Vikas Fotedar

Knowledge of Risk Factors & Early Detection Methods and Practices towards Breast Cancer among Nurses in Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

BACKGROUND Breast cancer is an increasing health problem in India. Screening for early detection should lead to a reduction in mortality from the disease. It is known that motivation by nurses influences uptake of screening methods by women. This study aimed to investigate knowledge of breast cancer risk factors and early detection methods and the practice of screening among nurses in Indira Gandhi Medical College, Shimla, Himachal Pradesh. MATERIALS AND METHODS A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge of breast cancer risk factors, early detection methods and practice of screening methods among 457 nurses working in an Indira Gandhi Medical College, Shimla-H.P. Chi square test, Data was analysed using SPSS version 16. Test of significance used was chi square test. RESULTS The response rate of the study was 94.9%. The average knowledge of risk factors about breast cancer of the entire population is 49%. 10.5% of nurses had poor knowledge, 25.2% of the nurses had good knowledge, 45% had very good knowledge and 16.3% of the nurses had excellent knowledge about risk factors of breast cancer and early detection methods. The knowledge level was significantly higher among BSC nurses than nurses with Diploma. 54% of participants in this study reportedly practice BSE at least once every year. Less than one-third reported that they had CBE within the past one year. 7% ever had mammogram before this study. CONCLUSIONS Results from this study suggest the frequent continuing medical education programmes on breast cancer at institutional level is desirable.

Sclerosing stromal tumour of the ovary

Abstract Sclerosing stromal tumours (SSTs) are rare, benign, sex cord stromal tumours of the ovary. They affect women, who complain mainly of menstrual irregularity, in their second and third decades. We report a histologically confirmed case of a 23-year-old woman who presented with complaints of abdominal pain and irregular menstruation. She later underwent surgery when a pre-pathology workup raised the suspicion of a malignant tumour. It is imperative to consider the differential diagnosis of an SST of the ovary in a young woman with an ovarian tumour.

DCE-MRI and parametric imaging in monitoring response to neoadjuvant chemotherapy in breast carcinoma: a preliminary report

Purpose Neoadjuvant chemotherapy is recommended in patients with locally advanced breast cancer. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables evaluation of the tumour neovasculature that occurs prior to any volume change, which helps identify early treatment failures and allows prompt implementation of second-line therapy. Material and methods We conducted a prospective study in 14 patients with histopathologically proven breast cancer. DCE-MRI data were acquired using multisection, T1-weighted, 3D vibe sequences with fat suppression before, during, and after IV bolus injection (0.1 mmol/kg body weight, Gadoversetamide, Optimark). Post-processing of dynamic contrast perfusion data was done with the vendor’s Tissue 4D software to generate various dynamic contrast parameters, i.e. Ktrans, Kep, Ve, initial area under the time signal curve (IAUC), apparent diffusion coefficient (ADC), and enhancement curve. Patients underwent MRI examinations at baseline, and then after two cycles, and finally at completion of chemotherapy. Results Based on Sataloff criteria for pathological responses, four patients out of 14 were responders, and 10 were non-responders. At the 2nd MRI examination, IAUC was significantly smaller in responders than in non-responders (p = 0.023). When the results of the first and second MRI examinations were compared, Kep decreased from baseline to the second MRI (p = 0.03) in non-responders and in responders (p = 0.04). This change was statistically significant in both groups. The ADC values increased significantly in responders from baseline to the third MRI (p = 0.012). Conclusions In our study, IAUC and ADC were the only parameters that reliably differentiated responders from non-responders after two and three cycles of chemotherapy.

Breast cancer risk factor evaluation in a Western Himalayan state: A case–control study and comparison with the Western World

Context: Breast cancer incidence is increasing rapidly in India. The lifestyle, built, genetic makeup, reproductive and breastfeeding patterns are quite different in Indian females when compared to the Western population. Generalizing the Western data to the population residing in the Himalayan region would breed inaccuracies. Aim: The aim of our study was to identify risk factors in our own population in a Western Himalayan state of Himachal Pradesh, India. Subjects and Methods: A case–control study with 377 cases of invasive breast cancer and 346 hospital-based controls was conducted for 1 year. The data were collected by interviewing the individuals during their visit to hospital using a questionnaire. The data were analyzed using standard statistical techniques using SPSS version 17 software. Results: Factors found to have strong association with invasive breast cancer on multivariate analysis are late age at first childbirth >30 years, which is the strongest risk factor associated, late age of menopause > 50 years, high socioeconomic class, and age of female above 50 years. Conclusion: In our females, age >50 years, late age of menopause (>50 years), late age at first childbirth (>30 years), and high socioeconomic status were found to be major risk factors associated with breast cancer. Several factors implicated in the Western data were not found to be significant in our study. We need to identify such aspects in reproductive and breastfeeding patterns of women and spread awareness regarding the same.

Green Tobacco Sickness: A Brief Review

Green tobacco sickness (GTS) is the condition that mainly affects the tobacco harvesters. The condition is prevalent in Asian and South American tobacco harvesters. The present review was conducted to discuss the etiology, epidemiology, symptoms, and prevention of GTS. It is caused by the absorption of nicotine through the skin while the workers are engaged in handling the uncured tobacco leaves. The symptoms include nausea, vomiting, pallor, dizziness, headaches, increased perspiration, chills, abdominal pain, diarrhea, increased salivation, prostration, weakness, breathlessness, and occasional lowering of blood pressure. The prevalence of GTS varies from 8.2 to 47% globally. The use of personal protective equipment like water-resistant clothing, chemical-resistant gloves, plastic aprons, and rain-suits with boots should be used by the tobacco farmers to prevent its occurrence. An international-level awareness campaign has to be taken up and more stringent workers safety regulations have to be formulated.

Malignant intracranial hemangiopericytoma in a 22-year-old male with head injury and implications

We report a case of intracranial hemangiopericytoma of a young male of 22 years who presented with neurological signs of impaired memory, left hemiparesis, headache, and two episodes of focal seizures. A significant history of head trauma 9 years back was given. A space-occupying lesion was identified in the bilateral frontoparietal region. The surgical intervention involved bilateral frontoparietal craniotomy and Simpson Grade II excision of tumor. Postoperative conformal radiotherapy was administered. A marked neurological improvement was subsequently observed. Peak incidence of this disease is in the fourth or fifth decade. However, our case is an exception presenting at an age of 22 years. Associated history of head trauma has only been infrequently reported in the past.

What should dentists know and advise about electronic cigarettes to their patients

Electronic cigarettes (e-cigarettes) are battery-powered devices that convert nicotine into a vapor which can be inhaled. The vapors from e-cigarettes are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in e-cigarette vapors is safe. Worldwide use of electronic cigarettes has increased significantly over recent years but varies markedly between countries. The legal status of e-cigarettes is pending in most of the countries which are the need of the hour. The efficacy and effectiveness of e-cigarettes in smoking cessation or reducing the tobacco use are not established. The following review discusses the current data regarding e-cigarette, prevalence of e-cigarette, legislation of e-cigarettes, issues concerned with the use of the e-cigarette, and finally, the dentists being the health caregivers should be prepared to answer the patients′ questions about the advisability of using e-cigarettes as a smoking cessation device.

Dental anxiety levels and factors associated with it among patients attending a dental teaching institute in Himachal Pradesh

Background: Dental anxiety is often reported as a cause of irregular attendance, delay in seeking dental care, or even avoidance of seeking dental care, resulting in a poor oral health-related quality of life. Aim: To assess the dental anxiety levels and factors associated with it among patients attending a dental teaching institute in Himachal Pradesh. Methods: A cross-sectional questionnaire study was conducted on a sample of 246 subjects. The dental anxiety was measured by Modified Dental Anxiety Scale. (MDAS). The questionnaire consisted of questions on various demographic factors, experience about dental treatments, and various questions as mentioned MDAS. Data were analyzed by SPSS package 16. Tests used were t-test and analysis of variance. A P < 0.05 was considered statistically significant. Results: The prevalence of dental anxiety was 29.2%. The mean dental anxiety score was 9.22. ± 4.5. Females, those residing in villages, those who had past negative dental history, and students were significantly associated with dental anxiety. On multiple logistic regression analysis, only gender and residence were the strong predictors of association. There was a strong association between dental anxiety and postponement of treatment. Conclusion: The anxiety levels are low among the present population as compared to other states of India. However, we should try to prevent the dental anxiety among patients as dental anxiety leads to postponement of treatment, which ultimately affects the oral health-related quality of life.

Oral health status and treatment needs among health-care workers in Shimla district, Himachal Pradesh India

Objectives: To assess oral health status and treatment needs of the health workers in Shimla district, Himachal Pradesh. Materials and Methods: A cross-sectional study was conducted among health workers in Shimla district, Himachal Pradesh. A sample of 130 was selected by selecting three blocks randomly to get a required sample size of 126. Clinical recordings were done according to the World Health Organization diagnostic criteria 1997. The data were analyzed using SPSS package, Chicago, IL, version 16.0. The statistical tests used were t-test and ANOVA. A P < 0.05 was considered to be statistically significant. Results: The mean age of the study population was 48.42 ± 5.94 with a range of 25-57. The prevalence of dental caries in the present study was 80%. The mean decayed, missing, and filled teeth were 6 ± 5.42 and were higher in females and the age group of 55-64 years. Only 17 (13.1%) had healthy periodontium and calculus was found in 49 (47.7%) subjects. The need for prosthesis in upper jaw and lower jaw was for 33 (25.3%) and 61 (46.9%), respectively. Conclusion: The caries experience of the population was quite high. Hence, there is a need for treatment camps, and regular follow-up checkups for the health workers in Shimla district.

Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India

The prison population is a challenging one with many health problems including oral health. In a country such as India, the information regarding the oral health status in prisoners is scant. So, a cross-sectional study was carried out among a 311 prison inmate population of Kanda model jail, Shimla, Himachal Pradesh, India, to assess the dental caries levels, periodontal health status, and oral health-related quality of life (OHRQoL). Dental caries was present among 71.8% of the population and the mean decayed missing and filled teeth index (DMFT) of the population was 5.1 ± 2.1. Calculus was seen among 54.9% of the population. The mean severity score, summed for the 14 items in the scale was 14.57. Dental caries, periodontal disease, the number of missing teeth were significantly associated with OHRQoL. The population had a higher level of oral diseases and one half of the population reported that their oral condition had negatively impacted them in some way, thereby affecting their quality of life.