CANCER- THE RIGHTFUL EMPEROR OF ALL MALADIES OR A FALSE CLAIMANT?

Cancer has been a deadly disease afflicting man from ancient times.  Described in the Edwin Smith Surgical Papyrus that recounted   Egyptian literature dating 3000 to 2500 BC, and by Hippocrates, who considered cancer to be a growth, swelling or ulcer that caused great suffering and death.  

"Egyptology, A page of the Edwin Smith Payrus, late 17thC BC Wellcome M0008142" by http://wellcomeimages.org/indexplus/obf_images/b2/aa/134cde1b9de3d9a0bc53344f3092.jpg

Gallery: http://wellcomeimages.org/indexplus/image/M0008142.html. Licensed under CC BY 4.0 via Wikimedia Commons.

Despite a long history, cancer has proved to be unmanageable. It affects more people now than ever before and remains recalcitrant to various forms of therapy. Moreover, patient survival rates, which are calculated as a percentage of the affected individuals that continue to survive five years after diagnosis, have only marginally improved in the last fifty years or so. 

Considering the history, persistence and increasing number of deaths attributable to cancer the disease seems to deserve the title THE EMPEROR OF ALL MALADIES popularized by an insightful book by Siddhartha Mukherjee. 

And yet on closer consideration, the title seems undeserved.  The biological behavior of this age-old disease remains the same, as evidenced by the consistent five-year survival rates which continue to correlate closely with the stage at diagnosis.  The increasing number of cases and deaths in the last century has resulted from changing human activities that expose individuals to an ever-increasing number of carcinogens while simultaneously reducing health-promoting dietary and lifestyle factors. Last but not the least our constant failure in managing the disease, has been a  result of our unchanging treatment goals while dealing with cancer rather than the changing aggressiveness of the disease.

Cancer therapy has been consistently aimed at destroying the affected tissue and eradicating all transformed cells in a manner reminiscent of treating infections.   Eradication of cells that are morphologically similar to the cells of origin and   similar to other rapidly multiplying cells in terms of DNA synthesis and mitosis is bound to fail, considering the inevitable destruction of healthy cells. Surgical excision aimed at removing all affected tissue has not been very satisfactory either since even the most complete excision cannot ensure the removal of all malignant cells or those that although not malignant at the time are in various pre-transformation stages.

The molecular discoveries of the last 30 years have improved our understanding of the pathobiology of cancer.  It is now easy to recognize that cancer is not a new growth as implied by the term neoplasia.  Instead, it results from a complex aberration of cellular mechanisms involved in maintaining tissue integrity by cellular turnover and response to injury.  The complexity provides several possible mechanisms for prevention, delay and even reversal of the molecular changes that lead to cancer.  While therapeutic modalities based on a contemporary understanding of cancer are for the most part in experimental stages, the day is not far when we will successfully treat or at the very least favorably modify the disease outcomes and dethrone the false emperor. 

#Cancer

ORAL PATHOLOGY INDIA - OPEN MIKE

A FREE EVENT TO RAISE YOUR SPIRITS, GET YOU INVOLVED AND GET YOU NOTICED. Have you always felt all you need is a chance to showcase your abilities as a presenter/ public speaker? The wait is over; your big chance is here.

There are also lucky prizes for presenters and viewers.

Who can attend: anyone with a registration Webinar Registration

Clear Cell Lesions of Oral Cavity

“Clear cell lesions of the oral cavity,” although rare, present a unique set of challenges in diagnosis and management. Heterogenous origins that include odontogenic, salivary, lining epithelium, dermal appendages, melanocytes, renal, and even mesenchymal makes histological diagnosis challenging. While varying biological behaviors (indolent to aggressive) that require different management make an accurate diagnosis essential.

In a recent webinar by Dr. K. Karpagaselvi covered a wide range of clear cell lesions (listed in Picture) that occur in the oral cavity, highlighting the path to diagnosis through a combination of clinical evaluation and histological patterns using routine and specialized techniques.

Dr. Karpaga Selvi MDS Prof and Head,

Dept. of Oral and Maxillofacial Pathology, Vydehi Institute Of Dental Sciences, Bangalore, Karnataka, India.

Topic map of  Oral Clear Cell lesions discussed in  the webinar

You can also catch the whole webinar here.

 

If you like the content, please share, like, and comment. Also, join the ORAL PATHOLOGY INDIA community in promoting oral Pathology by Subscribing to the channel.

One Day International Oral Pathology Case Presentation Webinar

Excellence in sur gical pathology is closely dependent on extensive and in-depth knowledge of the multitude of clinical and histological presentations each pathology may develop. Gaining such experience is mostly reliant on reviewing a variety of case reports. However, it has become increasingly difficult to find platforms for sharing challenging and even rare case reports in recent years.  This event is being organized to provide a platform for case reports, emphasizing pathological presentation and diagnostic features.

This first of its kind event was successfully organized by eight independent organizations: Oral Pathology India, the Asian Society of Oral & Maxillofacial Pathology (ASOMP), and five colleges Vishnu Dental College, V.S. Dental College & Hospital, Manipal College of Dental Sciences, Vydehi Institute of Dental Sciences,  Genesis Institute of Dental Sciences & Research and College of Dental Sciences, Davangere, that joined hands to promote Oral Pathology, through Collaboration and education. The event schedule was 

Images from the event:

SCHOLARLY WORK MUST NOT ONLY BE DONE BUT ALSO BE SEEN TO BE DONE

I have paraphrased a well-known saying  "Not only must Justice be done; it must also be seen to be done.", not to make light of the seriousness of the need for justice but to highlight the importance of scholarly and academic work.  

It is undeniable that academic positions are saturated, and there is minimal possibility of new opportunities. At the same time, dwindling numbers of new admissions, economic downturn and an ever-increasing pool of available talent with varying levels of experience make the possibility of staff turnover a grim reality.   

So, whether, you are a student, young unemployed or for that matter employed oral pathologist, it is time to add to your credibility and achievement pool. Because merely attending a college in whichever role is not sufficient. While you are working, gaining knowledge and experience it is really essential that the work is seen. You may wonder why? First, to enable you to do the work and then to help you to continue working and if need be to find a different job where you can continue working.

The most important proof of scholastic/academic work is publications; this can start with your dissertation, especially if it is relatively recent. Old work is challenging to publish because of changing technological standards. In the interest of being honest and open, I have to say my dissertation fell into the same category. In 1997 it was somewhat difficult to publish, and I have to admit I did not try hard enough. I presented my findings as two papers in our national conference, and that was that. Do I wish I had tried? Definitely. And I hope you will not make the same mistake, if you still can, take the time and publish your dissertation. 

If you have published your dissertation wonderful, but still not enough. It would be best if you continued, and have more published research. Publications don't have to be primary research all the time; they can be secondary research such as literature reviews, systematic reviews, meta-analysis.   

But, even before your publications have reached a significant number, you must have a network of individuals with the same areas of interest who will read and hopefully cite your work when it is published. This can be best achieved by joining platforms such as ResearchGate, Google Scholar and professional networking platform LinkedIn.

ResearchGate an initiative by two researchers in 2008 to enable borderless collaboration has expanded to include over 17 million researchers from around the world, and through a service that remains free allows researchers to, authors and professionals to collaborate, guide and support each other, and share their work. Research Gate computes a score for all its members. That is considered an effective indicator of research activity. I have personally received considerable help from researchers on research gate; I have requested and received numerous articles and suggestions from researchers I didn't know otherwise.

Google Scholar is another useful platform. It keeps track of your publications and citations, besides providing an easy way of recording article's/book's citation in different formats. It also identifies research that may be interesting to you and is an easy way of finding the top journals in various fields by looking at the metrics.

LinkedIn is another essential platform; that provides endless networking, collaboration, and various opportunities to seek and provide help and support.

As I type this, I can picture my ex-students, and many colleagues thinking there we go again, and to be honest, they are right. I have reiterated the importance of building a global network many times. I was delighted when in a recent interview with Dr Prathibha Prasad about her journey and life in the UAE as an oral pathologist she also was unequivocal in her support of the need for an active professional and scholarly presence.

https://www.facebook.com/watch/?v=328969311714356&extid=Lm7Tg9UvbexqYkEv

In my own life, LinkedIn played an important role, especially by making it possible for me to connect with Dr Babak Sarrafpour. I got to know him by just following my routine of connecting with every oral pathologist I find. Then I discovered that he was the only oral pathologist with interest in biomechanics, I visited him at The University of Sydney, and in the course of a most engaging interaction he suggested I submit my work as a PhD proposal. I did, with his help & support and was accepted in the University Of Sydney in a matter of months, sadly couldn't join the program since the cost was beyond my savings. The experience, however, rekindled an old passion for completing my studies, which to me, is a doctorate. Subsequently, I applied and was accepted in another outstanding university, the University of Otago New Zealand, and will hopefully begin my course post-COVID.

I feel a disclaimer is needed; the suggestions are based on personal views and are not in any way influenced by any of the companies mentioned. Hope you will be opening these sites to check them out and join if you haven't already. Creating or even updating your profile can take some time, but you don't have to do it in one day. Just keep aside 15 minutes or half an hour a day, and you should be on your way to a very connected professional life in a matter of days. 

 

Please share your opinions, suggestions and experiences.

And subscribe with your email from the desktop version.

 

IS IT BETTER TO HAVE HAD COVID-19 & SURVIVED THAN TO HAVE NEVER HAD IT ALL?

 

It is less than a week since I posted this, however, in the interim, there has been a report of two cases of reinfection. It is still not much when we consider the 26 million recorded infections, still, it needs to be considered. Read the summary at read the summary  https://blogs.jwatch.org/hiv-id-observations/index.php/cases-of-sars-cov-2-reinfection-highlight-the-limitations-and-the-mysteries-of-our-immune-system/2020/08/30/?query=C19&cid=DM98059_NEJM_Registered_Users_and_InActive&bid=253773475

Even as an oral pathologist with no clinical worries of tooth cutting, aerosol contamination, and the like I am not untouched by the challenges that the dental profession is facing each day due to the increasing number of Covid-19 cases. Possibly like every other dentist, I have all the relevant updates delivered to my mailbox each day.

Yesterday an interesting one caught my eye, a letter to the editor of NEJM “Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2” by Wyllie, Ann L., et al. They report findings of their recent study on the effectiveness of the salivary sample in the diagnosis of COVID- 19 infection. Significantly the study found saliva to be at the very least as useful as nasopharyngeal swab specimens for quantitative reverse- transcriptase PCR detection of Covid-19. The authors highlighted the importance of saliva as the test sample, negating the need for trained personnel involvement, and exposure. 

https://www.nejm.org/doi/full/10.1056/NEJMc2016359

From a dental viewpoint, it is noteworthy that :

• Asymptomatic patient’s saliva carried a recoverable number of virus copies.
• The overall virus count and percentage of cases where the virus could be recovered were higher in saliva than the nasopharyngeal swabs, up to 10 days after the infection.
• The salivary recovery of virus copies was more consistent throughout the clinical course of the disease. 

The authors relate some of the finding of higher salivary virus counts and overall recovery rates to the inherent ease of salivary sample collection in comparison to the nasopharyngeal specimen collection—an explanation that is no doubt, logical and valid.  

Nonetheless, when we combine all the findings, it seems fair to surmise that SARS-CoV-2 RNA is consistently found in the saliva of both asymptomatic and symptomatic patients.

While reading this article, the statement that the level of Covid-19 RNA decreased after the onset of symptom in both salivary and nasopharyngeal specimens caught my attention and aroused my curiosity. A few search entries in google and I was at the CDC website with exciting updates,

·       Concentrations of virus RNA in upper respiratory specimens declines after onset of symptoms.

·       COVID-19 replication-competent the virus has not been recovered following symptom onset in mild to moderate cases after 10 days and 10-20 days in severe cases.

·       High-risk household and hospital contacts did not develop the infection if their exposure to a case-patient started 6 days or more after the case patient’s illness onset.

·       Currently, six months after the emergence of SARS-CoV-2, there have been no confirmed cases of SARS-CoV-2 reinfection.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html#key-findings

 So, in summary, current data has shown recovery of virus copies from the saliva of asymptomatic patients, and those with early symptoms. The virus then reduces in numbers and disappearing after ten days in those with mild and moderate symptoms, and 20 days in those with severe symptoms.

It seems that the safest bet is to treat patients who were infected and recovered.

Considering we are now resigned that for the foreseeable future the entire population remains at risk and an eventual infection is almost inevitable, COVID -19 tests may become the first test, where testing positive becomes a requirement before any treatment.   

AND So it may come to pass that  - Tis better to have had COVID & survived than to have never had it at all…

These are unprecedented times indeed!!

NORMAL BODY TEMPERATURE- CHANGING THE STANDARD

 COVID-19 is on our minds, incessantly and endlessly playing in our ears on every call, on the news, online-offline and everywhere.

Even though I am not a betting person, I think it is safe to bet we have all given in to the need to check our temperature at some point.

My moment of truth was a few days back when I felt feverish. I reached for the thermometer, and it showed  96.2 F (35.7 C). I thought my eyesight was playing up. So I reached for the digital thermometer and got the reading 96.2 F. Not high not even the normal  “98.6 F or 37 C (range: 97.2-99.5 F / 36.2-37.5C ) as established by the German Physician Carl R A Wunderlich in the 19^th century. Then I recalled that this had happened to me before although I never really bothered with it always considering the digital thermometer must not be accurate or the batteries must be weak.  But now I am more sensitive to such things as the temperature records, thanks to COVID-19. 

"Normal body temperature. 

Thermometer showing slightly above 36°C" by "Ivan Radic" 

 is licensed under a Creative Commons Attribution 2.0 Generic License.

I remembered an article titled “Decreasing human body temperature in the United States since the Industrial Revolution” by Myroslava Protisv that had momentarily caught my attention in early January  I had tagged it for a later read. I then forgot about it in the Covid-19 information deluge. 

A quick search and I found the article, which describes the previous values derived from the study of armpit temperature in 25000 patients is no longer appropriate, with the average American temperature now running more than a degree lower.  “The authors who analysed 677,423 human body temperatures from three cohorts spanning 157 years of measurement found a decrease of -0.03 C and -0.32 C in men and women respectively per birth decade.

What does this mean for diagnosing fever? So far nothing, as experts agree that a fever still remains a fever that is a rise in temperature to above 100 F  for adults and,  and high temperatures above 103 F( 39.4 C)  the level for causing concern and a need for visiting the emergency room for adults.

 On the other hand, the article’s findings are very significant to the normal body temperature values followed around the world.  The authors have related the fall to decrease in metabolic rate to different factors, mainly reducing population-level chronic inflammation due to reduction in mild persistent infections and changes in ambient temperatures in recent times.  The resting metabolic rate reflects the body temperature and ambient temperature. The body temperature increases when the ambient temperature falls and decreases when the ambient temperature rises.  So essentially, population-level presence of chronic inflammation and ambient temperatures control the body temperature.

Assuming these explanations are valid, and the authors make a compelling argument. The normal temperatures around the world’s different regions with vastly different climates, as seen in the map and levels of infections, was never the same as those that were found by Carl R A Wunderlich in Germany.

https://www.climate-charts.com/World-Climate-Maps.html#temperature

Although currently, experts agree that the changes to the normal temperature do not affect the level considered as fever, and that may very well be the case in severe fever, one has to wonder, if that is the case in establishing the presence of fever itself.

Multiple questions need to be answered.

What is the normal body temperature range of people from different climatic and hygiene level regions of the world?

Can individuals’ basic( normal) body temperature change within their lifetime by on relocating to a climatically different region?

Intriguing questions that we have the means to answer due to the COVID-19 pandemic.  

The spread of coronavirus disease (COVID -19) across the globe has made the simple thermometer a star gadget, with thermometers becoming the most often purchased gadget during the COVID-19 pandemic.    Temperature screening has taken an entirely new dimension, with more temperatures, checked and recorded per day than ever before.

This combination of availability of the equipment (thermometer), skill and awareness of the importance of recording the body temperature provides us with the exceptional opportunity to establish the new range of normal  body temperature region-wise around the world through extensive collaborative studies.

Please share your comments and thoughts. I would love to hear from you.

If you like the content subscribe using your email to receive a notification of new posts.