Nadisha Sewwandi Piyarathne

Head and neck cancer (HNC) is among the top ten malignancies worldwide and is associated with high morbidity and mortality. Oral potentially malignant disorders (OPMDs) predispose to certain HNCs. Recent studies suggest emerging roles of extracellular vesicles (EVs) in malignant transformation and provide potential in the management of HNC. This systematic review aimed to evaluate the role of EVs in HNC and OPMDs. The systematic review followed PRISMA‐2020 guidelines and was registered with PROSPERO. A comprehensive literature search was conducted in five electronic databases (Medline, Scopus, Embase, Cochrane and Web of Science), yielding 3705 initial records. Following de‐duplication and independent screening, 237 eligible articles were included. Data extraction was performed by two independent reviewers. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Thematic analysis with narrative data synthesis was conducted and the results were organised under the following subthemes: EV isolation and characterisation methods, EV role in cancer and OPMDs progression, immune modulation, biomarker potential, and therapeutic applications. Studies included in the review were published between “1985–2025” and showed an accelerated growth in EV research after 2020. Most of the studies relied on traditional isolation and characterisation techniques including ultracentrifugation, transmission electron microscopy and flow cytometry. Most evidence was reported from preclinical studies and demonstrated EVs’ promise as biomarkers for early detection, prognostication, and therapeutic targets. However, the findings also underscored the need for standardised protocols. Current evidence on EVs’ role as drivers of epithelial mesenchymal transition, invasion, immune escape, metabolic reprogramming, and angiogenesis in the pathogenesis of HNC are summarised together with the role of EVs as biomarkers in HNC and potential applications in HNC therapy and therapy resistance. Mechanistic insights into the biological behaviour of EVs in HNC are provided and evidence‐based recommendations for future research are proposed in this review.

Oral potentially malignant disorders (OPMDs) have varying risk of malignant transformation (MT), yet the underlying mechanisms remain unclear. Recent evidence suggest emerging role of stem cells in carcinogenesis. This systematic review aimed to synthesizes current knowledge on the role of stem cells in OPMD and MT. Review protocol was developed in accordance with PRISMA 2020 guidelines and registered with PROSPERO. Literature searches identified 4882 records from PubMed, Scopus, Embase, and Web of Science databases; from these, n = 97 primary research studies were selected via two stage screening. Data extraction and narrative synthesis was conducted according to synthesis without meta‐analysis (SWiM) guidelines. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal checklists. Studies included in this review were published between 2006–2025, where majority of the research were from India and China. Immunohistochemistry (IHC) was used to identify stem cell biomarkers in tissue samples, most studies demonstrated that higher expression of stem cell markers (CD44, ALDH1, HELLS, TARIF, SOX2, NANOG, and CD147) correlated with severity of epithelial dysplasia. Longitudinal data identified ALDH1 and Bmi‐1 as promising prognostic biomarkers linked to MT. Evidence from cell culture and animal model experiments suggested potential therapeutic applications of stem cells and their exosomes in haltering the progression of OPMD. Notably, a clinical trial incorporated stem cell markers as surrogate end points for evaluating treatment options. While findings underscore the prognostic and therapeutic relevance of stem cells in OPMD, lack of prospective designs in biomarker validation and absence of clinical trial evidence on stem cell therapies limit clinical applicability.

Oral squamous cell carcinoma (OSCC) and its precursor, oral epithelial dysplasia (OED) comprises significant disease burdens in southeast Asia. In Sri Lanka, OSCC is the commonest cancer in males. Oral health-related quality of life (OHQoL) assesses the impact of oral health on the overall well-being of an individual. This study aimed to investigate OHQoL using Oral Health Impact Profile (OHIP-14), to identify the most affected domains in the study groups and potential associations with sociodemographic variables. A cross-sectional study with 129 participants including OSCC, OED and control groups was conducted using a translated version of OHIP-14. Data analysis was conducted using SPSS and Graph Pad Prism software. The total OHIP-14 scores were compared between study groups. Descriptive statistics on OHQoL domains and correlation with monthly income and OHIP-14 score were conducted. The mean OHIP-14 scores were 25 ± 13, 14 ± 8.1, and 2.4 ± 3.3 for the OSCC, OED, and control groups respectively with a statistically significant difference ( p value <0.0001). Domains with highest mean scores indicating a poorer OHQoL in OSCC and OED groups were physical pain and psychological disability. Worse OHQoL correlated with low monthly income in patients. This study identified most affected domains in the OHQoL in study groups and revealed a correlation between income and OHQoL in patients. The findings have important implications for clinicians to take OHQoL into consideration during treatment design and inform policy changes to improve outcomes for OSCC and OED patients.

Background Osteopontin (OPN) is linked to cancer progression, metastasis, and treatment resistance in head and neck cancer (HNC). This meta-analysis evaluated OPN as a prognostic biomarker in HNC. Method A comprehensive search was conducted for studies published up to December 2023, including English papers on HNC analyzing OPN expression. Data extraction, quality assessment, and quantitative analysis were performed using fixed and random effect models with 95% CI. Heterogeneity and publication bias were assessed with I2 and Egger’s regression test. Results Fifty-one studies were included. OPN expression was significantly elevated in tissue and plasma in HNC compared to control (SMD 0.98; 95% CI 0.47–1.49; I2 = 13%; p < 0.00). High plasma OPN predicted poor survival (HR: 2.00; I2 = 64%; P = 0.03), as did high tissue OPN (hazard ratio: 2.71, 95% confidence interval = 1.51–4.87; I2 = 49.4%, p > 0.05). Elevated plasma OPN correlated with smoking, poorly differentiated neoplasms, larger tumors, advanced stage, and lymph node metastasis. Positive tissue OPN was associated with nodal involvement, advanced stage, male gender, and smoking. Conclusion OPN is a robust prognostic biomarker in HNC, indicating tumor aggressiveness and poor prognostic outcomes. Standardized measurement protocols and further validation in prospective studies are necessary.

Objectives: Antibiotic resistance (ABR) constitutes a significant burden to economies in developing countries. In the ‘One‐Health’ concept, ABR in human, animals, and environment is interconnected. The aim of this study was to critically appraise literature on ABR in all three domains in One Health, within the Sri Lankan geographical context.Methods: The protocol was registered with PROSPERO and followed PRISMA 2020 guidelines. A comprehensive electronic literature search was conducted in PubMed, Scopus, Web of Science databases and grey literature via Google Scholar. Out of 298 abstracts, 37 articles were selected following screening. A risk of bias assessment was conducted using Joanna Briggs Institute tools. Following blinded data extraction, descriptive data analysis and narrative synthesis were performed.Results: This review included studies published between 2016‐2023. Of the included studies, 17 (45.9%) reported data on samples obtained from humans, 9 (24.3%) from animals, and 6 (16.2%) from environmental sources, two studies (5.4%) from humans and animals, one study on animal and environment; whereas two studies including all three domains. ABR of 32 different bacteria (Gram negative⸺17, Gram positive⸺14) was retrieved; E. coli was the most frequently studied bacteria followed by MRSA and ESBL. For E. coli, a median resistance over 50% was reported for sulfamethoxazole (88.8%), trimethoprim (79.1%), ampicillin (60%) and tetracycline (50.3%) with the highest resistance for erythromycin (98%). Of a total of 21 antibiotic‐resistance genes in E. coli, the highest genotypic resistance was for tet‐A (48.5%).Conclusions: A comprehensive description of ABR for a total of 32 bacteria, 62 antibiotics and 46 ABR genes is presented. This review discusses the contemporary ABR landscape in Sri Lanka through the One Health lens, highlighting key methodological and empirical research gaps.

Oral Squamous Cell Carcinoma (OSCC) poses a significant health challenge, with early detection being crucial for effective treatment and improved survival rates. While previous studies have examined the use of standard photographs, such as those from smartphones, for oral lesion classification, they typically rely solely on images, overlooking the potential benefits of incorporating multiple modalities. This study addresses this gap by proposing a multimodal deep-learning pipeline incorporating diverse data sources, including patient metadata, which mimics the diagnostic approach of clinicians in early detection of oral cancer. The study leverages state-of-the-art image encoders to classify oral lesions into benign and potentially malignant categories. A performance comparison of six pre-trained deep-learning models (MobileNetV3-Large, MixNet-S, ResNet-50, HRNet-W18-C, DenseNet-121, and Inception_v3) is presented. The performance of the proposed pipeline achieved an overall accuracy of 81%, precision of 79%, recall of 79%, F1-score of 78%, and a Matthews Correlation Coefficient (MCC) of 0.57 using the MobileNetV3-Large image encoder. The findings highlight the efficacy of integrating multiple data modalities for more accurate early detection of potential malignancies compared to using only image data. The outcomes could pave the way for improved clinical decision-making and patient outcomes.

Introduction: Malignancies in the oral cavity poses significant health burden in Sri Lanka and demonstrate an increasing trend. The aim of this study was to analyze the characteristics of patients with oral cavity malignancies presenting to a tertiary care center during 2020-2022.Methodology: Hospital records of patients diagnosed with primary oral cavity malignancies presenting to the Dental Teaching Hospital Peradeniya were entered by two investigators to Microsoft Excel spreadsheet according to the National Cancer Control Program format. Descriptive data analysis was conducted using Microsoft Excel software.Results: A total of 193 patients were reported during this period, approximately 9 patients per month. Mean age and standard deviation of the cohort were 61±13 years. The male to female ratio was 2.8:1. There were a total of 17 histological types of malignancies, the commonest being squamous cell carcinoma 74.1%. From the total, 50.8% were diagnosed at advanced clinical stages. The commonest anatomical locations of malignancies were buccal mucosa 36.5% followed by border of the tongue 18.8%. Surgical resection was offered for 163 (84.4%) patients, while 5 (2.6%) received surgery and radiotherapy, and one (0.5%) received surgery and chemotherapy.Conclusions: Male gender, older age group and low socio-economic status were common among patients with oral cavity malignancies in Sri Lanka. The commonest location was buccal mucosa while commonest histological type was squamous cell carcinoma. Late diagnosis remains a major barrier in managing oral malignancies in the country.

The incidence of oral squamous cell carcinoma (OSCC), and its precursor, oral epithelial dysplasia (OED), is on the rise, especially in South Asia. OSCC is the leading cancer in males in Sri Lanka, with >80% diagnosed at advanced clinical stages. Early detection is paramount to improve patient outcome, and saliva testing is a promising non-invasive tool. The aim of this study was to assess salivary interleukins (lL1β, IL6, and IL8) in OSCC, OED and disease-free controls in a Sri Lankan study cohort. A case-control study with OSCC (n = 37), OED (n = 30) patients and disease-free controls (n = 30) was conducted. Salivary lL1β, IL6, and IL8 were quantified using enzyme-linked immuno-sorbent assay. Comparisons between different diagnostic groups and potential correlations to risk factors were assessed. Salivary levels for the three tested interleukins increased from disease-free controls through OED, and were highest in OSCC samples. Furthermore, the levels of IL1β, IL6, and IL8 increased progressively with OED grade. The discrimination between patients (OSCC and OED) and controls, as assessed by AUC of receiver operating characteristic curves, was 0.9 for IL8 (p = 0.0001) and 0.8 for IL6 (p = 0.0001), while IL1β differentiated OSCC from controls (AUC 0.7, p = 0.006). No significant associations were found between salivary interleukin levels and smoking, alcohol, and betel quid risk factors. Our findings suggest that salivary IL1β, IL6, and IL8 are associated with disease severity of OED, and are potential biomarkers for predicting disease progression in OED, and the screening of OSCC.