A REVIEW ON CURRENT SCENARIO OF ORAL CANCER IN INDIA WITH SPECIAL EMPHASIS ON MODERN DETECTION SYSTEMS AND BIOMARKERS

  • JEEVITAA KSHERSAGAR Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur 416006, MS, India
  • POONAM BEDGE Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur 416006, MS, India
  • RAKHI JAGDALE Department of Pathology, Shri Siddhivinayak Ganpati Cancer Hospital, Miraj, Sangli, MS, India
  • YASHWANT TORO Department of Scientific and Industrial Research Organization, Shri Siddhivinayak Ganpati Cancer Hospital, Miraj, Sangli, MS, India
  • SHIMPA SHARMA Department of Medicine, Dr. D. Y. Patil Medical College Kolhapur 416006, MS, India
  • MEGHNAD JOSHI Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur 416006, MS, India, Stem Plus Biotech Pvt. Ltd. SMK Commercial Complex, Bus Stand Road, Sangli, MS - 416416, India

Abstract

Oral squamous cell carcinoma is a major public health concern worldwide and a growing threat for rapidly developing economies such as India, where it ranks among the top three cancers. This review aims to discuss the national status of oral cancer in terms of incidences and mortality. We have added the emphasis on clinical characteristics of oral potentially malignant disorders and emerging optical diagnostic techniques to detect oral lesions which would otherwise go undetected by a conventional oral examination. Modern detection systems such as autofluorescence, chemiluminiscence, Narrowband imaging and Raman spectroscopy will definitely aid Conventional oral examination for diagnosis. Definitive diagnosis of oral cancer by using saliva and serum-based noninvasive biomarkers can minimize the need of tissue biopsies and patient discomfort. Urgent research efforts are required to find new ways to identify and examine high-risk population for the early diagnosis and prevention of Oral squamous cell carcinoma.

Keywords: Biomarkers, Detection Methods, Early Diagnosis, Oral Squamous Cell Carcinoma

References

1. Kozhuharov N, Goudev A, Flores D, Maeder MT, Wal-Ter J, Shrestha S, et al. Effect of a strategy of comprehensive vasodilation vs usual care on mortality and heart failure rehospitalization among patients with acute heart failure: the galactic randomized clinical trial. Rev Argent Cardiol 2020;88:78-85.
2. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 2013;132:1133–45.
3. Deng L, Liu H. MicroRNA-506 suppresses growth and metastasis of oral squamous cell carcinoma via targeting GATA6. Int J Clin Exp Med 2015;8:1862–70.
4. Goel H, Singhal S, Mathur R, Syeda S, Kumar R, Kumar A, et al. Promoter hypermethylation of LATS2 gene in oral squamous cell carcinoma (OSCC) among North Indian population. Asian Pac J Cancer Prev 2020;21:1283–7.
5. Guneri P, Epstein JB. Late-stage diagnosis of oral cancer: components and possible solutions. Oral Oncol 2014;50:1131–6.
6. Dikshit R, Gupta PC, Ramasundarahettige C, Gajalakshmi V, Aleksandrowicz L, Badwe R, et al. Cancer mortality in India: a nationally representative survey. Lancet 2012;379:1807–16.
7. Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M. Assessment of knowledge and screening in oral, breast, and cervical cancer in the population of the Northeast Region of India. JCO Global Oncol 2020;6:601–9.
8. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005;366:1809–20.
9. Omar E. Current concepts and future of noninvasive procedures for diagnosing oral squamous cell carcinoma-a systematic review. Head Face Med 2015;11:6.
10. Yakob M, Fuentes L, Wang MB, Abemayor E, Wong DTW. Salivary biomarkers for the detection of oral squamous cell carcinoma-current state and recent advances. Curr Oral Heal Reports 2014;1:133–41.
11. Liu D, Zhao X, Zeng X, Dan H, Chen Q. Non-invasive techniques for detection and diagnosis of oral potentially malignant disorders. Tohoku J Exp Med 2016;238:165–77.
12. Iyer S, Thankappan K, Balasubramanian D. Early detection of oral cancers: current status and future prospects. Curr Opin Otolaryngol Head Neck Surg 2016;24:110–4.
13. Laprise C, Shahul HP, Madathil SA, Thekkepurakkal AS, Castonguay G, Varghese I, et al. Periodontal diseases and risk of oral cancer in Southern India: results from the HeNCe life study. Int J Cancer 2016;139:1512–9.
14. Byakodi R, Byakodi S, Hiremath S, Byakodi J, Adaki S, Marathe K, et al. Oral cancer in India: an epidemiologic and clinical review. J Community Health 2012;37:316–9.
15. Shridhar K, Rajaraman P, Koyande S, Parikh PM, Chaturvedi P, Dhillon PK, et al. Trends in mouth cancer incidence in Mumbai, India (1995-2009): an age-period-cohort analysis. Cancer Epidemiol 2016;42:66–71.
16. Warnakulasuriya S, Johnson NW, Waal I Van Der. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007;36:575–80.
17. Sachdev R, Garg K, Singh G. Oral leukoplakia and its malignant transformation as a diagnostic tool in oral squamous cell carcinoma: a retrospective clinicopathological study. Indian J Oral Health Res 2020;6:16-9.
18. Bhargava S. Need of oral precancer awareness initiatives in India. Open Dent J 2016;10:417–9.
19. Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med 2015;45:155–66.
20. Kumar A, Cascarini L, Mccaul JA, Kerawala CJ, Coombes D, Godden D, et al. How should we manage oral leukoplakia? Br J Oral Maxillofac Surg 2013;51:377–83.
21. Nair DR, Pruthy R, Pawar U, Chaturvedi P. Oral cancer: premalignant conditions and screening–an update. J Cancer Res Ther 2012;8 Suppl 1:57–66.
22. Akrish S, Eskander Hashoul L, Rachmiel A, Ben Izhak O. Clinicopathologic analysis of verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma as part of the clinicopathologic spectrum of oral proliferative verrucous leukoplakia: a literature review and analysis. Pathol Res Practice 2019;215:152670.
23. Waal I Van Der. Potentially malignant disorders of the oral and oropharyngeal mucosa?; present concepts of management. Oral Oncol 2010;46:423–5.
24. Wetzel SL. Oral potentially malignant disorders. Dent Clin NA 2020;64:25–37.
25. Juan C, Prera H, Holmes BJ, Valentino A, Harshan M, Bacchi CE, et al. Macrocystic (Mammary Analogue) secretory carcinoma, an unusual variant and a pitfall in the differential diagnosis of cystic lesions in the head and neck. Am J Surg Pathol 2019;43:1483-92.
26. Bewley AF, Farwell DG. Oral leukoplakia and oral cavity squamous cell carcinoma. Clin Dermatol 2017;35:461-7.
27. Muto M, Nakane M, Katada C, Sano Y, Ohtsu A, Esumi H, et al. Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites. Cancer 2004;101:1375–81.
28. Karthikeson PS. Oral lichen planus–a review. J Pharm Sci Res 2020;12:196-8.
29. Varghese SS, George GB, Sarojini SB, Vinod S, Mathew P, Mathew DG, et al. Epidemiology of oral lichen planus in a cohort of South Indian population: a retrospective study. J Cancer Prev 2016;21:55–9.
30. Fernando Augusto Cervantes Garcia de S, Thais Cachute P, Adriana Aigotti Haberbeck B, Luiz Eduardo Blumer R. Oral lichen planus versus epithelial dysplasia: difficulties in diagnosis. Braz J Otorhinolaryngol 2009;75:716–20.
31. Scully C, Carrozzo M. Oral mucosal disease: lichen planus. Br J Oral Maxillofac Surg 2008;46:15–21.
32. Muthubabu K, Srinivasan MK, Jeeva G. Pedicle tongue flap surgery in oral submucous fibrosis. J Evid Based Med Healthc 2016;3:3860-3.
33. Ray J, Chatterjee R, Chaudhuri K. Oral submucous fibrosis: a global challenge. rising incidence, risk factors, management, and research priorities. Periodontology 2019;80:200–12.
34. Rethman MP. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. J Am Dent Assoc 2010;141:509–20.
35. Heaton CM, Durr ML, Tetsu O, Van Zante A, Wang SJ. TP53 and CDKN2a mutations in never-smoker oral tongue squamous cell carcinoma. Laryngoscope 2014;124:267–73.
36. Annertz K, Anderson H, Birklund A, Mller T, Kantola S, Mork J, et al. Incidence and survival of squamous cell carcinoma of the tongue in scandinavia, with special reference to young adults. Int J Cancer 2002;101:95–9.
37. Hu S, Arellano M, Boontheung P, Wang J, Zhou H, Jiang J, et al. Salivary proteomics for oral cancer biomarker discovery. Clin Cancer Res 2008;14:6246–52.
38. Khanna R. Fluorescence diagnostics: a forthcoming non invasive screening adjunct in oral cancer. J Res Med Dent Sci 2016;4:79.
39. Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomized controlled trial. Lancet 2005;365:1927–33.
40. Carreras Torras C, Gay Escoda C. Techniques for early diagnosis of oral squamous cell carcinoma: a systematic review. Med Oral Patol Oral Cir Bucal 2015;202020:305–15.
41. Sankaranarayanan R, Ramadas K, Thara S, Muwonge R, Thomas G, Anju G, et al. Long term effect of visual screening on oral cancer incidence and mortality in a randomized trial in Kerala, India. Oral Oncol 2013;49:314–21.
42. Baykul T, Yilmaz HH, Aydin UA, Aydin MA, Aksoy MC, Yildirim D. Early diagnosis of oral cancer. J Int Med Res 2010;38:737–49.
43. Brad W. Oral cancer and precancerous lesions. CA Cancer J Clin 2002;52:195–215.
44. Petruzzi M, Lucchese A, Nardi GM, Lauritano D, Favia G, Serpico R, et al. Evaluation of autofluorescence and toluidine blue in the differentiation of oral dysplastic and neoplastic lesions from non dysplastic and neoplastic lesions: a cross-sectional study. J Biomed Opt 2014;19:76003.
45. Singh SP, Ibrahim O, Byrne HJ, Mikkonen JW, Koistinen AP, Kullaa AM, et al. Recent advances in optical diagnosis of oral cancers: review and future perspectives. Head Neck 2016;38:2403–11.
46. Masthan KMK, Aravindha Babu N, Dash KC, Elumalai M. Advanced diagnostic aids in oral cancer. Asian Pacific J Cancer Prev 2012;13:3573–6.
47. Rashid A, Warnakulasuriya S. The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review. J Oral Pathol Med 2015;44:307–28.
48. Laronde D, Corbett K. Adjunctive screening devices for oral lesions: their use by canadian dental hygienists and the need for knowledge translation. Int J Dent Hyg 2017;15:187-94.
49. Green B, Cobb ARM, Brennan PA, Hopper C. Optical diagnostic techniques for use in lesions of the head and neck: review of the latest developments. Br J Oral Maxillofac Surg 2014;52:675–80.
50. Bhatia N, Matias MAT, Farah CS. Assessment of a decision making protocol to improve the efficacy of VELscope??? in general dental practice: a prospective evaluation. Oral Oncol 2014;50:1012–9.
51. Sambandham T. The application of vizilite in oral cancer. J Clin Diagnostic Res 2013;7:185–6.
52. Reddy GS, Sekhar PC, Kumar KK, Lalith K, Ramana Reddy BV, Rao KE. Diagnosis of oral cancer: the past and present. J Orofac Sci 2014;6:10.
53. Nagi R, Reddy Kantharaj YB, Rakesh N, Janardhan Reddy S, Sahu S. Efficacy of light based detection systems for early detection of oral cancer and oral potentially malignant disorders: systematic review. Med Oral Patol Oral Cir Bucal 2016;1212121:447–55.
54. Stoor P, Pulkkinen J, Grenman R. Bioactive glass S53P4 in the filling of cavities in the mastoid cell area in surgery for chronic otitis media. Ann Otol Rhinol Laryngol 2010;119:377–82.
55. Vu AN, Matias M, Farah CS. Diagnostic accuracy of narrow band imaging for the detection of oral potentially malignant disorders. Oral Dis 2015;21:519–29.
56. Yang S, Lee Y, Chang L. Use of endoscopy with narrow-band imaging system in detecting squamous cell carcinoma in oral chronic non-healing ulcers. Clin Oral Invest 2013;18:949-59.
57. Yang SW, Lee YS, Chang LC, Hwang CC, Luo CM, Chen TA. Clinical characteristics of narrow-band imaging of oral erythroplakia and its correlation with pathology. BMC Cancer 2015;15:406.
58. Yang S, Lee Y, Chang L. Diagnostic significance of narrow-band imaging for detecting high-grade dysplasia, carcinoma in situ, and carcinoma in oral leukoplakia. Laryngoscope 2012;122:2754–61.
59. Lin CJ, Grandis JR, Carey TE, Gollin SM, Whiteside TL, Koch WM, et al. Basic science review head and neck squamous cell carcinoma cell lines?: established models and rationale for selection. Head Neck 2007;29:163–88.
60. Cals FLJ, Schut TCB, Hardillo JA, Jong RJB De, Koljenovi S, Puppels GJ. Investigation of the potential of Raman spectroscopy for oral cancer detection in surgical margins. Laboratory Investigation 2015;95:1186–96.
61. Krishna H, Majumder SK, Chaturvedi P, Sidramesh M, Gupta PK. In vivo raman spectroscopy for detection of oral neoplasia: a pilot clinical study. J Biophotonics 2014;7:690–702.
62. Sahu A, Sawant S, Mamgain H, Krishna CM. Raman spectroscopy of serum: an exploratory study for the detection of oral cancers. Analyst 2013;138:4161.
63. Singh SP, Deshmukh A, Chaturvedi P, Murali Krishna C. Raman spectroscopic identification of premalignant lesions in oral buccal mucosa. J Biomedical Optics 2012;17:1050021.
64. Sahu A, Deshmukh A, Hole AR, Chaturvedi P, Krishna CM. In vivo subsite classification and diagnosis of oral cancers using Raman spectroscopy. J Innov Opt Health Sci 2016;9:1650017.
65. Science C. Raman spectroscopic analysis of blood, urine, saliva and tissue of oral potentially malignant disorders and malignancy-a diagnostic study. Int J Oral Craniofac Sci 2016;2:11–4.
66. Jou YJ, Lin C Der, Lai CH, Chen CH, Kao JY, Chen SY, et al. Proteomic identification of salivary transferrin as a biomarker for early detection of oral cancer. Anal Chim Acta 2010;681:41–8.
67. Brinkman BMN, Wong DTW. Disease mechanism and biomarkers of oral squamous cell carcinoma. Curr Opin Oncol 2006;18:228–33.
68. Wu CC, Chu HW, Hsu CW, Chang KP, Liu HP. Saliva proteome profiling reveals potential salivary biomarkers for detection of oral cavity squamous cell carcinoma. Proteomics 2015;15:3394–404.
69. Katakura A, Yamamoto N, Sakuma T, Sugahara K, Onda T, Noguchi S, et al. A screening test for oral cancer using saliva samples: proteomic analysis of biomarkers in whole saliva. J Oral Maxillofac Surgery Med Pathol 2013;27:1–5.
70. Chai YD, Zhang L, Yang Y, Su T, Charugundla P, Ai J, et al. Discovery of potential serum protein biomarkers for lymph node metastasis in oral cancer. Head Neck 2015;38:118–25.
71. Sivadasan P, Kumar M, Sathe GJ, Balakrishnan L, Palit P, Gowda H, et al. Human salivary proteome-a resource of potential biomarkers for oral cancer. J Proteomics 2015;127:89–95.
72. Liu W, Zeng L, Li N, Wang F, Jiang C, Guo F, et al. Quantitative proteomic analysis for novel biomarkers of buccal squamous cell carcinoma arising in background of oral submucous fibrosis. BMC Cancer 2016;16:584.
73. Cheng G. Circulating miRNAs: roles in cancer diagnosis, prognosis and therapy. Adv Drug Delivery Rev 2015;81:75–93.
74. Lu YC, Chang JTC, Huang YC, Huang CC, Chen WH, Lee LY, et al. Combined determination of circulating miR-196a and miR-196b levels produces high sensitivity and specificity for early detection of oral cancer. Clin Biochem 2015;48:115–21.
75. Hou B, Ishinaga H, Midorikawa K, Shah SA, Nakamura S, Hiraku Y, et al. Circulating microRNAs as novel prognosis biomarkers for head and neck squamous cell carcinoma. Cancer Biol Ther 2015;16:1042–6.
76. Hui ABY, Lenarduzzi M, Krushel T, Waldron L, Pintilie M, Shi W, et al. Comprehensive MicroRNA profiling for head and neck squamous cell carcinomas. Clin Cancer Res 2010;16:1129–39.
77. Manikandan M, Deva Magendhra Rao AK, Rajkumar KS, Rajaraman R, Munirajan AK. Altered levels of miR-21, miR-125b-2*, miR-138, miR-155, miR-184, and miR-205 in oral squamous cell carcinoma and association with clinicopathological characteristics. J Oral Pathol Med 2015;44:792–800.
78. Liao L, Wang J, Ouyang S, Zhang P, Wang J, Zhang M. Expression and clinical significance of microRNA-1246 in human oral squamous cell carcinoma. Med Sci Monit 2015;21:776–81.
79. de Carvalho AC, Scapulatempo-Neto C, Maia DCC, Evangelista AF, Morini MA, Carvalho AL, et al. Accuracy of microRNAs as markers for the detection of neck lymph node metastases in patients with head and neck squamous cell carcinoma. BMC Med 2015;13:108.
80. Liborio Kimura TN, Jung HM, Chan EKL. MiR-494 represses HOXA10 expression and inhibits cell proliferation in oral cancer. Oral Oncol 2015;51:151–7.
81. Hauser B, Zhao Y, Pang X, Ling Z, Myers E, Wang P, et al. Functions of MiRNA-128 on the regulation of head and neck squamous cell carcinoma growth and apoptosis. PLoS One 2015;10:1–15.
82. Lee SA, Kim JS, Park SY, Kim HJ, Yu SK, Kim CS, et al. miR-203 downregulates Yes-1 and suppresses oncogenic activity in human oral cancer cells. J Biosci Bioeng 2015;120:351–8.
83. Bandil K, Singhal P, Sharma U, Hussain S, Basu S, Parashari A, et al. Impacts of TNF-LTA SNPs/Haplotypes and lifestyle factors on oral carcinoma in an Indian population. Mol Diagnosis Ther 2016;20:469–80.
84. Zaravinos A. An updated overview of HPV-associated head and neck carcinomas. Oncotarget 2014;5:3956–69.
85. Kumaraswamy K, Vidhya M. Human papilloma virus and oral infections: an update. J Cancer Res Thera 2011;7:120.
86. Chang S, Abdul kareem S, Merican AF, Zain RB. Oral cancer prognosis based on clinicopathologic and genomic markers using a hybrid of feature selection and machine learning methods. BMC Bioinformatics 2013;14:170.
87. Tassone P, Old M, Teknos TN, Pan Q. p53-based therapeutics for head and neck squamous cell carcinoma. Oral Oncol 2013;49:733–7.
88. Sinevici N, Jeff O. Oral cancer: deregulated molecular events and their use as biomarkers. Oral Oncol 2016;61:12–8.
89. Huang S, Cheng S, Chuang W, Chen I, Liao C, Wang H. Cyclin D1 overexpression and poor clinical outcomes in taiwanese oral cavity squamous cell carcinoma. World J Surg Onc 2012;10:1–7.
90. Zhao Y, Yu D, Li H, Nie P, Zhu Y, Liu S, et al. Cyclin D1 overexpression Is associated with poor clinicopathological outcome and survival in oral squamous cell carcinoma in asian populations: insights from a meta-analysis. PLoS One 2014;9:e93210.
91. Jamil N Al-Swiahb, Huang C, Fang FM, Chuang HC, Huang HY. Prognostic Impact of p16, p53, epidermal growth factor receptor, and human papillomavirus in oropharyngeal cancer in a betel nut–chewing area. Arch Otolaryngol Head Neck Surg 2010;136:502–8.
92. Chang I, Rehman AO, Wang C. Molecular signaling in oral cancer invasion and metastasis. In: M Fribley A. (eds) Targeting Oral Cancer. Springer, Cham; 2016.
93. Oliveira LR, Prognostic AR. Prognostic significance of immunohistochemical biomarkers in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2011;40:298–307.
94. Sarkis SA, Abdullah BH, Majeed BAA, Talabani NG. Immunohistochemical expression of epidermal growth factor receptor (EGFR) in oral squamous cell carcinoma in relation to proliferation, apoptosis, angiogenesis and lymphangiogenesis. Head Neck Oncol 2010;13:1–8.
95. Mahendra A, Shreedhar B, Kamboj M, Singh A, Singh A, Agrawal A, et al. Epidermal growth factor receptor protein: a biological marker for oral precancer and cancer. J Dent Surg 2014;2014:1–8.
96. Kurosu T, Ohga N, Hida Y, Maishi N, Akiyama K, Kakuguchi W, et al. HuR keeps an angiogenic switch on by stabilising mRNA of VEGF and COX-2 in tumour endothelium. Br J Cancer 2011;104:819–29.
97. Nayak S, Mati M, Chandra S, Bhatia V, Mehrotra D, Kumar S, et al. VEGF-A immunohistochemical and mRNA expression in tissues and its serum levels in potentially malignant oral lesions and oral squamous cell carcinomas. Oral Oncol 2012;48:233–9.
98. Ruan M, Zhang Z, Li S, Yan M, Liu S, Yang W, et al. Activation of toll-like receptor-9 promotes cellular migration via up-regulating MMP-2 expression in oral squamous cell carcinoma. Plos One 2014;9:1–7.
99. Lu L, Xue X, Lan J, Gao Y, Xiong Z, Zhang H, et al. MicroRNA-29a upregulates MMP2 in oral squamous cell carcinoma to promote cancer invasion and anti-apoptosis. Biomed Pharmacother 2014;68:13–9.
100. Sawant S, Gokulan R, Dongre H, Vaidya M. Prognostic role of Oct4, CD44 and c-Myc in radio–chemo-resistant oral cancer patients and their tumourigenic potential in immunodeficient mice. Clin Oral Investigations 2015;20:43–56.
101. Dasari S, Rajendra W, Valluru L. Evaluation of soluble CD44 protein marker to distinguish the premalignant and malignant carcinoma cases in cervical cancer patients. Med Oncol 2014;31:139.
102. Pereira HM, Reis IM, Reategui EP, Gordon C, Saint-victor S, Duncan R, et al. Risk strati fi cation system for oral cancer screening. Cancer Prev Res 2016;9:445–55.
103. Jaa O, Xiao Z, Sha Z. MHC class 1-related chain a and b ligands are differently expressed in cancer cell lines. Immunol Disord Immunothe 2016;1:1–5.
104. Tamaki S, Kawakami M, Ishitani A, Kawashima W, Kasuda S, Yamanaka Y, et al. Soluble MICB serum levels correlate with disease stage and survival rate in patients with oral squamous cell carcinoma. Anticancer Res 2010;30:4097–101.
Statistics
24 Views | 32 Downloads
Citatons
How to Cite
KSHERSAGAR, J., BEDGE, P., JAGDALE, R., TORO, Y., SHARMA, S., & JOSHI, M. (2020). A REVIEW ON CURRENT SCENARIO OF ORAL CANCER IN INDIA WITH SPECIAL EMPHASIS ON MODERN DETECTION SYSTEMS AND BIOMARKERS. International Journal of Applied Pharmaceutics, 12(4), 1-10. https://doi.org/10.22159/ijap.2020.v12s4.40098
Section
Full Proceeding Paper