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Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Oral cancer is common in men from developing countries, and is increased by tobacco and alcohol use. We aimed to assess the effect of visual screening on oral cancer mortality in a cluster-randomised controlled trial in India. Of the 13 clusters chosen for the study, seven were randomised to three rounds of oral visual inspection by trained health workers at 3-year intervals and six to a control group during 1996–2004, in Trivandrum district, Kerala, India. Healthy participants aged 35 years and older were eligible for the study. Screen-positive people were referred for clinical examination by doctors, biopsy, and treatment. Outcome measures were survival, case fatality, and oral cancer mortality. Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis. Analysis was by intention to treat. Of the 96 517 eligible participants in the intervention group, 87 655 (91%) were screened at least once, 53 312 (55%) twice, and 29 102 (30%) three times. Of the 5145 individuals who screened positive, 3218 (63%) complied with referral. 95 356 eligible participants in the control group received standard care. 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group (mortality rate ratio 0·79 [95% CI 0·51–1·22]). 70 oral cancer deaths took place in users of tobacco or alcohol, or both, in the intervention group, compared with 85 in controls (0·66 [0·45–0·95]). The mortality rate ratio was 0·57 (0·35–0·93) in male tobacco or alcohol users and 0·78 (0·43–1·42) in female users. Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37 000 oral cancer deaths worldwide.

Abstract Background: Oral cancer is a major health problem in India. Recently an increase in the oral cancer incidence among young individuals without any habits was observed, which may be due to Human Papilloma Virus (HPV). However, information on the prevalence of HPV in oral cancer in India is sparse. This study aims to document the frequency of HPV16 infection in oral squamous cell carcinoma (SCC) and to study its correlation with treatment outcome. Methods: Paraffin-embedded tissue blocks of 183 patients with SCC of the oral cavity were studied. HPV16 prevalence was detected by a polymerase chain reaction and expression of p16INK4a was analyzed by immunohistochemistry. This was correlated with clinical outcomes. Results: The prevalence of HPV 16 was 6.6% and all were carcinoma tongue. All HPV-positive patients showed intense expression of p16INK4a. The five-year overall survival (OS) and disease-free survival (DFS) for HPV positive patients were higher compared to HPV negative patients (100% versus 74.5% and 100% versus 70.8% respectively). The five-year OS and DFS for patients with p16INK4a intense expression were also higher compared to p16INK4a weak expression (91.2% versus 57.4% and 82% versus 22.5% respectively). Five-year OS and DFS of patients with HPV16 positivity and p16INK4a intense expression were significantly higher than patients with HPV negative and p16INK4a weak expression (100% versus 54.7% and 100% versus 22.5% respectively). Conclusion: The frequency of HPV16 positivity in oral cancer was low in this study with a site predilection to the oral tongue. p16INK4a expression did not correlate with HPV status. A better treatment outcome was observed in HPV-positive cancers. We also observed better treatment outcomes in patients with p16INK4A overexpression irrespective of HPV status.

BackgroundIn India, cardiovascular events are often diagnosed at lower blood pressures (BP) than in Western countries, questioning whether the actual World Health Organization cut-off points for hypertension (systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mm Hg) are appropriate in low resource countries.MethodsA large population-based cohort study including 167 331 adults aged 35–90 years, living in a rural area, was followed up during a 7-year mean duration for all-cause mortality and cardiovascular disease (CVD) deaths. At baseline, casual BP was measured, and lifestyle was assessed through a questionnaire. Death rates were calculated according to SBP and DBP, and their association was examined in a multivariate analysis, among all subjects, then stratified by sex and age groups.ResultsForty-five per cent of the study subjects had hypertension. The nadir of CVD death rates was observed at 110 mm Hg for casual SBP and 75–80 mm Hg for casual DBP. In the multivariate analysis, SBP from 120 mm Hg and DBP from 90 mm Hg were significantly associated with risks of ischaemic heart disease and stroke. High SBP and DBP values were greater predictors of mortality in the young age group (34–44 years) than in the old age group (65+ years). SBP was a stronger independent predictor of CVD than DBP.ConclusionsSBP and DBP were associated with CVD mortality at thresholds lower than the current hypertension definition. Measurement limited to SBP alone would be effective in screening for CVD risk in large populations.

A population based cohort study including 167 343 adults aged 34 and above living in a rural area were recruited and followed-up during January 1996–December 2004 as part of an ongoing oral cancer screening programme. Blood pressure and body mass index (BMI) were measured at baseline and at 3 year intervals. Demographic details and lifestyle factors were also collected through a questionnaire. These subjects were actively followed-up for vital status by field workers through municipal death registers, records collected from social and religious organisations, and during repeated house visits and cause of deaths were determined by verbal autopsy.The mortality risks associated with chewing (and 95% CIs), after adjusting for age, sex, socio-economic dietary variables, and for other habits, were 0.90 (0.86 to 0.94) for all-cause, 1.07 (0.94 to 1.22) for cancer and 1.22 (1.04 to 1.44) for tobacco-related cancer; with smoking the respective mortality risks were 1.31 (1.24 to 1.39), 1.63 (1.37 to 1.94) and 1.68 (1.36 to 2.08); and with alcohol use the risks were 1.13 (1.06 to 1.20), 1.32 (1.11 to 1.57) and 1.47 (1.19 to 1.80). Reduced risk of all-cause mortality by chewing was observed only in the 60–84 years old group (0.90 (0.85 to 0.94)), and detrimental effects of chewing on cancer mortality were shown in the young and middle-age groups: 34–39 years old (1.33 (0.67 to 2.65)), and 40–59 years old (1.26 (1.03 to 1.55)). An analysis of the association between BMI and change in weight in relation to mortality risk showed that low BMI was found to be a predictor of mortality, while high BMI was not.

Background: This study examines socio-demographic determinants of participation in a population-based randomized controlled trial that proved that oral visual inspection was effective in reducing oral cancer mortality in high-risk individuals in India. Methods: Multivariate logistic regression was used to establish socio-demographic characteristics of participants versus non-participants in the intervention arm. Compliance with referral was analysed according to the socio-demographic characteristics of screen-positives. Results: Of 96,517 eligible subjects, 87,655 were screened, 8688 individuals never received the invitation and 174 refused screening. Compared to the non-screened, a higher proportion of screened individuals were women (OR = 4.51; CI: 4.28–4.75), lived in better housing (OR = 1.35; CI: 1.25–1.41), had television/radio (OR = 1.50; CI: 1.43–1.58) and were tobacco and alcohol users (OR = 2.75; CI: 2.57–2.95). Being 65 and older decreased the chances of screening (OR = 0.39; CI: 0.37–0.42), as well as living in high-size households (OR = 0.73; CI: 0.68–0.78). Sixty-three percent of 5143 screen-positives complied with referral. Controlling for all other factors, individuals older than 44, and those with more advanced lesions were more likely to comply with referral ( p < 0.001). Individuals living in better housing were less likely to comply with referral (OR = 0.79; CI: 0.65–0.95). Conclusions: In summary, adequate coverage can be obtained in population-based oral screening in developing countries. The study underscores the important role of patient-provider communication in assuring high compliance with referral.

Masked Image Modelling (MIM) is an effective self-supervised pre-training (SSP) task that helps models learn task-agnostic representations, improving fine-tuning for downstream tasks. However, in remote sensing, high random masking ratios hinder the capture of small objects and local details, causing misalignment between pre-training and fine-tuning. To address this, we propose Object-Centric MIM (OCMIM) for better object-level representation learning. First, an object-centric data generator automatically sets up targeted pre-training data based on object characteristics, optimizing object detection. Second, an attention-guided mask generator enhances MIM by focusing on highly attended object regions instead of random masking. This approach improves feature discrimination and object detection performance. Experiments on six remote sensing benchmarks demonstrate that OCMIM-based SSP outperforms traditional methods, making it a superior pre training strategy for remote sensing object detection.

Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest. We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan-accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37-1.51) and 1.48-fold (1.38-1.58) elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%-17.2%) and 3.3% (2.6%-4.0%) of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000-1,744,700). Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y. Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented. Please see later in the article for the Editors' Summary.

To evaluate oral cancer screening by visual inspection. A cluster randomized controlled trial was initiated in Trivandrum district, Kerala, India. Of 13 population clusters, seven were randomly allocated to three rounds of screening between 1996 and 2004, while standard care was provided in six (control arm). An activity-based approach was employed to calculate costs associated with various components of the screening trial. Information on the resources used and on clinical events in each trial arm was derived from trial databases. Total costs for each cluster were estimated in 2004 United States dollars (US$). The incremental cost per life-year saved was calculated for all eligible individuals and for high-risk individuals (i.e. tobacco or alcohol users). The proportion of oral cancers detected at an early stage (i.e. stage I or II) was higher in the intervention arm than the control arm (42% versus 24%, respectively). The incremental cost per life-year saved was US$ 835 for all individuals eligible for screening and US$ 156 for high-risk individuals. Oral cancer screening by visual inspection was performed for under US$ 6 per person. The most cost-effective approach to oral cancer screening by visual inspection is to offer it to the high-risk population. Targeted screening of this group will ensure that screening can be offered at a reasonable cost in a limited-resource setting.