Carcinoma cheek: regional pattern and management

Oral cancer varies globally and regionally, and is closely linked with geographical, social, economical, biological, ethnic, dietary and environmental factors. In western countries it accounts for about 2-5% while in the south-east Asia for about 40% of all cancers. In Pakistan it is second commonest tumour after bronchogenic carcinoma in males and breast carcinoma in females. The objectives of this study were to find out the pattern of carcinoma cheek in our region, its etiological associations, management and prognosis. This study was conducted in the Otolaryngology and Head and Neck Surgery Department of Civil Hospital, Karachi from April 1995 to December 1998. It was prospective study. Forty-five cases of primary carcinoma cheek were diagnosed and investigations including OPG and CT scan were carried out along with other required investigations to evaluate the extension of tumour, bony erosion and metastasis. TNM staging was done. All patients were treated surgically, sent for post-operative radiotherapy or chemoradiation and followed up for 3 years. Among 45 cases of oral cancer, 28 were females and 17 were males. Common presenting symptom was growth or ulcer. It was more common in 41-50 years of age. Squamous cell carcinoma [SCC] was found in 95.5% of the cases. Most of the patients 31[68%] were in T4 stage. Surgical excision was done in all cases with reconstruction in 23 cases and neck dissection in 39 cases. In the follow up for 3 years, 30 patient remained disease free. Carcinoma cheek is a common entity in our region and now it is seen in relatively younger patients. Oral cancer is a self preventable disease. What is required is to develop awareness of oral hygiene and discourage the habit of social carcinogens use. Early diagnosis and treatment offers better chance of cure whereas advance disease has a poor prognosis

Emergency preparedness and humanitarian action: the research deficit. Eastern Mediterranean Region perspective

The WHO Eastern Mediterranean Region, extending from Morocco in the west to Pakistan in the east, with a population exceeding 490 million, suffers a large proportion of both natural and manmade disasters. Humanitarian partners in the health sector have played a major role in averting the excessive mortality and morbidity in response to previous emergencies; nevertheless much remains to be done to provide the evidence through rigorous research methods to standardize other essential elements of the health response to humanitarian emergencies. Strengthening of academic institutions, prioritization of research, financial resources and linkages with institutions in the developed world can ameliorate the situation in the Region

Nutrition in humanitarian crises

It is anticipated that humanitarian crisis situations will continue to occur in countries of the Eastern Mediterranean Region affecting large segments of vulnerable populations. Subsequently the magnitude and effectiveness of the humanitarian response, particularly for food and nutrition, must be based on best practices and sound information of affected populations.To bridge the burgeoning gap between the food and nutrition needs of affected populations and the available resources, four key areas need to be addressed by the humanitarian agencies: adequate knowledge and skills in public health nutrition; effective coordination between humanitarian organizations when conducting nutritional assessments and interventions; efficient and appropriate delivery of services; communication, awareness and advocacy. This paper discusses approaches to how these may be improved