Iatrogenic alkalosis during high-dose methotrexate therapy

INSTRUCTIONS TO AUTHORS AND OTHER LITERARY WORKS OF FICTION
	.	p. 315
	DOI:10.4103/0019-509X.253303
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EDITORIAL
	Risk of second malignancy after modern conformal and proton beam radiotherapy-Minimizing risks, improving survivorshipInstructions to authors and other literary works of fiction	p. 316
	Srinivas Chilukuri, Rakesh Jalali DOI:10.4103/ijc.IJC_549_18
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GYNEC CANCER
	Barriers affecting uptake of cervical cancer screening in low and middle income countries: A systematic review	p. 318
	Pradeep Devarapalli, Satyanarayana Labani, Narayanasetti Nagarjuna, Poonam Panchal, Smita Asthana DOI:10.4103/ijc.IJC_253_18   BACKGROUND: Cervical cancer is the second-most common cancer among women in the developing world and approximately 500,000 cases are diagnosed each year. In developed countries, cervical cancer (CCa) accounts for only 3.6% of newly diagnosed cancers. OBJECTIVE: The present study aims to identify the most effective barriers associated with CCa screening uptake in low and middle-income countries (L and MICs) and aid to adopt effective measures to overcome prevailing barriers to the attainment of CCa uptake in the community. MATERIALS AND METHODS: Health sciences electronic databases like MEDLINE, PubMed, Cochrane library, and Google Scholar were searched for studies published until August 2017. Keywords used for the search were ("cervical cancer screening"), ("barriers"), AND ("low income countries" OR "Middle income countries"). Articles were reviewed and data were extracted by using Mendeley Desktop Software (V-1.17.10). Income-level classification of countries was done as per the World Bank 2017 report. Statistical software like SPSS-V.23 and Medical-V.14 were used for the statistical application. RESULTS: A total of 31 studies met the inclusion criteria with a total of 25,650 participants. The sample size of the included studies ranged from 97 to 5929 participants. Articles majorly reported data on participants from African region (51.6%) and minimally in the Western Pacific region (3.2%). Sampling methods among studies varied from convenience sampling-12 (39.7%) to consecutive sampling-1 (3.2%). Besides, two studies (6.5%) did not discuss their sampling procedures. It was observed that "Lack of information about CCa and its treatment" (Barrier of lack of knowledge and Awareness); "Embracement or shy" (Psychological Barrier); "Lack of time" (structural Barrier); and "Lack of family support" (Sociocultural and religious barrier) were the most commonly reported among all 22 barriers. CONCLUSION: There is a need of policies advancement of CCa screening programs by focusing on aspects of accessibility, affordability, CCa education, and the necessity of screening to improve screening uptake to control the CCa morbidity and mortality rate in L and MIC's.
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	A comparative analysis of quality of life after postoperative intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for cervical cancer	p. 327
	Sarthak Kumar Mohanty, Supriya Chopra, Anisha Mudaliar, Sadhana Kannan, Umesh Mahantshetty, Reena Engineer, Jaya Ghosh, Jyoti Bajpai, Sudeep Gupta, Shyamkishore Shrivastava DOI:10.4103/ijc.IJC_453_17   AIMS: The aim of this study is to compare the quality of life (QOL) between adjuvant three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) for cervical cancer. MATERIALS AND METHODS: QOL assessment was done at the baseline and then longitudinally after completing (chemo) radiation. All patients completed EORTC QLQ-C30 and EORTC QLQ Cx-24 modules. Independent-sample t-test was used to compare the mean scores between the two groups. Analysis of variance was used to compare differences in QOL measures over the six time points (baseline, post-RT, 3, 6, 9, and 12 months after treatment) and between treatment groups (3DCRT vs. IMRT). Linear mixed model was also performed to account for attrition. RESULTS: Overall, 64 patients (image-guided IMRT, n = 40 and 3DCRT, n = 24) completed QOL assessment. The median age and follow-up period were 48 years and 15.5 months, respectively. General QOL domains such as emotional (at 12 months, P = 0.04) and social (at 3 months, P = 0.02 and 12 months, P = 0.03) were better with IMRT. Pain (12 months, P = 0.03); fatigue (12 months, P = 0.05); nausea and vomiting (12 months, P = 0.03); insomnia (post-RT, P = 0.05 and 12 months, P = 0.03); appetite loss (post-RT and 12 months, P = 0.04); and diarrhea (6 months, P = 0.02 and 12 months, P = 0.003) scores were significantly better with IMRT. On linear mixed model analysis, there was a significant interaction between treatment cohort and assessment intervals for physical, emotional, and social functioning, appetite loss, diarrhea, lymphedema, and menopausal symptom scores were significantly better with IMRT. CONCLUSIONS: Treatment technique (IMRT vs. 3DCRT) impacts early QOL in undergoing adjuvant radiation for cervical cancer.
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	Prevalence and nonsexual transmission of human papilloma virus (HPV) in the adolescence girls from rural area of Maharashtra state, India	p. 336
	Atul Budukh, Amita Maheshwari, Vrushali Palayekar, Sonali Bagal, Pallavi Purwar, Kedar Deodhar, Rajesh Dikshit, Rajendra Badwe DOI:10.4103/ijc.IJC_188_18   OBJECTIVE: To find out the prevalence of human papilloma virus (HPV) in adolescent girls and to access the nonsexual transmission of HPV from their mother by using the same old cloth used by their mother. METHOD: Menstrual pads were collected from the women of age group years to find out the presence of HPV and whether it can be used as a cervical cancer screening tool. The results of the said study have been published in the European Journal of Cancer Prevention. During this study, menstrual pads of the daughters of participating women were collected to see the nonsexual transmission of HPV. After conducting the health education and obtaining the informed consent, we interviewed 57 mothers (age group 30–50, married, sexually active) and daughters [age group 12–18, unmarried (not exposed to sex)] from the rural area of Pune district of Maharashtra state, India. The menstrual pads were collected and transported to Mumbai for polymerase chain reaction (PCR) testing. HPV testing was carried out by PCR. RESULTS: Out of 57, 28 (49%) daughters and 23 (40.4%) mothers provided menstrual pad. Out of 23 mothers, one was HPV positive [4.3%: 95% confidence interval (CI) 0.2–23.0] and out of 28 girls, 3 (10.7%: 95% CI 2.0–33.0) were HPV positive. The daughter, whose mother was HPV positive, had negative result for HPV. CONCLUSION: The HPV prevalence in adolescence girls was 10.7%. There may be other nonsexual medium that might have caused HPV in adolescence girls, which needs further research.
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LUNG CANCER
	Correlation between human leukocyte antigen-G expression and clinical parameters in oral squamous cell carcinoma	p. 340
	Xianjun Shen, Peng Wang, Panpan Dai, Bei Jin, Yongqing Tong, Haisheng Lin, Gengsheng Shi DOI:10.4103/ijc.IJC_602_17   BACKGROUND: Human leukocyte antigen-G (HLA-G) is a tumor-associated molecule, whose expression may help the cancer cells to escape the immune response. AIMS: The aim of this study was to evaluate the diagnostic value of HLA-G level in oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: A total of 52 patients who had definite pathological diagnosis and 20 cases of healthy controls were enrolled in this clinical trial. Immunohistochemisty (IHC) and quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) analysis were considered for HLA-G identification and multilevel validations. Statistical analysis was performed using SPSS and statistical significance was determined at P < 0.05. RESULTS: IHC results demonstrated that the expression of HLA-G in OSCC was strongly positive and the rate of positive expression was 55.77% (29/52), but the expression of HLA-G in healthy controls was negative (0/20). Furthermore, RT-PCR results showed that the positive expression rate of HLA-G messenger RNA was weak in healthy controls, but strong in OSCC. Besides, HLA-G expression in the tumors was significantly correlated with histological grade. CONCLUSIONS: Our results suggested that HLA-G is associated with the prognosis of OSCC and may serve as a novel therapeutic target.
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BREAST CANCER
	Clinico-pathological characteristics and treatment outcome in invasive lobular carcinoma of the breast: An Indian experience	p. 344
	Ajay Gogia, Vinod Raina, Surya Vansham Suryanarayan Deo, Nootan Kumar Shukla, Sandeep Mathur, Bidhu Kalyan Mohanti, Daya Nand Sharma DOI:10.4103/ijc.IJC_428_18   BACKGROUND: Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer and accounts for 10%–15% of all breast cancers in the west. There is a scarcity of data on ILC from the Indian subcontinent. This report intends to present the patterns of care, survival outcomes, and prognostic factors of ILC treated in a tertiary care institute. MATERIALS AND METHODS: This retrospective analysis included consecutive patients diagnosed with ILC and registered at our Institute between 2009 and 2016. RESULTS: We included 97 patients with a median age of 53 years (range 28–80). American Joint Committee on Cancer (7th edition) stage distribution was stage I-8.24%, stage II-45.36%, stage III- 34.10%, and stage IV-12.30%. Bilateral breast cancer was seen in 8 cases. Estrogen receptor, progesterone receptor, and HER 2/neu positivity was 90%, 85%, and 9%, respectively. Triple-negative breast cancer constituted 5% of cases. Twenty-nine events were recorded (systemic and locoregional relapse) with a median follow-up of 3.5 years. Three years relapse-free survival (RFS) and overall survival were 80% and 60%, respectively. Bones were the most common site of metastasis. Age <45 years [HR-1.4 (0.8–2.1), P < 0.001] and advanced clinical tumor stage [T4, HR-2.1 (1.1–3.8), P = 0.001] were associated with poor RFS. CONCLUSION: ILC constituted 2.5% of breast cancer cases at our institute. Triple negativity and HER-2/neu positivity were seen in 9% and 5% of cases, respectively. Age <45 years and advanced clinical tumor stage were associated with poor RFS.
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	Comparison of harmonic scalpel and conventional technique in the surgery for breast cancer: A systematic review and meta-analysis	p. 348
	Zili Zhang, Lin Li, Yi Pang, Qi Li, Chunli Guo, Yongchao Wang, Chengpei Zhu, Xiangchao Meng DOI:10.4103/ijc.IJC_306_18   BACKGROUND: Harmonic scalpel is considered as a promising surgical tool for breast cancer, while its advantage over conventional approach is still controversial. Therefore, we performed this meta-analysis to compare the outcomes of harmonic scalpel and conventional tools in the surgery for breast cancer. MATERIALS AND METHODS: Studies reporting the outcomes of harmonic scalpel and conventional technologies were systematically searched from online databases, PubMed and EMBASE up to April 30, 2018. Data were presented as odds ratio, risk ratio (RR), and mean difference (MD) with 95% confidence interval (CI). RESULTS: Intraoperative blood loss (I2 = 96%, P < 0.05, MD = −68.78, 95% CI −93.31 to −44.24), seroma (I2 = 3%, P = 0.41, RR = 0.63, 95% CI 0.46–0.86) and hematoma formation (I2 = 0%, P = 0.64, RR = 0.41, 95% CI 0.23–0.73), drainage volume (I2 = 89%, P < 0.05, MD = −105.33, 95% CI −161.33 to −49.33) and time (I2 = 93%, P < 0.05, MD = −2.18, 95% CI −3.75 to −0.61), necrosis (I2 = 35%, P = 0.20, RR = 0.37, 95% CI 0.16–0.86), surgical duration (I2 = 79%, P < 0.05, MD = −8.49, 95% CI −16.56 to −0.43), and hospital stay (I2 = 97%, P < 0.05, MD = −0.94, 95% CI −1.74 to −0.14) are significantly different between the two groups. CONCLUSIONS: Harmonic scalpel is superior to conventional tools in terms of decreasing intraoperative blood loss, seroma and hematoma formation, drainage volume and time, necrosis prevalence, surgical duration, and hospital stay, which should be strongly recommended in the surgery for breast cancer.
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	Harmonic scalpel versus conventional diathermy: Is one really better than the other?	p. 359
	Suhani DOI:10.4103/ijc.IJC_551_18
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	Comparison of resection margins and cosmetic outcome following intraoperative ultrasound-guided excision versus conventional palpation-guided breast conservation surgery in breast cancer: A randomized controlled trial	p. 361
	Tejas Vispute, Suhani, V Seenu, Rajinder Parshad, Smriti Hari, Sanjay Thulkar, Sandeep Mathur DOI:10.4103/ijc.IJC_2_18   INTRODUCTION: Use of intraoperative ultrasound (IOUS) has been shown to help achieve satisfactory cosmesis and negative margins in breast conserving surgery (BCS). This study has been done to compare the oncological and cosmetic outcomes following BCS using conventional palpatory method and IOUS. MATERIALS AND METHODS: This is a prospective randomized controlled trial conducted at a tertiary care teaching and research institute in India. Patients with early operable breast cancer willing for BCS were included. Tumors were excised with 1 cm margin. In palpatory group, tumor was palpated and 1 cm margin was taken with a measuring scale while in the second group, IOUS was used to mark the margins. Histopathological evaluation was done to assess margins and cosmesis was assessed by patient, resident doctor, and nurse independently. RESULTS: Sixty patients were included, 32 in the ultrasonography-guided and 28 in palpation-guided wide local excision. The mean age of patients was 48.78 years. In both groups, mean tumor size was 3.18 cm. Margin thickness and positivity was higher in palpatory group (though P > 0.05). Most patients were satisfied with cosmesis. There was no significant difference in complications and specimen volume in both groups. Presence of ductal carcinoma in situ component and expression of Her2neu by tumor cells had a significant impact on margin positivity. CONCLUSIONS: Intraoperative use of ultrasound offers a real-time assessment of margin status and may reduce the margin positivity rate compared to conventional palpation-guided method.
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	Examination of methylation changes of VIM, CXCR4, DOK7, and SPDEF genes in peripheral blood DNA in breast cancer patients	p. 366
	Atefeh Shirkavand, Zahra Niki Boroujeni, Seyed Ahmad Aleyasin DOI:10.4103/ijc.IJC_100_18   BACKGROUND: Studying whole blood DNA methylation as a risk marker has valuable applications in either diagnosis or staging of breast cancer. We investigated whole blood DNA methylation status of VIM, CXCR4, DOK7, and SPDEF genes in breast cancer patients in comparison to healthy control subjects. MATERIALS AND METHODS: 60 patients with breast cancer and 40 healthy controls were examined. Genomic DNA isolated from peripheral blood and restriction enzyme polymerase chain reaction (REP) method was applied for analysis. Real-time PCR was used to confirm methylation status of the aforementioned genes and therefore to find out the methylation differences between normal and breast cancer subjects. RESULTS: Level of DOK7 promoter hypomethylation in normal and breast cancer samples was significant (P-value = 0.001). The study, also, showed that hypomethylation of VIM and CXCR4 genes are significant in patients compared with normal cases (P-value < 0.05). Furthermore, SPDEF promoter hypomethylation was not significantly differed between normal and breast cancer samples (P-value = 0.2). CONCLUSIONS: Hypermethylation of DOK7 gene in DNA from patients affected with breast cancer offers a biomarker for diagnosis of the breast cancer. This study indicates that methylation status of VIM and CXCR4 genes changes in breast cancer; so, they can be used as molecular biomarkers in breast cancer prognosis.
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BRAIN TUMORS
	The risk of secondary cancer in pediatric medulloblastoma patients due to three-dimensional conformal radiotherapy and intensity-modulated radiotherapy	p. 372
	Reham S Sherif, Wael M Elshemey, Ehab M Attalla DOI:10.4103/ijc.IJC_410_18   BACKGROUND: Craniospinal irradiation (CSI) is the standard radiation therapy treatment for medulloblastoma. The aim of this study was to estimate and compare the lifetime risk of radiation-induced secondary cancer in pediatric medulloblastoma patients using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: 3D-CRT and IMRT plans were performed for 10 CSI pediatric patients. The average absorbed doses for organs at risk (OARs) was calculated from dose-volume histograms on the treatment planning system. The average lifetime risk of radiation-induced secondary cancer was then calculated. RESULTS: Lifetime risk of secondary cancer for CSI pediatric patients treated using IMRT decreases in some OARs compared with those treated using 3D-CRT. This is attributable to the decrease in the average absorbed dose in some OARs when using IMRT technique. CONCLUSION: Follow-up of medulloblastoma pediatric patients should be performed after ending the treatment course in order to diagnose early secondary tumors. IMRT technique is substantially better than 3D-CRT in terms of lifetime risk of radiation-induced secondary cancer, probably due to reduced dose to OARs especially to the thyroid, which is the most sensitive organ to radiation.
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SHARED DECISION MAKING
	Jordanian physicians' perceived barriers and facilitators to patient participation in treatment decision-making: An exploratory study	p. 377
	Rana F Obeidat, Robin M Lally DOI:10.4103/ijc.IJC_122_18   BACKGROUND: Successful implementation of shared decision-making in clinical encounters is influenced by system, patient, and clinician factors that both facilitate and present barriers to patient-centered care. Little is known about which factors Jordanian physicians believe influence their ability to implement shared decision-making with cancer patients. AIMS: To determine Jordanian physicians' perceived barriers and facilitators to patient participation in treatment decision-making. SETTINGS AND DESIGN: A cross-sectional exploratory survey design was used in the study. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons was recruited. MATERIALS AND METHODS: A valid measure of physicians' views of shared decision-making was slightly modified from its original English and used to collect data. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for windows version 19.0 (SPSS, Inc., Chicago, IL, USA). Descriptive and inferential statistics were carried as appropriate. RESULTS: Insufficient time to spend with the patient, patient expecting a certain treatment rather than a consultation, and the patient's family overriding the decision-making process were the most frequently reported barriers to patient participation in treatment decision-making. Physicians believed that patients trust in physicians and patient being accompanied at the consultation were important facilitators of patient participation in treatment decision-making. CONCLUSIONS: Jordanian physicians perceive multiple barriers to patient participation in treatment decision-making. Patient-related difficulties (e.g., indecision), and system-related difficulties, in particular, patient's family influence on the decision-making process are more prevalent among Jordanian physicians compared to Western physicians.
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TOBACCO
	Effectiveness of two psychological intervention techniques for de-addiction among patients with addiction to tobacco and alcohol – A double-blind randomized control trial	p. 382
	Rahul Ganavadiya, B R Chandra Shekar, S Suma, Pallavi Singh, Ruchika Gupta, Poonam Tomar Rana, Shubham Jain DOI:10.4103/ijc.IJC_650_17   Objective: The objective of this study was to evaluate effectiveness of two psychological intervention techniques (reading – writing therapy vs. games – narrative therapy) using motivational intervention alone as a control among tobacco addicts. Materials and Method:This randomized control trial was conducted over a period of 6 months from April to September 2013 at a de-addiction center in Madhya Pradesh, India. Patients with moderate-to-high levels of dependence as determined by Fagerstrom Test for Nicotine Dependence (FTND) admitted for treatment in a de-addiction center were recruited. A cluster randomization technique was used for allocation of participants to three different groups. Group allocation was concealed from investigator and done by coordinator. Three interventions were group A – motivational intervention alone, group B – games and story therapy along with motivational intervention, and group C – reading and writing therapy along with motivational intervention. Interventions were applied for 1 month. Two postintervention follow-ups (one at the time of discharge and one after 1 month following discharge) were done to assess level of dependence using FTND besides undertaking urine cotinine analysis among three randomly selected participants in each group. Results: A total of 82 participants (28 in group A, 27 each in groups B and C) completed the study. Eighty-one (98.8%) participants had complete abstinence at the end of 1 month with no significant difference in the success rate between different categories (P = 0.357). At the end of 1 month following discharge from center, only 7 participants (8.5%) had complete abstinence and 51 participants (62.2%) had partial reduction and remaining 24 participants (29.3%) were considered failures with no difference between three groups (P = 0.768). Conclusion: Although overall abstinence was low (8.5%), all intervention techniques were equally effective in at least reducing level of dependence with no significant difference in their efficacy.
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	Designing and validation of text messages for m-Health intervention for tobacco cessation and management	p. 390
	Puneet Chahar, Vikrant R Mohanty, YB Aswini DOI:10.4103/ijc.IJC_569_17   BACKGROUND: Tobacco is a growing epidemic and tobacco-related death results in health consequences and lost economic opportunities. Tobacco cessation efforts mandate the use of multiple strategies to bring about behaviour change. AIM: To develop and validate health promotive text messages using transtheoretical model and prospect theory for behaviour change. SETTINGS AND DESIGN: The present observational study was conducted in a tertiary care hospital, Delhi among patients reporting at Tobacco Cessation Centre (TCC). METHODS: The study was divided into two phases: first involved development of text messages in local language (Hindi) using a sound theoretical basis (TTM and prospect theory) and second phase dealt with validation of the developed text messages by patients and experts in the field of tobacco cessation. STATISTICAL ANALYSIS: Descriptive statistics was obtained using the SPSS version 17. RESULTS: The sample comprised 20 males and 6 females. Average appeal score ranged from 6.1 to 9.6 (54 messages). Forty two messages out of a total of 54 messages were found to be appropriate after validation by the experts. Mean words of the final messages (42 messages) was 24.5 ± 1.3. Two hundred ninety one (90%) out of a total of 324 questionnaires showed adequate understanding of message as assessed by the reviewers. CONCLUSIONS: The current effort developed and validated health promotive text messages package to aid in tobacco cessation. The preventive text messages were grounded in evidence and sound theoretical basis and followed a standard validating procedure leading to satisfactory understanding and appeal in all domains.
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	The tobacco trade and trail in Karnataka	p. 394
	Punith Shetty, Roomani Srivastav, Arpan Debnath, R Murali, A Shamala DOI:10.4103/ijc.IJC_131_18   CONTEXT: Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. Despite innumerable laws, the overall picture of the current system is not clear and the menace of tobacco persists. What does it take to stop this menace? The present study made an attempt to throw some light on the prevailing discrepancy in the current system. AIMS: The aim of the study was to explore the knowledge and attitude of people involved in growth and sales of tobacco. MATERIALS AND METHODS:This qualitative research was aimed at farmers growing tobacco in Mysore district and vendors selling tobacco in Bangalore. Snowball sampling technique was used to select the farmers. Simple random sampling technique was used to shortlist vendors selling tobacco products in Bangalore. Data were collected using semistructured questionnaire through interviews which were recorded using an audio recorder. RESULTS: Inductive analysis was conducted for the present study and the responses were divided into three categories, that is, awareness of laws, compliance to laws, and opinion regarding banning tobacco. Ninety percent of the growers and all the tobacco vendors (100%) were aware of the laws governing them; however, the compliance was poor in both the populations (32% and 20%, respectively). CONCLUSIONS: Implementation of law is an area that needs to be strengthened. Violations of these laws are not adequately reported; this matter should be dealt with. It was seen that the system which creates the laws itself promotes the growth and thereby the distribution of the tobacco products.
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	Nicotinic acetylcholine receptor gene polymorphism is not associated with tobacco-related oral squamous cell carcinoma	p. 399
	Deepa Rajesh, SM Azeem Mohiyuddin, Sharath Balakrishna, A V Moideen Kutty DOI:10.4103/ijc.IJC_325_18   BACKGROUND: Nicotinic acetylcholine receptor is implicated in carcinogenesis indirectly through increasing nicotine dependence and directly through its impact on cell-cycle regulation. Functional polymorphism in nicotinic acetylcholine receptor alpha-5 subunit gene (CHRNA5 c.1192G>A; rs16969968) is associated with nicotine dependence and risk of lung cancer. AIM: The aim of this study was to evaluate the association of CHRNA5 c.1192G>A polymorphism with the risk of oral squamous cell carcinoma (OSCC). SETTINGS AND DESIGN: This was a rural teaching hospital-based case-control study. MATERIALS AND METHODS: A total of 100 histopathologically confirmed cases of OSCC patients and 100 age- and gender-matched healthy individuals were genotyped for CHRNA5 c.1192G>A polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. Allele and genotype frequencies among case and control groups were compared by Chi-squared test (Fisher's exact). RESULTS: The frequency of CHRNA5 c.1192A allele was 22% in OSCC patients and 26% in control individuals. The difference in the distribution of alleles and genotypes between case and control groups was not significant (P > 0.05). CONCLUSIONS: CHRNA5 c.1192G>A polymorphism is not associated with the risk of developing OSCC.
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	Prevalence of oral mucosal lesions among smokeless tobacco usage: A cross-sectional study	p. 404
	Kaveri Hallikeri, Venktesh Naikmasur, Kruthika Guttal, Mangalore Shodan, Niranjan Kochli Chennappa DOI:10.4103/ijc.IJC_178_18   BACKGROUND: Tobacco use is one of the most prevalent forms of habit and associated with development of potential malignant disorders. The aim of the present study was to investigate the prevalence and distribution of oral mucosal lesions (OMLs) among smokeless tobacco users. MATERIALS AND METHODS: This is a hospital-based cross-sectional study. All the patients with the history of smokeless tobacco habit were included in the study. The patients were interviewed using the preformed questionnaire, including the patient's demographic details, the type of habit, duration, frequency, and the associated oral mucosal pathology. Further, patients were clinically examined and recorded on tobacco-related oral lesions. RESULTS: Prevalence of OML was 54.18%, and 91.50% being among male and with higher frequency at the age of second and fourth decade. The prevalence of oral submucous fibrosis, leukoplakia, carcinoma, lichen planus, and erythroplakia was 26.95, 10.35, 9.94, 5.5, and 0.66%, respectively. Smokeless tobacco habit was prevailing among males (98.79%) compared to females (9.37%). Frequency of habit-associated OML was statistically significant with odds ratio 0.24. CONCLUSION: The study proves a definite association between smokeless tobacco habit and OML. The data necessitate to correlate and follow up the individuals with smokeless form of tobacco habits to establish the definite correlation between the habit and oral mucosal lesions.
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CASE REPORTS
	A novel frameshift mutation in the MLH1 gene in a patient with Lynch syndrome	p. 410
	Arti S Pandey, Sudip Shrestha DOI:10.4103/ijc.IJC_349_18   A novel mutation in the MLH1 gene likely to be pathogenic for Lynch syndrome was discovered in a proband with a family history of colon cancer. Immunohistochemistry showed negative expression of PMS2 and MLH1 in the resected tumor sample. The mutation lies at the highly conserved C-terminus of the MLH1 protein, the region through which it dimerizes with PMS2 to carry out its mismatch repair function.
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	Creatinine kinase elevation and peripheral neuropathy during nivolumab treatment of a patient with metastatic renal cell carcinoma	p. 413
	Melih Simsek, Mehmet Bilici, Salim Basol Tekin DOI:10.4103/ijc.IJC_151_18   We report elevation of creatinine kinase (CK), which is an uncommon adverse event related to treatment with nivolumab. Nivolumab is a monoclonal antibody against programmed cell death-1 and an effective agent in metastatic renal cell carcinoma (RCCa). Here, we report a case of 58 year-old male receiving nivolumab as fourth-line treatment for metastatic RCCa. The patient was admitted to our clinic with pelvic pain and weakness in his legs. Elevated CK level was noted and he was hospitalized. About 1 mg/kg methylprednisolone was initiated and nivolumab was discontinued. On the second day of his hospitalization, left facial palsy occurred. After his neuropathy improved and CK level normalized, the patient was discharged. Neurological immune-related adverse events are very rare with nivolumab but can be serious.
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IMAGES IN ONCOLOGY
	Trousseau's sign in the left internal jugular vein in gastric cancer	p. 415
	Dillibabu Ethiraj, Venkatraman Indiran, Kannan Kanakaraj, Prabakaran Madhuraimuthu DOI:10.4103/ijc.IJC_321_18
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VIEWPOINT
	Potential role of whole-body diffusion magnetic resonance imaging in tumor staging for pregnant patients with cancer	p. 417
	Abhishek Mahajan, GV Santhosh Kumar, Tanvi Vaidya, Meenakshi Thakur, Subhash Desai DOI:10.4103/ijc.IJC_244_18   Malignancy during pregnancy poses a serious threat to the growing fetus. In this special situation, the diagnostic procedures and treatment to cancer will be more damaging to the developing fetus than the cancer itself. However, to safeguard the health of the mother from cancer, appropriate diagnostic and therapeutic tools are to be used that would minimize risk to fetal health. Diffusion-weighted whole-body imaging with background body signal suppression has the potential to answer most of these diagnostic dilemmas in the case of malignancy in pregnancy. This is one of the first such reports highlighting the role of a noninvasive, nonionizing whole-body imaging technique which does not require external contrast injection and can also be used for monitoring treatment response.
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	Cancer has almost a similar psychosocial impact on family caregivers as those of the patients; but are we doing enough for them?	p. 419
	Sourav Goswami, Subodh Saran Gupta DOI:10.4103/ijc.IJC_628_18
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LETTER TO THE EDITOR
	Skin and mucosal ulcerations and acute kidney failure due to methotrexate toxicity in a patient with non-Hodgkin's lymphoma	p. 421
	Xia Song, Yinyin Guo, Hui Zhao, Wenbiao Hu DOI:10.4103/ijc.IJC_195_18
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	Health and well-being of cancer caregivers in a changed role of breadwinners	p. 422
	Md Mahbub Hossain DOI:10.4103/ijc.IJC_266_18
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	Iatrogenic alkalosis during high-dose methotrexate therapy: An avertable cause	p. 423
	Kritika Agrawal, Satyajit Majhi, Nishkarsh Gupta, Rakesh Garg DOI:10.4103/ijc.IJC_92_18
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HISTORY OF CANCER
	A pituitary tumor turned-to-be a glioma: A surgical case from the Madras General Hospital 1928	p. 424
	Ramya Raman, Anantanarayanan Raman DOI:10.4103/ijc.IJC_12_19   A three-page paper entitled "A case of glioma (embryonal neurocytoma) of the brain simulating pituitary tumour," written by K. G. Pandalai, Surgeon at the Madras General Hospital, and T. B. Menon, Pathologist at the Madras Medical College, was published in the Indian Medical Gazette. This paper refers to an occasional finding of a brain tumor (a glioma), presurgically diagnosed as a pituitary tumor, in 1928. This was close to the period when surgeons across the developed world believed in that cancers were by no means common among the native people of India as it was in Europe. Leopold Rogers of the Bengal Medical Service, Calcutta, in 1925 refuted this belief indicating that malignant tumors were equally common in Bengal (India) and England. Nevertheless, this report by Pandalai and Menon strikes a unique chord since the tumor was subsequently determined as a glioma – an embryonal neurocytoma -– with adequate evidences drawn from the state-of-the-art volume "A classification of the tumors of the glioma group on a histogenetic basis with a correlated study of prognosis" by Percival Bailey and Harvey Cushing published in Philadelphia in 1926. This Pandalai-–Menon report impresses as pioneering and trailblazing, on a brain tumor detected in 1928, given that earliest exclusive departments of neurosurgery were established in Christian Medical College, Vellore, and Madras Medical College, Madras, by Jacob Chandy and Balasubramanian Ramamurthi, respectively, nearly two decades later.
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