Publications by authors named "Arun Elangovan"

29 Publications

  • Page 1 of 1

Impact of Immunohistochemical profiling of Glioblastoma multiforme on clinical outcomes: Real-world scenario in resource limited setting.

Clin Neurol Neurosurg 2021 Jun 4;207:106726. Epub 2021 Jun 4.

Department of Radiotherapy& Oncology, PGIMER, Chandigarh, India. Electronic address:

Objective: Intuition into the molecular pathways of glioblastoma multiforme (GBM) has changed the diagnostic, prognostic, and therapeutic approaches. We investigated the influence of various clinical and molecular prognostic factors on survival outcomes in radically treated GBM patients.

Methods: Medical records of 160 GBM patients treated between January-2012 and December-2018 with surgery followed by post-operative external beam radiotherapy (EBRT) with/without temozolomide (TMZ) were reviewed. Immunohistochemical (IHC) assays were performed for IDH1mutation, ATRX loss, TP53 overexpression and Ki-67% index. Apart from disease and treatment-related factors' influence on clinical outcomes, the impact of IHC markers in prognostication was analyzed using appropriate statistical tests.

Results: The median overall survival (OS) was 14 months. EBRT with concurrent TMZ was given to 60% of patients and 42.5% completed the standard Stupp-protocol. Significant improvements in OS was observed in patients aged ≤ 50years (2-year OS: 22.1% vs. 12.5%, p = 0.001), those who underwent gross total resection (2-year OS: 21.8% vs. 12.8%, p = 0.002), received concurrent TMZ (21.9% vs. 12.5%, p = 0.005), completed the entire Stupp-protocol (2-year OS: 23.4% vs. 6.5%, p = 0.000), and with Ki-67 index <20% (2-year OS: 23.3% vs. 11.6%, p = 0.015). On multivariate analysis, IDH1 mutation, ATRX loss, TP53 expression, and Ki-67 ≤ 20% were significant prognosticators of outcomes.

Conclusion: GBM patients treated with concurrent chemoradiation and those who completed the full Stupp-protocol experienced better survival outcomes. Molecular biology significantly impacts clinical outcomes and plays a key deterministic role in newer management strategies.
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http://dx.doi.org/10.1016/j.clineuro.2021.106726DOI Listing
June 2021

Expanding role of radiotherapy in adenoid cystic carcinoma of the tracheobronchial tree: a new horizon.

Tumori 2021 May 12:3008916211012461. Epub 2021 May 12.

Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Background: Primary adenoid cystic carcinomas (ACCs) of central trachea-bronchi system are rare and heterogeneous tumors. Definitive radiotherapy (RT) is the recommended treatment in surgically unresectable or incomplete resection or in the presence of severe comorbidities.

Objective: To evaluate the clinical features and outcomes of patients with ACC of trachea-bronchi treated with radiotherapy.

Methods: Retrospective medical records review was done in all patients with histologically confirmed ACC of trachea-bronchi between January 2010 and December 2019. Patient disease and treatment characteristics and toxicity data were analyzed. Overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were computed using Kaplan-Meier method (log-rank test).

Results: Nineteen patients (10 women and 9 men) were included in this analysis with median age of 40 years (range, 14-70). Of these patients, 63.2% (n = 12) presented in stage IV disease. Twelve and three patients received definitive (median dose 67.8 Gy) and adjuvant (median dose 50 Gy) RT, respectively. The median follow-up was 42.5 months (range, 4-120); 15 patients were alive and 4 were dead at that time. Local recurrence or progression was observed in 52.6% and distant metastasis found in 47.3% of patients. The 5-year OS, LRFS, and DMFS for all patients were 81.2%, 52.8%, and 39.6%, respectively. Baseline lymph node involvement showed significant impact on OS (56.3% vs 100%, = 0.011). Among patients receiving definitive RT, patients with higher RT dose (⩾66 Gy) had significantly better survival outcomes (5-year LRFS: 75% vs 16.7%, = 0.013).

Conclusion: Definitive RT is an exemplary treatment for unresectable disease. Higher dose is recommended to improve long-term outcomes.
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http://dx.doi.org/10.1177/03008916211012461DOI Listing
May 2021

Multimodality treatment for Central Nervous System Germ Cell Tumors: Disease spectrum and management strategies - A tertiary care center experience from India.

Clin Neurol Neurosurg 2021 Mar 13;202:106481. Epub 2021 Jan 13.

Department of Radiotherapy & Oncology, PGIMER, Chandigarh, India. Electronic address:

Objective: Intracranial germ cell tumors (GCTs) are relatively rare neoplasms, representing 2-3 % of paediatric brain tumors in Western countries and 8-15 % in East Asia. Here, we discuss the clinical features and treatment outcomes in patients with central nervous system (CNS) GCTs treated at our institute.

Methods: Medical records of all primary CNS GCT patients were retrieved retrospectively from 2007 to 2019. Demographic, clinical, treatment and follow up details were entered in a predesigned proforma. Overall survival (OS) and progression-free survival was computed using Kaplan-Meier method and Log-Rank test. Effect of various prognostic factors on survival outcomes was assessed by univariate and multivariate analysis.

Results: A total of 28 CNS GCT patients were included in this analysis. Median age at presentation was 17 years (range, 7-45 years) with a male to female ratio of 1.8:1. Pineal region was the commonest location, encountered in 15 patients (53.6 %). Pure germinoma was the most frequent histology observed, seen in 19 patients (67.9 %). Male gender and germinoma histology were highly associated with pineal location (p = 0.043 and p = 0.052, respectively). Fourteen patients underwent surgical intervention and nine patients underwent biopsy for diagnostic purpose or to relieve the obstructive symptoms. Only 23 patients (82.1 %) received chemotherapy. However, all patients received radiotherapy (Craniospinal irradiation/whole brain radiotherapy/whole ventricular radiotherapy/ or local radiotherapy). After a median follow-up of 53 months (range, 7-150), 23 patients (82.1 %) were alive. OS was significantly affected by histology (89 % in germinoma vs. 60 % in non-germinomatous, p = 0.054) and location (93 % in pineal region vs. 64.2 % in other location, p = 0.042). Age, gender and surgery did not have any impact on the survival outcomes.

Conclusion: CNS GCTs are relatively rare and heterogeneous neoplasms commonly seen in pineal and suprasellar locations. A combination of chemotherapy and radiotherapy had shown excellent outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2021.106481DOI Listing
March 2021

Primary broad ligament adenocarcinoma.

Autops Case Rep 2020 Sep 2;10(4):e2020176. Epub 2020 Sep 2.

Postgraduate Institute of Medical Education and Research (PGIMER), Department of Pathology. Chandigarh, India.

Primary broad ligament carcinoma is a very rare occurrence with 28 reported cases worldwide, to date. The epidemiology, treatment strategy and prognosis are still uncertain because of the scarcity of cases. Currently, all broad ligament carcinomas are managed similar to epithelial ovarian cancer. We report the case of a 43-year-old female with a prolonged complaint of abdominal pain and intermittent urinary retention, requiring frequent catheterization. She was diagnosed with obstructive right hydroureteronephrosis. The abdominal Contrast Enhanced Computed Tomography (CECT) revealed a well-defined heterogeneous lesion of 2.1х3х3.2cm size in the right lateral and posterior wall of the cervix. An ultrasound (USG)-guided Fine Needle Aspiration Cytology (FNAC) of the mass was done and it was suspected to be malignant. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, pelvic lymph-nodal sampling, and peritoneal washing. Histological examination depicted an endometrioid adenocarcinoma of the broad ligament. She received adjuvant chemotherapy, followed by hormonal therapy. It has been five years since her surgery, and she is now alive and disease free.
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http://dx.doi.org/10.4322/acr.2020.176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703128PMC
September 2020

Primary mediastinal germ cell tumors: Survival outcomes and prognostic factors - 10 years experience from a tertiary care institute.

Rare Tumors 2020 18;12:2036361320972220. Epub 2020 Nov 18.

Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Primary Mediastinal Germ Cell Tumor (PMGCT) is a rare and heterogeneous entity. These tumors are typically diagnosed in young adults and carry a poor prognosis. We conducted this study to evaluate the role of radiotherapy on treatment outcomes and prognostic factors in PMGCT that may allow a more adapted treatment strategy to improve survival. Case records of patients who presented with PMGCT over a period of 10-years from January-2009 to December-2019 were retrospectively evaluated. Survival analyses were calculated using Kaplan-Meier (Log-rank) method. Poor prognostic factors for survival were evaluated with Multivariate analysis using Cox-regression method. A total of 46-patients data was analyzed, the majority of the patients were males (95.7%) with a median age of 25-years (range, 17-62). Non-seminomatous histology was predominant (60.9%). Sixteen-patients (34.7%) presented with complications at their initial presentation. Majority of the patients were treated with multimodality approach using chemotherapy, surgery, and/or radiotherapy. At a median follow-up of 40.8 months, the 1, 3, and 5-year overall survival (OS) was 69.6%, 52.2%, and 44.7% respectively. Patients who received radiotherapy in first-line treatment showed significant improvement in 5-year OS (72% vs 30%,  = 0.004) and disease-free survival (70% vs 24%,  = 0.007) in comparison with patients who did not receive. Multivariate analysis revealed that radiotherapy, chemotherapy, surgery, and complications at presentation were independent prognostic factors for OS. PMGCTs are aggressive neoplasms especially in patients presenting with disease-related complications. Dual modality management (radiotherapy as local therapy along with chemotherapy) had shown improvement in survival.
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http://dx.doi.org/10.1177/2036361320972220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682202PMC
November 2020

Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility.

Brachytherapy 2021 Jan-Feb;20(1):58-65. Epub 2020 Sep 30.

Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada.

Purpose: The purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR).

Methods And Materials: A total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound-based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores.

Results: We found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3-11), which increased to 12 (7-17) at 4 weeks and 9 (5-14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion.

Conclusions: Single-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.
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http://dx.doi.org/10.1016/j.brachy.2020.08.015DOI Listing
September 2020

Clinical Outcomes and Prognostic Factors in Gastric Carcinoma Patients with Curative Surgery Followed by Adjuvant Treatment: Real-World Scenario.

J Gastrointest Cancer 2021 Jun;52(2):616-624

Department of Radiotherapy and Oncology, PGIMER, Chandigarh, 160012, India.

Background: A wide range of adjuvant treatment regimens exist in gastric carcinoma patients which include chemotherapy, radiotherapy, and/or both either sequential or concurrent. The study aimed to assess the benefit of adjuvant sequential chemotherapy followed by radiotherapy for operable gastric cancers and evaluate the prognostic factors associated with clinical outcomes.

Methods: Patients of stage IB-III gastric carcinoma who underwent radical surgery followed by adjuvant treatment from January 2013 to December 2016 were analyzed retrospectively. Survival was computed using Kaplan-Meier method and prognostic factors were analyzed in multivariate analysis using Cox progression hazard model. A P value < 0.05 was taken as statistically significant.

Results: A total of 108 patients were identified with a median follow-up of 31.7 months (range: 6-96). Seventy-two percent of the patients received adjuvant sequential chemoradiation (N = 77) and 28% of patients received chemotherapy alone. The median survival was 26 months (95% CI: 23.09-28.90). Overall survival (OS) rates for 1, 2, 3, 4, and 5 years were 88.9%, 57.4%, 40.7%, 28.8%, and 20.4%, respectively. Five-year OS for stage-IB, II, and III was 75%, 45%, and 8.3%, respectively (p = 0.023). Surgical margin positivity (9.5% vs. 26.9%, p = 0.042), signet-ring cell histology (6.5% vs. 25.8%, p = 0.00), and adjuvant sequential chemoradiation (p = 0.002) showed a significant impact on survival outcomes and proved as independent prognostic factors.

Conclusion: The present study demonstrated that survival in gastric carcinoma is influenced by the stage of disease and surgical margins. In locally advanced patients, radical surgery followed by sequential chemoradiation based on a doublet/triplet regimen was an independent prognostic factor for survival. Majority of patients in our set-up presented in locally advanced stage, curative resection followed by adjuvant sequential chemoradiation was an independent prognostic factor for survival.
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http://dx.doi.org/10.1007/s12029-020-00440-wDOI Listing
June 2021

Evaluation of Multimodality Management of Adenoid Cystic Carcinoma of the Head and Neck.

Indian J Otolaryngol Head Neck Surg 2019 Oct 7;71(Suppl 1):628-632. Epub 2018 Jul 7.

1Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Adenoid cystic carcinoma is a relatively rare tumour arising from salivary glands of head and neck region. Surgery and radiotherapy form standard treatment modalities in the management of this tumor. In this analysis we present results of multimodality treatment in our cohort of patient. This retrospective analysis evaluated results of treatment in forty patients diagnosed with adenoid cystic carcinoma of the head and neck. Evaluation was done to identify prognostic factors affecting the disease free survival. A median disease free survival of 34 ± 2.42 (Median ± SE) versus 10 ± 5.45 months was seen in patients undergoing surgery followed by post operative radiotherapy versus radiotherapy alone ( = 0.01). A radiotherapy dose more than 60 Gy was associated with a better disease free survival compared with patients receiving less than 60 Gy ( = 0.01). Positive surgical margins and perineural invasion were associated with a poor treatment outcome ( = 0.02) Patients with c-kit positive status showed a poor local control rate ( = 0.05).
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http://dx.doi.org/10.1007/s12070-018-1442-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848353PMC
October 2019

Bilateral adnexal masses in a perimenopausal female.

Cytopathology 2020 01 24;31(1):68-70. Epub 2019 Jul 24.

Department of Cytology and Gynecologic Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/cyt.12746DOI Listing
January 2020

Platinum sensitive carcinoma of ovary relapsed as pericardial effusion with cardiac tamponade.

BMJ Case Rep 2019 Mar 22;12(3). Epub 2019 Mar 22.

Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association-IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.
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http://dx.doi.org/10.1136/bcr-2018-228268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510153PMC
March 2019

Prospective Study to Quantify Expansion Volumes Around the Involved Pelvic Lymph Nodes to Plan Simultaneous Integrated Boost in Patients With Cervical Cancer Undergoing Pelvic Intensity Modulated Radiation Therapy.

Pract Radiat Oncol 2019 Jul - Aug;9(4):e394-e399. Epub 2019 Feb 22.

Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India.

Purpose: This study aimed to calculate the expansion margins around enlarged pelvic lymph nodes to encompass internal motion and setup errors during intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer.

Methods And Materials: Four-dimensional computed tomography scans were obtained for 19 patients with cervical cancer, and 32 fluorodeoxyglucose-avid pelvic lymph nodes were delineated in different respiratory phases to calculate respiratory displacement. Setup variations during daily treatments were estimated from on-board imaging. Descriptive statistics were used to quantify the expansion margins using Mc Kenzie and Van Herk formulas separately. An analysis of variance was used to analyze the volumetric impact of the margins.

Results: Based on the McKenzie formula, an internal margin (internal target volume) of 3 mm and setup margin (planning target volume) of 5 mm was required to adequately encompass respiratory and setup uncertainties, respectively. Although the use of the Van Herk formula necessitated a single 6 mm expansion margin for all uncertainties, which resulted in a significant reduction in boost volume, inherent limitations in our methodology might pose a higher risk of target miss with such smaller margins.

Conclusions: An isotropic expansion margin of 3 mm for the internal target volume and 5 mm for the planning target volume is necessary for enlarged pelvic lymph nodes while planning intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer.
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http://dx.doi.org/10.1016/j.prro.2019.02.006DOI Listing
December 2019

Conventional radiotherapy and intensity-modulated radiotherapy in carcinoma vulva: An experience from a tertiary medical center of India.

South Asian J Cancer 2019 Jan-Mar;8(1):41-43

Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India.

Context: Vulvar cancer is one of the uncommon gynecological malignancies. Multimodality treatment with surgery, radiotherapy, and chemotherapy are required for treatment of the disease.

Aims: The aim of the study was to evaluate clinical outcome in patients of carcinoma vulva, treated at our institution.

Subjects And Methods: This was a retrospective-cohort study done in 50 patients with squamous cell carcinoma of the vulva, treated at our institution from January 2008 to December 2014. Data were analyzed on the basis of age, stage, type of treatment received, and treatment-related toxicity. Disease-free survival and overall survival were estimated.

Statistical Analysis Used: Kaplan-Meier survival analysis and Chi-square test were used for statistical analysis.

Results: Majority of the patients (52%) had presented with Stage III disease. Thirty-six of 50 patients underwent surgery: simple vulvectomy - 2, radical vulvectomy - 34, bilateral inguinal lymph node dissection was done in 32 patients, and 1 patient underwent ipsilateral-inguinal lymph node dissection. Among 40 patients who received radiotherapy and eight patients received palliative radiotherapy. Seventeen patients underwent intensity-modulated radiotherapy (IMRT) and 15 patients received conventional radiotherapy. Significantly less Grade 2 or more skin toxicity ( = 0.003) observed in patients who underwent IMRT. Among non-IMRT group, eight patients required treatment break during radiation. At a median follow-up time of 25.5 months, median overall survival was 31 months and median disease-free survival was 25 months. About 42% patients were alive and free of disease at last follow-up.

Conclusions: Modified radical vulvectomy with inguinal lymph node dissection followed by radiotherapy is the mainstay of management of locally advanced carcinoma vulva. Using IMRT, we could minimize the treatment related radiation toxicity and treatment breaks.
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http://dx.doi.org/10.4103/sajc.sajc_66_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348779PMC
February 2019

Analysis of volumetric and dosimetric changes in mid treatment CT scan in carcinoma nasopharynx: implications for adaptive radiotherapy.

J Exp Ther Oncol 2019 Jan;13(1):33-39

Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.

Objective: Carcinoma of nasopharynx is a radiosensitive tumor and therapeutic response during radiation treatment can result in dosimetric variations in the delivered dose to the tumor and critical organs. This study was done to evaluate the volumetric and dosimetric changes seen in tumor tissue and organs at risk in a mid treatment planning scan and its implications for adaptive replanning. Twenty patients of locally advanced carcinoma nasopharynx were evaluated. All patients were started on treatment with a baseline treatment plan on SIB-VMAT. To evaluate volumetric and dosimetric changes during treatment, a mid treatment CT scan (MTS) was taken at the 17 fraction of treatment and compared with the baseline planning CT scan (BS). Adaptive treatment plans were generated on the MTS and further treatment was continued on the adaptive plans. The mean weight loss observed at the 17th fraction of treatment was 3.4 ± 2.6 kg(Mean±S.D). The mean neck diameter at C2 level was 14.19±1.02 and 13.29 ± 1.14 cm in the BS and MTS respectively (p=0.001). The GTV 70 volume showed a 29.16% volume loss. The mean doses received by the right and left parotids were 25.45±0.98 and 24.64±3.8 Gy in the baseline treatment plan and 33.21±11.29 (p=0.054) and 31.76±8.44 Gy respectively in the MTS (p=0.016) The mean weight loss showed a statistically significant correlation with increase in the right parotid(p=0.043) and left parotid doses(p=0.024). Weight loss during treatment combined with volume changes in target tissues mandate routine adaptive replanning while treating carcinoma nasopharynx.
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January 2019

Toxicity and clinical outcomes with definitive three-dimensional conformal radiotherapy (3DCRT) and concurrent cisplatin chemotherapy in locally advanced cervical carcinoma.

Jpn J Clin Oncol 2019 Feb;49(2):146-152

Department of Radiotherapy & Oncology, PGIMER, Chandigarh.

Objective(s): This study aimed to retrospectively evaluate the toxicity and clinical outcomes in patients of locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) and concurrent chemotherapy.

Material And Methods: Two hundred and ten newly diagnosed patients of locally advanced cervical cancer of FIGO 2009 Stage II-III treated with 3DCRT (46 Gy/23 fractions/4½ weeks) and weekly concurrent Cisplatin (40 mg/m2), from January 2013 to 2015 were analyzed. A planning computed tomography was performed and contouring was done according to published guidelines. External radiotherapy was followed by Intracavitary brachytherapy delivered to a dose of 9 Gy HDR in 2-fractions, given one week apart. The endpoints were treatment related toxicities and clinical outcomes. Local control (LC), overall survival (OS) and disease free survival (DFS) were evaluated and toxicities were documented using the common terminology criteria for adverse events (v3.0) (CTCAE).

Results: The median follow up time was 37 (range, 19-54) months. The 3 year OS, DFS and LC were 84.2%, 80.6% and 81% respectively. Grade ≥3 acute skin, upper and lower gastrointestinal (GI) and genitourinary (GU) toxicity was observed in 3 (1.4%), 11 (5.2%), 12 (5.7%) and 0 (0%) patients, respectively. Grade ≤2 hematological toxicity was observed in 154 (73.3%) patients. Grade ≥3 late GI and GU toxicity was seen in 9 (4.2%) patients and 2 (0.9%) patients, respectively.

Conclusion: 3DCRT with concurrent chemotherapy results in good loco-regional control with acceptable normal tissue toxicity. In the background of indeterminate evidence regarding routine practice of intensity modulated radiotherapy in carcinoma of the cervix, 3DCRT may be considered as the treatment of choice.
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http://dx.doi.org/10.1093/jjco/hyy164DOI Listing
February 2019

Evaluation of Reirradiation in Locally Advanced Head and Neck Cancers: Toxicity and Early Clinical Outcomes.

J Oncol 2018 26;2018:8183694. Epub 2018 Mar 26.

Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

Objectives: Locoregional recurrence is the predominant pattern of treatment failure in advanced head and neck cancers. Reirradiation is a useful modality to treat inoperable head and neck cancer patients with recurrent disease. The aim of the present study was to analyze the treatment toxicity and early clinical outcomes in patients undergoing reirradiation.

Methods: Twenty patients of head and neck cancers with recurrences or second cancers were evaluated. Reirradiation was done using simultaneous integrated boost volumetric modulated arc therapy (SIB VMAT), intensity modulated radiotherapy (IMRT), or conventional radiotherapy using 6MV photons. Dose prescription ranged from 30 to 60 Gy in conventional fractionation.

Results: Seventeen males and three females were evaluated in this analysis. The median age of patients under study was 56.5 years. At time of analysis 8 patients (40%) had a complete response, 7 patients (35%) had progressive disease, and 25% had partial response or stable disease. Grade III-IV mucositis, dermatitis, xerostomia, dysphagia, and trismus were seen in 20%, 20%, 50%, 35%, and 45% patients, respectively, during retreatment. Patients receiving a radiotherapy dose less than 45 Gy showed a higher incidence of progressive disease ( = 0.01). The median disease-free survival for patients receiving reirradiation dose of ≥46 Gy was 19 ± 3.3 months (median ± S Error) compared to 8 ± 2.61 months for those with a dose prescription less than 45 Gy ( = 0.03). At 18-month follow-up 26% of patients undergoing reirradiation were disease-free.

Conclusions: Our results show improved tumor control using a prescription of doses ≥46 Gy in retreatment setting.
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http://dx.doi.org/10.1155/2018/8183694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892228PMC
March 2018

Comparative Evaluation of Endovac and Conventional Irrigating Syringe on Apical Extrusion in Primary Molars. An in vitro Study.

J Clin Pediatr Dent 2018;42(5):355-360. Epub 2018 May 15.

Objectives: The present study was undertaken to evaluate and compare the apical extrusion of irrigant and depth of irrigant penetration into dentine using the EndoVac irrigating system and manual irrigation system in primary molar teeth.

Study Design: Twenty five extracted primary molars satisfying the inclusion and exclusion criteria were divided into two groups with 29 roots in each group with an equal distribution of apical foramen area. The teeth were mounted in pre-weighed glass bottles and the canals were irrigated with 5.25% sodium hypochlorite solution mixed with acid fuchsin using either of irrigating systems according to the group ascertained. The amount of irrigant extruded was recorded. The roots were sectioned at two mm, four mm and six mm from the apex and examined under a stereomicroscope for depth of irrigant penetration.

Results: Apical extrusion of the irrigant solution was significantly less with the EndoVac system (1.18±1.04) when compared with the manual irrigation system (2.3±1.55) (P=0.002)*. Results showed that greater irrigant penetration was achieved using the EndoVac irrigation system compared to the manual irrigation system (P= 0.000)*. With both the irrigation systems, the depth of irrigant penetration was better in the six mm sections followed by the four mm sections and two mm sections (P=0.000)*.

Conclusion: The EndoVac irrigation system demonstrated better efficacy compared to manual irrigation system with less apical extrusion and better depth of irrigant penetration into dentine.
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http://dx.doi.org/10.17796/1053-4625-42.5.6DOI Listing
December 2018

Correction: Evaluation of Acute Toxicity and Early Clinical Outcome in Head and Neck Cancers Treated With Conventional Radiotherapy and Simultaneous Integrated Boost Arc Radiotherapy.

World J Oncol 2017 10 5;8(5):174. Epub 2017 Nov 5.

Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India.

[This corrects the article DOI: 10.14740/wjon1049w.].
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http://dx.doi.org/10.14740/wjon1049wc1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687898PMC
October 2017

Evaluation of Acute Toxicity and Early Clinical Outcome in Head and Neck Cancers Treated With Conventional Radiotherapy and Simultaneous Integrated Boost Arc Radiotherapy.

World J Oncol 2017 Aug 27;8(4):117-121. Epub 2017 Aug 27.

Department of Radiation Oncology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India.

Background: Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques.

Methods: Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/m weekly or 100 mg/m thrice weekly.

Results: The incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073).

Conclusion: SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers.
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http://dx.doi.org/10.14740/wjon1049wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650008PMC
August 2017

Comparative Evaluation of the Efficacy of EndoVac and Conventional Irrigating Systems in Primary Molars - An in Vitro Study.

J Clin Pediatr Dent 2018;42(2):140-145. Epub 2017 Oct 31.

Objective: The present study was undertaken to evaluate and compare the apical extrusion of irrigant and depth of irrigant penetration into the dentinal tubules using the EndoVac irrigating system and the manual irrigation system in primary molar teeth.

Study Design: Twenty five extracted primary molars satisfying the inclusion and exclusion criteria were divided into two groups of 29 roots in each group with an equal distribution of apical foramen area. The teeth were mounted in pre-weighed glass bottles and the canals were irrigated with both the irrigating systems using 5.25% sodium hypochlorite solution mixed with acid fuchsin which enables the irrigating solution to penetrate efficiently into the dentinal tubules. The amount of irrigant extruded was recorded. The roots were sectioned at 2mm, 4mm and 6mm from the apex and examine the depth of irrigant penetration into the dentinal tubules under a stereomicroscope.

Results: Apical extrusion of the irrigant was significantly less with the EndoVac system (1.18±1.04gms) when compared to manual irrigation system (2.3±1.55gms) (P<0.05). EndoVac irrigation system showed greater depth of irrigant penetration into the dentinal tubules (49.90±17.52mm, 32.17±12.20mm and 15.70±8.91mm) compared to the manual irrigation system (30.48±16.27mm, 14.74±9.67mm and 5.59±7.09mm) at 6mm, 4mm and 2mm respectively (P<0.05). Results showed that the depth of irrigant penetration into the dentinal tubules with both the irrigating systems was found to be significantly greater in the six mm sections compared to the four mm and two mm sections (P<0.05).

Conclusion: The EndoVac irrigation system showed significantly greater efficacy compared to the manual irrigation system in primary molars with less amount of irrigant extrusion and better depth of irrigant penetration into the dentinal tubules.
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http://dx.doi.org/10.17796/1053-4628-42.2.10DOI Listing
June 2018

Pre-Treatment Nutritional Status and Radiotherapy Outcome in Patients with Locally Advanced Head and Neck Cancers.

Gulf J Oncolog 2017 Sep;1(25):61-63

Department of Radiotherapy and Otolaryngology, PGIMER, Chandigarh, India.

Aim: Poor oral intake and associated nutritional depletion can affect treatment outcome in locally advanced head and neck cancers. The aim of this study was to evaluate the pre radiotherapy nutritional status as a predictor for response to radiotherapy treatment.

Patients And Methods: Fifty patients of locally advanced head and neck cancers undergoing radical chemoradiotherapy were evaluated in this prospective analysis. Patients were treated with definitive radiotherapy to a total dose of 60-70 Gy along with concurrent chemotherapy with injection Cisplatin 100mg/m2 delivered three weekly. The patients were evaluated for pre-treatment nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. The PG-SGA evaluation was completed just before starting radiotherapy treatment and scores correlated to treatment outcome.

Results: Forty-seven male and three female patients were evaluated in this analysis. The median PG-SGA score was 8 with a range from 2-14.Grade 3-4 mucositis was seen in seven patients (21.8%) with PGSGA <9 compared to 55.5% in those with PG-SGA score = 9 (p=0.01). At the time of evaluation a complete response was seen in 16 patients (32%) with a PG-SGA score <9 compared to 4 patients (8%) with a PGSGA =9 (p=0.05). The median survival was 16±2.8months (Median ±S. Error) and 17±2.9 months in those with PG-SGA <9 and =9 respectively (p=0.49, log rank).

Conclusion: PG-SGA nutritional score <9 is associated with a better local control and acute toxicity profile in radically treated head and neck cancer patients.
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September 2017

Evaluation of 4% Articaine and 2% Lignocaine Intraligamentary Injection Administered with Single Tooth Anesthesia-Wand.

Contemp Clin Dent 2017 Apr-Jun;8(2):315-320

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India.

Background: The available literature confirms the effectiveness of intraligamentary injections equal to nerve blocks and articaine equal to lignocaine with better depth of penetration for single tooth pulpectomy procedures with less postoperative soft tissue trauma. An advancement in the field of local anesthesia delivery is the Single Tooth Anesthesia-Wand (STA-Wand) which is relatively pain-free and offers comfort to the child.

Aims: This study aims to evaluate and compare the anesthetic effectiveness and postoperative complications of 4% articaine and 2% lignocaine intraligamentary injection administered as single tooth anesthesia using a computer-controlled local anesthetic delivery system, the STA-Wand.

Settings And Design: Using a randomized, split-mouth, cross-over study design, twenty children aged 4-10 years who required bilateral mandibular pulpectomies were administered intraligamentary injections with 4% articaine and 2% lidocaine in two appointments using STA-Wand. Pain, anxiety, and cooperation levels were scored by an operator and an observer at four phases of treatment using Wong-Baker Faces Pain Rating Scale and Two-6 point Co-operation Anxiety Rating Scale. Results were tabulated and analyzed.

Statistical Analysis: Mann-Whitney U-test, paired -test, and Student's -test.

Results: Both the local anesthetic agents were equally effective with no significant difference ( > 0.05) throughout rest of the treatment procedure compared to injection phase in minimizing pain, anxiety, and gaining the cooperation levels of children whereas during injection phase, 4% articaine showed superior effectiveness in minimizing pain compared to 2% lignocaine ( = 0.054).

Conclusion: Both the local anesthetic agents delivered using STA-Wand is clinically acceptable, effective, and safe for usage in children.
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http://dx.doi.org/10.4103/ccd.ccd_882_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551340PMC
August 2017

Shade selection of primary maxillary anterior teeth in children using Vitapan classical shade guide.

Indian J Dent Res 2016 Nov-Dec;27(6):657-660

Department of Pedodontics and Preventive Dentistry, Madha Dental College and Hospital, Chennai, Tamil Nadu, India.

Aim: The purpose of this study was to determine the closest matching shade for primary maxillary anterior teeth from the most widely used Vitapan classical shade guide available for permanent teeth.

Materials And Methods: A total of 313 children aged between 3 and 5 years were evaluated. Vitapan classical shade guide was used to determine the shade of six primary maxillary anterior teeth. Scores obtained were noted down in a scoring sheet and values were tabulated. Data collected were tabulated and statistically analyzed using Pearson Chi-square test.

Results: A1 was found to be the closest matching shade for primary maxillary anterior teeth. D3 was found to be the least prevalent shade for primary maxillary anterior teeth. There was no statistical significant difference in the shades among teeth of same quadrant (p > 0.05) and also between teeth of right and left quadrants (p > 0.05), respectively.

Conclusion: A1 shade of Vitapan classical shade guide is the most prevalent shade for primary maxillary anterior teeth and can be satisfactorily reproduced to all primary maxillary anterior teeth in general.
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http://dx.doi.org/10.4103/0970-9290.199596DOI Listing
January 2018

Why Newly Diagnosed Cancer Patients Require Supportive Care? An Audit from a Regional Cancer Center in India.

Indian J Palliat Care 2016 Jul-Sep;22(3):326-30

Department of Radiotherapy, PGIMER, Chandigarh, India.

Purpose: The present study was planned to record the distressing symptoms of newly diagnosed cancer patients and evaluate how the symptoms were addressed by the treating oncologists.

Materials And Methods: All newly diagnosed cancer patients referred to the Department of Radiotherapy during May 2014 were asked to complete a questionnaire after taking their consent. The Edmonton symptom assessment scale-regular questionnaire was used to assess the frequency and intensity of distressing symptoms. The case records of these patients were then reviewed to compare the frequency and intensity documented by the treating physician. The difference in the two sets of symptoms documented was statistically analyzed by nonparametric tests using SPSS software version 16.

Results: Eighty-nine patients participated in this study, of which only 19 could fill the questionnaire on their own. Anxiety was the most common symptom (97.8%) followed by depression (89.9%), tiredness (89.9%), and pain (86.5%). The treating physicians recorded pain in 83.1% whereas the other symptoms were either not documented or grossly underreported. Anxiety was documented in 3/87 patients, but depression was not documented in any. Tiredness was documented in 12/80 patients, and loss of appetite in 54/77 patients mentioning them in the questionnaire. Significant statistical correlation could be seen between the presence of pain, anxiety, depression, tiredness, and loss of appetite in the patients.

Conclusion: The study reveals that the distressing symptoms experienced by newly diagnosed cancer patients are grossly underreported and inadequately addressed by treating oncologists. Sensitizing the oncologists and incorporating palliative care principles early in the management of cancer patients could improve their holistic care.
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http://dx.doi.org/10.4103/0973-1075.185049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973495PMC
August 2016

Efficacy of three-tone disclosing agent as an adjunct in caries risk assessment.

Contemp Clin Dent 2015 Jul-Sep;6(3):358-63

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai, Tamil Nadu, India.

Background: Today, most approaches to caries viewed that catastrophic change in normal plaque biofilm is responsible for the disease. The behavior and composition of the biofilm are a reflection of the oral environment; the caries is a reflection of adverse changes occurring in that environment. Thus, it is important to identify the pathogenicity of the plaque biofilm so as to predict the caries risk. The recently developed three-tone plaque disclosing agent was used to test its ability in identifying the pathogenicity of plaque.

Aim: To assess the efficacy of three-tone plaque disclosing agent in identifying the plaque pathogenicity and correlate with the clinical caries status and microbiological findings.

Materials And Methods: Sixty children of 6-13 years age group of both sexes were clinically examined for caries and plaque scores, and then disclosing agent was applied; the color stained plaque samples were collected and cultured for microbiological assessment, and the data were analyzed based on the caries status of the children.

Results: There was a significant difference between the pathological plaque of caries active and caries free group (P < 0.05). The pathological plaque scores and the total colony counts, Streptococcus counts and mutans streptococci counts increased with the increase in caries.

Conclusion: Three-tone plaque disclosing agent was effective in identifying pathological plaque and can be used as one of the chairside adjuvants in caries risk assessment.
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http://dx.doi.org/10.4103/0976-237X.161887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549987PMC
August 2015

Comparative evaluation of shear bond strength and microleakage of tricalcium silicate-based restorative material and radioopaque posterior glass ionomer restorative cement in primary and permanent teeth: an in vitro study.

J Indian Soc Pedod Prev Dent 2014 Oct-Dec;32(4):304-10

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India.

Background: Restoration of carious primary molars is still a major concern while treating the young children that too in deep carious lesion which extends below the cemento-enamel junction (CEJ) where pulp protection and achieving adequate marginal seal are very important to prevent secondary caries. The needs were met with the development of new materials. One such of new bioactive material is tricalcium silicate-based restorative material (Biodentine), recommended for restoring deep lesions.

Aim: To evaluate and compare shear bond strength and microleakage of tricalcium silicate-based restorative material (Biodentine) and glass ionomer cement (Fuji IX GP) in primary and permanent teeth.

Materials And Methods: Occlusal surface of crowns were ground flat. PVC molds were stabilized over flat dentin surface and filled with tricalcium silicate-based restorative material (Biodentine)/glass ionomer cement (Fuji IX GP) according to group ascertained. Shear bond strength was evaluated using universal testing machine (INSTRON). Standardized Class II cavities were prepared on both primary and permanent teeth, and then restored with tricalcium silicate-based restorative material (Biodentine)/glass ionomer cement (Fuji IX GP) according to group ascertained, over which composite resin material was restored using an open sandwich technique. Microleakage was assessed using dye penetration. Microleakage was examined using a stereomicroscope.

Results: RESULTS showed that glass ionomer cement (Fuji IX GP) exhibited better shear bond strength than tricalcium silicate-based restorative material (Biodentine). Mean microleakage score for glass ionomer cement (Fuji IX GP) in permanent teeth was 1.52 and for primary teeth was 1.56. The mean microleakage for tricalcium silicate-based restorative material (Biodentine) in permanent teeth was 0.76 and for primary teeth was 0.60. Glass ionomer cement (Fuji IX GP) exhibited more microleakage than tricalcium silicate-based restorative material (Biodentine), which was statistically significant both in permanent (P = 0.02) and primary (P = 0.006) teeth.

Conclusion: Shear bond strength of glass ionomer cement (Fuji IX GP) is greater than tricalcium silicate-based restorative material (Biodentine) in both primary and permanent teeth. Tricalcium silicate-based restorative material (Biodentine) exhibited less microleakage compared to glass ionomer cement (Fuji IX GP) in both primary and permanent molars.
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http://dx.doi.org/10.4103/0970-4388.140952DOI Listing
August 2016

Comparative evaluation of fluoride release and recharge of pre-reacted glass ionomer composite and nano-ionomeric glass ionomer with daily fluoride exposure: an in vitro study.

J Indian Soc Pedod Prev Dent 2013 Oct-Dec;31(4):234-9

Departments of Pedodontics and Preventive Dentistry, Uthandi, Chennai, Tamil Nadu, India.

Aim: This in vitro study was designed to investigate the effects of daily fluoride exposures on fluoride release and recharge by prereacted glass ionomer (PRG) composite and nano-ionomeric glass ionomer.

Materials And Methods: Seventy-two specimens (36 of each material) were prepared and by placing the restorative materials into Teflon mold. Each specimen was subjected to one of three daily treatments (n = 12): (1) No fluoride treatment (control); (2) application of a fluoride dentifrice (1,000 ppm) once daily; and (3) the same regimen as (2), plus immersion in a 0.05% sodium fluoride (NaF) mouth rinse (225 ppm) immediately following the dentifrice application. Specimens were suspended in a storage vial containing 10 ml demineralizing solution for 6 h and transferred to a new test tube containing 10 ml remineralizing solution for 18 h. Fluoride treatments of the specimens were completed every day prior to their immersion in the demineralizing solution. Media solutions were buffered with equal volumes of total ionic strength adjustment buffer (TISAB) II; fluoride levels were measured using a digital ion analyzer and fluoride electrode throughout the 21 day duration of the experiment.

Results: Nano-ionomeric glass ionomer showed a better amount of fluoride release than PRG composite irrespective of the fluoride treatment supplementation (P < 0.01). Additional fluoride supplementation improved fluoride release and recharge ability for both the materials when compared to their respective control groups. The fluoride recharge for both materials did not show any sustained pattern of release.

Conclusion: Nano-ionomeric glass ionomer demonstrated a greater ability to release and recharge compared with that of PRG composite.
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http://dx.doi.org/10.4103/0970-4388.121820DOI Listing
September 2015

Child's dental fear: cause related factors and the influence of audiovisual modeling.

J Indian Soc Pedod Prev Dent 2013 Oct-Dec;31(4):215-20

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India.

Background: Delivery of effective dental treatment to a child patient requires thorough knowledge to recognize dental fear and its management by the application of behavioral management techniques. Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) helps in identification of specific stimuli which provoke fear in children with regard to dental situation. Audiovisual modeling can be successfully used in pediatric dental practice.

Aim: To assess the degree of fear provoked by various stimuli in the dental office and to evaluate the effect of audiovisual modeling on dental fear of children using CFSS-DS.

Materials And Methods: Ninety children were divided equally into experimental (group I) and control (group II) groups and were assessed in two visits for their degree of fear and the effect of audiovisual modeling, with the help of CFSS-DS.

Results: The most fear-provoking stimulus for children was injection and the least was to open the mouth and having somebody look at them. There was no statistically significant difference in the overall mean CFSS-DS scores between the two groups during the initial session (P > 0.05). However, in the final session, a statistically significant difference was observed in the overall mean fear scores between the groups (P < 0.01). Significant improvement was seen in group I, while no significant change was noted in case of group II.

Conclusion: Audiovisual modeling resulted in a significant reduction of overall fear as well as specific fear in relation to most of the items. A significant reduction of fear toward dentists, doctors in general, injections, being looked at, the sight, sounds, and act of the dentist drilling, and having the nurse clean their teeth was observed.
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http://dx.doi.org/10.4103/0970-4388.121815DOI Listing
September 2015

Prevalence of dentofacial abnormalities in children and adolescents with β-thalassaemia major.

Indian J Dent Res 2013 Jul-Aug;24(4):406-10

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India.

Background: β-thalassaemia major is a hereditary hemolytic anemia and the patients often experience growth retardation, protrusive maxilla, and depressed nasal bride leading to various degrees of malocclusion.

Aim: The purpose of this investigation is to find the prevalence of dentofacial abnormalities in β-thalassaemia major patients.

Subjects And Methods: Seventy-two patients between 6 and 18 years of age diagnosed with β-thalassaemia major were examined for extraoral abnormalities, malocclusion, oral hygiene, and dental caries. Data obtained were tabulated and statistically analyzed using Chi-square and paired t-test.

Results: Thirty-nine (54.2%) were males and 33 (45.8%) were females. Prominent extraoral abnormalities were found in 41 (56.9%) of the individuals. Study population predominantly had class I occlusion (59.7%) followed by class II occlusion (23.6%) and no class III occlusion. Mean oral hygiene index-simplified score was 2.43 ± 1.24, mean decayed missing filled teeth (DMFT) score was 7.10 ± 3.92, and deft was 5.68 ± 3.12.

Conclusion: Despite starting regular blood transfusion at an early age, β-thalassaemia major patients showed marked facial abnormalities. When compared with individuals with no systemic disease, oral hygiene status was similar, but the caries experience was higher in β-thalassaemia major patients. Therefore, emphasis to educate these patients in the prevention and control of dental caries and maintenance of good oral hygiene should be considered.
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http://dx.doi.org/10.4103/0970-9290.118360DOI Listing
September 2015

Comparative evaluation of the antimicrobial efficacy of four chewing sticks commonly used in South India: an in vitro study.

Indian J Dent Res 2012 Nov-Dec;23(6):840

Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai, Tamilnadu, India.

Background And Aim: The use of chewing sticks has been well documented since ancient times in India. Chewing sticks are a good alternative to the toothbrush for maintaining oral hygiene. The present study was designed and conducted to compare and evaluate the antimicrobial effects of the aqueous extracts of neem, miswak, mango, and banyan chewing sticks against two bacterial species considered the most important in the initiation and progression of dental caries, namely Streptococcus mutans and Lactobacillus acidophilus, respectively.

Materials And Methods: Twigs of the above mentioned chewing sticks were sun dried and powdered, and sterile aqueous solutions of 10%, 25% and 50% concentrations were prepared. Culture plates for S mutans and L acidophilus were prepared and the growth was transferred to nutrient agar and Mueller-Hinton agar; antimicrobial activity of the extracts was tested after 72 h, using the disc diffusion method. Normal saline was used as control.

Results: The antimicrobial activity of neem, miswak, and mango extracts increased as their concentrations increased. Both banyan extract and saline showed no antimicrobial activity against the organisms tested.

Conclusion And Recommendations: Based on the zones of inhibition, aqueous extracts of neem showed the most antimicrobial activity against S mutans, while miswak extracts showed superior antimicrobial activity against L acidophilus. We recommend further phytochemical and pharmacological studies to discover newer nonsynthetic tooth pastes and mouthwashes.
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http://dx.doi.org/10.4103/0970-9290.111283DOI Listing
April 2014