Oral field cancerization: Genetic profiling for a prevention strategy for oral potentially malignant disorders

Background: Oral cancer therapy, such as radiation or surgical treatment, has pernicious long-term effects that patients suffer throughout their life, the disability being considerable with delayed diagnosis. It is well known that many oral cancers develop from oral potentially malignant disorders (OPMDs). Patients diagnosed with OPMDs may have an increased risk of developing cancer anywhere in the oral cavity. Early detection and intervention could be essential prevention strategies to inhibit oral cancer progression. OPMDs may not immediately develop into carcinoma. However, this condition provides a “field” of specific abnormalities wherein evolving altered genetic cells can be explained with the “field cancerization” concept. Purpose: This review aims to describe the “field cancerization” concept in oral cancer and OPMD, which is expected to contribute to a better clinical management strategy for oral cancer prevention. Review: “Oral field cancerization” describes oral cancers that develop in multifocal areas of pre-cancerous changes. It can be found as histologically abnormal tissue surrounding the tumor, suggesting that oral cancer often consists of multiple independent lesions. Conclusion: The oral field cancerization concept should prompt healthcare professionals to remind their patients that frequent oral examination with histological studies and molecular testing is mandatory for those at high risk of developing malignancies

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Post-glossectomy in lingual carcinomas: a scope for sign language in rehabilitation

The treatment option for cancers of the tongue is glossectomy, which may be partial, sub-total, or total, depending on the size of the tumour. Glossectomies result in speech deficits for these patients, and rehabilitative therapy involving communication modalities is highly recommended. Sign language is a possible therapeutic solution for post-glossectomy oral cancer patients. Patients with tongue cancers who have undergone total glossectomy as a surgical treatment can utilise sign language to replace their loss of speech production and maintain their engagement in life. This manuscript emphasises the importance of sign language in rehabilitation strategies in post-glossectomy patients

A review of research on cytological approach in salivary gland masses

To evaluate the diagnostic accuracy of fine-needle aspirations (FNAs) in salivary gland pathologies. A comprehensive literature search was conducted in the PubMed database using related Medical Subject Heading terms “sensitivity and specificity of FNA in salivary gland” and “diagnostic accuracy of FNA in salivary gland” for the period 1980–2016, and we found that 414 research studies had been published. PRISMA technology was utilized to prepare flow chart for displaying data search strategy. A total of 385 articles were excluded based on the established inclusion and exclusion criteria of the study. Twenty-nine research studies were included. Those twenty-nine studies on the sensitivity and specificity of FNAs in salivary gland pathology consisted of 5274 cases of benign, malignant and inflammatory salivary gland lesions. The present study identified a range of 87%–100% sensitivity and 90%–100% specificity for the usefulness of FNAs in distinguishing benign and malignant salivary gland lesions. Although a considerable number of studies have been identified that reported on sensitivity and specificity of FNAs in salivary gland pathologies, each study had a different approach in reporting the sensitivity and specificity. We emphasize that standardized reporting protocols of sensitivity and specificity report supported with checklists would help future researchers to interpret this cytological method and make more accurate clinical utility and usefulness reports on salivary gland pathologies

Oral mucosal lesions in patients with pemphigus and pemphigoid skin diseases: a cross sectional study from southern India.

Objective:To assess the prevalence of oral mucosal lesions in patients with pemphigus and pemphigoid diseases from Southern India. Design and Methods: A cross-sectional hospital based study was conducted from August 2010 to July 2011. Patients with confirmed pemphigus and pemphigoid skin disease were selected and informed to participate in the study. Oral examination of all participants were done to document site and type of oral manifestation and diagnostic procedures such as histopathological and Immunofluorescence methods were performed to confirm the diagnosis. Demographic details such as age, gender and occupation were also documented. The results of the study were analyzed by SPSS software version 19.0 (Armonk, NY) and presented as descriptive statistics. Results: Sixty percent of the patients exhibited oral mucosal manifestations. A higher female (86.66%) predilection of autoimmune blistering disease was observed in the study. A slightly higher number of pemphigoid patients (53.33%, 16 out of 30) were reported than pemphigus (46.66%, 14 out of 30 cases). The most common subtypes of pemphigus is Pemphigus vulgaris 71% (10 out of 14) among pemphigus, and bullous pemphigoid 87.5%(14 out of 16) among pemphigoid. Buccal mucosa (92.85%) is the most common site in pemphigus patients, where as hard palate (12.5%) is mostly commonly reported site in pemphigoid patients. Initial involvement of oral tissue in disease process was observed in 78.57% of pemphigus, and 12.5% of pemphigoid patients. Conclusion: Oral mucosal lesions are more frequently associated in pemphigus patients. Oral mucosal lesions are the initial site of disease process in pemphigus patients. The significance of diagnosis of oral lesions at earlier stage of disease, specifically pemphigus may help in early intervention of disease and help to reduce the morbidity and mortality state. The study emphasizes multidisciplinary approach in diagnosis and management of both pemphigus and pemphigoid