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Background Tumor immune infiltrate has been explored in oral squamous cell carcinoma (OSCC), but studies on simultaneous characterization of multiple immune cell subtypes separately in stromal and intraepithelial tumor compartments are limited. Objectives We aimed to investigate the immune cell infiltrate in OSCC by using immunohistochemistry (IHC) for a panel of inflammatory cells in stromal and epithelial tumor compartments for a better characterization of the tumors. Methods Thirty-six OSCC lesions and nine normal oral mucosa (NOM) samples from patients attending Khartoum Dental Teaching Hospital, Sudan were investigated for presence of tumor infiltrating lymphocytes, tumor-associated macrophages, tumor-associated neutrophils, and PD-L1 positive cells in the inflammatory infiltrate by single and double IHC. Digital quantitative analysis (Aperio Technologies Inc.) was performed separately for stromal and epithelial compartments. Results OSCC cases displayed a higher inflammatory infiltrate in the associated stroma, but not in the epithelial compartment when compared to NOM. The immunosuppressive type of inflammatory infiltrate, that is, T regulatory cells (FoxP3+ cells) was identified to be significantly higher in the epithelial compartment of tumors with advanced clinical state. An immunoscore developed by combining intraepithelial FoxP3+ and CD4+ cells was found significantly higher in lesions from elderly patients, localized at toombak dipping-related sites, poorly differentiated OSCCs, or with loco-regional lymph node spreading. Conclusions Despite heavy immune cell infiltration in tumor-associated stroma, the majority of OSCCs in this cohort displayed a low intraepithelial immune infiltration. An immunoscore based on combined CD4 and FoxP3 intraepithelial expression may serve as an indicator of advanced tumor progression and should be further investigated for its use as potential prognostic biomarker in OSCC. publishedVersion

OBJECTIVES: To present a new method to assess the cervical lymph nodes status in head and neck cancer patients. METHODS: Twenty-five oral and maxillofacial cancer patients underwent preoperative CT imaging. The cervical lymph node features on CT scan were examined. Each parameter was given a score, and the total scores in each case was calculated and referred to as metastatic score (MS). Then, patients underwent neck dissection, and all dissected lymph nodes were sent for histopathology. RESULTS: All cases with MS ≥ 6 were histopathologically positive, and all cases with MS ≤ 3 were histopathologically negative. All cases of nodal sizes > 3 cm were histopathologically positive, 82% of cases of nodal sizes between 2.1 and 3 cm were histopathologically positive, 40% of cases of nodal sizes between 1 and 2 cm were histopathologically positive, and all cases of lymph nodes sizes

Objectives To analyse the clinical and histopathological features of oral leukoplakia (OL) in the Sudan, and to identify the risk factors associated with dysplastic and malignant changes. Methods Records of 117 cases with the diagnosis of OL at the Department of Oral Pathology in the period from 2010 to 2017 were reviewed. Results Of the 117 cases included in this study, 30 cases (25.6%) showed carcinoma in the initial diagnostic biopsy. The mean age at diagnosis was 59.8 years with a male/female ratio of 3.3:1. The lip (48.7%) and the gingiva (31.6%) were the predominantly affected sites. Multivariate regression analysis revealed that females were associated with 3.36-fold [95% confidence interval (CI), 1.36-10.76; P = 0.012] higher risk of malignant transformation compared with males. Verrucous leukoplakia was associated with 3.38-fold (95% CI, 1.12-10.19; P = 0.031) higher risk of malignant transformation compared with homogeneous leukoplakia. Exclusive Toombak dipping was the significant risk factor for the presence of dysplasia in OL (odds ratio, 9.35; 95% CI, 1.28-67.99; P = 0.027). Conclusions Clinical and histopathological features of OL were analysed and correlated. Toombak dipping was the significant risk factor for dysplastic changes, while female gender and verrucous leukoplakia were the factors associated with malignant transformation.

Background: Oral squamous cell carcinoma (OSCC) is increasing at an alarming rate particularly in low-income countries. This urges for research into noninvasive, user-friendly diagnostic tools that can be used in limited-resource settings. This study aims to test and validate the feasibility of e-nose technology for detecting OSCC in the limited-resource settings of the Sudanese population. Methods: Two e-nose devices (Aeonose™, eNose Company, Zutphen, The Netherlands) were used to collect breath samples from OSCC (n = 49) and control (n = 35) patients. Patients were divided into a training group for building an artificial neural network (ANN) model and a blinded control group for model validation. The Statistical Package for the Social Sciences (SPSS) software was used for the analysis of baseline characteristics and regression. Aethena proprietary software was used for data analysis using artificial neural networks based on patterns of volatile organic compounds. Results: A diagnostic accuracy of 81% was observed, with 88% sensitivity and 71% specificity. Conclusions: This study demonstrates that e-nose is an efficient tool for OSCC detection in limited-resource settings, where it offers a valuable cost-effective strategy to tackle the burden posed by OSCC. publishedVersion

ObjectivesAutoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan.MethodsThis was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016.ResultsOut of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita.ConclusionsThe clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials.

Background. Improving patient satisfaction and quality of life is of great importance when considering the different prosthetic treatment options for patients with severely resorbed residual alveolar ridges. We aimed to evaluate and compare patients’ satisfaction when changing from fixed, removable, and/or conventional implant prostheses to basal implant-supported prostheses. Methods. Sixty patients with a history of fixed, removable, and/or conventional implant prostheses who received basal implant-supported prostheses (BCS®, IHDE Implant System) were included in this study. Direct interviews were conducted using a four-section questionnaire that covered sociodemographic data, clinical examination, information on previous prostheses, and new implant information. The obtained data were statistically analysed using a Wilcoxon signed-rank test and chi-squared test. Results. Patients were predominantly female, partially edentulous, and aged between 40 and 59 years. Patients’ general satisfaction with basal implants was very high (7.7 out of 8). Patients’ satisfaction with comfort, mastication, speech, and aesthetics significantly improved with the new basal implants. Males aged between 40 and 59 years and patients who had previously used both fixed and removable prostheses were generally the most satisfied. Although some patients had complaints, they still had high satisfaction and would choose the same treatment modality again. Conclusions. Basal implant-supported prostheses have a positive impact on oral health and highly increase patients’ satisfaction.

Leishmaniasis in Yemen is still not fully investigated nor well studied. Recently, outbreaks of cutaneous leishmaniasis (CL) in western highland were declared. However, there are no reports concerning the disease and the circulating species in the region. The aim of this study was to determine the prevalence of cutaneous leishmaniasis in Utmah district located in Western Highlands in Yemen. A cross-sectional survey was carried out at those highlands. For the survey, 1165 participants were subjected to Leishmanin Skin Test (LST) accompanied with direct interviews and physical examination. The overall prevalence of cutaneous leishmaniasis in the district was 18.5% and the cutaneous leishmaniasis (CL) was more frequent in the escarpments with a prevalence of 37%, including 5.5% for active lesion and 31.5% for scar of healed lesions. Children under the age of 16 years old comprised most of the CL cases (76.3%). The escarpments of western highlands in Yemen were hyperendemic areas for CL and the infection was more prevalent in children.

Objective: The aim of this study was to evaluate preoperative anemia in patients undergoing oral and maxillofacial surgery under general anesthesia. Material and methods: A prospective cross sectional hospital-based study was carried at Khartoum Teaching Dental Hospital. Five hundred and twenty three patients were included in the study, 324were males and 199 were females. Patients’ age was ranging from 6 months to 84 years. Children formed 34.6% of the patients. Cleft lip and palate constituted the largest number of the patients (173). There were 70 oral cancer patients, 126 trauma patients and 154 patients with benign lesions. Anemia was defined according to the WHO criteria as hemoglobin concentration (Hb) less than 13 g/dl for males, less than 12 g/dl for females while Children were diagnosed based on their age. Variables related to hemoglobin level, age, gender and related diseases were analyzed. Test of significance (P< 0.05) was applied using SPSS version 20. Results: Preoperative investigations revealed a high prevalence of anemia in patients constituting 48.2% for men, 45% for females and 47% for children. Severe anemia was found in 4.5% of children and 1.4% of males. The mean hemoglobin level for males was 12.8 ± 2.1 g/dl, for females was 12.1± 4 . 1 and for children was11.4±1.6. One way analysis of variance revealed a significant difference in the mean of hemoglobin between patients with different diseases (P-value=0.001). Conclusion: The findings of this study indicated that anemia is a common finding among patients undergoing oral and maxillofacial surgery and most of the time it was discovered during the preoperative investigation for surgery preparation.

Background: Pleomorphic adenoma is a common benign salivary gland neoplasm characterized by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality is the commonest benign tumor to arise in the minor salivary gland. Simian virus 40 (SV40), is a highly oncogenic DNA tumor virus (polyomaviridae) which was recently found to be associated with various human tumors including pleomorphic adenoma. The virus is a monkey virus which was believed to be transmitted to humans only under exceptional situations. Objective: The aim of this study was to evaluate the presence of SV40 DNA among Sudanese patient with pleomorphic adenoma of the salivary glands. Material and Method: This is a case control study was conducted at Khartoum state, during period 2006-2012. Thirty study samples represents as cases that had salivary gland pleomorphic adenoma and ten normal salivary gland tissues represent as controls. Qualitative polymerase chain reaction (PCR) was used to evaluate the presence of SV40 DNA. Results: In this study, human pleomorphic adenoma (PA) of salivary gland specimens and normal salivary gland tissues used as control were analyzed by qualitative polymerase chain reaction (PCR) for SV40. All sample (case and control) Tissue specimens were SV40 negative. Conclusion: The findings of this study showed the absence of SV40 DNA in salivary and did not indicate any role among patients with PA.

Oral verrucous carcinoma is a clinico-pathological variant of OSCC. The most frequent affected sites intraoral are the mucosa of the buccal area and alveolus, also the gingiva. It’s a locally aggressive tumor. Generally it is related to tobacco use specially the chewed and snuffed types, hence it named “snuff dipper's cancer’’, the recurrence is high due to the dysplastic cells around the tumor. This is a case of Sudanese male diagnosed with verrucous carcinoma in the Oral and Maxillofacial Clinic.

In this short communication, we report on a 25-year-old male patient who presented with a longstanding painless swelling under the tongue. It was of a gradual onset and course, but 2 months before presentation it suddenly increased in size. Local examination revealed a tender firm pigmented mass in the midline of the mouth floor. The differential diagnosis included dermoid cyst, salivary glands tumours, mucocele or vascular anomaly. The investigations done were not conclusive. He underwent surgical exploration, and mycetoma was a surgical surprise. Although mycetoma is common problem in the tropics, such a presentation is a rarity. In tropical and subtropical regions, mycetoma should be considered in the differential diagnosis of oral cavity masses.

Background: A progressive increase in the incidence and mortality of oral cancer is expected in Sudan. However, updated information on the epidemiology and pattern of the disease in the country is needed to draw the attention of the local authorities. Aim: The aim of this study has been to describe the pattern of cancer cases attending a referral oral and maxillofacial hospital in Sudan during the period 2006-2007. Settings and Design: The investigation was conducted as a cross-sectional study using the hospital records. Materials and Methods: From the hospital database, all cancer cases registered during the study period have been reported and their demographic characteristics, clinical information and history of oral habits were included. Statistics: Statistical Package for Social Sciences (version 12) was used for data analysis. Frequency distributions of the study variables were made and the association between pairs of variables was examined using the Chi-square test with a level of significance of 0.01. Results and Conclusion: Of the 261 cases included in this study, the most common pattern was found to be an intraoral squamous cell carcinoma (73.6%). The male to female ratio was approximately 3:2. Dropout rates were alarmingly high regardless of the patient's state of residence. The observation of this study indicated that most of the patients seek treatment when the tumor reaches late stage. More public health efforts are therefore needed to investigate the current impact of the problem as well as for prevention and early detection of the cases.

Objective The role of qat chewing, tobacco (shammah) dipping, smoking, alcohol drinking, and oral viral infection as risk factors for oral squamous cell carcinoma (OSCC) in Yemen was assessed. Study Design A total of 60 cases of OSCC and 120 age- and gender-matched controls were analyzed with respect to demographic data, history of oral habits, and the presence of human papillomavirus (HPV)-16, HPV-18, or Epstein-Barr virus (EBV) as determined by Taqman quantitative polymerase chain reaction. Logistic regression analysis was used to identify independent predictors of the disease. Results Shammah use was the only risk factor for OSCC, with an odds ratio of 12.6 (CI, 3.3-48.2) and 39 (CI, 14-105) for the ex-users and current users, respectively. The association of shammah use alone with OSCC exceeded that of shammah use in combination with qat chewing, smoking, or both. EBV infection, smoking, and qat chewing showed no association with OSCC, while neither HPV-16 nor HPV-18 were detected in any sample. Conclusions Shammah use is a major risk factor for oral cancer in Yemen.