Adjunctive Utility of Toluidine Blue in Detecting Dysplastic Cells in Oral Mucosal Lesions in Comparison with Histopathology

Introduction: Oral cancer is one of the most common cancers globally and in Sri Lanka, which follows premalignant lesions. It is curable if it is detected early. Several adjunctive methods to diagnose premalignant lesions early are available. Among these, Toluidine blue staining method before a biopsy is currently receiving much attention. Method: This is a prospective study done by studying 103 patients presented to the Oral and Maxillofacial Surgery Unit, District General Hospital, Gampaha, Sri Lanka. The oral lesions of all the patients are categorized as benign, premalignant, and malignant by clinical examination. Toluidine Blue mouth wash is introduced to all the patients, followed by biopsy from the stained sites and the clinically decided sites in non-stained lesions. Histopathological diagnosis was obtained for all cases. The accuracy of diagnosis of premalignant, malignant, and benign cases by clinical assessment and by using Toluidine blue was assessed and compared statistically in relation to sensitivity, specificity, positive predictive and negative predictive values, and likelihood ratios (LR). Results: Toluidine blue has no added advantage over clinical examination in our setup even though it might be helpful in screening. However, it has an added value to confirm clinically benign cases as benign. Conclusion: Toluidine Blue can be used as an adjunct in screening and to confirm clinically benign cases so that those can be followed up in clinics without doing unnecessary biopsies.

Unplanned 30-Day Readmissions after Hyper-CVAD Chemotherapy in Patients with Acute Lymphoblastic Leukemia

Introduction: The aim of this study was to investigate the rate and causes of re-hospitalization in the first 30 days after Hyper-CVAD chemotherapy in all patients with acute lymphoblastic leukemia. Methods: This descriptive, analytical and cross-sectional study was performed on 827 admissions in ALL patients aged 18 years and older with unplanned hospitalization after HyperCVAD chemotherapy in less than 30 days’ post chemotherapy from April 2016 to April 2018 in Hematology and medical oncology department. Results: The rate of unplanned re-admission was 9.91% in all patients. Mean follow-up time was 13.77 ± 6.26 months and the mean age of patients was 35.55 ± 14.6 years. Re-admission rate was more frequent in men (65.7%) and most patients were readmitted only once. The mean duration of re-admission was 8.2±4.15 days and most patients were re-admitted after cycles IB, IIIB and IVB of hyper-CVAD chemotherapy. The most common causes of readmission were febrile neutropenia and pancytopenia. Except for significant changes in CBC, no significant changes were observed in other laboratory tests. Urine culture and blood culture were reported positive in 13.6% and 31.57% respectively, and E-coli was the most common organism isolated from cultures. Conclusion: We found increased rate of re-admission following hyper-CVAD chemotherapy in patients with acute lymphoblastic leukemia which was due to side effects of chemotherapy regimen. It seems to be important not only for high rate of mortality and morbidity in patients resulting from this chemotherapy regimen, but also imposing the heavy cost on health system. Therefore, more effective preventive measures are necessary and useful.