Salivary Lactate Dehydrogenase as a Potential Biomarker in Oral Potentially Malignant Disorders and Head & Neck Cancer- A Systematic Review and Meta-analysis.

BACKGROUND: The prognosis of head &neck cancer (HNC) depends on its early detection, diagnosis, and treatment, which has advocated a search for a simple, reliable, noninvasive, cost-effective tool to aid in the same. Salivary lactate dehydrogenase has gained interest in recent years, meeting the above requisite. OBJECTIVES: To evaluate the levels of salivary lactate dehydrogenase in patients with oral potentially malignant disorders (OPMD), HNC, and in the healthy control group (CG); to find the correlation, grade-wise and genderwise difference between them; and to assess whether it can be used as a potent biomarker in OPMD and HNC. MATERIALS AND METHODS: A comprehensive search of the specialized 14 databases and 4 institutional repositories was performed for including the studies evaluating salivary lactate dehydrogenase in OPMD and HNC patients either comparing or not comparing to the healthy control group in the systematic review process. The meta-analysis was performed with the eligible study data with the STATA version 16, 2019 software with 95% CI and p ≤ 0.05 in the random-effects model. RESULTS: Twenty-eight studies of case-control, interventional, or uncontrolled non-randomized design evaluating salivary lactate dehydrogenase were included. A total of 2074 subjects were included, involving HNC, OPMD, and CG. The salivary lactate dehydrogenase levels were significantly higher in HNC than in CG & oral leukoplakia (OL) (p=0.00); in OL & oral submucous fibrosis (OSMF) than CG (p=0.00); and higher in HNC than OSMF, however not significant (p=0.49). Also, the salivary lactate dehydrogenase levels had no significant difference between males and females in CG, HNC, OL, and OSMF groups(p> 0.05). DISCUSSION: It is evident that the epithelial transformations in the various OPMD and HNC, and the proceeding necrosis in the case of HNC, raises the LDH levels. It's also worth noting that when degenerative alterations continue, the SaLDH levels rise correspondingly, which are higher in HNC than in OPMD. Hence, it is essential to determine the cut-off values for SaLDH for establishing that the patient may have HNC or OPMD. It would be easy to follow-up frequently and perform investigations such as biopsy for the cases with high SaLDH levels, thereby aiding in the early detection and improving the prognosis of HNC. Moreover, the increased SaLDH levels were indicative of a lower degree of differentiation and an advanced disease leading to a poor prognosis. Salivary sample collection is less invasive, simple, and more acceptable to the patient; however, saliva collection is a time-consuming procedure as it is mostly collected by the passive spit method. Also, it is more feasible to repeat the SaLDH analysis during the follow-up, but the method has recently gained interest for over a decade. CONCLUSION: Salivary lactate dehydrogenase can be a potential biomarker for the screening, early detection, and follow-up of OPMD or HNC being simple, noninvasive, cost-effective, and readily acceptable modality. However, more studies with new standardized protocols are recommended to determine the precise cut-off levels for HNC and OPMD. Keywords (MeSH): L-Lactate dehydrogenase; Saliva; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Oral; Precancerous conditions.

Comparative evaluation of the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel in oral lichen planus-a double-blinded randomized control trial.

OBJECTIVES: The a im of this study is to evaluate and compare the efficacy of Nigella sativa (75% v/v) cream and clobetasol propionate (0.05% w/w) gel for the management of oral lichen planus (OLP). STUDY DESIGN: Sixty clinically diagnosed cases of OLP were stratified into moderate cases or severe cases based on burning sensation before getting allocated to group I receiving Nigella sativa cream and group II receiving clobetasol propionate gel, two times a day for 45 days. Patients were examined every 15 days for a change in burning sensation and size of the lesion using the numeric pain rating scale (NRS) and a standard Vernier caliper, respectively. Statistical tests including Mann-Whitney U, Wilcoxon signed-rank, Friedman's, Dunn's post hoc, unpaired t, paired t, one-way repeated measures ANOVA, and Bonferroni's post hoc were applied. RESULTS: There was a statistically significant reduction in the burning sensation as well as the size of the lesion in both groups (P ≤ 0.05). There was an 87.8% (moderate cases) and 85.7% (severe cases) reduction in the mean NRS scores on the 45th day in group I when compared to the 96.5% (moderate cases) and 93.48% (severe cases) in group II. There was a 92.9% (moderate cases) and 90.7% (severe cases) reduction in the size of the lesion in group I when compared to the 92.6% (moderate cases) and 93.1% (severe cases) in group II. CONCLUSION: The topical application of Nigella sativa cream was effective and comparable to clobetasol propionate 0.05% gel in the management of OLP, without any side effects. Hence, this study recommends the use of topical Nigella sativa cream therapy in the management of OLP. CLINICAL RELEVANCE: The current mainstay of treatment for OLP is the administration of topical or systemic corticosteroids, which are known to cause side effects, demanding a search for an alternative. Nigella sativa oil cream could be a safe, promising, cost-effective, adjunctive, or alternative modality. Clinical trial registration number: CTRI/2020/07/026745 (India).

Awareness and Knowledge Among Dental and Medical Undergraduate Students Regarding Human Papilloma Virus and Its Available Preventive Measures.

Background: India is a major contributor to the global burden of human papilloma virus (HPV) infection and associated diseases like cervical and oropharyngeal cancers. Hence, it is essential to recognize the existing knowledge pool of current healthcare students about HPV and its preventive measures to translate this into benefits for the society in the future. Objective: To determine the awareness and knowledge among dental and medical undergraduate students regarding HPV and its diagnosis and prevention. Methods: This cross-sectional study enrolled in 577 dental and undergraduate medical students from a tertiary-care teaching hospital. A questionnaire containing 20 closed-ended multiple-choice questions was used to assess their knowledge regarding HPV and its transmission, cervical cancer and its screening, as well as HPV vaccines and their attitude towards them. Descriptive statistics, Mann Whitney U test, and Chi square test were employed for statistical analysis. p ≤ 0.05 was considered statistically significant. Results: The study consisted of 52.68% dental and 47.31% medical students, with a mean age of 20.95 ± 1.82 years, M:F ratio of 0.7:1, and a mean overall score of 10.75 ± 5.18 (average). The mean scores for knowledge about HPV, its vaccination, and its diagnosis were 7.98 ± 3.26 (good), 1.61 ± 0.95 (average), and 1.15 ± 1.16 (average), respectively. These scores showed no significant difference between the courses as well as the genders (p > 0.05). Conclusion: Overall, the dental and medical undergraduate students presented an average level of knowledge and awareness regarding HPV and its prevention. This reflects a greater need for educating healthcare professionals in order to have a ripple effect on society at large.