Indian Journal of Occupational and Environmental Medicine (Indian J Occup Environ Med) 2018 | September-December | Volume 22 | Issue 3

Occupational health surveillance Damodar Vishnu Lele Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120, Occupational health surveillance Damodar Vishnu Lele Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120 The untold story of fluoridation: Revisiting the changing perspectives Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127 The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.  Occupational and environmental exposure to lead and reproductive health impairment: An overview Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137 Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction.  Upper extremity muscular strength in push–pull tasks: Model approach towards task design Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143 Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.  Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151 One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.  The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress Roberto Menicagli, O Marotta, L Menicagli Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155 Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde.  Impact of school air quality on children's respiratory health Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162 Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.  Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation Amitava Pal, Prakash C Dhara Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169 Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators.  A comparative study of byssinosis in jute industries Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176 Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers.  Nipah virus: South India in panic mode Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178

The untold story of fluoridation: Revisiting the changing perspectives Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127 The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.

Occupational and environmental exposure to lead and reproductive health impairment: An overview Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137 Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction.

Upper extremity muscular strength in push–pull tasks: Model approach towards task design Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143 Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.

Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151 One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.

The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress Roberto Menicagli, O Marotta, L Menicagli Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155 Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde.

Impact of school air quality on children's respiratory health Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162 Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.

Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation Amitava Pal, Prakash C Dhara Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169 Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators.

A comparative study of byssinosis in jute industries Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176 Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers.

Nipah virus: South India in panic mode Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178

Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome

Abstract

Purpose

To evaluate phenotypic changes of various immune cells in the peripheral blood in the patients with sleep apnea/hypopnea syndrome (OSAHS).

Methods

This is a case–control study. The peripheral venous blood was collected. A subset of T cells, B cells, natural killer cells, and dendritic cells was analysed using various markers and flow cytometry. Regression curve analysis was made to examine the correlation between the change of immune cells and aponea hypoxia index (AHI) and oxygen desaturation.

Results

The percentage of CD3⁺/CD4⁺ T lymphocytes (P < 0.001) and CD19⁺ B cells (P < 0.001) and the CD4⁺/CD8⁺ ratio (P < 0.001) in the OSAHS patients were significantly increased compared with those in the control group without OSAHS, and CD4⁺/CD8⁺ ratio positively correlated with aponea hypoxia index (r = 0.37, P < 0.001) but negatively correlated with the lowest SaO₂ (r = − 0.2, P < 0.001), whereas a greater reduction in the percentage of CD3⁺/CD8⁺ T cells (P < 0.001). Moreover, the ratios of CD3⁺/CD16⁺/CD56⁺ natural killer (NK)-like T cells (P < 0.05) and CD3⁻/CD16⁺/CD56⁺ NKT cells (P < 0.001) were significantly lower in the OSAHS group than those in the control group. However, no significant difference was observed in the percentage of CD3⁺ total T cells, CD8⁺/CD28⁺ T cells, CD8⁺/CD28⁻ T cells, DC1, DC2, and DC1/DC2 dendritic cells between the OSAHS and control groups.

Conclusion

Our study showed differential responses of various types of immune cells in the peripheral blood in patients with OSAHS and their correlation with severity of oxygen desaturation.

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Table of contents

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Masthead

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“Five‐point eight‐line” anatomic flap design for precise hemitongue reconstruction

Abstract

Background

Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes.

Methods

Hemitongue specimens were obtained from minipigs to study the three‐dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty‐one patients were randomly enrolled into the following two groups: a "five‐point eight‐line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups.

Results

All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05).

Conclusions

The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.

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Clinical Thyroidology® for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Higher iodine intake in the mother during pregnancy is associated with higher child IQ. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^® for the Public – Highlighted Article appeared first on American Thyroid Association.

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Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective

To report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110dB at 2000 or 4000Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear.

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Tislelizumab in Combination With Chemotherapy as First-Line Treatment in Adults With Inoperable, Locally Advanced or Metastatic Gastric, or Gastroesophageal Junction Carcinoma

Condition:   Gastric, or Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Tislelizumab (BGB-A317) combined with oxaliplatin and capecitabine or Tislelizumab (BGB-A317) combined with Cisplatin and 5-FU;   Drug: Placebo combined with oxaliplatin and capecitabine or Placebo combined with Cisplatin and 5-FU
Sponsor:   BeiGene
Not yet recruiting

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Cell Death and Differentiation

• 
  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

  Posted:2018-12-13

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells, Published online: 13 December 2018; doi:10.1038/s41418-018-0245-x

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

• Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

  Posted:2018-12-13

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2, Published online: 13 December 2018; doi:10.1038/s41418-018-0247-8

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

• Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

  Posted:2018-12-13

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation, Published online: 13 December 2018; doi:10.1038/s41418-018-0254-9

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

• Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

  Posted:2018-12-13

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective, Published online: 13 December 2018; doi:10.1038/s41418-018-0253-x

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

• By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

  Posted:2018-12-11

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737, Published online: 11 December 2018; doi:10.1038/s41418-018-0244-y

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

• The proneural gene <i>ASCL1</i> governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene <i>NDRG1</i>

  Posted:2018-12-11

  The proneural gene ASCL1 governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene NDRG1

  The proneural gene <i>ASCL1</i> governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene <i>NDRG1</i>, Published online: 11 December 2018; doi:10.1038/s41418-018-0248-7

  The proneural gene ASCL1 governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene NDRG1

• Mutant p53 as a guardian of the cancer cell

  Posted:2018-12-11

  Mutant p53 as a guardian of the cancer cell

  Mutant p53 as a guardian of the cancer cell, Published online: 11 December 2018; doi:10.1038/s41418-018-0246-9

  Mutant p53 as a guardian of the cancer cell

• A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

  Posted:2018-12-05

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer, Published online: 05 December 2018; doi:10.1038/s41418-018-0242-0

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

Egyptian Rheumatology and Rehabilitation (Egypt Rheumatol Rehabil) 2019 | January-March | Volume 46 | Issue 1

Intra-articular injection of platelet-rich plasma and therapeutic exercise in knee osteoarthritis Mona E. M Badr, Eman A. R Hafez, Atif I El-Ghaweet, Heba M El-Sayed Egyptian Rheumatology and Rehabilitation 2019 46(1):1-10 Context There is no definite treatment strategy capable of decreasing destruction of cartilage and enhancing its healing. Intra-articular injection of platelet-rich plasma (PRP) provides a lot of growth factors that are capable of stimulating regeneration of cartilage and is supposed to be a future solution to patients with osteoarthritis (OA). Aim To detect the efficacy of intra-articular injection of PRP or therapeutic exercise (Ex) alone as well as a combination of both in the treatment of idiopathic knee OA. Settings and design A prospective randomized controlled clinical study was conducted. Patients and methods A total of 60 patients, 44 to 65 years of age, having idiopathic unilateral knee OA were included in the study and were divided into three groups: PRP group included 20 patients and were treated with intra-articular PRP injection, Ex group included 20 patients and were treated with only therapeutic Ex, and PRP and Ex group included 20 patients who were treated with both PRP intra-articular injection and therapeutic Ex. Evaluation of all patients was done by visual analogue scale, tenderness, range of motion, thigh circumference, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at baseline and 1 and 6 months later. Objective evaluation was done through MRI of osteoarthritic knee at baseline and 6 months later. Statistical analysis Statistical analyses were performed using SPSS for windows, version 20.0. Results Baseline WOMAC score differences among the three groups were not statistically significant but were significant 6 months after treatment. In PRP and Ex groups, there was a significant improvement after treatment, whereas a highly significant improvement in PRP+Ex group. MRI grading differences among the three groups were not significant before or after treatment, with no improvement in all three groups after treatment. Conclusion A combination of intra-articular injection of PRP and therapeutic Ex resulted in significantly lesser visual analogue scale, WOMAC score, and joint tenderness compared with PRP or Ex alone.

Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis Samia M Abd El-Monem, Ahmed Y Ali, Nashwa I Hashaad, Ahmed M Bendary, Hend A.F Abd El-Aziz Egyptian Rheumatology and Rehabilitation 2019 46(1):11-20 Aim The aim was to detect specific ECG changes in rheumatoid arthritis (RA) patients as well as to study atherosclerotic changes of the carotid arteries as an indicator of cardiovascular system risk factors and to correlate findings with disease activity and severity parameters to elucidate possible associations between these variables. Patients and methods This study included 30 RA patients, 30 age-matched and sex-matched systemic lupus erythematosus patients and 30 age-matched and sex-matched healthy volunteers as control groups. The patients were subjected to clinical examination, assessment of disease activity score-28 (DAS28), functional disability Health Assessment Questionnaire, and laboratory and radiological assessments. ECG and measurement of the carotid intima media thickness (CIMT) by carotid ultrasound scan was also done. Results Ten (33.3%) RA patients had ECG abnormalities, with ST or T-wave abnormality being the most common abnormality present. RA patients had the highest frequencies of ECG abnormalities. Most ECG changes occurred in RA patients using steroids (90%). ST or T-wave abnormality in RA occurred more in patients with a higher swollen joint count, higher DAS28, and a higher patients’ global health assessment. RA patients had the highest mean. The mean CIMT was significantly higher in RA patients with ECG abnormalities. There were significant positive correlations of average CIMT with DAS28, Health Assessment Questionnaire, and Simple Erosion Narrowing Score. There were significant positive correlations of mean CIMT with the level of triglycerides, cholesterol, high-density lipoprotein, erythrocyte sedimentation rate, and a highly significant correlation between mean CIMT and C-reactive protein. CIMT at a cut-off point of 0.75 mm can predict ECG abnormalities with high sensitivity and specificity. Conclusion ECG changes were present in 33.3% of RA patients. Increased CIMT was observed in RA patients and correlated well with disease activity and severity parameters.

The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury Shereen Fawaz, Fatma Kamel, Ahmed El Yasaky, Heba El Shishtawy, Ahmed Genedy, Reda M Awad, Lobna El Nabil Egyptian Rheumatology and Rehabilitation 2019 46(1):21-26 Background Functional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI. Purpose Our randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs. Patients and methods Our study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential). Conclusion Our study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.

Electromyographic study to predict functional outcome of transforaminal epidural steroid injection in lumbosacral radiculopathy Hussein Sultan, Tamer H Shehata, Wafaa S El-Emary, Shehad M Fakhry Egyptian Rheumatology and Rehabilitation 2019 46(1):27-34 Context Epidural steriod injections (ESIs) are commonly used for managment of lumbosacral radiculopathy (LSR). Predicting outcomes after ESIs could be another valuable application of needle electromyography (EMG) in these patients. Aim The aim was to determine if EMG study can predict the functional outcome of transforaminal ESIs in patients with LSR. Materials and methods The study included 20 patients with clinical diagnosis of LSR. Peripheral nerve conduction study, late responses, somatomsensory evoked potentials, and needle EMG were performed in both lower limbs followed by transforaminal ESI under fluoroscopic guidance. The functional outcome was evaluated using visual analog scale for pain and Oswestry disability index (ODI) that were performed before and after injections. Results There were statistically significant decrease in pain severity (visual analog scale; P=0.022) and in ODI (improvement in functional score; P=0.029) after injection in patients with symptom duration less than 3 months compared with patients with longer duration of symptoms. In patients with negative EMG findings, there was a significantly greater reduction in pain severity (P<0.01) and ODI score (P<0.01) after injection compared with patients with positive findings. Regression analysis showed that negative needle EMG findings were significant predictors of pain reduction (P=0.001) and functional improvement (P=0.002) in patients with LSR after ESI. Conclusion This study supports the notion that EMG studies can be used for prediction of functional outcome in patients with LSR performing transforaminal ESI.

Body, wrist, and hand anthropometric measurements as risk factors for carpal tunnel syndrome Mohamed H Imam, Marwa M Hasan, Rehab A ELnemr, Riham H El-Sayed Egyptian Rheumatology and Rehabilitation 2019 46(1):35-41 Aim The aim of this study was to identify cut-off values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS). Patients and methods This study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cut-off values, sensitivity, and specificity were calculated separately for each measured parameter. Results There were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS. Conclusion The cut-off values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS.

Importance of patient education in management of patients with rheumatoid arthritis: an intervention study Soha H Senara, Wafaa Y Abdel Wahed, Shimaa E Mabrouk Egyptian Rheumatology and Rehabilitation 2019 46(1):42-47 Background People living with chronic diseases such as rheumatoid arthritis (RA) are extremely in need of patient education (PE) to adapt and cope with the effects of the disease and treatments. PE comprises all educational activities provided for patients, including aspects of therapeutic education, health education, and health promotion. Objective The aim of this study was to evaluate the effect of PE program following the eight evidence-based EULAR-2015 recommendations in the management of patients with RA. Patients and methods A randomized controlled clinical trial with two parallel arms was carried out at the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Fayoum University, Egypt. One hundred patients (both sexes) having RA were included in the study, and their mean age was 39.23±11.28 years, with range from 19 to 71 years. Patients were randomly allocated into two comparable groups: group I received health education through designed PE program and group II did not receive PE program. Disease activity and disability were assessed at the start of study and at two visits later, that is, after 3 months and 6 months, by using the 28 joint disease activity score 28 and the Health Assessment Questionnaire disability index. Results On comparing laboratory investigation and outcome scores at follow-up visits, although there were no significant differences between the two study groups regarding laboratory investigation, disease activity score 28 and Health Assessment Questionnaire scores at the start of the study, comparative differences were reported in the follow-up visits. Significant decreases in the laboratory values and scores were reported in group I, whereas no difference was reported in group II. Conclusion PE interventions in patients with RA documented significant improvements in behavior, pain, and disability among these patients.

Depression in patients with chronic low back pain N Nassar, N Assaf, D Farrag, D Ibrahim, A Al-Sheekh Egyptian Rheumatology and Rehabilitation 2019 46(1):48-54 Background Low back pain is a common health issue affecting at least 80% of individuals during their lifetime. It is usually recurrent and develops into chronic low back pain (CLBP). In chronic pain, psychosocial risk factors become relevant, and may explain how individuals respond to pain. CLBP is often comorbid with depression. Aim The aim of this study was to detect if there is an association between depression and functional disability in patients with CLBP. Patients and methods This cross-sectional, descriptive preliminary study included 50 patients with CLBP. Pain intensity was measured using visual analogue scale (VAS), functional disability was measured using the Oswestry Disability Index (ODI), and depression assessment was done using Beck depression inventory (BDI) questionnaire II. Results The mean age of the patients was 43.66±13.96 years. Mean scores for VAS, ODI, and BDI were 5.38±2.42, 18.66±7.26, and 22.40±9.20, respectively. A strong positive correlation was found between VAS and each of ODI and BDI (r=0.797 and 0.515, respectively; P=0.000). Similarly, a positive significant linear relation was detected between degree of disability by ODI and severity of depression by BDI (P=0.039). Conclusion Depression strongly influences pain intensity and degree of disability in patients with CLBP. Screening and early management of depression is essential for reducing pain and disability associated with CLBP.

Comparative study between platelet-rich plasma injection and steroid injection in mild–moderate shoulder osteoarthritis and their relation to quality of life Dalia Salah Saif, Deena Mamdouh Serag, Mohamed Ahmed El Tabl Egyptian Rheumatology and Rehabilitation 2019 46(1):55-61 Context Osteoarthritis (OA) is a degenerative joint disorder that causes joint pain and stiffness. Platelet-rich plasma (PRP) is considered a recent effective line of management of OA. Aims To compare the effect of local injection of PRP versus steroid in shoulder OA and their relation to quality of life. Patients and methods This study included 50 patients with mild–moderate OA shoulder diagnosed according to Samilson and Prieto grading system of shoulder OA and were recruited from the outpatient clinic of physical medicine, and rehabilitation, Faculty of Medicine, Menoufia University Hospital, in the period between 2017 and 2018. The study included both sexes. Group I included 25 patients who were injected intra-articularly with PRP in the affected shoulder, and group II included 25 patients who were injected with triamcinolone acetate. They were evaluated by Western Ontario Osteoarthritis Shoulder index and visual analogue scale before and after injection. Statistical analysis A descriptive and analytic study by SPSS, version 16, on IBM compatible computer was done. Results There was a highly statistical significant difference between preinjection and postinjection parameters regarding Western Ontario Osteoarthritis Shoulder score and visual analogue scale in both groups, with more improvement in the PRP group. Conclusion Intra-articular injections with PRP and steroids are effective less-invasive lines of shoulder OA treatment, with superiority to PRP owing to more persistence of its effects.

Comparison between the roles of musculoskeletal ultrasound and magnetic resonance imaging in detection of joint inflammation and destruction in rheumatoid arthritis Sherihan M Salama Egyptian Rheumatology and Rehabilitation 2019 46(1):62-69 Background Detection of early signs of synovitis and bone erosions by modern radiological techniques such as musculoskeletal ultrasound (US) and MRI has gained a great interest, as early diagnosis and treatment to target for patients of rheumatoid arthritis (RA) has its impact on disease control. Aim The aim of the following study is to detect the ability of US compared with MRI for the early detection of joint synovitis and bone erosion in RA patients. Patients and methods Six hundred joints (second to fifth metacarpophalangeal joints and second to fifth proximal interphalangeal joints) were examined in 50 patients with RA diagnosis. Clinical assessment, noncontrast MRI, US, and conventional radiography were performed for synovitis and bone erosion evaluation. Results and conclusion We concluded that both US and MRI had high ability to detect inflamed joints with close agreement but favoring the US, especially with the added value of power Doppler US where it can reflect increased vascularity associated with inflammation and also with higher scores for these affected joints than that shown by MRI. On the other hand, the study has found that although both US and MRI had high ability to detect erosions with close agreement, the MRI favorably had higher scores for joint erosions compared with the scores shown by US.

Journal of The Egyptian Society of Nephrology and Transplantation (J Egypt Soc Nephrol Transplant) 2018 | October-December | Volume 18 | Issue 4

Relation of wnt-signaling antagonist sclerostin to valvular calcification and carotid intimal-medial thickness in hemodialysis patients Ghada El-Said, Mohamed AbdAlbary, Ahmed Bahi, Rash R Elzehry, Ghada El-Kannishy Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):103-111 Introduction Sclerostin (Scl) is a Wnt pathway antagonist and is considered to have a role in the bone-vascular axis in patients with chronic kidney disease. However, there is a paucity of data on the relation of circulating serum Scl and valvular calcifications (VCs) in chronic kidney disease and hemodialysis (HD) patients. The present study aimed to evaluate the relationship between serum Scl level and cardiac valve calcification (CVC) as well as carotid intimal-medial thickness (CIMT) in HD patients. Patients and methods This cross-sectional study included 75 HD patients in Mansoura Nephrology and Dialysis Unit. Patients with age older than 75 years, rheumatic valvular disease, cardiomyopathy, prosthetic valves, ischemic heart disease, and carotid artery surgery were excluded. Echocardiogram calcification scores were used to assess the degree of aortic and mitral valve calcification. CIMT was measured using B-mode ultrasonography. Patients’ basic clinical and biochemical data were recorded. Serum Scl level was measured using commercially available enzyme-linked immunosorbent assay kits before HD sessions. Results CIMT (>0.9 mm) was present in 68% of the patients. Double-valve calcification (aortic and mitral) was present in 72% of the patients and 21.3% of the patients had single-valve calcification. Serum Scl level was significantly higher in studied HD patients than normal healthy control (P=0.05). There was a significant negative correlation between serum Scl level and degree of cardiac valve calcification as well as with CIMT. Multiple linear regression analysis revealed that age was the strongest predictor for CIMT in HD patients. Conclusion Cardiac valve calcification and increased CIMT were prevalent in HD patients. Serum Scl level was strongly related to both CVC and CIMT, and it may be considered as one of the calcification modulators in HD patients.

Risk factors, clinical manifestations, and outcomes of Pneumocystis jirovecii infection in post-renal transplant recipients Jitesh Jeswani, Suraj Godara, Chandani Bhagat Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):112-115 Introduction Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. A timely diagnosis of PJP is difficult and relies on clinical features, imaging, and detection of the organism. The aim of this study was to evaluate the risk factors, clinical presentation, and outcomes for 15 patients who developed PJP infection. Patients and methods A retrospective clinical study included all 578 kidney transplant patients who underwent kidney transplantation at the Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. Of the 578 patients, 15 patients developed PJP infection. Results The median age of all recipients was 55.3 years. The mean duration of prophylaxis was 6.9 months (range: 3–9 months). Only one patient had cytomegalovirus infection, and eight patients had a history of graft rejection. Most of our patients had fever and cough as the presenting symptoms, and all patients had breathlessness on admission. Bilateral haziness seen on chest radiograph was present in seven patients, and 10 patients had bilateral ground-glass appearance on high-resolution computed tomography scan. PCR finding for PJP was positive in all patients. Mortality was seen in four patients, where all the four cases had received anti-rejection therapy with ATG. Conclusion We concluded that among renal transplant recipients, PJP can still occur several months after transplantation, late after prophylaxis discontinuation. Treatment with anti-rejection therapy appears to be the major risk factor for PJP in these patients.

Predictive value of novel biomarkers for acute kidney injury in critically ill patients at Assiut University Hospitals Effat A.E Tony, Hatem H.M Maghraby, Shady Y Gayed, Ayat A Sayed Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):116-125 Introduction Acute kidney injury (AKI) is a clinical problem in critically ill patients, which is associated with adverse outcomes. There is a persistent need to find reliable biomarkers for the early diagnosis and prediction of AKI. Many genes are upregulated in the damaged kidneys, with the subsequent protein products appearing in the urine. Urinary liver-type fatty acid-binding protein (uL-FABP) and urinary kidney injury molecule-1 (uKIM-1) are among the promising upregulated biomarkers. Aim To assess the ability of uL-FABP in comparison with kidney injury molecule-1 for early prediction of AKI in adult critically ill patients. Patients and methods A cohort study was conducted enrolling 100 critically ill patients admitted to medical critical care units (CCUs) who had risk factors for developing AKI. Acute Physiology and Chronic Health Evaluation II score was calculated on admission. Serum creatinine was measured on admission and thereafter daily till the seventh day of CCU stay. Urine samples for uL-FABP and uKIM-1 assay were collected at the time of CCU admission, on day 3, and on day 5. Results Among critically ill patients, 60% had AKI diagnosed mostly on the second (53.3%) and third (40%) day of CCU admission. There was a significant difference in Acute Physiology and Chronic Health Evaluation II score (P<0.001), and duration of CCU stay (P<0.01) between AKI and non-AKI groups. The mean baseline of uKIM-1 was significantly higher in patients with AKI (7.17±1.56 ng/ml) compared with those without AKI (3.01±0.85 ng/ml; P=0.01). A significant high baseline uL-FABP level in patients with AKI was 168.51±45.98 (P<0.001). The area under the receiver operating characteristic curves of uKIM-1 and uL-FABP levels at the time of admission for prediction of AKI in critically ill patients within the first 7 days of their stay were 0.95 and 0.78, respectively, with a better predictive performance of uKIM-1 than uL-FABP. Conclusion UKIM-1 was a sensitive and specific biomarker (superior to uL-FABP) for the prediction of AKI in critically ill patients.

Spectrum of biopsy-proven kidney diseases at a tertiary care hospital in South India Sanjeev S Manjunath, Chettypunyam S Chetan, Chaandrashekar Manoj, Satish Suchitha, Krishnamurthy K Kiran, Gangadhar Chirag Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):126-129 Introduction The prevalence of kidney diseases, glomerular and tubulointerstitial, varies with the geographical area, socioeconomic conditions of the people, population demographics, race and ethnicity, access to health care, and also the threshold for doing a renal biopsy. Objective The primary objective was to study the prevalence of biopsy-proven kidney diseases presenting to a tertiary care hospital in Mysore, South India. Patients and methods We have retrospectively analyzed the renal biopsy data from 2005 to 2013. The clinical and laboratory data of patients were collected from biopsy request forms, and histopathology data were recorded. Biopsy specimens were examined by light and immunofluorescence microscopy. As a hospital policy, all biopsies were based on definite indications. A total of 1113 biopsies were considered. Transplant biopsies and those with inadequate specimen were excluded. Results A total of 914 patients had some kind of glomerulopathy. Minimal change disease (n=182/1113) was the commonest histological type among glomerular diseases, followed in order by postinfectious glomerulonephritis, focal segmental glomerular sclerosis, membranous glomerulopathy, and immunoglobulin A nephropathy. Among the secondary glomerular diseases, the commonest was diabetic nephropathy (n=72) followed by lupus nephritis (n= 58) and crescentic glomerulonephritis. Most common indication for renal biopsy was nephrotic syndrome (n=274/1113), chronic kidney disease (n=141), acute glomerulonephritis (n=107), acute kidney injury with unclear etiology or delayed recovery, and rapidly progressive glomerulonephritis. Conclusion Nephrotic syndrome was the commonest indication for renal biopsy, and minimal change nephrotic syndrome (MCNS) was the most common glomerular disease followed by focal segmental glomerular sclerosis. Membranoproliferative glomerulonephritis, the incidence of which has decreased in the developed world, still accounts for a significant number in our population. There is a need for electronic data monitoring in India with nationwide integration for a proper analysis of the changing trends of diseases occurring over an extended time frame.

Cognitive disorders in chronic kidney disease and hemodialysis patients Ahmed S El Belbessi, Iman E El Gohary, Hesham A Sheshtawi, Mona M Abdulmoneim Mohamed Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):130-136 Introduction Cognitive impairment (CI) is common in individuals with chronic kidney disease (CKD) and among those treated with hemodialysis (HD). It may jeopardize treatment adherence by affecting the efficiency of every-day tasks, including correct medication and dietary rules. The severity of CKD is associated with the severity of CI, independent of age, education, and other key confounders. It is important to identify those patients with CI to reduce the considerable morbidity associated with this condition and improve their quality of life. Objectives The aim of the present study is to assess cognitive functions in patients with chronic renal diseases and patients on regular HD and to identify CI in these patients. Patients and methods A total of 30 patients with CKD were recruited from the outpatient clinic of Alamerya General Hospital (group I), and 30 HD patients were enrolled in the dialysis unit of the Alamerya General Hospital (group II). Moreover, 30 sex-matched and age-matched patients were recruited as controls (group III). Montreal Cognitive Assessment (MoCA) and Depression Anxiety Stress scale-21 were used as cognitive and neurological tests. Result The mean executive functions score was significantly lower in group II (2.37±0.67) in comparison with group I (3.33±0.48), with a P value less than 0.001, and it is also significantly lower in groups I and II in comparison with the control group (3.90±0.31), with a P value of 0.002 and less than 0.001, respectively. The mean attention score was significantly lower in group I (4.20±0.81) and group II (4.23±0.94) in comparison with the control group (5.27±0.69), with a P value of less than 0.001. The mean memory score was significantly lower in group I (3.10±0.40) and group II (2.57±0.90) in comparison with the control group (4.47±0.73), with a P value of less than 0.001. The mean total MoCA test score was significantly lower in group II (22.87±1.68) in comparison with group I (24.27±1.26), with a P value of less than 0.017, and it is also significantly lower in groups I and II in comparison with the control group (28.33±1.47), with a P value of less than 0.001. Conclusion Impaired renal function affects total MoCA score in the studied groups.

A study of comparison of clinical assessment of substituted frailty versus performance-based frailty in patients on maintenance hemodialysis program funded by cashless government scheme Priyadarshini John, Manjusha Yadla, Sailaja Singiri Journal of The Egyptian Society of Nephrology and Transplantation 2018 18(4):137-143 Introduction Frailty is common in patients on maintenance dialysis.The common methods used to assess Frailty include questionnaires,Frailty index.SF-36 is a commonly used questionnaire to assess quality of life.SF-36 in modified version may be used as substituted Frailty index.Whether Frailty can be assessed with the substituted frailty index is not clear. We tried to compare the two methods of assessment of Frailty with Performance based Frailty and Substituted Frailty to analyse the better index of assessment in patients on maintenance dialysis. Aim The aims were to compare frailty using two different methods of assessment in patients on maintenance hemodialysis and to determine the utility of substituted frailty as screening tool for assessment of frailty. Patients and methods We studied frailty in patients on maintenance hemodialysis using two different methods of assessment. Fried frailty index is performance based and is inconvenient to assess in every patient. In a search to find an alternative, we came across another method of evaluation using physical function (PF) component in SF-36 score. We studied quality of life in these patients using SF-36 questionnaire. PF in SF-36 scale was used as a substitute for gait speed and grip strength, which are the components in the original frailty index. The other components like unintentional weight loss, physical inactivity and physical exertion were the same in both the methods of assessment. Substituted frailty (Fsubs)=PF score on SF-36, unintentional weight loss greater than 4.5 kg, physical exhaustion, and physical inactivity. Performance-based frailty/measured frailty (Fmeas)=weight loss greater than 4.5 kg, physical exhaustion, low physical activity, handgrip strength assessment, and gait speed. Results A total of 117 (78%) patients reported frailty based on self-assessment (substituted frailty, Fsubs) and 136 (90.6%) patients had frailty on performance-based frailty index using Fried frailty index (Fmeas). Overall, 28 (18.6%) patients had performance-based frailty only and did not report the symptoms suggestive of frailty. Age and sex were not significantly different among the groups. In our study, we observed the sensitivity of Fsubs (substituted frailty) was 79.5%, specificity was 35.7%, and accuracy was 75.3%. Positive predictive value of Fsubs was 92.30% and negative predictive value was 15.15%. Conclusion Substituted frailty may be a useful screening modality to identify frailty in patients on maintenance hemodialysis.

The Journal of Indian Association of Physiotherapists (Physiother - J Indian Assoc Physiother)

Expanding the horizon of physiotherapy profession Sanjiv Kumar Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):49-52

Cognition and quality of life in older adults Dhara Abhinav Sharma, Megha Sandip Sheth, Disha Janak Dalal Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):53-57 BACKGROUND: According to the recent report by the Ministry of Statistics in India, number of elderly accounts for 8.6% of the country's population. Aging causes biological as well as psychological changes. Decline in cognitive functions is one of the normative changes of aging; however, this may impact both physical and mental health of an individual. Quality of Life (QoL) is one of the prime features of successful aging. Hence, this study was undertaken to correlate the level of cognition and QoL in older adults. METHODOLOGY: One twenty-nine males and females of age 60–75 with or without cognitive impairment were selected using convenience sampling, those who could not read Hindi, who had any unstable medical condition, whose vision could not be corrected to normal level, and those with impaired speech were excluded from the study. Montreal cognitive assessment (MoCA) was administered to assess the cognitive level. QoL was assessed by QoL-Alzheimer's disease (AD) scale. RESULTS: Result indicated that there is a moderate positive correlation between MoCA and QoL-AD with r = 0.465 and P < 0.05. CONCLUSION: The study concludes that the level of cognition and QoL of older adults are moderately in positive correlation with each other.

Reaction time in sitting and standing postures among typical young adults MN Anitha, Vijay Raj V Samuel Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):58-62 CONTEXT: Reaction time (RT) is one of the important components of physical fitness. Evaluation of RT is vital to understand and plan a training program. There is a need to comprehend the normative values of RT in young adults in different functional postures, which will enable the clinician to plan the fitness program effectively. AIMS: The aim of this study was to observe the RT in sitting and standing postures among typical young adults. SETTINGS AND DESIGN: This was an observational study. SUBJECTS AND METHODS: Sixty-five young Indian men and women students from a college at Mysore were included in the study. The participants' dominant hand was used to assess the RT in standing and sitting postures with their dominant hand. With the given distance, the RT was then calculated using standard conversion formulae. STATISTICAL ANALYSIS USED: The RT between standing and sitting was analyzed using mean, standard deviation (SD), and paired t-test. RESULTS: The RT analyzed for 22 men in sitting showed excellent RT with a mean 0.1188 (SD 0.0455) and 0.0929 (SD 0.0385) in sitting and standing postures, respectively. Women (n = 43) in sitting had a good RT with a mean of 0.1401 (SD 0.0314) and in standing an excellent RT with a mean of 0.1092 (SD 0.0323). Men had better performance when compared with women, both in standing and sitting postures. Paired test for standing and sitting showed significant difference with t value of 5.364 and P < 0.005, with reduced RT in standing. CONCLUSIONS: The study concludes that the RT is comparatively reduced in standing than in sitting among the young adults.

Comparative effects of Stratified Back care approaches in individuals with nonspecific low back pain Bashir Bello, Muhyiddeen Suleiman Bichi Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):63-72 BACKGROUND: Stratified Back care is a recently developed method for treating low back pain. PURPOSE: This study compared the effects of two stratified care approaches (sub-grouping for targeted treatment [STarT] and specific treatment of the problems of the spine [STOPS] in patients with nonspecific low back pain [NSLBP]). MATERIALS AND METHODS: Forty-six individuals, with NSLBP, participated in this single-blinded, randomized clinical trial. Participants were randomly assigned into one of the two groups: STarT Back Group (n = 23) or STOPS group (n = 23). Treatment was applied twice weekly for 8 weeks. Outcomes assessed pre- and post-interventions were pain intensity (PI) using numeric pain rating scale and functional disability (FD) using the Oswestry Disability Index. Participants in both groups were comparable in age (44.65 ± 9.03 vs. 46.40 ± 7.39) years. At baseline, PI, FD, and anthropometric values were comparable in both groups. RESULTS: The Results showed a significant difference in PI between the STarT and STOPS with a mean difference of −1.24 and 95% confidence interval (−0.86 to −0.04), P < 0.05, with no significant difference in FD, P > 0.05 between the groups. However, there was a significant difference within each group in pain and FD with P < 0.05. CONCLUSION: It was concluded that STarT Back approach was more effective in reducing PI only than STOPS approach in individuals with NSLBP.

Enhancing professionalism in physiotherapy interns using a structured teaching and assessment module Mariya Jiandani, Amita Mehta Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):73-78 INTRODUCTION: Professionalism describes the skills, competency, attributes, and behavior of an individual belonging to a profession. The physiotherapy graduate on completion of internship has direct access with the community as a professional. Hence, there is a need to explicitly teach and assess professionalism. The purpose of this study was to prepare a module to enhance professionalism and use tools to assess the professional attributes uniformly. MATERIALS AND METHODS: A module was formulated with the help of experts, literature review, and guidelines of various physiotherapy regulatory bodies nationally and internationally. Focused group discussions were used as a method to identify competencies. After designing the module, a prospective intervention trial was conducted wherein 40 students who joined the internship program of a tertiary care hospital of India, were enrolled for the study. A participatory approach was used which included an interactive workshop on “ethics in clinical practice, communication skills, and professionalism.” A written pre-post evaluation and workplace-based assessment were carried out in four core physiotherapy areas. Competencies and attributes were measured using tools such professional mini-evaluation exercise (P-MEX), prevalidated checklist for clinical reasoning, patient feedback form, and a retro-preevaluation of self-assessment form of the American Physical Therapy Association. RESULTS: A total of 34 students completed the module. Data were analyzed using SPSS 16 software. Nonparametric Wilcoxon Signed Rank test was used to analyze the descriptive data. The statistical significance was kept at P < 0.05 at a confidence interval of 95%. There was a statistically significant increase in the knowledge component pre-post analysis (P < 0.00). Change in professional attributes as measured by P-MEX showed a significant change in Doctor-patient relationship (P < 0.01) and interprofessional skills (P < 0.001) followed by reflective skills (P < 0.007) and time management skills (P < 0.003). There was also a significant difference in total patient feedback scores from baseline (P < 0.01). CONCLUSION: The module helped students gain the knowledge and skills required to communicate and handle difficult situations relevant to physiotherapy practice.

Cross-cultural adaptation, reliability, validity, and factor analysis of the Gujarati version of the Tampa scale of kinesiophobia in chronic low back pain Dibyendunarayan Dhrubaprasad Bid, A Thangamani Ramalingam, Saumi R Sinha, Payal B Rathi, Vidhi N Patel, Jainab M Rajwani, Krutika N Patel Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):79-86 BACKGROUND: Nowadays more attention is being given to standardizing the outcome measures for improving treatment methods for chronic low back pain (CLBP). The Gujarati translation of the Tampa scale of kinesiophobia (TSK) in patients with CLBP has never been validated in the native Gujarati population. PURPOSE: Translating, culturally adapting, and validating the Gujarati version of the TSK-Gujarati (TSK-G) to allow its use for Gujarati-speaking patients with CLBP. MATERIALS AND METHODS: The development of the TSK-G questionnaire involved its translation and backtranslation, a final review by an expert committee, and testing of the pre final version in establishing its correspondence to the original English version. The psychometric testing included reliability by internal consistency (Cronbach's α), test-retest reliability (intraclass coefficient correlation [ICC]), convergent and divergent validity (Pearson's correlation) by comparing TSK-G to a numerical pain rating scale, fear-avoidance beliefs questionnaire (FABQ), the Roland Morris disability questionnaire (RMDQ), and patient health questionnaire-9 (PHQ-9); and factor analysis. RESULTS: Factor analysis indicated a 6-factor 17-item solution (64.07% of explained variance). The questionnaire showed satisfactory internal consistency (0.639) and moderate test-retest reliability (ICC 0.696). Divergent validity showed low correlations with numerical pain rating scale (r = 0.044), the RMDQ-G (r = 0.06), and PHQ-9-G (r = 0.269); but convergent validity showed highly significant correlation with FABQ-G (r = 0.407, P = 0.001). CONCLUSION: The successful translation of TSK questionnaire into the Gujarati language shows good psychometric properties and factorial structure and approximates the results of the current English version of the TSK questionnaire.

Long-term effectiveness of physiotherapy in a case of ankylosing spondylitis Ratan P Khuman Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):88-92 Ankylosing spondylitis (AS) is a relatively uncommon inflammatory arthritis that affects the axial joints. The diagnosis is often missed and markedly delayed. Here, we report a delayed diagnosis of AS in a 47-year-old male, 10 years after the onset of back symptoms, using the modified New York criteria. The objective of this case report is to outline the long-term effectiveness of physiotherapy interventions. The condition was managed with supervised physiotherapy intervention and unsupervised home exercises for 3 months and was followed for 1 year to investigate the long-term effectiveness of the interventions. It was found that the combination of supervised physiotherapy interventions and unsupervised home exercises had promising short term as well as long-term effects without deterioration in AS symptoms with increased patient satisfaction and confidence.

Feasibility of application of constraint-induced movement therapy in a child with hemiplegic cerebral palsy: A single-case study Darshanaben J Tadvi, Vasanthan Rajagopalan Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):93-97 Children suffering from hemiplegic cerebral palsy (CP) develop developmental disregard (DD). In addition, they fail to comprehend the consequences of nonuse. The utility of affected upper limb is jeopardized. Current evidence supports the use of constraint-induced movement therapy (CIMT) for upper limb function in individuals with hemiplegia. This single-case study attempts to identify feasibility of application of pediatric CIMT on a child with hemiplegic CP. The aim of this study is to identify the benefits and feasibility of application of CIMT for improving quality of the upper limb movement in a child with hemiplegic CP. A 2½-year-old girl with hemiplegic CP visited the outpatient department (OPD) with the problem of lack of use of the right upper limb for activities and play along with the poorer quality of the upper limb movement. Disregard index was calculated to identify the presence of DD. CIMT was chosen as the child had above minimal ability to open fingers and extend the wrist. A 2-week intervention was designed based on the goal-oriented, ability-specific, child-specific practice of functional tasks. A rigid tape was used to provide constraint. The child was motivated to play with the affected hand for 2 h in the OPD and 2 h at home. Tasks of incremental difficulty were utilized as shaping method. The improvement in the quality of movement was measured using quality of upper extremity skilled test (QUEST) and Assisting Hand Assessment (AHA). The score on QUEST improved from 66.35 to 72.1, AHA improved from 66 to 73, and the disregard index score improved from 42.75 to 26.3 in 2 weeks. The treatment was adjusted to accommodate the behavior of the child.

Providing cancer rehabilitation services: Are there some guiding principles? Tan Yeow Leng, Saw Hay Mar Physiotherapy - The Journal of Indian Association of Physiotherapists 2018 12(2):98-99

The prognostic impact of pathologic lymph nodes in HPV-positive oropharyngeal cancers

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Margueritta El Asmar, Hua-Ling Tsai, Carole Fakhry, Christopher A. Maroun, Rajarsi Mandal, Drew M. Pardoll, Hao Wang

Abstract

Purpose

Recent pathologic staging of HPV-positive oropharyngeal squamous cell carcinomas (OPSCC) is solely dependent on number of pathologic nodes. Using a large dataset, we aimed to understand how increase in pathologic lymph nodes (LN) associated with overall survival.

Materials and methods

National Cancer Database was queried for HPV-positive OPSCC patients undergoing primary surgery with LN dissection between 2010 and 2013. Kaplan-Meier, univariate and multivariate Cox models were used to evaluate overall survival. Interaction between nodal status and radiotherapy was examined.

Results

Implications of pathologic LN on overall survival differed according to receipt of post-operative radiotherapy (p-value_interaction = 0.008). In patients who did not receive adjuvant radiotherapy, there were no significant differences in risk of death from 0 to 2 pathologic nodes (adjusted HR (aHR) 0.92, 95%CI 0.61–1.4). However, risk increased by 18% on average with each additional LN thereafter (aHR 1.18, 95%CI 1.1–1.27). Among radiotherapy patients, after adjusting for other variables, patients with 1 pathologic LN had 70% lower risk of death than those with 0 pathologic LN (aHR 0.30, 95%CI 0.14–0.64). Thereafter, risk increased on average by 7% with each additional LN (aHR 1.07, 95%CI 1–1.14).

Conclusion

The prognostic impact of pathologic nodes in resected HPV-positive OPSCC differs by receipt of radiotherapy, with better outcomes in post-operative radiotherapy treated patients with one pathologic LN than none. These findings suggest that LN involvement may improve anti-tumor immune responses following radiotherapy, or result in earlier detection and treatment of disease. These results merit further studies to corroborate these findings and establish the underlying mechanism.

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Effect of Red Light Rhinophototherapy on Nasal Patency in Patients with Allergic Rhinitis

Purpose. The effect of red light rhinophototherapy (RLRPT) on nasal patency in patients with a clinical diagnosis of allergic rhinitis was investigated. Materials and Methods. Subjects were randomly divided into 2 groups, with patients in one group given one treatment session of RLRPT, followed by medical treatment. Those in the second group were treated with medical treatment only. The rhinitis symptoms were evaluated both before and 30 minutes after RLRPT and 2 days later. The nasal patency was objectively measured through the use of both active anterior rhinomanometry and acoustic rhinometry before and 30 minutes after RLRPT. Results. All rhinitis symptoms, including nasal congestion, significantly improved 30 minutes after a single RLRPT treatment, but worsened again, particularly for sneezing, 2 days later. Nasal resistance slightly decreased 30 minutes after RLRPT. The first minimal cross-sectional area did not change after RLRPT, but the second minimal cross-sectional area with the volume of the nasal cavity between 2.0 and 5.0 cm from the tip of the nosepiece significantly lessened. Conclusions. This study showed that RLRPL did not objectively improve patient's nasal patency. Registration Number. The trial is registered with NCT03752645.

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In this issue

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Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma

Abstract

Background

To assess the association between radiation therapy (RT) use and overall survival (OS) for patients with metastatic head and neck squamous cell carcinomas (HNSCC).

Methods

We analyzed the National Cancer Database to identify patients with newly diagnosed metastatic HNSCC from 2004 to 2013 who were treated with up‐front chemotherapy. Associations between the use of RT and OS were evaluated.

Results

We identified 3516 patients with metastatic HNSCC who were treated with chemotherapy; 2288 (65%) were also treated with RT. The addition of RT to chemotherapy was associated with prolonged survival (median: 13.6 vs 11.3 months, log‐rank P < .001). After adjusting for other prognostic factors in a multivariable Cox model, propensity score matching and landmark analyses limited to patients who survived at least 3, 6, and 12 months after diagnosis, the use of RT remained associated with prolonged survival.

Conclusion

The addition of RT to chemotherapy in the up‐front management of metastatic HNSCC was associated with prolonged OS in this study.

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