RESUMEN
Background:In India, the incidence of cancer of buccal mucosa is a serious public health issue where a large fraction is related to the poor treatment outcome. Identification of high-risk oral premalignant lesions could constitute as one of the key factors in reducing the morbidity, mortality and cost of treatment associated with oral squamous cell carcimnoma (OSCC).Methods: Total 62 subjects of buccal mucosa lesions were enrolled in this study. Using immunohistochemistry, expression of p53 and CD44 was studied from paraffin embedded tumor tissue blocks. Results: Nuclear p53 expression was significantly higher in premalignant lesions compared to malignant tumors (P=0.037), and also in early stage OSCC patients (P=0.012). On correlating CD44 protein expression with different clinicopathological parameters of OSCC patients, significant inverse correlation of CD44 was observed with lymphnode metastasis (P=0.042) and tumor stage (P=0.042).Conclusion: p53 expression is associated with patients having premalignant lesions & having significant higher risk of progressing to OSCC. Expression of both, p53 and CD44 were found to be early events in oral cancer. Thus, for identifying high risk OSCC patients for better patient management, p53 and CD44 might be useful significant biomarkers; however, further study in more number of patients is needed to identify their precise role in oral carcinogenesis.
RESUMEN
Guillain-Barre Syndrome (GBS) has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Successful management mandates anticipation, prompt recognition and optimal treatment of neuromuscular respiratory failure in GBS. AIMS: To identify clinical and electrodiagnostic predictors of neuromuscular respiratory paralysis in GBS. MATERIALS AND METHODS: Forty six patients of GBS were studied over a 6 year period, the study being 2 year retrospective and 4 year prospective. Clinical and electrodiagnostic data were compared between ventilated (28) and non-ventilated (18) patients. The clinical parameters assessed were median age, gender, antecedent infection, prior lung disease, time to peak disability, bifacial weakness, upper limb weakness, bulbar paralysis, neck weakness and autonomic dysfunction. Electrodiagnostic studies included motor nerve conduction studies in 11 ventilated and 13 non-ventilated patients, done prior to maximum disability in each group. Multiple logistic regression analysis was used to compare the two groups. RESULTS: Comparing the clinical data in the ventilated and non-ventilated groups, 'early peak disability', autonomic dysfunction and bulbar weakness predicted the onset of respiratory paralysis. Age, gender, neck or bifacial weakness, upper limb paralysis, or preceding infection did not influence the development of neuromuscular respiratory weakness. Electrodiagnostic testing revealed abnormal H reflex and F waves to be the commonest abnormality in either group. Although data was not sufficient for statistical analysis, the presence of markedly attenuated Compound Muscle Action Potentials inexcitable motor nerves and denervation changes on the electromyography, was commoner in the ventilated group. Thirty six patients received treatment with either plasmapheresis (12) or intravenous immunoglobulin (24). Overall mortality was 5, all 5 patients being on assisted ventilation. CONCLUSION: Early progression to peak disability, bulbar dysfunction and autonomic instability predicted the development of neuromuscular respiratory paralysis in GBS. Early electrodiagnostic studies in this series suggest axonopathic GBS as a predictor of respiratory paralysis, a finding that needs to be evaluated with sufficient data to permit statistical analysis.