Omar Kujan

Dilemmas of Oral Cancer Screening: An Update

Oral cancer is a global health burden with high mortality and morbidity. Advances in treatment have failed to improve the relatively poor survival rate due to late-stage diagnosis. Early detection and screening have been shown to be effective in reducing mortality and morbidity of most common cancers. Several studies have evaluated the effectiveness of oral cancer screening programs but clear results were not obtained. This narrative commentary aimed to give a critical insight into the dilemma of oral cancer screening and to suggest recommendations for future trends. Conventional oral examination still constitutes the gold standard screening tool for potentially malignant oral lesions and cancer. Interestingly, the findings of the most lasting (15-year) randomized controlled trial on oral cancer screening using visual examination (Kerala) supported the introduction of a screening program in high-risk individuals. Several screening adjuncts exist but are still not at the introduction stage. Further research to find an appropriate adjunct reliable tool for oral cancer screening is needed. In conclusion, oral cancer fulfills most of the essential principles of cancer screening but still many points need to be clarified. Therefore, there is a striking need to establish a global consortium on oral cancer screening that will oversee research and provide recommendations for health authorities at regular intervals.

Suicidal behavior and psychological distress in university students: a 12-nation study

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

Antioxidant Properties of Nigella sativa

Molecular oxygen (O2) is essential in all species for the production of energy within mitochondria; a process known as oxidative phosphorylation. The end products of this process include adenosine triphosphate (ATP), water (H2O) and carbon dioxide (CO2). In addition, very small amounts of reactive oxygen species (ROS) or free radicals are continuously produced as a consequence of normal metabolism of oxygen but which, on occasions when they become overabundant, may toxically damage cells, and therefore need to be biochemically neutralized or extruded from cells. Antioxidants are defined as substances capable of delaying or inhibiting production of ROS intermediates. Cells can either make these antioxidants endogenously, or receive them through the diet.

Fragile histidine triad expression in oral squamous cell carcinoma and precursor lesions

Pupose: Fragile histidine triad (FHIT) expression in precursor oral lesions (POL) and oral squamous cell carcinomas (OSCC) was studied with regard to (a) the frequency of loss of FHIT expression, (b) whether loss of FHIT expression correlates with degree of dysplasia in POLs, (c) whether FHIT loss predicts high-risk POLs that are more likely to transform, and (d) whether FHIT loss in OSCCs correlates with survival. Experimental Design: Ninety-four POLs and 86 OSCCs were immunostained for FHIT. Survival analysis was done for cases with validated clinical outcomes. Results: By optimizing the immunostaining protocol, we found that FHIT is expressed in a distinctive strong nuclear and weak cytoplasmic pattern in oral tissues. Loss of FHIT expression was found in 42 of 94 (45%) POLs and in 66 of 86 (77%) OSCCs. We observed a statistically significant positive correlation between frequency of FHIT loss and increasing grade of dysplasia (χ2 = 13.8; degrees of freedom = 4; P = 0.008). Loss of FHIT expression in POLs that progressed to malignancy was more frequent than in those that did not [17 of 25 (68%) versus 12 of 29 (41.4%), respectively]. This difference was statistically significant (χ2 = 3.8; degrees of freedom = 1; P = 0.046). In OSCCs, loss of FHIT staining indicated a worse prognosis (survival rate, 36.2%) than when positive FHIT staining was observed (survival rate, 50%), but the difference was not statistically significant (P = 0.546, Kaplan-Meier, log-rank). Conclusions: FHIT seems to localize to both nuclear and cytoplasmic domains. FHIT inactivation occurs early in oral carcinogenesis and may be useful molecular marker for progressive dysplastic oral lesions.

Screening for oral cancer.

people, which is often reinforced by legislation, such people are marginalised and endangered. It is our historical treatment of prostitutes that has made them vulnerable to violence and abuse. Criminalising prostitution denies people, in this case mainly women, choices and the right to control their own bodies. There has been debate as to whether prostitutes have choices; our duty is to increase their relatively few options, not reduce them further. It is abuse of human beings, no matter what their occupation, that must be combated. The “evil” that Due points to consists of activities that are crimes and morally and ethically unacceptable in any walk of life, and we are bound to apply the protections of society from abuse to every person equally. Health professionals have to adopt morally neutral positions if they are to work with and help every member of society equally. Whether abolition of prostitution is a realistic or desirable goal is irrelevant to a duty, collectively and individually, to care for prostitutes. Due’s position is an example of confusing morals with ethics. The Lancet is correct in stating that the health profession’s ethic mandates the protection of the vulnerable, and that only by providing them the full protection of the law and the resources of our society will that mandate be fulfilled. Prostitutes are a group of people who have greater than average health and social needs and the health professions have, by and large, failed them abysmally. The Lancet joins other medical journals such as the CMAJ and criminologists in calling for the decriminalisation and protection of prostitutes. As one of us has stated, “the criminal law is a rather ineffective custodian of moral norms, especially when these are disobeyed by many and disagreed with by many more”. Only by making our society completely inclusive will we achieve true distributive justice. Prostitutes are indeed people too, with real needs. If we forget this fact, we betray our commitment to caring.

Immunohistochemical Expression of p53 in Pleomorphic Adenoma and Carcinoma Ex Pleomorphic Adenoma

Context. Immunohistochemical stains for p53 are used as a diagnostic marker associated with malignancy in several histologic types of salivary gland tumors. This marker may be useful in differentiating pleomorphic adenoma (PA) from carcinoma ex pleomorphic adenoma (CPA), as these tumors are often difficult to distinguish on the basis of morphology alone. Objective. to evaluate whatever inactivation of tumor suppressor gene (p53) increases with the tumor progression from normal salivary tissue to PA and eventually CPA. Design. Paraffin blocks of 29 cases of PA, which were surrounded by normal parotid gland, and 27 cases of carcinoma ex pleomorphic adenoma were retrieved and validated. In all cases of carcinoma ex pleomorphic adenoma, a PA “ghost” was identified, and the malignant element was either undifferentiated carcinoma or adenocarcinoma. Results. The results showed negative nuclear expression of P53 in normal parotid gland. Nuclear P53 was expressed strongly in 6/29 (20.7%) pleomorphic salivary adenoma and 10/27 (37%) carcinoma ex pleomorphic adenoma. Conclusion. Our data suggest that inactivation of p53 may play an important role in the evolution of pleomorphic salivary adenoma and carcinoma ex pleomorphic adenoma.

Screening for oral cancer-a perspective from the Global Oral Cancer Forum.

Screening for oral cancer should be defined as the application of a test to people who are apparently free of disease to identify those who may have oral cancer and to distinguish them from those who may not. The aim of the test is not to be diagnostic but to identify changes that may be the earliest signs of impending disease. Defined in this way, screening is an ongoing public health measure, often funded by governments. A screening program must do no harm and must be cost effective. Governments demand that strict evidence of benefits and cost effectiveness be met before a program may be implemented. Although many studies have investigated the utility of potential screening tests, there have been few evaluations of screening programs and only one randomized controlled trial. Systematic reviews have concluded that there is insufficient evidence to show that oral cancer screening can reduce mortality from oral cancer, and to date, no country has implemented a formal oral cancer screening program. This paper reviews this evidence and tries to identify the barriers to screening and suggests areas of focus for future research.

Cross - national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems.

The utility of oral brush cytology in the early detection of oral cancer and oral potentially malignant disorders: A systematic review

OBJECTIVES This systematic review aimed to analyze the published evidence for the use of oral brush cytology for the early detection of oral cancer and oral potentially malignant disorders (OPMDs). METHODS Literature was systematically searched through several databases: MEDLINE, EMBASE, PubMed, SCOPUS, Cochrane Library, and Web of Science. Additional review was performed through cross-checks on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of oral brush cytology on human tissues and its applications in the diagnosis, screening, or surveillance of oral cancer or OPMDs. RESULTS The search strategy resulted in 343 abstracts or full-text articles, of which 36 met the inclusion criteria. The year of publication ranged from 1994 to 2017, and a total of 4302 samples from OPMDs, oral squamous cell carcinoma, and healthy controls have been investigated. Baby toothbrush, cytobrush, OralCDx® , and Orcellex® are the brushes that were used to obtain transepithelial mucosal samples for conventional and liquid-based cytology evaluation. CONCLUSIONS Findings from this study indicate that meaningful evidence-based recommendations for the implementation of a minimally invasive technique to be utilized as an adjunctive tool for screening and early detection of oral cancer and OPMDs are complicated from the reported studies in the literature. There is need for well-designed clinical studies to assess the accuracy of oral brush cytology utilizing validated cytological assessment criteria for the diagnosis and prediction of OPMDs.

Oral potentially malignant disorders: risk of progression to malignancy

Oral potentially malignant disorders (OPMDs) have a statistically increased risk of progressing to cancer, but the risk varies according to a range of patient- or lesion-related factors. It is difficult to predict the risk of progression in any individual patient, and the clinician must make a judgment based on assessment of each case. The most commonly encountered OPMD is leukoplakia, but others, including lichen planus, oral submucous fibrosis, and erythroplakia, may also be seen. Factors associated with an increased risk of malignant transformation include sex; site and type of lesion; habits, such as smoking and alcohol consumption; and the presence of epithelial dysplasia on histologic examination. In this review, we attempt to identify important risk factors and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.