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BACKGROUND: Considering the pandemic's mode of transmission, the impact on quality of life (QOL) is likely to be exaggerated among healthcare workers (HCWs) who treat head and neck diseases (hHCWs). METHODS: A cross-sectional self-reported QOL assessment was undertaken between July and September 2020 using the World Health Organization Quality of Life instrument sent out to hHCWs. Factors that predicted a poorer QOL were identified using regression models and mediation analysis. RESULTS: Responses from 979 individuals across 53 countries were analyzed with 62.4% participation from low- and middle-income countries. The physical domain had the highest mean scores of 15 ± 2.51, while the environmental domain was the lowest (14.17 ± 2.42). Participants from low- and middle-income countries had a significantly worse physical (p < 0.001) and environmental (p < 0.001) domains, while a low coronavirus disease 2019-related mortality significantly impacted the environmental domain (p-0.034). CONCLUSION: QOL-related issues among hHCWs are a vexing problem and need intervention at an individual and systems level in all parts of the world.

Background: Various studies have associated inflammation with carcinogenesis. But still, the role of inflammatory markers in oral cancer has not been evaluated extensively. Most of the existing studies have been done on patients of varied sites, and their sample size is also scarce. In this study, we have evaluated the impact of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on various clinicopathological factors and survival. Methodology: This was a retrospective analysis of prospectively collected data of 400 patients with oral squamous cell cancer. The pretreatment neutrophil and lymphocyte and platelet counts were recorded, and NLR and PLR were calculated for all patients. The NLR and PLR tertiles were correlated with the incidence of various clinicopathological factors and overall survival. Results: The median follow-up of the cohort was 36 months. The mean survival of the cohort was 41.7 months. PLR was associated with higher incidence of adverse clinicopathological factors. There was a trend of decreased overall survival with increasing NLR tertile. It was found to be significant only for the group which received adjuvant chemoradiotherapy (P 0.01). Patients with higher PLR values have been found to have a lower overall survival (P 0.006). Conclusion: NLR and PLR can be used to predict survival and outcomes in patients oral cavity cancer. PLR is a good predictor for adverse clinicopathological factors and survival. NLR can predict survival only in the subset of patients who have received chemotherapy.

Introduction: Oral cancers are among the most common cancers in the Indian subcontinent and tobacco is the most common implicated etiologic agent for these cancers. Over last two decades, significant changes have occurred in the lifestyle of people in the subcontinent. Antitobacco legislations have made developed and awareness about the harmful effects of tobacco and related products have increased. We hypothesized that this would lead to change in tobacco use pattern and hence impact the trends of oral cancer in India. Methodology: We analyzed the hospital records of patients having buccal mucosa and tongue cancers at a tertiary care cancer center. We noted the trends of patients presenting with these cancers 4 yearly, over a period of 16 years and in this way tried to assess the impact of legislation and awareness activities upon cancer incidence and trends. Results:: This study has shown that the number of patients presenting with tongue and buccal mucosa cancers has not decreased over the years. Increase in buccal mucosa cancers is marginally more than that of the tongue cancer. Proportion of males with respect to females presenting with these cancers has increased. There has been no significant decline in the younger patients presenting with these cancers. Common age of presentation of tongue cancers has come down. Conclusion: The findings of this study highlight the ineffectiveness of current laws and awareness programs in reducing the menace of oral cancer.

Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with the use of areca nut, and is mainly seen in the parts of Southeast Asia and the Indian subcontinent. We hypothesized that oral cancers occurring in presence of OSMF are clinicopathologically a distinct entity.We analyzed 289 treatment naïve patients of oral cancer. They were followed up for a median of 44 months. Association of presence of OSMF with other histopathological factors was done using the χOral squamous cell carcinoma along with OSMF was seen more often in younger patients (P .001) and males (P .007), and had a lower T-stage (P .002) and N-stage (P .000). These were thinner (P .002), less infiltrative (P .04) tumors and required adjuvant therapy less frequently (P .017). The mean disease specific survival, overall for those with and without OSMF was 58.8 and 48.6 months (P .002), and specifically for stages III and IV was 49.4 and 38.5 months, respectively (P .053).Oral squamous cell carcinomas associated with OSMF are associated with good clinicopathologic profile and have better prognosis and oncological outcomes.

Despite meticulous surgery and proper adjuvant treatment, outcome of oral squamous cell carcinoma remains unpredictable. This shows that there may be other factors which should be considered while prognosticating these patients. Many a times there is spread of disease beyond the gross margin which can alter the margin status. We hypothesized that microscopic spread beyond gross disease may portend a poor prognosis.This is a retrospective study of prospectively collected data of 1025 treatment naïve oral squamous cell carcinoma patients. All patients underwent surgery from January 2012 to October 2013, this was followed by appropriate adjuvant treatment. Demographic and histopathological details were noted from the electronic medical records.Microscopic spread beyond gross disease (MSGD) is associated with higher incidence of nodal positivity (p 0.046), peri-neural invasion (p 0.001), thicker tumours (p 0.024) and poor differentiation (p 0.060). The overall survival in patients with MSGD was 32.45 months vs. 37.5 months in patients without MSGD (p 0.002).Tumours with MSGD tend to have a higher incidence of nodal metastasis, PNI and thicker tumours. Presence of MSGD was associated with lower overall survival as compared to those without.

Chewing of areca nut in different forms such as betel quid or commercially produced pan masala and gutkha is common practice in the Indian subcontinent and many parts of Asia and is associated with a variety of negative health outcomes, particularly oral and esophageal cancers. Areca nut-specific alkaloids arecoline, arecaidine, guvacoline, and guvacine have been implicated in both the abuse liability and the carcinogenicity of the areca nut. Therefore, variations in the levels of areca alkaloids could potentially contribute to variations in addictive and carcinogenic potential across areca nut-containing products. Here, we developed an accurate and robust liquid chromatography-tandem mass-spectrometry (LC-MS/MS) method for simultaneous quantitation of all four areca alkaloids and applied this method to the analysis of a range of products obtained from India, China, and the United States. The results of the analyses revealed substantial variations in the levels of alkaloids across the tested products, with guvacine being the most abundant (1.39-8.16 mg/g), followed by arecoline (0.64-2.22 mg/g), arecaidine (0.14-1.70 mg/g), and guvacoline (0.17-0.99 mg/g). Substantial differences in the relative contribution of individual alkaloids to the total alkaloid content were also observed among the different products. Our results highlight the need for systematic surveillance of constituent levels in areca nut-containing products and a better understanding of the relationship between the chemical profile and the harmful potential of these products.

Background The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity. Methods This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted. Result The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue. Conclusion Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

With the advent of nicotine replacement therapy, the consumption of the nicotine is on the rise. Nicotine is considered to be a safer alternative of tobacco. The IARC monograph has not included nicotine as a carcinogen. However there are various studies which show otherwise. We undertook this review to specifically evaluate the effects of nicotine on the various organ systems. A computer aided search of the Medline and PubMed database was done using a combination of the keywords. All the animal and human studies investigating only the role of nicotine were included. Nicotine poses several health hazards. There is an increased risk of cardiovascular, respiratory, gastrointestinal disorders. There is decreased immune response and it also poses ill impacts on the reproductive health. It affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms which leads to cancer. It also affects the tumor proliferation and metastasis and causes resistance to chemo and radio therapeutic agents. The use of nicotine needs regulation. The sale of nicotine should be under supervision of trained medical personnel.

Background: Caesarean section is a time honoured approach which was introduced in clinical practice as a lifesaving procedure both for the mother and the baby. The study was to compare the cesarean delivery rates over last 7 years and to examine the indications contributing to changed trends, if any. Methods: To compare the rate and indications of cesarean delivery over last 7 years. Data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2009, 2012, 2015, in the Department of Obstetrics and Gynaecology at Jhalawar Medical College, Jhalawar, Rajasthan, India. The rate and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate. Repeat caesarean delivery rate increased from 24.66/1000 live births in 2009 to 46.56/1000 live births in 2015. FD, scar tenderness, NPOL mainly contributed to it. Results: The cesarean delivery rate increased from 149.33/1000 live births in 2009 to 234.03/1000 live births in 2015, with an increase in primary cesarean delivery rate from 124.66/1000 live births in 2009 to 187.46/1000 live births in 2015. Fetal distress, non-progression of labor, obstetric indications contributed to this increase. Conclusions: There is significant increase in the total cesarean rate with primary cesarean due to fetal distress accounting for most of the increase.

Smart antenna is one of the fastest emerging technologies. An antenna array is a set of individual antennas that are used for transreceiving the electromagnetic signals. In this paper weighting method is used to control the behaviour of the array along with sidelobe cancellation techniques. Three basic algorithms that are Kaiser-Bessel, Blackman and Gaussian are used to find the array weights. As a result an array factor of amplitudes 1, 0.6561, 0.2521 with side lobes which are being cancelled to yield maximum directional beam.

Areca nut is widely consumed by all ages groups in many parts of the world, especially south-east Asia. The objective of this review is to systematically review and collate all the published data that are related to the systemic effects of areca nut. The literature search was performed by an electronic search of the Pubmed and Cochrane databases using keywords and included articles published till October 2012. We selected studies that covered the effect of areca nut on metabolism, and a total of 62 studies met the criteria. There is substantial evidence for carcinogenicity of areca nut in cancers of the mouth and esophagus. Areca nut affects almost all organs of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It causes or aggravates pre-existing conditions such as neuronal injury, myocardial infarction, cardiac arrhythmias, hepatotoxicity, asthma, central obesity, type II diabetes, hyperlipidemia, metabolic syndrome, etc. Areca nut affects the endocrine system, leading to hypothyroidism, prostate hyperplasia and infertility. It affects the immune system leading to suppression of T-cell activity and decreased release of cytokines. It has harmful effects on the fetus when used during pregnancy. Thus, areca nut is not a harmless substance as often perceived and proclaimed by the manufacturers of areca nut products such as Pan Masala, Supari Mix, Betel quid, etc. There is an urgent need to recognize areca nut as a harmful food substance by the policy makers and prohibit its glamorization as a mouth freshener. Strict laws are necessary to regulate the production of commercial preparations of areca nut.

Introduction: There is a saying that “cancer cures smoking” as people often quit tobacco after diagnosis of cancer. Very few studies have analyzed the change in tobacco habits of a user after diagnosis of cancer in a relative or friend. Materials and Methods: In this cross-sectional study, 161 friends and relatives of 40 patients treated at Tata Memorial Hospital, Mumbai, India, were interviewed. They were given a questionnaire related to their tobacco habits. The results were analyzed statistically using Wilcoxon signed-rank test and Mann–Whitney test using SPSS. Results: Of the studied individuals, 114 were friends and 47 were blood relatives. 141 used smokeless tobacco, 18 were smokers, and 2 consumed tobacco in both the forms. The mean frequency of tobacco consumption among the friends and relatives before diagnosis of cancer was 12.24 per day and that at the time of interview was 9.76 per day. 35 persons (21.7%) stopped consumption whereas 19 (11.8%) reduced usage after diagnosis of cancer. The difference in mean consumption at median duration of 174 days is statistically significant (P = 0.0005). Conclusions: The diagnosis of tobacco-related cancer has significant impact on the tobacco consumption of friends and relatives. The abstinence rate is comparable to that of various tobacco deaddiction therapies in vogue.

Background: To study indications, intraoperative and postoperative complications and fetomaternal outcome in cesarean sections done at full dilatation.Methods: This is a prospective cross-sectional study which was conducted in the department of obstetrics and gynecology, RNT medical college, Udaipur from November 2018 to April 2019. 100 cases of caesarean sections at full dilatation which were performed during this period were analyzed for indications and maternal and fetal morbidity.Results: Among these 100 cesarean sections, majority of cases were in the age group of 21-30 years (46%), booked and Primigravida(81%).Most common indications were cephalo-pelvic disproportion (27%) and fetal distress (21%). Most commonly baby was delivered either by vertex (44%) or by Patwardhan (31%). Intraoperative complications were higher in terms of hematuria in 41%, Atonic PPH in 35%, uterine incision extension in 28% of cases. In one case bladder injury was noticed. Increased incidence of post-operative febrile illness and wound infection were noted. 44% baby’s required nursery admission, most commonly due to birth asphyxia (16%) and RDS (11%).Conclusions: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity, Neonatal morbidity and mortality. So proper monitoring during labor and involvement of skilled obstetrician in decision making and delivery is crucial to minimize fetomaternal complications.

Background: Abnormal uterine bleeding (AUB) is a common clinical presentation in gynecology. Alteration in thyroid hormones level has been associated with menstrual disturbances. This study is aimed to know the prevalence of thyroid disorders amongst AUB patients and also the different patterns of menstrual abnormalities associated with thyroid disorders.Methods: 100 Patient of clinically diagnosed AUB were taken from gynecology OPD at RNT Medical College Udaipur from October 2019 to March 2019. All the patients from 19 to 45 age groups presenting with menstrual disturbances were tested for thyroid function by measuring ST3, ST4, and S.TSH. Statistical analysis done by percentage formula.Results: Out of 100 women of AUB, majority were in the age group of 31-40 years (38%). 44% presented with menorrhagia. 65% were euthyroid, 17% had subclinical hypothyroidism, 15% had overt hypothyroidism and 3% were diagnosed as hyperthyroid. Subclinical hypothyroidism, overt hypothyroidism and hyperthyroidism were detected mostly in the age group of 31-40 years. The commonest bleeding abnormalities in hypothyroid patient were oligomenorrhoea while most of the hyperthyroid cases were having menorrhagia.Conclusions: The study concludes that biochemical evaluation of thyroid function is an easy, reliable method and should be made mandatory in all cases of AUB.

Background: Maternal weight gain is one of the most important independent predictors of infant birth weight. It is stated that under nutrition during pregnancy and low birth weight increase the risk for diabetes and cardiovascular disease in adulthood. Normal weight gain of pregnancy 11kg weight gain should be according to pre-pregnancy BMI. Patients with BMI > 25 should gain weight of 7kg patient with normal BMI should gain 11kg weights.Methods: This is a hospital based prospective study and was conducted in the Department of Obstetrics and Gynaecology, RNT Medical college Udaipur from November 2018 to March 2019 to find association between maternal weight gain and birth weight. Exclusion criteria included congenital malformations, multiple pregnancy, polyhydraminos, preeclampsia, diabetes, cardiovascular, kidney disease, RH negative pregnancy. Results were calculated by percentage.Results: excessive weight gain during pregnancy increases baby weight. Out of total 100 cases, 88 (88%) cases are Hindus and 12 (12%) cases are Muslims. Out of total 100 cases 72 cases (72%) belong to urban, 28 (28%) belong to Rural area. Out of 100 patients 32 patients gain weight less than 11kg among which 16 newborn have weight less than 2.5kg, 68 patients have weight gain more than 11kg and 67 have baby weight more than 2.5kg.Conclusions: Excessive maternal weight gain during pregnancy increases birth weight. In view of the apparent association between high birth weight and adult adiposity, an advantageous time to initiate obesity prevention efforts may be during pregnancy.

Oral cancer (ICD-10:C00-C08) is now a significant health issue in many parts of the world due to widespread use of tobacco, alcohol, and areca nut [1, 2]. According to GLOBOCON 2012, oral cancer is the 17th most common cancer in the world with about 300,373 new cases and 145,353 deaths in 2012 which is expected to rise to 406,022 and 197,811, respectively, by 2025 [3]. This cancer effects both the developed and developing countries but there is wide global difference in the incidence of this cancer (~20 fold) [2]. It is more common in South Asia (e.g., India, Sri Lanka, Pakistan, Taiwan), Latin America (e.g., Brazil, Uruguay, Puerto Rico and Cuba), Eastern Europe (e.g., Hungary, Slovenia, Slovakia), Western Europe (e.g., Germany, France), and Pacific regions (e.g., Papua New Guinea) [2]. It is the most common cancer among males and overall the 3rd most common cancer in India with age-standardized rate (ASR) of 7.2 but contributes highest to the number of new cases annually [3, 4].

Head neck squamous cell carcinomas (HNSCCs) are a significant cause of morbidity and mortality all around the world. Just like tobacco and alcohol, Human papilloma virus (HPV) infection is now recognized to play a role in the pathogenesis of a subset of HNSCCs. Unprotected sexual behaviours with the HPV carrier plays an important role in transmission of this virus. The global incidence of head and neck cancers is declining, but the incidence of HPV related head and neck cancers is rapidly increasing over the last few decades. However, most institutions do not mandate documentation of sexual history or counselling of patients regarding sexual practices like they do for tobacco and alcohol addictions in HNSCC patients. The aim of this review of literature is to analyse if there is a strong evidence to correlate oral sex with HPV related HNSCC and counsel the patient’s regarding sexual behaviours.

OBJECTIVES In India, a 2003 law ("COPTA") banned tobacco advertising with the exception of "point of sale" and "on-pack" advertising. Given substantial evidence regarding the impact of point of sale advertising (PoS), we analyzed the prevalence of encountering such advertising in Mumbai, India. METHODS A survey was conducted of 199 current and recent former tobacco users recruited at the Tata Memorial Hospital (Mumbai). Enrollees were queried regarding their exposure to tobacco advertising in the last 30 days through multiple media sources. Descriptive epidemiologic techniques were used to characterize the data. RESULTS Overall, 95% of participants were men and 5% were women (mean age=49 years). All were current tobacco users or quit using all forms of tobacco in the last 60 days. Participants' responses revealed that PoS tobacco advertising had been encountered in the last 30 days for cigarettes (61%), bidis (54%), and smokeless tobacco (59%). Other forms of tobacco advertising were virtually non-existent. CONCLUSIONS PoS tobacco advertising remains prominent and highly visible to consumers in Mumbai, India, indicating corporate exploitation of a loophole in the COPTA legislation. Given the observed compliance with the currently imposed bans, revisions of COPTA to include all forms of tobacco promotion and advertising would be impactful.

The submandibular gland is responsible for 70% to 90% of unstimulated saliva production. Its excision causes a decrease in basal salivary flow resulting in increased symptoms of subjective xerostomia and decreased quality of life. In this study, we have tried to assess the pattern of nodal metastasis in relation to the submandibular gland. With this study, we have tried to find out whether submandibular gland preservation is a viable option in patients with carcinoma of the oral cavity.This was a prospective study conducted in a tertiary care cancer center. The fibrofatty tissue surrounding the submandibular gland was divided into 6 parts depending upon its location with the submandibular gland. All these 6 parts along with the submandibular gland were separately sent for histopathological analysis. Metastasis pattern in level Ib region was noted.The study included 137 patients with carcinoma of the oral cavity who underwent neck dissections. Eighty-five patients had clinic-radiologically N0 neck, 52 patients had cN+ (clinically node positive) neck. Level Ib was involved in 8.2% of the cases with cN0 (clinically node negative neck). In patients with cN+ neck, level Ib metastasis was seen in 40% of the cases. Metastasis in N0 necks in the area deep to the submandibular gland was seen in only 1 case (9% of all pathologically node-positive patients) with cN0 neck. This was the only case in which submandibular gland mobilization would have been required to take out the metastatic node. Even in cases with N+ neck, deep metastasis was seen in 4 cases only (14.8%). None of them had a primary tumor in the tongue. Therefore, there is a possibility of preserving the submandibular gland in cases of carcinoma of the tongue.Involvement of level Ib in early tongue cancers is not very common and direct metastases to the submandibular glands are rare. Even when metastasis is present in level Ib, it can be excised without affecting the submandibular gland. In early tongue lesions, submandibular gland mobilization for dissection at level Ib is not required as no metastases deep to the submandibular glands were seen in these patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Background: The aim of this study was to compare the efficacy and safety of iron sucrose with oral iron in the treatment of iron deficiency anemia of pregnancy.Methods: An interventional comparative study was conducted at Jhalawar Medical College, Jhalawar involving 80 pregnant women with iron deficiency anemia from March 2016 to August 2016. Inclusion criteria were gestational age between 24-32 weeks with established iron deficiency anemia, with hemoglobin between 7-10g/dl. Target Hemoglobin was 11 g/dl. In intravenous iron sucrose group iron sucrose dose was calculated from following formula: total iron dose required (mg) = 2.4 x body weight in Kg x (target Hb – Patient’s Hb g/dl) + 500. In oral iron, group patient received ferrous-sulphate 335 mg daily BD. Hb level were reviewed at 2, 4, 6 weeks.Results: Change in Hemoglobin level from baseline significantly higher in IV iron group than oral iron group. In IV iron, group mean value of baseline Hb was 8.07±0.610 g/dl and in oral iron group was 8.48±0.741 g/dl. At the end of 6-week mean hemoglobin in IV iron sucrose was 10.66±0.743 g/dl and in oral iron group was 10.08±0.860 g/dl.Conclusions: Intravenous iron sucrose elevates more Hb than oral iron, with less adverse effects.

Objective: To assess the severity of acute toxicities of postoperative adjuvant therapy on oral squamous cell carcinoma (OSCC) patients with and without submucous fibrosis (SMF). Materials and Methods: The study population comprised treatment naïve OSCC patients who underwent curative intent surgical resection from June 2010 to April 2011 followed by adjuvant treatment. Patients whose treatment details including toxicity profile were available were included in the study. One-hundred nine patients met the inclusion criteria of whom 36 had associated SMF and 73 no SMF. Overall, 35 patients received chemotherapy (CT) with radiotherapy (RT) and the rest only RT. Forty-two patients had centralized and 67 lateralized lesions. All patients with centralized lesions and 3 with lateralized lesion received radiation to bilateral face and neck. All others received ipsilateral radiation. The severity of mucositis, xerostomia, and skin toxicity (as per radiation therapy oncology group scale of acute toxicity) was compared between the SMF and non-SMF groups and patients with centralized and lateralized lesions. Results: CT in addition to RT did not add significant to the assessed toxicities. Severe mucositis as well as treatment breaks were more in SMF group as compared to non-SMF group (P = 0.001 and

Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. It is widely available and used by all the sections of the Indian society. It is genotoxic as it increases sister chromatin exchange and chromatin aberrations. Among humans, it is a leading cause of oral submucous fibrosis that often progresses to oral cancer. Among experimental animals, it leads to neoplastic lesions in lung, liver and stomach. It is hepatotoxic leading to increased level of enzymes, deranged carbohydrate and lipid metabolism. It is harmful to kidneys and testes leading to increased creatinine and sperm deformities respectively. PM is a very harmful substance affecting almost all organ systems, and there is immediate need for a national policy on complete ban on the production, storage, sale and marketing of PM.