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Ayurveda is the ancient Indian system of health care and longevity. It involves a holistic view of man, his health and illness. Even though dentistry was not a specialised branch of Ayurveda, it is included in Shalakya Tantra. Oral diseases continue to be a major health problem worldwide. Oral health also reflects body health. For prevention and treatment of oral diseases modern medicine has limited success. Ayurveda is good alternate for that and may lead to novel preventive or therapeutic strategies for oral health. This 500 years old system of medicine not only recommends treatment with specific herbs and minerals to cure oral diseases but also recommends some daily use therapeutic procedures for the prevention of and maintenance of oral health. Recently there is grown interest in use of ayurvedic drugs for oral health and proper hygiene. Ayurveda herbs and natural products have been used for their pharmacological applications, wound healing, anti-inflammatory, antimicrobial, antioxidant properties have been proven to be safe and effective for oral disease and hygiene including various therapeutic ayurvedic procedures. Key words: Oral health, Oral diseases, Ayurvedic herbs.

The biological production of nanoparticles has taken center stage among the various generation methods available owing to its environment-friendly characteristics and reduced energy requirements. A protocol for pigment-assisted silver nanoparticle (AgNP) synthesis was established, employing an extracellular composite pigment produced by the Ascomycota Talaromyces purpurogenus (presently Talaromyces purpureogenus). The extracellular pigment can reduce the precursor silver salt into nanoparticles in the presence of sodium hydroxide and light. Transmission electron microscopy may be used to characterize the bio-generated nanoparticles, which can also be tested for their biological properties using antimicrobial and anticancer assays.

Background: Nimotuzumab is an anti-epidermal growth factor receptor monoclonal antibody which can be added to chemoradiotherapy (CRT) to improve efficacy for management of locally advanced squamous cell carcinoma of the head and neck (LASCCHN). We prospectively evaluated the efficacy and safety of nimotuzumab with CRT for LASCCHN and compared with CRT alone. Materials and Methods: In this prospective study, 29 LASCCHN (Stage III–IVb) patients received Nimotuzumab plus CRT or CRT alone. Treatment included six cycles of cisplatin (40–50 mg/week) or carboplatin (area under the curve-based), nimotuzumab (200 mg/week), and radiotherapy (60–70 Gy). Tumor response was evaluated as per response evaluation criteria in solid tumors criteria. MoS was estimated using the Kaplan–Meier method. Toxicity and adverse events (AE's) were assessed as per CTCAE v 4.0. Results: At 24 weeks after completion of treatment, the tumor response rate (complete response, partial response, stable disease) was 53.3% and 35.7% favoring nimotuzumab arm while progression of disease was 40% and 35.7% in Nimotuzumab plus CRT and CRT groups, respectively. However, the objective response rate was 57% and 30% in favor of nimotuzumab arm. At median follow-up of 45.5 months, MoS was 33 months in Nimotuzumab plus CRT and 27 months in CRT group. The 5-year survival rate was 33.3% in Nimotuzumab plus CRT versus 7.1% in CRT group. Nimotuzumab was observed to be safe with no additional AE's such as hypersensitivity, hypomagnesemia, and allergic reaction was reported. Conclusion: Addition of Nimotuzumab to standard CRT showed improved survival rate in unresectable, LASCCHN patients without producing additional toxicity.

Long-term local control is possible in a highly radio-responsive tumor-like carcinoma of the nasopharynx, even in the recurrent setting. High-dose-rate brachytherapy boost with its steep dose fall-off helps achieve salvage by providing optimal dose coverage to the tumor volume which is in close anatomic proximity to critical structures at the base of the skull. Here, we report the case of a 58-year-old lady, an old case of carcinoma nasopharynx presented with recurrence of symptoms in the form of nasal blockade along with a right pre-auricular swelling. Further evaluation showed an fluorodeoxyglucose-avid nasopharyngeal mass, a biopsy from which was positive for nasopharyngeal carcinoma (NPC). She first received re-radiation with external beam radiotherapy using 6 MV photons to the face and neck along with concurrent chemotherapy with cisplatin followed by brachytherapy boost with Rotterdam’s Brachytherapy Applicator @5 Gray×2# 1 week apart. Brachytherapy is a feasible tool that allows dose escalation to achieve long-term tumor control in locally advanced NPCs.

Cervical carcinoma is one of the commonest cancers affecting women in the low- and middle-income countries. The standard treatment of locally advanced cases by external beam radiotherapy (EBRT) along with single-agent cisplatin-based concurrent chemotherapy is effective, but rates of treatment failure and recurrence remain high. There exists a need to augment the treatment protocol. One modality to do that is by addition of another radiosensitizer/chemotherapeutic agent. In total, 40 women with histologically proven locally advanced cervical cancer were included in the study. The first 20 (Arm 1) were treated with EBRT along with concurrent cisplatin at 40 mg/m2 (maximum 70 mg). The next 20 patients (Arm 2) received the same treatment but also received oral capecitabine 460 mg/m2 during EBRT. Treatment-related toxicity and disease response rates at 6 months were compared in the two arms. Overall survival at 5 years of patients in the two arms was also compared. During treatment, 40% of patients in Arm 1 developed anemia compared to 45% in Arm 2. In total, 5% patients in Arm 1 and 10% in Arm 2 developed grade 2 leucopenia. A higher incidence of proctitis and diarrhea was seen in Arm 2 (30%) than in Arm 1 (15%). The grade of proctitis and diarrhea was also higher in Arm 2 than in Arm 1. None of the patients developed hand-foot syndrome. All the complications were managed symptomatically and did not cause significant treatment break in either treatment arms except in one patient in Arm 2. At 6-month follow-up, four patients (20%) in both arms had residual or progressive disease. At the end of 5 years, the mean overall survival in the two Arms 1 and 2 was 47.9 and 48.4 months, respectively. The addition of capecitabine to standard concurrent chemoradiotherapy with cisplatin for locally advanced cervical cancer is well tolerated even on an OPD basis though there is increased incidence of acute proctitis and diarrhea with this combination. No difference in treatment efficacy or improvement in survival between the two protocols was seen in our study though this may have been influenced by the small sample size and short period of follow-up of our study. We recommend a phase II/III study to further evaluate the efficacy and tolerability of this regimen.

Purpose: Approximately one-third of patients attending the tertiary care center require palliative management. The purpose of this study was to investigate the role of palliative radiation in alleviating the pain and symptoms and improvement in quality of life (QOL). Methods: This was a prospective study aimed to evaluate patients attending two oncology centers and those who require palliative radiation. During 3 years, 1365 patients attended radiation oncology center for various malignancies. Of these patients, 304 patients were treated with palliative radiation for various indications. These patients were followed up for a period of up to 6 months for symptom relief and improved QOL. Results: About 22% of patients received palliative radiation primarily for carcinoma lung, breast, and prostate malignancy. Analysis revealed elderly patients in the age group of 50–70 being the most commonly affected and most common presentation was pain, swelling, and headache. The most common site of metastases was bone including the spine and brain. Most commonly employed schedule of palliative radiation was 30 Gy in 10 fractions and 20 Gy in 5 fractions. Patients responded well to palliative radiation and had improved pain relief and QOL. Conclusions: Palliative radiation is an important part of the management of cancer care and when given improves QOL, and significant pain relief.

Background: With increase in the footfall to mountainous areas for occupational and recreational purposes, tackling the burden of high-altitude illnesses is a growing public health challenge. High-altitude pulmonary edema (HAPE) is a serious medical condition with peculiar epidemiological characteristics. HAPE is a significant cause of morbidity and mortality among Indian soldiers posted to high-altitude areas. Aims and objectives of the study were to study the common clinical presentation of HAPE among Indian army soldiers and to study the association between induction patterns and acclimatization status with the onset of HAPE.Methods: An observational study was undertaken to study the clinical and epidemiological characteristics of all cases of HAPE from years 2016 to 2019, among Indian army soldiers posted to high-altitude areas in Ladakh. Diagnosis was made by the Lake-Louise consensus criteria. Data was entered in Microsoft Excel and descriptive and inferential statistical tools were applied to test for associations between the variables studied.Results: The overall incidence rate of HAPE was found to be 5.91 per 1,000 soldiers with high frequency among young men. Breathlessness, cough, and headache were the common complaints. 69.45% of cases occurred among men who revisited the mountains after a brief sojourn to the plains. At higher altitudes, incidence rates were higher among acclimatized individuals.Conclusions: HAPE occurs more frequently during the subsequent visits compared to first exposure to high altitude. At extreme altitudes, acclimatization protocols do not confer complete protection against HAPE.

Context: Gliomas are a heterogeneous group of relatively rare cancers that have an important public health-care implication due to their high levels of mortality and morbidity. While standard management guidelines are available, their implementation in a resource-limited scenario needs greater scrutiny. Settings and Design: This is a retrospective analysis of disease characteristics, treatment parameters including the time to imaging and time to treatment, and overall survival (OS) at 1 and 5 years in patients of brain gliomas. Subjects and Methods: Demographic, clinical, and follow-up data of histologically proven glioma patients that received radiotherapy (RT) between 2009 and 2013 at two tertiary care hospitals of India were collected and analyzed. Statistical Analysis: Kaplan–Meier curves were used to compare OS at 12 and 60 months. Cross-tabulation and Pearson's Chi-square test were used to study the association of study variables with survival. Results: One hundred and nine patients were included. The mean age was 45 years and males were three times as common as females. Astrocytomas were the most common histology with Grade IV astrocytomas comprising 48% of the total. The OS at 12 and 60 months was 79.8% and 24%, respectively, for the entire cohort. The average time taken for brain imaging from onset of symptoms was 24 days, while the time to surgery and the time to start RT were 18 and 44 days, respectively. Old age and ability to tolerate treatment were shown to affect survival at 1 year from diagnosis, though tumor histology and grade had an apparent impact on long-term prognosis. Conclusions: Hospital registries are an important source of demographic and clinical information on less common cancers such as gliomas. Increasing awareness among the general public and sensitization of primary health-care apparatus are critical for early diagnosis and treatment.

Nanoscience has induced a profound revolution in all industrial domains, notably in the food and electronic industries. The food industry has constantly augment the quality, shelf life, safety and traceability of products. This has led to development of nanomaterials for food packaging and nanosensors to detect contaminations. Nanomaterials are to develop ‘improved’, ‘active’ and ‘intelligent food packaging. Nanomaterials have also been conjugated with biobased polymers to develop environmentally friendly nanocomposites. This article review nanopackaging of food with emphasis on carbon nanotubes, nanosensors, nanowires, nanolaminates, nanocomposites, nanocrystals, biobased fillers for nanocomposite, and antimicrobial nanoparticles.

This study reports a facile, cost effective, nontoxic and eco-friendly method for the synthesis of gold nanoparticles. In this paper, leaf extract of Mentha piperita was successfully used to reduce chloroauric acid, leading to synthesis of gold nanoparticles (AuNPs). The synthesized nanoparticles were further characterized by UV-visible spectroscopy, Fourier transform infrared spectroscopy, dynamic light scattering, transmission electron microscopy and field emission scanning electron microscopy. Kinetics studies like effect of volume of leaf extract, precursor, pH, temperature for the synthesis of AuNPs were studied spectrophotometrically. Synthesized AuNPs were found to possess hexagon structure where size of nanoparticles was ~78nm in diameter. These biologically synthesized AuNPs exhibited significant activity against cancerous cell lines MDA-MB-231 and A549 and was compared with the normal 3T3-L1 cell line. Anti-inflammatory and analgesic activities were studied on a Wistar rat model to gauge the impact of AuNPs for a probable role in these applications. AuNPs gave positive results for both these activities, although the potency was less as compared to the standard drugs. These results suggested that the leaves extract of Mentha piperita is a very good bioreductant for the synthesis of AuNPs and have potential for various biomedical and pharmaceutical applications.

In recent years, green syntheses have been researched comprehensively to develop inexpensive and eco-friendly approaches for the generation of nanoparticles. In this context, plant and microbial sources are being examined to discover potential reducing agents. This study aims to utilize an extracellular pigment produced by Talaromyces purpurogenus as a prospective reducing agent to synthesize silver nanoparticles (AgNPs). Biosynthesized AgNPs were characterized by transmission electron microscopy (TEM), dynamic light scattering (DLS), electron probe micro analyser (EPMA), and zeta potential. The pigment functional groups involved in the generation of AgNPs were investigated using Fourier transform infrared spectroscopy. TEM images showed that the generated nanoparticles were spherical, hexagonal, rod-shaped, and triangular-shaped with a particle size distribution from 4 to 41 nm and exhibited a surface plasmon resonance at around 410 nm. DLS and zeta potential studies revealed that the particles were polydispersed and stable (&minus, 24.8 mV). EPMA confirmed the presence of elemental silver in the samples. Biosynthesized AgNPs exhibited minimum inhibitory concentrations of 32 and 4 &mu, g/mL against E. coli and S. epidermidis, respectively. Further, cytotoxicity of the AgNPs was investigated against human cervical cancer (HeLa), human liver cancer (HepG2), and human embryonic kidney (HEK-293) cell lines using 5-fluorouracil as a positive control. A significant activity was recorded against HepG2 cell line with a half-maximal inhibitory concentration of 11.1 &mu, g/mL.

Background: The incidence of oropharyngeal carcinoma is increasing despite decline in the incidence of head and neck cancers of other sites. Functional organ preservation with minimal toxicity and better survival is the management goal in oropharyngeal cancers (OPCs). Morbidity of surgery favors radiotherapy as primary modality in OPCs. Here, we have reviewed and analyzed various prognostic factors and results of conventional radiotherapy in patients treated at our institute with two-dimensional planning. Materials and Methods: The records of 70 patients who were treated radically with radiotherapy with or without concurrent chemotherapy from January 2014 to May 2018 were analyzed in our institute. Results: The median age was 61.5 years with male:female ratio of 6:1. History of tobacco use was present in 83%. Stage IVA comprised the bulk with 63% of cases. Eighty-one percent of the patients received concurrent cisplatin. Median disease-free survival at 1 and 5 years was 71.4% and 54.3%, respectively. Median overall survival at 1 and 5 years was 74.3% and 60%, respectively. Conclusion: Varied patient-related, tumor-related, and treatment-related factors determine the clinical severity and tumor stage and help in predicting survival in oropharyngeal carcinoma.

Introduction: Oral cavity cancer is the third most common cancer in India. It presents a major burden on health services in India due to the widespread and rampant use of tobacco. Moreover, as per the Indian Council of Medical Research 2016 data, it ranks the fifth in overall mortality rate among different cancers prevalent in India. Aims and Objectives: The aim was to study and present our data on patient- and tumor-related factors as well as overall survival (OS) among patients of oral cavity cancer treated with surgery and radiotherapy at our center. The objective was to find the difference in OS in various subgroups of patients at 2 and 5 years from treatment. Materials and Methods: This was a retrospective study carried out in a tertiary care center of North India. The data collected were of patients treated between November 12 and November 16. A total of 112 cases of oral cavity cancers were studied. The patient-related variables that were analyzed included age, gender, history of tobacco or alcohol use, and presence of preexisting comorbidities. The tumor-related factors that were studied were tumor subsite, stage, and histological grade. OS of patients with varying parameters was compared at 2 and 5 years. Results: OS at 5 years for Stage I was 100% and decreased to 85% for Stage II. For Stages III and IV, the 5-year survival was a mere 43% and 42%, respectively. Conclusion: Treatment results at our center were comparable to world literature.

Background: Brain metastases are a major cause of mortality and morbidity in cancer patients and are seen as a terminal event in the natural course of disease. Whole-brain radiotherapy (WBRT) has remained the most commonly used treatment for multiple metastases. Although it provides symptomatic relief, the effects have low durability and local failure is common. Stereotactic radiosurgery (SRS) techniques such as Gamma Knife have been shown to be as effective as surgery in control of limited (1–3) metastases. Aim: The aim of this is to study the role of SRS boost after WBRT in patients of 1–3 brain metastases. Objective: (1) To compare the survival of patients with 1–3 brain metastases treated with WBRT with versus without SRS boost. (2) To compare the duration of functional independence (FI) and normal neurocognitive function (NNF) posttreatment in the patients belonging to the two groups. Materials and Methods: Twenty-six patients with 1–3 brain metastases received WBRT to a dose of 30 Gy in 10 fractions. Half the patients (13) were also given an SRS boost of 16–20 Gy by the Gamma Knife technique. All patients were followed up at twelve weekly intervals for a period of 9 months and assessed for survival, FI (Karnofsky Performance Status Score (KPS) >60%) and NNF (Hindi Mental Status Examination Score >24). Results: At 9 months, the median survival in the SRS boost group was 27 weeks compared to 22 weeks in the no boost group. The mean duration of FI and NNF was 24 and 12 weeks in the boost and nonboost groups, respectively. The differences between two groups were not statistically significant. Conclusions: Although results are not significant, a definite trend toward improvement in median survival, FI, and neurocognitive function in patients who received an SRS boost after WBRT is seen.

Nabeel Ahmad,1 Sharad Bhatnagar,1 Syed Salman Ali,2 Rajiv Dutta3 1School of Biotechnology, 2School of Pharmaceutical Sciences, IFTM University, Lodhipur Rajput, Moradabad, Uttar Pradesh, India; 3Institute of Bio-Science and Technology, Shri Ramswaroop Memorial University, Barabanki, Uttar Pradesh, India Abstract: Synthesis of nanomaterials holds infinite possibilities as nanotechnology is revolutionizing the field of medicine by its myriad applications. Green synthesis of nanoparticles has become the need of the hour because of its eco-friendly, nontoxic, and economic nature. In this study, leaf extract of Rosa damascena was used as a bioreductant to reduce silver nitrate, leading to synthesis of silver nanoparticles (AgNPs) in a single step, without the use of any additional reducing or capping agents. The synthesized nanoparticles were characterized by the use of UV-visible spectroscopy, fourier transform infrared spectroscopy, dynamic light scattering, transmission electron microscopy, and field emission scanning electron microscopy. Time-dependent synthesis of AgNPs was studied spectrophotometrically. Synthesized AgNPs were found to possess flower-like spherical structure where individual nanoparticles were of 16 nm in diameter, whereas the agglomerated AgNPs were in the range of 60–80 nm. These biologically synthesized AgNPs exhibited significant antibacterial activity against Gram-negative bacterial species but not against Gram-positive ones (Escherichia coli and Bacillus cereus). Anti-inflammatory and analgesic activities were studied on a Wistar rat model to gauge the impact of AgNPs for a probable role in these applications. AgNPs tested positive for both these activities, although the potency was less as compared to the standard drugs. Keywords: silver nanoparticles, green synthesis, anti-inflammatory, analgesic, animal model study, antibacterial

The use of large metal on metal bearings has led to a reduction in the risk of dislocation post hip arthroplasty. Because of this, and also because of the technical difficulties associated with resurfacing surgery in particular, it could be argued that a less meticulous approach to acetabular cup placement has developed in comparison with conventional metal on polyethylene arthroplasty. Resurfacing cups may produce significant clinical problems when placed at the extremes of version, including increased production of metal debris and psoas tendonitis. Presented in this article is evidence that EBRA software (Einzel-Bild-Roentgen-Analysis, University of Innsbruck, Austria) can be used to reliably assess the version of resurfacing cups, when radiographs are of sufficient quality. The cups have characteristic appearances when placed at the extremes of version. These characteristics can allow the surgeon to identify poorly positioned cups without the use of software.

Cutaneous T-cell lymphoma (CTCL) is the most common primary cutaneous lymphoma but rarely encountered. It is often misdiagnosed with allergic or infectious dermatological conditions and is usually a diagnosis of exclusion. The subsets of CTCL primarily consist of CD4 + and CD30 + lymphoproliferative disorders including mycoses fungoides. Herein, we report a case of CD 8 + ve CTCL stage IA that was previously misdiagnosed with cutaneous tuberculosis with no response to antitubercular therapy. After a confirmatory diagnosis of CTCL with multiple sites involved, he was treated with definitive local radiotherapy alone and had a complete response to treatment with no recurrence at 5 year's follow-up.

Background: The treatment of end-stage osteonecrosis of the femoral head remains a challenge to the orthopaedic surgeon. Historically, total hip arthroplasty for this condition has been associated with poor rates of survival and function when compared with total hip arthroplasty for the treatment of osteoarthritis. The purpose of this study was to determine the medium-term clinical and radiographic results of metal-on-metal hip resurfacing arthroplasty in patients with end-stage osteonecrosis of the femoral head. Methods: From June 1994 to March 2004, a consecutive single-surgeon series of seventy-three hip resurfacing procedures were performed in sixty patients for the treatment of end-stage osteonecrosis of the femoral head. The cohort included forty-two men (ten of whom had a bilateral resurfacing) and eighteen women (three of whom had a bilateral resurfacing). The mean age was forty-three years (range, seventeen to sixty-nine years). A clinical and radiographic review was performed. Results: There were four revision operations and one planned revision of the seventy-three hips during the follow-up period. Two of these revisions were necessitated by aseptic failure of the femoral component. This represents an overall survival rate of 93.2% at a mean of 6.1 years of follow-up (range, two to twelve years). Conclusions: On the basis of this study, metal-on-metal resurfacing of the hip for osteonecrosis can be considered a safe and effective form of surgery for this group of patients. Longer-term follow-up is required to confirm the expected continued success of this form of arthroplasty in this difficult-to-treat population. Level of Evidence: Therapeutic Level IV. See Instructions to Authors on [jbjs.org][1] for a complete description of levels of evidence. [1]: http://jbjs.org