Magister Scientiae Dentium - MSc(Dent) / Background: Oral cancer is a major global healthcare problem. Its prevalence is increasing, and late-stage presentation is common. More than 500,000 patients are estimated to have oral cancer worldwide. Oral cavity squamous cell carcinoma (SCC) accounts for 90-94% of oral cancers. Survival rates for oral cancer are very poor, at around 50% and has not improved considerably in the previous decades even with advances in therapeutic interventions. Screening programs have been introduced for a number of major cancers and have demonstrated a compelling effect in their early detection. It’s now well established that the early detection of the malignancies is a competent way of improving the clinical outcome for patients. It’s believed that to reduce death and morbidity from this disease it is important to detect it at an early stage, when lesions are localized. Aim: To assess the level of awareness and knowledge of oral cancer among dental patients visiting Khartoum dental teaching Hospital. Method: A cross- sectional survey using a self-administered questionnaire with 18 questions was distributed to 193 patients between 18 and 65 years to collect the information. Results: The results indicate that there were more females (107; 55%) than males (86; 45%). There was a non-significant difference between alcohol consumption and awareness of oral cancer. However, the frequency results revealed that the majority of participants (98; 92 %), who reported they has heard about oral cancer, were females, while almost a quarter of participants (18; 21%) who had never heard about it, were males. This suggested that female patients were more aware of oral cancer than males. Participants, who declared hearing about oral cancer were more highly qualified educationally, whereas a quarter of them who declared they had never heard about it, were poorly qualified educationally.

Low and middle-income countries (LMICs) around the world are experiencing a global cancer crisis. For treatable disease, cancer specific mortality in LMICs is much higher than in high-income countries. Botswana is a middle-income country in Sub-Saharan Africa that had its population decimated by the AIDS epidemic. In the aftermath and due to the successful implementation of an anti-retroviral program, patients are living longer and are developing cancer. Cervical cancer is one of the leading causes of death in women around the world, but it is curable. Patients in Botswana live far from treatment centers and therefore often present with locally advanced disease that can be cured with a combination of chemotherapy, external beam radiation therapy and brachytherapy. The goal of this present study is to describe the challenges and implementation of brachytherapy in the country of Botswana in 2012 and to report its uses within the cervical cancer population between 2012 and 2014. The government of Botswana recognized that there was a need for in country brachytherapy to help reduce the cervical cancer burden. A public-private partnership was negotiated through the government of Botswana in order to bring brachytherapy into the country. In March 2011, a Nucletron HDR-Brachytherapy unit that uses Ir-192 was installed at Gaborone Private Hospital. Longitudinal support from international partners provided instruction in insertion, dosimetry, physics and management of complications. The initial burden of patients presented with severe cervical fibrosis and vaginal stenosis due to late presentation of disease. This resulted in numerous complications in the first treatments, which included failed insertions, perforations and bleeding. Following training and support from international partners, complications have been reduced. There are about 45 insertions performed each month, with an average of 3 insertions per patient. Introduction of HDR Brachytherapy to Botswana has led to decreased treatment time, reduced complications, increased patient compliance and projected improved survival. Implementation of brachytherapy was facilitated by a public-private partnership and onsite mentorship by expert clinicians. Further research is needed to evaluate impact on patient quality of life and survival, and whether this experience can be replicated for other tumor sites.

Abstract This thesis describes the development of a personal machine-to-machine (M2M) healthcare system that is both flexible and scalable. Based on the IPv6 protocol, the system can be used over a low-power wireless personal area network (6LoWPAN). Since a hierarchical network structure offers excellent accessibility, the system is applicable both to local and international healthcare services. To further enhance scalability and reliability, the proposed system combines 6LoWPAN with mobile techniques, depending on whether the sensor is located inside or outside the range of a wireless sensor network (WSN). Employing wearable low-power sensors, the system measures health parameters dynamically. For wireless transmission, these sensors are connected to an M2M node either through the internet or through an external IPv4/IPv6-enabled network. The applicability of the IEEE 802.15.4 and 6LoWPAN protocols to wide area networks were verified in practical tests using an M2M gateway. To assess the physical health of an individual, the system uses heart rate variability analysis in time and frequency domains. Acquired data are first stored on a server for analysis. Results of the analysis are then automatically sent to Android-based mobile devices carried by the individual or appointed healthcare providers. In this way, mobile techniques are used to support remote health monitoring services. This personal M2M healthcare system has the capacity to accurately process a large amount of biomedical signals. Moreover, due to its ability to use mobile technology, the system allows patients to conveniently monitor their own health status, regardless of location. / Tiivistelmä Tutkimuksessa kehitetään henkilökohtainen mobiililaitteden välillä toimiva (M2M) terveydenhoitojärjestelmä, joka mahdollistaa joustavan ja skaalautuvan potilaan terveyden monitoroinnin. Perustuen IPv6-protokollaan, sovellusta voidaan käyttää matalatehoisen langattoman 6LowPAN-verkon yli. Koska hierarkkinen verkkorakenne tarjoaa erinomaisen saavutettavuuden, järjestelmän kapasiteetti riittää paitsi kaupungin sisäisten myös kansainvälisten terveyspalvelujen järjestämiseen. Skaalattavuuden ja luotettavuuden vuoksi ehdotettu järjestelmä yhdistelee 6LowPAN-tekniikkaa mobiiliteknologiaan riippuen siitä onko sensori langattoman sensoriverkon kuuluvuusalueella vai sen ulkopuolella. Puettavia matalatehoisia sensoreita käyttävä järjestelmä kykenee mittaamaan terveysparametreja dynaamisesti. Langatonta siirtoa varten nämä sensorit on kytketty M2M-solmuun joko internetin tai ulkoisen IPv4/IPv6-verkon kautta. Käytännön testeissä IEEE802.15.4- ja 6LowPAN-protokollien soveltaminen laajaverkossa mahdollistettiin tähän soveltuvalla M2M-yhdyskäytävällä. Yksilöiden fyysisen terveyden arvioinnissa järjestelmä käyttää sydämen sykevaihtelun analysointia aika- ja taajuustasossa. Data tallennetaan palvelimelle analysointia varten. Analyysin tulokset lähetetään automaattisesti henkilöiden omiin tai heidän lääkäriensä mobiililaitteisiin. Näin mobiiliteknologiaa käytetään tukemaan terveyden etämonitorointipalveluja. Tämä henkilökohtainen M2M-kommunikointiin perustuva terveydenhoitojärjestelmä kykenee käsittelemään tarkkaan suuriakin määriä 6LowPAN-verkon ja internetin kautta tulevia biolääketieteellisiä signaaleja. Lisäksi kyky käyttää mobiiliteknologiaa tekee järjestelmästä potilaille miellyttävän tavan monitoroida omaa terveydentilaansa sijaintipaikasta riippumatta.