Orthodontic Pain and Patients’ Quality of Life: Patient Experiences and Provider Assessments

Objectives:To compare orthodontic pain and its Influence on quality of patient’s life as perceived by them with that assessed by their orthodontic care providers.Materials and Methods:It was crosses sectional study involving 75 patients attending the orthodontic clinic and14 orthodontic care providers from September to October 2010. Patients aged 16 and older, receiving fixed orthodontic treatments were included. Patients and orthodontists scored painduring different orthodontic procedures using a qualitative pain intensity scale which graded pain for different orthodontic procedures. Oral health related quality of life (OHRQoL) was assessed by means of a 4-point likert scale to measure the influence of orthodontic treatment related pain on different aspects of life.Results:For change of consistency of diet (p=0.02) statistically significant difference was observed between mean ranks of patients and orthodontists. For pain during record taking, higher mean ranks were reported for patients aged between 20-30 years (p = 0.01) whereas for pain after separator placement, patients aged above 30 had higher mean ranks (p = 0.05).Conclusions:Orthodontists can accurately estimate the degree of pain their patients’ experience. Significant proportions of patients experience substantial degrees pain during the visits, subsequent to orthodontic visits and pain due to fixed orthodontic appliance therapy transiently affects patients’ OHRQoL

The Expression of Programmed Death Ligand-1 within Stages of Oral Squamous Cell Carcinoma: Immunohistochemical Analysis

Background: Oral squamous cell carcinoma is prevalent in South Asian countries with rising cases of its incidence and mortality. Despite advancements in treatment, survival and recurrence rates are poor. Immunotherapy is a novel therapeutic modality in immunooncology. Immune checkpoint proteins are under investigation for clinical implications amongst which Programmed Death Ligand-1 has shown valuable results in certain malignancies. Aims: To determine the immunohistochemical expression of Programmed Death Ligand-1(PD-L1) in oral squamous cell carcinoma and to find an association of Programmed Death Ligand-1 with stage and clinicopathological parameters of oral squamous cell carcinoma.Study Design:Cross-sectional study.Place and Duration of Study:Ziauddin Medical University, Karachi, 1 Year duration during 2018-2019.Methods: A total number of140 biopsy confirmed cases of oral squamous cell carcinoma were recruited in the study. Immunohistochemical expression of Programmed Death Ligand-1 was evaluated and associated with the clinicopathological parameters of oral squamous cell carcinoma (OSCC). The data was statistically analyzed through Descriptive statistics and Chi square test by using SPSS v.20.Results: Out of 140 participants, 74% were males (n=103) and 26% were females (n=37). Programmed Death Ligand-1 positivity was observed in 62.1% of cases (n=87). The Mean age of the participants was 48.91 ± 11.7 years. The most common site of cancer involvement was buccal mucosa and majority of participants were habitual of consuming chewable products i.e. Pan, Gutka and betel nut (89; 64%). Stage III and IV tumours comprised a major portion of cases in our study.(52; 37%), (56; 40%).A statistically significant p-value was noted for the association of Programmed Death Ligand-1 with stage II and IV tumours. (P-values: 0.029, 0.001)The association of Programmed Death Ligand-1 with other variables such as age, gender, ethnicity, sites or habits was not statistically significant.Conclusion:This study concludes that the statistical significance of Programmed Death Ligand-1 expression with tumour stage is suggestive of worsening prognosis and might have detrimental effects as tumour progresses in advanced stage. Programmed Death Ligand-1 positivity in patients having oral squamous cell carcinoma could be useful in future research in the light of cancer immunotherapy which has shown success in oncology.

Association of Clinicopathological Features with Lymph Node Metastasis: A Cross Sectional Study of Oral Squamous Cell Carcinoma Patients

Aims: The aim of this study is to determine association between lymph node metastasis and various clinico-pathological parameters in order to predict their future prognosis of cancer patients.Study Design:Cross sectional study design.Place and Duration of Study:Ziauddin Hospital, North Nazimabad campus, Karachi.Methodology:November 2018 to September 2019.Results:The present study enrolled 140 OSCC patients visiting ZiauddinUniversity of which 30 (21.4%) were females and 110 (78.6%) were male patients. The mean age of patients was 46.99 ± 12.26. The buccal mucosa was the most common site observed 93 (66.4%). The mean size of tumour was 4.05 ± 2.261 mm, mean thickness was 1.70 ±1.32 mm. It was found that lymph node metastasis was not present in 66 (47.1%) of OSCC cases, 22 (15.7%) cases were found N1, 9(6.4%) N2a, 27(19.3%) N2b, 3 (2.1%) and 13(9.3%) N3 Significant association was found between age and lymph node metastasis: (P0.02); however, gender showed no significant association. (P0.149).Thickness of tumor, site of tumor, peri-neural invasion, lympho-vascular invasion and bone penetration showed significant association with lymph node metastasis with (P0.040, 0.021, 0.016, 0.00 and 0.001) respectively.Conclusion:Our study showed significant association of lymph node involvement with tumour staging, tumour thickness, lymphovascular involvement,perineuralinvasion and bone penetration. Our suggestion is to incorporate these clinic-pathological variables while determining the treatment and prognosis of Oral squamous cell Carcinoma(OSCC). Given the very high incidence and prevalence of Oral Cancer in our country and the region further multi-centered researches should be carried out and with larger sample sizes. Early diagnosis and restrictions on smokeless tobacco products can limit the occurrence and progression of OSCC.

Knowledge, Attitude and Practice Regarding Infection Control Procedures among Dentists of Karachi

Aim: Infection control is crucial in any clinical setting. It is vital that all dentists must follow the infection control protocols in their clinics to prevent cross-infection. In a dental clinic, even simple dental procedures including extractions, scaling and root planning, dental crown preparations and root canal treatment, have a high risk of exposure to blood, which may cause transmission blood-borne diseases. Dentist’s compliance with these guidelines and recommendations have been recently studied in different parts of the world. Hence this study was performed to evaluate the knowledge, attitude, and practice regarding infection control measures among private dental practioners in Karachi, Pakistan.Study Design:Cross-sectional study.Place and Duration of Study:This study was conducted for a period of four months in Karachi, Pakistan. Materialsand Methods: Present cross–sectional study was performed by interviewing 234dentists via a questionnaire based upon various questions regarding infection control. Sample were collected using convenience sampling, from private dental clinics in Karachi, Pakistan. Setting:Questionnaire were sent to 400 general dentist in Karachi,out of which 234 replied.Results: Mostly (69%) dentists who took part in the study were males. Regarding infection control, most of the individuals had a comprehensive understanding of infection control techniques. Isolation was considered to play a vital role in cross-infection prevention by 97.3% of the dentists. 93.2% used autoclave for sterilization and majority had thorough knowledge of the process involved. Regarding preventive measures, 66.7% of the dentists were vaccinated against major infectiousagents in our society and 92.2% took protective measures required to prevent cross-infection.Conclusion: Knowledge, attitudes and practices regarding infection control of dentists in private clinic of Karachi, Pakistan are satisfactory.

E-Cadherin as a Marker for Nodal Metastasis in Head and Neck Squamous Cell Carcinoma

Aim: Head and neck cancers, all over the world, contribute greatly to the number of deaths, despite the advancements in the therapeutic strategies. It is characterized by locoregional disease with a tendency for metastasis to the cervical lymph nodes. The pre-operative detection of lymph node metastasis is critical for the effective treatment of patients with head and neck squamous cell carcinoma. Therefore the objective of this study was to identify E-cadherin as a marker for prediction of lymph node metastasis in head and neck squamous cell carcinoma (HNSCC).Study Design:Cross-sectional study.Place and Duration of Study: Dow University of Health Sciences, Karachi. 1 Year duration.Methodology:Cross-sectional analysis of 54 subjects with HNSCC, who underwent neck dissections, was carried out. Expression of E-cadherin was evaluated using immunohistochemical analysis and traditional histological parameters, and correlation of E-Cadherin with histologically verified presence of regional metastases was determined. Data was subjected to descriptive statistics and chi-square using Spss v.16.0.Results:54 patients included 33 males (61.1%) and 21 females (38.9%) aged from 18 to 73 (mean 44.8±12.7). A statistically significant relationship between the Downregulation of E-cadherin and histologically verified presence of nodal metastasis was established. (p value= 0.01).Conclusion:This study shows that low E-cadherin expression is useful for predicting lymph node metastases in cases of head and neck carcinoma.

Histopathological predictors of nodal metastases in oral squamous cell carcinoma

Background: Oral cancer is regarded as the sixth most common malignant tumor and is one of the leading cause of death. Lymph node metastasis is a major factor for the prognosis of oral squamous cell carcinoma [OSCC]. The objective of study was to compare the lymph node metastases with different histopathological parameters to identify high risk patients with the need for extensive treatment plans

Methods: 140 histologically proven OSCC patients visiting Ziauddin College of Dentistry were included in this study. The clinico-pathological parameters were compared by using Chi-square, Kruskal-Willis and Mann-Whitney

Results: There were 90 male and 50 female patients with 29.8% in 49-58 years age group. Buccal mucosa was the most common site of tumor. The predominant morphology of OSCC was moderately differentiated OSCC with stage IV disease. Lymph node metastasis was present in 48.6% of patients. Perineural invasion [22.9%], lymphovascular invasion [8.6%] and distant metastasis [11.1%] were also recorded. The mean tumor size was 3.45mm +/-1.95mm and mean tumor thickness was 1.8 +/-1.6mm

Conclusion: A significant association between grade, stage, tumor size, tumor thickness and distant metastasis with lymph node involvement was found. However further studies with larger sample size are required to validate these results

Role of periodontal therapy in type II diabetes mellitus

The purpose of this study was to observe a gender based effect of periodontal therapy on glycaemic control of type II diabetes mellitus. This Interventional study was conducted on one hundred four patients suffering from type II diabetes mellitus, both gender were included from twenty five to sixty five years of age. Periodontal parameters were calculated using the community periodontal index need, bleeding on probing, tooth mobility and furcation involvement. The glycaemic status was evaluated by determining glycosylated haemoglobin [HbA1c] levels at base line before non-surgical periodontal therapy and three months after receiving the treatment. All the examination and data collection were carried out by a single examiner. The data were analysed using the SPSS version 15.It was conducted that the periodontal parameters along with the reduction in the results of glycaemic parameters significantly improved [p 0.005] and more pronounced in female patients than male patients.It was concluded that the severity of the periodontal disease is the most important risk factor related to poor glycaemic control

Spectrum of prostate lesions: a decade experience

The prostate gland is found at the base of the bladder, surrounding the urethra. A rising interest has been noted in the diseases of the prostrate in the last decade or so. This is attributed to the fact that a high incidence of the prostatic carcinoma has been noted in different geographical locations and multi ethnic groups. Carcinoma of the prostate is the most common form of cancer in males in the United States, second only to lung cancer. retrospective study. This study was carried out at Department of pathology, Dow Medical College, Karachi between January 2003-2012. A retrospective study of 317 prostatic biopsies was conducted, based on the histopathological reports, with the purpose of identifying patients with prostatic lesions. Records of all specimens of prostatic tissue received for histopathology from the Civil hospital Karachi were used in this study. The data obtained were subjected to descriptive statistical analysis using SPSS version 16.0. The total number of patients included in this study was 317. The mean age of the patients was 64.9 +/- 8.12 with an age range of 48-100. 7.9% [n=25] patients had prostatic adenocarcinoma whereas 91.8% of patients showed benign nodular hyperplasia. Overall the incidence of prostatic cancers is more in the western countries as compared to the east. This can be attributed to the fact that the west has screening programs that leads to early detection. However screening programs should also be introduced and made available to general public and in males over the age of 50, PSA level detection should be made compulsory