Neoadjuvant chemotherapy or chemoradiotherapy in head and neck cancer

The multidisciplinary approach to treating squamous cell carcinoma of the head and neck is complex and evolving. Chemotherapy is increasingly being incorporated into the treatment of squamous cell carcinoma of the head and neck. Previously, radiotherapy following surgery was the standard approach to the treatment of loco regionally advanced resectable disease. Data from randomized trials have confirmed the benefits of concurrent chemo radiotherapy in the adjuvant setting. Chemo radiotherapy is also the recommended approach for unresectable disease. Advanced loco regional disease is the most frequent clinical situation in Head and Neck cancer. The standard of care for most clinicians is a multidisciplinary treatment with concomitant chemotherapy plus radiotherapy (CRT). However, retrospective studies have shown that in patients treated with CRT there was a relative increase in systemic relapse due to a lack of systemic control. For this reason a renewed interest has appeared for the incorporation of induction chemotherapy in the treatment of locally advanced Head and Neck Cancer. Furthermore new combination regimens with taxanes have shown to be more active than the classical cisplatin and 5-fluorouracil induction regimen. Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both loco regionally advanced and recurrent/metastatic squamous cell carcinoma of the head and neck

Trends in mouth cancer incidence in Mumbai, India (1995–2009): An age-period-cohort analysis

AbstractIntroductionDespite tobacco control and health promotion efforts, the incidence rates of mouth cancer are increasing across most regions in India. Analysing the influence of age, time period and birth cohort on these secular trends can point towards underlying factors and help identify high-risk populations for improved cancer control programmes.MethodsWe evaluated secular changes in mouth cancer incidence among men and women aged 25–74 years in Mumbai between 1995 and 2009 by calculating age-specific and age-standardized incidence rates (ASR). We estimated the age-adjusted linear trend for annual percent change (EAPC) using the drift parameter, and conducted an age–period–cohort (APC) analysis to quantify recent time trends and to evaluate the significance of birth cohort and calendar period effects.ResultsOver the 15-year period, age-standardized incidence rates of mouth cancer in men in Mumbai increased by 2.7% annually (95% CI:1.9 to 3.4), p<0.0001) while rates among women decreased (EAPC=−0.01% (95% CI:−0.02 to −0.002), p=0.03). APC analysis revealed significant non-linear positive period and cohort effects in men, with higher effects among younger men (25–49 years). Non-significant increasing trends were observed in younger women (25–49 years).ConclusionsAPC analyses from the Mumbai cancer registry indicate a significant linear increase of mouth cancer incidence from 1995 to 2009 in men, which was driven by younger men aged 25–49 years, and a non-significant upward trend in similarly aged younger women. Health promotion efforts should more effectively target younger cohorts

The carcinoma of parathyroid gland

Parathyroid carcinoma constitutes less than 1% of primary hyperparathyroidism. The exact etiology is not known. Prior radiation to neck, chronic renal failure and genetic factors are thought to play a role. The male to female ratio is one. Parathyroid carcinomas are slow growing, have a tendency to recur locally and metastasize late. 95% of parathyroid carcinomas are functioning. The major distinguishing features of malignant hyperparathyroidism are presence of a palpable mass in the neck and features of severe hypercalcemia. By far the most important test to diagnose primary hyperparathyroidism is serum level of Immunoreactive PTH. The diagnosis of primary hyperparathyroidism is essentially clinical and biochemical. Biopsy is not necessary before definitive surgery. CT scan appears to be the best investigation for detecting the primary tumor, its local extent and metastases. Most of the symptoms are attributable to hypercalcemia, which needs to be treated aggressively. Early surgery with 'en bloc' resection of the tumor is the only potentially curative treatment. Parathyroid carcinoma is traditionally said to be resistant to radiotherapy. Various chemotherapeutic agents have been used with partial anecdotal responses. The 5-year survival is about 50% and 10-year survival varies from 13-49%

ChatGPT: An online cross-sectional descriptive survey comparing perceptions of healthcare workers to those of other professionals

Background: Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial intelligence tool that interacts using natural human language. Its recent launch has generated immense interest and utilization. Objectives: Our primary aim was to document the early perceptions regarding ChatGPT and its potential impact on the lives of healthcare professionals. Our secondary aim was to compare the perceptions of healthcare professionals regarding ChatGPT with those of non-healthcare professionals. Materials and Methods: The survey questions were decided by all authors in consultation. Between February 6, 2023, and February 17, 2023, we conducted an anonymous survey using Google Forms. The survey comprised nine multiple-choice questions, related to perceptions about ChatGPT. The respondents were divided into two groups based on their profession (healthcare versus others). The survey results were analyzed using ChatGPT. Results: There were 210 participants; 157 (74.8%) were healthcare professionals, and 53 (25.2%) were from other fields. Less than half the respondents (n = 89, 42.4%) reported that they had already asked ChatGPT a question. Significantly fewer healthcare professionals (n = 63, 40.1%) than non-healthcare professionals (n = 25, 47.2%) had used ChatGPT; P = 0.01. Majority of respondents (161/210; 76.6%) expected ChatGPT to have less than 50% impact on them in the year 2023. However, significantly more healthcare professionals (n = 122, 77.7%) than non-healthcare professionals (n = 39, 73.6%) thought that the change would be less than 50%; P = 0.049. More healthcare professionals expected ChatGPT to positively impact their careers (n = 82, 52.2% versus n = 20, 37.7%; P < 0.001). More respondents from the healthcare sector (n = 32, 20.4%) planned to make changes in their career as a result of ChatGPT than respondents from other professions (n = 6, 11.3%); P = 0.008. Additionally, more healthcare professionals considered that the effect on the future of civilization and the human race (as predicted by Stephen Hawking) would be favorable (n = 113, 72%) as compared to non-healthcare professionals (n = 36, 67.9%); P = 0.019. Conclusions: Although fewer healthcare professionals have accessed and used ChatGPT than non-healthcare professionals,healthcare professionals' perception of ChatGPT is predominantly positive. Regardless of our professions, all of us will need to reinvent ourselves in the new era of artificial intelligence and chatbots