Impact of histopathological parameters in prognosis of oral squamous cell carcinoma.

OBJECTIVE: Squamous cell carcinomas comprise approximately 90% of all oral malignancies. There is a wide geographical variation in the incidence of oral cancer, with South and South East Asia (SSEA) accounting for almost two third of new cases. The prognosis of oral cancer is influenced by a vast array of factors including demographic, clinical, histopathological and molecular factors. The objective this review is to analyse the impact of histopathological features assessed in hematoxylin and eosin stained sections on the prognosis of OSCC. MATERIALS AND METHODS: Medline and Scopus data base search was performed in order to identify related articles on histopathological parameters in predicting prognosis of oral squamous cell carcinoma. The primary emphasis is on the studies conducted in SSEA, with an accompanying comparison of their findings with those from research conducted in other parts of the world. RESULTS: It has been shown that the number of studies conducted in SSEA is not proportionate to the high prevalence of Oral Cancer in the region. There is no significant difference between the findings from SSEA compared to the rest of the world. It is clearly shown that most histopathological parameters can be accurately used to predict nodal metastasis and prognosis. CONCLUSIONS: Histopathological parameters can be used reliably in planning treatment of Oral cancer. Clinicians should combine clinical and histopathological parameters in drawing treatment plan for Oral Cancer.

Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) remains the most common cancer among males in Sri Lanka. Metastasis to neck is a crucial prognostic factor. A modified radical/radical neck dissection including levels I -V, was performed in patients with OSCC who had a clinically positive neck (cN+). Currently, evidence suggests that sparing level V in a cN+ may be justified due to less chance of metastasis in early stages of the disease. To the best of our knowledge, the incidence of metastasis to level V in patients with cN+s has not been previously investigated in a Sri Lankan context. We aimed to determine level V lymph node metastasis and related clinicopathological indicators in cN+s in patients with OSCC. A multicentre retrospective study investigated postoperative biopsy reports of 187 patients for five years. OSCC patients with cN+s who underwent neck dissections of levels I-V were included. Only 6.4% of patients had histopathologically positive level V lymph nodes. A total of 127 lymph nodes were harvested from level V of those who showed level V positivity and out of them 68 were positive with a third of cases showing extranodal extension (ENE). The buccal mucosa (n=4) and lateral aspect of the anterior two thirds of the tongue (n=4) were the common primary sites for level V metastasis. In patients who showed positivity in levels III and IV, a considerably higher probability of level V nodes being positive was seen, which was statistically significant (p = 0.0001). We have concluded that the routine performance of a modified radical/radical neck dissection for cN+s should be stopped, as the incidence of Level V positivity is significantly low. Assessing the cN+ for N stage, status of levels III and IV, pattern of invasion, differentiation, and the site may be used instead as predictors for level V positivity.

The effect of thriphala, a herbal Ayurveda formulation, on serum lipids, in patients on a maintenance dose of atorvastatin for hyperlipidaemia: a randomized controlled trial

Introduction: Thriphala, a herbal medicinal formulation, is a bedrock of Ayurveda therapeutics with many postulated benefits. Objectives: We performed a clinical trial to test the effects of Swastha Thriphala®, a proprietary preparation of thriphala, on serum lipid parameters in patients receiving atorvastatin. Methods: Consenting adults receiving a maintenance dose of atorvastatin 10mg (Atorlip®) daily from a clinic of the Institute of Cardiology, National Hospital of Sri Lanka for lipid regulation, were randomly assigned, after counselling, to receive either the proprietary herbal medicinal product Swastha Thriphala® (Treatment Group, n= 101) or a placebo (Control Group n= 97), at the stipulated dose daily, for three calendar months. Results: In the treatment group (n=101) the addition of a proprietary preparation of thriphala formulated as caplets of Swastha Thriphala®, in the standard daily dosage for three months, as an adjunct to atorvastatin 10mg, had a significant (p<0.0001) reduction in the mean total blood cholesterol, mean cholesterol/HDL ratio (p<0.0001), and mean non- HDL-cholesterol (p<0.0001) when compared to the Control Group (n=97) receiving placebo caplets in the same daily dose, with atorvastatin 10mg, for the same period. In the Treatment Group mean HDL, LDL, HS-CRP, and triglyceride concentrations showed non-significant reductions, and nonsignificant elevations in the Control Group Conclusions: Swastha Thriphala® when used in the stipulated dosage as an adjunct to atorvastatin 10 mg daily, significantly enhances its cholesterol reducing action in patients. The use of Swastha Thriphala® as single therapy for lipid regulation, and the mode of its action deserve investigation.

Impact of a traditional dietary supplement with coconut milk and soya milk on the lipid profile in normal free living subjects.

Background. The effects of coconut fat and soya fat on serum lipids are controversial. This study was designed to investigate the lipid effects of coconut milk and soya milk supplementation on the lipid profile of free living healthy subjects. Methods. Sixty (60) healthy volunteers aged 18-57 years were given coconut milk porridge (CMP) for 5 days of the week for 8 weeks, followed by a 2-week washout period, subsequent to which they received isoenergetic soya milk porridge (SMP) for 8 weeks. Results. The LDL (low density lipoprotein) levels decreased with CMP and reached statistical significance in the total study population and in the >130 baseline LDL group. The HDL (high density lipoprotein) levels rose significantly with CMP supplementation (P = 0.000). Conclusions. We conclude that coconut fat in the form of CM does not cause a detrimental effect on the lipid profile in the general population and in fact is beneficial due to the decrease in LDL and rise in HDL. SMP will be of benefit only in those whose baseline LDL levels are elevated.

Performance against local service quality indicators: re-setting the indicators.

Local service quality indicators (SQIs) both for genitourinary medicine and HIV were drafted following patient and public involvement in 2009. At that time there were few published data to help in setting some of the original SQIs. Our clinical performance was audited against these SQIs in 2009 and subsequently re-audited in 2010 and 2011. The SQIs were revised based upon the results of the three audits. This paper attempts to explain the revisions based upon the audits. Commissioners are currently working with service providers around the country to develop HIV clinical outcome indicators that link payment to performance. It is vital to ensure that clinical outcome indicators are set correctly so that they are challenging but still achievable. We hope other services may wish to audit performance against our revised measures. If such data were to be pooled this could provide evidence for more robust benchmarking.

A case series of the management of symptomatic azole-resistant candida.

Patients with symptomatic azole-resistant Candida albicans or non-albicans candida are difficult to manage. Treatment is largely anecdotal due to the relatively small number of patients. We present six case reports which highlight our own observation in clinical practice including four patients who were treated successfully with topical amphotericin B/flucytosine vaginal gel for 14 days (Stoke-on-Trent formula).