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Background and objective Head and neck cancer can arise from any site like hypo-pharynx, oro-pharynx, lip, oral cavity, or larynx. Almost 90% of them are head and neck squamous cell carcinomas (HNSCC). In the current project, the goal was to determine the frequency of acute side effects in terms of mucositis during and immediately post-irradiation period in patients receiving concurrent three-dimensional (3D) radiotherapy in a tertiary care hospital. Methodology This descriptive case series with 106 enrolled patients was carried out from December 2019 to May 2020 at the Department of Radiation Oncology following approval. All patients were given radiotherapy or chemo-radio-therapy as per the clinician's advice and hospital protocol. All patients were evaluated at pre radiation time, at weekly intervals during treatment and at 11 weeks from 1st radiation fraction. Data was entered and analyzed by Statistical Package for Social Sciences, version 20 (SPSS Inc., Chicago, IL). Chi-square and Fisher's exact test was applied as p-value ≤ 0.05 was considered significant. Results In the present study, all patients (n=106) showed a mean age of 57.8 ± 8.3 years. There was a gradual increase in grades of mucositis in all patients after treatments until seven weeks. After one month of post-treatment, a decrease in grades of mucositis was observed in all patients. Conclusion Acute side effects appeared in all patients receiving 3D radiation therapy (RT) although the treatment response was good. Hence, we concluded it has a high incidence of treatment-related toxicities but it is safe.
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Faculty feedback program (FFP) at CMH Multan Institute of Medical Sciences (CIMS) was conducted for obtaining feedback for basic medical sciences faculty and evaluated to highlight its weaknesses for future improvement. The evaluation design was utilization-focused evaluation (UFE) keeping in mind its two essential elements. First element is the primary intended users (PIU) of the evaluation, namely the college faculty and students which were clearly identified and personally engaged to investigate intended use of the evaluation. Second element required the evaluator to ensure that the intended use of evaluation by PIU guide all other decisions made about the evaluation process. It was a mixed method study (qualitative and quantitative methods both) conducted from August 2018 to August 2019 in CIMS Multan with IRB approval following the steps of UFE. The whole program evaluation was conducted in two parts - first part constituted the 2018 manual FFP evaluation that provided suggestions for a FFP conducted in 2019 online. In step 2 the 2019 online FFP was evaluated again forming basis for future recommendations. Hence the PIUs response was recorded twice in the evaluation cycle - initially after the manual 2018 basic science FFP (response rate: 53%) - after which based on our findings a report was generated and recommendations suggested which were implemented in the 2019 online FFP and response observed again (response rate: 85.7%) to complete the evaluation cycle. Open-end questions were asked from faculty (qualitative analysis) with three themes emerging regarding FFP procedure, questionnaire and timing. An acknowledgement of shift of FFP procedure from manual (2018) to online system (2019) was observed in which faculty praised the ease (72.2%), confidentiality (66.6%), anonymity (50%) and transparency (33.3%) of the online system compared to manual FFP, which was reported to be a rather tense experience (83%). Regarding questionnaire, 38% faculty members reported feedback questions asked from students to be vague and 66.6% claimed that the timing was inappropriate and should have been end of academic year. When asked for suggestions for improvement in 2018 FFP, 72% faculty suggested training students on providing feedback and making the procedure user friendly (83%). Student response regarding both feedback was obtained online by a survey with closed ended questions (quantitative study). Fifty-three percent college students were satisfied with the online FFP giving an average rating of 3.2 to the software user interface and 85% affirmed that using the online software aided in providing anonymous responses helping them provide candid feedback. Seventy-five percent students agreed that online feedback system in 2019 had streamlined the feedback process and made it more efficient compared to the paper-based manual survey of 2018. After evaluating 2019 online FFP, few suggestions were recommended for future FFP including obtaining formative as well as summative faculty feedback, supplementing feedback with teacher's self-assessment/pen picture and incorporating 360 multi-source feedback.
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No-shows for scheduled appointments are a frequent occurrence, creating unused appointment slots and reducing patient quality of care and access to services while increasing loss to follow-up and medical costs. The aim of our study was to determine the factors that lead to patients missing their dental appointments in Eastern Province Military Hospitals, Kingdom of Saudi Arabia. The study population included military personnel and their families attending the dental clinics of these hospitals. In our study, the percentage of missed appointments was 58.1%, while 54.4% of participants canceled dental appointments in the past. Thirty-six percent preferred morning appointments while 56% preferred an afternoon appointment and were likely to miss a morning appointment if given one. The most common reasons for missing an appointment were forgetting about it (24.3%) and the inability to get time off either from work or school (15.4%); 1.5% of patients stated they had a bad dental experience and feared dental treatment while the unavailability of transport accounted for 0.7% of patients. Of the reasons given for canceling an appointment, the inability to get time off from work/school was the most common (22.1%) while a dislike for treatment was the least common (0.7%). Canceling an appointment was significantly correlated with missing an appointment among the surveyed sample (P=0.00). In our research, 60.3% of participants still relied on their personal diary to remember appointments, which could be a reason for the high rate of missed appointments. Fifty-nine percent of respondents felt that missing an appointment was important to them, while 72% stated that missed appointments could affect the work of the clinic but still believed that automatic appointments should be given to patients who missed them and a change be made accordingly. Since major factors included a lack of a reminder message and appointments scheduled at inconvenient timings, some steps that can help reduce the frequency of missed appointments include sending a reminder message to patients, giving preference to their schedules for appointments, giving patients shorter appointments, reducing intervals between subsequent appointments, and educating patients regarding the treatment plan, to reduce anxiety.
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INTRODUCTION: Periodontitis is one of the most common causes of tooth loss worldwide. Recently, special attention has been paid to natural medication for its treatment. For this purpose, propolis (bee glue) activity has also been investigated. Its antibacterial properties are mainly attributed to flavonones pinocembrin, flavonols galangin and to the caffeic acid phenethyl ester. This study is aimed at evaluating the antimicrobial effects of propolis from Pakistan on 35 clinical isolates of pigmented anaerobic periodontal pathogens. METHODS: This study was conducted in the Microbiology department, University of Health Sciences, Lahore, Pakistan. Pathogens included were Porphyromonas asaccharolytica (n=9), Porphyromonas gingivalis (n=13), Prevotella intermedia (n=9), Prevotella melaninogenica (n=4). Minimum inhibitory concentration (MIC) to three antibiotics was obtained by E-test method. All strains were sensitive to amoxicillin plus clavulanic acid and metronidazole, but 100% of P asaccharolytica and P melaninogenica strains displayed intermediate resistance to tetracycline while 69.2% P gingivalis and 100% P intermedia strains exhibited complete resistance to tetracycline. Screening for antibacterial activity of propolis extract was done by agar well diffusion assay, and all strains were found sensitive to ethanolic extract of propolis. RESULTS: MIC was obtained by agar incorporation technique with values ranging from 0.064 to 0.512 mg/ml. It was also noticed that percentage yield of ethanolic extract of propolis prepared from ultrasonic extraction method was higher compared to extract obtained with maceration. CONCLUSION: These results indicate that propolis from this region has potent antimicrobial activity against pigmented anaerobic periodontal pathogens. Taking into consideration the increasing resistance in anaerobic bacteria, this effective antimicrobial activity of propolis gives hope in the treatment of oral cavity diseases.
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Sanger and coworkers introduced DNA sequencing in 1970s for the first time. It principally relied on termination of growing nucleotide chain when a dideoxythymidine triphosphate (ddTTP) was inserted in it. Detection of terminated sequences was done radiographically on Polyacrylamide Gel Electrophoresis (PAGE). Improvements that have evolved over time in original Sanger sequencing include replacement of radiography with fluorescence, use of separate fluorescent markers for each nucleotide, use of capillary electrophoresis instead of polyacrylamide gel electrophoresis and then introduction of capillary array electrophoresis. However, this technique suffered from few inherent limitations like decreased sensitivity for low level mutant alleles, complexities in analyzing highly polymorphic regions like Major Histocompatibility Complex (MHC) and high DNA concentrations required. Several Next Generation Sequencing (NGS) technologies have been introduced by Roche, Illumina and other commercial manufacturers that tend to overcome Sanger sequencing limitations and have been reviewed. Introduction of NGS in clinical research and medical diagnostics is expected to change entire diagnostic approach. These include study of cancer variants, detection of minimal residual disease, exome sequencing, detection of Single Nucleotide Polymorphisms (SNPs) and their disease association, epigenetic regulation of gene expression and sequencing of microorganisms genome.
