Multidisciplinary Management of Patients with Unresectable Hepatocellular Carcinoma: A Critical Appraisal of Current Evidence

Hepatocellular carcinoma (HCC) is a leading cause of new cancer diagnoses in the United States, with an incidence that is expected to rise. The etiology of HCC is varied and can lead to differences between patients in terms of presentation and natural history. Subsequently, physicians treating these patients need to consider a variety of disease and patient characteristics when they select from the many different treatment options that are available for these patients. At the same time, the treatment landscape for patients with HCC, particularly those with unresectable HCC, has been rapidly evolving as new, evidence-based options become available. The treatment plan for patients with HCC can include surgery, transplant, ablation, transarterial chemoembolization, transarterial radioembolization, radiation therapy, and/or systemic therapies. Implementing these different modalities, where the optimal sequence and/or combination has not been defined, requires coordination between physicians with different specialties, including interventional radiologists, hepatologists, and surgical and medical oncologists. As such, the implementation of a multidisciplinary team is necessary to develop a comprehensive care plan for patients, especially those with unresectable HCC

COMPARISON IN BENEFITS OF HERBAL MOUTHWASHES WITH CHLORHEXIDINE MOUTHWASH: A REVIEW

Objective: To discuss the benefits of herbal mouthwashes with the standard chlorhexidine mouthwash. This review is conducted to explore the benefits of herbal mouthwashes.Methods: Many herbal extracts are now available as mouthwash for maintaining the good oral hygiene. Plaque accumulation and increase in oral micro- organisms are the main factors for poor oral hygiene. Herbal extracts such as German chamomile, Terminalia chebula, Aloe vera, Green tea, peppermint satva, turmeric, neem, triphala, pomegranate extracts, guava extract, propolis, alum, darim leaves, mulethi, etc., are similar to chlorhexidine in plaque control and gingivitis reduction. Many herbal mouthwashes contain herbs with anti-microbial property such as neem, yavani satva, nagavalli, Gandhapura taila, pilu, Bibhitaka, Ocimum, Echinacea, Chameli leaves, etc. Many herbs are with anti-inflammatory and anti-oxidant property such as neem, clove, triphala (combination of amalaki, haritaki, and vibhitaki), tulsi, grapefruit, celery, licorice, katha, spearmint, and chamomile essential oil. Some herbal mouthwash with chamomile extract kills some skin pathogens such as staphylococcus and Candida species. Mixture of Staphysagria, Chamomilla, Echinacea, Plantago, Ocimum, and Cistus extracts used as mouth wash which was is better than chlorhexidine in reducing salivary mutans streptococcicount. Hence usage of herbal mouthwash will enhance the oral hygiene comparatively with chlorhexidine mouthwash without any adverse effects. Result: Though herbal mouthwashes has the ability to maintain good oral hygiene on daily basis, but still it is less effective than chlorhexidine mouthwash during treatments like gingivitis, periodontitis, trauma, etc. Conclusion: Besides the disadvantages, chlorhexidine mouthwash plays effective role during dental treatments on short term usage. Herbal mouthwashes are suitable for maintaining good oral prophylaxis. Many programs have to be conducted to make them aware about mouthwashes in their oral hygiene.Keywords: Chlorhexidine, Herbal, Mouthwash, Oral hygiene, Prophylaxis

Physico-Chemical Analysis of Groundwater Covering the Parts of Padmanabhanagar, Bangalore Urban District

The present study evaluated the ground water quality and physico-chemical characteristics of the water samples collected from 15 bore wells in the study area which is situated in Rangappa Layout which is located in the Ittamadgu Village of Uttarahalli Hobli which falls in the Bangalore South taluk of the Bangalore Urban district. Physico-chemical characteristics of the collected water samples, various parameters like pH, Temperature, Total Suspended Solids, Turbidity, Total Dissolved Solids, Total Hardness, Electrical Conductivity, Sodium, Potassium, Ca, Mg, Cl, HCO3, CO3, NO3, F, SO4, PO4, Cr+6, Fe, Cu, Pb, Ni, Zn are analyzed. Spatial variation maps are prepared to understand the distribution. The variation in elevation, overburden thickness, fractures, rate of discharge are determined. Hill piper, Wilcox and USSL have been obtained to determine the percentage of salinity and alkalinity of water. The quality of water found suitable for drinking purpose