Stark differences in cancer epidemiological data between GLOBOCAN and GBD: Emphasis on oral cancer and wider implications.

Background: GLOBOCAN 2020 and Global Burden of Disease (GBD) 2019 are the two most established global online cancer databases. It is important to examine the differences between the two platforms, to attempt to explain these differences, and to appraise the quality of the data. There are stark differences for lip and oral cancers (LOC) and we attempt to explain these by detailed analysis of ten countries at the extremes of differences. Methods: Age-standardised incidence rates (ASIR) of LOC were obtained from GLOBOCAN 2020 and GBD 2019. Five countries with the greatest and smallest fold differences were selected. A systematic search of PubMed and Embase electronic databases was then performed to identify publications reporting the incidence of LOC in the selected countries between 2015 and 2022. Specifically, data sources of the articles were examined and evaluated. Findings: For LOC, greatest differences were found in Papua New Guinea, Vietnam, China, Pakistan, and Indonesia (group A). In contrast, the United States of America (USA), Brazil, France, Germany, and India (group B) had the least differences between the two databases. Interpretation: It is not surprising that when GLOBOCAN and GBD could not obtain high-quality or accessible LOC data from national or local cancer registries, as in group A, discrepancies would be seen between the two online databases. In contrast, where only minor differences were seen between GLOBOCAN and GBD, as in group B, presumptively due to those countries having well-established cancer registries and healthcare administrative systems, the literature is more consistent. Moreover, many studies have grouped lip and oral cavity with pharynx and categorised outputs as "oral and oropharyngeal cancer" or "oral cavity and pharynx cancer". Those categorisations lacked subsite accuracy and failed to realise that oral cancer and oropharyngeal cancer have completely different etiological factors, pathogeneses, prognosis, and treatment outcomes. Funding: This research received no specific grant or funding from any funding agency in the public, commercial, or not-for-profit sectors, and the authors received no financial support for the research, authorship, and/or publication of this article.

Incidence and Pattern of Patient-Perceived Oral Medicine Emergencies during Lockdown: Experience of Tertiary Health Care Centre of Eastern Nepal.

Background There has been a significant drop in the number of patients seeking oral medicine care during the lockdown period. Objective To find the incidence and pattern of patient perceived oral medicine emergencies in the tertiary healthcare centre of eastern Nepal, during the lockdown period. Method The clinical profile of patients seeking oral medicine care between 30th April 2021 to 25th June 2021 (period of strict lockdown in Sunsari district) was recorded. Data were recorded in an excel sheet and transferred to Statistical Package for the Social Sciences version 11.5. Frequency and proportion were calculated. Result During the lockdown, 300 patients had visited the hospital with different oral diseases seeking the care of an oral physician. The average number of patients seeking oral medicine care per day was approximately six. Of the total patients, 110 patients had pain as their chief complaint, 48 had wound and 34 had a burning sensation in the mouth. Among them 82% perceived their complaint as an emergency. The provisional diagnosis was temporomandibular disorders in 40 patients, trigeminal neuralgia in 38 patients and 34 had carcinoma. Conclusion Patients seeking oral medicine care during the lockdown period had decreased by about one-third. Pertaining to oral medicine, pain in any orofacial area was the most common patient perceived emergency condition followed by wound and burning sensation. Maximum number of patients visiting the department perceived their complain as an emergency.

Localization of Mental Foramen in Panoramic Radiographs of 18-30 Year Olds: A Hospital Based Study.

Background The position of the mental foramen demonstrates anatomical variations, although typically it is reported to be either between the apices of the first and second premolars or below the apex of the second premolar. Objective To determine the radiographic position of mental foramen in relation to Premolar crown and apex, in panoramic radiographs. Method Following ethical approval a retrospective study was conducted in 510 panoramic radiographs of 18-30 year olds from archives of Department of Oral Medicine and Radiology. The position of mental foramen was scored using crown and apex scores according to scoring criteria given by Jasser and Nwoku, 1998. Descriptive statistics was calculated and Chi-square test was applied to assess variation in position of mental foramen between genders and right and left side of mandible. Kappa statistics was applied to assess intra-observer reliability. Result The most common scoring for position of mental foramen on right side crown and apex was 3 (49.4%) followed by 4 (45.9%). Similarly, on left side the most common score for crown and apex was 3 (50.8%) followed by 4 (44.3%). There was no statistically significant difference in position between the genders. Comparing the right and left sides, the position was symmetrical in 83.3% for crown and apex scores. The Kappa values indicated good agreement for intraobserver reliability. Conclusion The most common position for the mental foramen is between the first and second premolar teeth; though, anatomical variations are seen.

Assessment of Oral Mucositis among Patients Undergoing Radiotherapy for Head and Neck Cancer: An Audit.

Background Radiation-induced oral mucositis is one of the major ionizing radiation toxicities and normal tissue injuries resulting from radiotherapy. It occurs in up to 80% of head and neck cancer irradiated patients, reaching up to 100% in patients with altered fractionation. Objective To assess the grade of Radiation induced oral mucositis as per World Health Organization grading system among post-radiotherapy patients of Head and Neck cancer. Method World Health Organization grading for oral mucositis was done in patients reporting to Department of Radiation oncology for radiotherapy at BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 71 patients in 1 month duration were included. Result Grade 2 mucositis was most common, 52.11% followed by grade 1 (22.5%), grade 3 (18.3%) and grade 4 (7.04%). There were no post-radiotherapy patients who presented without mucositis. Conclusion Radiation induced oral mucositis is a common adverse reaction of radiotherapy. With increase in dose and duration of radiotherapy, grade of mucositis was increasing.

Microinvasion: A Clinical Dilemma.

Microinvasive oral squamous cell carcinoma (MIOSCC) is an early stage malignant tumour,showing invasion of the epithelial cells confined to the superficial lamina propria. This is matter of debate in respect to the clinical presentation, metastasis, therapeutic intervention and prognosis. A 32-year female reported to the department with chief complaint of wound and burning sensation in her left back region of lower gums. Clinical diagnosis of erosive oral lichen planus was made and topical steroid was started. The lesion clinically healed with the use of topical medicine. After stopping the medication the lesion recurred, following which, excisional biopsy was done. On histopathological evaluation diagnosis of microinvasive oral squamous cell carcinoma was made. Recurrence of similar symptom in the same site was seen 10 weeks later, which now showed features of moderate dysplasia. Clinical features of microinvasive oral squamous cell carcinoma resembles premalignant lesion, leading to difficulty in diagnosis, treatment and prognostic assessment. Thus, adequate representation of this entity is necessary.

Influence of learning-style preferences in academic performance in the subject of human anatomy: an institution-based study among preclinical medical students.

Purpose: The present study was conducted to find the preferred mode of learning among first-year preclinical students and compare the preferred mode of learning with sex, faculty of students, and academic performance of the students using the VARK questionnaire. Methods: A cross-sectional study was done among 142 first-year Bachelor of Medicine-Bachelor of Surgery and Bachelor of Dental Surgery students from February to May 2018. Demographic data and various academic performance marks were recorded for each individual. VARK (visual, aural, read/write and kinesthetic) questionnaire version 7.8 was administered to calculate the score of each component. Mean VARK scores were calculated and each student classified by their preferred mode of learning. The preferred mode of learning was compared with sex, nationality, faculty of students, and academic performance using χ 2, unpaired t-tests, and the Mann-Whitney U test. P<0.05 was taken as statistically significant for comparison. Results: A majority of the students (53.52%) were multimodal. The most common multimodal mode of preference was bimodal (26.06%), while the most common unimodal preference was kinesthetic (29.06%). Total V score, K score, and VARK score were higher among males, while A and R scores were higher among females. The K score (7.96±2.35 in males and 6.96±2.43 in females) differed significantly (P=0.019) between male and female subjects. More subjects with higher scores in the theory exam of anatomy were unimodal learners (53.8%) compared to multimodal learners (46.2%). Conclusion: From this study, it can be concluded that undergraduate students were diverse in their learning styles, but most were multimodal. Though learning styles were found to vary by sex, nationality, and academic performance, differences were not statistically significant.

Knowledge, Attitude and Practice of Dental Students Regarding Treatment of Patients with HIV or AIDS in Nepal.

Background There have been discrepancies in providing treatment to HIV positive patients across healthcare fields, due to lack of knowledge. Currently, there is an increasing awareness of discrepancies in the provision of dental care for HIV positive patients and a potential relationship to health care professional knowledge and attitudes towards these individuals. Objective To analyze dental students' knowledge, attitudes and practices regarding treatment of HIV patients in Nepal. Method An online survey was sent to all dental students via blue-eval. Mixed effects logistic regression was used to predict a likelihood of the dental treatments between HIV negative and HIV Positive patients. Logistic regression was used to predict the likelihood of dental treatments for HIV patients based on the knowledge of human immunodeficiency virus. Result Two hundred six students (65%) responded to the survey from dental colleges in Nepal. All students had worked with at least one HIV positive patient. Overall, students felt uncomfortable providing dental treatments to HIV positive patients, with only 29% likely to perform a prophylaxis and filling, 18% orthodontic treatment, 16% endodontic treatment, 12% periodontal scaling, and only 10% extractions. Conclusion Currently dental students in Nepal are uncomfortable in providing treatment to HIV/ AIDS patients.

Even a Tooth Slips Sometimes.

While impaction of a tooth or two in dentoalveolar region is common, ectopic presence of them in non-dentate area is less commonly reported. A 45-year-old female reported to the department with pain on right back teeth region since two days. On examination, grossly decayed 46, root stump 47, missing 48, with poor periodontal status were noted. Panoramic radiograph was advised for screening, which revealed an inverted impacted 48 at the right ramus just below subcondylar region. However, it was an incidental finding and the patient was asymptomatic, she was informed about the pros and the cons of her case and kept under close monitoring.

Validation of Nepalese Oral Health Impact Profile14 and Assessment of Its Impact in Patients with Oral Submucous Fibrosis in Nepal.

BACKGROUND: Oral Health Impact Profile-14 (OHIP-14) is one of the most internationally used oral health related quality of life (OHRQoL) questionnaire available in various languages. The study was aimed to validate Nepalese version of OHIP-14 and to assess impact of quality of life (QoL) in patients with oral submucous fibrosis (OSF). METHODS: An interventional OHRQoL study was conducted among OSF patients visiting Department of Oral Medicine and Radiology, BP Koirala Institute of Health Sciences, Dharan using OHIP-14 after translation and validation process. Following the baseline questionnaire, 74 patients were treated with dexamethasone and hyaluronidase for 6 weeks and followed up for 6 months during which OHIP-14 was again administered. RESULTS: For concurrent validity, Nepalese OHIP-14 scores were associated with self-perceived oral health status, self-perceived dental treatment need and satisfaction with oral health status. For internal reliability, inter-item correlation coefficient varied from 0.2-0.8. Corrected item-total correlation coefficients were between 0.43-0.80. Cronbach's alpha was 0.90. Commercial tobacco product chewing with arecanut (Gutka Ⓡ ) was seen among 45% with median frequency and duration of 7.5(0-20) times/day and 10(0-60) years, respectively. Median OHIP-14 score at baseline 18(0-45), was significantly (p<0.001) different from 6 months' follow-up [5(0-15)]. Impact score at baseline was mainly influenced by age (r(s) =0.32, p=0.005), frequency of habit (r(s) =0.44, p<0.001) and duration of habit (r(s) =0.31, p=0.006). s CONCLUSIONS: Nepalese version of OHIP-14 is a valid and, reliable instrument to measure OHRQoL in OSF patients. OHRQoL in OSF patients can be improved after professional treatment regime.

A systematic review of medical interventions for oral submucous fibrosis and future research opportunities.

Oral Diseases (2011) 17 (Suppl. 1), 42-57 Oral submucous fibrosis (OSF) is a chronic, insidious disease caused by areca nut use, and is associated with both significant morbidity (including pain and reduced oral opening) and an increased risk for malignancy. This systematic review explored and updated the current medical (i.e., non-surgical) interventions available for the management of OSF. Of the 27 published medical interventions, there were four randomized controlled trials. The overall quality of these randomized controlled studies was assessed using the GRADE approach and significant limitations that challenged the conclusions were found. However, this review was valuable in terms of identifying opportunities to provide recommendations for future research, in terms of the populations to research, the types of interventions needed, the types of outcomes to be measured, the study designs needed, and the infrastructure required to conduct studies. The next step is to initiate a pathway for a low-cost research plan leading to the development of a brief protocol for future clinical trials in this field, with an emphasis on conducting studies in regions of the world where OSF is prevalent.

A rare presentation of oral pemphigus vulgaris as multiple pustules.

Pemphigus vulgaris is an autoimmune blistering disease affecting the mucous membrane and skin. Ulcers, vesicles, bulla, erosions are the common manifestations of the disease. It is uncommon to find multiple pustular lesions in the oral cavity. Here, we report the first case of multiple pustules involving the lateral borders of tongue, buccal mucosa, hard palate, soft palate, vestibule and the gingiva of a 53 year old male. Histopathologic and Immunofluoroscence study was suggestive of pemphigus vulgaris. The condition improved with systemic corticosteroid along with adjuvant therapy. Key words: pemphigus vulgaris, multiple pustules, immunofluorescence, corticosteroids.