Jennifer Geraldine Doss

Is the burden of oral diseases higher in urban disadvantaged community compared to the national prevalence

BackgroundThe urban low income has often been assumed to have the greatest dental treatment needs compared to the general population. However, no studies have been carried out to verify these assumptions. This study was conducted to assess whether there was any difference between the treatment needs of an urban poor population as compared to the general population in order to design an intervention programme for this community.MethodsA random sampling of living quarters (households) in the selected areas was done. 586 adults over 19 years old living in these households were clinically examined using World Health Organization (WHO) Oral Health Survey criteria 4th edition (1997).ResultsThe overall prevalence of dental caries, periodontal disease, denture wearers and temporomandibular joint problems were 70.5%, 97.1%, 16.7% and 26%, respectively. The majority (80.5%) needed some form of dental treatment. The highest treatment needs were found in the oldest age group while the lowest were in the youngest group (19-29 years) (p = 0.000). The most prevalent periodontal problem was calculus; regardless of gender, ethnicity and age. Significantly more females (20.5%) wore prosthesis than males (11.1%) (p = 0.003). Prosthetic status and need significantly increased with age (p = 0.000). About one in four adults had Temporo-Mandibular Joint (TMJ) problems. Overall, it was surprising to note that the oral disease burden related to caries, prosthetic status and treatment need were lower in this population as compared to the national average (NOHSA, 2010). However, their periodontal disease status and treatment needs were higher compared to the national average indicating a poor oral hygiene standard.ConclusionsThe evidence does not show that the overall oral disease burden and treatment needs in this urban disadvantaged adult population as higher than the national average, except for periodontal disease. The older age groups and elderly were identified as the most in need for oral health intervention and promotion. An integrated health intervention programme through a multisectoral common risk factor approach in collaboration with the Faculties of Medicine, Dentistry and other agencies is needed for the identified target group.

Oral cancer awareness and its determinants among a selected Malaysian population.

OBJECTIVE To assess oral cancer awareness, its associated factors and related sources of information among a selected group of Malaysians. METHODS A cross-sectional survey was conducted on all Malaysian ethnic groups aged ≥15 years old at eight strategically chosen shopping malls within a two week time period. Data were analysed using chi-square tests and multiple logistic regression. Significance level was set at α<0.05. RESULTS Most (84.2%) respondents had heard of oral cancer. Smoking was the most (92.4%) recognized high risk habit. Similar levels of awareness were seen for unhealed ulcers (57.3%) and red/white patches (58.0%) as signs of oral cancer. Age, gender, ethnicity, marital status, education, occupation and income were significantly associated with oral cancer awareness (p<0.05). CONCLUSIONS There was a general lack of awareness regarding the risk habits, early signs and symptoms, and the benefits of detecting this disease at an early stage. Mass media and health campaigns were the main sources of information about oral cancer. In our Malaysian population, gender and age were significantly associated with the awareness of early signs and symptoms and prevention of oral cancer, respectively.

Promoting oral cancer awareness and early detection using a mass media approach

BACKGROUND AND AIM Less than 50% of oral cancer cases are diagnosed at early stages of the disease and this is in part due to poor awareness and lack of knowledge on the signs and symptoms of oral cancer. This study sought to measure the baseline awareness of oral cancer in Malaysia and aimed to increase public awareness and knowledge of oral cancer using a mass media campaign. METHODS Baseline awareness and impact of the campaign was measured using self-administered questionnaires sent via email to individuals. The campaign was aired on two national television channels and the reach was monitored through an independent programme monitoring system. RESULTS 78.2% of respondents had heard of oral cancer, and this increased significantly after the campaign. However, the ability to recognize signs and symptoms remains unchanged. We found that the level of awareness differed between the distinct ethnic subgroups and the reach of the campaign was not uniform across all ethnicities. CONCLUSION This substantial study to measure the oral cancer awareness in Malaysia provides important baseline data for the planning of public health policies. Despite encouraging evidence that a mass media campaign could increase the awareness of oral cancer, further research is required to address the acceptability, comprehensiveness and effectiveness. Furthermore, different campaign approaches may be required for specific ethnic groups in a multi-ethnic country such as Malaysia.

The oral health of people with chronic schizophrenia: A neglected public health burden.

Objective: People with chronic schizophrenia have high rates of physical ill-health such as heart disease. However, there has been less attention to the issue of poor oral health including dental caries (tooth decay) and periodontal (gum) disease, although both have consequences for quality of life and systemic physical health. We therefore measured tooth decay and gum disease in Malaysians with schizophrenia. Methods: We recruited long-stay inpatients with schizophrenia from June to October 2014. Four dental specialists assessed oral health using the decayed–missing–filled teeth index, the Community Periodontal Index of Treatment Needs and the Debris Index of the Simplified Oral Hygiene Index. Results were compared with the 2010 Oral Health survey of the general Malaysian population. Results: A total of 543 patients participated (66.7% males, 33.3% females; mean age = 54.8 years [standard deviation = 16.0]) with a mean illness duration of 18.4 years (standard deviation = 17.1). The mean decayed–missing–filled teeth was 20.5 (standard deviation = 9.9), almost double that of the general population (11.7). Higher decayed–missing–filled teeth scores were associated with both older age (p < 0.001) and longer illness duration (p = 0.048). Only 1% (n = 6) had healthy gums. Levels of decay and periodontal disease were greatest in those aged between 45 and 64 years, coinciding with the onset of tooth loss. Conclusion: Dental disease in people with schizophrenia deserves the same attention as other comorbid physical illness. The disparity in oral health is most marked for dental decay. Possible interventions include oral health assessments using standard checklists designed for non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth and early dental referral.

Quality of life associated factors in head and neck cancer patients in a developing country using the FACT-H&N.

Health-related quality of life (HRQoL) associated factors are vital considerations prior to treatment decision-making for head and neck cancer patients. The study aimed to identify potential socio-demographic and clinical prognostic value of HRQoL in head and neck cancer patients in a developing country. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N)-V4 in Urdu language was administered among 361 head and neck cancer patients. Data were statistically tested through multivariate analysis of variance (MANOVA) and regression modeling to identify the potentially associated factors. Treatment status, tumor stage and tumor site had the strongest negative impact on patients HRQoL, with a statistically significant decrement in FACT summary scales (effect size >0.15). Moderate associated factors of HRQoL included treatment type, marital status, employment status and age (effect size range 0.06-0.15). Weak associated factors of HRQoL with a small effect size (>0.01-0.06) included tumor size and type, gender, education level and ethnicity. This study reports 12 socio-demographic and clinical variables that have a significant impact on HRQoL of head, and neck cancer patients, and that should be considered during treatment decision-making by multidisciplinary teams and also in future HRQoL studies conducted in other developing countries.

Health-Seeking Behaviour and Delayed Presentation of Oral Cancer Patients in a Developing Country: A Qualitative Study based on the Self-Regulatory Model

Background: The aim of this study was to explore reasons for delayed health-seeking for late stage oral cancer patients. Methods: Semi-structured in-depth interviews were conducted with 35 oral cancer patients with TNM stage III to IV disease, who were treated at six tertiary regional centres managing oral cancer throughout Malaysia. Interviews were audio-recorded, transcribed verbatim, coded using NVivo (version 10.0) qualitative software and analysed using framework analysis. Results: Participants interpreted their early symptoms as a minor condition and did not consider it as requiring immediate attention. Four types of coping strategies causing delayed help-seeking emerged: 1) self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting general medical practitioners (GPs) instead of dentists. Socio-economic factors, cultural beliefs and religious practices have some influence on diagnostic delay. Conclusion: Low levels of public knowledge and awareness regarding early signs and symptoms of oral cancer as well as GPs’ misdiagnosis of early lesions results in delayed diagnosis.

Measuring health-related quality of life impacts among head and neck cancer patients of a developing country

S enhanced Raman scattering (SERS) nanotags are a new class of labels for optical detection based on Raman scattering. Central advantages include the tremendous spectral multiplexing capacity for simultaneous target detection due to the narrow width of vibrational Raman bands, the need for only a single laser excitation wavelength to excite the Raman spectra of all SERS nanotags, quantification using the fingerprint intensity of the corresponding SERS nanotags; high photostability and optimal contrast by using red to near-infrared (NIR) excitation in order to minimize the disturbing auto fluorescence of cells and tissues.H Sodium Iodide Symporter mediated (NIS) radio iodide accumulation is the basis of effective targeted radio iodide therapy in differentiated thyroid cancers. NIS is aberrantly expressed in majority of the breast cancer (BC) subtypes although its relevance and regulation is poorly understood. To get an insight on NIS transcriptional regulation, we have identified the presence of three putative regulatory p53-binding sites on full-length human NIS promoter by genome wide in silico analysis. Since p53 mutations in BC are frequently observed, we have investigated the role of p53 in NIS regulation. Over expression of wild type p53 as a transgene or activation of endogenous p53 by doxorubicin (DR) treatment in BC cell lines results in significant reduction of promoter activity. Further the siRNA-mediated p53 knockdown effect shows reversal on reduced transcript (p<0.005). Abrogation of p53 binding sites by site directed mutagenesis also results in significant increase in promoter activity (p<0.05) indicating NIS-promoter repression is p53-dependent. Further, direct binding of p53 to human NIS promoter is also confirmed by chromatin immunoprecipitation analysis. As a result of endogenous p53 activation by DR, cellular NIS protein content is also reduced and thus impacting NIS-mediated iodide uptake significantly (p<0.05). Further, DR drug effect is validated in breast cancer xenograft model by optical bioluminescence imaging. This study provides novel information revealing complete biochemical and functional basis to show that human NIS is a direct target of p53 in BC cells. Our study opens up a scope for establishing link between aberrant NIS expression and p53 mutations in BC patients.The LIM kinase family of serine protein kinases contains two members, LIM kinase 1 (LIMK1) and LIM kinase 2 (LIMK2). LIMK1 was first isolated from olfactory epithelial cell lines [1], and LIMK2 from a rat cDNA library using human LIMK1 cDNA as a probe [2]. LIMK1 and 2 are structurally similar and share 50% amino acid homology, human and mouse LIMK1 share 95% amino acid homology. The amino terminus of LIMK contains two double zinc finger LIM domains, followed by a PDZ domain. Both domains are involved in protein-protein interaction [3].Activation of checkpoint kinase 1 (Chk1) is essential in chemoresistance of hepatocarcinoma (HCC) to 5-fluorouracil (5-FU) and other antimetabolite family of drugs. In this study, we demonstrated that PHA-767491, a dual inhibitor of two cell cycle checkpoint kinases, cell division cycle kinase 7 (Cdc7) and cyclin-dependent kinase 9 (Cdk9), has synergistic antitumor effect with 5-FU to suppress human HCC cells both in vitro and in vivo. Compared with the sole use of each agent, PHA-767491 in combination with 5-FU exhibited much stronger cytotoxicity and induced significant apoptosis manifested by remarkably increased caspase 3 activation and poly(ADP-Ribose) polymerase fragmentation in HCC cells. PHA-767491 directly counteracted the 5-FU-induced phosphorylation of Chk1, a substrate of Cdc7; and decreased the expression of the anti-apoptotic protein myeloid leukemia cell 1, a downstream target of Cdk9. In tumor tissues sectioned from nude mice HCC xenografts, administration of PHA-767491 also decreased Chk1 phosphorylation and increased in situ cell apoptosis. Our study suggests that PHA- 767491 could enhance the efficacy of 5-FU by inhibiting Chk1 phosphorylation and down-regulating Mcl1 expression through inhibition of Cdc7 and Cdk9, thus combinational administration of PHA-767491 with 5-FU could be potentially beneficial to patients with advanced and resistant HCC.A metaplasia (ADM), an inflammatory lesion associated with replacement of acinar cells by tubular complexes is thought to represent a condition with increased risk of neoplasia. However, the direct evidence linking acinar-to-ductal metaplasia and development of pancreatic neoplasm is still lacking. Glucocorticoid-mediated signaling pathway is known to be a part of the feedback control machinery of immune system that acts to suppress excessive immune activity. In the present study, we explored the role of GR in development of ADM and pancreatic intraepithelial neoplasia (PanIN) in mice with pancreatitis. We initially identified that evaluated levels of activated glucocorticoid receptors (GR) were observed in patients of chronic pancreatitis and pancreatic ductal adeno carcinomas (PDAC). Utilizing mice conditionally expressed KrasG12D in acinar cell with or without loss of GR, we demonstrated that GR activation was required for generation of metaplastic ductal lesion and development of pancreatic intraepithelial neoplasia (PanIN) in mice with experimental pancreatitis. Administration of dexamethasone,a potent synthetic glucocorticoid was sufficient to induce development of PanINs and PDACs in KrasG12D mice that harbored single-allele deletion of p53. We further revealed that non-genomic activation of GR was a key action that led to evaluate c-Src signaling and trigger a pathological threshold of Ras activity necessary for neoplastic transformation. In contrast, treatment of dasatinib, a Src kinase inhibitor suppressed development of PanINs and PDACs induced by dexamethasone. Importantly, Cre-lox based lineage-tracing mice was applied and identified that GR activation directly transformed GFP-tagged KrasG12D-expressing acinar cells to tumorigenic cells. The findings explained why inflammatory ductal reprogramming predisposes to development of pancreatic neoplasm.S is highly vulnerable to oxidative damage to both nuclear and mitochondrial DNA due to minimal cytosolic anti-oxidants and deficient DNA damage repair mechanism. Recent studies have shown that there is increased incidence of children with Retinoblastoma (Rb) in children conceived by ART and in cases where fathers smoke. This study was planned to analyze the sperm DNA quality in fathers of children with non-familial Rb (NFRb).A total of 75 fathers of children with NFRb and 75 fathers of healthy children were recruited for the study. Semen samples were collected and normal semen parameters analyzed. Markers for Sperm DNA damage calculated as DNA fragmentation index (DFI), 8-hydroxy-2’-deoxyguanosine (8-OHdG) and Reactive Oxygen Species (ROS) levels were analyzed. The fathers underwent 6 months intervention of yoga and meditation. In the fathers of RB, the seminal mean ROS levels were significantly higher (36.086±1.83 vs 20.51±2.71 RLU/s/million; p<0.05) than in controls. here was a significant increase in mean DFI levels (31.50±6.67 vs 21.9±9.4; p<0.001) and the levels of 8-OHdG levels (66.02±2.91 vs 23.10±2.71 pg/ml) were significantly higher (p<0.05) in fathers of Rb cases vs controls. Only 24 cases underwent 6 month practice of meditation/yoga and these cases showed significant decline in all 3 parameters. Oxidative damage to sperm DNA may be the aetiology of Rb as oxidized mutagenic DNA adducts persist even after fertilization. There was significant improvement in DNA integrity following practice of meditation/yoga and this may reduce incidence of childhood morbidity and even cancer.