Overexpression of Hypoxia-Inducible Factor-1α and Its Relation with Aggressiveness and Grade of Oral Squamous Cell Carcinoma.

Hypoxia-inducible factor-1α (HIF-1α) has been shown to be involved in cancer metastasis in several cancer types. There is however conflicting evidence of HIF-1α expression with oral cancer prognosis. Therefore, this study set out to investigate HIF-1α overexpression and its relationship with the aggressiveness and grade of oral squamous cell carcinoma (OSCC) and to explore the diagnostic potential of HIF-1α overexpression in OSCC in a cohort of Pakistani patients. Immunostaining of HIF-1α was performed on 54 OSCC and 14 normal oral mucosa (NOM) tissue samples and various cut-offs were used to evaluate its immunohistochemical expression. HIF-1α expression in OSCC samples was significantly higher than in controls, with minimal immunoreactivity in NOM. HIF-1α overexpression was significantly associated with increased tumor size (p = 0.046). However, no association was found between HIF-1α overexpression and increasing Broder's histological grade or TNM stage. The cut-off >10% cells with moderate to marked intensity carried a sensitivity of 70% and a specificity of 100% to distinguish between tumor and control. ROC curve analysis of HIF-1α weighted histoscores showedHIF-1α overexpression as a highly sensitive and specific diagnostic test (p < 0.001, AUC = 0.833). HIF-1α overexpression is a tumor-specific finding associated with increased tumor size and carries a potential diagnostic role.

Effectiveness of acetaminophen in control of breakthrough pain: Randomized controlled trial.

OBJECTIVE: To reduce postoperative pain by using additional analgesic agent in between the usual parenteral analgesia that is used in the postoperative period in surgical patients. METHODS: The double-blind, randomised control intervention was conducted from June to November 2015 at Rehman Medical Institute, Peshawar, Pakistan, and comprised postoperative surgical patients of either gender aged 18 or more who had undergone uneventful elective surgery The subjects were divided into test and placebo groups. In the test group, 1gm acetaminophen was additionally prescribed, while in the control group placebo (starch) was administered. Demographics were noted and pain score was recorded using three internationally validated pain scales; Verbal pain intensity scale, Visual analogue scale, and Numeric pain scale. SPSS version 15.0 is used for calculation. Data was collected twice over 48 hours. RESULTS: Out of 220 patients, 165(75 %) were male with mean age 31.5±1.93 years and 55(25%) were female with mean age 31.5±1.48 years. There were 118(53.6%) patients in the test group and 102(43.4%) in the control group. In the first 24 hours the cumulative pain score, from numeric pain scale and visual analogue scale, for the control group showed 5(4.90%) patients had no pain, 39(38.24%) had mild pain, 52(50.98%) moderate pain and 6(5.80%) had severe pain. In the test group, 13(11.02%) reported no pain, 83(70.34%) had mild pain, 19(16%) had moderate pain while 3(2.54%) complained of severe pain. In the next 48 hours cumulative pain score in the test group showed 44(37.29%)subjects had no pain, 67(56.78%) had mild pain, 6(5.08%) had moderate pain, 1(0.85%) had severe pain, while in the control group 10(10%) had no pain, 56(55%) had mild pain, 33(32%) had moderate pain and 3(3%) had severe pain. . CONCLUSIONS: Additional acetaminophen reduced mild to moderate pain between two doses of parenteral analgesia.

Postoperative pain management in the surgical wards of a tertiary care hospital in Peshawar.

OBJECTIVE: To assess levels of postoperative pain with reference to internationally validated protocols. METHODS: The hospital-based survey of postoperative patients was conducted from February 2012 to April 2012 in the surgical wards of Rehman Medical Institute, Peshawar. A questionnaire was devised incorporating internationally validated World Health Organisation pain scoring system to assess the level of pain control. The severity of postoperative pain was further evaluated by correlating it with various variables. RESULTS: Of the 210 patients interviewed, 80(38%) were males with a mean age of 44.16±20.37 and 130(62%) were females with a mean age of 36.47±14.39. Overall, 84(40%) patients experienced mild pain, 82(39%) experienced moderate pain and 33(16%) experienced severe pain, while only 11(5%) experienced no pain when assessed within the first 24 hours following surgery. The same patients when interviewed within the 48 hours following surgery showed 117(56%) were in mild pain, 72(34%) in moderate to severe pain and 21(10%) had no pain. CONCLUSIONS: The achievement of absolute no pain for all patients in the post-operative phase is next to impossible, but it should remain the ultimate target.