Toluidine blue: yet another low cost method for screening oral cavity tumour margins in third world countries.

OBJECTIVE: To use toluidine blue intra-operatively to identify tumour involved margins after the removal of oral cavity squamous cell carcinoma, and to compare the findings with those of final histopathology. METHODS: The study was conducted at the Aga Khan University Hospital from December 1, 2009, to March 14, 2010, and comprised 56 consecutive patients with biopsy-proven squamous cell carcinoma of oral cavity regardless of grade and stage of tumour. Intra-operatively toluidine blue was used on the resected tumour margins and the staining patterns were assessed. Results were then compared with the final histopathology report. RESULTS: A total of 11(19.64%) margins were positive with toluidine blue staining out of which 8 (14.28%) were false positive. Sensitivity and specificity was found to be 100% and 84.9% respectively with a positive predictive value of 27.2%; a negative predictive value of 100%; and diagnostic accuracy of 85.71%. CONCLUSION: Toluidine blue costs only Rs25 (USD 0.30) and takes only 5 minutes for application and interpretation. It can be used with significant confidence in smaller lesions (T-l and T-II) as an alternative to frozen sections in developing countries where facilities are unavailable. Its use in larger lesions (T-lll and TIV) remains the topic of controversy and awaits a multi centre trial with a larger cohort.

Professionalism in medical students at a private medical college in Karachi, Pakistan.

OBJECTIVE: To determine levels of professionalism in undergraduate medical students at a private medical college and assess how changes emerge during their training. METHODS: The study was conducted at Aga Khan University, a tertiary care teaching hospital, during November and December 2011. Freshmen, Year 3 and Year 5 students were requested to fill out a questionnaire. It was designed to assess the participants' levels of professionalism and how they perceived the professional environment around them by incorporating previously described scales. The questionnaire was re-validated on a random sample of practising clinicians at the same hospital. SPSS 17 was used for statistical analysis. RESULTS: The study sample comprised 204 participants. The mean score for level of individual professionalism was 7.72+/-3.43. Only 13 (6.4%) students had a score one standard deviation above the faculty mean. About 24 (11.8%) were one standard deviation and 35 (17.2%) were 2 standard deviations below the faculty mean. The remaining 130 (63.7%) were >2 standard deviations below the faculty mean. Considering the level of education, the mean score for level of professionalism was 8.00+/-3.39 for freshmen, 6.85+/-3.41 for year 3 students, and 8.40+/-3.34 for year 5 students. CONCLUSION: The currently employed teaching practices inculcating the values of professionalism in medical students are serving as a buffer to maintain the pre-training levels of professionalism from declining.

Nasal encephaloceles presenting at later ages: experience of otorhinolaryngology department at a tertiary care center in Karachi, Pakistan.

Encephaloceles are anomalous herniations of the meninges, with or without brain matter. Globally the incidence of encephalocele is about 1 per 35,000 births, but it is more frequently reported in Southeast Asia. As the defect is more pertinent to embryological development, an encephalocele is a more common entity in an infant with a mean age of presentation ranging between 15.5 and 21 months; making an encephalocele presenting for the first time in a relatively, older individual a rare occurrence. Consequently a surgeon might not consider an encephalocele among his differentials. Here we present a series of encephaloceles that presented at a later than usual age as nasal masses to the otorhinolaryngology department of our hospital, and recommend that the differential of encephalocele be entertained for nasal masses as proceeding with routine procedures may result in potentially lethal complications.

Knowledge attitude and practices among urban women of Karachi, Pakistan, regarding breast cancer.

OBJECTIVE: To determine the knowledge,attitudes and practices of urban women regarding breast cancer and its available screening modalities. METHODS: The cross-sectional, questionnaire-based, descriptive study was conducted in the urban population of Karachi in November 2010. Female attendants (n=373) visiting a tertiary care centre and four of its urban outreach centres during the study period were administered a questionnaire. The answers were then scored with regard to their knowledge. Frequencies and percentages were computed through SPSS 17, and analysis of variance was used to confirm significance. RESULTS: Of the 373 participants with a mean age of 32.4+/-10.9 years, 293 (78.6%) were married, and 257 (69%) were housewives. The education level was considerably high; with 214 (57.4%) graduates. The mean score for knowledge of risk factors was 2.84 out of a total of 13; which was significantly associated with marital status and income. Age > 40 years, education level, income and employment status were also significantly associated with higher mean screening awareness scores. Nearly 182 (48.8%) had heard about Breast Self Examination and 142 (38%) knew how to perform one. However, only 97 (25.9%) regularly performed such an exam. Almost all 3621 (97%) women wanted more media awareness campaigns regarding the issue. CONCLUSION: There is a real need for comprehensive health education programmes focusing on breast cancer awareness in Pakistan.

Mucoepidermoid carcinoma of the base of tongue.

Mucoepidermoid carcinomas are thought to arise from the reserve cells of salivary gland ducts. Minor salivary glands are located all around the oral cavity and base of the tongue; however few cases of MEC of the base of the tongue have been reported in literature and no guidelines are available for its management. Here we would like to present the case of a 71 year old male with mucoepidermoid carcinoma of the base of the tongue successfully treated with surgical excision and neck dissection. Regular clinical follow up showed no signs of recurrence at 9 months post excision.

Comparison of outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post operative patients with a principle diagnosis of squamous cell carcinoma of the oral cavity.

OBJECTIVES: Squamous cell carcinoma of the oral cavity has a profound impact on a patient's nutritional intake, 40-50% of head and neck cancer patients have a markedly impaired nutritional status at the time of their initial presentation. Studies show that patients who have better nutritional status have fewer complications and a better survival rate. Therefore, enteral nutritional support plays an important part in their management. Due to the lack of relevant data, surgeons help patients make informed decisions regarding their mode of nutritional support and perform gastrostomy or place nasogastric tube depending on the patient's preference. This study addresses the need for scientific data regarding the impact and psychosocial acceptance of both these modalities in our population. METHODS: A retrospective review of patient's charts with a principle diagnosis of squamous cell carcinoma of the oral cavity, receiving surgery +/- adjuvant radiotherapy was carried out. Patients were also questioned regarding their experience with the mode of nutrition and its impact on their life during their regular follow up consultations. Post therapy change in weight, psychosocial acceptance and quality of life were considered as measures of outcome. RESULTS: A mean weight loss of 5.43 +/- 3.4 kg (p = 0.025) was noticed in 15 patients on nasogastric feeding. On the other hand, significantly less weight loss of 1.25 +/- 5.12 kg (p = 0.025) was noticed in the patients receiving nutrition via gastrostomy tubes; nine patients had a mean weight gain of 2.89 +/- 1.95 kg and the rest had similar weight loss of 5.427 +/- 3.4 kg. CONCLUSION: The authors of the study recommend that gastrostomies should be considered for patients requiring long term post operative enteral nutritional support in patients of head and neck cancers.