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Abstract: The oral microbiome has long been considered a measure of overall systemic health. It is often significantly altered in case of chronic inflammation or any other systemic infection. Therefore, a shift in oral microbiota and oral health is bound to be observed in diabetics infected with the coronavirus. The prognosis of COVID-19 in a diabetic individual is often worse than that in a healthy individual. The increased pathogenicity of coronavirus in diabetics is due to the peculiar ways in which it interacts with specific physiological mechanisms in a diabetic patient and vice versa. Diabetes Mellitus Type-II (DM -II) is one of the most frequently associated co-morbidities in a COVID-19 patient, and therefore it is even more pertinent that their interrelationship is understood. It is essential to recognize the above-mentioned interactions and consider their implications while treating susceptible patients. This article attempts to review and summarize the said vital interactions. Additionally, it attempts to guide and prepare oral health professionals on what to expect and how to treat diabetic patients in a future where coronavirus is, as unfortunate as it is, a regularity and not a rarity.

Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

Objectives: To identify potential candidate proteins which are secretory in nature and present at a higher abundance in oral cancer patients with tobacco habits. Methods: Conditioned media of tobacco-treated and -untreated non-neoplastic oral keratinocytes were analyzed using iTRAQ-based mass spectrometry. Hypersecreted proteins; SPARC (osteonectin), cwcv and kazal like domains proteoglycan 1 (SPOCK1); prosaposin (PSAP); and protein tyrosine phosphatase, receptor type S (PTPRS) were validated by enzyme-linked immunosorbent assay (ELISA) using saliva samples from oral cancer patients who are tobacco users. Results: Proteomic analysis of tobacco-treated and -untreated cells led to the identification of 2873 proteins. Among these, 378 proteins showed high abundance and 253 proteins showed low abundance (2-fold cutoff) in conditioned-media of tobacco-treated cells. ELISA-based validation showed significantly higher levels of SPOCK1, PSAP, and PTPRS in oral cancer patients with tobacco chewing habits compared to healthy controls. However, PSAP showed low specificity compared to SPOCK1 and PTPRS. Conclusions: This study indicates significantly increased levels of SPOCK1, PSAP, and PTPRS in saliva of oral cancer patients with tobacco habits. These protein biomarkers might be useful to identify tobacco users with high risk of developing oral cancers.

Aim Thermoplastic immobilization devices are used in head and neck radiotherapy to increase precision of treatment delivery. However, there is concern about increase in radiation induced skin morbidity with the use of such devices. This study was conducted with an aim to evaluate any increase in clinically observed skin reactions with the use of thermoplastic immobilization devices. Materials and methods Fifty patients of head and neck cancers undergoing radical radiotherapy were randomized into two study groups in this prospective randomized study. Group ‘A’ received treatment with thermoplastic immobilization device. Group ‘B’ received treatment without any immobilization device. A weekly assessment of normal tissue reactions was done using Radiation Therapy Oncology Group (RTOG) acute radiation acute radiation morbidity scoring criteria. Results Increase in skin reactions was seen in patients using thermoplastic devices. Grade 3 reactions were seen in 56 vs 52% in the study and control group respectively. The difference was however not statistically significant (p = 0.09). Conclusion Increase in skin dose with use of thermoplastic immobilization devices may not clinically translate into a significant increase in acute skin reactions. Thermoplastic immobilization devices can be safely used in head and neck cancers to ensure accurate radiation delivery. How to cite this article Bahl A, Ghosal S, Kapoor R, Bhattacharya T, Sharma SC. Clinical Implications of Thermoplastic Mask Immobilization on Acute Effects of Radiotherapy in Head and Neck Cancers. J Postgrad Med Edu Res 2012;46(4):187-189.

Breast carcinoma is one of the commonest malignancies in women, however metastatic involvement of the breast is extremely rare. The lymphomas and other neoplasms of hematological origin are the most common extra-mammary malignancies that may metastasize to the breast. Medullary carcinoma of the thyroid rarely metastasizes to the breast. It is important to accurately differentiate a metastatic lesion from a primary malignancy in the breast to avoid unnecessary surgical procedures and to implement an appropriate systemic therapy. We report the mammographic, ultrasonographic and color Doppler findings of an unusual case of medullary thyroid carcinoma metastatic to the breast with clinico-pathological correlation.