Oral epithelial dysplasia with lymphocytic immune response: clinicopathological characterisation of 44 cases

AIMS

Oral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well-demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted.

METHODS AND RESULTS

Cases of solitary OED with LIR for which a clinical photograph was available were identified in the authors' institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well-demarcated hyperkeratotic plaques lacking diffuse white-and-red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous 'lichenoid' features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%).

CONCLUSIONS

Virtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well-demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.

Secrecy inhibits support: A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya

AIM

this study aimed to gain understanding of the views of community members in relation to obstetric fistula.

DESIGN AND METHOD

a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data.

SETTING

participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital.

FINDINGS

the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered.

CONCLUSIONS

A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.

Intermittent sand filtration for wastewater treatment in rural areas of the Middle East--a pilot study

This paper concentrates on Intermittent Sand Filtration (ISF) as a polishing stage for effluent from a facultative pond. During the three-year research program, the system operated with an influent flow-rate of 500-1,000 L/day and an average BOD concentration of 200-400 hydraulic and BOD loadings of 110-200 L/m2/day and 20-40 gBOD/m2/day, respectively. Flow to the ISF was applied intermittently with a different number of doses in each run. In addition, the effects of the frequency and the duration of rest periods (no feeding) were studied. Removal of 90-95% of BOD and 75-90% of COD and TSS was achieved consistently throughout the study period. Elevated levels of nitrification were observed with 95-100% removal of NH3. The ISF performed best when fed with 5-10 doses/day. Reducing the daily number of doses to 3/day at the same hydraulic loading rate resulted in a 20-30% reduction in removal efficiency. The 2-4 week rest period had no effect on the biological activity in the subsequent run. However, rest periods of more than 30 days were found to negatively affect removal efficiency.