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This study determined the oral bioavailability of mycophenolic acid, the active metabolite of mycophenolate mofetil, in patients undergoing nonmyeloablative hematopoietic cell transplantation. Eighteen adults receiving a preparative regimen containing fludarabine, cyclophosphamide, and total body irradiation were studied. Immune suppression consisted of cyclosporine and mycophenolate 1 g twice daily. Pharmacokinetic variability was high after intravenous and oral dosing. Intravenous dosing resulted in a median area under the curve (AUC) of 28.3 μg·h/mL (range, 9.96-70.4) and an oral AUC of 16.7 μg·h/mL (range, 9.38-35.3). C max after intravenous and oral dosing was 12.18 and 5.29 μg/mL, respectively. The median oral bioavailability was 72.3% (20.5%-172%), with 8-fold variability. Five patients (28%) had an oral bioavailability ≤50%. At time of oral pharmacokinetics, 15 patients (83%) had an AUC 0-12 <30 μg·h/mL. The initial oral dose should be at least 25% greater than the intravenous dose with follow-up assessment of plasma concentrations. [ABSTRACT FROM AUTHOR]

Introduction: Lip and oral cavity cancer is the second most frequent cancer in India, accounting for more than 10% of the total cancer incidence in the country. Oral malignancies are frequently found and diagnosed at advanced stages, resulting in dismal survival rates. The influence of healthcare-related factors in the diagnostic interval of oral cancer remains poorly understood., Methods and Material: This study followed the principles of the Aarhus statement for early cancer diagnosis research. Researchers non-selectively recruited 261 patients with histopathologically proven Squamous Cell Carcinoma of the oral cavity at the comprehensive Cancer Care Centre in Northern Kerala, India. They acquired information in direct patient interviews using validated instruments. They triangulated self-reported data with case notes, referral letters and biopsy results., Results: The median (Interquartile range) diagnostic interval reported by the study participants ( n = 261) was 36.00 (14.00-76.50) days. The proportion of participants having diagnostic intervals of more than 30 days was 57.9% ( n = 151). The predictors of diagnostic interval include 'Type of advice provided by the health care provider', Number of healthcare providers consulted in the diagnostic journey, 'Age of the participant', 'Monthly income' and 'Caste'., Conclusion: Nearly three-fifths of the study participants had diagnostic intervals that exceeded the acceptable limit, highlighting the need to streamline the facilities and processes required for early diagnosis of oral cancer. Strengthening the health system at the primary level by incorporating referral guidelines and in-service training of primary care practitioners will reduce diagnostic intervals for oral cancer., Competing Interests: All authors report no relationships that could be construed as a conflict of interest., (© the authors; licensee ecancermedicalscience.)

Multimedia, being more attention-getting and attention-holding, is a powerful tool for mass awareness creation and is used for intervention among students in many studies. Our aim was to see the effectiveness of an educational short film in tobacco awareness generation and to compare it with the traditional lecture-based awareness. Selected schools were divided into two groups as per convenience. Short film was used as intervention in Group 1 and PowerPoint-based lecture in Group 2. The increase in awareness was assessed by a pre and posttest. On analysis, though both methods increased awareness as given by higher posttest score, it is found that the awareness levels showed a statistically significant difference between educational short film on hazards of tobacco and power point-based lecture using Mann-Whitney test. Our study proves that an educational short film carefully scripted and picturized can be used effectively in imparting awareness in school-based tobacco control programs., Competing Interests: None

Background: The incidence of oral cancer is increasing in south-central Asia. Though it can be detected early, most cases were reported in late stages, resulting in a poor prognosis. Reducing the patient interval will facilitate early diagnosis and better disease survival.  The paucity of research on the patient interval in oral cancer has limited our ability to design and evaluate programs for early diagnosis., Methods: The study was conducted to identify the duration of patient interval and associated factors in oral cancer. Patients with oral cancer reporting at a tertiary cancer center during the study period were interviewed using validated data collection tools. The 'Aarhus statement' guidelines were followed in designing and reporting the study., Results: Among the 261 participants, 54% reported a patient interval of more than 90 days. The median (IQR) patient interval was 92 (38-168) days. In the multivariate binary logistic regression model, those who approached healthcare facilities due to pain (OR, 8.3, 95% CI, 2.9 to 23.4) were more likely to have a patient interval of more than 90 days over those who came due to insistence by family. Smoking status (Current smoker vs. never smoker) at the time of diagnosis (OR, 2.518, 95% CI, 1.3 to 4.7), Stage of cancer (late vs. early) of participants (OR, 2.62, 95% CI, 1.3 to 5.2), and time of travel (>30 minutes vs. ≤ 10 minutes) to health care facility (OR 5.8, 95% CI, 1.6 to 21.7) were the other significant predict8  6766667ors for the patient interval of more than 90 days., Conclusion: Patient interval in oral cancer can be reduced by improving symptom awareness, abstinence from tobacco use, and facilitating access to health care facilities. The double burden of tobacco use in oral cancer, as it increases the risk of disease occurrence and delays symptom presentation, needs serious policy considerations in the context of cancer prevention.

Aim: The aim of this in vitro study was to compare the effects of herbal irrigants with conventional irrigants on microhardness and flexural strength of root dentin., Materials and Methods: Sixty extracted permanent maxillary canines were selected. Decoronated roots were sectioned longitudinally into buccal and lingual segments to get 120 specimens. These were embedded in auto polymerizing acrylic resin and further grounded with fine emery papers under distilled water. Of these, 100 root segments without any defects were selected, further divided into four test groups and a control group according to the irrigants used ( n = 20). Group 1: 2.5% Sodium hypochlorite, Group 2: Miswak stick extract, Group 3: Cashew leaves extract. Group 4: Mango leaves extract and Group 5: Normal saline (control). All specimens were treated with 5 ml of each irrigant for 10 minutes and rinsed immediately. Dentin microhardness was measured with a Vickers indenter, and the flexural strength test was done using a universal testing machine. The data were analyzed using one-way ANOVA and the intergroup comparison by student t -test., Results: The experimental groups showed a significant reduction in microhardness values when compared with the control group. Intragroup comparison among experimental groups, herbal irrigants showed the least reduction in microhardness values at cervical, middle, and apical thirds. When compared to the control group, the flexural strength values decreased significantly with experimental groups., Conclusion: Within the limitation of this study, it was concluded that herbal irrigants were least detrimental to root dentin microhardness when compared with conventional irrigant. But the flexural strength was equally reduced by both conventional and herbal irrigants., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Conservative Dentistry.)

Introduction: Community based programs can assist in early detection and improved survival of breast cancer., Aims: To assess the feasibility and explore challenges of a district-wide door-to-door breast cancer screening program "ASWAS" conducted in Kannur district, Kerala, India from 2011 to 2014. METHODS: Aggregate data from survey records were collected in terms of the population screened, referred, diagnosed, and treated. Case records of breast cancer patients who were identified were reviewed and updated. In-depth interviews were conducted with program stakeholders. The contents of the interview were organized into a strength, weakness, opportunity and threat (SWOT) matrix to describe the screening program., Results: A total of 1,049,410 eligible women above 30 years residing in 81 panchayats were visited door-to-door by 8,200 community volunteers; of them, 93% were screened using a symptom-risk factor checklist. Of those referred with symptoms (n = 5353), 81% attended the cancer camp. In total, 23 breast cancer cases were confirmed. 14 (61%) were in early stages, treated, and are disease free at 3-year follow-up. Those in the advanced stage and old age had poor outcomes. SWOT analysis identified political support, female volunteers, community engagement, dedicated fund for treatment, and teamwork as strengths. Weaknesses included poor healthcare access, maintaining volunteer motivation, and issues around sustainability., Conclusion: Community participation with the engagement of the health system and local self-government are required for implementing a comprehensive cancer screening strategy. Breast-cancer screening program using local volunteers for early detection is feasible in low-income settings, thereby improving survival., Competing Interests: None

Purpose: Noncommunicable disease (NCD) prevention is emerging as a public health priority in developing countries. For better health outcome in these countries, it is necessary to understand the different community-based interventions developed and implemented across the world., Objective: The objective of the current review is to identify the best strategies used in community-based health intervention (CBHI) programs across the world., Materials and Methods: For review, we searched in PubMed and Google Scholar with the keywords "community based," "health interventions," "health promotions," "primary prevention," chronic diseases," "lifestyle-related diseases," and "NCD." Data were extracted using predesigned data extraction form. CBHI studies detailing their intervention strategies only were included in the review., Results: Out of 35 articles reviewed, 14 (40%) were randomized control trials, while 18 (51.4%) were quasi-experimental design. Individual level ( n = 14), group level ( n = 5), community level ( n = 6), and policy level ( n = 4) intervention strategies were identified. Twenty-three (64%) studies were based on interventions for 1 year and above. Twenty-eight (80%) studies were intervened among specific populations such as Latinos and so on., Conclusion: Successful programs advocate for a package or a chain of interventions than a single intervention. The type of interventions at different levels, namely individual, group, community, and policy levels vary across studies, but individual, and group level interventions are more frequently used., Competing Interests: There are no conflicts of interest.

Background: Oral cancer is a major public health challenge, and about one-fifth of all oral cancer cases reported globally are from India. In spite of the potential for early detection by simple visual examination, the majority of patients report in later stages of the disease, especially in low and middle-income countries. We report the results from a district level population-based oral cancer screening program., Methods: A cross-sectional survey was carried out among people aged >15 years in 48 panchayats of Kannur district in Kerala, India. This comprehensive multi-stakeholder district-wide screening was carried out in six stages including planning, sensitization, recruiting of community volunteers and training, survey, organization of specialist camps and referring to cases to cancer center. The descriptive statistical analysis was performed using EpiData analysis software (Version 2.2.2.180)., Results: Among the 1,061,088 people in 265,272 houses surveyed, 2507 of them attended the screening camps, and 13 oral cancers and 174 oral precancers were detected. Majority of the oral cancer patients were male (69%), with primary education or illiterate (62%) and low socioeconomic status (61%). Five of the patients diagnosed with early-stage cancer are alive and have good oral health-related quality of life., Conclusion: Detection of precancerous and early-stage cancers should be a priority of oral cancer screening programs. The possible key for addressing cancer screening needs of the rural population is to equip the primary health centers in cancer screening activities with available human resources while adapting to local context., Competing Interests: There are no conflicts of interest.

Background: Smoking and smokeless tobacco use are almost always initiated and established during adolescence. More than 80% of adult smokers begin smoking before 18 years of age. The main objective of the present study is to assess the feasibility of preventing adolescent tobacco use with the help of a specially designed tobacco control program., Materials and Methods: A cross sectional survey on tobacco use and related health effects was conducted using a structured questionnaire in 13 randomly selected schools in Kannur district of Kerala. These students were followed for a period of one academic year with multiple spaced interventions such as anti-tobacco awareness classes, formation of anti-tobacco task forces, inter-school competitions, supplying IEC (information, education and communication) materials and providing a handbook on tobacco control for school personnel. Final evaluation was at the end of one year., Results: There were 4,144 school children who participated in the first phase of the study. The prevalence of tobacco smoking and chewing habits were 9.85% and 2.24% respectively. Ninety-one percent had parental advice against tobacco use and only 3.79% expressed desire for future tobacco use. The final evaluation witnessed a sharp decline in the current tobacco use as 4.68%. We observed a statistically significant difference towards the future use of tobacco (p<0.001) and awareness about the ill effects of passive smoking (p<0.001) among boys and girls. Further a significantly increased knowledge was observed among boys compared to girls about tobacco and oral cancer (p=0.046)., Conclusions: The comprehensive school based tobacco control project significantly reduced the tobacco use pattern in the target population. School tobacco projects incorporating frequent follow ups and multiple interventions appear more effective than projects with single intervention.