eye rhinoscopy and also by use of the surgical microscope. The comparison of both methods reveals that microscopic rhinoscopy is superior in providing more accurate details of intranasal lesions in leprosy and biopsy can be taken in a precise manner from accurate and representative sites. Use of the microscope with adequate exposure and bright illumination provides precise details of lesions and an opportunity for bimanual manipulation, photography, teaching and recording. Thus, it is worthwhile to perform microscopic rhinoscopy in such cases.

Antroscopic study of the maxillary antrum in lepromatous leprosy.

The technique of antroscopy affords an accurate assessment of chronic sinus disease. It was performed in twelve patients suffering from lepromatous leprosy in order to determine the type, nature and site of the lesion. Antral involvement with lepromatous leprosy may begin with a localized area of erythema progressing to granuloma formation or ulceration. The antero-inferior part of the antrum is the most commonly affected site.

Scleroma of the eustachian tube: salpingoscleroma.

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity with the mucosa of the upper respiratory tract. Involvement of the eustachian tube is uncommon. In the present study nasopharyngoscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion at the orifices of the eustachian tube. A lesion involving the eustachian tube was found in six cases (30 per cent). Lesions occurred in the form of atrophic changes with crusting, granuloma and fibrotic thick areas. Involvement of the eustachian tube was found to be associated with intranasal scleroma and was more common at the granulomatous stage. Eustachian tube scleroma had a possible association with subsequent changes in the tympanogram pattern. Nasopharyngoscopy was found to be of therapeutic value in removing the crust, discharge and granulations at the eustachian tube orifices.

A massive sublingual--cervical dermoid.

An unusual case of a massive sublingual-cervical dermoid is presented. The salient features of the condition in relation to its incidence, embryology, pathology, symptomatology and management are discussed.

An unusual tumour mistaken as a lingual thyroid (a case report).

A rare case of benign mass with hypertrophic sero-mucinous gland presenting as a tumour at the junction of the anterior two-thirds and the posterior third of the middle of the tongue is reported, which is found to be of great academic interest because of its unique situation of that of a lingual thyroid and its characteristic histological picture. The salient features of the lesion are discussed.

Disturbance of taste in leprosy.

The sense of taste was assessed in a group of 30 leprosy patients. The method used and the results are presented. Twelve patients (40 per cent) showed some degree of impairment of taste sensation and this was shown to be related to the severity of the disease. The possible reasons for the loss of taste are discussed.

A few points in the management of juvenile nasopharyngeal angiofibroma.

A few points based on our experience on 100 cases of nasopharyngeal angiofibroma are described, which are found very useful in the successful removal of nasopharyngeal fibroma. A new technique for the control of haemorrhage by a muscle graft immediately after the removal of an angiofibroma is advocated.

Bilateral transitional-type inverted papilloma of the nose and paranasal sinuses.

An uncommon bilateral transitional-type inverted papilloma of the nose and paranasal sinuses is presented, and the salient features of the lesion are discussed. The patient is well and without any signs of recurrence in either side of the nose more than two years after the first diagnosis and complete surgical excision of both tumours. Commonly unilateral, this tumour may occasionally be bilateral. In the present communication an uncommon case of bilateral inverted transitional-type papilloma, with a long history of allergy, is described with some comments on its pathogenesis.

Endoscopy in nasal myiasis.

Nasal myiasis is a common disease in tropical and developing countries. The maggots cause extensive necrosis, sloughing and destruction of intranasal tissue and reach to deep and inaccessible areas of the nose and paranasal sinuses. In such a situation removal of maggots is difficult by manual extraction and several sittings are required. To overcome this problem nasal endoscope is being used for removal of maggots under direct vision. In comparing both methods nasal endoscopic procedure is found to be superior to the manual extraction method for removal of maggots. The maggots located in deep and inaccessible area can be approached more easily by endoscopic procedure. The disease is being controlled in shorter time and in few sittings. Thus quick and complete eradication of myiasis is possible before the maggots cause irreparable damage to the intranasal tissues.