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2020| July-September | Volume 57 | Issue 3
Online since
August 10, 2020
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CASE REPORTS
Primary retroperitoneal GIST: Case report and review of literature
Krunal H Khobragade, Shraddha Patkar, Mahesh Goel, Ayushi Sahay
July-September 2020, 57(3):334-336
DOI
:10.4103/ijc.IJC_556_18
PMID
:32675441
Extraintestinal gastrointestinal stromal tumors (EGISTs) are mesenchymal tumor with no connection to tubular gastrointestinal system. They commonly arise from omentum and mesentry. Retroperitoneum is a rare primary site. We herein report a case of a 33 year old woman who underwent upfront surgery for primary retroperitoneal gastrointestinal stromal tumor and is now disease-free on adjuvant Imatinib.
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BREAST CANCER
Study of Ki-67 index in the molecular subtypes of breast cancer: Inter-observer variability and automated scoring
Divya Meermira, Meenakshi Swain, Swarnalata Gowrishankar
July-September 2020, 57(3):289-295
DOI
:10.4103/ijc.IJC_719_18
PMID
:32769300
Background:
Ki-67 index is an important prognostic marker in breast cancer and is also used to differentiate luminal A subtype from luminal B. Inter-observer variations in determining the index and the cut-off value to be considered in distinguishing the two subtypes remain problems in clinical practice.
Methods:
MIB-1 immunohistochemistry was done on 200 cases of breast cancer with 50 cases in each molecular subtype. The Ki-67 scoring was done manually by two observers and automated method (using the software ImmunoRatio). The mean value of Ki-67 was calculated in each molecular group and in the entire estrogen receptor and progesterone receptor (ER/PR) positive group. The inter-observer variability between the two observers and the automated method was also assessed.
Results:
The mean and median values of Ki-67 of all the 200 cases obtained by manual scoring was 31.13% and 29.65% by observer 1, 28.48% and 27.90% by observer 2, and 38.27% and 35.45% by the automated method. The mean Ki-67 value obtained by manual scoring, in luminal A, luminal B, HER2 enriched and triple negative was 21.07%, 37.19%, 33.72% and 27.27%, respectively. There was significant correlation between the two observers and with the automated scoring.. The mean value of the Ki-67 index in the ER/PR positive group was 29.1%.
Conclusion:
The inter-observer correlation and the correlation with the automated scoring system of the Ki-67 index was good. 29.1% was the mean Ki-67 index in the ER/PR positive group and this value was within the acceptable range as per St Galen's recommendation.
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REVIEW ARTICLES
Dexmedetomidine in cancer surgeries: Present status and consequences with its use
Abhijit S Nair, Mohammed Salman Saifuddin, Vibhavari Naik, Basanth Kumar Rayani
July-September 2020, 57(3):234-238
DOI
:10.4103/ijc.IJC_376_19
PMID
:32769293
Dexmedetomidine is a centrally acting α2 adrenoreceptor agonist used in perioperative medicine due to its sedative, analgesic and sympatholytic properties. Recently animal data has pointed towards potential role of dexmedetomidine in promoting cancer recurrence and metastasis when used perioperatively especially after breast surgeries. This is because of presence of α2 adrenoreceptors in breast cancer tissue. We reviewed existing literature in which dexmedetomidine was used in cancer surgeries and investigated its role in recurrence and metastasis.
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TOBACCO
Enhancing identification and counseling skills of dental undergraduate students using a customized Tobacco Counseling Training Module (TCTM) – A piloting of the process using ADDIE framework
BR Chandrashekar, TV Chacko, KM Anand, K Suvetha, HP Jaishankar, S Suma
July-September 2020, 57(3):296-310
DOI
:10.4103/ijc.IJC_229_19
PMID
:32769291
Background:
Tobacco use has emerged as a major public health problem. But, most graduates in medical and dental schools receive limited systematic training. The objective of this education innovation project was to enhance dental undergraduate student's ability to identify tobacco users through oral manifestations and improve their counseling skills using a customized Tobacco Counseling Training Module (TCTM).
Methods:
A TCTM for students of dentistry was developed using ADDIE framework as a guide. Content and construct validation of the module was done by six subject experts using Delphi technique for obtaining consensus. Pilot testing was done on 20 students of third year BDS. Pre- and post-intervention assessment of knowledge, attitude, self-confidence was done using learning outcomes questionnaire. Ability to correctly identify oral manifestations was assessed using extended item MCQs and tobacco counseling skills using a modified KEECC. The difference in mean scores were computed and subjected to further statistical analysis using SPSS version 22.
Results:
There was a significant improvement in post intervention scores for mean knowledge (5.5 ± 1.4 to 13.2 ± 1.1), attitude (5.6 ± 0.9 and 8.5 ± 0.5), self-confidence (1.5 ± 0.5 and 3.1 ± 0.2), ability to correctly identify oral manifestations (5.2 ± 1.4 and 9.4 ± 0.8) and tobacco counseling skills.
Conclusion:
It is possible to introduce the module in the existing curriculum and its effectiveness evaluation shows benefit in terms of Kirkpatrick's Level 1, 2, 3 (improvement in knowledge, attitude, self-confidence, ability to identify oral manifestations, and tobacco counseling skills) of training effectiveness.
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BREAST CANCER
Breast cancer in Andaman and Nicobar Islands: A retrospective analysis
PP Abdul Shahid, Lena Charlette Stephen
July-September 2020, 57(3):282-288
DOI
:10.4103/ijc.IJC_707_18
PMID
:32675443
Background:
Breast cancer is the most common cancer in India among women. This study was conducted to describe the demographic, clinical, histopathological, endocrinological and survival pattern of breast cancer patients in Andaman and Nicobar Islands.
Methods:
The study was done in Medical Oncology department of GB pant hospital. Data was retrieved from the case sheets of patients who consulted from 1st February 2015 to 31st January 2018. As this hospital is the only referral hospital, the patients are representative of all cancer patients in the Island, and the population base is well defined.
Results:
During the study period, 85 breast cancer patients were treated. Of the 82 female patients, the standardized incidence rates in 2015, 2016 and 2017 were 8.82, 13 and 14.42 per 100,000 women respectively. The prevalence and mortality rates in 2015, 2016, 2017 were 14.88, 27.96, 40.37, and 1.1, 2.74, 0.55 per 100,000 women respectively. Metastasis was detected at the time of diagnosis in 18.8% of patients. Estrogen receptor (ER) and progesterone receptor (PR) positivity was reported in 55.9% of patients, HER 2 positivity in 28.1% and triple negativity in 27.3%. The overall survival at 12, 24, and 36 months follow-up were 88.9%, 84.3% and 52.7% respectively. In univariable analysis, the hazard ratios were significantly higher for patients with metastasis and diagnosis before 2015.
Conclusion:
As compared to the country, breast cancer incidence was lower in the Islands with better survival. Stage at diagnosis was the most important factor determining survival in these patients.
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CASE REPORTS
Primary yolk sac tumor of orbit: Report of a rare case
Sandhya V Poflee, Prajkta S Pawar, Nilesh S Gaddewar, Waman K Raut
July-September 2020, 57(3):337-339
DOI
:10.4103/ijc.IJC_595_18
PMID
:32594074
Extragonadal germ cell tumors (GCTs) of head and neck region account for 5% of all benign and malignant GCTs. Orbit is an uncommon site for occurrence of extragonadal GCTs. Pure yolk sac tumor (YST) of orbit is a rare neoplasm and only a few cases are reported in the literature. An 18-month-old boy presented with right eye proptosis of 2 months duration. Because of rapid clinical course and magnetic resonance imaging (MRI) findings, neoplastic lesion was suspected. Histopathological examination of the biopsy revealed neoplasm with possibility of GCT. Raised serum alpha-feto-protein levels suggested YST component. Positivity for immunohistochemical markers Glypican-3 and SALL4 confirmed pure YST nature of the tumor. The child received six cycles of cisplatin-based chemotherapy with significant reduction in size of the tumor, followed by exenteration of the orbit. This case is reported for its rarity as well as for highlighting diagnostic characteristics and management of orbital YST.
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PICC fracture and embolization into pulmonary artery - a rare but potentially life-threatening complication: A case report
VP Krishnan, Shreepal Jain, Jayashree Mishra, Sangeeta Mudaliar
July-September 2020, 57(3):340-342
DOI
:10.4103/ijc.IJC_834_18
PMID
:32788437
Peripherally inserted central catheter (PICCs) are popular means of long-term intravenous access in oncology patients. Fracture and embolization are rare but potentially serious complications. Here we present an unusual fracture of the PICC line in a 9-year-old boy with Ewing's sarcoma with embolization to the right ventricle (RV) and right pulmonary artery (RPA) which was retrieved percutaneously by trans-catheter snare assisted retrieval. Adequate care and precautions like handling by trained nursing staff/parental education must be undertaken to prevent such complications.
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A complex karyotype with t(11;12)(q23;p13) translocation with coexistent clones of deletion 5q and cryptic deletion 7q in acute myeloid leukemia
Anurita Pais, Shailesh Pande, Gauri Pradhan, Smita Patil
July-September 2020, 57(3):330-333
DOI
:10.4103/ijc.IJC_473_18
PMID
:32675439
We report a rare case of acute myeloid leukemia (AML) with a cytogenetically complex karyotype with coexistence of KMT2A/MLL Mixed Lineage Leukemia (11q23) rearrangement with 5q deletion and 7q deletion as unrelated clones along with evolution of a subclone with translocation between chromosomes 6 and 17. A novel MLL fusion partner region 12p13 was identified in a 52 year old woman who presented with pyrexia of unknown origin. Unraveling the complexity of genomic alterations occurring in AML patients will lead to better understanding of leukemic transformation and identification of subsets of patients that may respond differently to therapy.
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COMMENTARY
Living with cancer: Urgent need for emotional health support
Annie Alexander, R Srinivasa Murthy
July-September 2020, 57(3):360-362
DOI
:10.4103/ijc.IJC_113_19
PMID
:32594071
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EDITORIALS
A call for transparency in data reporting
Sudeep R Shah, CS Pramesh, Vinay H Deshmane
July-September 2020, 57(3):229-230
DOI
:10.4103/ijc.IJC_882_20
PMID
:32788433
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Ki-67 in breast cancer:
Simulacra and simulation
Tanuja Shet
July-September 2020, 57(3):231-233
DOI
:10.4103/ijc.IJC_565_19
PMID
:32769299
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GENITOURINARY TRACT
Mucinous tubular and spindle cell carcinoma of the kidney: A case series with a brief review of the literature
Shraddha A Adamane, Santosh Menon, Gagan Prakash, Ganesh Bakshi, Amit Joshi, Palak Popat, Sangeeta B Desai
July-September 2020, 57(3):267-281
DOI
:10.4103/ijc.IJC_642_18
PMID
:32675442
Background:
Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare low grade renal tumour exhibiting characteristic morphological features. We share our experience and discuss briefly, a review of the current literature.
Methods:
Electronic medical records were searched between January 2005 to January 2017. The histopathology and immunohistochemistry slides were retrieved and reviewed.
Results:
Eleven cases of MTSCC were identified. Mean age at presentation was 53.9 (age range 41 to 71) years with a slight female preponderance (F: M=6:5). Clinical stage at presentation was: Stage I (4 cases), Stage II (3 cases), Stage III (1 case), and Stage IV (3 cases). The average tumour size was 7.5cm (range 3.5 to 17cm). Microscopically, characteristic biphasic tumour with tubular and spindle cell morphology with variable mucinous stroma was noted in all. The prominent immunohistochemical profile revealed positivity for CK7 (7/8, 87.5%), AMACR (6/8, 75%), AE1/3 (4/4, 100%), CD10 (3/10, 27.3%), and Vimentin (3/3, 100%). Seven patients (Stage I and II) had been treated with nephrectomy, whereas only a diagnostic biopsy was available in four patients who presented with locally advanced disease (n=1) or distant metastasis (n=3) at presentation. The mean follow-up was 37.8 months (range 8 to 96 months), available in 10 out of 11 patients, without recurrence in nine while one died 8 months after diagnosis.
Conclusion:
MTSCC is an indolent renal cancer with characteristic morphology. However, presentation with locally advanced disease or distant metastasis may be seen in a subset of these patients. This warrants close follow-up in even localized tumors.
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HEMATOLYMPHOID MALIGNANCY
Changes in social support among patients with hematological malignancy undergoing hematopoietic stem cell transplantation in Souzhou, China
Yongchun Liang, Mingming Zhou, Wei Yu, Haifang Wang
July-September 2020, 57(3):253-261
DOI
:10.4103/ijc.IJC_443_18
PMID
:32788435
Background:
Evidence regarding social support in patients is mostly from cross-sectional studies. Very few studies have focused on the change in social support systems before and after hematopoietic stem cell transplantation.
Methods:
A total of 191 patients were investigated before transplantation and at 30, 90 and 180 days post-transplantation. The social support for patients was evaluated by the Perceived Social Support Scale (PSSS).
Results:
The overall PSSS scores showed a continuous decline in means from 71.29 ± 9.73 before the transplantation to 69.44 ± 10.61, 68.73 ± 10.04, and 66.37 ± 12.02 at 30, 90 and 180 days post-transplantation, respectively. In comparison to the baseline, the overall PSSS scores decreased significantly at 90 and 180 days post-transplantation (
P
< .05). The Generalized Estimated Equation (GEE) analysis found that patients with no transplant-related complications, higher household income, and better educational status had preferable social support.
Conclusion:
Social support presented a marked downward trend during the six month period. Patients with no transplant-related complications, higher household income and better educational status had preferable social support. Therefore, social support as a high-priority quality of life should be given close attention in the early phase of transplantation. Positive measures should be taken to improve social support in the early phase of transplantation especially among individuals undergoing this procedure for the first time.
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Outcomes of T-lymphoblastic lymphoma treated with pediatric ALL-like protocol
Manju Sengar, Robert Carr, Hasmukh Jain, Raajit Chanana, Venkatesh Rangarajan, Epari Sridhar, Tanuja Shet, Hari Menon, Sumeet Gujral, Siddhartha Laskar
July-September 2020, 57(3):262-266
DOI
:10.4103/ijc.IJC_616_18
PMID
:32594075
Background:
The management of T-lymphoblastic lymphoma (T-LBL) in adults poses uncertainties, including optimal chemotherapy regimen, need for radiotherapy, and the benefit of stem cell transplant. This retrospective case series investigated the efficacy of the pediatric BFM-90 regimen in adult patients and evaluated the role of early response assessment by positron emission tomography with computed tomography (PET-CT) in predicting outcomes.
Methods:
Patients aged 15 years or older with T-LBL diagnosed at Tata Memorial Hospital, Mumbai, India were given chemotherapy according to the European BFM-90 protocol (n = 38). The patients were evaluated for early response by interim PET-CT, post-induction and monitored for toxicity and long-term outcomes.
Results:
Thirty-eight consecutive patients (median age 23.5 years) were analyzed. After a median follow-up of 33.5 (1–77) months, following induction, 35 out of 38 patients (92.1%) had achieved complete response (CR) on PET-CT. Thirty (78.9%) patients treated according to BFM-90 were alive in first remission. Three-year event-free survival for those with CR on PET-CT was 78%, against no survivors for those who remained PET-positive.
Conclusion:
This study demonstrates the feasibility and efficacy of BFM-90 approach in adults with T-LBL. We found an early PET response to be highly predictive of outcome.
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LETTERS TO THE EDITOR
Pediatric chronic myeloid leukemia with myeloid blast crisis and complex karyotype at presentation
Sudha Sazawal, Kanwaljeet Singh, Sunita Chhikara, Rekha Chaubey, Pravas Mishra, Tulika Seth, Renu Saxena
July-September 2020, 57(3):343-345
DOI
:10.4103/ijc.IJC_208_17
PMID
:32769290
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103
Olaparib, a new hope for ovarian cancer
Zarka Samoon, Adnan Abdul Jabbar
July-September 2020, 57(3):346-347
DOI
:10.4103/ijc.IJC_1_19
PMID
:32675438
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99
An unusual durable response with palbociclib plus letrozole in hormone receptor positive metastatic breast cancer after multiple lines of therapy
Ilavarasi Vanidassane, Ekta Dhamija, Shailendra Singh Naik, Atul Batra
July-September 2020, 57(3):348-350
DOI
:10.4103/ijc.IJC_66_19
PMID
:32769294
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Diffuse Large B-Cell Lymphoma presenting as isolated pleural effusion with excellent response to R-PEPC regimen
Abhenil Mittal, Ajay Gogia, Saumyaranjan Mallick
July-September 2020, 57(3):351-353
DOI
:10.4103/ijc.IJC_217_19
PMID
:32594072
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Comment on “Multiple logistic regression analysis predicts cancer risk among tobacco usage with glutathione
R
-transferase p1 genotyping in patients with head and neck cancer”
Sharath Balakrishna
July-September 2020, 57(3):354-355
DOI
:10.4103/ijc.IJC_322_19
PMID
:32594073
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956
81
Future burden of gallbladder cancer in Delhi
Rajeev K Malhotra, Nalliah Manoharan
July-September 2020, 57(3):356-357
DOI
:10.4103/ijc.IJC_426_19
PMID
:31736470
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Do little things cast great shadows?
Sema Yilmaz Rakici, Tuba Uyar Cankay
July-September 2020, 57(3):358-359
DOI
:10.4103/ijc.IJC_683_20
PMID
:32788438
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LUNG CANCER
Local failure patterns after radical resection and adjuvant chemotherapy in patients with pN2 nonsmall-cell lung cancer: A retrospective analysis
Chenyu Wang, Haixia Li, Yongshun Chen, Hong Ge
July-September 2020, 57(3):323-329
DOI
:10.4103/ijc.IJC_691_18
PMID
:32769295
Background:
The patterns of local failure in stage pN2 nonsmall-cell lung cancer (NSCLC) patients undergoing radical resection and adjuvant chemotherapy are controversial.
Methods:
The sites of local failure were compared in subgroups of patients with relevant clinicopathologic features (e.g., location and size of primary lesions).
Results:
Totally 75 patients with local failure after radical resection and adjuvant chemotherapy for pN2 NSCLC were included in the analysis. Thirty-seven (49.3%) patients had distant metastasis. The median duration from surgical resection to local failure was 11 months (range: 3–45 months). Sites with ≥10% failure rate in all subgroups based on the location of the primary lesions included 4R, 7, the ipsilateral hilum, and the stump. Additional sites with ≥10% failure rate included 2R, 2L, 4L, and 5 for lesions in the left upper lobe; 4L and 5 for lesions in the left lower lobe; and 2R and 3P for lesions in the right upper-middle lobe. Squamous cell carcinoma affected the stump failure rate compared to adenocarcinoma (56.3%
vs.
18.0%,
P
= 0.003). Tumor diameter ≥5 cm affected the stump failure rate compared to tumor diameter <5 cm (44.0%
vs
. 18.0%,
P
= 0.016). Skip N2 metastasis affected the ipsilateral hilum failure rate compared to nonskip N2 metastasis (7.5%
vs.
31.4%,
P
= 0.008)
Conclusions:
For pN2 NSCLC patients undergoing radical resection and adjuvant chemotherapy, different lung lobes had different high-risk failure sites. Left lung cancer is prone to bilateral mediastinal lymph nodes recurrence, while right lung cancer mainly recurs with ipsilateral mediastinal lymph nodes. Moreover, the local failure patterns are influenced by pathological type, tumor size, and skip N2 metastasis.
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MCQS
MCQs on “Prevalence, patterns, and sociocultural factors associated with use of tobacco-based dentifrices (
Gul
) in India”
HS Darling, S Jayalakshmi, Pradeep Jaiswal
July-September 2020, 57(3):321-322
DOI
:10.4103/ijc.IJC_810_20
PMID
:32788436
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NEWS FROM THE WORLD OF ONCOLOGY
News from the world of oncology
July-September 2020, 57(3):363-365
DOI
:10.4103/ijc.IJC_820_20
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485
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REVIEW ARTICLES
Grossing and reporting of colorectal cancer resection specimens: An evidence-based approach
Sanjeev Vasudev Katti, Roopa Rachel Paulose, Basawantrao Malipatil, Namita Sinha Verma
July-September 2020, 57(3):239-252
DOI
:10.4103/ijc.IJC_546_20
PMID
:32788434
Appropriate management of the patient with colorectal carcinoma depends on obtaining key prognostic and predictive information from the resection specimen. These include the quality of surgery, extent of lymph nodal clearance, presence of nodal disease, vascular invasion, residual disease post neoadjuvant treatment, and completeness of resection. A meticulous and structured approach to dissection of the resection specimen and subsequent histological examination by the pathologist is crucial in providing this information to the treating clinician. A good macroscopic examination also serves to audit the quality of other services including radiology, surgery, and oncology. This article attempts to review dissection and reporting guidelines with an evidence-based approach and hopes to guide pathologists to understand the basis behind the recommended protocols.
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TOBACCO
Prevalence, patterns and sociocultural factors associated with use of tobacco-based dentifrices (
Gul
) in India
Rashmi Mehra, Vikrant Mohanty, YB Aswini, Shivam Kapoor, Vaibhav Gupta
July-September 2020, 57(3):311-320
DOI
:10.4103/ijc.IJC_717_18
PMID
:32675444
Background:
India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4%).
Gul
is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of
Gul
and its social determinants among adults in the capital city of India, Delhi.
Methods:
The cross-sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for
Gul
users to assess practice and pattern of use.
Results:
The overall prevalence of
Gul
users was found to be 4.9% with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7%) and unskilled workers (45.2%). 74.9% started using
Gul
to treat dental pain with 93.47% of them reporting pain relief.
Conclusion:
Gul
usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of
Gul
usage.
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