Role of HRCT Thorax in preoperative assessment of RT-PCR COVID-19 negative oral cancer patients

Background: Oral cancer accounts for 30% of all types of cancer in India. Surgery is the mainstay of treatment but due to the recent outbreak of COVID-19, there is a partial or complete disruption of health services in the country. The initial delay in the treatment was due to cancellations of planned surgeries as per government regulations and reduction in public transportation. In the latter half of the initial relaxation of the lockdown, we formulated our institutional protocol for the surgical treatment of oral cancer patients. On admission, all patients were kept in isolated wards followed by RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) testing on the same day. RT-PCR negative patients are subjected to HRCT Thorax (High-resolution Computer Tomography). This ensured the safety of health care workers, patients, and patient attendees. Keeping this in mind, we did an observational study on the role of HRCT in the pre-operative screening of asymptomatic oral cancer patients.  Materials and methods: Retrospective analysis of prospectively collected data of 150 patients was done. HRCT reporting was done by two experienced senior radiologists of the Department of Radiology at our hospital. Results: The number of patients under the CO-RADS 1 category was 121 and CO-RADS 2 category was 29, according to CO-RADS classification. The results of RT-PCR and HRCT were compared and there was a 100% positive correlation between RT-PCR and HRCT Thorax. Conclusion: Our study supported the use of HRCT Thorax as a diagnostic tool in pre-operative screening of oral cancer patients for COVID 19, particularly in RT-PCR negative cases

Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

Background: Because of its prompt onset of action and clearance, the use of etomidate as an anaesthetic induction agent is increasing in clinical practice. However, etomidate-induced myoclonus (EIM) remains a prevalent issue. Such myoclonic activity can be prevented by the administration of drugs that inhibit subcortical neuronal activity. Aims: This study was designed to compare the effects of pre-treatment with dexmedetomidine and fentanyl–midazolam combination on EIM as well as on attenuation of pharyngolaryngeal reflex. Materials and Methods: One hundred adult patients with the American Society of Anesthesiologists Grades 1 or 2 posted for elective surgery were enrolled and were randomly divided into two groups of 50 patients each. Group D received dexmedetomidine (1 μg/kg) in over 10 min and Group F received midazolam (0.02 mg/kg) + fentanyl (2 μg/kg) intravenously. Haemodynamic variables, incidence and severity of myoclonus were recorded. Results: The incidence of EIM was lower in Group F (26%) when compared to Group D (40%), but the difference was not statistically significant (P = 0.28). Eighteen per cent of the subjects in Group F had Grade 1 myoclonus as compared to 32% of Group D, whereas 8% of the subjects in Group F had Grade 2 myoclonus as compared to 6% of Group D. None of the patients in Group F experienced myoclonus of Grade 3, whereas 2% of the subjects had Grade 3 myoclonus. Conclusion: Administration of a combination of fentanyl and midazolam, along with dexmedetomidine as a pre-treatment, has been found to be an effective strategy for mitigating the incidence of myoclonus

Laparoscopic Roux-en-Y gastric bypass: Outcomes of a case-matched comparison of primary versus revisional surgery

Introduction: Laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy are popular bariatric procedures. Certain complications may necessitate revision. Adverse outcomes are reported after revisional bariatric surgery. We compared patients undergoing revisional versus primary laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods: This was retrospective comparative 1:1 case-matched analysis of revisional LRYGB Group A versus primary LRYGB (pLRYGB/Group B). Matching was based on body mass index (BMI) and comorbidities. BMI decrease at 6 and 12 months post-surgery, comorbidity resolution, operative time, morbidity and length of hospital stay (LOS) were compared. Total decrease in BMI, i.e., change from before initial bariatric procedure to 12 months after revision for Group A was also compared. Results: Median BMI (inter-quartile range) for Group A decreased to 44.74 (7.09) and 41.49 (6.26) at 6 and 12 months, respectively, for Group B corresponding figures were 38.74 (6.9) and 33.79 (6.64) (P = 0.001 and P = 0.0001, respectively). Total decrease in BMI (Group A) was 9.8, whereas BMI decrease at 12 months for Group B was 15.2 (P = 0.23). Hypertension resolved in 63% (Group A), 70% (Group B) (P = 0.6). Diabetes resolution was 80% (Group A), 63% (Group B) (P = 0.8). Operative time for Groups A, B was 151 ± 17, 137 ± 11 min, respectively (P = 0.004). There was no difference in morbidity and LOS. Conclusion: Comorbidity resolution after revisional and pLRYGB are similar. Less weight loss is achieved after revision than after pLRYGB, but total weight loss is comparable. Revisional surgery is safe when performed by experienced surgeons in high-volume centres

Integrated analysis of whole exome and RNA sequencing for Neo-epitope peptide prediction in buccal cancer

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy globally, but ranks first in India because of the extensive use of tobacco, betel-quid and alcohol.  Despite, the availability of aggressive treatments, the survival for HNSCC patients remains relatively poor. High-throughput sequencing technologies have identified several mutant genes and pathways in cancer genomes but the transcription patterns of these genetic alterations remain unclear. We performed an integrated analysis of whole exome and RNA sequencing to gain a better understanding of the transcriptional consequences of these genetic mutations, thus paving the way to identifying biomarkers and neo-epitopes. To this end, we conducted a prospective study on patients diagnosed with HNSCC from Gujarat, India. Detailed clinical data was collected from a total of 541 consented patients. Additionally, DNA and RNA was extracted from a subset of nine buccal cancer patients from both tumor and blood (Age 44 ± 9: M: 7, F: 2). Whole exome and RNA sequencing was performed on an Illumina platform followed by data analysis using bioinformatics tools. Normalized expression of all coding variants were compiled and variants with Alt allele depth in RNA-seq >= 1 was prioritized for HLA binding and neo-epitope prediction using our proprietary pipeline OncoPeptVAC. As previously reported, DNA sequencing results revealed recurrent frameshift/nonsense and missense mutations in the TP53, PIK3CA, CASP8, FAT1, TTN, FSIP2 and CDKN2A genes. Additionally, unique mutations were observed in the CA6, FGD3, FLG2, COX 4l1, CD58, MAPK1, HLA-A and HLA-DQB1genes, previously not associated with head and neck cancers. A positive correlation between the mutant allele frequency in Exome and RNA-seq data confirmed the expression of both missense and frameshift mutant genes. Our results show that the majority of the mutation derived peptides were not predicted to be immunogenic for the HLA types considered. Peptides derived from variants in TP53, ANKRD12, EPHB2, ZNF200, TRPM4, CHD4, PLEC, KMT2C, GLTSCR1 were predicted to have neo-epitopes properties in buccal cancer. These findings provide a platform to predict immunogenic neo-epitopes which could be used in the development of personalized vaccines for patients with buccal cancer

Imaging advances in oral cavity cancer and perspectives from a population in need: Consensus from the UK-India oral cancer imaging group

Oral squamous cell carcinoma (OSCC) accounts for a third of the cancer burden in India, with a correspondingly high cancer-specific mortality. Although treatment of OSCC in India mirrors that of high-income nations, extreme burden of disease, late presentation, and the associated advanced stage of disease pose unique challenges in a resource-constrained environment. Despite a multimodal treatment paradigm, survival rates are low. Often the cause for late presentation is the delayed diagnosis, inappropriate investigation and referral, and compromised or incorrect treatment, leading to poor patient outcomes and costs to the health-care provider. To address these issues, the first UK-India Symposium on Advances in Oral Cancer Imaging Symposium was organized in Bangalore, India, in April 2019; participants included radiologists, imaging scientists, clinicians, and data scientists from the United Kingdom, India, Singapore, and the United States. Following the discussions held during this meeting, in this manuscript, we present evidence-based guidance for the role of imaging in OSCC, recommendations for service development, and details of future potential for evolution in head and neck imaging