041131   MADISETTY A, SURYADEVARA A, CHINTA S K, VUPPU S, MARELLA V R R (Radiation Oncology Dep, Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, Email: draparnasuryadevara@gmail.com) : Should we consider thyroid gland as an organ at risk in carcinoma breast patients receiving adjuvant radiation by conformal technique? A single institute dosimetric study. Indian J Cancer 2020, 57(4), 393-7.

The most common malignancy among Indian women is carcinoma of the breast. In the management of breast cancer (BC), radiation therapy (RT) is given to breast or chest wall and supraclavicular lymph nodal (SCLN) area, with at least part of the thyroid receiving RT dose.There is an increased incidence of hypothyroidism (HT) among BC patients after RT involving the SCLN area. Moreover, the incidence of HT in India is higher than in the West. The aim of our study is to dosimetrically evaluate the thyroid doses during RT for BC. This is a single institute prospective study (n = 131). Radiation was planned by three-dimensional conformal radiation therapy (3D-CRT) technique and dose-volume parameters for thyroid gland were noted. The median thyroid gland volume was 7.4 cc. The median of the mean dose to thyroid gland was 2068 cGy, V10 was 42 %, and V40 was 33 %. In other studies, BC patients with smaller thyroid gland were more prone to HT (volume <8 cc). In our study, we have seen that the median thyroid volume was 7.4 cc. Our study showed a lower mean dose to the thyroid gland and smaller volume thyroid glands than in the literature. As the incidence of HT is higher in India, compared to the west and our patients had small volume thyroid glands, they could be at higher risk of developing HT RT. So BC patients should be monitored for HT and should be given a dose constraint while planning RT.

3 illus, 1 table, 13 ref

042943   ISLAM A, AHMED A, NAQVI I H, PARVEEN S (Jamia Millia Islamia, New Delhi - 110 025, Email: sparveen2@jmi.ac.in) : Emergence of deadly severe acute respiratory syndrome coronavirus-2 during 2019–2020. Indian J Virol 2020, 31(2), 128–36.

Wuhan, the city in Hubei province in China is in the focus of global community due to the outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), formerly known as 2019-nCoV. The virus emerged in humans from Wuhan seafood market probably via zoonotic transmission. Within a few days the virus spread its tentacles rapidly to neighboring cities in China and to different geographical regions through travelers and to some extent by human to human transmission leading to significant disease burden globally. More than 2,00,000 people (including more than 8000 deaths) have been infected with this respiratory illness across 167 countries and territories worldwide leading to a pandemic. The present review provides an outline about emergence and spread of SARSCoV-2 from Wuhan, China in 2019–2020. We have also provided information about the classification, genome, proteins, clinical presentation of COVID-19, type of clinical specimens to be collected and diagnostic methods adopted to identify the respiratory illness. In addition we have also provided information about transmission dynamics, prevention measures and treatment options that are available at the present. Subsequently, we have given a comprehensive overview of the spread of this infection from China to the other parts of the globe. Management of the ongoing outbreak of SARS-CoV-2 encompassing surveillance, clinical, immunological, genetic and evolutionary investigations are likely to provide the desired results. Joint efforts of global scientific community are needed at this hour in terms of enhancement of research on development of accurate diagnostics, antiviral therapeutics and finally into formation of an effective vaccine against the emerging novel coronavirus.

2 illus, 1 table, 16 ref

042942   BHATTACHARYA S, SHARMA P, MATHUR H, RASHEED H, SINGH S, RAJPUT G, AGNIHOTRI S, NIRMAL P, KAUR S (Pharmaceutics Dep, ISF Coll of Pharmacy, Moga, Punjab - 142 001, Email: sankhabhatt@gmail.com) : Recent apprise on coronavirus and its terrible insinuations. Indian J Virol 2020, 31(2), 121–7.

Epidemically increased evidence reveals that the link between the 2019-nCoV and other similar strain of coronaviruses circulating in bats and specifically the Rhinopodous bat sub-species. These sub-species are ample and widely present in Southern China, Middle East Africa and Europe. Recent studies show that more than 500 CoV have been identified in bats in China. The Center for Diseases Control and Prevention and the World Health Organization maintains a website that is updated frequently with new cases of MERS-CoV infection. As per WHO Situation report 16th, 24,554 number of cases confirmed globally out of which 99.22 % cases from china. A new coronavirus (2019-nCoV) is causing respiratory syndrome mostly in Hubei Province, China. Corona Virus spread over 24 countries including Japan, India, Korea, and other countries 2019-CoV infection vary from mild, moderate or severe illness; the later includes severe pneumonia, ARDS, sepsis and septic shock. There are two diagnostic tests for coronavirus infection i.e. molecular test and serology test. In this review article there are the various recent cases of the patients that are suffering from the corona virus, the outcome of these studies is that corona virus infection is an epidemic disease which affects Central Nervous System (CNS).

1 illus, 2 tables, 34 ref

042941   AKHTER S, AKHTAR S (Sukkur IBA Univ, Sindh, Pakistan, Email: shireen.soomro@iba-suk.edu.pk) : Emerging coronavirus diseases and future perspectives. Indian J Virol 2020, 31(2), 113–20.

Coronavirus related infectious diseases seems to be biggest challenge of 21 century that have been constantly emerging and threating public health around the globe. Coronavirus disease-19 (COVID-19) that was detected as cause of respiratory tract infection in China by end the December 2019 impelled World Health Organization to declare in January 2020 public health emergency of international concern and consequently pandemic in March 2020. Over a past six months COVID-19 pandemic has wrapped up all continents except Antarctica. Scientists around the globe are finding way to tackle and reduce the ultimate risk and size of pandemic with lower morbidity and mortality rates. In this context, technologies such as sequencing, Crispr and artificial intelligence are playing vital role in diagnosis and management of infectious disease in contrast to conventional methods. Despite of this, there is a need to have rapid and early diagnostic tools and systems that recognize infectious disease in asymptotic condition. Here we provide an overview on the recent CoV outbreak and contribution of technologies with the emphasis on the future management for detection of such infectious diseases.

3 illus, 47 ref

046375   POURHOSSEINISERANI M, RAZMI G R (Pathobiology Dep, Ferdowsi Univ of Mashhad, Mashhad, Iran, Email: razmi@um.ac.ir) : Molecular detection of Theileria spp. and Babesia spp. in sheep and vector ticks in Ramsar and Tonkabon areas of Mazandaran province, Iran. J Vet Parasitol 2020, 34(2), 82-8.

The prevalence of Babesia and Theileria species in sheep and vector ticks in Tonkabon and Ramsar areas of Iran was investigated. A total of fifty blood samples and 45 ticks were collected from sheep from local flocks, suspected of piroplasmosis during 2013-2014. Giemsa stained blood smears were screened for piroplasms. DNA extracted from blood samples and salivary glands and ovaries of ticks were amplified with primers for Babesia spp. and Theileria spp. by semi nested-PCR. Piroplasms were observed in 22 (44 %) blood smears. In the first round of semi-nested PCR, the frequency of Theileria spp. and Babesia spp. in the sheep were 37 (74 %) and 7 (14 %), respectively. The results of semi-nested PCR showed that the frequency of T. ovis, T. lestoquardi, mixed Theileria infection, B. ovis and B. motasi were 16 (32 %), 17 (34 %), 17 (34 %), 6(12 %) and 1(2 %), respectively. Out of the 45 ticks collected, 39 were identified as Rhipicephalus bursa (86.7 %), three were Dermacentor raskimensis (6.7 %), two were Hyalomma marginatum (4.4 %) and one was Haemaphysalis spp. (2.2 %). Piroplasms could not be detected in salivary glands and ovary samples of ticks by semi-nested PCR. Based on the results of the study, it was concluded that piroplasm infection is common in sheep in Ramsar and Tonkabon areas.

4 illus, 1 table, 30 ref

042939   KUMAR R, NAGPAL S, KAUSHIK S, MENDIRATTA S (Microbiology Dep, All India Institute of Medical Sciences, New Delhi, Email: ramesh.aiims07@gmail.com) : COVID-19 diagnostic approaches: Different roads to the same destination. Indian J Virol 2020, 31(2), 97–105.

‘‘SARS-CoV2’’, a previously unknown strain of coronaviruses caused a severe respiratory disease called Coronavirus disease (COVID-19) which emerged from Wuhan city of China on 30 December 2019, and declared as Global health problem by World Health Organisation within a month. In less than two and half months (11 March, 2020) it was declared as a pandemic disease due to its rapid spreading ability, it covered more than 211 countries infecting around 1.7 million persons and claiming around 1.1 lakhs lives within merely 100 days of its emergence. Containment of the infection of this virus is the only available measure to control the disease as no vaccine or specific antiviral treatment is available. Confirmed detection of the virus followed by isolation of the infected person at the earliest possible is the only measure to prevent this disease. Although there are number of methods available for detection of virus and to combat this disease in the present pandemic situation, but these available diagnostic methods have their own limitations. The speedy and exponential global spread of this disease strongly urges the fast and economic diagnostics tools. Additional to the available diagnostic methods, there is a sudden surge for development of various of methods and platforms to diagnose the COVID-19. The review summarized the advantage and disadvantage of various diagnostic approaches being used presently for COVID-19, newer detection methods in developmental stage and the feasibility of advanced platforms like newer nano-sensor based on-thespot detection technologies.

1 illus, 1 table, 51 ref

042938   AKRAM M Z (Animal Production and Technologies Dep, Nig?de O¨ mer Halisdemir Univ, 51240 Nig?de, Turkey, Email: zeeshanakram219@gmail.com) : Inanimate surfaces as potential source of 2019-nCoV spread and their disinfection with biocidal agents. Indian J Virol 2020, 31(2), 94–6.

The WHO has declared COVID-19 illness a global health concern which is caused by 2019-nCoV, causing severe respiratory tract infections in humans. Transmissibility among individual to individual have been reported through droplets and probably also via contaminated surfaces and hands. Human coronaviruses can persist on inanimate surfaces such as plastic, glass, fibers and metals up to nine days. 2019-nCoV remains infectious in air for 3 h and on inanimate surfaces such as cardboard, copper, plastic and steel up to 24, 4, 72 and 48 h respectively. Disinfectant activity of various biocidal agents against coronaviruses like ethanol (62–71 %), sodium hypochlorite (0.1 %) and hydrogen peroxide (0.5 %) can be regarded effective against 2019-nCoV as well. As no vaccine and antiviral therapies have been discovered for 2019-nCoV, prevention of further spread will viable option to control the ongoing and future outbreaks.

3 tables, 15 ref

041129   WANG C, LI H, CHEN Y, GE H (Radiation Oncology Dep, Zhengzhou Univ, Zhengzhou, China, Email: chenyuwang321@163.com) : Local failure patterns after radical resection and adjuvant chemotherapy in patients with pN2 nonsmall-cell lung cancer: A retrospective analysis. Indian J Cancer 2020, 57(3), 323-9.

The patterns of local failure in stage pN2 nonsmall‑cell lung cancer (NSCLC) patients undergoing radical resection and adjuvant chemotherapy are controversial. The sites of local failure were compared in subgroups of patients with relevant clinicopathologic features (e.g., location and size of primary lesions). Totally 75 patients with local failure after radical resection and adjuvant chemotherapy for pN2 NSCLC were included in the analysis. Thirty‑seven (49.3 %) patients had distant metastasis. The median duration from surgical resection to local failure was 11 months (range: 3–45 months). Sites with ≥10 % failure rate in all subgroups based on the location of the primary lesions included 4R, 7, the ipsilateral hilum, and the stump. Additional sites with ≥10 % failure rate included 2R, 2L, 4L, and 5 for lesions in the left upper lobe; 4L and 5 for lesions in the left lower lobe; and 2R and 3P for lesions in the right upper-middle lobe. Squamous cell carcinoma affected the stump failure rate compared to adenocarcinoma (56.3 % vs. 18.0 %, P = 0.003). Tumor diameter ≥5 cm affected the stump failure rate compared to tumor diameter <5 cm (44.0 % vs. 18.0 %, P = 0.016). Skip N2 metastasis affected the ipsilateral hilum failure rate compared to nonskip N2 metastasis (7.5 % vs. 31.4 %, P = 0.008). For pN2 NSCLC patients undergoing radical resection and adjuvant chemotherapy, different lung lobes had different high-risk failure sites. Left lung cancer is prone to bilateral mediastinal lymph nodes recurrence, while right lung cancer mainly recurs with ipsilateral mediastinal lymph nodes. Moreover, the local failure patterns are influenced by pathological type, tumor size, and skip N2 metastasis.

2 illus, 3 tables, 30 ref

042937   CHIRUMBOLO S, BJØRKLUND G (Neurosciences Dep, Verona Univ, Verona, Italy, Email: salvatore.chirumbolo@univr.it) : Wheat and chaffs in the interpretation of the current COVID19 outbreak in Italy. Indian J Virol 2020, 31(2), 85–93.

The COVID19 outbreak in Italy is still a big concern. The Italian Government has recommended citizens to respect faithfully any compulsory legal disposition in order to stay home and so contributing in escaping viral contacts and slowing down epidemic. Emergency has raised a widely animated debate about how to read and comprehend the daily case numbers, the medical and caregivers availability, the needs to swab asymptomatic subjects. In this review the authors discuss about the many wheat and chaffs of how this virus disease is addressed .

2 illus, 1 table, 53 ref

041128   MEHRA R, MOHANTY V, ASWINI Y B, KAPOOR S, GUPTA V (Public Health Dentistry Dep, Maulana Azad Institute of Dental Sciences, Delhi - 110 002, Email: rm17111991@gmail.com) : Prevalence, patterns and sociocultural factors associated with use of tobacco-based dentifrices (Gul) in India. Indian J Cancer 2020, 57(3), 311-20.

India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4 %). Gul is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of Gul and its social determinants among adults in the capital city of India, Delhi. The cross‑sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for Gul users to assess practice and pattern of use. The overall prevalence of Gul users was found to be 4.9 % with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7 %) and unskilled workers (45.2 %). 74.9 % started using Gul to treat dental pain with 93.47 % of them reporting pain relief. Gul usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of Gul usage.

1 illus, 2 tables, 36 ref

042936   BAHADUR S, LONG W, SHUAIB M (Hainan Univ, Haikou 570228, China, Email: saraj@hainanu.edu.cn) : Human coronaviruses with emphasis on the COVID-19 outbreak. Indian J Virol 2020, 31(2), 80–4.

Human coronaviruses are known as respiratory pathogens mainly associated with a range of respiratory diseases. In the past 18 years, the beginning of severe acute respiratory syndrome human coronavirus (SARS-HCoV), Middle East respiratory syndrome coronavirus (MERSCoV) and now the (COVID-19) have driven the HCoV into the platform of the scientific community due to their high pathogenicity in humans. Our study about the HCoV has contributed extensively to the understanding of HCoV pathogenesis its outbreak and precautionary measurements mainly COVID-19. By the 16-February 2020, total existing diagnosis cases of COVID-19, in china now numbered around 57,255, total cumulative diagnosis is about 68,592, total existing suspicion is about 8228, a total severe existing disease 11,272, the total cumulative cure is about 9671 with more than 1666 cumulative deaths have been reported. The purpose of the review is to summarize the present knowledge on the viral diversity, reservoir hosts, and geographical distributions of Human coronavirus (COVID-19) in China.

2 illus, 20 ref

041127   CHANDRASHEKAR B R, CHACKO T V, ANAND K M, SUVETHA K, JAISHANKAR H P, SUMA S (Public Health Dentistry Dep, JSS Dental Coll and Hospital, Mysore, Karnataka, Email: drchandrubr@yahoo.com) : Enhancing identification and counseling skills of dental undergraduate students using a customized Tobacco Counseling Training Module (TCTM) – A piloting of the process using ADDIE framework. Indian J Cancer 2020, 57(3), 296-310.

Tobacco use has emerged as a major public health problem. But, most graduates in medical and dental schools receive limited systematic training. The objective of this education innovation project was to enhance dental undergraduate student’s ability to identify tobacco users through oral manifestations and improve their counseling skills using a customized Tobacco Counseling Training Module (TCTM). A TCTM for students of dentistry was developed using ADDIE framework as a guide. Content and construct validation of the module was done by six subject experts using Delphi technique for obtaining consensus. Pilot testing was done on 20 students of third year BDS. Pre- and post-intervention assessment of knowledge, attitude, self-confidence was done using learning outcomes questionnaire. Ability to correctly identify oral manifestations was assessed using extended item MCQs and tobacco counseling skills using a modified KEECC. The difference in mean scores were computed and subjected to further statistical analysis using SPSS version 22. There was a significant improvement in post intervention scores for mean knowledge (5.5 ± 1.4 to 13.2 ± 1.1), attitude (5.6 ± 0.9 and 8.5 ± 0.5), self‑confidence (1.5 ± 0.5 and 3.1 ± 0.2), ability to correctly identify oral manifestations (5.2 ± 1.4 and 9.4 ± 0.8) and tobacco counseling skills. It is possible to introduce the module in the existing curriculum and its effectiveness evaluation shows benefit in terms of Kirkpatrick’s Level 1, 2, 3 (improvement in knowledge, attitude, self‑confidence, ability to identify oral manifestations, and tobacco counseling skills) of training effectiveness.

7 tables, 25 ref

042934   MANDAL D (Biochemistry Dep, PDM Univ, Bahadurgarh, Haryana - 124 507, Email: dkmandal2000@yahoo.com) : Coronavirus threat to Indian population: Risk factors, transmission dynamics and preparedness to prevent the spread of the virus. Indian J Virol 2020, 31(2), 71–4.

Recent novel coronavirus outbreak in Wuhan City of Hubei province in China infected nearly 70,000 individuals and killed more than 1700 people within a short span of time leading to global pandemic. The disease is now spread to 26 countries in Asia, North America, Europe and Australasia. The virus is spreading rapidly to Asiapacific and Southeast Asian countries. The disease is posing a serious threat to human population and has devastating impact on public health and economy. So far 3 Indians are infected and India is at risk of rapid spread of the disease because of its geographical location and other favorable conditions. With a poorer global health security index compared to China (India-57 and China-51), any such situation will have worse outcome. In near future there are also possibilities of similar kind of disease outbreak caused by new strains of coronaviruses due to factors like species jump of new viruses, high population density and inadequate medical facilities. In this short review we have highlighted the risk factors and transmission dynamics of coronaviruses that may pose a serious threat to India. We have also discussed about the possible preventive measure our country should take to control any such outbreak situation.

1 illus, 18 ref

041126   MEERMIRA D, SWAIN M, GOWRISHANKAR S (Histopathology Dep, Apollo Hospitals, Hyderabad, Telangana, Email: swarnalatag@gmail.com) : Study of Ki-67 index in the molecular subtypes of breast cancer: Inter-observer variability and automated scoring. Indian J Cancer 2020, 57(3), 289-95.

Ki-67 index is an important prognostic marker in breast cancer and is also used to differentiate luminal A subtype from luminal B. Inter-observer variations in determining the index and the cut-off value to be considered in distinguishing the two subtypes remain problems in clinical practice. MIB-1 immunohistochemistry was done on 200 cases of breast cancer with 50 cases in each molecular subtype. The Ki‑67 scoring was done manually by two observers and automated method (using the software ImmunoRatio). The mean value of Ki‑67 was calculated in each molecular group and in the entire estrogen receptor and progesterone receptor (ER/PR) positive group. The inter-observer variability between the two observers and the automated method was also assessed. The mean and median values of Ki‑67 of all the 200 cases obtained by manual scoring was 31.13 % and 29.65 % by observer 1, 28.48 % and 27.90 % by observer 2, and 38.27 % and 35.45 % by the automated method. The mean Ki‑67 value obtained by manual scoring, in luminal A, luminal B, HER2 enriched and triple negative was 21.07 %, 37.19 %, 33.72 % and 27.27 %, respectively. There was significant correlation between the two observers and with the automated scoring.. The mean value of the Ki-67 index in the ER/PR positive group was 29.1 %. The inter-observer correlation and the correlation with the automated scoring system of the Ki-67 index was good. 29.1 % was the mean Ki-67 index in the ER/PR positive group and this value was within the acceptable range as per St Galen’s recommendation.

6 illus, 4 tables, 33 ref

042932   MOHANDAS A, BHAT A I (Crop Protection Div, ICAR-Indian Institute of Spices Research, Kozhikode, Kerala - 673 012, Email: aib65@yahoo.co.in) : Recombinase polymerase amplification assay for the detection of piper yellow mottle virus infecting black pepper. Indian J Virol 2020, 31(1), 38–44.

Recombinase polymerase amplification (RPA) is a quick, specific, sensitive molecular tool carried out at a constant temperature for pathogen detection. In the present study, RPA and reverse transcription (RT) RPA assays were optimized for the detection of piper yellow mottle virus (PYMoV) infecting black pepper. Out of the eight primer pairs targeted to amplify open reading frames (ORFs) 2 and 3 of the virus, the primer pair targeted to ORF2 gave specific amplification only with DNA isolated from infected plant but not with healthy plant. A magnesium acetate concentration of 18 mM, 40 min of incubation time and a temperature of 37^–42 $°$C was found optimum for detection of the virus in RPA assay. Comparison of sensitivity of detection revealed that RPA could detect the virus up to 10^-5 dilution of the total DNA while PCR could detect the virus up to 10^-4 dilution indicating that RPA is 10 times more sensitive than PCR. RPA was further simplified using crude extract as template which could detect the virus up to 10^-3 dilution. RT-RPA was optimized for the detection of PYMoV using total RNA isolated from infected plants as the template. Both RT-RPA and RPA assays were validated using field samples of black pepper representing different varieties and geographical regions by using CTAB isolated DNA, crude DNA extract and cDNA. Our study showed that RPA and RT-RPA can be successfully adopted as a substitute to PCR for detection of PYMoV infecting black pepper.

4 illus, 20 ref

041125   SHAHID P A, STEPHEN L C (Community Medicine Dep, Andaman and Nicobar Islands Institute of Medical Sciences, Andaman and Nicobar Islands, Port Blair, Email: lenacharlette@gmail.com) : Breast cancer in Andaman and Nicobar Islands: A retrospective analysis. Indian J Cancer 2020, 57(3), 282-8.

Breast cancer is the most common cancer in India among women. This study was conducted to describe the demographic, clinical, histopathological, endocrinological and survival pattern of breast cancer patients in Andaman and Nicobar Islands. The study was done in Medical Oncology department of GB pant hospital. Data was retrieved from the case sheets of patients who consulted from 1^st February 2015 to 31^st January 2018. As this hospital is the only referral hospital, the patients are representative of all cancer patients in the Island, and the population base is well defined. During the study period, 85 breast cancer patients were treated. Of the 82 female patients, the standardized incidence rates in 2015, 2016 and 2017 were 8.82, 13 and 14.42 per 100,000 women respectively. The prevalence and mortality rates in 2015, 2016, 2017 were 14.88, 27.96, 40.37, and 1.1, 2.74, 0.55 per 100,000 women respectively. Metastasis was detected at the time of diagnosis in 18.8 % of patients. Estrogen receptor (ER) and progesterone receptor (PR) positivity was reported in 55.9 % of patients, HER 2 positivity in 28.1 % and triple negativity in 27.3 %. The overall survival at 12, 24, and 36 months follow-up were 88.9 %, 84.3 % and 52.7 % respectively. In univariable analysis, the hazard ratios were significantly higher for patients with metastasis and diagnosis before 2015. As compared to the country, breast cancer incidence was lower in the Islands with better survival. Stage at diagnosis was the most important factor determining survival in these patients.

3 illus, 2 tables, 38 ref

042931   MUTHAIYAN M, PUSHAN S S, NAOREM L D, VENKATESAN A (Pondicherry Univ, Pondicherry - 605 014, Email: amouda@gmail.com) : Understanding of zaire ebolavirus–human protein interaction for drug repurposing. Indian J Virol 2020, 31(1), 28–37.

The Ebola virus is a human aggressive pathogen causes Ebola virus disease that threatens public health, for which there is no Food Drug Administration approved medication. Drug repurposing is an alternative method to find the novel indications of known drugs to treat the disease effectively at low cost. The present work focused on understanding the host–virus interaction as well as host virus drug interaction to identify the disease pathways and host-directed drug targets. Thus, existing direct physical Ebola–human protein–protein interaction (PPI) was collected from various publicly available databases and also literature through manual curation. Further, the functional and pathway enrichment analysis for the proteins were performed using database for annotation, visualization, and integrated discovery and the enriched gene ontology biological process terms includes chromatin assembly or disassembly, nucleosome organization, nucleosome assembly. Also, the enriched Kyoto Encyclopedia of Genes and Genome pathway terms includes systemic lupus erythematosus, alcoholism, and viral carcinogenesis. From the PPI network, important large histone clusters and tubulin were observed. Further, the host–virus and host–virus–drug interaction network has been generated and found that 182 drugs are associated with 45 host genes. The obtained drugs and their interacting targets could be considered for Ebola treatment.

6 illus, 3 tables, 49 ref

041124   ADAMANE S A, MENON S, PRAKASH G, BAKSHI G, JOSHI A, POPAT P, DESAI S B (Pathology Dep, Tata Memorial Hospital, Mumbai, Maharashtra, Email: mensantosh@gmail.com) : Mucinous tubular and spindle cell carcinoma of the kidney: A case series with a brief review of the literature. Indian J Cancer 2020, 57(3), 267-81.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare low grade renal tumour exhibiting characteristic morphological features. We share our experience and discuss briefly, a review of the current literature. Electronic medical records were searched between January 2005 to January 2017. The histopathology and immunohistochemistry slides were retrieved and reviewed. Eleven cases of MTSCC were identified. Mean age at presentation was 53.9 (age range 41 to 71) years with a slight female preponderance (F: M=6:5). Clinical stage at presentation was: Stage I (4 cases), Stage II (3 cases), Stage III (1 case), and Stage IV (3 cases). The average tumour size was 7.5cm (range 3.5 to 17cm). Microscopically, characteristic biphasic tumour with tubular and spindle cell morphology with variable mucinous stroma was noted in all. The prominent immunohistochemical profile revealed positivity for CK7 (7/8, 87.5 %), AMACR (6/8, 75 %), AE1/3 (4/4, 100 %), CD10 (3/10, 27.3 %), and Vimentin (3/3, 100 %). Seven patients (Stage I and II) had been treated with nephrectomy, whereas only a diagnostic biopsy was available in four patients who presented with locally advanced disease (n=1) or distant metastasis (n=3) at presentation. The mean follow-up was 37.8 months (range 8 to 96 months), available in 10 out of 11 patients, without recurrence in nine while one died 8 months after diagnosis. MTSCC is an indolent renal cancer with characteristic morphology. However, presentation with locally advanced disease or distant metastasis may be seen in a subset of these patients. This warrants close follow-up in even localized tumors.

2 illus, 4 tables, 44 ref

042929   KUMAR AS, MAURYA V K, PRASAD A K, BHATT M L B, SAXENA S K (Centre for Advanced Research (CFAR) Dep, King George’s Medical Univ, Lucknow - 226 003, Email: shailen@kgmcindia.edu) : Structural, glycosylation and antigenic variation between 2019 novel coronavirus (2019-nCoV) and SARS coronavirus (SARS-CoV). Indian J Virol 2020, 31(1), 13–21.

The emergence of 2019 novel coronavirus (2019-nCoV) is of global concern and might have emerged from RNA recombination among existing coronaviruses. CoV spike (S) protein which is crucial for receptor binding, membrane fusion via conformational changes, internalization of the virus, host tissue tropism and comprises crucial targets for vaccine development, remain largely uncharacterized. Therefore, the present study has been planned to determine the sequence variation, structural and antigenic divergence of S glycoprotein which may be helpful for the management of 2019-nCoV infection. The sequences of spike glycoprotein of 2019-nCoV and SARS coronavirus (SARS-CoV) were used for the comparison. The sequence variations were determined using EMBOSS Needle pairwise sequence alignment tools. The variation in glycosylation sites was predicted by NetNGlyc 1.0 and validated by N-GlyDE server. Antigenicity was predicted by NetCTL 1.2 and validated by IEDB Analysis Resource server. The structural divergence was determined by using SuperPose Version 1.0 based on cryo-EM structure of the SARS coronavirus spike glycoprotein. Our data suggests that 2019-nCoV is newly spilled coronavirus into humans in China is closely related to SARS-CoV, which has only 12.8 % of difference with SARS-CoV in S protein and has 83.9 % similarity in minimal receptor-binding domain with SARS-CoV. Addition of a novel glycosylation sites were observed in 2019-nCoV. In addition, antigenic analysis proposes that great antigenic differences exist between both the viral strains, but some of the epitopes were found to be similar between both the S proteins. In spite of the variation in S protein amino acid composition, we found no significant difference in their structures. Collectively, for the first time our results exhibit the emergence of human 2019-nCoV is closely related to predecessor SARS-CoV and provide the evidence that 2019-nCoV uses various novel glycosylation sites as SARS-CoV and may have a potential to become pandemic owing its antigenic discrepancy. Further, demonstration of novel Cytotoxic T lymphocyte epitopes may impart opportunities for the development of peptide based vaccine for the prevention of 2019-nCoV.

3 illus, 2 tables, 31 ref

041123   SENGAR M, CARR R, JAIN H, CHANANA R, RANGARAJAN V, SRIDHAR E, SHET T, MENON H, GUJRAL S, LASKAR S (Medical Oncology Dep, Tata Memorial Hospital, Mumbai, Maharashtra, Email: dr.hkjain@gmail.com) : Outcomes of T-lymphoblastic lymphoma treated with pediatric all-like protocol. Indian J Cancer 2020, 57(3), 262-6.

The management of T‑lymphoblastic lymphoma (T‑LBL) in adults poses uncertainties, including optimal chemotherapy regimen, need for radiotherapy, and the benefit of stem cell transplant. This retrospective case series investigated the efficacy of the pediatric BFM‑90 regimen in adult patients and evaluated the role of early response assessment by positron emission tomography with computed tomography (PET‑CT) in predicting outcomes. Patients aged 15 years or older with T‑LBL diagnosed at Tata Memorial Hospital, Mumbai, India were given chemotherapy according to the European BFM‑90 protocol (n = 38). The patients were evaluated for early response by interim PET-CT, post-induction and monitored for toxicity and long-term outcomes. Thirty‑eight consecutive patients (median age 23.5 years) were analyzed. After a median follow‑up of 33.5 (1–77) months, following induction, 35 out of 38 patients (92.1 %) had achieved complete response (CR) on PET‑CT. Thirty (78.9 %) patients treated according to BFM‑90 were alive in first remission. Three‑year event‑free survival for those with CR on PET‑CT was 78 %, against no survivors for those who remained PET‑positive. This study demonstrates the feasibility and efficacy of BFM‑90 approach in adults with T‑LBL. We found an early PET response to be highly predictive of outcome.

2 illus, 2 tables, 15 ref

041122   LIANG Y, ZHOU M, YU W, WANG H (Nursing Dep, The First Affiliated Hospital of Soochow Univ, Suzhou, Jiangsu, China, Email: spring05263@163.com) : Changes in social support among patients with hematological malignancy undergoing hematopoietic stem cell transplantation in Souzhou, China. Indian J Cancer 2020, 57(3), 253-61.

Evidence regarding social support in patients is mostly from cross-sectional studies. Very few studies have focused on the change in social support systems before and after hematopoietic stem cell transplantation. A total of 191 patients were investigated before transplantation and at 30, 90 and 180 days post-transplantation. The social support for patients was evaluated by the Perceived Social Support Scale (PSSS). The overall PSSS scores showed a continuous decline in means from 71.29 ± 9.73 before the transplantation to 69.44 ± 10.61, 68.73 ± 10.04, and 66.37 ± 12.02 at 30, 90 and 180 days post-transplantation, respectively. In comparison to the baseline, the overall PSSS scores decreased significantly at 90 and 180 days post-transplantation (P< .05). The Generalized Estimated Equation (GEE) analysis found that patients with no transplant‑related complications, higher household income, and better educational status had preferable social support. Social support presented a marked downward trend during the six month period. Patients with no transplant-related complications, higher household income and better educational status had preferable social support. Therefore, social support as a high‑priority quality of life should be given close attention in the early phase of transplantation. Positive measures should be taken to improve social support in the early phase of transplantation especially among individuals undergoing this procedure for the first time.

4 illus, 6 tables, 30 ref

041121   KATTI S V, PAULOSE R R, MALIPATIL B, VERMA N S (Pathology Dep, Columbia Asia Hospital Whitefield, Bangalore, Karnataka, Email: sanjeev.katti@gmail.com) : Grossing and reporting of colorectal cancer resection specimens: An evidence-based approach. Indian J Cancer 2020, 57(3), 239-52.

Appropriate management of the patient with colorectal carcinoma depends on obtaining key prognostic and predictive information from the resection specimen. These include the quality of surgery, extent of lymph nodal clearance, presence of nodal disease, vascular invasion, residual disease post neoadjuvant treatment, and completeness of resection. A meticulous and structured approach to dissection of the resection specimen and subsequent histological examination by the pathologist is crucial in providing this information to the treating clinician. A good macroscopic examination also serves to audit the quality of other services including radiology, surgery, and oncology. This article attempts to review dissection and reporting guidelines with an evidence‑based approach and hopes to guide pathologists to understand the basis behind the recommended protocols.

13 illus, 8 tables, 56 ref

042928   PANDEY N V (Indian Astrobiology Research Centre, Mumbai, Email: niteshpandey@iarc.res.in) : DNA viruses and cancer: Insights from evolutionary biology. Indian J Virol 2020, 31(1), 1–9.

When it comes to understanding the exact mechanisms behind the virus induced cancers, we have often turned to molecular biology. It would be fair to argue that our understanding of cancers caused by viruses has significantly improved since the isolation of Epstein–Barr virus from Burkitt’s lymphoma. However they are some important questions that remain unexplored like what advantage do viruses derive by inducing carcinogenesis? Why do viruses code for the so called oncogenes? Why DNA viruses are disproportionately linked to cancers? These questions have been addressed from the lens of evolutionary biology in this review. The evolutionary analysis of virus induced cancer suggests that persistent strategy of infection could be a stable strategy for DNA viruses and also the main culprit behind their tendency to cause cancer. The framework presented in the review not only explains wider observations about cancer caused by viruses but also offers fresh predictions to test the hypothesis.

48 ref

042927   NILEENA NKM , RAMAKRISHNAN N , CHARLES M I , DEENADAYALAN H , RANGANATHAN L (Nithra Institute of Sleep Sciences, Chennai, Tamil Nadu, Email: ram@nithra.com) : Obstructive sleep apnea and floppy eyelid syndrome: An eye opener. Indian J Sleep Med 2020, 15(4), 69–72.

Obstructive sleep apnea (OSA) is a common yet underdiagnosed sleep disorder associated with partial or complete obstruction of upper airway during sleep. Floppy eyelid syndrome (FES) is another frequently overlooked diagnosis associated with lax upper eyelids, a soft and foldable tarsus, and a chronic papillary conjunctivitis of the upper palpebral conjunctiva. There has been growing literature to support the association between the two, and this study explores the same and also the clinical implications. Retrospective study from 2015 to 2018 at a freestanding sleep clinic, India. Patients who were diagnosed with FES at an ophthalmic care hospital, and referred for evaluation of suspected OSA based on symptoms of snoring and daytime hypersomnolence were included in the study. Subjects underwent clinical evaluation and polysomnography, if required. All the referrals were males and the mean age was 49.8 ± 13.4. Of 51 patients, 13 (25.4 %) were not willing to undergo sleep study as they were unwilling to accept the possible association of OSA and FES and/or could not afford additional testing. Thirty-six of the 38 patients with FES were diagnosed of OSA (94.8 %) and 20 of 38 had severe OSA (55.5 %). Of the 38 patients diagnosed with OSA, only one patient accepted continuous positive airway pressure (CPAP) therapy. Ophthalmologists were able to effectively screen patients for OSA with simple screening questions about snoring and daytime hypersomnolence. The association between OSA and FES was significant but a large proportion of patients were not ready to undergo sleep study or commence treatment despite being diagnosed and explained the consequences of untreated severe OSA.

1 table, 24 ref

041120   NAIR A S, SAIFUDDIN M S, NAIK V, RAYANI B K (Anaesthesiology Dep, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, Email: abhijitnair95@outlook.com) : Dexmedetomidine in cancer surgeries: Present status and consequences with its use. Indian J Cancer 2020, 57(3), 234-8.

Dexmedetomidine is a centrally acting α2 adrenoreceptor agonist used in perioperative medicine due to its sedative, analgesic and sympatholytic properties. Recently animal data has pointed towards potential role of dexmedetomidine in promoting cancer recurrence and metastasis when used perioperatively especially after breast surgeries. This is because of presence of α2 adrenoreceptors in breast cancer tissue. We reviewed existing literature in which dexmedetomidine was used in cancer surgeries and investigated its role in recurrence and metastasis.

1 table, 27 ref

042926   REDDY KR B K , NAIR S (Pediatric Pulmonology and Sleep Dep, Shishuka Children's Specialty Hospital, Bengaluru, Karnataka, Email: drbharathreddykr@gmail.com) : A comparative study of polysomnography findings in children with prader–willi syndrome and non-syndromic children. Indian J Sleep Med 2020, 15(4), 65–8.

There are insufficient data in India on sleep issues in children with Prader–Willi syndrome (PWS). This study was undertaken to describe the prevalence of sleep problems, polysomnography findings, and treatment of sleep issues in children with PWS. (1) To determine the prevalence of sleep problems in children with PWS and (2) to compare the polysomnography (PSG) findings in children with PWS and non-syndromic children with obstructive sleep apnea (OSA). Retrospective data of children who underwent polysomnography for the diagnosis of sleep problems were extracted and divided into two groups. The first group consisted of 20 children with PWS, and the second group consisted of 22 non-syndromic children with OSA. History was analyzed using a parent-administered sleep questionnaire, and a level one polysomnography was performed in all study subjects. No significant difference was noted in the sleep history between the two groups. The OSA prevalence of the PWS group was 100 %. The OAHI, OAHI (REM), baseline oxygen saturation, and time of saturation below 90 % were significantly affected in the PWS group compared to the non-syndromic group. Thirteen children with PWS who had moderate-to-severe OSA were started on CPAP and were clinically better, of which nine of them who underwent a follow-up sleep study showed resolution of OSA on PSG. Children with PWS suffer from moderate-to-severe OSA. OSA with significant hypoxemia is seen in REM sleep in PWS children, necessitating the need for early intervention with noninvasive ventilation. All children with PWS must undergo PSG due to possible underestimation of sleep issues on parental history. The degree of obstruction could be underestimated on parental history in children with PWS, thus necessitating the need for a sleep study in all children with PWS, especially prior to hGH therapy.

2 tables, 16 ref

042925   SHAH V S, SARDANA V (Neurology Dep, Government Medical Coll, Kota, Rajasthan, Email: vsard13@gmail.com) : Study of obstructive sleep apnea in acute ischemic stroke patients. Indian J Sleep Med 2020, 15(4), 60–4.

The study was done to assess the impact of obstructive sleep apnea (OSA) on acute ischemic stroke. To see the prevalence and severity of obstructive sleep apnea in patients with acute ischemic stroke in Rajasthan, to identify patients with acute ischemic stroke who should be screened for OSA, and to compare short-term neurological and functional outcomes in stroke patients with and without OSA. This is a prospective analytical study of 50 patients with acute ischemic stroke. National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were calculated at admission. After 10 days, all patients underwent minimum 4 hours of polysomnography. OSA was diagnosed when apneas hypopneas index (AHI) is more than 5 per hour. NIHSS scoring was done at discharge, and mRS scoring was done after 1 month. Categorical variables were compared using the χ² test and numerical variables using the t-test for independent samples. Statistical significance was set at 5 %. The prevalence of OSA was 36 %. Obesity and high Epworth sleepiness scale were predictors of OSA. The distribution of stroke topography was similar in OSA and non-OSA groups. NIHSS and mRS were comparable in OSA and non-OSA groups. Difference in recovery of NIHSS was significant between OSA and non-OSA groups (1.16 and 2, respectively, p-value: 0.0017). There was a statistically significant difference in mRS at 1 month between OSA and non-OSA groups (2.88 and 2.53, respectively, p-value: 0.02). As poor neurological recovery during the hospital stay and poor functional recovery at 1 month in patients with acute ischemic stroke with OSA were found, our study highlights screening of OSA particularly for obese patients and patients with high Epworth sleepiness scale.

2 illus, 2 tables, 13 ref

042924   VASUDEV P , ARJUN P , AZEEZ A K, NAIR S (Respiratory Medicine Dep, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, Email: dr.p.arjun@gmail.com) : Prevalence of cognitive impairment in obstructive sleep apnea and its association with the severity of obstructive sleep apnea: A cross-sectional study. Indian J Sleep Med 2020, 15(4), 55–9.

Cognitive impairment in obstructive sleep apnea (OSA) is a widely unrecognized entity. Earlier studies have shown variable results for the prevalence of this entity. Hence, this study was done to determine the prevalence of cognitive impairment in patients diagnosed to have OSA and its association with the severity of OSA.  All in-patients and outpatients who were diagnosed to have OSA by polysomnography in a tertiary care hospital in Kerala, India, were included in this study. Cognitive function was assessed by Montreal cognitive assessment (MoCA) and their scores were calculated. Daytime sleepiness was assessed by the Epworth sleepiness scale (ESS).  96 OSA patients were included in the study. 19.8 % of patients had mild OSA, 29.2 % of patients had moderate OSA, and 51 % of patients had severe OSA. The prevalence of cognitive impairment in OSA patients in this study was found to be 58.3 % (95 % confidence interval, 47.8– 68.3 %). There were 35 (62.5 %) patients with cognitive impairment in the severe OSA group, while the moderate and mild OSA groups had 17 (30.4 %) and 4 (7.1 %) patients, respectively. There was a significant negative correlation between AHI and MoCA score, indicating that cognitive impairment is associated with the severity of OSA. The prevalence of cognitive impairment in our study was 58.3 %, which was found to be more in those with severe OSA. It was also found that cognitive impairment is associated with the severity of OSA. Cognitive impairment in OSA is associated with the severity of OSA and is a correctable condition that can improve the quality of life.

2 illus, 2 tables, 16 ref

041119   KHANDE T A, JOSHI A R, KHANDEPARKAR S G S, KULKARNI M M, GOGATE B P, KAKADE A R, SAHU P D, KHILLARE C D (Pathology Dep, Shrimati Kashibai Navale Medical Coll and General Hospital, Pune, Maharashtra, Email: siddhigsk@yahoo.co.in) : Study of ER, PR, HER2/neu, p53, and Ki67 expression in primary breast carcinomas and synchronous metastatic axillary lymph nodes. Indian J Cancer 2020, 57(2), 190-7.

Breast cancer (BCA) is the second most common cancer among women in India and accounts for 7% of global burden of BCA. The axillary lymph node status is an independent prognostic factor. The combined estrogen receptor (ER), progesterone receptor (PR), and HER2/neu biomarker expression is a predictor of BCA status for therapeutic guidance. Studies have demonstrated that these biomarkers are unstable throughout their tumor progression. Varying concordance and discordance rates in the biomarker expression between primary breast carcinoma (PBC) and metastatic axillary lymph node (MALN) status are reported. This study was conducted for studying and comparing the expression of immunohistochemistry (IHC) markers, i.e.,ER, PR, HER2/neu, p53, and Ki67 between PBC and their corresponding MALN for prognostication and therapeutic purpose. Sixty cases of PBC with metastasis to axillary lymph nodes diagnosed between years 2008 and 2014 were included in the study. A technique of manual tissue array was employed for cases subjected to IHC. Analyses of the expression of IHC markers were attempted between the PBC and their corresponding synchronous MALN and classified as concordant or discordant. Results were subjected to statistical analysis. Substantial agreement was observed for biomarker ER, PR, HER2/neu, p53, and Ki67 expression between PBC and MALN with k‑value 0.79, 0.75, 0.89, 0.7, and 0.6, respectively There was high concordance for the IHC markers: ER, PR, HER2/neu, p53, and Ki67 expression in matched pairs of PBC and corresponding synchronous MALN. However, the discordance noted in small subgroups cannot be overlooked. Thus, there is a need to perform ER, PR, HER2/neu, p53, and Ki67 IHC studies routinely in both PBC and MALN to help design therapies that are tailored to target the specific tumor clones and render maximum benefit to patients.

1 illus, 7 tables, 26 ref

042923   IYER S R , IYER R R (Ambika Clinics-Dombivli (East) Dist Thane and Kharghar, Navi Mumbai, Maharashtra, Email: sramiyer@gmail.com) : Obstructive sleep apnea and venous thrombosis: Clinical implications. Indian J Sleep Med 2020, 15(3), 51–3.

Obstructive sleep apnea (OSA), although a disease of upper respiratory airway, has profound effects on body systems. The breathing abnormalities have effects on venous return. Pooling of blood in legs during apnea–hypopnea, coupled with hemodynamic changes and pathological cascades, favors thrombosis in legs and subsequent thromboembolism. An OSA has possible implications in vascular endothelial injury, stagnant blood flow, increased coagulability (Virchow’s triad), and Trousseau’s syndrome. An OSA suspicion must be high in all patients with venous thrombosis, particularly in those who have recurrent episodes of this disorder.

19 ref

042922   KINIMI I , SHINDE S S , RAO N M (Pediatrics Dep, Manipal Hospitals, Bengaluru, Karnataka, Email: ilinkinimi@gmail.com) : Home mechanical ventilation in children: A 7-year experience. Indian J Sleep Med 2020, 15(3), 46–50.

To review the profile of children requiring home mechanical ventilation (HMV), the diagnoses, modes of presentation, age at initiating HMV, and outcome of these children on follow-up. This is a retrospective observational study. We included all children up to 18 years of age who were started on HMV between May 2013 to April 2020 at our hospital. Source of data was the hospital records of children receiving HMV. Clinical data were captured on Excel sheet and analyzed. Fifty-seven children were started on HMV with a mean age of 6.43 years (range of 3 months to 17 years 8 months) at start of HMV; 35 (61.4 %) were male and 22 (38.6 %) were female. Fifteen (17.5 %) of 57 presented with acute respiratory failure, and 42 (73.6 %) of 57 with chronic respiratory failure. Thirty-nine (68.4 %) of 57 had an established diagnosis of a neuromuscular disease (NMD) of 22 (56.41 %) of 39 had an underlying diagnosis of spinal muscular atrophy 2 (SMA type II) which was also the most common diagnosis in this study. Average age at initiating ventilation in the neuromuscular group was 7.92 years (range: 4 months–17 years 8 months) and the other non-NMD group was 2.91years (range: 3 months–15 years). Seven children were on invasive tracheostomy and 50 on noninvasive ventilation (NIV). Fifty-six children were started on BiPAP, and one child is on CPAP. Two children have been weaned of HMV and are doing well. There were three episodes of life-threatening complications in three different children, and the annual rate of hospitalization with respiratory morbidity was 0.36 per child. There has been no mortality in this study period. Home mechanical ventilation improves the life expectancy and enhances the quality of care and survival. Under the appropriate clinical scenarios, HMV significantly reduces the economic, psychosocial burden on the family and improves quality of life for the child. Transition to home care is challenging, especially in developing countries with lack of nursing care/home care support, but is feasible with meticulous planning wherein parents or caregivers are the key partners. To the authors knowledge, this is the largest case series of children on HMV from India.

4 illus, 1 table, 15 ref

042921   DESHMUKH K , KHANNA A (Fuqua School of Business, Durham, USA, Email: kartik.deshmukh@ duke.edu) : Seasonality of obstructive sleep apnea in Asia: Insights from google trends. Indian J Sleep Med 2020, 15(3), 39–45.

Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing encountered in clinical practice and has considerable medical and psychosocial consequences. Snoring is the most common sign of OSA, yet it is most often ignored. Seasonal changes may lead to changes in body weight, pharyngeal flow, and frequency of allergies, which in turn leads to changes in the severity of OSA. The seasonal pattern of worsening of OSA can be demonstrated by the analysis of information-seeking behavior on the internet from a specific region. Google, the most popular search engine, indexes the queries with every search performed and makes this information available to the public through Google trends. In the current study, we used Google trends data to investigate the seasonal variation in sleep-disordered breathing in eight countries in the Asia-Pacific region (India, Hong Kong, Thailand, Singapore, Malaysia, Taiwan, Japan, and South Korea) from 2015 to 2020. The seasonality of queries for the term “snoring” was analyzed using the cosinor model. Peaks and troughs in trends of search volume index (SVI) or normalized search volume during the specific period for the term “snoring” were evident. There were significant differences in mean SVI values across the seasons. Cosinor models confirmed the seasonality for “snoring” in all countries in the study. The peak season for queries corresponded to the cold climate in the respective countries, with maximum amplitude seen in India. Obstructive sleep apnea exhibits seasonality with increased severity in winter. The results of this study can guide targeted implementation of sleep awareness program in winters to increase the awareness and the management of OSA across the Asian countries.

3 illus, 3 tables, 33 ref

041117   ANAND M, PARIKH A, SHAH S P (Radiation Oncology Dep, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, Email: drmridul.sachdeva@gmail.com1) : Comparison of thermoplastic masks and knee wedge as immobilization devices for image‑guided pelvic radiation therapy using cone beam computed tomography. Indian J Cancer 2020, 57(2), 182-6.

Pelvic radiotherapy is generally performed with the use of an immobilization and positioning device. The objective of the study was to ascertain and compare setup errors between the two positioning devices. A total of 35 patients of stage II and III cervical cancers were enrolled in the study and divided into two groups, one using knee wedge and the other using thermoplastic pelvic mask as an immobilization device. Radiation was planned by four field box conformal technique. The random and systematic setup errors were then calculated for each patient in both the groups in the mediolateral (ML), superoinferior (SI), and anteroposterior (AP) directions. The translational mean setup variation in the lateral, longitudinal, and vertical direction is 0.17 ± 0.24, −0.12 ± 0.48, and −0.18 ± 0.27 cm for thermoplastic pelvic mask and −0.03 ± 0.26, −0.04 ± 0.48, and −0.09 ± 0.37 cm for knee wedge, respectively. The systematic setup error and random errors were 0.24, 0.48, 0.27 cm and 0.31, 0.60, and 0.40 cm for thermoplastic mask and 0.26, 0.48, and 0.37 cm and 0.38, 0.37, and 0.45 cm for knee wedge in ML, SI, and AP axis, respectively. The one way analysis of variance test was applied to compare the setup errors in between the three axes for both the immobilization devices. To compare the positioning accuracy of thermoplastic mask and knee wedge, Student’s t‑test was applied. Both the tests were found to be insignificant (P value > 0.05). Thermoplastic mask and knee wedge are equally effective as immobilization devices for treating cervical cancers with conformal techniques.

1 illus, 3 tables, 22 ref

041116   RAMANUJAN V, KRISHNAMURTHY A, VENKATARAMANI K, KUMAR C (Orthopedic Oncology Dep, Cancer Institute (WIA), Chennai, Tamil Nadu, Email: drarvindkrishnamurthy@yahoo.co.in) : Pulmonary metastasectomy in primary extremity osteosarcoma: Choosing wisely, along with a brief review of literature. Indian J Cancer 2020, 57(2), 172-81.

Despite the advances in systemic treatment, about 30 %–40 % of the patients with extremity osteosarcomas relapse and more than 80 % of these relapses localize in the lungs. Our understanding of the management of pulmonary metastases from extremity osteosarcomas is largely based on retrospective data from single institutions or compiled from registries; hence, there is great degree of variability in the reported management of pulmonary metastasis in patients with osteosarcomas. To analyze the demographic profile, disease characteristics and survival outcomes of patients who had undergone potentially curative pulmonary metastasectomies from extremity osteosarcomas. Retrospective analysis of the 37 patients with resectable pulmonary metastasis(both synchronous and metachronous) from osteosarcoma of the extremity, treated from January 1, 2003 to December 31, 2017 at a tertiary regional cancer center in South India. The median overall survival (OS) of our patient cohort was 38 ± 2.7 months. The 2‑, 3‑, and 5‑year OS were 86 ± 5.8 %, 60.8 ± 8.6 %, and 20.7 ± 7.4 %, respectively. A formal analysis of the various prognostic factors revealed disease-free interval >2 years, completion of the planned systemic chemotherapy, and absence of pulmonary recurrence post-metastasectomy to be significantly influencing the survival outcomes. Our study reiterates the need for consideration of pulmonary metastasectomy in carefully selected patients of extremity osteosarcomas. There is a paucity of data on pulmonary metastasectomies from India and our cohort is possibly the largest series for pulmonary metastasectomies from an osteosarcoma primary. In routine clinical practice, we recommend that the final decision to proceed with pulmonary metastasectomy should ideally be taken by a multidisciplinary tumor board on a case‑by‑case basis.

2 illus, 3 tables, 40 ref

041115   MORADI K, BABAEI E, REZVANI N, SAFARALIZADEH R, BASHIRI H, FEIZI M A H (Animal Biology Dep, Tabriz Univ, Tabriz, Iran, Email: pourfeizi@eastp.ir) : High potential of SOX21 gene promoter methylation as an epigenetic biomarker for early detection of colorectal cancer. Indian J Cancer 2020, 57(2), 166-71.

Despite the advances in screening during the past decades, colorectal cancer (CRC) still is a leading cause of cancer deaths worldwide. Therefore, the development of new diagnostic methods is necessary. The aim of this study was to compare methylation changes of SRY‑Box 21 (SOX21) gene promoter in tumor tissues and their normal adjacent mucosa in patients with CRC and to examine the relationship between the methylation levels and demographic/clinicopathological factors. A total of 41 CRC patients participated in the present study. After the extraction of DNA and bisulfite treatment of the samples, the methylation levels were determined by using the MethyLight method. Two‑sided Mann–Whitney U test was used to compare the median level of methylation in tumor tissues and their adjacent normal mucosa. The methylation rates in tumor tissue samples were significantly higher compared to their adjacent normal mucosa (P < 0.0001). No association between demographic/clinicopathological factors and methylation status observed in tumor tissues. A receiver operating characteristics curve was constructed and tissue samples exhibited a sensitivity of 80.5 % and specificity of 97.6 % for SOX21 promoter methylation. The results of this study indicated the high potential of SOX21 gene promoter methylation as a candidate noninvasive diagnostic biomarker in stool and plasma of colorectal cancer patients. However, further studies with larger sample sizes are required to evaluate the specific role of SOX21 methylation as a biomarker for early detection of CRC.

2 illus, 3 tables, 26 ref

042920   KANCHAN S , BHARDWAJ K K , TIWARI S , BAKSHI S , VAJPEI P (Physiology Dep, King George's Medical Univ, Lucknow, Uttar Pradesh, Email: drshwetakanchan@ gmail.com) : Effect of coronavirus disease-2019 pandemic on the sleep quality of indian population. Indian J Sleep Med 2020, 15(3), 35–8.

This survey was conducted to compare the sleep quality of the general Indian population before the coronavirus disease2019 (COVID-19) pandemic and during the pandemic using Pittsburgh Sleep Quality Index (PSQI). It is a cross-sectional online survey-based study conducted on 1,000 consenting Indian adult citizens. The survey was circulated by the investigators through an online link on various social media platforms. It had questions based on PSQI to access the sleep quality. The mean PSQI before the pandemic was found to be 4.37 and during the pandemic to be 5.00. Results showed that the pandemic had deteriorated the sleep quality of general population of India. All the sleep parameters in the PSQI scale showed deterioration in sleep quality due to the pandemic. Significant change was seen in the level of enthusiasm—34.3 % people lacked the enthusiasm to get the things performed before the pandemic while 48.4 % people lacked the enthusiasm to get the things performed during the pandemic. The study indicated a marked decrease in the sleep quality during the pandemic as compared to before the pandemic. This survey informs about the change in sleep quality parameters due to COVID-19 pandemic.

3 tables, 16 ref

041114   VAROL U, UZUM Y, SENGUL A, KORKMAZ U B, PARVIZI M, AKYOL M, TASKAYNATAN H, SALMAN T, OFLAZOGLU U, ALACACIOGLU A ET AL (Medical Oncology Dep, Izmir Katip Celebi Univ Ataturk Training and Research Hospital, Manisa, Turkey, Email: dralaca2000@yahoo.com) : An analysis of adjuvant treatment strategies in operated pancreatic cancer patients: An Izmir oncology group study. Indian J Cancer 2020, 57(2), 158-63.

Adjuvant treatment is necessary in pancreatic cancer patients, but the optimal approach is not clear yet. Our aim was to explore the effectiveness of adjuvant treatment modalities in patients with operated pancreatic cancer. There were five groups of patients operated for primary pancreas adenocarcinoma. The first two groups included patients who were treated with only adjuvant chemotherapy or radiotherapy. The patients in third group had received combination chemotherapy and radiotherapy either sequentially or concomitantly. The fourth group was composed of patients who were treated with adjuvant chemotherapy after concurrent chemoradiotherapy, whereas the patients in the fifth group were only observed after surgery without any adjuvant treatment. There were 83 operated pancreatic cancer patients available for analysis. Median age of the patients was 63 years (range, 40–82 years). There were 55 patients who had local disease recurrence (n = 14) or metastasis (n = 41) during or after adjuvant treatment. The median overall survival for all patients was 14 months. When we compared the median survival of patients who had any adjuvant treatment with the patients treated without any adjuvant therapy, we found a significant statistical difference between the groups(32.4 vs 6.5 months; P = 0.000). In addition, survival of each treatment group was also compared with each other but we did not find any significant statistical difference. Our result suggests that any adjuvant therapy in the treatment of pancreatic cancer patients is important. However, we could not find any superiority between adjuvant treatment modalities.

2 tables, 30 ref

041113   SHET T, PAI T, WADASADAWALA T, NAIR N, GULIA S (Pathology Dep, Tata Memorial Hospital, Mumbai, Maharashtra, Email: tanujashet5@gmail.com) : Grossing and reporting of breast cancer specimens: An evidence-based approach. Indian J Cancer 2020, 57(2), 144-57.

A histopathology report offers important prognostic and predictive information that helps plan systemic therapy in breast cancer. However, in many cases a pathologist fails to provide relevant information chiefly due to the lack of awareness of the impact of these parameters in clinical decision‑making. This review seeks to put forth common practice points in grossing and reporting of specimens harboring breast cancer with focus on latest revisions in the same. Just as it is important to document tumor size, tumor type, margins, estrogen receptor/progesterone receptor, and human epidermal growth factor (ER/PR/HER2) in breast cancer, we need to also focus on sentinel node grossing, nodal burden, size of nodal metastasis, and extranodal extension. In parallel, increasing number of patients are getting neoadjuvant chemotherapy in breast cancer and points in grossing and reporting of such specimens are also alluded to. This article will serve as reference guide to pathologists on what we do and why we do the same.

3 illus, 2 tables, 68 ref

041112   DARLING H S, RASTOGI S (Medical Oncology and Hemato-oncology Dep, Narayana Superspeciality Hospital, Gurugram, Haryana, Email: doc_iaf@yahoo.com) : Rare cancers in India: A road less travelled. Indian J Cancer 2020, 57(2), 139-43.

Globally, rare cancers as a group are commoner than any single common cancer. They represent an unmet medical need, and this issue gets further amplified in India due to various reasons, including the limited accessibility of healthcare system to the population at large. The scarce available data yet only represents the tip of the iceberg, due to poor registration and incomplete medical cover. Rare cancers, as a consequence, are driven further away from attention of the policy‑makers and financial authorities. Poor research prospectives and lesser administrative support restrict the research in this field. There is an urgent need for initiating studies exclusively on rare cancers in India, considering their prevalence and deprived management, as many countries are already pursuing work in this field. All such inadequacies ultimately affect the patient outcomes. In this review, after discussing these aspects, we suggest a stepwise approach to improve the care of rare cancers in India.

16 ref

041111   BUTTI A K, YADAV S K, VERMA A, DAS A, NAEEM R, CHOPRA R, SINGH S, SARIN N (Pathology Dep, North Delhi Municipal Corporation Medical Coll and Hindu Rao Hospital, Delhi -110 007, Email: drnamrata50@gmail.com) : Chronic calculus cholecystitis: Is histopathology essential post-cholecystectomy?. Indian J Cancer 2020, 57(1), 89-92.

Carcinoma of the gall bladder (GB) is the most common malignancy of the gastrointestinal tract. One percent of cholecystectomy specimens show incidental gall bladder cancers (GBCs). Our aim of the study to was evaluate the utility of routine histopathology of cholecystectomy specimens removed with a diagnosis of gall bladder diseases (GBD). A retrospective study was done reviewing the histopathological records of 906 patients who underwent cholecystectomy. Demographic details, gross findings, and microscopic findings noted. All the cases were categorized into two groups, A and B. Group A included the cases with any gross abnormality including wall thickness ≥4 mm and group B included rest of the cases. Majority of the patients were in the age group of 31–40 years of age. Out of 906 patients studied, majority of them were females with F:M ratio of 6.14:1. Of the 47 cases which were included in group A (with macroscopic abnormality), six cases had gall bladder carcinoma on microscopy. One case from group B with macroscopically normal-appearing GB had invasive carcinoma on microscopy. In our study, we found a sensitivity of 85.71 % and specificity of 95.44 %, while positive predictive value (PPV) was 91.11 % and negative predictive value (NPV) was 99.65 % of macroscopic abnormality in the diagnosis of invasive carcinoma. All cholecystectomy specimens must be examined by histopathologists who must decide whether processing for microscopy is needed. Microscopic examination may be reserved for the specimen with a macroscopic lesion. This will result in a reduction of costs and pathology workload without compromising patient management.

1 illus, 2 tables, 21 ref

041110   MANUR J G, SEBASTIAN M G J, DAVID S M (Radiation Oncology Dep, M.S Ramaiah Medical Coll and Hospital, Bengaluru, Karnataka, Email: drjanakimg@gmail.com) : Chemo-radiation outcomes for esophageal cancer: A reflection from a tertiary cancer center on selection of patients for more aggressive therapy. Indian J Cancer 2020, 57(1), 84-8.

Most esophageal cancer patients present with poor nutritional status and may not tolerate radical treatment. We aim to identify patients who are good candidates for chemo-radiation (CTRT). Fifty-four patients treated with CTRT were followed up for a mean period of 28 months and factors affecting the outcome were analyzed along with the recurrence pattern. Forty-eight patients (88 %) received CTRT and all completed treatment as scheduled. Eighteen (32 %), 15 (27 %) patients were alive with and without disease, respectively, at 28 months while 20 (37 %) were dead. There was no statistically significant correlation between local failure and any of the factors like length, grade of the tumor, and chemotherapy received. Esophageal cancer patients present at an advanced stage and hence careful selection of patients for radical CTRT is very important for providing relatively longer disease-free interval. Equally important is the close monitoring of patients during treatment which helps in completing the planned treatment which translates into a better long-term outcome.

3 tables, 11 ref

041109   YADAV A, GOYAL P, AGRAWAL C R, BOTHRA S J, JAIN P, CHOUDHURY K D, GUPTA S K, SHARMA M, BAJAJ R, UPADHYAY A ET AL (Medical Oncology Dep, Rajiv Gandhi Cancer Institute and Research Centre, Delhi - 110 085, Email: chaturbhujagrawal06@rediffmail.com) : Efficacy and tolerability of nimotuzumab in combination with chemotherapy in recurrent and metastatic squamous cell carcinoma of head and neck at a cancer center in Northern India. Indian J Cancer 2020, 57(1), 76-83.

Squamous cell carcinoma of head and neck (SCCHN) account for approximately 30-33 % of all cancer and the median survival for recurrent and metastatic(R/M) SCCHN remains less than 1 year despite modern advances in therapy. Chemotherapy, usually single agent remains the backbone of therapy in these patients. EGFR antibodies are being used in (R/M) SCCHN. Nimotuzumab is one such agent that has anti-EGFR action similar to other agents without similar skin toxicity. Prospective, interventional, non-randomized study done at Rajiv Gandhi Cancer Institute and Research Centre. A total 124 patients were enrolled and divided into Arm A (Chemotherapy + Nimotuzumab) and Arm B (Chemotherapy) in a ratio of 1:1 i.e., 62 in each arm. They were evaluated and treated as per protocol after a written informed consent. Statistical analysis was done using the SPSS software. Quantitative variables were compared using Unpaired t-test/Mann-Whitney Test. Qualitative variables were compared using Chi-Square test /Fisher’s exact test. Kaplan-Meier analysis was used to assess the PFS, with log rank test for comparison between the groups. A p value of < 0.05 was considered statistically significant. The most frequent primary location of tumor was oral cavity (n=38, 69 %) and (n=33, 56.9 %) in both arms. The overall response rate in Arm A was 38.2 % and 19 % in Arm B (p= 0.023). The disease control rate in Arm A was 74.5 % and 43.1 % Arm B (p= 0.0007). The median PFS in Arm A was 5.2 months whereas it was 3.2 months in Arm B (p= 0.009). In this study, the combination of Nimotuzumab plus platinum/taxane based chemotherapy was active and well tolerated in Indian patients in R/M SCCHN. Addition of Nimotuzumab to chemotherapy had a response rate of 38.2 % and median PFS of 5.2 months are strong arguments for clinically testing this combination.

1 illus, 6 tables, 15 ref

041108   YILDIRIM H C, ERGEN S A, SEDEF E, SAHIN M, KARACAM S C, SENOCAK M S, DINCBAS F O (Radiation Oncology Dep, Istanbul Univ-Cerrahpasa, Istanbul, Turkey, Email: hcumhur@yahoo.com) : Erectile dysfunction in prostate cancer patients treated with intensity-modulated radiation therapy. Indian J Cancer 2020, 57(1), 70-5.

Sexual dysfunction is an important side-effect after radiotherapy (RT) for prostate cancer (PCa). The aim of this study was to compare sexual functions of PCa patients before and after intensity-modulated RT and to analyze their correlation with penile bulb (PB) doses and patient characteristics. Forty-two patients who underwent RT ± hormone therapy for PCa between 2010 and 2013 were analyzed. Sexual functions assessed by patient-reported questionnaire and physician reported scale before and 3 years after treatment. The effect of patients’ age, prostate volume, testosterone levels, comorbidity, smoking status, tumor stage, RT technique, hormone therapy, and PB doses to sexual functions were investigated. After 3 years of RT, 64.3 % of all patients had a lower erectile score; and 75 % of patients who were previously potent (n = 24) had become impotent after treatment. However sexual desire still remained in 75.8 % of patients who had desire before treatment (n = 33). Statistical analysis showed that two parameters were correlated with postradiotherapy impotency outcome; PB mean radiation dose (P = 0.033) and testosterone levels (P = 0.032). RT, despite modern techniques, affects the sexual function of PCa patients in varying degrees. Reducing radiation doses to penile structures may play a role in preventing erectile dysfunction.

5 tables, 27 ref

041107   VENKATASUBRAMANIYAN M, RAJAPPA S K, AGARWAL M, CHOPRA A, SINGH A, PAUL R (Head and Neck Surgical Oncology Dep, Rajiv Gandhi Cancer Institute and Research Centre, Delhi - 110 085, Email: mudit1000@gmail.com) : Infrahyoid flap revisited – a head and neck surgical perspective in the Indian setting. Indian J Cancer 2020, 57(1), 62-9.

In India, head and neck cancer contributes to about 35 % of all malignancies. Among head and neck squamous cell cancers, buccal mucosa and tongue are the most common subsites. Reconstruction of defects after resection of primary in these subsites with acceptable cosmetic and functional outcomes remains a challenging task. In the era of free flaps, many pedicled flaps are being overlooked. Infrahyoid flap (IHF) is one among them. This study discusses the feasibility of IHF in reconstruction of small and medium-sized defects in subsites of the oral cavity. This study is a retrospective analysis of 23 patients who underwent IHF and reconstruction after excision of primary in a case of oral cavity squamous cell carcinoma from January 2010 till November 2017 with a median follow-up of 15 months. Patients who were diagnosed as a case of squamous cell carcinoma in oral cavity subsites (T1–T3 and N0/N1–N2) and in whom the anticipated defect size was small to medium were included. The evaluation was then done based on the possibility to reach recipient site, vitality after transposition, definitive integration, and clinical outcome. Out of 23 patients, 5 patients had flap-related complications of which 1 patient had total skin paddle necrosis and 4 patients had partial skin paddle necrosis at distal end. However, no patient developed oro-cutaneous fistula or required corrective surgery. The maximum flap dimension was 9 × 4 cm and average flap dimension was 6 × 4 cm. The postoperative outcome of all patients remained uneventful. The infrahyoid myocutaneous flap is a reliable and convenient flap which can be used as a good alternative for free flaps in small and medium-sized defects of the oral cavity.

14 illus, 2 tables, 21 ref

041106   SARI M, SAIP P (Internal Medicine Dep, Istanbul Univ, Fatih/Istanbul, Turkey, Email: drmuratsari@gmail.com) : Eribulin monotherapy in heavily pretreated metastatic breast cancer patients in real life. Indian J Cancer 2020, 57(1), 55-61.

Our retrospective, single-center study aimed at evaluating the efficacy and safety of eribulin in heavily pretreated metastatic breast cancer (MBC) in routine clinical practice. Twenty-eight patients treated with eribulin for MBC between May 2014 and November 2017 were included in our study. Clinical and biological assessment of toxicity was controlled at each visit. Tumor response was evaluated every three cycles of treatment. Median age at eribulin treatment was 52.5-year. Tumors were hormone receptor positive (71.4 %), HER2-positive (10.7 %), and triple negative (TN) (25 %). Most of the patients (92.8 %) presented with visceral metastases, mainly in the lymph nodes (57.1 %) and liver (53.6 %). Median previous metastatic chemotherapy line was 4 [1–7]. Median number of metastatic sites were 3 (1–4). Median number of eribulin cycles was 4. At the end of follow-up period, 36 % of the patients were still alive. Eighteen patients died due to disease progression. The objective response rate was 21.5 % with a 42.9 % clinical benefit rate. Median progression-free survival and overall survival (OS) were 4 (95 % CI: 2.7–5.2) and 14 (95 % CI: 11.8–16.1) months, respectively. Treatment was well tolerated. None of the patients discontinued eribulin treatment due to toxicity. The most commonly reported toxicities were asthenia (71.4 %), peripheral neuropathy (67.9 %), and neutropenia (46.4 %). Eribulin is an effective new treatment option in heavily pretreated MBC, with a manageable toxicity profile. Our results confirm that treatment with eribulin is feasible and safe in real-world patients.

3 illus, 4 tables, 19 ref

044849   GURUCHARAN I, BALASUBRAMANIAN S, SEKAR M (Conservative Dentistry and Endodontics Dep, SRM Dental Coll, Chennai, Tamil Nadu, Email: skmdc2006@gmail.com) : “Bioactive primers”-macroshield against micro-leakage in restorative dentistry?. J Orofac Res 2020, 9(3), 55-6.

In today’s dental era, minimal intervention dentistry is widely recommended to conserve maximal sound tooth structure by careful removal  of  only  caries  infected  dentin. However, residual bacteria which remain in dentinal tubules of relatively healthy part of dentin make it  impossible to achieve a complete caries free environment. This brief commentary will highlight on the recent advancements in adhesive resin composites with significant antibacterial effects which may aid ineffective restoration of such cavities.

6 ref

042919   KUMAR R , KUMAR A , YADAV S R, ISH P , GUPTA N , CHAKRABARTI S (Pulmonary Dep, Vardhman Mahavir Medical Coll and Safdarjung Hospital, New Delhi, Email: Shibdas1@yahoo.co.in) : Sleep-disordered breathing and stroke: A common yet ignored association. Indian J Sleep Med 2020, 15(2), 30–4.

One of the major causes of long-term disability is stroke. It is widely accepted that the morbidity and mortality caused by stroke can be reduced by aggressively treating the risk factors. One of the modifiable and independent risk factors for stroke is Sleep-disordered breathing (SDB). Untreated SDB may be responsible for an increased risk of stroke and death. Severity of SDB could be used to predict the functional dependence of the patient and poor outcome in stroke patients. Treating SDB with positive airway pressure (PAP) therapy in stroke patients may have impact on functional and neurological outcome. This review discusses the common co-occurrence of the stroke and SDB, its pathogenesis, the effects of SDB on stroke morbidity and mortality, impact of stroke on the sleep architecture, and the possibility of improvement with CPAP therapy.

61 ref

044848   RAVINDRAN R, RAJENDRAN H, DEVI N K (Oral Pathology and Microbiology Dep, Azeezia Coll of Dental Sciences & Research, Meeyannoor, Kerala, Email: rathyravindran27@gmail.com ) : Knowledge, attitude and practice of research ethics among dental professionals in dental colleges of South Kerala-A pilot study. J Orofac Res 2020, 9(3), 49-54.

Research in the  field  of dentistry  is  increasing  but  there  is  dearth  of  information  investigating  the  knowledge, attitude  and  practice  of  dental  professionals  for  ethical  principles  in  research  especially  in  developing  countries  like  India.  The outcome  of the  present  study  will  help  the  institution  to  understand  how  well  research  ethics  areaccepted  in  their  institution. A cross sectional survey using validated questionnaire  was administered to faculty members and postgraduates of two dental  colleges in  south  Kerala. The  questionnaire  was  designed  to  take  approximately  10  minutes  to  complete  and  participantswere asked to return it in drop box provided at principal’s office. A total of 97/113 dental professionals participated in the study  with  a response  rate  of  86 %.  Based on  the  questionnaire,  there  was  fair  knowledge  among  the  faculties  and  postgraduatesregarding  informed  consent,  research  involving  children  and  research  on  retrospective  samples.  Less  than  one  fourth  of  results showed good attitude towards research ethics whereas more than three fourth participants showed moderate attitude. There was no statistically significant difference between faculty and postgraduates on comparison of attitude towards research ethics (p<0.148). With regards to research ethics practice, about half of participants had moderate knowledge and less than half of participants had low  knowledge.  However,  the  difference  of  knowledge  among  faculty  and  postgraduates  was  not  statistically  significant (p<0.756). The  present  study  highlights  the  need  for  nationwide  study  about  research  ethics  to  determine  the generalizability of the results and the importance of research ethics training program .

4 tables, 10 ref

044847   GUPTA P (Swami Vivekanda Medical Mission, Udhampur- 182101, Jammu and Kashmir, Email: pankajtherock3@gmail.com ) : Chemopreventive effects of dietary sulforaphane in oral cancer- A review. J Orofac Res 2020, 9(3), 39-43.

Oral cancer is a potentially fatal disease which constitutes an important part of tumors occurring in the head and neck region. It not only affects the overall health but also affects the  mental health, appearance, employment, social life and family living. It can also cause serious changes in the functioning of the upper aero digestive tract that affects the quality of life in patients. The use  of  conventional  treatment  modalities  depend  on  tumor  respectability  and  location  as  well  as  feasibility  of  organ preservation approach. However, their role in oral cancer treatment is non-selective and can cause damage to normal tissue. In particular, chemo radiotherapy is associated with systemic toxicities that often reduce patient compliance and prevent timely completion of therapy. Scientists around the world are now developing a new treatment known as 'green chemoprevention' in which  broccoli  and  other  vegetables  are  used to  prevent  the  onset  of  carcinoma.  In  this  review  article,  the  author  presents  a detailed review about the chemotherapeutic effect of sulforaphane, a dietary component from broccoli sprouts in the prevention of  oral  cancer.que is a  shear-based  moment, a force  obtained  from  a  twisted  spring  wire  in  its  effort  to  un-twist  itself  which causes  rotation.  In dentition, it pertains  to  facio-lingual  root  movement  and  control.  Also,  it  refers  to  the  amount  of  twist applied to an arch wire in bracket engagement or activation. Despite the advent of numerous treatment philosophies, appliance systems and torque prescriptions and considerable research done in the past, torque is still an enigma. The key is to understand not  only  how  we  reach  where  we  are  but  also  to  learnhow  to  manage  the  torque  properly,  focusing  on  the  technical  and biomechanical  purposes  that  led  to  the change  of  the  torque  values  over  time.  The  present  review  focuses  on  application  of torque in orthodontics.

2 tables, 43 ref

041105   KUNHERI B, RAJ R V, VIJAYKUMAR D K, PAVITHRAN K (Radiation Oncology Dep, Amrita Institute of Medical Sciences, Kochi, Kerala, Email: beenakunheri@yahoo.co.in) : Impact of St. Gallen surrogate classification for intrinsic breast cancer sub-types on disease features, recurrence, and survival in South Indian patients. Indian J Cancer 2020, 57(1), 49-54.

Breast cancer is a heterogeneous group of disease, and recently, intrinsic sub-typing on the basis of gene expression profiling is found to be a predictor of breast cancer clinical course. The St. Gallen has released surrogate classification for breast cancer sub-types depending on immunohistochemistry (IHC) markers. The aim of our study was to analyze the distribution of sub-types using IHC surrogate markers in our patient population and to assess the clinico-pathological factors in different sub-types. A total of 635 non-metastatic patients who underwent radical intend treatment from January 2011 to December 2013 were included for this retrospective analysis. A statistical analysis was done by Windows SPSS version 20. The Chi-square test was used to examine the correlations of these sub-types with clinico-pathological parameters. The Kaplan-Meier method estimates were used for survival analysis. The median follow-up was 42.77 months (5 months to 112 months). Luminal B was the predominant group. Disease free survival (DFS) at 5 years was 95 % in luminal A, 78 % in luminal B HER-2 negative, 80 % in luminal B HER-2 positive, 72 % in triple negative, and 79 % in HER-2/neu non-luminal. Tumor size, Ki67, T stage, N stage, and grade were significantly associated with DFS in all biological type with a P value of less than 0.05. Surrogate classification was successfully applied in our patient cohort. Luminal B and triple negative sub-groups were more prevalent in our patients, and this finding is at variance with published international data. Biological sub-type also emerged as an important predictor of survival.

1 illus, 3 tables, 18 ref