Nar Singh Verma

Oral mucositis in morning vs. evening irradiated patients: a randomised prospective study.

Purpose: Patients of head and neck cancer undergoing radiotherapy develop oral mucositis. The severity of mucositis may also depend on the time of administration of radiation apart from patient-related factors. The most radiosensitive phase of the cell cycle (G2-M) occurs in the late afternoon and evening in human oral mucosa; therefore, it is more vulnerable to radiation injury in the evening. The present study evaluated prospectively the severity of acute oral mucositis in head and neck carcinoma patients irradiated in the morning (08:00–11:00 h) versus late afternoon/evening (15:00–18:00 h). Method: A total of 212 patients of head and neck carcinoma were randomised to morning (08:00–11:00 h) and evening (15:00–18:00 h) groups. The grades of oral mucosa ulceration were compared in the two groups. Results: The grades of mucositis were marginally higher in the evening-irradiated group than in the morning-irradiated group 38% vs. 26% (p = 0.08). Conclusion: The observed incidence of grade III/IV mucositis in morning vs. evening irradiated patients may be because of the existence of circadian rhythm in the cell cycle of normal mucosa. This knowledge may provide a possibility of treating the patients with decreased toxicity to oral mucosa.

Association of salivary cortisol with chronomics of 24 hours ambulatory blood pressure/heart rate among night shift workers

Recent studies indicate a circadian rhythm in blood pressure and heart rate and its association with various neurotransmitters. In the present study, we examine the circadian nature of blood pressure/heart rate and salivary cortisol in night shift workers and whether these circadian changes produced by night shifts are reversible. Sixteen healthy nurses of both genders, aged 20-40 years, performing day and night shift duties, were randomly selected out of 22 who volunteered for this study. Ambulatory blood pressure monitoring was done in all the subjects and salivary cortisol levels were analyzed during both day and night shift duties. There were clinically significant changes in the Acrophase of blood pressure and cortisol levels, indicating ecphasia (odd timing of systolic blood pressure) individually during night as well as day shifts. However, this pattern was statistically not significant. A reverse pattern of Acrophase was observed in 8 out of 16 subjects when they were posted on day shift. No significant change was found in midline estimating statistics of rhythm (MESOR) of blood pressure values. Changes in Double amplitude (Predictable change) were observed in 8 subjects during night shifts as well as in 7 subjects during day shifts. However, the pattern was not similar and night workers had an altered circadian pattern in the night as well as during day shifts. Changes in Double amplitude, Acrophase and Salivary cortisol were found during night as well as day shifts but these changes were not statistically significant (p > 0.05) due to incomplete recovery during day shifts (changes again seen when they came back to day shifts). Salivary cortisol levels were lowest in early morning, increased at midnight and further increased in the afternoon during night shifts along with ecphasia. It is possible that nurses working the night shift felt more tired due to the altered circadian cycle.

Cardiovascular sequel of neck irradiation in head and neck cancer patients

Abstract Purpose: The baroreflex is an important afferent mechanism controlling autonomic functions. As afferent nerves course through the neck, they are susceptible to damage by neck irradiation in head and neck cancer patients. With increased survival of head and neck cancer patients because of improved therapy, the cardiovascular morbidity and mortality in them have become apparent and this is of clinical concern. There are few case reports of baroreflex failure as a chronic sequel to neck irradiation. Objectives: The present study evaluated the changes in cardio-autonomic tone and postural cardiovascular reflex in neck-irradiated patients. Methods: Head and neck cancer patients who had received neck irradiation (n = 15) and healthy controls (n = 15) were evaluated for heart rate variability with time domain analysis of 5 min ECG recording. Postural cardiovascular reflexes were studied with changes in blood pressure and heart rate in the lying to standing test. Results: Our results suggest that there is a reduction in overall time domain measures of heart rate variability and weakened postural reflexes in neck-irradiated patients. Conclusion: Decreased heart rate variability in neck-irradiated patients reflects an independent risk of cardiovascular morbidity. The early detection of cardiovascular impairment in such patients may help healthcare professionals in providing better care. Furthermore, the dose delivered to the carotid sinus should be monitored and restricted.

Prevalence of generalized and abdominal obesity in police worker - A cross-sectional study

Background: Police work generally recognized as a most stressful and dangerous occupation. Despite of sufficient physical activity most police worker is suffering from overweight or obesity. There is a scarcity of knowledge regarding prevalence of obesity in police worker in India. This study was conducted to assess the lifestyle-related health problems of the police personnel. Objectives: To assess the prevalence of generalized and abdominal obesity (AO) in police worker and to see the association of obesity with nature and duration of service. Materials and Methods: This cross-sectional observational study conducted on 245 police personnel working at provincial armed constabulary, Sitapur. After informed consent demographic data of individuals such as age, duration of service, nature of duties, and types of foods were recorded. Anthropometric parameters were measured using standardized techniques. Available data analyze using Chi-square test to see significance of association with different variables. Result: In this study, the mean age of individual was 40.34 ± 8.23 and mean duration of service was 23.29 ± 8.49. Majority (95.92%) of police worker were involved in field or shift duty and only 4.08% of individual involved in office work, 77.14% of individuals were having generalized obesity and 82.04% were having AO. According to the duration of service majority of the individuals were obese and their association with AO was highly significant (P = 0.004). Nature of job showed that 82.31% of individuals having AO related to field or shift and there association was not significant. Conclusion: Effective implementation of a physical fitness program, a regular balanced diet, inoculation of training for managing stress can improve the life of police personnel and make them less prone to be obese and related disorder. Health checkup should be made mandatory to avoid their negligent behavior and early detection of lifestyle-related disorder.