Prognostic potential of CK-19 managing disseminated oral squamous cell carcinomas in Pakistan: A descriptive cross-sectional study.

A cross-sectional study was conducted to assess the adoptability of CK-19 as a routine diagnostic assay and potential prognostic marker following disseminated oral squamous cell carcinoma in Pakistani population. The current descriptive study was conducted at Isra Dental College Hospital, Isra University, Hyderabad, Pakistan. Suspected patients of oral squamous cell carcinomas (OSCC), who visited the Isra Dental College Hospital's outpatient department from January 2014 up to January 2015 with four year follow up (from January 2015 up to December 2019), were included after ethical approval of the Institutional board. SPSS version 21.0 was used for data analysis. Sixty cases of oral squamous cell carcinoma (OSCC) were selected for CK-19 quantification by using PCR before and after incisional biopsy. Of the 60 included subjects, fifty-two (87 %) were male, whereas only 8 were female. The mean age of females was 43.2±21.5years and the mean age of males was 36.14±14.1years. Of the 12 CK-19 positive cases, only seven cases of OSCCs were found positive following four year follow up duration. Our study shows that CK-19 has a positive (20%) prognostic potential for diagnosing disseminated carcinomas (p=0.0001). Before adopting CK-19 as a routine laboratory assay for diagnosing disseminated carcinomas, proper research is required to fulfil existing knowledge gap and standardising clinical and histopathological criteria for disseminating OSCCs in parallel to CK-19 concentration.

Prevalence of Human Papilloma Virus Sub Genotypes following Head and Neck Squamous Cell Carcinomas in Asian Continent, A Systematic Review Article.

OBJECTIVES: In current era of blue brain intelligence and technology access at ease, standardization of disease etiology demands extensive research to drop-down human papilloma virus associated head and neck squamous cell carcinomas impact at large. Present retrospection aims to estimate comparative association of human papilloma virus sub-genotypes in head and neck squamous cell carcinomas, critical analysis of existing research gap, treatment progress, co-infection, gender association, national status and challenges following Human papilloma virus led head and neck squamous cell carcinomas among world largest continent. BACKGROUND: Head and neck squamous cell carcinomas are not just like malignancies of uterine cervix, lymph nodes and breast cancers. Human papilloma virus led head and neck squamous cell carcinomas treatment directly impact Central nervous system in humans. Intriguingly, human papilloma virus mediated immune response increases patient survival, which indirectly transmit human papilloma virus in future generations and act as a potential threat developing neurogenic disorders. METHODS: An objective based search strategy, following comprehensive and specific search approaches were made to retrieve recent 12 years research data from five different NCBI databases. Out of 300 shortlisted articles, only 24 principal studies met the inclusion criteria. RESULTS: Highest human papilloma virus prevalence (10.42 %) was found in South Asia, 5.8 % in South East Asia, 5.7 % East Asia, 2.5% in west Asia and no relevant updated data was found from central Asian continent. Highest prevalence (10%) of HPV genotype-16 was recorded in Asia among 3, 710 enrolled cases including 2201 males, 1149 females and 360 cases of unknown gender. While undifferentiated multiple HPV genotype prevalence was 5.5 % (204 cases). Lowest percentage of HPV sub-types 68, 72, 57, 39 were recorded respectively. Pakistan ranked top reporting highest number of HPV-16 cases, Taiwan HPV-18, India HPV-31, Japan HPV-35 and Singapore in HPV-16 and HPV-18 co-infection rates respectively. CONCLUSIONS: Exact prevalence of HPV associated head and neck squamous cell carcinomas among Asian population is still debatable. Due to higher heterogeneity (P< 0.00001), I2 = 81-88% at 95 % confidence interval), non-availability and limitations of reported studies from Asian sub-continents especially central Asia, western Asia and from south and south east Asia demand large scale collaborative research culture to standardize head and neck squamous cell carcinomas aetiology.
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Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases.

BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. RESULTS: In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p < 0.001). Patients in the transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). CONCLUSION: A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates.

Radiographic Predictors for Mechanical Failure After Adult Spinal Deformity Surgery: A Retrospective Cohort Study in 138 Patients.

STUDY DESIGN: Retrospective cohort study at a single institution. OBJECTIVE: We aimed at estimating the rate of revision procedures and identify radiographic predictors of mechanical failure after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Mechanical failure rates after adult spinal deformity surgery range 12% to 37% in literature. Although the importance of spinal and spino-pelvic alignment is well documented for surgical outcome and ideal alignment has been proposed as sagittal vertical axis (SVA) < 5 cm, pelvic tilt < 20° and lumbar lordosis (LL) = pelvic incidence ±â€Š9°, the role of radiographic sagittal spine parameters and alignment targets as predictors for mechanical failure remains uncertain. METHODS: A consecutive cohort of adult spinal deformity patients who underwent corrective surgery with at least 5 levels of instrumentation between January 2008 and December 2012 at a single tertiary spine unit were followed for at least 2 years. Time to death or failure was recorded and cause-specific Cox regressions were applied to evaluate predictors for mechanical failure or death. RESULTS: A total of 138 patients with median age of 61 years were included for analysis. Follow up ranged 2.1 to 6.8 years. In total 47% had revision and estimated failure rates were 16% at 1 year increasing to 56% at 5 years. A multivariate analysis adjusting for age at surgery showed increased hazard of failure from LL change > 30°, postoperative TK > 50°, and SS ≤30°. LL change was mostly because of 3-column osteotomy and ending the instrumentation at L5 or S1 increased the hazard of failure more than 6 fold compared with more cranial lumbar levels. CONCLUSION: Mechanical failure rate was 47% after adult spinal deformity corrective surgery. LL change > 30°, postoperative TK > 50°, and postoperative SS ≤30° were independent radiographic predictors associated with increased hazard of failure. LEVEL OF EVIDENCE: 4.