Background: Rabies remains a persistent public health threat in India, while gaps in surveillance and coordination of control measures undermine progress towards ending human rabies deaths. The World Health Organization advocates a One Health approach, combining mass dog vaccination, post-exposure prophylaxis (PEP), and Integrated Bite Case Management (IBCM). IBCM is not yet incorporated into India’s national rabies action plan for rabies elimination (NAPRE). This study seeks to generate robust evidence on the effectiveness, cost-effectiveness, feasibility, facilitators and barriers of IBCM implemented within Kerala’s Rabies Control Program. Methods: This will be an implementation-research, adopting a stepped-wedge cluster randomized controlled trial (RCT) design. IBCM will be implemented across six administrative blocks in Thiruvananthapuram District, Kerala, across diverse rural and urban settings, and including tribal population representation. The IBCM intervention includes stakeholder training and support, and active animal surveillance aligned with WHO guidance. Suspect or probable rabies exposures presenting at selected health facilities and identified via a community-based hotline will trigger investigations and responses including dog vaccination and sensitization. Prior to IBCM implementation, baseline data will be collected on management of dog bites, bite patient incidence and health case seeking behaviours. Hospital-based event tracking of bite cases will be conducted at enrolled public health facilities before and after IBCM implementation. The resulting RCT data will be used to model the impacts and cost-effectiveness of IBCM, including the potential for cost savings through judicious PEP, if scaled up across Kerala. To understand the barriers and facilitators to IBCM implementation, we will use in-depth interviews and focus group discussions with stakeholders. Discussion: There is an urgent need to strengthen rabies surveillance, including coordination across health and animal health sectors and outbreak responses to accelerate rabies elimination. IBCM is expected to lead to improved PEP completion, increased detection and laboratory confirmation of rabid dogs, strengthened dog vaccination coverage, and targeted outbreak responses in high-risk areas. This RCT will provide critical evidence to inform policy, support scale-up, generate insights into contextual barriers and facilitators for IBCM implementation, and guide India’s One Health rabies elimination strategy. Unlike the Goa model that relies on hotline reporting, this study evaluates a health-sector–initiated IBCM approach that identifies cases through dog-bite patients presenting to health facilities, enabling more comprehensive One Health integration and greater event capture. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial CTRI registration No. REF/2024/04/081804 ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study is approved by the WHO Ethics Committee (2024.9.Ind), Kerala University of Health Sciences (AX04/SOP07A/V2) and the ethics committee of Government Medical College, Thiruvananthapuram (HEC No.12/06/2024/MCT). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes This is a protocol and no results are presented based on any data analysis
Aim:The aim of the present study is to analyse the role of glucose transporter (GLUT)-1 in oral cancer. This study was performed to evaluate the expression of GLUT-1 in normal oral epithelium, to evaluate the expression of GLUT-1 levels in the tissue samples of grades of oral squamous cell carcinoma (OSCC) [well-differentiated (WD), moderately differentiated (MD), and poor differentiated (PD)], and to statistically compare the expression of GLUT-1 in normal epithelium and in the grades of OSCC. Materials and Methods:The study sample comprised formalin-fixed and paraffin-embedded tissue specimens from 12 cases of histopathologically diagnosed WD OSCC and ten cases of MD and PD OSCC and formalin-fixed paraffin-embedded tissue specimens from ten cases of normal oral mucosa. Sections were mounted on glass slides coated with aminopropyltriethoxysilane (APES; Sigma chemical co., USA) and processed for subsequent immunohistochemical study to demonstrate GLUT-1. Results:In our study, the GLUT-1 expression score of OSCC demonstrated strong positivity in 16 cases (50%), weak positivity in 11 cases (34.38%), and negativity in 5 cases (15.62%). There was significant correlation at a P value of 0.007 for expression of GLUT-1 in normal oral epithelium and OSCC. Conclusion:Over-expression of GLUT-1 in peripheral cells of tumour islands and invasive front could reflect the active metabolism which may be taking place in these areas where cellular proliferation and invasion is at the highest. The notable expression of GLUT-1 in malignant cells reveals glucose transporters play a key role in tumour progression and metastasis.
BACKGROUND:Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers. MATERIALS AND METHODS:As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann-Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters. RESULTS:All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow. CONCLUSION:This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.
Introduction:Subepithelial connective tissue grafts (CTGs) represent the gold standard of treatment for gingival recession; however, the method is associated with some limitations, stemming from necessity of a donor site and the inherent complexity of the harvesting technique. The present study utilizes Mucoderm® (porcine-derived collagen matrix) and amnion membrane (allograft), as a substitute approach for root coverage. Objectives:The purpose of the study is to evaluate the efficaciousness of the root coverage outcomes when employing Mucoderm® and amniotic membrane (AM) versus CTG. Materials and Method:A randomized clinical trial was conducted comparing coronally advanced flap with Mucoderm®, AM and CTG was conducted involving 15 patients subdivided into groups of five. The periodontal pocket depth, clinical attachment level, recession depth, and keratinized tissue width were measured preoperatively and at 1 and 3 months postoperatively. Results:Statistical analysis showed that Mucoderm® showed statistically significant results compared to CTG with regard to clinical parameters and complete coverage, whereas AM showed poorer results in terms of thickness of the gingiva. Conclusion:The study results indicated that Mucoderm® and AM could serve as viable alternatives CTGs in root coverage procedures.
