Recurrence in Oral Squamous Cell Carcinoma Associated with Wide Field of Cancerization: Analysis of 93 Cases.

Background: The late presentation of oral squamous cell carcinoma (OSCC) patients in the Sudan, with advanced stages and wide field of cancerization, have a negative impact on both the morbidity and the mortality of these patients. The present study aimed to investigate the clinicopathological behavior of OSCC and predictors of development of recurrence in these patients. Methods: This a prospective longitudinal study of 93 OSCC patients surgically treated at Khartoum Teaching Dental Hospital. Tumor's associated field of cancerization was identified. The patients were followed clinically on regular basis, for a year, for the development of recurrence. Results: Out of the 93 patients, 57 (61.3%) were males and 36 (38.7%) were females. 82% of the patients presented with stage IV tumors, and 58 (62.4%) of the cases had nodal metastasis. Twenty-eight (30%) patients developed recurrence. Of them 17 (18.3%) had regional recurrence, eight (8.6%) had local recurrence and three (3.2%) had locoregional recurrence. Multivariate cox regression analysis showed that Toombak dipping (P.value = 0.001), tumor staging (P.value = 0.039) and presence of mucosal filed changes (P.value = 0.001) were independent predictors for local recurrence and positive pathological lymph nodes (P.value = 0.00) and extranodal extension (P.value = 0.040) were independent predictors for regional recurrence. Conclusion: The present study showed that OSCC patients in the Sudan present with advanced lesions, mostly associated with wide field of cancerization particularly Toombak dippers. Overall recurrences were identified in 30% of the cases, regional recurrence was the commonest type followed by local recurrence.

Oral ID® as an adjunctive tool for surgical margin assessment in patients with oral squamous cell carcinoma: a comparative study / Oral ID® como uma ferramenta adjuvante para avaliação da margem cirúrgica em pacientes com carcinoma oral de células escamosas: um estudo comparativo

Objective: The condition of the resected margin in oral squamous cell carcinoma continues to be an important prognostic factor; the use of optic technology could help surgeons in determining the margin status at real time. This study aims to evaluate Oral ID, a hand held device that uses the principal of auto-fluorescence to determine surgical safe margins in patients with oral squamous cell carcinoma, and to compare the results with those of the conventional 1 cm margin method. Material and Methods: This study was a descriptive, comparative analytical study carried out at Khartoum Dental Teaching Hospital and Oral Histopathology Diagnostic Laboratory, Faculty of Dentistry, University of Khartoum. A total of 92 margins obtained from 31 patients, 46 margins were taken by Oral ID and the other 46 were taken by the traditional 1cm method. All margins were examined histologically with conventional Hematoxylin and Eosin stain. Results: It was found that all tumors showed fluorescence loss; A significant association was found between the use of Oral ID and obtaining a free margin P (0.02) the sensitivity of Oral ID was found to be 74% the specificity was found to be 89%. Ten out of the 46 margins obtained by fluorescence showed mild dysplasia and two margins showed high grade dysplasia. The 46 margins obtained by the traditional 1cm margin showed different field alterations two were involved, one was close, five showed high grade dysplasia and 14 showed mild dysplasia yielding a specificity of 52.2%. Conclusion: Using Oral ID for surgical margin assessment increases the accuracy to 74% compared to the conventional method which was found to be 52.2%. The results of the device are comparable to other auto-fluorescence devices of different trademarks. Further development of the device to help overcome its limitations is strongly advised (AU)

Objetivo: A condição da margem ressecada no carcinoma oral de células escamosas continua sendo um importante fator prognóstico; o uso de tecnologia óptica pode ajudar cirurgiões a determinar o status da margem em tempo real. O objetivo deste estudo é avaliar o Oral ID, um aparelho portátil que utiliza o princípio da autofluorescência para determinar margens de segurança cirúrgicas em pacientes com carcinoma oral de células escamosas, e comparar os resultados com o método convencional de margem de 1 cm. Material e Métodos: Este estudo foi um estudo descritivo, analítico e comparativo realizado no Khartoum Dental Teaching Hospital e no Laboratório de Diagnóstico de Histopatologia Oral da Faculdade de Odontologia, Universidade de Khartoum. Um total de 92 margens foram obtidas de 31 pacientes, 46 margens foram obtidas por Oral ID e as outras 46 foram obtidas pelo método tradicional de 1 cm. Todas as margens foram examinadas histologicamente com coloração convencional de Hematoxilina e Eosina. Resultados: Verificou-se que todos os tumores apresentaram perda de fluorescência; uma associação significativa foi encontrada entre o uso de Oral ID e a obtenção de uma margem livre P (0,02), a sensibilidade de Oral ID foi de 74% e a especificidade de 89%. Dez das 46 margens obtidas por fluorescência mostraram displasia leve e duas margens mostraram displasia de alto grau. As 46 margens obtidas pela margem tradicional de 1cm apresentaram diferentes alterações de campo, duas estavam envolvidas, uma estava próxima, cinco apresentaram displasia de alto grau e 14 apresentaram displasia leve com especificidade de 52,2%. Conclusão: O uso de Oral ID para avaliação da margem cirúrgica aumenta a acurácia para 74% em comparação com o método convencional, que foi encontrado em 52,2%. Os resultados do dispositivo são comparáveis a outros dispositivos de autofluorescência de diferentes marcas comerciais. O desenvolvimento do dispositivo para ajudar a superar suas limitações é fortemente recomendado. (AU)

TNFSF/TNFRSF cytokine gene expression in sickle cell anemia: Up-regulated TNF-like cytokine 1A (TL1A) and its decoy receptor (DcR3) in peripheral blood mononuclear cells and plasma.

BACKGROUND: Sickle cell anemia (SCA), a disorder with an important inflammatory component, where vasoocclusion is major contributor to the disease pathophysiology. Pro-inflammatory cytokines play an important regulatory role in the process of inflammation. We investigated the expression TL1A/DR3/DcR3 cytokine signaling pathway in peripheral blood mononuclear cells (PBMC) and their corresponding plasma levels in SCA subjects who presented with acute painful episodes. MATERIALS AND METHODS: PBMC were isolated from the blood of SCA subjects and normal healthy controls. RNA isolated from PBMC was used for real time gene expression of TL1A/DR3/DcR3. Gene expression was compared in subgroups within SCA subjects with co-inherited fetal hemoglobin (HbF) or alpha-globin gene deletions. Plasma prepared from blood was used for determination of TL1A/DR3/DcR3 proteins by ELISA assays. RESULTS: In the PBMC of SCA subjects, expression of TL1A and DcR3 is elevated, while DR3 expression is lowered in comparison to normal control PBMC. In SCA subjects with HbF > 10%, TL1A/DcR3 expression is lower, while HbF < 10% is associated with increased TL1A/DcR3 expression. Moreover, subjects with HbF > 10% appear to have significantly fewer pain episodes in comparison to those with HbF < 10%. Deletion of alpha-globin genes appears to have no significant effect on TL1A/DR3/DcR3 expression. Circulating levels of TL1A, DR3 and DcR3 in plasma were significantly elevated in SCA subjects. CONCLUSIONS: Elevated TL1A and DcR3 expression in PBMC of SCA subjects during painful vasoocclusive crisis, suggest an altered TL1A expression may contribute to the pathophysiology of vasoocclusive crisis in SCA. HbF > 10% appears to moderate TL1A elevation, while HbF < 10% exacerbates TL1A/DcR3 responses. Furthermore, subjects with HbF > 10% have significantly lower pain episodes reported as compared to subjects with HbF < 10%.

The Epidemiology and Management of Bell's Palsy in the Sudan.

BACKGROUND: Bell's palsy is an acute idiopathic facial nerve paralysis of sudden onset. It is the most common cause of lower motor neuron facial nerve paralysis with an annual incidence of 15-30 per 100,000.The objective of this work is to study the prevalence and the management of Bell's palsy in the Sudan. A descreptive retrospective cross-sectional study was carried at Khartoum Teaching Dental Hospital, Khartoum General Teaching Hospital.In the retrospective, the records and files of 698 patients with Bell's palsy, were reviewed in relation to age, gender, site, risk factors, season, and type of treatment.In addition, 48 patients with Bell's palsy were evaluated using the House-Brackman scale in relation to the above-mentioned variables.Therefore, a total number of 746 cases were studied. Fifty five percent of them were females and the remaining 45% were males, around 38% of them were in the age group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of onset where 53.5% of the cases occurred. Steroids are the commonly prescribed drugs in majority of the cases, accounting for 47.3%. STUDY DESIGN: The study is a retrospective cross sectional hospital based study. The study was carried out in Khartoum Teaching Dental Hospital and in the Physiotherapy Department of Khartoum Teaching General hospital.The files and records of the patients with Bell's palsy in Khartoum Teaching Dental Hospital in the years 1/1/2004 -31/12/2008, and Khartoum Teaching General Hospital (physiotherapy department) in the years 2007- July 2009 (total number 746). RESULTS: A total number of 746 cases were studied . Fifty five percent of them were females and the remaining 45% were male. Around 38% of them were in the group 21-40 year. Fifty seven percent of the patients were affected on the right side of the face. Winter was the commonest season of the onset where 53.5% of the cases occurred. CONCLUSION: The study showed predominance of females. A peak incidence was seen in the age group 21-40 years. A predilection was found for the right side of face.

Existence of HbF Enhancer Haplotypes at HBS1L-MYB Intergenic Region in Transfusion-Dependent Saudi ß-Thalassemia Patients.

Background and Objectives. ß-Thalassemia and sickle cell disease are genetic disorders characterized by reduced and abnormal ß-globin chain production, respectively. The elevation of fetal hemoglobin (HbF) can ameliorate the severity of these disorders. In sickle cell disease patients, the HbF level elevation is associated with three quantitative trait loci (QTLs), BCL11A, HBG2 promoter, and HBS1L-MYB intergenic region. This study elucidates the existence of the variants in these three QTLs to determine their association with HbF levels of transfusion-dependent Saudi ß-thalassemia patients. Materials and Methods. A total of 174 transfusion-dependent ß-thalassemia patients and 164 healthy controls from Eastern Province of Saudi Arabia were genotyped for fourteen single nucleotide polymorphisms (SNPs) from the three QTL regions using TaqMan assay on real-time PCR. Results. Genotype analysis revealed that six alleles of HBS1L-MYB QTL (rs9376090C p = 0.0009, rs9399137C p = 0.008, rs4895441G p = 0.004, rs9389269C p = 0.008, rs9402686A p = 0.008, and rs9494142C p = 0.002) were predominantly associated with ß-thalassemia. In addition, haplotype analysis revealed that haplotypes of HBS1L-MYB (GCCGCAC p = 0.022) and HBG2 (GTT p = 0.009) were also predominantly associated with ß-thalassemia. Furthermore, the HBS1L-MYB region also exhibited association with the high HbF cohort. Conclusion. The stimulation of HbF gene expression may provide alternative therapies for the amelioration of the disease severity of ß-thalassemia.

Anaerobic/aerobic treatment of greywater via UASB and MBR for unrestricted reuse.

The aim of the present study was to investigate the efficiency of integrated up-flow anaerobic sludge blanket (UASB) as anaerobic system followed by membrane bioreactor (MBR) as aerobic system for the treatment of greywater for unrestricted reuse. Pilot-scale UASB and MBR units were installed and operated in the NRC, Egypt. Real raw greywater was subjected to UASB and the effluent was further treated with microfiltration MBR. The necessary trans-membrane pressure difference is applied by the water head above the membrane (gravity flow) without any energy input. The average characteristics of the raw greywater were 95, 392, 298, 10.45, 0.4, 118.5 and 28 mg/L for total suspended solids (TSS), chemical oxygen demand (COD), biochemical oxygen demand (BOD), total phosphates, nitrates, oil and grease, and total Kjeldahl nitrogen (TKN), respectively. The pH was 6.71. The UASB treatment efficiency reached 19.3, 57.8, 67.5 and 83.7% for TSS, COD, BOD5 and oil and grease, respectively. When the UASB effluent was further treated with MBR, the overall removal rate achieved 97.7, 97.8, 97.4 and 95.8% for the same parameters successively. The characteristics of the final effluent reached 2.5, 8.5, 6.1, 0.95, 4.6 and 2.3 mg/L for TSS, COD, BOD, phosphates, oil and grease and TKN, respectively. This final treated effluent could cope with the unrestricted water reuse of local Egyptian guidelines.

Stereology and ultrastructure of chronic phase axonal and cell soma pathology in stretch-injured central nerve fibers.

Magnetic resonance imaging (MRI) suggests that with survival after human traumatic brain injury (TBI), there is ongoing loss of white and grey matter from the injured brain during the chronic phase. However; direct quantitative experimental evidence in support of this observation is lacking. Using the guinea pig stretch-injury optic nerve model, quantitative evidence by stereology of damage to the optic nerve and retina was sought. Stretch injury was applied to the right optic nerve of 15 adult male guinea pigs. Three animals each at 1, 2, 3, 8, or 12 weeks' survival were killed and prepared for transmission electron microscopy (TEM). The estimated number of intact and injured axons within bins of transverse diameters 0-0.5, 0.51-1.0, 1.01-1.5, 1.51-2.0, 2.01-2.5, and 2.51-3.0 µm in the middle segment of each injured optic nerve and from 5 control animals were compared across all survival time points. The estimated numbers of intact and pyknotic retinal ganglion cells from the same animals were also compared. Loss of myelinated fibers continued throughout the experimental period. The most rapid loss was of the largest fibers; loss of intermediate-sized fibers continued, but the numbers of the smallest fibers increased from 3 weeks onward. There was hypertrophy and proliferation of glial cells within the surrounding neuropil. A relatively low-grade loss of retinal ganglion cells occurred throughout the experiment, with about 60% remaining at 12 weeks' survival. We provide quantitative evidence that after traumatic axonal injury (TAI) there is a continuing loss of nerve fibers and their cell bodies from a CNS tract over a 3-month post-traumatic interval.